Friday, February 10, 2012
open access: Cytoreductive Surgery Combined with Hyperthermic Intraperitoneal Intraoperative Chemotherapy in the Treatment of Advanced Epithelial Ovarian Cancer
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  in contrast to local hyperthermia that has not . 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  resulting in significant decrease of anastomotic failures . 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]....."
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.
"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......
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
AbstractThe 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.
(very short) abstract: A Surveillance Conundrum: A Case of 4 Distinct Primary Malignancies in a BRCA-1 Mutation Carrier - Intl Jnl Gyn Pathology
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: 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...)
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
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
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
Occult Primary (Cancer of Unknown Primary)
- 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)
NCCN Guidelines for Detection, Prevention, & Risk Reduction (*includes genetic syndromes, supportive care):
- Breast and/or Ovarian Genetic Assessment
- Hereditary Breast and/or Ovarian Cancer
- Li-Fraumeni Syndrome
- Cowden Syndrome
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."