scholarly journals Conservative Surgery in Endometrial Cancer

2021 ◽  
Vol 11 (1) ◽  
pp. 183
Author(s):  
Alessandra Gallo ◽  
Ursula Catena ◽  
Gabriele Saccone ◽  
Attilio Di Spiezio Sardo
Keyword(s):  
Endometrial Cancer ◽  
Standard Of Care ◽  
Complete Response ◽  
Conservative Surgery ◽  
Primary Treatment ◽  
Nccn Guidelines ◽  
Fertility Sparing ◽  
Age Of Diagnosis ◽  
Cancer Network ◽  
Hysteroscopic Resection

Endometrial cancer (EC) is the sixth most common female cancer worldwide. The median age of diagnosis is 65 years. However, 4% of women diagnosed with EC are younger than 40 years old, and 70% of these women are nulliparous. These data highlight the importance of preserving fertility in these patients, at a time when the average age of the first pregnancy is significantly delayed and is now firmly established at over 30 years of age. National Comprehensive Cancer Network (NCCN guidelines state that the primary treatment of endometrial endometrioid carcinoma, limited to the uterus, is a total hysterectomy, bilateral salpingo-oophorectomy and surgical staging. Fertility-sparing treatment is not the standard of care, and patients eligible for this treatment always have to undergo strict counselling. Nowadays, a combined approach consisting of hysteroscopic resection, followed by oral or intrauterine-released progestins, has been reported to be an effective fertility-sparing option. Hysteroscopic resection followed by progestins achieved a complete response rate of 95.3% with a recurrence rate of 14.1%. The pregnancy rate in women undergoing fertility-sparing treatment is 47.8%, but rises to 93.3% when only considering women who tried to conceive during the study period. The aim of the present review is to provide a literature overview reflecting the current state of fertility-sparing options for the management of EC, specific criteria for considering such options, their limits, the implications for reproductive outcomes and the latest research trends in this direction.

Financial conflicts of interest among the National Comprehensive Cancer Network (NCCN) Clinical Practice Guideline (CPG) Panelists in 2019.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 15-15
Author(s):  
Aakash Desai ◽  
Madhuri Chengappa ◽  
Ronald S. Go ◽  
Thejaswi Poonacha
Keyword(s):  
Expert Witness ◽  
Conflicts Of Interest ◽  
Standard Of Care ◽  
Nccn Guidelines ◽  
Non Hodgkin Lymphoma ◽  
Advisory Boards ◽  
The Us ◽  
Financial Conflicts Of Interest ◽  
Cancer Network ◽  
The Impact

15 Background: CPG are evidence-based guidelines, which serve as a standard of care in practice, quality improvement, and reimbursement. The extent of financial conflicts of Interest (FCOI) in NCCN guidelines has not been recently evaluated. Our study evaluated the extent of FCOI in the NCCN CPG among the 10 most common malignancies in the US. Methods: We examined the latest 2019 version of the NCCN CPG for the 10 most common cancers by incidence in the US. Using disclosure lists, we catalogued the FCOIs for the panelists under various categories outlined in the CPG. We also tabulated the companies/institutions involved in each disclosure. An “episode” describes 1 instance of participation of a panelist in 1 company in 1 category of each guideline. “Affiliation” describes a commercial, industry, or institute affiliation reported by a panelist in each episode. Results: Of the 491 panelists on the CPG, 483 (98.3%) completed FCOI disclosures. 224 (46.38%) reported at least 1 FCOI. A total of 1,103 episodes were disclosed with an average of 4.9 episodes per panelist with FCOI. Being a part of scientific advisory boards, consultant, or expert witness was the most common FCOI category (19.9%). A total of 191 companies were associated with 1,103 episodes of FCOI. The top companies were Bristol Myers Squibb, Merck, Genentech and AstraZeneca. Among the top 10 cancers, the prevalence of FCOI were lung (56%), bladder (52%), pancreatic (52%), non-Hodgkin lymphoma (50%), kidney (49%), colorectal (43%), breast (42%), melanoma (40%), prostate (38%), and uterine (32%). Among the panelists with FCOI, 26%, 17%, and 57% reported 1, 2, and > 3 episodes, respectively. There were 127 episodes among the CPG chairs/vice chairs who reported FCOI (mean 6.4). The chairs/vice chairs of uterine, pancreatic, melanoma, and prostate cancer CPG did not have any FCOI. Conclusions: FCOI are very prevalent among the top 10 NCCN CPG panelists. In almost half of the CPG, the majority of the panelists had at least 1 FCOI. Over half of the CPG chairs/vice chairs reported multiple FCOI. Further studies are necessary to determine the impact of these FCOI.

Combined Oral Medroxyprogesterone/Levonorgestrel-Intrauterine System Treatment for Women With Grade 2 Stage IA Endometrial Cancer

2017 ◽  
Vol 27 (4) ◽  
pp. 738-742 ◽  
Author(s):  
Ji Young Hwang ◽  
Da Hee Kim ◽  
Hyo Sook Bae ◽  
Mi-La Kim ◽  
Yong Wook Jung ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Progressive Disease ◽  
Medical Center ◽  
Endometrial Adenocarcinoma ◽  
Complete Response ◽  
Dilatation And Curettage ◽  
Fertility Sparing ◽  
Stage Ia ◽  
The Mean

ObjectiveThe aim of this study was to evaluate the oncologic and pregnancy outcomes of combined oral medroxyprogesterone acetate (MPA)/levonorgestrel-intrauterine system (LNG-IUS) treatment in young women with grade 2–differentiated stage IA endometrial adenocarcinoma who wish to preserve fertility.MethodsWe retrospectively reviewed the medical records of patients with grade 2 stage IA endometrial adenocarcinoma who had received fertility-sparing treatment at CHA Gangnam Medical Center between 2011 and 2015. All of the patients were treated with combined oral MPA (500 mg/d)/LNG-IUS, and follow-up dilatation and curettage were performed every 3 months.ResultsA total of 5 patients were included in the study. The mean age was 30.4 ± 5.3 years (range, 25–39 years). After a mean treatment duration of 11.0 ± 6.2 months (range, 6–18 months), complete response (CR) was shown in 3 of the 5 patients, with partial response (PR) in the other 2 patients. One case of recurrence was reported 14 months after achieving CR. This patient was treated again with combined oral MPA/LNG-IUS and achieved CR by 6 months. The average follow-up period was 44.4 ± 26.2 months (range, 12–71 months). There were no cases of progressive disease. No treatment-related complications arose.ConclusionsCombined oral MPA/LNG-IUS treatment is considered to be a reasonably effective fertility-sparing treatment of grade 2 stage IA endometrial cancer. Although our results are encouraging, it is preliminary and should be considered with experienced oncologists in well-defined protocol and with close follow-up.

Hysteroscopic Resection in Fertility-Sparing Surgery for Atypical Hyperplasia and Endometrial Cancer: Safety and Efficacy

2015 ◽  
Vol 22 (7) ◽  
pp. 1178-1182 ◽  
Author(s):  
Patrizia De Marzi ◽  
Alice Bergamini ◽  
Stefania Luchini ◽  
Micaela Petrone ◽  
Gian Luca Taccagni ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Atypical Hyperplasia ◽  
Safety And Efficacy ◽  
Fertility Sparing Surgery ◽  
Fertility Sparing ◽  
Hysteroscopic Resection

Impact of treatment duration in fertility-preserving management of endometrial cancer or atypical endometrial hyperplasia

2019 ◽  
Vol 29 (4) ◽  
pp. 699-704 ◽  
Author(s):  
Yiqin Wang ◽  
Rong Zhou ◽  
Haibo Wang ◽  
Huixin Liu ◽  
Jianliu Wang
Keyword(s):  
Endometrial Cancer ◽  
Pregnancy Rate ◽  
Treatment Duration ◽  
Endometrial Hyperplasia ◽  
Complete Response ◽  
Time Interval ◽  
Duration Of Treatment ◽  
Atypical Endometrial Hyperplasia ◽  
Fertility Sparing ◽  
Significant Difference

ObjectiveFertility preservation is an option for selected patients with endometrial hyperplasia or cancer. This study aimed to evaluate whether duration of treatment impacts the oncologic and reproductive outcomes.MethodsWe retrospectively reviewed patients diagnosed with endometrial cancer/atypical endometrial hyperplasia who underwent fertility-sparing treatment from January 2012 to December 2016. As the duration of treatment required by the patients was different, the patients who achieved a complete response were grouped according to the treatment duration as groups A (≤6 months), B (6–9 months), and C (>9 months).ResultsWith the prolongation of treatment duration from 6 months to 9 months to >9 months, the accumulative complete response rates for 67 patients were 58%, 76%, and 95.5%, respectively. Among groups A, B, and C there was no significant difference in the relapse rates (21.1%, 25%, and 36.4%, respectively, p=0.60) or the median time interval to relapse (14, 13, and 13.5 months, respectively, p=0.90). Maintenance treatment was an independent protective factor for recurrence (p=0.001), while the complication of diabetes was an independent risk factor for recurrence (p=0.03). Fertility rates (31%, 18.2%, and 62.5%, respectively, p=0.12) and the time interval to pregnancy (14, 13, and 8 months, respectively, p=0.67) were not significantly different among the three groups. Assisted reproductive technology was positively associated with a higher pregnancy rate (p=0.02) and a body mass index ≥25 kg/m2 was negatively associated with the pregnancy rate (p=0.047).ConclusionsLonger treatment duration was associated with higher rates of complete response. Longer treatment duration (>9 months) was not associated with a decrease in success rates of pregnancy.

scholarly journals Small Bowel Adenocarcinoma, Version 1.2020, NCCN Clinical Practice Guidelines in Oncology

2019 ◽  
Vol 17 (9) ◽  
pp. 1109-1133 ◽  
Author(s):  
Al B. Benson ◽  
Alan P. Venook ◽  
Mahmoud M. Al-Hawary ◽  
Mustafa A. Arain ◽  
Yi-Jen Chen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Small Bowel ◽  
Treatment Options ◽  
Standard Of Care ◽  
Primary Treatment ◽  
Evidence Based ◽  
Small Bowel Adenocarcinoma ◽  
Advanced Stage ◽  
Nccn Guidelines ◽  
Rare Malignancy

Small bowel adenocarcinoma (SBA) is a rare malignancy of the gastrointestinal tract that has increased in incidence across recent years. Often diagnosed at an advanced stage, outcomes for SBA are worse on average than for other related malignancies, including colorectal cancer. Due to the rarity of this disease, few studies have been done to direct optimal treatment, although recent data have shown that SBA responds to treatment differently than colorectal cancer, necessitating a separate approach to treatment. The NCCN Guidelines for Small Bowel Adenocarcinoma were created to establish an evidence-based standard of care for patients with SBA. These guidelines provide recommendations on the workup of suspected SBA, primary treatment options, adjuvant treatment, surveillance, and systemic therapy for metastatic disease. Additionally, principles of imaging and endoscopy, pathologic review, surgery, radiation therapy, and survivorship are described.

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