2006, Vol 4, No 2
The management of the gestational trophoblastic disease
GIN ONKOL 2006, 4 (2), p. 79-89
ABSTRACT

The gestational trophoblastic disease comprises 4 different diseases, i.e. hydatiform mole, invasive mole, choriocarcinoma and placental site tumour. Their common feature is the excretion of HCG and high chemosensitivity (with the exception of the placental site tumour). In the low-risk group the curability reaches 100%, thanks to single-agent therapy with methotrexate or dactinomycin. In the high-risk group, multi-drug chemotherapy is used; the most common regimen is EMA-CO: etoposide, methotrexate, dactinomycin, vincristine and cyclophosphamide. The response rate is about 80%. The presence of brain metastases (10%) requires simultaneous radio- and chemotherapy. Many time, the treatment is preceded by excision of the metastatic tumour on craniotomy. There have been attempts at radiotherapy and/or hepatic arteries embolisation in case of liver metastases (10%). Metastatic lesion in the lungs (80%) require long chemotherapy, but after HCG decreases to normal limits, residual lesions in the lungs are merely radiological findings and do not require further treatment. The management of relapses is a combination of surgery and chemotherapy. The leading regimen is EMA-CE: etoposide, methotrexate, dactinomycin and cisplatin. High-dose chemotherapy with subsequent stem cells transplantation is attempted. Rescue regimens in the recurrent disease are successfully based on paclitaxel, cisplatin and etoposide. The follow-up consists in determination of the serum HCG concentration.

Keywords: gestational trophoblastic disease (GTD), chemotherapy, metastases, combined treatment, relapses, follow-up
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Is optimal surgical cytoreduction an independent prognostic factor for women with advanced ovarian cancer?
GIN ONKOL 2006, 4 (2), p. 90-98
ABSTRACT

In Poland ovarian cancer is on fifth place regarding morbidity and fourth most common cause of cancer-related death in women. Surgical cytoreduction followed by paclitaxel and platinum-based chemotherapy is standard of care in advanced ovarian cancer. The aim of this study was to assess, if optimal surgical cytoreduction is an independent prognostic factor in this group of patients. Clinical data of 358 women with FIGO stage III ovarian cancer treated in Maria Sklodowska-Curie Memorial Cancer Centre – Institute, Warsaw, between 1995 and 1999 were assessed. Primary endpoint was PFS. Multivariable analysis showed that optimal surgical cytoreduction was not independent prognostic factor. Optimal surgery was statistically less frequently performed in older patients (p=0.06; borderline statistical significance), FIGO stage III C and patients with performance status 1 or 2 according to WHO criteria (p<0.001). Grade and FIGO stage were identified as independent prognostic factors for PFS. Median PFS were 11.4 and 5.7 months in optimally and suboptimally cytoreduced group respectively. We conclude that optimal surgical cytoreduction was not independent prognostic factor in this group of patients because there was correlation between surgical resectability and certain clinical factors.

Keywords: ovarian cancer, surgery, optimal cytoreduction, residual disease
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Tumour hypoxia as a predictive factor for radiotherapy
GIN ONKOL 2006, 4 (2), p. 99-107
ABSTRACT

Radiotherapy is, next to surgery, the basic method of treatment in oncology. The intensive searching of the predictive factors for radiotherapy effectiveness, are still continuing. The mechanism of radiotherapy action depends on the cellular oxygen presence. The latest studies evidence, that the molecular oxygen, through the mechanism of fixation, leads to destruction of the DNA damage, caused by the ionizing radiation, repair. Number of studies has demonstrated, that the tumour hypoxia evaluation correlates with radiotherapy effectiveness. However, the universal method assessing the tumour hypoxia does not exist. Actually used methods, as Eppendorf’s electrode, the molecular markers of hypoxia evaluation, or PET studies with oxydo-reductive radiopharmaceutical agents, bring conflicting results. So, a lot of doubts about the quantitative and qualitative character of relationship between hypoxia and sensitivity for radiotherapy still exist. Moreover, the analysis is impeded by fact, that the hypoxia has significant negative prognostic influence on the treatment results with radiotherapy, through the genome and proteomic changes induction. The paper presents the actual status of knowledge about the influence of tumour hypoxia on radiotherapy effectiveness.

Keywords: hypoxia, radiotherapy, predictive assay, anemia, cervix carcinoma
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The effectiveness of multimodality management of the rectal cancer in females
GIN ONKOL 2006, 4 (2), p. 108-114
ABSTRACT

Rectal cancer incidence among females in Poland increases. Surgery remains the mainstay of treatment. Anterior resection with total mesorectal excision (TME) is the preferred option in the most cases. Some patients have locally advanced tumours or synchronous gynaecologic abnormalities and need extended resections. Objective: Aim of the study was the evaluation of incidence and pattern of concomitant gynaecologic lesions and analysis of impact of multimodality co-operation between surgeon and gynaecologist on functional and oncological outcomes. Material and methods: Consecutive 34 women (age 35-81, mean 59.6) underwent R0 resection with sphincter-preserving TME from 01.1998 to 12.1999 and were studied prospectively. Follow-up period was five years. Results: 9% females underwent hysterectomy or adnexectomy previously. At the time of surgery 36% had abnormal internal genitalia: 15% at the uterus, 6% at ovaries, 6% at uterus and ovaries, in 9% adherence to the rectum was found. In 3% malignant infiltration was microscopically confirmed. No postoperative mortality was noticed. Anastomotic leakage developed in 9%, postoperative bleeding in 3%, delayed wound healing in 12%, prolonged bowel paralysis in 3%, anterior resection syndrome in 6%, urological disturbances in 9%. Isolated local recurrences were found in 6%. 64% five-year overall survival was achieved. Survival rate was 91.7% in Dukes A, 63.6% in B and 36.4% in C (p<0.05). Conclusions: Numerous females with rectal cancer have gynaecologic abnormalities and need extended resections. Due to adequate co-operation of surgeon and gynaecologist and optimal multimodality management, acceptable postoperative morbidity and optimising oncological outcomes can be achieved.

Keywords: rectal cancer, anterior resection, total mesorectal excision (TME), hysterectomy, adnexectomy
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Assessment of quality of life of patients with ovarian cancer treated by multidrug chemotherapy based on questionnaire-aided survey
GIN ONKOL 2006, 4 (2), p. 115-124
ABSTRACT

The paper aims to assess the quality of life of patients with ovarian cancer treated by multidrug chemotherapy. Our material includes 383 females treated at the Department of Female Genital Neoplasms of the Centre of Oncology in Warsaw, Poland, since 2001 thru 2004. The study was performed based on the questionnaires QLQ-C30 and QLQ-OV28, supplied by the EORTC bureau in Brussels, Belgium. One subgroup included 280 patients receiving paclitaxel- and platinum-based chemotherapy regimens. Another subgroup of 103 women received Endoxan- and platinum-based chemotherapy. When assessing the patients’ quality of life, the following parameters were taken into account: age, clinical stage of neoplasm, completeness of surgical resection and treatment phase. The patients were questioned before institution of chemotherapy, in the middle of treatment (after 3 courses) and after termination of treatment. Based on the results obtained, we may state that clinical stage, completeness of resection and treatment phase have a significant influence on the patients’ quality of life, while type of chemotherapy had no impact on the quality of life parameters analysed. Very frequent disorders of emotional and social functioning of the patients usually took the form of reluctant attitude towards the disease and treatment, as well as a negative perception of own body. Predominance of psychological disorders over physical symptoms suggests that maybe a greater emphasis should be placed on psychological care of oncology patients.

Keywords: ovarian cancer, quality of life, QLQ-C30 and QLQ-OV28 questionnaires, performance score, symptom score
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Ligation of internal iliac arteries in life-threatening bleeding in patients with uterine cervical cancer
GIN ONKOL 2006, 4 (2), p. 125-130
ABSTRACT

Massive bleeding from an extensive, exophytic tumour is a serious complication in treatment of advanced stages of cervical carcinoma. Ligation of the internal iliac artery is an effective, therapeutic procedure in controlling massive bleeding by process of tissue ischaemia. Although in a number of cases, surgical approach requires good anatomical knowledge and skills because of the highly deformed pelvic anatomy due to radiotherapy or to the recurrence of cancerous tissue. The aim of the study was to evaluate internal iliac artery ligation in patient with advanced cervical cancer with massive, life-threatening bleeding. The described patient’s case illustrates common clinical course of an advanced stage of a cervical cancer treated with internal iliac artery ligation, when the local methods of haemostasis are ineffective. The extensive cancer process extent unables introduction of haemostatics brachyteraphy. Massive bleeding and progressive anaemia could only be controlled by surgical internal iliac artery ligation. The above described proceeding enables administration of further treatment in a short period of time and improves the quality of patient's life.

Keywords: internal iliac artery, artery ligation, cervical cancer, advanced stage carcinoma, haemorrhage
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