Isolated Para-Aortic Nodal Recurrence in Endometrial Cancer

Aim: While cytoreductive surgery should be considered for patients with regional recurrence of endometrial cancer, the management of isolated para-aortic lymph node recurrence remains controversial. We investigated the frequency of isolated recurrence in the para-aortic lymph nodes and the effectiveness of surgery for such recurrence. Methods: A retrospectively maintained endometrial cancer database at the Cancer Institute Hospital in Japan was reviewed to identify sites of metastasis and recurrence. Results: A total of 2322 patients with endometrial cancer underwent primary treatment with systemic lymphadenectomy between 1984 and 2015. Systematic pelvic and para-aortic lymph node dissection was performed in 889 patients (Group 1), while 1433 patients underwent dissection of only the pelvic lymph nodes (Group 2). Although 16 patients (1.1%) in Group 2 had isolated para-aortic recurrences, only 3 patients (0.3%) in Group 1 had documented recurrences in the para-aortic lymph nodes (p = 0.043). Although second recurrence occurred in 30.0% of patients who underwent surgical recurrence treatment, second recurrence occurred in 77.8% of patients who underwent non-surgical recurrence treatment (p = 0.037). In addition, the overall survival rate for patients who underwent surgical recurrence treatment (80.0%) was significantly higher than that for patients who underwent non-surgical recurrence treatment (33.3%) (p = 0.026). Conclusions: Patients who underwent dissection of only the pelvic lymph nodes had a higher frequency of isolated recurrence in the para-aortic lymph nodes. In addition, a relatively good prognosis could be achieved with surgical treatment for isolated recurrence in the para-aortic lymph nodes, which was better than that achieved using non-surgical methods.

How to win the ovarian cancer stem cell battle: destroying the roots

Ovarian cancer has the highest mortality rate among gynecologic malignancies.The combination of cytoreductive surgery and chemotherapy is the standard regimen for the treatment of ovarian cancer.The initial treatment is usually effective,but many patients with ovarian cancer experience recurrence,and treatment options for recurrent disease remain challenging.Cancer stem cells(CSCs)are suggested to play an essential role in cancer recurrence after initial chemotherapy.Furthermore,they are of great interest as CSCs may also be involved in chemotherapy susceptibility.Thus,understanding the characteristics and mechanisms by which CSCs display resistance to therapeutic agents is important to design effective cancer treatments.In this review,we describe and discuss current therapeutic regimens for ovarian cancer,as well as the various CSC markers,association between CSCs and disease progression,correlation of CSCs with poor prognosis,enrichment of CSCs in tumor tissues following repeated chemotherapy cycles,activation of major signaling pathways following chemotherapy,and potential inhibitors that suppress these signaling cascades.In addition,clinical trials evaluating novel targeted therapies to overcome chemotherapy resistance will be reviewed.The combination of traditional chemotherapy and CSC-targeted therapy could be an effective and promising anticancer treatment for ovarian cancer.Understanding the biological properties of CSCs and the mechanism of chemotherapy resistance are critical to design and develop new therapeutic strategies to overcome CSC-associated chemotherapy resistance.