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Objective To evaluate the clinical value of sentinel lymph nodes (SLN) in predicting pelvic lymph node status for early cervical squamous cell carcinoma,and approach the clinical significance of SLN detection for guiding radical abdominal trachelectomy (RAT).Outcomes of follow up and fertility were also observed.Methods A total of 31 patients with stage Ⅰ a2-Ⅰ bl squamous cell carcinoma planned to be given RAT and pelvic lymphadenectomy were enrolled.99mTe-labeled phytate was injected before surgery.Intraoperatively,SLN were identified,excised,and submitted to fast frozen section.Systematic bilateral pelvic lymphadenectomy was performed,and then RAT was performed in patients with negative SLN.All nodes were sent for routine pathological examination and immunostained with anti-cytokeratin antibody to detect micrometastases.Results SLN were detected in all patients (100％,31/31).A total of 109 SLN were identified with a mean number of 3.5 per patient.Of these,SLN of 2 patients were positive on frozen sections and proved to be metastasis by final pathologic examination and quitted the RAT.No missed micrometastasis was found using immunohistochemical staining in SLN and other lymph nodes using histologically node-negative cases.No false negative cases was found and the negative value was 100％ (31/31).The sensitivity,accuracy,and false negative rates were 100％,100％,and 0,respectively.Perioperative complications occured in 5 patients including 2 cases of bladder injury and 3 cases of uterine artery injury.No relapses occurred during follow-up.Five of 19 patients with procreative desire conceived pregnancies (4 spontaneous abortion and 1 premature birth) after surgery.Conclusions The identification of SLN using 99mTc-labeled phytate could predict the pelvic lymph node status in early stage cervical cancer.Under the guidance of SLN detection,RAT is a feasible operative modality with well prognosis and low complications for young patients who desire to preserve reproductive function.
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Objective To observe and cpmpare the efficacy and complications of hyperfractional integrated intraeavitary brachtherapy in middle-advanced squamous-cell carcinoma with the traditionsl brachytherapy.Methods In the observed group,328 patients with cervical cancer received hypeffractional integrated intracavitary after loading therapy between Jan 2004 and Jan 2005 were selected.The dose of point A was 2.5 Gy-3.0 Gy/fraction,2 fractions per week,and the total dose of reference point A was 49.8 Gy in stage Ⅱ b,52.6 Gy in stage in Ⅲb.In the control group,331 cases treated with traditional aflerloading brachytherapy between Jan 2002 and Dec 2003 were selected.The dose of point A was 5.0～7.0 Gy/fraction,1 fraction per week,and the total dose of point A was 50.1 Gy in stage Ⅱb,53.5 Gy in stage Ⅲb.In vitro irradiation began at the same time with the intracavitary brachytherapy.The whole pelvic was irradiated with 15 MV X-rays.Results In the observed group,the recent control rate of stage Ⅱb was 97.2%(104/107),94.1%(208/221)for stage Ⅲb.The 3-year survival rate was 80.5%(264/328).and the 5-year survival rate was 68.6%(225/328).The complication rate was 5.2%(17/328)for cystitis, 14.6%(48/328) for proctitis.Out of 331 cases in control group,the recent control rate of stage Ⅱb was 95.4%(103/108),92.8%(207/223)for stage Ⅲb.The 3-year survival rate was 75.2%(249/331),the 5-vear survival rate was 62.5%(207/331).The complication rate was 13.3%(44/331)for cystitis,and 32.3%(107/331)for proctitis.Conclusions Compared with combination of traditional brachytherapy and external radiotherapy,combination of hyperfraetional integrated brachtherapy therapy and external radiotherapy has no significant improvement for recent control rate and long-term survival rate,but could reduce the complication rates of cystitis and proctitis.
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Objective To evaluate the efficacy and toxicities of gemcitabine combined with ifosfamide and anthracycline chemotherapy for recurrent platinum resistant ovarian epithelial cancer.Methods Gemcitabine 800 mg/m2 ( day 1, 8 ), ifosfamide 1.5 g/m2 ( day 1 - 3 ), adriamycin 40 mg/m2 or epirubicin 60 mg/m2 (day 1 ) or mitoxantrone 10 mg/m2 (day 1, 8 ) were used in recurrent platinum resistant/refractory ovarian cancer patients, the cycle was repeated at interval of 21 to 28 days.Results A total of 60 patients received 172 cycles combined chemotherapy.There were no one cases complete response, while partial response 22 (37%, 22/60), stable 23 (38%, 23/60) and progression 15 (25%,15/60) were observed, with clinical benefit rate 75% (45/60).The median time of progression-free survival was 7 months, and the median overall survival time was 20 months.The main side effect was hematologic toxicity with leukopenia rate of 82% (49/60), among which Ⅲ - Ⅳ accounted for 31%(15/49).Digestive reaction was all in Ⅰ - Ⅱ , accounted for 42% (25/60).Conclusion The regimen of gemcitabine combined with ifosfamide and anthracycline is feasible, tolerable and effective in patients with recurrent platinum resistant/refractory epithelial ovarian cancer.
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Objective To explore the clinicopathological characteristics of hereditary ovarian cancer syndrome(HOCS). Methods From Jan. 2000 to Jan. 2007, among 580 cases of primary ovarian cancer, 42 cases(herediatary group),who had a positive family history of ovarian cancer and met the diagnostic criteria of HOCS, were analyzed retrospectively. One hundred cases without a family history of ovarian cancer were enrolled randomizely as control group (sporadic group). Results The incidence of HOCS was 7.2% (42/580). Forty-two cases associated tumors affected at least 2 successive generations in 31 families and affected 1 generation in 8 families. Eighty-seven percent (27/31)was from maternal lineage, while 13% (4/31)from paternal lineage. Earlier age of onset was significantly difference between two groups[(49±10) years vs. (55±10) years, P<0.05]. There were 90% belong to serous adenocarcinoma in the herediatary group, while 84% in the sporadic group. There was statistical difference in the proportion of mucinous adenocarcinoma (0 vs. 11%, P<0.05). The most common clinical manifestations were abdominal distention and anorexia (64% vs. 70%, P>0.05), International Federational of Gynecology Obstetrics(FIGO)stage Ⅲ (62% vs. 63%, P>0.05) between two groups. Fourteen cases (33%,14/42) were previously untreated in the herediatary group, while 40 cases (40%, 40/100) in the sporadic group. There were 15 cases (36%, 15/42) underwent secondary surgery and 15 cases (36%, 15/42) underwent third surgery or more in berediatary group, while 50 cases (50%, 50/100) and 27 cases(27%, 27/100) in the sporadic group. The mean number of ehemotberapy cycles received in two groups was 13.3 and 11.8 (P>0.05). The 3-year and 5-year survival rate in herediatary group were 73.6% and 54.9% respectively, compared with 47.4% and 21.2% (P<0.05) in sporadic group. Conclusion Hereditary ovarian cancer mostly from maternal lineage are featuring in early age of onset, serous adenocarcinoma, advanced stage (stage Ⅲ), and better prognosis after the comprehensive treated by cytoreductive surgery plus with chemotherapy.
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Objective:To retrospectively analyze the clinical features of intestinal tract metastatic tumors of ovarian cancer,and estimate the feasibility of resection and its relation to prognosis.Methods:64 patients with ovarian cancer associated with intestinal tract metastasis were brought into this clinical analysis.The extent of intestinal tract involvement was evaluated preoperatively.Cytoreduction was defined as the residual lesion less than 1 cm3,at the same time pelvic and paraaortic lymphadenectomy and/or biopsy were implied.Intestinal surgery included tumor stripping surgery and/or intestinal repair,intestinal resection or colostomy.Regular chemotherapy was administrated,postoperative complications as well as prognosis were evaluated.Results:54 cases (84.8%) had rectum/sigmoid colon metastasis,metatsis in other parts of colon were 26 cases,small intestinal metastasis were 18 cases,infiltration of serosal and superficial muscular layer were 47 cases,17 cases had deep muscular layer and mucosal infiltration.Epithelial cancer which had invaded intestinal mucosa were 4 cases (7.7%) ,no invading to intestinal mucosa was detected in germnoma.All the 64 patients were recepted surgical treatment,including tumor stripping surgery in 44 cases,intestinal resection in 20 cases,sigmoidal and rectal resection in 14 cases,and colonost omy in 6 cases.The optical cytoreduction was[FK(WB00018。142mmZQ1mm]achieved in 56 cases (87.5%),and post-chemotherpy regression rate was 58.9%,but the post-chemotherpy regression rate was only 12.5% in 8 patients who got partial resection;regular chemotherapy was finished in 49 cases,and the regression rate was 65.3%,but the regression rate was only 15.4% in those who couldn’t finish regular chemotherapy.Postoperative morbidity was 26.6%,and two patients died of postoperative peritonitis.Conclusion:Intestinal tract is the common metastatic site of ovarian cancer,tumor stripping and intestinal resection are not only feasible but also prerequisite for optimal cytoreduction,postoperative regular chemotherapy can improve prognosis of ovarian cancer.