ABSTRACT
Locally advanced cervical carcinoma had been treated with radiation therapy until 1999, when five different large clinical trials showed an overall survival benefit when chemotherapy was administered concomitantly with radiotherapy. The chemotherapy agents used in these trials were cisplatin, cisplatin combined with fluorouracil or hydroxyurea. Weekly cisplatin (40 mg/m(2)) achieved the best responses, even when compared with the combination with fluorouracil. These results led the United States National Cancer Institute (NCI) to recommend platinum-based chemotherapy for the treatment of locally advanced cervical carcinoma. Other cytotoxic agents have been tried in combination with radiotherapy for the management of the disease, including carboplatin, paclitaxel, gemcitabine and even topotecan. Gemcitabine has shown promising results and the combination of paclitaxel and carboplatin has proved safe and effective. However, to date, there has been no agent or combination of agents to have shown superiority over weekly cisplatin. Biologic agents such as bevacizumab, cetuximab, sorafenib and erlotinib are currently being tried in different trials in combination with radiotherapy and cisplatin. Celecoxib, a COX-2 inhibitor was evaluated in an RTOG study in combination with cisplatin and flourouracil with radiation therapy with no apparent effect on DFS and poor rates of locoregional control. Chemoradiation is the current standard therapy in locally advanced cervical carcinoma. The integration of novel agents will be established by the ongoing clinical trials.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Uterine Cervical Neoplasms/drug therapy , Uterine Cervical Neoplasms/radiotherapy , Combined Modality Therapy , Female , HumansABSTRACT
OBJECTIVE: To know the characteristics of endometrial adenocarcinoma in young patients and to review the published experience in patients with endometrial adenocarcinoma that were conservatively managed with hormonal therapy to spare their fertility. METHODS: We carried out a search in the Survey conducted by the Section of Oncologic Gynecology of SEGO (Spanish Society of Gynecologists) to identify the characteristics of young patients with endometrial adenocarcinoma. In addition we searched MEDLINE and other databases for English-language articles describing patients with endometrial adenocarcinoma who were treated with hormonal therapy. The search included articles published between January 1966 and January 2007. RESULTS: Endometrial carcinoma in patients under 45 years old is an unusual condition that shows a more favourable pattern than in older patients. One hundred and thirty-three patients were found in the search. The average duration of hormonal therapy was approximately six months. The average response time was 12 weeks; 76% of patients treated with hormonal therapy had a complete response and the other 24% never responded to treatment. Of those who initially responded, 66% percent did not show recurrence of disease. The other 34% had a relapse. There have been 4 published deaths of conservatively managed patients. CONCLUSION: A conservative approach in these patients can offer reasonable oncological security and the opportunity of fulfilling their maternal desires in selected cases. However, consideration should be taken regarding the potential adverse outcomes that have been recently published in the literature (AU)
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Subject(s)
Humans , Female , Pregnancy , Adenocarcinoma/diagnosis , Adenocarcinoma/drug therapy , Endometrial Neoplasms/complications , Endometrial Neoplasms/diagnosis , Endometrial Neoplasms/drug therapy , Adenocarcinoma/pathology , Antineoplastic Agents, Hormonal/metabolism , Antineoplastic Agents, Hormonal/therapeutic use , Endometrial Neoplasms/pathology , Fertility , Pregnancy OutcomeABSTRACT
Objetivo: Determinar qué variables predicen de modo independiente el pronóstico de las pacientes con cáncer epitelial de ovario en nuestro medio. Material y métodos: Tras seleccionar 217 pacientes con diagnóstico histológico de cáncer epitelial de ovario tratadas entre 1985 y 1995 se revisaron sus preparaciones y se confirmó el diagnóstico por un mismo patólogo. Se revisó la clasificación del tipo histológico, grado arquitectural y nuclear. Finalmente se ha realizado un análisis de las variables que modificaron la supervivencia de modo univariante y multivariante aplicando un modelo de regresión múltiple para conocer las variables independientes. Resultados: La supervivencia actuarial global a los 5 años de nuestras pacientes fue del 54 por ciento y la supervivencia actuarial a los 10 años del 36 por ciento. La supervivencia actuarial libre de enfermedad fue del 48 por ciento y a los 10 años ha sido del 26 por ciento. El análisis multivariante demostró que las variables independientes que modificaron la supervivencia en el estadio I fueron: grado nuclear del tumor, ascitis (×6) y tamaño del tumor (×4). En los estadios avanzados (II-IV) fueron: enfermedad clínica tras quimioterapia (×7) y grado nuclear (×6).Conclusiones: El grado nuclear del tumor valorado por un mismo patólogo y la existencia de enfermedad clínica tras quimioterapia fueron las variables independientes que modificaron la supervivencia de las pacientes con cáncer de ovario tras la aplicación de un análisis multivariante (AU)
Subject(s)
Adolescent , Adult , Aged , Female , Middle Aged , Humans , Multivariate Analysis , Prognosis , Carcinoma, Endometrioid/diagnosis , Carcinoma, Endometrioid/classification , Carcinoma/complications , Carcinoma/diagnosis , Carcinoma/classification , Ovarian Neoplasms/complications , Ovarian Neoplasms/diagnosis , Ovarian Neoplasms/drug therapy , Neoplasm Staging/methods , Histological Techniques , Karnofsky Performance Status/standards , Carcinoma/drug therapy , Carcinoma, Endometrioid/drug therapy , Carcinoma, Endometrioid/radiotherapyABSTRACT
Objetivos: Evaluar si la sobreexpresión de la proteína nuclear p53 tiene algún impacto en la supervivencia en las pacientes con cáncer de ovario y si se asocia con otros factores pronósticos. Material y métodos: Se evalúan mediante técnicas de inmunohistoquímica la sobreexpresión de p53 en 78 pacientes con cáncer epitelial de ovario diagnosticadas en nuestro centro entre 1985 y 1993. Resultados: La sobreexpresión de la proteína p53 mutada empeora la supervivencia de estas pacientes al considerar todos los estadios. (Supervivencia a cinco años del 84 por 100 en el grupo de tinción negativa frente al 46 por 100 en el grupo de tinción positiva. p < 0,05). La sobreexpresión de dicha proteína se correlaciona de modo estadísticamente significativo con estadios avanzados (83 por 100 de tinción positiva frente a un 62 por 100 en estadios precoces), tumores con grado nuclear agresivo (90 por 100 de positividad en pacientes con grado nuclear G3, frente al 55 por 100 en pacientes G1-G2) y pacientes que fueron sometidas a citorreducción subóptima (85 por 100 de positividad frente al 65 por 100 en pacientes con citorreducción óptima). Conclusión: La acumulación de p53 en el núcleo de las células de cáncer epitelial de ovario se asocia a un peor pronóstico y se correlaciona con estadios más avanzados, grados nucleares más agresivos y cirugía subóptima (AU)
