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Japanese Journal of Clinical Oncology Advance Access





Published: Wed, 17 Jan 2018 00:00:00 GMT

Last Build Date: Wed, 17 Jan 2018 01:44:59 GMT

 



Maintenance hormonal therapy after treatment with medroxyprogesterone acetate for patients with atypical polypoid adenomyoma

Wed, 17 Jan 2018 00:00:00 GMT

Abstract
Background
As atypical polypoid adenomyoma (APA) has been reported to be a hormone-related tumor, we aimed to analyze the efficacy and safety of maintenance hormonal therapy after fertility-preserving treatment of these patients with medroxyprogesterone acetate (MPA).
Methods
Data were retrospectively analyzed from patients with APA who were treated with a fertility-preserving regimen including MPA between October 2001 and December 2011. Eighteen patients were treated with MPA and 14 (77.8%) achieved either a complete or a partial response after the planned treatment. Five patients took progestin for maintenance therapy.
Results
Eighteen patients were treated for a mean observation period of 96.7 months. While taking the maintenance therapy, no patient had APA relapse. One patient developed well-differentiated endometrioid adenocarcinoma 18 months after she stopped taking maintenance progestin. Eleven patients without maintenance therapy underwent hysterectomy, andnine of them developed well-differentiated endometrial cancer. Through univariate analysis, there was a significant difference in time to hysterectomy between patients with and without maintenance therapy (P = 0.015). Through multivariate analysis, body mass index (BMI), menstrual status before protocol therapy, maintenance treatment, and pregnancy were found to be significantly associated with a lower risk of hysterectomy. No patient had a recurrence of APA after hysterectomy during the observation period (median, 54 months; range, 2–148 months).
Conclusion
No patient showed progression while receiving hormonal therapy, including initial protocol therapy. Maintenance hormonal therapy after treatment with MPA was highly effective and safe, particularly in patients with BMI ≧24 kg/m2 and irregular menstruation cycle.









How to treat borderline resectable pancreatic cancer: current challenges and future directions

Thu, 11 Jan 2018 00:00:00 GMT

Abstract
Borderline resectable pancreatic cancer (BRPC) is an advanced tumor in contact with the surrounding major vessels, making R0 resection difficult to achieve. Neoadjuvant treatment is expected to provide substantial local control and prolong survival. However, there is no standard treatment. I therefore conducted a strategic literature search from January 2013 to September 2017 and identified 37 clinical studies of pancreatic cancer, including BRPC, to evaluate treatment interventions. Twenty (54%) studies were prospective. Neoadjuvant regimens were as follows: chemotherapy (CT) followed by chemoradiotherapy (CRT) or radiotherapy (RT) (n = 16, 43%), CT alone (n = 11, 30%), CRT alone (n = 9, 24%) and RT alone (n = 1, 3%). Radiotherapy was employed in 70% of the studies. Phase II studies were most frequent (55%), and we were unable to identify a Phase III study. The National Comprehensive Cancer Network’s classifications were most frequently used as criteria for BRPC, although resectability status is not standardized. Radiological central review was used in three of eight multi-institutional studies. Assessing on-going or planned clinical trials for BRPC, administration of oxaliplatin, irinotecan, fluorouracil and leucovorin therapy or albumin-bound paclitaxel plus gemcitabine therapy, and randomized trials that evaluate the significance of CRT or RT combined with CT were identified as important topics for further consideration. Although standardization of classifications and improvement of infrastructure are required, a standard treatment of BRPC will likely be developed, which will improve prognosis in the near future because several important randomized trials are running.