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.

Analysis of incidence and overall survival of patients with vulvar cancer in Poland in 2008–2016 — implications for cancer registries

Objectives: To analyze the incidence and overall survival rate of patients with vulvar cancer in Poland, based on the reporting data from the National Health Fund.Material and methods: The incidence of vulvar cancer in Poland in 2008–2016 (9-year follow-up period) by voivodship and the number of patients undergoing combined hospital treatment were analyzed. For the group of patients treated systemically, overall survival (OS) probability was calculated using the Kaplan-Meier estimation method.Results: In the period 2008–2016 in Poland, the diagnosis of malignant neoplasm of the vulva (C51% group) was made in 29,702 patients. The mean annual prevalence rate per 100,000 inhabitants was 8.3 ± 1.2 for Poland. The largest numbers of patients were reported in Mazowieckie and Slaskie voivodeships and the lowest in Opolskie and Podlaskie voivodeships. The median overall survival of patients treated with the combined method in 2008–2016 in Poland was 64.7 months (95% Cl: 58.0–70.0). One-year survival rate was observed in 77.6% of patients, 2-year in 64.4%, 3-year in 58%, over 5 years — 54.22%.Conclusions: In the years 2008–2016 in Poland, based on the data reported to the National Health Fund, the incidence of vulvar cancer was 4 times higher than the statistics of the National Cancer Registry, the WHO or the USA, which indicates either substantive or reporting errors. In Poland, 54% of patients treated with the combined therapy survive over 5 years which is a much lower result compared to highly developed countries

Molecular classification of endometrial carcinoma, is it the new era of precision medicine?

For many years endometrial cancer has been subdivided into oestrogen — dependent (type I) and oestrogen — independent (type II), according to classical Bokhman classification. Histopathological evaluation including type and grade of tumour, along with clinical factors have been considered as very important prognostic factors that impact treatment decision. However, histologically similar tumours may have different outcomes. Recent molecular findings and new histopathological parameters have given new concept on risk stratification. The Cancer Genome Atlas Research Network (TCGA) of tumours have brought new insights into endometrial cancer management. Four molecular subgroups have been described: POLE ultramutated (POLE mut), p53 mutant (p53abn), mismatch repair deficient (MMRd) and non-specific molecular profile (NSMP). This new subdivision has been recently introduced in the European risk stratification system

Overall survival (OS) in patients after chemotherapy for cervical cancer in Poland in years 2008–2015

Objectives: To analyze cervical cancer prevalence as well as treatment methods, and its effects and assessment of overall survival of patients after chemotherapy for cervical cancer in Poland. Material and methods: Data were collected from the registry of the National Health Fund (the only public payer in Poland). The data of patients treated in 2008–2015, who were shown to the payer with the diagnosis of malignant neoplasm of cervix (C53 according to the ICD-10 classification), were included in the analysis. The annual and eight-year prevalence rates were calculated. The overall survival was calculated for patients treated with chemotherapy. Results: In the analyzed period (2008–2015), 83,100 women were diagnosed with C53, of which 33,300 (40%) were reported in the group of hospital treatment. The median age of patients was 59 years (58.8 ± 12.87). The highest prevalence rate was observed in 2008 (16.94 patients/100,000 inhabitants). The highest annual and period (2008–2015) prevalence rates patients per 100,000 inhabitants were observed in the Podlaskie (17.03 and 115.53 respectively) and Pomorskie (14.19 and 101.43 respectively) voivodeships and the lowest in Dolnośląskie voivodeship (10.47 and 78.87 respectively) and Podkarpackie voivodeship (10.79 and 71.29 respectively). Mean survival time was 55.12 months and its median 45.46 months. Annual survival time was observed in 76.79% of patients, 2-year in 60.61%; 3-year in 53.08% and 5-year in 46.65%. Conclusions: In the years 2008–2015 in Poland, the incidence of cervical cancer was even 4 times higher than the EU average, and the mortality was as much as 70% higher than the average for EU countries