2006, Vol 4, No 1
Biochemical diagnostics of gynecological malignancies – what’s new?
GIN ONKOL, 2006, 4 (1), p. 10-13
ABSTRACT

The analysis of the utility of serum SCC determination, combined with other tumor markers and cytokine assessment in cervical cancer patients, was performed. However, only CA 125 levels were found to relate to the histopathological type of the tumor, and were higher in adenocarcinoma. In addition, in patients with adenocarcinoma, CA 125 presented higher diagnostic sensitivity than CEA, standard tumor marker for cervical cancer. We have also shown that complementary IL-6 and SCC assessment in patients with cervical cancer improve the diagnostic sensitivity, independent of histopathological type. This would be especially important for early diagnostics and monitoring of patients. We have also demonstrated the possible use of bone metabolism markers in patients after oncological treatment with posttreatment osteoporosis, which is a common side effect of cancer treatment. Actually, bone metabolism markers join the array of tumor markers, to monitor osteoporosis treatment. For the monitoring purposes, these markers are more efficient than densitometry methods. Our preliminary results on osteocalcin, PINP and Ctx point at PINP as the most promising marker.

Keywords: tumor markers, cytokines, markers of bone turnover, cervical carcinoma, diagnostic sensitivity
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The evaluation of intra- and postoperative complications related to debulking surgery with bowel resection in patients with FIGO stage III-IV ovarian cancer
GIN ONKOL, 2006, 4 (1), p. 14-22
ABSTRACT

Introduction: The surgical treatment of advanced ovarian cancer patients is based on the maximal debulking. In a lot of patients, the necessity of widening operation range to the infiltrated organs takes place. These procedures may be connected with higher risk of intraoperative and early postoperative complications. Sometimes, the exteriorization of ileostomy is necessary, what leads to the quality of life deterioration. Aims of the study: 1) The assessment of the quantity and quality of intra- and postoperative complications in ovarian cancer patients with FIGO stage III-IV in which, to achieve the optimal debulking, partial bowel resection was performed. 2) The evaluation of intra- and postoperative complications, related to surgery with bowel resection, compared to Hartmann surgery in examined group of patients. Material and method: The analysis of 39 debulking surgical procedures with partial intestinal resection and postoperative period in ovarian cancer patients, FIGO stage III-IV, was performed. The following factors were analyzed: the size of excised tumor, the intestinal resection range, method of anastomosis or stoma exteriorization, size of lesions left, blood loss, hemoglobin concentration before and after surgery, quantity and reasons for reoperations, postoperative complications, the length of hospitalizations, time to start with chemotherapy treatment. Results: During 39 operations, the most frequent type of intestinal resection was the sigmoidectomy or proctosigmoidectomy. This kind of surgery was performed in 29 patients. In the remaining patients, left- and right-side hemicolectomy or partial enterectomy was done. There were 24 enteroenterostomies performed, and 15 Hartmann procedures. In 32 patients, the diameter of left tumor lesions was less than 10 mm. Among complications forcing the reoperations were: bleeding in 3 (7.6%) patients, the separation of anastomosis in 3 (7.6%) patients, bowel obstruction in 1 (2.5%) patient, stomach perforation in 1 (2.5%) patient. There were no deaths during postoperative period. There were not noted any differences between surgery with anastomosis and Hartmann surgery in aspect of quantity of complications, blood loss, and the time of surgery. Conclusions: Intestinal resection, during debulking surgery in advanced ovarian cancer patients, brings good results, and complications related to surgery are to be accepted. The quantity of perioperative complications, related to surgery with anastomosis, and to Hartmann surgery is similar. If it is possible, the surgery with enteroenterostomosis should be performed.

Keywords: Hartmann surgery, ovarian cancer, debulking surgical procedure, intestinal anastomosis, complications related to bowel surgery
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Combined therapy of patients with uterine sarcomas – evaluation of treatment results and analysis of prognostic factors
GIN ONKOL, 2006, 4 (1), p. 23-30
ABSTRACT

Objectives: The aim of the study was to assess the efficacy of combined therapy (surgery plus radiotherapy) and reasons of treatment failure in patients with uterine sarcoma. Material and methods: The analyzed clinical material involved 95 patients with uterine sarcoma (US) treated in the Cracow Branch of the Center of Oncology between 1980 and 1999. The studied group consisted of 70 patients with leiomyosarcoma (LS) and 25 patients with endometrial stromal sarcoma (ESS). Seventy-three women were diagnosed with stage I and II and 22 with stage III and IVA US. All patients in this group underwent radical hysterectomy with salpingo-oophorectomy followed by postoperative irradiation consisting of vaginal brachytherapy and external beam radiotherapy of the small pelvic area. Results: Out of 95 patients in the tested group, 46 (48.4%) patients survived 5 years with no evidence of disease. In the group of early-stage US there were 60.3% 5-year disease-free survivals. None of 9 patients with stage IVA was cured. In 36 among 47 uncured patients (76.6%) distant metastases was found. Conclusion: Combined surgery plus radiotherapy treatment was effective therapy in patients with early-stage US, nevertheless, it was ineffective in the group with advanced US, as none of the 9 patients with grade IVA was cured. The basic cause of treatment failure in the LS group was the spread of malignancy, whereas in the ESS group – locoregional recurrence.

Keywords: sarcoma uteri, surgery, radiotherapy, distant metastases, treatment failure
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Endometrial cancer and concomitant diseases
GIN ONKOL, 2006, 4 (1), p. 31-37
ABSTRACT

Introduction: Among provided risk factors for endometrial cancer, following factors are mentioned: concomitant chronic diseases, especially diabetes, hypertension and obesity, but their influence on the treatment results is still not fully recognized. Objective: The aim of the study was the evaluation of the concomitant diseases influence on the conjugated treatment results in endometrial cancer. Material and method: The study covered 880 endometrial cancer patients, treated with adjuvant radiotherapy, between 1992 and 1998 at Maria Sklodowska-Curie Memorial Cancer Centre in Warsaw. All patients were treated with typical surgery – hysterectomy and adnexectomy. In the analysed group were patients in I, II and III clinical stage, according to FIGO. As the criterion of the treatment effectiveness was the overall survival and disease-free survival accepted. The multivariate Cox’s analysis was performed. The following factors were analysed: clinical stage of the disease, the histological type of the tumour, grading, the depth of stromal invasion, age and the performance status, body mass index (BMI), the period of the hormonal activity and the presence of concomitant diseases. Results: Patients with diabetes were 1.56 times at death risk (p=0.008), and 1.38 times at the disease recurrence risk (p=0.047), when compared to the control group. Conclusions: There has been confirmed, that among the concomitant diseases, only diabetes demonstrated statistical significance, affecting as well overall survival as disease-free survival.

Keywords: risk factors, endometrial cancer, diabetes, concomitant diseases, adjuvant radiotherapy
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Yolk sac tumour – characteristics of patient’s group and treatment outcome
GIN ONKOL, 2006, 4 (1), p. 38-45
ABSTRACT

Introduction: Yolk sac tumour is a very rare, highly aggressive germ cell neoplasm of ovaries. The aim of the paper: The aim of this paper is to present the group of patients, diagnosed with EST, treated in Department of Gynaecological Oncology, Cancer Centre, Warsaw, between 1994-2001. Material and methods: 11 patients were involved into the analysis. Yolk sac tumour was diagnosed in 13.25% of all patients with malignant germ cell tumours of reproductive organs. All patients were operated primarily outside our Centre. Results: The patients age varied from 16 to 44 years of age. Stage I according to FIGO classification was diagnosed in 6 patients (54.5%), 1 patient was with stage II, 2 patients in stage III and 2 patients in IV. All patients received 3 to 7 cycles of chemotherapy based on BEP regimen. I line therapy allowed to obtain 9 complete remissions, 1 stabilization of disease, and 1 case of progression. Recurrence of disease was found in 2 patients after about 6 months from first line treatment. Treatment failures (disease progression or recurrence) was reported in 3 patients that is in 27.7%. 3 patients were lost to follow-up during the first 4 months from prior chemotherapy. Within the rest of the group, no deaths were reported during observation period lasting from 2.6 to more than 10 years. In 3 patients the conservative surgery was performed; one successful pregnancy with delivery of healthy neonate was reported. Conclusions: The cure of the patients with yolk sac tumour is possible nowadays. Also it is possible to preserve fertility. But such outcome require to introduce the therapy as soon as possible, meaning optimal and proper staging surgery as well as intensive and early introduced chemotherapy.

Keywords: yolk sac tumour/endodermal sinus tumour, malignant germ cell tumors, treatment, chemotherapy, surgery
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