L1CAM Is Not a Predictive Factor in Early-stage Squamous-cell Cervical Cancer

AIM

Our study aimed to assess expression of L1 cell adhesion molecule (L1CAM) in early-stage cervical squamous-cell cancer as a prognostic factor.

PATIENTS AND METHODS

This retrospective, single-institution study included 154 patients who underwent radical hysterectomy for early-stage squamous cell cervical cancer between 2007 and 2017. Tumor samples from 154 patients were available for L1CAM analysis by immunohistochemistry. Among all patients, radical abdominal hysterectomy was performed in 144 cases.

RESULTS

L1CAM expression was positive in 24 tumors (15.6%) of the whole group. In relation to the grade of differentiation and the presence of lymphovascular invasion, L1CAM expression did not show an association (p=0.154 and p=0.306, respectively). The disease-free interval and overall survival also did not significantly differ between L1CAM-positive and L1CAM-negative cases (p=0.427 and p=0.240, respectively). For histopathological characteristics, L1CAM-positive cases had a significantly higher median tumor size (p=0.015). Even in the selected group of 115 cases without nodal infiltration, L1CAM status had no effect on the relapse rate during follow-up.

CONCLUSION

Our study did not confirm the results of previous studies showing L1CAM expression to be a negative prognostic factor in cervical cancer. In our study, increased L1CAM expression in early-stage squamous-cell cervical cancer was not associated with adverse prognosis regarding disease recurrence, disease-free survival, nor overall survival. L1CAM expression was correlated only with the size of the tumor.

Role of adjuvant therapy in intermediate-risk cervical cancer patients - Subanalyses of the SCCAN study

OBJECTIVE

The "intermediate-risk" (IR) group of early-stage cervical cancer patients is characterized by negative pelvic lymph nodes and a combination of tumor-related prognostic risk factors such as tumor size ≥2 cm, lymphovascular space invasion (LVSI), and deep stromal invasion. However, the role of adjuvant treatment in these patients remains controversial. We investigated whether adjuvant (chemo)radiation is associated with a survival benefit after radical surgery in patients with IR cervical cancer.

METHODS

We analyzed data from patients with IR cervical cancer (tumor size 2-4 cm plus LVSI OR tumor size >4 cm; N0; no parametrial invasion; clear surgical margins) who underwent primary curative-intent surgery between 2007 and 2016 and were retrospectively registered in the international multicenter Surveillance in Cervical CANcer (SCCAN) study.

RESULTS

Of 692 analyzed patients, 274 (39.6%) received no adjuvant treatment (AT-) and 418 (60.4%) received radiotherapy or chemoradiotherapy (AT+). The 5-year disease-free survival (83.2% and 80.3%; PDFS = 0.365) and overall survival (88.7% and 89.0%; POS = 0.281) were not significantly different between the AT- and AT+ groups, respectively. Adjuvant (chemo)radiotherapy was not associated with a survival benefit after adjusting for confounding factors by case-control propensity score matching or in subgroup analyses of patients with tumor size ≥4 cm and <4 cm. In univariable analysis, adjuvant (chemo)radiotherapy was not identified as a prognostic factor in any of the subgroups (full cohort: PDFS = 0.365; POS = 0.282).

CONCLUSION

Among patients with IR early-stage cervical cancer, radical surgery alone achieved equal disease-free and overall survival rates to those achieved by combining radical surgery with adjuvant (chemo)radiotherapy.

Stratification of lymph node metastases as macrometastases, micrometastases, or isolated tumor cells has no clinical implication in patients with cervical cancer: Subgroup analysis of the SCCAN project

BACKGROUND

In cervical cancer, presence of lymph-node macrometastases (MAC) is a major prognostic factor and an indication for adjuvant treatment. However, since clinical impact of micrometastases (MIC) and isolated tumor-cells (ITC) remains controversial, we sought to identify a cut-off value for the metastasis size not associated with negative prognosis.

METHODS

We analyzed data from 967 cervical cancer patients (T1a1L1-T2b) registered in the SCCAN (Surveillance in Cervical CANcer) database, who underwent primary surgical treatment, including sentinel lymph-node (SLN) biopsy with pathological ultrastaging. The size of SLN metastasis was considered a continuous variable and multiple testing was performed for cut-off values of 0.01-1.0 mm. Disease-free survival (DFS) was compared between N0 and subgroups of N1 patients defined by cut-off ranges.

RESULTS

LN metastases were found in 172 (18%) patients, classified as MAC, MIC, and ITC in 79, 54, and 39 patients, respectively. DFS was shorter in patients with MAC (HR 2.20, P = 0.003) and MIC (HR 2.87, P < 0.001), while not differing between MAC/MIC (P = 0.484). DFS in the ITC subgroup was neither different from N0 (P = 0.127) nor from MIC/MAC subgroups (P = 0.449). Cut-off analysis revealed significantly shorter DFS compared to N0 in all subgroups with metastases ≥0.4 mm (HR 2.311, P = 0.04). The significance of metastases <0.4 mm could not be assessed due to limited statistical power (<80%). We did not identify any cut-off for the size of metastasis with significantly better prognosis than the rest of N1 group.

CONCLUSIONS

In cervical cancer patients, the presence of LN metastases ≥0.4 mm was associated with a significant negative impact on DFS and no cut-off value for the size of metastasis with better prognosis than N1 was found. Traditional metastasis stratification based on size has no clinical implication.

Relugolix combination therapy and symptoms of uterine myomatosis - selected case reports of indication spectrum and treatment outcomes

OBJECTIVE

An illustrative review of the indications for relugolix combination therapy (RCT) in the management of symptoms associated with uterine myomatosis.

METHODS

A set of annotated case reports from outpatient and clinical practice.

RESULTS

The file includes a non-invasive methodology for defining excessive menstrual bleeding using the pictorial bleeding assessment chart (PBAC). It also presents the use of RCT as a fertility-sparing procedure prior to elective myomectomy and the management of isthmic fibroids as an uterine factor of infertility. Cases of RCT of adenomyosis in primary sterility and in extragenital forms of endometriosis are commented. Emergent events associated with complications of myomatosis in pregnancy are represented by a case report of necrotizing diff use myomatosis in puerperium. The differential-diagnostic confusion of adnexal pathology and myomatosis, RCT as a final solution to failed pharmacotherapy, and the alternative of hysterectomy in premenopause illustrate the diverse spectrum of indications for pharmacological treatment, including the possibility of dual therapy with RCT and aGnRH.

CONCLUSION

Relugolix combination therapy as an effective and safe causal treatment expands the therapeutic spectrum and options for reproductive medicine specialists and registering gynaecologists. The availability of conservative treatment in combination with surgical treatment leads to optimalization and greater effectiveness of therapeutic procedures and increased quality of life for women with myomatosis.

Th e role of CDK12 in tumor bio logy

BACKGROUND

Physiological function of cyclin-dependent kinase 12 (CDK12) is crucial for several cellular processes, including regulation of transcription, RNA splicing, transcription termination and polyadenylation. It is well documented by now that CDK12 controls transcription of the unique set of genes involved in DNA-damage response, replication of DNA and response to cellular stress. Just recently, a key function of CDK12 in the induction of tandem duplication of specific DNA sequences within the metastatic castrate resistant prostate tumors has been documented. Therefore, it is possible to recognize CDK12 as a tumor suppressor; nevertheless, there is a growing body of evidence that CDK12 can support tumor growth under specific circumstances and thus act as a tumor oncogene. CDK12 therefore represents an alternative dia-gnostic approach for breast, ovarian and prostate tumors, especially when conventional treatment is not active and there is a need for more effective approaches, such as concept of synthetic lethality.

METHODS

The discussed scientific papers can be reached at the PubMed and Scopus databases before 1th of April 2020.

PURPOSE

The aim of the review is to summarize current knowledge relevant to the function of CDK12 as a tumor suppressor or oncogene in various tumors and to discuss the use of specific CDK12 inhibitors for patient treatment. At the end of the article, we discuss the potential use of CDK12 in the treatment of specific tumors by its targeted inhibition in monotherapy or in combination with poly (ADP ribose) polymerase 1 (PARP1) and checkpoint kinase 1 (CHK1) inhibitors. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.

Lower-Limb Lymphedema after Sentinel Lymph Node Biopsy in Cervical Cancer Patients

Simple Summary

Lower-limb lymphedema (LLL) is a well-recognized adverse outcome of the surgical management of cervical cancer. Recently, sentinel lymph node (SLN) biopsy has emerged as an alternative procedure to systematic pelvic lymphadenectomy (PLND) aiming to decrease the risk of complications, especially LLL development. Our study represents the first prospective analysis of LLL incidence in cervical cancer patients after a uterine procedure with SLN biopsy, without systematic PLND. In an international multicenter trial SENTIX, the group of 150 patients was prospectively evaluated using both objective and subjective LLL assessments in 6 months intervals for 2 years. Contrary to the expectations, our results showed that SLN biopsy does not eliminate the risk of LLL development which occurred in a mild or moderate stage in about 26% of patients with a median interval to the onset of 9 months.

Abstract

Background: To prospectively assess LLL incidence among cervical cancer patients treated by uterine surgery complemented by SLN biopsy, without PLND. Methods: A prospective study in 150 patients with stage IA1–IB2 cervical cancer treated by uterine surgery with bilateral SLN biopsy. Objective LLL assessments, based on limb volume increase (LVI) between pre- and postoperative measurements, and subjective patient-perceived swelling were conducted in six-month periods over 24-months post-surgery. Results: The cumulative incidence of LLL at 24 months was 17.3% for mild LLL (LVI 10–19%), 9.2% for moderate LLL (LVI 20–39%), while only one patient (0.7%) developed severe LLL (LVI > 40%). The median interval to LLL onset was nine months. Transient edema resolving without intervention within six months was reported in an additional 22% of patients. Subjective LLL was reported by 10.7% of patients, though only a weak and partial correlation between subjective-report and objective-LVI was found. No risk factor directly related to LLL development was identified. Conclusions: The replacement of standard PLND by bilateral SLN biopsy in the surgical treatment of cervical cancer does not eliminate the risk of mild to moderate LLL, which develops irrespective of the number of SLN removed.

Adverse events of PARP inhibitors

OBJECTIVE

An evaluation of the safety of poly-ADP-ribose-polymerase inhibitors (PARPi) in ovarian cancer treatment.

METHODS

An analysis of the studies on PARP inhibitors, a summary of the most common and serious adverse events.

RESULTS

According to the studies, the most common adverse events of PARPi include hematotoxicity, nausea and vomiting. Serious adverse events leading to dose reduction or treatment interruption or termination include anemia, thrombocytopenia, nausea, fatigue and hypertension.

CONCLUSION

According to the results of the recent studies, the treatment of ovarian cancer with PARP inhibitors is generally safe.

Bilateral simultaneous tubal pregnancy

OBJECTIVE

We present a rare case of peroperatively diagnosed bilateral tubular pregnancy.

DESIGN

Case report.

SETTING

Department of Obstetrics and Gynekology, Novy Jicin Hospital.

CONCLUSION

In the case of ectopic pregnancy always think about the possibility of contralateral pathology and during the surgical revision remember a thorough inspection of both fallopian tubes.

ERAS protocol in gynecologic oncology

OBJECTIVE

To summarize current knowledge of the ERAS protocol in gynecologic oncology surgery.

DESIGN

Review article.

SETTINGS

Department of Obstetrics and Gynecology, University Hospital Ostrava, Ostrava, Department of Obstetrics and Gynecology, University of Ostrava, Ostrava.

METHODS

Literature review, PubMed and Medline databases were used to search relevant literature from 1995 to 2019.

CONCLUSION

ERAS (Enhanced Recovery after Surgery) is a perioperative treatment program based on evidence-based medicine. Guidelines consist of pre-operative, perioperative and post-operative care items. Implementation of the ERAS protocol leads to a decrease in complications up to 40% and a reduction in hospitalization by up to 30%, thereby reducing overall costs without increasing the number of rehospitalizations. Multidisciplinary cooperation not only with anesthesiologists and consultant surgeons, but also with nutritional specialists and nurses is crucial.

Gynecological tumor triplicity

OBJECTIVE

Information about an interesting real clinical case.

DESIGN

Case repor.

SETTING

Clinic of Gynecology and Obstetrics, University hospital in Ostrava.

METHODS AND RESULTS

A 64-year-old female patient with no family history of gynecologic tumors was indicated to total laparoscopic radical hysterectomy due to confirmed squamous cervical carcinoma stage IB1. The operation was converted to laparotomy due to unexpected peroperative finding of ovarian malignancy. Peroperatively, left ovary borderline tumor and tiny implants on the surface of uterus and small pelvis walls were confirmed. Radical abdominal hysterectomy, bilateral salpingo-oophrectomy, omentectomy, appendectomy, pelvic lymphadenectomy and peritonectomy were performed.

CONCLUSION

Definitive postoperative histology further revealed an endometroid adenocarcinoma of the uterus, serous left ovary borderline tumor with non-invasive implants and no residual tumor of cervical carcinoma. In our clinic, several tumor duplicities were reported, but this is the first case of a gynecological tumor triplicity. As far we know, this is the first case report refering to a gynecological tumor triplicity in one time. Keywords gynecologic, multiple, malignancy, radical surgery.

[The possibility of using progesterone receptor modulators in the treatment of myomas]

OBJECTIVE

To summarize the knowledge about the effect of selective progesterone receptor modulators and their use in the treatment of myomas in women of childbearing age and in perimenopause.

DESIGN

Review article.

RESULTS

Long-term treatment with ulipristal acetate maximizes its effectiveness, it helps to achieve faster bleeding control and increases the number of pa-tients with fibroid volume reduction of more than 50%. Ulipristal acetate is the most effective drug in the medical treatment of myomas and its use will change the approach to surgical treatment.

[The use of selective progesterone receptor modulators in the treatment of myomas]

OBJECTIVE

To summarize the knowledge of the effect of selective progesterone receptor modulators and their use in the treatment of myomas in women of childbearing age and in perimenopause.

DESIGN

Review articleResults: Long-term treatment with ulipristal acetate maximizes its effectiveness, it helps to achieve faster bleeding control and increases the number of patients with fibroid volume reduction of more than 50%. Ulipristal acetate is the most effective drug in the medical treatment of myomas and its use will change the approach to surgical treatment.

[Basal cell carcinoma in a young patient]

OBJECTIVE

The aim of this article is to highlight a possible occurrence of basal cell carcinoma in young patient.

DESIGN

Case report.

SETTING

Porodnicko-gynekologická klinika FN Ostrava.

METHODS

We report case of a 37-year-old patient with a lesion of a vulva, which persisted for 3 years. The patient was during these free years repeatedly examined by a gynecologist and a dermatologist. She was treated by antibiotics and corticosteroids without any effect. After 3 years she was sent to an expert examination, during which was removed a biopsy. From the biopsy specimen was diagnosed basal cell carcinoma. Radical excision was indicated due tu the finding.

RESULTS

Patient is now 29 months disease-free.

CONCLUSION

Any persistent lesion in the vulvar region should be subjected to histological examination, even in young patients where the diagnosis of basal cell vulvar carcinoma is very unlikely.

Uterine tumors resembling ovarian sex cord tumors (UTROSCT). Report of a case with lymph node metastasis

Uterine tumors resembling ovarian sex cord tumors (UTROSCT) have an uncertain histogenesis. Although generally considered to be benign, they metastasize in some cases. We report the case of a 53-year-old woman who presented with vaginal bleeding. Clinical examination revealed a tumor sized 1.5 cm in diameter localized in the subendometrial region of the uterine wall. Histologically, the tumor consisted of epithelioid oval cells arranged in solid nests, trabeculae and ribbons. Immunohistochemically, approximately 1% of tumor cells expressed strong desmin positivity, calponin in 10% of cells, WT1 in 80% cells, and Ki-67 was positive in about 5 % of tumor cells. All the other immunohistochemical reactions applied including anti-cytokeratin antibodies were negative. The RT-PCR method for identification of the JAZF1-JJAZ1 fusion transcript was negative. In one lymph node in the right iliac artery region, a metastasis of UTROSCT was found. This finding adds to the previously reported UTROSCT cases with metastatic spread.

KEYWORDS

uterine tumors resembling ovarian sex cord tumors - UTROSCT - metastasis - lymph node.

[Parametrial involvement in early stage cervical cancer patients with tumor less 2 cm: The myth or reality?]

OBJECTIVE

The aim is review of studies exploring the relationship of parametrial involvement with other tumor-related factors (lymphovascular space invasion, depth of stromal invasion, status of sentinel lymph node) in early stage cervical cancer patients with tumor less than 2 cm.

DESIGN

Review.

SETTINGS

Department of Obstetrics and Gynaecology, University Hospital Ostrava.

METHODS

Searching of the literature in database PubMed by combination of the key words: early stage, cervical cancer, parametrial involvement, parametrectomy.

CONCLUSION

Based on literature review, the metastatic parametrial involvement in early-stage cervical cancer patients with tumor less than 2 cm and with other tumor-related factors is very rare. Before omitting of parametrectomy in these low-risk patients, these encouraging data must be confirmed in the prospective multicentric trials.

Characteristics of sentinel lymph nodes' metastatic involvement in early stage of vulvar cancer

BACKGROUND

Nodal involvement is one of the most significant prognostic factors in early-stage vulvar cancer.

AIMS

To determine the diagnostic accuracy of sentinel lymph node (SLN) detection in early-stage vulvar cancer and to describe the characteristics of metastatic lymph node involvement.

METHODS

Of 23 women with early-stage squamous cell vulvar cancer included in the study, five had lateral lesions and 18 had midline lesions. SLN detection was performed by using a radioactive tracer and blue dye, followed by radical vulvectomy or radical wide excision with uni/bilateral inguinofemoral lymphadenectomy, depending on tumour size and localization. SLNs were subsequently examined with haematoxylin-eosin and immunohistochemistry.

RESULTS

The SLN detection was successful in all 23 women (100%) and in 38 of 41 groins (92.3%) tested. The total number of SLNs was 67, with an average of 1.76 per groin. In total, 20 positive SLNs were detected in 14 of 23 patients. From a total of 20 positive SLNs, micrometastases were found in five SLNs and isolated tumour cells in one SLN. We experienced one case with a false negativity of SLN. Sensitivity, negative predictive value, accuracy and false negativity of SLN detection were 93.3%, 88.8%, 95.6% and 7.1% respectively.

CONCLUSION

The SLN biopsy performed by an experienced team is a feasible method, with high accuracy in patients with early-stage vulvar cancer. Prognostic value of micrometastases should be confirmed in further studies.

[Lymphatic mapping in cervical cancer]

BACKGROUND AND AIMS

The aim of the study is to analyze the feasibility of intraoperative sentinel lymph nodes (SLN) detection using gamma detection probe and blue dye in patients with cervical cancer.

DESIGN AND SUBJECTS

Prospective clinical study. 106 patients with cervical cancer were included into the study in the period from May 2004 to November 2006.

METHODS AND RESULTS

Patients were divided into three groups according to the tumor volume. Lymphoscintigraphy was performed following an injection of 99m Tc-labeled nanocolloid and intraoperatively the SLN were identified visually after marking of lymphatic vessels with blue dye and further detected using a handheld gamma detection probe. The SLN were histologically and immunohistochemically analyzed. Total number of 309 SLN with an average of 2.9 per patient were identified. The SLN detection rate was 94.3% per patient, 84.4 % per side, and depended on the tumor volume. Metastatic disease was detected in 39 patients (36.8%) and micrometastatic disease in 15 patients (14.2%). Sensitivity and negative predictive value calculated were 93.9% and 98.0%, false negative rate reached 5.1.

CONCLUSIONS

Intraoperative detection of SLN using combination of technecium-99-labeled nanocolloid and blue dye represents a feasible, safe and accurate technique to identify lymphatic spreading in stages IA2-IB1 of cervical cancer.

[Sentinel node detection in early stage of cervical carcinoma using 99mTc-nanocolloid and blue dye]

OBJECTIVE

The aim of the study was to analyse the feasibility of intraoperative sentinel lymph nodes (SLN) detection using gamma detection probe and blue dye in patients undergoing radical hysterectomy for treatment of early stage of cervical cancer.

DESIGN

Prospective case observational study.

METHODS

In the period from May 2004 to February 2006 77 patients with early stage of cervical cancer who underwent a radical surgery were included into the study. Patients were divided into three groups according to the tumour volume. First group consists of patients FIGO IA2 and FIGO IB1 with tumour diameter less than 2 cm, second group tumours FIGO IB1 with tumour diameter more than 2 cm and third group stadium IB2. SLN was detected by blue dye and Tc99. Preoperative lymphoscintigraphy was done after Tc99 colloid injection, intraoperative detection was performed by visual observation and by hand-held gamma-detection probe. SLN were histologically and immunohistochemically analysed.

RESULTS

A total number of 2764 lymph nodes with an average 36 and 202 SLN with an average 2.6 were identified. The SLN detection rate was 94.8% per patient and 85.1% for the side of dissection and depends on the tumor volume. SLN were identified in obturator area in 48%, in external iliac area in 15%, in common iliac and internal iliac both in 9%, in interiliac region in 8%, in praesacral region in 6% and in parametrial area in 5%. Metastatic disease was detected in 31 patients (40.2%), metastatic involvement of SLN only in 12 patients (15.6%). False negative rate was 2.6%, sensitivity and negative predictive value calculated by patient were 923% and 95.7%.

CONCLUSIONS

Intraoperative lymphatic mapping using combination of technecium-99-labeled nanocolloid and blue dye are feasible, safe and accurate techniques to identified SLN in early stage of cervical cancer.

[Lymphatic mapping and detection of sentinel node in early stages of cervical carcinoma]

OBJECTIVE

The aim of the study was to analyse two methods of intraoperative sentinel node detection using blue dye and blue dye with Tc99 labeled tracer in early stage of the cervical cancer.

DESIGN

Prospective case observational study.

SETTING

Department of Obstetrics and Gynecology, University Hospital Ostrava.

METHODS

From May 2004 to September 2005, 49 patients with cervical cancer who underwent a radical surgery were included into the study. Sentinel lymph node was detected using blue dye in the first group of 23 patients and by blue dye with Tc99 in the second group of 26 patients. Intraoperative sentinel node detection was performed by visual aspection in the first group, and by visual aspection and by hand-held gamma-probe in the second group.

RESULTS

Patients were divided according to stage of the disease into three subgroups FIGO IA2, FIGO IB1 and FIGO IB2. A total number of 1561 lymph node with an average 32 and 94 SLN with an average 1.9 were identified. The specific detection rate per site was 63% in the first group and 80.8% in the second group respectively. Metastatic disease was detected in 26 patients (41%) and metastatic involvement of SLN only in 11 patients (17.4%). Sensitivity and negative predictive value were 100% in both groups, false negativity was 0%.

CONCLUSION

Detection of SLN by combination of blue dye and Tc99 labeled tracer has a higher detection rate of SLN than detection by blue dye alone.

Detection of sentinel lymph nodes in cervical cancer. A comparison of two protocols

BACKGROUND

The aim of this study was lymphatic mapping to identify SLN in cervical cancer (CaCerv) with radioactive colloids, intraoperative detection with patent blue dye (PBD) and gamma probe (GP) and biopsy and comparison of two protocols.

MATERIAL AND METHODS

In 54 patients with CaCerv before hysterectomy and lymph nodes dissection (LND) we performed preoperative lymphoscintigraphy utilizing 99mTc-colloid (Nanocoll, SentiScint or Nanocis), activity 40 MBq, on the operation day (30 women) or the day before operation (24 women). Gynaecologists injected 4 peritumoural injections of colloid into the cervix around the tumour. Scintigraphy followed 25-50 minutes (one-day protocol) or 12-19 hours (two-day protocol) after injection. Gynaecologists also injected 4 peritumoural injections of PBD into the cervix around the tumour. All women underwent SLN biopsy and LND (in average 35 lymph nodes were taken) and hysterectomy. SLNs (active and/or blue lymph nodes) were examined by a pathologist [histopathology and immunohistochemistry (IH) with detection of cytokeratine]. No SLN was examined without IH.

RESULTS

The gynaecologists withdrew 123 SLNs (on average 2.27/1 patient) and in total 1898 lymph nodes (on average 35/1 patient). In 1 woman the tumour was inoperable. Two-day protocol, which involved scintigraphy, PBD and GP detected SLNs on both sides (45 SLNs) in 17 women (70.8%), SLNs on the one side (6 SLNs) in 3 patients (12.5%) and no SLNs were found in 4 women (16.7%). One-day protocol detected SLNs on both sides in 23 patients (74.1%)--63 SLNs, in 7 women on one side (25.9%)--9 SLNs. Metastases in SLNs (with or without metastases in other LN) were found in 21 patients (38.9%)--in 1 woman of stage FIGO IB1, in 1 woman of stage FIGO IB2, in 1 patient of stage FIGO IIIA and in all 18 patients of stage FIGO IIIB. False negative SLN detection was 0%.

CONCLUSIONS

In SLN detection in patients with CaCerv, all 3 methods--scintigraphy, PBD and GP--should be used, and the success rate of SLN detection increases, although scintigraphy has lower significance than in SLN detection in malignant melanoma and breast cancer. One-day protocol had a better detection rate of SLN than two-day protocol. The method is promising but its results are not as unequivocal and optimistic as in breast cancer and malignant melanoma, and it is still experimental. Additional experience is necessary.

[Radical surgical therapy and role of adjuvant chemotherapy in ovarian tumors of borderline malignancy]

OBJECTIVE

Evaluation of the benefit of the radical surgical therapy in the assessment of prognostic factors and indication of adjuvant therapy in patients with borderline tumors of ovary.

DESIGN

Retrospective study.

SETTING

Department of Obstetrics and Gynecology, University Hospital, Ostrava.

METHODS

The group consists of 26 patients operated on our department, 12 of which underwent restaging operation after insufficient primary surgery in different hospital and 14 underwent primary surgery in our department. The average age was 42.9 years.

RESULTS

Radical surgery with regional lymphadenectomy was performed in 18 cases (69%) and non-radical in 8 cases (31%). In 7 patients (27%) fertility preservation operation was done. According to histological results 19 tumors (73%) were of serous type, 7 being of mucinous type (27%). There were no other histological types in our group. The lymphnodes were positive in 4 cases (22%) out of 18. Eight patients were indicated for adjuvant chemotherapy (31%), 4 of them for regional lymphnodes positivity, 2 for peritoneal implants, 1 patient for tumor residuum. The last case was a patient with tumor duplicity of a borderline tumor of ovary stage FIGO IIC and corporal carcinoma stage FIGO IB. We had one case of recurrence after fertility preservation surgery. There was no case of pregnancy yet.

CONCLUSIONS

Borderline tumors of ovary have good prognosis and low recurrence rate. In spite of that, there exists a group of women with higher risk of recurrence and disease progression which can be fatal. These patients may benefit from adjuvant therapy, which is indicated after evaluation of risk factors ideally acquired from the radical surgery.

[Hormone replacement therapy and ovarian tumors]

OBJECTIVE

Analysis of risk and protective factors and hormone replacement therapy in the aethiology and pathogenesis of ovarian cancer. The role of hormone replacement therapy in the complex treatment in women with ovarian cancer is discussed.

DESIGN

Reviewed article.

SETTING

Department of Obstetrics and Gynaecology, University Hospital Ostrava.

METHODS

Analysis of epidemiological studies.

CONCLUSION

The role of hormone replacement therapy as a risk factor of ovarian cancer has not been confirmed. Hormone replacement therapy as a part of supportive and symptomatic therapy has been acceptable in a great deal of patients with ovarian cancer.