IB Disease Research Articles

Fecal Microbiome Patterns in IBS, IBD, and Celiac Disease versus Healthy Controls

Fecal Microbiome Patterns in IBS, IBD, and Celiac Disease versus Healthy Controls

983P - Risk of cancer associated death in younger vs older patients with FIGO stage I endometrial cancer

Background: Although age is considered a traditional risk factor for relapse in stage I endometrial cancer, whether it impacts endometrial cancer-related death is unclear. We aimed to assess disease risk factors, overall survival (OS), disease-free survival (DFS), and cancer-specific survival, in patients > =70 (OP) vs. <70 (YP) years of age with or without adjuvant therapy. Methods: We reviewed medical records of all patients who underwent surgery for stage I endometrial cancer between 2000 and 2013 in British Columbia, Canada. Descriptive, logistic regression, multivariate Cox regression and competing risks analyses were used to evaluate patient outcomes. Results: 365 OP and 1063 YP were included (n = 1428). No significant differences were found between OP and YP with regards to disease risk factors such as stage IB disease and lymphovascular invasion (LVI). However, OP had higher odds of non-endometrioid histology (OR 1.88, p < 0.001). 22 (6%) OP and 78 (7.3%) YP received adjuvant chemotherapy (CT); 120 (32.9%) OP and 290 (27.3%) YP received adjuvant radiotherapy (RT). When adjusted for histology, LVI and grade, YP were more likely to receive CT (OR 2.10, p = 0.009); no significant difference in odds of receiving RT was found between YP and OP (OR 0.86, p = 0.33). OP experienced higher odds of relapse (OR 1.95, p = 0.001) and worse OS (HR 4.12, p < 0.001) and DFS (HR 2.18, p < 0.001) than YP after adjusting for risk factors. 10-year OS (endometrioid: 61.9 vs 89.2%; non-endometrioid: 46.1 vs 85.8%, p < 0.001) and DFS (endometrioid: 86.7 vs 91.9%; non-endometrioid: 69.6 vs 84.5%, p < 0.001) were worse for OP. Controlling for risk factors, OP experienced a higher incidence of endometrial cancer-related death than YP (HR = 2.09, p < 0.001). Conclusions: In patients with stage I endometrial cancer, patients > =70 years had higher odds of having non-endometrioid histology as well as relapse and death due to endometrial cancer, yet were less likely to receive adjuvant CT. Appropriate adjuvant therapy should be considered regardless of age, as recurrent disease is still a significant cause of mortality in older patients with stage I endometrial cancer. Legal entity responsible for the study: BC Cancer. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Image-guided, intensity-modulated radiation therapy in definitive radiotherapy for 1433 patients with cervical cancer

ObjectiveImage guidance should be used for patients with cervical cancer treated with definitive intensity-modulated radiation therapy (IMRT). In this study, we provided a pattern of image guidance and verified it in a large population. MethodsWe retrospectively analyzed patients with stages IB1–IVA cervical cancer treated with IMRT combined with high-dose brachytherapy and concurrent chemotherapy in our institute from January 2005 to December 2015. A dose of 50.4 Gy in 28 fractions was prescribed to the planning target volume with fixed-field IMRT, volumetric modulated arc therapy, or helical tomotherapy. Daily megavoltage computed tomography (CT) or weekly cone-beam CT (CBCT)/CT-on-rail were used for image guidance. Considering tumor regression during treatment, a second CT simulation and IMRT planning after 20 fractions of IMRT was performed. ResultsA total of 1433 patients were included in this study. Four hundred thirteen patients (28.8%) had regional lymph node metastases. A total of 1261 patients (88.0%) received concurrent chemotherapy. The median follow-up was 32.2 months (range, 1.9–124.9 months). The 3-year overall survival (OS), disease-free survival (DFS), and local control (LC) rates were 83.0%, 75.0%, and 87.4%, respectively. The 3-year DFS rates for patients with stages IB1, IB2, IIA, IIB, IIIA, IIIB, and IVA disease were 90.2%, 87.6%, 84.0%, 76.7%, 61.6%, 59.8%, and 25.9%. The incidence rates of grade 3 or greater chronic gastrointestinal and genitourinary toxicities were 2.3% and 1.3%. ConclusionThis pattern of image guidance was rational for patients with cervical cancer treated with IMRT. The survival rates were high, and the toxicities were acceptable.

Disparities in the use of fertility-sparing surgery for early stage cervical cancer

Women with early stage cervical cancer who are of reproductive age and wish to preserve fertility may be candidates for fertility-sparing surgery (FSS). The goal of this study was to examine the presence of disparities in the use of fertility-preserving surgery (FSS) and to investigate outcomes in this group. Retrospective cohort study. The National Cancer Database was used to identify patients aged <=35 years diagnosed with cervical cancer between 2004-2015. Those with stage IA2 or IB1 squamous cell carcinoma (SCC) or adenocarcinoma (AC) who underwent definitive treatment by hysterectomy (HYST) versus cone resection or trachelectomy (FSS) were identified. Univariate analysis was performed with chi-square and Mann-Whitney tests. Overall survival (OS) was evaluated for cases diagnosed between 2004-2014 after generation of Kaplan-Meier curves and compared with the log-rank test. A Cox model was constructed to control for confounders. A total of 2623 patients met the inclusion criteria. Median patient age at the time of diagnosis was 31 years (IQR:5). The majority had squamous cell carcinoma (62.4%) and stage IB1 disease (84.1%). The rate of FSS was 13.6%. Compared to patients who underwent HYST, those who received FSS were younger (median 30 vs 32 yrs, p<0.001), had fewer co-morbidities (3.6% vs 7.6%, p=0.007), were more likely to reside in large metropolitan areas (61.1% vs 49.5%, p<0.001), have private insurance (75.8% vs 62.9%, p<0.001), higher median income (p<0.001), present with stage IA2 disease (25.2% vs 14.4%, p<0.001) and adenocarcinoma (45.4% vs 36.3%, p=0.001). No differences were noted based on patient race (p=0.14). After controlling for clinical stage, histology, age, presence of co-morbidities, and area of residence, private insurance and higher income were associated with the receipt of FSS. There was no difference in OS between patients who received HYST (n=2036) and FSS (n=305), p=0.37; 5-yr OS rates were 93.5% and 94.5%, respectively. After controlling for age, clinical stage, histology, presence of medical comorbidities and performance of lymph node dissection, receipt of FSS was not associated with a worse survival (HR: 0.75, 95% CI: 0.42, 1.37). Socio-economic disparities exist in the utilization of FSS for early stage cervical cancer. For this selected population no difference in OS was found. This is critical information for patients referred for oncofertility consultation.

Recurrence Pattern after Adjuvant Radiotherapy for Endometrioid Type Endometrial Cancer

Objective: To define recurrence pattern of endometrioid type endometrium cancer performed adjuvant radiotherapy.Study Design: 351 patients who underwent at least total abdominal hysterectomy with bilateral salpingo-oophorectomy and followed by adjuvant radiotherapy (vaginal brachytherapy or pelvic radiotherapy or both) for endometrioid type endometrium carcinoma were included. The patients who received systemic adjuvant treatment after surgery were excluded from the study except for 18 patients who received concomitant chemo-radiotherapy. Recurrence was categorized as pelvic recurrence included areas distal to the pelvic inlet, as abdominal recurrence included areas between pelvic inlet and diaphragm and findings such as ascites and peritonitis carcinomatosa, and the rest of recurrences including lung, cutaneous, liver parenchyma and bone as extra-abdominal recurrence.Results: The median age was 57 years (range; 29-82). 236 patients had stage I, 25 had stage II, 63 had stage III and 14 had stage IV disease (by FIGO 2009). Lymph node metastasis was determined in 21.8% of patients who underwent lymphadenectomy (n: 289). The median follow-up time was 46 months (range; 1-190). Throughout follow-up, recurrence was developed in 55 (15.7%) patients. Only pelvic recurrence was determined in 11 (3.1%) patients. There was recurrence beyond the pelvis in 44 (80%) of the recurrent patients. Thirty-five (%63.6) of recurrent patients had extra-abdominal recurrence. Twenty-three (41.8%) of recurrent patients had stage IB disease. The recurrence developed in 10% of patients with stage I&amp;II, whereas it was occurred in 31% of patients with stage III&amp;IV (p&lt;0.0001).Conclusion: Radiotherapy provides local control of the disease, but recurrence is likely to be extra-pelvic and extra-abdominal in this patient group.

Adjuvant treatment patterns and outcomes in patients with stage IB-IIIA non-small cell lung cancer in France, Germany, and the United Kingdom based on the LuCaBIS burden of illness study

ObjectivesTo inform health-technology assessments of new adjuvant treatments, we describe treatment patterns in patients with complete resection of stage IB-IIIA non-small cell lung cancer (NSCLC) in France, Germany, and the United Kingdom (UK). Materials and methodsData were collected via medical record abstraction. Patients were aged ≥18 years with completely resected stage IB-IIIA NSCLC, diagnosed between 01 January 2009 and 31 December 2011. Median follow-up was 26 months. Adjuvant treatment patterns and clinical outcomes were summarized descriptively. ResultsAmong the 831 patients studied, 239 (29%) had stage IB disease, 179 (22%) had stage IIA disease, 165 (20%) had stage IIB disease, and 248 (30%) had stage IIIA disease. Adjuvant systemic therapy was received by 402 patients (48.4%), (France, 61.8%; Germany, 51.9%; UK, 33.4%). Use of adjuvant therapy increased with increasing stage of disease. Cisplatin/vinorelbine and carboplatin/vinorelbine were the most frequently prescribed adjuvant regimens. Median disease-free survival was 48.0 months (95% confidence interval [CI] 42.3–not estimable); the 25th percentile was 13.2 months (95% CI, 11.0–15.3). 204 patients (24%) died during the follow-up period. The median overall survival was not reached, the 25th percentile was 31.2 months (95% CI 26.8–36.0 months). 272 patients (33%) had disease recurrence during the follow-up period. For 86 of those patients, the first recurrence was local or regional with no distant metastasis and 14 had further progression to metastatic disease during the follow-up time. For the other 186 patients, the first recurrence involved distant metastases. A total of 200 patients had metastatic disease at any time during study follow-up. ConclusionsLess than half the patients with stage IB-IIIA NSCLC in this observational study received adjuvant systemic therapy. A high rate of first recurrence with distant metastatic disease was observed, emphasising the need for more effective systemic adjuvant therapies in this population.

Postoperative radiation rates in stage IIA1 cervical cancer: Is surgical treatment justified? An Israeli Gynecologic Oncology Group Study

ObjectivesData on the outcome of stage IIA1 cervical cancer is limited, as these tumors comprise a small percentage of early tumors. NCCN guidelines suggest consideration of surgical management for small tumors with vaginal involvement. Our objective was to evaluate the risk of adjuvant radiotherapy in stage IIA1 cervical cancer and its associated features, in order to improve selection of patients for surgical management. MethodsA retrospective cohort study comparing surgically treated cervical cancer patients with stage IB1 and stage IIA1 disease. Women treated between 2000 and 2015 in ten Israeli medical centers were included. Patient and disease features were compared between stages. The relative risk (Fisher's exact test) of receiving post-operative radiation was calculated and compared for each risk factor. A general linear model (GLM) was used for multivariable analysis. Results199 patients were included, of whom 21 had stage IIA1 disease. Most features were comparable for stage IB1 and stage IIA1 disease, although patients with vaginal involvement were more likely to have close surgical margins (23.8% vs 8.5%, p = 0.03). Patients with stage IIA1 disease were more likely to receive radiation after surgery (76% vs. 46%, RR = 1.65 (1.24–2.2), p = 0.011). Vaginal involvement as well as depth of stromal invasion, LVSI and lymph node metastases were independent predictors of radiation on multivariable general linear modeling. ConclusionsCervical cancer patients with vaginal involvement are highly more likely to require postoperative radiation. We recommend careful evaluation of these patients before surgical management is offered.

(P24) Patterns of Care and Outcomes in Early Stage Neuroendocrine Carcinoma of the Cervix

Neuroendocrine small cell carcinoma (NESCC) is a rare form of cervical cancer associated with poor outcomes. When compared to other histotypes of invasive carcinoma arising in the uterine cervix, NESCC tend to present at more advanced stages, demonstrate greater frequency of regional lymph node involvement, and, stage by stage, have a worse 5-year prognosis than invasive squamous carcinomas. However, due to their rarity, consensus regarding the optimal therapeutic strategy for early stage disease is lacking. After obtaining IRB approval, all women in the National Cancer Database diagnosed with early stage (FIGO1-IIA) NESCC were identified. Coded patient demographics, tumor characteristics, and data regarding treatment were abstracted. Univariate and multivariate analyses, including Cox survival regression analyses, were performed using SPSS Version 24.0 (SPSS Inc., Chicago, IL). A total of 104 subjects with stage I-IIA NESCC whose treatment included hysterectomy were identified. Mean age at diagnosis for these women was 41 +/- 14.1 years. Stage at diagnosis for these subjects was IA (n=12), IB1 (n=46), 1B2 (n=33) and IIA (n=5). Eight subjects were reported to have IB disease not otherwise specified. Nearly half (n=50, 48.1%) were treated with a combination of hysterectomy, radiation and chemotherapy, while smaller proportions of women were treated a combination of hysterectomy and chemotherapy (n=33, 31.7%), hysterectomy alone (n=20, 19.2%) or hysterectomy with adjuvant radiotherapy (n=1, 1.0%, p<0.0001). A total of 18 patients who received radiotherapy also received brachytherapy. Of these, 8 received neoadjuvant brachytherapy while the remainder received adjuvant brachytherapy. In univariate analysis, lower stage, Caucasian or Hispanic race/ethnicity, the absence of positive lymph nodes, and negative surgical margins were each significantly associated with improved survival (all p<0.05). However, the addition of radiotherapy to treatment plans did not significantly improve outcomes (p>0.05). Furthermore, neither the timing of chemotherapy (neoadjuvant vs. adjuvant) nor type of chemotherapy used (multi-agent vs. single-agent) were associated with improved OS (p>0.05), either in unstratified univariate analyses or when subjects were stratified by treatment regimen or tumor size (>4cm vs <4 cm; p>0.05). Lastly, we found that neoadjuvant chemotherapy failed to increase the likelihood of negative surgical margins for stage IB2 tumors (p >0.05). In multivariate analyses, tumor stage and patient race were the only variables that remained significantly associated with OS (p<0.05) . Use of chemotherapy and/or radiotherapy had no influence on survival after controlling for other variables. Analysis of U.S. hospital-based data indicates that neither chemotherapy nor radiation improves outcomes of surgically resectable early stage (FIGO IA-IIA) neuroendocrine carcinomas of the uterine cervix. This finding suggests that a prospective analysis of new treatment options is warranted with the goal of optimizing outcomes and quality of life for women impacted by NESCC.

Which Patients With Cervical Squamous Cell Carcinoma Might Benefit From Neoadjuvant Chemotherapy?

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 55-year-old postmenopausal woman, gravida 5 para 5, with past medical history significant for hypertension, presented to the emergency department with profuse vaginal bleeding and a hemoglobin level of 9 g/dL. The biopsy from an irregular 6-cm cervical mass was consistent with moderately differentiated cervical squamous cell carcinoma. The physical examination did not reveal vaginal or parametrial extension of the tumor. Pelvic magnetic resonance imaging disclosed the known carcinoma, as well as a 9.2 × 7.7 × 6.7 cm anterior uterine fibroid (Fig 1). A staging positron emission tomography scan was negative for metastatic disease. After blood transfusion and vaginal packing, the patient was referred to discuss the immediate management of her newly diagnosed bleeding bulky cervical cancer. In the absence of parametrial or vaginal extension and in the absence of lymph node metastasis (both on clinical examination and imaging), she was classified as having International Federation of Gynecology and Obstetrics stage IB2 disease.

Clinicopathological features of younger (aged ≤ 50 years) lung adenocarcinoma patients harboring the EML4‐ALK fusion gene

BackgroundThe EML4‐ALK fusion gene has recently been identified as a driver mutation in a subset of non‐small cell lung cancers. In subsequent studies, EML4‐ALK has been detected in a low percentage of patients, and was associated with a lack of EGFR or KRAS mutations, younger age, and adenocarcinoma with acinar histology. Cases with the EML4‐ALK fusion gene were examined to clarify the clinicopathological characteristics of young adenocarcinoma patients.MethodsBetween December 1998 and May 2009, 85 patients aged ≤ 50 with lung adenocarcinoma were treated at our hospital. We examined 49 samples from adenocarcinoma patients who underwent surgical resection, chemotherapy, and/or radiotherapy for the EML4‐ALK gene. None of the patients received ALK inhibitors because these drugs had not been approved in Japan before 2012. EML4‐ALK fusion genes were screened using multiplex reverse‐transcription PCR assay, and were confirmed by direct sequencing.ResultsThe EML4‐ALK fusion gene was detected in five tumors (10.2%). One patient had stage IB disease, one had stage IIIA, and three had stage IV. Histologically, there was one solid adenocarcinoma, two acinar adenocarcinomas, and two papillary adenocarcinomas. EML4‐ALK fusion genes were mutually exclusive to EGFR and KRAS mutations. The five‐year survival rate was 59.4% in patients without EML4‐ALK fusion and was not reached in patients with EML4‐ALK fusion.ConclusionThe EML4‐ALK fusion gene may be a strong oncogene in younger patients with lung adenocarcinoma.

The prevalence of occult endometrial cancer in women undergoing hysterectomy for benign indications

ObjectiveTo estimate the frequency of occult endometrial cancer in women undergoing hysterectomy for benign indications. Study designWe performed a retrospective review of all patients undergoing hysterectomies for benign indications at our institution from 2006 to 2014. A departmental database was used to identify all hysterectomies performed, and institutional tumor registry was used to identify cases of endometrial carcinoma. Occult carcinomas were defined as cases with no suspicion preoperatively and histopathologic diagnosis of endometrial cancer postoperatively. ResultsA total of 6981 hysterectomies were performed for benign indications. Among these, thirteen patients (0.19%) were found to have occult endometrial cancer, with an overall rate of 1 in 537 patients (95% confidence interval 1:314–1:1008). Twelve patients had stage IA and one had stage IB disease. Median age of women found to have endometrial cancer was 50 years (range 35–72 years). The median BMI was 29.8 kg/m2 (range 21.3–50.4 kg/m2). The most common indications for hysterectomy were abnormal bleeding (47%), postmenopausal bleeding (15%), adnexal mass (15%), prolapse (15%), and endometrial hyperplasia without atypia (8%). Of the postmenopausal women that had bleeding, all patients underwent evaluation of the endometrium, however 75% of samples did not have adequate amount of endometrium to be evaluated and 25% were found to have hyperplasia. ConclusionThis is one of the largest single institution cohorts to examine occult malignancy. Unexpected endometrial carcinomas were found to occur in 0.19% or 1:537 (95% confidence interval 1:314–1:1008) hysterectomies for benign indications in our population. PrécisOccult endometrial carcinomas are found to occur in 1:537 (0.19%) hysterectomies for benign indications.

Single-institutional outcomes of adjuvant brachytherapy for Stage I endometrial cancer—Are outcomes consistent with randomized studies?

PurposeVaginal brachytherapy (VBT) alone has been shown to be a viable adjuvant treatment strategy for most patients with Stage I endometrioid endometrial cancer. We sought to examine our institutional data following practice pattern changes resulting from the publications of GOG-99 and PORTEC-2. Methods and MaterialsWe retrospectively analyzed women who underwent adjuvant VBT after surgical staging for Stage 1 endometrioid endometrial cancer at our institution from 2007 to 2014. ResultsWe identified 297 women. Median time to last followup or death was 52.3 months (interquartile range: 32.3–72.3 months). By International Federation of Gynecology and Obstetrics 2009 staging, 162 patients (54.5%) had Stage IA and 128 (43.1%) had Stage IB disease. Ninety-nine (33.3%) patients had Grade 1, 153 (51.5%) had Grade 2, and 45 (15.2%) had Grade 3 disease. According to GOG-249 and PORTEC-2 criteria, 167 (56.2%) and 127 (42.7%) patients were with high–intermediate–risk disease. Two women had Stage IB Grade 3 disease. The most common high-dose-rate–VBT regimen was 2100 cGy/three fractions to a depth of 5 mm. Four (two acute and two late) (1.3%) Grade 3 genitourinary toxicities were reported: three episodes of vaginal dehiscence (after second course of VBT, 2 months after completion of VBT, and 1 year after completion of VBT) and one episode of radiation necrosis. Twenty-one (7%) women recurred: three recurred in the vagina, two recurred in the pelvic lymph nodes, and 16 recurred distantly. ConclusionsOutcomes appear consistent with published randomized data in women with high–intermediate–risk endometrial cancer who are treated with brachytherapy alone. Recurrence and complication rates were minimal.

Non-small cell lung cancer in surgically treated women.

To determine whether female patients operated on for non-small cell lung cancer (NSCLC) have a survival advantage compared to male patients. We analyzed data from 1,426 prospectively collected patients submitted to lung resection for NSCLC between 1999 and 2008. Two groups, including 1,014 male and 412 female patients, were compared. Female patients were significantly younger, were more frequently asymptomatic, were less likely to be smokers, had better preoperative respiratory function, had a lower frequency of COPD, and were less commonly affected by cardiovascular comorbidity than men. Adenocarcinoma was more frequently present and early pathological stage (stage IA) more frequently detected in women at diagnosis. The operative mortality was significantly lower among women (1.6% vs 4.6%) (P = 0.012), and women underwent significantly more segmentectomies and fewer pneumonectomies (P = 0.001). The disease-related 5-year survival rate was significantly higher in women (66% vs 51%) (P = 0.0008). At univariate analysis the absence of symptoms at presentation, lower pathological stage, squamous cell type, and female gender were positive factors influencing long-term survival. At multivariate analysis low pathological stage, squamous cell type and female gender were confirmed as independent positive prognostic predictors. Women had a significant survival advantage irrespective of the histological subtype at pathological stage IA, IB, IIB and IIIA disease (P <0.05). Female gender was confirmed to be a particular subset amongst patients affected by NSCLC and exerted a positive effect on disease-related survival of patients submitted to surgical resection. This important effect of gender should be cautiously kept in mind in analyzing the results of current and future trials for lung cancer therapy.

Role of Neoadjuvant Chemotherapy in Treatment of Cervical Cancer: A Case Series of Thirty-Eight Patients Treated at Bangabandhu Sheikh Mujib Medical University in Dhaka, Bangladesh

Background: Cervical cancer is the second most common malignancy of women in Bangladesh. Surgery is the mainstay of treatment of patients with early invasive cancer confined to cervix. While the five-year survival rate after surgery for stage IB1 disease exceeds 90%, it is only 60% - 70% for stage IB2 and IIA2 (tumor size > 4 cm). To improve the outcome of treatment, two to three cycles of Neoadjuvant Chemotherapy (NACT) has been evaluated as a treatment strategy in stage IB2 and IIA2 diseases. Objectives: This study aimed to evaluate the role of neoadjuvant chemotherapy (NACT) followed by Radical Surgery (RS) among the patients with early bulky cervical cancer (Stage IB2 & IIA2) to reduce the tumor size to achieve radical resectibility. Methods: This study was carried out at the Gynaecological Oncology Division of the Department of Obstetrics and Gynecology at Bangabandhu Sheikh Mujib Medical University (BSMMU) during the period July 2015 to December 2015. Thirty-eight patients with early bulky cervical cancer without any prior medical or surgical treatment received NACT using intravenous paclitaxel 175 mg/m2 and cisplatin 75 mg/m2 followed by radical surgery. The primary outcome measure assessed the response to NACT to reduce the size of the tumor. Secondary outcome measures assessed the resectibility of tumor and compared the preoperative clinical stage to the postoperative pathological stage. This study also assessed the relationship of intraoperative and postoperative complications including the adverse effects of postoperative radiotherapy and chemoradiotherapy. Results: Clinical response to NACT was 94.7% (84.2% complete response + 10.5% partial response). Progressive disease was found in two cases (5.3%). Duration of surgery was less than 2 hours in 81.6% cases and greater than 3 hours in 13.2% cases only. All women lived 5 to 10 hours away from Dhaka and could not return for in person follow-up. It was possible to get telephone follow-up on twenty-four women (63%). Seven (29%) had died from their cancers within one year of their surgery. Seventeen women were alive and disease free two years after completeion of their treatment. Conclusion: NACT is a feasible approach for improving the resectability of early stage bulky cervical cancer at BSMMU.

Is the ovarian preservation safe in young women with stages IB-IIA villoglandular adenocarcinoma of the uterine cervix?

ObjectiveBecause villoglandular adenocarcinoma (VGA) of the uterine cervix has favorable features and outcomes, patients receive less radical surgery and young women preserve their ovaries. We aimed to evaluate the clinicopathological features and outcomes of VGA and to see if the ovarian preservation is safe in young women with VGA.MethodsWe retrospectively reviewed medical records and identified patients with VGA, who had been treated and followed from January 2004 to December 2015.ResultsThis study consisted of 17 patients with VGA, including 9 premenopausal women. International Federation of Gynecology and Obstetrics (FIGO) stage IB1 disease was found in 12 patients (70.6%), IA1 in 2, IA2 in 1, IB2 in 1, and IIA1 in 1. Of the 12 women diagnosed with stage IB1 disease, a young woman received only conization and she has not showed a recurrence. During a median follow-up of 58 months (range: 12–116), 4 patients, who had undergone radical surgery for stage IB1 disease, had a recurrence and one of them died due to disease progression. Among patients with stages IB–IIA disease, 2 premenopausal women did not receive simultaneous oophorectomy or chemoradiation therapy. Both of them had a recurrent tumor at adnexa.ConclusionThis study revealed favorable features and outcomes of VGA. However, the appropriate treatment for young women with early-stage VGA must be cautiously selected. Ovarian preservation might not be safe when young women with stages IB–IIA VGA undergo surgical procedures.

Minimal deviation adenocarcinoma (adenoma malignum) of the uterine cervix: clinicopathological analysis of 17 cases.

ObjectiveThe aim of this study was to evaluate the clinicopathological features of minimal deviation adenocarcinoma (MDA) and to analyze its prognostic factors.MethodsWe retrospectively analyzed the medical records of 17 patients who were diagnosed with MDA at a single institution between January 2005 and December 2015.ResultsThe median age of the patients was 47.7 years (33–75 years). MDA was diagnosed in 7 patients (41.2%) before performing definitive surgery. Stage IB disease was diagnosed in 12 patients (70.6%) and advanced stage disease (stage II: 3, stage III: 2) in 5. MDA was incidentally diagnosed following hysterectomy for benign conditions in 6 patients. Adjuvant therapy was administered to 13 patients (76.5%). During median follow-up over 33.6 months (7–99 months), 11 patients (64.7%) showed no evidence of disease, 6 (35.3%) showed persistent or recurrent disease and 5 died of the disease. Peutz-Jeghers syndrome was not suspected in any patient, and no mutation was detected in the 3 patients who underwent genetic testing. Univariate analysis showed that advanced stage disease (P=0.016) and lymphovascular space invasion (P=0.002) demonstrated a statistically significant association with poor overall survival (OS) rates. Advanced stage disease continued to show a significant association with poor OS rates (hazard ratio, 2.92; 95% confidence interval, 1.097–7.746; P=0.032) even after multivariate analysis.ConclusionEarly diagnosis is important to manage MDA. Clinicians should consider MDA among the differential diagnoses in patients with a suspicious clinical presentation even with negative cervical screening tests.

Meta-analysis of adjuvant chemotherapy versus surgery alone in T2aN0 stage IB non-small cell lung cancer.

Although there is a strong evidence that adjuvant chemotherapy after surgery was effective in Stages II and IIIA patients involved nonsmall cell lung cancer (NSCLC), its eligibility in Stage IB disease has been unknown. Therefore, this meta-analysis was aimed to compare the effects of adjuvant chemotherapy versus surgery alone in patients with Stage IB NSCLC. We systematically searched for articles from their inclusion to July 2016. An article search was performed in PubMed, Embase, Medline, and Cochrane Library. Irrelevant literature was excluded with the preferred reporting items for systematic reviews and meta-analysis standards. Overall survival (OS) was the primary end-point, which was defined as the time from randomization until death from any cause; our second end-point was disease-free survival (DFS). All analyses were based on intention-to-treat. Six randomized controlled trials with total of 2007 patients were included in present meta-analysis. The results were expressed as risk ratios (RR) with 95% confidence intervals (CIs). Compared to surgery alone, patients can benefit from adjuvant chemotherapy after surgery in terms of 5-year OS (RR = 1.19; 95% CI, 1.03-1.37; P = 0.02) and 5-year DFS (RR = 1.36; 95% CI, 1.13-1.63; P = 0.001). There was no significant difference in terms of benefit according to certain patient characteristics, such as age, gender, tumor histology, smoking history, and resection type. Adjuvant chemotherapy after surgery was beneficial to the patients with Stage IB disease in terms of OS and progression-free survival. Therefore, we recommend clinicians to take this treatment strategy into account for the patients with Stage IB NSCLC.

Adjuvant Chemotherapy with or without Concurrent Radiotherapy for Patients with Stage IB Gastric Cancer: a Subgroup Analysis of the Adjuvant Chemoradiotherapy in Stomach Tumors (ARTIST) Phase III Trial.

PurposeWe aimed to discuss the roles of radiation and chemotherapy as adjuvant treatment in patients with staged IB GC who were enrolled in the adjuvant chemoradiotherapy in stomach tumors (ARTIST) trial.Materials and MethodsAmong the 458 patients who were enrolled in the ARTIST trial, 99 had stage IB disease. The patients were randomly assigned to receive either adjuvant chemoradiotherapy with capecitabine plus cisplatin (XP, n=50) or chemoradiotherapy (XPRT, n=49). Survival analyses were performed in accordance with the AJCC 2010 staging system.ResultsAccording to the AJCC 2010 system, stage migration from IB to II occurred in 71% of the patients; 98% of the T2 N0 cases were reclassified as T3 N0, and 42% of the T1 N1 cases were reclassified as T1 N2. When comparing survival outcomes between the XPRT and XP arms for stage IB cancer (AJCC 2002), no significant difference in 5-year disease-free survival (DFS) between the 2 arms was found. (median 5-year DFS, not reached, P=0.256). The patients classified as having stage IB cancer (AJCC 2002) and reclassified as having stage II cancer (AJCC 2010) exhibited worse prognoses than those who remained in stage IB, although the difference was not statistically significant (5-year DFS rate, 83% vs. 93%). When we compared 5-year DFS in 70 patients with stage II (AJCC 2010), the addition of radiotherapy to XP chemotherapy did not show better outcome than XP alone (P=0.137).ConclusionsThe role of adjuvant chemoradiotherapy in the treatment of stage IB GC (AJCC 2002) warrants further investigation.

ES 10.04 Carbon-ion Therapy

ES 10.04 Carbon-ion Therapy

Difference in Practice Patterns in the Management of Endometrial Cancer: A Survey of the Members of 4 East Asian Gynecologic Oncology Groups.

The aim of this article was to identify current practice patterns of care in the surgical and adjuvant management of endometrial cancer in East Asia (Korea, Japan, China, and Taiwan) METHODS: A validated 20-item questionnaire on surgical and adjuvant procedures for endometrial cancer was sent to active members of the Gynecologic Oncology Group from 4 East Asian countries. Data were collected using an Internet survey database. A total of 376 members from Korea (n = 108), Japan (n = 140), China (n = 51), and Taiwan (n = 77) responded to the survey. With respect to early-stage endometrial cancer, laparotomy (57.7%) was the most preferred mode of surgery in Japan, whereas laparoscopy was the most common in the remaining 3 countries. For patients with presumed stage IA/G1 disease, approximately 65% of respondents favored systematic lymphadenectomy. For patients with presumed stage IB disease, most respondents stated that systematic lymphadenectomy should be performed (92.6% for stage IBG1, 95.8% for stage IBG3). Meanwhile, the extents of lymphadenectomy differed among countries (P < 0.001). Considerable agreement was noted between countries regarding indications for adjuvant therapy for stage IIIA or IIIC1 disease, whereas the preferred options for adjuvant therapy varied according to country (P < 0.001). Specifically, chemotherapy was the most common selection option in Japan, whereas concurrent chemoradiotherapy was preferred in the other countries. Considerable agreement was identified with respect to the necessity for lymphadenectomy for surgical staging and the indications for adjuvant therapy. However, extents of surgery and preferred adjuvant treatment options for endometrial cancer varied widely between countries.