2006, Vol 4, No 3
Chemotherapy-related anaemia in ovarian cancer patients treated with paclitaxel and a platinum compound – preliminary analysis
GIN ONKOL 2006, 4 (3), p. 151-159
ABSTRACT

Aim: The aim of the paper is to evaluate the problem of anaemia in patients treated with paclitaxel and cis- or carboplatin as a first line treatment for ovarian cancer. Material and methods: The analysis comprised patients who completed 6 cycles of chemotherapy and who commenced the treatment not sooner than in 2004. The patients were not selected in any way with respect to anaemia. The data concerning the haemoglobin concentration and the management of anaemia were collected retrospectively. The blood counts taken into consideration had been performed on the day of the chemotherapy or on the previous day. Results: The patients’ age ranged from 31 to 78. Patients with FIGO IIIC stage ovarian cancer accounted for 67.5% of the whole group. The haemoglobin concentration at the beginning of the treatment was 9.5 – 14.4 g/dl (average 11.8 g/dl). In the course of subsequent chemotherapy cycles, a gradual decrease was observed, down to the values of 7.2 – 13.8 g/dl (average 10.9 g/dl) at the 6th cycle. In 52 patients, at least one count was below 11 g/dl, including 13 patients with haemoglobin below 9 g/dl. Chemotherapy had to be postponed due to anaemia in 10 patients; 9 patients required erythrocyte concentrate transfusion. No patients was administered epoietin and 3 patients were administered alpha-darbepoietin. Conclusions: 30% of the patients in the whole group maintained a haemoglobin concentration above 11 g/dl in the course of treatment. This fact implies that anaemia is very common in ovarian cancer patients treated with paclitaxel and a platinum compound. However, the prophylaxis or management of anaemia still seems to be insufficient, despite the availability of erythropoietic proteins.

Keywords: anaemia, erythropoietic proteins, chemotherapy, supportive care, ovarian cancer
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Self-image and sexual marital function of post-hysterectomy women. Perspective of patients and their husbands
GIN ONKOL 2006, 4 (3), p. 160-176
ABSTRACT

Aim of the present study is to assess the impact of hysterectomy on marital psychosexual function of women, as seen by themselves and their husbands. Assessment concerns the level of self-esteem and self-image and own sexual impressions and quality of marital sex. Material and method: Fifty marital pairs (100 persons) were assessed using the questionnaire Marital Sexual Problems” including two subscales Sexual Impressions and Quality of Sex and Self-esteem Form. The women finished basic antineoplastic treatment 6 months prior to inclusion in the psychological study. None of the spouses sought psychological or sexological assistance before. Results: Hysterectomy significantly lowered own impressions, libido level, satisfaction derived from sexual intercourse, frequency of orgasm in women treated for cancer. However, in the opinion of their partners, neither sexual response nor quality of sexual life have changed. Both groups differ significantly in the assessment of “real ego” of women, while the assessment of “ideal ego” is identical in both groups. In women, self-esteem decreased significantly after hysterectomy, but their husbands have not noticed any change. Women evaluated worst their physical features and social position, at best – their intellectual virtues and interpersonal relations. Husbands did not notice any difference in physical, intellectual and interpersonal attractiveness, but emphasized lower assessment of their emotional and social status. Conclusions: Divergence of assessment of marital sexual life, problems with self-esteem and self-image performed by women being treated for genital cancer and their husbands indicate areas of threats for marital function. Causes for these threats reside in the lack of good, open communication between partners. Thereof results incomplete knowledge of alterations in feelings, thoughts and behaviour of women induced by treatment of uterine cancer.

Keywords: women, self-image, sexual marital functioning, hysterectomy
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Impact of time-interval between surgery and institution of chemotherapy on prognosis in FIGO stage III ovarian cancer patients
GIN ONKOL 2006, 4 (3), p. 177-185
ABSTRACT

Ovarian cancer is the 5th most common malignancy in Polish women and is the 4th most common cause of death. Surgical treatment with subsequent platinum derivates-based chemotherapy combined with paclitaxel is the cornerstone of treatment of far advanced cases. The aim of this paper was to analyze patients treated since 1995 thru 1999 for FIGO stage III ovarian cancer. The primary end-point was progression-free survival (PFS). Based on our results, time interval between surgery and institution of chemotherapy had no influence on PFS in the study population. Median PFSs for particular quartiles were 8.4 months, 4.9 months, 7.8 months and 7.2 months respectively. Survival curves for these subgroups did not differ significantly (log rank test, p=0.74). Similar results were obtained when analyzing two groups of patients: those undergoing optimal surgical resection and those, in whom optimal procedure was impossible. In conclusion, time interval between surgery and adjuvant chemotherapy does not influence prognosis measured as progression-free survival in FIGO stage III ovarian cancer patients.

Keywords: ovarian cancer, surgery, time interval, chemotherapy
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Prognostic significance of radial and distal clearance for females with T4 rectal cancer requiring hysterectomy
GIN ONKOL 2006, 4 (3), p. 186-192
ABSTRACT

Objectives: Females with unresectable rectal cancer have a poor prognosis. In some cases curative treatment for tumors infiltrating the internal genitalia (T4) may be achieved with multivisceral excision. Radiochemotherapy combined with extended resection can improve local control and survival. Aim of the study was to evaluate long-term oncological outcomes of combined curative therapy with sphincter preservation for women with T4 rectal cancer involving internal reproductive organs. Material and methods: Consecutive 21 females in years 1997-2003 underwent R0 anterior resection of the rectum with excision of internal genitalia in one tissue block combined with radiochemotherapy and were studied retrospectively. Two-year disease-free survival rates were analyzed in relation to patient age, tumor differentiation, lymph node metastases, blood loss, radial and distal resection margins. Results: Survival rate was significantly increased (p<0.05) for females after resections with distal margin minimum 1 cm and radial margin minimum 2 mm microscopically free of cancer infiltration (80.0 vs. 27.3% and 71.4 vs. 14.3%, respectively). Lymph node metastases also significantly influenced poor prognosis (85.7 vs. 35.7%). Age less than 60 years, well or moderate tumor differentiation and blood loss <1 L were related to enhanced survival but with the lack of statistical importance (66.7 vs. 41.8%, 55.6 vs. 55.0% and 75.0 vs. 47.1%, respectively). Conclusions: Extended surgery combined with radiochemotherapy may result in improved long-term outcomes for females with T4 rectal cancer infiltrating internal genitalia. Effective local control with adequate resection margins and node-negative status are significantly related to enhanced survival rates.

Keywords: locally advanced rectal cancer, sphincter preservation, hysterectomy, distal margin, radial margin
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Molecular adhesives in the spreading of epithelial ovarian carcinoma
GIN ONKOL 2006, 4 (3), p. 193-201
ABSTRACT

The spreading of epithelial ovarian carcinoma is associated with molecular mechanisms involving cell surface receptors, components of the basement membrane, intercellular adhesion molecules and cell-derived signals. A crucial role in cell adhesion and mobility is played by E-cadherin and catenin. The expression of the cadherin – catenin complex decreases with clinical progression of ovarian carcinoma. Simultaneously, this complex is re-expressed when neoplasia starts to spread across the peritoneum. A changing expression or malfunctioning of integrin receptors and their relationship with cells of the extracellular matrix (ECM) indicate a strong correlation with the progression of tumour or the potential of metastasis. Lysophosphatide acid mediates a laminin-induced cell migration in the local autocrine regulation. The first step in developing metastasis is the degradation of type IV collagen with the activity of metal proteinases and proangiogenic factors, which are observed to be highly expressed in ovarian carcinoma cells. An essential role in the migration of neoplastic cells that are negatively dependant on growth factors and integrin receptors is played by the kinase of focal adhesion contacts (FAK). An increased expression of this kinase involves a higher clinical progression of tumour, metastases to lymph nodes and the existence of distant metastases. A major prerequisite for metastasis to develop is a disorder of the cell adhesion mechanism, which consequently induces changes in the adhesion between cells and between cells and the extracellular matrix. This mechanism is of vital importance to the spreading of ovarian carcinoma within the abdominal cavity.

Keywords: epithelial ovarian carcinoma, cell adhesion, FAK, cadherin
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