Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 28
Filter
1.
Gynecol Oncol ; 157(1): 78-84, 2020 04.
Article in English | MEDLINE | ID: mdl-32131977

ABSTRACT

OBJECTIVE: The French national rare gynecological tumor network has been established to improve the quality of care through offering expertise in double reading histological diagnosis, reviewing cases and guiding management of these tumors through specialized multidisciplinary tumor boards and online clinical guidelines (www.ovaire-rare.com). The aim of this study is to evaluate the impact of the development and implementation of this network by assessing the conformity of medical practice with the guidelines concerning the granulosa cell tumors (GCTs). METHODS: This is a French nationwide study, including 463 patients (out of the 639 identified patients) with a definitive diagnosis of GCT between 2011 and 2016. Surgical practices were analyzed for conformity with the current guidelines (www.ovaire-rare.org). Medical records, surgical and pathological reports were systematically analyzed. Total conformity was defined by a conservative (unilateral salpingo-oophorectomy) or radical surgery (hysterectomy and bilateral salpingo-oophorectomy) including surgical staging (omentectomy, peritoneal biopsies and peritoneal cytology) according to the FIGO stage. Partial conformity referred to a conservative or radical surgery without surgical staging and non-conformity was defined as a non-optimal surgery as recommended by the guidelines. RESULTS: Median age at diagnosis was 49 years old (range 10-89). The median size of tumor was 94 mm (range 5-400). Radical surgery was performed in 240 patients (52%); while a fertility-sparing surgery was performed in 98 cases (21%). A surgical staging was performed in 76 cases (16%) and an evaluation of the endometrium in 289 cases (62%). Surgery was fully compliant with the guidelines in 65 patients (14%), partially compliant in 213 patients (46%), non-compliant in 137 patients (30%) and not assessable in 48 cases (10%). A statistically significant difference for compliance was observed in restaging surgery (p < 0,001), radical surgery (p = 0,017) and the period (before or after) of the implementation of the network (p < 0,001). Survival analyses did not allow us to demonstrate a significant difference in overall survival nor in PFS although there was a trend in favor of optimal surgery compared to incomplete/non optimal surgery. CONCLUSION: Surgical management's conformity to the guidelines increases over time from 2011 to 2016. According to this study, the implementation of a national network dedicated to rare gynecologic tumors seems to significantly improve the surgical management of the patients with ovarian granulosa cell tumors.


Subject(s)
Granulosa Cell Tumor/diagnosis , Granulosa Cell Tumor/surgery , Gynecologic Surgical Procedures/standards , Ovarian Neoplasms/diagnosis , Ovarian Neoplasms/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Child , Cohort Studies , Female , France/epidemiology , Granulosa Cell Tumor/mortality , Guideline Adherence , Gynecologic Surgical Procedures/methods , Gynecologic Surgical Procedures/statistics & numerical data , Humans , Middle Aged , Neoplasm Staging , Ovarian Neoplasms/mortality , Rare Diseases/diagnosis , Rare Diseases/surgery , Retrospective Studies , Young Adult
2.
Ann Oncol ; 30(5): 845-852, 2019 05 01.
Article in English | MEDLINE | ID: mdl-30851097

ABSTRACT

BACKGROUND: Few data are available on long-term fatigue (LTF) and quality of life (QoL) among epithelial ovarian cancer survivors (EOCS). In this case-control study, we compared LTF, symptoms and several QoL domains in EOCS relapse-free ≥3 years after first-line treatment and age-matched healthy women. PATIENTS AND METHODS: EOCS were recruited from 25 cooperative GINECO centers in France. Controls were randomly selected from the electoral rolls. All participants completed validated self-reported questionnaires: fatigue (FACIT-F), QoL (FACT-G/O), neurotoxicity (FACT-Ntx), anxiety/depression (HADS), sleep disturbance (ISI), and physical activity (IPAQ). Severe LTF (SLTF) was defined as a FACIT-F score <37/52. Univariate and multivariate logistic regressions were conducted to analyze SLTF and its influencing factors in EOCS. RESULTS: A total of 318 EOCS and 318 controls were included. EOCS were 63-year-old on average, with FIGO stage I/II (50%), III/IV (48%); 99% had received platinum and taxane chemotherapy, with an average 6-year follow-up. There were no differences between the two groups in socio-demographic characteristics and global QoL. EOCS had poorer FACIT-F scores (40 versus 45, P < 0.0001), lower functional well-being scores (18 versus 20, P = 0.0002), poorer FACT-O scores (31 versus 34 P < 0.0001), and poorer FACT-Ntx scores (35 versus 39, P < 0.0001). They also reported more SLTF (26% versus 13%, P = 0.0004), poorer sleep quality (63% versus 47%, P = 0.0003), and more depression (22% versus 13%, P = 0.01). Fewer than 20% of EOCS and controls exercised regularly. In multivariate analyses, EOCS with high levels of depression, neurotoxicity, and sleep disturbance had an increased risk of developing SLTF (P < 0.01). CONCLUSION: Compared with controls, EOCS presented similar QoL but persistent LTF, EOC-related symptoms, neurotoxicity, depression, and sleep disturbance. Depression, neuropathy, and sleep disturbance are the main conditions associated with severe LTF.


Subject(s)
Cancer Survivors/statistics & numerical data , Carcinoma, Ovarian Epithelial/epidemiology , Fatigue/epidemiology , Ovarian Neoplasms/epidemiology , Quality of Life/psychology , Adult , Aged , Aged, 80 and over , Anxiety/epidemiology , Anxiety/etiology , Carcinoma, Ovarian Epithelial/physiopathology , Carcinoma, Ovarian Epithelial/psychology , Carcinoma, Ovarian Epithelial/therapy , Case-Control Studies , Combined Modality Therapy , Cross-Sectional Studies , Depression/epidemiology , Depression/etiology , Fatigue/etiology , Female , France/epidemiology , Humans , Middle Aged , Ovarian Neoplasms/physiopathology , Ovarian Neoplasms/psychology , Ovarian Neoplasms/therapy , Surveys and Questionnaires , Young Adult
4.
Ann Oncol ; 29(8): 1784-1792, 2018 08 01.
Article in English | MEDLINE | ID: mdl-29767688

ABSTRACT

Background: Niraparib is a poly(ADP-ribose) polymerase inhibitor approved in the USA and Europe for maintenance treatment of adult patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer who are in complete or partial response to platinum-based chemotherapy. In the pivotal ENGOT-OV16/NOVA trial, the dose reduction rate due to treatment-emergent adverse event (TEAE) was 68.9%, and the discontinuation rate due to TEAE was 14.7%, including 3.3% due to thrombocytopenia. A retrospective analysis was carried out to identify clinical parameters that predict dose reductions. Patients and methods: All analyses were carried out on the safety population, comprising all patients who received at least one dose of study drug. Patients were analyzed according to the study drug consumed (i.e., as treated). A predictive modeling method (decision trees) was used to identify important variables for predicting the likelihood of developing grade ≥3 thrombocytopenia within 30 days after the first dose of niraparib and determine cut-off points for chosen variables. Results: Following dose modification, 200 mg was the most commonly administered dose in the ENGOT-OV16/NOVA trial. Baseline platelet count and baseline body weight were identified as risk factors for increased incidence of grade ≥3 thrombocytopenia. Patients with a baseline body weight <77 kg or a baseline platelet count <150 000/µl in effect received an average daily dose ∼200 mg (median = 207 mg) due to dose interruption and reduction. Progression-free survival in patients who were dose reduced to either 200 or 100 mg was consistent with that of patients who remained at the 300 mg starting dose. Conclusions: The analysis presented suggests that patients with baseline body weight of <77 kg or baseline platelets of <150 000/µl may benefit from a starting dose of 200 mg/day. ClinicalTrials.gov ID: NCT01847274.


Subject(s)
Indazoles/administration & dosage , Neoplasm Recurrence, Local/drug therapy , Ovarian Neoplasms/drug therapy , Piperidines/administration & dosage , Poly(ADP-ribose) Polymerase Inhibitors/administration & dosage , Thrombocytopenia/epidemiology , Administration, Oral , Adult , Body Weight , Dose-Response Relationship, Drug , Female , Humans , Incidence , Indazoles/adverse effects , Maintenance Chemotherapy/adverse effects , Maintenance Chemotherapy/methods , Neoplasm Recurrence, Local/blood , Neoplasm Recurrence, Local/mortality , Ovarian Neoplasms/blood , Ovarian Neoplasms/mortality , Piperidines/adverse effects , Platelet Count , Poly(ADP-ribose) Polymerase Inhibitors/adverse effects , Progression-Free Survival , Retrospective Studies , Risk Factors , Thrombocytopenia/blood , Thrombocytopenia/chemically induced
5.
Ann Oncol ; 29(3): 737-743, 2018 03 01.
Article in English | MEDLINE | ID: mdl-29267856

ABSTRACT

Background: Health-related quality of life (HRQoL) was a secondary end point in AGO-OVAR 16, which randomized 940 patients with EOC after first-line chemotherapy to maintenance pazopanib (PZ) or placebo (P). Additional post hoc analyses were carried out to investigate additional patient-centered end points. Patients and methods: HRQoL was measured with EORTC-QLQ-C30, QLQ-OV28 and EQ-5D-3L. Pre-specified end points included mean differences in HRQoL between treatment arms. Exploratory analyses included quality-adjusted progression-free survival (QAPFS), impact of specific symptoms and progressive disease (PD) on HRQoL and time to second-line chemotherapy. The objective was to provide clinical perspective to the significant median PFS gain of 5.6 months with PZ. Results: There were statistically significant differences between PZ and P in QLQ-C30 global health status [5.5 points; 95% confidence interval (CI), 0.7-10.4, P = 0.024] from baseline to 25 months, but not EQ-5D-3L (0.018 points; 95% CI - 0.033 to 0.069, P = 0.485). The impact of diarrhea was captured in QLQ-OV28 Abdominal/GI-Symptoms scale (8.1 points; 95% CI 3.6-12.5, P = 0.001). QAPFS was 386 days (95% CI 366-404 days) with PZ versus 359 days (95% CI 338-379 days) with placebo (P = 0.052). PD was associated with a decline in HRQoL (P < 0.0001). Median time to second-line chemotherapy was 19.7 months with PZ and 15.0 months with P [hazard ratio (HR) 0.72, 95% CI 0.69-0.86, P = 0.0001]. Conclusions: There were small to no significant mean score differences in global HRQoL and EQ5D-3L between PZ and placebo, respectively, despite the increased toxicity of PZ. Exploratory end points including QAPFS, impact of specific symptoms on HRQoL during treatment and at PD help place the PFS gain with PZ in context and interpret the results. Additional patient-centered end points should be considered in trials of maintenance therapy in EOC beyond mean differences in HRQoL scores alone, to support the benefit to patients of prolongation of PFS. Clinical Trials Registration Number: NCT00866697.


Subject(s)
Antineoplastic Agents/adverse effects , Carcinoma, Ovarian Epithelial/drug therapy , Maintenance Chemotherapy/adverse effects , Ovarian Neoplasms/drug therapy , Pyrimidines/adverse effects , Quality of Life , Sulfonamides/adverse effects , Adult , Angiogenesis Inhibitors/adverse effects , Double-Blind Method , Female , Humans , Indazoles , Maintenance Chemotherapy/methods , Middle Aged , Neoplasm Recurrence, Local/drug therapy , Patient Reported Outcome Measures , Progression-Free Survival , Time-to-Treatment
6.
Br J Cancer ; 116(3): 303-309, 2017 01.
Article in English | MEDLINE | ID: mdl-28072765

ABSTRACT

Backround:Patients with metastatic endometrial carcinoma have a poor prognosis and PIK3CA mutations and amplifications are common in these cancers. This study evaluated the efficacy and safety of the pure PI3K inhibitor BKM120 in advanced or recurrent endometrial carcinoma. METHODS: This phase II, multicentre, single-arm, double strata (histological low grade (LG) or high grade (HG)) open-label study enrolled patients with histologically confirmed advanced or recurrent endometrial carcinoma who had received not more than one prior chemotherapy regimen. Patients received initially BKM120 100 mg tablets once daily. Primary end points were proportion of patients free of progression at 2 months (HG strata) or at 3 months (LG strata), objective response rate (ORR), and safety. RESULTS: A total of 40 patients were enrolled, of whom 16 patients had received BKM120 at 100 mg. Because of high toxicities (cutaneous rash (54%), depressive events (47%), and anxiety (40%), the IDMC has proposed to stop recruitment at 100 mg and to continue the clinical trial with a lower dose of 60 mg per day. In addition, 24 patients (median age 67 years old) were newly enrolled (14 in the LG strata and 10 in the HG strata). Rate of nonprogression at 2 months in the HG strata was 70% and at 3 months was 60% in the LG strata. Median progression-free survival (PFS) for all patients is 4.5 months (CI 95% 2.8-6.1), and the median PFS for LG strata is 8.3 months compared with 3.8 months for the HG strata. No response was reported. At 60 mg per day, the most commonly reported treatment-related adverse events (AEs) were hyperglycaemia (58%), cognitive (31%), digestive (28%), hepatic liver functions (26%), and rash (23%). The most commonly reported treatment-related grade ⩾3 AEs were HTA (17%), hyperglycaemia (17%), and increased alanine aminotransferase (24%). Five patients (21%) stopped BKM120 for toxicity. CONCLUSIONS: The BKM120 was associated with an unfavourable safety profile and minimal antitumour activity in monotherapy in advanced or recurrent endometrial carcinoma. The clinical trial was stopped before end of recruitment for toxicity.


Subject(s)
Aminopyridines/therapeutic use , Antineoplastic Agents/therapeutic use , Carcinoma, Endometrioid/drug therapy , Endometrial Neoplasms/drug therapy , Morpholines/therapeutic use , Aged , Aged, 80 and over , Carcinoma, Endometrioid/pathology , Chemotherapy, Adjuvant , Disease Progression , Endometrial Neoplasms/pathology , Female , Humans , Middle Aged , Neoplasm Recurrence, Local/pathology , Phosphoinositide-3 Kinase Inhibitors , Recurrence , Treatment Outcome
7.
Ann Oncol ; 25(11): 2191-2196, 2014 Nov.
Article in English | MEDLINE | ID: mdl-25210017

ABSTRACT

BACKGROUND: Lenalidomide has dual antiangiogenic and immunomodulatory properties and confirmed antitumor activity in hematologic malignancies. A phase II study investigating the safety and efficacy of continuous lenalidomide in recurrent ovarian cancer patients was initiated. PATIENTS AND METHODS: Patients with histologically confirmed epithelial ovarian, fallopian tube or primary peritoneal carcinoma, with asymptomatic recurrence 6 months after prior therapy were treated with continuous oral lenalidomide (20 mg/day). The primary end point was to evaluate efficacy according to the rate of disease control at 4 months. Secondary objectives were progression-free survival (PFS) and safety. RESULTS: Most of the 45 patients enrolled and treated had serous histology (78%) and a single line of prior chemotherapy (73%). Median platinum-free interval (PFI) was 11.3 months (range 6.9-56.8). Clinical benefit at 4 months was 38% [95% confidence interval (CI) 23% to 53%]. A 59% disease control rate was reported in patients with a PFI >12 months versus 24% with PFI of 6-12 months (P = 0.023). Four patients had RECIST partial responses and 21 had stable disease. CA125 responses were reported in eight patients, including one complete response. Median PFS was 3.4 months (95% CI 2.4-4.4). Most frequent toxicity was hematologic, notably grade 3-4 neutropenia in 29% of patients, along with fatigue (69%), gastrointestinal toxicity (constipation 53%, abdominal pain 49%, diarrhea 38%, nausea/vomiting 36%) and thrombosis (11%). Eight patients withdrew due to related toxicity. CONCLUSIONS: Lenalidomide shows interesting efficacy in late recurrent ovarian cancer patients. Toxicity was mainly hematologic, gastrointestinal and venous thrombosis. Future studies will evaluate combination of lenalidomide with chemotherapy agents. CLINICALTRIALSGOV: NCT01111903.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Neoplasm Recurrence, Local/drug therapy , Neoplasms, Glandular and Epithelial/drug therapy , Ovarian Neoplasms/drug therapy , Thalidomide/analogs & derivatives , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/adverse effects , CA-125 Antigen/blood , Carcinoma, Ovarian Epithelial , Disease-Free Survival , Drug-Related Side Effects and Adverse Reactions/pathology , Fallopian Tube Neoplasms , Female , Humans , Lenalidomide , Membrane Proteins/blood , Middle Aged , Neoplasm Recurrence, Local/chemically induced , Neoplasm Recurrence, Local/pathology , Neoplasm Staging , Neoplasms, Glandular and Epithelial/blood , Neoplasms, Glandular and Epithelial/pathology , Ovarian Neoplasms/blood , Ovarian Neoplasms/pathology , Platinum/adverse effects , Thalidomide/administration & dosage , Thalidomide/adverse effects
8.
J Gynecol Obstet Biol Reprod (Paris) ; 40(6): 514-21, 2011 Oct.
Article in French | MEDLINE | ID: mdl-21807469

ABSTRACT

PURPOSE: An update on the management of invasive cervical cancer (from stage IB) diagnosed during pregnancy with reference to the recent French guidelines. PATIENTS AND METHODS: We retrospectively analyzed patients for whom invasive cervical cancer was diagnosed during pregnancy and managed jointly by Jeanne-de-Flandres and Roubaix maternity and by Oscar-Lambret cancer center between 2002 and 2009. RESULTS: Five patients were included: four stage IB1, and one stage IB2. Five pregnancies resulted in the birth of six alive children. Three patients received neoadjuvant chemotherapy during pregnancy. One patient had a laparoscopic pelvic lymphadenectomy in first trimester. Two laparoscopic extraperitoneal paraortic lymphadenectomy have been made. The mean time of survey is 47.5 months (12-94 months). One patient died of her cancer. CONCLUSION: The diagnosis of cervical cancer during pregnancy involves the same therapeutic guidelines in the absence of pregnancy. The laparoscopic pelvic lymphadenectomy (up to 20 to 24 weeks of gestation) is crucial in the therapeutic treatment for tumors less than 4cm. Neoadjuvant chemotherapy is used during pregnancy for patients refusing medical termination of pregnancy.


Subject(s)
Carcinoma, Squamous Cell/therapy , Guideline Adherence , Neuroendocrine Tumors/therapy , Pregnancy Complications, Neoplastic/therapy , Uterine Cervical Neoplasms/therapy , Carcinoma, Squamous Cell/pathology , Disease Progression , Female , France , Guideline Adherence/statistics & numerical data , Humans , Infant, Newborn , Neoplasm Invasiveness , Neoplasm Staging , Neuroendocrine Tumors/pathology , Practice Guidelines as Topic , Pregnancy , Pregnancy Complications, Neoplastic/pathology , Pregnancy Outcome , Pregnancy, Twin/physiology , Time Factors , Uterine Cervical Neoplasms/pathology
9.
Bull Cancer ; 96(12): 1199-205, 2009 Dec.
Article in French | MEDLINE | ID: mdl-19948448

ABSTRACT

Upper abdomen cytoreduction is an important and challenging surgery that should be considered only if a macroscopically complete cytoreduction is expected. Techniques of the main procedures are addressed herein, as well as their respective morbidity and indications. Given its complexity, this surgery should be reserved to specialized teams, working in specialized centers.


Subject(s)
Liver Neoplasms/surgery , Ovarian Neoplasms/surgery , Pancreatectomy/methods , Peritoneal Neoplasms/surgery , Splenectomy/methods , Female , Humans , Liver Neoplasms/secondary , Neoplasm, Residual , Ovarian Neoplasms/pathology , Pancreatectomy/adverse effects , Peritoneal Neoplasms/secondary , Peritoneum/surgery , Splenectomy/adverse effects
10.
Cancer Radiother ; 13(6-7): 511-4, 2009 Oct.
Article in French | MEDLINE | ID: mdl-19717325

ABSTRACT

The treatment of advanced cervix is concomitant radiochemotherapy. Local prognosis and global survival depend on tumoral volume, locoregional extension and radio sensitivity of the lesion. This one is function of tumoral hypoxia, tumoral interstitial pressure and existence of an anaemia. DCE-MRI allows to quantify pilot vascular parameters of the first two factors. Combined analysis: tumoral volume, anaemia and vascular parameters before and in the course of treatment allows a strong correlation with the risk of local recurrence and global survival.


Subject(s)
Diffusion Magnetic Resonance Imaging/methods , Magnetic Resonance Imaging/methods , Uterine Cervical Neoplasms/drug therapy , Uterine Cervical Neoplasms/radiotherapy , Adult , Anemia/complications , Anemia/epidemiology , Combined Modality Therapy , Europe/epidemiology , Female , Humans , Incidence , Neoplasm Recurrence, Local/drug therapy , Neoplasm Recurrence, Local/epidemiology , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/surgery , Neovascularization, Pathologic/epidemiology , Predictive Value of Tests , Prognosis , Risk Factors , Spin Labels , Uterine Cervical Neoplasms/pathology
11.
Ann Oncol ; 18(12): 1985-9, 2007 Dec.
Article in English | MEDLINE | ID: mdl-17761699

ABSTRACT

BACKGROUND: The evaluation of first-line intensive combination therapy in small cell carcinoma of the ovary (SCCO). PATIENTS AND METHODS: Debulking surgery; four to six cycles of chemotherapy with cisplatin (P) 80 mg/m(2) day 1, adriamycin (A) 40 mg/m(2) day 1, vepeside (V) 75 mg/m(2)/day days 1-3, cyclophosphamide (EP) 300 mg/m(2)/day days 1-3, every 3 weeks and granulocyte colony-stimulating factor with, in case of a complete remission, high-dose chemotherapy with carboplatin, vepeside, cyclophosphamide and stem-cell support. RESULTS: Twenty-seven patients (median age 25 years); International Federation of Gynecology and Obstetrics stage: five I, four IIC, 17 IIIC-IV and one unknown. Twenty patients underwent complete surgery. Eight patients progressed under chemotherapy. Among 18 patients in complete response (CR), 10 received high-dose chemotherapy (CT) (three stem-cell collection failures, two protocol violations, two disease progression and one refusal). The main grade 3-4 toxic effects were hematologic. There were eight relapses among the 18 CR, four of which were pelvic alone. Among the 27 patients, 13 died and 10 patients are in CR1, three in CR2. The median follow-up is 37 months (8-166) and the median duration of the 18 CR is 30 months (5-111). Overall survival at 1 and 3 years is 58% [confidence interval (CI) 40% to 75%] and 49% (CI 30% to 67%). CONCLUSIONS: Initial dose-intensive therapy achieves interesting overall survival in SCCO.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Small Cell/drug therapy , Hypercalcemia/complications , Ovarian Neoplasms/drug therapy , Adolescent , Adult , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Carcinoma, Small Cell/complications , Child , Dose-Response Relationship, Drug , Female , Humans , Ovarian Neoplasms/complications , Prospective Studies , Treatment Outcome
13.
Gynecol Obstet Fertil ; 34(9): 716-9, 2006 Sep.
Article in French | MEDLINE | ID: mdl-16971152

ABSTRACT

Gestational choriocarcinoma is a rare malignant tumour with a strong metastatic potential. We report a case of a 31-year-old patient with a gestational trophoblastic tumor revealed by renal and pulmonary metastases, one year after a normal pregnancy. The diagnosis was established by the pathologist on the radical nephrectomy specimen. The evolution was quickly favorable after adequate treatment using multiagent chemotherapy. This case highlights the polymorphic aspects of the gestational choriocarcinoma and stresses the importance of a betaHCG assessment anytime abnormal symptoms occur in the outcome of a pregnancy.


Subject(s)
Choriocarcinoma/diagnosis , Uterine Neoplasms/diagnosis , Adult , Choriocarcinoma/pathology , Choriocarcinoma/secondary , Chorionic Gonadotropin, beta Subunit, Human/blood , Female , Humans , Kidney Neoplasms/diagnosis , Kidney Neoplasms/drug therapy , Kidney Neoplasms/secondary , Lung Neoplasms/diagnosis , Lung Neoplasms/drug therapy , Lung Neoplasms/secondary , Magnetic Resonance Imaging , Pregnancy , Uterine Neoplasms/pathology
14.
Semin Surg Oncol ; 19(1): 36-41, 2000.
Article in English | MEDLINE | ID: mdl-10883022

ABSTRACT

Early stage epithelial ovarian carcinoma is defined pathologically as a tumor strictly limited to one or both ovaries without any extra-ovarian disease (i.e., Stage IA or B of the International Federation of Gynecology and Obstetrics (FIGO) classification). This diagnosis can be obtained only after an exhaustive surgical staging procedure, performed as soon as the diagnosis of epithelial invasive ovarian carcinoma is established. This staging surgery currently encompasses a peritoneal cytology, the thorough inspection of all the visceral and parietal peritoneal surfaces with biopsy of any abnormality, total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH + BSO), random peritoneal biopsies, omentectomy, appendectomy and bilateral pelvic and para-aortic lymphadenectomies, up to the left renal vein. The results of this staging procedure and its indications are discussed. In all of the cases, the radical removal of the pathologic adnexa is indicated, along with the complete peritoneal and retroperitoneal staging. While fertility-sparing surgery (avoiding hysterectomy and contralateral adnexectomy, if possible) seems to be safe for young women, a TAH + BSO is the rule for the others. Adjuvant chemotherapy can be omitted in well-differentiated tumors with a negative staging operation, but currently it remains indicated in all other cases. Indeed, the ultimate goal in early stage ovarian carcinoma is to not impair by inadequate management the high chance of a cure.


Subject(s)
Carcinoma/pathology , Carcinoma/surgery , Ovarian Neoplasms/pathology , Ovarian Neoplasms/surgery , Female , Humans , Laparoscopy , Laparotomy , Lymphatic Metastasis , Neoplasm Invasiveness , Neoplasm Staging , Reoperation
15.
Cancer Radiother ; 4(2): 113-21, 2000.
Article in French | MEDLINE | ID: mdl-10812356

ABSTRACT

At the turn of this century, the evidence of the benefits of a concurrent chemo-radiotherapy in locally advanced tumors and the development of mini-invasive surgery (laparoscopic and radical vaginal surgery) are the two main advances in the management of cervical carcinomas. From a personal experience of 304 cervical carcinomas, the different techniques of laparoscopy used in cervical carcinomas are addressed and discussed. Their long-term results when involved in the management protocols of cervical carcinomas at different stages are reported. From this series, some conclusions are drawn: 1) laparoscopy can spare a laparotomy in early-stage node-negative patients with low tumoral volume; 2) it can spare a systematic extended-field radiation therapy in high-risk patients with node-negative para-aortic exploration; 3) it can spare surgery in patients with a centro-pelvic advanced stage or recurrence, possibly candidates for an exenterative procedure, if occult spread is found in the intra- or retroperitoneal areas. The more and more frequent combination of the mini-invasive surgery for staging and treatment and radiotherapy or chemotherapy explains the need for new protocols of a more and more complex and specialized management.


Subject(s)
Adenocarcinoma/surgery , Carcinoma, Adenosquamous/surgery , Carcinoma, Squamous Cell/surgery , Laparoscopy , Lymph Node Excision , Uterine Cervical Neoplasms/surgery , Adenocarcinoma/drug therapy , Adenocarcinoma/mortality , Adenocarcinoma/radiotherapy , Adult , Antineoplastic Agents/therapeutic use , Carcinoma, Adenosquamous/drug therapy , Carcinoma, Adenosquamous/mortality , Carcinoma, Adenosquamous/radiotherapy , Carcinoma, Squamous Cell/drug therapy , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/radiotherapy , Chemotherapy, Adjuvant , Cisplatin/therapeutic use , Combined Modality Therapy , Female , Humans , Hysterectomy , Neoplasm Recurrence, Local/surgery , Ovary/surgery , Probability , Prognosis , Radiotherapy, Adjuvant , Survival Analysis , Time Factors , Uterine Cervical Neoplasms/drug therapy , Uterine Cervical Neoplasms/mortality , Uterine Cervical Neoplasms/radiotherapy
17.
Bull Cancer ; 82(11): 975-80, 1995 Nov.
Article in French | MEDLINE | ID: mdl-8535025

ABSTRACT

We performed a retrospective analysis on all head and neck cancers with hypercalcemia seen between January 1988 and June 1993 at the Centre Oscar-Lambret, cancer center of northern France. Hypercalcemia, non albumin-corrected, higher than 2.60 mmol/l was observed in 173 of 3,394 consecutive patients (5%). Median age of patients with hypercalcemia was 53 years and 97% of these patients were males. All patients with hypercalcemia had advanced or recurrent and/or metastatic squamous cell carcinoma of head and neck (SCCHN); 31 of them were not pretreated. There was no significant difference in histology between patients with or without hypercalcemia, but hypercalcemia was most commonly associated with lesions of the oropharynx (p = 0.00001). The median of calcemia was of 2.83 mmol/l (2.61-4.70). Gastrointestinal and neurologic symptoms respectively occurred in 24% and in 14% of patients and bone metastases in 25% of patients. Median survival after the first determination of hypercalcemia was of 7 weeks (0-128) for the overall group of 173 patients and of 12 weeks (1-128) for those 31 patients with hypercalcemia at initial diagnosis. Prognosis associated factors were: efficacy of antitumour treatment, performance status and hypercalcemia superior or not to 3 mmol/l. We concluded that hypercalcemia in head and neck cancer is usually a late manifestation associated with advanced, recurrent and/or metastatic disease and carries a poor prognosis. The prolongation of survival can be obtained in some patients if an effective antitumour treatment is feasible.


Subject(s)
Carcinoma, Squamous Cell/complications , Head and Neck Neoplasms/complications , Hypercalcemia/etiology , Adult , Aged , Bone Neoplasms/secondary , Carcinoma, Squamous Cell/epidemiology , Carcinoma, Squamous Cell/pathology , Female , Head and Neck Neoplasms/epidemiology , Head and Neck Neoplasms/pathology , Humans , Hypercalcemia/epidemiology , Incidence , Male , Middle Aged , Prognosis , Retrospective Studies , Sex Factors , Survival Rate
18.
Article in French | MEDLINE | ID: mdl-2277168

ABSTRACT

We report a case history of a woman of 66 years of age who had a granulocytic sarcoma of the cervix which presented as metrorrhagia and which at first was thought to be an anaplastic cancer. The poor general state of the patient made it impossible to start any anti-leukaemic treatment and the patient died two months after the diagnosis was made. A review of the literature shows that 62 cases of granulocytic sarcoma have been reported of which 22 were in the breast, 19 in the ovary, 13 in the cervix or the uterus, 6 in the vagina and 2 in the vulva. The cells seem to invade the blood and the bone marrow in all occasions by the time of diagnosis or at the most a few weeks later and cases of granulocytic solitary sarcoma are very rare. It blood has not been attacked it is difficult to make a histological diagnosis unless immunological marking and Giemsa staining is carried out together with Leder's reaction. The treatment should be similar to those used for acute myeloid leukaemia.


Subject(s)
Leukemia, Myeloid , Uterine Cervical Neoplasms , Aged , Anaplasia , Breast Neoplasms/pathology , Diagnosis, Differential , Female , Genital Neoplasms, Female/pathology , Humans , Leukemia, Myeloid/pathology , Uterine Cervical Neoplasms/pathology
SELECTION OF CITATIONS
SEARCH DETAIL
...