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Oonk MHM, Slomovitz B, Baldwin PJW, van Doorn HC, van der Velden J, de Hullu JA, Gaarenstroom KN, Slangen BFM, Vergote I, Brännström M, van Dorst EBL, van Driel WJ, Hermans RH, Nunns D, Widschwendter M, Nugent D, Holland CM, Sharma A, DiSilvestro PA, Mannel R, Boll D, Cibula D, Covens A, Provencher D, Runnebaum IB, Luesley D, Ellis P, Duncan TJ, Tjiong MY, Cruickshank DJ, Kjølhede P, Levenback CF, Bouda J, Kieser KE, Palle C, Spirtos NM, O'Malley DM, Leitao MM, Geller MA, Dhar K, Asher V, Tamussino K, Tobias DH, Borgfeldt C, Lea JS, Bailey J, Lood M, Eyjolfsdottir B, Attard-Montalto S, Tewari KS, Manchanda R, Jensen PT, Persson P, Van Le L, Putter H, de Bock GH, Monk BJ, Creutzberg CL, van der Zee AGJ. Radiotherapy Versus Inguinofemoral Lymphadenectomy as Treatment for Vulvar Cancer Patients With Micrometastases in the Sentinel Node: Results of GROINSS-V II. J Clin Oncol 2021; 39:3623-3632. [PMID: 34432481 PMCID: PMC8577685 DOI: 10.1200/jco.21.00006] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE The Groningen International Study on Sentinel nodes in Vulvar cancer (GROINSS-V)-II investigated whether inguinofemoral radiotherapy is a safe alternative to inguinofemoral lymphadenectomy (IFL) in vulvar cancer patients with a metastatic sentinel node (SN). METHODS GROINSS-V-II was a prospective multicenter phase-II single-arm treatment trial, including patients with early-stage vulvar cancer (diameter < 4 cm) without signs of lymph node involvement at imaging, who had primary surgical treatment (local excision with SN biopsy). Where the SN was involved (metastasis of any size), inguinofemoral radiotherapy was given (50 Gy). The primary end point was isolated groin recurrence rate at 24 months. Stopping rules were defined for the occurrence of groin recurrences. RESULTS From December 2005 until October 2016, 1,535 eligible patients were registered. The SN showed metastasis in 322 (21.0%) patients. In June 2010, with 91 SN-positive patients included, the stopping rule was activated because the isolated groin recurrence rate in this group went above our predefined threshold. Among 10 patients with an isolated groin recurrence, nine had SN metastases > 2 mm and/or extracapsular spread. The protocol was amended so that those with SN macrometastases (> 2 mm) underwent standard of care (IFL), whereas patients with SN micrometastases (≤ 2 mm) continued to receive inguinofemoral radiotherapy. Among 160 patients with SN micrometastases, 126 received inguinofemoral radiotherapy, with an ipsilateral isolated groin recurrence rate at 2 years of 1.6%. Among 162 patients with SN macrometastases, the isolated groin recurrence rate at 2 years was 22% in those who underwent radiotherapy, and 6.9% in those who underwent IFL (P = .011). Treatment-related morbidity after radiotherapy was less frequent compared with IFL. CONCLUSION Inguinofemoral radiotherapy is a safe alternative for IFL in patients with SN micrometastases, with minimal morbidity. For patients with SN macrometastasis, radiotherapy with a total dose of 50 Gy resulted in more isolated groin recurrences compared with IFL.
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Affiliation(s)
- Maaike H M Oonk
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Peter J W Baldwin
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Helena C van Doorn
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | | | | | | | | | - Mats Brännström
- Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | | | - Willemien J van Driel
- Center of Gynecological Oncology Amsterdam, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - David Nunns
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Martin Widschwendter
- UCL EGA Institute for Women's Health, University College London, London, United Kingdom
| | - David Nugent
- Leeds Teaching Hospitals NHS Trust, St James' University Hospital, Leeds, United Kingdom
| | - Cathrine M Holland
- Manchester University NHS Foundation Trust-St Marys Hospital, Manchester, United Kingdom
| | - Aarti Sharma
- University Hospital of Wales, Cardiff, United Kingdom
| | | | - Robert Mannel
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK
| | - Dorry Boll
- Catharina Ziekenhuis Eindhoven, the Netherlands
| | - David Cibula
- First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Al Covens
- University of Toronto, Toronto, Ontario, Canada
| | | | - Ingo B Runnebaum
- Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - David Luesley
- University of Birmingham, Birmingham, United Kingdom
| | - Patricia Ellis
- Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Timothy J Duncan
- Norfolk and Norwich University Hospital NHS Trust, Norwich, United Kingdom
| | - Ming Y Tjiong
- Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Derek J Cruickshank
- James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, United Kingdom
| | | | | | - Jiri Bouda
- University Hospital Pilsen, Charles University, Faculty of Medicine, Pilsen, Czech Republic
| | | | | | | | - David M O'Malley
- Ohio State University Comprehensive Cancer Center-James Cancer Hospital, Columbus, OH
| | | | | | | | - Viren Asher
- University Hospitals of Derby and Burton, Derby, United Kingdom
| | | | | | | | | | - Jo Bailey
- St Michaels Hospital, Bristol, United Kingdom
| | | | | | | | | | - Ranjit Manchanda
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | | | | | | | - Hein Putter
- Leiden University Medical Center, Leiden, the Netherlands
| | - Geertruida H de Bock
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | - Ate G J van der Zee
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Yap J, Slade D, Goddard H, Dawson C, Ganesan R, Velangi S, Sahu B, Kaur B, Hughes A, Luesley D. Sinecatechins ointment as a potential novel treatment for usual type vulval intraepithelial neoplasia: a single-centre double-blind randomised control study. BJOG 2021; 128:1047-1055. [PMID: 33075197 DOI: 10.1111/1471-0528.16574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To compare the safety and efficacy of 10% sinecatechins (Veregen® ) ointment against placebo in the treatment of usual type vulvar intraepithelial neoplasia (uVIN). DESIGN A Phase II double-blind randomised control trial. SETTING A tertiary gynaecological oncology referral centre. POPULATION All women diagnosed with primary and recurrent uVIN. METHODS Eligible patients were randomised 1:1 to receive either sinecatechins or placebo ointment (applied three times daily for 16 weeks) and were followed up at 2, 4, 8, 16, 32 and 52 weeks. MAIN OUTCOME MEASURES The primary outcome measure, recorded at 16 and 32 weeks, was histological response (HR). Secondary outcome measures included clinical (CR) response, toxicity, quality of life and pain scores. RESULTS There was no observed difference in HR between the two arms. However, of the 26 patients who were randomised, all 13 patients who received sinecatechins showed either complete (n = 5) or partial (n = 8) CR, when best CR was evaluated. In placebo group, three patients had complete CR, two had partial CR, six had stable disease and two were lost to follow up. Patients in the sinecatechins group showed a statistically significant improvement in best observed CR as compared with the placebo group (P = 0.002). There was no difference in toxicity reported in either group. CONCLUSION Although we did not observe a difference in HR between the two treatment arms, we found that 10% sinecatechins application is safe and shows promise in inducing clinical resolution of uVIN lesions and symptom improvement, thus warranting further investigation in a larger multicentre study. TWEETABLE ABSTRACT A randomised control study indicating that sinecatechins ointment may be a novel treatment for uVIN.
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Affiliation(s)
- J Yap
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
| | - D Slade
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - H Goddard
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
| | - C Dawson
- Department of Microbiology & Infection, Warwick Medical School, University of Warwick, Coventry, UK
| | - R Ganesan
- Department of Histopathology, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - S Velangi
- Department of Dermatology, Queen Elizabeth Hospital, Birmingham, UK
| | - B Sahu
- Department of Obstetrics and Gynaecology, The Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - B Kaur
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - A Hughes
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - D Luesley
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
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Yap J, Fox R, Narsia N, Pinheiro-Maia S, Pounds R, Woodman C, Luesley D, Ganesan R, Kehoe S, Dawson C. Under expression of the Sonic Hedgehog receptor, Patched1 (PTCH1), is associated with an increased risk of local recurrence in squamous cell carcinoma of the vulva arising on a background of Lichen Sclerosus. PLoS One 2018; 13:e0206553. [PMID: 30379908 PMCID: PMC6209322 DOI: 10.1371/journal.pone.0206553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/15/2018] [Indexed: 11/18/2022] Open
Abstract
Objective Dysregulation of the Hedgehog (Hh) pathway has been described in a variety of cancers, including cervical cancer, a disease which shares a common aetiology with vulval squamous cell carcinoma (VSCC). Here, we investigate a large number of primary VSCC cases for evidence of Hedgehog pathway activation and examine the implications of pathway activity on clinical outcomes in a cohort of patients with primary VSCC. Methods Archival histology blocks containing VSCC and histologically normal adjacent epithelium were retrieved from a cohort of 91 patients who underwent treatment for primary VSCC. Immunohistochemistry staining was undertaken to assess for the expression of key Hh pathway components (SHH, PTCH1, GLI1). A competing risks statistical model was used to evaluate the implications of the levels of key Hh pathway components on clinical outcomes. Results We show that 92% of primary VSCC cases over-expressed one or more components of the Hh signalling pathway when compared to the adjacent normal epithelium. While expression of SHH and GLI1 did not correlate with any clinicopathological criteria, over- or under-expression of PTCH1 was associated with a reduced or increased risk of developing a local disease recurrence, respectively. In VSCC arising on a background of Lichen Sclerosus, the risk of local recurrence was potentiated in cases where PTCH1 was under-expressed. Conclusions Our findings reveal, for the first time, that the Hh pathway is activated in VSCC and that PTCH1 expression can be used as a biomarker to stratify patients and inform clinicians of the risk of their local recurrence, particularly in cases of VSCC associated with LS.
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Affiliation(s)
- Jason Yap
- Birmingham Cancer Research UK Cancer Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, West Midlands, United Kingdom
- * E-mail: (JY); (CD)
| | - Richard Fox
- Birmingham Cancer Research UK Cancer Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - Natalie Narsia
- Birmingham Cancer Research UK Cancer Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom
- Department of Clinical and Molecular Pathology & Laboratory of Molecular Pathology, Palacky University, Olomouc, Moravia, Czech Republic
| | - Sonia Pinheiro-Maia
- Birmingham Cancer Research UK Cancer Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - Rachel Pounds
- Birmingham Cancer Research UK Cancer Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - Ciaran Woodman
- Birmingham Cancer Research UK Cancer Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - David Luesley
- Birmingham Cancer Research UK Cancer Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, West Midlands, United Kingdom
| | - Raji Ganesan
- Department of Histopathology, Birmingham Women’s NHS Foundation Trust, Birmingham, West Midlands, United Kingdom
| | - Sean Kehoe
- Birmingham Cancer Research UK Cancer Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, West Midlands, United Kingdom
| | - Christopher Dawson
- Birmingham Cancer Research UK Cancer Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom
- * E-mail: (JY); (CD)
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Pounds R, Tahir S, Dawson C, Woodman C, Luesley D, Yap J. A survey on the use of topical steroids in patients treated for lichen sclerosus-associated vulval squamous cell carcinoma. J OBSTET GYNAECOL 2017; 38:265-269. [PMID: 29017363 DOI: 10.1080/01443615.2017.1352572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Evidence suggests that lichen sclerosus (LS) is the primary aetiological factor for local vulval recurrence (LVR) in vulval squamous cell carcinoma (VSCC). The long-term application of topical corticosteroids is believed to prevent LVR. Patients treated for LS-associated VSCC at a gynaecological cancer centre were invited to complete a questionnaire to evaluate whether they are receiving corticosteroids. 55 of the 95 eligible patients (58%) completed the questionnaire; LS was treated in 69%, with steroids given to 84.2%. Most received steroids >3 months, but discontinued treatment once asymptomatic. An online survey was distributed to 313 British Gynaecological Cancer Society members to determine whether gynaecological oncologists prescribe corticosteroids for LS following VSCC surgery. 41 consultants (13.1%) completed the survey; 70.7% prescribe topical corticosteroids (potent/very potent in 79.3%), and 58.6% treat >1 year. Our findings demonstrate that patients are more likely to be given topical corticosteroids if symptomatic of LS. Furthermore, although treatment regimens vary, the majority of respondents advocate the use of very potent steroids and would support a tertiary chemopreventative trial. Impact statement What is already known on this subject: Local vulval recurrence (LVR) affects approximately one in four women who have received surgery for vulval squamous cell carcinoma (VSCC). What the results of this study add: Lichen sclerosus (LS), an inflammatory dermatosis, is recognised as the likely primary aetiological factor for LVR. Although there is evidence to suggest that long-term topical corticosteroid use in patients with residual LS may prevent LVR, the extent to which women were given topical steroids following surgery remains unclear. Our patient questionnaire evaluates if these patients are already receiving topical steroids, along with the strength of such steroids and duration of treatment. The consultant survey determines whether clinicians currently prescribe topical steroids following VSCC surgery, as well as the strength and duration of steroid therapy. What the implications are of these findings for clinical practice and/or further research: We aim to establish whether the gynaecological oncology community believe that long-term steroids may prevent LVR in women with LS-associated VSCC and whether they would support and recruit to a multicentre tertiary chemopreventative trial. These findings could influence a future clinical trial and may alter the ongoing management of these women.
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Affiliation(s)
- Rachel Pounds
- a Birmingham Women's Hospital, Mindelsohn Way , Birmingham , United Kingdom
| | - Sanna Tahir
- b School of Medicine, College of Medical and Dental Sciences , University of Birmingham , Birmingham , United Kingdom
| | - Christopher Dawson
- c Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences , University of Birmingham , Birmingham , United Kingdom
| | - Ciaran Woodman
- c Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences , University of Birmingham , Birmingham , United Kingdom
| | - David Luesley
- c Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences , University of Birmingham , Birmingham , United Kingdom
| | - Jason Yap
- c Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences , University of Birmingham , Birmingham , United Kingdom
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Nagenthiran S, O’Neill D, Luesley D, Yap J. Iso-prognostic factors which predicts local disease recurrence in vulvar squamous cell carcinoma: a literature review. Eur J Obstet Gynecol Reprod Biol 2016. [DOI: 10.1016/j.ejogrb.2016.07.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Leonard S, Pereira M, Fox R, Gordon N, Yap J, Kehoe S, Luesley D, Woodman C, Ganesan R. Over-expression of DNMT3A predicts the risk of recurrent vulvar squamous cell carcinomas. Gynecol Oncol 2016; 143:414-420. [PMID: 27623253 DOI: 10.1016/j.ygyno.2016.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 08/25/2016] [Accepted: 09/01/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Cancer initiation and progression has been linked to aberrant expression of the DNA methyltransferases (DNMT), the enzymes which establish and maintain DNA methylation patterns throughout the genome. In this study, we investigated if DNMT expression in vulvar squamous cell carcinomas (VSCC) was related to clinical outcome. METHODS DNMT1, DNMT3A and DNMT3B expression was measured in a subset of cases drawn from a cohort of consecutive women treated for primary VSCC at the Pan Birmingham Gynaecological Cancer Centre between 2001 and 2008. Univariable and multivariable competing risk modelling was performed to identify whether DNMT expression was associated with local disease recurrence or disease morbidity. RESULTS Over-expression of DNMT3A in the invasive component of the tumour was seen in 44% of tumours and was associated with an increased risk of local vulvar recurrence (LVR) (HR=4.51, p=0.012). This risk was found to increase further after adjustment for disease stage (HR=6.00, p=0.003) and groin node metastasis (HR=4.81, p=0.008). Over-expression of DNMT3B was associated with an increased risk of LVR (HR=5.69 p=0.03), however this ceased to be significant after adjustment for groin node metastasis. In a subset analysis, over-expression of DNMT3A was found to be significantly more common in VSCCs that stained negative for CDKN2A. CONCLUSIONS These observations are consistent with the possibility that epigenetic changes contribute to vulvar neoplasia and DNMT3A over-expression may be useful in predicting local disease recurrence.
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Affiliation(s)
- Sarah Leonard
- Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Merlin Pereira
- Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Richard Fox
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Naheema Gordon
- Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Jason Yap
- Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Sean Kehoe
- Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - David Luesley
- Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Ciaran Woodman
- Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Raji Ganesan
- Birmingham Women's NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2TG, United Kingdom.
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Soo-Hoo S, Luesley D. Vulval and vaginal cancer in pregnancy. Best Pract Res Clin Obstet Gynaecol 2016; 33:73-8. [DOI: 10.1016/j.bpobgyn.2015.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
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Kehoe S, Hook J, Nankivell M, Jayson GC, Kitchener H, Lopes T, Luesley D, Perren T, Bannoo S, Mascarenhas M, Dobbs S, Essapen S, Twigg J, Herod J, McCluggage G, Parmar M, Swart AM. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial. Lancet 2015; 386:249-57. [PMID: 26002111 DOI: 10.1016/s0140-6736(14)62223-6] [Citation(s) in RCA: 838] [Impact Index Per Article: 93.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The international standard of care for women with suspected advanced ovarian cancer is surgical debulking followed by platinum-based chemotherapy. We aimed to establish whether use of platinum-based primary chemotherapy followed by delayed surgery was an effective and safe alternative treatment regimen. METHODS In this phase 3, non-inferiority, randomised, controlled trial (CHORUS) undertaken in 87 hospitals in the UK and New Zealand, we enrolled women with suspected stage III or IV ovarian cancer. We randomly assigned women (1:1) either to undergo primary surgery followed by six cycles of chemotherapy, or to three cycles of primary chemotherapy, then surgery, followed by three more cycles of completion chemotherapy. Each 3-week cycle consisted of carboplatin AUC5 or AUC6 plus paclitaxel 175 mg/m(2), or an alternative carboplatin combination regimen, or carboplatin monotherapy. We did the random assignment by use of a minimisation method with a random element, and stratified participants according to the randomising centre, largest radiological tumour size, clinical stage, and prespecified chemotherapy regimen. Patients and investigators were not masked to group assignment. The primary outcome measure was overall survival. Primary analyses were done in the intention-to-treat population. To establish non-inferiority, the upper bound of a one-sided 90% CI for the hazard ratio (HR) had to be less than 1.18. This trial is registered, number ISRCTN74802813, and is closed to new participants. FINDINGS Between March 1, 2004, and Aug 30, 2010, we randomly assigned 552 women to treatment. Of the 550 women who were eligible, 276 were assigned to primary surgery and 274 to primary chemotherapy. All were included in the intention-to-treat analysis; 251 assigned to primary surgery and 253 to primary chemotherapy were included in the per-protocol analysis. As of May 31, 2014, 451 deaths had occurred: 231 in the primary-surgery group versus 220 in the primary-chemotherapy group. Median overall survival was 22.6 months in the primary-surgery group versus 24.1 months in primary chemotherapy. The HR for death was 0.87 in favour of primary chemotherapy, with the upper bound of the one-sided 90% CI 0.98 (95% CI 0.72-1.05). Grade 3 or 4 postoperative adverse events and deaths within 28 days after surgery were more common in the primary-surgery group than in the primary-chemotherapy group (60 [24%] of 252 women vs 30 [14%] of 209, p=0.0007, and 14 women [6%] vs 1 woman [<1%], p=0.001). The most common grade 3 or 4 postoperative adverse event was haemorrhage in both groups (8 women [3%] in the primary-surgery group vs 14 [6%] in the primary-chemotherapy group). 110 (49%) of 225 women receiving primary surgery and 102 (40%) of 253 receiving primary chemotherapy had a grade 3 or 4 chemotherapy related toxic effect (p=0.0654), mostly uncomplicated neutropenia (20% and 16%, respectively). One fatal toxic effect, neutropenic sepsis, occurred in the primary-chemotherapy group. INTERPRETATION In women with stage III or IV ovarian cancer, survival with primary chemotherapy is non-inferior to primary surgery. In this study population, giving primary chemotherapy before surgery is an acceptable standard of care for women with advanced ovarian cancer. FUNDING Cancer Research UK and the Royal College of Obstetricians and Gynaecologists.
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Affiliation(s)
- Sean Kehoe
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Jane Hook
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Matthew Nankivell
- Medical Research Council Clinical Trials Unit, University College London, London, UK.
| | - Gordon C Jayson
- Department of Medical Oncology, Christie Hospital and University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Henry Kitchener
- Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | | | - David Luesley
- Pan-Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
| | - Timothy Perren
- St James's Institute of Oncology, St James's University Hospital, Leeds, UK
| | - Selina Bannoo
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Monica Mascarenhas
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Stephen Dobbs
- Department of Gynaecological Oncology, Belfast City Hospital, Belfast, UK
| | - Sharadah Essapen
- St Lukes Cancer Centre, Royal Surrey County Hospital, Guildford, UK
| | - Jeremy Twigg
- James Cook University Hospital, Middlesbrough, UK
| | - Jonathan Herod
- Department of Gynaecology, Liverpool Women's Hospital, Liverpool, UK
| | - Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK
| | - Mahesh Parmar
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Ann-Marie Swart
- Medical Research Council Clinical Trials Unit, University College London, London, UK; Department of Medicine, University of East Anglia, Norwich, UK
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Affiliation(s)
| | - David Luesley
- Pan-Birmingham Gynaecological Cancer Centre; City Hospital; Dudley Road; Birmingham; B18 7QH; UK
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Kehoe S, Hook J, Nankivell M, Jayson GC, Kitchener HC, Lopes T, Luesley D, Perren T, Bannoo S, Mascarenhas M, Dobbs S, Essapen S, Twigg J, Herod J, McCluggage WG, Parmar M, Swart AM. Chemotherapy or upfront surgery for newly diagnosed advanced ovarian cancer: Results from the MRC CHORUS trial. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.5500] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5500 Background: First line treatment of advanced ovarian cancer (OC) is accepted to be primary surgery (PS) followed by adjuvant platinum-based chemotherapy (P-CT). However, the EORTC55971 trial suggested neoadjuvant chemotherapy (NACT) is an alternative, showing increased optimal debulking rates and reduced surgical complications without detriment to survival. CHORUS (CRUK 07/009) is the 2nd phase III randomized controlled trial to investigate timing of initial surgery in OC. Methods: Patients (pts) with clinical FIGO stage III-IV OC (pelvic mass, extrapelvic metastases and CA125/CEA ratio >25) were randomized to standard treatment (PS followed by 6 cycles P-CT) or NACT (3 cycles P-CT either side of surgery). CHORUS was designed to demonstrate non-inferiority of NACT, excluding a 6% absolute detriment in 3yr survival from 50% expected with PS (1-sided alpha 10%). Primary outcome was overall survival (OS) and secondary outcomes were progression free survival (PFS), toxicity and quality of life. Results: 550 women (276 PS, 274 NACT) were randomized from 74 centres (72 UK, 2 NZ) between Mar 2004 and Aug 2010. Baseline characteristics were well balanced: median age 65yrs, median tumor size 80mm, 25% FIGO stage IV, 19% WHO PS 2. Median follow-up was 3yrs, 410 pts have died. Treatment data are summarized in the Table. 3yr survival in the control arm was 32%. Intention to treat analysis showed a median OS of 22.8 months for PS vs 24.5 months for NACT (hazard ratio (HR) 0.87 in favor of NACT, 80% CI 0.76 – 0.98) and median PFS of 10.2 vs 11.7 months (HR 0.91, 0.81 – 1.02). OS results represent a 5% absolute benefit in 3yr survival for NACT to 37% and the upper 80% CI allows us to exclude a survival benefit for PS. Conclusions: NACT was associated with increased optimal debulking, less early mortality and similar survival in this poor prognosis group. CHORUS results are consistent with EORTC55971 and strengthen evidence that NACT is a viable alternative to PS. Clinical trial information: ISRCTN74802813. [Table: see text]
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Affiliation(s)
- Sean Kehoe
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jane Hook
- MRC Clinical Trials Unit, London, United Kingdom
| | - Matthew Nankivell
- Medical Research Council Clinical Trials Unit, London, United Kingdom
| | - Gordon C. Jayson
- Department of Medical Oncology, Christie Hospital and University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Henry Charles Kitchener
- Academic Unit of Obstetrics and Gynaecology, University of Manchester, Manchester, United Kingdom
| | - Tito Lopes
- Royal Cornwall Hospitals NHS Foundation Trust, Truro, United Kingdom
| | - David Luesley
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, United Kingdom
| | - Timothy Perren
- St James's Institute of Oncology, St. James's University Hospital, Leeds, United Kingdom
| | | | | | - Stephen Dobbs
- Department of Gynaecological Oncology, Belfast City Hospital, Belfast, Northern Ireland
| | | | - Jeremy Twigg
- Department of Gynaecological Oncology, James Cook University Hospital, Middlesborough, United Kingdom
| | - Jonathan Herod
- Department of Gynaecology, Liverpool Women's Hospital, Liverpool, United Kingdom
| | - W. Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland
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Abstract
BACKGROUND This is an updated version of the original Cochrane review first published in Issue 4, 2009. There is an ongoing debate about the indications for, and value of, adjuvant pelvic radiotherapy after radical surgery in women with early cervical cancer. Certain combinations of pathological risk factors are thought to represent sufficient risk for recurrence, that they justify the use of postoperative pelvic radiotherapy, though this has never been shown to improve overall survival, and use of more than one type of treatment (surgery and radiotherapy) increases the risks of side effects and complications. OBJECTIVES To evaluate the effectiveness and safety of adjuvant therapies (radiotherapy, chemotherapy followed by radiotherapy, chemoradiation) after radical hysterectomy for early-stage cervical cancer (FIGO stages IB1, IB2 or IIA). SEARCH METHODS For the original review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), Issue 4, 2008. The Cochrane Gynaecological Cancer Group Trials Register, MEDLINE (January 1950 to November 2008), EMBASE (1950 to November 2008). We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. For this update, we extended the database searches to September 2011 and searched the MetaRegister for ongoing trials. SELECTION CRITERIA Randomised controlled trials (RCTs) that compared adjuvant therapies (radiotherapy, chemotherapy followed by radiotherapy, or chemoradiation) with no radiotherapy or chemoradiation, in women with a confirmed histological diagnosis of early cervical cancer who had undergone radical hysterectomy and dissection of the pelvic lymph nodes. DATA COLLECTION AND ANALYSIS Two review authors independently abstracted data and assessed risk of bias. Information on grade 3 and 4 adverse events was collected from the trials. Results were pooled using random-effects meta-analyses. MAIN RESULTS Two RCTs, which compared adjuvant radiotherapy with no adjuvant radiotherapy, met the inclusion criteria; they randomised and assessed 397 women with stage IB cervical cancer. Meta-analysis of these two RCTs indicated no significant difference in survival at 5 years between women who received radiation and those who received no further treatment (risk ratio (RR) = 0.8; 95% confidence interval (CI) 0.3 to 2.4). However, women who received radiation had a significantly lower risk of disease progression at 5 years (RR 0.6; 95% CI 0.4 to 0.9).Although the risk of serious adverse events was consistently higher if women received radiotherapy rather than no further treatment, these increased risks were not statistically significant, probably because the rate of adverse events was low. AUTHORS' CONCLUSIONS We found evidence, of moderate quality, that radiation decreases the risk of disease progression compared with no further treatment, but little evidence that it might improve overall survival, in stage IB cervical cancer. The evidence on serious adverse events was equivocal.
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Affiliation(s)
- Linda Rogers
- Department of Obstetrics and Gynaecology, H Floor Old Main Building, Observatory, Cape Town, South Africa.
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12
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Connolly C, Chan KK, Singh K, Sundar S, Luesley D, Anwar MS, Fernando IN. Outcomes following interval debulking surgery in primary peritoneal carcinoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Abstract
BACKGROUND Colposcopy is an essential part of the National Health Service Cervical Screening Programme (NHSCSP). It is used for both diagnosis and treatment of pre-cancerous cells of the cervix. Despite colposcopy being a commonly performed and relatively invasive procedure, very little research has explored the potential long-term impacts of colposcopic examination upon patient quality of life.The aim of this study is to investigate and quantify any potential reduction in women's quality of life following a colposcopy procedure. More specifically, the degree of female sexual dysfunction and the excess risk of adverse events in those undergoing colposcopy will be explored. If such risks are identified, these can be communicated to women before undergoing colposcopy. It will also assist in identifying whether there are particular sub-groups at greater risk and if so, this may lead to a re-evaluation of current recommendations concerning colposcopically directed treatments. METHODS/DESIGN Cohort study using postal surveys to assess sexual function and quality of life in women who have attended for colposcopy (cases), compared with those who have not attended colposcopy (controls). The prevalence and excess risk of female sexual dysfunction will be determined. Logistic regression will identify the predictors of adverse outcomes. DISCUSSION There are more than 400,000 colposcopy appointments each year in England, of which 134,000 are new referrals. There is some evidence that there may be long-term implications for women treated under colposcopy with respect to adverse obstetric outcomes, persisting anxiety, increased rates of sexual dysfunction and reduced quality of life. Reliably establishing whether such adverse outcomes exist and the excess risk of adverse events will facilitate informed decision-making and patient choice.
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Affiliation(s)
- Sarah M Flanagan
- Department of Primary Care Clinical Sciences, The University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Sue Wilson
- Department of Primary Care Clinical Sciences, The University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - David Luesley
- Department of Primary Care Clinical Sciences, The University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Sarah L Damery
- Department of Primary Care Clinical Sciences, The University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Sheila M Greenfield
- Department of Primary Care Clinical Sciences, The University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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15
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Moss EL, Owen G, Jones PW, Sarhanis P, Nordin A, Luesley D, Redman CWE. The British Gynaecological Cancer Society Delphi consultation exercise on expected standards of practice for doctors specializing in the area of gynecological oncology. Int J Gynecol Cancer 2010; 20:488-91. [PMID: 20686369 DOI: 10.1111/igc.0b013e3181a835a3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine a set of auditable standards applicable to physicians working in the area of gynecological oncology, which could be implemented as accreditation criteria for the revalidation procedure. DESIGN A 3-round Delphi consultation exercise. SETTING British Gynaecological Cancer Society (BGCS) members and delegates at the 2006 and 2007 Annual BGCS conferences Population 35 BGCS members, 72 delegates attending the 2006 BGCS conference and 120 delegates attending the 2007 conference. METHODS A preliminary Delphi consultation of members was performed electronically to determine the contents of the final Delphi questionnaires. Prioritization was achieved by scoring each parameter on a 5-point Likert scale. MAIN OUTCOME MEASURE The mean score awarded to each benchmarking parameter and the identification of parameters scoring 4 or above 75% or more of the respondents. RESULTS The first round contained responses from 68 participants in stage 1 and 72 in stage 2. The second round included 120 participants. Nine of the auditable standards in first round and 10 in the second round achieved a score of 4 or above 75% or more of the participants and were therefore considered to be essential for revalidation. The selected criteria focused on an individual clinician's caseload and performance, multidisciplinary team working and continued professional development. CONCLUSIONS This study has used the Delphi technique to identify auditable standards which could be used in the revalidation process of physicians working in the area of gynecological cancer.
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Affiliation(s)
- Esther L Moss
- University Hospital of North Staffordshire, Stoke on Trent, Staffordshire, UK
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16
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Nevin J, Luesley D. Defining the surgical management of suspected early-stage ovarian cancer by estimating patient numbers through alternative management strategies. BJOG 2010; 117:114; author reply 114-6. [PMID: 20002373 DOI: 10.1111/j.1471-0528.2009.02431.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nevin J, Luesley D, Chan KK, Singh K, Balega J, Sundar S. Meeting the challenge of developing and maintaining radical hysterectomy skills. BJOG 2010; 117:1-4. [DOI: 10.1111/j.1471-0528.2009.02417.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Abstract
BACKGROUND There is an ongoing debate about the indications for, and value of, adjuvant pelvic radiotherapy after radical surgery in women with early cervical cancer. Certain combinations of pathologic risk factors are thought to represent sufficient risk for recurrence, that they justify the use of post-operative pelvic radiotherapy, though this has never been shown to improve overall survival, and use of more than one type of treatment (surgery and radiotherapy) increases the risks of side-effects and complications. OBJECTIVES To evaluate the effectiveness and safety of adjuvant therapies (radiotherapy, chemotherapy followed by radiotherapy, chemoradiation) after radical hysterectomy for early stage cervical cancer (FIGO stages IB1, IB2 or IIA). SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Issue 4, 2008. The Cochrane Gynaecological Cancer Group Trials Register, MEDLINE (January 1950 to November 2008), EMBASE (1950 to November 2008). We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. SELECTION CRITERIA Randomised controlled trials (RCTs) that compared adjuvant therapies (radiotherapy, chemotherapy followed by radiotherapy, or chemoradiation) with no radiotherapy or chemoradiation, in women with a confirmed histological diagnosis of early cervical cancer who had undergone radical hysterectomy and dissection of the pelvic lymph nodes. DATA COLLECTION AND ANALYSIS Two review authors independently abstracted data and assessed risk of bias. Information on grade three and four adverse events was collected from the trials. Results were pooled using random effects meta-analyses. MAIN RESULTS Two RCTs, which compared adjuvant radiotherapy with no adjuvant radiotherapy, met the inclusion criteria; they randomised and assessed 397 women. Meta-analysis of these two RCTs indicated no significant difference in survival at five years between women who received radiation and those who received no further treatment (Relative risk (RR) = 0.8, 95% Confidence interval (CI): 0.3 to 2.4). However, women who received radiation had a significantly lower risk of disease progression at five years (RR = 0.6, 95% CI 0.4 to 0.9).Although the risk of serious adverse events was consistently higher if women received radiotherapy rather than no further treatment, these increased risks were not statistically significant, probably because the rate of adverse events was low. AUTHORS' CONCLUSIONS We found evidence, of moderate quality, that radiation decreases the risk of disease progression compared with no further treatment, but little evidence that it might improve overall survival. The evidence on serious adverse events was equivocal.
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Affiliation(s)
- Linda Rogers
- Pan-Birmingham Gynaecological Cancer Centre, City Hospital, Dudley Road, Birmingham, UK, B18 7QH
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20
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Thangaratinam S, Walker P, Freeman-Wang T, Luesley D, Cruickshank M, Redman CWE. Identifying the performance criteria for appraisal of colposcopists: benchmarking Delphi. BJOG 2007; 114:1288-91. [PMID: 17877682 DOI: 10.1111/j.1471-0528.2007.01442.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Colposcopy forms an essential part of National Health Service Cervical Screening Programme (NHSCSP). With an increased emphasis on accountability and improved performance, there is a need to identify the performance criteria that are essential to be satisfied by the colposcopists at the time of appraisal. OBJECTIVE To identify the performance criteria essential for appraisal of colposcopists by two-generational Delphi survey. DESIGN Delphi survey. SETTING Annual British Society for Colposcopy and Cervical Pathology conference (BSCCP 2005, Edinburgh, UK). POPULATION Four hundred and ninety-nine delegates attending the above conference. METHOD A two-generational Delphi survey was undertaken to identify the criteria needed for appraisal. The participants were asked to rate the relevance of quality items that might be considered necessary for appraisal of performance of colposcopists. After the first round, the results were presented, and the respondents were given the chance to reflect on their response and change it if necessary. MAIN OUTCOME MEASURES Criteria considered to be essential for appraisal of colposcopists in areas of training, diagnostic and therapeutic aspects and communication. RESULTS In the first round, 306/499 (61%) participants returned the completed questionnaire. Sixty percent (187/306) of participants returned their questionnaire in the second round. In addition to BSCCP certification, four other criteria were identified, which were quality of recorded findings, biopsy rate when atypia noted, proportion of biopsies histologically adequate and proportion of normal initial posttreatment follow-up smears. CONCLUSION This Delphi survey has been the first to identify criteria to be used in the annual appraisal of professionals. It has resulted in a number of criteria that could be considered for the appraisal and possible revalidation of colposcopists practising in UK.
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21
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Singh K, Yeo Y, Honest H, Ganesan R, Luesley D. Antigen processing and correlation with immunological response in vulval intraepithelial neoplasia—A study of CD1a, CD54 and LN3 expression. Gynecol Oncol 2006; 102:489-92. [PMID: 16516282 DOI: 10.1016/j.ygyno.2006.01.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2005] [Revised: 12/27/2005] [Accepted: 01/04/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To study the antigen-presenting cells and co-stimulatory factors (HLA class 2 antigen and adhesion molecule) in different grades of vulval intraepithelial neoplasia (VIN). MATERIAL AND METHODS Forty-five histology specimens were obtained from 21 women who had previously undergone vulval biopsies for VIN and included 12 specimens of VIN I, 5 of VIN II and 28 of VIN III. The CD1a (Langerhans cell/antigen-presenting cell marker) and co-stimulatory factors--HLA Class 2 antigens (LN3) and the adhesion molecule (CD54)--were semi-quantitatively analyzed in all the specimens. Pearson Chi-squared test was used for statistical analysis. RESULTS CD1a was increased in 11/12 (91.6%) biopsies with VIN I, in 3/5 (60%) of VIN II and in 4/28(14.3%) of VIN III. There was thus an inverse correlation between CD1a and severity of VIN (Pearson Chi-squared = 26.876, P = 0.001). Qualitatively, there was a basal location of CD1a-positive cells in normal epithelium but had a haphazard distribution in both low grade and high grade VIN. There was no statistical significance in the distribution of LN3 and CD54 in different grades of VIN. CONCLUSIONS This study shows an alteration in the numbers and spatial arrangement of CD1a-positive Langerhans/antigen-presenting cells in different grades of VIN. There is an increase in the number of cells with CD1a expression in low grade VIN and a decrease in the number of these cells in high grade VIN. Reduction in CD1a expression may reflect the inability of the host to mount an adequate immune response due to reduced antigen presentation in high grade VIN.
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Affiliation(s)
- Kavita Singh
- Department of Gynaecological Oncology, Birmingham Women's Hospital, Birmingham, UK.
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22
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Nevin J, Luesley D. Re: "Laparoscopically assisted radical vaginal hysterectomy vs. radical abdominal hysterectomy for cervical cancer: a match controlled study". Gynecol Oncol 2005; 98:521-2; author reply 522-3. [PMID: 15913745 DOI: 10.1016/j.ygyno.2005.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2005] [Revised: 02/23/2005] [Accepted: 03/08/2005] [Indexed: 10/25/2022]
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Watts A, Kehoe S, Luesley D. Community-based post-operative follow-up visit after major surgery for benign gynaecological conditions: a prospective study. J OBSTET GYNAECOL 2005; 17:468-71. [PMID: 15511924 DOI: 10.1080/01443619750112466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The time from surgery to discharge after major procedures for benign gynaecological conditions continues to fall. This small prospective study was undertaken to assess the postoperative problems encountered by patients after gynaecological surgery for a variety of benign disorders, and the potential of the 6-week surgical follow-up to be performed by the patient's family doctor rather than the hospital. The patients' and doctors' satisfaction with such care was determined. The study showed that follow-up in the community was acceptable to both patient and doctor. When problems arose after discharge most patients ( 50%) contacted their family doctor. At the 6-week visit few had physical problems, though most (58-100% depending on the Group) felt that a 6-week follow-up was required. Six-week postoperative follow-up by the family doctor is acceptable, and could permit more effective use of hospital specialists, though would increase the workload of family doctors.
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Affiliation(s)
- A Watts
- City Hospital Trust, Birmingham, UK
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24
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Bosze P, Luesley D. EAGC Course Book on Colposcopy. Int J Gynecol Cancer 2004. [DOI: 10.1111/j.1048-891x.2004.014325.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Cuzick J, Szarewski A, Cubie H, Hulman G, Kitchener H, Luesley D, McGoogan E, Menon U, Terry G, Edwards R, Brooks C, Desai M, Gie C, Ho L, Jacobs I, Pickles C, Sasieni P. Management of women who test positive for high-risk types of human papillomavirus: the HART study. Lancet 2003; 362:1871-6. [PMID: 14667741 DOI: 10.1016/s0140-6736(03)14955-0] [Citation(s) in RCA: 365] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Certain types of human papillomavirus (HPV) are the primary cause of almost all cervical cancers. HPV testing of cervical smears is more sensitive but less specific than cytology for detecting high-grade cervical intraepithelial neoplasia (CIN2+). HPV testing as a primary screening approach requires efficient management of HPV-positive women with negative or borderline cytology. We aimed to compare the detection rate and positive predictive values of HPV assay with cytology and to determine the best management strategy for HPV-positive women. METHODS We did a multicentre screening study of 11085 women aged 30-60 years. Women with borderline cytology and women positive for high-risk HPV with negative cytology were randomised to immediate colposcopy or to surveillance by repeat HPV testing, cytology, and colposcopy at 12 months. FINDINGS HPV testing was more sensitive than borderline or worse cytology (97.1% vs 76.6%, p=0.002) but less specific (93.3% vs 95.8%, p<0.0001) for detecting CIN2+. Of 825 randomised women, surveillance at 12 months was as effective as immediate colposcopy. In women positive for HPV at baseline, who had surveillance, 73 (45%) of 164 women with negative cytology and eight (35%) of 23 women with borderline cytology were HPV negative at 6-12 months. No CIN2+ was found in these women, nor in women with an initial negative HPV test with borderline (n=211) or mild (32) cytology. INTERPRETATION HPV testing could be used for primary screening in women older than 30 years, with cytology used to triage HPV-positive women. HPV-positive women with normal or borderline cytology (about 6% of screened women) could be managed by repeat testing after 12 months. This approach could potentially improve detection rates of CIN2+ without increasing the colposcopy referral rate.
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Affiliation(s)
- Henna Jaleel
- Department of Genito-Urinary Medicine, Whittall Street Clinic, Birmingham B4 6DH, UK
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Abstract
The number of colposcopies performed annually in the UK is increasing. Nurse colposcopists have been introduced by many units to cope with this workload. The small amount of evidence to support the introduction of nurse colposcopists suggests that nurses are viable alternative providers of colposcopy. This study compares the performance of nurse colposcopists with that of doctors.
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Affiliation(s)
- Richard W Todd
- Department of Obstetrics and Gynaecology, City Hospital NHS Trust, Birmingham B18 7QH
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28
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Poole CJ, Perren T, Burton A, Jordan SD, Jenkins AH, Mould JJ, Spooner DA, Luesley D, Chan KK, Sturman S, Earl HM. Phase II clinical trials of cisplatin-then-paclitaxel and paclitaxel-then-cisplatin in patients with previously untreated advanced epithelial ovarian cancer. Ann Oncol 2000; 11:1603-8. [PMID: 11205470 DOI: 10.1023/a:1008343519687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To examine the activity and safety of two sequentially scheduled chemotherapy regimens comprising four cycles of paclitaxel (pctx) 200 mg/m2/3 hours then four cycles ofcisplatin (cisDDP) 100 mg/m2, and vice versa, in patients with previously untreated advanced ovarian cancer. PATIENTS AND METHODS Between January 1994 and February 1996, we recruited 30 patients to the pctx-then-cisDDP regimen and 29 to cisDDP-then-pctx, in parallel phase II trials. RESULTS Both regimens were predictably active with responses seen in 22 of 30 patients (OR 74%; CR 27%, PR 47%) treated with pctx-then-cisDDP, as against 13 of 21 patients (OR 62%; CR 38%, PR 24%) treated with cisDDP-then-pctx. The OR rate to four cycles of pctx (induction) was 43%, with 27% disease progression; the OR to four cycles of cisDDP (induction) was 57%, with 5% progression. However, progression rates across both induction and consolidation phases were 16% (pctx-then-cisDDP) and 29% (cisDDP-then-pctx). Both regimens were unacceptably neurotoxic. II patients suffering grade 3 sensory neurotoxicity (5 on pctx-then-cisDDP, 6 on cisDDP-then-pctx) and 20 having grade 3 deafness (9 on pctx- then-cisDDP, 11 on cisDDP-then-pctx). CONCLUSION The activity of these sequential regimens justifies their further development using the less neurotoxic platinum analogue carboplatin, perhaps combining paclitaxel with other platinum non-cross resistant drugs.
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Affiliation(s)
- C J Poole
- CRC Trials Unit, Institute for Cancer Studies, University of Birmingham, UK.
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29
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Affiliation(s)
- D Luesley
- Department of Obstetrics and Gynaecology, Birmingham Women's Hospital
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30
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Herod J, Burton A, Buxton J, Tobias J, Luesley D, Jordan S, Dunn J, Poole CJ. A randomised, prospective, phase III clinical trial of primary bleomycin, ifosfamide and cisplatin (BIP) chemotherapy followed by radiotherapy versus radiotherapy alone in inoperable cancer of the cervix. Ann Oncol 2000; 11:1175-81. [PMID: 11061615 DOI: 10.1023/a:1008346901733] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Phase II studies have shown primary (neo-adjuvant) chemotherapy with bleomycin, ifosfamide and cisplatin (BIP) is active against inoperable cervical cancer. We present here results of a randomised phase III multicentre trial comparing radical radiotherapy with neo-adjuvant BIP chemotherapy followed by radical radiotherapy in patients with inoperable cervical cancer, designed to discover whether this combination might improve survival. PATIENTS AND METHODS Patients with inoperable cervical carcinoma were randomised to pelvic radiotherapy alone [RT] or two to three cycles of bleomycin 30 units/24-hour infusion, ifosfamide 5 g/m2/24 hours, and cisplatin 50 mg/m2) chemotherapy followed by pelvic radiotherapy (BIP + RT). Randomisation was stratified by stage and radiotherapy centre. RESULTS One hundred seventy-two eligible women were randomised into this trial; eighty-six to RT and eighty-six to BIP + RT. A total of 190 cycles of chemotherapy were given. Median follow-up for the 47 patients still alive is 9 years with a minimum follow-up of 3 years. Complete or partial response occurred in 51 of 86 (59%) of those randomised to RT and 60 of 86 (69%) of those randomised to BIP + RT. The difference between response rates does not reach statistical significance (chi2 = 2.06, P = 0.15). Median survival is two years with an actuarial survival at five years of 32% (95% confidence interval (95% CI): 25%-39%). There is no significant difference between the treatment groups (chi2log-rank = 0.11, P = 0.74). CONCLUSIONS This study does not show any survival benefit from the use of neo-adjuvant BIP chemotherapy in advanced cervical cancer.
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Affiliation(s)
- J Herod
- CRC Trials Unit, Institute for Cancer Studies, University of Birmingham, Edgbaston, UK
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Abstract
OBJECTIVE A prospective study to evaluate the success of a modified vestibulectomy in treating vulvar vestibulitis. METHODS Fifty seven consecutive women with vulvar vestibulitis and suitable for surgery based on the criteria: superficial dyspareunia, erythematous vestibular region, positive Q-tip test, symptoms reduced with local anesthetic cream. A modified vestibulectomy with or without a modified Fentons procedure was performed. Response was based on return to normal coitus, 3 months after surgery. RESULTS Most women suffered from chronic conditions (median duration of symptoms = 18 months). The median age was 28 years (range 18-53). Any infections were treated prior to surgery. All but 4 (7%) had histological abnormalities, mainly non-specific inflammation. In 18% of women who had cervical cytology some abnormality was detected. Mean follow-up time was 12 months (range 2-42). Three women were not evaluable. Complete response to surgery was achieved in 33 (61.1%) of the women, partial response was achieved in 15 (27.8%). Six (11.1%) had persistent symptoms, four of whom has psychosexual problems. CONCLUSION Presently, surgery remains the most successful intervention for vulvar vestibulitis. Modified surgery which is less destructive seems to afford acceptable results. The completion of randomized studies are needed to recognise the optimum surgical procedure.
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Affiliation(s)
- S Kehoe
- Department of Gynaecological Oncology, City Hospital Trust, Birmingham, UK.
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Cope G, Thorpe G, Holder R, Luesley D, Jordan J. Serum and tissue antioxidant capacity in cervical intraepithelial neoplasia investigated using an enhanced chemiluminescent reaction. Ann Clin Biochem 1999; 36 ( Pt 1):86-93. [PMID: 10370766 DOI: 10.1177/000456329903600112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Depleted antioxidant defence has been implicated in the pathogenesis of cervical neoplasia. We determined the systemic and local antioxidant status of women with this condition. Thirty-four women with varying grades of cervical intraepithelial neoplasia, 25 patients who had been treated successfully with diathermy loop excision, and 56 women who had no evidence of cervical abnormality acted as controls. Total antioxidant capacity of serum and protein-free serum, and of neat and protein-free homogenized cervical punch biopsies were determined using enhanced chemiluminescence. Mean serum antioxidant capacity of patients with current neoplasia and treated patients was not significantly different from that of controls. However, mean antioxidant capacity of homogenized cervical tissue from women with neoplasia was significantly lower than control means (P < 0.005), while results for treated patients were intermediate between those from diseased and normal samples (P < 0.05). The enhanced chemiluminescence technique has potential as a suitable method for measuring total antioxidant capacity of cervical tissue, and warrants further investigations using other tissue types. Significant antioxidant depletion in cervical intra-epithelial neoplasia appears to be confined to the local cervical mucosa.
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Affiliation(s)
- G Cope
- Wolfson Applied Technology Laboratory, University of Birmingham, Queen Elizabeth Medical Centre, Edgbaston, UK.
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Abstract
The National Health Service Cervical Screening Programme has issued minimum standards for a colposcopy service that facilitates audit. We have looked at the performance of a teaching hospital colposcopy service by analysing the case notes of 639 women who underwent large loop excision of the transformation zone over a nine-month period in 1995. We found delays in patient assessment and communication of results. There was overtreatment, particularly at first visit, and an excessive number of treatments were performed under general anaesthesia. A worrying number of women failed to have a follow up smear performed, but in those that did we found a reassuring treatment success rate. Our findings led to changes in the structure and functioning of the colposcopy clinic that should improve the detection of significant disease and improve the timeliness of diagnosis and the speed with which we communicate results.
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Affiliation(s)
- G Teale
- Colposcopy Dept, Birmingham Women's Hospital, NHS Trust, UK
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Kehoe S, Luesley D, Chan KK. A pilot study on early post-operative morbidity and technique of inguinal node dissection in vulval carcinoma. EUR J GYNAECOL ONCOL 1998; 19:374-6. [PMID: 9744729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Inguinal lymphadenectomy is part of the management plan for most cases of vulval carcinoma. The surgical techniques have been modified over the years resulting in less destructive operations. Even so, inguinal lymphadenectomy continues to pose difficulties particularly relating to wound breakdown and lymphocyst formation. Many different methods are described, though none have undergone any comparative assessment regarding morbidity. This small study compares two methods performed on the same patients. The radical procedure included excision of the fascia lata and exposure of the femoral vessels and nerve. The anatomically-directed method was more conservative with surgery directed at removing the nodes as described in anatomical textbooks. Both methods resulted in equal lymph node retrieval, though the subjective short-term morbidity was reduced with the more conservative surgery. This approach did not result in any detrimental outcomes regarding relapse disease, though a randomised trial is required to corroborate these findings.
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Affiliation(s)
- S Kehoe
- Department of Gynaecological Oncology, City Hospital Trust, Birmingham, UK
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Mulherin DM, Sheeran TP, Kumararatne DS, Speculand B, Luesley D, Situnayake RD. Sjögren's syndrome in women presenting with chronic dyspareunia. Br J Obstet Gynaecol 1997; 104:1019-23. [PMID: 9307528 DOI: 10.1111/j.1471-0528.1997.tb12060.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To identify cases of Sjögren's syndrome among women with chronic dyspareunia who did not already have a diagnosed rheumatological disorder. DESIGN Prospective recruitment over 12 months. SETTING Tertiary referral service for the assessment of vulval disease. PARTICIPANTS Women with chronic dyspareunia who had musculoskeletal symptoms, Raynaud's phenomenon or symptoms of ocular or oral dryness. METHODS The women underwent a Schirmer tear test and a comprehensive auto-antibody screen including latex fixation test for rheumatoid factor, antinuclear, anti-Ro, anti-La and anti-salivary duct antibodies. A labial salivary gland biopsy and vaginal biopsy were taken for routine histological analysis. MAIN OUTCOME MEASURES Cases of definite and probable Sjögren's syndrome were identified using the European criteria. RESULTS Eleven women were assessed for features of Sjögren's syndrome. Four had definite primary Sjögren's syndrome, two had probable primary Sjögren's syndrome and one had probable secondary Sjögren's syndrome. Among these seven women the median duration of vaginal symptoms was seven years (range 0.25-20), of ocular symptoms was one year (range 0.25-2) and of oral symptoms was 1.5 years (range 0-6). In all but one woman dyspareunia presented before ocular or oral symptoms, often by many years. CONCLUSIONS Although well-recognised as a feature of established Sjögren's syndrome, this study emphasises that chronic dyspareunia can be a presenting feature in these women, antedating the emergence of ocular or oral symptoms by many years. Symptoms of ocular or oral dryness, Raynaud's phenomenon or musculoskeletal symptoms should be sought in women with chronic dyspareunia to identify those who merit further investigation.
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Affiliation(s)
- D M Mulherin
- Department of Rheumatology, City Hospital, Birmingham, UK
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Ellis JR, Etherington I, Galloway D, Luesley D, Young LS. Antibody responses to HPV16 virus-like particles in women with cervical intraepithelial neoplasia infected with a variant HPV16. Lancet 1997; 349:1069-70. [PMID: 9107250 DOI: 10.1016/s0140-6736(05)62292-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Kehoe S, Herod J, van Geene P, Shafi M, Redman C, Luesley D, Chan K. Intentional non-radical surgery and survival in advanced ovarian cancer: results of a pilot study. Int J Gynecol Cancer 1996. [DOI: 10.1046/j.1525-1438.1996.06060448.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Affiliation(s)
- S Kehoe
- Department of Obstetrics & Gynaecology, City Hospital Trust, Birmingham, U.K
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Warwick J, Kehoe S, Earl H, Luesley D, Redman C, Chan KK. Long-term follow-up of patients with advanced ovarian cancer treated in randomised clinical trials. Br J Cancer 1995; 72:1513-7. [PMID: 8519669 PMCID: PMC2034090 DOI: 10.1038/bjc.1995.539] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The data from two prospective randomised phase III trials that were initiated by the West Midlands Ovarian Cancer Study Group (WMOCSG) in 1981 and 1986, recruiting 167 and 195 patients respectively, have been pooled and the survival patterns of the 362 patients treated for advanced epithelial ovarian cancer within clinical trials in the West Midlands over the 10 year period (1981-91) have been explored. All patients had histologically proven epithelial ovarian cancer and all had residual disease after primary surgery, with the majority having stage III/IV disease. The primary treatment for all patients was debulking surgery followed by platinum-based chemotherapy. Eligible patients were further randomised to undergo a second debulking operation. The main end point, survival, was assessed using Kaplan-Meier curves and the log-rank test. A Cox proportional hazards model identified performance status (P = 0.002), residual disease (P = 0.005) and albumin level (P = 0.04) as independent prognostic factors. A multivariate model to predict survival curves for patients with the best and worst prognoses was developed with predicted 5 year survival of 30% and 3% for those in the best and worst prognostic groups respectively. The identification of clinical interventions to improve outcome is an urgent matter since the prognosis for patients with advanced ovarian cancer remains poor.
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Affiliation(s)
- J Warwick
- CRC Trials Unit, CRC Institute for Cancer Studies, University of Birmingham, Queen Elizabeth Hospital, UK
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Kehoe S, Ward K, Luesley D, Chan KK. The application of flow cytometric DNA analysis in detecting the presence of malignant cells in ovarian carcinoma peritoneal fluids. Br J Obstet Gynaecol 1995; 102:656-9. [PMID: 7654646 DOI: 10.1111/j.1471-0528.1995.tb11406.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To compare flow cytometric detection of malignant cells with standard cytological evaluation in patients with ovarian carcinoma. SETTING The City Hospital Trust, The Women's Hospital and CRC Trials Unit, Birmingham. SUBJECTS Forty-three patients with histologically proven ovarian carcinoma and positive cytology, and a control population of 20 patients undergoing surgery for benign gynaecological conditions. METHODS Prospective, blinded study examining ascitic fluid or peritoneal washings obtained at primary surgery by flow cytometric DNA analysis and cytological examination. RESULTS Flow cytometry detected aneuploid cells in 27/43 (63%) of malignant and 7/20 (35%) of benign fluid specimens. In malignant samples the mean aneuploid count was 38.5% (range 1-98%) with a mean S-phase fraction of 5.2% (range 0-33.9%). In benign specimens the mean aneuploid count was 30.4% (range 14.5-66.4%). Based on these results, the overall sensitivity of cytometric detection of malignant cells was 71.4%, specificity 65%, with a positive predictive value of 85.1%. False positivity was found mainly in patients with benign ovarian cysts. Further examination revealed four false negative and four false positive results, where the peritoneal fluid and ovarian tissue DNA ploidy status concurred. Assuming such results to be correct increased the sensitivity of the test to 88.5% and specificity to 85%. CONCLUSIONS Although flow cytometry can glean information beyond the capabilities of cytological assessment, using the premise that aneuploid cells alone indicate malignancy, it remains secondary to cytology in the detection of malignant cells in peritoneal fluids.
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Affiliation(s)
- S Kehoe
- Cancer Research Campaign, University of Birmingham, UK
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Abstract
Ovarian cancer remains the main cause of death from gynaecological malignancy in England and Wales. Since the reports by Griffiths et al. in the 1970s that optimal cytoreduction to less than or equal to 1.5 cm is associated with an increase in survival there has been a gradual trend towards more radical surgery aimed at maximal tumour reduction. Since these first reports many others have made similar observations, so that now maximal surgical endeavour aimed at cytoreduction is almost standard practice. However, the majority of these reports are based on retrospective analysis, small numbers, poor standardization of treatment and other methodological inconsistencies. To date, no prospective randomized trials have been completed to confirm Griffiths's findings. The authors propose the case for a randomized trial before accepting a new and potentially morbid procedure as standard practice.
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Kehoe S, Luesley D. Pathology and management of vulval pain and pruritus. Curr Opin Obstet Gynecol 1995; 7:16-9. [PMID: 7742509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Vulval pain and pruritus are symptoms associated with benign or malignant diseases. The paucity of information regarding aetiological factors confounds a logical approach to successful therapeutic and preventative strategies. Research continues to address the possible relationship between human papillomavirus and benign, premalignant and malignant vulval conditions. Although present in many conditions, oncogenesis caused by human papillomavirus has yet to be proven as a cause of vulvar premalignant and malignant diseases. The natural history and management of these and benign disorders have been reported during the period of review. Some of the new findings may alter present concepts and practices.
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Affiliation(s)
- S Kehoe
- Department of Obstetrics and Gynaecology, City Hospital, Birmingham, UK
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Kehoe S, Luesley D. Comparison of laparoscopically assisted vaginal hysterectomy and bilateral salpingo-oophorectomy with conventional abdominal hysterectomy and bilateral salpingo-oophorectomy. Br J Obstet Gynaecol 1994; 101:647. [PMID: 8043552 DOI: 10.1111/j.1471-0528.1994.tb13669.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Luesley D, Blomfield P, Dunn J, Shafi M, Chenoy R, Buxton J. Cigarette smoking and histological outcome in women with mildly dyskaryotic cervical smears. Br J Obstet Gynaecol 1994; 101:49-52. [PMID: 8297868 DOI: 10.1111/j.1471-0528.1994.tb13009.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To determine which patient related variables, available at the point of referral, predict the presence of high grade intraepithelial neoplasia when the smear result is mild dyskaryosis with or without co-existent koilocytosis. DESIGN Multivariate analysis of prospective programme trial. SETTING Academic Department Colposcopy clinics at Dudley Road Hospital, Birmingham, UK. SUBJECTS One hundred and sixty-seven women, whose worst ever cervical smear was mild dyskaryosis with or without koilocytosis, referred to colposcopy clinics. All the women had complete data sets, as determined by the format of an ongoing programme, and all were treated by diathermy loop excision of the cervical transformation zone. MAIN OUTCOME MEASURES Age, parity, contraceptive practice, smoking habit, duration of abnormal cytology and the grade of histology in the excised transformation zone. RESULTS Forty-seven out of 78 (60%) smokers, compared with 18 out of 73 (25%) nonsmokers, had high grade disease. The other variables considered in the analysis were not significant or very weakly associated with histological grade when analysed in a univariate analysis. Stepwise logistic regression identified cigarette smoking as a powerful independent predictor of high grade disease. CONCLUSION These data suggest a strong association between smoking and high grade intraepithelial neoplasia in a population of women whose worst ever smear report was mild dyskaryosis. Smoking is a variable that could be built into models to facilitate referral for colposcopic assessment.
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Affiliation(s)
- D Luesley
- Department of Obstetrics and Gynaecology, Dudley Road Hospital, Birmingham, UK
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Taylor J, Goodman M, Luesley D. Is home best?--early discharge. Nurs Times 1993; 89:31-3. [PMID: 8415062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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49
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Kehoe S, Luesley D, Rollason T. Ovarian carcinoma presenting with inguinal metastatic lymphadenopathy 33 months prior to intraabdominal disease. Gynecol Oncol 1993; 50:128-30. [PMID: 8349155 DOI: 10.1006/gyno.1993.1177] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Ovarian carcinoma normally presents at an advanced stage of disease, with symptoms of gastrointestinal disturbances. We report a case of ovarian carcinoma presenting with metastatic inguinal lymphadenopathy which preceded any evidence of intraabdominal disease by 33 months. This is the first report of such a case. It defies the expected presentation and course of ovarian malignancies. The case is all the more rare when the incidence of inguinal node involvement in ovarian cancer is considered. The management of this patient and theoretical explanations are discussed.
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Affiliation(s)
- S Kehoe
- Cancer Research Campaign Trials Unit, Queen Elizabeth Medical Centre, Birmingham, United Kingdom
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50
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Walsh PN, Conliffe C, Abdulkadir AS, Kelehan P, Conroy R, Foley M, Lenehan P, Murphy JF, Stronge J, Cantwell B, Wright C, Millward M, Carpenter M, Lennard T, Wilson R, Home C, Corbett AR, O’Sullivan G, Collins JK, Doran M, McDermott EWM, Mercer P, Smyth P, O’Higgins NJ, Duffy MJ, Reilly D, McDermott E, Faul C, Fennelly JJ, O’Higgins N, Lowry S, Russell H, Atkinson R, Hickey I, O’Brien F, O’Mahony A, O’Donoghue M, Pomeroy M, Prosser ES, Barker F, Casey M, Carroll K, Davis M, Duffy G, O’Kennedy R, Smyth PPA, O’Carroll D, Hetherton AM, Coveney E, McAlister V, Murray MJ, Brayden DJ, O’Hora A, Street J, O’Leary J, Pollock AM, Crowley M, Healy I, Murphy J, Landers R, Burke L, O’Brien D, Annis P, Hogan J, Kealy W, Lewis FA, Doyle CT, Callaghan M, Whelan A, Feighery C, Bresnihan B, Kelleher D, Reams G, Murphy A, Hall N, Casey EB, Mulherin D, Doherty E, Yanni G, Wallace E, Jackson J, Bennett M, Tighe O, Mulcahy H, O’Donoghue D, Croke DT, Cahill RJ, Beattie S, Hamilton H, O’Morain C, Corridan B, Collins RA, O’Morain CA, Fitzgerald E, Gilvarry JM, Leader M, Fielding JF, Johnson BT, Lewis SA, Love AHG, Johnston BT, Collins JSA, McFarland RJ, Johnston PW, Collins BJ, Kilgallen CM, Murphy GM, Markey GM, McCormack JA, Curry RC, Morris TCM, Alexander HD, Edgar S, Treacy M, O’Connell MA, Weir DG, Sheehan J, O’Loughlin G, Traynor O, Walsh N, Xia HX, Daw MA, Keane CT, Dupont C, Gibson G, McGinnity E, Walshe J, Carmody M, Donohoe J, McGrath P, O’Moore R, Kieran E, Rogers S, McKenna KE, Walsh M, Bingham EA, Hughes AE, Nevin NC, Todd DJ, Stanford CF, Callender ME, Burrows D, Paige DG, Allen GE, O’Brien DP, Gough DB, Phelan C, Given HF, Kamal SZ, Kehoe S, Coldicott S, Luesley D, Ward K, MacDonnell HF, Mullins S, Gordon I, Norris LA, Devitt M, Bonnar J, Sharma SC, Sheppard BL, Fitzsimons R, Kingston S, Garvey M, Hoey HMCV, Glasgow JFT, Moore R, Robinson PH, Murphy E, Murphy JFA, Wood AE, Sweeney P, Neligan M, MacLeod D, Cunnane G, Kelly P, Corcoran P, Clancy L, Drury RM, Drury MI, Powell D, Firth RGR, Jones T, Ferris BF, O’Flynn W, O’Donnell J, Kingston SM, Cunningham F, Hinds GME, McCluskey DR, Howell F, O’Mahony M, Devlin J, O’Reilly O, Buttanshaw C, Jennings S, Keane ER, Foley-Nolan C, Ryan FM, Taylor M, Lyons RA, O’Kelly F, Mason J, Carroll D, Doherty K, Flynn M, O’Dwyer R, Gilmartin JJ, McCarthy CF, Armstrong C, Mannion D, Feely T, Fitzpatrick G, Cooney CM, Aleong JC, Rooney R, Lyons J, Phelan DM, Joshi GP, McCarroll SM, Blunnie WP, O’Brien TM, Moriarty DC, Brangan J, Kelly CP, Kenny P, Gallagher H, McGovern E, Luke D, Lowe D, Rice T, Phelan D, Lyons JB, Lyons FM, McCoy DM, McGinley J, Hurley J, McDonagh P, Crowley JJ, Donnelly SM, Tobin M, Fitzgerald O, Maurer BJ, Quigley PJ, King G, Duly EB, Trinick TR, Boyle D, Wisdom GB, Geoghegan F, Collins PB, Goss C, Younger K, Mathias P, Graham I, MacGowan SW, Sidhu P, McEneaney DJ, Cochrane DJ, Adgey AAJ, Anderson JM, Moriarty J, Fahy C, Lavender A, Lynch L, McGovern C, Nugent AM, Neely D, Young I, McDowell I, O’Kane M, Nicholls DP, McEneaney D, Nichols DP, Campbell NPS, Campbell GC, Halliday MI, O’Donnell AF, Lonergan M, Ahearne T, O’Neill J, Keaveny TV, Ramsbottom D, Boucher-Hayes D, Sheahan R, Garadaha MT, Kidney D, Freyne P, Gearty G, Crean P, Singh HP, Hargrove M, Subareddy K, Hurley JP, O’Rourke W, O’Connor C, FitzGerald MX, McDonnell TJ, Chan R, Stinson J, Hemeryck L, Feely J, Chopra MP, Sivner A, Sadiq SM, Abernathy E, Plant L, Bredin CP, Hickey P, Slevin G, McCrory K, Long M, Conlon P, Walker F, Fitzgerald P, O’Neill SJ, O’Connor CM, Quigley C, Donnelly S, Southey A, Healy E, Mulcahy F, Lyons DJ, Keating J, O’Mahony C, Roy D, Shattock AG, Hillary IB, Waiz A, Hossain R, Chakraborthy B, Clancy LP, O’Reilly L, Byrne C, Costello E, O’Shaughnessy E, Cryan B, Farrell J, Walshe JJ, Mellotte GJ, Ho CA, Morgan SH, Bending MR, Bonner J. Inaugural national scientific medical meeting. Ir J Med Sci 1993. [PMCID: PMC7101915 DOI: 10.1007/bf02942100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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