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Oripova Mexriniso, Researcher of the Samarkand branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology
Ortikova Xilola, Researcher of the Samarkand branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology
Djuraev Mirjalol, director of the Samarkand branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology, doctor of medical sciences, professor Orifova Feruza,
Samarkand branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology
Sulimova Olga,
Samarkand branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology
E- mail: [email protected]
RETROSPECTIVE ANALYSIS OF COMPLEX TREATMENT OF PATIENTS WITH UTERINE SARCOMAS
Abstract: The results of a retrospective analysis of 52 patients with uterine sarcomas are presented. The methods of complex treatment and their prognosis in patients with uterine sarcomas are analyzed. It has been established that the presence of a residual tumor in the pelvis after non-radical surgery significantly worsens the prognosis of the disease. Endometrial stromal sarcoma and poorly differentiated uterine leiomyosarcoma occur more aggressively.
Keywords: uterine leiomyosarcoma, endometrial sarcoma, treatment.
Relevance. Uterine sarcomas are malignant mesenchy- errors leading to non-radical treatment, as in uterine sarcomas mal tumors, their frequency among all malignant tumors [1; 4; 11]. The literature data point to the ineffectiveness of ra-of the uterus is 2-6% and less than 1% among malignant diation therapy as an independent method of treating patients tumors of the female genital organs. To date, according to with malignant mesenchymal tumors of the uterus. However, the literature, knowledge of the prognostic characteristics of in some cases, the use of this method in combination with uterine sarcoma is considered the key to understanding the surgery and chemotherapy, as well as taking into account the development of the disease, which is extremely important histological form of the tumor, improves the long-term results for assessing the individual prognosis and probabilistic re- of treatment [2; 5; 10]. The effectiveness of antitumor drug sponse to therapy [3; 5; 8]. The main clinical symptoms of treatment is also different.
uterine sarcomas are uterine bleeding of varying intensity The high malignancy of sarcoma, the rapid progression
(observed in 70-80% of cases), an increase in abdominal of the process and the propensity for metastasis determine volume, abdominal pain, putrid vaginal discharge, weakness, the need for radical surgical treatment, adjuvant chemother-anemia [2; 6; 9]. apy and radiation therapy [3; 7]. In 60% of patients, uterine
Questions of treatment tactics for uterine sarcomas re- sarcoma is diagnosed in advanced stages, and therefore the main controversial to date. All authors agree that only one op- problem of early diagnosis of this disease is extremely urgent. eration should be performed in an amount not less than hys- The purpose of the research: analysis of methods of
terectomy with appendages. In none of the types of malignant complex treatment and its prognosis in patients with uterine tumors of the genitals, there are so many medical diagnostic sarcomas (US).
Section 2. Medical science
Material and research methods. Patients were treated in the tumor department of the reproductive system of Samarkand branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology from 2014 to 2017.
For all patients, analysis and statistical processing of case histories were performed. The obtained results were processed by the variation statistics methods on the Pentium IV personal computer using the Microsoft Office Excel 2003 software package. For statistical analysis used the criteria of student-Fisher.
The study included 28 patients leiomyosarcoma (LMS), 16 patients - endometrial stromal uterine sarcoma (ESUS), 2 patients - carcinoma of the uterine sarcomas (CUS) and 6 patients, 4 ofwhich with LMS and 2 is operated with the ESS cancer institutions. According to these studies, all patients underwent laparotomy, hysterectomy with appendages.
According to the data of this study, all patients were divided into 3 groups: 1-group-6(l1.5%) patients who received only surgical treatment; 2-group -24(46.2%) patients who received the combined treatment (operation + AChTh); 3-main group - 22(42.3%) patients who received complex treatment (surgery + 4 courses of AChTh + combined radiation therapy).
The distribution of patients by age groups: 30-39 years 4(7.7%), 40-49 years old 28(54%), 50-59l-17(32.7%), 60 years old and above -3(5.6%). We know of the 4 main histological types of uterine sarcomas according to the Samarkand branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology the most common uterine leiomyosarcoma - 73%(38 out of 52). 14 patients (36%) were younger than 50 years old, and 3 patients (9%) were over 60 years old, the remaining 21 patients (55%) aged 50-59 l. At the 2nd place was endometrial stromal sarcoma of the uterus, macroscopically similar to the exophytic form of endometrial adenocarcinoma in 9 patients (17%), poorly differentiated uterine sarcoma was detected in 3 patients (5.7%) and uterine carcinosarcoma -2 cases (3.8%).
The problem of early diagnosis of uterine sarcoma still remains unsolved in gynecology. The preliminary diagnosis was based on the grounds of complaints and clinical signs. The main diagnostic methods for suspected lesions of this malignant tumor were the following: 1 - complete and full blood count, biochemical blood test, coagulogram; 2 - in order to identify the morphological features of various variants of the uterine body sarcomas, differential diagnosis and identification of the capabilities of the morphological method, a scraping from the uterine cavity, a biopsy from a recurrent and from a metastatic tumor were carried out; 3 - conducted ultrasound and x-ray examination, which are necessary to ob-
tain information about the size of the tumor and the degree of its germination in neighboring organs; 4 - MRI and CT examination were performed to determine the structure of the tumor and identify metastases in distant organs; 5 - excretory urography to determine the presence of tumor germination in the organs of the excretory system (state of the renal excretory function, n / 3 ureters permeability, bladder wall); 6 - irrigoscopy to clarify signs of tumor invasion into the rectum.
The results of the study. According to a retrospective analysis of patient histories, a preliminary diagnosis was made on the basis of complaints from patients and the following signs of illness: acyclic bleeding was observed in 36 patients (69%); an increase in the size of the abdomen due to the rapid growth of a tumor or myoma node in 11 patients (21%); anemia of varying severity in 16 patients (30.8%); deterioration of the patient's condition with a combination of several symptoms in 44 patients (84.6%); relapses after removal of polyps and submucous nodes in 3 patients (5.7%); recurrent tumor of the cervical stump after supravaginal amputation of the uterus in 2 (3.8%). When studying the results of general blood tests of patients with uterine sarcomas, we found that in almost all patients the disease was complicated by varying degrees of severity of anemia.
In the period before the operation for histological verification all patients were produced by indications scraping of the uterine cavity, and biopsy of recurrent of metastatic tumors. Based on this study, only 18 patients had a primary diagnosis before surgery (fractional scraping of the uterus, polypectomy, biopsy from a recurrent tumor) and amounts to 34.6%. This indicates that tumor cells are not always determined by scrapings.
Ultrasound is a routine method for diagnosing uterine sarcoma. An ultrasound study, if there is a rapid growth of myoma node, will give us the opportunity to suspect uterine sarcoma. In addition, necrosis in the center of the myoma node, tissue heterogeneity, degree of echogenicity and density are considered ultrasound for early diagnosis of uterine sarcomas. According to the results of the study, all patients underwent an ultrasound study in the pre-operative period. Suspected uterine sarcoma was diagnosed by ultrasound in 38 patients (82%).
An X-ray study method was used primarily to conduct chest x-rays to all patients, to clarify the state of the lungs, whether there are metastases in the lungs. A distant lung metastasis was detected in 2 patients in the pre-operative period. In 32 patients, radiological criteria of chronic bronchitis were revealed. It is difficult to accurately diagnose uterine sarcoma prior to surgery or biopsy of a tumor tissue.
According to an MRI study, the clinical diagnosis of uterine sarcoma was established in 42(80.8%) patients who were confirmed in a postoperative histological study. Diagnosis of
uterine sarcoma in the period of menopause is that, against the background of a suddenly changing, rapidly growing benign tumor of the uterus, a degeneration into uterine sarcoma can be suspected. In patients of the first group who did not undergo chemotherapy due to severe extragenital pathology, a histological form of endometrial protromal sarcoma of the uterus revealed a relapse after 62 ± 5 days (in 6/6 patients). Patients of the second group (24 = 100%) who received the combined treatment - operation + autoscopic chemotherapy (AChTh), with the histological form of ESUS in 3/24(12.5%) and with poorly differentiated LMS in 4/24(16.7%), a relapse was detected after 92 ± 7 days. 11/24(45.8%) patients had a relapse after 120 ± 6 days. In 6(25%) patients after 142 ± 7 days were admitted with distant metastasis
In the main group, which consisted of 22 patients, after the combined therapy (operation + AChTh + combined radiation therapy), 18 months after the combined treatment, distant metastasis (multiple metastasis in the lungs) was revealed in one patient, with a histological form of poorly differentiated endometrial sarcoma. In addition to the above, as a result, due to the performed non-radical operation in non-oncological institutions, 6 patients were admitted with continued tumor growth in a short time (from 32 to 70 days). Of these, two had complications in the form of bilateral ureterohydronephrosis of 2-3 degrees, and in the first stage, prior to chemotherapy,
they were forced to deliver percutaneous nephroconeostomy on both sides and for a long time to prepare the patient for a course of chemotherapy, to improve biochemical parameters. Two patients had liver metastases in the postoperative period in the coming months (up to 64 days).
Conclusion. The high malignancy of uterine sarcoma, the rapid pace of tumor progression, the tendency to frequent local recurrences indicate the need for a radical operation. The presence of a residual tumor in the pelvis after non-radical surgery significantly worsens the prognosis of the disease. Despite the combined and complex treatment methods, endometrial stromal sarcoma and poorly differentiated uterine leiomyosarcoma is more aggressive than uterine leiomyosarcoma and carcinosarcoma. In the post-operative period, the administration of adjuvant polychemotherapy (AChTh) to affect subclinical metastases, which at the time of treatment may be outside the anatomical zone of the tumor, gives us the opportunity to improve the results of surgical intervention. A timely radical surgery, supplemented by adjuvant chemotherapy in combination with radiation therapy, a comprehensive approach to the treatment of US, improves long-term results of treatment, prolongs a recurrent period, survival and quality of life of patients. Early diagnosis of uterine sarcomas even before the operating period allows us to carry out not only radical, but also organ-preserving operations in patients of reproductive age.
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