Treatment of Invasive Cervical Cancer: Rijeka Experience

The aim of this retrospective analysis was to evaluate the survival rate in 661 patients with cervical cancer regarding two time periods 1990–1996 and 1997–2003 and the specific stage related risk factors. The respective five-year survival was 71.7% and 80.0%. Analyzing the risk factors in the univariate and multivariate regression modalities ultimately only two parameters, the two time periods and FIGO staging were found to be independent prognostic factors. The observed total improvement in the survival rate of the second time period is followed by an increase in conservative surgery in stage T1A1, a reduction in the use of adjuvant radiotherapy among operable stages T1b1, T1b2 and T2A, while the treatment of locally advanced cervical cancer did not differ significantly

ANALYSIS OF PROGNOSTIC FACTORS AND OF TYPE OF TREATMENT IN PATIENTS WITH ENDOMETRIAL CANCER IN THE FIRST FIGO STAGE

Cilj rada. Ispitati važnost histopatoloških čimbenika rizika i svrsishodnost načina liječenja u bolesnica s rakom endometrija u kirurškom – FIGO stadiju I. Metode. Retrospektivno je izdvojeno 219 bolesnica s rakom endometrija u kojih je učinjen sveobuhvatni staging (lavat negativan, limfne žlijezde negativne). Srednja dob bolesnica iznosila je 59 godina (SD 8, min. 39, maks. 75 godina). Vrijeme promatranja iznosilo je od 1 do 180 mjeseci, medijana 68 mjeseci. Analizirani su u odnosu na petogodišnje preživljenje sljedeći prognostički čimbenici: dob bolesnice, dubina invazije miometrija, histologija i diferenciranost tumora, vrsta histerektomije i primjena adjuvantne radioterapije. U 85 bolesnica učinjena je radikalna histerektomija, dok je njih 55 primilo adjuvantnu radioterapiju. Rezultati. Ukupno preživljenje promatrane skupine bolesnica iznosi 92,8%. Analizom svih prognostičkih parametara nije nađena značajnost u razlici preživljenja. Od 219 bolesnica njih 82 (37,4%) imale su kumulativne negativne prognostičke čimbenike, slabo diferencirani tumor ili neendometrioidni histološki nalaz ili invaziju miometrija preko polovice, a preživljenje između visoko rizične i nisko rizične skupine se bitno ne razlikuje (93,9% odnosno 91,2%). Primjena radikalne histerektomije uz adjuvantnu radioterapiju ne daje bolje rezultate preživljenja od radikalne histerektomije. Zaključak. Prema našoj retrospektivnoj analizi čimbenika rizika u bolesnica s rakom endometrija prvog FIGO stadija, analizirani čimbenici rizika nemaju prognostičko obilježje. Primjena radikalne histerektomije s ili bez adjuvantne radioterapije zdjelice ne pruža bolje rezultate u smislu preživljenja, i daljnju primjenu treba temeljito preispitati.Objective. To analyze the effect of histopathologic characteristics and usefullness of therapy mode in FIGO stage I endometrial cancer patients. Methods. Retrospectively were analyzed 219 endometrial cancer patients with hysterectomy, salpingoophorectomy and pelvic lymphadenectomy (peritoneal cytology and nodes negative). Patients characteristics include age, myometrial invasion, FIGO substages, histologic type, tumor grade, type of hysterectomy and adjuvant radio¬therapy. The mean age was 59 years (SD 8, Min. 39, Max. 75 years). Follow up ranges from 1 to 180 months (median 68). In 85 patients radical hysterectomies were performed and 45 patients received adjuvant radiotherapy. Results. Five year disease related survival was 92,8%. There is no significant difference among analyzed histopathologic patient’s characteristics related to five years survival. In 82 (37.3%) patients out of 219 were found cumulative negative prognostic factors (high risk patients) including non-endometrioid histology, poor tumor differentiation and/or outer half of miometrial invasion. There is no difference in survival between low (91,2%) and high risk patients (93,9%). Radical hysterectomy as well as adjuvant radiotherapy has no advantage in five year survival. Conclusion. This retrospective study has not identified histopathologic prognostic significant characteristics in FIGO stage I endometrial cancer patients. The use of radical hysterectomy and/or adjuvant radiotherapy has not better five years survival and should be reevaluated

Temeljna načela kirurškog liječenja zloćudnih ginekoloških novotvorina

In the treatment of gynecologic malignancies surgery represents a cornerstone of gynecologic oncology. Surgery is important to establish the definitive diagnosis, to define the extent of disease and to eliminate the tumor according to the type and localization. The most frequent tumors among gynecologic malignancies are cervical, endometrial and ovarian cancer. Actual surgical approach in early cervical cancer with microscopic extension includes conservative techniques, in the first place the use of conisation. In the same group of patients but with fulfilled reproductive activities, hysterectomy is recommended. Radical surgery could be applied in invasive cervical cancer staged IB1 to IIA. Surgical treatment in the advanced stage of cervical cancer could be exerted exclusively in controlled trials as a part of multimodal treatment. Endometrial cancer still remains incompletely defined in the extension of surgical procedures. Namely, lymphadenectomy in patients with endometrial cancer according to the low rate of lymphatic dissemination is not completely accepted in hospital daily practice. Furthermore, the increasing use of minimal invasive surgery transforms our way of thinking, especially in the case of endometrial cancer. Ovarian cancer still remains an unresolved diagnostic problem with negative implication in the treatment efficacy. About two thirds of patients are in advanced stage at the time of their first surgery, primarily for the lack of a high effective screening test as well as unknown pathophysiology in early ovarian cancer development. In early ovarian cancer comprehensive staging should be done, while in patients with advanced disease standard approach should include maximal effort in surgical cytoreduction.Kirurški tretman malignih novotvorina ženskog spolnog sustava predstavlja početak i osnovu svakog onkološkog liječenja. Kirurški je zahvat, naime, od temeljne važnosti pri postavljanju konačne dijagnoze, određivanju stadija bolesti, kao i za uklanjanje tumorske mase tijekom prvog operacijskog zahvata sukladno lokalizaciji i vrsti malignoma. Najčešću pojavnost malignoma ženskih spolnih organa nalazimo na cerviksu, endometriju i ovariju. Suvremeni kirurški pristup liječenju ranog stadija - mikroskoposkog raka vrata maternice uključuje konzervativne zahvate u smislu konizacije. U slučajevima gdje je reprodukcija završena može se posegnuti za histerektomijom. Radikalna kirurgija predstavlja metodu izbora u klinički invazivnom obliku bolesti (stadij IB1 do IIA). Kirurško liječenje viših stadija može se rabiti u kontroliranim studijama u sklopu multimodalnog liječenja. Rak endometrija i dalje ostaje u određenom smislu nedovoljno definiran u smislu opsežnosti samoga kirurškog zahvata. Naime, limfadenektomija kod bolesnica s rakom endometrija s obzirom na relativno nisku stopu limfogenog rasapa i dalje predstavlja kamen spoticanja u kliničkoj praksi. S druge strane, sve opsežnije uvođenje endoskopske kirurgije otvorilo je nepovratni put ka prihvaćanju operativnih zahvata s minimalno invazivnim tehnikama. Rak jajnika još uvijek predstavlja veliki dijagnostički i terapijski problem. Kako ne postoje široko primijenjeni učinkoviti testovi probira, bolest se u dvije trećine bolesnica otkriva tek u uznapredovaloj fazi s posljedičnom visokom stopom smrtnosti koja premašuje zbroj smrtnosti svih preostalih ginekoloških malignoma. U bolesnica s naizgled ranim stadijem bolesti potrebno je učiniti sveobuhvatni kirurški zahvat radi određivanja točnog stadija bolesti, dok u bolesnica s uznapredovalom bolešću standardni pristup uključuje optimalnu kiruršku citoredukciju

Temeljna načela kirurškog liječenja zloćudnih ginekoloških novotvorina

In the treatment of gynecologic malignancies surgery represents a cornerstone of gynecologic oncology. Surgery is important to establish the definitive diagnosis, to define the extent of disease and to eliminate the tumor according to the type and localization. The most frequent tumors among gynecologic malignancies are cervical, endometrial and ovarian cancer. Actual surgical approach in early cervical cancer with microscopic extension includes conservative techniques, in the first place the use of conisation. In the same group of patients but with fulfilled reproductive activities, hysterectomy is recommended. Radical surgery could be applied in invasive cervical cancer staged IB1 to IIA. Surgical treatment in the advanced stage of cervical cancer could be exerted exclusively in controlled trials as a part of multimodal treatment. Endometrial cancer still remains incompletely defined in the extension of surgical procedures. Namely, lymphadenectomy in patients with endometrial cancer according to the low rate of lymphatic dissemination is not completely accepted in hospital daily practice. Furthermore, the increasing use of minimal invasive surgery transforms our way of thinking, especially in the case of endometrial cancer. Ovarian cancer still remains an unresolved diagnostic problem with negative implication in the treatment efficacy. About two thirds of patients are in advanced stage at the time of their first surgery, primarily for the lack of a high effective screening test as well as unknown pathophysiology in early ovarian cancer development. In early ovarian cancer comprehensive staging should be done, while in patients with advanced disease standard approach should include maximal effort in surgical cytoreduction.Kirurški tretman malignih novotvorina ženskog spolnog sustava predstavlja početak i osnovu svakog onkološkog liječenja. Kirurški je zahvat, naime, od temeljne važnosti pri postavljanju konačne dijagnoze, određivanju stadija bolesti, kao i za uklanjanje tumorske mase tijekom prvog operacijskog zahvata sukladno lokalizaciji i vrsti malignoma. Najčešću pojavnost malignoma ženskih spolnih organa nalazimo na cerviksu, endometriju i ovariju. Suvremeni kirurški pristup liječenju ranog stadija - mikroskoposkog raka vrata maternice uključuje konzervativne zahvate u smislu konizacije. U slučajevima gdje je reprodukcija završena može se posegnuti za histerektomijom. Radikalna kirurgija predstavlja metodu izbora u klinički invazivnom obliku bolesti (stadij IB1 do IIA). Kirurško liječenje viših stadija može se rabiti u kontroliranim studijama u sklopu multimodalnog liječenja. Rak endometrija i dalje ostaje u određenom smislu nedovoljno definiran u smislu opsežnosti samoga kirurškog zahvata. Naime, limfadenektomija kod bolesnica s rakom endometrija s obzirom na relativno nisku stopu limfogenog rasapa i dalje predstavlja kamen spoticanja u kliničkoj praksi. S druge strane, sve opsežnije uvođenje endoskopske kirurgije otvorilo je nepovratni put ka prihvaćanju operativnih zahvata s minimalno invazivnim tehnikama. Rak jajnika još uvijek predstavlja veliki dijagnostički i terapijski problem. Kako ne postoje široko primijenjeni učinkoviti testovi probira, bolest se u dvije trećine bolesnica otkriva tek u uznapredovaloj fazi s posljedičnom visokom stopom smrtnosti koja premašuje zbroj smrtnosti svih preostalih ginekoloških malignoma. U bolesnica s naizgled ranim stadijem bolesti potrebno je učiniti sveobuhvatni kirurški zahvat radi određivanja točnog stadija bolesti, dok u bolesnica s uznapredovalom bolešću standardni pristup uključuje optimalnu kiruršku citoredukciju

Treatment of Invasive Cervical Cancer: Rijeka Experience

The aim of this retrospective analysis was to evaluate the survival rate in 661 patients with cervical cancer regarding two time periods 1990–1996 and 1997–2003 and the specific stage related risk factors. The respective five-year survival was 71.7% and 80.0%. Analyzing the risk factors in the univariate and multivariate regression modalities ultimately only two parameters, the two time periods and FIGO staging were found to be independent prognostic factors. The observed total improvement in the survival rate of the second time period is followed by an increase in conservative surgery in stage T1A1, a reduction in the use of adjuvant radiotherapy among operable stages T1b1, T1b2 and T2A, while the treatment of locally advanced cervical cancer did not differ significantly

Treatment of Invasive Cervical Cancer: Rijeka Experience

The aim of this retrospective analysis was to evaluate the survival rate in 661 patients with cervical cancer regarding two time periods 1990–1996 and 1997–2003 and the specific stage related risk factors. The respective five-year survival was 71.7% and 80.0%. Analyzing the risk factors in the univariate and multivariate regression modalities ultimately only two parameters, the two time periods and FIGO staging were found to be independent prognostic factors. The observed total improvement in the survival rate of the second time period is followed by an increase in conservative surgery in stage T1A1, a reduction in the use of adjuvant radiotherapy among operable stages T1b1, T1b2 and T2A, while the treatment of locally advanced cervical cancer did not differ significantly

Učinak zgodnje detekcije cervikalnega karcinoma

Background Treatment effectiveness and clinical outcome of patients with cervical carcinoma FIGO stage IA1 and IA2 are analyzed in three different time period at the Department of Obstetrics and Gynecology Rijeka, Croatia. Methods Retrospective analysis of the hospital chart of all cervical cancer patients between 1991 and 2005 was conducted with five-year follow up. Results Data on cervical cancer distribution by stage and five-year survival are presented. Separately analyzed age, histology type and treatment modalities in stage FIGO IA1 and IA2 during three consecutive five-year periods are presented. Conclusions Conservative surgical approach – conization alone in stage IA1 of the squamous cell carcinoma is reasonable and safe treatment option for reproductive active women. During observed periods conization became the most used surgical technique applied in almost two third of FIGO IA1 cervical cancer patients. Lymph vascular space invasion in stage IA1 lead to adjunct pelvic lymphadenectomy with unclear clinical benefit. In cervical cancer patients stage IA2 simple hysterectomy and pelvic lymphadenectomy could be accepted as a standard treatment. In these patients further studies are recommended to evaluate other less radical surgical techniques – simple and radical trachelectomy with or without pelvic lymphadenectomy. Radical hysterectomy in both stages IA1 and IA2, based on personal experience and literature data represents a surgical overtreatment and should be abandoned

Učinak zgodnje detekcije cervikalnega karcinoma

Background Treatment effectiveness and clinical outcome of patients with cervical carcinoma FIGO stage IA1 and IA2 are analyzed in three different time period at the Department of Obstetrics and Gynecology Rijeka, Croatia. Methods Retrospective analysis of the hospital chart of all cervical cancer patients between 1991 and 2005 was conducted with five-year follow up. Results Data on cervical cancer distribution by stage and five-year survival are presented. Separately analyzed age, histology type and treatment modalities in stage FIGO IA1 and IA2 during three consecutive five-year periods are presented. Conclusions Conservative surgical approach – conization alone in stage IA1 of the squamous cell carcinoma is reasonable and safe treatment option for reproductive active women. During observed periods conization became the most used surgical technique applied in almost two third of FIGO IA1 cervical cancer patients. Lymph vascular space invasion in stage IA1 lead to adjunct pelvic lymphadenectomy with unclear clinical benefit. In cervical cancer patients stage IA2 simple hysterectomy and pelvic lymphadenectomy could be accepted as a standard treatment. In these patients further studies are recommended to evaluate other less radical surgical techniques – simple and radical trachelectomy with or without pelvic lymphadenectomy. Radical hysterectomy in both stages IA1 and IA2, based on personal experience and literature data represents a surgical overtreatment and should be abandoned