1
|
Roof KA, Andre KE, Modesitt SC, Schirmer DA. Maximizing ovarian function and fertility following chemotherapy in premenopausal patients: Is there a role for ovarian suppression? Gynecol Oncol Rep 2024; 53:101383. [PMID: 38633671 PMCID: PMC11021951 DOI: 10.1016/j.gore.2024.101383] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
As more premenopausal patients undergo fertility preserving cancer treatments, there is an increased need for fertility counseling and ovarian sparing strategies. Many patients receive gonadotoxic chemotherapeutic agents which can put them at risk of primary ovarian insufficiency or profoundly diminished ovarian reserve. Traditionally, estradiol and follicle stimulating hormone (FSH) values have been used to evaluate ovarian function but more recently, reproductive endocrinologists have been proponents of anti-mullerian hormone (AMH) as a validated measure of ovarian potential. While the gold standard for fertility preservation remains oocyte cryopreservation, data suggest there may be additional interventions that can mitigate the gonadotoxic effects of chemotherapeutic agents. The main objectives of this focused review were to quantify the risk of primary ovarian failure associated with the most common chemotherapies used in treatment of gynecologic cancers and to evaluate and recommend potential interventions to mitigate toxic effects on ovarian function. Chemotherapeutic agents can cause direct loss of oocytes and primordial follicles as well as stromal and vascular atrophy and the extent is dependent upon mechanism of action and age of the patient. The risk of ovarian failure is the highest with alkylating agents (42.2 %), anthracyclines (<10-34 % in patients under 40 years versus 98 % in patients aged 40-49), taxanes (57.1 %) and platinum agents (50 %). Multiple trials demonstrate that gonadotropin releasing hormone (GnRH) agonists, when administered concurrently with chemotherapy, may have protective effects, with more patients experiencing resumption of a regular menstruation pattern and recovering ovarian function more quickly post-treatment. Premenopausal patients receiving chemotherapy for the treatment of gynecologic cancers should receive adequate counseling on the potential adverse effects on their fertility. Although oocyte cryopreservation remains the gold standard for fertility preservation, there is some evidence to suggest that GNRH agonists could help maintain and preserve ovarian function and should be considered.
Collapse
Affiliation(s)
- Kelsey A. Roof
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Kerri E. Andre
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Susan C. Modesitt
- Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United States
| | - D. Austin Schirmer
- Division of Reproductive Endocrinology, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United States
| |
Collapse
|
2
|
Washington CJ, Karanth SD, Wheeler M, Aduse-Poku L, Braithwaite D, Akinyemiju TF. Racial and socioeconomic disparities in survival among women with advanced-stage ovarian cancer who received systemic therapy. Cancer Causes Control 2024; 35:487-496. [PMID: 37874478 PMCID: PMC10838826 DOI: 10.1007/s10552-023-01810-y] [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: 08/01/2023] [Accepted: 09/29/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE The purpose of this study was to assess the association between race/ethnicity and all-cause mortality among women with advanced-stage ovarian cancer who received systemic therapy. METHODS We analyzed data from the National Cancer Database on women diagnosed with advanced-stage ovarian cancer from 2004 to 2015 who received systemic therapy. Race/ethnicity was categorized as Non-Hispanic (NH) White, NH-Black, Hispanic, NH-Asian/Pacific Islander, and Other. Income and education were combined to form a composite measure of socioeconomic status (SES) and categorized into low-, mid-, and high-SES. Multivariable Cox proportional hazards models were used to assess whether race/ethnicity was associated with the risk of death after adjusting for sociodemographic, clinical, and treatment factors. Additionally, subgroup analyses were conducted by SES, age, and surgery receipt. RESULTS The study population comprised 53,367 women (52.4% ages ≥ 65 years, 82% NH-White, 8.7% NH-Black, 5.7% Hispanic, and 2.7% NH-Asian/Pacific Islander) in the analysis. After adjusting for covariates, the NH-Black race was associated with a higher risk of death versus NH-White race (aHR: 1.12; 95% CI: 1.07,1.18), while Hispanic ethnicity was associated with a lower risk of death compared to NH-White women (aHR: 0.87; 95% CI: 0.80, 0.95). Furthermore, NH-Black women versus NH-White women had an increased risk of mortality among those with low-SES characteristics (aHR:1.12; 95% CI:1.03-1.22) and mid-SES groups (aHR: 1.13; 95% CI:1.05-1.21). CONCLUSIONS Among women with advanced-stage ovarian cancer who received systemic therapy, NH-Black women experienced poorer survival compared to NH-White women. Future studies should be directed to identify drivers of ovarian cancer disparities, particularly racial differences in treatment response and surveillance.
Collapse
Affiliation(s)
- Caretia J Washington
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL, USA
| | - Shama D Karanth
- University of Florida Health Cancer Center, Gainesville, FL, USA
- Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Meghann Wheeler
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL, USA
| | - Livingstone Aduse-Poku
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL, USA
| | - Dejana Braithwaite
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL, USA
- University of Florida Health Cancer Center, Gainesville, FL, USA
- Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Tomi F Akinyemiju
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27708, USA.
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA.
| |
Collapse
|
3
|
Richardson MT, Barry D, Steinberg JR, Thirunavu V, Strom DE, Holder K, Zhang N, Turner BE, Magnani CJ, Weeks BT, Young AMP, Lu CF, Wolgemuth TR, Laasiri N, Squires NA, Anderson JN, Karlan BY, Chan JK, Kapp DS, Roque DR, Salani R. Underrepresentation of racial and ethnic minority groups in gynecologic oncology: An analysis of over 250 trials. Gynecol Oncol 2024; 181:1-7. [PMID: 38096673 DOI: 10.1016/j.ygyno.2023.12.001] [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: 10/16/2023] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To describe the participation of racial and ethnic minority groups (REMGs) in gynecologic oncology trials. METHODS Gynecologic oncology studies registered on ClinicalTrials.gov between 2007 and 2020 were identified. Trials with published results were analyzed based on reporting of race/ethnicity in relation to disease site and trial characteristics. Expected enrollment by race/ethnicity was calculated and compared to actual enrollment, adjusted for 2010 US Census population data. RESULTS 2146 gynecologic oncology trials were identified. Of published trials (n = 252), 99 (39.3%) reported race/ethnicity data. Recent trials were more likely to report these data (36% from 2007 to 2009; 51% 2013-2015; and 53% from 2016 to 2018, p = 0.01). Of all trials, ovarian cancer trials were least likely to report race/ethnicity data (32.1% vs 39.3%, p = 0.011). Population-adjusted under-enrollment for Blacks was 7-fold in ovarian cancer, Latinx 10-fold for ovarian and 6-fold in uterine cancer trials, Asians 2.5-fold in uterine cancer trials, and American Indian and Alaska Native individuals 6-fold in ovarian trials. Trials for most disease sites have enrolled more REMGs in recent years - REMGs made up 19.6% of trial participants in 2007-2009 compared to 38.1% in 2016-2018 (p < 0.0001). CONCLUSION Less than half of trials that published results reported race/ethnicity data. Available data reveals that enrollment of REMGs is significantly below expected rates based on national census data. These disparities persisted even after additionally adjusting for population size. Despite improvement in recent years, additional recruitment of REMGs is needed to achieve more representative and equitable participation in gynecologic cancer clinical trials.
Collapse
Affiliation(s)
- Michael T Richardson
- Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Danika Barry
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Jecca R Steinberg
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Vineeth Thirunavu
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Danielle E Strom
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Kai Holder
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Naixin Zhang
- Division of Gynecologic Oncology, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Brandon E Turner
- Harvard Radiation Oncology Program, Boston, MA, United States of America
| | - Christopher J Magnani
- Division of Urological Surgery, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Brannon T Weeks
- Brigham and Women's Hospital/Massachusetts General Hospital Integrated Residency Program in Obstetrics and Gynecology, Boston, MA, United States of America
| | - Anna Marie P Young
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Connie F Lu
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Tierney R Wolgemuth
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Nora Laasiri
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Natalie A Squires
- Department of Obstetrics and Gynecology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, United States of America
| | - Jill N Anderson
- Department of Obstetrics and Gynecology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, United States of America
| | - Beth Y Karlan
- Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, CA, United States of America
| | - John K Chan
- California Pacific / Palo Alto Medical Foundation / Sutter Research Institute, San Francisco, CA, United States of America
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Dario R Roque
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Ritu Salani
- Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, CA, United States of America.
| |
Collapse
|
4
|
Safavi P, Moghadam KB, Haghighi Z, Ferns GA, Rahmani F. Interplay between LncRNA/miRNA and TGF-β Signaling in the Tumorigenesis of Gynecological Cancer. Curr Pharm Des 2024; 30:CPD-EPUB-138262. [PMID: 38303530 DOI: 10.2174/0113816128284380240123071409] [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: 09/26/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024]
Abstract
Gynecologic cancers are among the most common malignancies with aggressive features and poor prognosis. Tumorigenesis in gynecologic cancers is a complicated process that is influenced by multiple factors, including genetic mutations that activate various oncogenic signaling pathways, including the TGF-β pathway. Aberrant activation of TGF-β signaling is correlated with tumor recurrence and metastasis. It has been shown that non-coding RNAs (ncRNAs) have crucial effects on cancer cell proliferation, migration, and metastasis. Upregulation of various ncRNAs, including long non-coding RNAs (lncRNA) and microRNAs (miRNAs), has been reported in several tumors, like cervical, ovarian, and endometrial cancers, but their cellular mechanisms remain to be investigated. Thus, recognizing the role of ncRNAs in regulating the TGF-β pathway may provide novel strategies for better treatment of cancer patients. The present study summarizes recent findings on the role of ncRNAs in regulating the TGF-β signaling involved in tumor progression and metastasis in gynecologic cancers.
Collapse
Affiliation(s)
- Pegah Safavi
- Department of Medical Radiation, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Kimia Behrouz Moghadam
- Department of Medicinal Chemistry, Faculty of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran
| | - Zahra Haghighi
- Kashmar School of Medical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A Ferns
- Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex BN1 9PH, UK
| | - Farzad Rahmani
- Kashmar School of Medical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
- Metabolic Syndrome Research center, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
5
|
Rieder SM, Burgess E, Rutledge T, Sussman A, Boyce T, Pankratz VS, Kano M. Critical decisions: A mixed-methods study of decision-making among diverse gynecologic cancer patients considering therapeutic clinical trial enrollment. Gynecol Oncol 2024; 184:103-110. [PMID: 38301308 DOI: 10.1016/j.ygyno.2024.01.031] [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: 09/29/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Participation in therapeutic clinical trials does not reflect the diversity of gynecologic cancer patients, limiting access to novel therapeutics and generalizability of results. Reasons for inequities in participation among historically underrepresented populations remain undertheorized, as studies have shown equal willingness to participate among groups. We sought to apply a precarity framework to conceptualize the factors that impact patients' desire to enroll, to improve equity in gynecologic oncology clinical trial participation. METHODS Gynecologic cancer patients at a single tertiary care facility in the Southwestern United States who discussed participation in therapeutic clinical trial with their oncology provider from 2020 to 2021 were identified. Enrolled participants completed surveys and qualitative interviews regarding treatment experiences and decision-making. Oncology providers completed parallel surveys at the time of their patient's enrollment. Descriptive statistics and thematic coding were used to analyze data. RESULTS 30 patients were enrolled and participated in surveys and interviews. No differences were found in quantitative data assessing shared decision-making and patient-centered communication between those who enrolled and those who did not. Qualitative data demonstrated that patients who declined trial enrollment expressed concerns regarding uncertainty and loss of control, independence in decision-making, and significant resource challenges and financial toxicity of cancer treatment. CONCLUSIONS We identified a constellation of factors that contribute to desire to enroll in clinical trials, that we describe using the framework of precarity. Through identification of precarious patients and mitigation of burdens, we anticipate improved enrollment and retention in therapeutic clinical trials among diverse gynecologic oncology patients.
Collapse
Affiliation(s)
- Stephanie Margrit Rieder
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA; Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM, USA.
| | - Ellen Burgess
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Teresa Rutledge
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA; Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Andrew Sussman
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA; Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Tawny Boyce
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | | | - Miria Kano
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA; Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| |
Collapse
|
6
|
Barandouzi ZA, Eng T, Shelton J, Khanna N, Scott I, Meador R, Bruner DW. Associations of the gut microbiome with psychoneurological symptom cluster in women with gynecologic cancers: a longitudinal study. Support Care Cancer 2023; 31:626. [PMID: 37819383 DOI: 10.1007/s00520-023-08058-x] [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: 05/05/2023] [Accepted: 09/20/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE The present study aimed to evaluate the associations between the gut microbiome and psychoneurological symptoms (PNS) cluster in women with gynecologic cancers over time. METHODS In this secondary data analysis, 19 women with cervical and endometrial cancers treated with radiotherapy were followed at pre-treatment, 6-8 weeks, and 6 months post-treatment. To measure symptoms, Functional Assessment of Cancer Therapy-General (FACT-G) and Patient Health Questionnaire-9 (PHQ-9) were used. An average Z score of at least three out of five symptoms was computed as the PNS cluster total score. Rectal swabs were also collected at the same time points and sequenced using 16S rRNA V4 regions. The Kruskal-Wallis and permutational multivariable analysis of variance tests were used to compare α- and β-diversity between patients with high and low PNS cluster. The linear discriminant analysis effect size (LEfSe) tested taxa differences between study groups. Also, the linear mixed-effect model was used to evaluate the association of the gut microbiome and the PNS cluster over cancer treatment. RESULTS The patients' mean age was 58 years, 47% Black, 52% single/divorced, and 66% had college or above education. Among the participants, 63% had endometrial cancer with stage I disease. There was a different taxonomy profile between patients with high and low PNS. Patients with high PNS had a lower α-diversity than those with low PNS (Shannon, p = 0.03, evenness, p = 0.03). The mixed effects model results showed that low α-diversity and abundance of Fusicatenibacter and Ruminococcus were associated with high PNS cluster over cancer treatment. CONCLUSION The association between the gut microbiome and PNS cluster suggest that the gut microbiota plays a role in developing the PNS cluster. Future larger studies are required to shed light on the gut microbiota role in symptom development in gynecologic cancer patients.
Collapse
Affiliation(s)
- Zahra Amirkhanzadeh Barandouzi
- School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, GA, 30322, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Tony Eng
- Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
- School of Medicine, Emory University, 201 Dowman Dr, Atlanta, GA, 30322, USA
| | - Joseph Shelton
- Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
- School of Medicine, Emory University, 201 Dowman Dr, Atlanta, GA, 30322, USA
| | - Namita Khanna
- Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
- School of Medicine, Emory University, 201 Dowman Dr, Atlanta, GA, 30322, USA
| | - Isabelle Scott
- School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Rebecca Meador
- School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Deborah Watkins Bruner
- School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, GA, 30322, USA.
- Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA.
| |
Collapse
|
7
|
Burkett WC, Iwai Y, Gehrig PA, Knittel AK. Fractured and delayed: A qualitative analysis of disruptions in care for gynecologic malignancies during incarceration. Gynecol Oncol 2023; 176:1-9. [PMID: 37393632 PMCID: PMC10528285 DOI: 10.1016/j.ygyno.2023.06.017] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Women are experiencing growing rates of incarceration at twice the pace of that for men. Additionally, one-third will be older than 55 years of age by the end of the decade. Women who are incarcerated experience a higher prevalence of gynecologic malignancies and present with higher stage disease, which may be contributing to the greater mortality from cancer than the age-adjusted US population. Limited access to guideline-recommended screening and prevention and resource limitations across correctional facilities may result in gynecologic cancer disparities. Reasons for delayed gynecologic cancer care in prisons remain underexplored. Therefore, we sought to identify contributors to delayed gynecologic cancer care among women experiencing incarceration. METHODS Women at a single tertiary center in the Southeastern U.S. who were incarcerated and were diagnosed with a gynecologic cancer during 2014-2021 were identified in the electronic medical record. Note text was extracted and contributors to delay were identified and categorized using the RADaR method. Descriptive statistics were used to assess quantitative data. RESULTS 14 patients were identified with a total of 14,879 text excerpts. Data reduction was performed to identify excerpts that were relevant to the central research question resulting in 175 relevant note excerpts. Delays prior to the tertiary care visit included patient and institutional contributors. Delays during transition from the tertiary center to prison included discharge planning and loss to follow-up during/after incarceration. Transportation, authorization, and restraints were concrete contributors. Abstract contributors included communication, and the patient's emotional experience. CONCLUSIONS We identify myriad contributors to delayed or fractured gynecologic cancer care in women experiencing incarceration. The impact of these issues warrants further study and intervention to improve care.
Collapse
Affiliation(s)
- Wesley C Burkett
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
| | - Yoshiko Iwai
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America.
| | - Paola A Gehrig
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, United States of America.
| | - Andrea K Knittel
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
| |
Collapse
|
8
|
Shalowitz DI, Schroeder MC, Birken SA. An implementation science approach to the systematic study of access to gynecologic cancer care. Gynecol Oncol 2023; 172:78-81. [PMID: 36972637 DOI: 10.1016/j.ygyno.2023.03.012] [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: 02/24/2023] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Barriers to access to cancer care are profoundly threatening to patients with gynecologic malignancies. Implementation science focuses on empirical investigation of factors influencing delivery of clinical best practices, as well as interventions designed to improve delivery of evidence-based care. We outline one prominent framework for conducting implementation research and discuss its application to improving access to gynecologic cancer care. METHODS Literature on the use of the Consolidated Framework for Implementation Research (CFIR) was reviewed. Delivery of cytoreductive surgery for advanced ovarian carcinoma was selected as an illustrative case of an evidence-based intervention (EBI) in gynecologic oncology. CFIR domains were applied to the context of cytoreductive surgical care, highlighting examples of empirically-assessable determinants of care delivery. RESULTS CFIR domains include Innovation, Inner Setting, Outer Setting, Individuals, and Implementation Process. "Innovation" relates to characteristics of the surgical intervention itself; "Inner Setting" relates to the environment in which surgery is delivered. "Outer Setting" refers to the broader care environment influencing the Inner Setting. "Individuals" highlights attributes of persons directly involved in care delivery, and "Implementation Process" focuses on integration of the Innovation within the Inner Setting. CONCLUSIONS Prioritization of implementation science methods in the study of access to gynecologic cancer care will help ensure that patients are able to utilize interventions with the greatest prospect of benefiting them.
Collapse
Affiliation(s)
- David I Shalowitz
- West Michigan Cancer Center, Kalamazoo, MI, United States of America; Collaborative on Equity in Rural Cancer Care, Kalamazoo, MI, United States of America.
| | - Mary C Schroeder
- Collaborative on Equity in Rural Cancer Care, Kalamazoo, MI, United States of America; Division of Health Services Research, College of Pharmacy, University of Iowa, Iowa City, IA, United States of America
| | - Sarah A Birken
- Collaborative on Equity in Rural Cancer Care, Kalamazoo, MI, United States of America; Department of Implementation Science, School of Medicine, Wake Forest University, Winston-Salem, USA
| |
Collapse
|
9
|
Rades D, Al-Salool A, Yu NY, Soror T. Pre-treatment Emotional Distress in Patients Receiving Radiotherapy for Gynecologic Cancers. Cancer Diagn Progn 2023; 3:320-326. [PMID: 37168969 PMCID: PMC10165383 DOI: 10.21873/cdp.10218] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/13/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND/AIM Patients with gynecologic cancers selected for external-beam radiotherapy or brachytherapy may experience emotional distress. We aimed to identify patients who may benefit from early psycho-oncological intervention. PATIENTS AND METHODS We investigated 10 potential risk factors of emotional distress in a retrospective series of 122 patients planned for radiotherapy of gynecologic cancers. Factors included COVID-19 pandemic, number of physical problems, age, performance status, tumor site/stage, surgery, chemotherapy, brachytherapy, and history of another tumor. p-Values <0.005 indicated significance, and p-values <0.06 trends. RESULTS Frequencies of worry, fear, sadness, depression, nervousness, and loss of interest were 41%, 57%, 39%, 16%, 38%, and 20%, respectively. Significant associations with at least one of these symptoms were found for ≥5 physical problems and no upfront surgery. Trends were observed for chemoradiotherapy, history of another tumor, worse performance status, and younger age. CONCLUSION The prevalence of pre-radiotherapy emotional distress was remarkable in patients with gynecologic cancers. Patients with risk factors may benefit from immediate psycho-oncological assistance.
Collapse
Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Ahmed Al-Salool
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, U.S.A
| | - Tamer Soror
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| |
Collapse
|
10
|
Ioffe YJ, Hong L, Joachim-Célestin M, Soret C, Montgomery S, Unternaehrer JJ. Genetic Testing in the Latinx community: Impact of acculturation and provider relationships. Gynecol Oncol 2023; 169:125-130. [PMID: 36577267 DOI: 10.1016/j.ygyno.2022.12.001] [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: 09/15/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The current study aimed to explore attitudes toward genetic germline testing and intentions to test in Latinas from Southern California. We hypothesized that patients' acculturation and education levels, as well as comfort with health care providers, are positively associated with attitudes and intentions toward genetic testing. METHODS A survey was offered concurrently to Latinx female patients at a gynecologic oncology practice and to unaffiliated Latinx community members. The survey assessed demographics, structural, psychosocial, and acculturation factors and genetic testing attitudes and intentions via validated scales. RESULTS Of 148 surveys collected, 66% of responders had low levels of acculturation. 50% of women had government-subsidized insurance; 22% had no schooling in the US. 67% of participants did not carry a diagnosis of cancer. Women with higher acculturation levels were more likely to consider genetic testing (rs = 0.54, p = .001). Higher acculturated women and less acculturated women under 50 were more likely to consider testing if it had been recommended by a female, trusted, or Hispanic/Latinx provider (rs = 0.22, p = .01, rs = 0.27, p = .003 and rs = 0.19, p = .003, respectively) or if there was a recent cancer diagnosis (self or family, rs = 0.19, p = .03). Overall, education correlated with intention to test. The more education outside of the US, the less negative was the attitude toward being tested (rs = -0.41, p = .002). CONCLUSIONS Direct experiences with cancer, more schooling and higher acculturation coupled with provider characteristics determined if Latinas were more open to testing. Provider characteristics mattered: having a female, Latinx, Spanish speaking provider was important for genetic testing decision-making. These findings are particularly pertinent in areas with high Latinx populations.
Collapse
Affiliation(s)
- Yevgeniya J Ioffe
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Loma Linda University School of Medicine, Loma Linda, CA, United States of America.
| | - Linda Hong
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Loma Linda University School of Medicine, Loma Linda, CA, United States of America
| | | | - Carmen Soret
- School of Behavioral Health, Loma Linda University, United States of America
| | - Susanne Montgomery
- School of Behavioral Health, Loma Linda University, United States of America
| | - Juli J Unternaehrer
- Department of Basic Sciences, Division of Biochemistry, Loma Linda University School of Medicine, United States of America
| |
Collapse
|
11
|
Lv N, Shen S, Chen Q, Tong J. Long noncoding RNAs: glycolysis regulators in gynaecologic cancers. Cancer Cell Int 2023; 23:4. [PMID: 36639695 PMCID: PMC9838043 DOI: 10.1186/s12935-023-02849-2] [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: 07/24/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023] Open
Abstract
The three most common gynaecologic cancers that seriously threaten female lives and health are ovarian cancer, cervical cancer, and endometrial cancer. Glycolysis plays a vital role in gynaecologic cancers. Several long noncoding RNAs (lncRNAs) are known to function as oncogenic molecules. LncRNAs impact downstream target genes by acting as ceRNAs, guides, scaffolds, decoys, or signalling molecules. However, the role of glycolysis-related lncRNAs in regulating gynaecologic cancers remains poorly understood. In this review, we emphasize the functional roles of many lncRNAs that have been found to promote glycolysis in gynaecologic cancers and discuss reasonable strategies for future research.
Collapse
Affiliation(s)
- Nengyuan Lv
- grid.268505.c0000 0000 8744 8924Department of the Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053 Zhejiang Province People’s Republic of China ,grid.13402.340000 0004 1759 700XDepartment of Obstetrics and Gynecology, Affiliated Hangzhou First People’s Hospital, Zhejiang University of Medicine, Hangzhou, 310006 Zhejiang Province People’s Republic of China
| | - Siyi Shen
- grid.268505.c0000 0000 8744 8924Department of the Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053 Zhejiang Province People’s Republic of China ,grid.13402.340000 0004 1759 700XDepartment of Obstetrics and Gynecology, Affiliated Hangzhou First People’s Hospital, Zhejiang University of Medicine, Hangzhou, 310006 Zhejiang Province People’s Republic of China
| | - Qianying Chen
- grid.268505.c0000 0000 8744 8924Department of the Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053 Zhejiang Province People’s Republic of China ,grid.13402.340000 0004 1759 700XDepartment of Obstetrics and Gynecology, Affiliated Hangzhou First People’s Hospital, Zhejiang University of Medicine, Hangzhou, 310006 Zhejiang Province People’s Republic of China
| | - Jinyi Tong
- grid.268505.c0000 0000 8744 8924Department of the Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053 Zhejiang Province People’s Republic of China ,grid.13402.340000 0004 1759 700XDepartment of Obstetrics and Gynecology, Affiliated Hangzhou First People’s Hospital, Zhejiang University of Medicine, Hangzhou, 310006 Zhejiang Province People’s Republic of China
| |
Collapse
|
12
|
Farzaneh M, Najafi S, Dari MAG, Sheykhi-Sabzehpoush M, Dayer D, Cheraghzadeh M, Azizidoost S. Functional roles of long noncoding RNA MALAT1 in gynecologic cancers. Clin Transl Oncol 2023; 25:48-65. [PMID: 36042115 DOI: 10.1007/s12094-022-02914-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/25/2022] [Indexed: 02/06/2023]
Abstract
Gynecologic cancers are reproductive disorders characterized by pelvic pain and infertility. The identification of new predictive markers and therapeutic targets for the treatment of gynecologic cancers is urgently necessary. One of the recent successes in gynecologic cancers research is identifying the role of signaling pathways in the pathogenesis of the disease. Recent experiments showed long noncoding RNAs (lncRNA) can be novel therapeutic approaches for the diagnosis and treatment of gynecologic cancers. LncRNA are transcribed RNA molecules that play pivotal roles in multiple biological processes by regulating the different steps of gene expression. Metastasis-associated lung adenocarcinoma transcript-1 (MALAT1) is a well-known lncRNA that plays functional roles in gene expression, RNA processing, and epigenetic regulation. High expression of MALAT1 is closely related to numerous human diseases. It is generally believed that MALAT1 expression is associated with cancer cell growth, autophagy, invasion, and metastasis. MALAT1 by targeting multiple signaling pathways and microRNAs (miRNAs) could contribute to the pathogenesis of gynecologic cancers. In this review, we will summarize functional roles of MALAT1 in the most common gynecologic cancers, including endometrium, breast, ovary, and cervix.
Collapse
|
13
|
Locke GE, Mendez LC, Martell K, Weiss Y, Choi S, D'Alimonte L, Barnes E, Taggar A, Leung E. Opioid consumption and pain in patients with gynecological cancer who underwent spinal anesthesia vs. general anesthesia for interstitial brachytherapy. Brachytherapy 2022; 21:806-813. [PMID: 36220758 DOI: 10.1016/j.brachy.2022.07.010] [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: 04/29/2022] [Revised: 07/18/2022] [Accepted: 07/28/2022] [Indexed: 12/14/2022]
Abstract
AIMS Interstitial brachytherapy (ISBT) is an effective option for delivering conformal high dose radiation to the target volume with better organ-at risk sparing but is thought to be more invasive and painful than other methods. This study investigated pain levels and opioid consumption in patients who received spinal anesthesia (SA) or general anesthesia (GA) for their ISBT. MATERIALS AND METHODS Patients that underwent ISBT from April 2014 to September 2018 were analyzed from a prospective institutional database. The most prevalent malignancies were cervical (45%), recurrent endometrial (27%) and vaginal (20%) cancers. Baseline patient characteristics, radiation treatment details, anesthesia records, and inpatient charts were obtained. Opioid consumption was quantified as oral morphine equivalent per day (OMEq/day) from implantation until removal. Pain score levels were collected by using an 11-point scoring system. RESULTS Ninety nine patients received GA and 40 patients received SA as their anesthesia for ISBT. During their first admission, 76 patients (55%) required intravenous opioids. Patients receiving SA had significantly lower mean pain scores on the morning of their procedure 6 (Interquartile range [IQR] 2-8) vs. 0 (IQR: 0-1); p < 0.001]. Pain did not significantly differ between cohorts at any other time. During the first admission, SA patients had a lower median opioid usage of 23 (IQR: 9-47) mg/day compared to GA patients at 38 (IQR: 21-71) mg/day (p = 0.011). No difference in opioid consumption was seen during subsequent admissions. CONCLUSIONS In patients undergoing ISBT, SA provides better immediate pain control post insertion compared to GA. Patients who received SA used lower amounts of opioids during their first ISBT insertion.
Collapse
Affiliation(s)
- Gordon E Locke
- University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada
| | - Lucas C Mendez
- Division of Radiation Oncology, London Health Sciences Centre, London, Canada
| | - Kevin Martell
- Department of Radiation Oncology, University of Calgary, Alberta, Canada
| | - Yonatan Weiss
- University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada
| | - Stephen Choi
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Laura D'Alimonte
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Elizabeth Barnes
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Amandeep Taggar
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Eric Leung
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Ontario, Canada.
| |
Collapse
|
14
|
Barnes D, Mohammad N, Hoang L, Anglesio M, Hollis RL, Gourley C, Stuart HC, Carey MS, Stuart GC. Multisite gynecologic endometrioid adenocarcinomas: Can mutation profiling be used to distinguish synchronous primary cancers from metastases? Gynecol Oncol Rep 2022; 44:101076. [PMID: 36299398 PMCID: PMC9589011 DOI: 10.1016/j.gore.2022.101076] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/26/2022] Open
Abstract
It is well recognized that some patients with endometrioid gynecological cancers have tumors arising in multiple sites (ovary, endometrium, and endometriosis) at the time of diagnosis. Molecular analysis has helped discern whether these multisite cancers represent synchronous primary tumors or alternatively metastatic disease. We present a complex case of a patient with endometrioid carcinomas arising in multiple sites. We discuss the use of mutation profiling to discern clonality and highlight how this information may inform the clinical management of such cases.
Collapse
Affiliation(s)
- Dominique Barnes
- Department of Obstetrics and Gynecology, University of British Columbia, Canada,Corresponding author at: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of British Columbia, 2775 Laurel Street, 6th Floor, DHCC, Vancouver, BC V5Z 1M9, Canada.
| | - Nissreen Mohammad
- Department of Pathology, Vancouver General Hospital and the University of British Columbia, Canada
| | - Lien Hoang
- Department of Pathology, Vancouver General Hospital and the University of British Columbia, Canada
| | - Michael Anglesio
- Department of Obstetrics and Gynecology, University of British Columbia, Canada
| | - Robert L. Hollis
- The Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, MRC Institute of Genetics and Cancer, University of Edinburgh, UK
| | - Charlie Gourley
- The Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, MRC Institute of Genetics and Cancer, University of Edinburgh, UK
| | - Heather C. Stuart
- Department of Surgery, Vancouver General Hospital, and the University of British Columbia, Canada
| | - Mark S. Carey
- Department of Obstetrics and Gynecology, University of British Columbia, Canada
| | - Gavin C.E. Stuart
- Department of Obstetrics and Gynecology, University of British Columbia, Canada
| |
Collapse
|
15
|
Song Y, Zhang Y. Research progress of neoantigens in gynecologic cancers. Int Immunopharmacol 2022; 112:109236. [PMID: 36113318 DOI: 10.1016/j.intimp.2022.109236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 09/01/2022] [Accepted: 09/04/2022] [Indexed: 11/24/2022]
Abstract
The incidence and mortality of gynecological cancers have increased over the past decade. In the absence of effective treatment strategies, many advanced patients develop resistance to conventional therapies and have poor prognosis. Neoantigens have emerged as a novel tumor-specific antigen (TSA) that arises from genomic mutations in tumor cells. With higher immunogenicity than tumor-associated antigens (TAA), they have no risk of developing autoimmune response, leading them an attractive candidate for tumor therapeutic vaccines. With the development of next-generation sequencing (NGS) technology, the identification of neoantigens has been gradually improved, and the scope of application of neoantigen vaccines has continued to expand. Combined with other therapies such as immune-checkpoint inhibitors (ICIs) or adoptive cell therapy (ACT), the application of neoantigen in gynecological cancers has extended to clinical practice. Here, we reviewed the preclinical and clinical studies of neoantigens in gynecological cancers.
Collapse
|
16
|
Hassett MJ, Wong S, Osarogiagbon RU, Bian J, Dizon DS, Jenkins HH, Uno H, Cronin C, Schrag D. Implementation of patient-reported outcomes for symptom management in oncology practice through the SIMPRO research consortium: a protocol for a pragmatic type II hybrid effectiveness-implementation multi-center cluster-randomized stepped wedge trial. Trials 2022; 23:506. [PMID: 35710449 PMCID: PMC9202326 DOI: 10.1186/s13063-022-06435-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 03/25/2022] [Accepted: 05/27/2022] [Indexed: 11/24/2022] Open
Abstract
Background Many cancer patients experience high symptom burden. Healthcare in the USA is reactive, not proactive, and doctor-patient communication is often suboptimal. As a result, symptomatic patients may suffer between clinic visits. In research settings, systematic assessment of electronic patient-reported outcomes (ePROs), coupled with clinical responses to severe symptoms, has eased this symptom burden, improved health-related quality of life, reduced acute care needs, and extended survival. Implementing ePRO-based symptom management programs in routine care is challenging. To study methods to overcome the implementation gap and improve symptom control for cancer patients, the National Cancer Institute created the Cancer-Moonshot funded Improving the Management of symPtoms during And following Cancer Treatment (IMPACT) Consortium. Methods Symptom Management IMplementation of Patient Reported Outcomes in Oncology (SIMPRO) is one of three research centers that make up the IMPACT Consortium. SIMPRO, a multi-disciplinary team of investigators from six US health systems, seeks to develop, test, and integrate an electronic symptom management program (eSyM) for medical oncology and surgery patients into the Epic electronic health record (EHR) system and associated patient portal. eSyM supports real-time symptom tracking for patients, automated clinician alerts for severe symptoms, and specialized reports to facilitate population management. To rigorously evaluate its impact, eSyM is deployed through a pragmatic stepped wedge cluster-randomized trial. The primary study outcome is the occurrence of an emergency department treat-and-release event within 30 days of starting chemotherapy or being discharged following surgery. Secondary outcomes include hospitalization rates, chemotherapy use (time to initiation and duration of therapy), and patient quality of life and satisfaction. As a type II hybrid effectiveness-implementation study, facilitators and barriers to implementation are assessed throughout the project. Discussion Creating and deploying eSyM requires collaboration between dozens of staff across diverse health systems, dedicated engagement of patient advocates, and robust support from Epic. This trial will evaluate eSyM in routine care settings across academic and community-based healthcare systems serving patients in rural and metropolitan locations. This trial’s pragmatic design will promote generalizable results about the uptake, acceptability, and impact of an EHR-integrated, ePRO-based symptom management program. Trial registration
ClinicalTrials.gov NCT03850912. Registered on February 22, 2019. Last updated on November 9, 2021.
Collapse
Affiliation(s)
- Michael J Hassett
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, 450 Brookline Avenue, Boston, MA, 02215, USA.
| | - Sandra Wong
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | | | - Don S Dizon
- Lifespan Cancer Institute and Brown University, Providence, RI, USA
| | | | - Hajime Uno
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Christine Cronin
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Deborah Schrag
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | |
Collapse
|
17
|
Simmons D, Blank SV, ElNaggar AC, Chastek B, Bunner SH, McLaurin K. Health Care Resource Utilization and Costs Associated with Disease Progression in Ovarian Cancer. Adv Ther 2022; 39:2544-61. [PMID: 35362863 DOI: 10.1007/s12325-022-02086-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/10/2022] [Indexed: 11/05/2022]
Abstract
Introduction Ovarian cancer (OC) is one of the leading causes of cancer mortality among women in the United States. With the approval of first-line maintenance therapies, patients with OC experienced prolonged first-line progression-free survival. While the literature addresses some costs associated with OC, further research is needed on the costs of progression that are potentially deferred or prevented by early maintenance. The objective of this study was to capture the health care resource utilization and costs of patients with advanced OC who never received poly(ADP ribose) polymerase (PARP) inhibitor maintenance. Methods We conducted a descriptive retrospective analysis of treatment patterns and the consequences of progression through several lines of therapy (LOTs) in patients with OC, using claims from commercial and Medicare Advantage health plan members in the United States from the Optum Research Database between January 1, 2010, and April 30, 2019. Patients were required to have an index OC diagnosis (≥ 2 non-diagnostic claims). We examined up to 4 LOTs and the time between treatments. Results A total of 5498 women met the eligibility criteria. As the number of LOTs increased, the median duration of each line decreased from 137 days in LOT1 to 94 days in LOT4, and the time between lines also decreased from 245 to 0 days. Ambulatory care visits were a major driver of health care resource utilization, with a median of about 6 monthly visits during active treatment. The mean total monthly health care costs for patients with at least 2 LOTs were US$8588 (SD: $8533) before LOT2 and increased to $15,358 (SD: $21,460) during or after LOT2. Conclusions Prolonging progression-free survival after first-line treatment in patients with OC may provide the opportunity to delay or prevent later treatment, the financial toxicity felt by patients, and the economic burden to the health care system associated with progression. Ovarian cancer is a complex disease in which > 70% of patients are diagnosed with advanced disease, and one of the leading causes of cancer mortality among women in the United States. A variety of maintenance therapy options, including bevacizumab, PARP inhibitors, and PARP plus bevacizumab combination therapies, have demonstrated improvements in progression-free survival. By delaying disease progression after completion of first-line therapy, a simultaneous decrease in post-progression health care costs may be seen. The objective of this study was to capture the health care resource utilization and costs of patients with advanced ovarian cancer who did not receive a PARP inhibitor at any time in their treatment In patients never receiving a PARP inhibitor, this study documented substantial health care resource usage and costs associated with progression beyond the first line of treatment (surgery and/or chemotherapy) in ovarian cancer. These were largely driven by the number of ambulatory care visits. When these visits are combined with emergency department visits and inpatient stays, high costs are incurred by both patients and third-party payers Prolonging progression-free survival after first-line treatment in patients with ovarian cancer may delay or prevent the need for later treatment, the financial burden felt by patients, and the economic burden to the health care system associated with subsequent disease progressions
Collapse
|
18
|
Song Y, Pan S, Li K, Chen X, Wang ZP, Zhu X. Insight into the role of multiple signaling pathways in regulating cancer stem cells of gynecologic cancers. Semin Cancer Biol 2021; 85:219-233. [PMID: 34098106 DOI: 10.1016/j.semcancer.2021.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/11/2021] [Revised: 05/24/2021] [Accepted: 06/01/2021] [Indexed: 12/29/2022]
Abstract
Mounting evidence has demonstrated that a myriad of developmental signaling pathways, such as the Wnt, Notch, Hedgehog and Hippo, are frequently deregulated and play a critical role in regulating cancer stem cell (CSC) activity in human cancers, including gynecologic malignancies. In this review article, we describe an overview of various signaling pathways in human cancers. We further discuss the developmental roles how these pathways regulate CSCs from experimental evidences in gynecologic cancers. Moreover, we mention several compounds targeting CSCs in gynecologic cancers to enhance the treatment outcomes. Therefore, these signaling pathways might be the potential targets for developing targeted therapy in gynecologic cancers.
Collapse
Affiliation(s)
- Yizuo Song
- Center of Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Shuya Pan
- Center of Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Kehan Li
- Center of Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Xin Chen
- Center of Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Z Peter Wang
- Center of Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.
| | - Xueqiong Zhu
- Center of Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China.
| |
Collapse
|
19
|
Sun Z, Wang S, Yang R, Li X, Yang Y, Qi X, Ma Y, Xu W. Gestational diabetes mellitus and risks of gynecologic cancers: Results from a nationwide Swedish twin study. Gynecol Oncol 2021; 162:142-147. [PMID: 33934849 DOI: 10.1016/j.ygyno.2021.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Type 2 diabetes has been associated with increased risk of gynecologic cancers, yet the effect of gestational diabetes mellitus (GDM) on gynecologic cancers is unclear. OBJECTIVES To examine associations between GDM history and subsequent gynecologic cancers in parous women, and to explore whether gestational hypertension (GH) plays a role in the associations. STUDY DESIGN The population-based cohort study included 15,941 individuals from the Swedish Twin Registry. The history of GDM and GH was ascertained based on self-reports. Incident cases of gynecologic cancers (including cancers of the cervix, uterus, ovaries and other female genitalia) were obtained from the National Patients Registry and the Swedish Cancer Registry. Generalized estimating equation models were applied to analyze associations between GDM and gynecologic cancers. Stratified analysis was used to explore whether associations between GDM and gynecologic cancers differed by GH. Additive and multiplicative interactions were calculated between GDM and GH. RESULTS Of all participants, 350 (2.2%) had GDM, and 1762 (11.1%) had incident gynecologic cancers. No statistically significant associations were found between GDM and risks of any gynecologic cancers. However, GDM was associated with an increased risk of ovarian cancer (OR = 5.29, 95% CI: 1.63-17.19) in women with GH. Interactions between GDM and GH were observed on the additive scale (Attributable proportion due to interaction: 0.86, 95% CI 0.42-1.30, P < 0.001). CONCLUSIONS The associations between GDM and risks of gynecologic cancers were not evident, but the effect of GDM on the risk of ovarian cancer was modified by GH. Further validation in larger cohorts is warranted.
Collapse
Affiliation(s)
- Zhuoyu Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China; Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China
| | - Shuqi Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China; Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China
| | - Rongrong Yang
- Public Health Science and Engineering College, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xuerui Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China; Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China
| | - Yumeng Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China; Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China
| | - Xiuying Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China; Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China
| | - Yaomei Ma
- Department of Gynecological Oncology, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China.
| | - Weili Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China; Tianjin Center for International Collaborative Research in Environment, Nutrition and Public Health, Tianjin, China; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
| |
Collapse
|
20
|
Hashemipour M, Boroumand H, Mollazadeh S, Tajiknia V, Nourollahzadeh Z, Rohani Borj M, Pourghadamyari H, Rahimian N, Hamblin MR, Mirzaei H. Exosomal microRNAs and exosomal long non-coding RNAs in gynecologic cancers. Gynecol Oncol 2021; 161:314-327. [PMID: 33581845 DOI: 10.1016/j.ygyno.2021.02.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [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: 12/30/2020] [Accepted: 02/03/2021] [Indexed: 02/08/2023]
Abstract
Gynecologic cancer is a group of any malignancies affecting reproductive tissues and organs of women, including ovaries, uterine, cervix, vagina, vulva, and endometrium. Several types of molecular mechanisms are associated with the progression of gynecologic cancers. Among it can be referred to the most widely studied non-coding RNAs (ncRNAs), specifically microRNAs (miRNAs) and long ncRNAs (lncRNAs). As yet, lncRNAs are known to serve key biological roles via various mechanisms, such as splicing regulation, chromatin rearrangement, translation regulation, cell-cycle control, genetic imprinting and mRNA decay. Besides, miRNAs govern gene expression by modulation of mRNAs and lncRNAs degradation, suggestive of needing more research in this field. Generally, driving gynecological cancers pathways by miRNAs and lncRNAs lead to the current improvement in cancer-related technologies. Exosomes are extracellular microvesicles which can carry cargo molecules among cells. In recent years, more studies have been focused on exosomal non-coding RNAs (exo-ncRNAs) and exosomal microRNAs (exo-miRs) because of being natural carriers of lnc RNAs and microRNAs via programmed process. In this review we summarized recent reports concerning the function of exosomal microRNAs and exosomal long non-coding RNAs in gynecological cancers.
Collapse
Affiliation(s)
| | - Homa Boroumand
- School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Samaneh Mollazadeh
- Natural Products and Medicinal Plants Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Vida Tajiknia
- Department of Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mina Rohani Borj
- Department of Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Pourghadamyari
- Department of Clinical Biochemistry, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Neda Rahimian
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran.
| | - Michael R Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein 2028, South Africa.
| | - Hamed Mirzaei
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran.
| |
Collapse
|
21
|
Islam JY, Deveaux A, Previs RA, Akinyemiju T. Racial disparities in palliative care utilization among metastatic gynecological cancer patients living at last follow-up: An analysis of the National Cancer Data Base. Data Brief 2020; 34:106705. [PMID: 33473361 PMCID: PMC7803651 DOI: 10.1016/j.dib.2020.106705] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 12/24/2020] [Accepted: 12/28/2020] [Indexed: 02/02/2023] Open
Abstract
The National Comprehensive Cancer Network recommends palliative care should be integrated in to cancer care starting from cancer diagnosis. However, traditionally palliative care is prioritized for cancer patients at the end-of-life. In our main article titled “Racial and Ethnic Disparities in Palliative Care Utilization Among Gynecological Cancer Patients” we present data describing racial/ethnic disparities among metastatic gynecological cancer patients who were deceased at last follow-up. Here, we expand our population to evaluate racial disparities in palliative care utilization among (1) all metastatic gynecologic cancer patients, regardless of vital status (alive or deceased) (n = 176,899) and (2) among only patients who were alive at last follow-up (n = 66,781). We used data from the 2016 National Cancer Database (NCDB) and included patients between ages 18–90 years with metastatic (stage III-IV) gynecologic cancers including, ovarian, cervical and uterine cancer. Palliative care was defined by NCDB as non-curative treatment, and could include surgery, radiation, chemotherapy, and pain management or any combination. We used multivariable logistic regression to evaluate racial disparities in palliative care use among our two populations of interest. Overall, the mean age of gynecologic cancer patients utilizing palliative care was 66 years. Five percent of all metastatic gynecologic oncology patients utilized palliative care overall; and by cancer site palliative care use was as follows: 4% among ovarian, 9% among cervical, and 11% among uterine cancer patients. Among patients who utilized palliative care, 62% utilized surgery, radiation or chemotherapy only and 12% utilized pain management as a form of palliative care. Among ovarian cancer patients, Hispanic ovarian cancer patients were less likely to utilize palliative care compared to their NH-White counterparts (aOR: 0.79, 95% CI: 0.68–0.91). Among cervical cancer patients, we observed that Hispanic (aOR: 0.65, 95% CI: 0.56–0.75) and Asian (aOR: 0.74, 95% CI: 0.59–0.93) were less likely to utilize palliative care than NH-White cervical cancer patients. We observed no racial disparities in palliative care utilization among uterine cancer patients. When we focused on patients who were alive at last follow-up we found that only 3% of patients utilized palliative care. We also conducted multivariable analyses of racial/ethnic disparities among ovarian and cervical cancer patients who were alive at last follow-up. We were unable to conduct multivariable analyses of uterine cancer patients who were alive at last follow-up due to limited sample size of those who utilized palliative care. We observed no racial/ethnic disparities among this patient population of metastatic gynecologic patients.
Collapse
Affiliation(s)
- Jessica Y Islam
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, United States.,Department of Population Health, Duke Health System, Durham, NC, United States
| | - April Deveaux
- Department of Population Health, Duke Health System, Durham, NC, United States
| | - Rebecca A Previs
- Division of Gynecological Oncology, Duke Cancer Institute, Durham, NC, United States
| | - Tomi Akinyemiju
- Department of Population Health, Duke Health System, Durham, NC, United States
| |
Collapse
|
22
|
Islam JY, Deveaux A, Previs RA, Akinyemiju T. Racial and ethnic disparities in palliative care utilization among gynecological cancer patients. Gynecol Oncol 2021; 160:469-76. [PMID: 33276985 DOI: 10.1016/j.ygyno.2020.11.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/27/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Palliative care (PC) is recommended for gynecological cancer patients to improve survival and quality-of-life. Our objective was to evaluate racial/ethnic disparities in PC utilization among patients with metastatic gynecologic cancer. METHODS We used data from the 2016 National Cancer Database (NCDB) and included patients between ages 18-90 years with metastatic (stage III-IV) gynecologic cancers including, ovarian, cervical and uterine cancer who were deceased at last contact or follow-up (n = 124,729). PC was defined by NCDB as non-curative treatment, and could include surgery, radiation, chemotherapy, and pain management or any combination. We used multivariable logistic regression to evaluate racial disparities in PC use. RESULTS The study population was primarily NH-White (74%), ovarian cancer patients (74%), insured by Medicare (47%) or privately insured (36%), and had a Charlson-Deyo score of zero (77%). Over one-third of patients were treated at a comprehensive community cancer program. Overall, 7% of metastatic gynecologic deceased cancer patients based on last follow-up utilized palliative care: more specifically, 5% of ovarian, 11% of cervical, and 12% of uterine metastatic cancer patients. Palliative care utilization increased over time starting at 4% in 2004 to as high as 13% in 2015, although palliative care use decreased to 7% in 2016. Among metastatic ovarian cancer patients, NH-Black (aOR:0.87, 95% CI:0.78-0.97) and Hispanic patients (aOR:0.77, 95% CI:0.66-0.91) were less likely to utilize PC when compared to NH-White patients. Similarly, Hispanic cervical cancer patients were less likely (aOR:0.75, 95% CI:0.63-0.88) to utilize PC when compared to NH-White patients. CONCLUSIONS PC is highly underutilized among metastatic gynecological cancer patients. Racial disparities exist in palliative care utilization among patients with metastatic gynecological cancer.
Collapse
|
23
|
McKenzie ND, Hong H, Ahmad S, Holloway RW. The gut microbiome and cancer immunotherapeutics: A review of emerging data and implications for future gynecologic cancer research. Crit Rev Oncol Hematol 2020; 157:103165. [PMID: 33227575 DOI: 10.1016/j.critrevonc.2020.103165] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 04/28/2020] [Revised: 10/23/2020] [Accepted: 11/05/2020] [Indexed: 12/18/2022] Open
Abstract
Investigation of the gynecologic tract microbial milieu has revealed potential new biomarkers. Simultaneously, immunotherapeutics are establishing their place in the treatment of gynecologic malignancies. The interplay between the microbiome, the tumor micro-environment and response to therapy is a burgeoning area of interest. There is evidence to support that microbes, through their genetic make-up, gene products, and metabolites affect human physiology, metabolism, immunity, disease susceptibility, response to pharmacotherapy, and the severity of disease-related side effects. Specifically, the richness and diversity of the gut microbiome appears to affect carcinogenesis, response to immunotherapy, and modulate severity of immune-mediated adverse effects. These effects have best been described in other tumor types and these have shown compelling results. This review summarizes the current understanding and scope of the interplay between the human microbiome, host factors, cancer, and response to treatments. These findings support further exploring whether these associations exist for gynecologic malignancies.
Collapse
Affiliation(s)
- Nathalie D McKenzie
- AdventHealth Cancer Institute, Division of Gynecologic Oncology, Orlando, FL, 32804, USA
| | - Hannah Hong
- AdventHealth Cancer Institute, Division of Gynecologic Oncology, Orlando, FL, 32804, USA; Kansas City University of Medicine and Biosciences, Kansas City, MO, 64106, USA
| | - Sarfraz Ahmad
- AdventHealth Cancer Institute, Division of Gynecologic Oncology, Orlando, FL, 32804, USA.
| | - Robert W Holloway
- AdventHealth Cancer Institute, Division of Gynecologic Oncology, Orlando, FL, 32804, USA
| |
Collapse
|
24
|
Russo S, Walker JL, Carlson JW, Carter J, Ward LC, Covens A, Tanner EJ, Armer JM, Ridner S, Hayes S, Taghian AG, Brunelle C, Lopez-Acevedo M, Davidson BA, Schaverien MV, Ghamande SA, Bernas M, Cheville AL, Yost KJ, Schmitz K, Coyle B, Zucker J, Enserro D, Pugh S, Paskett ED, Ford L, McCaskill-Stevens W. Standardization of lower extremity quantitative lymphedema measurements and associated patient-reported outcomes in gynecologic cancers. Gynecol Oncol 2020; 160:625-632. [PMID: 33158510 DOI: 10.1016/j.ygyno.2020.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 07/01/2020] [Accepted: 10/20/2020] [Indexed: 01/07/2023]
Abstract
Practice changing standardization of lower extremity lymphedema quantitative measurements with integrated patient reported outcomes will likely refine and redefine the optimal risk-reduction strategies to diminish the devastating limb-related dysfunction and morbidity associated with treatment of gynecologic cancers. The National Cancer Institute (NCI), Division of Cancer Prevention brought together a diverse group of cancer treatment, therapy and patient reported outcomes experts to discuss the current state-of-the-science in lymphedema evaluation with the potential goal of incorporating new strategies for optimal evaluation of lymphedema in future developing gynecologic clinical trials.
Collapse
Affiliation(s)
- Sandra Russo
- National Cancer Institute, Division of Cancer Prevention, 9609 Medical Center Drive, Rockville, MD 20892-9785, USA.
| | - Joan L Walker
- Stephen Cancer Center, OUHSC, Oklahoma City, OK 73104, USA.
| | - Jay W Carlson
- Cancer Research for Ozarks, 1235 E. Cherokee, Springfield, MO 65804, USA.
| | - Jeanne Carter
- Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, 10022, USA.
| | - Leigh C Ward
- University of Queensland, St Lucia, Brisbane, QLD 4072, Australia.
| | - Allan Covens
- University of Toronto and Sunnybrook Health Science Centre, Toronto, ON M4N 3M5, Canada.
| | - Edward J Tanner
- Northwestern Medicine, Feinberg School of Medicine, Prentice Women's Hospital, 250 E Superior, Chicago, IL 60611, USA.
| | - Jane M Armer
- Sinclair School of Nursing, University of Missouri Health, DC 116.05, Ellis Fischel Cancer Center, 115 Business Loop 70 West, Columbia, MO 65203, USA.
| | - Sheila Ridner
- Vanderbilt University School of Nursing, 461 21st Ave South, Nashville, TN 37240, USA.
| | - Sandi Hayes
- Queensland University of Technology, School of Public Health and Biomedical Innovation, Queensland, Australia.
| | - Alphonse G Taghian
- Harvard Medical School/Massachusetts General Hospital, Radiation Oncology, Boston, MA 02114, USA.
| | - Cheryl Brunelle
- Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, MA 02114, USA.
| | - Micael Lopez-Acevedo
- The George Washington University Hospital, School of Medicine and Health Sciences, 2150 Pennsylvania Ave, NW, Washington, DC 20037, USA.
| | - Brittany A Davidson
- Duke University School of Medicine, Duke Cancer Center, 20 Duke Medical Center, Durham, NC 27710, USA.
| | - Mark V Schaverien
- The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
| | - Sharad A Ghamande
- Augusta University, Augusta Oncology, 3696 Wheeler Road, Augusta, GA 30909, USA.
| | - Michael Bernas
- TCU and UNTHSC School of Medicine, Forth Worth, TX 76207, USA.
| | | | | | - Kathryn Schmitz
- Penn State Cancer Institute, 400 University Drive, Hershey, PA 17033, USA.
| | - Barbara Coyle
- Patient Advocate, Lymphedema Advocacy Group, Minneapolis, MN, USA
| | - Jeannette Zucker
- National Lymphedema Network, 411 Lafayette Street, 6th Floor, New York, NY 10003, USA.
| | - Danielle Enserro
- NRG Oncology Statistics and Data Management Center, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
| | - Stephanie Pugh
- NRG Oncology Statistics and Data Management Center, 1600 JFK Blvd, Suite 1020, Philadelphia, PA 1903, USA.
| | - Electra D Paskett
- The Ohio State University, 1590 N High Street, Suite 525, Columbus, OH 43210, USA.
| | - Leslie Ford
- National Cancer Institute, Division of Cancer Prevention, 9609 Medical Center Drive, Rockville, MD 20892-9785, USA.
| | - Worta McCaskill-Stevens
- National Cancer Institute, Division of Cancer Prevention, 9609 Medical Center Drive, Rockville, MD 20892-9785, USA.
| |
Collapse
|
25
|
Abstract
Over the last decade, there has been a dramatic surge in research exploring the human gut microbiome and its role in health and disease. It is now widely accepted that commensal microorganisms coexist within the human gastrointestinal tract and other organs, including those of the reproductive tract. These microorganisms, which are collectively known as the "microbiome", contribute to maintaining host physiology and to the development of pathology. Next generation sequencing and multi-'omics' technology has enriched our understanding of the complex and interdependent relationship that exists between the host and microbiome. Global changes in the microbiome are known to be influenced by dietary, genetic, lifestyle, and environmental factors. Accumulating data have shown that alterations in the gut microbiome contribute to the development, prognosis and treatment of many disease states including cancer primarily through interactions with the immune system. However, there are large gaps in knowledge regarding the association between the gut microbiome and gynecologic cancers, and research characterizing the reproductive tract microbiome is insufficient. Herein, we explore the mechanisms by which alterations in the gut and reproductive tract microbiome contribute to carcinogenesis focusing on obesity, hyperestrogenism, inflammation and altered tumor metabolism. The impact of the gut microbiome on response to anti-cancer therapy is highlighted with an emphasis on immune checkpoint inhibitor efficacy in gynecologic cancers. We discuss dietary interventions that are likely to modulate the metabolic and immunologic milieu as well as tumor microenvironment through the gut microbiome including intermittent fasting/ketogenic diet, high fiber diet, use of probiotics and the metabolic management of obesity. We conclude that enhanced understanding of the microbiome in gynecologic cancers coupled with thorough evaluation of metabolic and metagenomic analyses would enable us to integrate novel preventative strategies and adjunctive interventions into the care of women with gynecologic cancers.
Collapse
Affiliation(s)
- Mariam M AlHilli
- Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH, United States of America.
| | - Victoria Bae-Jump
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, United States of America
| |
Collapse
|
26
|
Ismaili N, Elmajjaoui S. COVID-19 and Gynecological Cancers: A Summary of International Recommendations. SN Compr Clin Med 2020;:1-8. [PMID: 32904733 DOI: 10.1007/s42399-020-00475-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 08/20/2020] [Indexed: 11/26/2022]
Abstract
Morocco and the rest of the world are experiencing a pandemic of a new coronavirus known as COVID-19 or SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). On August 24, 2020, the spread of the virus in Morocco had caused more than 52,000 cases and 880 deaths. Cancer patients are more susceptible to develop an infection than people without cancer because of their immunosuppression caused by the disease and treatments (surgery and chemotherapy). Therefore, these patients are at higher risk of infection with COVID-19 and a much higher risk of developing more serious forms. Given this epidemiological context, the establishment of guidelines for patients with gynecological cancers, requiring multidisciplinary management during the global COVID-19 pandemic, is crucial to limit their infection while maintaining their chances for a cure. In this paper, we summarize the international COVID-19 recommendations on the prioritization of surgical cases, the perioperative protective measures, the precautions to be taken in the brachytherapy unit, the COVID-19 screening, and finally the therapeutic indications of gynecological cancers by tumor location.
Collapse
|
27
|
Coppola M, Giurazza F, Corvino F, Pane F, Silvestre M, Niola R. Severe metrorrhagia in patients with advanced gynecologic cancer: endovascular treatment benefits in acute and chronic setting. Radiol Med 2020; 126:277-282. [PMID: 32661778 DOI: 10.1007/s11547-020-01251-6] [Citation(s) in RCA: 2] [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: 06/24/2019] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Interventional radiology plays an established role in the management of many conditions of the female reproductive tract. Since in benign gynecological and obstetric pathologies, as myomas and postpartum hemorrhages, uterine arteries embolization has been already evaluated, this manuscript aims to report on a single-center experience concerning the endovascular management of metrorrhagia caused by gynecological malignancies. MATERIALS AND METHODS Single-center retrospective analysis of thirty patients affected by gynecologic cancer treated with endovascular embolization between January 2016 and December 2018 for acute or chronic metrorrhagia. RESULTS All patients were in advanced oncological stage (III or IV) with loco-regional spread of the tumor or invasion of pelvic structures, with a poor performance status. They were not suitable for surgery. On initial CT angiography, contrast media extravasation was confirmed in two patients (6.6%), while on DSA examination, tumor stain was displayed in 28 patients (93.4%). In two patients (6.6%) a pseudoaneurysm was reported. CONCLUSIONS Endovascular treatment of metrorrhagia in oncologic patients could be a valid therapeutic alternative, especially when in elderly patients with poor clinical conditions not suitable for surgery. A bilateral and superselective embolization using non-resorbable embolic agents should be performed, except for those cases in which there is infiltration of major vessels causing pseudoaneurysms or fistulas that require embolization.
Collapse
Affiliation(s)
- Milena Coppola
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
| | - Francesco Giurazza
- Department of Vascular and Interventional Radiology, Cardarelli Hospital, Naples, Italy
| | - Fabio Corvino
- Department of Vascular and Interventional Radiology, Cardarelli Hospital, Naples, Italy
| | - Francesco Pane
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Mattia Silvestre
- Department of Vascular and Interventional Radiology, Cardarelli Hospital, Naples, Italy
| | - Raffaella Niola
- Department of Vascular and Interventional Radiology, Cardarelli Hospital, Naples, Italy
| |
Collapse
|
28
|
Kurnit KC, Reid P, Moroney JW, Fleming GF. Immune checkpoint inhibitors in women with gynecologic cancers: Practical considerations. Gynecol Oncol 2020; 158:531-537. [PMID: 32641238 DOI: 10.1016/j.ygyno.2020.06.499] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 03/08/2020] [Accepted: 06/21/2020] [Indexed: 12/17/2022]
Abstract
Immune checkpoint inhibitors are an exciting new class of cancer therapeutics. Recently, a PD-1 inhibitor has been approved by the Food and Drug Administration for several indications that are relevant to patients with gynecologic malignancies. In this review, we explore the clinical considerations for the use of checkpoint inhibitor therapy in this population. Specifically, we will discuss the approved indications, recommended dosing, clinical monitoring while on treatment, common adverse events, and treatment of adverse events should they arise. Additionally, we will review mechanisms of resistance and other challenges associated with the use of checkpoint inhibitors. We will conclude with a discussion of possible future directions for immunotherapy in women with gynecologic cancers.
Collapse
Affiliation(s)
- Katherine C Kurnit
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, The University of Chicago, Chicago, IL, United States.
| | - Pankti Reid
- Department of Medicine, Section of Rheumatology, The University of Chicago, Chicago, IL, United States
| | - John W Moroney
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, The University of Chicago, Chicago, IL, United States
| | - Gini F Fleming
- Department of Medicine, Section of Hematology-Oncology, The University of Chicago, Chicago, IL, United States
| |
Collapse
|
29
|
Adjei Boakye E, Grubb L, Peterson CE, Osazuwa-Peters N, Grabosch S, Ladage HD, Huh WK. Risk of second primary cancers among survivors of gynecological cancers. Gynecol Oncol 2020; 158:719-26. [PMID: 32616403 DOI: 10.1016/j.ygyno.2020.06.492] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/11/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Survivors of gynecologic cancers have an increased risk of developing second primary cancers (SPC); however it is unclear which sites have higher risks. We aimed to ascertain risk of SPC among survivors of gynecological cancer, and identify anatomic sites at risk of SPC. METHODS We queried the Surveillance, Epidemiology and End Results database (2000-2016) for confirmed cases of index gynecological (cervix uteri [cervical], corpus and uterus [endometrial], ovarian, vaginal, and vulvar) cancers. Risk of SPC was estimated using standardized incidence ratios (SIRs: observed/expected cases) and excess absolute risks (EARs: observed - expected cases) per 10,000 person-years at risk (PYR). SIRs and EARs were stratified by index anatomic site and latency interval. RESULTS Among the cohort of 301,210 gynecological cancer survivors, 19,005 (6.31%) developed an SPC (SIR = 1.16; 95% CI, 1.15-1.18 and EAR = 17.2 cases per 10,000 PYR) compared with the general population. All gynecological cancer survivors (except survivors of ovarian) had a significant risk of developing SPC (SIR range 1.06-2.16), with survivors of vulvar cancer having the highest risk (SIR = 2.16; 95% CI, 2.06-2.27; EAR = 139.5 per 10,000 PYR). Risk of SPC was highest within the first 5 years post-diagnosis for survivors of cervical, vulvar and vaginal cancers. CONCLUSIONS While most index gynecological cancer sites are associated with increased risk of SPC, risk is highest among survivors of vulvar cancer. These findings have the potential to inform lifelong surveillance recommendations for gynecological cancer survivors.
Collapse
|
30
|
Gardner AB, Charo LM, Mann AK, Kapp DS, Eskander RN, Chan JK. Ovarian, uterine, and cervical cancer patients with distant metastases at diagnosis: most common locations and outcomes. Clin Exp Metastasis 2020; 37:107-13. [PMID: 31758289 DOI: 10.1007/s10585-019-10007-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/11/2019] [Indexed: 12/11/2022]
Abstract
To determine the location patterns of distant metastases at initial staging and outcomes of ovarian, uterine, and cervical cancer patients. Data were obtained from the SEER database from 2010 to 2015. Analyses were performed using Kaplan-Meier and multivariate Cox proportional hazard methods. Of 3035 patients (median age: 63, range: 17-95) with stage IV gynecologic cancer, ovarian, uterine, and cervical cancers were present in 42%, 40%, and 18% of the cohort. The proportion of lung, liver, bone and brain metastases were identified in 38%, 57%, 4%, and 1% of ovarian cancer patients, 62%, 22%, 13%, and 3% of uterine cancer patients, and 59%, 16%, 23%, and 2% of cervical cancer patients, respectively. The 5-year disease-specific survival for all patients was 19%. Those with liver metastases had survival rates of 26% compared to 15% for lung, 13% for bone, and 6% for brain (p < 0.0001). Patients with ovarian, uterine, and cervical cancers had survival rates of 28%, 12%, and 12%, respectively (p < 0.0001). On multivariate analysis, brain metastasis (HR = 1.64, 95% CI 1.21-2.22, p < 0.01), uterine (HR = 1.77, 95 CI 1.56-2.02, p < 0.0001) and cervical (HR = 1.35, 95% CI 1.11-1.63, p < 0.01) cancers, and lack of insurance (HR = 1.41, 95% CI 1.16-1.73, p < 0.001) were independent predictors for poorer survival. Age, year, region, and race did not affect prognosis. Stage IV ovarian cancer most frequently metastasizes to the liver, whereas uterine and cervical cancers spread more to the lung. Overall, these patients have poor prognosis, particularly those with uterine or cervical primary disease or brain metastases.
Collapse
|
31
|
Abstract
OPINION STATEMENT Research into novel therapies for gynecologic cancers is underfunded, and as a result, we are still playing catchup with other solid tumors in the realm of immune checkpoint inhibition. This is despite the fact that two of the most common gynecologic cancers in the USA have strong biologic rationales for response to these agents. Work is now underway to demonstrate safe and effective therapies for our patients. As we better understand the immune system, and more specifically the tumor microenvironment, we will be able to achieve complete responses. The immune system can learn, adapt, and provide ongoing surveillance; if only we could mimic its abilities.
Collapse
Affiliation(s)
- J Stuart Ferriss
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Phipps 281, Baltimore, MD, 21287, USA.
| | - M Yvette Williams-Brown
- Departments of Women's Health and Oncology, The University of Texas at Austin Dell Medical School, 1301 W 38th St, Suite 705, Austin, TX, 78705, USA
| |
Collapse
|
32
|
Martin A, Stewart JR, Gaskins J, Medlin E. A Systematic Assessment of Google Search Queries and Readability of Online Gynecologic Oncology Patient Education Materials. J Cancer Educ 2019; 34:435-440. [PMID: 29353371 DOI: 10.1007/s13187-017-1319-z] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The Internet is a major source of health information for gynecologic cancer patients. In this study, we systematically explore common Google search terms related to gynecologic cancer and calculate readability of top resulting websites. We used Google AdWords Keyword Planner to generate a list of commonly searched keywords related to gynecologic oncology, which were sorted into five groups (cervical cancer, ovarian cancer, uterine cancer, vulvar cancer, vaginal cancer) using five patient education websites from sgo.org . Each keyword was Google searched to create a list of top websites. The Python programming language (version 3.5.1) was used to describe frequencies of keywords, top-level domains (TLDs), domains, and readability of top websites using four validated formulae. Of the estimated 1,846,950 monthly searches resulting in 62,227 websites, the most common was cancer.org . The most common TLD was *.com. Most websites were above the eighth-grade reading level recommended by the American Medical Association (AMA) and the National Institute of Health (NIH). The SMOG Index was the most reliable formula. The mean grade level readability for all sites using SMOG was 9.4 ± 2.3, with 23.9% of sites falling at or below the eighth-grade reading level. The first ten results for each Google keyword were easiest to read with results beyond the first page of Google being consistently more difficult. Keywords related to gynecologic malignancies are Google-searched frequently. Most websites are difficult to read without a high school education. This knowledge may help gynecologic oncology providers adequately meet the needs of their patients.
Collapse
Affiliation(s)
- Alexandra Martin
- Department of Obstetrics, Gynecology and Women's Health, University of Louisville School of Medicine, 529 South Jackson Street, Louisville, KY, 40202, USA.
| | - J Ryan Stewart
- Department of Obstetrics, Gynecology and Women's Health, University of Louisville School of Medicine, 529 South Jackson Street, Louisville, KY, 40202, USA
| | - Jeremy Gaskins
- Department of Bioinformatics and Biostatistics, University of Louisville School of Public Health and Information Sciences, Louisville, KY, USA
| | - Erin Medlin
- Department of Obstetrics, Gynecology and Women's Health, University of Louisville School of Medicine, 529 South Jackson Street, Louisville, KY, 40202, USA
| |
Collapse
|
33
|
Marangoz Ç, Demir A, Yazgan EÖ. Adaptation of the Sexuality Scale for Women with Gynecologic Cancer for Turkish Patients. Asia Pac J Oncol Nurs 2019; 6:177-186. [PMID: 30931363 PMCID: PMC6371671 DOI: 10.4103/apjon.apjon_49_18] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: Diagnosis and treatment of gynecologic cancers can have a negative impact on sexuality. Identification of sexual problems and concerns is key to enable appropriate management. Therefore, there is a need for a valid and reliable instrument for evaluating the sexuality of patients. This study aimed to adapt the sexuality scale for women with gynecologic cancer for Turkish patients with gynecologic cancer. Methods: A cross-sectional study of 150 volunteer patients with gynecologic cancer was undertaken in Turkey. The patients completed a semi-structured demographic data form and the sexuality scale for women with gynecologic cancer. We assessed the reliability, language accuracy, and content and construct validities of the Turkish version of the scale. Results: Exploratory and confirmatory factor analyses showed that the scale had four factors. In the exploratory factor analysis, seven items were discarded from the scale because their load values were <0.3. In the confirmatory factor analysis, the coefficients were higher than 0.3. The total Cronbach's α was 0.72. Conclusions: The sexuality scale for women with gynecologic cancer (Turkish version) is a valid and reliable instrument for evaluating the sexuality of Turkish patients with gynecologic cancer.
Collapse
Affiliation(s)
- Çigdem Marangoz
- Department of Rheumatology, Ibni Sina Hospital, Ankara University School of Medicine, Ankara, Turkey
| | - Ayten Demir
- Department of Nursing, Faculty of Nursing, Ankara University, Ankara, Turkey
| | - Eda Özge Yazgan
- Department of Nursing, Faculty of Nursing, Ankara University, Ankara, Turkey
| |
Collapse
|
34
|
Sbarra M, Miccò M, Corvino M, Persiani S, Gui B, Di Paola V, Manfredi R. CT findings after pelvic exenteration: review of normal appearances and most common complications. Radiol Med 2019; 124:693-703. [PMID: 30806919 DOI: 10.1007/s11547-019-01009-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
Abstract
The aim of this review is to illustrate normal computed tomography (CT) findings and the most common complications in patients who underwent pelvic exenteration (PE) for advanced, persistent or recurrent gynecological cancers. We review the various surgical techniques used in PE, discuss optimal CT protocols for postsurgical evaluation and describe cross-sectional imaging appearances of normal postoperative anatomic changes as well as early and late complications. The interpretation of abdominopelvic CT imaging after PE is very challenging due to remarkable modifications of normal anatomy. After this radical pelvic surgery, the familiarity with expected CT appearances is crucial for diagnosis and appropriate management of potentially life-threatening complications in patients who underwent PE.
Collapse
|
35
|
Varga A, Piha-Paul S, Ott PA, Mehnert JM, Berton-Rigaud D, Morosky A, Yang P, Ruman J, Matei D. Pembrolizumab in patients with programmed death ligand 1-positive advanced ovarian cancer: Analysis of KEYNOTE-028. Gynecol Oncol 2018; 152:243-250. [PMID: 30522700 DOI: 10.1016/j.ygyno.2018.11.017] [Citation(s) in RCA: 165] [Impact Index Per Article: 27.5] [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: 08/03/2018] [Revised: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate safety, tolerability, and antitumor activity of pembrolizumab monotherapy in patients with programmed death ligand 1 (PD-L1)-expressing advanced ovarian cancer enrolled in the multicohort, phase Ib KEYNOTE-028 trial. METHODS Key inclusion criteria were age ≥18 years; advanced ovarian epithelial, fallopian tube, or primary peritoneal carcinoma; failure of previous therapy; and tumor PD-L1 positivity. Patients received pembrolizumab (10 mg/kg every 2 weeks) for ≤24 months or until disease progression/intolerable toxicity. Tumor response was assessed per RECIST v1.1 (investigator review). Adverse events (AEs) were graded using CTCAE version 4.0. Primary end point was confirmed objective response rate (ORR) per RECIST v1.1 (investigator review); data cutoff date was February 20, 2017. RESULTS Twenty-six patients (median age, 57.5 years) with PD-L1-positive advanced metastatic ovarian cancer received pembrolizumab; 38.5% had metastatic disease, and 73.1% previously received ≥3 lines of therapy. Treatment-related AEs (TRAEs) occurred in 19 (73.1%) patients, most commonly arthralgia (19.2%), nausea (15.4%), and pruritus (15.4%). One grade 3 TRAE (increased plasma transaminase level) occurred. No deaths and no treatment discontinuations due to TRAEs occurred. After a median follow-up duration of 15.4 months, ORR was 11.5% (1 complete response, 2 partial responses); 7 patients (26.9%) achieved stable disease. Median progression-free and overall survival were 1.9 (95% CI, 1.8-3.5) and 13.8 (95% CI, 6.7-18.8) months, respectively. CONCLUSION Pembrolizumab conferred durable antitumor activity with manageable safety and toxicity in patients with advanced PD-L1-positive ovarian cancer and is under further investigation in an ongoing phase II trial, KEYNOTE-100.
Collapse
Affiliation(s)
- Andrea Varga
- Department of Drug Development, Gustave Roussy Cancer Campus, Villejuif, France.
| | - Sarina Piha-Paul
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Patrick A Ott
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Janice M Mehnert
- Developmental Therapeutics/Phase I Program, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Anne Morosky
- Department of Oncology, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Ping Yang
- Biostatistics and Research Decision Sciences, MSD China, Beijing, China
| | - Jane Ruman
- Department of Oncology, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Daniela Matei
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
36
|
McKenzie ND, Kennard JA, Ahmad S. Fertility preserving options for gynecologic malignancies: A review of current understanding and future directions. Crit Rev Oncol Hematol 2018; 132:116-124. [PMID: 30447916 DOI: 10.1016/j.critrevonc.2018.09.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 08/02/2018] [Accepted: 09/29/2018] [Indexed: 02/08/2023] Open
Abstract
Gynecological malignancies affect significant proportion of women in whom fertility preservation is a priority. Advancing reproductive technology and modern surgical techniques are changing the way young women with cancer are counseled regarding their fertility plans at time of cancer diagnosis. This review article provides the reader with fertility preserving updates in gynecologic malignancies as well as those with genetic predisposition for gynecologic malignancies. The different types of gynecologic malignancies including cervical, endometrial, and ovarian cancers and their unique obstacles are addressed separately. New insights into conservative cervical cancer surgery and fertility preserving neoadjuvant chemotherapy followed by fertility preserving surgery for cervical cancer are discussed. Hormonal management of endometrial cancer are highlighted. Additionally, better understanding of ovarian failure with modern chemotherapy/radiation therapy is summarized. Finally, modern reproductive techniques such as ovarian cryopreservation are reviewed as well as those in early stages are development such as artificial ovarian tissue are previewed.
Collapse
Affiliation(s)
- Nathalie D McKenzie
- Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute, Orlando, FL, 32804, USA.
| | - Jessica A Kennard
- Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute, Orlando, FL, 32804, USA
| | - Sarfraz Ahmad
- Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute, Orlando, FL, 32804, USA.
| |
Collapse
|
37
|
Knight S, Lambaudie E, Sabiani L, Mokart D, Provansal M, Tallet A, Houvenaeghel G. Pelvic exenterations for gynecologic cancers: A retrospective analysis of a 30-year experience in a cancer center. Eur J Surg Oncol 2018; 44:1929-34. [PMID: 30262326 DOI: 10.1016/j.ejso.2018.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 08/23/2018] [Accepted: 08/24/2018] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The objective of this study was to report a 30-year experience of PE for gynecologic malignancies in a cancer center. MATERIALS AND METHODS A retrospective study was conducted at Institut Paoli-Calmette including patients who underwent PE for gynecologic malignancies. Four periods were evaluated: P1 before 1992, P2 between 1993 and 1999, P3 between 2000 and 2006 and P4 after 2006. The study evaluated the number of PE performed during each period, the type of PE, its level, indication, location of the primary tumor, patient age, previous radiotherapy ≥45 Gy, the rate of "curative" PE and exenteration-related reconstructive techniques. 90-day post-operative mortality and morbidity using the National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI-CTCAE) v 4.03 were reported. RESULTS 277 PE were performed. The number of PE performed for recurrences rose during the study period (p = 0.042), PE performed for central tumors increased during P3 (64.4%) and P4 (67.4%) (p < 0.0001) and administration of radiotherapy ≥45 Gy was more frequent (p < 0.0001). The rate of "curative" PE increased (p < 0.0001). In multivariate analysis, "curative" PE were correlated with PE type, central locations and study period. Pelvic filling was progressively more frequently performed (p = 0.002). 90-day complication rate was 56.3%. In multivariate analysis there was a significant difference in distribution of CTCAE grade 3-4-5 morbidity depending on the period. Overall survival (OS) improved during the 2 last periods (p = 0.008). CONCLUSION A better selection of eligible patients for PE, namely through improvement in imaging techniques, has enabled to raise the rate of curative PE.
Collapse
|
38
|
Moroney MR, Flink D, Sheeder J, Blake EA, Carrubba AR, Fisher CM, Guntupalli SR. Radiation therapy is not an independent risk factor for decreased sexual function in women with gynecologic cancers. Rep Pract Oncol Radiother 2018; 23:331-336. [PMID: 30127672 DOI: 10.1016/j.rpor.2018.07.007] [Citation(s) in RCA: 6] [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: 10/03/2017] [Revised: 04/07/2018] [Accepted: 07/22/2018] [Indexed: 01/02/2023] Open
Abstract
Aim To evaluate the associations of external beam radiation therapy (EBRT) and intracavitary brachytherapy (IB) with decreased sexual function. Background There's inconsistent evidence on whether radiation for gynecologic cancers has an impact on sexual health. IB, an underutilized treatment modality, is thought to have less adverse effects than EBRT. Materials and methods A cross-sectional study examining decreased sexual function following radiation for gynecologic cancers. A decrease in sexual function was measured as a change in the Female Sexual Function Index (FSFI) from before to after treatment, with a significant decrease determined by Reliable Change Index Statistic (RCIS). Chi-square and t-tests were employed. Results 171 women completed the survey; 35% (n = 60) received radiation, of whom 29 received EBRT and IB (48%), 15 EBRT alone (25%), 16 IB alone (27%). Women who received radiation had similar rates of decreased sexual function as women who did not (47% vs. 38%, P = 0.262). EBRT and IB had similar rates of decreased sexual function compared to women with no radiation (50% vs. 38% P = 0.166 and 47% vs. 38% P = 0.309). Women experiencing decreased sexual function were more likely to be under 50 years old (OR 5.4, 95%CI 1.6-18.1), have received chemotherapy (OR 5.7, 95%CI 1.4-22.9), and have cervical cancer (OR 7.8, 95%CI 2.1-28.8). Conclusions Treatment with EBRT or IB does not appear to impair sexual function in women with gynecologic cancer. Age less than 50, concurrent chemotherapy, and cervical cancer may place women with gynecologic cancer at higher risk for decreased sexual function following radiation.
Collapse
Affiliation(s)
- Marisa R Moroney
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA
| | - Dina Flink
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA
| | - Jeanelle Sheeder
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA
| | - Erin A Blake
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA
| | - Aakriti R Carrubba
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA
| | - Christine M Fisher
- Department of Radiation Oncology, University of Colorado Denver, Aurora, CO, USA
| | - Saketh R Guntupalli
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA
| |
Collapse
|
39
|
Raoufi J, İşcan SC, Hanedan C, Özkan EE, Çerçi SS, Erdemoğlu E, Erdemoğlu E. Incidence of suspicious axillary lymph node involvement in fluorine-18 fluoro-D-glucose positron emission tomography/computed tomography in gynecologic cancers. Turk J Obstet Gynecol 2018; 15:99-104. [PMID: 29971187 PMCID: PMC6022426 DOI: 10.4274/tjod.12144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/26/2018] [Indexed: 12/01/2022] Open
Abstract
Objective: There is scarce information about axillary lymph node involvement in gynecologic cancers. We analyzed the incidence of suspicious axillary lymph nodes in gynecologic cancers. Materials and Methods: We retrospectively analyzed the positron emission tomography/computed tomography findings of 251 patients with endometrial, cervical, and ovarian cancer. There is no cut-off value documented for axillary metastases from gynecologic cancers; therefore we adopted the cut-off standardized uptake values (SUVs) proclaimed in breast cancer. Results: A total of 251 patients records were available for analysis; 40 patients (15.9%) with suspicious axillary lymph nodes were included in the study. Twenty-one and a half percent (n=20/93) of patients with endometrium cancer, 14.1% (n=14/99) of patients with ovarian cancer, and 10% (n=6/59) of those with cervical cancer had suspicious axillary lymph nodes. Patients with an maximum SUV (SUVmax) uptake higher than 3 underwent axillary lymph node biopsy. None of them was found to have axillary metastases of gynecologic cancers in the pathologic evaluation. In one patient with endometrial cancer, an obscure breast ductal carcinoma was diagnosed, another patient with endometrial cancer was found to have follicular lymphoma. The third patient with endometrial cancer had no malignancy in axillary lymph node biopsy, but had Hurthle cell neoplasia in a thyroid biopsy; the patient did not accept any surgical or medical treatment for endometrial cancer and died 23 months later. There were three (7.5%) metachronous cancers out of 40 gynecologic cancers; two patients were explained above, the third patient with endometrium cancer, who was not histopathologically evaluated although the axillary SUVmax was <3, had rectosigmoid cancer and glioblastoma metachronously. Conclusion: Our study shows that an important ratio (14-21%) of patients with gynecologic cancer has suspicious axillary lymph nodes. Increased SUVmax, particularly above 3, might be used as an indication for axillary biopsy and may help to identify secondary metastatic cancer.
Collapse
Affiliation(s)
- Jalal Raoufi
- Süleyman Demirel University Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Isparta, Turkey
| | - Serhan Can İşcan
- Süleyman Demirel University Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Isparta, Turkey
| | - Candost Hanedan
- Süleyman Demirel University Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Isparta, Turkey
| | - Emine Elif Özkan
- Süleyman Demirel University Faculty of Medicine, Department of Radiation Oncology, Isparta, Turkey
| | - Sevim Süreyya Çerçi
- Süleyman Demirel University Faculty of Medicine, Department of Nuclear Medicine, Isparta, Turkey
| | - Ebru Erdemoğlu
- Isparta Maternity and Children's Diseases Hospital, Clinic of Obstetrics and Gynecology, Isparta, Turkey
| | - Evrim Erdemoğlu
- Süleyman Demirel University Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Isparta, Turkey
| |
Collapse
|
40
|
Ahmed A, Deng W, Tew W, Bender D, Mannel RS, Littell RD, DeNittis AS, Edelson M, Morgan M, Carlson J, Darus CJ, Fleury AC, Modesitt S, Olawaiye A, Evans A, Fleming GF. Pre-operative assessment and post-operative outcomes of elderly women with gynecologic cancers, primary analysis of NRG CC-002: An NRG oncology group/gynecologic oncology group study. Gynecol Oncol 2018; 150:300-305. [PMID: 29807694 DOI: 10.1016/j.ygyno.2018.05.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/11/2018] [Accepted: 05/14/2018] [Indexed: 11/13/2022]
Abstract
INTRODUCTION CC-002 is a prospective cooperative group study conducted by NRG Oncology to evaluate whether a pre-operative GA-GYN score derived from a predictive model utilizing components of an abbreviated geriatric assessment (GA) is associated with major post-operative complications in elderly women with suspected ovarian, fallopian tube, primary peritoneal or advanced stage papillary serous uterine (GYN) carcinoma undergoing primary open cytoreductive surgery. METHODS Patients 70 years or older with suspected advanced gynecologic cancers undergoing evaluation for surgery were eligible. A GA-GYN score was derived from a model utilizing the GA as a pre-operative tool. Patients were followed for six weeks post-operatively or until start of chemotherapy. Post-operative events were recorded either directly as binary occurrence (yes or no) using CTCAE version 4.0. RESULTS There were 189 eligible patients, 117 patients with primary surgical intervention and 37 patients undergoing interval cytoreduction surgery. The association between higher GA-GYN score and major postoperative complications in patients undergoing primary surgery was not significant (p = 0.1341). In a subgroup analysis of patients with advanced staged malignant disease who underwent primary cytoreductive surgery, there was a trend towards an association with the GA-GYN score and post-operative complications. CONCLUSION The pre-operative GA-GYN score derived from a predictive model utilizing components of an abbreviated geriatric assessment was not predictive of major post-operative complications in elderly patients undergoing primary open cytoreductive surgery. However, there was an association between GA-GYN score and post-operative complications in a subgroup of patients with advanced staged malignant disease.
Collapse
Affiliation(s)
- Amina Ahmed
- Department of OB/GYN, Division of Gyn Oncology, Rush University Medical Center, Chicago, IL 60612, United States.
| | - Wei Deng
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY 4263, United States.
| | - William Tew
- Department of Internal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, United States.
| | - David Bender
- Gyn/Onc Division, University of Iowa, Iowa City, IA 52242, United States.
| | - Robert S Mannel
- Department of OB/GYN, University of Oklahoma, Oklahoma City, OK 73190, United States.
| | - Ramey D Littell
- Kaiser Permanente Northern California Gynecologic Cancer Program, San Francisco, CA 94115, United States.
| | - Albert S DeNittis
- Department of Radiation Oncology, Main Line Hospital, Wynnewood, PA 19096, United States.
| | - Mitchell Edelson
- Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA 19001, United States.
| | - Mark Morgan
- Department of OB/GYN, University of Pennsylvania Hospital System, Philadelphia, PA 19104, United States.
| | - Jay Carlson
- Cancer Research for the Ozarks, Springfield, MO 65804, United States.
| | - Christopher J Darus
- Division of Gynecologic Oncology, Maine Medical Center, Scarborough, ME 04074, United States.
| | - Aimee C Fleury
- Department of Gynecologic Oncology, Women's Cancer Center of Nevada, Las Vegas, NV 89169, United States.
| | - Susan Modesitt
- Department of OB/GYN, University of Virginia, Charlottesville, VA 22908, United States.
| | - Alexander Olawaiye
- Department of Obstetrics & Gynecology, University of Pittsburgh Cancer Institute, Pittsburgh, PA 15213, United States.
| | - Anthony Evans
- Marshfield Clinic, OB-GYN Dept, Marshfield, WI 54449, United States.
| | - Gini F Fleming
- Section of Medical Oncology, University of Chicago, Chicago, IL 60637, United States.
| |
Collapse
|
41
|
Shaw J, Bulsara C, Cohen PA, Gryta M, Nichols CB, Schofield L, O'Sullivan S, Pachter N, Hardcastle SJ. Investigating barriers to genetic counseling and germline mutation testing in women with suspected hereditary breast and ovarian cancer syndrome and Lynch syndrome. Patient Educ Couns 2018; 101:938-944. [PMID: 29273311 DOI: 10.1016/j.pec.2017.12.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 12/01/2017] [Accepted: 12/11/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The aim of the current study was to explore barriers to genetic counseling and testing in women with gynecological cancers deemed at significant risk of carrying a germline mutation. METHODS A qualitative study using semi-structured interviews and inductively analysed thematically. Eight patients with ovarian or endometrial cancer participated in individual semi-structured telephone interviews that assessed motivation for genetic counseling and testing, perceived benefits and barriers, timing of the approach, perceptions of the referral process to genetic services and locus of control in relation to cancer and health. RESULTS Analysis of the interview transcripts revealed five themes relating to perceptions of genetic counseling and testing: Lack of importance; Level of information received; Timing of referral processes; Fear and anxiety; Resistance to and perceptions of counseling. CONCLUSIONS Participants had a limited understanding of hereditary cancer syndromes and did not appreciate the benefits of genetic testing. A consistent approach at the time of referral to genetic services is needed to ensure that the level and format of information is appropriate for patients. PRACTICE IMPLICATIONS The rationale for genetic testing needs to be better explained to patients and the timing of referral should be based both on treatment priorities and patient preferences.
Collapse
Affiliation(s)
- Josephine Shaw
- St. John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Caroline Bulsara
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Paul A Cohen
- St. John of God Subiaco Hospital, Subiaco, Western Australia, Australia; Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia; Division of Women's and Infants' Health, School of Medicine, University of Western Australia, Crawley, Western Australia, Australia.
| | - Madeleine Gryta
- School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Cassandra B Nichols
- Genetic Services of Western Australia, Subiaco, Western Australia, Australia; Inherited Cancer Connect Partnership (ICCon)
| | - Lyn Schofield
- Genetic Services of Western Australia, Subiaco, Western Australia, Australia
| | - Sarah O'Sullivan
- Genetic Services of Western Australia, Subiaco, Western Australia, Australia; WOMEN Centre, West Leederville, Western Australia, Australia
| | - Nicholas Pachter
- Genetic Services of Western Australia, Subiaco, Western Australia, Australia; School of Paediatrics and Child Health, University of Western Australia, Australia; School of Medicine and Pharmacology, University of Western Australia, Australia
| | - Sarah J Hardcastle
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| |
Collapse
|
42
|
Krishnan V, Schaar B, Tallapragada S, Dorigo O. Tumor associated macrophages in gynecologic cancers. Gynecol Oncol 2018; 149:205-13. [PMID: 29395307 DOI: 10.1016/j.ygyno.2018.01.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 01/11/2018] [Accepted: 01/14/2018] [Indexed: 12/14/2022]
Abstract
The complex tumor microenvironment in gynecologic cancers plays a major role in modulating anti-tumor immune responses. The interaction of cancer cells with the diverse spectrum of immune effector cells has an important impact on the efficacy of standard chemotherapy and novel immunotherapy approaches. In this review, we specifically focus on the role of macrophages in ovarian, endometrial and cervical cancers. We discuss the origins of macrophages and their polarization state dictated by the microenvironment's cues. Within the tumor niche, tumor-associated macrophages (TAMs) promote tumor growth and mediate immune-suppression thereby effecting treatment responses. We outline clinical strategies that directly target TAMs, including inhibition of macrophage differentiation, prevention of the recruitment of monocytes to the tumor, enhancement of phagocytosis and immune checkpoint blockade.
Collapse
|
43
|
Annunziata CM, Kohn EC. Clinical trials in gynecologic oncology: Past, present, and future. Gynecol Oncol 2017; 148:393-402. [PMID: 29212614 DOI: 10.1016/j.ygyno.2017.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 10/13/2017] [Revised: 11/17/2017] [Accepted: 11/20/2017] [Indexed: 12/18/2022]
Abstract
The Gynecologic Oncology Group has historically performed ground-breaking, practice-changing clinical trials in women's cancers. The current standard of care for initial treatment of ovarian, endometrial, cervical, and trophoblastic cancers was determined by clinical trials completed within this cooperative group structure. For example, trial GOG-0111 set the standard for combining platinum and taxane chemotherapy in ovarian cancer, and more recently GOG-0240 provided evidence for adding bevacizumab to chemotherapy for women with advanced cervical cancer. The landscape of clinical trial design has markedly changed in recent decades, with a clear emphasis on streamlining drug development towards specific patient populations and indications for investigational agents. Translational science in gynecologic cancers can set the stage for rapid and efficient introduction of new therapies for our patients. The gynecologic oncology community of researchers and clinicians is well positioned to enter into the new era of drug development, with breakthrough discoveries increasing each year. It is clear that we must incorporate smarter clinical trial design to get the right drugs to the right patients expeditiously, so we can continue to improve outcome for women with gynecologic cancers.
Collapse
Affiliation(s)
- Christina M Annunziata
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States.
| | - Elise C Kohn
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| |
Collapse
|
44
|
Demirel MA, Süntar İ. The Role of Secondary Metabolites on Gynecologic Cancer Therapy: Some Pathways and Mechanisms. Turk J Pharm Sci 2017; 14:324-334. [PMID: 32454632 DOI: 10.4274/tjps.49368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/15/2016] [Accepted: 07/19/2017] [Indexed: 12/27/2022]
Abstract
Gynecologic cancers are among the most common cancers in humans and animals. Treatment success depends on several factors including stage at diagnosis, tumor type, origin and metastasis. Currently, surgery, chemotherapy, and radiotherapy are preferred in the treatment of these cancers. However, many anticarcinogenic drugs can cause severe adverse effects and also the expected response to treatment may not be obtained. In recent studies, the importance of the relationship between cancer and inflammation has been emphasized. Therefore, several phytochemicals that exhibit beneficial bioactive effects towards inflammatory pathways were proven to have anticarcinogenic potential for gynecologic cancer therapy. This review summarizes the role of inflammatory pathways in gynecologic cancers and effective secondary metabolites for cancer therapy.
Collapse
Affiliation(s)
- Mürşide Ayşe Demirel
- Gazi University, Faculty of Pharmacy, Laboratory Animals Breeding and Experimental Research Center, Ankara, Turkey
| | - İpek Süntar
- Gazi University, Faculty of Pharmacy, Department of Pharmacognosy, Ankara, Turkey
| |
Collapse
|
45
|
Damato AL, Kassick M, Viswanathan AN. Rectum and bladder spacing in cervical cancer brachytherapy using a novel injectable hydrogel compound. Brachytherapy 2017; 16:949-955. [PMID: 28619385 DOI: 10.1016/j.brachy.2017.04.236] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 12/13/2016] [Revised: 03/19/2017] [Accepted: 04/13/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to evaluate injection of a novel hydrogel (TraceIT; Augmenix, Waltham, MA) between the cervix, rectum, and bladder in female cadavers compared with, and in addition to, the current standard of gauze packing, for organ-at-risk sparing in cervical cancer brachytherapy planning. METHODS AND MATERIALS This brachytherapy cadaver study used T2-weighted MRI and CT imaging to compare three scenarios: (1) gauze packing alone, (2) hydrogel injection placed in the cervical fornices and rectovaginal septum, and (3) gauze packing in conjunction with hydrogel injection. Hydrogel distribution was evaluated. Doses to 2 cm3 volumes (D2cc) for the rectum, bladder, and sigmoid were collected. Statistical significance (p < 0.05) was evaluated using a two-tailed paired t test. RESULTS Hydrogel was successfully injected to space the bladder and rectum from the cervix in all five cadavers. The spacer was easily identifiable on both CT and MRI. The use of hydrogel in addition to packing resulted in a 22% decrease in rectum D2cc dose (p = 0.02), a 10% decrease in bladder D2cc (p = 0.27), and no change in sigmoid D2cc dose. No difference was observed between hydrogel only vs. gauze packing only. CONCLUSIONS Our results revealed a significant clinically meaningful decrease in rectal D2cc associated with the use of hydrogel in addition to gauze packing-TraceIT hydrogel holds promise as a spacer in cervical cancer therapy.
Collapse
Affiliation(s)
- Antonio L Damato
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Akila N Viswanathan
- Department of Radiation Oncology and Molecular Radiation Science, Johns Hopkins Medicine, Baltimore, MD.
| |
Collapse
|
46
|
Zanagnolo V, Garbi A, Achilarre MT, Minig L. Robot-assisted Surgery in Gynecologic Cancers. J Minim Invasive Gynecol 2017; 24:379-396. [PMID: 28104497 DOI: 10.1016/j.jmig.2017.01.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 11/29/2016] [Revised: 01/09/2017] [Accepted: 01/09/2017] [Indexed: 11/30/2022]
Abstract
Robotic-assisted surgery is a technological advancement that facilitates the application of minimally invasive techniques for complex operations in gynecologic oncology. The objective of this article was to review the literature regarding the role of robotic-assisted surgery to treat women with gynecologic cancers. The majority of publications on robotic surgery are still retrospective or descriptive in nature; however, the data for managing patients with a robotic-assisted approach show comparable, and at times improved, outcomes compared with both laparoscopy (2-dimensional) and laparotomy approaches. Robotic-assisted surgery has been used for patients with endometrial cancer and resulted in the increased use of minimally invasive surgery with improved outcomes compared with laparotomy and partially with laparoscopy. This has been shown in large cohorts of patients as well as in obese patients in whom the complication rates have significantly decreased. For early cervical cancer, robotic radical hysterectomy seems to be safe and feasible and to be preferable to laparotomy with seemingly comparable oncologic outcomes. Robotic-assisted surgery and conventional laparoscopy to stage women with early-stage ovarian cancer seem to have similar surgical and oncologic outcomes, with a shorter learning curve for robotic-assisted surgery. However, robotic-assisted surgery appears to be more expensive than laparotomy and traditional laparoscopy. In conclusion, robotic-assisted surgery appears to facilitate the surgical approach for complex operations to treat women with gynecologic cancers. Although randomized controlled trials are lacking to further elucidate the equivalence of robot-assisted surgery with conventional methods in terms of oncologic outcome and patients' quality of life, the technology appears to be safe and effective and could offer a minimally invasive approach to a much larger group of patients.
Collapse
Affiliation(s)
- Vanna Zanagnolo
- Gynecology Department, European Institute of Oncology, Milan, Italy.
| | - Annalisa Garbi
- Gynecology Department, European Institute of Oncology, Milan, Italy
| | | | - Lucas Minig
- Gynecology Department, Instituto Valenciano de Oncología, Valencia, Spain
| |
Collapse
|
47
|
Zamarin D, Jazaeri AA. Leveraging immunotherapy for the treatment of gynecologic cancers in the era of precision medicine. Gynecol Oncol 2016; 141:86-94. [PMID: 27016233 PMCID: PMC5007873 DOI: 10.1016/j.ygyno.2015.12.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/25/2015] [Accepted: 12/30/2015] [Indexed: 12/14/2022]
Abstract
During the past decade significant progress in the understanding of stimulatory and inhibitory signaling pathways in immune cells has reinvigorated the field of immuno-oncology. In this review we outline the current immunotherapy based approaches for the treatment of gynecological cancers, and focus on the emerging clinical data on immune checkpoint inhibitors, adoptive cell therapies, and vaccines. It is anticipated that in the coming years biomarker-guided clinical trials, will provide for a better understanding of the mechanisms of response and resistance to immunotherapy, and guide combination treatment strategies that will extend the benefit from immunotherapy to patients with gynecologic cancers.
Collapse
Affiliation(s)
- Dmitriy Zamarin
- Department of Medicine, Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, United States
| | - Amir A Jazaeri
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas, MD Anderson Cancer Center, United States.
| |
Collapse
|
48
|
Abstract
Fertility preservation is one of the major concerns of young patients diagnosed with gynecological cancer. With newer treatment regimens and better surgical techniques, survival rates after cancer treatment have improved, hence preservation of fertility has recently become an important issue in the treatment of gynecological cancers. Fertility sparing surgery may be an option for early-stage cervical cancer with the development of loop excision techniques and radical trachelectomy which allows a radical approach to cervix cancer at the same time preserving the uterus and thus fertility. Fertility preservation is possible in Stage 1 epithelial ovarian cancers, germ cell ovarian tumors, and borderline cancers. Hormonal therapy with progestin agents is effective in early endometrial cancer. In patients desiring future pregnancy, fertility sparing options must be explored before starting treatment for gynecologic cancers.
Collapse
|
49
|
Liu Y, Qin A, Li T, Qin X, Li S. Effect of statin on risk of gynecologic cancers: a meta-analysis of observational studies and randomized controlled trials. Gynecol Oncol 2014; 133:647-55. [PMID: 24736024 DOI: 10.1016/j.ygyno.2014.04.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [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: 03/04/2014] [Revised: 04/03/2014] [Accepted: 04/06/2014] [Indexed: 12/19/2022]
Abstract
Objective. Epidemiologic and clinical findings are inconsistent concerning the risk for gynecologic cancers associated with statin use. We conducted a detailed meta-analysis of all relevant original studies to evaluate the effects of statin on the risk of gynecologic cancers. Methods. We searched PubMed, Embase, and Cochrane library databases up to February 2014 looking for eligible studies. Summary relative risk (RR) estimates and 95% confidence intervals (CIs) were used to calculate the risk using random-effects models. Results. A total of 14 (4 randomized controlled trials, 5 cohorts, and 5 case-control) studies, involving 12,904 gynecologic cancer cases, contributed to the analysis. Pooled results indicated a non-significant decrease of total gynecologic cancer risk among statin users (RR=0.89; 95% CI, 0.78-1.01). Stratified analyses across cancer site revealed a modest protective effect of statin on ovarian cancer (RR=0.79; 95% CI, 0.64-0.98), while no association was found for endometrial cancer (RR=0.90; 95% CI, 0.75-1.07). The effect of statin use against cervical cancer and vulvar cancer is not conclusive. Furthermore, long-term statin use (>5years use) did not significantly affect the risk of endometrial cancer (RR=0.69; 95% CI, 0.44-1.10), but had an obvious decrease on the risk of ovarian cancer (RR=0.48; 95% CI, 0.28-0.80). Conclusions. Our results suggest that statin use was inversely associated with ovarian cancer risk, and the association was stronger for long-term statin use (>5years). The evidence for a protective effect of statin use against other gynecologic cancers is suggestive but not conclusive, which deserves further investigation.
Collapse
Affiliation(s)
- Yanqiong Liu
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Aiping Qin
- Department of Obstetrics and Gynecology and Reproductive center, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Taijie Li
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xue Qin
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Shan Li
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
| |
Collapse
|
50
|
Kumar RV, Bhasker S. Potential opportunities to reduce cervical cancer by addressing risk factors other than HPV. J Gynecol Oncol 2013; 24:295-7. [PMID: 24167663 PMCID: PMC3805908 DOI: 10.3802/jgo.2013.24.4.295] [Citation(s) in RCA: 11] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 09/27/2013] [Accepted: 09/27/2013] [Indexed: 11/30/2022] Open
Abstract
Cervical cancer is the most common cancer in developing world and 80% of global burden is reported from these nations. Human papillomavirus along with poverty, illiteracy/lower education level and standards, multi-parity, tobacco, malnutrition and poor genital hygiene may act synergistically to cause cervical cancer. Risk factor of cervical cancer may in itself be the reason for non-viability of cervical cancer vaccine program in this part of the world. Interventions to address these risk factors in addition to vaccination of girls before their sexual debut may hold promises of reducing the morbidity and mortality of female genital cancers.
Collapse
Affiliation(s)
- Ramaiah Vinay Kumar
- Department of Radiotherapy, Kidwai Memorial Institute of Oncology, Bangalore, India
| | | |
Collapse
|