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        Impact of vaginal brachytherapy in intermediate and high-intermediate risk endometrial cancer: a multicenter study from the FRANCOGYN group

        Pierre-Alain Reboux,Henri Azaïs,Charles-Henry Canova,Sofiane Bendifallah,Lobna Ouldamer,Emilie Raimond,Delphine Hudry,Charles Coutant,Olivier Graesslin,Cyril Touboul,Pierre Collinet,Alexandre Bricou,C 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.4

        Objective: According to recent European Society of Medical Oncology, European Society of Gynaecological Oncology and European Society of Radiotherapy and Oncology guidelines,adjuvant vaginal brachytherapy (VB) is optional in patients with intermediate risk (IR) and high-intermediate risk (HIR) endometrial cancer (EC). The aim of this French retrospective,multicenter study was to assess the impact of VB in these groups on local recurrence rate,local recurrence-free survival (RFS) and overall survival (OS). Methods: Data of 191 patients with IR and HIR EC who underwent primary surgery with or without VB and no other adjuvant treatment between 2000 and 2016 were extracted from the FRANCOGYN database. Rate of local recurrence, OS and local RFS in these two groups were compared using the Kaplan-Meier method. Results: The number of patients with IR and HIR EC were 118 and 73 respectively. VB was used in 92 patients in IR group and 43 in HIR group. Median follow-up was 22 months. In the HIR group, the local recurrence rate was significantly higher in the no adjuvant therapy group in comparison with the VB group (16.7% and 0% respectively, p=0.02). There was also a significant improvement in local RFS (p=0.01) in VB group. In IR EC, there is no significant difference on local recurrence rate (4.2% and 3.2%, respectively, p=1.00) or local RFS (p=0.54) between the two groups. Conclusions: VB is an efficient adjuvant treatment for patients with HIR EC. VB is not associated with an improvement of RFS or OS in IR EC patient.

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        Implications of a two-step procedure in surgical management of patients with early-stage endometrioid endometrial cancer

        Emmanuelle Arsène,Géraldine Bleu,Benjamin Merlot,Loïc Boulanger,Denis Vinatier,Olivier Kerdraon,Pierre Collinet 대한부인종양학회 2015 Journal of Gynecologic Oncology Vol.26 No.2

        Objective: Since European Society for Medical Oncology (ESMO) recommendations and French guidelines, pelvic lymphadenectomyshould not be systematically performed for women with early-stage endometrioid endometrial cancer (EEC) preoperativelyassessed at presumed low- or intermediate-risk. The aim of our study was to evaluate the change of our surgical practices afterESMO recommendations, and to evaluate the rate and morbidity of second surgical procedure in case of understaging after thefirst surgery. Methods: This retrospective single-center study included women with EEC preoperatively assessed at presumed low- orintermediate-risk who had surgery between 2006 and 2013. Two periods were defined the times before and after ESMOrecommendations. Demographics characteristics, surgical management, operative morbidity, and rate of understaging werecompared. The rate of second surgical procedure required for lymph node resection during the second period and its morbiditywere also studied. Results: Sixty-one and sixty-two patients were operated for EEC preoperatively assessed at presumed low-or intermediate-riskbefore and after ESMO recommendations, respectively. Although immediate pelvic lymphadenectomy was performed morefrequently during the first period than the second period (88.5% vs. 19.4%; p<0.001), the rate of postoperative risk-elevating orupstaging were comparable between the two periods (31.1% vs. 27.4%; p=0.71). Among the patients requiring second surgicalprocedure during the second period (21.0%), 30.8% did not undergo the second surgery due to their comorbidity or old age. For the patients who underwent second surgical procedure, mean operative time of the second procedure was 246.1±117.8minutes. Third operation was required in 33.3% of them because of postoperative complications. Conclusion: Since ESMO recommendations, second surgical procedure for lymph node resection is often required for womenwith EEC presumed at low- or intermediate-risk. This reoperation is not always performed due to age/comorbidity of thepatients, and presents a significant morbidity.

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