1.An evaluation of prognostic factors, oncologic outcomes, and management for primary and recurrent squamous cell carcinoma of the vulva
Jessie Y. LI ; Christopher K. ARKFELD ; Joan TYMON-ROSARIO ; Emily WEBSTER ; Peter SCHWARTZ ; Shari DAMAST ; Gulden MENDERES
Journal of Gynecologic Oncology 2022;33(2):e13-
Objective:
To evaluate prognostic factors, outcomes, and management patterns of patients treated for squamous cell carcinoma of the vulva.
Methods:
One hundred sixty-four women were retrospectively identified with primary squamous cell carcinoma of the vulva treated at our institution between 1/1996–12/2018. Descriptive statistics were performed on patient, tumor, and treatment characteristics. The χ2 tests and t-tests were used to compare categorical variables and continuous variables, respectively. Recurrence free survival (RFS), overall survival (OS), and disease-specific survival (DSS) were analyzed with Kaplan-Meier estimates, the log-rank test, and Cox proportional hazards.
Results:
Median follow-up was 52.5 months. Five-year RFS was 67.9%, 60.0%, 42.1%, and 20.0% for stage I–IV, respectively. Five-year DSS was 86.2%, 81.6%, 65.0%, and 42.9% for stage I–IV, respectively. On multivariate analysis, positive margins predicted overall RFS (hazard ratio [HR]=3.55; 95% confidence interval [CI]=1.18–10.73; p=0.025), while presence of lichen sclerosus on pathology (HR=2.78; 95% CI=1.30–5.91; p=0.008) predicted local RFS. OS was predicted by nodal involvement (HR=2.51; 95% CI=1.02–6.13; p=0.043) and positive margins (HR=5.19; 95% CI=2.03–13.26; p=0.001). Adjuvant radiotherapy significantly improved RFS (p=0.016) and DSS (p=0.012) in node-positive patients. Median survival after treatment of local, groin, and pelvic/distant recurrence was 52, 8, and 5 months, respectively.
Conclusion
For primary treatment, more conservative surgical approaches can be considered with escalation of treatment in patients with concurrent precursor lesions, positive margins, and/or nodal involvement. Further studies are warranted to improve risk stratification in order to optimize treatment paradigms for vulvar cancer patients.
2.Stage III uterine serous carcinoma: modern trends in multimodality treatment
Jessie Y. LI ; Melissa R. YOUNG ; Gloria HUANG ; Babak LITKOUHI ; Alessandro SANTIN ; Peter E. SCHWARTZ ; Shari DAMAST
Journal of Gynecologic Oncology 2020;31(4):e53-
Objective:
To examine outcomes in a modern treatment era for stage III uterine serous carcinoma (USC).
Methods:
Fifty women were retrospectively identified as 2009 International Federation of Gynecology and Obstetrics stage III USC patients who received radiotherapy (RT) at our institution between 1/2003–5/2018. The patients were divided into 2 cohorts: 20 in the early era (2003–2010) and 30 in the modern era (2011–2018). Patient characteristics were compared using χ 2 tests for categorical variables and t-tests for continuous variables. Recurrence free survival (RFS) and overall survival (OS) were analyzed with Kaplan-Meier estimates, the logrank test, and Cox proportional hazards.
Results:
The modern era differed from the early era in the increased use of volume-directed external beam RT (EBRT) as opposed to vaginal brachytherapy (VB) alone (33.3% vs 5.0%, p=0.048), minimally invasive surgery (56.7% vs. 25%, p=0.027), sentinel node sampling (26.7% vs. 0%, p=0.012), computed tomography imaging in the perioperative period (63.3% vs. 30%, p=0.044), and human epidermal growth factor receptor 2eu testing (96.7% vs.55%, p=0.001). Median follow-up for early and modern eras was 37.27 and 33.23 months, respectively. The early vs. modern 3-year RFS was 33% and 64% (p=0.039), respectively, while the 3-year OS was 55% and 90% (p=0.034). Regional nodal recurrence more common among the patients who received VB only (p=0.048).
Conclusion
Modern era treatment was associated with improved RFS and OS in patients with stage III USC. Regional nodal recurrences were significantly reduced in patients who received EBRT.
3.Financial toxicity in patients with gynecologic malignancies: a cross sectional study
Burak ZEYBEK ; Emily WEBSTER ; Natalia POGOSIAN ; Joan TYMON-ROSARIO ; Alan BALCH ; Gary ALTWERGER ; Mitchell CLARK ; Gulden MENDERES ; Gloria HUANG ; Masoud AZODI ; Elena S. RATNER ; Peter E. SCHWARTZ ; Alessandro D. SANTIN ; Vaagn ANDIKYAN
Journal of Gynecologic Oncology 2021;32(6):e87-
Objective:
To evaluate financial toxicity and assess its risk factors among patients with gynecologic cancers.
Methods:
This is a cross sectional study that included 2 survey tools, as well as patient demographics, disease characteristics, and treatment regimen. Financial toxicity is measured by validated Comprehensive Score for Financial Toxicity (COST) tool. Participants were also asked to complete a 55-question-survey on attitudes and perspectives surrounding cost of care. Descriptive statistics was used to report patient demographics. Spearman's rank correlation was calculated to assess the relation between financial toxicity and patient/disease related variables. Graphpad Prism Software Version 8.0 was used for analyses.
Results:
A total of 50 patients with various gynecologic malignancies were enrolled. Median COST score was 20.5 (range, 1–33). Sixty-five percent of the patients reported being in debt due to their cancer care and 4% filed bankruptcy. Correlation analysis showed that COST score was correlated with age (r=−0.3, p=0.028), malignancy type (r=0.3, p=0.039) and income (r=0.3, p=0.047). Ovarian cancer patients had significantly less financial toxicity (median COST score=23) when compared to patients with other gynecologic malignancies (median COST score=17, p=0.043). When scores were dichotomized into low (score ≥22) and high toxicity (score <22), 58% (29/50) of the patients were noted to have high financial toxicity. Enrollment to a clinical trial did not significantly alleviate financial burden.
Conclusion
Financial toxicity is a significant burden even among highly insured gynecologic oncology patients. Age, malignancy type and income were correlated with high financial burden.