abstract
Wednesday, December 24, 2014
Short-Term Risk of Colorectal Cancer in Individuals With Lynch Syndrome: A Meta-Analysis
abstract
Tuesday, December 23, 2014
Primary peritoneal carcinoma after prophylactic oophorectomy in women with a family history of ovarian cancer - Cancer Genetics and Epigenetics
open access
Neurotoxicity in Ovarian Cancer Patients on GOG 218
abstract
Neurotoxicity in Ovarian Cancer Patients on Gynecologic Oncology Group (GOG) Protocol 218: Characteristics Associated with Toxicity and the Effect of Substitution with Docetaxel: An NRG Oncology/Gynecologic Oncology Group study.
OBJECTIVES:
To describe characteristics associated with neurotoxicity (NT) in advanced ovarian cancer patients treated on Gynecologic Oncology Group 218 and examine effect of substituting docetaxel for paclitaxel in these patients.METHODS:
The development of NT was defined as Common Toxicity Criteria grade (G) ≥1. The association between substitution with docetaxel and NT improvement was explored with generalized estimating equations adjusting for treatment cycle and NT grading at previous cycle.RESULTS:
Of 1,864 evaluable patients, 1,329 (71%) developed G≥1 NT during the study. Nearly half appeared within the first two cycles of chemotherapy, with 31% experiencing G≥2. Older patients or those with worse quality of life (QoL) scores at baseline (p<0.05) were more likely to experience NT. One-hundred-six patients received docetaxel as substitute for paclitaxel. Of them, 47 patients started with docetaxel at cycle one due to reaction to paclitaxel (n=32), fear of NT (n=4), other reasons (n=11), whereas 59 patients switched to docetaxel during cycle 2-6 due to NT (n=32), reaction to paclitaxel (n=19), and other reasons (n=8). Although the protocol instructed otherwise, the majority continued paclitaxel despite G≥2 NT symptoms. There was no evidence that substitution with docetaxel improved NT (Odds Ratio): 1.57; 95% CI 0.98-2.54; p>0.05). Of 59 patients who switched to docetaxel, only seven (12%) discontinued taxane prior to chemotherapy completion. A roughly equal chance of worsening NT was reported on paclitaxel (6%) as on docetaxel (5%).CONCLUSIONS:
Age and worse QoL at baseline are associated with NT. Substitution of docetaxel did not improve NT symptoms.Racial disparity in 30-day morbidity and mortality after surgery for ovarian cancer
abstract
CONCLUSIONS:
African American race was not an independent predictor of poor 30-day outcomes. Interestingly, AAs with OC are underrepresented in quality-seeking hospitals. Efforts to minimize this racial disparity should target optimization of comorbidities and improving access to high-volume centers for AA women.Monday, December 22, 2014
European recommendations for biomarker-based chemoprevention trials
open access-ecancermedicalscience
Abstract
A survey of treatment approaches of malignant ascites in Germany and Austria (gasto/gyn/medonc)
Abstract
BACKGROUND:
METHODS:
One hundred and twenty-eight medical oncologists (MO), gastroenterologists (GE), and gynecologists (GYN) completed an electronic questionnaire consisting of 33 questions.CONCLUSIONS:
Repeated PC is the main pillar of treatment of MA; its effect is only temporary and requires significant hospital resources. Further treatment strategies of MA have to be evaluated in prospective studies. Targeted therapies like catumaxomab and VEGF inhibitors should be integrated into these.Sunday, December 21, 2014
Distribution and case-fatality ratios by cell-type for ovarian carcinomas: A 22-year series....
abstract
Distribution and case-fatality ratios by cell-type for ovarian carcinomas: A 22-year series of 562 patients with uniform current histological classification
Highlights
- •
- Among 562 ovarian cancers classified by cell-type, high grade serous carcinoma and its variants accounted for 85% of tumor deaths
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- Reproducibility of cell-type designation among gynecologic pathology experts was excellent
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- 1.7% of type II tumors (high grade serous carcinomas and variants) were FIGO stage I with comprehensive surgical staging
Background
Methods
Results
Conclusions
Prevalence of Germline Mutations in Cancer Predisposition Genes in Patients with Pancreatic Cancer
abstract
BACKGROUND:& Aims:
We investigated the prevalence of germline mutations in APC, ATM, BRCA1, BRCA2, CDKN2A, MLH1, MSH2, MSH6, PALB2, PMS2, PRSS1, STK11, and TP53 in patients with pancreatic cancer.
METHODS:
The Ontario Pancreas Cancer Study enrolls consenting participants with pancreatic cancer from a province-wide electronic pathology database; 708 probands were enrolled from April 2003 through August 2012. To improve precision of BRCA2 prevalence estimates, 290 probands were randomly selected from 3 strata, based on family history of breast and/or ovarian cancer, pancreatic cancer, or neither. Germline DNA was analyzed by next-generation sequencing using a custom multiple-gene panel. Mutation prevalence estimates were calculated from the sample for the entire cohort.RESULTS:
Eleven pathogenic mutations were identified: 3 in ATM, 1 in BRCA1, 2 in BRCA2, 1 in MLH1, 2 in MSH2, 1 in MSH6, and 1 in TP53. The prevalence of mutations in all 13 genes was 3.8% (95% confidence interval, 2.1%-5.6%). Carrier status was significantly associated with breast cancer in the proband or first-degree relative (P<.01), and colorectal cancer in the proband or first-degree relative (P<.01), but not family history of pancreatic cancer, age of diagnosis, or stage at diagnosis. Of patients with a personal or family history of breast and colorectal cancer, 10.7% (4.4%-17.0%) and 11.1% (3.0%-19.1%) carried pathogenic mutations, respectively.CONCLUSIONS:
A small but clinically important proportion of pancreatic cancer is associated with mutations in known predisposition genes. The heterogeneity of mutations identified in this study demonstrates the value of using a multiple-gene panel in pancreatic cancer.Is the endometrial evaluation routinely required in patients with adult granulosa cell tumors of the ovary?
abstract
OBJECTIVE:
granulosa cells tumors (GCTs) are the most common estrogen-secreting ovarian tumors; perhaps due to the persistent hyperestrogenism, a wide spectrum of associated endometrial pathologies ranging from endometrial hyperplasia to carcinoma has been documented in patients with GCTs. The aim of this study is to evaluate the incidence of endometrial pathologies in a large series of GCTs patients treated in MITO centers.
METHODS:
a retrospective multi-institutional review of patients with granulosa cell tumors of the ovary treated or referred to MITO centers was conducted. Descriptive statistics were used to characterize the patient population and to assess the association of GCT and endometrial abnormalities at the time of diagnosis; multivariate regression analysis was also performed to identify independent predictors of endometrial abnormalities.RESULTS:
a total of 150 patients with primary adult GCT was identified. During the preoperative assessment, endometrial pathology was found in 35.9% of symptomatic patients and in 90.9% of asymptomatic women with endometrial thickening at transvaginal ultrasound. At the time of surgery, hyperplasia was documented in 29.2% of patients, whereas endometrial cancer occurred in 7.5% of patients. Almost all of the patients (97.6%) with endometrial hyperplasia were older than 40 years. All patients with endometrial cancer were older than 40 years and postmenopausal.CONCLUSIONS:
endometrial carcinoma/atypical hyperplasia were commonly observed in GCT patients>40 years; based on these data, endometrial sampling should be performed in symptomatic women at least 40 years of age. In asymptomatic women<40 years, endometrial sampling is of low yield.Saturday, December 20, 2014
A multicenter, non-randomized, phase II study of docetaxel and carboplatin administered every 3 weeks as 2nd line chemotherapy in patients with first relapse of platinum sensitive epithelial ovarian, peritoneal or fallopian tube
open access
Conclusions
Incidence of breast and gynaecological cancers by ethnic group in England, 2001-2007
open access
Conclusions
Skin Cancer Risk in BRCA1/2 Mutation Carriers
abstract
Women with BRCA1/2 mutations have an elevated risk of breast and ovarian cancer. These patients and their clinicians are often concerned about their risk for other cancers, including skin cancer. Research evaluating the association between BRCA1/2 mutations and skin cancer is limited and has produced inconsistent results. Herein, we review the current literature on the risk of melanoma and non-melanoma skin cancers in BRCA1/2 mutation carriers. No studies have shown a statistically significant risk of melanoma in BRCA1 families. BRCA2 mutations have been linked to melanoma in large breast and ovarian cancer families, though a statistically significant elevated risk was reported in only one study. Five additional studies have shown some association between BRCA2 mutations and melanoma, while four studies did not find any association. With respect to non-melanoma skin cancers, studies have produced conflicting results. Given the current state of medical knowledge, there is insufficient evidence to warrant increased skin cancer surveillance of patients with a confirmed BRCA1/2 mutation or a family history of a BRCA1/2 mutation, in the absence of standard risk factors. Nonetheless, suspected BRCA1/2 mutation carriers should be counseled about skin cancer risks and may benefit from yearly full skin exams.
Very late recurrence (after more than 20 years) of epithelial ovarian carcinoma: case report and literature review
"Lifelong follow-up is critically important for ovarian cancer patients."
(Opinion - and clinical/research reporting)
abstract
PURPOSE:
To present a case of very late (more than 20 years) recurrence of epithelial ovarian carcinoma and to review the pertinent literature. We encountered a 50-year-old patient who, at the age of 22, underwent cytoreductive surgery and adjuvant chemotherapy for stage III serous ovarian carcinoma. She recurred after 28 years and underwent secondary surgery and chemotherapy.METHOD:
A PubMed search of the English literature containing the following key words: ovarian cancer, late recurrence, late relapse, late metastasis was performed.RESULTS:
Only five cases (including the present one) with recurrence after more than 20 years are so far on record. Of these, four patients were 33 years old or younger and had advanced stage at diagnosis. Time to recurrence ranged from 21 to 28 years. All patients had serous carcinoma and three had recurrence in lymph nodes.CONCLUSIONS:
Very late recurrence is an extremely rare event and may result from either regrowth of dormant tumor cells or from development of a new cancer. Lifelong follow-up is critically important for ovarian cancer patients.Future Oncology - Index: Themed Content: Minimizing morbidity in radiation oncology
Index
Best of the Radiosurgery Society®
Scientific Meeting 2014: stereotactic radiosurgery/stereotactic body
radiotherapy treatment of extracranial and intracranial lesions
|
Research Article
Chest
wall and rib irradiation and toxicities of early-stage lung cancer
patients treated with CyberKnife stereotactic body radiotherapy
|
Special Report
The promise of combining radiation therapy and immunotherapy: morbidity and toxicity
|
Review
Radiation oncology: physics advances that minimize morbidity
|
Radioprotective agents for radiation therapy: future trends
|
Radiobiological modifiers in clinical radiation oncology: current reality and future potential
|
The use of angiotensin II receptor antagonists to increase the efficacy of radiotherapy in cancer treatment
|
Radiogenomics: the search for genetic predictors of radiotherapy response
|
New ways to successfully target tumor vasculature in ovarian cancer
abstract
Friday, December 19, 2014
Combining images and genetic data proves gene loss behind aggressive ovarian cancers - PTEN
Preclinical Efficacy for AKT Targeting in Clear Cell Carcinoma of the Ovary
abstract
The aim of this study was to determine the role of AKT as a therapeutic target in ovarian clear cell carcinoma (CCC), an aggressive, chemoresistant histological subtype of ovarian cancer. AKT activation was assessed by immunohistochemistry (IHC) using human tissue microarrays of primary ovarian cancers, comprised of both CCC and serous adenocarcinoma (SAC). The growth-inhibitory effect of AKT-specific targeting by, the small molecule inhibitor, perifosine was examined using ovarian CCC cell lines in vitro and in vivo. Finally, the activity of perifosine was examined using in CCC-derived tumors that had acquired resistance to anti-VEGF or chemotherapeutics like bevacizumab or cisplatin, respectively. Interestingly, AKT was frequently activated both in early-stage and advanced-stage CCCs.
Treatment of CCC cells with perifosine attenuated the activity of AKT targeted therapy for ovarian clear cell carcinoma. AKT-mTORC1 signaling, inhibited proliferation, and induced apoptosis. The effect of perifosine was more profound under conditions of high AKT activity compared to low AKT activity. Increased AKT activation and enhanced sensitivity to perifosine were observed in the context of cisplatin-resistant CCC. Treatment with perifosine concurrently with cisplatin significantly enhanced the anti-tumor effect of cisplatin. Moreover, perifosine showed significant anti-tumor activity in CCC-derived tumors that had acquired resistance to bevacizumab or cisplatin. Collectively, these data reveal that AKT is frequently activated in ovarian CCCs and is a promising therapeutic target in aggressive forms of ovarian cancer.
Implications: AKT-targeted therapy has value in a front-line setting as well as a second-line treatment for recurrent disease developing after platinum-based chemotherapy or bevacizumab treatment.
Interactions of Multitargeted Kinase Inhibitors and Nucleoside Drugs: Achilles Heel of Combination Therapy?
abstract (technical)
fluorothymidine (FLT)
Targeting those with decreased meaning and peace: a supportive care opportunity
abstract
PURPOSE:
To evaluate if an individual's level of meaning/peace (M/P) predicts various quality of life (QOL) and mental well-being measures. To identify targets that might enhance the overall spiritual well-being and QOL of ovarian cancer patients.METHODS:
Multi-site analysis of women with newly diagnosed stages II-IV ovarian, primary peritoneal, or fallopian tube cancer. Patients completed the following surveys: Functional Assessment of Chronic Illness Therapy-Ovarian (FACT-O), Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp), Edmonton Symptom Assessment System (ESAS), Hospital Anxiety and Depression Scale (HADS), Templer's Death Anxiety Scale (DAS), Herth Hope Index (HHI), and Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS). Linear regression models were created to examine the effect of M/P (FACIT-Sp) upon QOL, symptoms, and other measures of mental well-being. These models adjusted for the effect of site, race, age, stage, anaphylaxis to chemotherapy, and partner status as potential confounders.RESULTS:
This study enrolled 104 patients from three separate sites. After adjusting for potential confounders, it was found that higher M/P predicted better QOL (FACT-O) (p < 0.0001). Higher M/P also predicted decreased death anxiety, depression, and anxiety (p ≤ 0.005). Finally, higher M/P predicted increased hope and coping scores (p ≤ 0.0005).CONCLUSIONS:
Level of M/P is associated with several important mental and physical health states. This information may allow providers to identify patients at increased risk for mental/physical distress and may facilitate early referral to targeted psychotherapy interventions focused on improving patient QOL and decreasing anxiety and depression.Predictive factors for the presence of malignant transformation of pelvic endometriosis
abstract
OBJECTIVES:
To determine predictive factors for the presence of malignant transformation in ovarian endometriotic cysts.STUDY DESIGN:
This was an IRB approved, case control study analyzing patient data from 2004 to 2013. Pathology database records were searched to identify patients with benign endometrioma and ovarian carcinoma arising in the background of endometriosis. Inclusion criteria required each patient to have a preoperative diagnosis of adnexal mass and no other findings concerning for malignancy. Patient clinical records were queried for preoperative symptoms, serum CA125 levels and radiologic findings. Pathologic data were collected including histology, tumor grade and stage.RESULTS:
A total of 138 patients met inclusion criteria; 42 women with ovarian cancer arising in the background of endometriosis and 96 women with benign endometrioma. Women diagnosed with ovarian cancer were significantly older than women with endometriosis (53.6 vs. 39.2 years). There was no difference in presence of symptoms between the two groups. Women with malignant tumors were found to have significantly larger cysts (14cm vs. 7.5cm; p<0.0001) that were more often multilocular (45.7% vs. 12.2%; p<0.0001), and contained solid components (77.1% vs. 14.5%; p<0.0001). Among patients that were observed prior to surgery there was a significant difference in the change in size of the mass over time with 4.2cm increase for cases vs. 1.0cm increase for controls (p=0.02). Multiple logistic regression analysis indicated that for every 5 years increase in age there was an adjusted OR of 2.17 (p=0.003). An age of 49 years or greater had an 80.6% sensitivity (95% CI: 62.5-92.5%) and an 82.9% specificity (95% CI: 67.9-92.8%) for malignancy, and solid component on imaging had an adjusted OR of 23.7 (p<0.0001). Serum CA125 levels tended to be higher in patients with malignant tumors but did not reach statistical significance with a mean of 204.9 vs. 66.9 (p=0.1).CONCLUSIONS:
Significant predictors for malignant transformation of endometriosis include cyst characteristics and age. Women above the age of 49 with multilocular cysts and solid components are at high risk for malignant transformation of endometriosis. Serum CA125 level is not a significant predictor of malignant transformation.Wednesday, December 17, 2014
NIH complementary and integrative health agency gets new name (U.S.)
NCCIH
The National Institutes of Health agency with primary responsibility for research on promising health approaches that already are in use by the American public has a new name — the National Center for Complementary and Integrative Health (NCCIH).....
Searching for metastases in ovarian tissue before autotransplantation: a tailor-made approach
abstract
OBJECTIVE:
To exclude minimal residual disease in remaining ovarian tissue after harvesting the ovarian cortex for cryopreservation, by means of a tailor-made approach.DESIGN:
Retrospective case series.SETTING:
Hospital laboratory.PATIENT(S):
We evaluated the ovarian and tubal tissue from 47 cancer patients (breast cancer, [non-]Hodgkin lymphoma; osteo-, Ewing, myxoid lipo-, and oropharyngeal synovial sarcoma; cervical, rectal, and esophageal cancer), who had stored ovarian tissue for fertility preservation.INTERVENTION(S):
Immunohistochemistry (IHC) with tumor-related antibodies and genetic mutation analysis were performed to detect micrometastases by multiple sectioning at three levels of the paraffin-embedded formalin-fixed material. Molecular assays were performed with the use of tissue between these three levels of sectioning.MAIN OUTCOME MEASURE(S):
Detection of micrometastases in ovaries.RESULT(S):
We analyzed 847 ovarian slides to detect isolated tumor cells (ITCs) or micrometastases by IHC. In only one case (1/47) were ITCs detected in the fallopian tube. That patient had an intra-abdominal metastatic esophageal carcinoma. Additional DNA analyses of breast and rectal cancer, Ewing sarcoma, and human papilloma virus in cervical patients did not show evidence of micrometastases in the ovarian tissue.CONCLUSION(S):
The tailor-made approach consisted of patient-specific tumor markers which were used to search for ovarian micrometastases. We found evidence of metastatic disease within the fallopian tube of a patient with intraperitoneal metastatic esophageal adenocarcinoma.Survival outcome of stage I ovarian clear cell carcinoma with lympho-vascular space invasion
abstract
BACKGROUND:
The clinical impact of lympho-vascular space invasion (LVSI) in early-stage ovarian clear cell carcinoma (OCCC) is not well understood. Given the distinct tumor biology and survival patterns of OCCC, the significance of LVSI on survival outcome and treatment response was examined in OCCC.METHODS:
A multicenter study was conducted to examine stage IA-IC3 OCCC cases that underwent primary surgical staging including lymphadenectomy. LVSI status was determined from archived histopathology slides, correlated with clinico-pathological results, chemotherapy patterns, and survival outcomes.RESULTS:
LVSI was observed in 47 (20.3%) among 232 cases. In univariate analysis, LVSI was associated with older age (p=0.042), large tumor size (p=0.048), and stage IC (p=0.035). In survival analysis, LVSI was associated with decreased disease-free survival (DFS, 5-year rate, 70.6% versus 92.1%, p=0.0004) and overall survival (OS, 78.8% versus 93.3%, p=0.008) on univariate analysis. After controlling for age, tumor size, stage, and chemotherapy use, LVSI remained an independent prognostic factor for decreased survival outcomes (DFS, hazard ratio [HR] 4.35, 95% confidence interval [CI] 1.73-10.9, p=0.002; and OS, HR 4.73, 95%CI 1.60-14.0, p=0.015). Among 210 cases who received postoperative chemotherapy, while regimen type did not impact survival outcome regardless of LVSI status (DFS, p=0.63), the number of administered cycles showed a survival benefit towards ≥6cycles for patients with LVSI-positive tumors (DFS p=0.009, and OS p=0.016).CONCLUSION:
LVSI is an important marker to predict survival outcome of stage I OCCC. Regardless of chemotherapy type, patients with stage I OCCC showing LVSI may benefit from receiving postoperative chemotherapy.Surgical site infection after primary surgery for epithelial ovarian cancer: predictors and impact on survival
abstract
OBJECTIVE::
Surgical site infection (SSI) following epithelial ovarian cancer (EOC) primary surgery (PS) occurs in 10-15% of women. Perioperative factors associated with SSI and impact of SSI on survival were determined.METHODS::
EOC cases that underwent PS from 1/2/2003-12/30/2011 were retrospectively reviewed. SSIs were defined according to ACS NSQIP. Logistic regression models were fit to identify factors associated with SSI. Cox proportional hazards models were utilized to evaluate the association of patient and perioperative characteristics with overall survival (OS) and disease-free survival (DFS).RESULTS::
Among 888 cases, 96 (10.8%) developed SSI: 32 superficial, 2 deep, and 62 organ/space. Factors independently associated with superficial SSI were increasing BMI (odds ratio 1.41 [95% confidence interval, 1.12, 1.76] per 5kg/m2), increasing operative time (1.24 [1.02, 1.50] per hour), and advanced stage (III/IV) (10.22 [1.37, 76.20]). Factors independently associated with organ/space SSI were history of gastroesophageal reflux disease (2.13 [1.23, 3.71]), surgical complexity (intermediate 3.11 [1.02, 9.49]; high 8.07 [2.60, 25.09]; referent: low), and residual disease (RD) (measureable ≤1cm 1.77 [0.96, 3.27]; suboptimal >1cm (3.36 [1.48, 7.61]; referent: microscopic). Occurrence of superficial (hazard ratio 1.69 [1.12, 2.57]) or organ/space (1.46 [1.07, 2.00]) SSI was independently associated with worse OS. SSI occurrence was not independently associated with DFS.CONCLUSIONS::
SSI after PS is associated with decreased OS. Most risk factors for SSI are not modifiable. Alternative measures to lower rates of SSIs are needed as this may improve OS. Preoperative identification of SSI risk factors may assist in risk-assessment and operative planning.Challenges in managing genetic cancer risk: a long-term qualitative study of unaffected women carrying BRCA1/BRCA2 mutations
abstract
Purpose:
Women carrying BRCA1/BRCA2 germ-line mutations have an increased risk of developing breast/ovarian cancer. To minimize this risk, international guidelines recommend lifelong surveillance and preventive measures. This study explores the challenges that unaffected women genetically predisposed to breast/ovarian cancer face in managing their risk over time and the psychosocial processes behind these challenges
Methods:
Between 2011 and 2013, biographical qualitative interviews were conducted in Switzerland with 32 unaffected French- and Italian-speaking women carrying BRCA1/BRCA2 mutations. Their mutation status had been known for at least 3 years (mean, 6 years). Data were analyzed through constant comparative analysis using software for qualitative analysis.
Results:
From the time these women received their positive genetic test results, they were encouraged to follow medical guidelines. Meanwhile, their adherence to these guidelines was constantly questioned by their social and medical environments. As a result of these contradictory pressures, BRCA1/BRCA2 mutation carriers experienced a sense of disorientation about the most appropriate way of dealing with genetic risk.
Conclusion:
Given the contradictory attitudes of health-care professionals in caring for unaffected BRCA1/BRCA2 mutation carriers, there is an urgent need to educate physicians in dealing with genetically at-risk women and to promote a shared representation of this condition among them.
Clinical characteristics and outcomes of patients with stage I epithelial ovarian cancer compared to fallopian tube cancer
abstract
OBJECTIVE:
Compare clinical characteristics and survival between patients with stage I epithelial ovarian cancer and fallopian tube cancer.STUDY DESIGN:
We identified women with stage I epithelial ovarian cancer and fallopian tube cancer that underwent treatment between 2000 and 2010......RESULTS:
The study group consisted of 385 women with epithelial ovarian cancer and 43 with fallopian tube cancer. Patients with fallopian tube cancer had a higher rate of stage IA disease (65% vs. 48%; P = 0.02) and grade 3 tumors (60.4% vs. 30.9%; P < 0.001). Patients with fallopian tube cancer had a significantly higher rate of breast cancer (25.6% vs. 5.7%; P < 0.001) and BRCA 1 mutations (45.8% vs. 9.1% P < 0.001). There was no difference in the rates of platinum-based and paclitaxel chemotherapy between the groups. Women with fallopian tube cancer were more likely to have received six or more cycles of chemotherapy (58.1% vs. 44.1%; P = 0.02). The 5-year disease-free survival rates were 100% in women with fallopian tube cancer and 93% in patients with epithelial ovarian cancer (P = 0.04). The 5-year overall survival rates were 100% and 95% for fallopian tube cancer and epithelial ovarian cancer, respectively (P = 0.7).CONCLUSIONS:
We found a higher rate of stage IA, grade 3, and serous carcinoma in fallopian tube cancer. Women with fallopian tube cancer had a higher rate of breast cancer. There was no difference in overall survival between the groups.Positron Emission Tomography (PET) in Oncology
Free Full-Text
1.8.1. Ovarian Cancer
There is mounting evidence that FDG-PET/CT has an increasing role in the management of ovarian cancer, with its main indication to detect tumor recurrence in presence of rising CA-125 serum values and negative conventional imaging studies [93]. The benefits of the use of FDG-PET/CT in these settings has been reported several times in the literature [94,95], with a sensitivity of more than 90% in detecting occult metastases. In the study of Zimny et al., FDG-PET/CT preceded the conventional diagnosis by a median of 6 months in patients judged clinically free of disease. Menzel et al. suggest that a PET indication is worthwhile at CA 125 levels of approximately 30 U/mL [96]. A more recent prospective multi-center, cohort study (90 patients) confirmed the impact of FDG-PET/CT in suspected recurrent ovarian cancer, which affected disease management decisions in 60% of the cases (in 49% with a high, in 11% with a medium clinical impact) with a much higher detection rate compared to conventional imaging [97].For the characterization of asymptomatic adnexal findings, FDG-PET/CT has no place due to lack of sensitivity [98], and MRI remains the best imaging modality choice.
For the initial staging of ovarian cancer, FDG-PET/CT is not routinely used. Nevertheless, some publications noticed that it could be interesting in advanced epithelial ovarian cancer, in particular for the detection of supradiaphragmatic lymph node metastases like parasternal lymph nodes, with better accuracy than conventional CT (detection rate: 67% vs. 33%) [99]. However, increased mediastinal FDG uptake was not shown to play a significant prognostic role, while complete cytoreduction did [100]. For the initial preoperative staging of ovarian cancer, FDG-PET/CT may be superior compared to CT alone [101,102], but some publications also observed limits, as De Iaco et al., who reported a sensitivity and specificity of 78 and 68% respectively, with a high rate of false negative results in lesions <5 mm such as found in presence of peritoneal carcinomatosis [103].
However, conflicting results have been reported on the sensitivity of FDG-PET/CT scan in detecting peritoneal carcinomatosis; Turlakow, Suzuki and Kim reported higher diagnostic accuracy of FDG-PET/CT than CeCT in this settings, with a sensitivity and specificity for FDG-PET/CT of 67%–92.2% and 90%–94% respectively, as compared to 22%–88.5% and 65%–77% respectively for CeCT [104,105,106]. The sensitivity of FDG-PET/CT proved also similar to that of conventional MRI, and even better for detecting small peritoneal lesions (<2 cm) in patients with recurrent ovarian cancer [107]. However, FDG-PET/CT has limits, in particular for the detection of small peritoneal implants (<5 mm) because of the limited PET resolution, and surgical staging remains the gold standard [108]. The good performances of FDG-PET/CT in detecting peritoneal carcinomatosis lead to interesting information for optimizing patient selection for cytoreductive surgery in recurrent ovarian cancer; recently, Ebina et al. observed that FDG-PET/CT led to a change in management plan in 58.4% in that case, with a total number of patients in whom cytoreductive surgery was selected as the treatment of choice increased from 12 to 35 according to FDG-PET-CT results [109]. In the preoperative management, FDG-PET/CT is also able to detect distant metastases (25/95 patients upstaged from FIGO stage III to stage IV by FDG-PET/CT in a recent study [110]. However, upward stage migration did not worsen the prognosis of stage III patients, and in advanced ovarian cancer, the only prognostic factor that retained a significant prognostic value is the quality of response to cytoreductive therapy. Another study proposed FDG-PET/CT criteria such as FDG-PET/CT stage IV, pleural exudates, and PET-positive large bowel mesentery implants, which were statistically significant in the prognosis univariate analysis to guide the administration of neo-adjuvant chemotherapy in advanced ovarian cancer, but, once again, incomplete tumor debulking was the only statistically significant independent prognostic variable using multivariate analysis (p = 0.0001) [111]. Other prognostic factors like MTV or TGL may be interesting, but more data are needed at this time to confirm that [112].
- See more at: http://www.mdpi.com/2072-6694/6/4/1821/htm#sthash.MzNWUkeA.dpuf
Dynamic Changes in Numbers and Properties of Circulating Tumor Cells and Their Potential Applications | HTML
Free Full-Text
Abstract
: Circulating tumor cells (CTCs) can be detected in the blood of different types of early or advanced cancer using immunology-based assays or nucleic acid methods. The detection and quantification of CTCs has significant clinical utility in the prognosis of metastatic breast, prostate, and colorectal cancers. CTCs are a heterogeneous population of cells and often different from those of their respective primary tumor. Understanding the biology of CTCs may provide useful predictive information for the selection of the most appropriate treatment. Therefore, CTC detection and characterization could become a valuable tool to refine prognosis and serve as a “real-time biopsy” and has the potential to guide precision cancer therapies, monitor cancer treatment, and investigate the process of metastasis. - See more at: http://www.mdpi.com/2072-6694/6/4/2369/htm#sthash.UvsIAwMW.dpufAbstract
: Circulating tumor cells (CTCs) can be detected in the blood of different types of early or advanced cancer using immunology-based assays or nucleic acid methods. The detection and quantification of CTCs has significant clinical utility in the prognosis of metastatic breast, prostate, and colorectal cancers. CTCs are a heterogeneous population of cells and often different from those of their respective primary tumor. Understanding the biology of CTCs may provide useful predictive information for the selection of the most appropriate treatment. Therefore, CTC detection and characterization could become a valuable tool to refine prognosis and serve as a “real-time biopsy” and has the potential to guide precision cancer therapies, monitor cancer treatment, and investigate the process of metastasis. - See more at: http://www.mdpi.com/2072-6694/6/4/2369/htm#sthash.UvsIAwMW.dpufAbstract
: Circulating tumor cells (CTCs) can be detected in the blood of different types of early or advanced cancer using immunology-based assays or nucleic acid methods. The detection and quantification of CTCs has significant clinical utility in the prognosis of metastatic breast, prostate, and colorectal cancers. CTCs are a heterogeneous population of cells and often different from those of their respective primary tumor. Understanding the biology of CTCs may provide useful predictive information for the selection of the most appropriate treatment. Therefore, CTC detection and characterization could become a valuable tool to refine prognosis and serve as a “real-time biopsy” and has the potential to guide precision cancer therapies, monitor cancer treatment, and investigate the process of metastasis. - See more at: http://www.mdpi.com/2072-6694/6/4/2369/htm#sthash.UvsIAwMW.dpufAbstract
: Circulating tumor cells (CTCs) can be detected in the blood of different types of early or advanced cancer using immunology-based assays or nucleic acid methods. The detection and quantification of CTCs has significant clinical utility in the prognosis of metastatic breast, prostate, and colorectal cancers. CTCs are a heterogeneous population of cells and often different from those of their respective primary tumor. Understanding the biology of CTCs may provide useful predictive information for the selection of the most appropriate treatment. Therefore, CTC detection and characterization could become a valuable tool to refine prognosis and serve as a “real-time biopsy” and has the potential to guide precision cancer therapies, monitor cancer treatment, and investigate the process of metastasis. - See more at: http://www.mdpi.com/2072-6694/6/4/2369/htm#sthash.UvsIAwMW.dpufTuesday, December 16, 2014
Hereditary Cancer-Associated Mutations in Women Diagnosed with Two Primary Cancers: An Opportunity to Identify Hereditary Cancer Syndromes after the First Cancer Diagnosis
FullText Myriad Genetic Laboratories, Inc., Salt Lake City, Utah, USA
Results: Among women with both breast and ovarian cancer, 22.4% (2,237/9,982) had a BRCA1 or BRCA2 mutation. Among women with both colorectal and ovarian cancer, 28.1% (264/941) had a mutation associated with LS. In 66.6% of BRCA1 or BRCA2 mutation carriers and in 58.3% of LS mutation carriers, >5 years passed between the cancer diagnoses.......
Table 2. Interval between the first and the second cancer diagnosis in patients with HBOC
Table 4. Interval between first and second cancer diagnoses in patients with LS
What really matters in end-of-life discussions? Perspectives of patients in hospital with serious illness and their families
open access
Interpretation: We identified elements of goals-of-care discussions that are most important to older adult patients in hospital with serious illness and their family members. We found that guideline-recommended elements of goals-of-care discussions are not often addressed by health care providers. Our results can inform interventions to improve the determination of goals of care in the hospital setting.
Lynch Syndrome Caused by Germline PMS2 Mutations: Delineating the Cancer Risk
abstract
Significant SIRs were observed for cancers of the small bowel, ovaries, breast, and renal pelvis.
Monday, December 15, 2014
(Lynch Syndrome etc) ASCO CPG Endorsement of the Familial Risk–Colorectal Cancer: ESMO CPG
open access
Hereditary Colorectal Cancer Syndromes: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the Familial Risk–Colorectal Cancer: European Society for Medical Oncology Clinical Practice Guidelines
Lynch syndrome
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Colon and rectum: Colonoscopy every 1 to 2 years, starting at age 20 to 25 or 5 years before the youngest case in the family. No upper limit is established.
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Endometrium and ovary: Gynecological examination, pelvic ultrasound (not CA-125), and aspiration biopsy every year, from age 30 to 35 years. Consider prophylactic hysterectomy and salpingoophorectomy when childbearing is completed.
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Gastric cancer: For gastric cancer, the search for the presence of Helicobacter pylori and subsequent eradication is recommended in mutation carriers. In case of a high incidence of gastric cancer in some populations, some experts recommend upper GI endoscopy every 1 to 3 years.
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Other Lynch-associated cancers: Surveillance is not recommended due to the low sensitivity and specificity. (Although there are insufficient data supporting surveillance for other target organs, it may be considered in the context of family history.)....... Unlike CRC, data to support the effectiveness of transvaginal ultrasound and endometrial biopsy for gynecologic surveillance are lacking, and only surgical removal of the uterus and ovaries (fallopian tubes???) has been shown to reduce incidence of endometrial and ovarian cancers.10 Individuals with LS also have an elevated risk of developing other cancers, specifically tumors of the urinary tract (lifetime risk, 5% to 12%), small intestine, ovary (lifetime risk, 4% to 12%), stomach (lifetime risk, 8% to 10%), pancreas (lifetime risk, 4%), biliary tract, brain, and skin.11,12 Comparisons of phenotype according to MMR gene mutation have shown that MLH1-mutation carriers tend to develop CRC at younger ages, whereas MSH2 carriers seem to be at higher risk for extracolonic cancers, and for women with MSH6 mutations, the risk for endometrial cancer may surpass the lifetime CRC risk.13–15 In contrast, the risks for CRC and endometrial cancer seem to be lower among individuals with mutations in PMS2 (15% to 20%) compared with carriers of other MMR gene mutations.16........
Saturday, December 13, 2014
Commentary on ‘Performance of ultrasound as a second line test to serum CA125 in ovarian cancer screening’
Commentary - open access
Conclusions
Thursday, December 11, 2014
Enhanced recovery pathways in gynecologic oncology
abstract
Highlights
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- Enhanced Recovery Pathways (ERP) are safe for patients undergoing complex gynecologic oncology operations, including colonic resection.
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- Incorporation of a comprehensive ERP is associated with reduced length of stay, excellent patient satisfaction, and lower costs.
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- Successful implementation of ERP requires standardization and cooperation within the care team.
Abstract
Objective
Methods
Results
Conclusion
Old drug, new trick: Repurposing metformin for gynecologic cancers?
abstract
Highlights
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- We summarize the molecular mechanisms of action mediating metformin's protective effect in cancer.
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- Review the preclinical and epidemiological evidences for metformin's potential role in gynecological cancers.
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- Description of ongoing prospective testing of metformin in gynecologic cancers and future directions.
Abstract
Objective
Methods
Results
Conclusions
Combining clinical assessment and the Risk of Ovarian Malignancy Algorithm for the prediction of ovarian cancer
abstract
Objectives
Methods
Results
Conclusions
CA125 kinetic parameters predict optimal cytoreduction in patients with advanced epithelial ovarian cancer treated with neoadjuvant chemotherapy
CA125
Highlights
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- This paper aims at determining the optimal CA125 cut-off value to accurately predict complete cytoreduction after NAC.
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- A CA125 level < 75 UI/ml after the 3rd NAC was an independent predictor factor for complete surgery.
Abstract
Objective
Methods
Results
Conclusion
Chemotherapy-induced peripheral neuropathy and its impact on health-related quality of life among ovarian cancer survivors PROFILES registry
abstract
Highlights
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- Neuropathy symptoms were experienced by 51% of women with ovarian cancer, especially tingling hands/feet and numbness in fingers/toes.
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- Even up to 12 years after the end of treatment some women experience neuropathy symptoms.
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- Neuropathy was associated with worse functioning, overall HRQoL, pain and insomnia.
Abstract
Objective
Methods
Results
Conclusion
Prognostic value of lymph node ratio in patients with advanced epithelial ovarian cancer
abstract
Highlights
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- Lymph node status is a prognostic factor in ovarian cancer.
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- Lymph node ratio reflects lymph node spread and surgical extent.
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- Lymph node ratio predicts overall survival more concisely.
Abstract
Objective
Methods
Results
Conclusion
Laparoscopic staging of apparent early stage ovarian cancer: Results of a large, retrospective, multi-institutional series
abstract
Highlights
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- Stage of disease is still the most important prognostic factor in early ovarian cancer.
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- Among early ovarian cancer patients there is a non-negligible percentage of upstaged patients.
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- A complete and accurate surgical staging can be safely achieved through laparoscopic surgery, when performed in referral centers.
Abstract
Objective
Patients and methods
Results
Conclusion
Endometriosis and ovarian cancer - World Journal of Clinical Oncology
open access
..........In addition, we know about the possible links between endometriosis and cancer for almost 100 years. Despite clear evidence revealing that endometriosis increases ovarian cancer risks, it is possible that it may not affect disease progression after the appearance of ovarian cancer. However, despite clear evidence revealing that endometriosis increases ovarian cancer risk, our knowledge of the risk factors is far from established. In our review, we focused on the most recent approaches including possible biomarkers and genetic approaches....
Enteroenterostomy - emedicine
emedicine
Background
Tuesday, December 09, 2014
New Downloadable Slides: Adding Precision and Power to Progress in Ovarian Cancer Management
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