Clinical Ovarian and Other Gynecologic Cancer最新文献

Introduction

This study was aimed at evaluating the efficacy and tolerability of oxaliplatin/doxorubicin combination therapy in patients with platinum-sensitive and platinum-resistant ovarian cancer.

Materials and Methods

Patients with recurrent ovarian cancer after 1 regimen of platinum-based chemotherapy received doxorubicin (50 mg/m² intravenously) and oxaliplatin (130 mg/m² intravenously) on day 1 every 3 weeks. The platinum-free interval was set to be < 24 months.

Results

A total of 33 patients were enrolled (21 platinum-resistant and 12 platinum-sensitive relapses). The response rate in platinum-resistant ovarian cancer was lower than in platinum-sensitive disease (33.4% vs. 54.5%), although the difference was not statistically significant (P = .59). The median progression-free survival (PFS) and overall survival in the whole cohort were 7.4 and 24.3 months, respectively. PFS in platinum-sensitive cancer was longer than in platinum-resistant cancer (10.8 vs. 6.7 months); however, this difference did not reach statistical significance (P = .14).

Conclusion

The combination of oxaliplatin/doxorubicin is an active regimen for patients with platinum-sensitive and platinum-resistant recurrent ovarian cancer.

This study aimed to determine the postoperative fever index in the gynecologic oncology patient associated with significant infectious morbidity. A retrospective analysis was performed of 355 patients who underwent abdominal surgery. Charts were reviewed to evaluate postoperative temperature and risk factors for infectious morbidity. Statistical analyses were performed as indicated by the data type, including the Student t test, Mann-Whitney U test, χ² test, and 1-way analysis of variance. A value of P < .05 was considered significant. There were 210 patients with temperatures < 100.5°F (group 1), 69 with a temperature ≥ 100.5°F to < 101°F (group 2), and 76 with a temperature ≥ 101°F (group 3). Demographic data were similar among groups. There were 285 diagnostic tests performed, with 51 test results indicative of infectious morbidity. Patients in group 3 underwent more testing and had more positive test results compared with groups 1 and 2. The majority of diagnostic testing and positive test results (60%) were in patients from group 3. Groups 1 and 2 were statistically similar in the number of positive test results and antibiotic duration, demonstrating a lower risk of infectious morbidity compared with group 3. This study suggests that a postoperative temperature of ≥ 101°F appears to be a better predictor of significant infectious morbidity compared with the prior definition of a temperature ≥ 100.5°F. Furthermore, this illustrates the need for the development of a postoperative temperature evaluation protocol to avoid expensive evaluations and empiric treatment of benign causes of postoperative fever.

Introduction

The primary debulking surgery that is performed to achieve complete debulking is one of the most important prognostic factors in patients with advanced ovarian cancer. However, the relationship between lymph node metastases and the surgical outcome is still unclear. This study analyzed the effect of the N factor on the prognosis of patients with pT3C ovarian cancer who underwent optimal surgery (OpS).

Patients and Methods

The participants were 68 patients with pT3C serous adenocarcinoma. The overall survival (OS) and the median survival time (MST) were analyzed by the diameter of the residual tumor and by lymph node metastasis using the Kaplan-Meier method and the log-rank test. The patients received retroperitoneal lymph node dissection in the pelvic cavity up to the para-aortic lymph nodes. The patients in the OpS group were further divided into a complete-surgery group with no residual tumor and a group with residual tumor of less than 1 cm, and differences were analyzed.

Results

The OS rates in the OpS group and Sub-OpS group were 77.5% and 11.1%, respectively. According to the analyses made by different levels of lymph node metastasis in all patients, the OS rates in patients with N0 and N1 disease were 77.1% and 47.5%, respectively; the prognosis was significantly poorer in the N1 group. According to the analyses of the N factor in the OpS group, the prognosis was significantly poorer in the N1 group even with OpS compared with that in the N0 group (53.7% and 86.6%, respectively). Furthermore, in the N1 group with OpS, the prognosis was significantly better in the complete-surgery group than in the other group with residual tumor of less than 1 cm (77.8% and 16.7%, respectively).

Conclusion

The prognosis of pT3CpN1 ovarian cancer with OpS was as poor as with Sub-OpS. However, the results suggested that the prognosis could be improved if the tumor was completely resected in OpS.

Background

The aim of this study was to find out the long-term survival of patients with primary International Federation of Gynecology and Obstetrics (FIGO) stage IIIC epithelial ovarian cancer (EOC IIIC) in a population-based patient cohort treated in Norway in 2002.

Patients and Methods

All 198 women with a diagnosis of EOC IIIC who underwent surgery were included. The data were derived from notifications to the Norwegian Cancer Registry and medical, surgical, and histopathologic records. The hospitals were grouped into teaching hospitals (THs) and nonteaching hospitals (NTHs). The follow-up period was from 0 to 106 months.

Results

The long-term survival at 8 years was 15% for women operated on at THs and 10% for women operated on at NTHs (P < .05). The median survival was 35.6 months at THs and 23.4 months at NTHs (P < .05). After simultaneous adjustment for 4 prognostic factors (age, histologic type, grade of differentiation, and residual disease), the risk of death within 8 years at NTHs was unchanged, with a hazard ratio of 1.38 (95% confidence interval [CI], 1.00-1.89), compared with THs.

Conclusion

Patients operated on for EOC IIIC at THs achieved better long-term survival than did patients operated on at NTHs. Centralization of EOC IIIC surgery should be introduced in all countries to improve outcomes for this patient group.

Background

A 2-week waiting time from primary care referral to first specialist assessment is recommended for patients with symptoms of suspected cancer, such as post-menopausal bleeding (PMB). We compared 2 different booking systems in relation to the observed waiting time for patients with suspected uterine cancer.

Methods

Data were collected concurrently between July 2009 and August 2010, and captured the duration of waiting time from referral to specialist assessment for each woman with PMB. A comparison of 2 outpatient booking systems on waiting times was undertaken for 2 District Health Boards (DHBs) in New Zealand. DHB1 uses a centralized booking system, and DHB2 uses a clinic-based system.

Results

A total of 147 women were included in the timing analysis. At DHB1, 2 of 90 women (2%) were seen within 2 weeks and 61 of 90 women (68%) waited more than 42 days. At DHB2, 24 of 57 women (42%) were seen within 2 weeks and 19 of 57 women (33%) waited more than 42 days. Overall, only 18% of women in this study were seen within the 2-week time-frame and 80 of 147 women (54%) waited more than 42 days from referral to specialist assessment.

Conclusions

In this study, a clinic-based booking system was associated with shorter waiting times compared with a centralized booking system in 2 reasonably comparable DHB services. Waiting times were longer than the recommended guidelines, regardless of booking system. Further research is needed to clarify the effects of these different booking systems on waiting times.

Background

Patients with ovarian cancer whose disease relapses or progresses within 6 months after frontline platinum- and taxane-containing therapy have a poor prognosis and limited treatment options. In this phase II study, the activity and safety profiles of patupilone, a novel microtubule-targeting agent, were assessed in patients with platinum-resistant or -refractory ovarian, primary fallopian tube, or primary peritoneal cancer.

Patients and Methods

Patients whose disease relapsed while they were either receiving or within 6 months after completion of their most recent platinum-based therapy were given patupilone 10 mg/m² by a 20-minute intravenous infusion once every 3 weeks (q3w). The primary study endpoint was the overall response rate (ORR), defined as the percentage of patients with a complete or partial response (PR) according to Response Evaluation Criteria in Solid Tumors (RECIST).

Results

Patients (N = 112) received a median of 4 cycles of patupilone. Median overall survival was 11.2 months. The ORR was 6.3%. Disease control according to RECIST was observed in 57 (50.9%) patients (7 [6.3%] PRs, 50 [44.6%] stable disease). Median duration of disease control was 5.4 months, whereas median progression-free survival was 2.8 months. Diarrhea, the most common adverse event (AE) regardless of relationship to study drug (55.4% grade 1/2, 25.0% grade 3/4), was predictable and generally manageable. Other AEs, including nausea, vomiting, fatigue, and peripheral neuropathy, were generally mild.

Conclusion

Patupilone was well tolerated and demonstrated an encouraging disease control rate in these patients with platinum-resistant or -refractory disease; this is a challenging population with a poor prognosis.