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Ovarian cancer is the most lethal malignancy of the female genital tract. Genetic predisposition, usage of hormone, relative disease and reproduction, and lifestyle factors are possible risk factors for ovarian cancer. Women can be stratified into high risk and general populations according to the ovarian cancer risk. Screening and prevention were reviewed for the two populations. Population-based trials in the general population have not demonstrated that screening improves early detection or survival. Strengthening the awareness of tumor prevention and conducting effective screening and prevention in the high-risk population are cost-effective methods to reduce the incidence and mortality of ovarian cancer.
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The tertiary prevention approaches of ovarian cancer include whole-person care, training of the patients to cooperate with physicians in the periods of treatment and follow-up, training program of the qualified surgeons, and recognition of biological behavior changes of relapse after PARPi therapy. Surgery remains the cornerstone in the management of ovarian cancer, but the role of surgery after PARPi remains unknown. Recently, the US FDA withdrew the indication of three PARP inhibitors in the treatment of recurrent ovarian cancer with ≥3 lines of chemotherapy because of their ≥30% increased death risk. Thus, we should pay more attention to the biological recurrence and chemoresistance caused by PARP inhibitors and post-progression survival in ovarian cancer.
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Background@#In China, secondary cytoreductive surgery (SCR) has been widely used in ovarian cancer (OC) over the past two decades. Although Gynecologic Oncology Group-0213 trial did not show its overall survival benefit in first relapsed patients, the questions on patient selection and effect of subsequent targeting therapy are still open. The preliminary data from our pre-SOC1 phase II study showed that selected patients with second relapse who never received SCR at recurrence may still benefit from surgery. Moreover, poly(ADP-ribose) polymerase inhibitors (PARPi) maintenance now has been a standard care for platinum sensitive relapsed OC. To our knowledge, no published or ongoing trial is trying to answer the question if patient can benefit from a potentially complete resection combined with PARPi maintenance in OC patients with secondary recurrence. @*Methods@#SOC-3 is a multi-center, open, randomized, controlled, phase II trial of SCR followed by chemotherapy and niraparib maintenance vs chemotherapy and niraparib maintenance in patients with platinum-sensitive second relapsed OC who never received SCR at recurrence. To guarantee surgical quality, if the sites had no experience of participating in any OC-related surgical trials, the number of recurrent lesions evaluated by central-reviewed positron emission tomography–computed tomography image shouldn't be more than 3. Eligible patients are randomly assigned in a 1:1 ratio to receive either SCR followed by 6 cyclesof platinum-based chemotherapy and niraparib maintenance or 6 cycles of platinum-based chemotherapy and niraparib maintenance alone. Patients who undergo at least 4 cycles of chemotherapy and must be, in the opinion of the investigator, without disease progression, will be assigned niraparib maintenance. Major inclusion criteria are secondary relapsed OC with a platinum-free interval of no less than 6 months and a possibly complete resection. Major exclusion criteria are borderline tumors and non-epithelial ovarian malignancies, received debulking surgery at recurrence and impossible to complete resection. The sample size is 96 patients. Primary endpoint is 12-month non-progression rate.
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Background@#Two randomized phase III trials (EORTC55971 and CHORUS) showed similar progression-free and overall survival in primary or interval debulking surgery in ovarian cancer, however both studies had limitations with lower rate of complete resection and lack of surgical qualifications for participating centers. There is no consensus on whether neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) could be a preferred approach in the management of advanced epithelial ovarian cancer (EOC) in the clinical practice. @*Methods@#The Asian SUNNY study is an open-label, multicenter, randomized controlled, phase III trial to compare the effect of primary debulking surgery (PDS) to NACT-IDS in stages IIIC and IV EOC, fallopian tube cancer (FTC) or primary peritoneal carcinoma (PPC).The hypothesis is that PDS enhances the survivorship when compared with NACT-IDS in advanced ovarian cancer. The primary objective is to clarify the role of PDS and NACT-IDS in the treatment of advanced ovarian cancer. Surgical quality assures include at least 50% of no gross residual (NGR) in PDS group in all centers and participating centers should be national cancer centers or designed ovarian cancer section or those with the experience participating surgical trials of ovarian cancer. Any participating center should be monitored evaluating the proportions of NGR by a training set. The aim of the surgery in both arms is maximal cytoreduction. Tumor burden of the disease is evaluated by diagnostic laparoscopy or positron emission tomography/computed tomography scan. Patients assigned to PDS group will undergo upfront maximal cytoreductive surgery within 3 weeks after biopsy, followed by 6 cycles of standard adjuvant chemotherapy. Patients assigned to NACT group will undergo 3 cycles of NACT-IDS, and subsequently 3 cycles of adjuvant chemotherapy. The maximal time interval between IDS and the initiation of adjuvant chemotherapy is 8 weeks. Major inclusion criteria are pathologic confirmed stage IIIC and IV EOC, FTC or PPC; ECOG performance status of 0 to 2; ASA score of 1 to 2. Major exclusion criteria are non-epithelial tumors as well as borderline tumors; low-grade carcinoma; mucinous ovarian cancer. The sample size is 456 subjects. Primary endpoint is overall survival.
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Background@#Two randomized phase III trials (EORTC55971 and CHORUS) showed similar progression-free and overall survival in primary or interval debulking surgery in ovarian cancer, however both studies had limitations with lower rate of complete resection and lack of surgical qualifications for participating centers. There is no consensus on whether neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) could be a preferred approach in the management of advanced epithelial ovarian cancer (EOC) in the clinical practice. @*Methods@#The Asian SUNNY study is an open-label, multicenter, randomized controlled, phase III trial to compare the effect of primary debulking surgery (PDS) to NACT-IDS in stages IIIC and IV EOC, fallopian tube cancer (FTC) or primary peritoneal carcinoma (PPC).The hypothesis is that PDS enhances the survivorship when compared with NACT-IDS in advanced ovarian cancer. The primary objective is to clarify the role of PDS and NACT-IDS in the treatment of advanced ovarian cancer. Surgical quality assures include at least 50% of no gross residual (NGR) in PDS group in all centers and participating centers should be national cancer centers or designed ovarian cancer section or those with the experience participating surgical trials of ovarian cancer. Any participating center should be monitored evaluating the proportions of NGR by a training set. The aim of the surgery in both arms is maximal cytoreduction. Tumor burden of the disease is evaluated by diagnostic laparoscopy or positron emission tomography/computed tomography scan. Patients assigned to PDS group will undergo upfront maximal cytoreductive surgery within 3 weeks after biopsy, followed by 6 cycles of standard adjuvant chemotherapy. Patients assigned to NACT group will undergo 3 cycles of NACT-IDS, and subsequently 3 cycles of adjuvant chemotherapy. The maximal time interval between IDS and the initiation of adjuvant chemotherapy is 8 weeks. Major inclusion criteria are pathologic confirmed stage IIIC and IV EOC, FTC or PPC; ECOG performance status of 0 to 2; ASA score of 1 to 2. Major exclusion criteria are non-epithelial tumors as well as borderline tumors; low-grade carcinoma; mucinous ovarian cancer. The sample size is 456 subjects. Primary endpoint is overall survival.
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No abstract available.
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Female , Humans , Asia , China , Genital Neoplasms, Female , Gynecologic Surgical Procedures , Laparoscopy , Laparotomy , Medical Oncology , Ovarian Neoplasms/pathology , Republic of KoreaABSTRACT
10.3969/j.issn.1007-3969.2013.04.00X
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Notch signal pathway is one of crucial pathways related to cell fate determination, regulating cell differentiation, proliferation and apoptosis, with an effect of organ formation and morphogenesis. Abnormal activation of Notch gene occurs in many tumor cells, such as brain tumors, breast cancer and hepatoma. Recent studies have been found that the notch pathway out of control was related with growth of ovarian cancer. And Notch3 involving in the development and progression of ovarian cancer has been attracted extensive attention by experts and scholars. This review focuses on the literatures of Notch3 and related molecules regulating the development and progression of epithelial ovarian cancer.
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Background and purpose:Primary malignant melanomas of the uterine cervix and vagina are rare neoplasms with very poor prognosis. This article aimed at investigating the clinicopathologic characteristics, treatment and prognosis of primary malignant melanomas of the cervix and vagina. Methods:The clinical data of 51 patients with primary malignant melanomas of the cervix and vagina treated at Fudan University Shanghai Cancer Center from Dec.1998 to Jul. 2011 were reviewed. Results:The 2-and 4-year progression-free survival (PFS) rates were 32.8%and 13.1%, respectively. The 2-and 4-year overall survival (OS) rates were 67.2%and 39.8%, respectively. Three patients survived more than 5 years. Twenty-nine (56.9%) patients had a recurrence. The common sites were vaginal stump/pelvis (10 patients, 34.5%), liver (4 patients, 13.9%), lung (3 patients, 10.3%), bone (3 patients, 10.3%) and vulva (3 patients, 10.3%). Larger tumor size and lymphovascular space invasion were the independent predictors of poor OS (P<0.05). Pelvic lymph nodes metastases were associated with shorter PFS (P=0.05). Among them, those who received combined immunotherapy and chemoradiotherapy achieved longer median time to progression (TTP) (17 months) compared with patients who had chemotherapy alone (9 months) or immunotherapy alone (11 months). Conclusion:Primary melanomas of cervix and vagina have a very poor prognosis. The multidisciplinary treatment of combining surgery, chemoradiotherapy, and immunotherapy can improve the patients’ prognosis.
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The aim of this review is to examine the current status of gynecological cancer in China focusing on epidemiological data. Epidemiological data on gynecological cancer in China is sparse. Therefore, most of the data were estimated via extrapolation based on a few available datasets. Cervical cancer is relatively rare and the incidence and mortality rate are largely decreasing. However, in young women, the incidence and mortality rates are increasing. The overall and age-specific incidence rates of cervical cancer appear to be varied according to geographical areas. The overall prevalence rate of human papillomavirus (HPV) in China is similar with other eastern Asian countries, but the age-specific HPV prevalence showed sustained high HPV prevalence rates in elderly women. There is not yet an established national program for cervical cancer prevention. The incidence rate of corpus and ovarian cancers in China slightly increased between 2000 and 2005, but is still lower than Japan or Korea. There is no reliable, national-level data on mortality rates of corpus and ovarian cancer in China. Breast cancer is one of the most rapidly increasing cancers in China. The increase was sharper in young women than in elderly women. Both increased risk and change of population size/structure contributed to the increase of breast cancer.
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Aged , Female , Humans , Asian People , Breast Neoplasms , China , Endometrial Neoplasms , Incidence , Japan , Korea , Ovarian Neoplasms , Prevalence , Uterine Cervical NeoplasmsABSTRACT
Bladder function is controlled by the hypogastric nerves (sympathetic) and pelvic splanchnic nerves (parasympathetic) , and these two nerve fibers intermingle to form the pelvic plexus. Pelvic surgery was one of the important modalities being used in pelvis-gynecology, but it was commonly found that the modality could cause bladder dysfunction because of its damage to the pelvic plexus. Pelvis-gynecologic surgeries like Pive Ⅱ-Ⅳ radical hysterectomy (RH), total vaginectomy, Hartman, Dixon, and posterior pelvic exenteration are among the most important causes of urinary dysfunction. Recently, urinary dysfunction has become the major issue for patients undergoing pelvic surgery in terms of quality-of-life. Pelvic autonomic nerve-sparing (PANS) protects postsurgical bladder function in radical RH and other pelvic surgery. The review tried to discuss different types of PANS being used in variety of pelvis-gynecologic surgery. Type Ⅰ PANS can be performed in Piver Ⅱ RH in patients with endometrioid cancer, and urinary catheter will be removed 3 days after operation. Type Ⅱ PANS is used in Piver Ⅲ RH, and the catheter can be successfully removed 7 days after surgery. Sometimes, type Ⅲ PANS is administered in one-side tumor-free cardinal ligament resection, and the patients will retain their catheter for 3 weeks postoperatively. Type Ⅱ or type Ⅲ PANS may be used in total vaginectomy, Hartman, Dixon, and posterior pelvic exenteration.
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1cm, there was a significant statistical difference in median survival of 61 and 12 months, respectively (? 2 =16.60, P =0.0001). The median survival for patients with and without peritoneal chemotherapy were 27 and 12 months, respectively (? 2 =3.45, P =0.0633). Residual disease, FIGO stage, recurrent ascites, uterus muscle involvement were independent prognostic determinants of survival identified by Cox's stepwise regression analysis. Conclusions Aggressive surgical cytoreduction should be performed in elderly AEOC patients as well as in younger patients, but multi-course platinum-based chemotherapy should be used in accordance with the performance status of elder women.
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<p><b>OBJECTIVE</b>To study the role of secondary cytoreductive surgery (SCR) in patients with recurrent advanced epithelial ovarian cancer.</p><p><b>METHODS</b>From Jan. 1986 to Dec. 1997, 60 women with recurrent advanced epithelial ovarian cancer treated with SCR were retrospectively reviewed. Survival curves were computed using the Kaplan-Meier method with differences in survival estimated by log-rank test. Independent prognostic factors were identified by Cox's stepwise regression, and the affecting factors of SCR evaluated by Logistic stepwise regression.</p><p><b>RESULTS</b>Of the 60 patients, 23 (38.3%) were cytoreduced to small macroscopic residual (</= 1 cm) and 37 retained larger residual, with an estimated median survival of 19 months and 8 months respectively. Multivariate analysis revealed that residual disease (P = 0.0041) after SCR, as well as refractory ascites (P = 0.0191) and progression-free interval (P = 0.0116), were independent factors of survival. Refractory ascites (relative risk = 20.36, P = 0.0072) and residual disease after primary surgery (relative risk = 5.16, P = 0.0096) were factors affecting SCR.</p><p><b>CONCLUSION</b>Secondary cytoreductive surgery is definitely effective in the treatment of recurrent advanced epithelial ovarian carcinoma, particularly in those who have received primary optimal cytoreduction with a progression-free interval > 12 months and without refractory ascites.</p>
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Adult , Female , Humans , Middle Aged , Logistic Models , Neoplasm Recurrence, Local , General Surgery , Neoplasm, Residual , General Surgery , Ovarian Neoplasms , General Surgery , Prognosis , Survival AnalysisABSTRACT
6 months was 42.3 months, longer than 17.5 months for patients with PFI ≤ 6 months, no statistical significance was found ( P =0.1418). Multivariate analysis strongly suggested that PFI and the courses of second line chemotherapy were independent prognostic factors of survival after secondary treatment for epithelial ovarian cancer. For those patients with PFI ≤ 6 months, the smaller the size of residual lesion ( P =0.0003) and the more the cycle of effective second line chemotherapy ( P =0.0004), the longer the survival after the secondary cytoreduction. Conclusions:The results suggested that successful secondary cytoreductive surgery combined with multicycles second line chemotherapy may be an effective way to lengthen the survival on retreatment for patients with platinum resistant and recurrent epithelial ovarian cancer.
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Objective To investigate the timing and role of systemic retroperitoneal lymphadenectomy in patients with ovarian cancer. Methods From Jan. 1987 to Feb. 1994, 50 patients with ovarian cancer, who underwent retroperitoneal lymphadenectomy on second-look laparotomy (SLL), were retrospectively studied. Results The median age was 49 years. Overall survival at 3 and 5 years were 72% and 62%, respectively. Twenty of 50 (40%) women were found SLL(+),and the rates of positive SLL were related to International Federation of Gynecology Obstetrics (FIGO) stage, with 16% in stage ⅠandⅡ, 64% in stage Ⅲ and Ⅳ (P
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Objective To study the characteristics, therapies and prognosis of the patients with epithelial ovarian cancer (EOC) that are initially categorized as extra abdominal adenocarcinoma of unknown primary Methods Twenty five patients with EOC, who were treated in the Cancer Hospital of Fudan University from Jan 1986 to Dec 1997, and manifesting as extra peritoneal or liver parenchyma metastases at the time of presentation, without detectable ovarian tumors, were retrospectively studied Results Supraclavicular and inguinal lymph node metastases were common in this group of patients, with 6 and 5 cases respectively, and 6 patients with more than two sites metastases simultaneously 16 patients (64%) were optimally surgical debulked 20 patients with stage Ⅳ EOC initially presenting as extra abdominal metastases experienced a better prognosis, with an estimated median survival of 24 months. Of whom the median survival was 30 months in patients presenting with pleural effusion or supraclavicular lymph node metastases Vs 19 months in those with other sites spread ( P =0 026 4) Conclusions The prognosis of such cases, particularly for those with supraclavicular lymphadenopathy or malignant pleural effusion, is a lot better than other stage Ⅳ EOC patients, probably because of most of the patients initially presenting with distant metastases being generally in a good condition competent for aggressive surgery or multi cycle chemotherapy
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Objective To investigate individualized and multi-phase management of recurrent epithelial ovarian carcinoma in order to improve survival of the patients. Methods From 1998 to 2002, 70 patients with recurrent epithelial ovarian carcinoma were enrolled in the present study. The treatments were divided into: (1) Induction of tumor remission:platinum sensitive patients were treated with paclitaxol + cisplatin (TP) or carboplatin + cyclophosphamide(CP)regimen; platinum resistant patients used Taxol + mitomycin(TM)or etoposide+ mitomycin(VM)regimen. Resection of tumors was done in an attempt to reduce the residual tumor with a diameter less than 1cm. Local radiotherapy was performed for those with residual tumor and who achieved clinical response after chemotherapy or surgery. (2) Consolidation therapy: chemotherapy with lower doses was administrated after disease remission. Interferon was used as immunotherapy during chemotherapy and radiotherapy. Survial analysis was done. Results (1) The 1, 2, 3, 4, 5-year survival rates were 67%, 51%, 45%, 38%, 32% . Median survival was 38.57 months. (3)The 1,2,3-year progression-free survival rates of the research arm were 41%, 37%, 24%. Median progression-free survival was 12.00 months. (4) Multivariate analysis revealed that platinum-free interval (P
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1 cm after secondary cytoreduction.
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6) of platinum based intravenous chemotherapy prolonged the survival of patients with suboptimal cytoreduction Intraperitoneal chemotherapy was one of the dominant long term survival determinants, and mainly on those with size of residual disease less than 1 cm