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Ciurea S.O.,Hospital Israelita Albert Einstein | Saliba R.M.,Hospital Israelita Albert Einstein | Hamerschlak N.,Hospital Israelita Albert Einstein | Karduss Aurueta A.J.,Institute Cancerologia Las Americas | And 17 more authors.
Leukemia and Lymphoma | Year: 2012

Unrelated cord blood transplant (CBT) is an alternative treatment option for patients who lack a matched donor. However, the optimal type and intensity of the preparative regimen remains unclear. We evaluated the toxicity and outcomes of a conditioning regimen consisting of melphalan 140 mg/m 2 (day - 8), thiotepa 10 mg/kg (day - 7), fludarabine 160 mg/m 2 over 4 days (days - 6 to - 3) and rabbit antithymocyte globulin (ATG) 1.25 mg/kg (day - 4) and 1.75 mg/kg (day - 3) (FMT). Forty-seven patients with advanced hematologic malignancies with a median age of 23 years (30 adults and 17 children) were treated. Sixty percent of patients were in remission at transplant. Ninety-one percent of the patients engrafted neutrophils after a median of 22 days, and all but one of the patients achieving donor engraftment had hematopoietic recovery with 100% cord blood-derived cells. Grade 3 gastrointestinal toxicity was the major non-hematopoietic toxicity, occurring in 32% of patients. Cumulative incidence of day-100 grade IIIV acute graft-versus-host disease (aGVHD) and chronic graft-versus-host disease (cGVHD) was 53% and 34%, respectively, and non-relapse mortality at day 100 and 2 years was 11% and 40%. Two-year disease-free and overall survival rates were 31% and 44%, respectively. These results suggest that FMT is a feasible conditioning regimen for patients undergoing CBT. © 2012 Informa UK, Ltd. Source

Pareja R.,Institute Cancerologia Las Americas | Rendon G.J.,Institute Cancerologia Las Americas | Sanz-Lomana C.M.,Hospital Quiron | Monzon O.,Hospital San Jose | Ramirez P.T.,University of Houston
Gynecologic Oncology | Year: 2013

Objective. Radical trachelectomy is a standard treatment for selected patients with early-stage cervical cancer. Outcomes arewell established for vaginal radical trachelectomy (VRT), but not for abdominal radical trachelectomy (ART). Methods. We searchedMEDLINE, EMBASE, and CINAHL (October 1997 through October 2012) using the terms: uterine cervix neoplasms, cervical cancer, abdominal radical trachelectomy, vaginal radical trachelectomy, fertility sparing, and fertility preservation.We included original articles, case series, and case reports. Excluded were review articles, articles with duplicate patient information, and articles not in English. Results. We identified 485 patients. Ages ranged from 6 to 44 years. Themost common stage was IB1 (331/464; 71%), and the most common histologic subtype was squamous cell carcinoma (330/470; 70%). Operative times ranged from 110 to 586 min. Blood loss ranged from 50 to 5568 mL. Three intraoperative complications were reported. Forty-seven patients (10%) had conversion to radical hysterectomy. One hundred fifty-five patients (35%) had a postoperative complication. The most frequent postoperative complication was cervical stenosis (n = 42; 9.5%). The median follow-up time was 31.6 months (range, 1-124). Sixteen patients (3.8%) had disease recurrence. Two patients (0.4%) died of disease. A total of 413 patients (85%) were able tomaintain their fertility. A total of 113 patients (38%) attempted to get pregnant, and 67 of them (59.3%) were able to conceive. Conclusion. ART is a safe treatment option in patients with early-stage cervical cancer interested in preserving fertility. © 2013 Elsevier Inc. All rights reserved. Source

Ramirez P.T.,University of Houston | Pareja R.,Institute Cancerologia Las Americas | Rendon G.J.,Institute Cancerologia Las Americas | Millan C.,Hospital Quiron | And 2 more authors.
Gynecologic Oncology | Year: 2014

The standard treatment for women with early-stage cervical cancer (IA2-IB1) remains radical hysterectomy with pelvic lymphadenectomy. In select patients interested in future fertility, the option of radical trachelectomy with pelvic lymphadenectomy is also considered a viable option. The possibility of less radical surgery may be appropriate not only for patients desiring to preserve fertility but also for all patients with low-risk early-stage cervical cancer. Recently, a number of studies have explored less radical surgical options for early-stage cervical cancer, including simple hysterectomy, simple trachelectomy, and cervical conization with or without sentinel lymph node biopsy and pelvic lymph node dissection. Such options may be available for patients with low-risk early-stage cervical cancer. Criteria that define this low-risk group include: squamous carcinoma, adenocarcinoma, or adenosquamous carcinoma, tumor size < 2 cm, stromal invasion < 10 mm, and no lymph-vascular space invasion. In this report, we provide a review of the existing literature on the conservative management of cervical cancer and describe ongoing multi-institutional trials evaluating the role of conservative surgery in selected patients with early-stage cervical cancer. © 2013 Elsevier Inc. Source

Chuang L.T.,Mount Sinai School of Medicine | Randall T.C.,Harvard University | Denny L.,University of Cape Town | Johnston C.M.,University of Michigan | And 20 more authors.
International Journal of Gynecological Cancer | Year: 2016

Objectives To identify common barriers to teaching and training and to identify strategies that would be useful in developing future training programs in gynecologic oncology in low-and middle-income countries. Methods There is a lack of overall strategy to meet the needs of education and training in gynecologic oncology in low-and middle-income countries, the leaderships of sister societies and global health volunteers met at the European Society of Gynecologic Oncology in October 23, 2015. The challenges of the training programs supported by gynecologic oncology societies, major universities and individual efforts were presented and discussed. Strategies to improve education and training were identified. Results Major challenges include language barriers, limited surgical equipment, inadequate internet access, lack of local support for sustainability in training programs, inadequate pathology and radiation oncology, finance and a global deficiency in identifying sites and personnel in partnering or developing training programs. The leaderships identified various key components including consultation with the local Ministry of Health, local educational institutions; inclusion of the program into existing local programs, a needs assessment, and the development of curriculum and regional centers of excellence. Conclusions Proper preparation of training sites and trainers, the development of global curriculum, the establishment of centers of excellence, and the ability to measure outcomes are important to improve education and training in gynecologic oncology in low-and middle-income countries. Copyright © 2016 by IGCS and ESGO. Source

Pareja R.,Institute Cancerologia Las Americas | Rendon G.J.,Institute Cancerologia Las Americas | Vasquez M.,Hospital Universitario San Vicente Of Paul | Echeverri L.,Institute Cancerologia Las Americas | And 3 more authors.
Gynecologic Oncology | Year: 2015

Radical trachelectomy is the treatment of choice in women with early-stage cervical cancer wishing to preserve fertility. Radical trachelectomy can be performed with a vaginal, abdominal, or laparoscopic/robotic approach. Vaginal radical trachelectomy (VRT) is generally not offered to patients with tumors 2 cm or larger because of a high recurrence rate. There are no conclusive recommendations regarding the safety of abdominal radical trachelectomy (ART) or laparoscopic radical trachelectomy (LRT) in such patients. Several investigators have used neoadjuvant chemotherapy in patients with tumors 2 to 4 cm to reduce tumor size so that fertility preservation may be offered. However, to our knowledge, no published study has compared outcomes between patients with cervical tumors 2 cm or larger who underwent immediate radical trachelectomy and those who underwent neoadjuvant chemotherapy followed by radical trachelectomy. We conducted a literature review to compare outcomes with these 2 approaches. Our main endpoints for evaluation were oncological and obstetrical outcomes. The fertility preservation rate was 82.7%, 85.1%, 89%; and 91.1% for ART (tumors larger than > 2 cm), ART (all sizes), NACT followed by surgery and VRT (all sizes); respectively. The global pregnancy rate was 16.2%, 24% and 30.7% for ART, VRT, and NACT followed by surgery; respectively. The recurrence rate was 3.8%, 4.2%, 6%, 7.6% and 17% for ART (all sizes), VRT (all sizes), ART (tumors > 2 cm), NACT followed by surgery, and VRT (tumors > 2 cm). These outcomes must be considered when offering a fertility sparing technique to patients with a tumor larger than 2 cm. © 2015 Elsevier Inc. All rights reserved. Source

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