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1.
Eur J Surg Oncol ; 48(11): 2308-2314, 2022 11.
Article in English | MEDLINE | ID: mdl-36184421

ABSTRACT

Pelvic exenteration, first described in 1948 and subsequently refined, may be offered as a last hope of cure to patients with recurrent or locally advanced pelvic tumours, where radiotherapy is not an option. It is a complex, morbid, ultra-radical procedure involving en-bloc resection of the female reproductive organs, lower urinary tract, and a portion of the rectosigmoid. This article discusses the evolution of and current indications for pelvic exenteration in gynaecologic oncology as well as the reasons for its decline: primary and secondary prevention of cervical cancer (the recurrence of which is the most common indication for exenteration); improvements in treatment of cervical, endometrial, vaginal and vulvar cancer in the primary and recurrent setting; and the advent of novel therapies.


Subject(s)
Genital Neoplasms, Female , Pelvic Exenteration , Radiation Oncology , Uterine Cervical Neoplasms , Vulvar Neoplasms , Humans , Female , Genital Neoplasms, Female/radiotherapy , Genital Neoplasms, Female/surgery , Uterine Cervical Neoplasms/radiotherapy , Uterine Cervical Neoplasms/surgery , Vulvar Neoplasms/radiotherapy , Vulvar Neoplasms/surgery , Neoplasm Recurrence, Local/prevention & control , Retrospective Studies
2.
Gynecol Oncol ; 158(1): 47-53, 2020 07.
Article in English | MEDLINE | ID: mdl-32381362

ABSTRACT

OBJECTIVES: To determine the impact of chemotherapy dose reductions and dose delays on progression-free survival (PFS) in women with ovarian cancer receiving first line chemotherapy in a real world prospective cohort study. METHODS: Patients with newly diagnosed epithelial ovarian (or peritoneal, fallopian tube) cancer enrolled in a national Australian prospective study, OPAL, who commenced three-weekly carboplatin (AUC 5 or 6) and paclitaxel 175 mg/m2 (CP) or carboplatin (AUC 5 or 6) and dose-dense weekly paclitaxel 80 mg/m2 (DD-CP) were eligible. Primary endpoint was PFS. RESULTS: 634 evaluable patients, 309 commenced CP and 325 DD-CP. Patient's age was similar in the two groups (median 62 years, range 21-79). All planned chemotherapy doses were completed by 66% vs 40% (p < 0.001) in the CP and DD-CP groups respectively. There was at least one treatment delay in 28% vs 58% (p < 0.001) in the CP and DD-CP groups, respectively, and 29% vs 49% (p < 0.001), respectively, required at least a 15% dose reduction for either carboplatin or paclitaxel. Median PFS was 29.2 [22.9, 43.8] and 21.5 [19.4, 23.1] months in the CP and DD-CP groups respectively. Adjusting for age, histology and FIGO stage PFS did not differ between treatment groups. Median PFS was similar in patients irrespective of dose reduction or dose delay. CONCLUSION: Patients receiving DD-CP required more dose reductions and delays due to haematological toxicities and lower completion rates than CP without significant difference in median PFS between CP and DD-CP. Median PFS was similar in patients irrespective of dose reduction or dose delay.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Carcinoma, Ovarian Epithelial/drug therapy , Ovarian Neoplasms/drug therapy , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Carboplatin/administration & dosage , Carboplatin/adverse effects , Carcinoma, Ovarian Epithelial/surgery , Chemotherapy, Adjuvant , Cohort Studies , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Humans , Middle Aged , Neoadjuvant Therapy , Ovarian Neoplasms/surgery , Paclitaxel/administration & dosage , Paclitaxel/adverse effects , Progression-Free Survival , Prospective Studies , Retrospective Studies , Young Adult
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