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This is a retrospective study of patients treated for early-stage cervical cancer to identify pathologic risk factors associated with ovarian metastases and, therefore, to establish when ovarian preservation can be performed without increasing the risk of relapse in order to improve the quality of life in premenopausal patients. Between 1982 and 2004, 1965 patients with FIGO stage IA2–IB–IIA cervical squamous cell carcinoma and nonsquamous histology types were surgically treated; 1695 (86%) patients underwent primary radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic node dissection, the remaining 270 patients (14%) had their ovaries preserved. The clinical records were reviewed for all patients and clinical features at presentation, the histopathology and follow-up data were recorded. Overall, ovarian metastases were diagnosed in 16 of 1695 patients, for an incidence rate of 0.9%. Univariate analysis shows age (≤45 vs >45 years: P= 0.0079), FIGO stage (IB1–IIA ≤4 cm vs IB2–IIA >4 cm: P= 0.0133), histology (squamous vs nonsquamous, P= 0.0014), noninvolved peripheral stromal thickness (<3 vs >3 mm: P= 0.0001), lymphvascular space involvement (present vs absent, P= 0.0007), lymph node status (positive vs negative, P= 0.00009) to be statistically associated with the presence of ovarian metastases. Multivariate analysis shows only age (P= 0.0119), FIGO stage (P= 0.011), histology (P= 0.001), and unaffected peripheral stromal thickness (<3 mm: P= 0.037) to be independent risk factors for ovarian metastases. Based on the present data and on the data available in the literature, ovarian preservation could be safely performed in young patients with early-stage squamous cell carcinoma (histology as the most significant risk factor), with macroscopically normal ovaries, and with preserved peripheral unaffected cervical stroma.

The aim of this study was to verify the impact of primary surgical approach and adjuvant radiation therapy (RT) on survival, recurrence rate, and pattern of relapse in stage II endometrial cancer patients. Two hundred three subjects were retrospectively reviewed; 135 (66%) underwent simple hysterectomy (SH) and 68 (34%) radical hysterectomy (RH). Sixty-six of 111 (59%) of stage IIA and 67 of 92 (73%) of stage IIB patients underwent adjuvant radiation therapy. Actuarial survival rates for stage IIA and IIB were 86% and 74% at 5 years and 82% and 68% at 10 years, respectively. Survival rates by surgical procedure were 79% in the SH group and 94% in the RH group at 5 years and 74% and 94% at 10 years, respectively (P < 0.05). The overall recurrence rate was 13.8% (28/203); by adjuvant treatment it was 18.6% (13/70) in the observation group and 11.3% (15/133) in the RT group. Most of the relapses were locoregional in the observation group and distant in the RT group. Survival rates by RT were not statistically different. Subjects treated with RH improved their survival compared with the SH group; the difference was significant, but randomized studies should confirm this trend. Although adjuvant RT seemed to reduce the recurrence rate, there was no significant difference in survival, and so the role of RT still needs further verification.

Research on young individuals and childbearingadults being treated for neoplasia has revealed a rising number of requests for treatmentsaimed to maintain the possibility to conceive. To answer such requests, it isimportant for medical professionals to consider the necessity to cure thewoman, to preserve her fertility, to give information both on the effect ofneoplasia and treatments on pregnancy. Patients have to be informedon the possible treatment alternatives that are less aggressive towards thereproductive function, but at the same time, give desirable results in terms ofsurvival. Neoplasiaand Fertility describes the state-of-the-arton fertility preservation in women affected by neoplasia. The 11 book chapters informthe reader with the goal of equipping them with the required information needed to present the condition and to discuss the possibility of conceiving, andhow to manage patients after oncologic treatments at different stages of pregnancy. KeyFeatures- Informs the reader about therelationship between gynecological cancer and fertility in women through 11chapters- Describes a broad range of cancers andrelevant treatment options for maintaining fertility- Explains the role of a 'FertilitySparing Team' in clinics- Familiarizes the reader with theethics behind oncology treatments with reference to female fertility- Describes fertility issues related to hereditarycancers in women- Includes references for furtherreading The book serves as an informativereference on the subject to medical doctors in the gynecology, obstetrics and midwifespecialties, and nurses training the gynecological oncology. It will also be ofinterest to healthcare administrators involved in fertility and oncologyclinics, as well as general practitioners in family medicine.

. Sartori E, Gadducci A, Landoni F, Lissoni A, Maggino T, Zola P, Zanagnolo V. Clinical behavior of 203 stage II endometrial cancer cases: The impact of primary surgical approach and of adjuvant radiation therapy. The aim of this study was to verify the impact of primary surgical approach and adjuvant radiation therapy (RT) on survival, recurrence rate, and pattern of relapse in stage II endometrial cancer patients. Two hundred three subjects were retrospectively reviewed; 135 (66%) underwent simple hysterectomy (SH) and 68 (34%) radical hysterectomy (RH). Sixty‐six of 111 (59%) of stage IIA and 67 of 92 (73%) of stage IIB patients underwent adjuvant radiation therapy. Actuarial survival rates for stage IIA and IIB were 86% and 74% at 5 years and 82% and 68% at 10 years, respectively. Survival rates by surgical procedure were 79% in the SH group and 94% in the RH group at 5 years and 74% and 94% at 10 years, respectively (P < 0.05). The overall recurrence rate was 13.8% (28/203); by adjuvant treatment it was 18.6% (13/70) in the observation group and 11.3% (15/133) in the RT group. Most of the relapses were locoregional in the observation group and distant in the RT group. Survival rates by RT were not statistically different. Subjects treated with RH improved their survival compared with the SH group; the difference was significant, but randomized studies should confirm this trend. Although adjuvant RT seemed to reduce the recurrence rate, there was no significant difference in survival, and so the role of RT still needs further verification.

The purpose of this study was to identify patterns of relapse and to determine the outcome of salvage treatment and the factors influencing survival of endometrial cancer relapsing patients. One thousand six hundred and six endometrial cancer (stages I to IV) patients treated at five Italian institutions were retrospectively reviewed. Of these, 209 (13%) subjects had recurred; the site of relapse was vagina in 35 cases (16.7%), pelvis in 67 (32.1%), and distant locations in 107 (51.2%). Most of the patients relapsed within 24 months: 45% (94) recurred within 1 year, 20.6% (43) between 1 and 2 years. Adjuvant radiotherapy (RT) seemed to reduce the percentage of pelvic recurrence in high risk early stages (IB-IIA) subjects and a higher proportion of patients failed at a distant site when postoperative external-beam pelvic RT was given. However survival curves were not statistically different in the two groups for stage IB endometrial cancer patients. Five and 10-year survival rates of patients with recurrent disease was 26% and 22%, respectively. Relapse of endometrial cancer is often early and at distant sites. Survival rate was related to site of relapse, disease-free interval, and postoperative treatment as independent prognostic variables. The site of relapse is the most important predictor of survival of patients with recurrent disease.

. The purpose of this study was to identify patterns of relapse and to determine the outcome of salvage treatment and the factors influencing survival of endometrial cancer relapsing patients. One thousand six hundred and six endometrial cancer (stages I to IV) patients treated at five Italian institutions were retrospectively reviewed. Of these, 209 (13%) subjects had recurred; the site of relapse was vagina in 35 cases (16.7%), pelvis in 67 (32.1%), and distant locations in 107 (51.2%). Most of the patients relapsed within 24 months: 45% (94) recurred within 1 year, 20.6% (43) between 1 and 2 years. Adjuvant radiotherapy (RT) seemed to reduce the percentage of pelvic recurrence in high risk early stages (IB‐IIA) subjects and a higher proportion of patients failed at a distant site when postoperative external‐beam pelvic RT was given. However survival curves were not statistically different in the two groups for stage IB endometrial cancer patients. Five and 10‐year survival rates of patients with recurrent disease was 26% and 22%, respectively. Relapse of endometrial cancer is often early and at distant sites. Survival rate was related to site of relapse, disease‐free interval, and postoperative treatment as independent prognostic variables. The site of relapse is the most important predictor of survival of patients with recurrent disease.

Nowadays, the cost for oncology diseases is growing rapidly, in particular as a consequence of the introduction of new drugs and new diagnostic procedures, and becoming a considerable percentage of the global healthcare expense. On the other hand, a substantial amount of that cost is considered to be imputable to the follow-up procedures. The aim of our paper is to introduce the debate about follow-up policies adopted in gynecological oncology throughout a literature review just based on cost-effectiveness and cost-efficacy in order to explore if the data are consistent with evidences available in this field. Furthermore, it is discussed if common practice fits the needs of patients, gynecological oncologists, and health service. Despite the fact that in gynecological oncology we must consider different clinical situations concerning each specific neoplasm with their peculiar natural history, some general considerations could be drawn in order to set up future initiatives properly

From January 1992 to June 2004, 113 patients affected by low malignant ovarian tumor were followed at the Gynecologic Departments of five Italian Institutions. Fifty-two (46.0%) patients have been operated on laparoscopic surgery. In 53 patients (46.9%) a fertility sparing surgical treatment have been chosen. The diameters of the ovarian cysts ranges between 20 to 300 mm. In 22/113 (19.5%) cases we observed tumor rupture or spilling during surgery and this incidence was greater in the group of patients treated by laparoscopy. In 13/113 (11.5%) patients we observed a relapse; the incidence of relapse, however, is not dependent on the type of surgical approach. The progression-free survival is higher for stages IA-IC if compared to stages more than Ist. Type of surgical approach, laparoscopic vs laparotomic, does not seems to influence the PFS; when cystectomy is performed, the PFS is significantly lower if compared with demo- litive surgery or monolateral annessectomy. Seven pregnacies were obtained: in one case miscarriage has been observed, whereas 6 healthy baby born all but one by vaginal delivery. Conservative laparoscopic surgery has to be performed by an oncologist surgeon to obtain better results in term of both relapse-free survival and pregnancies.

Background: Increased interleukin-6 (IL-6) levels and a vaginal pH of >4.7 are associated with obstetric complications such as preterm delivery and low birth weight. Topical treatments, able to maintain a physiological vaginal pH, could help in the prevention of vaginal infections.Study aim: In a randomized, double-blind, placebo-controlled trial, we evaluated the effects of an acidic buffering vaginal gel (Miphil®) on vaginal pH and IL-6 levels in pregnant women.Patients and methods: Seventy low-risk women pregnant with a singleton (second trimester) were enrolled in the trial. Thirty-five were randomized to the acidic gel, 2.5 g every 3 days for 12 weeks, and 35 to the corresponding placebo. Vaginal pH and vaginal IL-6 level were measured at baseline and after 12 weeks. Women were then followed until delivery. The main outcome measures were vaginal pH, vaginal pH normalization (pH<4.5) and vaginal IL-6 levels.Results: Vaginal pH at baseline was 4.6±0.4 and 4.4±0.3 in the acidic gel and the placebo group, respectively. At baseline, a total of 40% (14 35) and 22%(8 35) of women in each group, respectively, had a vaginal pH of . 4.7. At week 12, the vaginal pH was 4.3±0.3 in the acidic gel group and 4.3±0.3 in the placebo group (NS). The acidic gel normalized the vaginal pH in ten out of 14 women (p=0.04) in comparison with only one out of eight women in the placebo group (NS). The acidic gel induced a significant (p<0.02) reduction of vaginal IL-6 from 12.0±7 to 8.9±5 pg l (.36%). In the placebo group, IL-6 increased from 9.0±5 to 13.5±6.8 pg l (+50%) (p=0.05). Birth weight was 2978±700 g in the placebo group and 3241±477 g in the acidic gel group (p=0.06).Conclusions: The use of the acidic gel in low-risk pregnant women is able to maintain a physiological vaginal ecosystem and prevents the increases of vaginal pH and vaginal IL-6. Prospective and controlled trials are warranted to evaluate whether this acidic gel can reduce obstetric complications linked to vaginal inflammation during pregnancy.