Annals of Palliative Medicine

Risk factors of pleural effusion after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in late-stage and recurrent ovarian cancer

Pleural effusion (PE) is one of the most common complications of advanced recurrent ovarian cancer. However, no studies have revealed the risk factors for PE after surgery. The purpose of this study is to observe the incidence and risk factors of PE after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with late-stage and recurrent ovarian cancer. A retrospective analysis of 77 patients with late-stage and recurrent ovarian cancer after CRS + HIPEC was conducted. According to the presence of PE within 7 days after operation, two groups were formed. The basic information, surgical process, and laboratory examinations of the two groups were analyzed and compared to conduct a regression analysis. The incidence of postoperative PE was 57.1% (44/77 patients). Among these patients, the prevalence of grade I-II and grade III-IV PE was 42.8% (33/77 patients) and 14.3% (11/77 patients), respectively. There were statistically significant differences between the two groups in terms of preoperative PE, the duration of surgery, intraoperative blood loss, postoperative level of albumin, intestinal involvement, and diaphragmatic involvement. Among these, preoperative PE and diaphragmatic involvement were identified as independent risk factors of postoperative PE. Patients with late-stage and recurrent ovarian cancer invariably develop postoperative PE after CRS + HIPEC. Preoperative PE and diaphragmatic involvement are independent risk factors of postoperative PE. It is estimated that the incidence of postoperative PE among patients with these two independent risk factors is approximately 100%. Hence, we should promote the prevention and treatment of PE to improve its prognosis.

Chronic schizophrenia with aggravation of psychiatric symptoms after cancer surgery: a case report and mini literature review

Patients with cancer and comorbid psychiatric disorders, including schizophrenia, may experience aggravation of psychiatric symptoms during cancer treatment. Oncology hospitals without dedicated psychiatric wards sometimes face challenges in managing cases with severe psychiatric symptoms. Concerns exist that the worsening of psychiatric symptoms may lead to the interruption of cancer treatment. A woman in her 60s had chronic schizophrenia, with an estimated onset in her 20s. She had long been prescribed quetiapine (150 mg/day, oral), haloperidol (0.75 mg/day, oral), nitrazepam (10 mg/day, oral), and paroxetine (20 mg/day, oral). At X years, she was diagnosed with ovarian cancer and underwent surgery following discontinuation of the psychotropics. On day 2 after hospitalization, she became confused, hallucinatory, and delusional with severe agitation. Although initially stabilized, the patient exhibited worsening psychiatric symptoms again on day 7. Ultimately, the patient was mentally stabilized with adjusted doses of oral quetiapine (250 mg/day) and haloperidol (1.5 mg/day, oral) and was discharged on day 16. Thanks to the intervention, cancer treatment continued uninterrupted. Patients with comorbid schizophrenia and cancer may present severe psychiatric symptoms in the cancer perioperative period, even if schizophrenia is in a chronic phase. Postoperative delirium, withdrawal delirium, and exacerbation of schizophrenia were speculated to be the possible contributing factors in this case. When patients with cancer also have schizophrenia, oncologists and liaison psychiatrists need to carefully monitor their mental status to prevent interruptions in cancer treatment.

Early response to neoadjuvant chemotherapy helps decrease recurrence rate of cervical cancer: a systematic review and meta-analysis

Neoadjuvant chemotherapy has been used for treatment of cervical cancer for a long time; however, the role of early non-response on prognosis is still confusing. This study was designed to assess its impact on disease-free survival (DFS). Databases "PubMed", "Embase" and the "Cochrane Library" were searched out through May 2020, and both random effects model and fixed effect model were employed to calculate the main pooled results. I2 and Cochrane Q test were used to test the heterogeneity among the studies. Funnel plot with Begg's and Egger's tests was used to assess the publication bias that may exist in the study. Sensitivity analysis was performed to detect the origin of the heterogeneity. A total of 1,349 articles were found at first; then, after several rounds of exclusion, we identified 8 articles with 9 studies which were accordant with the standards of the inclusion. A combined analysis was performed among the 1,462 responders and 490 non-responders. For 1-year DFS, sub-analysis showed hazard ratio (HR) was 0.25 (95% CI: 0.14-0.43) using RECIST criteria; and HR was 0.52 (95% CI: 0.36-0.75) using WHO criteria; Egger's test showed that P=0.35 for RECIST criteria and P=0.57 for WHO criteria; Begg's test showed P=0.34 for RECIST criteria and P=0.60 for WHO criteria. For 3-year DFS, HR was 0.26 (95% CI: 0.16-0.43) using RECIST criteria and was 0.47 (95% CI: 0.30-0.73) using WHO criteria. For 5-year DFS, HR was 0.26 (95% CI: 0.16-0.42) using RECIST criteria and was 0.49 (95% CI: 0.33-0.71) using WHO criteria. Early non-response to neoadjuvant chemotherapy was significantly associated with higher recurrence of cervical cancer. Prospective randomized studies are warranted to validate this finding.

The predictive value of postoperative C-reactive protein (CRP), procalcitonin (PCT) and triggering receptor expressed on myeloid cells 1 (TREM-1) for the early detection of pulmonary infection following laparoscopic general anesthesia for cervical cancer treatment

To analyze the predictive value of postoperative C-reactive protein (CRP), procalcitonin (PCT), and triggering receptor expressed on myeloid cells 1 (TREM-1) for the early detection of pulmonary infection following laparoscopic general anesthesia for cervical cancer treatment. We enrolled 80 patients who underwent radical surgery for cervical cancer in our hospital from March 2018 to March 2020 and divided them into an infected group (n=34) and non-infected group (n=46) according to whether they were complicated by lung infection after surgery. The levels of CRP, PCT, and TREM-1 were compared between the two groups, and logistic regression was used to analyze the risk factors for pulmonary infection. The ROC curve was used to analyze the predictive value of the individual detection of CRP, PCT, or TREM-1 as well as their combined detection. The levels of CRP, PCT, and TREM-1 in the infected group were higher than those in non-the infected group 24 h after operation (P<0.05) and tumor TNM staging, previous lung disease, postoperative use of a ventilator, intraoperative use of antibacterial drugs, PCT, CRP, and ICAM-1 were significantly correlated with pulmonary infection (P<0.05). The postoperative application of a ventilator, PCT (increasing), CRP (increasing), and ICAM-1 (increasing) were all individual factors that could affect the development of pulmonary infection (P<0.05). ROC curve results showed that the critical score of combined detection was 3.026, and the area under the curve (AUC) was 0.786 (0.637-0.935), the sensitivity was 90.52%, and the specificity was 89.63%. The levels of PCT, CRP, and TREM-1 are abnormally increased in patients with pulmonary infection after laparoscopic general anesthesia for cervical cancer treatment. Their combined detection can be used as an effective means to predict the occurrence of pulmonary infections in the early stage and their level should direct timely intervention to improve the prognosis of patients.

Successful treatment of a patient with brain metastases from endometrial cancer using Niraparib: a case report

Endometrial cancer (EC) is the second most common gynecologic malignancy in China, and the incidence and mortality rates have increased in recent years. Brain metastasis from EC is extremely rare, affecting only 0.3-1.16% of EC patients. The prognosis for patients with brain metastasis from EC is poor, with a median survival time of 3.5-6.5 months from the diagnosis of brain metastasis. Niraparib is a poly (adenosine diphosphate-ribose) polymerase (PARP) inhibitor that uses the concept of synthetic lethality in the presence of a mutation in the breast cancer susceptibility gene (BRCA). Niraparib is recommended as a maintenance treatment for ovarian cancer patients with platinum-sensitive relapse and has been shown to increase progression-free survival. Niraparib was found to enter the brain via the blood-brain barrier, which resulted in a higher concentration of the drug in the brain tissues and better tumor-suppressing effects. There was none report about the applications of PARP inhibitor for endometrial cancer with brain metastases. Here, we present the case of a 62-year-old woman whose Peripheral blood gene detection had shown BRCA1 mutation with brain metastases from high-grade serous carcinoma of the endometrium who was successfully treated with Niraparib and remained free of disease progression for 6 months.

Capacity of endometrial thickness measurement to diagnose endometrial carcinoma in asymptomatic postmenopausal women: a systematic review and meta-analysis

Endometrial thickness (ET) is closely related to many gynecological symptoms. The measurement of ET is also an important tool for evaluating adverse symptoms such as bleeding in postmenopausal women. However, the significance of ET in asymptomatic women is still unclear. The purpose of this study was to determine the correlation between ET and the incidence of endometrial lesions in asymptomatic women after menopause, and to statistically analyze the correlation with a 5 mm cutoff value. A systematic literature search was conducted in May 2021 to screen out articles that reported that ET measurement was used to diagnose endometrial carcinoma (EC), endometrial hyperplasia (EH), and endometrial polyps (EP) in asymptomatic postmenopausal women who did not use hormone replacement therapy (HRT). The endometrial membrane was set at 5 mm as the cut-off, and using 5 mm as the cut-off of the ET, the relationship between the thickness of the endometrium and the prevalence of EC, EH, and EP was evaluated. Relative risk (RR) and standardized mean difference (SMD) were extrapolated with 95% confidence interval (CI). After screening, 9 studies reported a total of 3,620 cases of asymptomatic postmenopausal women whose ET was measured. Among them, there were 1,758 cases of ET <5 mm, the probability of EC, EH, and EP were 0.284% (5/1,758), 0.398% (7/1,758), and 0.626% (11/1,758), respectively. In another 1,862 cases with ET ≥5 mm, the probabilities of EC, EH, and EP were 1.128% (21/1,862), 1.128% (21/1,862), and 1.557% (29/1,862), respectively. The results showed that ET can be used as a risk factor for predicting EC and other pathological changes. The results of this meta-analysis show that when the ET is greater than 5 mm, the incidence of EC, EH, and EP increases significantly. It is reasonable to use ET as a screening test for EC and EH in asymptomatic postmenopausal women.

Remifentanil injected during analepsia shortens length of postanesthesia care unit stay in patients undergoing laparoscopic surgery for endometrial cancer: a randomized controlled trial

To guarantee efficient operating room (OR) activity, tracheal extubation is often performed in the postanesthesia care unit (PACU). Therefore, the ability of PACU to accommodate postoperative patients is crucial. Optimizing extubation management may speed up the turnover of PACU beds. The aim of the present study was to investigate the effect of remifentanil, which is used during analepsia, on the length of PACU stay in patients undergoing laparoscopic surgery for endometrial cancer. In this prospective trial, we recruited a total of 99 patients, who were scheduled for laparoscopic surgery for endometrial cancer. At the end of the surgery, all patients were immediately transferred to the PACU and continued mechanical ventilation. Upon PACU admission, sputum aspiration was routinely performed. If the hemodynamic parameters fluctuated >30% of the baseline level, or patients moved unconsciously without reaching the criteria of extubation, a bolus injection of either 1 μg/kg remifentanil (Rem group, n=51) or propofol 1.0 mg/kg (Pro group, n=48) was randomly administered. The primary outcome was the duration of PACU stay. The secondary outcomes included time to respiratory breath recovery and time to extubation, along with bispectral index (BIS) values and hemodynamic status after remifentanil or propofol intervention. Times of repeated intervention, rescue administration of vasoactive drugs, and the incidence of adverse events were recorded. Visual analog scale and satisfaction scores at the time of PACU discharge were also evaluated. The duration of PACU stay was shorter in the Rem group than in the Pro group [49 (46.47-51.06 minutes) vs. 62 minutes (60.75-69.29 minutes), P<0.0001]. Compared with the Pro group, the time to spontaneous breathing recovery, the time to extubation, and the incidence of hypoxemia after extubation were reduced in the Rem group (P<0.0001, P<0.0001, P=0.03, respectively). After anesthetic administration, the BIS value decreased less in the Rem group (P<0.0001); blood pressure and heart rate (HR) declined, but were comparable in both groups. Remifentanil, which is injected during analepsia, significantly shortens the duration of PACU stay without increasing adverse events in the peri-extubation period.

Relationship between CD177 and the vasculogenic mimicry, clinicopathological parameters, and prognosis of epithelial ovarian cancer

To explore the relationship between CD177 and the vasculogenic mimicry (VM), clinicopathological parameters, and prognosis of epithelial ovarian cancer. Tumor tissue samples and clinicopathological data were collected from 98 patients with epithelial ovarian cancer. The expression of CD177 in tumor tissues was detected by immunohistochemical streptavidin-peroxidase conjugate (SP) method, while the VM structure in tumor tissues was identified by CD31/periodic acid-Schiff (PAS) double staining in order to analyze the relationship between CD177, VM, clinicopathological parameters, and the prognosis of epithelial ovarian cancer. The proportion of the positive expression of CD177 (CD177+) in 98 ovarian cancer tissues was higher than that of the negative expression of CD177 (CD177-) (65.31% vs. 34.69%, P0.05). Correlation analysis showed that CD177+ was positively correlated with VM formation, tumor differentiation degree, tumor diameter, and tumor stages (P<0.05), and was negatively correlated with platinum sensitivity (P<0.05). Kaplan-Meier survival analysis showed that the survival time of CD177+ patients was significantly shorter than that of CD177- patients (P<0.05). CD177+ is associated with the tumor malignancy of patients with epithelial ovarian cancer, and may participate in the formation of VM structure in epithelial ovarian cancer tissues. It can thus serve as important indicator for the prognosis of patients.

Meta-analysis of excision repair cross complementary gene 1 (ERCC1) expression and platinum chemosensitivity in patients with ovarian cancer

Ovarian cancer is one of the most common malignant tumors in women. Due to the lack of typical clinical symptoms and ineffective screening methods for early ovarian cancer, 60-70% of patients with ovarian cancer are diagnosed as middle and late stage when they are already suffering abdominal distension, abdominal pain, or pelvic tumor. This study aimed to comprehensively investigate the correlation of excision repair cross complementary gene 1 (ERCC1) expression and the chemosensitivity of ovarian cancer. A meta-analysis was conducted to comprehensively and quantitatively evaluate the relevant research in this area. The literature published in PubMed, Web of Science, CQVIP, China National Knowledge Infrastructure (CNKI), and Wanfang databases from establishment to June 2019 were searched. The evaluation index of chemotherapy sensitivity was clinical effective rate (complete remission plus partial remission). Two researchers independently screened the literature and extracted the data according to the inclusion and exclusion criteria. A total of 7 articles met the inclusion criteria, comprising 402 patients with ovarian cancer. The results showed that there was a significant difference in chemosensitivity between the low ERCC1 expression group and the high ERCC1 expression group (OR =5.19, 95% CI: 3.15-8.54, P<0.01), with the results of the ethnicity subgroup analysis being the same for the Asian and Caucasian populations. The chemosensitivity of ovarian cancer patients with a low expression of ERCC1 is greater than that of patients with high expression.

Evaluation of safety and efficacy of apatinib combination with chemotherapy for ovarian cancer treatment: a systematic review and meta-analysis

Apatinib in combination with chemotherapy (CT) has been used in the treatment of ovarian cancer (OC), however, the safety and efficacy are unclear. The study aims at systematic evaluation of the safety and efficacy of the apatinib targeted therapy in combination with CT for the treatment of patients with advanced OC. Literature about randomized controlled clinical trials was searched using search engines such as PubMed, EMBASE, Web of Science, CNKI, the Cochrane Library, CBM, VIP and the Wanfang. We collected the related clinical studies of apatinib in combination with CT in the treatment of OC. The duration of the data retrieval related to clinical studies was from the database establishment to September 2020. Adverse reactions (ADRs) due to treatment, disease control rate (DCR), and that of objective response rate (ORR), were collected as indicators to show treatment outcomes. The literature was independently screened by two researchers. They extracted the data and evaluated the risk of biases of the included studies. Then, Revman 5.4 software was employed for performing the meta-analysis. Twelve randomized controlled clinical trials with 698 patients having an advanced stage of OC were included. The results revealed that in comparison with the treatment with only CT, apatinib targeted therapy combination with CT showed significant improvement in the patients' ORR [OR =3.19, 95% CI: (2.06, 4.94), P0.05). The effects of apatinib combination with CT for the treatment of OC are significantly better than the CT used alone in ORR and DCR, despite with a relative low incidence of adverse effects. However, due to the very low number of studies available, the results need to be further verified using a high-quality, large sample and long-term studies.

The role systematic lymphadenectomy plays in determining the survival outcome for advanced ovarian cancer patients: a meta- analysis

This study aims to evaluate the role systematic lymphadenectomy (SL) p l a y s in advanced ovarian cancer (OC) patients. A meta-analysis was done to compare the progression-free survival (PFS) rates and overall survival (OS) rates between SL and unsystematic lymphadenectomy (USL). An extensive literature search from the dates of January 1, 1994, to today was performed. In total, we analyzed 15 studies [3 randomized controlled trials (RCTs) and 12 observation studies], which included 33,257 patients with advanced OC who underwent SL or USL. We compared the survival outcomes of PFS and OS between SL and USL stratified by research type, respectively. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were combined and analyzed by using the Revman 5.3 software. For RCTs, SL did not improve the survival outcomes for advanced OC. Only 2 RCTs compared PFS, and 3 RCTs compared the OS rates between SL and USL. Two RCTs demonstrated that there was no difference in PFS between SL and USL (HR: 0.91; 95% CI: 0.81-1.04; P=0.16>0.05); at the same time, 3 RCTs also demonstrated that there were no difference in OS between SL and USL (HR: 0.94, 95% CI: 0.88-1.00; P=0.07>0.05). However, in observational studies, SL showed increased PFS (HR: 0.93, 95% CI: 0.92-0.95; P<0.00001) and OS (HR: 0.91, 95% CI: 0.89-0.93, P<0.00001) for advanced OC patients. The heterogeneity and publication bias in the included studies were within acceptable thresholds. These findings suggest the possibility that SL cannot improve survival outcomes for advanced OC patients. However, we cann ot completely ignore the results of observational studies. More relevant RCTs are needed to investigate the role of SL for advanced OC patients.

Compounding or confounding?—addressing context-specific disparities in access to outpatient specialty palliative care

Despite proven benefit of outpatient specialty palliative care on symptom burden, quality-of-life, and survival, only 20-30% of eligible patients with gynecologic cancers receive a referral, even in high-resource health systems. Socioeconomically disadvantaged and culturally marginalized populations face inequitable access to specialty palliative care. However, the relationships between social determinants of health (SDOH) and palliative care utilization remain understudied. We evaluated rates of outpatient specialty palliative care referral and assessed disparities associated with SDOH. A single institution retrospective cohort quality improvement study evaluated gynecologic oncology patients receiving care in Kansas City, Kansas (midwestern United States) who met American Society of Clinical Oncology (ASCO) criteria for referral to outpatient specialty palliative care from 2019-2022. Eligible patients were stratified based on whether or not they were referred to an outpatient specialty palliative care provider. Groups were compared based on clinical factors [age, cancer site, stage, primary versus recurrent disease status, body mass index (BMI)], and SDOH (race, ethnicity, primary language, insurance status, having a primary care provider (PCP), distance from the hospital, rurality, and Area Deprivation Index (ADI). Descriptive statistics and multivariable logistic regression were performed, and odds ratios were calculated. During the study period, 432 gynecologic oncology patients were eligible for referral to outpatient specialty palliative care, of which 191 (44%) were referred and 146 (34%) ultimately saw a palliative care provider. Patients who received a palliative care referral more frequently had recurrent disease and lower BMI. Patients were referred to a palliative care provider less commonly if they lived in a rural or disadvantaged (>70th percentile ADI) county, lived further from a National Cancer Institute (NCI)-designated cancer center, or if they were established with a PCP. On multivariable logistic regression evaluating rurality, distance, deprivation, and primary care access, only rurality and primary care access remained significant. Rural patients were less likely to be referred to a palliative care provider [odds ratio (OR) 0.3, 95% confidence interval (CI): 0.17-0.54, P<0.001], and patients without a PCP were more likely to be referred to palliative care provider (OR 1.8, 95% CI: 1.1-2.95, P=0.01). Gynecologic cancer patients were less commonly referred to outpatient specialty palliative care if living in a distant, rural or disadvantaged county or if established with primary care. For our patient population, rurality and access to primary care were the primary SDOH driving referral to palliative care. This analysis demonstrates the importance of understanding effects of SDOH to tailor quality improvement interventions to prioritize the most pressing needs of a given patient population in a context-dependent manner.

Tuberous sclerosis complex misdiagnosed as multiple metastases in a cervical cancer patient: case report and literature review

Tuberous sclerosis complex (TSC) is an autosomal dominant disorder that affects multiple organs and is caused by inactive mutations in the TSC1 or TSC2 genes. The main symptoms of TSC are neurocutaneous syndrome and benign hamartoma formation. Notably, malignancy is not an indication of TSC. In this article, we present the case of a 48-year-old female with cervical cancer (CC) combined with TSC, who was misdiagnosed with multiple metastases. Toe masses, pelvic nodules, and multiple osteogenic lesions were initially observed. Multi-site puncture biopsies and a toe amputation were performed; the pathology results did not indicate malignancy. Subsequently, hypomelanotic macules on the back, subependymal nodules (SENs), ungual fibromas, multiple renal cysts, and sclerotic-bone-lesions (SBLs) of the skull, and vertebrae were observed, leading to a diagnosis of TSC. Given that TSC is a benign disease and has not yet caused any organ disfunction, no special treatment was provided to this patient. After a follow-up period of almost 65 months, the patient's quality of life remained good without therapy. Oncologists should pay attention to benign diseases in the face of multiple lesions to reduce misdiagnosis and overtreatment. In addition, TSC may interact with CC through molecular mechanisms, such as the mammalian target of rapamycin (mTOR) pathway.

The prognostic value of the lymph node ratio in patients with stage IIIC ovarian cancer treated with preoperative chemotherapy

Ovarian cancer is a major cause of morbidity and mortality in females. Due to the unremarkable symptoms associated with early ovarian cancer, many patients are already in the advanced stages at first diagnosis. Recent studies have shown that the lymph node ratio (LNR) has a certain value in predicting the prognosis of patients with ovarian cancer. However, preoperative chemotherapy may lead to changes in the LNR, and thus, the predictive value of the LNR in such patients is unclear. Therefore, this study examined the predictive value of the LNR in ovarian cancer patients undergoing preoperative chemotherapy. A total of 208 patients with stage IIIC ovarian cancer, who were treated in the Fourth Clinical Medical College of Xinxiang Medical University, Xinxiang Central Hospital from January 2014 to January 2016, were recruited for this study. The median LNR was 0.32. Patients with LNR <0.32 were defined as the control group and those with LNR ≥0.32 were defined as the observation group. The prognosis of the two groups was compared. The LNR in the observation group was significantly higher than that of the control group (0.63±0.21 vs. 0.19±0.08; P=0.000). Patients in the observation group showed significantly higher postoperative recurrence rates (51.92% vs. 22.12%; P=0.000), greater incidences of postoperative metastasis (43.27% vs. 17.31%; P=0.000), and significantly increased postoperative mortality (36.54% vs. 11.54%; P=0.000) compared to the control group. The survival function showed that the overall survival, recurrence-free survival, and metastasis-free survival were all significantly shorter in the observation group compared to the control group (P=0.000). The receiver operating characteristic curves showed that the LNR had certain diagnostic value for postoperative recurrence [area under the curve (AUC) =0.658; 95% confidence interval (CI): 0.582 to 0.734; P=0.000], postoperative metastasis (AUC =0.640; 95% CI: 0.560 to 0.720; P=0.001), and postoperative mortality (AUC =0.653; 95% CI: 0.569 to 0.737; P=0.001) in patients with stage IIIC ovarian cancer treated with preoperative chemotherapy. The LNR has good prognostic value in patients with locally advanced ovarian cancer treated with preoperative chemotherapy.

Postoperative pleural effusion after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in ovarian cancer patients: predictive role of preoperative albumin levels, diaphragmatic disease involvement and preoperative pleural effusion

Malignant transformation of ovarian teratoma responded well to immunotherapy after failed chemotherapy: a case report

Mature cystic teratomas (MCTs), also known as dermoid cysts, are the most common ovarian germ cell tumors and the most common ovarian neoplasms in patients younger than 20 years. MCTs mainly appear as pelvic masses that are made up of different types of well differentiated derivates of at least two germinative cell types. MCT of the ovary is always benign lesions with slow growth and good prognosis. Unfortunately, in about 1-2% of cases, it may undergo malignant transformation. At present, surgical treatment is the preferred option for the early stage of malignant transformation of teratomas, while with a high postoperative recurrence rate. For advanced or recurrent malignant ovarian teratomas, the effect of conventional chemotherapy or radiotherapy is poor, leading to high mortality. Thus, identifying novel treatment for malignant transformed MCTs is an urgently need in clinic. Recently, PD-1 antibody-based immunotherapy has achieved great success in treatment of lung cancer, melanoma, and other malignant tumors. However, its effect on the malignant transformation of ovarian teratomas has not yet been reported. Here we reported a patient who suffered malignant transformation of ovarian teratoma and responded well to camrelizumab, an anti-PD-1 inhibitor.

Clinical analysis of five case reports of ovarian teratoma with anti-N-methyl-D-aspartate receptor encephalitis

We have collected the data of five patients with ovarian teratoma and anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis admitted to the Southern Hospital of Southern Medical University from June 2014 to December 2017, we found that all of them started with psychiatric symptoms, four had autonomic nervous system dysfunction, while all of them exposed to abnormal brain and pelvic imaging, four patients required mechanical ventilation to assist breathing during the hospital stay. The serum anti-NMDAR antibodies were positive in five patients. After immunotherapy and surgery, all patients showed favorable prognosis. Pathology: four mature teratomas and one immature teratoma. In conclusion, patients with ovarian teratoma with anti-NMDAR encephalitis often begins with neurological and psychiatric symptoms, it is easy to be misdiagnosed due to the lack of overt symptoms, while the early detection and tumor resection combined with immunotherapy will win favorable prognosis.

The effects of intestinal air cavity on dose distribution of volume modulated arc therapy for cervical cancer

This study explored the effects of air cavity on the dose distribution of radiotherapy in patients after extensive hysterectomy. In patients who have an air cavity in the intestines near the planning target volume (PTV), the photon beams may interact with the air cavity to cause electron disequilibrium (ED), resulting in a reduction in the absorbed dose by the surrounding tissues. In this paper, the electron density assignment (EDA) of the air cavity was used to simulate the disappearance of the intestinal gas, and the effects of the intestinal air cavity on the volume modulated arc therapy (VMAT) results were examined. A total of 21 patients who underwent VMAT after extensive hysterectomy were enrolled in this retrospective analysis. The dose parameters from the selected treatment plan were used the experimental reference. The treatment plan of the reference group was copied, and the intestinal air cavity structure was identified using the computed tomography (CT) simulation image. The electron density value of the intestine near the cavity was measured and averaged according to the intestinal electron density value recommended by International Commission Radiological Units (ICRU) report No. 46. The averaged value was assigned to the air cavity structure. Subsequently, the treatment plan was re-calculated without changing other parameters, and the resulting treatment plan was defined as the experimental group. The dose parameters of the PTV and organs at risk (OAR) in the 2 groups were assessed, and the influence of the intestinal air cavity on the VMAT dose distribution in cervical cancer patients was analyzed. The minimum dose (D98) and the maximum dose (D2) of the PTV was significantly different between the experimental group and the control group (P<0.05), however, mean dose of the PTV was comparable between the 2 groups. The dose parameters of OARs were not significantly different between the two groups except the bone structural organs. When the intestinal air cavity is large and related to the target area, the intestinal air cavity should be intervened, and the patient should be treated with radiotherapy after the intestinal gas decreases.