Cancer of the corpus uteri: 2021 update Koskas, Martin; Amant, Frédéric; Mirza, Mansoor Raza ...
International journal of gynecology and obstetrics,
October 2021, 2021-10-00, 20211001, Letnik:
155, Številka:
S1
Journal Article
Recenzirano
Odprti dostop
Endometrial cancer is the most common gynecological malignancy in high‐ and middle‐income countries. Although the overall prognosis is relatively good, high‐grade endometrial cancers have a tendency ...to recur. Recurrence needs to be prevented since the prognosis for recurrent endometrial cancer is dismal. Treatment tailored to tumor biology is the optimal strategy to balance treatment efficacy against toxicity. Since The Cancer Genome Atlas defined four molecular subgroups of endometrial cancers, the molecular factors are increasingly used to define prognosis and treatment. Standard treatment consists of hysterectomy and bilateral salpingo‐oophorectomy. Lymphadenectomy (and increasingly sentinel node biopsy) enables identification of lymph node‐positive patients who need adjuvant treatment, including radiotherapy and chemotherapy. Adjuvant therapy is used for Stage I–II patients with high‐risk factors and Stage III patients; chemotherapy is especially used in non‐endometrioid cancers and those in the copy‐number high molecular group characterized by TP53 mutation. In advanced disease, a combination of surgery to no residual disease and chemotherapy with or without radiotherapy results in the best outcome. Surgery for recurrent disease is only advocated in patients with a good performance status with a relatively long disease‐free interval.
Synopsis
The latest state‐of‐the‐art treatment for endometrial cancer is described, incorporating the most recent new data that influence its clinical management.
Cancer of the corpus uteri Amant, Frédéric; Mirza, Mansoor Raza; Koskas, Martin ...
International journal of gynecology and obstetrics,
October 2018, 2018-Oct, 2018-10-00, 20181001, Letnik:
143, Številka:
S2
Journal Article
Recenzirano
Odprti dostop
Endometrial cancer is the most common gynecological malignancy in high‐income countries. Although the overall prognosis is relatively good, high‐grade endometrial cancers have a tendency to recur. ...Recurrence needs to be prevented since the prognosis for recurrent endometrial cancer is dismal. Treatment tailored to tumor biology is the optimal strategy to balance treatment efficacy against toxicity. Standard treatment consists of hysterectomy and bilateral salpingo‐oophorectomy. Lymphadenectomy (with ongoing studies of sentinel node biopsy) enables identification of lymph node positive patients who need adjuvant treatment, including radiotherapy and chemotherapy. Adjuvant radiotherapy is used for Stage I–II patients with high‐risk factors and Stage III lymph node negative patients. In advanced disease, a combination of surgery to no residual disease and chemotherapy results in the best outcome. Surgery for recurrent disease is only advocated in patients with a good performance status with a relatively long disease‐free interval.
The latest state‐of‐the‐art treatment for endometrial cancer is described, incorporating the most recent new data that influence its clinical management.
Management of pregnancy in women with cancer Wolters, Vera; Heimovaara, Joosje; Maggen, Charlotte ...
International journal of gynecological cancer,
03/2021, Letnik:
31, Številka:
3
Journal Article
Recenzirano
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As the incidence of cancer in pregnancy has been increasing in recent decades, more specialists are confronted with a complex oncologic-obstetric decision-making process. With the establishment of ...(inter)national registries, including the International Network on Cancer, Infertility and Pregnancy, and an increasing number of smaller cohort studies, more evidence on the management of cancer during pregnancy is available. As fetal, neonatal, and short-term pediatric outcomes after cancer treatment are reassuring, more women receive treatment during pregnancy. Prenatal treatment should adhere to standard treatment as much as possible to optimize maternal prognosis, always taking into account fetal well-being. In order to guarantee the optimal treatment for both mother and child, a multidisciplinary team of specialists with expertise should be involved. Apart from oncologic treatment, a well-considered obstetric and perinatal management plan discussed with the future parents is crucial. Results of non-invasive prenatal testing are inconclusive in women with cancer and alternatives for prenatal anomaly screening should be used. Especially in women treated with chemotherapy, serial ultrasounds are strongly recommended to follow-up fetal growth and cervical length. After birth, a neonatal assessment allows the identification of any cancer or treatment-related adverse events. In addition, placental histologic examination aims to assess the fetal risk of metastasis, especially in women with malignant melanoma or metastatic disease. Breastfeeding is discouraged when systemic treatment needs to be continued after birth. At least a 3-week interval between the last treatment and nursing is recommended to prevent any treatment-induced neonatal effects from most non-platinum chemotherapeutic agents.
Endometrial cancer is the most common type of cancer of the female reproductive tract. Although prognosis is generally good for patients with low-grade and early-stage diseases, the outcomes for ...high-grade and metastatic/recurrent cases remain poor, since traditional chemotherapy regimens based on platinum and taxanes have limited effects. No targeted agents have been approved so far, although several new drugs have been tested without striking results in clinical trials. Over the last decades, many efforts have been made towards the establishment and development of preclinical models, aiming at recapitulating the structural and molecular determinants of the disease. Here, we present an overview of the most commonly used in vitro and in vivo models and discuss their peculiar features, describing their main applications and the value in the advancement of both fundamental and translational endometrial cancer research.
Since the conception of the definition of PABC, more data on the cellular and molecular differences between PrBC and PPBC (including their respective tissue microenvironments figure, B) have become ...available. In clinical practice, this difference is obvious: the treatment of PrBC is individualised according to gestational age and taking foetal safety into consideration, whereas treatment decisions for PPBC do not need to account for these concerns. ...there is a need for a better understanding of the importance of parity status as an independent prognostic factor for worse outcomes in premenopausal breast cancer. Only a separate investigation of both entities will improve our understanding of the biology of breast cancer during pregnancy, lactation, involution, and thereafter, and help to decipher the pathways underlying differences in tumour biology. ...we recommend that the term PABC is no longer used, allowing investigators to focus specifically on breast cancer during pregnancy (PrBC) or during the postpartum period (PPBC), which could ultimately lead to optimised therapeutic modalities, particularly for PPBC with a poor prognosis.
Advocates for not doing a surgical staging procedure refer to the absence of a survival benefit in randomised studies.3,4 Although these studies have their weaknesses, patients are instead offered ...adjuvant pelvic external beam radiotherapy (EBRT) and brachytherapy in high-to-intermediate risk and high-risk patients to improve local control and relapse-free interval.2 Advocates for lymphadenectomy rely on well designed retrospective studies.5,6 In contrast with radiotherapy, pelvic lymphadenectomy allows the identification of nodal disease. In The Lancet Oncology, Emma Rossi and colleagues report on the outcomes of the FIRES trial.8 In this prospective study across ten centres in the USA, sentinel-lymph-node mapping followed by the gold standard pelvic lymphadenectomy was done in 340 patients.
Clinical management of uterine sarcomas Amant, Frédéric, Prof; Coosemans, An, MD; Debiec-Rychter, Maria, Prof ...
The lancet oncology,
12/2009, Letnik:
10, Številka:
12
Journal Article
Recenzirano
Summary Malignant pure mesenchymal uterine tumours encompass endometrial stromal sarcoma (ESS), uterine leiomyosarcoma, and undifferentiated sarcomas. This Review discusses pathology, preoperative ...diagnosis, and standard treatment of uterine leiomyosarcoma and low-grade ESS (distinct from undifferentiated uterine sarcomas), with an emphasis on targeted treatment. We show that several features on ultrasonography and MRI can raise suspicion of a uterine sarcoma; however, there are no pathognomonic features on any imaging technique. For both ESS and uterine leiomyosarcoma, hysterectomy with bilateral salpingo-oophorectomy, but without lymphadenectomy, is the standard surgical treatment for early stage disease. The clinical benefit of chemotherapy is limited, which underscores the importance of targeted therapy. ESS and uterine leiomyosarcoma are driven by different pathways, resulting in a different clinical behaviour. ESS typically is a hormone-sensitive tumour with indolent growth. Uterine leiomyosarcoma is notorious for its aggressive growth and poor outcome. Individualisation of treatment is mandatory, because randomised trials are almost non-existent. The progesterone and oestrogen receptors are clinically important targets for most primarily advanced or recurrent ESS and a subset of recurrent uterine leiomyosarcomas. Potential future targets and targeted treatments that are under investigation are presented for both entities.
The first joint European Society for Medical Oncology (ESMO), European SocieTy for Radiotherapy & Oncology (ESTRO) and European Society of Gynaecological Oncology (ESGO) consensus conference on ...endometrial cancer was held on 11-13 December 2014 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of endometrial cancer. Before the conference, the expert panel prepared three clinically-relevant questions about endometrial cancer relating to the following four areas: prevention and screening, surgery, adjuvant treatment and advanced and recurrent disease. All relevant scientific literature, as identified by the experts, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. Results of this consensus conference, together with a summary of evidence supporting each recommendation, are detailed in this article. All participants have approved this final article.
Breast cancer in pregnancy Amant, Frédéric, Dr; Loibl, Sibylle, MD; Neven, Patrick, MD ...
The Lancet (British edition),
02/2012, Letnik:
379, Številka:
9815
Journal Article
Recenzirano
Breast cancer staging and treatment are possible during pregnancy, and should be defined in a multidisciplinary setting. Tumour biology, tumour stage, and gestational stage at diagnosis determine the ...appropriate approach. Surgery for breast cancer is possible during all trimesters of pregnancy. Radiotherapy is possible during pregnancy but, dependent on the fetal dose received, can result in poor fetal outcomes. The decision to give radiotherapy should be made on an individual basis. Evidence increasingly supports administration of chemotherapy from 14 weeks' gestation onwards. New breast cancer treatments might be applicable to pregnant patients, but tamoxifen and trastuzumab are contraindicated during pregnancy. Cancer treatment during pregnancy will decrease the need for early delivery and thus prematurity, which is a major concern in management of breast cancer in pregnancy.
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