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Tombini M, Narducci F, Ricci L, Sancetta B, Boscarino M, Quintiliani L, Lanzone J, Straffi M, Di Lazzaro V, Assenza G. Resilience and psychosocial factors in adult with epilepsy: A longitudinal study. Epilepsy Behav 2024; 154:109746. [PMID: 38513570 DOI: 10.1016/j.yebeh.2024.109746] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/10/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE Resilience is conceptually characterized as a dynamic process encompassing positive adaptation in the context of significant adversity. Our goal was to assess the resilience in people with epilepsy (PWE) and how it impacts longitudinally on psychosocial factors, with a particular focus on the manifestation of stigmatization-related feelings. METHODS We consecutively enrolled 78 adults PWE (42.5 ± 16.2 years old); among them 36 (46.1 %) were seizure-free. All subjects completed at baseline (T0) the Resilience Scale (RS-14) and questionnaires for the assessment of depressive symptoms, anxiety and quality of life: respectively, Beck Depression Inventory-II (BD-II), Generalized Anxiety Disorder-7 (GAD-7) and QOLIE-31 (Q31). All patients were followed up prospectively and re-evaluated after 6-22 months (T1; mean: 14 ± 8 months; median 14 months); at follow up they also completed the Stigma Scale of Epilepsy (SSE) for the assessment of the stigma associated with epilepsy. We correlated resilience values with all psychosocial scores at T0 and T1. Factors associated with resilient and vulnerable outcomes were identified. Finally, a multiple stepwise regression analysis was applied to identify predictors for resilience and stigma perception. RESULTS The results showed for the RS-14 score a significant direct correlation with the Q31 (p < 0.001) and an inverse correlation with the depressive and anxiety symptoms at both times (T0 and T1), as evaluated with BDI-II (p < 0.001) and GAD-7 (p < 0.001). Finally, we found a significant inverse correlation between RS-14 at T0 and the levels of stigmatization assessed with SSE at T1 (p =.015). Using a multiple stepwise regression analysis separately for resilience and stigma perception, depressive symptoms turned out as the best predictors for both variables. Finally, considering longitudinal evaluation we did not observe significant changes in depressive and anxious symptoms, despite a significant reduction in the total number of seizures at follow up. CONCLUSIONS Our study showed that depressive symptoms, anxiety and quality of life were significantly associated with resilience in PwE. Finally, as a novel finding resilience was proved to affect the perception of stigma related to epilepsy more than seizures.
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Affiliation(s)
- M Tombini
- Unità di Neurologia, Neurofisiologia, Neurobiologia, Dipartimento di Medicina, Università Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Roma, Italy; Unità di Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, via Álvaro del Portillo 200, 00128 Roma, Italy.
| | - F Narducci
- Unità di Neurologia, Neurofisiologia, Neurobiologia, Dipartimento di Medicina, Università Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Roma, Italy
| | - L Ricci
- Unità di Neurologia, Neurofisiologia, Neurobiologia, Dipartimento di Medicina, Università Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Roma, Italy; Unità di Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, via Álvaro del Portillo 200, 00128 Roma, Italy
| | - B Sancetta
- Unità di Neurologia, Neurofisiologia, Neurobiologia, Dipartimento di Medicina, Università Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Roma, Italy; Unità di Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, via Álvaro del Portillo 200, 00128 Roma, Italy
| | - M Boscarino
- Unità di Neurologia, Neurofisiologia, Neurobiologia, Dipartimento di Medicina, Università Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Roma, Italy; Unità di Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, via Álvaro del Portillo 200, 00128 Roma, Italy; Dipartimento di Neuroriabilitazione, IRCCS Fondazione Salvatore Maugeri, Milano, Italia
| | - L Quintiliani
- Psicologia Clinica, Fondazione Policlinico Universitario Campus Bio-Medico, via Álvaro del Portillo 200, 00128 Roma, Italy
| | - J Lanzone
- Dipartimento di Neuroriabilitazione, IRCCS Fondazione Salvatore Maugeri, Milano, Italia
| | - M Straffi
- Unità di Neurologia, Neurofisiologia, Neurobiologia, Dipartimento di Medicina, Università Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Roma, Italy
| | - V Di Lazzaro
- Unità di Neurologia, Neurofisiologia, Neurobiologia, Dipartimento di Medicina, Università Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Roma, Italy; Unità di Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, via Álvaro del Portillo 200, 00128 Roma, Italy
| | - G Assenza
- Unità di Neurologia, Neurofisiologia, Neurobiologia, Dipartimento di Medicina, Università Campus Bio-Medico, via Álvaro del Portillo 21, 00128 Roma, Italy; Unità di Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, via Álvaro del Portillo 200, 00128 Roma, Italy
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Cordoba A, Hajj Houssein E, Escande A, Scouarnec C, Narducci F, Martinez Gomez C, Leblanc E, Hudry D, Pasquesoone C, Taieb S, Mirabel X, Lartigau EF, Le Tinier F. Intermediate-risk endometrial cancer treated with adjuvant brachytherapy using single dosimetric planning: long-term outcome and toxicity assessment. Eur J Obstet Gynecol Reprod Biol 2024; 298:23-30. [PMID: 38705010 DOI: 10.1016/j.ejogrb.2024.04.040] [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: 11/27/2023] [Revised: 03/22/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE Brachytherapy of the vaginal dome is the recommended adjuvant treatment for intermediate-risk endometrial cancer. This study assessed the results of dosimetric planning of high-dose-rate brachytherapy exclusively in the first treatment session. STUDY DESIGN This retrospective study included all patients who underwent hysterectomy for endometrial cancer followed by adjuvant brachytherapy of the vaginal dome between 2012 and 2015. Local recurrence rates, overall survival (OS) rates, recurrence-free survival (RFS) rates, and related acute and late toxicity rates were evaluated. RESULTS This analysis included 250 patients, of whom 208 were considered to be at high-intermediate risk of disease recurrence. After a median follow-up of 56 months, the cumulative incidence of local recurrence was 4.8% at 3 years [95% confidence interval (CI) 2.8-8.3] and 7.8% at 5 years (95% CI 4.8-12.6). The 5-year OS rate was 86.2% (95% CI 80.6-90.3), and the 5-year RFS rate was 77.5% (95% CI 71.1-82.7). Acute toxicity occurred in 20 (8%) patients, of which two patients had grade ≥3 toxicity. Only one patient (0.4%) presented with late grade ≥3 toxicity. CONCLUSION These findings confirm the tolerability of this brachytherapy approach, indicating minimal cases of late grade ≥3 toxicity, associated with a good 5-year OS rate. With the advent of molecular prognostic factors, the current focus revolves around discerning those individuals who gain the greatest benefit from adjuvant therapy, and tailoring treatment more effectively.
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Affiliation(s)
- Abel Cordoba
- Academic Department of Radiation Oncology and Brachytherapy, Oscar Lambret Cancer Centre, Lille, France.
| | - El Hajj Houssein
- Department of Surgical Oncology, Oscar Lambret Cancer Centre, Lille, France
| | - Alexandre Escande
- Academic Department of Radiation Oncology and Brachytherapy, Oscar Lambret Cancer Centre, Lille, France
| | - Cyrielle Scouarnec
- Academic Department of Radiation Oncology and Brachytherapy, Oscar Lambret Cancer Centre, Lille, France
| | - Fabrice Narducci
- Department of Surgical Oncology, Oscar Lambret Cancer Centre, Lille, France
| | | | - Eric Leblanc
- Department of Surgical Oncology, Oscar Lambret Cancer Centre, Lille, France
| | - Delphine Hudry
- Department of Surgical Oncology, Oscar Lambret Cancer Centre, Lille, France
| | | | - Sophie Taieb
- Department of Medical Imaging, Oscar Lambret Cancer Centre, Lille, France
| | - Xavier Mirabel
- Academic Department of Radiation Oncology and Brachytherapy, Oscar Lambret Cancer Centre, Lille, France
| | - Eric F Lartigau
- Academic Department of Radiation Oncology and Brachytherapy, Oscar Lambret Cancer Centre, Lille, France
| | - Florence Le Tinier
- Academic Department of Radiation Oncology and Brachytherapy, Oscar Lambret Cancer Centre, Lille, France
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Lambaudie E, Bogart E, Le Deley MC, El Hajj H, Gauthier T, Hebert T, Collinet P, Classe JM, Lecuru F, Motton S, Conri V, Ferrer C, Marchal F, Ferron G, Probst A, Jauffret C, Narducci F. The Influence of Surgical Complexity and Center Experience on Postoperative Morbidity After Minimally Invasive Surgery in Gynecologic Oncology: Lessons Learned from the ROBOGYN-1004 Trial. Ann Surg Oncol 2024:10.1245/s10434-024-15265-1. [PMID: 38616209 DOI: 10.1245/s10434-024-15265-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 03/22/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND This study was a secondary analysis of the ROBOGYN-1004 trial conducted between 2010 and 2015. The study aimed to identify factors that affect postoperative morbidity after either robot-assisted laparoscopy (RL) or conventional laparoscopy (CL) in gynecologic oncology. METHODS The study used two-level logistic regression analyses to evaluate the prognostic and predictive value of patient, surgery, and center characteristics in predicting severe postoperative morbidity 6 months after surgery. RESULTS This analysis included 368 patients. Severe morbidity occurred in 49 (28 %) of 176 patients who underwent RL versus 41 (21 %) of 192 patients who underwent CL (p = 0.15). In the multivariate analysis, after adjustment for the treatment group (RL vs CL), the risk of severe morbidity increased significantly for patients who had poorer performance status, with an odds ratio (OR) of 1.62 for the 1-point difference in the WHO performance score (95 % CI 1.06-2.47; p = 0.027) and according to the type of surgery (p < 0.001). A focus on complex surgical acts showed significant more morbidity in the RL group than in the CL group at the less experienced centers (OR, 3.31; 95 % CI 1.0-11; p = 0.05) compared with no impact at the experienced centers (OR, 0.87; 95 % CI 0.38-1.99; p = 0.75). CONCLUSION The findings suggest that the center's experience may have an impact on the risk of morbidity for patients undergoing complex robot-assisted surgical procedures.
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Affiliation(s)
| | | | - Marie-Cécile Le Deley
- Oscar Lambret Cancer Center, Lille, France
- Université Paris-Sud, UVSQ, CESP, INSERM, Université Paris-Saclay, Villejuif, France
| | - Houssein El Hajj
- Paoli Calmettes Institute, Marseille, France.
- Oscar Lambret Cancer Center, Lille, France.
| | | | | | | | | | | | | | | | | | - Frederic Marchal
- CRAN, UMR 7039, CNRS Institut de Cancérologie de Lorraine Vandoeuvre les-Nancy, Université de Lorraine, Nancy, France
| | - Gwenael Ferron
- Institut Claudius Regaud Cancer Center-Toulouse, Toulouse, France
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Cordoba A, Gesta E, Escande A, Noeuveglise A, Cayez R, Halty A, Ladjimi MT, Narducci F, Hudry D, Martinez Gomez C, Cordoba S, Le Deley MC, Barthoulot M, Lartigau EF. Interstitial needles versus intracavitary applicators only for locally advanced cervical cancer: results from real-life dosimetric comparisons. Front Oncol 2024; 14:1347727. [PMID: 38567146 PMCID: PMC10985138 DOI: 10.3389/fonc.2024.1347727] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/09/2024] [Indexed: 04/04/2024] Open
Abstract
Background and purpose Image-guided adapted brachytherapy (IGABT) is superior to other radiotherapy techniques in the treatment of locally advanced cervical cancer (LACC). We aimed to investigate the benefit of interstitial needles (IN) for a combined intracavitary/interstitial (IC/IS) approach using IGABT over the intracavitary approach (IC) alone in patients with LACC after concomitant external beam radiotherapy (EBRT) and chemotherapy. Materials and methods We included consecutive patients with LACC who were treated with IC/IS IGABT after radiochemotherapy (RCT) in our retrospective, observational study. Dosimetric gain and sparing of organs at risk (OAR) were investigated by comparing the IC/IS IGABT plan with a simulated plan without needle use (IC IGABT plan) and the impact of other clinical factors on the benefit of IC/IS IGABT. Results Ninety-nine patients were analyzed, with a mean EBRT dose of 45.5 ± 1.7 Gy; 97 patients received concurrent chemotherapy. A significant increase in median D90% High Risk Clinical target volume (HR-CTV) was found for IC/IS (82.8 Gy) vs IC (76.2 Gy) (p < 10-4). A significant decrease of the delivered dose for all OAR was found for IC/IS vs IC for median D2cc to the bladder (77.2 Gy), rectum (68 Gy), sigmoid (53.2 Gy), and small bowel (47 Gy) (all p < 10-4). Conclusion HR-CTV coverage was higher with IC/IS IGABT than with IC IGABT, with lower doses to the OAR in patients managed for LACC after RCT. Interstitial brachytherapy in the management of LACC after radiotherapy provides better coverage of the target volumes, this could contribute to better local control and improved survival of patients.
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Affiliation(s)
- Abel Cordoba
- Department of Radiotherapy and Brachytherapy, Oscar Lambret Center, Lille, France
| | - Estelle Gesta
- Department of Radiotherapy and Brachytherapy, Oscar Lambret Center, Lille, France
| | | | | | - Romain Cayez
- Department Medical Physics, Oscar Lambret Center, Lille, France
| | - Adrien Halty
- Department Medical Physics, Oscar Lambret Center, Lille, France
| | | | - Fabrice Narducci
- Department Gynecologic surgical Oncology, Oscar Lambret Center, Lille, France
| | - Delphine Hudry
- Department Gynecologic surgical Oncology, Oscar Lambret Center, Lille, France
| | | | - Sofia Cordoba
- Department of Radiotherapy and Brachytherapy, Hospital Puerta de Hierro, Madrid, Spain
| | | | - Maël Barthoulot
- Department Biostatistics and Methodology, Oscar Lambret Center, Lille, France
| | - Eric F. Lartigau
- Department of Radiotherapy and Brachytherapy, Oscar Lambret Center, Lille, France
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Classe JM, Frenel JS, Berton D, Gladieff L, Ferron G, Lecuru F, Bourgin C, Narducci F, Loaec C. [State of results of HIPEC for epithelial ovarian cancer in the primary treatment or for relapse]. Bull Cancer 2024; 111:261-266. [PMID: 36906402 DOI: 10.1016/j.bulcan.2023.01.019] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/25/2023] [Indexed: 03/11/2023]
Abstract
Peritoneal carcinomatosis is an unavoidable development of ovarian cancer, from the first treatment to relapses, and is the main cause of patients death. Hyperthermic intraperitoneal chemotherapy (HIPEC), is a hope for cure for patients with ovarian cancer. HIPEC is based on direct application of chemotherapy on the perioneum with high concentration of chemotherapy enhanced with specific effects of hyperthermia. Theoretically, HIPEC could be proposed at different steps of ovarian cancer development. But the hypothesis of efficiency of a new treatment must be assessed before being routinely applied. Numerous clinical series are already published about HIPEC used in primary treatment of ovarian cancer or for relapses. These series are mostly retrospectives and based on heterogeneous parameters as inclusion criteria of patients, intra peritoneal chemotherapy, concentration, temperature, duration of HIPEC. Taking into account this heterogeneity it is not possible to draw strong scientific conclusions about HIPEC efficiency to treat ovarian cancer patients. We proposed a review allowing a better understanding of current recommendations of the use of HIPEC in ovarian cancer patients.
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Affiliation(s)
- Jean-Marc Classe
- Institut de Cancerologie de l'Ouest, Département d'oncologie chirurgicale, Saint-Herblain, France; Nantes Université, Nantes, France.
| | - Jean-Sébastien Frenel
- Institut de Cancerologie de l'Ouest, Département d'oncologie chirurgicale, Saint-Herblain, France
| | - Dominique Berton
- Institut de Cancerologie de l'Ouest, Département d'oncologie chirurgicale, Saint-Herblain, France
| | - Laurence Gladieff
- Institut Claudius Regaud-IUCT-O, Département d'oncologie médicale, Toulouse, France
| | - Gwenaël Ferron
- Institut Claudius Regaud-IUCT-O, Département d'oncologie médicale, Toulouse, France
| | - Fabrice Lecuru
- Institut Curie, Paris, Université de Paris, Service de chirurgie sénologique, gynécologique et plastie, Paris, France
| | - Charlotte Bourgin
- Institut de Cancerologie de l'Ouest, Département d'oncologie chirurgicale, Saint-Herblain, France
| | - Fabrice Narducci
- Oscar Lambret, Département de Gynecologie Oncologique, Lille, France
| | - Cécile Loaec
- Institut de Cancerologie de l'Ouest, Département d'oncologie chirurgicale, Saint-Herblain, France
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Mokarram Dorri N, Del M, Cannone F, Lefebvre M, Loaec C, Sabiani L, Jauffret C, Blache G, Houvenaeghel G, Carcopino X, Classe JM, Narducci F, Martinez A, Lambaudie E. Is minimally invasive surgical approach a reasonable option in apparent early stage epithelial ovarian cancer restaging? Results from a multicentric retrospective study. Eur J Surg Oncol 2024; 50:107976. [PMID: 38354484 DOI: 10.1016/j.ejso.2024.107976] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/22/2023] [Accepted: 01/20/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION To perform surgical staging of early stage ovarian cancer (EOC), conventional laparoscopy (LS) and robot-assisted laparoscopy (RLS) appear to be reliable procedures compared to open surgery. But oncologicals results with long-term follow up are limited in the literature. The objective of this study is to evaluate the surgical and long-term survival for patients managed by minimally invasive surgery (MIS). MATERIALS AND METHODS We conducted a multicentric retrospective study in 6 institutions. All patients referred for epithelial EOC (apparent stage I-IIa) managed with LS and RLS were involved. RESULTS From December 2008 to December 2017, 140 patients were included (109 in LS group and 31 in RLS group). A total of 27 (19.2 %) patients were upstaged to an advanced ovarian cancer (FIGO stage > IIA), and 73 % of patients received chemotherapy. Mean operative time was 265,8 ± 88,4 min and significantly longer in RLS group (LS = 254,5 ± 86,8; RLS = 305,6 ± 85,5; p = 0,008). Rate of severe post-operative complications (grade 3) was 5,7 %. Thirteen conversion to laparotomy occurred, including one per-operative hemorrhaege. After a mean follow-up of 60,7 months, 29 (20.7 %) patients recurred, with a time to recurrence was >24 months in 51,7 % of cases. Overall survival (OS) was 88.6 % and disease-free survival (DFS) was 79.3 %. Oncologic outcomes were similar between LS and RLS group (OS: p = 0,504 and DFS: p = 0,213). CONCLUSION Surgical staging of EOC by LS or RLS approach has long-term equivalent surgical and oncological approach. These results seem to be equivalent to open surgery according to literature review.
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Affiliation(s)
| | - Mathilde Del
- Department of Surgical Oncology, Institut Claudius Regaud - Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Francesco Cannone
- Department of Obstetrics and Gynecology, Azienda di Rilievo Nazionale e Alta Specializzazione (ARNAS) Garibaldi, Catania, Italy
| | - Manon Lefebvre
- Department of Surgical Oncology, Oscar Lambret Cancer Centre, Lille, Hauts-de-France, France
| | - Cecile Loaec
- Department of Surgery, Institut de Cancerologie de l'Ouest, Boulevard Professor Monod, 44805, Saint Herblain, France
| | - Laura Sabiani
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Camille Jauffret
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Guillaume Blache
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Gilles Houvenaeghel
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France; Inserm, CNRS, Institut Paoli Calmettes, CRCM, Aix Marseille Univ, Marseille, France
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), University Avignon, CNRS, IRD, IMBE, UMR 7263, Marseille, France
| | - Jean-Marc Classe
- Department of Surgery, Institut de Cancerologie de l'Ouest, Boulevard Professor Monod, 44805, Saint Herblain, France
| | - Fabrice Narducci
- Department of Surgical Oncology, Oscar Lambret Cancer Centre, Lille, Hauts-de-France, France
| | - Alejandra Martinez
- Department of Surgical Oncology, Institut Claudius Regaud - Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Eric Lambaudie
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France; Inserm, CNRS, Institut Paoli Calmettes, CRCM, Aix Marseille Univ, Marseille, France
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Montesinos-Albert M, Giroux PA, Hudry D, Pasquesoone C, Narducci F, Martinez-Gomez C. Complex abdominal wall reconstruction for an isolated parietal recurrence of ovarian cancer. Int J Gynecol Cancer 2023:ijgc-2023-004855. [PMID: 37989478 DOI: 10.1136/ijgc-2023-004855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Affiliation(s)
| | | | - Delphine Hudry
- Department of Surgical Oncology, Oscar Lambret Cancer Centre, Lille, France
| | | | - Fabrice Narducci
- Department of Surgical Oncology, Oscar Lambret Cancer Centre, Lille, France
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El Hajj H, Narducci F, McCluggage G, Pasquesoone C. Intracystic endometrioid borderline tumor. Int J Gynecol Cancer 2023; 33:1663-1665. [PMID: 37543373 PMCID: PMC10579465 DOI: 10.1136/ijgc-2022-004151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 08/07/2023] Open
Affiliation(s)
- Houssein El Hajj
- Department of Surgical Oncology, Oscar Lambret Cancer Centre, Lille, Hauts-de-France, France
| | - Fabrice Narducci
- Department of Surgical Oncology, Oscar Lambret Cancer Centre, Lille, Hauts-de-France, France
| | | | - Camille Pasquesoone
- Department of Pathology, Oscar Lambret Cancer Centre, Lille, Hauts-de-France, France
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Assenza G, Sancetta BM, Lanzone J, Narducci F, Ricci L, Boscarino M, Marrelli A, Ciuffini R, Piccioli M, Di Lazzaro V, Tombini M. Resilience predicts and modulates anxiety severity in people with epilepsy. Epilepsy Behav 2023; 147:109390. [PMID: 37619458 DOI: 10.1016/j.yebeh.2023.109390] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Anxiety is one of the most relevant psychiatric comorbidities in people with epilepsy (PwE). The role of resilience (RES) in the development of anxiety is not well understood. We purposed to better characterize RES impact on anxiety severity in PwE. MATERIALS AND METHODS One hundred and seventy-six PwE underwent online surveys including a collection of socio-demographic, seizure-related, and psychological variables. PwE were grouped according to the data collected; anxiety levels were compared through non-parametric statistics. Hierarchical regression analysis (HRA) and logistic regression were performed to characterize RES contribute in predicting the presence and the severity of anxiety. Mediation/moderation analysis was performed to evaluate causal effects among RES, depression, and anxiety. RESULTS Anxiety did not differ according to socio-demographic and seizure-related variables, exemption for the presence of drug-related adverse effects. Depression, RES, and sleep quality provided the major contribute on anxiety variance. The addiction of RES level in HRA and logistic regression provided a significant increase of R-squared value (p-value = 0.02) and of area under the curve (p-value = 0.03), respectively. RES modulated depression/anxiety relationship (p-value < 0.001), whereas depression did not mediate RES/anxiety correlation (p-value = 0.68). CONCLUSIONS We demonstrated that RES is a significant independent predictor of anxiety in PwE and is able to modulate depression impact on anxiety. Moreover, we confirmed the relevance of depression and sleep quality on anxiety severity.
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Affiliation(s)
- G Assenza
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - B M Sancetta
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy.
| | - J Lanzone
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy
| | - F Narducci
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - L Ricci
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - M Boscarino
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy
| | - A Marrelli
- UOC Neurophysiopathology, Ospedale San Salvatore, L'Aquila, Italy
| | - R Ciuffini
- Department of MeSVA, Università degli Studi dell'Aquila, L'Aquila, Italy
| | - M Piccioli
- UOC Neurology, PO San Filippo Neri, ASL Roma 1, Rome, Italy
| | - V Di Lazzaro
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - M Tombini
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
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10
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Wisztorski M, Aboulouard S, Roussel L, Duhamel M, Saudemont P, Cardon T, Narducci F, Robin YM, Lemaire AS, Bertin D, Hajjaji N, Kobeissy F, Leblanc E, Fournier I, Salzet M. Fallopian tube lesions as potential precursors of early ovarian cancer: a comprehensive proteomic analysis. Cell Death Dis 2023; 14:644. [PMID: 37775701 PMCID: PMC10541450 DOI: 10.1038/s41419-023-06165-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/08/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023]
Abstract
Ovarian cancer is the leading cause of death from gynecologic cancer worldwide. High-grade serous carcinoma (HGSC) is the most common and deadliest subtype of ovarian cancer. While the origin of ovarian tumors is still debated, it has been suggested that HGSC originates from cells in the fallopian tube epithelium (FTE), specifically the epithelial cells in the region of the tubal-peritoneal junction. Three main lesions, p53 signatures, STILs, and STICs, have been defined based on the immunohistochemistry (IHC) pattern of p53 and Ki67 markers and the architectural alterations of the cells, using the Sectioning and Extensively Examining the Fimbriated End Protocol. In this study, we performed an in-depth proteomic analysis of these pre-neoplastic epithelial lesions guided by mass spectrometry imaging and IHC. We evaluated specific markers related to each preneoplastic lesion. The study identified specific lesion markers, such as CAVIN1, Emilin2, and FBLN5. We also used SpiderMass technology to perform a lipidomic analysis and identified the specific presence of specific lipids signature including dietary Fatty acids precursors in lesions. Our study provides new insights into the molecular mechanisms underlying the progression of ovarian cancer and confirms the fimbria origin of HGSC.
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Affiliation(s)
- Maxence Wisztorski
- Univ.Lille, Inserm, CHU Lille, U-1192 - Laboratoire Protéomique Réponse Inflammatoire Spectrométrie de Masse - PRISM, F-59000, Lille, France
| | - Soulaimane Aboulouard
- Univ.Lille, Inserm, CHU Lille, U-1192 - Laboratoire Protéomique Réponse Inflammatoire Spectrométrie de Masse - PRISM, F-59000, Lille, France
| | - Lucas Roussel
- Univ.Lille, Inserm, CHU Lille, U-1192 - Laboratoire Protéomique Réponse Inflammatoire Spectrométrie de Masse - PRISM, F-59000, Lille, France
| | - Marie Duhamel
- Univ.Lille, Inserm, CHU Lille, U-1192 - Laboratoire Protéomique Réponse Inflammatoire Spectrométrie de Masse - PRISM, F-59000, Lille, France
| | - Philippe Saudemont
- Univ.Lille, Inserm, CHU Lille, U-1192 - Laboratoire Protéomique Réponse Inflammatoire Spectrométrie de Masse - PRISM, F-59000, Lille, France
| | - Tristan Cardon
- Univ.Lille, Inserm, CHU Lille, U-1192 - Laboratoire Protéomique Réponse Inflammatoire Spectrométrie de Masse - PRISM, F-59000, Lille, France
| | - Fabrice Narducci
- Univ.Lille, Inserm, CHU Lille, U-1192 - Laboratoire Protéomique Réponse Inflammatoire Spectrométrie de Masse - PRISM, F-59000, Lille, France
- Department of Gynecology Oncology, Oscar Lambret Cancer Center, 59020, Lille, France
| | - Yves-Marie Robin
- Univ.Lille, Inserm, CHU Lille, U-1192 - Laboratoire Protéomique Réponse Inflammatoire Spectrométrie de Masse - PRISM, F-59000, Lille, France
- Department of Gynecology Oncology, Oscar Lambret Cancer Center, 59020, Lille, France
| | - Anne-Sophie Lemaire
- Univ.Lille, Inserm, CHU Lille, U-1192 - Laboratoire Protéomique Réponse Inflammatoire Spectrométrie de Masse - PRISM, F-59000, Lille, France
- Department of Gynecology Oncology, Oscar Lambret Cancer Center, 59020, Lille, France
| | - Delphine Bertin
- Univ.Lille, Inserm, CHU Lille, U-1192 - Laboratoire Protéomique Réponse Inflammatoire Spectrométrie de Masse - PRISM, F-59000, Lille, France
- Department of Gynecology Oncology, Oscar Lambret Cancer Center, 59020, Lille, France
| | - Nawale Hajjaji
- Univ.Lille, Inserm, CHU Lille, U-1192 - Laboratoire Protéomique Réponse Inflammatoire Spectrométrie de Masse - PRISM, F-59000, Lille, France
- Medical Oncology Department, Oscar Lambret Cancer Center, 59020, Lille, France
| | - Firas Kobeissy
- Department of Neurobiology, Center for Neurotrauma, Multiomics & Biomarkers (CNMB), MorehouseSchool of Medicine, Atlanta, GA, 30310, USA
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Eric Leblanc
- Univ.Lille, Inserm, CHU Lille, U-1192 - Laboratoire Protéomique Réponse Inflammatoire Spectrométrie de Masse - PRISM, F-59000, Lille, France.
- Department of Gynecology Oncology, Oscar Lambret Cancer Center, 59020, Lille, France.
| | - Isabelle Fournier
- Univ.Lille, Inserm, CHU Lille, U-1192 - Laboratoire Protéomique Réponse Inflammatoire Spectrométrie de Masse - PRISM, F-59000, Lille, France.
- Institut Universitaire de France, 75000, Paris, France.
| | - Michel Salzet
- Univ.Lille, Inserm, CHU Lille, U-1192 - Laboratoire Protéomique Réponse Inflammatoire Spectrométrie de Masse - PRISM, F-59000, Lille, France.
- Institut Universitaire de France, 75000, Paris, France.
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11
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Pautier P, Genestie C, Gladieff L, Kurtz JE, Lortholary A, de La Motte Rouge T, Gaillard AL, Ducassou A, Dubot C, Rouleau E, Narducci F, Demontoy S, Hennequin C. Recommandations pour la pratique clinique Nice/Saint-Paul-de-Vence 2022–2023 : Prise en charge du cancer du col de l'utérus avancé. Bull Cancer 2023; 110:6S44-6S50. [PMID: 37573038 DOI: 10.1016/s0007-4551(23)00333-8] [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] [Indexed: 08/14/2023]
Abstract
French recommendations for clinical practice, Nice/Saint-Paul-de-Vence 2022-2023: Management of advanced cervical cancer The prognosis of cervical cancer remained pejorative until recently, first-line treatment consisting of platinum-based chemotherapy, associated with bevacizumab whenever possible, without any other therapeutic innovation for several years. However in 2022, immunotherapy appeared in the therapeutic landscape. Pembrolizumab can now be prescribed, thanks to the early access status granted by the HAS in September 2022, in patients with PD-L1 positive tumors. In parallel, bevacizumab generic is now reimbursed, allowing its association with chemotherapy on top of pembrolizumab, if indicated. For patient relapsing after platinium salts, and who never received immunotherapy, cemiplimab could be delivered and reimboursed since spring 2023, whatever could be PD-L1 status. Pretherapeutic work-up includes imaging combining MRI and PET/CT or CT of the chest, abdomen and pelvis, as well as evaluation of PD-L1 status on tumor and immune cells to define the CPS score that will determine eligibility to pembrolizumab treatment (CPS > 1). Possibilities of locoregional treatment depend on individual situations and are discussed on a case-by-case basis in multidisciplinary meetings. Early supportive care is always recommended and inclusion in clinical trials must be systematically considered.
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Affiliation(s)
- Patricia Pautier
- Département d'oncologie médicale, service de gynécologie, Gustave-Roussy, Villejuif, France.
| | | | - Laurence Gladieff
- Département d'oncologie médicale, institut Claudius-Régaud, Toulouse, France
| | - Jean-Emmanuel Kurtz
- Département d'oncologie médicale, institut de cancérologie de Strasbourg, Strasbourg, France
| | - Alain Lortholary
- Service d'oncologie médicale, institut de cancérologie Catherine-de-Sienne, Nantes, France
| | | | | | - Anne Ducassou
- Département de radiothérapie, institut Claudius-Régaud, Toulouse, France
| | - Coraline Dubot
- Département d'oncologie médicale, centre François-Baclesse, Caen, France
| | - Etienne Rouleau
- Service de génétique des tumeurs, Gustave-Roussy, Villejuif, France
| | - Fabrice Narducci
- Département de cancérologie gynécologique, centre Oscar-Lambret, Lille, France
| | - Sylvain Demontoy
- Département de radiothérapie, institut du cancer de Montpellier, Montpellier, France
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12
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Hanvic B, Lecuru F, Vanacker H, Pautier P, Narducci F, Cherifi F, Floquet A, Angeles MA, Berton D, Pomel C, Kalbacher E, Provansal M, Fernandez Y, Rouge TDLM, Roméo C, Laas E, Morice P, Hudry D, Meriaux E, Guyon F, Illac-Vauquelin C, Selle F, Meeus P, Genestie C, Salleron J, Ray-Coquard I. Impact of surgery and chemotherapy in ovarian sex cord-stromal tumors from the multicentric Salomé study including 469 patients. A TMRG and GINECO group study. Gynecol Oncol 2023; 174:190-199. [PMID: 37210929 DOI: 10.1016/j.ygyno.2023.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/14/2022] [Revised: 05/06/2023] [Accepted: 05/12/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Identifying prognostic factors and evaluating the impact of adjuvant chemotherapy in patients with sex cord stromal tumors (SCST) is crucial. In this study, we aimed to address these challenges. METHODS We conducted a retrospective analysis of data from 13 centers of the French Rare malignant gynecological tumors (TMRG) network. We enrolled 469 adult patients with malignant SCST who received upfront surgery since 2011 to July 2015. RESULTS 75% were diagnosed with adult Granulosa cell tumors, and 23% had another subtype. With a median follow-up of 6.4 years, 154 patients (33%) developed a first recurrence, 82 (17%) two recurrences, and 49 (10%) three recurrences. Adjuvant chemotherapy was administered in 14.7% of patients at initial diagnosis. In relapse, perioperative chemotherapy was administered in 58.5%, 28.2%, and 23.8% of patients, respectively, in the first, second, and third relapse. In the first-line therapy, age under 70 years, FIGO stage, and complete surgery were associated with longer progression-free survival (PFS). Chemotherapy had no impact on PFS in early-stage disease (FIGO I-II). The PFS was similar using BEP or other chemotherapy regimens (HR 0.88 [0.43; 1.81]) in the first-line therapy. In case of recurrence, PFS was statistically prolonged by complete surgery, but perioperative chemotherapy use did not impact PFS. CONCLUSION Chemotherapy use did not impact survival in the first-line or relapse setting in SCST. Only surgery and its quality demonstrated benefit for PFS in ovarian SCST in any lines of treatment.
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Affiliation(s)
| | | | | | | | | | | | - Anne Floquet
- Medical Oncology, Institut Bergonié, Bordeaux, France
| | | | - Dominique Berton
- Medical Oncology, Institut de Cancérologie de l'Ouest, site René Gauducheau, Nantes, France
| | | | - Elsa Kalbacher
- Medical Oncology CHU de Besançon, Hôpital Jean Minjoz, Besançon, France
| | | | - Yolanda Fernandez
- Medical Oncology, Institut de Cancérologie de Lorraine, Nancy, France
| | | | | | | | | | | | | | | | | | - Frédéric Selle
- Medical Oncology, Groupe Hospitalier Diaconesses Croix Saint Simon, Hôpital de la Croix Saint Simon, Paris, France
| | | | | | - Julia Salleron
- Biostatistics, Institut de Cancérologie de Lorraine, Nancy, France
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13
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Nucera B, Rinaldi F, Dono F, Lanzone J, Evangelista G, Consoli S, Tappatà M, Narducci F, Troisi S, Trinka E, Brigo F. Progesterone and its derivatives for the treatment of catamenial epilepsy: A systematic review. Seizure 2023; 109:52-59. [PMID: 37229848 DOI: 10.1016/j.seizure.2023.05.004] [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: 03/10/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE Catamenial epilepsy (CE) is defined as an increase in seizure frequency during specific phases of the menstrual cycle in women with epilepsy. The treatment usually includes a combination of non-hormonal and hormonal therapies. This systematic review summarizes the available data on the efficacy of progesterone and its derivates to treat CE. METHODS We performed a systematic search of the literature to identify studies reporting data on the use of progesterone and its derivatives (any type and dose) for the treatment of CE. The main outcome included the efficacy of progesterone and its derivatives on seizure frequency. RESULTS Nineteen articles (457 patients) were included; four were randomized controlled trials (two comparing progesterone vs placebo and two comparing norethisterone vs placebo). Progesterone was generally administered during the luteal phase (from day 15 to 25) or during perimenstrual exacerbations (from day 23 to 25), with an average dose of 10-30 mg/day to a maximum of 300 mg/day. The therapy, usually well tolerated, was ineffective in the randomized controlled trials; conversely, it was associated with an overall reduction in seizure frequency in case reports and uncontrolled studies. CONCLUSIONS Although data from uncontrolled studies suggest that hormone therapy with progesterone may be useful in the treatment of CE, its efficacy has not been demonstrated in controlled trials. The possible antiseizure effect of progesterone could be mediated by its active metabolite allopregnanolone, making the plasmatic measurement of these hormones mandatory to evaluate efficacy. Further randomized controlled trials should investigate the efficacy of progesterone and its derivatives, addressing these pharmacological issues.
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Affiliation(s)
- B Nucera
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano, Italy; Paracelsus Medical University, A-5020 Salzburg, Austria.
| | - F Rinaldi
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano, Italy; Paracelsus Medical University, A-5020 Salzburg, Austria
| | - F Dono
- Department of Neuroscience, Imaging and Clinical Science, ''G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - J Lanzone
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of Milan Institute, Italy
| | - G Evangelista
- Department of Neuroscience, Imaging and Clinical Science, ''G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - S Consoli
- Department of Neuroscience, Imaging and Clinical Science, ''G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - M Tappatà
- IRCCS Istituto delle Scienze Neurolgiche di Bologna, Ospedale Bellaria, Italy
| | - F Narducci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Italy
| | - S Troisi
- Pediatric Neurology, Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - E Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Member of the ERN EpiCARE, Salzburg, Austria
| | - F Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano, Italy
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14
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Cordoba A, El Hajj H, Martinez-Gomez C, Hudry D, Narducci F. Should the cut-off for concomitant radiochemotherapy and intracavitary 3D adaptive uterovaginal brachytherapy be 3 cm? Int J Gynecol Cancer 2023:ijgc-2023-004530. [PMID: 37068850 DOI: 10.1136/ijgc-2023-004530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Affiliation(s)
| | - Houssein El Hajj
- Department of Surgical Oncology, Curie Institute Hospital Group, Saint Cloud, France
| | | | - Delphine Hudry
- Department of Surgical Oncology, Oscar Lambret Center, Lille, France
| | - Fabrice Narducci
- Department of Surgical Oncology, Oscar Lambret Center, Lille, France
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15
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Serouart B, Cordoba A, Martinez-Gomez C, Bogart E, Le Deley MC, Leblanc É, Hudry D, Escande A, Le Tinier F, Pasquesoone C, Taieb S, El Hajj H, Narducci F. Results of a 20 Year Retrospective Analysis of Early-Stage Cervical Cancer: Should 3 cm Be Considered the New Ariadne's Thread in Early Cervical Cancer Treatment? Cancers (Basel) 2023; 15:cancers15051570. [PMID: 36900360 PMCID: PMC10001182 DOI: 10.3390/cancers15051570] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/09/2023] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
(1) This study aims to evaluate the overall survival (OS) and recurrence-free survivals (RFS) and assess disease recurrence of early-stage cervical cancer (ESCC) patients treated with minimally invasive surgery (MIS). (2) This single-center retrospective analysis was performed between January 1999 and December 2018, including all patients managed with MIS for ESCC. (3) All 239 patients included in the study underwent pelvic lymphadenectomy followed by radical hysterectomy without the use of an intrauterine manipulator. Preoperative brachytherapy was performed in 125 patients with tumors measuring 2 to 4 cm. The 5-year OS and RFS rates were 92% and 86.9%, respectively. Multivariate analysis found two significant factors associated with recurrence: previous conization with HR = 0.21, p = 0.01, and tumor size > 3 cm with HR = 2.26, p = 0.031. Out of the 33 cases of disease recurrence, we witnessed 22 disease-related deaths. Recurrence rates were 7.5%, 12.9%, and 24.1% for tumors measuring ≤ 2 cm, 2 to 3 cm, and > 3 cm, respectively. Tumors ≤ 2 cm were mostly associated with local recurrences. Tumors > 2 cm were frequently associated with common iliac or presacral lymph node recurrences. (4) MIS may still be considered for tumors ≤ 2 cm subject to first conization followed by surgery with the Schautheim procedure and extended pelvic lymphadenectomy. Due to the increased rate of recurrence, a more aggressive approach might be considered for tumors > 3 cm.
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Affiliation(s)
- Benjamin Serouart
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France
| | - Abel Cordoba
- Department of Radiotherapy, Oscar Lambret Center, 59000 Lille, France
| | | | - Emilie Bogart
- Department of Biostatistics, Oscar Lambret Center, 59000 Lille, France
| | | | - Éric Leblanc
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France
| | - Delphine Hudry
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France
| | - Alexandre Escande
- Department of Radiotherapy, Oscar Lambret Center, 59000 Lille, France
| | | | | | - Sophie Taieb
- Department of Imaging, Oscar Lambret Center, 59000 Lille, France
| | - Houssein El Hajj
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France
- Correspondence: ; Tel.: +33-7-69-21-12-99
| | - Fabrice Narducci
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France
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16
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Hanvic B, Lecuru F, Vanacker H, Pautier P, Narducci F, Cherifi F, Floquet A, Angeles M, Berton-Rigaud D, Pomel C, Kalbacher E, Provansal Gross M, Fernandez Y, De La Motte Rouge T, Selle F, Meeus P, Genestie C, Salleron J, Ray-Coquard I. 13O Impact of surgery and chemotherapy in ovarian sex cord-stromal tumors from the multicentric Salomé study including 469 patients: A TMRG and GINECO group study. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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17
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Hotton J, Bogart E, Le Deley MC, Lambaudie E, Narducci F, Marchal F. Ergonomic Assessment of the Surgeon's Physical Workload During Robot-Assisted Versus Standard Laparoscopy in a French Multicenter Randomized Trial (ROBOGYN-1004 Trial). Ann Surg Oncol 2023; 30:916-923. [PMID: 36175710 DOI: 10.1245/s10434-022-12548-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 08/11/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Standard laparoscopy (SL) is responsible for musculoskeletal disorders in surgeons because of poor ergonomic positions, which could be reduced by robot-assisted laparoscopy (RAL) owing to the surgeons' seated position. One of the aims of the ROBOGYN-1004 study (NCT01247779) was to evaluate surgeons' workloads during real-time procedures of gynecological oncological surgery. METHODS Patients with gynecological cancer eligible for minimally invasive surgery were recruited from 13 French centers between December 2010 and December 2015. Physical workload was evaluated using the Borg scale every hour over the surgery duration and the perception of workload evaluated using NASA-TLX at the end of surgery. RESULTS A total of 369 patients were recruited, of whom 176 underwent RAL and 193 underwent SL (per-protocol analysis). Posture during SL was significantly more challenging for all body parts except the back. There was an increase in discomfort over time (up to 4 h) for the hands and arms, neck, and legs in SL compared with RAL. Perceived physical activity and abilities were rated higher in SL than in RAL (p < 0.01), whereas perceived personal performance was higher in SL (p < 0.01). Perceived physical effort during surgery was lower in RAL than in SL. CONCLUSIONS RAL improves the perception of physical workload. Compared with SL, the perceived effort is lower in RAL regardless of the complexity of the surgery.
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Affiliation(s)
| | - Emilie Bogart
- DRCI - Unité de Méthodologie et de Biostatistiques, Centre Oscar Lambret, Lille, France
| | - Marie-Cécile Le Deley
- DRCI - Unité de Méthodologie et de Biostatistiques, Centre Oscar Lambret, Lille, France
| | - Eric Lambaudie
- Surgical Department, Institut Paoli-Calmette, Marseille, France
| | | | - Frédéric Marchal
- Surgical Department, CRAN, UMR 7039, CNRS Institut de Cancérologie de Lorraine, Université de Lorraine, Vandoeuvre-les-Nancy, France
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18
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Hotton J, Bogart E, Le Deley MC, Lambaudie E, Narducci F, Marchal F. ASO Visual Abstract: Ergonomic Assessment of the Surgeon's Physical Workload During Robot-Assisted Versus Standard Laparoscopy in a French Multicenter Randomized Trial (ROBOGYN-1004 Trial). Ann Surg Oncol 2023; 30:924-925. [PMID: 36402895 DOI: 10.1245/s10434-022-12608-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
| | - Emilie Bogart
- DRCI - Unité de Méthodologie et de Biostatistiques, Centre Oscar Lambret, Lille, France
| | - Marie-Cécile Le Deley
- DRCI - Unité de Méthodologie et de Biostatistiques, Centre Oscar Lambret, Lille, France
| | - Eric Lambaudie
- Surgical Department, Institut Paoli-Calmette, Marseille, France
| | | | - Frédéric Marchal
- Surgical Department, CRAN, UMR 7039, Université de Lorraine, CNRS Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France
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19
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Lefebvre M, Duchatelet M, El Hajj H, De Courrèges A, Wallet J, Bellier C, Le Tinier F, Le Deley MC, Martinez Gomez C, Leblanc E, Narducci F, Hudry D. Stage I Clear Cell and Serous Uterine Carcinoma: What Is the Right Adjuvant Therapy? Curr Oncol 2023; 30:1174-1185. [PMID: 36661739 PMCID: PMC9858549 DOI: 10.3390/curroncol30010090] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/02/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
This single-center study aimed to retrospectively evaluate the survival outcomes of patients with FIGO stage I clear cell and serous uterine carcinoma according to the type of adjuvant treatment received. The data were collected between 2003 and 2020 and only patients with stage I clear cell or serous uterine carcinoma treated with primary surgery were included. These were classified into three groups: No treatment or brachytherapy only (G1), radiotherapy +/- brachytherapy (G2), chemotherapy +/- radiotherapy +/- brachytherapy (G3). In total, we included 52 patients: 18 patients in G1, 16 in G2, and 18 in G3. Patients in the G3 group presented with poorer prognostic factors: 83.3% had serous histology, 27.8% LVSI, and 27.8% were FIGO stage IB. Patients treated with adjuvant radiotherapy showed an improved 5-year overall survival (OS) (p = 0.02) and a trend towards an enhanced 5-year progression-free survival (PFS) (p = 0.056). In contrast, OS (p = 0.97) and PFS (p = 0.84) in the chemotherapy group with poorer prognostic factors, were similar with increased toxicity (83.3%). Radiotherapy is associated with improved 5-year OS and tends to improve 5-year PFS in women with stage I clear cell and serous uterine carcinoma. Additional chemotherapy should be cautiously considered in serous carcinoma cases presenting poor histological prognostic factors.
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Affiliation(s)
- Manon Lefebvre
- Department of Gynecologic Oncology, Centre Oscar Lambret, 59000 Lille, France; (M.D.); (H.E.H.); (C.M.G.); (E.L.); (F.N.); (D.H.)
| | - Mathilde Duchatelet
- Department of Gynecologic Oncology, Centre Oscar Lambret, 59000 Lille, France; (M.D.); (H.E.H.); (C.M.G.); (E.L.); (F.N.); (D.H.)
| | - Houssein El Hajj
- Department of Gynecologic Oncology, Centre Oscar Lambret, 59000 Lille, France; (M.D.); (H.E.H.); (C.M.G.); (E.L.); (F.N.); (D.H.)
| | - Antoine De Courrèges
- Methodology and Biostatistics Department, Oscar Lambret Comprehensive Cancer Center, 59020 Lille, France; (A.D.C.); (J.W.); (M.C.L.D.)
| | - Jennifer Wallet
- Methodology and Biostatistics Department, Oscar Lambret Comprehensive Cancer Center, 59020 Lille, France; (A.D.C.); (J.W.); (M.C.L.D.)
| | - Charlotte Bellier
- Department of Medical Oncology, Centre Oscar Lambret, 59000 Lille, France;
| | - Florence Le Tinier
- Academic Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center, 59020 Lille, France;
| | - Marie Cécile Le Deley
- Methodology and Biostatistics Department, Oscar Lambret Comprehensive Cancer Center, 59020 Lille, France; (A.D.C.); (J.W.); (M.C.L.D.)
| | - Carlos Martinez Gomez
- Department of Gynecologic Oncology, Centre Oscar Lambret, 59000 Lille, France; (M.D.); (H.E.H.); (C.M.G.); (E.L.); (F.N.); (D.H.)
- Univ. Lille, Inserm, CHU Lille, U1192—Protéomique Réponse Inflammatoire Spectrométrie de Masse—PRISM, 59000 Lille, France
| | - Eric Leblanc
- Department of Gynecologic Oncology, Centre Oscar Lambret, 59000 Lille, France; (M.D.); (H.E.H.); (C.M.G.); (E.L.); (F.N.); (D.H.)
- Univ. Lille, Inserm, CHU Lille, U1192—Protéomique Réponse Inflammatoire Spectrométrie de Masse—PRISM, 59000 Lille, France
| | - Fabrice Narducci
- Department of Gynecologic Oncology, Centre Oscar Lambret, 59000 Lille, France; (M.D.); (H.E.H.); (C.M.G.); (E.L.); (F.N.); (D.H.)
- Univ. Lille, Inserm, CHU Lille, U1192—Protéomique Réponse Inflammatoire Spectrométrie de Masse—PRISM, 59000 Lille, France
| | - Delphine Hudry
- Department of Gynecologic Oncology, Centre Oscar Lambret, 59000 Lille, France; (M.D.); (H.E.H.); (C.M.G.); (E.L.); (F.N.); (D.H.)
- Univ. Lille, Inserm, CHU Lille, U1192—Protéomique Réponse Inflammatoire Spectrométrie de Masse—PRISM, 59000 Lille, France
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Narducci F, Lanzone J, Ricci L, Marrelli A, Piccioli M, Boscarino M, Vico C, Sancetta B, Di Lazzaro V, Tombini M, Assenza G. Determinants of medication adherence in people with epilepsy: A multicenter, cross-sectional survey. Epilepsy Behav 2023; 138:109029. [PMID: 36512930 DOI: 10.1016/j.yebeh.2022.109029] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Poor medication adherence in people with epilepsy (PwE) increases mortality, hospitalization, and poor quality of life, representing a critical challenge for clinicians. Several demographic, clinical, and neuropsychological factors were singularly found associated with medication adherence in several studies, but the literature lacks a comprehensive study simultaneously assessing all these variables. METHODS We performed a multicenter and cross-sectional study using online questionnaires with the following clinical scales: Morisky Medication Adherence Scale (MMAS-8), Quality of Life in Epilepsy Inventory 31 (QoLIE-31), Beck Depression Inventory-II (BDI-II), Generalized Anxiety Disorder-7 (GAD-7) and 14-item Resilience scale (RES14) in a population of 200 PwE. We used the ANOVA test and Spearman's correlation to evaluate the relationship between medication adherence and demographic, clinical (seizure frequency, number of anti-seizure medications), and neuropsychological characteristics. We trained separate machine learning models (logistic regression, random forest, support vector machine) to classify patients with medium-high adherence (MMAS-8 ≥ 6) and poor adherence (MMAS-8 < 6) and to identify the main features that influence adherence. RESULTS Women were more adherent to medication (p-value = 0.035). Morisky Medication Adherence Scale -8 showed a direct correlation with RES14 (p-value = 0.001) and age (p-value = 0.001), while was inversely correlated with BDI-II (p-value = 0.001) and GAD-7 (p-value = 0.001). In our model, the variables mostly predicting treatment adherence were QoLIE-31 subitems, followed by age, resilience, anxiety, years of school, and disease duration. CONCLUSION Our study confirms that gender, age, and neuropsychological traits are relevant factors in predicting medication adherence to PwE. Furthermore, our data provided the first evidence that machine learning on multidimensional self-report questionnaires could help to develop a decisional support system in outpatient epilepsy clinics.
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Affiliation(s)
- F Narducci
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - J Lanzone
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of Milan Institute, Italy.
| | - L Ricci
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - A Marrelli
- UOC Neurophysiopathology, Ospedale San Salvatore, L'Aquila, Italy
| | - M Piccioli
- UOC Neurology, PO San Filippo Neri, ASL Roma 1, Rome, Italy
| | - M Boscarino
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - C Vico
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - B Sancetta
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - V Di Lazzaro
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - M Tombini
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - G Assenza
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
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Cordoba A, Durand B, Escande A, Taieb S, Amor MBH, Le Deley MC, Michel A, Le Tinier F, Hudry D, Martinez C, Leblanc E, Becourt S, Abdedaim C, Bresson L, Lartigau E, Mirabel X, Narducci F. Prognostic impact of tumor size reduction assessed by magnetic resonance imaging after radiochemotherapy in patients with locally advanced cervical cancer. Front Oncol 2022; 12:1046087. [PMID: 36531006 PMCID: PMC9756130 DOI: 10.3389/fonc.2022.1046087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/16/2022] [Accepted: 11/02/2022] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE Pelvic magnetic resonance imaging (MRI) is a key exam used for the initial assessment of loco-regional involvement of cervical cancer. In patients with locally advanced cervical cancer, MRI is used to evaluate the early response to radiochemotherapy before image-guided brachytherapy, the prognostic impact of which we aimed to study. METHODS Patients with locally advanced cervical cancer treated using concomitant radiochemotherapy followed by closure treatment between January 2010 and December 2015 were included in this study. Clinical, anatomopathological, radiological, therapeutic, and follow-up data were evaluated. RESULTS After applying the inclusion and exclusion criteria to the initially chosen 310 patients, 232 were included for evaluation (median follow-up period, 5.3 years). The median age was 50 years (range, 25-83 years), and the median tumor size was 47.5 mm (range, 0-105 mm). Based on the International Federation of Gynaecology and Obstetrics classification system, 9 patients were in stage IB2; 20, IB3; 2, IIA; 63, IIB; 4, IIIA; 7, IIIB; and 127, IIIC1 or higher. The re-evaluation MRI was performed at the median dose of 55.5 Gy, and median reduction in tumor size was 55.2% (range, -20-100%). There was a difference between the disease-free and overall survival rates of the patients with a tumor response greater or lesser than 50%. The risk of recurrence or death reduced by 39% in patients with a tumor size reduction >50%. The overall 5-year survival rate of patients with a response greater and lesser than 50% were 77.7% and 61.5%, respectively. The 5-year disease-free survival rate for these two groups of patients were 68.8% and 51.5%, respectively. CONCLUSION Our study confirms the prognostic impact of tumor size reduction using MRI data obtained after radiochemotherapy in patients with locally advanced cervical cancer.
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Affiliation(s)
- Abel Cordoba
- Academic Radiotherapy Department, Oscar Lambret Center, Lille, France
| | - Benedicte Durand
- Academic Radiotherapy Department, Oscar Lambret Center, Lille, France
| | - Alexandre Escande
- Academic Radiotherapy Department, Oscar Lambret Center, Lille, France
| | - Sophie Taieb
- Radiology Department, Oscar Lambret Center, Lille, France
| | | | | | - Andree Michel
- Biostatistics Department, Oscar Lambret Center, Lille, France
| | | | - Delphine Hudry
- Medical Oncology Department, Oscar Lambret Center, Lille, France
| | - Carlos Martinez
- Medical Oncology Department, Oscar Lambret Center, Lille, France
| | - Eric Leblanc
- Medical Oncology Department, Oscar Lambret Center, Lille, France
| | | | - Cyril Abdedaim
- Surgical Oncology Department, Oscar Lambret Center, Lille, France
| | - Lucie Bresson
- Department of Surgical Oncology, Polyclinique Henin Beaumont, Henin, France
| | - Eric Lartigau
- Academic Radiotherapy Department, Oscar Lambret Center, Lille, France
| | - Xavier Mirabel
- Academic Radiotherapy Department, Oscar Lambret Center, Lille, France
| | - Fabrice Narducci
- Medical Oncology Department, Oscar Lambret Center, Lille, France
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El Hajj H, Castel M, Dennis T, Pasquesoone C, Sassi A, Leblanc E, Narducci F, Hudry D. Conservative treatment of glassy cell cervical cancer: A case report. Oncol Lett 2022; 25:16. [DOI: 10.3892/ol.2022.13602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/31/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Houssein El Hajj
- Department of Gynecologic Oncology, Oscar Lambret Cancer Center, BP307 Lille, France
| | - Mathilde Castel
- Department of Gynecologic Oncology, Oscar Lambret Cancer Center, BP307 Lille, France
| | - Thomas Dennis
- Department of Gynecologic Oncology, Oscar Lambret Cancer Center, BP307 Lille, France
| | | | - Asma Sassi
- Department of Pathology, Oscar Lambret Cancer Center, BP307 Lille, France
| | - Eric Leblanc
- Department of Gynecologic Oncology, Oscar Lambret Cancer Center, BP307 Lille, France
| | - Fabrice Narducci
- Department of Gynecologic Oncology, Oscar Lambret Cancer Center, BP307 Lille, France
| | - Delphine Hudry
- Department of Gynecologic Oncology, Oscar Lambret Cancer Center, BP307 Lille, France
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23
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Zola P, Ciccone G, Piovano E, Fuso L, Di Cuonzo D, Castiglione A, Pagano E, Peirano E, Landoni F, Sartori E, Narducci F, Bertetto O, Ferrero A. Effectiveness of Intensive Versus Minimalist Follow-Up Regimen on Survival in Patients With Endometrial Cancer (TOTEM Study): A Randomized, Pragmatic, Parallel Group, Multicenter Trial. J Clin Oncol 2022; 40:3817-3827. [PMID: 35858170 DOI: 10.1200/jco.22.00471] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE In the absence of clear evidence from randomized trials, the intensity of follow-up regimens after surgical treatment of endometrial cancer is highly variable in clinical practice. To reduce this uncertainty, we conducted a randomized trial to test whether an intensive (INT) versus a minimalist (MIN) follow-up regimen improves overall survival (OS) in patients undergoing operation for endometrial cancer. METHODS The TOTEM study was a large, pragmatic randomized trial, conducted in 42 hospitals (in Italy and France) including patients surgically treated for endometrial cancer, in complete clinical remission, International Federation of Gynecology and Obstetrics stage I-IV. After stratification by center and risk of relapse (low or high), patients were randomly assigned (1:1) to INT or MIN hospital-based follow-up regimens. The study was powered to demonstrate an absolute improvement of 5% of the 5-year OS with the INT regimen. RESULTS In total, 1,871 patients were randomly assigned between November 2008 and July 2018, and 1,847 patients (98.7%) were available for the final analysis (60% low risk). After a median follow-up of 69 months, the 5-year OS was 90.6% in the INT and 91.9% in the MIN arms (hazard ratio, 1.13, 95% CI, 0.86 to 1.50, P = .380). No differences in OS were found in subgroup analyses considering age, cancer treatment, risk of relapse, and degree of adherence of the center to the scheduled follow-up. The probability of detecting a relapse was slightly higher in the INT arm (hazard ratio, 1.17; 95% CI, 0.92 to 1.48; P = .194). CONCLUSION An INT follow-up in endometrial cancer-treated patients does not improve OS, even in high-risk patients. According to available evidence, there is no need to routinely add vaginal cytology, laboratory, or imaging investigations to the MIN regimens used in this trial.
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Affiliation(s)
- Paolo Zola
- Dipartimento di Scienze Chirurgiche, Università degli studi di Torino, Torino, Italy
| | - Giovannino Ciccone
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO Piemonte, Torino, Italy
| | - Elisa Piovano
- SC Ginecologia e Ostetricia n. 3, AOU Città della Salute e della Scienza di Torino, Ospedale Sant'Anna, Torino, Italy
| | - Luca Fuso
- SCDU Ginecologia e Ostetricia, AO Ordine Mauriziano Torino, Torino, Italy
| | - Daniela Di Cuonzo
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO Piemonte, Torino, Italy
| | - Anna Castiglione
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO Piemonte, Torino, Italy
| | - Eva Pagano
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO Piemonte, Torino, Italy
| | - Elena Peirano
- Dipartimento di Scienze Chirurgiche, Università degli studi di Torino, Torino, Italy
| | - Fabio Landoni
- Clinica Ginecologica UNIMIB, Ospedale San Gerardo, Monza, Italy
| | - Enrico Sartori
- Divisione di Ostetricia e Ginecologia, Università di Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Fabrice Narducci
- Département de Cancérologie Gynécologique, Centre Oscar Lambret, Lille, France
| | - Oscar Bertetto
- AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Annamaria Ferrero
- SCDU Ginecologia e Ostetricia, AO Ordine Mauriziano Torino, Torino, Italy
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Slama J, Runnebaum IB, Scambia G, Angeles MA, Bahrehmand K, Kommoss S, Fagotti A, Narducci F, Matylevich O, Holly J, Martinelli F, Koual M, Kopetskyi V, El-Balat A, Corrado G, Căpîlna ME, Schröder W, Novàk Z, Shushkevich A, Fricová L, Cibula D. Analysis of risk factors for recurrence in cervical cancer patients after fertility-sparing treatment: The FERTISS retrospective multicenter study. Am J Obstet Gynecol 2022; 228:443.e1-443.e10. [PMID: 36427596 DOI: 10.1016/j.ajog.2022.11.1295] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Fertility-sparing treatment in patients with cervical cancer should, in principle, follow identical algorithms to that in patients without future reproductive plans. In recent years, a trend toward nonradical procedures, such as conization or simple trachelectomy, has become apparent in medical literature, because of their associations with better pregnancy outcomes. However, the published reports included small numbers of patients and heterogenous treatment strategies to ascertain the safety of such approaches. OBJECTIVE This study aimed to collect multi-institutional data regarding the oncological outcomes after fertility-sparing treatment in patients with cervical cancer and to identify prognostic risk factors, including the influence of the radicality of individual cervical procedures. STUDY DESIGN Patients aged 18 to 40 years with International Federation of Gynecology and Obstetrics 2018 stage IA1 with positive lymphovascular space invasion or ≥IA2 cervical cancer who underwent any type of fertility-sparing procedure were eligible for this retrospective observational study, regardless of their histotype, tumor grade, and history of neoadjuvant chemotherapy. Associations between disease- and treatment-related characteristics with the risk of recurrence were analyzed. RESULTS A total of 733 patients from 44 institutions across 13 countries were included in this study. Almost half of the patients had stage IB1 cervical cancer (49%), and two-thirds of patients were nulliparous (66%). After a median follow-up of 72 months, 51 patients (7%) experienced recurrence, of whom 19 (2.6%) died because of the disease. The most common sites of recurrence were the cervix (53%) and pelvic nodes (22%). The risk of recurrence was 3 times higher in patients with tumors >2 cm in size than in patients with smaller tumors, irrespective of the treatment radicality (19.4% vs 5.7%; hazard ratio, 2.982; 95% confidence interval, 1.383-6.431; P=.005). The recurrence risk in patients with tumors ≤2 cm in size did not differ between patients who underwent radical trachelectomy and patients who underwent nonradical (conization and simple trachelectomy) cervical procedures (P=.957), regardless of tumor size subcategory (<1 or 1-2 cm) or lymphovascular space invasion. CONCLUSION Nonradical fertility-sparing cervical procedures were not associated with an increased risk of recurrence compared with radical procedures in patients with tumors ≤2 cm in size in this large, multicenter retrospective study. The risk of recurrence after any type of fertility-sparing procedure was significantly greater in patients with tumors >2 cm in size.
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Affiliation(s)
- Jiri Slama
- First Faculty of Medicine, Department of Obstetrics and Gynecology, Charles University and General University Hospital, Prague, Czech Republic.
| | - Ingo Bernard Runnebaum
- Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart Rome, Rome, Italy
| | | | - Kiarash Bahrehmand
- Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary
| | - Stefan Kommoss
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Anna Fagotti
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart Rome, Rome, Italy
| | - Fabrice Narducci
- Department of Gynecology Oncology, Oscar Lambret Cancer Center, Lille, France
| | - Olga Matylevich
- Gynecologic Oncology Department, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Belarus
| | - Jessica Holly
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Fabio Martinelli
- Fondazione IRCCS Istituto Nazionale Tumori - Milan, Milan, Italy
| | - Meriem Koual
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, Paris, France
| | | | - Ahmed El-Balat
- Department of Gynecology and Obstetrics, University Clinic Frankfurt, Goethe-University, Frankfurt am Main, Germany; Spital Uster, Women's Hospital, Uster, Switzerland
| | - Giacomo Corrado
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart Rome, Rome, Italy
| | - Mihai Emil Căpîlna
- First Obstetrics and Gynecology Clinic, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, Romania
| | | | - Zoltán Novàk
- Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary
| | - Alexander Shushkevich
- Gynecologic Oncology Department, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Belarus
| | - Lenka Fricová
- First Faculty of Medicine, Department of Obstetrics and Gynecology, Charles University and General University Hospital, Prague, Czech Republic
| | - David Cibula
- First Faculty of Medicine, Department of Obstetrics and Gynecology, Charles University and General University Hospital, Prague, Czech Republic
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Hudry D, Le Guellec S, Meignan S, Bécourt S, Pasquesoone C, El Hajj H, Martínez-Gómez C, Leblanc É, Narducci F, Ladoire S. Tumor-Infiltrating Lymphocytes (TILs) in Epithelial Ovarian Cancer: Heterogeneity, Prognostic Impact, and Relationship with Immune Checkpoints. Cancers (Basel) 2022; 14:5332. [PMID: 36358750 PMCID: PMC9656626 DOI: 10.3390/cancers14215332] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 08/13/2023] Open
Abstract
Epithelial ovarian cancers (EOC) are often diagnosed at an advanced stage with carcinomatosis and a poor prognosis. First-line treatment is based on a chemotherapy regimen combining a platinum-based drug and a taxane-based drug along with surgery. More than half of the patients will have concern about a recurrence. To improve the outcomes, new therapeutics are needed, and diverse strategies, such as immunotherapy, are currently being tested in EOC. To better understand the global immune contexture in EOC, several studies have been performed to decipher the landscape of tumor-infiltrating lymphocytes (TILs). CD8+ TILs are usually considered effective antitumor immune effectors that immune checkpoint inhibitors can potentially activate to reject tumor cells. To synthesize the knowledge of TILs in EOC, we conducted a review of studies published in MEDLINE or EMBASE in the last 10 years according to the PRISMA guidelines. The description and role of TILs in EOC prognosis are reviewed from the published data. The links between TILs, DNA repair deficiency, and ICs have been studied. Finally, this review describes the role of TILs in future immunotherapy for EOC.
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Affiliation(s)
- Delphine Hudry
- Inserm, U1192–Protéomique Réponse Inflammatoire Spectrométrie de Masse–PRISM, Lille University, F-59000 Lille, France
- Department of Gynecologic Oncology, Oscar Lambret Center, F-59000 Lille, France
| | - Solenn Le Guellec
- Department of Gynecologic Oncology, Oscar Lambret Center, F-59000 Lille, France
| | - Samuel Meignan
- Tumorigenesis and Resistance to Treatment Unit, Centre Oscar Lambret, F-59000 Lille, France
- CNRS, Inserm, CHU Lille, UMR9020-U1277-CANTHER-Cancer Heterogeneity Plasticity and Resistance to Therapies, Lille University, F-59000 Lille, France
| | - Stéphanie Bécourt
- Department of Gynecologic Oncology, Oscar Lambret Center, F-59000 Lille, France
| | - Camille Pasquesoone
- Department of Gynecologic Oncology, Oscar Lambret Center, F-59000 Lille, France
| | - Houssein El Hajj
- Department of Gynecologic Oncology, Oscar Lambret Center, F-59000 Lille, France
| | | | - Éric Leblanc
- Inserm, U1192–Protéomique Réponse Inflammatoire Spectrométrie de Masse–PRISM, Lille University, F-59000 Lille, France
- Department of Gynecologic Oncology, Oscar Lambret Center, F-59000 Lille, France
| | - Fabrice Narducci
- Inserm, U1192–Protéomique Réponse Inflammatoire Spectrométrie de Masse–PRISM, Lille University, F-59000 Lille, France
- Department of Gynecologic Oncology, Oscar Lambret Center, F-59000 Lille, France
| | - Sylvain Ladoire
- Department of Medical Oncology, Centre Georges-François Leclerc, F-21000 Dijon, France
- INSERM, CRI-866 Faculty of Medicine, F-21000 Dijon, France
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Boria F, Chiva L, Chacon E, Zanagnolo V, Fagotti A, Kucukmetin A, Mom C, Chakalova G, Shamistan A, Malzoni M, Narducci F, Arencibia O, Raspagliesi F, Toptas T, Cibula D, Kaidarova D, Meydanli MM, Tavares M, Golub D, Perrone AM, Poka R, Zusterzeel PLM, Aluloski I, Goffin F, Haidopoulos D, Haller H, Jach R, Yezhova I, Bernardino M, Bharathan R, Maenpaa MM, Sukhin V, Feron JG, Fruscio R, Kukk K, Ponce J, Demirkiran F, Vorgias G, Povolotskaya N, Coronado Martín PJ, Marina T, Zapardiel I, Bizzarri N, Gorostidi M, Gutierrez M, Manzour N, Berasaluce A, Martin-Calvo N. SUCCOR quality: validation of ESGO quality indicators for surgical treatment of cervical cancer. Int J Gynecol Cancer 2022; 32:1236-1243. [PMID: 36583728 DOI: 10.1136/ijgc-2022-003790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To evaluate whether compliance with European Society of Gynaecological Oncology (ESGO) surgery quality indicators impacts disease-free survival in patients undergoing radical hysterectomy for cervical cancer. METHODS In this retrospective cohort study, 15 ESGO quality indicators were assessed in the SUCCOR database (patients who underwent radical hysterectomy for International Federation of Gynecology and Obstetrics (FIGO) stage 2009 IB1, FIGO 2018 IB1, and IB2 cervical cancer between January 2013 and December 2014), and the final score ranged between 0 and 16 points. Centers with more than 13 points were classified as high-quality indicator compliance centers. We constructed a weighted cohort using inverse probability weighting to adjust for the variables. We compared disease-free survival and overall survival using Cox proportional hazards regression analysis in the weighted cohort. RESULTS A total of 838 patients were included in the study. The mean number of quality indicators compliance in this cohort was 13.6 (SD 1.45). A total of 479 (57.2%) patients were operated on at high compliance centers and 359 (42.8%) patients at low compliance centers. High compliance centers performed more open surgeries (58.4% vs 36.7%, p<0.01). Women who were operated on at centers with high compliance with quality indicators had a significantly lower risk of relapse (HR=0.39; 95% CI 0.25 to 0.61; p<0.001). The association was reduced, but remained significant, after further adjustment for conization, surgical approach, and use of manipulator surgery (HR=0.48; 95% CI 0.30 to 0.75; p=0.001) and adjustment for adjuvant therapy (HR=0.47; 95% CI 0.30 to 0.74; p=0.001). Risk of death from disease was significantly lower in women operated on at centers with high adherence to quality indicators (HR=0.43; 95% CI 0.19 to 0.97; p=0.041). However, the association was not significant after adjustment for conization, surgical approach, use of manipulator surgery, and adjuvant therapy. CONCLUSIONS Patients with early cervical cancer who underwent radical hysterectomy in centers with high compliance with ESGO quality indicators had a lower risk of recurrence and death.
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Affiliation(s)
- Felix Boria
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
| | - Luis Chiva
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
| | - Enrique Chacon
- Department of Gynecologic Oncology, Universidad de Navarra, Pamplona, Navarra, Spain
| | | | - Anna Fagotti
- Agostino Gemelli IRCCS, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Milano, Lombardia, Italy
| | | | - Constantijne Mom
- Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | | | | | - Mario Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
| | | | - Octavio Arencibia
- Department of Gynecology, University Maternal Hospital Canary Islands, Las Palmas, Las Palmas, Spain
| | | | - Tayfun Toptas
- Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Research and Training Hospital, Antalya, Turkey
| | - David Cibula
- Department of Obstetrics and Gynecology, University of Prague, Prague, Czech Republic
| | - Dilyara Kaidarova
- Department of Oncogynecology, Kazahskij naucno-issledovatel'skij institut onkologii i radiologii, Almaty, Kazakhstan
| | - Mehmet Mutlu Meydanli
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | | | - Dmytro Golub
- Department of Surgery, LISOD - Israeli Oncological Hospital, Kyiv Region, Ukraine
| | - Anna Myriam Perrone
- Division of Gynecologic Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Robert Poka
- Department of Obstetrics and Gynecology, Unit of Gynecologic Oncology; Institute of Obstetrics and Gynecology; Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | - Igor Aluloski
- Department of Gynecologic Oncology, University Clinic of Gynecology and Obstetrics, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopjeskopje, Macedonia
| | - Frederic Goffin
- Department of Obstetrics and Gynecology, University of Liege, Liege, Belgium
| | - Dimitrios Haidopoulos
- Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Robert Jach
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
| | | | - Margarida Bernardino
- Department of Gynecology, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
| | - Rasiah Bharathan
- University Hospitals of Leicester NHS Trust, Leicester, Leicester, UK
| | - Minna M Maenpaa
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Vladyslav Sukhin
- Department of Oncology, Radiology and Radiation Medicine, V N Karazin Kharkiv National University, Harkiv, Ukraine.,Department of Oncogynecology, Grigoriev Institute for Medical Radiology NAMS of Ukraine, Harkiv, Ukraine
| | | | - Robert Fruscio
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.,Clinic of Obstetrics and Gynecology, Hospital San Gerardo, Monza, Italy
| | - Kersti Kukk
- North Estonia Medical Centre, Tallinn, Estonia
| | - Jordi Ponce
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
| | - Fuat Demirkiran
- Istanbul University Cerrrahpasa Medical Faculty, istanbul, Turkey
| | - George Vorgias
- Metaxa Cancer Hospital of Piraeus, Piraeus, Attika, Greece
| | - Natalia Povolotskaya
- Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth NHS Trust, Portsmouth, UK
| | - Pluvio J Coronado Martín
- Department of Obstetrics and Gynecology, Hospital Clinico San Carlos IdISSC, Complutense University, Madrid, Spain
| | - Tiermes Marina
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Ignacio Zapardiel
- Department of Gynecologic Oncology, La Paz University Hospital, Madrid, Spain
| | - Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | | | - Monica Gutierrez
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
| | - Nabil Manzour
- Department of Gynecologic Oncology, Universidad de Navarra, Pamplona, Navarra, Spain
| | - Arantxa Berasaluce
- Department of Preventive Medicine and Public Health, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Nerea Martin-Calvo
- ,Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain
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El Hajj H, Hudry D, Gomez CM, Boscher A, Duchatelet M, Leblanc E, Narducci F. Protected Laparoscopic Large Ovarian Cyst Aspiration: A five steps alternative to laparotomy. J Minim Invasive Gynecol 2022; 29:1038-1039. [PMID: 35753617 DOI: 10.1016/j.jmig.2022.06.018] [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: 03/20/2022] [Revised: 06/11/2022] [Accepted: 06/18/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE In this video, we describe a five-step surgical technique allowing to safely incise and aspirate the content of large ovarian cysts through a single port laparoscopic incision. This allows performing laparoscopic oophorectomies instead of large xypho-pubic laparotomies. DESIGN A Stepwise demonstration of the technique with narrated video footage. SETTING Ovarian masses, especially cysts, are common gynecological conditions (1). However, depending on their size, large adnexal cysts are usually managed with transverse or midline laparotomies (2). This is to prevent cyst ruptures and abdominal contamination and ensure the oncological safety of the procedure (3-5). Different leak-proof aspiration techniques were described in the literature allowing for safe large cyst aspiration and adnexectomy through a mini-laparotomy incision or via laparoscopy (2,3,6-10). We describe a five steps surgical technique allowing for closed aspiration of ovarian intracystic fluid and adnexectomy while respecting oncological safety. INTERVENTIONS Step 1: Perform diagnostic laparoscopy to rule out peritoneal carcinomatosis contraindicating this procedure then after cyst exposition, thoroughly dry the cyst wall. Step 1 Bis: Cut the cuff of a sterile glove to prepare a square piece of membrane Step 2: Place a protective gauze, then apply the surgical glue to the ovarian cyst wall followed by the glove/membrane application. Perform a purse suture through the glove/membrane and the ovarian wall superficially to ensure further adhesion and prevent ovarian fluid spillage. Step 3: Incise the ovarian wall then introduce the aspiration cannula and tighten the purse suture to aspirate the cystic fluid. Step 4: After aspiration is complete, tighten the suture and close the glove to guarantee a closed space and prevent abdominal contamination. Step 5: Perform laparoscopic oophorectomy or cystectomy. Safely remove the specimen in an endoscopic retrieval bag through the trocar incision. CONCLUSION This technique allows safe laparoscopic large ovarian cysts resections while respecting oncologic safety and preventing intraabdominal spillage and contamination.
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Affiliation(s)
- Houssein El Hajj
- Department of Gynecologic Oncology, Oscar Lambret Cancer Centre, Lille, France.
| | - Delphine Hudry
- Department of Gynecologic Oncology, Oscar Lambret Cancer Centre, Lille, France
| | | | - Adrien Boscher
- Department of Gynecologic Oncology, Oscar Lambret Cancer Centre, Lille, France
| | - Mathilde Duchatelet
- Department of Gynecologic Oncology, Oscar Lambret Cancer Centre, Lille, France
| | - Eric Leblanc
- Department of Gynecologic Oncology, Oscar Lambret Cancer Centre, Lille, France
| | - Fabrice Narducci
- Department of Gynecologic Oncology, Oscar Lambret Cancer Centre, Lille, France
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28
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Querleu D, Hudry D, Narducci F, Rychlik A. Radical Hysterectomy After the LACC Trial: Back to Radical Vaginal Surgery. Curr Treat Options Oncol 2022; 23:227-239. [PMID: 35195838 DOI: 10.1007/s11864-022-00937-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 11/24/2022]
Abstract
OPINION STATEMENT Classical radical vaginal hysterectomy first performed by Anton Pawlik in Prague in 1888 and popularized by Frederic Schauta is now a historical technique virtually abandoned due to painful perineal incision, a high rate of urinary dysfunction, and the inability to perform lymph node assessment. However, the heritage of this approach has been still used and taught in a few centers outside their Austrian birthplace. A combined vaginal and laparoscopic approach was developed in the 1990s by French and German surgeons who designed diverse surgical techniques for which a novel classification is proposed. All these techniques are different from the so-called laparoscopically assisted radical vaginal hysterectomy (LARVH), a term widely used for laparoscopic radical hysterectomies with vaginal extraction of the specimen. Interestingly, after the publication of the LACC trial (Laparoscopic Approach to Cervical Cancer), the radical vaginal approach has found a very timely application. The creation of a vaginal cuff before performing radical laparoscopic hysterectomy described in 2007 by Leblanc as "Schautheim" operation can be used as a protective maneuver to avoid tumor spillage and potentially overturn the negative outcome of minimally invasive surgery in early-stage cervical cancer. As a result, the combination of radical vaginal and laparoscopic steps of surgery is one possible evolution after the LACC trial that needs further investigation. The forgotten vaginal surgical technique needs a specific learning curve. The creation of a vaginal cuff should be mastered by every gynecological oncologist.
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Affiliation(s)
- Denis Querleu
- Department of Gynecologic Oncology, Policlinico Agostino Gemelli, Via della Pineta Sacchetti, 217, 00168, Rome, RM, Italy.,Department of Obstetrics and Gynecology, University Hospital of Strasbourg, 5 Avenue Molière, 67200, Strasbourg, France
| | - Delphine Hudry
- Department of Gynecologic Oncology, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000, Lille, France
| | - Fabrice Narducci
- Department of Gynecologic Oncology, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000, Lille, France
| | - Agnieszka Rychlik
- Department of Gynecologic Oncology, National Research Institute of Oncology, Wilhelma Konrada Roentgena 5, 02-781, Warsaw, Poland.
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29
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Saadeh R, Berthet A, Marchant S, Kraus F, Aissaoui O, Narducci F, Leblanc E, Hudry D. Total parietal peritonectomy for 61 patients: a retrospective study. EUR J GYNAECOL ONCOL 2022. [DOI: 10.31083/j.ejgo4301009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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30
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Chacon E, Manzour N, Zanagnolo V, Querleu D, Núñez-Córdoba JM, Martin-Calvo N, Căpîlna ME, Fagotti A, Kucukmetin A, Mom C, Chakalova G, Shamistan A, Gil Moreno A, Malzoni M, Narducci F, Arencibia O, Raspagliesi F, Toptas T, Cibula D, Kaidarova D, Meydanli MM, Tavares M, Golub D, Perrone AM, Poka R, Tsolakidis D, Vujić G, Jedryka MA, Zusterzeel PLM, Beltman JJ, Goffin F, Haidopoulos D, Haller H, Jach R, Yezhova I, Berlev I, Bernardino M, Bharathan R, Lanner M, Maenpaa MM, Sukhin V, Feron JG, Fruscio R, Kukk K, Ponce J, Minguez JA, Vázquez-Vicente D, Castellanos T, Boria F, Alcazar JL, Chiva L. SUCCOR cone study: conization before radical hysterectomy. Int J Gynecol Cancer 2022; 32:117-124. [PMID: 35039455 DOI: 10.1136/ijgc-2021-002544] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [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: 02/28/2021] [Accepted: 12/06/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate disease-free survival of cervical conization prior to radical hysterectomy in patients with stage IB1 cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) 2009). METHODS A multicenter retrospective observational cohort study was conducted including patients from the Surgery in Cervical Cancer Comparing Different Surgical Aproaches in Stage IB1 Cervical Cancer (SUCCOR) database with FIGO 2009 IB1 cervical carcinoma treated with radical hysterectomy between January 1, 2013, and December 31, 2014. We used propensity score matching to minimize the potential allocation biases arising from the retrospective design. Patients who underwent conization but were similar for other measured characteristics were matched 1:1 to patients from the non-cone group using a caliper width ≤0.2 standard deviations of the logit odds of the estimated propensity score. RESULTS We obtained a weighted cohort of 374 patients (187 patients with prior conization and 187 non-conization patients). We found a 65% reduction in the risk of relapse for patients who had cervical conization prior to radical hysterectomy (hazard ratio (HR) 0.35, 95% confidence interval (CI) 0.16 to 0.75, p=0.007) and a 75% reduction in the risk of death for the same sample (HR 0.25, 95% CI 0.07 to 0.90, p=0.033). In addition, patients who underwent minimally invasive surgery without prior conization had a 5.63 times higher chance of relapse compared with those who had an open approach and previous conization (HR 5.63, 95% CI 1.64 to 19.3, p=0.006). Patients who underwent minimally invasive surgery with prior conization and those who underwent open surgery without prior conization showed no differences in relapse rates compared with those who underwent open surgery with prior cone biopsy (reference) (HR 1.94, 95% CI 0.49 to 7.76, p=0.349 and HR 2.94, 95% CI 0.80 to 10.86, p=0.106 respectively). CONCLUSIONS In this retrospective study, patients undergoing cervical conization before radical hysterectomy had a significantly lower risk of relapse and death.
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Affiliation(s)
- Enrique Chacon
- Gynecologic Oncology, Universidad de Navarra, Pamplona, Navarra, Spain
| | - Nabil Manzour
- Clinica Universidad de Navarra Departamento de Ginecologia y Obstetricia, Pamplona, Navarra, Spain
| | | | | | | | - Nerea Martin-Calvo
- Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain
| | | | - Anna Fagotti
- University Hospital Agostino Gemelli Gynaecological Oncology Complex Operative Unit, Roma, Lazio, Italy
| | | | - Constantijne Mom
- Amsterdam University Medical Centres, Amsterdam, Noord-Holland, Netherlands
| | | | | | - Antonio Gil Moreno
- Gynecology, Vall d'Hebron Hospital, Sant Cugat Del Vallés, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Barcelona, Spain
| | - Mario Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecologic Surgery, Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
| | | | | | | | - Tayfun Toptas
- Gynecologic Oncology, Saglik Bilimleri University Antalya Research and Training Hospital, Antalya, Turkey
| | - David Cibula
- Department of Obstetrics and Gynecology, University of Prague, Prague, Czech Republic
| | - Dilyara Kaidarova
- Oncogynecology, Kazahskij Naucno-issledovatel'skij Institut Onkologii i Radiologii, Almaty, Kazakhstan
| | - Mehmet Mutlu Meydanli
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | | | - Dmytro Golub
- Department of Surgery, LISOD-Israeli Oncological Hospital, Kyiv, Ukraine
| | - Anna Myriam Perrone
- Azienda Ospedaliero-Universitaria di Bologna Policlinico SantOrsola-Malpighi, Bologna, Italy
| | - Robert Poka
- Obstetrics and Gynecology, Unit of Gynecologic Oncology, Institute of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Dimitrios Tsolakidis
- General Hospital of Thessaloniki Papageorgiou, Thessaloniki, Central Macedonia, Greece
| | | | - Marcin A Jedryka
- Oncological Gynecology, Lower Silesian Cancer Center, Wroclaw, Poland
| | | | | | - Frederic Goffin
- Obstetrics and Gynecology, University of Liege, Liege, Belgium
| | - Dimitrios Haidopoulos
- Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Robert Jach
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
| | | | - Igor Berlev
- North-Western State Medical University, NN Petrov Research Institute of Oncology, Saint-Petersburg, Saint-Petersburg, Russian Federation
| | - Margarida Bernardino
- Gynecology, Instituto Português de Oncologia de Lisboa, Lisboa, Lisboa, Portugal
| | - Rasiah Bharathan
- University Hospitals of Leicester NHS Trust, Leicester, Leicester, UK
| | - Maximilian Lanner
- Kardinal Schwarzenberg'sches Krankenhaus, Schwarzach, Steiermark, Austria
| | - Minna M Maenpaa
- Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Vladyslav Sukhin
- Oncogynecology, Grigorev Institute for Radiology, Kharkiv, Ukraine
| | | | - Robert Fruscio
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy.,Clinic of Obstetrics and Gynecology, Hospital San Gerardo, Monza, Italy
| | - Kersti Kukk
- North Estonia Medical Centre, Tallinn, Estonia
| | - Jordi Ponce
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
| | | | | | | | - Felix Boria
- Clinica Universidad de Navarra Departamento de Ginecologia y Obstetricia, Madrid, Spain
| | - Juan Luis Alcazar
- Obstetrics and Gynecology, School of Medicine, University of Navarra, Pamplona, Spain
| | - Luis Chiva
- Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
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31
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Hudry D, El Hajj H, Narducci F, Leblanc E. Laparoscopic ureteral reimplantation applying the modified psoas hitch and Lich-Gregoir onlay technique: a 10-step surgical video. Int Urogynecol J 2021; 33:2577-2579. [PMID: 34626201 DOI: 10.1007/s00192-021-04990-w] [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: 05/17/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Describe the surgical technique of laparoscopic ureterovesical reimplantation applying the modified psoas hitch with Lich-Gregoire onlay technique to manage a distal ureteral fistula after a hysterectomy for a gynecologic malignancy. MATERIALS AND METHODS This video illustrates the surgical technique of laparoscopic ureteral reimplantation applying the modified psoas hitch with Lich-Gregoire onlay technique in a ten-step surgical video. RESULTS Step 1: closure of the caudal ureter.Step 2: Ureter mobilization. Step 3: Ureter spatulation. Step 4: Bladder mobilization. Step 5: Detrusor muscle incision. Step 6: Bladder suspension. Step 7: Mucosal incision. Step 8: Ureterovesical anastomosis. Step 9: JJ stent insertion. Step 10: Detrusor muscle closure. CONCLUSION Intraoperative identification of ureteral injury and prompt repair are recommended. Ureteral repair technique depends on the ureteral injury site. Distal ureteral injuries (UIs) might require either uretero-ureterostomy or ureteral reimplant with or without a psoas hitch. The Lich-Gregoir is one of the two most frequently used anti-vesicoureteral reflux techniques and has acceptable complication rates.
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Affiliation(s)
- Delphine Hudry
- Department of Surgical Oncology, Oscar Lambret Cancer Center, Lille, France
| | - Houssein El Hajj
- Department of Surgical Oncology, Oscar Lambret Cancer Center, Lille, France. .,Department of Gynecologic Oncology, Centre Oscar Lambret, 3 rue Frédérique Combemale, Lille, France.
| | - Fabrice Narducci
- Department of Surgical Oncology, Oscar Lambret Cancer Center, Lille, France
| | - Eric Leblanc
- Department of Surgical Oncology, Oscar Lambret Cancer Center, Lille, France
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32
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Touboul C, Legendre G, Agostini A, Akladios C, Bendifallah S, Bolze PA, Bouet PE, Chauvet P, Collinet P, Dabi Y, Delotte J, Deffieux X, Dion L, Gauthier T, Kerbage Y, Koskas M, Millet P, Narducci F, Ouldamer L, Ploteau S, Santulli P, Golfier F. [Guidelines for Clinical Practice of the French College of Obstetricians and Gynecologists 2021: Prophylactic procedures associated with gynecologic surgery]. ACTA ACUST UNITED AC 2021; 49:805-815. [PMID: 34520857 DOI: 10.1016/j.gofs.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To draw up recommendations on the use of prophylactic gynecologic procedures during surgery for other indications. DESIGN A consensus panel of 19 experts was convened. A formal conflict of interest policy was established at the onset of the process and applied throughout. The entire study was performed independently without funding from pharmaceutical companies or medical device manufacturers. The panel applied the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system to evaluate the quality of evidence on which the recommendations were based. The authors were advised against making strong recommendations in the presence of low-quality evidence. Some recommendations were ungraded. METHODS The panel studied 22 key questions on seven prophylactic procedures: 1) salpingectomy, 2) fimbriectomy, 3) salpingo-oophorectomy, 4) ablation of peritoneal endometriosis, 5) adhesiolysis, 6) endometrial excision or ablation, and 7) cervical ablation. RESULTS The literature search and application of the GRADE system resulted in 34 recommendations. Six were supported by high-quality evidence (GRADE 1+/-) and 28 by low-quality evidence (GRADE 2+/-). Recommendations on two questions were left ungraded due to a lack of evidence in the literature. CONCLUSIONS A high level of consensus was achieved among the experts regarding the use of prophylactic gynecologic procedures. The ensuing recommendations should result in improved current practice.
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Affiliation(s)
- C Touboul
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Tenon (AP-HP), Sorbonne Université, 4, rue de la Chine, 75020 Paris, France.
| | - G Legendre
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU Anger, 4, rue Larrey, 49933 Angers cedex 9, France
| | - A Agostini
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital de la Conception (AP-HM), Marseille, France
| | - C Akladios
- Service de Gynécologie Obstétrique et Médecine de la Reproduction des hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - S Bendifallah
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Tenon (AP-HP), Sorbonne Université, 4, rue de la Chine, 75020 Paris, France
| | - P A Bolze
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'hôpital Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - P E Bouet
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU Anger, 4, rue Larrey, 49933 Angers cedex 9, France
| | - P Chauvet
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU Estaing, 1, place Lucie-Aubrac, 63000 Clermont-Ferrand, France
| | - P Collinet
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Jeanne-de-Flandre, avenue Eugène-Avinée, 59000 Lille, France
| | - Y Dabi
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Tenon (AP-HP), Sorbonne Université, 4, rue de la Chine, 75020 Paris, France
| | - J Delotte
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital de l'Archet 2, 151, route de Saint-Antoine, 06200 Nice, France
| | - X Deffieux
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'hôpital A.-Béclêre (AP-HP), 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
| | - L Dion
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du Centre Hospitalier Universitaire de Rennes, 16, boulevard de Bulgarie, 35200 Rennes, France
| | - T Gauthier
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France
| | - Y Kerbage
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Jeanne-de-Flandre, avenue Eugène-Avinée, 59000 Lille, France
| | - M Koskas
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de de l'hôpital Bichat (AP-HP), 46, rue Henri-Huchard, 75018 Paris, France
| | - P Millet
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital de l'Archet 2, 151, route de Saint-Antoine, 06200 Nice, France
| | - F Narducci
- Département de Cancérologie Gynécologique, Centre de Lutte Contre le Cancer Oscar-Lambret, Lille, France
| | - L Ouldamer
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU de Tours, 2, boulevard Tonnellé, 37000 Tours, France
| | - S Ploteau
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU de Nantes, 38 bd Jean-Monnet, 44093 Nantes cedex 1, France
| | - P Santulli
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Cochin (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - F Golfier
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'hôpital Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
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Boria F, Chiva L, Zanagnolo V, Querleu D, Martin-Calvo N, Căpîlna ME, Fagotti A, Kucukmetin A, Mom C, Chakalova G, Shamistan A, Malzoni M, Narducci F, Arencibia O, Raspagliesi F, Toptas T, Cibula D, Kaidarova D, Meydanli MM, Tavares M, Golub D, Perrone AM, Poka R, Tsolakidis D, Vujić G, Jedryka MA, Zusterzeel PLM, Beltman JJ, Goffin F, Haidopoulos D, Haller H, Jach R, Yezhova I, Berlev I, Bernardino M, Bharathan R, Lanner M, Maenpaa MM, Sukhin V, Feron JG, Fruscio R, Kukk K, Ponce J, Alonso-Espías M, Minguez JA, Vázquez-Vicente D, Manzour N, Jurado M, Castellanos T, Chacon E, Alcazar JL. Radical hysterectomy in early cervical cancer in Europe: characteristics, outcomes and evaluation of ESGO quality indicators. Int J Gynecol Cancer 2021; 31:1212-1219. [PMID: 34321289 DOI: 10.1136/ijgc-2021-002587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/04/2021] [Accepted: 07/01/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Comprehensive updated information on cervical cancer surgical treatment in Europe is scarce. OBJECTIVE To evaluate baseline characteristics of women with early cervical cancer and to analyze the outcomes of the ESGO quality indicators after radical hysterectomy in the SUCCOR database. METHODS The SUCCOR database consisted of 1272 patients who underwent radical hysterectomy for stage IB1 cervical cancer (FIGO 2009) between January 2013 and December 2014. After exclusion criteria, the final sample included 1156 patients. This study first described the clinical, surgical, pathological, and follow-up variables of this population and then analyzed the outcomes (disease-free survival and overall survival) after radical hysterectomy. Surgical-related ESGO quality indicators were assessed and the accomplishment of the stated recommendations was verified. RESULTS The mean age of the patients was 47.1 years (SD 10.8), with a mean body mass index of 25.4 kg/m2 (SD 4.9). A total of 423 (36.6%) patients had a previous cone biopsy. Tumor size (clinical examination) <2 cm was observed in 667 (57.7%) patients. The most frequent histology type was squamous carcinoma (794 (68.7%) patients), and positive lymph nodes were found in 143 (12.4%) patients. A total of 633 (54.8%) patients were operated by open abdominal surgery. Intra-operative complications occurred in 108 (9.3%) patients, and post-operative complications during the first month occurred in 249 (21.5%) patients, with bladder dysfunction as the most frequent event (119 (10.3%) patients). Clavien-Dindo grade III or higher complication occurred in 56 (4.8%) patients. A total of 510 (44.1%) patients received adjuvant therapy. After a median follow-up of 58 months (range 0-84), the 5-year disease-free survival was 88.3%, and the overall survival was 94.9%. In our population, 10 of the 11 surgical-related quality indicators currently recommended by ESGO were fully fulfilled 5 years before its implementation. CONCLUSIONS In this European cohort, the rate of adjuvant therapy after radical hysterectomy is higher than for most similar patients reported in the literature. The majority of centers were already following the European recommendations even 5 years prior to the ESGO quality indicator implementations.
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Affiliation(s)
- Felix Boria
- Clinica Universidad de Navarra Departamento de Ginecologia y Obstetricia, Madrid, Spain
| | - Luis Chiva
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
| | | | - Denis Querleu
- Department of Surgery, Institut Bergonie, Bordeaux, France
| | - Nerea Martin-Calvo
- Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain
| | | | - Anna Fagotti
- Department of Woman, Child, and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | | | - Constantijne Mom
- Amsterdam University Medical Centres, Amsterdam, Noord-Holland, Netherlands
| | | | | | - Mario Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecologic Surgery, Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
| | | | | | - Francesco Raspagliesi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Tayfun Toptas
- Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Research and Training Hospital, Antalya, Turkey
| | - David Cibula
- Department of Obstetrics and Gynecology, University of Prague, Prague, Czech Republic
| | - Dilyara Kaidarova
- Oncogynecology, Kazahskij Naucno-Issledovatel'skij Institut Onkologii i Radiologii, Almaty, Kazakhstan
| | - Mehmet Mutlu Meydanli
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Mariana Tavares
- Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - Dmytro Golub
- Department of Surgery, LISOD - Israeli Oncological Hospital, Kyiv region, Ukraine
| | - Anna Myriam Perrone
- Azienda Ospedaliero-Universitaria di Bologna Policlinico SantOrsola-Malpighi, Bologna, Italy
| | - Robert Poka
- Obstetrics and Gynecology, Unit of Gynecologic Oncology, Institute of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Dimitrios Tsolakidis
- General Hospital of Thessaloniki Papageorgiou, Thessaloniki, Central Macedonia, Greece
| | | | - Marcin A Jedryka
- Department of Oncological Gynecology, Uniwersytet Medyczny im Piastów Śląskich we Wrocławiu (Wroclaw Medical University), Wroclaw, Poland
| | | | | | - Frederic Goffin
- Department of Obstetrics and Gynecology, University of Liege, Liege, Belgium
| | - Dimitrios Haidopoulos
- Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Robert Jach
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
| | | | - Igor Berlev
- North-Western State Medical University. N.N. Petrov Research Institute of Oncology, Saint-Petersburg, Saint-Petersburg, Russian Federation
| | - Margarida Bernardino
- Department of Gynecology, Instituto Português de Oncologia de Lisboa, Lisboa, Lisboa, Portugal
| | - Rasiah Bharathan
- University Hospitals of Leicester NHS Trust, Leicester, Leicester, UK
| | - Maximilian Lanner
- Kardinal Schwarzenberg'sches Krankenhaus, Schwarzach, Steiermark, Austria
| | - Minna M Maenpaa
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Vladyslav Sukhin
- Department of Oncology, Radiology and Radiation Medicine, V N Karazin Kharkiv National University, Harkiv, Ukraine.,Department of Oncogynecology, Grigoriev Institute for Medical Radiology NAMS of Ukraine, Harkiv, Ukraine
| | | | - Robert Fruscio
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy.,Clinic of Obstetrics and Gynecology, Hospital San Gerardo, Monza, Italy
| | - Kersti Kukk
- North Estonia Medical Centre, Tallinn, Estonia
| | - Jordi Ponce
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
| | - María Alonso-Espías
- Department of Gynecologíc Oncology, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Jose Angel Minguez
- Department of Gynecology, Clinica Universitaria de Navarra, Pamplona, Navarra, Spain
| | | | - Nabil Manzour
- Clinica Universidad de Navarra Departamento de Ginecologia y Obstetricia, Pamplona, Navarra, Spain
| | - Matias Jurado
- Department of Gynecology, Clinica Universitaria de Navarra, Pamplona, Navarra, Spain
| | - Teresa Castellanos
- Department of Gynecology, Clinica Universitaria de Navarra, Madrid, Spain
| | - Enrique Chacon
- Department of Gynecologic Oncology, Universidad de Navarra, Pamplona, Navarra, Spain
| | - Juan Luis Alcazar
- Department of Obstetrics and Gynecology, School of Medicine; University of Navarra, Pamplona, Spain
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Mari R, Pomel C, Colombo PE, Narducci F, Garnier S, Carbuccia N, Guille A, Provansal M, Cappiello MA, Rousseau F, Blache G, Lambaudie E, Birnbaum D, Bertucci F, Sabatier R. Circulating tumor DNA as a noninvasive marker of resectability in ovarian carcinomas. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5548 Background: Ovarian cancer is the leading cause of death by gynecological cancer. Complete surgery remains one of the main prognostic factors. Laparoscopic exploration is mandatory to assess surgical resectability at diagnosis or after neoadjuvant chemotherapy. However, there is no clinical or biological marker that can correctly predict resectability and may be able to avoid a second laparoscopic exploration for initially unresectable diseases. Our aim was to assess circulating tumor DNA (ctDNA) value as a predictive non-invasive marker of evolution towards resectability for patients with epithelial ovarian cancer receiving first-line chemotherapy. Methods: We explored in this work one of the secondary objectives of the CIDOC study (NCT03302884). CIDOC is a multicenter prospective study aiming to explore ctDNA value as early marker of disease relapse after first-line treatment for epithelial ovarian cancer. Patients with mucinous histology or early stages not requiring chemotherapy are excluded. Plasma samples are collected at diagnosis, during neoadjuvant chemotherapy, and during follow-up. After DNA extraction, panel-based next generation sequencing is performed on both tumor samples and germline DNA, and somatic mutations of interest are selected for ctDNA monitoring. ctDNA analyses are conducted using droplet digital PCR (BioRad QX200) by measuring the variant allele fraction (VAF) of previously identified mutations. Results: This intermediary analysis has included 47 patients diagnosed between March 2017 and December 2019. Median age was 69 years old (48 – 84). Most of the patients had advanced disease (89.4% stage FIGO III or IV), serous histology (94.8%), and high grade tumor (92.3%). Most of the patients underwent complete interval cytoreductive surgery (76.3% vs 17.4% complete upfront surgery). Most of the tumors had TP53 mutations (85.1%), following by alterations involving DNA repair genes (38.3%). Median cell-free DNA concentration at baseline was 0.38 ng/µL (0 – 12.8). ctDNA was identified in 92.1% of patients at baseline with a median VAF of 1.84% (0 – 42.52%). ctDNA VAF was correlated to the peritoneal dissemination ( p= 0.039) assessed with the peritoneal cancer index. ctDNA clearance after preoperative chemotherapy tended to be correlated to achievement of complete interval surgery for patients receiving neoadjuvant chemotherapy ( p= 0.108). Conclusions: ctDNA may be a promising non-invasive marker to assess peritoneal cancer spreading and to predict surgical resectability after neoadjuvant chemotherapy. If confirmed in larger populations, this may enable to avoid additional surgical explorations for patients who remain ctDNA positive after chemotherapy. Clinical trial information: NCT03302884.
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Affiliation(s)
- Roxane Mari
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | - Christophe Pomel
- Department of Surgical Oncology, Centre Jean Perrin, Clermont-Ferrand, France
| | - Pierre-Emmanuel Colombo
- Department of Surgical Oncology, Institut Regional du Cancer de Montpellier, Montpellier, France
| | - Fabrice Narducci
- Department of Surgical Oncology, Centre Oscar Lambret, Lille, France
| | - Séverine Garnier
- Aix-Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Nadine Carbuccia
- Aix-Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Arnaud Guille
- Aix-Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Magali Provansal
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | | | | | - Guillaume Blache
- Department of Surgical Oncology, Institut Paoli Calmettes, Marseille, France
| | - Eric Lambaudie
- Department of Surgical Oncology, Institut Paoli Calmettes, Marseille, France
| | - Daniel Birnbaum
- Aix-Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Francois Bertucci
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | - Renaud Sabatier
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
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El Hajj H, Vanseymortier M, Hudry D, Bogart E, Abdeddaim C, Leblanc E, Le Deley MC, Narducci F. Rationale and study design of the CHIPPI-1808 trial: a phase III randomized clinical trial evaluating hyperthermic intraperitoneal chemotherapy (HIPEC) for stage III ovarian cancer patients treated with primary or interval cytoreductive surgery. ESMO Open 2021; 6:100098. [PMID: 33819750 PMCID: PMC8047490 DOI: 10.1016/j.esmoop.2021.100098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/01/2020] [Revised: 02/12/2021] [Accepted: 03/01/2021] [Indexed: 12/03/2022] Open
Abstract
Background Ovarian cancer remains the most lethal gynecologic malignancy with high recurrence rates. Because recurrence involves primarily the peritoneum, intraperitoneal chemotherapy is being evaluated as a new approach to treat microscopic peritoneal disease. One trial showed that cisplatin–paclitaxel intraperitoneal chemotherapy with intravenous paclitaxel improved survival but increased morbidity. Another trial reported a significant improvement in overall survival (OS) and disease-free survival (DFS) without increasing the morbidity (P = 0.76) or mortality rates (hazard ratio 0.67, P = 0.02) after adding hyperthermic intraperitoneal chemotherapy (HIPEC) to interval cytoreduction. The current trial aims to evaluate the impact of adding HIPEC to primary or interval cytoreductive surgery for epithelial ovarian cancer (EOC) on the efficacy, safety, treatment feasibility, and quality of life. Patients and methods This is an international, multicenter, open-label, randomized (1 : 1), two-arm, phase III clinical trial that will enroll 432 patients with newly diagnosed International Federation of Gynecology and Obstetrics (FIGO) stage III EOC. Patients are randomized to receive or not HIPEC with the standard of care. Inclusion criteria include patients with FIGO stage III EOC, Fallopian tube carcinoma or primary peritoneal cancer who undergo complete primary or interval cytoreduction. The primary objective is to assess DFS of the addition of HIPEC. Secondary objectives are the assessment of OS, safety, return to intended oncologic treatment, quality of life and the trade-off between efficacy and morbidity. Conclusions The results might help extend the indications of HIPEC to include patients undergoing primary cytoreduction, providing a standardized protocol for HIPEC in EOC management and reliable information on the quality of life after adding HIPEC. Ovarian cancer remains the most lethal gynecologic cancer with high rates of recurrence involving primarily the peritoneum. Intraperitoneal chemotherapy is being evaluated as a new therapeutic approach to treat microscopic peritoneal disease. This trial evaluates the impact of adding HIPEC to primary or interval cytoreductive surgery for EOC. This trial evaluates the efficacy, safety, treatment feasibility and quality of life after the addition of HIPEC. This is an international, multicenter, open label, randomized, phase III clinical trial.
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Affiliation(s)
- Houssein El Hajj
- Gynecologic Oncology Department, Oscar Lambret Cancer Centre, Lille, France.
| | - M Vanseymortier
- Clinical Research and Innovation Department, Oscar Lambret Cancer Centre, Lille, France
| | - D Hudry
- Gynecologic Oncology Department, Oscar Lambret Cancer Centre, Lille, France
| | - E Bogart
- Clinical Research and Innovation Department, Oscar Lambret Cancer Centre, Lille, France
| | - C Abdeddaim
- Medical Oncology Department, Oscar Lambret Cancer Center, Lille, France
| | - E Leblanc
- Gynecologic Oncology Department, Oscar Lambret Cancer Centre, Lille, France
| | - M C Le Deley
- Paris-Saclay University, Paris-Sud University, UVSQ, CESP, INSERM, Villejuif, France
| | - F Narducci
- Gynecologic Oncology Department, Oscar Lambret Cancer Centre, Lille, France
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Chiva L, Zanagnolo V, Querleu D, Martin-Calvo N, Arévalo-Serrano J, Căpîlna ME, Fagotti A, Kucukmetin A, Mom C, Chakalova G, Aliyev S, Malzoni M, Narducci F, Arencibia O, Raspagliesi F, Toptas T, Cibula D, Kaidarova D, Meydanli MM, Tavares M, Golub D, Perrone AM, Poka R, Tsolakidis D, Vujić G, Jedryka MA, Zusterzeel PLM, Beltman JJ, Goffin F, Haidopoulos D, Haller H, Jach R, Yezhova I, Berlev I, Bernardino M, Bharathan R, Lanner M, Maenpaa MM, Sukhin V, Feron JG, Fruscio R, Kukk K, Ponce J, Minguez JA, Vázquez-Vicente D, Castellanos T, Chacon E, Alcazar JL. SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer. Int J Gynecol Cancer 2020; 30:1269-1277. [PMID: 32788262 DOI: 10.1136/ijgc-2020-001506] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [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: 04/20/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Minimally invasive surgery in cervical cancer has demonstrated in recent publications worse outcomes than open surgery. The primary objective of the SUCCOR study, a European, multicenter, retrospective, observational cohort study was to evaluate disease-free survival in patients with stage IB1 (FIGO 2009) cervical cancer undergoing open vs minimally invasive radical hysterectomy. As a secondary objective, we aimed to investigate the association between protective surgical maneuvers and the risk of relapse. METHODS We obtained data from 1272 patients that underwent a radical hysterectomy by open or minimally invasive surgery for stage IB1 cervical cancer (FIGO 2009) from January 2013 to December 2014. After applying all the inclusion-exclusion criteria, we used an inverse probability weighting to construct a weighted cohort of 693 patients to compare outcomes (minimally invasive surgery vs open). The first endpoint compared disease-free survival at 4.5 years in both groups. Secondary endpoints compared overall survival among groups and the impact of the use of a uterine manipulator and protective closure of the colpotomy over the tumor in the minimally invasive surgery group. RESULTS Mean age was 48.3 years (range; 23-83) while the mean BMI was 25.7 kg/m2 (range; 15-49). The risk of recurrence for patients who underwent minimally invasive surgery was twice as high as that in the open surgery group (HR, 2.07; 95% CI, 1.35 to 3.15; P=0.001). Similarly, the risk of death was 2.42-times higher than in the open surgery group (HR, 2.45; 95% CI, 1.30 to 4.60, P=0.005). Patients that underwent minimally invasive surgery using a uterine manipulator had a 2.76-times higher hazard of relapse (HR, 2.76; 95% CI, 1.75 to 4.33; P<0.001) and those without the use of a uterine manipulator had similar disease-free-survival to the open surgery group (HR, 1.58; 95% CI, 0.79 to 3.15; P=0.20). Moreover, patients that underwent minimally invasive surgery with protective vaginal closure had similar rates of relapse to those who underwent open surgery (HR, 0.63; 95% CI, 0.15 to 2.59; P<0.52). CONCLUSIONS Minimally invasive surgery in cervical cancer increased the risk of relapse and death compared with open surgery. In this study, avoiding the uterine manipulator and using maneuvers to avoid tumor spread at the time of colpotomy in minimally invasive surgery was associated with similar outcomes to open surgery. Further prospective studies are warranted.
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Affiliation(s)
- Luis Chiva
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
| | | | | | - Nerea Martin-Calvo
- Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain
| | | | | | | | | | | | | | | | - Mario Malzoni
- Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
| | | | | | | | - Tayfun Toptas
- Saglik Bilimleri University Antalya Research and Training Hospital, Antalya, Turkey
| | - David Cibula
- Department of Obstetrics and Gynecology, University of Prague, Prague, Czech Republic
| | - Dilyara Kaidarova
- Oncogynecology, Kazahskij Naucno-issledovatel'skij Institut Onkologii i Radiologii, Almaty, Kazakhstan
| | - Mehmet Mutlu Meydanli
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | | | - Dmytro Golub
- LISOD - Israeli Oncological Hospital, Kyiv, Ukraine
| | - Anna Myriam Perrone
- Azienda Ospedaliero-Universitaria di Bologna Policlinico SantOrsola-Malpighi, Bologna, Italy
| | - Robert Poka
- Obstetrics and Gynecology; Unit of Gynecologic Oncology; Institute of Obstetrics and Gynecology; Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | | | - Marcin A Jedryka
- Oncological Gynecology, Lower Silesian Cancer Center, Wroclaw, Poland
| | | | | | - Frederic Goffin
- Obstetrics and Gynecology, University of Liege, Liege, Belgium
| | - Dimitrios Haidopoulos
- Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Robert Jach
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
| | | | - Igor Berlev
- North-Western State Medical University. N.N. Petrov Research Institute of Oncology, St Petersburg, Russia
| | | | | | | | - Minna M Maenpaa
- Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Vladyslav Sukhin
- Oncogynecology, Grigorev Institute for Radiology, Kharkiv, Ukraine
| | | | - Robert Fruscio
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy.,Clinic of Obstetrics and Gynecology, Hospital San Gerardo, Monza, Italy
| | - Kersti Kukk
- North Estonia Medical Centre, Tallinn, Estonia
| | - Jordi Ponce
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
| | - Jose Angel Minguez
- Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | | | - Teresa Castellanos
- Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Enrique Chacon
- Obstetrics and Gynecology, Universidad de Navarra, Pamplona, Spain
| | - Juan Luis Alcazar
- Obstetrics and Gynecology, School of Medicine; University of Navarra, Pamplona, Spain
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Sawan D, Bosc R, La Padula S, Leblanc E, Narducci F, Touboul C, Meningaud JP, Hersant B. Immediate vaginal reconstruction following pelvic exenteration using the pedicled vertical Deep Inferior Epigastric Perforator (DIEP) flap: A technical note. Ann Chir Plast Esthet 2020. [PMID: 32536474 DOI: 10.1016/j.anplas.2019.09.004.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/01/2022]
Abstract
Immediate vaginal reconstruction is usually offered following pelvic exenteration for recurrent cervical cancer in women previously treated with radiotherapy or with severe radiation-induced fistulae. Introduction of muscle-sparing flaps, such as the pedicled vertical deep inferior epigastric perforator (DIEP) flap, provides viable tissues for vaginal reconstruction and is associated with reduced donor-site morbidity. This report describes the surgical technique, which is one of the procedures of choice for vaginal reconstruction. It is safe and beneficial, especially for women with gynecologic cancer who have undergone pelvic exenteration after failed radiation therapy.
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Affiliation(s)
- D Sawan
- Department of Plastic, Reconstructive, Aesthetic and Maxillo-Facial Surgery, Henri-Mondor University Hospital, 94000 Créteil, France.
| | - R Bosc
- Department of Plastic, Reconstructive, Aesthetic and Maxillo-Facial Surgery, Henri-Mondor University Hospital, 94000 Créteil, France
| | - S La Padula
- Department of Plastic, Reconstructive, Aesthetic and Maxillo-Facial Surgery, Henri-Mondor University Hospital, 94000 Créteil, France
| | - E Leblanc
- Department of Surgical Oncology, Oscar Lambret, 59000 Lille, France
| | - F Narducci
- Department of Surgical Oncology, Oscar Lambret, 59000 Lille, France
| | - C Touboul
- Intercommunal Hospital Center of Creteil, 94000 Créteil, France
| | - J-P Meningaud
- Department of Plastic, Reconstructive, Aesthetic and Maxillo-Facial Surgery, Henri-Mondor University Hospital, 94000 Créteil, France
| | - B Hersant
- Department of Plastic, Reconstructive, Aesthetic and Maxillo-Facial Surgery, Henri-Mondor University Hospital, 94000 Créteil, France
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Sawan D, Bosc R, La Padula S, Leblanc E, Narducci F, Touboul C, Meningaud JP, Hersant B. Immediate vaginal reconstruction following pelvic exenteration using the pedicled vertical Deep Inferior Epigastric Perforator (DIEP) flap: A technical note. ANN CHIR PLAST ESTH 2020; 65:e1-e5. [PMID: 32536474 DOI: 10.1016/j.anplas.2019.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/27/2019] [Revised: 09/11/2019] [Accepted: 09/26/2019] [Indexed: 10/24/2022]
Abstract
Immediate vaginal reconstruction is usually offered following pelvic exenteration for recurrent cervical cancer in women previously treated with radiotherapy or with severe radiation-induced fistulae. Introduction of muscle-sparing flaps, such as the pedicled vertical deep inferior epigastric perforator (DIEP) flap, provides viable tissues for vaginal reconstruction and is associated with reduced donor-site morbidity. This report describes the surgical technique, which is one of the procedures of choice for vaginal reconstruction. It is safe and beneficial, especially for women with gynecologic cancer who have undergone pelvic exenteration after failed radiation therapy.
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Affiliation(s)
- D Sawan
- Department of Plastic, Reconstructive, Aesthetic and Maxillo-Facial Surgery, Henri-Mondor University Hospital, 94000 Créteil, France.
| | - R Bosc
- Department of Plastic, Reconstructive, Aesthetic and Maxillo-Facial Surgery, Henri-Mondor University Hospital, 94000 Créteil, France
| | - S La Padula
- Department of Plastic, Reconstructive, Aesthetic and Maxillo-Facial Surgery, Henri-Mondor University Hospital, 94000 Créteil, France
| | - E Leblanc
- Department of Surgical Oncology, Oscar Lambret, 59000 Lille, France
| | - F Narducci
- Department of Surgical Oncology, Oscar Lambret, 59000 Lille, France
| | - C Touboul
- Intercommunal Hospital Center of Creteil, 94000 Créteil, France
| | - J-P Meningaud
- Department of Plastic, Reconstructive, Aesthetic and Maxillo-Facial Surgery, Henri-Mondor University Hospital, 94000 Créteil, France
| | - B Hersant
- Department of Plastic, Reconstructive, Aesthetic and Maxillo-Facial Surgery, Henri-Mondor University Hospital, 94000 Créteil, France
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Kerbage Y, Kakkos A, Kridelka F, Lambaudie E, Bats AS, Hébert T, Goffin F, Wallet J, Leblanc E, Hudry D, Narducci F. Lomboaortic Lymphadenectomy in Gynecological Oncology: Laparotomy, Laparoscopy or Robot-Assisted Laparoscopy? Ann Surg Oncol 2020; 27:3891-3897. [DOI: 10.1245/s10434-020-08471-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Indexed: 11/18/2022]
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Narducci F, Bogart E, Hebert T, Gauthier T, Collinet P, Classe JM, Lecuru F, Delest A, Motton S, Conri V, Ferrer C, Marchal F, Ferron G, Probst A, Thery J, Le Deley MC, Lefebvre D, Francon D, Leblanc E, Lambaudie E. Severe perioperative morbidity after robot-assisted versus conventional laparoscopy in gynecologic oncology: Results of the randomized ROBOGYN-1004 trial. Gynecol Oncol 2020; 158:382-389. [PMID: 32467054 DOI: 10.1016/j.ygyno.2020.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 12/13/2019] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE In gynecologic oncology, minimally invasive surgery using conventional laparoscopy (CL) decreases the incidence of severe morbidity compared to open surgery. In 2005, robot-assisted laparoscopy (RL) was approved for use in gynecology in the US. This study aimed to assess whether RL is superior to CL in terms of morbidity incidence. METHODS ROBOGYN-1004 (ClinicalTrials.gov, NCT01247779) was a multicenter, phase III, superiority randomized trial that compared RL and CL in patients with gynecologic cancer requiring minimally invasive surgery. Patients were recruited between 2010 and 2015. The primary endpoint was incidence of severe perioperative morbidity (severe complications during or 6 months after surgery). RESULTS Overall, 369 of 385 patients were included in the as-treated analysis: 176 and 193 underwent RL and CL, respectively. The median operating time for RL was 190 (range, 75-432) minutes and for CL was 145 (33-407) minutes (p < 0.001). The blood loss volumes for the corresponding procedures were 100 (0-2500) and 50 (0-1000) mL (p = 0.003), respectively. The overall rates of conversion to open surgery for the corresponding procedures were 7% (10/176) and 5% (10/193), respectively (p = 0.52). Severe perioperative morbidity occurred in 28% (49/176) and 21% (41/192) of patients who underwent RL and CL, respectively (p = 0.15). At a median follow-up of 25.1 months (range, 0.6-78.2), no significant differences in overall and disease-free survival were observed between the groups. CONCLUSIONS RL was not found superior to CL with regard to the incidence of severe perioperative morbidity in patients with gynecologic cancer. In addition, RL involved a longer operating time than CL.
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Affiliation(s)
| | | | | | | | | | | | | | - Alain Delest
- Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | | | | | | | - Frederic Marchal
- CRAN, UMR 7039, Université de Lorraine, CNRS Institut de Cancérologie de Lorraine Vandoeuvre-les-Nancy, France
| | - Gwenael Ferron
- Institut Claudius Regaud Cancer Center, Toulouse, France
| | | | | | - Marie-Cécile Le Deley
- Oscar Lambret Cancer Center, Lille, France; Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | | | - Daniel Francon
- Institut Paoli Calmettes Cancer Center, Marseille, France
| | | | - Eric Lambaudie
- Institut Paoli Calmettes Cancer Center, Marseille, France
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Leblanc E, Narducci F, Hudry D, Mailliez A, Lemaire AS, Tresch-Bruneel E, Salzet M, Pomel C, Caquant F, Houvenaeghel G, Charvolin JY, Crouzet A, Guyon F, Fouche Y, Ferron G, Gouy S, Vaini-Cowen V, Fourchotte V, Golfier F, Collinet P. Results of a prospective phase II national study: Prophylactic radical fimbriectomy (NCT01608074), in women with a documented high risk of breast/ovarian cancer—Final pathological results and outcomes. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.1594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1594 Background: Risk-reducing salpingo-oophorectomy (RRSO) is the gold standard in surgical prophylaxis of pelvic high-grade serous carcinoma (HGSC) for women at risk of breast/ovarian cancer. Due to significant adverse effects of early oophorectomy, 20-30% of women delay or deny performing this operation. Recent data highlight the fallopian origin of most pelvic HGSC, especially its fimbrial part. Thus, we suggested a new two-step risk-reducing procedure: the radical fimbriectomy (RF) with delayed oophorectomy (DO) (Leblanc et al Gyn Oncol 2011), leading to the current RF/DO Phase 2 study. We present the definitive results on primary and secondary objectives of this trial. Methods: BRCA1/2 carriers or any women with a documented familial risk of breast/ovarian cancer were first counseled to perform a classical laparoscopic RRSO. If they denied, they were offered to enter the RF/DO study. All specimens were submitted to the SEE-FIM pathological protocol. Pathological data along with all intra- and 30-day and beyond post-operative adverse events were prospectively recorded. Follow-up consisted in an annual clinical breast and gynecological examination, with tumor markers and hormonal status assessment. Primary endpoint was the rate of pelvic serous carcinoma. Secondary endpoints were procedure morbidity, rates of tubal abnormalities, breast cancer, secondary oophorectomy. Results: From January 2012 to October 2014, 121 RF were performed: 120 by laparoscopy, 1 laparotomy (concurrent myomectomy). An occult neoplasia was found in 3 cases with 1 invasive HGSC. Intraoperative complications were two grade1 bleedings without transfusion with no grade ≥3 early post-operative or delayed complication. With a median follow-up of 5.3 years (0.2 -7.6), no patient developed any pelvic HGSC, 21 patients developed a breast cancer (3 de novo, 18 recurrences/contralateral.). 1 cancer-free BRCA1-mutated lady delivered safe twins, after an uneventful post-RF pregnancy obtained with assisted reproductive technology (ART). Overall, 29 women underwent DO (by choice: 12 or menopause: 17) resulting in grade 3b complication in 1 case, but no pathological abnormality. Conclusions: RF/DO appears as a safe, well tolerated and effective procedure in terms of occult neoplasia detection. A successful pregnancy with ART was possible after radical fimbriectomy. Longer follow-up and larger cohort are necessary to confirm its efficacy in terms of ovarian cancer prophylaxis. Clinical trial information: NCT01608074.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sebastien Gouy
- Department of Surgery, Gustave Roussy Cancer Centre, Villejuif, France
| | | | | | - Francois Golfier
- Centre de Reference des Maladies Trophoblastiques, Centre Hospitalier Lyon-Sud, EMR3738, Université Lyon 1, Lyon, France
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Bataille B, Escande A, Le Tinier F, Parent A, Bogart E, Collinet P, Bresson L, Narducci F, Leblanc E, Lemaire AS, Taieb S, Lartigau E, Mirabel X, Cordoba A. Outcomes of pre-operative brachytherapy followed by hysterectomy for early cervical cancer. Int J Gynecol Cancer 2019; 30:181-186. [PMID: 31871113 DOI: 10.1136/ijgc-2019-000617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 05/22/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVE The standard of care for early cervical cancer is radical hysterectomy; however, consideration of pre-operative brachytherapy has been explored. We report our experience using pre-operative brachytherapy plus Wertheim-type hysterectomy to treat early stage cervical cancer. METHODS This single-center study evaluated consecutive patients with histologically proven node-negative early stage cervical cancer (International Federation of Gynecology and Obstetrics 2009 stage IB1-IIB) that was treated using pre-operative brachytherapy and hysterectomy. Pre-brachytherapy staging was performed using magnetic resonance imaging (MRI) and pelvic lymph node assessment was performed using lymphadenectomy. The tumor and cervical tissues were treated using brachytherapy (total dose 60 Gy) followed by Wertheim-type hysterectomy. The study included patients from January 2000 to December 2013. RESULTS A total of 80 patients completed a median follow-up of 6.7 years (range 5.4-8.5). The surgical specimens revealed a pathological complete response for 61 patients (76%). Patients with incomplete responses generally had less than 1 cm residual tumor at the cervix, and only one patient had lymphovascular space involvement. The estimated 5-year rates were 88% for overall survival (95% CI 78% to 94%) and 82% for disease-free survival (95% CI 71% to 89%). Toxicities were generally mild-to-moderate, including 26 cases (33%) of grade 2 late toxicity and 10 cases (13%) of grade 3 late toxicity. Univariate analyses revealed that poor disease-free survival was associated with overweight status (≥25 kg/m2, HR 3.05, 95% CI 1.20 to 7.76, p=0.019) and MRI tumor size >3 cm (HR 3.05, 95% CI 1.23 to 7.51, p=0.016). CONCLUSIONS Pre-operative brachytherapy followed by Wertheim-type hysterectomy may be safe and effective for early stage cervical cancer, although poorer outcomes were associated with overweight status and MRI tumor size >3 cm.
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Affiliation(s)
- Benoit Bataille
- Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France
| | - Alexandre Escande
- Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France
| | - Florence Le Tinier
- Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France
| | - Audrey Parent
- Methodology and Biostatistics Department, Centre Oscar Lambret, Lille, France
| | - Emilie Bogart
- Methodology and Biostatistics Department, Centre Oscar Lambret, Lille, France
| | - Pierre Collinet
- Gynecological Surgery Department, Hopital Jeanne de Flandre, Lille, Hauts-de-France, France
| | - Lucie Bresson
- Gynecological Surgery Department, Centre Oscar Lambret, Lille, France
| | - Fabrice Narducci
- Gynecological Surgery Department, Centre Oscar Lambret, Lille, France
| | - Eric Leblanc
- Gynecological Surgery Department, Centre Oscar Lambret, Lille, France
| | | | - Sophie Taieb
- Medical Imaging Department, Centre Oscar Lambret, Lille, France
| | - Eric Lartigau
- Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France
| | - Xavier Mirabel
- Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France
| | - Abel Cordoba
- Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France
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Angeles MA, Mallet E, Rouanet P, Cabarrou B, Méeus P, Lambaudie E, Foucher F, Narducci F, Loaec C, Gouy S, Guyon F, Marchal F, Gladieff L, Martínez-Gómez C, Migliorelli F, Martinez A, Ferron G. Comparison of postoperative complications and quality of life between patients undergoing continent versus non-continent urinary diversion after pelvic exenteration for gynecologic malignancies. Int J Gynecol Cancer 2019; 30:233-240. [PMID: 31796531 DOI: 10.1136/ijgc-2019-000863] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 08/22/2019] [Revised: 09/26/2019] [Accepted: 10/01/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Pelvic exenteration and its reconstructive techniques have been associated with high postoperative morbidity and a negative impact on patient quality of life. The aim of our study was to compare postoperative complications and quality of life in patients undergoing continent compared with non-continent urinary diversion after pelvic exenteration for gynecologic malignancies. METHODS We designed a multicenter study of patients from 10 centers who underwent an anterior or total pelvic exenteration with urinary reconstruction for histologically confirmed persistent or recurrent gynecologic malignancy after previous treatment with radiotherapy. From January 2005 to September 2008, we included patients retrospectively, and from September 2008 to May 2009, patients were included prospectively which allowed collection of quality of life data. Demographic, surgical, and follow-up data were analyzed. Postoperative complications were classified according to the Clavien-Dindo classification. Quality of life was assessed using the European Organization for Research and Treatment of Cancer (EORTC)-QLQ-C30 (V.3.0) and EORTC-QLQ-OV28 quality of life questionnaires. We compared patients who underwent a continent urinary diversion with those who underwent a non-continent reconstruction. RESULTS We included 148 patients, 92 retrospectively and 56 prospectively. Among them, 77.4% had recurrent disease and 22.6% persistent disease after the primary treatment. In 70 patients, a urinary continent diversion was performed, and 78 patients underwent a non-continent diversion. Median age of the continent and incontinent groups was 53.5 (range 33-78) years and 57 (26-79) years, respectively. There were no significant differences between the continent and non-continent groups in median length of hospitalization (28.5 vs 26 days, P=0.19), postoperative grade III-IV complications (42.9% vs 42.3%, P=0.95), complications needing surgical (27.9% vs 34.6%, P=0.39) or radiological (14.7% vs 12.8%, P=0.74) intervention, and complication type (digestive (23.2% vs 16.7%, P=0.32) and urinary (15.9% vs 16.7%, P=0.91)). There were no significant differences between the groups in global health, global quality of life, and body image perception scores 1 year after surgery. CONCLUSION Continent and incontinent urinary reconstructions are equivalent in terms of postoperative complications and quality of life scores.
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Affiliation(s)
- Martina Aida Angeles
- Surgical Oncology, Institut Claudius Regaud IUCT-oncopole, Toulouse, Occitanie, France
| | - Estelle Mallet
- Surgical Oncology, Centre Antoine-Lacassagne, Nice, Provence-Alpes-Côte d'Azu, France
| | - Philippe Rouanet
- Department of Surgical Oncology, Institut régional du Cancer de Montpellier, Montpellier, France
| | - Bastien Cabarrou
- Biostatistics Unit, Institut Claudius Regaud, Toulouse, Occitanie, France
| | - Pierre Méeus
- Department of Surgical Oncology, Institut Léon Bérard, Lyon, France
| | | | - Fabrice Foucher
- Department of Surgical Oncology, Centre Eugene Marquis, Rennes, Bretagne, France
| | | | - Cécile Loaec
- Institut de Cancerologie de l'Ouest, Nantes, France
| | - Sebastien Gouy
- Institut Gustave-Roussy, Villejuif, Île-de-France, France
| | | | - Frédéric Marchal
- Surgical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, Lorraine, France
| | - Laurence Gladieff
- Medical Oncology, Institut Claudius Regaud, Toulouse, Occitanie, France
| | - Carlos Martínez-Gómez
- Surgical Oncology, Institut Claudius Regaud IUCT-oncopole, Toulouse, Occitanie, France.,INSERM CRCT 1, Toulouse, France
| | - Federico Migliorelli
- Department of Women, Children and Adolescents, Hopitaux Universitaires de Geneve, Geneva, Switzerland
| | - Alejandra Martinez
- INSERM CRCT 1, Toulouse, France.,Institut Claudius Regaud, Toulouse, Occitanie, France
| | - Gwenael Ferron
- Institut Claudius Regaud, Toulouse, Occitanie, France .,INSERM CRCT 19, Toulouse, France
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Lécuru F, Bakrin N, Classe JM, Colombo PE, Ferron G, Freyer G, Glehen O, Gouy S, Huchon C, Narducci F, Pocard M, Pomel C, Rouzier R. [CHIP and ovarian cancer]. Gynecol Obstet Fertil Senol 2019; 47:617-618. [PMID: 31252153 DOI: 10.1016/j.gofs.2019.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Indexed: 06/09/2023]
Affiliation(s)
- F Lécuru
- Service de chirurgie cancérologique gynécologique et du Sein, hôpital européen Georges Pompidou, AP-HP, 75015 Paris, France; Faculté de médecine, université Paris Descartes, 75006 Paris, France; UMR S1124, université Paris Descartes, 75006 Paris, France.
| | - N Bakrin
- Chirurgie générale, oncologique et endocrinienne, centre hospitalier Lyon Sud, hospices civils de Lyon, 69495 Pierre-Bénite, France; EMR 3738, faculté Lyon Sud Charles Mérieux, université Lyon 1, 69000 Lyon, France
| | - J M Classe
- Chirurgie oncologique, institut de cancérologie de l'Ouest, 44000 Nantes, France; Faculté de médecine, université de Nantes, 44000 Nantes, France
| | - P E Colombo
- Département de chirurgie, Centre Val d'Aurelle, 34000 Montpellier, France
| | - G Ferron
- Institut universitaire du Cancer, 31100 Toulouse, France
| | - G Freyer
- Service d'onclogie médicale, institut de cancérologie des hospices civils de Lyon, 69000 Lyon, France; Université Lyon 1, 69000 Lyon, France
| | - O Glehen
- Chirurgie générale, oncologique et endocrinienne, centre hospitalier Lyon Sud, hospices civils de Lyon, 69495 Pierre-Bénite, France; EMR 3738, faculté Lyon Sud Charles Mérieux, université Lyon 1, 69000 Lyon, France
| | - S Gouy
- Département de chirurgie, institut Gustave Roussy, 94800 Villejuif, France
| | - C Huchon
- Service de gynécologie et obstétrique, université Versailles-Saint-Quentin en Yvelines, CHI Poissy-St-Germain, 10, rue du champ Gaillard, BP 3082, 78303 Poissy cedex, France; EA 7285 Risques cliniques et sécurité en santé des femmes, université Versailles-Saint-Quentin en Yvelines, 78000 Versailles, France
| | - F Narducci
- Centre Oscar Lambret, 59000 Lille, France
| | - M Pocard
- Unité Inserm U1275, université Paris 7, CAP Paris-Tech : Carcinose Péritoine Paris technologique, hôpital Lariboisière, 2, rue Ambroise Paré, 75475 Paris cedex 10, France; Chirurgie digestive cancérologique, hôpital Lariboisière, Assistance publique des Hôpitaux de Paris, 2, rue Ambroise Paré, 75475 Paris cedex 10, France
| | - C Pomel
- Service de chirurgie oncologique, Centre Jean Perrin, 63011 Clermont-Ferrand, France; Université d'Auvergne, 63011 Clermont-Ferrand, France
| | - R Rouzier
- Département de chirurgie, institut Curie, 92210 Saint-Cloud, France; Université Versailles St Quentin, 78000 Versailles, France
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Bataille B, Le Tinier F, Escande A, Parent A, Bogart E, Narducci F, Leblanc E, Hudry D, Lemaire A, Lesoin A, Chevalier A, Taieb S, Ben Haj Amor M, Lartigau E, Mirabel X, Cordoba A. Intracavitary Preoperative Brachytherapy Followed By Whertheim-Type Hysterectomy in Localized Cervical Cancer: Clinical Data and Toxicity Results from a Single Institution Experience. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tock S, Wallet J, Belhadia M, Hudry D, Ghesquière L, Narducci F, Leblanc E. Outcomes of the use of different vulvar flaps for reconstruction during surgery for vulvar cancer. Eur J Surg Oncol 2019; 45:1625-1631. [DOI: 10.1016/j.ejso.2019.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 04/07/2019] [Accepted: 04/16/2019] [Indexed: 12/19/2022] Open
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Hudry D, Narducci F, Andrade C, Leblanc E. Extra-peritoneal para-aortic lymphadenectomy by robot assisted laparoscopy (EPLRL) in 10 steps. Gynecol Oncol 2019; 155:170-171. [PMID: 31439360 DOI: 10.1016/j.ygyno.2019.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/31/2019] [Accepted: 08/02/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Delphine Hudry
- Oscar Lambret Center, Lille, France; Laboratory PRISM - Inserm U1192, Lille University, France.
| | - Fabrice Narducci
- Oscar Lambret Center, Lille, France; Laboratory PRISM - Inserm U1192, Lille University, France
| | | | - Eric Leblanc
- Oscar Lambret Center, Lille, France; Laboratory PRISM - Inserm U1192, Lille University, France
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Lavoue V, Huchon C, Akladios C, Alfonsi P, Bakrin N, Ballester M, Bendifallah S, Bolze P, Bonnet F, Bourgin C, Chabbert-Buffet N, Collinet P, Courbiere B, De la motte rouge T, Devouassoux-Shisheboran M, Falandry C, Ferron G, Fournier L, Gladieff L, Golfier F, Gouy S, Guyon F, Lambaudie E, Leary A, Lecuru F, Lefrere-Belda M, Leblanc E, Lemoine A, Narducci F, Ouldamer L, Pautier P, Planchamp F, Pouget N, Ray-Coquard I, Rousset-Jablonski C, Senechal-Davin C, Touboul C, Thomassin-Naggara I, Uzan C, You B, Daraï E. Management of epithelial cancer of the ovary, fallopian tube, primary peritoneum. Long text of the joint French clinical practice guidelines issued by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY, endorsed by INCa. (Part 2: systemic, intraperitoneal treatment, elderly patients, fertility preservation, follow-up). J Gynecol Obstet Hum Reprod 2019; 48:379-386. [DOI: 10.1016/j.jogoh.2019.03.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
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Lavoue V, Huchon C, Akladios C, Alfonsi P, Bakrin N, Ballester M, Bendifallah S, Bolze PA, Bonnet F, Bourgin C, Chabbert-Buffet N, Collinet P, Courbiere B, De la Motte Rouge T, Devouassoux-Shisheboran M, Falandry C, Ferron G, Fournier L, Gladieff L, Golfier F, Gouy S, Guyon F, Lambaudie E, Leary A, Lecuru F, Lefrere-Belda MA, Leblanc E, Lemoine A, Narducci F, Ouldamer L, Pautier P, Planchamp F, Pouget N, Ray-Coquard I, Rousset-Jablonski C, Senechal-Davin C, Touboul C, Thomassin-Naggara I, Uzan C, You B, Daraï E. Management of epithelial cancer of the ovary, fallopian tube, and primary peritoneum. Long text of the Joint French Clinical Practice Guidelines issued by FRANCOGYN, CNGOF, SFOG, and GINECO-ARCAGY, and endorsed by INCa. Part 1: Diagnostic exploration and staging, surgery, perioperative care, and pathology. J Gynecol Obstet Hum Reprod 2019; 48:369-378. [PMID: 30936027 DOI: 10.1016/j.jogoh.2019.03.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 03/03/2019] [Accepted: 03/19/2019] [Indexed: 11/27/2022]
Abstract
An MRI is recommended for an ovarian mass that is indeterminate on ultrasound. The ROMA score (combining CA125 and HE4) can also be calculated (grade A). In presumed early-stage ovarian or tubal cancers, the following procedures should be performed: an omentectomy (at a minimum, infracolic), an appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C), and pelvic and para-aortic lymphadenectomies (grade B) for all histologic types, except the expansile mucinous subtypes, for which lymphadenectomies can be omitted (grade C). Minimally invasive surgery is recommended for early-stage ovarian cancer, when there is no risk of tumor rupture (grade B). For FIGO stages III or IV ovarian, tubal, and primary peritoneal cancers, a contrast-enhanced computed tomography (CT) scan of the thorax/abdomen/pelvis is recommended (grade B), as well as laparoscopic exploration to take multiple biopsies (grade A) and a carcinomatosis score (Fagotti score at a minimum) (grade C) to assess the possibility of complete surgery (i.e., leaving no macroscopic tumor residue). Complete surgery by a midline laparotomy is recommended for advanced ovarian, tubal, or primary peritoneal cancer (grade B). For advanced cancers, para-aortic and pelvic lymphadenectomies are recommended when metastatic adenopathy is clinically or radiologically suspected (grade B). When adenopathy is not suspected and when complete peritoneal surgery is performed as the initial surgery for advanced cancer, the lymphadenectomies can be omitted because they do not modify either the medical treatment or overall survival (grade B). Primary surgery (before other treatment) is recommended whenever it appears possible to leave no tumor residue (grade B).
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Affiliation(s)
- V Lavoue
- Service de gynécologie, CHU de Rennes, Hôpital sud, 16 Bd de Bulgarie, 35000 Rennes, France; INSERM 1242, Chemistry, Oncogenesis, Stress and Signaling, Centre Eugène Marquis, Rue Bataille Flandres-Dunkerques, Rennes, France.
| | - C Huchon
- Service de Gynécologie, CHI Poissy, France
| | - C Akladios
- Service de Gynécologie, Hôpital Hautepierre, CHU Strasbourg, France
| | - P Alfonsi
- Service d'Anesthésie, Hôpital Saint Joseph, Paris, France
| | - N Bakrin
- Service de chirurgie digestive, CHU Lyon-Sud, Pierre-Bénite, Lyon, France
| | - M Ballester
- Service de gynécologie, GH Diaconesses Croix Saint Simon, Paris, France
| | - S Bendifallah
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, 4 rue de La Chine, APHP, Institut Universitaire de Cancérologie Sorbonne Université, UMRS-938, France
| | - P A Bolze
- Service de chirurgie gynécologique, CHU Lyon-Sud, Pierre Bénite, Lyon, France
| | - F Bonnet
- Service d'anesthésie, Hôpital Tenon, AP-HP, Paris, France
| | - C Bourgin
- Service de Chirurgie Gynécologique, Hôpital Jeanne de Flandres, CHRU, Lille, France
| | - N Chabbert-Buffet
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, 4 rue de La Chine, APHP, Institut Universitaire de Cancérologie Sorbonne Université, UMRS-938, France
| | - P Collinet
- Service de Chirurgie Gynécologique, Hôpital Jeanne de Flandres, CHRU, Lille, France
| | - B Courbiere
- Pôle Femmes-Parents-Enfants - Centre Clinico-Biologique d'AMP, AP-HM La Conception, 147 bd Baille, 13005 Marseille/Aix Marseille Université, CNRS, IRD, Avignon Université, IMBE UMR 7263, 13397 Marseille, France
| | | | | | - C Falandry
- Service d'oncogériatrie, Hospices civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, Lyon, France
| | - G Ferron
- Service d'oncologie chirurgicale, Institut Claudius Regaud, IUCT Oncopole, Toulouse, France
| | - L Fournier
- Service de radiologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - L Gladieff
- Service d'oncologie médicale, Institut Claudius Regaud, IUCT Oncopole, Toulouse, France
| | - F Golfier
- Service de chirurgie gynécologique, CHU Lyon-Sud, Pierre Bénite, Lyon, France
| | - S Gouy
- Service de chirurgie, Institut Gustave Roussy, Villejuif, France
| | - F Guyon
- Service de chirurgie, Institut Bergonié, Bordeaux, France
| | - E Lambaudie
- Service de chirurgie, Institut Paoli Calmette, Marseille, France
| | - A Leary
- Service d'oncologie médicale, Institut Gustave Roussy, Villejuif, France
| | - F Lecuru
- Service de chirurgie gynécologique et oncologique, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - M A Lefrere-Belda
- Service d'anatomo-pathologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - E Leblanc
- Service de chirurgie, Centre Oscar Lambret, Lille, France
| | - A Lemoine
- Service d'anesthésie, Hôpital Tenon, AP-HP, Paris, France
| | - F Narducci
- Service de chirurgie, Centre Oscar Lambret, Lille, France
| | - L Ouldamer
- Service de chirurgie gynécologique, CHU de Tours, France
| | - P Pautier
- Service d'oncologie médicale, Institut Gustave Roussy, Villejuif, France
| | - F Planchamp
- Service de méthodologie, Institut Bergonié, Bordeaux, France
| | - N Pouget
- Service de chirurgie, Curie (site Saint Cloud), Paris, France
| | - I Ray-Coquard
- Service d'oncologie médicale, Centre Léon Bérard, Lyon, France
| | | | | | - C Touboul
- Service de chirurgie gynécologique, CHI de Créteil, Créteil, France
| | | | - C Uzan
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié Salpêtrière, Institut Universitaire de Cancérologie, Sorbonne Université, INSERM U938, France
| | - B You
- Service d'oncologie médicale, Institut de cancérologie des Hospices Civils de Lyon, Pierre-Bénite, Lyon, Paris, France
| | - E Daraï
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, 4 rue de La Chine, APHP, Institut Universitaire de Cancérologie Sorbonne Université, UMRS-938, France
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Belhadia M, Narducci F, Leblanc E, Borghesi Y, Boukerrou M, Hersant B. [How I do… to use indocyanine green to check the flap viability in vaginal reconstruction]. ACTA ACUST UNITED AC 2019; 47:484-486. [PMID: 30818040 DOI: 10.1016/j.gofs.2019.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Indexed: 11/17/2022]
Affiliation(s)
- M Belhadia
- Service de cancérologie gynécologique, Centre Oscar Lambret, 3, rue Frédéric Combemale, 59000 Lille, France.
| | - F Narducci
- Service de cancérologie gynécologique, Centre Oscar Lambret, 3, rue Frédéric Combemale, 59000 Lille, France
| | - E Leblanc
- Service de cancérologie gynécologique, Centre Oscar Lambret, 3, rue Frédéric Combemale, 59000 Lille, France
| | - Y Borghesi
- Service de cancérologie gynécologique, Centre Oscar Lambret, 3, rue Frédéric Combemale, 59000 Lille, France
| | - M Boukerrou
- Department of Gynecology and Obstetrics, University Hospital of South Reunion Island, BP 350, 97448 Saint Pierre cedex, Réunion; Faculty of Medicine - University of Réunion, 97490 St Denis, Réunion; CEPOI, Perinatal Center of Study of the Indian Ocean, University Hospital of South Reunion Island, Faculty of medicine, St Pierre 97448, Réunion
| | - B Hersant
- Service de cancérologie gynécologique, Centre Oscar Lambret, 3, rue Frédéric Combemale, 59000 Lille, France; Department of plastic and reconstructive surgery, Henri-Mondor hospital, 51, avenue du Maréchal-de-Lattre-de-Tassigny, Créteil 94010, France
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