V. Di Donato

Tertiary cytoreductive surgery in recurrent epithelial ovarian cancer: A multicentre MITO retrospective study

OBJECTIVES To evaluate the impact of tertiary cytoreductive surgery (TCS) on survival in recurrent epithelial ovarian cancer (EOC), and to determine predictors of complete cytoreduction. METHODS A multi-institutional retrospective study was conducted within the MITO Group on a 5-year observation period. RESULTS A total of 103 EOC patients with a ≥6month treatment-free interval (TFI) undergoing TCS were included. Complete cytoreduction was achieved in 71 patients (68.9%), with severe post-operative complications in 9.7%, and no cases of mortality within 60days from surgery. Multivariate analysis identified the complete tertiary cytoreduction as the most potent predictor of survival followed by FIGO stage I-II at initial diagnosis, exclusive retroperitoneal recurrence, and TCS performed ≥3years after primary diagnosis. Patients with complete tertiary cytoreduction had a significantly longer overall survival (median OS: 43months, 95% CI 31-58) compared to those with residual tumor (median OS: 33months, 95% CI 28-46; p<0.001). After multivariate adjustment the presence of a single lesion and good (ECOG 0) performance status were the only significant predictors of complete surgical cytoreduction. CONCLUSIONS This is the only large multicentre study published so far on TCS in EOC with ≥6month TFI. The achievement of postoperative no residual disease is confirmed as the primary objective also in a TCS setting, with significant survival benefit and acceptable morbidity. Accurate patient selection is of utmost importance to have the best chance of complete cytoreduction.

Hormone replacement therapy after prophylactic risk-reducing salpingo-oophorectomy and breast cancer risk in BRCA1 and BRCA2 mutation carriers: A meta-analysis

BACKGROUND Hormone replacement therapy (HRT) has been tested in women with BRCA1 and BRCA2 mutations who underwent risk-reducing salpingo-oophorectomy (RRSO), but its effect on breast cancer (BC) risk has never been appraised using meta-analysis comparison. We performed the first meta-analysis aimed to clarify whether HRT after RRSO could negatively impact on BC risk in women carriers of BRCA1 and BRCA2 mutations. METHODS AND MATERIAL Pubmed and Scopus databases were searched to retrieve articles written in the English language. Trials comparing RRSO with or without HRT were identified and only those trials with available BC events were included. BC risk was the main endpoint. RESULTS Three trials with 1100 patients were included. There was not a significantly higher BC risk in BRCA1 and BRCA2 mutation carriers receiving HRT after RRSO (HR = 0.98; 95% CI 0.63-1.52). There was a slightly but not significantly, benefit in BC risk reduction in favor of estrogen alone HRT versus estrogen plus progesterone HRT formulation (OR = 0.53; 95% CI 0.25-1.15). CONCLUSION HRT use after RRSO in BRCA 1 and BRCA2 mutation carries does not affect BC risk. Comparison of the different HRT types suggests that estrogen alone should be related to lowest BC risk.

OP29.03: Identification of parametria by 2D-3D ultrasound in patients with cervical cancer: new perspectives and future applications

Objectives: The aim of this study was to evaluate the feasibility of distinguishing the ventral parametrium (vesico-uterine ligament), the lateral parametrium (paracervix), and the dorsal parametrium (recto-uterine ligament) by 2D and 3D ultrasound (US) scan in patients affected by cervical cancer (CC), using anatomy during surgery as probative evidence. Methods: From November 2009 to February 2011, we prospectively analysed 38 consecutive patients, affected by early and locally advanced CC. All patients underwent pelvic US with both transabdominal and transvaginal approaches. Each exam was performed by 2 different operators with 2D and 3D-US scan. Anatomical observations of parametria revealed during the ultrasound evaluations were confirmed by intraoperative live scan. Results: We identified ultrasonographically the ventral and dorsal parametrium in a longitudinal scan, the lateral parametrium in a transversal scan. At the US, the ventral parametrium appears as a hiperechoic ligament with vessels, that starts from the cervix and ends at the lateral side of the bladder. The lateral parametrium is a hiperechoic ligament that starts from the lateral cervix and ends laterally under the iliac vessel. The dorsal parametrium starts from the sacro-uterine and ends at the rectum. We always identified the uterine artery. Proof of the correct identification of the different parts of the parametria was conducted during surgery. The surgeon applied one clip in every parametrium and it was identified by intraoperative live scan procedures. We could identify ventral and lateral parametria in every patient. We could not recognize the dorsal parametria in 8 patients (23.5%). Conclusions: The evaluation of the different cervical parametria can be considered feasible. The identification of dorsal parametria is more difficult than ventral and lateral parametria. We concluded that this method could be used in most cases as an aid in the assessment of parametrial involvement.

OP31.08: Pelvic relapse in patients treated for epithelial ovarian cancer. The role of transvaginal sonography

the patient with cervical carcinoma by using transvaginal ultrasound (TVUS). Methods: Based on the histological diagnosis of cervical cancer (biopsies and cone) and clinical stage of disease FIGO IB, 26 women have been included in the study. All patients underwent colour Doppler evaluation to assess intratumoral blood flow (colour scores), resistance index (RI), peak systolic velocity (PSV) and tumour size. Results: We were able to calculate the volume of tumour for all 26 patients and final results were: mean volume of tumour is 4.57 cm3, mean volume in pathologoanatomic specimen is 4.96 cm3. We found that TVUS measurement is more accurate in endophytic tumours with longest diameter under 2 cm, but there are problems with exophytic tumours. The mean difference in measurements were with tumours more than 3 cm and in exophytic ones. The ultrasound findings in exophytic tumours and those with the longest diameter more than 3 cm confirmed the presence of parametrial extension and node involvement. Conclusions: Our data suggest that TVUS measurement in estimation of the longest diameter and the volume of tumour with the help of colour Doppler examination in cervical carcinoma has to be considered a necessary procedure that give us information for stage of the disease in small tumours where a conservative management is an issue. However, TVUS has an important supportive aspect in women with cervical carcinoma stage IB willing to use ultrasound as assistance in the process of decision making.