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Volume 24, Issue 106, November - December, 2020

Type II Uterine Body Carcinoma (UBC), Pattern of the Disease in Egyptians, A Single Institutional Experience

Hala Aziz Shokralla1♦, Ahmed Elsayed Fathalla2

1Assistant Professor of Medical Oncology-National Cancer Institute-Cairo University, Egypt; Email: Halaaziz2001@yahoo.Com
2Assistant Professor of Surgical Oncology-National Cancer Institute-Cairo University, Egypt; Email: drasf1975@gmail.com

♦Corresponding author
Assistant Professor of Medical Oncology-National Cancer Institute-Cairo University, Egypt; Email: Halaaziz2001@yahoo.Com

ABSTRACT

Background: UBC is 2nd common gynecological malignancy after cervix. It increases worldwide due to prolongation of life & obesity. Two main types exist (I & II); type II is more aggressive, occurs at older age, less common (20%), unrelated to estrogen, poorly differentiated and deeply invade myometrium. Main presentation is abnormal uterine bleeding, diagnosed by endometrial sampling either aspiration or blind D&C. LNs affection is most important prognostic factor. Pelvic radiation (RT)+/- brachytherapy is the recommended adjuvant treatment. Multiagent chemotherapy (CTH) +/- RT improves disease free survival (DFS) & overall survival (OS) when using platinum/taxanes based regimen. Aims: to study clinicopathological features of all cases of type II UBC, pathological subtypes, management protocols, surgery, RT & CTH given & outcome 'DFS'& 'OS'. Materials & Methods: A single institution prospective analysis of all cases presented to NCI-Cairo University with type II UBC candidate for surgery over a period of 4 years from June 2016 until June 2020; 60 cases were included. Data collected then analyzed. Results: median age was 62 years with commonest age group was 60-70ys (34 cases, 56.6%). Main presentation was postmenopausal bleeding (52 cases, 86.6%). Dilatation & curettage (D&C) were done for (56 cases, 93.3%). Carcinosarcomas dominated the pathology (34 cases, 56.6%). Most cases surgically staged via open approach (54 cases, 90%) with minimal invasive techniques in 6 cases (10%). Only 32 cases (53.3%) underwent lymphadenectomy with positive LNs encountered in 14 cases (23.3%) and grade III predominate (26 cases, 43.3%). Postoperative positive margins found in 4 cases (6.6%). 63.3% (38 cases) were FIGO stage II. Adjuvant EBRTH (5000cGY/25Fr) was given to (36 cases, 60%), Brachytherapy (700cGY/3Fr) to (26 cases, 43.3%). (34 cases, 56.6%) received adjuvant CTH (platinum/taxanes based) + RT in advanced stage & high-grade tumors. Conclusion: Surgery is the primary treatment for early stages disease. In cases of irresectable tumors neoadjuvant combined RT/CTH is preferred. In advanced disease surgical debulking is justified. Pelvic RT +/- brachy therapy combined with multi-agent chemotherapy improves DFS and OS.

Keywords: Type II UBC, Outcome, NCI, EGYPT

Medical Science, 2020, 24(106), 4064-4072
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