Clinical Trial (still recruiting)
Thursday, April 11, 2013
Reporting Guidance for Oncologic 18F-FDG PET/CT Imaging
open access
Journal of Nuclear Medicine, published on April 10, 2013 as doi:10.2967/jnumed.112.112177
" The written report (or its electronic counterpart) is the primary
mode of communication between the physician interpreting an
imaging study and the referring physician. The content of this
report not only influences patient management and clinical
outcomes but also serves as legal documentation of services
provided and can be used to justify medical necessity, billing
accuracy, and regulatory compliance. Generating a high-quality
PET/CT report is perhaps more challenging than generating
a report for other imaging studies because of the complexity of
this hybrid imaging modality. This article discusses the essential
elements of a concise and complete oncologic 18F-FDG PET/
CT report and illustrates these elements through examples
taken from routine clinical practice......
".....Finally, imaging physicians should be aware that referring
physicians at many institutions now make the reports of
imaging studies directly available to patients. This is an
additional incentive to avoid emotional terminology (e.g.,
dramatic increase or too numerous to count), which is generally
unhelpful and might provoke unnecessary patient
anxiety."
Effects of Melatonin on Appetite and Other Symptoms in Patients With Advanced Cancer and Cachexia: A Double-Blind Placebo-Controlled Trial
Abstract/link to Editorial
Conclusion In cachectic patients with advanced cancer, oral melatonin 20 mg at night did not improve appetite, weight, or quality of
life compared with placebo.
Footnotes
-
See accompanying editorial on page 1257
Appropriate, Timely Referral to Palliative Care Services: A Name Change Will Not Help - Correspondence
Correspondence
TO THE EDITOR:
"We agree with Wentlandt et al1 that many health professionals involved in cancer care harbor significant misunderstandings about what palliative care services can provide and when they should become involved. We believe similar misconceptions are held by many patients and their family members. Therefore, any attempt to facilitate appropriate and timely referral to specialist palliative care services should address misconceptions and concerns held by patients, family members, and health professionals.......
"....Interestingly, in the study by Wentlandt et al,1 approximately one
third of physicians indicated they would be more likely to make earlier
referrals to palliative care if it was renamed “supportive care.” In our
own study, we explored patient and caregiver views on alternative
names such as “symptom management team,” “pain experts,” and
“supportive care team.” None were deemed suitable. Participants
concluded that it would take more than a name change for them to
want to hear about palliative care.......
Central Venous Catheter Care for the Patient With Cancer: American Society of Clinical Oncology Clinical Practice Guideline
open access
Key Recommendations
-
There is insufficient evidence to recommend a specific type of CVC or insertion site, but femoral vein insertion should be avoided, except in certain emergency situations
-
CVCs should be placed by well-trained health care providers
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Use of a CVC clinical care bundle is recommended
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Use of antimicrobial/antiseptic-coated CVCs and/or heparin-impregnated CVCs has been shown to be beneficial, but the benefits and costs must be carefully considered before they can be routinely used
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Prophylactic use of systemic antibiotics is not recommended before CVC insertion
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Cultures of blood from the CVC and/or tissue at the entrance-exit sites should be obtained before initiation of antibiotic therapy; most clinically apparent exit- or entrance-site infections as well as bloodstream infections can be managed with appropriate microbial therapy, so CVC removal may not be necessary; antimicrobial agents should be optimized once the pathogens are identified; catheter removal should be considered if the infection is caused by an apparent tunnel or port-site infection, fungi, or nontuberculous mycobacteria or if there is persistent bacteremia after 48 to 72 hours of appropriate antimicrobial treatment
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Routine flushing with saline is recommended
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Prophylactic warfarin and low–molecular weight heparin have not been shown to decrease CVC-related thrombosis, so routine use is not recommended
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Tissue plasminogen activator (t-PA) is recommended to restore patency in a nonfunctioning CVC; CVC removal is recommended when the catheter is no longer needed, if there is a radiologically confirmed thrombosis that does not respond to anticoagulation therapy, or if fibrinolytic or anticoagulation therapy is contraindicated
Joint SOGC-GOC-SCC Clinical Practice Guideline - Epidemiology and Investigations for Suspected Endometrial Cancer
Blogger's Note: see article for levels of evidence
~~~~~~~~~~~~~~~~~~~~~~~~
No. 291, April 2013 (Replaces no. 51, November 1996)Abstract
Objective: To review the evidence relating to the epidemiology ofendometrial cancer and its diagnostic workups.
Recommendations
1. A complete focused history should be taken and a physical
examination carried out in patients with suspected endometrial
cancer. Attention should be paid to predisposing factors for excess
estrogen stimulation of the endometrium such as long history of
anovulation, obesity, menstrual irregularity, or long-term use of
unopposed estrogen or tamoxifen. Patients with a strong family
history of endometrial, ovarian, and colorectal cancers might have
inherited Lynch syndrome (hereditary non-polyposis colorectal
cancer syndrome) that increases their lifetime risk of developing
endometrial cancer. Genetic counselling and testing can be used
to individualize risk-management interventions including screening
strategies and treatment options. (III-B)
2. Endometrial cancer should be ruled out in perimenopausal and
postmenopausal patients with abnormal vaginal bleeding. (II-1A)
3. Depending on access, histologic endometrial evaluation
and transvaginal ultrasound are the preferred initial
diagnostic investigations for patients with suspected
endometrial cancer. (II-1B)
4. Histologic evaluation of the endometrium should be done in all
patients in whom endometrial cancer is suspected. (II-1A)
5. Hysteroscopic examination should be considered in patients with
persistent uterine bleeding with benign endometrial sampling or
insufficient endometrial sampling after ultrasound. (II-2B)
6. Formal review of the histopathology should be considered in
patients with high grade tumours or rare histologic types such as
serous, clear cell, or mucinous types. (III-B)
7. Additional tumour markers, CT scan, and MRI scan should not be
used routinely. (III-D)
The association of active smoking with multiple cancers: national census-cancer registry cohorts with quantitative bias analysis
Abstract
Purposes
(1) Determine the
association of multiple cancers with smoking, focusing on cancers with
an uncertain association; and (2) illustrate quantitative bias analysis
as applied to registry data, to adjust for misclassification of smoking
and residual confounding by alcohol and obesity.
Methods
New Zealand 1981 and
1996 censuses, including smoking questions, were linked to cancer
registry data giving 14.8 million person-years of follow-up. Rate ratios
(RR) for current versus never smokers, adjusting for age, sex,
ethnicity and socioeconomic factors were calculated and then subjected
to quantitative bias analysis.
Results
RR estimates for
lung, larynx (including ear and nasosinus), and bladder cancers adjusted
for measured confounders and exposure misclassification were 9.28 (95 %
uncertainty interval 8.31–10.4), 6.14 (4.55–8.30), and 2.22
(1.94–2.55), respectively. Moderate associations were found for cervical
(1.82; 1.51–2.20), kidney (1.29; 1.07–1.56), liver cancer (1.75;
1.37–2.24; European only), esophageal (2.14; 1.73–2.65), oropharyngeal
(2.30; 1.94–2.72), pancreatic (1.68; 1.44–1.96), and stomach cancers
(1.42; 1.22–1.66). Protective associations were found for endometrial
(0.67; 0.56–0.79) and melanoma (0.72; 0.65–0.81), and borderline
association for thyroid (0.76; 0.58–1.00), colon (0.89; 0.81–0.98), and
CML (0.66; 0.44–0.99). Remaining cancers had near null associations.
Adjustment for residual confounding suggested little impact, except the
RRs for endometrial, kidney, and esophageal cancers were slightly
increased, and the oropharyngeal and liver (European/other) RRs were
decreased.
Conclusions
Our large study
confirms the strong association of smoking with many cancers and
strengthens the evidence for protective associations with thyroid cancer
and melanoma. With large data sets, considering and adjusting for
residual systematic error is as important as quantifying random error.
Understanding communication between surgeon and patient in outpatient consultations
Abstract
Background
There
is an assumption that there is a similarity between surgeon-patient and
primary care consultations. Yet, surgeon communication has had far less
analytic attention than its primary care counterparts. Therefore, this
assumption of similarity (and the proposition here of dissimilarity) has
yet to be evidenced through detailed interactional analysis.
Methods
Conversation
analysis (CA) is a methodology used to understand both mundane and
institutional interactions. Using CA, we have developed an understanding
of surgeon-patient interactions in outpatient clinic settings in New
Zealand. Rather than attempting to determine what ‘bad’ communication
is, we describe and analyse what occurs routinely in surgeon-patient
consultations, particularly how these interactions are built up by both
patient and doctor.
Toxicity of Bevacizumab in Combination with Chemotherapy in Older Patients
Blogger's Note: although not specific to ovarian cancer, worth reading
Abstract
Background. Bevacizumab
leads to improved survival for patients with metastatic colorectal
cancer (CRC) or non-small cell lung cancer
(NSCLC) when added to chemotherapy (and ovarian cancer). Little is known
about factors associated with receipt of bevacizumab, or whether
bevacizamab
is associated with increased toxicity when added to
chemotherapy.
Patients and Methods. We
conducted a prospective study of patients aged ≥65 years, which
evaluated the association between geriatric assessment
(GA) metrics and chemotherapy toxicity. We examined
differences in characteristics and outcomes of patients with CRC and
NSCLC
cancers who received bevacizumab with chemotherapy
versus chemotherapy alone.
Results. From a total of
207 patients, 27 (13%) received bevacizumab plus chemotherapy and 180
(87%) received chemotherapy alone.
Groups were similar in sociodemographic and cancer
characteristics. There were no baseline differences in GA domains except
that patients with heart disease were less likely
to receive bevacizumab (4% vs. 26%, p = .01). Seventy-eight
percent of patients who had bevacizumab had grade 3–5 toxicity compared
to only 57% who received chemotherapy
alone (p = .06). Patients receiving bevacizumab were more likely to develop grade 3 hypertension than those who received chemotherapy
alone (15% vs. 2%, p < .01). In multivariable analysis, factors associated with grade 3 or more toxicity included: bevacizumab (OR: 2.86, p = .04), CRC (OR: 2.54, p < .01), and baseline anemia (OR: 2.58, p = .03).
Conclusion. Heart disease
was more common in those who did not receive bevacizumab. Older
patients who receive bevacizumab with chemotherapy
have a higher odds of developing a grade 3–5
toxicity compared with those who receive chemotherapy alone.
paywalled: The mechanism of mismatch repair and the functional analysis of mismatch repair defects in Lynch syndrome
abstract
The
majority of Lynch syndrome (LS), also known as hereditary non-polyposis
colorectal cancer (HNPCC), has been linked to heterozygous defects in
DNA mismatch repair (MMR). MMR is a highly conserved pathway that
recognizes and repairs polymerase misincorporation errors and nucleotide
damage as well as functioning as a damage sensor that signals
apoptosis. Loss-of-heterozygosity (LOH) that retains the mutant MMR
allele and epigenetic silencing of MMR genes are associated with an
increased mutation rate that drives carcinogenesis as well as
microsatellite instability that is a hallmark of LS/HNPCC. Understanding
the biophysical functions of the MMR components is crucial to
elucidating the role of MMR in human tumorigenesis and determining the
pathogenetic consequences of patients that present in the clinic with an
uncharacterized variant of the MMR genes. We summarize the historical
association between LS/HNPCC and MMR, discuss the mechanism of the MMR
and finally examine the functional analysis of MMR defects found in
LS/HNPCC patients and their relationship with the severity of the
disease.
Identification of miRNA modulators to PARP inhibitor response (clear cell ovarian)
Abstract
Based on the principle of synthetic lethality, PARP inhibitors have been shown to be very effective in killing cells deficient in homologous recombination (HR), such as those bearing mutations in BRCA1/2. However, questions regarding their wider use persist and other determinants of responsiveness to PARP inhibitor remain to be fully explored. MicroRNAs (miRNAs) are small non-coding RNAs, which serve as post-transcriptional regulators of gene expression and are involved in a wide variety of cellular processes, including the DNA damage response (DDR). However, little is known about whether miRNAs might influence sensitivity to PARP inhibitors. To investigate this, we performed a high throughput miRNA mimetic screen, which identified several miRNAs whose over-expression results in sensitization to the clinical PARP inhibitor olaparib. In particular, our findings indicate that hsa-miR-107 and hsa-miR-222 regulate the DDR and sensitise tumour cells to olaparib by repressing expression of RAD51, thus impairing DSB repair by HR. Moreover, elevated expression of hsa-miR-107 has been observed in a subset of ovarian clear cell carcinomas, which correlates with PARP inhibitor sensitivity and reduced RAD51 expression. Taken together, these observations raise the possibility that these miRNAs could be used as biomarkers to identify patients that may benefit from treatment with PARP inhibitors.
Epigenome-wide Ovarian Cancer Analysis Identifies a Methylation Profile Differentiating Clear Cell Histology with Epigenetic Silencing of HERG K+ Channel
Abstract
Ovarian
cancer remains the leading cause of death in women with gynecologic
malignancies, despite surgical advances and the development of more
effective chemotherapeutics. As increasing evidence indicates that clear
cell ovarian cancer may have unique pathogenesis, further understanding
of molecular features may enable us to begin to understand the
underlying biology and histology-specific information for improved
outcomes. To study epigenetics in clear cell ovarian cancer, fresh
frozen tumor DNA (n=485) was assayed on Illumina Infinium
HumanMethylation450 BeadChips. We identified a clear cell ovarian cancer
tumor methylation profile (n=163) which we validated in two independent
replication sets (set 1, n=163; set 2, n=159), highlighting 22 CpG loci
associated with nine genes (VWA1, FOXP1, FGFRL1, LINC00340, KCNH2,
ANK1, ATXN2, NDRG21, and SLC16A11). Nearly all of the differentially
methylated CpGs showed a propensity toward hypermethylation among clear
cell cases. Several loci, methylation inversely correlated with tumor
RNA expression, most notably KCNH2 (HERG; a potassium channel) (p=9.5 x
10-7), indicating epigenetic silencing. In addition, a
predicted methylation class mainly represented by the clear cell cases
(20 clear cell out of 23 cases) had improved survival time. Although
these analyses included only 30 clear cell carcinomas, results suggest
that loss of expression of KCNH2 (HERG) by methylation could be a good
prognostic marker, given that overexpression of the potassium (K+)
channel Eag family members promotes increased proliferation and results
in poor prognosis. Validation in a bigger cohort of clear cell tumors
of the ovary will assist some of these unanswered questions.
New paradigms to explain metastasis - April 11, 2013 e-grandrounds
e-eso
e-grandround GR239 - 11 April 2013 - 18:15-19:00 CET
Expert: Elizabeth Comen, Memorial Sloan-Kettering Cancer Center, New York, USA
Discussant: Daniel Helbling, Gastrointestinal Tumorcenter Zurich, Zurich, Switzerland
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(Nov 2012) Intraperitoneal chemotherapy in ovarian cancer: a review of tolerance (post operative IP/HIPEC)
open access
Purpose: To review the two main approaches of intraperitoneal (IP) chemotherapy delivery in ovarian cancer: postoperative adjuvant IP chemotherapy after cytoreductive surgery (CRS) and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC).
Methods: A literature search was conducted to identify studies that employed postoperative adjuvant IP chemotherapy after CRS or combined CRS and intraoperative HIPEC in patients with ovarian cancer. Data of interest included chemotherapy protocol, morbidity and mortality, and survival data.
Results: Three large randomized controlled trials comprising 707 patients with advanced ovarian cancer who received postoperative adjuvant IP chemotherapy were reviewed. Morbidity rate ranged from 56% to 94% in IP chemotherapy, and mortality rate ranged from 1% to 2%. Median disease-free survival ranged from 24 to 28 months, and overall survival ranged from 49 to 66 months. Planned chemotherapy completion rates ranged from 42% to 71%. Twenty-four nonrandomized studies that reported HIPEC comprised 1167 patients with both advanced and recurrent ovarian cancer. In patients with advanced ovarian cancer, mortality ranged from 0% to 5%, minor morbidity ranged from 16% to 90%, and major morbidity ranged from 0% to 40%. Median disease-free survival ranged from 13 to 56 months, and overall survival ranged from 14 to 64 months. Survival at 5 years ranged from 35% to 70%. In patients with recurrent ovarian cancer, the mortality rate ranged from 0% to 10%, minor morbidity ranged from 7% to 90%, and major morbidity ranged from 0% to 49%. Median disease-free survival ranged from 13 to 24 months and overall survival from 23 to 49 months. Survival at 5 years ranged from 12% to 54%.
Conclusion: There is level-one evidence suggesting the benefit of postoperative adjuvant intraperitoneal chemotherapy for patients with advanced ovarian cancer after cytoreductive surgery, albeit catheter-related complications resulted after treatment discontinuation. Studies report the use of HIPEC predominantly in the setting of recurrent disease and have demonstrated encouraging results, which merits further investigation in future clinical trials.
OncologyTube - GOG 209 Metastatic Cancer update from SGO 2013
video
Description:
Dr. David Miller, MD discusses updates in metastatic cancer research concerning the GOG 209 trial
OncologyTube - David Miller, MD Four randomized positive trials for ovarian cancer
video
Description:
Dr. David Miller, MD sits down with Bradley Monk, MD at this year's Society of Gynecologic Oncology meeting in Los Angeles to talk about four randomized positive trials for ovarian cancer
OncologyTube - Patients Treated at High Volume Center Have High Cure rate
video
Description:
Krishnansu S Tewari, M.D. talks at the Society of Gynecologic Oncology meeting about a study which states patients treated at high volume center have high cure rate
OncologyTube - Interval Cytoreduction SGO 2013
video
Description:
Dr. Thomas Herzog, MD and Bradley Monk, MD discuss interval cytoreduction at this year's 2013 Society of Gynecologic Oncology meeting (2:48 min)
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