• Title, Summary, Keyword: vaginal metastasis

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Predicting Factors for Positive Vaginal Surgical Margin Following Radical Hysterectomy for Stage IB1 Carcinoma of the Cervix

  • Sethasathien, Sethawat;Charoenkwan, Kittipat;Settakorn, Jongkolnee;Srisomboon, Jatupol
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.5
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    • pp.2211-2215
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    • 2014
  • Background: To examine the incidence of positive vaginal surgical margins and determine the predicting factors following radical hysterectomy for stage IB1 carcinoma of the cervix. Materials and Methods: The clinical and histological data of 656 FIGO stage IB1 cervical cancer patients who had radical hysterectomy with bilateral pelvic lymphadenectomy (RHPL) from January 2003 to December 2012 were retrospectively reviewed and were analyzed for their association with a positive vaginal surgical margin. A p-value of < 0.05 was considered significant. Results: Thirty-five patients (5.3%) had positive vaginal surgical margins following RHPL; 24 (3.7%) for intraepithelial lesions and 11 (1.7%) for carcinoma. On multivariate analysis, microscopic vaginal involvement by high-grade squamous intraepithelial lesion and/or carcinoma (adjusted odd ratio (OR) 186.8; 95% confidence interval (CI) 48.5-718.5) and squamous histology (OR 8.7; 95% CI 1.7-44.0), were significantly associated with positive vaginal surgical margin. Conclusions: Microscopic vaginal involvement by HSIL and/or carcinoma are strong predictors for positive vaginal surgical margins for stage IB1 cervical cancer patients undergoing radical hysterectomy. Preoperative 'mapping' colposcopy or other strategies should be considered to ensure optimal vaginal resection.

Prognosis of Eight Chinese Cases of Primary Vaginal Yolk Sac Tumor with a Review of the Literature

  • Tang, Qiong-Lan;Jiang, Xue-Feng;Yuan, Xiao-Ping;Liu, Yong;Zhang, Lin;Tang, Xiao-Feng;Zhou, Jia-Jia;Li, Hai-Gang;Fang, Jian-Pei;Xue, Lin
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.21
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    • pp.9395-9404
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    • 2014
  • Background: Primary vaginal yolk sac tumor is a rare malignancy in the pediatric population, and a diagnostic challenge and appropriate initial treatment remains unsolved. The aim of this study was to investigate the clinicopathologic features, treatment and prognosis of this tumor. Materials and Methods: Eight cases of primary vaginal yolk sac tumor were reported with a literature review. Results: There were 4 pure yolk sac tumor cases and four mixed germ cell tumors containing yolk sac tumor element, including two cases with embryonal carcinoma and two cases with embryonal carcinoma and dysgerminoma. Partial vaginectomy was performed in four cases and all patients received chemotherapy. 85 cases in literatures were reviewed and 9 cases were misdiagnosed. Follow-up data was available in 77 cases and 5-year overall survival rate was 87.6%. 5-year survival rate of biopsy with chemotherapy, conservative surgery with chemotherapy and radical surgery with chemotherapy was 91.1%, 100% and 28.6%, respectively (p<0.001). Compared to cases without relapse or metastasis after initial treatment, patients with relapse or metastasis had a shorter overall survival (35.6% vs 96.6%, p<0.001). Conclusions: Mixed germ cell tumor containing yolk sac tumor element was not uncommon and partial vaginectomy may be a good choice for primary vaginal mixed yolk sac tumor type to eradicate local tumor cells and provide complete information for pathological diagnosis and postoperative adjuvant therapy.

Radiation Therapy of Primary Carcinoma of the Vagina (원발성 질암의 방사선치료)

  • Huh, Seung-Jae;Shin, Kyung-Hwan;Ahn, Yong-Chan;Ha, Sung-Whan;Park, Charn-Il
    • Radiation Oncology Journal
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    • v.13 no.1
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    • pp.63-67
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    • 1995
  • A retrospective study was carried out of 20 patients with histologically proven invasive carcinoma of the vagina from 1979 to 1993; 17 cases with curative primary radiotherapy and three cases with postoperative radiotherapy. The five and ten year overall survival rates were $79\%$ and $53\%$, respectively. Survival was strongly correlated with stage. Five year survival rates of stage I, stage II, and stage III, IV were $100\%$, $78\%$, and $0\%$, respectively. Eight patients experienced recurrences: five within the irradiated volume, two distant metastasis, and one combined both local and distant metastasis. There was no significant late complication. From these data, radiation is effective in the management of the vaginal cancer patients and optimum treatment modality and total dose recommendation are made.

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Concurrence of Uterine Tube Adenocarcinoma, Vaginal Fibroma, and Pyometra in a Dog (개에서 난관 선암종, 질 섬유종 및 자궁축농증 병발 1예)

  • Jeon, Eun-Ki;Kim, Ill-Hwa;Chang, Dong-Woo;Mo, In-Pil;Kang, Hyun-Gu
    • Journal of Veterinary Clinics
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    • v.30 no.4
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    • pp.310-314
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    • 2013
  • A 12-year-old, female mixed breed dog presented with a vaginal mass protruding outside the vulva. The patient was non-gravid, with normal defecation and urination. Serum chemistry revealed azotemia and increased alkaline phosphatase. Hematology findings were normal. Blood electrolytes showed mild hypernatremia. Ultrasonography demonstrated severely enlarged uterine horns, a uterine body with anechoic to hypoechoic fluids, and a focal hypoechoic area within the mass of the right uterine tube. On computed tomography, metastasis was not confirmed. Other computed tomography findings suggested a right ovarian cyst, an enlarged, fluid-filled uterus, and an enlarged vagina with a mass. Ovariohysterectomy, episiotomy, and vaginectomy were performed. The case was diagnosed as uterine tube adenocarcinoma, vaginal fibroma, and pyometra. This case is the first reported concurrent occurrence in dogs.

Prognostic analysis of uterine cervical cancer treated with postoperative radiotherapy: importance of positive or close parametrial resection margin

  • Kim, Yi-Jun;Lee, Kyung-Ja;Park, Kyung Ran;Kim, Jiyoung;Jung, Wonguen;Lee, Rena;Kim, Seung Cheol;Moon, Hye Sung;Ju, Woong;Kim, Yun Hwan;Lee, Jihae
    • Radiation Oncology Journal
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    • v.33 no.2
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    • pp.109-116
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    • 2015
  • Purpose: To analyze prognostic factors for locoregional recurrence (LRR), distant metastasis (DM), and overall survival (OS) in cervical cancer patients who underwent radical hysterectomy followed by postoperative radiotherapy (PORT) in a single institute. Materials and Methods: Clinicopathologic data of 135 patients with clinical stage IA2 to IIA2 cervical cancer treated with PORT from 2001 to 2012 were reviewed, retrospectively. Postoperative parametrial resection margin (PRM) and vaginal resection margin (VRM) were investigated separately. The median treatment dosage of external beam radiotherapy (EBRT) to the whole pelvis was 50.4 Gy in 1.8 Gy/fraction. High-dose-rate vaginal brachytherapy after EBRT was given to patients with positive or close VRMs. Concurrent platinum-based chemoradiotherapy (CCRT) was administered to 73 patients with positive resection margin, lymph node (LN) metastasis, or direct extension of parametrium. Kaplan-Meier method and log-rank test were used for analyzing LRR, DM, and OS; Cox regression was applied to analyze prognostic factors. Results: The 5-year disease-free survival was 79% and 5-year OS was 91%. In univariate analysis, positive or close PRM, LN metastasis, direct extension of parametrium, lymphovascular invasion, histology of adenocarcinoma, and chemotherapy were related with more DM and poor OS. In multivariate analysis, PRM and LN metastasis remained independent prognostic factors for OS. Conclusion: PORT after radical hysterectomy in uterine cervical cancer showed excellent OS in this study. Positive or close PRM after radical hysterectomy in uterine cervical cancer correlates with poor prognosis even with CCRT. Therefore, additional treatments to improve local control such as radiation boosting need to be considered.

Evaluation of Treatment Outcomes of Early-Stage Endometrial Cancer Radiotherapy: A Single Center Experience

  • Demiral, S.;Beyzadeoglu, M.;Sager, O.;Dincoglan, F.;Uysal, B.;Gamsiz, H.;Akin, M.;Turker, T.;Dirican, B.
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.22
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    • pp.9599-9602
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    • 2014
  • Background: Postoperative adjuvant radiotherapy (RT) in the management of early stage endometrial cancer (EC) is still controversial. Here we report our institutional experience with patients who received postoperative RT for stage I-II EC over a period of 35 years and assess potential predictors of local recurrence (LR), distant metastasis (DM), and overall survival (OS). Materials and Methods: A total of 188 patients undergoing postoperative RT for stage IA-II EC between 1977 and 2012 were evaluated. Some 96 received median 46 Gy whole pelvic radiotherapy (WPRT) (range: 40-60 Gy), 37 were given WPRT with vaginal cuff therapy (VCT), and 55 received only VCT either with brachytherapy (BT) or stereotactic body radiotherapy (SBRT). Chemotherapy was given to 5 patients with uterine papillary serous carcinoma (UPSC). Logistic regression analysis was used to assess the effect of clinicopathological factors on LR, DM, and OS. Results: Median follow-up time was 11 years (range: 1-35 years). At the time of analysis, 34 patients were not alive. Of the 15 patients with LR, 7 (46.7%) recurred in the vaginal stump, 5 (33.3%) in the pelvic region, and 3 (20%) in the paraaortic nodal region, while 12 had distant metastasis. UPSC histology (p=0.027), sole VCT (p=0.041), high histologic grade (p=0.034), and age ${\geq}71$ (p=0.04) were poor prognostic factors on univariate analysis. Conclusions: In our patients receiving radiotherapy for early-stage EC, grade III disease and age ${\geq}71$ were associated with shorter OS whereas UPSC histology was an independent predictor for both LR and DM.

Radiotherapy Results of Carcinoma of the Cervix with Positive Resection Margin (절제연 양성 자궁경부암의 수술후 방사선치료)

  • Huh Seung Jae;Kim Won Dong;Wu Hong Gyun;Kim Dae Yong;Ha Sung Whan;Ahn Yong Chan;Kim Il Han;Park Charn Il
    • Radiation Oncology Journal
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    • v.14 no.4
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    • pp.317-322
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    • 1996
  • Purpose : Patients with cervical cancer who have positive resection margins after radical hysterectomy are at increased risk for local recurrence. The result of postoperative pelvic radiotherapy for cervix cancer with positive resection margins were analyzed to evaluate the role of radiotherapy. Materials and Methods : Between n 1979 and 1992, 60 patients of cervix carcinoma were treated with postoperative radiotherapy after radical hysterectomy and pelvic lymphadenectomy because of positive vaginal (48 patients) or parametrial resection margins (12 patients). Patients were treated with external beam radiation therapy (EBRT) alone (12 Patients) or EBRT plus vaginal ovoid irradiation (VOI) (48 patients). The median followup period was 55 months. Results : The 5-year actuarial disease free and overall survival rates for all patients were $75.2\%$, $84.1\%$, respectively. The overall recurrence rate was $23\%$ (14/60). In 48 patients with Positive vaginal resection margins, the pelvic recurrence was $8\%$ (4/48). Distant metastasis was $15\%$(7/48). Of the 43 patients with positive vaginal resection margins treated with EBRT and VOI, recurrence rate was $21\%$(9/43) , while recurrence rate was $40\%$(2/5) in the EBRT only treated group. In 12 patients with positive parametrial margins, three patients ($25\%$) had distant metastases. The most significant prognostic factor was lymph node metastasis. Complications resulting from radiotherapy occurred at a rate of $32\%$(19/60) and grade III complications occurred in three patients ($5\%$). Conclusion : Postoperative radiotherapy can produce excellent pelvic control rates in patients with positive resection margins. In patients with positive vaginal margins, whole pelvic EBRT and VOI is recommended.

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Adjuvant external beam radiation and brachytherapy for vaginal resection margin positive cervical cancer

  • Kim, Donghyun;Ki, Yongkan;Kim, Wontaek;Park, Dahl;Lee, Joohye;Lee, Jayoung;Jeon, Hosang;Nam, Jiho
    • Radiation Oncology Journal
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    • v.36 no.2
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    • pp.147-152
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    • 2018
  • Purpose: To evaluate the treatment outcomes of adjuvant external beam radiation therapy (EBRT) and vaginal brachytherapy (VB) following radical hysterectomy in cervical cancer patients with involved vaginal resection margin (VRM). Materials and Methods: We retrospectively reviewed the medical records of 21 patients treated with postoperative EBRT and VB for positive VRM FIGO stage IB-IIA cervical cancer between 2003 and 2015. Concurrent platinum-based chemotherapy was administered to all patients. Results: The median whole pelvis EBRT dose was 50.4 Gy (range, 45 to 50.4 Gy). In the VB, the median dose per fraction, number of fractions, and total dose delivered were: 4 Gy (range, 3.0 to 4.0 Gy), 4 fractions (range, 3 to 5 fractions), and 16 Gy (range, 12 to 20 Gy), respectively. At a median follow-up of 46 months (range, 9 to 122 months), local recurrence was observed in 2 patients, and distant metastasis was present in 7 patients. All patients with local recurrence subsequently developed distant metastases. The 5-year local control, disease-free survival, and overall survival rates were 89.1%, 65.9%, and 62.9%, respectively. Of the 21 patients, 7 patients (33.3%) reported grade 2 acute toxicity; however, there were no grade 3 or higher acute adverse events. Grade 1-2 late toxicities were observed in 8 patients. Late grade 3 urinary toxicity was reported in 1 patient. Conclusions: Adjuvant EBRT and VB showed excellent local control and low toxicity in cervical cancer patients with positive VRM. Although limited by its retrospective nature, the findings from our study provide evidence supporting the use of additional VB in pathologically involved VRM.

Outcomes of Non-Metastatic Gestational Trophoblastic Neoplasia: Twelve Year Experience from a Northern Thailand Tertiary Care Center

  • Suprasert, Prapaporn;Manopunya, Manatsawee
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.14
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    • pp.5913-5916
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    • 2015
  • Gestational trophoblastic neoplasia (GTN) is the malignant form of gestational trophoblastic disease. In non-metastatic GTN, the outcomes of treatment are impressive with methotrexate (MTX) or actinomycin D. We retrospectively reviewed the outcomes of non-metastatic GTN treated at our center from January, 1999 to December, 2013. One hundred and nine patients were recruited to the study. The median age was 33.1 years and over 90% were referral cases. Abnormal vaginal symptoms developed in 37.6% while 56.4% were asymptomatic. The most common antecedent pregnancy was a complete mole (92.7%) with the median interval time from antecedent pregnancy to GTN development being 2.0 months. The median pretreatment B-hCG was 5,624 mIu/ml. The most common first line treatment was methotrexate (MTX) and folinic acid (91.7%) followed by weekly MTX (4.6%), etoposide+ MTX+actinomycin D (EMA) (2.8%), and actinomycin D (0.9%), with the median number of cycles at 5.0. The positive response to first line chemotherapy was 73.8%. The patients were given subsequent chemotherapeutic regimens after resistance to the first line therapy and showed a final remission rate of 89.9%.The significant factor that was frequently found in patients who were non-responders to the first line treatment was a hysterectomy procedure. Two patients developed lung metastasis and brain metastasis at one and four years after the first treatment, respectively. In conclusion, the outcomes of non-metastatic GTN were excellent. However, the patients need long term follow up due to the possibility of developing multiple organ metastases.

Prognostic Value of Pathological Characteristics of Invasive Margins in Early-stage Squamous Cell Carcinomas of the Uterine Cervix

  • Khunamornpong, Surapan;Settakorn, Jongkolnee;Sukpan, Kornkanok;Suprasert, Prapaporn;Lekawanvijit, Suree;Siriaunkgul, Sumalee
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.9
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    • pp.5165-5169
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    • 2013
  • Background: To evaluate the pathological characteristics of invasive margins in early-stage cervical squamous cell carcinomas and their association with other clinicopathological features including clinical outcomes. Materials and Methods: Patients with FIGO stage IB-IIA cervical squamous cell carcinomas who received surgical treatment and had available follow-up information were identified. Their histological slides were reviewed for prognostic variables including tumor size, grade, extent of invasion, lymphovascular invasion, involvement of vaginal margin or parametrium, and lymph node metastasis. The characteristics of invasive margins including invasive pattern (closed, finger-like, or spray-like type), degree of stromal desmoplasia, and degree of peritumoral inflammatory reaction were evaluated along the entire invasive fronts of tumours. Associations between the characteristics of invasive margins and other clinicopathological variables and disease-free survival were assessed. Results: A total of 190 patients were included in the study with a median follow-up duration of 73 months. Tumour recurrence was observed in 18 patients (9%). Spray-like invasive pattern was significantly more associated as compared with closed or finger-like invasive pattern (p=0.005), whereas the degree of stromal desmoplasia or peritumoral inflammatory reaction was not. Low degree of peritumoral inflammatory reaction appeared linked with lymph node metastasis (p=0.021). In multivariate analysis, a spray-like invasive pattern was independently associated with marked stromal desmoplasia (p=0.013), whilst marked desmoplasia was also independently associated with low inflammatory reactions (p=0.009). Furthermore, low inflammatory reactions were independently associated with positive margins (p=0.022) and lymphovascular invasion (p=0.034). The patients with spray-like invasive pattern had a significantly lower disease-free survival compared with those with closed or finger-like pattern (p=0.004). Conclusions: There is a complex interaction between cancer tissue at the invasive margin and changes in surrounding stroma. A spray-like invasive pattern has a prognostic value in patients with early-stage cervical squamous cell carcinoma.