Optimal therapy for IB2 and IIA2 cervical cancer: surgery or chemoradiotherapy?

David K.Gaffney 대한부인종양학회 2012 Journal of Gynecologic Oncology Vol.23 No.4

Impact on survival with adjuvant radiotherapy for clear cell, mucinous, and endometriod ovarian cancer: the SEER experience from 2004 to 2011

Sagar C. Patel,Jonathan Frandsen,Sudershan Bhatia,David Gaffney 대한부인종양학회 2016 Journal of Gynecologic Oncology Vol.27 No.5

Objective: Evaluate the impact of radiotherapy on cause specific survival (CSS) and overallsurvival (OS) for stage (I–III) clear cell, mucinous, and endometriod ovarian cancer. Methods: We analyzed incidence, survival, and treatments from the Surveillance,Epidemiology, and End Results (SEER) Program from 2004 to 2011 for clear cell, mucinous,and endometriod histologies of the ovary for stages (I–III). We examined CSS and OS for allthree histologies combined and each histology with relation to the use of adjuvant radiationtherapy (RT). Survival analysis was calculated by Kaplan-Meier and log-rank analysis. Results: CSS was higher in individuals not receiving RT at 5 years (81% vs. 74%) and 10 years(74% vs. 65%, p=0.003). OS was higher in individuals not receiving RT at 5 years (76% vs. 73%) and 10 years (64% vs. 59%, p=0.039). Stage III patients receiving RT had a higher OS at5 years (54% vs. 44%) and 10 year intervals (36% vs. 30%, p=0.037). Stage III patients withmucinous histology receiving RT had a higher OS at 5 years (50% vs. 36%) and 10 years (45%vs. 26%, p=0.052). Conclusion: Those receiving RT had a lower CSS and OS at 5 and 10 years. However, subgroupanalysis revealed a benefit of RT in terms of OS for all stage III patients and for stage IIIpatients with mucinous histology.

Femtosecond X-ray Absorption Spectroscopy at a Hard X-ray Free Electron Laser: Application to Spin Crossover Dynamics

Lemke, Henrik T.,Bressler, Christian,Chen, Lin X.,Fritz, David M.,Gaffney, Kelly J.,Galler, Andreas,Gawelda, Wojciech,Haldrup, Kristoffer,Hartsock, Robert W.,Ihee, Hyotcherl,Kim, Jeongho,Kim, Kyung Hw American Chemical Society 2013 The journal of physical chemistry. A, Molecules, s Vol.117 No.4

<P>X-ray free electron lasers (XFELs) deliver short (<100 fs) and intense (∼10<SUP>12</SUP> photons) pulses of hard X-rays, making them excellent sources for time-resolved studies. Here we show that, despite the inherent instabilities of current (SASE based) XFELs, they can be used for measuring high-quality X-ray absorption data and we report femtosecond time-resolved X-ray absorption near-edge spectroscopy (XANES) measurements of a spin-crossover system, iron(II) tris(2,2′-bipyridine) in water. The data indicate that the low-spin to high-spin transition can be modeled by single-exponential kinetics convoluted with the overall time resolution. The resulting time constant is ∼160 fs.</P><P><B>Graphic Abstract</B> <IMG SRC='http://pubs.acs.org/appl/literatum/publisher/achs/journals/content/jpcafh/2013/jpcafh.2013.117.issue-4/jp312559h/production/images/medium/jp-2012-12559h_0008.gif'></P>

Multidisciplinary perspectives on newly revised 2018 FIGO staging of cancer of the cervix uteri

Jonathan S. Berek,Koji Matsuo,Brendan H. Grubbs,David K. Gaffney,Susanna I. Lee,Aoife Kilcoyne,천기정,유종우,Lu Liu,Yifeng Shao,Tianhui Chen,김미선,Mikio Mikami 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.2

Recent developments in imaging technology, radiotherapeutic approaches, biological target therapy, and increased use of minimally invasive surgery have drastically changed the paradigm for management of women with cervical cancer. Until now, the International Federation of Gynecology and Obstetrics (FIGO) staging system was based primarily on clinical examination with limited additional diagnostic procedures allowed by the FIGO staging system. In 2018, the prior 2014 FIGO staging system was revised to incorporate imaging and pathological findings, when available, into the new staging system (Table 1) [1]. Multidisciplinary perspectives on newly revised 2018 FIGO staging of cancer of the cervix uteri are discussed by gynecologic oncologists, radiation oncologists, radiologists, pathologists, and epidemiologists in this manuscript (Table 2).

FIGO staging of endometrial cancer: 2023

Jonathan S. Berek,Xavier Matias-Guiu,Carien Creutzberg,Christina Fotopoulou,David Gaffney,Sean Kehoe,Kristina Lindemann,David Mutch,Nicole Concin,Endometrial Cancer Staging Subcommittee,FIGO Women's C 대한부인종양학회 2023 Journal of Gynecologic Oncology Vol.34 No.5

Introduction: Many advances in the understanding of the pathologic and molecular features of endometrial cancer have occurred since the FIGO staging was last updated in 2009. Substantially more outcome and biological behavior data are now available regarding the several histological types. Molecular and genetic findings have accelerated since the publication of The Cancer Genome Atlas (TCGA) data and provide improved clarity on the diverse biological nature of this collection of endometrial cancers and their differing prognostic outcomes. The goals of the new staging system are to better define these prognostic groups and create substages that indicate more appropriate surgical, radiation, and systemic therapies. Methods: The FIGO Women's Cancer Committee appointed a Subcommittee on Endometrial Cancer Staging in October 2021, represented by the authors. Since then, the committee members have met frequently and reviewed new and established evidence on the treatment, prognosis, and survival of endometrial cancer. Based on these data, opportunities for improvements in the categorization and stratification of these factors were identified in each of the four stages. Data and analyses from the molecular and histological classifications performed and published in the recently developed ESGO/ESTRO/ESP guidelines were used as a template for adding the new subclassifications to the proposed molecular and histological staging system. Results: Based on the existing evidence, the substages were defined as follows: S tage I (IA1): non-aggressive histological type of endometrial carcinoma limited to a polyp or confined to the endometrium; (IA2) non-aggressive histological types of endometrium involving less than 50% of the myometrium with no or focal lymphovascular space invasion (LVSI) as defined by WHO criteria; (IA3) low-grade endometrioid carcinomas limited to the uterus with simultaneous low-grade endometrioid ovarian involvement; (IB) non-aggressive histological types involving 50% or more of the myometrium with no LVSI or focal LVSI; (IC) aggressive histological types, i.e. serous, high-grade endometrioid, clear cell, carcinosarcomas, undifferentiated, mixed, and other unusual types without any myometrial invasion. S tage II (IIA): non-aggressive histological types that infiltrate the cervical stroma; (IIB) non-aggressive histological types that have substantial LVSI; or (IIC) aggressive histological types with any myometrial invasion. S tage III (IIIA): differentiating between adnexal versus uterine serosa infiltration; (IIIB) infiltration of vagina/parametria and pelvic peritoneal metastasis; and (IIIC) refinements for lymph node metastasis to pelvic and para-aortic lymph nodes, including micrometastasis and macrometastasis. S tage IV (IVA): locally advanced disease infiltrating the bladder or rectal mucosa; (IVB) extrapelvic peritoneal metastasis; and (IVC) distant metastasis. The performance of complete molecular classification (POLEmut, MMRd, NSMP, p53abn) is encouraged in all endometrial cancers. If the molecular subtype is known, this is recorded in the FIGO stage by the addition of “m” for molecular classification, and a subscript indicating the specific molecular subtype. When molecular classification reveals p53abn or POLEmut status in Stages I and II, this results in upstaging or downstaging of the disease (IICmp53abn or IAmPOLEmut). Summary: The updated 2023 staging of endometrial cancer includes the various histological types, tumor patterns, and molecular classification to better reflect the improved understanding of the complex nature of the several types of endometrial carcinoma and their underlying biologic behavior. The changes incorporated in the 2023 staging system should provide a more evidence-based context for treatment recommendations and for the more refined future collection of outcome and survival data.

Survival analysis of endometrial cancer patients with cervical stromal involvement

Jonathan E. Frandsen,William T. Sause,Mark K. Dodson,Andrew P. Soisson,Thomas W. Belnap,David K. Gaffney 대한부인종양학회 2014 Journal of Gynecologic Oncology Vol.25 No.2

Objective: Stage II endometrial cancer is relatively uncommon. There is no consensus for appropriate adjuvant therapy in endometrial cancer patients with cervical stromal involvement (International Federation of Gynecology and Obstetrics [FIGO] stage II). This study investigates how adjuvant treatments and tumor characteristics influence overall survival (OS) and disease-free survival (DFS) in stage II patients in order to establish better treatment guidelines. Methods: This multi-institution, Institutional Review Board approved, study is a retrospective review of 40 endometrial cancer patients with cervical stromal involvement treated from 1993 to 2009. Kaplan-Meier estimates were used to evaluate OS and DFS. Results: OS was 85% at three years and 67% at five years. There were no significant differences in age, histology, depth of invasion, comorbid conditions, surgical staging or recurrence between patients who received radiation therapy (RT) and those who did not. However, patients with FIGO grade 1 cancers were less likely to receive RT (p=0.007). Patients treated with RT had a similar 5 year OS (n=33, 69%) to those treated with surgery only (n=7, 60%, p=0.746). There were no OS differences when evaluating by grade, histology, or depth of invasion between patients who did and did not receive RT. Four patients recurred: three were locoregional failures only, and one failed locally and distant. Conclusion: Patients receiving RT had higher grade tumors. Despite this, OS was comparable between the RT and the no RT cohorts. Local failure was the predominant pattern of failure. Endometrial cancer patients with cervical stromal involvement likely receive better locoregional control with the addition of adjuvant RT and we continue to advocate for RT in most cases.