2007, Vol 5, No 1
Diagnosis and treatment of neuroendocrine cervical cancer – own experience and review of literature
GIN ONKOL 2007, 5 (1), p. 6-14
ABSTRACT

Aim of paper: Neuroendocrine cervical cancer is a significant diagnostic and therapeutic challenge. For many years, these neoplasms were not differentiated from small-cell cancer. It was known, that these cancers were associated with poor prognosis and, in spite of combination of several therapeutic modalities, treatment outcome was far below expectations. Material and methods: Based on retrospective analysis and using synaptophysin and chromogranin A staining and assessment of cellular proliferative activity using MIB1 antibodies, out of 14 small-cell cancers 5 cases were selected, which fulfilled the criteria for neuroendocrine neoplasms and clinical course of the patients affected was analyzed. Results: In all cases, the disease has been diagnosed in FIGO stage I. Treatment consisted in extended hysterectomy m. Wertheim-Meigs and adjuvant radiochemotherapy. In two patients (40%), treatment failure was observed after a relatively short follow-up (within less than 16 months). One patient died due to liver metastases and in the other, faced with failure of chemotherapy, we instituted somatostatin receptor treatment. Conclusion: Immature or small-cell cervical cancer requires differentiation with neuroendocrine cancer and confirmation of its true nature by immunohistochemical studies. Therapy should encompass modern chemotherapy protocols and (in selected cases) isotope therapy using radio-labeled somatostatin analogs. Somatostatin analog therapy is reserved for patients featuring expression of somatostatin receptor on the surface of cancer cells.

Keywords: neuroendocrine cervical cancer, somatostatin analogs, synaptophysin, chromogranin A
DOWNLOAD ARTICLE (PDF)
Primary peritoneal serous carcinoma – diagnosis, management and prognosis
GIN ONKOL 2007, 5 (1), p. 15-21
ABSTRACT

Primary peritoneal serous carcinoma (PPSC) is a rarely diagnosed malignancy. Furthermore, use of different terminology and classifications in reporting particular cases precludes collection and presentation of reliable epidemiological data. As a consequence, we lack adequate experience, enabling confident management of patients with this diagnosis. On histological grounds, PPSC is a neoplasm identical to invasive epithelial ovarian cancer. Also, patients present a similar profile of clinical symptoms. Most often these include abdominal pain, gastrointestinal disorders and weight loss. Clinical staging is based on surgical-pathological criteria of advanced ovarian cancer. Therapeutic management, i.e. combination of cytoreductive surgery and chemotherapy, is similar to that used in the treatment of late-stage ovarian cancer. Systemic adjuvant and palliative treatment includes chemotherapy protocols based on platinum derivates, recently combined with paclitaxel. Proper administration of combined treatment yields a high response rate and mean survival time of about 40 weeks. Prognosis in PPSC is not fully elucidated. Some studies indicate that prognosis is similar to that seen in late-stage ovarian cancer, while others report worse outcomes and shorter survival. Unfavourable prognostic factors include: suboptimal cytoreduction, poor general condition, advanced age of patient and 4th clinical stage. Data gathered hitherto point to highly similar natural course of PPSC and ovarian cancer, justifying the same therapeutic approach in both these conditions.

Keywords: primary peritoneal serous carcinoma, advanced ovarian cancer, diagnosis, treatment, prognosis
DOWNLOAD ARTICLE (PDF)
Prognostic factors in patients with vulvar cancer in the material of the Cracow Division of Centre of Oncology
GIN ONKOL 2007, 5 (1), p. 22-28
ABSTRACT

Aim of paper: Analysis of clinical material included 116 patients with vulvar cancer treated at the Cracow Division of the Centre of Oncology since 1990 thru 2003, aiming at assessment of treatment outcome and determination of prognostic factors. Material and methods: The patients’ mean age was 67 years. Microscopic study revealed highly differentiated tumour in 34.5%, medium differentiated tumour in 37.1% and non differentiated tumour in 28.4%. In 57.7% of patients, inguinal lymph nodes were clinically unaffected, while 42.3% of patients presented with unilateral or bilateral clinically evident lymph node metastases. 54.3% of patients had non advanced disease (I and II in the TNM scale), while the remaining 45.7% had advanced disease (III and IVA degree). One hundred four patients (89.7%) underwent primary surgical treatment, while the remaining 12 (10.3%) received radiotherapy only. Probability of survival was estimated using the Kaplan-Meier method and impact of selected factors on the patients’ survival was estimated using the Cox’s proportional hazard model. Results: Cumulative 5-year survival rate was 40.5%. For TNM clinical stages I-IVA this was 60.9%, 55%, 26.5% and 10.5%, respectively. For age groups under 70 and above 70 this was 52.9% and 22.9%, respectively, while considering inguinal lymph node status N0, N1 and N2 this was 52.2%, 30.0% and 15.8%, respectively. For histological tumour grades G1, G2 and G3, 5-year survival rates were 65%, 39.5% and 12.1%, respectively. Conclusions: Statistically significant unfavourable impact on 5-year symptom-free survival rate had: age above 70 years, poorly differentiated tumour (G3), clinically evident lymph node metastases and clinical stages III and IVA. Multivariate analysis by Cox revealed that independent prognostic factors for 5-year survival were patients’ age, clinical status of inguinal lymph nodes and TNM clinical stage of vulvar cancer.

Keywords: vulvar cancer, prognostic factors, surgical treatment, irradiation, inguinal lymph nodes
DOWNLOAD ARTICLE (PDF)
Hemostatic effect of high dose irradiation in advanced cervical cancer
GIN ONKOL 2007, 5 (1), p. 29-35
ABSTRACT

Introduction: The first symptom of advanced cervical cancer is vaginal bleeding. Profuse bleeding may sometimes require embolisation or ligation of iliac arteries. However, in the case of massive infiltration of parametra, surgical intervention may be impossible. In such cases, a viable alternative is palliative irradiation. Aim of paper was to assess direct haemostatic effect of high dose, short term irradiation and radiation side-effects in patients undergoing such treatment. Material and method: The study included 42 patients treated at the Dept. of Female Genital Neoplasms of the Centre of Oncology in Warsaw, undergoing pelvic irradiation using 5 fractions of 4 Gy up to a total dose of 20 Gy. The patients’ mean age was 61 y (range: 35-86 y). All patients were in FIGO grade IIIB-IV. Prior to irradiation, 5 patients had a nephrostomy placed due to hydronephrosis, while 12 patients received 1-6 units of blood because of low haemoglobin level. Early and late radiation-induced reactions were assessed. Results: Direct haemostatic effect was obtained in 34 patients (83%); thereof in 26 patients (63%) after the first course and in 8 patients (20%) after the second course. A statistically significant correlation (χ2 = 12.7869; p=0.031) was found between baseline haemoglobin level and haemostatic effect. Conclusions: 1. In patients presenting with severe bleeding due to advanced cervical cancer, a satisfactory haemostatic effect may be obtained by high dose, short term irradiation of the pelvis. 2. In patients presenting with a higher haemoglobin level, this effect may be obtained already after the first course of irradiation. 3. 5x4 Gy fractionation is well tolerated by the patients. Neither early nor delayed severe radiation-induced reactions have been observed.

Keywords: advanced cervical cancer, radiotherapy, high-dose fractions, haemostatic effect
DOWNLOAD ARTICLE (PDF)
Metastasis of choriocarcinoma to the spinal canal – case report and review of literature
GIN ONKOL 2007, 5 (1), p. 36-41
ABSTRACT

At the Department of Female Genital Neoplasms of the Center of Oncology Institute in Warsaw, a 24 years old woman presenting with choriocarcinoma in the 4th clinical stage with metastases to the central nervous system, lungs and liver has been successfully treated. Metastases to the central nervous system were located in the spinal canal at the C4-D1 level; another metastatic lesion was described at the D3-D4 level. Metastases appeared 3 months after her giving birth to a healthy, mature infant. The patient was referred to the Center of Oncology after previous neurosurgical intervention at another hospital, aiming at excision of spinal canal lesions erroneously interpreted as angiomas. Our treatment began with the patient presenting flaccid paralysis of lower extremities, severe paresis of upper extremities and assisted respiration. Poor general condition of the patient precluded administration of aggressive multidrug chemotherapy, therefore she received methotrexate in monotherapy. Improvement of her condition enabled institution of chemotherapy adequate to the clinical stage of her disease. She received multidrug chemotherapy according to the EMA-EP protocol with intrathecal administration of methotrexate. Treatment was complicated by dramatic increase of transaminase activity, clotting disturbances, signs of diabetes insipidus, fever and neutropenia. Ultimately, her HCG level normalized. At 3 years after completion of therapy, the patient lives without signs of recurrence of choriocarcinoma.

Keywords: gestational trophoblastic tumor, CNS metastases, intrathecal methotrexate, HCG, chemotherapy
DOWNLOAD ARTICLE (PDF)