Ana Opinião

Men seeking counselling in a Breast Cancer Risk Evaluation Clinic

Background Hereditary breast and ovary cancer syndrome affects both genders but little is known about the uptake of genetic services by men. The objective of this study is to characterise the male population counselled through a multidisciplinary breast/ovarian program. Methods Descriptive analysis of male patients counselled from January 2000 to December 2015. Data in this analysis include new cancer diagnoses during prospective follow up. Results From 4,320 families registered, 362 male patients were identified: 236 (65.2%) from hereditary cancer families (HCF) and 126 (34.8%) from non-HCF. In HCF, 121 patients (51.3%) were mutation carriers (MC): BRCA2 – 102 (84.3%), BRCA1 – 16 (13.2%), CHEK2 – 1 (0.8%) and TP53 – 2 (1.7%). Non-HCF included 126 patients: 85 (67.5%) belonged to families without pathogenic mutations or with variants of unknown clinical significance; 22 (17.5%) refused testing after counselling and 19 (15.0%) did not meet criteria for testing. Both HCF and non-HCF included patients with previous cancer diagnoses: HCF- Breast Cancer (BC) - 18; prostate cancer (PC) - 13; melanoma - 1; others - 7) and non-HCF (BC - 77; PC - 20; gastric cancer (GC) - 1; melanoma - 8; bladder cancer - 1; others - 22). From the 121 MC identified (including the TP53 and CHEK2 carriers), 97 patients (80.2%) adhered to prospective surveillance. With a median follow-up of 36.9 months, 17 cancers were diagnosed in 14 patients, PC being the most frequently diagnosed neoplasia (5 cases). Eleven patients (78.6%) are alive and three patients died of advanced cancer (2 with GC, 1 with disseminated adenocarcinoma). Conclusion We observed a high adherence to counselling, genetic testing and active surveillance by men belonging to hereditary BC families. Male carriers of pathogenic DNA variants are at risk for several cancers and should be included in prospective follow-up studies.

898PPRIMARY CYTOREDUCTIVE SURGERY (PCS) VS NEOADJUVANT CHEMOTHERAPY (NACT) FOR ADVANCED OVARIAN CARCINOMA (AOC): DECISION CRITERIA AND EFFICACY OUTCOMES

ABSTRACT Aim: PCS is the standard of care for aOC but NACT and interval debulking surgery (IDS) are acceptable treatment options for patients (pts) with stages IIIC and IV OC. Our aims are to characterize OC pts treated with PCS or NACT in our centre and to analyse decision criteria and efficacy outcomes of both strategies. Methods: All pts with ovarian tumours registered at the Southern Portuguese Cancer Registry (ROR-Sul) between 2006-2011 were reviewed for age at diagnosis, histology, FIGO stage, treatment (none, surgery and/or CT), progression free survival (PFS), overall survival (OS), criteria for NACT, number of platinum based CT cycles and residual macroscopic disease. Results: From 345 pts registered with ovarian tumours, 258 were epithelial ovarian cancers (EOC) (75%). EOC pts had a median age of 62 yrs (10-90); 64 (25%) were treated with surgery alone, 53 (21%) with NACT (stages IIIB-3, IIIC-15, IV-29) and 94 (37%) with PCS (25% stages IA-IC; 23% IIA-IIIA; 51% IIIB-IV).Other pts (17%) were not treated at our centre (only pathology review, multidisciplinary decision or death before treatment). For similar stages (IIIB-IV), median age was higher for NACT pts (64 yrs, 36-90) vs 59 yrs (33-82); median number of CT cycles was 8 (NACT) and 6 (PCS). Nine pts in the NACT group progressed and died before IDS. Complete resection of macroscopic disease was achieved in 24 (55%) of NACT pts and in 17 (36%) of PCS pts. Median OS and PFS were 29,2 and 8,1 months (NACT) and 38,1 months and 10,6 months (PCS). Bad prognosis pathology (mucinous/clear cell) was observed in 10 pts (3 NACT, 7 PCS). NACT decision was based on radiological criteria (74% of cases) such as implants >2cm outside the pelvis, lymphadenopathies above renal hilum, pre-sacred retroperitoneal disease or liver metastasis. In 14 pts (26%), comorbidities contraindicated upfront surgery. Conclusions: NACT was mostly decided for older pts with contraindications for upfront surgery and/or with radiologically determined unresectable disease. Observed OS was similar to that observed in trials with more fit pts. OS for the PDS group is in line with previous reports of single centre studies with experience in OC treatment. Disclosure: All authors have declared no conflicts of interest.