Cisplatin based chemotherapy is commonly used
Cisplatin-based chemotherapy is commonly used in adjuvant CCRT, but data on carboplatin-based chemotherapy with radiotherapy is lacking. Khoury et al reported that patients treated with carboplatin-based chemoradiotherapy show worse outcomes. However, the impact on patient comorbidities was not reported, and patients treated with carboplatin usually have impaired renal function. In this study, eight patients were treated with a carboplatin-based regimen. We found no correlation between carboplatin-based regimens and outcomes. The combination of gemcitabine plus cisplatin is usually used to treat metastatic herpes simplex virus type 1 cancer. Some prospective studies have been conducted using low doses of gemcitabine as a chemosensitizer with radiotherapy. Our study showed that elderly patients can tolerate and finish conventional doses of gemcitabine (800–1000 mg/m2, given on days 1 and 8 and repeated every 21 days).
Our study has several limitations. First, it is limited by its retrospective nature. Second, compared to patients treated with radiotherapy alone or TURBT alone, patients receiving CCRT after TURBT included in this analysis were highly selected. They have stronger physical reserves and less comorbidities. Third, late pelvis toxicity and quality of life could not be assessed comprehensively. Finally, the number of cases is inadequate for contributing a significant finding in multivariate analysis and survival analysis.
Conflict of interest
Acknowledgments The authors would like to thank Ms. Chiu-Mei Yeh for her help with statistical analysis and advice. This study was funded by an unrestricted research grant from Taipei Veterans General Hospital (V104A-008).
Introduction Vaginal malignancy is a rare disease, accounting for about 3% of all malignant neoplasms of the female genital tract. Leiomyosarcoma accounts for only a small proportion of vaginal cancer and only about 140 cases have been reported in the literature. There is no consensus on the treatment of vaginal leiomyosarcoma; wide surgical excision with or without radiotherapy is the most common treatment modality.
Case report Three years after the third surgery, a 7 × 4 cm recurrent tumor was found in the same area with extension to the perineum and rectum. Magnetic resonance imaging (MRI) of the abdomen and pelvis revealed a 7 × 4 cm heterogeneously enhancing mass arising from the posterior wall of the lower vagina and extending to the submucosa of the rectum and perineum (Fig. 1). Her chest radiography was normal. The patient was counseled to have a repeat wide local excision, with or without radiation, or abdominoperineal resection. The patient requested the most definitive operation with the lowest rate of recurrence. In 2007, she underwent a major operation including abdominoperineal resection with end colostomy, total hysterectomy, posterior vaginectomy, and regional lymph node dissection including those in the perirectal, inferior mesenteric and inguinal areas. The surgical specimen consisted of a 7 × 4 cm protruding firm tumor involving both the vaginal cuff and rectal wall. The resection margin in the perineum was 1.0 cm from the vaginal tumor (Fig. 2). Histologic examination of the protruding vaginal wall tumor showed that it was composed of closely packed interlacing fascicles of spindle cells with slightly enlarged hyperchromatic and pleomorphic nuclei, frequent abnormal mitotic figures (>10 per 10 HPF on average), and absence of definite tumor necrosis (Fig. 3). The tumor invaded the submucosa of the rectum. The section margins of the perineum and perianal skin were all free of disease. A recurrent low-grade leiomyosarcoma of the vagina with extension to the submucosa of the rectum was considered. The body of the uterus and both ovaries were not involved. All lymph nodes were negative. The final pathologic diagnosis of the tumor was International Federation of Gynecology and Obstetrics Stage II vaginal low-grade leiomyosarcoma. No adjuvant treatment was given and she was disease-free six years following the fourth definitive surgery.