J.G. Cohen

Three versus six cycles of adjuvant platinum-based chemotherapy in early stage clear cell ovarian carcinoma – A multi-institutional cohort

OBJECTIVES To determine if 6 versus 3cycles of adjuvant platinum-based chemotherapy with or without taxane impacts survival in early stage ovarian clear cell carcinoma (OCCC). METHODS We retrospectively identified all cases of stage I and II OCCC treated at 5 institutions from January 1994 through December 2011. Patients were divided into 2 groups: those who received 3 versus 6cycles of adjuvant chemotherapy. Our cohort consisted of 210 patients with stage IA-II disease, 116 of whom underwent full surgical staging. Cox proportional hazards regression and Kaplan-Meier analyses were performed to evaluate progression-free (PFS) and overall survival (OS) between groups. RESULTS Among 210 eligible patients, the median age was 53years (range 30-88). The majority of patients were Caucasian (83.8%). All patients received adjuvant chemotherapy with 90% receiving carboplatin and paclitaxel. Thirty-eight (18.1%) patients received 3cycles, and 172 (81.9%) patients received 6cycles of adjuvant treatment. Recurrence rate was comparable between groups (18.4% vs. 27.3% for 3 vs. 6cycles, p=0.4). There was no impact of 3 versus 6cycles of chemotherapy on PFS (hazard ratio [HR] 1.4; 95% confidence interval [CI] 0.63-3.12, p=0.4) or OS (HR 1.65; 95% CI 0.59-4.65, p=0.3) on univariate analysis. There was no benefit to more chemotherapy in stratified analysis by stage nor on multivariate analysis adjusting for the impact of stage. Subgroup analysis of surgically staged patients also showed no difference in survival between 3 versus 6cycles of chemotherapy. CONCLUSIONS Three cycles of platinum with or without taxane adjuvant chemotherapy were comparable to 6cycles with respect to recurrence and survival in patients diagnosed with early stage ovarian clear cell carcinoma in this retrospective multi-institutional cohort. CONDENSATION Three cycles of platinum with or without taxane adjuvant chemotherapy are comparable to 6 cycles with respect to recurrence and survival in patients diagnosed with early stage ovarian clear cell carcinoma in this retrospective multi-institutional cohort.

Cancer Genetic Counseling and Testing: Perspectives of Epithelial Ovarian Cancer Patients and Gynecologic Oncology Healthcare Providers

Multi-gene panel testing has expanded the genetic information available to cancer patients. The objective was to assess provider behaviors and attitudes and patient knowledge and attitudes towards genetic counseling and testing. An online survey was distributed to Society of Gynecologic Oncology members and a written questionnaire was administered to patients diagnosed with epithelial ovarian cancer at a tertiary care referral center. Most of the 233 (18% response rate) provider respondents were gynecologic oncologists. Access to a genetic counselor was reported by 87% of providers and 55% deferred all testing to genetic counselors. Of 53 ovarian cancer patient respondents, two-thirds had previously seen a genetic counselor or undergone testing. Patients’ attitudes about genetic counseling and/or testing were favorable with respect to themselves (70–81%) and their family members (94%). Less than 25% of patients indicated worrying about health care discrimination, lack of privacy, or high cost. Seventy-seven percent of patients demonstrated a desire to obtain genetic information even if the results were not currently actionable, and 20% of providers stated they test for only those genes with guideline-supported actionable results. Provider practice differences were identified in screening and prevention strategies for patients with deleterious non-BRCA mutations and variants of uncertain significance. The variation in clinical interpretation of results associated with poorly defined cancer risks signals a need for more comprehensive training and guidelines to ensure access to evidence-based care.

Re-exploration of vertical rectus abdominis myocutaneous flap for vaginal reconstruction: Case report and review of the literature

The vertical rectus abdominis myocutaneous (VRAM) flap is a versatile and well-established reconstructive technique for many defects created as a result of colorectal and gynecologic extirpation. However, major re-operation in the pelvis following a VRAM flap reconstruction several months later is uncommon, and the safety and integrity of the VRAM flap in this setting has not been described. This case examines VRAM flap preservation during repeat exploratory laparotomy, and a unique view of the VRAM flap during interval exploration. We demonstrate an intact flap after lysis of adhesions with an audible Doppler signal, and maintenance of flap integrity in the postoperative period. This further substantiates its use as a durable rotational flap for perineal tissue defects.

The Role of Oxidative Stress in Ovarian Cancer: Implications for the Treatment of Patients

Abstract Ovarian cancer is the eighth most common cancer in the world and the seventh leading cause of cancer death in women worldwide. It is often undetected until disease has reached an advanced stage with the majority of patients found to have Stage III or IV disease on presentation. Oxidative stress (OS) appears to play a major role in the development and progression of ovarian cancer with various events in malignant transformation linked to reactive oxygen species (ROS). Many changes take place in and around the ovaries during ovulation, such as the repeated destruction and repair of the ovarian surface epithelium, resulting in the development OS. When antioxidants fail to remove ROS, OS increases and mutations in DNA occur. Further evidence is provided by patients with endometriosis, who appear to be at higher risk of ovarian cancer due to OS conditions within endometrioitic lesions. Multiparity, lactation, and oral contraceptive pill use all reduce the number of lifetime ovulations, a factor that appears important in protecting against ovarian cancer development. Endogenous antioxidants enzymes, such as superoxide dismutase, catalase, and glutathione peroxidase, are critical for maintaining normal cell function by converting ROS to less harmful forms; however, increasing the intake of dietary or supplemental antioxidants, such as vitamins, carotenoids, and minerals, does not appear to prevent the development of ovarian cancer. Greater success may arise by increasing the prevalence of endogenous enzymatic antioxidants or by finding additional methods that can decrease the amount of ROS present in the ovarian environment.Ovarian cancer is the eighth most common cancer in the world and the seventh leading cause of cancer death in women worldwide. It is often undetected until disease has reached an advanced stage with the majority of patients found to have Stage III or IV disease on presentation. Oxidative stress (OS) appears to play a major role in the development and progression of ovarian cancer with various events in malignant transformation linked to reactive oxygen species (ROS). Many changes take place in and around the ovaries during ovulation, such as the repeated destruction and repair of the ovarian surface epithelium, resulting in the development OS. When antioxidants fail to remove ROS, OS increases and mutations in DNA occur. Further evidence is provided by patients with endometriosis, who appear to be at higher risk of ovarian cancer due to OS conditions within endometrioitic lesions. Multiparity, lactation, and oral contraceptive pill use all reduce the number of lifetime ovulations, a factor that appears important in protecting against ovarian cancer development. Endogenous antioxidants enzymes, such as superoxide dismutase, catalase, and glutathione peroxidase, are critical for maintaining normal cell function by converting ROS to less harmful forms; however, increasing the intake of dietary or supplemental antioxidants, such as vitamins, carotenoids, and minerals, does not appear to prevent the development of ovarian cancer. Greater success may arise by increasing the prevalence of endogenous enzymatic antioxidants or by finding additional methods that can decrease the amount of ROS present in the ovarian environment.