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Dedifferentiated endometrial adenocarcinoma: A rare but aggressive form of endometrial cancer
Abstracts
Results: Two hundred eighty-eight cases were analyzed; HA–CMC was utilized in 130 procedures (45%). On univariate analysis, HA– CMC was associated with complete cytoreduction, high surgical complexity score, performance status (PS) = 0, and being alive at last follow-up (all p b 0.01). Kaplan Meier analysis indicated that neither PFS nor OS was significantly different between subjects with or without HA–CMC use (median PFS 16.8 vs 16.4 months, p = 0.36; median OS 40.6 vs 36 months, p = 0.33). PFS was significantly shorter amongst subjects with age N50, Stage IV disease, visible residual disease, or interval cytoreduction (all p b 0.05). Additionally, major postoperative complications and PS N1 were associated with shorter OS (p b 0.05). After controlling for confounding factors using multivariate Cox proportional hazards regression, HA–CMC use did not independently predict PFS (HR 0.94; 95% CI: 0.70–1.25) or OS (HR 1.0; 95% CI: 0.74–1.37). The only factors independently negatively predictive of OS were residual disease (HR 1.45; 95% CI: 1.04–2.02), age N 70 (HR 1.66; 95% CI: 1.06–2.6), and PS N 1 (HR 1.96; 95% CI: 1.4–2.76). Conclusion: HA–CMC adhesion barrier placement at the time of primary or interval cytoreductive surgery for ovarian, fallopian tube, and peritoneal cancer does not compromise recurrence or survival outcomes.
doi:10.1016/j.ygyno.2014.07.063
Quantification of interfractional uterus motion for intact cervical cancer patients Lisa Tachikia, Josephine Chenb, I-Chow Hsub, Rajni Sethib. aUniversity of California, Irvine School of Medicine, Irvine, CA, USA, bDepartment of Radiation Oncology, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA. Objectives: In order to assess the potential application of precision IMRT, we characterize and quantify the interfraction motion of the uterus for cervical cancer patients who received daily MVCT scans while undergoing definitive radiotherapy. Methods: Six consecutive patients undergoing definitive radiotherapy with Tomotherapy for cervical cancer were included in this study. Daily MVCT scans were obtained for each patient, which allowed excellent visualization of pelvic structures. The uterus was delineated on the initial planning CT and on subsequent MVCT scans. Daily displacements of the fundus, cervix, and center of mass (COM), with respect to uterine position on initial planning CT scan, were recorded. Results: Mean displacement of the fundus was 7.58 mm (anterior), 17.61 mm (posterior), 3.79 mm (superior), 14.65 mm (inferior), 6.06 mm (left) and 6.57 mm (right). Mean displacement of the cervix was 7.56 mm (anterior), 9.65 mm (posterior), 5.18 mm (superior), 5.02 mm (inferior), 7.52 mm (left) and 5.54 mm (right). Mean displacement of the COM was 3.7 mm (anterior), 6.80 mm (posterior), 3.29 mm (superior), 7.01 mm (inferior), 1.66 mm (left), and 2.93 mm (right). There was a statistically significant difference in uterus displacement between the fundus, the cervix, and the COM in each of the six directions that were measured (p b 0.05, ANOVA). Conclusion: Using high-quality daily CT scans, we found that displacement of the fundus or cervix was larger than displacement of the center of mass, and prior studies focusing on COM may underestimate uterine displacement. This data may be used to inform margin recommendations for highly conformal radiotherapy planning techniques for patients with an intact uterus.
doi:10.1016/j.ygyno.2014.07.064
403
Dedifferentiated endometrial adenocarcinoma: A rare but aggressive form of endometrial cancer M. Zakhour, H. Poya, S. Natarajan, A. Axtell. Objectives: Dedifferentiated endometrial adenocarcinoma is a rare, and likely underreported, aggressive form of endometrial cancer. We present a cohort of patients with a diagnosis of FIGO grade 3 endometrial adenocarcinoma after hysterectomy to determine the frequency of reclassification as dedifferentiated tumors and to report their clinical outcomes. Methods: A consecutive series of patients diagnosed with FIGO grade 3 endometrioid endometrial adenocarcinoma after hysterectomy and staging between 2010 and 2013 at single institution were identified. All pathology was re-reviewed by a single gynecologic pathologist who was blinded to patients' clinical outcomes to determine which of these tumors demonstrated dedifferentiation, described as a histologic component which completely lacks glandular differentiation. Demographics and clinical outcomes were determined from the patients' medical records. Results: The cohort included 26 patients who underwent hysterectomy and staging, and whose final tumor pathology was described as FIGO grade 3. Upon pathology re-review, 9 (35%) were reclassified as having a dedifferentiated tumor component. Median age (61 versus 68 years) and BMI (32 versus 29) for patients with dedifferentiated versus grade 3 tumors were comparable (p = 0.3 and p = 0.4 respectively). Eight of 9 (89%) patients with dedifferentiated tumors presented at an advanced stage (FIGO III–IV), versus 7 of 17 (41%) patients with grade 3 tumors (p = 0.03). Patients with dedifferentiated tumors demonstrated a trend towards more aggressive disease, with 5 of 9 (55%) having progressive or recurrent disease, versus 4 of 17 (23%) of those with grade 3 tumors (p = 0.19). Four patients (44%) with a dedifferentiated tumor component are now dead of disease, while only 2 patients (12%) with grade 3 tumors are deceased (p = 0.13). Median follow-up time for living patients was comparable: 25.5 months versus 22 months. Patients with dedifferentiated tumors were more likely to have type 2 diabetes (55% versus 29%). The incidence of other comorbidities, such as hypertension and hyperlipidemia, was comparable. Conclusion: Dedifferentiated endometrial cancers often present at advanced stages and demonstrate a trend towards more clinically aggressive courses than patients with FIGO grade 3 endometrial cancers. These tumors may be underdiagnosed on final pathology in patients with endometrial cancer. Appropriately identifying patients with dedifferentiated tumors may have implications for adjuvant treatment and surveillance in the future.
doi:10.1016/j.ygyno.2014.07.065
Lymphovascular space invasion and peritoneal cytology are not affected by the use of minimally invasive surgical approaches in patients with endometrial cancer M. Hopkinsa, A.R. Richmondb, G.C. Chengc, K. Behbakhtc, S. Davidsonc, M.A. Spillmanc, J. Sheederc, M.D. Postc, S.R. Guntupallic. aUniversity of Colorado School of Medicine, USA, bUniversity of Colorado School of Medicine, Department of Pathology, USA, cUniversity of Colorado School of Medicine, Department of Obstetrics and Gynecology, USA. Objectives: Minimally invasive (MI) surgery has become the standard treatment for endometrial cancer and offers significant benefits over abdominal approaches. There is discrepant data regarding lymphovascular space invasion (LVSI) and positive peritoneal cytology with the use of a uterine manipulator. Previous small-scale studies have established an increased incidence of this phenomenon. This discrepancy may unnecessarily place patients into a higher risk category for adjuvant treatment.
Results: Two hundred eighty-eight cases were analyzed; HA–CMC was utilized in 130 procedures (45%). On univariate analysis, HA– CMC was associated with complete cytoreduction, high surgical complexity score, performance status (PS) = 0, and being alive at last follow-up (all p b 0.01). Kaplan Meier analysis indicated that neither PFS nor OS was significantly different between subjects with or without HA–CMC use (median PFS 16.8 vs 16.4 months, p = 0.36; median OS 40.6 vs 36 months, p = 0.33). PFS was significantly shorter amongst subjects with age N50, Stage IV disease, visible residual disease, or interval cytoreduction (all p b 0.05). Additionally, major postoperative complications and PS N1 were associated with shorter OS (p b 0.05). After controlling for confounding factors using multivariate Cox proportional hazards regression, HA–CMC use did not independently predict PFS (HR 0.94; 95% CI: 0.70–1.25) or OS (HR 1.0; 95% CI: 0.74–1.37). The only factors independently negatively predictive of OS were residual disease (HR 1.45; 95% CI: 1.04–2.02), age N 70 (HR 1.66; 95% CI: 1.06–2.6), and PS N 1 (HR 1.96; 95% CI: 1.4–2.76). Conclusion: HA–CMC adhesion barrier placement at the time of primary or interval cytoreductive surgery for ovarian, fallopian tube, and peritoneal cancer does not compromise recurrence or survival outcomes.
doi:10.1016/j.ygyno.2014.07.063
Quantification of interfractional uterus motion for intact cervical cancer patients Lisa Tachikia, Josephine Chenb, I-Chow Hsub, Rajni Sethib. aUniversity of California, Irvine School of Medicine, Irvine, CA, USA, bDepartment of Radiation Oncology, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA. Objectives: In order to assess the potential application of precision IMRT, we characterize and quantify the interfraction motion of the uterus for cervical cancer patients who received daily MVCT scans while undergoing definitive radiotherapy. Methods: Six consecutive patients undergoing definitive radiotherapy with Tomotherapy for cervical cancer were included in this study. Daily MVCT scans were obtained for each patient, which allowed excellent visualization of pelvic structures. The uterus was delineated on the initial planning CT and on subsequent MVCT scans. Daily displacements of the fundus, cervix, and center of mass (COM), with respect to uterine position on initial planning CT scan, were recorded. Results: Mean displacement of the fundus was 7.58 mm (anterior), 17.61 mm (posterior), 3.79 mm (superior), 14.65 mm (inferior), 6.06 mm (left) and 6.57 mm (right). Mean displacement of the cervix was 7.56 mm (anterior), 9.65 mm (posterior), 5.18 mm (superior), 5.02 mm (inferior), 7.52 mm (left) and 5.54 mm (right). Mean displacement of the COM was 3.7 mm (anterior), 6.80 mm (posterior), 3.29 mm (superior), 7.01 mm (inferior), 1.66 mm (left), and 2.93 mm (right). There was a statistically significant difference in uterus displacement between the fundus, the cervix, and the COM in each of the six directions that were measured (p b 0.05, ANOVA). Conclusion: Using high-quality daily CT scans, we found that displacement of the fundus or cervix was larger than displacement of the center of mass, and prior studies focusing on COM may underestimate uterine displacement. This data may be used to inform margin recommendations for highly conformal radiotherapy planning techniques for patients with an intact uterus.
doi:10.1016/j.ygyno.2014.07.064
403
Dedifferentiated endometrial adenocarcinoma: A rare but aggressive form of endometrial cancer M. Zakhour, H. Poya, S. Natarajan, A. Axtell. Objectives: Dedifferentiated endometrial adenocarcinoma is a rare, and likely underreported, aggressive form of endometrial cancer. We present a cohort of patients with a diagnosis of FIGO grade 3 endometrial adenocarcinoma after hysterectomy to determine the frequency of reclassification as dedifferentiated tumors and to report their clinical outcomes. Methods: A consecutive series of patients diagnosed with FIGO grade 3 endometrioid endometrial adenocarcinoma after hysterectomy and staging between 2010 and 2013 at single institution were identified. All pathology was re-reviewed by a single gynecologic pathologist who was blinded to patients' clinical outcomes to determine which of these tumors demonstrated dedifferentiation, described as a histologic component which completely lacks glandular differentiation. Demographics and clinical outcomes were determined from the patients' medical records. Results: The cohort included 26 patients who underwent hysterectomy and staging, and whose final tumor pathology was described as FIGO grade 3. Upon pathology re-review, 9 (35%) were reclassified as having a dedifferentiated tumor component. Median age (61 versus 68 years) and BMI (32 versus 29) for patients with dedifferentiated versus grade 3 tumors were comparable (p = 0.3 and p = 0.4 respectively). Eight of 9 (89%) patients with dedifferentiated tumors presented at an advanced stage (FIGO III–IV), versus 7 of 17 (41%) patients with grade 3 tumors (p = 0.03). Patients with dedifferentiated tumors demonstrated a trend towards more aggressive disease, with 5 of 9 (55%) having progressive or recurrent disease, versus 4 of 17 (23%) of those with grade 3 tumors (p = 0.19). Four patients (44%) with a dedifferentiated tumor component are now dead of disease, while only 2 patients (12%) with grade 3 tumors are deceased (p = 0.13). Median follow-up time for living patients was comparable: 25.5 months versus 22 months. Patients with dedifferentiated tumors were more likely to have type 2 diabetes (55% versus 29%). The incidence of other comorbidities, such as hypertension and hyperlipidemia, was comparable. Conclusion: Dedifferentiated endometrial cancers often present at advanced stages and demonstrate a trend towards more clinically aggressive courses than patients with FIGO grade 3 endometrial cancers. These tumors may be underdiagnosed on final pathology in patients with endometrial cancer. Appropriately identifying patients with dedifferentiated tumors may have implications for adjuvant treatment and surveillance in the future.
doi:10.1016/j.ygyno.2014.07.065
Lymphovascular space invasion and peritoneal cytology are not affected by the use of minimally invasive surgical approaches in patients with endometrial cancer M. Hopkinsa, A.R. Richmondb, G.C. Chengc, K. Behbakhtc, S. Davidsonc, M.A. Spillmanc, J. Sheederc, M.D. Postc, S.R. Guntupallic. aUniversity of Colorado School of Medicine, USA, bUniversity of Colorado School of Medicine, Department of Pathology, USA, cUniversity of Colorado School of Medicine, Department of Obstetrics and Gynecology, USA. Objectives: Minimally invasive (MI) surgery has become the standard treatment for endometrial cancer and offers significant benefits over abdominal approaches. There is discrepant data regarding lymphovascular space invasion (LVSI) and positive peritoneal cytology with the use of a uterine manipulator. Previous small-scale studies have established an increased incidence of this phenomenon. This discrepancy may unnecessarily place patients into a higher risk category for adjuvant treatment.