Gynecology Oncology
Kavitha Nagandla; Khine Khine Lwin; Phyu Synn Oo; Thin Thin Win; Afshan Sumera
Articles in Press, Accepted Manuscript, Available Online from 13 March 2024
Abstract
Background and Objective: The management of cervical cancer during pregnancy is significantly challenging. This systematic review summarises the current data on chemotherapy agents (platinum and taxanes) in the management of cervical cancer during pregnancy.
Methods: Two independent investigators searched ...
Read More
Background and Objective: The management of cervical cancer during pregnancy is significantly challenging. This systematic review summarises the current data on chemotherapy agents (platinum and taxanes) in the management of cervical cancer during pregnancy.
Methods: Two independent investigators searched the literature and extracted data from all studies that examined the efficacy and safety of platinum and taxanes in managing cervical cancer during pregnancy. A quantitative synthesis of the published articles was performed and Kaplan–Meier survival curves were estimated to determine the overall and progression-free survival.
Results: Overall, 43 studies with 114 patients were included in this systematic review. All patients received neoadjuvant chemotherapy during pregnancy; the majority received platinum-based chemotherapy. Cisplatin was the main platinum-based chemotherapy agent in 49% (n = 56) of patients, followed by combined platinum and paclitaxel therapy in 36% (n = 41) of patients. A few and two patients were treated with single-agent vincristine and platinum with external beam radiation therapy, respectively. Bleomycin and 5-fluorouracil were administered to two patients. The most frequent complications were grade 2 thrombocytopenia and grade 3 hepatotoxicity in 32 (28%) and 18(20.5%) cases, respectively. The common fetal complications were low birth weight and growth restriction. Chemotherapy was well tolerated by most women in the case group. The progression-free survival was 35% (n = 22).
Conclusion: Platinum and taxane neoadjuvant chemotherapy has proven to be safe and effective in preventing cervical cancer disease progression until definitive surgical treatment.
Gynecology Oncology
Ganesalingam Murali; CheeMeng Yong; Nagandla Kavitha; Chew Hua Yeoh
Articles in Press, Accepted Manuscript, Available Online from 26 March 2024
Abstract
Pelvic exenteration (PE) is a surgical procedure that requires an en-bloc excision of lower abdominopelvic structures. Despite its high morbidity, PE is most indicated for treatment of advanced primary or locally recurrent pelvic cancers. We aim to evaluate our experience with PE for patients with gynaecological ...
Read More
Pelvic exenteration (PE) is a surgical procedure that requires an en-bloc excision of lower abdominopelvic structures. Despite its high morbidity, PE is most indicated for treatment of advanced primary or locally recurrent pelvic cancers. We aim to evaluate our experience with PE for patients with gynaecological cancers over 8 years from January 2011 to 31 December 2019 that were identified through hospital databases. Patient demographic characteristics, indications, surgical characteristics and outcomes were retrospectively assessed. Overall survival (OS) was analysed with Kaplan-Meier method and log rank test. Cox proportional hazards regression was used to model survival outcomes. Twenty- one patients were identified with recurrent cervical, endometrial, ovarian and, or vaginal cancer underwent PE. Local disease recurrence was the most common indication in 80.9%. The primary tumor origin was the cervix in 80.9%, followed by endometrial origin 9.5%. PE was performed as curative intent in 62% and in 38% as palliative intent. The most common early complication was wound infections and late complications included deep vein thrombosis, lymphocyst and recurrent urinary tract infections. The median survival at 6 months is 85.7% and 12 months is 57.1 %. Our five-year OS was 54.3 % (95% CI 34.2, 74.6). Our case series illustrates pelvic exenteration provides about 54.3% of 5-year survival chance in a selected group of patients. The early-and late complications rate are similar to those described historically. Pelvic exenteration results in sustained survival in selected patients and continued efforts must focus on identifying those patients who could potentially benefit most from PE.
