Early-stage Carcinoma Research Articles

Quality of life between early stage and advanced stage nasopharyngeal carcinoma patients in dr. sardjito hospital yogyakarta, Indonesia

Background: Patients with advanced stage Nasopharyngeal Carcinoma (NPC) have much better quality of life compared to other types of cancer, which causes the patients to experience misdiagnosis or they go to see the doctor in an already advanced stage, consequently therapy becomes more complex. Research used specific questionnaire measurements for head and neck cancer, which was the European Organization for Research and Treatment of Head and Neck Cancer Quality of Life Questionnaire (EORTC QLQ-H & N35) to detect small changes in NPC patients’ quality of life at the initial clinical staging is required. Method: A cross sectional study, all observations on research subjects were made once at the beginning of NPC staging and on the same episode in ENT Policlinic Dr. Sardjito Hospital Yogyakarta Indonesia, starting from September 2018 - March 2019. Result: Derived from 78 research subjects consist of 50 men & 28 women diagnosed with Nasopharyngeal Carcinoma, on NPC patients research subject with European Organization For Research And Treatment Of Cancer - Head and Neck Cancer assessment of Life Quality Questionnaire (EORTC QLQ-H & N35) resulted that the early stages who had good quality of life were 11 patients (14.1%) and poor quality of life was 1 patient (1.3%), while advanced stage NPC patients who had good quality of life were 62 patients (79.5%) and 4 patients had poor quality of life (5.1%).

Role of MRI in staging of carcinoma cervix in correlation with USG and CT scan

Background: Uterine cervical cancer is the most common gynecologic malignancy and the second most common cancer in women worldwide in terms of incidence and mortality. The present study was conducted to assess MR imaging staging in uterine cervical carcinoma. Materials & Methods: This study was conducted on 60 patients of neoplastic etiology involving endocervix. Patients were scanned on 1.5Tesla MRI Scanner. Contrast enhanced scans were performed wherever indicated. The contrast used in the study was Gadolinium-DTPA at the rate 0.1 ml mol/kg. MR characteristics of different sequences including the contrast-enhanced sequences were noted and recorded.Results: MRI showed high rate of detection (96.7 %) as compared to CT scan and USG with failure of detection only in lesion staged Ia1 or Ia2 which represents microscopic involvement of carcinoma of cervix. CT scan was able to detect nodes in 80 % cases. USG failed to demonstrate enlarged nodes in 6 cases. Maximum stage was IV seen in 21% followed by IIb in 20% and Ib2 in 16%. The difference was significant (P< 0.05).Conclusion: Authors found that MRI is highly sensitive in detection of early stage of carcinoma of cervix.

Sentinel lymph node mapping in early breast cancer using methylene blue dye

Background: With the introduction of the concept of sentinel lymph node biopsy (SLNB), the surgical management of the axilla has undergone a paradigm change in clinically node-negative early breast cancer, and complete axillary dissection is avoided if the sentinel lymph node (SLN) is negative for metastasis. Aim: The purpose of this study was to identify the reliability, accuracy, and safety of using methylene blue dye (MBD) in SLNB for early-stage carcinoma of the breast. Materials and Methods: A prospective study was conducted among 151 early breast carcinoma patients (T1/2N0M0) from December 2012 to February 2016. Intraoperative identification of the SLN was done by injecting 5 ml of 1% MBD into the subareolar region of the breast. All the blue-stained lymph nodes were then surgically excised and sent for frozen section examination. Results: The mean age of presentation was 54.10 years. Thirty out of 151 cases had SLN metastasis and 115 cases were negative for malignancy on the frozen section. On the final histopathological examination, 36 cases had metastasis and 115 cases were negative for malignancy. The false-negative rate was 5%. No patients developed anaphylactic/allergic or any type of skin reaction following MBD injection. The accuracy, positive predictive value, and negative predictive value of sentinel node identification using MBD were 96.02%, 100%, and 95.04%, respectively. After a mean follow-up of 10 months, no patient was found to be with ipsilateral axillary or supraclavicular recurrence. Conclusion: The use of MBD in SLNB for the diagnosis of axillary metastasis is reliable, accurate, and safe.

2807 Endoscopic Management of Tumors of Minor Ampulla: A Multicenter Case Series

INTRODUCTION: Ampullary and duodenal carcinoma are aggressive cancers with poor 5 year survival rates. Like colorectal cancer, ampullary and duodenal carcinomas are also thought to follow the adenoma-carcinoma sequence. Ampullectomy is a well-established treatment for early stage carcinoma of major ampulla. Several studies have established its safety and efficacy in the management of major ampullary tumor. However, tumors arising in the minor ampulla are relatively rare and there are no good case series on endoscopic management of these tumors. We report a multicenter case series of endoscopic ampullectomy in the management of minor ampullary tumors. METHODS: To establish the safety and efficacy of endoscopic ampullectomy in the management of minor ampullary tumors. Consecutive patients undergoing ampullectomy for minor ampullary tumor at four hospitals were included in this study over a period of 5 years. A total of 6 patients were included in the study and all six patients underwent ERCP for purpose of minor ampullectomy. MRCP and EUS was performed on all patients prior to ERCP to rule out invasion. Pancreatic stents were placed after ampullectomy in 5 patients. RESULTS: Ampullectomy was technically successful in all 6 patients. One patient required two ERCPs for complete ampullectomy. The tumors varied in size from 1 cm to 3 cm. Pathology revealed adenoma in three patients, adenoma with high grade dysplasia in one patient, carcinoma in one patient, and carcinoid tumor in one patient. One patient (16%) developed post ERCP pancreatitis; this patient was kept in the hospital for 2 days. No other major complications were noted. Follow-up for these patients ranged from 2 to 5 years with EGD using duodenoscope at 3 months, one year and yearly thereafter. One patient had recurrence at 2 years which was thought to be recurrent tumor (4 mm). This patient was treated with repeat ampullectomy. CONCLUSION: This study demonstrates the safety and efficacy of endoscopic removal of minor ampullary tumors. Our case-series showed a comparable rate of procedure-related complication of (16.6%), as one out of six patients was found to have pancreatitis. The other 5 patients had no complications and were discharged within 24 hours. Among the patients who followed up, there were no recurrences of tumor and no patient was found to have cancer develop over a mean follow-up period of 2 to 5 years. This demonstrates that complete removal of these lesions via endoscopic resection is safe and has favorable outcomes.

Herpes Simplex and Epstein-Barr Viruses Co-infection in Early-Stage Nasopharyngeal Carcinoma Treated with Concurrent Chemoradiation: Proteomic Analysis of Formalin-fixed Paraffin-embedded Samples from a Non-endemic Region

Herpes Simplex and Epstein-Barr Viruses Co-infection in Early-Stage Nasopharyngeal Carcinoma Treated with Concurrent Chemoradiation: Proteomic Analysis of Formalin-fixed Paraffin-embedded Samples from a Non-endemic Region

Dosimetric evaluation of automatic and manual plans for early nasopharyngeal carcinoma to radiotherapy

To investigate dosimetric differences and plan qualities between manual plans and automatic plans for nasopharyngeal carcinoma (NPC) in early stage, and provide better options to maximize the benefits. Sixteen cases diagnosed with early NPC were retrospectively investigated. Conventional step and shoot IMRT with 7-fields and full arc volumetric-modulated arc therapy (VMAT) with double arcs were manually generated by experienced planners and automatically generated by Auto-Planning module in Pinnacle3 respectively, such as IMRT manual-planning (mIMRT), IMRT auto-planning (aIMRT), VMAT manual-planning (mVMAT), and VMAT auto-planning (aVMAT) for each patient. Target coverage, organs at risk sparing, monitor units, and planning times were compared and evaluated. All parameters of plans are able to fulfill International Commission on Radiation Units and Measurements repor (ICRU) 83 recommendations. Automatic plans are comparable or superior to manual plans without time-consuming planning process. The CI and HI for PTVs are better in aVMAT when compared with aIMRT and mVMAT, but those are similar between aIMRT and mVMAT. Automatic plans not only have superior dose homogeneity and conformity in PTVs, but also have better sparing for spinal cord or slightly reduce the doses received by other OARs, while the VMAT plans have better sparing for brain stem, especially the aVMAT plans. However, Dmax, V30, and V40 of brain stem are similar between aIMRT and mVMAT without significant difference. The monitor units and planning time for treatment plans have been significantly decreased through automatic planning technique. The automatic VMAT plan has greater clinical advantages and should be recommended to a better option for treating NPC in early stage, while automatic IMRT would be preferentially considered instead of manual VMAT.

A Machine Learning Based Risk Stratification Model Could Predict Recurrence in Early-Stage Colon Carcinoma via Digital Pathology Images: A Double-Center Study

A Machine Learning Based Risk Stratification Model Could Predict Recurrence in Early-Stage Colon Carcinoma via Digital Pathology Images: A Double-Center Study

Long-term clinical outcomes of supracricoid partial laryngectomy with cricohyoidoepiglottopexy for glottic carcinoma

Background: Laryngeal carcinoma should be treated with the intent of organ-sparing, and supracricoid partial laryngectomy with cricohyoidoepiglottopexy (CHEP) might be an important option.Aims/objectives: The purpose of this study was to evaluate the clinical outcomes of glottic carcinoma patients treated with CHEP.Materials and methods: A series of 164 cases with glottic carcinoma undergoing CHEP from 2006 to 2010 was retrospectively analyzed.Results: The 10-year overall survival (OS) rate, disease-specific survival (DSS) rate, and disease-free survival (DFS) rate were 77.6%, 78.8%, 74.1%, respectively. The OS, DSS, and DFS of patients with stage T1 were higher than patients with stages T2 and T3. Patients with locoregional recurrence and distant metastases had lower OS and DFS than patients with neither recurrence nor metastasis. The DFS of patients with advanced laryngeal carcinoma was worse than that of patients with early-stage carcinoma. T2 and T3 stages, locoregional recurrence, and distant metastases had predictive value regarding patient survival. Additionally, the decannulation rate of postoperative patients was 95.1%, and the nasogastric feeding tube removal rate was 100%.Conclusions and Significance: CHEP provided reliable oncologic and functional outcomes, and it should be considered as a standard function-sparing option for glottic T1b, T2, and selected T3 carcinoma patients.

Database analysis of patients with hepatocellular carcinoma and treatment flow in early and advanced stages.

Despite recent developments in treatment modalities and diagnosis, the prognosis of advanced hepatocellular carcinoma (HCC) remains unsatisfactory. To gain insight into treatment decisions for HCC patients, their characteristics and treatment flow in the early and advanced stages were examined. HCC patients' characteristics and treatment flow were retrospectively analyzed using the Japanese medical claims database. The 8999 patients' mean age at HCC diagnosis was 71.1 years, with no difference between early (Stage I/II) and advanced (Stage III/IV) stages. The mean observation period was 26.2 months, shorter in advanced than in early stages. HCV hepatitis was reported in 52.0% of HCC patients, with concomitant hypertension in 53.4%, type 2 diabetes in 45.8%, cirrhosis in 39.3%, and hyperlipidemia in 15.5%. The rates of HCV hepatitis, hypertension, and hyperlipidemia decreased with stage progression. Analysis of treatment flow showed that, at all disease stages, transcatheter arterial chemoembolization (TACE) was the most common first to fourth‐line treatment. Epirubicin was the most frequently (44.1%) used chemotherapeutic agent for first‐line TACE, followed by miriplatin (23.6%) and cisplatin (12.3%). With stage progression, cisplatin use increased. Sorafenib was used concomitantly for first‐line TACE in 3.2% of patients, and its use increased significantly in advanced stages. Clear differences in baseline characteristics and treatment flow between early and advanced stages were identified. Continuous analysis of the database with longer follow‐up may provide useful information about treatment selection and prediction of outcome such as survival.

A comparison of adjuvant therapy approaches for patients with early-stage uterine serous carcinoma.

5517 Background: Uterine serous carcinoma is a less common subtype of endometrial cancer that is associated with poorer survival. The optimal post-operative adjuvant treatment strategy for these patients remains uncertain. Methods: This multi-institutional, retrospective cohort study evaluated patients with early stage uterine serous carcinoma. Patients with FIGO Stage IA-II disease after surgery, whose tumors had serous or mixed serous/non-serous histology were included. Patients with carcinosarcoma were excluded. Clinical data were abstracted from local medical records. Summary statistics, Fisher’s exact, and Kruskal-Wallis tests were used to analyze demographic and clinical characteristics. Univariable and multivariable analyses were performed for recurrence-free survival (RFS) and overall survival (OS). Results: 634 patients were included. 77% of patients had Stage IA disease, 42% showed no myometrial invasion. The majority had pure serous histology (72%) and LVSI (76%). Adjuvant treatment varied: 12% received no adjuvant therapy, 7% had chemotherapy alone, 51% had cuff brachytherapy, 12% had cuff brachytherapy with chemotherapy (cuff/chemo), and 19% underwent pelvic radiation (EBRT). Complete RFS and OS data were available for 607 and 609 patients, respectively, and the median follow-up time was 58 months. As compared with patients who received no adjuvant therapy, patients who received cuff or cuff/chemo had improved RFS (cuff: HR 0.70, p = 0.02; cuff/chemo HR 0.53, p = 0.01) and OS (cuff HR 0.56, p = 0.001; cuff/chemo HR 0.48, p = 0.01). In a direct comparison, patients with cuff/chemo had better RFS and OS than those with chemotherapy alone (RFS HR 0.52, p = 0.03; OS HR 0.50, p = 0.05). There were no differences in RFS or OS for women who received chemotherapy alone or EBRT. Improved survival with cuff and cuff/chemo persisted on multivariable analyses (included age, stage, LVSI, adjuvant therapy type); additionally, EBRT was also associated with improved OS. In analyses limited to patients without myometrial invasion, patients with cuff or cuff/chemo had improved RFS and OS compared with observation alone. Conclusions: The use of adjuvant cuff brachytherapy with and without chemotherapy was associated with improved RFS and OS in patients with early stage uterine serous carcinoma.

Early-stage primary signet ring cell carcinoma of the colon with magnifying endoscopic findings

Early-stage primary signet ring cell carcinoma of the colon with magnifying endoscopic findings

Feasibility of Performing Laparoscopic Completion Staging in Incidentally Diagnosed Early-Stage Ovarian Carcinoma Patients

Laparoscopy has been described as a method for surgical reassessment in patients with ovarian cancer since the early 1970s; however, these early reports were received with limited acceptance of laparoscopy as a replacement for laparotomy. The objective of this study was to assess the feasibility of laparoscopy as an option for completion staging in ovarian carcinoma. A retrospective analysis was performed at our institute from January 2015 till June 2016 of patients who were diagnosed with early ovarian carcinoma incidentally following surgery elsewhere. Completion staging was done laparoscopically. 12 patients had undergone completion staging. The average age was 33 years. Initial biopsy following the first surgery was epithelial ovarian carcinoma in nine patients, granulosa cell tumor in two patients and teratoma in one patient. After the first surgery, CA-125 levels were elevated in two patients. The average duration between the two surgeries was 55 days. Five patients showed residual malignancy after completion staging, of which four (33%) patients were upstaged. The average number of pelvic and para-aortic lymph nodes dissected was 16 and 7 respectively, of which none were positive. Two patients underwent fertility-preserving surgery, preserving the contralateral ovary and uterus. None of the patients required conversion to laparotomy. Postoperative recovery was uneventful in all the patients. Average hospital stay was 4.5 days. Adjuvant chemotherapy was given to six patients. Completion staging should be considered for patients diagnosed with early ovarian cancer following surgery for undiagnosed adnexal mass. Laparoscopic staging is feasible in such cases without any increase in morbidity.

Prognostic factors and outcomes of early-stage small cell neuroendocrine carcinoma of the cervix: 37 cases from a single center

BackgroundThe objective of this study is to investigate small cell neuroendocrine carcinoma of the cervix (SCCC), using a retrospective clinicopathological characteristic and treatment approach.MethodWe retrospectively analyzed cases of early-stage SCCC, identified between 2006 and 2016, in women who received radical surgery and adjuvant chemotherapy with or without radiotherapy. Kaplan–Meier and one-way ANOVA analyses were performed.ResultA total of 37 cases of SCCC are presented in this study, of which 21 had stage IB1 SCCC, 12 had stage IB2, 3 had stage IIA1, and 1 had stage IIA2. All patients were treated with radical surgery and adjuvant chemotherapy, specifically, 26 with radical surgery followed by adjuvant chemotherapy plus radiation and 11 with neoadjuvant chemotherapy (NACT) followed by radical surgery. After a median follow-up time of 27 months (range, 8–115 months), the 2-year and 5-year disease-free survival rate for all patients was 51.9% and 34.1%, respectively, and the overall survival rate was 60.3% and 38.6%, respectively. Univariate analysis showed that International Federation of Gynecology and Obstetrics (FIGO) stage and tumor size may be a predictor of a poor prognosis. NACT and adjuvant radiation did not improve survival over adjuvant chemotherapy alone but should not be a significant independent prognostic factor for survival.ConclusionEven in patients with early-stage SCCC, the prognosis is poor, although FIGO stage and tumor size may act as surrogate factors prognostic of survival.

Evaluation of Carotid Artery and Carotid Sinus doses in Early stage Carcinoma Glottis with and without bolus

Evaluation of Carotid Artery and Carotid Sinus doses in Early stage Carcinoma Glottis with and without bolus

Interpretation and Implications of LACC Trial

LACC trial is a multicentre randomized controlled noninferiority trial. It evaluated the oncological outcomes after minimally invasive surgery and open abdominal radical hysterectomy among women with early-stage cervical cancer. The results showed lower disease-free survival (DFS) and overall survival (OS) in the minimally invasive surgery (MIS) arm. The results of the LACC trial were surprising and contrary to the outcomes in various other retrospective studies which compared outcomes in MIS and open arms for carcinoma cervix. We write this review article to rebut the LACC trial and point out few shortcomings of the trial. These may explain the outcomes. The surgeon proficiency criteria for MIS RH in the trial are inadequate. Surgeons were required to submit two unedited operative videos of MIS radical hysterectomy and outcomes of at least ten cases. The routine use of a uterine manipulator causes tumour fragmentation and is against the norms of oncosurgery. Missing histopathological data in almost a third of cases and inadequate follow-up data add to the lacunae. We think the inferior oncological outcomes in MIS arm are not due to MIS per se but due to these factors. Great caution is required in interpreting the results of the LACC trial. The authors of LACC trial mention that the results cannot be generalized to low-risk patients who still can undergo laparoscopic surgery. We recommend further trials to address the issue of safety of minimal access surgery in the treatment of early-stage carcinoma cervix. MIS radical hysterectomy can still be considered an oncologically safe treatment option in trained hands.

Elective Neck Dissection Versus Wait-and-Watch Policy for Oral Cavity Squamous Cell Carcinoma in Early Stage: A Systematic Review and Meta-Analysis Based on Survival Data

Whether elective neck dissection (END) should be adopted for patients with clinically early-stage (cT1-2N0M0) oral cavity squamous cell carcinoma (OCSCC) remains debated. The aim of this systematic review was to compare the survival benefit of END with that of the wait-and-watch policy (WW) for patients with early-stage OCSCC based on survival data. According to the inclusion criteria, an exhaustive search for eligible studies was conducted. The study inclusion and data extraction were performed by 2 reviewers independently. The risk of bias was assessed in duplicate using the Risk Of Bias In Nonrandomized Studies of Interventions instrument. The hazard ratio (HR) of the time-to-event data was extracted or estimated. RevMan 5.3 and STATA 15.1 were adopted for data synthesis. Of the 35 studies that were included, only 5 were assessed as having a low risk of bias. Results of the meta-analyses showed END could significantly decrease neck recurrence (relative risk=0.45; confidence interval [CI], 0.35-0.59; P<.00001) and improve disease-free survival (HR=0.55; CI, 0.42-0.71; P<.00001), overall survival (HR=0.75; CI, 0.64-0.86; P<.0001), and disease-specific survival (HR=0.76; CI, 0.61-0.94; P=.01) compared with WW for patients with cT1-2N0. The subgroup analysis showed that END could decrease neck recurrence (P<.00001) and improve disease-free survival (P=.001) for patients with early-stage tongue cancer and that supraomohyoid neck dissection could decrease neck recurrence (P=.02). For patients with cT1N0, END could significantly decrease the proportion with neck recurrence (P=.0008) and improve disease-free survival (P=.0003), but the difference between overall survival and disease-specific survival did not achieve significance. END can decrease recurrence and improve survival time for patients with early-stage OCSCC. More high-quality studies are needed to make a solid conclusion, especially for patients with cT1N0M0.

Fusion Imaging and Virtual Navigation to Guide Percutaneous Thermal Ablation of Hepatocellular Carcinoma: A Review of the Literature.

As medical imaging advancements have improved the detectability of hepatocellular carcinoma (HCC) in early stages, the approach to percutaneous thermal ablation for curative treatment has concomitantly advanced. Although many centers are adopting cross-sectional imaging to guide percutaneous ablation, the majority of procedures are still performed under ultrasound (US) guidance worldwide. Challenges to ultrasound guidance may present due to relatively poor resolution particularly with small or isoechoic lesions, or due to intervening structures such as the bowel or diaphragm that obstruct lesional visualization. Fusion imaging (FI) systems have been employed to address these challenges. By merging or synchronizing the real-time images from US with a previously obtained cross-sectional study, FI mitigates the inherent limitations of each individual imaging modality and expands procedural feasibility and technical outcomes. This manuscript reviews the current literature on the use of FI during percutaneous thermal ablation of HCC.

Adjuvant radiotherapy in carcinoma buccal mucosa; more conformal the best: Is it so?

Since 1980s, computerization has made improvements in radiation therapy delivery from conventional two-dimensional to three-dimensional conformal radiotherapy (2DCRT to 3DCRT) to intensity-modulated radiotherapy (IMRT) and its newer versions. This small study is aimed to compare the existing techniques for planning target volume (PTV) and organ at risk (OAR) dose distribution parameters in postoperative buccal mucosa cases. Ten post operative cases of early stage carcinoma buccal mucosa in whom only post operative bed irradiation was indicated was enrolled and was planned with conventional, 3DCRT and IMRT techniques to get 95% PTV coverage and dose received by organs at risk were recorded and evaluated. Mean and standard deviation values for PTV 95% for IMRT, 3DCRT, and conventional plans were 96.4 ± 1.8, 95.1 ± 1.9, and 91 ± 2.7, respectively. Dose received by OARs was high in conventional technique when compared to the other two. Maximum dose received by 1 cc of brain (46.2 ± 7.9 and 60.8 ± 3.8) (priority was given for PTV coverage) and mean dose received by the same eye (13.6 ± 1.4 and 22 ± 2.4) were less in IMRT when compared to 3DCRT. However, maximum dose received by 1 cc of brainstem (29.7 ± 7.6 and 14.1 ± 9.5), optic chiasma (29.2 ± 4.2 and 12 ± 2.1), spinal cord (31.8 ± 3 and 20.9 ± 4.2), and the same-side optic nerve (22 ± 6.9 and 11.7 ± 9.4) and mean dose received by opposite-side parotid (8.7 ± 1.1 and 1.7 ± 0.4) and submandibular gland (18.6 ± 1.7 and 3.2 ± 0.9) were more with IMRT when compared to 3DCRT. In postoperative cases of early-stage carcinoma buccal mucosa, it is good enough to treat with 3DCRT technique. Here, the target area will be well lateralized, and 3DCRT technique can give good target coverage and less dose to OARs, especially the only remaining major salivary glands.

Carcinoma vulva patterns of recurrence and treatment outcomes: A single-institution experience.

The aim of this study was to evaluate the patterns of recurrence and outcomes in patients with vulvar cancer treated with surgery, with or without postoperative radiotherapy (RT) or RT alone. The hospital records were retrospectively analyzed from February 2007 to May 2016. All patients that had biopsy-proven carcinoma vulva were included for analysis. Surgery was done by simple or radical vulvectomy with or without lymph node dissection. Radical RT dose was 60 Gy (photons alone or with electron boost). Adjuvant RT was administered in case of node positivity or positive margins. A total of 76 patients were diagnosed as squamous cell carcinoma of vulva. The median age was 59 years. About 59 patients were treated by surgery and 17 patients were treated by radical RT. The most common stage was IB. Adjuvant RT was administered in 10 patients. About 13 patients (22%) underwent inguinal lymphadenectomy. At a median follow-up of 35 months, 49 patients (64.4%) were alive, 27 died, and 6 patients were lost to follow-up. Locoregional recurrence rate was 24.5% in radical surgery group, 12% in surgery plus adjuvant RT group, and 47% in radical RT group. Distant metastasis rate was 4%. The progression-free survival at 3 years was 45.3% and 35.5% in the surgery group and radical RT group, respectively. Surgery resulted in favorable local control rates in early-stage carcinoma vulva. Adjuvant RT is indicated in case of nodal positivity or positive margins. Radical RT can be considered as an alternative in patients with comorbidities.

Outcomes after Adjuvant Therapy in High-Intermediate and High-risk Early-stage Uterine Carcinoma

Outcomes after Adjuvant Therapy in High-Intermediate and High-risk Early-stage Uterine Carcinoma