Glassy cell carcinoma (GCC) of the uterine cervix is a rare entity. This study aims at describing the clinical characteristics and outcomes of cervical GCC patients treated in a comprehensive cancer ...center.
We retrospectively reported patients and tumors characteristics, therapeutic management, overall survival (OS), progression-free progression (PFS), relapse rates, and toxicities.
Between 1994 and 2014, 55 patients were treated with curative intent. The median age at diagnosis was 41 years (range, 20–68). Among 22 patients with early stage tumors (IA2-IB1-IIA1), 17 had preoperative brachytherapy, followed by radical hysterectomy. Among 33 patients with locally advanced disease (≥IB2), 32 underwent chemoradiation±brachytherapy boost. After a median follow-up of 5.4 years (range, 0.15–21.7 years), 18/55 (33%) patients experienced tumor relapse. Local recurrence occurred in 2/22 (9%) patients with early disease (treated with upfront surgery) and in 3/32 (9%) patients with locally advanced disease. Most frequent relapses were distant, occurring in a total of 11/55 patients (20%). PFS rates at 5-year were 86.4% (95% CI: 63.4–95.4) for early stage versus 75.9% (95% CI: 55.2–89.2) for locally advanced stages, respectively (P=0.18).
Large cohort data are warranted to guide the optimal management of GCC. From this retrospective analysis, a multimodal approach yielded to good disease control in early stages tumors. Given the high-risk of distant failure, consideration should be given to adjuvant chemotherapy in locally advanced disease.
Le « glassy cell carcinoma » du col utérin est une entité rare. Cette étude rétrospective décrit les caractéristiques cliniques et thérapeutiques des patientes atteintes de « glassy cell carcinoma ».
Nous rapportons les caractéristiques des patientes et des tumeurs, les types de traitements reçus, les survies globales et sans progression, les taux de rechute et la toxicité.
Entre 1994 et 2014, 55 patientes ont été traitées à visée curative à l’institut Gustave-Roussy. L’âge médian au moment du diagnostic était de 41 ans (20–68). Parmi 22 patientes atteintes de tumeur de stade précoce (IA2-IB1-IIA1), 17 ont reçu une curiethérapie préopératoire, suivie d’une hystérectomie totale. Parmi 33 patientes atteintes d’une maladie localement évoluée (stade≥IB2), 32 ont reçu une chimioradiothérapie avec ou sans curiethérapie. Après un suivi médian de 5,4 ans (0,15–21,7 ans), 18/55 (33 %) patientes ont été atteintes d’une rechute tumorale. Une récidive locale est survenue chez 2/22 (9 %) patientes atteintes d’une tumeur de stade précoce (traitées par chirurgie initiale) et chez 3/32 (9 %) patientes atteintes d’une maladie localement évoluée. Les rechutes les plus fréquentes étaient métastatiques, survenant chez 11/55 patientes (20 %). Les taux de survie sans progression à 5 ans étaient de 86,4 % (IC à 95 % intervalle de confiance à 95 % : 63,4–95,4) respectivement pour les tumeurs de stade précoce contre 75,9 % (IC à 95 % : 55,2–89,2) pour celles localement évoluées (p=0,18).
Une approche multimodale a permis un bon contrôle de la maladie dans lesstades précoces. Compte tenu du risque élevé d’échec à distance, une chimiothérapie adjuvante devrait être envisagée dans les maladies localement évoluées.
The Obermair nomogram was recently developed to predict the risk of relapse in patients with borderline ovarian tumours (BOTs) based on five readily available clinical, biological, and pathological ...characteristics. We set out to externally validate and assess its robustness using a multi-institutional BOT database.
All consecutive patients treated for BOTs in the two participating centres between January 1980 and December 2008 and who had all the nomogram variables documented were identified for analysis.
Three hundred and fourteen eligible patients were identified and used for external validation analysis. The median follow-up and initial relapse time were 46.43 (range: 0.1-360) and 66.64 (range: 8-77) months, respectively. The nomogram concordance index was 0.54 (95% CI, 0.52-0.56). The correspondence between the actual relapse and the nomogram predictions suggests a limited calibration of the nomogram in the validation cohort.
This external validation study of the Obermair nomogram showed limitations in its generalisability to a new and independent patient population.
For gynecological cancers, even at an early stage, the standard treatment is "radical excision" involving hysterectomy (radical or not) with bilateral salpingo-oophorectomy. But for young patients ...with early stage disease, many recent studies have focused on preservation of subsequent fertility by keeping at least one ovary and the uterus. The main objective of this fertility-sparing surgery is to preserve fertility, if this can be accomplished without increasing the oncological risks. Whether the initial site of the cancer is the cervix, uterine fundus or ovary, the oncologic validation of fertility-sparing treatment requires several evaluation criteria: a rigorous clinical, radiological and surgical staging to verify that the pathology is truly at an early initial stage; expert pathologic interpretation of biopsy specimens to validate the histological criteria of "good prognosis"; provision of complete and understandable patient education verifying the true objectives for this fertility-sparing treatment (whose intent is to retain a potential for subsequent fertility without guaranteeing it) and provision of an explanation of the oncological constraints and implications of fertility-sparing surgery in the event of a possible pregnancy. As always in oncology, this strategy demands teamwork requiring successive discussions with the patient and spouse and thorough discussion of the oncological safety of this fertility-sparing strategy in multidisciplinary consultation meetings before "giving a green light".
Background
Behavior of serous borderline ovarian tumors with micropapillary patterns (MP-SBOT) is thought to be worse than those without micropapillary patterns, but few cohort studies have compared ...epidemiological characteristics, surgical management, and recurrence rates between these two groups.
Methods
In a French retrospective multicenter study of 475 borderline ovarian tumors (BOT) treated from 1990 to 2009, we studied patients with a serous BOT and treated after 2000 including 20 patients with and 77 patients without micropapillary patterns.
Results
Patients with MP-SBOT were younger (
P
= 0.01), often asymptomatic (
P
= 0.04), and with abnormal CA 125 serum levels (
P
= 0.04). Peritoneal implants were more frequently observed in these patients (
P
= 0.01); also, they underwent conservative treatment more frequently (
P
= 0.002), had a higher risk of misdiagnosis with invasive carcinoma by intraoperative histology (
P
< 0.05), and had more frequent restaging surgery (
P
= 0.001). No difference in recurrence was noted between the groups. No disease-related mortality was observed.
Conclusions
Patients with MP-SBOT represent a heterogeneous population in terms of presence of invasive peritoneal implants. Conservative surgery could be a suitable option for MP-SBOT patients without implants and who wish to conserve childbearing potential, without increasing the risk of recurrence.
Abstract Introduction The aim of the present study was to prospectively evaluate morbidity of intra-peritoneal hyperthermic chemotherapy (HIPEC) using Oxaliplatin as consolidation therapy for ...advanced epithelial ovarian carcinoma and, secondly, to study peritoneal recurrence. Methods Between 2004 and 2007, 31 patients from 18 to 65 years with FIGO stage IIIC epithelial ovarian carcinoma were treated by surgery and a total of 6 cycles of platinum based chemotherapy. Those patients were eligible for consolidation therapy. We performed a second look laparotomy operation with intra-peritoneal hyperthermic chemotherapy. We used Oxaliplatin 460 mg/m2 with 2 l/m2 of dextrose in an open medial laparotomy for a total of 30 min at a temperature of 42–44 °C. Results The grade 3 morbidity rate was 29% (95 CI: 14–45%). Nine patients experienced a total of 13 exploratory laparotomies for intra-abdominal bleeding after HIPEC. Two-year disease free and overall survival were 27% and 67% respectively. As a result of this high level of morbidity the trial was closed. Conclusion Using intra-peritoneal Oxaliplatin associated with hyperthermia as consolidation therapy for advanced ovarian cancer results in a high risk of grade 3 morbidities with only a small benefit on survival.
Background: The aim of this study was to determine the prognostic factors for patients with advanced stage, low malignant potential ovarian tumour (LMPOT). Patients and methods: A retrospective ...review of 80 patients with serous LMPOT and peritoneal implants treated at or referred to our institution was carried out. Results: Sixty-five patients had non-invasive implants. Fifteen patients had invasive implants. Twenty-nine patients had stage II and 51 patients had stage III disease. Three patients died of evolutive invasive disease and four of complications of treatment. The only prognostic factor of progression to ‘evolutive invasive disease’ is the pathologic subtype of peritoneal implants. The 5-year rates of evolutive invasive disease in patients with non-invasive implants and invasive implants were 2% and 31%, respectively (P <0.002). Conclusions: In this series, the only prognostic factor for patients with advanced stage borderline tumour is the type of peritoneal implant. More patients died of the treatment’s complications than of the disease itself. The patients’ prognosis with non-invasive implants seems to be excellent, and conservative management could be discussed in younger patients.
Ovarian yolk sac tumor (YST) is a very rare malignancy arising in young women. Chemotherapy has dramatically improved the prognosis. Current treatment consists of surgery followed by bleomycin, ...etoposide, and cisplatin (BEP) chemotherapy. However, given the rarity of this tumor, ovarian YST-specific survival and outcome after such treatment are not precisely known.
This report concerns prospectively recorded cases that were either treated at Institut Gustave Roussy (Villejuif, France) or referred there for advice about therapy. From 1990 to 2006, 52 patients underwent surgery followed by BEP chemotherapy. Data on patient characteristics, treatment, survival, and fertility outcome were analyzed to assess treatment efficacy and gonadal toxicity after achieving a complete remission.
Thirty-five patients had stage I/II tumors while 17 patients presented with stage III/IV disease. With a median follow-up of 68 months, the overall 5-year survival and disease-free survival rates were 94% and 90%, respectively. Forty-one women underwent fertility-sparing surgery. Pregnancy was achieved in 12 of 16 (75%) women who attempted conception. Overall, 19 pregnancies have been recorded.
BEP chemotherapy following fertility-sparing surgery is a very effective treatment of ovarian YSTs. Most of the patients who attempt conception after complete remission will have children.
Abstract Objective The aim of this study was to review the results of completion surgery after chemoradiation therapy in stage IB2/II cervical carcinoma. Methods Analysis of series published in the ...literature about completion surgery in this context. Results Stages of the disease included in those series were stage IB2–IVA disease. The rate of residual disease was correlated with initial stage of the disease and the use of preoperative brachytherapy. Morbidity of such management varied between 15% and 47% and was correlated with the radicality of the surgical procedure and the size of the residual disease. The rate of complete pathological response varied between 52% and 76%. The survival of patients was correlated with the presence and the size of the residual disease and the presence of a nodal involvement. Conclusion Completion surgery after chemoradiation therapy has a place in the multimodality management of stage IB2 or II cervical cancer, particularly in cases of bulky residual disease. Nevertheless further investigations are needed, particularly with collaborative studies, to analyze the real impact of such surgery on the survival of patients.
Abstract Background Patients with high-risk gestational trophoblastic neoplasia (GTN) need multi-agent chemotherapy to be cured. The most common regimen is etoposide (E), methotrexate (M) and ...actinomycin D (A), alternating weekly with cyclophosphamide (C) plus vincristine (O) (EMA/CO). Cisplatin (P) is a very active drug, but it is usually restricted to second-line therapies. Herein, we report the results of a cisplatin-based therapy: APE (actinomycin D, cisplatin, and etoposide). Patients and methods The efficacy and safety of APE for high-risk GTN (defined by Institut Gustave-Roussy (IGR) criteria and/or an International Federation of Gynaecology and Obstetrics (FIGO) score >6) are reported. Patients with brain metastasis or placental-site trophoblastic tumour were excluded. Results Between 1985 and 2013, 95 patients were treated with APE for high-risk GTN: 59 patients as first-line, 36 as ⩾2nd-line therapy. There was 94.7% complete remission, though five patients relapsed. One patient died from GTN after multiple lines of chemotherapy. The five-year overall survival rate (median follow-up 5.7 years) was 97% (95% confidence interval (CI): 91–99%). No death from toxicity occurred. Long-term, six grade-1 neuro-toxicities, three grade-1 and two grade-2 oto-toxicities, and one grade-1 renal toxicity were recorded. One patient developed AML-M4 after APE and EMA/CO. Thirty-four of 35 women, who wished to become pregnant, succeeded and all had at least one live birth. Conclusion With a 97% long-term overall survival rate, limited long-term toxicity, and an excellent reproductive outcome, APE could be regarded as an alternative option to EMA/CO as a standard therapy for high-risk GTN.
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