Khadra Galaal

Evaluation of prognostic factors and treatment outcomes in uterine carcinosarcoma

OBJECTIVE The aims of this study were to determine the prognostic factors, survival outcomes and response to adjuvant therapy in women with uterine carcinosarcoma treated in a single institution. STUDY DESIGN This is a cohort study of women diagnosed with carcinosarcoma and treated at the Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UK. The medical records of all patients diagnosed with carcinosarcoma between January 1960 and July 2002 were reviewed. RESULTS A total of 93 women were identified during this period. The median age was 67 years. The most common presentation was abnormal vaginal bleeding, occurring in 85%, followed by pelvic mass in 45%, and abdominal pain in 38%. At surgery there was extra-uterine spread in 54% of women. The median follow-up was 33 months (range 4-146 months). Adjuvant therapy was not associated with survival advantage. Recurrence was diagnosed in 55 patients (59%) and the overall 5-year survival for all stages was 33%. On multivariate analysis depth of myometrial invasion, stage and pelvic nodes metastasis were associated with poor survival. CONCLUSION The poor outcome for these patients may reflect the aggressive nature of carcinosarcoma and that at the time of presentation more than 50% have extra-uterine disease, which was associated with significant poorer survival. Systemic adjuvant therapy has not been associated with significant improvement in the outcome. More studies are needed to better define the appropriate treatment for this rare cancer.

The impact of BMI on surgical complications and outcomes in endometrial cancer surgery—An institutional study and systematic review of the literature

OBJECTIVES We aimed to evaluate the association between body mass index (BMI), perioperative complications and outcomes in endometrial cancer (EC) patients at our institution. In addition, we performed a systematic review to compare our results to the literature. METHODS This was a retrospective study of surgically managed EC patients between January 2006 and January 2015. Patient characteristics, surgical complications and intra- and postoperative outcomes were evaluated across BMI groups; BMI <30kg/m(2), BMI ≥30kg/m(2) and BMI ≥40kg/m(2). The systematic review was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. RESULTS In total, we identified 627 women of which 514 were included; 249 women had a BMI of <30kg/m(2), 195 women had a BMI of 30-39.9kg/m(2), and 70 women were morbidly obese (BMI ≥40kg/m(2)). Obese women (BMI ≥30kg/m(2)) had significantly more postoperative surgical complications, including wound complications and antibiotics use, which was confirmed by the systematic review. The increase in complications mainly occurred in open surgery and morbidly obese patients were at highest risk. Obesity did not impact other outcomes including 30-day mortality. CONCLUSION Obesity is associated with an increased risk of surgical morbidity in EC patients, and is most profound in open surgery and among the morbidly obese. Laparoscopic surgery may well prevent the majority of postoperative complications in this group of patients, and should therefore be the favoured approach.

Small volume stage 1B1 cervical cancer: Is radical surgery still necessary?

OBJECTIVE Current surgical treatment of FIGO stage 1B1 cervical cancer is radical surgery. However, several reports have shown that for small tumours a more conservative approach can be as effective in terms of survival, whilst at the same time reducing the morbidity associated with removing the parametrium. The objective of our study was to report survival and obstetric outcomes following conservative management of small-volume stage 1B1 disease. METHODS All patients with FIGO stage 1B1 cancer and estimated tumour volume of less than 500 mm(3) in a loop biopsy specimen were included in the study, irrespective of other histological characteristics. A second loop biopsy was performed to rule out residual disease in 79% of patients. RESULTS Sixty two women were identified with a median age of 35 years (range 27-67). Median tumour length was 9.75 mm (7.2-20) and median depth of invasion was 1.55 mm (0.3-5). Thirty five women (56.4%) were treated with loop biopsy, whilst 27 (45.6%) had simple hysterectomy. Fifty seven women (92%) had pelvic lymphadenectomy and one positive node was recorded. After a median follow up of 56 months (16-132) no recurrence was noted. Seven full term pregnancies have been achieved. There were no preterm deliveries or mid-term miscarriages. CONCLUSION Cervical loop biopsy or simple hysterectomy combined with negative pelvic lymphadenectomy for small-volume stage 1B1 cervical cancer offers excellent prognosis in terms of survival. Postoperative morbidity is reduced and obstetric outcomes may be improved. Should these results be verified by further prospective studies, radical surgery for these women may be avoided.

The effect of lifestyle interventions on the quality of life of gynaecological cancer survivors: A systematic review and meta-analysis.

OBJECTIVE We aimed to evaluate the effectiveness of lifestyle interventions in improving the quality of life (QoL) of endometrial and ovarian cancer survivors. METHODS The review was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, and the Cochrane Handbook for Systematic Reviews of Interventions. We performed a search of MEDLINE (1946-2015), EMBASE (1980-2015), CINAHL (1981-2015), PsycINFO (1806-2015) and the Cochrane Trial Register to identify studies evaluating the effect of lifestyle interventions on the QoL of endometrial and ovarian cancer survivors. RESULTS Eight studies fulfilled the inclusion criteria and comprised a total of 413 patients. Three studies were randomised controlled trials (RCTs), which showed that lifestyle interventions may improve physical functioning and significantly reduce fatigue in endometrial cancer survivors. In addition, lifestyle interventions in endometrial cancer survivors resulted in significant weight loss and improved physical activity levels, but did not show improvements in global QoL in the meta-analysis (P=0.75, P=0.49). Non-randomised trials in ovarian cancer survivors support the feasibility of lifestyle interventions and suggest they may result in QoL improvements. CONCLUSIONS Lifestyle interventions have the potential to improve the QoL of endometrial cancer and ovarian cancer survivors, and may significantly reduce fatigue. However, the current evidence is limited and there is a need for future studies to further evaluate lifestyle interventions and their effect on QoL outcomes.

The impact of BMI on quality of life in obese endometrial cancer survivors: Does size matter?

BACKGROUND Survivorship and quality of life issues are becoming increasingly relevant in endometrial cancer as a result of the marked increase in incidence of the disease combined with excellent and improving long term survival. OBJECTIVE The purpose of this study was to evaluate the effect of obesity on quality of life (QoL) in endometrial cancer survivors. METHODS Participants were endometrioid endometrial cancer survivors diagnosed between 2008 and 2013. Quality of life was measured through the European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ-C30, version 3.0). Associations between BMI and quality of life were determined by means of multivariate analyses. RESULTS 322 women diagnosed with endometrioid endometrial cancer were invited to participate. Excluded were 15 women with unknown BMI, 40 with non-endometrioid histology and 10 with concurrent cancer. The QLQ-C30 questionnaire was completed by 158 (61.5%) women, of which 63 women (40%) were obese (BMI ≥ 30-39.9), and 30 women (19%) were morbidly obese (BMI ≥ 40). Morbidly obese women reported worse physical, role and social functioning and more somatic complaints. CONCLUSION Morbid obesity is associated with poorer quality of life in endometrial cancer survivors. Life style interventions such as exercise programs and diet interventions could be viable means to improve the quality of life of obese endometrial cancer survivors. Future research should focus on means to improve quality of life in obese endometrial cancer survivors.

Body mass index, physical activity and quality of life of ovarian cancer survivors: Time to get moving?

OBJECTIVE To evaluate the association between body mass index (BMI), physical activity (PA) and the quality of life (QoL) of ovarian cancer survivors. METHODS We performed a two-centre cross-sectional study of women who had been treated for ovarian cancer between January 2007 and December 2014 at the Royal Cornwall Hospital Trust and the Plymouth Hospitals NHS Trust. QoL was assessed using the EORTC QLQ-C30 and QLQ-OV28 questionnaires, and PA using the Godin Leisure Time Exercise questionnaire. RESULTS In total, 293 ovarian cancer survivors were invited to participate, of which 209 women (71.3%) responded. Thirty-five percent of women were overweight and 18% were obese, whilst only 21% met recommendations for PA. Obesity was associated with significantly poorer global QoL, physical, cognitive and social functioning, a poorer body image and more symptomatology. Sedentary behaviour was associated with poorer QoL scores including global QoL, physical, role, social and sexual functioning. After adjustment, BMI and PA both remained independently associated with QoL scores. CONCLUSION Obesity and inactivity are associated with poorer QoL among ovarian cancer survivors. Future interventions promoting PA and weight loss should be evaluated as possible means to improve the QoL of this population.

High‐grade vaginal intraepithelial neoplasia: can we be selective about who we treat?

To determine the role of conservative management in high‐grade vaginal intraepithelial neoplasia (HG VaIN).

Intra‐operative frozen section analysis for suspected early‐stage ovarian cancer: 11 years of Gateshead Cancer Centre experience

Please cite this paper as: Cross P, Naik R, Patel A, Nayar A, Hemming J, Williamson S, Henry J, Edmondson R, Godfrey K, Galaal K, Kucukmetin A, Lopes A. Intra‐operative frozen section analysis for suspected early‐stage ovarian cancer: 11 years of Gateshead Cancer Centre experience. BJOG 2012;119:194–201.

Quality of life in ovarian cancer survivors: the influence of obesity

Objective In this study, we evaluated the effect of body mass index (BMI) on the quality of life of ovarian cancer survivors. Methods Women diagnosed with ovarian cancer at the Royal Cornwall Hospital Trust between January 2008 and May 2013 were identified. Ovarian cancer survivors were invited to participate by completing the European Organization for Research and Treatment of Cancer QLQ-C30 (quality of life) questionnaire. Univariate and multiple regression analyses were used to determine associations between BMI and quality-of-life outcomes. Results A total of 176 ovarian cancer survivors were invited to participate, of which 133 were eligible for this study. In total, 81 ovarian cancer survivors (60.4%) completed the questionnaire, of which 26 responders (32.1%) were overweight (BMI, 25–29.9 kg/m2) and 27 (33.3%) were obese (BMI, ≥30 kg/m2). Increasing BMI was significantly associated with poorer quality-of-life outcomes in terms of physical functioning and emotional functioning, and this effect persisted for physical functioning after multiple regression analysis. Conclusions Increasing BMI is associated with poorer quality-of-life outcomes in terms of physical and emotional functioning in ovarian cancer survivors. Further research is needed to evaluate the association between BMI and quality of life from diagnosis to survivorship to develop novel interventions.

Tumor size: a better independent predictor of distant failure and death than depth of myometrial invasion in International Federation of Gynecology and Obstetrics stage I endometrioid endometrial cancer.

Objective Depth of myometrial invasion is considered as the strongest predictor of distant failure and death from disease in stage I endometrial cancer. The aim of this study was to determine whether tumor size (TS) is an independent prognostic indicator of survival and a better predictor than depth (%) of myometrial invasion, in stage I endometrioid endometrial cancer. Methods This was a retrospective study of all women with International Federation of Gynecology and Obstetrics stage I endometrioid endometrial carcinoma from January 2000 to December 2007, who had surgery at the Northern Gynaecological Oncology Centre. Surgicopathological, follow-up, and survival data were collected. Tumor size (a continuous variable) was defined as the maximum tumor dimension. Univariate and multivariate analyses to predict distant recurrence and death from disease were performed comparing known risk factors. The prognostic accuracy of TS was then assessed by receiver operating characteristic curve analyses, and an optimum cutoff was proposed. Results A total of 216 women were identified. Pelvic lymphadenectomy was performed in 51 women (24%). The median follow-up time was 80 months (95% confidence interval [95% CI], 34–131 months), with 9 distant recurrences and 11 disease-related deaths. Tumor size was the only independent predictor of both distant recurrence (hazard ratio [HR], 1.05; 95% CI, 1.02–1.08; P = 0.004) and death from disease (HR, 1.03; 95% CI, 1.00–1.07; P = 0.05). Myometrial invasion only predicted distant failure (HR, 1.03, 95% CI, 1.00–1.05; P = 0.03). In women who did not have pelvic lymph node dissection (n = 165), only TS retained its independent prognostic value to predict both distant failure (HR, 1.08; 95% CI, 1.03–1.13; P = 0.002) and death from disease (HR, 1.05; 95% CI, 1.01–1.10; P = 0.02). In women who underwent pelvic lymphadenectomy, none of the variables predicted the above outcomes. Conclusions Tumor size could play a significant role in risk stratification and planning adjuvant treatment in women with International Federation of Gynecology and Obstetrics stage I endometrioid endometrial cancer.