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van der Horst RL, van der Hel O, Lutgens L, van der Aa M, Slangen B, Kruitwagen R, Lalisang RI. The role of multimodal adjuvant therapy for FIGO I-II carcinosarcoma of the uterus: a systematic review. Crit Rev Oncol Hematol 2022; 175:103701. [PMID: 35533817 DOI: 10.1016/j.critrevonc.2022.103701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/07/2022] [Accepted: 05/02/2022] [Indexed: 11/26/2022] Open
Abstract
The uterine carcinosarcoma (UCS) is a rare entity with poor prognosis. Treatment of FIGO I-II UCS usually consists of surgery with or without adjuvant treatment. Due to the high metastatic potential, aggressive combined modality adjuvant treatment approaches, consisting of chemo- and radiotherapy, have been of interest. Our systematic review aims to compare survival, disease control and toxicity profiles in patients receiving adjuvant chemoradiation to other adjuvant strategies (e.g.observation, chemotherapy or radiotherapy). A total of ten studies were included for a combined cohort size of 6,520 patients. Generally, the studies showed a trend towards improved disease control and survival in patients undergoing adjuvant multimodal treatment, although statistical significance was often not reached. Selection bias and non-randomized treatment allocation pose serious challenges to extrapolate these outcomes to clinical practice. We recommend additional prospective research on the role of adjuvant chemoradiation in FIGO I-II UCS.
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Affiliation(s)
- R L van der Horst
- Division Medical Oncology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht the Netherlands; GROW-School for Oncology and Reproduction, Maastricht University, the Netherlands; Maastricht UMC+ Comprehensive Cancer Center, Maastricht, the Netherlands
| | - O van der Hel
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - L Lutgens
- GROW-School for Oncology and Reproduction, Maastricht University, the Netherlands; Department of Radiation Oncology, MAASTRO Clinic, Maastricht, the Netherlands; Maastricht UMC+ Comprehensive Cancer Center, Maastricht, the Netherlands
| | - M van der Aa
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - B Slangen
- GROW-School for Oncology and Reproduction, Maastricht University, the Netherlands; Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, the Netherlands; Maastricht UMC+ Comprehensive Cancer Center, Maastricht, the Netherlands
| | - R Kruitwagen
- GROW-School for Oncology and Reproduction, Maastricht University, the Netherlands; Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, the Netherlands; Maastricht UMC+ Comprehensive Cancer Center, Maastricht, the Netherlands
| | - R I Lalisang
- Division Medical Oncology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht the Netherlands; GROW-School for Oncology and Reproduction, Maastricht University, the Netherlands; Maastricht UMC+ Comprehensive Cancer Center, Maastricht, the Netherlands
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Algera M, van Driel W, Slangen B, Kruitwagen R, Wouters M, Ten Cate A, Aalders A, van der Kolk A, Kruse A, Jong AVHD, van de Swaluw A, Visschers B, Buis C, Gerestein C, Smeets C, Boll D, van de Laar R, Ngo D, Davelaar E, Ooms E, van Dorst E, Schmeink C, van Es E, Roes E, Ten Cate F, Rijcken F, Dunné FRV, Fons G, Jansen G, Verhoeve H, Nagel H, Keizer H, Smedts H, Ebisch I, van de Lande J, Louwers J, Briet J, De Waard J, Diepstraten J, Vollebergh J, Van der Avoort I, Van Dijk J, Lange J, Mens J, Gaarenstroom K, Overmars K, De Vries L, Hofman L, Bartelink L, Huisman M, Verbruggen M, Vos M, Huisman M, Kleppe M, van den Hende M, van der Aa M, Wust M, Baas M, Engelen M, Scheers E, Moonen-Delarue M, Tjiong M, Leffers N, Reesink N, Timmers P, Kolk P, Vencken P, Yigit R, Smit R, Westenberg S, Coppus S, Stam T, Schukken T, van Baal W, Minderhoud-Bassie W, Van der Plas-Koning Y, van Ham M. Impact of the COVID-19-pandemic on patients with gynecological malignancies undergoing surgery: A Dutch population-based study using data from the 'Dutch Gynecological Oncology Audit'. Gynecol Oncol 2022; 165:330-338. [PMID: 35221132 PMCID: PMC8860632 DOI: 10.1016/j.ygyno.2022.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/13/2022] [Accepted: 02/16/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The COVID-19-pandemic caused drastic healthcare changes worldwide. To date, the impact of these changes on gynecological cancer healthcare is relatively unknown. This study aimed to assess the impact of the COVID-19-pandemic on surgical gynecological-oncology healthcare. METHODS This population-based cohort study included all surgical procedures with curative intent for gynecological malignancies, registered in the Dutch Gynecological Oncology Audit, in 2018-2020. Four periods were identified based on COVID-19 hospital admission rates: 'Pre-COVID-19', 'First wave', 'Interim period', and 'Second wave'. Surgical volume, perioperative care processes, and postoperative outcomes from 2020 were compared with 2018-2019. RESULTS A total of 11,488 surgical procedures were analyzed. For cervical cancer, surgical volume decreased by 17.2% in 2020 compared to 2018-2019 (mean 2018-2019: n = 542.5, 2020: n = 449). At nadir (interim period), only 51% of the expected cervical cancer procedures were performed. For ovarian, vulvar, and endometrial cancer, volumes remained stable. Patients with advanced-stage ovarian cancer more frequently received neoadjuvant chemotherapy in 2020 compared to 2018-2019 (67.7% (n = 432) vs. 61.8% (n = 783), p = 0.011). Median time to first treatment was significantly shorter in all four malignancies in 2020. For vulvar and endometrial cancer, the length of hospital stay was significantly shorter in 2020. No significant differences in complicated course and 30-day-mortality were observed. CONCLUSIONS The COVID-19-pandemic impacted surgical gynecological-oncology healthcare: in 2020, surgical volume for cervical cancer dropped considerably, waiting time was significantly shorter for all malignancies, while neoadjuvant chemotherapy administration for advanced-stage ovarian cancer increased. The safety of perioperative healthcare was not negatively impacted by the pandemic, as complications and 30-day-mortality remained stable.
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Affiliation(s)
- M.D. Algera
- Maastricht University Medical Center (MUMC), Department of Obstetrics and Gynecology, Maastricht, the Netherlands,GROW- School for Oncology and Developmental Biology, Maastricht, the Netherlands,Dutch Institute for Clinical Auditing (DICA), Scientific Bureau, Leiden, the Netherlands,Corresponding author at: Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA Leiden, the Netherlands
| | - W.J. van Driel
- Center for Gynecological Oncology Amsterdam, Netherlands Cancer Institute, Department of Gynecology, Amsterdam, the Netherlands
| | - B.F.M. Slangen
- Maastricht University Medical Center (MUMC), Department of Obstetrics and Gynecology, Maastricht, the Netherlands,GROW- School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - R.F.P.M. Kruitwagen
- Maastricht University Medical Center (MUMC), Department of Obstetrics and Gynecology, Maastricht, the Netherlands,GROW- School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - M.W.J.M. Wouters
- Dutch Institute for Clinical Auditing (DICA), Scientific Bureau, Leiden, the Netherlands,Netherlands Cancer Institute, Department of Surgical Oncology, Amsterdam, the Netherlands,Leiden University Medical Center, Leiden, the Netherlands
| | - the participants of the Dutch Gynecological Oncology Collaborator groupBaalbergenA.1Ten CateA.D.2AaldersA.L.3van der KolkA.4KruseA.J.5JongA.M.L.D. Van Haaften-de6van de SwaluwA.M.G.7VisschersB.A.J.T.8BuisC.C.N.9GeresteinC.G.1017SmeetsC.M.W.H.11BollD.12van de LaarR.13NgoD.H.14DavelaarE.15OomsE.A.16van DorstE.B.L.17SchmeinkC.E.18van EsE.J.M.19RoesE.M.20Ten CateF.A.21RijckenF.E.M.22DunnéF.M.R. Rosier-van23FonsG.24JansenG.H.25VerhoeveH.R.26NagelH.T.C.27KeizerH.H.28SmedtsH.P.M.29EbischI.M.W.30van de LandeJ.2LouwersJ.A.31BrietJ.32De WaardJ.33DiepstratenJ.4VolleberghJ.H.A.34Van der AvoortI.A.M.35Van DijkJ.E.W.36LangeJ.G.37MensJ.W.M.20GaarenstroomK.N.69OvermarsK.38De VriesL.C.39HofmanL.N.40BartelinkL.R.41HuismanM.A.42VerbruggenM.B.43VosM.C.44HuismanM.45KleppeM.46van den HendeM.47van der AaM.48WustM.D.49BaasM.I.50EngelenM.J.A.51ScheersE.C.A.H.52Moonen-DelarueM.W.G.53TjiongM.Y.54LeffersN.55ReesinkN.56TimmersP.J.57KolkP.58VenckenP.M.L.H.59YigitR.60SmitR.A.61WestenbergS.M.62CoppusS.F.P.J.63StamT.C.27SchukkenT.K.64van BaalW.M.65Minderhoud-BassieW.66Van der Plas-KoningY.W.C.M.67van HamM.A.P..C.68Reinier de Graaf Groep, Delft, the NetherlandsSpaarne Gasthuis, Haarlem, the NetherlandsRijnstate Ziekenhuis, Arnhem, the NetherlandsStichting Olijf, the NetherlandsIsala Klinieken, Zwolle, the NetherlandsHagaZiekenhuis, The Hague, the NetherlandsDijklander Ziekenhuis, Hoorn, the NetherlandsStichting Zorgsaam Zeeuws Vlaanderen, Terneuzen, the NetherlandsNij Smellinghe, Drachten, the NetherlandsMeander Medisch Centrum, Amersfoort, the NetherlandsSlingeland Ziekenhuis, Doetinchem, the NetherlandsCatharina Ziekenhuis, Eindhoven, the NetherlandsVieCuri Medisch Centrum, Venlo, the NetherlandsElkerliek Ziekenhuis, Helmond, the NetherlandsLangeland Ziekenhuis, Zoetermeer, the NetherlandsRode Kruis Ziekenhuis, Beverwijk, the NetherlandsUniversity Medical Center Utrecht, Utrecht, the NetherlandsSint Anna Ziekenhuis, Geldrop, the NetherlandsSint Jansgasthuis, Weert, the NetherlandsErasmus Medical Center Cancer Institute, Rotterdam, the NetherlandsBovenij Ziekenhuis, Amsterdam, the NetherlandsAlrijne Zorggroep, Leiderdorp, the NetherlandsTer Gooi Ziekenhuis, Hilversum, the NetherlandsAcademic Medical Center, Amsterdam, the NetherlandsTjongerschans Ziekenhuis, Heereveen, the NetherlandsOnze Lieve Vrouwe Gasthuis, Amsterdam, the NetherlandsHaaglanden Medical Center, the Hague, the NetherlandsMedisch Centrum Leeuwarden, Leeuwarden, the NetherlandsAmphia Ziekenhuis, Breda, the NetherlandsCanisius Wilhelmina ziekenhuis, Nijmegen, the NetherlandsDiakonessenhuis, Utrecht, the NetherlandsZiekenhuisgroep Twente, Almelo, the NetherlandsFranciscus Gasthuis & Vlietland, Rotterdam, the NetherlandsBernhoven Ziekenhuis, Uden, the NetherlandsIkazia Ziekenhuis, Rotterdam, the NetherlandsStreekziekenhuis Koningin Beatrix, Winterswijk, the NetherlandsSint Antonius Ziekenhuis, Nieuwengein, the NetherlandsAmstelland Ziekenhuis, Amstelveen, the NetherlandsTreant Zorggroep, Hoogeveen, the NetherlandsAlbert Schweitzer Ziekenhuis, Dordrecht, the NetherlandsGelderse Vallei, Ede, the NetherlandsDeventer Ziekenhuis, Deventer, the NetherlandsZaans Medisch Centrum, Zaandam, the NetherlandsElisabeth- TweeSteden Ziekenhuis, Tilburg, the NetherlandsGelre Ziekenhuis, Apeldoorn, the NetherlandsMartini Ziekenhuis, Groningen, the NetherlandsIJsselland Ziekenhuis, Capelle aan de IJssel, the NetherlandsNetherlands Comprehensive Cancer Organisation (NCCN), the NetherlandsSaxenburgh Medisch Centrum, Hardenberg, the NetherlandsZiekenhuis Rivierenland, Tiel, the NetherlandsZuyderland Medisch Centrum, Heerlen, the NetherlandsWilhelmina Ziekenhuis, Assen, the NetherlandsLaurentius Ziekenhuis, Roermond, the NetherlandsVrije Universiteit Medisch Centrum, Amsterdam, the NetherlandsOmmelander Ziekenhuis, Scheemda, the NetherlandsMedisch Centrum Twente, Enschede, the NetherlandsMaasstad Ziekenhuis, Rotterdam, the NetherlandsGroene Hart Ziekenhuis, Gouda, the NetherlandsBravis Ziekenhuis, Roosendaal, the NetherlandsUniversity Medical Center Groningen, Groningen, the NetherlandsJeroen Bosch Ziekenhuis, ‘s-Hertogenbosch, the NetherlandsNoordwest Ziekenhuisgroep, Alkmaar, the NetherlandsMaxima Medisch Centrum, Veldhoven, the NetherlandsAntonius Ziekenhuis, Sneek, the NetherlandsFlevoziekenhuis, Almere, the NetherlandsSint Jansdal Ziekenhuis, Harderwijk, the NetherlandsAdmiraal de Ruyter Ziekenhuis, Vlissingen, the NetherlandsRadboud University Medical Center, Nijmegen, the NetherlandsLeiden University Medical Center, Leiden, the Netherlands
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Pouwer A, Hinten F, van der Velden J, Smolders R, Slangen B, Zijlmans H, IntHout J, van der Zee A, Boll D, Gaarenstroom K, Arts H, de Hullu J. Volume-controlled versus short drainage after inguinofemoral lymphadenectomy in vulvar cancer patients: A Dutch nationwide prospective study. Gynecol Oncol 2017; 146:580-587. [DOI: 10.1016/j.ygyno.2017.06.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/26/2017] [Accepted: 06/27/2017] [Indexed: 11/25/2022]
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te Grootenhuis N, van der Zee A, van Doorn H, van der Velden J, Vergote I, Zanagnolo V, Baldwin P, Gaarenstroom K, van Dorst E, Trum J, Slangen B, Runnebaum I, Tamussino K, Hermans R, Provencher D, de Bock G, de Hullu J, Oonk M. Sentinel nodes in vulvar cancer: Long-term follow-up of the GROningen INternational Study on Sentinel nodes in Vulvar cancer (GROINSS-V) I. Gynecol Oncol 2016; 140:8-14. [DOI: 10.1016/j.ygyno.2015.09.077] [Citation(s) in RCA: 177] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/21/2015] [Accepted: 09/26/2015] [Indexed: 11/25/2022]
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Abstract
We investigated the physiological regulation of renal function by nitric oxide (NO) and its interactions with the endothelial cyclooxygenase products in the conscious, chronically catheterized rat. A subpressor dose of NO inhibitor nitro-L-arginine methyl ester (L-NAME) produced renal vasoconstriction that was unaffected by cyclooxygenase inhibition with indomethacin (Indo). Acute, high-dose L-NAME produced a pressor response of approximately 40 mmHg and marked renal vasoconstriction. Indo selectively amplified the renal vasoconstriction, whereas inhibition of the thromboxane-endoperoxide receptor had no effect. Chronic NO inhibition for 5 wk led to sustained hypertension and renal vasoconstriction; the latter was amplified by acute Indo. These data suggest that in the normal, conscious rat the kidney is under important NO-dependent tone. There is no obvious interaction between NO and the cyclooxygenase products in control of basal renal function. When systemic NO inhibition is produced with either acute or chronic high-dose L-NAME, the kidney is severely vasoconstricted. The renal vasoconstriction is not ameliorated by thromboxane-endoperoxide antagonism but is exacerbated by cyclooxygenase blockade, suggesting that vasodilator cyclooxygenase products compensate for the renal hypoperfusion because of severe NO deficiency.
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Affiliation(s)
- C Baylis
- Department of Physiology, West Virginia University, Morgantown 26506-9229, USA
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