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Heimovaara JH, van Calsteren K, Lok CAR, Evens AM, Hoegl J, Ferber A, Fernandes A, Vriens I, van Zuylen L, Amant F. Results of an international survey on the current organization of care for pregnant women with cancer. Acta Obstet Gynecol Scand 2024; 103:751-756. [PMID: 38298117 PMCID: PMC10993336 DOI: 10.1111/aogs.14748] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 09/22/2023] [Revised: 11/08/2023] [Accepted: 11/21/2023] [Indexed: 02/02/2024]
Abstract
The global incidence of cancer is increasing, including its incidence in women of reproductive age. Still, physicians encounter this situation rarely, which could lead to substandard care. This research sought to explore opportunities to improve future care for pregnant women with cancer, by describing the outcomes of a survey distributed to physicians all over the world focusing on clinical experience with pregnant women with cancer, the organization of care and current gaps in knowledge. We included 249 responses from physicians working across 36 countries. Responses demonstrate a wide variation in the organization of care - generally lacking centralization, and the physicians' acknowledgement of insufficient knowledge on the management of pregnant women with cancer. There is a need for improvement through national centralization and/or establishing advisory boards for cancer in pregnancy. Seeing the paucity of cancer in pregnancy experience, the importance of global multidisciplinary collaboration is emphasized.
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Affiliation(s)
- Joosje H. Heimovaara
- Department of OncologyKU LeuvenLeuvenBelgium
- Department of GynecologyAntoni van Leeuwenhoek – Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Kristel van Calsteren
- Department of Obstetrics and GynecologyUniversity Hospitals LeuvenLeuvenBelgium
- Department of Development and RegenerationKU LeuvenLeuvenBelgium
| | - Christianne A. R. Lok
- Department of GynecologyAntoni van Leeuwenhoek – Netherlands Cancer InstituteAmsterdamThe Netherlands
- Center for Gynecological Oncology Amsterdam (CGOA)Antoni van Leeuwenhoek – Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Andrew M. Evens
- Rutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA
| | - Jorge Hoegl
- Department of Obstetrics and Gynecology, Division of Gynecological OncologyHospital General del Este “Dr. Domingo Luciani”CaracasVenezuela
| | - Andres Ferber
- Department of Medical OncologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Andreina Fernandes
- Laboratorio de Genética MolecularInstituto de Oncología y HematologíaCaracasVenezuela
| | - Ingeborg Vriens
- Department of Medical OncologyMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Lia van Zuylen
- Department of Medical OncologyAmsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center AmsterdamAmsterdamThe Netherlands
| | - Frédéric Amant
- Department of OncologyKU LeuvenLeuvenBelgium
- Department of GynecologyAntoni van Leeuwenhoek – Netherlands Cancer InstituteAmsterdamThe Netherlands
- Division Gynecologic OncologyUniversity Hospitals LeuvenLeuvenBelgium
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Hoegl J, Viveros-Carreño D, Palacios T, Gallego-Ardila A, Rauh-Hain JA, Estrada EE, Noll F, Krause K, Baiocchi G, Minig L, Grillo-Ardila CF, Pareja R. Peritoneal carcinomatosis after minimally invasive surgery versus open radical hysterectomy: systematic review and meta-analysis. Int J Gynecol Cancer 2022; 32:1497-1504. [PMID: 36351746 DOI: 10.1136/ijgc-2022-003937] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 11/11/2022] Open
Abstract
OBJECTIVE To assess the incidence of peritoneal carcinomatosis in patients undergoing minimally invasive or open radical hysterectomy for cervical cancer. METHODS The MEDLINE (accessed through Ovid), Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Clinical Trials, and Scopus databases were searched for articles published from inception up to April 2022. Articles published in English were considered. The included studies reported on patients with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IA-IIA squamous cell carcinoma, adenocarcinoma, and/or adenosquamous carcinoma of the cervix who underwent primary surgery. Studies had to report at least one case of peritoneal carcinomatosis as a recurrence pattern, and only studies comparing recurrence after minimally invasive surgery versus open surgery were considered. Variables of interest were manually extracted into a standardized electronic database. This study was registered in PROSPERO (CRD42022325068). RESULTS The initial search identified 518 articles. After the removal of the duplicate entries from the initial search, two authors independently reviewed the titles and abstracts of the remaining 453 articles. Finally, 78 articles were selected for full-text evaluation; 22 articles (a total of 7626 patients) were included in the analysis-one randomized controlled trial and 21 observational retrospective studies. The most common histology was squamous cell carcinoma in 60.9%, and the tumor size was <4 cm in 92.8% of patients. Peritoneal carcinomatosis pattern represented 22.2% of recurrences in the minimally invasive surgery approach versus 8.8% in open surgery, accounting for 15.5% of all recurrences. The meta-analysis of observational studies revealed a statistically significant higher risk of peritoneal carcinomatosis after minimally invasive surgery (OR 1.90, 95% CI 1.32 to 2.74, p<0.05). CONCLUSION Minimally invasive surgery is associated with a statistically significant higher risk of peritoneal carcinomatosis after radical hysterectomy for cervical cancer compared with open surgery.
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Affiliation(s)
- Jorge Hoegl
- Obstetrics and Gynecology. Division of Gynecological Oncology, Hospital General del Este "Dr. Domingo Luciani", Caracas, Bolivarian Republic of Venezuela
| | - David Viveros-Carreño
- Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, Colombia.,Gynecologic Oncology, Clínica Universitaria Colombia and Centro de tratamiento e investigación sobre cáncer Luis Carlos Sarmiento Angulo - CTIC, Bogotá, Colombia
| | - Tatiana Palacios
- Hospital Infantil Universitario de San Jose. Fundación Universitaria de Ciencias de la Salud - FUCS, Bogotá, Colombia
| | - Andres Gallego-Ardila
- Vicerrectoría de Investigación, Fundación Universitaria de Ciencias de la Salud FUCS, Bogota, Colombia
| | - Jose Alejandro Rauh-Hain
- The University of Texas MD Anderson Cancer Center Department of Gynecologic Oncology and Reproductive Medicine, Houston, Texas, USA
| | | | - Florencia Noll
- Ginecología Oncológica, Hospital Sanatorio Allende, Cordoba, Argentina
| | - Kate Krause
- The University of Texas MD Anderson Cancer Center Research Medical Library, Houston, Texas, USA
| | - Glauco Baiocchi
- Gynecologic Oncology, ACCamargo Cancer Center, Sao Paulo, Brazil
| | - Lucas Minig
- Gynecologic Oncology, Valencian Institute of Oncology (IVO), Valencia, Spain
| | - Carlos Fernando Grillo-Ardila
- Universidad Nacional de Colombia Departamento de Obstetricia y Ginecología, Bogota, Colombia.,Grupo de Investigación Clínica y Epidemiológica del Cáncer, Instituto Nacional de Cancerología, Bogota, Colombia
| | - Rene Pareja
- Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, Colombia .,Gynecology, Gynecologic Oncology, Clinica ASTORGA, Medellin, and Instituto Nacional de Cancerología, Medellin, Colombia
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Hoegl J, Fernandes A, Escalona S, López Basalo A, Pareja R. Gynecologic Oncology at Home: a new opportunity to teach and learn. Int J Gynecol Cancer 2022; 32:1615-1616. [PMID: 36288815 DOI: 10.1136/ijgc-2022-004067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Jorge Hoegl
- Departamento de Ginecología y Obstetricia, Hospital General del Este Dr. Domingo Luciani, Caracas, Venezuela, Bolivarian Republic of
| | - Andreina Fernandes
- Laboratorio de Genética Molecular, Instituto de Oncología y Hematología, Caracas, Venezuela, Bolivarian Republic of
| | - Sunangela Escalona
- Centro Médico de Oncología, Barquisimeto, Venezuela, Bolivarian Republic of
| | | | - Rene Pareja
- Gynecology, Gynecologic Oncology, Clinica ASTORGA, Medellin, and Instituto Nacional de Cancerología, Bogotá, Colombia, Medellin, Colombia
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Fernandes A, Viveros-Carreño D, Hoegl J, Ávila M, Pareja R. Human papillomavirus-independent cervical cancer. Int J Gynecol Cancer 2021; 32:1-7. [PMID: 34725203 DOI: 10.1136/ijgc-2021-003014] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/18/2021] [Indexed: 12/13/2022] Open
Abstract
Cervical cancer is the fourth most frequent cancer in women worldwide, representing nearly 8% of all female cancer deaths every year. The majority of cases of cervical cancer are caused by human papillomavirus (HPV); however, up to 5% of tumors are not associated with HPV-persistent infection and, moreover, the new WHO Female Genital Tumors classification subdivided cervical squamous and adenocarcinomas into HPV-associated and HPV-independent tumors. Based on this new information, the aim of this review is to provide an overview of HPV-independent cervical cancer, evaluating diagnostic techniques, molecular profiles, and clinical outcomes. The HPV-independent tumors are characterized by a differentiated molecular profile with lower proliferative activity, a p53 immunostaining, a decreased expression of cyclin-dependent kinase inhibitor proteins, such as p16, p14, and p27, and alterations in PTEN, p53, KRAS, CTNNB1, ARID1A, and ARID5B HPV-independent tumors are associated with both adenocarcinomas and squamous histologic subtypes, with lymph node involvement in the early stages, more distant metastasis, and generally worse oncological outcomes. Thus far, no specific therapeutic strategies have been developed based on HPV status; however, with advancing knowledge of differences in the molecular profiles and possible targetable alterations, novel approaches may offer potential options in the near future. Investigators should report on clinical outcomes, evaluating the overall response rates to specific treatments, and consider new biomarkers to establish more accurate prognostics factors.
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Affiliation(s)
- Andreina Fernandes
- Laboratorio de Genética Molecular, Instituto de Oncología y Hematología, Caracas, Bolivarian Republic of Venezuela
| | - David Viveros-Carreño
- Department of Gynecologic Oncology, Instituto Nacional de Cancerologia, Bogota, Colombia
| | - Jorge Hoegl
- Obstetrics and Gynecology. Division of Gynecological Oncology, Hospital General del Este "Dr. Domingo Luciani", Caracas, Bolivarian Republic of Venezuela
| | - Maira Ávila
- Laboratorio de Genética Molecular, Instituto de Oncología y Hematología, Caracas, Bolivarian Republic of Venezuela
| | - Rene Pareja
- Department of Gynecologic Oncology, Instituto Nacional de Cancerologia, Bogota, Colombia .,Clínica ASTORGA, Medellín, Colombia
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Hoegl J, Rodriguez J, Estrada EE, Heymann M, Pareja R. Virtual journal club during the pandemic: a valuable learning tool. Int J Gynecol Cancer 2021; 32:105-106. [PMID: 33990356 DOI: 10.1136/ijgc-2021-002712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jorge Hoegl
- Department of Gynecology Oncology, Servicio oncológico hospitalario Instituto Venezolano de los Seguros Sociales, Caracas, Venezuela.,Department of Gynecology Oncology, Centro Clínico Profesional Caracas, Unidad de Ginecología Oncológica, Caracas, Venezuela
| | - Juliana Rodriguez
- Department of Gynecology Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia.,Department of Gynecology and Obstetrics, Section of Gynecologic Oncology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Erick Estuardo Estrada
- Department of Gynecology and Obstetrics, Hospital General San Juan de Dios, Guatemala City, Guatemala
| | - Monica Heymann
- Department of Gynecology Oncology, Instituto Salvadoreño del Seguro Social, San Salvador, El Salvador
| | - Rene Pareja
- Department of Gynecology Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
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Lopez A, Rodriguez J, Estrada E, Aragona A, Chavez C, Amaro K, De Padua C, Borges Garnica A, Rendón G, Alméciga A, Serrano O, Scasso S, Laufer J, Greif D, Taranto F, Hoegl J, Calderaro di Ruggiero F, Pareja R. Neoadjuvant chemotherapy in pregnant patients with cervical cancer: a Latin-American multicenter study. Int J Gynecol Cancer 2021; 31:468-474. [PMID: 33649015 DOI: 10.1136/ijgc-2020-001764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe oncologic and obstetric outcomes in patients diagnosed with cervical cancer during pregnancy who had a successful delivery after neoadjuvant chemotherapy. METHODS A multicenter retrospective review was conducted in 12 institutions from six Latin American countries, between January 2007 and December 2018. Data collected included clinical characteristics, neoadjuvant chemotherapy agents, treatment, obstetric and oncologic outcomes. RESULTS Thirty-three patients were included. Median age was 34 years (range 31-36). Twenty (60.6%) women were diagnosed at early stage (IB), and 13 (39.4%) with locally advanced stage (IIA-IIIB) according to FIGO 2009 classification. Carboplatin and paclitaxel was the most frequent combination used (60.6%). Partial and complete response rates were 27.3% and 9.1%, respectively. Median gestational age at delivery was 35 weeks (range 34-36). All patients had live births delivered by cesarean section. Obstetric pathology: pre-term labor, placenta percreta or intra-uterine growth restriction, was documented in seven patients (21.2%). Two (6.1%) neonates had low birth weight. Definitive treatment was primary chemo-radiation in 19 (57.6%) patients, radical hysterectomy in 11 (33.3%), abandoned radical hysterectomy with para-aortic lymphadenectomy and ovarian transposition in 1 patient (3.0%), and no further treatment in 2 (6.1%) patients. After a median follow-up of 16.3 months (range 2.0-36.9), 8 (26.7%) patients had recurrent disease. Of these, four (13.3%) died due to disease. CONCLUSION Neoadjuvant chemotherapy may be offered to patients wishing to preserve an ongoing pregnancy in order to achieve fetal maturity. Long-term consequences of chemotherapy in the child are yet to be determined.
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Affiliation(s)
- Aldo Lopez
- Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Juliana Rodriguez
- Department of Gynecology Oncology, Instituto Nacional de Cancerologia, Bogota, Colombia.,Department of Gynecology and Obstetrics. Section of Gynecologic Oncology, Fundacion Santa Fe de Bogota, Bogota, Colombia
| | - Erick Estrada
- Department of Gynecology and Obstetrics, Hospital General San Juan de Dios, Guatemala City, Guatemala, Guatemala
| | - Alejandro Aragona
- Hospital Municipal de Oncologia Marie Curie, Buenos Aires, Federal District, Argentina
| | - Carlos Chavez
- Instituto Regional de Enfermedades Neoplásicas (IREN Sur), Arequipa, Peru
| | - Karina Amaro
- Hospital Nacional Cayetano Heredia, Lima, Lima, Peru
| | | | - Alfredo Borges Garnica
- Unidad de Terapia Antineoplásica (UTAN), Centro Médico Guerra Méndez, Valencia, Venezuela, Bolivarian Republic
| | - Gabriel Rendón
- Department of Gynecologic Oncology, Instituto de Cancerología- Las Américas-AUNA, Medellin, Antioquia, Colombia
| | - Adriana Alméciga
- Department of Gynecology Oncology, Instituto Nacional de Cancerologia, Bogota, Colombia
| | - Oscar Serrano
- Department of Gynecologic Oncology, Hospital Militar Centra, Bogotá, Colombia
| | - Santiago Scasso
- Department of Gynecologic Oncology, Hospital Pereira Rossell, Montevideo, Uruguay
| | - Joel Laufer
- Department of Gynecologic Oncology, Hospital Pereira Rossell, Montevideo, Uruguay
| | - Diego Greif
- Department of Gynecology, Hospital de Clínicas Dr. Manuel Quintela, Universidad de la República, Montevideo, Uruguay
| | - Fernando Taranto
- Department of Gynecology, Hospital de Clínicas Dr. Manuel Quintela, Universidad de la República, Montevideo, Uruguay
| | - Jorge Hoegl
- Servicio Oncológico Hospitalario del Instituto Venezolano de los Seguros Sociales, Caracas, Venezuela
| | | | - René Pareja
- Department of Gynecology Oncology, Instituto Nacional de Cancerologia, Bogota, Colombia .,Clínica de Oncología Astorga, Universidad Pontificia Bolivariana, Medellin, Colombia
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Rodriguez J, Fletcher A, Heredia F, Fernandez R, Ramírez Salazar H, Sanabria D, Burbano Luna J, Guerrero E, Pierre M, Rendón GJ, Rosero I, Trujillo LM, Ribeiro R, Baiocchi G, Lopez Blanco A, Malca M, Hoegl J, Borges Garnica A, Lasso de la Vega J, Scasso S, Laufer J, Estrada EE, Gutierrez Criado A, Herbert Nuñez GS, Cantú‐de Leon D, Medina G, Pendola Gómez L, Saadi J, Noll F, Arévalo Sandoval D, Ferreira Oliveira A, Pareja R. Alternative management for gynecological cancer care during the COVID-2019 pandemic: A Latin American survey. Int J Gynaecol Obstet 2020; 150:368-378. [PMID: 32526044 PMCID: PMC9087623 DOI: 10.1002/ijgo.13272] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/20/2020] [Accepted: 06/05/2020] [Indexed: 12/13/2022]
Abstract
Objective To determine the acceptance rate of treatment alternatives for women with either preinvasive conditions or gynecologic cancers during the COVID‐19 pandemic among Latin American gynecological cancer specialists. Methods Twelve experts in gynecological cancer designed an electronic survey, according to recommendations from international societies, using an online platform. The survey included 22 questions on five topics: consultation care, preinvasive cervical pathology, and cervical, ovarian, and endometrial cancer. The questionnaire was distributed to 1052 specialists in 14 Latin American countries. A descriptive analysis was carried out using statistical software. Results A total of 610 responses were received, for an overall response rate of 58.0%. Respondents favored offering teleconsultation as triage for post‐cancer treatment follow‐up (94.6%), neoadjuvant chemotherapy in advanced stage epithelial ovarian cancer (95.6%), and total hysterectomy with bilateral salpingo‐oophorectomy and defining adjuvant treatment with histopathological features in early stage endometrial cancer (85.4%). Other questions showed agreement rates of over 64%, except for review of pathology results in person and use of upfront concurrent chemoradiation for early stage cervical cancer (disagreement 56.4% and 58.9%, respectively). Conclusion Latin American specialists accepted some alternative management strategies for gynecological cancer care during the COVID‐19 pandemic, which may reflect the region’s particularities. The COVID‐19 pandemic led Latin American specialists to accept alternative management strategies for gynecological cancer care, especially regarding surgical decisions. The COVID‐19 pandemic led Latin American specialists to accept alternative management strategies for gynecological cancer care, especially regarding surgical decisions.
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Affiliation(s)
- Juliana Rodriguez
- Department of Gynecologic OncologyInstituto Nacional de CancerologíaBogotáColombia
- Section of Gynecologic OncologyFundación Santa Fe de BogotáBogotáColombia
| | - Angélica Fletcher
- Department of Gynecologic OncologyCentro de Investigaciones Oncológicas Clínica San Diego – CIOSADBogotaColombia
| | - Fernando Heredia
- Department of Gynecology and ObstetricsSchool of MedicineUniversidad de ConcepciónConcepciónChile
| | | | | | - Daniel Sanabria
- Section of Gynecologic OncologyFundación Santa Fe de BogotáBogotáColombia
| | | | - Eduardo Guerrero
- Department of Radiotherapy OncologyInstituto Nacional de CancerologíaBogotaColombia
| | - Marc‐Edy Pierre
- Department of OncologyCentro de InvestigacionesOncológicas Clínica San Diego ‐ CIOSADBogotaColombia
| | - Gabriel J. Rendón
- Department of Gynecologic OncologyInstituto de Cancerología‐Las Américas‐Auna, Hospital GeneralMedellínColombia
| | - Indira Rosero
- Unit of CancerCentro Médico ImbanacoClínica Nuestra Señora de los RemediosCaliColombia
| | - Lina María Trujillo
- Department of Gynecologic OncologyInstituto Nacional de CancerologíaBogotáColombia
| | - Reitan Ribeiro
- Department of Surgical OncologyErasto Gaertner HospitalCuritibaBrazil
| | - Glauco Baiocchi
- Department of Gynecologic OncologyAC Camargo Cancer CenterSao PauloBrazil
| | - Aldo Lopez Blanco
- Department of Gynecologic surgeryInstituto Nacional de Enfermedades NeoplásicasLimaPerú
| | - Magaly Malca
- Service of Gynecologic OncologyHospital Edgardo Rebagliati MartinsLimaPerú
| | - Jorge Hoegl
- Service of Gynecologic OncologyServicio Oncológico HospitalarioCaracasVenezuela
| | | | | | - Santiago Scasso
- Department of Gynecologic OncologyHospital Pereira RossellMontevideoUruguay
| | - Joel Laufer
- Department of Gynecologic OncologyHospital Pereira RossellMontevideoUruguay
| | | | | | | | | | | | - Luis Pendola Gómez
- Service of MastologyION SolcaCentro Oncológico Integral (CENONI)GuayaquilEcuador
| | - José Saadi
- Service of GynecologySection of Gynecologic OncologyHospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Florencia Noll
- Service of GynecologySection of Gynecologic OncologyHospital Italiano de Buenos AiresBuenos AiresArgentina
| | | | | | - Rene Pareja
- Department of Gynecologic OncologyInstituto Nacional de CancerologíaBogotáColombia
- Clínica de Oncología AstorgaUniversidad Pontificia BolivarianaMedellinColombia
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