Adjuvant chemotherapy of ovarian cancer using paclitaxel/cisplatin protocol in women over 70 – analysis of treatment course and toxicity

Aim of paper: Analysis of clinical course of 1st line chemotherapy acc. to paclitaxel/cisplatin protocol in women over 70 with ovarian cancer. Secondary endpoint was treatment-related toxicity in this population of patients. Material and method: This retrospective study included 25 patients over 70 with confirmed diagnosis of ovarian cancer at the beginning of their therapy (study group) and 25 patients under 70 continuing their therapy (control group). All patients underwent primary surgery and received adjuvant chemotherapy (paclitaxel 135 mg/m2 and cisplatin 75 mg/m2). Treatmentrelated toxicity was assessed using Common Terminology Criteria for Adverse Events v. 3.0 (CTCAE). Results: Patients in both groups did not differ significantly in clinical stage of their disease. Women in the study group presented a significantly higher proportion of poorly differentiated ovarian cancer as compared with controls. Baseline mean CA-125 level was similar in both groups. No significant intergroup differences occurred concerning the number of chemotherapy cycles delivered or mortality rate during the therapy. Proportion of patients requiring delay or cessation of treatment was similar in both groups. No significant difference was observed in remission rates between study and control groups. Incidence of hematologic complications, renal failure, neurotoxicity and hepatotoxicity was similar in both groups. No cardiologic complications were noticed in this population of patients and proportion of patients who required blood transfusion was similar in both groups. Conclusions: Course of treatment, toxicity and clinical response are not age-dependent in patients with ovarian cancer receiving paclitaxel/cisplatin protocol.Cel: Analiza przebiegu chemioterapii I rzutu z wykorzystaniem schematu paklitaksel/cisplatyna u kobiet powyżej 70. roku życia chorujących na raka jajnika. Dodatkowo oceniano toksyczność tego leczenia w badanej grupie pacjentek. Materiał i metody: Badaniem retrospektywnym objęto grupę 25 pacjentek z rozpoznanym rakiem jajnika, które miały ponad 70 lat w momencie rozpoczęcia terapii (grupa badana), oraz grupę 25 pacjentek w wieku poniżej 70 lat w trakcie trwania terapii (grupa kontrolna). Pacjentki z obu grup zostały poddane pierwotnemu zabiegowi operacyjnemu i następowej chemioterapii: paklitakselem (135 mg/m2) i cisplatyną (75 mg/m2). Toksyczność terapii oceniano według Common Terminology Criteria for Adverse Events v. 3.0 (CTCAE). Wyniki: Pacjentki z obu grup nie różniły się znamiennie w odniesieniu do stopnia klinicznego zaawansowania. U kobiet z grupy badanej odnotowano istotny wzrost odsetka raka jajnika o niskim stopniu histologicz nego zróżnicowania w porównaniu z grupą kontrolną. Średnie stężenie markera CA-125 przed rozpoczęciem leczenia było podobne w obu grupach. Nie stwierdzono istotnych statystycznie różnic pomiędzy grupami w odniesieniu do liczby podanych cykli chemioterapii oraz odsetka zgonów w trakcie terapii. Odsetek pacjentek wymagających czasowego przerwania terapii lub odstąpienia od jej kontynuowania był podobny w obu grupach. Wśród pacjentek z grupy badanej w porównaniu z grupą kontrolną nie wykazano znamiennej statystycznie różnicy w odniesieniu do odsetka pacjentek, które osiągnęły remisję. Częstość występowania powikłań hematologicznych, niewydolności nerek, neurotoksyczności i hepatotoksyczności była podobna w obu grupach. W obu grupach nie stwierdzono występowania powikłań kardiologicznych. Odsetek pacjentek wymagających transfuzji krwi w obu grupach był podobny. Wnioski: Przebieg i toksyczność terapii oraz odpowiedź kliniczna nie są czynnikami zależnymi od wieku pacjentki podczas stosowania schematu paklitaksel/cisplatyna w leczeniu raka jajnika

Subamniotic Haematoma Associated with an Uneventful Labour

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Can Replacing CA125 with HE4 in Risk of Malignancy Indices 1–4 Improve Diagnostic Performance in the Presurgical Assessment of Adnexal Tumors?

Aims. To assess whether replacing CA125 with HE4 in the classical formulas of risk of malignancy indices (RMIs) can improve diagnostic performance. Methods. For each of 312 patients with an adnexal mass, classical RMIs 1–4 were computed based on ultrasound score, menopausal status, and serum CA125 levels. Additionally, modified RMIs (mRMIs) 1–4 were recalculated by replacing CA125 with HE4. Results. Malignant pathology was diagnosed in 52 patients (16.67%). There was no significant difference in diagnostic performance (area under the receiver operating characteristic curve [AUC]) between each classical RMI and its corresponding mRMI. In the entire sample, the AUC was 0.899, 0.900, 0.895, and 0.908 for classical RMIs 1–4 compared to 0.903, 0.929, 0.930, and 0.931 for mRMIs 1–4. In premenopausal patients, the AUC was 0.818, 0.798, 0.795, and 0.802 for classical RMIs 1–4 compared to 0.839, 0.875, 0.876, and 0.856 for mRMIs 1–4. In postmenopausal patients, the AUC was 0.906, 0.895, 0.896, and 0.906 for classical RMIs 1–4 compared to 0.907, 0.923, 0.924, and 0.930 for mRMI 1–4. Conclusions. Use of HE4 instead of CA125 did not significantly improve diagnostic performance of RMIs 1–4 in patients with an adnexal mass

Efficacy of Continuous Glucose Monitoring on Glycaemic Control in Pregnant Women with Gestational Diabetes Mellitus—A Systematic Review

Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy, affecting up to 14% of pregnant women. The population of patients with risk factors of GDM is increasing; thus, it is essential to improve management of this condition. One of the key factors affecting perinatal outcomes in GDM is glycaemic control. Until recently, glucose monitoring was only available with self-monitoring of blood glucose (SMBG). However, nowadays, there is a new method, continuous glucose monitoring (CGM), which has been shown to be safe in pregnancy. Since proper glycaemia assessment has been shown to affect perinatal outcomes, we decided to perform a systematic review to analyse the role of CGM in glycaemic control in GDM. We conducted a web search of the MEDLINE, EMBASE, Cochrane Library, Scopus, and Web of Science databases according to the PRISMA guidelines. The web search was performed by two independent researchers and resulted in 14 articles included in the systematic review. The study protocol was registered in the PROSPERO database with registration number CRD42021289883. The main outcome of the systematic review was determining that, when compared, CGM played an important role in better glycaemic control than SMBG. Furthermore, glycaemic control with CGM improved qualification for insulin therapy. However, most of the articles did not reveal CGM’s role in improving neonatal outcomes. Therefore, more studies are needed to analyse the role of CGM in affecting perinatal outcomes in GDM

Does the Risk of Ovarian Malignancy Algorithm Provide Better Diagnostic Performance Than HE4 and CA125 in the Presurgical Differentiation of Adnexal Tumors in Polish Women?

Aim. This study compared the diagnostic performance of the Risk of Ovarian Malignancy Algorithm (ROMA) and HE4 and CA125 for the presurgical differentiation of adnexal tumors. Material and Methods. This prospective study included 302 patients admitted for surgical treatment due to adnexal tumors. The ROMA was calculated depending on CA125, HE4, and menopausal status. Results. Fifty patients were diagnosed with malignant disease. In the differentiation of malignant from nonmalignant adnexal tumors, the area under curve (AUC) was higher for ROMA and HE4 than that for CA125 in both the premenopausal and postmenopausal subgroups. In the differentiation of stage I FIGO malignancies and epithelial ovarian cancer from nonmalignant pathologies, the AUC of HE4 and ROMA was higher than that of CA125. The ROMA performed significantly better than CA125 in the differentiation of all malignancies and differentiation of stage I FIGO malignancies from nonmalignant pathologies (p=0.043 and p=0.025, resp.). There were no significant differences between the ROMA and the tumor markers for any other variants. Conclusions. The ROMA is more useful than CA125 for the differentiation of malignant (including stage I FIGO) from nonmalignant adnexal tumors. It is also as useful as HE4 and CA125 for the differentiation of epithelial ovarian cancer from nonmalignant adnexal tumors

Can Replacing CA125 with HE4 in Risk of Malignancy Indices 1–4 Improve Diagnostic Performance in the Presurgical Assessment of Adnexal Tumors?

Aims. To assess whether replacing CA125 with HE4 in the classical formulas of risk of malignancy indices (RMIs) can improve diagnostic performance. Methods. For each of 312 patients with an adnexal mass, classical RMIs 1–4 were computed based on ultrasound score, menopausal status, and serum CA125 levels. Additionally, modified RMIs (mRMIs) 1–4 were recalculated by replacing CA125 with HE4. Results. Malignant pathology was diagnosed in 52 patients (16.67%). There was no significant difference in diagnostic performance (area under the receiver operating characteristic curve [AUC]) between each classical RMI and its corresponding mRMI. In the entire sample, the AUC was 0.899, 0.900, 0.895, and 0.908 for classical RMIs 1–4 compared to 0.903, 0.929, 0.930, and 0.931 for mRMIs 1–4. In premenopausal patients, the AUC was 0.818, 0.798, 0.795, and 0.802 for classical RMIs 1–4 compared to 0.839, 0.875, 0.876, and 0.856 for mRMIs 1–4. In postmenopausal patients, the AUC was 0.906, 0.895, 0.896, and 0.906 for classical RMIs 1–4 compared to 0.907, 0.923, 0.924, and 0.930 for mRMI 1–4. Conclusions. Use of HE4 instead of CA125 did not significantly improve diagnostic performance of RMIs 1–4 in patients with an adnexal mass