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Valabrega G, Pothuri B, Oaknin A, Graybill WS, Sánchez AB, McCormick C, Baurain JF, Tinker AV, Denys H, O'Cearbhaill RE, Hietanen S, Moore RG, Knudsen AØ, de La Motte Rouge T, Heitz F, Levy T, York W, Gupta D, Monk BJ, González-Martín A. Efficacy and safety of niraparib in patients aged 65 years and older with advanced ovarian cancer: Results from the PRIMA/ENGOT-OV26/GOG-3012 trial. Gynecol Oncol 2024; 187:128-138. [PMID: 38833992 DOI: 10.1016/j.ygyno.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/01/2024] [Accepted: 03/11/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVE To evaluate the impact of age on the efficacy and safety of niraparib first-line maintenance therapy in patients with newly diagnosed advanced ovarian cancer with a complete/partial response to first-line platinum-based chemotherapy. METHODS Post hoc analysis of the phase 3 PRIMA/ENGOT-OV26/GOG-3012 study (NCT02655016). Patients in the intent-to-treat population were categorized according to age at baseline (<65 years vs ≥65 years), and progression-free survival (PFS), safety, and health-related quality of life (HRQOL) were evaluated for each age subgroup (clinical cutoff date, May 17, 2019). Safety findings were also evaluated according to a fixed starting dose (FSD) or an individualized starting dose (ISD). RESULTS Of 733 randomized patients, 289 (39.4%) were ≥65 years (190 niraparib, 99 placebo) at baseline. Median PFS (niraparib vs placebo) and hazard ratios (95% CI) were similar in patients aged <65 years (13.9 vs 8.2 months; HR, 0.61 [0.47-0.81]) and ≥65 years (13.7 vs 8.1 months; HR, 0.53 [0.39-0.74]). The incidences of any-grade and grade ≥3 treatment-emergent adverse events (TEAEs) were similar across age subgroups; in the niraparib arm, TEAEs leading to dose discontinuation occurred in 7.8% of patients <65 years and 18.4% of patients ≥65 years. ISD use lowered the incidence of grade ≥3 thrombocytopenia events in niraparib-treated patients compared with the FSD (<65 years: 42.8% vs 18.0%; ≥65 years 57.0% vs 26.1%). HRQOL was comparable across age subgroups. CONCLUSION Niraparib efficacy, safety, and HRQOL were generally comparable across age subgroups, although patients ≥65 years had a higher rate of discontinuations due to TEAEs. ISD use reduced grade ≥3 thrombocytopenia events regardless of age.
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Affiliation(s)
- Giorgio Valabrega
- AO Ordine Mauriziano Torino and Department of Oncology, University of Torino, Torino, Italy.
| | - Bhavana Pothuri
- GOG Foundation and Departments of Obstetrics/Gynecology and Medicine, Division of Gynecologic Oncology, Laura & Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Ana Oaknin
- Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Ana Beatriz Sánchez
- Unit of Genetic Counseling in Cancer and Gynecologic Oncology, Hospital General Universitario de Elche, Elche, Spain
| | | | - Jean-François Baurain
- Université Catholique de Louvain and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Anna V Tinker
- BC Cancer Vancouver, University of British Columbia, Department of Medicine, Vancouver, BC, Canada
| | - Hannelore Denys
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Roisin E O'Cearbhaill
- Gynecologic Oncology Group (GOG) and Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Sakari Hietanen
- Department of Obstetrics and Gynecology, Turku University Hospital, Turku, Finland
| | - Richard G Moore
- Division of Gynecologic Oncology, Wilmot Cancer Institute, Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
| | | | | | - Florian Heitz
- AGO Study Group; Department for Gynaecology and Gynaecologic Oncology, Kliniken Essen-Mitte, Essen, Germany; Department of Gynaecology, Charité-Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; and Berlin Institute of Health, Berlin, Germany
| | - Tally Levy
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Tel Aviv Faculty School of Medicine, Tel Aviv University, Holon, Israel
| | | | | | - Bradley J Monk
- Divison of Gynecologic Oncology, HonorHealth Research Institute, University of Arizona, Creighton University, Phoenix, AZ, USA
| | - Antonio González-Martín
- Medical Oncology Department, Cancer Center Clínica Universidad de Navarra, Madrid, Program in Solid Tumours, CIMA, Pamplona, and Grupo Español de Investigación en Cancer ginecológicO (GEICO), Madrid, Spain
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Assavapokee N, Santibenchakul S, Ratree S, Lertkhachonsuk R, Phoolcharoen N. Examining the impact of age on chemotherapy completion in epithelial ovarian, fallopian tube and primary peritoneal cancer: a retrospective cohort study in Thailand. BMJ Open 2024; 14:e083270. [PMID: 39025817 PMCID: PMC11261680 DOI: 10.1136/bmjopen-2023-083270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 06/27/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVE To explore the difference in chemotherapy completion and reasons for discontinuation between older (≥70 years) and younger (<70 years) patients. DESIGN Retrospective cohort study. SETTING Single tertiary centre in Thailand. PARTICIPANTS The patients who received chemotherapy from 1 January 2009 to 30 June 2021 were included and followed up until 30 June 2022. Of the 757 patients with epithelial ovarian, fallopian tube and primary peritoneal cancer (EOC), 108 were in the older group and 649 were in the younger group. PRIMARY AND SECONDARY OUTCOME MEASURES The difference in chemotherapy completion, the association between younger and older patients and early discontinuation of chemotherapy. RESULTS The proportion of chemotherapy completion was significantly lower in older versus younger patients (84.3% versus 92.6%, p=0.007). Excluding discontinuation due to disease progression, the chemotherapy completion was comparable (93.5 versus 95.7%, p=0.456). Dose reduction and grade 3-4 hematotoxicity occurred more often in the older group. The univariable logistic regression model showed that older age (≥70 years) was significantly associated with early chemotherapy discontinuation (OR 2.39; 95% CI 1.29-4.24). However, after adjusting for potential confounders, age was not significantly associated with early discontinuation (OR 1.20; 95% CI 0.54-2.66). Multiple comorbidities and types of surgery were identified as independent risk factors for chemotherapy discontinuation. CONCLUSION The completion of chemotherapy was observed in a majority of older adults with EOC. Age is not the only determinant of chemotherapy completion. Comorbidity and disease status are crucial for determining chemotherapy discontinuation.
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Affiliation(s)
- Nicha Assavapokee
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Somsook Santibenchakul
- Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sasivimon Ratree
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ruangsak Lertkhachonsuk
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Natacha Phoolcharoen
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Bagheri M, Khansarinejad B, Mondanizadeh M, Azimi M, Alavi S. MiRNAs related in signaling pathways of women's reproductive diseases: an overview. Mol Biol Rep 2024; 51:414. [PMID: 38472662 DOI: 10.1007/s11033-024-09357-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/15/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND One of the main health issues that can affect women's health is reproductive diseases, such as polycystic ovary syndrome (PCOS), endometriosis (EMs), uterine leiomyomas (ULs), and ovarian cancer (OC). Although these diseases are very common, we do not have a complete understanding of their underlying cellular and molecular mechanisms. It is important to mention that the majority of patients are diagnosed with these diseases at later stages because of the absence of early diagnostic techniques and dependable molecular indicators. Hence, it is crucial to discover novel and non-invasive biomarkers that have prognostic, diagnostic and therapeutic capabilities. MiRNAs, also known as microRNAs, are small non-coding RNAs that play a crucial role in regulating gene expression at the post-transcriptional level. They are short in length, typically consisting of around 22 nucleotides, and are highly conserved across species. Numerous studies have shown that miRNAs are expressed differently in various diseases and can act as either oncogenes or tumor suppressors. METHODS The author conducted a comprehensive review of all the pertinent papers available in web of science, PubMed, Google Scholar, and Scopus databases. RESULTS We achieved three goals: providing readers with better information, enhancing search results, and making peer review easier. CONCLUSIONS This review focuses on the investigation of miRNAs and their involvement in various reproductive disorders in women, including their molecular targets. Additionally, it explores the role of miRNAs in the development and progression of these disorders.
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Affiliation(s)
- Malihe Bagheri
- Department of Biotechnology and Molecular Medicine, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Behzad Khansarinejad
- Department of Microbiology and Immunology, Arak University of Medical Sciences, Arak, Iran
| | - Mahdieh Mondanizadeh
- Department of Biotechnology and Molecular Medicine, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran.
| | - Mohadeseh Azimi
- Department of Biochemistry and Genetics, Arak University of Medical Sciences, Arak, Iran
| | - Shima Alavi
- Department of Obstetrics and Gynecology, Ghods Hospital, Arak, Iran
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Lavoue V, Raimond E, Ballester M, Carcopino X, Azais H, Kerbage Y, Koskas M, Lecointre L, Huchon C, Touboul C, Ouldamer L. [FRANCOGYN group: A brief history]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:51-54. [PMID: 37839793 DOI: 10.1016/j.gofs.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVES Describing the constitution of the FRANCOGYN group (a national French research group in Oncological and Gynecological Surgery) and present its current and future development. METHODS Literature review using PUBMed database with the keyword "FRANCOGYN". OBJECTIVES Describing the constitution of the FRANCOGYN group (a national French research group in Oncological and Gynecological Surgery) and present its current and future development. RESULTS The FRANCOGYN group was formed in December 2015, bringing together over the years more than 17 gynecological and oncological surgical department in France. The group carries out clinical research on gynecological pelvic cancers by constituting retrospective cohorts. Its legitimacy allows it to lead or co-lead the drafting of recommendations for clinical practice in the field of gynecological cancers. It now offers prospective randomized research funded by national grants. CONCLUSION The FRANCOGYN network allows us to propose a national reflection on the surgical management of pelvic cancers in women, resulting in numerous international reference publications.
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Affiliation(s)
- Vincent Lavoue
- Service de gynécologie, Francen institut de recherche en santé, environnement et travail (Irset) - UMR_S 1085, site Hôpital Sud, CHU de Rennes, université de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France.
| | - Emilie Raimond
- Service de gynécologie, CHU de Reims, université de Reims, Reims, France
| | - Marcos Ballester
- Service de gynécologie, Diaconesses, Croix Saint-Simon, Paris, France
| | - Xavier Carcopino
- Service de gynécologie, université de Marseille, AP-HM, Marseille, France
| | - Henri Azais
- Service de gynécologie, hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | - Yohan Kerbage
- Service de gynécologie, université de Lille, Lille, France
| | - Martin Koskas
- Service de gynécologie, hôpital Bichat, AP-HP, Paris, France
| | - Lise Lecointre
- Service de gynécologie, CHU de Strasbourg, Strasbourg, France
| | - Cyrille Huchon
- Service de gynécologie, hôpital Lariboisière, AP-HP, Paris, France
| | - Cyril Touboul
- Service de gynécologie, hôpital Tenon (AP-HP.6) Paris, Sorbonne université, UMRS U938 : biologie et thérapie des cancers, Paris, France
| | - Lobna Ouldamer
- Service de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, université François-Rabelais, unité Inserm 1069, 2, boulevard Tonnelle, 37044 Tours, France
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Rousseau F, Ranchon F, Bardin C, Bakrin N, Lavoué V, Bengrine-Lefevre L, Falandry C. Ovarian cancer in the older patient: where are we now? What to do next? Ther Adv Med Oncol 2023; 15:17588359231192397. [PMID: 37724138 PMCID: PMC10505350 DOI: 10.1177/17588359231192397] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 07/19/2023] [Indexed: 09/20/2023] Open
Abstract
In recent years, major advances have been made toward the individualization of epithelial ovarian cancer care, leading to an overall improvement of patient outcomes. However, real-life data indicate that the oldest populations do not benefit from this, due to aspects related to cancer (more aggressive histopathological features), treatment (i.e. frequently suboptimal), and the host (increased toxicities in patients with lower physiological reserve). A specific risk-benefit perspective should therefore be taken when considering surgery, chemotherapy, and maintenance treatments: the decision for cytoreductive surgery should include geriatric vulnerability and surgical complexity, neo-adjuvant chemotherapy being an option when primary surgery appears at high risk; carboplatin paclitaxel association remains the standard even in vulnerable older patients; and bevacizumab and poly(ADP-ribose) polymerase inhibitors maintenance are interesting options provided they are prescribed according to their indications with a close monitoring of their toxicities. Future studies should aim to individualize care without limiting access of older patients to innovation. A specific focus is needed on age-specific translational analyses (focusing on tumor mutational burden and impaired biological pathways), a better patient stratification according to geriatric parameters, an adaptation of both oncological treatment and geriatric interventions, and treatment adaptations not a priori but according to formal pharmacokinetic data.
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Affiliation(s)
- Frédérique Rousseau
- Institut Paoli Calmettes Institute, Marseille, France
- Société Francophone d'OncoGériatrie (SOFOG)
- Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO)
| | - Florence Ranchon
- Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Hospices Civils de Lyon, Pierre-Bénite, France
- CICLY Centre pour l’Innovation en Cancérologie de Lyon, Oullins, France
- Société Française de Pharmacie Oncologique (SFPO)
| | - Christophe Bardin
- Service de Pharmacie Clinique, Hôpital Cochin AP-HP Centre Université Paris Cité, Paris, France
- Société Française de Pharmacie Oncologique (SFPO)
| | - Naoual Bakrin
- Hospices Civils de Lyon, Service de Chirurgie Digestive, CHU Hôpital Lyon-Sud, Pierre-Bénite Cedex, France
- Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO)
| | - Vincent Lavoué
- Service de Gynécologie, CHU de Rennes, Hôpital Sud, Rennes, France
- UMR S1085, IRSET-INSERM, Université de Rennes, Rennes, France
- Groupe Français de chirurgie Oncologique et Gynécologique (FRANCOGYN)
| | - Leila Bengrine-Lefevre
- Département d’Oncologie Médicale, Centre Georges-Francois Leclerc, Dijon, France
- Société Francophone d'OncoGériatrie (SOFOG)
- Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO)
| | - Claire Falandry
- Hospices Civils de Lyon, Unité de Gériatrie, Centre Hospitalier de la Croix Rousse, 103, Grande Rue de la Croix-Rousse, Lyon 69004, France
- Université de Lyon, CarMeN Laboratory, INSERM U.1060/Université Lyon 1/INRA U1397/INSA Lyon/Hospices Civils Lyon Bâtiment CENS-ELI 2D; Hôpital Lyon Sud Secteur 2; Pierre-Bénite 69310, France
- Université Claude Bernard Lyon 1, Pierre-Bénite 69310, France Société Francophone d'OncoGériatrie (SOFOG)
- Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO)
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Sundar S, Nordin A, Morrison J, Wood N, Ghaem-Maghami S, Nieto J, Phillips A, Butler J, Burton K, Gornall R, Dobbs S, Glasspool R, Peevor R, Ledermann J, McNeish I, Ratnavelu N, Duncan T, Frost J, Lim K, Michael A, Brockbank E, Gajjar K, Taylor A, Bowen R, Andreou A, Ganesan R, Nicum S, Edmondson R, Clayton R, Balega J, Rolland P, Maxwell H, Fotopoulou C. British Gynaecological Cancer Society Recommendations for Evidence Based, Population Data Derived Quality Performance Indicators for Ovarian Cancer. Cancers (Basel) 2023; 15:337. [PMID: 36672287 PMCID: PMC9856668 DOI: 10.3390/cancers15020337] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 01/06/2023] Open
Abstract
Ovarian cancer survival in the UK lags behind comparable countries. Results from the ongoing National Ovarian Cancer Audit feasibility pilot (OCAFP) show that approximately 1 in 4 women with advanced ovarian cancer (Stage 2, 3, 4 and unstaged cancer) do not receive any anticancer treatment and only 51% in England receive international standard of care treatment, i.e., the combination of surgery and chemotherapy. The audit has also demonstrated wide variation in the percentage of women receiving anticancer treatment for advanced ovarian cancer, be it surgery or chemotherapy across the 19 geographical regions for organisation of cancer delivery (Cancer Alliances). Receipt of treatment also correlates with survival: 5 year Cancer survival varies from 28.6% to 49.6% across England. Here, we take a systems wide approach encompassing both diagnostic pathways and cancer treatment, derived from the whole cohort of women with ovarian cancer to set out recommendations and quality performance indicators (QPI). A multidisciplinary panel established by the British Gynaecological Cancer Society carefully identified QPI against criteria: metrics selected were those easily evaluable nationally using routinely available data and where there was a clear evidence base to support interventions. These QPI will be valuable to other taxpayer funded systems with national data collection mechanisms and are to our knowledge the only population level data derived standards in ovarian cancer. We also identify interventions for Best practice and Research recommendations.
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Affiliation(s)
- Sudha Sundar
- Pan Birmingham Gynaecological Cancer Centre, City Hospital and Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B152TT, UK
| | - Andy Nordin
- East Kent Hospitals University Foundation NHS Trust, Ethelburt Road, Canterbury CT1 3NG, UK
- National Cancer Registration & Analysis Service (NCRAS), NHS Digital, Wellington House, 133-155 Waterloo Rd., London SE1 8UG, UK
| | - Jo Morrison
- GRACE Centre, Department of Gynaecological Oncology, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton TA1 5DA, UK
| | - Nick Wood
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR7 1PP, UK
| | | | - Jo Nieto
- Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK
| | - Andrew Phillips
- Derby Gynaecological Cancer Centre, University Hospitals of Derby and Burton, Royal Derby Hospital, Uttoxeter Rd., Derby DE22 3NE, UK
| | - John Butler
- Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Kevin Burton
- Glasgow Royal Infirmary, PRMH Building, Glasgow G4 0SF, UK
| | - Rob Gornall
- Department Gynaecological Oncology, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Gloucester GL53 7AN, UK
| | - Stephen Dobbs
- Department of Gynaecological Oncology, Belfast City Hospital, Belfast BT9 7AB, UK
| | - Rosalind Glasspool
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde and University of Glasgow, Glasgow G12 0YN, UK
| | - Richard Peevor
- Consultant Gynaecological Oncologist, Clinical Lead for Colposcopy & Gynaecological Cancer MDT, Betsi Cadwaladr University Health Board, Bangor LL57 2PW, UK
| | - Jonathan Ledermann
- UCL Cancer Institute, University College London and UCL Hospitals, London WC1E 6DD, UK
| | - Iain McNeish
- Department of Surgery and Cancer, Imperial College, London W12 0NN, UK
| | - Nithya Ratnavelu
- Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK
| | - Tim Duncan
- Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK
| | - Jonathan Frost
- Royal United Hospitals Bath NHS Foundation Trust, Bath BA1 3NG, UK
| | | | - Agnieszka Michael
- University of Surrey and Royal Surrey County Hospital, Guildford GU2 7XH, UK
| | - Elly Brockbank
- Royal London Hospital, Barts Health NHS Trust, London EC1 1BB, UK
| | - Ketankumar Gajjar
- Nottingham University Hospitals NHS Trust, City Hospital, Nottingham NG5 1PB, UK
| | | | - Rebecca Bowen
- Royal United Hospitals Bath NHS Foundation Trust, Bath BA1 3NG, UK
| | - Adrian Andreou
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Bath BA1 3NG, UK
| | - Raji Ganesan
- Department of Cellular Pathology, Birmingham Women’s Hospital, Birmingham SY16 4LE, UK
| | - Shibani Nicum
- UCL Cancer Institute, University College London and UCL Hospitals, London WC1E 6DD, UK
| | - Richard Edmondson
- Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and St Mary’s Hospital, Manchester M13 9PL, UK
| | - Richard Clayton
- Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Janos Balega
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, West Midlands, Birmingham B15 2SQ, UK
| | - Phil Rolland
- Department Gynaecological Oncology, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Gloucester GL53 7AN, UK
| | - Hilary Maxwell
- Dorset County Hospital NHS Foundation Trust, Dorset DT1 2JY, UK
| | - Christina Fotopoulou
- Department of Surgery and Cancer, Gynaecologic Oncology, Imperial College London, London W12 0NN, UK
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