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Adolph L, Mann A, Liu XQ, Roberts L, Robinson C, Popowich S, Dean E, Kean S, Fischer G, Altman AD. Follow-up of women with cervical adenocarcinoma in situ treated by conization: A single centre clinical experience. Gynecol Oncol 2024; 187:74-79. [PMID: 38733955 DOI: 10.1016/j.ygyno.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/25/2024] [Accepted: 05/05/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE Hysterectomy has been the historical gold standard final step in the treatment algorithm of adenocarcinoma in situ (AIS) recommended by most North American colposcopy guidelines. AIS disproportionately affects young childbearing age women, therefore a fertility sparing treatment option is desirable. Our study examines the impact of conservative treatment of AIS with conization followed by serial surveillance. METHODS A retrospective chart review was completed of patients treated for AIS from 2006 to 2020. Charts were identified by pathologic diagnosis of AIS on cervical and uterine specimens. Charts were excluded if AIS was not treated with conization, if AIS was not confirmed on initial conization specimen, or if invasive disease was found at initial conization. RESULTS 121 patient charts were analyzed. Median age of patients at first conization and hysterectomy was 34.8 and 40.9, respectively. First conization was by Cold Knife Cone in 58% of patients, and by Loop Electrosurgical Excisional Procedure in 42% of patients. Median follow-up period in our study was 609 days. 5% of patients had recurrence, with only one patient who recurred as cancer. One case of recurrence had a positive initial conization margin. Median time to recurrence was 700 days. 47% of patients underwent eventual hysterectomy. Residual AIS was found in 23% of hysterectomy specimens. Adenocarcinoma was diagnosed on hysterectomy specimen in four patients. CONCLUSION Our study demonstrates the oncologic safety of treating AIS with conization and serial surveillance. Routine hysterectomy completed as a part of the AIS treatment algorithm, as in current clinical guidelines, is unnecessary.
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Affiliation(s)
- L Adolph
- Department of Obstetrics, Gynecology and Reproductive Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - A Mann
- Department of Obstetrics, Gynecology and Reproductive Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - X Q Liu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - L Roberts
- Department of Obstetrics, Gynecology and Reproductive Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - C Robinson
- Department of Obstetrics, Gynecology and Reproductive Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - S Popowich
- Department of Obstetrics, Gynecology and Reproductive Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - E Dean
- Department of Obstetrics, Gynecology and Reproductive Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - S Kean
- Department of Obstetrics, Gynecology and Reproductive Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - G Fischer
- Department of Pathology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - A D Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; CancerCare Manitoba, Winnipeg, Manitoba, Canada
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Casalino S, Bruce S, Serfas K, Altman AD, Kean S, Lambert P, McManus KJ, Hartley JN, Nachtigal MW. Exploring the role of a multidisciplinary hereditary gynecologic oncology clinic in epithelial ovarian cancer risk-reducing surgical decision-making practices: A mixed-methods study. J Genet Couns 2023; 32:728-743. [PMID: 36808790 DOI: 10.1002/jgc4.1684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/01/2022] [Accepted: 01/16/2023] [Indexed: 02/22/2023]
Abstract
Individuals that have gynecologic reproductive organs with pathogenic variants in BRCA1 or BRCA2 ("BRCA-positive") have an increased risk of developing high-grade serous ovarian cancer (HGSOC). The majority of HGSOC develops in the fallopian tubes and later spreads to the ovaries and peritoneal cavity. Therefore, risk-reducing salpingo-oophorectomy (RRSO) is recommended for those who are BRCA-positive to preventatively remove their ovaries and fallopian tubes. The Hereditary Gynecology Clinic (HGC) is a provincial program in Winnipeg, Canada, that specifically targets care to the unique needs of such individuals through an interdisciplinary team of gynecological oncologists, menopause specialists, and registered nurses. A mixed-methods study design was used to explore the decision-making processes of these BRCA-positive individuals who have been recommended (or who completed) RRSO and experiences with healthcare providers at the HGC influenced this decision. Individuals who are BRCA-positive without a previous diagnosis of HGSOC and who had previously received genetic counselling were recruited from the HGC and the provincial cancer genetics program (Shared Health Program of Genetics & Metabolism). Forty-three people completed a survey and 15 participated in an in-depth interview about their experiences and decisions surrounding RRSO. Surveys were analyzed to compare scores on validated scales related to decision-making and cancer-related worry. Qualitative interviews were transcribed, coded, and analyzed using interpretive description. Participants described the complex decisions faced by those who are BRCA-positive, which are intertwined with life experiences and circumstances including age, marital status, and family disease history. Participants interpreted their HGSOC risk through a personalized "lens" of contextual factors that impacted perceptions about the practical and emotional implications of RRSO and the need for surgery. Mean scores on validated scales evaluating the HGC's impact on decisional outcomes and preparedness for decision-making about RRSO were not significant, indicating that the HGC played a supportive role, rather than helping with decision-making itself. Therefore, we present a novel framework that consolidates the various influences on decision-making and connects them to the psychological and practical implications of RRSO in the context of the HGC. Strategies for improving support, decisional outcomes, and the overall experiences of individuals who are BRCA-positive attending the HGC are also described.
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Affiliation(s)
- Selina Casalino
- Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
- Pathology and Laboratory Medicine, Sinai Health, Toronto, Ontario, Canada
| | - Sharon Bruce
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kim Serfas
- Shared Health Program of Genetics and Metabolism, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Alon D Altman
- Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Sarah Kean
- Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Pascal Lambert
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Kirk J McManus
- Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Jessica N Hartley
- Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mark W Nachtigal
- Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
- Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
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3
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Cabasag CJ, Arnold M, Rutherford M, Ferlay J, Bardot A, Morgan E, Butler J, O'Connell DL, Nelson G, Høgdall C, Schnack T, Gavin A, Elwood M, Hanna L, Gourley C, De P, Saint-Jacques N, Mørch LS, Woods RR, Altman AD, Sykes P, Cohen PA, McNally O, Møller B, Walsh P, Morrison DS, Bray F, Soerjomataram I. Shifting incidence and survival of epithelial ovarian cancer (1995-2014): A SurvMark-2 study. Int J Cancer 2023; 152:1763-1777. [PMID: 36533660 DOI: 10.1002/ijc.34403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/04/2022] [Accepted: 10/25/2022] [Indexed: 12/23/2022]
Abstract
The aim of the study is to provide a comprehensive assessment of incidence and survival trends of epithelial ovarian cancer (EOC) by histological subtype across seven high income countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway and the United Kingdom). Data on invasive EOC diagnosed in women aged 15 to 99 years during 1995 to 2014 were obtained from 20 cancer registries. Age standardized incidence rates and average annual percentage change were calculated by subtype for all ages and age groups (15-64 and 65-99 years). Net survival (NS) was estimated by subtype, age group and 5-year period using Pohar-Perme estimator. Our findings showed marked increase in serous carcinoma incidence was observed between 1995 and 2014 among women aged 65 to 99 years with average annual increase ranging between 2.2% and 5.8%. We documented a marked decrease in the incidence of adenocarcinoma "not otherwise specified" with estimates ranging between 4.4% and 7.4% in women aged 15 to 64 years and between 2.0% and 3.7% among the older age group. Improved survival, combining all EOC subtypes, was observed for all ages combined over the 20-year study period in all countries with 5-year NS absolute percent change ranging between 5.0 in Canada and 12.6 in Denmark. Several factors such as changes in guidelines and advancement in diagnostic tools may potentially influence the observed shift in histological subtypes and temporal trends. Progress in clinical management and treatment over the past decades potentially plays a role in the observed improvements in EOC survival.
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Affiliation(s)
| | - Melina Arnold
- International Agency for Research on Cancer, Lyon, France
| | - Mark Rutherford
- International Agency for Research on Cancer, Lyon, France
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Jacques Ferlay
- International Agency for Research on Cancer, Lyon, France
| | - Aude Bardot
- International Agency for Research on Cancer, Lyon, France
| | - Eileen Morgan
- International Agency for Research on Cancer, Lyon, France
- Northern Ireland Cancer Registry, Center for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | | | - Dianne L O'Connell
- The Daffodil Center, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Gregg Nelson
- Tom Baker Cancer Center, University of Calgary, Calgary, Alberta, Canada
| | - Claus Høgdall
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Tine Schnack
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Odense University Hospital, Odense, Denmark
| | - Anna Gavin
- Northern Ireland Cancer Registry, Center for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Mark Elwood
- Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | | | - Charlie Gourley
- Institute of Genetics and Cancer, Cancer Research UK Edinburgh Center, The University of Edinburgh, Edinburgh, Scotland, UK
| | | | | | - Lina Steinrud Mørch
- The Danish Cancer Society Research Center, Cancer Surveillance and Pharmacoepidemiology, Copenhagen, Denmark
| | - Ryan R Woods
- Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
| | - Alon D Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Manitoba, Canada
- CancerCare Manitoba Research Institute, Manitoba, Canada
| | - Peter Sykes
- University of Otago, Christchurch, New Zealand
| | - Paul A Cohen
- Department of Gynaecological Oncology, St John of God Subiaco Hospital, Perth, Western Australia, Australia
- Discipline of Obstetrics and Gynaecology, Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Orla McNally
- Royal Women's Hospital, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | | | - Paul Walsh
- National Cancer Registry Ireland, Cork, Ireland
| | | | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
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4
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Nelson G, Fotopoulou C, Taylor J, Glaser G, Bakkum-Gamez J, Meyer LA, Stone R, Mena G, Elias KM, Altman AD, Bisch SP, Ramirez PT, Dowdy SC. Enhanced recovery after surgery (ERAS®) society guidelines for gynecologic oncology: Addressing implementation challenges - 2023 update. Gynecol Oncol 2023; 173:58-67. [PMID: 37086524 DOI: 10.1016/j.ygyno.2023.04.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Despite evidence supporting its use, many Enhanced Recovery After Surgery (ERAS) recommendations remain poorly adhered to and barriers to ERAS implementation persist. In this second updated ERAS® Society guideline, a consensus for optimal perioperative care in gynecologic oncology surgery is presented, with a specific emphasis on implementation challenges. METHODS Based on the gaps identified by clinician stakeholder groups, nine implementation challenge topics were prioritized for review. A database search of publications using Embase and PubMed was performed (2018-2023). Studies on each topic were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded by an international panel according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. RESULTS All recommendations on ERAS implementation challenge topics are based on best available evidence. The level of evidence for each item is presented accordingly. CONCLUSIONS The updated evidence base and recommendations for stakeholder derived ERAS implementation challenges in gynecologic oncology are presented by the ERAS® Society in this consensus review.
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Affiliation(s)
- G Nelson
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - C Fotopoulou
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - J Taylor
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G Glaser
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - J Bakkum-Gamez
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - L A Meyer
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R Stone
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - G Mena
- Department of Anesthesiology, Critical Care and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K M Elias
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Reproductive Biology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - A D Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - S P Bisch
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - P T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, USA
| | - S C Dowdy
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, MN, USA
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5
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Shirley J, Lambert P, Nachtigal MW, Altman AD. A comparison of synoptic reports and dictated reports to enhance and standardize surgical documentation and quality of care in epithelial ovarian cancer. Gynecol Oncol 2023; 170:54-58. [PMID: 36640651 DOI: 10.1016/j.ygyno.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/01/2023] [Accepted: 01/02/2023] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The purpose of this study is to assess the degree to which synoptic reports (SRs) and dictated reports (DRs) document elements of the Ovarian Cancer Pan-Canadian Standards Data Elements (OCPCDE) checklist, and to compare their completeness. Analysis of dictated versus synoptic reporting has never been performed for suspected epithelial ovarian cancer (EOC) based on literature review at the time of data collection (1-12). METHODS A retrospective chart review was performed including 254 charts of women 18 years or older, from 2012 to 2017, undergoing surgery for suspected EOC. Charts from five gynecologic oncologists, at a single tertiary care centre were used. The OCPCDE checklist was used to evaluate their completeness. Comparison of completeness between SRs and DRs was done using linear regression with a fixed effect of surgeon to account for intraclass correlation. RESULTS The data showed that SRs included 20.1% more data elements than DRs. Data elements that may be perceived as being more critical were more likely to be documented in SRs. Residual disease data was documented in 51.7% DR versus 99.1% of SR. Descriptive data upon entering the abdomen was more frequently documented in DRs. CONCLUSION This study shows that synoptic reporting includes more data elements deemed important by the OCPCDE checklist authors for suspected epithelial ovarian cancer surgery in our centre. We would recommend continuation of SRs in our department, and implementation of synoptic reporting in other gynecologic oncology centres where surgery for suspected epithelial ovarian cancer is performed.
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Affiliation(s)
- Jenna Shirley
- Department of Obstetrics, Gynecology and reproductive Sciences, University of Manitoba, Canada
| | - Pascal Lambert
- Department of Epidemiology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Mark W Nachtigal
- Department of Obstetrics, Gynecology and reproductive Sciences, University of Manitoba, Canada; Department of Biochemistry and Medical Genetics, University of Manitoba, Canada; CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Alon D Altman
- Department of Obstetrics, Gynecology and reproductive Sciences, University of Manitoba, Canada; CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada; Division of Gynecologic Oncology, CancerCare Manitoba, Winnipeg, MB, Canada.
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6
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Aubrey C, Pond GR, Helpman L, Vicus D, Elit L, Plante M, Lau S, Kwon JS, Altman AD, Willows K, Feigenberg T, Sabourin J, Samouelian V, Bernard L, Cockburn N, Saunders NB, Piedimonte S, Teo-Fortin LA, Kim SR, Sadeq N, Jang JH, Shamiya S, Nelson G. Oncologic Outcomes of Surgically Treated Cervical Cancer with No Residual Disease on Hysterectomy Specimen: A 4C (Canadian Cervical Cancer Collaborative) Working Group Study. Curr Oncol 2023; 30:1977-1985. [PMID: 36826114 PMCID: PMC9955159 DOI: 10.3390/curroncol30020153] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 01/25/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
Minimally invasive surgery for the treatment of macroscopic cervical cancer leads to worse oncologic outcomes than with open surgery. Preoperative conization may mitigate the risk of surgical approach. Our objective was to describe the oncologic outcomes in cases of cervical cancer initially treated with conization, and subsequently found to have no residual cervical cancer after hysterectomy performed via open and minimally invasive approaches. This was a retrospective cohort study of surgically treated cervical cancer at 11 Canadian institutions from 2007 to 2017. Cases initially treated with cervical conization and subsequent hysterectomy, with no residual disease on hysterectomy specimen were included. They were subdivided according to minimally invasive (laparoscopic/robotic (MIS) or laparoscopically assisted vaginal/vaginal hysterectomy (LVH)), or abdominal (AH). Recurrence free survival (RFS) and overall survival (OS) were estimated using Kaplan-Meier analysis. Chi-square and log-rank tests were used to compare between cohorts. Within the total cohort, 238/1696 (14%) had no residual disease on hysterectomy specimen (122 MIS, 103 AH, and 13 VLH). The majority of cases in the cohort were FIGO 2018 stage IB1 (43.7%) and underwent a radical hysterectomy (81.9%). There was no statistical difference between stage, histology, and radical vs simple hysterectomy between the abdominal and minimally invasive groups. There were no significant differences in RFS (5-year: MIS/LVH 97.7%, AH 95.8%, p = 0.23) or OS (5-year: MIS/VLH 98.9%, AH 97.4%, p = 0.10), although event-rates were low. There were only two recurrences. In this large study including only patients with no residual cervical cancer on hysterectomy specimen, no significant differences in survival were seen by surgical approach. This may be due to the small number of events or due to no actual difference between the groups. Further studies are warranted.
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Affiliation(s)
- Christa Aubrey
- Division of Gynecologic Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB T6G 1Z2, Canada
- Correspondence: ; Tel.: +1-780-432-8337
| | - Gregory R. Pond
- Department of Oncology, Escarpment Cancer Research Institute, McMaster University, Hamilton, ON L8V 5C2, Canada
| | - Limor Helpman
- Division of Gynecologic Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON L8V 5C2, Canada
| | - Danielle Vicus
- Division of Gynecologic Oncology, Sunnybrook Health Science Center, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Laurie Elit
- Division of Gynecologic Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON L8V 5C2, Canada
| | - Marie Plante
- Division of Gynecologic Oncology, Centre Hospitalier Universite de Quebec, Laval University, Quebec City, QC G1R 2J6, Canada
| | - Susie Lau
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada
| | - Janice S. Kwon
- Division of Gynecologic Oncology, Vancouver General Hospital, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Alon D. Altman
- Division of Gynecologic Oncology, Winnipeg Women’s Hospital, University of Manitoba, Winnipeg, MB R3E 0L8, Canada
| | - Karla Willows
- Division of Gynecologic Oncology, Queen Elizabeth II Health Science Center, Dalhousie University, Halifax, NS B3K 4N1, Canada
| | - Tomer Feigenberg
- Division of Gynecologic Oncology, Trillium Health Partners, Mississauga, University of Toronto, Toronto, ON L5B 1B8, Canada
| | - Jeanelle Sabourin
- Division of Gynecologic Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB T6G 1Z2, Canada
| | - Vanessa Samouelian
- Division of Gynecologic Oncology, Centre Hospitalier de l’Universite de Montreal, University of Montreal, Montreal, QC H2X 3E4, Canada
| | - Laurence Bernard
- Division of Gynecologic Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON L8V 5C2, Canada
| | - Norah Cockburn
- Division of Gynecologic Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON L8V 5C2, Canada
| | - Nora-Beth Saunders
- Division of Gynecologic Oncology, Winnipeg Women’s Hospital, University of Manitoba, Winnipeg, MB R3E 0L8, Canada
| | - Sabrina Piedimonte
- Division of Gynecologic Oncology, Sunnybrook Health Science Center, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Ly-Ann Teo-Fortin
- Division of Gynecologic Oncology, Centre Hospitalier Universite de Quebec, Laval University, Quebec City, QC G1R 2J6, Canada
| | - Soyoun Rachel Kim
- Division of Gynecologic Oncology, Sunnybrook Health Science Center, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Noor Sadeq
- Division of Gynecologic Oncology, Queen Elizabeth II Health Science Center, Dalhousie University, Halifax, NS B3K 4N1, Canada
| | - Ji-Hyun Jang
- Division of Gynecologic Oncology, Vancouver General Hospital, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Sarah Shamiya
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB T5H 3V9, Canada
| | - Gregg Nelson
- Division of Gynecologic Oncology, Tom Baker Cancer Center, University of Calgary, Calgary, AB T2N 4N2, Canada
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7
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Tinker AV, Dhani NC, Ghatage P, McLeod D, Samouëlian V, Welch SA, Altman AD. A rapidly evolving landscape: immune checkpoint inhibitors in pretreated metastatic endometrial cancer. Ther Adv Med Oncol 2023; 15:17588359231157633. [PMID: 36950270 PMCID: PMC10026109 DOI: 10.1177/17588359231157633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/30/2023] [Indexed: 03/20/2023] Open
Abstract
Background and objectives Endometrial cancer is a common malignancy and recurrences can be fatal. Although platinum-pretreated endometrial tumors are commonly treated with anthracyclines and taxanes, there is no current standard of care. Both immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) have been extensively assessed in this setting, including tumors selected for DNA mismatch repair (MMR)/microsatellite instability (MSI) and programmed death-ligand 1 expression status. This review will provide evidence-based guidance on use of ICIs alone or in combination with TKIs in patients with pretreated advanced, persistent, or recurrent metastatic endometrial cancer. Data sources and methods Randomized phase II-III trials in unselected populations pretreated, recurrent, or metastatic endometrial cancer and phase I-II trials in biomarker selected populations were identified from PubMed as well as conference proceedings using the key search terms 'immune checkpoint inhibitors', 'endometrial cancer', and 'advanced'. Results A total of nine eligible studies were identified assessing ICI monotherapy for biomarker-selected or ICI plus TKI combinations and a dual ICI regimen for biomarker-unselected patients with pretreated recurrent or metastatic endometrial cancer. In MMR/MSI-selected tumors, five phase I/II studies evaluated ICI monotherapy indicating benefit in these patients. Only the phase III KEYNOTE-775 trial reported a statistically significant overall survival improvement for the combination of pembrolizumab plus lenvatinib compared with docetaxel or paclitaxel regardless of MMR/MSI status. Conclusions Pembrolizumab plus lenvatinib is indicated for patients with unselected pretreated metastatic endometrial cancer and pembrolizumab monotherapy is a preferred option for patients with MMRd/MSI-H tumors.
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Affiliation(s)
| | - Neesha C. Dhani
- Princess Margaret Cancer Centre, University of
Toronto, Toronto, ON, Canada
| | - Prafull Ghatage
- Tom Baker Cancer Centre, University of Calgary,
Calgary, AB, Canada
| | | | - Vanessa Samouëlian
- Centre Hospitalier de l’Université de Montréal
(CHUM), Centre de Recherche du CHUM (CRCHUM), Université de Montréal,
Montréal, QC, Canada
| | - Stephen A. Welch
- London Regional Cancer Program, Western
University, London, ON, Canada
| | - Alon D. Altman
- CancerCare Manitoba, University of Manitoba,
Winnipeg, MB, Canada
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8
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Winchar K, Lambert P, McManus KJ, Chodirker B, Kean S, Serfas K, Decker K, Nachtigal MW, Altman AD. Referral, Genetic Counselling, and BRCA Testing in the Manitoba High-Grade Serous Ovarian Cancer Population, 2004-2019. Curr Oncol 2022; 29:9365-9376. [PMID: 36547149 PMCID: PMC9777417 DOI: 10.3390/curroncol29120735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 12/02/2022] Open
Abstract
(1) Background: The primary objective of this study was to examine the rate of genetic referral, BRCA testing, and BRCA positivity amongst all patients with high-grade serous ovarian cancers (HGSOC) from 2004-2019. The secondary objective was to analyze secondary factors that may affect the rates of referral and testing. (2) Methods: This population-based cohort study included all women diagnosed with HGSOC using the Manitoba Cancer Registry, CervixCheck registry, Medical Claims database at Manitoba Health, the Hospital Discharge abstract, the Population Registry, and Winnipeg Regional Health Authority genetics data. Data were examined for three different time cohorts (2004-2013, 2014-2016; 2017-2019) correlating to practice pattern changes. (3) Results: A total of 944 patients were diagnosed with HGSOC. The rate of genetic referrals changed over the three timeframes (20.0% → 56.7% → 36.6%) and rate of genetic testing increased over the entire timeframe. Factors found to increase rates of referral and testing included age, histology, history of oral contraceptive use, and family history of ovarian cancer. Prior health care utilization indicators did not affect genetic referral or testing. (4) Conclusion: The rate of genetic referral (2004-2016) and BRCA1/2 testing (2004-2019) for patients with a diagnosis of HGSOC increased over time. A minority of patients received a consultation for genetics counselling, and even fewer received testing for a BRCA1/2. Without a genetic result, it is difficult for clinicians to inform treatment decisions. Additional efforts are needed to increase genetics consultation and testing for Manitoban patients with HGSOC. Effects of routine tumour testing on rates of genetic referral will have to be examined in future studies.
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Affiliation(s)
- Kelcey Winchar
- Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
| | - Pascal Lambert
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB R3E OV9, Canada
- Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB R3E OV9, Canada
| | - Kirk J. McManus
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB R3E OV9, Canada
- Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB R3E OV9, Canada
| | - Bernie Chodirker
- Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB R3E OV9, Canada
- Pediatrics and Child Health (Section of Genetics and Metabolism), University of Manitoba, Winnipeg, MB R3E OV9, Canada
| | - Sarah Kean
- Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
| | - Kim Serfas
- Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB R3E OV9, Canada
| | - Kathleen Decker
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB R3E OV9, Canada
- Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB R3E OV9, Canada
| | - Mark W. Nachtigal
- Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB R3E OV9, Canada
- Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB R3E OV9, Canada
| | - Alon D. Altman
- Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB R3E OV9, Canada
- Correspondence: ; Tel.: +1-204-787-2967
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9
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Cadoo K, Simpkins F, Mathews C, Liu YL, Provencher D, McCormick C, ElNaggar AC, Altman AD, Gilbert L, Black D, Kabil N, Bennett J, Munley J, Aghajanian C. Olaparib treatment for platinum-sensitive relapsed ovarian cancer by BRCA mutation and homologous recombination deficiency status: Phase II LIGHT study primary analysis. Gynecol Oncol 2022; 166:425-431. [PMID: 35803835 PMCID: PMC9909678 DOI: 10.1016/j.ygyno.2022.06.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/20/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Olaparib treatment resulted in significant improvement in objective response rates (ORRs) and progression-free survival (PFS) over non‑platinum chemotherapy in patients with BRCA1/BRCA2-mutated (BRCAm) platinum-sensitive relapsed ovarian cancer (PSROC) and ≥2 prior lines of platinum-based chemotherapy in the phase III SOLO3 study. LIGHT (NCT02983799) prospectively evaluated olaparib treatment for patients with PSROC and known BRCAm and homologous recombination deficiency (HRD) status. METHODS In this phase II open-label multicenter study, patients with PSROC and ≥1 prior line of platinum-based chemotherapy were assigned to cohorts by presence of germline BRCAm (gBRCAm), somatic BRCAm (sBRCAm), HRD-positive tumors without BRCAm, or HRD-negative tumors. The primary endpoint was investigator-assessed ORR. Secondary endpoints included disease control rate (DCR) and PFS. Tumors were analyzed using Myriad BRACAnalysis CDx and myChoice HRD assays; HRD-positive tumors were defined using a genomic instability score of ≥42. RESULTS Of 272 enrolled patients, 271 received olaparib and 270 were included in efficacy analyses. At data cut-off, ORRs in the gBRCAm, sBRCAm, HRD-positive, and HRD-negative cohorts were 69.3%, 64.0%, 29.4%, and 10.1%, respectively. DCRs were 96.0%, 100.0%, 79.4%, and 75.3% in each cohort, respectively. Median PFS was 11.0, 10.8, 7.2, and 5.4 months, respectively. The most common (≥ 20%) treatment-emergent adverse events included nausea, fatigue/asthenia, vomiting, anemia, constipation, diarrhea, and decreased appetite. CONCLUSIONS Olaparib treatment demonstrated activity across all cohorts. The greatest efficacy was observed in the BRCAm cohorts, regardless of gBRCAm/sBRCAm. For patients without a BRCAm, greater efficacy was observed in the HRD-positive than the HRD-negative cohorts. The safety profile was consistent with that established in previous olaparib studies.
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Affiliation(s)
- Karen Cadoo
- Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY, USA,.
| | - Fiona Simpkins
- Department of Obstetrics and Gynecology, Jordan Center for Gynecologic Oncology at the Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Cara Mathews
- Program in Women’s Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital, Brown University, Providence, RI, USA
| | - Ying L. Liu
- Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY, USA
| | | | | | | | - Alon D. Altman
- CancerCare Manitoba, Research Institute of Oncology and Hematology, University of Manitoba, Winnipeg Manitoba, Canada
| | - Lucy Gilbert
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Destin Black
- Willis-Knighton Cancer Center, Shreveport, LA, USA
| | | | | | | | - Carol Aghajanian
- Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY, USA
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10
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Altman AD, Rozenholc A, Saciragic L, Liu XQ, Nelson G. The Canadian Gynecologic Oncology Peri-operative Management Survey: re-examining Enhanced Recovery After Surgery (ERAS) recommendations. Int J Gynecol Cancer 2022; 32:ijgc-2022-003562. [PMID: 35750353 DOI: 10.1136/ijgc-2022-003562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Enhanced Recovery After Surgery (ERAS) is a global surgery quality improvement program associated with improved clinical outcomes across the spectrum of disciplines, including gynecologic oncology. The objective of this study was to re-survey the practice of ERAS Gynecologic Oncology guidelines across Canada, after the initial guidelines publication (2016), subsequent guidelines update (2019), and Society of Gynecologic Oncology of Canada (GOC) education events. METHODS A survey was created and developed through the GOC Communities of Practice ERAS section and distributed to all members between March and November 2021. The results of this survey were compared with the survey performed in 2015 RESULTS: The initial GOC survey in 2015 included 77/92 active gynecologic oncologists (84%) representing all provinces in Canada. The current updated survey had responses from 59/118 active gynecologic oncologists (51%) also from every province. Compared with the original survey there was a statistically significant improvement in uptake of 10 ERAS recommendations: smoking/alcohol cessation, modern fasting guidelines (allowance of clear fluids and solid food pre-operatively), carbohydrate loading, pre-operative warming, early feeding, post-operative laxative use, avoidance of nasogastric tubes and abdominal drains, foley catheter removal at 6 hours, and active mobilization (all p<0.003). Only two fields (stopping oral contraceptive medications pre-operatively and foley catheter removal post-operative day 1) showed worsening uptake across the two surveys (p<0.01). The ERAS recommendations that did not change in the examined time frame included routine use of mechanical bowel preparation, venous thromboembolism prophylaxis, pre-operative antibiotics, and additional antibiotic dosing for prolonged surgery. CONCLUSIONS This survey demonstrates increased uptake of 10 of the ERAS guideline recommendations among Canadian gynecologic oncology providers. These findings may translate to improvements in clinical outcomes and healthcare system-level benefits including increased hospital capacity and cost savings.
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Affiliation(s)
- Alon D Altman
- Gynecologic Oncology, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
- CancerCareManitoba, Research Institute in Oncology and Hematology, Winnipeg, Manitoba, Canada
| | - Alexandre Rozenholc
- Gynecologic Oncology Service; Obstetrics and Gynecology Service, Hopital de Gatineau, Gatineau, Quebec, Canada
| | - Lana Saciragic
- Gynecologic Oncology, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Xiao-Qing Liu
- Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gregg Nelson
- Department of Obstetrics & Gynecology, University of Calgary, Calgary, Alberta, Canada
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11
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Moldovan N, Lambert P, Ong A, Altman AD. A population-based study of outcomes in adjuvant radiotherapy for stage II endometrial carcinoma. Int J Gynecol Cancer 2022; 32:ijgc-2021-003210. [PMID: 35732352 DOI: 10.1136/ijgc-2021-003210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Our study aimed to analyze recurrence and survival outcomes in stage II endometrial cancer patients treated with adjuvant radiotherapy at CancerCare Manitoba, a Canadian provincial cancer program. METHODS This retrospective population-based cohort study identified all International Federation of Gynecology and Obstetrics (FIGO) 2009 stage II endometrioid type endometrial carcinoma diagnosed between January 1995 and December 2019. All patients underwent surgery followed by vaginal vault brachytherapy alone or external beam pelvic radiotherapy plus vaginal vault brachytherapy. We used Kaplan-Meier curves to describe overall survival and recurrence-free survival, and cumulative incidence to describe recurrence. Cox regression was used to predict overall survival and recurrence-free survival competing risk regression to predict recurrence. RESULTS A total of 121 patients were included (78 vaginal brachytherapy alone and 43 external beam pelvic radiotherapy plus vaginal brachytherapy) with a median age of 62 (range 24-85). The median follow-up was 55.2 months (range 7.1-147.9) in the vaginal brachytherapy group and 41.9 months (range 7.4-127.0) in the pelvic radiotherapy group. Lymph node dissection was performed in 79 (65.3%) patients. There were 14 (17.9%) recurrences (8 vaginal vault, 3 pelvic, 3 distant) with vaginal brachytherapy and 7 (16.3%) recurrences (3 vaginal vault, 2 pelvic, 2 distant) with external beam pelvic radiotherapy. The 5 year overall survival was 73.1% with vaginal vault brachytherapy vs 73.7% with external beam pelvic radiotherapy plus vaginal brachytherapy (p=0.31), the 5 year recurrence-free survival was 65.0% vs 68.2% (p=0.61), and the 5 year recurrence risk was 20.3% vs 19.4% (p=0.94). On univariable and multivariable analysis, only age was a statistically significant predictor for overall survival and recurrence-free survival (p<0.05), but not lymphovascular space invasion (HR, 2.97; 95% CI, 0.99 to 8.93 for overall survival, p=0.15). The type of adjuvant radiotherapy did not predict for recurrence (p=0.94). CONCLUSIONS There was no significant difference in overall survival, recurrence-free survival, and recurrence risk between vaginal vault brachytherapy vs external beam pelvic radiotherapy plus vaginal vault brachytherapy in patients with stage II endometrial cancer.
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Affiliation(s)
| | - Pascal Lambert
- Department of Epidemiology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Aldrich Ong
- Radiation Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Alon D Altman
- CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Gynecologic Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
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12
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Tinker AV, Altman AD, Bernardini MQ, Ghatage P, Gien LT, Provencher D, Salvador S, Doucette S, Oza AM. A Pan-Canadian Consensus Statement on First-Line PARP Inhibitor Maintenance for Advanced, High-Grade Serous and Endometrioid Tubal, Ovarian, and Primary Peritoneal Cancers. Curr Oncol 2022; 29:4354-4369. [PMID: 35735457 PMCID: PMC9221681 DOI: 10.3390/curroncol29060348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022] Open
Abstract
The majority of patients with advanced, high-grade epithelial-tubo ovarian cancer (EOC) respond well to initial treatment with platinum-based chemotherapy; however, up to 80% of patients will experience a recurrence. Poly(ADP-ribose) Polymerase (PARP) inhibitors have been established as a standard of care maintenance therapy to prolong remission and prevent relapse following a response to first-line platinum-chemotherapy. Olaparib and niraparib are the PARP inhibitors currently approved for use in the first-line maintenance setting in Canada. Selection of maintenance therapy requires consideration of patient and tumour factors, presence of germline and somatic mutations, expected drug toxicity profile, and treatment access. This paper discusses the current clinical evidence for first-line PARP inhibitor maintenance therapy in patients with advanced, high-grade EOC and presents consensus statements and a treatment algorithm to aid Canadian oncologists on the selection and use of PARP inhibitors within the Canadian EOC treatment landscape.
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Affiliation(s)
- Anna V. Tinker
- Division of Medical Oncology, BC Cancer, Vancouver, BC V5Z 4E6, Canada;
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Alon D. Altman
- Division of Gynecologic Oncology, Cancer Care Manitoba, Winnipeg, MB R3E 0V9, Canada;
- Department of Obstetrics Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
| | - Marcus Q. Bernardini
- Division of Gynecologic Oncology, Princess Margaret Cancer Center, University Health Network, Sinai Health System, Toronto, ON M5B 2M9, Canada;
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON M5G 1X8, Canada;
| | - Prafull Ghatage
- Department of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada;
- Department of Gynecological Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Lilian T. Gien
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON M5G 1X8, Canada;
- Division of Gynecologic Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Diane Provencher
- Institut du Cancer de Montréal, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 0A9, Canada;
- Division of Gynecologic Oncology, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Shannon Salvador
- Department of Obstetrics and Gynecology, McGill University Jewish General Hospital, Montreal, QC H3T 1E2, Canada;
| | | | - Amit M. Oza
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON M5G 1X8, Canada;
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada
- Correspondence:
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13
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Nachtigal MW, Musaphir P, Dhiman S, Altman AD, Schweizer F, Arthur G. Cytotoxic capacity of a novel glycosylated antitumor ether lipid in chemotherapy-resistant high grade serous ovarian cancer in vitro and in vivo. Transl Oncol 2021; 14:101203. [PMID: 34416424 PMCID: PMC8379490 DOI: 10.1016/j.tranon.2021.101203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 01/04/2023] Open
Abstract
L-Rham induces apoptosis-independent cell death in high grade serous ovarian cancer (HGSOC) cells. L-Rham-induced cell death is dose and time dependent in HGSOC cells grown as 2D or 3D cultures. L-Rham is as effective as paclitaxel to reduce tumor burden and metastasis in a CAM model. L-Rham significantly reduces tumor formation in a low tumor burden model. L-Rham blocks ascites formation.
Chemotherapy resistant high grade serous ovarian cancer remains a clinically intractable disease with a high rate of mortality. We tested a novel glycosylated antitumor ether lipid called l-Rham to assess the in vitro and in vivo efficacy on high grade serous ovarian cancer cell lines and patient samples. l-Rham effectively kills high grade serous ovarian cancer cells grown as 2D or 3D cultures in a dose and time dependent manner. l-Rham efficacy was tested in vivo in a chicken allantoic membrane/COV362 xenograft model, where l-Rham activity was as effective as paclitaxel in reducing tumor weight and metastasis. The efficacy of l-Rham to reduce OVCAR3 tumor xenografts in NRG mice was assessed in low and high tumor burden models. l-Rham effectively reduced tumor formation in the low tumor burden group, and blocked ascites formation in low and high tumor burden animals. l-Rham demonstrates efficacy against OVCAR3 tumor and ascites formation in vivo in NRG mice, laying the foundation for further development of this drug class for the treatment of high grade serous ovarian cancer patients.
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Affiliation(s)
- Mark W Nachtigal
- Department of Biochemistry and Medical Genetics, University of Manitoba, 301 BMSB-745 Bannatyne Avenu, Winnipeg, Manitoba R3E 0J9, Canada; Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba R3E 0J9, Canada; CancerCare Manitoba Research Institute, Winnipeg, Manitoba R2H 2A6, Canada.
| | - Paris Musaphir
- Department of Biochemistry and Medical Genetics, University of Manitoba, 301 BMSB-745 Bannatyne Avenu, Winnipeg, Manitoba R3E 0J9, Canada
| | - Shiv Dhiman
- Department of Chemistry, University of Manitoba, Winnipeg, Manitoba R3T 2N2, Canada
| | - Alon D Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba R3E 0J9, Canada
| | - Frank Schweizer
- Department of Chemistry, University of Manitoba, Winnipeg, Manitoba R3T 2N2, Canada
| | - Gilbert Arthur
- Department of Biochemistry and Medical Genetics, University of Manitoba, 301 BMSB-745 Bannatyne Avenu, Winnipeg, Manitoba R3E 0J9, Canada
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14
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Mathews CA, Simpkins F, Cadoo KA, Liu YL, Provencher DM, McCormick C, ElNaggar A, Altman AD, Gilbert L, Black D, Kabil N, Bennett J, Munley J, Yu J, Aghajanian C. Olaparib treatment (Tx) in patients (pts) with platinum-sensitive relapsed ovarian cancer (PSR OC) by BRCA mutation (BRCAm) and homologous recombination deficiency (HRD) status: Overall survival (OS) results from the phase II LIGHT study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5515 Background: LIGHT (NCT02983799) evaluated olaparib Tx in pts with PSR OC in cohorts with known BRCAm and HRD status. We report the final OS analyses. Methods: We conducted anopen-label, non-randomized, multicenter study of pts with PSR OC and ≥1 prior line of platinum-based chemotherapy (CTx). Pts were assigned to one of 4 cohorts: germline (g) BRCAm; somatic (s) BRCAm; HRD +ve (non-BRCAm); and HRD -ve. Genomic instability score (GIS) and gBRCAm status were determined by Myriad myChoice and BRACAnalysis CDx tests, respectively. HRD +ve tumors were defined by a GIS ≥42. Pts received olaparib Tx (starting dose 300 mg bid) until disease progression or unacceptable toxicity. OS was a secondary endpoint and was analyzed at 12 months (mo) after the primary analysis and 18 mo after the last pt was enrolled. Safety was assessed in pts who received ≥1 dose. Results: Data cut-off (DCO) was Aug 27, 2020. Of 272 enrolled pts, 271 received olaparib; of these, 270 had measurable disease at baseline and were included in efficacy analyses (Table). At DCO, 40% of pts had died (maturity) with a median follow-up in censored pts of 26.3 mo. Kaplan–Meier 18-mo OS rates were 86%, 88%, 79%, and 60% in the gBRCAm, sBRCAm, HRD +ve (non-BRCAm), and HRD -ve cohorts, respectively. Platinum-based CTx was the most common first subsequent Tx and was received by 39% pts after olaparib discontinuation. At DCO, the median duration of Tx was 7.4 mo and 244 pts had discontinued treatment, mainly due to disease progression (72%); 5% discontinued due to treatment-emergent adverse events (TEAEs). The only TEAE leading to discontinuation in >1 pt was nausea (2 pts). Serious TEAEs were reported in 25% of pts. The most common serious TEAE was small intestinal obstruction (6%). Three adverse events of special interest occurred, each in 1 pt (<1%): acute myeloid leukemia (post discontinuation), pneumonitis, and pulmonary fibrosis. Conclusions: In the final OS analysis, 18-mo OS ranged from 60–88% across the 4 cohorts. Consistent with the primary analysis, the 18-mo OS rate was highest in the BRCAm cohorts (similar OS in g and sBRCAm); among pts without a BRCAm, 18-mo OS was highest in the HRD +ve cohort. No new safety signals were observed compared with the primary analysis and with prior olaparib studies. Clinical trial information: NCT02983799. [Table: see text]
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Affiliation(s)
- Cara Amanda Mathews
- Program in Women’s Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital, Brown University, Providence, RI
| | - Fiona Simpkins
- Department of Obstetrics and Gynecology, Jordan Center for Gynecologic Oncology at the Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | | | - Ying L Liu
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Diane M. Provencher
- Centre Hospitalier de l'Université de Montréal (CHUM), Division of Gynecologic Oncology, Montréal, QC, Canada
| | | | - Adam ElNaggar
- West Cancer Center and Research Institute, Memphis, TN
| | - Alon D Altman
- CancerCare Manitoba, Research Institute of Oncology and Hematology, University of Manitoba, Winnipeg, MB, Canada
| | - Lucy Gilbert
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, QC, Canada
| | | | | | | | | | - Judy Yu
- AstraZeneca, Gaithersburg, MD
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15
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Mercier NB, Roberts LF, Azordegan N, Altman AD. Extra-uterine endometrial stromal sarcoma of the left adnexa and distal ureter: A case report. Gynecol Oncol Rep 2021; 36:100702. [PMID: 33553557 PMCID: PMC7851353 DOI: 10.1016/j.gore.2021.100702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/02/2021] [Accepted: 01/10/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Nora-Beth Mercier
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lesley F Roberts
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nazila Azordegan
- Department of Pathology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alon D Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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16
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Poliquin V, Singh PK, Leylek M, Dean E, Liu M, Altman AD. The Risk of Postoperative Infectious Complications Following Massive Intraoperative Blood Loss During Gynaecologic Laparotomy: Retrospective Cohort Study. J Obstet Gynaecol Can 2020; 43:19-25. [PMID: 33153939 DOI: 10.1016/j.jogc.2020.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine whether massive intraoperative blood loss (MIBL) was independently associated with postoperative infectious complications after gynaecologic laparotomy. METHODS We conducted a retrospective cohort study of patients undergoing gynaecologic laparotomy who were exposed or not exposed to MIBL. The outcome of interest was composite postoperative febrile morbidity. Multiple logistic regression was used to determine the association between exposure and outcome while controlling for measured covariates. RESULTS The primary outcome was identified to have occurred in 48% (144 of 298) of surgeries with MIBL compared with 12% (51 of 413) of surgeries without MIBL (P < 0.0001). MIBL was found to be strongly and independently associated with primary outcome (adjusted odds ratio 7.04; 95% confidence interval 4.62-10.74; P < 0.0001) after adjusting for age, body mass index, diabetes, immunosuppression, type of procedure, incision type, drains left in situ, and bowel complications. CONCLUSION MIBL is strongly and independently associated with postoperative febrile morbidity after gynaecologic laparotomy.
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Affiliation(s)
- Vanessa Poliquin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Manitoba, Winnipeg, MB
| | - Prabjot K Singh
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
| | - Melike Leylek
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Manitoba, Winnipeg, MB
| | - Erin Dean
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Manitoba, Winnipeg, MB
| | - Michelle Liu
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Manitoba, Winnipeg, MB
| | - Alon D Altman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Manitoba, Winnipeg, MB.
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Altman AD, Robert M, Armbrust R, Fawcett WJ, Nihira M, Jones CN, Tamussino K, Sehouli J, Dowdy SC, Nelson G. Guidelines for vulvar and vaginal surgery: Enhanced Recovery After Surgery Society recommendations. Am J Obstet Gynecol 2020; 223:475-485. [PMID: 32717257 DOI: 10.1016/j.ajog.2020.07.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/17/2020] [Accepted: 07/22/2020] [Indexed: 02/07/2023]
Abstract
This is the first collaborative Enhanced Recovery After Surgery Society guideline for optimal perioperative care for vulvar and vaginal surgeries. An Embase and PubMed database search of publications was performed. Studies on each topic within the Enhanced Recovery After Surgery vulvar and vaginal outline were selected, with emphasis on meta-analyses, randomized controlled trials, and prospective cohort studies. All studies were reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation system. All recommendations on the Enhanced Recovery After Surgery topics are based on the best available evidence. The level of evidence for each item is presented.
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Affiliation(s)
- Alon D Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Magali Robert
- Department of Obstetrics and Gynecology, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Robert Armbrust
- Department of Gynecology with Center for Oncological Surgery, Charité University Medicine of Berlin, European Competence Center for Ovarian Cancer, Berlin, Germany
| | - William J Fawcett
- Department of Anaesthesia, Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
| | - Mikio Nihira
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of California, Riverside, Riverside, CA
| | - Chris N Jones
- Department of Anaesthesia, Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
| | - Karl Tamussino
- Division of Gynecology, Medical University of Graz, Graz, Austria
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité University Medicine of Berlin, European Competence Center for Ovarian Cancer, Berlin, Germany
| | - Sean C Dowdy
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, MN
| | - Gregg Nelson
- Division of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
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Butler J, Finley C, Norell CH, Harrison S, Bryant H, Achiam MP, Altman AD, Baxter N, Bentley J, Cohen PA, Chaudry MA, Dixon E, Farrell R, Fegan S, Hashmi S, Hogdall C, Jenkins JT, Kwon J, Mala T, McNally O, Merrett N, Nelson G, Nordin A, Park J, Porter G, Reynolds J, Schieman C, Schnack T, Spigelman A, Svendsen LB, Sykes P, Thomas R. New approaches to cancer care in a COVID-19 world. Lancet Oncol 2020; 21:e339-e340. [PMID: 32615112 PMCID: PMC7324090 DOI: 10.1016/s1470-2045(20)30340-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/28/2020] [Indexed: 12/25/2022]
Affiliation(s)
- John Butler
- Department of Gynecological Oncology, The Royal Marsden NHS Foundation Trust, London, UK; Policy & Information, Cancer Research UK, London, E20 1JQ, UK
| | - Christian Finley
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada; Canadian Partnership Against Cancer, Toronto, ON, Canada
| | | | | | - Heather Bryant
- Canadian Partnership Against Cancer, Toronto, ON, Canada
| | - Michael P Achiam
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, Copenhagen, Denmark
| | - Alon D Altman
- Department of Gynecologic Oncology, University of Manitoba, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Nancy Baxter
- Department of Surgery and LiKa Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - James Bentley
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS, Canada
| | - Paul A Cohen
- Department of Gynaecologic Oncology, St John of God Subiaco Hospital, Subiaco, WA, Australia
| | - M Asif Chaudry
- Department of Gastrointestinal Surgery, The Royal Marsden NHS Foundation Trust, London, UK
| | - Elijah Dixon
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Rhonda Farrell
- Gynaecological Oncology Department, Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Scott Fegan
- Department of Obstetrics and Gynaecology, The Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Salila Hashmi
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Claus Hogdall
- Department of Gynaecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - John T Jenkins
- Department of Surgery, St. Mark's Hospital, Middlesex, UK
| | - Janice Kwon
- Department of Obstetrics and Gynaecology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Tom Mala
- Department of Gastrointestinal and Paediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - Orla McNally
- Oncology and Dysplasia Service, The Royal Women's Hospital, Melbourne, VIC, Australia
| | - Neil Merrett
- Faculty of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Gregg Nelson
- Department of Gynecologic Oncology, University of Calgary, Calgary, AB, Canada
| | - Andy Nordin
- East Kent Gynaecological Centre, East Kent Hospitals University NHS Foundation Trust, Kent, UK
| | - Jason Park
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Geoff Porter
- Canadian Partnership Against Cancer, Toronto, ON, Canada; Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - John Reynolds
- Department of Surgery, Trinity Translational Medicine Institute, St. James's Hospital, Dublin, Ireland
| | - Colin Schieman
- Section of Thoracic Surgery, University of Calgary, Calgary, AB, Canada
| | - Tine Schnack
- Department of Gynaecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Allan Spigelman
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Lars Bo Svendsen
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, Copenhagen, Denmark
| | - Peter Sykes
- Department of Obstetrics and Gynaecology, University of Otago, Christchurch, New Zealand
| | - Robert Thomas
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
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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. J Obstet Gynaecol Can 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Cabasag CJ, Butler J, Arnold M, Rutherford M, Bardot A, Ferlay J, Morgan E, Møller B, Gavin A, Norell CH, Harrison S, Saint-Jacques N, Eden M, Rous B, Nordin A, Hanna L, Kwon J, Cohen PA, Altman AD, Shack L, Kozie S, Engholm G, De P, Sykes P, Porter G, Ferguson S, Walsh P, Trevithick R, Tervonen H, O'Connell D, Bray F, Soerjomataram I. Exploring variations in ovarian cancer survival by age and stage (ICBP SurvMark-2): A population-based study. Gynecol Oncol 2020; 157:234-244. [PMID: 32005583 DOI: 10.1016/j.ygyno.2019.12.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/24/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The study aims to evaluate the differences in ovarian cancer survival by age and stage at diagnosis within and across seven high-income countries. METHODS We analyzed data from 58,161 women diagnosed with ovarian cancer during 2010-2014, followed until 31 December 2015, from 21 population-based cancer registries in Australia, Canada, Denmark, Ireland, New Zealand, Norway, and United Kingdom. Comparisons of 1-year and 3-year age- and stage-specific net survival (NS) between countries were performed using the period analysis approach. RESULTS Minor variation in the stage distribution was observed between countries, with most women being diagnosed with 'distant' stage (ranging between 64% in Canada and 71% in Norway). The 3-year all-ages NS ranged from 45 to 57% with Australia (56%) and Norway (57%) demonstrating the highest survival. The proportion of women with 'distant' stage was highest for those aged 65-74 and 75-99 years and varied markedly between countries (range:72-80% and 77-87%, respectively). The oldest age group had the lowest 3-year age-specific survival (20-34%), and women aged 65-74 exhibited the widest variation across countries (3-year NS range: 40-60%). Differences in survival between countries were particularly stark for the oldest age group with 'distant' stage (3-year NS range: 12% in Ireland to 24% in Norway). CONCLUSIONS International variations in ovarian cancer survival by stage exist with the largest differences observed in the oldest age group with advanced disease. This finding endorses further research investigating international differences in access to and quality of treatment, and prevalence of comorbid conditions particularly in older women with advanced disease.
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Affiliation(s)
- Citadel J Cabasag
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France.
| | - John Butler
- Royal Marsden Hospital, Fulham Road, London SW3 6JJ, England, UK
| | - Melina Arnold
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France
| | - Mark Rutherford
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France; Biostatistics Research Group, Department of Health Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Aude Bardot
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France
| | - Jacques Ferlay
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France
| | - Eileen Morgan
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France; Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Bjørn Møller
- Cancer Registry of Norway, Institute of Population-based Cancer Research, P.O. Box 5313, Majorstuen, 0304 Oslo, Norway
| | - Anna Gavin
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Charles H Norell
- Policy & Information Directorate, Cancer Research UK, London, England, UK
| | - Samantha Harrison
- Policy & Information Directorate, Cancer Research UK, London, England, UK
| | - Nathalie Saint-Jacques
- Nova Scotia Health Authority Cancer Care Program, Registry & Analytics, 1276 South Street, Halifax B3H 2Y9, NS, Canada
| | - Michael Eden
- National Cancer Registrations and Analysis Service, Public Health England, Wellington House, London, UK
| | - Brian Rous
- National Cancer Registrations and Analysis Service, Public Health England, Wellington House, London, UK
| | - Andy Nordin
- East Kent Hospitals University National Health Service Foundation Trust, Kent, England, UK
| | - Louise Hanna
- Velindre University National Health Service Trust, Cardiff, Wales, UK
| | - Janice Kwon
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer, Department of Surgical Oncology, Vancouver, British Columbia, Canada
| | - Paul A Cohen
- University of Western Australia, Division of Obstetrics and Gynaecology, Crawley, Western Australia, Australia; St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Alon D Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
| | - Lorraine Shack
- Cancer Control Alberta, Alberta Health Services, 2210 2nd Street, SW, Calgary, AB T2S 3C3, Canada
| | - Serena Kozie
- Registry Department, Saskatchewan Cancer Agency, Regina, SK S4W 0G3, Canada
| | - Gerda Engholm
- Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Prithwish De
- Surveillance & Cancer Registry, Cancer Care Ontario, 620 University Ave., Toronto, ON M5G 2L7, Canada
| | - Peter Sykes
- University of Otago, Christchurch, New Zealand
| | - Geoff Porter
- Canadian Partnership Against Cancer, 145 King Street West, Suite 900, Toronto, Ontario M5H 1J8, Canada
| | - Sarah Ferguson
- Gynecologic Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Paul Walsh
- National Cancer Registry Ireland, Cork Airport Business Park, Kinsale Road, Cork T12 CDF7, Ireland
| | - Richard Trevithick
- Western Australia Cancer and Palliative Care Network Policy Unit, Health Networks Branch, Department of Health, Perth, Western Australia, Australia
| | - Hanna Tervonen
- Cancer Institute NSW, PO Box 41, Alexandria NSW 1435, Australia
| | - Dianne O'Connell
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France
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Altman AD, Helpman L, McGee J, Samouëlian V, Auclair MH, Brar H, Nelson GS. Enhanced recovery after surgery: implementing a new standard of surgical care. CMAJ 2020; 191:E469-E475. [PMID: 31036609 DOI: 10.1503/cmaj.180635] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Alon D Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta.
| | - Limor Helpman
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta
| | - Jacob McGee
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta
| | - Vanessa Samouëlian
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta
| | - Marie-Hélène Auclair
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta
| | - Harinder Brar
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta
| | - Gregg S Nelson
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta
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Wijk L, Udumyan R, Pache B, Altman AD, Williams LL, Elias KM, McGee J, Wells T, Gramlich L, Holcomb K, Achtari C, Ljungqvist O, Dowdy SC, Nelson G. International validation of Enhanced Recovery After Surgery Society guidelines on enhanced recovery for gynecologic surgery. Am J Obstet Gynecol 2019; 221:237.e1-237.e11. [PMID: 31051119 DOI: 10.1016/j.ajog.2019.04.028] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/17/2019] [Accepted: 04/24/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Enhanced Recovery After Surgery Society publishes guidelines on perioperative care, but these guidelines should be validated prospectively. OBJECTIVE To evaluate the association between compliance with Enhanced Recovery After Surgery Gynecologic/Oncology guideline elements and postoperative outcomes in an international cohort. STUDY DESIGN The study comprised 2101 patients undergoing elective gynecologic/oncology surgery between January 2011 and November 2017 in 10 hospitals across Canada, the United States, and Europe. Patient demographics, surgical/anesthesia details, and Enhanced Recovery After Surgery protocol compliance elements (pre-, intra-, and postoperative phases) were entered into the Enhanced Recovery After Surgery Interactive Audit System. Surgical complexity was stratified according to the Aletti scoring system (low vs medium/high). The following covariates were accounted for in the analysis: age, body mass index, smoking status, presence of diabetes, American Society of Anesthesiologists class, International Federation of Gynecology and Obstetrics stage, preoperative chemotherapy, radiotherapy, operating time, surgical approach (open vs minimally invasive), intraoperative blood loss, hospital, and Enhanced Recovery After Surgery implementation status. The primary end points were primary hospital length of stay and complications. Negative binomial regression was used to model length of stay, and logistic regression to model complications, as a function of compliance score and covariates. RESULTS Patient demographics included a median age 56 years, 35.5% obese, 15% smokers, and 26.7% American Society of Anesthesiologists Class III-IV. Final diagnosis was malignant in 49% of patients. Laparotomy was used in 75.9% of cases, and the remainder minimally invasive surgery. The majority of cases (86%) were of low complexity (Aletti score ≤3). In patients with ovarian cancer, 69.5% had a medium/high complexity surgery (Aletti score 4-11). Median length of stay was 2 days in the low- and 5 days in the medium/high-complexity group. Every unit increase in Enhanced Recovery After Surgery guideline score was associated with 8% (IRR, 0.92; 95% confidence interval, 0.90-0.95; P<.001) decrease in days in hospital among low-complexity, and 12% (IRR, 0.88; 95% confidence interval, 0.82-0.93; P<.001) decrease among patients with medium/high-complexity scores. For every unit increase in Enhanced Recovery After Surgery guideline score, the odds of total complications were estimated to be 12% lower (P<.05) among low-complexity patients. CONCLUSION Audit of surgical practices demonstrates that improved compliance with Enhanced Recovery After Surgery Gynecologic/Oncology guidelines is associated with an improvement in clinical outcomes, including length of stay, highlighting the importance of Enhanced Recovery After Surgery implementation.
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Affiliation(s)
- Lena Wijk
- Department of Obstetrics and Gynecology, Örebro University Hospital, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Sweden.
| | - Ruzan Udumyan
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Sweden
| | - Basile Pache
- Department of Obstetrics and Gynecology, Lausanne University Hospital, Lausanne, Switzerland
| | - Alon D Altman
- Winnipeg Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Laura L Williams
- Gynecologic Oncology of Middle Tennessee, HCA Centennial Hospital, Nashville, TN
| | - Kevin M Elias
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Jake McGee
- London Health Sciences Centre, London, ON, Canada
| | | | | | - Kevin Holcomb
- Clinical Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY
| | - Chahin Achtari
- Gynecology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Olle Ljungqvist
- Department of Surgery, Örebro University Hospital, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Sweden
| | - Sean C Dowdy
- Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN
| | - Gregg Nelson
- Division of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
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Evans D, Goldstein S, Loewy A, Altman AD. No 385 - Indications de l'examen pelvien. Journal of Obstetrics and Gynaecology Canada 2019; 41:1235-1250. [DOI: 10.1016/j.jogc.2019.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kean SL, Altman AD. Uterine Inversion as a Result of a Large Prolapsed Carcinosarcoma of the Uterus. J Obstet Gynaecol Can 2019; 41:1181-1184. [PMID: 30686610 DOI: 10.1016/j.jogc.2018.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Uterine inversion is most commonly seen in labour and delivery. However, it can be associated with uterine tumours, including gynaecologic malignancy. CASE In a 66-year-old woman, uterine inversion identified at laparotomy that was found to be associated with uterine carcinosarcoma (malignant mixed mesodermal tumour) represents an unusual presentation. Surgical approach necessitated a vertical hysterotomy to amputate and deliver the uterine tumour. CONCLUSION Uterine inversion in gynaecologic oncology may be associated with sarcoma or malignant mixed mesodermal tumour. This can represent a diagnostic and surgical challenge and should be considered.
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Affiliation(s)
- Sarah L Kean
- Department of Obstetrics, Gynecology, and Reproductive Science, University of Manitoba, Winnipeg, MB.
| | - Alon D Altman
- Department of Obstetrics, Gynecology, and Reproductive Science, University of Manitoba, Winnipeg, MB
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McCuaig JM, Stockley TL, Shaw P, Fung-Kee-Fung M, Altman AD, Bentley J, Bernardini MQ, Cormier B, Hirte H, Kieser K, MacMillan A, Meschino WS, Panabaker K, Perrier R, Provencher D, Schrader KA, Serfas K, Tomiak E, Wong N, Young SS, Gotlieb WH, Hoskins P, Kim RH. Evolution of genetic assessment for BRCA-associated gynaecologic malignancies: a Canadian multisociety roadmap. J Med Genet 2018; 55:571-577. [PMID: 30042185 PMCID: PMC6119348 DOI: 10.1136/jmedgenet-2018-105472] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/18/2018] [Accepted: 07/02/2018] [Indexed: 01/21/2023]
Abstract
The landscape of genetic testing in ovarian cancer patients has changed dramatically in recent years. The therapeutic benefits of poly ADP-ribose polymerase (PARP) inhibitors in treatment of BRCA1/2-related ovarian cancers has resulted in an increased demand and urgency for genetic testing results, while technological developments have led to widespread use of multi-gene cancer panels and development of tumour testing protocols. Traditional genetic counselling models are no longer sustainable and must evolve to match the rapid evolution of genetic testing technologies and developments in personalized medicine. Recently, representatives from oncology, clinical genetics, molecular genetics, pathology, and patient advocacy came together to create a national multi-disciplinary Canadian consortium. By aligning stakeholder interests, the BRCA Testing to Treatment (BRCA TtoT) Community of Practice aims to develop a national strategy for tumour and germline BRCA1/2 testing and genetic counselling in women with ovarian cancer. This article serves to provide an overview of the recent evolution of genetic assessment for BRCA1/2-associated gynecologic malignancies and outline a Canadian roadmap to facilitate change, improve genetic testing rates, and ultimately improve outcomes for hereditary ovarian cancer patients and their families.
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Affiliation(s)
- Jeanna M McCuaig
- Familial Breast & Ovarian Cancer Clinic, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Tracy L Stockley
- Division of Clinical Laboratory Genetics and Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Shaw
- Department of Pathology, University Health Network, Toronto, Ontario, Canada
| | - Michael Fung-Kee-Fung
- Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Alon D Altman
- Department of Gynecologic Oncology, University of Manitoba, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - James Bentley
- Department of Obstetrics and Gynecology, Nova Scotia Health Authority, Halifix, Nova Scotia, Canada
| | - Marcus Q Bernardini
- Department of Gynecologic Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Beatrice Cormier
- Department of Obstetrics and Gynecology, Université de Montreal, Montreal, Quebec, Canada
| | - Hal Hirte
- Department of Gynecologic Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Katharina Kieser
- Department of Gynecologic Oncology, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Andree MacMillan
- Provincial Medical Genetics Program, Eastern Health, St John's, Newfoundland and Labrador, Canada
| | - Wendy S Meschino
- Department of Genetics, North York General Hospital, Toronto, Ontario, Canada
| | - Karen Panabaker
- Medical Genetics Program of Southwestern Ontario, London Health Sciences Centre, London, Ontario, Canada
| | - Renee Perrier
- Department of Medical Genetics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Diane Provencher
- Department of Obstetrics and Gynecology, Université de Montreal, Montreal, Quebec, Canada
| | - Kasmintan A Schrader
- Hereditary Cancer Program, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Kimberly Serfas
- Department of Genetics and Metabolism, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Eva Tomiak
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Nora Wong
- Department of Medical Genetics, CIUSSS West-Central Montreal Jewish General Hospital, Montreal, Canada
| | - Sean S Young
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Walter Henri Gotlieb
- Department of Gynecologic Oncology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Paul Hoskins
- Department of Gynecologic Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Raymond H Kim
- Familial Breast & Ovarian Cancer Clinic, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Mayba J, Lambert P, Turner D, Lotocki R, Dean E, Popowich S, Altman AD, Nachtigal MW. Examining the Selection Criteria of Neoadjuvant Chemotherapy Patients. J Obstet Gynaecol Can 2017; 40:595-603. [PMID: 29276164 DOI: 10.1016/j.jogc.2017.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 09/18/2017] [Accepted: 09/19/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To identify predictors of neoadjuvant chemotherapy (NAC) and to examine toxicities, dose reduction, interruptions, and second-line chemotherapy MATERIALS AND METHODS: A retrospective chart review of 391 patients with late-stage ovarian cancer diagnosed between January 1, 2004 and December 31, 2010 was conducted. Logistic regression was used to predict chemotherapy type. Cumulative incidence of toxicities, dose reduction, and treatment interruption were calculated using the Kaplan-Meier method. Overall survival was analyzed using time-varying Cox regression models. A competing risk model was used to predict second-line chemotherapy with death as a competing risk. RESULTS Older patients were less likely to receive primary debulking (OR 0.710; 95% CI 0.55-0.92, P = 0.0108), as were patients with longer diagnostic intervals. Clear-cell, endometrioid, and mucinous carcinoma were more likely to receive adjuvant treatment than unclassified epithelial (OR 6.964; 95% CI 2.02-24.03, P = 0.0021). Adjuvant patients experienced higher incidence of chemotherapy toxicities (P <0.0001) and treatment interruption (P = 0.016) at 3 months. There was no statistically significant difference in the incidence of chemotherapy dose reduction of >20% in the NAC and adjuvant populations (P = 0.142). Neoadjuvant patients were more likely to require more than one line of chemotherapy ([Subhazard Ratio] = 4.334; 95% CI 2.51-7.50, P <0.0001). CONCLUSION Our study found that patients with shorter diagnostic intervals, more advanced age, and unclassified epithelial histotype were more likely to receive NAC. NAC patients did not experience a higher incidence of chemotherapy toxicities, treatment interruption, or dose reduction. There is treatment selection bias for sicker patients being treated with NAC.
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Affiliation(s)
- Julia Mayba
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
| | - Pascal Lambert
- CancerCare Manitoba Department of Epidemiology, Winnipeg, MB
| | - Donna Turner
- CancerCare Manitoba Department of Epidemiology, Winnipeg, MB
| | - Robert Lotocki
- Department of Obstetrics Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB; CancerCare Manitoba Division of Gynecologic Oncology, Winnipeg, MB
| | - Erin Dean
- Department of Obstetrics Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB; CancerCare Manitoba Division of Gynecologic Oncology, Winnipeg, MB
| | - Shaundra Popowich
- Department of Obstetrics Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB; CancerCare Manitoba Division of Gynecologic Oncology, Winnipeg, MB
| | - Alon D Altman
- Department of Obstetrics Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB; CancerCare Manitoba Division of Gynecologic Oncology, Winnipeg, MB.
| | - Mark W Nachtigal
- Department of Obstetrics Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB; CancerCare Manitoba Division of Gynecologic Oncology, Winnipeg, MB; Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB; CancerCare Manitoba Research Institute in Oncology and Hematology, Winnipeg, MB
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Altman AD, Lefas G, Power L, Lambert P, Lotocki R, Dean E, Nachtigal MW. Rate of Appendiceal Metastasis with Non-Serous Epithelial Ovarian Cancer in Manitoba. J Obstet Gynaecol Can 2017; 40:180-185. [PMID: 28826644 DOI: 10.1016/j.jogc.2017.05.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/24/2017] [Accepted: 05/31/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study sought to evaluate the rate of appendiceal involvement in non-serous mucinous and endometrioid-associated epithelial ovarian cancers. METHODS The Manitoba Cancer Registry and CancerCare database were used to find all women with non-serous epithelial ovarian, fallopian tube, or primary peritoneal cancer between 1995 and 2011. All patients with an appendectomy were then identified, and their final pathology findings were reviewed. Women who did not receive treatment or lacked follow-up were excluded. RESULTS We identified 338 patients from 1995-2011 with no prior appendectomy. Of these, 16.6% received an appendectomy, and 22.8% were clinically evaluated. Most cases within this cohort were mucinous (62%) and stage 1 (63%). Four appendiceal metastases were identified (7.2%), and one half appeared clinically normal at the time of surgery (3.6%). Within the mucinous histologic type, 32.7% of patients received an appendectomy, with a metastatic rate of 5.7%. Of the 127 endometrioid cases, only 10 patients received an appendectomy, and 2 were found to have metastases. No metastases were found in the 85 patients in the clear cell cohort, only 5 of whom received an appendectomy. CONCLUSION Routine appendectomy or clinical assessment of the appendix is valuable for all non-serous ovarian cancers. The rate of involvement for endometriosis-associated ovarian cancers may be significantly higher than expected, and further studies need to be conducted.
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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.
| | - Georgia Lefas
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB
| | - Laura Power
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB
| | - Pascal Lambert
- Department of Epidemiology, CancerCare Manitoba, Winnipeg, MB
| | - Robert Lotocki
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB; Division of Gynecologic Oncology, 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
| | - 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
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Raizman Z, Hosseini B, Kean S, Altman AD. Paraneoplastic myositis secondary to poorly differentiated serous carcinoma of ovarian/tubal origin. Gynecol Oncol Rep 2017; 20:112-114. [PMID: 28435850 PMCID: PMC5390659 DOI: 10.1016/j.gore.2017.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 03/24/2017] [Accepted: 04/04/2017] [Indexed: 11/28/2022] Open
Abstract
Ovarian cancer can present as paraneoplastic myositis. Presented with progressive weakness unresponsive to treatment with glucocorticoids Imaging revealed bilateral ovarian masses, myositis resolved after surgery. Ovarian cancer should be included on the differential diagnosis of a patient presenting with myositis.
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Affiliation(s)
- Zachary Raizman
- Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Boshra Hosseini
- Department of Obstetrics Gynecology and Reproductive Sciences, University of Manitoba, Canada
| | - Sarah Kean
- Cancer Care Manitoba, Division of Gynecologic Oncology, Manitoba, Canada
| | - Alon D Altman
- Department of Obstetrics Gynecology and Reproductive Sciences, University of Manitoba, Canada.,Cancer Care Manitoba, Division of Gynecologic Oncology, Manitoba, Canada
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Penner-Goeke S, Lichtensztejn Z, Neufeld M, Ali JL, Altman AD, Nachtigal MW, McManus KJ. The temporal dynamics of chromosome instability in ovarian cancer cell lines and primary patient samples. PLoS Genet 2017; 13:e1006707. [PMID: 28376088 PMCID: PMC5395197 DOI: 10.1371/journal.pgen.1006707] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 04/18/2017] [Accepted: 03/20/2017] [Indexed: 01/12/2023] Open
Abstract
Epithelial ovarian cancer (EOC) is the most prevalent form of ovarian cancer and has the highest mortality rate. Novel insight into EOC is required to minimize the morbidity and mortality rates caused by recurrent, drug resistant disease. Although numerous studies have evaluated genome instability in EOC, none have addressed the putative role chromosome instability (CIN) has in disease progression and drug resistance. CIN is defined as an increase in the rate at which whole chromosomes or large parts thereof are gained or lost, and can only be evaluated using approaches capable of characterizing genetic or chromosomal heterogeneity within populations of cells. Although CIN is associated with numerous cancer types, its prevalence and dynamics in EOC is unknown. In this study, we assessed CIN within serial samples collected from the ascites of five EOC patients, and in two well-established ovarian cancer cell models of drug resistance (PEO1/4 and A2780s/cp). We quantified and compared CIN (as measured by nuclear areas and CIN Score (CS) values) within and between serial samples to glean insight into the association and dynamics of CIN within EOC, with a particular focus on resistant and recurrent disease. Using quantitative, single cell analyses we determined that CIN is associated with every sample evaluated and further show that many EOC samples exhibit a large degree of nuclear size and CS value heterogeneity. We also show that CIN is dynamic and generally increases within resistant disease. Finally, we show that both drug resistance models (PEO1/4 and A2780s/cp) exhibit heterogeneity, albeit to a much lesser extent. Surprisingly, the two cell line models exhibit remarkably similar levels of CIN, as the nuclear areas and CS values are largely overlapping between the corresponding paired lines. Accordingly, these data suggest CIN may represent a novel biomarker capable of monitoring changes in EOC progression associated with drug resistance.
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Affiliation(s)
- Signe Penner-Goeke
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Zelda Lichtensztejn
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Megan Neufeld
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer L. Ali
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alon D. Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mark W. Nachtigal
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kirk J. McManus
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
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Love AJ, Lambert P, Turner D, Lotocki R, Dean E, Popowich S, Altman AD, Nachtigal MW. Diagnostic and referral intervals for Manitoba women with epithelial ovarian cancer - the Manitoba Ovarian Cancer Outcomes (MOCO) study group: a retrospective cross-sectional study. CMAJ Open 2017; 5:E116-E122. [PMID: 28401127 PMCID: PMC5378539 DOI: 10.9778/cmajo.20160100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Epithelial ovarian cancer has the highest mortality of all gynecologic cancers. The poor survival rates are often attributed to the advanced stage at which most of these cancers are detected. We sought to examine the effects of patient demographics, comorbidities and presenting symptoms on diagnostic and referral intervals by location of first presentation (emergency department v. elsewhere) and to identify factors that affect these intervals. METHODS We performed a retrospective analysis of chart and medical record data for ovarian cancers, with the exceptions of sex cord and germ cell tumours, diagnosed between 2004 and 2010 in Manitoba, Canada. Data were collected on baseline characteristics, time to diagnosis and referral, number and type of physician visits and emergency department visits. RESULTS The final cohort consisted of 601 patients. Sixty-three percent of patients received their diagnosis within 60 days of initial presentation, and 75.2% had their cancer diagnosed within 2 physician encounters. The median diagnostic interval for all stages of patients presenting to the emergency department was 7 days, compared with 55 days for patients presenting elsewhere. Early stage patients not presenting to the emergency department had their diagnosis a median of 34.0 days later than patients with advanced disease (95% confidence interval [CI] 22.22 to 45.69, p < 0.0001). The presence of some symptoms was associated with shortened diagnostic intervals. Patients with serous, clear-cell or endometrioid histotypes were less likely to have first presentation beginning in the emergency department (odds ratio [OR] 0.40, 95% CI 0.24 to 0.64, p = 0.0001; OR 0.28, 95% CI 0.14 to 0.59, p = 0.007) than those with unclassified epithelial histotype. INTERPRETATION For this group of patients, the main factor associated with diagnostic and referral intervals is presentation to the emergency department. These patients likely required more urgent attention for their more symptomatic disease, leading to quicker diagnosis and referral patterns, despite poorer prognosis.
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Affiliation(s)
- Allison J Love
- University of Manitoba (Love), Max Rady College of Medicine; Department of Epidemiology (Lambert, Turner), CancerCare Manitoba; Department of Obstetrics Gynecology and Reproductive Sciences (Lotocki, Dean, Popowich, Altman, Nachtigal) University of Manitoba; Division of Gynecologic Oncology (Lotocki, Dean, Popowich, Altman) CancerCare Manitoba; Department of Biochemistry and Medical Genetics (Nachtigal), University of Manitoba; Research Institute in Oncology and Hematology (Nachtigal), CancerCare Manitoba, Winnipeg, Man
| | - Pascal Lambert
- University of Manitoba (Love), Max Rady College of Medicine; Department of Epidemiology (Lambert, Turner), CancerCare Manitoba; Department of Obstetrics Gynecology and Reproductive Sciences (Lotocki, Dean, Popowich, Altman, Nachtigal) University of Manitoba; Division of Gynecologic Oncology (Lotocki, Dean, Popowich, Altman) CancerCare Manitoba; Department of Biochemistry and Medical Genetics (Nachtigal), University of Manitoba; Research Institute in Oncology and Hematology (Nachtigal), CancerCare Manitoba, Winnipeg, Man
| | - Donna Turner
- University of Manitoba (Love), Max Rady College of Medicine; Department of Epidemiology (Lambert, Turner), CancerCare Manitoba; Department of Obstetrics Gynecology and Reproductive Sciences (Lotocki, Dean, Popowich, Altman, Nachtigal) University of Manitoba; Division of Gynecologic Oncology (Lotocki, Dean, Popowich, Altman) CancerCare Manitoba; Department of Biochemistry and Medical Genetics (Nachtigal), University of Manitoba; Research Institute in Oncology and Hematology (Nachtigal), CancerCare Manitoba, Winnipeg, Man
| | - Robert Lotocki
- University of Manitoba (Love), Max Rady College of Medicine; Department of Epidemiology (Lambert, Turner), CancerCare Manitoba; Department of Obstetrics Gynecology and Reproductive Sciences (Lotocki, Dean, Popowich, Altman, Nachtigal) University of Manitoba; Division of Gynecologic Oncology (Lotocki, Dean, Popowich, Altman) CancerCare Manitoba; Department of Biochemistry and Medical Genetics (Nachtigal), University of Manitoba; Research Institute in Oncology and Hematology (Nachtigal), CancerCare Manitoba, Winnipeg, Man
| | - Erin Dean
- University of Manitoba (Love), Max Rady College of Medicine; Department of Epidemiology (Lambert, Turner), CancerCare Manitoba; Department of Obstetrics Gynecology and Reproductive Sciences (Lotocki, Dean, Popowich, Altman, Nachtigal) University of Manitoba; Division of Gynecologic Oncology (Lotocki, Dean, Popowich, Altman) CancerCare Manitoba; Department of Biochemistry and Medical Genetics (Nachtigal), University of Manitoba; Research Institute in Oncology and Hematology (Nachtigal), CancerCare Manitoba, Winnipeg, Man
| | - Shaundra Popowich
- University of Manitoba (Love), Max Rady College of Medicine; Department of Epidemiology (Lambert, Turner), CancerCare Manitoba; Department of Obstetrics Gynecology and Reproductive Sciences (Lotocki, Dean, Popowich, Altman, Nachtigal) University of Manitoba; Division of Gynecologic Oncology (Lotocki, Dean, Popowich, Altman) CancerCare Manitoba; Department of Biochemistry and Medical Genetics (Nachtigal), University of Manitoba; Research Institute in Oncology and Hematology (Nachtigal), CancerCare Manitoba, Winnipeg, Man
| | - Alon D Altman
- University of Manitoba (Love), Max Rady College of Medicine; Department of Epidemiology (Lambert, Turner), CancerCare Manitoba; Department of Obstetrics Gynecology and Reproductive Sciences (Lotocki, Dean, Popowich, Altman, Nachtigal) University of Manitoba; Division of Gynecologic Oncology (Lotocki, Dean, Popowich, Altman) CancerCare Manitoba; Department of Biochemistry and Medical Genetics (Nachtigal), University of Manitoba; Research Institute in Oncology and Hematology (Nachtigal), CancerCare Manitoba, Winnipeg, Man
| | - Mark W Nachtigal
- University of Manitoba (Love), Max Rady College of Medicine; Department of Epidemiology (Lambert, Turner), CancerCare Manitoba; Department of Obstetrics Gynecology and Reproductive Sciences (Lotocki, Dean, Popowich, Altman, Nachtigal) University of Manitoba; Division of Gynecologic Oncology (Lotocki, Dean, Popowich, Altman) CancerCare Manitoba; Department of Biochemistry and Medical Genetics (Nachtigal), University of Manitoba; Research Institute in Oncology and Hematology (Nachtigal), CancerCare Manitoba, Winnipeg, Man
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Altman AD, Nelson GS. The Canadian Gynaecologic Oncology Perioperative Management Survey: Baseline Practice Prior to Implementation of Enhanced Recovery After Surgery (ERAS) Society Guidelines. Journal of Obstetrics and Gynaecology Canada 2016; 38:1105-1109.e2. [DOI: 10.1016/j.jogc.2016.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 09/12/2016] [Indexed: 12/28/2022]
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Bernardini MQ, Gien LT, Lau S, Altman AD, Gilks B, Ferguson SE, Köbel M, Samouëlian V, Wesa M, Cameron A, Nelson G, Han G, Clarke B, Ho TC, Panzarella T, Atenafu EG, McAlpine JN. Treatment related outcomes in high-risk endometrial carcinoma: Canadian high risk endometrial cancer consortium (CHREC). Gynecol Oncol 2016; 141:148-54. [PMID: 26854651 DOI: 10.1016/j.ygyno.2016.02.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/02/2016] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The lack of randomized clinical data pertaining to optimal surgery and adjuvant treatment in women with high-risk histotypes of endometrial cancer has resulted in selective management based on institutional policies. The objective of this study was to assess differences in treatment strategies and their outcomes among various institutions. METHOD High-risk endometrial cancer cases (2000-2012) with corresponding clinicopathologic data were collected from 7 academic cancer centers. Histotypes included grade 3 endometrioid (EC3), serous (ESC), clear cell (CCC) and carcinosarcoma (CS). Associations with overall survival were performed using Cox proportional hazard regression. RESULTS 1260 patients treated between 2000 and 2012 were included in the study: 398 EC3, 449 ESC, 91 CCC, 236 CS and 83 'other'. The use of adjuvant chemotherapy, adjuvant radiation, and extent of surgical staging were statistically different among the 7 centers (P<0.001). Histotype was independently associated with overall survival (OS) in patients with stage 1 and 2 disease who underwent surgical staging (P=0.0324). Adjuvant radiation was associated with improved OS for EC3 and CCC and adjuvant chemotherapy was associated with improved OS for ESC and CS. There was a high rate of recurrence (17.8% and 21.4%) in completely staged, stage 1A patients with ESC and CS respectively. CONCLUSION There exists a wide variation in practice and outcomes for high-risk histotypes of endometrial cancer. The relative impact of adjuvant therapy appears to be histotype dependent and prospective studies examining adjuvant treatment in high-risk histotypes should use caution combining them together.
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Affiliation(s)
| | - Lilian T Gien
- Division of Gynecologic Oncology, University of Toronto, Canada
| | - Susie Lau
- Division of Gynecologic Oncology, McGill University, Canada
| | - Alon D Altman
- Division of Gynecologic Oncology, University of Manitoba, Canada
| | - Blake Gilks
- Department of Pathology and Laboratory Medicine, University of British Columbia, Canada
| | | | - Martin Köbel
- Department of Pathology and Laboratory Medicine, University of Calgary, Canada
| | | | - Mina Wesa
- Division of Gynecologic Oncology, University of British Columbia, Canada
| | - Anna Cameron
- Division of Gynecologic Oncology, University of Calgary, Canada
| | - Gregg Nelson
- Division of Gynecologic Oncology, University of Calgary, Canada
| | - Guangming Han
- Department of Pathology and Laboratory Medicine, University of Toronto, Canada
| | - Blaise Clarke
- Department of Pathology and Laboratory Medicine, University of Toronto, Canada
| | - T C Ho
- Division of Gynecologic Oncology, University of Toronto, Canada
| | - Tony Panzarella
- Biostatistics Department, Princess Margaret Cancer Centre, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Canada
| | - Eshetu G Atenafu
- Biostatistics Department, Princess Margaret Cancer Centre, Canada
| | - Jessica N McAlpine
- Division of Gynecologic Oncology, University of British Columbia, Canada
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Altman AD, Bentley JR, Rittenberg PV, Murray SK. Luteinized Thecomas (“Thecomatosis”) with Sclerosing Peritonitis (LTSP): Report of 2 Cases and Review of an Enigmatic Syndrome Associated with a Peritoneal Proliferation of Specialized (vimentin+/keratin+/CD34+) Submesothelial Fibroblasts. Journal of Obstetrics and Gynaecology Canada 2016; 38:41-50. [DOI: 10.1016/j.jogc.2015.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 07/25/2015] [Indexed: 01/09/2023]
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Al Wazzan A, Popowich S, Dean E, Robinson C, Lotocki R, Altman AD. Malignant transformation of mature cystic teratoma of the ovary: 30-year experience of a single tertiary care center. EUR J GYNAECOL ONCOL 2016; 37:809-813. [PMID: 29943926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To review the authors' experience with this rare disease and describe their management modality and the outcome. MATERIAL AND METHODS From January 1983 to December 2013, 13 patients with malignant transformation arising in ovarian MCT were treated at the Division of Gynecologic Oncology in the University of Manitoba. Demographic characteristics, symptoms, signs, stage, mode of therapy, and results of follow-up were reviewed retrospectively. RESULTS Median age at diagnosis was 53 years (range 25-65). The most common presenting symptom was a palpable mass in nine cases. Squamous cell carcinoma (SCC) was found in 38% (five cases), adenocarcinoma in 15% (two cases), anaplastic carcinoma in 8% (one case), and papillary thyroid carcinoma in 38% (five cases). Eight cases were Stage I, two cases were Stage II, and three cases were Stage III. All patients underwent surgery. Five patients received adjuvant treatment with platinum-based chemotherapy + pelvic radiation. Four patients had recurrent disease (two SCC and two adenocarcinoma). Three patients died of disease after recurrence. The median follow up period of the entire patient population was 60 months, with a three-year overall survival of 76%. CONCLUSION Malignant transformation of MCT is large ovarian tumors that mainly occur in patients in their fifth and sixth decades of life. They often present as incidental pathologic findings after surgery for MCT. SCC has traditionally been the most common pathology, however in the present series, the authors found that papillary thyroid carcinoma was equally common. Platinum-based chemotherapy with pelvic radiation in early stage (including Stage IA) and locally recurrent dis- ease should be offered. Advanced stages and mucinous adenocarcinoma represent a poorer prognosis despite adjuvant treatment. In patients with papillary thyroid carcinoma, conservative surveillance in early stage and adjuvant total thyroidectomy with radioactive iodine treatment in advanced stage disease appears to be an effective treatment.
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Abstract
BACKGROUND Uterine rupture is a tear in the uterine wall involving its full thickness, resulting in the formation of a defect in the uterine wall. The major risk factor is the presence of uterine scarring (specifically from Caesarean section), but it can also occur in an unscarred uterus. Although rare, this has been shown to result in more severe complications. CASE A 31-year-old woman, gravida 6 para 6, without prior uterine incision or manipulation developed significant postpartum bleeding. She was found to have a uterine rupture with retroperitoneal extension, and surgical management was required. CONCLUSION Early diagnosis of uterine rupture with rapid initiation of supportive and surgical care may significantly improve prognosis. It is imperative to consider uterine rupture in any obstetrical patient with hemodynamic instability or hemorrhage, regardless of whether risk factors (including a previous uterine scar) are present.
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Affiliation(s)
- Olga Haakman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg MB
| | - Devon Ambrose
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg MB
| | - Christina Katopodis
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg MB
| | - Alon D Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg MB; Division of Gynecologic Oncology, University of Manitoba, Winnipeg MB
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Altman AD, Ferguson SE, Atenafu EG, Köbel M, McAlpine JN, Panzarella T, Lau S, Gien LT, Gilks B, Clarke B, Cameron A, Nelson G, Han G, Samouëlian V, Ho TC, Louie K, Bernardini MQ. Canadian high risk endometrial cancer (CHREC) consortium: analyzing the clinical behavior of high risk endometrial cancers. Gynecol Oncol 2015; 139:268-74. [PMID: 26352641 DOI: 10.1016/j.ygyno.2015.09.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/01/2015] [Accepted: 09/03/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The objective of this study is to analyze the clinical behavior of endometrial carcinomas by high risk(HR) histotype, including stage, overall survival, recurrence free survival and patterns of failure. METHODS This is a retrospective multi-institutional cohort study performed at 7 tertiary care centers across Canada between 2000 and 2012 and included: grade 3 endometrioid (EC3), endometrial serous cancer (ESC), clear cell carcinomas (CCC) and carcinosarcoma (CS). Clinicopathological and outcome data was collected. RESULTS 1260 women with endometrial carcinoma with 1013 having staging procedures were identified; 398 EC3, 449 ESC, 236 CS and 91 CCC. 51.8% had lymphovascular space invasion (LVSI) and 18.5% had omental involvement with a statistically significant difference between tumor types (p=0.0005 and 0.0047 respectively); ESC had a significantly greater rate of omental involvement compared to EC3 (22% to 9%, p=0.0005). Within the entire cohort 49.3% were stage 1, 10.6% were stage 2, 27.4% were stage 3 and 12.7% were stage 4. Overall survival and recurrence free survival were significantly different between histotypes (p<0.0001) with CS having the worst outcome. Overall 31.5% of patients recurred. CS and ESC had a higher distant recurrence rate compared to EC3 (29.6%, 31.0% compared to 16.4%, p=0.0002 and p<0.001). CONCLUSION This study is one of the largest clinical cohorts of HR endometrial cancers. We have further clarified the impact of histotype and stage on recurrence and survival, and the high likelihood of distant recurrence. However, the differences are modest and risk prediction models will require additional molecular markers.
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Affiliation(s)
- Alon D Altman
- Division of Gynecologic Oncology, University of Manitoba, Canada
| | | | - Eshetu G Atenafu
- Biostatistics Department, Princess Margaret Cancer Centre, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Canada
| | - Martin Köbel
- Department of Pathology and Laboratory Medicine, University of Calgary, Canada
| | - Jessica N McAlpine
- Division of Gynecologic Oncology, CHUM-Hôpital Notre-Dame, Canada; Division of Gynecologic Oncology, University of British Columbia, Canada
| | - Tony Panzarella
- Biostatistics Department, Princess Margaret Cancer Centre, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Canada
| | - Susie Lau
- Division of Gynecologic Oncology, McGill University, Canada
| | - Lilian T Gien
- Division of Gynecologic Oncology, University of Toronto, Canada
| | - Blake Gilks
- Division of Anatomic Pathology, University of British Columbia, Canada
| | - Blaise Clarke
- Department of Pathology and Laboratory Medicine, University of Toronto, Canada
| | - Anna Cameron
- Division of Gynecologic Oncology, University of Manitoba, Canada
| | - Gregg Nelson
- Division of Gynecologic Oncology, University of Calgary, Canada
| | - Guangming Han
- Department of Pathology and Laboratory Medicine, University of Toronto, Canada
| | | | - T C Ho
- Division of Gynecologic Oncology, University of Toronto, Canada
| | - Kim Louie
- Division of Obstetrics and Gynecology, University of British Columbia, Canada
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Vair B, Altman AD, Nelson G. Time to surgery and the risk of cancer progression in patients with gynaecologic cancers of the lower genital tract. J Obstet Gynaecol Can 2015; 37:338-44. [PMID: 26001687 DOI: 10.1016/s1701-2163(15)30284-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE There is little current evidence to define an appropriate surgical wait time in patients with cancer. The aim of this study was to examine whether increased time to surgery in patients with early-stage lower genital tract cancers resulted in a risk of cancer progression. METHODS We conducted a population-based retrospective cohort study of women presenting with stage I squamous cell carcinoma of the cervix, vulva, and vagina and undergoing surgical treatment in Calgary, Alberta between 2000 and 2010. Cancer stage and disease characteristics were compared at two time points: the time of initial presentation to the gynaecologic oncology service and the time of surgery. RESULTS One hundred fifty-six patients met the inclusion criteria. There was progression of cancer stage in 10 cases (6.4%). In keeping with the current wait time targets, time to surgery was categorized as ≤ 28 days (59 patients; 38%) and > 28 days (97 patients; 62%). Progression occurred in seven of the 123 cases of cervical cancer (9%). In all seven cases, time to surgery was > 28 days (P = 0.095). None of the three cases of vaginal cancer had disease progression. Progression occurred in three (10%) of the 30 cases of vulvar cancer. In two of these three cases, time to surgery was > 28 days (P = 0.586). The relative risk for disease progression with prolonged time to surgery for all women in the cohort was 5.5 (95% CI 0.7 to 42.1) (P = 0.091). CONCLUSION In patients with early squamous cell carcinoma of the lower genital tract, increased time to surgery (> 28 days) is not associated with cancer progression.
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Affiliation(s)
- Brett Vair
- Department of Obstetrics and Gynecology, University of Calgary, Calgary AB
| | - Alon D Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Manitoba, Winnipeg MB
| | - Gregg Nelson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Calgary, Calgary AB
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Altman AD, Thompson J, Nelson G, Chu P, Nation J, Ghatage P. Use of aromatase inhibitors as first- and second-line medical therapy in patients with endometrial adenocarcinoma: a retrospective study. J Obstet Gynaecol Can 2014; 34:664-72. [PMID: 22742486 DOI: 10.1016/s1701-2163(16)35320-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The primary objective of this study was to examine the role of aromatase inhibitors (AIs) as first- or second-line medical treatment in women with endometrial adenocarcinoma who were not candidates for surgical management. The secondary objective was to examine the role of AIs in adjuvant and palliative treatment. METHODS Thirty women with endometrial adenocarcinoma who were treated with aromatase inhibitors between 2000 and 2010 at the Tom Baker Cancer Centre in Calgary, Alberta were assessed in a retrospective analysis. Disease response was based on response evaluation criteria in solid tumours. Kruskal-Wallis test was used to compare non-parametric variables and Fisher exact test was used to compare the health variables. RESULTS Seventeen patients received AIs as first- or second-line medical treatment, five received adjuvant therapy, and eight received palliative treatment. The median age of patients in the first or second line medical treatment group was significantly greater than that of patients in the adjuvant or palliative group (P = 0.042). There was no significant difference in median weight or body mass index. The subjective clinical response rate with medical treatment was 70%. In the first- or second-line medical treatment group, only seven patients had available response data. Our study showed stable disease in 5/7 (71%), partial response in 1/7 (14%), and progression in 1/7 (14%) patients. CONCLUSION This retrospective clinical series examining use of an aromatase inhibitor as first- or second-line medical therapy in women with endometrial carcinoma showed that AIs are a potential treatment for patients who have a contraindication to surgery and who either have failed or cannot use megestrol therapy.
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Affiliation(s)
- Alon D Altman
- Winnipeg Health Science Centre, CancerCare Manitoba, Gynecologic Oncology, Winnipeg MB
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Altman AD, Nelson GS, Ghatage P, McIntyre JB, Capper D, Chu P, Nation JG, Karnezis AN, Han G, Kalloger SE, Köbel M. The diagnostic utility of TP53 and CDKN2A to distinguish ovarian high-grade serous carcinoma from low-grade serous ovarian tumors. Mod Pathol 2013; 26:1255-63. [PMID: 23558569 DOI: 10.1038/modpathol.2013.55] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 02/11/2013] [Accepted: 02/12/2013] [Indexed: 01/24/2023]
Abstract
Low-grade serous carcinomas and serous borderline tumors, combined herein and referred to as low-grade serous tumors, show distinct molecular alterations and clinical behaviors compared with high-grade serous carcinomas. The discrimination between low-grade serous tumors and high-grade serous carcinomas can be challenging on small tissue samples, such as cell blocks of paracentesis fluid or biopsies from omental disease. The purpose of this study was to test the ability of TP53 and CDKN2A immunohistochemistry to distinguish between high-grade serous carcinomas and low-grade serous tumors on small tissue samples. Tissue microarrays containing 582 high-grade serous carcinomas, 45 low-grade serous carcinomas, and 49 serous borderline tumors, confirmed by contemporary histopathological review, were stained for TP53 and CDKN2A (DO7 and E6H4 antibody clones, respectively). TP53 was scored as completely absent, wild-type pattern or overexpressed (>60%), and CDKN2A was scored as either negative/patchy (<90%) or block expression (>90%). The combination of the two markers, ie, the TP53 wild-type pattern and CDKN2A patchy expression, had sensitivity for low-grade serous tumors of 89%, a specificity of 93%, a positive predictive value of 68%, and a negative predictive value of 98%. These markers can, therefore, be used on small biopsies/cell blocks to refute a diagnosis of low-grade serous tumors. These findings may inform emerging neoadjuvant therapeutic strategies in advanced ovarian cancers and may be crucial for future clinical trials on molecular-based therapies.
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Affiliation(s)
- Alon D Altman
- Department of Obstetrics and Gynecology, Division of Gynecological Oncology, Winnipeg Health Sciences Center, University of Manitoba, Winnipeg, MB, Canada
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Abstract
Objective This retrospective study of all women who accessed the 2006 Manitoba Pap Test Week clinics was designed to determine factors associated with inadequate cervical cancer screening and changes in cervical cancer screening behavior. Methods Data were acquired using the CervixCheck Manitoba registry and an ancillary database of demographic information collected from clinic attendees. Results The study included 1124 women. Of these, 53% (n = 598) were under-screened (no Pap test in the previous 2 years) prior to accessing the clinics. Logistic regression analyses demonstrated that older age (odds ratio [OR] = 1.02, 95% confidence interval [CI] 1.01–1.03), no doctor (OR = 1.4, 95% CI 1.05–1.54), and living in Canada < 1 year (OR = 5.5, 95% CI 2.73–11.12) were associated with being under-screened prior to accessing the Pap Test Week clinics. Thirty-seven percent (n = 223) of under-screened women demonstrated improved screening status subsequent to the 2006 Pap Test Week (had a subsequent Papanicolaou [Pap] test performed within 2 years) and these women were more likely to live in an urban setting (P = 0.003), be younger (P < 0.001), originate outside Canada (P = 0.006), have lived in Canada for less than 1 year (P = 0.006), and have had an abnormal Pap test result in 2006 (P < 0.001). Previously under-screened women were less likely to become adequately-screened subsequent to 2006 if they had a Pap test performed at a Pap Test Week clinic compared to having a Pap test performed elsewhere (37% versus 60%, P < 0.001). Conclusion This study identified a subset of under-screened women accessing Pap Test Week clinics whose screening status might be most modifiable.
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Affiliation(s)
- V Poliquin
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Canada
- Correspondence: Vanessa Poliquin, WT 120, Women’s Hospital, 735 Notre Dame Ave, Winnipeg, Manitoba R3E 0L8, Canada, Tel +1 204 787 2071, Email
| | - K Decker
- CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - AD Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Canada
- CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Division of Gynecologic Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - R Lotocki
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Canada
- CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Division of Gynecologic Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
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Altman AD, Allen VM, McNeil SA, Dempster J. Pfannenstiel Incision Closure: A Review of Current Skin Closure Techniques. Journal of Obstetrics and Gynaecology Canada 2009; 31:514-520. [DOI: 10.1016/s1701-2163(16)34213-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
OBJECTIVE To estimate the incidence of gestational trophoblastic disease in Nova Scotia and to evaluate the effect of time and maternal age on these rates. METHODS Information on women with a pathologically confirmed diagnosis of gestational trophoblastic disease was extracted from the Nova Scotia Gestational Trophoblastic Disease Registry between 1990 and 2005. The total numbers of deliveries and pregnancies were determined from the Nova Scotia Atlee Perinatal Database and consensus data derived from Statistics Canada. RESULTS Four-hundred twenty-eight women were identified with gestational trophoblastic disease. Hydatidiform moles showed rates of 220/100,000 pregnancies, 264/100,000 total births, and 266/100,000 live births. Rates of partial mole were twofold higher than complete mole (P<.001). The rates of hydatidiform mole were highest in both younger (younger than 20 years old, P=.02) and older age groups (30-34 years old, P=.04, and at least 35 years old, P=.02). The rates of hydatidiform mole were highest in both younger (less than 20 years old, P=.02) and older age groups (30-34 years old, P .04, and 35 or more years old P=.02). The rates of partial moles were significantly higher in women older than 20 years of age (P<.001) and increased with increasing age (P<.001); the reverse trend was seen in complete mole (P<.001). There was no temporal change in rates or average age of hydatidiform mole during the study period. CONCLUSION The rates of hydatidiform mole in Nova Scotia estimated by this population-based study using comprehensive validated information, are higher than most previously reported. Maternal age was a significant factor in the risk for molar pregnancies.
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Affiliation(s)
- Alon D Altman
- Izaak Walton Killam Health Centre, Queen Elizabeth II Health Science Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
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Altman AD, McLaughlin J, Schellenberg R, Penner C, Arbour L, Tsang P, Ballem P, Lim KI. Hereditary Angioedema Managed with Low-Dose Danazol and C1 Esterase Inhibitor Concentrate: A Case Report. Journal of Obstetrics and Gynaecology Canada 2006; 28:27-31. [PMID: 16533452 DOI: 10.1016/s1701-2163(16)32048-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hereditary angioedema (HAE) is a rare life-threatening disease that can occur in pregnancy. CASE A nulliparous woman was diagnosed as having HAE at 22 weeks of gestation after a series of symptomatic episodes. Following an initial course of C1 esterase inhibitor (C1EI) therapy for an acute episode of HAE, she was treated with danazol for prophylaxis. Danazol did not prevent recurrence of symptoms, its use was discontinued after six weeks. Thereafter, the patient was treated exclusively with C1EI at weekly intervals for exacerbations of her HAE. At 37 weeks' gestation, she delivered healthy 3050 g female neonate. At the time of discharge the female neonate had no signs of virilization or congenital anomalies. CONCLUSION Low dose danazol was ineffective in treating this woman's HAE in pregnancy. The use of C1EI in pregnancy is associated with good outcomes.
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Affiliation(s)
- Alon D Altman
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS
| | | | - Robert Schellenberg
- Division of Allergy and Immunology, Department of Medicine, University of British Columbia, Vancouver BC
| | - Charles Penner
- Department of Internal Medicine, St. Joseph's General Hospital Comox BC
| | - Laura Arbour
- Department of Medical Genetics, University of British Columbia Vancouver BC
| | - Peter Tsang
- Division of Hematology, Department of Medicine, University of British Columbia, Vancouver BC
| | - Penny Ballem
- Division of Hematology, Department of Medicine, University of British Columbia, Vancouver BC
| | - Kenneth I Lim
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC
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Altman AD, Golden D, Seidenberg B, Kavee D, Parker JG. Free perforation in regional enteritis. Report of 2 cases and review of the literature. Am J Dig Dis 1966; 11:658-63. [PMID: 5943770 DOI: 10.1007/bf02233515] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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