Neoadjuvant chemotherapy followed by fertility sparing surgery in cervical cancers size 2-4 cm; emerging data and future perspectives.

BACKGROUND: Approach to the management of early stage cervical cancers with tumor size >2 cm in women who desire fertility preservation has been fraught with controversy. Fertility sparing surgery for FIGO 2018 stage IB cancers has been validated most for tumors ≤2 cm. In this review, our objective was to evaluate the oncologic and obstetric outcomes for women that underwent neoadjuvant chemotherapy (NACT) before fertility sparing surgery for tumors 2-4 cm. METHODS: We performed a systematic literature review and searched PubMed, Google Scholar, Cochrane Reviews and UpToDate (from January 2000 to February 2021) using the terms: cervical cancer, fertility preservation, trachelectomy, radical trachelectomy, neoadjuvant chemotherapy, cervical cancer treatment, stage IB1 or IB2 cervical cancer, and cervical cancer size 2-4 cm. We included manuscripts with information on patients with tumor sizes 2-4 cm, lymph node status, follow-up, obstetric and oncologic outcome. We excluded review articles or articles without all pertinent patient information. RESULTS: Eighteen articles were identified including 249 patients. For final analysis, 114 met inclusion criteria. All included patients had FIGO 2018 stage IB2 cervical cancer, underwent neoadjuvant chemotherapy and subsequent fertility sparing surgery. Vaginal radical trachelectomy, cold knife conization, abdominal radical trachelectomy, laparoscopic radical trachelectomy, simple vaginal trachelectomy, and cone laser were performed in 46 (40.4%), 26 (22.8%), 14 (12.3%), 13 (11.4%), 8 (7%), and 7 (6.1%) women, respectively. The most common regimen of chemotherapy was platinum-based therapy with cisplatin. The follow-up time reported in all studies ranged from 1 to 225 months. Of 64 attempted pregnancies, there were 49 (76.6%) viable deliveries which included 6 preterm births (9.4%). The recurrence rate was 6.1% and two patients (1.8%) died of disease. CONCLUSION: Fertility sparing surgery following NACT is an option for women with cervical cancers that are 2-4 cm that wish to preserve fertility without sacrificing oncologic or obstetric outcomes. Confirmation of these findings are anticipated from an ongoing international phase II clinical trial [1].

Interday Reliability and Usefulness of a Reactive Strength Index Derived From 2 Maximal Rebound Jump Tests.

PURPOSE: To examine the interday reliability and usefulness of a reactive strength index (RSI) derived from a maximal 5-rebound jump test (5max RJT) and a maximal 10-rebound jump test (10/5 RJT). METHODS: Twenty male field-sport athletes (24.5 [3.0] y, 1.78 [0.1] m, 84.9 [5.2] kg) and 15 female participants (21.1 [0.9] y, 1.65 [0.73] m, 62.0 [5.1] kg) performed 2 maximal repetitions of the 5max RJT and the 10/5 RJT on 2 testing days after a specific warm-up. A 1-wk period separated testing days, and these sessions were preceded by a familiarization session. RSI was calculated by dividing jump height (in meters) by contact time (in seconds). The 5max RJT and the 10/5 RJT trial with the highest RSI on each testing day were used for reliability and usefulness analysis. RESULTS: Both tests were deemed reliable for determining RSI for male, female, and pooled male and female cohorts, as the intraclass correlation coefficients were ≥.80 and the coefficient of variation was ≤10%. Only the 5max RJT was rated as "good" at detecting the smallest worthwhile change in performance for female athletes (smallest worthwhile change: 0.10 > typical error: 0.07). The 5max RJT for men and the 10/5 RJT for men and women were rated "good" in detecting a moderate change in performance only. CONCLUSIONS: Both tests are reliable for the determination of RSI, but the usefulness of the tests in detecting the smallest worthwhile change is questionable.

Sixteen polymorphic microsatellite markers for a federally threatened species, Hexastylis naniflora (Aristolochiaceae), and co-occurring congeners.

PREMISE OF THE STUDY: Twenty microsatellite loci were developed for the federally threatened species Hexastylis naniflora (Aristolochiaceae) to examine genetic diversity and to distinguish this species from co-occurring congeners, H. heterophylla and H. minor. METHODS AND RESULTS: Next-generation sequencing approaches were used to identify microsatellite loci and design primers. One hundred fifty-two primer pairs were screened for repeatability, and 20 of these were further characterized for polymorphism. In H. naniflora, the number of alleles identified for polymorphic loci ranged from two to 23 (mean ∼8.8), with a mean heterozygosity of 0.39. CONCLUSIONS: These 16 polymorphic primers for H. naniflora will be useful tools in species identification and quantifying genetic diversity within the genus.

Pretreatment imaging can be used to select imaging guidance, ultrasound alone versus CT plus ultrasound, for percutaneous renal radiofrequency ablation.

OBJECTIVE: Although CT is most commonly used for guidance of radiofrequency ablation (RFA) of renal masses, other publications have shown that ultrasound alone may be used. Therefore, we compared the complications and technical effectiveness of renal RFA guided by ultrasound alone versus combined CT and ultrasound guidance. MATERIALS AND METHODS: We retrospectively analyzed outcomes and complications of percutaneous renal RFA in two groups of patients for whom RFA was guided by either ultrasound alone (group 1) or combined CT and ultrasound (group 2). The sole factor in determining the method of guidance was preablation imaging. All other technical factors were consistent between the two groups. RESULTS: There were 28 masses in 27 patients in group 1 and 32 masses in 29 patients in group 2. There was an overall major complication rate of 3.3% (2/60). Major complications occurred equally in group 2 (3.1% [1/32]) compared with group 1 (3.6% [1/28]). Overall ablative effectiveness was 93% (26/28) in group 1 and 84% (27/32) in group 2. There was no statistical difference between the two groups. CONCLUSION: In proper hands, sonography guidance alone is a safe and effective method for performance of renal RFA in preselected cases and can decrease CT utilization. The use of CT is reserved for situations in which pretreatment RFA imaging suggests difficulty in ultrasound mass visualization or when the mass is in close proximity to structures that may be injured by thermal ablation.

Is segmental enhancement inversion on enhanced biphasic MDCT a reliable sign for the noninvasive diagnosis of renal oncocytomas?

OBJECTIVE: The objective of our study was to retrospectively determine whether segmental enhancement inversion or other CT patterns seen at enhanced biphasic MDCT are predictive for the diagnosis of renal oncocytoma. MATERIALS AND METHODS: Twenty-nine patients with 32 oncocytomas diagnosed by either biopsy or resection who had undergone enhanced biphasic CT between January 2004 and March 2010 were included in this study. Biphasic CT scans were analyzed for the presence of segmental enhancement inversion. Segmental enhancement inversion was defined as a renal mass with two distinctive segments in which the attenuation of the segments changed between the two phases of CT. The masses were further characterized on imaging to determine if any imaging feature is predictive of renal oncocytoma. RESULTS: Of the 32 renal oncocytomas, 16 oncocytomas were eliminated from analysis. These masses were eliminated because they were larger than 4 cm (n = 4), the CT examinations were inadequate (n = 10), or the pathology results were questionable (n = 2). The remaining 16 tumors (mean size, 2.6 cm; range, 1.8-3.9 cm) were included in our study. Only two tumors showed distinct segments of variable degrees of enhancement, with one of those tumors having segmental enhancement inversion. Three masses had a central region of low density. The most common feature, identified in eight of the 16 oncocytomas, was a slightly heterogeneous mass that became homogeneous on the later phase of CT. Three oncocytomas had a homogeneous appearance on both phases. CONCLUSION: Contrary to a prior report, we did not find segmental enhancement inversion to be a characteristic enhancement pattern of small renal oncocytomas on biphasic MDCT. We found no specific features on biphasic CT that could be considered reliable and could strongly suggest the diagnosis of renal oncocytoma.