宫颈癌患者卵巢移位手术后放射治疗对卵巢功能的作用分析

目的探讨卵巢移位术对宫颈癌患者放射治疗后卵巢功能的作用。方法选取2008年5月至2012年5月收治的40例宫颈癌患者为研究对象,行卵巢移位术治疗,并按照患者放射治疗指征在手术后进行放射性治疗,观察其手术前、手术后和放射治疗结束1个月后和放射治疗结束6个月后血清中性激素水平以及随访情况。结果手术后患者血清性激素水平无明显变化,化疗结束1个月后垂体分泌卵泡刺激素（FSH）和促黄体生成素（LH）水平明显上升,雌二醇（E2）和孕酮（P）水平明显下降（P〈0．05）,并于化疗结束6个月后恢复手术前水平。放射治疗结束6个月后,25例患者出现潮热、盗汗、烦躁、失眠等围绝经期症状,性生活满意度为37．5％,且复发1例,手术后生活质量（QOL）满意度为51．2％,无死亡病例。放射治疗结束1年后围绝经期症状自行消失,仅3例患者存在围绝经期症状,性生活满意度为95．0％,QOL满意度96．4％,2例复发,患者全部生存。放射治疗结束6个月与1年后两组在围绝经期症状、性生活满意度和QOL满意度差异均具有统计学意义（P〈0．05）。结论卵巢移位术能够有效保护宫颈癌患者放射治疗后卵巢功能,操作方便、疗效可靠,且明显降低了复发率,对患者手术后生活质量的提高具有重要意义,值得临床广泛推广。     

Ovarian transposition and metachronous ovarian metastasis in a premenopausal colorectal carcinoma patient: a case report

Colon cancer has a high incidence of metastasis, with an estimated 0.8–7.4% of colorectal adenocarcinoma (CRC) cases metastasizing to the ovary. The role of prophylactic bilateral oophorectomy in CRC is contested in the literature, particularly in premenopausal patients. Further, it is unclear if prophylactic removal of the contralateral ovary is indicated in cases of direct involvement of one ovary to reduce recurrence. Facing a lack of evidence for survival benefit, hormonal complications, and sterilization, some choose to pursue fertility sparing options. For female patients interested in additional pregnancies, the ovaries can be surgically relocated in a prophylactic procedure known as ovarian transposition; as even small doses of radiation to the ovary can effectively sterilize women in their 30 s. We present a case of a 29-year-old female who underwent ovarian transposition of the right ovary before initiating chemoradiation for primary left sided colon adenocarcinoma with direct invasion of the left ovary. Months later, she presented to the emergency department (ED) with abdominal pain suspicious for ovarian torsion. On restaging computerized tomography (CT), she was diagnosed with symptomatic right ovarian metastasis in the transposed ovary, requiring reoperation and oophorectomy. For this patient, and for others facing critical decisions about ovarian preservation in advanced colorectal cancer, the question remains how to balance fertility concerns with optimal minimization of metastasis and recurrence.     

A clinical review of seventeen patients with ovarian dysgerminoma

This is a retrospective evaluation of 17 patients with the diagnosis of ovarian dysgerminoma who were treated at the University of Iowa Hospitals from January 1938, to December 1976. Not a single patient was lost to follow-up. The majority of patients were between 11 to 30 years old. Seven patients died with disease, 3 during the 1st year, 3 during the 2nd year and 1 during the 4th year after diagnosis. In this series we have 10 patients with no evidence of disease (NED). The duration of follow-up of that group is from 51 months to 444 months with a median of 102 months. Postoperative radiation therapy is a valuable adjuvant to surgical treatment for dysgerminoma.     

放疗对宫颈癌根治术患者卵巢功能影响

目的 在保留并移位卵巢的ⅠB1-ⅡA2期根治术后需辅助放疗的年轻宫颈癌患者中,评估移位卵巢剂量学参数与临床不同卵巢功能状态之间相关性。方法 回顾2015-2017年间86例患者疗前和疗后2年内移位卵巢功能和临床相关症状,并评价放疗技术中移位卵巢的剂量学参数以及移位卵巢的功能状态之间的相关性。术后放疗采用不同体外保护移位卵巢,68例IMRT或VMAT,18例二维等中心放疗。结果 卵巢和PTV最近距离与卵巢剂量≥V5Gy呈负相关(P=0.025)。V8Gy、Dmean与疗后FSH(为卵巢血清卵泡刺激素,FSH)呈正相关(P=0.011、0.020)。即V8Gy体积越大Dmean越高,疗后FSH越高卵巢功能越差。二维技术中≥V5Gy低于三维技术,剂量降低明显。疗后卵巢功能正常者平均年龄33.4岁,而卵巢功能衰竭者平均年龄39.6岁(P=0.007)。不同卵巢状态患者间保留卵巢数目、是否同步化疗均相近,但与疗前FSH、E2(雌二醇)水平相关,即疗前FSH水平越高E2越低,疗后卵巢FSH水平越高E2越低。疗前保留卵巢但功能衰竭者均进行了新辅助化疗且年龄略高。结论 年龄,卵巢 V_{8 Cy}、D_mean,悬吊卵巢与 PTV 最近距离,疗前有无新辅助化疗及放疗技术均会影响移位卵巢功能的保护。     

Long-term changes in natural killer activity after external pelvic radiotherapy

Peripheral lymphocytes from 24 Stage I endometrial cancer patients treated 3–5 years earlier were tested for their natural killer (NK) cell activity against K562 cell line targets and for surface markers. The patients were free of recurrence at the time of investigation. They belonged to a clinical trial where group A (control) received surgery only and group B also received 4000 rad external pelvic field irradiation post surgery. Lymphocyte suspensions from group B patients showed, on a per cell basis, a higher NK activity and a higher percentage of cells bearing receptors for the Fc part of immunoglobuline G than did group A lymphocytes. Expressed per volume unit of blood, however, these differences were insignificant. A depletion of T lymphocytes from the peripheral circulation was seen 3–5 years after radiotherapy. On a per cell basis, however, the T cell functional capacity, as estimated from the mitogenic (PHA) response, seemed unaffected.     

Radiotherapy for Ovarian Cancers - Redefining the Role

Radiation therapy in ovarian cancers has been considered an outdated concept for many years, mainly due totoxicity and failure to show benefit in terms of survival. Chemotherapy has been extensively used after surgeryfor these cancers and it has almost replaced radiation therapy as an adjuvant treatment. Nevertheless, failuresin ovarian cancers continue to occur even with the use of newer and effective chemotherapy regimens. About70% patients demonstrate recurrence in the abdomen or pelvis after first line chemotherapy in ovarian cancers.With advances in technology and sophistication of radiation techniques, along with the molecular and biologicalknowledge of distinct histological subtypes, there is a need to redefine the role of radiation therapy. This reviewarticle focuses on the literature on use of radiation in ovarian cancers and its rationale and indications in thepresent day. For this, a literature pub med/medline search was performed from January 1975 to March 2014 toredefine the role of radiotherapy in ovarian cancers.     

The reconstruction after en-bloc resection of giant cell tumors at the distal radius: A systematic review and meta-analysis of the ulnar transposition reconstruction technique

BackgroundEn-bloc resection of giant cell tumors (GCTs) of the distal radius remains the mainstay treatment for those with high-graded lesions. Several techniques have been described for reconstruction of the resected segment, of which transposition of the ipsilateral ulna is scarcely reported.ObjectivesTo investigate the efficacy and safety of the different techniques of ulnar translocation following GCTs total resection.MethodsA systematic review and meta-analysis was conducted concerning the reported functional outcomes, including grip strength, range of forearm motion, functional scores, and new bone formation, as well as postoperative complications, such as delayed union, local recurrence and metastasis. The ranges of functional outcomes were reviewed and the pooled prevalence rates of complication and their respective 95% confidence intervals (95% CIs) were computed.ResultsIn a total of 12 studies, 90 patients (51.1% males, 84.8% had Campanacci grade III tumors) underwent five different reconstruction techniques. As compared to the normal side, the mean grip strength in the affected side ranged between 59 and 71%. The average union time was 1–8 months, while delayed union was reported in 50% (95% CI, 15.35 to 84.65) of patients whom their grafts were fixed with Steinmann pins. The shortest union time, the highest forearm supination and pronation degrees, new bone formation at the ulnar stump, and the highest functional scores were reported following a modified distal radius plate technique. Using a dynamic compression plate and a clover leaf plate provided lower, but considerable, functional outcomes.ConclusionUlnar translocation following GCT en-bloc resection warrants additional investigation in large cohorts and well-designed studies to corroborate the promising outcomes presented in this review.     

Subjective assessment versus ultrasound models to diagnose ovarian cancer: A systematic review and meta-analysis

IntroductionMany national guidelines concerning the management of ovarian cancer currently advocate the risk of malignancy index (RMI) to characterise ovarian pathology. However, other methods, such as subjective assessment, International Ovarian Tumour Analysis (IOTA) simple ultrasound-based rules (simple rules) and IOTA logistic regression model 2 (LR2) seem to be superior to the RMI.Our objective was to compare the diagnostic accuracy of subjective assessment, simple rules, LR2 and RMI for differentiating benign from malignant adnexal masses prior to surgery.Materials and methodsMEDLINE, EMBASE and CENTRAL were searched (January 1990–August 2015). Eligibility criteria were prospective diagnostic studies designed to preoperatively predict ovarian cancer in women with an adnexal mass.ResultsWe analysed 47 articles, enrolling 19,674 adnexal tumours; 13,953 (70.9%) benign and 5721 (29.1%) malignant. Subjective assessment by experts performed best with a pooled sensitivity of 0.93 (95% confidence interval [CI] 0.92–0.95) and specificity of 0.89 (95% CI 0.86–0.92). Simple rules (classifying inconclusives as malignant) (sensitivity 0.93 [95% CI 0.91–0.95] and specificity 0.80 [95% CI 0.77–0.82]) and LR2 (sensitivity 0.93 [95% CI 0.89–0.95] and specificity 0.84 [95% CI 0.78–0.89]) outperformed RMI (sensitivity 0.75 [95% CI 0.72–0.79], specificity 0.92 [95% CI 0.88–0.94]). A two-step strategy using simple rules, when inconclusive added by subjective assessment, matched test performance of subjective assessment by expert examiners (sensitivity 0.91 [95% CI 0.89–0.93] and specificity 0.91 [95% CI 0.87–0.94]).ConclusionsA two-step strategy of simple rules with subjective assessment for inconclusive tumours yielded best results and matched test performance of expert ultrasound examiners. The LR2 model can be used as an alternative if an expert is not available.     

Adjuvant radiotherapy after radical prostatectomy: Evidence and analysis

Although surgery provides excellent control for localized prostate cancer, pathologic examination of more than one-third of specimens will reveal positive surgical margins, seminal vesicle invasion, and/or extracapsular extension, thus putting these patients at increased risk of cancer recurrence. “Adjuvant” radiotherapy (ART) refers to treatment of patients with an undetectable PSA that is delivered after surgery (usually less than 12-16 weeks from the time of surgery). Currently, there are no standardized guidelines for the use of ART and the bulk of patients are solely monitored for signs of recurrence after prostatectomy. In this article, we review the evidence for ART from three randomized clinical trials. Although radiation therapy in the adjuvant setting has generally been well tolerated, we also examine the complication data associated with treatment. In addition, we discuss the technical aspects of treatment, including dose escalation and treatment target volume. The ability to increase dose and limit target volume would likely result in higher cure rates and decreased side effects, thus ensuring a better clinical outcome and increasing quality of life. Finally, we discuss the cost-effectiveness of ART, in the context of other medical interventions.     

Protective ostomies in ovarian cancer surgery: a systematic review and meta-analysis

ObjectiveTo assess the benefit of protective ostomies on anastomotic leak rate, urgent re-operations, and mortality due to anastomotic leak complications in ovarian cancer surgery.MethodsA systematic literature search was performed in MEDLINE, Web of Science, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials for all studies on anastomotic leak and ostomy formation related to ovarian cancer surgery. Non-controlled studies, case series, abstracts, case reports, study protocols, and letters to the editor were excluded. Meta-analysis was performed on the primary endpoint of anastomotic leak rate. Subgroup analysis was carried out based on type of bowel resection and bevacizumab use. Secondary endpoints were urgent re-operations and mortality associated with anastomotic leak, length of hospital stay, postoperative complications, 30-day readmission rate, adjuvant chemotherapy, survival, and reversal surgery in ostomy and non-ostomy patients.ResultsA total of 17 studies (2,719 patients) were included: 16 retrospective cohort studies, and 1 case-control study. Meta-analysis of 17 studies did not show a decrease in anastomotic leak rate in ostomy patients (odds ratio [OR]=1.01; 95% confidence interval [CI]=0.60–1.70; p=0.980). Meta-analysis of ten studies (1,452 women) did not find a decrease in urgent re-operations in the ostomy group (OR=0.72; 95% CI=0.35–1.46; p=0.360). Other outcomes were not considered for meta-analysis due to the lack of data in included studies.ConclusionProtective ostomies did not decrease anastomotic leak rates, and urgent re-operations in ovarian cancer surgery. This evidence supports the use of ostomies in very select cases.     

Chemotherapy-related late adverse effects on ovarian function in female survivors of childhood and young adult cancer: A systematic review

BackgroundAnti-cancer treatment may reduce the fertile life span and induce premature menopause. This review aims to provide an overview of the available literature on effects of chemotherapy only on the incidence of ovarian dysfunction and to evaluate the relationship between dose of chemotherapy, age at time of treatment, and time since treatment in female survivors of childhood and young adult cancer.MethodsA comprehensive search of electronic databases was performed (search date December 2015).Results45 studies were included, describing, in total, 5607 female survivors. Median age at menopause was earlier in cancer survivors than in the general population. The prevalence of amenorrhoea varied from 0% to 83%. Those exposed to MVPP protocols were at highest risk for amenorrhoea (39–79%), as were breast cancer survivors receiving cyclophosphamide-containing regimens, in whom the prevalence of amenorrhoea was 40–80%. The most important risk factors for ovarian dysfunction were: (1) alkylating agents, specifically procarbazine and busulfan, (2) older age at treatment.ConclusionBreast cancer survivors, those treated with procarbazine or other alkylating agents and those with a higher age at diagnosis are at highest risk of diminished ovarian function. However, all studies included in this review showed methodological limitations. It is imperative that nation-wide registries guarantee long term follow-up during the adult life of cancer survivors.     

Factors predicting postoperative morbidity after cytoreductive surgery for ovarian cancer: a systematic review and meta-analysis

ObjectiveAdvances in ovarian cancer cytoreductive surgery have enabled more extensive procedures to achieve maximal cytoreduction but with a consequent increase in postoperative morbidity and mortality. The aim of this study was to evaluate factors for postoperative morbidity after extensive cytoreductive surgery for primary epithelial ovarian cancer (EOC), particularly those which may be modifiable.MethodsElectronic databases were searched. Meta-analysis was conducted using random-effects models.ResultsFifteen relevant studies, involving 15,325 ovarian cancer patients, were included in this review. Severe 30-day postoperative complications occurred in 2,357 (15.4%) patients. The postoperative mortality rate was 1.92%. Meta-analysis demonstrated that patient with following risk factors; age (p<0.001), Eastern Cooperative Oncology Group score >0 (p=0.001), albumin level <3.5 g/dL (p<0.001), presence of ascites on CT scan (p=0.013), stage IV disease (p<0.001) and extensive surgical procedure (p<0.001) has a significantly increase risk of developing postoperative complications. Surgical procedures including peritonectomy (p=0.012), splenectomy (p<0.001) and colon surgery (p<0.001) were significant predictors for postoperative complications. Moreover, we found that patients who received neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) had a lower risk of developing severe complications compared to those who underwent primary debulking surgery (PDS) (p<0.001).ConclusionOur study demonstrated that patient performance status and hypoalbuminemia were the only significant adjustable preoperative risk factors associated with postoperative complications. Patients who underwent NACT-IDS had a lower risk of developing severe complications compared to PDS.Trial RegistrationInternational Prospective Register of Systematic Reviews (PROSPERO) Identifier: CRD42021282770     

Ovarian cancer in Lynch syndrome; a systematic review

ObjectiveThe aim was to systematically review the characteristics of ovarian cancer in women with Lynch syndrome (LS) and evaluate the role of surveillance in detection of ovarian cancer in LS.MethodsAll studies between 1979 and 2015 of women with ovarian cancer and LS or at 50% risk of LS were evaluated. Two reviewers independently evaluated eligible studies and extracted data on age at diagnosis, histological type, FIGO stage, and way of detection according to pre-specified criteria. The studies were assessed for quality using the Newcastle-Ottawa quality assessment scales.ResultsThe quality score of the 49 identified studies was at least 6 out of 8 and provide clinical information on 747 LS women with ovarian cancer. The mean age at diagnosis was 45.3 (range 19–82) years. Most frequent mutations were MSH2 (47%) and MLH1 (38%). Histopathological data were available for 445 women. The most frequently reported histological type was mixed type (mucinous/endometrioid/clear cell carcinomas) (n = 136; 31%). Most tumours (281, 65%) were diagnosed at an early stage (FIGO I/II). Six studies evaluating the effect of surveillance of ovarian cancer, reported that seven of 22 (32%) ovarian cancers were found during surveillance, 6/7 (86%) were detected at an early stage.ConclusionThis systematic review describes that ovarian cancer in women with LS has a wide age-range of onset, is often diagnosed at an early stage with frequently endometrioid/clear cell histology. Data about the role of surveillance in detection of ovarian cancer in women with LS are scarce however detection at an early stage seems possible.     

宫颈癌放疗时保留卵巢功能的研究进展

目前国内外研究报道均提示移位卵巢放疗后成功保留内分泌功能概率不高。宫颈癌放疗后卵巢功能与多种因素相关,如放疗剂量和方式、患者年龄、移位位置、同期化疗药物。因此对不同患者来说,放疗时需要控制卵巢组织在个体化剂量限制内才可能更加有效保留卵巢功能。     

Genetic variants as ovarian cancer first-line treatment hallmarks: A systematic review and meta-analysis

BackgroundThe potential predictive value of genetic polymorphisms in ovarian cancer first-line treatment is inconsistently reported. We aimed to review ovarian cancer pharmacogenetic studies to update and summarize the available data and to provide directions for further research.MethodsA systematic review followed by a meta-analysis was conducted on cohort studies assessing the involvement of genetic polymorphisms in ovarian cancer first-line treatment response retrieved through a MEDLINE database search by November 2016. Studies were pooled and summary estimates and 95% confidence intervals (CI) were calculated using random or fixed-effects models as appropriate.ResultsOne hundred and forty-two studies gathering 106871 patients were included. Combined data suggested that GSTM1-null genotype patients have a lower risk of death compared to GSTM1-wt carriers, specifically in advanced stages (hazard ratio (HR), 0.68; 95% CI, 0.48–0.97) and when submitted to platinum-based chemotherapy (aHR, 0.61; 95% CI, 0.39–0.94). ERCC1 rs11615 and rs3212886 might have also a significant impact in treatment outcome (aHR, 0.67; 95% CI, 0.51–0.89; aHR, 1.28; 95% CI, 1.01–1.63, respectively). Moreover, ERCC2 rs13181 and rs1799793 showed a distinct ethnic behavior (Asians: aHR, 1.41; 95% CI, 0.80–2.49; aHR, 1.07; 95% CI, 0.62–1.86; Caucasians: aHR, 0.10; 95% CI, 0.01–0.96; aHR, 0.18; 95% CI, 0.05–0.68, respectively).Conclusion(s)The definition of integrative predictive models should encompass genetic information, especially regarding GSTM1 homozygous deletion. Justifying additional pharmacogenetic investigation are variants in ERCC1 and ERCC2, which highlight the DNA Repair ability to ovarian cancer prognosis. Further knowledge could aid to understand platinum-treatment failure and to tailor chemotherapy strategies.     

化疗致卵巢功能损伤的研究进展

化疗药物对女性癌症患者的卵巢功能造成损害,可引起卵巢功能早衰。损伤发生率及机制尚需进一步的研究,促性腺激素释放激素激动剂(GnRHa)似能够保护化疗时的卵巢功能,卵巢组织移植保护卵巢功能技术上可行,但尚需解决一些问题。     

化疗致卵巢功能损伤的研究进展

化疗药物对女性癌症患者的卵巢功能造成损害,可引起卵巢功能早衰。损伤发生率及机制尚需进一步的研究,促性腺激素释放激素激动剂（GnRHa）似能够保护化疗时的卵巢功能,卵巢组织移植保护卵巢功能技术上可行,但尚需解决一些问题。     

Genetic variants and normal tissue toxicity after radiotherapy: A systematic review

During the last decade, nearly 60 studies have addressed possible associations between various genetic sequence alterations and risk of adverse reactions after radiotherapy. We report here an overview of these studies with information on the genetic variants, tumour type, number of patients included, the endpoint studied, the mechanism(s) by which the candidate genes are involved in the pathogenesis of normal tissue toxicity, and odds ratios (ORs) for candidate variants. Though many positive results have been reported, inconsistent findings and non-replication of previous results have frequently occurred. This can presumably be attributed to certain methodological shortcomings including lack of statistical power to detect small effect sizes. Based on theoretical considerations and experiences from other scientific fields, we discuss how future studies should be designed in order to successfully unravel the genetics of normal tissue radiosensitivity. We propose a model of the allelic architecture that may underlie differences in normal tissue radiosensitivity. Genome wide association studies have proven a powerful tool to identify novel loci that affect various phenotypes. Nonetheless, genome wide association studies are extremely demanding in terms of sample size. Furthermore, certain limitations still relate to this kind of studies, emphasizing the need for international consortia such as the ESTRO GENEPI.     

Female erectile tissues and sexual dysfunction after pelvic radiotherapy: A scoping review

Sexual function is a vital aspect of human health and is recognized as a critical component of cancer survivorship. Understanding and evaluating the impacts of radiotherapy on female sexual function requires precise knowledge of the organs involved in sexual function and the relationship between radiotherapy exposure and sexual tissue function. Although substantial evidence exists describing the impact of radiotherapy on male erectile tissues and related clinical sexual outcomes, there is very little research in this area in females. The lack of biomedical data in female patients makes it difficult to design studies aimed at optimizing sexual function postradiotherapy for female pelvic malignancies. This scoping review identifies and categorizes current research on the impacts of radiotherapy on normal female erectile tissues, including damage to normal functioning, clinical outcomes of radiation-related female erectile tissue damage, and techniques to spare erectile tissues or therapies to treat such damage. An evaluation of the evidence was performed, and a summary of findings was generated according to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Extension for Scoping Reviews guidelines. Articles were included in the review that involved normal female erectile tissues and radiotherapy side effects. The results show that little scientific investigation into the impacts of radiotherapy on female erectile tissues has been performed. Collaborative scientific investigations by clinical, basic, and behavioral scientists in oncology and radiotherapy are needed to generate radiobiologic and clinical evidence to advance prospective evaluation, prevention, and mitigation strategies that may improve sexual outcomes in female patients.     

Race in ovarian cancer treatment and survival: a systematic review with meta-analysis

Objective  There has long been recognition of racial disparities in cancer treatment and survival. In order to investigate the etiology of racial disparities in ovarian cancer, we undertook a systematic review of the published literature. Methods  Focusing on North America, our search of MEDLINE, PsychInfo, and EMBASE databases recovered 513 abstracts of which 98 underwent full text screening resulting in 24 studies included in the final review. After assessing heterogeneity, results were pooled where possible in a meta-analysis using a random effects model. Results  Eight articles reported treatment outcomes, nine survival, and seven both. Overall African Americans were less likely to receive any form of surgical treatment for ovarian cancer [pooled relative risk (RR) 1.17 (95% confidence interval (CI): 1.10, 1.23)] compared with white women. Although the majority of the included articles reporting survival outcomes did not control for known covariates such as medical co-morbidities or treatment, we were able to pool the unadjusted results from eight articles. Taken together the meta-analysis of 106,704 women did not find a difference in five-year survival between whites and African Americans, RR 1.07 (95% CI: 0.97, 1.18). When the results were stratified by year of cancer diagnosis, studies which captured patients prior to 1985 yielded a five-year RR of survival for whites compared to African Americans of 0.93 (95% CI: 0.89, 0.97) compared with 1.17 (95% CI: 1.05, 1.31) after 1985. Conclusion  These results suggest that racial disparities in ovarian cancer are not due to underlying biological differences rather to the unequal application of existing treatments. Previous presentation of results  The results from this study were presented at the XVIII IEA World Congress of Epidemiology, September 20–24, 2008 in Porto Alegre, Rio Grande do Sul, Brazil.