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Abstract: Objectives: The purpose of this retrospective study was to assess the clinical outcome of patients with high-risk, early-stage endometrioid endometrial cancer (stage Ib or II with myometrial invasion > 50%, grade 2–3). Methods: We assessed 192 patients who underwent hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy, had histologically negative pelvic nodes, and had negative CT findings for aortic node involvement. Results: Tumor relapsed in 36 patients after a median time of 21.2months. The recurrence was vaginal in 7 (19.4%), distant in 16 (44.4%), aortic in 8 (22.2%), and involved multiple sites in 5 (13.9%). There was a trend to a lower vaginal recurrence rate in the 143 patients who received adjuvant radiotherapy (+chemotherapy) compared with the 46 who did not (2.1% versus 8.7%). Distant or aortic recurrences were lower in the 37 patients who received adjuvant chemotherapy (+radiotherapy) than in the 152 who did not (2.7% versus 18.4%, p =0.02). Of the 29 patients who received sequential adjuvant chemotherapy and radiotherapy, none developed local recurrence and only one had distant recurrence. There was a trend for a better 5-year progression-free survival and overall survival for the patients who received chemotherapy (+radiotherapy) compared with those who did not (86.0% versus 71.3%, and 92.3% versus 75.6%, respectively). Conclusions: Our data appear to suggest that adjuvant chemotherapy reduces the risk of distant or aortic recurrences and that sequential adjuvant chemotherapy and radiotherapy achieve an excellent local and distant control of disease in these clinical settings. [Copyright &y& Elsevier]

This article focuses on ovarian cancer. Epithelial ovarian cancer is the among the five leading sites for cancer incidence and mortality in women from developed countries. This malignancy ranges widely in frequency among different geographic areas and ethnic groups, with a high incidence in Northern Europe and the U.S. and a low incidence in Japan. Some investigations appear to show that low-dose estrogen pills confer substantial protection against the development of ovarian cancer. An American study, aiming to assess the impact of dose of oral contraception on ovarian cancer risk, revealed that the protective effect was similar for women who started oral contraception before 1972.

The article presents an abstract of the paper "Combining Sanctuary Visits With Off-Site Lectures to Address the Bushmeat in Cameroon," by A. Wilson and S. Costo, to be presented at the 21st Congress of the International Primatological Society in Entebbe, Uganda on June 25-30, 2006.

A letter to the editor is presented about the significance of the size of ovarian lesions as measured by sonography, in the estimation of the risk of malignancy.

Abstract: Purpose: Neoadjuvant chemotherapy [NACT] followed by radical hysterectomy is an alternative therapeutic option to concurrent chemotherapy–radiotherapy for locally advanced cervical cancer. However there are very few data about the effectiveness of any post-operative treatment in this clinical setting. The purpose of this study was to correlate the patterns of recurrence and the clinical outcomes of cervical cancer patients who received NACT, with postoperative adjuvant treatment. Patients and methods: This retrospective multicenter study included 333 patients with FIGO stage Ib2–IIb cervical cancer who underwent platinum-based NACT followed by radical surgery. Pathological responses were retrospectively assessed as complete; optimal partial; and suboptimal response. Overall optimal response rate was the sum of complete and optimal partial response rates. Results: On the whole series, recurrence-free survival was significantly longer in patients who achieved an overall optimal response than in those who did not (p<0.0001), and in patients who received adjuvant chemotherapy compared to those who did not (p=0.0001). On multivariate analysis, consolidation therapy (p=0.0012) was the only independent prognostic variable for recurrence-free survival; whereas FIGO stage (p=0.0169) and consolidation therapy (p=0.0016) were independent prognostic variables for overall survival. Conclusion: Optimal responders after chemo-surgical treatment for FIGO stage Ib2–IIb cervical cancer do not need any further treatment. Additional cycles of chemotherapy could be of benefit for patients with suboptimal response and intra-cervical residual disease. Both adjuvant chemotherapy and adjuvant radiation treatments do not seem to improve the clinical outcome of patients with extra-cervical residual disease compared to no further treatment. [Copyright &y& Elsevier]

Abstract: Objectives: The purpose of this retrospective multicenter study was to correlate patterns of recurrences and clinical outcome of cervical cancer patients who underwent neoadjuvant chemotherapy [NACT] to surgery. Methods: This study was conducted on 333 patients with FIGO stage Ib2–IIb cervical cancer who underwent NACT to surgery with pelvic lymphadenectomy. The median follow-up was 66.5months (range, 8–212months). Overall optimal response rate was the sum of complete and optimal partial response rates. Results: An overall optimal response was obtained in 64 patients (19.2%). As for the 220 sub-optimal responders (66.1%), 127 patients had negative nodes and negative parametria and/or surgical margins, 75 patients had positive nodes with positive or negative parametria and/or surgical margins, and 18 patients had positive parametria and/or surgical margins with negative nodes. At the time of the present analysis, 79 (23.7%) of the 333 patients had a recurrence after a median time of 14.9months (range, 4.5–123months). Recurrent disease was pelvic in 50 (63.3%), extra-pelvic in 22 (27.9%), and both in 7 (8.8%). On multivariate analysis, pathological response to NACT was an independent prognostic variable for recurrence-free and overall survival. Patients who did not achieve an overall optimal response had a 2.757-fold higher risk of recurrence and a 5.413-fold higher risk of death than those who obtained an overall optimal response. Conclusions: Results appear to suggest that the chemo-surgical approach is an effective therapeutic option for patients with stage Ib2–IIb cervical cancer and that pathological response to NACT is the strongest prognostic factor for the outcome. [Copyright &y& Elsevier]

: ObjectiveA combination of carboplatin (CBDCA) and paclitaxel (TAX) is the standard treatment in advanced ovarian cancer (AOC) patients. Epidoxorubicin (EDX) is an active treatment in AOC and exhibits nonoverlapping toxicities with CBDCA and TAX; moreover, when added to platinum-based chemotherapy, it improves long-term survival. We have therefore conducted a phase II study to evaluate the tolerability and antitumor activity of an EDX/TAX/CBDCA (ETC) triplet in AOC patients.: MethodsPatients with histologically confirmed suboptimal stage III–IV ovarian cancer who had not previously received cytotoxic drugs were treated with TAX (175 mg/m2 in a 3-h iv infusion), CBDCA (AUC 6, Calvert formula), and EDX (75 mg/m2 iv bolus) all given on day 1 every 28 days for a maximum of six courses on an outpatient basis. EDX dosage was chosen after a pilot phase I study.: ResultsFifty-five patients were registered, of whom 5 were determined ineligible bacause of age. Forty-two of the 50 are evaluable for response; 27 (64%) achieved a clinical complete response (CR) and 9 (21%) a partial response (PR) for a response rate of 86% (95% CI 71–94%). Thirty-three patients underwent a secondary debulking procedure after a median of 6 courses (range 2–6). Pathological CR and PR were observed in 9 (27.3%) and 21 (63.6%), respectively; among patients with persistent disease a successful cytoreduction (<1 cm) was obtained in 53.8% of patients. At a median follow up of 35.6 months (range 0–55.5) median progression-free survival is 19.5 months and median overall survival is 36 months. The most common adverse effects were G3–4 leukopenia and thrombocytopenia which occurred in 59 and 37% of patients, respectively.: ConclusionsThe ETC combination given according to the outlined doses and schedule is highly active in AOC patients with poor prognostic factors and deserves further study. [Copyright &y& Elsevier]