Efficacy and tolerability of lower-dose topotecan in recurrent ovarian cancer: a retrospective case review

Topotecan (1.5 mg/m(2)/day for 5 consecutive days of a 21-day cycle) is an established recurrent ovarian cancer treatment, but myelosuppression can be dose limiting. This study evaluates the activity and tolerability of low-dose topotecan in our clinical experience. Case records were reviewed for patients with recurrent ovarian cancer in first through third relapse. Eligible patients had received > or =2 cycles of < or =1.25 mg/m(2) topotecan. Adverse events were evaluated using laboratory and clinical evaluation data. Twenty-seven eligible patients, most with advanced disease, received a total of 209 cycles (median, six cycles). Grade 3 or 4 hematologic toxicities during 184 cycles in 24 assessed patients were neutropenia, leukopenia, thrombocytopenia, and anemia in 35%, 28%, 36%, and 11% of cycles, and 21, 19, 16, and 10 patients, respectively. Only four grade 4 toxicities occurred: anemia (one) and thrombocytopenia (three). Myelosuppression was reversible, noncumulative, and manageable. Moreover, nonhematologic toxicity was generally mild to moderate, and the only two grade 3 events were constipation and deep vein thrombosis. Low-dose topotecan was active in this setting. Lower-dose topotecan is generally well tolerated and active in patients with pretreated ovarian cancer. Prospective clinical trials of low-dose topotecan in recurrent ovarian cancer are warranted.     

Obstetric outcomes of pregnancy after conservative treatment of endometrial cancer: case series and literature review

ObjectiveTo evaluate the pregnancy courses and obstetric outcomes in patients conceived after conservative treatment of endometrial cancer.Materials and MethodsCase series and systemic review of pregnancy women after fertility-sparing treatment of endometrial cancer. Patients with early stage endometrial cancer were identified through Tumor Registry in Chang Gung Memorial Hospital between 1990 and 2005 and MEDLINE search. Diagnosed cases were managed by fertility-sparing therapies. Pregnancies followed by assisted reproductive technology and spontaneous or ovulation with intrauterine insemination were designated as Group 1 and Group 2, respectively.ResultsFive livebirths in three patients with two sets of twin pregnancy were delivered. Adding 47 women in the MEDLINE search literature, there were 65 deliveries with 77 livebirths. Groups 1 and 2 had 15 and 50 deliveries, respectively. Group 1 had 23 livebirths including four sets of twins and two sets of triplets, whereas 54 livebirths consisted of two sets of twins and one set of triplets were noted in Group 2 (p = 0.003). Seven preterm deliveries were noted in Group 1 and three in Group 2 (p = 0.001). Cesarean rate was 93.3% versus 22.0% (p < 0.001) in Groups 1 and 2, respectively. Pregnancy-induced hypertension and gestational diabetes mellitus were significant between the two groups (p = 0.035). One mother died of disease after delivery. No neonatal morbidity was reported.ConclusionsFor women who had completed conservative treatments in early endometrial cancer, assisted reproductive technology provided a choice of scheduled conception for those with subfertility or chronic anovulation.     

An unusual presentation of endometrial cancer: a case report and literature review

BACKGROUND: The purpose of this case report is to describe the failure of standard diagnostic work up in the presence of an advanced stage endometrial cancer and briefly review the literature about the efficacy of the currently utilized diagnostic tools in the evaluation of women with postmenopausal bleeding (PMB). CASE: A 71-year-old normal weight lady presented with an unprovoked PMB. Initial evaluation consisted of pelvic ultrasound followed by office hysteroscopy and directed endometrial biopsy. Biopsy was negative but her symptom persisted, so she had a repeat hysteroscopy with dilatation and curettage (D&C) in the operating room. The D&C histology was again negative but elevated CA 125 and a suspicious looking intramural "fibroid" on ultrasound and MRI prompted our advice for hysterectomy. At the time of surgery, a stage III C endometrial cancer was found. CONCLUSION: A high level of vigilance is required in the evaluation of women presenting with symptoms suspicious for endometrial cancer. When these symptoms persist despite negative initial work up, continuing evaluation and sometimes intervention are required on the part of the clinician.     

Granulosa cell tumor and endometrial cancer: a case report and review of the literature

Granulosa cell tumors (GCTs) of the ovary are an uncommon type of ovarian cancer, representing only 2-5%. Frequently, their tumoral cells present some features of normal granulosa cells, like hormonal production. As a consequence, this neoplasia can be diagnosed either by common ovarian cancer symptoms or endometrial pathologies due to an estrogenic effect. Symptoms caused by estrogen production can also give rise to different clinical manifestations depending on whether they appear in postmenopausal or young women. In the case we present below, a patient was referred for presenting postmenopausal bleeding of one year's duration. Once endometrial cancer was diagnosed and subsequently staged, an ovarian mass was detected. We report an atypical case of ovarian cancer with the aim of reviewing the clinical features of GCT, as well as its prognosis, treatment and follow-up recommendations, according to the available literature.     

Prolonged stabilization of platinum/paclitaxel-refractory ovarian cancer with topotecan: a case report and review of the literature

A combination of a paclitaxel and platinum analog is currently the standard first-line chemotherapy for women with ovarian cancer, with response rates of 20-37%. As patients who relapse have a poor prognosis and treatment options are limited, there is an urgent need to develop new agents with novel mechanisms of action for use as a second-line, non-cross-resistant chemotherapy in ovarian cancer. In this report, we describe a patient with platinum/paclitaxel-refractory ovarian cancer who received topotecan and reached long-term stabilization of her disease. The patient was administered 1.5 mg/m2 topotecan for five days in 17 cycles. She was also given granulocyte colony-stimulating factor (G-CSF) support to prevent severe granulocytopenia; no hematologic toxic effect was experienced. Her quality of life was good throughout the treatment, and also her daily activities were unaffected.     

Advanced endometrial adenocarcinoma following endometrial ablation: a case report and review of the literature

Endometrial ablation is an alternate method to hysterectomy when treating dysfunctional uterine bleeding (menorrhagia, metrorrhagia and postmenopausal) that does not respond to hormonal treatment or curettage among a carefully evaluated and selected patient population. Its safety and efficacy have been confirmed in large studies. We present a case of advanced staged endometrial carcinoma diagnosed after endometrial ablation that followed uneventful preoperative work-up.     

Radical trachelectomy for early stage cervical cancer: A case series and literature review

Objective

Radical trachelectomy (RT) is an alternative treatment for preserving fertility in patients with cervical cancer. Because women with operable cervical cancer opting for fertility preservation are scarce, few cases have been reported in Taiwan. Here we report our cases series.

Alport syndrome and pregnancy: a case series and literature review

Purpose

To assess pregnancy outcome in women with Alport syndrome and the impact of pregnancy on the disease progression.

Methods

We describe one of the largest series of pregnancies in Alport syndrome. Seven pregnancies of six women were monitored by a multidisciplinary team of nephrologists and gynecologists. After delivery, patients were followed for at least 3 years. We compare our results with those in the literature.

Results

Pregnancy course was uneventful in the patient with isolated microscopic hematuria. In the other cases, all presenting mild proteinuria at conception, some complications occurred. Proteinuria worsened during the last trimester, reaching nephrotic ranges in five out of six pregnancies and was associated with fluid overload leading to hospitalizations and early delivery. The majority of the newborns had a low birth weight. The two patients with arterial hypertension at conception and twin pregnancy developed pre-eclampsia and renal function deterioration persisted after delivery. The one with pre-pregnancy renal dysfunction reached end-stage renal disease. In the other patients, in which renal function and blood pressure were and remained normal, proteinuria improved after delivery and no signs of disease progression were recorded at last observation.

Conclusions

Our observations suggest that Alport syndrome should be considered a potential risk factor for pregnancy in proteinuric patients due to the development of pre-eclampsia, renal function deterioration, and/or full-blown nephrotic syndrome that results in anasarca, slowing of fetal growth and pre-term delivery. Thus, all women with Alport syndrome should receive pre-conceptional counseling and be kept in close follow-up during pregnancy.

     

Hormone therapy in advanced and recurrent endometrial cancer: a systematic review

Endometrial cancer is a hormone-dependent malignancy, and the majority has a precursor phase of endometrial hyperplasia. Histologic subtypes have been recognized with differing natural history. The relationship between hormone response, histology, and molecular profile is not established, but the relevant biology is summarized. This study was a systematic review of the literature to identify which populations should be considered for hormone interventions. Systematic searches were carried out in the English literature for randomized controlled trials and phase II studies of hormone interventions in endometrial cancer. Five randomized trials and 29 phase II studies were identified comprising a total of 2471 patients. In previously untreated patients with grade 1 (G1) or G2 tumors, the response rate for progestogens and the progression-free survival is in the range of 11-56% and 2.5-14 months, respectively. Higher response rates are seen in progesterone receptor-positive cases. Phase II studies comprise the majority of the data and many are of poor quality. There was considerable heterogeneity in patient selection, prior treatment, and type of regimen, and meta-analysis was not possible. G3 or G4 toxicity was less than 5%. We conclude that hormone receptor assessments should be carried out in all patients entered on clinical trials and may aid clinical management in selected cases. Receptor-negative status should not be an absolute contraindication to hormone intervention. Integration of hormone treatment with conventional chemotherapy and growth factor-targeted therapy needs to be explored.     

Primary hyperparathyroidism in pregnancy: a case series and literature review

Primary Hyperparathyroidism (PHP) in pregnancy constitutes a serious danger to mother and fetus. The diagnosis of PHP in pregnancy presents a challenge, and PHP commonly goes unidentified and untreated in pregnancy. We present four case reports about patients having PHP, which is very rare condition in pregnancy and their treatment modalities. Three patients, not to be controlled biochemically, denied the parathyroidectomy operation although they are informed about the details of their disease. They are followed up with medical therapy. The first one had no maternal or fetal complications, the second one acquired nephrolithiasis crisis in the last trimester and the third one gave birth to a premature baby who succumbed to tetany. The fourth patient who underwent parathyroidectomy operation in the second trimester had no maternal or fetal complications. PHP in pregnancy is a preventable cause of fetal and maternal mortality and morbidity. Thus, suspecting from PHP during the pregnancy and early diagnosis is critically important in terms of maternal and fetal wellness.     

Essure a novel option for the treatment of hydrosalpinx: a case series and literature review

Objective: The aim of this study is to evaluate the use of hysteroscopic Essure device placement for the treatment of hydrosalpinx (HS)-related infertility in patients with laparoscopic contraindications and compared their pregnancy outcomes following IVF–ICSI treatment with those patients having had laparoscopic tubal occlusion (LTO).

Patients: From 2008 to 2014 a total of 50 patients were diagnosed with unilateral or bilateral hydrosalpinges: 29 patients had laparoscopic contraindications and were treated hysteroscopically and 21 patients were treated with laparoscopical salpingectomy.

Results: Of the 29 patients who underwent treatment with Essure®, 21 began a cycle of in vitro fertilization (IVF), and 13 finished in embryo transfer that resulted in seven clinical pregnancies. Furthermore, in the group of women treated with salpingectomy, 17 started an IVF cycle that resulted in 12 clinical pregnancies. The clinical pregnancy rate per patient with an IVF cycle started was 33.3% and 70.6%, the live-birth rate per patient was 14.3% and 52.9%, the miscarriage rate was 57.1% and 18.2%, and the implantation rate was 16.3% and 34.1% for hysteroscopy and laparoscopy, respectively.

Conclusion: Essure® placement is an alternative method for occlusion of hydrosalpinges before IVF. Monitoring the live-birth rate confirms that this option may be considered when laparoscopy is impossible or contraindicated.     

Pregnancy following endometrial ablation: case history and literature review

A total of 43 pregnancies that occurred subsequent to endometrial ablation were reported to July 2002. Only 17 of these pregnancies had progressed beyond 20 weeks. We report a successful planned pregnancy following endometrial ablation and sterilization reversal, culminating in vaginal birth after a previous Caesarean section. The English literature has been reviewed to ascertain family planning practices, uterine cavity assessment and pregnancy outcomes after endometrial ablation/resection. Pregnancy management recommendations are provided. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to list the various pregnancy complications associated with a history of endometrial ablation, and to describe the changes in the endometrial cavity following endometrial ablation.     

Splenic metastasis from endometrial carcinoma: report of a case and review of literature

Introduction  

Splenic metastasis from endometrial carcinoma is a rare clinical event, with only 11 cases documented previously in the literature.     

Pregnancy after endometrial ablation: English literature review and case report

Endometrial ablation is an effective treatment for dysfunctional uterine bleeding. The incidence of pregnancy after endometrial destruction is low and is reported to be 0.7%. We report what is to the best of our knowledge the first case of pregnancy after microwave endometrial ablation and review the outcomes of 74 pregnancies after various methods of endometrial destruction.     

Bilateral hydrosalpinges masquerading as ovarian cancer: a late complication of microwave endometrial ablation: a case report and literature review

We report on a late presentation of bilateral hydrosalpinges 2 years following microwave endometrial ablation. The patient was reviewed in the Gynaecological Oncology Centre on account of a raised cancer antigen 125 (CA125) and suspicious appearances on ultrasound and computed tomography. Benign tubal masses should be considered amongst the differential diagnosis in women presenting with adnexal masses and a raised CA125 following endometrial ablative procedures.     

Lower genital tract rhabdomyosarcoma: case series and literature review

OBJECTIVE: Rhabdomyosarcoma (RMS) of the lower genital tract is a rare tumor. It tends to occur in childhood in the vagina and in rare cases, RMS can originate in the uterine cervix, with a peak incidence in the 2nd decade. METHODS: A hospital-based tumor registry was searched to find all patients with female genital tract RMS, which were treated between 1999 and 2004. The medical records of all patients were reviewed. A single pathologist reviewed all pathologic specimens. RESULTS: Among the 1,528 patients with genital tract malignancies, six RMS were found: three vaginas, three cervixes. All patients presented with vaginal bleeding. Mean age of patients was 16(13-30). The lesions in vagina were clinically staged as stage I (2), stage II (1) and in cervix were stage I (2) and stage III(1). All of the patients were treated with surgery and adjuvant chemotherapy. One patient with cervical RMS was treated with adjuvant chemo radiation. Two patients with cervical RMS died from the large size and extent of the disease 9 and 11 months after diagnosis, but all patients with vaginal RMS remain alive after a mean follow-up of 38 months. CONCLUSION: Most patients present with vaginal bleeding and a palpable cervical or vaginal mass. While the optimal management of these tumors is uncertain, primary therapy with wide local excision and chemotherapy can result in prolonged survival and cure in patients with early stage RMS. Vaginal lesions have a better prognosis than cervical lesions. In patients with un-embrional RMS, large size of lesion, cervical origin and extent of disease, survival rates was decreased.