However, if lymphadenectomy
is therapeutic, as suggested by the SEPAL trial, the para-aortic area needs to be targeted by surgery, radiation or both in most (if not all) patients with documented lymphatic dissemination in the pelvis.[9, 32] In these cases, we need also to be aware that para-aortic disease is usually present in the anatomical area above the IMA. After many decades of debate, there are still no convincing data demonstrating a therapeutic role of lymphadenectomy in EC. Why is that? First, lymphadenectomy, like radiotherapy, is a locoregional treatment. For this reason, if lymphadenectomy is therapeutic, it is more likely to improve locoregional control and less likely to affect systemic disease. However, as overall patient survival is mainly driven by the presence of occult systemic disease, in the absence of an efficacious adjuvant systemic treatment, http://www.selleckchem.com/products/acalabrutinib.html it is unlikely that lymphadenectomy will demonstrate any survival benefits. We are therefore in a difficult situation. Patients with poorly differentiated EC (grade 3 or type II) are more likely to present with
occult lymphatic dissemination, but are also more likely to die of systemic disease. But patients with endometrioid grade 1 and 2 cancer are less likely to die of systemic disease and more likely to respond to systemic treatment and to be cured at the time of lymphatic recurrence. However, in these patients, lymphatic MG-132 in vivo dissemination is rare (Fig. 3),[15, 16] making it very difficult to demonstrate a therapeutic role of lymphadenectomy. Adenosine triphosphate Perhaps use of SLN mapping will be helpful for adequate patient selection in patients with low-risk tumor.[38-41] The continuing debate about the role of lymphadenectomy will probably end only when molecularly guided imaging or new biologic therapy becomes available to identify and treat systemic metastatic disease. “
“The aim of this study was to retrospectively report our experience (efficacy/morbidity) with cytoreductive surgery+hyperthermic intraperitoneal
chemotherapy (CRS+HIPEC) for the management of recurrent/relapsed ovarian granulosa cell tumors (OGCT). From 2010 to 2013, six patients underwent CRS+HIPEC. CRS was performed with standard peritonectomy procedures and visceral resections directed towards complete elimination of tumors from the abdominopelvic cavity. HIPEC was performed with cisplatin (50 mg/m2) and doxorubicin (15 mg/m2) and allowed to circulate in the abdominopelvic cavity for 90 min at 41.0–42.2°C. Cytoreduction completeness (CC-0) was achieved in all except one patient (CC-1). Five patients had OGCT recurrences in abdomen+pelvis and one patient in abdomen only. No grade V morbidity (Clavien–Dindo classification) occurred. Two patients developed lung atelectasis, which was managed by mere chest physiotherapy (grade I). One patient developed urinary tract infection (grade II) and another patient developed pneumonia (grade II) – both of which were managed by antibiotics.