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Lee YJ, Chung YS, Lee JY, Nam EJ, Kim SW, Kim YT, Kim S. Role of diagnostic laparoscopy in deciding primary treatment in advanced-stage ovarian cancer. J Gynecol Oncol 2023; 34:e17. [PMID: 36562129 PMCID: PMC9995876 DOI: 10.3802/jgo.2023.34.e17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/10/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE We evaluated the usefulness of preoperative diagnostic laparoscopy for treatment planning in patients with advanced-stage ovarian cancer. METHODS We retrospectively analyzed 614 patients diagnosed with advanced-stage ovarian cancer between January 2010 and May 2018. Primary debulking surgery (PDS) or neoadjuvant chemotherapy (NAC) followed by interval debulking surgery were selected based on preoperative laparoscopic (Group 1, n=192) and computed tomography findings (Group 2, n=422). The primary outcomes in the PDS and NAC groups were suboptimal cytoreduction (residual disease >1 cm) rate and non-high-grade serous carcinoma (non-HGSC) rate, respectively. RESULTS The patients who underwent PDS in group 1 and group 2 were 49 (25.5%) and 279 (66.1%), respectively. The suboptimal cytoreduction rate after PDS was lower in Group 1 than in Group 2 (2.0% vs 11.1%, p=0.023). Moreover, Group 1 showed a tendency toward a lower proportion of non-HGSC patients who underwent NAC than that in Group 2 (9.1% vs. 15.4%, p=0.069). Further, Group 1 showed lower rates of postoperative morbidity than Group 2 (5.2% vs. 10.4%, p=0.033). However, Kaplan-Meier analysis showed no significant differences in survival outcomes between the 2 groups. CONCLUSION Diagnostic laparoscopy reduced the suboptimal cytoreduction rate in the PDS group and the implementation rate of NAC in non-HGSC patients. Moreover, it reduced postoperative morbidity without affecting survival in both groups. Thus, diagnostic laparoscopy is a valuable diagnostic tool for determining the primary treatment.
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Affiliation(s)
- Yong Jae Lee
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Young Shin Chung
- Department of Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jung-Yun Lee
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ji Nam
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Wun Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Young Tae Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sunghoon Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
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Intraoperative Tumor Detection Using Pafolacianine. Int J Mol Sci 2022; 23:ijms232112842. [PMID: 36361630 PMCID: PMC9658182 DOI: 10.3390/ijms232112842] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/16/2022] [Accepted: 10/21/2022] [Indexed: 12/24/2022] Open
Abstract
Cancer is a leading cause of death worldwide, with increasing numbers of new cases each year. For the vast majority of cancer patients, surgery is the most effective procedure for the complete removal of the malignant tissue. However, relapse due to the incomplete resection of the tumor occurs very often, as the surgeon must rely primarily on visual and tactile feedback. Intraoperative near-infrared imaging with pafolacianine is a newly developed technology designed for cancer detection during surgery, which has been proven to show excellent results in terms of safety and efficacy. Therefore, pafolacianine was approved by the U.S. Food and Drug Administration (FDA) on 29 November 2021, as an additional approach that can be used to identify malignant lesions and to ensure the total resection of the tumors in ovarian cancer patients. Currently, various studies have demonstrated the positive effects of pafolacianine’s use in a wide variety of other malignancies, with promising results expected in further research. This review focuses on the applications of the FDA-approved pafolacianine for the accurate intraoperative detection of malignant tissues. The cancer-targeting fluorescent ligands can shift the paradigm of surgical oncology by enabling the visualization of cancer lesions that are difficult to detect by inspection or palpation. The enhanced detection and removal of hard-to-detect cancer tissues during surgery will lead to remarkable outcomes for cancer patients and society, specifically by decreasing the cancer relapse rate, increasing the life expectancy and quality of life, and decreasing future rates of hospitalization, interventions, and costs.
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Nikolaidi A, Fountzilas E, Fostira F, Psyrri A, Gogas H, Papadimitriou C. Neoadjuvant treatment in ovarian cancer: New perspectives, new challenges. Front Oncol 2022; 12:820128. [PMID: 35957909 PMCID: PMC9360510 DOI: 10.3389/fonc.2022.820128] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 07/01/2022] [Indexed: 11/13/2022] Open
Abstract
Ovarian cancer remains the leading cause of death from gynecological cancer. Survival is significantly related to the stage of the disease at diagnosis. Of quite importance is primary cytoreductive surgery, having as a goal to remove all visible tumor tissue, and is the standard primary treatment in combination with platinum-based chemotherapy for patients with advanced ovarian carcinoma. Neo-adjuvant chemotherapy (NACT) has been implemented mostly in treating advanced disease, with studies performed having numerous limitations. Data extrapolated from these studies have not shown inferiority survival of NACT, compared to primary debulking surgery. The role of NACT is of particular interest because of the intrinsic mechanisms that are involved in the process, which can be proven as therapeutic approaches with enormous potential. NACT increases immune infiltration and programmed death ligand-1 (PDL-1) expression, induces local immune activation, and can potentiate the immunogenicity of immune-exclude high grade serous ovarian tumors, while the combination of NACT with bevacizumab, PARP inhibitors or immunotherapy remains to be evaluated. This article summarizes all available data on studies implementing NACT in the treatment of ovarian cancer, focusing on clinical outcomes and study limitations. High mortality rates observed among ovarian cancer patients necessitates the identification of more effective treatments, along with biomarkers that will aid treatment individualization.
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Affiliation(s)
- Adamantia Nikolaidi
- Oncology Department, Private General Maternity, Gynecological and Pediatric Clinic “MITERA“ Hospital, Athens, Greece
- *Correspondence: Adamantia Nikolaidi,
| | - Elena Fountzilas
- Second Department of Medical Oncology, Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece
- European University Cyprus, Engomi, Cyprus
| | - Florentia Fostira
- Molecular Diagnostics Laboratory, National Centre for Scientific Research ‘Demokritos’, Athens, Greece
| | - Amanda Psyrri
- Section of Medical Oncology, Department of Internal Medicine, “Attikon” Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Helen Gogas
- First Department of Medicine, ‘Laiko’ General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Christos Papadimitriou
- Oncology Unit, Second Department of Surgery, “Aretaieion” University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
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Burns JM, Shafer E, Vankayala R, Kundra V, Anvari B. Near Infrared Fluorescence Imaging of Intraperitoneal Ovarian Tumors in Mice Using Erythrocyte-Derived Optical Nanoparticles and Spatially-Modulated Illumination. Cancers (Basel) 2021; 13:cancers13112544. [PMID: 34067308 PMCID: PMC8196853 DOI: 10.3390/cancers13112544] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 01/05/2023] Open
Abstract
Simple Summary Ovarian cancer has a greater mortality rate than all gynecological malignancies combined. While cytoreductive surgery remains the primary therapeutic approach, its success is limited by the inability to visualize all tumor nodules for resection. We developed light activated nano-sized particles derived from red blood cells as potential imaging probes for near infrared fluorescence imaging of tumors during cytoreductive surgery. We present the first demonstration of the use of these nanoparticles in conjunction a spatially-modulated illumination (SMI) modality to image ovarian intraperitoneal tumors in mice. Our findings indicate that, at 24 h post-administration, these nanoparticles accumulated at higher levels in tumors as compared to organs, and that use of SMI enhances the image contrast. Abstract Ovarian cancer is the deadliest gynecological cancer. Cytoreductive surgery to remove primary and intraperitoneal tumor deposits remains as the standard therapeutic approach. However, lack of an intraoperative image-guided approach to enable the visualization of all tumors can result in incomplete cytoreduction and recurrence. We engineered nano-sized particles derived from erythrocytes that encapsulate the near infrared (NIR) fluorochrome, indocyanine green, as potential imaging probes for tumor visualization during cytoreductive surgery. Herein, we present the first demonstration of the use of these nanoparticles in conjunction with spatially-modulated illumination (SMI), at spatial frequencies in the range of 0–0.5 mm−1, to fluorescently image intraperitoneal ovarian tumors in mice. Results of our animal studies suggest that the nanoparticles accumulated at higher levels within tumors 24 h post-intraperitoneal injection as compared to various other organs. We demonstrate that, under the imaging specifications reported here, use of these nanoparticles in conjunction with SMI enhances the fluorescence image contrast between intraperitoneal tumors and liver, and between intraperitoneal tumors and spleen by nearly 2.1, and 3.0 times, respectively, at the spatial frequency of 0.2 mm−1 as compared to the contrast values at spatially-uniform (non-modulated) illumination. These results suggest that the combination of erythrocyte-derived NIR nanoparticles and structured illumination provides a promising approach for intraoperative fluorescence imaging of ovarian tumor nodules at enhanced contrast.
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Affiliation(s)
- Joshua M. Burns
- Department of Bioengineering, University of California, 900 University Ave., Riverside, CA 92521, USA; (J.M.B.); (E.S.); (R.V.)
| | - Elise Shafer
- Department of Bioengineering, University of California, 900 University Ave., Riverside, CA 92521, USA; (J.M.B.); (E.S.); (R.V.)
| | - Raviraj Vankayala
- Department of Bioengineering, University of California, 900 University Ave., Riverside, CA 92521, USA; (J.M.B.); (E.S.); (R.V.)
- Radoptics, LLC, 1002 Health Science Rd. E., Suite P214, Irvine, CA 92612, USA
| | - Vikas Kundra
- Department of Cancer Systems Imaging and Department of Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, #57, Houston, TX 77030, USA;
| | - Bahman Anvari
- Department of Bioengineering, University of California, 900 University Ave., Riverside, CA 92521, USA; (J.M.B.); (E.S.); (R.V.)
- Correspondence:
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Altman AD, Lambert P, Dean E, Robinson C, Nachtigal MW, Kean S. Response to Multi-Line Chemotherapy in Non-Serous Epithelial Ovarian Cancer. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:1217-1222. [PMID: 32694071 DOI: 10.1016/j.jogc.2020.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To describe the response rate to chemotherapy, rates of recurrence, and overall survival in patients with non-serous epithelial ovarian cancers. METHODS This retrospective cohort study used the Manitoba Cancer Registry to identify all women with non-serous epithelial ovarian, fallopian, or peritoneal cancer treated between 1995 and 2010. Chart review entailed extracting information regarding therapy and outcomes. All patients with recurrence were identified and response to chemotherapy was assessed. RESULTS We identified 392 patients with non-serous ovarian cancers, 192 of whom received chemotherapy in the first-line setting. Optimal debulking resulted in improvements in rates of recurrence and overall survival (P < 0.001). Histology did not have an effect on recurrence or overall survival. Forty-eight patients (25%) had a recurrence and received second-line therapy, and 21 (11%) received third-line therapy. Response rates were similar regardless of histology. In the second-line setting, 40.9%-83.3% of patients (other > mucinous > clear cell > endometrioid) and in the third-line setting, 33.3%-75.0% of patients (other > mucinous > clear cell > endometrioid) received >6 lines of chemotherapy. Twenty-three percent of patients experienced a recurrence within 2 years of first-line therapy. Two-year survival was 79.4% after first-line treatment, 27.6% after second-line treatment, and 19.5% after third-line treatment. CONCLUSION Patients with clear cell ovarian cancer had chemotherapy continuation rates similar to those of previously reported studies. This is one of the first studies reporting response rates for mucinous and endometrioid subtypes. Recurrent disease responds to treatment with second- and third-line therapy, emphasizing the importance of offering patients subsequent lines of chemotherapy for disease management. Further studies are needed to determine the optimal regimen.
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Affiliation(s)
- Alon D Altman
- Department of Obstetrics Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB; Division of Gynecologic Oncology, CancerCare Manitoba, Winnipeg, MB.
| | - Pascal Lambert
- Department of Epidemiology, CancerCare Manitoba, Winnipeg, MB
| | - Erin Dean
- Department of Obstetrics Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB; Division of Gynecologic Oncology, CancerCare Manitoba, Winnipeg, MB
| | - Christine Robinson
- Department of Obstetrics Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB; Division of Gynecologic Oncology, CancerCare Manitoba, Winnipeg, MB
| | - Mark W Nachtigal
- Department of Obstetrics Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB; Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB; Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB
| | - Sarah Kean
- Department of Obstetrics Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB; Department of Epidemiology, CancerCare Manitoba, Winnipeg, MB
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Bendifallah S, Body G, Daraï E, Ouldamer L. [Diagnostic and prognostic value of tumor markers, scores (clinical and biological) algorithms, in front of an ovarian mass suspected of an epithelial ovarian cancer: Article drafted from the French Guidelines in oncology entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY under the aegis of CNGOF and endorsed by INCa]. ACTA ACUST UNITED AC 2019; 47:134-154. [PMID: 30733191 DOI: 10.1016/j.gofs.2018.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the diagnostic value of serum/urinary biomarkers and the operability diagnosis strategy to make management recommendations. METHODS Bibliographical search in French and English languages by consultation of Pubmed, Cochrane and Embase databases. RESULTS For the diagnosis of a suspicious adnexal mass on imaging: Serum CA125 antigen is recommended (grade A). Serum CAE is not recommended (grade C). The low evidence in literature concerning diagnostic value of CA19.9 does not allow any recommendation concerning its use. Serum Human epididymis protein 4 (HE4) is recommended (grade A). Comparison of data concerning diagnosis value of CA125 and HE4 show similar results for the prediction of malignancy in case of a suspicious adnexal mass on imaging (NP1). Urinary HE4 is not recommended (grade A). The use of circulating tumor DNA is not recommended (grade A). Tumor associated antigen-antibodies (AAbs) is not recommended (grade B). The use of ROMA score (Risk of Ovarian Malignancy Algorithm) is recommended (grade A). The use of Copenhagen index (CPH-I), R-OPS score, OVA500 is not recommended (grade C). For the prediction of resectability of an ovarian cancer with peritoneal carcinomatosis in the context of a primary debulking surgery: It is not recommendend to use serum CA125 (grade A). The low evidence in literature concerning diagnostic value of HE4 does not allow any recommendation concerning its use in this context. No recommendation can be given concerning CA19.9 and CAE. For the prediction of resectability of an ovarian cancer with peritoneal carcinomatosis in the context of surgery after neoadjuvant chemotherapy: the low evidence in literature concerning diagnostic value of serum markers in this context does not allow any recommendation concerning their use in this context. Place of laparoscopy for the prediction of resectability in case of upfront surgery of an ovarian cancer with peritoneal carcinomatosis robust data shows that the use of laparoscopy significantly reduce futile laparotomies (LE1). Laparoscopy is recommended in this context (grade A). Fagotti score is a reproducible tool (LE1) permitting the evaluation of feasibility of an optimal upfront debulking (NP4), its use is recommended (grade C). A Fagotti score≥8 is correlated to a low probability of complete or optimal debulking surgery (LE4) (grade C). There is no sufficient evidence to recommend the use of the modified Fagotti score or any other laparoscopic score (LE4). In case of laparotomy for an ovarian cancer with peritoneal carcinomatosis, the use of Peritoneal Cancer Index (PCI) is recommended (grade C). For the prediction of overall survival, disease free survival and the prediction of postoperative complications, the clinical and statistical of actually available tools do not allow any recommendation.
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Affiliation(s)
- S Bendifallah
- Département de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris (AP-HP), 4, rue de la Chine, 75020 Paris, France; UMR_S938, université de Sorbonne, 75000 Paris, France
| | - G Body
- Département de gynécologie, centre hospitalier universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Inserm U1069, université François-Rabelais, 37044 Tours, France
| | - E Daraï
- Département de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris (AP-HP), 4, rue de la Chine, 75020 Paris, France; Inserm UMR S 938, université Pierre-et-Marie-Curie, 75000 Paris, France
| | - L Ouldamer
- Département de gynécologie, centre hospitalier universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Inserm U1069, université François-Rabelais, 37044 Tours, France.
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Roze JF, Hoogendam JP, van de Wetering FT, Spijker R, Verleye L, Vlayen J, Veldhuis WB, Scholten RJPM, Zweemer RP. Positron emission tomography (PET) and magnetic resonance imaging (MRI) for assessing tumour resectability in advanced epithelial ovarian/fallopian tube/primary peritoneal cancer. Cochrane Database Syst Rev 2018; 10:CD012567. [PMID: 30298516 PMCID: PMC6517226 DOI: 10.1002/14651858.cd012567.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Ovarian cancer is the leading cause of death from gynaecological cancer in developed countries. Surgery and chemotherapy are considered its mainstay of treatment and the completeness of surgery is a major prognostic factor for survival in these women. Currently, computed tomography (CT) is used to preoperatively assess tumour resectability. If considered feasible, women will be scheduled for primary debulking surgery (i.e. surgical efforts to remove the bulk of tumour with the aim of leaving no visible (macroscopic) tumour). If primary debulking is not considered feasible (i.e. the tumour load is too extensive), women will receive neoadjuvant chemotherapy to reduce tumour load and subsequently undergo (interval) surgery. However, CT is imperfect in assessing tumour resectability, so additional imaging modalities can be considered to optimise treatment selection. OBJECTIVES To assess the diagnostic accuracy of fluorodeoxyglucose-18 (FDG) PET/CT, conventional and diffusion-weighted (DW) MRI as replacement or add-on to abdominal CT, for assessing tumour resectability at primary debulking surgery in women with stage III to IV epithelial ovarian/fallopian tube/primary peritoneal cancer. SEARCH METHODS We searched MEDLINE and Embase (OVID) for potential eligible studies (1946 to 23 February 2017). Additionally, ClinicalTrials.gov, WHO-ICTRP and the reference list of all relevant studies were searched. SELECTION CRITERIA Diagnostic accuracy studies addressing the accuracy of preoperative FDG-PET/CT, conventional or DW-MRI on assessing tumour resectability in women with advanced stage (III to IV) epithelial ovarian/fallopian tube/primary peritoneal cancer who are scheduled to undergo primary debulking surgery. DATA COLLECTION AND ANALYSIS Two authors independently screened titles and abstracts for relevance and inclusion, extracted data and performed methodological quality assessment using QUADAS-2. The limited number of studies did not permit meta-analyses. MAIN RESULTS Five studies (544 participants) were included in the analysis. All studies performed the index test as replacement of abdominal CT. Two studies (366 participants) addressed the accuracy of FDG-PET/CT for assessing incomplete debulking with residual disease of any size (> 0 cm) with sensitivities of 1.0 (95% CI 0.54 to 1.0) and 0.66 (95% CI 0.60 to 0.73) and specificities of 1.0 (95% CI 0.80 to 1.0) and 0.88 (95% CI 0.80 to 0.93), respectively (low- and moderate-certainty evidence). Three studies (178 participants) investigated MRI for different target conditions, of which two investigated DW-MRI and one conventional MRI. The first study showed that DW-MRI determines incomplete debulking with residual disease of any size with a sensitivity of 0.94 (95% CI 0.83 to 0.99) and a specificity of 0.98 (95% CI 0.88 to 1.00) (low- and moderate-certainty evidence). For abdominal CT, the sensitivity for assessing incomplete debulking was 0.66 (95% CI 0.52 to 0.78) and the specificity 0.77 (95% CI 0.63 to 0.87) (low- and low-certainty evidence). The second study reported a sensitivity of DW-MRI of 0.75 (95% CI 0.35 to 0.97) and a specificity of 0.96 (95% CI 0.80 to 1.00) (very low-certainty evidence) for assessing incomplete debulking with residual disease > 1 cm. In the last study, the sensitivity for assessing incomplete debulking with residual disease of > 2 cm on conventional MRI was 0.91 (95% CI 0.59 to 1.00) and the specificity 0.97 (95% CI 0.87 to 1.00) (very low-certainty evidence). Overall, the certainty of evidence was very low to moderate (according to GRADE), mainly due to small sample sizes and imprecision. AUTHORS' CONCLUSIONS Studies suggested a high specificity and moderate sensitivity for FDG-PET/CT and MRI to assess macroscopic incomplete debulking. However, the certainty of the evidence was insufficient to advise routine addition of FDG-PET/CT or MRI to clinical practice..In a research setting, adding an alternative imaging method could be considered for women identified as suitable for primary debulking by abdominal CT, in an attempt to filter out false-negatives (i.e. debulking, feasible based on abdominal CT, unfeasible at actual surgery).
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Affiliation(s)
- Joline F Roze
- UMC Utrecht Cancer CenterDepartment of Gynaecological OncologyUtrechtNetherlands3508 GA
| | - Jacob P Hoogendam
- UMC Utrecht Cancer CenterDepartment of Gynaecological OncologyUtrechtNetherlands3508 GA
| | - Fleur T van de Wetering
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityCochrane NetherlandsPO Box 85500UtrechtNetherlands3508 GA
| | - René Spijker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityCochrane NetherlandsPO Box 85500UtrechtNetherlands3508 GA
| | - Leen Verleye
- Belgian Health Care Knowledge CentreKruidtuinlaan 55BrusselsBelgium1000
| | - Joan Vlayen
- Belgian Health Care Knowledge CentreKruidtuinlaan 55BrusselsBelgium1000
| | - Wouter B Veldhuis
- University Medical Center UtrechtDepartment of RadiologyRoom E01.132PO Box 85500UtrechtNetherlands3508 GA
| | - Rob JPM Scholten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityCochrane NetherlandsPO Box 85500UtrechtNetherlands3508 GA
| | - Ronald P Zweemer
- UMC Utrecht Cancer CenterDepartment of Gynaecological OncologyUtrechtNetherlands3508 GA
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Tran AQ, Erim DO, Sullivan SA, Cole AL, Barber EL, Kim KH, Gehrig PA, Wheeler SB. Cost effectiveness of neoadjuvant chemotherapy followed by interval cytoreductive surgery versus primary cytoreductive surgery for patients with advanced stage ovarian cancer during the initial treatment phase. Gynecol Oncol 2018; 148:329-335. [PMID: 29273308 PMCID: PMC6002777 DOI: 10.1016/j.ygyno.2017.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/21/2017] [Accepted: 12/11/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Advanced stage epithelial ovarian cancer (AEOC) can be treated with either neoadjuvant chemotherapy (NACT) or primary cytoreductive surgery (PCS). Although randomized controlled trials show that NACT is non-inferior in overall survival compared to PCS, there may be improvement in short-term morbidity. We sought to investigate the cost-effectiveness of NACT relative to PCS for AEOC from the US Medicare perspective. METHODS A cost-effectiveness analysis using a Markov model with a 7-month time horizon comparing (1) 3cycles of NACT with carboplatin and paclitaxel (CT), followed by interval cytoreductive surgery, then 3 additional cycles of CT, or (2) PCS followed by 6cycles of CT. Input parameters included probability of chemotherapy complications, surgical complications, treatment completion, treatment costs, and utilities. Model outcomes included costs, life-years gained, quality-adjusted life-years (QALYs) gained, and incremental cost-effectiveness ratios (ICER), in terms of cost per life-year gained and cost per QALY gained. We accounted for differences in surgical complexity by incorporating the cost of additional procedures and the probability of undergoing those procedures. Probabilistic sensitivity analysis (PSA) was performed via Monte Carlo simulations. RESULTS NACT resulted in a savings of $7034 per patient with a 0.035 QALY increase compared to PCS; therefore, NACT dominated PCS in the base case analysis. With PSA, NACT was the dominant strategy more than 99% of the time. CONCLUSIONS In the short-term, NACT is a cost-effective alternative compared to PCS in women with AEOC. These results may translate to longer term cost-effectiveness; however, data from randomized control trials continues to mature.
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Affiliation(s)
- Arthur-Quan Tran
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, United States.
| | - Daniel O Erim
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, United States
| | - Stephanie A Sullivan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, United States
| | - Ashley L Cole
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, United States
| | - Emma L Barber
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, United States
| | - Kenneth H Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, United States
| | - Paola A Gehrig
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, United States
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, United States
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Radiological and Surgical Correlation of Disease Burden in Advanced Ovarian Cancer Using Peritoneal Carcinomatosis Index. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2018. [DOI: 10.1007/s40944-018-0175-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Kar A, Satapathy B, Pattnaik K, Dash PK. Trucut Biopsy vs FNAC of Pelvic Tumors-Who Wins the Match? J Cytol 2018; 35:179-182. [PMID: 30089950 PMCID: PMC6060571 DOI: 10.4103/joc.joc_63_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Preoperative pathologic diagnosis of pelvic tumors is mandatory for proper management of patients like neoadjuvant chemotherapy and interval debulking. Currently there are many minimally invasive methods available which include fine-needle aspiration cytology (FNAC) and trucut biopsy, mostly complimentary to each other. FNAC is a cheap, rapid and sensitive method for diagnosis of pelvic tumors. It can be done as an outpatient procedure without complications. But with it, the tissue architecture cannot be seen. Trucut biopsy on the other hand reveals tissue architecture and can help in grading and subtyping of malignant tumors. Trucut biopsy has to be done under image guidance like ultrasound and computed tomography. Patient is administered local anaesthetic and can be discharged safely after 2 hours. Pathologists familiar with histomorphology can give a correct diagnosis easily. But many times sampling errors may occur; especially in large tumors, resulting only in necrosis, hemorrhage and degenerated tissue bits. Also differentiation of borderline from malignant ovarian tumors is very difficult. In case of mixed tumors one component may be missed. Hard tumors like fibromas and leiomyomas yield scanty material and result in inadequate reporting. With FNAC, the overall accuracy rate is estimated to be around 96.3%. With trucut biopsy, adequacy is from 91 to 95% and accuracy is approximately 98% in different studies. When both methods are combined, the adequacy is 100%, diagnostic accuracy 95.5%, sensitivity 94.9% and specificity 100%. Therefore depending on the clinical diagnosis and the location of tumors, either FNAC and/or trucut biopsy can be chosen.
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Affiliation(s)
- Asaranti Kar
- Department of Pathology, S.C.B. Medical College, Cuttack, Odisha, India
| | | | - Kaumudee Pattnaik
- Department of Pathology, S.C.B. Medical College, Cuttack, Odisha, India
| | - Prafulla K Dash
- Department of Surgical Oncology, AHRCC, Cuttack, Odisha, India
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11
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Jones NL, Chen L, Chatterjee S, Tergas AI, Burke WM, Hou JY, Ananth CV, Neugut AI, Hershman DL, Wright JD. National Trends in Extended Procedures for Ovarian Cancer Debulking Surgery. Int J Gynecol Cancer 2018; 28:19-25. [PMID: 28953134 PMCID: PMC5734991 DOI: 10.1097/igc.0000000000001132] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Primary cytoreduction for ovarian cancer often requires extended radical procedures and is associated with significant morbidity. In 2010, neoadjuvant chemotherapy was shown to have similar survival to primary cytoreduction but with less need for radical surgery. We hypothesized that the increased use of neoadjuvant chemotherapy would decrease the use of radical cytoreductive procedures and thus examined trends in the performance of radical cytoreductive procedures. METHODS We used the Nationwide Inpatient Sample to determine the annual number of extended procedures (colon, small intestine, liver, diaphragm, spleen, and gastric resection, ileostomy, colostomy) performed in women undergoing surgery for ovarian cancer from 1998 to 2013. Estimates were weighted to provide national averages. To account for changes in incidence over time, we used national incidence rates and report procedures performed per 1000 new cases of ovarian cancer. Trends were assessed using Cochrane-Armitage tests. RESULTS We identified 274,639 ovarian cancer patients who underwent surgery, ranging from 15,720 to 18,714 procedures performed each year. We identified a significant increase in the use of extended procedures over this period. These differences were significant for absolute numbers of procedures, rate per 1000 new ovarian cancer cases, and percent per hysterectomy/bilateral salpingoophorectomy for rectosigmoid resection, diaphragm resection, splenectomy, ileostomy, and liver resection. Specifically, the use of these procedures rose from 1998 to 2010, declined in 2011, and rose again in 2012 and 2013. CONCLUSIONS Although there was a transient decrease in the use of extended cytoreductive procedures from 2010 to 2011 after the publication of randomized neoadjuvant trial data, use of these procedures again rose in 2012 and 2013.
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Affiliation(s)
- Nathaniel L Jones
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons
- New York Presbyterian Hospital
| | - Ling Chen
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons
| | - Sudeshna Chatterjee
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons
- New York Presbyterian Hospital
| | - Ana I. Tergas
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons
- Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University
- Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons
- New York Presbyterian Hospital
| | - William M. Burke
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons
- Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons
- New York Presbyterian Hospital
| | - June Y. Hou
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons
- Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons
- New York Presbyterian Hospital
| | - Cande V. Ananth
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons
- Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University
| | - Alfred I. Neugut
- Department of Medicine, Columbia University College of Physicians and Surgeons
- Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University
- Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons
- New York Presbyterian Hospital
| | - Dawn L. Hershman
- Department of Medicine, Columbia University College of Physicians and Surgeons
- Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University
- Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons
- New York Presbyterian Hospital
| | - Jason D. Wright
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons
- Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons
- New York Presbyterian Hospital
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12
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Abstract
OBJECTIVE Although fluorescence imaging is being applied to a wide range of cancers, it remains unclear which disease populations will benefit greatest. Therefore, we review the potential of this technology to improve outcomes in surgical oncology with attention to the various surgical procedures while exploring trial endpoints that may be optimal for each tumor type. BACKGROUND For many tumors, primary treatment is surgical resection with negative margins, which corresponds to improved survival and a reduction in subsequent adjuvant therapies. Despite unfavorable effect on patient outcomes, margin positivity rate has not changed significantly over the years. Thus, patients often experience high rates of re-excision, radical resections, and overtreatment. However, fluorescence-guided surgery (FGS) has brought forth new light by allowing detection of subclinical disease not readily visible with the naked eye. METHODS We performed a systematic review of clinicatrials.gov using search terms "fluorescence," "image-guided surgery," and "near-infrared imaging" to identify trials utilizing FGS for those received on or before May 2016. INCLUSION CRITERIA fluorescence surgery for tumor debulking, wide local excision, whole-organ resection, and peritoneal metastases. EXCLUSION CRITERIA fluorescence in situ hybridization, fluorescence imaging for lymph node mapping, nonmalignant lesions, nonsurgical purposes, or image guidance without fluorescence. RESULTS Initial search produced 844 entries, which was narrowed down to 68 trials. Review of literature and clinical trials identified 3 primary resection methods for utilizing FGS: (1) debulking, (2) wide local excision, and (3) whole organ excision. CONCLUSIONS The use of FGS as a surgical guide enhancement has the potential to improve survival and quality of life outcomes for patients. And, as the number of clinical trials rise each year, it is apparent that FGS has great potential for a broad range of clinical applications.
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13
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Neoadjuvant chemotherapy and chemotherapy cycle number: A national multicentre study. Gynecol Oncol 2017; 147:257-261. [PMID: 28800940 DOI: 10.1016/j.ygyno.2017.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/01/2017] [Accepted: 08/04/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Six cycles of consolidation chemotherapy have become the standard for ovarian cancer treatment regimen following primary cytoreduction, yet with neoadjuvant chemotherapy (NAC), only 3 consolidation cycles are used. This study examines the effects of number of chemotherapy cycles in women with ovarian cancer that are being treated with neoadjuvant chemotherapy. In addition, we examined the effect of number of cycles on survival on consolidation and total chemotherapy. METHODS All patients with stage IIIC and IV high grade serous carcinoma (HGSC) were identified at 4 major Canadian cancer centers treated with NAC. A retrospective chart review was conducted using the medical charts and registry databases. RESULTS 403 NAC patients were identified. 47% had zero residual disease. Chemotherapy cycles were divided into <3cycles or ≥4cycles for NAC and consolidation treatments and analyzed with multivariate analysis. 139/403 (34.5%) received ≥4cycles of NAC and had a worse prognosis than <3cycles (p=0.011). 70/403 (17.4%) received ≥4cycles of consolidation treatment and there was no difference in survival (p=0.33) CONCLUSION: Women with advanced HGSC are managed with a combination of surgery and chemotherapy. This is a study of a homogenous cohort of patients with stage IIIC or IV high grade serous cancers who received NAC. ≥4cycles of NAC had a worse outcome than <3cycles likely due to poor prognostic factors or poor response. The number of consolidation cycles did not appear to make a difference in overall survival.
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14
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van de Vrie R, van Meurs HS, Rutten MJ, Naaktgeboren CA, Opmeer BC, Gaarenstroom KN, van Gorp T, Ter Brugge HG, Hofhuis W, Schreuder HWR, Arts HJG, Zusterzeel PLM, Pijnenborg JMA, van Haaften M, Engelen MJA, Boss EA, Vos MC, Gerestein KG, Schutter EMJ, Kenter GG, Bossuyt PMM, Mol BW, Buist MR. Cost-effectiveness of laparoscopy as diagnostic tool before primary cytoreductive surgery in ovarian cancer. Gynecol Oncol 2017. [PMID: 28645428 DOI: 10.1016/j.ygyno.2017.06.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of a diagnostic laparoscopy prior to primary cytoreductive surgery to prevent futile primary cytoreductive surgery (i.e. leaving >1cm residual disease) in patients suspected of advanced stage ovarian cancer. METHODS An economic analysis was conducted alongside a randomized controlled trial in which patients suspected of advanced stage ovarian cancer who qualified for primary cytoreductive surgery were randomized to either laparoscopy or primary cytoreductive surgery. Direct medical costs from a health care perspective over a 6-month time horizon were analyzed. Health outcomes were expressed in quality-adjusted life-years (QALYs) and utility was based on patient's response to the EQ-5D questionnaires. We primarily focused on direct medical costs based on Dutch standard prices. RESULTS We studied 201 patients, of whom 102 were randomized to laparoscopy and 99 to primary cytoreductive surgery. No significant difference in QALYs (utility=0.01; 95% CI 0.006 to 0.02) was observed. Laparoscopy reduced the number of futile laparotomies from 39% to 10%, while its costs were € 1400 per intervention, making the overall costs of both strategies comparable (difference € -80 per patient (95% CI -470 to 300)). Findings were consistent across various sensitivity analyses. CONCLUSION In patients with suspected advanced stage ovarian cancer, a diagnostic laparoscopy reduced the number of futile laparotomies, without increasing total direct medical health care costs, or adversely affecting complications or quality of life.
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Affiliation(s)
- Roelien van de Vrie
- Department of Gynecology, Center for Gynecologic Oncology Amsterdam, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Hannah S van Meurs
- Department of Gynecology, Center for Gynecologic Oncology Amsterdam, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Marianne J Rutten
- Department of Gynecology, Center for Gynecologic Oncology Amsterdam, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Christiana A Naaktgeboren
- Department of Epidemiology, Center for Gynecologic Oncology Amsterdam, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Brent C Opmeer
- Clinical Research Unit, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Katja N Gaarenstroom
- Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Toon van Gorp
- Department of Gynecology, Maastricht University Medical Center+, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Henk G Ter Brugge
- Department of Gynecology, Isala Hospital, PO Box 10400, 8000 GK Zwolle, The Netherlands
| | - Ward Hofhuis
- Department of Gynecology, Sint Franciscus Gasthuis, PO Box 10900, 3004 BA Rotterdam, The Netherlands
| | - Henk W R Schreuder
- Department of Gynecologic oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Henriette J G Arts
- Department of Gynecology, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Petra L M Zusterzeel
- Department of Gynecology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Johanna M A Pijnenborg
- Department of Gynecology, Elisabeth-Tweesteden Hospital, PO Box 90151, 5000 LC Tilburg, The Netherlands
| | - Maarten van Haaften
- Department of Gynecology, Diakonessenhuis, PO Box 80250, 3508 TG Utrecht, The Netherlands
| | - Mirjam J A Engelen
- Department of Gynecology, Atrium Medical Center, PO Box 4446, 6401 CX Heerlen, The Netherlands
| | - Erik A Boss
- Department of Gynecology, Máxima Medical Center, PO Box 7777, 5500 MB Veldhoven, The Netherlands
| | - M Caroline Vos
- Department of Gynecology, Elisabeth-Tweesteden Hospital, PO Box 90151, 5000 LC Tilburg, The Netherlands
| | - Kees G Gerestein
- Department of Gynecology, Meander Medical Center, PO Box 1502, 3800 BM Amersfoort, The Netherlands
| | - Eltjo M J Schutter
- Department of Gynecology, Medical Spectrum Twente, PO Box 50 000, 7500 KA Enschede, The Netherlands
| | - Gemma G Kenter
- Department of Gynecology, Center for Gynecologic Oncology Amsterdam, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Patrick M M Bossuyt
- Department of Epidemiology, Center for Gynecologic Oncology Amsterdam, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Ben Willem Mol
- The Robinson Institute, School of Pediatrics and Reproductive Health, University of Adelaide, 55 King William Road, North Adelaide, SA 5006, Australia
| | - Marrije R Buist
- Department of Gynecology, Center for Gynecologic Oncology Amsterdam, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
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15
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Guerrero Y, Singh SP, Mai T, Murali RK, Tanikella L, Zahedi A, Kundra V, Anvari B. Optical Characteristics and Tumor Imaging Capabilities of Near Infrared Dyes in Free and Nano-Encapsulated Formulations Comprised of Viral Capsids. ACS APPLIED MATERIALS & INTERFACES 2017; 9:19601-19611. [PMID: 28524652 DOI: 10.1021/acsami.7b03373] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Near infrared (NIR) fluorescent molecules and nanosized structures can serve as potential optical probes for image-guided removal of small tumor nodules (≲ 1 mm diameter). Although indocyanine green (ICG) remains as the only FDA-approved NIR dye, other organic dyes are under extensive development for enhanced imaging capabilities. One such dye is BrCy106-NHS where bromine is substituted for aromatic structures in cyanine dyes. Herein, we investigate the absorption and fluorescence characteristics of ICG and BrCy106-NHS, and quantitatively assess their tumor imaging capabilities in free (non-encapsulated) and a nano-encapsulated form that utilizes the capsid protein (CP) from genome-depleted plant-infecting brome mosaic virus as the encapsulating shell. We refer to these nanoconstructs as optical viral ghosts (OVGs). For example, when fabricated at CP to dye concentration ratio of 200, value of the spectrally integrated fluorescence emission for BrCy106-NHS-doped OVGs is ∼60 times higher than that of ICG-doped OVGs. Our analysis of homogenized mice intraperitoneal tumors indicate that the averaged total fluorescence emission associated with the use of BrCy106-NHS-doped can be at least about 44 times greater than that of ICG-doped OVGs. Our results suggest that OVGs containing BrCy106-NHS may potentially serve as effective optical probes for tumor imaging.
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Affiliation(s)
- Yadir Guerrero
- Department of Bioengineering, University of California , Riverside, California 92521, United States
| | | | - Turong Mai
- Department of Bioengineering, University of California , Riverside, California 92521, United States
| | | | - Leela Tanikella
- Department of Bioengineering, University of California , Riverside, California 92521, United States
| | - Atta Zahedi
- Department of Bioengineering, University of California , Riverside, California 92521, United States
| | | | - Bahman Anvari
- Department of Bioengineering, University of California , Riverside, California 92521, United States
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16
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Hoogendam JP, Roze JF, van de Wetering FT, Spijker R, Verleye L, Vlayen J, Veldhuis WB, Scholten RJPM, Zweemer RP. Positron emission tomography (PET) and magnetic resonance imaging (MRI) for assessing tumour resectability in advanced epithelial ovarian, fallopian tube and/or primary peritoneal cancer. Hippokratia 2017. [DOI: 10.1002/14651858.cd012567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Jacob P Hoogendam
- UMC Utrecht Cancer Center; Department of Gynaecological Oncology; Utrecht Netherlands 3508 GA
| | - Joline F Roze
- UMC Utrecht Cancer Center; Department of Gynaecological Oncology; Utrecht Netherlands 3508 GA
| | - Fleur T van de Wetering
- Julius Center for Health Sciences and Primary Care / University Medical Center Utrecht; Dutch Cochrane Centre; PO Box 85500 Utrecht Netherlands 3508 GA
| | - René Spijker
- Julius Center for Health Sciences and Primary Care / University Medical Center Utrecht; Dutch Cochrane Centre; PO Box 85500 Utrecht Netherlands 3508 GA
| | - Leen Verleye
- Belgian Health Care Knowledge Centre; Kruidtuinlaan 55 Brussels Belgium 1000
| | - Joan Vlayen
- Belgian Health Care Knowledge Centre; Kruidtuinlaan 55 Brussels Belgium 1000
| | - Wouter B Veldhuis
- University Medical Center Utrecht; Department of Radiology; Room E01.132 PO Box 85500 Utrecht Netherlands 3508 GA
| | - Rob JPM Scholten
- Julius Center for Health Sciences and Primary Care / University Medical Center Utrecht; Dutch Cochrane Centre; PO Box 85500 Utrecht Netherlands 3508 GA
| | - Ronald P Zweemer
- UMC Utrecht Cancer Center; Department of Gynaecological Oncology; Utrecht Netherlands 3508 GA
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17
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Rutten MJ, van Meurs HS, van de Vrie R, Gaarenstroom KN, Naaktgeboren CA, van Gorp T, Ter Brugge HG, Hofhuis W, Schreuder HWR, Arts HJG, Zusterzeel PLM, Pijnenborg JMA, van Haaften M, Fons G, Engelen MJA, Boss EA, Vos MC, Gerestein KG, Schutter EMJ, Opmeer BC, Spijkerboer AM, Bossuyt PMM, Mol BW, Kenter GG, Buist MR. Laparoscopy to Predict the Result of Primary Cytoreductive Surgery in Patients With Advanced Ovarian Cancer: A Randomized Controlled Trial. J Clin Oncol 2016; 35:613-621. [PMID: 28029317 DOI: 10.1200/jco.2016.69.2962] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose To investigate whether initial diagnostic laparoscopy can prevent futile primary cytoreductive surgery (PCS) by identifying patients with advanced-stage ovarian cancer in whom > 1 cm of residual disease will be left after PCS. Patients and Methods This multicenter, randomized controlled trial was undertaken within eight gynecologic cancer centers in the Netherlands. Patients with suspected advanced-stage ovarian cancer who qualified for PCS were eligible. Participating patients were randomly assigned to either laparoscopy or PCS. Laparoscopy was used to guide selection of primary treatment: either primary surgery or neoadjuvant chemotherapy followed by interval surgery. The primary outcome was futile laparotomy, defined as a PCS with residual disease of > 1 cm. Primary analyses were performed according to the intention-to-treat principle. Results Between May 2011 and February 2015, 201 participants were included, of whom 102 were assigned to diagnostic laparoscopy and 99 to primary surgery. In the laparoscopy group, 63 (62%) of 102 patients underwent PCS versus 93 (94%) of 99 patients in the primary surgery group. Futile laparotomy occurred in 10 (10%) of 102 patients in the laparoscopy group versus 39 (39%) of 99 patients in the primary surgery group (relative risk, 0.25; 95% CI, 0.13 to 0.47; P < .001). In the laparoscopy group, three (3%) of 102 patients underwent both primary and interval surgery compared with 28 (28%) of 99 patients in the primary surgery group ( P < .001). Conclusion Diagnostic laparoscopy reduced the number of futile laparotomies in patients with suspected advanced-stage ovarian cancer. In women with a plan for PCS, these data suggest that performance of diagnostic laparoscopy first is reasonable and that if cytoreduction to < 1 cm of residual disease seems feasible, to proceed with PCS.
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Affiliation(s)
- Marianne J Rutten
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Hannah S van Meurs
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Roelien van de Vrie
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Katja N Gaarenstroom
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Christiana A Naaktgeboren
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Toon van Gorp
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Henk G Ter Brugge
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Ward Hofhuis
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Henk W R Schreuder
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Henriette J G Arts
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Petra L M Zusterzeel
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Johanna M A Pijnenborg
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Maarten van Haaften
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Guus Fons
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Mirjam J A Engelen
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Erik A Boss
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - M Caroline Vos
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Kees G Gerestein
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Eltjo M J Schutter
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Brent C Opmeer
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Anje M Spijkerboer
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Patrick M M Bossuyt
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Ben Willem Mol
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Gemma G Kenter
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Marrije R Buist
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
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Multimodal Magnetic Resonance and Near-Infrared-Fluorescent Imaging of Intraperitoneal Ovarian Cancer Using a Dual-Mode-Dual-Gadolinium Liposomal Contrast Agent. Sci Rep 2016; 6:38991. [PMID: 28004770 PMCID: PMC5177955 DOI: 10.1038/srep38991] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 11/15/2016] [Indexed: 01/22/2023] Open
Abstract
The degree of tumor removal at surgery is a major factor in predicting outcome for ovarian cancer. A single multimodality agent that can be used with magnetic resonance (MR) for staging and pre-surgical planning, and with optical imaging to aid surgical removal of tumors, would present a new paradigm for ovarian cancer. We assessed whether a dual-mode, dual-Gadolinium (DM-Dual-Gd-ICG) contrast agent can be used to visualize ovarian tumors in the peritoneal cavity by multimodal MR and near infra-red imaging (NIR). Intraperitoneal ovarian tumors (Hey-A8 or OVCAR3) in mice enhanced on MR two days after intravenous DM-Dual Gd-ICG injection compared to controls (SNR, CNR, p < 0.05, n = 6). As seen on open abdomen and excised tumors views and confirmed by optical radiant efficiency measurement, Hey-A8 or OVCAR3 tumors from animals injected with DM-Dual Gd-ICG had increased fluorescence (p < 0.05, n = 6). This suggests clinical potential to localize ovarian tumors by MR for staging and surgical planning, and, by NIR at surgery for resection.
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Eo W, Kim HB, Lee YJ, Suh DS, Kim KH, Kim H. Preoperative Lymphocyte-Monocyte Ratio Is a Predictor of Suboptimal Cytoreduction in Stage III-IV Epithelial Ovarian Cancer. J Cancer 2016; 7:1772-1779. [PMID: 27698915 PMCID: PMC5039359 DOI: 10.7150/jca.15724] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 06/29/2016] [Indexed: 12/29/2022] Open
Abstract
Objective: To determine whether the preoperative lymphocyte-monocyte ratio (LMR) is a predictor of suboptimal cytoreduction in advanced-stage epithelial ovarian cancer (EOC). Methods: Preoperative clinico-pathologic and hematologic parameters were reviewed in a total of 154 patients with EOC submitted to primary cytoreductive surgery. Patients were categorized into two different groups according to the results of cytoreductive surgery: optimal and suboptimal cytoreduction. Continuous variables were categorized into two groups using the best cutoff points selected on the receiver operating characteristic (ROC) curve for suboptimal cytoreduction. Results: Based on data collected from the 154 patients, 133 (86.4%) and 21 (13.6%) patients presented with stage III and IV disease, respectively. One hundred seventeen (76.0%) patients had serous adenocarcinoma, and 92 (59.7%) had histologic tumor grade 3. The optimal and suboptimal cytoreduction groups included 96 (62.3%) and 58 patients (37.7%), respectively. The best LMR cutoff point for suboptimal cytoreduction was 3.75. On multivariate logistic regression analysis, age, cancer antigen 125, white blood cell count, and LMR were found to be the strongest predictors for suboptimal cytoreduction (P=0.0037, 0.0249, 0.0062, and 0.0015, respectively). Conclusion: Preoperative LMR is an independent predictor of suboptimal cytoreduction. It provides additional prognostic information beyond the biological parameters of the tumor.
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Affiliation(s)
- Wankyu Eo
- Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hong-Bae Kim
- Department of Obstetrics and Gynecology, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea
| | - Yong Joo Lee
- Department of Medicine, Pusan National University Graduate School
| | - Dong Soo Suh
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ki Hyung Kim
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Heungyeol Kim
- Department of Obstetrics and Gynecology, College of Medicine, Kosin University, Busan, Korea
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Takada T, Tsutsumi S, Takahashi R, Ohsone K, Tatsuki H, Suto T, Kato T, Fujii T, Yokobori T, Kuwano H. Control of primary lesions using resection or radiotherapy can improve the prognosis of metastatic colorectal cancer patients. J Surg Oncol 2016; 114:75-9. [PMID: 27111137 DOI: 10.1002/jso.24255] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/26/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Control of the primary lesions in metastatic colorectal cancer (mCRC) is still controversial. For rectal cancer patients, not only resection but also irradiation is expected to provide palliative effects. We investigated the effects of resection and irradiation of primary lesions (local control) on the prognosis of mCRC patients. PATIENTS Forty-seven patients with mCRC at our institute were examined, with 34 in the local controlled group and 13 in the uncontrolled group. RESULTS The median survival time (MST) of the local controlled and uncontrolled groups were 2.90 and 1.39 years (P = 0.028). Cox proportional hazard regression analysis showed that local control was an independent prognostic factor (P < 0.05). The patients who underwent primary lesion resection had significantly longer MST (2.90 vs. 1.39 years, P = 0.032) than those in the uncontrolled group. In rectal cancer patients, the patients who underwent irradiation to control the primary lesions had a significantly longer MST than the uncontrolled patient group (1.97 vs. 1.39 years, P = 0.019). CONCLUSIONS Local control of primary lesions may improve the prognosis in mCRC patients. In rectal cancer patients with metastasis, not only resection but also irradiation of the primary lesions may be a useful therapeutic strategy. J. Surg. Oncol. 2016;114:75-79. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Takahiro Takada
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Soichi Tsutsumi
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Ryo Takahashi
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Katsuya Ohsone
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Hironori Tatsuki
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Toshinaga Suto
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Toshihide Kato
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Takaaki Fujii
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Takehiko Yokobori
- Department of Molecular Pharmacology and Oncology, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Hiroyuki Kuwano
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan
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Guerrero YA, Bahmani B, Singh SP, Vullev VI, Kundra V, Anvari B. Virus-resembling nano-structures for near infrared fluorescence imaging of ovarian cancer HER2 receptors. NANOTECHNOLOGY 2015; 26:435102. [PMID: 26443474 DOI: 10.1088/0957-4484/26/43/435102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Ovarian cancer remains the dominant cause of death due to malignancies of the female reproductive system. The capability to identify and remove all tumors during intraoperative procedures may ultimately reduce cancer recurrence, and lead to increased patient survival. The objective of this study is to investigate the effectiveness of an optical nano-structured system for targeted near infrared (NIR) imaging of ovarian cancer cells that over-express the human epidermal growth factor receptor 2 (HER2), an important biomarker associated with ovarian cancer. The nano-structured system is comprised of genome-depleted plant-infecting brome mosaic virus doped with NIR chromophore, indocyanine green, and functionalized at the surface by covalent attachment of monoclonal antibodies against the HER2 receptor. We use absorption and fluorescence spectroscopy, and dynamic light scattering to characterize the physical properties of the constructs. Using fluorescence imaging and flow cytometry, we demonstrate the effectiveness of these nano-structures for targeted NIR imaging of HER2 receptors in vitro. These functionalized nano-materials may provide a platform for NIR imaging of ovarian cancer.
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Affiliation(s)
- Yadir A Guerrero
- Department of Bioengineering, University of California, Riverside, CA 92521, USA
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22
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Sasaki Y, Miwa K, Yamashita K, Sunakawa Y, Shimada K, Ishida H, Hasegawa K, Fujiwara K, Kodaira M, Fujiwara Y, Namiki M, Matsuda M, Takeuchi Y, Katsumata N. A phase I study of farletuzumab, a humanized anti-folate receptor α monoclonal antibody, in patients with solid tumors. Invest New Drugs 2014; 33:332-40. [PMID: 25380636 PMCID: PMC4387250 DOI: 10.1007/s10637-014-0180-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 10/17/2014] [Indexed: 12/13/2022]
Abstract
Farletuzumab is a humanized monoclonal antibody against folate receptor α (FRA). The purpose of the study is to assess safety and tolerability, the pharmacokinetic (PK) profile, and preliminary antitumor effect. Patients with ovarian cancer (OC) or FRA-expressing solid tumors who are resistant to standard treatments were eligible for the study. After single-dose administration for PK assessment, farletuzumab was administered by intravenous injection, repeating every week until disease progression. Dose-limiting toxicities (DLTs) were defined as grade 4 hematological and grade 3/4 nonhematological toxicities. Dose escalation was planned in 4 cohorts (50, 100, 200, and 400 mg/m2). Fourteen patients with OC and two patients with gastric cancer (GC) received farletuzumab infusion. Neither DLTs nor grade 3/4 toxicities were reported in all cohorts. Major adverse events, including grade 1/2 infusion related reaction (15 patients, 93.8 %), headache (seven patients, 43.8 %), and nausea and decreased appetite (five patients each, 31.3 %), were observed and medically managed. AUC and Cmax increased dose-dependently and linear PK profiles were observed. No tumor shrinkage was recorded, but long-term disease stabilization for 25 and 20 months was observed in one patient with clear cell OC (100 mg/m2) and one patient with GC (400 mg/m2), respectively. No cumulative toxicity occurred in any patient. Farletuzumab was well tolerated in Japanese patients with a similar PK profile as compared with the US population. Long-term disease stabilization was observed in a subpopulation of clear cell OC and GC; both of them were resistant and progressive after standard chemotherapies (ClinicalTrials.gov Identifier: NCT01049061).
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Affiliation(s)
- Yasutsuna Sasaki
- Department of Medical Oncology, Saitama International Medical Center-Comprehensive Cancer Center, Saitama Medical University, Saitama, Japan,
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Nasser S, von Heymann C, Feldheiser A, Schäfer-Graf U, Klempert I, Pöllinger A, Krackhardt F, Henrich W, Sehouli J, Pietzner K. A rare case of ovarian cancer in pregnancy complicated by pulmonary embolus and myocardial infarction: management dilemmas. J Surg Case Rep 2014; 2014:rju099. [PMID: 25312441 PMCID: PMC4194630 DOI: 10.1093/jscr/rju099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Malignant ovarian neoplasms diagnosed during pregnancy at advanced stages are very rare. The clinical course and prognosis of pregnant patients diagnosed with epithelial ovarian cancer is similar to that of non-pregnant patients. We describe our management of a woman diagnosed with FIGO IIIc ovarian cancer at Caesarean section. Immediately after surgery she suffered a pulmonary embolus and a myocardial infarction. She showed signs of a severe pulmonary hypertension (59 mmHg). Four weeks later the pulmonary hypertension was still moderate but, despite her critical status, she underwent primary debulking surgery (PDS). This was performed under extensive anaesthesiological monitoring. Through this rare case, we show that despite the complex initial status of a critically ill patient, PDS can still remain the mainstay of treatment in patients with advanced ovarian cancer as most patients are able to tolerate even extensive debulking surgery without the need for neoadjuvant chemotherapy.
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Affiliation(s)
- Sara Nasser
- Department of Gynaecological Oncology Charite Comprehensive Cancer Centre, Charite - Universitaetsmedizin Berlin, Berlin, Germany
| | - Christian von Heymann
- Department of Anaesthesiology and Intensive Care Medicine, Charite - Universitaetsmedizin Berlin, Berlin, Germany
| | - Aarne Feldheiser
- Department of Anaesthesiology and Intensive Care Medicine, Charite - Universitaetsmedizin Berlin, Berlin, Germany
| | - Ute Schäfer-Graf
- Department of Obstetrics, St. Joseph Hospital Berlin Tempelhof, Berlin 12101, Germany
| | - Iris Klempert
- Institute of Pathology, Charite - Universitaetsmedizin Berlin, Berlin, Germany
| | - Alexander Pöllinger
- Department of Radiology, Charite - Universitaetsmedizin Berlin, Berlin, Germany
| | - Florian Krackhardt
- Department of Cardiology, Charite - Universitaetsmedizin Berlin, Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics, Charite - Universitaetsmedizin Berlin, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynaecological Oncology Charite Comprehensive Cancer Centre, Charite - Universitaetsmedizin Berlin, Berlin, Germany
| | - Klaus Pietzner
- Department of Gynaecological Oncology Charite Comprehensive Cancer Centre, Charite - Universitaetsmedizin Berlin, Berlin, Germany
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Bahmani B, Guerrero Y, Bacon D, Kundra V, Vullev VI, Anvari B. Functionalized polymeric nanoparticles loaded with indocyanine green as theranostic materials for targeted molecular near infrared fluorescence imaging and photothermal destruction of ovarian cancer cells. Lasers Surg Med 2014; 46:582-92. [DOI: 10.1002/lsm.22269] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2014] [Indexed: 01/15/2023]
Affiliation(s)
- Baharak Bahmani
- Department of Bioengineering; University of California; Riverside California 92521
| | - Yadir Guerrero
- Department of Bioengineering; University of California; Riverside California 92521
| | - Danielle Bacon
- Department of Bioengineering; University of California; Riverside California 92521
| | - Vikas Kundra
- Department of Diagnostic Radiology; The University of Texas, MD Anderson Cancer Center; Houston Texas 77030
| | - Valentine I. Vullev
- Department of Bioengineering; University of California; Riverside California 92521
| | - Bahman Anvari
- Department of Bioengineering; University of California; Riverside California 92521
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Tian R, Li M, Wang J, Yu M, Kong X, Feng Y, Chen Z, Li Y, Huang W, Wu W, Hong Z. An intracellularly activatable, fluorogenic probe for cancer imaging. Org Biomol Chem 2014; 12:5365-74. [DOI: 10.1039/c4ob00297k] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A newly designed, dual-functional probe based on intracellular activation has been successfully developed for the detection of cancer cells.
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Affiliation(s)
- Ruisong Tian
- State Key Laboratory of Medicinal Chemical Biology
- College of Life Sciences
- Nankai University
- Tianjin 300071, P. R. China
- College of Material Science and Chemical Engineering
| | - Mingjie Li
- State Key Laboratory of Medicinal Chemical Biology
- College of Life Sciences
- Nankai University
- Tianjin 300071, P. R. China
| | - Jin Wang
- State Key Laboratory of Medicinal Chemical Biology
- College of Life Sciences
- Nankai University
- Tianjin 300071, P. R. China
| | - Min Yu
- State Key Laboratory of Medicinal Chemical Biology
- College of Life Sciences
- Nankai University
- Tianjin 300071, P. R. China
| | - Xiuqi Kong
- State Key Laboratory of Medicinal Chemical Biology
- College of Life Sciences
- Nankai University
- Tianjin 300071, P. R. China
| | - Yupeng Feng
- State Key Laboratory of Medicinal Chemical Biology
- College of Life Sciences
- Nankai University
- Tianjin 300071, P. R. China
| | - Zeming Chen
- State Key Laboratory of Medicinal Chemical Biology
- College of Life Sciences
- Nankai University
- Tianjin 300071, P. R. China
| | - Yuxi Li
- College of Material Science and Chemical Engineering
- Tianjin University of Science and Technology
- Tianjin 300457, P. R. China
| | | | - Wenjie Wu
- College of Material Science and Chemical Engineering
- Tianjin University of Science and Technology
- Tianjin 300457, P. R. China
| | - Zhangyong Hong
- State Key Laboratory of Medicinal Chemical Biology
- College of Life Sciences
- Nankai University
- Tianjin 300071, P. R. China
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26
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Michielsen K, Vergote I, Op de Beeck K, Amant F, Leunen K, Moerman P, Deroose C, Souverijns G, Dymarkowski S, De Keyzer F, Vandecaveye V. Whole-body MRI with diffusion-weighted sequence for staging of patients with suspected ovarian cancer: a clinical feasibility study in comparison to CT and FDG-PET/CT. Eur Radiol 2013; 24:889-901. [PMID: 24322510 DOI: 10.1007/s00330-013-3083-8] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 11/13/2013] [Accepted: 11/14/2013] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To evaluate whole-body MRI with diffusion-weighted sequence (WB-DWI/MRI) for staging and assessing operability compared with CT and FDG-PET/CT in patients with suspected ovarian cancer. METHODS Thirty-two patients underwent 3-T WB-DWI/MRI, (18) F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) and CT before diagnostic open laparoscopy (DOL). Imaging findings for tumour characterisation, peritoneal and retroperitoneal staging were correlated with histopathology after DOL and/or open surgery. For distant metastases, FDG-PET/CT or image-guided biopsies were the reference standards. For tumour characterisation and peritoneal staging, WB-DWI/MRI was compared with CT and FDG-PET/CT. Interobserver agreement for WB-DWI/MRI was determined. RESULTS WB-DWI/MRI showed 94 % accuracy for primary tumour characterisation compared with 88 % for CT and 94 % for FDG-PET/CT. WB-DWI/MRI showed higher accuracy of 91 % for peritoneal staging compared with CT (75 %) and FDG-PET/CT (71 %). WB-DWI/MRI and FDG-PET/CT showed higher accuracy of 87 % for detecting retroperitoneal lymphadenopathies compared with CT (71 %). WB-DWI/MRI showed excellent correlation with FDG-PET/CT (κ = 1.00) for detecting distant metastases compared with CT (κ = 0.34). Interobserver agreement was moderate to almost perfect (κ = 0.58-0.91). CONCLUSIONS WB-DWI/MRI shows high accuracy for characterising primary tumours, peritoneal and distant staging compared with CT and FDG-PET/CT and may be valuable for assessing operability in ovarian cancer patients. KEY POINTS • Whole-body MRI with diffusion weighting (WB-DWI/MRI) helps to assess the operability of suspected ovarian cancer. • Interobserver agreement is good for primary tumour characterisation, peritoneal and distant staging. • WB-DWI/MRI improves mesenteric/serosal metastatic spread assessment compared with CT and FDG-PET/CT. • Retroperitoneal/cervical-thoracic nodal staging using qualitative DWI criteria was reasonably accurate. • WB-DWI/MRI and FDG-PET/CT showed the highest diagnostic impact for detecting thoracic metastases.
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Affiliation(s)
- Katrijn Michielsen
- Department of Radiology, Medical Imaging Research Centre, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
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Laparoscopic diagnosis of adenocarcinoma of the appendix mimicking serous papillary adenocarcinoma of the peritoneum. Case Rep Obstet Gynecol 2013; 2013:248917. [PMID: 24383020 PMCID: PMC3872105 DOI: 10.1155/2013/248917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 11/11/2013] [Indexed: 11/23/2022] Open
Abstract
Primary carcinoma of the vermiform appendix is a rare disease with few clinical symptoms. Accordingly, preoperative diagnosis of appendiceal cancer is challenging because of the lack of specific symptoms. We herein report a case of appendicular adenocarcinoma found unexpectedly during laparoscopic surgery in a 69-year-old Japanese female patient diagnosed with serous papillary adenocarcinoma, in order to determine whether optimal cytoreduction could successfully be achieved at the time of primary surgery. We performed diagnostic laparoscopic surgery in order to make a correct diagnosis based on the histological tissue. The vermiform appendix was found to contain a tumor measuring 1.5 cm wide and 4.5 cm long. Laparoscopic appendectomy, partial omentectomy, and partial resection of the lesion in the peritoneum were performed. The histological diagnosis was mucinous adenocarcinoma of the vermiform appendix, and the stage was T4NxM1. The patient received adjuvant chemotherapy with mFOLFOX 6 (5FU, leucovorin, and oxaliplatin). She achieved stable disease and was alive with disease eleven months after surgery. We therefore recommend that gynecologists should not rule out the possibility of appendiceal cancer, even in cases with preoperative findings similar to those of serous papillary adenocarcinoma of the peritoneum with peritoneal disseminated tumors.
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Ahmed S, Leis A, Fields A, Chandra-Kanthan S, Haider K, Alvi R, Reeder B, Pahwa P. Survival impact of surgical resection of primary tumor in patients with stage IV colorectal cancer: results from a large population-based cohort study. Cancer 2013; 120:683-91. [PMID: 24222180 DOI: 10.1002/cncr.28464] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 10/01/2013] [Accepted: 10/04/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Currently, there is very low-quality evidence available regarding benefit of surgical resection of the primary tumor (SRPT), in patients with stage IV colorectal cancer (CRC). In the absence of randomization, the reported benefit may reflect selection of younger and healthier patients with good performance status. A large population-based cohort study was undertaken to determine the survival benefit of SRPT in advanced CRC by eliminating various biases reported in the literature. METHODS A retrospective cohort study involving patients with stage IV CRC, diagnosed between 1992 and 2005, in the province of Saskatchewan, Canada. Survival was estimated by using the Kaplan-Meier method. Survival distribution was compared by log-rank test. Cox proportional multivariate regression analysis was performed to determine survival benefit of SRPT by controlling other prognostic variables. RESULTS A total of 1378 eligible patients were identified. Their median age was 70 years (range, 22-98 years) and male:female ratio was 1.3:1; 944 (68.5%) of them underwent SRPT. Among 1378 patients, 42.3% received chemotherapy and 19.1% received second-generation therapy. Patients who underwent SRPT and received chemotherapy had median overall survival of 18.3 months (95% confidence interval [CI] = 16.6-20 months) compared with 8.4 months (95% CI = 7.1-9.7 months) if they were treated with chemotherapy alone (P < .0001). Cox proportional analysis revealed that use of chemotherapy (hazard ratio [HR] = 0.47, 95% CI = 0.41-0.54), SRPT (HR = 0.49, 95% CI = 0.41-0.58), second-line chemotherapy (HR = 0.47, 95% CI = 0.45-0.64), and metastasectomy (HR = 0.54, 95% CI = 0.45-0.64) were correlated with superior survival. CONCLUSIONS SRPT improves survival in patients with stage IV CRC, independent of other prognostic variables including age, performance status, comorbid illness and chemotherapy.
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Affiliation(s)
- Shahid Ahmed
- Saskatchewan Cancer Agency, Regina, Canada; Department of Oncology, University of Saskatchewan, Saskatoon, Canada; Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
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Tangjitgamol S, Hanprasertpong J, Cubelli M, Zamagni C. Neoadjuvant chemotherapy and cytoreductive surgery in epithelial ovarian cancer. World J Obstet Gynecol 2013; 2:153-166. [DOI: 10.5317/wjog.v2.i4.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 02/06/2013] [Indexed: 02/05/2023] Open
Abstract
Ovarian cancer is one of the leading causes of death among gynecological cancers. This is because the majority of patients present with advanced stage disease. Primary debulking surgery (PDS) followed by adjuvant chemotherapy is still a mainstay of treatment. An optimal surgery, which is currently defined by leaving no gross residual tumor, is the goal of PDS. The extent of disease as well as the operative setting, including the surgeon’s skill, influences the likelihood of successful debulking. With extensive disease and a poor chance of optimal surgery or high morbidity anticipated, neoadjuvant chemotherapy (NACT) prior to primary surgery is an option. Secondary surgery after induction chemotherapy is termed interval debulking surgery (IDS). Delayed PDS or IDS is offered to patients who show some clinical response and are without progressive disease. NACT or IDS has become more established in clinical practice and there are numerous publications regarding its advantages and disadvantages. However, data on survival are limited and inconsistent. Only one large randomized trial could demonstrate that NACT was not inferior to PDS while the few randomized trials on IDS had inconsistent results. Without a definite benefit of NACT prior to surgery over PDS, one must carefully weigh the chances of safe and successful PDS against the morbidity and risks of suboptimal surgery. Appropriate selection of a patient to undergo PDS followed by chemotherapy or, preferably, to have NACT prior to surgery is very important. Some clinical characteristics from physical examination, serum tumor markers and/or findings from imaging studies may be predictive of resectability. However, no specific features have been consistently identified in the literature. This article will address the clinical data on prediction of surgical outcomes, the role of NACT, and the role of IDS.
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Oge T, Yalcin OT, Ozalp SS, Kebapci M, Aydin Y, Telli E. Sonographically guided core biopsy: a minimally invasive procedure for managing adnexal masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:2023-2027. [PMID: 24154907 DOI: 10.7863/ultra.32.11.2023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES We hypothesized that sonographically guided core biopsy is an effective method for the differential diagnosis of adnexal masses and evaluated patients who underwent core biopsies in our gynecologic oncology department. METHODS We reviewed the medical records of 55 patients who underwent sonographically guided core biopsies in our gynecologic oncology department between 2010 and 2013. Patients with suspected ovarian malignancies who were unsuitable for optimal debulking surgery and patients at risk for higher morbidity and mortality because of a poor performance status, suspected nongynecologic tumors, and peritoneal tuberculosis were indicated for sonographically guided biopsy. RESULTS The indications for sonographically guided core biopsy were candidacy for suboptimal cytoreduction (n = 32 [58.2%]), a poor performance status (n = 11 [20.0%]), and suspected nongynecologic tumors (n = 12 [21.8%]). Histopathologic evaluations revealed primary ovarian tumors in 36 patients (65.5%). Tuberculosis was found to be the second most common disease (n = 8 [14.5%]) among the patients who underwent core biopsies. In 2 patients (3.6%), histologic examination revealed metastatic colorectal cancer. CONCLUSIONS Sonographically guided core biopsy may be preferred as a minimally invasive procedure for managing adnexal masses, particularly in patients with advanced ovarian cancer and high comorbidities who might benefit from neoadjuvant chemotherapy and in cases of suspected nongynecologic tumors, including pelvic tuberculosis.
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Affiliation(s)
- Tufan Oge
- Department of Obstetrics and Gynecology, Eskisehir Osmangazi University School of Medicine, 26100 Eskisehir, Turkey.
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Abstract
Ovarian cancer (OC) is a disease of elderly women. The disease spreads insidiously and presents at an advanced stage at initial diagnosis for most patients. Several groups reported at least a two-fold increased risk of death in women older than 65. Various theories have been proposed to explain this survival disparity in older women, including: (1) more aggressive cancer with advanced age, (2) inherent resistance to chemotherapy, (3) individual patient factors such as multiple concurrent medical problems, and (4) physician and health-care biases toward the elderly that lead to inadequate surgery, less than optimal chemotherapy, and poor enrollment in clinical trials. As a result of this high clinical variability, oncologists need to be more familiar with the comprehensive geriatric assessment to better identify vulnerable patients at higher risk of complications. Several geriatric tools are available to assess the physiologic and functional capacities of older patients and to better individualize treatment. This paper gives an overview of the management of elderly patients with OC, in particular the integration of chemotherapy, surgery, and geriatric assessment to improve treatment tolerance and survival outcomes.
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Affiliation(s)
- G Freyer
- From the Lyon 1 University and Department of Medical Oncology, Lyon Sud Hospital, Lyon, France; Memorial Sloan-Kettering Cancer Center, New York, NY; Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK
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Optimal Debulking Targets in Women With Advanced Stage Ovarian Cancer: A Retrospective Study of Immediate Versus Interval Debulking Surgery. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2012; 34:558-566. [DOI: 10.1016/s1701-2163(16)35272-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Deloia JA, Bhagwat NR, Darcy KM, Strange M, Tian C, Nuttall K, Krivak TC, Niedernhofer LJ. Comparison of ERCC1/XPF genetic variation, mRNA and protein levels in women with advanced stage ovarian cancer treated with intraperitoneal platinum. Gynecol Oncol 2012; 126:448-54. [PMID: 22609620 DOI: 10.1016/j.ygyno.2012.05.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 05/08/2012] [Accepted: 05/09/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Approximately 20% of patients receiving platinum-based chemotherapy for epithelial ovarian cancer (EOC) are refractory or develop early recurrence. Identifying these patients early could reduce treatment-associated morbidity and allow quicker transfer to more effective therapies. Much attention has focused on ERCC1 as a potential predictor of response to therapy because of its essential role in the repair of platinum-induced DNA damage. The purpose of this study was to accurately measure protein levels of ERCC1 and its essential binding partner XPF from patients with EOC treated with platinum-based therapy and determine if protein levels correlate with mRNA levels, patient genotypes or clinical outcomes. METHODS ERCC1 and XPF mRNA and protein levels were measured in frozen EOC specimens from 41 patients receiving intraperitoneal platinum-based chemotherapy using reverse transcription polymerase chain reaction and western blots. Genotypes of common nucleotide polymorphisms were also analyzed. Patient outcomes included progression free (PFS) and overall survival (OS). RESULTS Expression of ERCC1 and XPF were tightly correlated with one another at both the mRNA and protein level. However, the mRNA and protein levels of ERCC1 were not positively correlated. Likewise, none of the SNPs analyzed correlated with ERCC1 or XPF protein levels. There was an inverse correlation between mRNA levels and patient outcomes. CONCLUSION Neither genotype nor mRNA levels are predictive of protein expression. Despite this, low ERCC1 mRNA significantly correlated with improved PFS and OS.
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Affiliation(s)
- Julie A Deloia
- School of Public Health and Health Services, The George Washington University, NW, Washington, DC 20037, USA
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Vergote I, Amant F, Kristensen G, Ehlen T, Reed NS, Casado A. Primary surgery or neoadjuvant chemotherapy followed by interval debulking surgery in advanced ovarian cancer. Eur J Cancer 2011; 47 Suppl 3:S88-92. [PMID: 21944035 DOI: 10.1016/s0959-8049(11)70152-6] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Advanced ovarian cancer has a poor prognosis. De-bulking surgery and platinum-based chemotherapy are the cornerstones of the treatment. Primary debulking surgery has been the standard of care in advanced ovarian cancer. Recently a new strategy with neoadjuvant chemotherapy followed by interval debulking surgery has been developed. In a recently published randomised trial of the EORTC-NCIC (European Organisation for Research and Treatment of Cancer - National Cancer Institute Canada) in patients with extensive stage IIIc and IV ovarian cancer it was shown that the survival was similar for patients randomised to neoadjuvant chemotherapy followed by interval debulking compared to primary debulking surgery, followed by chemotherapy. The post-operative complications and mortality rates were lower after interval debulking than after primary debulking surgery. The most important independent prognostic factor for overall survival was no residual tumour after primary or interval debulking surgery. In some patients obtaining the goal of no residual tumour at interval debulking is difficult due to chemotherapy-induced fibrosis. On the other hand the patients randomised had very extensive stage IIIc and IV disease and in patients with metastases smaller than 5 cm the survival tended to be better after primary debulking surgery. Hence, selection of the correct patients with stage IIIc or IV ovarian cancer for primary debulking or neoadjuvant chemotherapy followed by interval debulking surgery is important. Besides imaging with CT, diffusion MRI and/or PET-CT, also laparoscopy can play an important role in the selection of patients. It should be emphasised that the group of patients included in this study had extensive stage IIIc or IV disease. Surgical skills, especially in the upper abdomen, remain pivotal in the treatment of advanced ovarian cancer. However, very aggressive surgery should be tailored according to the general condition and extent of the disease of the patients. Otherwise, this type of aggressive surgery will result in unnecessary postoperative morbidity and mortality without improving survival. Hence, neoadjuvant chemotherapy should not be an easy way out, but is in some patients with stage IIIc or IV ovarian cancer a better alternative treatment option than primary debulking. According to the current treatment algorithm at the University Hospitals Leuven about 50% of the patients with stage IIIc or IV ovarian cancer are selected for neoadjuvant chemotherapy.
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van Dam GM, Themelis G, Crane LMA, Harlaar NJ, Pleijhuis RG, Kelder W, Sarantopoulos A, de Jong JS, Arts HJG, van der Zee AGJ, Bart J, Low PS, Ntziachristos V. Intraoperative tumor-specific fluorescence imaging in ovarian cancer by folate receptor-α targeting: first in-human results. Nat Med 2011; 17:1315-9. [PMID: 21926976 DOI: 10.1038/nm.2472] [Citation(s) in RCA: 1131] [Impact Index Per Article: 87.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 03/11/2011] [Indexed: 01/03/2023]
Abstract
The prognosis in advanced-stage ovarian cancer remains poor. Tumor-specific intraoperative fluorescence imaging may improve staging and debulking efforts in cytoreductive surgery and thereby improve prognosis. The overexpression of folate receptor-α (FR-α) in 90-95% of epithelial ovarian cancers prompted the investigation of intraoperative tumor-specific fluorescence imaging in ovarian cancer surgery using an FR-α-targeted fluorescent agent. In patients with ovarian cancer, intraoperative tumor-specific fluorescence imaging with an FR-α-targeted fluorescent agent showcased the potential applications in patients with ovarian cancer for improved intraoperative staging and more radical cytoreductive surgery.
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Affiliation(s)
- Gooitzen M van Dam
- Department of Surgery, Division of Surgical Oncology, BioOptical Imaging Center, University of Groningen, Groningen, The Netherlands.
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Crane LMA, van Oosten M, Pleijhuis RG, Motekallemi A, Dowdy SC, Cliby WA, van der Zee AGJ, van Dam GM. Intraoperative imaging in ovarian cancer: fact or fiction? Mol Imaging 2011; 10:248-57. [PMID: 21521557 PMCID: PMC3763956 DOI: 10.2310/7290.2011.00004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 10/09/2010] [Indexed: 02/06/2023] Open
Abstract
Tumor-targeted fluorescence imaging for cancer diagnosis and treatment is an evolving field of research that is on the verge of clinical implementation. As each tumor has its unique biologic profile, selection of the most promising targets is essential. In this review, we focus on target finding in ovarian cancer, a disease in which fluorescence imaging may be of value in both adequate staging and in improving cytoreductive efforts, and as such may have a beneficial effect on prognosis. Thus far, tumor-targeted imaging for ovarian cancer has been applied only in animal models. For clinical implementation, the five most prominent targets were identified: folate receptor α, vascular endothelial growth factor, epidermal growth factor receptor, chemokine receptor 4, and matrix metalloproteinase. These targets were selected based on expression rates in ovarian cancer, availability of an antibody or substrate aimed at the target approved by the Food and Drug Administration, and the likelihood of translation to human use. The purpose of this review is to present requirements for intraoperative imaging and to discuss possible tumor-specific targets for ovarian cancer, prioritizing for targets with substrates ready for introduction into the clinic.
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Affiliation(s)
- Lucia M A Crane
- Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Trimble EL, Birrer MJ, Hoskins WJ, Marth C, Petryshyn R, Quinn M, Thomas GM, Kitchener HC, Aghajanian C, Alberts DS, Armstrong D, Brown J, Coleman RL, Colombo N, Eisenhauer E, Friedlander M, Fujiwara K, Hunsberger S, Kaye S, Ledermann JA, Lee S, Look K, Mannel R, McNeish IA, Minasian L, Oza A, Paul J, Poveda A, Pujade-Lauraine E, Schoenfeldt M, Swart AM, von Gruenigen V, Wenzel L. Current academic clinical trials in ovarian cancer: Gynecologic Cancer Intergroup and US National Cancer Institute Clinical Trials Planning Meeting, May 2009. Int J Gynecol Cancer 2011; 20:1290-8. [PMID: 21151709 DOI: 10.1111/igc.0b013e3181ee1c01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To review the current status of large phase academic clinical trials for women with ovarian cancer, address cross-cutting issues, and identify promising areas for future collaboration. METHODS In May 2009, the Gynecologic Cancer Intergroup, which represents 19 Cooperative Groups conducting trials for women with gynecologic cancer, and the US National Cancer Institute convened a Clinical Trials Planning Meeting. RESULTS The topics covered included the impact of new developments in cancer biology upon molecular targets and novel agents, pharmacogenomics, advances in imaging, the potential benefit of diet and exercise to reduce the risk of recurrence, academic partnership with industry, statistical considerations for phases 2 and 3 trials, trial end points, and symptom benefit and health-related quality-of-life issues. The clinical trials discussed spanned the spectrum of ovarian cancer from initial diagnosis, staging, and cytoreductive surgery to consolidation chemotherapy, and treatment of recurrent disease. CONCLUSIONS Ongoing and effective collaboration with industry, government, and patients aims to ensure that the most important scientific questions can be answered rapidly. We encourage women with ovarian cancer and their oncologists to consider participation in the academic clinical trials conducted by the member groups of the Gynecologic Cancer Intergroup.
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Affiliation(s)
- Edward L Trimble
- National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-7436, USA.
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Napoletano C, Bellati F, Landi R, Pauselli S, Marchetti C, Visconti V, Sale P, Liberati M, Rughetti A, Frati L, Panici PB, Nuti M. Ovarian cancer cytoreduction induces changes in T cell population subsets reducing immunosuppression. J Cell Mol Med 2011; 14:2748-59. [PMID: 19780872 PMCID: PMC3822725 DOI: 10.1111/j.1582-4934.2009.00911.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Surgery is the primary therapeutic strategy for most solid tumours; however, modern oncology has established that neoplasms are frequently systemic diseases. Being however a local treatment, the mechanisms through which surgery plays its systemic role remain unknown. We have investigated the influence of cytoreduction on the immune system of primary and recurrent ovarian cancer. All ovarian cancer patients show an increase in CD4+CD25+FOXP3+ circulating cells (CD4 Treg). CD4/CD8 ratio is increased in primary tumours, but not in recurrent neoplasms. Primary cytoreduction is able to increase circulating CD4 and CD8 effector cells and decrease CD4 naïve T cells. CD4+ Treg cells rapidly decreased after primary tumour debulking, while CD8+CD25+FOXP3+ (CD8 Treg) cells are not detectable in peripheral blood. Similar results on CD4 Treg were observed with chemical debulking in women subjected to neoadjuvant chemotherapy. CD4 and CD8 Treg cells are both present in neoplastic tissue. Interleukin (IL)-10 serum levels decrease after surgery, while no changes are observed in transforming growth factor-β1 and IL-6 levels. Surgically induced reduction of the immunosuppressive environment results in an increased capacity of CD8+ T cells to respond to the recall antigens. None of these changes was observed in patients previously subjected to chemotherapy or affected by recurrent disease. In conclusion, we demonstrate in ovarian cancer that primary debulking is associated with a reduction of circulating Treg and an increase in CD8 T-cell function. Debulking plays a beneficial systemic effect by reverting immunosuppression and restoring immunological fitness.
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Affiliation(s)
- Chiara Napoletano
- Department of Experimental Medicine, 'Sapienza' University of Rome, Italy
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Lestrade L. Cancer épithélial évolué de l’ovaire de la patiente âgée: quel état des lieux suite à la Conférence internationale de Vancouver? ONCOLOGIE 2011. [DOI: 10.1007/s10269-011-1988-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Comparison of diaphragmatic surgery at primary or interval debulking in advanced ovarian carcinoma: An analysis of 163 patients. Eur J Cancer 2011; 47:191-8. [DOI: 10.1016/j.ejca.2010.08.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 08/16/2010] [Accepted: 08/24/2010] [Indexed: 11/24/2022]
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Zikan M, Fischerova D, Pinkavova I, Dundr P, Cibula D. Ultrasound-guided tru-cut biopsy of abdominal and pelvic tumors in gynecology. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:767-772. [PMID: 20737454 DOI: 10.1002/uog.8803] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To analyze the safety, adequacy and accuracy of tru-cut biopsy and to evaluate factors potentially affecting adequacy. METHODS We analyzed retrospectively a group of patients who had undergone tru-cut biopsy for either primary suboptimally operable tumors, recurrence or suspected non-genital or secondary tumor. Tru-cut biopsy was performed either transvaginally or transabdominally, using an automatic biopsy gun with disposable needle and needle guide attached to the probe. The adequacy, i.e. obtaining a sample sufficient for identification of the origin of the tumor and performance of immunohistochemistry; accuracy, i.e. agreement between biopsy and final postoperative histology; and safety, as determined by complication rate, were assessed. Variables potentially influencing adequacy were analyzed using the orthogonal projections to latent structure method. RESULTS A total of 195 biopsies were performed on 190 patients. An adequate sample was obtained in 178 (91.3%) biopsies. The final histology was not in agreement with the result from tru-cut biopsy in two out of 118 patients who underwent subsequent surgery (accuracy 98.3%). There were complications in two cases out of the 195 biopsies performed (1.0%). Ascites, elevated CA 125, primary suboptimal operable tumor, serous epithelial ovarian cancer histology, carcinomatosis and vaginal approach were significant positive predictors for the achievement of an adequate sample, while recurrence as an indication, non-serous and non-ovarian histotypes and transabdominal approach were negative predictors. CONCLUSION Ultrasound-guided tru-cut biopsy is an efficient, minimally invasive, accurate and safe diagnostic method in the management of advanced, recurrent or atypical abdominal and pelvic tumors of probable non-genital origin, where unnecessary laparotomy or laparoscopy can be avoided. The adequacy of tru-cut biopsy is mainly influenced by indication group, histology, site of biopsy and approach. Our analysis can help in counseling the patient before the procedure and helps to explain the possible causes of failure of the procedure.
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Affiliation(s)
- M Zikan
- Oncogynecologic Center, Department of Obstetrics and Gynecology and, First Medical Faculty and General Teaching Hospital, Charles University, Prague, Czech Republic.
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Tsolakidis D, Amant F, Van Gorp T, Leunen K, Neven P, Vergote I. The role of diaphragmatic surgery during interval debulking after neoadjuvant chemotherapy: an analysis of 74 patients with advanced epithelial ovarian cancer. Int J Gynecol Cancer 2010; 20:542-51. [PMID: 20686373 DOI: 10.1111/igc.0b013e3181d4de23] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The purpose of this retrospective study was to evaluate diaphragmatic surgery in achieving optimal cytoreductive results and its associated complications during interval debulking surgery in patients with advanced ovarian cancer. METHODS After retrospective review of medical records, diaphragmatic surgery was performed in 74 of 128 consecutive patients with advanced epithelial ovarian cancer who underwent interval debulking, between September 1993 and December 2007. Four different approaches were performed: coagulation (group 1), stripping (group 2), combination of stripping with coagulation (group 3), and diaphragm full-thickness resection including muscle with pleura (group 4). Cytoreductive outcome, morbidity, overall survival, and disease-free survival were analyzed. RESULTS Two patients (2.7%) had International Federation of Gynecology and Obstetrics stage IIIB disease; 46 (62.16%), stage IIIC; and 26 (35.13%), stage IV. After 3 to 4 cycles of neoadjuvant platinum-based chemotherapy, the diaphragmatic disease was coagulated in 43 patients (58.10%) and was only stripped in 10 (13.51%); in 19 patients (25.67%), a combination of these techniques was applied; and in 2 (2.70%), the disease was resected, with the adjacent infiltrated part of the diaphragmatic muscle and the pleura above it. Debulking to no residual was achieved in 95%, 100%, 100%, and 50% for groups 1, 2, 3, and 4, respectively. The median disease-free survival was 15, 14, and 14 months, and the median overall survival was 34, 30, and 51 months for groups 1, 2, and 3, respectively, and were not reached for group 4. Minor and major complications were comparable among the groups. Pleural effusions were the most frequent associated complication, and chest tube placement (1.3%) or thoracocentesis (4%) were necessary for the relief of respiratory distress. The perioperative mortality rate was 0%. CONCLUSIONS Diaphragmatic surgery during interval debulking enhances optimal cytoreduction rates and improves survival with acceptable and manageable morbidity. In patients with thick (>4 mm) or large (>1 cm) lesions, stripping the diaphragm or full-thickness resection of the diaphragmatic muscle is preferred.
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Affiliation(s)
- Dimitris Tsolakidis
- Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
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Nezhat FR, DeNoble SM, Liu CS, Cho JE, Brown DN, Chuang L, Gretz H, Saharia P. The safety and efficacy of laparoscopic surgical staging and debulking of apparent advanced stage ovarian, fallopian tube, and primary peritoneal cancers. JSLS 2010; 14:155-68. [PMID: 20932362 PMCID: PMC3043561 DOI: 10.4293/108680810x12785289143990] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To describe our experience with laparoscopic primary or interval tumor debulking in patients with presumed advanced ovarian, fallopian tube, or peritoneal cancers. METHODS This is a retrospective analysis of a prospective case series. Women with presumed advanced (FIGO stage IIC or greater) ovarian, fallopian tube, or primary peritoneal cancers deemed appropriate candidates for laparoscopic debulking by the primary surgeon(s) were recruited. RESULTS The study comprised 32 patients who underwent laparoscopic evaluation. Seventeen underwent total laparoscopic primary or interval cytoreduction, with 88.2% optimal cytoreduction. Eleven underwent diagnostic laparoscopy and conversion to laparotomy for cytoreduction, with 72.7% optimal cytoreduction. Four patients had biopsies, limited cytoreduction, or both. In the laparoscopy group, 9 patients have no evidence of disease (NED), 6 are alive with disease (AWD), and 2 have died of disease (DOD), with mean follow-up time of 19.7 months. In the laparotomy group, 3 patients are NED, 5 are AWD, and 3 are DOD, with mean follow-up of 25.8 months. Estimated blood loss and length of hospital stay were less for the laparoscopy group (P=0.008 and P=0.03), while operating time and complication rates were not different. Median time to recurrence was 31.7 months for the laparoscopy group and 21.5 months for the laparotomy group (P=0.3). CONCLUSIONS Laparoscopy can be used for diagnosis, triage, and debulking of patients with advanced ovarian, fallopian tube, or primary peritoneal cancer and is technically feasible in a well-selected population.
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Affiliation(s)
- Farr R Nezhat
- Division of Gynecologic Oncology and Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Columbia University Department of Obstetrics and Gynecology, St. Luke's-Roosevelt Medical Center, New York, New York 10019, USA.
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Thigpen JT, Alberts D, Birrer M, Copeland L, Coleman RL, Markman M, Bast RC, Eisenhauer EL, Fleming G, Fracasso PM, Gershenson DM, Herzog T, Monk BJ, Ozols RF, Rustin G, Brady MF, Shrader M, Ranganathan A. Current Challenges and Future Directions in the Management of Ovarian Cancer: Proceedings of the First Global Workshop on Ovarian Cancer. ACTA ACUST UNITED AC 2010. [DOI: 10.3816/coc.2010.n.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Vergote I, Tropé CG, Amant F, Kristensen GB, Ehlen T, Johnson N, Verheijen RHM, van der Burg MEL, Lacave AJ, Panici PB, Kenter GG, Casado A, Mendiola C, Coens C, Verleye L, Stuart GCE, Pecorelli S, Reed NS. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med 2010; 363:943-53. [PMID: 20818904 DOI: 10.1056/nejmoa0908806] [Citation(s) in RCA: 1657] [Impact Index Per Article: 118.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Primary debulking surgery before initiation of chemotherapy has been the standard of care for patients with advanced ovarian cancer. METHODS We randomly assigned patients with stage IIIC or IV epithelial ovarian carcinoma, fallopian-tube carcinoma, or primary peritoneal carcinoma to primary debulking surgery followed by platinum-based chemotherapy or to neoadjuvant platinum-based chemotherapy followed by debulking surgery (so-called interval debulking surgery). RESULTS Of the 670 patients randomly assigned to a study treatment, 632 (94.3%) were eligible and started the treatment. The majority of these patients had extensive stage IIIC or IV disease at primary debulking surgery (metastatic lesions that were larger than 5 cm in diameter in 74.5% of patients and larger than 10 cm in 61.6%). The largest residual tumor was 1 cm or less in diameter in 41.6% of patients after primary debulking and in 80.6% of patients after interval debulking. Postoperative rates of adverse effects and mortality tended to be higher after primary debulking than after interval debulking. The hazard ratio for death (intention-to-treat analysis) in the group assigned to neoadjuvant chemotherapy followed by interval debulking, as compared with the group assigned to primary debulking surgery followed by chemotherapy, was 0.98 (90% confidence interval [CI], 0.84 to 1.13; P=0.01 for noninferiority), and the hazard ratio for progressive disease was 1.01 (90% CI, 0.89 to 1.15). Complete resection of all macroscopic disease (at primary or interval surgery) was the strongest independent variable in predicting overall survival. CONCLUSIONS Neoadjuvant chemotherapy followed by interval debulking surgery was not inferior to primary debulking surgery followed by chemotherapy as a treatment option for patients with bulky stage IIIC or IV ovarian carcinoma in this study. Complete resection of all macroscopic disease, whether performed as primary treatment or after neoadjuvant chemotherapy, remains the objective whenever cytoreductive surgery is performed. (Funded by the National Cancer Institute; ClinicalTrials.gov number, NCT00003636.)
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Affiliation(s)
- Ignace Vergote
- University Hospitals, K.U. Leuven Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Herestraat 49, B-3000 Leuven, Belgium.
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Guarneri V, Piacentini F, Barbieri E, Conte PF. Achievements and unmet needs in the management of advanced ovarian cancer. Gynecol Oncol 2010; 117:152-8. [DOI: 10.1016/j.ygyno.2009.11.033] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 10/20/2009] [Accepted: 11/19/2009] [Indexed: 10/20/2022]
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Weinberg LE, Rodriguez G, Hurteau JA. The role of neoadjuvant chemotherapy in treating advanced epithelial ovarian cancer. J Surg Oncol 2010; 101:334-43. [PMID: 20187069 DOI: 10.1002/jso.21482] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The current management of advanced ovarian cancer consists of aggressive primary cytoreductive surgery (PCS) followed by combination platinum based chemotherapy. Recent studies have suggested that platinum-based chemotherapy may be of benefit in patients with advanced ovarian cancer prior to cytoreductive surgery (neoadjuvant chemotherapy, NACT). The concept of NACT has not been completely validated in the treatment of ovarian cancer. This review will discuss the role of NACT in patients with advanced epithelial ovarian cancer.
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Affiliation(s)
- Lori E Weinberg
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Kumpulainen S, Sankila R, Leminen A, Kuoppala T, Komulainen M, Puistola U, Hurme S, Hiekkanen H, Mäkinen J, Grénman S. The effect of hospital operative volume, residual tumor and first-line chemotherapy on survival of ovarian cancer — A prospective nation-wide study in Finland. Gynecol Oncol 2009; 115:199-203. [DOI: 10.1016/j.ygyno.2009.07.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 07/08/2009] [Accepted: 07/09/2009] [Indexed: 11/26/2022]
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50
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Risum S, Høgdall E, Engelholm SA, Fung E, Lomas L, Yip C, Petri AL, Nedergaard L, Lundvall L, Høgdall C. A Proteomics Panel for Predicting Optimal Primary Cytoreduction in Stage III/IV Ovarian Cancer. Int J Gynecol Cancer 2009; 19:1535-8. [DOI: 10.1111/igc.0b013e3181a840f5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The objective of this prospective study was to evaluate CA-125 and a 7-marker panel as predictors of incomplete primary cytoreduction in patients with stage III/IV ovarian cancer (OC). From September 2004 to January 2008, serum from 201 patients referred to surgery for a pelvic tumor was analyzed for CA-125. In addition, serum was analyzed for 7 biomarkers using surface-enhanced laser desorption/ionization time-of-flight mass spectrometry. These biomarkers were combined into a single-valued ovarian-cancer-risk index (OvaRI). CA-125 and OvaRI were evaluated as predictors of cytoreduction in 75 stage III/IV patients using receiver operating characteristic curves.Complete primary cytoreduction (no macroscopic residual disease) was achieved in 31% (23/75) of the patients. The area under the receiver operating characteristic curve was 0.66 for CA-125 and 0.75 for OvaRI.The sensitivity and specificity of CA-125 for predicting incomplete cytoreduction were 71% (37/52) and 57% (13/23), respectively (P = 0.04). The sensitivity and specificity of OvaRI for predicting incomplete cytoreduction were 73% (38/52) and 70% (16/23), respectively (P = 0.001). In conclusion, CA-125 and an index of 7 biomarkers were found to be predictors of cytoreduction. However, future studies of biomarkers are anticipated to promote early diagnosis and provide prognostic information to guide treatment of OC patients. In addition, new biomarkers might also play a role in predicting outcome from primary surgery in OC patients.
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