Evidence-Based Practice Guideline for the Management of Lymphedema Proposed by the Japanese Lymphedema Society.

Background: Secondary lymphedema mostly occurs as an aftereffect of cancer treatment, and it is estimated that 100,000-150,000 patients are affected in Japan. An estimated 3500 patients, develop lymphedema of the lower and upper extremities each year secondary to uterine and breast cancer treatment. Medical reimbursement was first instituted in April 2008 by the Ministry of Health, Labour and Welfare in Japan. Since 2008, we have developed guidelines regarding treatment options for patients with lymphedema based on scientific evidence. This is the third edition of the guidelines established by the Japanese Lymphedema Society (JLES), published in 2018. The JLES Practice Guideline-Making Committee (PGMC) developed 21 clinical questions (CQs). Methods and Results: A review of these 15 CQs was performed in accordance with the methodology for establishing clinical guidelines. The 15 recommendations for each of these CQs were developed and discussed until consensus by the PGMC was reached. Moreover, outside members who had no involvement in these guidelines evaluated the contents using the Appraisal of Guidelines for Research and Evaluation (AGREE) II reporting checklist. Conclusion: These guidelines have been produced for the adequate management of lymphedema by doctors and other medical staff on the lymphedema management team of medical institutes, including nurses, physical technicians, and occupational therapists.

Prognosis and adjuvant chemotherapy for patients with positive peritoneal cytology in stage IA endometrial cancer.

This study evaluated the influence of positive peritoneal cytology (PPC) on the prognosis of patients with stage IA endometrial cancer, and the usefulness of adjuvant chemotherapy in their treatment. We retrospectively analyzed the data of patients with stage IA endometrial cancer admitted in our hospital between 2005 and 2015. Among 989 patients who underwent peritoneal cytology, 135 (13.7%) had PPC. Multivariate analysis extracted several independent risk factors for recurrence in stage IA patients, including those with PPC. Adjuvant chemotherapy did not cause a significant difference in the 5-year relapse-free survival rate in patients with PPC (p = 0.78). Similarly, the 5-year recurrence-free survival rate with or without chemotherapy was not different among type II cancer patients (p = 0.11). However, the baseline risk of 5-year relapse-free survival without chemotherapy in patients with PPC and type II was very low (66.7%). While PPC was an independent risk factor for recurrence in stage IA endometrial cancer, adjuvant chemotherapy did not influence the survival rate in patients with PPC. While it is controversial whether adjuvant chemotherapy should be administered in stage IA uterine cancer with only PPC as a prognostic factor, it should be considered for early-stage patients who have multiple risk factors for recurrence.

Laparoscopic Anterior Pelvic Exenteration with Super Radical Parametrectomy for a Recurrent Low-Grade Endometrial Sarcoma That is Resistant to Hormone Therapy and Chemotherapy.

STUDY OBJECTIVE: To show total laparoscopic complete resection of a recurrent low-grade endometrial sarcoma. DESIGN: Step-by-step demonstration of the technique of laparoscopic anterior pelvic exenteration with super radical parametrectomy, including the explanation of detailed pelvic anatomy (Canadian Task Force classification III). SETTING: Low-grade endometrial stromal sarcoma (LGESS) is a rare malignancy that makes up around 0.2% of all uterine malignancies [1]. Total abdominal hysterectomy and bilateral salpingo-oophorectomy is a standard treatment; however, the recurrence risk is quite high [2]. For a recurrent LGESS that is resistant to hormone therapy and chemotherapy, complete resection with negative surgical margins (R0 resection) can be the most promising method [3]. PATIENT: The patient had undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy because of a LGESS. Almost 20 years later, a recurrent LGESS was detected at the vaginal stump, and the patient underwent several rounds of chemotherapy and hormonal therapy. These treatments were inefficacious, and the recurrent tumor progressed. An abdominal computed tomographic scan revealed that the recurrent tumor occupied the vaginal stump, involved the bladder and the left ureter, and extended to the left pelvic sidewall. INTERVENTIONS: Anterior pelvic exenteration with super radical parametrectomy was performed laparoscopically with no blood transfusion. R0 resection could be achieved without any intraoperative and postoperative complications. Without any adjuvant treatment, there has been no sign of recurrence during the 12 months that have passed since the surgery. This video obtained institutional review board approval through our local ethics committee in the Cancer Institutional Hospital (institutional review board number 2016-1007). CONCLUSION: The good visualization and meticulous dissection provided during laparoscopic surgery can make the approach advantageous and may contribute to R0 achievement.

En Bloc Resection of an Aggressive Angiomyxoma by a Novel Combination Laparoscopic and Open Perineal Approach.

STUDY OBJECTIVE: To show a novel combination laparoscopic and open perineal approach to complete resection of aggressive angiomyxoma. DESIGN: Step-by-step video demonstration of the combination approach (Canadian Task Force classification III). SETTING: Combined laparoscopic and open perineal approach was performed in the tertiary center. PATIENT: A 46-year-old woman presented with an 8-cm vulvar mass, diagnosed as an aggressive angiomyxoma. The patient, who strongly desired to preserve her uterus and ovaries, provided informed consent for resection of the tumor by our combination approach, also approved by our Institutional Review Board. INTERVENTION: Combined laparoscopic and open perineal approach. MEASUREMENTS AND MAIN RESULTS: Aggressive angiomyxoma is a rare mesenchymal neoplasm that occurs most often in the female pelviperineal region [1]. Aggressive angiomyxoma is locally infiltrative, and high postoperative local recurrence rates (36%-72%) due to incomplete resection have been reported [2]. Therefore, until recently, wide surgical excision with tumor-free margins have been the most commonly accepted treatment. However, aggressive angiomyxoma is a benign, slow-growing tumor, and because extensive surgical resection, which is associated with high operative morbidity rates, has not been shown to have a significant effect on prognosis, a more conservative procedure may be preferable [3]. The mass was located mainly at the left ischiorectal fossa, but it extended above the pelvic diaphragm and was attached to internal obturator muscle, vagina, bladder, urethra, and rectum. We excised the tumor completely and without complications by a combined laparoscopic and open perineal approach. Twelve months have passed since the surgery, and there has been no adjuvant treatment and no sign of recurrence. CONCLUSION: Our combination approach to aggressive angiomyxoma in the pelviperineal region is technically feasible, and the good visualization and meticulous dissection provided during the laparoscopic portion of the surgery contribute to complete resection.

Clinical management of the status of atypical endometrial cells using the descriptive reporting format for endometrial cytology.

OBJECTIVE: We aimed to develop and reinforce a clinical management regimen for atypical endometrial cell (ATEC) categories within the descriptive reporting format for endometrial cytology. METHODS: Between January 2013 and December 2014, 215 samples, for which histological examination was performed immediately or within 3 months after cytology, were cytologically diagnosed as ATEC. For these samples, the medical records were retrospectively reviewed to identify risk factors for malignancy. RESULTS: Among 152 samples diagnosed as ATEC, of undetermined significance, 19 (12.5%) were malignant. In the younger group (age <55 years), the χ2 values of body mass index (BMI) ≥25 kg/m2 (5.85), gravidity (5.64) and parity (5.15) were relatively high, suggesting that these were risk factors for malignancy. Of the nulligravida patients, those with BMI ≥25 kg/m2 , 28% were diagnosed with malignant disease. In the older group (≥55 years), endometrial thickening (6.84), atypical genital bleeding (6.43) and BMI ≥25 kg/m2 (3.79) were found to be risk factors for malignancy. Of the patients with endometrial thickening and atypical genital bleeding, 67% were diagnosed with malignant disease. Among 63 samples diagnosed as ATEC, cannot exclude atypical endometrial hyperplasia or more, 35 (55.6%) samples were positive for malignancy. CONCLUSIONS: High-risk patients diagnosed with ATEC, of undetermined significance were identified. Endometrial biopsy should be considered for nulligravida patients aged <55 years with a BMI ≥25 kg/m2 .

Oral leukoplakia, a precancerous lesion of squamous cell carcinoma, in patients with long-term pegylated liposomal doxorubicin treatment.

Pegylated liposomal doxorubicin (PLD) has a good safety profile, but long-term use has been associated with development of squamous cell carcinoma of the tongue and oral cavity (SCCTO) in some patients. The study objective was to estimate the prevalence of oral leukoplakia, a known precursor of SCCTO, in patients with ovarian cancer and long-term PLD use.After approval of the institutional review board, medical record of 114 patients who were treated with PLD at our institution between January 2010 and December 2016 were retrospectively reviewed. All those patients have been referred for routine monitoring of oral mucositis every time before administration by a dentist. The patient characteristics included in the evaluation were age, smoking and drinking habits, the PLD dose and schedule, and presence or absence of oral leukoplakia and SCCTO at each oral examination. The relationships of the incidence of oral leukoplakia and patient characteristics were analyzed.The median total PLD dose was 160 (range 40-1550) mg/m. Oral leukoplakia was seen in 6 (5.3%) patients. The median PLD dose, at the time of oral leukoplakia diagnosis, was 685 (range 400-800) mg/m. SCCTO was not found. Univariate analysis revealed that age, Brinkman index, and habitual drinking were not considered as risk factors for oral leukoplakia, and only total PLD dose (OR, 1.470; 95% CI, 1.19-1.91; P < .001) remained as a significant independent risk factor for oral leukoplakia. The ROC curve analysis indicated that the optimal cutoff value of the total PLD dose to predict development of oral leukoplakia was 400 mg/m. The sensitivity was 100% and the specificity was 88.8%. No patient discontinued PLD because of oral leukoplakia or SCCTO.The 2 most important clinical observations were the occurrence of oral leukoplakia in patients with long-term PLD use and that the development of oral leukoplakia was related to a total cumulative dose ≥400 mg/m. Routine oral surveillance is recommended, particularly when the cumulative total dose exceeds 400 mg/m.

Maintenance hormonal therapy after treatment with medroxyprogesterone acetate for patients with atypical polypoid adenomyoma.

BACKGROUND: As atypical polypoid adenomyoma (APA) has been reported to be a hormone-related tumor, we aimed to analyze the efficacy and safety of maintenance hormonal therapy after fertility-preserving treatment of these patients with medroxyprogesterone acetate (MPA). METHODS: Data were retrospectively analyzed from patients with APA who were treated with a fertility-preserving regimen including MPA between October 2001 and December 2011. Eighteen patients were treated with MPA and 14 (77.8%) achieved either a complete or a partial response after the planned treatment. Five patients took progestin for maintenance therapy. RESULTS: Eighteen patients were treated for a mean observation period of 96.7 months. While taking the maintenance therapy, no patient had APA relapse. One patient developed well-differentiated endometrioid adenocarcinoma 18 months after she stopped taking maintenance progestin. Eleven patients without maintenance therapy underwent hysterectomy, andnine of them developed well-differentiated endometrial cancer. Through univariate analysis, there was a significant difference in time to hysterectomy between patients with and without maintenance therapy (P = 0.015). Through multivariate analysis, body mass index (BMI), menstrual status before protocol therapy, maintenance treatment, and pregnancy were found to be significantly associated with a lower risk of hysterectomy. No patient had a recurrence of APA after hysterectomy during the observation period (median, 54 months; range, 2-148 months). CONCLUSION: No patient showed progression while receiving hormonal therapy, including initial protocol therapy. Maintenance hormonal therapy after treatment with MPA was highly effective and safe, particularly in patients with BMI ≧24 kg/m2 and irregular menstruation cycle.

Efficacy of Transanal Drainage Tube Placement After Modified Posterior Pelvic Exenteration for Primary Ovarian Cancer.

OBJECTIVE: The aim of this study was to investigate the clinical usefulness of the placement of a transanal drainage tube (TDT) to prevent anastomotic leakage after a modified posterior pelvic exenteration (MPPE) for the treatment of primary ovarian cancer. METHODS: We performed a retrospective review of all the consecutive patients who had undergone an MPPE for primary ovarian, tubal, or peritoneal cancer between October 2012 and November 2016 at our institution. Patient-related, disease-related, and surgery-related data were collected. RESULTS: One hundred five patients who underwent an MPPE were included in this study. A TDT was placed in all the patients. A diverting ileostomy was created during cytoreductive surgery in 7 patients (7%). Those who underwent a diverting ileostomy tended to have a greater degree of surgical invasiveness, as was reflected by a longer operative time, a serious loss of blood, and a large quantity of intraoperative blood transfusion. Anastomotic leakage occurred in 1 patient (1%), and a diverting ileostomy was created for this patient. CONCLUSIONS: Transanal drainage tube placement seems to be an effective and safe procedure that can decrease the rate of anastomotic leakage and the need for a diverting stoma after MPPE for ovarian cancer. However, some patients inevitably require a diverting stoma despite the TDT placement.

Comparison of secondary cytoreductive surgery plus chemotherapy with chemotherapy alone for recurrent epithelial ovarian, tubal, or peritoneal carcinoma: A propensity score-matched analysis of 112 consecutive patients.

To compare secondary cytoreductive surgery (SCS) plus chemotherapy with chemotherapy alone in Japanese patients with recurrent epithelial ovarian, tubal, or peritoneal cancer (ROC).From our institutional database, we identified 112 patients who underwent therapy for ROC between 2005 and 2013. Of the 112 patients, 77 received salvage chemotherapy alone (CT group) and 35 received SCS plus chemotherapy (SCS group). To reduce the impact of treatment selection bias on treatment outcomes, propensity score-matching analysis was used.In the entire cohort, prognostic features were poorer in the CT group than in the SCS group. The platinum-free interval was significantly lower (15.35 months vs 30.77 months), cancer antigen 125 (CA125) level was significantly higher (247.38 IU/mL vs 83.17 IU/mL), and number of solitary recurrence sites was significantly lower in the CT group than in the SCS group. The matched cohort consisted of 29 CT and 29 SCS patients with a median follow-up period of 24 and 58 months, respectively. In the matched cohort, progression-free survival (PFS) was longer in the SCS group than in the CT group (P = .02); however, overall survival did not differ (P = .23).SCS might be associated with improved PFS in ROC patients. SCS is beneficial in appropriately selected ROC patients.

Total Laparoscopic Resection Surgery for a Cervical Carcinoma that Recurred in the Pelvic Sidewall After Radical Hysterectomy and Adjuvant Concurrent Chemoradiotherapy.

STUDY OBJECTIVE: To show total laparoscopic resection of a cervical carcinoma that recurred at the left pelvic sidewall after radical hysterectomy and concurrent chemoradiotherapy (CCRT). DESIGN: A step-by-step demonstration of the technique in a surgical video, including the strategy for achieving complete surgical resection with negative margins (R0 resection) (Canadian Task Force Classification III). SETTING: For high-risk cervical carcinoma, radical hysterectomy and adjuvant CCRT is the standard treatment, but even this multimodal therapy cannot prevent recurrence. When the recurrent mass is localized in the pelvic cavity, R0 resection offers the most promise; however, for laterally recurring cervical carcinoma, the resectability rate is low, owing mainly to severe adhesion and fibrosis, and thus the morbidity and mortality rates are high. Because laparoscopy optimizes visualization and provides for meticulous dissection, laparoscopic surgery can be advantageous over open surgery for resection of cervical carcinoma recurring at the pelvic sidewall after radical hysterectomy and adjuvant CCRT. INTERVENTIONS: A 48-year-old woman with stage IB2 cervical adenocarcinoma had undergone radical hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and, because lymph node metastasis was found in the removed lymph nodes, adjuvant CCRT. At 6 months after completion of this multimodal therapy, a recurrent mass was detected at the left pelvic sidewall. The mass involved the left ureter, bladder, left internal iliac vessels, and endopelvic fascia, and left renal function was unrecoverable. Tumor excision and left nephroureterectomy were performed laparoscopically. The total operating time was 608 minutes, blood loss volume was 250 mL, and blood transfusion was not required. Complete tumor clearance (R0 resection) was achieved by resection of the left internal iliac vessels, left internal obturator muscle, left pubococcygeal muscle, left ureter, and bladder. There were no postoperative complications. Institutional Review Board approval was obtained through our local Ethics Committee in Cancer Institute hospital. CONCLUSION: Complete laparoscopic resection surgery for recurrent cervical carcinoma at the pelvic sidewall after radical hysterectomy and adjuvant CCRT is technically feasible. The good visualization and meticulous dissection provided during laparoscopic surgery make the approach advantageous for the management of laterally recurrent cervical carcinoma.

Extraction of a specimen through an umbilical zigzag incision during laparoscopic surgery for endometrial cancer.

BACKGROUND: Though laparoscopic surgery has recently been applied in the treatment of early-stage endometrial cancer, the presence of a large uterus is a hindrance to specimen extraction from the abdominal cavity. We describe a laparoscopic surgical technique for endometrial cancer involving the extraction of the resected specimen through an umbilical zigzag incision. CASE PRESENTATION: A 63-year-old woman with endometrial cancer underwent a total hysterectomy and bilateral salpingo-oophorectomy that was performed laparoscopically. The surgical specimen was extracted through an umbilical zigzag incision. This umbilical zigzag incision created a larger fascial and peritoneal opening, facilitating the removal of the specimen. The final histopathologic results revealed stage 1A G1 endometrioid adenocarcinoma and multiple uterine leiomyomas. Three months after surgery, the wound in the umbilical region was inconspicuous, along with the inward movement of the umbilicus. CONCLUSIONS: A laparoscopic surgical technique for endometrial cancer involving the extraction of the specimen through an umbilical zigzag incision seems to reduce the difficulties associated with laparoscopic surgery and maintains cosmesis. Further analyses involving larger numbers of cases and long-term follow-up periods are warranted to evaluate this surgical method.

Clinicopathological Features of Early and Late Recurrence of Endometrial Carcinoma After Surgical Resection.

OBJECTIVES: The incidence of endometrial carcinoma has been increasing annually in developed nations; it is currently the second most common gynecological malignancy. Although the majority of patients are diagnosed at an early stage, 15% to 20% reportedly recur; consequently, patients are usually followed clinically for 3 years after the initial curative surgery. We therefore aimed to determine the incidence and clinicopathological features of early and late recurrences of endometrial carcinoma after surgical resection. MATERIALS AND METHODS: This retrospective study was performed using the clinical records of 2233 patients who underwent surgical resection for endometrial carcinoma between January 1970 and December 2009 at a single cancer center. Tumor recurrences were classified as early (<5 years) and late (>5 years) after initial surgery. Clinicopathological variables and tumor recurrence patterns were compared between the early and late recurrence groups. Survival analysis was performed using the Kaplan-Meier method. RESULTS: Among 2233 study patients, 255 (11.4%) experienced endometrial carcinoma recurrence; of these, early and late recurrences occurred in 232 (91.0%) and 23 (9.0%) patients, respectively. Late recurrence was associated with invasion of less than half of the myometrium at diagnosis and the presence of histopathological features of endometrioid adenocarcinoma with low- or intermediate-grade histological subtype and absence of lymphovascular invasion. After recurrence, there was no significant difference in overall survival between the early and late recurrence groups (P = 0.437). Furthermore, surgical treatment was associated with a significantly improved prognosis in the late recurrence group (P = 0.044). CONCLUSIONS: The findings of this study indicated that patients who initially underwent successful treatment for low-grade and early-stage endometrial carcinoma should be followed clinically for more than 5 years. In cases of late recurrence, surgical management may improve prognosis.

Vulvar Reconstruction Following Surgery for Vulvar Cancer Using a Stepladder V-Y Advancement Medial Thigh Flap.

OBJECTIVE: The aim of this study was to identify the risks and benefits of the stepladder V-Y advancement medial thigh flap for vulvovaginal reconstruction in comparison to direct skin closure. METHODS: Fifty-four patients with vulvar cancer treated in our hospital between 1992 and 2013 were enrolled in this study. The cohort group (group A) consisted of 25 patients who underwent surgery from August 2006 until April 2013. During this period, we changed our surgical paradigm to incorporate reconstructive plastic surgery immediately following surgery for vulvar cancer performed by gynecologic oncologists. The control group (group B) consisted of 29 patients treated between 1992 and August 2006. During this period, our surgical approach was limited to direct skin closure with no reconstructive plastic surgery. Perioperative findings and clinical outcomes were compared retrospectively. RESULTS: Patient characteristics and surgical procedures, other than the reconstructive surgery, were the same for the 2 groups. The mean blood loss and operative times were similar, and there were no major complications in either group; however, the average length of hospital stay was significantly shorter in group A (P = 0.04). CONCLUSIONS: Stepladder V-Y advancement medial thigh flap lowers posttreatment morbidity and improves quality of life for patients with vulvar cancer. Rapid recovery from surgery is reflected in the short hospital stay, and it enables immediate induction of adjuvant therapy. It may possibly contribute to improved treatment outcome.

Resection of the vaginal vault for vaginal recurrence of cervical cancer after hysterectomy and brachytherapy.

BACKGROUND: We describe our experiences with vaginal vault resection for vaginal recurrence of cervical cancer after hysterectomy and radiotherapy. After operative treatment, the rate of vaginal vault recurrence of uterine cervical cancer is reported to be about 5%. There is no consensus regarding the treatment for these cases. METHODS: Between 2004 and 2012, eight patients with vaginal vault recurrence underwent removal of the vaginal wall via laparotomy after hysterectomy and radiotherapy. RESULTS: The median patient age was 45 years (range 35 to 70 years). The median operation time was 244.5 min (range 172 to 590 min), the median estimated blood loss was 362.5 mL (range 49 to 1,890 mL), and the median duration of hospitalization was 24.5 days (range 11 to 50 days). Two patients had intraoperative complications: a grade 1 bowel injury and a grade 1 bladder injury. The following postoperative complications were observed: one patient had vaginal vault bleeding, three patients developed vesicovaginal fistulae, and one patient had repeated ileus. Two patients needed clean intermittent catheterization. Local control was achieved in five of the eight cases. CONCLUSIONS: Vaginal vault resection is an effective treatment for vaginal recurrence of cervical cancer after hysterectomy and radiotherapy. However, complications of this procedure can be expected to reduce quality of life. Therefore, this operation should be selected with great care.

Unexpected tumor progression after conization for carcinoma in situ of the uterine cervix.

AIM: To determine the safety and usefulness of conization with an electrosurgical loop (the loop electrosurgical excision procedure [LEEP]) in young women with carcinoma in situ (CIS) of the uterine cervix. METHODS: A retrospective medical chart review of five patients with CIS initially treated with LEEP conization between 2002 and 2010 and who later experienced recurrence in the form of invasive or advanced disease was conducted. RESULTS: The median patient age at initial LEEP conization was 41years (33-56years). The margin status in conization specimens was positive in three of the five patients. The median time to detection of tumor progression was 50months (17-58months). Magnetic resonance imaging was effective in detecting tumor recurrence in all cases. In four patients, hysterectomy was performed to treat the recurrence; these four patients are currently alive and disease-free. One patient with cervical lymph nodes and bone metastases was treated with chemotherapy alone; however, the patient died. In surgical specimens, tumor progression was observed extending toward the endometrium in all five patients and toward the vagina in two patients. CONCLUSION: This study indicates that patients with CIS occasionally show unexpected tumor progression after conization and the progression could be life-threatening. Recurrent disease often shows tumor progression toward the endometrium or vagina, leading to difficulties in its detection at periodic pelvic examinations.

Parametrial involvement in FIGO stage IB1 cervical carcinoma diagnostic impact of tumor diameter in preoperative magnetic resonance imaging.

BACKGROUND: In the surgical treatment for early-stage cervical carcinoma, it is important to identify preoperatively a low-risk group of patients as candidates for less radical surgery to avoid the morbidity associated with radical hysterectomy. The aim of this study was to evaluate the correlation between tumor diameter measured preoperatively using magnetic resonance imaging (MRI) and pathological prognostic factors in International Federation of Gynecology and Obstetrics (FIGO) stage IB1 cervical carcinoma. METHODS: A total of 125 patients with FIGO stage IB1 cervical cancer were included in this study. Clinical records, pathology reports, and MRI findings were retrospectively reviewed. RESULTS: Histological diagnosis was squamous cell carcinoma in 57 patients and non squamous cell carcinoma in 68 patients. All patients underwent preoperative evaluation by MRI within a median period of 13.5 days before surgery. The tumor diameter measured by MRI ranged from zero (no tumor detected) to 42 mm, with a median of 23 mm.Pathological prognostic factors included parametrial involvement, lymph node metastasis,deep stromal invasion, and lymphovascular space invasion. All these factors were found less frequently in patients with a smaller tumor diameter. Most notably, parametrial involvement was seen in none of the patients with tumors 20 mm or less and was detected only in patients with tumors greater than 20 mm (P = 0.01). CONCLUSIONS: In the FIGO stage IB1 cervical carcinoma, the tumor diameter measured preoperatively by MRI correlates well with other pathological prognostic factors, especially with parametrial involvement. This finding suggests that the tumor diameter measured in preoperative MRI may serve as a strong predictor of parametrial involvement in FIGO stage IB1 cervical carcinoma, which can be used to select a candidate population for less radical surgery without the need for a cone biopsy before hysterectomy.

Stage IA ovarian cancers: comparison of sonographic findings and histopathologic types between patients with normal and elevated serum cancer antigen 125 levels.

OBJECTIVES: The purpose of this study was to compare sonographic findings and histopathologic types of stage IA ovarian cancers between groups with normal and elevated cancer antigen 125 (CA-125) levels. METHODS: Between 2000 and 2009, 146 stage IA ovarian cancers were treated surgically (85 invasive and 61 borderline, 73 self-referred with tumor-related symptoms, 20 self-referred with nonspecific symptoms, 52 identified through screening, and 1 other). Of these, 87 cases (60%) had normal serum CA-125 levels (<35 U/mL). Their pre-operative sonographic findings and histopathologic types were compared to those of cases with elevated CA-125 levels. RESULTS: Statistically significant differences were found between the proportions of patients with elevated CA-125 levels in groups having tumors with maximal diameters of less than 20 cm and at least 20 cm (P = .03) and groups having tumors with less than 50% and 50% to 80% solid components (P = .02). In the group with normal CA-125 levels, we found predominantly mucinous adenocarcinoma in multilocular cysts with less than 50% solid components (25 cases), and clear cell adenocarcinoma in unilocular cysts with less than 50% solid components (12 cases), whereas in the group with elevated CA-125 levels, mucinous adenocarcinoma in multilocular cysts with less than 50% solid components (19 cases) and endometrioid adenocarcinoma in solid tumors (≥80% solid components) were predominant (5 cases). CONCLUSIONS: Stage IA ovarian cancers with normal CA-125 levels tend to be smaller, have less solid components, and have a slightly different distribution of histopathologic types than cancers with elevated CA-125 levels.

Phase I study of concurrent chemoradiotherapy with weekly cisplatin and paclitaxel chemotherapy for locally advanced cervical carcinoma in Japanese women.

The purpose of this study was to evaluate the use of concurrent chemoradiotherapy involving weekly administration of cisplatin and paclitaxel for the treatment of locally advanced cervical carcinoma in Japanese women. Twenty Japanese patients were registered for this phase I study. Radiation therapy was performed using external irradiation and high-dose rate intracavitary irradiation of the pelvis. Chemotherapy was performed once a week until termination of the radiation therapy. The dose of cisplatin was decided as 30 mg/m2, and the initial dose of paclitaxel was set as 30 mg/m2, with a planned incremental increase of 10 mg/m2 up to 70 mg/m2. When 3 to 6 patients were registered at each dose level and dose-limiting toxicity (DLT) was noted in more than 3 patients, the dose level was assumed to be the maximum tolerated dose. Among the 20 patients, 1 patient experienced DLT during 2 courses because of dehydration and arrhythmia. In another patient, chemotherapy was discontinued after 4 courses because of a hypersensitivity reaction to paclitaxel at dose level 3. No patient experienced DLT resulting from hematologic toxicities. All patients underwent radiation therapy according to schedule without any discontinuations. A complete response was obtained in 16 patients. Based on the results obtained from this study, weekly administration of 30 mg/m2 cisplatin and 50 mg/m2 paclitaxel with concurrent chemoradiotherapy can be considered a tolerable and safe dose for the treatment of locally advanced cervical carcinoma in Japanese women.