Background: Ovarian, fallopian tube, and primary peritoneal cancers often share clinical characteristics and are typically diagnosed at advanced stages due to nonspecific symptoms. The utility of tumor markers, particularly CA125 and HE4, in the diagnosis and follow-up of these cancers remains an area of active investigation. Objectives: The CEEGOG (Central and Eastern European Gynecologic Oncology Group) OX-01 study aimed to evaluate HE4's role alongside CA125 in follow-up for advanced-stage ovarian, fallopian tube, and primary peritoneal cancers. It assessed the potential for detecting recurrence using marker elevation and imaging methods, examining the necessity of dynamic monitoring and current cut-off values' accuracy for early relapse detection. Methods: In this multicenter prospective cohort study, 117 eligible patients with Stage III-IV cancers were included. Patients had elevated CA125 or HE4 at diagnosis and achieved complete remission after first-line treatment. HE4 and CA125 levels were monitored every 3-4 months in the first two years and every six months thereafter. CT scans were performed if markers exceeded set thresholds or increased by over 20%. Results: During a median follow-up of 13.7 months, 73% of patients relapsed. Median HE4 levels were significantly higher in relapsed patients. A 10 IU/mL increase from baseline in CA125 had a sensitivity of 83% and specificity of 93%, while a 15 pmol/L increase in HE4 had a sensitivity of 74% and specificity of 92% for predicting relapse up to three months before CT scan detection. Conclusions: The study found that dynamic changes in HE4 and CA125 levels, rather than predefined cut-off values, are crucial for early relapse detection. These markers may offer a significant lead time over imaging, potentially enabling earlier intervention. Further research is needed to validate these findings.
- Publication type
- Journal Article MeSH
Cíl: Ucelený přehled operační léčby karcinomu vulvy vč. recidivujících forem. Metodika: Přehledová práce podávající základní přehled o patogenezi, diagnostice a operační léčbě karcinomu vulvy se zaměřením na možnosti terapie jeho recidiv. Součástí je ilustrativní kazuistika prezentující pacientku s invazivním spinocelulárním karcinomem vulvy s iterativními lokálními recidivami a následným rozvojem nádorové triplicity a vzdáleného metastatického postižení. Závěr: Operační léčba zůstává hlavní modalitou terapie karcinomu vulvy, a to i v případě lokálně pokročilých či recidivujících nálezů. V těchto případech je nezbytností multidisciplinární spolupráce operačních oborů. Důležitou úlohu při včasném odhalování recidiv má disciplinovanost odléčených pacientek s participací na pravidelné dispenzární péči. Případnou alternativou k operačnímu řešení zůstává (chemo) radioterapie, v klinické praxi má pak radioterapie nezastupitelné místo v adjuvantní terapii. Regionální a vzdálené recidivy se vyznačují špatnou prognózou.
Objective: A comprehensive overview of the surgical treatment of vulvar cancer, including recurrent forms. Methodology: A review work providing a basic overview of the pathogenesis, diagnosis and surgical treatment of vulvar cancer with a focus on the possibilities of treatment of its recurrences. It includes an illustrative case report presenting a patient with invasive squamous cell carcinoma of the vulva with iterative local recurrences and subsequent development of tumor triplicity and distant metastatic involvement. Conclusion: Surgical treatment remains the main modality of vulvar cancer therapy, even in the case of locally advanced or recurrent findings. In these cases, multidisciplinary cooperation of operational fields is necessary. The discipline of treated patients with participation in regular dispensary care plays an important role in the early detection of recurrences. (Chemo) radiotherapy remains a possible alternative to the surgical solution; in clinical practice, radiotherapy has an irreplaceable place in adjuvant therapy. Regional and distant recurrences are characterized by a poor prognosis.
- MeSH
- Gynecologic Surgical Procedures methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Neoplasm Metastasis MeSH
- Vulvar Neoplasms * surgery MeSH
- Recurrence MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- Review MeSH
