RESUMEN
OBJECTIVES: To assess compliance to current surgical staging and adjuvant treatment guidelines for patients with early-stage epithelial ovarian carcinoma and its impact on overall survival. METHODS: Patients diagnosed between 1991 and 1997 with early-stage ovarian cancer were recruited from the Regional Cancer Registry of the central region in the Netherlands. Demographic data, tumour characteristics, surgical findings and therapeutic data were abstracted from medical records. Patients were classified into optimal and non-optimal surgical staging. Overall survival was estimated using Kaplan-Meier method. To adjust for age hazard ratios for overall survival were estimated with a Cox Proportional Hazards model. RESULTS: One hundred and twenty-five patients were included in the study, 41 of them (32.8%) were optimally staged. Guidelines for adjuvant radio- or chemotherapy were adequately followed in all 62 grade I patients and in 44 out of 59 grade II and III patients (74.6%). During 734.6 person-years of follow up 31 patients died. Five-year overall survival figures were 97.6% in the optimally staged group and 68.5% in the non-optimally staged group. Patients who were non-optimally staged, had a significant higher risk to die than those who were optimally staged (HR: 7.4; 95% CI: 1.7-32.2). In patients with a grade II and III tumours, complete surgical staging still had a significant influence on survival (HR: 3.8; 95% CI 1.7-8.3). In women with grade II or III tumours, adjuvant radio- or chemotherapy administered in accordance to the guidelines did not improve overall survival regardless whether they were optimally staged or not. CONCLUSION: Incomplete staging in early-stage ovarian cancer leads to gross mis-classification in grade II and III tumours and to a lesser extent in grade I tumours. This leads to undertreatment in both surgical and adjuvant therapy. Subsequently unnecessary deaths may occur. More effort must be put in identifying obstacles interfering with compliance of guidelines.
Asunto(s)
Adhesión a Directriz , Neoplasias Glandulares y Epiteliales/tratamiento farmacológico , Neoplasias Glandulares y Epiteliales/cirugía , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/cirugía , Guías de Práctica Clínica como Asunto , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Quimioterapia Adyuvante , Femenino , Humanos , Estimación de Kaplan-Meier , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Glandulares y Epiteliales/radioterapia , Países Bajos , Neoplasias Ováricas/radioterapia , Modelos de Riesgos Proporcionales , Radioterapia Adyuvante , Sistema de Registros/estadística & datos numéricos , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
During the last decade, intraperitoneal injection of phosphorus-32 chromic phosphate (P-32 CP) has been used principally for its initial intended purpose, the palliative management of malignant ascites. The authors describe a patient with a stage IIIB well-differentiated extraovarian peritoneal serous papillary adenocarcinoma. As a palliative treatment for malignant ascites, P-32 CP was instilled intraabdominally eight times. Adverse effects were limited to the third instillation, when abdominal pain occurred as a result of leakage of the P-32 CP in the subcutaneous tissue. The P-32 CP instillations reduced the frequency of paracentesis for almost 1 year, until disease progression prevented palliation. Considering the few palliative options, there could be more widespread use of P-32 CP as a palliative treatment for patients with malignant ascites caused by ovarian cancer or extraovarian peritoneal adenocarcinoma. However, intraperitoneal P-32 CP is not without potential intestinal complications, which must be considered before it is recommended.
Asunto(s)
Ascitis/radioterapia , Compuestos de Cromo/administración & dosificación , Compuestos de Cromo/uso terapéutico , Cuidados Paliativos/métodos , Neoplasias Peritoneales/radioterapia , Fosfatos/administración & dosificación , Fosfatos/uso terapéutico , Adenocarcinoma Papilar/complicaciones , Adenocarcinoma Papilar/radioterapia , Adulto , Ascitis/etiología , Ascitis/cirugía , Fraccionamiento de la Dosis de Radiación , Femenino , Estudios de Seguimiento , Humanos , Inyecciones Intraperitoneales , Neoplasias Ováricas/radioterapia , Paracentesis , Neoplasias Peritoneales/complicaciones , Radiofármacos/administración & dosificación , Radiofármacos/uso terapéutico , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate the reproducibility of the clinical judgement of gynaecologists, gynaecologists in training and gynaecologic oncologists and to compare the predictive performance of the offhand assessment with the predictive performance of existing mathematical models for the pre-operative assessment of the adnexal mass. DESIGN: Questionnaire with paper cases of women operated on for an adnexal mass. SETTING: Gynaecological unit in a teaching hospital in the South of The Netherlands. POPULATION: Women who underwent surgery for adnexal mass between January 1991 and December 1998. METHODS: We offered 45 gynaecologists five different sets of 34 cases, with data on female age and menopausal status, a written description of the sonography, Doppler flow measurement and serum CA125 measurement. Nine observers for every set were asked to estimate the probability of malignancy. MAIN OUTCOME MEASURES: The reproducibility of the risk estimates as made by the participants was expressed with an intraclass correlation coefficients. The accuracy of the judgement of the clinicians and the result of mathematical models in the prediction of malignancy were expressed with sensitivity, specificity, and receiver-operating characteristic curves. RESULTS: Neither clinically relevant nor statistically significant differences could be found between the accuracy of the risk assessments made by the clinicians and the accuracy of the risk assessments made by prediction models. CONCLUSION: This study demonstrates that at this moment there is no need to introduce complicated predictive scoring systems such as neural networks or logistic regression models for the pre-operative assessment of the adnexal masses.