Treatment patterns, health care utilization, and costs of ovarian cancer in Central and Eastern Europe using a Delphi panel based on a retrospective chart review.

OBJECTIVE: Despite the considerable disease burden of ovarian cancer, there were no cost studies in Central and Eastern Europe. This study aimed to describe treatment patterns, health care utilization, and costs associated with treating ovarian cancer in Hungary, Poland, Serbia, and Slovakia. METHOD: Overall clinical practice for management of epithelial ovarian cancer was investigated through a 3-round Delphi panel. Experts completed a survey based on the chart review (n = 1542). The survey was developed based on clinical guidelines and the International Federation of Gynecology and Obstetrics Annual Report. Means, ranges, and outlier values were discussed with the experts during a telephone interview. Finally, consensus estimates were obtained in face-to-face workshops. Based on these results, overall cost of ovarian cancer was estimated using a Markov model. RESULTS: The patients included in the chart review were followed up from presurgical diagnosis and in each phase of treatment, that is, surgical staging and primary surgery, chemotherapy and chemotherapy monitoring, follow-up, and palliative care. The 5-year overall cost per patient was €14,100 to €16,300 in Hungary, €14,600 to €15,800 in Poland, €7600 to €8100 in Serbia, and €12,400 to €14,500 in Slovakia. The main components were chemotherapy-associated costs (68%-74% of the total cost), followed by cost of primary treatment with surgery (15%-21%) and palliative care (3%-10%). CONCLUSIONS: Patients with ovarian cancer consume considerable health care resources and incur substantial costs in Central and Eastern Europe. These findings may prove useful for clinicians and decision makers in understanding the economic implications of managing ovarian cancer in Central and Eastern Europe and the need for innovative therapies.

[Giant uterine leiomyoma causing acute symptoms]. / Akut tüneteket okozó óriásmyoma.

The case history of a 71-year-old woman with acute dyspnoea caused by a giant leiomyoma and severe acute anemia due to intratumoral hemorrhage is presented. Urgent operation was performed, and a 13.5 kg pendular tumor was removed. The cornerstones of the differential diagnoses and therapy of giant abdominal tumors is discussed.

[Methods and conditions of fertility preservation in early-stage ovarian tumors]. / A fertilitás megtartásának lehetoségei, feltételei és módjai korai petefészek-daganatok esetén.

The aim of this study is to review the literature of fertility-sparing techniques and their safety in early-stage malignant ovarian tumors, especially in epithelial ovarian cancer. Fertility preservation is widely accepted in early-stage borderline, germ cell and sex cord-stromal tumors. Based on data from retrospective studies, fertility-sparing surgery in epithelial ovarian cancer can be recommended in stage IA, grade 1-2 and favorable hystologic type ovarian cancer. Above stage IA, or in grade 3, or in clear-cell tumors decision making process about fertility-sparing surgery should be individual. Correct surgical staging is mandatory and oncologic safety should be of primary importance. In the group of carefully selected patients oncological outcomes are identical to those of radical surgery. Spontaneous pregnancy rates vary, but they are generally high. Adequate counseling with patients, detailed documentation and careful follow-up is of outstanding importance. In order to improve the quality of fertility preservation techniques, establishment of treatment centers is recommended.

[The results of ovarian cancer therapy in the Hungarian Centers in 2002-2003]. / Petefészekrákos betegek kezelési eredményei a hazai centrumokban 2002-2003-ban.

UNLABELLED: Authors presented data of treatment results and course of disease in 487 ovarian cancer patients treated by primary surgery and paclitaxel-carboplatin combination chemotherapy between July 1, 2002 and December 31, 2003. PATIENTS: Most of our patients (87.8%) belonged to the age-group between 40-70 years. Distribution of their histological diagnosis was as 69.6% serous, 10.7% mucinous, 5.1% endometrial and 4.7% undifferentiated carcinoma. The grade distribution was found as 8.4% grade 1, 40.9% grade 2 and 35.9% grade 3. RESULTS: The primary surgery was evaluated as optimal in 41.7%, suboptimal in 37.3% and exploration was performed in 21.1%. Most patients started chemotherapy 20 days after surgery and 74.2% of them got six courses. During the evaluation period 61 intervallum laparotomies were performed, and resulted on 55.7% optimal debulking. Complete remission was found in 58.9%, and partial remission in 14.7% of patients. This treatment resulted on a complete remission in 40.9% at the follow-up of 12 months.

[Experience in first-line chemotherapy with paclitaxel for the treatment of ovarian carcinomas]. / Paclitaxel elsó vonalbeli alkalmazásával szerzett kezdeti tapasztalataink ovariumcarcinomák kezelésében.

OBJECTIVE: The purpose of this study was to investigate the possible benefit of the paclitaxel based combined chemotherapy introduced as an "up front" chemotherapy in Hungary for the treatment of ovary cancer. METHODS: Data of four Hungarian Ovary Cancer Treatment Center was collected, evaluated and presented here as a preliminary retrospective study. Data of 67 patients was included into the investigation who underwent laparatomy followed with paclitaxel/carboplatin or paclitaxel/cisplatin combined chemotherapy between 1st of July 1999 and 31st of December 2000. The paclitaxel was administered as 135 mg/m2 i.v. infusion for 3 hours. The main attention was pay on the response rate and the side effect occurred during the administration of the anticancer drugs. RESULTS: 34 out of 67 patients underwent optimal surgery, and 33 out of 67 had got suboptimal procedure only. The chemotherapy was started at the 7th postoperative day. 430 cycles of chemotherapy was evaluated. The overall response rate (RR) at the end of the treatment was 76.1% (CR 68.65%. PR 7.46%). At the end of the follow-up there was 41 patients free of disease (61.19%), 12 patients alive with residual disease (17.91%), 10 patients (14.9%) died of disease, and there was 4 (6%) patients lost. The overall survival (OS) during the follow up period was 16.82 months. In the suboptimally operated group, 36.3% of the patients (12/33) underwent second laparotomy after the 3rd cycle of chemotherapy. Optimal operation was done in 8 out of this 12 patients and all of optimally operated patients remained free of disease at the and of the follow up. Three treatment out of 67 was interrupted because of major side effect, and 13 patients needed supportive treatment. Eleven blood transfusions was performed during the chemotherapy and erythropoetin (EPO) was administered in two patients. CONCLUSIONS: The outcome of patients during of follow up period was better in the optimally operated group. There was 2 death compared to 8 in suboptimally operated group, the progression free survival (PFS) was longer (8 vs. 6.54 months), and so was the OS (17.11 vs. 16.54 months). More disease free patients was registered at the end of follow-up in the optimally operated group (29 vs. 12). The haematological side effect was also more frequent in the suboptimally operated group (12 vs 1). The data suggest that the quality of initial surgical procedure remains the main prognostic factor even if paclitaxel based combine chemotherapy is administered. On the other hand due to the paclitaxel based chemotherapy seems to be a promising "up front" treatment in patients with ovary cancer with few major side effect generally, and quite a lot haematological side effect in the suboptimally operated group only.

[Transposition of ovaries during radical hysterectomy for cervical cancer]. / A petefészkek transpositiója méhnyakrák miatt végzett radikális méheltávolítás során.

INTRODUCTION: 422 radical hysterectomies were performed for cervical cancer between 1st July 1990. and 31st December 2000. in the 1st Department of Obstetrics and Gynecology, Semmelweis Medical University. At least one of the ovaries was conservated and suspended in 21 cases. AIM(S): The aim of this study is to preserve ovaries guaranteeing natural oestrogen production for young patients suffering in early stage cervical cancer, and to prove appropriate efficacy of their method. PATIENTS/METHOD(S): According to present examinations transposition of ovary (21 patients) and radiotherapy made as a part of the protocol can only slightly influence the endocrine function of ovary. RESULTS: Only in one case of 21 a hormonal substitution was needed for treating menopausal syndrome. Studying histopathologically ovaries removed during 422 radical hysterectomies the authors could not find any metastasis given by early stage (I/A2 or I/B) cervical cancer. Following and controlling their patients after ovarial transpositions for a long period they could not observe any pathological ovarial disorder (cyst). CONCLUSION(S): According to the data of international literature the authors conclude, that transposition of ovaries during radical hysterectomy for well-selected, younger aged, early staged cervical cancer cases can result only a low risk, but much better quality of life for the patients.

[Assessment of prognostic factors in common ovarian tumors of varying malignancy]. / Különbözô malignitású petefészek-daganattal kezelt betegek prognosztikai faktorainak vizsgálata.

OBJECTIVE: The outcome and prognosis of apparently similar cases of epithelial ovarian cancers with the same histology and stage is highly variable. The objective was to compare survival and prognostic factors of patients treated at the 1st Department of Obstetrics and Gynecology of Semmelweis University between 1993-2003 with the similar data of the 25th Annual Report on the Results of Treatment in Gynecological Cancer of FIGO. In addition, the aim was to assess the prognostic value of MMP activities and fibronectin concentration in ovarian tumour patients. METHODS: The 25th Annual Report of FIGO included 5694 patients with ovarian tumours from 32 countries diagnosed and treated between 1995 and 1998. Hungary did not participate in this report. Between 1993 and 2003, 180 patients with common epithelial ovarian tumours had been treated at the 1st Department of Obstetrics and Gynecology of Semmelweis University. Treatment and survival data derived from medical record review and from the Population Register Office. In order to compare different prognostic factors, a multivariate Cox proportional regression analysis was performed. The authors measured MMP activities in 33 surgically removed ovarian tumours, serum and ascites by applying zymographic technique. Fibronectin content was determined by Western blot analysis and quantitated by densitometry. RESULTS: The 5-year survival was 90.0% and 30.9% in the case of ovarian tumours with low malignant potential and of epithelial ovarian cancers, respectively. Multivariate analysis identified adverse prognostic factors including advanced age (>60 years) and stage, high grade and suboptimal operation with residual macroscopic disease and the presence of ascites. However, the histological type was not identified to be an adverse prognostic factor in this study. No correlation could be seen between the histology of the ovarian tumours and the elevation of MMP-2/9 activity. More interestingly, however, MMP-9 expression and fibronectin concentration were significantly elevated and the activated forms of both MMP-9 and MMP-2 were more frequent in ovarian cancer patients who developed recurrent disease. CONCLUSION: A great deal of effort should be devoted to identification of further prognostic factors to improve treatment of ovarian cancer. These prognostic factors might help to identify those ovarian cancer patients at the time of diagnosis whose disease will have unfavourable outcome. Our data support the notion that high expression of MMP-9 and fibronectin indicates poor prognosis of ovarian cancer patients.

[Role of Caelyx in second line treatment of ovarian cancer]. / A Caelyx helye a petefészekrák másodvonalbeli kezelésében.

The authors published their own experiences and results of Caelyx treatment based on 40 ovarian cancer patients treated in 9 different institutions. Patients had been treated with platinum based or platinum-taxol combination chemoterapy. Their average age was 57.2 years (35-80). The average time to progression was 3.8 months (1-8). The effects of the therapy were assessed on 36 patients and the results were 3 CR, 8 PR, 7 SD and 18 PD. Summarised the Caelyx therapy caused improvement in 30.55% of the patients and stabilisation in 19.44%. Supportive therapy was needed in 8 cases.

[Status report on the chemotherapy of ovarian cancer at special cancer centers in Hungary (2002-2003)]. / A petefészekrák gyógykezelésének helyzete a különkeretes Centrumokban 2002-2003-ban Magyarországon.

Data on the first-line treatment of ovarian cancer in special centers of Hungary 2002 and 2003 are presented, involving 283 and 416 patients, respectively. Patients' age, clinical stage and histological type of the tumor were highly similar to literature data, while grades were different. Surgical effectiveness in case of IIIc staged tumors with >1 cm residual mass was 37%. The ratio of interval laparotomy was about 15%. Overall response rates of the first-line treatment of ovarian cancer was 82%, while the rate of complete remissions was 60%. The authors provide detailed analysis of factors that can improve the chemotherapy of ovarian cancer in Hungary.

Primary non-Hodgkin's lymphoma of the uterine cervix successfully treated by neoadjuvant chemotherapy: case report.

INTRODUCTION: Primary non-Hodgkin's lymphoma of the uterine cervix is a rare malignancy. The mainstay of therapy consists of irradiation alone or irradiation with either surgery or chemotherapy. CASE REPORT: We present the case of a 56-year-old woman diagnosed with a bulky, Ann Arbor stage IE, primary, diffuse, large B-cell non Hodgkin's lymphoma of the uterine cervix. We administered neoadjuvant chemotherapy according to CHOP protocol (cyclophosphamide, adriamycin, vincristine, and prednisone) followed by radical hysterectomy, bilateral salpingo-oophorectomy, and regional lymph node dissection. Clinical and pathological responses to the chemotherapy were complete. The patient is alive 5 years after the initial diagnosis. CONCLUSION: Our case emphasizes the importance of neoadjuvant chemotherapy that can provide a control of the distant microscopic metastases.