Analysis of para-aortic lymphadenectomy up to the level of the renal vessels in apparent early-stage ovarian cancer.

ObjectiveThe aim of this study was to evaluate the impact of para-aortic lymphadenectomy up to the renal vessels on the accurate staging in ovarian cancer patients presumed preoperatively to be confined to the ovary.MethodsWe retrospectively analyzed data on 124 patients with primary epithelial ovarian cancer who were preoperatively thought to have tumor confined to the ovary and underwent primary staging surgery. The distribution of lymph node metastasis and various risk factors for nodal involvement were investigated.ResultsSURGICAL STAGING YIELDED: 87 (70.2%) patients had International Federation of Gynecology and Obstetrics (FIGO) stage I disease and 37 (29.8%) patients had stage II-III disease: 4 IIA, 6 IIB, 9 IIC, 1 IIIA, and 17 IIIC. Eighty-six patients had pelvic lymphadenectomy only and 69 had pelvic and para-aortic lymphadenectomy. Lymph node metastases were found in 17 (24.6%) of 69 patients; 5 (7.2%) patients had lymph node metastasis in the pelvic lymph nodes only, 8 (11.6%) in the para-aortic lymph nodes only, and 4 (5.8%) in both pelvic and para-aortic lymph nodes. Six (8.7%) patients had lymph node metastasis in the para-aortic lymph node above the level of the inferior mesenteric artery. On multivariate analysis, grade 3 tumor (p=0.01) and positive cytology (p=0.03) were independent predictors for lymph node metastasis.ConclusionA substantial number of patients with apparently early ovarian cancer had upstaged disease. Of patients who underwent lymphadenectomy, some patients had lymph node metastasis above the level of the inferior mesenteric artery. Para-aortic lymphadenectomy up to the renal vessels may detect occult metastasis and be of help in tailoring appropriate adjuvant treatment as well as giving useful information about the prognosis

Long-term results of early adjuvant concurrent chemoradiotherapy for high-risk, early stage uterine cervical cancer patients after radical hysterectomy

Abstract Background The aim of the present study was to investigate the long-term survival outcomes and toxicities associated with our experienced early administration of adjuvant concurrent chemoradiotherapy (CCRT). Methods Ninety-eight patients with pelvic lymph node metastasis, positive resection margin, and/or parametrial invasion who received adjuvant CCRT between 1995 and 2011 were analyzed retrospectively. The first cycle of platinum-based adjuvant chemotherapy was initiated within 2–3 weeks after surgery (median, 12 days) and continued every 4 weeks for a total of 4 cycles. Adjuvant radiotherapy was performed during the second and third cycles of chemotherapy. Results After a median follow-up period of 119 months for survivors, 13 patients (13.3%) experienced recurrence and 11 patients died of cancer during the follow-up period. The 5-year recurrence-free survival and cancer specific survival rates were 87.6% and 90.6%, respectively. Ninety-four patients (95.9%) received ≥3 cycles of chemotherapy. Total radiation dose of ≥45 Gy was delivered in 91 patients (92.9%). Grade 3–4 hematologic and gastrointestinal toxicities developed in 37 (37.8%) and 14 (14.3%) patients during CCRT, respectively. Conclusion The present study confirmed the long-term safety and encouraging survival outcomes of early administration of adjuvant CCRT, suggesting the benefits of early time to initiation of adjuvant treatments

Simplified Selection Criteria for Secondary Cytoreductive Surgery in Recurrent Ovarian Cancer

(1) Background: Multiple confounding factors influence the indications for secondary cytoreductive surgery (SCS) in patients with ovarian cancer (OC). We aimed to identify the factors associated with patients most likely to benefit from SCS. (2) Methods: We retrospectively reviewed the medical records of patients with recurrent ovarian cancer from 2003 to 2021. The potential factors influencing treatment outcomes and survival between patients who received chemotherapy alone and those who received SCS after recurrence were evaluated. (3) Results: Recurrent OC was identified in 262 patients, with a median age of 53 (20–80) years. Of these patients, 87.4% had an initial stage III/IV disease. Eighty-nine (34%) patients received SCS. The median survival was 41.0 (95% confidence interval [CI], 37.4–44.5) months and 88.0 (95% CI, 64.2–111.7) months in the chemotherapy and surgery groups, respectively. A multivariate analysis showed limited regional carcinomatosis (single region or up to three regions with limited carcinomatosis) (p = 0.045) as the only significant factor for predicting no residual disease after SCS. In platinum-sensitive recurrent patients with limited regional recurrence, the complete resection rate was 87.6%. (4) Conclusions: SCS had a significant impact on survival in the selected patient population. Limited regional recurrence (single region or up to three regions with limited carcinomatosis) may be a simple criterion for SCS in platinum-sensitive recurrent OC patients

The old age itself is not an independent poor prognostic factor in epithelial ovarian cancer (EOC)

Background: The speed of aging of Korea is the highest in the world. Previous studies about the relationship between age and EOC have shown inconsistent results and almost all of them have been from western countries. The aims of this study were to demonstrate the effect of old age (age ≥65) on the clinic-pathologic factors and survivals in Korean patients with EOC. Methods: After a retrospective chart review of 486 EOC patients including 70 elderly patients who underwent surgery for EOC between January 2000 and February 2010, we compared the demographics, surgical outcomes, clinic-pathologic factors, chemotherapy administered and survivals of younger versus older patients. Results: Mean age of younger (n=416) and older (n=70) groups were 47 (range, 14-64) and 70 (range, 65-84), respectively. The characteristics which were different between two groups were as follows: body mass index (kg/m2), 22.8±3.4 vs. 24.1±3.6, p=0.002; cardiovascular diseases, 46 (11.1%) vs. 44 (62.9%), p=0.000; diabetes mellitus, 18 (4.3%) vs. 15 (21.4%), p=0.000; stage, p=0.012; Clear cell carcinoma histologic type, 55 (13.2%) vs. 3 (4.3%), p=0.029; Omentum involvement, 169 (48.1%) vs. 43 (66.2%), p=0.000; Ascites cytology, 216 (53.5%) vs. 42 (62.7%), p=0.012. On the contrary, optimal debulking rate, recur rate, lines of chemotherapy, total courses of chemotherapy, 1-year progression free survival (51.6% vs. 58.8%, p=0.450) and 5-year overall survival (83.5% vs. 76.0%, p=0.525) were all similar between two groups. Cox regression analyses failed to show any of the characteristics which were shown to be different between groups but stage might have confounding effects on the age and survival relationship. Conclusions: If optimal debulking and chemotherapy statuses are the same, old age itself is not an independent poor prognostic factor despite the higher stage of older patients. Therefore, maximal effort should be directed towards optimal debulking surgery and chemotherapy for elderly EOC patients.