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Implications of a two-step procedure in surgical management of patients with early-stage endometrioid endometrial cancer.

Emmanuelle ARSENE ; Geraldine BLEU ; Benjamin MERLOT ; Loic BOULANGER ; Denis VINATIER ; Olivier KERDRAON ; Pierre COLLINET

Journal of Gynecologic Oncology.2015;26(2):125-133. doi:10.3802/jgo.2015.26.2.125

OBJECTIVE: Since European Society for Medical Oncology (ESMO) recommendations and French guidelines, pelvic lymphadenectomy should not be systematically performed for women with early-stage endometrioid endometrial cancer (EEC) preoperatively assessed at presumed low- or intermediate-risk. The aim of our study was to evaluate the change of our surgical practices after ESMO recommendations, and to evaluate the rate and morbidity of second surgical procedure in case of understaging after the first surgery. METHODS: This retrospective single-center study included women with EEC preoperatively assessed at presumed low- or intermediate-risk who had surgery between 2006 and 2013. Two periods were defined the times before and after ESMO recommendations. Demographics characteristics, surgical management, operative morbidity, and rate of understaging were compared. The rate of second surgical procedure required for lymph node resection during the second period and its morbidity were also studied. RESULTS: Sixty-one and sixty-two patients were operated for EEC preoperatively assessed at presumed low-or intermediate-risk before and after ESMO recommendations, respectively. Although immediate pelvic lymphadenectomy was performed more frequently during the first period than the second period (88.5% vs. 19.4%; p<0.001), the rate of postoperative risk-elevating or upstaging were comparable between the two periods (31.1% vs. 27.4%; p=0.71). Among the patients requiring second surgical procedure during the second period (21.0%), 30.8% did not undergo the second surgery due to their comorbidity or old age. For the patients who underwent second surgical procedure, mean operative time of the second procedure was 246.1+/-117.8 minutes. Third operation was required in 33.3% of them because of postoperative complications. CONCLUSION: Since ESMO recommendations, second surgical procedure for lymph node resection is often required for women with EEC presumed at low- or intermediate-risk. This reoperation is not always performed due to age/comorbidity of the patients, and presents a significant morbidity.
Aged ; Carcinoma, Endometrioid/epidemiology/pathology/*surgery ; Endometrial Neoplasms/epidemiology/pathology/*surgery ; Female ; Humans ; *Hysterectomy/methods/statistics & numerical data ; Lymph Node Excision/*methods/standards/statistics & numerical data ; Middle Aged ; Morbidity ; Neoplasm Staging/standards ; Pelvis ; Postoperative Complications/epidemiology ; Prognosis ; Reoperation/statistics & numerical data ; Retrospective Studies ; *Salpingectomy/methods/statistics & numerical data

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Efficacy and tolerability of paclitaxel, ifosfamide, and cisplatin as a neoadjuvant chemotherapy in locally advanced cervical carcinoma.

Giuseppa SCANDURRA ; Giuseppe SCIBILIA ; Giuseppe Luigi BANNA ; Gabriella D'AGATE ; Helga LIPARI ; Stefania GIERI ; Paolo SCOLLO

Journal of Gynecologic Oncology.2015;26(2):118-124. doi:10.3802/jgo.2015.26.2.118

OBJECTIVE: To evaluate the efficacy and tolerability of a neoadjuvant paclitaxel, ifosfamide, and cisplatin chemotherapy in patients with locally advanced cervical carcinoma. METHODS: Patients with histologically confirmed locally advanced cervical carcinoma, aged > or =18 years, were treated with intravenous ifosfamide 5,000 mg/m2 and mesna 5,000 mg/m2, on day 1; intravenous paclitaxel 175 mg/m2 and cisplatin 75 mg/m2, on day 2; every 3 weeks for three cycles. Following chemotherapy, operable patients underwent radical hysterectomy and pelvic lymphadenectomy, and, if necessary, adjuvant radiotherapy. RESULTS: One hundred fifty-two patients with median age 53 years (range, 24 to 79 years), FIGO stage IIB in 126 (89%), were treated with chemotherapy for median 3 cycles (range, 1 to 3). Treatment was delayed or withdrawn in 23 patients (15%). One hundred thirty-nine patients (91%) underwent surgery. Postchemotherapy pathological complete response rate was 18% (25 patients). Postoperative radiotherapy was administered in 100 patients (72%). The 5-year overall survival and progression-free survival were 87.3% (95% confidence interval [CI], 84.5 to 90.3) and 76.4% (95% CI, 73.5 to 79.5), respectively. CONCLUSION: Neoadjuvant paclitaxel, ifosfamide, and cisplatin chemotherapy was feasible and effective in the treatment of locally advanced cervical carcinoma patients with older age and more advanced disease stage than reported in previous studies. Hematological and renal toxicity could be carefully prevented.
Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Carcinoma, Squamous Cell/*drug therapy/mortality/pathology ; Cisplatin/*administration & dosage/adverse effects ; Disease Progression ; Feasibility Studies ; Female ; Humans ; Ifosfamide/*administration & dosage/adverse effects ; Middle Aged ; Neoadjuvant Therapy ; Paclitaxel/*administration & dosage/adverse effects ; Retrospective Studies ; Treatment Outcome ; Uterine Cervical Neoplasms/*drug therapy/mortality/pathology ; Young Adult

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Low initial human papillomavirus viral load may indicate worse prognosis in patients with cervical carcinoma treated with surgery.

Ting DENG ; Yanling FENG ; Junsheng ZHENG ; Qidan HUANG ; Jihong LIU

Journal of Gynecologic Oncology.2015;26(2):111-117. doi:10.3802/jgo.2015.26.2.111

OBJECTIVE: To evaluate the prognostic implication of human papillomavirus (HPV) viral load in cervical cancer patients who underwent radical hysterectomy. METHODS: We conducted a retrospective review of patients with stage IA2 through stage IIIA cervical carcinoma who underwent radical hysterectomy at Sun Yat-sen University Cancer Center between January 2005 and December 2009. Patients who had undergone preoperative hybrid capture 2 testing to detect HPV DNA were included. A total of 346 patients positive for HPV DNA were enrolled and stratified into two groups according to the median HPV viral load. RESULTS: HPV viral load was significantly correlated with lymphovascular space invasion (p=0.026) and deep stromal invasion (p=0.024). However, other factors, such as age, stage, histologic grade, histologic type, lymph node metastasis, and tumor size, were not significantly associated with viral load. Low HPV viral load was correlated with poor disease-free survival in univariate analysis (p=0.037) and multivariate analysis (p=0.027). There was no significant difference in overall survival with regard to initial HPV viral load. CONCLUSION: Low initial HPV viral load may be a poor prognostic factor for cervical cancer patients who have undergone radical hysterectomy.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell/*diagnosis/surgery/virology ; Female ; Humans ; Middle Aged ; Papillomaviridae/*isolation & purification ; Papillomavirus Infections/complications/diagnosis/surgery/virology ; Prognosis ; Retrospective Studies ; Treatment Outcome ; Uterine Cervical Neoplasms/*diagnosis/surgery/virology ; *Viral Load ; Young Adult

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Conventional versus nerve-sparing radical surgery for cervical cancer: a meta-analysis.

Hee Seung KIM ; Keewon KIM ; Seung Bum RYOO ; Joung Hwa SEO ; Sang Youn KIM ; Ji Won PARK ; Min A KIM ; Kyoung Sup HONG ; Chang Wook JEONG ; Yong Sang SONG

Journal of Gynecologic Oncology.2015;26(2):100-110. doi:10.3802/jgo.2015.26.2.100

OBJECTIVE: Although nerve-sparing radical surgery (NSRS) is an emerging technique for reducing surgery-related dysfunctions, its efficacy is controversial in patients with cervical cancer. Thus, we performed a meta-analysis to compare clinical outcomes, and urinary, anorectal, and sexual dysfunctions between conventional radical surgery (CRS) and NSRS. METHODS: After searching PubMed, Embase, and the Cochrane Library, two randomized controlled trials, seven prospective and eleven retrospective cohort studies were included with 2,253 patients from January 2000 to February 2014. We performed crude analyses and then conducted subgroup analyses according to study design, quality of study, surgical approach, radicality, and adjustment for potential confounding factors. RESULTS: Crude analyses showed decreases in blood loss, hospital stay, frequency of intraoperative complications, length of the resected vagina, duration of postoperative catheterization (DPC), urinary frequency, and abnormal sensation in NSRS, whereas there were no significant differences in other clinical parameters and dysfunctions between CRS and NSRS. In subgroup analyses, operative time was longer (standardized difference in means, 0.948; 95% confidence interval [CI], 0.642 to 1.253), while intraoperative complications were less common (odds ratio, 0.147; 95% CI, 0.035 to 0.621) in NSRS. Furthermore, subgroup analyses showed that DPC was shorter, urinary incontinence or frequency, and constipation were less frequent in NSRS without adverse effects on survival and sexual functions. CONCLUSION: NSRS may not affect prognosis and sexual dysfunctions in patients with cervical cancer, whereas it may decrease intraoperative complications, and urinary and anorectal dysfunctions despite long operative time and short length of the resected vagina when compared with CRS.
Constipation/epidemiology/etiology ; Female ; Humans ; Hysterectomy/adverse effects/*methods ; Intraoperative Complications/epidemiology ; *Organ Sparing Treatments/adverse effects/methods ; Pelvis/*innervation/surgery ; Rectum/*innervation/surgery ; Sexual Dysfunction, Physiological/epidemiology/etiology ; Urinary Bladder/*innervation/surgery ; Urinary Retention/epidemiology/etiology ; Uterine Cervical Neoplasms/epidemiology/*surgery ; Uterus/innervation/surgery ; Vagina/innervation/surgery

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Efficacy and oncologic safety of nerve-sparing radical hysterectomy for cervical cancer: a randomized controlled trial.

Ju Won ROH ; Dong Ock LEE ; Dong Hoon SUH ; Myong Cheol LIM ; Sang Soo SEO ; Jinsoo CHUNG ; Sun LEE ; Sang Yoon PARK

Journal of Gynecologic Oncology.2015;26(2):90-99. doi:10.3802/jgo.2015.26.2.90

OBJECTIVE: A prospective, randomized controlled trial was conducted to evaluate the efficacy of nerve-sparing radical hysterectomy (NSRH) in preserving bladder function and its oncologic safety in the treatment of cervical cancer. METHODS: From March 2003 to November 2005, 92 patients with cervical cancer stage IA2 to IIA were randomly assigned for surgical treatment with conventional radical hysterectomy (CRH) or NSRH, and 86 patients finally included in the analysis. Adequacy of nerve sparing, radicality, bladder function, and oncologic safety were assessed by quantifying the nerve fibers in the paracervix, measuring the extent of paracervix and harvested lymph nodes (LNs), urodynamic study (UDS) with International Prostate Symptom Score (IPSS), and 10-year disease-free survival (DFS), respectively. RESULTS: There were no differences in clinicopathologic characteristics between two groups. The median number of nerve fiber was 12 (range, 6 to 21) and 30 (range, 17 to 45) in the NSRH and CRH, respectively (p<0.001). The extent of resected paracervix and number of LNs were not different between the two groups. Volume of residual urine and bladder compliance were significantly deteriorated at 12 months after CRH. On the contrary, all parameters of UDS were recovered no later than 3 months after NSRH. Evaluation of the IPSS showed that the frequency of long-term urinary symptom was higher in CRH than in the NSRH group. The median duration before the postvoid residual urine volume became less than 50 mL was 11 days (range, 7 to 26 days) in NSRH group and was 18 days (range, 10 to 85 days) in CRH group (p<0.001). No significant difference was observed in the 10-year DFS between two groups. CONCLUSION: NSRH appears to be effective in preserving bladder function without sacrificing oncologic safety.
Adenocarcinoma/mortality/pathology/surgery ; Adult ; Carcinoma, Adenosquamous/mortality/pathology/surgery ; Carcinoma, Squamous Cell/mortality/pathology/surgery ; Female ; Humans ; Hysterectomy/adverse effects/*methods ; Middle Aged ; *Organ Sparing Treatments/adverse effects/methods ; Pelvis/*innervation/surgery ; Recovery of Function ; Survival Analysis ; Treatment Outcome ; Urinary Bladder/*innervation/physiology/surgery ; Uterine Cervical Neoplasms/mortality/pathology/*surgery ; Uterus/*innervation/surgery

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FIGO's staging classification for cancer of the ovary, fallopian tube, and peritoneum: abridged republication.

Jaime PRAT

Journal of Gynecologic Oncology.2015;26(2):87-89. doi:10.3802/jgo.2015.26.2.87

No abstract available.
Fallopian Tube Neoplasms/classification/*pathology ; Female ; Gynecology/organization & administration/standards ; Humans ; International Agencies ; Neoplasm Staging/methods/*standards ; Obstetrics/organization & administration/standards ; Ovarian Neoplasms/classification/*pathology ; Peritoneal Neoplasms/classification/*pathology ; *Practice Guidelines as Topic

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Ovarian cancer risk reduction through opportunistic salpingectomy.

Janice S KWON

Journal of Gynecologic Oncology.2015;26(2):83-86. doi:10.3802/jgo.2015.26.2.83

No abstract available.
Cost-Benefit Analysis ; *Elective Surgical Procedures/economics/utilization ; Fallopian Tubes/surgery ; Female ; Humans ; Hysterectomy/economics/methods/utilization ; Incidence ; Ovarian Neoplasms/economics/epidemiology/*prevention & control ; *Risk Reduction Behavior ; Salpingectomy/economics/*utilization ; Sterilization, Tubal/economics/utilization

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Nerve-sparing radical hysterectomy: time for a new standard of care for cervical cancer?.

Noriaki SAKURAGI

Journal of Gynecologic Oncology.2015;26(2):81-82. doi:10.3802/jgo.2015.26.2.81

No abstract available.
Female ; Humans ; Hysterectomy/*methods ; *Organ Sparing Treatments ; Pelvis/*innervation ; Rectum/*innervation ; Urinary Bladder/*innervation ; Uterine Cervical Neoplasms/*surgery ; Uterus/*innervation

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A case of inguinal lymph node squamous cell carcinoma of unknown origin, accompanied with carcinoma in situ of cervix.

Sung Ha LEE ; Min Jung KIM ; Hee Jung LEE ; Sa Jin KIM ; Jong Sup PARK ; Soo Young HUR

Journal of Gynecologic Oncology.2008;19(2):145-149. doi:10.3802/jgo.2008.19.2.145

Metastatic Cancer of Unknown Primary Site (CUP) accounts for approximately 3-5% of all malignant neoplasms. CUP represents a heterogeneous group of metastatic tumors for which no primary site can be detected following a thorough medical history, careful clinical examination, and extensive diagnostic work-up. Several authors have reported poor prognosis of this malignancy, because there is no consensus on diagnostic guidelines and optimal therapy. Historically, chemotherapy has been the cornerstone of treatment for patients with CUP. We experienced a case of inguinal lymph node squamous cell carcinoma of unknown origin, accompanied with carcinoma in situ of the cervix. We report this case with a brief review of the literatures.
Carcinoma in Situ ; Carcinoma, Squamous Cell ; Cervix Uteri ; Consensus ; Female ; Humans ; Lymph Nodes ; Prognosis

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Tenascin-X and leukemia inhibitory factor receptor are down-regulated in leiomyoma compared with normal myometrium.

Sun Ok LEE ; Soo Yoon LEE ; Sa Ra LEE ; Woong JU ; Seung Cheol KIM

Journal of Gynecologic Oncology.2008;19(2):139-144. doi:10.3802/jgo.2008.19.2.139

OBJECTIVE: Uterine leiomyomas are the most common tumor of the uterus. But the molecular causes of uterine leiomyoma remain unclear. We conducted the current investigation in order to elucidate the molecular mechanisms in the development of uterine leiomyoma. METHODS: We employed a new and accurate reverse transcription-polymerase chain reaction (RT-PCR) method that involved annealing control primers (ACPs) to identify the genes that are differently expressed in uterine leiomyoma. RESULTS: Using 120 ACPs, we identified and sequenced 14 differently expressed genes (DEGs) in uterine leiomyoma compared with normal myometrium. Basic Local Alignment Search Tool (BLAST) searches were performed to examine the known functions of these genes associated with uterine leiomyoma. We confirmed differently expressed patterns in more cases using the RT-PCR method. We also detected two novel genes, Tenascin-X and Leukemia Inhibitory Factor Receptor (LIFR), which had not yet been reported to have any functions associated with uterine leiomyoma. RT-PCR confirmation shows that both of these two genes are down-regulated in uterine leiomyoma. CONCLUSION: Our results suggest that Tenascin-X and LIFR may play a role in the development of uterine leiomyoma. Although further studies are required to establish the precise mechanisms with which these genes are involved in the genesis of uterine leiomyoma, the present research is significant in that it is the first study which detects down-regulated novel genes in uterine leiomyoma using the ACP system.
Animals ; Female ; Leiomyoma ; Leukemia ; Leukemia Inhibitory Factor ; Mice ; Myometrium ; Receptors, OSM-LIF ; Tenascin ; Uterus

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