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The Lancet 05/2012; 379(9830):1949-50. · 38.28 Impact Factor
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Gynécologie Obstétrique & Fertilité 04/2012; 40(5):330-2. · 0.52 Impact Factor
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ABSTRACT: The Endometrioid Borderline ovarian tumor (EBOT) is the third most common histological subtype of borderline ovarian tumors. Very little is known about the prognosis and management of this entity. This paper consists of a review of the literature and an analysis of clinical series.
A review of the literature on this topic was conducted identifying series reporting consecutive cases of EBOT using 2 search engines (MEDLINE and Pubmed). Personal data on this topic have been included and concern a series of patients treated between 1985 and 2009 for EBOT. These cases included in this series had complete data concerning patient management and follow-up > 12 months.
16 patients were studied: 7 had been treated conservatively and 9 radically. All 16/16 patients had stage I disease at the initial diagnosis but one patient had also developed synchronous endometrioid adenocarcinoma of the uterine corpus. After a median time of 24 months (range, 12-132) post treatment, one (1/16) patient had developed two recurrences. She remains disease-free 42 months after the end of treatment of the last recurrence. These data were compared to the results of 4 series previously reported in the literature. In fact, the present series reports on the first recurrence in EBOT (which was an invasive lesion).
Endometrioid borderline ovarian tumors carry a good prognosis. Most EBOT tumors are stage I, therefore surgical staging is not necessary in most of the cases. However, uterine curettage is required in cases of uterine preservation.
Surgical Oncology 03/2012; 21(3):178-84. · 2.44 Impact Factor
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ABSTRACT: Laparoscopic para-aortic lymphadenectomy (PAL) is being used increasingly to stage patients with locally advanced cervical cancer (LACC) and to define radiation field limits before chemoradiation therapy (CRT). This study aimed to define clinical implications, review complications, and determine whether surgical complications delayed the start of CRT.
We retrospectively reviewed a continuous series of patients with LACC, with no positive para-aortic (PA) nodes on positron emission tomography-computed tomography (PET-CT) and who had undergone a primary laparoscopic PAL.
From November 2007 to June 2010, 98 patients with LACC underwent pretherapeutic PAL. Two patients did not undergo PAL: extensive carcinomatosis was discovered in one case and a technical problem arose in the other. No perioperative complications occurred. Seven patients had a lymphocyst requiring an imaging-guided (or laparoscopic) puncture. Eight patients (8.4%, which corresponds to the false-negative PET-CT rate) had metastatic disease within PA lymph nodes. In cases of suspicious pelvic nodes on PET-CT, the risk for PA nodal disease was greater (24.0% versus 2.9%). When patients with and without surgical morbidity were compared, the median delay to the start of treatment was not significantly different (15 days; range, 3-49 days versus 18 days; range, 3-42 days).
The morbidity of laparoscopic PAL was limited and the completion of treatment was not delayed when complications occurred. Nevertheless, if PET-CT of the pelvic area is negative, the interest in staging PAL could be discussed because the risk for PA nodal disease is very low.
Gynécologie Obstétrique & Fertilité 02/2012; 40(3):153-7. · 0.52 Impact Factor
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ABSTRACT: The aim of this study was to describe the clinical features of vaginal melanoma and treatments available.
This is a retrospective review of patients with primary vaginal melanoma operated from 2000 to 2010 at Gustave-Roussy Institute.
Six patients had surgery for a vaginal melanoma out of 37 patients operated for vaginal cancer in our institute in the same period (13.6%). Median age was 53.5 years [48-66]. The melanoma presented as a macroscopically visible nodular tumor in all case. Median tumour size was 5.4cm [1.5-15]. Five of the six patients had a [18F] fluoro-deoxy-glucose positron-emission tomography combined with integrated computed tomography (FDG-PET/CT) before surgery. Initial management included two conservative treatments and four colpectomy with one anterior exenteration. Two sigmoidcolpoplasties were performed. Lymph node metastases were found in only one patient. Median progression free survival was 10.5 months [4-51]. All patients have relapsed, three of them in the 6 months following surgery. Recurrences were local in three patients and distant in three patients. Local recurrences were surgically treated. In one case, electrochemotherapy was performed. One patient with locoregional disease underwent a pelvic isolated perfusion. One patient had a KIT mutation. Two patients died at 12 and 83 months.
Vaginal melanoma had a poor prognosis. The 5-year overall survival is under 20% from literature data. Local and/or distant recurrences are frequent and new local and adjuvant treatments are currently evaluated.
Gynécologie Obstétrique & Fertilité 02/2012; 40(5):273-8. · 0.52 Impact Factor
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ABSTRACT: To determine the prognosis of and prognostic factors for mesenteric node involvement in patients undergoing a bowel resection at the time of debulking surgery for primary treatment of advanced-stage ovarian cancer (ASOC).
A retrospective review of patients treated between 2005 and 2008 for ASOC and undergoing initial and interval debulking surgery with bowel resection (whatever the bowel segment). The characteristics and prognostic impact of mesenteric node involvement were studied.
During the study period, 52 patients underwent debulking surgery for ASOC with bowel resection. Eighteen and 34 patients underwent initial or interval debulking surgery respectively. The most frequent site of the bowel resection was the rectosigmoid colon (38 patients; 73%) and 12 patients had resection of at least 2 intestinal segments. All patients had a complete macroscopic resection of peritoneal disease. Nineteen patients (37%) had mesenteric node involvement with a median of 4 involved nodes (range, 1-12). The degree of involvement of the intestinal wall and retroperitoneal node involvement (pelvic or para-aortic) had no impact on the risk of mesenteric node involvement. Overall survival and the location of recurrent disease were similar in patients with or without spread to mesenteric nodes.
This study suggests that mesenteric node involvement is frequent in patients undergoing bowel resection in ASOC. Such spread does not appear to have an impact on patient survival. Modifying peroperative (particularly the extent of the mesocolon resection) or postoperative management is therefore unnecessary.
European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 11/2011; 38(2):170-5. · 2.56 Impact Factor
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ABSTRACT: Lymphoceles are the most frequent complications following systematic lymphadenectomy in gynaecologic cancers. Some of them may have clinical significance with high morbidity. Through a review of literature, we describe surgical methods (way of surgery, lymphadenectomy type, sentinel lymph node, peritonization, drainages, lymphostasis, surgical patch) and medical methods (somatostatin analogs and nutrition treatment) which could prevent lymphoceles formation after pelvic and lumboaortic lymphadenectomy.
Gynécologie Obstétrique & Fertilité 11/2011; 39(12):698-703. · 0.52 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the prognostic factors of patients undergoing completion surgery for locally advanced-stage cervical cancer after initial chemoradiation therapy (CRT).
Patients fulfilling the following inclusion criteria were studied: stage IB2-IVA cervical carcinoma; tumour initially confined to the pelvic cavity on conventional imaging; pelvic external radiation therapy with delivery of 45 Gy to the pelvic cavity and concomitant chemotherapy (cisplatin 40 mg/m(2) per week) followed by utero-vaginal brachytherapy; completion surgery after the end of radiation therapy including at least a hysterectomy.
One-hundred and fifty patients treated between 1998 and 2007 fulfilled inclusion criteria. Nineteen patients had pelvic nodes involved and 19 had para-aortic nodes involved. Seventy-two patients (48%) had complete surgical sterilization of the cervix. Prognostic factors for overall survival in the multivariable analysis were the presence and level of nodal spread (positive pelvic nodes alone: HR = 2.03, positive para-aortic nodes: HR = 5.46; P < 001) and the presence and size of residual disease (RD) in the cervix (RD ≤ 1 cm: HR = 1.92, RD > 1cm: HR = 3.85; P = 02).
In this series, the presence and size of RD and histologic nodal involvement were the strongest prognostic factors. Such results suggest that the survival of these patients could potentially be enhanced by improving the rate of complete response in the irradiated area and by initially detecting patients with para-aortic spread.
Gynécologie Obstétrique & Fertilité 05/2011; 39(5):274-80. · 0.52 Impact Factor
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ABSTRACT: [(18)F]fluoro-deoxy-glucose positron-emission tomography combined with integrated computed tomography (FDG-PET/CT) is commonly used for advanced stage cervical cancer but its efficiency is discussed in early stage. The aim of this study was to evaluate false negative rate of FDG-PET/CT in early-stage cervical and vaginal cancer.
Patients treated between 2005 and 2008 for stage IB1 cervical cancer and stage I vaginal cancer who underwent a FDG-PET/CT followed by a pelvic lymphadenectomy were studied.
Eighteen patients were included with bilateral pelvic lymphadenectomy (16 cervical cancer, two vaginal cancer). The median age of patients was 41 years. Radical hysterectomy was performed for 16 patients, by a laparoscopic approach in 15 cases and by a laparotomic approach in one case. One patient had a simple hysterectomy and one had exclusive radiotherapy. No patient had pelvic or para-aortic fixation on FDG-PET/CT. Three patients have proven pelvic involvement and one had para-aortic metastases. The false-negative rate and negative predictive value of FDG-PET/CT were 17% and 83% respectively.
The accuracy of FDG-PET/CT imaging in predicting the pelvic nodal status is very low in patients with early-stage cervical and vaginal cancer and is not able to replace surgical exploration.
Gynécologie Obstétrique & Fertilité 03/2011; 39(4):193-7. · 0.52 Impact Factor
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ABSTRACT: The aim of this study was to describe how recurrences were diagnosed in the largest series of patients treated for an advanced-stage serous borderline ovarian tumour.
From 1973 to 2006, 45 patients with a serous borderline tumour and peritoneal implants relapsed among 162 patients with a follow-up exceeding 1 year. Data concerning recurrences and the mode of diagnosis were reviewed.
The median follow-up interval was 8.2 years (range 19-286 months). The mode of diagnosis of recurrences was imaging (n = 19), clinical symptoms (n = 8), cancer antigen (CA) 125 elevation (n = 7), secondary surgery (n = 5) and unknown (n = 6). The median time to recurrence was 31 months (range 4-242 month). The type of recurrence was invasive low-grade serous carcinoma in 14 patients. Five patients died of recurrent tumour. Among the 39 patients with a known mode of diagnosis of recurrence, the most frequent diagnostic method for invasive recurrences was blood CA 125 elevation (6 of 13) and the majority of noninvasive recurrences were diagnosed by imaging (16 of 23).
This study demonstrates that ultrasound is the most relevant follow-up procedure in this context. Nevertheless, the blood CA 125 test is of particular interest for detecting invasive recurrent disease, which is the most crucial event.
Annals of Oncology 03/2011; 22(3):631-5. · 6.43 Impact Factor
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E Chéreau,
R Rouzier, S Gouy,
G Ferron,
F Narducci,
C Bergzoll,
C Huchon,
F Lécuru,
C Pomel,
E Daraï,
E Leblanc,
D Querleu,
P Morice
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ABSTRACT: Treatment of Advanced Ovarian Cancer (AOC) includes surgery with complete cytoreduction, one of the strongest prognostic factors. To achieve complete cytoreduction, diaphragmatic surgery is often required. There is currently a lack of information in the literature regarding the morbidity and impact of this type of surgery. The aim of this study is to report specific pulmonary morbidity and overall morbidity associated with diaphragmatic surgery in patients with AOC.
We conducted a multicentric (6 centres), retrospective study that included 148 patients operated on between 2004 and 2008. Patient characteristics, surgical course and postoperative complications were collected.
The complete cytoreduction rate was 84%. The surgery was categorised by timing as initial, interval or recurrence surgery in 38%, 51% and 11% of patients, respectively. In 69% of patients, one or more postoperative complications occurred: pulmonary complication (42%), digestive fistula (7%) or lymphocyst (18%). The pulmonary complications were pleural effusion (37%), pulmonary embolism (5%), pneumothorax (4%) and pulmonary infection (2%). These complications required revision surgery, pleural evacuation, or lymphocyst evacuation in 13%, 14%, and 11% of the cases, respectively. Postoperative mortality was 3%. Risk factors for pulmonary complications were the addition of extensive upper surgery to the diaphragmatic surgery (p = 0.014) and the size of the diaphragmatic resection (p = 0.012).
Diaphragmatic surgery achieved complete removal of the tumour but resulted in pulmonary complications in addition to complications of radical surgery.
European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 02/2011; 37(2):175-80. · 2.56 Impact Factor
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ABSTRACT: With tumour size, node involvement is the most important prognosis factor in advanced stage cervical cancer. Para-aortic (PA) disease is observed in 15 to 30% of these patients. CT scan and magnetic resonance imaging (MRI) are not efficient enough to detect these lesions and PET CT have false negatives. Surgical staging is useful to detect carcinosis associated and to adapt therapy (radiotherapy fields are extended if PA nodes are involved). Laparoscopy was crucial to develop this staging because its morbidity associated to chemoradiotherapy is limited. If prognosis impact of PA lymphadenectomy is well established, therapeutic impact is still discussed. The systematic extension of this staging to pelvic nodes that are included in the basic radiotherapy fields is debated because it does not modify therapeutic management and is morbid. Radiotherapy progress, especially with boost and combination to MRI (MRIT), will impact on future therapeutic management.
Gynécologie Obstétrique & Fertilité 10/2010; 38(11):668-71. · 0.52 Impact Factor
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ABSTRACT: To evaluate the morbidity rate in patients following completion surgery (hysterectomy±lymphadenectomy) after chemoradiation therapy (CRT) for an advanced stage cervical cancer.
Patients fulfilling the following inclusion criteria were studied: (1) stage IB2-IVA cervical carcinoma; (2) tumor initially confined to the pelvic cavity; (3) pelvic external radiation therapy with delivery of 45Gy with concomitant chemotherapy (cisplatin 40mg/m(2)/week) followed by utero-vaginal brachytherapy; (4) completion surgery after the end of radiation therapy including at least a hysterectomy.
One-hundred and fifty patients treated between 1998 and 2007 fulfilled inclusion criteria. Thirty-seven (25%) patients had 55 post-operative complications (17 had severe complications requiring surgical or radiological treatment). Two deaths related to postoperative morbidity had occurred. The risk of complications was increased with a radical hysterectomy (OR=2.4; P=0.04) and the presence of residual cervical disease (≤1cm: OR=4.3, >1cm: OR=2.5; P=0.01).
In the present study, the morbidity of completion surgery (based on hysterectomy with or without lymphadenectomy) is very high in patients treated with initial CRT for locally advanced cervical cancer whereas the therapeutic value of such surgery remains unproven.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 10/2010; 39(8):624-31. · 0.42 Impact Factor
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ABSTRACT: Upper abdomen cytoreduction is an important and challenging surgery that should be considered only if a macroscopically complete cytoreduction is expected. Techniques of the main procedures are addressed herein, as well as their respective morbidity and indications. Given its complexity, this surgery should be reserved to specialized teams, working in specialized centers.
Bulletin du cancer 12/2009; 96(12):1199-205. · 0.67 Impact Factor
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ABSTRACT: The treatment of the advanced ovarian adenocarcinoma, most frequently stage at diagnostic, relies on association of surgery and chemotherapy. The current standard is the association carboplatine-paclitaxel. In spite of this treatment, relapses are frequent, and the prognosis thus remains very reserved. Presently the current areas of research aim at both improving the efficiency of treatments and decreasing their toxicity. So the various trials dealt with the use of the other cytotoxics having proved efficiency against relapses either in double-agent therapy or in association in the current standard, or in the administration of the chemotherapy by intra peritoneal way. They also investigated the possibility of pursuing the therapeutic sequence by a treatment of maintenance or consolidation. As for numerous cancerous pathologies, the targeted therapies, notably the antiangiogenic one, represent an important hope in the treatment of the ovarian cancer.
Bulletin du cancer 12/2009; 96(12):1207-13. · 0.67 Impact Factor
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ABSTRACT: The aim of this study was to assess the outcomes of the largest series of patients treated conservatively for a stage II or III serous borderline ovarian tumor.
From 1969 to 2006, 41 patients were treated conservatively for an advanced-stage serous borderline ovarian tumor. Patient outcomes were reviewed.
Twenty patients had undergone a unilateral salpingo-oophorectomy, 18 a unilateral cystectomy and two bilateral cystectomy (unknown for one patient). Three patients had invasive implants. The median duration of follow-up was 57 months (range 4-235). The recurrence rate was high (56%), but overall survival remained excellent (100% at 5 years, 92% at 10 years). One death had occurred due to an invasive ovarian recurrence. Eighteen pregnancies (nine spontaneous) were observed in 14 patients.
This study demonstrates that spontaneous pregnancies can be achieved after conservative treatment of advanced-stage borderline ovarian tumors (with noninvasive implants) but the recurrence rate is high. Nevertheless, this high rate has no impact on survival. Conservative surgery can be proposed to patients with a borderline tumor of the ovary and noninvasive peritoneal implants. Should infertility persist following treatment of the borderline tumor, an in vitro fertilization procedure can be cautiously proposed.
Annals of Oncology 08/2009; 21(1):55-60. · 6.43 Impact Factor
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ABSTRACT: Early stage of cervical cancer is defined by disease confined to the cervix and upper vagina (stage IA to IIA). For early stage, no treatment has demonstrated clear superiority. Treatment options for women with early stage include either exclusive radiotherapy, or radical surgery, or brachytherapy before radical surgery. Radical hysterectomy or trachelectomy include the resection of the parametrium. The rational of parametrectomy is to remove occult disease in the parametrium and its removal is the cause of much of the morbidity of the surgery, specially urinary complications. This surgery can be performed by laparascopy with quality of life improvement and less blood loss but urinary morbidity is still important. The question is if it's possible to be less radical and still oncologically safe. Parametrial invasion is rare in patients with small tumours without lymphovascular space involvement and negative pelvic nodes (no poor prognostic factors). Sentinel node negative could be a strong criteria to predict parametrial involvement. This review reports studies exploring the safety of omitting parametrectomy in these low risk patients and the future possibilities to evaluate these new indications.
Gynécologie Obstétrique & Fertilité 07/2009; 37(6):504-9. · 0.52 Impact Factor
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ABSTRACT: The aim of this study was to assess the outcomes of women treated conservatively for a serous borderline ovarian tumour with stromal microinvasion (SBOT-SMI) but without micropapillary pattern. Ten women treated conservatively for a stage I (n= 8) or stage IIIB (n= 2) tumour were followed up. With a median follow-up duration of 62 months (range 7-117 months), five recurrences developed on the preserved ovary. All lesions were borderline recurrences (with noninvasive peritoneal implants in one). All women are currently disease free. Three women achieved a spontaneous pregnancy and three became pregnant after an in vitro fertilisation procedure. This study suggests that conservative treatment of SBOT-SMI is safe.
BJOG An International Journal of Obstetrics & Gynaecology 06/2009; 116(6):860-2. · 3.41 Impact Factor
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Gynécologie Obstétrique & Fertilité 01/2009; 37(1):81-2. · 0.52 Impact Factor
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ABSTRACT: Borderline ovarian tumours (BOT) do not exhibit overt stromal invasion and are less aggressive than invasive epithelial ovarian tumours. BOT also arise in younger patients than those who develop epithelial ovarian tumours. Our aim was to evaluate the feasibility of ovarian cryopreservation (OC) in patients treated for BOT.
A retrospective study of data concerning young patients (less than 35 years of age) who underwent surgery for a BOT with OC planned during the surgical procedure.
Twenty-three patients, treated between January 2002 and February 2008, were initially selected but six of them were excluded from the present study (four because the tumour was malignant and two because it was benign). Finally, 17 patients were diagnosed as having BOT based on the frozen section analysis. In nine (53%) of these cases, OC was finally performed. In eight cases, OC was not performed; instead, in four cases a simple cystectomy was finally performed (one patient was in fact pregnant at the time of surgery), in one case malignant disease was found and in three (18%) patients OC was not technically feasible because no normal ovarian parenchyma was evident on gross inspection.
In patients treated for a BOT, OC was eventually feasible in 53% of patients in whom this procedure was initially planned. In 18%, this procedure was aborted because no macroscopic healthy ovarian tissue could be found.
Human Reproduction 01/2009; 24(4):850-5. · 4.47 Impact Factor
