BORDERLİNE MÜSİNÖZ OVER TÜMÖRLERİ : 26 OLGUDA RETROSPEKTİF DEĞERLENDİRME

Overin borderline müsinöz tümörlerini invaziv müsinöz karsinomlardan ayırmak için kullanılan histolojik kriterler çok tartışmalıdır

Lokal ileri evre serviks kanseri tanısı ile radyokemoterapi uygulanan olgularda erken sonuçlar

Radiotherapy is the standart treatment of locally advanced cervical cancer. Recent results of the prospective randomized trials showed an overall survival and local control advantage for cisplatin based therapy given concurrently with radiation therapy. Thirty-nine patients who received concurrent chemoradiation between October 1999 and December 2000 were evaluated for treatment response, local control and toxicity. Thirty-nine patients with stage IB-IVA cervical carcinoma received weekly cisplatin 40 mg/m2 concurrent with radiotherapy. Median cisplatin administration was 5 weeks. Thirty-two patients received both external and intracavitary radiotherapy and seven patients received only external radiotherapy because of insufficient tumor response for intracavitary apllication. Total external radiotherapy dose was 64.8 Gy with 1.8 Gy daily fractions in patients who received only external radiotherapy. Midline shielding was performed at 50.4 Gy in patients who were going to receive brachytherapy and the total external radiotherapy dose was 54-59.4 Gy. Brachytherapy was performed with Rotterdam applicator via microSelectron HDR machine. A total dose of 8.5-18 Gy was applied to point A. Median age was 55. Distribution by stages according to FIGO staging system were as follows: stage IB 5.1 %, IIA 28.2%, IIB 43.6%, IIIA 7.7%, IIIB 12.8% and IVA 2.6%. Histologically 33 (84.6%) were epidermoid carcinoma, 1 was adenocarcinoma, 2 were indiffrentiated carcinoma, 1 was malignant epithelial tumor. In two patients histological subtype could not be specified. The median duration of follow-up was 20 months. Four patients (10.3%) had local recurrence and three developed distant metastases being two lung and one bone metastases. Thirty patients (76.9%) had complete response, 8 had (20.5%) partial response and one had (2.6%) stable disease. During or after radiochemotherapy 46.2% of the patients developed toxicity due to chemotherapy. Early and late radiation morbidity rates were 66.7% and 71.8% respectively. No grade III-IV toxicity was observed. Concurrent chemoradiation for locally advanced cervical cancer is the treatment of choice in suitable patients providing high response rates with acceptable toxicity.Radyoterapi, lokal ileri evre serviks kanserlerinde standart tedavi yöntemidir. Ancak son yıllarda yapılan prospektif randomize çalışmaların sonuçları radyoterapi ile eşzamanlı kemoterapi uygulamasının yalnız radyoterapiye oranla lokal kontrol ve sağkalım avantajı sağladığını göstermiştir. Bu amaçla Ekim 1999-Aralık 2000 tarihleri arasında serviks kanseri tanısıyla kliniğimizde radyokemoterapi uygulanan 39 olgu erken dönem tedavi yanıtı, lokal kontrol ve yan etkiler açısından değerlendirilmiştir. Evre IB-IVA serviks kanseri tanılı 39 olguya pelvik radyoterapiyle eş zamanlı, haftalık 40 mg/m2 cisplatin uygulanmıştır. Cisplatin uygulaması medyan 5 hafta yapılmış, 32 olguya eksternal ve intrakaviter radyoterapi uygulanırken 7 olguda tümör yanıtının intrakaviter tedavi için uygun olmaması nedeniyle yalnız eksternal radyoterapi uygulanmıştır. Eksternal radyoterapi günlük 1.8 Gy'lik fraksiyonlarla yalnız eksternal radyoterapi uygulanan olgularda toplam 64.8 Gy, eksternal radyoterapi ve brakiterapi uygulanan olgularda ise 50.4 Gy'de orta hat koruması yapılarak toplam 54-59.4 Gy dozlarda uygulanmıştır. Brakiterapi uygulamaları Rotterdam aplikatör seti ile A noktasına toplam 8.5-18 Gy olacak şekilde mikroSelectron-HDR IR-192 cihazı ile gerçekleştirilmiştir. Medyan yaşı 55 olan olguların evrelere göre dağılımı FIGO evreleme sistemine göre %5.1 evre IB, %28.2 evre IIA, %43.6 evre IIB, %7.7 evre IIIA, %12.8 evre IIIB ve %2.6 evre IVA oranında şeklindedir. Histopatolojik değerlendirmede 33 olguda (%84.6) epidermoid karsinom, 1 olguda (%2.6) adenokarsinom, 2 olguda (%5.1) indiferan tümör, 1 olguda (%2.6) malign epitelial tümör saptanmış, 2 olguda (%5.1) ise biopsi sonucu yalnız malign tanısı konulabilmiş, histopatolojik tip belirlenememiştir. Medyan 20 ay takip edilen olguların 4'ünde (%10.3) lokal yineleme, 3 olguda (%7.7) biri kemik, ikisi akciğere olmak üzere uzak metastaz gelişmiştir. Klinik yanıt değeriendirmesinde 30 olguda (%76.9) tam, 8 olguda (%20.5) kısmi yanıt, 1 olguda (%2.6) stabil yanıt saptanmıştır. Radyokemoterapi sırası ve sonrasında kemoterapiye bağlı toksisite oranı %46.2, radyoterapiye bağlı erken toksisite oranı %66.7, geç toksisite oranı %71.8 olup olguların ileri evre serviks kanserlerinde eşzamanlı radyokemoterapi uygulamaları yüksek yanıt oranları ve kabul edilebilir toksisitesi nedeniyle uygun olgularda tercih edilen tedavi yöntemidir

Synchronous Primary Cancers of the Female Reproductive Tract in Turkish Women

WOS: 000299260200004PubMed ID: 21790215Objectives: To evaluate the synchronous gynecologic cancers in Turkish women. Materials and methods: A population-based longitudinal cohort study was conducted using Izmir Cancer Registry (ICR) data on gynecologic cancer patients diagnosed in the period 1993 to 2005. The registry covers the 3.7 million population of Izmir and has been collecting data on cancer incidence and survival of cancer patients' since 1992. The ICR collects data on all new cases of cancer from all the hospitals (n = 22) in the city. Results: A total of 4,185 women were identified with gynecologic cancer between 1993 and 2005, 1,526 with endometrial, 1,206 with cervical, 1,198 with ovarian, 115 with vulvar, 67 with other uterine (sarcoma etc.), 33 with vaginal and 40 with other gynecologic cancers (tuba uterina etc.). Fifty-five (1.3%) patients with invasive synchronous primary cancers were identified, 43 of these tumor pairs being endometrium-ovaries (81%), 66 of all lesions being endometrioid adenocarcinomas. Conclusions: Independent primary tumors of the endometrium and ovary are the most commonly encountered synchronous tumors of the female genital tractus with endometrioid adenocarcinoma as the most frequent component

Effect of surgical staging on 539 patients with borderline ovarian tumors: A Turkish Gynecologic Oncology Group study

WOS: 000327923400010PubMed ID: 24016409Objective. The objectives of this study were to examine demographic and clinicopathologic characteristics and to determine the effects of primary surgery, surgical staging and the extensiveness of staging. Methods. In a retrospective Turkish multicenter study, 539 patients, from 14 institutions, with borderline ovarian tumors were investigated. Some of the demographic, clinical and surgical characteristics of the cases were evaluated. The effects of type of surgery, surgical staging; complete or incomplete staging on survival rates were calculated by using Kaplan-Meier method. Results. The median age at diagnosis was 40 years (range 15-84) and 71.1% of patients were premenopausal. The most common histologic types were serous and mucinous. Majority of the staged cases were in Stage IA (735%). 242 patients underwent conservative surgery. Recurrence rates were significantly higher in conservative surgery group (8.3% vs. 3%). Of all patients in this study, 294 (545%) have undergone surgical staging procedures. Of the patients who underwent surgical staging, 228 (77.6%) had comprehensive staging including lymphadenectomy. Appendectomy was performed on 204 (37.8%) of the patients. The median follow-up time was 36 months (range 1-120 months). Five-year survival rate was 100% and median survival time was 120 months. Surgical staging, lymph node sampling or dissection and appendectomy didn't cause any difference on survival. Conclusion. Comprehensive surgical staging, lymph node sampling or dissection and appendectomy are not beneficial in borderline ovarian tumors surgical management. (C) 2013 Elsevier Inc. All rights reserved