Clinicopathological factors of pelvic lymph nodes involvement in advanced serous ovarian cancer

Objectives: Retroperitoneal lymph nodes metastases occur frequently in patients with ovarian cancer. Lymphadenectomyincreases risk of perioperative complications. In clinical practice to reduce rate of complications aortocaval lymphadenectomyis omitted and solely resection of pelvic lymph nodes is performed. To establish factors affecting metastases to pelviclymph nodes in advanced ovarian cancer.Material and methods: A retrospective study among patients with serous advanced ovarian cancer (FIGO IIIB–IVB) wasconducted at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw and Department of GynecologicOncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw. All patients underwentsurgical treatment including pelvic lymphadenectomy between 2014 and 2017. Data including age, body mass index(BMI), pretreatment CA125 serum level, tumor volume, grading, one-/both-sided tumor, menopausal status, ascites wereanalysed as possible factors influencing the pelvic lymph nodes involvement. The statistical analysis was performed withPython software.Results: 87 consecutive patients were eligible for the study. Metastases to pelvic lymph nodes were found in 29 (33.33%)patients. Pretreatment serum CA-125 concentration (652 U/mL vs 360.9 U/mL, p < 0.05) and high grade histology correspondedwith pelvic nodal involvement.Conclusions: The knowledge of factors influencing metastases to pelvic lymph nodes may help clinicians in proper counsellingand tailoring of therapy

Retrospective analysis of the diagnostic effectiveness of the sentinel lymph node biopsy (SLNB) in vulvar cancer

Objectives: Inguinal lymphadenectomy used in the treatment of vulvar cancer often results in complications, such aslymphoedema or abnormal wound healing. Aim of this study was assessment of the diagnostic effectiveness of the sentinellymph node biopsy (SLNB) procedure in patients treated due to vulvar cancer.Material and methods: Eighty-four patients diagnosed with squamous cell vulvar carcinoma (FIGO I-IV) underwentpreoperative lymphoscintigraphy with technetium 99 to map sentinel lymph node. During surgery sentinel lymph nodeswere identified and resected, followed by complete bilateral groin lymphadenectomy.Results: Sentinel lymph nodes were mapped with lymphoscintigraphy and biopsied in 84.3% and 90.1% of patients, respectively.False negative predictive value (FNPV) was 9.1% and false negative rate (FNR) was recorded in 16.7% of cases. Patientsin advanced stages (FIGO III and IV) had significantly lower rate of lymphatic mapping compared to those in stage I and II(OR = 0.148, p = 0.022). Detection of sentinel lymph node in lymphoscintigraphy for tumor grade 2 and 3 was nearly eighttimes lower than for grade 1 cancers, however without statistical significance (OR = 0.126, p = 0.058).Conclusions: The use of SLNB should be limited to vulvar cancer patients in early clinical stages

Contemporary principles of diagnostic and therapeutic management in cervical and ovarian neuroendocrine tumors

Enhancing knowledge about neuroendocrine neoplasms causes the need to improve management of these tumors. Althoughthese tumors are rare in clinical practice, their biological diversity makes both diagnostics and therapy a challengefor contemporary oncology. The article discusses the latest developments in the diagnostic procedures and methods oftreatment of the cervical and ovarian neuroendocrine tumors. Algorithms are presented to understand the differences intherapeutic management in these malignancies

Prognosis of the patients suffered from uterine carcinosarcoma from rural and urban areas

Objectives: Uterine carcinosarcoma is a very aggressive neoplasm. Patients’ median age at diagnosis ranges from 62 to 67 years. The aim of this study was to compare treatment results and prognostic factors for residents of urban and rural areas suffering from uterine carcinosarcoma. Material and methods: Clinical outcomes of 58 uterine carcinosarcoma patients treated in one institution were assessed: 25 residents of rural and 33 of urban areas. All the patients were treated by using surgery followed by chemotherapy (48 pts) or radiotherapy (10 pts). Standard chemotherapy regimen comprised of paclitaxel 175 mg/m2 and carboplatin on day one at area under curve (AUC) six every 21 days. Radiotherapy was performed by combined treatment – tele and brachytherapy. External beam pelvic radiation therapy (EBRT) once a day, five days a week with a daily fraction size of 1.8 Gy over five weeks at cumulative dose 50.4 Gy was the first part of adjuvant treatment. High-dose-rate (HDR) brachytherapy at dose 22.5 Gy was the second part of radiotherapy. Results: A strong correlation between tumor diameter and the presence of lymph node metastasis was observed. Tumor size greater then 4.5 cm correlated with presence of node involvement and this parameter was statistically significant (p = 0.015). There was no significant correlation between other analyzed clinical factors and overall survival. In the period 2004 – 2010 43.5% (10/23) and 50% (14/28) of rural and urban residents, respectively, died due to carcinosarcoma progression. Conclusion: Uterine carcinosarcoma patients in rural and urban areas seem to have similar outcomes.

Measurement of HE4 six months after first-line treatment as optimal time in identifying patients at high risk of progression advanced ovarian cancer

Objectives: The objective of the study was to assess the usefulness of determining HE4 and CA125 in ovarian cancer patients, to indicate which of the measurements may be optimal in the prognosis, depending on the treatment scheme. Material end methods: The concentrations of CA125 and HE4 were performed in 70 patients with advanced ovarian cancer during I-line therapy and after treatment. The subjects were divided based on the treatment scheme: group I - primary surgery and adjuvant chemotherapy, II- neoadjuvant therapy, and surgery. Results: Multivariate analysis showed that HE4 levels six months after treatment was significantly higher in patients with disease progression. ROC analysis in the group of patients treated with neoadjuvant therapy showed that the cut-off values indicating relapse for HE4 and CA125 after six months of follow up, were > 90.4 pmol/L, > 25.6 IU/mL, respectively. In the group of patients not treated with neoadjuvant therapy, the cut-off points differentiating patients with progression were: HE4 > 79.1 pmol/L, CA125 > 30.7 IU/mL. We demonstrated significantly higher HE4 and CA125 at both 6- and 12-months follow-up in patients treated with neoadjuvant therapy. In both groups of patients, the cut-off points were lower than those proposed by the manufacturer of the kits. Conclusions: Measurement of HE4 six months after treatment may be useful in identifying patients at high risk of progression, especially when CA125 levels may be non-specifically elevated. The cut-off values indicating relapse for HE4 and CA125 after six months of follow up may be lower than the normal range

Recommendations of the Polish Society of Gynaecologists and Obstetricians, Polish Paediatric Society, Polish Society of Family Medicine, Polish Society of Vaccinology, Polish Society of Oncological Gynaecology and Polish Society of Colposcopy and Pathophysiology of the Uterine Cervix on prophylactic vaccinations against infections with human papillomaviruses in Poland

Several hundred million people are infected with genital genotypes of the human papillomavirus (HPV) annually in the world. The infections transmitted mainly through sexual routes are usually asymptomatic, but can lead to the development of cervical, vulvar, vaginal, anal, penile cancers, some head and neck cancers and genital warts (condylomas). The fraction HPV-related cancers range from nearly 100% in the case of cervical cancer to several/over a dozen percent in the case of other cancers and diseases. There are no effective drugs against HPV, but prophylactic HPV vaccines are available free of charge in immunization programmes in many countries around the world. In Poland, HPV vaccinations have so far been executed out on the pocket or in free-of-charge, local-governmental prevention programs, but the vaccination coverage of the target population does not exceed 10%. From November 2021, one of the vaccines is available with a 50% reimbursement, work is underway to reimburse the next ones, and the National Oncology Strategy assumes the implementation of the HPV immunization programmes and vaccination of 60% of the teen population by 2028. Three prophylactic HPV vaccines are registered. All of them are safe and their effectiveness in the prevention of diseases caused by vaccine genotypes reaches almost 100%, provided that full post-vaccination immunity is obtained before the contact with the virus. Girls aged 11-13 are the priority target cohort for HPV vaccination in Poland. The implementation of routine, free-of-charge HPV immunization in the Preventive Immunization Program (PIP) for all adolescents should be pursued. Persons over the age of 13 may also benefit from HPV vaccination and should be vaccinated according to product specifications. In addition to free access under the PIP, the key element for the success of the implementation of HPV vaccinations in Poland will be the education of medical personnel and parents of adolescents to be vaccinated

European Society of Gynaecological Oncology Guidelines for the Management of Patients With Vulvar Cancer

Objective The aim of this study was to develop clinically relevant and evidence-based guidelines as part of European Society of Gynaecological Oncology's mission to improve the quality of care for women with gynecologic cancers across Europe. Methods The European Society of Gynaecological Oncology Council nominated an international development group made of practicing clinicians who provide care to patients with vulvar cancer and have demonstrated leadership and interest in the management of patients with vulvar cancer (18 experts across Europe). To ensure that the statements are evidence based, the current literature identified from a systematic search has been reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the development group (expert agreement). The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 181 international reviewers including patient representatives independent from the development group. Results The guidelines cover diagnosis and referral, preoperative investigations, surgical management (local treatment, groin treatment including sentinel lymph node procedure, reconstructive surgery), radiation therapy, chemoradiation, systemic treatment, treatment of recurrent disease (vulvar recurrence, groin recurrence, distant metastases), and follow-up

TP53 status and taxane-platinum versus platinum-based therapy in ovarian cancer patients: A non-randomized retrospective study

<p>Abstract</p> <p>Background</p> <p>Taxane-platinum therapy (TP) has replaced platinum-based therapy (PC or PAC, DNA damaging chemotherapy) in the postoperative treatment of ovarian cancer patients; however, it is not always effective. TP53 protein plays a differential role in response to DNA-damaging agents and taxanes. We sought to define profiles of patients who benefit the most from TP and also of those who can be treated with PC.</p> <p>Methods</p> <p>We compared the effectiveness of PC/PAC (n = 253) and TP (n = 199) with respect to tumor TP53 accumulation in ovarian cancer patients with FIGO stage IIB-IV disease; this was a non-randomized retrospective study. Immunohistochemical analysis was performed on 452 archival tumors; univariate and multivariate analysis by the Cox's and logistic regression models was performed in all patients and in subgroups with [TP53(+)] and without TP53 accumulation [TP53(-)].</p> <p>Results</p> <p>The advantage of taxane-platinum therapy over platinum-based therapy was seen in the TP53(+), and not in the TP53(-) group. In the TP53(+) group taxane-platinum therapy enhanced the probability of complete remission (p = .018), platinum sensitivity (p = .014), platinum highly sensitive response (p = .038) and longer survival (OS, p = .008). Poor tumor differentiation diminished the advantage from taxane-platinum therapy in the TP53(+) group. In the TP53(-) group PC/PAC was at least equally efficient as taxane-platinum therapy and it enhanced the chance of platinum highly sensitive response (p = .010). However, in the TP53(-) group taxane-platinum therapy possibly diminished the risk of death in patients over 53 yrs (p = .077). Among factors that positively interacted with taxane-platinum therapy in some analyses were endometrioid and clear cell type, FIGO III stage, bulky residual tumor, more advanced age of patient and moderate tumor differentiation.</p> <p>Conclusion</p> <p>Our results suggest that taxane-platinum therapy is particularly justified in patients with TP53(+) tumors or older than 53 years. In the group of patients ≤53 yrs and with TP53(-) tumors platinum-based therapy is possibly equally efficient. We provide hints for planning randomized trials to verify these observations.</p