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Introduction: To assess the rate of disease control and survival after adjuvant treatment in patients with uterine papillary serous (PSC) and clear cell carcinoma (CCC) and compare the results between these two subtypes. Methods: The medical charts of 199 patients with de novo uterine PSC or CCC who underwent radiotherapy (RT) following surgery between 2001 and 2019 in three radiation oncology departments were retrospectively evaluated. Adjuvant treatment was decided by a multidisciplinary tumor board. All patients were planned to undergo adjuvant 4–6 cycles of chemotherapy with external beam RT (EBRT) and/or vaginal brachytherapy (VBT). Results: Median age was 63 years for all, 64 years for PSC, and 59 years for CCC, respectively. Complete surgical staging was applied in 98% of patients. Histopathologic subtype was PSC in 142 (71%) and pure CCC in 57 (29%) patients, respectively. FIGO stage was I in 107 (54%), II in 35 (18%), and III in 57 (28%) patients, respectively. Lympho‐vascular space invasion and positive peritoneal cytology (PPC) were present in 42% and 10% of patients, respectively. All patients but 23 (12%) underwent adjuvant chemotherapy. Median follow‐up was 49.5 months for all patients, 43.9 months for patients with PSC, and 90.4 months for patients with CCC, respectively. During follow‐up, 20 (10%) patients developed pelvic recurrence (PR) and 37 (19%) developed distant metastasis (DM). PSC subtype increased the PR and DM rates, although the latter not statistically significant. The 5‐year overall survival and disease‐free survival rate was 73% and 69% for all patients, 71% and 66% for patients with PSC, and 77% and 75% for patients with CCC, respectively. The difference was more prominent in patients with stage ≥ IB disease. In multivariate analysis, advanced age and PPC significantly decreased all survival rates. Conclusion: PSC has a worse prognosis than CCC with regard to pelvic and distant recurrence with a trend for decreased survival rates. Therefore, a more aggressive therapy is needed for patients with uterine PSC, particularly in patients with stage ≥ IB disease. [ABSTRACT FROM AUTHOR]

Background Women with postmenopausal bleeding should be evaluated efficiently to exclude endometrial carcinoma. Aims To estimate the risk of endometrial cancer using individual case characteristics among women with postmenopausal bleeding in whom the endometrial thickness is >4 mm. Methods Women with postmenopausal bleeding underwent clinical evaluation followed by transvaginal ultrasonography and endometrial biopsy. Clinical evaluation included age, body mass index, duration of menopause, number of bleeding episodes and amount of bleeding. Results This study included 142 women, and endometrial carcinoma was found in 18 (12.7%). Older age, higher body mass index, longer duration of menopause, longer lasting bleeding episodes, higher amount of bleeding and recurrent bleeding episodes were the clinical characteristics associated with endometrial cancer. However, multivariate analysis revealed >55 years of age during postmenopausal bleeding, history of recurrent bleeding episodes and bleeding exceeding 5 pads per day in each episode as significant parameters, which predicted the presence of endometrial cancer among women with postmenopausal bleeding. Conclusions Prompt evaluation is required in women with postmenopausal bleeding to exclude endometrial cancer. Transvaginal ultrasonography is a reasonable first-line approach, and invasive sampling is required when ultrasonographic endometrial thickness is above 4 mm. However, about 90% of women with postmenopausal bleeding will finally be found to have a nonmalignant condition. Therefore, women who are at increased cancer risk should further be distinguished. This may be achieved using individual patient characteristics that result in a more accurate evaluation strategy with lower rates of unnecessary invasive procedures. [ABSTRACT FROM AUTHOR]

Aim: Depth of appendiceal metastasis in patients with epithelial ovarian carcinoma (EOC) has not been previously analyzed for a possible relationship with clinico-pathological variables. Methods: Sixty-nine patients with EOC treated at Hacettepe University were retrospectively analyzed. All of the patients had appendiceal metastasis. Pathological slides were re-reviewed by the same pathologist. Appendiceal metastases were defined as serosal (if tumoral spread involved only serosa of the appendix) or sero-mucosal (if tumoral spread also involved either muscular or mucosal surfaces of the appendix). Univariate and multivariate analysis did not reveal a significant difference with respect to the prognostic variables between the groups. Results: Thirty-nine patients had serosal appendiceal metastasis (56.5%), while the remaining 30 patients (43.5%) had appendiceal metastasis extending toward the muscular layer (seromucosal metastasis: 16 within muscularis mucosa, 14 within the mucosa of the appendix). The mean age at the time of diagnosis was 54.58 years (range, 26-88 years), with no significant difference between the groups ( P = 0.9). Comparison of the survival rates between the two groups did not reveal a significant difference. Three-year survival rates were 23.3% in the serosal metastasis and 27.9% in the seromucosal metastasis group ( P = 0.9). This figure was 25% for patients with only muscular metastasis and 41.6% for patients with appendiceal metastasis extending to the mucosal layer ( P = 0.2). Conclusion: This is the first report to analyze the metastatic pattern of EOC on the appendix with respect to depth of invasion which could not reveal a significant difference. [ABSTRACT FROM AUTHOR]

Aim: To compare Pfannenstiel and midline incisions with respect to efficacy and early postoperative surgical site complications in patients with early stage cervical carcinoma. Methods: Patients with cervical carcinoma who underwent radical hysterectomy during 1995–2004 are retrospectively reviewed. There were 40 patients in the Pfannenstiel group and 71 patients in the midline group. Patients' age, type of incision, operative time, hospitalization length, postoperative surgical site complications, pre and postoperative Hb levels, number of extracted pelvic and paraaortic lymph nodes were the variables collected from the patients' files and oncology follow-up forms. Results: Mean age (53.5 ± 6.96 vs 55.9 ± 10.5, P = 0.2) and preoperative Hb levels of patients (12.52 ± 1.48 vs 12.94 ± 1.34, P = 0.17) were not statistically different in midline and Pfannenstiel groups, respectively. Operative time (141.8 ± 36 vs 135.8 ± 31 min), number of extracted lymph nodes in pelvic (23.05 ± 9.7 vs 23.5 ± 8.07) and paraaortic areas (3.17 ± 1.68 vs 2.66 ± 1.15) were not significantly different among the midline and Pfannenstiel groups, respectively ( P > 0.05). Although postoperative incisional complications were more common in the midline group, this difference did not reach a significant level (11.3% vs 7.5%, P = 0.52). Duration of hospitalization was not significantly different between the midline and Pfannenstiel groups, respectively (6.3 ± 2.69 vs 6.2 ± 2.72 days, P = 0.21). Multivariate analysis revealed postoperative Hb levels to be significantly different among the groups ( P = 0.017, OR = 1.59, 95% CI: 1.08–2.35). Conclusion: Pfannenstiel incision can be used for radical hysterectomy with pelvic and paraaortic lymphadenectomy in selected patients with cervical carcinoma, without any negative influence on optimal resectability of tumor and surgical morbidity. [ABSTRACT FROM AUTHOR]