Radical Hysterectomy in Early-Stage Cervical Cancer: Abandoning the One-Fits-All Concept

Two pillars in modern oncology are treatment personalization and the reduction in treatment-related morbidity. For decades, the one-fits-all concept of radical hysterectomy has been the cornerstone of early-stage cervical cancer surgical treatment. However, no agreement exists about the prevalent method of parametrial invasion, and the literature is conflicting regarding the extent of parametrectomy needed to achieve adequate surgical radicality. Therefore, authors started investigating if less radical surgery was feasible and oncologically safe in these patients. Two historical randomized controlled trials (RCTs) compared classical radical hysterectomy (RH) to modified RH and simple hysterectomy. Less radical surgery showed a drastic reduction in morbidity without jeopardizing oncological outcomes. However, given the high frequency of adjuvant radiotherapy, the real impact of reduced radicality could not be estimated. Subsequently, several retrospective studies investigated the chance of tailoring parametrectomy according to the tumor's characteristics. Parametrial involvement was shown to be negligible in early-stage low-risk cervical cancer. An observational prospective study and a phase II exploratory RCT have recently confirmed the feasibility and safety of simple hysterectomy in this subgroup of patients. The preliminary results of a large prospective RCT comparing simple vs. radical surgery for early-stage low-risk cervical cancer show strong probability of giving a final answer on this topic.

Does cytoreductive surgery followed by adjuvant chemo-radiotherapy decrease the risk of recurrence and death in stage III endometrial cancer?

INTRODUCTION

The optimal postoperative adjuvant treatment for stage III endometrial cancer (EC) is controversial. The aim of the study was to evaluate the impact of cytoreductive surgery (CRS) and adjuvant chemoradiotherapy (CRT) on relapse-free survival (RFS) and overall survival (OS) in stage III EC.

METHODS

Data on 36 patients with stage III EC were reviewed. A review of the literature was performed.

RESULTS

Median follow-up was 31 months (range 3-195). All patients underwent radical surgery with lymph nodes assessment in 29 (80.6%). The histologic specimen revealed 27 (75%) type I and 9 (25%) type II cancers staged IIIA, IIIB, IIIC1, and IIIC2 in 9 (25%), 3 (8.3%), 17 (47.2%), and 7 (19.5%) patients, respectively. At the end of surgery, 32 (88.9%) had no residual tumor. Eighteen (50%) patients were treated with CRT (50% with sandwich approach, 50% with concurrent chemotherapy [CT]), 4 (11.1%) patients received radiotherapy (RT), and 14 (38.9%) had multiagent CT. Four patients (11.1%) with a residual tumor larger than 1 centimeter after surgery died of disease. The 5-year median recurrent free survival (RFS) for CRT, RT, and CT was 69.1%, 37.5%, and 23.8%, respectively (p = 0.05); the 5-year OS for CRT, RT, and CT was 83%, 35.7%, and 25%, respectively (p = 0.023). Multivariate analyses showed residual tumor as independent predictor for recurrence and death. CRT showed a borderline significance on OS.

CONCLUSIONS

Our study demonstrated that optimal cytoreduction is the most significant prognostic factor and adjuvant CRT seems to be associated with a significant decreased risk of recurrence in stage III EC.

Perfectionistic traits and importance given to parenthood are associated with infertility-related quality of life in a sample of infertile women with and without endometriosis

OBJECTIVE

To assess quality of life and psychological differences between infertile women with endometriosis and without endometriosis. To investigate predictive role of perfectionism, mindful awareness and beliefs about parenthood to quality of life in a sample of women with fertility problems.

METHODS

43 infertile women (22 with endometriosis; 21 without endometriosis) who recurred to Assisted Reproductive Treatments (ARTs) in the last 12 months took part to this cross-sectional study. Sociodemographic and clinical data were collected by means of a structured ad hoc questionnaire. Fertility Quality of Life, Fertility Problem Inventory - Need of parenthood subscale, Obsessive Beliefs Questionnaire - Perfectionism subscale, and Cognitive and Affective Mindfulness Scale - Revised were used to assess target outcomes.

RESULTS

Any difference in quality of life and psychological condition was found between infertile women with and without endometriosis. Importance given to parenthood (beta = -.60, p < .001) and perfectionism (beta = -.30, p < .05) predicted quality of life related to fertility issues, independently of group.

CONCLUSIONS

Infertility might elicit self-discrepancy between real-self (i.e. being infertile) and ideal-self (being fertile), which in turn has a negative impact on quality of life. Conclusions about the role of psychologist in ART's team are discussed.

Correction to: Post-operative cognitive decline (POCD) after gynaecologic surgery: current opinions and future applications

The original version of this article unfortunately contained a mistake. The given names and family names of all authors were interchanged.

Primary vulvar nocardiosis

BACKGROUND

Nocardiosis is an uncommon disease, and the primary skin infection is usually at the site of a recent injury. Nocardia is a saprophytic bacterium of the soil belonging to the order Actinomycetales.

CASE

A 68-year-old woman presented with a painful, hard, dark reddish lesion located in the right hemivulva. She had been treated by radiotherapy for a vulvar leiomyosarcoma arising from the left Bartholin gland at the age of 45. Pathology results demonstrated nocardial infection, initially advanced despite antibiotic therapy. The necrosis extended to and involved the ischiopubic bone, requiring extensive surgical treatment. We performed a radical vulvectomy with partial pubic bone excision to remove the necrotic tissue. A transverse gracilis-myocutaneous free flap was used for vulvar reconstruction. Wound necrosis recurrence required a rectus abdominis myocutaneous flap reconstruction, with an excellent final result.

CONCLUSION

This is the first report of primary vulvar nocardiosis. This infection may simulate advanced vulvar carcinoma requiring extensive surgical treatment.

Selective uterine artery embolization: a new therapeutic approach in a patient with low-risk gestational trophoblastic disease

We report a case of persistent gestational trophoblastic disease (GTD) in which a selective uterine artery embolization instead of invasive surgery achieved both the control of pelvic hemorrhage and of disease.

Laparoscopic-assisted vaginal hysterectomy versus abdominal hysterectomy in endometrial cancer

OBJECTIVE

To see whether laparoscopy provides exact staging and effective treatment of endometrial cancer patients, compared with total abdominal hysterectomy, with shorter hospital stay, prompter recovery, and better quality of life.

METHOD

This retrospective study identified 110 patients scheduled for surgery for early-stage endometrial cancer. Fifty-five (50%) were treated by laparoscopic-assisted vaginal hysterectomy (LAVH) and 55 (50%) by total abdominal hysterectomy (TAH). All patients underwent pelvic lymphadenectomy. The majority of patients (79%) had stage I disease.

RESULTS

The mean number of lymph nodes removed was 17 for the LAVH group and 18.5 for the TAH group (p = 0.294). Compared with TAH, LAVH required a significantly longer operating time (220 vs. 175 min; p < 0.01); but shorter hospital stay (4 vs. 8.5 days; p < 0.001) and less estimated blood loss (177 cm3 vs. 285 cm3; p = 0.02). Overall, there were fewer post-operative complications in the LAVH group (6 vs. 11 cases; p < 0.001). Three TAH patients (5.4%) had recurrence of disease. No LAVH patients had recurrences and all are currently disease-free.

CONCLUSION

These findings suggest LAVH gives correct staging of endometrial disease, like TAH, but with fewer complications and a slightly longer operating time.

Soft X-ray Emission Spectroscopy at ESRF Beamline 26 Based on a Helical Undulator

A new soft X-ray spectrograph for X-ray emission spectroscopy excited by synchrotron radiation is presented. The apparatus is now installed on beamline 26 at the ESRF in Grenoble. A brief description of the beamline is given and then several components of the spectrograph are covered in more detail. Results of experiments performed both with direct non-monochromated undulator radiation and with monochromated radiation are reported.

Ceftazidime monotherapy vs. combined therapy in Pseudomonas pulmonary infections in cystic fibrosis

To evaluate whether the addition of an aminoglycoside might enhance the clinical efficacy of ceftazidime in cystic fibrosis patients with acute exacerbations of chronic Pseudomonas lung infections we carried out a prospective, comparative, randomized blind study with three schedules: ceftazidime vs. ceftazidime plus sisomicin (C/S) vs. piperacillin plus sisomicin, for a total of 60 courses of 14 days of treatment. Each treatment led to clinical and radiologic improvement with marked reduction of signs of acute infection. Statistically there was no significant difference in clinical responses among the schedules. No side effect appeared during treatments with ceftazidime or C/S. Hyperpyrexia was seen in 35% of patients receiving piperacillin. Decrease in Pseudomonas aeruginosa count to less than 10(5) colony-forming units/ml of sputum was achieved in 60% of patients treated with C/S and in 30% of patients who received ceftazidime or piperacillin plus sisomicin (statistically not significant). A transient increase in mean geometric minimal inhibitory concentrations for ceftazidime and piperacillin was observed at the end of the combined therapies. A larger percentage of persistent resistant strains of P. aeruginosa was seen after the combined therapies. We conclude that ceftazidime as monotherapy may be an effective alternative in Pseudomonas lung infections in cystic fibrosis patients. Its clinical efficacy seems not to be enhanced by the addition of an aminoglycoside, although reduction of Pseudomonas in the sputum was better achieved by the combination of C/S.