NOTE: The above recommendations must be read along with the footnotes on pages 3--4 of this schedule.
Wednesday, March 02, 2011
podcast/text: Benefits and Dangers of Vitamin Supplements for Cancer Patients - Cancerwise | Cancer blog from MD Anderson Cancer Center
Note: includes discussion regarding cardiovascular risks
Reputable online resources
Through online resources, patients can check into the efficacy and safety of herbal or natural supplements. MD Anderson has several online articles and web pages that provide information about supplements and nutrition. The Learning Center at MD Anderson can also provide information on other reputable online resources.
HVO Welcomes Society of Gynecologic Oncologists as Sponsor
HVO Welcomes Society of Gynecologic Oncologists
as Sponsor
[Washington, DC - February 26, 2011] - Health Volunteers Overseas is pleased to announce that the Society of Gynecologic Oncologists has joined as a sponsor. According to the World Health Organization (WHO), cancer is one of the leading causes of death worldwide. The WHO reports that in 2005, cancer accounted for 7.6 million of all deaths with more than 70% of these cancer deaths occurring in the developing world. WHO projects 9 million people will be dying from cancer in 2015. These startling statistics show the great need for oncology training in the developing world.
Tuesday, March 01, 2011
N.L. may send more cancer tests to Ontario - Nfld. & Labrador - CBC News (pathology)
"The departure of a pathologist from Newfoundland and Labrador's largest health authority last month may force the province to send breast cancer laboratory samples out of the province for assessment.
Breast cancer pathologist Dr. Nikita Makretsov resigned from the health authority, effective February 14, 2011......"cont'd
Monday, February 28, 2011
SGO annual meeting - Special Session Highlights Late-Breaking Abstract -- CHICAGO, Feb. 28, 2011 press release: - adherence with NCCN guidelinelines 144,449 ovarian cancer patient study/database
Featured Late-Breaking Abstract for 2011
The following late-breaking abstract will be highlighted during the LBA session, March 8:
- Adherence with National Comprehensive Cancer Network (NCCN) Guidelines Associated with Improved Survival in Ovarian Cancer Patients, A Study of 144,449 Patients From the National Cancer Data Base: A Project from The Society of Gynecologic Oncologists (SGO) Quality and Outcomes Committee -- M. Powell
full free access (pdf) A nomogram for estimating the probability of ovarian cancer
Note: see Table 1 Distribution of age in years, morphology index ultrasound score, and serum CA125 level among patients with benign and malignant adnexal masses
Objective
Accurate preoperative estimates of the probability of malignancy in women with adnexal masses are essential for ensuring optimal care. This study presents a new statistical model for combining predictive information and a graphic decision support tool for calculating risk of malignancy.Research Highlights
►This study presents a statistical model for measuring probability of ovarian cancer.
►Model includes age, ultrasound score, CA125 value, and nonlinearity adjustments.
►Excellent discrimination and calibration are obtained across the probability range.
"The nomogram developed in this study is not ready for clinical use, because it reflects the experience of a single institution. Further research using data from multiple institutions is required to develop a final model. However, these results demonstrate that accounting for non-linearity in the effects of age and CA125 yields better estimates of malignancy risk. Utilization of similar models in the treatment decision making process could reduce unnecessary referrals and increase appropriate referrals for women with masses identified pre-operatively as suspicious for malignancy."
►Model includes age, ultrasound score, CA125 value, and nonlinearity adjustments.
►Excellent discrimination and calibration are obtained across the probability range.
"The nomogram developed in this study is not ready for clinical use, because it reflects the experience of a single institution. Further research using data from multiple institutions is required to develop a final model. However, these results demonstrate that accounting for non-linearity in the effects of age and CA125 yields better estimates of malignancy risk. Utilization of similar models in the treatment decision making process could reduce unnecessary referrals and increase appropriate referrals for women with masses identified pre-operatively as suspicious for malignancy."
full free access (pdf): Improved survival in non-Ashkenazi Jewish ovarian cancer patients with BRCA1 and BRCA2 gene mutations
OBJECTIVES: Previous studies report a survival advantage in ovarian cancer patients with Ashkenazi Jewish (AJ) breast cancer gene (BRCA) founder mutations. The purpose of this study was to determine if this association exists in patients with non-Ashkenazi Jewish (non-AJ) BRCA mutations. We also sought to account for "survival bias" by minimizing lead time that may exist between diagnosis and genetic testing.
CONCLUSIONS: This multicenter study demonstrates a significant survival advantage in advanced stage ovarian cancer patients with non-AJ BRCA mutations, confirming the previous studies in the Jewish population. This improved survival was evident when accounting for the "survival bias" that coincides with genetic testing.
full free access (pdf): A phase I study with an expanded cohort to assess the feasibility of intraperitoneal carboplatin and intravenous paclitaxel in untreated ovarian, fallopian tube, and primary peritoneal carcinoma: A Gynecologic Oncology Group study
full free access: Feasibility of same-day discharge after laparoscopic surgery in gynecologic oncology
OBJECTIVE: The purpose of this study is to evaluate whether same-day discharge after laparoscopic gynecologic oncology surgery is feasible and determines factors associated with admission.
METHODS: This retrospective cohort study included all patients consented for laparoscopy by two gynecologic oncologists at a tertiary care academic teaching hospital between January 2006 and June 2009. Procedures included those not typically discharged same-day, such as total laparoscopic simple or radical hysterectomies or radical trachelectomy +/- salpingo-oophorectomy +/- pelvic and para-aortic lymph node dissection +/- omentectomy. Those discharged same-day were compared to those admitted. Multivariate logistic regression analysis was done to determine factors associated with admission.
RESULTS: Three hundred three patients were included. 6.9% were converted to laparotomy. One hundred forty-seven (48.5%) had same-day discharge (median stay 295minutes). Among outpatients, 7 (4.8%) were readmitted within three weeks of surgery. Three patients (2%) could have avoided the ER or hospital admission had they been originally admitted postoperatively. No patients with same-day discharge had a major acute postoperative complication. Factors associated with admission include age (OR 1.76 for age 70years vs 50years, p=0.001), surgeon (OR 6.91, p<0.0001), conversion to laparotomy (p<0.0001), radical hysterectomy (OR 3.43, p=0.002), length of surgery (OR 2.94 for 4hours vs 2hours, p<0.0001), and surgery start time after 1PM (OR 3.77, p=0.0001).
CONCLUSION: Same-day discharge for laparoscopic gynecologic oncology surgery is feasible, with low morbidity and few readmissions within three weeks of surgery. Successful same-day discharge can increase by refining patient selection and operating room scheduling.
full free access: CA125 surveillance increases optimal resectability at secondary cytoreductive surgery for recurrent epithelial ovarian cancer
CONCLUSIONS: Each week delay after first CA125 elevation correlated with a 3% increased chance of suboptimal resection at SCS (secondary cytoreductive surgery). Serial CA125 surveillance for early detection of recurrence may increase rates of optimal SCS and potentially influence overall survival. (47 vs. 23months, p<0.0001)
full free access: Meta-analysis: Circulating vitamin D and ovarian cancer risk
OBJECTIVE: To review and summarize evidence from longitudinal studies on the association between circulating 25 hydroxyvitamin D (25(OH)D) and the risk of ovarian cancer (OC).
RESULTS: Overall, ten individual-level studies were included that reported on the association between circulating vitamin D levels and OC incidence..........
CONCLUSIONS: A tentative inverse association of circulating 25(OH)D with OC incidence was found, which did not reach statistical significance but which requires clarification by additional studies due to potentially high clinical and public health impact.
Research Highlights
►As we know, this is the first systematic review and meta-analysis evaluating the association between serum 25(OH)D levels and ovarian cancer risk.►The method for comprehensive trend estimation from summarized dose–response data was used for combining all results from individual studies so far.
►A potential weak inverse association between serum vitamin D and ovarian cancer risk was found in this meta-analysis.
full free access: Wound complications after gynecologic cancer surgery
Definitions of adhesiolysis:
Scar tissue can form as a result of prior surgery or infections involving reproductive tact, urinary tract or vaginal canal causing severe pain. Adhesiolysis is the surgical procedure used to remove this scar tissue.
www.urogyncenter.com/ug-glossary.htm
Research highlights
► Retrospective review of patients undergoing abdominal surgery for suspected cancer.► Wound complications correlated with BMI, prior surgery, albumin, adhesiolysis, length of surgery.
► A nomogram predicting post-operative wound complications was created and validated.
Nuclear P27 (gene) expression in benign, borderline (LMP) and invasive tumors of the ovary and its association with prognosis: A GOG group study
Abstract
Objective
Nuclear p27 expression was examined in non-invasive and invasive ovarian tumors from a cross-sectional study, and clinical relevance of p27 was evaluated in the primary tumors from women participating in two randomized phase III treatment trials.Methods
An immunohistochemistry assay was used to detect p27 in formalin-fixed paraffin-embedded ovarian tumors from 3 distinct sources.Research Highlights
► Low p27 expression is associated with malignant transformation of the ovary.► A cyclin E to p27 ratio > 1.0 may be associated with shorter survival.
► Study required confirming increased recurrences with low p27 in early stage patients.
Correlation of macroscopic and microscopic pathology in risk reducing salpingo-oophorectomy: Implications for intraoperative specimen evaluation
Abstract Objective
A minority of risk-reducing salpingo-oophorectomy (RRSO) specimens from BRCA mutation carriers will contain clinically occult carcinoma that is detectable only using a specialized pathologic evaluation protocol. Although intraoperative detection of cancer may alter immediate surgical management, technical complications impairing pathologic diagnosis may result if fresh tissue dissection and frozen sections are performed on unselected RRSO specimens. We hypothesize that macroscopic specimen findings may predict which RRSO specimens contain cancer and therefore may guide selection of specimens for intraoperative pathologic evaluation. The aim of this study was to correlate the macroscopic and microscopic pathologic findings in RRSO.Research highlights
► Most occult carcinomas detected in RRSO specimens were not grossly visible.► A minority of visible nodules >5 mm in the ovary or tube harbored occult carcinoma.
► No cancer was identified in any of the grossly visible cysts of the ovary or tube.
Review Multidisciplinary management of malignant ovarian germ cell tumours
Abstract
Objectives
Malignant ovarian germ cell tumours (MOGCT) are rare cancers of young women. Limited prospective trials exist from which evidence-based management can be developed. This review summarizes the available literature concerning MOGT in order to provide the clinician with information relevant to their multidisciplinary management.Multiple synchronous primary ovarian malignancies in a patient with a MLH-1 mutation: Impact on potential fertility preservation (MLH1 is one of the Lynch Syndrome genes) including commentary
"EOC associated with HNPCC syndrome differs compared to sporadic cases with mean age at diagnosis of 42.7"
(Note: Definition synchronous: occurring or existing at the same time)
Abstract:
Introduction
While the majority of epithelial ovarian cancer (EOC) is due to sporadic mutations, approximately 10% of cases are secondary to hereditary germ line mutations: 85–90% of tumors are caused by BRCA1 and BRCA2 gene mutations while hereditary non-polyposis colorectal cancer (HNPCC), or Lynch syndrome, accounts for the remainder [1].HNPCC patients may have synchronous primary tumors at the time of prophylactic or therapeutic surgery, involving the colon, ovary, uterus or a combination thereof. We present an unusual case of a patient with HNPCC syndrome and three primary ovarian neoplastic processes without coexisting colon or uterine malignancies, and underscore the importance of hysterectomy and bilateral salpingo-oophorectomy in cancer-associated mutation carriers from Lynch syndrome families........cont'd
Also: link to referenced article:
Cancer
Fertility preservation in young women with epithelial ovarian cancer
Volume 115, Issue 18, 15 September 2009, Pages 4118-4126
METHODS: Women aged ≤50 years with stage IA or IC epithelial ovarian cancer who were registered in the Surveillance, Epidemiology, and End Results database were examined.......cont'd
abstract: A microRNA survival signature (MiSS) for advanced ovarian cancer (serous)
Abstract
Objectives
MicroRNAs (miRNAs) are a class of small non-coding RNAs that negatively regulate gene expression primarily through post-transcriptional modification. We tested the hypothesis that miRNA expression is associated with overall survival in advanced ovarian cancer.Results
Of all patients, 80% had high-grade, stage IIIC tumors and 64% underwent optimal cytoreduction. The median survival for the entire cohort was 49 ± 4 months. The training set identified 3 miRNAs associated with survival — miR-337, miR-410, and miR-645. An miRNA signature containing miR-410 and miR-645 was most strongly associated with overall survival in the training set (HR = 2.96, 95% CI: 1.51–5.78). This miRNA survival signature (MiSS) was validated in the test set (HR = 1.71, 95% CI: 1.05–2.78). The MiSS was independent of FIGO stage and surgical debulking.Conclusions
The data suggest that an MiSS that contains miR-410 and miR-645 is negatively associated with overall survival in advanced serous ovarian cancer. This signature, when further validated, may be useful in individualizing care for the ovarian cancer patient. Pathway analyses identify biologically plausible mechanisms.Recommended Adult Immunization Schedule --- United States, 2011 including those with health conditions- Fig. 2
Clinical practice guidelines as marketing tools -- Collier 183 (3): E141 -- Canadian Medical Association Journal
Blogger's Note: bias exist no matter the source, what does matter is the degree and ultimately the intent (ethics)
....................................................................................
"If the guidelines are funded by government or private donors, a bias toward recommending particular pharmaceuticals may not be present."
abstract: The use of Chinese herbal medicine to improve quality of life in women undergoing chemotherapy for ovarian cancer: a double-blind placebo-controlled randomized trial with immunological monitoring — Ann Oncol
Background: This study aimed to evaluate traditional Chinese medicine (TCM) in improving quality of life (QOL), reducing chemotoxicity and modulating immune function in patients undergoing chemotherapy.
Review Article: A Systematic Review of Cancer-Related Fatigue Measurement Questionnaires
Discussion:
Most tools had been validated in mixed populations and are relatively insensitive to differences in fatigue to cancer stage. Most instruments are burdensome for those with advanced cancer.
Conclusions:
In all, 40 CRF instruments were identified. Validity and reliability varied by questionnaire. The ideal item numbers, scale, and domains are not established and may be population dependent.
Sunday, February 27, 2011
Saturday, February 26, 2011
ESMO: Community Oncology: Ensuring the Best Standards of Care
“The important thing is that community oncologists should not work alone. They should be part of a network and participate in a common reflection and also work with others in clinical research. In France, community oncologists work closely with university hospitals or big cancer centers and are in contact with larger teams. National and international guidelines are followed and ensure that patients receive quality treatment.”
abstract: Pleural Effusion Detected at CT prior to Primary Cytoreduction for Stage III or IV Ovarian Carcinoma: Effect on Survival
Purpose: To determine the prognostic importance of pleural effusions on preoperative computed tomographic (CT) images in patients with advanced epithelial ovarian cancer.
abstract : Red and processed meat consumption and risk of ovarian cancer: a dose-response meta-analysis of prospective studies : British Journal of Cancer
Conclusion:
Results from this dose-response meta-analysis suggest that red and processed meat consumption is not associated with risk of ovarian cancer. Although a lower consumption of red and processed meat may offer protection against other types of cancer, other interventions are needed to reduce the risk of ovarian cancer.
PROSPERO - International prospective register of systematic reviews
PROSPERO is an international database of prospectively registered systematic reviews in health and social care. Key features from the review protocol are recorded and maintained as a permanent record in PROSPERO. This will provide a comprehensive listing of systematic reviews registered at inception, and enable comparison of reported review findings with what was planned in the protocol.
Mechanical Bowel Preparation for Gynecologic Laparoscopy: A Prospective Randomized Trial of Oral Sodium Phosphate Solution vs Single Sodium Phosphate Enema (including safety issues)
Mechanical Bowel Preparation for Gynecologic Laparoscopy: A Prospective
Randomized Trial of Oral Sodium Phosphate Solution vs Single Sodium
Phosphate Enema
Abstract
Study Objective
To compare the effect of mechanical bowel preparation using oral sodium phosphate (NaP) solution vs single NaP enema on the quality of the surgical field in patients undergoing advanced gynecologic laparoscopic procedures.full free access: (2010) MSH6 and PMS2 mutation positive Australian Lynch syndrome families: novel mutations, cancer risk and age of diagnosis of colorectal cancer
Background
Approximately 10% of Lynch syndrome families have a mutation in MSH6 and fewer families have a mutation in PMS2. It is assumed that the cancer incidence is the same in families with mutations in MSH6 as in families with mutations in MLH1/MSH2 but that the disease tends to occur later in life, little is known about families with PMS2 mutations. This study reports on our findings on mutation type, cancer risk and age of diagnosis in MSH6 and PMS2 families..........cont'd
"Lynch syndrome is an autosomal dominantly inherited cancer syndrome
characterised by early onset epithelial cancers. Patients with Lynch
syndrome have an increased risk of developing malignancies during their
lifetime, at a mean age of disease onset that is significantly lower
than that observed in the general population. In addition to the high
risk of developing CRC, Lynch syndrome patients are also at risk of
developing malignancies in a variety of organs that include the uterus,
small bowel, stomach, ovary, bladder, pancreas and the urinary tract [2,3]."
Friday, February 25, 2011
Thursday, February 24, 2011
EvidenceUpdates: Comparing the diagnostic performance of 2 clinical decision rules to rule out deep vein thrombosis in primary care patients including commentaries
Note: secondary link below w/o commentaries BUT full free access, also see Table 1 for risk factors including malignancies:
Comparing the Diagnostic Performance of 2 Clinical Decision Rules to Rule Out Deep Vein Thrombosis in Primary Care Patients
(why it's important)
"With an annual incidence of 1 to 2 per 1,000 inhabitants, deep vein thrombosis (DVT) is relatively rare in primary care, but it is feared for its associated morbidity and mortality if left untreated...."
website TCGA Cancer Genomics + 20 cancer study (including ovarian) updated Jan 2011
About Cancer Genomics
Explore information and resources to improve your understandingof cancer genomics, the importance of tumor samples in genomic
research and the role of cancer genomics in personalized medicine.
plus:
Cancers Selected for Study
Following the success of The Cancer Genome Atlas (TCGA)Pilot Project, NIH announced in September 2009 that it is
investing $275 million in TCGA over the next two years of
this five-year program to chart the genomic changes
involved in more than 20 types of cancer. To date,
TCGA has achieved comprehensive sequencing,
characterization, and analysis of the genomic changes
in the brain cancer, glioblastoma multiforme, and
ovarian cancer.
CANCER TISSUES BEING COLLECTED FOR POTENTIAL STUDY
Last Updated: January 16, 2011 Expand All | Collapse AllCentral Nervous System (Brain)
Breast
Gastrointestinal
Gynecologic
Head and Neck
Hematologic
Thoracic
Urologic
Wednesday, February 23, 2011
CME/Conference Management - Lynch Syndrome Patient Conference - MD Anderson Cancer Center Apr 2, 2011
Lynch Syndrome Patient Conference
April 2, 2011-Saturday 9 a.m. – 3 p.m.
Hyatt Regency Hill Country
9800 Hyatt Resort Drive
San Antonio, Texas
Registration fee: $20. prior to March 11th, 2011
Commentary: microRNAs in stage I epithelial ovarian cancer : The Lancet Oncology
"In epithelial ovarian cancer (EOC), miRNA-expression profiles have been described that are associated with different characteristics of ovarian cancer (eg, tumour subtype, stage, histological grade, prognosis, and therapy resistance)........However, these studies should focus on pure histotypes, as EOC is thought to be a heterogeneous disease in which some histotypes are completely different entities all together, with different response outcomes to standard treatment. Another confounding factor for prognostic marker discovery might be exposure to platinum-based combination chemotherapy. Preferably, only patients who did not receive chemotherapy should be analysed for PFS. Because stage I EOC samples are relatively rare, we encourage additional studies to be done by international consortia. With the above-mentioned considerations in mind, valid miRNA biomarkers will be identified that can be of use in the clinic, and help to personalise treatment."
clinical trial recruiting: Women Who Are At Risk Or May Have Lynch Syndrome - Full Text View - ClinicalTrials.gov
ClinicalTrials.gov Identifier: NCT00508573
| Estimated Enrollment: | 1000 |
| Study Start Date: | May 2007 |
| Estimated Primary Completion Date: | May 2012 (Final data collection date for primary outcome measure) |
abstract: Familial Tumors of the Uterine Corpus
Abstract
Women with Lynch syndrome are at considerable risk for developing endometrial carcinoma, but current screening guidelines for detection of Lynch syndrome focus almost exclusively on colorectal carcinoma. Lynch syndrome associated colorectal and endometrial carcinomas have some important differences with implications for screening strategies. These differences are discussed in this review, along with the most effective screening criteria and testing methods for detection of Lynch syndrome in endometrial carcinoma patients.
Association between miR-200c and the survival of patients with stage I epithelial ovarian cancer: a retrospective study of two independent tumour tissue collections : The Lancet Oncology
Interpretation
miR-200c has potential as a predictor of survival, and is a biomarker of relapse, in stage I EOC.
full free access: Bisphosphonate Use and the Risk of Subtrochanteric or Femoral Shaft Fractures in Older Women, February 23, 2011 JAMA
Conclusion Among older women, treatment with a bisphosphonate for more than 5 years was associated with an increased risk of subtrochanteric or femoral shaft fractures; however, the absolute risk of these fractures is low.
Treatment-Related Mortality With Bevacizumab in Cancer Patients, February 2, 2011— JAMA review - 2.5 vs 1.7 % risk not dependent on type of solid tumor/dose
Data Synthesis: A total of 10 217 patients with a variety of advanced solid tumors from 16 RCTs were included in the analysis. The overall incidence of FAEs with bevacizumab was 2.5% (95% CI, 1.7%-3.9%). Compared with chemotherapy alone, the addition of bevacizumab was associated with an increased risk of FAEs, with an RR of 1.46 (95% CI, 1.09-1.94; P = .01; incidence, 2.5% vs 1.7%). This association varied significantly with chemotherapeutic agents but not with tumor types or bevacizumab doses.
Tuesday, February 22, 2011
Abstract: Persistent Noncompliance With the Work-Hour Regulation (patient safety)
Note:
the Transportation Industry has been dealing with 'hours of service'
issues for decades (same issues/different industry - fatigue)
on December 29, 2010. For details, visit the HOS Proposed Rule page to view the complete rulemaking, summary of changes, FAQs, and other related information.
Health-related quality of life and cancer clinical trials — Therapeutic Advances in Medical Oncology
"...Health-related quality of life has become a more accurate predictor of survival than some other clinical parameters, such as performance status. The overall outlook for the routine assessment of patient-reported outcomes in clinical trials is assured and, eventually, it is likely to become a standard part of clinical practice. ...."
Feb 21st, 2011: Ovarian cancer - Cancer Network (worth reading/overview of ovarian cancer)
Note: good overview of ovarian cancer biology, treatments, genetics, diet, environment, hormonal factors...
By Stephen C. Rubin, MD, Paul Sabbatini, MD, and Akila N. Viswanathan, MD, MPH | February 21, 2011
Expert Perspectives in Oncology: Contemporary Approaches in Targeting Angiogenesis prIME Oncology
Note: requires registration to view (free), also speaks about ICON 7 (ovarian cancer/avastin trial) Module Six Practical Considerations in Patient Management Involving Antiangiogenic Therapy
St. Gallen Satellite Symposium titled,: “‘Perplexing Questions in Early Breast Cancer: Answers from the Experts | prIME Oncology
Note: requires registration to view (free)
Meeting Overview
We are pleased to invite you to our St Gallen Satellite Symposium titled, “Perplexing Questions in Early Breast Cancer: Answers from the Experts," to be held on 17 March 2011 in St Gallen, Switzerland.
During this interactive meeting, leaders in the field will discuss clinical issues in the field of early breast cancer.
Monday, February 21, 2011
Prima BioMed Receives Regulatory Scientific Advice on CVac Phase III Trial -- SYDNEY, Feb. 18, 2011 /PRNewswire/ --
"......The trial will be conducted on 750 patients in a double blind placebo controlled study randomized 1:1 of CVac vs. Standard of Care (currently there is no approved maintenance therapy for ovarian cancer), across multiple sites in Europe, the US and Australia....."
full free access (pdf): Frequencies of BRCA1 and BRCA2 mutations among 1,342 unselected patients with invasive ovarian cancer (Ontario, Canada study including demographics)
Abstract
BACKGROUND: The heritable fraction of ovarian cancer exceeds that of any other common adult cancer. Most inherited cases of ovarian cancer are due to a germline mutation in BRCA1 or BRCA2. It is important to have an accurate estimate of the proportion of ovarian cancer patients who carry a mutation and the specific factors which predict the presence of a mutation.METHODS: We tested a population-based series of 1342 unselected patients diagnosed with invasive ovarian cancer between 1995-1999 and 2002-2004 in Ontario, Canada, for germline mutations in BRCA1 and BRCA2. The two genes were tested in their entirety, using a range of techniques, including multiplex ligation-dependent probe amplification (MLPA).
RESULTS: Among the 1342 women, 176 women carried a mutation (107 in BRCA1, 67 in BRCA2, and two in both genes) for a combined mutation frequency of 13.3%. Seven deletions were identified using MLPA (3.9% of all detected mutations). The prevalence of mutations was particularly high among women diagnosed in their forties (24.0%), in women with serous ovarian cancer (18.0%) and women of Italian (43.5%), Jewish (30.0%) or Indo-Pakistani origin (29.4%). A mutation was seen in 33.9% of women with a first-degree relative with breast or ovarian cancer and in 7.9% of women with no first-degree relative with breast or ovarian cancer. No mutation was seen in women with mucinous carcinoma.
CONCLUSIONS: BRCA1 and BRCA2 mutations are common in women with invasive ovarian cancer. All women diagnosed with invasive non-mucinous ovarian cancer should be considered to be candidates for genetic testing.
Wound complications after gynecologic cancer surgery (risk factors)
CONCLUSIONS: Wound complications are common in gynecologic oncology. Further studies should explore whether risk factor modification decreases complications.
Zoledronic acid preserves bone mineral density in premenopausal women who develop ovarian failure due to adjuvant chemotherapy: Final results from CAL
Note: side effects
INTERPRETATION: ZA every 3 months is well tolerated and prevents rapid bone loss in premenopausal women that develop CIOF. Giving ZA with rather than 1 year after the start of adjuvant chemotherapy is the preferred sequence to prevent bone loss.
Sunday, February 20, 2011
Platinum-based adjuvant chemotherapy on moderate - and high-risk stage I and II epithelian ovarian cancer patients. Long-term single institution exper
Background Although the optimal management of women with FIGO stages I and II epithelial ovarian cancer (EOC) is still controversial, platinum-based adjuvant chemotherapy (CT) is the mainstay of treatment. Suboptimal survival results have led to major efforts to identify prognostic factors, improve surgical staging and develop adjuvant therapies to improve patients' outcomes.
Patients and methods We evaluate in a retrospective study clinical efficacy and the toxicity profile of a platinum-based adjuvant CT in FIGO stages I and II EOC treated at our institution from March 1984 to December 2006. Grade I FIGO stages IA-IB were excluded from the analysis. In the first period (1984-1997), patients received a platinum-based regimen without taxanes. In the second period from 1997 onwards, patients were treated with carboplatin and paclitaxel. Four to six cycles of adjuvant CT were administered. Potential predictive factors of efficacy and the role of paclitaxel addition were also analysed.
Results One hundred and fifty-eight patients (60 treated with paclitaxel) met inclusion criteria and were evaluable. Median age at diagnosis was 53.7 years (range 19-81) and most patients had an Eastern Cooperative Oncology Group performance status score (ECOG) of 0-1 (91.8%); 82.9% patients had pathological stage I and 17.1% pathological stage II. With a median follow up of 8.34 years (range 4.4-11.6), 103 patients (74.1%) were free of disease and 110 of them were alive (79.1%). Median relapse-free survival (RFS) and median overall survival (OS) had not been reached at the time of the analysis. No survival difference was found between paclitaxel and carboplatin combination or non-paclitaxel-containing regimens. Statistically significant prognostic factors for better RFS in the multivariate analysis were: ECOG 0 (p=0.023; HR 0.32; 95% CI 0.17-0.57); FIGO I stage (p<0.001; HR 0.30; 95% CI 0.15-0.58); I-II histological grade (p=0.005; HR 0.38; 95% CI 0.19-0.75); mucinous histology (p=0.013; HR 0.28; 95% CI 0.13-0.53); non-surgical adherences (p<0.002, HR 0.32; 95% CI 0.15-0.54); paracolic gutters inspection (p=0.033; HR 0.50; 95% CI 0.26-0.95) and liver surface biopsies (p=0.048; HR 0.64; 95% CI 0.41-0.98).Toxicity was generally mild and non-haematologic events were the most commonly found (62.9% of the total). The most frequent haematologic toxicities were neutropenia (41.7% in all grades, 9.5% grade 3-4) and anaemia (29.1% in all grades, 3.2% grade 3-4).
Conclusions The long-term outcome of this series is comparable to the published evidence and reflects the limited activity of platinum-based CT in the adjuvant setting. The potential survival advantage of the addition of paclitaxel to carboplatin cannot be definitively answered due to the small number of patients, the limited follow-up and the retrospective nature of the study. More effective and specific treatments are clearly required, in particular for those patients with stage II and undifferentiated tumours. Quality of surgery entails prognostic value.
Patients and methods We evaluate in a retrospective study clinical efficacy and the toxicity profile of a platinum-based adjuvant CT in FIGO stages I and II EOC treated at our institution from March 1984 to December 2006. Grade I FIGO stages IA-IB were excluded from the analysis. In the first period (1984-1997), patients received a platinum-based regimen without taxanes. In the second period from 1997 onwards, patients were treated with carboplatin and paclitaxel. Four to six cycles of adjuvant CT were administered. Potential predictive factors of efficacy and the role of paclitaxel addition were also analysed.
Results One hundred and fifty-eight patients (60 treated with paclitaxel) met inclusion criteria and were evaluable. Median age at diagnosis was 53.7 years (range 19-81) and most patients had an Eastern Cooperative Oncology Group performance status score (ECOG) of 0-1 (91.8%); 82.9% patients had pathological stage I and 17.1% pathological stage II. With a median follow up of 8.34 years (range 4.4-11.6), 103 patients (74.1%) were free of disease and 110 of them were alive (79.1%). Median relapse-free survival (RFS) and median overall survival (OS) had not been reached at the time of the analysis. No survival difference was found between paclitaxel and carboplatin combination or non-paclitaxel-containing regimens. Statistically significant prognostic factors for better RFS in the multivariate analysis were: ECOG 0 (p=0.023; HR 0.32; 95% CI 0.17-0.57); FIGO I stage (p<0.001; HR 0.30; 95% CI 0.15-0.58); I-II histological grade (p=0.005; HR 0.38; 95% CI 0.19-0.75); mucinous histology (p=0.013; HR 0.28; 95% CI 0.13-0.53); non-surgical adherences (p<0.002, HR 0.32; 95% CI 0.15-0.54); paracolic gutters inspection (p=0.033; HR 0.50; 95% CI 0.26-0.95) and liver surface biopsies (p=0.048; HR 0.64; 95% CI 0.41-0.98).Toxicity was generally mild and non-haematologic events were the most commonly found (62.9% of the total). The most frequent haematologic toxicities were neutropenia (41.7% in all grades, 9.5% grade 3-4) and anaemia (29.1% in all grades, 3.2% grade 3-4).
Conclusions The long-term outcome of this series is comparable to the published evidence and reflects the limited activity of platinum-based CT in the adjuvant setting. The potential survival advantage of the addition of paclitaxel to carboplatin cannot be definitively answered due to the small number of patients, the limited follow-up and the retrospective nature of the study. More effective and specific treatments are clearly required, in particular for those patients with stage II and undifferentiated tumours. Quality of surgery entails prognostic value.
Lynch Syndrome and MYH-Associated Polyposis: Review and Testing Strategy. Goodenberger M, Lindor NM.
Abstract
Individuals with Lynch syndrome have an increased risk for colorectal cancer, endometrial cancer, and other associated cancers such as gastric cancer, ovarian cancer, urothelial cancers, hepatobiliary tract cancer, brain cancer, cancer of the small intestine, pancreatic cancer, and particular skin cancers.
Lynch syndrome caused by defects in DNA mismatch repair genes, and diagnostic testing for Lynch syndrome begins with microsatellite instability and immunohistochemical analysis on the tumor specimen followed by germline genetic testing and possibly further studies on the tumor. MYH-associated polyposis syndrome is a recently characterized, autosomal recessive, polyposis syndrome caused by biallelic mutations in the MYH gene. Individuals carrying 2 copies of the mutation have a significantly increased risk of polyposis, colorectal cancer, upper gastrointestinal polyps and additional features commonly seen in familial adenomatous polyposis syndrome. Genetic testing for MYH mutation is complicated by the phenotypic overlap of MYH-associated polyposis with other colorectal cancer syndromes. This study serves to clarify the best testing approach.
Lynch syndrome caused by defects in DNA mismatch repair genes, and diagnostic testing for Lynch syndrome begins with microsatellite instability and immunohistochemical analysis on the tumor specimen followed by germline genetic testing and possibly further studies on the tumor. MYH-associated polyposis syndrome is a recently characterized, autosomal recessive, polyposis syndrome caused by biallelic mutations in the MYH gene. Individuals carrying 2 copies of the mutation have a significantly increased risk of polyposis, colorectal cancer, upper gastrointestinal polyps and additional features commonly seen in familial adenomatous polyposis syndrome. Genetic testing for MYH mutation is complicated by the phenotypic overlap of MYH-associated polyposis with other colorectal cancer syndromes. This study serves to clarify the best testing approach.
Surgical management of bowel obstruction in gynaecological malignancies.
Abstract
PURPOSE OF REVIEW: Bowel obstruction in gynaecological malignancies continues to present clinical challenges and a multidisciplinary approach to discuss management is crucial. Surgery, usually with palliative intent, is associated with significant morbidity and mortality. There is an absence of level 1 evidence and national guidelines, and only limited quality-of-life data.RECENT FINDINGS: Acute bowel obstruction in gynaecological cancer patients is rare and surgery is associated with a higher morbidity and mortality rate. Less commonly, emergency bowel obstruction cases will have had radiotherapy or recent chemotherapy, which also increases surgical morbidity and mortality. However, most often, bowel obstruction in irradiated gynaecological cancer patients is not due to cancer. Ovarian cancer is the most common malignancy. Caution is needed in those EOC patients with ascites, short treatment-free interval, acute abdomen and chemoresistance. Comorbidities are frequent. The decision for surgery should be made on an individual basis. Palliative care input is important early in patient management as for most patients the surgical goal is palliation and not cure. There is still a paucity of published data on quality-of-life assessments.
SUMMARY: There is a need to identify those patients who may benefit from palliative surgical intervention and those who will not. Ideally, agreed national guidelines should be produced and regularly reviewed.
Undetectable antimüllerian hormone levels and recovery of chemotherapy-induced ovarian failure in women with breast cancer on an oral aromatase inhibitors
Abstract
OBJECTIVE: Knowledge of the menopause status of a woman with breast cancer is important for good clinical practice. Long-lasting amenorrhea is frequent in this population, often for reasons other than definitive menopause. Antiestrogens like tamoxifen or oral aromatase inhibitors (AIs) may reactivate the ovary causing vaginal bleeding, menstruation, pregnancy, and unopposed endometrial stimulation. In contrast to tamoxifen, AIs are not active against breast cancer in the presence of functional ovaries. Antimüllerian hormone (AMH) is a potential marker of residual ovarian function that can predict not only the onset of menopause but also chemotherapy-induced amenorrhea (CIA) and fertility. We assess the value of AMH in women who recovered from CIA on an AI.
Retrospective study of the impact of pharmacogenetic variants on paclitaxel toxicity and survival in patients with ovarian cancer.
PURPOSE: Paclitaxel has a broad spectrum of anti-tumor activity and is useful in the treatment of ovarian, breast, and lung cancer. Paclitaxel is metabolized in the liver by CYP2C8 and CYP3A4 and transported by P-glycoprotein. The dose-limiting toxicities are neuropathy and neutropenia, but the interindividual variability in toxicity and also survival is large. The main purpose of this study was to investigate the impact of genetic variants in CYP2C8 and ABCB1 on toxicity and survival.
METHODS: The 182 patients previously treated for ovarian cancer with carboplatin and paclitaxel in either the AGO-OVAR-9 or the NSGO-OC9804 trial in Denmark or Sweden were eligible for this study. Genotyping was carried out on formalin-fixed tissue. The patients' toxicity profiles and survival data were derived from retrospective data. CYP2C8*3, ABCB1 C1236T, G2677T/A, and C3435T were chosen a priori for primary analysis; a host of other variants were entered into an exploratory analysis.
RESULTS: Clinical data and tissue were available from a total of 119 patients. Twenty-two single nucleotide polymorphisms (SNPs) in 10 genes were determined. Toxicity registration was available from 710 treatment cycles. In the primary analysis, no statistically significant correlation was found between CYP2C8*3, ABCB1 C1236T, G2677T/A, and C3435T and neutropenia, sensoric neuropathy, and overall survival.
CONCLUSION: CYP2C8*3 and the ABCB1 SNPs C1236T, G2677T/A, and C3435T were not statistically significantly correlated to overall survival, sensoric neuropathy, and neutropenia in 119 patients treated for ovarian cancer with paclitaxel/carboplatin.
Sugars in diet and risk of cancer in the NIH-AARP diet and health study
Abstract
Prospective epidemiologic data on the effects of different types of dietary sugars on cancer incidence have been limited. In this report, we investigated the association of total sugars, sucrose, fructose, added sugars, added sucrose and added fructose in the diet with risk of 24 malignancies.
Participants (n = 435,674) aged 50-71 years from the NIH-AARP Diet and Health Study were followed for 7.2 years. The intake of individual sugars was assessed using a 124-item food frequency questionnaire (FFQ)......... We identified 29,099 cancer cases in men and 13,355 cases in women. In gender-combined analyses, added sugars were positively associated with risk of esophageal adenocarcinoma ; added fructose was associated with risk of small intestine cancer ; and all investigated sugars were associated with increased risk of pleural cancer. In women, all investigated sugars were inversely associated with ovarian cancer. We found no association between dietary sugars and risk of colorectal or any other major cancer.
Measurement error in FFQ-reported dietary sugars may have limited our ability to obtain more conclusive findings. Statistically significant associations observed for the rare cancers are of interest and warrant further investigation.
Participants (n = 435,674) aged 50-71 years from the NIH-AARP Diet and Health Study were followed for 7.2 years. The intake of individual sugars was assessed using a 124-item food frequency questionnaire (FFQ)......... We identified 29,099 cancer cases in men and 13,355 cases in women. In gender-combined analyses, added sugars were positively associated with risk of esophageal adenocarcinoma ; added fructose was associated with risk of small intestine cancer ; and all investigated sugars were associated with increased risk of pleural cancer. In women, all investigated sugars were inversely associated with ovarian cancer. We found no association between dietary sugars and risk of colorectal or any other major cancer.
Measurement error in FFQ-reported dietary sugars may have limited our ability to obtain more conclusive findings. Statistically significant associations observed for the rare cancers are of interest and warrant further investigation.
Long-term clinical and immunological effects of p53-SLP® vaccine in ovarian cancer patients
Abstract
Vaccine-induced p53-specific immune responses were previously reported to be associated with improved response to secondary chemotherapy in small cell lung cancer patients. We investigated longterm clinical and immunological effects of the p53-SLP® vaccine in recurrent ovarian cancer patients. Twenty patients were immunized with the p53-SLP® vaccine between July 2006 and August 2007.Follow-up information on patients was obtained. Clinical responses to secondary chemotherapy after p53-SLP® immunizations was determined by computerized tomography and/or tumour marker levels (CA125). Disease-specific survival was compared with a matched historical control group. Immune responses were analysed by flow cytometry, proliferation assay, IFN-γ ELISPOT and/or cytokine bead array. Lymphocytes cultered from skin biopsy were analysed by flow cytometry and proliferation assay.
Of twenty patients treated with the p53-SLP® vaccine, seventeen were subsequently treated with chemotherapy. Eight of these volunteered another blood sample. No differences in clinical response rates to secondary chemotherapy or disease-specific survival were observed between immunized patients and historical controls (p=0.925, resp. p=0.601). P53-specific proliferative responses were observed in 5/8 patients and IFN-γ production in 2/7 patients. Lymphocytes cultured from a prior injection site showing inflammation during chemotherapy did not recognise p53-SLP®. Thus treatment with the p53- SLP® vaccine does not affect responses to secondary chemotherapy or survival, although p53-specific T-cells do survive chemotherapy.
Phase II Clinical Study of the Combination Chemotherapy Regimen of Irinotecan Plus Oral Etoposide for the Treatment of Recurrent Ovarian Cancer
OBJECTIVE: To evaluate the efficacy and safety of the combination chemotherapy regimen of irinotecan plus oral etoposide for the treatment of patients with recurrent ovarian cancer after previous treatment with platinum and taxane agents.
PATIENTS AND METHODS: A total of 42 patients with recurrent ovarian cancer who had an evaluable lesion and provided informed consent for participation in the present study were analyzed. Irinotecan was administered intravenously at a dose of 60 mg/m on days 1 and 15. Etoposide was administered orally at a daily dose of 50 mg/body weight from days 1 to 21. A 28-day period comprised one cycle. The tumor response, adverse events, progression-free survival, and overall survival were examined. Tumor response was evaluated based on the Response Evaluation Criteria in Solid Tumors and the serum CA125 levels (Gynecologic Cancer Intergroup criteria). Adverse events were assessed according to the NCI-CTCAE (version 3.0).
RESULTS: Partial response was observed in 21 patients, stable disease in 14 patients, and progressive disease in 7 patients. The response rate was 50.0%, and the clinical benefit (partial response + stable disease) rate was 83.3%. Hematological toxicities of at least grade 3 severity included leukopenia in 21 patients (50.0%), neutropenia in 22 patients (52.4%), thrombocytopenia in 1 patient (2.4%), anemia in 9 patients (21.4%), and febrile neutropenia in 3 patients (7.1%). Nonhematological toxicities of at least grade 3 severity included queasy feeling in 5 patients (11.9%), vomiting in 3 patients (7.1%), and diarrhea in 2 patients (4.8%). Acute myeloid leukemia occurred in one patient (2.4%).
CONCLUSIONS: It is suggested that combination chemotherapy with irinotecan plus oral etoposide offers significant clinical benefit to patients with recurrent ovarian cancer previously treated with platinum and taxane agents.
Diagnostic performance of urgent referrals for suspected gynaecological malignancies.
PURPOSE: The objective of this study was to investigate the outcome of the urgent referrals with suspected gynaecological malignancy.
CONCLUSION: The overall predictive value of two-week wait referrals for suspected gynaecological malignancies is low. Refinement of the current referral guidelines is required with particular emphasis in the premenopausal women where the diagnostic performance of the urgent referrals is significantly poorer.
Gynecological Cancers. [Methods Mol Biol. 2011]
Abstract
The clinical problems raised in patients presenting with all forms of gynecological malignancy are currently addressed using conventional cross-sectional imaging, usually MRI. In general, F-18 FDG PET-CT has not been shown to have a clinical role in any of these cancers at presentation, although studies are under way to use this form of metabolic imaging to predict prognosis and the response to treatment. Although F-18 FDG PET-CT is superior to conventional imaging techniques, it is only moderately sensitive in demonstrating lymph node metastasis preoperatively, and is inadequate for local staging of patients with endometrial cancer. In ovarian cancer, F-18 FDG PET-CT provides an accurate assessment of the extent of disease, particularly in areas difficult to assess for metastases by CT and MRI such as the abdomen and pelvis, mediastinum, and supraclavicular region. F-18 FDG PET-CT is a sensitive method of detecting pelvic and para-aortic lymph nodal disease in cervical cancer, and appears to be superior to MRI and CT despite the limitations in identifying small foci of disease. In the main, as elsewhere in patients with cancer, the value of PET-CT is in identifying and defining the extent of recurrent disease, in distinguishing between posttreatment fibrosis and recurrence, and possibly in monitoring response to therapy.
Non-Curable Tumours of the Female Genital Tract: Therapeutic Options in Bowel Stenosis and Bleeding
BACKGROUND: ...... Ovarian cancer is in particular associated with peritoneal carcinomatosis or local tumour progression entailing different intestinal complications.
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Thursday, February 17, 2011
most recent top 5 popular blog views (just curious?)
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Wednesday, February 16, 2011
full free access: Lessons From the Adjuvant Bevacizumab Trial on Colon Cancer: What Next?
"........Finally, how should we consider the use of antiangiogenic therapy in general in the adjuvant setting? Will VEGF blockade ever suffice when administered as single antiangiogenic agent in combination with chemotherapy, or will we need to combine bevacizumab with other antiangiogenic agents? Although an easy solution at this stage would be to lose interest in the therapeutic potential of antiangiogenic therapy in the adjuvant setting because of these initial disappointing results, the more challenging way forward will require a better understanding of the underlying mechanisms of why bevacizumab treatment differs so much in the adjuvant setting versus the macrometastatic setting. Only by achieving this goal will it be possible to make a more informed decision on this important matter"
abstract: Disease course patterns after discontinuation of bevacizumab (Avastin): pooled analysis of randomized phase III trials
also note: secondary link source including professional commentary
http://plus.mcmaster.ca/EvidenceUpdates/NewArticles.aspx?Page=1&ArticleID=38192#ArticleComments
Abstract:
Purpose: Preclinical studies have suggested accelerated tumor growth, local invasion, and distant metastasis after withdrawal of treatment with some antiangiogenic agents. To investigate whether discontinuation of bevacizumab treatment is associated with accelerated disease progression or increased mortality, we retrospectively analyzed five randomized, placebo-controlled phase III studies in 4,205 patients with breast, colorectal, renal, and pancreatic cancer.
Conclusion This
retrospective analysis of five placebo-controlled clinical trials does
not support a decreased time to disease progression,
increased mortality, or altered disease
progression pattern after cessation of bevacizumab therapy.
Footnotes
-
Supported in part by F. Hoffmann-La Roche, Basel, Switzerland.
-
Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.
-
Clinical trial information can be found for the following: NCT00738530.
CRD Summary/Commentary: Increased ovarian cancer risk associated with menopausal estrogen therapy is reduced by adding a progestin
original link source: http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=12009104538
Reference: Cancer 2009; 115(3): 531-539
Source: DARE
Date published: 15/02/2011 14:53
Summary
by: Hazel Burnham
CRD Summary: The authors concluded that oestrogen therapy use increased ovarian cancer in a duration-dependent manner; adding progestins appeared to reduce this effect to some extent. The conclusions appeared to be supported by the evidence but the limited search, lack of reporting of review methods and study quality, and reliance upon predominantly observational studies mean that findings should be interpreted with caution.
CRD Commentary: The review question was stated and appropriate inclusion criteria were defined. Limiting the search to English language published studies identified in one database plus references and linked articles may have resulted in the omission of other relevant studies and raised the potential for publication and language bias. However, no evidence of publication bias was found. Methods used to select studies and extract data were not described, so it is not known whether efforts were made to reduce reviewer errors and bias. Study validity was not assessed, so results from these studies and any synthesis may not be reliable.
Other than duration of oestrogen-only therapy/oestrogen plus progestin therapy use, no information was provided about participants. No information was provided about which potential confounders were adjusted for in individual studies. Data were pooled using meta-analysis and heterogeneity was assessed. Studies were predominantly observational and adjustments were made for potential confounders. The authors’ conclusions appeared to be supported by the evidence, but the limited search, lack of reporting of review methods and study quality, and reliance upon predominantly observational studies mean that findings should be interpreted with caution.
CRD Commentary: The review question was stated and appropriate inclusion criteria were defined. Limiting the search to English language published studies identified in one database plus references and linked articles may have resulted in the omission of other relevant studies and raised the potential for publication and language bias. However, no evidence of publication bias was found. Methods used to select studies and extract data were not described, so it is not known whether efforts were made to reduce reviewer errors and bias. Study validity was not assessed, so results from these studies and any synthesis may not be reliable.
Other than duration of oestrogen-only therapy/oestrogen plus progestin therapy use, no information was provided about participants. No information was provided about which potential confounders were adjusted for in individual studies. Data were pooled using meta-analysis and heterogeneity was assessed. Studies were predominantly observational and adjustments were made for potential confounders. The authors’ conclusions appeared to be supported by the evidence, but the limited search, lack of reporting of review methods and study quality, and reliance upon predominantly observational studies mean that findings should be interpreted with caution.
About this library entry
Category: 6.4.1 Female sex hormones | Cancer: gynaecological | Menopause / hormone replacement therapy (HRT)
NeLM area: Evidence > Medication Safety
full free access: How Research Influences Policy Makers: Still Hazy After All These Years — J. Natl. Cancer Inst. Steven Lewis (author)
"Libraries have been written about the theory and practice of public policy making. Yet, this enormous scholarship has proved insufficient to lift the veil of mystery and idiosyncrasy that shrouds the art of decision making. The heady ambition to turn both clinical practice and health policy into evidence-based bastions of rationalist decision making has been downgraded; the vocabulary is now “evidence-informed,” and the realm of admissible evidence has been greatly expanded to include preferences, political contingencies, and psychology (1). This newfound conceptual modesty and nuance does not suggest that we should abandon efforts to understand decision-making processes and to enhance the role of research-based evidence in policy. It merely confirms the complexity, contingency, and messiness of the terrain............This leads to a second issue: the definition of “use.” The questionnaires simply asked whether the respondents intended to use the brief. We do not know what “use” means.." cont'd
abstract: Indication for oophorectomy during cytoreduction for intraperitoneal metastatic spread of colorectal or appendiceal origin(cytoreductive surgery/HIPEC)
BACKGROUND: The incidence of ovarian metastases at the time of peritoneal carcinomatosis, and the influence of such metastases on survival after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), are unknown.
METHODS: This retrospective analysis included 194 women subjected to CRS and HIPEC since 2001. The incidence of ovarian metastases, disease-free survival and disease-specific survival were analysed.
RESULTS: The histological diagnosis was colorectal cancer carcinomatosis in 108 patients, peritoneal mucinous carcinomatosis (PMCA) in 23 and disseminated peritoneal adenomucinosis (DPAM) in 63. Ninety-nine patients underwent oophorectomy during the HIPEC procedure. Ovarian metastases were confirmed in at least 52 per cent of the patients. There was a significant difference in disease-free survival between women with or without ovarian metastases in both PMCA and DPAM groups (P = 0·044 and P = 0·010 respectively). No significant differences in survival were found in the group with colorectal cancer carcinomatosis.
CONCLUSION: When peritoneal carcinomatosis of colorectal or appendiceal origin is confirmed, at least 52 per cent of ovaries will have synchronous metastases. Disease-free survival after a HIPEC procedure for PMCA or DPAM is significantly lower in women with ovarian metastases. Oophorectomy during CRS for peritoneal carcinomatosis should be strongly considered.
METHODS: This retrospective analysis included 194 women subjected to CRS and HIPEC since 2001. The incidence of ovarian metastases, disease-free survival and disease-specific survival were analysed.
RESULTS: The histological diagnosis was colorectal cancer carcinomatosis in 108 patients, peritoneal mucinous carcinomatosis (PMCA) in 23 and disseminated peritoneal adenomucinosis (DPAM) in 63. Ninety-nine patients underwent oophorectomy during the HIPEC procedure. Ovarian metastases were confirmed in at least 52 per cent of the patients. There was a significant difference in disease-free survival between women with or without ovarian metastases in both PMCA and DPAM groups (P = 0·044 and P = 0·010 respectively). No significant differences in survival were found in the group with colorectal cancer carcinomatosis.
CONCLUSION: When peritoneal carcinomatosis of colorectal or appendiceal origin is confirmed, at least 52 per cent of ovaries will have synchronous metastases. Disease-free survival after a HIPEC procedure for PMCA or DPAM is significantly lower in women with ovarian metastases. Oophorectomy during CRS for peritoneal carcinomatosis should be strongly considered.
abstract: Metastatic neoplasms of the ovaries: a clinicopathological study of 97 cases (metastatic breast, GI neoplasms....)
OBJECTIVE: To present the clinicopathological features of metastatic ovarian neoplasms with emphasis in the diagnostic challenge.
METHODS: This is a retrospective study including 97 patients with pathological diagnosis of metastatic ovarian neoplasms, examined during the decade 2000-2009. The gross, microscopical and immunohistochemical characteristics as well as the clinical data (age of the patients, origin of the neoplasm, symptoms, treatment options) and 5-year survival rates were examined.
RESULTS: The mean age of the patients is 55 years (range 26-78 years). 62.89% of the tumors were metastatic from extragenital organs (from stomach 21.65%, breast 15.46%, colon 15.46%, appendix 3.09%, pancreas 2.06%, lung 1.03% and kidney 1.03%, sarcoma 1.03% melanoma 1.03%) and 37.11% tumors originated from the genital tract. The 3-year survival rates ranged from 25.39% for metastatic ovarian neoplasms originating outside the genital tract up to 29.41% for those originating from the genital tract. Tumor immunohistochemistry is a helpful aid in the differential diagnosis mainly between primary mucinous ovarian tumors and metastatic colon cancers and in the recognition of metastatic breast cancers and other neoplasms of the GI tract.
CONCLUSION: The management of metastatic ovarian neoplasms should include specific immunohistochemical methods in order to identify the primary neoplasm site. The differential diagnosis of a pelvic mass should always include metastatic neoplasms of the ovaries.
METHODS: This is a retrospective study including 97 patients with pathological diagnosis of metastatic ovarian neoplasms, examined during the decade 2000-2009. The gross, microscopical and immunohistochemical characteristics as well as the clinical data (age of the patients, origin of the neoplasm, symptoms, treatment options) and 5-year survival rates were examined.
RESULTS: The mean age of the patients is 55 years (range 26-78 years). 62.89% of the tumors were metastatic from extragenital organs (from stomach 21.65%, breast 15.46%, colon 15.46%, appendix 3.09%, pancreas 2.06%, lung 1.03% and kidney 1.03%, sarcoma 1.03% melanoma 1.03%) and 37.11% tumors originated from the genital tract. The 3-year survival rates ranged from 25.39% for metastatic ovarian neoplasms originating outside the genital tract up to 29.41% for those originating from the genital tract. Tumor immunohistochemistry is a helpful aid in the differential diagnosis mainly between primary mucinous ovarian tumors and metastatic colon cancers and in the recognition of metastatic breast cancers and other neoplasms of the GI tract.
CONCLUSION: The management of metastatic ovarian neoplasms should include specific immunohistochemical methods in order to identify the primary neoplasm site. The differential diagnosis of a pelvic mass should always include metastatic neoplasms of the ovaries.
abstract: The spread pattern of right and left epithelial ovarian cancers
OBJECTIVE: No attention has been paid in the past to the spread pattern of right and left epithelial carcinomas of the ovaries. We aimed to investigate the incidence, spread pattern and distribution of lymph node metastasis in epithelial ovarian cancer (EOC), comparing right versus left EOC of any stage, where the contralateral ovary is apparently and histologically tumor-free.
full access: Assessing the information desire of patients with advanced cancer by providing information with a decision aid, which is evaluated in a randomized trial: a study protocol
Discussion
This study attempts to settle the debate on the desirability of informing patients with cancer. In contrast to several earlier studies, we will actually deliver information on treatment options to patients at the point of decision making.Trial registration: NTR1113
abstract: Tubal ligation and the risk of ovarian cancer: review and meta-analysis — Hum Reprod Update (serous/mucinous/endometrioid)
BACKGROUND The reduction of ovarian cancer (OC) risk in women with a history of tubal ligation (TL) has been reported repeatedly, mostly on small populations. We have aimed to provide a critical overview of the studies available to date and to conduct a meta-analysis.
METHODS There were 40 relevant studies identified. The studies were divided into two groups for strict and extended meta-analysis, respectively. Subgroup analysis was performed for age, time dependency since TL, histological types of OC and BReast CAncer (BRCA) mutation.
RESULTS Meta-analysis of 13 strictly selected studies showed a reduced risk of epithelial OC by 34%. The protective effect of TL was confirmed even in a subgroup of women 10–14 years after the procedure. The risk reduction was confirmed for the endometrioid (RR = 0.40) and serous (RR = 0.73) cancers but not for mucinous.
CONCLUSIONS The review of relevant articles, as well as the meta-analysis of selected studies, yields consistent data on a significant reduction of OC risk in women who had undergone TL. The results of this meta-analysis should provide an impulse for further research on the etiology of ovarian epithelial cancers, focusing particularly on the importance of retrograde transport of endometrial cells.
summary: Abagovomab: an anti-idiotypic CA-125 targeted immunotherapeutic agent for ovarian cancer phase 111 MIMOSA trial
Abagovomab: an anti-idiotypic CA-125 targeted immunotherapeutic agent for ovarian cancer
Rachel N Grisham1, Jonathan Berek2, Jacobus Pfisterer3 & Paul Sabbatini†1
Ovarian cancer remains the leading cause of death due to gynecologic malignancies. Most patients present with advanced disease at the time of diagnosis. Although many have a good initial response to surgical debulking and platinum-based chemotherapy, relapse is common, with the eventual development of chemotherapy resistance. Innovative treatments are needed in the remission setting to prolong the disease-free interval or prevent recurrence. Abagovomab is a murine monoclonal anti-idiotypic antibody (molecular wieght: 165–175 kDa) that functionally imitates the tumor-associated antigen, CA-125. It has been shown to be well tolerated and to induce a sustained immune response in initial Phase I and II clinical trials. An ongoing, double-blind, placebo-controlled, multicenter, Phase III trial (MIMOSA) completed its double-blind period in December 2010 and will compare abagovomab maintenance therapy to placebo, which will definitively determine the efficacy of this immunotherapeutic approach in patients with ovarian cancer.
Monday, February 14, 2011
full free access: Effect of preventive messages tailored to family history on health behaviors: the Family Healthware Impact Trial. Ann Fam Med. 2011 (includes ovarian cancer)
PURPOSE: We wanted to determine the impact of automated family history assessment and tailored messages for coronary heart disease, stroke, diabetes, colorectal, breast, and ovarian cancer on preventive behaviors compared with a standard preventive message. ....cont'd for full free access
OXiGENE Inc. (OXGN) Enters into Collaborative Agreement with NCI for Cancer Drug - Intl Business Times (Zybrestat/Avastin))
OXiGENE Inc., a clinical-stage biopharmaceutical company focused on developing novel therapeutics to treat cancer and eye diseases, has entered into a cooperative research and development agreement with the National Cancer Institute’s (NCI) Cancer Therapy Evaluation Program (CTEP) to collaborate on the conduct of a randomized phase 2 trial of OXiGENE’s ZYBRESTAT in combination with bevacizumab in patients with relapsed ovarian cancer.....cton'd
full free text: The safety implications of missed test results for hospitalised patients: a systematic review -- BMJ Quality and Safety (references World Alliance for Patient Safety)
Introduction
The World Alliance for Patient Safety recently identified poor test follow-up as one of the major processes contributing to
unsafe patient care.1 Failure to follow up test results increases the risk of missed or delayed diagnoses. This may produce suboptimal clinical
outcomes2–8 with potential medicolegal implications.9–12......
.........All seven studies explored the impact on patient outcomes31–33 35–38 which included no negative effects,31 a delayed diagnosis from a missed x-ray report,37 one case of missed positive Chlamydia where the patient subsequently developed pelvic inflammatory disease,36 inappropriate or unnecessary antibiotics prescribed,35 missed cancer diagnoses33 and death.38.....cont'd
.........All seven studies explored the impact on patient outcomes31–33 35–38 which included no negative effects,31 a delayed diagnosis from a missed x-ray report,37 one case of missed positive Chlamydia where the patient subsequently developed pelvic inflammatory disease,36 inappropriate or unnecessary antibiotics prescribed,35 missed cancer diagnoses33 and death.38.....cont'd
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