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Vahteristo M, Leinonen MK, Sarkeala T, Anttila A, Heinävaara S. Lower incidence of vaginal cancer after cervical human papillomavirus screening - long-term follow-up of Finnish randomized screening trial. Prev Med 2024; 185:108031. [PMID: 38849059 DOI: 10.1016/j.ypmed.2024.108031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/21/2024] [Accepted: 06/04/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE Around 70% of vaginal cancers and 40-50% of vulvar cancers are attributable to human papillomavirus (HPV). Globally the burden of these diseases is estimated to grow due to the increasing HPV prevalence and rapidly aging global population. We aimed to examine if HPV screening for cervical cancer has an additional beneficial effect in preventing vaginal and vulvar cancers. To assess this, we used long-term follow-up data from the Finnish randomized HPV screening trial. METHODS Between 2003 and 2008, over 236,000 women were individually randomized (1:1) to primary HPV or cytology screening in Southern Finland. We followed this cohort up to the year 2020. To compare the study arms, we calculated site-specific and pooled incidence rate ratios (IRRs) and mortality rate ratios (MRRs) for vaginal and vulvar cancers using Poisson regression. RESULTS During 3,5 million person-years of follow-up, the IRR for vaginal cancer in the HPV arm compared to the cytology arm was 0.40 (95% CI 0.17-0.88) and the corresponding MRR was 0.74 (95% 0.21-2.24). The corresponding IRR for vulvar cancer was 0.73 (95% 0.50-1.08) and the MRR was 0.64 (95% 0.23-1.62). The pooled IRR was 0.67 (95% 0.47 ̶ 0.95) and MRR 0.67 (95% 0.31 ̶ 1.37). CONCLUSION We found lower incidence of vaginal cancers with HPV screening compared to cytology screening. To validate our results, we recommend analyzing data on vaginal and vulvar cancers also from other HPV screening studies.
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Affiliation(s)
- Maija Vahteristo
- Finnish Cancer Registry, 00130 Helsinki, Finland; Department of Public Health, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland.
| | - Maarit K Leinonen
- Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Ahti Anttila
- Finnish Cancer Registry, 00130 Helsinki, Finland
| | - Sirpa Heinävaara
- Finnish Cancer Registry, 00130 Helsinki, Finland; Department of Public Health, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
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Tung HJ, Wang YC, Lin CY, Liao MJ, Pan YB, Jung SM, Wang CC, Huang HJ, Chao A, Chou HH, Chang TC, Yang LY, Lai CH. Human papillomavirus prevalence, genotype distribution, and prognostic factors of vaginal cancer. Int J Cancer 2024. [PMID: 39046705 DOI: 10.1002/ijc.35105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/22/2024] [Accepted: 05/22/2024] [Indexed: 07/25/2024]
Abstract
We aimed to investigate human papillomavirus (HPV) prevalence and genotype distribution and prognostic factors in vaginal cancer (VC). VC patients who received treatment between 1989 and 2020 were retrospectively reviewed. L1 general polymerase chain reaction (PCR) followed by HPV Blot (King Car, I-Lan, Taiwan) and E6 type-specific-PCR were performed for genotyping firstly. P16 and p53 immunohistochemistry staining was performed. Univariate and multivariate analyses identified predictors of clinical outcomes.79 VC patients were eligible for analysis. 73 patients (92.4%) were squamous cell carcinoma (SCC) and 6 (7.6%) as non-SCC. The median follow-up time was 134.3 months (range 0.9-273.4). Among nine initially HPV-negative cases, seven were identified as being positive through HPV16/18/45/52/58 whole-genome amplification followed by Sanger sequencing (WGASS). HPV DNA sequences were detected in 98.6% of SCC and 83.3% of non-SCC, respectively, with HPV16 (49.4%), HPV52 (15.2%) and HPV58 (8.9%) being predominant. Patients with paraaortic lymph node (LN) metastasis had a 5-year cancer-specific survival (CSS) rate of 0%. Multivariate analysis revealed that only p16 and stage were significantly correlated with prognosis. Variables with strong correlations (p16- and HPV-positivity, LN metastasis and stage), were included in models 2-5 alternatively. Stage III/IV (hazard ratio [HR] = 3.64-4.56) and LN metastasis (HR = 2.81-3.44) were significant negative predictors of CSS, whereas p16-positivity (HR = 0.29-0.32) and HPV-positivity (HR = 0.14) were related to better prognosis. In conclusion, 97.5% of VCs were HPV-positive with WGASS. Stage III/IV and LN metastasis were significant negative predictors, whereas p16- and HPV-positivity were significantly associated with better prognosis.
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Affiliation(s)
- Hsiu-Jung Tung
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - You-Chen Wang
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Branch and Chang Gung University College of Medicine, Keelung, Taiwan
| | - Chiao-Yun Lin
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Min-Jie Liao
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Branch and Chang Gung University College of Medicine, Keelung, Taiwan
| | - Yu-Bin Pan
- Clinical Trial Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Ming Jung
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Pathology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chun-Chieh Wang
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Huei-Jean Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Angel Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hung-Hsueh Chou
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Lan-Yan Yang
- Division of Clinical Trial, Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan, Taiwan
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Huang J, Chan SC, Pang WS, Mak FY, Fung YC, Lok V, Zhang L, Lin X, Lucero-Prisno DE, Xu W, Zheng ZJ, Elcarte E, Withers M, Wong MCS. Incidence distributions, risk factors and trends of vaginal cancer: A global population-based study. BJOG 2024. [PMID: 38924674 DOI: 10.1111/1471-0528.17887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/23/2024] [Accepted: 06/02/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE This study aimed to investigate the incidence, risk factors and trends for vaginal cancer. DESIGN Retrospective observational design. SETTING Data were collected from multiple sources, including the Global Cancer Observatory, Cancer Incidence in Five Continents Plus, Global Burden of Disease, World Bank and the United Nations. POPULATION Individuals diagnosed with vaginal cancer. METHODS The study collected data on vaginal cancer from the specified sources. The age-standardised rate (ASR) of vaginal cancer was calculated for different regions and age groups. Multivariable and univariable linear regression analyses were performed to examine the associations between risk factors and the incidence of vaginal cancer. Trend analysis was conducted using joinpoint regression analysis, and the average annual percentage change (AAPC) was calculated to quantify the temporal trend. MAIN OUTCOME MEASURES The main outcome measures of the study were the incidence of vaginal cancer, risk factors associated with the disease and the trend of its incidence over time. RESULTS There were 17 908 newly reported cases of vaginal cancer (ASR = 0.36, 95% CI 0.30-0.44) in 2020, with the highest ASRs reported in South-Central Asia and Southern Africa. Risk factors associated with a higher incidence of vaginal cancer included a higher prevalence of unsafe sex and human immunodeficiency virus (HIV) infection. The temporal trend showed an overall rising incidence globally, with Iceland (AAPC = 29.56, 95% CI 12.12-49.71), Chile (AAPC = 22.83, 95% CI 13.20-33.27), Bahrain (AAPC = 22.05, 95% CI 10.83-34.40) and the UK (AAPC = 1.40, 95% CI 0.41-2.39) demonstrating the most significant rising trends. CONCLUSIONS The significant regional disparities and risk factors associated with vaginal cancer underscore the necessity for targeted interventions and education, particularly in regions with a lower human development index (HDI) and a higher prevalence of human papillomavirus (HPV) infection. The increasing incidence trend emphasises the need for enhanced HPV vaccination rates to prevent the development of vaginal cancer.
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Affiliation(s)
- Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China
- Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Sze Chai Chan
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Wing Sze Pang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Fung Yu Mak
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Yat Ching Fung
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Veeleah Lok
- Department of Global Public Health, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Lin Zhang
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Suzhou, China
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Xu Lin
- Department of Thoracic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Wanghong Xu
- School of Public Health, Fudan University, Shanghai, China
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | | | - Mellissa Withers
- Department of Population and Health Sciences, Institute for Global Health, University of Southern California, Los Angeles, California, USA
| | - Martin C S Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China
- Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Department of Global Health, School of Public Health, Peking University, Beijing, China
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Javadi K, Ferdosi-Shahandashti E, Rajabnia M, Khaledi M. Vaginal microbiota and gynecological cancers: a complex and evolving relationship. Infect Agent Cancer 2024; 19:27. [PMID: 38877504 PMCID: PMC11179293 DOI: 10.1186/s13027-024-00590-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 06/04/2024] [Indexed: 06/16/2024] Open
Abstract
The vagina hosts a community of microorganisms known as the vaginal microbiota. This community is relatively stable and straightforward, with Lactobacillus species being the most dominant members. The vaginal microbiota has various functions that are essential for maintaining human health and balance. For example, it can metabolise dietary nutrients, produce growth factors, communicate with other bacteria, modulate the immune system, and prevent the invasion of harmful pathogens. When the vaginal microbiota is disrupted, it can lead to diseases and infections. The observed disturbance is distinguished by a reduction in the prevalence of Lactobacillus and a concurrent rise in the number of other bacterial species that exhibit a higher tolerance to low oxygen levels. Gynecologic cancers are a group of cancers that affect the female reproductive organs and tissues, such as the ovaries, uterus, cervix, vagina, vulva, and endometrium. These cancers are a major global health problem for women. Understanding the complex interactions between the host and the vaginal microorganisms may provide new insights into the prevention and treatment of gynecologic cancers. This could improve the quality of life and health outcomes for women.
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Affiliation(s)
- Kasra Javadi
- Department of Microbiology, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Elaheh Ferdosi-Shahandashti
- Biomedical and Microbial Advanced Technologies Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mehdi Rajabnia
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
| | - Mansoor Khaledi
- Department of Microbiology and Immunology, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran.
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Bhattacharyya T, Chakraborty S, Achari RB, Mallick I, Arunsingh M, Shenoy S, Harilal V, Phesao V, Maulik S, Manjunath NV, Mukherjee P, Sarkar N, Sinha A, Sarkar S, Vashistha B, Khanum H, Chatterjee S. Enhancing quality assurance in radiotherapy for gynaecological cancers: implementation of an on-demand peer review process. Br J Radiol 2024; 97:680-693. [PMID: 38401533 PMCID: PMC11027236 DOI: 10.1093/bjr/tqae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVES Ensuring high-quality radiotherapy requires peer-reviewing target volumes. The Royal College of Radiologists recommends peer review specifically for individual target volumes in cases of gynaecological cancers. This study presents the outcomes of implementing an on-demand peer review system for gynaecological cancers within our institute. METHODS The peer review process was planned for gynaecological cancer cases intended for curative radiotherapy. After junior clinical oncologists (COs) completed the segmentation, two senior COs specializing in gynaecological cancers conducted the peer review. All peer review outcomes were recorded prospectively. The audit process compliance, the proportion of patients requiring major and minor modifications in target volumes, the direction of changes, and the factors influencing these changes were reported. RESULTS A total of 230 patients were eligible, and out of these, 204 (88.3%) patients underwent at least one peer review. Among the patients, 108 required major modifications in their target volumes. P-charts revealed a stabilization in the need for major modifications at the end of three months, indicating that 38.2% and 28% of patients still required major modifications for the nodal and primary CTV, respectively. Multivariable analysis demonstrated that major modifications were associated with the use of extended field radiotherapy and radical radiation in non-cervical primary cases. CONCLUSIONS An on-demand peer review system was feasible and resulted in clinically meaningful, major modifications in the target volumes for 53% of patients. ADVANCES IN KNOWLEDGE Gynaecological cancers require ongoing peer review to ensure quality of care in radiotherapy. A flexible on-demand system not only ensures that patient treatment start is not delayed but also has an important educational role for junior trainees.
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Affiliation(s)
- Tapesh Bhattacharyya
- Depzartment of Radiation Oncology, Tata Medical Center, Kolkata, 14 MAR E-W, Kolkata, West Bengal, 700156, India
| | - Santam Chakraborty
- Depzartment of Radiation Oncology, Tata Medical Center, Kolkata, 14 MAR E-W, Kolkata, West Bengal, 700156, India
| | - Rimpa Basu Achari
- Depzartment of Radiation Oncology, Tata Medical Center, Kolkata, 14 MAR E-W, Kolkata, West Bengal, 700156, India
| | - Indranil Mallick
- Depzartment of Radiation Oncology, Tata Medical Center, Kolkata, 14 MAR E-W, Kolkata, West Bengal, 700156, India
| | - Moses Arunsingh
- Depzartment of Radiation Oncology, Tata Medical Center, Kolkata, 14 MAR E-W, Kolkata, West Bengal, 700156, India
| | - Shashank Shenoy
- Depzartment of Radiation Oncology, Tata Medical Center, Kolkata, 14 MAR E-W, Kolkata, West Bengal, 700156, India
| | - Vishnu Harilal
- Depzartment of Radiation Oncology, Tata Medical Center, Kolkata, 14 MAR E-W, Kolkata, West Bengal, 700156, India
| | - Vezokhoto Phesao
- Depzartment of Radiation Oncology, Tata Medical Center, Kolkata, 14 MAR E-W, Kolkata, West Bengal, 700156, India
| | - Shaurav Maulik
- Depzartment of Radiation Oncology, Tata Medical Center, Kolkata, 14 MAR E-W, Kolkata, West Bengal, 700156, India
| | | | - Prattusha Mukherjee
- Depzartment of Radiation Oncology, Tata Medical Center, Kolkata, 14 MAR E-W, Kolkata, West Bengal, 700156, India
| | - Nivedita Sarkar
- Depzartment of Radiation Oncology, Tata Medical Center, Kolkata, 14 MAR E-W, Kolkata, West Bengal, 700156, India
| | - Avinaba Sinha
- Depzartment of Radiation Oncology, Tata Medical Center, Kolkata, 14 MAR E-W, Kolkata, West Bengal, 700156, India
| | - Sebanti Sarkar
- Depzartment of Radiation Oncology, Tata Medical Center, Kolkata, 14 MAR E-W, Kolkata, West Bengal, 700156, India
| | - Bhanu Vashistha
- Depzartment of Radiation Oncology, Tata Medical Center, Kolkata, 14 MAR E-W, Kolkata, West Bengal, 700156, India
| | - Hashmath Khanum
- Depzartment of Radiation Oncology, Tata Medical Center, Kolkata, 14 MAR E-W, Kolkata, West Bengal, 700156, India
| | - Sanjoy Chatterjee
- Depzartment of Radiation Oncology, Tata Medical Center, Kolkata, 14 MAR E-W, Kolkata, West Bengal, 700156, India
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Qian J, Gracious K, Chen L, Xu S. Primary vaginal cancer after hysterectomy for benign conditions: a systematic review of the literature. Front Oncol 2024; 14:1334778. [PMID: 38347832 PMCID: PMC10859505 DOI: 10.3389/fonc.2024.1334778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/12/2024] [Indexed: 02/15/2024] Open
Abstract
Background Primary vaginal cancer is a rare condition. Some studies have revealed an increased risk of vaginal cancer among patients who have undergone hysterectomy for premalignant and malignant cervical disease. However, there is limited literature available on primary vaginal cancer following hysterectomy for benign conditions. Objectives This review aimed to investigate available evidence on clinical characteristics, treatments, and outcomes of primary vaginal cancer following hysterectomy for benign diseases. Additionally, we provide a case of a patient who developed primary vaginal cancer 10 years after undergoing hysterectomy for abnormal uterine bleeding. Search strategy We conducted a comprehensive literature search on PubMed, Scopus, Web of Science using a combination of title and abstract represented by "hysterectomy", and "vaginal cancer"; "vaginal neoplasm"; and "cancer of vagina". No article type restrictions were applied. Main results Eight studies with a total of 56 cases were included in this review. The main symptom observed was vaginal bleeding. Squamous cancer was found to be the most common type, followed by adenocarcinoma. The majority of vaginal cancer cases occurred approximately 10 years after undergoing hysterectomy. The most common location of the tumor was in the vaginal apex. The management approaches varied and details were available in 25 cases. Among these, 7 cases were treated with radiotherapy alone, 1 case received concurrent chemoradiation therapy, and the of rest of the cases underwent surgery as the primary treatment, with or without additional adjuvant therapy. Data of follow-up was available for 15 cases, with 2 cases resulting in death and 2 cases experiencing recurrence. The other cases were alive and well at the time of considered follow up. Conclusion Primary vaginal cancer after hysterectomy for benign conditions is an extremely rare condition. It is essential to have high-level evidence to guide the screening and treatment strategy for this rare condition. A part of women who have undergone hysterectomy for benign disorders can benefit from vaginal cytology evaluation. It is reasonable to postpone the initial screening after surgery and to extend the interval between subsequent screenings. Further retrospective case-control trials are expected to determine which specific subgroups of patients mentioned above might most potentially benefit from screening. The treatment decision for vaginal cancer after hysterectomy is more favorable to radiotherapy-based management rather than surgery. Vaginal endometrioid adenocarcinoma may arise from the malignant transformation of endometriosis. More studies are expected to investigate the correlation between these two diseases.
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Affiliation(s)
- Jing Qian
- Department of Gynecology, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, Zhejiang, China
| | - Kaoma Gracious
- International Education College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Li Chen
- Department of Gynecology, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, Zhejiang, China
| | - Song Xu
- Department of Gynecology, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, Zhejiang, China
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Yousefi B, Sadoughi F, Asemi Z, Mansournia MA, Hallajzadeh J. Novel Perspectives for the Diagnosis and Treatment of Gynecological Cancers using Dysregulation of PIWI Protein and PiRNAs as Biomarkers. Curr Med Chem 2024; 31:453-463. [PMID: 36786140 DOI: 10.2174/0929867330666230214101837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/23/2022] [Accepted: 12/23/2022] [Indexed: 02/15/2023]
Abstract
The term "gynecological cancer" is used for a group of cancers occurring in the female reproductive system. Some of these cancers are ranked as the leading causes of death in developed and developing countries. The lack of proper diagnostic strategies is one of the most important reasons that make them lethal. PIWI-interacting RNAs or piRNAs are a class of small non-coding RNAs, which contain 24-32 nucleotides. These RNAs take part in some cellular mechanisms, and their role in diverse kinds of cancer is confirmed by accumulative evidence. In this review, we gather some information on the roles of these RNAs and members of the PIWI protein family to provide new insight into accurate diagnostic biomarkers and more effective anti-cancer drugs with fewer side effects.
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Affiliation(s)
- Bahman Yousefi
- Molecular Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Biochemistry, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Sadoughi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, I.R. Iran
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, I.R. Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Jamal Hallajzadeh
- Department of Biochemistry and Nutrition, Research Center for Evidence-Based Health Management, Maragheh University of Medical Sciences, Maragheh, Iran
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8
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Fukai S, Maeda S, Chikazawa K, Rikiyama T. Strangulated bowel obstruction caused by vaginal perforation due to vaginal cancer in a patient with chronic uterine prolapse. BMJ Case Rep 2023; 16:e255815. [PMID: 38086574 PMCID: PMC10728924 DOI: 10.1136/bcr-2023-255815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
A woman in her 90s with chronic uterine prolapse presented with abdominal pain and a vaginal mass. The patient had generalised peritonitis and a strangulated bowel obstruction originating from a perforated posterior vagina. We performed partial intestinal resection and a total hysterectomy, including excision of the perforation of the vaginal site and the adnexa. The patient died on postoperative day 8 due to worsening systemic sepsis. The pathological diagnosis revealed an invasive carcinoma in the perforated area of the vagina. Obstetric factors are the most frequent cause of female genital tract perforation, and chronic uterine prolapse is associated with this condition; however, vaginal cancer has never been reported as a cause of perforation. Therefore, close collaboration in gynaecology should be considered to investigate whether vaginal perforation and uterine prolapse are related to cancer.
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Affiliation(s)
- Shota Fukai
- Department of Urology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shimpei Maeda
- Jichi Ika University Saitama Medical Center, Saitama, Japan
| | - Kenro Chikazawa
- Obstetrics and Gynecology, Jichi Medical University, Saitama Medical Center, Saitama-shi, Japan
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Vali M, Maleki Z, Jahani MA, hajizade-valokolaee M, Hashemi SN, sedighi S, Ghelichi-ghojogh M, Hassanipour S, Solati A, Javanian M, Nikbakht HA. Survival rate of vaginal cancer in Asian countries: a systematic review and meta-analysis. Ann Med Surg (Lond) 2023; 85:5577-5583. [PMID: 37920653 PMCID: PMC10619580 DOI: 10.1097/ms9.0000000000001097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/13/2023] [Indexed: 11/04/2023] Open
Abstract
Introduction Vaginal cancer is one of the major causes of mortality in women, which mostly takes place in low- and middle-income countries. Assessing the survival rate of vaginal cancer is essential to investigate the success rate of current treatments and screening tools. This study aims to determine the survival rate of vaginal cancer in Asia. Methods This systematic review was carried out using four international databases, including Medline/Pubmed, ProQuest, Scopus, Web of Knowledge, and also Google Scholar. Articles were investigated up to the end of August 2021. The authors utilized the Newcastle-Ottawa Scale to evaluate the quality of the articles. Evaluating the papers for heterogeneity was performed using the Cochrane test and I² statistic. Meta-regression analysis was also applied based on the year of the study. Results Three articles (13 records) fulfilled the inclusion criteria. Based on the random model, the overall 5-year survival rate was 74.63%. Also, the rates of survival in relation to the type of treatment including chemotherapy, radiotherapy, or other modalities, were 78.53, 78.44, and 68.54%, respectively. According to meta-regression analysis, no correlation was found between the survival rate and the year of the study. Conclusion The vaginal cancer survival rate is lower in Asian countries compared to that of developed countries. Increasing patient survival rates in such countries is crucial by implementing newer diagnostic tools, advanced surgical techniques, and goal-oriented treatments. Early diagnosis in lower stages and educating the populations about risk factors and preventative measures are also necessary for raising the rate of survival.
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Affiliation(s)
- Mohebat Vali
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Maleki
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad-Ali Jahani
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Maryam hajizade-valokolaee
- Health assistant, midwifery comprehensive health center, Babol University of Medical Sciences, Babol, Iran
| | | | - Saman sedighi
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Mousa Ghelichi-ghojogh
- Metabolic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Arezo Solati
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mostafa Javanian
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Hossein-Ali Nikbakht
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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10
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Ahamed Kp S, Britto JP, Arunachalam K. Intracavitary Applicator for Sequential Delivery of Localized Hyperthermia Through Non-Metallic Uterine Tandem. IEEE Trans Biomed Eng 2023; 70:2955-2963. [PMID: 37130251 DOI: 10.1109/tbme.2023.3272398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
In this article, we report the design and demonstration of a flexible coaxial wire antenna with a low profile flexible choke for delivering localized hyperthermia (HT) treatment to the cervix through a custom designed uterine tandem applicator. Resistive and magnetic materials were investigated for determining the flexible choke design suited for intracavitary HT treatment at 915 MHz. Measurements of the intracavitary antenna with the flexible choke in tissue mimicking phantom and ex-vivo bovine muscle through the non-metallic uterine tandem prototype confirm the ability to deliver localized HT to the cervix at 915 MHz and 50 mm insertion depth.
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11
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Porragas-Paseiro HS, Guntupalli S, Xiong J, Greenwood A. A complete durable response of vaginal clear cell carcinoma with pembrolizumab: A case report. Gynecol Oncol Rep 2023; 49:101160. [PMID: 37636492 PMCID: PMC10448069 DOI: 10.1016/j.gore.2023.101160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/13/2023] Open
Abstract
Primary clear cell adenocarcinoma of the vagina represents a rare form of cancer historically correlated with in-utero diethylstibestrol (DES) exposure. Mainstay treatment modalities include surgery, radiation, and chemotherapy. There has been a growing interest in immunotherapy in the field of oncology. KEYNOTE 826 demonstrated that patients with persistent, recurrent, or metastatic cervical cancer including patients who had adenocarcinoma showed improved progression and overall survival by the addition Pembrolizumab to chemotherapy plus or minus bevacizumab. To date, there are no documented cases using pembrolizumab as adjuvant treatment for active or recurrent vaginal clear cell adenocarcinoma. We present a case of a young patient with recurrent vaginal clear cell carcinoma who showed a complete and durable response to Pembrolizumab.
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Affiliation(s)
- Hector S. Porragas-Paseiro
- University of Colorado School of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, United States
| | - Saketh Guntupalli
- University of Colorado School of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, United States
| | - Jessie Xiong
- University of Colorado School of Medicine, Department of Pathology, United States
| | - Ashley Greenwood
- University of Colorado School of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, United States
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12
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Harris CJ, Rowell EE, Jayasinghe Y, Cost C, Childress KJ, Frederick NN, McNally O, Appiah L, Anazodo A. Pediatric, adolescent, and young adult breast and reproductive tumors. Pediatr Blood Cancer 2023; 70 Suppl 5:e29422. [PMID: 36458682 DOI: 10.1002/pbc.29422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/03/2021] [Accepted: 08/17/2021] [Indexed: 12/04/2022]
Abstract
Tumors of the breast and reproductive organs that occur in children, adolescents, and young adults (AYA) have different biological features and can present special challenges. Although prognosis for these tumors is generally favorable, the long-term effects of treatment can be debilitating. Treatments are often multimodal and may include surgery as well as chemotherapy and/or radiation, which can cause considerable distress and anxiety related to loss of femininity or masculinity, concern over future fertility, or sexual dysfunction. Thus, tumors of the reproductive organs in pediatric/AYA patients require special consideration of the treatment effects beyond the intended oncologic outcome. Multidisciplinary teams should be involved in their care and address issues of fertility, sexual dysfunction, and psychosexual concerns before treatment begins. This review addresses histology, risk factors, prognosis, staging and treatment of gynecologic, breast and testicular cancers in pediatric and AYA patients.
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Affiliation(s)
- Courtney J Harris
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Erin E Rowell
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Yasmin Jayasinghe
- Royal Women's Hospital, Parkville, Victoria, Australia
- Royal Children's Hospital, Parkville, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
| | - Carrye Cost
- Children's Hospital Colorado, Aurora, Colorado
| | - Krista J Childress
- Children's Healthcare of Atlanta, Atlanta, Georgia
- Emory University, Atlanta, Georgia
| | - Natasha N Frederick
- Department of Pediatrics and the Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, Hartford, Connecticut
- University of Connecticut School of Medicine, Farmington, Connecticut
| | - Orla McNally
- Royal Women's Hospital, Parkville, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
| | | | - Antoinette Anazodo
- Sydney Children's Hospital, Sydney, New South Wales, Australia
- Prince of Wales Hospital, Sydney, New South Wales, Australia
- School of Women's and Children's, University of New South Wales, High St Kensington, New South Wales, Australia
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13
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Nout R, Calaminus G, Planchamp F, Chargari C, Lax SF, Martelli H, McCluggage WG, Morice P, Pakiz M, Schmid MP, Stunt J, Timmermann B, Vokuhl C, Orbach D, Fotopoulou C. ESTRO/ESGO/SIOPe guidelines for the management of patients with vaginal cancer. Radiother Oncol 2023; 186:109662. [PMID: 37244358 DOI: 10.1016/j.radonc.2023.109662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/29/2023] [Indexed: 05/29/2023]
Abstract
Primary vaginal malignancies are rare, comprising only 2% of all female genital tract malignancies in adults and 4.5% in children. As part of its mission to improve the quality of care for women with gynecological cancers across Europe, the European Society of Gynaecological Oncology (ESGO) jointly with the European Society for Radiotherapy & Oncology (ESTRO) and the European Society of Pediatric Oncology (SIOPe) developed evidence-based guidelines in order to improve the management of patients with vaginal cancer within a multidisciplinary setting. ESTRO/ESGO/SIOPe nominated practicing clinicians who are involved in the management of vaginal cancer patients and have demonstrated leadership through their expertise in clinical care and research, their national and international engagement and profile as well as dedication to the topics addressed to serve on the expert panel (13 experts across Europe comprising the international development group). To ensure that the statements were evidence based, the current literature was reviewed and critically appraised. In the case of absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Prior to publication, the guidelines were reviewed by 112 independent international practitionners in cancer care delivery and patient representatives and their comments and input were incorporated and addressed accordingly. These guidelines cover comprehensively the diagnostic pathways as well as the surgical, radiotherapeutical and systemic management and follow-up of adult patients (including those with rare histological subtypes) and pediatric patients (vaginal rhabdomyosarcoma and germ cell tumours) with vaginal tumours.
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Affiliation(s)
- Remi Nout
- Department of radiotherapy, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | - Gabriele Calaminus
- Department of paediatric hematology and oncology, University Children's Hospital, Bonn, Germany
| | | | - Cyrus Chargari
- Departement of radiation oncology, Institut Gustave Roussy, Villejuif, France
| | - Sigurd F Lax
- Department of Pathology, Hospital Graz II, Graz and School of Medicine, Johannes Kepler University, Linz, Austria
| | - Hélène Martelli
- Department of Paediatric surgery, Hôpital Universitaire Bicêtre, Paris, France
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Philippe Morice
- Department of gynecologic surgery, Institut Gustave Roussy, Villejuif, France
| | - Maja Pakiz
- Department of gynecologic oncology and breast oncology, University Medical Centre Maribor, Maribor, Slovenia
| | - Maximilian Paul Schmid
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center Vienna, Vienna, Austria
| | - Jonáh Stunt
- Department of radiotherapy, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Beate Timmermann
- Department of particle therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), German Cancer Consortium (DKTK), Essen, Germany
| | - Christian Vokuhl
- Department of pathology, Universitätsklinikum Bonn, Bonn, Germany
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), PSL University, Institut Curie, Paris, France
| | - Christina Fotopoulou
- Department of surgery & cancer, Queen Charlotte's & Chelsea Hospital, London, United Kingdom
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14
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Nout RA, Calaminus G, Planchamp F, Chargari C, Lax S, Martelli H, McCluggage WG, Morice P, Pakiz M, Schmid MP, Stunt J, Timmermann B, Vokuhl C, Orbach D, Fotopoulou C. ESTRO/ESGO/SIOPe Guidelines for the management of patients with vaginal cancer. Int J Gynecol Cancer 2023; 33:1185-1202. [PMID: 37336757 DOI: 10.1136/ijgc-2023-004695] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Primary vaginal malignancies are rare, comprising only 2% of all female genital tract malignancies in adults and 4.5% in children. As part of its mission to improve the quality of care for women with gynecological cancers across Europe, the European Society of Gynaecological Oncology (ESGO) jointly with the European Society for Radiotherapy & Oncology (ESTRO) and the European Society of Pediatric Oncology (SIOPe) developed evidence-based guidelines in order to improve the management of patients with vaginal cancer within a multidisciplinary setting.ESTRO/ESGO/SIOPe nominated practicing clinicians who are involved in the management of vaginal cancer patients and have demonstrated leadership through their expertise in clinical care and research, their national and international engagement and profile as well as dedication to the topics addressed to serve on the expert panel (13 experts across Europe comprising the international development group). To ensure that the statements were evidence based, the current literature was reviewed and critically appraised.In the case of absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Prior to publication, the guidelines were reviewed by 112 independent international practitionners in cancer care delivery and patient representatives and their comments and input were incorporated and addressed accordingly.These guidelines cover comprehensively the diagnostic pathways as well as the surgical, radiotherapeutical and systemic management and follow-up of adult patients (including those with rare histological subtypes) and pediatric patients (vaginal rhabdomyosarcoma and germ cell tumours) with vaginal tumours.
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Affiliation(s)
- Remi A Nout
- Radiotherapy, Erasmus MC Cancer Centre, Rotterdam, Please Select, Netherlands
| | - Gabriele Calaminus
- Department of Paediatric Hematology and Oncology, University Children's Hospital, Bonn, Germany
| | | | - Cyrus Chargari
- Department of Radiation Oncology, Institut Gustave-Roussy, Villejuif, Île-de-France, France
| | - Sigurd Lax
- Pathology, Hospital Graz Sud-West, Graz, Austria
- Johannes Kepler Universitat Linz, Linz, Austria
| | - Hélène Martelli
- Department of Paediatric surgery, Hôpital Universitaire Bicêtre, Paris, France
| | | | - Philippe Morice
- Surgery, Institut Gustave-Roussy, Villejuif, Île-de-France, France
| | - Maja Pakiz
- Department of Gynecologic Oncology and Breast Oncology, University Medical Centre Maribor, Maribor, Slovenia
| | - Maximilian P Schmid
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center Vienna, Wien, Austria
| | - Jonáh Stunt
- Department of Radiotherapy, Erasmus MC Cancer Centre, Rotterdam, Zuid-Holland, Netherlands
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
- West German Proton Therapy Centre, Essen, Germany
| | - Christian Vokuhl
- Department of Pathology, Universitätsklinikum Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, Paris, France
| | - Christina Fotopoulou
- Gynaecologic Oncology, Imperial College London Faculty of Medicine, London, London, UK
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15
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Tarcha Z, Konstantinoff KS, Ince S, Fraum TJ, Sadowski EA, Bhosale PR, Derenoncourt PR, Zulfiqar M, Shetty AS, Ponisio MR, Mhlanga JC, Itani M. Added Value of FDG PET/MRI in Gynecologic Oncology: A Pictorial Review. Radiographics 2023; 43:e230006. [PMID: 37410624 DOI: 10.1148/rg.230006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Fluorine 18-fluorodeoxyglucose (FDG) PET and MRI independently play a valuable role in the management of patients with gynecologic malignancies, particularly endometrial and cervical cancer. The PET/MRI hybrid imaging technique combines the metabolic information obtained from PET with the excellent soft-tissue resolution and anatomic details provided by MRI in a single examination. MRI is the modality of choice for assessment of local tumor extent in the pelvis, whereas PET is used to assess for local-regional spread and distant metastases. The authors discuss the added value of FDG PET/MRI in imaging gynecologic malignancies of the pelvis, with a focus on the role of FDG PET/MRI in diagnosis, staging, assessing treatment response, and characterizing complications. PET/MRI allows better localization and demarcation of the extent of disease, characterization of lesions and involvement of adjacent organs and lymph nodes, and improved differentiation of benign from malignant tissues, as well as detection of the presence of distant metastasis. It also has the advantages of decreased radiation dose and a higher signal-to-noise ratio of a prolonged PET examination of the pelvis contemporaneous with MRI. The authors provide a brief technical overview of PET/MRI, highlight how simultaneously performed PET/MRI can improve stand-alone MRI and PET/CT in gynecologic malignancies, provide an image-rich review to illustrate practical and clinically relevant applications of this imaging technique, and review common pitfalls encountered in clinical practice. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Ziad Tarcha
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110-8131 (Z.T., K.S.K., S.I., T.J.F., P.R.D., A.S.S., M.R.P., J.C.M., M.I.); Department of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, Wis (E.A.S.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (P.R.B.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.Z.)
| | - Katerina S Konstantinoff
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110-8131 (Z.T., K.S.K., S.I., T.J.F., P.R.D., A.S.S., M.R.P., J.C.M., M.I.); Department of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, Wis (E.A.S.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (P.R.B.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.Z.)
| | - Semra Ince
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110-8131 (Z.T., K.S.K., S.I., T.J.F., P.R.D., A.S.S., M.R.P., J.C.M., M.I.); Department of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, Wis (E.A.S.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (P.R.B.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.Z.)
| | - Tyler J Fraum
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110-8131 (Z.T., K.S.K., S.I., T.J.F., P.R.D., A.S.S., M.R.P., J.C.M., M.I.); Department of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, Wis (E.A.S.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (P.R.B.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.Z.)
| | - Elizabeth A Sadowski
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110-8131 (Z.T., K.S.K., S.I., T.J.F., P.R.D., A.S.S., M.R.P., J.C.M., M.I.); Department of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, Wis (E.A.S.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (P.R.B.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.Z.)
| | - Priya R Bhosale
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110-8131 (Z.T., K.S.K., S.I., T.J.F., P.R.D., A.S.S., M.R.P., J.C.M., M.I.); Department of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, Wis (E.A.S.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (P.R.B.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.Z.)
| | - Paul-Robert Derenoncourt
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110-8131 (Z.T., K.S.K., S.I., T.J.F., P.R.D., A.S.S., M.R.P., J.C.M., M.I.); Department of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, Wis (E.A.S.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (P.R.B.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.Z.)
| | - Maria Zulfiqar
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110-8131 (Z.T., K.S.K., S.I., T.J.F., P.R.D., A.S.S., M.R.P., J.C.M., M.I.); Department of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, Wis (E.A.S.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (P.R.B.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.Z.)
| | - Anup S Shetty
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110-8131 (Z.T., K.S.K., S.I., T.J.F., P.R.D., A.S.S., M.R.P., J.C.M., M.I.); Department of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, Wis (E.A.S.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (P.R.B.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.Z.)
| | - Maria R Ponisio
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110-8131 (Z.T., K.S.K., S.I., T.J.F., P.R.D., A.S.S., M.R.P., J.C.M., M.I.); Department of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, Wis (E.A.S.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (P.R.B.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.Z.)
| | - Joyce C Mhlanga
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110-8131 (Z.T., K.S.K., S.I., T.J.F., P.R.D., A.S.S., M.R.P., J.C.M., M.I.); Department of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, Wis (E.A.S.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (P.R.B.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.Z.)
| | - Malak Itani
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110-8131 (Z.T., K.S.K., S.I., T.J.F., P.R.D., A.S.S., M.R.P., J.C.M., M.I.); Department of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, Wis (E.A.S.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (P.R.B.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.Z.)
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16
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Elshennawy RA, Aird C, Boyle W, Yap J, Williams A, Ganesan R. Nonsquamous Malignancies of Vagina and Vulva: 23-Year Experience at a Tertiary Center in the United Kingdom. Int J Gynecol Pathol 2023; 42:327-337. [PMID: 36731045 DOI: 10.1097/pgp.0000000000000924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Under 10% of gynaecological cancers are diagnosed in the vulva and vagina, mostly squamous cell carcinomas. Melanoma, Paget disease, basal cell carcinomas, and other cancers can present with vulval/vaginal symptoms. The pathology information system of a tertiary referral center for vulvo-vaginal cancers was searched for cancers of the vulva and vagina from 1996 to 2019. Squamous carcinomas were excluded, and the remaining entities were catalogued. A total of 221 nonsquamous cancers were found, including 135 vaginal and 86 vulval cases. One hundred eight cases of metastatic carcinomas from the endometrium, cervix, ovary, bowel, bladder, kidney, and breast formed the largest category. Basal cell carcinomas constituted the second largest category. Others included melanomas, Paget disease, and adenoid cystic carcinomas. Primary adenocarcinomas included porocarcinoma, mammary type carcinoma, enteric type carcinoma, clear cell carcinoma, Bartholin gland adenocarcinoma and malignant transformation of hidradenoma papilliferum. The vulva and vagina can harbor a wide range of nonsquamous malignancies. The most challenging of these are adenocarcinomas which can be metastatic from other sites. The dominance of metastatic carcinomas in this series is likely to reflect consultation practice of specialist pathologists.
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17
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Farzamfar S, Elia E, Richer M, Chabaud S, Naji M, Bolduc S. Extracellular Matrix-Based and Electrospun Scaffolding Systems for Vaginal Reconstruction. Bioengineering (Basel) 2023; 10:790. [PMID: 37508817 PMCID: PMC10376078 DOI: 10.3390/bioengineering10070790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/14/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023] Open
Abstract
Congenital vaginal anomalies and pelvic organ prolapse affect different age groups of women and both have significant negative impacts on patients' psychological well-being and quality of life. While surgical and non-surgical treatments are available for vaginal defects, their efficacy is limited, and they often result in long-term complications. Therefore, alternative treatment options are urgently needed. Fortunately, tissue-engineered scaffolds are promising new treatment modalities that provide an extracellular matrix (ECM)-like environment for vaginal cells to adhere, secrete ECM, and be remodeled by host cells. To this end, ECM-based scaffolds or the constructs that resemble ECM, generated by self-assembly, decellularization, or electrospinning techniques, have gained attention from both clinicians and researchers. These biomimetic scaffolds are highly similar to the native vaginal ECM and have great potential for clinical translation. This review article aims to discuss recent applications, challenges, and future perspectives of these scaffolds in vaginal reconstruction or repair strategies.
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Affiliation(s)
- Saeed Farzamfar
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - Elissa Elia
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - Megan Richer
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - Stéphane Chabaud
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - Mohammad Naji
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran 1666677951, Iran
| | - Stéphane Bolduc
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
- Department of Surgery, Faculty of Medicine, Laval University, Québec, QC G1V 0A6, Canada
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18
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Van Trappen P, Lebbe I, De Cuypere E, Claes N. Case report: a robotic-vaginal approach for total vaginectomy and hysterectomy with pelvic sentinel lymph node dissection in primary vaginal melanoma: a 10-step technique and literature review. Front Surg 2023; 10:1189196. [PMID: 37304184 PMCID: PMC10250735 DOI: 10.3389/fsurg.2023.1189196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 05/03/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Primary vaginal melanoma is extremely rare, has a poor prognosis, and occurs mostly in elderly women. The diagnosis is based on histology and immunohistochemistry of a biopsy. Given the rarity of vaginal melanoma, no standardized treatment guidelines are established; however, surgery is the primary treatment modality in the absence of metastatic disease. Most reports in the literature are retrospective single cases, case series, and population-based studies. The open surgical approach is the main modality reported. Here, we report for the first time a 10-step combined robotic-vaginal technique, with en bloc resection of the uterus and total vagina, for treating clinically early-stage primary vaginal melanoma. In addition, the patient in our case underwent a robotic pelvic bilateral sentinel lymph node dissection. The literature on the surgical approach for vaginal melanoma is reviewed. Case presentation A 73-year-old woman was referred to our tertiary cancer center and was clinically staged according to the 2009 International Federation of Gynaecology and Obstetrics (FIGO) staging for vaginal cancer as FIGO-stage I (cT1bN0M0) and according to the American Joint Committee on Cancer (AJCC) for (cutaneous) Melanoma Staging as clinical stage IB. Preoperative imaging with magnetic resonance imaging, FDG-positron emission tomography-computed tomography, and ultrasound of the groins did not reveal any adenopathy nor metastases. The patient was planned for a combined vaginal and robotic en bloc total vaginectomy and hysterectomy, as well as a pelvic bilateral sentinel lymph node dissection. Results The surgical procedure was performed in 10 steps described in this case report. The pathology revealed free surgical margins and negative test results for all sentinel lymph nodes. The postoperative recovery process was uneventful, and the patient was discharged on day 5. Conclusion The main surgical approach reported for primary early-stage vaginal melanoma is open surgery. A minimally invasive surgical approach, described here as a combined vaginal-robotic en bloc total vaginectomy and hysterectomy, for the surgical treatment of early-stage vaginal melanoma enables precise dissection, low surgical morbidity, and fast recovery for the patient.
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Affiliation(s)
- Philippe Van Trappen
- Department of Gynecology and Gynecological Oncology, AZ Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Ines Lebbe
- Department of Gynecology and Gynecological Oncology, AZ Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Eveline De Cuypere
- Department of Medical Oncology, AZ Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Nele Claes
- Department of Medical Oncology, AZ Sint-Jan Hospital Bruges, Bruges, Belgium
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Kesic V, Carcopino X, Preti M, Vieira-Baptista P, Bevilacqua F, Bornstein J, Chargari C, Cruickshank M, Erzeneoglu E, Gallio N, Gultekin M, Heller D, Joura E, Kyrgiou M, Madić T, Planchamp F, Regauer S, Reich O, Esat Temiz B, Woelber L, Zodzika J, Stockdale C. The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) consensus statement on the management of vaginal intraepithelial neoplasia. Int J Gynecol Cancer 2023; 33:446-461. [PMID: 36958755 PMCID: PMC10086489 DOI: 10.1136/ijgc-2022-004213] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) developed consensus statements on pre-invasive vulvar lesions in order to improve the quality of care for patients with vaginal intraepithelial neoplasia (VaIN). The management of VaIN varies according to the grade of the lesion: VaIN 1 (low grade vaginal squamous intraepithelial lesions (SIL)) can be subjected to follow-up, while VaIN 2-3 (high-grade vaginal SIL) should be treated. Treatment needs individualization according to the patient's characteristics, disease extension and previous therapeutic procedures. Surgical excision is the mainstay of treatment and should be performed if invasion cannot be excluded. Total vaginectomy is used only in highly selected cases of extensive and persistent disease. Carbon dioxide (CO2) laser may be used as both an ablation method and an excisional one. Reported cure rates after laser excision and laser ablation are similar. Topical agents are useful for persistent, multifocal lesions or for patients who cannot undergo surgical treatment. Imiquimod was associated with the lowest recurrence rate, highest human papillomavirus (HPV) clearance, and can be considered the best topical approach. Trichloroacetic acid and 5-fluorouracil are historical options and should be discouraged. For VaIN after hysterectomy for cervical intraepithelial neoplasia (CIN) 3, laser vaporization and topical agents are not the best options, since they cannot reach epithelium buried in the vaginal scar. In these cases surgical options are preferable. Brachytherapy has a high overall success rate but due to late side effects should be reserved for poor surgical candidates, having multifocal disease, and with failed prior treatments. VaIN tends to recur and ensuring patient adherence to close follow-up visits is of the utmost importance. The first evaluation should be performed at 6 months with cytology and an HPV test during 2 years and annually thereafter. The implementation of vaccination against HPV infection is expected to contribute to the prevention of VaIN and thus cancer of the vagina. The effects of treatment can have an impact on quality of life and result in psychological and psychosexual issues which should be addressed. Patients with VaIN need clear and up-to-date information on a range of treatment options including risks and benefits, as well as the need for follow-up and the risk of recurrence.
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Affiliation(s)
- Vesna Kesic
- Medical Faculty, University of Belgrade, Clinic of Obstetrics and Gynecology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397, Marseille, France
| | - Mario Preti
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Pedro Vieira-Baptista
- Lower Genital Tract Unit Centro Hospitalar de São João, Porto, Portugal
- Hospital Lusiadas, Porto, Portugal
| | | | - Jacob Bornstein
- Galilee Medical Center and Azrieli Faculty of Medicine, Bar-Ilan, Israel
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Maggie Cruickshank
- Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, UK
| | - Emre Erzeneoglu
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Hacettepe University, Ankara, Turkey
| | - Niccolò Gallio
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Murat Gultekin
- Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Debra Heller
- Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Elmar Joura
- Department of Gynecology and Gynecologic Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Maria Kyrgiou
- Surgery and Cancer - West London Gynecological Cancer Center, IRDB, Department of Gut, Metabolism & Reproduction-Surgery & Cancer, Imperial College London, London, UK
- Imperial Healthcare NHS Trust, Queen Charlotte's & Chelsea Hospital West London Gynaecological Cancer Centre, London, UK
| | - Tatjana Madić
- Clinic for Obstetrics and Gynecology, University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Sigrid Regauer
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Olaf Reich
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Bilal Esat Temiz
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Hacettepe University, Ankara, Turkey
| | - Linn Woelber
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
- Dysplasia Center Hamburg; Jerusalem Hospital Hamburg, Hamburg, Germany
| | - Jana Zodzika
- Department of Obstetrics and Gynaecology Rīga Stradiņš University, Riga, Latvia
| | - Colleen Stockdale
- Department of Obstetrics & Gynecology, University of Iowa, Iowa City, Iowa, USA
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20
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Forner DM. Characteristics and survival of primary vaginal malignancy: an analysis of the German nationwide cancer registry data. J Cancer Res Clin Oncol 2023; 149:1115-1122. [PMID: 35314872 DOI: 10.1007/s00432-022-03982-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/10/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Vaginal neoplasms are rare. To study the survival of patients depending on tumour characteristics and age, the data from the national cancer registries in Germany were analysed. METHODS In a retrospective analysis, data from 2006 to 2015 on disease stage, survival, and factors that might affect prognosis were analysed. RESULTS Altogether, out of 4004 datasets, 2194 were deemed adequate to be included in the analysis. Overall survival at 5 years (5YSR) and relative survival (5RSR) were 48.6% (95%CI 45.4-52.1%) and 58.7% (95%CI 55.3-61.2%) for carcinomas, but significantly worse at 20.2% (95%CI 8.3-32.0%) and 24.2% (95%CI 16.4-32.0%) for melanomas and 38.3% (95%CI 23.3-53.5%) and 44.4% (95%CI 31.5-56.8%) for sarcomas. 5YSR and 5RSR correlated significantly with FIGO stages (5YSR: 66.9-10.1%; 5RSR: 81.7-11.9%, p = 0.04). Furthermore, survival depended on the absence of LN metastases (5RSR: 59.1% vs. 38.0%, p < 0.001), and the tumour grading had an influence (5RSR: 83.7-52.1%). We also noted that prognosis was worse for older patients ≥75 years (5RSR:51.2%) than for patients <55 years (62.2%) and 55-74 years of age (61.6%). CONCLUSION Unless LN metastases, local advanced tumours and G3 grading are associated with a worse prognosis. Relative survival of older patients decreases, perhaps indicating that treatment compromises have been made.
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Affiliation(s)
- Dirk Michael Forner
- Department of Gynaecology, Gynaecologic Oncology and Obstetrics, Evangelisches Krankenhaus Köln Kalk, Buchforststrasse 2, 51103, Köln, Germany.
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21
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Fort M, Yaney A, Copeland L, Quick A. FIGO IVB Vaginal Cancer with Non-Contiguous Rectal Metastasis treated with definitive chemoradiation: a case report. Gynecol Oncol Rep 2023; 46:101166. [PMID: 37021062 PMCID: PMC10068109 DOI: 10.1016/j.gore.2023.101166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/08/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
•Noncontiguous rectal metastasis of vaginal squamous cell carcinoma.•Definitive treatment of vaginal cancer with rectal metastasis.•Chemoradiation and brachytherapy for vaginal SCC with local metastasis.
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Affiliation(s)
- Marie Fort
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Corresponding author at: 7912 Treeheights ct, Cincinnati, OH, 45242, United States.
| | - Alexander Yaney
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Larry Copeland
- The Ohio State University and the James Cancer Center, Division of Gynecologic Oncology, Columbus, OH, United States
| | - Allison Quick
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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22
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The Role of P16, P53, KI-67 and PD-L1 Immunostaining in Primary Vaginal Cancer. Cancers (Basel) 2023; 15:cancers15041046. [PMID: 36831389 PMCID: PMC9954710 DOI: 10.3390/cancers15041046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND To analyze clinical, pathological and immunohistochemical correlates of survival in vaginal cancer patients. METHODS Retrospective analysis of primary vaginal cancer patients, treated at the Department of Gynecology and Gynecological Oncology of the University Hospital Bonn between 2007 and 2021. RESULTS The study cohort comprised 22 patients. The median age was 63 years (range: 32-87 years). Squamous cell histology was present in 20 patients. Five-year OS in Stage I, II, III and IV was 100%, 56.25%, 0% and 41.67%, respectively (p = 0.147). Five-year DFS was 100%, 50%, 0% and 20.83%, respectively (p = 0.223). The 5-year OS was significantly reduced in the presence of nodal metastasis (p = 0.004), lymphangiosis (p = 0.009), hemangiosis (p = 0.002) and an age above 64 years (p = 0.029). Positive p 16 staining was associated with significantly improved OS (p = 0.010). Tumoral and immune cell PD-L1 staining was positive in 19 and in 16 patients, respectively, without significant impact on OS; 2 patients with metastastic disease are long-term survivors treated with either bevacizumab or pembrolizumab. CONCLUSION P16 expression, absence of lymph- or hemangiosis, nodal negative disease and an age below 64 years show improved survival rates in PVC. Tumoral PD-L1 expression as well as PD-L1 expression on immune cells is frequent in PVC, without impacting survival. Within our study cohort, long-term survivors with recurrent PVC are treated with anti-VEGF and immunotherapy.
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23
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Meixner E, Arians N, Bougatf N, Hoeltgen L, König L, Lang K, Domschke C, Wallwiener M, Lischalk JW, Kommoss FK, Debus J, Hörner-Rieber J. Vaginal cancer treated with curative radiotherapy with or without concomitant chemotherapy: oncologic outcomes and prognostic factors. TUMORI JOURNAL 2023; 109:112-120. [PMID: 34724840 PMCID: PMC9896533 DOI: 10.1177/03008916211056369] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Vaginal cancer is a rare disease for which prospective randomized trials do not exist. We aimed to assess survival outcomes, patterns of recurrence, prognostic factors, and toxicity in the curative treatment using image-guided radiotherapy (RT). METHODS In this retrospective review, we identified 53 patients who were treated at a single center with external beam radiotherapy and brachytherapy with or without concomitant chemotherapy from 2000 to 2021. RESULTS With a median follow-up of 64.5 months, the Kaplan-Meier 2-, 5-, and 7-year overall survival (OS) was found to be 74.8%, 62.8%, and 58.9%, respectively. Local and distant control were 67.8%, 65.0%, and 65.0% and 74.4%, 62.6%, and 62.6% at 2, 5, and 7 years, respectively. In univariate Cox proportional hazards ratio analysis, OS was significantly correlated to FIGO stage (hazard ratio [HR] 1.78, p = 0.042), postoperative RT (HR 0.41, p = 0.044), and concomitant chemotherapy (HR 0.31, p = 0.009). Local control rates were superior when an equivalent dose in 2-Gy fractions (EQD2) of ⩾65 Gy was delivered (HR 0.216, p = 0.028) and with the use of concurrent chemotherapy (HR 0.248, p = 0.011). Not surprisingly, local control was inferior for patients with a higher TNM stage (HR 3.303, p = 0.027). Minimal toxicity was observed with no patients having documentation of high-grade toxicity (CTCAE grade 3+). CONCLUSION In treatment of vaginal cancer, high-dose RT in combination with brachytherapy is well tolerated and results in effective local control rates, which significantly improve with an EQD2(α/β=10) ⩾65 Gy. Multivariate analyses revealed concomitant chemotherapy was a positive prognostic factor for overall and progression-free survival.
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Affiliation(s)
- Eva Meixner
- Department of Radiation Oncology,
Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation
Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases
(NCT), Heidelberg, Germany
- Eva Meixner, MD, Department of Radiation
Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg,
Baden-Württemberg 69120, Germany.
| | - Nathalie Arians
- Department of Radiation Oncology,
Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation
Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases
(NCT), Heidelberg, Germany
| | - Nina Bougatf
- Department of Radiation Oncology,
Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation
Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases
(NCT), Heidelberg, Germany
| | - Line Hoeltgen
- Department of Radiation Oncology,
Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation
Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases
(NCT), Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology,
Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation
Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases
(NCT), Heidelberg, Germany
| | - Kristin Lang
- Department of Radiation Oncology,
Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation
Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases
(NCT), Heidelberg, Germany
| | - Christoph Domschke
- Department of Gynecology and
Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus Wallwiener
- Department of Gynecology and
Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Jonathan W. Lischalk
- Department of Radiation Oncology,
Perlmutter Cancer Center, New York University Langone Health, New York, NY,
USA
| | - Felix K.F. Kommoss
- Department of Pathology, Institute of
Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology,
Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation
Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases
(NCT), Heidelberg, Germany
- Heidelberg Ion Therapy Center (HIT),
Heidelberg, Germany
- Clinical Cooperation Unit Radiation
Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology,
Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation
Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases
(NCT), Heidelberg, Germany
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24
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Shen Y, Meng X, Wang L, Wang X, Chang H. Advanced primary vaginal squamous cell carcinoma: A case report and literature review. Front Immunol 2022; 13:1007462. [PMID: 36483563 PMCID: PMC9722770 DOI: 10.3389/fimmu.2022.1007462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background Vaginal carcinoma is a gynecological malignancy with low incidence, and there are few relevant and specific guidelines for vaginal cancer in our country and abroad. Here, we report the case who was diagnosed with advanced, primary vaginal squamous cell carcinoma and underwent integrated treatment successfully. Case introduction A 64-year-old Chinese woman underwent subtotal hysterectomy for uterine fibroids in 1998 and laparoscopic extensive residual cervical resection, bilateral ovarian salpingectomy, and pelvic lymph node dissection for residual cervical adenocarcinoma (stage IB1) in the First Affiliated Hospital of China Medical University in 2018. There was no postoperative review. The patient experienced vaginal discharge in March 2020, and vaginal bleeding occurred in July 2020. Our patient was diagnosed with stage IVA vaginal squamous cell carcinoma, based on a gynecological examination, colposcopy biopsy with histopathological examination, computed tomography scan, and tumor marker levels by two professors. After three phases of treatment (sequential treatment with chemotherapy plus radiotherapy, chemotherapy combined with immune checkpoint inhibitors, and immune checkpoint inhibitors combined with tyrosine kinase inhibitors therapy), her condition improved. Her current state is generally good, and she has achieved complete remission. Conclusion We report a rare case of a patient with primary advanced vaginal carcinoma combined with cervical adenocarcinoma. The patient was treated for approximately 2 years, and her personalized treatment showed promising results. We will continue to follow up with the patient and monitor her response to the current treatment process.
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25
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Wong RWC, Webster F, Bosse T, Focchi G, Gilks CB, Hoang L, Howitt BE, McAlpine J, Ordi J, Singh N, Lax SF, McCluggage WG. Data Set for the Reporting of Carcinomas of the Vagina: Recommendations From the International Collaboration on Cancer Reporting (ICCR). Int J Gynecol Pathol 2022; 41:S23-S33. [PMID: 35703457 DOI: 10.1097/pgp.0000000000000883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Primary carcinomas of the vagina are uncommon and currently detailed recommendations for the reporting of resection specimens of these neoplasms are not widely available. The International Collaboration on Cancer Reporting (ICCR) is developing standardized, evidence-based reporting data sets for multiple cancer sites. We describe the development of a cancer data set by the ICCR expert panel for the reporting of primary vaginal carcinomas and present the core and noncore data elements with explanatory commentaries. This data set has incorporated the updates in the 2020 World Health Organization Classification of Female Genital Tumours, 5th edition. The data set addresses controversial issues such as tumor grading, margin assessment, and the role of ancillary studies. The adoption of this data set into clinical practice will help ensure standardized data collection across different countries, facilitate future research on vaginal carcinomas, and ultimately lead to improvements in patient care.
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Zhou WL, Yue YY. Development and validation of models for predicting the overall survival and cancer-specific survival of patients with primary vaginal cancer: A population-based retrospective cohort study. Front Med (Lausanne) 2022; 9:919150. [PMID: 36106318 PMCID: PMC9464817 DOI: 10.3389/fmed.2022.919150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/12/2022] [Indexed: 11/18/2022] Open
Abstract
Background No models have been developed to predict the survival probability for women with primary vaginal cancer (VC) due to VC’s extreme rareness. We aimed to develop and validate models to predict the overall survival (OS) and cancer-specific survival (CSS) of VC patients. Methods A population-based multicenter retrospective cohort study was carried out using the 2004–2018 Surveillance, Epidemiology, and End Results Program database in the United States. The final multivariate Cox model was identified using the Brier score and Harrell’s C concordance statistic (C-statistic). The decision curve, calibration plot, and area under the time-dependent receiver operating characteristic curve (AUC) were used to evaluate model prediction performance. Multiple imputation followed by bootstrap was performed. Bootstrap validation covered the entire statistic procedure from model selection to baseline survival and coefficient calculation. Nomograms predicting OS and CSS were generated. Results Of the 2,417 eligible patients, 1,692 and 725 were randomly allocated to the training and validation cohorts. The median age (Interquartile range) was 66 (56–78) and 65 (55–76) for the two cohorts, respectively. Our models had larger net benefits in predicting the survival of VC patients than the American Joint Committee on Cancer stage, presenting great discrimination ability and excellent agreement between the expected and observed events. The performance metrics of our models were calculated in three cohorts: the training cohort, complete cases of the validation cohort, and the imputed validation cohort. For the OS model in the three cohorts, the C-statistics were 0.761, 0.752, and 0.743. The slopes of the calibration plots were 1.017, 1.005, and 0.959. The 3- and 5-year AUCs were 0.795 and 0.810, 0.768 and 0.771, and 0.770 and 0.767, respectively. For the CSS model in the three cohorts, the C-statistics were 0.775, 0.758, and 0.755. The slopes were 1.021, 0.939, and 0.977. And the 3- and 5-year AUCs were 0.797 and 0.793, 0.786 and 0.788, and 0.757 and 0.757, respectively. Conclusion We were the first to develop and validate exemplary survival prediction models for VC patients and generate corresponding nomograms that allow for individualized survival prediction and could assist clinicians in performing risk-adapted follow-up and treatment.
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Affiliation(s)
- Wei-Li Zhou
- Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yang-Yang Yue
- Department of Health Management, Shengjing Hospital, China Medical University, Shenyang, China
- *Correspondence: Yang-Yang Yue,
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Hou X, Yue S, Liu J, Qiu Z, Xie L, Huang X, Li S, Hu L, Wu J. Association of Tumor Size With Prognosis in Patients With Resectable Endometrial Cancer: A SEER Database Analysis. Front Oncol 2022; 12:887157. [PMID: 35814421 PMCID: PMC9259839 DOI: 10.3389/fonc.2022.887157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/04/2022] [Indexed: 12/24/2022] Open
Abstract
This study aimed to explore the relationship between tumor size (Ts) and prognosis in endometrial cancer (EC). A total of 52,208 patients with EC who underwent total hysterectomy were selected from the Surveillance, Epidemiology, and End Results Program database. Overall survival (OS) and endometrial cancer-specific survival (ESS) were chosen as survival outcomes. The Cox proportional hazards model was used to explore the effect of Ts on prognosis. The restricted cubic splines based on the Cox regression model were used to determine the nonlinear relationship between Ts and survival. When Ts was analyzed as a categorical variable, the risk of death increased with Ts, with the highest risk in patients with Ts > 9 cm with regard to all-cause death (ACD) (hazard ratio [HR] 1.317; 95% confidence interval [CI], 1.196-1.450; P < 0.001) and endometrial cancer-specific death (ESD) (HR, 1.378; 95% CI, 1.226-1.549; P < 0.001). As a continuous variable, Ts showed a nonlinear relationship with ACD (HR, 1.061; 95% CI, 1.053-1.069; P < 0.001) and ESD (HR, 1.062; 95% CI, 1.052-1.073; P < 0.001). The risk of mortality increased quickly with Ts when Ts was less than 7.5 cm and then leveled off when Ts was larger than 7.5 cm in all patients. Among patients with lymph node metastasis, the risk of poor prognosis decreased rapidly with Ts when Ts was less than 3.5 cm, and subsequently increased sharply with Ts when Ts ranged from 3.5 cm to 7.5 cm, and then increased slowly when Ts was larger than 7.5 cm (P < 0.001 for nonlinearity). There was a nonlinear relationship between Ts and prognosis in patients with EC. Clinicians should not ignore the impact of small tumors on prognosis in EC patients with lymph node metastasis.
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Affiliation(s)
- Xuefei Hou
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Guangdong Engineering Research Center of Collaborative Innovation Technology of Clinical Medical Big Data Cloud Service in Medical Consortium of West Guangdong Province, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Suru Yue
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jie Liu
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Zhiqing Qiu
- Department of Pharmacy, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Liming Xie
- Department of Pharmacy, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xueying Huang
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Shasha Li
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Liren Hu
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jiayuan Wu
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Guangdong Engineering Research Center of Collaborative Innovation Technology of Clinical Medical Big Data Cloud Service in Medical Consortium of West Guangdong Province, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
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Bakirarar B, Namli Kalem M, Kalem Z. Factors that affect survival in vaginal cancer: a seer analysis. J OBSTET GYNAECOL 2022; 42:2307-2313. [PMID: 35543117 DOI: 10.1080/01443615.2022.2049717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed to investigate the factors that affect survival in vaginal cancer by means of a large population-based database that had been monitored over a 42 year period (1975-2017). It was investigated which factors were most predictive in survival. This study evaluated the factors that affect survival in primary vaginal cancer as one of the rarest gynaecological cancers. Relationships were explored between survival and age and race of patient, in situ/invasive behaviour of tumour, histological type, stage, grade, surgical treatment, and year of diagnosis. Survival rate was found to be higher at younger ages and earlier stages, in in situ and squamous cell carcinomas, in the presence of previous surgery, and diagnosis from 2000 onward. It was shown that other causes were more predictive of mortality in older patients and that mortality due to other causes decreased in patients diagnosed from 2000 onward. Mortalities due to cancer were found to be lower in the patients who had underwent surgery.At the end of this study, an estimation model was developed for 10-year survival in vaginal cancer and software was created for the model. Impact StatementWhat is already known on this subject? Primary vaginal cancer is very rare, accounting for 2% of female genital tract malignancies. Due to its low incidence and difficulty of its final diagnosis, vaginal cancer has the least amount of data among all female genital tract malignancies. It is difficult for clinicians to estimate the survival with already limited data on vaginal cancer in the literature.What do the results of this study add? Survival rate was found to be higher at younger ages and earlier stages, in in situ and squamous cell carcinomas, in the presence of previous surgery, and diagnosis from 2000 onward. It was shown that other causes were more effective in mortality with older age and that mortality due to other causes decreased in patients diagnosed from 2000 onward. Mortalities due to cancer were found to be lower in the patients who had underwent surgery.What are the implications of these findings for clinical practice and/or further research? It is anticipated that such studies will contribute to the transformation of societal data collection methods into a prospective nature and lead the way for stronger survival estimation models to be developed in days to come.
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Affiliation(s)
- Batuhan Bakirarar
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
| | - Muberra Namli Kalem
- Department of Obstetrics and Gynecology, Istinye University School of Medicine, Istanbul, Turkey
| | - Ziya Kalem
- Department of Obstetrics and Gynecology, Istinye University School of Medicine, Istanbul, Turkey
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Mai YF, Chan IS, Lai CR, Chen YJ. Primary poorly differentiated carcinoma of the vagina with focal neuroendocrine differentiation: a tumour with aggressive behaviour. BMJ Case Rep 2022; 15:e247554. [PMID: 35396236 PMCID: PMC8995952 DOI: 10.1136/bcr-2021-247554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2022] [Indexed: 11/03/2022] Open
Abstract
Primary vaginal neuroendocrine tumours are extremely rare but aggressive. We report a case of primary poorly differentiated vaginal carcinoma with focal neuroendocrine differentiation. The clinical stage was cT3N1M0, FIGO stage III. The patient received six cycles of cisplatin-based concurrent chemoradiation therapy (CCRT) followed by six cycles of adjuvant chemotherapy (IEP protocol: ifosfomide, epirubicin and cisplatin). Pelvic MRI scans obtained after treatment completion revealed no residual tumour in the vagina. However, the patient experienced severe dyspnoea 2 months later. Chest X-ray revealed a reticulonodular interstitial pattern over bilateral lungs with suspicion of lymphangitic carcinomatosis. Further chest, abdominal and pelvic CT scans showed bilateral lung metastases with multiple mediastinal, left lower neck and left axilla, intra-abdominal and pelvic lymphadenopathies. For this rare tumour, cisplatin-based CCRT followed by IEP protocol adjuvant chemotherapy may have a limited treatment effect. Further studies are necessary to provide more information on clinical management.
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Affiliation(s)
- Yi-Fan Mai
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - I-San Chan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Obstetrics and Gynaecology, Division of Gynaecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chiung-Ru Lai
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Jen Chen
- Department of Obstetrics and Gynaecology, Division of Gynaecology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, Department of Obstetrics and Gynaecology, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Mesonephric Adenocarcinoma of the Vagina Harboring TP53 Mutation. Diagnostics (Basel) 2022; 12:diagnostics12010119. [PMID: 35054285 PMCID: PMC8774656 DOI: 10.3390/diagnostics12010119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 12/21/2022] Open
Abstract
Mesonephric adenocarcinoma (MA) of the female genital tract is a rare but distinct entity, exhibiting unique morphological, immunophenotypical, and molecular characteristics. Vaginal MA is hypothesized to arise from the mesonephric remnants located in the lateral vaginal wall. A 52-year-old woman presented with vaginal bleeding. Physical examination revealed a protruding mass in the left vaginal wall. Pelvic magnetic resonance imaging revealed a 2.5-cm mass arising from the left upper vagina and extending posterolaterally to the extravaginal tissue. The punch biopsy was diagnosed as poorly differentiated adenocarcinoma. She received radical surgical resection. Histologically, the tumor displayed various architectural patterns, including compactly aggregated small tubules, solid cellular sheets, endometrioid-like glands and ducts, intraluminal micropapillae, cribriform structure, and small angulated glands accompanied by prominent desmoplastic stroma. The tubules and ducts possessed hyaline-like, densely eosinophilic intraluminal secretions. The tumor extended to the subvaginal soft tissue and had substantial perineural invasion. Immunostaining revealed positivity for the mesonephric markers, including GATA3, TTF1, and PAX2, while showing very focal and weak positivity for estrogen receptor and negativity for progesterone receptor. Additionally, we observed a complete absence of p53 immunoreactivity. Targeted sequencing analysis revealed that the tumor harbored both activating KRAS p.G12D mutation and truncating TP53 p.E286* mutation. A thorough review of the previous literature revealed that 4.5% (3/67) of vaginal/cervical MAs and 0.9% (1/112) of uterine/ovarian mesonephric-like adenocarcinomas harbor TP53 mutations, indicating that this is very uncommon in malignant mesonephric lesions. In summary, we presented a rare case of vaginal MA uniquely harboring pathogenic TP53 mutation, resulting in p53 aberration.
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Essentiality of Trace Elements in Pregnancy, Fertility, and Gynecologic Cancers-A State-of-the-Art Review. Nutrients 2021; 14:nu14010185. [PMID: 35011060 PMCID: PMC8746721 DOI: 10.3390/nu14010185] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 12/18/2022] Open
Abstract
Gynecological neoplasms pose a serious threat to women's health. It is estimated that in 2020, there were nearly 1.3 million new cases worldwide, from which almost 50% ended in death. The most commonly diagnosed are cervical and endometrial cancers; when it comes to infertility, it affects ~48.5 million couples worldwide and the number is continually rising. Ageing of the population, environmental factors such as dietary habits, environmental pollutants and increasing prevalence of risk factors may affect the reproductive potential in women. Therefore, in order to identify potential risk factors for these issues, attention has been drawn to trace elements. Trace mineral imbalances can be caused by a variety of causes, starting with hereditary diseases, finishing with an incorrect diet or exposure to polluted air or water. In this review, we aimed to summarize the current knowledge regarding trace elements imbalances in the case of gynecologic cancers as well as female fertility and during pregnancy.
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Role of radiotherapy in the treatment of primary vaginal cancer: Recommendations of the French society for radiation oncology. Cancer Radiother 2021; 26:292-297. [PMID: 34955415 DOI: 10.1016/j.canrad.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Primary vaginal cancers are rare tumours, for which external beam radiotherapy and brachytherapy are major treatment tools. Given the complexity of brachytherapy techniques, the treatment should be performed in specialised centres. We present the recommendations of the French society for radiation oncology on the indications and techniques for external beam radiotherapy and brachytherapy for primary vaginal cancer.
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Naz F, Tariq I, Ali S, Somaida A, Preis E, Bakowsky U. The Role of Long Non-Coding RNAs (lncRNAs) in Female Oriented Cancers. Cancers (Basel) 2021; 13:6102. [PMID: 34885213 PMCID: PMC8656502 DOI: 10.3390/cancers13236102] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/14/2021] [Accepted: 11/30/2021] [Indexed: 12/15/2022] Open
Abstract
Recent advances in molecular biology have discovered the mysterious role of long non-coding RNAs (lncRNAs) as potential biomarkers for cancer diagnosis and targets for advanced cancer therapy. Studies have shown that lncRNAs take part in the incidence and development of cancers in humans. However, previously they were considered as mere RNA noise or transcription byproducts lacking any biological function. In this article, we present a summary of the progress on ascertaining the biological functions of five lncRNAs (HOTAIR, NEAT1, H19, MALAT1, and MEG3) in female-oriented cancers, including breast and gynecological cancers, with the perspective of carcinogenesis, cancer proliferation, and metastasis. We provide the current state of knowledge from the past five years of the literature to discuss the clinical importance of such lncRNAs as therapeutic targets or early diagnostic biomarkers. We reviewed the consequences, either oncogenic or tumor-suppressing features, of their aberrant expression in female-oriented cancers. We tried to explain the established mechanism by which they regulate cancer proliferation and metastasis by competing with miRNAs and other mechanisms involved via regulating genes and signaling pathways. In addition, we revealed the association between stated lncRNAs and chemo-resistance or radio-resistance and their potential clinical applications and future perspectives.
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Affiliation(s)
- Faiza Naz
- Punjab University College of Pharmacy, Allama Iqbal Campus, University of the Punjab, Lahore 54000, Pakistan;
| | - Imran Tariq
- Punjab University College of Pharmacy, Allama Iqbal Campus, University of the Punjab, Lahore 54000, Pakistan;
- Department of Pharmaceutics and Biopharmaceutics, University of Marburg, Robert-Koch-Str. 4, 35037 Marburg, Germany or (S.A.); (A.S.); (E.P.)
| | - Sajid Ali
- Department of Pharmaceutics and Biopharmaceutics, University of Marburg, Robert-Koch-Str. 4, 35037 Marburg, Germany or (S.A.); (A.S.); (E.P.)
- Angström Laboratory, Department of Chemistry, Uppsala University, 75123 Uppsala, Sweden
| | - Ahmed Somaida
- Department of Pharmaceutics and Biopharmaceutics, University of Marburg, Robert-Koch-Str. 4, 35037 Marburg, Germany or (S.A.); (A.S.); (E.P.)
| | - Eduard Preis
- Department of Pharmaceutics and Biopharmaceutics, University of Marburg, Robert-Koch-Str. 4, 35037 Marburg, Germany or (S.A.); (A.S.); (E.P.)
| | - Udo Bakowsky
- Department of Pharmaceutics and Biopharmaceutics, University of Marburg, Robert-Koch-Str. 4, 35037 Marburg, Germany or (S.A.); (A.S.); (E.P.)
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Vaginal high-grade sarcoma in pregnancy. Gynecol Oncol Rep 2021; 38:100881. [PMID: 34926762 PMCID: PMC8651769 DOI: 10.1016/j.gore.2021.100881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/02/2021] [Accepted: 10/10/2021] [Indexed: 11/22/2022] Open
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35
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Kwon DH, Malpica A, Zaleski M, Euscher ED, Ramalingam P. Immunohistochemical Loss of DPC4 in Tumors With Mucinous Differentiation Arising in or Involving the Gynecologic Tract. Int J Gynecol Pathol 2021; 40:523-532. [PMID: 33405429 DOI: 10.1097/pgp.0000000000000754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
DPC4 immunohistochemistry (IHC) is usually part of the work-up of mucinous neoplasms in the ovary where the distinction between an ovarian primary and metastatic pancreaticobiliary adenocarcinoma (PanACa) must be made. Although DPC4 IHC is lost in about 55% (46%-61%) of PanACas and typically retained in most primary ovarian mucinous neoplasms, no study has evaluated the expression of this marker in a large cohort of neoplasms arising in or involving gynecologic (GYN) organs. In this study, we retrospectively analyzed the expression of DPC4 IHC in a total of 251 tumors and lesions related to the GYN tract in which DPC4 IHC stain was performed during the initial pathology evaluation. Of these, 138 were primary GYN tumors and lesions, 31 were metastatic GYN tumors involving non-GYN sites, and 83 were metastatic non-GYN tumors involving the GYN tract. We identified 27 cases with loss of DPC4 IHC expression of which 20 cases met the inclusion criteria (i.e. clinical information was available to determine the site of tumor origin). We observed that loss of DPC4 nuclear expression was most commonly seen in tumors of endocervical origin (n=7), of which 5 were gastric-type cervical adenocarcinomas (GCxACa) and 2 were usual-type cervical adenocarcinomas, either primary or metastatic. This was followed by tumors of the pancreaticobiliary tract (n=5), ovary (n=2), and appendix (n=1). In addition, 1 gastric-type vaginal adenocarcinoma (GVaACa) also showed loss of DPC4. Our findings indicate that in female patients with mucinous neoplasms involving the ovary or other sites, with loss of DPC4 by IHC, and negative pancreaticobiliary imaging, the possibility of an occult GCx/GVaACa, and rarely an ovarian primary must be considered.
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Affiliation(s)
- Dong Hyang Kwon
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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36
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Stein R, Ganeshan D, Gopireddy DR, Chaudhry A, Kumar S, Bande K, Bhosale P, Lall C. Current update on vaginal malignancies. Abdom Radiol (NY) 2021; 46:5353-5368. [PMID: 34338815 DOI: 10.1007/s00261-021-03228-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 12/24/2022]
Abstract
Primary vaginal cancers are rare and account for 1-3% of all gynecologic malignancies. There are several histological subtypes that affect a wide range of the population. Imaging plays an important role in the diagnosis, staging, and treatment planning of vaginal cancers. This article reviews the relevant anatomy, clinical findings, imaging characteristics, and recent advances in the management of vaginal malignancies.
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Affiliation(s)
- Rachel Stein
- Department of Radiology, University of Florida School of Medicine - Jacksonville, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL, 32209, USA.
| | | | - Dheeraj Reddy Gopireddy
- Department of Radiology, University of Florida School of Medicine - Jacksonville, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL, 32209, USA
| | - Ammar Chaudhry
- Department of Diagnostic Radiology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Sindhu Kumar
- Department of Radiology, University of Florida School of Medicine - Jacksonville, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL, 32209, USA
| | - Karthik Bande
- Department of Radiology, University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - Priya Bhosale
- Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chandana Lall
- Department of Radiology, University of Florida School of Medicine - Jacksonville, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL, 32209, USA
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Kilcoyne A, Gottumukkala RV, Kang SK, Akin EA, Hauck C, Hindman NM, Huang C, Khanna N, Paspulati R, Rauch GM, Said T, Shinagare AB, Stein EB, Venkatesan AM, Maturen KE. ACR Appropriateness Criteria® Staging and Follow-up of Primary Vaginal Cancer. J Am Coll Radiol 2021; 18:S442-S455. [PMID: 34794599 DOI: 10.1016/j.jacr.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/28/2021] [Indexed: 11/30/2022]
Abstract
Primary vaginal cancer is rare, comprising 1% to 2% of gynecologic malignancies and 20% of all malignancies involving the vagina. More frequently, the vagina is involved secondarily by direct invasion from malignancies originating in adjacent organs or by metastases from other pelvic or extrapelvic primary malignancies. Data on the use of imaging in vaginal cancer are sparse. Insights are derived from the study of imaging in cervical cancer and have reasonable generalizability to vaginal cancer due to similar tumor biology. Given the trend toward definitive chemoradiation for both cancers in all but early stage lesions, principles of postchemoradiation tumor response evaluation are largely analogous. Accordingly, many of the recommendations outlined here are informed by principles translated from the literature on cervical cancer. For pretreatment assessment of local tumor burden and in the case of recurrent vaginal cancer, MRI is the preferred imaging modality. PET/CT has demonstrated utility for the detection of nodal metastatic and unexpected distant metastatic disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Aoife Kilcoyne
- Panel Vice Chair, Massachusetts General Hospital, Boston, Massachusetts.
| | | | - Stella K Kang
- Panel Chair, New York University Medical Center, New York, New York
| | - Esma A Akin
- The George Washington University Medical Center, Washington, District of Columbia; ABNM Board Member; and IAC Board Member
| | - Carlin Hauck
- Sutter Medical Center Sacramento, Sacramento, California
| | - Nicole M Hindman
- Associate Chair, Diversity & Health Equity, MR Safety Officer, and Director, Female Pelvic Imaging, New York University Medical Center, New York, New York; and Fellow Rep., Board of the Society for Advanced Body Imaging
| | - Chenchan Huang
- New York University Langone Medical Center, New York, New York
| | - Namita Khanna
- Emory University, Atlanta, Georgia; Society of Gynecologic Oncology
| | | | - Gaiane M Rauch
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tamer Said
- Program Director, Family Medicine Residency Program, University Hospitals Cleveland Medical Center, Cleveland, Ohio; and Primary care physician
| | - Atul B Shinagare
- Chief, Abdominal Imaging and Intervention, Brigham & Women's Hospital Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Erica B Stein
- Director, Body CT, University of Michigan Medical Center, Ann Arbor, Michigan
| | | | - Katherine E Maturen
- Specialty Chair, University of Michigan, Ann Arbor, Michigan; and Member, Society of Abdominal Radiology Board of Directors
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Dentry M, McBean R, Garrett A, Brown N. A novel technique for a rare diagnosis: MRI-guided vaginal biopsy of Skene gland adenocarcinoma: Pictorial Essay. J Med Imaging Radiat Oncol 2021; 65:724-727. [PMID: 34240821 DOI: 10.1111/1754-9485.13277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/15/2021] [Indexed: 12/20/2022]
Abstract
FDG-PET and MRI imaging of the pelvis identified a suspicious lesion in a patient with a history of small cell neuroendocrine tumour of the vagina, and after a negative surgical biopsy, a multidisciplinary team meeting decided to proceed with MRGB (magnetic resonance-guided biopsy). The patient remains well and in remission two years after anterior exenteration, with final histology of the lesion determined to be Skene gland adenocarcinoma. MRGB is a novel and effective way to diagnose vaginal lesions.
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Affiliation(s)
- Matt Dentry
- I-Med Radiology, The Wesley Hospital, Brisbane, Queensland, Australia
| | - Rhiannon McBean
- I-Med Radiology, The Wesley Hospital, Brisbane, Queensland, Australia
| | - Andrea Garrett
- I-Med Radiology, The Wesley Hospital, Brisbane, Queensland, Australia
| | - Nicholas Brown
- I-Med Radiology, The Wesley Hospital, Brisbane, Queensland, Australia
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Matylevich OP, Trukhan HV, Zubets OI, Mavrichev SA. Twenty years' experience of primary vaginal cancer treatment at one cancer centre: does residence status matter? Ecancermedicalscience 2021; 15:1267. [PMID: 34567252 PMCID: PMC8426020 DOI: 10.3332/ecancer.2021.1267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives To study the long-term results of the treatment of patients with vaginal cancer and to examine whether there are any differences in diagnostic and survival rates between urban and rural patients. Methods The data of 70 patients with primary vaginal cancer treated at NN Alexandrov National Cancer Centre of Belarus from 2000 to 2019 were included. The median age was 64 years (range = 56–75). Morphology in 91.4% (64/70) of the cases was squamous cell cancer, in 7.1% (5/70) it was adenocarcinoma and in 1.4% (1/70) it was adenosquamous carcinoma. In total, there were 31 patients from urban and 39 from rural areas. The groups were comparable in age (61 versus 67, p = 0.104), morphology (p = 0.188) and distribution of stages: stage I in 7 and 10 patients (22.6% and 25.6%, respectively; p = 0.999), stage II in 14 and 16 patients (45.1% and 41.0%, respectively; p = 0.810), stage III in 6 and 6 patients (19.4% and 15.4%, respectively; p = 0.754) and stage IV in 4 and 7 patients (12.9% and 18.0%, respectively; p = 0.744). Results The median follow-up time was 33 months (range = 1–220). A total of 42 women died: 28 from progression of vaginal cancer and 14 from other diseases. Overall survival (OS) was 31.9 ± 6.8%, median survival was 41 months (95% CI = 0.0–105.3). Disease-specific survival (DSS) for the entire group was 54.5 ± 6.8%; median was not reached. The overall survival rate of urban women was 44.8 ± 10.6% and for rural it was 22.5 ± 8.2% (p = 0.142); DSS was 57.6 ± 10.5% and 53.0 ± 8.4% (p = 0.448), respectively. Conclusion DSS rate was 54.0 ± 6.8% and the OS rate did not exceed 31.9 ± 6.8%. Rural residence was not associated with late stage at diagnosis or receipt of treatment.
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Affiliation(s)
- Olga P Matylevich
- Gynecologic Oncology Department, NN Alexandrov National Cancer Centre of Belarus, a/g Lesnoy-2, 223040 Minsk, Belarus
| | - Hanna V Trukhan
- Department of Oncology, Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus, Brovki Street, 3, build. 3, 220013 Minsk, Belarus
| | - Olga I Zubets
- Cancer Control Department, NN Alexandrov National Cancer Centre of Belarus, a/g Lesnoy-2, 223040 Minsk, Belarus
| | - Siarhei A Mavrichev
- Gynecologic Oncology Department, NN Alexandrov National Cancer Centre of Belarus, a/g Lesnoy-2, 223040 Minsk, Belarus
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Kumari A, Podder AR. Multiple Primary Malignancies—Challenges in Diagnosis and Management for a Gynecological Oncologist. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00588-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rasmussen CL, Bertoli HK, Sand FL, Kjaer AK, Thomsen LT, Kjaer SK. The prognostic significance of HPV, p16, and p53 protein expression in vaginal cancer: A systematic review. Acta Obstet Gynecol Scand 2021; 100:2144-2156. [PMID: 34546565 DOI: 10.1111/aogs.14260] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Human papillomavirus (HPV), p16, and p53 have been investigated as prognostic markers in various HPV-related cancers. Within the field of vaginal cancer, however, the evidence remains sparse. In this systematic review, we have compiled the presently published studies on the prognostic significance of HPV and immunohistochemical expression of p16 and p53 among women with vaginal cancer. MATERIAL AND METHODS We conducted a systematic search of PubMed, Embase, and Cochrane Library to identify relevant studies published until April 2021. We included studies reporting survival after histologically verified vaginal cancers tested for HPV, p16, and/or p53. Survival outcomes included overall survival, disease-free survival, disease-specific survival, and progression-free survival. RESULTS We included a total of 12 studies. The vast majority of vaginal cancer cases included in each study were squamous cell carcinomas (84%-100%). Seven studies reported survival after vaginal cancer according to HPV status, and the majority of these studies found a tendency towards improved survival for women with HPV-positive vaginal cancer. Three out of four studies reporting survival according to p16 status found an improved survival among women with p16-positive vaginal cancer. For p53, only one of six studies reported an association between p53 expression and survival. CONCLUSIONS This systematic review suggests that women with HPV- and p16-positive vaginal cancer have an improved prognosis compared with those with HPV- or p16-negative vaginal cancer. Results for p53 were varied, and no conclusion could be reached. Only 12 studies could be included in the review, of which most were based on small populations. Hence, further and larger studies on the prognostic impact of HPV, p16, and p53 in vaginal cancer are warranted.
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Affiliation(s)
- Christina L Rasmussen
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Hanna K Bertoli
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Freja L Sand
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Alexander K Kjaer
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Louise T Thomsen
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Friedman SN, Itani M, Dehdashti F. PET Imaging for Gynecologic Malignancies. Radiol Clin North Am 2021; 59:813-833. [PMID: 34392921 DOI: 10.1016/j.rcl.2021.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This review article summarizes the clinical applications of established and emerging PET tracers in the evaluation of the 5 most common gynecologic malignancies: endometrial, ovarian, cervical, vaginal, and vulvar cancers. Emphasis is given to 2-deoxy-2-[18F]fluoro-d-glucose as the most widely used and studied tracer, with additional clinical tracers also explored. The common imaging protocols are discussed, including standard dose ranges and uptake times, established roles, as well as the challenges and future directions of these imaging techniques. The key points are emphasized with images from selected cases.
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Affiliation(s)
- Saul N Friedman
- Division of Nuclear Medicine, Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA
| | - Malak Itani
- Section of Abdominal Imaging, Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA
| | - Farrokh Dehdashti
- Division of Nuclear Medicine, Edward Mallinckrodt Institute of Radiology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA.
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Zulfiqar M, Shetty A, Yano M, McGettigan M, Itani M, Naeem M, Ratts VS, Siegel CL. Imaging of the Vagina: Spectrum of Disease with Emphasis on MRI Appearance. Radiographics 2021; 41:1549-1568. [PMID: 34297630 DOI: 10.1148/rg.2021210018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The vagina is a median fibromuscular structure of the female reproductive system that extends from the vulva inferiorly to the uterine cervix superiorly. As most vaginal lesions are detected at gynecologic examination, imaging performed for nongynecologic indications can frequently cause concomitant vaginal pathologic conditions to be overlooked. The vagina is often underevaluated at routinely performed pelvic transvaginal US because of a narrow scan area and probe positioning. MRI has progressively become the imaging method of choice for vaginal pathologic conditions, as it provides excellent soft-tissue detail with unparalleled delineation of the complex pelvic floor anatomy and helps establish a diagnosis for most vaginal diseases. It is important that radiologists use a focused approach toward understanding and correctly recognizing different vaginal entities that may otherwise go unnoticed. In this case-based review, the authors discuss the key imaging features of wide-ranging vaginal pathologic conditions, with emphasis on appearance at MRI. Knowledge of vaginal anatomy and embryology is helpful in evaluating congenital anomalies at imaging. Often seen incidentally, vaginal inflammation can cause diagnostic confusion. Because of its central location in the pelvis, the vagina can form fistulas to the urinary bladder, colon, rectum, or anus. Vaginal masses can be neoplastic and nonneoplastic and include a myriad of benign and malignant conditions, some of which have characteristic imaging features. Therapeutic and nontherapeutic vaginal foreign bodies include pessaries, vaginal mesh, and packing that can be seen with or without associated complications. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Maria Zulfiqar
- From the Mallinckrodt Institute of Radiology (M.Z., A.S., M.I., M.N., C.L.S.) and Department of Obstetrics and Gynecology (V.S.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (M.Y.); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Fla (M.M.); and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M.M.)
| | - Anup Shetty
- From the Mallinckrodt Institute of Radiology (M.Z., A.S., M.I., M.N., C.L.S.) and Department of Obstetrics and Gynecology (V.S.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (M.Y.); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Fla (M.M.); and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M.M.)
| | - Motoyo Yano
- From the Mallinckrodt Institute of Radiology (M.Z., A.S., M.I., M.N., C.L.S.) and Department of Obstetrics and Gynecology (V.S.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (M.Y.); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Fla (M.M.); and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M.M.)
| | - Melissa McGettigan
- From the Mallinckrodt Institute of Radiology (M.Z., A.S., M.I., M.N., C.L.S.) and Department of Obstetrics and Gynecology (V.S.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (M.Y.); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Fla (M.M.); and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M.M.)
| | - Malak Itani
- From the Mallinckrodt Institute of Radiology (M.Z., A.S., M.I., M.N., C.L.S.) and Department of Obstetrics and Gynecology (V.S.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (M.Y.); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Fla (M.M.); and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M.M.)
| | - Muhammad Naeem
- From the Mallinckrodt Institute of Radiology (M.Z., A.S., M.I., M.N., C.L.S.) and Department of Obstetrics and Gynecology (V.S.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (M.Y.); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Fla (M.M.); and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M.M.)
| | - Valerie S Ratts
- From the Mallinckrodt Institute of Radiology (M.Z., A.S., M.I., M.N., C.L.S.) and Department of Obstetrics and Gynecology (V.S.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (M.Y.); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Fla (M.M.); and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M.M.)
| | - Cary Lynn Siegel
- From the Mallinckrodt Institute of Radiology (M.Z., A.S., M.I., M.N., C.L.S.) and Department of Obstetrics and Gynecology (V.S.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (M.Y.); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Fla (M.M.); and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M.M.)
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Abstract
The role of hybrid imaging with 2-[18F] flourodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT) is continuously evolving and now considered standard practice in evaluation of disease stage, treatment response, recurrent disease and follow-up for numerous primary malignancies. In gynecological malignancies FDG PET/CT plays an important role, not only in the assessment of disease in the pre-and post-therapy setting, but also in radiation therapy (RT) planning by defining the metabolically active gross tumor volume (GTV. The glucose analogue radiotracer, FDG, is by far the most utilized radiotracer in PET/CT and is typically seen with high uptake in malignant cells. The radiotracer FDG has a high sensitivity but low specificity for malignancy, as benign processes with an inflammatory response for example infection, are also FDG-avid. In the evaluation of the female pelvic region an awareness of potential confounding factors in the interpretation of FDG is essential as variations of FDG uptake occur in accordance with the menstrual cycle and the menopausal state. Incidental imaging findings in the female genital can pose differential diagnostic challenges as false-positive and false-negative findings in benign and malignant processes are not uncommon. Gynecological malignancies continue to pose major public health problems with cervical cancer as the fourth most common cancer in women ranking after breast cancer, colorectal cancer and lung cancer. Familiarity with frequently encountered benign and malignant variants and pitfalls in FDG PET/CT in the female pelvic region can aid the reader in differential diagnostic considerations.
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Affiliation(s)
- Danijela Dejanovic
- Department of Clinical Physiology, Nuclear Medicine and PET, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
| | - Naja Liv Hansen
- Department of Clinical Physiology, Nuclear Medicine and PET, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine and PET, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
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Mamede R, Beja M, Djokovic D, Costa C. Invasive mole presenting as a heavily bleeding vaginal lesion 3 weeks after uterine evacuation. BMJ Case Rep 2021; 14:14/6/e242208. [PMID: 34155019 DOI: 10.1136/bcr-2021-242208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Gestational trophoblastic disease occurs in 1-3:1000 gestations worldwide. Up to one-fifth of complete hydatidiform moles undergo malignant transformation, with 2%-4% manifesting as metastatic disease. Of these, a third present with vaginal metastases, which can cause bleeding and discharge. We describe the case of a 49-year-old primiparous woman presenting with syncope and intense bleeding from an anterior vaginal lesion, 3 weeks after uterine evacuation for a presumed spontaneous abortion. A vaginal metastatic nodule was suspected; haemostasis was achieved with vaginal packing, precluding the need for surgical intervention. The patient was ultimately diagnosed with invasive mole with vaginal and lung metastases (stage III high-risk gestational trophoblastic neoplasia (GTN)) and started on multiple-agent chemotherapy. Two months later the lesion had regressed completely, and remission was reached 2 weeks later. Clinicians should consider the possibility of metastatic GTN with vaginal involvement whenever heavy vaginal bleeding follows a recent history of failed pregnancy.
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Affiliation(s)
- Rita Mamede
- Obstetrics and Gynaecology Department, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | - Mariana Beja
- Obstetrics and Gynaecology Department, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | - Dusan Djokovic
- Obstetrics and Gynaecology Department, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal.,Obstetrics and Gynaecology Department, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Cristina Costa
- Obstetrics and Gynaecology Department, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal.,Obstetrics and Gynaecology Department, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
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Rosalik K, Tarney C, Han J. Human Papilloma Virus Vaccination. Viruses 2021; 13:v13061091. [PMID: 34201028 PMCID: PMC8228159 DOI: 10.3390/v13061091] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 12/30/2022] Open
Abstract
Human papilloma virus (HPV) is the most common sexually transmitted infection worldwide causing a variety of benign and malignant conditions. A significant portion of the global population is infected with HPV, with the virus attributed to causing up to 5% of cancers worldwide. Bivalent, quadrivalent, and nine-valent vaccinations exist to aid in the prevention of these diseases and have been proven to be effective at preventing both benign and malignant disease. While vaccination is readily accessible in more developed countries, barriers exist to worldwide distribution and acceptance of vaccination. Vaccination and screening of HPV infection when used in combination are proven and predicted to decrease HPV related pathology. Improvements in vaccination formulations, for treatment as well as prevention, are actively being sought from a variety of mechanisms. Despite these advancements, and the data supporting their efficacy, there has been substantial delay in obtaining adequate vaccination coverage. In reviewing these challenges and looking forward to new vaccine development—especially within the current pandemic—it is clear from the challenges of HPV we require methods to more effectively encourage vaccination, ways to dispel vaccination myths as they occur, and implement better processes for vaccine distribution globally.
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Affiliation(s)
- Kendal Rosalik
- Madigan Army Medical Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431, USA;
- Correspondence:
| | - Christopher Tarney
- Madigan Army Medical Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431, USA;
| | - Jasmine Han
- General Leonard Wood Army Community Hospital, Department of Obstetrics and Gynecology, 4430 Missouri Ave, Ford Leonard Wood, MO 65473, USA;
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Ninimiya SY, Ansu-Mensah M, Bawontuo V, Kuupiel D. Mapping evidence on ovarian, endometrial, vaginal, and vulva cancer research in Africa: a scoping review protocol. Syst Rev 2021; 10:108. [PMID: 33849664 PMCID: PMC8045365 DOI: 10.1186/s13643-021-01654-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/29/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Globally, cancer is generally recognized as a developmental threat yet most countries in Africa lack capacity to diagnose cancer especially gynecological cancers resulting in late detection and poor outcomes. However, most studies on gynecological cancers in Africa tend to focus on cervical cancer compared to the other gynecological cancers. Therefore, this scoping review will aim to describe the existing literature on the epidemiological burden of ovarian, endometrial, vaginal, and vulva cancers, their risk factors, and potential screening methods/techniques in Africa to identify priority research gaps for further research to inform health policy decisions. METHODS The framework promulgated by Arksey and O'Malley and improved by Levac et al. will be used as a guide for this scoping review. A comprehensive search for relevant published studies in PubMed, CINAHL, SCOPUS, Google Scholar, and ScienceDirect with no date limitation to the last search date. The database search strategy will include keywords, Boolean operators, and medical subject heading terms. We will additionally consult the WHO/IARC website, IHME/Global Burden of Disease Study. A snowball approach will also be used to search the reference list of all included studies to obtain relevant papers for possible inclusion in this review. We will include articles that involve African countries, focused on ovarian, endometrial, vaginal, and vulva cancers, their risk factors, and potential screening methods/techniques in any language. We will exclude studies on cervical cancer and other cancers as well as review articles. The abstracts and full-text selection will be conducted by two independent reviewers using this review's eligibility criteria as a guide. All the review selection tools, and the data extraction form will be pilot tested for accuracy and consistency. The data will be organized into thematic areas, summarized and the results communicated narratively. DISCUSSION It is anticipated that this review will reveal important literature gaps to guide future research to inform health policy decisions about ovarian, endometrial, and rare gynecological neoplasms in Africa. This review's findings will be disseminated via peer review journals, conferences, and other social media such Twitter and LinkedIn.
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Affiliation(s)
- Sebastian Yidana Ninimiya
- Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana.,St. Theresa's Hospital, Nandom, Upper West Region, Ghana
| | | | - Vitalis Bawontuo
- Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana.,Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7530, South Africa
| | - Desmond Kuupiel
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7530, South Africa. .,Research for Sustainable Development (r4ds) consult, Sunyani, Ghana.
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Bonelli P, Borrelli A, Tuccillo FM, Buonaguro FM, Tornesello ML. The Role of circRNAs in Human Papillomavirus (HPV)-Associated Cancers. Cancers (Basel) 2021; 13:1173. [PMID: 33803232 PMCID: PMC7963196 DOI: 10.3390/cancers13051173] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 12/28/2022] Open
Abstract
Circular RNAs (circRNAs) are a new class of "non-coding RNAs" that originate from non-sequential back-splicing of exons and/or introns of precursor messenger RNAs (pre-mRNAs). These molecules are generally produced at low levels in a cell-type-specific manner in mammalian tissues, but due to their circular conformation they are unaffected by the cell mRNA decay machinery. circRNAs can sponge multiple microRNAs or RNA-binding proteins and play a crucial role in the regulation of gene expression and protein translation. Many circRNAs have been shown to be aberrantly expressed in several cancer types, and to sustain specific oncogenic processes. Particularly, in virus-associated malignancies such as human papillomavirus (HPV)-associated anogenital carcinoma and oropharyngeal and oral cancers, circRNAs have been shown to be involved in tumorigenesis and cancer progression, as well as in drug resistance, and some are useful diagnostic and prognostic markers. HPV-derived circRNAs, encompassing the HPV E7 oncogene, have been shown to be expressed and to serve as transcript for synthesis of the E7 oncoprotein, thus reinforcing the virus oncogenic activity in HPV-associated cancers. In this review, we summarize research advances in the biogenesis of cell and viral circRNAs, their features and functions in the pathophysiology of HPV-associated tumors, and their importance as diagnostic, prognostic, and therapeutic targets in anogenital and oropharyngeal and oral cancers.
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Affiliation(s)
- Patrizia Bonelli
- Molecular Biology and Viral Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (F.M.T.); (F.M.B.); (M.L.T.)
| | - Antonella Borrelli
- Innovative Immunological Models, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy;
| | - Franca Maria Tuccillo
- Molecular Biology and Viral Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (F.M.T.); (F.M.B.); (M.L.T.)
| | - Franco Maria Buonaguro
- Molecular Biology and Viral Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (F.M.T.); (F.M.B.); (M.L.T.)
| | - Maria Lina Tornesello
- Molecular Biology and Viral Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (F.M.T.); (F.M.B.); (M.L.T.)
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Fabian A, Krug D, Alkatout I. Radiotherapy and Its Intersections with Surgery in the Management of Localized Gynecological Malignancies: A Comprehensive Overview for Clinicians. J Clin Med 2020; 10:E93. [PMID: 33383960 PMCID: PMC7796321 DOI: 10.3390/jcm10010093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 02/07/2023] Open
Abstract
Surgery, including minimally invasive surgery, and radiotherapy are key modalities in the treatment of gynecological malignancies. The aim of this review is to offer the multidisciplinary care team a comprehensive summary of the intersections of surgery and radiotherapy in the local treatment of gynecological malignancies. Recent advances in radiotherapy are highlighted. Relevant publications were identified through a review of the published literature. Ovarian, endometrial, cervical, vaginal, and vulvar cancer were included in the search. Current guidelines are summarized. The role of radiotherapy in adjuvant as well as definitive treatment of these entities is synthesized and put into context with surgery, focusing on survival and quality of life. Although these outcomes have improved recently, further research must be focused on the number of life years lost, and the potential morbidity encountered by patients.
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Affiliation(s)
- Alexander Fabian
- Department of Radiation Oncology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany;
| | - David Krug
- Department of Radiation Oncology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany;
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany
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50
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Zhou WL, Yue YY. Radiotherapy Plus Chemotherapy Is Associated With Improved Survival Compared to Radiotherapy Alone in Patients With Primary Vaginal Carcinoma: A Retrospective SEER Study. Front Oncol 2020; 10:570933. [PMID: 33392073 PMCID: PMC7775586 DOI: 10.3389/fonc.2020.570933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/11/2020] [Indexed: 12/22/2022] Open
Abstract
Background The efficacy of radiotherapy plus chemotherapy (RTCT) versus radiotherapy alone (RT) in the treatment of primary vaginal carcinoma has been controversial. We aimed to evaluate the up-to-date efficacy of RTCT on primary vaginal carcinoma in a real-world cohort. Methods We performed a retrospective analysis in patients with primary vaginal carcinoma retrieved from the Surveillance, Epidemiology, and End Results Program database from 2004 to 2016. Kaplan-Meier survival curves were plotted and compared by the log-rank test. Inverse probability weighting (IPW)-adjusted multivariate Cox proportional hazards and Fine-Gray competing-risk model was applied. Results Of the 1,813 qualified patients with primary vaginal carcinoma from 2004 to 2016, 1,137 underwent RTCT and 676 underwent RT. The median survival time was 34 months for the RT group and 63 months for the RTCT group. RTCT was significantly associated with improved overall survival (unadjusted HR = 0.71, 95% CI 0.62-0.82, p < 0.001; adjusted HR = 0.73, 95% CI 0.63-0.84, p < 0.001) and cancer-specific survival (unadjusted sHR = 0.81, 95% CI 0.69-0.95, p = 0.012; adjusted sHR = 0.81, 95% CI 0.69-0.96, p = 0.016). Age, histological type, tumor size, surgery, and FIGO stage were all independent prognostic factors for survival (p < 0.05 for all). Subgroup analysis demonstrated that RTCT was significantly associated with better survival in most subgroups, except for those with adenocarcinoma, tumor size <2 cm, or FIGO stage I. Moreover, sensitivity analysis did not alter the beneficial effects of RTCT. Conclusion RTCT is significantly correlated with prolonged survival in patients with primary vaginal carcinoma. RTCT should be applied to most patients with primary vaginal carcinoma instead of RT alone, except for those with adenocarcinoma, tumor size <2 cm, or FIGO stage I.
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Affiliation(s)
- Wei-Li Zhou
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang-Yang Yue
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China
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