1. Wasson M, Magtibay P 2nd, Magtibay P 3rd, Magrina J. Incidence of occult uterine malignancy following vaginal hysterectomy with morcellation. J Minim Invasive Gynecol 2017 Feb 22. doi: 10.1016/j.jmig.2017.01.025.
 
2. Kyrgiou M, Kalliala I, Markozannes G, Gunter MJ, Paraskevaidis E, Gabra H, Martin-Hirsch P, Tsilidis KK. Adiposity and cancer at major anatomical sites: umbrella review of the literature. BMJ 2017; 356: j477.
 
3. Steinberg AC, Schimpf MO, White AB, et al. Preemptive analgesia for postoperative hysterectomy pain control: systematic review and clinical practice guidelines. Am J Obstet Gynecol 2017 Mar 25. doi: 10.1016/j.ajog.2017.03.013
 
4. Janda M, Gebski V, Davies LC, et al. Effect of total laparoscopic hysterectomy vs. total abdominal hysterectomy on disease-free survival among women with stage I endometrial cancer: a randomized clinical trial. JAMA 2017; 317:1224-1233.
 
5. Committee Opinion No. 704: Human papillomavirus vaccination. Obstet Gynecol 2017 Mar 24. doi: 10.1097/AOG.0000000000002052.
 
6. Topsoee MF, Settnes A, Ottesen B, Bergholt T. A systematic review and meta-analysis of the effect of prophylactic tranexamic acid treatment in major benign uterine surgery. Int J Gynaecol Obstet 2017; 136:120-127.
 
7. Ricci S, Stone RL, Fader AN. Uterine leiomyosarcoma: epidemiology, contemporary treatment strategies and the impact of uterine morcellation. Gynecol Oncol 2017 Feb 13. doi: 10.1016/j.ygyno.2017.02.019.
 
8. Matsuo K, Machida H, Shoupe D, Melamed A, Muderspach LI, Roman LD, Wright JD. Ovarian conservation and overall survival in young women with early-stage cervical cancer. Obstet Gynecol 2017; 129:139-151. 
 
9. Munro MG. Leiomyosarcoma and myomectomy: is the cat ever in the bag? BJOG 2016; 123:2188
 
10. alaska MJ, Haidopoulos D, Guyon F, Morice P, Zapardiel I, Kesic V. European Society of Gynecological Oncology statement on fibroid and uterine morcellation. Int J Gynecol Cancer 2017; 27:189-192.
 

[1]     G. Nelson, A. D. Altman, A. Nick, L. A. Meyer, P. T. Ramirez, C. Achtari, J. Antrobus, J. Huang, M. Scott, L. Wijk, N. Acheson, O. Ljungqvist, and S. C. Dowdy, “Guidelines for postoperative care in gynecologic / oncology surgery : Enhanced Recovery After Surgery ( ERAS ® ) Society recommendations — Part II,” Gynecol. Oncol., vol. 140, no. 2, pp. 323–332, 2016.

 We provide evidence supporting postoperative management of patients undergoing gynecologic/oncology surgery. • This guideline will help integrate knowledge into practice, align perioperative care, and encourage future investigations.

 Guias ERAS parte 2: para el cuidado del pre y intraoperatorio en cirugias de ginecologia oncooógica



 
[2]     M. Report, “The American Society of Clinical Oncology 2016 annual meeting : A review and summary of selected abstracts,” Gynecol. Oncol., vol. 142, pp. 388–394, 2016.

 Reporte del SGO 2016: revisión y articulos seleccionados



 
[3]     A. A. Roma, T. Mistretta, A. Diaz, D. Vivar, K. J. Park, I. Alvarado-cabrero, G. Rasty, J. G. Chanona-vilchis, Y. Mikami, S. R. Hong, N. Teramoto, R. Ali-fehmi, D. Barbuto, J. K. L. Rutgers, and E. G. Silva, “Gynecologic Oncology New pattern-based personalized risk strati fi cation system for endocervical adenocarcinoma with important clinical implications and surgical outcome  , ☆☆,” Gynecol. Oncol., vol. 141, no. 1, pp. 36–42, 2016.

 We present a recently introduced three tier pattern-based histopathologic systemto stratify endocervical adeno- carcinoma (EAC) that better correlates with lymph node (LN)metastases than FIGO staging alone, and has the advantage of safely predicting node-negative disease in a large proportion of EAC patients. The systemconsists of stratifying EAC into one of three patterns: pattern A tumors characterized by well-demarcated glands fre- quently forming clusters or groups with relative lobular architecture and lacking destructive stromal invasion or lymphovascular invasion (LVI), pattern B tumors demonstrating localized destructive invasion (small clusters or individual tumor cellswithin desmoplastic stroma often arising frompattern A glands), and pattern C tumors with diffusely infiltrative glands and associated desmoplastic response. Three hundred and fifty-two caseswere included;mean follow-up 52.8months. Seventy-three patients (21%) had pattern A tumors; all were stage I and therewere no LNmetastases or recurrences. Pattern Bwas seen in 90 tumors (26%); allwere stage I and LVIwas seen in 24 cases (26.6%).Nodal diseasewas found in only 4 (4.4%) pattern B tumors (one IA2, two IB1, one IB not further specified (NOS)), each ofwhich showed LVI. Pattern Cwas found in 189 cases (54%), 117 had LVI (61.9%) and 17% were stage II or greater. Forty-five (23.8%) patients showed LNmetastases (one IA1, 14 IB1, 5 IB2, 5 IB NOS, 11 II, 5 III and4 IV) and recurrenceswere recorded in 41 (21.7%) patients. Thisnewrisk stratification system identifies a subset of stage I patientswith essentially no risk of nodal disease, suggesting that patientswith pat- tern A tumors can be spared lymphadenectomy. Patients with pattern B tumors rarely present with LN metastases, and sentinel LN examination could potentially identify these patients. Surgical treatmentwith nodal resection is justified in patients with pattern C tumors.

 Nuevo sistema de estratificación de adenocarcinoma del cuello de utero según el patrón morfológico de invasión para mejor predicción del status ganglionar.



 
[4]     G. F. Sawaya, “Cervical cancer screening in women over 65 . CON : Reasons for uncertainty,” Gynecol. Oncol., vol. 142, no. 3, pp. 383–384, 2016.

Editorial: screening en cancer cervical en mayores de 65 años. CONTRA


 

[5]     K. K. Shih, C. Hajj, M. Kollmeier, M. K. Frey, Y. Sonoda, N. R. Abu-rustum, and K. M. Alektiar, “Impact of postoperative intensity-modulated radiation therapy ( IMRT ) on the rate of bowel obstruction in gynecologic malignancy,” Gynecol. Oncol., vol. 143, no. 1, pp. 18–21, 2016.

Objective. The purposewas to determine the potential impact of IMRT on the rate of bowel obstruction (BO), in patients with gynecologicmalignancies undergoing postoperative pelvic RT. Methods. We performed a retrospective review of all patients with endometrial or cervical cancer who re- ceived postoperative pelvic RT at our institution from2000 to 2012. Patientswho received definitive or palliative RT, or those with BOdue to disease progression,were excluded. Standard two-sided statistical testswere used to evaluate for associated risk factors. Kaplan-Meier, Log rank and Cox proportional hazards regression analysis testswere performed for actuarial analysis. Results. A total of 224 patientswere identified, 120 (54%) received postoperative pelvic IMRT and 104 (46%) 3-dimentional (3-D) RT.Medianfollow-up timewas 67months.BOwas grade 1 (asymptomatic) in2/228 (0.9%), grade 2 (conservativemanagement) in 4 (1.8%), and grade 3≥ in 4 (1.8%). Overall, the 5-year actuarial rate of BO was 4.8%. The 5-year rate of BO in the IMRT group was 0.9% compared to 9.3% for 3-D RT (p=0.006). Patients with BMI ≥ 30 kg/m2 were less likely to develop BO (2.6% vs. 8.3; p=0.03). On multivariate analysis, only IMRT retained its significance as an independent predictor of less BO (p=0.022). Conclusions. The use of postoperative IMRT for cervical and endometrial cancer was associatedwith signifi- cant reduction in the rate of bowel obstruction. This differencemaintained its statistical significance onmultivar- iate analysis. Such finding if confirmed by others will help further solidify the benefit of IMRT in gynecologic cancers.

 Estudio retrospectivo que evalua el impacto de la IMRT sobre la obstruccion intestinal en pacientes con cáncer ginecológico que requirieron RT pelviana en el postoperatorio.



 
[6]     V. Thomas, P. Maher, A. Ternamian, G. Vilos, A. Loddo, H. Reich, E. Downes, I. A. Rachman, L. Clevin, M. S. Abrao, G. Keckstein, M. Stark, and B. Van Herendael, “Principles of safe laparoscopic entry,” Eur. J. Obstet. Gynecol. Reprod. Biol., 2016.

 Revisión de la literatura, consideraciones y recomendaciones sobre las técnicas de entrada en laparoscopía.

 



[7]     S. Uccella, M. Bonzini, S. Palomba, F. Fanfani, M. Malzoni, M. Ceccaroni, R. Seracchioli, A. Ferrero, R. Berretta, E. Vizza, D. Sturla, G. Roviglione, G. Monterossi, P. Casadio, E. Volpi, D. Mautone, G. Corrado, F. Bruni, G. Scambia, and F. Ghezzi, “Gynecologic Oncology Laparoscopic vs . open treatment of endometrial cancer in the elderly and very elderly : An age-strati fi ed multicenter study on 1606 women  ,☆☆,” Gynecol. Oncol., vol. 141, no. 2, pp. 211–217, 2016.

 Objective To investigate in depth the effect of increasing age on the peri-operative outcomes of laparoscopic treatment for endometrial cancer, compared to open surgery, with stratification of patients according to the different defini- tions of elderly age used in the literature. Methods. Data of consecutive patientswho underwent surgery for endometrial cancer staging at six centers were reviewed and analyzed accordingto surgical approach (laparoscopic or open),differentdefinitions of elder- ly and very elderly age (≥65 years, ≥75 years, ≥80 years), and class of age (b65; ≥65– b 75; ≥75–80; ≥80 years). Multivariable analysis to correct for possible confounders and propensity-scorematching tominimize selection biaswere used. Results. A total of 1606 patientswere included: 938 and 668 patients received laparoscopic and open surgery, respectively.With increasing age, fewer patients received laparoscopy (P b 0.001with ANOVA). The percentage of patients who received lymphadenectomy declined significantly in both groups for age ≥80 years. Blood trans- fusions, incidence andseverity of post-operative complications, and hospital staywere significantly lower among patients who had laparoscopy both in younger (b65 years) and elderly (whether defined as ≥65 or ≥75 years) patients, with no effect of age on any of the characteristics analyzed (ANOVA: P N 0.05). The same tendency was observed among very-elderly patients (≥80 years). Multivariable and propensity score-matched analysis confirmed these findings. Conclusions. Laparoscopy for staging endometrial cancer retains its advantages over open surgery even in elderly and very-elderly patients. Our data strongly suggest that minimally-invasive surgery is advantageous even among subjects ≥80 years.

 Ventajas de la cirugia laparoscopica sobre la pobalcion anciana y muy anciana



 
[8]     C. S. Walsh, “Two decades beyond BRCA1 / 2 : Homologous recombination , hereditary cancer risk and a target for ovarian cancer therapy ,” Gynecol. Oncol., vol. 137, no. 2, pp. 343–350, 2015.

 Almost exactly 20 years after their discovery, the BRCA1 and BRCA2 genes have become the target of the first “personalized” therapy available for patients with ovarian cancer. In December 2014, a poly(ADP-ribose) polymerase (PARP) inhibitorwas grantedexpeditedapprovedby theUnitedStates Food andDrugAdministration for use in advanced ovarian cancer patientswith germline BRCA1/2 mutationswho have received three ormore prior lines of chemotherapy. This review article will discuss (1) the BRCA1 and BRCA2 genes within the larger context of homologous recombination deficiency; (2) the advances in our understanding of hereditary cancer risk and the dramatic shifts that have occurred in the genetic testing landscape since the landmark 2013 Supreme Court ruling invalidating patents on BRCA1 and BRCA2 genetic testing; and (3) the clinical trials leading to the approval of olaparib, the first in human PARP inhibitor.

 Una revision del estudio sobre BRCA 1/ BRCA2 y su uso en la terapeutica actual.


 

[9]     A. A. Wright, K. Bohlke, D. K. Armstrong, M. A. Bookman, W. A. Cliby, R. L. Coleman, D. S. Dizon, J. J. Kash, L. A. Meyer, K. N. Moore, A. B. Olawaiye, J. Oldham, R. Salani, D. Sparacio, W. P. Tew, I. Vergote, and M. I. Edelson, “Neoadjuvant Chemotherapy for Newly Diagnosed , Advanced Ovarian Cancer : Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline,” J. Clin. Oncol., vol. 34, 2016.

 Panel de expertos y revisión sistemática: Guia para el uso de la quimioterapia neoadyuvante y cirugia de intervalo en mujeres con estadio IIIC o IV de cancer de ovario.


 

 [10]     A. A. Wright, K. Bohlke, D. K. Armstrong, M. A. Bookman, W. A. Cliby, R. L. Coleman, D. S. Dizon, J. J. Kash, L. A. Meyer, K. N. Moore, A. B. Olawaiye, J. Oldham, R. Salani, D. Sparacio, W. P. Tew, I. Vergote, and M. I. Edelson, “Neoadjuvant chemotherapy for newly diagnosed , advanced ovarian cancer : Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline ,” Gynecol. Oncol., vol. 143, no. 1, pp. 3–15, 2016.

 Purpose. To provide guidance to clinicians regarding the use of neoadjuvant chemotherapy and interval cytoreduction among women with stage IIIC or IV epithelial ovarian cancer. Methods. The Society of Gynecologic Oncology and the American Society of Clinical Oncology convened an Expert Panel and conducted a systematic review of the literature. Results. Four phase III clinical trials form the primary evidence base for the recommendations. The pub- lished studies suggest that for selected women with stage IIIC or IV epithelial ovarian cancer, neoadjuvant chemotherapy and interval cytoreduction are non-inferior to primary cytoreduction and adjuvant chemotherapy with respect to overall and progression-free survival and are associated with less perioper- ative morbidity and mortality. Recommendations. All women with suspected stage IIIC or IV invasive epithelial ovarian cancer should be evaluated by a gynecologic oncologist prior to initiation of therapy. The primary clinical evaluation should include a CT of the abdomen and pelvis, and chest imaging (CT preferred).Women with a high peri- operative risk profile or a low likelihood of achieving cytoreduction to b1 cmof residual disease (ideally to no visible disease) should receive neoadjuvant chemotherapy. Women who are fitfor primary cytoreductive surgery, andwith potentially resectable disease,may receive either neoadjuvant chemother- apy or primary cytoreductive surgery.However, primary cytoreductive surgery is preferred if there is a high likelihood of achieving cytoreduction to b1 cm(ideally to no visible disease)with acceptablemorbidity. Be- fore neoadjuvant chemotherapy is delivered, all patients should have confirmation of an invasive ovarian, fallopian tube, or peritoneal cancer.

 Panel de expertos y revisión sistemática de la literatura: Guía práctica sobre la quimioterapia neoadyuvante para el cancer de ovario avanzado.

 

 [1] G. D. Aletti and W. A. Cliby, “Time for centralizing patients with ovarian cancer : what are we waiting for ?,” Gynecol. Oncol., vol. 142, no. 2, pp. 209–210, 2016.

Editorial. Importancia en la centralizacion de las pacientes con cancer de ovario

 [2] N. Colombo, C. Creutzberg, F. Amant, T. Bosse, A. González-martín, J. Ledermann, C. Marth, R. Nout, D. Querleu, M. Raza, C. Sessa, T. Esmo, E. Estro, E. Consensus, and C. Working, “ESMO – ESGO – ESTRO consensus conference on endometrial cancer : Diagnosis , treatment and follow-up q,” Radiother. Oncol., vol. 117, pp. 559–581, 2015.

 

The first joint European Society for Medical Oncology (ESMO), European SocieTy for Radiotherapy & Oncology (ESTRO) and European Society of Gynaecological Oncology (ESGO) consensus conference on endometrial cancer was held on 11–13 December 2014 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of endometrial cancer. Before the conference, the expert panel prepared three clinically-relevant questions about endometrial cancer relating to the following four areas: Prevention and screening, surgery, adjuvant treatment and advanced and recurrent disease. All rel- evant scientific literature, as identified by the experts, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. Results of this consensus conference, together with a summary of evidence supporting each rec- ommendation, are detailed in this article. All participants have approved this final article. ? 2015 The Authors. Published by Elsevier Ireland Ltd. Radiotherapy and Oncology 117 (2015) 559–581 This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc- nd/4.0/)

 

Consenso de expertos sobre cancer de endometrio: diagnosis, tratamiento y seguimiento.
Vale la pena como referencia.

 [3] S. M. Crafton, K. Bixel, and J. L. Hays, “PARP inhibition and gynecologic malignancies : A review of current literature and on-going trials,” Gynecol. Oncol., vol. 142, no. 3, pp. 588–596, 2016.

 

The poly (ADP-ribose) polymerase (PARP) family of enzymes isimportant in severalDNArepairpathways. Drugs that inhibit these enzymes have been investigated inmany types of cancer, but their application in the treatment of gynecologic malignancies has rapidly evolved – as manifested by the 2014 FDA approval for olaparib in the treatment of recurrent ovarian cancer associatedwith a germline BRCA mutation (gBRCA). In efforts to broaden their efficacy, current clinical trials have demonstrated benefit of olaparib, and other PARP inhibitors (PARPi), as single agents and in combination with cytotoxic chemotherapy and biologic agents, in wide ranging populations. Although themajority of data for PARPi in gynecologicmalignancies has been specifically regarding ovarian can- cer, their role in thetreatment of uterine and cervical cancer is currently being investigated. This reviewwill serve as a synopsis of seminal trials to date, summarize the breadth of clinical application in on-going studies, query how these results may change future practice, and reflect on questions yet to be answered.

 

Revisión de la literatura y trials actuales sobre PARP inhibitions

 [4] P. Dahm-kähler, C. Palmqvist, C. Staf, E. Holmberg, and L. Johannesson, “Centralized primary care of advanced ovarian cancer improves complete cytoreduction and survival - A population-based cohort study,” Gynecol. Oncol., vol. 142, no. 2, pp. 211–216, 2016.

 

Objective. To evaluate centralized primary care of advanced ovarian and fallopian tube cancers in a complete populationcohort in relationto complete cytoreduction, timeinterval fromsurgery to chemotherapy andrelative survival. Methods. A regional population-based cohort study of women diagnosed with primary ovarian and fallopian tube cancers and included in the Swedish Quality Registry (SQR) during 2008–2013 in a regionwhere primary care of advanced stages was centralized in 2011. Surgical, oncological characteristics, outcomes, follow-ups and relative survivals were analyzed. Results. There were 817 women diagnosed with ovarian and fallopian tube cancers during 2008–2013 and 523 were classified as FIGO stage III-IV and further analyzed. Primary debulking surgery (PDS) was performed in 81% and neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) in 11%. Complete cytoreduction at PDSwas performed in 37% before compared to 49% after centralization (p b 0.03). The chemo- therapy protocols were identical in the cohorts and they received and completed the planned chemotherapy equally. The time interval between PDS and chemotherapy was 36 days (median) before compared to 24 days after centralization (p b 0.01). The relative 3-year survival rate inwomen treated by PDS was 44% compared to 65% after centralization and the estimated excess mortality rate ratio (EMRR) was reduced (RR 0.58; 95% CI 0.42–0.79). Comparing the complete cohorts before and after centralization, regardless primary treatment, the relative 3-year survival rate increased from40% to 61%with reduced EMRR (RR 0.59; 95% CI 0.45–0.76). Conclusion. Centralized primary care of advanced ovarian and fallopian tube cancers increases complete cytoreduction, decreases time interval fromPDS to chemotherapy and improves relative survival significantly.

 

Estudio de una cohorte de pacientes con cancer de ovario y trompa en un solo centro con respecto a la cirugia de citoreducción, tiempo de intervalo y sobrevida.

[5] L. Elit, “Cervical cancer screening in women over 65 . PRO : Are we asking the right question ?,” Gynecol. Oncol., vol. 142, no. 3, pp. 381–382, 2016.

 

Editorial: screening en cancer cervical en mayores de 65 años. PRO.

 [6] V. Gallotta, M. Petrillo, C. Conte, G. Vizzielli, A. Fagotti, G. Ferrandina, F. Fanfani, B. Costantini, V. Carbone, and G. Scambia, “Laparoscopic Versus Laparotomic Surgical Staging for Early-Stage Ovarian Cancer : A Case-Control Study,” J. Minim. Invasive Gynecol., vol. 23, no. 5, pp. 769–774, 2016.

 

Study Objective: To evaluate the oncologic outcomes of patients with early-stage ovarian cancer (eOC) managed by lapa- roscopy or laparotomy in a single high-volume gynecologic cancer center. Design: Retrospective case-control study (Canadian Task Force classification II-2). Setting: Catholic University of the Sacred Hearth, Rome, Italy. Patients: Data of consecutive women with eOC undergoing comprehensive laparoscopic staging between 2007 and 2013 were matched with a cohort of patients undergoing open surgery between 2000 and 2011. Four-year survival outcomes were analyzed using the Kaplan-Meier method. Measurements and Results: Sixty women undergoing staging via laparoscopy were compared with a cohort of 120 patients undergoing open surgery. Baseline characteristics were similar between groups. Seventy percent of patients underwent adju- vant platinum based chemotherapy without differences between the 2 groups. Operative time (p5.01), estimated blood loss (p5.032), and median hospital stay (p5.001) were higher in patients submitted to laparotomic versus laparoscopic staging. As of October 2015, median duration of follow-up was 38 months (range, 24 -48), recurrent disease was documented in 16 patients (13.3%) in the laparotomic group and in 5 patients (8.3%) in the laparoscopic group (p5.651), without differences in the pattern of recurrence presentation. Four-year progression-free survival (PFS) and overall survival (OS) rates were 89% and 92% in the laparoscopic group, respectively, and 81% and 91% in the laparotomic group, without any statistical significant difference between the groups (4-year PFS p 5 .651; 4-year OS p 5 .719). Conclusion: The findings of the present study suggests that in the surgical treatment of FIGO stage I ovarian cancer, laparoscopy is associated with equivalent oncologic outcome compared with a conventional abdominal approach.

 

Estudio retrospectivo caso control que evalua los resultados oncológicos en pacientes con cancer de ovario incial manejados por laparoscopia vs laparotomia en un solo centro.

 [7] M. Kamrava, “Intensity modulated radiation therapy for women with gynecologic cancers : this horse is also already out of the barn,” Gynecol. Oncol., vol. 143, no. 1, pp. 1–2, 2016.

 

Editorial. El uso de IMRT en cánceres ginecológicos.

 [8] S. Kehoe, J. Hook, M. Nankivell, G. C. Jayson, H. Kitchener, T. Lopes, D. Luesley, T. Perren, and S. Bannoo, “Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer ( CHORUS ): an open-label , randomised , controlled , non-inferiority trial,” Lancet, vol. 386, no. 9990, pp. 249–257, 2015.

 

Background The international standard of care for women with suspected advanced ovarian cancer is surgical debulking followed by platinum-based chemotherapy. We aimed to establish whether use of platinum-based primary chemotherapy followed by delayed surgery was an eff ective and safe alternative treatment regimen. Methods In this phase 3, non-inferiority, randomised, controlled trial (CHORUS) undertaken in 87 hospitals in the UK and New Zealand, we enrolled women with suspected stage III or IV ovarian cancer. We randomly assigned women (1:1) either to undergo primary surgery followed by six cycles of chemotherapy, or to three cycles of primary chemotherapy, then surgery, followed by three more cycles of completion chemotherapy. Each 3-week cycle consisted of carboplatin AUC5 or AUC6 plus paclitaxel 175 mg/m², or an alternative carboplatin combination regimen, or carboplatin monotherapy. We did the random assignment by use of a minimisation method with a random element, and stratifi ed participants according to the randomising centre, largest radiological tumour size, clinical stage, and prespecifi ed chemotherapy regimen. Patients and investigators were not masked to group assignment. The primary outcome measure was overall survival. Primary analyses were done in the intention-to-treat population. To establish non-inferiority, the upper bound of a one-sided 90% CI for the hazard ratio (HR) had to be less than 1·18. This trial is registered, number ISRCTN74802813, and is closed to new participants. Findings Between March 1, 2004, and Aug 30, 2010, we randomly assigned 552 women to treatment. Of the 550 women who were eligible, 276 were assigned to primary surgery and 274 to primary chemotherapy. All were included in the intention-to-treat analysis; 251 assigned to primary surgery and 253 to primary chemotherapy were included in the per-protocol analysis. As of May 31, 2014, 451 deaths had occurred: 231 in the primary-surgery group versus 220 in the primary-chemotherapy group. Median overall survival was 22·6 months in the primary-surgery group versus 24·1 months in primary chemotherapy. The HR for death was 0·87 in favour of primary chemotherapy, with the upper bound of the one-sided 90% CI 0·98 (95% CI 0·72–1·05). Grade 3 or 4 postoperative adverse events and deaths within 28 days after surgery were more common in the primary-surgery group than in the primary-chemotherapy group (60 [24%] of 252 women vs 30 [14%] of 209, p=0·0007, and 14 women [6%] vs 1 woman [<1%], p=0·001). The most common grade 3 or 4 postoperative adverse event was haemorrhage in both groups (8 women [3%] in the primary-surgery group vs 14 [6%] in the primary-chemotherapy group). 110 (49%) of 225 women receiving primary surgery and 102 (40%) of 253 receiving primary chemotherapy had a grade 3 or 4 chemotherapy related toxic eff ect (p=0·0654), mostly uncomplicated neutropenia (20% and 16%, respectively). One fatal toxic eff ect, neutropenic sepsis, occurred in the primary-chemotherapy group. Interpretation In women with stage III or IV ovarian cancer, survival with primary chemotherapy is non-inferior to primary surgery. In this study population, giving primary chemotherapy before surgery is an acceptable standard of care for women with advanced ovarian cancer.

 

CHORUS trail: estudio controlado y randomizado cirugia primaria vs cirugia del intervalo en cancer de ovario avanzado

 [9] H. Mahdi, B. Nutter, F. Abdul-karim, S. Amarnath, and P. G. Rose, “The impact of combined radiation and chemotherapy on outcome in uterine papillary serous carcinoma compared to chemotherapy alone,” J. Gynecol. Oncol., vol. 27, no. 2, pp. 1–11, 2016.

 

Objective: To investigate the impact of pelvic radiation on survival in patients with uterine serous carcinoma (USC) who received adjuvant chemotherapy. Methods: Patients with stage I-IV USC were identified from the Surveillance, Epidemiology, and End Results program 2000 to 2009. Patients were included if treated with surgery and chemotherapy. Patients were divided into two groups: those who received chemotherapy and pelvic radiation therapy (CT_RT) and those who received chemotherapy only (CT). Kaplan- Meier curves and Cox regression proportional hazard models were used. Results: Of the 1,838 included patients, 1,272 (69%) were CT and 566 (31%) were CT_ RT. Adjuvant radiation was associated with significant improvement in overall survival (OS; p<0.001) and disease-specific survival (DSS; p<0.001) for entire cohort. These findings were consistent for the impact of radiation on OS (p<0.001) and DSS (p<0.001) in advanced stage (III-IV) disease but not for early stage (I–II) disease (p=0.21 for OS and p=0.82 for DSS). In multivariable analysis adjusting for age, stage, race and extent of lymphadenectomy, adjuvant radiation was a significant predictor of OS and DSS for entire cohort (p=0.003 and p=0.05) and in subset of patients with stage III (p=0.02 and p=0.07) but not for patients with stage I (p=0.59 and p=0.49), II (p=0.83 and p=0.82), and IV USC (p=0.50 and p=0.96). Other predictors were stage, positive cytology, African American race and extent of lymphadenectomy. Conclusion: In USC patients who received adjuvant chemotherapy, adjuvant radiation was associated with significantly improved outcome in stage III disease but not for other stages. Positive cytology, extent of lymphadenectomy and African race were significant predictors of outcome.

 

Estudio comparativo entre la combinación de radioterapia pelviana y quimioterapia vs quimioterapia sola en pacientes con carcinoma seroso papilar de endometrio en cuanto a sobrevida.

 [10] G. Nelson, A. D. Altman, A. Nick, L. A. Meyer, P. T. Ramirez, C. Achtari, J. Antrobus, J. Huang, M. Scott, L. Wijk, N. Acheson, O. Ljungqvist, and S. C. Dowdy, “Guidelines for pre- and intra-operative care in gynecologic / oncology surgery : Enhanced Recovery After Surgery ( ERAS ® ) Society recommendations — Part I,” Gynecol. Oncol., vol. 140, no. 2, pp. 313–322, 2016.

 

We provide evidence supporting pre- and intra-operative management of patients undergoing gynecologic/oncology surgery. • This guideline will help integrate knowledge into practice, align perioperative care, and encourage future investigations.

 

Guia ERAS Parte 1: para el cuidado del pre e intra operatorio