2019, Vol 17, No 3
PET/CT imaging in the diagnosis and treatment planning in recurrent ovarian cancer
Curr Gynecol Oncol 2019, 17 (3), p. 95–106
DOI: 10.15557/CGO.2019.0011

Aim: The aim of the study was to assess the role of positron emission tomography with computed tomography (PET/CT) in monitoring patients after primary treatment of ovarian cancer and its usefulness in planning secondary treatment in patients with recurrence. We also attempted to determine standardized uptake value (SUV) thresholds typical for active neoplastic process, which are useful in making decisions on further therapy. Materials and methods: A total of 140 patients (mean age 57 years) treated between 2010 and 2014 due to recurrent ovarian cancer in two Polish gynecologic oncology centers were included in the study. Treatment in accordance with the standard treatment protocol for ovarian cancer, i.e. primary multiorgan cytoreduction, adjuvant chemotherapy, and the availability of full clinical data were the inclusion criteria. Gynecologic examination, transvaginal and transabdominal ultrasound, CA-125 measurement and 18F-fluorodeoxyglucose PET/CT were performed in the study group in the follow-up period after primary treatment. No PET/CT was performed in the control group. Results: Microscopic recurrence of ovarian cancer in the region of pelvic lymph nodes was found in 29 out of 34 patients with SUV ≥2.4 and in 6 out of 51 patients with SUV <2.4. SUV ≥3.5 for para-aortic lymph nodes was associated with recurrence in this region in 24/25 cases. SUV <3.5 confirmed recurrence in only 1 out of 60 patients. Conclusions: PET/CT is characterized by high efficacy in detecting recurrence after primary treatment. PET/CT performed in the study group as part of monitoring patients after standard treatment of ovarian cancer was associated with longer survival after secondary treatment compared to women without PET/CT follow-up. SUV threshold for active neoplastic process was 3.5 for para-aortic location and 2.4 for pelvic lymph nodes.

Keywords: ovarian cancer, recurrence, PET/CT, SUV
The role of lymphadenectomy in accurate staging and treatment of endometrial cancer
Curr Gynecol Oncol 2019, 17 (3), p. 107–110
DOI: 10.15557/CGO.2019.0012

Aim of the study: Inaccurate lymph node staging affects treatment planning and may contribute to worse prognosis. A retrospective study was performed to confirm this hypothesis. Materials and methods: Data about patients diagnosed with stage I–III endometrial cancer between January 1, 2008 and December 31, 2009 (cases with multiple primary tumors were excluded) was extracted from cancer register of Kyiv City Clinical Oncology Centre. Hypothesis: The absence of lymphadenectomy in a patient with apparent early stage endometrial cancer, but with undiagnosed lymph node metastases may lead to understaging and undertreatment with worse prognosis and outcomes. Cancer-specific survival was the primary outcome. Results: From 564 patients assessed for eligibility, 61 were excluded. Cancer-related death was reported in 76 cases: 39 stage I, 14 – stage II, and 23 – stage III patients. Median cancer-specific survival was 27 months for stage I, 14 months for stage II, and 19 months for stage III (p = 0.01). Three-year cancer-specific survival rate was 33.3% for stage I, 0% for stage II, and 17.4% for stage III. Intergroup analysis showed a statistically significant difference in survival between stage I and stage II patients (p = 0.005), but there was no statistically significant difference in survival between stage III and stage I or II patients (p = 0.072 and p = 0.151, respectively). Conclusions: The same rates of cancer-specific survival may indicate that the presented cases of apparently early stage endometrial cancer were understaged and consequently undertreated. Further studies in larger groups of patients are needed.

Keywords: endometrial neoplasms, mortality, diagnosis, therapeutics
Gestational trophoblastic disease: a ten-year review
Curr Gynecol Oncol 2019, 17 (3), p. 111–117
DOI: 10.15557/CGO.2019.0013

Objectives: To determine the prevalence of different types of gestational trophoblastic disease, assess the factors involved in malignant conditions and to determine treatment outcomes. Methodology: A retrospective review was conducted to investigate all gestational trophoblastic disease cases from January 2002 to December 2011. Results: A total of 123 patients were diagnosed with gestational trophoblastic disease within ten years, including 98 cases of benign and 25 cases of malignant gestational trophoblastic disease. There were 53 (43.1%) patients with partial and 45 (36.6%) with complete hydatidiform mole. Malignant forms accounted for 25 (20.3%), persistent trophoblastic disease for 22 (17.9%) and choriocarcinoma for 3 (2.4%) cases. The risk of developing malignant gestational trophoblastic disease increased by 5% every year of life. Twenty-two women received methotrexate, including 19 stage I patients receiving single-agent methotrexate, with complete recovery achieved in 12 patients (63%). Seven stage I patients put on actinomycin D achieved complete recovery (37%). Three patients with choriocarcinoma received EMA-CO regimen as treatment. Conclusion: We estimated the prevalence of gestational trophoblastic disease at 2.8 in 1,000 pregnancies, which is higher compared to Europe/USA. The risk factors for malignant disease included age, high parity, and long interval since the last child birth. Standard treatment allows for favorable outcomes.

Keywords: molar pregnancy, gestational trophoblastic disease, gestational trophoblastic neoplasia, choriocarcinoma, partial mole
Mean platelet volume to lymphocyte ratio as a novel marker in patients with breast cancer who underwent curative resection
Curr Gynecol Oncol 2019, 17 (3), p. 118–122
DOI: 10.15557/CGO.2019.0014

Background: Platelets play an essential role in cancer progression and metastasis. Mean platelet volume (MPV) is considered to be an effective marker for platelet activation. There is a positive correlation between lymphopenia and cancer prognosis. This study aimed to determine the prognostic significance of MPV/lymphocyte ratio (MPVLR) in breast cancer patients undergoing curative resection. Methods: Data of 139 breast cancer patients who underwent curative resection between January 2013 and December 2018 were analyzed retrospectively. The chi-square test evaluated the relationship between MPVLR and clinicopathological variables. MPVLR was obtained by dividing MPV by lymphocyte count. The Kaplan–Meier log-rank test assessed the correlation between MPVLR and disease-free survival (DFS). Results: The median follow-up was 41 (13–66) months. The best predicted optimal cut-off value for MPVLR by receiver operating characteristic (ROC) analysis was 4.34 (sensitivity 0.556, specificity 0.727). Patients were categorized into two groups as high MPVLR (>4.34) and low MPVLR (<4.34). The DFS rate in the elevated MPVLR group was significantly lower than in the low MPVLR group (p = 0.038). Multivariate analysis was not performed because only MPVLR was found significant for DFS in univariate analysis. We found a significant correlation between MPVLR and platelet to lymphocyte ratio (PLR) and MPV level. Conclusion: DFS was significantly shorter in patients with elevated MPVLR level. We believe that MPVLR can be used as a new prognostic marker in breast cancer patients undergoing curative resection.

Keywords: breast cancer, mean platelet volume, mean platelet volume to lymphocyte ratio, platelets
Vaginal intraepithelial neoplasia – a difficult diagnostic and therapeutic problem
Curr Gynecol Oncol 2019, 17 (3), p. 123–134
DOI: 10.15557/CGO.2019.0015

Vaginal intraepithelial neoplasia is a rare, usually asymptomatic condition mainly caused by human papillomavirus infection. It is characterized by the presence of epithelial dysplasia, which may give rise to invasive vaginal cancer. Vaginal intraepithelial neoplasia most often develops in women over 50 years of age, it usually occurs at the vaginal vault and is multifocal. The condition is usually diagnosed in patients with a history of hysterectomy, especially due to intraepithelial cervical lesions. There are currently no uniform guidelines to specify the management in patients with vaginal intraepithelial neoplasia. There are various treatment options, the efficacy of which depends on multiple factors. Treatment should be adjusted individually for each patient, accepted by the patient and implemented in an experienced center. The aim of this paper was to review the literature on the diagnosis, treatment, incidence and the risk of progression of vaginal intraepithelial neoplasia into invasive cancer. Clinicians should know the efficacy of different treatment options in order to be able to chose the best treatment strategy and implement it at the right time. We searched through the PubMed database for papers published up to January 2020 using the following keywords: vaginal intraepithelial neoplasia/VaIN, vaginal dysplasia, HPV DNA tests, cytology, colposcopy, hysterectomy, treatment, human papillomavirus. We additionally searched through links to the downloaded articles.

Keywords: vaginal intraepithelial neoplasia, human papillomavirus, incidence, treatment
Role of antioxidant vitamins in the development of uterine fibroids: a literature review
Curr Gynecol Oncol 2019, 17 (3), p. 135–140
DOI: 10.15557/CGO.2019.0016

Vitamins A, C, D and E are antioxidants, which are associated with anticarcinogenic activity. Uterine fibroids are a group of benign monoclonal neoplasms of various etiology and pathogenesis (gene mutations, hormonal disturbances, and changes in signaling pathways, cytokines and proangiogenic factors). In recent years, the pleiotropic role of antioxidant vitamins has caught attention. They contribute to the reduction of the amount of DNA damage caused by free oxygen radicals and inhibition of cell proliferation and angiogenesis; they also stimulate apoptosis and decrease metalloproteinase activity, which decreases cell mobility associated with the spread of neoplasms. It has also been demonstrated that antioxidant vitamins are able to eradicate cancer stem cells, which are responsible for cancer treatment resistance. Apart from that, some of them affect numerous signaling pathways and the expression of other genes. The results of different studies concerning the impact of antioxidant vitamins on the development of uterine fibroids are inconsistent to a large extent. Cohort studies (NHANES and Black Women’s Health Study) did not produce any definitive results either. However, it is believed that higher levels of vitamins A, C and D may inhibit the development of uterine fibroids, unlike vitamin E, whose role is unclear.

Keywords: uterine fibroids, antioxidant vitamins: A, C, D, E
Pelvic kidney: a challenging abnormality for surgeons
Curr Gynecol Oncol 2019, 17 (3), p. 141–143
DOI: 10.15557/CGO.2019.0017

Objective: Pelvic kidney is the most common congenital renal anomaly with an incidence of 1 in 1,000 to 1 in 2,000. A pelvic kidney can be encountered at pelvic or paraaortic lymphadenectomy. Case: A 70-year-old female patient undergoing pelvic-paraaortic lymphadenectomy due to serous endometrial cancer. Due to the known right pelvic kidney, lymphadenectomy was more difficult and gentle. Conclusion: Preoperative evaluation of the pelvic kidney is important to avoid any complications during surgery. Lymphadenectomy should be more careful in patients with pelvic kidney.

Keywords: pelvic kidney, lymphadenectomy, gynecology