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Explorative Study on the Predictive and Prognostic Value of Early Complete Metabolic Response By FDG-PET–CT During Neoadjuvant Chemotherapy in Patients With Advanced Ovarian Cancer FDG-PET-CT对晚期卵巢癌新辅助化疗早期完全代谢反应预测及预后价值的探索性研究
Pub Date : 2012-06-01 DOI: 10.1016/j.cogc.2012.04.003
Andrea Angelo Martoni , Marta Rosati , Claudio Zamagni , Pierandrea De Jaco , Paolo Castellucci , Sara Quercia , Alessandra Bernardi , Stefano Fanti

Background and Aim

Early complete metabolic response (e-CMR) by fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) during neoadjuvant chemotherapy (NACT) in advanced ovarian cancer (AOC) could have predictive and prognostic value. The present explorative study prospectively investigated changes of dual-time FDG-PET, at baseline and after 3 cycles of NACT in patients who were not candidates for upfront debulking surgery by comparing with standard serum cancer antigen 125 (CA-125) monitoring.

Patients and Methods

Fifty consecutive patients with AOC were treated with 6 cycles of carboplatin/paclitaxel before surgery. FDG-PET and serum CA-125 were evaluated at baseline and after 3 cycles. e-CMR and early complete biochemical response (e-CBR) were defined as the normalization of the maximum standardized uptake values and serum CA-125 levels, respectively.

Results

e-CMR and e-CBR were observed in 34% and 38% of patients, respectively. At the end of NACT, an optimal pathologic response (pR) and optimal surgery with no residual tumor (R0) were achieved in 23 (46%) and 26 (52%) patients, respectively. E-CMR and e-CBR positive predictive value was 88% and 84% for pR and 88% and 89% for R0, respectively. After a median follow-up of 42 months, 41 (82%) patients had progressed and 32 (64%) died. Median progression-free survival and overall survival were 13.8 and 28.1 months, respectively. At multivariate analysis, e-CMR, but not e-CBR, showed an independent prognostic value with regard to both progression-free survival and overall survival.

Conclusions

e-CMR may predict pR and R0 surgery obtained at the end of NACT and identify patients a favorable long-term outcome.

背景和目的氟-18氟脱氧葡萄糖正电子发射断层扫描(FDG-PET)在晚期卵巢癌(AOC)新辅助化疗(NACT)期间的早期完全代谢反应(e-CMR)可能具有预测和预后价值。本探索性研究通过与标准血清癌抗原125 (CA-125)监测比较,前瞻性地研究了未进行术前减脂手术的患者在基线和3个周期NACT后双时间FDG-PET的变化。患者与方法连续50例AOC患者术前给予6个周期的卡铂/紫杉醇治疗。在基线和3个周期后评估FDG-PET和血清CA-125。e-CMR和早期完全生化反应(e-CBR)分别被定义为最大标准化摄取值和血清CA-125水平的正常化。结果- cmr和e-CBR分别占34%和38%。在NACT结束时,分别有23例(46%)和26例(52%)患者达到最佳病理反应(pR)和最佳手术无肿瘤残留(R0)。pR和R0的E-CMR和e-CBR阳性预测值分别为88%和84%和88%和89%。中位随访42个月后,41例(82%)患者进展,32例(64%)死亡。中位无进展生存期和总生存期分别为13.8个月和28.1个月。在多变量分析中,e-CMR,而不是e-CBR,在无进展生存期和总生存期方面显示出独立的预后价值。结论:cmr可以预测NACT结束时获得的pR和R0手术,并确定患者良好的长期预后。
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引用次数: 3
Intraperitoneal Catheter Placement: The “Hammock” Technique 腹腔内置管:“吊床”技术
Pub Date : 2012-06-01 DOI: 10.1016/j.cloc.2011.08.001
Christina L. Kushnir , Aimee C. Fleury , David F. Silver , Nick M. Spirtos

Background

Ovarian cancer is the leading cause of death from gynecologic malignancies in the United States. The NCI released a clinical announcement supporting the use of intraperitoneal chemotherapy in addition to intravenous chemotherapy. However, multiple trials have shown that IP administration is severely limited by catheter complications.

Purpose

We present a new technique for inserting and securing IP catheters in order to prevent the previously reported complications, in particular obstruction of the catheter, bowel and vaginal cuff perforation.

Methods

From March 2006 through February 2010, 38 patients with stage III or IV ovarian cancer underwent optimal cytoreductive surgery and had an IP catheter placed via the “Hammock” technique.

Results

14 patients underwent modified posterior exenteration (37%); 6 underwent splenectomy (16%); thirteen small bowel resections (34%). All 38 patients underwent pelvic and aortic lymphadenectomy. Two patients had reservoir complications; one “flipped over”, and the other had an infection at the port site. Both patient’s elected to discontinue the IP portion of the chemotherapy regimen. 219 cycles of chemotherapy were completed (96%) out of a possible 228 cycles. The only complications were related to the reservoir. There were no catheter-related complications.

Conclusion

As an increasing number of IP catheters are placed at the time of cytoreductive surgery, we will continue to have catheter complications and IP chemotherapy administration difficulties. In using the “Hammock” Technique, we had no catheter complications, and a 96% chemotherapy completion rate. We recommend using the “Hammock” Technique for inserting and securing IP catheters at the time of cytoreductive surgery. .

背景:在美国,卵巢恶性肿瘤是导致妇科恶性肿瘤死亡的主要原因。NCI发布了一项临床声明,支持在静脉化疗之外使用腹腔化疗。然而,多项试验表明,导管并发症严重限制了IP给药。目的介绍一种新的IP导管插入和固定技术,以防止先前报道的并发症,特别是导管阻塞,肠和阴道袖口穿孔。方法从2006年3月到2010年2月,38例III期或IV期卵巢癌患者接受了最佳细胞减少手术,并通过“吊床”技术放置了IP导管。结果改良后拔牙14例(37%);6例行脾切除术(16%);13例小肠切除术(34%)。所有38例患者均行盆腔和主动脉淋巴结切除术。2例患者有水库并发症;其中一人“翻身”,另一人在港口感染。两位患者都选择停止化疗方案的IP部分。在可能的228个化疗周期中,完成了219个化疗周期(96%)。唯一的并发症与水库有关。无导管相关并发症。结论随着细胞减缩术中导管置入数量的增加,导管并发症和化疗给药难度将持续增加。在使用“吊床”技术时,我们没有出现导管并发症,化疗完成率为96%。我们建议在细胞减少手术时使用“吊床”技术插入和固定IP导管。
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引用次数: 3
Patient Recall of Health Care Events and Time to Diagnose a Suspected Ovarian Cancer 患者回忆医疗事件和诊断疑似卵巢癌的时间
Pub Date : 2012-06-01 DOI: 10.1016/j.cogc.2012.04.001
Lisa M. Hess , Michael W. Method , Frederick B. Stehman , Tess D. Weathers , Paridha Gupta , Jeanne M. Schilder

Introduction

Patient recall is often used by clinicians to create a history of care leading to consultation with a gynecologic oncologist. Although patient recall may be an efficient method to explore the context of the patient's concerns, the accuracy of recall and its potential impact on care are unknown. This study sought to explore the consistency of patient recall compared with data found in health care records.

Patients and Methods

This study enrolled 105 eligible patients who were referred to a gynecologic oncologist for suspected ovarian cancer. Ninety-one of these patients were interviewed regarding symptoms, health care events, and the dates leading to diagnosis. The medical records of these patients from all previous providers were obtained and data were abstracted. The intraclass correlation coefficient (intraclass correlation coefficient, ICC[3,1]) was used to examine correspondence between recall and medical record data.

Results

There was low correspondence between patient recall and the medical record for time to diagnosis (ICC = 0.12; 95% confidence interval [CI] = −0.09 to 0.33; P = .12) and health care events (0.15; 95% CI, −0.05 to 0.348; P = .008).

Conclusions

There should be limited confidence in information obtained from patient recall given the inconsistency between recall and actual dates and events.

临床医生经常使用患者回忆来创建与妇科肿瘤学家会诊的护理史。虽然患者回忆可能是一种有效的方法,以探索患者的关注背景,回忆的准确性和其对护理的潜在影响是未知的。本研究旨在探讨患者回忆与医疗记录数据的一致性。患者和方法本研究纳入了105例因疑似卵巢癌而转诊至妇科肿瘤科的符合条件的患者。对其中91名患者进行了关于症状、医疗保健事件和诊断日期的访谈。从所有以前的提供者那里获得这些患者的医疗记录,并对数据进行摘要。使用类内相关系数(intraclass correlation coefficient, ICC[3,1])检验召回与病历数据之间的对应关系。结果患者回忆与病历的诊断时间相关性较低(ICC = 0.12;95%置信区间[CI] = - 0.09 ~ 0.33;P = .12)和卫生保健事件(0.15;95% CI,−0.05 ~ 0.348;P = .008)。结论由于回忆与实际日期和事件不一致,从患者回忆中获得的信息可信度有限。
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引用次数: 13
Serous Borderline Tumor of the Fallopian Tube Presenting as an Ectopic Pregnancy: Case Report and Review of the Literature 输卵管浆液性交界性肿瘤表现为异位妊娠:病例报告及文献复习
Pub Date : 2012-06-01 DOI: 10.1016/j.cogc.2012.05.001
Judit Albareda , M. Jose Garcia Rubio , Manuel Albi , Patricia Dhimes
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引用次数: 0
Symptoms of Pelvic Floor Disorders and Quality of Life Measures in Postoperative Patients With Endometrial Cancer 子宫内膜癌术后患者盆底障碍的症状和生活质量措施
Pub Date : 2012-06-01 DOI: 10.1016/j.cogc.2012.04.002
Patrick A. Nosti , Colleen D. McDermott , Jeanne M. Schilder , Frederick B. Stehman , Patrick J. Woodman

Background

The primary goal of this study was to determine the prevalence of pelvic floor symptoms in postoperative patients with endometrial cancer. The secondary goal was to assess the impact of these issues on patient quality of life.

Methods

This cross-sectional study looked at women (N = 25) returning for postoperative care at least 6 months after total abdominal hysterectomy for endometrial cancer. Demographic and clinical data were collected. Severity of pelvic floor symptoms was assessed using the short-form version of the Pelvic Floor Distress Inventory (PFDI-20). The impact of these symptoms on quality of life was assessed using the short-form version of the Pelvic Floor Impact Questionnaire (PFIQ-7). Demographic data and PFDI-20 and PFIQ-7 scores were summarized using descriptive statistics.

Results

Pelvic symptoms were reported at a much higher rate than seen in the general public. Symptom prevalence was reported by 21/25 (84%) patients on the PFDI-20 questionnaire, with a mean score of 52.5 ± 64.8. Patients reported prevalence of symptoms in the following order: urinary symptoms (19/25 [76%]) > colorectal-anal symptoms (17/25 [68%]) > pelvic organ prolapse symptoms (11/25 [44%]). Slightly fewer than half (11/24) of the study participants reported quality of life issues associated with their pelvic symptoms, with a mean score in the mild range: 26.4 ± 64.5. The reported prevalence of the effect of pelvic symptoms on quality of life was urinary (10/25 [40%]) > colorectal-anal (8/24 [33%]) > pelvic organ prolapse (4/24 [17%]).

Conclusion

This study has shown that there was a high prevalence of symptoms of PFDs in our population after abdominal hysterectomy for endometrial cancer.

本研究的主要目的是确定子宫内膜癌术后患者盆底症状的患病率。第二个目标是评估这些问题对患者生活质量的影响。方法:这项横断面研究观察了因子宫内膜癌而接受全腹子宫切除术后至少6个月的妇女(N = 25)。收集了人口统计学和临床数据。盆底症状的严重程度通过盆底窘迫量表(PFDI-20)进行评估。使用盆底影响问卷(PFIQ-7)评估这些症状对生活质量的影响。采用描述性统计对人口学资料和PFDI-20、PFIQ-7评分进行汇总。结果盆腔症状的发生率远高于普通人群。在PFDI-20问卷调查中,有21/25(84%)的患者报告了症状患病率,平均得分为52.5±64.8分。患者报告的症状发生率顺序如下:泌尿系统症状(19/25 [76%]);结直肠-肛门症状(17/25 [68%])>盆腔器官脱垂症状(11/25[44%])。略少于一半(11/24)的研究参与者报告了与盆腔症状相关的生活质量问题,平均评分在轻度范围:26.4±64.5。据报道,盆腔症状对生活质量影响的患病率为泌尿系(10/25 [40%]);结直肠-肛门(8/24 [33%])>盆腔器官脱垂(4/24[17%])。结论本研究表明,在我们的人群中,子宫内膜癌腹部子宫切除术后出现PFDs症状的发生率很高。
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引用次数: 14
Malignant Uterine Perivascular Epithelioid Cell Tumor: A Case Report 恶性子宫血管周围上皮样细胞瘤1例报告
Pub Date : 2012-06-01 DOI: 10.1016/j.cogc.2012.05.002
Dina J. Chamsy , Scott C. Purinton , Kelley S. Carrick , Debra L. Richardson
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引用次数: 1
期刊
Clinical Ovarian and Other Gynecologic Cancer
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