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A Ansink

Publications and source records attributed to A Ansink.

11 recordsLinked to original sources
PubMed2006

Neoadjuvant chemoradiation for advanced primary vulvar cancer.

BACKGROUND: In advanced stage primary vulvar cancer, treatment is tailored to individual patient needs. Combined treatment modalities have been developed, using chemotherapy, radiotherapy and surgery. OBJECTIVES: To determine whether the combined treatment strategy using concurrent neoadjuvant chemoradiation therapy followed by surgery is effective and safe in vulvar cancer patients with advanced primary disease. Main outcomes of interest were: types of surgical intervention following chemoradiation and survival, recurrence and complication rates. SEARCH STRATEGY: We searched the Cochrane Gynaecological Cancer Review Group Specialised Register. The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE (PubMed), EMBASE, CANCERLIT, other databases and reference lists of articles. The latest search was conducted on 12 March 2005. SELECTION CRITERIA: Studies of curative treatment of patients with advanced, primary squamous cell carcinoma of the vulva were included. Treatment included concurrent radiotherapy and chemotherapy, followed by surgery. DATA COLLECTION AND ANALYSIS: Twenty-eight abstracts and papers were selected either by the search strategy or by checking the cross references. Randomised controlled trials (RCTs) were not available. Five studies met the inclusion criteria. (Eifel 1995; Landoni 1996; Montana 2000; Moore 1998; Scheistroen 1993). Two authors (HCvD, MV-L) independently assessed trial quality and extracted data. Study authors were contacted for additional information. Adverse effects information was collected from the trials. MAIN RESULTS: Chemotherapy was given uniformly within each of the five selected studies. However, four different chemoradiation schedules were applied. Radiotherapy dose fractionation techniques, fields and target definitions varied. Skin toxicity was observed in nearly all patients. Wound breakdown, infection, lymphedema, lymphorrhea and lymphoceles were also common. Operability was achieved in 63 to 92% of cases in the four studies using 5FU and CDDP or 5FU and MMC. In contrast, only 20% of the patients who received Bleomycin were operable after chemoradiation. After a follow up of 5 to 125 months, 26 to 63% of participants were alive and well. A total of 27 to 85% of participants died due to treatment related causes or disease. The five studies included in this review show that preoperative chemoradiotherapy reduces tumour size and improves operability. However, complications of treatment are considerable and information on the effects of quality of life (QOL) is not available. Furthermore, treatment results of the respective studies diverge considerably. AUTHORS' CONCLUSIONS: Patients with inoperable primary tumours or lymph nodes benefit from chemoradiation if an operation can be performed. In patients with large tumours that can only be treated with anterior and/or posterior exenteration complications of neoadjuvant therapy might outweigh complications of exenterative surgery. With the current knowledge neoadjuvant therapy is not justified in patients with tumours that can be adequately treated with radical vulvectomy and bilateral groin node dissection alone.

Carcinoma, Squamous Cell↗
PubMed2000

Surgical interventions for early squamous cell carcinoma of the vulva.

BACKGROUND: Radical surgery has been standard treatment for patients with early vulvar cancer since mid century. Survival figures are excellent, but complication rates are high. Over the last two decades, surgical treatment has become more individualised in order to decrease complications in patients with limited disease. OBJECTIVES: To determine whether the effectiveness and safety of individualised treatment is comparable with that of more extensive (non-individualised) surgery. SEARCH STRATEGY: The cirteria set by the Cochrane Gynaecological Cancer Group were used. We searched Medline and Embase (last search on 16 November 1999) We used our own publication archives, based on a prospective handsearch of six leading relevant journalswhich was started in December 1986. Reference lists of identified studies, gynaecological cancer handbooks and conference abstracts were also used. SELECTION CRITERIA: Types of study: RCT's, case control and observational studies on the effectiveness of surgical treatment of vulvar cancer. TYPES OF PARTICIPANTS: patients with cT1N0M0 squamous cell carcinoma of the vulva. Types of interventions: local surgical treatment as well as regional lymph node dissection. Types of outcome measurements: overall, disease specific and disease free survival; treatment complications; quality of life issues. DATA COLLECTION AND ANALYSIS: The two reviewers independently assessed study quality and extracted data. MAIN RESULTS: Only two studies with a total of 94 participants were included in the review. Both were observational studies. None of the other eleven considered studies met the minimum criteria as set by the Cochrane Collaboration. From these two studies, it can be concluded that: 1. radical local excision is as safe as a radical vulvectomy; 2. An ipsilateral lymph node dissection is safe in patients with a well lateralised tumour, and 3. A superficial groin node dissection is not as safe as a full femoro-inguinal groin node dissection. The fourth question we intended to answer is of great clinical importance: is the triple incision technique as safe as an en bloc dissection? This question could only be answered by using some of the unselected studies. From these studies, the triple incision technique appears to be as safe as the en bloc technique. REVIEWER'S CONCLUSIONS: The available evidence regarding surgical treatment of early vulvar cancer is generally of poor quality. From the evidence with sufficient quality we conclude that radical local excision, ipsilateral lymph node dissection in lateral tumors and triple incision technique are safe treatment options for early vulvar cancer. However, superficial groin node dissection results in an excess of groin recurrences compared to a full femoro-inguinal groin node dissection.

Carcinoma, Squamous Cell↗
PubMed2000

Primary groin irradiation vs primary groin surgery for early vulvar cancer.

BACKGROUND: Despite changes in technique, morbidity after surgical treatment for vulvar cancer is considerable and mainly related to the groin dissection. Primary radiotherapy to the groin is expected to result in lower morbidity. However, studies on the efficacy of primary radiotherapy for the groins in terms of groin recurrences and survival show conflicting results. OBJECTIVES: To determine whether the effectiveness and safety of primary radiotherapy to the inguino-femoral lymph nodes is comparable with surgery SEARCH STRATEGY: The literature search was carried out using the criteria set by the Cochrane Gynaecological Cancer Group. A MEDLINE and EMBASE search using the Mesh Heading 'vulvar neoplasms' and textword 'vulva' was performed. Publications on the effectiveness of primary radiotherapy treatment of early squamous cell carcinoma of the vulva were selected. SELECTION CRITERIA TYPE OF STUDY: Randomized clinical trials, case-control and observational studies of primary radiotherapy of the groin Type of participants: Patients with early squamous cell cancer of the vulva Type of interventions: inguino-femoral lymph node dissection and primary radiotherapy of the inguino-femoral lymph nodes. Type of outcome measurements: incidence of groin recurrences, survival and morbidity DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed study quality and extracted results MAIN RESULTS: Out of nine reviewed papers only three met the selection criteria. From these studies, (one randomised controlled trial ¿RCT¿ one case-control and one observational study) it became clear from the RCT that the incidence of groin recurrences after primary radiotherapy is higher compared with surgery. survival was also worse in the radiotherapy group. The other two studies showed a higher than expected number of groin recurrences after primary radiotherapy. Morbidity after primary radiotherapy was lower compared with surgery. The conclusion of the RCT was criticized on the grounds of the depth of the radiotherapy administered. The depth of 3 cm used in the RCT, is too shallow to administer an optimal dose to the deeper groin nodes. REVIEWER'S CONCLUSIONS: As shown in an RCT, primary radiotherapy to the groin results in less morbidity but also in a higher number of groin recurrences compared with surgery. Although the technique of radiotherapy in the RCT was criticized, other uncontrolled data do not give evidence for a similar or better groin control for radiotherapy when compared to surgery. This means that surgery is still to be considered the cornerstone of therapy for the groin nodes in women with vulvar cancer. Individual patients not fit enough to withstand surgery can be treated with primary radiotherapy.

Carcinoma, Squamous Cell↗
PubMed1996

Vulvar squamous cell carcinoma.

Squamous cell carcinoma of the vulva is a rare disease, mainly seen in elderly women. Risk factors are advanced age, an immunocompromised status, longstanding vulvar dystrophy, VIN, a history of vulvar human papillomavirus infection, and a history of cervical cancer. Vulvar cancer should be considered as a skin tumor and detection is possible in an early stage. However, because of patients' and doctors' delay, one in three vulvar cancers is not treated before an advanced stage. The tumor metastasizes mainly lymphatogenic. Spread starts in the inguinal lymph nodes. In the middle of this century, standard treatment, consisting of an en bloc dissection of the vulva and inguinal lymph nodes has been developed and applied. As a result, considerably improved survival rates were achieved: up to 90% 5-year survival rates for patients without lymph node metastases. However, complication rates were high. In recent years, a more individualized approach has replaced standard treatment. Surgical treatment now depends on the localization, size and extent of the tumor, and is followed or preceded by radiotherapy in selected cases. The role of chemotherapy in advanced disease is currently being studied in several referral centers. The most important success in the treatment of vulvar cancer in recent years is the maintenance of high survival rates despite considerably less extensive surgical treatment, resulting in lower complications rates. An important challenge for the near future will be the improvement of the management of advanced disease. However, an even more difficult issue may be the prevention of such large lesions. The reduction of treatment delays requires a considerable effort in education of both health care workers and the general public.

Carcinoma, Squamous Cell↗
PubMed1996

Recurrent stage IB cervical carcinoma: evaluation of the effectiveness of routine follow up surveillance.

OBJECTIVE: To study the effectiveness of follow up surveillance in detecting recurrent disease following radical hysterectomy for Stage IB cervical carcinoma. DESIGN: Retrospective analysis of clinical records using a computerised database. PARTICIPANTS: Six hundred and seventy-four patients with Stage IB carcinoma of the cervix underwent radical hysterectomy and lymph node dissection. INTERVENTIONS: Standard follow up surveillance consisted of clinical history and physical examination six weeks post surgery, and subsequently three monthly for the first year, six monthly for the second year, and yearly thereafter until 10 years post-treatment. RESULTS: Of the 674 patients, 112 (17%) developed recurrent disease. In only 29/112 (26%) was recurrent disease detected at the time of routine follow up visits. Nearly half of the patients (44%) were referred by their general practitioner between visits to the clinic because of suspicion of recurrent disease. CONCLUSION: Routine follow up surveillance is ineffective in detecting recurrent cervical carcinoma. Only one in four recurrences were detected at the time of a clinical visit.

Adult↗
PubMed1995

Cytokeratin subtypes and involucrin in squamous cell carcinoma of the vulva. An immunohistochemical study of 41 cases.

BACKGROUND: Histologic grade seems to be of limited prognostic significance in patients with vulvar carcinoma. However, the study of cytokeratin expression is of potential interest because it allows a more precise evaluation of the degree of squamous differentiation. This study was conducted to investigate whether differences in cytokeratin expression exist between normal vulvar epithelium and vulvar carcinoma and whether these differences are prognostically significant. METHODS: The expression of several differentiation markers, i.e., cytokeratin (CK) 10, CK 13, and involucrin, was studied in samples of 41 vulvar carcinomas. The expression of CK 8, 10, 13, and 14 was compared with CK expression in normal vulvar epithelium and was correlated with tumor grade and tumor growth pattern. Tumor growth pattern was considered type A if infiltrating tumor cell nests showed a layer of small, basaloid cells bordering the surrounding mesenchymal tissue and was considered type B if this was not the case. Prognosis was based on whether disease recurred or not. RESULTS: Sixteen patients had disease recurrence. No prognostic significance of tumor grade was found. Tumor growth pattern was prognostically significant: in patients with a type A tumor, recurrence was observed less often than in patients with a type B tumor (P = 0.03). Cytokeratin 14, typical for basal cells of normal vulvar epithelium, was expressed in all tumors, whereas CK 8 was not expressed in any tumor. A relationship between tumor growth pattern and the concordant expression of differentiation markers was observed: in 55% of type A tumors and in none of type B tumors, concordant expression of CK 10, CK 13, and involucrin was found. CONCLUSION: The expression of differentiation markers in vulvar carcinoma is related strongly to the tumor growth pattern, and this pattern is prognostically significant.

Biomarkers, Tumor↗
PubMed1995

"Microinvasive" adenocarcinoma of the cervix implanting in an episiotomy scar.

Episiotomy scar tumor implantation arising from a cervical carcinoma is rare. This report details a patient who developed an episiotomy implant from a "microinvasive" adenocarcinoma of the cervix 5 months following vaginal delivery. The implant behaved as a primary focus for metastases to the inguinal lymph nodes. Despite subsequent treatment with chemotherapy and radiotherapy the patient succumbed to the disease. The case is the first reporting a poor outcome following an episiotomy scar implant from a primary cervical adenocarcinoma. The poor outcome highlights the controversy regarding the use of the term microinvasive with respect to glandular cervical lesions.

Adenocarcinoma↗
PubMed1989

New monoclonal antibodies recognizing epidermal differentiation-associated keratins in formalin-fixed, paraffin-embedded tissue. Keratin 10 expression in carcinoma of the vulva.

Two monoclonal antibodies (MAb) specific for differentiation-related epidermal keratins have been developed. They represent specific molecular probes for different stages of epidermal differentiation. Antibody DE-K10 is chain-specific for cytokeratin polypeptide no. 10 (56.5 kD) expressed in all suprabasal layers of the epidermis. Antibody DE-SCK is specific for modified stratum corneum keratins and thus represents a marker for the terminal step of epidermal differentiation. Since the epitopes identified by both antibodies are preserved in formalin-fixed, paraffin-embedded tissue sections, these antibodies can be used for retrospective studies of differentiation in various pathological processes. We have used antibody DE-K10 to study the cytokeratin 10 expression in 26 stage II or III vulvar squamous cell carcinomas. Preliminary data suggest an increased risk of recurrence in cytokeratin 10 negative tumours.

Antibodies, Monoclonal↗
PubMed1989

Absence of differentiation-related expression of keratin 10 in early stages of vulvar squamous carcinoma.

Using specific monoclonal antibodies (DE-K10 and DE-SCK respectively), the expression of some differentiation-related epidermal keratins was studied in 38 human vulvar squamous carcinomas. In the epidermis, expression of keratin 10 (K10) strictly paralleled the extent of differentiation; it was absent in the basal layer, appeared in the first suprabasal layers and increased in concentration towards the granular layer. However, K10 was rarely detected (1 case out of 12) in early stages of vulvar squamous carcinomas (tumours less than 2 cm, clinical stage I) regardless of the tumour grade. In larger and more advanced tumours (greater than 2 cm, clinical stages II and III), K10 was detected in 21 out of 26 cases. Its expression appeared to be related to maturation of malignant keratinocytes, being preferentially detected in more-differentiated parts. Occasionally however, cells that did not show histological signs of keratinisation were also K10-positive. Modified stratum corneum keratins (recognized specifically by monoclonal antibody DE-SCK) were detected in the most keratinized areas (horn pearls and their close vicinity) of some K10-positive tumours, i.e., in a pattern close to their normal expression in terminally differentiated epidermal cells. These data suggest differences in the regulation of K10 expression during the differentiation processes in the normal keratinising squamous epithelium and in squamous carcinomas. While the normal pattern of vulvar epithelial differentiation is accompanied by an increasing expression of K10, malignant keratinocytes, also when these are histologically moderately or well differentiated, cease expressing this keratin in the early stages of tumour development.

Antibodies, Monoclonal↗
PubMed1988

Why is breast cancer so frequent in The Netherlands?

The very high incidence rate of breast cancer in The Netherlands, and in other Western industrialized countries, has to be explained by promoting environmental factors. The possible contributions by hormones and nutrition are reviewed. It is concluded that the promotion of breast cancer is likely to occur during breast development and several subsequent decades. A hypothesis is discussed which could explain how the affluent Western diet, a relative lack of physical activity and possibly also an overall increase of stress lead to a greater bio-availability of oestrogens at normal plasma concentrations. In this model the decrease of sex hormone binding globulin and a change of the binding equilibrium between oestrogens and plasma proteins in the presence of free fatty acids are central. Intra-abdominal fat accumulation, or frank central obesity, would favour this mechanism. Leads to further investigation and preliminary results are presented.

Body Composition↗