Radiation and hormonal therapy for primary treatment of stage I endometrial cancer and long-term survival

Progesterone Enhances Niraparib Efficacy in Ovarian Cancer by Promoting Palmitoleic-Acid-Mediated Ferroptosis

Poly (adenosine 5'-diphosphate-ribose) polymerase inhibitors (PARPi) are increasingly important in the treatment of ovarian cancer. However, more than 40% of BRCA1/2-deficient patients do not respond to PARPi, and BRCA wild-type cases do not show obvious benefit. In this study, we demonstrated that progesterone acted synergistically with niraparib in ovarian cancer cells by enhancing niraparib-mediated DNA damage and death regardless of BRCA status. This synergy was validated in an ovarian cancer organoid model and in vivo experiments. Furthermore, we found that progesterone enhances the activity of niraparib in ovarian cancer through inducing ferroptosis by up-regulating palmitoleic acid and causing mitochondrial damage. In clinical cohort, it was observed that progesterone prolonged the survival of patients with ovarian cancer receiving PARPi as second-line maintenance therapy, and high progesterone receptor expression combined with low glutathione peroxidase 4 (GPX4) expression predicted better efficacy of PARPi in patients with ovarian cancer. These findings not only offer new therapeutic strategies for PARPi poor response ovarian cancer but also provide potential molecular markers for predicting the PARPi efficacy.

Effects of radiotherapy on the survival of patients with stage IA and low-grade stage IB uterine endometrioid carcinoma

The present study aimed to evaluate the effects of radiotherapy on the overall survival of patients with primary stage IA, grade I-III uterine endometrioid carcinoma or stage IB, grade I-II uterine endometrioid carcinoma. A total of 7504 patients with stage IA, grade I-III uterine endometrioid carcinoma, and 857 patients with stage IB, grade I-II uterine endometrioid carcinoma were collected for the present study. Following propensity score matching (PSM), statistical analysis was performed for the equalized number of patients with stage IA, grade I-III uterine endometrioid carcinoma (n = 383) and patients with stage IB, grade I-II uterine endometrioid carcinoma (n = 330). For patients with primary stage IA, grade I-III uterine endometrioid carcinoma, radiotherapy was found to promoted a reduced 5-year overall survival rates [hazard ratio (HR), 1.726; 95% confidence interval (CI), 1.456-2.046; P < 0.05]. In patients with primary stage IB, grade I-II uterine endometrioid carcinoma, no significant differences were observed in the 5-year overall survival rates between radiotherapy and no radiotherapy groups (P = 0.059). In conclusion, radiotherapy may not improve 5-year overall survival for patients with primary stage IA, grade I-III or stage IB, grade I-II uterine endometrioid carcinoma.

The Preeminent Value of the Apparent Diffusion Coefficient in Assessing High-Risk Factors and Prognosis for Stage I Endometrial Carcinoma Patients

Objectives

To evaluate the role of the apparent diffusion coefficient (ADC) value in the individualized management of stage I endometrial carcinoma (EC).

Methods

A retrospective analysis was performed on 180 patients with stage I EC who underwent 1.5-T magnetic resonance imaging. The mean ADC (mADC), minimum ADC (minADC), and maximum ADC (maxADC) values of each group were measured and compared. We analyzed the relationship between ADC values and stage I EC prognosis by Kaplan-Meier method and Cox proportional hazards analysis.

Results

Patients with lower ADC values were more likely to be characterized by higher grades, specific histological subtypes and deeper myometrial invasion. The mADC, minADC and maxADC values (×10^-3 mm²/s) were 1.045, 0.809 and 1.339, respectively, in grade 1/2 endometrioid carcinoma with superficial myometrial invasion, which significantly differed from those in grade 3 or nonendometrioid carcinoma or with deep myometrial invasion (0.929, 0.714 and 1.215) (P=<0.001, <0.001 and <0.001). ADC values could be used to predict these clinicopathological factors. Furthermore, the group with higher ADC values showed better disease-free survival and overall survival.

Conclusions

The present study indicated that ADC values were associated with the high-risk factors for stage I EC and to assess whether fertility-sparing, ovarian preservation or omission of lymphadenectomy represent viable treatment options. Moreover, this information may be applied to predict prognosis. Thus, ADC values could contribute to managing individualized therapeutic schedules to improve quality of life.

Patterns of care and outcomes of radiotherapy or hormone therapy in patients with medically inoperable endometrial adenocarcinoma

OBJECTIVE

The optimal treatment for medically inoperable endometrioid endometrial adenocarcinoma is unknown. The goal of this study was to evaluate the patterns of care and efficacy of radiotherapy (RT) or hormone therapy (HT) in the treatment of these patients.

METHODS

We performed a query of the National Cancer Database (NCDB) of patients with medically inoperable endometrioid adenocarcinoma of the endometrium diagnosed between 2004 and 2016 and treated with either RT or HT. A multivariate Cox regression model and propensity weighted analyses were used to evaluate overall survival after controlling for confounding variables. A multinomial logistic regression model was used to assess predictors of RT or HT use.

RESULTS

A total of 1036 patients were included in this cohort, and 73% (n = 759) were treated with RT alone. Patients who received definitive HT compared to RT were more likely to be older, diagnosed in the earlier years of this analysis, treated at lower-case volume centers, diagnosed with high-grade disease, or located outside of metropolitan areas. On multivariate analysis, treatment with HT alone versus RT alone was associated with significantly worse overall survival in the multivariate Cox model but not on propensity score weighted analysis. Interaction effect testing revealed that older patients and those treated at lower-volume centers had improved survival with RT compared to HT.

CONCLUSIONS

We identified factors associated with the receipt of RT or HT in medically inoperable endometrial cancer patients. Treatment with RT correlated with improved survival compared to HT in older patients and those treated at lower-volume centers.

Recent developments in selenium-containing polymeric micelles: prospective stimuli, drug-release behaviors, and intrinsic anticancer activity

Selenium is capable of forming a dynamic covalent bond with itself and other elements and can undergo metathesis and regeneration reactions under optimum conditions. Its dynamic nature endows selenium-containing polymers with striking sensitivity towards some environmental alterations. In the past decade, several selenium-containing polymers were synthesized and used for the preparation of oxidation-, reduction-, and radiation-responsive nanocarriers. Recently, thioredoxin reductase, sonication, and osmotic pressure triggered the cleavage of Se-Se bonds and swelling or disassembly of nanostructures. Moreover, some selenium-containing nanocarriers form oxidation products such as seleninic acids and acrylates with inherent anticancer activities. Thus, selenium-containing polymers hold promise for the fabrication of ultrasensitive and multifunctional nanocarriers of radiotherapeutic, chemotherapeutic, and immunotherapeutic significance. Herein, we discuss the most recent developments in selenium-containing polymeric micelles in light of their architecture, multiple stimuli-responsive properties, emerging immunomodulatory activities, and future perspectives in the delivery and controlled release of anticancer agents.

Trends over time in the incidence and use of hormonal therapy in endometrial cancer: a population-based study in the Netherlands

INTRODUCTION

According to current guidelines, hormonal therapy may be applied in endometrioid type endometrial cancer as an alternative to surgery for fertility preservation and in medically unfit patients. Since it is unknown how often hormonal therapy is applied, the objective of this study was to investigate trends over time in hormonal therapy use in the background of the overall incidence of endometrial cancer.

METHODS

All patients with endometrial cancer (n=48 222) registered in the Netherlands Cancer Registry in the period 1989-2018 were included. European age-standardized incidence rates with corresponding estimated annual percentage change were calculated to describe trends in the incidence of endometrial cancer. The use of hormonal therapy was analyzed in the three periods 1989-1998, 1999-2008, and 2009-2018 for the following sub-groups: primary and adjuvant therapy, International Federation of Gynecology and Oncology (FIGO) stage I-II and III-IV, and by age group.

RESULTS

The European age-standardized incidence rate of endometrioid endometrial cancer peaked in 2004 with a significant increase from 1989 to 2004 (annual percentage change 0.55; 95% CI 0.10 to 0.99, p=0.020) and a subsequent decrease from 2005 to 2018 (annual percentage change -1.79; 95% CI -2.28 to -1.31, p<0.001). The incidence rate of non-endometrioid type endometrial cancer increased significantly in the study period. Hormonal therapy was used in 1482 (3.5%) patients with endometrioid endometrial cancer. Among patients with FIGO stage I aged ≤40 years, hormonal therapy increased from 0% in 1989-1998 to 27% in 2009-2018. Primary hormonal treatment increased from 175 patients (5.5%) to 329 patients (7.8%) in those aged ≥75 years. Adjuvant hormonal treatment was mostly used in advanced stage endometrial cancer.

CONCLUSIONS

The use of primary hormonal therapy in endometrioid type endometrial cancer increased over time in patients aged ≤40 years and among elderly patients. The observed trends in the current use of hormonal therapy support the need to study the effect of hormonal treatment in elderly patients and as adjuvant treatment in advanced stage endometrial cancer.