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In this study, 683 patients with endometrial cancer (EC) after comprehensive surgical staging were classified into four risk groups as low (LR), intermediate (IR), high-intermediate (HIR) and high-risk (HR), according to the recent consensus risk grouping. Patients with disease confined to the uterus, ≥50% myometrial invasion (MI) and/or grade 3 histology were treated with vaginal brachytherapy (VBT). Patients with stage II disease, positive/close surgical margins or extra-uterine extension were treated with external beam radiotherapy (EBRT)±VBT. The median follow-up was 56 months. The overall survival (OS) was significantly different between LR and HR groups, and there was a trend between LR and HIR groups. Relapse-free survival (RFS) was significantly different between LR and HIR, LR and HR and IR and HR groups. There was no significant difference in OS and RFS rates between the HIR and HR groups. In HR patients, the OS and RFS rates were significantly higher in stage IB - grade 3 and stage II compared to stage III and non-endometrioid histology without any difference between the two uterine-confined stages and between stage III and non-endometrioid histology. The current risk grouping does not clearly discriminate the HIR and IR groups. In patients with comprehensive surgical staging, a further risk grouping is needed to distinguish the real HR group.Impact statementWhat is already known on this subject? The standard treatment for endometrial cancer (EC) is surgery and adjuvant radiotherapy (RT) and/or chemotherapy is recommended according to risk factors. The recent European Society for Medical Oncology (ESMO), European Society of Gynaecological Oncology (ESGO) and European Society for Radiotherapy and Oncology (ESTRO) guideline have introduced a new risk group. However, the risk grouping is still quite heterogeneous.What do the results of this study add? This study demonstrated that the current risk grouping recommended by ESMO-ESGO-ESTRO does not clearly discriminate the intermediate risk (IR) and high-intermediate risk (HIR) groups.What are the implications of these findings for clinical practice and/or further research? Based on the results of this study, a new risk grouping can be made to discriminate HIR and IR groups clearly in patients with comprehensive surgical staging. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to evaluate the prognostic significance of adequate lymph node dissection (LND) (≥10 pelvic lymph nodes (LNs) and ≥ 5 paraaortic LNs removed) in patients with International Federation of Gynecology and Obstetrics (FIGO) stage II endometrioid endometrial cancer (EEC). Methods: A multicenter department database review was performed to identify patients who had been operated and diagnosed with stage II EEC at seven centers in Turkey retrospectively. Demographic, clinicopathological, and survival data were collected and analyzed. Results: We identified 284 women with stage II EEC. There were 170 (59.9%) patients in the adequate lymph node dissection (LND) group and 114 (40.1%) in the inadequate LND group. The 5‐year overall survival (OS) rate of the inadequate LND group was significantly lower than that of the adequate LND group (84.1% vs. 89.1%, respectively; p = 0.028). In multivariate analysis, presence of lymphovascular space invasion (LVSI) (hazard ratio [HR]: 2.39, 95% confidence interval [CI]: 1.23–4.63; p = 0.009), age ≥ 60 (HR: 3.30, 95% CI: 1.65–6.57; p = 0.001], and absence of adjuvant therapy (HR: 2.74, 95% CI: 1.40–5.35; p = 0.003) remained as independent risk factors for decreased 5‐year disease‐free survival (DFS). Inadequate LND (HR: 2.34, 95% CI: 1.18–4.63; p < 0.001), age ≥ 60 (HR: 2.67, 95% CI: 1.25–5.72; p = 0.011), and absence of adjuvant therapy (HR: 4.95, 95% CI: 2.28–10.73; p < 0.001) were independent prognostic factors for decreased 5‐year OS in multivariate analysis. Conclusion: Adequate LND and adjuvant therapy were significant for the improvement of outcomes in FIGO stage II EEC patients. Furthermore, LVSI was associated with worse 5‐year DFS rate in stage II EEC. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To identify factors predictive of poor prognosis in women with stage III nonserous epithelial ovarian cancer (EOC) who had undergone maximal or optimal primary cytoreductive surgery (CRS) followed by six cycles of intravenous carboplatin/paclitaxel chemotherapy. Methods: A multicenter, retrospective department database review was performed to identify patients with stage III nonserous EOC who had undergone maximal or optimal primary CRS followed by six cycles of carboplatin/paclitaxel chemotherapy at seven gynecological oncology centers in Turkey. Demographic, clinicopathological and survival data were collected. Results: A total of 218 women met the inclusion criteria. Of these, 64 (29.4%) patients had endometrioid, 61 (28%) had mucinous, 54 (24.8%) had clear‐cell and 39 (17.9%) had mixed epithelial tumors. Fifty‐five (25.2%) patients underwent maximal CRS, whereas 163 (74.8%) had optimal debulking. With a median follow‐up of 31.5 months, the 5‐year progression‐free survival (PFS) and overall survival (OS) rates were 34.8% and 44.2%, respectively. Bilaterality (hazard ratio [HR] 1.44, 95% CI 1.01–2.056; P = 0.04), age (HR 2.25, 95% CI 1.176–4.323; P = 0.014) and maximal cytoreduction (HR 0.34, 95% CI 0.202–0.58; P < 0.001) were found to be independent prognostic factors for PFS. However, age (HR 2.6, 95% CI 1.215–5.591; P = 0.014) and maximal cytoreduction (HR 0.31, 95% CI 0.166–0.615; P < 0.001) were defined as independent prognostic factors for OS. Conclusion: The extent of CRS seems to be the only modifiable prognostic factor associated with stage III nonserous EOC. Complete cytoreduction to no gross residual disease should be the main goal of management in these women. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The purpose of this study was to determine the prognostic factors and patterns of failure in lymphovascular space invasion (LVSI)‐positive women with stage IIIC endometrioid endometrial cancer (EC). Methods: A multicenter, retrospective, department database review was performed to identify LVSI‐positive patients with stage IIIC endometrioid EC at five gynecological oncology centers in Turkey. Demographic, clinicopathological and survival data were collected. Results: We identified 172 LVSI‐positive women with stage IIIC endometrioid EC during the study period; 75 (43.6%) were classified as Stage IIIC1 and 97 (56.4%) as Stage IIIC2. The median age at diagnosis was 59 years, and the median duration of follow up was 34.5 months. The total number of recurrences was 46 (26.7%). We observed 14 (8.1%) locoregional recurrences, 12 (7.0%) retroperitoneal failures and 20 (11.6%) distant relapses. For the entire study cohort, 5‐year progression‐free survival (PFS) was 67.4%, while the 5‐year overall survival (OS) rate was 75.1%. Grade 3 histology (hazard ratio [HR] 2.62, 95% confidence interval [CI] 1.34–5.12; P = 0.005), cervical stromal invasion (HR 2.33, 95% CI 1.09–4.99; P = 0.028) and myometrial invasion (MMI) ≥50% (HR 4.0, 95% CI 1.16–13.69; P = 0.028) were found to be independent prognostic factors for decreased OS. Conclusion: Uterine factors such as grade 3 disease, cervical stromal invasion and deep MMI seem to be independently associated with decreased OS in LVSI‐positive women with stage IIIC endometrioid EC. The high distant recurrence rate in this subgroup of patients warrants further studies in order to identify the most effective treatment strategy for those patients. [ABSTRACT FROM AUTHOR]

: ObjectiveTo investigate the effectiveness of a single preoperative dose of misoprostol in abdominal myomectomies.: DesignPlacebo-controlled randomized prospective study.: SettingDepartment of obstetrics and gynecology in a university hospital.: Patient(s)Twenty-five women with symptomatic uterine leiomyomas.: Intervention(s)Among patients undergoing abdominal myomectomies, an hour before the operation women in the study group (n = 13) were given a single dose of vaginal misoprostol (400 μg); those in the control group (n = 12) were given placebo.: Main outcome measure(s)Intraoperative blood loss, duration of operation, duration of postoperative hospitalization, and the need for blood transfusion were compared between the control and study groups.: Result(s)Blood loss, operation time, and need for postoperative blood transfusion were significantly reduced in the group given vaginal misoprostol. No difference was observed among patients in terms of the time of hospitalization.: Conclusion(s)A single preoperative dose of vaginal misoprostol is a simple, reliable method for reducing intraoperative blood loss and need for postoperative blood transfusion after abdominal myomectomies. [Copyright &y& Elsevier]