Gynecologic oncology
-
Gynecologic oncology · Dec 2007
Ten-year data on 138 patients with endometrial carcinoma and postoperative vaginal brachytherapy alone: no need for external-beam radiotherapy in low and intermediate risk patients.
To evaluate long-term outcome, risk factors, and causes of death in stage I-IIIA endometrial carcinoma (EC) patients treated only with adjuvant vaginal brachytherapy (VB) and to clarify for which subgroups of patients it is safe to omit external-beam radiotherapy (EBRT). ⋯ Restricting adjuvant therapy to VB alone seems to be safe in low and intermediate risk EC and can be recommended. As death rarely relates to early-stage EC, value of adjuvant therapy is probably better reflected by DFS rather than by overall survival.
-
Gynecologic oncology · Dec 2007
Predictors of extended intensive care unit resource utilization following surgery for ovarian cancer.
To identify perioperative variables associated with length of stay in the surgical intensive care unit (SICU), and overall cost of hospitalization in order to optimize resource utilization among patients undergoing surgery for ovarian cancer. ⋯ Extensive fluid resuscitation during surgery, poor nutritional status, and > or = 63 years are associated with a prolonged postoperative SICU stay. These data may facilitate a reduction in unnecessary ICU admissions for patients without these risk factors and thereby optimize resource utilization following surgery for ovarian cancer.
-
Achieving long-term protection following vaccination is crucial to ensuring that high levels of immunity are maintained within a population while eliminating the need to introduce booster vaccinations. Based on an analysis of the hepatitis B virus vaccine, several factors have been shown to contribute to long-term protection, namely: specific lymphoproliferation, the in vivo humoral response, and immune memory. To ensure protection against persistent human papillomavirus (HPV) infection and the subsequent development of cervical lesions, an effective HPV vaccine must be able to induce strong humoral immune responses. ⋯ Similarly the bivalent HPV vaccine has been shown to induce long-term immunity with >98% seropositivity maintained after 4.5 years of follow-up and geometric mean titres at this time point remaining substantially higher than those noted with naturally acquired infection. Countrywide registration regarding population and health events in a stable population of approximately 25 million makes the Nordic countries an ideal setting for the evaluation of long-term cervical cancer control. Population-based long-term efficacy trials conducted in these countries aim to investigate the long-term efficacy of HPV vaccination with regard to invasive cervical cancer, and the results of these trials are awaited with interest.
-
Gynecologic oncology · Nov 2007
Comparative StudyRisk factors for benign, borderline and invasive mucinous ovarian tumors: epidemiological evidence of a neoplastic continuum?
Some molecular and histological evidence suggests that mucinous epithelial ovarian cancers develop via a sequence from benign tumor through borderline tumor to invasive cancer. Such a sequence would predict some shared risk factors between the different tumor types. To investigate this, we examined risk factors for benign, borderline and invasive mucinous ovarian tumors. ⋯ Overall, the risk factors for mucinous cancers appear to differ from other subtypes of ovarian cancer. Furthermore, patterns of risk factors across benign, borderline and invasive mucinous ovarian tumors are generally consistent with an adenoma-to-carcinoma sequence as the developmental pathway for this subtype of ovarian cancer. Our findings also suggest the potential preventability of borderline and invasive mucinous ovarian cancer by smoking cessation and by surgical excision of identifiable precursor lesions.
-
Gynecologic oncology · Nov 2007
Clinical trial endpoints in ovarian cancer: report of an FDA/ASCO/AACR Public Workshop.
The unique characteristics of cancer, particularly issues involving the use of surrogate endpoints in clinical trials, present special challenges in the development of cancer drugs. In response, the U.S. Food and Drug Administration (FDA) has partnered with the American Society of Clinical Oncology, the American Association for Cancer Research, and the American Society of Hematology to conduct public workshops evaluating potential endpoints for drug approvals for the most common tumor types. ⋯ Expert commentary provided by panel members will inform FDA's draft guidance on clinical endpoints for cancer drug approvals and will be discussed at meetings of the FDA's Oncologic Drugs Advisory Committee. FDA intends to develop a set of principles that can be used to define efficacy standards for drugs used to treat ovarian and other cancers.