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1.
Anticancer Res ; 39(9): 5053-5056, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519614

RESUMO

Primary ovarian carcinoids are very rare tumors that belong to the germ cell family of ovarian malignancies. They account for less than 1% of all carcinoid tumors and for less than 0.1% of all ovarian neoplasms. Recurrences are even rarer, with only few cases reported in the literature. Strumal carcinoid has recently been recognized as an extremely rare distinct entity. We report on a patient with bilateral mature cystic teratoma with millimetric foci of ovarian strumal carcinoid who developed lymph node para aortic metastasis after 30 years from primary diagnosis. Our case is thus far the second report of a metastatic strumal carcinoid and the first one in which strumal carcinoid occurred bilaterally and was also metastatic.


Assuntos
Tumor Carcinoide/diagnóstico , Neoplasias Ovarianas/diagnóstico , Estruma Ovariano/diagnóstico , Biópsia , Tumor Carcinoide/terapia , Terapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Neoplasias Ovarianas/terapia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Estruma Ovariano/terapia , Tomografia Computadorizada por Raios X
3.
Wiad Lek ; 72(7): 1397-1402, 2019.
Artigo em Polonês | MEDLINE | ID: mdl-31398175

RESUMO

Recently, the intensive development of immunotherapies in the treatment of malignant tumors has been observed. The investigated treatment approaches including specific monoclonal antibodies, adoptive therapy and also anticancer vaccinations. The implementation of immunotherapy seems to be promising in treatment of the most malignant and fatal tumors including ovarian cancer. However, current findings have shown only a nonsignificant improvement of patients' survival. The possible cause of failure may be immunotherapy barriers that are a result of low immunogenicity level of ovarian cancer cells, mutation variability, and also the presence of a specific, immunosuppressive tumor microenvironment, which stimulates the cancer progression. The review presents the selected mechanisms of tumor resistance to immunological therapy. In order to project effective treatment approaches, it is necessary to understand both, mechanisms leading to the correct response for the treatment and causing therapeutic failures, resulting from resistance to therapy.


Assuntos
Imunoterapia , Neoplasias Ovarianas , Anticorpos Monoclonais , Feminino , Humanos , Fatores Imunológicos , Neoplasias Ovarianas/terapia , Microambiente Tumoral
4.
J Surg Oncol ; 120(4): 794-802, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31309588

RESUMO

BACKGROUND AND OBJECTIVES: To review long-term survival outcomes of patients with Peritoneal metastasis (PM) who underwent colorectal cancer (CRS) and intraperitoneal chemotherapy (PIC). METHODS: Patients that underwent CRS, with or without PIC, from January 1996 to March 2018 at the Peritonectomy Unit of St. George Hospital, Sydney were retrospectively analyzed from a prospectively maintained database. RESULTS: The study comprised of 1225 cases, including 687 females (56.1%) and 538 males (43.9%). Diagnoses included CRC (n = 363), followed by HAMN (n = 317), LAMN (n = 297), mesothelioma (n = 101), ovarian cancer (n = 55), and others including gastric, sarcoma, and neuroendocrine tumor (n = 92). The median OS, 5- and 10-year survivals for CRC were 35 months, 33% and 8%, respectively. Patients with LAMN, in relative to HAMN, experienced a higher median OS, 5- and 10-year survivals (248 months vs 63 months; 82% vs 52% and 59% vs 28%). The median OS for mesothelioma was 60 months with 5- and 10-year survivals of 48% and 19%, respectively. In ovarian cancer, the median OS was 30 months with 5- and 10-year survivals of 26% and 10%, respectively. For the remaining histological diagnoses, median OS and 5-year survival were 28 months and 27%, respectively. CONCLUSION: Our large-cohort data showed that CRS/PIC can provide long-term survival benefit to patients with PM of gastrointestinal and ovarian origin.


Assuntos
Neoplasias do Apêndice/mortalidade , Quimioterapia do Câncer por Perfusão Regional/mortalidade , Neoplasias Colorretais/mortalidade , Procedimentos Cirúrgicos de Citorredução/mortalidade , Neoplasias Pulmonares/mortalidade , Mesotelioma/mortalidade , Neoplasias Ovarianas/mortalidade , Neoplasias Peritoneais/mortalidade , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Apêndice/patologia , Neoplasias do Apêndice/terapia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/terapia , Terapia Combinada , Feminino , Seguimentos , Humanos , Injeções Intraperitoneais , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Masculino , Mesotelioma/patologia , Mesotelioma/terapia , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/terapia , Assistência Perioperatória , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/terapia , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Taxa de Sobrevida
5.
J Surg Oncol ; 120(3): 550-557, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31267569

RESUMO

BACKGROUND AND OBJECTIVES: Hypertherm intraperitoneal chemotherapy (HIPEC) is increasingly used in the treatment of ovarian, tubal, and primary peritoneal cancer (OC). The aim was to evaluate short-term morbidity of cytoreductive surgery (CRS) and carboplatin HIPEC. METHODS: Prospective feasibility study performed from January 2016 to December 2017. Twenty-five patients with primary OC (FIGO III-IV) received upfront or interval CRS combined with carboplatin HIPEC at dose 800 mg/m 2 . Primary outcome measurements: grade 3 to 5 adverse events within 30 days according to Common Terminology Criteria for Adverse Events. Secondary outcome measurements: reoperation rate, length of hospital stay, readmission rate, and time from surgery to systemic chemotherapy administration. RESULTS: No deaths (grade 5) or grade 4 adverse events were observed. Eleven patients (44.0%) experienced at least one grade 3 adverse event, the most common being an infection (28.0%) and neutropenia (12.0%). The reoperation rate was 8.0%. The median hospital stay was 14 days (range 9-25 days), and five patients (25.0%) were readmitted within 30 days after surgery. Median time from surgery to the administration of the first dose of systemic chemotherapy was 41 days (range 24-81 days). CONCLUSION: Our small-scale prospective study supports that CRS and carboplatin HIPEC used for primary advanced-stage OC is feasible with acceptable morbidity.


Assuntos
Carboplatina/administração & dosagem , Carcinoma Epitelial do Ovário/terapia , Neoplasias das Tubas Uterinas/terapia , Hipertermia Induzida/métodos , Neoplasias Ovarianas/terapia , Neoplasias Peritoneais/terapia , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Carcinoma Epitelial do Ovário/tratamento farmacológico , Carcinoma Epitelial do Ovário/cirurgia , Quimioterapia Adjuvante , Procedimentos Cirúrgicos de Citorredução/métodos , Neoplasias das Tubas Uterinas/tratamento farmacológico , Neoplasias das Tubas Uterinas/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/cirurgia , Paclitaxel/administração & dosagem , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Peritoneais/cirurgia , Estudos Prospectivos
6.
Gynecol Oncol ; 154(2): 259-265, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31176555

RESUMO

Immature teratomas (IT) are rare and recurrences uncommon. A 12-year-old female with grade 3 (high-grade) ovarian IT underwent surgical resection but experienced early recurrences; the first was treated with surgery but the second was metastatic and managed with chemotherapy, resulting in growing-teratoma-syndrome and need for further surgery. She now remains well in uneventful clinical follow-up. We believe chemotherapy could be reserved for very carefully selected recurrent IT cases, which may alter the natural history of disease.


Assuntos
Recidiva Local de Neoplasia/patologia , Neoplasias Ovarianas/patologia , Teratoma/patologia , Quimioterapia Adjuvante , Criança , Feminino , Humanos , Imagem por Ressonância Magnética , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/terapia , Tratamentos com Preservação do Órgão/métodos , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/terapia , Teratoma/diagnóstico por imagem , Teratoma/terapia , alfa-Fetoproteínas/análise
7.
Gynecol Oncol ; 154(2): 426-431, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31178150

RESUMO

OBJECTIVE: To examine associations between post-diagnosis use of antihypertensive (AH) medications including thiazide diuretics (TDs), angiotensin converting enzyme inhibitors (ACEIs), beta blockers (BBs) [both non-selective (NSBBs) and selective (SBBs)] and calcium channel blockers (CCBs) and ovarian cancer-specific survival. METHODS: This cohort study used SEER-Medicare data on 2195 women 66+ years of age who were diagnosed with ovarian cancer during 2007-2012 and who survived for at least 12 months. Use of an AH class was defined as two or more fills during the year after diagnosis. Ovarian cancer-specific death was assessed starting one year after diagnosis and continued through the end of 2013. Associations between AH use and ovarian cancer-specific mortality were assessed using Cox proportional hazard models, comparing users of a given class of AH to non-AH users. RESULTS: Overall, 718 (33%), 690 (31%), 521 (24%), 154 (7%) of women used a TD, ACEI, BB, or CCB, respectively, with some women (48%) using more than one class of drug. Ovarian cancer-specific mortality was found to be lower among women who used an ACEI (adjusted hazard ratio [aHR] 0.76, 95% confidence interval [CI] 0.63-0.92), a TD (aHR 0.82, 95%CI 0.68-0.99), or a NSBB (aHR 0.60, 95%CI 0.43-0.83), but no such association was seen in women who took a SBB or CCB. CONCLUSION: We observed that women who took certain forms of an AH medication during the year following a diagnosis of ovarian cancer were thereafter at a relatively reduced risk of dying from their disease. However, the potential for residual confounding by disease severity argues for a cautious interpretation.


Assuntos
Carcinoma Epitelial do Ovário/mortalidade , Hipertensão/tratamento farmacológico , Neoplasias Ovarianas/mortalidade , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Carcinoma Epitelial do Ovário/complicações , Carcinoma Epitelial do Ovário/terapia , Estudos de Casos e Controles , Feminino , Humanos , Hipertensão/complicações , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/terapia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Inibidores de Simportadores de Cloreto de Sódio/uso terapêutico , Estados Unidos/epidemiologia
9.
Crit Rev Oncol Hematol ; 140: 28-38, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31176270

RESUMO

Ovarian cancer (OC) is the fifth most common cause of cancer death in women worldwide. Despite treatment options have continued to improve in recent years, the recurrence rate is still high; in fact around 80% of patients relapses within 18 months. Recently, the scientific landscape is agree in asserting that the ovarian cancer is not a single disease but the outcome of patients depends from the molecular and biological characterization of tumor tissue. In this scenario, molecular targeted therapy given alone or in combination with chemotherapy is showing significant results. We review the different options for the treatment of ovarian cancer recurrence, including the role of surgery, in order to try outlining a possible treatment algorithm evaluating the recent scientific literature and the most important trials.


Assuntos
Antineoplásicos/uso terapêutico , Terapia de Alvo Molecular , Recidiva Local de Neoplasia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Feminino , Humanos , Neoplasias Ovarianas/tratamento farmacológico
10.
Rev Med Suisse ; 15(651): 1027-1031, 2019 May 15.
Artigo em Francês | MEDLINE | ID: mdl-31091037

RESUMO

New targeted therapies modify therapeutic strategies for advanced stage breast and tubo-ovarian cancers. Chemotherapy and endocrine therapy remain the cornerstones of breast cancer treatment. Inhibitors of CDK4/6, mTOR and PI3K are associated with endocrine therapy to increase its effectiveness. PARP inhibitors outperform chemotherapy in BRCA1/2 mutation carriers. Immunotherapy integrates into the treatment of triple-negative cancers with very promising results. For tubo-ovarian cancers, the concept of « platinum-sensitive ¼ has been tempered since the arrival of antiangiogenic treatment and PARP inhibitors that prolong the disease control not only in patients with BRCA1/2 mutation, but also in others.


Assuntos
Neoplasias da Mama , Neoplasias Ovarianas , Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama/genética , Neoplasias da Mama/terapia , Feminino , Genes BRCA1 , Genes BRCA2 , Humanos , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/terapia , Inibidores de Poli(ADP-Ribose) Polimerases/uso terapêutico
11.
J Stroke Cerebrovasc Dis ; 28(7): e92-e94, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31097325

RESUMO

Amaurosis fugax (AmF) is defined as transient monocular visual loss secondary to retinal ischemia. In most patients presenting with AmF, the attack of visual loss occurs in the same eye. A 64-year-old woman experienced transient visual loss in her right eye. Three days after that, an attack happened on the left side. In total, she had 5 episodes of AmF in 2 months. AmF occurred on both sides at different times, and so may be referred to as "Alternating AmF". Diffusion-weighted magnetic resonance imaging showed high-intensity lesions in various parts of brain, and laboratory examination revealed elevated D-dimer and ovarian tumor marker. We suspected Trousseau syndrome and found a giant ovary tumor. After removal of the tumor, no recurrence was observed. When a patient with alternating AmF is encountered, screening for malignancy is essential.


Assuntos
Adenocarcinoma de Células Claras/complicações , Amaurose Fugaz/etiologia , Neoplasias Ovarianas/complicações , Tromboembolia/etiologia , Trombofilia/etiologia , Adenocarcinoma de Células Claras/sangue , Adenocarcinoma de Células Claras/diagnóstico , Adenocarcinoma de Células Claras/terapia , Amaurose Fugaz/diagnóstico por imagem , Biomarcadores Tumorais/sangue , Coagulação Sanguínea , Angiografia Cerebral/métodos , Imagem de Difusão por Ressonância Magnética , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias Ovarianas/sangue , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/terapia , Recidiva , Síndrome , Tromboembolia/sangue , Tromboembolia/diagnóstico por imagem , Trombofilia/sangue , Trombofilia/diagnóstico , Resultado do Tratamento
12.
Georgian Med News ; (288): 32-36, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31101771

RESUMO

The aim of the study was to evaluate the clinical and epidemiological characteristics of the contingent of patients with RH on the example of the southern region of Ukraine. The research was carried out at the clinical bases of the Department of surgery № 4 with oncology course of the Odessa National Medical University. The standardized indicators of morbidity and mortality for 2007-2016 are analyzed. In addition, an analysis of the survival of 350 patients with stage III-IV in the period 2011-2015 was evaluated. The total one-and three-year survival (TS - total survival); disease free one-and three-year survival (DFS) - disease free survival; FFTF - freedom from treatment failure; event free survival (EFS) - event free survival were estimated. All patients were examined using conventional clinical and laboratory methods according to the standards of diagnosis and treatment of cancer patients, approved by orders of the Ministry of Health of Ukraine No. 140 dated 27.07.1998 and No. 554 dated 17.09.2007. The stage of the tumor process was determined according to the International Classification of TNM 6-th edition (2009). Patients have agreed to use individual clinical data for scientific purposes. The lifetime curves and the values of the surrogate variable were created by the Kaplan-Meyer method. Statistical analysis of the data was performed using the Statistica 10.0 (Dell StatSoft Inc., USA) package; It was established that during the analyzed period (2007-2016) in Odessa oblast there was a gradual decrease in mortality from RV from 5.5 cases per 100,000 population in 2007 to 3.8 in 2016. Dynamics of standardized indicators of morbidity and mortality from the RN shows a probable depopulation and on the effectiveness of the measures used in the region in the primary and secondary prevention of oncopathology. The overall survival of patients with severe forms of URN does not exceed 30 months (28.3±1.4 months). The use of HIPEC technology can increase the overall survival rate to 33.1±1.4 months, DFS to 17.2±1.6 months, FFTF to 17.0±1.6 months, EFS to 16.8±0,9 months, and PFS - up to 16,9±0,8 months.


Assuntos
Carcinoma Epitelial do Ovário , Neoplasias Ovarianas , Carcinoma Epitelial do Ovário/epidemiologia , Carcinoma Epitelial do Ovário/terapia , Intervalo Livre de Doença , Feminino , Humanos , Estadiamento de Neoplasias , Neoplasias Ovarianas/epidemiologia , Neoplasias Ovarianas/terapia , Taxa de Sobrevida , Ucrânia/epidemiologia
14.
BMC Cancer ; 19(1): 424, 2019 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-31064330

RESUMO

BACKGROUND: pressurized intraperitoneal aerosol chemotherapy (PIPAC), with or without electrostatic precipitation (ePIPAC), was recently introduced in the treatment of peritoneal metastases (PM) from ovarian cancer (OC). Preliminary clinical data are promising, but several methodological issues as well the anticancer efficacy of PIPAC remain unaddressed. Here, we propose a rat ePIPAC model that allows to study these issues in a clinically relevant, reproducible, and high throughput model. METHODS: laparoscopy and PIPAC were established in healthy Wistar rats. Aerosol properties were measured using laser diffraction spectrometry based granulometric analyses. Electrostatic precipitation was accomplished using a commercially available generator (Ultravision™). A xenograft model of ovarian PM was created in athymic rats using intraperitoneal (IP) injection of SKOV-3 luciferase positive cells. Tumor growth was monitored weekly by in vivo bioluminescence imaging. RESULTS: PIPAC and electrostatic precipitation were well tolerated using a capnoperitoneum of 8 mmHg. All rats survived the (e)PIPAC procedure and no gas or aerosol leakage was observed over the entire procedure. With an injection pressure of 20 bar, granulometry showed a mean droplet diameter (D(v,0.5)) of 47 µm with a flow rate of 0.5 mL/s, and a significantly lower diameter (30 µm) when a flow rate of 0.8 mL/s was used. Experiments using IP injection of SKOV-3 luciferase positive cells showed that after IP injection of 20 × 106 cells, miliary PM was observed in all animals. PIPAC was feasible and well supported in these tumor bearing animals. CONCLUSIONS: we propose a reproducible and efficient rodent model to study PIPAC and ePIPAC in OC xenografts with widespread PM. This model allows to characterize and optimize pharmacokinetic and biophysical parameters, and to evaluate the anti-cancer efficacy of (e)PIPAC treatment.


Assuntos
Antineoplásicos/administração & dosagem , Laparoscopia/métodos , Neoplasias Ovarianas/terapia , Neoplasias Peritoneais/terapia , Ensaios Antitumorais Modelo de Xenoenxerto/métodos , Aerossóis/administração & dosagem , Animais , Linhagem Celular Tumoral , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Feminino , Humanos , Injeções Intraperitoneais/efeitos adversos , Injeções Intraperitoneais/métodos , Neoplasias Ovarianas/patologia , Neoplasias Peritoneais/patologia , Neoplasias Peritoneais/secundário , Peritônio/efeitos dos fármacos , Peritônio/patologia , Pressão , Ratos , Ratos Nus , Ratos Wistar , Eletricidade Estática
15.
Acta Cytol ; 63(5): 361-370, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31048578

RESUMO

BACKGROUND: The purpose of this study was to clarify the clinicopathological characteristics of, and the clinical approach used to identify, atypical glandular cells (AGCs) in Japan based on cervical cytology screening. OBJECTIVES: This study included 1,254 patients with AGCs who underwent cervical cytology. METHOD: Data from patients with AGCs were used to examine the practical management of AGCs and the histological results. RESULTS: The incidence of AGCs was 0.20% (1,254/614,791). The 1,254 AGC cases included 859 endocervical cells not otherwise specified (NOS), 3 glandular cells NOS, 91 endocervical cells favor neoplasia (FN), and 301 atypical endometrial cells (AEMCs). Among the 1,254 AGC patients, the histological diagnosis was benign in 666 (53.1%), cervical intraepithelial neoplasia (CIN) 1 in 60 (4.8%), CIN2 in 31 (2.5%), CIN3 in 52 (4.1%), squamous cell carcinoma in 19 (1.5%), adenocarcinoma in situ in 39 (3.1%), cervical adenocarcinoma in 106 (8.5%), endometrial carcinoma in 209 (16.7%), ovarian cancer in 26 (2.1%), other malignancy in 4 (0.3%), and other under follow-up in 42 (3.3%). When the 1,254 AGC patients were divided into three medical intervention degrees according to histology, AGC-NOS, AGC-FN, and AEMC required no medical intervention in 78.7, 13.2, and 25.9% (678, 12, and 78) of the patients, cervical cone resection in 13.0, 9.9, and 0.3% (112, 9, and 1) of the patients, and radical laparotomy for invasive cancer in 8.3, 76.9, and 73.8% (72, 70, and 222) of the patients, respectively. CONCLUSIONS: Our histological results supported the medical interventions applied for AGC diagnosis and treatment. AGC cases require careful histological evaluation.


Assuntos
Adenocarcinoma/patologia , Carcinoma de Células Escamosas/patologia , Neoplasia Intraepitelial Cervical/patologia , Colo do Útero/patologia , Neoplasias do Endométrio/patologia , Glândulas Exócrinas/patologia , Neoplasias Ovarianas/patologia , Teste de Papanicolaou , Neoplasias do Colo do Útero/patologia , Esfregaço Vaginal , Adenocarcinoma/terapia , Adulto , Idoso , Carcinoma de Células Escamosas/terapia , Neoplasia Intraepitelial Cervical/terapia , Neoplasias do Endométrio/terapia , Feminino , Humanos , Japão , Pessoa de Meia-Idade , Neoplasias Ovarianas/terapia , Valor Preditivo dos Testes , Prognóstico , Neoplasias do Colo do Útero/terapia , Adulto Jovem
16.
Minerva Med ; 110(4): 301-319, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31081309

RESUMO

The identification of a mutation in ovarian cancer (OC) predisposition genes plays a crucial role in the management of cancer prevention, diagnosis, and treatment. In healthy carriers, the detection of a specific mutation might justify more intensive and personalised surveillance programmes, chemopreventive measures, and prophylactic surgeries. Moreover, the identification of a mutation in affected OC patients might provide fundamental knowledge of the tumour pathogenesis, thus guiding treatment choices. This is a comprehensive review of the molecular pathways involved in the pathogenesis of hereditary ovarian cancers, the clinical-pathological features of these tumours, and the potential implications for their prevention and clinical management.


Assuntos
Neoplasias Ovarianas/genética , Neoplasias Colorretais Hereditárias sem Polipose/genética , Feminino , Genes BRCA1 , Genes BRCA2 , Humanos , Mutação , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/terapia , Vigilância da População , Procedimentos Cirúrgicos Profiláticos
17.
Minerva Med ; 110(4): 367-384, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31124637

RESUMO

Ovarian cancer is the fifth leading cause of cancer death among women and the most lethal gynecologic malignancy. Most women with advanced epithelial ovarian cancer will experience many episodes of recurrent disease with progressively shorter disease-free intervals. For women whose disease continues to respond to platinum-based drugs, the disease can often be controlled for 5 years or more. Enormous progress has been made in the management of this disease, and new targeted treatments such as antiangiogenic drugs, poly(adenosine diphosphate-ribose) polymerase inhibitors, and immune checkpoint inhibitors offer potential for improved survival. A variety of combination strategies are being evaluated to leverage these agents. The objective of this review is to summarize results from clinical trials that tested cytotoxic drugs and target strategies for the treatment of ovarian cancer with particular attention to Phase III and ongoing trials.


Assuntos
Neoplasias Ovarianas/terapia , Carcinoma Epitelial do Ovário/patologia , Carcinoma Epitelial do Ovário/terapia , Feminino , Humanos , Estadiamento de Neoplasias , Neoplasias Ovarianas/patologia
18.
Cancer Imaging ; 19(1): 27, 2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31142357

RESUMO

BACKGROUND: Epithelial ovarian cancer (EOC) typically spreads intra-abdominally, but preoperative evaluation with FDG PET/CT often reveals metabolically active supradiaphragmatic lymph nodes (sdLNs). Their clinical significance and behavior during treatment has not been established. METHODS: EOC patients with PET positive sdLNs at diagnosis were prospectively followed with PET/CT after primary chemotherapy and at the first recurrence. In each patient, 2 most active LNs in 5 different supradiaphramatic regions were evaluated and the size and changes in FDG uptake (SUVmax) were recorded. The patients´ overall response to primary treatment was defined with RECIST criteria. The behavior of sdLNs during chemotherapy were compared in treatment responders and non-responders. Recurrence patterns were monitored. RESULTS: Forty-one patients with 127 PET/CT scans were systematically evaluated. In pretreatment scan, 76% (31/41) of patients had FDG-avid sdLNs in multiple anatomical sites. Only a minority (22/136) of the sdLNs were enlarged in size, but their histopathologic confirmation by biopsy was not possible. Only 6/41 patients had FDG-avid sdLNs in a single surgically approachable site. The sdLNs became inactive during primary chemotherapy more often in the RECIST responders compared to the non-responders (HR 1.46 (95%CI: 1.09-1.96), p = 0.002). The size and SUVmax values did not predict treatment outcome. In 50% of the responders the same sdLNs reactivated when recurrence occurred. Persistent post-treatment metabolic activity did not predict earlier disease relapse (p = 0.59). CONCLUSION: The behavior of metabolically active sdLNs during chemotherapy supports their metastatic nature. Due to their distribution to multiple regions, the benefit of removal of reachable sdLNS seems unlikely. TRIAL REGISTRATION: NCT, NCT01276574 . Registered 1 September 2010.


Assuntos
Carcinoma Epitelial do Ovário/diagnóstico por imagem , Metástase Linfática/diagnóstico por imagem , Neoplasias Ovarianas/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Adulto , Idoso , Carcinoma Epitelial do Ovário/patologia , Carcinoma Epitelial do Ovário/terapia , Feminino , Fluordesoxiglucose F18/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/terapia , Compostos Radiofarmacêuticos
19.
Chirurgia (Bucur) ; 114(2): 222-233, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31060655

RESUMO

Introduction: Peritoneal carcinomatosis represents an advanced stage of tumor dissemination of abdominal cancers in general and colorectal cancer in particular. The only therapeutic methods currently available for the treatment of this pathology are systemic chemotherapy (palliative character) and cytoreductive surgery (CR) with intraperitoneal chemotherapy. After evaluation of evidence-based medical literature and current guide lines we can state that CR + HIPEC procedure is considered to be the treatment of choice in case of patients with peritoneal carcinomatosis of colorectal, ovarian and mucinous appendicular origin. Material and method: In the present study we prospectively analyzed the immediate postoperative results obtained in the first 50 patients that were treated by our team for peritoneal carcinomatosis of different origin. We described the protocol of selection, the patients characteristics that were included in our CR+HIPEC program and analyzed the complications and death rate. Results: From January 2015 till Dec 2018 we evaluated 98 patients with peritoneal carcinomatosis. From them, 51 received radical CR+HIPEC treatment, 33 were not suitable for surgery because of the exclusion criteria's and 15 had only exploratory laparotomies. In regard with the histopathological diagnosis, 30 patients had ovarian cancer and 19 had colorectal cancer or peritoneal pseudomixoma of appendicular origin. There was no 30 days postoperative mortality. The incidence of significant postoperative complications was 15%. Conclusions: Cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy is a complex technique accompanied by an acceptable rate of complications and postoperative deaths, the results being optimized by a standardized perioperative management and patient selection. The initial results obtained by our team emphasize the feasibility of this procedure, with immediate good results, as a result of a standardization protocol of patient selection and perioperative care.


Assuntos
Neoplasias Colorretais/patologia , Procedimentos Cirúrgicos de Citorredução , Hipertermia Induzida , Neoplasias Ovarianas/patologia , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Peritoneais/cirurgia , Adulto , Idoso , Neoplasias do Apêndice/patologia , Neoplasias do Apêndice/terapia , Neoplasias Colorretais/terapia , Terapia Combinada , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Ovarianas/terapia , Seleção de Pacientes , Neoplasias Peritoneais/secundário , Estudos Prospectivos , Pseudomixoma Peritoneal/patologia , Pseudomixoma Peritoneal/terapia , Resultado do Tratamento , Adulto Jovem
20.
Int J Nanomedicine ; 14: 2757-2772, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31118609

RESUMO

Background and purpose: Surgery is regarded as the gold standard for patients with advanced ovarian cancer. However, complete surgical removal of tumors remains extremely challenging; fewer than 40% of patients are cured. Here, we developed a new modality of theranostics for ovarian cancer based on a near-infrared light-triggered nanoparticle. Methods: Nanoparticles loading IR780 iodide on base of folate modified liposomes were prepared and used for theranostics of ovarian cancer. Tumor targeting of FA-IR780-NP was evaluated in vitro and in an ovarian xenograft tumor model. A fluorescence stereomicroscope was applied to evaluate the tumor recognition of FA-IR780-NP during surgery. FA-IR780-NP mediated photothermal therapy effect was compared with other treatments in vivo. Results: FA-IR780-NP was demonstrated to specifically accumulate in tumors. IR780 iodide selectively accumulated in tumors; the enhanced permeability and retention effect of the nanoparticles and the active targeting of folate contributed to the excellent tumor targeting of FA-IR780-NP. With the aid of tumor targeting, FA-IR780-NP could be used as an indicator for the real-time delineation of tumor margins during surgery. Furthermore, photothermal therapy mediated by FA-IR780-NP effectively eradicated ovarian cancer tumors compared with other groups. Conclusion: In this study, we present a potential, effective approach for ovarian cancer treatment through near-infrared fluorescence image-guided resection and photothermal therapy to eliminate malignant tissue.


Assuntos
Ácido Fólico/química , Hipertermia Induzida , Indóis/química , Raios Infravermelhos , Nanopartículas/química , Neoplasias Ovarianas/terapia , Fototerapia , Cirurgia Assistida por Computador , Animais , Linhagem Celular Tumoral , Sobrevivência Celular , Feminino , Fluorescência , Humanos , Lipossomos , Camundongos Endogâmicos BALB C , Camundongos Nus , Nanopartículas/toxicidade , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Distribuição Tecidual/efeitos dos fármacos
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