Cervicouterine Cancer Screening - TruScreen™ vs. Conventional Cytology: Pilot Study.

INTRODUCTION: Cervicouterine cancer (CC) is a health problem worldwide and is the fourth most common cancer in women, with a greater proportion of individuals affected by advanced stages of the disease in developing countries. OBJECTIVE: To determine the sensitivity and specificity of the TruScreen™ opto-electronic device vs. conventional cytology in CC screenings. METHODOLOGY: This is a prospective observational study that included individuals who presented for the first time at the Dysplasia Clinic of the Instituto Nacional de Cancerología from March 1 through April 30, 2016, and those referred due to abnormal conventional cytology. The patients were evaluated with the TruScreen™ device, conventional cytology, colposcopy and, if necessary, cervical biopsy. The results were analyzed by descriptive statistics as well as the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the TruScreen™, using conventional cytology as the standard. RESULTS: Thirty-two patients were included who met the inclusion criteria. The average age of the patients was 40 years (range, 23-61 years). For the diagnosis of high-grade intraepithelial lesions, the TruScreen™ device showed a 43% sensitivity, a 92% specificity, a PPV of 60%, and a NPV of 85%, whereas evaluation via cervical biopsy exhibited a 33% sensitivity, an 86% specificity, a 33% PPV, and an 86% NPV. The Kappa agreement index of the TruScreen™ with the colposcopies was 0.70. CONCLUSIONS: TruScreen™ demonstrated low sensitivity and high specificity compared with conventional cytology, which had a high NPV.

Brachytherapy versus radical hysterectomy after external beam chemoradiation with gemcitabine plus cisplatin: a randomized, phase III study in IB2-IIB cervical cancer patients.

BACKGROUND: The aim of the present study was to demonstrate that radical hysterectomy (RH) leads to improved survival outcomes in FIGO stage IB2-IIB cervical cancer when compared with standard brachytherapy (BCT) after identical external beam chemoradiation (EBRT-CT). PATIENTS AND METHODS: EBRT-CT treatment consisted of six courses of cisplatin at 40 mg/m² and gemcitabine at 125 mg/m² per week concurrent with 50.4 Gy of radiation. In the BCT arm, EBRT-CT was followed by BCT to reach a point A dose of 85 Gy, whereas in the experimental arm, a type III RH with bilateral pelvic lymph node dissection and para-aortic lymph node sampling (RH) was carried out within 4-6 weeks after EBRT-CT. RESULTS: Between May 2004 and June 2009, 211 patients were enrolled (BCT, 100 and RH, 111). At a median follow-up time of 36 months (3-80), progression-free survival (PFS) and overall survival (OS) rates were similar in both the arms. PFS rates were 74.8% and 71.7% in the BCT and RH arms [HR 0.6516 (95% confidence interval (CI) 0.3504-1.2116)], P = 0.186. OS rates were 76.3% in the BCT versus 74.5% in the surgical arm [HR 0.6981 (95% CI 0.3106-1.3439)], P = 0.236. No differences were observed in the pattern of local and systemic failures. CONCLUSIONS: This study failed to demonstrate that RH after EBRT-CT is superior to standard BCT.

A phase II study of multimodality treatment for locally advanced cervical cancer: neoadjuvant carboplatin and paclitaxel followed by radical hysterectomy and adjuvant cisplatin chemoradiation.

BACKGROUND: Our aim was to evaluate the efficacy and safety of neoadjuvant chemotherapy followed by radical hysterectomy and adjuvant radiation concurrent with weekly cisplatin for locally advanced cervical carcinoma. PATIENTS AND METHODS: Forty-three patients staged as IB2-IIIB were treated with three 21-day courses of carboplatin (area under the time-concentration curve 6 mg.min/ml) and paclitaxel at 175 mg/m(2) by 3-h infusion both on day 1 followed by radical type III hysterectomy and adjuvant radiation concurrent with 6-weekly doses of cisplatin at 40 mg/m(2). Response rate, resectability, toxicity and survival were evaluated. RESULTS: From December 2000 to June 2001, 43 patients were recruited. All were evaluated for response and toxicity to neoadjuvant chemotherapy. A total of 129 courses were administered. Clinical responses were seen in 41 patients (95%) [95% confidence interval (CI) 89.2% to 100%] with four (9%) complete and 37 (86%) partial. Forty-one patients underwent surgery (resectability 95%); pathologically complete or near-complete responses were seen in seven (17%) and eight (20%), respectively, positive surgical margins in five (12%), and positive pelvic lymph nodes in eight (20%). Twenty-six patients were scheduled for adjuvant chemoradiation. External radiation was delivered for 42.8 days (range 33-61), with a mean dose of 49.3 Gy (range 46-56), and a median of five cisplatin courses (two to six). The mean dose of brachytherapy was 32 Gy (range 25.5-35.6). Neoadjuvant therapy was well-tolerated with neutropenia grade 3 and 4 in 12% and 3% of the courses, respectively. Toxicity to adjuvant chemoradiation was mainly hematological and gastrointestinal, mostly grades 1/2. A total of 39 patients completed all scheduled treatment. At a median follow-up of 21 months (range 3-26), the projected overall survival in the intention-to-treat analysis was 79% (95% CI 62% to 88%). CONCLUSIONS: The triple modality of neoadjuvant chemotherapy followed by radical hysterectomy and adjuvant radiation concurrent with cisplatin is a highly active treatment for locally advanced cervical carcinoma with acceptable toxicity.

Concomitant chemoradiation versus neoadjuvant chemotherapy in locally advanced cervical carcinoma: results from two consecutive phase II studies.

BACKGROUND: Randomized studies comparing induction chemotherapy followed by surgical resection with radiation alone found that the neoadjuvant approach produces better results. So far, this latter modality has not been compared with standard concomitant chemoradiation. The objective of this report was to compare the results of two consecutive phase II studies: neoadjuvant chemotherapy followed by surgery or chemoradiation for the unresectable cases versus standard cisplatin-based chemoradiation. PATIENTS AND METHODS: From February 1999 to July 1999, 41 patients with cervical carcinoma, stages IB2-IIIB, were treated with neoadjuvant chemotherapy. Treatment consisted of three 21-day courses of cisplatin 100 mg/m(2) on day 1 and gemcitabine 1000 mg/m(2) on days 1 and 8, followed by either surgery or concomitant chemoradiation for the non-operable cases. From August 1999 to December 1999, an equal number of patients having comparable clinicopathological characteristics were treated with six weekly courses of cisplatin 40 mg/m(2) during standard pelvic radiation. RESULTS: A total of 82 patients were analyzed. Both groups were similar with regard to age, histology, International Federation of Gynecology and Obstetrics (FIGO) stage, tumor size, pretreatment hemoglobin levels, parametrial infiltration and performance status. In the neoadjuvant arm the overall response rate to induction chemotherapy was 95% (95% confidence interval 88% to 100%). Twenty-three patients had surgery and 14 underwent chemoradiation. In the definitive chemoradiation study, 38 patients completed treatment, the median number of cisplatin courses was six for a dose intensity of 33 mg/m(2)/week. Doses to points A and B were 85 Gy (range 68-95) and 55 Gy (range 51-65), respectively. Chemoradiation was delivered in 44.6 (range 28-113) days. Complete response rates after all treatment were similar: 97% and 87% in the neoadjuvant and chemoradiation groups, respectively. At a median follow-up of 28 (range 2-33) and 24 (range 3-30) months, respectively, there were no differences in overall survival. To date, 15 and 13 patients in the neoadjuvant and chemoradiation groups, respectively, have died of disease (P = 0.8567). CONCLUSIONS: The results of this non-randomized comparison suggest that induction chemotherapy followed by surgery or chemoradiation is at least as effective in terms of response and survival as standard cisplatin-based chemoradiation. A randomized study is needed to confirm these findings.

[Preliminary experience with the Miami type ileocolonic urinary reservoir in the practice of oncologic gynecology]. / Experiencia preliminar con el reservorio urinario ileocolónico tipo Miami en la práctica de Ginecología Oncológica.

OBJECTIVES: For many years we have used both ileal or colon conduits for urinary diversion during pelvic exenteration. Continent urinary reservoirs have replaced ileal and colon conduits as a method of urinary diversion at our institution. The aim of this study was to review the results and complications associated with continent urinary diversion in patients with gynecologic malignancies. METHODS: We reviewed the records of 26 patients who underwent construction of a continent urinary reservoir (Miami pouch) from February 1991 to June 1994 at the Department of Gynecologic Oncology of the National Cancer Institute of Mexico (Instituto Nacional de Cancerología). Twenty-four of these patients had received radiotherapy for gynecologic malignancies. RESULTS: An ileocolonic continent urinary reservoir (Miami pouch) was created in 26 patients, aged 38-81 years, as part of a concurrent anterior or total pelvic exenteration for primary or recurrent gynecologic malignancies (19 pts.), for the relief of a vesicovaginal fistula (3 pts.), hemorrhagic cystitis (2 pts.), or in substitution of an ileal conduit (2 pts.), with follow-up ranging from 2-54 months. Additional procedures performed concurrently with the Miami pouch and pelvic exenteration included low rectal anastomosis (11 pts.), pelvic floor reconstruction (8 pts.), and vaginal reconstruction (4 pts.). The complications associated with the reservoir included incontinence (1 pt.), ureteral strictures (3 pts.), pouch leakage (1 pt.), difficult self-catheterization (4 pts.), and urosepsis and pyelonephritis (6 pts.). One patient developed pouch stones. In this series, 95.6% of the patients were completely continent. No obstruction or reflux was noted in 92.3% of the cases. Nonsurgical management strategies used for reservoir-related complications included percutaneous nephrostomy, intravenous antibiotics, and percutaneous pouch decompression. Reoperation was required in 5 patients: one patient (early) due to a fistula, another patient required reimplantation due to obstruction, one patient with a nonfunctioning kidney underwent nephrectomy, and two patients with stoma stenosis. CONCLUSIONS: The Miami pouch is a low-pressure continent form of urinary diversion. The continence mechanism is easy to construct and the procedure can successfully be accomplished at the time of pelvic exenteration in patients with gynecologic malignancies. The rate of major complications of the Miami pouch is small and the continent urinary diversion can be undertaken with concurrent low rectal anastomosis or vaginal reconstruction.

[Epidermoid carcinoma originating from a mature cystic ovarian teratoma. Report of two cases and review of the literature]. / Carcinoma epidermoide originado en teratoma quístico maduro de ovario. Informe de dos casos y revisión de la literatura.

The incidence of developing malignancy in a mature cystic teratoma of the ovary is 1-2%. Most of the reported cases occur in postmenopausal women. This paper reports two cases of squamous cell carcinoma arising in a mature cystic teratoma of the ovary of which one occurred in a young woman. In the other case we could support the fact that the carcinomatous component has its origin in the columnar epithelium and epidermis of the teratomatous tissues.