Objective: The aim of this study was to clarify the clinical significance of isolated tumor cells (ITCs) or micrometastasis (MM) in regional lymph nodes in patients with International Federation of ...Gynecology and Obstetrics (FIGO) stage I to II endometrial cancer. Methods: In this study, a series of 63 patients with FIGO stage I to II were included, who had at least one of the following risk factors for recurrence: G3 endometrioid/serous/clear cell adenocarcinomas, deep myometrial invasion, cervical involvement, lympho-vascular space invasion, and positive peritoneal cytology. These cases were classified as intermediate-risk endometrial cancer. Ultrastaging by multiple slicing, staining with hematoxylin and eosin and cytokeratin, and microscopic examination was performed on regional lymph nodes that had been diagnosed as negative for metastases. Results: Among 61 patients in whom paraffin-embedded block was available, ITC/MM was identified in nine patients (14. 8%). Deep myometrial invasion was significantly associated with ITC/MM (p=0. 028). ITC/MM was an independent risk factor for extrapelvic recurrence (hazard ratio, 17. 9; 95% confidence interval CI, 1. 4 to 232. 2). The 8-year overall survival (OS) and recurrence-free survival (RFS) rates were more than 20% lower in the ITC/MM group than in the node-negative group (OS, 71. 4% vs. 91. 9%; RFS, 55. 6% vs. 84. 0%), which were statistically not significant (OS, p=0. 074; RFS, p=0. 066). Time to recurrence tended to be longer in the ITC/MM group than in the node-negative group (median, 49 months vs. 16. 5 months; p=0. 080). Conclusions: It remains unclear whether ITC/MM have an adverse influence on prognosis of intermediate-risk endometrial cancer. A multicenter cooperative study is needed to clarify the clinical significance of ITC/MM.
ABSTRACT For the purpose of improving the clinical efficacy of alpha‐fetoprotein (AFP)‐L3% in prenatal screening for trisomy 21, we calculated the multiple of the median (MoM) of AFP‐L3% (L3 MoM) ...and the ratio of L3 MoM to AFP MoM (L3 MoM/AFP MoM) in maternal serum. Maternal serum samples from 1822 women (maternal age 37.3 ± 3.8 years, and weeks of gestation 16.0 ± 1.0; mean ± SD) with unaffected pregnancies and 28 women (37.6 ± 4.6 years, 16.6 ± 3.1) pregnant with of trisomy 21 fetuses were obtained. The AFP concentration and AFP‐L3% in maternal serum were measured using a liquid‐phase binding assay. The areas under the receiver operating characteristic curves (AUCs) of AFP MoM, AFP‐L3%, L3 MoM, and L3 MoM/AFP MoM were 0.750, 0.868, 0.949 and 0.946, respectively. The AUCs of L3 MoM and L3 MoM/AFP MoM were significantly higher than AFP‐L3% (P < 0.05) and AFP MoM (P < 0.0005). However, no statistical difference was observed between the AUCs of L3 MoM and L3 MoM/AFP MoM. In conclusion, the L3 MoM should be an effective replacement for AFP‐L3% in prenatal trisomy 21 screening.
Objective: Concurrent chemoradiotherapy (CCRT) is the primary treatment for locally advanced cervical cancer. We studied prognostic factors for patients treated with CCRT. Methods: We retrospectively ...reviewed records of 85 consecutive patients with cervical cancer who were treated with CCRT between 2002 and 2011, with external beam radiation therapy, intracavitary brachytherapy, and platinum-based chemotherapy. Survival data were analyzed with Kaplan-Meier methods and Cox proportional hazard models. Results: Of the 85 patients, 69 patients (81%) had International Federation of Gynecology and Obstetrics (FIGO) stage III/IV disease; 25 patients (29%) had pelvic lymph node enlargement (based on magnetic resonance imaging), and 64 patients (75%) achieved clinical remission following treatment. Median maximum tumor diameter was 5.5 cm. The 3- and 5-year overall survival rates were 60.3% and 55.5%, respectively. Cox regression analysis showed tumor diameter >6 cm (hazard ratio HR, 2.3; 95% confidence interval CI, 1.2 to 4.6), pelvic lymph node enlargement (HR, 2.2; 95% CI, 1.1 to 4.5), and distant metastasis (HR, 10.0; 95% CI, 3.7 to 27.0) were significantly and independently related to poor outcomes. Conclusion: New treatment strategies should be considered for locally advanced cervical cancers with tumors >6 cm and radiologically enlarged pelvic lymph nodes.
Background: This study was conducted to investigate the recommended dose of paclitaxel for use in combination with a fixed dose of carboplatin and to evaluate the toxicity and efficacy of ...carboplatin–paclitaxel combination chemotherapy in patients with epithelial ovarian cancer. Methods: One hundred and ten patients were enrolled in the Phase I/II study and 97 patients were evaluated for further analysis, excluding 13 ineligible patients or patients with infringement of protocol: 15 patients for the Phase I and 82 for the Phase II study. In the Phase I trial, we studied dose escalation using a carboplatin dose of AUC 5 and paclitaxel levels of 150, 175 and 200 mg/m2. The grades of toxicity of the regimen of all patients enrolled in the Phase II study (n = 82), the progression-free survival time (PFS) of optimal-debulked patients and complete responders (n = 62) and the response rate of suboptimal-debulked patients (n = 39) were investigated. Results: After observing grade 4 neutropenia in four of six patients in the paclitaxel 200 mg/m2 administration group, we chose 175 mg/m2 as the recommended dose of paclitaxel in this regimen. At this dose, the median of PFS and response rate were 432 days (range, 19–907 days) and 66.7%, respectively. Conclusion: Combination chemotherapy using paclitaxel 175 mg/m2 and carboplatin AUC 5 is very well tolerated and highly effective for the treatment of ovarian cancer.
Background: The efficacy of drains and of antibiotics for prophylaxis of postoperative retroperitoneal infections following radical hysterectomy with systematic lymphadenectomy has not yet been ...adequately investigated. Methods: Patients who had just undergone radical hysterectomy were divided into three groups. We used a retroperitoneal drain transvaginally for Groups A (n = 54) and B (n = 55) and transabdominally for Group C (n = 103). Group A was administered a first- and Groups B and C a second- or third-generation cephem antibiotic as the prophylactic antibiotic. We compared the surgery time, blood loss, fever index and febrile morbidity in these three groups. Results: The average surgery time was Group A 344.2 ± 13.7 min (mean ± SE), Group B 425.6 ± 11.0 min and Group C 528.2 ± 10.9 min. A significant difference was observed among the groups (p < 0.05). In terms of blood loss during surgery, a significant increase (p < 0.05) occurred in Groups B (2400 ± 196 g) and C (2373 ± 130 g) compared with Group A (1820 ± 122 g). For fever index, Group A showed a value of 36.1 ± 2.7 dh, Group B 19.9 ± 2.4 dh and Group C 8.8 ± 1.5 dh. A significant difference was observed among the groups (p < 0.01). In terms of febrile morbidity, significant differences (p < 0.01, p < 0.0001) were observed between Groups B (14.6%) and C (8.7%) in comparison with Group A (44.4%), respectively. Conclusion: In radical hysterectomy with systematic lymphadenectomy, it may be preferable to choose transabdominal drains in the retroperitoneal space and second-generation cephem antibiotics for prophylaxis of postoperative retroperitoneal infections.
Case report
A 50-year-old woman with primary serous papillary carcinoma (PSPC) of peritoneal origin located in the posterior uterine serosa and cul-de-sac without peritoneal dissemination. No ...peritoneal dissemination was detected but the tumor metastasized to para-aortic and supraclavicular lymph nodes. After first chemotherapy course, pericardial effusion occurred. A pericardiectomy was performed to prevent cardiac failure. Subsequent chemotherapy with paclitaxel and carboplatin was effective against this tumor
Conclusion
In general, a typical type of PSPC usually develops distant metastasis with diffuse peritoneal dissemination; the present case shows unusual clinical behavior.
Objective Associations between the number of prior chemotherapy (CT) regimens and gastrointestinal (GI) perforation in patients receiving bevacizumab treatment has not been fully investigated. The ...aim of the study was to investigate the impact of > 3 prior CT regimens on GI perforation.MethodsWe retrospectively investigated the medical records of 133 patients with gynecological cancer who received bevacizumab-containing treatment. Bevacizumab was intravenously administered at a dose of 15 mg/kg every 4 weeks. Incidence of GI perforation was compared between < 2 and > 3 prior CT groups. ResultsTwenty-three (17.3%) patients had a history of > 3 CT; these patients received bevacizumab at 4-week intervals. The percentage of patients with prior surgery was significantly higher in the > 3 prior CT group (95.7% vs, 70.0%, P=0.008), while those with prior bowel resection was significantly higher in the > 3 prior CT group (30.4% vs. 12.7%, P=0.034). There was no significant difference in the mean number of bevacizumab cycles between the two groups (10.7 vs. 8.9, P=0.19). While GI perforation was observed in three (2.7%) patients in the < 2 prior CT group, no GI perforation was found in the > 3 prior CT group (P>0.99).ConclusionsA history of > 3 prior CT did not increase the risk for GI perforation when bevacizumab is administered at a dose of 15 mg/kg every 4 weeks in our cases.
There has been no report on the effectiveness of combination chemotherapy consisting of paclitaxel and carboplatin for pure-type ovarian squamous cell carcinoma (POSCC).
A 56-year-old Japanese woman ...diagnosed as having pT2c pN1 M0 pure-type ovarian squamous cell carcinoma was treated with combination chemotherapy consisting of paclitaxel and carboplatin every 3 weeks. Four months after the initial chemotherapy, multiple lung tumors appeared and a new tumor in the internal iliac area appeared. She died of disease 12 months after the first treatment.
Adjuvant chemotherapy consisting of paclitaxel and carboplatin for ovarian squamous cell carcinoma were not effective in this case.
PDF
