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Query: UMLS:C0476089 (endometrial cancer)
 11,379 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The Syed template (Alpha-Omega Services, Bellflower, CA) represents an advance in interstitial gynecologic brachytherapy; however, its appeal is diminished by inaccuracies in target definition secondary to suboptimal imaging of gynecologic tumors and the risk of viscus perforation during a "blind" procedure. Magnetic resonance (MR) scanning with an endorectal coil and computed tomography were studied as a possible tool to improve target definition and maximize treatment planning with Syed templates. Abdominopelvic contents could be visualized directly through a laparotomy incision or indirectly with a laparoscopic video display to allow further target definition and minimize complications associated with blind procedures after hysterectomy. The synthesis of these techniques with Syed template applications was attempted to potentiate the utility of this brachytherapy system. Five patients with apical vaginal tumors which arose after previous hysterectomies (two endometrial cancer recurrences, one recurrent uterine sarcoma, two primary vaginal cancers) were referred for radiotherapy. In three cases, external beam pelvic radiotherapy (median dose, 45 Gy; range, 45-50.4 Gy) was delivered initially. In all cases, the Syed applicator was used for the brachytherapy component of the treatment. In two cases, high-resolution MR images (400 x 400 microns) of the vaginal apex were obtained after insertion of an endorectal surface coil. The images defined the relationships between the template, target volume, bladder, rectum, and intestine. The other three cases were planned with computerized tomography (CT). In all cases, intraoperative examination of the abdominopelvic contents was provided when laparotomy and/or laparoscopy was performed by the surgical team. The median brachytherapy dose prescribed to the isodose envelope covering the target volume was 40 Gy (range, 31-50 Gy). In all cases, the target volumes could be encompassed by the 60 cGy/hr isodose line. Tumor volume estimation was better with MR than CT. Procedure time was shorter with laparoscopy than with laparotomy. In two cases, bowel displacement was performed (one tissue expander, one omental sling) to prevent viscus perforation by interstitial needles. Four of five patients responded completely to the treatment. In three cases, local control was maintained at a median follow-up of 11 months. In conclusion, endorectal coil MRI may be advantageous to CT of the pelvis in that it allows preplanning to be achieved with greater precision and with less planning time. Major intraoperative complications (i.e., perforation of hollow viscus organs) can be avoided when the course of interstitial catheters is visualized from above by the surgical team.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Improved treatment planning for the Syed-Neblett template using endorectal-coil magnetic resonance and intraoperative (laparotomy/laparoscopy) guidance: a new integrated technique for hysterectomized women with vaginal tumors. 789 94

At present there is no oral medicine available which is effective for advanced or recurrent case of elderly patients with gynecologic cancer. We report that a low-dose biweekly paclitaxel administration preserves quality of life (QOL) and seems to be "tumor dormancy like" therapy of good compliance with few side effects. A total of 11 cases were in ovarian cancer (5), uterine cancer (3), cervical cancer (2), and uterine sarcoma (1). The median age was 68 years old and the age range was 50 to 79 years old. We performed a standard treatment as a first time treatment. Afterwards, we obtained complete informed consent from the patients for progressive or recurrent cancer and administered biweekly paclitaxel 70 mg/m2 (80-100 mg/body) on an outpatient basis. We reviewed the effect, side effect and compliance of the medication. We judged the side effect based on the Japanese cancer treatment society common toxicity criteria. The result was only one patient death from PD and the other 10 patients were PR or a state of NC without side effect. An ovary cancer case patient lived for 67 months at best, an endometrial cancer case patient lived for 62 months at best, a cervical cancer case patient lived for 74 months at best, and a recurrent uterine sarcoma case patient lived for 76 months after recurrence and the QOL was good. In addition, there was no onset of side effect more than grade 2 in all of the cases and a compliance of medical administration was good. In these cases, we thought that a low-dose of biweekly paclitaxel administration was regarded as a therapy to preserve QOL without a serious side effect and a good compliance of medication. Furthermore, we intend to increase more cases and would like to report them in the future.
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PMID:[A trial of biweekly paclitaxel administration in consideration of QOL for advanced or recurrent gynecologic cancer]. 1591 75