Modified posterior pelvic exenteration for ovarian cancer.

Introduction: A modified posterior pelvic exenteration (MPE) might be needed to reach an optimal tumoral reduction. The issue of this study is to relate a multicentric experience of this kind of resection.

Materials: Three hundred five patients who needed an MPE were analyzed from 9 French cancer centers.

Patterns of care and outcome in elderly cervical cancer patients: a special focus on brachytherapy.

Background: The mean age of the general population has been prolonged and the incidence of cancer in elderly patients has increased. The purpose was to evaluate outcome of brachytherapy (BT) as an integrated part of the treatment of elderly patients with cervical cancer.

Patients And Methods: From November 1997 to January 2006, 1073 patients diagnosed with uterine cervical cancer with stages I-IV (FIGO) have completed BT at the Institut Gustave Roussy.

Exclusive radiotherapy for primary squamous cell carcinoma of the vagina.

Purpose: To retrospectively analyze results of external beam therapy (EBT) with brachytherapy (BT) for primary vaginal squamous cell carcinoma (PVSCC).

Materials And Methods: From 1970 to 2001, 91 patients were included. FIGO stages were: I (29%), II (38%), III (29%) and IVa (4%).

Should pelvic and para-aortic lymphadenectomy be different depending on histological subtype in epithelial ovarian cancer?

Background: The aim of this study was to determine the influence of the different histological subtypes (serous versus non-serous) on the location of nodal metastases in patients undergoing pelvic and para-aortic lymphadenectomies during the initial management of epithelial ovarian tumors.

Methods: We carried out a retrospective analysis of data concerning patients fulfilling the following inclusion criteria: (1) an epithelial ovarian tumor; (2) a complete pelvic and bilateral para-aortic lymphadenectomy up to the level of the left renal vein; (3) surgical procedures including lymphadenectomies performed before adjuvant chemotherapy; and (4) a description of the distribution of positive nodes removed between pelvic and para-aortic areas. Patients were classified into two groups according to the histological subtypes: serous (group 1) and non-serous (group 2) tumors.

Para-aortic involvement and interest of para-aortic lymphadenectomy after chemoradiation therapy in patients with stage IB2 and II cervical carcinoma radiologically confined to the pelvic cavity.

Background: Pelvic radiation therapy with concomitant chemotherapy (PCRT) is the standard treatment of stage IB2/II cervical carcinoma. The impact of concomitant chemotherapy on positive para-aortic nodes (PA+), however, remains unknown. The aim of this study was twofold: to evaluate the rate of histological PA+ after PCRT and to determine the survival of patients with PA+.

Chemoradiation therapy in pregnant patients treated for advanced-stage cervical carcinoma during the first trimester of pregnancy: report of two cases.

Two patients treated using chemoradiation therapy (CRT) (with fetus in utero) for advanced-stage squamous cell cervical carcinoma diagnosed during the first trimester of pregnancy are reported. One patient with a stage IVA disease diagnosed at 12 weeks of gestation was treated by exclusive CRT with the fetus in utero. She recurred 20 months after the end of the treatment.

[Radical trachelectomy: From the laparoscopic approach to the vaginal route].

Objective: To report our experience of laparoscopic and vaginal radical trachelectomies.

Material And Methods: Between February 2001 and May 2005, 10 patients met the requirements for a trachelectomy: 6 for a laparoscopic procedure, 4 for a vaginal procedure. In the laparoscopic procedure, coagulation of the uterine artery had to be performed in 2 patients whereas in the vaginal approach, it was always possible to conserve it.

Growing teratoma syndrome after ovarian germ cell tumors.

Objective: To analyze a series of occurrences of growing teratoma syndrome after ovarian germ cell tumors.

Methods: We analyzed a database containing 103 patients affected by pure or mixed ovarian immature teratoma.

Results: We report 12 patients fulfilling growing teratoma syndrome criteria (incidence 12%).

Endometrial disorders in patients with peritoneal serous papillary carcinoma.

Background: The purpose of this study was to evaluate the incidence rate of endometrial disease, particularly endometrial carcinoma, in patients with primary peritoneal serous papillary carcinoma (PSPC).

Methods: Retrospective review of clinical and histological data from 32 women undergoing surgery (with hysterectomy) for stage III or IV PSPC.

Results: Six patients underwent primary debulking surgery and 26 underwent interval debulking surgery after 3 or 4 courses of platinum-based chemotherapy.

[Identification and management of hereditary breast-ovarian cancers (2004 update)].

Background: Since the last recommendations, up to 2500 new references had been published on that topic.

Methodology: On the behalf of the health Minister, the Ad Hoc Committee consisted of 13 experts carried out a first version revisited by five additional experts who critically analyzed the first version of the report.

Main Updating: Breast and ovarian cancer seem to be associated with fewer deleterious mutations of BRCA1 and BRCA2 than previously thought.

[Laparoscopic pelvic exenteration for cervical cancer relapse: preliminary study].

Objectives: To determine the feasibility and short and midterm results of laparoscopic pelvic exenteration for cervical cancer relapse. Materials and methods. Five patients with centro-pelvic recurrence within 3 to 13 months after combined chemo-radiation therapy (associated to surgery for two cases) for cervical cancer tumors were included in a pilot study.

[Medical treatment of metastatic or recurrent cancer of the cervix].

Cervical cancer is the most frequent gynaecological cancer worldwide. Incidence is decreasing in industrialized countries but remains high in poorest countries. In metastatic or recurrent disease, the treatment is more often palliative.

Role of laparoscopy to evaluate candidates for complete cytoreduction in advanced stages of epithelial ovarian cancer.

The objective of this study was to evaluate the role of laparoscopy in selecting candidates for complete cytoreduction surgery in epithelial ovarian carcinoma. We performed an explorative laparoscopy in 15 women presenting with advanced ovarian carcinoma, and for whom the preoperative evaluation was considered unsatisfactory, to define the possibility of achieving a complete cytoreduction. We focused on three sites of carcinomatosis: bowel, liver pedicle, and right diaphragmatic dome.

[Concomitant chemoradiation in patients with cervix cancer].

Cervical cancer is the 2nd most common cancer among women, behind breast cancer. Concomitant chemoradiation has been assessed in more than 15 randomised clinical trials. A meta-analysis for overall survival showed a statistically significant difference in favour of chemoradiotherapy: relative risk (RR) = 1.

[Laparoscopic treatment of borderline ovarian tumor: analysis of 54 patients and clinical outcomes].

Objective: The aim of this study is to assess the clinical outcomes of laparoscopic treatment of borderline ovarian tumor (BOT).

Patients And Methods: Retrospective analysis of 54 patients treated using a laparoscopic approach for a BOT between January 1984 and January 2002.

Results: A conservative management was initially performed in 45 patients (83%).

[Laparoscopic total hysterectomy after radiochemotherapy in an obese woman with neuroendocrine carcinoma of the cervix: surgical and anesthesiological aspects].

Massive obesity is an important risk factor in gynaecologic surgery. The traumatic effect of traditional laparotomy on the parietal wall is responsible for important perioperative morbidity. We describe the first reported case of an obese woman (Body Mass Index = 55 kg/m2) with stage IIA neuroendocrine carcinoma of the cervix treated by laparoscopy after radiochemotherapy.

Survival in cervix cancer patients treated with radiotherapy followed by radical surgery.

Aim: To determine the incidence and predictive value of residual disease in the hysterectomy specimens of cervical cancer patients treated with primary radiotherapy, with or without chemotherapy, followed by surgery and to determine whether pathologically confirmed residual disease is a surrogate marker of outcome.

Methods: The medical records of patients treated for stage IB/II carcinoma of the cervix in a single institution between 1985 and 2000 were retrospectively analysed into two different groups, depending on whether they had received radiotherapy or concurrent chemo-radiotherapy. Six to 8 weeks after irradiation, all patients underwent radical or extrafascial hysterectomy and pelvic and para-aortic lymphadenectomy.

Results of hysterectomy in patients with bulky residual disease at the end of chemoradiotherapy for stage IB2/II cervical carcinoma.

Background: We assessed the clinical outcome after hysterectomy in patients with bulky residual disease after chemoradiotherapy for stage IB2/II cervical carcinoma.

Methods: Subjects were 10 patients who had bulky (>2 cm) residual disease in the cervix after external radiotherapy (45 Gy) combined with concomitant chemotherapy (cisplatin 40 mg/m2/week) and uterovaginal brachytherapy (15 Gy).

Results: Extrafascial hysterectomy was performed in three patients, type II radical hysterectomy was performed in six patients, and pelvic exenteration was performed in one patient.

Conservative treatment in epithelial ovarian cancer: results of a multicentre study of the GCCLCC (Groupe des Chirurgiens de Centre de Lutte Contre le Cancer) and SFOG (Société Francaise d'Oncologie Gynécologique).

Background: Results of conservative management of epithelial ovarian cancer (EOC) remain controversial in the literature. The aim of this study was to assess the clinical outcomes and fertility following fertility-sparing surgical management of EOC in a retrospective multicentre study.

Methods: A multicentre retrospective study was performed by members of two French groups.

Lymph node spread in stage III or IV primary peritoneal serous papillary carcinoma.

Background: The aim of this study was to determine the rates and topography of pelvic and para-aortic nodal involvement in patients with stage III or IV primary peritoneal serous papillary carcinoma (PSPC).

Methods: Retrospective review of 19 women who underwent a systematic bilateral pelvic and para-aortic lymphadenectomy.

Results: The overall frequency of lymph node involvement was 63% (12/19).

Results after laparoscopic management of serous borderline tumor of the ovary with peritoneal implants.

Objective: The aim of this study is to assess the clinical outcomes of laparoscopic treatment of borderline ovarian tumor (BOT) with peritoneal implants.

Methods: Retrospective analysis of patients treated initially and/or for recurrent disease using a laparoscopic approach for a stage II or stage III BOT between January 2001 and January 2004.

Results: Nine patients underwent a laparoscopic pure treatment of stage II/III serous borderline tumor.

[Initial or interval debulking surgery for advanced stage ovarian cancer: state-of-the-art. How to select patients?].

The management of advanced stage ovarian cancer has been deeply modified over the last few years. In patients with massive peritoneal spread, the use of neoadjuvant chemotherapy, followed by interval surgery, reduces the morbidity of radical surgery with an improvement of the quality of life. Nevertheless, results of ongoing randomized studies should be waited before stating about the results on survival of such management compared to initial debulking surgery.

[Pelvic and para-aortic lymphatic involvement in tubal carcinoma: topography and surgical implications].

Objective: The purpose of this study is to determine the topography of pelvic and para-aortic node involvement in Fallopian tube carcinoma (PFTC). This will help us to recommend appropriate surgical treatment options to the related patients.

Patients And Method: A retrospective study was performed on 19 women with PFTC who underwent a systematic bilateral pelvic and para-aortic lymphadenectomy.