The treatment of cervical cancer patients relies on surgery and radiotherapy (according to the stage) and requires a multimodal discussion before any treatment to avoid adding the morbidities of each ...individual intervention and to optimize functional and oncological outcomes. The places of surgery and radiotherapy have been highlighted in recent international guidelines. For early stage tumors, an exclusive surgery with or without fertility sparing (according to well defined criteria) is the therapeutic standard. For tumors with risk factors (measuring more than 2cm in size and/or presence of lymphovascular invasion) a preoperative brachytherapy can be proposed to minimize the need for postoperative external beam radiotherapy and optimize local control. For locally advanced disease, the standard treatment relies on chemoradiation followed by a brachytherapy boost. A primary paraaortic lymph node dissection may guide radiotherapy volumes and is useful to identify patients requiring a para-aortic radiotherapy. The technical evolutions of surgical approaches and technological improvement of radiotherapy and brachytherapy should be analyzed in the context of prospective studies. We review the literature on the respective places of radiotherapy and surgery for the treatment of cervical cancer.
The purpose of the current study was to evaluate the characteristics of borderline ovarian tumors (BOTs) diagnosed during pregnancy.
We conducted a retrospective multicenter study of 40 patients with ...BOTs diagnosed during pregnancy between 1997 and 2009 at five tertiary universitary departments of Gynecology and Obstetrics and one French cancer center. The medical records were reviewed to determine surgical procedure, histology, restaging surgery and recurrence.
Mean patient age was 30.2±5.4 years. Most BOTs were diagnosed during the first trimester of pregnancy (62%). Salpingo-oophorectomy (N = 24) was more frequently performed than cystectomy (N = 11) during pregnancy (P = 0.01). Only two patients had an initial complete staging. BOTs were mucinous, serous and mixed in 48%, 42% and 10% of patients, respectively. Twenty-one percent of mucinous BOTs exhibited intraepithelial carcinoma or microinvasion. Forty-seven percent of serous BOTs exhibited micropapillary features, noninvasive implants or microinvasion. Restaging surgery performed in 52% patients resulted in upstaging in 24% of cases. Recurrence rate in patients with serous BOT with micropapillary features or peritoneal implants was 7.5%.
BOTs diagnosed during pregnancy exhibit a high incidence of aggressive features and are rarely completely staged initially. Given this setting, up-front salpingo-oophorectomy should be considered and restaging planned.
This study concerns the process by which agents select control laws. Participants adjusted their walking speed in a virtual environment in order to intercept approaching targets. Successful ...interception can be achieved with a constant bearing angle (CBA) strategy that relies on prospective information, or with a modified required velocity (MRV) strategy, which also includes predictive information. We manipulated the curvature of the target paths and the display condition of these paths. The curvature manipulation had large effects on the walking kinematics when the target paths were not displayed (informationally poor display). In contrast, the walking kinematics were less affected by the curvature manipulation when the target paths were displayed (informationally rich display). This indicates that participants used an MRV strategy in the informationally rich display and a CBA strategy in the informationally poor display. Quantitative fits of the respective models confirm this information-driven switch between the use of a strategy that relies on prospective information and a strategy that includes predictive information. We conclude that agents are able of taking advantage of available information by selecting a suitable control law.
In theory, a safe approach to an intersection implies that drivers can simultaneously manage two scenarios: they either choose to cross or to give way to an oncoming vehicle. In this article we ...formalize the critical time for safe crossing (CT cross ) and the critical time for safe stopping (CT stop ) to represent crossing and stopping possibilities, respectively. We describe these critical times in terms of affordances and empirically test their respective contribution to the driver's decision-making process. Using a driving simulator, three groups of participants drove cars with identical acceleration capabilities and different braking capabilities. They were asked to try to cross an intersection where there was an oncoming vehicle, if they deemed the maneuver to be safe. If not, they could decide to stop or, as a last resort, make an emergency exit. The intersections were identical among groups. Results showed that although the crossing possibilities (CT cross ) were the same for all groups, there were between-group differences in crossing frequency. This suggests that stopping possibilities (CT stop ) play a role in the driver's decision-making process, in addition to the crossing possibilities. These results can be accounted for by a behavioral model of decision making, and provide support for the hypothesis of choice between affordances.
Climatic Research Unit temperature version 5 (CRUTEM5) is an extensive revision of our land surface air temperature data set. We have expanded the underlying compilation of monthly temperature ...records from 5,583 to 10,639 stations, of which those with sufficient data to be used in the gridded data set has grown from 4,842 to 7,983. Many station records have also been extended or replaced by series that have been homogenized by national meteorological and hydrological services. We have improved the identification of potential outliers in these data to better capture outliers during the reference period; to avoid classifying some real regional temperature extremes as outliers; and to reduce trends in outlier counts arising from climatic warming. Due to these updates, the gridded data set shows some regional increases in station density and regional changes in temperature anomalies. Nonetheless, the global‐mean timeseries of land air temperature is only slightly modified compared with previous versions and previous conclusions are not altered. The standard gridding algorithm and comprehensive error model are the same as for the previous version, but we have explored an alternative gridding algorithm that removes the under‐representation of high latitude stations. The alternative gridding increases estimated global‐mean land warming by about 0.1°C over the course of the whole record. The warming from 1861–1900 to the mean of the last 5 years is 1.6°C using the standard gridding (with a 95% confidence interval for errors on individual annual means of −0.11 to +0.10°C in recent years), while the alternative gridding gives a change of 1.7°C.
Key Points
We describe the fifth major update of a data set of global land air temperature, CRUTEM5
CRUTEM5 is based on an expanded network of 7,983 stations (up from 4,842) and improved identification of outlier values
The estimated increase in global land air temperature from 1861–1900 to 2015–2019 is 1.6°C (or 1.7°C with an alternative gridding method)
Background
Pelvic exenteration remains one of the most mutilating procedures, with important postoperative morbidity, an altered body image, and long-term physical and psychosocial concerns. This ...study aimed to assess quality of life (QOL) during the first year after pelvic exenteration for gynecologic malignancy performed with curative intent.
Methods
A French multicentric prospective study was performed by including patients who underwent pelvic exenteration. Quality of life by measurement of functional and symptom scales was assessed using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 (version 3.0) and the EORTC QLQ-OV28 questionnaires before surgery, at baseline, and 1, 3, 6, and 12 months after the procedure.
Results
The study enrolled 97 patients. Quality of life including physical, personal, fatigue, and anorexia reported in the QLQ-C30 was significantly reduced 1 month postoperatively and improved at least to baseline level 1 year after the procedure. Body image also was significantly reduced 1 month postoperatively. Global health, emotional, dyspnea, and anorexia items were significantly improved 1 year after surgery compared with baseline values. Unlike younger patients, elderly patients did not regain physical and social activities after pelvic exenteration.
Conclusions
Therapeutic decision on performing a pelvic exenteration can have a severe and permanent impact on all aspects of patients’ QOL. Deterioration of QOL was most significant during the first 3 months after surgery. Elderly patients were the only group of patients with permanent decreased physical and social function. Preoperative evaluation and postoperative follow-up evaluation should include health-related QOL instruments, counseling by a multidisciplinary team to cover all aspects concerning stoma care, sexual function, and long-term concerns after surgery.
Purpose
Patients with locally advanced cervical cancer (LACC) are usually treated with concurrent chemoradiotherapy. Extended-field chemoradiotherapy is indicated in case of para-aortic node ...involvement at initial assessment. 18-Fluoro-2-deoxy-
d
-glucose positron emission tomography/computed tomography (18-FDG PET/CT) is currently considered to be the most accurate method of detection of node or distant metastases. The goal of this study was to evaluate the accuracy of PET at detecting para-aortic lymph node metastases in LACC patients with a negative morphological imaging.
Methods
Patients from five French institutions with LACC and both negative morphologic (magnetic resonance imaging, CT scan) and functional (PET or PET/CT) findings at the para-aortic level and distantly were submitted to a systematic infrarenal para-aortic node dissection either by laparoscopy or laparotomy. On the basis of pathological results, sensitivity, specificity, and positive and negative predictive values of PET/CT were assessed for para-aortic lymph node involvement.
Results
A total of 125 LACC patients (stage IB2–IVA disease with two local recurrences) fulfilled the inclusion criteria. All had an ilio-infrarenal para-aortic lymphadenectomy, either by laparoscopy (
n
= 117) or laparotomy (
n
= 8). Twenty-one patients (16.8%) had pathologically proven para-aortic metastases. Among them, 14 (66.7%) had negative PET/CT. Overall morbidity of surgery was 7.2%. All but one of the complications were mild and did not delay chemoradiotherapy. Sensitivity, specificity, and positive and negative predictive value of the PET/CT were 33.3, 94.2, 53.8, and 87.5%, respectively, for the detection of microscopic lymph node metastases.
Conclusions
Laparoscopic staging surgery seems warranted in LACC patients with negative PET scan who are candidates for definitive concurrent chemoradiotherapy or exenteration.
Abstract
STUDY QUESTION
Can a nomogram be used to predict the individual probability of live birth (LB) in women with borderline ovarian tumours (BOTs) receiving primary fertility-sparing surgery?
...SUMMARY ANSWER
A nomogram built according to the woman's age, histological subtype (serous versus mucinous), type of ovarian surgical treatment and FIGO stage can accurately predict the probability of LB in women with BOT.
WHAT IS KNOWN ALREADY
Current prediction models determine the probability of pregnancy after medically assisted reproduction (MAR) and form the basis of patient counselling to guide the decision as to whether to consider in vitro fertilization but do not take into account prediction of the LB rate.
STUDY DESIGN, SIZE, DURATION
This was a retrospective multi-centre study including 187 women with fertility-sparing surgery for BOT diagnosed between January 1980 and December 2013.
PARTICIPANTS/MATERIALS, SETTING, METHODS
A multivariate logistic regression analysis of selected factors and a nomogram to predict the subsequent LB rate was constructed. A bootstrapping technique was used for internal validation.
MAIN RESULTS AND THE ROLE OF CHANCE
Fifty-one women had LB (27.3%). Taking into account multiple pregnancies, the overall LB rate was 40.1% (75/187). Federation International of Gynaecology and Obstetric (FIGO) stage, age at diagnosis, histological subtype and surgery type were included in the nomogram. The predictive model had an AUC of 0.742 (95% CI, 0.644–0.825) and 0.72 (95% CI, 0.621–0.805) before and after the 200 repetitions of bootstrap sample corrections, respectively, and showed a good calibration.
LIMITATIONS, REASONS FOR CAUTION
The retrospective nature of the study cannot exclude all biases. Our nomogram is based on simple criteria, but did not take into account the evaluation of ovarian reserve. It demonstrates a fair relevance, but requires external validation before routine use.
WIDER IMPLICATIONS OF THE FINDINGS
Clinicians are increasingly interested in such tools to support the patient in making an informed decision about treatment options. This nomogram contributes to the decision-making by defining simple risk factors of poor LB probability that can help identify good candidates for MAR.
STUDY FUNDING/COMPETING INTEREST(S)
No external funding was used for this study. There are no conflicts of interest to declare.
TRIAL REGISTRATION NUMBER
N/A.
Objective
To develop a risk scoring system (RSS) for predicting recurrence in women with borderline ovarian tumours (BOTs).
Design
Cohort study of women with BOTs.
Setting
French multicentre tertiary ...care centres.
Population
A cohort of 360 women with BOTs who received primary surgical treatment between January 2000 and December 2013.
Methods
Clinical and pathological factors affecting recurrence in women with BOTs.
Main outcome measure
The development of a model for the prediction of recurrence in women with BOTs.
Results
Overall the recurrence rate was 20.0% (72/360). Recurrence was associated with five variables: age < 45 years; preoperative serum tumour marker CA125 > 150 IU/mL; a serous histological subtype; International Federation of Gynecology and Obstetrics (FIGO) stage other than IA; and ovarian surgery other than bilateral salpingo‐oophorectomy (BSO; i.e. cystectomy and unilateral salpingo‐oophorectomy). These variables were included in the RSS and assigned scores ranging from 0 to 6. The discrimination of the RSS was 0.82 (95% confidence interval, 95% CI 0.79–0.85). A total score of 8 points corresponded to the optimal threshold of the RSS, with a rate of recurrence of 11.8% (35/297) and 58.7% (37/63) for women at low risk (<8 points) and women at high risk (≥8 points), respectively. The diagnostic accuracy was 85.0%.
Conclusions
This study shows that the risk of BOT recurrence can be accurately predicted so that women at high risk can benefit from adapted surgical treatment.
Tweetable
Our RSS permitted women with BOTs at low risk to be distinguished from women with BOTs at high risk of recurrence.
Tweetable
Our RSS permitted women with BOTs at low risk to be distinguished from women with BOTs at high risk of recurrence.
To evaluate the morbidity and therapeutic value of surgery after concurrent chemoradiotherapy and brachytherapy in a multicentric series of patients with advanced cervical cancer.
Patients with stage ...IB2 to IVA cervical cancer treated with concurrent chemoradiotherapy and pelvic radiotherapy followed by brachytherapy and surgery from seven participating French comprehensive cancer centers were enrolled. The surgical treatment consisted of a hysterectomy, which ranged from radical hysterectomy to anterior pelvic exenteration, and lymph node resection. Acute toxicity, pathological response, overall, and disease-free survival were assessed for each pathological response to therapy.
One hundred seventy-five patients were enrolled from September 1987 to June 2002. The median age was 44 years 27;75. Patients distribution according to clinical classification was as follows: 41 stage IB2, 18 IIA, 77 IIB, 12 IIIA, 14 IIIB, and 13 IVA. Forty-six patients experienced 51 postoperative complications. Thirty-three patients experienced grade 2 morbidity (18.9%, 33/175), among whom 19 experienced urinary complications (57.5%, 19/175). No post treatment mortality was observed. Grade 3 toxicity rate was 6.9% (12/175). Pathological complete response rate was 38% (67/175). After a median follow-up of 36 months, overall survival and disease-free survival were significantly better in patients who had a pathological complete response to therapy than those who achieved a partial pathological response (
P < 0.0001).
Surgery after concurrent chemoradiotherapy and brachytherapy for advanced cervical cancer leads to an acceptable morbidity. Furthermore, surgery allows evaluation of the pathological response to therapy and improves local control in the case of partial pathological response.
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