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.

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.

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.

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.

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.

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.