51
|
Murji A, Biberoğlu K, Leng J, Mueller MD, Römer T, Vignali M, Yarmolinskaya M. Use of dienogest in endometriosis: a narrative literature review and expert commentary. Curr Med Res Opin 2020; 36:895-907. [PMID: 32175777 DOI: 10.1080/03007995.2020.1744120] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective: Endometriosis affects up to 10% of women of reproductive age, and the main goal of treatment is to relieve symptoms. Progestins have been the mainstay of endometriosis suppression, of which dienogest has become an important option in many parts of the world. This is an expert literature review, with recommendations on the use of dienogest in the context of various clinical considerations when treating endometriosis.Methods: A search of PubMed was conducted for papers published between 2007 and 2019 on the use of dienogest in endometriosis. Experts reviewed these and included those they considered most relevant in clinical practice, according to their own clinical experience.Results: Evidence regarding the long-term use (>15 months) of dienogest for the management of endometriosis is presented, with experts concluding that the efficacy of dienogest should be assessed primarily on its impact on pain and quality of life. Fertility preservation, the option to avoid or delay surgery, and managing bleeding irregularities that can occur with this treatment are also considered. Counseling women on potential bleeding risks before starting treatment may be helpful, and evidence suggests that few women discontinue treatment for this reason, with the benefits of treatment outweighing any impact of bleeding irregularities.Conclusions: Overall, the evidence demonstrates that dienogest offers an effective and tolerable alternative or adjunct to surgery and provides many advantages over combined hormonal contraceptives for the treatment of endometriosis. It is important that treatment guidelines are followed and care is tailored to the woman's individual needs and desires.
Collapse
|
52
|
Papadia A, Ehm L, Gasparri ML, Wang J, Radan AP, Mueller MD. Unilateral versus bilateral lymph-nodal metastases and oncologic outcome in vulvar cancer patients. J Cancer Res Clin Oncol 2020; 146:1877-1881. [PMID: 32266536 DOI: 10.1007/s00432-020-03196-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/21/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the difference in oncologic outcome between vulvar cancer patients with uni- and bilateral inguino-femoral lymph nodal involvement and to identify factors affecting their oncologic outcome MATERIALS AND METHODS: Patients who underwent inguino-femoral lymphadenectomy for vulvar cancer were classified into three groups according to their lymph nodal status at the histology analysis (negative, positive one side, positive bilaterally). PFS and OS survival were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed to analyze factors predicting overall survival and progression-free survival. Multivariable models were used for variables reporting a p value ≤ 0.1 at the univariate analysis. p values ≤ 0.05 were considered statistically significant. RESULTS One hundred and forty-six patients were considered for the analysis. Patients with bilaterally negative lymph nodes had significantly longer PFS and OS as compared to patients with unilateral and bilateral involvement. Patients with unilateral lymph nodal involvement had better PFS than patients with bilateral lymph nodal involvement. Among these patients, the difference in the OS approached but did not reach statistical significance. At the multivariate analysis, the tumor size affected PFS and lymph nodal involvement affected OS. CONCLUSION Vulvar cancer patients with bilateral positive lymph nodes have worse oncologic outcome as compared to patients with unilateral lymph nodal involvement; similarly, patients with unilateral lymph nodal involvement have worse oncological outcome as compared to patients with bilateral negative lymph nodes. Furthermore, tumor size and lymph nodal status are independent factors predicting recurrence rate and overall survival, respectively.
Collapse
|
53
|
Siegenthaler F, Knabben L, Mohr S, Nirgianakis K, Imboden S, Mueller MD. Visualization of endometriosis with laparoscopy and near-infrared optics with indocyanine green. Acta Obstet Gynecol Scand 2020; 99:591-597. [PMID: 31943126 DOI: 10.1111/aogs.13803] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/16/2019] [Accepted: 12/31/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Endometriosis is a common health problem, affecting 10% of women of reproductive age. Laparoscopic surgery is proven to relieve pain and to improve fertility in women with endometriosis. However, identifying peritoneal endometriosis lesions may be difficult due to their polymorphic aspects. Endometriosis lesions harbor a high degree of neovascularization. The visualization of tissue perfusion by the additional use of near infrared fluorescence imaging with indocyanine green (ICG) may improve the detection of endometriosis lesions. MATERIAL AND METHODS In a single-center, prospective, single-arm pilot study, patients undergoing laparoscopic surgery for suspected endometriosis and/or infertility were recruited. All patients first had white light imaging with systematical documentation of all suspicious areas. ICG was then administered intravenously at .3 mg/kg bodyweight and the near infrared imaging was activated and an identical documentation of suspected lesions was performed again. After removal, the specimen were sent to pathology. CLINICAL TRIAL REGISTRATION clinicaltrials.gov NCT03850158. RESULTS In total, 173 suspected lesions were identified and excised, of which 150 had histologically proven endometriosis. Of the total number, 166 suspected lesions were detected using white-light and 32 with ICG. Among the 32 suspected lesions found with ICG, 22 were confirmed to be endometriosis. Seven additional lesions were identified with ICG alone, of which only one was histologically proven endometriosis. Positive predictive values were 89.8%, 68.8% and 86.7% for white-light laparoscopy alone, near-infrared (NIR)-ICG visualization alone, and the combination of white-light and NIR-ICG, respectively. ICG exposure time, previous abdominal surgery and rARSM stage showed a statistically significant impact on the ICG detection rate. In seven patients, ICG was used for the resection of deep infiltrating nodules from the rectum. In these cases, NIR fluorescence imaging with ICG was useful to define the borders between an endometriotic nodule and healthy tissue. CONCLUSIONS The diagnostic value of NIR-ICG imaging in identifying endometriosis appears to be minimal. ICG exposure time over 20 minutes, no previous abdominal surgery and low rASRM stages have a significant positive effect on the ICG detection rate. NIR fluorescence imaging with ICG was helpful in the resection of deep infiltrating nodules in providing a better visualization of endometriosis.
Collapse
|
54
|
Xu J, Falconer C, Nguyen Q, Crawford J, McKinnon BD, Mortlock S, Senabouth A, Andersen S, Chiu HS, Jiang L, Palpant NJ, Yang J, Mueller MD, Hewitt AW, Pébay A, Montgomery GW, Powell JE, Coin LJ. Genotype-free demultiplexing of pooled single-cell RNA-seq. Genome Biol 2019; 20:290. [PMID: 31856883 PMCID: PMC6921391 DOI: 10.1186/s13059-019-1852-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/07/2019] [Indexed: 11/21/2022] Open
Abstract
A variety of methods have been developed to demultiplex pooled samples in a single cell RNA sequencing (scRNA-seq) experiment which either require hashtag barcodes or sample genotypes prior to pooling. We introduce scSplit which utilizes genetic differences inferred from scRNA-seq data alone to demultiplex pooled samples. scSplit also enables mapping clusters to original samples. Using simulated, merged, and pooled multi-individual datasets, we show that scSplit prediction is highly concordant with demuxlet predictions and is highly consistent with the known truth in cell-hashing dataset. scSplit is ideally suited to samples without external genotype information and is available at: https://github.com/jon-xu/scSplit.
Collapse
|
55
|
Papadia A, Garbade A, Gasparri ML, Wang J, Radan AP, Mueller MD. Minimally invasive surgery does not impair overall survival in stage IIIC endometrial cancer patients. Arch Gynecol Obstet 2019; 301:585-590. [PMID: 31781888 DOI: 10.1007/s00404-019-05393-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 11/19/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE We aimed to evaluate weather survival is impaired in stage IIIC endometrial cancer patients treated with minimally invasive surgery as compared to laparotomy. METHODS We analyzed surgical data and oncologic outcome of histologically proven stage IIIC endometrial cancer patients who were treated at our institution via laparotomy or via laparoscopic surgery. All the patients underwent a systematic pelvic and para-aortic lymphadenectomy and a complete tumor resection. Perioperative morbidity and overall survival of the patients subjected to the two surgical approaches were compared. RESULTS Sixty-six patients with stage IIIC endometrial cancer were identified. Of these, 15 patients were operated via laparotomy and 51 via laparoscopy. The two groups were similar with regards to median age at diagnosis, BMI, histotype, number of affected lymph nodes, and median maximal diameter of the affected lymph nodes. Patients undergoing laparoscopic surgery had fewer perioperative complications, a smaller estimated blood loss, and were subjected less frequently to transfusions. Overall survival at 60 months of follow-up did not differ between the two groups. At uni- and multivariate analysis, surgical approach did not affect survival. Only age was a variable associated with overall survival. CONCLUSIONS Minimally invasive surgery has better perioperative outcomes and does not impair survival in stage IIIC endometrial cancer patients. Age at diagnosis is the only factor independently affecting survival.
Collapse
|
56
|
Imboden S, Tapia C, Scheiwiller N, Kocbek V, Altermatt HJ, Janzen J, Mueller MD, McKinnon B. Early-stage endometrial cancer, CTNNB1 mutations, and the relation between lymphovascular space invasion and recurrence. Acta Obstet Gynecol Scand 2019; 99:196-203. [PMID: 31562818 DOI: 10.1111/aogs.13740] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 09/16/2019] [Accepted: 09/23/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Women diagnosed with early-stage (FIGO 1) endometrial cancer, grade 1 and 2 can have a good prognosis. Most of these women can be treated successfully with a hysterectomy and bilateral salpingo-oophorectomy and without the additional adjuvant treatment that is accompanied by more risks for complications. However, when recurrence does occur, the consequences can be dire. Accurate decisions must therefore be made by surgeons to avoid either under- or over-treatment. Risk and patient stratification for tailoring treatment still need further improvement. Both histopathology and genetic variants could be integrated into the decision process if relevant factors were identified. MATERIAL AND METHODS Morphological features and the presence of selected genetic mutations in isolated malignant endometrial epithelial cells from these tumors were analyzed in a strictly defined cohort of FIGO 1, grade 1 and 2 low-risk endometrial cancer. Their presence in this cohort, their relation to recurrence, and the association between histopathological features and mutations were determined. This analysis was performed using archival formalin-fixed paraffin-embedded tissue, complete re-evaluation of histopathological features, laser capture microdissection of epithelial cells, and a polymerase chain reaction-based mutational screening assay. RESULTS Twenty-one women with recurrence, after initial identification as low-risk endometrial cancer, were compared with 20 matched control women. The histological marker of lymphovascular invasion was significantly associated with recurrence. There was also a very high prevalence of mutations in CTNNB1 gene, occurring in 50% of this cohort. PTEN mutations were also observed in 27.8% of cases and PIK3CA mutations in 22.2%; none of these mutations were significantly related to recurrence. CONCLUSIONS This study supports the importance of lymphovascular space invasion to identify women with significant risk for recurrence in initially low-risk, early-stage endometrial cancer. It also identifies CTNNB1 as a significant mutation in early-stage disease, and although it may not represent a marker for recurrence its high prevalence in early stage disease could have relevance for both pathogenesis and early treatment.
Collapse
|
57
|
Bongers M, Quinn SD, Mueller MD, Krämer B, Tuschy B, Sütterlin M, Bassil Lasmar R, Chudnoff S, Thurkow A, De Wilde RL. Evaluation of uterine patency following transcervical uterine fibroid ablation with the Sonata system (the OPEN clinical trial). Eur J Obstet Gynecol Reprod Biol 2019; 242:122-125. [DOI: 10.1016/j.ejogrb.2019.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 09/04/2019] [Accepted: 09/18/2019] [Indexed: 01/05/2023]
|
58
|
Imboden S, Mereu L, Siegenthaler F, Pellegrini A, Papadia A, Tateo S, Mueller MD. Oncological safety and perioperative morbidity in low-risk endometrial cancer with sentinel lymph-node dissection. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2019; 45:1638-1643. [DOI: 10.1016/j.ejso.2019.05.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/10/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
|
59
|
Imboden S, Nastic D, Ghaderi M, Rydberg F, Rau TT, Mueller MD, Epstein E, Carlson JW. Phenotype of POLE-mutated endometrial cancer. PLoS One 2019; 14:e0214318. [PMID: 30917185 PMCID: PMC6436745 DOI: 10.1371/journal.pone.0214318] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/11/2019] [Indexed: 12/21/2022] Open
Abstract
Background and purpose Individualized therapy in endometrial cancer, the most common gynaecologic cancer in the developed world, focuses on identifying specific molecular subtypes. Mutations in the exonuclease domain of the DNA polymerase epsilon (POLE) gene define one such subtype, which causes an ultra-mutated tumour phenotype. These tumours may have an improved progression-free survival and may be receptive to specific therapies. However, the clinical phenotype of these tumours is unknown. The objective of this study was to evaluate the clinical and genetic features of POLE-mutated tumours from a large cohort of women whose cases are characterized by: (1) the availability of detailed clinical and lifestyle data; (2) mutation analysis; and (3) long-term follow-up. Methods A total of 604 patients with endometrial cancer were included in the study. Data from a detailed questionnaire, including lifestyle and family history information, provided extensive pertinent information on the patients. Sequencing of exons 9–14 of the POLE gene was performed. Follow-up data were gathered and analysed. Results Hotspot pathogenic POLE mutations were identified in N = 38/599 patients (6.3%). Patients with a POLE-mutated tumour were significantly younger, were more often nulliparous, and had a history of smoking. POLE-mutated tumours were more frequently aneuploid. Prognosis for patients with hotspot POLE-mutated tumours was significantly better in comparison with patients with non-mutated tumours; however careful selection of pathogenic mutations is essential to the definition of this prognostically favourable group. Conclusions This study demonstrates that POLE-mutated endometrial cancer is significantly associated with previously unknown clinicopathologic characteristics. Outcome in POLE-mutated tumours was excellent in cases with hotspot mutations. Our results suggest that prediction of excellent outcome in cases of POLE-mutated EMCA should be restricted to cases of EMCA with hotspot mutations until further data are available on the rising number of mutations with unknown significance.
Collapse
|
60
|
Papadia A, Morosi C, Wang J, Gasparri ML, Rau T, Ghezzi F, Mueller MD. SLN mapping in early-stage cervical cancer as a minimal-invasive triaging tool for multimodal treatment. Eur J Surg Oncol 2019; 45:679-683. [PMID: 30732972 DOI: 10.1016/j.ejso.2019.01.184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/15/2019] [Accepted: 01/27/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND To evaluate sensitivity, false negative rate and negative predictive value of the combination of sentinel lymph node (SLN) mapping and frozen section (FS) in triaging cervical cancer patients to a definitive chemo-radiotherapy. METHODS A retrospective analysis of patients with histologically proven cervical cancer undergoing laparoscopic SLN mapping and frozen section of the SLNs followed by a completion radical hysterectomy, pelvic and/or paraarotic lymphadenectomy. Sensitivity, false negative rate and negative predictive value of the SLN mapping, of the frozen section and of the combination of the two in identifying micro- and macrometastases were calculated. RESULTS One-hundred and four patients with cervical cancer underwent surgery. Of these, 87 (83.7%) had bilateral detection rates at the SLN mapping and underwent FS evaluation and were selected for statistical analysis. Twenty-five patients had lymph nodal metastases at H&E staining. Of these, 24 displayed metastatic disease to the SLNs and one to a NSLN accounting for a FN rate of 4.0%. Metastases were identified in 21 patients at the FS analysis. Four patients had metastases in the SLNs that were missed at the FS analysis. The FN rate of the FS is 12.5% if we excluded isolated tumour cells in the analysis. The FN rate of the combined methodology (SLN mapping and FS of the SLN) is 16%. Twenty-one out of 25 patients (84.0%) could correctly be triaged to a definitive chemo-radiotherapy. CONCLUSIONS The combination of SLN mapping and FS of the SLNs is efficient in triaging patients to a definitive chemo-radiotherapy.
Collapse
|
61
|
Brandner S, Aeberhard C, Mueller MD, Kuhn A. Cognitive changes in older women after urogynaecological surgery. Ginekol Pol 2018; 89:587-592. [PMID: 30508209 DOI: 10.5603/gp.a2018.0101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/11/2018] [Accepted: 10/18/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The need for pelvic floor surgery will increase with an aging population in the future. Aim of this prospective study was to evaluate the evolution of cognitive function in elderly women after urogynaecological surgery. MATERIAL AND METHODS Between 2010 and 2014, 51 female patients 70 years and older who underwent urogynaecological surgery participated in this study. Geriatric and urogynaecological assessment were performed before and six weeks after surgery, including the Mini-COG test, the clock-drawing test, a depression scale, an activities of daily living questionnaire, and the German pelvic floor questionnaire. RESULTS Mean age was 77 years (range 70-91). Overall, 15 women were operated for incontinence, 31 for prolapse, and five for miscellaneous reasons. Only two (3.9%) of the 51 women developed postoperative delirium. Abnormal cognitive findings increased from preoperatively 15.7% to 39.2% six weeks after surgery (odds ratio 3.4, 95% confidence interval 1.3 to 8.7, p < 0.001). There were no statistically significant pre-post differences in activities of daily living and depression scores. Pelvic floor function indices improved significantly Conclusion: This study shows an overall decline of cognitive function in a vulnerable group of elderly women during the short-term postoperative period. Postoperative cognitive dysfunction (POCD) after surgery has been described for other types of non-cardiac surgery but has been understudied in urogynaecological surgery. These patients need interdisciplinary management to prevent or minimize adverse effects of surgery on cognitive function.
Collapse
|
62
|
Gasparri ML, Caserta D, Benedetti Panici P, Papadia A, Mueller MD. Surgical staging in endometrial cancer. J Cancer Res Clin Oncol 2018; 145:213-221. [PMID: 30460411 DOI: 10.1007/s00432-018-2792-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/12/2018] [Indexed: 01/17/2023]
Abstract
In several malignancies, it has been demonstrated that the lymph nodal status is the most important pathologic factor affecting prognosis and giving the indication to further adjuvant treatment. The surgical assessment of the lymph nodal status in endometrial cancer is debated since 30 years. Recently, the sentinel lymph node mapping is rapidly gaining clinical acceptance in endometrial cancer. The adoption of Indocyanine Green as a safe and user friendly tracer for sentinel lymph node mapping increased the speed to which this procedure is getting applied in clinical practice. As a consequence of this rapid growth, several fundamental questions have been raised and are still debatable. In this manuscript, we discuss the importance of a known pathological lymph nodal status, the technique of the sentinel lymph node mapping with the reported false negative rates and detection rates according to the different tracers adopted, and the clinical scenarios in which a sentinel lymph node mapping could be employed.
Collapse
|
63
|
Papadia A, Gasparri ML, Wang J, Radan AP, Mueller MD. Sentinel node biopsy for treatment of endometrial cancer: current perspectives. ACTA ACUST UNITED AC 2018; 71:25-35. [PMID: 30318882 DOI: 10.23736/s0026-4784.18.04337-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The risk of lymph nodal metastases in endometrial cancer varies greatly according to the characteristics of the primary tumor. Surgical staging with a systematic lymphadenectomy in endometrial cancer is debated since three decades. On one hand, it provides important pathological information on the spread of the tumor allowing for an appropriate decision making on adjuvant treatment but on the other side it is characterized by a non-negligible short and long-term morbidity. In the past decade, various efforts have been made in the attempt to apply the concept of the sentinel lymph node mapping in endometrial cancer. The sentinel lymph node mapping has the potential to provide the necessary pathological lymph nodal information at a reasonable cost in terms of morbidity. In this review, the most relevant aspects of the sentinel lymph node mapping in endometrial cancer are summarized. Furthermore, the performance in terms of false negative rates and detection rates, the clinical value of the pathological ultrastaging, its clinical applicability in different scenarios including patients preoperatively considered to be at low or at high risk are discussed. Oncological outcome of the patients who have been submitted to a sentinel lymph node mapping as compared to a full lymhadenectomy are presented as well as technical aspects to improve the performance of the surgical technique.
Collapse
|
64
|
Papadia A, Buda A, Gasparri ML, Di Martino G, Bussi B, Verri D, Mueller MD. Correction to: The impact of different doses of indocyanine green on the sentinel lymph-node mapping in early stage endometrial cancer. J Cancer Res Clin Oncol 2018; 144:2193. [PMID: 30196439 DOI: 10.1007/s00432-018-2741-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Unfortunately, the P value at multivariate analysis for ICG concentration in Table 3 was incorrectly published.
Collapse
|
65
|
Imboden S, Knabben L, Mueller MD, Günthert AR, Lössl K. Bone in the breast? Long term toxicity 21 years after interstitial brachytherapy as a boost. Rep Pract Oncol Radiother 2018; 23:337-340. [PMID: 30127673 DOI: 10.1016/j.rpor.2018.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/02/2018] [Accepted: 06/23/2018] [Indexed: 11/17/2022] Open
Abstract
An 81-year-old patient developed an exulcerous tumor in her left breast 21 years after breast cancer treatment with lumpectomy and adjuvant radiotherapy. At the time of the initial treatment 21 years ago, whole breast irradiation was performed with a prescribed dose of 48 Gy and a maximal dose of 69 Gy. In addition, the patient received a 14.7 Gy boost with multicatheter brachytherapy as partial breast irradiation. In general, fat necrosis after radiotherapy, surgery or trauma is a minor problem for patients, but can lead to diagnostic difficulties. The incidence varies: the literature indicates that it occurs in up to 34% of cases. The direct pathogenesis is not clear; it can be due to high radiation dose to the breast, dosimetric inhomogeneities or surgical complications (seromas and inflammation). The tumor in the case described here, occurring more than two decades after the primary treatment, is a rarity in this extent and is an unusual clinical, radiological, and histological finding. It provides a good example of the need for an individualized approach to treatment.
Collapse
|
66
|
Nirgianakis K, Gasparri ML, Radan AP, Villiger A, McKinnon B, Mosimann B, Papadia A, Mueller MD. Obstetric complications after laparoscopic excision of posterior deep infiltrating endometriosis: a case–control study. Fertil Steril 2018; 110:459-466. [DOI: 10.1016/j.fertnstert.2018.04.036] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 04/09/2018] [Accepted: 04/24/2018] [Indexed: 10/28/2022]
|
67
|
Papadia A, Buda A, Gasparri ML, Di Martino G, Bussi B, Verri D, Mueller MD. The impact of different doses of indocyanine green on the sentinel lymph-node mapping in early stage endometrial cancer. J Cancer Res Clin Oncol 2018; 144:2187-2191. [DOI: 10.1007/s00432-018-2716-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 07/19/2018] [Indexed: 11/24/2022]
|
68
|
Papadia A, Gasparri ML, Radan AP, Stämpfli CAL, Rau TT, Mueller MD. Retrospective validation of the laparoscopic ICG SLN mapping in patients with grade 3 endometrial cancer. J Cancer Res Clin Oncol 2018; 144:1385-1393. [PMID: 29691646 DOI: 10.1007/s00432-018-2648-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 04/19/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate the sensitivity, negative predictive value (NPV) and false-negative (FN) rate of the near infrared (NIR) indocyanine green (ICG) sentinel lymph node (SLN) mapping in patients with poorly differentiated endometrial cancer who have undergone a full pelvic and para-aortic lymphadenectomy after SLN mapping. METHODS We performed a retrospective analysis of patients with endometrial cancer undergoing a laparoscopic NIR-ICG SLN mapping followed by a systematic pelvic and para-aortic lymphadenectomy. Inclusion criteria were a grade 3 endometrial cancer or a high-risk histology (papillary serous, clear cell carcinoma, carcinosarcoma, and neuroendocrine carcinoma) and a completion pelvic and para-aortic lymphadenectomy to the renal vessels after SLN mapping. Overall and bilateral detection rates, sensitivity, NPV, and FN rates were calculated. RESULTS From December 2012 until January 2017, 42 patients fulfilled inclusion criteria. Overall and bilateral detection rates were 100 and 90.5%, respectively. Overall, 23.8% of the patients had lymph node metastases. In one patient, despite negative bilateral pelvic SLNs, a metastatic non-SLN-isolated para-aortic metastasis was detected. This NSLN was clinically suspicious and sent to frozen section analysis during the surgery. FN rate, sensitivity, and NPV were 10, 90, and 97.1%, respectively. For the SLN mapping algorithm, FN rate, sensitivity, and NPV were 0, 100, and 100%, respectively. CONCLUSIONS Laparoscopic NIR-ICG SLN mapping in high-risk endometrial cancer patients has acceptable sensitivity, FN rate, and NPV.
Collapse
|
69
|
Gasparri ML, Mueller MD, Taghavi K, Papadia A. Conventional versus Single Port Laparoscopy for the Surgical Treatment of Ectopic Pregnancy: A Meta-Analysis. Gynecol Obstet Invest 2018; 83:329-337. [PMID: 29669329 DOI: 10.1159/000487944] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 02/22/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIMS A new minimally invasive laparoscopic approach for ectopic pregnancy, the laparo-endoscopic single site surgery (LESS), has recently been introduced. The aim of this study is to compare the surgical outcome of this approach with conventional laparoscopy for ectopic pregnancy. METHOD A review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement was performed. Electronic databases PubMed, MEDLINE, and Scopus were searched in December 2017 by searching the terms "single port laparoscopy" or "laparoendoscopic single site-surgery" or "single site laparoscopy" or "single-incision laparoscopic surgery" and "ectopic pregnancy." Studies comparing the 2 techniques and reporting surgical outcome were selected. Endpoints included comparison of length of operative time (OT), hemoglobin drop, length of hospitalization, number of patients requiring packed red blood cells (PRBC) transfusion, intra- and post-operative complication rates between patients undergoing conventional laparoscopy and those undergoing LESS. RESULTS A total of 56 studies were retrieved of which 5 studies including 460 patients met selection criteria. No differences were found between conventional laparoscopy and LESS with regards to length of OT time (even after stratification for presence of hemoperitoneum and/or adhesions), length of hospitalization, mean hemoglobin drop, number of patients requiring transfusions of PRBC, and intra- and post-operative complications. CONCLUSION The management of ectopic pregnancies with LESS does not seem to be superior to conventional laparoscopy.
Collapse
|
70
|
Bersinger NA, McKinnon B, Kuhn A, Santi A, Mueller MD. Pain Symptoms and Peritoneal Fluid Cytokine and Marker Concentrations in Women with and without Endometriosis. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/2284026509001003-404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose Endometriosis is not only associated with infertility, it is also a common cause of pain in women, leading to work absenteeism and a reduced quality of life. The objective of this study was to confirm the increased peritoneal fluid (PF) concentration of several cytokines in endometriosis patients, to investigate their association with pain levels, and to identify new biological markers in the PF which are neurostimulatory and thus responsible for the appearance and severity of different types of pain. Methods Our sample group included 111 patients with histologically confirmed endometriosis and 47 controls undergoing laparoscopy for reasons of abdominal pain or infertility. They rated their pain during menstruation, during sexual intercourse and general lower abdominal pain prior to undergoing surgery in our clinic using a visual analogue scale. During laparoscopy, PF was aspirated. Marker cytokine concentrations were measured by immunoassay and correlated to the Revised American Fertility Society (rAFS) stage of endometriosis and to the pain level using non-parametric methods. Results Differences were found between the correlations of the peritoneal fluid levels of many cytokines with dysmenorrhea or lower abdominal pain, and with the presence of severe endometriosis (rAFS III+IV). Glycodelin and osteoprotegerin (OPG) show the strongest associations with menstrual pain, while IL-8, MCP-1 and OPG were correlated to the stage of endometriosis. Low density cytokine protein arrays did not contribute to finding new markers for endometriosis and pain. Conclusions These findings illustrate the large variation of cytokine levels between patients. Glycodelin, IL-8 and OPG are the most likely targets for further investigations towards their future clinical use.
Collapse
|
71
|
Gasparri ML, Bardhi E, Ruscito I, Papadia A, Farooqi AA, Marchetti C, Bogani G, Ceccacci I, Mueller MD, Benedetti Panici P. PI3K/AKT/mTOR Pathway in Ovarian Cancer Treatment: Are We on the Right Track? Geburtshilfe Frauenheilkd 2017. [PMID: 29093603 DOI: 10.1055/s-0043-118907]+[] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022] Open
Abstract
The high recurrence rate and the low overall survival in ovarian cancer suggest that a more specific therapeutic approach in addition to conventional treatment is required. Translational and clinical research is investigating new molecular targets in order to find an alternative way to affect tumor growth and to minimize the overlap of toxicity of antiblastic agents. Given its implication in many cellular activities including regulation of cell growth, motility, survival, proliferation, protein synthesis, autophagy, transcription, as well as angiogenesis, PI3K/AKT/mTOR is one of the most investigated intracellular signaling pathways. A dis-regulation of this pathway has been shown in several tumors, including ovarian cancer. In this setting, mTor proteins represent a potential target for inhibitors, which could ultimately play a pivotal role in counteracting cellular proliferation. Recently, mTor inhibitors have been approved in the treatment of pancreatic neuroendocrine tumors, mantle cell lymphoma and renal cancer. Clinical trials have assessed the safety of these drugs in ovarian cancer patients. Ongoing phase I and II studies are evaluating the oncologic outcome of mTor inhibitor treatment and its effect in combination with conventional chemotherapy and target agents.
Collapse
|
72
|
Gasparri ML, Bardhi E, Ruscito I, Papadia A, Farooqi AA, Marchetti C, Bogani G, Ceccacci I, Mueller MD, Benedetti Panici P. PI3K/AKT/mTOR Pathway in Ovarian Cancer Treatment: Are We on the Right Track? Geburtshilfe Frauenheilkd 2017. [PMID: 29093603 DOI: 10.1055/s-0043-118907] [] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022] Open
Abstract
The high recurrence rate and the low overall survival in ovarian cancer suggest that a more specific therapeutic approach in addition to conventional treatment is required. Translational and clinical research is investigating new molecular targets in order to find an alternative way to affect tumor growth and to minimize the overlap of toxicity of antiblastic agents. Given its implication in many cellular activities including regulation of cell growth, motility, survival, proliferation, protein synthesis, autophagy, transcription, as well as angiogenesis, PI3K/AKT/mTOR is one of the most investigated intracellular signaling pathways. A dis-regulation of this pathway has been shown in several tumors, including ovarian cancer. In this setting, mTor proteins represent a potential target for inhibitors, which could ultimately play a pivotal role in counteracting cellular proliferation. Recently, mTor inhibitors have been approved in the treatment of pancreatic neuroendocrine tumors, mantle cell lymphoma and renal cancer. Clinical trials have assessed the safety of these drugs in ovarian cancer patients. Ongoing phase I and II studies are evaluating the oncologic outcome of mTor inhibitor treatment and its effect in combination with conventional chemotherapy and target agents.
Collapse
|
73
|
Mohr S, Siegenthaler F, Imboden S, Kuhn A, Mueller MD. Transvaginal Excision of an Eroded Sacrocolpopexy Mesh by Using Single-Incision Laparoscopic Surgery Equipment. J Minim Invasive Gynecol 2017; 24:1079-1080. [DOI: 10.1016/j.jmig.2017.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 03/27/2017] [Accepted: 04/01/2017] [Indexed: 11/30/2022]
|
74
|
Gasparri ML, Bardhi E, Ruscito I, Papadia A, Farooqi AA, Marchetti C, Bogani G, Ceccacci I, Mueller MD, Benedetti Panici P. PI3K/AKT/mTOR Pathway in Ovarian Cancer Treatment: Are We on the Right Track? Geburtshilfe Frauenheilkd 2017; 77:1095-1103. [PMID: 29093603 PMCID: PMC5658232 DOI: 10.1055/s-0043-118907] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/02/2017] [Accepted: 08/25/2017] [Indexed: 01/15/2023] Open
Abstract
The high recurrence rate and the low overall survival in ovarian cancer suggest that a more specific therapeutic approach in addition to conventional treatment is required. Translational and clinical research is investigating new molecular targets in order to find an alternative way to affect tumor growth and to minimize the overlap of toxicity of antiblastic agents. Given its implication in many cellular activities including regulation of cell growth, motility, survival, proliferation, protein synthesis, autophagy, transcription, as well as angiogenesis, PI3K/AKT/mTOR is one of the most investigated intracellular signaling pathways. A dis-regulation of this pathway has been shown in several tumors, including ovarian cancer. In this setting, mTor proteins represent a potential target for inhibitors, which could ultimately play a pivotal role in counteracting cellular proliferation. Recently, mTor inhibitors have been approved in the treatment of pancreatic neuroendocrine tumors, mantle cell lymphoma and renal cancer. Clinical trials have assessed the safety of these drugs in ovarian cancer patients. Ongoing phase I and II studies are evaluating the oncologic outcome of mTor inhibitor treatment and its effect in combination with conventional chemotherapy and target agents.
Collapse
|
75
|
Sbracia M, McKinnon B, Scarpellini F, Marconi D, Rossi G, Simmilion C, Mueller MD, Barnea ER, Mueller M. PreImplantation Factor in endometriosis: A potential role in inducing immune privilege for ectopic endometrium. PLoS One 2017; 12:e0184399. [PMID: 28902871 PMCID: PMC5597204 DOI: 10.1371/journal.pone.0184399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 08/23/2017] [Indexed: 01/19/2023] Open
Abstract
Endometriosis is a chronic inflammatory condition characterised by the growth of endometrial epithelial and stromal cells outside the uterine cavity. In addition to Sampson’s theory of retrograde menstruation, endometriosis pathogenesis is facilitated by a privileged inflammatory microenvironment, with T regulatory FoxP3+ expressing T cells (Tregs) being a significant factor. PreImplantation Factor (PIF) is a peptide essential for pregnancy recognition and development. An immune modulatory function of the synthetic PIF analog (sPIF) has been successfully confirmed in multiple animal models. We report that PIF is expressed in the epithelial ectopic cells in close proximity to FoxP3+ stromal cells. We provide evidence that PIF interacts with FoxP3+ cells and modulates cell viability, dependent on cell source and presence of inflammatory mediators. Our finding represent a novel PIF-based mechanism in endometriosis that has potential for novel therapeutics.
Collapse
|