Maria Cristina Moruzzi

Imaging techniques for the evaluation of cervical cancer.

Improvements in the treatment of cervical carcinoma have made it possible to offer optimal and personalised treatment. Cervical cancer staging is based on clinical examination and histological findings. Many diagnostic methods are used in clinical practice. Magnetic resonance imaging is considered the optimal method for staging cervical carcinoma because of its high accuracy in assessing local extension of disease and distant metastases. Ultrasound has gained increased attention in recent years; it is faster, cheaper, and more widely available than other imaging techniques, and is highly accurate in detecting tumour presence and evaluating local extension of disease. Magnetic resonance imaging and ultrasound are often used together with computed tomography or positron emission tomography combined with computed tomography to assess the whole body, a more accurate detection of pathological lymph nodes and metabolic information of the disease.

Phase 2 trial of nonpegylated doxorubicin (Myocet) as second-line treatment in advanced or recurrent endometrial cancer

Background: Advanced or recurrent endometrial cancer is associated with a poor prognosis, and results obtained with systemic therapy are far from being impressive. Myocet is an interesting formulation of citrate conjugated doxorubicin encapsulated in nonpegylated liposomes. This phase 2 study was designed to evaluate the objective response rate and the toxicity profile of Myocet in women with advanced or recurrent endometrial cancer. Methods: Patients with diagnosis of advanced or recurrent endometrial cancer failing 1 previous carboplatin-paclitaxel chemotherapy were enrolled. Myocet was administered at the dose of 60 mg/m2 intravenously on day 1 every 4 weeks. Results: Eighteen patients were enrolled in our institution from September 2007 to January 2010. No complete or partial response was observed. Stable disease was registered in 5 patients (27.5%). Median time to progression was 9 weeks. Median time to death was 24 weeks. Grade 3/4 anemia was reported in 2 patients (11%). Grade 3/4 neutropenia was observed in 16.5% and 44% of patients, respectively. The major nonhematologic toxicities (grades 3/4) were fatigue (22%), nausea, and vomiting (5.5%). Conclusions: Myocet presents no activity, and only few stabilizations of disease of limited duration in this recurrent endometrial carcinoma population previously treated with platinum-taxane chemotherapy are reported.

Imaging in gynecological disease (8): ultrasound characteristics of ovarian borderline tumor recurrence

To describe the sonographic characteristics of borderline ovarian tumor (BOT) recurrence.

Impact of aromatase inhibitor treatment on vertebral morphology and bone mineral density in postmenopausal women with breast cancer.

Objective:The aim of this study was to evaluate the impact of aromatase inhibitor (AI) treatment on vertebral morphology by vertebral fracture assessment in postmenopausal women with early-stage breast cancer. Methods:A clinical cross-sectional study was conducted. A group of 156 postmenopausal women with breast cancer (mean [SD] age, 60.4 [10.1] y; mean [SD] time since menopause, 11.7 [9.2] y) was included in the study. Eighty-two women received AI treatment, whereas 74 women did not. Women underwent extensive medical history check and risk factor assessment together with vertebral morphology and bone mineral density (BMD) evaluation. Results:In the studied population, the prevalence of vertebral fractures identified by vertebral fracture assessment was 16.6%. Multivariate analysis showed that AI treatment was significantly associated with vertebral fractures (adjusted P < 0.04). Women receiving AI treatment had a higher prevalence of vertebral fractures than women not treated with AIs (25.6% vs 4%). The risk of vertebral fractures in women treated with AIs was significantly higher than in non–AI-treated women (adjusted odds ratio, 4.7; P < 0.005). Vertebral fractures of the highest grade were identified at the lumbar spine. Women treated with AIs had a significantly lower BMD than women not treated with AIs (P < 0.01). Reduction of BMD was significantly associated with length of therapy, whereas there was no association between length of treatment and risk of vertebral fractures. Conclusions:AI treatment severely impacts vertebral morphology. Our study demonstrates a high prevalence of asymptomatic vertebral fractures in women treated with AIs.

Glucocorticoid therapy as a significant risk factor for osteoporosis and fractures in an Italian postmenopausal population

Abstract Objective: To analyze the potential effects of glucocorticoid treatment without an osteoporosis prevention strategy and to precociously identify patients at high risk of osteoporosis and fragility fractures in the postmenopausal period. Methods: A total of 382 postmenopausal patients, 177 exposed and 205 not exposed to glucocorticoid therapy, were studied using a standard questionnaire. Epidemiological as well as clinical data that included the most recent absorptiometry test results were examined. Results: Osteoporosis and fractures were frequent in the postmenopausal glucocorticoid-treated patients. Fragility fractures occurred more frequently in glucocorticoid-treated patients (vertebral fractures represented 45% of all fractures) than in the non-glucocorticoid-treated patients. In particular, the highest fracture percentage was found in 50- to 65-year-old glucocorticoid-treated patients, a subset of patients showing a prevalence of osteoporosis similar to that of non-exposed menopausal subjects older than 65. Glucocorticoid therapy increases the risk of fragility fractures fivefold and doubles the risk of osteoporosis in menopausal patients. Conclusions: Glucocorticoid treatments put menopausal patients at a high risk of incurring fragility fractures even in the early postmenopausal period. The management of strategies for fracture prevention must take into consideration early intervention in patients undergoing or about to undergo glucocorticoid treatment.

Prospective multimodal imaging assessment of locally advanced cervical cancer patients administered by chemoradiation followed by radical surgery. The PRICE (PRospective Imaging of CErvical cancer and neoadjuvant treatment) study 2: the role of ultrasound after chemoradiation to assess residual tumor

To determine the diagnostic performance of two‐dimensional (2D) ultrasound parameters, three‐dimensional (3D) power Doppler and contrast‐enhanced indices in detecting residual disease in locally advanced cervical cancer patients triaged to neoadjuvant treatment followed by radical surgery.

Ultrasound appearance of breast cancer metastatic to uterine leiomyoma

Metastases to the uterus occur very rarely, accounting for less than 10% of all cases of metastases involving the female genital tract; mammary and gastrointestinal carcinomas are the most frequent extragenital primary neoplasms metastasizing to the uterine corpus1. Very little data is available in the literature including 24 cases of breast cancer metastasized to a uterine leiomyoma2, as assessed at surgery (N=16), and autoptic evaluation (n=8).Metastases to the uterus occur very rarely, accounting for less than 10% of all cases of metastases involving the female genital tract; mammary and gastrointestinal carcinomas are the most frequent extragenital primary neoplasms metastasizing to the uterine corpus1 . Very little data is available in the literature including 24 cases of breast cancer metastasized to a uterine leiomyoma2 , as assessed at surgery (N = 16), and autoptic evaluation (n = 8).

Role of Intraoperative Ultrasound to Extend the Application of Minimally Invasive Surgery for Treatment of Recurrent Gynecologic Cancer

STUDY OBJECTIVE To describe the potential role of intraoperative ultrasound (IOUS) in the detection and localization of recurrent disease in gynecologic cancer patients during minimally invasive surgery (MIS). DESIGN A prospective cohort study (Canadian Task Force classification II-1). SETTING A university hospital. PATIENTS Fifty-one gynecologic cancer patients with isolated recurrent disease. INTERVENTIONS IOUS during secondary cytoreductive surgery (SCS) by MIS. MEASUREMENTS AND MAIN RESULTS From November 2015 to February 2017 51 gynecologic cancer patients with isolated recurrent disease and candidates for SCS were treated by MIS. Recurrent tumor was preoperatively assessed at clinical examination, transvaginal and transabdominal sonography, and radiologic evaluation in all women. Twelve of 51 women (23.5%) needed IOUS. Type of disease was ovarian in 5 women (42%), endometrial in 4 (33%), cervical in 1 (8%), vaginal cancer in 1 (8%), and uterine sarcoma in 1 (8%). Recurrence was localized deep in the pelvis in 7 cases (58%), lymph nodes in 3 (25%), and extraperitoneal in 2 cases (17%). Recurrence was dimmed in the surgical field, due to either presence of adherences, deep anatomic position, small size, and/or lack of tactile feeling. IOUS was able to identify the lesions in all women, allowing MIS (83% laparoscopy and 17% robotic) complete cytoreduction, with no conversion to laparotomy. Median operative time was 150 minutes (range, 77-280). No intraoperative/postoperative complications occurred. Histologic examination confirmed the presence of recurrence in 11 of 12 cases (92%), whereas the remaining case showed inflammatory tissue. With a median follow-up time of 15 months (range, 6-19), all patients except 2 were still alive. CONCLUSIONS About 1 of 4 patients (25%) with single gynecologic cancer recurrence needs IOUS to benefit from MIS for complete secondary cytoreduction.