Search

Background: This study assessed the role of fertility preserving surgery in the treatment of patients with stage 1a ovarian carcinoma, with or without chemotherapy. Methods: The study was done in NCI-Cairo University and El-Galaa Teaching Hospital from 2006 to 2011. 32 women younger than 35years, with histologically confirmed early ovarian carcinoma (FIGO stage 1a, G1, or G2), underwent fertility preserving resection for the treatment of their malignancies. Patients with borderline tumours were excluded from the study. Findings: Macroscopic unilateral tumuors were seen in 32 patients. Twenty-six (81%) patients had G1 tumours, among which 18 (69%) tumours were serous, six of 18 (30%) were mucinous, two (7.77%) were endometrioid, and none was clear cell type. Six (19%) patients had G2 tumours, all of which were serous cell type. The median follow up period was 48months. Two (6%) women were lost to follow up. Three (10%) women went for a second look operation after pregnancy, during cesarean section. All of them were free of any detectable disease. Two (7%) patients had abdominal exploration to investigate abnormal ultrasound finding. One patient with an invasive recurrence had completion to radical surgery with pelvic and para-aortic lymph node dissection, followed by adjuvant chemotherapy, and remained free of disease until the end of the follow up period. Another patient with a borderline tumour underwent ovarian cystectomy with ovarian preservation and continued her follow up period without further events. Since this patient had a borderline tumour, we regarded this study recurrence rate to be only one patient (3%), without any mortality. None of our patients had distant metastases. After treatment, only 18 of 30 (60%) women have recorded attempted conception, 12 of 18 (67%) had full term pregnancy, four of 18 (22%) had mid-trimestric abortion. All patients had normal conceptions and normal vaginal deliveries after full-term pregnancies. Interpretation: Fertility preserving surgery in stage 1a, G1, or G2 ovarian carcinoma can be considered proper treatment strategy in patients with this disease. [ABSTRACT FROM AUTHOR]

Background: Survival rates of paediatric rhabdomyosarcoma have improved tremendously during the past decade by the development of risk stratification. This approach has favoured tailoring of treatment using multi-therapeutic modalities. Methods: Patients were given upfront surgical resection followed by systemic chemotherapy using the vincristine/actinomycin-D/cyclophosphamide (VAC) regimen, with subsequent further local control by surgery or radiotherapy, or both, according to risk stratification into low, intermediate, and high risk groups. Findings: The study included 40 patients; their median age was 3.5years (range: 8months to 17years), 28 were boys and 12 were girls. 2-year overall survival (OS) and event-free survival (EFS) were 87% and 45% respectively. After univariate analysis, OS was 100% for a complete response versus 92% for only partial response (p=0.03). OS was 94% if there were no distant metastasis versus 66% if metastasis was present (p=0.024). On the other hand, EFS was 88% for complete response versus 46% for partial response (p<0.001), and was 80% if upfront surgery was done versus 33% if only simple biopsy was taken (p=0.03). Local radiotherapy versus no radiotherapy was highly associated with EFS, with a difference of 75% versus 0%, respectively (p<0.001). Interpretation: Complete response and extent of disease are two important factors influencing survival in childhood rhabdomyosarcoma. Both local control measures, surgical resection and radiation therapy, and treatment response are important variables predicting EFS. The poor outcome of patients with metastatic disease necessitates further therapeutic approaches to improve survival. [ABSTRACT FROM AUTHOR]