Variation in gynecological oncology follow-up practice: Attributable                     to cancer centers or to patient characteristics? A Piedmont Regional Oncology                     Network Study

Fuso, Luca; Evangelista, Andrea; Pagano, Eva; Piovano, Elisa; Perotto, Stefania; Mazzola, S.; Bertoldo, E.; Porta, Maria Rosa La; Rosmino, C; Furbatto, G; Abate, S; Costanzo, Gianna Di; Trossarelli, Gianfranco; Baù, Maria Grazia; Carnino, F; Gambaro, G.; Piantanida, Paola; Alabiso, Oscar; Galletto, L.; Zavallone, Laura; Rossi, Annalisa; Barbero, Maggiorino; Tessa, M.; Katsaros, Dionyssios; Danese, Saverio; Brignolo, Paola; Gorzegno, G.; Grillo, R.; Apolone, Giovanni; Ciccone, Giovannino; Zola, Paolo

doi:10.1177/030089161109700502

Cited by 10 publications

(4 citation statements)

References 17 publications

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“…The majority of affected individuals are diagnosed early and usually cured with surgery alone or in combination with radiatiotherapy [27]. However, mortality rate of this cancer has experienced a sharper rise than its incidence over the last decades [28][29][30][31]. Despite all the development in therapeutic strategies for this malignancy, end-stage patients face poor prognoses, and the 5-year survival rate is as low as 25-45% [26].…”

Section: Curcumin and Endometrial Cancermentioning

confidence: 99%

Therapeutic role of curcumin and its novel formulations in gynecological cancers

et al. 2020

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Gynecological cancers are among the leading causes of cancer-associated mortality worldwide. While the number of cases are rising, current therapeutic approaches are not efficient enough. There are considerable side-effects as well as treatment resistant types. In addition, which all make the treatment complicated for afflicted cases. Therefore, in order to improve efficacy of the treatment process and patients’ quality of life, searching for novel adjuvant treatments is highly warranted. Curcumin, a promising natural compound, is endowed with numerous therapeutic potentials including significant anticancer effects. Recently, various investigations have demonstrated the anticancer effects of curcumin and its novel analogues on gynecological cancers. Moreover, novel formulations of curcumin have resulted in further propitious effects. This review discusses these studies and highlights the possible underlying mechanisms of the observed effects.

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Section: Curcumin and Endometrial Cancermentioning

confidence: 99%

Therapeutic role of curcumin and its novel formulations in gynecological cancers

et al. 2020

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“…The results of the TOTEM trial did not show any improvement in OS and in early detection of relapses for patients treated for endometrial cancer and followed with a 5-year INT regimen of follow-up, independently from their risk of relapse. More recent guidelines have moved toward less INT follow-up regimens, [3][4][5] but in the early 2000s, recommendations on follow-up in patients with endometrial cancer were contradictory, and the follow-up schemes adopted by the centers were heterogeneous, 13,[23][24][25][26][27] being the existing evidence derived from small retrospective/historical cohort studies. Because the follow-up represents a high time and resource consuming activity 28 and the urgent need for a large and well-designed RCT was highlighted, 29 the TOTEM study was set up in 2008 as a large, pragmatic, randomized trial to test whether a more INT regimen of follow-up could improve the OS in patients treated for endometrial cancer.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] The follow-up requires a considerable investment of clinical resources 6,7 although there is a surprisingly scarcity of evidence supporting the effectiveness of follow-up in either improving survival or quality of life in patients with cancer 8 and low agreement among guidelines. 9 Moreover, adherence to guidelines is low, barely 50%, 10 and intensive (INT) follow-up regimens, with multiple scheduled visits and examinations, are widely adopted 11 at least in Southern Europe, 6,12,13 maybe because of a supposed utility and for medicolegal issues.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Intensive Versus Minimalist Follow-Up Regimen on Survival in Patients With Endometrial Cancer (TOTEM Study): A Randomized, Pragmatic, Parallel Group, Multicenter Trial

Zola

Ciccone

Piovano

et al. 2022

JCO

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PURPOSE In the absence of clear evidence from randomized trials, the intensity of follow-up regimens after surgical treatment of endometrial cancer is highly variable in clinical practice. To reduce this uncertainty, we conducted a randomized trial to test whether an intensive (INT) versus a minimalist (MIN) follow-up regimen improves overall survival (OS) in patients undergoing operation for endometrial cancer. METHODS The TOTEM study was a large, pragmatic randomized trial, conducted in 42 hospitals (in Italy and France) including patients surgically treated for endometrial cancer, in complete clinical remission, International Federation of Gynecology and Obstetrics stage I-IV. After stratification by center and risk of relapse (low or high), patients were randomly assigned (1:1) to INT or MIN hospital-based follow-up regimens. The study was powered to demonstrate an absolute improvement of 5% of the 5-year OS with the INT regimen. RESULTS In total, 1,871 patients were randomly assigned between November 2008 and July 2018, and 1,847 patients (98.7%) were available for the final analysis (60% low risk). After a median follow-up of 69 months, the 5-year OS was 90.6% in the INT and 91.9% in the MIN arms (hazard ratio, 1.13, 95% CI, 0.86 to 1.50, P = .380). No differences in OS were found in subgroup analyses considering age, cancer treatment, risk of relapse, and degree of adherence of the center to the scheduled follow-up. The probability of detecting a relapse was slightly higher in the INT arm (hazard ratio, 1.17; 95% CI, 0.92 to 1.48; P = .194). CONCLUSION An INT follow-up in endometrial cancer–treated patients does not improve OS, even in high-risk patients. According to available evidence, there is no need to routinely add vaginal cytology, laboratory, or imaging investigations to the MIN regimens used in this trial.

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“…This is due to the fact that the majority of endometrial cancer is detected early and often cured with surgery alone or in combination with radiation therapy. However, over the past 15 years the rate of increase in mortality from endometrial cancer has accelerated faster than the incidence of the disease [1–4]. …”

Section: Introductionmentioning

confidence: 99%

Aberrantly activated pSTAT3-Ser727 in human endometrial cancer is suppressed by HO-3867, a novel STAT3 inhibitor

Tierney

McCann

Naidu

et al. 2014

Gynecologic Oncology

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Objective Constitutive activation of STAT3 is a hallmark of various human cancers, although an increased pSTAT3 expression in high grade human endometrial cancer has not been reported. In the present study, we examine the expression of STAT family of proteins in endometrial cancer cell lines and the efficacy of HO-3867, a novel STAT3 inhibitor designed in our lab. Methods Expression of STAT family proteins was evaluated via western blot. The cell viability, post treatment with HO-3867, was assessed using MTT, cell-cycle profile and annexin assay. In vivo efficacy of HO-3867 was evaluated using xeonograft mice. Results Expression of activated STATs was inconsistent among the cell lines and 18 human endometrial cancer specimens tested. While pSTAT3 Tyr705 was not expressed in any of the cell lines, pSTAT3 Ser727 was highly expressed in endometrial cancer cell lines and tumor specimens. HO-3867 decreased the expression of pSTAT3 Ser727 while total STAT3 remained constant; cell viability decreased by 50–80% and induced G2/M arrest in 55% of Ishikawa cells at the G2/M cell cycle checkpoint. There was an increase in p53, a decrease in Bcl2 and Bcl-xL, and cleavage of caspase-3, caspase-7 and PARP. HO-3867 mediated a dosage-dependent inhibition of the growth of xenografted endometrial tumors. Conclusions HO-3867 treatment decreases the high levels of pSTAT3 Ser727 in endometrial cancer cells by inducing cell cycle arrest and apoptosis. This suggests a specific role of serine-phosphorylated STAT3, independent of tyrosine phosphorylation in the oncogenesis of endometrial cancer. HO-3867 could potentially serve as an adjunctive targeted therapy.

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Variation in gynecological oncology follow-up practice: Attributable to cancer centers or to patient characteristics? A Piedmont Regional Oncology Network Study

Cited by 10 publications

References 17 publications

Therapeutic role of curcumin and its novel formulations in gynecological cancers

Therapeutic role of curcumin and its novel formulations in gynecological cancers

Effectiveness of Intensive Versus Minimalist Follow-Up Regimen on Survival in Patients With Endometrial Cancer (TOTEM Study): A Randomized, Pragmatic, Parallel Group, Multicenter Trial

Aberrantly activated pSTAT3-Ser727 in human endometrial cancer is suppressed by HO-3867, a novel STAT3 inhibitor

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