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A feasibility study on maintenance of docetaxel after paclitaxel-carboplatin chemotherapy in patients with advanced ovarian cancer.

Seiji ISONISHI ; Masaaki SUZUKI ; Hiroaki NAGANO ; Koichiro TAKAGI ; Masahito SHIMAUCHI ; Masakiyo KAWABATA ; Kazuhiko OCHIAI

Journal of Gynecologic Oncology.2013;24(2):154-159. doi:10.3802/jgo.2013.24.2.154

OBJECTIVE: To test the concept of taxane sequencing, this feasibility trial evaluated maintenance of docetaxel after paclitaxel and carboplatin combination chemotherapy in patients with stage IC-IV ovarian cancer. METHODS: All patients received debulking surgery followed by paclitaxel and carboplatin chemotherapy. Attainment of clinically defined complete or partial response was confirmed by image scanning. Maintenance of docetaxel started at an initial dose of 70 mg/m2 every 4 weeks for 6 cycles and was extended to 10 cycles unless disease progression and/or recurrence during the protocol therapy or unacceptable toxicities were seen. RESULTS: Stage subsets in 20 eligible patients were as follows: IIIB, 2 patients (10%); IIIC, 13 patients (65%); IV, 5 patients (25%). Neutropenia was common (40% with grade 3 or 4) and was most frequent during first or second cycle although the disabling peripheral neuropathy was not observed. Twelve patients completed protocol therapy (6< or =cycles), while 8 patients failed to complete 6-cycle chemotherapy, because of progressive disease (5 patients) or grade 4 toxicities (3 patients). Median PFS was 20 months and 3-year PFS rate was 12%. Median overall survival was 39 months and 3-year OS rate was 69%. CONCLUSION: Six cycles of single-agent docetaxel maintenance chemotherapy is feasible and generally tolerable to women with advanced ovarian cancer who attained a clinically defined response to initial paclitaxel and carboplatin based chemotherapy.
Bridged Compounds ; Carboplatin ; Disease Progression ; Drug Therapy, Combination ; Feasibility Studies ; Female ; Humans ; Maintenance Chemotherapy ; Neutropenia ; Ovarian Neoplasms ; Paclitaxel ; Peripheral Nervous System Diseases ; Recurrence ; Taxoids

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Risk stratification of abdominopelvic failure for FIGO stage III epithelial ovarian cancer patients: implications for adjuvant radiotherapy.

Jee Suk CHANG ; Woong Sub KOOM ; Sang Wun KIM ; Sunghoon KIM ; Yong Bae KIM ; Young Tae KIM ; Gwi Eon KIM

Journal of Gynecologic Oncology.2013;24(2):146-153. doi:10.3802/jgo.2013.24.2.146

OBJECTIVE: To analyze patterns of abdominopelvic failures and to define subgroups for the use of adjuvant radiotherapy in the International Federation of Gynecology and Obstetrics (FIGO) stage III epithelial ovarian cancer (EOC). METHODS: We reviewed 149 patients treated with debulking surgery followed by intravenous taxane and platinum chemotherapy between 1999 and 2008. Patient characteristics, patterns of failure, abdominopelvic failure APF-free survival (APFFS) and overall survival (OS) were analyzed. RESULTS: The median age of the patients was 51 years. Thirty-two patients (21.5%) were found to have residuum >2 cm after surgery. The median pretreatment CA-125 was 604 and 54.4% of patients had a decline in CA-125 > or =90% between pretreatment and at postoperative 1 month. With a median follow-up of 50 months, 79 patients (53.0%) experienced abdominopelvic failure (APF). The 5-year APF-free survival rate was 41.1%. Lymph node metastasis, size of residual disease, and decline in CA-125 were found to be significant prognostic factors for APF upon multivariate analysis. The group of patients in whom abdominopelvic irradiation was indicated as definitive postoperative treatment comprised 55% of the overall patient population and their 5-year survival rate was 68%. CONCLUSION: The stratification was suggested to predict APF based on lymph node metastasis, size of residual tumor, and decline in CA-125. Adjuvant radiotherapy covering the whole abdominopelvis using the intensity modulation technique may be considered to reduce APF in FIGO stage III EOC patients with intermediate risk.
Bridged Compounds ; Follow-Up Studies ; Gynecology ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Neoplasm, Residual ; Neoplasms, Glandular and Epithelial ; Obstetrics ; Ovarian Neoplasms ; Platinum ; Radiotherapy, Adjuvant ; Survival Rate ; Taxoids

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CA-125 cut-off value as a predictor for complete interval debulking surgery after neoadjuvant chemotherapy in patients with advanced ovarian cancer.

Naoto FURUKAWA ; Yoshikazu SASAKI ; Aiko SHIGEMITSU ; Juria AKASAKA ; Seiji KANAYAMA ; Ryuji KAWAGUCHI ; Hiroshi KOBAYASHI

Journal of Gynecologic Oncology.2013;24(2):141-145. doi:10.3802/jgo.2013.24.2.141

OBJECTIVE: In the present study, we evaluated changes in CA-125 cut-off values predictive of complete interval debulking surgery (IDS) after neoadjuvant chemotherapy (NAC) using receiver operating characteristic (ROC) analysis. METHODS: This retrospective single-institution study included patients with International Federation of Gynecology and Obstetrics (FIGO) stage III epithelial ovarian cancer and a pre-NAC serum CA-125 level of greater than 40 U/mL who were treated with neoadjuvant platinum-based chemotherapy followed by IDS between 1994 and 2009. Logistic regression analysis was used to evaluate univariate and independent multivariate associations with the effect of clinical, pathological, and CA-125 parameters on complete IDS, and ROC analysis was used to determine potential cut-off values of CA-125 for prediction of the possibility of complete IDS. RESULTS: Seventy-five patients were identified. Complete IDS was achieved in 46 (61.3%) patients and non-complete IDS was observed 29 (38.7%). Median pre-NAC CA-125 level was 639 U/mL (range, 57 to 6,539 U/mL) in the complete IDS group and 1,427 U/mL (range, 45 to 10,989 U/mL) in the non-complete IDS group. Median pre-IDS CA-125 level was 15 U/mL (range, 2 to 60 U/mL) in the complete IDS group and 53 U/mL (range, 5 to 980 U/mL) in the non-complete IDS group (p<0.001). Multivariate analyses performed with complete IDS as the endpoint revealed only pre-IDS CA-125 as an independent predictor. The odds ratio of non-complete IDS was 10.861 when the pre-IDS CA-125 level was greater than 20 U/mL. CONCLUSION: The present data suggest that in the setting of IDS after platinum-based NAC for advanced ovarian cancer, a pre-IDS CA-125 level less than 20 U/mL is an independent predictor of complete IDS.
Gynecology ; Humans ; Logistic Models ; Multivariate Analysis ; Neoplasms, Glandular and Epithelial ; Obstetrics ; Odds Ratio ; Ovarian Neoplasms ; Retrospective Studies ; ROC Curve

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Reproductive factors for ovarian cancer in southern Chinese women.

Maria PASALICH ; Dada SU ; Colin W BINNS ; Andy H LEE

Journal of Gynecologic Oncology.2013;24(2):135-140. doi:10.3802/jgo.2013.24.2.135

OBJECTIVE: To investigate the association between reproductive factors and the risk of ovarian cancer among southern Chinese women. METHODS: A hospital-based case-control study was undertaken in Guangzhou, Guangdong Province, between 2006 and 2008. A structured questionnaire was used to obtain information on parity, oral contraceptive use and other reproductive factors in a sample of 500 incident ovarian cancer patients and 500 controls (mean age, 59 years). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using unconditional logistic regression models. RESULTS: High parity was inversely associated with ovarian cancer, with an adjusted OR 0.43 (95% CI, 0.30 to 0.62) for women who had given birth to 3 or more children compared to women who had given no more than one birth. Ever use of oral contraceptives was also protective against ovarian cancer; adjusted OR 0.56 (95% CI, 0.40 to 0.78). No association was found for hormone replacement therapy, menopausal status, hysterectomy and family history of ovarian and/or breast cancer. CONCLUSION: High parity and oral contraceptive use are associated with a lower risk of ovarian cancer in southern Chinese women.
Asian Continental Ancestry Group ; Breast ; Case-Control Studies ; Child ; China ; Contraceptives, Oral ; Female ; Hormone Replacement Therapy ; Humans ; Hysterectomy ; Logistic Models ; Odds Ratio ; Ovarian Neoplasms ; Parity ; Parturition ; Surveys and Questionnaires

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LNG-IUS treatment of non-atypical endometrial hyperplasia in perimenopausal women: a randomized controlled trial.

Hatem ABU HASHIM ; Abdelhady ZAYED ; Essam GHAYATY ; Mohamed EL RAKHAWY

Journal of Gynecologic Oncology.2013;24(2):128-134. doi:10.3802/jgo.2013.24.2.128

OBJECTIVE: To compare the efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS) and oral norethisterone acetate (NET) for treatment of non-atypical endometrial hyperplasia in perimenopausal women. METHODS: One hundred and twenty perimenopausal women with non-atypical endometrial hyperplasia were selected in this randomized controlled trial. Patients received LNG-IUS (n=59) or NET (n=61; 15 mg/day for 3 weeks/cycle) for 3-6 months. Outpatient follow-up with endometrial biopsies were undertaken at 3, 6, and 12 months intervals after treatment. Outcome measures were; the regression rate, the time to regression and hysterectomy rate. RESULTS: A significantly higher regression rate was noted in the LNG-IUS group than in NET group at the 3rd, 6th and 12th month follow-up visits using intention-to-treat analysis (67.8% vs. 47.5%, relative risk [RR], 1.42; 79.7% vs. 60.7%, RR, 1.31; and 88.1% vs. 55.7%, RR, 1.58, respectively). However, no significant difference was found regarding the median time to regression (3 months). The hysterectomy rate during the follow-up period was significantly higher in the NET group (57.4% vs.22%, p<0.001). CONCLUSION: LNG-IUS treatment of non-atypical endometrial hyperplasia in perimenopausal women is more effective than NET for achieving disease regression for the majority within 1 year. Moreover, it can reduce the number of hysterectomies performed.
Biopsy ; Endometrial Hyperplasia ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Norethindrone ; Outcome Assessment (Health Care) ; Outpatients

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A comparison of uterine papillary serous, clear cell carcinomas, and grade 3 endometrioid corpus cancers using 2009 FIGO staging system.

Ha Jeong KIM ; Tae Joong KIM ; Yoo Young LEE ; Chel Hun CHOI ; Jeong Won LEE ; Duk Soo BAE ; Byoung Gie KIM

Journal of Gynecologic Oncology.2013;24(2):120-127. doi:10.3802/jgo.2013.24.2.120

OBJECTIVE: This study was designed to compare survival outcomes of patients with uterine papillary serous carcinoma (UPSC) or clear cell carcinoma (CC) to those of patients with grade 3 endometrioid carcinoma (G3EC) according to 1988 and 2009 International Federation of Gynecology and Obstetrics (FIGO) staging systems. METHODS: We retrospectively reviewed all patients with endometrial cancer treated at a single institution between 1995 and 2009. Among the 647 patients with endometrial cancer, 51 with G3EC and 46 with UPSC and CC histology were confirmed. RESULTS: 1988 FIGO stage, 2009 FIGO stage, and extrauterine metastasis were significantly different between the UPSC and CC group and G3EC group (p=0.002, p=0.041, and p=0.020, respectively). Restaging from the 1988 FIGO to the 2009 FIGO criteria increased the number of stage I cases by 10 (11.0%). Overall, 8 in the UPSC and CC and 2 in the G3EC group were down-staged to stage I. In the UPSC and CC group, the 3-year overall survival for 1988 FIGO stage I was 92.9%. When UPSC and CC patients were restaged using the 2009 staging system, the 3-year overall survival of 2009 FIGO stage I dropped to 81.6%. UPSC and CC was associated with poor OS outcome compared with G3EC, after adjustment for 2009 FIGO stage and other clinicopathologic factors. CONCLUSION: We observed that UPSC and CC patients had different prognosis according to the old and new FIGO staging system. Our results suggest that UPSC and CC compared with the G3EC may retain the 1988 FIGO to be a slightly better discriminator than 2009 FIGO.
Carcinoma, Endometrioid ; Endometrial Neoplasms ; Female ; Gynecology ; Humans ; Neoplasm Metastasis ; Obstetrics ; Prognosis ; Retrospective Studies

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Microscopic lesions of fallopian tubes in endometrioid carcinoma of the endometrium: How effective are the macroscopic tubal sampling techniques?.

Ibrahim KULAC ; Alp USUBUTUN

Journal of Gynecologic Oncology.2013;24(2):114-119. doi:10.3802/jgo.2013.24.2.114

OBJECTIVE: Extrauterine involvement of endometrial carcinoma has a significant effect on the patients' prognosis and treatment decision. In classical method, macroscopic section is taken from the fallopian tube sparing the fimbrial ends. Fimbrial end of fallopian tube may be involved by tumors and precursor lesions. This study aims to determine the importance of sampling of fimbrial ends of fallopian tube in endometrioid endometrial carcinoma specimens. METHODS: We reevaluated the fallopian tubes of 200 cases of endometrioid endometrial carcinoma cases that have no macroscopic tubal lesion. A hundred cases were sampled with classical method, and the other 100 were sampled with a new method that includes the fimbrial ends. Statistical difference was examined by Fisher's exact test. RESULTS: No microscopic tubal lesion lesion was detected in cases that were sampled with the classical method. In contrast, there were 4 cases with tubal lesions in patients sampled with the new technique; 3 of them were located in the fimbrial end. Of the 3, there was one microscopic invasive carcinoma and two proliferative endometrial glandular lesions. Endometriosis was detected in two of the 4 cases with tubal lesions. CONCLUSION: Including the fimbrial end of fallopian tube to macroscopic sampling could detect more tubal lesions, which might provide additional prognostic and pathogenetic information of endometrioid endometrial carcinoma.
Carcinoma, Endometrioid ; Endometrial Neoplasms ; Endometriosis ; Fallopian Tubes ; Female ; Humans ; Prognosis

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Concurrent chemoradiotherapy with low-dose daily cisplatin for high risk uterine cervical cancer: a long-term follow-up study.

Kimio USHIJIMA ; Keizo FUJIYOSHI ; Kouichiro KAWANO ; Naotake TSUDA ; Shin NISHIO ; Hidehiro ETO ; Toshiharu KAMURA

Journal of Gynecologic Oncology.2013;24(2):108-113. doi:10.3802/jgo.2013.24.2.108

OBJECTIVE: To evaluate the clinical efficacy of concurrent chemoradiotherapy (CCRT) using daily low-dose cisplatin for cervical cancer. METHODS: Fifty-one patients with locally advanced cervical cancer (FIGO stage IB2, bulky IIA, IIB-IVA) who were treated with CCRT as primary therapy at Kurume University Hospital between 2000 and 2007 were retrospectively reviewed. CCRT consisted of 5 mg/m2/day of cisplatin 5 days per week, and external beam radiotherapy (EBRT) administrated to whole pelvis to 45-50.6 Gy. High-dose-rate intracavitary brachytherapy was delivered in a single dose of 4-5 Gy at point A, once a week after 20-30 Gy of EBRT. RESULTS: The median follow-up duration was 42 months (range, 5 to 116 months). The overall response rate was 94.1%. Five year overall survival rate was 71.5% and 46.2% in stage I or II, and stage III or IVA, respectively. During follow-up period, 30 recurrences (58.8%) were found, the local failure rate was 39%, and distant failure rate was 35.2%, and both (local and distant) were 15.7%. Hematological toxicities were the most frequent acute toxicities. Grade 3 and 4 neutropenia was observed in 37.3%. Late intestinal toxicities appeared in 7 cases (13.7%), which occurred between 6 and 114 months after treatment. Four cases required bowel surgery. CONCLUSION: CCRT using daily low-dose cisplatin was tolerable and showed favorable initial response as the primary therapy for locally advanced uterine cervical cancer. But there was no remarkable long-term benefit for patients' survival or local disease control in this study. The incidence of late intestinal toxicity still requires further investigation.
Brachytherapy ; Chemoradiotherapy ; Cisplatin ; Follow-Up Studies ; Humans ; Incidence ; Neutropenia ; Pelvis ; Recurrence ; Retrospective Studies ; Survival Rate ; Uterine Cervical Neoplasms

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Should studies of maintenance therapy be maintained in women with ovarian cancer?.

Michael A BOOKMAN

Journal of Gynecologic Oncology.2013;24(2):105-107. doi:10.3802/jgo.2013.24.2.105

No abstract available.
Female ; Humans

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LNG-IUS treatment of non-atypical endometrial hyperplasia: Can Pipelle endometrial sampling be an accurate method of follow-up evaluation?.

Mi Kyoung KIM ; Seok Ju SEONG

Journal of Gynecologic Oncology.2013;24(2):103-104. doi:10.3802/jgo.2013.24.2.103

No abstract available.
Follow-Up Studies

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