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Wang ZT, Deng ZM, Dai FF, Yuan MQ, Liu SY, Li BS, Cheng YX. Tumor immunity: A brief overview of tumor‑infiltrating immune cells and research advances into tumor‑infiltrating lymphocytes in gynecological malignancies (Review). Exp Ther Med 2024; 27:166. [PMID: 38476909 PMCID: PMC10928974 DOI: 10.3892/etm.2024.12453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/03/2023] [Indexed: 03/14/2024] Open
Abstract
Tumor immunity is a promising topic in the area of cancer therapy. The 'soil' function of the tumor microenvironment (TME) for tumor growth has attracted wide attention from scientists. Tumor-infiltrating immune cells in the TME, especially the tumor-infiltrating lymphocytes (TILs), serve a key role in cancer. Firstly, relevant literature was searched in the PubMed and Web of Science databases with the following key words: 'Tumor microenvironment'; 'TME'; 'tumor-infiltrating immunity cells'; 'gynecologic malignancies'; 'the adoptive cell therapy (ACT) of TILs'; and 'TIL-ACT' (https://pubmed.ncbi.nlm.nih.gov/). According to the title and abstract of the articles, relevant items were screened out in the preliminary screening. The most relevant selected items were of two types: All kinds of tumor-infiltrating immune cells; and advanced research on TILs in gynecological malignancies. The results showed that the subsets of TILs were various and complex, while each subpopulation influenced each other and their effects on tumor prognosis were diverse. Moreover, the related research and clinical trials on TILs were mostly concentrated in melanoma and breast cancer, but relatively few focused on gynecological tumors. In conclusion, the present review summarized the biological classification of TILs and the mechanisms of their involvement in the regulation of the immune microenvironment, and subsequently analyzed the development of tumor immunotherapy for TILs. Collectively, the present review provides ideas for the current treatment dilemma of gynecological tumor immune checkpoints, such as adverse reactions, safety, personal specificity and efficacy.
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Affiliation(s)
- Zi-Tao Wang
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Zhi-Min Deng
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Fang-Fang Dai
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Meng-Qin Yuan
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Shi-Yi Liu
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Bing-Shu Li
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Yan-Xiang Cheng
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
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Shehaj I, Schröder M, Linz VC, Krajnak S, Almstedt K, Stewen K, Schwab R, Hasenburg A, Schmidt M, Heimes AS. Occurrence and Management of Immunotherapy-Associated Adverse Events in Patients with Gynecological Cancers. Cancers (Basel) 2024; 16:1371. [PMID: 38611049 PMCID: PMC11011090 DOI: 10.3390/cancers16071371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have emerged as an essential therapeutic approach in treating many solid tumors. ICIs enhance the body's anti-tumor T-cell activity, resulting in a novel spectrum of immunotherapy-related side effects. This novel spectrum of adverse events differs significantly from the side effects of conventional chemotherapy. It, therefore, requires special attention in the diagnosis and management of immunotherapy-related adverse events (irAEs). The present study aimed to retrospectively analyze the incidence, diagnosis, and management of irAEs in patients with gynecologic malignancies who received ICIs and to discuss these findings in the context of the recent literature. METHODS In the present retrospective overview, we evaluated patients with gynecologic malignancies (breast, endometrial, cervical, ovarian) who received ICIs with regard to the incidence, type, and time to onset of irAEs. A total of 61 patients treated at the Department of Gynecology and Obstetrics, University Medical Center Mainz, Germany, between 2018 and 2023 were included in the analysis. RESULTS A total of 32.8% of patients developed an irAE of any grade or type. The median time to irAE was 24 weeks. The most frequently observed irAEs were grade 1 (20%) or 2 (35%). Immunotherapy-related grade 3 or 4 adverse events occurred in 45% of patients (40% grade 3, 5% grade 4). The most common type of irAE in our cohort was hypothyroidism, followed by hepatitis and colitis. Cox regression analysis identified the duration of ICI therapy as the only significant factor influencing the incidence of irAEs (p = 0.004). CONCLUSION The broad spectrum of irAEs and the onset time of irAEs are important challenges of therapy with ICIs, requiring proactive monitoring and tailored management strategies to optimize the safety and efficacy of immunotherapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Anne-Sophie Heimes
- Department of Gynecology and Obstetrics, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (I.S.); (M.S.); (V.C.L.); (S.K.); (K.A.); (K.S.); (R.S.); (A.H.); (M.S.)
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Zhang Y, Lu Y, Wang X, He K, Fang M, Xu J, Xu Y, Tao F, Lü P. Causal Relationship between Immune Cells and Gynecological Cancers through Bidirectional and Multivariable Mendelian Randomization Analyses. J Cancer 2024; 15:1880-1889. [PMID: 38434980 PMCID: PMC10905409 DOI: 10.7150/jca.92627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 01/27/2024] [Indexed: 03/05/2024] Open
Abstract
Background: Evidence suggests potential associations between gynecological malignancies and various immune cell chemicals and systems. However, establishing a causal relationship remains uncertain. Methods: This work employed Wald ratio for one single-nucleotide polymorphism (SNP) or the inverse-variance weighted method (IVW) for multiple SNPs to conduct bidirectional two-sample Mendelian randomization (MR) analysis by utilizing genome-wide association study (GWAS) data. We employed supplementary methods, including MR-Egger and weighted median methods, to detect and correct for the influence of horizontal pleiotropy. In addition, we also use colocalization analysis for further validation. Results: In IVW analysis, increases in relative count of circulating CD11c+ HLA-DR++ conventional dendritic cells (cDC) were associated with an elevated risk of breast cancer (OR [95% CI], 1.1295 [1.0632-1.2000], P = 8.044 × 10-5), while elevated levels of HLA-DR on plasmacytoid dendritic cells (DC) and HLA-DR on DC were protective against breast cancer. In addition, actual count of CD39+ resting Treg AC was also shown to be causally associated with the development of ovarian cancer, whereas a high relative count of CD28+ CD45RA- CD8+ T cells reduced the risk of cervical cancer. Sensitivity analysis revealed almost no evidence of bias in the current study. Multivariable MR (MVMR) analyses further confirmed a direct impact of the CD11c+ HLA-DR++ cDC immune phenotype on breast cancer. Colocalization analysis showed the lead SNP, rs780094, suggesting HLA-DR GWAS shared a common genetic mechanism with breast cancer. Conclusions: The MR study identified significant causal relationships between multiple immunophenotypes and breast cancer, aiming to provide clinicians with some reference for cancer prediction and explore further potential associations between immune phenotypes and gynecologic tumors.
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Affiliation(s)
- Yangyang Zhang
- Institute of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China; Shanghai Medical College, Fudan University, Shanghai, China
| | - Yangyuxiao Lu
- The First Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China
| | - Xuanyu Wang
- College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Keren He
- The First Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China
| | - Mengqi Fang
- The First Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China
| | - Jiabao Xu
- Department of Immunology and Microbiology, Basic Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Ye Xu
- Department of Immunology and Microbiology, Basic Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Fangfang Tao
- Department of Immunology and Microbiology, Basic Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Ping Lü
- Department of TCM, Taizhou First People's Hospital, Taizhou, Zhejiang 318020, China
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Hu Z, Ma L, Ding Y, Zhao X, Shi X, Lu H, Liu K. Enhancing the Accuracy of Lymph-Node-Metastasis Prediction in Gynecologic Malignancies Using Multimodal Federated Learning: Integrating CT, MRI, and PET/CT. Cancers (Basel) 2023; 15:5281. [PMID: 37958454 PMCID: PMC10648189 DOI: 10.3390/cancers15215281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/22/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Gynecological malignancies, particularly lymph node metastasis, have presented a diagnostic challenge, even with traditional imaging techniques such as CT, MRI, and PET/CT. This study was conceived to explore and, subsequently, to bridge this diagnostic gap through a more holistic and innovative approach. By developing a comprehensive framework that integrates both non-image data and detailed MRI image analyses, this study harnessed the capabilities of a multimodal federated-learning model. Employing a composite neural network within a federated-learning environment, this study adeptly merged diverse data sources to enhance prediction accuracy. This was further complemented by a sophisticated deep convolutional neural network with an enhanced U-NET architecture for meticulous MRI image processing. Traditional imaging yielded sensitivities ranging from 32.63% to 57.69%. In contrast, the federated-learning model, without incorporating image data, achieved an impressive sensitivity of approximately 0.9231, which soared to 0.9412 with the integration of MRI data. Such advancements underscore the significant potential of this approach, suggesting that federated learning, especially when combined with MRI assessment data, can revolutionize lymph-node-metastasis detection in gynecological malignancies. This paves the way for more precise patient care, potentially transforming the current diagnostic paradigm and resulting in improved patient outcomes.
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Affiliation(s)
- Zhijun Hu
- Department of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, China; (Z.H.); (X.Z.)
| | - Ling Ma
- Library, Shanghai Jiao Tong University, Shanghai 200240, China; (L.M.); (X.S.)
| | - Yue Ding
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China;
| | - Xuanxuan Zhao
- Department of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, China; (Z.H.); (X.Z.)
| | - Xiaohua Shi
- Library, Shanghai Jiao Tong University, Shanghai 200240, China; (L.M.); (X.S.)
| | - Hongtao Lu
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China;
| | - Kaijiang Liu
- Department of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, China; (Z.H.); (X.Z.)
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Fan T, Luo C. Minimal clinically important difference of the Functional Living Index-Emesis in patients with gynecological malignant tumor: A post hoc analysis of a single-arm study. J Obstet Gynaecol Res 2023; 49:2711-2716. [PMID: 37553232 DOI: 10.1111/jog.15769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 07/26/2023] [Indexed: 08/10/2023]
Abstract
AIM This study aimed to explore the impact of minimum clinically important difference (MCID) of the Functional Living Index-Emesis (FLIE) in patients with gynecologic malignancies. METHOD This post hoc analysis included patients with gynecological malignant tumors in the Department of Oncology of our hospital between October 2020 and October 2021. RESULTS A total of 149 patients (aged 50.05 ± 12.24 years) were included. Most of the patients were married (75.8%), lived in the city (60.4%), and had a history of motion sickness (75.8%). The degree of nausea (9.00 [0.00, 16.00] vs. 30.00 [16.00, 48.00], P < 0.001) and vomiting (9.00 [0.00, 16.00] vs. 30.00 [16.00, 48.00], P < 0.001) were significantly improved after treatment. Taking the options in the scale as the subjective anchor, the MCID of FLIE for nausea and vomiting were 28.5 and 29 in anchor-based analysis, respectively. In the distribution-based analysis, the MCID of FLIE for nausea and vomiting were 2.41, 6.04, and 9.66; and 2.31, 5.78, and 9.24 in effect size of 0.2, 0.5, and 0.8, respectively. CONCLUSION The MCID of FLIE for nausea and vomiting in patients with gynecological malignant tumors was 28.5 and 29 in the anchor-based analysis, with higher specificity, and 6.04 and 5.78 in the distribution-based analysis, with higher sensitivity. The development of the MCID scale might be used to interpret the clinical significance of chemotherapy-induced nausea and vomiting in patients with gynecological malignancies and help to calculate the sample size for future clinical trials.
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Affiliation(s)
- Tingting Fan
- Oncology Department, Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Caifeng Luo
- Department of Nursing, Medical College of Jiangsu University, Zhenjiang, China
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Khattar H, Goel R, Kumar P. Artificial Intelligence in Gynaecological Malignancies: Perspectives of a Clinical Oncologist. Cureus 2023; 15:e45660. [PMID: 37868441 PMCID: PMC10589801 DOI: 10.7759/cureus.45660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Gynecological malignancies are treated with a multi-disciplinary approach. There are two important factors, the stage and Karnofsky performance status scale (KPS) of patients, which guide the treatment strategy by single or multiple modalities in terms of surgery, radiotherapy, or chemotherapy. Various aspects are included in the workflow of gynecological malignancies, like screening, diagnosis in each individual, treatment modalities, and finally, follow-up to see for outcomes leading to the development of new research protocols. The quality data plays an important role in every step. Artificial Intelligence (AI) will play an important role if it is developed in the above-mentioned steps. AI is already established partially in every aspect of the management of gynecological cancer. It needs to be strengthened and incorporated further in a more robust form. This needs an association between clinicians, software engineers, and stakeholders. This article reviews the role of AI in various steps of the workflow of gynecological malignancies and discusses a few clinical aspects that may be researched to find solutions by AI.
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Affiliation(s)
- Himanshi Khattar
- Radiation Oncology, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly, IND
| | - Ruchica Goel
- Gynaecological Oncology/In Vitro Fertilization, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly, IND
| | - Piyush Kumar
- Radiation Oncology, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly, IND
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Kovacevic N, Cilensek I, Merlo S, Segedin B. Modern approach to the management of genitourinary syndrome in women with gynecological malignancies. Radiol Oncol 2023; 57:292-298. [PMID: 37494601 PMCID: PMC10476906 DOI: 10.2478/raon-2023-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/25/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND The term genitourinary syndrome of menopause was first used in 2014 by the North American Menopause Society and the International Society for the Study of Women's Sexual Health to describe conditions previously known as atrophic vaginitis, urogenital atrophy, or vulvovaginal atrophy. It is a complex, chronic, progressive condition characterized by a wide range of signs and symptoms affecting sexual function and the tissues of the urinary and genital tracts. The main cause of genitourinary syndrome of menopause is estrogen deficiency caused by ovarian removal or dysfunction. The most bothersome symptoms are vaginal dryness, decreased vaginal lubrication, and pain during penetration and intercourse. They all have a negative impact on the quality of life. CONCLUSIONS The main goal of treatment is to relieve the symptoms. Treatment modalities are pharmacological or non-pharmacological. The first-line treatment for mild to moderate symptoms is the use of personal lubricants and moisturizers, but the gold standard is estrogen replacement therapy. Hormone therapy may not be an option for women with hormone-dependent cancer.
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Affiliation(s)
- Nina Kovacevic
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Health Care Angela Boškin, Jesenice, Slovenia
| | - Ines Cilensek
- Institute of Histology and Embryology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Sebastjan Merlo
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Barbara Segedin
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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Tu M, Xu J. Advances in immunotherapy for gynecological malignancies. Crit Rev Oncol Hematol 2023:104063. [PMID: 37385307 DOI: 10.1016/j.critrevonc.2023.104063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/21/2023] [Accepted: 06/25/2023] [Indexed: 07/01/2023] Open
Abstract
To date, surgery, chemotherapy and radiotherapy are mainly used to treat or remove gynecological malignancies. However, these approaches have their limitations when facing complicated female diseases such as advanced cervical and endometrial cancer (EC), chemotherapy-resistant gestational trophoblastic neoplasia and platinum-resistant ovarian cancer. Instead, immunotherapy, as an alternative, could significantly improve prognosis of those patients receiving traditional treatments, with better antitumor activities and possibly less cellular toxicities. Its' development is still not fast enough to meet the current clinical needs. More preclinical studies and larger-scale clinical trials are required. This review aims to introduce the landscape and up-to-date status of immunotherapy against gynecological malignancies, with a discussion of the challenges and future direction.
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Affiliation(s)
- Mengyan Tu
- Women's Reproductive Health Laboratory of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang, China
| | - Junfen Xu
- Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang, China.
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Gao L, Wang S, Xu J, Lu D. Efficacy of octreotide to reduce lymphorrhea and prevent lymphocele after pelvic lymph node excision in gynecological malignancies. J Obstet Gynaecol Res 2023. [PMID: 37254619 DOI: 10.1111/jog.15702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/17/2023] [Indexed: 06/01/2023]
Abstract
AIM To study the efficacy of octreotide to reduce lymphorrhea and prevent lymphocele after pelvic lymph node excision in gynecological malignancies. METHODS Patients with more than 200 mL of lymph drained per day until postoperative day 3 after pelvic lymph node excision were enrolled. Of the 75 patients, 36 were managed by conservative methods without the injection of octreotide, and the other 39 patients were treated with the injection of octreotide. The treated group was injected with 0.1 mg octreotide q8h for 5 days, starting on postoperative day 3. The drainage tube was removed when the amount of drained lymph decreased to 100 mL per day. The age, BMI, operation time, removed lymph nodes, amount of lymph, duration of drain placement, proportion of patients with lymphocele and complications between these two group were compared. RESULTS The total and mean daily amount of lymph produced per patient was significantly lower in the octreotide-treated group than in the untreated group. The duration of drain placement was shorter in the octreotide group than in the untreated group. The proportion of patients with lymphocele in the treatment group was lower than that in the untreated group. CONCLUSIONS The injection of octreotide is effective to reduce lymphorrhea and prevent lymphocele after pelvic lymph node excision in gynecological malignancies.
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Affiliation(s)
- Lingling Gao
- Department of Obstetrics and Gynecology, Northern Jiangsu People's Hospital Affiliated to Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Siying Wang
- Department of Obstetrics and Gynecology, Northern Jiangsu People's Hospital Affiliated to Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Jianbo Xu
- Department of Obstetrics and Gynecology, Northern Jiangsu People's Hospital Affiliated to Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Dan Lu
- Department of Obstetrics and Gynecology, Northern Jiangsu People's Hospital Affiliated to Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China
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Zhou Z, Ge J, Ye K, Zhang Y, Hu Q, Wang L, Chen Y. Comparison of Robotic-Assisted vs. Conventional Laparoscopy for Para-aortic Lymphadenectomy in Gynecological Malignancies: A Systematic Review and Meta-Analysis. Front Surg 2023; 9:843517. [PMID: 36684197 PMCID: PMC9845261 DOI: 10.3389/fsurg.2022.843517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 03/02/2022] [Indexed: 01/05/2023] Open
Abstract
Background Robotic-assisted surgery is one of the novel minimally invasive surgical techniques for the treatment of gynecological malignancies. The aim of this systematic review and meta-analysis was to compare the outcomes of robot-assisted vs. conventional laparoscopy for para-aortic lymphadenectomy (PAL) in patients with gynecological malignancies. Methods An electronic search in PubMed, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar databases was performed for articles, published up to 01st November 2021. Outcomes including operating time (OT), total blood loss (TBL), length of stay (LOS), and complication rate (CR) in robot-assisted vs. conventional laparoscopy were investigated. Results A total of nine studies (7 non-RCTs and 2 RCTs) involving 914 participants were included. Of them, 332 patients underwent robotic laparoscopy (robotic group) and 582-conventional laparoscopy (conventional laparoscopy group). A significant decrease in TBL (MD = -149.1; 95% CI: -218.4 to -79.91) [ml] was observed in the robotic group as compared to the conventional laparoscopy group. However, no significant difference was noted for OT, CR, and LOS in the overall findings. Further subgroup analysis showed that the robotic group had a lower OT in mixed histological populations and studies reporting on the extraperitoneal approach. The lower chance of TBL was observed in mixed histological populations and studies involving extraperitoneal approach, Caucasian population, and non-RCTs design. Conclusions Robotic laparoscopy has a significant advantage over the conventional laparoscopy approach for PAL in gynecological malignancies. Further prospective observational studies embedded with a large sample size are needed to validate our findings.
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Zhang XQ, Li L. A meta-analysis of XRCC1 single nucleotide polymorphism and susceptibility to gynecological malignancies. Medicine (Baltimore) 2021; 100:e28030. [PMID: 34918657 PMCID: PMC8677953 DOI: 10.1097/md.0000000000028030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/11/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Gynecological malignant tumor is a serious threat to women's health, cervical cancer, endometrial cancer and ovarian cancer are the most common. The eponymous protein encoded by the XRCC1 (X-ray repair cross complementation 1) gene is an important functional protein in the process of single-stranded DNA damage. Non-synonymous mutations of XRCC1 gene cause amino acid sequence changes that affect protein function and DNA repair ability, and may affect the interaction with other DNA repair proteins, leading to increased risk of tumor development. Many studies have assessed the association between XRCC1 gene polymorphism and the risk of cancer in the female reproductive system, but the results have been inconclusive. In this study, the relationship between XRCC1 Arg399Gln, Arg194Trp, Arg280His single nucleotide polymorphisms and susceptibility to gynecological malignancies was further explored by meta-analysis. METHODS English database: Pubmed, Medline, Excerpta Medica Database, Cochrance, etc; Chinese database: China national knowledge infrastructure, Wanfang Database, etc. STATA14 was used for statistical analysis, such as odd ratio (OR) value, subgroup analysis, heterogeneity test, sensitivity analysis, and publication bias. RESULTS In gynecologic cancers, the allele frequency difference of Arg399Gln case control group was statistically significant (GvsA: P = .007). There was no significant difference in allele frequency in the Arg194Trp and Arg280His case control groups (P = .065, 0.198). In different gene models, Arg399Gln was significantly correlated with gynecologic cancers susceptibility (GGvs AA: OR 0.91; 95% confidence interval [CI], 0.85 0.98); Arg194Trp was significantly correlated with gynecologic cancers susceptibility (CCvs TT: OR 0.94; 95% CI 0.88,1.00; CCvs CT: OR 0.97; 95% CI 0.90, 1.05); Arg280His was significantly correlated with gynecologic cancers susceptibility (GGvs AA: OR 0.98; 95% CI 0.94, 1.02; GGvs GA: OR 1.00;95% CI 0.97, 1.04). In the subgroup analysis, Arg399Gln and Arg194Trp were significantly correlated with gynecologic cancers susceptibility in the Asian race (P = .000, 0.049). In the analysis of different cancer subgroups, Arg399Gln and cervical cancer susceptibility were statistically significant (P = .039). Arg194Trp and endometrial cancer susceptibility were statistically significant (P = .033, 0.001). CONCLUSIONS XRCC1 Arg399Gln, Arg194Trp, Arg280His single nucleotide polymorphisms were associated with gynecologic cancer susceptibility. Arg399Gln genotype was statistically significant in relation to cervical cancer susceptibility. Arg194Trp genotype was statistically significant in relation to endometrial cancer susceptibility.
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Radhakrishna N, Palled SR, Pasha T, Buchapudi RR, Govardhan HB, Thimmaiah N, Viswanath L. Estimation of dose-volume parameters of female urethra as organ-at-risk during interstitial brachytherapy in gynecological malignancies. J Contemp Brachytherapy 2021; 13:519-25. [PMID: 34759976 DOI: 10.5114/jcb.2021.109788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/24/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose: Interstitial brachytherapy (ISBT) is often used as post-external beam radiotherapy (EBRT) to treat locally advanced gynecological malignancies. Female urethra is in close proximity to the target during ISBT. However, it has not been evaluated as an organ-at-risk (OAR). Overlapping symptoms caused by radiation-induced bladder toxicity vs. urethral toxicity make it difficult to identify and report urethral toxicities separately. This was a retrospective study to estimate dose-volume parameters of female urethra during high-dose-rate ISBT. Material and methods: Data of 24 patients with gynecological malignancies treated by ISBT were selected. Urethra and periurethral regions were retrospectively contoured. Mean volume, Dmax, Dmean, D2cc, D1cc, D0.5cc, D0.2cc, and D0.1cc were documented. Unpaired t-test was used for comparison of means. Results: 20/24 Ca. cervix, 1/24 Ca. vagina, and 3/24 Ca. vaginal vault received 6-6.5 Gy in 4 ISBT fractions. Mean urethral length was 3.54 ±0.55 cm. Mean doses received by urethra per BT fraction were Dmax = 4.23 ±1.32 Gy, Dmean = 2.71 ±1.01 Gy, D0.2cc = 3.31 ±1.07, and D0.1cc = 3.54 ±1.09 Gy. Comparison of total BT 2 Gy equivalent dose (EQD2) with 4 fractions for urethra between patients with (9/24) and without anterior vaginal wall (15/24) involvement included Dmean = 18.79 ±7.49 Gy vs. 11.14 ±6.15 Gy*, D1cc = 10.90 ±10.03 Gy vs. 4.54 ±3.93 Gy*, D0.5cc = 19.50 ±8.69 Gy vs. 11.97 ±6.54 Gy*, D0.2cc = 23.78 ±8.94 Gy vs. 15.51 ±7.39 Gy*, and D0.1cc = 25.88 ±9.37 Gy vs. 17.39 ±8.03 Gy*, respectively (*p < 0.05). Conclusions: Female urethra receives significant doses during ISBT for gynecological malignancies, especially when the anterior vaginal wall is within the target volume. Reporting doses to urethra would enable to develop clinical correlation and dose-volume constraints for urethra as organ-at-risk in future.
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Islam JY, Saraiya V, Previs RA, Akinyemiju T. Health Care Access Measures and Palliative Care Use by Race/Ethnicity among Metastatic Gynecological Cancer Patients in the United States. Int J Environ Res Public Health 2021; 18:6040. [PMID: 34199732 PMCID: PMC8200023 DOI: 10.3390/ijerph18116040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 12/25/2022]
Abstract
Palliative care improves quality-of-life and extends survival, however, is underutilized among gynecological cancer patients in the United States (U.S.). Our objective was to evaluate associations between healthcare access (HCA) measures and palliative care utilization among U.S. gynecological cancer patients overall and by race/ethnicity. We used 2004-2016 data from the U.S. National Cancer Database and included patients with metastatic (stage III-IV at-diagnosis) ovarian, cervical, and uterine cancer (n = 176,899). Palliative care was defined as non-curative treatment and could include surgery, radiation, chemotherapy, and pain management, or any combination. HCA measures included insurance type, area-level socioeconomic measures, distance-to-care, and cancer treatment facility type. We evaluated associations of HCA measures with palliative care use overall and by race/ethnicity using multivariable logistic regression. Our population was mostly non-Hispanic White (72%), had ovarian cancer (72%), and 24% survived <6 months. Five percent of metastatic gynecological cancer patients utilized palliative care. Compared to those with private insurance, uninsured patients with ovarian (aOR: 1.80,95% CI: 1.53-2.12), and cervical (aOR: 1.45,95% CI: 1.26-1.67) cancer were more likely to use palliative care. Patients with ovarian (aOR: 0.58,95% CI: 0.48-0.70) or cervical cancer (aOR: 0.74,95% CI: 0.60-0.88) who reside >45 miles from their provider were less likely to utilize palliative care than those within <2 miles. Ovarian cancer patients treated at academic/research programs were less likely to utilize palliative care compared to those treated at community cancer programs (aOR: 0.70, 95%CI: 0.58-0.84). Associations between HCA measures and palliative care utilization were largely consistent across U.S. racial-ethnic groups. Insurance type, cancer treatment facility type, and distance-to-care may influence palliative care use among metastatic gynecological cancer patients in the U.S.
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Affiliation(s)
- Jessica Y. Islam
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA;
- Cancer Epidemiology Program, Center for Immunization and Infection Research in Cancer (CIIRC), H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27701, USA
| | - Veeral Saraiya
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC 27514, USA;
| | - Rebecca A. Previs
- Division of Gynecological Oncology, Duke Cancer Institute, Durham, NC 27710, USA;
| | - Tomi Akinyemiju
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27701, USA
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14
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Afrin S, AlAshqar A, El Sabeh M, Miyashita-Ishiwata M, Reschke L, Brennan JT, Fader A, Borahay MA. Diet and Nutrition in Gynecological Disorders: A Focus on Clinical Studies. Nutrients 2021; 13:1747. [PMID: 34063835 DOI: 10.3390/nu13061747] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 11/17/2022] Open
Abstract
A healthy lifestyle and a balanced diet play a paramount role in promoting and maintaining homeostatic functions and preventing an array of chronic and debilitating diseases. Based upon observational and epidemiological investigations, it is clear that nutritional factors and dietary habits play a significant role in gynecological disease development, including uterine leiomyoma, endometriosis, polycystic ovary syndrome, and gynecological malignancies. Diets rich in fruits and vegetables, Mediterranean diets, green tea, vitamin D, and plant-derived natural compounds may have a long-term positive impact on gynecological diseases, while fats, red meat, alcohol, and coffee may contribute to their development. Data regarding the association between dietary habits and gynecological disorders are, at times, conflicting, with potential confounding factors, including food pollutants, reduced physical activity, ethnic background, and environmental factors limiting overall conclusions. This review provides a synopsis of the current clinical data and biological basis of the association between available dietary and nutritional data, along with their impact on the biology and pathophysiology of different gynecological disorders, as well as an outlook on future directions that will guide further investigational research.
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15
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Sone K, Toyohara Y, Taguchi A, Miyamoto Y, Tanikawa M, Uchino-Mori M, Iriyama T, Tsuruga T, Osuga Y. Application of artificial intelligence in gynecologic malignancies: A review. J Obstet Gynaecol Res 2021; 47:2577-2585. [PMID: 33973305 DOI: 10.1111/jog.14818] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/25/2021] [Indexed: 12/28/2022]
Abstract
With the development of machine learning and deep learning models, artificial intelligence is now being applied to the field of medicine. In oncology, the use of artificial intelligence for the diagnostic evaluation of medical images such as radiographic images, omics analysis using genome data, and clinical information has been increasing in recent years. There have been increasing numbers of reports on the use of artificial intelligence in the field of gynecologic malignancies, and we introduce and review these studies. For cervical and endometrial cancers, the evaluation of medical images, such as colposcopy, hysteroscopy, and magnetic resonance images, using artificial intelligence is frequently reported. In ovarian cancer, many reports combine the assessment of medical images with the multi-omics analysis of clinical and genomic data using artificial intelligence. However, few study results can be implemented in clinical practice, and further research is needed in the future.
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Affiliation(s)
- Kenbun Sone
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yusuke Toyohara
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ayumi Taguchi
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuichiro Miyamoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Michihiro Tanikawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mayuyo Uchino-Mori
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takayuki Iriyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tetsushi Tsuruga
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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16
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Dwivedi SKD, Rao G, Dey A, Mukherjee P, Wren JD, Bhattacharya R. Small Non-Coding-RNA in Gynecological Malignancies. Cancers (Basel) 2021; 13:1085. [PMID: 33802524 PMCID: PMC7961667 DOI: 10.3390/cancers13051085] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/18/2021] [Accepted: 02/25/2021] [Indexed: 12/12/2022] Open
Abstract
Gynecologic malignancies, which include cancers of the cervix, ovary, uterus, vulva, vagina, and fallopian tube, are among the leading causes of female mortality worldwide, with the most prevalent being endometrial, ovarian, and cervical cancer. Gynecologic malignancies are complex, heterogeneous diseases, and despite extensive research efforts, the molecular mechanisms underlying their development and pathology remain largely unclear. Currently, mechanistic and therapeutic research in cancer is largely focused on protein targets that are encoded by about 1% of the human genome. Our current understanding of 99% of the genome, which includes noncoding RNA, is limited. The discovery of tens of thousands of noncoding RNAs (ncRNAs), possessing either structural or regulatory functions, has fundamentally altered our understanding of genetics, physiology, pathophysiology, and disease treatment as they relate to gynecologic malignancies. In recent years, it has become clear that ncRNAs are relatively stable, and can serve as biomarkers for cancer diagnosis and prognosis, as well as guide therapy choices. Here we discuss the role of small non-coding RNAs, i.e., microRNAs (miRs), P-Element induced wimpy testis interacting (PIWI) RNAs (piRNAs), and tRNA-derived small RNAs in gynecological malignancies, specifically focusing on ovarian, endometrial, and cervical cancer.
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Affiliation(s)
- Shailendra Kumar Dhar Dwivedi
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (S.K.D.D.); (A.D.)
| | - Geeta Rao
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (G.R.); (P.M.)
| | - Anindya Dey
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (S.K.D.D.); (A.D.)
| | - Priyabrata Mukherjee
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (G.R.); (P.M.)
- Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Jonathan D. Wren
- Biochemistry and Molecular Biology Department, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
- Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- Genes & Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - Resham Bhattacharya
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (S.K.D.D.); (A.D.)
- Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- Department of Cell Biology, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
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17
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Kunogi H, Hsu IC, Yamaguchi N, Kusunoki S, Nakagawa K, Sugimori Y, Fujino K, Terao Y, Ogishima D, Yoshimura R, Sasai K. CT-Guided Pelvic Lymph Nodal Brachytherapy. Front Oncol 2021; 10:532555. [PMID: 33680907 PMCID: PMC7933543 DOI: 10.3389/fonc.2020.532555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 12/31/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose This is a report of our initial experience using computed tomography (CT)-guided interstitial high dose rate (HDR) brachytherapy to treat bulky pelvic nodal metastases as a part of definitive radiotherapy. Material and methods Between February 2015 and April 2019, 14 cervical/endometrial cancer patients presenting with bulky pelvic node(s) underwent nodal interstitial brachytherapy boost in our institution. In total, 17 nodes were treated. The median maximum diameters of the positive nodes at the time of diagnosis and at the first nodal implant were 25 mm (range: 10-65 mm) and 16 mm (range: 9-51 mm), respectively. Dosimetry data of the lymph nodal target volume and small bowel were collected and compared using the paired-sample t-test. Treatment-related toxicities were classified using the Common Terminology Criteria for Adverse Events version 4.0. Results The median follow-up time for all patients was 26 months. Local recurrence in pelvic nodes occurred in one patient (7%) after 16 months. One patient experienced grade 3 bladder bleeding, and one patient experienced grade 2 pubic bone fracture. No patient had grade 2 or greater gastrointestinal toxicity. In the dosimetric analysis, the mean nodal brachytherapy D90% in terms of the total equivalent dose of 2 Gy (EQD2) was 65.6 Gyαβ10. The mean small bowel dose (SBD)0.1cc and SBD1cc in terms of the total EQD2 were 60.4 and 56.5 Gyαβ3, respectively. Nodal D90% was significantly higher in terms of the total EQD2 than the SBD0.1cc (p = 0.003) and SBD1cc (p < 0.001). The Kaplan-Meier 2-year pelvic control estimate was 90%. Conclusions CT-guided interstitial HDR pelvic nodal brachytherapy appears to be well tolerated with excellent local control in cervical or endometrial cancer patients with bulky pelvic nodes. This approach may offer a useful therapeutic option for unresected bulky pelvic nodes.
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Affiliation(s)
- Hiroaki Kunogi
- Department of Radiation Oncology, Juntendo University, Tokyo, Japan
| | - I-Chow Hsu
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, United States
| | - Nanae Yamaguchi
- Department of Radiation Oncology, Juntendo University, Tokyo, Japan
| | - Soshi Kusunoki
- Department of Gynecology, Juntendo University, Tokyo, Japan
| | - Keiko Nakagawa
- Department of Radiation Oncology, Tokyo Medical Dental University, Tokyo, Japan
| | - Yayoi Sugimori
- Department of Gynecology, Juntendo University, Tokyo, Japan
| | | | - Yasuhisa Terao
- Department of Gynecology, Juntendo University, Tokyo, Japan
| | - Daiki Ogishima
- Department of Gynecology, Juntendo University, Tokyo, Japan
| | - Ryoichi Yoshimura
- Department of Radiation Oncology, Tokyo Medical Dental University, Tokyo, Japan
| | - Keisuke Sasai
- Department of Radiation Oncology, Juntendo University, Tokyo, Japan
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18
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Smile TD, Reddy CA, Qiao-Guan G, Winter WI, Stephans KL, Woody NM, Balagamwala EH, Amarnath SR, Magnelli A, AlHilli MM, Michener CM, Mahdi H, DeBernardo RL, Rose PG, Cherian SS. Stereotactic body radiotherapy for the treatment of oligometastatic gynecological malignancy in the abdomen and pelvis: A single-institution experience. J Radiosurg SBRT 2021; 7:189-197. [PMID: 33898082 PMCID: PMC8055243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE/OBJECTIVES Metastasis-directed therapy with stereotactic body radiotherapy (SBRT) in the setting of oligometastatic disease is a rapidly evolving paradigm given ongoing improvements in systemic therapies and diagnostic modalities. However, SBRT to targets in the abdomen and pelvis is historically associated with concerns about toxicity. The purpose of this study was to evaluate the safety and efficacy of SBRT to the abdomen and pelvis for women with oligometastases from primary gynecological tumors. MATERIALS/METHODS From our IRB-approved registry, all patients who were treated with SBRT between 2014 and 2020 were identified. Oligometastatic disease was defined as 1 to 5 discrete foci of clinical metastasis radiographically diagnosed by positron emission tomography (PET) and/or computerized tomography (CT) imaging. The primary endpoint was local control at 12 months. Local and distant control rates were estimated using the Kaplan-Meier method. Time intervals for development of local progression and distant progression were calculated based on follow up visits with re-staging imaging. Acute and late toxicity outcomes were determined based on Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. RESULTS We identified 34 women with 43 treated lesions. Median age was 68 years (range 32-82), and median follow up time was 12 months (range 0.2-54.0). Most common primary tumor sites were ovarian (n=12), uterine (n=11), and cervical (n=7). Median number of previous lines of systemic therapy agents at time of SBRT was 2 (range 0-10). Overall, SBRT was delivered to 1 focus of oligometastasis in 29 cases, 2 foci in 2 cases, 3 foci in 2 cases, and 4 foci in 1 case. All patients were treated comprehensively with SBRT to all sites of oligometastasis. Median prescription dose was 24 Gy (range 18-54 Gy) in 3 fractions (range 3-6) to a median prescription isodose line of 83.5% (range 52-95). Local control by lesion at 12 and 24 months was 92.5% for both time points. Local failure was observed in three treated sites among two patients, two of which were at 11 months in one patient, and the other at 30 months. Systemic control rate was 60.2% at 12 months. Overall survival at 12 and 24 months was 85% and 70.2%, respectively. Acute grade 2 toxicities included nausea (n=3), and there were no grade > 3 acute toxicities. Late grade 1 toxicities included diarrhea (n=1) and fatigue (n=1), and there were no grade > 2 toxicities. CONCLUSION SBRT to oligometastatic gynecologic malignancies in the abdomen and pelvis is feasible with encouraging preliminary safety and local control outcomes. This approach is associated with excellent local control and low rates of toxicity during our follow-up interval. Further investigations into technique, dose-escalation and utilization are warranted.
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Affiliation(s)
- Timothy D Smile
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chandana A Reddy
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - George Qiao-Guan
- College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - W Ian Winter
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kevin L Stephans
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Neil M Woody
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ehsan H Balagamwala
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sudha R Amarnath
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Chad M Michener
- Gynecological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Haider Mahdi
- Gynecological Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Peter G Rose
- Gynecological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sheen S Cherian
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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Abstract
The decades-long global obesity epidemic has resulted in steady increase in the incidence of obesity-related malignancies. The associated diagnostic and therapeutic implications present a clinical challenge for gynecologic oncology treatment strategies. Recent studies have provided solid evidence for an independent, linear, positive correlation between a pathologically increased body mass index and the probability of developing endometrial or postmenopausal breast cancer. The pathogenesis is complex and the subject of current research. Proposed causes include pathologically increased serum levels of sexual steroids and adiponectin, obesity-induced insulin resistance, and systemic inflammatory processes. The scientific evidence for an association between obesity and other gynecological malignancies is, however, less solid. The clinical relevance of obesity as a risk factor for epithelial ovarian cancer, cervical cancer and vulvar cancer appears to be negligible.
Nevertheless, obesity appears to have a negative impact on prognosis and oncologic outcomes for all gynecological cancers. Whether or not this effect can be interpreted as correlative or causal is still a subject of ongoing debate.
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Affiliation(s)
- Heinz Kölbl
- Klinische Abteilung für Allgemeine Gynäkologie und Gynäkologische Onkologie, Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien, Wien, Austria
| | - Thomas Bartl
- Klinische Abteilung für Allgemeine Gynäkologie und Gynäkologische Onkologie, Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien, Wien, Austria
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Abstract
Background: Cancer is a complex disease that arises from the accumulation of multiple genetic and non-genetic changes. Advances in sequencing technologies have allowed unbiased and global analysis of patient-derived tumor samples and the discovery of genetic and transcriptional changes in key genes and oncogenic pathways. That in turn has facilitated a better understanding of the underlying causes of cancer initiation and progression, resulting in new therapeutic targets. Methods: In our study, we have analyzed the mutational landscape of gynecological malignancies using datasets from The Cancer Genome Atlas (TCGA). We have also analyzed Oncomine datasets to establish the impact of their alteration on disease recurrence and survival of patients. Results: In this study, we analyzed a series of different gynecological malignancies for commonly occurring genetic and non-genetic alterations. These studies show that white women have higher incidence of gynecological malignancies. Furthermore, our study identified 16 genes that are altered at a frequency >10% among all of the gynecological malignancies and tumor suppressor TP53 is the most altered gene in these malignancies (>50% of the cases). The top 16 genes fall into the categories of either tumor suppressor or oncogenes and a subset of these genes are associated with poor prognosis, some affecting recurrence and survival of ovarian cancer patients. Conclusion: In sum, our study identified 16 major genes that are broadly mutated in a large majority of gynecological malignancies and in some cases predict survival and recurrence in patients with gynecological malignancies. We predict that the functional studies will determine their relative role in the initiation and progression of gynecological malignancies and also establish if some of them represents drug targets for anti-cancer therapy.
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Affiliation(s)
| | - Romi Gupta
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
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21
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Lei J, Wang Y, Guo X, Yan S, Ma D, Wang P, Li B, Du W, Guo R, Kan Q. Low preoperative serum ALB level is independently associated with poor overall survival in endometrial cancer patients. Future Oncol 2020; 16:307-316. [PMID: 32039638 DOI: 10.2217/fon-2019-0732] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Aim: To reveal the prognostic significance of serum albumin (ALB) concentration in endometrial cancer (EC) patients in China. Patients & methods: 345 EC patients were enrolled in a single center, and the preoperative serum ALB concentration were measured. Kaplan-Meier curve analysis and Cox proportional hazards regression model were performed to evaluate the associations between ALB concentration and overall survival (OS) of EC patients. Results: The EC patients with lower preoperative serum ALB concentration exhibited a significantly poorer OS (p < 0.05). Univariate analysis and multivariate analysis indicated that serum ALB concentration was an independent prognostic factor of unfavorable OS for EC patients. Conclusion: Our results showing that ALB concentration may serve as an independent prognostic factor for EC patients.
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Affiliation(s)
- Jia Lei
- Department of Gynecologic Oncology, The First Affiliated Hospital of Zhengzhou University, Jianshe East Road, Zhengzhou 450052, PR China
| | - Yue Wang
- Department of Obstetrics & Gynecology, Henan Province People's Hospital, 7 Weiwu Road, Zhengzhou 450052, PR China
| | - Xiangqian Guo
- Department of Preventive Medicine, Institute of Biomedical Informatics, Joint National Laboratory for Antibody Drug Engineering, Cell Signal Transduction Laboratory, School of Basic Medical Sciences, Henan University, Kaifeng 475004, PR China
| | - Shuping Yan
- Department of Gynecologic Oncology, The First Affiliated Hospital of Zhengzhou University, Jianshe East Road, Zhengzhou 450052, PR China
| | - Dimeng Ma
- Department of Gynecologic Oncology, The First Affiliated Hospital of Zhengzhou University, Jianshe East Road, Zhengzhou 450052, PR China
| | - Pengran Wang
- Department of Gynecologic Oncology, The First Affiliated Hospital of Zhengzhou University, Jianshe East Road, Zhengzhou 450052, PR China
| | - Bijun Li
- Department of Gynecologic Oncology, The First Affiliated Hospital of Zhengzhou University, Jianshe East Road, Zhengzhou 450052, PR China
| | - Wenjun Du
- Department of Gynecologic Oncology, The First Affiliated Hospital of Zhengzhou University, Jianshe East Road, Zhengzhou 450052, PR China
| | - Ruixia Guo
- Department of Gynecologic Oncology, The First Affiliated Hospital of Zhengzhou University, Jianshe East Road, Zhengzhou 450052, PR China
| | - Quancheng Kan
- Department of Gynecologic Oncology, The First Affiliated Hospital of Zhengzhou University, Jianshe East Road, Zhengzhou 450052, PR China
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22
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Mukai Y, Koike I, Matsunaga T, Yokota NR, Takano S, Sugiura M, Sato M, Miyagi E, Hata M. Radiation Therapy for Uterine Cervical Cancer With Lung Metastases Including Oligometastases. In Vivo 2020; 33:1677-1684. [PMID: 31471423 DOI: 10.21873/invivo.11655] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/13/2019] [Accepted: 07/16/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND/AIM To investigate the role and outcomes of radiation therapy (RT) for stage IVB uterine cervical cancer (UCC) patients with lung (oligo) metastases due to the lack of recent reports on the subject. PATIENTS AND METHODS The cohort for this retrospective study comprised 23 consecutive patients with UCC (squamous cell carcinoma, n=13) and lung metastases who had received pelvic RT. Ten had lung metastases only, including 7 with oligometastases (≤4 lung metastases); the remaining 13 also had other distant metastases. RESULTS Nine (39.1%) of the 22 patients (95.7%) completed RT without interruption. The 1-year primary progression-free rate was 95.2%. The 1-year overall survival rate was 47.2 % (estimated median survival: 9 months). Significant prognostic factors for survival included: i) ≤4 lung metastases (p=0.035), ii) unilateral lung metastases (p=0.039), iii) primary tumor diameter <100 mm (p<0.001), and iv) ECOG performance status <1 (p=0.015). CONCLUSION RT is safe and effective for stage IVB UCC patients with lung metastases.
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Affiliation(s)
- Yuki Mukai
- Department of Radiation Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Izumi Koike
- Department of Radiation Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tatsuya Matsunaga
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Naho Ruiz Yokota
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Syoko Takano
- Department of Radiation Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Madoka Sugiura
- Department of Radiation Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Mizuki Sato
- Department of Radiation Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masaharu Hata
- Department of Radiation Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Cianci S, Rumolo V, Rosati A, Scaletta G, Alletti SG, Cerentini TM, Sleiman Z, Lordelo P, Angerame D, Garganese G, Uccella S, Tarascio M, Scambia G. Sarcopenia in Ovarian Cancer Patients, Oncologic Outcomes Revealing the Importance of Clinical Nutrition: Review of Literature. Curr Pharm Des 2019; 25:2480-2490. [PMID: 31333115 DOI: 10.2174/1381612825666190722112808] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/20/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Ovarian cancer is the leading cause of death among gynecological malignancies. Its usual clinical manifestation is at advanced stages, with nutritional impairment, weight loss, and a consequent decline in skeletal muscle mass and strength (defined as sarcopenia). The relationship between sarcopenia and decreased survival was demonstrated not only in ovarian cancer but also in other cancer types, such as hepatocellular, pancreatic, lung, colon, cervical, metastatic breast, and renal cancer. The aim of this study is to review the current evidence regarding the relationship between sarcopenia and the surgical and oncological outcomes in ovarian cancer patients. METHODS The systematic search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRSIMA) statement. The terms "SARCOPENIA" AND "OVARIAN CANCER" were systematically used to search PubMed and Scopus databases. Original reports in English language were identified, with the purpose to include all relevant papers regarding the role of sarcopenia and indicators of skeletal muscle quality assessment in gynecological ovarian cancer. RESULTS A total of 9 studies were considered eligible for the present review. The strength of recommendation was moderate and the level of evidence was low in all selected articles. No prospective studies were conducted and most of the papers were case-control series comparing ovarian cancer sarcopenic population vs. non sarcopenic population. CONCLUSIONS Sarcopenia appears to have an important role in oncological outcomes of ovarian cancer patients. However, sarcopenia occurrence during disease history and mechanisms underlying the possible impairment in prognosis should be better investigated. Prospective trials are awaited in order to obtain a better insight in this topic.
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Affiliation(s)
- Stefano Cianci
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valerio Rumolo
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Rosati
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Scaletta
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Salvatore Gueli Alletti
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Taís Marques Cerentini
- Postgraduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Zaki Sleiman
- Lebanese American University, Department of Obstetrics and Gynecology, Zahar street, Beirut, Lebanon
| | | | - Daniela Angerame
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, Brazil
| | - Giorgia Garganese
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefano Uccella
- Obstetrics and Gynecology Department, Nuovo Ospedale degli Infermi, Biella, Italy
| | - Mattia Tarascio
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Nattenmüller J, Rom J, Buckner T, Arvin J, Bau B, Sohn C, Kauczor HU, Schott S. Visceral abdominal fat measured by computer tomography as a prognostic factor for gynecological malignancies? Oncotarget 2018; 9:16330-42. [PMID: 29662648 DOI: 10.18632/oncotarget.24667] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/27/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction Obesity is associated with increased incidence of ovarian (OC), cervical (CC) and endometrium cancer (EC). However, the impact of body composition (BC) on overall survival (OS), especially of visceral adipose tissue (VAT) is not yet understood. Methods In 189 women with gynecological malignancies (31 OC, 104 CC, 54 EC, mean age 62.9y; mean BMI 26.8 kg/m2; median follow-up 30.7months) with routine staging CT-scans at baseline (mean interval: 4.3 months), densitometric quantification of total (TAT), visceral, and subcutaneous-fat-area (SAT), inter-muscular-fat-area (IMFA), and skeletal-muscle-index (SMI) was performed to analyze the impact of BC on survival. Results With a mean follow-up of 30.7 months 48 patients had died. We observed no significant differences regarding BMI, the adipose- and muscle-distribution between surviving and deceased women. Univariate analyses revealed no significant BC-parameter with impact on OS, which was confirmed by different multivariate models. A subgroup analysis of OC, CC and EC showed only a protective impact of SMI on survival in the subgroup of CC. Conclusions Despite the increased incidence of gynecological malignancies in obese, we found no significant impact of BC including VAT on patient survival. Further studies with larger cohorts are needed to quantify BC and its metabolomic impact regarding treatment and prognosis.
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Tinelli G, Cappuccio S, Parente E, Fagotti A, Gallotta V, Conte C, Costantini B, Gueli Alletti S, Scambia G, Vizzielli G. Resectability and Vascular Management of Retroperitoneal Gynecological Malignancies: A Large Single-institution Case-Series. Anticancer Res 2017; 37:6899-6906. [PMID: 29187471 DOI: 10.21873/anticanres.12153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 09/27/2017] [Accepted: 09/29/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To report on morbidity and oncological outcomes in a consecutive series of gynecological malignancies involving the vascular district. PATIENTS AND METHODS We retrospectively evaluated a consecutive series between 1/2015 and 1/2017 with suspicious gynecological malignancies involving the vascular district. Peri-operative data and survival rates were computed. RESULTS Eight-hundred-four women with gynecological malignancies were admitted for major oncologic surgery during the study period, and among them, 50 cases (6.2%) showed vascular involvement. Twenty-seven and 23 patients were submitted to minor and major vascular procedures, respectively. R0 resection was achieved in 44 patients. There were no perioperative mortalities. Major postoperative complications occurred in 6 patients (12.0%). The 2-year disease free survival (DFS) was 67% if R0 resection was achieved. In patients with positive pathological margins (n=2), the 2-year DFS was 33%. CONCLUSION Vascular procedures can be safely performed with a proper pre-operative planning and may not be an impediment to major gynecological oncological surgery.
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Affiliation(s)
- Giovanni Tinelli
- Division of Vascular Surgery, "Agostino Gemelli" Foundation University Hospital, Catholic University, Rome, Italy
| | - Serena Cappuccio
- Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Catholic University, Rome, Italy
| | - Ezio Parente
- Division of Vascular Surgery, "Agostino Gemelli" Foundation University Hospital, Catholic University, Rome, Italy
| | - Anna Fagotti
- Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Catholic University, Rome, Italy
| | - Valerio Gallotta
- Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Catholic University, Rome, Italy
| | - Carmine Conte
- Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Catholic University, Rome, Italy
| | - Barbara Costantini
- Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Catholic University, Rome, Italy
| | - Salvatore Gueli Alletti
- Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Catholic University, Rome, Italy
| | - Giovanni Scambia
- Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Catholic University, Rome, Italy
| | - Giuseppe Vizzielli
- Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Catholic University, Rome, Italy
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Lee HJ, Lee YH, Chong GO, Hong DG, Lee YS. Robotic-assisted Transperitoneal Infrarenal Para-aortic Lymphadenectomy for Gynecological Malignancies: Comparison with a Laparoscopic Approach. Anticancer Res 2017; 37:7087-7093. [PMID: 29187500 DOI: 10.21873/anticanres.12182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 10/19/2017] [Accepted: 10/23/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM We evaluated the clinical feasibility and surgical outcomes of robotic-assisted transperitoneal infrarenal para-aortic lymphadenectomy (TIPAL) in patients with gynecological malignancies. PATIENTS AND METHODS The perioperative outcomes in 90 patients with gynecological malignancies who underwent laparoscopic (n=43) or robotic-assisted (n=47) TIPAL were compared retrospectively. RESULTS The operative time for pelvic and total lymphadenectomy were significantly shorter in the robotic-assisted approach, whereas the time for infrarenal para-aortic lymphadenectomy did not differ statistically. In contrast, the number of infrarenal para-aortic lymph nodes was significantly higher in the robotic-assisted approach. We compared the time per retrieved lymph node in both approaches, and those for pelvic, infrarenal para-aortic, and total lymphadenectomy were significantly shorter in the robotic-assisted approach. CONCLUSION In our study, the robotic-assisted TIPAL took less time to retrieve a lymph node than the laparoscopic approach. The robotic-assisted approach for TIPAL is feasible for the staging and treatment of patients with gynecological malignancies.
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Affiliation(s)
- Hyun Jung Lee
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yoon Hee Lee
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Gun Oh Chong
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Dae Gy Hong
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yoon Soon Lee
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Hasan S, Ricco A, Jenkins K, Lanciano R, Hanlon A, Lamond J, Yang J, Feng J, Good M, Noumoff J, Brady L. Survival and Control Prognosticators of Recurrent Gynecological Malignancies of the Pelvis and Para-aortic Region Treated with Stereotactic Body Radiation Therapy. Front Oncol 2016; 6:249. [PMID: 27921006 PMCID: PMC5118455 DOI: 10.3389/fonc.2016.00249] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/09/2016] [Indexed: 01/30/2023] Open
Abstract
Purpose To define prognostic factors associated with improved survival and local control (LC) for gynecologic cancer recurrences limited to the pelvis and para-aortic (PA) region using stereotactic body radiation therapy (SBRT). Methods Between 2/2008 and 7/2014, 30 women (35 targets) with pelvic or PA recurrence of endometrioid (n = 12), cervical (n = 11), ovarian (n = 3), uterine-serous (n = 2), or carcinosarcoma (n = 2) cancer were treated with SBRT. Eleven recurrences were located in the central pelvis, 11 along the pelvic sidewall (PSW), and 13 in the PA region. Results Five-year survival for all patients was 42% with a median survival of 43.4 months. Multivariate analysis revealed better performance status (PS), and smaller clinical tumor volume was significant for improved survival (p < 0.05). Conclusion SBRT is a local therapy for recurrent gynecological malignancies in the pelvis and PA region with curative potential. SBRT is especially effective for LC when targeting PSW or PA recurrence and for patients with a cervical/endometrioid uterine primary. Survival is improved for patients with better PS and smaller recurrence volume prior to SBRT.
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Affiliation(s)
- Shaakir Hasan
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Anthony Ricco
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Kaylette Jenkins
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Rachelle Lanciano
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Alexandra Hanlon
- University of Pennsylvania School of Nursing , Philadelphia, PA , USA
| | - John Lamond
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Jun Yang
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Jing Feng
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Michael Good
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Joel Noumoff
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Luther Brady
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
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Mazzola R, Ricchetti F, Fiorentino A, Levra NG, Fersino S, Di Paola G, Ruggieri R, Alongi F. Weekly Cisplatin and Volumetric-Modulated Arc Therapy With Simultaneous Integrated Boost for Radical Treatment of Advanced Cervical Cancer in Elderly Patients: Feasibility and Clinical Preliminary Results. Technol Cancer Res Treat 2016; 16:310-315. [PMID: 27402633 DOI: 10.1177/1533034616655055] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND To evaluate the feasibility and clinical preliminary results of weekly cisplatin and volumetric-modulated arc therapy to the pelvis with simultaneous integrated boost to macroscopic disease in a cohort of elderly patients. MATERIALS AND METHODS Inclusion criteria of this prospective study were age ≥70 years, Karnofsky performance status 70 to 100, locally advanced histologically proven squamous cervical carcinoma, and patients unable to undergo brachytherapy. Radiation doses prescribed were 66 Gy to the macroscopic disease and 54 Gy to the pelvic nodes in 30 fractions. Weekly cisplatin dose was 40 mg/mq. RESULTS A total of 30 patients were recruited. Median follow-up was 32 months (range: 8-48 months). Median age was 72 years (range: 70-84 years). The 3-year overall survival and local control were 93% and 80%, respectively. The median time to progression was 24 months (range: 6-30 months). Analyzing clinical outcome grouping based on the stage of disease, II versus III, the 3-year overall survival was 100% and 85%, respectively. The 3-year local control was 91% for stage II and 67% for stage III. Acute and late toxicities were acceptable without severe events. CONCLUSION Weekly cisplatin and volumetric-modulated arc therapy-simultaneous integrated boost for radical treatment of advanced cervical cancer in the current cohort of elderly patients were feasible. Long-term results and prospective randomized trials are advocated.
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Affiliation(s)
- Rosario Mazzola
- 1 Radiation Oncology, Sacro Cuore Don Calabria-Cancer Care Center, Negrar, Verona, Italy
| | - Francesco Ricchetti
- 1 Radiation Oncology, Sacro Cuore Don Calabria-Cancer Care Center, Negrar, Verona, Italy
| | - Alba Fiorentino
- 1 Radiation Oncology, Sacro Cuore Don Calabria-Cancer Care Center, Negrar, Verona, Italy
| | - Niccolò Giaj Levra
- 1 Radiation Oncology, Sacro Cuore Don Calabria-Cancer Care Center, Negrar, Verona, Italy
| | - Sergio Fersino
- 1 Radiation Oncology, Sacro Cuore Don Calabria-Cancer Care Center, Negrar, Verona, Italy
| | | | - Ruggero Ruggieri
- 1 Radiation Oncology, Sacro Cuore Don Calabria-Cancer Care Center, Negrar, Verona, Italy
| | - Filippo Alongi
- 1 Radiation Oncology, Sacro Cuore Don Calabria-Cancer Care Center, Negrar, Verona, Italy
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Zheng X, Huang H, Zheng X, Li B. Olive oil exhibits osteoprotection in ovariectomized rats without estrogenic effects. Exp Ther Med 2016; 11:1881-1888. [PMID: 27168821 DOI: 10.3892/etm.2016.3138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 02/11/2016] [Indexed: 01/09/2023] Open
Abstract
The present study was designed to evaluate the effect of olive oil on bone and uterus in ovariectomized rats. A total of 34 surgically ovariectomized or sham-operated virgin Sprague-Dawley rats were divided into four groups: i) Sham-operated control rats (sham group); ii) Ovariectomized rats (OVX group); iii) Olive oil-supplemented ovariectomized rats (olive group); and iv) Diethylstilbestrol-supplemented ovariectomized rats (E2 group). At 12 weeks following left ventricular blood sacrificed to detect plasma estradiol (E2), interleukin-1β (IL-1β) and IL-6 levels. Bone mineral density (BMD) of the lumbar spine was evaluated using dual-energy X-ray absorptiometry, and the left femur proximal 1/3 slices were observed using transmission electron microscopy. Uterine wet weight and the uterus index (ratio of uterine wet weight and body weight) were compared, and the uterine endometrium was observed using a light microscope. In the OVX group, serum E2 was significantly lower and IL-1β and IL-6 levels were significantly higher compared with the sham group. By contrast, serum E2 levels increased and IL-1β levels decreased in the olive group, but showed no significant difference compared with the sham group. The lumbar spine BMD in the olive group was increased compared with OVX group. Electron microscopy revealed sparse collagen fibers in the OVX group, with decreased density and multi-cavity, showing pathological features of osteoporosis. By contrast, the situation was improved in the E2 and olive groups, in which organelles such as the rough endoplasmic reticulum, mitochondria and Golgi apparatus were visible and active. Compared with the sham group rats, the uterine wet weight and uterine index decreased in the OVX and olive groups; however, no statistically significant difference was observed in the E2 group. Furthermore, endometrial hyperplasia was not observed in the olive group, which were apparently different from E2 group. The present results suggest that olive oil can effectively reduce bone loss in ovariectomized rats, and with no or only mild effects on the uterine endothelium.
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Affiliation(s)
- Xiaohua Zheng
- Department of Gynecology and Obstetrics, Fuzhou General Hospital of Nanjing Command PLA, Fuzhou, Fujian 350025, P.R. China
| | - Huijuan Huang
- Department of Gynecology and Obstetrics, Fuzhou General Hospital of Nanjing Command PLA, Fuzhou, Fujian 350025, P.R. China
| | - Xiaobing Zheng
- Department of Neurosurgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Baoheng Li
- Department of Gynecology and Obstetrics, Fuzhou General Hospital of Nanjing Command PLA, Fuzhou, Fujian 350025, P.R. China
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Mieszało K, Ławicki S, Szmitkowski M. [The utility of metalloproteinases (MMPs) and their inhibitors (TIMPs) in diagnostics of gynecological malignancies]. Pol Merkur Lekarski 2016; 40:193-197. [PMID: 27088204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Metalloproteinases (MMPs) are a family of proteolytic enzymes, involved in the degradation of collagen and other extracellular matrix components. They play a very important role in many physiological processes, i.e. angiogenesis, hemostasis, cyclic changes in the endometrium, wounds healing, as well as in tumor growth and spreading. Already performed studies have shown significant increase in the expression of MMP-2 and MMP-9 in the most common gynecological cancer (cervix, endometrium, ovary) compared to normal tissue and benign lesions. In addition, the MMP-9 concentration correlated with the clinical stage and the presence of distant metastases. Moreover the level of MMP-2 was significantly associated with the degree of malignancy. MMP-7 may be helpful in the diagnosis of ovarian cancer and useful in estimating of lymph node metastasis presence in endometrial cancer. In the detection of cervical cancer it may be useful to evaluate the expression of MMP-11 and MMP-12 (absent in normal cells) and their increase according to the degree of tissue damage. The usefulness of metalloproteinases in the diagnosis of gynecological cancer still requires confirmation test. However, it appears that they will be valuable factors in diagnostic complement, especially in combination with conventional markers, i.e. CA 125, SCCAg or HE-4.
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Affiliation(s)
| | - Sławomir Ławicki
- Department of Biochemical Diagnostics, Medical University of Białystok
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Hildebrandt T, Thiel FC, Fasching PA, Graf C, Bani MR, Loehberg CR, Schrauder MG, Jud SM, Hack CC, Beckmann MW, Lux MP. Health utilities in gynecological oncology and mastology in Germany. Anticancer Res 2014; 34:829-835. [PMID: 24511019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND AIMS Cost increases in the healthcare system are leading to a need to distribute financial resources in accordance with the value of each service performed. Health-economic decision-making models can support these decisions. Due to the previous unavailability of health utilities in Germany (scored states of health as a basis for calculating quality-adjusted life-years, QALYs) for women undergoing treatment, international data are often used for such models. However, these may widely deviate from the values for a woman actually living in Germany. It is, therefore, necessary to collect and analyze health utilities in Germany. MATERIALS AND METHODS In a questionnaire survey, health utilities were collected, along with data for a healthy control group, for 580 female patients receiving treatment in the fields of mastology and gynecological oncology using a German version of the EuroQol questionnaire (EQ-5D) and a visual analogue scale (VAS). Data were also collected for the patients' medical history, tumor disease, and treatment. RESULTS Significant differences with regard to quality of life were measured in relation to the individual tumor entities and in comparison to the controls. Apart from the healthy control group, patients with breast or cervical carcinoma had the best quality of life. In patients with recurrent and metastatic disease, those with breast carcinoma experienced the greatest impairment of their quality of life. According to current treatment, the most important impairment of life quality occurred in patients under radiotherapy and after surgical treatment. There are significant differences from the health utilities recorded for other countries - for example, the state of health declines much more markedly in patients with metastatic disease among American women with breast carcinoma than among German women, in whom recurrent disease and a first diagnosis of metastasis were comparable. Overall, the VAS was able to distinguish more adequately than the EQ-5D questionnaire between the different situations and impairments resulting from diagnosis and therapy. CONCLUSION Health utilities are now, for the first time, available for further health-economics analyses in the field of gynecological oncology and mastology for women living in Germany. Important differences in these utilities from those of other countries are evident.
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Affiliation(s)
- Thomas Hildebrandt
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Universitätsstrasse 21-23, 91054 Erlangen, Germany.
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Nassir M, Roth A, Gasimli K, Braicu EI, Fotopoulou C, Mawrin C, Badakhshi H, Warnke JP, Sehouli J. Is endometrial cancer really a neurophobic tumor? A case report and review of the literature. Anticancer Res 2014; 34:249-257. [PMID: 24403471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Brain metastases due to endometrial cancer are rare and usually occur in the context of widespread disease. We present a rare case of a 74-year-old woman with recurrent endometrial cancer in terms of a solitary brain lesion two years after initial diagnosis. She was treated with local resection of the brain metastasis and subsequent whole-brain radiotherapy. She then experienced relapse twice, presenting two solitary metastases at two different time points at the same location as at initial diagnosis, but never showed any signs of extracranial widespread disease. The patient has been alive for 13 months after detection of her initial brain metastasis. Despite the identification of some risk factors, there is still very limited knowledge why some patients develop brain metastases as the only sign of distant spread. Our review of the literature revealed that the combination of two treatment modalities yields higher survival rates than single treatment-alone, as was the case in the presented patient. Further case reports, as well as large and prospective studies, may contribute to a better understanding of the etiology and dynamics of this disease and allow better evaluation of treatment options.
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Affiliation(s)
- Mani Nassir
- Department of Gynecology, Campus Virchow Clinic, Charité Medical University Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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