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1.  Lymphocele and Ovarian Cancer: Risk Factors and Impact on Survival 
The Oncologist  2012;17(9):1198-1203.
This retrospective study describes the incidence, impact on survival, and the risk factors for symptomatic lymphoceles in patients with ovarian cancer.
Learning Objectives
After completing this course, the reader will be able to: Identify risk factors for lymphoceles after cytoreductive surgery in ovarian cancer.Describe the impact of lymphocleles on outcomes in women with ovarian cancer.
This article is available for continuing medical education credit at CME.TheOncologist.com
Introduction.
We describe the incidence, impact on survival, and the risk factors for symptomatic lymphoceles in patients with ovarian cancer.
Methods.
This retrospective study includes patients with ovarian cancer who had complete cytoreductive surgery and para-aortic and pelvic lymphadenectomy performed in our institute from 2005 to 2011. Patients were classified into two groups: patients with symptomatic lymphoceles and a control group.
Results.
During the study period, 194 patients with epithelial ovarian cancer underwent cytoreductive surgery and a lymphadenectomy without macroscopic residual disease. Fifty-four patients had symptomatic lymphoceles (28%). In the multivariate analysis, only supraradical surgery was significantly and independently associated with the risk of symptomatic lymphoceles occurring postoperatively. Median follow-up was 24.8 months (range, 1–74 months). Survival rates were not significantly different between the symptomatic lymphocele group and the control group. Two-year disease-free survival rates were 54% for the lymphocele group and 48% for the control group. Two-year overall survival rates were 90% for the lymphocele group and 88% for the control group.
Conclusions.
Symptomatic lymphoceles occur frequently after cytoreductive surgery in ovarian cancer. Supraradical surgery is an independent risk factor. The occurrence of symptomatic lymphoceles does not decrease survival. Nevertheless, further studies are needed to reduce the risk of lymphoceles in such patients.
doi:10.1634/theoncologist.2012-0088
PMCID: PMC3448413  PMID: 22707515
Lymphadenectomy; Ovarian cancer; Lymphocele; Cytoreductive surgery; Survival
2.  Factors Associated with Altered Long-Term Well-Being After Prophylactic Salpingo-Oophorectomy Among Women at Increased Hereditary Risk for Breast and Ovarian Cancer 
The Oncologist  2011;16(9):1250-1257.
Factors associated with long-term altered well-being after prophylactic bilateral salpingo-oophorectomy, namely, lower quality of life, altered sexual functioning, greater anxiety, and more endocrine symptoms, were identified.
Learning Objectives
After completing this course, the reader will be able to: Describe factors associated with decreased well-being after PBSO in order to prospectively identify patients at risk.Provide pre-operative counseling and information to patients at risk of decreased well-being after PBSO.
This article is available for continuing medical education credit at CME.TheOncologist.com
Background.
Prophylactic bilateral salpingo-oophorectomy (PBSO) might alter several components of well-being, such as sexual functioning and endocrine symptoms, in women at high risk for hereditary breast and/or ovarian cancer, compared with the general population. We searched for factors associated with altered long-term well-being in this population (lower quality of life [QOL], altered sexual functioning, greater anxiety, more endocrine symptoms).
Methods.
All high-risk women who had undergone PBSO during the past 15 years in a single cancer center were contacted by mail. Upon acceptance, they were sent five questionnaires: (a) general social questions, (b) the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30, (c) Sexual Activity Questionnaire, (d) Functional Assessment of Cancer Therapy – Endocrine Symptom, and (5) State-Trait Anxiety Inventory. Logistic analyses were used to identify factors associated with altered results. Because of multiple testing, only p-values ≤ .01 were considered significant.
Results.
One hundred twelve of 175 women (64%) returned the completed questionnaires at a mean duration (standard deviation) of 6.0 (5.1) years after PBSO. QOL was positively influenced by two baseline factors: a high educational level and occupying an executive position. However, younger age at PBSO was associated with lower social functioning and greater anxiety. At the time of the study, practicing a sport and the avoidance of weight gain (≥10%) were highly related to QOL, sexual pleasure, endocrine symptoms, and anxiety in the univariate analysis and predictive of better QOL and lower anxiety in the multivariate analysis.
Conclusions.
Younger women and women with a low educational level and no occupation appear to be at higher risk for altered long-term well-being. After surgery, practicing a sport and stable weight may help maintain overall well-being.
doi:10.1634/theoncologist.2010-0336
PMCID: PMC3228172  PMID: 21765195
Quality of life; BRCA; Hereditary breast and ovarian cancer; Prophylactic oophorectomy; Menopause; Sexual function
3.  Analysis of Morbidity and Clinical Implications of Laparoscopic Para-Aortic Lymphadenectomy in a Continuous Series of 98 Patients with Advanced-Stage Cervical Cancer and Negative PET–CT Imaging in the Para-Aortic Area 
The Oncologist  2011;16(7):1021-1027.
A series of patients with locally advanced cervical cancer, with no positive para-aortic nodes on positron emission tomography–computed tomography who had undergone a primary laparoscopic para-aortic lymphadenectomy was retrospectively reviewed. Morbidity was limited and the completion of treatment was not delayed when complications occurred.
Background.
Laparoscopic para-aortic lymphadenectomy (PAL) is being used increasingly to stage patients with locally advanced cervical cancer (LACC) and to define radiation field limits before chemoradiation therapy (CRT). This study aimed to define clinical implications, review complications, and determine whether surgical complications delayed the start of CRT.
Methods.
We retrospectively reviewed a continuous series of patients with LACC, with no positive para-aortic (PA) nodes on positron emission tomography–computed tomography (PET–CT) and who had undergone a primary laparoscopic PAL.
Results.
From November 2007 to June 2010, 98 patients with LACC underwent pretherapeutic PAL. Two patients did not undergo PAL: extensive carcinomatosis was discovered in one case and a technical problem arose in the other. No perioperative complications occurred. Seven patients had a lymphocyst requiring an imaging-guided (or laparoscopic) puncture. Eight patients (8.4%, which corresponds to the false-negative PET–CT rate) had metastatic disease within PA lymph nodes. In cases of suspicious pelvic nodes on PET–CT, the risk for PA nodal disease was greater (24.0% versus 2.9%). When patients with and without surgical morbidity were compared, the median delay to the start of treatment was not significantly different (15 days; range, 3–49 days versus 18 days; range, 3–42 days).
Conclusions.
The morbidity of laparoscopic PAL was limited and the completion of treatment was not delayed when complications occurred. Nevertheless, if PET–CT of the pelvic area is negative, the interest in staging PAL could be discussed because the risk for PA nodal disease is very low.
doi:10.1634/theoncologist.2011-0007
PMCID: PMC3228132  PMID: 21659610
Cervical cancer; Para-aortic lymphadenectomy; Laparoscopy; Staging; Morbidity; Lymphocyst
4.  Prognosis and Prognostic Factors of the Micropapillary Pattern in Patients Treated for Stage II and III Serous Borderline Tumors of the Ovary 
The Oncologist  2011;16(2):189-196.
In this study on 168 patients with stage II and stage III serous borderline tumor of the ovary, micropapillary pattern did not appear to signify a poor prognosis. The only prognostic factor for recurrence in these patients was the use of conservative surgery.
Learning Objectives
After completing this course, the reader will be able to: Discuss the prognostic impact of a micropapillary pattern in patients with stage II and III serous borderline ovarian tumors (SBOT).Consider when conservative surgery is an appropriate intervention in patients with SBOT-MP.
This article is available for continuing medical education credit at CME.TheOncologist.com
Background.
To determine the prognosis of a micropapillary (MP) pattern in patients with stage II and stage III serous borderline tumor of the ovary (SBOT).
Methods.
Review of patients with stage II and stage III SBOT treated or referred to our institution with characterization of an MP pattern and its clinical impact.
Results.
In 1969–2006, 168 patients were reviewed. Fifty-six patients had SBOT-MP. The rate of conservative surgery was lower in the SBOT-MP group than in the typical SBOT group, but the rate of patients with more than three peritoneal sites with implants was higher in the SBOT-MP group. The rate of invasive implants was not statistically different between the two groups. Eighteen recurrences were observed (six of them in the form of invasive disease) in the SBOT-MP group. Only one death was observed. The overall survival times and recurrence-free intervals were similar in both groups. The only prognostic factor for recurrence in the SBOT-MP group was the use of conservative surgery.
Conclusions.
In the present series, an MP pattern doesn't appear to signify a poor prognosis. The only prognostic factor for recurrence in SBOT-MP was the use of conservative surgery. Further studies on the MP pattern are needed to evaluate prognosis and the results of conservative surgery.
doi:10.1634/theoncologist.2009-0139
PMCID: PMC3228092  PMID: 21273510
Borderline tumor; Conservative surgery; Micropapillary pattern; Ovary; Peritoneal implants; Recurrence
5.  Prognostic Factors and Morbidities After Completion Surgery in Patients Undergoing Initial Chemoradiation Therapy for Locally Advanced Cervical Cancer 
The Oncologist  2010;15(4):405-415.
The study evaluates the prognostic factors and morbidities of patients undergoing completion surgery for locally advanced-stage cervical cancer after initial chemoradiation therapy.
Learning Objectives
After completing this course, the reader will be able to: Rate the prognostic factors for overall survival in patients undergoing completion surgery after initial chemoradiation therapy (CRT) for locally advanced cervical cancer.In cervical cancer patients undergoing completion surgery, consider using laparoscopy to decrease the morbidity of the surgery.In cervical cancer patients undergoing completion surgery, use PET-CT imaging to improve detection of para-aortic involvement.
This article is available for continuing medical education credit at CME.TheOncologist.com
Purpose.
The aim of this study was to evaluate the prognostic factors and morbidities of patients undergoing completion surgery for locally advanced-stage cervical cancer after initial chemoradiation therapy (CRT).
Patients and Methods.
Patients fulfilling the following inclusion criteria were studied: stage IB2–IVA cervical carcinoma, tumor initially confined to the pelvic cavity on conventional imaging, pelvic external radiation therapy with delivery of 45 Gy to the pelvic cavity and concomitant chemotherapy (cisplatin, 40 mg/m2 per week) followed by uterovaginal brachytherapy, and completion surgery after the end of radiation therapy including at least a hysterectomy.
Results.
One-hundred fifty patients treated in 1998–2007 fulfilled the inclusion criteria. Prognostic factors for overall survival in the multivariate analysis were the presence and level of nodal spread (positive pelvic nodes alone: hazard ratio [HR], 2.03; positive para-aortic nodes: HR, 5.46; p < .001) and the presence and size of residual disease (RD) in the cervix (p = .02). Thirty-seven (25%) patients had 55 postoperative complications. The risk for complications was higher with a radical hysterectomy (p = .04) and the presence of cervical RD (p = .01).
Conclusion.
In this series, the presence and size of RD and histologic nodal involvement were the strongest prognostic factors. Such results suggest that the survival of patients treated using CRT for locally advanced cervical cancer could potentially be enhanced by improving the rate of complete response in the irradiated area (cervix or pelvic nodes) and by initially detecting patients with para-aortic spread so that treatment could be adapted in such patients. The morbidity of completion surgery is high in this context.
doi:10.1634/theoncologist.2009-0295
PMCID: PMC3227965  PMID: 20332143
Chemoradiation therapy; Completion surgery; Locally advanced cervical cancer; Morbidities; Nodal involvement; Prognostic factors; Residual disease; Survival
6.  Poly(I:C) induces intense expression of c-IAP2 and cooperates with an IAP inhibitor in induction of apoptosis in cancer cells 
BMC Cancer  2010;10:327.
Background
There is increasing evidence that the toll-like receptor 3 (TLR3) is an interesting target for anti-cancer therapy. Unfortunately, most laboratory investigations about the impact of TLR3 stimulation on human malignant cells have been performed with very high concentrations - 5 to 100 μg/ml - of the prototype TLR3 ligand, poly(I:C). In a previous study focused on a specific type of human carcinoma - nasopharyngeal carcinoma - we have shown that concentrations of poly(I:C) as low as 100 ng/ml are sufficient to induce apoptosis of malignant cells when combined to a pharmacological antagonist of the IAP family based on Smac mimicry.
Methods
This observation prompted us to investigate the contribution of the IAP family in cell response to poly(I:C) in a variety of human malignant cell types.
Results
We report a rapid, intense and selective increase in c-IAP2 protein expression observed under stimulation by poly(I:C)(500 ng/ml) in all types of human malignant cells. In most cell types, this change in protein expression is underlain by an increase in c-IAP2 transcripts and dependent on the TLR3/TRIF pathway. When poly(I:C) is combined to the IAP inhibitor RMT 5265, a cooperative effect in apoptosis induction and/or inhibition of clonogenic growth is obtained in a large fraction of carcinoma and melanoma cell lines.
Conclusions
Currently, IAP inhibitors like RMT 5265 and poly(I:C) are the subject of separate therapeutic trials. In light of our observations, combined use of both types of compounds should be considered for treatment of human malignancies including carcinomas and melanomas.
doi:10.1186/1471-2407-10-327
PMCID: PMC2928000  PMID: 20576118
7.  3D-conformal Accelerated Partial Breast Irradiation treatment planning: the value of surgical clips in the delineation of the lumpectomy cavity 
Background
Accurate localisation of the lumpectomy cavity (LC) volume is one of the most critical points in 3D-conformal Partial breast irradiation (3D-APBI) treatment planning because the irradiated volume is restricted to a small breast volume. Here, we studied the role of the placement of surgical clips at the 4 cardinal points of the lumpectomy cavity in target delineation.
Methods
Forty CT-based 3D-APBI plans were retrieved on which a total of 4 radiation oncologists, two trainee and two experienced physicians, outlined the lumpectomy cavity. The inter-observer variability of LC contouring was assessed when the CTV was defined as the delineation that encompassed both surgical clips and remodelled breast tissue.
Results
The conformity index of tumour bed delineation was significantly improved by the placement of surgical clips within the LC (median at 0.65). Furthermore, a better conformity index of LC was observed according to the experience of the physicians (median CI = 0.55 for trainee physicians vs 0.65 for experienced physicians).
Conclusions
The placement of surgical clips improved the accuracy of lumpectomy cavity delineation in 3D-APBI. However, a learning curve is needed to improve the conformity index of the lumpectomy cavity.
doi:10.1186/1748-717X-4-70
PMCID: PMC2808304  PMID: 20042124

Results 1-7 (7)