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1.
Gynecol Oncol ; 166(1): 100-107, 2022 07.
Article in English | MEDLINE | ID: mdl-35568583

ABSTRACT

BACKGROUND: The aim of the study was to compare health-related quality of life (QoL) and oncological outcome between gynaecological cancer patients undergoing pelvic exenteration (PE) and extended pelvic exenteration (EPE). EPEs were defined as extensive procedures including, in addition to standard PE extent, the resection of internal, external, or common iliac vessels; pelvic side-wall muscles; large pelvic nerves (sciatic or femoral); and/or pelvic bones. METHODS: Data from 74 patients who underwent PE (42) or EPE (32) between 2004 and 2019 at a single tertiary gynae-oncology centre in Prague were analysed. QoL assessment was performed using EORTC QLQ-C30, EORTC CX-24, and QOLPEX questionnaires specifically developed for patients after (E)PE. RESULTS: No significant differences in survival were observed between the groups (P > 0.999), with median overall and disease-specific survival in the whole cohort of 45 and 49 months, respectively. Thirty-one survivors participated in the QoL surveys (20 PE, 11 EPE). No significant differences were observed in global health status (P = 0.951) or in any of the functional scales. The groups were not differing in therapy satisfaction (P = 0.502), and both expressed similar, high willingness to undergo treatment again if they were to decide again (P = 0.317). CONCLUSIONS: EPEs had post-treatment QoL and oncological outcome comparable to traditional PE. These procedures offer a potentially curative treatment option for patients with persistent or recurrent pelvic tumour invading into pelvic wall structures without further compromise of patients´ QoL.


Subject(s)
Pelvic Exenteration , Pelvic Neoplasms , Humans , Pelvic Exenteration/methods , Pelvic Neoplasms/surgery , Quality of Life , Retrospective Studies , Surveys and Questionnaires
2.
Eur J Cancer ; 143: 88-100, 2021 01.
Article in English | MEDLINE | ID: mdl-33290995

ABSTRACT

BACKGROUND: The management of cervical cancer patients with intraoperative detection of lymph node involvement remains controversial. Since all these patients are referred for (chemo)radiation after the surgery, the key decision is whether radical hysterectomy should be completed as originally planned, taking into account an additional morbidity associated with extensive surgical dissection prior to adjuvant treatment. The ABRAX study investigated whether completing a radical uterine procedure is associated with an improved oncological outcome of such patients. PATIENTS AND METHODS: We performed retrospective analyses of 515 cervical cancer patients (51 institutions, 19 countries) who were referred for primary curative surgery between 2005 and 2015 (stage IA-IIB, common tumour types) in whom lymph node involvement was detected intraoperatively. Patients were stratified according to whether the planned uterine surgery was completed (COMPL group, N = 361) or abandoned (ABAND group, N = 154) to compare progression-free survival. Definitive chemoradiation was given to 92.9% patients in the ABAND group and adjuvant (chemo)radiation or chemotherapy to 91.4% of patients in the COMPL group. RESULTS: The risks of recurrence (hazard ratio [HR] 1.154, 95% confidence intervals [CI] 0.799-1.666, P = 0.45), pelvic recurrence (HR 0.836, 95% CI 0.458-1.523, P = 0.56), or death (HR 1.064, 95% CI 0.690-1.641, P = 0.78) were not significantly different between the two groups. No subgroup showed a survival benefit from completing radical hysterectomy. Disease-free survival reached 74% (381/515), with a median follow-up of 58 months. Prognostic factors were balanced between the two groups. FIGO stage and number of pelvic lymph nodes involved were significant prognostic factors in the whole study cohort. CONCLUSION: We showed that the completion of radical hysterectomy does not improve survival in patients with intraoperatively detected lymph node involvement, regardless of tumour size or histological type. If lymph node involvement is confirmed intraoperatively, abandoning uterine radical procedure should be considered, and the patient should be referred for definitive chemoradiation. CLINICAL TRIALS IDENTIFIER: NCT04037124.


Subject(s)
Hysterectomy/methods , Uterine Cervical Neoplasms/surgery , Adult , Aged , Cohort Studies , Female , Humans , Middle Aged , Retrospective Studies , Survival Analysis , Uterine Cervical Neoplasms/mortality , Uterine Cervical Neoplasms/pathology
3.
Gynecol Oncol ; 148(3): 456-460, 2018 03.
Article in English | MEDLINE | ID: mdl-29366509

ABSTRACT

OBJECTIVES: The aim of this study was to assess the detection rate, false-negative rate and sensitivity of SLN in LN staging in tumors over 2cm on a large cohort of patients. METHODS: Data from patients with stages pT1a - pT2 cervical cancer who underwent surgical treatment, including SLN biopsy followed by systematic pelvic lymphadenectomy, were retrospectively analyzed. A combined technique with blue dye and radiocolloid was modified in larger tumors to inject the tracer into the residual cervical stroma. RESULTS: The study included 350 patients with stages pT1a - pT2. Macrometastases, micrometastases, and isolated tumor cells were found in 10%, 8%, and 4% of cases. Bilateral detection rate was similar in subgroups with tumors<2cm, 2-3.9cm, and ≥4cm (79%, 83%, 76%) (P=0.460). There were only two cases with false-negative SLN ultrastaging for pelvic LN status among those with bilateral SLN detection. The false negative rate was very low in all three subgroups of different tumor sizes (0.9%, 0.9%, and 0.0%; P=0.999). Sensitivity reached 96% in the whole group and was high in all three groups (93%, 93%, 100%; P=0.510). CONCLUSIONS: If the tracer application technique is adjusted in larger tumors, SLN biopsy can be equally reliable in pelvic LN staging in tumors smaller and larger than 2cm. The bilateral detection rate and false negative rate did not differ in subgroups of patients with tumors<2cm, 2-3.9cm, and ≥4cm.


Subject(s)
Adenocarcinoma/pathology , Carcinoma, Adenosquamous/pathology , Carcinoma, Squamous Cell/pathology , Lymph Nodes/pathology , Uterine Cervical Neoplasms/pathology , Adenocarcinoma/diagnosis , Adult , Aged , Carcinoma, Adenosquamous/diagnosis , Carcinoma, Squamous Cell/diagnosis , False Negative Reactions , Female , Humans , Lymph Node Excision , Lymphatic Metastasis , Middle Aged , Neoplasm Micrometastasis , Neoplasm Staging , Pelvis , Sensitivity and Specificity , Sentinel Lymph Node Biopsy , Tumor Burden , Uterine Cervical Neoplasms/diagnosis
4.
Klin Onkol ; 30(6): 420-425, 2017.
Article in Czech | MEDLINE | ID: mdl-29271212

ABSTRACT

BACKGROUND: Axillary dissection (AD) is an integral part of the surgical staging of breast cancer. This operation can be source of major long term complications, e. g., lymphedema. Reducing the radicality of these operations has been the subject of many clinical trials, especially those addressing the metastatic infiltration of axillary lymph nodes uncovered either by clinical staging or by sentinel lymph node (SLN) biopsy (when the clinical staging was negative). Exact clinical (mainly ultrasonographic) staging and marking of the lymph nodes detected by staging plays a key role in deciding the optimum clinical regimen. PURPOSE: Three possibilities were tested in clinical trials: The possibility of replacing the AD by radiotherapy in the case of tumorous infiltration of SLN, when clinical staging was negative; the possibility of omitting AD (in patients with positive clinical axillary staging) and replacing it with SLN biopsy after neoadjuvant chemotherapy; and the possibility of marking lymph nodes in axilla that were suspected of infiltration at the time of clinical staging. RESULTS: The studies showed clear evidence that avoiding AD was safe in oncology patients who showed infiltration of axillary SLN and negative clinical staging. Despite the high false negativity of using SLN biopsies in patients with a positive clinical staging after neoadjuvant chemotherapy, this false negativity could be reduced by using lymph node marking. By implementing these methods, it should be possible to define exactly the group of patients in whom complete pathological remission occurs after neoadjuvant chemotherapy.Key words: breast neoplasms - axilla - lymph nodes The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 17. 4. 2017Accepted: 2. 7. 2017.


Subject(s)
Breast Neoplasms/pathology , Lymph Node Excision/methods , Lymphatic Metastasis/diagnosis , Neoplasm Staging/methods , Axilla , Breast Neoplasms/surgery , Clinical Trials as Topic , Female , Humans , Sentinel Lymph Node Biopsy
5.
Rozhl Chir ; 96(8): 328-333, 2017.
Article in Czech | MEDLINE | ID: mdl-29058922

ABSTRACT

INTRODUCTION: Genetic mutations are responsible for 5-10% of all breast and ovarian carcinomas, while most of them are caused by a mutation of the BRCA gene. Women with this type of mutation have a lifetime risk of breast and ovarian cancer and therefore, they require very intensive medical care, including surgical prevention. Specifically, prophylactic bilateral mastectomy and prophylactic salpingo-oophorectomy are done, which undoubtedly decrease the riskof cancer. The aim of this review article is to inform healthcare professionals and the general public about the satisfaction of BRCA positive women with their decision to undergo these prophylactic surgeries, and also about the impact of these procedures on sexuality, menopausal symptoms, mental health and the overall quality of life. METHODS: Search of original studies and review articles onthe influence of prophylactic surgeries on the life of women with BRCA genemutation. RESULTS: In general, although some changes are observed after the prophylactic surgeries, the overall quality of life does not change. A significant reduction in anxiety and fear of cancer is observed after both prophylactic bilateral mastectomy andprophylactic bilateral salpingo-oophorectomy, providing great psychological relief to the affected women. However, prophylactic bilateral salpingo-oophorectomy causes premature menopause in premenopausal women at the time of surgery and the associated occurrence of menopausal symptoms. Some of the symptoms can be significantly reduced by hormone replacement therapy but will not be eliminated altogether. In postmenopausal women, no or minimal worsening of menopausal symptoms was reported. After prophylactic bilateral mastectomy, particularly appearance-related problems were observed. In both types of surgery, sexual problems were also observed. CONCLUSION: The relief of reducingthe risk of cancerappears to be so great and so important for women that it outweighs the other negative effects of these prophylactic procedures.Key words: BRCA1/2 mutation - breast cancer - ovarian cancer - prophylactic bilateral salpingo-oophorectomy - prophylactic bilateral mastectomy.


Subject(s)
Breast Neoplasms , Genes, BRCA1 , Genes, BRCA2 , Prophylactic Mastectomy , Breast Neoplasms/genetics , Breast Neoplasms/prevention & control , Breast Neoplasms/surgery , Female , Humans , Mutation , Personal Satisfaction , Quality of Life
6.
Ceska Gynekol ; 81(3): 192-201, 2016.
Article in Czech | MEDLINE | ID: mdl-27882762

ABSTRACT

OBJECTIVE: To determine the effect of antepartal methods on the prevention of birth injuries in primiparous women. DESIGN: Retrospective study. SETTING: Nemocnice Ceský Krumlov, a.s. METHODS: Between February 2014 and November 2015 were 315 primiparous women questioned after a vaginal delivery on the use of methods of birth injury prevention (vaginal dilatators EPI-NO and Aniball, perineal massage, natural methods - raspberry-leaf tea or linseed). Consecutively, the rates of intact perineum, perineal tears and episiotomies among respective methods were compared with the control group using no preventive method. The effects of the methods were tested on the occurrence of spontaneous or vaginal operative delivery. RESULTS: There was a significantly higher number of women with intact perineum after the use of vaginal dilatators (43.1% vs.14.1% in control group (p < 0.001). We also found a significant reduction of episiotomies in this group (29.3% vs. 57.7%, p < 0.001). There was no significant effect of perineal massage, raspberry-leaf tea or linseed on perineum injury prevention. A lower occurrence of vaginal operative delivery was also confirmed in the group of women using vaginal dilatators (p = 0.02). CONCLUSION: Significant benefit of the use of the antepartal vaginal dilatators in the reduction of birth injuries was shown as well as of the occurrence of vaginal operative delivery.


Subject(s)
Complementary Therapies/methods , Delivery, Obstetric/adverse effects , Episiotomy , Perineum/injuries , Prenatal Care/methods , Adult , Dilatation , Female , Humans , Massage , Pregnancy , Retrospective Studies , Vagina
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