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Volume 3, Number 5 – May, 2004 |
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The following articles appeared in this month's issues of the surveyed journals. Articles that seem to be of most interest to the practicing gynecologic oncologist are included. The journals that are surveyed are New England Journal of Medicine, Journal of Clinical Oncology, Gynecologic Oncology, Cancer, American Journal of Obstetrics and Gynecology, Lancet, Cancer Research, Obstetrics and Gynecology, Journal of the National Cancer Institute, Journal of the American Medical Association and American Journal of Surgical Pathology. The participants in this program are the active clinical fellows at Memorial Hospital: Mario Leitao, Christopher Awtrey, Sarah Ferguson, Alan Schlaerth, Destin Black and Margrit Juretzka. The managing editor is Douglas Levine. Comments, questions, complaints and suggestions are always welcome, please E-mail us at: VJC@smgo.org or click here. To subscribe or unsubscribe to the VJC, click here. Gynecologic Oncology – Christopher Awtrey Title: Systematic review of management options for women with a hereditary predisposition to ovarian cancer Authors: Barry Rosen, Janice Kwon, Michael Fung Kee Fung, Anna Gagliardi, Alexandra Chambers Source: Gynecologic Oncology, Volume 93, Issue 2, May 2004, Pages 280-286 Summary: This is systematic review of cohort studies and case series that have looked at the impact of risk-reducing salpingo-oophorectomy on the rate of subsequent ovarian, fallopian tube and peritoneal cancers in women with an inherited risk. The evidence suggests that surgery protects against ovarian cancer, as well as increasing life expectancy following the procedure when compared to controls. The complication rates of the procedure are small following laparoscopic BSO. The potential long term risks of surgical menopause on patients as well as alternatives to the procedures are considered. This is an exceptional review of this very important topic. Click here for abstract from Gynecologic Oncology Title: Radical hysterectomy and pelvic lymphadenectomy for stage IB2 cervical cancer Authors: Laura J. Havrilesky, Charles A. Leath, Warner Huh, Brian Calingaert, Rex C. Bentley, John T. Soper and Angeles Alvarez Secord Source: Gynecologic Oncology, Volume 93, Issue 2, May 2004, Pages 429-434 Summary: This study evaluated survival and adverse outcomes of patients with stage Ib2 cervical cancer treated with type III radical hysterectomy and lymphadenectomy. The authors divided their 72 patients into 3 groups; those with high, intermediate and low risk factors. Factors associated on multivariate analysis to confer a survival benefit included Caucasian race, inner 2/3 invasion of the cervix, absence of LVSI and older age. The 5 year survival for the high, intermediate and low risk groups were 47%, 80% and 100% respectively. Most of the 17 patients, (94%) in the high risk group received adjuvant radiation treatment and of the 10 patient that recurred in this group none were salvaged with additional therapy. There were 49 patients in the intermediate group and none of the 13 that recurred in this group had undergone adjuvant treatment. Interestingly, 12 of 13 patients recurred in the pelvis and 5, 38% were salvaged. This study is important ground work as we consider the future GOG study that hopes to answer the important question of what the best approach this group of patients is, either surgery followed by tailored RT or chemo-RT alone. Click here for abstract from Gynecologic Oncology Journal of Clinical Oncology - Mario Leitao Nothing of interest this month Journal of the National Cancer Institute – Alan Schlaerth Nothing of interest this month Obstetrics and Gynecology – Margrit Juretzka Nothing of interest this month American Journal of Obstetrics and Gynecology – Sarah Ferguson Title: Morbidity of cytoreductive surgery in the elderly Authors: Jason D. Wright, Thomas J. Herzog and Matthew A. Powell Source: American Journal of Obstetrics and Gynecology, Volume 190, Issue 5, May 2004, Pages 1398-1400 Summary: Ovarian cancer in elderly patients may not be treated as aggressively as in younger patients. This study evaluated the feasibility and morbidity of cytoreductive surgery in the elderly. Of 175 patients, 129 (74%) were less than 70 years of age and 46 (26%) were 70 or older. Optimal cytoreduction to a largest tumor diameter of <1 cm was possible in 82% of the younger patients vs 81% of the elderly (P = 1.00). The stage distribution, complication rate, duration of hospital stay, and survival were similar between the groups. Aggressive surgical cytoreduction is both safe and feasible in elderly patients. Age should not be considered a contraindication to cytoreductive surgery. Click here for abstract from AM J OB/GYN New England Journal of Medicine – Mario Leitao Nothing of interest this month Journal of the American Medical Association – Margrit Juretzka Title: Treatment for Cervical Intraepithelial Neoplasia and Risk of Preterm Delivery Authors: Sadler, Lynn, Saftlas, Audrey, Wang, Wenquan, Exeter, Melissa, Whittaker, John, McCowan, Lesley Source: JAMA 2004 291: 2100-2106 Summary: This retrospective cohort study of patients in an Auckland New Zealand colposcopy clinic evaluated whether LEEP, laser ablation, or conization (n=652 total) increased risk of preterm delivery compared with no treatment (n=425). Overall rate of preterm delivery was 13.8% and rate of pPROM was 6.2%. There was no significant increase in risk of total preterm delivery (adjusted relative risk [aRR], 1.1; 95% [CI], 0.8-1.5) for any treatment. However, risk of pPROM was significantly increased following treatment with laser conization (aRR, 2.7; 95% CI, 1.3-5.6) or LEEP (aRR, 1.9; 95% CI, 1.0-3.8), but not laser ablation (aRR, 1.1; 95% CI, 0.5-2.4). Click here for abstract from JAMA Cancer – Destin Black Title: Sentinel Lymph node biopsy is not accurate in predicting lymph node status for patients with cervical carcinoma Authors: Pierangelo Marchiolè, M.D., Annie Buénerd, M.D., Jean-Yves Scoazec, M.D., Ph.D., Daniel Dargent, M.D., Patrice Mathevet, M.D., Ph.D, Lesley Source: Cancer, Volume 100, Issue 10, Pages 2154-2159 Summary: This prospective study evaluated twenty-nine consecutive patients with early stage cervical carcinoma treated with pelvic lymphadenectomy and radical surgery that underwent sentinel lymph node biopsy following lymphatic mapping with patent blue dye. Three patients (10%) were found to have positive sentinel lymph nodes. When multilevel sectioning in conjunction with immunohistochemical analysis was performed, 5 of the remaining 26 patients (19%) had micrometastases in the pelvic lymph nodes. Two of these five patients also had micrometastases in a sentinel lymph node; however, the other three patients had negative findings on sentinel lymph node biopsy despite having micrometastases in non sentinel pelvic lymph nodes. The authors concluded that the high false-negative rate (87.5%) associated with sentinel lymph node biopsy raises questions regarding the validity of the sentinel lymph node concept in cervical carcinoma. Click here for abstract from Cancer Lancet – Sarah Ferguson Nothing of interest this month Cancer Research – Destin Black Nothing of interest this month American Journal of Surgical Pathology – Alan Schlaerth Title: Arias-Stella Reaction of the Endocervix: A Report of 18 Cases With Emphasis on Its Varied Histology and Differential Diagnosis. Authors: Nucci, Marisa R MD, Young, Robert H MD Source: American Journal of Surgical Pathology. 28(5):608-612, May 2004. Summary: The authors in this study describe 18 cases of patients with Arias-Stella reaction of the endocervix to highlight histological features and prevent a misdiagnosis of carcinoma. The principal consideration in the diagnosis was clear cell carcinoma. Clinicopathologic features most helpful in identifying an Arias-Stella reaction were a lack of a suspicious mass, an absence of desmoplastic response, a lack of an infiltrative pattern, a spectrum of cytologic atypia, low nuclear-cytoplasmic ratios, and lack of mitotic activity. In general, mitotic activity would suggest a malignant process. Click here for abstract from AM J Surg Path Title: Vulvar Acanthosis With Altered Differentiation: A Precursor to Verrucous Carcinoma? Authors: Nascimento, Alessandra F MD, Granter, Scott R MD, Cviko, Aida MD, PHD, Yuan, L MD, Hecht, Jonathan L MD, PHD, Crum, Christopher P MD Source: American Journal of Surgical Pathology. 28(5):638-643, May 2004. Summary: The purpose of this study was to evaluate characteristics of verrucous carcinomas of the vulva in order to define potential candidate precursor lesions. This study identified nine cases of verrucous carcinoma of the vulva (VC). The median age of these patients was 83 year of age. All evaluable VCs were HPV negative. VCs shared similar morphologic risk factors with lichen sclerosis found in 1 case and lichen simplex chronicus in 7 cases. Also, seven of the cases showed a distinctive noninvasive squamous epithelial proliferation of marked acanthosis, loss of the granular cell layer, and multilayered parakeratosis. However, the possibility of vulvar acanthosis being a precursor to vulvar carcinoma could not be determined and warrants further investigation. Click here for abstract from AM J Surg Path This issue of the Virtual Journal Club is sponsored by GlaxoSmithKline. |
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