The Role of 2D/3D Ultrasound to Assess the Response to Neoadjuvant Chemotherapy in Locally Advanced Cervical Cancer.

INTRODUCTION: Different imaging techniques were introduced to improve preoperative clinical staging of locally advanced cervical cancer (LACC) with transvaginal ultrasound (TV-US) or transrectal ultrasound (TR-US) representing a promising staging technique in the evaluation of the local extension of the disease for invasive tumors. The aim of this study was to evaluate the response to neoadjuvant chemotherapy (NACT) in LACC by 2D/3D ultrasound examination. MATERIALS AND METHODS: We prospectively enrolled patients affected by histologically and clinically confirmed LACC. All patients were scheduled for 3 cycles of platinum-based NACT followed by radical surgery. The ultrasound examination was performed at every cycle and within 10 days before surgery. The parameters evaluated were: the volume (automatically computed by the VOCAL software) and the mass vascularization. RESULTS: From March 2010 to March 2019, 157 women were recruited. Among these patients, 12 of them were excluded: 6 for the presence of distant metastases, 4 for rare histology, and 2 for severe comorbidities not allowing the protocol treatment. Seventeen patients after NACT were excluded because they were not amenable to radical surgery. Thus, 128 were considered for the final analysis of whom 106 (83%) were considered responders to NACT by histology. The sensibility and specificity of ultrasound with regard to the response to chemotherapy compared to histological specimen were 94 and 82%, respectively, with an accuracy of 92%. The positive predictive value and negative predictive value were 96 and 75%, respectively. Finally, we found that nonetheless there was a trend towards a continuous response to chemotherapy among patients who were considered responders to NACT at pathological examination; the major volume and vascularization index (VI) reduction were observed during the first 2 cycles (74, 71% and 47, 63%, respectively). On the contrary, non-responders showed an initial reduction of the VI (4.86 consisting of 33%, 95% CI 0.79-8.92, p = 0.013), but no significant modification in tumour volume along NACT. CONCLUSION: 2D/3D ultrasound is useful in assessing early response to NACT in patients with LACC.

Intraperitoneal chemotherapy by ultrasound-guided direct puncture in recurrent ovarian cancer: feasibility, compliance, and complications.

OBJECTIVE: This prospective pilot study investigated the feasibility, complications, and compliance of the administration of intraperitoneal (IP) chemotherapy by direct puncture under ultrasonographic guidance performed on consecutive patients with recurrent ovarian cancer (ROC). METHODS: Patients were evaluated to undergo secondary cytoreduction and/or to receive IP chemotherapy. Patients received standard intravenous therapy for ROC plus IP administration by direct puncture needle, under ultrasonographic guidance. RESULTS: From January 2008 to January 2011, 38 patients were enrolled. A total of 402 IP procedures were performed, with a mean of 10.5 procedures per patient. The feasibility rate was 97.4%. In 237 cases (98.8%) of subgroup 1 (abdominal wall thickness ≤6 cm), the procedure was performed after 1 attempt, meanwhile in 6% of cases of subgroup 2 (abdominal wall thickness >6 cm), more than 1 attempt was necessary (P < 0.01). The mean procedure time was 10 minutes (range, 5-30 minutes). We recorded a total of 2.25% mild intraprocedure complications. No significant difference was identified for the complication rate according to the abdominal wall thickness or according to the number of previous laparotomies. A total of 5 procedures (1.2%) were not performed as a result of patients' noncompliance. The mean pain score according to the visual analog pain scale was moderate at the first evaluation (after 3 minutes) and mild at the final evaluation (after 10 minutes). CONCLUSIONS: The administration of IP chemotherapy with a direct puncture, under ultrasound guidance, for patients with ROC, is a safe and feasible method, with a high acceptance from patients.

Intraperitoneal paclitaxel as consolidation treatment in ovarian cancer patients: a case control study.

OBJECTIVE: It was the aim of this study to assess the role, feasibility and safety of consolidation intraperitoneal (IP) paclitaxel in patients affected by advanced ovarian cancer. METHODS: Patients affected by advanced ovarian cancer with complete pathological response after standard treatment were enrolled in this study. The consolidation chemotherapy schedule consisted of 12-16 cycles of IP paclitaxel, 60 mg/mq weekly (group A). Chemotherapy was delivered with a direct puncture under ultrasonographic guidance at each cycle. Survival data of this group of patients were compared with those from a control group with analogous characteristics submitted to observation only (group B). RESULTS: Seventy patients were included in the study, 28 in group A and 42 in group B. Treatment-related toxicity was mild. In 3/28 patients (11%), technical difficulties in accessing the peritoneum were observed. Median time to recurrence was 25 months (range 4-64) in group A and 17.5 months (range 2-60) in group B. Estimated 3-year disease-free survival was 56 and 33% (p < 0.05) in group A and B, respectively; no significant difference in 3-year overall survival was observed (87 vs. 83%; p value not significant). CONCLUSION: Weekly IP consolidation chemotherapy with paclitaxel 60 mg/mq is well tolerated and, in this experience, a prolongation of progression-free survival was observed.

Neoadjuvant chemotherapy plus radical surgery in locally advanced cervical cancer during pregnancy: a case report.

Management of cervicocarcinoma during pregnancy is influenced by gestational age, stage of disease, and patient's desire to maintain her pregnancy. We report a case of a pregnant patient with locally advanced cervicocarcinoma successfully treated by neoadjuvant chemotherapy, followed by caesarean section and radical surgery.

Late breast cancer recurrence to the uterine cervix with a review of the literature.

The cervix is a possible site of metastasis from any primary malignancy, but no specific indication on follow-up examination is present. We present an asymptomatic patient with isolated breast cancer cervical recurrence diagnosed by colposcopy after 11 years from primary disease. After a PubMed search and a review of current guidelines, no indication to follow-up examination regarding the cervix is present. The adoption of colposcopy in cancer survivors might be an aid to gynecologists in diagnosing cancer recurrence. Cancer survivors might benefit from a more thorough gynecologic examination as compared with the simple Papanicolaou test.

Ovarian cancer, diagnosed with PET, with bilateral inguinal lymphadenopathy as primary presenting sign.

BACKGROUND: Ovarian cancer groin lymph nodes metastases are rare. Only one case of disease spread isolated to the groins has been reported in the English literature. We report the case of a patient with bilateral inguinal lymphadenopathy due to tumor metastases and in which tumor origin was diagnosed using [(18)F]fluorodeoxyglucose positron emission tomography (PET). CASE REPORT: This is the first case of bilateral groin lymph nodes as sole site of metastases from ovarian cancer. Primary origin was identified using PET. CONCLUSIONS: In rare cases, the ovaries can directly metastasis to the groin even in a relatively initial tumor growth phase. PET may play a role in the diagnosis of occult ovarian tumors.