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The history of lymphatic mapping: a gynecologic perspective
Published in Charles F. Levenback, Ate G.J. van der Zee, Robert L. Coleman, Clinical Lymphatic Mapping in Gynecologic Cancers, 2022
Although Way was incorrect in his assessment, he did make a prophetic plea for the establishment of special treatment centers for patients with vulvar cancer because of its rarity, the difficulty of radical surgery for vulvar cancer, and the need for experienced medical and nursing care. Way foreshadowed both the formation of the subspecialty of gynecologic oncology and the establishment of comprehensive cancer centers.
Uterine Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Claudia von Arx, Hani Gabra, Christina Fotopoulou
Clinical assessment will include abdominal and pelvic examination with speculum to assess cervical and vaginal status, along with transvaginal and transabdominal ultrasound to assess endometrial thickness, uterine size, hydronephrosis, ascites, and concomitant ovarian lesions. A direct biopsy can be taken in the clinic, for example, by pipelle or other commercial aspirators, when the endometrial thickness is greater than 5 mm30; however, the diagnostic efficacy of a pipelle or a solitary biopsy alone can be limited and wrongly negative. In the prospective Gynaecologic Oncology Group (GOG) 167 trial evaluating almost 300 patients, an incidence of 26% of coexistent cancer together with atypical hyperplasia was described in hysterectomy specimens, whereas in 30% of the cases, an upgrading of the initial hyperplasia to cancer occurred. For that reason, fractionated curettage is the gold standard of the diagnostic algorithm of patients with PMB.31
Doctor–patient communication
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
J. Richard Smith, Krishen Sieunarine, Mark Bower, Gary Bradley, Giuseppe Del Priore
In gynecologic oncology, patients face a frightening diagnosis and an uncertain future. It is increasingly recognized that patients wish to know their diagnosis and to be kept informed of the progress of treatment. This has resulted in a revolution in the approach to patient–doctor communication. The era of professional paternalism, protecting patients from the diagnosis and remaining unrealistically optimistic to the dying patient, is over. With this change in approach has come a realization that effective communication skills are not innate, but can be taught, learned, retained, and used to improve patient care. More and more healthcare professionals, including gynecologic oncologists, are receiving training in communication with patients, their families, and other professionals.
The effect of consolidation chemotherapy after concurrent chemoradiation on the prognosis of locally advanced cervical cancer: a systematic review and meta-analysis
Published in Journal of Obstetrics and Gynaecology, 2022
Lan Zhong, Kemin Li, Liang Song, Rutie Yin
Since 1999, Gynaecologic Oncology Group (GOG) five randomised studies showed obvious survival advantage when locally advanced disease (LACC) (2009 FIGO stages IIB to IVA), bulky disease (2009 FIGO stages IB2 and IIA2), and those with risk factors following radical hysterectomy treated with cisplatin-based concurrent chemoradiotherapy (CCRT) compared with radiotherapy alone since chemotherapy acted as a radiation sensitiser due to direct cytotoxicity or inhibition of sub-lethal/lethal radiation-induced damage repair (Keys et al. 1999; Morris et al. 1999; Rose et al. 1999; Whitney et al. 1999; Peters et al. 2000). Then CCRT was recommended as the standard treatment for cervical cancer by the National Cancer Institute (NCI) of the US National Institute of Health. CCRT was also believed to play a role in the control of subclinical metastases because of systemic chemotherapy. Even though, there was still a 20–30% chance of local recurrence (Rose et al. 1999; Whitney et al. 1999), and 18–25% of distant recurrence (Whitney et al. 1999; Eifel et al. 2004) for cervical cancer patients after being treated with CCRT. Aiming to completely eradicate potential undetected micrometastases, consolidation chemotherapy came into the area of interest.
Analysis of the prognostic factors determining the oncological outcomes in patients with high-risk early-stage cervical cancer
Published in Journal of Obstetrics and Gynaecology, 2022
Fatih Kilic, Caner Cakir, Dilek Yuksel, Vakkas Korkmaz, Gunsu Kimyon Comert, Nurettin Boran, Sevgi Koc, Taner Turan, Osman Turkmen
As reported in the present study and the studies mentioned above, the treatment modalities used in early-stage cervical cancer are effective in achieving local disease control but are not effective in controlling distant metastases. This has led to the investigation of different treatment modalities in place of adjuvant RT or CCRT in the presence of high-risk factors. Many studies have argued the addition of adjuvant chemotherapy to RT or CCRT in order to control distant recurrences in the patients with high-risk factors (Sehouli et al. 2012; Takekuma et al. 2017; Cohen et al. 2019). In a randomised and controlled phase III study, Seholi et al. compared sequential chemotherapy (CT; paclitaxel and carboplatin) and RT with CCRT (RT and concomitant cisplatin) in the patients with stage IB-IIB cervical cancer possessing high-risk factors who underwent radical hysterectomy. They reported no survival benefit for sequential CT + RT (p = 0.235) (Sehouli et al. 2012). The studies to date have not clearly demonstrated the superiority and safety of the addition of adjuvant chemotherapyin high-risk patients yet (Sehouli et al. 2012; Takekuma et al. 2017; Cohen et al. 2019). However, Gynaecologic Oncology Group/Radiation Therapy Oncology Group 0724 (NCT00980954) randomised phase III study is proceeding to clarify the role of adjuvant chemotherapy in high-risk early-stage cervical cancer (Radiation Therapy Oncology Group 2019). The results of this phase III study will determine whether chemoradiotherapy followed by adjuvant chemotherapy provides a survival benefit.
Adjuvant chemotherapy in patients with uterine carcinosarcoma: a review of clinical outcomes and considerations
Published in Expert Opinion on Orphan Drugs, 2021
Aiko Ogasawara, Daisuke Shintatni, Sho Sato, Kosei Hasegawa
As this disease is rare, there have been only a limited number of trials for UCS. In particular, few prospective studies have been conducted on UCS only. Phase II and III trials for first-line or adjuvant chemotherapy in patients with UCS are listed in Table 1 and 2. We listed the trials in Table 1 if more than half of the patients in each trial were in advanced or recurrent disease. Trials of adjuvant chemotherapy in early-stage UCS are listed in Table 2. Various chemotherapies have been evaluated for UCS in either advance/recurrent or early-stage diseases. The Gynecologic Oncology Group (GOG) has tested the efficacy of single agent chemotherapy for UCS. Ifosfamide showed the best response rate (RR) (32.2%) as a single agent chemotherapy [24], compared to other drugs, such as paclitaxel (18.2%) [25], cisplatin (18%) [26], ixabepilone (11.8%) [27], doxorubicin (9.8%) [28], topotecan (10%) [29], oral trimetrexate (4.8%) [30], thalidomide (4.4%) [31], and pazopanib (0%) [32] (Table 1). Anastrozole, aromatase inhibitor, for metastatic uterine carcinosarcoma sowed clinical benefit rate of 43% (2/7) [33]. But the duration of benefit remains within 9 months. Ifosfamide was considered as the most active agent for chemotherapy in patients with UCS as such, the trials of combination chemotherapy comprised mainly of ifosfamide containing regimes. For combination therapy without ifosfamide, there was only one phase II trial of gemcitabine plus docetaxel, and the RR was 8.3% for this combination chemotherapy [34] (Table 1).