Neoadjuvant chemotherapy prior to fertility-sparing surgery in cervical tumors larger than 2 cm: a systematic review on fertility and oncologic outcomes

2021 ◽  
Vol 31 (3) ◽  
pp. 387-398
Author(s):  
Javier Burbano ◽  
Fernando Heredia ◽  
Daniel Sanabria ◽  
Edison Gilberto Ardila ◽  
David Viveros-Carreño ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cervical Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Systematic Reviews ◽  
Observational Studies ◽  
Oncologic Outcomes ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Fertility Sparing Surgery ◽  
Fertility Sparing

BackgroundManagement of cervical cancer tumors >2 cm has been a subject of controversy, with management often considered as either up-front radical trachelectomy or neoadjuvant chemotherapy before fertility-sparing surgery.MethodsA systematic literature review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) checklist. This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO). We searched Medline through PubMed, EMBASE, Cochrane Central Register of Controlled Trials, SCOPUS, and OVID between January 1985 and December 2020. Eligibility criteria for selecting studies were English language, randomized controlled trials, and observational studies including information on fertility and oncologic outcomes. All titles were managed in EndNote X7. Risk of bias was evaluated using the Joanna Briggs Institute (JBI) critical appraisal checklist for observational studies.ResultsTwenty-three studies with 205 patients who received neoadjuvant chemotherapy were included. The majority of patients (92.2%, n=189) had stage IB FIGO 2009 cervical cancer. The preferred regimen used was cisplatin in combination with paclitaxel or ifosfamide (80%, n=164). One hundred and eighty patients (87.8%) underwent fertility-sparing surgery; radical vaginal trachelectomy, abdominal trachelectomy, conization, and simple trachelectomy were performed in 62 (34.4%), 49 (27.2%), 34 (18.9%), and 26 (14.4%) women, respectively. In nine patients (5%) the type of procedure was not specified. The follow-up time reported in all studies ranged between 6 and 69 months. In 112 women who sought a pregnancy after surgery, 84.8% (n=95) achieved a gestation.The global recurrence and death rates were 12.8% and 2.8%, respectively.ConclusionNeoadjuvant chemotherapy followed by fertility-sparing surgery is a promising strategy that might allow fertility preservation in highly selected patients with cervical cancer with tumors >2 cm while providing acceptable oncologic outcomes. Results of prospective studies are required to validate its oncological safety.Systematic review registration numberPROSPERO CRD42020203789.

scholarly journals Fertility sparing surgery following neoadjuvant chemotherapy of cervical cancer figo stage IB2 - case report

2019 ◽  
Author(s):  
Aljosa Mandic ◽  
Miona Davidovic-Grigoraki ◽  
Bojana Gutic ◽  
Natasa Prvulovic Bunovic ◽  
Nenad Solajic ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Case Report ◽  
Neoadjuvant Chemotherapy ◽  
Figo Stage ◽  
Fertility Sparing Surgery ◽  
Fertility Sparing

scholarly journals Impact of integrating pharmacists into primary care teams on health systems indicators: a systematic review

2019 ◽  
Vol 69 (687) ◽  
pp. e665-e674 ◽  
Author(s):  
Benedict Hayhoe ◽  
Jose Acuyo Cespedes ◽  
Kimberley Foley ◽  
Azeem Majeed ◽  
Judith Ruzangi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Health System ◽  
Quality Assessment ◽  
Observational Studies ◽  
Assessment Tool ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Quality Assessment Tool

BackgroundEvidence suggests that pharmacists integrated into primary care can improve patient outcomes and satisfaction, but their impact on healthcare systems is unclear.AimTo identify the key impacts of pharmacists’ integration into primary care on health system indicators, such as healthcare utilisation and costs.Design and settingA systematic review of literature.MethodEmbase, MEDLINE, Scopus, the Health Management Information Consortium, CINAHL, and the Cochrane Central Register of Controlled Trials databases were examined, along with reference lists of relevant studies. Randomised controlled trials (RCTs) and observational studies published up until June 2018, which considered health system outcomes of the integration of pharmacists into primary care, were included. The Cochrane risk of bias quality assessment tool was used to assess risk of bias for RCTs; the National Institute of Health National Heart, Lung, and Blood Institute quality assessment tool was used for observational studies. Data were extracted from published reports and findings synthesised.ResultsSearches identified 3058 studies, of which 28 met the inclusion criteria. Most included studies were of fair quality. Pharmacists in primary care resulted in reduced use of GP appointments and reduced emergency department (ED) attendance, but increased overall primary care use. There was no impact on hospitalisations, but some evidence of savings in overall health system and medication costs.ConclusionIntegrating pharmacists into primary care may reduce GP workload and ED attendance. However, further higher quality studies are needed, including research to clarify the cost-effectiveness of the intervention and the long-term impact on health system outcomes.

Oncological and pregnancy outcomes after high-dose density neoadjuvant chemotherapy and fertility-sparing surgery in cervical cancer

2014 ◽  
Vol 135 (2) ◽  
pp. 213-216 ◽  
Author(s):  
Helena Robova ◽  
Michael J. Halaska ◽  
Marek Pluta ◽  
Petr Skapa ◽  
Jan Matecha ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Pregnancy Outcomes ◽  
High Dose ◽  
Fertility Sparing Surgery ◽  
Fertility Sparing

scholarly journals Fertility-Sparing Surgery In Early Stage Cervical Cancer

2018 ◽  
Vol 12 (1) ◽  
pp. 37
Author(s):  
IN Gede Budiana ◽  
Tjokorda Gede Astawa Pemayun
Keyword(s):  
Cervical Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Early Stage ◽  
Reproductive Function ◽  
Reproductive Age ◽  
Radical Trachelectomy ◽  
Fertility Sparing Surgery ◽  
Younger Age ◽  
Fertility Sparing ◽  
Early Stage Cervical Cancer

Cervical cancer is a malignancy in women that cause major impacts, not only biologically, but also in various aspects of life. On patients during reproductive age, cervical cancer poses severe sexual and reproductive debilitation. Trend in the onset of first diagnosis is moving towards younger age, and mostly affect women in their reproductive age. This would give a bad impact on the sustainability of the patient’s reproductive function. Until now, fertilitysparing approach for the management of early-stage cervical cancer is still rare in Indonesia. However, some options of conservative surgical therapy are available for patients who desire fertility, namely conization, simple tracellectomy, radical trachelectomy, and also neoadjuvant chemotherapy. These options have been proven effective and safe, while maintaining patients’ reproductive functions. ABSTRAKKanker serviks merupakan suatu penyakit keganasan pada wanita yang memiliki dampak luas, tidak hanya pada tubuh penderita, namun juga berbagai aspek kehidupan penderita. Pada penderita di usia reproduktif, kanker serviks menimbulkan masalah seksual dan reproduksi yang berat bagi penderita. Kini usia dimana terjadinya kanker serviks mulai menunjukkan kecenderungan yang semakin muda yang tentunya memberikan dampak buruk terhadap keberlangsungan fungsi reproduksi pasien. Hingga saat ini, tatalaksana kanker serviks stadium awal dengan pendekatan fertility-sparing masih jarang dilakukan di Indonesia. Namun, beberapa pilihan terapi bedah konservatif tersedia bagi pasien yang menginginkan fertilitas, yakni konisasi, trakelektomi sederhana, trakelektomi radikal. hingga pemberian kemoterapi neo-adjuvant. Pilihan terapi ini telah terbukti efektif dan aman, serta mampu mem pertahankan fungsi reproduksi pasien.

scholarly journals Bivalirudin Versus Heparin During Intervention in Acute Coronary Syndrome: A Systematic Review of Randomized Trials

2020 ◽  
Vol 20 (1) ◽  
pp. 3-15
Author(s):  
Sukhdee Bhogal ◽  
Debabrata Mukherjee ◽  
Jayant Bagai ◽  
Huu T. Truong ◽  
Hemang B. Panchal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Stent Thrombosis ◽  
Systematic Reviews ◽  
Bleeding Complications ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Coronary Syndrome ◽  
Ischemic Complications ◽  
Meta Analyses ◽  
Acute Stent Thrombosis

Introduction: Bivalirudin and heparin are the two most commonly used anticoagulants used during Percutaneous Coronary Intervention (PCI). The results of Randomized Controlled Trials (RCTs) comparing bivalirudin versus heparin monotherapy in the era of radial access are controversial, questioning the positive impact of bivalirudin on bleeding. The purpose of this systematic review is to summarize the results of RCTs comparing the efficacy and safety of bivalirudin versus heparin with or without Glycoprotein IIb/IIIa Inhibitors (GPI). Methods: This systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses PRISMA statements for reporting systematic reviews. We searched the National Library of Medicine PubMed, Clinicaltrial.gov and the Cochrane Central Register of Controlled Trials to include clinical studies comparing bivalirudin with heparin in patients undergoing PCI. Sixteen studies met inclusion criteria and were reviewed for the summary. Findings: Several RCTs and meta-analyses have demonstrated the superiority of bivalirudin over heparin plus routine GPI use in terms of preventing bleeding complications but at the expense of increased risk of ischemic complications such as stent thrombosis. The hypothesis of post- PCI bivalirudin infusion to mitigate the risk of acute stent thrombosis has been tested in various RCTs with conflicting results. In comparison, heparin offers the advantage of having a reversible agent, of lower cost and reduced incidence of ischemic complications. Conclusion: Bivalirudin demonstrates its superiority over heparin plus GPI with better clinical outcomes in terms of less bleeding complications, thus making it as anticoagulation of choice particularly in patients at high risk of bleeding. Further studies are warranted for head to head comparison of bivalirudin to heparin monotherapy to establish an optimal heparin dosing regimen and post-PCI bivalirudin infusion to affirm its beneficial effect in reducing acute stent thrombosis.

Fertility-sparing surgery of cervical cancer >2 cm (International Federation of Gynecology and Obstetrics 2009 stage IB1–IIA) after neoadjuvant chemotherapy

2019 ◽  
Vol 30 (1) ◽  
pp. 115-121 ◽  
Author(s):  
Freweini Martha Tesfai ◽  
Judith R Kroep ◽  
Katja Gaarenstroom ◽  
Cor De Kroon ◽  
Rhiannon Van Loenhout ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Neoadjuvant Chemotherapy ◽  
International Federation ◽  
Obstetric Outcomes ◽  
Clear Cell Adenocarcinoma ◽  
Radical Trachelectomy ◽  
Fertility Sparing Surgery ◽  
Gynecology And Obstetrics ◽  
Fertility Sparing ◽  
Cervical Tumors

ObjectiveTo assess the feasibility, safety, oncological, and obstetric outcomes in patients with cervical tumors >2 cm treated with neoadjuvant chemotherapy in preparation for abdominal radical trachelectomy.MethodsA retrospective analysis of patients with cervical cancer >2 cm (up to 6 cm) was conducted in patients who were selected to receive neoadjuvant chemotherapy before abdominal radical trachelectomy. Surgical and clinical outcomes were examined in relation to radiological and pathological results. In addition, obstetric outcomes were described. The Mann–Whitney U test and Fisher’s exact test were performed to compare radiological findings between successful and unsuccessful abdominal radical trachelectomy procedures. International Federation of Gynecology and Obstetrics (FIGO) 2009 staging classification was used for this study.ResultsA total of 19 women were treated with neoadjuvant chemotherapy for cervical tumors >2 cm at our institution between May 2006 and July 2018. The median age was 28 years (range 19–36). The distribution of FIGO stages was seven patients stage IB1 (37%), 10 patients stage IB2 (53%), and two patients (10%) stage IIA. Mean clinical tumor size was 4.4 cm (range 3.5–6.0). Histology revealed 74% cases of squamous cell carcinoma. The remaining patients had adenocarcinoma (21%) and only one patient had clear cell adenocarcinoma (5%). Chemotherapy consisted of six weekly cycles of cisplatin (70 mg/m2) and paclitaxel (70 mg/m2). In 15 of the 19 patients (74%) fertility was successfully preserved. In the four patients in whom fertility preservation failed, one patient had stable disease after three cycles and did not meet the criteria for fertility-sparing surgery and three patients had intra- or post-operative indications for adjuvant therapy. Three of the 19 patients (15.7%) had a relapse, two of whom died. One case was in the group of successful abdominal radical trachelectomy.ConclusionNeoadjuvant chemotherapy followed by fertility-sparing surgery may be a feasible and safe option in select patients with cervical tumors >2 cm. Unfavorable prognostic factors are defined as non-responsiveness and non-squamous pathology, which can help in patient selection for fertility-sparing surgery.

Oncological outcomes after fertility-sparing surgery for cervical cancer: a systematic review

2016 ◽  
Vol 17 (6) ◽  
pp. e240-e253 ◽  
Author(s):  
Enrica Bentivegna ◽  
Sebastien Gouy ◽  
Amandine Maulard ◽  
Cyrus Chargari ◽  
Alexandra Leary ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cervical Cancer ◽  
Oncological Outcomes ◽  
Fertility Sparing Surgery ◽  
Fertility Sparing

scholarly journals Buteyko method for people with asthma: a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e049213
Author(s):  
Karla Morganna Pereira Pinto de Mendonça ◽  
Sean Collins ◽  
Tácito ZM Santos ◽  
Gabriela Chaves ◽  
Sarah Leite ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Secondary Data ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Plain Language ◽  
Randomised Controlled ◽  
Meta Analyses

IntroductionButeyko method is recommended as a non-pharmacological treatment for people with asthma. Although the worldwide interest in the Buteyko method, there is a paucity of studies gathering evidence to support its use. Therefore, we aim to conduct a systematic review and meta-analysis to assess the effects of the Buteyko method in children and adults with asthma.Methods and analysisWe will search on Cochrane Central Register of Controlled Trials, MEDLINE, Embase, US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov and WHO International Clinical Trials Registry Platform for studies focusing on the Buteyko method for children and adults with asthma. The searches will be carried out in September 2021 from database’s inception to the present. We will include randomised controlled trials comparing Buteyko method alone with asthma education or inactive control intervention. There will be no restriction on language. Primary outcomes include quality of life, asthma symptoms and adverse events/side effects. Two review authors will independently screen the studies for inclusion and extract data. We will assess the quality of the included studies using the ‘Risk of Bias’ tool. The certainty of the evidence will be assessed using the GRADE approach. Data synthesis will be conducted using Review Manager software. Reporting of the review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance and the Cochrane Handbook for Systematic Reviews of Interventions.Ethics and disseminationThis study will assess and provide evidence for the use of the Buteyko method in people with asthma. We will analyse secondary data and this does not require ethics approval. The findings will be published in peer-reviewed journals, at relevant conferences and will be shared in plain language in social media. Moreover, the findings of this review could guide the direction of healthcare practice and research.PROSPERO registration numberCRD42020193132.

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