OBJECTIVE: The purpose of this study is to validate the Gynecologic Oncology Group (GOG) criteria for adjuvant treatment in a different cohort of patients and to evaluate the simplified risk criteria predicting the prognosis and tailoring adjuvant treatment in patients with surgically staged endometrial cancer. METHODS: We performed a retrospective analysis of 261 consecutive patients with surgically staged endometrial cancer between January 2000 and February 2013. All patients had complete staging procedures and were surgically staged according to the 2009 International Federation of Gynecology and Obstetrics staging system. Clinical and pathologic data were obtained from medical records. We designed the simplified risk criteria for adjuvant treatment according to the risk factors associated with survival. The patients were divided into low and low-intermediate, high-intermediate, and high-risk groups according to the GOG criteria and simplified criteria and their survivals were compared. Receiver-operating characteristic curve analysis was used to evaluate the prognostic significance of both criteria. RESULTS: Median follow-up time was 48 months (range, 10 to 122 months). According to the GOG criteria, we identified 197 low and low-intermediate risk patients, 20 high-intermediate risk patients, and 44 high-risk patients. There were significant differences in disease-free (p<0.001) and overall survival (p<0.001) among the three groups. Using the simplified risk criteria, we identified 189 low and low-intermediate risk patients, 28 high-intermediate risk patients, and 44 high-risk patients. There were significant differences in disease-free (p<0.001) and overall survival (p<0.001) among the three groups. The performance of the simplified criteria (area under the curve [AUC]=0.829 and 0.916 for disease recurrences and deaths, respectively) was as good as the GOG criteria (AUC=0.836 and 0.921 for disease recurrences and deaths, respectively). CONCLUSION: The simplified criteria may be easily applicable and offer useful information for planning strategy of adjuvant treatment in patients with surgically staged endometrial cancer as the GOG criteria.
Adult ; Aged ; Aged, 80 and over ; Chemotherapy, Adjuvant ; Endometrial Neoplasms/pathology/surgery/*therapy ; Female ; Humans ; Middle Aged ; Neoplasm Staging ; Prognosis ; Radiotherapy, Adjuvant ; Retrospective Studies ; Risk Factors ; Survival Analysis

OBJECTIVE: The purpose of the present study was to evaluate treatment outcomes and prognostic factors in cervical cancer patients with isolated para-aortic lymph node (PALN) metastases. We especially tried to evaluate PALN factors such as size, site and number. METHODS: From August 1994 to December 2009, 40 cervical cancer patients with isolated PALN node metastases at initial diagnosis were selected for analysis. Patients underwent both extended field external beam and intracavitary brachytherapy. Fourteen patients received 5-fluorouracil and cisplatin (FP) and 16 patients received weekly concurrent cisplatin. Information of PALN, such as size, site, and number, was founded before PALN radiotherapy. RESULTS: The median follow-up time after primary treatment was 28.5 months (range, 2 to 213 months). The 3-year overall and progression-free survival rate after primary treatment was 44.3% and 31.3%, respectively. In multivariate analysis including tumor stage, performance status, and chemotherapy, FP regimen concurrent chemoradiotherapy was more effective than radiotherapy alone (p=0.030). The 3-year progression-free survival rate was 41.9% and 11.1% in patients with PALN numbers of < or =1 and > or =2, respectively (p=0.008). The 3-year progression-free survival rate was 42.1% and 19.2% in patients with PALN size of <1.5 cm and > or =1.5 cm, respectively (p=0.031). CONCLUSION: The radiologic features of PALN, such as number or size, can be used to determine prognosis in PALN metastatic cervical cancer patients. Furthermore, FP regimen concurrent chemoradiotherapy was associated with better patient survival than radiotherapy alone. However, more studies are required to confirm possible different treatment outcomes between FP and weekly cisplatin regimens.
Brachytherapy ; Chemoradiotherapy ; Cisplatin ; Disease-Free Survival ; Fluorouracil ; Follow-Up Studies ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Treatment Outcome ; Uterine Cervical Neoplasms

OBJECTIVE: Concurrent chemoradiation therapy (CCRT) is the standard treatment for locally advanced cervical cancer. Although the optimal chemotherapeutic regimen is not yet defined, previous randomized trials have demonstrated that 5-fluorouracil (5-FU) plus cisplatin every 3 weeks and weekly cisplatin are the most popular regimens. The purpose of this study was to compare the outcomes of weekly CCRT with cisplatin and monthly CCRT with 5-FU plus cisplatin for locally advanced cervical cancer. METHODS: We retrospectively reviewed data from 255 patients with FIGO stage IIB-IVA cervical cancer. Patients were classified into two CCRT groups according to the concurrent chemotherapy: weekly CCRT group, consisted of CCRT with weekly cisplatin for six cycles; and monthly CCRT group, consisted of CCRT with cisplatin and 5-FU every 4 weeks for two cycles followed by additional consolidation chemotherapy for two cycles with the same regimen. RESULTS: Of 255 patients, 152 (59.6%) patients received weekly CCRT and 103 (40.4%) received monthly CCRT. The mean follow-up period was 39 months (range, 1 to 186 months). Planned CCRT was given to 130 (85.5%) patients in weekly CCRT group and 84 (81.6%) patients in monthly CCRT group, respectively. Severe adverse effects were more common in the monthly CCRT group than in the weekly CCRT group. There were no statistically significant differences in progression-free survival and overall survival between the two groups (p=0.715 and p=0.237). CONCLUSION: Both weekly CCRT and monthly CCRT seem to have similar efficacy for patients with locally advanced cervical cancer, but the weekly cisplatin is better tolerated.
Cisplatin ; Consolidation Chemotherapy ; Disease-Free Survival ; Fluorouracil ; Follow-Up Studies ; Humans ; Retrospective Studies ; Uterine Cervical Neoplasms

OBJECTIVE: Concurrent chemoradiation therapy (CCRT) is the standard treatment for locally advanced cervical cancer. Although the optimal chemotherapeutic regimen is not yet defined, previous randomized trials have demonstrated that 5-fluorouracil (5-FU) plus cisplatin every 3 weeks and weekly cisplatin are the most popular regimens. The purpose of this study was to compare the outcomes of weekly CCRT with cisplatin and monthly CCRT with 5-FU plus cisplatin for locally advanced cervical cancer. METHODS: We retrospectively reviewed data from 255 patients with FIGO stage IIB-IVA cervical cancer. Patients were classified into two CCRT groups according to the concurrent chemotherapy: weekly CCRT group, consisted of CCRT with weekly cisplatin for six cycles; and monthly CCRT group, consisted of CCRT with cisplatin and 5-FU every 4 weeks for two cycles followed by additional consolidation chemotherapy for two cycles with the same regimen. RESULTS: Of 255 patients, 152 (59.6%) patients received weekly CCRT and 103 (40.4%) received monthly CCRT. The mean follow-up period was 39 months (range, 1 to 186 months). Planned CCRT was given to 130 (85.5%) patients in weekly CCRT group and 84 (81.6%) patients in monthly CCRT group, respectively. Severe adverse effects were more common in the monthly CCRT group than in the weekly CCRT group. There were no statistically significant differences in progression-free survival and overall survival between the two groups (p=0.715 and p=0.237). CONCLUSION: Both weekly CCRT and monthly CCRT seem to have similar efficacy for patients with locally advanced cervical cancer, but the weekly cisplatin is better tolerated.
Cisplatin ; Consolidation Chemotherapy ; Disease-Free Survival ; Fluorouracil ; Follow-Up Studies ; Humans ; Retrospective Studies ; Uterine Cervical Neoplasms

OBJECTIVE: The aim of this study was to ascertain whether all cervical cancer patients who received adjuvant concurrent chemoradiation (CCRT) for high risk of treatment failure after radical hysterectomy are at the same risk of treatment failure, and if not, to propose trial treatment modification. METHODS: Between January 1999 and December 2007, 58 patients with FIGO stage Ib-IIa cervical cancer received adjuvant CCRT due to high risk factors such as positive lymph nodes or positive parametrium, or positive vaginal resection margins. Patients were divided into two Groups. Group A were patients with negative parametrium, negative vaginal resection margins, and only unilateral lymph node metastasis (involved L/N< or =2). Group B were those with either bilateral pelvic lymph node involvement, or more than 2 lymph node involvement, or positive parametrium with lymph node involvement. RESULTS: During a median follow-up period of 34 months (range, 6 to 102 months), 9 patients (15.5%) experienced recurrence; among whom 2 patients (2/28, 7.1%) were Group A, and 7 patients (7/30, 23.3%) were Group B. At 3 years, the estimated progression-free survival rate of all 58 patients was 78.3%, and the overall survival rate was 89.7%. Patients in Group A had significantly better progression-free survival (88.2% vs. 68.2%, p=0.042) and overall survival rate (100% vs. 78.8%, p=0.034) than Group B. CONCLUSION: Treatment modifications such as consolidation chemotherapy after CCRT may be considered based on the poor prognosis of very high risk patients such as those patients in Group B.
Consolidation Chemotherapy ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Hysterectomy ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Risk Factors ; Survival Rate ; Treatment Failure ; Uterine Cervical Neoplasms

OBJECTIVE: This study was undertaken to evaluate the efficacy of postoperative concurrent chemoradiotherapy (CCRT) and to investigate the recurrence and survival rates after adjuvant CCRT in high risk early cervical cancer (stage IA2, IB, IIA) patients who were treated by radical hysterectomy and pelvic lymphadenectomy. METHODS: From July 1994 to June 2003, we reviewed the chart of 146 patients who underwent radical abdominal hysterectomy and pelvic lymphadenectomy at Ajou University Hospital for early cervical cancer (stage IA2, IB, IIA). CCRT was performed in 30 patients with high risk factors such as positive pelvic lymph node, positive parametrial involvement, or positive surgical margins. Chemotherapy consisted of cisplatin (70 mg/m2 on day 1) and 5-FU (1000 mg/m2 on day 2-5) for 4 cycles every 4 weeks beginning 2-3 weeks after operation. Pelvic radiotherapy were started with 2nd and 3rd cycle of chemotherapy concurrently. We compared the recurrence rate and survival rate with 114 patients who received no adjuvant therapy after operation. The mean follow up period was 49 months (24-94 months). RESULTS: Disease recurred in 9 of 144 patients treated with surgery (6.3%). There were recurrences in 3 patients after CCRT (10.0%), and in 6 patients in the control group (5.3%) respectively. The actuarial 5-year overall survival rates for patients with adjuvant CCRT, and with no adjuvant treatment were 100%vs. 96.8% (p>0.05). The recurrence and progression-free survival rates were 9.5% vs 6.3%, 90.5% vs. 93.7% (p>0.05). CONCLUSION: This study shows good local control and 5 years overall and progression free survival rates in the high-risk cervical cancer patients after CCRT which is similar results seen in control group. Our results indicate that adjuvant concurrent chemoradiotherapy seems to be effective in stage IA2-IIA cervical cancer patients with high risk.
Chemoradiotherapy* ; Cisplatin ; Disease-Free Survival ; Drug Therapy ; Fluorouracil ; Follow-Up Studies ; Humans ; Hysterectomy* ; Lymph Node Excision* ; Lymph Nodes* ; Radiotherapy ; Recurrence ; Risk Factors ; Survival Rate ; Uterine Cervical Neoplasms

OBJECTIVE: Concurrent chemoradiotherapy is the idea where the chemotherapeutic agent acts as a radiosensitizer thus producing a synergistic effect between radiotherapy and chemotherapy. We evaluated the efficacy and toxicity of concurrent chemoradiotherapy (CCRT) in loco-regionally advanced cervical cancer patients. METHODS: The medical records were retrospectively reviewed for 24 patients who underwent CCRT (cisplatin 70 mg/m2 on day 1, 29; 5-FU: 1000 mg/m2 on day 2-5 and 30-33 X 4 cycles), 26 patients who underwent weekly CCRT (cisplatin: 40 mg/m2 X 6 weeks) and 62 patients who had underwent radiation therapy alone for loco-regionally advanced cervical cancer at Ajou University Hospital. Toxicity was assessed according to the Gynecologic Oncology Group toxicity criteria. Statistical analysis was performed with chi- squre test. RESULTS: 2 year overall survival rate of patients only treated with RT was 75.0% (39/52). When this was compaired to CCRT, 83.3% (20/24) with monthly CCRT and 88.5% (23/26) with weekly CCRT of 2 year overall survival rates were attained. Recurrence rates were measured 2 years after each therapy done, they were 30.8% (16/52) with RT, 25.0% (6/24) with weekly CCRT, and 23.1% (6/26) monthly CCRT. During CCRT, grade 3 and 4 acute complication rates of nausea/vomiting (20.8% vs. 3.8%) and leukocytopenia (29.1% vs. 15.4%) was significantly higher in monthly group compared to weekly group (p<0.05). Weekly group had more patients who completed planned therapy compaired to monthly group (70.9% vs. 84.6%). CONCLUSION: CCRT improved overall survival rates and disease-free survival rate, but in some cases increased acute toxicity, and it is suggested that CCRT may be advantageous compared to radiation therapy for loco-regionally advanced cervical cancer. Weekly CCRT does not seem to afford distinct advantages in terms of acute toxicities over monthly CCRT, except for possible better patient compliance. Due to small size sample and short duration of follow up, further study of a large group of patients and the long survival rate is necessary.
Chemoradiotherapy* ; Disease-Free Survival ; Drug Therapy ; Fluorouracil ; Follow-Up Studies ; Humans ; Leukopenia ; Medical Records ; Patient Compliance ; Radiotherapy ; Recurrence ; Retrospective Studies ; Survival Rate ; Uterine Cervical Neoplasms*

OBJECTIVE: The purpose of this study was to evaluate the efficacy and toxicity of concurrent chemor- adiotherapy (CCRT) in loco-regionally advanced cervical cancer patients. METHODS: The medical records of 24 patients were retrospectively reviewed who underwent CCRT' and 62 patients who had underwent radiation therapy alone at the Department of Obstetrics and Gynecology, Ajou University Hospital from September, 1994 to August 2000 for loco-regionally advanced cervical cancer (stage IIb-IVa and Ib-IIa with bulky tumor mass or pelvic lymph node involvement detected by magnetic resonance imaging). Radiotherapy was performed for 7 weeks during which the patients underwent radiotherapy and chemotherapy concomitantly. Chemotherapeutic regimen consisted of cisplatin (75 mg/m2 on day 1, 4) and 5-FU (1000 mg/m2 on day 2-5, 30-33). The toxicity was assessed according to the GOG toxicity criteria. RESULTS: In the CCRT group, 2 of 18 patients (11.1%) had recurrent disease. Of the 22 patients who were followed up, the overall survival rate was 83.3%, and the relapse-free survival rate was 89.9%. In the radiotherapy alone group, 19 of 61 patients (32.3%) had recurrent disease. Of the 62 patients who were followed up, the overall survival rate was 75.4% and the relapsed-free survival rate was 67.7%. Relative risk reduction rate of the death rate in the CCRT group was 66% (RR 0.34), and 32% (RR 0.68) in the recurrence rate. Acute toxicities in the CCRT group were enteritis grade 3:3 (12.5%), leukopenia grade 3:2 (8.3%), anemia grade 3:1 (4.1%) and grade 4:2 (8.3%). The acute toxicities in the radiation therapy alone group were enteritis grade 3:7 (11.3%), rectal bleeding grade 3:1 (1%). Increased acute toxicities developed in the CCRT group. CONCLUSION: This study shows improved overall survival rates and relapse-free survival rates but some increase in acute toxicity. It is suggested that CCRT be the standard treatment of loco-regionally advanced cervical cancer. Due to small size sample and short duration of follow up, further study of a large group of patients and the long term survival rate are necessary.
Anemia ; Chemoradiotherapy* ; Cisplatin ; Drug Therapy ; Enteritis ; Fluorouracil ; Follow-Up Studies ; Gynecology ; Hemorrhage ; Humans ; Leukopenia ; Lymph Nodes ; Medical Records ; Mortality ; Obstetrics ; Radiotherapy ; Recurrence ; Retrospective Studies ; Risk Reduction Behavior ; Survival Rate ; Uterine Cervical Neoplasms*

No abstract available.
Humans ; Hysterectomy* ; Lymph Node Excision* ; Lymph Nodes* ; Uterine Cervical Neoplasms*

It is a rare occurrence that cervical cancer and aplastic anemia are combined, but eight cases were reported since Fujiu's report in 1968. There has been no one who have reported the case of like this in Korea. And so, we report this case for the support of idea of treatment in aplastic anemia patient combined with cervical cancer. The knowledges required are early detection of malignancy and the individualization of the treatment according to the status of the patient, the bone marrow function saving procedure and the prevention of the patient from death involved with bleeding and sepsis induced by infection.
Anemia, Aplastic* ; Bone Marrow ; Hemorrhage ; Humans ; Korea ; Sepsis ; Uterine Cervical Neoplasms*