Gynaecological tumours – Related resources

Cochrane reviews

• Addition of cisplatin-based chemotherapy to radiotherapy seems to increase survival and decrease disease progression in the adjuvant treatment of early stage cervical cancer with risk factors for recurrence, although the evidence is insufficient .
• Adding neoadjuvant chemotherapy to surgery may not to improve overall survival in early or locally advanced cervical cancer .
• Groin surgery may be more effective than groin irradiation in the prevention of groin recurrence in early vulvar cancer .
• Neoadjuvant chemoradiotherapy seems to be of some benefit for patients with irresectable vulvar tumour or groin nodes, when followed by excision of at least tumour bed and groin nodes .
• Vaginal hysterectomy appears to have significant benefits over abdominal hysterectomy and should be preferred. Laparoscopic hysterectomy appears to have no benefits over vaginal approach and the operation time is longer. Compared to abdominal hysterectomy, laparoscopic approach has many advantages but again the operation time is longer and there is a greater risk of urinary tract injuries .
• Lymphadenectomy appears not to decrease the risk of death or disease recurrence compared with no lymphadenectomy in women with presumed stage I endometrial cancer .
• More intense regimens of cytotoxic drugs, preferably containing paclitaxel or platinum, give longer progression-free survival than less intensive ones for advanced endometrial adenocarcinoma but at the expense of increased toxicity. For benefits on overall survival or quality of life the evidence is insufficient .
• Interval debulking surgery for advanced epithelial ovarian cancer seem to be effective in cases wherein the primary surgery was not performed by the gynecologic oncologists, but the evidence is insufficient .
• Intraperitoneal chemotherapy in the primary treatment of advanced ovarian cancer improves both overall and disease free survival .
• Uterine artery embolization (UAE) for symptomatic uterine fibroids offers a shorter hospital stay and a quicker return to routine activities as compared to hysterectomy or myomectomy but is associated with more minor complications .
• Total vs. subtotal hysterectomy for benign gynaecological conditions has probably no difference in the rates of incontinence, constipation or measures of sexual function .

Other evidence summaries

• Taxanes appear to be effective in the treatment of advanced breast and ovarian cancer .
• Nafarelin appears to decrease uterine bleeding, improve haematologic parameters and symptoms in patients with leiomyomas .

Literature

• Hennessy BT, Coleman RL, Markman M. Ovarian cancer. Lancet 2009 Oct 17;374(9698):1371-82.
• Stewart EA. Uterine fibroids. Lancet 2001 Jan 27;357(9252):293-8.
• Levy BS. Modern management of uterine fibroids. Acta Obstet Gynecol Scand 2008;87(8):812-23.
• Blair AR, Casas CM. Gynecologic cancers. Prim Care 2009 Mar;36(1):115-30, ix.