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Olthof EP, Bergink-Voorthuis BJ, Wenzel HHB, Mongula J, van der Velden J, Spijkerboer AM, Adam JA, Bekkers RLM, Beltman JJ, Slangen BFM, Nijman HW, Smolders RGV, van Trommel NE, Zusterzeel PLM, Zweemer RP, Stalpers LJA, Mom CH, van der Aa MA. Diagnostic accuracy of MRI, CT, and [ 18F]FDG-PET-CT in detecting lymph node metastases in clinically early-stage cervical cancer - a nationwide Dutch cohort study. Insights Imaging 2024; 15:36. [PMID: 38332397 PMCID: PMC10853153 DOI: 10.1186/s13244-023-01589-1] [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: 09/22/2023] [Accepted: 11/29/2023] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES Imaging is increasingly used to assess lymph node involvement in clinically early-stage cervical cancer. This retrospective study aimed to evaluate the diagnostic accuracy of MRI, CT, and [18F]FDG-PET-CT. METHODS Women with International Federation of Gynaecology and Obstetrics (FIGO) 2009 stage IA2-IIA cervical cancer and pretreatment imaging between 2009 and 2017 were selected from the Netherlands Cancer Registry. Patient-based and region-based (i.e. pelvic and common iliac) nodal status was extracted from radiology reports. Pathology results were considered the reference standard for calculating accuracy indices. Multiple imputation was used for missing pathology to limit verification bias risk. RESULTS Nodal assessment was performed in 1676 patients with MRI, 926 with CT, and 379 with [18F]FDG-PET-CT, with suspicious nodes detected in 17%, 16%, and 48%, respectively. [18F]FDG-PET-CT was used to confirm MRI/CT results in 95% of patients. Pathology results were imputed for 30% of patients. [18F]FDG-PET-CT outperformed MRI and CT in detecting patient-based nodal metastases with sensitivities of 80%, 48%, and 40%, and AUCs of 0.814, 0.706, and 0.667, respectively, but not in specificity: 79%, 92%, and 92%. Region-based analyses showed similar indices in the pelvic region, but worse performance in the common iliac region with AUCs of 0.575, 0.554, and 0.517, respectively. CONCLUSIONS [18F]FDG-PET-CT outperformed MRI and CT in detecting nodal metastases, which may be related to its use as a verification modality. However, MRI and CT had the highest specificity. As MRI is generally performed routinely to assess local and regional spread of cervical cancer, [18F]FDG-PET-CT can be used to confirm suspicious nodes. CRITICAL RELEVANCE STATEMENT Accurate assessment of the nodal status in clinically early-stage cervical cancer is essential for tumour staging, treatment decision making and prognosis. KEY POINTS • The accuracy of MRI, CT or [18F]FDG-PET-CT for nodal staging in early cervical cancer is a subject of discussion. • Overall, [18F]FDG-PET-CT outperformed MRI, followed by CT, when used as a verification modality. • Staging with MRI and the addition of [18F]FDG-PET-CT to verify high-risk cases seems to be a good approach.
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Affiliation(s)
- Ester P Olthof
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, DT, Utrecht, 3511, The Netherlands.
- Department of Gynecological Oncology, Amsterdam University Medical Center, Center for Gynecologic Oncology Amsterdam (CGOA), Amsterdam, The Netherlands.
| | - Brenda J Bergink-Voorthuis
- Department of Health Technology and Services Research, Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - Hans H B Wenzel
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, DT, Utrecht, 3511, The Netherlands
| | - Jordy Mongula
- Department of Obstetrics and Gynaecology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Jacobus van der Velden
- Department of Gynecological Oncology, Amsterdam University Medical Center, Center for Gynecologic Oncology Amsterdam (CGOA), Amsterdam, The Netherlands
| | - Anje M Spijkerboer
- Department of Radiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Judit A Adam
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, The Netherlands
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Obstetrics and Gynecology, Medical Center and GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Jogchum J Beltman
- Department of Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Brigitte F M Slangen
- Department of Obstetrics and Gynecology, Medical Center and GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, Groningen, The Netherlands
| | - Ramon G V Smolders
- Department of Gynaecological Oncology, Erasmus MC Cancer Institute University Medical Center, Rotterdam, The Netherlands
| | - Nienke E van Trommel
- Center for Gynaecologic Oncology Amsterdam (CGOA), The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Petra L M Zusterzeel
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ronald P Zweemer
- Department of Gynaecological Oncology, University Medical Centre Utrecht, Utrecht Cancer Centre, Utrecht, The Netherlands
| | - Lukas J A Stalpers
- Department of Radiation Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Constantijne H Mom
- Department of Gynecological Oncology, Amsterdam University Medical Center, Center for Gynecologic Oncology Amsterdam (CGOA), Amsterdam, The Netherlands
| | - Maaike A van der Aa
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, DT, Utrecht, 3511, The Netherlands
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Schuurman TN, Schaafsma M, To KH, Verhoef VMJ, Sikorska K, Siebers AG, Wenzel HHB, Bleeker MCG, Roes EM, Zweemer RP, de Vos van Steenwijk PJ, Yigit R, Beltman JJ, Zusterzeel PLM, Lok CAR, Bekkers RLM, Mom CH, van Trommel NE. Optimising follow-up strategy based on cytology and human papillomavirus after fertility-sparing surgery for early stage cervical cancer: a nationwide, population-based, retrospective cohort study. Lancet Oncol 2023; 24:1349-1358. [PMID: 37952541 DOI: 10.1016/s1470-2045(23)00467-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND The optimal follow-up strategy to detect recurrence after fertility-sparing surgery for early stage cervical cancer is unknown. Tailored surveillance based on individual risks could contribute to improved efficiency and, subsequently, reduce costs in health care. The aim of this study was to establish the predictive value of cervical cytology and high-risk human papillomavirus (HPV) testing to detect recurrent cervical intraepithelial neoplasia grade 2 or worse (CIN2+; including recurrent cervical cancer) after fertility-sparing surgery. METHODS In this nationwide, population-based, retrospective cohort study, we used data from the Netherlands Cancer Registry and the Dutch Nationwide Pathology Databank. All patients aged 18-40 years with cervical cancer of any histology who received fertility-sparing surgery (ie, large loop excision of the transformation zone, conisation, or trachelectomy) between Jan 1, 2000, and Dec 31, 2020, were included. Pathology data from diagnosis, treatment, and during follow-up were analysed. The primary and secondary outcomes were the cumulative incidence of recurrent CIN2+ and recurrence-free survival, overall and stratified by results for cytology and high-risk HPV. FINDINGS 1548 patients were identified, of whom 1462 met the inclusion criteria. Of these included patients, 19 568 pathology reports were available. The median age at diagnosis was 31 years (IQR 30-35). After a median follow-up of 6·1 years (IQR 3·3-10·8), recurrent CIN2+ was diagnosed in 128 patients (cumulative incidence 15·0%, 95% CI 11·5-18·2), including 52 patients (cumulative incidence 5·4%, 95% CI 3·7-7·0) with recurrent cervical cancer. The overall 10-year recurrence-free survival for CIN2+ was 89·3% (95% CI 87·4-91·3). By cytology at first follow-up visit within 12 months after fertility-sparing surgery, 10-year recurrence-free survival for CIN2+ was 92·1% (90·2-94·1) in patients with normal cytology, 84·6% (77·4-92·3) in those with low-grade cytology, and 43·1% (26·4-70·2) in those with high-grade cytology. By high-risk HPV status at first follow-up visit within 12 months after surgery, 10-year recurrence-free survival for CIN2+ was 91·1% (85·3-97·3) in patients who were negative for high-risk HPV and 73·6% (58·4-92·8) in those who were positive for high-risk HPV. Cumulative incidence of recurrent CIN2+ within 6 months after any follow-up visit (6-24 months) in patients negative for high-risk HPV with normal or low-grade cytology was 0·0-0·7% and with high-grade cytology was 0·0-33·3%. Cumulative incidence of recurrence in patients positive for high-risk HPV with normal or low-grade cytology were 0·0-15·4% and with high-grade cytology were 50·0-100·0%. None of the patients who were negative for high-risk HPV without high-grade cytology, at 6 months and 12 months, developed recurrence. INTERPRETATION Patients who are negative for high-risk HPV with normal or low-grade cytology at 6-24 months after fertility-sparing surgery, could be offered a prolonged follow-up interval of 6 months. This group comprises 80% of all patients receiving fertility-sparing surgery. An interval of 12 months seems to be safe after two consecutive negative tests for high-risk HPV with an absence of high-grade cytology, which accounts for nearly 75% of all patients who receive fertility-sparing surgery. FUNDING KWF Dutch Cancer Society.
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Affiliation(s)
- Teska N Schuurman
- Department of Gynecologic Oncology, Center of Gynecologic Oncology Amsterdam, location Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Gynecologic Oncology, Center of Gynecologic Oncology Amsterdam, location Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Mirte Schaafsma
- Department of Gynecologic Oncology, Center of Gynecologic Oncology Amsterdam, location Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Pathology, Amsterdam University Medical Center, location VU University Medical Center, Amsterdam, Netherlands; Department of Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Kaylee H To
- Faculty of Medicine, VU Amsterdam, Amsterdam, Netherlands
| | - Viola M J Verhoef
- Department of Obstetrics and Gynecology, Maxima Medical Center, Eindhoven, Netherlands
| | - Karolina Sikorska
- Department of Biostatistics, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Albert G Siebers
- Palga, the Dutch Nationwide Pathology Databank, Houten, Netherlands
| | - Hans H B Wenzel
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
| | - Maaike C G Bleeker
- Department of Pathology, Amsterdam University Medical Center, location VU University Medical Center, Amsterdam, Netherlands; Department of Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Eva Maria Roes
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Ronald P Zweemer
- Department of Gynecologic Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Peggy J de Vos van Steenwijk
- Department of Obstetrics and Gynecology, Maastricht University Medical Center and GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
| | - Refika Yigit
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, Netherlands
| | - Jogchum J Beltman
- Department of Gynecology, Leiden University Medical Center, Leiden, Netherlands
| | - Petra L M Zusterzeel
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Christianne A R Lok
- Department of Gynecologic Oncology, Center of Gynecologic Oncology Amsterdam, location Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynecology, Maastricht University Medical Center and GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands; Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands; Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, Netherlands
| | - Constantijne H Mom
- Department of Gynecologic Oncology, Center of Gynecologic Oncology Amsterdam, location Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Nienke E van Trommel
- Department of Gynecologic Oncology, Center of Gynecologic Oncology Amsterdam, location Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, Netherlands.
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Warmerdam DHM, van Geloven N, Beltman JJ, De Kroon CD, Rietbergen DDD, van Poelgeest MIE, Gaarenstroom KN. Sentinel lymph node procedure in early-stage vulvar cancer: Correlation of lymphoscintigraphy with surgical outcome and groin recurrence. Eur J Surg Oncol 2023; 49:107006. [PMID: 37572588 DOI: 10.1016/j.ejso.2023.107006] [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: 05/22/2023] [Revised: 06/26/2023] [Accepted: 08/02/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION In early-stage vulvar squamous cell carcinoma (VSCC) a sentinel lymph node (SLN) procedure is regarded successful if at least one SLN is removed with minimal residual radioactivity. An inguinofemoral lymphadenectomy is considered if not all SLNs visualized on lymphoscintigraphy can be found, with subsequent increased morbidity. We correlated lymphoscintigraphy findings with surgical outcome and groin recurrence with focus on number of SLNs found. METHODS This study concerns a retrospective cohort of 171 women treated for early-stage VSCC who underwent a SLN procedure between 2000 and 2020. The risk of groin recurrence was compared after either a successful or complete SLN procedure, i.e. removal of all SLNs that were visualized on lymphoscintigraphy. RESULTS In 13 (7.6%) groins of 171 patients SLN visualization on lymphoscintigraphy failed. In 230 of the 246 (93.5%) groins in which a SLN was visualized, at least one SLN was found during surgery. In 224 of the 246 (91.1%) groins the SLN procedure was regarded either successful (n = 14) or complete (n = 210). An isolated groin recurrence was documented in 5 out of 192 (2.6%, 95%-CI; 0.34 to 4.9) SLN-negative groins after a median follow-up of 47.0 months. All recurrences were noted in the complete SLN group (5/180 groins). The difference with the successful SLN group (0/12 groins) was not significant. CONCLUSION Risk of groin recurrence was 2.6% after SLN negative biopsy in early-stage VSCC. The risk appeared not increased if at least one SLN was found with minimal residual radioactivity, in case more SLNs were visualized on lymphoscintigraphy.
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Affiliation(s)
- Daniëlle H M Warmerdam
- Department of Gynecology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
| | - Nan van Geloven
- Department of Biomedical Data Sciences (section Medical Statistics), Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
| | - Jogchum J Beltman
- Department of Gynecology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
| | - Cor D De Kroon
- Department of Gynecology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
| | - Daphne D D Rietbergen
- Daphne D.D. Rietbergen: Department of Radiology, Section Nuclear Medicine, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
| | - Mariette I E van Poelgeest
- Department of Gynecology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
| | - Katja N Gaarenstroom
- Department of Gynecology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
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Sultanov M, Zeeuw JD, Koot J, der Schans JV, Beltman JJ, Fouw MD, Majdan M, Rusnak M, Nazrul N, Rahman A, Nakisige C, Rao AP, Prasad K, Guruvare S, Biesma R, Versluis M, de Bock GH, Stekelenburg J. Investigating feasibility of 2021 WHO protocol for cervical cancer screening in underscreened populations: PREvention and SCReening Innovation Project Toward Elimination of Cervical Cancer (PRESCRIP-TEC). BMC Public Health 2022; 22:1356. [PMID: 35840949 PMCID: PMC9284962 DOI: 10.1186/s12889-022-13488-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 05/04/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022] Open
Abstract
Background High-risk human papillomavirus (hrHPV) testing has been recommended by the World Health Organization as the primary screening test in cervical screening programs. The option of self-sampling for this screening method can potentially increase women’s participation. Designing screening programs to implement this method among underscreened populations will require contextualized evidence. Methods PREvention and SCReening Innovation Project Toward Elimination of Cervical Cancer (PRESCRIP-TEC) will use a multi-method approach to investigate the feasibility of implementing a cervical cancer screening strategy with hrHPV self-testing as the primary screening test in Bangladesh, India, Slovak Republic and Uganda. The primary outcomes of study include uptake and coverage of the screening program and adherence to follow-up. These outcomes will be evaluated through a pre-post quasi-experimental study design. Secondary objectives of the study include the analysis of client-related factors and health system factors related to cervical cancer screening, a validation study of an artificial intelligence decision support system and an economic evaluation of the screening strategy. Discussion PRESCRIP-TEC aims to provide evidence regarding hrHPV self-testing and the World Health Organization’s recommendations for cervical cancer screening in a variety of settings, targeting vulnerable groups. The main quantitative findings of the project related to the impact on uptake and coverage of screening will be complemented by qualitative analyses of various determinants of successful implementation of screening. The study will also provide decision-makers with insights into economic aspects of implementing hrHPV self-testing, as well as evaluate the feasibility of using artificial intelligence for task-shifting in visual inspection with acetic acid. Trial registration ClinicalTrials.gov, NCT05234112. Registered 10 February 2022 Supplementary Information The online version contains supplementary material available at (10.1186/s12889-022-13488-z).
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Affiliation(s)
- Marat Sultanov
- Department of Health Sciences, Global Health Unit, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
| | - Janine de Zeeuw
- Department of Health Sciences, Global Health Unit, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jaap Koot
- Department of Health Sciences, Global Health Unit, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jurjen van der Schans
- Department of Health Sciences, Global Health Unit, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
| | - Jogchum J Beltman
- Department of Gynecology, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
| | - Marlieke de Fouw
- Department of Gynecology, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
| | - Marek Majdan
- Institute for Global Health and Epidemiology, Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovak Republic
| | - Martin Rusnak
- Institute for Global Health and Epidemiology, Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovak Republic
| | | | - Aminur Rahman
- Health System and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | | | - Arathi P Rao
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Keerthana Prasad
- Manipal School of Information Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Shyamala Guruvare
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Regien Biesma
- Department of Health Sciences, Global Health Unit, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Marco Versluis
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health Unit, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden, Netherlands
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5
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Nieuwenhuyzen-de Boer GM, Hofhuis W, Reesink-Peters N, Willemsen S, Boere IA, Schoots IG, Piek JMJ, Hofman LN, Beltman JJ, van Driel WJ, Werner HMJ, Baalbergen A, van Haaften-de Jong AMLD, Dorman M, Haans L, Nedelcu I, Ewing-Graham PC, van Beekhuizen HJ. Adjuvant Use of PlasmaJet Device During Cytoreductive Surgery for Advanced-Stage Ovarian Cancer: Results of the PlaComOv-study, a Randomized Controlled Trial in The Netherlands. Ann Surg Oncol 2022; 29:4833-4843. [PMID: 35552938 PMCID: PMC9246793 DOI: 10.1245/s10434-022-11763-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/27/2022] [Indexed: 11/18/2022]
Abstract
Objective Standard surgical treatment of advanced-stage ovarian carcinoma with electrosurgery cannot always result in complete cytoreductive surgery (CRS), especially when many small metastases are found on the mesentery and intestinal surface. We investigated whether adjuvant use of a neutral argon plasma device can help increase the complete cytoreduction rate. Patients and Methods 327 patients with FIGO stage IIIB–IV epithelial ovarian cancer (EOC) who underwent primary or interval CRS were randomized to either surgery with neutral argon plasma (PlasmaJet) (intervention) or without PlasmaJet (control group). The primary outcome was the percentage of complete CRS. The secondary outcomes were duration of surgery, blood loss, number of bowel resections and colostomies, hospitalization, 30-day morbidity, and quality of life (QoL). Results Complete CRS was achieved in 119 patients (75.8%) in the intervention group and 115 patients (67.6%) in the control group (risk difference (RD) 8.2%, 95% confidence interval (CI) –0.021 to 0.181; P = 0.131). In a per-protocol analysis excluding patients with unresectable disease, complete CRS was obtained in 85.6% in the intervention group and 71.5% in the control group (RD 14.1%, 95% CI 0.042 to 0.235; P = 0.005). Patient-reported QoL at 6 months after surgery differed between groups in favor of PlasmaJet surgery (95% CI 0.455–8.350; P = 0.029). Other secondary outcomes did not differ significantly. Conclusions Adjuvant use of PlasmaJet during CRS for advanced-stage ovarian cancer resulted in a significantly higher proportion of complete CRS in patients with resectable disease and higher QoL at 6 months after surgery. (Funded by ZonMw, Trial Register NL62035.078.17.) Trial Registration Approved by the Medical Ethics Review Board of the Erasmus University Medical Center Rotterdam, the Netherlands, NL62035.078.17 on 20-11-2017. Recruitment started on 30-1-2018. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-022-11763-2.
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Affiliation(s)
- G M Nieuwenhuyzen-de Boer
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands. .,Department of Obstetrics and Gynecology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
| | - W Hofhuis
- Department of Obstetrics and Gynecology, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - N Reesink-Peters
- Department of Obstetrics and Gynecology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - S Willemsen
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.,Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands
| | - I A Boere
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - I G Schoots
- Department of Radiology and Nuclear Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J M J Piek
- Department of Obstetrics and Gynecology, Catharina Cancer Institute, Eindhoven, The Netherlands
| | - L N Hofman
- Department of Obstetrics and Gynecology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - J J Beltman
- Department of Obstetrics and Gynecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - W J van Driel
- Department of Gynecology, Center of Gynecological Oncology Amsterdam, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H M J Werner
- Department of Obstetrics and Gynecology, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A Baalbergen
- Department of Obstetrics and Gynecology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | | | - M Dorman
- Department of Obstetrics and Gynecology, Bravis Hospital, Bergen op Zoom, The Netherlands
| | - L Haans
- Department of Obstetrics and Gynecology, Haags Medical Centre, The Hague, The Netherlands
| | - I Nedelcu
- Department of Obstetrics and Gynecology, Groene Hart Hospital, Gouda, The Netherlands
| | - P C Ewing-Graham
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - H J van Beekhuizen
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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6
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Olthof EP, Wenzel H, van der Velden J, Spijkerboer AM, Bekkers R, Beltman JJ, Nijman HW, Slangen B, Smolders R, van Trommel N, Zusterzeel PLM, Zweemer R, Stalpers LJA, van der Aa M, Mom C. Treatment of bulky lymph nodes in locally advanced cervical cancer: boosting versus debulking. Int J Gynecol Cancer 2022; 32:861-868. [PMID: 35483738 PMCID: PMC9279830 DOI: 10.1136/ijgc-2022-003357] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective Treatment strategies for bulky lymph nodes in patients with locally advanced cervical cancer scheduled for definitive chemoradiation include nodal boosting with radiotherapy, surgical debulking, or both. The aim of this retrospective cohort study was to compare survival and toxicity in patients receiving these treatments and to compare them with a group that received neither form of treatment. Methods Women diagnosed between January 2009 and January 2017 with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB2, IIA2–IVA cervical cancer with lymph nodes ≥1.5 cm without upper limit on pretreatment imaging and treated with definitive chemoradiation were selected from the Netherlands Cancer Registry. Patients were categorized by intention-to-treat strategy: boosting, debulking, or neither treatment, with subgroup analysis for patients receiving both treatments, that is, debulking with boosting. Overall and relapse-free survival outcomes were compared by Kaplan-Meier and Cox regression analyses and toxicity by logistic regression analysis. Results Of 190 patients, 101 (53%) received only nodal boosting, 31 (16%) debulking alone, 29 (15%) debulking combined with boosting, and 29 (15%) received neither treatment. The 5 year overall and relapse-free survival for the treatment groups were 58%, 45% and 45% (p=0.19), and 47%, 44% and 46% (p=0.87), respectively. Multivariable Cox regression analyses demonstrated no differences in overall and relapse-free survival. Combination of debulking with boosting was associated with decreased overall and relapse-free survival compared with debulking alone (HR 2.47, 95% CI 1.22 to 5.00; and HR 2.37, 95% CI 1.14 to 4.93). Nodal boosting was independently associated with a decreased toxicity risk compared with debulking strategy (OR 0.37, 95% CI 0.16 to 0.83). Conclusions This study showed no survival benefit from either nodal boosting or debulking strategy in patients with suspicious bulky nodes. Nodal boosting might, however, be associated with less toxicity. Dual treatment with debulking and boosting showed a worse survival outcome because this group probably represents patients with poor prognostic factors.
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Affiliation(s)
- Ester Paulien Olthof
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands .,Department of Gynecological Oncology, Amsterdam University Medical Centres, Centre for Gynecological Oncology Amsterdam (CGOA), Amsterdam, The Netherlands
| | - Hans Wenzel
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jacobus van der Velden
- Department of Gynecological Oncology, Amsterdam University Medical Centres, Centre for Gynecological Oncology Amsterdam (CGOA), Amsterdam, The Netherlands
| | - Anje M Spijkerboer
- Department of Radiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Ruud Bekkers
- Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, The Netherlands
| | - Jogchum J Beltman
- Department of Gynecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Brigitte Slangen
- Department of Gynecologic Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ramon Smolders
- Department of Gynecological Oncology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Nienke van Trommel
- Department of Gynecological Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Centre for Gynecologic Oncology Amsterdam (CGOA), Amsterdam, The Netherlands
| | - Petra L M Zusterzeel
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ronald Zweemer
- Department of Gynecological Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lukas J A Stalpers
- Department of Radiation Oncology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Maaike van der Aa
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Constantijne Mom
- Department of Gynecological Oncology, Amsterdam University Medical Centres, Centre for Gynecological Oncology Amsterdam (CGOA), Amsterdam, The Netherlands
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7
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Laven P, Beltman JJ, Bense JE, van der Aa MA, Van Gorp T, Vos MC, Boll D, Arts H, Reesink N, Trimbos JB, Kruitwagen R. Incomplete surgical staging in clinical early-stage ovarian cancer: guidelines versus daily practice. Surg Open Sci 2021; 7:6-11. [PMID: 34778737 PMCID: PMC8577441 DOI: 10.1016/j.sopen.2021.09.002] [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: 05/25/2021] [Revised: 09/08/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background Incomplete surgical staging of patients with early-stage epithelial ovarian cancer (EOC) has been reported in up to 98% of cases, when based on the International Federation of Obstetrics and Gynecology (FIGO) staging procedure. The aim of the present retrospective study was to clarify the reasons for incomplete staging. Methods The PRISMA (Prevention Recovery Information System for Monitoring and Analysis) technique was used to evaluate cases with FIGO I-IIa EOC based on incomplete staging from five gynecologic oncologic center hospitals in the Netherlands in the period 2010-2014. Results Fifty cases with an incomplete surgical staging of EOC according to national guidelines were included. The most common reasons for incomplete staging were insufficient random biopsies of the peritoneum (n = 34, 68%), and less than ten lymph nodes being resected and/or found at pathology (n = 16, 32%). The most mentioned reason for not performing biopsies was, besides forgetting to do so, believing that after careful inspection and palpation, taking biopsies is irrelevant and/or already are being taken while performing a hysterectomy (peritoneum of cul-de-sac, bladder). The value of contralateral pelvic lymph node dissection in case of a unilateral ovarian malignancy was also doubted, influencing the number of lymph nodes resected. Conclusions The most important reasons for incomplete staging in EOC are, besides omitting elements by accident, questioning the importance of obligatory elements of the staging procedure. A structured list of staging steps during surgery and more evidence-based consensus concerning these obligatory elements might increase the number of complete staging procedures in EOC.
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Affiliation(s)
- P Laven
- Maastricht University Medical Centre, Department of Obstetrics and Gynecology and GROW - School for Oncology and Developmental Biology, P.O. Box 5800, 6202AZ Maastricht, The Netherlands
| | - J J Beltman
- Leiden University Medical Centre, Department of Obstetrics and Gynecology, Leiden, The Netherlands
| | - J E Bense
- Leiden University Medical Centre, Department of Obstetrics and Gynecology, Leiden, The Netherlands
| | - M A van der Aa
- Netherlands Comprehensive Cancer Organization, Department of Research, Utrecht, The Netherlands
| | - T Van Gorp
- Maastricht University Medical Centre, Department of Obstetrics and Gynecology and GROW - School for Oncology and Developmental Biology, P.O. Box 5800, 6202AZ Maastricht, The Netherlands.,Department of Obstetrics and Gynecology, Division of Gynecological Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - M C Vos
- Elisabeth-TweeSteden Hospital, Department of Obstetrics and Gynecology, Tilburg, The Netherlands
| | - D Boll
- Catharina Cancer Institute, Eindhoven, Department of Obstetrics and Gynecology, Eindhoven, The Netherlands
| | - Hgj Arts
- University Medical Centre Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands
| | - N Reesink
- Hospital Medical Spectrum Twente, Department of Obstetrics and Gynecology, Enschede, The Netherlands
| | - J B Trimbos
- Leiden University Medical Centre, Department of Obstetrics and Gynecology, Leiden, The Netherlands
| | - Rfpm Kruitwagen
- Maastricht University Medical Centre, Department of Obstetrics and Gynecology and GROW - School for Oncology and Developmental Biology, P.O. Box 5800, 6202AZ Maastricht, The Netherlands
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8
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Deken MM, van Doorn HC, Verver D, Boogerd LSF, de Valk KS, Rietbergen DDD, van Poelgeest MIE, de Kroon CD, Beltman JJ, van Leeuwen FWB, Putter H, Braak JPBM, de Geus-Oei LF, van de Velde CJH, Burggraaf J, Vahrmeijer AL, Gaarenstroom KN. Near-infrared fluorescence imaging compared to standard sentinel lymph node detection with blue dye in patients with vulvar cancer - a randomized controlled trial. Gynecol Oncol 2020; 159:672-680. [PMID: 33041071 DOI: 10.1016/j.ygyno.2020.09.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 08/04/2020] [Accepted: 09/27/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to assess the superiority of ICG-99mTc-nanocolloid for the intraoperative visual detection of sentinel lymph nodes (SLNs) in vulvar squamous cell carcinoma (VSCC) patients compared to standard SLN detection using 99mTc-nanocolloid with blue dye. METHODS In this multicenter, randomized controlled trial, VSCC patients underwent either the standard SLN procedure or with the hybrid tracer ICG-99mTc-nanocolloid. The primary endpoint was the percentage of fluorescent SLNs compared to blue SLNs. Secondary endpoints were successful SLN procedures, surgical outcomes and postoperative complications. RESULTS Forty-eight patients were randomized to the standard (n = 24) or fluorescence imaging group (n = 24) using ICG-99mTc-nanocolloid. The percentage of blue SLNs was 65.3% compared to 92.5% fluorescent SLNs (p < 0.001). A successful SLN procedure was obtained in 92.1% of the groins in the standard group and 97.2% of the groins in the fluorescence imaging group (p = 0.33). Groups did not differ in surgical outcome, although more short-term postoperative complications were documented in the standard group (p = 0.041). CONCLUSIONS Intraoperative visual detection of SLNs in patients with VSCC using ICG-99mTc-nanocolloid was superior compared to 99mTc-nanocolloid and blue dye. The rate of successful SLN procedures between both groups was not significantly different. Fluorescence imaging has potential to be used routinely in the SLN procedure in VSCC patients to facilitate the search by direct visualization. CLINICAL TRIAL REGISTRATION Netherlands Trial Register (Trial ID NL7443).
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Affiliation(s)
- Marion M Deken
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Helena C van Doorn
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Danielle Verver
- Department of Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Leonora S F Boogerd
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Kim S de Valk
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Daphne D D Rietbergen
- Department of Radiology, Section Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands; Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Cor D de Kroon
- Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jogchum J Beltman
- Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeffrey P B M Braak
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Section Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | | | - Katja N Gaarenstroom
- Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands.
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9
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Wenzel HHB, Smolders RGV, Beltman JJ, Lambrechts S, Trum HW, Yigit R, Zusterzeel PLM, Zweemer RP, Mom CH, Bekkers RLM, Lemmens VEPP, Nijman HW, Van der Aa MA. Survival of patients with early-stage cervical cancer after abdominal or laparoscopic radical hysterectomy: a nationwide cohort study and literature review. Eur J Cancer 2020; 133:14-21. [PMID: 32422504 DOI: 10.1016/j.ejca.2020.04.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [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: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 01/15/2023]
Abstract
AIM Recently, the safety of laparoscopic radical hysterectomy (LRH) has been called into question in early-stage cervical cancer. This study aimed to evaluate overall survival (OS) and disease-free survival (DFS) in patients treated with abdominal radical hysterectomy (ARH) and LRH for early-stage cervical cancer and to provide a literature review. METHODS Patients diagnosed between 2010 and 2017 with International Federation of Gynaecology and Obstetrics (2009) stage IA2 with lymphovascular space invasion, IB1 and IIA1, were identified from the Netherlands Cancer Registry. Cox regression with propensity score, based on inverse probability treatment weighting, was applied to examine the effect of surgical approach on 5-year survival and calculate hazard ratios (HR) and 95% confidence intervals (CIs). Literature review included observational studies with (i) analysis on tumours ≤4 cm (ii) median follow-up ≥30 months (iii) ≥5 events per predictor parameter in multivariable analysis or a propensity score. RESULTS Of the 1109 patients, LRH was performed in 33%. Higher mortality (9.4% vs. 4.6%) and recurrence (13.1% vs. 7.3%) were observed in ARH than LRH. However, adjusted analyses showed similar DFS (89.4% vs. 90.2%), HR 0.92 [95% CI: 0.52-1.60]) and OS (95.2% vs. 95.5%), HR 0.94 [95% CI: 0.43-2.04]). Analyses on tumour size (<2/≥2 cm) also gave similar survival rates. Review of nine studies showed no distinct advantage of ARH, especially in tumours <2 cm. CONCLUSION After adjustment, our retrospective study showed equal oncological outcomes between ARH and LRH for early-stage cervical cancer - also in tumours <2 cm. This is in correspondence with results from our literature review.
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Affiliation(s)
- Hans H B Wenzel
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
| | - Ramon G V Smolders
- Department of Gynaecological Oncology, Erasmus MC Cancer Institute University Medical Center, Rotterdam, the Netherlands
| | - Jogchum J Beltman
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Sandrina Lambrechts
- Department of Obstetrics and Gynaecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Hans W Trum
- Department of Gynaecologic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Refika Yigit
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Petra L M Zusterzeel
- Department of Gynaecological Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Ronald P Zweemer
- Department of Gynaecological Oncology, University Medical Centre Utrecht, Utrecht Cancer Centre, Utrecht, the Netherlands
| | - Constantijne H Mom
- Department of Gynaecologic Oncology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynaecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, the Netherlands
| | - Valery E P P Lemmens
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Maaike A Van der Aa
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
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10
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Nieuwenhuyzen-de Boer GM, Hofhuis W, Reesink-Peters N, Ewing-Graham PC, Schoots IG, Beltman JJ, Piek JMJ, Baalbergen A, Kooi GS, van Haaften A, van Huisseling H, Haans L, Dorman M, van Beekhuizen HJ. Evaluation of effectiveness of the PlasmaJet surgical device in the treatment of advanced stage ovarian cancer (PlaComOv-study): study protocol of a randomized controlled trial in the Netherlands. BMC Cancer 2019; 19:58. [PMID: 30642296 PMCID: PMC6332622 DOI: 10.1186/s12885-019-5275-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 10/13/2018] [Accepted: 01/03/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The most important goal for survival benefit of advanced stage ovarian cancer is to surgically remove all visible tumour, because complete cytoreductive surgery (CCS) has been shown to be associated with prolonged survival. In a remarkable number of women, CCS is very challenging. Especially in women with many small metastases on the peritoneum and intestinal surface, conventional CCS with electrosurgery is not able to be "complete" in removing safely all visible tumour. In this randomized controlled trail (RCT) we investigate whether the use of the PlasmaJet Surgical Device increases the rate of CCS, and whether this indeed leads to a longer progression free and overall survival. The main research question is: does the use of the PlasmaJet Surgical Device in surgery for advanced stage ovarian cancer result in an increased number of complete cytoreductive surgeries when compared with conventional surgical techniques. Secondary study objectives are: 30-day morbidity, duration of surgery, blood loss, length of hospitalisation, Quality of Life, disease-free survival, overall survival, percentage colostomy, cost-effectiveness. METHODS The study design is a multicentre single-blinded superiority RCT in two university and nine non-university hospitals in The Netherlands. Three hundred and thirty women undergoing cytoreductive surgery for advanced stage ovarian carcinoma (FIGO Stage IIIB-IV) will be randomized into two arms: use of the PlasmaJet (intervention group) versus the use of standard surgical instruments combined with electrocoagulation (control group). The primary outcome is the rate of complete cytoreductive surgery in both groups. Secondary study objectives are: 30-day morbidity, duration of surgery, blood loss, length of hospitalisation, Quality of Life, disease-free survival, overall survival, percentage colostomy, cost-effectiveness. Quality of life will be evaluated using validated questionnaires at baseline, at 1 and 6 months after surgery and at 1, 2, 3 and 4 years after surgery. DISCUSSION We hypothesize the additional value of the use of the PlasmaJet in CCS for advanced stage epithelial ovarian cancer. More knowledge about efficacy, side effects, recurrence rates, cost effectiveness and pathology findings after using the PlasmaJet Device is advocated. This RCT may aid in this void. TRIAL REGISTRATION Dutch Trial Register NTR6624 . Registered 18 August 2017. Medical Ethical Committee approval number: NL62035.078.17 (Medical Ethical Committee Erasmus Medical Centre Rotterdam).
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Affiliation(s)
- G M Nieuwenhuyzen-de Boer
- Department of Gynaecologic Oncology, Erasmus MC Cancer Institute, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - W Hofhuis
- Department of Obstetrics and Gynaecology, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - N Reesink-Peters
- Department of Obstetrics and Gynaecology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - P C Ewing-Graham
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - I G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J J Beltman
- Department of Obstetrics and Gynaecology, Leids University Medical Centre, Leiden, The Netherlands
| | - J M J Piek
- Department of Obstetrics and Gynaecology, Catharina Cancer Institute, Eindhoven, The Netherlands
| | - A Baalbergen
- Department of Obstetrics and Gynaecology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - G S Kooi
- Department of Obstetrics and Gynaecology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - A van Haaften
- Department of Obstetrics and Gynaecology, Haga Hospital, The Hague, The Netherlands
| | - H van Huisseling
- Department of Obstetrics and Gynaecology, Groene Hart Hospital, Gouda, The Netherlands
| | - L Haans
- Department of Obstetrics and Gynaecology, Haags Medical Centre, The Hague, The Netherlands
| | - M Dorman
- Department of Obstetrics and Gynaecology, Bravis Hospital, Bergen op Zoom, The Netherlands
| | - H J van Beekhuizen
- Department of Gynaecologic Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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11
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Van der Hoeven NMA, Van Wijk K, Bonfrer SE, Beltman JJ, Louwe LA, De Kroon CD, Van Asperen CJ, Gaarenstroom KN. Outcome and Prognostic Impact of Surgical Staging in Serous Tubal Intraepithelial Carcinoma: A Cohort Study and Systematic Review. Clin Oncol (R Coll Radiol) 2018; 30:463-471. [PMID: 29691126 DOI: 10.1016/j.clon.2018.03.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 02/28/2018] [Accepted: 03/21/2018] [Indexed: 12/20/2022]
Abstract
The optimal management of breast cancer susceptibility gene (BRCA)1/2 carriers with isolated serous tubal intraepithelial carcinoma (STIC) found at risk-reducing salpingo-oophorectomy (RRSO) is unclear. The prevalence of occult carcinoma and STIC in a consecutive series of BRCA1/2 carriers undergoing RRSO is reported. The outcome of staging procedures in BRCA1/2 carriers with isolated STIC at RRSO as well as the relationship between staging, chemotherapy treatment and risk of recurrence was assessed via a systematic review of the literature. Our series included 235 BRCA1/2 carriers who underwent RRSO. Federation of Gynaecology and Obstetrics stage IA carcinoma or STIC was found at RRSO in three (1.3%) and two (0.9%) patients, respectively. A systematic review of the literature included 82 BRCA1/2 carriers with isolated STIC found at RRSO. In 13/82 (16%) cases with STIC, staging was reported. In none of these cases staging revealed more advanced disease. Recurrent disease was found in four of 36 patients with reported follow-up. The estimated risk of recurrence in patients with isolated STIC at RRSO was about 11% (95% confidence interval 3-26%) after a median follow-up of 42 months (range 7-138). No recurrences were reported in those patients with STIC at RRSO who underwent staging or received chemotherapy. We found 1.3% occult carcinoma and 0.9% STIC at RRSO in our cohort of BRCA1/2 carriers. A systematic review of the literature suggests that additional treatment after RRSO, i.e. staging and/or chemotherapy, is associated with a lower risk of recurrence. However, data on staging and follow-up are limited.
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Affiliation(s)
- N M A Van der Hoeven
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - K Van Wijk
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - S E Bonfrer
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - J J Beltman
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - L A Louwe
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - C D De Kroon
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - C J Van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - K N Gaarenstroom
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands.
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12
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Boogerd LSF, Hoogstins CES, Gaarenstroom KN, de Kroon CD, Beltman JJ, Bosse T, Stelloo E, Vuyk J, Low PS, Burggraaf J, Vahrmeijer AL. Folate receptor-α targeted near-infrared fluorescence imaging in high-risk endometrial cancer patients: a tissue microarray and clinical feasibility study. Oncotarget 2017; 9:791-801. [PMID: 29416655 PMCID: PMC5787511 DOI: 10.18632/oncotarget.23155] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 09/05/2017] [Accepted: 11/15/2017] [Indexed: 12/26/2022] Open
Abstract
Objective Detection and resection of all malignant lesions is pivotal in staging and cytoreductive surgery (CRS) of endometrial cancer (EC). Intraoperative EC detection could be enhanced using OTL-38, a fluorescent-labelled folate receptor-α (FRα) targeted imaging agent. The objectives of this study were to investigate which subgroups of high-risk EC patients express FRα and assess feasibility of intraoperative EC detection using OTL-38. Results FRα expression on TMA was significantly correlated with tumor type (p < 0.01). Eighty-two percent of serous and clear cell carcinomas showed FRα expression. Four patients were enrolled in the clinical study. Using fluorescence imaging all omental (n = 3) and lymph node (LN) metastases (n = 16) could be clearly identified, including one otherwise undetected omental metastasis. However, false-positive fluorescence was identified in 17/50 non-metastatic LNs, caused by OTL-38 targeting of FRβ, expressed by tumor-associated activated macrophages. Conclusions This study describes high FRα expression in serous and clear cell EC and demonstrates the first experience of intraoperative FRα-targeted tumor detection in patients with these subtypes of EC. Although all metastases could be clearly identified using OTL-38, the role of tumor-associated macrophages should be further evaluated. Methods Immunohistochemical (IHC) staining of FRα expression was performed on tissue micro arrays (TMA) of 116 patients with high-risk EC features. Patients with either serous or clear cell EC, planned for staging or CRS, were eligible for inclusion in the clinical study and received an intravenous dose of 0.0125 mg/kg OTL-38, 2-3 hours prior to surgery. Resected lesions, identified by standard-of-care and/or fluorescence imaging, were histopathologically assessed for FRα and tumor status.
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Affiliation(s)
- Leonora S F Boogerd
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Katja N Gaarenstroom
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cornelis D de Kroon
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jogchum J Beltman
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tjalling Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ellen Stelloo
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap Vuyk
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Philip S Low
- Department of Chemistry and Center for Drug Discovery, Purdue University, West Lafayette, IN, USA
| | - Jacobus Burggraaf
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden Academic Center for Drug Research, Leiden, The Netherlands
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Schrevel M, Corver WE, Vegter ME, Ter Haar NT, Dreef EJ, Beltman JJ, Kenter G, Bosse T, de Kroon CD, Jordanova ES. L1 cell adhesion molecule (L1CAM) is a strong predictor for locoregional recurrences in cervical cancer. Oncotarget 2017; 8:87568-87581. [PMID: 29152102 PMCID: PMC5675654 DOI: 10.18632/oncotarget.20976] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 04/08/2017] [Accepted: 08/21/2017] [Indexed: 12/19/2022] Open
Abstract
Background L1 cell adhesion molecule (L1CAM) has been shown to be a prognostic marker in various cancer types, and has been suggested to play a role in epithelial mesenchymal transition (EMT). Here, we determined the prognostic significance of L1CAM in cervical cancer and its association with vimentin expression on tumor cells, indicative of EMT. Methods Formalin-fixed, paraffin-embedded primary tumor samples from 372 cervical cancer patients were collected for immunohistochemical analysis of L1CAM expression. In 109 FFPE specimens, the percentage of vimentin expressing tumor cells was determined by flow cytometry. Results Positive L1CAM expression (≥10% of tumor cells) was associated with disease-free survival, validated using RNAseq TCGA data. L1CAM expression was independently associated with locoregional recurrence-free survival (hazard ratio 2.62, 95% CI 1.33 – 5.17, P = 0.006), and strongly associated with percentage of vimentin expressing tumor cells (P = 0.003). Expression of both L1CAM and vimentin indicated a subgroup with the highest risk of recurrence (hazard ratio 3.15, 95% CI 1.25 – 7.92, P = 0.015). Conclusion L1CAM might be a promising new prognostic marker for locoregional recurrences in cervical cancer, and its association with vimentin expression suggests that L1CAM might affect tumor aggressiveness, possibly through EMT.
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Affiliation(s)
- Marlies Schrevel
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem E Corver
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Margit E Vegter
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Natalja T Ter Haar
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Enno J Dreef
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jogchum J Beltman
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gemma Kenter
- Department of Gynecology, VUmc, Centre for Gynecologic Oncology, Amsterdam, The Netherlands
| | - Tjalling Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cornelis D de Kroon
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ekaterina S Jordanova
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Gynecology, VUmc, Centre for Gynecologic Oncology, Amsterdam, The Netherlands
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Beltman JJ, Fitzgerald M, Buhendwa L, Moens M, Massaquoi M, Kazima J, Alide N, van Roosmalen J. Accelerated HIV testing for PMTCT in maternity and labour wards is vital to capture mothers at a critical point in the programme at district level in Malawi. AIDS Care 2011; 22:1367-72. [PMID: 20711887 DOI: 10.1080/09540121003758473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Round the clock (24 hours×7 days) HIV testing is vital to maintain a high prevention of mother to child transmission (PMTCT) coverage for women delivering in district health facilities. PMTCT coverage increases when most of the pregnant women will have their HIV status tested. Therefore routine offering of HIV testing should be integrated and seen as a part of comprehensive antenatal care. For women who miss antenatal care and deliver in a health facility without having had their HIV status tested, the labour and maternity ward could still serve as other entry points.
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Affiliation(s)
- J J Beltman
- Department of Obstetrics, Leiden University Medical Centre, RC, The Netherlands.
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Beltman JJ, Stekelenburg J, van Roosmalen J. [Crisis in human resources for health: millennium development goals for maternal and child health threatened]. Ned Tijdschr Geneeskd 2010; 154:A1159. [PMID: 20170558] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
International migration of health care workers from low-income countries to the West has increased considerably in recent years, thereby jeopardizing the achievements of The Millennium Development Goals, especially number 4 (reduction of child mortality) and 5 (improvement of maternal health).This migration, as well as the HIV/AIDS epidemic, lack of training of health care personnel and poverty, are mainly responsible for this health care personnel deficit. It is essential that awareness be raised amongst donors and local governments so that staffing increases, and that infection prevention measures be in place for their health care personnel. Western countries should conduct a more ethical recruitment of health care workers, otherwise a new millennium development goal will have to be created: to reduce the human resources for health crisis.
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Affiliation(s)
- Jogchum J Beltman
- Leids Universitair Medisch Centrum, afd. Verloskunde, The Netherlands.
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Beltman JJ, Wilde J. [Diagnostic image (310). A man with a knife in his head]. Ned Tijdschr Geneeskd 2007; 151:358. [PMID: 17352300] [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] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
A 30-year-old man presented with a knife in his head; it had perforated the left temporal area and its point was located in the mouth. After surgical removal of the knife, the patient left the hospital without functional deficits.
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Affiliation(s)
- J J Beltman
- Thyolo District Hospital, P.O. Box 21, Thyolo, Malawi.
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Beltman JJ, Segaar M, Ory FG. Knowledge of high-school students and adult OPD attenders of family planning methods and sexually transmitted diseases (including HIV) in rural Zimbabwe. Trop Doct 2000; 30:247-9. [PMID: 11075669 DOI: 10.1177/004947550003000428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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