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Re: PLEASE HELP SOLVE THIS MCQFrom: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)Tue Nov 27 07:40:07 2007
At Mon, 26 Nov 2007, Dr Manish Mandal wrote: > >HELLO CAN ANY ONE TELL THE CORRECT ANSWER OF THIS MULTIPLE CHOICE QUESTION WITH EXPLANATION > POST-OP RADIOTHERAPY IN A PT OP FOR CA ENDOMETRIUM IS INDICATED IN A)DEEP MYOMETRIAL INVASION B)PELVIC LYMPH NODE INVOLVEMENT C)ENLARGED UTERINE CAVITY D)POOR TUMOR DIFFERENTIATION > >-- DR MANISH MANDAL MEMBER OF THE GROUP http://groups.google.com/group/medicpass?hl=en > http://groups.google.com/group/medicpass?hl=en This is a study helpfull to the crowd that believe pelvic and paraarotic lympnode disection for well diff, less than 50% invasiion is not necessary. BJOG. 2007 Nov;114(11):1313-20. Epub 2007 Sep 5. Links Survival and recurrent disease after postoperative radiotherapy for early endometrial cancer: systematic review and meta-analysis.Johnson N, Cornes P. Department of Gynaecologic Oncology, Royal United Hospital, Bath, UK. nicholasjohnson@msn.com OBJECTIVE: To clarify the effect of postoperative (adjuvant) external-beam pelvic radiotherapy (EBRT) for different grades of early endometrial cancer. SEARCH STRATEGY: Meta-analysis of data from randomised trials stratified by histological risk factors supported by cohort studies. SELECTION CRITERIA: Cochrane methodology. DATA: Seven randomised trials were identified. Five were eligible for meta-analysis. Homogeneity was confirmed (I2 < 25%). MAIN OUTCOME MEASURES: Survival, site of recurrence and added complications. MAIN RESULTS: EBRT after hysterectomy for low-risk disease increases the odds of death (OR for overall survival 0.71; 95% CI 0.52-0.96). EBRT does not appear to alter survival for intermediate-risk cancers (stage ICG1/2 and IBG3) (OR 0.97; 95% CI 0.69-1.35). In contrast, EBRT offers a significant disease-free survival advantage for high-risk cancer (OR 1.76; 95% CI 1.07-2.89). The survival advantage benefits one in ten women. The definition of high risk is variable across studies but focuses on ICG3 (deeply invasive, poorly differentiated) tumours. Pelvic EBRT reduces the risk of pelvic recurrent disease in all types of invasive endometrial cancer (OR 0.27; 95% CI 0.16-0.44), but local recurrence may respond to salvage treatment. The risk of distant metastasis appears to be increased significantly by prophylactic EBRT (OR 1.58; 95% CI 1.07-2.35), but this might be because pelvic relapse in untreated women alters reporting of metastatic disease. AUTHORS' CONCLUSIONS: Adjuvant EBRT should not be used for low- (IA, IBG1) or intermediate-risk (IBG2) cancer, but it is associated with a 10% survival advantage for high-risk (stage ICG3) endometrial cancer. This challenges the role of a staging lymphadenectomy. PMID: 17803718 [PubMed - indexed for MEDLINE]
--
Take care, John
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