Background: Endometrial adenocarcinoma is commonly seen in postmenopausal women and uterine bleeding is the first sign in 90% of the cases. Bone metastasis as the presenting feature is extremely rare. We report two endometrial cancer patients with metastasis to the tibia and cervical vertebra at the time of primary disease. Cases: Two patients were diagnosed with stage IVB endometrial cancer with involvement of the tibia and cervical column, respectively. The first case was treated with 8 cycles of platinum, doxorubicin, and cyclophosphamide, but she died 3 months after the completion of chemotherapy as a result of progressive disease. The second case received surgery followed by chemotherapy with cisplatin and doxorubicin, but she died 2 months later. Conclusions: These cases highlight the rare and unusual presentation of endometrial cancer. For this reason a review of the literature is also provided for all cases with evidence of bone metastasis at presentation of the disease, and as a recurrence.

The aim of this study was to compare the outcome of patients with advanced ovarian carcinoma treated with neoadjuvant chemotherapy (NACT) with those treated conventionally with primary debulking surgery. From 1994 to 2003, all consecutive cases of advanced-stage epithelial ovarian carcinoma treated with NACT at the University of Bari were identified. A well-balanced group of women who underwent primary debulking surgery followed by platinum-based chemotherapy was selected as controls. Kaplan-Meier and Cox proportional hazards analyses were used to determine the predictors for survival. Thirty women with advanced-stage epithelial ovarian carcinoma were treated with NACT and compared to 30 patients who underwent primary debulking surgery. Patients in the NACT were significantly older and had a poorer performance status compared to the controls. However, no statistical difference was observed in overall disease-specific survival (P= 0.66) and disease-free survival (P= 0.25) between the two groups. Although patients in the NACT group are significantly older and have a poorer performance status, this treatment modality does not compromise survival. Prospective randomized trials comparing NACT to conventional treatment to determine the quality of life and cost/benefit outcomes are now appropriate for women presenting advanced epithelial ovarian cancer.

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