Tuesday, February 28, 2006
Sunday, February 26, 2006
Saturday, February 25, 2006
Prophylactic Surgery to Reduce the Risk of Gynecologic Cancers in the Lynch Syndrome - January 19, 2006 NEJM
Prophylactic Surgery to Reduce the Risk of Gynecologic Cancers in the Lynch Syndrome
Kathleen M. Schmeler, M.D., Henry T. Lynch, M.D., Lee-may Chen, M.D., Mark F. Munsell, M.S., Pamela T. Soliman, M.D., Mary Beth Clark, M.S.W., Molly S. Daniels, M.S., Kristin G. White, B.S., Stephanie G. Boyd-Rogers, R.N., Peggy G. Conrad, M.S., Kathleen Y. Yang, M.D., Mary M. Rubin, Ph.D., Charlotte C. Sun, Dr.P.H., Brian M. Slomovitz, M.D., David M. Gershenson, M.D., and Karen H. Lu, M.D.
ABSTRACT
Background Women with the Lynch syndrome (hereditary nonpolyposis colorectal cancer) have a 40 to 60 percent lifetime risk of endometrial cancer and a 10 to 12 percent lifetime risk of ovarian cancer. The benefit of prophylactic gynecologic surgery for women with this syndrome has been uncertain. We designed this study to determine the reduction in the risk of gynecologic cancers associated with prophylactic hysterectomy and bilateral salpingo-oophorectomy in women with the Lynch syndrome......
Monday, February 20, 2006
2005 Survey of HNPCC Management Analysis of Responses from 18 International Cancer Centres
Survey of HNPCC Management Analysis of Responses from 18 International Cancer Centres
Hereditary Cancer in Clinical Practice 4/2005
Survey of HNPCC Management Analysis of Responses from 18 International Cancer Centres
Hereditary Cancer in Clinical Practice 2005; 3(4) pp. 137-146
authors: Elizabeth Chow, Finlay Macrae, John Burn,
Introduction
HNPCC is an autosomal dominant condition with high penetrance for colorectal and certain other cancers. A mutation in one of the several mismatch repair genes is responsible. Mutational analysis is widely available to guide risk assessment and screening strategies in families with HNPCC. However, there are many management decisions that need to be made where the level of evidence supporting those decisions is low. In September 2003, participants at the International Collaborative Group for Hereditary Non-Polyposis Colorectal Cancer were invited to complete a questionnaire relating to their clinic practices, so as to inform the cancer genetics community about variations and levels of consensus.
Methods
Eighteen centres (three from Australia, nine from the UK, two from the USA, two from Denmark, one from Canada, one from Israel) responded to the questionnaire. The questionnaire covered clinical definitions of HNPCC and high and moderate risk, thresholds for referral to clinics, positioning and funding of pre-genetic testing in clinical management, indications and funding for mutational analysis, consent protocols, counselling relating to variants of uncertain significance, disclosure of genetic testing information across families, surveillance planning for colorectal, gynaecological and other malignancies, and surgical decision making. Responses were generally in the multiple choice format, and where appropriate one or more “correct” answers were allowed. Free text provision (“other”) was liberally provided throughout. The questionnaire was not anonymous. However, as there was no universal agreement from the contributors to identify their own familial clinic's response, the results are presented anonymously.
Results
Results are displayed with reference to the question and the multiple choice response alternatives.
A. Definition
1. In your familial bowel cancer practice, for the purposes of initiating direct mutational analysis (without necessarily requiring evidence of MSI/IHC MMR protein loss), which definition of HNPCC do you accept? (tick any)
a) Amsterdam I
b) Amsterdam II
c) Amsterdam II plus ovarian cancer
d) Amsterdam II plus stomach cancer
e) Amsterdam II plus biliary tract cancer
f) Amsterdam II plus brain cancer
g) Amsterdam II plus breast cancer in hMLH1
h) Amsterdam II plus clear cell cancer of kidney
i) Other---please specify any variation
Saturday, February 18, 2006
2006 Review: Cochrane Collaboration - Intraperitoneal chemotherapy for the initial management of primary epithelial ovarian cancer
Review]
Intraperitoneal chemotherapy for the initial management of primary epithelial ovarian cancer
K Jaaback and N Johnson
The Cochrane Database of Systematic Reviews 2006 Issue 1 (Status: New)
Copyright © 2006 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
DOI: 10.1002/14651858.CD005340.pub2 This version first published online: 25 January 2006 in Issue 1, 2006
Date of Most Recent Substantive Amendment: 15 November 2005
This record should be cited as: Jaaback K, Johnson N. Intraperitoneal chemotherapy for the initial management of primary epithelial ovarian cancer. The Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD005340. DOI: 10.1002/14651858.CD005340.pub2.
Abstract
Background
Ovarian cancer tends to be chemosensitive and confine itself to the surface of the peritoneal cavity for much of its natural history. These features have made it an obvious target for intraperitoneal chemotherapy. Chemotherapy for ovarian cancer is usually given as an intravenous infusion repeatedly over 5 to 8 cycles. Intraperitoneal chemotherapy (IP) is given by infusion of the chemotherapeutic agent directly into the peritoneal cavity. This may increase the anticancer effect with fewer systemic adverse effects in comparison to intravenous therapy.
Objectives
To determine if adding a component of the chemotherapy regime into the peritoneal cavity affects overall survival, progression free survival, quality of life (QOL) and toxicity for women receiving primary treatment of epithelial ovarian cancer.
Search strategy
The reviewers searched the UK Cochrane trials register, Gynaecological Cancer Group Specialised Register, computer databases and handsearched and cascade searched the major gynaecological oncology journals.
Selection criteria
The analysis was restricted to randomised controlled trials assessing women with a new diagnosis of primary epithelial ovarian cancer, of any FIGO stage, following primary cytoreductive surgery. Standard intravenous chemotherapy was compared with chemotherapy that included a component of intraperitoneal administration.
Data collection and analysis
Two reviewers conducted data extraction independently. The reviewers retrieved data on overall and disease free survival as well as adverse events and QOL and then performed a meta-analysis of outcomes, using hazard ratios for time-to-event variables and relative risks for dichotomous outcomes.
Main results
Eight randomised trials studied 1819 women receiving primary treatment for ovarian cancer. Women were less likely to die if they received an intraperitoneal (IP) component to the chemotherapy (hazard ratio (HR) =0.79; 95% confidence interval (CI): 0.70 to 0.90)and the disease free interval (HR =0.79; 95%CI: 0.69 to 0.90) was also significantly prolonged. There may be greater serious toxicity with regard to gastrointestinal effects, pain and fever but less ototoxicity with the intraperitoneal than the intravenous route.
Authors' conclusions
This analysis establishes the benefit of IP chemotherapy. It increases overall survival and progression free survival from advanced ovarian cancer. The results of this meta-analysis provide the most reliable estimates of the relative survival benefits of IP over IV therapy and should be used as part of this decision making process. However, the potential for catheter related complications and toxicity needs to be considered when deciding on the most appropriate treatment for each individual woman. The optimal dose, timing and mechanism of administration cannot be addressed from this meta-analysis. This needs to be addressed in the next phase of clinical trials.
Plain language summary
Intraperitoneal (IP) chemotherapy for advanced ovarian cancer improves both overall and disease free survival.
Ovarian cancer commonly spreads through the peritoneal cavity and usually responds to intravenous chemotherapy. This review compared the effectiveness of this intravenous chemotherapy to chemotherapy administered directly into the peritoneal cavity. The evidence suggests an improvement in survival if some of the chemotherapy is administered via the intraperitoneal route. The disadvantage is an increase in adverse effects principally relating to the presence of a peritoneal catheter, including pain, catheter blockage, gastrointestinal effects and infection.
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