COMBINATION OF PRONE POSITION AND INTENSITY-MODULATED RADIATION THERAPY (IMRT) REDUCES SMALL BOWEL DOSES IN RADIATION THERAPY FOR GYNECOLOGIC MALIGNANCIES

Objective： To evaluate if the combination of both prone position on a belly board and intensity-modulated radiotherapy （IMRT） further reduces the radiation dose to small bowel in pelvic RT for gynecologic malignancies. Methods： Conformal pelvic RT plans were computed in 13 patients with gynecologic malignancies who had pre-existing planning computed tomography （CT） scans in both the supine position and prone position on a belly board. There were 10 cervical cancer and 3 endometrial cancer patients. A limited arc technique （180° arc length） and an extended arc technique （340° arc length） were used in IMRT plans. Normal tissue regions of interest （ROI） included small bowel, large bowel and bladder. Dose and volume for normal tissue structures were traced and compared between supine and prone plans using the paired t-test. Results： For the limited arc technique, prone position using a belly board device improved small bowel sparing. Analysis of the results showed a 12~26 Gy reduction of volume of small bowel irradiation compared to the supine position. With the extended arc technique, there was no obvious radiation reduction in the prone position. Large bowel and bladder dose showed no significant differences between prone and supine position with either technique. Conclusion： Prone positioning on a belly board decreases the small bowel dose in gynecologic pelvic IMRT, and the magnitude of improvement depended on the limited arc IMRT technique used.

Application of traditional Chinese medicine acupoint needle embedding combined with emotional nursing in patients with gynecological malignant tumors

BACKGROUND Few relevant literature reports on applying acupoint press-needle embedding combined with emotional nursing in patients with a gynecological malignant tumor.AIM To explore the effect of traditional Chinese medicine acupoint needle embedding combined with emotional nursing on chemotherapy-related nausea and vomiting(CINV),cancer-related fatigue(CRF)and psychological state in patients with gynecological malignant tumors.METHODS Retrospective analysis of the clinical information of 84 patients with gynecological malignant tumors treated in our hospital from August 2020 to December 2022 Led to the development of an observation group(n=42)and a control group(n=42)based on various nursing approaches.Ondansetron hydrochloride injection was administered to the individuals in the control group.However,the observation group received emotional nursing based on the control group and acupoint pressneedle embedding of traditional Chinese medicine.Patients in both groups received the chemotherapy regimen of paclitaxel liposome+carbo-platin/cisplatin.For four weeks,both groups intervened.The CINV grade,quality of life,CRF,psychological status and sleep quality scores of the two groups before and RESULTS After intervention,the degree of CINV in the observation group was significantly better than that in the control group.After intervention,the scores of each dimension and total score of FLIE scale were significantly higher than those in the control group.After intervention,the scores of each dimension and total score of Piper Fatigue Scale were significantly lower than those in the control group(P<0.05).After intervention,the scores of avoidance and yield dimensions in the observation group were significantly lower than those in the control group,and the scores of confrontation dimension were significantly higher than those in the control group(P<0.05).After intervention,the sleep quality score of the observation group was significantly lower than that of the control group,and the Karnofsky Performance Status scale score was significantly higher than that of the control group(P<0.05).CONCLUSION The acupuncture point needle embedding of traditional Chinese medicine combined with emotional nursing can further reduce the incidence of chemotherapy-related nausea and vomiting in patients with gynecological malignant tumors,improve the quality of life and the degree of CRF,alleviate the bad psychological state,adopt a positive way to face the disease and treatment,and improve the quality of sleep and quality of life.

Lymphovenous anastomosis and complex decongestive therapy for severe deformed lymphedema with recurrent infection:A case report

BACKGROUND Lower extremity lymphedema is a common complication following treatment for gynecological malignancies.Its incidence rate can reach up to 70%,affecting~20 million people worldwide.However,specialized treatment centers are scarce,and there is a lack of consensus on treatment approaches.Furthermore,there are even fewer reports on the systematic and effective treatment of severe lymphedema with malformations.Effective management of this condition remains a significant challenge for clinicians.CASE SUMMARY A 40-year-old woman developed bilateral leg swelling 6 years after receiving treatment for endometrial cancer.Since August 2018,she experienced>30 episodes of lymphangitis.Upon presentation,she exhibited bilateral leg swelling and deformation,with four large swellings in the posterior thigh that impeded movement,and pain in the limbs.Skin manifestations included lichenoid lesions and features of deep sclerosis.Radionuclide lymphoscintigraphy confirmed the diagnosis of lower limb lymphedema.After 6 mo of complex decongestive therapy(CDT)and three lymphaticovenous anastomosis(LVA)treatments,the patient lost 49 kg in weight.She also experienced a maximum circumference reduction of 35.2 cm in the left lower limb and 37.5 cm in the right lower limb.The leg pain disappeared,her swelling significantly decreased,and she regained the ability to walk,cycle,and run normally.CONCLUSION The combined application of CDT and LVA therapy demonstrates significant positive effects in the treatment of severe,deformed stage III lymphedema.

Brain Metastases in Patients with Gynecologic Cancers: A Single Institution Experience and Review of the Literature

Objective: Brain Metastasis (BM) from primary gynecologic cancers is a rare entity. The advances and successes in the treatment of primary gynecologic malignancies, have led to prolonged survival and, a higher incidence of BM. This study aims to report the experience at our institution in managing these patients, and provide possible data points that may be essential to note as prognostic factors, and see if our findings are consistent with the literature in this subject. We also aim to provide a brief literature review of patients with gynecologic cancers and BM. Methods: This is a small single institution retrospective study of 23 patients with a gynecologic malignancy and BM, identified between the years 2007-2015. Data were collected on variables including patient demographics, disease and treatment. Results: The median overall survival from the primary diagnosis was 28 months. Median time from diagnosis of BM to death was 9 months. Conclusion: The outcomes in our study are similar to what is stated in the current literature with regard to BM from gynecologic malignancies. Our literature search also revealed that the molecular analysis and treatment of the primary tumor remain important to prevent BMs. The tendency of tumors to metastasize varies for one tumor type to another for the same type of tumor. The tendency to develop BM may not only depend on risk factors such as stage, grade, and histology, but also on the genetic profile of the primary tumor. The study suggests that multimodal treatment of BM has better outcomes in managing BM from gynecologic cancers.

Role of Mediterranean diet in preventing platinum based gastrointestinal toxicity in gynecolocological malignancies: A single Institution experience

BACKGROUND Gynecological malignancies represent a major cause of death in women and are often treated with platinum-based regimens.Patients undergoing chemotherapy suffer from alterations in nutritional status which may worsen gastrointestinal(GI)toxicities,quality of life and affect the overall prognosis.Indeed,assuring a good nutritional status and limiting toxicities during treatment are still major goals for clinicians.AIM To assess the role of Mediterranean Diet(MD)in reducing GI toxicities in patients with gynecological cancers treated with platinum-based regimens.METHODS We conducted an observational study on 22 patients with gynecological tumors treated with a platinum-based chemotherapy at Candiolo Cancer Institute FPO/IRCCS between January 2018 and June 2018.The food and frequency(FFQ)and the Patient-Reported Outcomes Common Terminology Criteria For Adverse Events(PRO-CTCAE)questionnaires were administered at baseline and at every Day 1 of each cycle.To evaluate the differences in GI toxicities the study population was divided in two groups according to the currently validated Mediterranean Diet Serving Score(MDSS)at baseline.RESULTS Patients with high MDSS reported a trend toward lower GI toxicities according to PRO-CTCAE at each timepoint(first evaluation:P=0.7;second:P=0.52;third:P=0.01).In particular,difference in nausea frequency and gravity(P<0.001),stomach pain frequency and gravity(P=0.01 and P=0.02),abdomen bloating frequency and gravity(P=0.02 and P=0.03),and interference with daily activities(P=0.02)were highly statistically significant at the end of treatment.More than 60%of patients changed their food habits during chemotherapy mainly because of GI toxicities.A higher reduction of food intake,both in terms of caloric(P=0.29)and of single nutrients emerged in the group experiencing higher toxicity.CONCLUSION Our results show that adherence to MD possibly reduces GI toxicity and prevents nutritional status impairment during chemotherapy treatment.Bigger studies are needed to confirm our results.

SURGICAL TREATMENT OF GYNECOLOGIC MALIGNANCES IN PATIENTS 70 YEARS OF AGE AND OLDER

Objective.T o assess the viability of surgical procedures on gynecologic malignant patients o f70years age and older.Methods.Between September1,1983to June30,1 999,57gynecologic malignant patients aged70years and older were treated by surgical procedures.A retrospective study was perf ormed.All patients were analyzed for preexisting medical conditions,length of hospital stay,morbidi-ty,and mortality.Results.Thirty-four patients had a n extensive surgical procedure,while a local surgical procedure was done in23 patients.Forty-one patientshad one or more preexisting medical i llnesses.Minor surgical morbidity occurred in24patientsand majo r surgical morbidity occurred in6patients.There were no differen ces in the types of surgical procedures,mean hospital stay,preexisting medical illness and postoperative complications between the two groups of patients70 to75year older and over age75.The major postoperative complications all occ urred in the extensive surgical procedure group that were higher as compared wit h local operation and postoperative mean stay was also significant-ly length in former group.Conclusions.The extensive surgical procedure can be performed fo r elderly patients with gynecologic malignances.Careful preoperative evaluatio n,monitoring,and meticulous postoperative care are vital to the success.

Malnutrition as a predictor of prolonged length of hospital stay in patients with gynecologic malignancy: A comparative analysis

Objective To explore the consistency of the Patient-generated Subjective Global Assessment(PG-SGA)and Nutritional Risk Screening-2002(NRS-2002)for nutritional evaluation of patients with gynecologic malignancy and their predictive effect on the length of hospital stay(LOS).Methods We recruited 147 hospitalized patients with gynecologic malignancy from Nanfang Hospital in 2017.Their nutritional status was assessed using the PG-SGA and NRS-2002.The consistency between the two assessments was compared via the Kappa test.The relationship between malnutrition and LOS was analyzed using crosstabs and Spearman’s correlation.Results The PG-SGA demonstrated that 66.7%and 54.4%of patients scoring≥2 and≥4 were malnourished,respectively.Furthermore,the NRS-2002 indicated that 55.8%of patients were at nutritional risk.Patients with ovarian cancer had a relatively high incidence of malnutrition.However,this was only significant for patients who scored≥4 in the PG-SGA(P=0.001 and P=0.019 for endometrial carcinoma and cervical cancer,respectively).The PG-SGA and NRS-2002 showed good consistency in evaluating the nutritional status of patients with gynecologic malignancy(0.689,0.643 for PG-SGA score≥2,score≥4 and NRS-2002,respectively).Both the scores of PG-SGA and NRS-2002 were positively correlated with LOS.Furthermore,prolonged LOS was higher in patients with malnutrition than in those with adequate nutrition.Conclusion The PG-SGA and NRS-2002 shared a good consistency in evaluating the nutritional status of patients with gynecologic malignancy.Both assessments could be used as predictors of LOS.

Endovascular stent treatment of the iliac vein stenosis caused by a pelvic lymphocele secondary to gynecologic malignancy

Over the past two years,6 patients had iliac vein stenosis caused by radiation and pelvic lymphocele secondary to gynecologic malignancy.Patients had symptomatic lymphoceles induced lower limb edema.Poor treatment of symptomatic lymphoceles,compression symptoms persist,all patients were performed endovascular stent therapy,clinical symptoms of lower limb were completely relieved.Iliac vein stenosis caused by radiation and pelvic lymphocele secondary to gynecologic malignancy,endovascular stent placement is a nonsurgical alternative for the reestablishment of venous flow and sustained relief of symptoms.

Evaluation of sentinel lymph nodes in vulvar, endometrial and cervical cancers

Sentinel lymph node （SLN） biopsies are a sensitive tool in evaluating lymph nodes for multiple cancers, and in some diseases they decrease morbidity in both the short- and long-term. SLN detection in gynecologic malignancies has been studied extensively over the past decade. We review the current literature on SLN dissection in vulvar, endometrial and cervical cancers. Large, well-designed trials in each of the three types of cancer have demonstrated high sensitivity and low false-negative rates when SLN biopsy is performed in the correct patients and with an appropriate technical approach. In all of these cases the addition of ultra-staging to conventional pathology yields increased detection of micrometastatic disease. Biopsy of the sentinel nodes is feasible and safe in early vulvar malignancies, with multiple studies describing low recurrence rates in those women who have with negative SLNs. There does not appear to be a survival benefit to lymphadenectomy over SLN biopsy and quality of life is improved in women undergoing SLN biopsy. Optimal treatment strategies for women with positive nodal biopsies, particularly in cases with micrometastatic disease, remain unclear. Multiple large studies investigating the utility of SLN biopsy in endometrial malignancy have found that sentinel nodal status is a reliable predictor of metastases in women with low-risk disease. Prospective studies are ongoing and suggest sentinel nodal detection may soon become widely accepted as an alternative standard of care for select cases of endometrial cancer. In cervical cancer, SLN biopsy is accurate for diagnosing metastatic disease in early stage tumors （≤ 2 cm diameter or stage ≤ IB2） where the risk of metastasis is low. It is unknown if women who undergo SLN biopsy alone will have different survival outcomes than women who undergo complete lymphadenectomy in these cases. In a specific population of women with vulvar cancer, SLN dissection is an effective and safe alternative to complete dissection. It can be offered as an alternative management strategy in these women. In women who do undergo SLN biopsy, it is associated with improved quality of life. Promising evidence supporting the utility of SLN dissection in endometrial and cervical cancer continues to emerge, and it may soon become a reasonable option for select patients. However, continued research and refnement of appropriate patient selection and long-term follow-up are necessary.

Tumor Vascular Markers： Possibilities for Detection of Breast Carcinoma

Breast cancer is one of the world＇s most urgent health problems. The first symptoms of mammary malignancies are manifested only at an advanced stage with significant mortality. Detecting this disease at an early stage gives the majority of patients a better chance of survival. The aim was to search for changes in gene expression of specific tumor vascular markers like death receptor 6 （Dr6） and glycoprotein M6B （Gpm6B） in the blood of patients with breast cancer. All subjects were divided into two groups. First group with patients are with different grades of breats tumors （n = 30）. Second group consists from healthy women （n = 15）. After isolation of mRNA from blood, RT-PCR was followed by gel electrophoresis. For statistical analysis one-way ANOVA was used with Student＇s T test using GraphPad InStat software. Significant changes in mRNA levels of gene Dr6 in all grades of first stage breast cancer were detected. The mRNA levels of Dr6 showed a rising tendency from GI （116% higher value than control） to G3 （198% higher than control）. During monitoring of the mRNA level of Gpm6B, a weaker increase was observed than in Dr6. The difference in GI was only 8% higher compared with controls and 44% at G3. From our results it can be concluded that DR6 is a more suitable marker for the diagnosis of breast malignancies in the early stages than Gpm6B. In our work, a non-invasive method for more timely and precise determination of the earlier stages of breast cancer is described, which could also contribute to monitoring the effectiveness of treatment, or regression of this disease.

Prospect of research and clinical application of arsenic compounds in chemotherapy for gynecological malignant tumors

Arsenic compounds,including various arsenic-containing compounds such as intravenous use of arsenic trioxide(ATO)and an oral tetra-arsenic tetra-sulfide(As4S4)-containing formula named the Realgar-Indigo naturalis formula(RIF).RIF,also known as Compound Huangdai Tablets,which exert anti-tumor effects through a variety of mechanisms,such as the induction of programmed cell death,induction of G1 or G2/M phase arrest,epigenetic regulation of miRNAs,and suppression of cancer stem cell properties.International multicenter clinical studies have shown that ATO and RIF have anti-tumorigenic effects on hematological tumors and some solids.Arsenic compounds also been used in the treatment of cervical cancer,endometrial cancer,ovarian cancer,especially advanced drug-resistant ovarian cancer.This article introduces the progress of ATO in combination chemotherapy,such as ATO with paclitaxel,adriamycin,cisplatin,etc in solid tumors and gynecological malignant tumors.The side effects associated with arsenic treatment,including cardiac disorders,skin and bone marrow suppression,etc.are also discussed in this review.Oral arsenic drugs also have a good therapeutic effect,it may be an outpatient oral chemotherapy new model for RIF to treatment recurrent ovarian cancer.

Molecular targeted therapy of gynecological malignanttumors: the development and challenge, from laboratory toclinic

More and more molecular drugs based on targeted therapy have been utilized in the treatment of gynecologic cancer,especially in ovarian cancer.In this article,we systematically review the current targeted therapeutic trials running in clinic.Large,randomized trials have been conducted in the treatment of ovarian cancer,endometrial cancer and cervical cancer by using small molecule,antisense,mutational gene as well as antibodies.Other planned or ongoing trials currently targeted at molecular markers which may play important roles in gynecological carcinogenesis and progression suggest that combination chemotherapy with molecular targeted therapy will ultimately be an important option.