scholarly journals When and how should peritoneal endometriosis be operated on in order to improve fertility rates and symptoms? The experience and outcomes of nearly 100 cases

2021 ◽  
Author(s):  
A. M. Dückelmann ◽  
E. Taube ◽  
E. Abesadze ◽  
V. Chiantera ◽  
J. Sehouli ◽  
...  
Keyword(s):  
Hormonal Therapy ◽  
Minimal Invasive Surgery ◽  
Early Stage ◽  
Minimal Invasive ◽  
Adjuvant Hormonal Therapy ◽  
Fertility Rates ◽  
Recurrence Rates ◽  
Peritoneal Endometriosis ◽  
Almost All

Abstract Purpose To analyze the follow-up results of patients suffering from symptomatic early-stage endometriosis after a consistent laparoscopic peritoneal stripping of the altered peritoneum (peritoneal endometriosis and surrounding inflamed tissue) was performed. This type of endometriosis is resistant to medical therapy and/or impairs fertility. Methods Using our prospectively maintained database, we were able to identify all symptomatic women with the suspicion of only peritoneal endometriosis who underwent laparoscopy at our endometriosis center over a period of 5 years. All procedures were carried out in a standardized fashion by one single surgeon, who is highly experienced in minimal invasive surgery, and included a suspended hormonal pretreatment for 2 months. Postoperative outcomes including complications, fertility and recurrence rates were analysed. Results Laparoscopic peritonectomy was performed on 94 women. Follow-up data were available in 87% of these cases. At the time of surgery, almost all patients tested showed signs of stage I or II endometriosis (44.7 and 48.9%, respectively). More than three-quarters of the women reported pain relief, inter alia, due to the post-surgical hormonal therapy. About one-third of the patients wanted to have children after the procedure. 62% of them became pregnant and the majority did so without the need for assisted reproductive therapy. In seven women a re-operation was performed. Conclusion According to our data, a consistent excision of altered peritoneum followed by adjuvant hormonal therapy and multimodal concepts results in better outcomes for the patient, particularly in regards to pregnancy and recurrence rates.

scholarly journals Adherence and persistence to adjuvant hormonal therapy in early stage breast cancer patients: A population-based retrospective cohort study in Israel.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12051-e12051
Author(s):  
Tal Sella ◽  
Gabriel Chodick
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Hormonal Therapy ◽  
Breast Cancer Survivors ◽  
Early Stage ◽  
Population Based ◽  
Early Stage Breast Cancer ◽  
Adjuvant Hormonal Therapy ◽  
Breast Cancer Patients ◽  
Suboptimal Adherence

e12051 Background: Adjuvant hormonal therapy has been consistently proven to improve multiple outcomes in early breast cancer. Nonetheless, data on rates of adherence and persistence with therapy outside West Europe and North America are scarce. We assessed the adherence and persistence with adjuvant hormonal in a retrospective population based cohort of breast cancer survivors in Maccabi Health Services (MHS), Israel. Methods: We identified women who were diagnosed with breast cancer and initiated adjuvant hormonal therapy between January 2000 and November 2008. Subjects were followed retrospectively from first dispensed tamoxifen or aromatase inhibitor (AI) and up to the earliest of the following events: disease recurrence (indicated by surgery, radiotherapy, chemotherapy or other related therapies), leaving MHS, death, or completion of 5 years of treatment. Discontinuation of therapy was defined as a 180-day or longer treatment gap. Adherence with therapy was assessed using proportion of days covered (PDC) during follow-up period. Survival analysis was used to determine the effect of adherence on all-cause mortality. Results: A total of 4178 women with breast cancer were followed for a median 7.8 years. Over 90% of patients received tamoxifen as the initial hormonal agent. Mean PDC was 84% with lower rates associated with younger age, smoking status, comorbidities and year of diagnosis. Residential area did not affect adherence. Differences were not found. Discontinuation of therapy occurred in 23% of study patients. Among persistent patients, 70% were optimally adherent with therapy (PDC>=80%). Association between adherence with therapy and survival is investigated. Conclusions: Adherence to adjuvant hormonal therapy among Israeli breast cancer patients with national health insurance is high in comparison to international reports. Nevertheless, suboptimal adherence was identified among younger (<45y) patients. Because of the efficacy of hormonal therapy in preventing recurrence and death in women with early-stage breast cancer, interventions are necessary to identify and prevent suboptimal adherence among high risk subgroups.

scholarly journals Early Discontinuation and Nonadherence to Adjuvant Hormonal Therapy in a Cohort of 8,769 Early-Stage Breast Cancer Patients

2010 ◽  
Vol 28 (27) ◽  
pp. 4120-4128 ◽  
Author(s):  
Dawn L. Hershman ◽  
Lawrence H. Kushi ◽  
Theresa Shao ◽  
Donna Buono ◽  
Aaron Kershenbaum ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Hormonal Therapy ◽  
Early Stage ◽  
Optimal Schedule ◽  
Medication Possession Ratio ◽  
Adjuvant Hormonal Therapy ◽  
Breast Cancer Patients ◽  
Early Discontinuation ◽  
Younger Women ◽  
Hormone Sensitive

Purpose While studies have found that adjuvant hormonal therapy for hormone-sensitive breast cancer (BC) dramatically reduces recurrence and mortality, adherence to medications is suboptimal. We investigated the rates and predictors of early discontinuation and nonadherence to hormonal therapy in patients enrolled in Kaiser Permanente of Northern California health system. Patients and Methods We identified women diagnosed with hormone-sensitive stage I-III BC from 1996 to 2007 and used automated pharmacy records to identify hormonal therapy prescriptions and dates of refill. We used Cox proportional hazards regression models to analyze factors associated with early discontinuation and nonadherence (medication possession ratio < 80%) of hormonal therapy. Results We identified 8,769 patients with BC who met our eligibility criteria and who filled at least one prescription for tamoxifen (43%), aromatase inhibitors (26%), or both (30%) within 1 year of diagnosis. Younger or older age, lumpectomy (v mastectomy), and comorbidities were associated with earlier discontinuation, while Asian race, being married, earlier year at diagnosis, receipt of chemotherapy or radiotherapy, and longer prescription refill interval were associated with completion of 4.5 years of therapy. Of those who continued therapy, similar factors were associated with full adherence. Women age younger than 40 years had the highest risk of discontinuation (hazard ratio, 1.51; 95% CI, 1.23 to 1.85). By 4.5 years, 32% discontinued therapy, and of those who continued, 72% were fully adherent. Conclusion Only 49% of patients with BC took adjuvant hormonal therapy for the full duration at the optimal schedule. Younger women are at high risk of nonadherence. Interventions to improve adherence and continuation of hormonal therapy are needed, especially for younger women.

scholarly journals Practical consensus recommendations on duration of adjuvant hormonal therapy in breast cancer

2018 ◽  
Vol 07 (02) ◽  
pp. 142-145 ◽  
Author(s):  
S. Gupta ◽  
M. Singh ◽  
Amish Vora ◽  
G. Babu ◽  
M. Walia ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Hormonal Therapy ◽  
Hormone Receptor ◽  
Early Stage ◽  
Adjuvant Hormonal Therapy ◽  
Breast Cancer Patients ◽  
Term Survival ◽  
Consensus Recommendations ◽  
Hormone Receptor Positive

AbstractOptimization of adjuvant systemic therapy in women with early-stage hormone receptor-positive breast cancer includes the consideration of chemotherapy and duration of hormone therapy. Adjuvant hormonal therapy significantly improves long-term survival of breast cancer patients with hormone receptor-positive disease. Despite the proven clinical efficacy of tamoxifen and aromatase inhibitors, many breast cancer survivors either fail to take the correct dosage at the prescribed frequency (adherence) or discontinue therapy (persistence). Expert oncologist discussed on the duration of adjuvant hormonal therapy for improvement of OS and quality of life of breast cancer patients by providing reduction in recurrence and mortality. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.

scholarly journals Giant Prolactinomas: Outcomes of Multimodal Treatments for 42 Cases with Long-Term Follow-Up

2018 ◽  
Vol 127 (05) ◽  
pp. 295-302 ◽  
Author(s):  
Liang Lv ◽  
Yu Hu ◽  
Senlin Yin ◽  
Peizhi Zhou ◽  
Yuan Yang ◽  
...  
Keyword(s):  
Dopamine Agonist ◽  
Early Stage ◽  
Pituitary Tumors ◽  
First Line ◽  
Cavernous Sinus Invasion ◽  
Initial Surgery ◽  
Long Term Follow Up ◽  
Giant Prolactinomas ◽  
Almost All

AbstractGiant prolactinomas represent a rare entity of pituitary tumors so that the management of these patients is still a prevalent challenge at present. Paying special attention to the treatment strategy and outcomes, we presented a large series of 42 cases looking forward to share our understanding and experience in management of these patients. Male patients accounted for 71.4% of this series and were relatively younger (35.70±2.42 vs. 52.00±3.55 years, p=0.0011) and harbored bigger tumors (14.57 vs. 7.74 cm3, p=0.0179) compared to females. Almost all of these tumors showed suprasellar extension (97.6%) and cavernous sinus invasion (92.9%). Dopamine agonist represented an efficient method to control PRL concentrations (98.8%) and reduce tumor burdens (81.2 %). PRL normalization was detected in 13 out of the 27 patients initially treated with bromocriptine (BRC) whereas none of the 14 patients with first-line operation gained a normalization of PRL concentration after surgery. Although there was no reliable predictor of tumor response, First PRL reduction was a predictive criterion for the nadir PRL level during the long-time period of follow-up for first-line bromocriptine treatment. In conclusion, patients with giant prolactinomas did not gain more benefits from initial surgery. Dopamine agonist (BRC) should be first-line treatment for giant prolactinomas whereas operation merely served as a remedy for acute compression symptoms and dopamine agonist resistance. Consecutive monitoring of serum PRL levels in the early stage of initial BRC treatment is useful for evaluation of therapeutic effect and further therapeutic decision.

An NCDB analysis of trends in male breast cancer from 2004-2009 and 2010-2014.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 544-544
Author(s):  
Esther Dubrovsky ◽  
Shira Schwartz ◽  
Jennifer Chun ◽  
Amber Guth ◽  
Deborah M. Axelrod ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Male Breast Cancer ◽  
Hormonal Therapy ◽  
Male Breast ◽  
Adjuvant Hormonal Therapy ◽  
Stage At Diagnosis ◽  
Female Patients ◽  
Treatment Type ◽  
To Receive

544 Background: To examine the trends in clinicopathologic features, treatment, and survival of male breast cancer (MBC), utilizing the National Cancer Data Base (NCDB). Methods: MBC patients entered in the NCDB from 2004-2009 were compared with those from 2010-2014 for demographics, stage at diagnosis, tumor characteristics, treatment type, and overall survival (OS). Male patients were also compared to female patients from the same time periods. Statistical analysis included Pearson’s chi-square test. Results: Of 2,047,868 breast cancer cases, a total of 19,409 (0.95%) men were available for analysis. The group of MBC patients from 2004 to 2009 included 9,790 men with a median age of 65. The group from 2010 to 2014 included 9,619 men with a median age of 66. In the later group there was a decreased rate of DCIS, increased rate of invasive ductal carcinoma, and increased rate of hormone positive tumors. Among the earlier and later MBC groups, 24% vs. 27% of patients underwent lumpectomy. Of these, 61% vs 68% received post-lumpectomy radiation, respectively. Patients in the later group (2010-2014) were more likely to receive adjuvant hormonal therapy (61% vs. 84%, p < 0.0001). MBC patients were older than female patients (65 vs. 61 years, p < 0.0001), had larger tumors (20mm vs. 16mm, p < 0.0001), slightly later stage at diagnosis, and more likely to undergo mastectomy (74 vs. 42%, p < 0.0001). MBC patients also had higher rates of hormone positive tumors, but lower rates of adjuvant hormonal therapy (55% vs. 58%, p < 0.0001). The OS for male vs. female patients in the 2004-2009 groups was 66% vs. 77% (median follow-up 73.9m vs 80.4m) respectively. Similarly, in the 2010-2014 groups, survival was 84% vs. 90% (median follow-up 33.85m vs 35.91m), respectively. Conclusions: Although men have higher rates of hormone positive tumors, they are less likely to receive adjuvant hormonal therapy. There was a significant trend over time towards more standard therapies in men, such as post-lumpectomy radiation and hormonal therapy use. There has been an improvement of OS in men which mirrors that in women. The disparities in outcomes between male and female patients, however, still require further investigation.

scholarly journals Substantial risk of recurrence even after 5 recurrence-free years in early-stage hepatocellular carcinoma patients

2020 ◽  
Vol 26 (4) ◽  
pp. 516-528
Author(s):  
Jihye Kim ◽  
Wonseok Kang ◽  
Dong Hyun Sinn ◽  
Geum-Youn Gwak ◽  
Yong-Han Paik ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Recurrence Rate ◽  
Early Stage ◽  
Cancer Staging ◽  
High Recurrence Rate ◽  
Recurrence Rates ◽  
Substantial Risk ◽  
Hcc Recurrence

Background/Aims: Although hepatocellular carcinoma (HCC) is notorious for its high recurrence rate, some patients do not experience recurrence for more than 5 years after resection or radiofrequency ablation for early-stage HCC. For those with five recurrence-free period, the risk of HCC recurrence within the next 5 years remains unknown.Methods: A total of 1,451 consecutive patients (median, 55 years old; males, 79.0%; hepatitis B virus-related, 79.3%) with good liver function (Child-Pugh class A) diagnosed with early-stage HCC by Barcelona Clinic Liver Cancer Staging and received radiofrequency ablation or resection as an initial treatment between 2005 and 2010 were analyzed.Results: During a median follow-up period of 8.1 years, 961 patients (66.2%) experienced HCC recurrence. The cumulative recurrence rates increased to 39.7%, 60.3%, and 71.0% at 2, 5, and 10 years, respectively, and did not reach a plateau. Five years after HCC diagnosis, 487 patients were alive without experiencing a recurrence. Among them, during a median of 3.9 additional years of follow-up (range, 0.1–9.0 years), 127 patients (26.1%) experienced recurrence. The next 5-year cumulative recurrence rate (5–10 years from initial diagnosis) was 27.0%. Male sex, higher fibrosis-4 scores, and alpha-fetoprotein levels at 5 years were associated with later HCC recurrence among patients who did not experience recurrence for more than 5 years.Conclusions: The HCC recurrence rate following 5 recurrence-free years after HCC treatment was high, indicating that HCC patients warrant continued HCC surveillance, even after 5 recurrence-free years.

Sign in / Sign up

Export Citation Format

Share Document