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台灣婦癌醫學會會訊
2008 年 12月
理事長: 王功亮醫師
秘書長: 張志隆醫師
各委員會召集人:
章程委員會：謝長堯理事
國際事務委員會：楊育正理事
會員資格審查委員會：陳祈安常務理事
財務委員會：顏明賢常務理事
醫療及倫理委員會：葉聯舜常務理事
教育委員會：周振陽理事
學術研究委員會：張廷彰常務理事
副秘書長：
南區-林浩醫師、中區-陳子和醫師、北區-陳子健醫師
學會網址: www.tago.org.tw
學會E-mail address: tago.gyn@gmail.com
學會地址：台北市中山區中山北路二段92號馬偕醫院平安樓12樓12043室
學會電話：（02）2543-3535 ext 3941
學會秘書: 黃璽懋小姐 |
本期編輯 陳子健 醫師
壹、 會務報告
一、近期學會活動
|
日期 |
活動名稱 |
活動地點 |
主辦單位 |
|
2008.12.20 |
專科醫師甄審 |
台北馬偕總院 |
中華民國婦癌
醫學會 |
|
2009.2.14-15 |
南區婦癌學術研討會 |
成功大學醫院 |
台灣婦癌醫學會 (周振陽大夫) |
|
2009.5.2-3 |
第十四屆台灣癌症聯合學術年會 |
國防醫學中心 |
中華民國婦癌
醫學會 |
|
2009.8.1-2 |
北區婦癌學術研討會 |
基隆長庚醫院 |
中華民國婦癌
醫學會
(張廷彰大夫) |
|
2009.11.中旬 |
中區婦癌學術研討會 |
彰化基督教醫院 |
台灣婦癌醫學會 (陳子和大夫) |
二、第六屆第四次理監事聯席會議報告
秘書長報告：
(一)、財務狀況報告：截至97年10月底止：
活儲（彰銀）：959,966元 基金（華南）：1,224,192元
郵政劃撥：1,198,812元 現金：6,058元
(二)、8月、9月及10月的會訊已E-mail給所有會員並放置於學會網站上。
(三)、謝謝大家熱情參與10月份的IGCS年會。
(四)、97年12月20日本年度「專科醫師甄審」筆試地點：馬偕醫院福音樓9樓第四講堂，時間：10：00∼11：30；口試地點：馬偕醫院福音樓8樓董事會議室、平安樓12樓12043室及12C會議室，時間：13：00∼17：00；本會有5位考生報考，資格已通過審核。各位出題的醫師請在12月上旬將考題交給余慕賢醫師。
(五)、準專科醫師資格審核辦法修訂及訓練實施事宜報告 (附件)
(六)、「第十四屆台灣癌症聯合學術年會」訂於98年5月2、3日，地點：國防醫學中心，主題：Molecular Oncology-Puhing Cancer Management a Step Forwards；壁報論文評審本會原本推派張廷彰醫師及葉聯舜醫師，但張廷彰醫師為主辦單位主要負責人，所以本會會另外推派評審，並建議主辦單位評審委員分成基礎組及臨床組。壁報論文甄選截稿日：98年2月15日（星期日）24：00止，投稿方式：97年11月16日起，至網站（www.hancan.com.tw）查詢及下載。
各委員會工作報告：
(一)、會員資格審查委員會（陳祈安醫師）：五位要考專科醫師甄審及2位申請入會審核資格通過。
(二)、教育委員會（周振陽醫師）「專科醫師再教育案」：
1、第四條更改為其他婦癌（Vaginal cancer, Tubal cancer---等）或有關跨科合作（包括泌尿科、大腸直腸科）之手術至少6例。
2、考量實際上的主觀條件，R/T的訓練擬修改為case-oriented必須繳交治療計劃、劑量、dosimetry-----等，來取代固定於R/T一個月的訓練規定。
3、完成後必須經由教育委員會認定通過並發給資格證明，始得報考專科醫師甄審。
4、並由秘書處負責追蹤Fellow之訓練。
(三)、學術研究委員會（張廷彰醫師）「學術研究委員案」：
希望學會能建立一個研究平台，以台灣為基礎的 study，成立類似美國的GOG、韓國的KGOG及日本的JGOG之組織，以三大婦科癌症為主題，每一個主題推舉一位召集人，以資深的主任擔當為宜，Cervical Cancer推派賴瓊慧醫師擔任召集人；Endometrial Cancer推派顏明賢醫師擔任召集人；Ovarian Cancer推派周振陽醫師擔任召集人；IDMC推派陳祈安醫師擔任召集人。詳細的實施及經費的籌措，張廷彰醫師進一步規劃。
臨時動議
11月29日在天母由國民健康局舉辦「法人論壇」，討論是否由政府全面實施全民施打子宮頸癌疫苗，請學會表達立場。（秘書處）
決議：以學術立場看，因目前追蹤期不夠長，安全性尚未完全確立，而且HPV疫苗只包括type16及18，僅有效涵蓋佔約65-70％的子宮頸癌，故本學會立場不贊成目前實施公費施打。
三、2008 IGCS 會議內容菁華
11/22在彰濱秀傳醫院所舉辦的中區婦癌學術研討會當中，馬偕醫院張志隆大夫與高雄榮總劉文雄大夫為會員們講述今年IGCS 會議中關於cervical cancer、endometrial cancer、ovarian cancer 方面的菁華。精采內容將於近日E-mail 給各位。
四、「第十四屆台灣癌症聯合學術年會」壁報論文甄選
截稿日期：2009年2月15日（星期日）24：00止，逾時不予受理
獎勵內容：基礎、臨床類各10名，發表口頭報告、頒發獎狀、獎金（獎金部份：前3名每名3萬元，第4到第10名每名1萬元）
投稿方式：2008年11月16日起，至下列網站查詢及下載
www.hancan.com.tw
※特別注意事項：本次壁報論文以網路上傳方式投稿，將會設定截止時間，請各會員務必配合，在截止時間之前完成上傳動作。
五、「第十四屆台灣癌症聯合學術年會」Logo徵稿
緣由：台灣癌症聯合學術年會是國內重要的癌症學術討論年會，定期舉辦已經有連續13年的歷史。經2008年8月23日第14屆第一次籌備會議討論後決議，聯合年會應有代表其精神的Logo，並向各學會會員徵稿。
設計內容：
1、代表台灣癌症聯合年會精神（例如：8隻小螃蟹合成一隻大螃蟹，或是一隻螃蟹殼上有8個小點等等………）
2、中文標題：「台灣癌症聯合學術年會」
3、英文標題：「Taiwan Joint Cancer Conference」
4、如經採用致贈獎金8000元
5、投稿請寄：14tjcc@gmail.com
6、截稿日期：2008年12月15日
六、學會網站誠徵衛教文章
歡迎各位會員踴躍賜稿，以充實學會的網站內容。來稿請e-mail至tago.gyn@gmail.com
貳、 會員動態及意見與回應
(歡迎提供會員動態、意見，以及衛教文章（學會E-mail address: tago.gyn@gmail.com)
�礡B 前月文獻選錄
(Ref 1)
單單有lymphovascular invasion 的early endometrial cancer， 要不要external beam radiation ?
(Ref 2)
以hysteroscopy 來進行endometrial cancer 的sentinel lymph node identification
(Ref 3)
對於 recurrent endometrial cancer 的新三合一regimen: carboplatin + paclitaxel + topotecan
(Ref 4)
Uterine carcinosarcoma: lymphadenectomy 有益，irradiation 則無
(Ref 5)
老年的endometrial cancer 仍宜建議手術治療
(Ref 1) Gynecol Oncol. 2008 Oct;111(1):49-54.
Adjuvant radiation for early stage endometrial cancer with lymphovascular invasion.
Croog VJ, Abu-Rustum NR, Barakat RR, Alektiar KM.
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
OBJECTIVE: To determine the impact of the decrease in use of postoperative pelvic external beam radiation (EBRT) in favor of intravaginal RT (IVRT) alone in patients with early stage endometrial cancer who had lymphovascular invasion (LVI). METHODS: Between 11/1988 and 5/2005, 126 patients treated with simple hysterectomy and postoperative RT had a final pathologic diagnosis of stage IB-IIB adenocarcinoma of endometrioid histology with documented LVI. The patients were divided into two groups based on the era of treatment, (early era: 1988-1996, vs. late era: 1997-2005), in order to best capture the shift away from the routine use of EBRT in favor of surgical staging and IVRT. RESULTS: Of the 126 patients, 35% (n=44) were treated in the early era and 65% (n=82) in the late era. The two groups were balanced in regards to age, race, depth of myometrial invasion, histologic grade, and cervical involvement. Significantly more patients had surgical staging and received IVRT alone in the late than early era (p=0.0001, 0.004, respectively). The rate of pelvic control was 93% for the early era compared to 97% for latter era (p=0.3). There was no significant impact of the treatment era on vaginal control, disease-free survival, or overall survival. CONCLUSIONS: These data suggest that the mere presence of LVI need not trigger the use of pelvic EBRT. Instead, the decision on whether to omit EBRT in patients with LVI should be made in the context of a patient's competing risk factors and comorbid conditions.
(Ref 2) Gynecol Oncol. 2008 Oct;111(1):62-7.
Cervical and hysteroscopic injection for identification of sentinel lymph node in endometrial cancer.
Perrone AM, Casadio P, Formelli G, Levorato M, Ghi T, Costa S, Meriggiola MC, Pelusi G.
Centre for Sexual Health, S. Orsola Hospital, University of Bologna, Bologna, Italy. amperrone@libero.it
OBJECTIVES: The aims of our study were to evaluate the possibility of identifying the sentinel lymph node (SLN) in patients with endometrial cancer (EC) and to directly compare two injection techniques, cervical and hysteroscopic injection. METHODS: Fifty-four patients with endometrial carcinoma, clinical stages I and II, were submitted to complete surgical staging through laparoscopy, as recommended by FIGO in 1988. For the mapping procedure the patients were divided into two groups of injection: the cervical injection group and hysteroscopic injection group. Technetium (Tc) 99m radiocolloid was used as tracer. RESULTS: Intraoperative detection rate of SLN was 70% in cervical group and 65% in the hysteroscopic group (p=n.s.). In the cervical group, all patients had SLN in the pelvis only and the mean SLN removed was 18 (range 2-26). In the hysteroscopic group, all patients had SNLs in the pelvis and two patients had SLN both in the pelvis and above the bifurcation of the aorta. Mean pelvic SLN removed was 20 (range 8-42). CONCLUSIONS: Our data shows that it is possible to identify the SLN in tumours of the endometrium. Both cervical and hysteroscopic techniques are feasible but the hysteroscopic procedure might represent the only method able to highlight the complete lymphatic drainage of the uterus as suggested by the presence of paraaortic positive SLN only in this group.
(Ref 3) Gynecol Oncol. 2008 Oct;111(1):27-34.
Paclitaxel, topotecan, and carboplatin in metastatic endometrial cancinoma: a Hellenic Co-operative Oncology Group (HeCOG) study.
Papadimitriou CA, Fountzilas G, Bafaloukos D, Bozas G, Kalofonos H, Pectasides D, Aravantinos G, Bamias A, Dimopoulos MA; Hellenic Co-operative Oncology Group.
Department of Clinical Therapeutics, Alexandra Hospital, University of Athens School of Medicine, Athens, Greece. chr_papadim@yahoo.gr
OBJECTIVE: Taxanes, and platinum compounds represent the chemotherapeutic agents with the greatest activity in metastatic endometrial carcinoma. We administered the combination of paclitaxel, topotecan and carboplatin to patients with metastatic or recurrent carcinoma of the endometrium to evaluate its activity and to define its toxicity. METHODS: Thirty-nine consecutive patients were treated on an outpatient basis with paclitaxel 150 mg/m(2), administered intravenously over a 3-h period and followed by carboplatin at AUC of 5 on day 3, with both agents proceding topotecan that was given at 0.75 mg/m(2)/day on days 1 through 3. The chemotherapy was repeated every 3 weeks with granulocyte colony-stimulating factor (G-CSF) support for a maximum of six courses. RESULTS: Twenty-one (60%) patients achieved objective clinical response (95% CI, 42.2-75.7%) including 4 (11.4%) complete and 17 (48.6%) partial responses. The median times to progression and survival for all patients were 8.9 and 17.7 months, respectively. Grade 3 or 4 thombocytopenia and neutropenia occurred in 5 (13%) and 4 (10%) patients, respectively, but only 2 episodes of neutropenic fever were encountered. Grade 2 or 3 neurotoxicity was observed in 23% of patients. CONCLUSIONS: The combination of paclitaxel, topotecan and carboplatin with G-CSF support appears active with acceptable toxicity in patients with metastatic or recurrent carcinoma of the endometrium.
(Ref 4) Gynecol Oncol. 2008 Oct;111(1):82-8.
Assessing the effects of lymphadenectomy and radiation therapy in patients with uterine carcinosarcoma: a SEER analysis.
Nemani D, Mitra N, Guo M, Lin L.
Department of Radiation Oncology, Hospital of University of Pennsylvania, Philadelphia, PA 19104, USA.
OBJECTIVE: The purpose of this analysis is to determine the pathologic prognostic factors and treatment outcome of patients with carcinosarcoma of the uterus. METHODS: A retrospective analysis of data from the Surveillance, Epidemiology, and End Results program of the National Cancer Institute between January 1, 1988 and November 1, 2003 was conducted. A total of 1855 with AJCC Stages I-III disease were identified who received primary surgical treatment. Overall survival curves were constructed using Kaplan-Meier curves. Cox proportional hazards model was used to identify factors predictive of overall survival. RESULTS: AJCC stage of all patients was as follows: 65% Stage I (n=1099), 14% Stage II (n=245), 21% Stage III (n=353). 57% (n=965) patients underwent LND. The median number of lymph nodes removed was 12 (SD=10.2); 119 (14%) patients had positive lymph nodes. Five-year overall survival (OS), disease free survival, and median survival were significantly improved for patients receiving lymph node dissection (LND) as compared to patients that received no LND, irrespective of radiotherapy. Adjuvant radiation therapy had no improvement on overall survival regardless of LND. There was no overall survival benefit to the addition of radiotherapy regardless of whether patients underwent a lymph node dissection or not. Age, race, marital status, lymph node dissection and stage were predictive of survival on multivariate analysis. CONCLUSIONS: Lymphadenectomy is significantly associated with improved overall survival in patients with Stage I-III uterine carcinosarcoma compared to no lymphadenectomy. The use of adjuvant radiotherapy conferred no overall survival benefit.
(Ref 5) Gynecol Oncol. 2008 Oct;111(1):35-40.
The impact of surgery on survival of elderly women with endometrial cancer in the SEER program from 1992-2002.
Ahmed A, Zamba G, DeGeest K, Lynch CF.
Department of OB/GYN, Division of Gynecologic Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA 52246, USA. amina.ahmed-md@advocatehealth.com
OBJECTIVES: Few population-based studies have evaluated surgical treatment and outcomes in elderly patients with endometrial cancer. The National Cancer Institute's SEER, Surveillance, Epidemiology and End Results, Program provides a database to examine this issue. The objective of this study was to determine the extent to which elderly women with endometrial cancer receive surgical treatment and to evaluate the impact of surgery on survival. METHODS: Data were obtained from the SEER registries for expanded races from 1992-2002. The inclusion criteria were women ages 50 to 95 with pathologically confirmed endometrial cancer. Cases with multiple primaries were excluded. The data were examined with respect to histology, radiotherapy use, extent of surgery and FIGO stage. The survival data were analyzed using a Cox proportional hazard model. Chi-squared tests were used to examine the extent to which elderly women with endometrial cancer receive surgical treatment, hysterectomy at minimum. Endometrial cancer-specific mortality was analyzed. RESULTS: 27,517 women were analyzed with 94% of the cohort receiving surgical treatments. There is a significant trend that suggests elderly women, aged 65+ years at time of endometrial cancer diagnosis, received surgical treatment less often than younger women (p<0.001). The age-adjusted hazard of death was reduced with surgical intervention. After adjustment for stage at diagnosis, histology, and radiotherapy, the hazard ratios for endometrial cancer-specific mortality were decreased when surgery was undertaken. CONCLUSIONS: In this population-based study, the poor prognosis associated with advanced age may be in part associated with the decreased frequency of surgical treatment. The reasons need to be further investigated. Continued efforts should be directed at providing surgical treatment for elderly patients with endometrial cancer.
附件
台灣婦癌醫學會
婦癌專科醫師訓練辦法及資格審核要點
第一條：需須向學會申請為準會員。
第二條：需須每年參加會員大會及地區學術研討會至少一次，無法參加應要事先向學會請假，並經教育委員會同意備案。
第三條：需須向學會提出未來兩年婦癌專科訓練的訓練計劃（由supervisor簽名認可），於本會認可之至少有兩位婦癌專科醫師之醫院接受婦科腫瘤之專科訓練滿二年。
第四條：婦癌手術之訓練(擔任至少為第一助手之案例)：子宮頸癌根除手術至少20例、子宮內膜癌手術至少10例、卵巢癌減積手術至少10例、及其他婦癌（Vaginal cancer, Tubal cancer, Vulvar cancer---等）或有關跨科合作之手術至少5例。
第五條：婦癌病理之訓練45例：須能診斷常見的婦癌疾病，包括子宮頸癌、卵巢癌、子宮內膜癌。(指導之病理科專科醫師證明)
第六條：陰道鏡檢查: 操作陰道鏡診斷至少50例。
第七條：放射線腫瘤治療需接受至少一個月的訓練參與治療至少6例。(提供指導之放射線腫瘤專科醫師證明)
第八條：參與婦癌化學治療至少20例。
第九條：自接受婦癌專科訓練起至參加婦癌專科醫師考試之間，有婦癌相關之原著論文或個案報告至少一篇，且為第一作者或通訊作者。
第十條：學會定期考核訓練計劃施行情形，包括準會員需提出之書面及口頭報告。
書面報告每年繳交兩次，截稿日期為1/31及7/31，報告內容需包括主治或協助的病人病例摘要。
口頭報告每年一次，時間為婦癌每季學術討論會日期，內容含婦癌臨床研究論文、化療、放療、陰道鏡、參與研究、論文，將來訓練規劃，遇到什麼困難、需要什麼協助，完成後經教育委員會認定通過並發給資格證明，始得報考專科醫師甄審。
放射線腫瘤訓練後，個案表格
|
日期 |
病例號碼 |
年齡 |
診斷 |
放射治療技術 |
劑量及次數 |
Target delineation |
F/U |
指導醫師核章 |
|
|
XXX |
31 |
Cx Ca IIb |
IMRT c SIB |
60 Gy/30fr |
GTV, CTV60, CTV50(Int.ext |
|
|
|
|
|
|
Cx Ca IIb |
Brachytherapy |
30 Gy/6fr |
To point A |
|
|
|
|
|
|
|
|
|
|
|
|
|
