Research

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9 pages, 1143 KiB

Open AccessArticle

Clinical Determinants Affecting Indications for Surgery and Chemotherapy in Recurrent Ovarian Granulosa Cell Tumor

by Hidekatsu Nakai, Eiji Koike, Kosuke Murakami, Hisamitsu Takaya, Yasushi Kotani, Rika Nakai, Ayako Suzuki, Masato Aoki, Noriomi Matsumura and Masaki Mandai

Healthcare 2019, 7(4), 145; https://doi.org/10.3390/healthcare7040145 - 14 Nov 2019

Cited by 3 | Viewed by 4060

Abstract

Background: Because reports on the management of recurrent granulosa cell tumor have been sparse, a consensus as to which patients should undergo surgical resection and which patients should be considered for chemotherapy has not been established. Methods: A total of 21 tumor recurrences [...] Read more.

Background: Because reports on the management of recurrent granulosa cell tumor have been sparse, a consensus as to which patients should undergo surgical resection and which patients should be considered for chemotherapy has not been established. Methods: A total of 21 tumor recurrences in eight patients with granulosa cell tumor were reviewed. Results: Surgery was performed as the main treatment for 13 recurrences, while chemotherapy was chosen as the main treatment for eight recurrences. Complete tumor resection could be accomplished in 13 of 16 surgeries (81.3%), which include all the ten recurrences without involvement of liver or diaphragm and without ascites. The number of recurrent masses was significantly higher in the early recurrence group (progression free survival < 2 years) than in the late recurrence (progression free survival > 2 years). All cases with a solitary recurrent tumor at an extra-peritoneal site presented a significantly longer progression free survival. Conclusions: For patients with recurrent granulosa cell tumor, surgery may provide the best disease control. In cases with complete resection, the number of recurrent masses was the predictive factor for the next recurrence, and adjuvant chemotherapy might be considered in such cases. Full article

(This article belongs to the Special Issue Diagnosis and Treatment for Gynecologic Cancers)

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9 pages, 240 KiB

Open AccessArticle

Clinical Factors Associated with Longer Hospital Stay Following Ovarian Cancer Surgery

by Christopher G. Smith, Daniel L. Davenport, Justin Gorski, Anthony McDowell, Brian T. Burgess, Tricia I. Fredericks, Lauren A. Baldwin, Rachel W. Miller, Christopher P. DeSimone, Charles S. Dietrich III, Holly H. Gallion, Edward J. Pavlik, John R. van Nagell, Jr. and Frederick R. Ueland

Healthcare 2019, 7(3), 85; https://doi.org/10.3390/healthcare7030085 - 03 Jul 2019

Cited by 9 | Viewed by 4847

Abstract

Background: Ovarian cancer (OC) is the leading cause of death from gynecologic malignancy and is treated with a combination of cytoreductive surgery and platinum-based chemotherapy. Extended length of stay (LOS) after surgery can affect patient morbidity, overall costs, and hospital resource utilization. [...] Read more.

Background: Ovarian cancer (OC) is the leading cause of death from gynecologic malignancy and is treated with a combination of cytoreductive surgery and platinum-based chemotherapy. Extended length of stay (LOS) after surgery can affect patient morbidity, overall costs, and hospital resource utilization. The primary objective of this study was to identify factors contributing to prolonged LOS for women undergoing surgery for ovarian cancer. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify women from 2012–2016 who underwent hysterectomy for ovarian, fallopian tube and peritoneal cancer. The primary outcome was LOS >50th percentile. Preoperative and intraoperative variables were examined to determine which were associated with prolonged LOS. Results: From 2012–2016, 1771 women underwent elective abdominal surgery for OC and were entered in the ACS-NSQIP database. The mean and median LOS was 4.6 and 4.0 days (IQR 0–38), respectively. On multivariate analysis, factors associated with prolonged LOS included: American Society of Anesthesiologists (ASA) Classification III (aOR 1.71, 95% CI 1.38–2.13) or IV (aOR 1.88, 95% CI 1.44–2.46), presence of ascites (aOR 1.88, 95% CI 1.44–2.46), older age (aOR 1.23, 95% CI 1.13–1.35), platelet count >400,000/mm³ (aOR 1.74, 95% CI 1.29–2.35), preoperative blood transfusion (aOR 11.00, 95% CI 1.28–94.77), disseminated cancer (aOR 1.28, 95% CI 1.03–1.60), increased length of operation (121–180 min, aOR 1.47, 95% CI 1.13-1.91; >180 min, aOR 2.78, 95% CI 2.13–3.64), and postoperative blood transfusion within 72 h of incision (aOR 2.04, 95% CI 1.59–2.62) (p < 0.05 for all). Conclusions: Longer length of hospital stay following surgery for OC is associated with many patient, disease, and treatment-related factors. The extent of surgery, as evidenced by perioperative blood transfusion and length of surgical procedure, is a factor that can potentially be modified to shorten LOS, improve patient outcomes, and reduce hospital costs. Full article

(This article belongs to the Special Issue Diagnosis and Treatment for Gynecologic Cancers)

Review

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10 pages, 2824 KiB

Open AccessReview

Differential Diagnosis of Uterine Leiomyoma and Uterine Sarcoma Using Magnetic Resonance Images: A Literature Review

by Ayako Suzuki, Masato Aoki, Chiho Miyagawa, Kosuke Murakami, Hisamitsu Takaya, Yasushi Kotani, Hidekatsu Nakai and Noriomi Matsumura

Healthcare 2019, 7(4), 158; https://doi.org/10.3390/healthcare7040158 - 05 Dec 2019

Cited by 25 | Viewed by 12183

Abstract

MRI plays an essential role in patients before treatment for uterine mesenchymal malignancies. Although MRI includes methods such as diffusion-weighted imaging and dynamic contrast-enhanced MRI, the differentiation between uterine myoma and sarcoma always becomes problematic. The present paper discusses important findings to ensure [...] Read more.

MRI plays an essential role in patients before treatment for uterine mesenchymal malignancies. Although MRI includes methods such as diffusion-weighted imaging and dynamic contrast-enhanced MRI, the differentiation between uterine myoma and sarcoma always becomes problematic. The present paper discusses important findings to ensure that sarcomas are not overlooked in magnetic resonance (MR) images, and we describe the update in the differentiation between uterine leiomyoma and sarcoma with recent reports. Full article

(This article belongs to the Special Issue Diagnosis and Treatment for Gynecologic Cancers)

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8 pages, 422 KiB

Open AccessReview

A New Therapeutic Strategy for Recurrent Ovarian Cancer―Bevacizumab beyond Progressive Disease

by Tadahiro Shoji, Hisashi Eto, Takanori Sato, Rikako Soma, Daisuke Fukagawa, Hidetoshi Tomabechi, Eriko Takatori, Takayuki Nagasawa, Seiya Sato, Masahiro Kagabu and Tsukasa Baba

Healthcare 2019, 7(3), 109; https://doi.org/10.3390/healthcare7030109 - 19 Sep 2019

Cited by 13 | Viewed by 3815

Abstract

Treatment beyond progressive disease (PD) is a concept that even after drugs become ineffective, their continued use is more beneficial for patients than their discontinuation. In recent years, a concept of bevacizumab beyond PD (BBP) has attracted attention in the treatment of various [...] Read more.

Treatment beyond progressive disease (PD) is a concept that even after drugs become ineffective, their continued use is more beneficial for patients than their discontinuation. In recent years, a concept of bevacizumab beyond PD (BBP) has attracted attention in the treatment of various cancers, and the usefulness of this concept has been evaluated. BBP has been proven to prolong overall survival (OS) in recurrent colorectal cancer and progression-free survival (PFS) in recurrent breast and lung cancers. With regard to the treatment of ovarian cancer, the MITO16/MaNGO-OV2B study (the Multicenter Phase III Randomized Study with Second Line Chemotherapy Plus or Minus Bevacizumab in Patients with Platinum Sensitive Epithelial Ovarian Cancer Recurrence After a Bevacizumab/Chemotherapy First Line) was conducted in patients with platinum-sensitive recurrence and the JGOG3023 study (the Open-Label, Randomized, Phase II Trial Evaluating the Efficacy and Safety of Standard of Care with or Without Bevacizumab in Platinum-Resistant Ovarian Cancer Patients Previously Treated with Bevacizumab for Front-Line or Platinum-Sensitive Ovarian Cancer) was conducted in patients with platinum-resistant recurrence. The MITO16/MaNGO-OV2B study, reported in the 2018 annual meeting of the American Society of Clinical Oncology, showed that BBP achieved prolonged PFS. In the JGOG3023 study, enrollment of patients was completed in December 2018, and the follow-up period has been initiated. Proving the effectiveness of BBP in the treatment of ovarian cancer may provide a new therapeutic strategy and contribute to improved treatment outcomes in patients with poor prognosis and limited therapeutic options. Full article

(This article belongs to the Special Issue Diagnosis and Treatment for Gynecologic Cancers)

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13 pages, 259 KiB

Open AccessFeature PaperReview

Immunotherapy for Uterine Cervical Cancer

by Masahiro Kagabu, Takayuki Nagasawa, Daisuke Fukagawa, Hidetoshi Tomabechi, Saiya Sato, Tadahiro Shoji and Tsukasa Baba

Healthcare 2019, 7(3), 108; https://doi.org/10.3390/healthcare7030108 - 17 Sep 2019

Cited by 36 | Viewed by 5253

Abstract

Cervical cancer is a malignant neoplastic disease that is the fourth most commonly occurring cancer in women worldwide. Since the introduction of angiogenesis inhibitors, treatments for recurrent and advanced cervical cancers have improved significantly in the past five years. However, the median overall [...] Read more.

Cervical cancer is a malignant neoplastic disease that is the fourth most commonly occurring cancer in women worldwide. Since the introduction of angiogenesis inhibitors, treatments for recurrent and advanced cervical cancers have improved significantly in the past five years. However, the median overall survival in advanced cervical cancer is 16.8 months, with a 5-year overall survival rate of 68% for all stages, indicating that the effects of the treatment are still unsatisfactory. The development of a new treatment method is therefore imperative. Recently, in the clinical oncology field, remarkable progress has been made in immunotherapy. Immunotherapy is already established as standard therapy in some fields and in some types of cancers, and its clinical role in all areas, including the gynecology field, will change further based on the outcomes of currently ongoing clinical trials. This manuscript summarizes the results from previous clinical trials in cervical cancer and describes the ongoing clinical trials, as well as future directions. Full article

(This article belongs to the Special Issue Diagnosis and Treatment for Gynecologic Cancers)

19 pages, 603 KiB

Open AccessReview

Development and Themes of Diagnostic and Treatment Procedures for Secondary Leg Lymphedema in Patients with Gynecologic Cancers

by Yumiko Watanabe, Masafumi Koshiyama, Keiko Seki, Miwa Nakagawa, Eri Ikuta, Makiko Oowaki and Shin-ichi Sakamoto

Healthcare 2019, 7(3), 101; https://doi.org/10.3390/healthcare7030101 - 27 Aug 2019

Cited by 9 | Viewed by 5364

Abstract

Patients with leg lymphedema sometimes suffer under constraint feeling leg heaviness and pain, requiring lifelong treatment and psychosocial support after surgeries or radiation therapies for gynecologic cancers. We herein review the current issues (a review of the relevant literature) associated with recently developed [...] Read more.

Patients with leg lymphedema sometimes suffer under constraint feeling leg heaviness and pain, requiring lifelong treatment and psychosocial support after surgeries or radiation therapies for gynecologic cancers. We herein review the current issues (a review of the relevant literature) associated with recently developed diagnostic procedures and treatments for secondary leg lymphedema, and discuss how to better manage leg lymphedema. Among the currently available diagnostic tools, indocyanine green lymphography (ICG-LG) can detect dermal lymph backflow in asymptomatic legs at stage 0. Therefore, ICG-LG is considered the most sensitive and useful tool. At symptomatic stage ≥1, ultrasonography, magnetic resonance imaging-lymphography/computed tomography-lymphography (MRI-LG/CT-LG) and lymphosintiography are also useful. For the treatment of lymphedema, complex decongestive physiotherapy (CDP) including manual lymphatic drainage (MLD), compression therapy, exercise and skin care, is generally performed. In recent years, CDP has often required effective multi-layer lymph edema bandaging (MLLB) or advanced pneumatic compression devices (APCDs). If CDP is not effective, microsurgical procedures can be performed. At stage 1–2, when lymphaticovenous anastomosis (LVA) is performed, lymphaticovenous side-to-side anastomosis (LVSEA) is principally recommended. At stage 2–3, vascularized lymph node transfer (VLNT) is useful. These ingenious procedures can help maintain the patient’s quality of life (QOL) but unfortunately cannot cure lymphedema. The most important concern is the prevention of secondary lymphedema, which is achieved through approaches such as skin care, weight control, gentle limb exercises, avoiding sun and heat, and elevation of the affected leg. Full article

(This article belongs to the Special Issue Diagnosis and Treatment for Gynecologic Cancers)

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12 pages, 1149 KiB

Open AccessReview

Current Position of the Molecular Therapeutic Targets for Ovarian Clear Cell Carcinoma: A Literature Review

by Tsukuru Amano, Tokuhiro Chano, Fumi Yoshino, Fuminori Kimura and Takashi Murakami

Healthcare 2019, 7(3), 94; https://doi.org/10.3390/healthcare7030094 - 30 Jul 2019

Cited by 10 | Viewed by 5503

Abstract

Ovarian clear cell carcinoma (OCCC) shows low sensitivity to conventional chemotherapy and has a poor prognosis, especially in advanced stages. Therefore, the development of innovative therapeutic strategies and precision medicine for the treatment of OCCC are important. Recently, several new molecular targets have [...] Read more.

Ovarian clear cell carcinoma (OCCC) shows low sensitivity to conventional chemotherapy and has a poor prognosis, especially in advanced stages. Therefore, the development of innovative therapeutic strategies and precision medicine for the treatment of OCCC are important. Recently, several new molecular targets have been identified for OCCC, which can be broadly divided into four categories: (a) downstream pathways of receptor tyrosine kinases, (b) anti-oxidative stress molecules, (c) AT-rich interactive domain 1A-related chromatin remodeling errors, and (d) anti-programmed death ligand 1/programmed cell death 1 agents. Several inhibitors have been discovered for these targets, and the suppression of OCCC cells has been demonstrated both in vitro and in vivo. However, no single inhibitor has shown a sufficient effectiveness in clinical pilot studies. This review outlines recent progress regarding the molecular biological characteristics of OCCC to identify future directions for the development of precision medicine and combinatorial therapies to treat OCCC. Full article

(This article belongs to the Special Issue Diagnosis and Treatment for Gynecologic Cancers)

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23 pages, 400 KiB

Open AccessReview

The Effects of the Dietary and Nutrient Intake on Gynecologic Cancers

by Masafumi Koshiyama

Healthcare 2019, 7(3), 88; https://doi.org/10.3390/healthcare7030088 - 07 Jul 2019

Cited by 29 | Viewed by 7647

Abstract

The contribution of diet to cancer risk has been considered to be higher in advanced countries than in developing countries. In this paper, I review the current issues (a review of the relevant literature), and the effects of the dietary and nutrient intake [...] Read more.

The contribution of diet to cancer risk has been considered to be higher in advanced countries than in developing countries. In this paper, I review the current issues (a review of the relevant literature), and the effects of the dietary and nutrient intake on three types of gynecologic cancer (cervical, endometrial and ovarian cancers). In cervical cancer, the most important roles of diet/nutrition in relation to cancer are prophylaxis and countermeasures against human papillomavirus (HPV) infection. The main preventive and reductive factors of cervical cancer are antioxidants, such as vitamin A, C, D and E, carotenoids, vegetables and fruits. These antioxidants may have different abilities to intervene in the natural history of diseases associated with HPV infection. For endometrial cancer, the increase in peripheral estrogens as a result of the aromatization of androgens to estrogens in adipose tissue in obese women and insulin resistance are risk factors. Thus, we must mainly take care to avoid the continuous intake of fat energy and sugar. In ovarian cancer, the etiology has not been fully understood. To the best of our knowledge, the long-term consumption of pro-inflammatory foods, including saturated fat, carbohydrates and animal proteins is a risk factor. The intake of acrylamide is also a risk factor for both endometrial and ovarian cancer. Most papers have been epidemiological studies. Thus, further research using in vitro and in vivo approaches is needed to clarify the effects of the dietary and nutrient intake in detail. Full article

(This article belongs to the Special Issue Diagnosis and Treatment for Gynecologic Cancers)

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