Saturday, February 25, 2012
UPDATE: Additional Web sites Selling MMS Sodium Chlorite Solution Not Authorized for Oral Consumption by Humans - Health Canada Advisory 2012-02-23
......Health Canada would also like to remind Canadians that there are no therapeutic products containing sodium chlorite authorized for oral consumption by humans. MMS may cause serious health problems that include poisoning, kidney failure and harm to red blood cells that reduces the ability of the blood to carry oxygen. Additional health problems may also include abdominal pain, nausea, vomiting, and diarrhoea.
Consumers should consult their health care practitioner if they have used or are using MMS products and report any adverse reaction to Health Canada.
Health Canada has notified distributors identified to date that the sale of sodium chlorite for human consumption is in contravention of the Food and Drugs Act. We have also requested that identified distributors remove product from the Canadian market. As such, the websites (www.miracle-mineral-supplement.com and www.mms1.ca) may or may not be operational. (Blogger's Note: the first website is still operational, the second website 'not found' - updated 11:14pm Feb 25th)
Advancing personalized medicine: Tailoring drugs to fit a patient's genetic predisposition
Drug effectiveness on common diseases Not all drugs are equally effective in all patients. Some types of drugs, such as analgesics,
are effective on almost all patients, whereas other types, such as anticancer agents, are effective only on 25% of patients. In working
towards the realization of personalized medicine, it is important to develop ways of using genetic information to prescribe to
patients the most suitable drugs in light of their genetic risk to side effects.
abstract: Incidence of metachronous second primary cancers in Osaka, Japan: update of analyses using population-based cancer registry data
Incidence of metachronous second primary cancers in Osaka, Japan: update of analyses using population-based cancer registry data:
(define: metachronous - Two or more cancers appearing at different points in time.)
Summary
Cancer survivors are at excess risk of developing second primary cancers, but the level of risk is uncertain in Japan.
To investigate the risk of survivors developing second primary cancers, we conducted a retrospective cohort study using data from the Osaka Cancer Registry. Study subjects were all reported cases aged 0-79, who were first diagnosed with cancer between 1985 and 2004 in Osaka and survived for at least 3 months, followed up through December 2005.
A metachronous second primary cancer was defined as any invasive second cancer which was diagnosed between 3 months and 10 years after the first cancer diagnosis.
The main outcome measures were incidence rates per 100,000 person-years, cumulative risk and standardized incidence ratios (SIRs) of second primary cancer. Metachronous second primary cancers developed in 13,385 (3.8%) out of 355,966 survivors after a median follow-up of 2.5 years. Sex-specific incidence rates of metachronous second primary cancer per 100,000 person-years increased with age, and were higher among males than females (except for age 0-49), but these rates did not differ over the study period. The 10-year cumulative risk was estimated as 13.0% for those who first developed cancer in their sixties (16.2% for men, 8.6% for women). The SIRs among those with first cancer at 0-39 years old and 40-49 years old were 2.13 and 1.52, respectively, in both sexes, while the SIRs among cancers of the mouth/pharynx, esophagus and larynx were much higher than one as for site relationships.
We showed that cancer survivors in Osaka, Japan, were at higher risk of second primary cancers compared to the general population. Our findings indicated that second primary cancers should be considered as a commonly encountered, major medical problem. Further study is required to advance our understanding for effective measures against multiple primary cancers.
To investigate the risk of survivors developing second primary cancers, we conducted a retrospective cohort study using data from the Osaka Cancer Registry. Study subjects were all reported cases aged 0-79, who were first diagnosed with cancer between 1985 and 2004 in Osaka and survived for at least 3 months, followed up through December 2005.
A metachronous second primary cancer was defined as any invasive second cancer which was diagnosed between 3 months and 10 years after the first cancer diagnosis.
The main outcome measures were incidence rates per 100,000 person-years, cumulative risk and standardized incidence ratios (SIRs) of second primary cancer. Metachronous second primary cancers developed in 13,385 (3.8%) out of 355,966 survivors after a median follow-up of 2.5 years. Sex-specific incidence rates of metachronous second primary cancer per 100,000 person-years increased with age, and were higher among males than females (except for age 0-49), but these rates did not differ over the study period. The 10-year cumulative risk was estimated as 13.0% for those who first developed cancer in their sixties (16.2% for men, 8.6% for women). The SIRs among those with first cancer at 0-39 years old and 40-49 years old were 2.13 and 1.52, respectively, in both sexes, while the SIRs among cancers of the mouth/pharynx, esophagus and larynx were much higher than one as for site relationships.
We showed that cancer survivors in Osaka, Japan, were at higher risk of second primary cancers compared to the general population. Our findings indicated that second primary cancers should be considered as a commonly encountered, major medical problem. Further study is required to advance our understanding for effective measures against multiple primary cancers.
© 2012 Japanese Cancer Association
abstract: Different Levels of Sialyl-Tn Antigen Expressed on MUC16 in Patients With Endometriosis and Ovarian Cancer
Different Levels of Sialyl-Tn Antigen Expressed on MUC16 in Patients With Endometriosis and Ovarian Cancer
Abstract:
Objective:
Although CA125 antigen is a useful marker for ovarian cancer, its expression is also elevated in endometriosis. The purpose of this study was to develop an assay method for evaluating differentially glycosylated MUC16 (CA125 core protein) in patients with endometriosis and ovarian cancer.
Materials and Methods:
We prepared MUC16-enriched fractions from peritoneal fluid of patients with endometriosis and conditioned medium of ovarian carcinoma-3 cells by gel filtration, and evaluated the expression of sialyl-Lea, Tn, and sialyl-Tn antigens by dot blot analysis. A sandwich enzyme-linked immunosorbent assay was developed to measure the level of sialyl-Tn antigen expressed on MUC16 (sTn/MUC16). The level of sTn/MUC16 was compared between patients with endometriosis (n = 21) and ovarian cancer (n = 36) and in ovarian cancers with different clinical diagnostic criteria. Furthermore, distribution of MUC16 and sialyl-Tn antigen in ovarian cancer tissues was observed immunohistochemically.
Results:
Sialyl-Tn antigen was markedly detectable in the MUC16-enriched fractions from conditioned medium of ovarian carcinoma-3 cells but negligible in those from the peritoneal fluid of the patients with endometriosis. The level of sTn/MUC16 determined by a sandwich enzyme-linked immunosorbent assay was significantly higher in the patients with ovarian cancer than that in the patients with endometriosis (P < 0.001).
An elevated level of sTn/MUC16 was detected in 44% of the patients with ovarian cancer but not all the patients with endometriosis. This level increased more prominently in the patients with ovarian cancer than that of MUC16 as both the clinical stage and cytological grade advanced. An elevated level of sTn/MUC16 was frequently found in the patients with serous and endometrioid carcinomas. Consistent with this, sialyl-Tn antigen was colocalized with MUC16 in serous and endometrioid ovarian cancer tissues.
Conclusions:
Estimation of the sTn/MUC16 level may be useful for discriminating endometriosis from ovarian cancer and for evaluating the clinical stage, cytological grade, and histological type of ovarian cancer.
abstract: Evolution of surgical treatment paradigms for advanced-stage ovarian cancer: Redefining ‘optimal’ residual disease
Evolution of surgical treatment paradigms for advanced-stage ovarian cancer: Redefining ‘optimal’ residual disease
Abstract:
Over the past 40 years, the survival of patients with advanced ovarian cancer has greatly improved due to the introduction of combination chemotherapy with platinum and paclitaxel as standard front-line treatment and the progressive incorporation of increasing degrees of maximal cytoreductive surgery. The designation of “optimal” surgical cytoreduction has evolved from residual disease ≤ 1 cm to no gross residual disease. There is a growing body of evidence that patients with no gross residual disease have better survival than those with optimal but visible residual disease. In order to achieve this, more radical cytoreductive procedures such as radical pelvic resection and extensive upper abdominal procedures are increasingly performed. However, some investigators still suggest that tumor biology is a major determinant in survival and that optimal surgery cannot fully compensate for tumor biology.
The aim of this review is to outline the theoretical rationale and historical evolution of primary cytoreductive surgery, to re-evaluate the preferred surgical objective and procedures commonly required to achieve optimal cytoreduction in the platinum/taxane era based on contemporary evidence, and to redefine the concept of “optimal” residual disease within the context of future surgical developments and analysis of treatment outcomes.
Highlights
► No gross residual disease is associated with superior survival outcomes for patients with advanced-stage epithelial ovarian cancer.► Complete cytoreduction should be the preferred surgical objective at the time of initial surgery for advanced-stage epithelial ovarian cancer.
Outcomes of Patients with Gynecologic Malignancies Undergoing Video-Assisted Thoracoscopic Surgery (VATS) and Pleurodesis for Malignant Pleural Effusion
Outcomes of Patients with Gynecologic Malignancies Undergoing Video-Assisted Thoracoscopic Surgery (VATS) and Pleurodesis for Malignant Pleural Effusion
Background
We evaluated the indications and outcomes of patients with known gynecologic malignancies that underwent video-assisted thoracoscopic surgery (VATS) and pleurodesis for malignant pleural effusion.
Methods
After IRB approval was obtained, a retrospective study of patients with gynecologic malignancies who underwent planned VATS/pleurodesis between 1/2000 and 7/2010 was performed. Abstracted data included demographics, diagnosis, disease status, treatment history, indication for VATS, complications, and outcomes
Results
42 patients (University of Alabama) with a gynecologic malignancy underwent VATS/pleurodesis. Median age was 63 years. 29 patients (69%) had ovarian cancer. 57% had recurrent disease at the time of VATS and 57% were undergoing chemotherapy at the time of VATS. 8 patients (19%) underwent perioperative VATS to improve pulmonary status. 7 patients (17%) underwent a palliative VATS. The median length of stay was 7 days (range 1–53). 62% had gross disease noted at the time of VATS. A mean of 1650 cc of fluid was drained at time of surgery (range 300–4500), and the majority (88%) of patients had a talc pleurodesis performed. 7 patients (17%) were readmitted within 30 days; 6 were for complications unrelated to their VATS............. Patients who underwent a perioperative VATS had the longest survival (845 days).
Conclusion
Patients with gynecologic malignancies may require a VATS/pleurodesis for symptomatic pleural effusions. This procedure appears to be safe and effective in this patient population.
Highlights
► Many patients with gynecologic malignancies will develop pleural effusion► Few studies exclusively evaluate the role of VATS/pleurodesis in gynecologic oncology patients
► VATS/pleurodesis can safely and effectively ameliorate symptoms of recurrent malignant pleural effusion.
Trends in therapy and survival of advanced stage epithelial ovarian cancer patients in the Netherlands
Trends in therapy and survival of advanced stage epithelial ovarian cancer patients in the Netherlands
Objective
The aim of this study was to describe trends in survival and therapy in advanced stage epithelial ovarian cancer (EOC) in the Netherlands and to determine if changes in therapy affected survival.
Methods
All EOC patients diagnosed in the Netherlands during 1989–2009 were selected from the Netherlands Cancer Registry. Differences in treatment over time were tested by the Cochran-Armitage trend test. Multivariable relative survival analyses were performed to test whether changes in treatment are associated with survival.
Results
23,399 EOC patients were diagnosed, of whom 15,892 (67.9%) in advanced stage (stage ≥ 2b).
In advanced stage patients, the proportion receiving (neo-)adjuvant chemotherapy and optimal debulking (residuals < 1 cm) increased over time in all age groups. In elderly patients (≥ 75 years) a stable proportion (approximately 28%) did not receive any treatment.
Five-year relative survival in advanced stage patients increased from 18% in 1989–1993 to 28% in 2004–2009. In the multivariable model survival improved over time (relative excess risk (RER) of 2004–2009 was 0.71, 95% CI 0.67-0.75 compared to 1989–1993). This RER attenuated to 0.85 (95% CI 0.80-0.90) and 0.91 (95% CI 0.83-0.99) with inclusion of treatment variables in the model (surgery with chemotherapy or optimal surgery with chemotherapy, respectively).
This suggests that the improvement was mainly, although not entirely, caused by changes in treatment.
Conclusion
Treatment in advanced stage EOC patients in the Netherlands improved over the last two decades; more patients received (neo)adjuvant chemotherapy and underwent optimal debulking surgery. Changes in treatment led to partial improvement of survival in EOC patients.
Highlights
► Survival in epithelial ovarian cancer patients improved in the last two decades. ► More Dutch patients receive the recommended (optimal) surgery and chemotherapy. ► Changes in therapy explain most but not all of the improved survival in the Netherlands.Diagnostic value of PET/CT is similar to that of conventional MRI and even better for detecting small peritoneal implants in patients with recurrent ovarian cancer.
The present study revealed that PET/CT is similar to conventional MRI for the detection of recurrent ovarian cancer. PET/CT has greater accuracy in the detection of small-to-medium-sized (<2 cm) peritoneal implants compared with MRI. This may affect surgical decision making.
abstract: Epigenetic epidemiology for cancer risk: harnessing germline epigenetic variation (reference to Lynch Syndrome)
Abstract
Genetic epidemiology aims to use the natural variation in the genome, namely single nucleotide polymorphisms and copy number variants to look for associations between particular genotypes and disease risk or prognosis.
Recent work is now aiming to look further into the genome at the natural variation present in the epigenome, in DNA methylation as well as histone modifications, which both regulate gene expression. Epigenetic epidemiology aims to address the same questions about disease risk and prognosis using the normal epigenetic variability. Some examples of rare "epimutations" that can be detected in peripheral blood DNA have been reported in the genes MLH1, MSH2 and IGF2. Other studies have reported increased cancer risk with skewed distributions of the normal pattern in cancer cases compared to controls, showing the promise of harnessing the normal variation in the epigenome. However, some confounding factors need to be considered including the relationship between the epigenome and increasing age and tissue heterogeneity.
Future studies using genome-wide approaches will likely find many more novel epigenetic biomarkers for cancer risk and prognosis.
Recent work is now aiming to look further into the genome at the natural variation present in the epigenome, in DNA methylation as well as histone modifications, which both regulate gene expression. Epigenetic epidemiology aims to address the same questions about disease risk and prognosis using the normal epigenetic variability. Some examples of rare "epimutations" that can be detected in peripheral blood DNA have been reported in the genes MLH1, MSH2 and IGF2. Other studies have reported increased cancer risk with skewed distributions of the normal pattern in cancer cases compared to controls, showing the promise of harnessing the normal variation in the epigenome. However, some confounding factors need to be considered including the relationship between the epigenome and increasing age and tissue heterogeneity.
Future studies using genome-wide approaches will likely find many more novel epigenetic biomarkers for cancer risk and prognosis.
Drug Shortages > Daunorubicin Hydrochloride Solution for Injection (updated 2/24/2012)
"The company cannot estimate a future release date for more product."
Biomarkers in Patients With Previously Untreated Invasive Ovarian Epithelial, Fallopian Tube, or Peritoneal Cancer - Full Text View - ClinicalTrials.gov (GOG-0252)
Purpose
RATIONALE: Studying samples of tumor
tissue, peritoneal cavity fluid, and blood from patients receiving
intraperitoneal chemotherapy may help doctors learn more about the
effects of intraperitoneal chemotherapy on cells. It may also help
doctors identify and learn more about biomarkers related to cancer.
PURPOSE: This research study is studying biomarkers in patients with previously untreated invasive ovarian epithelial, fallopian tube, or peritoneal cancer.
| Condition | Intervention |
|---|---|
|
Fallopian Tube Cancer Ovarian Cancer Primary Peritoneal Cavity Cancer |
Drug: intraperitoneal chemotherapy Genetic: gene expression analysis Genetic: protein analysis Other: flow cytometry Other: immunoenzyme technique Other: immunohistochemistry staining method Other: laboratory biomarker analysis |
France: Search for Predictors of Therapeutic Response in Ovarian Carcinoma - Full Text View - ClinicalTrials.gov
Search for Predictors of Therapeutic Response in Ovarian Carcinoma (miRSa)
This study is currently recruiting participants.
Verified February 2012 by Centre Francois Baclesse
First Received on July 8, 2011. Last Updated on February 23, 2012 History of Changes
Secondary Outcome Measures:
Further study details as provided by Centre Francois Baclesse:
Primary Outcome Measures:
- search for predictors of
response to chemotherapy [ Time Frame: 12 months after beginning
treatment ] [ Designated as safety issue: No ]the search for predictors of response to chemotherapy in patients with carcinoma of the ovary, the fallopian tube or peritoneal serous-type advanced by using (i) the miRNA profile of serum before treatment with chemotherapy and (ii) the identification of polymorphisms or SNPs (Single Nucleotide polymorphism) in particular genes involved in the metabolism of chemotherapy agents
Secondary Outcome Measures:
- profiling miRNA expression [ Time Frame: 1 month ] [ Designated as safety issue: No ]- Characterization of the response to treatment with profiling miRNA expression after the first course of chemotherapy in patients with carcinoma of the ovary, the fallopian tube or peritoneal serous-type advanced
- study of changes in serum miRNA expression [ Time Frame: 6 months ] [ Designated as safety issue: No ]- The study of changes in serum miRNA expression identified as predictive of tumor response during chemotherapy treatment.
Oral Therapies and Food: To Eat or Not to Eat? - Cancer Network
"As the treatment of cancer shifts increasingly more toward oral therapies, patients are now partly responsible for when and how they take their medication. Despite the potential for increased absorption if taken with food, most oncology drug labels warn patients to take the drug while fasting.
Last fall, Dr. Mark J Ratain brought up the issue of increased utilization of oral cancer treatment in the context of patient adherence and optimal utilization in the Journal of Clinical Oncology article, "Flushing oral oncology drugs down the toilet."[1]......
open access: Impact of electronic medical record on physician practice in office settings: a systematic review
Impact of electronic medical record on physician practice in office settings: a systematic review:
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.
Background:
Increased investments are being made for electronic medical records (EMRs) in Canada. There is a need to learn from earlier EMR studies on their impact on physician practice in office settings. To address this need, we conducted a systematic review to examine the impact of EMRs in the physician office, factors that influenced their success, and the lessons learned.
Results:
For this review we included publications cited in Medline and CINAHL between 2000 and 2009 on physician office EMRs. Studies were included if they evaluated the impact of EMR on physician practice in office settings. The Clinical Adoption Framework provided a conceptual scheme to make sense of the findings and allow for future comparison/alignment to other Canadian eHealth initiatives.In the final selection, we included 27 controlled and 16 descriptive studies. We examined six areas: prescribing support, disease management, clinical documentation, work practice, preventive care, and patient-physician interaction. Overall, 22/43 studies (51.2%) and 50/109 individual measures (45.9%) showed positive impacts, 18.6% studies and 18.3% measures had negative impacts, while the remaining had no effect. Forty-eight distinct factors were identified that influenced EMR success.
Several lessons learned were repeated across studies:
(a) having robust EMR features that support clinical use;
(b) redesigning EMR-supported work practices for optimal fit;
(c) demonstrating value for money;
(d) having realistic expectations on implementation; and
(e) engaging patients in the process.
Conclusions:
Currently there is limited positive EMR impact in the physician office. To improve EMR success one needs to draw on the lessons from previous studies such as those in this review.
abstract: A Binary Histologic Grading System for Ovarian Serous Carcinoma is an Independent Prognostic Factor: A Population-based Study of 4,317 Women diagnosed in Denmark 1978–2006
A Binary Histologic Grading System for Ovarian Serous Carcinoma is an Independent Prognostic Factor: A Population-based Study of 4,317 Women diagnosed in Denmark 1978–2006
Objective
To evaluate the prognostic significance of histologic grade on survival of ovarian serous cancer in Denmark during nearly 30 years.
Methods
Using the nationwide Danish Pathology Data Bank, we evaluated 4,317 women with ovarian serous carcinoma in 1978–2006. All pathology reports were scrutinized and tumors classified as either low-grade serous carcinomas (LGSC) or high-grade serous carcinomas (HGSC). Tumors in which the original pathology reports were described as well-differentiated were classified as LGSC, and those that were described as moderately or poorly differentiated were classified as HGSC. We obtained histologic slides from the pathology departments for women with a diagnosis of well-differentiated serous carcinoma during 1997–2006, which were then reviewed by expert gynecologic pathologists. Data were analyzed using Kaplan-Meier methods and Cox proportional hazards regression analysis with follow-up through June 2009.
Results
Women with HGSC had a significantly increased risk of dying (HR = 1.9; 95% CI: 1.6–2.3) compared with women with LGSC while adjusting for age and stage. Expert review of 171 women originally classified as well-differentiated in 1997–2006 were interpreted as LGSC in 30% of cases, whereas 12% were interpreted as HGSC and 50% as serous borderline ovarian tumors (SBT). Compared with women with confirmed LGSC, women with SBT at review had a significantly lower risk of dying (HR = 0.5; 95% CI: 0.22–0.99), and women with HGSC at review had a non-significantly increased risk of dying (HR = 1.6; 95% CI: 0.7–3.4).
Conclusions
A binary grading system is a significant predictor of survival for ovarian serous carcinoma.
Highlights
► The histologic diagnosis based on a binary grading system is an independent predictor of survival following ovarian serous carcinoma.► Expert gynecologic pathologists’ review of the histologic diagnosis further confirms the utility of the binary grading system.
abstract: Incidence of and Risk Factors for Postoperative Ileus in Women Undergoing Primary Staging and Debulking for Epithelial Ovarian Carcinoma
Incidence of and Risk Factors for Postoperative Ileus in Women Undergoing Primary Staging and Debulking for Epithelial Ovarian Carcinoma
Objective
Thorough primary cytoreduction for epithelial ovarian carcinoma (EOC) improves survival. The incidence of postoperative ileus (POI) in these patients may be underreported because of varying POI definitions and the evolving, increasingly complex contemporary surgical approach to EOC. We sought to determine the current incidence of POI and its risk factors in women undergoing debulking and staging for EOC.
Methods
We retrospectively identified the records of women who underwent primary staging and cytoreduction for EOC between 2003 and 2008. POI was defined as a surgeon's diagnosis of POI, return to nothing-by-mouth status, or reinsertion of a nasogastric tube. Perioperative patient characteristics and process-of-care variables were analyzed. Univariate analyses were used to identify POI risk factors; variables withP≤.20 were included in multivariate analysis.
Results
Among 587 women identified, the overall incidence of POI was 30.3% (25.9% without bowel resection, 38.5% with bowel resection;P = .002). Preoperative thrombocytosis, involvement of bowel mesentery with carcinoma, and perioperative red blood cell transfusion were independently associated with increased POI. Postoperative ibuprofen use was associated with decreased POI risk. Women with POI had a longer length of stay (median, 11 vs 6 days) and increased time to recovery of the upper (7.5 vs 4 days) and lower (4 vs 3 days) gastrointestinal tract (P < .001 for each).
Conclusions
The rate of POI is substantial among women undergoing staging and cytoreduction for EOC and is associated with increased length of stay. Modifiable risk factors may include transfusion and postoperative ibuprofen use. Alternative interventions to decrease POI are needed.
Highlights
► In this study, 30% of women undergoing EOC debulking had postoperative ileus (POI).► Transfusion was associated with increased POI in a dose–response fashion.
► Postoperative use of ibuprofen decreased the incidence of POI.
abstract: Does vitamin D protect against DNA damage?
Does vitamin D protect against DNA damage?
Source: Mutation Research/Fundamental and Molecular Mechanisms of Mutagenesis
Vitamin D is a secosteroid best known for its role in maintaining bone and muscle health. Adequate levels of vitamin D may also be beneficial in maintaining DNA integrity. This role of vitamin D can be divided into a primary function that prevents damage from DNA and a secondary function that regulates the growth rate of cells. The potential for vitamin D to reduce oxidative damage to DNA in a human has been suggested by clinical trial where vitamin D supplementation reduced 8-hydroxy-2′-deoxyguanosine, a marker of oxidative damage, in colorectal epithelial crypt cells.
Studies in animal models and in different cell types have also shown marked reduction in oxidative stress damage and chromosomal aberrations, prevention of telomere shortening and inhibition of telomerase activity following treatment with vitamin D.
The secondary function of Vitamin D in preventing DNA damage includes regulation of the poly-ADP-ribose polymerase activity in the DNA damage response pathway involved in the detection of DNA lesions. It is also able to regulate the cell cycle to prevent the propagation of damaged DNA, and to regulate apoptosis to promote cell death. Vitamin D may contribute to prevention of human colorectal cancer, though there is little evidence to suggest that prevention of DNA damage mediates this effect, if real.
Very limited human data mean that the intake of vitamin D required to minimise DNA damage remains uncertain.
Postoperative lymphocysts after lymphadenectomy for gynaecological malignancies: preventive techniques and prospects
Postoperative lymphocysts after lymphadenectomy for gynaecological malignancies: preventive techniques and prospects
Postoperative lymphocyst formation is an insufficiently recognised complication of lymphadenectomy for gynaecological malignancies. Lymphocysts are collections of lymph organised into cysts that develop in contact with lymphadenectomy compartments.There has been considerable debate about the relevance of lymphocyst prevention using surgical (eg. surgical mesh/complications.....) or pharmacotherapeutic methods. Here, we review the available studies about the impact of these methods on the incidence of lymphocysts. This review suggests that several techniques may decrease the incidence of lymphocysts when used in combination. On a literature basis, the peritoneum should be left open over the lymphadenectomy sites at the end of the procedure and drains should not be placed at the end of the procedure (infection rates?) . Omentoplasty should be encouraged and further studies are needed to assess the potential benefits of new energies. Postoperative octreotide therapy seems beneficial but the role of this drug in pelvic oncological surgery remains to be determined.
Omentoplasty - o·men·to·plas·ty (
-m
n
t
-pl
s
t
) n.
A surgical procedure in which a portion of the greater omentum is used to cover or fill a defect, augment arterial or portal venous circulation, absorb effusions, or increase lymphatic drainage.
abstract: Prognostic value of elevated preoperative serum CA125 in ovarian tumors of low malignant potential: A multinational collaborative study. (ANZGOG0801)
Prognostic value of elevated preoperative serum CA125 in ovarian tumors of low malignant potential: A multinational collaborative study. (ANZGOG0801)
Objective
Previous studies on prognostic factors in ovarian tumors of low malignant potential (LMP) were too small for robust conclusions. We examined the prognostic impact of preoperative serum CA125 ≥ 50 U/ML levels in patients diagnosed with ovarian LMP tumors in a large multinational cohort.
Methods
This retrospective study included 940 patients with ovarian LMP tumors diagnosed between 1985 and 2008 at six gynecologic cancer centers. Patients either had radical treatment (bilateral salpingo-oophorectomy with or without hysterectomy) or conservative, fertility-sparing treatment. Multivariate Cox proportional hazard models were used to determine independent prognostic factors for disease-free (DFS) and overall survival (OS). Based on receiver operating characteristic curve (ROC), a preoperative serum CA125 level ≥ 50 U/ml was considered “elevated”.
Results
CA125 was more often elevated in serous than in mucinous tumors and in advanced FIGO stages (2 to 4) compared to stage1. DFS at 5 years was 89% and 95% in patients with elevated and normal CA125 levels. Similarly, the 5-year OS was 90% among patients with elevated CA125 compared to 95% among patients with normal levels. For both DFS and OS elevated CA125 levels and advanced stages of the disease were independent prognostic factors. Analysis of subgroups revealed that CA125 was only prognostic in serous LMP tumors.
Conclusions
In the context of serous ovarian LMP tumors, elevated preoperative serum CA125 represents a biomarker independently associated with impaired disease-free and overall survival. CA125 is available in most centers and could inform surgeons about the risk of treatment failure.
Highlights
► CA125 is a known prognostic marker in invasive epithelial ovarian cancer.► Elevated levels are also prognostic in serous borderline ovarian cancers.
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