{"paper_id":"168750e4-7e38-4d81-aba3-1ebfd58550bb","body_text":"Submit Manuscript | http://medcraveonline.com\nThe systematic surgical staging in patients with SPEOC can be \naccomplished either with laparotomy or laparoscopy. Laparotomy \nis the preferable treatment approach for systematic surgical staging \nespecially in patients with advanced stage disease. Minimally invasive \ntechniques (laparoscopy and robotic‒assisted surgery) offer essential \nadvantages mainly in overweight and elderly patients (smaller \nincisions, better visualization, shorter hospital stay, less postoperative \npain, quick recovery and low risk for postoperative complications). \nHowever, they are significantly more difficult and time consuming \nand require advanced surgical skills. This is the reason why, minimally \ninvasive techniques are less popular and are mainly implemented in \npatients with early stage disease.3‒8,11,13,17‒19,23,24,27,31  \nIt is interesting to note, that pelvic and para‒aortic \nlymphadenectomy plays a crucial role in the systematic surgical \nstaging of patients with SPEOC. Moreover pelvic and para‒aortic \nlymphadenectomy represents the only way to diagnose patients \nwith stage III disease. 3‒8,27,31 The radical extent of pelvic and para‒\naortic lymph node dissection (more than 14 lymph nodes) in patients \nwith SPEOC, increases significantly the risk for postoperative \ncomplications.3‒8,23‒25,32,34 Consequently, in elderly patients and in \npatients with comorbidities (obesity, diabetes mellitus and coronary \nartery disease), the surgeon should carefully weigh the increased \nmorbidity with any survival advantage.3‒8,26,35,36\nOn the other hand, according to the recommendations of the \ninternational scientific societies (ACOG, FIGO and ESMO), \npostoperative adjuvant treatment (radiotherapy and/or chemotherapy) \nplays an equally important role in patients with malignancies of \nthe female genital tract and either increased risk for recurrence or \nat advanced disease stage. 3,4,7,8,10,11,13,17‒20,23‒29 However, in patients \nwith SPEOC, postoperative adjuvant treatment has a controversial \nrole.17,20,37 In this light, postoperative adjuvant treatment should be \nindividualized based on the risk of recurrence of each individual \nprimary cancer [3‒8,37,38]. Additionally, the postoperative adjuvant \ntreatment of each primary cancer should not affect the postoperative \nadjuvant treatment of the other neoplasm.3‒8,10,13,18‒20,22‒24,37,39‒42\nThe postoperative adjuvant radiotherapy in patients with SPEOC \nincludes vaginal brachytherapy and external radiotherapy. 3‒8,23‒25 \nVaginal brachytherapy is the adjuvant treatment of choice for \nintermediate risk endometrial cancer (EC) patients (stage IA grade \n3 endometrioid type EC, stage IB grade 1‒2 endometrioid type \nEC).3‒8,28,43‒48 It is well tolerated and minimizes the risk of local \nrecurrences but has no impact on overall survival. 43,45,47,49 Moreover, \nit is associated with well‒tolerated side effects and improved quality \nof life.3‒8,43,45,47,49 Especially for intermediate risk EC patients, vaginal \nbrachytherapy and external pelvic radiotherapy are equivalent in \nachieving local control of the disease.28,43‒46\nLikewise, external pelvic radiotherapy represents the adjuvant \ntreatment of choice in high risk EC patients (stage IB grade 3 \nendometrioid type EC, stage I non‒endometrioid type EC). 3‒8,28,44,46,49 \nIt is not well tolerated, being associated with significant morbidity and \nimpairment in the quality of life. 3‒8,43,50 Despite the fact that external \npelvic radiotherapy reduces the risk for local recurrences, it has no \nimpact on overall survival.3‒8,43,45,47,50,51\nIn contrast, postoperative adjuvant chemotherapy is the \nadjuvant treatment of choice in patients with SPEOC and advanced \nstage disease. 3‒8,38 The most common used chemotherapeutic \nagents in patients with SPEOC, are taxanes, anthracyclines \nObstet Gynecol Int J. 2016;4(6):216‒218. 216\n©2016 Androutsopoulos et al. This is an open access article distributed under the terms of the Creative Commons Attribution \nLicense, which permits unrestricted use, distribution, and build upon your work non-commercially.\nCurrent treatment options in patients with \nsynchronous primary endometrial and ovarian \ncancers\nVolume 4 Issue 6 - 2016\nGeorgios Androutsopoulos, Georgios \nMichail, Georgios Decavalas\nDepartment of Obstetrics and Gynecology, University of Patras, \nGreece\nCorrespondence: Georgios Androutsopoulos, Department of \nObstetrics and Gynecology, University of Patras, Medical School, \nRion 26504, Greece, T el 306974088092, \nEmail \nReceived: July 08, 2016 | Published: July 18, 2016\nObstetrics & Gynecology International Journal\nEditorial\n Open Access\nEditorial\nNowadays, synchronous primary cancers represent a very rare \nclinical entity. 1‒9 Especially in patients with malignancies of the \nfemale genital tract, only 0.5‒1.7% of them harbour synchronous \nprimary cancers.10‒15 Among them, synchronous primary endometrial \nand ovarian cancers (SPEOC) is the most common combination of \ncancers of the female genital tract. 1,6,10,11,13 They usually develop in \nyoung, obese, premenopausal and nulliparous women and the average \nage at diagnosis is approximately 50 years. 10,15‒21 Those patients are \ncommonly 10 ‒ 20 years younger than patients with single primary \nendometrial or ovarian cancer.11,18,19,21,22\nTo begin with, most international scientific societies (ACOG, FIGO \nand ESMO) recommend the systematic surgical staging as the initial \ntreatment approach in patients with malignancies of the female genital \ntract.3,4,7,8,10,11,13,17‒20,23‒30 In particular, the systematic surgical staging in \nthose patients with SPEOC includes: total abdominal hysterectomy \nwith bilateral salpingo‒oophorectomy, total omentectomy, \nappendectomy, pelvic and para‒aortic lymphadenectomy, complete \nresection of all disease, biopsies of any suspicious lesions and pelvic \nwashings.3‒8,11,13,17‒19,23,24,27,21\n\nCurrent treatment options in patients with synchronous primary endometrial and ovarian cancers\n217\nCopyright:\n©2016 Androutsopoulos et al.\nCitation: Androutsopoulos G, Michail G, Decavalas G. Current treatment options in patients with synchronous primary endometrial and ovarian cancers. \nObstet Gynecol Int J. 2016;4(6):216‒218. DOI: 10.15406/ogij.2016.04.00134\nand platinum compounds. The administration of postoperative \nadjuvant chemotherapy achieves high response rates in patients \nwith SPEOC. 3‒8,18,20 Nowadays, the postoperative combination of \nadjuvant radiotherapy with adjuvant chemotherapy shows promising \nresults, especially in high risk or at advanced stage SPEOC patients. \nThe combined application of adjuvant radiotherapy and adjuvant \nchemotherapy reduces the risk of relapse or death and increases \noverall survival in SPEOC patients.3‒8,18,20,28,44,46,49\nIn conclusion, the systematic surgical staging plays a crucial role \nin the treatment of SPEOC and offers many diagnostic, prognostic \nand therapeutic advantages. 3‒8,10,11,13,17‒20,23,24,26 Additionally, it allows \nmore sound and objective decisions on the necessity of postoperative \nadjuvant treatment in patients with SPEOC, in order to maximize \nsurvival and minimize the morbidity of over‒treatment (radiation \ninjury, regimen‒related toxicity) and the effects of under‒treatment \n(recurrent disease, increased mortality).3‒8,23‒26\nAcknowledgments\nNone.\nConflicts of interest\nNone.\nReferences\n1. 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