Role of Radical Surgery in Early Stages of Vaginal Cancer—Our Experience

2016 ◽  
Vol 26 (6) ◽  
pp. 1176-1181 ◽  
Author(s):  
Vandana Jain ◽  
Rupinder Sekhon ◽  
Shveta Giri ◽  
Rashmi Rekha Bora ◽  
Kanika Batra ◽  
...  
Keyword(s):  
Adjuvant Treatment ◽  
Radical Surgery ◽  
Disease Free Survival ◽  
International Federation ◽  
Stage I ◽  
Vaginal Cancer ◽  
Free Survival ◽  
Gynecology And Obstetrics ◽  
Disease Free

ObjectivesThe objective of our present study was to evaluate the efficacy of radical vaginectomy with or without radical hysterectomy in patients with International Federation of Gynecology and Obstetrics stage I and II vaginal cancers.Materials and MethodsA retrospective study was carried out on 11 patients aged 35 to 78 years. All the patients underwent radical surgery for vaginal cancer from April 2010 till June 2015. Kaplan-Meier analyses were used to calculate the disease-free survival and overall survival at 12 months.ResultsThe mean age of patients was 53.2 years. Ten patients were with International Federation of Gynecology and Obstetrics stage I, whereas one had stage II vaginal cancer. The histology was squamous cell cancer in 9 patients and small cell neuroendocrine cancer in 2 patients. The lesion was confined to the upper two third of the vagina in 8 cases, and the lower one third was involved in 3 cases. All the patients underwent radical surgery. Lymph node dissection was done in 9 patients out of whom lymph nodes were positive in 3 patients. Two patients had positive margins. Adjuvant treatment was given to patients with positive margins or positive nodes. Five patients did not require any adjuvant treatment, and 1 patient defaulted adjuvant treatment. One patient developed vesicovaginal fistula. Over a follow-up period ranging from 5 to 67 months, local recurrence developed in 1 patient, whereas no patient died of disease. One patient was lost to follow-up at 15 months. The 12-month disease-free survival was 88.9%, and 12-month overall survival was 100%.ConclusionsStage I and selected stage II vaginal cancer patients have good outcomes in terms of survival and local tumor control if managed judiciously by initial surgery followed by selective adjuvant therapy.

scholarly journals Role of radical surgery in early stages of vaginal cancer

2016 ◽  
Author(s):  
Vandana Jain ◽  
Rupinder Sekhon ◽  
Shveta Giri ◽  
Sudhir Rawal
Keyword(s):  
Overall Survival ◽  
Adjuvant Treatment ◽  
Radical Surgery ◽  
Disease Free Survival ◽  
Figo Stage ◽  
Stage I ◽  
Vaginal Cancer ◽  
Free Survival ◽  
Positive Margins ◽  
Disease Free

Objectives: The objective of our present study was to evaluate the efficacy of radical vaginectomy with or without radical hysterectomy in patients with FIGO stage I and II vaginal cancers. Materials and Methods: A retrospective study was carried out on 13 patients aged 35 – 78 years. All the patients underwent radical surgery for vaginal cancer from April 2010 till June 2015. Kaplan- meier analyses was used to calculate the disease free survival and overall survival at 12 months. Results: The mean age of patients was 54.9 years. Twelve patients were with FIGO stage I while one had stage II vaginal cancer. The histopathology was squamous cell cancer in 9 patients, small cell neuroendocrine cancer in two patients and malignant melanoma in 2 patients. The lesion was confined to upper 2/3 of vagina in 8 cases and lower 1/3 was involved in 5 cases. All the patients underwent radical surgery. Lymph node dissection was done in eleven patients out of whom lymph nodes were positive in 4 patients. Three patients had positive margins. Adjuvant treatment was given to patients with positive margins or positive nodes. Six patients did not require any adjuvant treatment and two patients defaulted adjuvant treatment. One patient developed Vesico-vaginal fistula. Over a follow up period ranging from 6 to 67 months, recurrence developed in two patients and one of them died of disease. The 12 months Disease free survival was 82.1% and 12 months Overall Survival was 90.9%. Conclusion: Stage I and selected stage II vaginal cancer patients have good outcomes in terms of survival and local tumor control if managed judiciously by initial surgery followed by selective adjuvant therapy.

Oxaliplatin, Fluorouracil, and Leucovorin as Adjuvant Treatment for Colon Cancer

2017 ◽  
Author(s):  
Kelly McLeon
Keyword(s):  
Colon Cancer ◽  
Adjuvant Treatment ◽  
Disease Free Survival ◽  
Stage Iii ◽  
Reference Standard ◽  
Free Survival ◽  
Stage Iii Colon Cancer ◽  
Study Intervention ◽  
Disease Free

The landmark MOSAIC trial examined whether the addition of oxaliplatin to a postoperative adjuvant treatment regimen of fluorouracil and leucovorin affected disease-free survival from colon cancer. The MOSAIC trial established the efficacy of FOLFOX over 5-FU/LV as adjuvant treatment for stage III colon cancer and established FOLFOX4 as the reference standard for adjuvant treatment for stage III disease. This chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case.

FEC 60 adjuvant chemotherapy (AdCT) in breast cancer (BC) patients (Pts): 10-year follow-up results

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10725-10725 ◽  
Author(s):  
F. Moura Silva ◽  
C. Tosello ◽  
M. T. Laloni ◽  
C. M. Andrade ◽  
A. Bertozzi ◽  
...  
Keyword(s):  
Disease Free Survival ◽  
Stage I ◽  
Stage Ii ◽  
Pathological Stage ◽  
Anticancer Effect ◽  
Free Survival ◽  
Metastatic Sites ◽  
To Receive ◽  
Disease Free

10725 Background: To evaluate the efficacy of the Epirubicin as a part of the FEC60 AdCT in operable BrC patients in a Brazilian single-center. Methods: We verified retrospectively our experience with FEC 60 as AdCT in pre and postmenopausal, node positive and negative, pathologic stage I, II and III patients with BrC. Pts were submitted after surgery to receive Fluorouracil 600 mg/m2, Epirubicin 60 mg/m2 and Cyclophosphamide 600 mg/m2 every 28 days for 6 cycles. Pts who were ER+ and/or PR+ received Tamoxifen (TMX) 20 mg/day for 5 years after AdCT. Radiotherapy was also offered at the end of AdCT if indicated. All patients were evaluated in terms of 10 year (y) Disease Free Survival (DFS) and Overall Survival (OS). The most common toxicities (acute and chronic) and metastatic sites will also be reported. Results: Between July 1983 and December 1995 a total of 752 patients (ranging from 22 to 77 years old - median 47.7) were encountered and all of them were evaluated to 10 year (y) DFS and OS. Approximately 61% of these patients received adjuvant TMX. Pts in premenopausal and postmenopausal represented 62.5% and 37.5% respectively. 72 (11%) pts had pathological stage I; 353 (46%) pts had stage II and 327 (43%) had stage III. The 10y DFS was 70%, 46% and 19% for stage I, II and III respectively. The 10y OS after a minimal follow-up of 122.98 months was 74%, 48% and 20% for stage I, II and III respectively. Conclusions: Our results demonstrated that FEC 60 regimen is active and well tolerated in the adjuvant treatment for BrC pts. We had about 89% of stage II and III pts and in this population FEC60 regimen add benefit. Nevertheless, the randomized studies indicate that the greatest anticancer effect of Epirubicin requires doses ranging from 75 to 120 mg/m2, but due to economic reasons (we integrate the brazilian public healthy system) we could not offer dosages greater than 60 mg/m2. FEC 60 was feasible and offered reasonable results in our population in terms of 10y DFS and OS. No significant financial relationships to disclose.

Combined modality treatment of cutaneous T cell lymphoma: results of a 6-year follow-up.

1986 ◽  
Vol 4 (7) ◽  
pp. 1094-1100 ◽  
Author(s):  
C F Winkler ◽  
E A Sausville ◽  
D C Ihde ◽  
A B Fischmann ◽  
G P Schechter ◽  
...  
Keyword(s):  
Electron Beam Irradiation ◽  
Cell Lymphoma ◽  
Disease Free Survival ◽  
Stage I ◽  
Stage Ii ◽  
Combined Modality Treatment ◽  
Cutaneous T Cell Lymphoma ◽  
Free Survival ◽  
Disease Free

Thirty-nine patients with cutaneous T cell lymphoma (CTCL; including mycosis fungoides or the Sezary syndrome) with no previous treatment other than topical therapy or oral corticosteroids, received total skin electron beam irradiation (TSEB) and either sequential or simultaneous systemic chemotherapy. Median follow-up, measured from the time of initiation of therapy to the time of analysis, is in excess of 6 years and extends to 100+ months. Thirteen patients with stage I disease (limited to skin with no adenopathy) received 3,000 rad total skin electron beam irradiation followed by three 2-week courses of daily intravenous (IV) mechlorethamine. Twenty-six patients with advanced disease (stage II-IV) received 2,400 rad of TSEB and simultaneous chemotherapy with two alternating three-drug regimens: vinblastine, doxorubicin, and bleomycin (VAB) alternating with cyclophosphamide, methotrexate, and prednisone (CMP) administered over 54 weeks. The overall response rate was 92% with 16 of 39 patients (41%) achieving a histologically documented complete response (CR). Stage I patients had a significantly increased CR rate (77%) compared with stage II-IV (P less than .01). The overall 6-year survival was 92% for stage I patients and 26% for stage II-IV patients (23%) (P less than .001). Among ten completely responding stage I patients, six remain alive and disease-free in excess of 72 months. The median disease-free survival is 26 months for completely responding stage II-IV patients (P = .04), but none are continuous disease-free survivors after protocol treatment. We conclude that combined modality treatment can be safely administered and produces prolonged disease-free survival in some stage I patients, but not in more advanced stage patients.

Long-Term Follow-Up of a Prospective Study of Combined Modality Therapy for Stage I–II Indolent Non-Hodgkin’s Lymphoma

2003 ◽  
Vol 21 (11) ◽  
pp. 2115-2122 ◽  
Author(s):  
John F. Seymour ◽  
Barbara Pro ◽  
Lillian M. Fuller ◽  
John T. Manning ◽  
Fredrick B. Hagemeister ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Follicular Lymphoma ◽  
Combined Modality Therapy ◽  
Disease Free Survival ◽  
Stage I ◽  
Low Grade ◽  
Free Survival ◽  
Combined Modality ◽  
Disease Free

Purpose: Standard therapy for patients with stage I–II indolent lymphoma has been involved-field radiation therapy (IF-XRT), which achieves 10-year disease-free survival in 40% to 50% of patients, with many of these patients cured. We investigated the potential for combined-modality therapy to increase the disease-free survival for such patients. Patients and Methods: A total of 102 eligible patients with stage I–II low grade lymphoma (International Working Formulation criteria) were enrolled from 1984 to 1992. Treatment comprised 10 cycles of risk-adapted chemotherapy (cyclophosphamide, vincristine, prednisone, bleomycin [COP-Bleo], and with doxorubicin added for some [CHOP-Bleo]) and 30 to 40 Gy IF-XRT. Results: The patients’ median age was 56 years (range, 28 to 77), with follicular histology in 83%, bulky disease (≥ 5 cm) in 24%, and stage II in 52%. There were no treatment-related deaths and 99% of patients attained complete remission. With a median follow-up of 10 years, the 10-year time to treatment failure and overall survival were 76% and 82%, respectively. For patients with follicular lymphoma, these figures were 72% and 80%, respectively. The only factor associated with treatment failure, for follicular lymphoma patients, was stage-modified International Prognostic Factors Index score (P = .02). None of 17 patients with diffuse small lymphocytic or mucosa-associated lymphoid tissue histology have relapsed. Elevated serum beta2-microglobulin was associated with shorter survival (P < .0001). The 10-year survival after relapse was 46%. There have been two cases of myelodysplasia and 12 other new malignancies, including four arising within radiation fields. Conclusion: With prolonged follow-up, combined-modality therapy with risk-adapted COP-/CHOP-Bleo and IF radiation has attained higher rates of disease control and survival than previously reported with IF-XRT alone. This apparent improvement is being further explored in an ongoing randomized trial.

scholarly journals Clinical Characteristics and Outcomes of Extranodal Stage I Diffuse Large B Cell Lymphoma in The Rituximab-Era

Blood ◽  
2020 ◽  
Author(s):  
Sabela Bobillo ◽  
Erel Joffe ◽  
Jessica A. Lavery ◽  
David Sermer ◽  
Paola Ghione ◽  
...  
Keyword(s):  
Disease Free Survival ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
Stage I ◽  
Free Survival ◽  
Large B Cell Lymphoma ◽  
The Central Nervous System ◽  
Multivariable Analyses ◽  
Disease Free

This retrospective study aimed to better define the characteristics and outcomes of extranodal stage I DLBCL in the rituximab era. Patients diagnosed with stage I DLBCL from 2001-2015 treated with rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) or R-CHOP-like regimens with or without radiation (RT) were included. We identified 1955 patients with newly diagnosed DLBCL, of whom 341 had stage I and were eligible for this analysis. Extranodal presentation was observed in 224 (66%) patients, while 117 (34%) had nodal involvement. The most common extranodal sites were bone 21%; stomach 19%; testis 9%; intestine 8%; breast 8%. Overall, 69% extranodal and 68% nodal patients received RT. Median follow-up was 5.5 years (interquartile range 4.3-8.2). 10-year overall survival (OS) and disease-free survival were 77% (95% CI 67%, 83%) and 77% (95% CI 68%, 85%). In the multivariable analyses, extranodal involvement was associated with worse OS (HR 3.44, 95% CI 1.05, 11.30) and progression-free survival (PFS) (HR 3.25, 95% CI 1.08, 9.72) compared to nodal. Consolidation RT was associated with better OS (HR, 0.26, 95% CI 0.12, 0.49) and PFS (HR, 0.35, 95% CI 0.18, 0.69) in the extranodal population; however, the benefit was no longer observed in patients with PET negative at the end of immunochemotherapy. Relapses occurred usually late (median 37 months) and the most common sites were the lymph nodes (31%) and the central nervous system (27%). Extranodal stage I DLBCL had a worse outcome than nodal. End of immunochemotherapy PET results may help select extranodal patients for consolidation RT.

scholarly journals Neo-adjuvant chemotherapy followed by surgery versus definitive chemo radiation as treatment for localized carcinoma cervix

2016 ◽  
Author(s):  
S. Singh ◽  
V. Goel ◽  
V. Talwar ◽  
S. Raina ◽  
S. Mitra ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radical Surgery ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Free Survival ◽  
Common Cancer ◽  
Group A ◽  
Group B ◽  
Disease Free

Background: Cervical cancer is ranked as the most common cancer in Indian women, second most common cancer worldwide and the leading cause of death in the developing countries. In the developing countries majority of the patients are diagnosed at locally advanced stages. The standard treatment of locally advanced cervical cancer is concomitant chemoradiation (CTRT) using platinum based chemotherapy. However, some randomized studies have shown improved results for patients receiving neoadjuvant chemotherapy (NACT) followed by surgical resection in comparison to patient receiving radiation alone. The present study was designed to compare response to the treatment and survival of and NACT followed by radical surgery (RS) with CTRT in the patients of uterine cervix of a tertiary cancer care centre. Patients and Methods: Retrospective study was performed in locally advanced/advance stage patients of cervix UTERI registered in the institute between years 2009 to 2013. Patients were included in the two groups, group A consists of 89 patients who have received NACT + RS and 67 patients in group B who have received CTRT. Clinical records were reviewed with particular reference to presenting complaint, clinical stage, response to the therapy, disease free survival and overall survival. Statistical analysis was done using SPSS version 22. Results: In the neoadjuvant group (group A) (n=89) the median age of patients was 53 years (range 31-80 years), most of the patients (70%) were presented with complaint of postmenopausal bleeding. Of the total patients, 69 (77.5%) underwent to radical surgery and 5 (8.5%) received radiotherapy after NACT. From 69 patients, who had undergone to surgery, 54 (78.3%) had also received radiation. The overall response to induction chemotherapy was 84%. In the chemo radiation group (group B) (n=65) median age was 56 years (33-75 years). Vaginal bleeding (34%) followed by postmenopausal bleeding (32%) was major presenting complaint in this group. Overall response to the complete treatment was 91%. The median follow up time was 14.3 months in group A and 12.2 months in group B. The disease free survival for NACT group was 32 months (95% CI 26.8-36.5) whereas for CTRT group it was 28 months (95% CI 23.5-33) with 12 and 13 recurrences per group (p = .226). In NACT group overall survival was 46.2 months (95% CI 44-48.3) and for CTRT group it was 38.3 months (95%CI 36.6-40) with 3 and 2 deaths per group (p=.883). Conclusion: Present study shows comparable results, with no difference in survival between both the groups. However, NACT + RS group had showed better disease free and overall survival than another group. Further studies should be performed with larger number of patients and longer duration of follow up.

scholarly journals Disease Free Survival of Stage I Endometrial Cancer after Surgery with or without Adjuvant Treatment

2021 ◽  
Vol 55 (1) ◽  
pp. 37
Author(s):  
Woraluk Moradokkasem ◽  
Nungrutai Saeaib ◽  
Tippawan Liabsuetrakul
Keyword(s):  
Endometrial Cancer ◽  
Adjuvant Treatment ◽  
Disease Free Survival ◽  
Myometrial Invasion ◽  
Stage I ◽  
Rank Test ◽  
Free Survival ◽  
Factors Associated ◽  
Disease Free ◽  
Better Than

This study aimed to define the disease free survival (DFS) and factors associated with recurrence in stage I endometrial cancer after surgery with and without adjuvant treatment. The demographic data, pathological results, adjuvant treatment (AT) and the outcome of patients with endometrial cancer stage I after surgery in Songklanagarind Hospital between January 2002 and July 2014 were collected. The DFS was analyzed by survival analysis and represented by Kaplan–Meier curves. The difference of DFS between AT and non-adjuvant treatment (NAT) groups was tested by the log-rank test. Distributions of risk factors by AT and recurrent status were analyzed using chi-square or Fisher exact tests for discrete factors, and unpaired t or Wilcoxon rank-sum tests for continuous factors. The 5-year DFS was; 91.6%, from a total of 268 patients. DFS in the NAT group was significantly better than that in the AT group (95.2 versus 86.5%, p-value = 0.01). Factors associated with recurrence in the NAT group were age, tumor grading, tumor size, and presence of lymphovascular involvement. Among the AT group, age and ratio of myometrial invasion were associated with recurrence. DFS in NAT was better than in AT and the potential factors associated with recurrence, after surgery with or without AT, were not the same.

scholarly journals Disease Free Survival of Stage I Endometrial Cancer after Surgery with or without Adjuvant Treatment

2019 ◽  
Vol 55 (1) ◽  
pp. 37
Author(s):  
Woraluk Moradokkasem ◽  
Nungrutai Saeaib ◽  
Tippawan Liabsuetrakul
Keyword(s):  
Endometrial Cancer ◽  
Adjuvant Treatment ◽  
Disease Free Survival ◽  
Myometrial Invasion ◽  
Stage I ◽  
Rank Test ◽  
Free Survival ◽  
Factors Associated ◽  
Disease Free ◽  
Better Than

This study aimed to define the disease free survival (DFS) and factors associated with recurrence in stage I endometrial cancer after surgery with and without adjuvant treatment. The demographic data, pathological results, adjuvant treatment (AT) and the outcome of patients with endometrial cancer stage I after surgery in Songklanagarind Hospital between January 2002 and July 2014 were collected. The DFS was analyzed by survival analysis and represented by Kaplan–Meier curves. The difference of DFS between AT and non-adjuvant treatment (NAT) groups was tested by the log-rank test. Distributions of risk factors by AT and recurrent status were analyzed using chi-square or Fisher exact tests for discrete factors, and unpaired t or Wilcoxon rank-sum tests for continuous factors. The 5-year DFS was; 91.6%, from a total of 268 patients. DFS in the NAT group was significantly better than that in the AT group (95.2 versus 86.5%, p-value = 0.01). Factors associated with recurrence in the NAT group were age, tumor grading, tumor size, and presence of lymphovascular involvement. Among the AT group, age and ratio of myometrial invasion were associated with recurrence. DFS in NAT was better than in AT and the potential factors associated with recurrence, after surgery with or without AT, were not the same.

Reduced Expression of DKK3 Is Associated With Adverse Clinical Outcomes of Uterine Cervical Squamous Cell Carcinoma

2013 ◽  
Vol 23 (1) ◽  
pp. 134-140 ◽  
Author(s):  
Seok-Woo Ryu ◽  
Jae Hyung Kim ◽  
Mi Kyung Kim ◽  
Youn-Jeong Lee ◽  
Jun-Soo Park ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Disease Free Survival ◽  
Cervical Squamous Cell Carcinoma ◽  
International Federation ◽  
Beta Catenin ◽  
Free Survival ◽  
Gynecology And Obstetrics ◽  
Disease Free

ObjectiveThe aim of this study was to assess the expression of DKK3 protein and its target, beta-catenin, in uterine cervical squamous cell carcinoma and to determine potential clinical correlations.Materials and MethodsSix carcinoma in-situ (CIS) tissues and 88 invasive cervical cancer tissues were included in the study. Twenty-two normal cervical tissues and one gastric cancer tissue were used as controls. The expression of DKK3 and beta-catenin proteins was evaluated by immunohistochemical analysis. Clinical and pathological parameters were obtained from medical records. Survival data were estimated using Kaplan-Meier estimates and compared with a log-rank test. Multivariate analysis was performed using the Cox regression method.ResultsDKK3 was predominantly present in the cytoplasm. Beta-catenin was observed only on the cellular membrane of both normal and cancer cells in contrast to earlier reports, in which beta-catenin was localized to the cytoplasm and nucleus of cancer cells. The expressions of beta-catenin and DKK3 were not correlated. Three of 6 CIS (50%) and 57 of 88 invasive cancer specimens (64.8%) had lower DKK3 expression than normal controls. DKK3 expression was decreased in a stage-dependent manner (P = 0.021). The patients with low expression of DKK3 were older than those with high expression of DKK3 (P < 0.01). Moreover, the patients with low DKK3 expression had a significantly lower 5-year disease-free survival rate than those with high DKK3 expression (P = 0.026). A multivariate analysis showed that International Federation of Gynecology and Obstetrics clinical stage and parametrial involvement were independent prognostic factors.ConclusionDecreased DKK3 expression was associated with advanced International Federation of Gynecology and Obstetrics clinical stages and was predictive of lower disease-free survival in patients with cervical squamous cell carcinoma. DKK3 may be implicated in cervical carcinogenesis through a beta-catenin–independent mechanism.

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