Friday, February 10, 2012
open access: Cytoreductive Surgery Combined with Hyperthermic Intraperitoneal Intraoperative Chemotherapy in the Treatment of Advanced Epithelial Ovarian Cancer
Background/Aims.
Intraperitoneal intraoperative hyperthermic chemotherapy (HIPEC) has been used in the treatment of ovarian cancer. The purpose of the study is to determine the efficacy of HIPEC after cytoreductive surgery in advanced ovarian cancer
From 2006 to 2010, 43 women with primary or recurrent ovarian cancer were enrolled in the study and underwent maximal cytoreductive surgery and HIPEC. The mean age of the patients was 59.9 yrs (16–82) years.
Table 1: Characteristics of the patients.
Table 2: Peritonectomy procedures.
Table 3: Complications ( 6 grade 111/1V events)
"...Severe morbidity (grade 3 and 4) has been recorded in 6 patients (14%). It is obvious that the most severe complication is the anastomotic failure. Anastomotic failure has been reported in other series as the most frequent complication [8, 9, 25]. Cisplatin has been incriminated to impair anastomotic healing in animal studies [26] in contrast to local hyperthermia that has not [27]. As a consequence, the failures may be attributed either to cisplatin or to the immediate restoration of the gastrointestinal tract after low-anterior resection particularly in those cases with preoperative partial intestinal obstruction. The importance of intestinal obstruction and the avoidance of immediate restoration of the gastrointestinal tract has been emphasized [9] resulting in significant decrease of anastomotic failures [28]. Therefore a protective colostomy seems to be a reasonable solution. Other severe complications as intra-abdominal abscess or sepsis or postoperative bleeding are infrequent [8, 9, 25]....."
Conclusions
Maximal cytoreductive surgery with standard peritonectomy procedures combined with intraperitoneal chemotherapy is a well-tolerated and feasible method for treatment of advanced epithelial ovarian cancer. It appears to improve long-term survival securing that complete or near complete cytoreduction is possible in the vast majority as well as the eradication of the microscopic residual tumor.
How long before CVac, a new treatment for ovarian cancer, is available in the UK? – Telegraph Blogs
"Since my blog post about the Stage 3 trial of CVac – a new treatment for ovarian cancer – I have been in contact with Dr Neil Frazer, who is heading this research for the Australian company Prima Biomed. He has answered my questions about the treatment, clarified the methodology and explained about Prima Biodmed's medical facility in Dubai where CVac will be supplied......
to open April - Concerned about ovarian cancer? Visit one of the DOVE clinics - media
Blogger's Note: the cost is not apparent nor availability to Quebec residents only or ?
MONTREAL - Of the 12 new DOVE clinics to open in the Montreal area as of April, the Anjou clinic is already up and running.
No referral is needed. Women age 50 and older with any symptoms – bloating, pelvic or abdominal pain, frequent urination, difficulty eating or feeling full quickly – lasting longer than two weeks but less than a year, are encouraged to go for testing.
Satellite Centre 1 — Clinique médicale du Haut Anjou, 7500 Galeries d’Anjou Blvd. 514-493-1999
Satellite Centre 2 — Clinique Familiale Pas-à-Pas, 3650 Henri Bourassa Blvd. E. 514-328-9797
Satellite Centre 3 — 8260 Maurice Duplessis Blvd. 514-643-1113
Satellite Centre 4 — Polyclinique Cabrini, 5700 St. Zotique St. E. 514-253-6776
Satellite Centre 5 — Clinique Perrier, 10749 Lajeunesse St. 514-383-0559
Satellite Centre 6 — Clinique Plein Ciel, 475 Côte Vertu Blvd. 514-337-3171
Satellite Centre 7 — Lakeshore General Hospital, 160 Stillview Rd., Pointe Claire 514-630-2225
Satellite Centre 8 — Cavendish Medical Centre Inc., 2545 Cavendish Blvd. 514-483-2424
Satellite Centre 9 — Lachine Hospital, 650 16th Ave., 514-934-1934, Local 77306
Satellite Centre 10 — Sacré Coeur Hospital, 5400 Gouin Blvd. W. 514-338-2222, Local 2063
Satellite Centre 11 — Queen Elizabeth Health Complex, 2100 Marlowe Ave. 514-699-4630
Satellite Centre 12 — St. Henri Medical Centre, 3966 Notre Dame St. W. 514-935-4330
abstract: No place like the hospital. [J Pain Symptom Manage
Source
Harvard Pilgrim Health Care Institute, Boston, Massachusetts 02215, USA. mgillick@partners.org
Abstract
The gold standard for end-of-life care is home hospice. A case is presented in which a patient dying of irreversible small bowel obstruction from metastatic cancer insisted on remaining in the acute care hospital for care when alternative sites of care, including a skilled nursing facility and residential hospice, were available to her and covered by her health insurance plan. The ethical issues raised by this case are discussed from the perspective of the patient, the clinical team, the hospital, and the insurance company. Over the past decade, hospital-based palliative care consultation and general inpatient hospice care have sought to improve the quality of dying in the hospital. To the extent that such efforts have been successful, they may result in increasing demand for the hospital as the site for terminal care in the future.FYI: top 5 most read items this week - Ovarian Cancer and Us Blog
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(very short) abstract: A Surveillance Conundrum: A Case of 4 Distinct Primary Malignancies in a BRCA-1 Mutation Carrier - Intl Jnl Gyn Pathology
Abstract
Women with HBOC syndrome present a unique challenge to the oncology community, as will many genetic cancer syndromes yet to be discovered as genetic testing increases in availability. Issues of management and, most importantly, implication are yet to be elucidated. After a diagnosis of epithelial ovarian carcinoma lifelong follow-up is recommended. Given the high recurrence rate and dismal long term prognosis of advanced epithelial ovarian carcinoma this recommendation is more often than not moot. There are no clear guidelines or recommendations for surveillance designed for women with disease free survival greater than five years. This case presents a unique scenario of a woman with predictable disease that remains unpreventable.
abstract: Histological Grading of Ovarian Clear Cell Adenocarcinoma: Proposal for a Simple and Reproducible Grouping System - Intl Jnl Gyn Pathology
Blogger's Note: 'interesting' stat ranges between early/advanced clear cell ovarian cancers; read full abstract for more details (full access requires subscription $$$); some details deleted for ease of reading
Abstract
"In this study, we aimed to develop a histological grading system for ovarian clear cell adenocarcinoma (CCA), based on the tumor growth architectures."
"The interobserver reproducibility and prognostic value of the assigned groups were analyzed for 159 CCAs from 5 institutions."
"In early-stage cases [International Federation of Gynecology and Obstetrics (FIGO) stage I–II], .....(survival rates 56-100%)
"In advanced cases (FIGO stage III–IV),.....(survival rates 16-52%)
"The proposed grouping system could divide patients with CCA into 3 subgroups with distinct prognostic indications, providing a 3-tier histological grading system for ovarian CCA."
abstract: A Systematic Review of Papers Examining the Use of Intraoperative Frozen Section in Predicting the Final Diagnosis of Ovarian Lesions Intl Jnl Gyn Pathology (clear cell, mucinous, borderline, invasive...)
Abstract
"This systematic review assesses the accuracy of the frozen section classification of benign and borderline lesions or invasive carcinoma when compared with the final diagnosis on paraffin section. A Pubmed database search identified 18 retrospective cohort studies, published since 2005 that satisfied the criteria, on the critical appraisal sheet of the center for evidence-based medicine, The University of Oxford.
The sensitivity, specificity, and negative and positive predictive values suggest that frozen section is more accurate at discriminating between benign lesions and invasive carcinoma than between benign and borderline or borderline lesions and invasive carcinoma and indicate a tendency to overcall benign tumors as borderline and borderline tumors as invasive malignancies.A narrative review of individual papers and abstracts suggests that this particular difficulty is encountered when dealing with clear cell carcinoma and mucinous lesions of all sorts.
This may have greater importance in the future with the introduction of targeted chemotherapy requiring accurate typing to guide the use of genetic analysis. It would be beneficial if future researchers comparing the results of frozen section and paraffin sections presented their results in the context of preoperative assessment of the clinical and radiological findings or the intraoperative appearances of the tumor and abdominal cavity, which would allow the identification of those cases in which the frozen section allowed a refinement of the diagnoses made using these modalities."
abstract: Frequency of Serous Tubal Intraepithelial Carcinoma in Various Gynecologic Malignancies: A Study of 300 Consecutive Cases
Abstract:
Serous tubal intraepithelial carcinoma (STIC) has been implicated in the pathogenesis of pelvic serous carcinoma. We hypothesized that, if this is the case, the frequency of STIC should be substantially lower in endometrial serous carcinomas, in nonserous gynecologic malignancies, and in benign gynecologic neoplasms than in ovarian or peritoneal serous carcinomas.
From 2007 to 2009 the fallopian tubes of 342 consecutive gynecologic cases were entirely submitted for histology using the Sectioning and Extensively Examining the FIMbriated end protocol.
This study included 300 of these cases (277 TAH-BSO, 23 BSO) after exclusion. The hematoxylin and eosin-stained slides from the fallopian tubes were independently reviewed by 2 gynecologic pathologists who were blinded to all other findings; disagreements were resolved by a third pathologist.
Among 46 cases of ovarian malignancies, STIC was identified in 6 (18.8%) of 32 cases of serous carcinoma, but not in any other subtype. Similarly, STIC coexisted in 4 (14.3%) of 28 cases of endometrial serous carcinoma; however, no STIC was identified in any of the 74 cases of nonserous endometrial malignancies. STIC was identified in 2 (28.6%) of 7 cases of peritoneal serous carcinoma.
No STIC was identified among 15 nongynecologic malignancies, 90 cases of benign conditions, and 27 cases of other conditions including 4 cases of cervical adenocarcinoma in situ and high-grade cervical intraepithelial lesions, 8 cases of endometrial atypical complex hyperplasias, and 15 cases of ovarian borderline tumors.
In conclusion, the fallopian tube may be the origin of some pelvic serous carcinomas. Other possibilities that may explain the origin of pelvic high-grade serous carcinoma are discussed. Given that STIC coexisted with 14% of endometrial serous carcinomas, a more unifying theory may be that gynecologic serous carcinomas and STIC are multifocal lesions.
abstract: (Avastin) Bevacizumab-Associated Fistula Formation in Postoperative Colorectal Cancer Patients - adverse events
Blogger's Note: adverse events are worth noting albeit other types of cancers; full text of paper would be required to properly assess the conclusions of this particular study
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Conclusions
Bevacizumab is the most common antiangiogenesis agent used for treatment of metastatic CRC. Previous adverse events associated with bevacizumab treatment include venous thromboembolism, poor wound healing, and spontaneous bowel perforation. In this report, late postoperative development of fistulas occurred relatively soon after initiation of bevacizumab and usually spontaneously resolved with cessation of bevacizumab treatment. Based on the timing of fistula development relative to operation and initiation of bevacizumab, fistulas are likely secondary to bevacizumab therapy rather than postsurgical complications. Bevacizumab-induced fistulas occur in a small, but significant proportion of CRC patients and must be recognized early.
2012 Recently updated NCCN Clinical Practice Guidelines in Oncology™ plus link to Ovarian Cancer (and other related) NCCN guidelines
Blogger's Note: Lynch Syndrome is included in the Colorectal Cancer section (*see below)
NCCN Guidelines for Treatment of Cancer by Site
- Bone Cancer Version 2.2012
- Breast Cancer Version 1.2012
- Colon Cancer Version 3.2012
- Hodgkin Lymphoma Version 1.2012
- Non-Hodgkin's Lymphomas Version 1.2012
- Rectal Cancer Version 3.2012
- Testicular Cancer Version 1.2012
- Waldenström's Macroglobulinemia / Lymphoplasmacytic Lymphoma Version 1.2012
- Cancer Related Fatigue (and others)
NCCN Guidelines for Supportive Care
- Distress Management Version 1.2012
NCCN Guidelines for Treatment of Cancer by Site (professional)
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Occult Primary (Cancer of Unknown Primary) 
Ovarian Cancer 
- Epithelial Ovarian Cancer (including Fallopian Tube Cancer and Primary Peritoneal Cancer)
- Borderline Epithelial Ovarian Cancer (Low Malignant Potential)
- Less Common Ovarian Histologies
Fallopian Tube Cancer (See Ovarian Cancer)
Primary Peritoneal Cancer (See Ovarian Cancer)
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NCCN Guidelines for Detection, Prevention, & Risk Reduction (*includes genetic syndromes, supportive care):
Colorectal Cancer Screening
Genetic/Familial High-Risk Assessment: Breast and Ovarian
- Breast and/or Ovarian Genetic Assessment
- Hereditary Breast and/or Ovarian Cancer
- Li-Fraumeni Syndrome
- Cowden Syndrome
Fasting Plus Chemo May Help in Cancer Fight - MedicineNet - research in mice
Blogger's Note: note that this research was done in mice
"We don't know whether in humans it's effective," Longo said. "It should be off limits to patients, but a patient should be able to go to their oncologist and say, 'What about fasting with chemotherapy or without' if chemotherapy was not recommended or considered?"
The researchers warned that fasting may not be safe for all cancer patients, particularly those who have already lost a significant amount of weight or have other conditions, such as diabetes. They added that fasting can cause headaches and a drop in blood pressure. The study also pointed out that cancer-free survival resulting from fasting may not extend to large tumors.
According to the American Cancer Society, "available scientific evidence does not support claims that fasting is effective for preventing or treating cancer. Even a short-term fast can have negative health effects, while fasting for a longer time could cause serious health problems."
abstract: Adapted ice cream as a nutritional supplement in cancer patients: impact on quality of life and nutritional status
Conclusions
The administration of ice cream could cover, in part, the social aspect of food and improve QLQ in malnourished cancer patients. These results are encouraging and deserve further confirmation.
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