Treatment Of Gynecologic Malignancies Research Articles

Better Survival with Three-Dimensional Conformal Radiotherapy Than with Conventional Radiotherapy for Cervical Cancer: A Population-Based Study

Three-dimensional conformal radiation therapy (3DCRT) has emerged as a preferred treatment for gynecologic malignancies. Yet its superiority to conventional radiotherapy (2-dimensional radiotherapy (2DRT)) for gynecologic malignancies has not been well established. Data from the 2005 to 2010 National Health Insurance Research Database (NHIRD) provided by the National Research Institutes in Taiwan were analyzed to address this issue. Patients were initially diagnosed as having cervical cancer according to the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) code 180, and this clinical diagnosis was confirmed histopathologically or cytologically. Kaplan-Meier method and Cox proportional hazards regression were used to analyze the reported data. Between January 2005 and December 2010, there were 776 patients with newly diagnosed cervical cancer without metastasis, local recurrence, or surgical treatment before RT and 132 and 644 patients, respectively, who received 2DRT and 3DCRT. After adjustment for age, diabetes mellitus, hypertension, coronary heart disease, hyperlipidemia, side effects, urbanization level, geographic region, and enrollee category in the 5-year follow-up period, the HR was 1.82 (95% CI, 1.16–2.85, P = 0.009). The 5-year survival rate in the 2DRT and 3DCRT groups was 73.0% and 82.3%, P = 0.007, respectively. Cervical cancer patients treated with 3DCRT had better overall survival.

Nerve-sparing robotic radical hysterectomy: our technique.

Robotic surgery is now becoming accepted for treatment of gynaecological malignancies. Nerve preservation during radical hysterectomy is increasingly being offered due to improved post-operative bladder and sexual function. We aimed to demonstrate the feasibility of performing a nerve-sparing radical hysterectomy robotically and to assess the oncological and functional outcomes associated with this surgery. Between August 2011 and January 2013, a total of 12 non-consecutive patients underwent robotic surgery for early stage cervical cancer at our institution. Patients comprising FIGO stage IA2 to IB1 were treated with nerve-sparing robotic radical hysterectomy using a C1 (Querleu-Morrow classification) type technique. The feasibility, operative time, blood loss, oncological outcome and post-operative bladder function were assessed. All the procedures were completed robotically without conversion to laparoscopy or laparotomy. The mean age of the patients was 56years (range 44-76) and their mean body mass index was 22.6kg/m(2) (range 18.1-26.4). The mean operative time was 156min (range 120-250); the mean blood loss was 120ml (50-250). The Foley catheter was removed on the third post-operative day, with full recovery of bladder function in all patients except one who required prolonged catheterisation for 3weeks. Residual urine was 40ml (range 30-80). Parametrial margins of 2.5-3cm, distal vaginal margins of 2-2.5cm and a mean nodal harvest of 24 (range 18-30) were achieved. The mean hospital stay was 3days (range 2-6). The median follow-up is 12months. There is no loco-regional recurrence. All the patients are sexually active. Robotic nerve-sparing radical hysterectomy is technically feasible to perform, and is oncologically safe for early stage cervical carcinoma.

Outpatient High-Dose-Rate Interstitial Brachytherapy in the Treatment of Gynecologic Malignancies

to have recurrence either local or metastatic. Initial data were obtained for 85 women. Treatment data: There was a significant relationship between the average baseline scores and patient age (P 50:037) for the vagina scale score and also for sexual dysfunction (P 50:038). There was no significant relationship for vagina scores and stage of disease (P 5 0:054) or for sexual dysfunction and stage P 50:44. There was a significant relationship between the maximum vagina scores at baseline and age (P 50:039), but not for stage of disease (P 5 0:077). For sexual dysfunction maximum scores there was no significant association with age (P 50:095) or disease stage. (P 50:31). Nineteen of the 85 patients had prior treatment with surgery and both their average vagina scores (P 50:025) and maximum vagina (P 50:045) scoreswere significantly lower than those for non-surgically treated patients. Similarly for sexual dysfunction scores,the averages scores (P 50:042) for those patients who had prior surgery were lower than those who had no surgery and the maximum score was significantly different (P 50:027). Statistical analysis of data: The mean subjective sexual function and satisfaction score was highest (0.4601) in patients in which gap between treatment and interview was 11 years and maximum score was highest (0.94) in same group. Average subjective LENT SOMA score was highest in patients who were interviewed after 11 years of treatment in comparison to other patients. The objective mean score VG (Vagina) was highest (0.6444) in patients who were interviewed after 11 years of treatment and maximum score (0.80) was highest (0.80) in patients in which gap between treatment and interview was 10 years. Average objective LENT SOMA score was highest in patients who were interviewed after 11 years of treatment in comparison to other patients (p value0.693). Average overall LENT SOMA score was highest in patients in which gap between treatment and interview was 11 years. (p value0.705) Conclusions: The LENT SOMA system was acceptable and feasible to use and gave us an insight into the morbidity in our patients. Since it is one of few studies in India on late morbidity in treated patients of carcinoma uterine cervix, it is an important step in comparing our data with the Western literature. It will also help us to develop effective management plans to reduce the post treatment symptoms and improve quality of life in patients of carcinoma uterine cervix.

恶性卵巢癌抗肿瘤间质治疗策略研究进展

超过80%的卵巢癌患者对化疗药物出现耐药性而复发，使得卵巢癌死亡率居妇科恶性肿瘤之首。与肿瘤细胞分化高度异质性相比，肿瘤间质细胞遗传性稳定，不大可能产生获得性突变而导致抗药性。本文综述了卵巢癌针对肿瘤间质的治疗策略，为恶性妇科肿瘤治疗降低毒副作用、防止复发和转移，进一步提高生存率指明了方向。 More than 80% of the patients with ovarian cancer chemotherapy relapse due to drug resistance, which makes the highest ovarian cancer mortality rates among the gynecologic malignancies. Compared with the highly heterogeneous tumor cell differentiation, tumor stroma cells have genetic stability, and it is unlikely to produce acquired mutations and lead to drug resistance. In view of the treatment strategies for tumor interstitium, ovarian cancer is reviewed in this paper. At the same time, we pointed out the direction for reducing toxicity, preventing the cancer recurrence and metastasis, improving the survival rate in the treatment of gynecologic malignancies.

The Outcomes of Elderly Patients in the Treatment of Gynecological Malignancy with Robotic Surgery

The Outcomes of Elderly Patients in the Treatment of Gynecological Malignancy with Robotic Surgery

Can hormone replacement therapy be used following treatment for gynecologic malignancies?

许多妇科肿瘤患者在手术或放射治疗后出现绝经和明显的神经精神症状。约30％～40％的妇科肿瘤发生于绝经前期或围绝经期，急速的绝经产生明显的症状，表现为绝经综合征（如血管舒缩综合征、潮热、阴道干涩、骨质疏松、失眠和精神障碍等），同时心血管疾病的发病率也明显增加。

Laparoscopic surgery in gynecological malignant tumors

Laparoscopic surgery is widely used in the treatment of gynecological malignancies,including the radical surgery or staging surgery of early cervical cancer,endometrial cancer and ovarian cancer.Its feasibility and safety of clinical practice in gynecologic malignancies has been approved,and the postoperative follow-up results indicate that the effectiveness of laparoscopic surgery is similar to open surgery.But the laparoscopic surgery treatment of gynecological malignancies is still in dispute.The research will focus on the affects of pneumoperitoneum to the malignant behavior of tumor cells and the mechanism about implantation metastasis of puncture site in future. Key words: Laparoscopic; Gynecological tumor; Gynecologic surgical procedures

Efficacy of lafutidine, a histamine H2-receptor antagonist, for taxane-induced peripheral neuropathy in patients with gynecological malignancies

ObjectiveLafutidine, an antagonist of histamine H2-receptor, has gastroprotective activity associated with activation of capsaicin-mediated sensory nerves. The objective of this study was to investigate the efficacy of lafutidine for the treatment of taxane-induced peripheral neuropathy in patients with gynecological malignancies. MethodsTwenty patients with taxane-induced peripheral neuropathy during the treatment of gynecological malignancy were enrolled in this study. After obtaining their informed consent, lafutidine (20mg per day) was administered orally, the efficacy of which was assessed according to the Patient Neurotoxicity Questionnaire item 1. ResultsSignificant, moderate, slight, and no effects were observed in four, five, five, and six patients, respectively. The efficacy including significant and moderate effect was observed in nine (45%) of the 20 patients (95% confidence interval, 25.8%–65.8%). No adverse effects due to lafutidine were observed. ConclusionThis pilot study supports the relatively high efficacy of lafutidine for the treatment of taxane-induced peripheral neuropathy. Further prospective studies are warranted.

Minimally Invasive Surgery in Gynecologic Oncology: A Review of Modalities and the Literature

Minimally invasive surgery is one of the newest and most exciting areas of development in procedural medicine. This field shows tremendous potential to increase therapeutic benefit while minimizing some of the painful or dangerous side effects of surgical interventions. Minimally invasive surgery has strong historic ties to the field of gynecology and has come a long way as technology and techniques have improved. This has increasingly allowed the application of laparoscopy to more complex procedures and the treatment of gynecologic malignancies. Three laparoscopic approaches, traditional laparoscopy, robotic assisted laparoscopy and laparoendoscopic single-site surgery are reviewed here. We discuss the basic approaches to these three laparoscopic techniques, and then review their applications in gynecologic oncology. We also touch on the evidence behind outcomes associated with their use.

Robotic surgery applications in the management of gynecologic malignancies

This review evaluates the use of robotic-assisted laparoscopic surgery in the treatment of gynecologic malignancies and objectively evaluates the use of these systems in performing radical hysterectomies and surgical staging of gynecologic malignancies. The review focuses on surgical length, blood loss, complications, recovery time, and adequacy of surgical staging of robotic-assisted surgery compared to abdominal and non-robotically assisted laparoscopic surgery for malignancies.

Photodynamic therapy effectively palliates gynecologic malignancies

Objective: Photodynamic therapy (PDT) is an alternative treatment for a variety of malignancies. Application of PDT in the treatment of gynecologic malignancies has been limited, however preliminary results are promising. PDT involves administering a systemic injection of Photofrin II, a selective tumor photosensitizer hematoporphyrin derivative, followed by exposure of tumor tissue to visible light at 630nm. The photodynamic destruction of tumor exhibits both cytocidal and vascular effects that may contribute to the tumorcidal effects observed.

Current principles for radiotherapy in cervical cancer

Cancer of the uterine cervix is most common in countries that do not have access to cervical cancer screening and prevention programs. Treatment of cervical cancer varies significantly between countries (adjusted to stage) and is dependent on medical resources. Radiotherapy for the treatment of gynecological malignancy has been used with different techniques for treating the local tumor and regional lymph nodes. This review discusses recommendations of radiotherapy for cervical cancer according to stage.

The Use of Retinoids in Ovarian Cancer

Ovarian cancer is the deadliest of all gynecologic malignancies. The search for novel treatment modalities to augment traditional chemotherapy and improve quality of life is ongoing. Retinoids, a class of compounds composed of vitamin A, its natural derivatives, and synthetic analogs, have been studied extensively in both the prevention and treatment of gynecologic malignancies. In this article, we reviewed preclinical studies and clinical trials conducted using retinoids in ovarian cancer.

Molecular Strategies of Deoxynucleotide Triphosphate Supply Inhibition Used in the Treatment of Gynecologic Malignancies.

Chemotherapies targeting deoxynucleotide triphosphate synthesis are of high medical interest in the treatment of gynecologic malignancies. In this article, we focus on targeted inhibitors of ribonucleotide reductase, an enzyme in charge of ribonucleotide reduction to their corresponding deoxyribonucleotide to be used as the building blocks of DNA. We also discuss human clinical trials have utilized ribonucleotide reductase subunit-specific inhibitors, particularly trials for women with cervical cancer.

Early Experience of Robotic Pelvic Exenteration Compared to Pelvic Exenteration for Treatment of Gynecologic Malignancy

Early Experience of Robotic Pelvic Exenteration Compared to Pelvic Exenteration for Treatment of Gynecologic Malignancy

Stereotactic Body Radiotherapy and Hypofractionated Radiotherapy for the Treatment of Gynecological Malignancies

Gynecological malignancies are traditionally treated with a combination of EBRT and brachytherapy. In certain situations however, brachytherapy may not be technically feasible or not advisable due to medical comorbidities. Management of isolated nodal recurrences, especially para-aortic, also presents a challenging dilemma. Technologic advances in planning now enable the delivery of ablative tumor doses with relative sparing of adjacent normal tissues.

Robotic surgery in gynecologic oncology

The objective of this article is to review the recently published literature on the use of robotic surgery in the management of gynecologic malignancies. Retrospective data collected from many institutions support the use of robotic surgery in the management of cervical, endometrial, and early-stage ovarian cancer. Benefits to robotic surgery include decreased blood loss, fewer perioperative complications, and decreased length of hospital stay, especially when compared to an open cohort. Disadvantages include costs associated with the robotic system and disposable equipment, accessibility to robotic surgical systems, loss of haptic sensation with the device, and lack of prospective trials validating its use in gynecologic oncology. Current evidence establishes a role for the use of robotic surgery in the treatment of gynecologic malignancies. Further research should be implemented to validate the use of robotic surgery in gynecologic malignancies and to compare its outcomes to those of open and laparoscopic surgery.

Cancer in pregnancy. Part I: basic diagnostic and therapeutic principles and treatment of gynecological malignancies

Cancer in pregnancy is a rare circumstance. However, the coincidence of pregnancy and malignancy is supposed to increase due to a general tendency of postponing childbearing to older age. To date, clinical guidelines are scarce and experience regarding therapeutic management is limited to case reports. This review focuses on general diagnostic and therapeutic principles including systemic therapy for malignancies in pregnancy. In part I, we report on diagnosis and therapy of gynecological tumors. The diagnosis of gestational cancer faces both oncologist and obstetrician to the dilemma of applying appropriate diagnostic techniques and adequate local and systemic therapy to an expectant mother without harming the fetus.

Risk factors for lower-limb lymphedema after surgery for cervical cancer

Lower-limb lymphedema (LLL) is a prevalent complication that is encountered after treatment for gynecological malignancies. The aim of this study was to evaluate the risk factors for postoperative LLL in patients with cervical cancer. We conducted a retrospective chart review for patients who had undergone surgery, including systematic lymphadenectomy, for cervical cancer. Patients who died of cancer, were evaluated for short periods of time (<2 years), had missing medical records, or were suffering from deep venous thrombosis were excluded. We utilized the International Society of Lymphology staging of lymphedema severity as the diagnostic criteria for LLL, and patients with stage II or III lymphedema, as objectively determined by physicians, were included in the group of patients with LLL. Multivariate analysis was performed to confirm independent risk factors. A total of 155 patients with cervical cancer were evaluated. Thirty-one patients (20.0%) contracted LLL with a median follow-up of 6.1 years. Suprafemoral node dissection (odds ratio, 9.5; 95% confidence interval, 1.2-73.3; P = 0.031) and adjuvant radiotherapy (3.7; 1.2-10.9; P = 0.019) were identified as independent risk factors. Given that the effectiveness of the above two therapeutic options for cervical cancer is currently controversial, the clinical benefits of these therapies should be reevaluated specifically to conserve the quality of life for patients with this disease.

Bevacizumab Related Hypertension and Reversible Posterior Leukoencephalopathy Syndrome in Gynecologic Malignancies: A case Control Study

Background: Bevacizumab is increasingly being used in the treatment of gynecologic malignancies, but has significant side-effects including hypertension and reversible posterior leukoencephalopathy (RPLS), which must be recognized by the gynecologic oncologist. Methods: A 26-month institutional retrospective review of bevacizumab in the treatment of gynecologic malignancies. Patients were grouped according to whether they had bevacizumab-related hypertension (defined as at least a grade one hypertensive toxicity) or not. There were no differences in patient demographics between the groups. Risk factors for developing bevacizumab-related hypertension were assessed using t-tests, Wilcoxon rank sum test and Fisher’s exact test. Results: Our group has treated 45 patients with bevacizumab. Fifteen (33%) patients had a pre-existing diagnosis of hypertension, 12 (80%) of whom had at least one elevated blood pressure during treatment. The 30 (67%) patients who did not have a pre-existing diagnosis of hypertension still had a high incidence of bevacizumab-related elevated blood pressure (14, 47%). The majority of patients (26, 58%) had at least one therapy cycle complicated by hypertension. Patients who experienced bevacizumab-related hypertension were significantly more likely than not to have a history of hypertension (odds ratio of 4.6, 95% CI 1.1-19.6). There was a 4.4% incidence of reversible posterior leukoencephalopathy. Patients with age equal to or greater than 75 years, stage IV disease, and creatinine elevations greater than or equal to 1.4 mg/dL were significantly more likely to develop bevacizumab-related hypertension. Other factors such as numbers of prior chemotherapies, cycles of bevacizumab, BMI, cancer site, and histology were not significantly associated with bevacizumab-related hypertension. Conclusions: Hypertension is a problem for patients on bevacizumab whether or not they have a pre-existing diagnosis. However, those with a history of hypertension were significantly more likely to have bevacizumab-related hypertension.