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McCluggage W.G.,Royal Group of Hospitals Trust | Hirschowitz L.,Birmingham Womens Hospital | Ganesan R.,Birmingham Womens Hospital | Kehoe S.,John Radcliffe Hospital | Nordin A.,East Kent Gynaecological Oncology Center
Journal of Clinical Pathology | Year: 2010

Aims: There are two commonly used staging systems for gynaecological cancers, namely Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) and TNM. The authors wished to ascertain which staging system is most commonly used in dealing with gynaecological cancers in the UK. Methods: The authors undertook a survey among participants in the National Gynaecological Pathology EQA scheme to investigate whether gynaecological pathologists in the UK use FIGO or TNM staging in their routine reporting of gynaecological cancers. Results: There were 105 respondents out of 278 participants (38%). Of the analysed results, a majority of respondents (64%) use FIGO staging, while 32% use both FIGO and TNM. 80% of respondents stated that their multidisciplinary team meeting uses FIGO staging, while 18% use both FIGO and TNM. Only an extremely small minority of pathologists and multidisciplinary team meetings use TNM alone. A survey of members of the British Gynaecological Cancer Society revealed similar findings. Conclusions: Since FIGO and TNM are not always equivalent, and there may be confusion when more than one staging system is used, it is recommended that FIGO staging be used for gynaecological cancers. The survey revealed support for the use of TNM, as well as FIGO, only for cervical cancer, since FIGO does not take the lymph node status into account. Given the prevalent practice in the UK, the British Association of Gynaecological Pathologists, British Gynaecological Cancer Society and gynaecological clinical reference group of the National Cancer Intelligence Network recommend that FIGO staging be used for gynaecological cancers with recording of the lymph node status for cervical cancer. This may be done by providing a TNM stage for this cancer type only or by recording the lymph-node status at the multidisciplinary team meeting.

Francis M.,Public Health England | Dennis N.L.,Public Health England | Hirschowitz L.,Birmingham Womens NHS Foundation Trust | Grimer R.,Royal Orthopaedic Hospital NHS Foundation Trust | And 3 more authors.
International Journal of Gynecological Cancer | Year: 2015

Objective Gynecologic sarcomas account for approximately 3% to 4% of all gynecologic malignancies and are associated with poor outcomes compared with gynecologic carcinomas. The aim of this study is to report the incidence and survival rates of the main gynecologic sarcomas using national English cancer registration data. Methods/Materials Records of gynecologic sarcomas diagnosed between 1985 and 2008 were extracted from the English National Cancer Data Repository. ICD-O3 morphology codes were used to assign tumor records to specific histologic subgroups. Incidence and 5-year relative survival rates were calculated. Results There were 5316 new cases of gynecologic sarcoma diagnosed in England between 1985 and 2008. Incidence rates increased significantly in the early 1990s, probably due to coding changes. Age-specific incidence rates were highest in women aged between 45 and 64 years. In the most recent period studied (2001-2008), incidence rates fluctuated between 8 and 9.6 per million. The most common anatomical site was the uterus (83% of all diagnoses), and the most common histologic diagnosis was leiomyosarcoma (52% of all diagnoses). Overall 5-year relative survival increased significantly between 1985-1989 and 2000-2004, from 34% to 48%. Conclusions Gynecologic sarcoma incidence rates have varied little since 1993, whereas survival has improved significantly. These results are consistent with previously published small series and case studies, and provide a more complete picture of gynecologic sarcoma incidence and survival patterns in England. © 2015 by IGCS and ESGO.

Chakrabarti M.,Apollo Gleneagles Cancer Hospital | Nordin A.,East Kent Gynaecological Oncology Center
Cochrane Database of Systematic Reviews | Year: 2016

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the value and safety of primary hysterectomy (simple or radical) before commencement of chemotherapy, radiotherapy or chemoradiotherapy for stage IB2/II cervical cancer. © 2016 The Cochrane Collaboration.

Greimel E.,Medical University of Graz | Nordin A.,East Kent Gynaecological Oncology Center | Lanceley A.,University College London | Creutzberg C.L.,Leiden University | And 15 more authors.
European Journal of Cancer | Year: 2011

Aim: A validation study was conducted to evaluate the psychometric properties of the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Endometrial Cancer Module (EORTC QLQ-EN24). This module was designed to assess disease and treatment specific aspects of the quality of life (QoL) of patients with endometrial cancer. Methods: Two hundred and sixty-eight women with endometrial cancer were recruited in different phases of treatment: after pelvic surgery (Group 1); during adjuvant chemotherapy and/or radiotherapy (Group 2); after completion of treatment (Group 3). Patients completed the EORTC QLQ-C30, the endometrial cancer module and a short debriefing questionnaire. Results: Multi-trait scaling analyses confirmed the hypothesised scale structure of the QLQ-EN24. Internal consistency reliability was good with Cronbach's alpha coefficients ranging from 0.74 to 0.86 (lymphoedema 0.80, urological symptoms 0.75, gastrointestinal symptoms 0.74, body image problems 0.86 and sexual/vaginal problems 0.86). Convergent and discriminant validity did not show any scaling errors for the subscales. The QLQ-EN24 module discriminated well between clinically different groups of patients. All items exhibited a high completion rate with less than 2% missing values except for the sexuality items (19%). Conclusion: The validation study supports the reliability, the convergent and divergent validity of the EORTC QLQ-EN24. This newly developed QLQ-EN24 module is a useful instrument for the assessment of the QoL in patients treated for endometrial cancer in clinical trials. © 2010 Elsevier Ltd. All rights reserved.

Tristram A.,University of Cardiff | Hurt C.N.,University of Cardiff | Madden T.,University of Cardiff | Powell N.,University of Cardiff | And 9 more authors.
The Lancet Oncology | Year: 2014

Background: Vulval intraepithelial neoplasia is a skin disorder affecting the vulva that, if left untreated, can become cancerous. Currently, the standard treatment for patients with vulval intraepithelial neoplasia is surgery, but this approach does not guarantee cure and can be disfiguring, causing physical and psychological problems, particularly in women of reproductive age. We aimed to assess the activity, safety, and feasibility of two topical treatments-cidofovir and imiquimod-as an alternative to surgery in female patients with vulval intraepithelial neoplasia. Methods: We recruited female patients (age 16 years or older) from 32 centres to an open-label, randomised, phase 2 trial. Eligibility criteria were biopsy-proven vulval intraepithelial neoplasia grade 3 and at least one lesion that could be measured accurately. We randomly allocated patients to topical treatment with either 1% cidofovir (supplied as a gel in a 10 g tube, to last 6 weeks) or 5% imiquimod (one 250 mg sachet for every application), to be self-applied three times a week for a maximum of 24 weeks. Randomisation (1:1) was done by stratified minimisation via a central computerised system, with stratification by hospital, disease focality, and presentation stage. The primary endpoint was a histologically confirmed complete response at the post-treatment assessment visit 6 weeks after the end of treatment (a maximum of 30 weeks after treatment started). Analysis of the primary endpoint was by intention to treat. Secondary outcomes were toxic effects (to assess safety) and adherence to treatment (to assess feasibility). We present results after all patients had reached the primary endpoint assessment point at 6 weeks; 2-year follow-up of complete responders continues. This trial is registered with Current Controlled Trials, ISRCTN 34420460. Findings: Between Oct 21, 2009, and Jan 11, 2013, 180 participants were enrolled to the study; 89 patients were randomly allocated cidofovir and 91 were assigned imiquimod. At the post-treatment assessment visit, a complete response had been achieved by 41 (46%; 90% CI 37.0-55.3) patients allocated cidofovir and by 42 (46%; 37.2-55.3) patients assigned imiquimod. After 6 weeks of treatment, 156 (87%) patients (78 in each group) had adhered to the treatment regimen. Five patients in the cidofovir group and seven in the imiquimod group either withdrew or were lost to follow-up before the first 6-week safety assessment. Adverse events of grade 3 or higher were reported in 31 (37%) of 84 patients allocated cidofovir and 39 (46%) of 84 patients assigned imiquimod; the most frequent grade 3 and 4 events were pain in the vulva, pruritus, fatigue, and headache. Interpretation: Cidofovir and imiquimod were active, safe, and feasible for treatment of vulval intraepithelial neoplasia and warrant further investigation in a phase 3 setting. Both drugs are effective alternatives to surgery for female patients with vulval intraepithelial neoplasia after exclusion of occult invasive disease. Funding: Cancer Research UK. © 2014 Tristram et al. Open Access article distributed under the terms of CC BY.

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