Objectives: Cervical cancer in the setting of uterovaginal prolapse is exceedingly rare. Altered anatomy can complicate treatment of underlying cancer. We first present a rare case of cervical cancer with invasion of uterovaginal prolapse as well as a systematic review of similar reported cases in the literature. The objective of this study was to compare the practice patterns and outcomes regarding cervical cancer with invasion of procidentia.
Methods:We conducted a systematic search of online databases (PubMed, Embase, Medline and the Cochrane Library) from 1990 to 2018 of all the cases of cervical cancer associated with stage III-IV uterovaginal prolapse. Patient demographics, pathology, surgical management, chemotherapy, radiation and disease-free survival were compared.
Results:Fifteen reported cases of cervical cancer in the setting of procidentia were identified (squamous cell carcinoma-14, clear cell carcinoma-1). The mean age at diagnosis was 74 years (range 54-89). Thirteen percent (n = 2) of cases presented with FIGO stage I disease, 67% (n = 10) with stage II, and 20% (n = 3) with stage III. All cases had stage III-IV uterovaginal prolapse. 73% (11) were treated surgically including nine patients who underwent vaginal hysterectomy. Among patients who underwent primary surgery, 7% (1) received adjuvant chemotherapy, 33% (5) adjuvant radiotherapy and 21% (3) both adjuvant chemotherapy and radiation. 33% (5) of surgical cases included procedures to address the pelvic organ prolapse (colpoclesis (n = 3), uterosacral suspension (n = 1) and anterior posterior repair (n = 1)). Two patients died from the disease within 12 months, one patient died from other causes within 1 month, and the remainder of patients were free of disease at last reported follow-up (Table 1).
Conclusions:Cervical cancer in the setting of stage III-IV uterovaginal prolapse can be managed successfully with standard treatment strategies (primary surgery with adjuvant therapy as necessary versus chemoradiation). When patients are surgical candidates, techniques to address the underlying prolapse can be used for symptomatic improvement.
Purpose Thermal ablation of small renal tumors is safe and efficacious. Thermoablation of tumors greater than 3 cm has decreased efficacy and a greater risk of complications. Combined embolization and radiofrequency ablation has shown encouraging results. We report on the use of combined single-session transarterial embolization and microwave ablation to treat large renal masses. Materials and Methods After obtaining IRB approval, a review of the medical record between October 2016 and January 2020 was performed. Patients with renal tumors who underwent combined transarterial embolization and microwave ablation were assessed retrospectively. Patient demographic information, intraoperative, postoperative, and follow-up data were recorded. Results Eleven patients were identified meeting inclusion criteria. The mean age was 73 years, with 64% male, an average BMI of 26.5, and average Charleston Comorbidity Index of 6.7. Nine tumors were identified as clear cell carcinoma, one as papillary carcinoma and one as an oncocytic neoplasm. Average tumor size was 4.5 cm (2.7-8.3), with an average RENAL score of 8.5. Successful ablation with a 5 mm margin was achieved in all patients, and in all cases, ablation and embolization were performed on the same day. The only related post-procedure complication was a single groin hematoma. Surveillance was performed with CT or MRI. Average follow-up was 419.5 days (range 27-747), with no patients showing evidence of recurrence to date. Conclusions Combined single-session transarterial embolization and microwave ablation is technically feasible, safe, and efficacious in treating large renal tumors in a series of 11 patients with no recurrence to date. Level of Evidence Level 4, case series.
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