This case presentation discusses a 36-year-old female patient with a history of total abdominal hysterectomy and bilateral salpingo-oophorectomy who presented with lower abdominal pain. Imaging and bloodwork were normal. She underwent six cycles of adjuvant chemotherapy following a diagnosis of high risk stage 1B ovarian cancer. At her one month follow up appointment she had no new complaints. The document then discusses the clinical manifestations, diagnosis, surgical staging and management of early and advanced stage ovarian cancer. It provides details on the role of surgery, chemotherapy and outcomes based on several studies.
Systematic lymphadenectomy did not improve overall survival compared to no lymphadenectomy in patients with optimally resected, lymph node-negative advanced ovarian cancer. Both groups had a median overall survival of approximately 67 months. While lymphadenectomy prolonged progression-free survival slightly from 25.5 to 25.5 months, this difference was not statistically significant. Lymphadenectomy removed significantly more lymph nodes than no lymphadenectomy, took an additional hour on average, and resulted in more blood loss, but quality of life outcomes were similar between the groups.
Presented at the American Society for Clinical Oncology Gastroenterology in January 2017 in San Francisco by Eric Raymond
Background: Sunitinib was approved by the FDA in 2011 for treatment of progressive, well-differentiated, advanced pancreatic neuroendocrine tumors (pNETs) based on a pivotal phase III study (NCT00428597) that showed a significant increase in progression-free survival (PFS) over placebo following early study termination. Subsequently, the FDA requested a post-approval study to support these findings.
Methods: In this open-label, phase IV clinical trial (NCT01525550), patients with progressive, well-differentiated, unresectable advanced/metastatic pNETs received continuous sunitinib 37.5 mg once daily. Eligibility criteria were similar to the phase III study. Primary endpoint was investigator-assessed PFS per RECIST 1.0. This study is ongoing.
Results: Sixty one treatment-naïve and 45 previously treated patients with progressive pNETs were treated with sunitinib: mean age, 54.6 years; males, 59.4%; white, 63.2%; ECOG PS 0, 65.1% or PS 1, 34.0%; and prior somatostatin analog, 48.1% (treatment-naïve, 39.3%; previously treated, 60.0%). At the data cutoff date, 82 (77%) patients discontinued treatment, mainly due to disease progression (46%). Median duration of treatment was ~11.9 months. Investigator-assessed median PFS (mPFS) was 13.2 months (95% CI, 10.9–16.7) in the overall population, with comparable mPFS in treatment-naïve and previously treated patients (13.2 vs 13.0 months). mPFS per independent radiologic review was 11.1 months (95% CI, 7.4–16.6). Objective response rate (ORR) per RECIST was 24.5%: 21.3% in treatment-naïve and 28.9% in previously treated patients. Median overall survival, although not yet mature, was 37.8 months. Treatment-emergent, all-causality adverse events (AEs) reported by ≥20% of all patients included neutropenia, diarrhea, leukopenia, fatigue, hand–foot syndrome, hypertension, abdominal pain, dysgeusia, and nausea. Most common grade 3/4 AEs were neutropenia (22%) and diarrhea (9%).
Conclusions: The mPFS of 13.2 months and ORR of 24.5% observed in this study support the outcomes of the pivotal phase III study of sunitinib in pNETs and confirm its activity in this setting. AEs were consistent with known safety profile of sunitinib.
O. Glehen - HIPEC in colorectal carcinomatosisGlehen
Pr Olivier Glehen presents HIPEC in colorectal carcinomatosis in Slovenia 2013. Présentation de la CHIP dans la carcinose péritonéale d'origine colorectale.
This document summarizes the LACE trial which compared total laparoscopic hysterectomy (TLH) to total abdominal hysterectomy (TAH) for the treatment of endometrial cancer. The trial involved 760 patients randomized across 20 centers in several countries. The results showed no significant differences in disease-free survival or overall survival between the TLH and TAH groups based on both intention-to-treat and per-protocol analyses. TLH was associated with shorter hospital stays and similar or lower rates of postoperative complications compared to TAH. The trial demonstrated that TLH is an equivalent treatment to TAH for stage I endometrial cancer.
A Coliseum with frail foundations: a critical analysis of the state-of-the-ar...Marco Lotti
Some considerations that made me convinced that the Coliseum HIPEC technique cannot be considered an adequate technique for the delivery of Hyperthermia.
Peritoneal Carcinomatosis : Dr Amit DangiDr Amit Dangi
Here are the key steps:
1. The left subphrenic space is entered by incising the peritoneum overlying the left hemidiaphragm.
2. The peritoneum is dissected off the left hemidiaphragm in a cephalad direction towards the diaphragmatic crus.
3. The peritoneum is then stripped down the left paracolic gutter towards the pelvis, removing all peritoneal surfaces.
4. The left subphrenic peritonectomy is then completed, exposing the left hemidiaphragm and removing all peritoneal surfaces in the left subphrenic space.
Pr Olivier Glehen (Lyon - France) presents HIPEC in treatment for colorectal and gastric carcinomatosis. La CHIP dans le traitement des carcinoses péritonéales d'origine colorectale et gastrique.
Dr. Ginger Gardner on Recurrent Ovarian Cancer (SHARE Program)bkling
This document discusses surgical options for recurrent ovarian cancer. It begins by outlining the goals of primary surgery for ovarian cancer, including establishing a tissue diagnosis, staging the disease, and debulking tumors. It then discusses cytoreductive surgery for advanced stage disease, noting that surgery is both diagnostic and therapeutic by removing large tumor masses. Secondary and tertiary debulking surgeries can provide a survival advantage for selected patients. New options like heated intraperitoneal chemotherapy are shown to augment surgical outcomes for recurrent ovarian cancer.
Systematic lymphadenectomy did not improve overall survival compared to no lymphadenectomy in patients with optimally resected, lymph node-negative advanced ovarian cancer. Both groups had a median overall survival of approximately 67 months. While lymphadenectomy prolonged progression-free survival slightly from 25.5 to 25.5 months, this difference was not statistically significant. Lymphadenectomy removed significantly more lymph nodes than no lymphadenectomy, took an additional hour on average, and resulted in more blood loss, but quality of life outcomes were similar between the groups.
Presented at the American Society for Clinical Oncology Gastroenterology in January 2017 in San Francisco by Eric Raymond
Background: Sunitinib was approved by the FDA in 2011 for treatment of progressive, well-differentiated, advanced pancreatic neuroendocrine tumors (pNETs) based on a pivotal phase III study (NCT00428597) that showed a significant increase in progression-free survival (PFS) over placebo following early study termination. Subsequently, the FDA requested a post-approval study to support these findings.
Methods: In this open-label, phase IV clinical trial (NCT01525550), patients with progressive, well-differentiated, unresectable advanced/metastatic pNETs received continuous sunitinib 37.5 mg once daily. Eligibility criteria were similar to the phase III study. Primary endpoint was investigator-assessed PFS per RECIST 1.0. This study is ongoing.
Results: Sixty one treatment-naïve and 45 previously treated patients with progressive pNETs were treated with sunitinib: mean age, 54.6 years; males, 59.4%; white, 63.2%; ECOG PS 0, 65.1% or PS 1, 34.0%; and prior somatostatin analog, 48.1% (treatment-naïve, 39.3%; previously treated, 60.0%). At the data cutoff date, 82 (77%) patients discontinued treatment, mainly due to disease progression (46%). Median duration of treatment was ~11.9 months. Investigator-assessed median PFS (mPFS) was 13.2 months (95% CI, 10.9–16.7) in the overall population, with comparable mPFS in treatment-naïve and previously treated patients (13.2 vs 13.0 months). mPFS per independent radiologic review was 11.1 months (95% CI, 7.4–16.6). Objective response rate (ORR) per RECIST was 24.5%: 21.3% in treatment-naïve and 28.9% in previously treated patients. Median overall survival, although not yet mature, was 37.8 months. Treatment-emergent, all-causality adverse events (AEs) reported by ≥20% of all patients included neutropenia, diarrhea, leukopenia, fatigue, hand–foot syndrome, hypertension, abdominal pain, dysgeusia, and nausea. Most common grade 3/4 AEs were neutropenia (22%) and diarrhea (9%).
Conclusions: The mPFS of 13.2 months and ORR of 24.5% observed in this study support the outcomes of the pivotal phase III study of sunitinib in pNETs and confirm its activity in this setting. AEs were consistent with known safety profile of sunitinib.
O. Glehen - HIPEC in colorectal carcinomatosisGlehen
Pr Olivier Glehen presents HIPEC in colorectal carcinomatosis in Slovenia 2013. Présentation de la CHIP dans la carcinose péritonéale d'origine colorectale.
This document summarizes the LACE trial which compared total laparoscopic hysterectomy (TLH) to total abdominal hysterectomy (TAH) for the treatment of endometrial cancer. The trial involved 760 patients randomized across 20 centers in several countries. The results showed no significant differences in disease-free survival or overall survival between the TLH and TAH groups based on both intention-to-treat and per-protocol analyses. TLH was associated with shorter hospital stays and similar or lower rates of postoperative complications compared to TAH. The trial demonstrated that TLH is an equivalent treatment to TAH for stage I endometrial cancer.
A Coliseum with frail foundations: a critical analysis of the state-of-the-ar...Marco Lotti
Some considerations that made me convinced that the Coliseum HIPEC technique cannot be considered an adequate technique for the delivery of Hyperthermia.
Peritoneal Carcinomatosis : Dr Amit DangiDr Amit Dangi
Here are the key steps:
1. The left subphrenic space is entered by incising the peritoneum overlying the left hemidiaphragm.
2. The peritoneum is dissected off the left hemidiaphragm in a cephalad direction towards the diaphragmatic crus.
3. The peritoneum is then stripped down the left paracolic gutter towards the pelvis, removing all peritoneal surfaces.
4. The left subphrenic peritonectomy is then completed, exposing the left hemidiaphragm and removing all peritoneal surfaces in the left subphrenic space.
Pr Olivier Glehen (Lyon - France) presents HIPEC in treatment for colorectal and gastric carcinomatosis. La CHIP dans le traitement des carcinoses péritonéales d'origine colorectale et gastrique.
Dr. Ginger Gardner on Recurrent Ovarian Cancer (SHARE Program)bkling
This document discusses surgical options for recurrent ovarian cancer. It begins by outlining the goals of primary surgery for ovarian cancer, including establishing a tissue diagnosis, staging the disease, and debulking tumors. It then discusses cytoreductive surgery for advanced stage disease, noting that surgery is both diagnostic and therapeutic by removing large tumor masses. Secondary and tertiary debulking surgeries can provide a survival advantage for selected patients. New options like heated intraperitoneal chemotherapy are shown to augment surgical outcomes for recurrent ovarian cancer.
While the role of radiation therapy in carcinoma cervix management is undauntable for all stages. Recurrent carcinoma cervix need a lot of personalisation
The document discusses new aspects of adjuvant therapy for endometrial cancer based on recent clinical trials. It summarizes three major randomized controlled trials from 2007-2008 that evaluated the role of external beam radiation therapy in early stage endometrial cancer and found no improvement in survival with its addition to surgery alone. Risk group stratification is important to identify patients most likely to benefit from adjuvant treatment.
Brachytherapy is a form of internal radiotherapy where radioactive sources are placed inside or next to the area requiring treatment. The document discusses the history, types, and applications of brachytherapy in gynaecological cancers such as cervical cancer, endometrial cancer, and vaginal cancer. It provides details on the procedures, applicators, treatment planning, and dose prescription for brachytherapy in these cancers. The key advantages of brachytherapy include high biological efficacy and rapid dose fall off leading to higher tolerance of normal tissues.
1. The document discusses treatment options and strategies for rectal cancer patients who achieve a clinical complete response after neoadjuvant chemoradiation therapy.
2. Key points discussed include patient selection criteria for active surveillance versus surgery, optimal timing of response assessment, and surveillance schedules for patients undergoing a watch-and-wait approach.
3. Studies presented showed that outcomes for complete responders managed non-operatively can be comparable to those having surgery, though local recurrence rates are higher with the non-operative approach. Strict patient selection and close surveillance are important.
Hysterectomy for benign conditions in a university hospital in2Tariq Mohammed
This study examined 251 women who underwent hysterectomies for benign conditions at a university hospital in Saudi Arabia between 1990 and 2002. The most common indications for hysterectomy were uterine fibroids (41.6%) and dysfunctional uterine bleeding (27.1%). Most abdominal hysterectomies (79%) were performed for fibroids and bleeding, while most vaginal hysterectomies (21%) were for uterine prolapse. Overall complication rates were 33.5% for abdominal hysterectomy and 30.4% for both procedures combined, with the most common complication being postoperative infection (18.7%).
This document discusses treatment options for operable gastric cancer. It notes that surgical resection is currently the only potentially curative treatment, and recommends resection for all non-metastatic cancers. While the optimal extent of lymphadenectomy is still debated, removing a minimum of 15 lymph nodes is recommended. Adjuvant chemotherapy, chemoradiation, and perioperative chemotherapy are strategies that can increase cure rates. Preoperative chemotherapy followed by postoperative chemoradiation may also improve outcomes compared to postoperative treatment alone.
This document discusses cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of peritoneal carcinomatosis. It provides details on the experience with CRS+HIPEC at King Faisal Specialist Hospital and Research Centre in Riyadh, Saudi Arabia. The following key points are discussed:
- Over 200 patients have undergone CRS+HIPEC for various cancer types, with no in-hospital mortality. Common cancer types included colon, gastric, and ovarian cancers.
- The procedure involves extensive abdominal surgery to remove all visible tumor, followed by heated chemotherapy delivered directly into the abdomen to treat any remaining microscopic disease.
- Out
Adjuvant Therapy in the Cancer of Uterine BodySujoy Dasgupta
This document discusses adjuvant therapy for endometrial cancer. It covers surgical staging and treatment based on risk level. Low risk stage IA or IB grade 1-2 cancers require only observation. Moderate risk cancers may benefit from vaginal or pelvic radiation. High risk stage III or higher cancers should receive chemotherapy followed by radiation. Lymph node dissection improves outcomes and should be performed routinely if possible. Special considerations are given for stage II, stage III-IV, and uterine papillary serous cancers.
Discuss the principles guiding the use of radiotherapy in surgeryAbdullahi Sanusi
The document discusses the principles guiding the use of radiotherapy in surgery. It covers topics such as the physical and biological basis of radiotherapy, indications and contraindications, treatment planning, technical aspects, and complications. Radiotherapy is an important clinical discipline for treating cancer and some benign diseases. About 60% of cancer patients require radiotherapy during their treatment course. The principles of radiotherapy are based on understanding the physical and biological effects of ionizing radiation on tumors and normal tissues. [END SUMMARY]
This study evaluated the safety and outcomes of simultaneous resection of primary rectal cancer and synchronous liver metastases compared to a staged approach. The study reviewed 198 patients treated at a single cancer center between 1984-2008. Results showed no significant differences in postoperative complications or mortality between simultaneous and staged resections. However, simultaneous resection was associated with shorter hospitalization. The study demonstrated the safety and feasibility of simultaneous resection in appropriately selected patients with rectal cancer and liver metastases when performed by experienced surgeons.
General surgery treatment guidelines Govt of India Dr Jitu Lal Meena
1. The document provides guidelines for the treatment of blunt abdominal trauma and cholecystectomy.
2. For blunt abdominal trauma, the guidelines recommend initial resuscitation and stabilization of patients. For diagnosis, focused abdominal sonography or diagnostic peritoneal lavage are suggested. For treatment, laparotomy is indicated for hemodynamically unstable patients or those with evidence of injury on investigations.
3. For cholecystectomy, the guidelines discuss the indications including symptomatic gallstone disease and complications. The optimal investigations and surgical techniques are provided for both open and laparoscopic approaches. Referral criteria and post-operative care are also outlined.
Neoadjuvant therapy, including chemotherapy and chemoradiotherapy, is being investigated for the treatment of esophageal cancer. While some studies have shown improved survival rates with neoadjuvant therapy compared to surgery alone, the evidence from clinical trials remains conflicting. Achieving a complete pathological response after neoadjuvant therapy is associated with significantly improved long-term survival. Further research is still needed to determine the optimal neoadjuvant approaches and to improve outcomes by reducing distant metastases.
This document summarizes the current state of neoadjuvant treatment options for esophageal and gastric cancer. It finds that neoadjuvant therapy prior to surgery should be considered for all patients with greater than T1 or node-positive disease. For esophageal cancer, most patients should receive neoadjuvant chemoradiation. For gastric cancer, there is strong support for adjuvant chemotherapy following surgery. Future areas of research include immunotherapy, targeted therapies, and combination approaches.
This document discusses innovations in pancreatic cancer treatment and research. It provides hope by highlighting advances that allow patients to live longer with the disease or be cured. These include early diagnosis, dedicated cancer specialists, clinical trials of new treatments, and laboratory research. The author advocates for a focus on both immediate patient care and long-term cures through a combination of new treatments and optimized patient selection for surgery.
Gastrointestinal Stromal Tumors: A clinicopathologic study of 67 cases.Dr./ Ihab Samy
Amr H. Sleema MD; Ihab S. Fayeka MD; Hany F. Habashyb MD;Amany Saberc MD;Alfred E. Namourd MD;Nevine F. Habashye MD
a: Surgical Oncology Department – National Cancer Institute – Cairo University – Egypt.
b: Surgery Department – Fayoum teaching hospital – Fayoum University – Egypt.
c: Medical Oncology Department – Minia Cancer Center – Egypt.
d: Medical Oncology Department – National Cancer Institute – Cairo University – Egypt.
e: Surgical Pathology Department - National Cancer Institute – Cairo University – Egypt.
Kasr el-aini journal of surgery Volume 15, No.2, May 2014
This document discusses adjuvant therapy for endometrial cancer and provides guidelines and recommendations. It summarizes incidence rates and risk groups for endometrial cancer. It then provides recommendations for adjuvant radiation therapy, brachytherapy, chemotherapy, or a combination based on histology, grade, myometrial invasion, lymphovascular space invasion status, and other risk factors. Ongoing randomized studies evaluating different adjuvant treatment approaches are also mentioned.
1. The document discusses prophylactic cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) in high-risk patients for peritoneal carcinomatosis. It covers topics like the peritoneum, mechanisms of peritoneal dissemination, cytoreduction, HIPEC, high-risk patients, FDG-PET scanning, and second-look surgery.
2. Second-look surgery found peritoneal carcinomatosis in 56% of high-risk patients, who had a 5-year survival rate of 90% after complete cytoreduction and HIPEC.
3. While showing promise, the study had some weaknesses like its sample size and criteria for considering patients as high-
Beat the Odds: New Treatments for Pancreatic Cancer - 12.6.18Summit Health
Presenter(s): Zubin M. Bamboat, MD, FACS, Surgical Oncologist; David Gallinson, DO, Oncologist
Pancreatic cancer is often a silent killer. While surgery provides the only chance for a cure, many patients are inoperable by the time they develop symptoms. Join us to learn all about pancreatic cancer, including risk factors and symptoms. Our experts will discuss how they are combating this deadly disease by using the latest in adjuvant and neoadjuvant therapies, surgery and novel medical treatments.
While the role of radiation therapy in carcinoma cervix management is undauntable for all stages. Recurrent carcinoma cervix need a lot of personalisation
The document discusses new aspects of adjuvant therapy for endometrial cancer based on recent clinical trials. It summarizes three major randomized controlled trials from 2007-2008 that evaluated the role of external beam radiation therapy in early stage endometrial cancer and found no improvement in survival with its addition to surgery alone. Risk group stratification is important to identify patients most likely to benefit from adjuvant treatment.
Brachytherapy is a form of internal radiotherapy where radioactive sources are placed inside or next to the area requiring treatment. The document discusses the history, types, and applications of brachytherapy in gynaecological cancers such as cervical cancer, endometrial cancer, and vaginal cancer. It provides details on the procedures, applicators, treatment planning, and dose prescription for brachytherapy in these cancers. The key advantages of brachytherapy include high biological efficacy and rapid dose fall off leading to higher tolerance of normal tissues.
1. The document discusses treatment options and strategies for rectal cancer patients who achieve a clinical complete response after neoadjuvant chemoradiation therapy.
2. Key points discussed include patient selection criteria for active surveillance versus surgery, optimal timing of response assessment, and surveillance schedules for patients undergoing a watch-and-wait approach.
3. Studies presented showed that outcomes for complete responders managed non-operatively can be comparable to those having surgery, though local recurrence rates are higher with the non-operative approach. Strict patient selection and close surveillance are important.
Hysterectomy for benign conditions in a university hospital in2Tariq Mohammed
This study examined 251 women who underwent hysterectomies for benign conditions at a university hospital in Saudi Arabia between 1990 and 2002. The most common indications for hysterectomy were uterine fibroids (41.6%) and dysfunctional uterine bleeding (27.1%). Most abdominal hysterectomies (79%) were performed for fibroids and bleeding, while most vaginal hysterectomies (21%) were for uterine prolapse. Overall complication rates were 33.5% for abdominal hysterectomy and 30.4% for both procedures combined, with the most common complication being postoperative infection (18.7%).
This document discusses treatment options for operable gastric cancer. It notes that surgical resection is currently the only potentially curative treatment, and recommends resection for all non-metastatic cancers. While the optimal extent of lymphadenectomy is still debated, removing a minimum of 15 lymph nodes is recommended. Adjuvant chemotherapy, chemoradiation, and perioperative chemotherapy are strategies that can increase cure rates. Preoperative chemotherapy followed by postoperative chemoradiation may also improve outcomes compared to postoperative treatment alone.
This document discusses cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of peritoneal carcinomatosis. It provides details on the experience with CRS+HIPEC at King Faisal Specialist Hospital and Research Centre in Riyadh, Saudi Arabia. The following key points are discussed:
- Over 200 patients have undergone CRS+HIPEC for various cancer types, with no in-hospital mortality. Common cancer types included colon, gastric, and ovarian cancers.
- The procedure involves extensive abdominal surgery to remove all visible tumor, followed by heated chemotherapy delivered directly into the abdomen to treat any remaining microscopic disease.
- Out
Adjuvant Therapy in the Cancer of Uterine BodySujoy Dasgupta
This document discusses adjuvant therapy for endometrial cancer. It covers surgical staging and treatment based on risk level. Low risk stage IA or IB grade 1-2 cancers require only observation. Moderate risk cancers may benefit from vaginal or pelvic radiation. High risk stage III or higher cancers should receive chemotherapy followed by radiation. Lymph node dissection improves outcomes and should be performed routinely if possible. Special considerations are given for stage II, stage III-IV, and uterine papillary serous cancers.
Discuss the principles guiding the use of radiotherapy in surgeryAbdullahi Sanusi
The document discusses the principles guiding the use of radiotherapy in surgery. It covers topics such as the physical and biological basis of radiotherapy, indications and contraindications, treatment planning, technical aspects, and complications. Radiotherapy is an important clinical discipline for treating cancer and some benign diseases. About 60% of cancer patients require radiotherapy during their treatment course. The principles of radiotherapy are based on understanding the physical and biological effects of ionizing radiation on tumors and normal tissues. [END SUMMARY]
This study evaluated the safety and outcomes of simultaneous resection of primary rectal cancer and synchronous liver metastases compared to a staged approach. The study reviewed 198 patients treated at a single cancer center between 1984-2008. Results showed no significant differences in postoperative complications or mortality between simultaneous and staged resections. However, simultaneous resection was associated with shorter hospitalization. The study demonstrated the safety and feasibility of simultaneous resection in appropriately selected patients with rectal cancer and liver metastases when performed by experienced surgeons.
General surgery treatment guidelines Govt of India Dr Jitu Lal Meena
1. The document provides guidelines for the treatment of blunt abdominal trauma and cholecystectomy.
2. For blunt abdominal trauma, the guidelines recommend initial resuscitation and stabilization of patients. For diagnosis, focused abdominal sonography or diagnostic peritoneal lavage are suggested. For treatment, laparotomy is indicated for hemodynamically unstable patients or those with evidence of injury on investigations.
3. For cholecystectomy, the guidelines discuss the indications including symptomatic gallstone disease and complications. The optimal investigations and surgical techniques are provided for both open and laparoscopic approaches. Referral criteria and post-operative care are also outlined.
Neoadjuvant therapy, including chemotherapy and chemoradiotherapy, is being investigated for the treatment of esophageal cancer. While some studies have shown improved survival rates with neoadjuvant therapy compared to surgery alone, the evidence from clinical trials remains conflicting. Achieving a complete pathological response after neoadjuvant therapy is associated with significantly improved long-term survival. Further research is still needed to determine the optimal neoadjuvant approaches and to improve outcomes by reducing distant metastases.
This document summarizes the current state of neoadjuvant treatment options for esophageal and gastric cancer. It finds that neoadjuvant therapy prior to surgery should be considered for all patients with greater than T1 or node-positive disease. For esophageal cancer, most patients should receive neoadjuvant chemoradiation. For gastric cancer, there is strong support for adjuvant chemotherapy following surgery. Future areas of research include immunotherapy, targeted therapies, and combination approaches.
This document discusses innovations in pancreatic cancer treatment and research. It provides hope by highlighting advances that allow patients to live longer with the disease or be cured. These include early diagnosis, dedicated cancer specialists, clinical trials of new treatments, and laboratory research. The author advocates for a focus on both immediate patient care and long-term cures through a combination of new treatments and optimized patient selection for surgery.
Gastrointestinal Stromal Tumors: A clinicopathologic study of 67 cases.Dr./ Ihab Samy
Amr H. Sleema MD; Ihab S. Fayeka MD; Hany F. Habashyb MD;Amany Saberc MD;Alfred E. Namourd MD;Nevine F. Habashye MD
a: Surgical Oncology Department – National Cancer Institute – Cairo University – Egypt.
b: Surgery Department – Fayoum teaching hospital – Fayoum University – Egypt.
c: Medical Oncology Department – Minia Cancer Center – Egypt.
d: Medical Oncology Department – National Cancer Institute – Cairo University – Egypt.
e: Surgical Pathology Department - National Cancer Institute – Cairo University – Egypt.
Kasr el-aini journal of surgery Volume 15, No.2, May 2014
This document discusses adjuvant therapy for endometrial cancer and provides guidelines and recommendations. It summarizes incidence rates and risk groups for endometrial cancer. It then provides recommendations for adjuvant radiation therapy, brachytherapy, chemotherapy, or a combination based on histology, grade, myometrial invasion, lymphovascular space invasion status, and other risk factors. Ongoing randomized studies evaluating different adjuvant treatment approaches are also mentioned.
1. The document discusses prophylactic cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) in high-risk patients for peritoneal carcinomatosis. It covers topics like the peritoneum, mechanisms of peritoneal dissemination, cytoreduction, HIPEC, high-risk patients, FDG-PET scanning, and second-look surgery.
2. Second-look surgery found peritoneal carcinomatosis in 56% of high-risk patients, who had a 5-year survival rate of 90% after complete cytoreduction and HIPEC.
3. While showing promise, the study had some weaknesses like its sample size and criteria for considering patients as high-
Beat the Odds: New Treatments for Pancreatic Cancer - 12.6.18Summit Health
Presenter(s): Zubin M. Bamboat, MD, FACS, Surgical Oncologist; David Gallinson, DO, Oncologist
Pancreatic cancer is often a silent killer. While surgery provides the only chance for a cure, many patients are inoperable by the time they develop symptoms. Join us to learn all about pancreatic cancer, including risk factors and symptoms. Our experts will discuss how they are combating this deadly disease by using the latest in adjuvant and neoadjuvant therapies, surgery and novel medical treatments.
Topic-Driven Round Table on Low Grade Serous Ovarian Cancerbkling
A discussion about low grade serous ovarian cancer with Dr. Amanda Nickles Fader, Director of Kelly Gynecologic Oncology Service, Johns Hopkins Hospital. This type of ovarian cancer behaves differently and is treated differently than other ovarian cancers. Join the conversation to learn more and ask an expert your questions.
The document summarizes a randomized controlled trial that compared neoadjuvant chemoradiotherapy plus surgery versus surgery alone for esophageal or junctional cancer. 368 patients were randomized to either neoadjuvant chemoradiotherapy consisting of carboplatin, paclitaxel and radiotherapy followed by surgery, or surgery alone. The primary outcome was overall survival, with secondary outcomes including progression-free survival and progression-free interval. After a minimum follow-up of 5 years, long-term results demonstrated improved overall and progression-free survival for patients who received neoadjuvant chemoradiotherapy prior to surgery compared to surgery alone.
This case report describes the treatment of a 55-year-old male patient diagnosed with gastric diffuse large B-cell lymphoma (DLBCL) at the Portsudan Oncology Center in Sudan from August 2018 to July 2021. The patient received 8 cycles of CHOP chemotherapy, followed by 8 cycles of rituximab and 30GY radiotherapy to the gastric region and lymph nodes. The treatment resulted in regression of lesions. However, the patient later experienced a relapse and was treated with 8 cycles of ICE chemotherapy, with regression of lesions observed again. The report discusses DLBCL and the challenges of treating it at a small oncology center with limited resources and capabilities.
This document summarizes the results of the PRODIGE 7 trial, which compared cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC) to cytoreductive surgery alone for patients with metastatic colorectal cancer and peritoneal carcinomatosis. The trial found no significant difference in overall survival between the two treatment groups. Patients who received HIPEC had higher rates of postoperative complications and longer hospital stays. For patients with 11-15 peritoneal lesions, HIPEC showed a potential survival benefit. However, given the lack of overall survival benefit and increased risks, the addition of HIPEC to standard treatment requires reconsideration.
The document provides information on cervical cancer including:
1. Statistics on global cancer incidence and mortality with cervical cancer among the most common cancers.
2. Risk factors for cervical cancer including human papillomavirus infection, young age of first intercourse, multiple sexual partners, and smoking.
3. Screening guidelines recommend co-testing with cytology and HPV testing every 5 years for women aged 30-65 or cytology alone every 3 years.
This document discusses the management of Wilms tumor and the role of radiotherapy. It covers the epidemiology, molecular biology, clinical presentation, diagnostic workup, staging, pathology, treatment options according to NWTS and SIOP protocols, and long-term treatment outcomes from NWTS trials. Radiotherapy techniques for flank irradiation, whole abdominal irradiation, whole lung irradiation, and conformal planning are also described.
Presentation at Chittaranjan Seva Sadan, Kolkata where Dr Dasgupta was invited as faculty in the CME organized by Medical Education and research Committee, Bengal Obstetrics and Gynaecological Society
This document discusses the management of ovarian cancer. It covers risk-reducing salpingo-oophorectomy (RRSO) for high-risk patients, surgical staging techniques including open and minimally invasive approaches, management of early-stage disease including adjuvant chemotherapy and radiation, cytoreductive surgery and goals for advanced-stage disease, and the role of interval debulking surgery after neoadjuvant chemotherapy. Complete resection of all tumor is the optimal outcome for advanced ovarian cancer to improve survival outcomes.
This document summarizes the presentation of a case of a 50-year-old female patient with stage 1 thymoma. It outlines her clinical presentation of cough and shortness of breath, as well as workup showing normal labs and imaging. Her thymoma was diagnosed and treatment with chemotherapy and radiation therapy was planned. The document then reviews clinical presentations, diagnostic workup, staging, and management approaches for thymoma including surgery, radiation therapy, chemotherapy, and combined modality treatment, with outcomes from various studies. Neoadjuvant chemotherapy followed by surgery was noted to obtain similar resectability and survival rates as upfront surgery for locally advanced thymoma.
This document outlines the treatment of advanced/metastatic renal cell carcinoma (RCC). It discusses that nephrectomy may still have a role in metastatic RCC for some patients. Active surveillance is an option for favorable risk metastatic RCC patients. Several trials found no differences between tyrosine kinase inhibitors as first line options for metastatic RCC. Second line options after progression on TKIs include mTOR inhibitors, VEGF inhibitors, and immune checkpoint inhibitors. Recent data supports immune checkpoint inhibitors like nivolumab plus ipilimumab as the new standard of care for first line treatment of metastatic RCC based on improved overall survival compared to sunitinib in clinical trials.
This study analyzed 159 patients with stage II-III colorectal cancer treated at St. Michael's Hospital between 2005-2012 to evaluate adherence to guidelines recommending adjuvant chemotherapy begin within 8 weeks of surgery. The mean time from surgery to chemotherapy was 7.2 weeks. Patients who experienced complications experienced further delays of 9.5 days. Barriers contributing to delays included time awaiting pathology results, referrals between departments, and port insertion. While trends suggested delays may increase recurrence risk, the association was weak; complications strongly correlated with higher recurrence. Areas for improvement were identified to optimize adherence to guidelines.
This document provides an overview of epithelial ovarian cancer including epidemiology, risk factors, pathology, clinical presentation, diagnosis, staging, treatment options, and outcomes. It discusses that ovarian cancer is the second most common gynecologic malignancy in Western countries. Seventy percent of patients present with advanced stage disease. Treatment depends on stage but typically involves surgery and platinum-based chemotherapy. Outcomes have improved over time but remain poor for advanced and recurrent disease.
Radiotherapy in Uterine & Cervical Cancer.pptxAtulGupta369
Radiotherapy
uterine carcinoma
cervix carcinoma
brachytherapy in uterine carcinoma
brachytherapy in cervical carcinoma
detailed decription
explanation about recent recommendations
explanations about landmark trials
one shot whole ppt for learning about EBRT and brachytherapy in cervical and uterine carcinoma
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2. outlines of presentation
• case presentation
• clinical manifestation
• diagnosis
• management
• case critics
1/17/2020 2
3. MRN 555758
• This is a 36 years old female patient presented with lower abdominal pain of
6 months duration.
• She has no cough ,chest pain ,loss of appetite
• She has no abdominal swelling, failure to pass faces and flatus.
• TAH and BSO was done 5 months back at Chorea hospital
•
1/17/2020 3
4. currently
• SUBJ: no new compliant
P/E
ECOG 1
V/S stable
Abdomen :there is midline scar
GUS:PV:no palpable mas, no discharge
1/17/2020 4
6. Cont.…
• CXR :normal
• Post op abdominopelvic u/s :normal
• CBC and OFT:normal
• Ca125=35.1
1/17/2020 6
7. ASST:High risk stage 1B ovarian ca
• Plan :give adjuvant cisplatin and taxol
• With this plan she has completed 6 cycle of chemotherapy 3 weeks ago and
she has normal mid cycle assessment .
• Currently she is appointed for her 1st follow up
1/17/2020 7
9. Clinical manifestations
• Historically, ovarian cancer was called a “silent killer,”
• a woman with early ovarian cancer was believed to have no or minimal symptoms
until she developed metastatic disease at which point abdominal symptoms :
bloating,
distention,
early satiety, loss of appetite, nausea,
weight loss and pelvic symptoms .
1/17/2020 9
10. cont..
• In premenopausal women, most of these masses are benign, as ovarian
cancer represents <5% of adnexal neoplasms.
• An adnexal mass in a postmenopausal woman has a higher likelihood of
malignancy, and surgical exploration is often indicated.
• Physical examination findings such as a fixed pelvic mass, palpable upper
abdominal mass, and ascites are highly suggestive of an ovarian malignancy
1/17/2020 10
11. DIAGNOSTIC WORKUP
• Evaluation of a pelvic mass will be influenced by:
the patient’s age,
clinical presentation,
and imaging features.
• An ovarian mass is more likely to be a malignant:
neoplasm in the pediatric,
perimenopausal,
and postmenopausal age
benign during the reproductive years
1/17/2020 11
12. Cont.…
• Ultrasound is often the first, noninvasive step for the evaluation of a pelvic
mass.
• Sonographic characteristics suggestive of malignancy include:
irregular borders with septations, ascites,
peritoneal masses,
enlarged nodes,
or matted bowel
1/17/2020 12
19. Surgery
• Surgery is a cornerstone of the diagnosis and treatment of ovarian
carcinoma.
• The surgical goals differ based on the nature and stage of disease.
• The most commonly encountered scenario unfortunately is that of
advanced epithelial ovarian cancer.
1/17/2020 19
20. PRINCIPLES OF SURGERY
• It is recommended that a gynecologic oncologist perform the appropriate
surgery.
• If clinical judgment indicates that maximum cytoreduction cannot be
achieved, neoadjuvant chemotherapy should be considered.
• Patients who are unable to be optimally debulked using minimally invasive
techniques should be converted to an open procedure.
1/17/2020 20
21. • An open laparotomy including a vertical midline abdominal incision should
be used in patients with a suspected malignant ovarian/fallopian
tube/primary peritoneal neoplasm in whom a surgical staging procedure, a
primary debulking procedure, an interval debulking procedure, or secondary
cytoreduction is planned.
1/17/2020 21
22. Operative Reports
• Surgeons should describe the following in the operative report:
Extent of initial disease before debulking pelvis, mid abdomen, or upper
abdomen (cutoffs: pelvic brim to lower ribs).
Amount of residual disease in the same areas after debulking.
Complete or incomplete resection; if incomplete, indicate the size of the
major lesion and total number of lesions.
1/17/2020 22
23. The rationale for debulking surgery
• Removing large necrotic masses promotes drug delivery to smaller tumors
with good blood supply.
• Removing resistant clones decreases the likelihood of early-onset drug
resistance.
• Tiny implants have a higher growth fraction that should be more
chemosensitive.
• Removing cancer in specific locations, such as tumors causing a bowel
obstruction, improves the patient’s nutritional and immunologic status.
1/17/2020 23
25. Surgery
• At diagnosis, approximately one third of patients with epithelial ovarian cancer have early-stage disease that is confined to
the ovary or pelvis.
• Although the 5-year survival for patients with early-stage ovarian cancer is much better than that for those with advanced
disease, relapse rates ranging from 20% to 30% have been quoted for patients with poor prognostic factors
• Classic clinical and pathologic prognostic factors, such as :
degree of differentiation,
FIGO sub stage,
histologic type,
dense adhesions, l
arge-volume ascites
, rupture before or during surgery, bilaterality, positive peritoneal cytology extra capsular growth, and age of the patient
have been identified as prognostic characteristics.
1/17/2020 25
28. Surgery
• Comprehensive surgical staging should be performed in all women with
apparent early-stage disease to confirm that the cancer is confined to the
adnexa.
• Fertility-sparing surgery with unilateral salpingo-oophorectomy may be
considered in a small subset of women with stage IA disease if the
contralateral ovary is normal in appearance.
• In addition to abdominal exploration and full surgical staging, endometrial
biopsy should be considered to sample the endometrium.
1/17/2020 28
29. Satoh et al
• A multi-institutional
• Retrospective
• On Stage I EOC treated with fertility-sparing surgery
• The objective of this study was to assess clinical outcomes and fertility in
patients treated conservatively for unilateral stage I invasive EOC.
1/17/2020 29
30. Satoh et al
1/17/2020 30
211 patients with
unilateral stage I EOC
N=21
group III: stage IA and
clear cell histology grade
3 , stage
IC and clear cell
histology, or stage IC and
G3
N=108
Group I: stage IA
and
favorable histology
N=82
group II: stage IA and
clear cell histology, or
stage IC and
favorable histology;
Pepts OS,RFS
Median duration of follow-up was 78
months
33. CONCLUSION
• Our data confirm that fertility-sparing surgery is a safe treatment for stage
IA patients with favorable histology and suggest that stage IA patients with
clear cell histology and stage IC patients with favorable histology can be
candidates for fertility-sparing surgery followed by adjuvant chemotherapy
1/17/2020 33
34. Do early ovarian ca need adjuvant chemo??
• Early studies by GOG and others have identified a small subgroup of patients with
well- to moderately differentiated :
(grade 1 or 2) stage IA and IB tumors who have a low risk of relapse and may not
require adjuvant therapy.
The NCCN guidelines state that women with early-stage (FIGO IA or IB) grade 1
endometrioid carcinoma of the ovary may be treated with surgical resection and
observation with expected 5-year survival rates on the order of 90%.
If observation is considered for women with early-stage grade 2 disease, full
surgical staging should be performed
1/17/2020 34
35. 5 year survival in ovarian ca
• Recently published data from the SEER Program of the NCI indicate t
• FIGO stage I and low grade= 92.3%.
• FIGO stage II=71.7%.
• FIGO stage III, the 5-year relative survival rate is only 27.4%.
• FIGO stage IA or IB grade 3, stage IC any grade, all clear cell carcinoma,
and completely resected stage II)=75%
1/17/2020 35
36. NEJM 1990
1/17/2020 36
92 patients
with grade 1
and 2 stage
1A and 1B
PEPTS
5Y DFS
OS
48
patients
recieve
44
patients
observat
ion
Melphal
an
5y DFS
91%
OS
98%
5Y
DFS.
98%
OS
94%
P
=0.43
37. TRIAL 2 NEJM 1990
1/17/2020 37
141 Patients
with stage 1A
and 1B high
grade
5y DFS
OS
68 patients
receive
melphalan
73 patient
to
observation
melphalan
5Y DFS
80%
OS
80%
5Y DFS
80.5%
OS
78%
P=0.48
38. EORTC action trial
1/17/2020 38
448 patients
Stage 1A and
1B grade 2 and
3
224
patients
reciev
chemo
224 patients
obserbation
PETS
OS
RFS
Platiniu
m based
chemo
40Europea
n centers
OS
85%
RFS
79.5
OS
80%
RFS
69%
P=0.009
39. • Women with FIGO IA grade 2 and 3 diseases, all stages IC-IIA, or any clear
cell histology were eligible for the trial.
• recurrence-free survival, but not overall survival, was significantly improved
in the chemotherapy group
1/17/2020 39
41. Advanced-Stage Disease
• Surgical Considerations:
Optimal or complete cytoreduction is one of the most important prognostic
factors for survival in patients with advanced-stage ovarian cancer.
Cytoreductive surgery in advanced-stage disease may improve the patient’s
disease-related symptoms such as abdominal pain and early satiety and allow
for the ability to maintain nutritional status.
1/17/2020 41
42. • The definition of “optimal cytoreduction” continues to evolve.
• Since 1986, the Gynecologic Oncology Group (GOG) has defined optimal
cytoreduction as leaving residual disease less than 1 cm in maximum tumor
diameter .
1/17/2020 42
45. Gynecol
Oncol 2006;
• Objectives: to determine the survival impact of adding extensive upper
abdominal surgical cytoreduction to standard surgical techniques for
advanced ovarian cancer
1/17/2020 45
46. • Methods: the records of all patients with stages IIIC–IV epithelial ovarian cancer who underwent
primary surgery at our institution from 1998 to 2003 were reviewed.
• The cohort was divided into 3 groups:
Group 1 patients required extensive upper abdominal surgery, such as diaphragm
peritonectomy/resection, resection of parenchymal liver or porta hepatis disease and/or
splenectomy with or without distal pancreatectomy, to achieve optimal cytoreduction (residual
disease ≤1 cm).
Group 2 patients were optimally cytoreduced by standard surgical techniques, including
hysterectomy, oophorectomy, omentectomy, and bowel resection.
Group 3 patients were suboptimally cytoreduced. Primary outcome measures were response to
primary chemotherapy, progression-free survival, and overall survival
1/17/2020 46
47. Gynecol
Oncol 2006
1/17/2020 47
262 patient
Stage 3c-4
G1
57
patients;
G2
122
patients;
G3
83
patients.
PETS
PFS
OS
CHEMO
RESPONS
OS
84 M
PFS
24 M
R
82%
OS
84M
PFS
23M
R
78%
R
57%
OS
38
M
PFS
11M
48. Conclusions
• Patients requiring extensive upper abdominal procedures to achieve optimal
cytoreduction demonstrated a similar initial response, progression-free
survival, and overall survival to patients optimally cytoreduced by standard
surgical techniques.
• The presence of bulky upper abdominal disease alone did not appear to
indicate poor tumor biology.
1/17/2020 48
50. Second-look laparotomy
• was introduced to assess the extent of residual disease following
cytoreductive surgery and adjuvant chemotherapy.
• Up to 20% to 50% of patients may have residual disease after adjuvant
therapy that was not detected on physical examination or by CA-125 levels or
imaging.
• Although SLL demonstrated the prognostic importance of a pathologic
remission, it was not found to have a therapeutic benefit in a GOG trial of
800 patients.
1/17/2020 50
51. NEJ M 351;24
1/17/2020 51
424 patients
After 10 surg>1cm
residual
PETS
OS
PFS216 eligible
patients receive
2^CYRS
208 to receive
chemotherapy alone.
Goal
To see effect of 2^
Cytoreductive surgMedian OS
36.2 month
PFS
12.5 M
median
35.7 month
PFS
12.7 M
P=0.54
52. Neoadjuvant Chemotherapy
• Patients in whom malnutrition is significant or the metastatic disease process
appears unrespectable may be treated with neoadjuvant chemotherapy
followed by interval cytoreduction and postoperative chemotherapy.
• However, there has been significant movement in considering neoadjuvant
chemotherapy for women who are candidates for even primary debulking
surgery.
1/17/2020 52
53. NEJM 363;10 NEJM.org september 2, 2010
1/17/2020 53
670Stage IIIC or IV
patients Underwent
randomization336 Were
assigned to
primary surgery
PETS
OS
PFS
334 Were assigned to
neoadjuvant
chemotherapyTo see the role of
neoadjuvant chemo
medianOS
29 months
PFS
12 months
Median OS
30 months
PFS
12 months
55. EORTC 55971 trial
1/17/2020 55
670 stage IIIC or
IV patients
336patient receive
primary surgery
334 patients receive
neoadjuvant chemo
Pepts
5year survival
To see goal of
neoadjuvant
chemo
57. conclusion
• In the EORTC trial, patients with stage IVB disease and bulky tumors had
better 5-year survival rates with neoadjuvant therapy,
• whereas those with stage IIIC and less bulky tumors had a greater survival
benefit with upfront surgery.
1/17/2020 57
59. Chemotherapy for Advanced-Stage Disease
• Platinum agents are the most active class of compounds in the adjuvant
treatment for ovarian cancer.
• Before 1980, alkylating-based regimens such as cyclophosphamide and
doxorubicin were used with clinical response rates of15% to 20%. GOG 47
demonstrated an improvement in clinical complete response rates (51% vs.
26%) and progression-free survival (13 vs. 8 months) with the addition of
cisplatin to cyclophosphamide and doxorubicin.
1/17/2020 59
62. Role of intraperitoneal chemotherapy
• The peritoneal cavity is the principal site of disease in ovarian cancer.
• Although the intensity of intravenous chemotherapy is limited mainly by
myelotoxicity, several active drugs can be administered directly into the
peritoneal cavity.
• The rationale for intraperitoneal therapy in ovarian cancer is that the
peritoneum, the predominant site of tumor, receives sustained exposure to
high concentrations of antitumor agents while normal tissues, such as the
bone marrow, are relatively spared.
1/17/2020 62
63. NEJM354;1 www.nejm.org january 5, 2006
1/17/2020 63
429stage 3c-4
Patients
214 Assigned to
intraperitoneal
therapy
215 Assigned to
intravenous
therapy
Median OS
65.6 months
Median PFS
18.3 months
Pepts
OS
PFS
Ppfs=0.05
Intraperitoneal
Cisplatin and IV
Paclitaxel
Median PFS
23.8 months
Median OS
49.7 months
Pos=0.
03
64. conclusions
• As compared with intravenous paclitaxel plus cisplatin, intravenous paclitaxel
plus intraperitoneal cisplatin improves survival in patients with optimally
debulked stage III ovarian cancer
1/17/2020 64
65. Management of recurrent Ovarian Cancer
• Women in clinical remission following initial adjuvant treatment for ovarian
cancer may be followed with a combination of physical examination, serial
CA-125 levels, and/or abdominal and pelvic CT.
• Detection of early relapse by a rising CA-125 is fairly specific, although the
lead time between biochemical and clinical progression may be up to 6
months.
1/17/2020 65
66. Cont.…
• Recurrent ovarian cancer is incurable.
• Chemotherapy is indicated to control disease-related symptoms.
• The benefit from chemotherapy in these patients depends on the platinum free
interval.
• Patients with platinum-resistant disease (a relapse <6 months)
• Patients with platinum semi-sensitive relapse (6-12months )have a response rate of
30% to second-line platinum treatment.
• In patients with platinum-sensitive relapse (>12months) the response rate to
platinum is 60–70%.
1/17/2020 66
67. Platinum resistant OC
• In the absence of a new therapeutic study, most patients with platinum-
resistant disease are treated with single agents such as pegylated liposomal
doxorubicin (PLD) or topotecan and other agents.
1/17/2020 67
68. OCEANS trial
• a randomized, placebo -controlled, phase 3 trial
• evaluating the efficacy and safety of bevacizumab combined with
gemcitabine + carboplatin for patients with platinum-sensitive recurrent
ovarian cancer .
• PEPTS, PFS,OS with GC + bevacizumab compared with GC + PL.
1/17/2020 68
69. OCEANS trial
1/17/2020 69
484 recurrent
platinum sensitive
patients
recurring>6mo242patients receive
GC+bevaccizumabe 242 patients receive GC+PL
PEPTS
OS
PFS
Median OS
33.6 months
DPFS
12.4 months
Median OS
32.9 months
DPFS
8.4 months
. Median follow-up
for OS was
58.2 months
Pos=0.65
Ppfs
<0.001
70. Cont.…
• In the OCEANS trial, the addition of bevacizumab to
carboplatin/gemcitabine chemotherapy resulted in improved progression-
free survival (median 12.4 vs. 8.4 months) in women with platinum-sensitive
recurrent disease.
• In the final survival analysis, there was not a significant increase in overall
survival with the addition of bevacizumab when compared to chemotherapy
alone (33.6 vs. 32.9 months).
1/17/2020 70
72. CALYPSO trial
• Pegylated Liposomal Doxorubicin and Carboplatin Compared With
Paclitaxel and Carboplatin for Patients With Platinum-Sensitive Ovarian
Cancer in Late Relapse
• randomized, multicenter, phase III noninferiority trial
1/17/2020 72
73. CALYPSO trial
1/17/2020 73
976 patients
Assigned CD
(n = 467) Assigned CP
(n = 509)
PFS
11.3 months
OS
immat
ure PFS
9.4 months
OS
immature
Pepts
PFS,OS
median follow-up of 22
months
P=0.005
75. • Patients who experience relapse >12 months after primary platinum-based
therapy have platinum-sensitive disease.
• The therapeutic landscape for these patients is dominated by reinduction of
platinum-based chemotherapy
1/17/2020 75
76. PARP INHIBITORS
• About 15% of epithelial ovarian cancers are deficient in homologous
recombination repair, owing to mutations in BRCA1/2.
• In up to 50% of patients with high-grade serous tumors, the tumor cells
may be deficient in homologous recombination as a result of germ line or
somatically acquired BRCA1/2 mutations, epigenetic inactivation of BRCA1,
or defects in the homologous recombination pathway that are independent
of BRCA1/2.
1/17/2020 76
77. Olaparib
• Olaparib is an oral poly (ADP-ribose) polymerase inhibitor with activity in
germline BRCA1 and BRCA2 (BRCA1/2) –associated breast and ovarian
cancers.
1/17/2020 77
78. NEJM
• a randomized, double-blind, placebo-controlled, phase 2 study to evaluate
maintenance treatment with olaparib in patients with platinum-sensitive,
relapsed, high-grade serous ovarian cancer who had received two or more
platinum based regimens and had had a partial or complete response to their
most recent platinum-based regimen.
1/17/2020 78
79. NEJM
•
1/17/2020 79
265 patients
136 were assigned to
the olaparib
129 to the placebo
group
MedianPF
S
8.4month
s
medianPFS
4.8 months
P<0.001
Pepts
PFS
82 investigational
sites in 16 countries
81. Cont.…
• In the platinum sensitive setting, olaparib maintenance therapy resulted in
progression-free survival benefit of 8.4 months compared to 4.8 months
with placebo for women with relapsed ovarian cancer, although an overall
survival benefit was not observed.
1/17/2020 81
83. NEJM.org on October 8, 2016.
• In this randomized, double-blind, phase 3 trial,
• patients were categorized according to the presence or absence of a germline
BRCA mutation (gBRCA cohort and
• non-gBRCA cohort) and the type of non-gBRCA mutation and were
randomly assigned in a 2:1 ratio to receive niraparib (300 mg) or placebo
once daily. The primary end point was progression-free survival
1/17/2020 83
84. NEJM.org on October 8, 2016.
1/17/2020 84
553 enrolled patients
203 patients BRCAM
350 Patients non
BRCA
372 patients receive
Niraparib 300mg po
daily
181 patients receive
placebo
Pepts
PFS
138 patient
BRCA
116 patient
snon BRCA
65 patient
BRCA234 patients non
BRCA
Median
PFS
21
months
Median
PFS
12.9
months
Median PFS
5.5months
Median PFS
3.8 months
P<0.001
85. • Maintenance niraparib resulted in a significant improvement in progression-
free survival, with the greatest benefit among patients with germline BRCA
mutations.
1/17/2020 85
86. Case critics
• Right risk assessment
• Chemotherapy options??
• Preop investigation should be collected
• Operation report should be attached with referral
• Right decision on adjuvant treatment
• 3 vs 6 cycle CT???
1/17/2020 86