Current therapy of patients with endometrial carcinoma

Abstract

Magnetic resonance imaging (MRI), 18-FDG positron emission tomography ((18)FDG PET-CT), and computed tomography (CT) have demonstrated disappointing detectability of lymph node metastases in endometrial cancer. The treatment of choice in patients with endometrial cancer is hysterectomy and bilateral salpingoophorectomy. Above all, obese patients with comorbidity have benefited the most from laparoscopically assisted approaches. For inoperable patients in FIGO stage I/II, radiation remains an alternative to hysterectomy. The role of pelvic and paraaortic lymphadenectomy is the most controversial issue in endometrial carcinoma treatment. The current spectrum of treatment ranges from no lymphadenectomy, exclusive pelvic or additional inframesentric paraaortic sampling, or complete pelvic to infrarenal paraaortic lymphadenectomy. The sentinel concept in patients with endometrial carcinoma is far from being introduced into routine clinical practice. Without a lymphadenectomy, decision making for adjuvant therapy remains a challenge, because no information is available from lymph node status and the reliability of pathologic grading is poor. For patients after hysterectomy with a low risk of local relapse (stage I/II without additional risk factors), vaginal brachytherapy is sufficient to prevent vaginal relapses. Adjuvant external beam irradiation (EBRT) in stage I/II demonstrated improved local control which impacted overall survival only in patients with high-risk features (higher age, grading myometrial infiltration). Stage IIIC patients seem to benefit from EBRT with regard to overall survival. In patients at high risk of progression (grade 3, MI > 50%, FIGO IIIC, unfavorable histology), multimodal treatment should be considered. The optimal substances and sequences are under investigation.

Possibility of pre-emptive analgesia with gabapentin for laparoscopic surgeries in gynecologic oncology

“…Это характеризуется низкими периопера-ционными осложнениями, более быстрым восстановлением и сниженным расходом анальгетиков по сравнению с открытыми доступами [5,7,8]. Исследование интенсив-ности боли у данных пациенток позволяет реально оценить потребность в опиоидных анальгетиках и риск развития нежелатель-ных явлений [2,5,6].…”

Comparative Assessment of Anesthesia Methods for Gynecologic Surgery

“…Уровень травматичности оперативных вме-шательств, выполняемых в онкогинекологии, существенно разнится -от малоинвазивных лапаро-скопических операций до обширных радикальных гистерэктомий с резекцией окружающих тканей малого таза [1,7,8]. Включение эпидуральной аналгезии (ЭА) как компонента общей анестезии при лапаротомных операциях на органах малого таза и применение контролируемой пациентом эпидуральной аналгезии (КПЭА) после операций (до 3 сут) является эффективным методом контроля интенсивности боли и способом снижения потреб-ности в опиоидных анальгетиках [9].…”

Current Treatment Options in Patients with Endometrial Cancer

“…However it is obvious that pelvic and para-aortic lymphadenectomy should be performed in patients with advanced stage type I EC, as well as in all patients with type II EC [15,24,25]. Also in any case of doubt, lymphadenectomy should be performed rather than abandoned [24].…”

“…In EC patients at increased risk for recurrence or with advanced stage disease, more aggressive management with postoperative adjuvant radiotherapy and/or chemotherapy is required [24]. Postoperative adjuvant radiotherapy includes external pelvic radiotherapy and/or brachytherapy.…”

“…Adjuvant chemotherapy is the mainstay of treatment for EC patients with locally advanced or metastatic disease [24,36]. The most active chemotherapeutic agents are: taxanes, anthracyclines and platinum compounds [36,37].…”