Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2001
TO THE EDITOR: From their study of patients referred for radioiodine ablation, Cholewinski et al.... more TO THE EDITOR: From their study of patients referred for radioiodine ablation, Cholewinski et al. (1) concluded that diagnostic whole-body scanning can be performed effectively with a 185-MBq (5-mCi) dose of 131 I 72 h before radioiodine ablation with no evidence of, and therefore no concern for, thyroid stunning. Their study group consisted of 122 patients who were given a diagnostic dose of 185 MBq 131 I and who were scanned 72 h later. On the day of scanning, after its completion, the patients received an ablation dose of 131 I (5,550 MBq in most cases); whole-body imaging (with spot views) was undertaken 72 h later. The diagnostic and postablation scans were inspected visually, taking note of the number of foci of uptake and the intensity of uptake. Analysis of their observations led to the conclusion that no stunning had occurred and that this was a consequence of the short time interval between the diagnostic and ablation doses. The phenomenon of stunning has been investigated using both qualitative (2,3) and quantitative methods, the latter using profile scanning (4) or an external neck probe (5). In our center we use a twin-head gamma camera in the measurement of uptake after the diagnostic dose (120 MBq) and, more recently, therapeutic dose (4,000 MBq) of radioiodine, taking into account correction for the effects of high counting rates. Uptake on the diagnostic scan is measured at 72 h and uptake of the ablation dose is measured on 1 or more occasions in the time interval 24-72 h. Shorter time intervals after the ablation dose were used to investigate the possibility of rapid turnover of the "destructive" ablation dose in the thyroid remnants. To date, 26 patients have been investigated. Thyroid uptake after the ablation dose was reduced in 25 of the 26 patients, being 39.4% Ϯ 22.9% (mean Ϯ SD) of the diagnostic uptake (range, 10%-100%). The mean uptake (ϮSD) of the diagnostic dose was 7.6% Ϯ 6.4%, and the mean time interval (ϮSD) between the diagnostic dose and the ablation dose was 16 Ϯ 10 d. Within the study group, 2 patients received the ablation dose on the day of the diagnostic scan and another patient received the ablation dose 4 d after the diagnostic dose. In all 3 patients, the uptake of the ablation dose was reduced, being 86%, 59%, and 40% of the diagnostic uptake, respectively. No differences between the diagnostic and postablation scans were seen on visual inspection. On the basis of our experience, quantitative assessment is an essential prerequisite before any conclusions are made with regard to the presence or absence of stunning. As a consequence, we believe that considerable doubts remain in relation to the authors' conclusion that there is no stunning effect using their protocol, and we are continuing to assess the magnitude of the problem in a larger pool of patients.
Background. Two prospective randomised trials, comparing neoadjuvant chemotherapy (NACT) with upf... more Background. Two prospective randomised trials, comparing neoadjuvant chemotherapy (NACT) with upfront debulking surgery (UDS) in advanced tubo-ovarian cancer (EORTC 55971 and MRC CHORUS), were analysed with the aim to examine the long term outcomes of the patients and identify any preferable therapeutic approaches for subgroup populations. Methods. Pre-planned individual updated patient data meta-analysis of both trials (NCT00003636 and ISRCTN74802813). , In the EORTC trial eligible women had biopsy proven stage IIIC or IV invasive epithelial tubo-ovarian carcinoma. In the CHORUS, trial the inclusion criteria were similar, but women with apparent stage IIIA and IIIB were also eligible. The main aim of the meta-analysis was to show non-inferiority in overall survival with NACT compared UDS using the "reverse Kaplan-Meier" method. Test for heterogeneity was based on the Cochran's Q heterogeneity statistic. Findings. 1220 women were randomised. The overall median follow-up was 7.6 years (EORTC 9.2 and CHORUS 5.9 years). Median patient age was 63 years (range 25-88 years) and median size of the largest metastatic tumour at diagnosis was 8 cm (range 0-50 cm). FIGO stage distribution was II-IIIB(4.5%), IIIC(68.1%), IV(18.9%) with 8.5% of data missing. There was no statistically significant difference for the entire population regarding the median overall survival (OS) between patients who underwent UDS and NACT (26.9 and 27.6 months; HR: 0.98, 95% CI: 0.87-1.10; p = 0.688). Median OS for EORTC and CHORUS patients was significantly different at 30.2 and 23.6 months, respectively (HR: 1.20, 95% CI:1.06-1.36;p=0.004) but not significantly heterogeneous (Cochran's Q p= 0.17). Variable outcomes were noted in some cohorts. Interpretation. Long-term follow-up data confirm that NACT and UDS result in similar OS in advanced tuboovarian cancer, with preferential outcomes in some patients. This meta-analysis, with long-term follow-up, confirms that NACT is a valuable treatment option for patients with Stage IIIC-IV tubo-ovarian cancer, especially in patients with a high tumour burden at presentation and/or poor performance status.
European journal of obstetrics, gynecology, and reproductive biology, 2017
The British Gynaecological Cancer Society has issued the first Endometrial (Uterine) Cancer guide... more The British Gynaecological Cancer Society has issued the first Endometrial (Uterine) Cancer guidelines as recommendation for practice for the UK.
We have used a relatively new trial methodology, the group sequential design, to prospectively ev... more We have used a relatively new trial methodology, the group sequential design, to prospectively evaluate two dose levels of bolus/infusional 5-fluorouracil (5-FU) and folinic acid in 192 consecutive-patients with advanced colorectal carcinoma. On day 1, all patients received 200 mg m-2 of folinic acid infusion over 2 h. Cohort A (n = 102 patients) received 500 mg m-2 5-FU by i.v. 1 5-min infusion followed by an infusion of 500 mg m-2 5-FU over 22 h. Treatment was repeated on day 2 and further cycles given 2-weekly. After sequential analysis excluded a response rate of over 40%, cohort B (n = 90 patients) received an increased dose of 600 mg m-2 5-FU bolus and infusion. Patients had received no prior 5-FU therapy and the two cohorts had similar demographic features. In 179 evaluable patients, the overall response rate was 18% (95% Cl 12-24%) with CR of 6% and PR of 12%, with no difference between the two cohorts. Overall median survival was 34 weeks (95% Cl 30-39) with no significant difference between cohorts (median survival 32 and 37 weeks in cohort A and B respectively; P = 0.27). On multivariate analysis, poor performance status, elevated initial WBC and alkaline phosphatase and low serum albumin were associated with reduced survival (P < 0.05), and initial raised WBC showed an association with reduced likelihood of response (P = 0.002). Overall toxicity was low with CTC grade 3 mucositis, diarrhoea, nausea or vomiting in < 6% of patients and no treatment-related deaths. Significant (grade 3 or above) leucopenia was more common in cohort B than in cohort A (9% and 1% respectively); there were more dose reductions, and the median administered dose intensity was lower in cohort B than in cohort A (89% and 97% respectively; P = 0.006). In this group of relatively unselected patients, we have confirmed a relatively low objective response rate and median survival of 7.8 months with this regimen. There was no significant difference in outcome between the two dose levels but the higher dose of 5-FU was associated with more dose reductions and greater toxicity.
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 1986
The value of [99mTc(V)]DMS and [131I]MIBG in imaging medullary carcinoma of the thyroid was inves... more The value of [99mTc(V)]DMS and [131I]MIBG in imaging medullary carcinoma of the thyroid was investigated in five patients. Results with [99mTc(V)]DMS were negative in all five patients as well as with [131I]MIBG in four patients; however, there was significant tumor uptake in one patient with [131I]MIBG.
networks focused on gynecological cancer research on a large scale. Intergroup collaboration and ... more networks focused on gynecological cancer research on a large scale. Intergroup collaboration and international contribution to establish the current and future worldwide standards of care is also a priority for the GCG. The GCG also has a good track record in rare tumors and will continue working on rare diseases along with international partners.
Isolated carcinoid tumor metastatic to the thyroid gland: report of a case initially diagnosed by... more Isolated carcinoid tumor metastatic to the thyroid gland: report of a case initially diagnosed by fine needle aspiration cytology. Acta Cytol. 50(1), 84-7 (2006). 10. Phan AT, et al: NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors. Pancreas. 39(6),784-98 (2010). Mananagement •Right lower and middle lobectomy Nov 2003 •Histology confirmed typical carcinoid tumour with complete resection margin •Well and back to work by Feb 2004. Discharged from respiratory follow-up
term disease free survival in a patient with metastatic adreno-cortical carcinoma after complete ... more term disease free survival in a patient with metastatic adreno-cortical carcinoma after complete pathological response to chemotherapy plus mitotane.
Purpose To compare the frequency of visceral relapse of BRCA1/2-deficient ovarian cancer to that ... more Purpose To compare the frequency of visceral relapse of BRCA1/2-deficient ovarian cancer to that of nonhereditary controls. Patients and Methods All patients diagnosed in Scotland with epithelial ovarian cancer (EOC) or primary peritoneal cancer (PPC) and a germline BRCA1/2 mutation were identified. Those with previous malignancy were excluded. Each remaining patient who experienced relapse was matched with two nonhereditary controls. Results Seventy-nine patients with EOC/PPC and germline BRCA1/2 mutations were identified. Fifteen had inadequate clinical data, two had carcinosarcoma, 27 had previous breast cancer, and 16 were in remission. Of the remaining 19 patients who were BRCA1/2 deficient, 14 patients (74%) developed visceral metastases compared with six (16%) of 38 patients in the control group. The percentages of liver, lung, and splenic metastases were 53%, 32%, and 32%, respectively, in the patients compared with 5%, 3%, and 5%, respectively, in the controls. When events ...
International Journal of Gynecological Cancer, 2011
In young patients with borderline ovarian tumor a conservative treatment approach does not seem t... more In young patients with borderline ovarian tumor a conservative treatment approach does not seem to have a significant impact on survival, and the outcome regarding fertility is good in general. It can be considered even if noninvasive peritoneal implants are discovered at the time of the initial surgery. In contrast, in patients with epithelial ovarian cancer, conservative surgery should be considered only in adequately staged patients, with a stage IA grade 1 (and probably 2) serous, mucinous or an endometrioid tumor, including a careful follow-up. Such an approach could also probably be discussed in stage IC grade 1 disease. In patients with nonepithelial malignant ovarian tumors, conservative surgery is also feasible, particularly in patients with malignant germ cell tumors because of their high chemosensitivity leading to an excellent prognosis in general.
Advanced ovarian cancer has a poor prognosis. Debulking surgery and platinum-based chemotherapy a... more Advanced ovarian cancer has a poor prognosis. Debulking surgery and platinum-based chemotherapy are the cornerstones of the treatment. Primary debulking surgery has been the standard of care in advanced ovarian cancer. Recently a new strategy with neoadjuvant chemotherapy followed by interval debulking surgery has been developed. In a recently published randomised trial of the EORTC-NCIC (European Organisation for Research and Treatment of Cancer − National Cancer Institute Canada) in patients with extensive stage IIIc and IV ovarian cancer it was shown that the survival was similar for patients randomised to neoadjuvant chemotherapy followed by interval debulking compared to primary debulking surgery, followed by chemotherapy. The post-operative complications and mortality rates were lower after interval debulking than after primary debulking surgery. The most important independent prognostic factor for overall survival was no residual tumour after primary or interval debulking surgery. In some patients obtaining the goal of no residual tumour at interval debulking is difficult due to chemotherapy-induced fibrosis. On the other hand the patients randomised had very extensive stage IIIc and IV disease and in patients with metastases smaller than 5 cm the survival tended to be better after primary debulking surgery. Hence, selection of the correct patients with stage IIIc or IV ovarian cancer for primary debulking or neoadjuvant chemotherapy followed by interval debulking surgery is important. Besides imaging with CT, diffusion MRI and/or PET-CT, also laparoscopy can play an important role in the selection of patients. It should be emphasised that the group of patients included in this study had extensive stage IIIc or IV disease. Surgical skills, especially in the upper abdomen, remain pivotal in the treatment of advanced ovarian cancer. However, very aggressive surgery should be tailored according to the general condition and extent of the disease of the patients. Otherwise, this type of aggressive surgery will result in unnecessary postoperative morbidity and mortality without improving survival. Hence, neoadjuvant chemotherapy should not be an easy way out, but is in some patients with stage IIIc or IV ovarian cancer a better alternative treatment option than primary debulking. According to the current treatment algorithm at the University Hospitals Leuven about 50% of the patients with stage IIIc or IV ovarian cancer are selected for neoadjuvant chemotherapy.
Introduction: Surgery is the mainstay of staging and treatment of ovarian cancer. Optimal quality... more Introduction: Surgery is the mainstay of staging and treatment of ovarian cancer. Optimal quality of ovarian cancer surgery implies complete staging and removal of all macroscopic tumour with minimal harm to the patient in order to ensure best patient outcome. However, variation in the quality of ovarian cancer surgery is apparent. In order to assess and improve the quality of care, quality indicators can be used. Methods: To identify candidate quality indicators, a literature search was performed using relevant MESH terms. These were assessed for validity, feasibility and measurability. Results: Five quality indicators for staging of presumed early-stage ovarian cancer and six for primary debulking surgery for advanced disease are proposed. Conclusion: The defined quality indicators can be used to monitor and improve the quality of surgery for ovarian cancer.
Purpose: To evaluate the efficacy of the aromatase inhibitor letrozole in preselected estrogen re... more Purpose: To evaluate the efficacy of the aromatase inhibitor letrozole in preselected estrogen receptor (ER)–positive relapsed epithelial ovarian cancer patients and to identify markers that predict endocrine-sensitive disease. Experimental Design: This was a phase II study of letrozole 2.5 mg daily until clinical or marker evidence of disease progression in previously treated ER-positive ovarian cancer patients with a rising CA125 that had progressed according to Rustin's criteria. The primary end point was response according to CA125 and response evaluation criteria in solid tumors (RECIST) criteria. Marker expression was measured by semiquantitative immunohistochemistry in sections from the primary tumor. Results: Of 42 patients evaluable for CA125 response, 7 (17%) had a response (decrease of >50%), and 11 (26%) patients had not progressed (doubling of CA125) following 6 months on treatment. The median time taken to achieve the CA125 nadir was 13 weeks (range 10-36). Of 3...
Radical hysterectomy combined with a pelvic lymphadenectomy or chemoradiation are traditionally t... more Radical hysterectomy combined with a pelvic lymphadenectomy or chemoradiation are traditionally the mainstays of treatment of International Federation of Gynecology and Obstetrics stages Ia2-IIa cervical cancer. The quality of radical surgery for cervical cancer influences local tumor control and survival. Hence, it is important to optimize and ensure the quality of surgical care for cervical cancer patients. In this paper, we discuss factors that are related to outcome after radical hysterectomy and propose a set of quality indicators that can be used to audit and improve the quality of surgical care for cervical cancer patients.
j o u r n a l h o m e p a g e : w w w. e j c o n l i n e. c o m between CS and LMS. CS appears to... more j o u r n a l h o m e p a g e : w w w. e j c o n l i n e. c o m between CS and LMS. CS appears to show more kinship to poorly differentiated endometrial carcinomas in behaviour. LMS did not show the same benefit from radiation. These results will help shape future management and clinical trials in uterine sarcomas.
PURPOSE: This was a multicentric, open, randomized, phase II study of single-agent paclitaxel and... more PURPOSE: This was a multicentric, open, randomized, phase II study of single-agent paclitaxel and oxaliplatin to evaluate the efficacy of oxaliplatin in a relapsing progressive ovarian cancer patient population and to analyze the safety profile and impact of both agents on quality of life, time to progression, and survival. PATIENTS AND METHODS: Eighty-six patients with platinum-pretreated advanced ovarian cancer were randomly assigned to two arms: 41 received paclitaxel at 175 mg/m2 over 3 hours every 3 weeks, and 45 received oxaliplatin at 130 mg/m2 over 2 hours every 3 weeks. For inclusion, patients had to have a performance status of 0 to 2 and to have received at least one and no more than two prior cisplatin- and/or carboplatin-containing chemotherapy regimens within the last 12 months. RESULTS: Seven confirmed responses were observed in each arm, for an overall response rate in the total treated population of 17% (95% confidence interval [CI], 7% to 32%) in the paclitaxel arm...
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2001
TO THE EDITOR: From their study of patients referred for radioiodine ablation, Cholewinski et al.... more TO THE EDITOR: From their study of patients referred for radioiodine ablation, Cholewinski et al. (1) concluded that diagnostic whole-body scanning can be performed effectively with a 185-MBq (5-mCi) dose of 131 I 72 h before radioiodine ablation with no evidence of, and therefore no concern for, thyroid stunning. Their study group consisted of 122 patients who were given a diagnostic dose of 185 MBq 131 I and who were scanned 72 h later. On the day of scanning, after its completion, the patients received an ablation dose of 131 I (5,550 MBq in most cases); whole-body imaging (with spot views) was undertaken 72 h later. The diagnostic and postablation scans were inspected visually, taking note of the number of foci of uptake and the intensity of uptake. Analysis of their observations led to the conclusion that no stunning had occurred and that this was a consequence of the short time interval between the diagnostic and ablation doses. The phenomenon of stunning has been investigated using both qualitative (2,3) and quantitative methods, the latter using profile scanning (4) or an external neck probe (5). In our center we use a twin-head gamma camera in the measurement of uptake after the diagnostic dose (120 MBq) and, more recently, therapeutic dose (4,000 MBq) of radioiodine, taking into account correction for the effects of high counting rates. Uptake on the diagnostic scan is measured at 72 h and uptake of the ablation dose is measured on 1 or more occasions in the time interval 24-72 h. Shorter time intervals after the ablation dose were used to investigate the possibility of rapid turnover of the "destructive" ablation dose in the thyroid remnants. To date, 26 patients have been investigated. Thyroid uptake after the ablation dose was reduced in 25 of the 26 patients, being 39.4% Ϯ 22.9% (mean Ϯ SD) of the diagnostic uptake (range, 10%-100%). The mean uptake (ϮSD) of the diagnostic dose was 7.6% Ϯ 6.4%, and the mean time interval (ϮSD) between the diagnostic dose and the ablation dose was 16 Ϯ 10 d. Within the study group, 2 patients received the ablation dose on the day of the diagnostic scan and another patient received the ablation dose 4 d after the diagnostic dose. In all 3 patients, the uptake of the ablation dose was reduced, being 86%, 59%, and 40% of the diagnostic uptake, respectively. No differences between the diagnostic and postablation scans were seen on visual inspection. On the basis of our experience, quantitative assessment is an essential prerequisite before any conclusions are made with regard to the presence or absence of stunning. As a consequence, we believe that considerable doubts remain in relation to the authors' conclusion that there is no stunning effect using their protocol, and we are continuing to assess the magnitude of the problem in a larger pool of patients.
Background. Two prospective randomised trials, comparing neoadjuvant chemotherapy (NACT) with upf... more Background. Two prospective randomised trials, comparing neoadjuvant chemotherapy (NACT) with upfront debulking surgery (UDS) in advanced tubo-ovarian cancer (EORTC 55971 and MRC CHORUS), were analysed with the aim to examine the long term outcomes of the patients and identify any preferable therapeutic approaches for subgroup populations. Methods. Pre-planned individual updated patient data meta-analysis of both trials (NCT00003636 and ISRCTN74802813). , In the EORTC trial eligible women had biopsy proven stage IIIC or IV invasive epithelial tubo-ovarian carcinoma. In the CHORUS, trial the inclusion criteria were similar, but women with apparent stage IIIA and IIIB were also eligible. The main aim of the meta-analysis was to show non-inferiority in overall survival with NACT compared UDS using the "reverse Kaplan-Meier" method. Test for heterogeneity was based on the Cochran's Q heterogeneity statistic. Findings. 1220 women were randomised. The overall median follow-up was 7.6 years (EORTC 9.2 and CHORUS 5.9 years). Median patient age was 63 years (range 25-88 years) and median size of the largest metastatic tumour at diagnosis was 8 cm (range 0-50 cm). FIGO stage distribution was II-IIIB(4.5%), IIIC(68.1%), IV(18.9%) with 8.5% of data missing. There was no statistically significant difference for the entire population regarding the median overall survival (OS) between patients who underwent UDS and NACT (26.9 and 27.6 months; HR: 0.98, 95% CI: 0.87-1.10; p = 0.688). Median OS for EORTC and CHORUS patients was significantly different at 30.2 and 23.6 months, respectively (HR: 1.20, 95% CI:1.06-1.36;p=0.004) but not significantly heterogeneous (Cochran's Q p= 0.17). Variable outcomes were noted in some cohorts. Interpretation. Long-term follow-up data confirm that NACT and UDS result in similar OS in advanced tuboovarian cancer, with preferential outcomes in some patients. This meta-analysis, with long-term follow-up, confirms that NACT is a valuable treatment option for patients with Stage IIIC-IV tubo-ovarian cancer, especially in patients with a high tumour burden at presentation and/or poor performance status.
European journal of obstetrics, gynecology, and reproductive biology, 2017
The British Gynaecological Cancer Society has issued the first Endometrial (Uterine) Cancer guide... more The British Gynaecological Cancer Society has issued the first Endometrial (Uterine) Cancer guidelines as recommendation for practice for the UK.
We have used a relatively new trial methodology, the group sequential design, to prospectively ev... more We have used a relatively new trial methodology, the group sequential design, to prospectively evaluate two dose levels of bolus/infusional 5-fluorouracil (5-FU) and folinic acid in 192 consecutive-patients with advanced colorectal carcinoma. On day 1, all patients received 200 mg m-2 of folinic acid infusion over 2 h. Cohort A (n = 102 patients) received 500 mg m-2 5-FU by i.v. 1 5-min infusion followed by an infusion of 500 mg m-2 5-FU over 22 h. Treatment was repeated on day 2 and further cycles given 2-weekly. After sequential analysis excluded a response rate of over 40%, cohort B (n = 90 patients) received an increased dose of 600 mg m-2 5-FU bolus and infusion. Patients had received no prior 5-FU therapy and the two cohorts had similar demographic features. In 179 evaluable patients, the overall response rate was 18% (95% Cl 12-24%) with CR of 6% and PR of 12%, with no difference between the two cohorts. Overall median survival was 34 weeks (95% Cl 30-39) with no significant difference between cohorts (median survival 32 and 37 weeks in cohort A and B respectively; P = 0.27). On multivariate analysis, poor performance status, elevated initial WBC and alkaline phosphatase and low serum albumin were associated with reduced survival (P < 0.05), and initial raised WBC showed an association with reduced likelihood of response (P = 0.002). Overall toxicity was low with CTC grade 3 mucositis, diarrhoea, nausea or vomiting in < 6% of patients and no treatment-related deaths. Significant (grade 3 or above) leucopenia was more common in cohort B than in cohort A (9% and 1% respectively); there were more dose reductions, and the median administered dose intensity was lower in cohort B than in cohort A (89% and 97% respectively; P = 0.006). In this group of relatively unselected patients, we have confirmed a relatively low objective response rate and median survival of 7.8 months with this regimen. There was no significant difference in outcome between the two dose levels but the higher dose of 5-FU was associated with more dose reductions and greater toxicity.
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 1986
The value of [99mTc(V)]DMS and [131I]MIBG in imaging medullary carcinoma of the thyroid was inves... more The value of [99mTc(V)]DMS and [131I]MIBG in imaging medullary carcinoma of the thyroid was investigated in five patients. Results with [99mTc(V)]DMS were negative in all five patients as well as with [131I]MIBG in four patients; however, there was significant tumor uptake in one patient with [131I]MIBG.
networks focused on gynecological cancer research on a large scale. Intergroup collaboration and ... more networks focused on gynecological cancer research on a large scale. Intergroup collaboration and international contribution to establish the current and future worldwide standards of care is also a priority for the GCG. The GCG also has a good track record in rare tumors and will continue working on rare diseases along with international partners.
Isolated carcinoid tumor metastatic to the thyroid gland: report of a case initially diagnosed by... more Isolated carcinoid tumor metastatic to the thyroid gland: report of a case initially diagnosed by fine needle aspiration cytology. Acta Cytol. 50(1), 84-7 (2006). 10. Phan AT, et al: NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors. Pancreas. 39(6),784-98 (2010). Mananagement •Right lower and middle lobectomy Nov 2003 •Histology confirmed typical carcinoid tumour with complete resection margin •Well and back to work by Feb 2004. Discharged from respiratory follow-up
term disease free survival in a patient with metastatic adreno-cortical carcinoma after complete ... more term disease free survival in a patient with metastatic adreno-cortical carcinoma after complete pathological response to chemotherapy plus mitotane.
Purpose To compare the frequency of visceral relapse of BRCA1/2-deficient ovarian cancer to that ... more Purpose To compare the frequency of visceral relapse of BRCA1/2-deficient ovarian cancer to that of nonhereditary controls. Patients and Methods All patients diagnosed in Scotland with epithelial ovarian cancer (EOC) or primary peritoneal cancer (PPC) and a germline BRCA1/2 mutation were identified. Those with previous malignancy were excluded. Each remaining patient who experienced relapse was matched with two nonhereditary controls. Results Seventy-nine patients with EOC/PPC and germline BRCA1/2 mutations were identified. Fifteen had inadequate clinical data, two had carcinosarcoma, 27 had previous breast cancer, and 16 were in remission. Of the remaining 19 patients who were BRCA1/2 deficient, 14 patients (74%) developed visceral metastases compared with six (16%) of 38 patients in the control group. The percentages of liver, lung, and splenic metastases were 53%, 32%, and 32%, respectively, in the patients compared with 5%, 3%, and 5%, respectively, in the controls. When events ...
International Journal of Gynecological Cancer, 2011
In young patients with borderline ovarian tumor a conservative treatment approach does not seem t... more In young patients with borderline ovarian tumor a conservative treatment approach does not seem to have a significant impact on survival, and the outcome regarding fertility is good in general. It can be considered even if noninvasive peritoneal implants are discovered at the time of the initial surgery. In contrast, in patients with epithelial ovarian cancer, conservative surgery should be considered only in adequately staged patients, with a stage IA grade 1 (and probably 2) serous, mucinous or an endometrioid tumor, including a careful follow-up. Such an approach could also probably be discussed in stage IC grade 1 disease. In patients with nonepithelial malignant ovarian tumors, conservative surgery is also feasible, particularly in patients with malignant germ cell tumors because of their high chemosensitivity leading to an excellent prognosis in general.
Advanced ovarian cancer has a poor prognosis. Debulking surgery and platinum-based chemotherapy a... more Advanced ovarian cancer has a poor prognosis. Debulking surgery and platinum-based chemotherapy are the cornerstones of the treatment. Primary debulking surgery has been the standard of care in advanced ovarian cancer. Recently a new strategy with neoadjuvant chemotherapy followed by interval debulking surgery has been developed. In a recently published randomised trial of the EORTC-NCIC (European Organisation for Research and Treatment of Cancer − National Cancer Institute Canada) in patients with extensive stage IIIc and IV ovarian cancer it was shown that the survival was similar for patients randomised to neoadjuvant chemotherapy followed by interval debulking compared to primary debulking surgery, followed by chemotherapy. The post-operative complications and mortality rates were lower after interval debulking than after primary debulking surgery. The most important independent prognostic factor for overall survival was no residual tumour after primary or interval debulking surgery. In some patients obtaining the goal of no residual tumour at interval debulking is difficult due to chemotherapy-induced fibrosis. On the other hand the patients randomised had very extensive stage IIIc and IV disease and in patients with metastases smaller than 5 cm the survival tended to be better after primary debulking surgery. Hence, selection of the correct patients with stage IIIc or IV ovarian cancer for primary debulking or neoadjuvant chemotherapy followed by interval debulking surgery is important. Besides imaging with CT, diffusion MRI and/or PET-CT, also laparoscopy can play an important role in the selection of patients. It should be emphasised that the group of patients included in this study had extensive stage IIIc or IV disease. Surgical skills, especially in the upper abdomen, remain pivotal in the treatment of advanced ovarian cancer. However, very aggressive surgery should be tailored according to the general condition and extent of the disease of the patients. Otherwise, this type of aggressive surgery will result in unnecessary postoperative morbidity and mortality without improving survival. Hence, neoadjuvant chemotherapy should not be an easy way out, but is in some patients with stage IIIc or IV ovarian cancer a better alternative treatment option than primary debulking. According to the current treatment algorithm at the University Hospitals Leuven about 50% of the patients with stage IIIc or IV ovarian cancer are selected for neoadjuvant chemotherapy.
Introduction: Surgery is the mainstay of staging and treatment of ovarian cancer. Optimal quality... more Introduction: Surgery is the mainstay of staging and treatment of ovarian cancer. Optimal quality of ovarian cancer surgery implies complete staging and removal of all macroscopic tumour with minimal harm to the patient in order to ensure best patient outcome. However, variation in the quality of ovarian cancer surgery is apparent. In order to assess and improve the quality of care, quality indicators can be used. Methods: To identify candidate quality indicators, a literature search was performed using relevant MESH terms. These were assessed for validity, feasibility and measurability. Results: Five quality indicators for staging of presumed early-stage ovarian cancer and six for primary debulking surgery for advanced disease are proposed. Conclusion: The defined quality indicators can be used to monitor and improve the quality of surgery for ovarian cancer.
Purpose: To evaluate the efficacy of the aromatase inhibitor letrozole in preselected estrogen re... more Purpose: To evaluate the efficacy of the aromatase inhibitor letrozole in preselected estrogen receptor (ER)–positive relapsed epithelial ovarian cancer patients and to identify markers that predict endocrine-sensitive disease. Experimental Design: This was a phase II study of letrozole 2.5 mg daily until clinical or marker evidence of disease progression in previously treated ER-positive ovarian cancer patients with a rising CA125 that had progressed according to Rustin's criteria. The primary end point was response according to CA125 and response evaluation criteria in solid tumors (RECIST) criteria. Marker expression was measured by semiquantitative immunohistochemistry in sections from the primary tumor. Results: Of 42 patients evaluable for CA125 response, 7 (17%) had a response (decrease of >50%), and 11 (26%) patients had not progressed (doubling of CA125) following 6 months on treatment. The median time taken to achieve the CA125 nadir was 13 weeks (range 10-36). Of 3...
Radical hysterectomy combined with a pelvic lymphadenectomy or chemoradiation are traditionally t... more Radical hysterectomy combined with a pelvic lymphadenectomy or chemoradiation are traditionally the mainstays of treatment of International Federation of Gynecology and Obstetrics stages Ia2-IIa cervical cancer. The quality of radical surgery for cervical cancer influences local tumor control and survival. Hence, it is important to optimize and ensure the quality of surgical care for cervical cancer patients. In this paper, we discuss factors that are related to outcome after radical hysterectomy and propose a set of quality indicators that can be used to audit and improve the quality of surgical care for cervical cancer patients.
j o u r n a l h o m e p a g e : w w w. e j c o n l i n e. c o m between CS and LMS. CS appears to... more j o u r n a l h o m e p a g e : w w w. e j c o n l i n e. c o m between CS and LMS. CS appears to show more kinship to poorly differentiated endometrial carcinomas in behaviour. LMS did not show the same benefit from radiation. These results will help shape future management and clinical trials in uterine sarcomas.
PURPOSE: This was a multicentric, open, randomized, phase II study of single-agent paclitaxel and... more PURPOSE: This was a multicentric, open, randomized, phase II study of single-agent paclitaxel and oxaliplatin to evaluate the efficacy of oxaliplatin in a relapsing progressive ovarian cancer patient population and to analyze the safety profile and impact of both agents on quality of life, time to progression, and survival. PATIENTS AND METHODS: Eighty-six patients with platinum-pretreated advanced ovarian cancer were randomly assigned to two arms: 41 received paclitaxel at 175 mg/m2 over 3 hours every 3 weeks, and 45 received oxaliplatin at 130 mg/m2 over 2 hours every 3 weeks. For inclusion, patients had to have a performance status of 0 to 2 and to have received at least one and no more than two prior cisplatin- and/or carboplatin-containing chemotherapy regimens within the last 12 months. RESULTS: Seven confirmed responses were observed in each arm, for an overall response rate in the total treated population of 17% (95% confidence interval [CI], 7% to 32%) in the paclitaxel arm...
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Papers by Nick Reed