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Lee CY, Chen PN, Kao SH, Wu HH, Hsiao YH, Huang TY, Wang PH, Yang SF. Deoxyshikonin triggers apoptosis in cervical cancer cells through p38 MAPK-mediated caspase activation. ENVIRONMENTAL TOXICOLOGY 2024; 39:4308-4317. [PMID: 38717057 DOI: 10.1002/tox.24323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/10/2024] [Accepted: 04/27/2024] [Indexed: 08/09/2024]
Abstract
Deoxyshikonin (DSK) is a biological component derived from Lithospermum erythrorhizon. Although DSK possesses potential anticancer activities, whether DSK exerts anticancer effects on cervical cancer cells is incompletely explored. This study was aimed to investigate the anticancer activity of DSK against cervical cancer cells and its molecular mechanisms. Cell viability was evaluated by MTT assay. Level of phosphorylation and protein was determined using Western blot. Involvement of signaling kinases was assessed by specific inhibitors. Our results revealed that DSK reduced viability of human cervical cell in a dose-dependent fashion. Meanwhile, DSK significantly elicited apoptosis of HeLa and SiHa cells. Apoptosis microarray was used to elucidate the involved pathways, and the results showed that DSK dose-dependently diminished cellular inhibitor of apoptosis protein 1 (cIAP1), cIAP2, and XIAP, and induced cleavage of poly(ADP-ribose) polymerase (PARP) and caspase-8/9/3. Furthermore, we observed that DSK significantly triggered activation of ERK, JNK, and p38 MAPK (p38), and only inhibition of p38 diminished the DSK-mediated pro-caspases cleavage. Taken together, our results demonstrate that DSK has anti-cervical cancer effects via the apoptotic cascade elicited by downregulation of IAPs and p38-mediated caspase activation. This suggests that DSK could act as an adjuvant to facilitate cervical cancer management.
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Affiliation(s)
- Chung-Yuan Lee
- Department of Obstetrics and Gynecology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Pei-Ni Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shao-Hsuan Kao
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Heng-Hsiung Wu
- Program for Cancer Biology and Drug Discovery, China Medical University, Taichung, Taiwan
| | - Yi-Hsuan Hsiao
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
- Women's Health Research Laboratory, Changhua Christian Hospital, Changhua, Taiwan
| | - Tzu-Yu Huang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Po-Hui Wang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
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2
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Horala A, Szubert S, Nowak-Markwitz E. Range of Resection in Endometrial Cancer-Clinical Issues of Made-to-Measure Surgery. Cancers (Basel) 2024; 16:1848. [PMID: 38791927 PMCID: PMC11120042 DOI: 10.3390/cancers16101848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
Endometrial cancer (EC) poses a significant health issue among women, and its incidence has been rising for a couple of decades. Surgery remains its principal treatment method and may have a curative, staging, or palliative aim. The type and extent of surgery depends on many factors, and the risks and benefits should be carefully weighed. While simple hysterectomy might be sufficient in early stage EC, modified-radical hysterectomy is sometimes indicated. In advanced disease, the evidence suggests that, similarly to ovarian cancer, optimal cytoreduction improves survival rate. The role of lymphadenectomy in EC patients has long been a controversial issue. The rationale for systematic lymphadenectomy and the procedure of the sentinel lymph node biopsy are thoroughly discussed. Finally, the impact of the molecular classification and new International Federation of Gynecology and Obstetrics (FIGO) staging system on EC treatment is outlined. Due to the increasing knowledge on the pathology and molecular features of EC, as well as the new advances in the adjuvant therapies, the surgical management of EC has become more complex. In the modern approach, it is essential to adjust the extent of the surgery to a specific patient, ensuring an optimal, made-to-measure personalized surgery. This narrative review focuses on the intricacies of surgical management of EC and aims at summarizing the available literature on the subject, providing an up-to-date clinical guide.
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Affiliation(s)
- Agnieszka Horala
- Division of Gynaecological Oncology, Department of Gynaecology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (S.S.); (E.N.-M.)
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Nakamura K, Kitahara Y, Yamashita S, Kigure K, Ito I, Nishimura T, Azuma A, Kanuma T. Reassessment of intensive surveillance practices adopted for endometrial cancer survivors. BMC Womens Health 2022; 22:355. [PMID: 35999573 PMCID: PMC9396785 DOI: 10.1186/s12905-022-01937-1] [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: 12/13/2021] [Accepted: 08/16/2022] [Indexed: 11/15/2022] Open
Abstract
Background In Japan, 17,000 women are newly diagnosed with endometrial cancer in 2018. The healthcare insurance policy in Japan provides more intensive patient surveillance compared with the United States and European countries. The aim of this study was to retrospectively analyze data, including surveillance methods, recurrence sites, salvage therapy, and survival period after recurrence, to consider the benefits of surveillance for patients with endometrial cancer. Methods Between January 2009 and December 2015, the medical records of patients who were initially diagnosed with the International Federation of Gynecology and Obstetrics stage I–IV endometrial cancer and treated were enrolled in this retrospective study. Only patients with stage IV cancer with peritoneal dissemination were included. Within the first 2 years, the included patients underwent tumor marker tests, Papanicolaou smear test every 1–3-months, and imaging analysis at 6–12- month intervals. Until 4 years, the patients underwent regular surveys every 4 months and imaging analysis annually. Subsequently, the patients received regular surveys every 6 -to 12-months. Results. Among 847 patients, 88 experienced recurrence, and their clinicopathological data were statistically analyzed. The recurrence site was not associated with the initial treatment method or histology. Among the patients with recurrence, 75% were asymptomatic. Univariate analysis demonstrated that time to recurrence and local recurrence were significant factors for survival outcomes, whereas multivariate analysis indicated that only local recurrence was a significant factor. In patients with distant metastasis, neither symptomatic nor asymptomatic recurrence showed a significant difference in survival. Conclusions In this retrospective study, an intensive surveillance protocol did not benefit patients with endometrial cancer. Thus, we hypothesize that the characterization of tumors by emerging technologies that can precisely predict the nature of the tumor will help tailor individualized and efficient surveillance programs. In addition, the ideal salvage therapy needs to be developed to benefit patients after recurrence.
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Wu J, Zhang L, Wu S, Liu Z. Ferroptosis: Opportunities and Challenges in Treating Endometrial Cancer. Front Mol Biosci 2022; 9:929832. [PMID: 35847989 PMCID: PMC9284435 DOI: 10.3389/fmolb.2022.929832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/25/2022] [Indexed: 11/22/2022] Open
Abstract
Ferroptosis, a new way of cell death, is involved in many cancers. A growing number of studies have focused on the unique role of ferroptosis on endometrial cancer. In this study, we made a comprehensive review of the relevant articles published to get deep insights in the association of ferroptosis with endometrial cancer and to present a summary of the roles of different ferroptosis-associated genes. Accordingly, we made an evaluation of the relationships between the ferroptosis-associated genes and TNM stage, tumor grade, histological type, primary therapy outcome, invasion and recurrence of tumor, and accessing the different prognosis molecular typing based on ferroptosis-associated genes. In addition, we presented an introduction of the common drugs, which targeted ferroptosis in endometrial cancer. In so doing, we clarified the opportunities and challenges of ferroptosis activator application in treating endometrial cancer, with a view to provide a novel approach to the disease.
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Affiliation(s)
- Jianfa Wu
- Department of Gynecology, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
- Department of Gynecology, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Li Zhang
- Department of Gynecology, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
- Department of Gynecology, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Suqin Wu
- Department of Gynecology, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
- Department of Gynecology, Shanghai University of Medicine and Health Sciences, Shanghai, China
- *Correspondence: Suqin Wu, ; Zhou Liu,
| | - Zhou Liu
- Department of Gynecology, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
- Department of Gynecology, Shanghai University of Medicine and Health Sciences, Shanghai, China
- *Correspondence: Suqin Wu, ; Zhou Liu,
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Rare pontine metastasis operated via endoscopic transsphenoidal transclival approach, a case report and brief review of literature. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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6
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Hepatectomy for liver metastases from cervical cancer with portal vein tumor thrombosis: a case report. Clin J Gastroenterol 2022; 15:441-445. [PMID: 35192190 DOI: 10.1007/s12328-022-01603-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
Abstract
The prognosis of patients with liver metastasis of cervical cancer is poor with an extremely short survival period, and there have been no reports of cervical cancer complicated by portal vein tumor thrombosis (PVTT). We report a case of cervical cancer developing liver metastasis with PVTT. A 49-year-old woman developed liver metastasis from cervical cancer with PVTT. The primary tumor was locally controlled with multidisciplinary treatment, including systemic therapy, surgical resection, and radiation. However, her follow-up abdominal computed tomography results showed two irregular tumors in the liver's segments 2 and 6. From the latter lesion, a low-density filling defect extended to the posterior branch of the portal vein, suggesting PVTT. Hepatectomy of the two metastases was performed to prevent portal vein obstruction during subsequent chemotherapy. Pathological analysis revealed metastatic squamous cell carcinoma from cervical cancer that developed a tumor thrombus at the posterior branch of the portal vein. The patient received adjuvant chemotherapy, but died 10 months after surgery for recurrent liver metastasis. We present the first case of liver resection for liver metastasis from cervical cancer with PVTT. Although cervical cancer with PVTT is associated with a poor prognosis, surgical resection is a feasible option for preventing portal vein obstruction during subsequent chemotherapy.
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7
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Rütten H, Verhoef C, van Weelden WJ, Smits A, Dhanis J, Ottevanger N, Pijnenborg JMA. Recurrent Endometrial Cancer: Local and Systemic Treatment Options. Cancers (Basel) 2021; 13:cancers13246275. [PMID: 34944893 PMCID: PMC8699325 DOI: 10.3390/cancers13246275] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/18/2021] [Accepted: 12/08/2021] [Indexed: 12/25/2022] Open
Abstract
The treatment of recurrent endometrial cancer is a challenge. Because of earlier treatments and the site of locoregional recurrence, in the vaginal vault or pelvis, morbidity can be high. A total of about 4 to 20% of the patients with endometrial cancer develop a locoregional recurrence, mostly among patients with locally advanced disease. The treatment options are dependent on previous treatments and the site of recurrence. Local and locoregional recurrences can be treated curatively with surgery or (chemo)radiotherapy with acceptable toxicity and control rates. Distant recurrences can be treated with palliative systemic therapy, i.e., first-line chemotherapy or hormonal therapy. Based on the tumor characteristics and molecular profile, there can be a role for immunotherapy. The evidence on targeted therapy is limited, with no approved treatment in the current guidelines. In selected cases, there might be an indication for local treatment in oligometastatic disease. Because of the novel techniques in radiotherapy, disease control can often be achieved at limited toxicity. Further studies are warranted to analyze the survival outcome and toxicity of newer treatment strategies. Patient selection is very important in deciding which treatment is of most benefit, and better prediction models based on the patient- and tumor characteristics are necessary.
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Affiliation(s)
- Heidi Rütten
- Department of Radiation Oncology, Radboudumc, 6525 GA Nijmegen, The Netherlands;
- Correspondence:
| | - Cornelia Verhoef
- Department of Radiation Oncology, Radboudumc, 6525 GA Nijmegen, The Netherlands;
| | - Willem Jan van Weelden
- Department of Obstetrics & Gynaecology, Radboudumc, 6525 GA Nijmegen, The Netherlands; (W.J.v.W.); (A.S.); (J.M.A.P.)
| | - Anke Smits
- Department of Obstetrics & Gynaecology, Radboudumc, 6525 GA Nijmegen, The Netherlands; (W.J.v.W.); (A.S.); (J.M.A.P.)
| | - Joëlle Dhanis
- Faculty of Medical Sciences, Radboud University, Houtlaan 4, 6525 XZ Nijmegen, The Netherlands;
| | - Nelleke Ottevanger
- Department of Medical Oncology, Radboudumc, 6525 GA Nijmegen, The Netherlands;
| | - Johanna M. A. Pijnenborg
- Department of Obstetrics & Gynaecology, Radboudumc, 6525 GA Nijmegen, The Netherlands; (W.J.v.W.); (A.S.); (J.M.A.P.)
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8
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de Souza C, Santos AVDSL, Rodrigues ECG, Dos Santos MA. Experience of Sexuality in Women with Gynecological Cancer: Meta-Synthesis of Qualitative Studies. Cancer Invest 2021; 39:607-620. [PMID: 33826457 DOI: 10.1080/07357907.2021.1912079] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Gynecological cancers have an impact on women's psychosexual health in which results vary from adjuvant cancer therapy, such as loss of pleasure, to anxious symptoms. This study aimed to present a meta-synthesis of qualitative primary studies on the sexual experience of women with gynecological cancer. The SPIDER tool and the PRISMA guidelines were used to recover evidence from the databases Web of Science, SCOPUS, PubMed/MedLine, CINAHL, PsycINFO and LILACS. Twenty articles were included. The thematic synthesis showed that alterations in sexual functions can be mitigated by direct involvement and dialogue with a sexual partner and the resignification of sexual intimacy.
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Affiliation(s)
- Carolina de Souza
- Graduate Program in Psychology, Ribeirão Preto School of Philosophy, Sciences and Letters, University of São Paulo, Ribeirão Preto, Brazil
| | - André Villela de Souza Lima Santos
- Graduate Program in Psychology, Ribeirão Preto School of Philosophy, Sciences and Letters, University of São Paulo, Ribeirão Preto, Brazil
| | - Elaine Campos Guijarro Rodrigues
- Graduate Program in Psychology, Ribeirão Preto School of Philosophy, Sciences and Letters, University of São Paulo, Ribeirão Preto, Brazil
| | - Manoel Antônio Dos Santos
- Psychology Department, Ribeirão Preto School of Philosophy, Sciences and Letters, University of São Paulo, Ribeirão Preto, Brazil
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Brain Metastases from Uterine Cervical and Endometrial Cancer. Cancers (Basel) 2021; 13:cancers13030519. [PMID: 33572880 PMCID: PMC7866278 DOI: 10.3390/cancers13030519] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 12/30/2022] Open
Abstract
Simple Summary This review investigated the prevalence, clinical characteristics, clinical presentation, diagnosis, treatment, and prognosis of patients with brain metastases from uterine cervical carcinoma (CC) and uterine endometrial carcinoma (EC). The findings of this review indicate the factors that can facilitate better treatment selection and, consequently, better outcomes in patients with CC and EC. Abstract Reports on brain metastases (BMs) from uterine cervical carcinoma (CC) and uterine endometrial carcinoma (EC) have recently increased due to the development of massive databases and improvements in diagnostic procedures. This review separately investigates the prevalence, clinical characteristics, clinical presentation, diagnosis, treatment, and prognosis of BMs from CC and uterine endometrial carcinoma EC. For patients with CC, early-stage disease and poorly differentiated carcinoma lead to BMs, and elderly age, poor performance status, and multiple BMs are listed as poor prognostic factors. Advanced-stage disease and high-grade carcinoma are high-risk factors for BMs from EC, and multiple metastases and extracranial metastases, or unimodal therapies, are possibly factors indicating poor prognosis. There is no “most effective” therapy that has gained consensus for the treatment of BMs. Treatment decisions are based on clinical status, number of the metastases, tumor size, and metastases at distant organs. Surgical resection followed by adjuvant radiotherapy appears to be the best treatment approach to date. Stereotactic ablative radiation therapy has been increasingly associated with good outcomes in preserving cognitive functions. Despite treatment, patients died within 1 year after the BM diagnosis. BMs from uterine cancer remain quite rare, and the current evidence is limited; thus, further studies are needed.
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Orbital metastasis of squamous cell cervical cancer: A case report and review of literature. Gynecol Oncol Rep 2020; 35:100689. [PMID: 33385055 PMCID: PMC7771102 DOI: 10.1016/j.gore.2020.100689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 01/22/2023] Open
Abstract
Common sites of metastatic disease seen in cervical cancer most often include the lungs and liver. Orbital metastasis secondary to cervical carcinoma is a rare form of metastatic disease. We report a 73-year-old woman who presented with ocular symptoms found to be secondary to orbital metastasis of cervical cancer. She underwent palliative radiation to the orbit and pelvis followed by systemic chemotherapy with carboplatin, paclitaxel, and bevacizumab. Prompt intervention was able to salvage her vision and improve her quality of life significantly. We identified 5 similar reported cases in which orbital metastasis was diagnosed simultaneously at the time of cervical cancer diagnosis. In these five cases, patients were treated with a combination of radiation and chemotherapy. Our case demonstrates an unusual presentation of isolated orbital metastatic disease secondary to squamous cell carcinoma of the cervix. Physicians should be aware that cervical cancer may metastasize to the eye leading to vision loss, and prompt intervention may be able to salvage one's vision and improve quality of life.
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Sun S, Lian X, Liu X, Ma J, Hou X, Zhang F, Hu K. Multimodal Therapy is a Better Choice for Patients with Brain Metastasis from Cervical Cancer. Cancer Manag Res 2020; 12:12395-12402. [PMID: 33293865 PMCID: PMC7719318 DOI: 10.2147/cmar.s283673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/12/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the prognostic factors and optimal management of cervical cancer patients with brain metastasis (BM). Materials and Methods We retrospectively reviewed the medical records of 7098 consecutive patients with cervical cancer from January 2000 to December 2019. Data for a total of 24 BM patients with cervical cancer were analyzed retrospectively in the present study. Results The incidence of BM from cervical cancer in our institution was 0.38%. The mean survival time was 7.2 months (median 6.2 months, 0.1–21.2 months). In the univariate analysis, the histopathology of neuroendocrine cancer, 2018 FIGO stage, Karnofsky performance status (KPS) at BM diagnosis, and treatment strategy were identified to be significant prognostic indicators for the survival of patients with BM from cervical cancer. In the multivariate analysis, KPS, chemotherapy, and radiotherapy were independent prognostic factors for survival. Recursive partition analysis (RPA) appeared to be a better prognostic tool than the other prognosis scoring classification systems. Conclusion When patients with BM from cervical cancer have good performance status and undergo comprehensive treatment, such as radiotherapy and chemotherapy, their survival time could be significantly prolonged. Patients with surgical indications may get better survival by postoperative radiotherapy and chemotherapy. Patients with BMs ≥3 may get better survival by whole-brain radiotherapy. But further studies are needed regarding the selection of surgical indications and radiotherapy modes. The prognosis scoring classification system for BM from cervical cancer needs to be improved.
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Affiliation(s)
- Shuai Sun
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Xin Lian
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Xiaoliang Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Jiabin Ma
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Xiaorong Hou
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
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Lin CS, Lin CL, Ying TH, Chiou HL, Hung CH, Liao WS, Hsieh YH, Kao SH. β-Mangostin inhibits the metastatic power of cervical cancer cells attributing to suppression of JNK2/AP-1/Snail cascade. J Cell Physiol 2020; 235:8446-8460. [PMID: 32324277 DOI: 10.1002/jcp.29688] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 03/18/2020] [Accepted: 03/22/2020] [Indexed: 12/25/2022]
Abstract
β-Mangostin is a natural mangostin with potent anticancer activity against various cancers. In this study, we further explored the anticancer activity of β-mangostin on cervical cancer cells. β-Mangostin did not affect cell viability and cell cycle distribution in HeLa and SiHa cells; however, it dose-dependently inhibited the migration and invasion of both the human cervical cancer cell lines. In addition, we observed that β-mangostin suppressed the expression of integrin αV and β3 and the downstream focal adhesion kinase/Src signaling. We also found that Snail was involved in the β-mangostin inhibited cell migration and invasion of HeLa cell. Then, our findings showed that β-mangostin reduced both nuclear translocation and messenger RNA expression of AP-1 and demonstrated that AP-1 could target to the Snail promoter and induce Snail expression. Kinase cascade analysis and reporter assay showed that JNK2 was involved in the inhibition of AP-1/Snail axis by β-mangostin in HeLa cells. These results indicate that β-mangostin can inhibit the mobility and invasiveness of cervical cancer cells, which may attribute to the suppression of both integrin/Src signaling and JNK2-mediated AP-1/Snail axis. This suggests that β-mangostin has potential antimetastatic potential against cervical cancer cells.
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Affiliation(s)
- Chun-Shiang Lin
- Institute of Biochemistry, Microbiology, and Immunology, Chung Shan Medical University, Taichung, Taiwan
| | - Chia-Liang Lin
- Institute of Biochemistry, Microbiology, and Immunology, Chung Shan Medical University, Taichung, Taiwan
| | - Tsung-Ho Ying
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hui-Ling Chiou
- Department of Medical Laboratory and Biotechnology, Chung Shan Medical University, Taichung, Taiwan
| | - Chia-Hung Hung
- Institute of Biochemistry, Microbiology, and Immunology, Chung Shan Medical University, Taichung, Taiwan
| | - Wei-Shan Liao
- Institute of Biochemistry, Microbiology, and Immunology, Chung Shan Medical University, Taichung, Taiwan.,Department of Clinical Pathology, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
| | - Yi-Hsien Hsieh
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Clinical Laboratory, Chung Shan Medical University Hospital, Taichung, Taiwan.,Department of Biochemistry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Shao-Hsuan Kao
- Institute of Biochemistry, Microbiology, and Immunology, Chung Shan Medical University, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Clinical Laboratory, Chung Shan Medical University Hospital, Taichung, Taiwan
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Kuo TN, Lin CS, Li GD, Kuo CY, Kao SH. Sesamin inhibits cervical cancer cell proliferation by promoting p53/PTEN-mediated apoptosis. Int J Med Sci 2020; 17:2292-2298. [PMID: 32922194 PMCID: PMC7484641 DOI: 10.7150/ijms.48955] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/17/2020] [Indexed: 12/28/2022] Open
Abstract
Background: Sesamin is a major bioactive compound in sesame seeds and has various biological properties, including anti-inflammatory and anticancer activities. Here, we explored whether sesamin activates p53, which is widely inhibited in cervical cancer cells, thereby inducing p53-mediated apoptosis. Methods: Human HeLa and SiHa cervical cancer cells and normal Hs68 dermal cells were used as cell models. Cell proliferation, cell cycle distribution, and apoptosis were evaluated by the CCK-8 assay and flow cytometry using PI/Annexin V staining, respectively. Protein expression and phosphorylation were determined using western blotting. The involvement of p53 in the apoptotic cascade was assessed by a specific inhibitor. Results: Sesamin (75 and 150 μM) clearly inhibited SiHa and HeLa cell proliferation in a dose-dependent fashion, but did not affect the proliferation of Hs68 cells. Meanwhile, sesamin increased the sub-G1 phase ratio and apoptosis, up to approximately 38.5% and 37.8%, respectively. Furthermore, sesamin induced p53 phosphorylation at serine-46 and serine-15 and upregulated the levels of PUMA, Bax, and PTEN, while inhibiting AKT phosphorylation at serine-473. Inhibition of p53 by pifithrin-α significantly reduced the levels of PUMA, Bax, and PTEN but restored AKT phosphorylation in SiHa cells exposed to sesamin. Pifithrin-α also reduced apoptosis and restored the proliferation of HeLa and SiHa cells exposed to sesamin. Conclusions: These findings indicate that sesamin inhibits cervical cancer cell proliferation, and its mechanism may be attributed to the induction of p53/PTEN-mediated apoptosis. This suggests that sesamin might be useful as an adjuvant in promoting anti-cervical cancer treatments.
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Affiliation(s)
- Tian-Ni Kuo
- Department of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan 710, Taiwan
| | - Chun-Shiang Lin
- Precision Medicine Center, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Guan-De Li
- Department of Medicine, Medical College, Chung Shan Medical University, Taichung 402, Taiwan
| | - Cheng-Yi Kuo
- Department of Biology and Anatomy, National Medical Center, Taipei 114, Taiwan
| | - Shao-Hsuan Kao
- Institute of Medicine, Medical College, Chung Shan Medical University, Taichung 402, Taiwan
- Clinical Laboratory, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- ✉ Corresponding author: Institute of Medicine, Medical College, Chung Shan Medical University, No.110, Sec. 1, Jianguo N. Rd., Taichung 402, Taiwan. E-mail: Tel: +886-4-24730022 ext. 11681
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Cerebral metastasis in recurrent squamous cell carcinoma of the vulva: case report and review of the literature. Arch Gynecol Obstet 2019; 301:327-332. [PMID: 31823036 DOI: 10.1007/s00404-019-05403-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Distant metastases from squamous cell cancer of the vulva (VSCC) are encountered rarely and are associated with a poor prognosis. Cerebral metastases have only been described anecdotally. CASE HISTORY A 51-year old woman was diagnosed with hepatic metastases due to VSCC. Initial therapy comprised wide local excision of the primary tumor with inguino-femoral lymphadenectomy (LAE) followed by stereotactic radiation of the singular hepatic metastasis while adjuvant chemoradiation of the vulva and lymphatics was declined. 3 years later, she subsequently developed lung and cerebral metastases. CONCLUSION The course of metastatic disease in VSCC is poorly understood. Further knowledge of the metastatic patterns in vulvar cancer is required for guidance of future therapeutic interventions.
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Pathologically confirmed brain metastases from primary uterine cervical tumors: two cases and a literature review. World J Surg Oncol 2019; 17:174. [PMID: 31672152 PMCID: PMC6824018 DOI: 10.1186/s12957-019-1720-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/03/2019] [Indexed: 12/26/2022] Open
Abstract
Background Pathologically confirmed brain metastasis from primary cervical cancer is extremely rare. Herein, we report two cases of intracranial metastasis from cervical cancer that were histopathologically confirmed after surgical excision. In addition, we conducted a literature review to characterize the clinical manifestation, pathogenesis, and treatment of these patients. Case summary Among the 1800 patients with primary cervical cancer who received therapy at our center from 2010 to 2018, two patients (0.1%) had definite histopathological evidence of brain metastasis. A 46-year-old female who had a history of poorly differentiated stage IIB cervical cancer with neuroendocrine differentiation presented with a solitary mass in the right occipital lobe 26 months after the initial diagnosis. She underwent surgery and chemotherapy but died of disease progression 9 months later. Another 55-year-old female diagnosed with poorly differentiated stage IVB cervical squamous cancer presented with a solitary mass in the right frontal lobe 16 months after simple hysterectomy. Twelve months later, multiple lesions were observed in the bilateral frontal-parietal lobe. The lesions were treated by surgery and stereotactic radiosurgery. The patient died of multiple organ failure 14 months later. Conclusion The pathogenesis and best management of brain metastasis from cervical cancer are not clear. Highly invasive subtypes or advanced cancer stages may be the key clinicopathological factors of brain metastasis. Surgical treatment is warranted in patients with a good health status and without metastasis to other sites.
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Yin Z, Tang H, Li L, Ni J, Yuan S, Lou H, Chen M. Impact of sites versus number of metastases on survival of patients with organ metastasis from newly diagnosed cervical cancer. Cancer Manag Res 2019; 11:7759-7766. [PMID: 31496818 PMCID: PMC6701644 DOI: 10.2147/cmar.s203037] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 07/22/2019] [Indexed: 01/30/2023] Open
Abstract
Objective The aim of this study was to investigate the potential associations of the sites and the number of specific metastases with survival in patients newly diagnosed with cervical cancer. Methods Medical records of patients with organ metastases of newly diagnosed cervical cancer at Zhejiang Cancer Hospital from October 2006 to December 2016 were reviewed retrospectively. Survival times were compared using the Kaplan-Meier method. Variables associated with survival were identified using univariate and multivariate Cox proportional hazards models. Results A total of 99 patients with newly diagnosed organ metastatic cervical cancer were identified. Median follow-up was 11.6 months (range, 0.5–114.7 months). Median overall survival (OS) time was 11.7 months from diagnosis, with 1, 2, and 5-year OS rates of 48.2%, 22.8%, and 12.6%, respectively. The most common site of organ metastasis was bone (36.8%), followed by lung (32.8%) and liver (24%). In univariate analysis, OS rates were better for bone metastasis than visceral metastasis (P=0.013), oligometastasis than non-oligometastasis (P=0.003) and single organ metastasis than multiple organ metastases (P=0.016), while that for liver metastasis was poorer than non-liver metastases (P<0.001). In multivariate analysis, liver metastasis (hazard ratio [HR] =4.02; 95% confidence interval [CI], 1.15-14.05, P=0.029) was significantly and independently related to poor overall survival. Conclusion Our data revealed the site of metastasis is associated with overall survival of patients with newly diagnosed organ metastatic cervical cancer, with liver metastasis signifying particularly poor overall survival. Individualized treatments should be administered to patients depending on the specific metastatic sites.
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Affiliation(s)
- Zhuomin Yin
- Department of Gynecologic Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, People's Republic of China.,Department of Radiation Oncology (Zhejiang Key Laboratory of Radiation Oncology), Zhejiang Cancer Hospital, Hangzhou 310022, People's Republic of China
| | - Huarong Tang
- Department of Gynecologic Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, People's Republic of China
| | - Li Li
- Department of Gynecologic Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, People's Republic of China
| | - Juan Ni
- Department of Gynecologic Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, People's Republic of China
| | - Shuhui Yuan
- Department of Gynecologic Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, People's Republic of China
| | - Hanmei Lou
- Department of Gynecologic Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, People's Republic of China
| | - Ming Chen
- Department of Radiation Oncology (Zhejiang Key Laboratory of Radiation Oncology), Zhejiang Cancer Hospital, Hangzhou 310022, People's Republic of China
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Dilek ON, Gür EÖ, Acar T, Aydoğmuş S. Chest wall metastasis of endometrial cancer: case report and review of the literature. Acta Chir Belg 2019; 119:243-247. [PMID: 29433406 DOI: 10.1080/00015458.2018.1438557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Introduction: Endometrial cancer is the fourth most common female cancer and also distant metastases to the chest wall associated with these tumors are seen less common. Surgical treatment options for metastases of endometrial cancer are limited. Case: A 57-year-old patient who underwent total abdominal hysterectomy + bilateral salpingo oophorectomy and received adjuvant chemotherapy for endometrioid-type adenocarcinoma of the endometrium and tuba is presented. The patient initially presented with pleural effusion 8 years ago and the tumor was detected while during etiologic screening. The patient had no problems after adjuvant chemotherapy and had been living in another city when she presented with a mass on the chest wall measuring 20 × 15 × 12 cm 8 years after the initial diagnosis and distant organ metastasis due to the first surgery was detected. The mass was first thought to be a sarcoma and the tru-cut biopsy revealed a metastatic lesion that was immunohistochemically similar to the first surgical specimen. The mass was resected with a wide radical excision and 'no touch' technique. The patient was then discharged with no postoperative complications. Conclusion: Here in, a case with a distant organ metastasis due to an endometrioid-type adenocarcinoma is presented accompanied by literature data.
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Affiliation(s)
- Osman Nuri Dilek
- Departments of General Surgery, İzmir Katip Çelebi University, Atatürk Education and Research Hospital, İzmir, Turkey
| | - Emine Özlem Gür
- Departments of General Surgery, İzmir Katip Çelebi University, Atatürk Education and Research Hospital, İzmir, Turkey
| | - Turan Acar
- Departments of General Surgery, İzmir Katip Çelebi University, Atatürk Education and Research Hospital, İzmir, Turkey
| | - Serpil Aydoğmuş
- Departments of Obstetric & Gynecology, İzmir Katip Çelebi University Atatürk Education and Research Hospital, İzmir, Turkey
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18
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Yin Z, Lou H, Tang H, Ni J, Zhou Q, Chen M. Efficacy of radical doses of pelvic radiotherapy for primary tumor treatment in patients with newly diagnosed organ metastatic cervical cancer. Radiat Oncol 2019; 14:82. [PMID: 31109371 PMCID: PMC6528279 DOI: 10.1186/s13014-019-1297-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 05/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The clinical efficacy of definitive pelvic radiotherapy for primary tumors in patients with newly diagnosed organ metastatic cervical cancer is unclear. Therefore, we conducted a retrospective study to evaluate the efficacy of definitive pelvic radiotherapy combined with systemic chemotherapy in patients with organ metastatic cervical cancer. METHODS We retrospectively analysed medical records from patients with newly diagnosed organ metastatic cervical cancer, all treated with chemotherapy at the Zhejiang Cancer Hospital between October 2006 and December 2016. Survival times were compared using the Kaplan-Meier method. The univariate log-rank method and multivariate Cox proportional hazard models were used to identify associated variables with survival. RESULTS A total of 48 patients were identified from 11,982 primary cervical cancer patients and divided into two groups according to treatment mode: 36 patients received chemotherapy combined with definitive pelvic radiotherapy (group A), 12 patients underwent chemotherapy with/without palliative pelvic radiotherapy (group B). Median follow-up was 14.4 months (range, 4.6-114.7 months). Median overall survival (OS) for group A and group B was 17.3 and 10 months, respectively. Using the univariate analysis, group A was found to have a better OS than group B (p = 0.002). In multivariate analysis, group A (hazard ratio [HR], 0.32; 95% confidence interval [CI], 0.15-0.67, p = 0.003) was associated with lower risk of death compared with group B. The main reason for treatment failure was found to be due to the progression of distant metastatic lesions in 36 patients (75%) from the whole cohort. CONCLUSION In this cohort of organ metastatic cervical cancer patients in good performance status, chemotherapy combined with definitive pelvic radiotherapy was associated with improved survival outcomes when compared with chemotherapy with/without palliative pelvic radiotherapy. Prospective trials evaluating definitive pelvic radiotherapy for newly diagnosed organ metastatic cervical cancer, therefore, are warranted.
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Affiliation(s)
- Zhuomin Yin
- Department of Radiation Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, China.,Department of Gynecologic Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Hanmei Lou
- Department of Gynecologic Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Huarong Tang
- Department of Gynecologic Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Juan Ni
- Department of Gynecologic Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Qiong Zhou
- Department of Gynecologic Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Ming Chen
- Department of Radiation Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, China. .,Department of Radiation Oncology (Zhejiang Key Laboratory of Radiation Oncology), Zhejiang Cancer Hospital, No. 1 Banshan East Road, Hangzhou, 310022, China.
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19
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Lee CH, Ying TH, Chiou HL, Hsieh SC, Wen SH, Chou RH, Hsieh YH. Alpha-mangostin induces apoptosis through activation of reactive oxygen species and ASK1/p38 signaling pathway in cervical cancer cells. Oncotarget 2018; 8:47425-47439. [PMID: 28537893 PMCID: PMC5564576 DOI: 10.18632/oncotarget.17659] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 04/20/2017] [Indexed: 01/04/2023] Open
Abstract
Alpha-mangostin, a natural xanthonoid, has been reported to possess the anti-cancer property in various types of human cancer. However, its effects and mechanism of α-mangostin in cervical cancer remain unclear. We found that α-mangostin effectively inhibited cell viability, resulted in loss of mitochondrial membrane potential (MMP), release of cytochrome C, increase of Bax, decrease of Bcl-2, and activation of caspase-9/caspase-3 cascade in cervical cancer cells. Alpha-mangostin elevated the contents of reactive oxygen species (ROS) to activate p38. Disrupting ASK1/p38 signaling pathway by a specific inhibitor of p38, or by the siRNAs against ASK1, MKK3/6, or p38, significantly abolished α-mangostin-induced cell death and apoptotic responses. Moreover, α-mangostin also repressed tumor growth in accordance with increased levels of p-ASK1, p-p38, cleaved-PARP and cleaved-caspase-3 in the tumor mass from the mouse xenograft model of cervical cancer. In the current study, we provided first evidence to demonstrate that dietary antioxidant α-mangostin could inhibit the tumor growth of cervical cancer cells through enhancing ROS amounts to activate ASK1/p38 signaling pathway and damage the integrity of mitochondria and thereby induction of apoptosis in cervical cancer cells.
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Affiliation(s)
- Chien-Hsing Lee
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.,Division of Pediatric Surgery, Department of Surgery, China Medical University Children's Hospital, Taichung, Taiwan
| | - Tsung-Ho Ying
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hui-Ling Chiou
- School of Medical Laboratory and Biotechnology, Chung Shan Medical University, Taichung, Taiwan
| | - Shu-Ching Hsieh
- School of Medical Laboratory and Biotechnology, Chung Shan Medical University, Taichung, Taiwan
| | - Shiua-Hua Wen
- Institute of Biochemistry, Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan
| | - Ruey-Hwang Chou
- Graduate Institute of Biomedical Sciences and Center for Molecular Medicine, China Medical University, Taichung, Taiwan.,Department of Biotechnology, Asia University, Taichung, Taiwan
| | - Yi-Hsien Hsieh
- Institute of Biochemistry, Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan.,Department of Biochemistry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Clinical Laboratory, Chung Shan Medical University Hospital, Taichung, Taiwan
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20
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Mouli SK, Gupta R, Sheth N, Gordon AC, Lewandowski RJ. Locoregional Therapies for the Treatment of Hepatic Metastases from Breast and Gynecologic Cancers. Semin Intervent Radiol 2018; 35:29-34. [PMID: 29628613 DOI: 10.1055/s-0038-1636518] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Breast cancer is the most common women's malignancy in the United States and is the second leading cause of cancer death. More than half of patients with breast cancer will develop hepatic metastases; this portends a poorer prognosis. In the appropriately selected patient, there does appear to be a role for curative (surgery, ablation) or palliative (intra-arterial treatments) locoregional therapy. Gynecologic malignancies are less common and metastases to the liver are most often seen in the setting of disseminated disease. The role of locoregional therapies in these patients is not well reported. The purpose of this article is to review the outcomes data of locoregional therapies in the treatment of hepatic metastases from breast and gynecologic malignancies.
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Affiliation(s)
- Samdeep K Mouli
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Ramona Gupta
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Neil Sheth
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Andrew C Gordon
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Robert J Lewandowski
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois.,Division of Hematology and Oncology, Department of Medicine, Northwestern University, Chicago, Illinois.,Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois
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21
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Kim SB, Hwang K, Joo JD, Han JH, Kim YB, Kim CY. Outcomes in 20 Gynecologic Cancer Patient with Brain Metastasis: A Single Institution Retrospective Study. Brain Tumor Res Treat 2017; 5:87-93. [PMID: 29188209 PMCID: PMC5700032 DOI: 10.14791/btrt.2017.5.2.87] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/15/2017] [Accepted: 10/16/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The incidence of brain metastasis (BM) in gynecologic cancers has risen recently, due to prolonged survival times and an early diagnosis. We analyzed treatment outcomes of patients with BM from gynecologic cancers. METHODS Among 951 patients with BM who were treated in neurosurgical department from July 2003 to February 2016, a total of 20 (2%) patients were from gynecologic cancers. The patients' clinical characteristics were collected by using medical records. There were 14 (66.7%) ovarian cancers, 4 (19.0%) uterine cancers, and 2 (9.5%) cervical cancers. As a primary treatment modality, 11 patients were treated with Gamma Knife surgery (GKS), 6 with surgical resection followed by whole brain radiation therapy (WBRT), and 3 with WBRT only. Overall and progression-free survival according to the primary origin and the primary treatment were analyzed. RESULTS Median overall survival time was 28 months, and progression-free survival was 15 months. In patients with ovarian cancer, median overall survival did not reach during the follow-up periods and progression-free survival time was 15 months. Median overall survival time in patients who received GKS as the primary treatment was 17 months and that in patients who underwent surgical resection followed by WBRT was 37.3 months (p=0.16). The median value of progression-free survival time in patients who received GKS as the primary treatment was 12 months and that in patients who underwent surgical resection with WBRT was 42 months (p=0.042). Median follow up period of over all patients was 13 months. CONCLUSION BM from gynecologic cancer is rare (2%), but our findings suggest that the prognosis might not always be poor. In our small series, surgical resection with WBRT was a treatment modality significantly associated with a longer progression-free survival. Additional studies with more cases and multi-institutional cooperation are needed to determine which treatment modality leads to better outcomes.
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Affiliation(s)
- Seung Bin Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kihwan Hwang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin-Deok Joo
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Ho Han
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Beom Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
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Abstract
OBJECTIVES In women with endometrial carcinoma (EC), tumor recurrences tend to occur in the 2- to 3-year period following surgical staging. Management of disease recurrence in EC poses significant challenges. These patients represent a heterogenous group where histologic subtypes, previous adjuvant management, interval since completion of adjuvant therapy, and size and site(s) of disease recurrence all have important implications on salvage therapies and prognosis. No randomized controlled trials have been published to determine optimal management in this group of patients. An expert panel was convened to reach consensus on the most appropriate management options in this group of patients. METHODS The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. RESULTS Five clinical variants were developed to address common scenarios in the management of women with recurrent EC. Group members reached consensus on the appropriateness of specific evaluation and treatment approaches with numerical ratings. CONCLUSIONS In combining available medical literature and expert opinions, this manuscript may serve as an aid for other practitioners in the appropriate management of women with recurrent EC.
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Abstract
IntroductionCervical cancer (CC) is the most common malignancy throughout developing countries, although considered rare, central nervous system metastasis (CNSm) does occur.ObjectiveThis study aimed to describe our experiences and compare them to other published cases.Materials and MethodsFrom May 2009 to August 2015, the files of all patients with CC treated at our referral center were reviewed.ResultsWe found 27 patients with CC and CNSm. Mean age at the time of CNS diagnosis was 50 ± 11 years, mean interval between initial CC and CNSm was 46 months; the most frequent initial International Federation of Gynecology and Obstetrics stage was IIB with 17 patients followed by IB in 4. Fifty-nine percent of patients had lung metastases at the time CNSm were diagnosed. Headache was the most common symptom, followed by weakness, altered mental status, and ataxia/cerebellar. Mean survival was 8.2 months after CNSm was discovered; 3 patients are still alive.ConclusionsThe present study describes the largest series of patients with CNSm from CC; this rare complication should be suspected in patients with CC who present with headache, ataxia, cranial nerve palsy, visual disturbance, altered mental status, focal weakness, or other neurological symptom, without other plausible explanation.
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Divine LM, Kizer NT, Hagemann AR, Pittman ME, Chen L, Powell MA, Mutch DG, Rader JS, Thaker PH. Clinicopathologic characteristics and survival of patients with gynecologic malignancies metastatic to the brain. Gynecol Oncol 2016; 142:76-82. [PMID: 27117923 DOI: 10.1016/j.ygyno.2016.04.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 04/02/2016] [Accepted: 04/22/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE No standardized treatment strategies exist for patients with gynecologic malignancies complicated by brain metastases. Identification of poor outcome characteristics, long-term survival indicators, and molecular markers could help individualize and optimize treatment. METHODS This retrospective cohort study included 100 gynecologic cancer patients with brain metastases treated at our institution between January 1990 and June 2009. Primary outcome was overall survival (OS) from time of diagnosis of brain metastases. We used univariate and multivariate analyses to evaluate associations between OS and clinical factors. We used immunohistochemistry to examine expression of five molecular markers in primary tumors and brain metastases in a subset of patients and matched controls. Statistical tests included the Student's paired t-test (for marker expression) and Kaplan-Meier test (for correlations). RESULTS On univariate analysis, primary ovarian disease, CA-125<81units/mL at brain metastases diagnosis, and isolated versus multi-focal metastases were all associated with longer survival. Isolated brain metastasis remained the only significant predictor on multivariate analysis (HR 2.66; CI 1.19-5.93; p=0.017). Expression of vascular endothelial growth factor A (VEGF-A) was higher in metastatic brain samples than in primary tumors of controls (p<0.0001). None of the molecular markers were significantly associated with survival. CONCLUSIONS Multi-modality therapy may lead to improved clinical outcomes, and VEGF therapy should be investigated in treatment of brain metastases.
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Affiliation(s)
- Laura M Divine
- Washington University School of Medicine & Alvin J. Siteman Cancer Center, St. Louis, MO, United States
| | - Nora T Kizer
- Department of Obstetrics and Gynecology, Springfield Clinic, Springfield, IL, Division of Gynecologic Oncology, United States
| | - Andrea R Hagemann
- Washington University School of Medicine & Alvin J. Siteman Cancer Center, St. Louis, MO, United States
| | - Meredith E Pittman
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - Ling Chen
- Division of Biostatistics, Washington University School of Medicine, Alvin J. Siteman Cancer Center, Saint Louis, MO, United States
| | - Matthew A Powell
- Washington University School of Medicine & Alvin J. Siteman Cancer Center, St. Louis, MO, United States
| | - David G Mutch
- Washington University School of Medicine & Alvin J. Siteman Cancer Center, St. Louis, MO, United States
| | - Janet S Rader
- Division of Gynecologic Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Premal H Thaker
- Washington University School of Medicine & Alvin J. Siteman Cancer Center, St. Louis, MO, United States.
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25
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Hepatic resection during cytoreductive surgery for primary or recurrent epithelial ovarian cancer. J Cancer Res Clin Oncol 2015; 142:1509-20. [PMID: 26660323 DOI: 10.1007/s00432-015-2090-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 11/30/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE Surgical cytoreduction remains a cornerstone in the management of patients with advanced and recurrent epithelial ovarian cancer. Parenchymal liver metastases determine stage VI disease and are commonly considered a major limit in the achievement of an optimal cytoreduction. The purpose of this manuscript was to discuss the rationale of liver resection and the morbidity related to this procedure in advanced and recurrent ovarian cancer. METHODS A search of the National Library of Medicine's MEDLINE/PubMed database until March 2015 was performed using the keywords: "ovarian cancer," "hepatic," "liver," and "metastases." RESULTS In patients with liver metastases, hepatic resection is associated with a similar prognosis as stage IIIC patients. The length of the disease-free interval between primary diagnosis and occurrence of liver metastases, as well as residual disease after resection, is the most important prognostic factors. In addition, the number of liver lesions, resection margins, and the gynecologic oncology group performance status seem to play also an important role in determining outcome. CONCLUSIONS In properly selected patients, liver resections at the time of cytoreduction increase rates of optimal cytoreduction and improve survival in advanced-stage and recurrent ovarian cancer patients.
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26
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Kim YZ, Kwon JH, Lim S. A clinical analysis of brain metastasis in gynecologic cancer: a retrospective multi-institute analysis. J Korean Med Sci 2015; 30:66-73. [PMID: 25552885 PMCID: PMC4278029 DOI: 10.3346/jkms.2015.30.1.66] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 08/21/2014] [Indexed: 01/03/2023] Open
Abstract
This study analyzes the clinical characteristics of the brain metastasis (BM) of gynecologic cancer based on the type of cancer. In addition, the study examines the factors influencing the survival. Total 61 BM patients of gynecologic cancer were analyzed retrospectively from January 2000 to December 2012 in terms of clinical and radiological characteristics by using medical and radiological records from three university hospitals. There were 19 (31.1%) uterine cancers, 32 (52.5%) ovarian cancers, and 10 (16.4%) cervical cancers. The mean interval to BM was 25.4 months (21.6 months in ovarian cancer, 27.8 months in uterine cancer, and 33.1 months in cervical cancer). The mean survival from BM was 16.7 months (14.1 months in ovarian cancer, 23.3 months in uterine cancer, and 8.8 months in cervical cancer). According to a multivariate analysis of factors influencing survival, type of primary cancer, Karnofsky performance score, status of primary cancer, recursive partitioning analysis class, and treatment modality, particularly combined therapies, were significantly related to the overall survival. These results suggest that, in addition to traditional prognostic factors in BM, multiple treatment methods such as neurosurgery and combined chemoradiotherapy may play an important role in prolonging the survival for BM patients of gynecologic cancer.
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Affiliation(s)
- Young Zoon Kim
- Division of Neurooncology, Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jae Hyun Kwon
- Department of Neurosurgery, Dong-A University Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Soyi Lim
- Department of Obstetrics and Gynecology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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Chou RH, Hsieh SC, Yu YL, Huang MH, Huang YC, Hsieh YH. Fisetin inhibits migration and invasion of human cervical cancer cells by down-regulating urokinase plasminogen activator expression through suppressing the p38 MAPK-dependent NF-κB signaling pathway. PLoS One 2013; 8:e71983. [PMID: 23940799 PMCID: PMC3733924 DOI: 10.1371/journal.pone.0071983] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 07/05/2013] [Indexed: 12/31/2022] Open
Abstract
Fisetin (3,3',4',7-tetrahydroxyflavone), a naturally occurring flavonoid, has been reported to inhibit proliferation and induce apoptosis in several cancer types. However, its effect on the anti-metastatic potential of cervical cancer cells remains unclear. In the present study, we found that fisetin inhibits the invasion and migration of cervical cancer cells. The expression and activity of urokinase plasminogen activator (uPA) was significantly suppressed by fisetin in a dose-dependent manner. We also demonstrated that fisetin reduces the phosphorylation of p38 MAPK, but not that of ERK1/2, JNK1/2, or AKT. Addition of a p38 MAPK inhibitor, SB203580, further enhanced the inhibitory effect of fisetin on the expression and activity of uPA and the invasion and motility in cervical cancer cells. Fisetin suppressed the TPA (tetradecanoylphorbol-13-acetate)-induced activation of p38 MAPK and uPA, and inhibited the TPA-enhanced migratory and invasive abilities. Furthermore, the promoter activity of the uPA gene was dramatically repressed by fisetin, which disrupted the nuclear translocation of NF-κB and its binding amount on the promoter of the uPA gene, and these suppressive effects could be further enhanced by SB203580. This study provides strong evidence for the molecular mechanism of fisetin in inhibiting the aggressive phenotypes by repression of uPA via interruption of p38 MAPK-dependent NF-κB signaling pathway in cervical cancer cells and thus contributes insight to the potential of using fisetin as a therapeutic strategy against cervical cancer by inhibiting migration and invasion.
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Affiliation(s)
- Ruey-Hwang Chou
- Graduate Institute of Cancer Biology and Center for Molecular Medicine, China Medical University, Taichung, Taiwan
- Department of Biotechnology, Asia University, Taichung, Taiwan
| | - Shu-Ching Hsieh
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yung-Luen Yu
- Graduate Institute of Cancer Biology and Center for Molecular Medicine, China Medical University, Taichung, Taiwan
- Department of Biotechnology, Asia University, Taichung, Taiwan
| | - Min-Hsien Huang
- Department of Rehabilitation Science, Department of Acupressure Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, County, Taiwan
| | - Yi-Chang Huang
- Institute of Biochemistry and Biotechnology, College of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yi-Hsien Hsieh
- Institute of Biochemistry and Biotechnology, College of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Biochemistry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Clinical Laboratory, Chung Shan Medical University Hospital, Taichung, Taiwan
- * E-mail:
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Radiosurgery to palliate symptoms in brain metastases from uterine cervix cancer. Acta Neurochir (Wien) 2013; 155:399-405. [PMID: 23238944 DOI: 10.1007/s00701-012-1576-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 11/23/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The optimal management of brain metastases from uterine cervix cancer (UCC) is not well defined because of the rarity of the condition and the scarcity of published reports. Here we report our experience with stereotactic radiosurgery for the management of brain metastases from UCC. METHODS Thirteen consecutive patients with brain metastases from UCC were managed with a Leksell gamma-knife at our institution between January 2003 and December 2010. Clinical features and radiosurgical outcomes of patients were analyzed retrospectively. RESULTS Gamma-knife radiosurgery (GKRS) was chosen as the only treatment in four patients and performed in combination with whole-brain radiotherapy (WBRT) in nine patients. GKRS was conducted simultaneously with WBRT within a 1-month interval in six patients and was chosen as the salvage treatment after WBRT in three patients. The mean number of metastatic brain lesions per patient was 5.7 (range, 1-16). The median cumulative tumor volume was 23.7 cm(3) (range, 2.7-40.2 cm(3)), and the median marginal dose covering the tumors was 14 Gy of a 50 % isodose line (range, 8-25 Gy). Nine patients showed relief of main neurologic symptoms after GKRS. The median length of time that the patients spent in an improved neurologic state was 11.1 weeks (range, 2-39.6 weeks). The local and distant control rates were 66.7 % and 77.8 %, respectively. The median survival from the date of GKRS until death was 4.6 months (range, 1.0-15.9 months). The 6-month and 12-month survival rates after GKRS were 38 and 15 %, respectively. CONCLUSIONS GKRS could be an efficient palliative measure to relieve neurologic symptoms caused by brain metastasis from UCC.
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Edwards JM, Lowery WJ, Secord AA. Quinary debulking for epithelial ovarian cancer. J Surg Case Rep 2012; 2012:7. [PMID: 24960732 PMCID: PMC3649565 DOI: 10.1093/jscr/2012.7.7] [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] [Indexed: 11/14/2022] Open
Abstract
We report a case of optimal quinary debulking for recurrent papillary serous carcinoma of the ovary involving the liver parenchyma through the full thickness of the diaphragm into the lung parenchyma. Multiple debulking procedures for ovarian cancer are controversial, especially when there is extensive upper abdominal or thoracic disease. Selection criteria for such extensive surgery include: good functional status, long disease-free interval, and absence of other systemic disease. Our patient tolerated her procedure well without evidence of residual disease over 6 months postoperatively.
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Hwang JH, Yoo HJ, Lim MC, Seo SS, Kang S, Kim JY, Park SY. Brain metastasis in patients with uterine cervical cancer. J Obstet Gynaecol Res 2012; 39:287-91. [PMID: 22690955 DOI: 10.1111/j.1447-0756.2012.01927.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIM The purpose of this study was to describe the features of patients with brain metastasis from cervical cancer. MATERIAL AND METHODS The medical records of patients with cervical cancer between February 2001 and June 2011 were reviewed retrospectively. Clinical characteristics, symptoms, treatment and survival in patients with brain metastasis were analyzed. RESULTS Eleven patients with brain metastasis from cervical cancer were identified, representing an incidence of brain metastasis in the study population of 0.45%. Median patient age at initial diagnosis of cervical cancer was 50 years (range 33-75 years). Non-squamous cell carcinoma was diagnosed in six (54.5%) of the 11 patients, with small cell carcinoma diagnosed in two patients. Ten of the 11 patients had lung-related metastasis at presentation; eight patients had lung metastasis, one had mediastinal lymph node metastasis, and one had pleural metastasis. The median interval from diagnosis of cervical cancer to identification of brain metastasis was 15.4 months (range 3.4-83.3 months). Nine patients presented with neurologic symptoms, such as headache, nausea, vomiting, seizure and extremity weakness. Initially, six patients received whole brain radiotherapy: three patients received chemotherapy; one underwent surgery; and one patient refused treatment. The median survival time after diagnosis of the brain metastases was 5.9 months (range 0.7-19 months). CONCLUSION The prognosis after diagnosis of the brain metastasis in patients with uterine cervical cancer is poor. The small cell type and lung metastasis seem to be related with brain metastasis and may be regarded as risk factors.
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Affiliation(s)
- Jong Ha Hwang
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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Mabuchi S, Isohashi F, Maruoka S, Hisamatsu T, Takiuchi T, Yoshioka Y, Kimura T. Post-treatment follow-up procedures in cervical cancer patients previously treated with radiotherapy. Arch Gynecol Obstet 2012; 286:179-85. [PMID: 22286388 DOI: 10.1007/s00404-012-2235-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 01/17/2012] [Indexed: 10/14/2022]
Abstract
PURPOSE We investigated the role of physical examination, CT scan, chest X-ray, and Pap smear in the routine follow-up program for cervical cancer patients previously treated with radiotherapy. METHODS The records of women who had developed recurrent cervical cancer after radiotherapy were retrospectively reviewed. The optimal procedure for the detection of recurrence was evaluated according to the disease-free interval (DFI). Survival analysis was performed based on the Kaplan-Meier method and comparisons between groups were made using the log-rank test. RESULTS A total of 146 recurrent cervical cancer patients were included in our database. The majority of recurrences were diagnosed either by symptoms, physical examination, or CT scan. The patients whose recurrent disease was detected by Pap smear, physical examination, or CT scan had a significantly longer survival than those detected by symptoms. When analyzed according to DFI, physical examination, and CT scan led to the detection of recurrence in patients with a DFI of 1-5 years. In contrast, chest X-ray and Pap smear only had a clinical impact on the diagnosis of recurrence in patients with a DFI of 1-2 years. CONCLUSIONS Chest X-ray and Pap smear can be routinely performed for the first 2 years after radiotherapy, but can be omitted or used sparingly thereafter.
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Affiliation(s)
- Seiji Mabuchi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan,
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Sareen P, Blandon RE, Binder NR, Wallace DL. Metastasis of squamous cell cervical carcinoma to the orbit of the eye. GYNECOLOGIC ONCOLOGY CASE REPORTS 2012; 2:83-6. [PMID: 24371627 DOI: 10.1016/j.gynor.2012.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 04/02/2012] [Indexed: 11/26/2022]
Abstract
► We compare characteristics of our case with five previously reported cases. ► We discuss possible mechanisms of dissemination and metastasis to the distant site. ► We discuss treatment options, but poor outcome was noted in all six cases.
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Affiliation(s)
- Pratibha Sareen
- Department of Obstetrics and Gynecology, University of Missouri, Kansas City, USA
| | - Roberta E Blandon
- Department of Obstetrics and Gynecology, University of Missouri, Kansas City, USA ; Saint Luke's Hospital of Kansas City, Kansas City, MO, USA
| | - Nicholas R Binder
- Department of Ophthalmology, University of Missouri, Kansas City, USA
| | - Darryl L Wallace
- Department of Obstetrics and Gynecology, University of Missouri, Kansas City, USA ; Saint Luke's Hospital of Kansas City, Kansas City, MO, USA
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Blecharz P, Urbański K, Mucha-Małecka A, Małecki K, Reinfuss M, Jakubowicz J, Skotnicki P. Hematogenous metastases in patients with Stage I or II endometrial carcinoma. Strahlenther Onkol 2011; 187:806-11. [DOI: 10.1007/s00066-011-2250-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 06/16/2011] [Indexed: 10/15/2022]
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Kamel SI, de Jong MC, Schulick RD, Diaz-Montes TP, Wolfgang CL, Hirose K, Edil BH, Choti MA, Anders RA, Pawlik TM. The role of liver-directed surgery in patients with hepatic metastasis from a gynecologic primary carcinoma. World J Surg 2011; 35:1345-54. [PMID: 21452068 DOI: 10.1007/s00268-011-1074-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The management of patients with liver metastasis from a gynecologic carcinoma remains controversial, as there is currently little data available. We sought to determine the safety and efficacy of liver-directed surgery for hepatic metastasis from gynecologic primaries. METHODS Between 1990 and 2010, 87 patients with biopsy-proven liver metastasis from a gynecologic carcinoma were identified from an institutional hepatobiliary database. Fifty-two (60%) patients who underwent hepatic surgery for their liver disease and 35 (40%) patients who underwent biopsy only were matched for age, primary tumor characteristics, and hepatic tumor burden. Clinicopathologic, operative, and outcome data were collected and analyzed. RESULTS Of the 87 patients, 30 (34%) presented with synchronous metastasis. The majority of patients had multiple hepatic tumors (63%), with a median size of the largest lesion being 2.5 cm. Of those patients who underwent liver surgery (n=52), most underwent a minor hepatic resection (n=44; 85%), while 29 (56%) patients underwent concurrent lymphadenectomy and 45 (87%) patients underwent simultaneous peritoneal debulking. Postoperative morbidity and mortality were 37% and 0%, respectively. Median survival from time of diagnosis was 53 months for patients who underwent liver-directed surgery compared with 21 months for patients who underwent biopsy alone (n=35) (p=0.01). Among those patients who underwent liver-directed surgery, 5-year survival following hepatic resection was 41%. CONCLUSIONS Hepatic surgery for liver metastasis from gynecologic cancer can be performed safely. Liver surgery may be associated with prolonged survival in a subset of patients with hepatic metastasis from gynecologic primaries and therefore should be considered in carefully selected patients.
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Affiliation(s)
- Sarah I Kamel
- Department of Surgery, Johns Hopkins University School of Medicine, Harvey 611, 600 N Wolfe Street, Baltimore, MD 21287, USA
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Spillman MA, Manning NG, Dye WW, Sartorius CA, Post MD, Harrell JC, Jacobsen BM, Horwitz KB. Tissue-specific pathways for estrogen regulation of ovarian cancer growth and metastasis. Cancer Res 2010; 70:8927-36. [PMID: 20959477 DOI: 10.1158/0008-5472.can-10-1238] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Menopausal estrogen (E2) replacement therapy increases the risk of estrogen receptor (ER)-positive epithelial ovarian cancers (EOC). Whether E2 is tumorigenic or promotes expansion of undiagnosed preexisting disease is unknown. To determine E2 effects on tumor promotion, we developed an intraperitoneal mouse xenograft model using ZsGreen fluorescent ER(-) 2008 and ER(+) PEO4 human EOC cells. Tumor growth was quantified by in vivo fluorescent imaging. In ER(+) tumors, E2 significantly increased size, induced progesterone receptors, and promoted lymph node metastasis, confirming that ERs are functional and foster aggressiveness. Laser-captured human EOC cells from ER(-) and ER(+) xenografted tumors were profiled for expression of E2-regulated genes. Three classes of E2-regulated EOC genes were defined, but <10% were shared with E2-regulated breast cancer genes. Because breast cancer selective ER modulators (SERM) are therapeutically ineffective in EOC, we suggest that our EOC-specific E2-regulated genes can assist pharmacologic discovery of ovarian-targeted SERM.
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Affiliation(s)
- Monique A Spillman
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045, USA.
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Park SH, Ro DY, Park BJ, Kim YW, Kim TE, Jung JK, Lee JW, Kim JY, Han CW. Brain metastasis from uterine cervical cancer. J Obstet Gynaecol Res 2010; 36:701-4. [PMID: 20598062 DOI: 10.1111/j.1447-0756.2010.01219.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Uterine cervical cancer usually spreads by local extension and through the rich lymphatic network to the retroperitoneal lymph nodes. However, brain metastasis from primary cervical cancer is extremely rare. They are usually seen late in the clinical course and have poor prognosis. We present a 48-year-old woman with squamous cell carcinoma of the cervix who developed multiple brain metastases after 30-month treatment of the primary disease. The patient received whole brain radiation therapy and steroids, and she is alive without any neurologic symptoms and signs at the 6-month follow-up after treatment of the recurrence.
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Affiliation(s)
- Sae Hyun Park
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Incheon St. Mary's Hospital, Incheon, Korea
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HANPRASERTPONG J, FUJIWARA K. Splenectomy and surgical cytoreduction in epithelial ovarian cancer: a review. Eur J Cancer Care (Engl) 2010; 20:287-93. [DOI: 10.1111/j.1365-2354.2010.01224.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
BACKGROUND The role of hepatic resection for gynaecological tumours is not well defined as evidence on the subject is lacking. This article describes a tertiary hepatopancreatobiliary unit's experience with hepatic resection for liver metastases from endometrioid primaries. METHODS Five women in whom liver metastases developed at 11 months to 10 years post-primary resection are presented. These patients subsequently underwent hepatic resection with disease-free survival of 8-66 months post-resection. RESULTS Outcomes in this patient series support hepatic resection in the face of isolated liver metastasis. CONCLUSIONS The authors advocate that patients with hepatic deposits should be referred to specialist hepatobiliary units with a view towards hepatic resection and a subsequent good outcome.
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Affiliation(s)
- Brett Knowles
- Departments of Surgery, Royal Infirmary of EdinburghEdinburgh, UK
| | | | - Anca Oniscu
- Departments of Pathology, Royal Infirmary of EdinburghEdinburgh, UK
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Barresi V, Tuccari G, Alafaci C, Caffo M. Importance of intraoperative cytology in the definition of cystic solitary brain lesions. Diagn Cytopathol 2009; 38:854-6. [PMID: 20014128 DOI: 10.1002/dc.21283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Prognostic factors for survival and intracerebral control after irradiation for brain metastases from gynecological cancer. Gynecol Oncol 2009; 114:506-8. [DOI: 10.1016/j.ygyno.2009.05.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Revised: 05/13/2009] [Accepted: 05/21/2009] [Indexed: 11/15/2022]
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Abstract
BACKGROUND Endometrial cancer is the most common gynecologic malignancy. The majority of patients have disease confined to the uterus and have an excellent overall prognosis. However, subgroups of patients have advanced primary disease or recurrences following primary treatment. METHODS The management of metastatic disease is variable, depending on factors such as comorbidities, tumor grade, performance status, and prior treatments. Management options include hormonal therapy and cytotoxic chemotherapy, as well as targeted therapies that inhibit angiogenesis and the cellular signaling pathways involved in cell growth and proliferation. A comprehensive review of these treatments for metastatic endometrial cancer was conducted and is discussed. RESULTS Hormonal therapy and cytotoxic chemotherapy have traditionally been used in the treatment of metastatic endometrial cancer. Advances in molecular biology have led to multiple potential targeted therapies to be used in the treatment of metastatic endometrial cancer. CONCLUSIONS While several treatment modalities are now available to treat patients who present with metastatic endometrial cancer, overall prognosis remains poor.
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Affiliation(s)
- Sarah M Temkin
- Department of Obstetrics/Gynecology, The University of Chicago, Chicago, IL 60637, USA.
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van Wijk F, van der Burg M, Burger CW, Vergote I, van Doorn H. Management of Surgical Stage III and IV Endometrioid Endometrial Carcinoma: An Overview. Int J Gynecol Cancer 2009; 19:431-46. [DOI: 10.1111/igc.0b013e3181a1a04f] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
This paper covers an overview of the literature on the management of advanced endometrial cancer, concentrating on patients with histopathologic endometrioid type of tumors. The different treatment modalities are described and management recommendations are proposed.The standard surgical procedure includes an extrafacial total hysterectomy with bilateral salpingo-oophorectomy, collection of peritoneal washings for cytology, and exploration of the intraabdominal contents. In cases of extensive disease in the abdomen, an optimal surgical cytoreduction is associated with improved survival. Further treatment with radiotherapy may be indicated based on the pathological staging information to improve loco-regional control. Primary radiotherapy is indicated in cases where surgery is contraindicated. Systemic treatment can either be hormone therapy or chemotherapy. Progesterons are the cornerstone of hormone therapy. Prognostic factors for response are the presence of high levels of progesterone and estrogen receptors and low grade histology. Paclitaxel is the most active single agent drug. The combination therapy with paclitaxel and carboplatin is adopted as first choice in patients with endometrial cancer because of the efficacy and low toxicity, although not proven in a randomized trial.The literature on the management of patients with advanced endometrial cancer is discussed in detail. Each stage of advanced disease is presented separately, and management recommendations are proposed, and alternative approaches are given.Ongoing clinical trials are described, and the focuses of ongoing research are mentioned.
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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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Dursun P, Ayhan A, Tarhan NC, Coban G, Kuscu E. Cerebellar metastasis in squamous cell vulvar carcinoma. Arch Gynecol Obstet 2008; 279:69-71. [DOI: 10.1007/s00404-008-0635-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2007] [Accepted: 03/17/2008] [Indexed: 11/25/2022]
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Abstract
Almost 125 years after the first documented case, pulmonary metastasectomy is still poorly understood. No other organ is subject to the wide histologic variety of metastatic insults, and this fact has complicated a complete exposition of when pulmonary metastasectomy may be beneficial. Many physicians still consider pulmonary metastatic disease to be always incurable, and they may underestimate existing surgical options including the benefits of pulmonary metastasectomy. In addition, technological improvements in radiological screening of pulmonary metastases and thoracoscopic resection are fundamentally altering the management of these patients and their surgery. This article reviews the history, form, and future of pulmonary metastasectomy, the literature that supports or refutes its application in various tumor types, and the screening and surgical evaluation that is needed prior to its performance.
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Affiliation(s)
- David I Sternberg
- Section of Thoracic Surgery, Columbia University Medical Center, New-York Presbyterian Hospital, New York, NY 10032, USA
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Demmy TL, Dunn KB. Surgical and Nonsurgical Therapy for Lung Metastasis: Indications and Outcomes. Surg Oncol Clin N Am 2007; 16:579-605, ix. [PMID: 17606195 DOI: 10.1016/j.soc.2007.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The management of pulmonary metastasis is a broad and multifaceted topic. Because of the filtration function and the favorable microenvironment of the lung, most malignancies cause pulmonary metastases. This article focuses on recent experience with secondary lung malignancies and their newer treatment options, indications, and technical aspects.
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Affiliation(s)
- Todd L Demmy
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14231, USA.
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Abstract
The aim of this study was to describe the features of patients with brain metastasis from cervical cancer. Twelve patients with brain metastasis from cervical cancer were identified. Information regarding symptoms, treatment, and survival was analyzed. The incidence of brain metastasis in our population was 0.77%. Median patient age at initial diagnosis of cervical cancer was 43.5 years (range 29-57 years) compared with 44.5 years (range 31-58 years) at identification of brain metastasis. Six patients had FIGO stage IB disease; three had stage IIB disease; and one each had stage IIIA, IIIB, and IVB disease. The median interval from diagnosis of cervical cancer to identification of brain metastasis was 17.5 months (range 1.1-96.1 months). All but one patient presented with neurologic symptoms. Eight patients received whole-brain irradiation and steroids, three received steroids alone, and one underwent surgery, followed by irradiation. All the patients who received whole-brain irradiation experienced improvement in their symptoms. Median survival from diagnosis of brain metastasis to death was 2.3 months (range 0.3-7.9 months). Five patients who received chemotherapy after brain irradiation had a median survival of 4.4 months compared to 0.9 months for those who received no additional treatment after brain irradiation (P= .016). Most patients with brain metastasis from cervical cancer presented with neurologic sequelae. Brain irradiation improved these symptoms. Survival after diagnosis of brain metastasis was poor; however, patients who received chemotherapy after brain irradiation appeared to have improved survival.
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Affiliation(s)
- J C Chura
- Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, 420 Delaware Street, Minneapolis, MN 55455, USA.
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Temkin SM, Hellman M, Lee YC, Abulafia O. Preclinic appointment telephone contact: an effective intervention for colposcopy clinic nonattendance. J Low Genit Tract Dis 2007; 11:118-21. [PMID: 17415118 DOI: 10.1097/01.lgt.0000236970.35125.4b] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the impact of preclinic appointment telephone contact with prospective patients on colposcopic clinic default rates. MATERIALS AND METHODS All women attending the Cornwall Colposcopy Service in Truro, UK, between July and October 2003, were recruited and randomly assigned into two groups. The patients in one group (group A) were contacted by telephone 12 to 24 hours before their clinic appointments to be reminded of their appointments. Confirmation of their attendance was obtained. For patients who indicated their inability to attend, a new date and time was offered. The patients in the other group (group B) were not contacted by telephone. RESULTS Ninety-one percent of patients randomized to group A attended their clinic appointment compared with 69% of patients in group B (who had no preclinic appointment telephone contact) (chi1=15.74; p=00073). The odds ratio was 4.68 (95% CI=2.8-10.45), thus implying that patients who were contacted by telephone before their clinic appointment are about five times more likely to attend compared with their counterparts who were not contacted by telephone. CONCLUSIONS Our study shows that preclinic appointment telephone contact of prospective patients attending colposcopy clinic was an effective intervention to reduce clinic nonattendance.
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Affiliation(s)
- Sarah M Temkin
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, State University of New York, Downstate, Brooklyn, NY, USA.
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dos Santos LA, Modica I, Flores RM, D'Angelica M, Aghajanian C, Chi DS, Abu-Rustum NR. En bloc resection of diaphragm with lung for recurrent ovarian cancer: A case report. Gynecol Oncol 2006; 102:596-8. [PMID: 16782176 DOI: 10.1016/j.ygyno.2006.03.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2006] [Revised: 03/20/2006] [Accepted: 03/21/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Multiple series have demonstrated the feasibility of full-thickness diaphragm resection for ovarian cancer metastatic to the diaphragm. However, direct extension of tumor into the lung is sometimes encountered, and successful resection of this type of implant has not been previously described in the gynecologic oncology literature. CASE REPORT We present the first case of en bloc full-thickness diaphragm resection including a portion of lung tissue using the EndoGIA stapler with primary diaphragmatic closure. DISCUSSION En bloc full-thickness diaphragm resection including a portion of lung tissue using the EndoGIA stapler is a safe, feasible, and effective method to optimize cytoreduction with disease-free margins in the context of invasive diaphragmatic ovarian cancer metastasis.
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Affiliation(s)
- Lisa A dos Santos
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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van der Veldt AAM, Hooft L, van Diest PJ, Berkhof J, Buist MR, Comans EFI, Hoekstra OS, Molthoff CFM. Microvessel density and p53 in detecting cervical cancer by FDG PET in cases of suspected recurrence. Eur J Nucl Med Mol Imaging 2006; 33:1408-16. [PMID: 16841142 DOI: 10.1007/s00259-006-0108-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2005] [Accepted: 02/26/2006] [Indexed: 01/02/2023]
Abstract
PURPOSE Cervical cancer is the second most frequently diagnosed cancer in women worldwide. About one-third of patients experience recurrent disease. A better chance of survival might be achieved by the early detection of recurrent cervical cancer. [(18)F]fluoro-2-deoxy-D-glucose (FDG) PET could be a promising imaging modality for this purpose, given that FDG PET has high diagnostic efficacy. Ideally, pre-selection of patients should be performed before considering FDG PET. The purpose of this study was to investigate parameters of primary cervical cancer associated with recurrence as a basis for pre-selection of patients in whom FDG PET should be performed. METHODS Thirty-eight cervical cancer patients, clinically suspected of having recurrent disease, underwent FDG PET. Tissue from primary tumours and nine histologically confirmed metastases was analysed for biomarkers possibly related to glucose metabolism and prognosis (vascular endothelial growth factor, CD31 for microvessel density, glucose transporter-1, hexokinases I, II and III, Ki67, p53, hypoxia-inducible factor 1alpha, and degree of infiltration by lymphocytes and macrophages). RESULTS Based on clinical outcome, sensitivity and specificity of FDG PET were 96% and 100%, respectively. Cox regression revealed microvessel density and p53 (tumour suppressor protein) to be the two most important biomarkers for prediction of recurrence (hazard ratios 2.54 and 2.28, respectively). By combining these two biomarkers in a parallel test, sensitivity and specificity in predicting recurrence were 87% and 71%, respectively. Leave-one-out cross-validation demonstrated predictive validity of a model based on microvessel density and p53. CONCLUSION In this first study of its kind, we have demonstrated that microvessel density and p53 profiles could be important in pre-selecting cervical cancer patients for detection of recurrence by FDG PET.
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Affiliation(s)
- Astrid A M van der Veldt
- Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam, The Netherlands
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