1,721,171 research outputs found
Cervical cancer staging
No full textThe "International Classification of the Stages of Carcinoma of the Uterine Cervix" dates back to 1950; since then, seven changes have been made to the staging system for cervical cancer (almost all were made to Stage I), the most recent being in 1995. The FIGO system of classification of cervical cancer is originally based on the results of clinical examination, essentially of the anatomical extent of disease, and is determined at the time of primary diagnosis. Only if the rules for clinical staging are strictly observed is it possible to compare results using different modalities of treatment. Cervical cancer remains a clinically staged malignancy according to the FIGO staging system. Surgical-pathologic staging would not be feasible for advanced-stage disease or in early-stage patients treated primarily with radiation, especially in nations that do not routinely offer surgical extirpation due to different or limited health care resources. However, surgical and pathological data are important for precise analysis of survival and prognostic risk factors
Surgery of advanced malignant epithelial tumours of the ovary
No full textSurgery is still the cornerstone in the management of advanced epithelial ovarian cancer (AEOC) patients. It involves: i. establishment of diagnosis and staging; ii. primary cytoreduction; iii. interval cytoreduction, interval debulking surgery (IDS) or surgery after neoadjuvant chemotherapy; iv. secondary cytoreduction during the assessment of the status of the disease at the end of primary chemotherapy - second look; v. surgery for recurrence; vi. palliation. Substantial evidence exists to demonstrate that if surgery is performed by gynaecologists with a special training in gynaecological oncology, a survival advantage can be achieved when compared with that obtained when general surgeons are primarily treating AEOC. Primary surgery with diagnostic and cytoreductive intent should be performed in accordance with the European Guidelines of Staging in Ovarian Cancer. Whether or not cytoreduction should systematically include lymphadenectomy is still a controversial issue. The strong correlation between chemosensitivity, successful debulking surgery and survival strongly support the concept that it is the biological characteristic of the disease rather than the aggressiveness of the surgeon to allow a successful cytoreduction to the real optimal disease status. It should be now recognised as the complete absence of disease at the end of the surgical procedure. Both IDS and neoadjuvant chemotherapy represent a strong effort to achieve such a status through less morbidity and a better quality of life for the patient. Surgery for recurrence and palliation need to be optimised both in terms of patient selection and a better integration with chemotherapy and ancillary management
Interval debulking surgery in advanced epithelial ovarian cancer
No full textCytoreductive surgery and chemotherapy are the mainstay for the treatment of advanced epithelial ovarian cancer. In order to minimize the tumour burden before chemotherapy, cytoreductive surgery is usually performed first. The importance of the amount of residual disease as the main prognostic factor for patients suffering from advanced disease has been almost universally accepted even in the absence of prospective randomized trials addressing the benefit of cytoreductive surgery. In the last decade, the value of debulking surgery after induction chemotherapy - interval debulking surgery, IDS - has been widely debated, especially after the completion of a prospective randomized study from the EORTC addressing the introduction of a surgical procedure with debulking intent preceded and followed by cytoreductive chemotherapy. The rationale of such a strategy in the context of the primary treatment of advanced ovarian cancer lies in a higher cytoreductibility to the 'optimal' status forwarded, and possibly facilitated, by chemotherapy. The results demonstrated a prolongation of both progression-free survival and median survival in favour of patients randomized to IDS (5 and 6 months, respectively). Multivariate analysis revealed IDS to be an independent prognostic factor which reduced the risk of death by 33% at 3 years and by 48% in subsequent re-evaluation after more than 6 years of observation. Despite the above, results have been questioned by many, leading the GOG to perform a similar study which has been concluded very recently. Nevertheless, the main concern regarding the application of IDS in all instances relates to the morbidity of two major surgical procedures integrated within a short period during which cytotoxic chemotherapy is also administered. Neoadjuvant chemotherapy has been recently proposed to avoid a non-useful surgical procedure in patients considered 'optimally unresectable' after diagnosis of advanced ovarian cancer. Whether or not this newer approach will translate into a longer survival with a better quality of life is going to be addressed by a novel EORTC study. Finally, the concept of a 'chemical' cytoreduction preceding and facilitating a subsequent 'surgical' effort has been recently introduced also in the treatment of recurrent disease. The EORTC has recently initiated a prospective randomized study (LOROCSON - Late Onset Recurrent Ovarian Cancer: Surgery or Not) to validate the importance of such an approach to be balanced with medical treatment alone not only in terms of survival but also as far as quality of life is concerned
Consolidation therapies revisited: weekly paclitaxel
No full textMost patients with advanced ovarian cancer exhibit clinically relevant objective and subjective responses to platinum/paclitaxel-based combination, which is now considered the standard chemotherapeutic regimen. Unfortunately, responses are generally of limited duration, and long-term disease-free survival is experienced by few patients. Efforts should be taken to maintain such a response as long as possible, where it realistically might be hoped that continuation of chemotherapy could consolidate the absence of clinically detectable disease. In this regard, the administration of paclitaxel on a weekly schedule seems to be particularly attractive, especially after the demonstration that a weekly regimen in heavily pretreated women bearing metastatic breast, head, and neck or lung cancers was proven to be well tolerated without the requirement of granulocyte colony-stimulating factors, with limited neurotoxicity and with substantial anticancer activity, thanks to its pro-apoptotic and antiangiogenesis properties. In Italy, a multi-institutional phase II prospective study (After-6 Protocol 2) has been initiated to verify the effectiveness of paclitaxel, administered on a weekly schedule (60 mg/m2 for 21 courses), in patients bearing microscopic residual disease detected at second-look operation to define its effectiveness after completing their primary platinum/paclitaxel chemotherapy treatment. When possible, patients were surgically re-evaluated thorough a third-look operation to evaluate the percentage of conversion of microPR into a pathological complete remission status. An interim evaluation based on 534 cycles administered to 41 patients showed than only one patient experienced grade 4 anemia, 7.4% grade 2 transient peripheral neurotoxicity, and 2.7% delay in treatment delivery. Therefore, weekly paclitaxel has been proven to be easily administered even in heavily pretreated patients, with acceptable hematological and neurological toxicity
Which second-line treatment regimen should be used following relapse of platinum-sensitive ovarian cancer?
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