Clinical Ovarian and Other Gynecologic Cancer最新文献

Background

Ovarian cancer as the most lethal gynecologic malignancy in women is poorly detected during early stages of carcinogenesis. Therefore, there is an emergent need to look for specific and sensitive biomarkers for early diagnosis of ovarian cancer.

Materials and Methods

In this study, we performed real-time polymerase chain reaction (PCR) to evaluate the expression of six proapoptotic genes, CASP8, BAK, APAF1, BAX, BID, and BAD, which contain CpG islands in their promoter regions. Afterward, the significantly downregulated genes were investigated by HpaII-PCR and methylation-specific PCR (MSP) to determine the methylation status between tumoral and adjacent normal tissues.

Results

The real-time PCR results in 24 tumoral and 9 normal adjacent tissues showed decreased expression of CASP8 and BAD genes in tumoral relative to normal samples. Furthermore, the methylation analysis showed no significant methylation between tumoral and normal samples.

Conclusion

Taken together, this could be concluded that downregulation of CASP8 and BAD genes in ovarian cancer may be as important causes for ovarian cancer carcinogenesis via inducing resistance to apoptosis; however, the downregulations are not due to promoter hypermethylation.

Background

To investigate the methylation pattern in promoter region of RASSF1A and PTEN genes in epithelial ovarian cancer patients in North India.

Patients and Methods

Fifty patients and 20 healthy controls were studied. Isolation of genomic DNA from peripheral blood and methylation-specific polymerase chain reaction (MSP) were applied for analysis.

Results

17 of 50 patients (34.0%) were found to be methylated for RASSF1A gene, whereas methylation of the PTEN gene occurred in 8 of 50 cases (16.0%). A statistically significant result was obtained (P = .01) for RASSF1A gene and correlated with the patients' clinicopathologic features.

Conclusion

Hypermethylation of both RASSF1A and PTEN genes in blood DNA from ovarian cancer patients might offer an exposition for early diagnosis of the malignancy.

Background

The aim of this study was to validate the risk-of-malignancy index (RMI) incorporating menopausal status, serum CA 125 levels, and imaging findings for discriminating benign from malignant pelvic masses and to evaluate the ability of 4 different RMIs.

Patients and Methods

This is a prospective study of 296 women admitted to the Department of Obstetrics and Gynecology of Kochi Health Sciences Center, between September 2011 and April 2014, for surgical exploration of pelvic masses. The RMI 1, 2, 3, and 4 methods were calculated for all patients together with the sensitivity, specificity, positive predictive value, and negative predictive value.

Results

The sensitivity of RMIs 1, 2, 3, and 4 was 73.0%, 81.1%, 73.0%, and 77.0%, respectively, and the specificity was 93.7%, 89.6%, 93.7%, and 92.3%, respectively. The RMI 2 was significantly better at predicting malignancy than RMIs 1 3; however, there was no statistically significant difference in performance of RMIs 2 4.

Conclusion

The RMI method is a valuable and applicable method in diagnosing pelvic masses with high risk of malignancy and a simple technique that can be used in gynecology clinics and less-specialized centers.

Background

The optimal therapy to treat relapsed, platinum-sensitive ovarian cancer remains elusive. Because most patients receive initial therapy with paclitaxel and platinum, there is a lack of cross-reaction of docetaxel and paclitaxel and retreatment with platinum is standard of care; we evaluated the toxicity and efficacy of docetaxel and carboplatin as salvage therapy for relapsed, platinum-sensitive ovarian cancer.

Materials and Methods

This phase II study treated the first-relapsed, platinum-sensitive, stage III/IV ovarian cancer patients with docetaxel 80 mg/m² intravenous (IV) over 60 minutes followed by carboplatin area under the curve 6 IV over 30 minutes every 21 days, for 6 cycles. End points were toxicity, response rates, relapse rates, event-free survival, and survival rates.

Results

Thirty-six patients were enrolled and 35 were evaluable. Twenty-three percent of patients were age ≥ 70 years. A total of 170 cycles of therapy were given. Ten patients required dose reduction. Thirty-eight percent had a delay in starting subsequent planned cycles. Most delays were due to hematologic recovery. Hematologic toxicity was most common and significant; 77% grade 4 neutropenia. One patient died from typhilitis. Total complete remission (38%) and partial remission (27%) rate was 65%. Median time to progression was 261 days (60-717). Five (14%) patients remain alive without ovarian cancer, with median follow-up of 5.1 years. Patients who entered the study with ≥ 12-month duration of initial remission had best response.

Conclusion

The combination of docetaxel and carboplatin has toxicity, especially hematologic, and requires growth factor support and close monitoring for infections. Its role for treating ovarian cancer patients was better in patients in whom initial response to therapy was ≥ 12 months.

Background

Concurrent chemoradiation causes toxicities such as enteritis, hematologic toxicities which may lead to treatment interruptions, and therefore inferior outcomes. Adequate supportive care is very important to complete the scheduled protocol. Most of our patients are from rural background with a heterogeneous social background (nutrition and social support). There is paucity of literature to evaluate the tolerance of this intense treatment in these groups of patients, and hence, this study was undertaken.

Methods

In this observational study, 30 rural women having carcinoma cervix treated with concurrent chemoradiation between January and July 2013 were reviewed retrospectively. They were assessed weekly for dyselectrolytemia, enteritis, and hematologic toxicity using Radiation Therapy Oncology Group Acute Radiation Morbidity Scoring Criteria. Treatment gaps along with reasons were recorded and correlated.

Results

Median age of patients was 54 years. Of the patients, 43.3% were International Federation of Gynecology and Obstetrics stage II and 46.7% stage III. Grade 3 enteritis was seen in 7 of 30 patients (23.3%). None (0%) had grade 3 or higher hematologic toxicity. Dyselectrolytemia–hyponatremia (46.66%), hypokalemia (26.66%), hypocalcemia (6.66%), and hypomagnesemia (10%) were noted. Two of thirty patients (6.66%) received the planned 5 cycles, cisplatin 40 mg/m² weekly. There were treatment interruptions in radiation in 6 (20%) and treatment delays in chemotherapy in 10 (33.33%) patients.

Conclusion

Concurrent chemoradiation for patients from rural areas is associated with higher acute toxicities. Regular monitoring for enteritis and dyselectrolytemias and timely intervention can help improve compliance and decrease treatment interruptions and thereby achieve the optimum treatment outcome.

About 10% to 15% of ovarian cancers are linked to genetic abnormalities, including breast cancer susceptibility gene (BRCA) mutations, and Lynch syndrome. The aim of this work was to provide comprehensive and updated review of this distinct type of ovarian cancer that carries genetic alterations in relation to its pathology, prevention, prognosis, and management. Genetic ovarian cancer has a distinct pathologic and molecular biology features. BRCA1 and BRCA2 mutation ovarian cancers are most likely to be high-grade serous adenocarcinomas. Many BRCA1-mutated tumors harbor a mutant p53 gene, c-myc overexpression, and epidermal growth factor receptor overexpression. Clinically, genetic ovarian cancer presents at a younger age than sporadic ovarian cancer. For prevention, risk-reduction salpingo-oophorectomy is an effective tool. Chemoprevention by oral contraceptives may represent an option. A recent study demonstrates improved progression-free survival and overall survival in patients whose ovarian cancer displays BRCA1 and BRCA2 mutation, relative to those who have normal BRCA1 and BRCA2 function. Recent management advances include PARP (poly[adenosine diphosphate {ADP}–ribose] polymerases) inhibitors. Significant progress has been recently made in elucidating the role of BRCA1 and BRCA2 mutation and Lynch syndrome on ovarian cancer prognosis and management.

Background

To identify the impact of weight, table surface, and table type on slipping in a simulation of minimally invasive gynecologic surgery.

Methods

A mannequin was placed into increasing Trendelenburg until a slip was observed; the table angle at the time of the event was measured (slip angle). The influence of mannequin position (supine vs. lithotomy), weight, table surface, and model was evaluated. A linear regression model was used to analyze the data.

Results

Mannequin weight, bed surface, and bed type all significantly impacted the slip angles. In general, higher mannequin weights tolerated significantly more Trendelenburg before slipping in the supine position but less in lithotomy compared to lower weights. In lithotomy, the disposable sheet and gelpad performed worse than the bean bag, egg crate foam, and bedsheet. There was no difference in slipping because of bed surface in the supine model. The Skytron operating table performed significantly better than the Steris operating table when tested with the bedsheet.

Conclusion

Operative position, patient weight, and bed surface together influence the slipping propensity. In lithotomy, heavier patients were more prone to slipping while the inverse was true in supine. The egg crate foam, bean bag, and bedsheet were the best antislip surfaces. Operating room table choice can mitigate slippage.