abstract: Preoperative Identification of a Suspicious Adnexal Mass: A Systematic Review and Meta-analysis. PET/MRI/U/S

 Blogger's Note: this abstract provides little comprehensive information (as per most abstracts)  noting that the journal of Gynecologic Oncology is a subscriber-based journal ($$$); 'nail in the coffin'  for ovarian cancer/pre-surgical assessment ??
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abstract: Preoperative Identification of a Suspicious Adnexal Mass: A Systematic Review and Meta-analysis [Gynecol Oncol. 2012] - PubMed - NCBI

Abstract

OBJECTIVE:

To systematically review the existing literature in order to determine the optimal strategy for preoperative identification of the adnexal mass suspicious for ovarian cancer.

METHODS:

A review of all systematic reviews and guidelines published between 1999 and 2009 was conducted as a first step. After the identification of a 2004 AHRQ systematic review on the topic, searches of MEDLINE for studies published since 2004 was also conducted to update and supplement the evidentiary base. A bivariate, random-effects meta-regression model was used to produce summary estimates of sensitivity and specificity and to plot summary ROC curves with 95% confidence regions.

RESULTS:

Four meta-analyses and 53 primary studies were included in this review. The diagnostic performance of each technology was compared and contrasted based on the summary data on sensitivity and specificity obtained from the meta-analysis. Results suggest that 3D ultrasonography has both a higher sensitivity and specificity when compared to 2D ultrasound. Established morphological scoring systems also performed with respectable sensitivity and specificity, each with equivalent diagnostic competence. Explicit scoring systems did not perform as well as other diagnostic testing methods. Assessment of an adnexal mass by colour Doppler technology was neither as sensitive nor as specific as simple ultrasonography. Of the three imaging modalities considered, MRI appeared to perform the best, although results were not statistically different from CT. PET did not perform as well as either MRI or CT. The measurement of the CA-125 tumour marker appears to be less reliable than do other available assessment methods.

CONCLUSION:

The best available evidence was collected and included in this rigorous systematic review and meta-analysis. The abundant evidentiary base provided the context and direction for the diagnosis of early-staged ovarian cancer.

abstract: (review of the literature) Screening for Distress and Unmet Needs in Patients With Cancer: Review and Recommendations

Screening for Distress and Unmet Needs in Patients With Cancer: Review and Recommendations

"....Many distress screening and unmet need tools have been subject to preliminary validation, but few have been compared head to head in independent centers and in different stages of cancer...."

The Naked Doctor: profiling overdiagnosis and overtreatment

The Naked Doctor (blog): profiling overdiagnosis and overtreatment 

(eg. "Introducing the Naked Doctor: When is ‘no action’ the best action?")

Posted by Gary Schwitzer in Disease mongering, overtesting, overtreatment

Hot flash remedies: Estrogen may be the best answer - Health News Review

Hot flash remedies: Estrogen may be the best answer

Reviewed by Christine Norton, MA; Karen Carlson, MD; and Gary Schwitzer

PLoS Medicine: The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview

2011 Cochrane Review: Maintenance chemotherapy for ovarian cancer

Independent Expert Reviews of News Stories: Can a new supplement boost immunity, slow aging? (TA-65)

Our Review Summary

The story attempts to provide readers with a summary of the results of an early study of how a "natural" product (TA-65) might alter a the truly natural course of aging. Despite some comments from outside experts, overall the story fails to answer many questions and ultimately presents an overly enthusiastic picture of the product.

Why This Matters:

A product that could stem the aging process would have mass appeal. The telomere story began in the late 1970s, and research has shown that telomere shortening limits the number of times cells can divide and has been shown to be associated with aging in at least animal models.

Cochrane Collaboration review: Interventions for the treatment of borderline ovarian tumours

Plain language summary

Interventions for the treatment of borderline ovarian tumours
Women with borderline (low malignant potential) ovarian tumours do very well after surgery and recurrences may be cured by further surgery. The ideal form of initial surgical treatment for borderline ovarian tumours is controversial. Furthermore, it is not known if additional treatment after surgery reduces the risk of re-appearance of tumours or of death.

In this review, we found six trials which enrolled 340 patients who had undergone surgery for borderline ovarian tumours. These trials compared the number of deaths among women who had various forms of treatment or no additional treatment after surgery. In five of the trials, the women had tumours confined to the ovaries and most were followed up for over 10 years. Only one trial enrolled women with tumours that had spread beyond the ovary, and this trial followed patients up for less than three years, which is not long enough to detect any difference between groups receiving different treatments. None of the trials found any demonstrable benefit from any of the additional forms of treatment. However, all six trials were conducted over 15 years ago and since then platinum-based chemotherapy has become widely used to treat advanced ovarian cancer. However, only one of the trials in our review assessed this more modern type of chemotherapy. Further trials of platinum-based chemotherapy and of less toxic treatments are needed, looking at the benefit of reducing the anxiety and distress of further surgery and treatment for relapse.

One further trial, which recruited 32 women who had borderline ovarian tumours in both ovaries, compared conservative surgery (taking away the most diseased ovary and removing the tumour from the other ovary) with ultra-conservative surgery (removing the tumours without taking away either ovary). Nearly all the women who had ultra-conservative surgery became pregnant compared with half of those who had conservative surgery. Although about two thirds of the women in the trial developed similar tumours again, most women got pregnant before the disease recurred, all had their recurrences treated by further surgery, none developed invasive ovarian cancer nor died of their tumour. This small study suggests that ultra-conservative surgery by an experienced surgeon with careful follow up for recurrence may be recommended for women with bilateral borderline ovarian tumours who still intend to have children but, ideally, this approach should be evaluated in other independent trials. Despite rigorous searches, we did not find any trial directly comparing conservative surgery with radical surgery (surgery to remove all of the female reproductive organs) or comparing keyhole surgery (laparoscopy) with open surgery (laparotomy) for women with borderline ovarian tumours.

full free access: Interventions with Family Caregivers of Cancer Patients: Meta-Analysis of Randomized Trials -- CA: A Cancer Journal for Clinicians

CME -- the Oncologist: Bevacizumab (Avastin): Concise Drug Review

Take this course

(Note: may require a subscription)

2010 Review: Cochrane Collaboration Topotecan for ovarian cancer

Background
Chemotherapeutic agents such as topotecan can be used to treat ovarian cancer. The effects of using topotecan as a therapeutic agent have not been previously been systematically reviewed.
Objectives
To evaluate the effectiveness and safety of topotecan for the treatment of ovarian cancer. 

Results: 

Participants were more likely to respond to topotecan on a 21-day cycle as opposed to a 42-day cycle (RR 7.23, 95% CI 0.94 to 55.36). Small tumor diameter, sensitivity to platinum-based chemotherapy was associated with better prognosis. Small sample size, methodological flaws and poor reporting of the included trials made measurement bias of the trials difficult to assess.

Plain language summary

Topotecan is an active second line chemotherapeutic drug, used to treat patients with relapsed ovarian carcinoma
It appears to have a similar level of effectiveness as paclitaxel and pegylated liposomal doxorubicin, though with different patterns of side effects. Larger, well-designed randomised controlled trials (RCTs) are required to define an optimal regime.

HealthNewsReview.org Tips for Understand Studies

subject areas covered:

Tips for Understand Studies

* Does The Language Fit The Evidence? - Association Versus Causation
* "Off-label" Drug Use and Marketing
* 7 Words (and more) You Shouldn't Use in Medical News
* News from Scientific Meetings
* Absolute vs. Relative Risk
* Number Needed to Treat (NNT)
* Commercialism
* Single Source Stories
* FDA Approval Not Guaranteed
* Phases of Drug trials
* Medical Devices
* Animal & Lab Studies

A review of PARP inhibitors: from bench to bedside — Ann Oncol

Conclusion: PARP inhibitors show promise as a powerful therapeutic tool, especially in the management of BRCA-associated breast and ovarian cancers but also in tumours where BRCA genes may be dysfunctional. Clinical studies are ongoing and many translational questions remain unanswered that will help clarify how to determine the best way to use PARP inhibitors.

Cochrane Collaboration review: Cytoreductive surgery plus chemotherapy versus chemotherapy alone for recurrent epithelial ovarian cancer

Plain language summary

Secondary surgical efforts to remove recurrent ovarian cancer in women who are no longer in remission
Ovarian cancer is the sixth most common cancer among women. Epithelial ovarian cancer is a disease in which malignant cells form in the tissue covering the ovary. It accounts for about 90% of ovarian cancers., the remaining 10% arise from germ cells and the sex cord and stroma of the ovary. Women with epithelial ovarian cancer that has returned after primary surgery (recurrent disease) may need secondary surgery to remove all or part of the cancer. The option of surgery (debulking or cytoreductive surgery) is currently offered to a select group of women with recurrent ovarian cancer. It is important to ascertain whether this surgery helps women with recurrent disease to survive for longer than if they only got chemotherapy.

We searched for studies that compared secondary cytoreductive surgery and chemotherapy with chemotherapy alone in women with recurrent epithelial ovarian cancer. Although we checked 1431 possible articles, we found no relevant studies. Therefore there is currently no evidence to determine if secondary cytoreductive surgery is better or worse than chemotherapy alone in terms of prolonging life.

The review highlights the need for good quality studies comparing secondary cytoreductive surgery to chemotherapy.

May 1/2010 - abstract/full access - Review: Practical considerations in ovarian cancer chemotherapy -- Therapeutic Advances in Medical Oncology

Note: this journal is offering free access (registration required)

The outcomes of ovarian cancer treatment are better when provided by gynecologic oncologists and in specialized hospitals: a systematic review

Centre for Review and Dissemination - Database of Abstracts of Reviews of Effects (DARE)

Authors' objectives:
To determine the efficacy of specialised care for patients with ovarian cancer.
Authors' conclusions:The outcome of ovarian cancer was better when treatment was provided in specialised settings (gynecologic oncologists or in specialised hospitals) than that provided in non-specialised settings.

CRD commentary:
"Given the limitations and the lack of reported methodology in the review process, although the results appeared promising the authors conclusion appears to be overstated."

abstract: Current state of biomarker development for clinical application in epithelial ovarian cancer