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Huang Z, Yao W, Zhong Z, Yang G, Liu J, Gu H, Huang J. Chemotherapy alone versus chemotherapy plus 125I brachytherapy for the second-line treatment of locally recurrent cervical cancer after/with radical treatment: A propensity score analysis. Heliyon 2024; 10:e24666. [PMID: 38298696 PMCID: PMC10828072 DOI: 10.1016/j.heliyon.2024.e24666] [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: 11/29/2023] [Revised: 12/25/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024] Open
Abstract
Rationale and objectives The primary aim of this study was to conduct a retrospective comparative analysis of the survival outcomes in patients with recurrent cervical cancer (CC). Specifically, we aimed to compare the efficacy of chemotherapy alone versus the combined approach of chemotherapy and 125I brachytherapy subsequent to the failure of initial chemotherapy treatment. Materials and methods Patients diagnosed with recurrent CC subsequent to the failure of initial chemotherapy from January 2007 to December 2016 were enrolled from 2 hospitals. These patients were then divided into two groups: Group A, which underwent second-line chemotherapy alone, and Group B, which received both second-line chemotherapy and 125I brachytherapy. The assessment of overall survival (OS) and progression-free survival (PFS) was carried out through propensity score matching (PSM) (1:1), Kaplan-Meier curves, log-rank tests, and Cox proportional hazard regression for survival analysis. Results A matched cohort comprising 88 patients each in Group A and Group B was included in the study. In Group A, the 1-, 2-, and 3-year cumulative PFS rates were 40.9 %, 15.9 %, and 5.7 % respectively, while in Group B, these rates were significantly higher at 79.5 %, 48.9 %, and 25.0 % (P = 0.003). Similarly, the 1-, 2-, and 3-year cumulative OS rates among Group A were 67.0 %, 27.3 %, and 5.7 % compared to 89.8 %, 63.6 %, and 30.7 % among Group B, suggesting a difference with statistical significance (P < 0.001) between the two groups. Moreover, the incidence of complications was similar between groups (P = 0.698). Conclusions Our findings suggest that the combined approach of chemotherapy and 125I brachytherapy yields superior therapeutic effects but similar complication rates compared to chemotherapy alone in patients experiencing local recurrence of CC following failed initial chemotherapy.
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Affiliation(s)
- Zhimei Huang
- Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, PR China
| | - Wang Yao
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Province Guangdong, PR China
| | - Zhihui Zhong
- Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, PR China
| | - Guang Yang
- Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, PR China
| | - Jihong Liu
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, PR China
| | - Haifeng Gu
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, PR China
| | - Jinhua Huang
- Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, PR China
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Lago V, Pradillo Aramendi T, Segarra-Vidal B, Padilla-Iserte P, Matute L, Gurrea M, Pontones JL, Delgado F, Domingo S. Comparation between the Bricker ileal conduit vs double-barrelled wet colostomy after pelvic exenteration for gynaecological malignancies. Eur J Obstet Gynecol Reprod Biol 2023; 282:140-145. [PMID: 36716537 DOI: 10.1016/j.ejogrb.2023.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/09/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND After exhausting other therapeutic options, pelvic exenteration is performed in patients who suffer from relapsed gynaecologic tumours, with most of them requiring some sort of urinary diversion. MATERIAL AND METHODS The main objective of this study was to assess the short- and medium/long-term urinary complications associated with the Bricker ileal conduit versus double-barrelled wet colostomy after performing a pelvic exenteration for gynaecologic malignancies. RESULTS A total of 61 pelvic exenterations were identified between November 2010 and April 2022; 29 Bricker ileal conduits and 20 double-barrelled wet colostomies were included in the urinary diversion analysis. Regarding the specific short-term urinary complications, no differences were found in the rate of urinary leakage (3 vs 0 %; p = 1), urostomy complications (7 vs 0 %; p = 0.51), acute renal failure (10 vs 20 %; p = 0.24) or urinary infection (0 vs 5 %; p = 0.41). Up to 69 % of patients with Bricker ileal conduits and 65 % of double-barrelled wet colostomies (p = 0.76) presented specific medium/long-term urinary complications. No differences in the rates of pyelonephritis (59 vs 53 %; p = 0.71), urinary fistula (0 vs 12 %; p = 0.13), ureteral stricture (10 vs 6 %; p = 1), conduit failure and reconstruction (7 vs 0 %; p = 0.53), renal failure (38 vs 29 %; p = 0.56) or electrolyte disorders (24 vs 18 %; p = 0.72) were found. CONCLUSIONS There are no significant differences in the rate of complications between double-barrelled wet colostomy and the Bricker ileal conduit. The long-term complications related to urinary diversion remained high regardless of the type of technique. In this context, the double-barrelled wet colostomy presents advantages such as the single stoma placement and the simplicity of the technique.
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Affiliation(s)
- Víctor Lago
- Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain; CEU Cardenal Herrera, Valencia, Spain.
| | | | | | | | - Luis Matute
- Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain
| | - Marta Gurrea
- Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain
| | - José Luis Pontones
- Urologic Oncology Department, University Hospital La Fe, Valencia, Spain
| | - Francisco Delgado
- Urologic Oncology Department, University Hospital La Fe, Valencia, Spain
| | - Santiago Domingo
- Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain
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Abu-Rustum N, Yashar C, Arend R, Barber E, Bradley K, Brooks R, Campos SM, Chino J, Chon HS, Chu C, Crispens MA, Damast S, Fisher CM, Frederick P, Gaffney DK, Giuntoli R, Han E, Holmes J, Howitt BE, Lea J, Mariani A, Mutch D, Nagel C, Nekhlyudov L, Podoll M, Salani R, Schorge J, Siedel J, Sisodia R, Soliman P, Ueda S, Urban R, Wethington SL, Wyse E, Zanotti K, McMillian NR, Aggarwal S. Uterine Neoplasms, Version 1.2023, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2023; 21:181-209. [PMID: 36791750 DOI: 10.6004/jnccn.2023.0006] [Citation(s) in RCA: 93] [Impact Index Per Article: 93.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Adenocarcinoma of the endometrium (also known as endometrial cancer, or more broadly as uterine cancer or carcinoma of the uterine corpus) is the most common malignancy of the female genital tract in the United States. It is estimated that 65,950 new uterine cancer cases will have occurred in 2022, with 12,550 deaths resulting from the disease. Endometrial carcinoma includes pure endometrioid cancer and carcinomas with high-risk endometrial histology (including uterine serous carcinoma, clear cell carcinoma, carcinosarcoma [also known as malignant mixed Müllerian tumor], and undifferentiated/dedifferentiated carcinoma). Stromal or mesenchymal sarcomas are uncommon subtypes accounting for approximately 3% of all uterine cancers. This selection from the NCCN Guidelines for Uterine Neoplasms focuses on the diagnosis, staging, and management of pure endometrioid carcinoma. The complete version of the NCCN Guidelines for Uterine Neoplasms is available online at NCCN.org.
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Affiliation(s)
| | | | | | - Emma Barber
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | - Susana M Campos
- Dana-Farber/Brigham and Women's Cancer Center
- Massachusetts General Hospital Cancer Center
| | | | | | | | | | | | | | | | | | | | | | - Jordan Holmes
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center
| | | | - Jayanthi Lea
- UT Southwestern Simmons Comprehensive Cancer Center
| | | | - David Mutch
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Christa Nagel
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Larissa Nekhlyudov
- Dana-Farber/Brigham and Women's Cancer Center
- Massachusetts General Hospital Cancer Center
| | | | | | - John Schorge
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - Rachel Sisodia
- Dana-Farber/Brigham and Women's Cancer Center
- Massachusetts General Hospital Cancer Center
| | | | - Stefanie Ueda
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | - Kristine Zanotti
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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Maluf FC, Zibetti GDM, Paulino E, de Melo AC, Racy D, Ferrigno R, Uson Junior PLS, Ribeiro R, Moretti R, Sadalla JC, Nogueira Rodrigues A, Carvalho FM, Baiocchi G, Callegaro-Filho D, Angioli R. Recommendations for the treatment of vulvar cancer in settings with limited resources: Report from the International Gynecological Cancer Society consensus meeting. Front Oncol 2022; 12:928568. [PMID: 36203438 PMCID: PMC9530794 DOI: 10.3389/fonc.2022.928568] [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: 04/25/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Due to scant literature and the absence of high-level evidence, the treatment of vulvar cancer is even more challenging in countries facing limited resources, where direct application of international guidelines is difficult. Recommendations from a panel of experts convened to address some of these challenges were developed. Methods The panel met in Rio de Janeiro in September 2019 during the International Gynecological Cancer Society congress and was composed of specialists from countries in Africa, Asia, Eastern Europe, Latin America, and the Middle East. The panel addressed 62 questions and provided recommendations for the management of early, locally advanced, recurrent, and/or metastatic vulvar cancer. Consensus was defined as at least 75% of the voting members selecting a particular recommendation, whereas a majority vote was considered when one option garnered between 50.0% and 74.9% of votes. Resource limitation was defined as any issues limiting access to qualified surgeons, contemporary imaging or radiation-oncology techniques, antineoplastic drugs, or funding for the provision of contemporary medical care. Results Consensus was reached for nine of 62 (14.5%) questions presented to the panel, whereas a majority vote was reached for 29 (46.7%) additional questions. For the remaining questions, there was considerable heterogeneity in the recommendations. Conclusion The development of guidelines focusing on areas of the world facing more severe resource limitations may improve medical practice and patient care.
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Affiliation(s)
- Fernando Cotait Maluf
- Hospital BP Mirante, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- *Correspondence: Fernando Cotait Maluf,
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Ter Glane L, Hegele A, Wagner U, Boekhoff J. Pelvic exenteration for recurrent or advanced gynecologic malignancies - Analysis of outcome and complications. Gynecol Oncol Rep 2021; 36:100757. [PMID: 33898694 PMCID: PMC8059060 DOI: 10.1016/j.gore.2021.100757] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 01/04/2023] Open
Abstract
Overall survival was 25.5% with a median follow-up of 47 months. Positive resection margins had a negative impact on survival. Neoadjuvant treatment correlated with achieving negative margins. 19% had no postoperative complications, major complications were observed in 40.4%
Pelvic exenterations are known to be a last resort therapeutic option for advanced or recurrent gynecologic malignancies, which are known to have poor prognosis. All women treated with anterior (APE) or total (TPE) pelvic exenteration at our University hospital within a five-year period were identified and their data retrospectively analysed. Parameters such as demographic information, tumor type and stage, previous therapy as well as complication rate and overall survival were evaluated. 47 women were enrolled in this study. Most common indication for PE was cervical cancer (51.1%) followed by carcinoma of the vagina (17%), vulva (10.6%), endometrium (8.5%), ovaries (4.3%) and uterus (2.1%). Patients had received 1, 2 or 3 treatment modalities prior in 12.8%, 38.8% and 21.2% respectively. Predominant urinary diversion was ileum conduit (75.5%). Major complications (Clavien Dindo ≥ III) were observed in 40.4%, none in 19.2%. Early mortality was 4.3%. Median Overall Survival (mOS) was 14 months with 2- and 3-year survival rates of 38.8% and 21.2% respectively. After a median follow up of 47 months, 25.5% were still alive. Excluding patients with metastatic disease (n = 10), mOS was 20.6 months with 2- and 3-year survival rates of 46% and 35.2%. OS was significantly worse for patients with positive margins (p = 0.003). Receiving neoadjuvant treatment (25.5%) correlated with negative margins (p = 0.013) but not with overall survival. PE is feasible with acceptable complication and mortality rates. The long-time benefit is notable bearing in mind the extensive nature of the malignancies and the procedure undertaken.
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Affiliation(s)
- L Ter Glane
- Department of Urology and Pediatric Urology, University Hospital of Giessen and Marburg (UKGM), Marburg, Germany
| | - A Hegele
- Department of Urology and Pediatric Urology, University Hospital of Giessen and Marburg (UKGM), Marburg, Germany.,Urological Center Mittelhessen, DRK Hospital Biedenkopf, Germany
| | - U Wagner
- Department of Gynecology, Gynecological Oncology and Gynecological Endocrinology, University Hospital of Giessen and Marburg (UKGM), Marburg, Germany
| | - J Boekhoff
- Department of Gynecology, Gynecological Oncology and Gynecological Endocrinology, University Hospital of Giessen and Marburg (UKGM), Marburg, Germany
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Gadducci A, Cosio S. Pharmacological Treatment of Patients with Metastatic, Recurrent or Persistent Cervical Cancer Not Amenable by Surgery or Radiotherapy: State of Art and Perspectives of Clinical Research. Cancers (Basel) 2020; 12:E2678. [PMID: 32961781 PMCID: PMC7565040 DOI: 10.3390/cancers12092678] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/04/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023] Open
Abstract
Cervical cancer patients with distant or loco-regional recurrences not amenable by surgery or radiotherapy have limited treatment options, and their 5-year overall survival (OS) rates range from 5% to 16%. The purpose of this paper is to assess the results obtained with chemotherapy and biological agents in this clinical setting. Several phase II trials of different cisplatin (CDDP)-based doublets and a phase III randomized trial showing a trend in response rate, progression-free survival, and OS in favor of CDDP + paclitaxel (PTX) compared with other CDDP-based doublets have been reviewed. The factors predictive of response to chemotherapy as well as the benefits and risks of the addition of bevacizumab to CDDP + PTX have been analyzed. The FDA has recently approved pembrolizumab for patients with recurrent or metastatic cervical cancer in progression on or after chemotherapy whose tumors were PD-L1 positive. Interesting perspectives of clinical research are represented by the use of immune checkpoint inhibitors alone or in addition to chemotherapy, whereas PARP inhibitors and PI3K inhibitors are still at the basic research phase, but promising.
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Affiliation(s)
- Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, 56127 Pisa, Italy;
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Rodriguez J, Fletcher A, Heredia F, Fernandez R, Ramírez Salazar H, Sanabria D, Burbano Luna J, Guerrero E, Pierre M, Rendón GJ, Rosero I, Trujillo LM, Ribeiro R, Baiocchi G, Lopez Blanco A, Malca M, Hoegl J, Borges Garnica A, Lasso de la Vega J, Scasso S, Laufer J, Estrada EE, Gutierrez Criado A, Herbert Nuñez GS, Cantú‐de Leon D, Medina G, Pendola Gómez L, Saadi J, Noll F, Arévalo Sandoval D, Ferreira Oliveira A, Pareja R. Alternative management for gynecological cancer care during the COVID-2019 pandemic: A Latin American survey. Int J Gynaecol Obstet 2020; 150:368-378. [PMID: 32526044 PMCID: PMC9087623 DOI: 10.1002/ijgo.13272] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/20/2020] [Accepted: 06/05/2020] [Indexed: 12/13/2022]
Abstract
Objective To determine the acceptance rate of treatment alternatives for women with either preinvasive conditions or gynecologic cancers during the COVID‐19 pandemic among Latin American gynecological cancer specialists. Methods Twelve experts in gynecological cancer designed an electronic survey, according to recommendations from international societies, using an online platform. The survey included 22 questions on five topics: consultation care, preinvasive cervical pathology, and cervical, ovarian, and endometrial cancer. The questionnaire was distributed to 1052 specialists in 14 Latin American countries. A descriptive analysis was carried out using statistical software. Results A total of 610 responses were received, for an overall response rate of 58.0%. Respondents favored offering teleconsultation as triage for post‐cancer treatment follow‐up (94.6%), neoadjuvant chemotherapy in advanced stage epithelial ovarian cancer (95.6%), and total hysterectomy with bilateral salpingo‐oophorectomy and defining adjuvant treatment with histopathological features in early stage endometrial cancer (85.4%). Other questions showed agreement rates of over 64%, except for review of pathology results in person and use of upfront concurrent chemoradiation for early stage cervical cancer (disagreement 56.4% and 58.9%, respectively). Conclusion Latin American specialists accepted some alternative management strategies for gynecological cancer care during the COVID‐19 pandemic, which may reflect the region’s particularities. The COVID‐19 pandemic led Latin American specialists to accept alternative management strategies for gynecological cancer care, especially regarding surgical decisions. The COVID‐19 pandemic led Latin American specialists to accept alternative management strategies for gynecological cancer care, especially regarding surgical decisions.
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Affiliation(s)
- Juliana Rodriguez
- Department of Gynecologic OncologyInstituto Nacional de CancerologíaBogotáColombia
- Section of Gynecologic OncologyFundación Santa Fe de BogotáBogotáColombia
| | - Angélica Fletcher
- Department of Gynecologic OncologyCentro de Investigaciones Oncológicas Clínica San Diego – CIOSADBogotaColombia
| | - Fernando Heredia
- Department of Gynecology and ObstetricsSchool of MedicineUniversidad de ConcepciónConcepciónChile
| | | | | | - Daniel Sanabria
- Section of Gynecologic OncologyFundación Santa Fe de BogotáBogotáColombia
| | | | - Eduardo Guerrero
- Department of Radiotherapy OncologyInstituto Nacional de CancerologíaBogotaColombia
| | - Marc‐Edy Pierre
- Department of OncologyCentro de InvestigacionesOncológicas Clínica San Diego ‐ CIOSADBogotaColombia
| | - Gabriel J. Rendón
- Department of Gynecologic OncologyInstituto de Cancerología‐Las Américas‐Auna, Hospital GeneralMedellínColombia
| | - Indira Rosero
- Unit of CancerCentro Médico ImbanacoClínica Nuestra Señora de los RemediosCaliColombia
| | - Lina María Trujillo
- Department of Gynecologic OncologyInstituto Nacional de CancerologíaBogotáColombia
| | - Reitan Ribeiro
- Department of Surgical OncologyErasto Gaertner HospitalCuritibaBrazil
| | - Glauco Baiocchi
- Department of Gynecologic OncologyAC Camargo Cancer CenterSao PauloBrazil
| | - Aldo Lopez Blanco
- Department of Gynecologic surgeryInstituto Nacional de Enfermedades NeoplásicasLimaPerú
| | - Magaly Malca
- Service of Gynecologic OncologyHospital Edgardo Rebagliati MartinsLimaPerú
| | - Jorge Hoegl
- Service of Gynecologic OncologyServicio Oncológico HospitalarioCaracasVenezuela
| | | | | | - Santiago Scasso
- Department of Gynecologic OncologyHospital Pereira RossellMontevideoUruguay
| | - Joel Laufer
- Department of Gynecologic OncologyHospital Pereira RossellMontevideoUruguay
| | | | | | | | | | | | - Luis Pendola Gómez
- Service of MastologyION SolcaCentro Oncológico Integral (CENONI)GuayaquilEcuador
| | - José Saadi
- Service of GynecologySection of Gynecologic OncologyHospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Florencia Noll
- Service of GynecologySection of Gynecologic OncologyHospital Italiano de Buenos AiresBuenos AiresArgentina
| | | | | | - Rene Pareja
- Department of Gynecologic OncologyInstituto Nacional de CancerologíaBogotáColombia
- Clínica de Oncología AstorgaUniversidad Pontificia BolivarianaMedellinColombia
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Federico A, Gallotta V, Foschi N, Costantini B, Conte C, Pinto F, Ercoli A, Ferrandina G, Dal Moro F, Bassi P, Zattoni F, Scambia G, Vizzielli G. Surgical outcomes of segmental ureteral resection with ureteroneocystostomy after major gynecologic surgery. Eur J Surg Oncol 2020; 46:1366-1372. [PMID: 32278519 DOI: 10.1016/j.ejso.2020.03.216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/09/2020] [Accepted: 03/21/2020] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Describing the surgical and oncological outcome of bladder-preserving ureter reconstruction (BPUR) with segmental ureteral resection after major gynecologic surgery. MATHERIALS AND METHODS Patients with BPUR admitted at a single institution between March 2012 and July 2018 were retrospectively analyzed. Surgical and oncological data were assessed. RESULTS Forty-six women with gynecologic tumors involving the ureter were treated with BPUR. R0 resection was achieved in 40/46 patients (86.9%), while pathologic margins were microscopically positive in 6 women (13.1%). Overall, 12 women (26.0%) received radiotherapy before surgery: among them, 8 patients received neoadjuvant chemoradiotherapy. Twenty-six women underwent BPUR during primary surgery, whereas 20 (43.4%) required BPUR upon recurrence. Twenty-six patients (56.2%) were found to have hydronephrosis at pre-operative workup. The psoas bladder hitch was the most common procedure performed for urinary reconstruction (63%) with respect to direct reimplantation (37%). Fourteen patients (14/46 = 30.4%) experienced urological complications. Urinary leakage occurred in 9 patients (19.5%), specifically: 5 uretero-vaginal fistula, 3 uroperitoneum, 1 uretero-enteral fistula. There were 3 cases (6.5%) of hydronephrosis at the side of ureteroneocystostomy and 2 cases (4.3%) of unilateral renal impairment requiring nephrectomy. At multivariate analysis only pre-operative radiotherapy (p = 0.047) and a history of pelvic irradiation (p = 0.025) were independently associated with an increased risk of developing severe urinary complications. CONCLUSIONS BPUR is feasible in gynecologic cancer with invasion of the urinary tract. However, since a slight increase of post-operative urological complications was observed in the previously irradiated fields, a personalized surgical planning is recommended for these women in the next future.
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Affiliation(s)
- Alex Federico
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Valerio Gallotta
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Nazario Foschi
- Division of Urology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Barbara Costantini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Carmine Conte
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Francesco Pinto
- Division of Urology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Alfredo Ercoli
- Department of Obstetrics and Gynecology, University of Messina, Messina, Italy
| | - Gabriella Ferrandina
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabrizio Dal Moro
- Department of Surgery, Oncology and Gastroenterology-Urology, University of Padua, Padua, Italy
| | - Pierfrancesco Bassi
- Division of Urology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Filiberto Zattoni
- Department of Surgery, Oncology and Gastroenterology-Urology, University of Padua, Padua, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Vizzielli
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Department of Surgery, Oncology and Gastroenterology-Urology, University of Padua, Padua, Italy.
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[Place of radiotherapy and surgery in the treatment of cervical cancer patients]. Cancer Radiother 2019; 23:737-744. [PMID: 31455591 DOI: 10.1016/j.canrad.2019.07.151] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/12/2019] [Accepted: 07/18/2019] [Indexed: 11/22/2022]
Abstract
The treatment of cervical cancer patients relies on surgery and radiotherapy (according to the stage) and requires a multimodal discussion before any treatment to avoid adding the morbidities of each individual intervention and to optimize functional and oncological outcomes. The places of surgery and radiotherapy have been highlighted in recent international guidelines. For early stage tumors, an exclusive surgery with or without fertility sparing (according to well defined criteria) is the therapeutic standard. For tumors with risk factors (measuring more than 2cm in size and/or presence of lymphovascular invasion) a preoperative brachytherapy can be proposed to minimize the need for postoperative external beam radiotherapy and optimize local control. For locally advanced disease, the standard treatment relies on chemoradiation followed by a brachytherapy boost. A primary paraaortic lymph node dissection may guide radiotherapy volumes and is useful to identify patients requiring a para-aortic radiotherapy. The technical evolutions of surgical approaches and technological improvement of radiotherapy and brachytherapy should be analyzed in the context of prospective studies. We review the literature on the respective places of radiotherapy and surgery for the treatment of cervical cancer.
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Factors Predictive of 90-Day Morbidity, Readmission, and Costs in Patients Undergoing Pelvic Exenteration. Int J Gynecol Cancer 2019; 28:975-982. [PMID: 29683876 DOI: 10.1097/igc.0000000000001251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Pelvic exenteration for recurrent gynecological malignancies is characterized by a high rate of severe complications. Factors predictive of morbidity, readmission, and cost were analyzed. METHODS Data of consecutive patients undergoing pelvic exenteration between January 2007 and December 2016 were prospectively evaluated. RESULTS Fifty-eight patients were included in the analysis. Anterior, posterior, and total exenterations were executed in 39 (67%), 9 (16%), and 10 (17%) patients, respectively. Ten (15.5%) severe complications occurred: 8 (20.5%), 0 (0%), and 1 (10%) after anterior, posterior, and total exenterations, respectively. Radiotherapy dosage, time between radiotherapy and surgery, and previous administration of chemotherapy did not influence 90-day complications and readmission. At multivariable analysis, albumin levels less than 3.5 g/dL (odds ratio, 16.2 [95% confidence interval, 2.85-92.8]; P = 0.002) and history of deep vein thrombosis (odds ratio, 9.6 [95% confidence interval, 0.93-98.2]; P = 0.057) were associated with 90-day morbidity. Low albumin levels independently correlated with readmission (P = 0.011). The occurrence of 90-day postoperative complications and readmission increased costs of a median of +12,500 and +6000 euros, respectively (P < 0.05). CONCLUSIONS Preoperative patient selection is a key point for the reduction of postoperative complications after pelvic exenteration. Further prospective studies are warranted to improve patient selection.
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Lin AJ, Ma S, Markovina S, Schwarz J, Mutch DG, Powell MA, Grigsby PW. Clinical outcomes after isolated pelvic failure in cervical cancer patients treated with definitive radiation. Gynecol Oncol 2019; 153:530-534. [PMID: 30905434 DOI: 10.1016/j.ygyno.2019.03.104] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/11/2019] [Accepted: 03/14/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To describe clinical outcomes in patients with isolated pelvic failures after definitive radiation treatment for cervical cancer. METHODS AND MATERIALS Cervical cancer patients with isolated pelvic failure after definitive radiation with brachytherapy boost were identified in a tertiary academic center database from 1997 to 2016. All patients received an FDG-PET scan prior to their initial treatment and at the time of their first recurrence. Isolated failures in the cervix or pelvic nodes were biopsy-proven. Distant failure and overall survival (OS) were censored outcomes. RESULTS Isolated pelvic failure was detected in 67(11%) out of 607 consecutive patients treated with external beam pelvic radiation and brachytherapy boost. The median time to isolated pelvic recurrence was 9 months (range 3-198). Median follow-up time for patients alive after isolated pelvic recurrence was 40 months (range 0.6-183). Of these 67 patients, 28(42%) received salvage surgery, 17(25%) received chemotherapy alone, and 22(33%) received neither surgery nor chemotherapy. The median time to distant failure after isolated pelvic failure was 20 months (95% CI 3-37), with no significant difference between patients treated surgically vs. non-surgically. FDG-avid pelvic and para-aortic nodes at initial presentation were associated with worse distant control after isolated pelvic failure (HR = 3.4, 95% CI 1.0-12). Median OS for patients treated with surgery, chemotherapy alone, and neither surgery nor chemotherapy was 29 months (95% CI 16-41), 12 months (95% CI 3-21), and 3 months (95% CI 1-5), respectively. CONCLUSIONS Patients who have pelvic and para-aortic nodal disease at initial presentation are at higher risk of failing distantly after isolated pelvic failure, which should be considered when counseling patients on aggressive surgical salvage. Surgical salvage was associated with prolonged survival after isolated pelvic failure.
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Affiliation(s)
- Alexander J Lin
- Department of Radiation Oncology, Washington University School of Medicine, United States of America
| | - Sirui Ma
- Department of Radiation Oncology, Washington University School of Medicine, United States of America
| | - Stephanie Markovina
- Department of Radiation Oncology, Washington University School of Medicine, United States of America
| | - Julie Schwarz
- Department of Radiation Oncology, Washington University School of Medicine, United States of America
| | - David G Mutch
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, United States of America
| | - Matthew A Powell
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, United States of America
| | - Perry W Grigsby
- Department of Radiation Oncology, Washington University School of Medicine, United States of America.
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Lago V, Poveda I, Padilla-Iserte P, Simón-Sanz E, García-Granero Á, Pontones JL, Matute L, Domingo S. Pelvic exenteration in gynecologic cancer: complications and oncological outcome. ACTA ACUST UNITED AC 2019. [DOI: 10.1186/s10397-019-1055-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Introduction
Pelvic exenteration (PE) is indicated in cases of unresponsive, recurrent pelvic cancer or for palliative intent. Despite the fact that the surgery is associated with a high rate of morbidity, it is currently the only real option that can effect a cure.
Material and methods
Patients who underwent PE between January 2011 and July 2017 in our centre were retrospectively reviewed. Data related to surgery, complications and outcomes were recorded.
Results
Twenty-three patients were included. PE was performed due to recurrent gynaecological cancer, persistence of disease and after first diagnosis in 19 (82%), 2 (9%) and 2 patients (9%), respectively. Total PE was performed in 15 cases (65%), followed by anterior PE in 5 cases (22%) and posterior PE in 3 cases (13%). Early grade II, III and IV complications occurred in 15 (65%), 5 (22%) and 2 patients (9%), respectively. No mortality was observed within 30 days. Medium-late grade II, III, IV and V complications occurred in 15 (65%), 11 (48%), 3 (13%) and 2 cases (9%), respectively. Two patients died after > 30-day period from surgery-related complications. The overall survival (OS) and disease-free survival (DFS) at 48 months after PE was 41.6% and 30.8% respectively.
Conclusions
PE provides about a 40% 4-year survival chance in a selected group of patients. The early-complications rate and 30-day mortality were acceptable. Nevertheless, the medium-late complication grades II–V were 65, 48, 18 and 9%, respectively. We must focus on identifying those patients who could potentially benefit most from PE.
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Le Saux O, Decullier E, Freyer G, Glehen O, Bakrin N. Long-term survival in patients with epithelial ovarian cancer following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). Int J Hyperthermia 2018; 35:652-657. [PMID: 30295114 DOI: 10.1080/02656736.2018.1518544] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE Despite a high response rate to first-line therapy, prognosis of epithelial ovarian carcinoma (EOC) remains poor. The objective of the present study was to evaluate the frequency of long-term survivors and to identify the prognostic factors associated with long-term survival in a French cohort of 566 patients. METHODS Patients treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for EOC in 13 French centers between 1991 and 2010 were included. Long-term survivors were defined as patients who survived more than 5 years after HIPEC and CRS, irrespective of relapse. RESULTS Seventy-eight long-term survivors were analyzed. The median follow-up was 74 months. Median age at the time of first HIPEC was 55.4 years (range [22.6-77.6]. Seven patients had advanced EOC and 71 patients had recurrent EOC (37 patients had platinum-resistant EOC and 32 had platinum-sensitive disease). More than half of the long-term survivors had high-grade serous ovarian cancer (HGSOC). In univariate analysis, age ≥50 years (p = .004), peritoneal cancer index (PCI) ≤ 8 (p = .049) and CA-125 < 100 (p = .02) were associated with long-term survival. There was a trend towards an association between higher CC-score and long-term survival (p = .057). CONCLUSION Age ≥50 years, PCI ≤8 and CA125 < 100 were associated with long-term survival in univariate analysis. There was a trend towards the significance of CC-score. Platinum-status was not associated with long-term survival.
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Affiliation(s)
- Olivia Le Saux
- a Medical oncology department , Hospices Civils de Lyon, Université de Lyon , Lyon , France
| | | | - Gilles Freyer
- a Medical oncology department , Hospices Civils de Lyon, Université de Lyon , Lyon , France
| | - Olivier Glehen
- c Department of General and Digestive Surgery , Centre Hospitalier Lyon Sud, Lyon 1 University , Lyon , France
| | - Naoual Bakrin
- c Department of General and Digestive Surgery , Centre Hospitalier Lyon Sud, Lyon 1 University , Lyon , France
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Lancrajan I, Lisencu I, Ignat L, Trisca R, Coman M, Mocean F. Improving communication within the interdisciplinary team monitoring young women with onco-gynecological pathology in Romania. ACTA ACUST UNITED AC 2018; 91:307-311. [PMID: 30093809 PMCID: PMC6082600 DOI: 10.15386/cjmed-948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 02/15/2018] [Accepted: 03/07/2018] [Indexed: 11/23/2022]
Abstract
Background The quality of medical care, as well as the application of effective treatments in the management of patients with gynecologic neoplasm, is of great importance. Finding new and efficient ways of communication between the doctors involved in the multidisciplinary team for the management of the disease, from the diagnosis to the reintegration into society, would help improve the quality of comprehensive patient care. Objective The objective of the study was to assess the collaboration of family physicians with specialists treating patients suffering from gynecologic cancer, in order to improve the relationship between them via electronic communication. Study design We conducted a descriptive, transversal study on 353 family physicians and 37 specialist doctors from Romania, between January and June 2015. For statistical data analysis, R for Data Analysis and Graphics version 3.2.1 was used. Results Most of the family physicians and specialist doctors believed that they provided the best care that they could, but consider that a multidisciplinary approach using online communication methods, in which doctors collaborate among each other, is needed. Conclusions Finding a simple, efficient and modern means of communication is essential in order to increase the efficiency of medical care overall.
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Affiliation(s)
- Ioan Lancrajan
- Public Health and Management Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioan Lisencu
- Oncology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Laurentiu Ignat
- Oncology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Rares Trisca
- Oncology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Madalina Coman
- Public Health and Management Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Floarea Mocean
- Public Health and Management Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Clinician's Update on the Benign, Premalignant, and Malignant Skin Tumours of the Vulva: The Dermatologist's View. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2017; 2017:2414569. [PMID: 28812059 PMCID: PMC5547714 DOI: 10.1155/2017/2414569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 06/18/2017] [Indexed: 12/12/2022]
Abstract
Correct and rapid diagnosis of skin tumours often requires biopsy and histopathological examination to differentiate benign lesions such as seborrhoeic keratoses or melanocytic naevi from premalignant and malignant lesions such as malignant melanoma. Particularly, to the untrained eye, any benign skin tumour—pigmented or nonpigmented—is easily mistaken for a malignant lesion. Qualified clinical evaluation is paramount in order to reduce the frequency of unwarranted skin biopsies. Herein, the most common benign, premalignant, and malignant vulvar skin tumours are reviewed.
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Outcome of Patients with Cervical and Vaginal Stump Carcinomas Treated with More Conservative Surgical Approaches: a 9-Year Experience of a Tertiary Oncology Center. Indian J Surg Oncol 2017; 8:267-273. [DOI: 10.1007/s13193-017-0640-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 02/27/2017] [Indexed: 10/20/2022] Open
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Margolis B, Kim SW, Chi DS. Long-term survival after anterior pelvic exenteration and total vaginectomy for recurrent endometrial carcinoma with metastatic inguinal nodes at the time of surgery. Gynecol Oncol Rep 2016; 19:39-41. [PMID: 28070552 PMCID: PMC5219612 DOI: 10.1016/j.gore.2016.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/21/2016] [Accepted: 12/23/2016] [Indexed: 11/05/2022] Open
Abstract
Pelvic exenteration can be used in patients with multifocal recurrence. Ability to achieve negative margins remains a necessity for pelvic exenteration. Individualized treatments are essential for those with recurrent malignancy.
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Affiliation(s)
- Benjamin Margolis
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032, USA; New York Presbyterian Hospital, 622 W 168th St, New York, NY 10032, USA
| | - Sun Woo Kim
- New York Presbyterian Hospital, 622 W 168th St, New York, NY 10032, USA; Weill Cornell Medical College, Cornell University, 1300 York Ave, New York, NY 10065, USA
| | - Dennis S Chi
- Weill Cornell Medical College, Cornell University, 1300 York Ave, New York, NY 10065, USA; Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Boussios S, Seraj E, Zarkavelis G, Petrakis D, Kollas A, Kafantari A, Assi A, Tatsi K, Pavlidis N, Pentheroudakis G. Management of patients with recurrent/advanced cervical cancer beyond first line platinum regimens: Where do we stand? A literature review. Crit Rev Oncol Hematol 2016; 108:164-174. [DOI: 10.1016/j.critrevonc.2016.11.006] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 10/10/2016] [Accepted: 11/14/2016] [Indexed: 01/12/2023] Open
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Pelvic Exenterations for Advanced and Recurrent Endometrial Cancer: Clinical Outcomes of 40 Patients. Int J Gynecol Cancer 2016; 26:716-21. [DOI: 10.1097/igc.0000000000000678] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveThe aim of this study was to analyze the clinical experience and outcome of patients who have undergone pelvic exenteration for primary advanced or recurrent endometrial cancer.MethodsWe analyzed the medical records of 40 women who underwent pelvic exenteration to treat primary advanced or recurrent endometrial cancer.ResultsPelvic exenteration was performed in 40 patients with primary advanced or recurrent endometrial cancer. Three patients (8%) underwent a primary exenteration, and 37 patients (92%) underwent a secondary exenteration. A total exenteration, anterior exenteration, and posterior exenteration was performed in 85%, 5%, and 10% of patients, respectively.In 31 cases, exenteration was performed with a curative aim, and in 9 cases, exenteration was performed with a palliative aim. The overall survival rates were 61.4% at 5 years and 51.1% at 10 years. For the 31 patients who underwent pelvic exenteration with a curative aim, the overall survival rates were higher than those for the entire study population and were 72.6% at 5 years and 59.4% at 10 years. For the 9 patients who underwent a palliative exenteration, the overall survival rates were 19.1% at 5 years and 0% at 10 years. This is to the best of our knowledge the biggest study of pelvic exenteration in patients with endometrial cancer.ConclusionsOur data show that pelvic exenterations are a valid therapeutic option with long-term survival in select patients.
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Macrì A, Fleres F, Arcoraci V, Alibrandi A, Mandolfino T, Cucinotta E, Saladino E. Evaluation of the Short- and Long-Term Outcome Predictors in Patients Undergoing Posterior Pelvic Exenteration: A Single-Center Experience. J Gynecol Surg 2016. [DOI: 10.1089/gyn.2015.0081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Antonio Macrì
- Department of Human Pathology, University of Messina, Messina, Sicily, Italy
| | - Francesco Fleres
- Department of Human Pathology, University of Messina, Messina, Sicily, Italy
| | - Vincenzo Arcoraci
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Sicily, Italy
| | - Angela Alibrandi
- Department of Statistics, University of Messina, Messina, Sicily, Italy
| | - Tommaso Mandolfino
- Anesthesiology and Neuroreanimation Unit, University of Messina, Messina, Sicily, Italy
| | - Eugenio Cucinotta
- Department of Human Pathology, University of Messina, Messina, Sicily, Italy
| | - Edoardo Saladino
- Department of Human Pathology, University of Messina, Messina, Sicily, Italy
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Abstract
INTRODUCTION About one third of patients with endometrial cancer (EC) relapse and face a limited prognosis, if surgery or radiotherapy are not feasible. The remaining therapeutic options are chemotherapy and endocrine therapy. AREAS COVERED This review summarizes the development of the first selective estrogen receptor (ER) down-regulator fulvestrant. This article provides its mechanism of action, pharmacokinetics and the available preclinical and clinical data. Furthermore, this review provides an overview of the market of treatments for recurrent or metastatic EC (RMEC) while also taking into account studies of fulvestrant in metastatic breast cancer. EXPERT OPINION Even if fulvestrant showed only marginal activity in two phase II trials, it shouldn't be abandoned but instead further developed in EC. Firstly, the dose of fulvestrant used in these trials was too low from today's point of view. Secondly, the available literature on other endocrine agents is full of limitations and does not provide a gold standard. Furthermore, given the activity of mTOR inhibitors in EC, there may also be synergistic effects, given the cross-regulation of ER and the PI3K/AKT/mTOR pathway. The authors suggest that a prospective, phase II trial in ER positive RMEC would help to further explore the efficacy and tolerability of fulvestrant together with a mTOR inhibitor.
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Affiliation(s)
| | - Marcus Schmidt
- a Department of Obstetrics and Gynecology , University Hospital Mainz , Mainz , Germany
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Our Experience of Laparoscopic Anterior Exenteration in Locally Advanced Cervical Carcinoma. J Minim Invasive Gynecol 2015; 23:396-403. [PMID: 26723571 DOI: 10.1016/j.jmig.2015.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 01/06/2023]
Abstract
STUDY OBJECTIVE To show the feasibility, technique, and results of laparoscopic anterior exenteration in selected patients. DESIGN A retrospective cohort study. SETTING Galaxy Care Laparoscopy Institute, Pune, India. PATIENTS Seventy-four of 85 patients who underwent laparoscopic anterior exenteration for stage IVA carcinoma of the cervix from January 2005 to January 2015 were analyzed; the median follow-up was 30 months. Contrast-enhanced computed tomographic imaging of the abdomen and pelvis was performed for all patients. INTERVENTIONS The same surgeon and team performed all the operations for uniformity in 10 operative steps. MEASUREMENTS AND MAIN RESULTS The mean operative time was 180 minutes, and the mean blood loss was 160 mL. The mean hospital stay was 6 days. The average number of lymph nodes removed was 21.4. Surgical margins were negative in all patients. Forty-two patients had positive lymph nodes. Chemoradiation was given to those with positive lymph nodes. Perioperative complications occurred in 15 (20.27%) patients including deep vein thrombosis, urinary tract infection, ureterosigmoid leak (n = 2/74), and so on. Positron emission tomographic imaging and computed tomographic scanning were performed at 6 months after surgery and 6 months after adjuvant therapy in those with positive lymph nodes. There was no immediate postoperative mortality. The overall survival rate at 5 years was 25%. CONCLUSION Laparoscopic anterior exenteration is feasible in cases of advanced carcinoma of the cervix. Results have shown that in selected patients this procedure is associated with good long-term survival.
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Management of recurrent or metastatic endometrial cancer in Germany: results of the nationwide AGO pattern of care studies from the years 2013, 2009 and 2006. Arch Gynecol Obstet 2015; 292:1355-60. [PMID: 26099624 DOI: 10.1007/s00404-015-3786-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 06/08/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The available literature on the treatment options for recurrent or metastatic endometrial cancer (EC) is full of controversies. Therefore, we explore the results of the AGO pattern of care studies from the years 2013, 2009 and 2006. METHODS A questionnaire was developed and sent to all 682 German gynecological departments in 2013 (775 in 2009, 500 in 2006, respectively). The results of the questionnaires were compared with each other using Fisher's exact test. RESULTS Responses were available in 40.0 % in 2013, 33.3 % in 2009 and 35.8 % in 2006. In 2013 the most preferred endocrine drug was progestin (79.8 %), followed by tamoxifen (42.8 %), aromatase inhibitor (19.8 %), fulvestrant (16.3 %) and a combination (3.9 %) (p < 0.001). 65.3, 59.8, 51.7 and 38.2 % of the participants used platinum, taxane, a combination of cytostatic drugs, anthracycline in metastatic EC, respectively (p = 0.215). 96.2, 92.7, 49.8 and 60.9 % of the participants performed an operation, radiotherapy, endocrine therapy and chemotherapy in 2013 because of a local recurrence, respectively (p < 0.001). Compared to 2009 and 2006 these rates remained stable (no p value <0.05). Because of a distant metastasis 50.4, 64.2, 78.5 and 90.8 % of the participants performed an operation, radiotherapy, endocrine therapy and chemotherapy in 2013, respectively (p < 0.001). Compared to 2009 and 2006 more participants performed an operation or radiotherapy and less an endocrine treatment. CONCLUSIONS Whereas progestin was the favorite drug, the participants of this study did not prefer a specific cytostatic drug for metastatic EC in 2013. This might have reflected the available literature, which did not provide a real standard of care.
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Evaluation of outcome and prognostic factors in 739 patients with uterine cervix carcinoma: a single institution experience. Contemp Oncol (Pozn) 2015; 19:130-6. [PMID: 26034391 PMCID: PMC4444446 DOI: 10.5114/wo.2015.51418] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 09/30/2014] [Accepted: 10/06/2014] [Indexed: 11/27/2022] Open
Abstract
Aim of the study The aim of this retrospective chart review was to determine the long-term outcomes and identify prognostic factors that impact the survival of patients with cervical cancer. Material and methods A retrospective chart review of 739 patients with International Federation of Gynaecology and Obstetrics (FIGO) stage I–IV cervical cancer treated with surgery, radiation or chemoradiation was performed. Patient charts were evaluated in terms of demographics, clinical outcomes, and survival. Disease-free survival (DFS) and overall survival (OS) were calculated with the Kaplan-Meier method, and differences in survival were compared with the log-rank test. Multivariate analysis was performed with a Cox proportional hazards model to determine the estimated hazard ratios (HR) with 95% confidence intervals (CI) for each prognostic factor. Results The Cox proportional hazards model demonstrated that pelvic nodal metastasis (p = 0.018), parametrial invasion (p = 0.015), and presence of disease in the surgical margin (p = 0.011) were all independent prognostic factors for OS. The 5-year OS rate of patients with negative pelvic lymph nodes was 67.1%, which was higher than the rate for those with positive nodes at 49.0% (p < 0.05). The 5-year OS rate was 54.3% for patients with metastasis to the parametrium, 79.2% with a cancer-free parametrium, 60.9% with a cancer-positive surgical margin, 85.4% with a cancer-negative surgical margin, and 64.3% with a 1–3 mm close surgical margin (p < 0.05). Conclusions Assessing pelvic lymph nodes, the parametrium, and surgical margins is important for survival and may aid in better identifying patients who would derive greater benefits from receiving adjuvant therapies and more aggressive treatments.
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Ezzati M, Abdullah A, Shariftabrizi A, Hou J, Kopf M, Stedman JK, Samuelson R, Shahabi S. Recent Advancements in Prognostic Factors of Epithelial Ovarian Carcinoma. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:953509. [PMID: 27382614 PMCID: PMC4897239 DOI: 10.1155/2014/953509] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 08/26/2014] [Indexed: 01/03/2023]
Abstract
Ovarian cancer remains the most common cause of gynecologic cancer-related death among women in developed countries. Nevertheless, subgroups of ovarian cancer patients experience relatively longer survival. Efforts to identify prognostic factors that characterize such patients are ongoing, with investigational areas including tumor characteristics, surgical management, inheritance patterns, immunologic factors, and genomic patterns. This review discusses various demographic, clinical, and molecular factors implicating longevity and ovarian cancer survival. Continued efforts at identifying these prognosticators may result in invaluable adjuncts to the treatment of ovarian cancer, with the ultimate goal of advancing patient care.
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Affiliation(s)
- Mohammad Ezzati
- Department of Obstetrics and Gynecology, Washington Hospital Center, 110 Irving Street NW, Washington, DC 20010, USA
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Amer Abdullah
- Department of Obstetrics, Gynecology and Reproductive Biology, Danbury Hospital, 24 Hospital Avenue, Danbury, CT 06810, USA
| | - Ahmad Shariftabrizi
- Department of Pathology and Laboratory Medicine, School of Medicine, Tufts University, 800 Washington Street, Boston, MA 02111, USA
| | - June Hou
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine and Montefiore Medical Center, Montefiore Centennial, 3332 Rochambeau Avenue, Bronx, NY 10467-2836, USA
| | - Michael Kopf
- Department of Medicine, Danbury Hospital, 24 Hospital Avenue, Danbury, CT 06810, USA
| | - Jennifer K. Stedman
- Department of Obstetrics, Gynecology and Reproductive Biology, Danbury Hospital, 24 Hospital Avenue, Danbury, CT 06810, USA
| | - Robert Samuelson
- Department of Obstetrics, Gynecology and Reproductive Biology, Danbury Hospital, 24 Hospital Avenue, Danbury, CT 06810, USA
| | - Shohreh Shahabi
- Department of Obstetrics, Gynecology and Reproductive Biology, Danbury Hospital, 24 Hospital Avenue, Danbury, CT 06810, USA
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Does intra-operative radiation at the time of pelvic exenteration improve survival for patients with recurrent, previously irradiated cervical, vaginal, or vulvar cancer? Gynecol Oncol 2014; 135:95-9. [DOI: 10.1016/j.ygyno.2014.07.093] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 07/12/2014] [Accepted: 07/19/2014] [Indexed: 11/20/2022]
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Düzgüner S, Zengin T, Taşçı T, Turan T, Boran N, Tulunay G, Köse MF. Long-term survival after total pelvic exenteration in a patient with recurrent cervical carcinoma: A case report. Turk J Obstet Gynecol 2014; 11:186-188. [PMID: 28913015 PMCID: PMC5558332 DOI: 10.4274/tjod.04207] [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: 11/27/2013] [Accepted: 12/24/2013] [Indexed: 12/01/2022] Open
Abstract
The management of recurrent cervical cancer depends mainly on previous treatment as well as on the site and extent of recurrence. Pelvic exenteration usually represents the only therapeutic approach with curative intent for women with central pelvic relapse who have previously received irradiation. In the present report, we share our experience regarding survival outcome in a patient with recurrent endocervical carcinoma who underwent total pelvic exenteration.
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Affiliation(s)
- Soner Düzgüner
- Dr. Sami Ulus Women's Health Teaching and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Tuba Zengin
- Etlik Zübeyde Hanım Women's Health Teaching and Research Hospital, Clinic of Gynecologic and Oncology, Ankara, Turkey
| | - Tolga Taşçı
- Etlik Zübeyde Hanım Women's Health Teaching and Research Hospital, Clinic of Gynecologic and Oncology, Ankara, Turkey
| | - Taner Turan
- Etlik Zübeyde Hanım Women's Health Teaching and Research Hospital, Clinic of Gynecologic and Oncology, Ankara, Turkey
| | - Nurettin Boran
- Etlik Zübeyde Hanım Women's Health Teaching and Research Hospital, Clinic of Gynecologic and Oncology, Ankara, Turkey
| | - Gökhan Tulunay
- Etlik Zübeyde Hanım Women's Health Teaching and Research Hospital, Clinic of Gynecologic and Oncology, Ankara, Turkey
| | - Mehmet Faruk Köse
- Bahçeşehir University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
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Westin SN, Rallapalli V, Fellman B, Urbauer DL, Pal N, Frumovitz MM, Ramondetta LM, Bodurka DC, Ramirez PT, Soliman PT. Overall survival after pelvic exenteration for gynecologic malignancy. Gynecol Oncol 2014; 134:546-51. [PMID: 25014540 DOI: 10.1016/j.ygyno.2014.06.034] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/27/2014] [Accepted: 06/30/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Five-Year survival after pelvic exenteration for gynecologic malignancies has been reported as high as 60%. The objective of this study was to determine overall survival (OS) after pelvic exenteration and evaluate factors impacting outcome. METHODS A retrospective review of all women who underwent pelvic exenteration at our institution between February 1993 and December 2010 was performed. OS was defined as time from exenteration to date of death or last contact. Survival analysis was performed using the Kaplan Meyer method. Multivariate analysis was performed to determine the impact of clinical and pathologic factors on survival outcomes. RESULTS One hundred sixty patients with gynecologic malignancy underwent pelvic exenteration. Five-year recurrence free survival (RFS) was 33% (95%CI 0.25-0.40). Factors which negatively impacted RFS included shorter treatment-free interval (p=.050), vulvar primary (p=.032), positive margins (p<.001), lymphovascular space invasion (LVSI, p<.001), positive lymph nodes (p<.001) and perineural invasion (p=0.030). In multivariate analysis, positive margins (p=.040), positive nodes (p<.001) and lymphovascular space invasion (LVSI, p=.003) retained a significant impact on RFS. Five-year OS was 40% (95% CI 0.32-0.48). Factors which negatively impacted OS included vulvar primary (p=.04), positive margins (p<.001), LVSI (p<.001), positive lymph nodes (p<.001) and perineural invasion (p=.008). In multivariate analysis, positive nodes (p=.001) and LVSI (p=.001) retained a significant impact on OS. CONCLUSION Five-year OS after pelvic exenteration was 40%. Survival outcomes have not significantly improved despite improvements in technique and patient selection. Multiple non-modifiable factors at the time of exenteration are associated with poor survival.
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Affiliation(s)
- Shannon N Westin
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
| | - Vijayashri Rallapalli
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Bryan Fellman
- Department of Biostatistics, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Diana L Urbauer
- Department of Biostatistics, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Navdeep Pal
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Michael M Frumovitz
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Lois M Ramondetta
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Diane C Bodurka
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Pamela T Soliman
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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Garrido Sánchez M, Tello Jiménez E, Liberal Vinagre M, Müller Bravo A, Mestanza Garrido J. Revisión de la exenteración pélvica en el cáncer de cérvix. Descripción de nuestra casuística. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2014. [DOI: 10.1016/j.gine.2013.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pelvic exenteration for recurrent gynecologic malignancy: a study of 28 consecutive patients at a single institution. Int J Gynecol Cancer 2014; 23:755-62. [PMID: 23407096 DOI: 10.1097/igc.0b013e318287a874] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the outcomes of patients undergoing pelvic exenteration (PE) for recurrent gynecologic malignancy. METHODS A retrospective review using all medical records of 28 consecutive patients who underwent PE between January 2002 and December 2011 at a single institution was conducted. Complications were graded according to Clavien-Dindo. Overall survival (OS) and disease-free survival (DFS) were estimated by the method of Kaplan-Meier. RESULTS Pelvic exenteration was performed for recurrent cancer in all patients. Distribution of primaries was as follows: cervix (n = 10), vagina (n = 5), ovary (n = 5), uterus (n = 4), tube (n = 2), Bartholin gland (n = 1), and vulva (n = 1). In all but 1 case, PE was performed with curative intent. Pelvic exenteration was total (n = 11), anterior (n = 2), or posterior (n = 15). Reconstructive procedures included urinary tract (n = 13), gastrointestinal tract (n = 26), pelvic floor (n = 6), and vagina (n = 5). There was no postoperative mortality within 30 days. All patients developed 1 or several early complications of various grades, and 22 patients (79%) developed late complications. Twelve patients (43%) underwent reoperation because of complications to PE, and 2 patients died within follow-up as a consequence of their PE. A complete tumor resection (R0) was obtained in 23 patients (82%). With a median follow-up of 27 months (range, 2-110 months), the 5-year OS and DFS rates were 70% and 41%, respectively. R0 resection was associated with increased OS (P < 0.001) and DFS (P = 0.015). CONCLUSIONS Pelvic exenteration for recurrent gynecologic malignancies can be associated with long-term survival in selected patients. However, postoperative complications are common and can be lethal.
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Pelvic exenteration: impact of age on surgical and oncologic outcomes. Gynecol Oncol 2013; 132:114-8. [PMID: 24262877 DOI: 10.1016/j.ygyno.2013.11.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 11/09/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate whether preoperative age impacts surgical outcomes, complication rates, and/or recurrence in women undergoing pelvic exenteration. METHODS All women who underwent a pelvic exenteration for any gynecologic indication at our institution from 1993 to 2010 were included. Women were stratified into groups based on age in years (young: ≤ 50, middle: 51-64, and senior: ≥ 65). Baseline characteristics, surgical outcomes, early (<60 days) and late (≥ 60 days) postoperative complications, and recurrence/survival outcomes were ascertained. Fisher's exact test or Kruskal-Wallis test was performed. Kaplan-Meier survival curves were compared. RESULTS 161 patients were included (58 young, 62 in the middle, and 41 senior). Women in the young group predominately had a diagnosis of cervical cancer (82.8%) while women in the senior group primarily had a diagnosis of vulvar or vaginal cancer (70.7%). Senior women were also more likely to have hypertension (p < 0.0001) and pulmonary disease (p = 0.040). Operative time was significantly shorter for women in the senior group (8.5h) compared with the middle (9.5h) and young group (10.1h) (p = 0.0089). There were no significant differences in early or late complications when stratified by age. The overall survival did not differ between age groups (p = 0.3760). CONCLUSION Although hypertension and pulmonary disease were more frequent in the senior age group, duration of surgery, blood loss, length of hospital stay and complication rates did not increase with age. Advanced chronological age should not be considered a contraindication to a potentially curative surgical procedure.
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Landoni F, Zanagnolo V, Rosenberg P, Lopes A, Radice D, Bocciolone L, Aletti G, Parma G, Colombo N, Maggioni A. Neoadjuvant chemotherapy prior to pelvic exenteration in patients with recurrent cervical cancer: Single institution experience. Gynecol Oncol 2013; 130:69-74. [DOI: 10.1016/j.ygyno.2013.02.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 02/24/2013] [Accepted: 02/27/2013] [Indexed: 10/27/2022]
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Nationwide Analysis on Surgical Staging Procedures and Systemic Treatment for Patients With Endometrial Cancer in Germany. Int J Gynecol Cancer 2013; 23:105-12. [DOI: 10.1097/igc.0b013e3182781a6c] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectiveIn 2009 and 2006, the Arbeitsgemeinschaft Gynäkologische Onkologie evaluated therapeutic approaches for endometrial carcinoma (EC) in Germany.Methods and MaterialsA questionnaire was developed and sent to 775 German gynecologic departments in 2009 (500 in 2006). The results of the questionnaires were compared with each other and with the recommendations of the Arbeitsgemeinschaft Gynäkologische Onkologie’s guideline. Subgroup analyses were performed, dividing the participating centers into small and large centers and into centers with less and more experience with EC.ResultsResponses were available in 33.3% in 2009 and 35.8% in 2006. Comparing 2009 with 2006, it became apparent that peritoneal washing cytology was performed in 94.6% versus 86.9% (P= 0.008), pelvic lymphadenectomy (LAN) in 98.3% versus 95.3%, and paraaortic LAN in 90.2% versus 73.8% (P< 0.001) for endometrioid EC, and LAN for histologic high-risk subtypes of EC in 99.6% versus 94.2% (P= 0.001), respectively. In 2009, all these criteria met the recommendation of the guidelines. Reoperation for LAN after postoperative upstaging was performed in 66.1% versus 50.6% (P= 0.002), and adjuvant systemic treatment with chemotherapy and endocrine therapy was performed in 63.7% versus 48.8% (P= 0.003) and 25.7% versus 15.4% (P= 0.014), respectively. This showed nonadherence to the guidelines. Laparoscopic approach was performed in 30.4% versus 19.7% (P= 0.014) of the participating centers, respectively. In subgroup analysis, laparoscopic approach showed a significant difference between small centers (11.5%) and large centers (27.3%) in 2006 (P= 0.012).ConclusionsGerman hospitals increasingly follow the guidelines concerning LAN and peritoneal washing cytology. However, recommendations concerning reoperating in upstaged patients and adjuvant treatment decisions do not meet the guidelines, thus underlining great uncertainties in this field of gynecologic oncology.
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Baiocchi G, Guimaraes G, Rosa Oliveira R, Kumagai L, Faloppa C, Aguiar S, Begnami M, Soares F, Lopes A. Prognostic factors in pelvic exenteration for gynecological malignancies. Eur J Surg Oncol 2012; 38:948-54. [DOI: 10.1016/j.ejso.2012.07.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 04/30/2012] [Accepted: 07/02/2012] [Indexed: 10/28/2022] Open
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Yoo HJ, Lim MC, Seo SS, Kang S, Yoo CW, Kim JY, Park SY. Pelvic exenteration for recurrent cervical cancer: ten-year experience at National Cancer Center in Korea. J Gynecol Oncol 2012; 23:242-50. [PMID: 23094127 PMCID: PMC3469859 DOI: 10.3802/jgo.2012.23.4.242] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 07/02/2012] [Accepted: 07/03/2012] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate survival and morbidity after pelvic exenteration (PE) for the curative management of recurrent cervical cancer. Methods We retrospectively evaluated patients with recurrent cervical cancer who underwent PE from January 2001 to April 2011. Patients were identified from the registry of our institution. The clinical status and demographic information was obtained by reviewing the medical records. Results Sixty-one recurrent cervical cancer patients underwent PE. Patients who received radiotherapy, operation, chemotherapy before PE were 98%, 41%, and 23%, respectively. The total morbidity rate was 44%; 10 (16%) patients had early complications (30 days or less after PE), whereas 22 (36%) patients had late complications. Wound problems were common early complications (7/18), and bowel fistulas were common late complications (9/30). The five-year overall survival and five-year disease-free survival were 56% and 49%, respectively. Median follow-up was 22 months (range, 1.8 to 60 months). Affecting factors for overall survival were resection margin status, pelvic wall and rectal involvement. Conclusion Our overall 5-year survival is encouraging. Although the morbidity rate is still high, PE is a potentially curative opportunity in gynecological malignancies with no other treatment options. The most important factors for overall survival after PE are the resection margin status, pelvic wall involvement and rectal involvement.
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Affiliation(s)
- Heon Jong Yoo
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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Achilli C, Palaia I, Perniola G, Di Donato V, Marchetti C, Benedetti Panici P. Complete remission after neoadjuvant chemotherapy of an advanced vulvar cancer patient: A case report. J Obstet Gynaecol Res 2012; 38:1036-9. [DOI: 10.1111/j.1447-0756.2011.01821.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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38
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Covert WM, Westin SN, Soliman PT, Langley GD. The role of mucoregulatory agents after continence-preserving urinary diversion surgery. Am J Health Syst Pharm 2012; 69:483-6. [PMID: 22382478 DOI: 10.2146/ajhp110212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The postsurgical use of N-acetylcysteine, octreotide, and other agents to reduce mucus accumulation after urinary diversion procedures is described. SUMMARY Patients undergoing continence-sparing bladder resection are at risk for infection and stone formation due to mucus accumulation. In addition to N-acetylcysteine, agents studied for mucoregulatory control in such patients include aspirin, urea, ranitidine, and octreotide. N-acetylcysteine has high mucolytic activity in vitro, and positive outcomes with instillations of 20% N-acetylcysteine solution have been reported in some patients. Significant mucus reductions were reported in small numbers of patients treated with oral ranitidine 300 mg daily or instillations of 30 mL of urea 40% solution, while the benefits of aspirin are more questionable. To date, there has been only one randomized controlled trial comparing various agents for mucus reduction after reconstructive bladder surgery; the results indicated no significant benefits with the use of N-acetylcysteine, aspirin, or ranitidine. In one small study (n = 40), the use of subcutaneous octreotide immediately before and for 15 days after surgery was reported to yield significant reductions in mucus production, the need for bladder irrigation to clear blockages, and the mean duration of hospital stays. CONCLUSION Various agents evaluated for mucus control after urinary diversion procedures (oral ranitidine or aspirin, N-acetylcysteine or urea instillations, and subcutaneous octreotide), while reportedly effective for some patients, remain of questionable benefit. More research is needed to define the optimal role of these agents for this indication.
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Affiliation(s)
- Wendy M Covert
- Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, 77030, USA.
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Iglesias DA, Westin SN, Rallapalli V, Huang M, Fellman B, Urbauer D, Frumovitz M, Ramirez PT, Soliman PT. The effect of body mass index on surgical outcomes and survival following pelvic exenteration. Gynecol Oncol 2012; 125:336-42. [PMID: 22261299 DOI: 10.1016/j.ygyno.2012.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 01/05/2012] [Accepted: 01/08/2012] [Indexed: 10/14/2022]
Abstract
OBJECTIVE We sought to evaluate whether preoperative body mass index (BMI) impacts surgical outcomes, complication rates, and/or recurrence rates in women undergoing pelvic exenteration. METHODS All women who underwent pelvic exenteration for gynecologic indications at our institution from 1993 through 2010 were included. Women were stratified into 3 groups based on BMI. Baseline characteristics, surgical outcomes, early (<60 days) and late (≥ 60 days) postoperative complications, and recurrence/survival outcomes were collected. Multivariate logistic regression analyses were performed. Kaplan-Meier survival curves were compared using log-rank test. RESULTS 161 patients were included (59 normal weight, 44 overweight, 58 obese). Median follow-up times were 22, 29, and 25 months. Most patients underwent total pelvic exenteration (68%); 64.6% had a vaginal reconstruction. On multivariate analysis, both overweight and obese patients had a higher risk of early superficial wound separation compared to normal weight patients - OR 10.74 (3.33-34.62, p<0.001) and OR 4.35 (1.40-13.52, p=0.011), respectively. Length of surgery was significantly longer for overweight (9.6h, OR 1.26, 1.02-1.55, p=0.032) and obese (10.1h, OR 1.24, 1.04-1.47, p=0.014) patients than for normal weight patients (8.7h). Late postoperative complications for patients in the normal weight, overweight, and obese groups were 47.5%, 45.5%, and 43.1% (p=0.144). There were no differences in time to recurrence (p=0.752) or overall survival (p=0.103) between groups. CONCLUSION Although operative times were longer and risk for superficial wound separation was significantly higher, pelvic exenteration appears to be feasible and safe in overweight and obese women with overall complication rates and survival outcomes comparable to normal weight women.
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Affiliation(s)
- David A Iglesias
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA
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Abstract
Surgical management for cervical carcinoma uses a wide variety of procedures for all stages of disease, ranging from the most conservative excisional biopsy to aggressive extirpative surgery with sophisticated reconstruction. Innovative surgical procedures have given fertility-sparing treatment options to women of reproductive age, and refinement and use of minimally invasive surgical approaches have minimized operative morbidity without sacrificing outcomes. Conservative staging procedures are being evaluated to improve survival in locally advanced disease. There have been many breakthroughs in the treatment of cervical carcinoma over recent years, which have improved not only survival but also the quality of ensuing life for women afflicted by this disease.
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Affiliation(s)
- Jessica L Berger
- Department of Obstetrics and Gynecology, Banner Good Samaritan Medical Center, Phoenix, AZ 85006, USA.
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Forner DM, Lampe B. Exenteration as a primary treatment for locally advanced cervical cancer: long-term results and prognostic factors. Am J Obstet Gynecol 2011; 205:148.e1-6. [PMID: 21640963 DOI: 10.1016/j.ajog.2011.03.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 02/04/2011] [Accepted: 03/29/2011] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Whereas pelvic exenteration is an established therapy for the treatment of recurrent cervical carcinoma, it is not often performed for primary locally advanced cervical cancer (LACC). STUDY DESIGN This retrospective study analyzed survival data and prognostic factors of 35 patients with LACC who were treated by pelvic exenteration. RESULTS After surgery, 33 patients (97%) were macroscopically free of tumor. In 20 patients, pelvic lymph nodes (LN) were involved, and in 6 of these, metastatic tissue had reached the paraaortal nodes. Overall, the patients' mean 5 year survival was 43%, and the median survival time was 30 months; these values ranged from 15% to 70% and from 15 to 44 months, respectively, depending on LN involvement (P=.006). Pelvic LN involvement was the only significant factor for overall survival found in the multivariate analysis (P=.02). CONCLUSION In LACC with free LNs and no distant metastases, pelvic exenteration has good long-term results.
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Guckenberger M, Bachmann J, Wulf J, Mueller G, Krieger T, Baier K, Richter A, Wilbert J, Flentje M. Stereotactic body radiotherapy for local boost irradiation in unfavourable locally recurrent gynaecological cancer. Radiother Oncol 2010; 94:53-9. [PMID: 20079550 DOI: 10.1016/j.radonc.2009.12.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 11/20/2009] [Accepted: 12/17/2009] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate outcome of radiotherapy for locally recurrent cervical and endometrial cancer. MATERIALS AND METHODS Nineteen patients were treated for a locally recurrent cervical (n=12) or endometrial (n=7) cancer median 26 months after initial surgery (n=18) or radiotherapy (n=1). The whole pelvis was irradiated with 50Gy conventionally fractionated radiotherapy (n=16). Because of large size of the recurrent cancer (median 4.5 cm) and peripheral location (n=12), stereotactic body radiotherapy (SBRT; median 3 fractions of 5Gy to 65%) was used for local dose escalation instead of (n=16) or combined with (n=3) vaginal brachytherapy. RESULTS After median follow-up of 22 months, 3-year overall survival was 34% with systemic progression the leading cause of death (7/10). Median time to systemic progression was 16 months. Three local recurrences resulted in a local control rate of 81% at 3 years. No correlation between survival, systemic or local control and any patient or treatment characteristic was observed. The rate of late toxicity>grade II was 25% at 3 years: two patients developed a grade IV intestino-vaginal fistula and one patient suffered from a grade IV small bowel ileus. CONCLUSION Image-guided SBRT for local dose escalation resulted in high rates of local control but was associated with significant late toxicity.
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Affiliation(s)
- Matthias Guckenberger
- Department of Radiation Oncology, Julius-Maximilians University, Wuerzburg, Germany.
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GADDUCCI ANGIOLO, TANA ROBERTA, COSIO STEFANIA, CIONINI LUCA. Treatment options in recurrent cervical cancer (Review). Oncol Lett 2010; 1:3-11. [PMID: 22966247 PMCID: PMC3436344 DOI: 10.3892/ol_00000001] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Accepted: 09/15/2009] [Indexed: 11/06/2022] Open
Abstract
The management of recurrent cervical cancer depends mainly on previous treatment and on the site and extent of recurrence. Concurrent cisplatin-based chemo-radiation is the treatment of choice for patients with pelvic failure after radical hysterectomy alone. However, the safe delivery of high doses of radiotherapy is much more difficult in this clinical setting compared with primary radiotherapy. Pelvic exenteration usually represents the only therapeutic approach with curative intent for women with central pelvic relapse who have previously received irradiation. In a recent series, the 5-year overall survival and operative mortality after pelvic exenteration ranged from 21 to 61% and from 1 to 10%, respectively. Free surgical margins, negative lymph nodes, small tumour size and long disease-free interval were associated with a more favourable prognosis. Currently, pelvic reconstructive procedures (continent urinary conduit, low colorectal anastomosis, vaginal reconstruction with myocutaneous flaps) are strongly recommended after exenteration. Concurrent cisplatin-based chemo-radiation is the treatment of choice for isolated para-aortic lymph node failure, with satisfactory chances of a cure in asymptomatic patients. Chemotherapy is administered with palliative intent to women with distant or loco-regional recurrences not amenable by surgery or radiotherapy. Cisplatin is the most widely used drug, with a response rate of 17-38% and a median overall survival of 6.1-7.1 months. Cisplatin-based combination chemotherapy achieves higher response rates (22-68%) when compared with single-agent cisplatin, but median overall survival is usually less than one year. In a recent Gynecologic Oncology Group (GOG) trial the combination topotecan + cisplatin obtained a significantly longer overall survival than single-agent cisplatin in patients with metastatic or recurrent or persistent cervical cancer. A subsequent GOG study showed a trend in terms of longer overall survival and better quality of life for the doublet cisplatin + paclitaxel vs. the doublets cisplatin + topotecan, cisplatin + vinorelbine, and cisplatin + gemcitabine. Molecularly targeted therapy may represent a novel therapeutic tool, but its use alone or in combination with chemotherapy is still investigational.
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Affiliation(s)
- ANGIOLO GADDUCCI
- Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa 56127, Italy
| | - ROBERTA TANA
- Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa 56127, Italy
| | - STEFANIA COSIO
- Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa 56127, Italy
| | - LUCA CIONINI
- Department of Oncology, Division of Radiotherapy, University of Pisa, Pisa 56127, Italy
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Abstract
Cervical cancer is the second most common malignancy in women and the third most common cause of cancer mortality worldwide. While primary and secondary preventions exist, the lack of widespread adoption leaves the treatment of cervical cancer an important oncologic problem. In this article, the management of early and locally advanced cervical carcinoma is reviewed, including staging, imaging, prognostic factors, and primary and adjuvant therapy and their outcomes.
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Affiliation(s)
- Lisa Barbera
- Department of Radiation Oncology, University of Toronto, Odette Cancer Centre, Toronto, Ontario, Canada
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Maggioni A, Roviglione G, Landoni F, Zanagnolo V, Peiretti M, Colombo N, Bocciolone L, Biffi R, Minig L, Morrow CP. Pelvic exenteration: ten-year experience at the European Institute of Oncology in Milan. Gynecol Oncol 2009; 114:64-8. [PMID: 19411097 DOI: 10.1016/j.ygyno.2009.03.029] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 03/16/2009] [Accepted: 03/21/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Analyze morbidity and survival after pelvic exenteration (PE) of gynecological malignancies. METHODS We reviewed 106 consecutive patients with gynecologic malignancies who underwent PE from June 1996 to April 2007 at the Division of Gynecology, European Institute of Oncology (IEO), Milan. RESULTS PE was performed for cancer of the cervix (62 patients), vagina (21 patients), vulva (9 patients), endometrium (9 patients), ovary (4 patients) and 1 uterine sarcoma. Mean age was 53.6 (30-78) years. 97% of the patients received radiotherapy before PE and 3 patients had PE as primary treatment. We performed 53 anterior, 48 total and 5 posterior PE. Median operation time, estimated blood loss and hospital stay were respectively 490 (200-780) minutes, 1240 (300-6500) ml and 21.6 (11-55) days. No residual tumor was left in 93% of the patients. Median follow-up was 22.3 (1.6-117) months. There were no post-operative deaths (<30 days from surgery) nor intra-operative mortality. Total morbidity rate was 66%; 48% of patients had early complications (<30 days after PE) whereas 52 patients (48.5%) had late complications; 70% of these occurred to the urinary tract and 25% were due to bowel occlusions or fistulas. Overall survival was 52%, 35%, 19% and 16% respectively for cervical, endometrial, vaginal and vulvar cancer. CONCLUSIONS PE is a feasible technique with no post-operative mortality and high percentage of long-survivors, although the morbidity rate still remains significantly high. Careful patient selection, pre- and post-operative care and optimal surgical skills in a Gynecologic Oncologic Center are the cornerstones to further improve quality of life and survival for these patients.
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Affiliation(s)
- Angelo Maggioni
- Division of Gynecologic Oncology, European Institute of Oncology, Via Ripamonti 435-20141, Milan, Italy
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Linkov F, Taioli E. Factors influencing endometrial cancer mortality: the Western Pennsylvania Registry. Future Oncol 2009; 4:857-65. [PMID: 19086851 DOI: 10.2217/14796694.4.6.857] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Endometrial carcinoma is the most common cancer of the lower female genital tract in the USA. Various factors, including age, body mass index, race, disease stage, diabetes, histology, tumor grade and other comorbid conditions were associated with endometrial carcinoma mortality in previous case-control and cross-sectional studies not involving tumor registries. Cancer registries are important sources of data on endometrial cancer; however, they are rarely utilized in current research projects. The purpose of this study was to analyze factors associated with endometrial cancer mortality in the University of Pittsburgh Medical Center (UPMC) Magee Cancer Registry (PA, USA). METHODS Data were obtained from the UPMC cancer registry from 1996 to 2007. A total of 1614 cases were identified using the Honest Broker system at Magee Womens Hospital. Key factors involved in endometrial cancer mortality were identified through survival analysis. RESULTS Among the characteristics available from the cancer registry, the following were the main ones associated with endometrial cancer mortality: race, stage, chemotherapy, parity and lymph node involvement. CONCLUSIONS This is one of the first studies that reported factors influencing endometrial cancer mortality in patients residing in Pittsburgh area. An improved understanding of risk factors associated with endometrial cancer morbidity and mortality may hold a key to better preventive strategies for endometrial carcinoma, especially for women in high-risk groups.
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Affiliation(s)
- Faina Linkov
- University of Pittsburgh Cancer Institute, 5150 Centre Ave, Suite 4-C, Room 466, Pittsburgh, PA 15232, USA.
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van Wijk F, van der Burg M, Burger CW, Vergote I, van Doorn HC. Management of Recurrent Endometrioid Endometrial Carcinoma: An Overview. Int J Gynecol Cancer 2009; 19:314-20. [DOI: 10.1111/igc.0b013e3181a7f71e] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In this paper, an overview of the literature on the management of recurrent endometrial cancer is presented, focusing on patients with histopathologic endometrioid type of tumors. The different treatment modalities are described, and a management recommendation scheme is presented. Indications for surgical treatment depend on resectability, site and size of the tumor, and performance status of the patient. Indications for radiotherapy depend on the site of the recurrence and also on the initial therapy received. When considering systemic treatment for patients with recurrent endometrial cancer, it is important to take into account the general health status and condition of the patient as well as which prior therapy the patient has received. The treatments of choice for patients with hormone-sensitive tumors (positive receptor levels, low-grade tumors, and long disease-free interval) are progestagens as first-line treatment and tamoxifen as second-line treatment. Patients with high-grade tumors, negative hormone receptor levels, and short treatment-free interval are best treated with chemotherapy. Paclitaxel, doxorubicin, and cisplatin are the most active combination therapy for these patients but with significant toxicity. In phase II studies, the combination therapy with paclitaxel and carboplatin seems to be as effective but less toxic and can be administered in outpatient clinic. The literature on the management of patients with recurrent endometrial cancer is discussed in detail. The different sites of recurrent disease (ie, local, regional, and/or distant) are evaluated separately; management recommendations are proposed, and alternative approaches are given.
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Abstract
Radical hysterectomy has been the standard surgical treatment for cervical cancer, achieving a good survival outcome. However, it is a major operation that has considerable potential long-term morbidity. With good prognosis achieved in most early cervical cancers, there is a trend towards more emphasis on maintaining good quality of life post-treatment. Many women diagnosed with cervical cancer are young, and fertility-sparing surgery such as trachelectomy would preserve their reproductive potential. Minimally invasive surgery, such as laparoscopic radical hysterectomy, can potentially improve post-operative recovery and cosmetic results while maintaining oncological safety. Sentinel lymph nodes assessment can minimize unnecessary systematic pelvic lymphadenectomy. Radicality of the hysterectomy may also be reduced in selected individuals with good prognostic factors, thus minimizing long-term pelvic floor dysfunction. This review aims to give a broad overview of the current status of these new trends in surgical management for cervical cancer.
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Affiliation(s)
- Karen KL Chan
- Queen Elizabeth Hospital, Northern Gynaecological Oncology Centre, Sheriff Hill, Gateshead, Tyne and Wear, NE9 6XS, UK, Tel.: +44 191 445 2706; Fax: +44 191 445 6192
| | - Raj Naik
- Tel.: +44 191 445 2706; Fax: +44 191 445 6192
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Lohsiriwat V, Lohsiriwat D. Comparison of immediate surgical outcomes between posterior pelvic exenteration and standard resection for primary rectal cancer: A matched case-control study. World J Gastroenterol 2008; 14:2414-7. [PMID: 18416472 PMCID: PMC2705100 DOI: 10.3748/wjg.14.2414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM: To determine the immediate surgical outcome and recovery of bowel function following posterior pelvic exenteration (PPE) for primary rectal cancer with suspected local invasion to the female internal reproductive organs, in comparison with a case-control series of standard resection for primary rectal cancer.
METHODS: We analyzed 10 consecutive female patients undergoing PPE for the aforementioned indication between December 2003 and May 2006 in a single institution. Data were prospectively collected during hospitalization, including patient demographics, tumor- and operation-related variables and early surgical outcomes. These patients were compared with a group of female patients, matched for age, co-morbidity and location of tumor, who underwent standard resection for primary rectal cancer in the same period (non PPE group).
RESULTS: In the PPE group, pathological reports showed direct invasion of the reproductive organs in 4 cases and an involvement of lymph nodes in 7 cases. A sphincter-saving operation was performed in each case. Operative time was longer (274 min vs 157 min, P < 0.001) and blood loss was greater (769 mL vs 203 mL, P = 0.008) in the PPE group. Time to first bowel movement, time to first defecation, time to resumption of normal diet, and hospital stay were not significantly different between the two groups. Postoperative complication rates were also similar.
CONCLUSION: PPE for rectal cancer was associated with longer operative time and increased blood loss, but did not compromise immediate surgical outcomes and postoperative bowel function compared to standard rectal resection.
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