- MeSH
- hysterektomie MeSH
- laparoskopie * MeSH
- lékařská onkologie MeSH
- lidé MeSH
- nádory děložního čípku * MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- dopisy MeSH
- komentáře MeSH
OBJECTIVES: The surgical management of advanced ovarian cancer involves complex surgery. Implementation of a quality management program has a major impact on survival. The goal of this work was to develop a list of quality indicators (QIs) for advanced ovarian cancer surgery that can be used to audit and improve the clinical practice. This task has been carried out under the auspices of the European Society of Gynaecologic Oncology (ESGO). METHODS: Quality indicators were based on scientific evidence and/or expert consensus. A 4-step evaluation process included a systematic literature search for the identification of potential QIs and the documentation of scientific evidence, physical meetings of an ad hoc multidisciplinarity International Development Group, an internal validation of the targets and scoring system, and an external review process involving physicians and patients. RESULTS: Ten structural, process, or outcome indicators were selected. Quality indicators 1 to 3 are related to achievement of complete cytoreduction, caseload in the center, training, and experience of the surgeon. Quality indicators 4 to 6 are related to the overall management, including active participation to clinical research, decision-making process within a structured multidisciplinary team, and preoperative workup. Quality indicator 7 addresses the high value of adequate perioperative management. Quality indicators 8 to 10 highlight the need of recording pertinent information relevant to improvement of quality. An ESGO-approved template for the operative report has been designed. Quality indicators were described using a structured format specifying what the indicator is measuring, measurability specifications, and targets. Each QI was associated with a score, and an assessment form was built. CONCLUSIONS: The ESGO quality criteria can be used for self-assessment, for institutional or governmental quality assurance programs, and for the certification of centers. Quality indicators and corresponding targets give practitioners and health administrators a quantitative basis for improving care and organizational processes in the surgical management of advanced ovarian cancer.
Endometrial cancer is the most common gynaecological malignancy for which platinum-based and anthracycline-based combinations, with/without taxanes, are the most active but toxic treatments. The preliminary results achieved with two molecule-targeted agents suggest that a better knowledge in molecular biology of this neoplasm might improve the clinical outcome. RECENT FINDINGS: Two major types (type I and type II) of endometrial cancer are known with specific features and different changes in the genetic setting. Mutation of phosphatase and tensin homologue deleted on chromosome 10, leading to hyperactivation of the mammalian target of rapamycin pathway, is a common alteration in type I, whereas human epidermal growth factor receptor 2/neu overexpression, with increased tumour proliferation, is frequent in type II.These alterations provide the rationale for molecule-targeted treatments. Phase II studies have been performed with the three major rapamycin analogue mammalian target of rapamycin inhibitors in recurrent or advanced endometrial cancer with promising results. Hyperexpression of human epidermal growth factor receptor 2/neu in endometrial cancer justifies clinical evaluation of trastuzumab, the humanized antihuman epidermal growth factor receptor 2/neu monoclonal antibody. SUMMARY: As with other targeted therapies, antitumour activity as single agent is limited but there is clear pharmacological indication for the evaluation of combination regimens, based on preclinical and clinical data. The identification of biomarkers of biological effects might help in the selection of potential responders.
