Weekly paclitaxel in heavily pretreated ovarian cancer patients: does this treatment still provide further advantages?

Objective

To evaluate the disease control rate (DCR) in heavily pretreated and relapsed ovarian cancer patients re-challenged with a weekly paclitaxel schedule and to establish whether a correlation between dose intensity, progression-free interval (PFI) and overall survival (OS) exists.

Methods

Retrospective data were collected from 30 heavily pretreated metastatic ovarian cancer patients who received 80?mg/m²/week paclitaxel regimen.

Results

The treatment was well tolerated and showed a DCR in 70% of the patients, with only one case of grade 3 hematological toxicity. One patient (3%) showed a complete response, 15 patients (50%) a partial response and five patients (17%) a stabilization of their disease. The regimen was mostly used as a fourth-line chemotherapy (range 2?C7). The median dose intensity in responding patients was 57.5?mg/m²/week and in those with progressive disease 49.7?mg/m²/week. (p?=?0.20). PFI and OS were increased in the responder patient groups with a log-rank test of 25.64 (p?<?0.001) and 15.10 (p?=?0.0001), respectively.

Conclusions

Weekly administration of paclitaxel was active and well tolerated as a salvage therapy for heavily pretreated ovarian cancer patients.     

Pharma Update Genitalkarzinome

Ovarian cancer

In early stage ovarian cancer chemotherapy containing platinum is recommended. In an advanced or recurrent situation combined chemotherapy with carboplatin/paclitaxel (area under the curve AUC5 175 mg/m²) is indicated. The vascular endothelial growth factor (VEGF) targeting agent bevacizumab can prolong the progress-free interval. For the treatment of platinum-sensitive ovarian cancer the preferred agents are carboplatin/gemcitabine, carboplatin/paclitaxel and carboplatin/caelyx. Platinum-resistant recrudescence primarily indicates a monochemotherapy and the recommended therapeutic options are polyethylene glycol (PEG) liposomal doxorubicin/topotecan/gemcitabine/paclitaxel.

Cervical cancer

A combined radiochemotherapy containing cisplatin is considered to be the standard of care in neoadjuvant and adjuvant treatment as well as in recurrent situations. Neoadjuvant dose-dense chemotherapy improves the 5-year survival rate and reduces overall mortality. Adjuvant chemotherapy only is not indicated. In a recurrent or metastasized situation for radiation-naive patients radiochemotherapy is indicated. The only approved regimen in Germany is a combination of cisplatin and topotecan. Results of the GOG 240 trial confirmed an enhancement of the progress-free survival with addition of the antibody bevacizumab.

Endometrial cancer

Of all endometrial cancer patients 20?% are considered to be high risk patients. The recurrence rate is 50?%. According to the current German S2K guidelines in all patients presenting with a TNM stage Ib G3, II and III as well as all serous or small cell endometrial carcinomas, platinum chemotherapy with carboplatin/paclitaxel (AUC5 175 mg/m²) is indicated sequential to radiation. In the palliative situation local surgical treatment or radiation is the main option. A possible combination with either gestagens or cytostatic therapy depends on the hormone receptor status.

Vulvar cancer

Radiochemotherapy is indicated in inoperable situations, extensive recrudescence or in non-in sano resected patients. In metastasized patients the use of a combined chemotherapy is criticized due to the high toxicity and low response rate.     

Phase III trial of induction gemcitabine or paclitaxel plus carboplatin followed by paclitaxel consolidation in ovarian cancer

Objective

The safety and efficacy of gemcitabine plus carboplatin (GC) or paclitaxel plus carboplatin (TC) induction regimens with or without paclitaxel consolidation therapy were assessed in ovarian cancer (OC).

Methods

Patients with stage IC-IV OC were randomized to either GC (gemcitabine 1000 mg/m², days 1 and 8, plus carboplatin area under the curve [AUC] 5, day 1) or TC (paclitaxel 175 mg/m² plus carboplatin AUC 6, day 1) every 21 days for up to six cycles. Patients with complete response (CR) were allowed optional consolidation with paclitaxel 135 mg/m² every 28 days for ≤ 12 months. Patients without CR received single-agent crossover therapy at induction doses/schedules until CR, disease progression (PD), or unacceptable toxicity. PD or death in 636 patients was required to compare induction arms with 80% statistical power for progression-free survival (PFS), the primary endpoint.

Results

Randomized induction therapy was received by 820 of 919 patients enrolled; 352 patients with CR received paclitaxel consolidation whereas 155 patients without CR received single-agent crossover therapy. PFS was similar for GC and TC (median, 20.0 and 22.2 months, respectively; P = .199). Despite high censoring rates (> 52%), overall survival was longer for TC (median, 57.3 versus 43.8 months for GC; P = .013). Controlling for patient characteristics including performance status, residual tumor size, and tumor stage, there was no statistical difference in a multivariate analysis (HR = 1.22; 95% CI = 0.99-1.52; P = .067).

Conclusions

GC does not improve PFS over TC as first-line induction chemotherapy in OC. Although favoring TC, overall survival analyses were limited by the study design and high censoring rates.     

Comparison of Platinum-based Neoadjuvant Chemotherapy and Primary Debulking Surgery in Patients with Advanced Ovarian Cancer

Purpose

Ovarian cancer is the sixth common cancer in women in developed countries. In severe cases, the optimal debulking is necessary. In order to increase optimal debulking and reduce preoperative complications, neoadjuvant chemotherapy followed by debulking surgery, and then chemotherapy again is introduced as substitute for primary surgery. In this study, we aim to evaluate perioperative outcome after neoadjuvant chemotherapy with carboplatin/paclyaxol in comparison with primary cytoreduction in patients with advanced ovarian cancer.

Methods

In this prospective study, 60 patients with advanced ovarian cancer due to the disease severity were assigned into neoadjuvant chemotherapy (n = 30) or control (n = 30) groups. In neoadjuvant chemotherapy group, patients received three cycles of carboplatin (5–6 area under the curve) and paclitaxel (175 mg/m²) preoperatively followed by interval surgery. The control group received primary surgery plus adjuvant chemotherapy. Preoperative outcome was compared between groups.

Results

Neoadjuvant group had significantly lower mean levels of CA 125 (p = 0.01) and less severe bleeding (p = 0.03) than control group. There was no significant difference between surgery time, preoperative complications, residual mass less than 1 cm, and hospital stay between groups. There was no mortality during the study.

Conclusion

Neoadjuvant chemotherapy caused less severe bleeding, but has no effect in decreasing complications after surgery; however, neoadjuvant chemotherapy followed by interval debulking surgery was not superior to primary debulking surgery followed by chemotherapy as a treatment option for patients with advanced ovarian carcinoma in this study.     

Evaluation of the relation between patient characteristics and the state of chemotherapy-induced nausea and vomiting in patients with gynecologic cancer receiving paclitaxel and carboplatin

Purpose

An antiemetic regimen for patients taking paclitaxel and carboplatin (TC) includes dexamethasone (20 mg) to protect against hypersensitivity. Chemotherapy-induced nausea and vomiting (CINV), however, is difficult to adequately control in patients receiving TC. In the present study, we retrospectively investigated risk factors for CINV in patients receiving TC with this antiemetic regimen based on a questionnaire.

Methods

Eligible patients were diagnosed with gynecologic cancer and receiving paclitaxel (175 mg/m²) intravenously for 3 h and carboplatin (area under the curve 5 mg/mL per min) on day 1 every 3 weeks in our institution, and treated with granisetron (3 mg) and dexamethasone (20 mg) for antiemesis. Data of nausea and vomiting assessed by Common Terminology Criteria for Adverse Events version4.0 were collected from the medical records. Patients were asked to complete a questionnaire including items such as age and hyperemesis. Logistic regression analysis was used to evaluate univariate and independent multivariate associations with items on nausea of grade 2 or greater and vomiting of grade 1 or greater.

Results

On univariate logistic analysis, no item was significantly associated with nausea of grade 2 or greater. Hypertension and hyperemesis gravidarum and adjuvant chemotherapy were significantly associated with delayed vomiting of grade 1 or greater. Multivariate analysis was performed with delayed vomiting of grade 1 or greater as an endpoint, and the resulting independent items were hypertension and hyperemesis gravidarum.

Conclusions

The present study showed that the risk factor for delayed vomiting of grade 1 or higher was a history of hyperemesis gravidarum in patients receiving conventional TC with dexamethasone (20 mg) and granisetron. Therefore, in patients with this risk factor, criteria of major organizations should be followed first.     

Prognostic factors in stage IA–IIA cervical cancer patients treated surgically: does the waiting time to the operation affect survival?

Purpose

This study aimed to identify prognostic factors in patients with stage IA?CIIA cervical cancer who had undergone radical surgery and clarify whether the waiting time to the operation affected the recurrence and survival outcome.

Materials and methods

We retrospectively reviewed the records of 117 patients who underwent surgical resection for stage IA?CIIA cervical cancer. Patients were subdivided based on the waiting time from the initial visit to a gynecologist until surgery. Univariate analyses were performed to evaluate factors associated with recurrence-free and overall survival.

Results

The mean time from the first visit to surgery was 48?days (range 20?C92). Recurrence-free and overall survival rates were not affected by the waiting time to the operation. On univariate analysis, lymph node metastasis (p?=?0.003) and lymph-vascular space invasion (p?=?0.015) were prognostic predictors of progression-free survival, while the waiting time to the operation was not (p?=?0.106). Lymph node metastasis (p?=?0.007), lymph-vascular space invasion (p?=?0.046), and the histological diagnosis (p?=?0.027) were prognostic predictors of overall survival, but the waiting time to the operation was not (p?=?0.653).

Conclusions

The waiting time to the operation from the initial visit to surgical intervention does not adversely affect the outcome of cervical cancer within the time frames analyzed in this study. Furthermore, surgery allows the status of the lymph nodes and lymph-vascular space invasion, dependent variables associated with survival, to be assessed accurately.     

Prediction, based on resection margins, of long-term outcome of cervical intraepithelial neoplasia 3 treated by Shimodaira-Taniguchi conization

Purpose

The aim of the present study was to analyze the long-term outcome of cervical intraepithelial neoplasia 3 (CIN 3) after treatment with the Shimodaira-Taniguchi conization procedure, based on the status of the resection margins.

Methods

In the Osaka University Hospital, conization using the Shimodaira-Taniguchi procedure has been routinely performed for CIN 3. Medical records of patients during the period from 2001 to 2008, whose post-conization diagnosis was CIN 3, were retrospectively analyzed for outcome versus margin status.

Results

During the median follow-up period of 565?days (range 34–3,013), CIN disease was again detected in 14 of 243 patients; it was found in 7 patients among 198 margin-negative cases, and in 7 patients among 45 margin-positive cases. There was a significant difference in the reappearance rate demonstrated between the cases with positive and negative margins (p?=?0.0018). Among the patients whose first follow-up post-conization cytology was normal, recurrence-free probability was significantly higher in margin-negative cases than in margin-positive ones (hazard ratio, 5.19; 95% CI, 1.175–22.994; p?=?0.0041).

Conclusion

For the first time, we demonstrate that after treatment of CIN 3 lesions by Shimodaira-Taniguchi conization the status of the resection margin was a significant predictor for long-term outcome.     

Outcomes and toxicities for the treatment of stage IVB cervical cancer

Objective

The prognosis of stage IVB cervical cancer is generally poor. In the current study, treatment outcomes were evaluated in patients with International Federation of Gynecologic Oncology stage IVB cervical cancer treated with radiotherapy and chemotherapy for progression-free survival (PFS) and treated-related toxicities.

Study Design

The medical records of the patients with stage IVB cervical cancer who were treated at the National Cancer Center, South Korea were reviewed retrospectively. From February 2002 to February 2010, 45 patients were diagnosed with FIGO stage IVB cervical cancer. Survival and toxicities were compared between the 13 patients with concomitant chemoradiotherapy (CCRT) with weekly cisplatin versus 20 patients with CCRT with 5-fluorouracil/cisplatin.

Results

Initial treatment included weekly cisplatin-CCRT, 5-fluorouracil/cisplatin-CCRT, neoadjuvant chemotherapy, and radiotherapy with subsequent combination chemotherapy in 13, 20, 4, and 5 patients, respectively. Overall survival (OS) and PFS were 26.2 and 6.7?months, respectively. There was no statistical difference in OS (p?=?0.47) and PFS (p?=?0.64) between the weekly cisplatin-CCRT and 5-fluorouracil/cisplatin-CCRT groups; however, the incidence of anemia?>grade 3 as an acute toxicity was higher in the 5-fluorouracil/cisplatin-CCRT chemotherapy regimen group than the weekly cisplatin-CCRT group (p?=?0.03). Acute toxicity?>grade 2 showed a tendency to be higher in the 5-fluorouracil/cisplatin-CCRT group. Based on multivariate analysis, poor performance status was the only independent prognostic factor of OS (p?=?0.03, 9.77; 95% CI 1.3–73.3) and PFS (p?=?0.04, 9.58; 95% CI 1.14–81.26).

Conclusions

CCRT using combination chemotherapeutic agents may not have survival advantage over single agent cisplatin-based CCRT. Further improvement in treatment is needed to increase survival outcomes and to decrease treatment-related toxicities in patients with stage IVB cervical cancer.     

Vascular endothelial growth factor gene polymorphisms and endometriosis risk: a meta-analysis

Purpose

The vascular endothelial growth factor (VEGF) gene polymorphism has been reported to be associated with endometriosis risk. The purpose of the present study was to perform a comprehensive meta-analysis to explore whether VEGF gene polymorphisms confer risk to endometriosis.

Methods

By searching PubMed and EMBASE databases, a total of 11 studies were identified. Crude odds ratio (OR) and their corresponding 95% confidence intervals (CI) for VEGF gene polymorphisms and endometriosis risk were calculated.

Result

An association of VEGF gene +936TC polymorphism with endometriosis was found (Fixed-effect model: TT?+?TC vs. CC: OR 1.184, 95% CI 1.027?C1.366, P?=?0.020; TC vs. CC: OR 1.187, 95% CI 1.024?C1.375, P?=?0.023. Random-effcet model: TT?+?TC vs. CC: OR 1.203, 95% CI 1.003?C1.443, P?=?0.046; TC vs. CC: OR 1.188, 95% CI 1.021?C1.382, P?=?0.026). No association between VEGF genes ?460CT, +405CG, ?2578AC, ?1154GA polymorphisms and endometriosis was observed.

Conclusion

Our results indicate that VEGF +936TC gene polymorphism is a risk factor for endometriosis, and not ?460CT, +405CG, ?2578AC, ?1154GA.     

Sialic acid levels in the blood in pregnant women with impaired glucose tolerance test

Purpose

Gestational diabetes (GDM) is a metabolic disease characterized by the impairment of glucose tolerance during pregnancy. Sialic acid (SA) is a component of glycolipid and glycoproteins found in hormone and enzymes in serum and tissues and high serum SA levels are observed in diabetic patients.

Methods

Serum SA levels were investigated in three groups, namely 61 normal pregnant women with normal 50 gr glucose loading test (group 1: gr 1), 36 patients with high 50 gr test values and normal 100 gr test (group 2: gr 2: group with impaired glucose tolerance test, IGT), and 8 patients with diagnosis of GDM (group 3:gr 3).

Results

According to Kruskal–Wallis test, significant difference was observed in SA levels between gr1 and gr2–gr3 (p?=?0.001). Difference was observed between groups with respect to age (p?p?=?0.001), BMI (p?=?0.001), and diabetes history in the family (p?=?0.001) (Table?1).

An auto-controlled prospective comparison of two embryos culture media (G III series versus ISM) for IVF and ICSI treatments

Purpose

To compare the effects of 2 different media on embryo morphology and development at days 2/3.

Method

Six hundred seventy-six attempts from 512 couples were included in this prospective auto-controlled study. Sibling oocytes of all couples undergoing an IVF (n?=?286) or ICSI (n?=?390) attempt were randomly assigned to either GIII series (Vitrolife) or ISM (Medicult) media. Primary end points were fertilization and embryo morphology rates.

Results

Fertilization rates in GIII series and ISM (IVF: 59.9 vs 62.0% and ICSI: 65.7 vs 66.8%) respectively were not different. GIII series showed an increase, compared to ISM, of early cleavage rate, (IVF: 25.8 vs 16.2% (p?=?0.005); ICSI: 40.8 vs 25.5% (p?<?0.0001), and good embryo morphology rate at day 2 [IVF: 64.6 vs 57.3% (p?=?0.01); ICSI: 74.2 vs 69.4 (p?=?0.03)] and at day 3 [IVF: 57.5 vs 49.0% (p?=?0.02); ICSI: 67.2 vs 61.6% (p?=?0.01)].

Conclusions

Embryo morphology at days 2/3 was significantly enhanced when the embryos were cultured in GIII series.     

Characteristics and prognosis of coexisting adnexa malignancy with endometrial cancer: a single institution review of 51 cases

Objective

To explore and compare the differences in the clinicopathological characteristics and prognosis of synchronous primary endometrial and ovarian cancers with primary endometrial cancer metastatic to adnexa.

Materials and methods

Between January 1997 and December 2009, 51 cases with endometrial cancer simultaneously with adnexa malignancy were identified. Among them, there were 18 cases with synchronous primary cancers of the endometrium and ovary (Group A) and 33 cases with primary endometrial cancer metastatic to the adnexa (Group B). Clinical and pathologic information was obtained from medical records. Parametric methods were used to compare clinical and pathologic features. Kaplan?CMeier survival analysis was performed and compared using log-rank test.

Results

The mean age at diagnosis of the disease was 56.6?±?10.8?years (range 34?C76?years) in Group A and 53.1?±?9.5?years (range 37?C76?years) in Group B. The two groups?? distribution of preoperative image findings, size of endometrial lesion, myometrial invasion, unilateral or bilateral, cervix invasion, and postoperative radiation existed significant differences. With a mean follow-up time of 4.3?±?3.4?years (range 2?C11?years), 5-year overall survival (OS) was 75 and 56% in Groups A and B, respectively (p?=?0.034). The univariate analysis showed only postoperative radiation and synchronous tumors were independent factors which affected OS (p?=?0.015; p?=?0.034) and progression-free survival (PFS) (p?=?0.015; p?=?0.036), respectively. Not any feature was revealed by multivariate analysis as independent prognostic factors.

Conclusion

Our results showed that OS and PFS of synchronous primary ovarian cancer in patients with endometrial cancer is better than those with ovarian metastasis patients. Pre- and intra-operative, intensive and careful assessment, and strict and continuous postoperative surveillance should pay attention to the endometrial cancer patients who preserved ovary for having possibility of coexisting occult ovarian lesions.     

Weekly carboplatin with paclitaxel compared to standard three-weekly treatment in advanced epithelial ovarian carcinoma — a retrospective study

Objective

To retrospectively compare primary treatment with weekly carboplatin/paclitaxel (PC-W) to the standard 3-weekly carboplatin/paclitaxel (PC-3W) in women with advanced epithelial ovarian cancer, tubal carcinoma and primary peritoneal carcinoma.

Methods

Medical records were assessed for age, stage of disease, tumor histology and grade, BRCA mutation status, and platinum sensitivity. Patients were treated with either paclitaxel (175 mg/m²) and carboplatin (AUC 6) every three weeks (PC-3W; 133 patients), or with weekly paclitaxel (80 mg/m²) and weekly carboplatin (AUC 2) on days 1, 8, and 15 every 28 days (PC-W; 267 patients).

Results

Patient baseline characteristics were similar in both groups. Median overall survival (OS) was similar for PC-W and PC-3W (64.5 months vs. 61.5 months), but PC-W had longer median progression-free survival [PFS: 27.4 months (95% CI, 22.7–31.4) vs. 19.5 months (95% CI, 15.6–22.2) for PC-3W, p = 0.0024] and a longer median platinum-free interval [PFI: 22.1 months (95% CI, 16.0–24.5) vs. 14.2 months (95% CI, 10.7–17.2) for PC-3W, p = 0.0075]. PC-W showed a significantly higher response rate (86.4% vs. 77.9% for PC-3W, p = 0.0435). Multivariate analysis including for age at diagnosis, stage of disease, optimal debulking, histology, BRCA status, pretreatment CA-125 and PFI revealed that the PC-W women had lower risk of death (HR = 0.587, 95% CI, 0.402–0.857, p = 0.0058), lower risk of disease progression (HR = 0.494, 95% CI, 0.359–0.680, p < 0.0001), higher 2- and 3-year survival rates, and decreased grade II hair loss, neuropathy and thrombocytopenia compared with the PC-3W women.

Conclusion

The PC-W protocol improved PFS and had a similar OS as PC-3W.     

Effects of oral estradiol and levonorgestrel on cardiovascular risk markers in postmenopausal women

Purpose

This study aimed at investigating changes in postmenopausal women’s cardiovascular risk markers induced by hormone therapy regimens of low (1.0?mg) or ultra-low (0.5?mg) doses of micronized estradiol (mE₂) and levonorgestrel (LNG).

Methods

Three randomized placebo-controlled trials were reanalyzed with regard to changes in cardiovascular risk markers, such as serum lipids, lipoproteins, and coagulation parameters. Trial 1 (n?=?210) was an 8-week study comparing the effects of 1.0 or 0.5?mg of unopposed mE₂ on menopausal symptoms. Trial 2 (n?=?194) was a 24-week study comparing the effects of 1.0?mg of mE₂ combined with 10, 20, or 40?μg of LNG on endometrial safety. Trial 3 (n?=?195) was a 52-week study comparing the effects of 1.0 or 0.5?mg?mE₂?+?40?μg LNG on bone metabolism.

Results

1.0?mg of unopposed mE₂ reduced low-density lipoprotein cholesterol (LDL-C) after as little as 8?weeks. 1.0?mg?mE₂ for 24?weeks lowered the serum levels of total cholesterol (TC) and LDL-C, whereas the addition of LNG caused decreases in the levels of high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) in a dose-dependent fashion. 1.0 or 0.5?mg?mE₂?+?40?μg LNG for 52?weeks also lowered the levels of TC, HDL-C, LDL-C, and TG. Both regimens slightly lowered antithrombin and Protein C activities within normal limits.

Conclusions

Hormone therapy using 1.0 or 0.5?mg of mE₂ and LNG lowers the serum levels of TC, HDL-C, LDL-C, and TG without significantly affecting coagulation/fibrinolysis parameters.     

Phase II study of paclitaxel in combination with carboplatin for patients with recurrent or persistent uterine sarcoma

Objective

To evaluate the efficacy and toxicity of combined paclitaxel and carboplatin treatment for persistent or recurrent uterine sarcoma.

Methods

Paclitaxel was administrated at 175?mg/m² intravenously over 3?h plus carboplatin at AUC 5 intravenously over 30?min every 3-week cycle in patients with recurrent or progressive uterine sarcoma, who were unsuitable candidates for curative treatment with either surgery or radiotherapy. The Simon’s two-stage optimal design was chosen for defining the total number of patients required for the phase II study. A total of 13 patients were entered in the study at the first stage of trial. A median of four cycles were administrated per patient, with a range of one to nine cycles. Prior to the study, 4 (30.8?%) of the 13 patients had received radiotherapy or chemotherapy. The response was measured by evaluation of the size of the mass by CT scan.

Results

The overall response rate was 15.4?% (2/13), with two patients exhibiting partial responses. There was 1 (7.7?%) case of stable disease and 9 (69.2?%) cases of progression disease. The median progression free survival was 2.23?months (95?% confidence interval 1.94–3.67). Peripheral neuropathy and hematologic toxicity, including anemia and neutropenia, were the most frequent adverse events. One patient died from treatment-related toxicities.

Conclusions

Paclitaxel in combination with carboplatin demonstrated acceptable levels of toxicity, but it was not active in the treatment of recurrent or progressive uterine sarcoma. This regimen might have limited role for advanced uterine sarcomas.     

Electroacupuncture for cervical ripening prior to labor induction: a randomized clinical trial

Purpose

The present study was aimed to compare the effects of the use of electroacupuncture and misoprostol in inducing labor in patients with Bishop score?<?7 and to observe the characteristics of labor in both methods.

Methods

As much as 67 pregnant women with Bishop score?<?7, single cephalic presentation with gestational age confirmed by first-trimester ultrasound, reactive cardiotocography, and amniotic fluid volume and estimated fetal weight within the respective normal ranges for gestational age were selected. They were randomized into 2 groups: electroacupuncture (AC) or misoprostol (M).

Results

There were no significant differences regarding age, gestational age, fetal weight, parity, Bishop score, or indication for induction. Labor was the main outcome, which was obtained in both groups without significant difference regarding frequency (p?=?0.07) and time of induction (p?=?0.29). Absence of obstetric complication, higher duration of labor (p?=?0.036), and tendency to a higher satisfaction of the patients (p?=?0.046) were observed among patients of group AC. Higher frequency of cesarean sections (p?=?0.014) and obstetric complications (9.3%) were observed among patients of group M.

Conclusions

Our results showed that electroacupuncture can be used to obtain cervical ripening, with similar results as compared with misoprostol, with a significantly higher frequency of vaginal deliveries and without occurrence of obstetric complications.     

Estimating risk factors for development of preeclampsia in teen mothers

Purpose

Our objective was to identify potentially modifiable risk factors for preeclampsia in a contemporary American teen population.

Methods

We conducted a retrospective cohort analysis of all teenage deliveries (≤18?years old) at one institution over a 4-year-period. All cases of preeclampsia were identified using the National Working Group for Hypertension in Pregnancy diagnostic criteria and compared to normotensive teenage mothers.

Results

Of the 730 included teen deliveries, 65 (8.9?%) women developed preeclampsia and demonstrated a higher prepregnancy body mass index when compared with controls (32.9?±?8.4 vs. 30.3?±?6.1?kg/m², p?=?0.002). Maternal obesity (body mass index ≥30?kg/m², RR 1.6, 95?% CI 1.0–2.8) and gestational weight gain above the Institute of Medicine recommended levels (RR 2.6, 95?% CI 1.5–4.4) were associated with higher risk for development of preeclampsia. When evaluating by severity or onset of disease, excessive weight gain in pregnancy was the strongest risk factor for mild (n?=?58) or late onset (n?=?54) preeclampsia (RR 2.5, 95?% CI 1.4–3.4).

Conclusions

Maternal obesity and excessive gestational weight gain place the gravid teen at increased risk for preeclampsia. The modifiable nature of these risk factors permits the possibility of intervention and prevention.     

Endometrial thickness measurement throughout a menstrual cycle in non-obese infertile patients with polycystic ovary syndrome

Purpose

To analyze the changes in the endometrial thickness in infertile polycystic ovary syndrome (PCOS) patients throughout an entire menstrual cycle and compare the changes to those seen in infertile patients without PCOS.

Methods

This prospective, cross-sectional study was conducted in a total of 58 non-obese, infertile women with PCOS. The endometrial thickness was measured at three different times throughout the menstrual cycle by ultrasound. Age- and body mass index (BMI)-matched control group consisted of 62 non-obese infertile patients without PCOS. Demographic, hormonal and the ultrasonographic measurements of the two groups were compared.

Results

Day 3 levels of LH were significantly different between the groups (p?=?0.013). Ovarian volume measurement was significant between the groups (p?=?0001). All the endometrial thickness measurements in the early, mid-cycle and late luteal phases were also significantly different; p?=?0.001 for all.

Conclusion

The study demonstrated an increased endometrial stripe measurements throughout a menstrual cycle in infertile patients with PCOS, when compared to infertile patients without PCOS.     

Neoadjuvant chemotherapy equalizes the optimal cytoreduction rate to primary surgery without improving survival in advanced ovarian cancer

Purpose(s)

To evaluate results of neoadjuvant chemotherapy (NACT) following debulking surgery in patients with extensive metastatic disease and/or poor medical performance

Method(s)

Advanced stage epithelial ovarian cancer patients were treated with either NACT followed by debulking surgery or primary surgery followed by adjuvant chemotherapy after assessment of the extent of disease by laparoscopy or laparotomy.

Results

Out of 297, 223 patients were in the primary surgery group, whereas 74 of them met NACT criteria. Optimal cytoreduction rates were 63.2 % in primary surgery group and 60.8 % in NACT group, respectively (p: 0.709). In the primary surgery group, the overall survival was significantly higher (p: 0.002). Mean patient age was more advanced (p: 0.014) and the performance status of patients was poorer (p < 0.001) in NACT group. Only patient group (primary surgery or neoadjuvant chemotherapy) (p: 0.001) retained significance as predictors of survival in multivariate analyses.

Conclusion(s)

Improved rate of optimal cytoreduction with NACT in advanced ovarian cancer patients does not prolong survival. The extent of disease at diagnosis is the primary determinant of survival. Randomizing patients with equally extensive disease and performance status to either NACT or primary debulking surgery in a future study will better clarify benefits attributed to NACT.