がんの科学と治療

Background: Chemoradiation is the standard of care for management of locally advanced cervical cancer, but failure to control systemic disease occurs in one third of patients. Neoadjuvant chemotherapy (NACT) has been investigated in management of locally advanced cervical cancer in order to improve its prognosis. We assessed the tolerability and response rate of weekly NACT with paclitaxel and carboplatin before radical concurrent chemoradiation (CRT).
Methods: Single arm phase II trial of 50 patients with locally advanced cervical cancer (stage IB2-IVA). Patients received weekly paclitaxel (80 mg/ m2 ) and carboplatin AUC2 for six cycles followed by CRT (weekly cisplatin 40 mg/m2 , 50.4 Gray over 28 fractions plus brachytherapy).
Results: A total of 50 patients were recruited. Baseline characteristics were: median age at diagnosis 56 years, 92% squamous, 8% adenocarcinoma, FIGO stage IB2 ( 4%), II (28%), IIIA (28%), IIIB (12%), IVA (28%). Complete or partial response rate was 88.3% post NACT and 72.1% post CCRT. The median follow up was 12 months. Grade 3 toxicities were 14.8% during NACT and 13.8% during CCRT.
Conclusion: Dose-dense weekly NACT with paclitaxel and carboplatin followed by CRT achieved a good response rate. It is feasible with acceptable toxicity of NACT and high compliance to radiotherapy.

Treatment for most endometrial cancer patients tends to be surgical. The treatment of choice for complete hysterectomy and bilateral salpingooophorectomy with or without lymphadenectomy has been an open abdominal approach. The application of pelvic lymphadenectomy in patients with early endometrial cancer is useful because it has a diagnostic role and a therapeutic role, prevents metastasis. It could be concluded that: endometrial cancer surgery can be conducted using an open procedure with high effectiveness in terms of nodal excision and complication rate and increased operational and postoperative enforcement.

Staging endometrial carcinoma to include pelvic lymphadenectomy in the recognition that lymph node status is one of the patients' most important prognostic factors. This led to widespread variations. Pelvic lymphadenectomy allows for accurate prognosis based on a pathological examination of the lymph node. It is an important marker of tumor aggressiveness Lymphadenectomy distinguishes patients with advanced disease and helps tailor adjuvant therapy for those with adverse risk factors. Thus, it can be concluded that: 1-Pelvic lymphadenectomy has a diagnostic role in the management of adjuvant therapy. Pelvic lymphadenectomy may have a therapeutic benefit, but more studies are needed to confirm this role.