2011, Vol 9, No 2
The expression of RARs and RXRs in cervical cancer tissues HPV(+)
CURR. GYNECOL. ONCOL. 2011, 9 (2), p. 73-81
ABSTRACT

Introduction: Retinoids are essential for the maintenance of epithelial differentiation and play a fundamental role in chemoprevention of epithelial carcinogenesis. Retinoids exert their biological functions through nuclear receptors, retinoic acid receptor (RAR) and retinoid X receptor (RXR). The present study made an effort to analyze serum blood concentration of retinoids in women with cervical cancer as well as to assess an expression of RARs and RXRs in postoperative cervical cancer tissues HPV 16/18 positive. Material and methods: The study material included tissue samples of 42 squamous cell carcinoma, 7 samples of adenocarcinoma cervix uteri and 26 samples carcinoma in situ. The assessment of serum level of retinol, expression of retinoid receptors and presence of HPVs genome was performed. Results and conclusions: The mean retinol content in blood serum of patients with cervical cancer associated with HPV infection type 16 and/or 18 was lower than in controls. The level of RARα, RARβ and RXRβ mRNA expression was significantly decreased in the study group of women with CIS, squamous cell carcinoma and adenocarcinoma cervix to compare morphologically to the control women. In squamous cell carcinoma and carcinoma in situ were found to exhibit a decreased expression of RARα by about 75%, RARβ by 90%, RXRβ by 70% and 83% respectively compared to the control tissues. Among adenocarcinomas RARα, RARβ, RXRβ were expressed in 10%. In the study cancer tissues RARγ, RXRα and RXRγ were expressed on the same level as in the control tissues.

Keywords: cervical cancer, retinoid, retinoic acid receptor A, retinoic acid receptor X
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Quality of life of women with inoperable ovarian cancer
CURR. GYNECOL. ONCOL. 2011, 9 (2), p. 82-94
ABSTRACT

Ovarian cancer presents a considerable clinical and social problem. Due to poorly understood etiology and lack of specific symptoms at early clinical stages, over 75% of patients are diagnosed when distant metastases have already developed. The aim of this paper was to assess the quality of life of women with inoperable ovarian tumor over the entire course of disease, with particular emphasis on far-advanced clinical stages. Study population consisted of 40 patients treated at the Greater Poland Cancer Center (Wielkopolskie Centrum Onkologii) in Poznań, Poland. The study was performed using a custom-designed questionnaire and the QLQ-C30 questionnaire. Our results indicate that self-assessed quality of life depends both on the disease itself and its course, and on sociodemographic factors, e.g. age and education. Neoplastic disease and implemented therapy considerably contribute to deterioration of the patients’ quality of life. Disease-associated malaise and limitations result in the patients’ social dysfunction and severely limited professional activity, leading to deterioration of the patients’ financial status, limitation of social life to closest relatives and friends, necessity to seek help of other people and, most importantly – altered family relations. Elucidation of factors responsible for poor quality of life of cancer patients may assist us in focusing on domains of life which are most affected. Furthermore, this may prove a valuable aid in developing more effective support mechanisms to be implemented during treatment.

Keywords: quality of life, ovarian cancer, quality of nursing care, patients’ satisfaction level, therapeutic modalities
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Three-drug regimen (aprepitant + palonosetron + dexamethasone) for prevention of nausea and vomiting associated with beam chemotherapy preceding transplantation of autologous hematopoietic stem cells
CURR. GYNECOL. ONCOL. 2011, 9 (2), p. 95-103
ABSTRACT

Aim of paper: Assessment of effectiveness of three-drug regimen of antiemetic treatment (aprepitant + palonosetron + dexamethasone) in preventing early and delayed nausea and vomiting associated with high-dose BEAM chemotherapy prior to transplantation of autologous hematopoietic cells. Obtained results were compared with effectiveness of one- or two-drug regimens (palonosteron or ondansetron + dexamethasone) implemented in historic control groups. Material and methods: Ninety-six patients were recruited (42 with Hodgkin lymphoma and 54 with non-Hodgkin lymphoma). Subgroups of patients were age-, gender-, weight- and stage-matched and suitable for statistical analysis. Myeloablative chemotherapy was administered according to the BEAM protocol. Effectiveness in preventing early nausea and vomiting was assessed since the start of chemotherapy until 24 hours after termination thereof. Delayed nausea and vomiting were assessed during 5 consecutive days after termination of cytostatic treatment. Severity of nausea was assessed using a 4-tiered scale: no nausea, mild nausea (not compromising everyday activity), moderate nausea (slightly affecting everyday activity) and severe nausea (significantly affecting everyday activity). Clinical response in terms of inhibition of vomiting was assessed as follows: complete response (no vomiting), mayor response (1-2 vomiting episodes), minor response (3-5 vomiting episodes), no response (over 5 vomiting episodes). Overall clinical response to antiemetic medication (nausea and vomiting) was assessed using a 4-tiered scale: good, intermediate, poor and none. Results and conclusions: Three-drug antiemetic regimen is significantly more effective than two-drug regimen, particularly in preventing early nausea and vomiting in patients receiving BEAM chemotherapy prior to transplantation of autologous hematopoietic cells.

Keywords: antiemetic therapy, hematopoietic stem cell transplantation, high-dose chemotherapy, NK-1 receptor antagonists, serotonin receptor antagonists, steroids
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Radiotherapy as the sole treatment in patients with endometrial cancer – retrospective evaluation of methods and outcomes
CURR. GYNECOL. ONCOL. 2011, 9 (2), p. 104-113
ABSTRACT

Since 1929, surgical treatment is an accepted treatment for endometrial cancer. Implementation of radiotherapy as an adjunct to surgical excision resulted in improved cure rates in patients with unfavorable prognostic factors. In this group of patients, many are those with internal medical comorbidities coexisting with their endometrial cancer, precluding surgical treatment. The paper presents a retrospective analysis of outcomes obtained using radiotherapy as the sole therapeutic modality since 1968 thru 1985. Study population includes 107 patients aged 43 to 83 years (mean age: 76 years). In 55 patients at clinical stages I and II, surgical treatment was impracticable mostly because of severe comorbidity. Fifty-two patients were at clinical stage III. Brachytherapy by application of Heyman capsules was performed in 75 patients, irradiation from external sources combined with radium brachytherapy using vaginal applicators and uterine probes – in 24 patients, while external beam radiotherapy only – in 8 patients. Upon irradiation, all patients underwent triple fractionated curettage of uterine cavity. Hysteroscopic inspection of uterine cavity is being performed since 1981, combined with collection of tissue samples under visual control for microscopic study. In the entire study population, 5-year survival rate was 47%. In the subgroup treated by Heyman capsules only, 5-year survival rate was 45%. Patients at clinical stages I and III had 5-year survival rates of 56% and 44%, respectively.

Keywords: uterine corpus radiotherapy, Heyman capsules, hysterography, hysteroscopy
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Gestational trophoblastic disease: the role of surgery
CURR. GYNECOL. ONCOL. 2011, 9 (2), p. 114-121
ABSTRACT

Gestational trophoblastic disease (GTD) is a rare, potentially malignant condition, originating in the fetal tissue and developing inside maternal organism. Treatment of gestational trophoblastic neoplasia, a worse form of GTD, is based on chemotherapy administered as single- or multi-drug protocols, selected depending on the presence of significant risk factors, while in some clinical situations surgical treatment may play a significant role. In particular, surgery is resorted to in cases of persistent disease, developing as a result of primary or secondary chemoresistance of the original pathology. In such a setting, adjuvant surgery, e.g. hysterectomy or excision of a single pulmonary GTD focus, considerably improves expected remission rate. Standard procedure performed in patients with chemoresistant, residual form of GTD is hysterectomy. The second most frequently performed procedure in GTD is excision of a pulmonary metastasis. Furthermore, surgical intervention in an emergency setting (e.g. massive hemorrhage) is relatively frequent in GDT. Apart of hysterectomy, available surgical options include hemostatic suture of bleeding tissue, ligation of internal iliac arteries or interventional radiology aiming at selective embolization of uterine arteries. Therefore, surgery plays an important role in eradication of persistent and chemoresistant forms of GTD and may be life-saving in emergency situations.

Keywords: gestational trophoblastic disease, gestational trophoblastic neoplasia, surgery, hysterectomy, pulmonectomy
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Colorectal cancer during pregnancy
CURR. GYNECOL. ONCOL. 2011, 9 (2), p. 122-129
ABSTRACT

According to literature data, colorectal cancer may coexist in 0.02-0.1% of all pregnancies. Pregnant women may develop any type of malignancy, usually breast cancer, cervical cancer, lymphomas, malignant melanoma, leukemias, ovarian cancer, thyroid cancer and digestive tract tumors. The commonest digestive tract malignancies are large bowel and rectal cancer. Pregnancy may alter the course of neoplastic disease. In this setting, one of the key diagnostic problems is the masking of tumor signs and symptoms by coexisting pregnancy, making correct diagnosis considerably more difficult. This results in higher clinical stages at presentation and delayed treatment. First published reports of colorectal cancer during pregnancy are usually incidental findings, discovered as a result of treatment of various complications of pregnancy. Modern oncologic science, supported by early tumor detection programs, enables timely diagnosis and effective treatment of many digestive tract tumors. Nevertheless, distortion of tumor signs by pregnancy, different dynamics of tumor growth, pregnancy-imposed limitations of diagnostic and therapeutic modalities, all contribute to delayed diagnosis and institution of correct treatment. Doctors should be vigilant and able to differentiate signs and symptoms pregnancy-related from those indicating a colorectal cancer. The scope of diagnostic and therapeutic modalities implemented when faced with a colorectal cancer coexisting or not with pregnancy is similar. Apart of clinical stage and tumor location, the key factors influencing timing and mode of treatment of a pregnant woman are gestational age and condition of the fetus.

Keywords: digestive tract cancer, colorectal cancer, pregnancy, diagnosis, treatment
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