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Vergote I, Van Nieuwenhuysen E, Casado A, Laenen A, Lorusso D, Braicu EI, Guerra-Alia E, Zola P, Wimberger P, Debruyne PR, Falcó E, Ferrero A, Muallem MZ, Kerger J, García-Martinez E, Pignata S, Sehouli J, Van Gorp T, Gennigens C, Rubio MJ. Randomized phase II BGOG/ENGOT-cx1 study of paclitaxel-carboplatin with or without nintedanib in first-line recurrent or advanced cervical cancer. Gynecol Oncol 2023; 174:80-88. [PMID: 37167896 DOI: 10.1016/j.ygyno.2023.04.028] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/19/2023] [Accepted: 04/29/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Nintedanib is an oral tyrosine kinase inhibitor targeting, among others, vascular endothelial growth factor receptor. The aim was to establish the role of nintedanib in addition to paclitaxel and carboplatin in first-line recurrent/metastatic cervical cancer. METHODS Double-blind phase II randomized study in patients with first-line recurrent or primary advanced (FIGO stage IVB) cervical cancer. Patients received carboplatin-paclitaxel with oral nintedanib 200 mg BID/placebo. The primary endpoint was progression-free survival (PFS) at 1.5 years and α = 0.15, β = 80%, one sided. RESULTS 120 patients (62 N, 58C) were randomized. Median follow-up was 35 months. Baseline characteristics were similar in both groups (total population: squamous cell carcinoma 62%, prior radiotherapy 64%, primary advanced 25%, recurrent 75%). The primary endpoint was met with a PFS at 1.5 years of 15.1% versus 12.8% in favor of the nintedanib arm (p = 0.057). Median overall survival (OS) was 21.7 and 16.4 months for N and C, respectively. Confirmed RECIST response rate was 48% for N and 39% for C. No new adverse events were noted for N. However, N was associated with numerically more serious adverse events for anemia and febrile neutropenia. Global health status during and at the end of the study was similar in both arms. CONCLUSION The study met its primary endpoint with a prolonged PFS in the N arm. No new safety signals were observed.
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Affiliation(s)
- I Vergote
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG) and University Hospitals Leuven, Division of Gynaecological Oncology, Leuven, European Union, Belgium.
| | - E Van Nieuwenhuysen
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG) and University Hospitals Leuven, Division of Gynaecological Oncology, Leuven, European Union, Belgium
| | - A Casado
- Hospital Clínico San Carlos, Spain and Grupo Español de Cáncer de Ovario (GEICO), Madrid, Spain
| | - A Laenen
- Leuven Biostatistics and Statistical Bioinformatics Centre, KU Leuven, Leuven, Belgium
| | - D Lorusso
- Multicentre Italian Trials in Ovarian Cancer and Gynecologic malignancies (MITO) and Fondazione Policlinico Universitario Gemelli IRCCS and Catholic University of Sacred Heart, Roma, Italy
| | - E I Braicu
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V (NOGGO) and Department of Gynecology with Center for Oncological Surgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Virchow Campus Clinic, Charité Medical University, Berlin, Germany; Stanford University, Department of Obstetrics and Gynecology, CA, USA
| | - E Guerra-Alia
- Hospital Universitario Ramón y Cajal, and GEICO, Madrid, Spain
| | - P Zola
- Mario Negri Gynecologic Oncology Group (MaNGO) and Department of Surgical Sciences Università degli Studi di Torino, Italy
| | - P Wimberger
- NOGGO and Technische Universität Dresden and NCT Dresden, Dresden, Germany
| | - P R Debruyne
- BGOG and Kortrijk Cancer Centre, AZ Groeninge, Kortrijk, Belgium; School of Life Sciences, Anglia Ruskin University, Cambridge, UK; School of Nursing & Midwifery, University of Plymouth, Plymouth, UK
| | - E Falcó
- GEICO and Policlinica Miramar, Palma de Mallorca, Spain
| | - A Ferrero
- MaNGO and Mauriziano Hospital and University of Torino, Torino, Italy
| | - M Z Muallem
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V (NOGGO) and Department of Gynecology with Center for Oncological Surgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Virchow Campus Clinic, Charité Medical University, Berlin, Germany
| | - J Kerger
- BGOG and Instituut Jules Bordet, Brussels, Belgium
| | - E García-Martinez
- Hospital General Universitario Morales Meseguer, Murcia, Spain and GEICO
| | - S Pignata
- MITO and Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale Napoli, Italy
| | - J Sehouli
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V (NOGGO) and Department of Gynecology with Center for Oncological Surgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Virchow Campus Clinic, Charité Medical University, Berlin, Germany
| | - T Van Gorp
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG) and University Hospitals Leuven, Division of Gynaecological Oncology, Leuven, European Union, Belgium
| | | | - M J Rubio
- Hospital Reina Sofía, Córdoba, Spain and GEICO
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Laga T, Van Rompuy AS, Busschaert P, Olbrecht S, Loverix L, Lodi F, Baert T, Van Gorp T, Vergote I, Lambrechts D, Van Nieuwenhuysen E. 14P Unravelling the immune landscape of non-epithelial ovarian cancer. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101035] [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: 04/05/2023] Open
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Matulonis U, Moore K, Lorusso D, Oaknin A, Pignata S, Denys H, Colombo N, Van Gorp T, Konner J, Romeo Marin M, Harter P, Murphy C, Tu Y, Zhu F, Esteves B, Method M, Birrer M, Coleman R, O'Malley D. 592P Exposure response (ER) analysis for efficacy and safety of mirvetuximab soravtansine (MIRV) in patients with folate receptor α (FRα)-positive cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.720] [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: 11/16/2022] Open
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Colombo N, Van Gorp T, Matulonis U, Oaknin A, Grisham R, Fleming G, Olawaiye A, Tudor I, Pashova H, Lorusso D. 536P Relacorilant + nab-paclitaxel in patients with recurrent, platinum-resistant ovarian cancer: Phase II subgroup analysis mirroring the patient population of an upcoming phase III study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.664] [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: 11/25/2022] Open
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Vergote I, Fidalgo AP, Hamilton E, Valabrega G, Van Gorp T, Sehouli J, Cibula D, Levy T, Welch S, Richardson D, Alía EG, Scambia G, Henry S, Wimberger P, Miller D, Martínez J, Monk B, Shacham S, Mirza M, Makker V. VP2-2022: Prospective double-blind, randomized phase III ENGOT-EN5/GOG-3055/SIENDO study of oral selinexor/placebo as maintenance therapy after first-line chemotherapy for advanced or recurrent endometrial cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.223] [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: 11/01/2022] Open
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Laven P, Beltman JJ, Bense JE, van der Aa MA, Van Gorp T, Vos MC, Boll D, Arts H, Reesink N, Trimbos JB, Kruitwagen R. Incomplete surgical staging in clinical early-stage ovarian cancer: guidelines versus daily practice. Surg Open Sci 2021; 7:6-11. [PMID: 34778737 PMCID: PMC8577441 DOI: 10.1016/j.sopen.2021.09.002] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/08/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background Incomplete surgical staging of patients with early-stage epithelial ovarian cancer (EOC) has been reported in up to 98% of cases, when based on the International Federation of Obstetrics and Gynecology (FIGO) staging procedure. The aim of the present retrospective study was to clarify the reasons for incomplete staging. Methods The PRISMA (Prevention Recovery Information System for Monitoring and Analysis) technique was used to evaluate cases with FIGO I-IIa EOC based on incomplete staging from five gynecologic oncologic center hospitals in the Netherlands in the period 2010-2014. Results Fifty cases with an incomplete surgical staging of EOC according to national guidelines were included. The most common reasons for incomplete staging were insufficient random biopsies of the peritoneum (n = 34, 68%), and less than ten lymph nodes being resected and/or found at pathology (n = 16, 32%). The most mentioned reason for not performing biopsies was, besides forgetting to do so, believing that after careful inspection and palpation, taking biopsies is irrelevant and/or already are being taken while performing a hysterectomy (peritoneum of cul-de-sac, bladder). The value of contralateral pelvic lymph node dissection in case of a unilateral ovarian malignancy was also doubted, influencing the number of lymph nodes resected. Conclusions The most important reasons for incomplete staging in EOC are, besides omitting elements by accident, questioning the importance of obligatory elements of the staging procedure. A structured list of staging steps during surgery and more evidence-based consensus concerning these obligatory elements might increase the number of complete staging procedures in EOC.
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Affiliation(s)
- P Laven
- Maastricht University Medical Centre, Department of Obstetrics and Gynecology and GROW - School for Oncology and Developmental Biology, P.O. Box 5800, 6202AZ Maastricht, The Netherlands
| | - J J Beltman
- Leiden University Medical Centre, Department of Obstetrics and Gynecology, Leiden, The Netherlands
| | - J E Bense
- Leiden University Medical Centre, Department of Obstetrics and Gynecology, Leiden, The Netherlands
| | - M A van der Aa
- Netherlands Comprehensive Cancer Organization, Department of Research, Utrecht, The Netherlands
| | - T Van Gorp
- Maastricht University Medical Centre, Department of Obstetrics and Gynecology and GROW - School for Oncology and Developmental Biology, P.O. Box 5800, 6202AZ Maastricht, The Netherlands.,Department of Obstetrics and Gynecology, Division of Gynecological Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - M C Vos
- Elisabeth-TweeSteden Hospital, Department of Obstetrics and Gynecology, Tilburg, The Netherlands
| | - D Boll
- Catharina Cancer Institute, Eindhoven, Department of Obstetrics and Gynecology, Eindhoven, The Netherlands
| | - Hgj Arts
- University Medical Centre Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands
| | - N Reesink
- Hospital Medical Spectrum Twente, Department of Obstetrics and Gynecology, Enschede, The Netherlands
| | - J B Trimbos
- Leiden University Medical Centre, Department of Obstetrics and Gynecology, Leiden, The Netherlands
| | - Rfpm Kruitwagen
- Maastricht University Medical Centre, Department of Obstetrics and Gynecology and GROW - School for Oncology and Developmental Biology, P.O. Box 5800, 6202AZ Maastricht, The Netherlands
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Thijssen S, Wildiers H, Punie K, Beuselinck B, Clement P, Remmerie C, Berteloot P, Han S, Van Nieuwenhuysen E, Van Gorp T, Vergote I, Smeets A, Nevelsteen I, Floris G, Weltens C, Menten J, Janssen H, Laenen A, Neven P. Features of durable response and treatment efficacy for capecitabine monotherapy in advanced breast cancer: real-world evidence from a large single-centre cohort. J Cancer Res Clin Oncol 2021; 147:1041-1048. [PMID: 33471187 DOI: 10.1007/s00432-020-03487-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 11/27/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE In metastatic breast cancer (MBC) population treated with capecitabine monotherapy, we investigated clinical-pathological features as possible biomarkers for the oncological outcome. METHODS Retrospective study of consecutive MBC patients treated at University Hospitals Leuven starting capecitabine between 1999 and 2017. The primary endpoint was the durable response (DR), defined as non-progressive disease for > 52 weeks. Other main endpoints were objective response rate (ORR), time to progression (TTP) and overall survival (OS). RESULTS We included 506 patients; mean age at primary breast cancer diagnosis was 51.2 years; 18.2% had de novo MBC; 98.8% were pre-treated with taxanes and/or anthracycline. DR was reached in 11.6%. Patients with DR, as compared to those without DR, were more likely oestrogen receptor (ER) positive (91.5% vs. 76.8%, p = 0.010) at first diagnosis, had a lower incidence of lymph node (LN) involvement (35.6% vs. 49.9%, p = 0.039) before starting capecitabine, were more likely to present with metastases limited to ≤ 2 involved sites (54.2% vs. 38.5%, p = 0.020) and time from metastasis to start of capecitabine was longer (mean 3.5 vs. 2.7 years, p = 0.020). ORR was 22%. Median TTP and OS were 28 and 58 weeks, respectively. In multivariate analysis (only performed for TTP), ER positivity (hazard ratio (HR) = 0.529, p < 0.0001), HER2 negativity (HR = 0.582, p = 0.024), absence of LN (HR = 0.751, p = 0.008) and liver involvement (HR = 0.746, p = 0.013), older age at capecitabine start (HR = 0.925, p < 0.0001) and younger age at diagnosis of MBC (HR = 0.935, p = 0.001) were significant features of longer TTP. CONCLUSION Our data display relevant clinical-pathological features associated with DR and TTP in patients receiving capecitabine monotherapy for MBC.
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Affiliation(s)
- S Thijssen
- Department of Gynecological Oncology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - H Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - K Punie
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - B Beuselinck
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - P Clement
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - C Remmerie
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - P Berteloot
- Department of Gynecological Oncology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - S Han
- Department of Gynecological Oncology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - E Van Nieuwenhuysen
- Department of Gynecological Oncology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - T Van Gorp
- Department of Gynecological Oncology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - I Vergote
- Department of Gynecological Oncology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - A Smeets
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - I Nevelsteen
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - G Floris
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - C Weltens
- Department of Radiotherapy, University Hospitals Leuven, Leuven, Belgium
| | - J Menten
- Department of Radiotherapy, University Hospitals Leuven, Leuven, Belgium
| | - H Janssen
- Department of Radiotherapy, University Hospitals Leuven, Leuven, Belgium
| | - A Laenen
- Department of Biostatistics, University Hospitals Leuven, Leuven, Belgium
| | - P Neven
- Department of Gynecological Oncology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
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Landolfo C, Achten ETL, Ceusters J, Baert T, Froyman W, Heremans R, Vanderstichele A, Thirion G, Van Hoylandt A, Claes S, Oosterlynck J, Van Rompuy AS, Schols D, Billen J, Van Calster B, Bourne T, Van Gorp T, Vergote I, Timmerman D, Coosemans A. Assessment of protein biomarkers for preoperative differential diagnosis between benign and malignant ovarian tumors. Gynecol Oncol 2020; 159:811-819. [PMID: 32994054 DOI: 10.1016/j.ygyno.2020.09.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 05/29/2020] [Accepted: 09/13/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To estimate the diagnostic value of tumor and immune related proteins in the discrimination between benign and malignant adnexal masses, and between different subgroups of tumors. METHODS In this exploratory diagnostic study, 254 patients with an adnexal mass scheduled for surgery were consecutively enrolled at the University Hospitals Leuven (128 benign, 42 borderline, 22 stage I, 55 stage II-IV, and 7 secondary metastatic tumors). The quantification of 33 serum proteins was done preoperatively, using multiplex high throughput immunoassays (Luminex) and electrochemiluminescence immuno-assay (ECLIA). We calculated univariable areas under the Receiver Operating Characteristic Curves (AUCs). To discriminate malignant from benign tumors, multivariable ridge logistic regression with backward elimination was performed, using bootstrapping to validate the resulting AUCs. RESULTS CA125 had the highest univariable AUC to discriminate malignant from benign tumors (0.85, 95% confidence interval 0.79-0.89). Combining CA125 with CA72.4 and HE4 increased the AUC to 0.87. For benign vs borderline tumors, CA125 had the highest univariable AUC (0.74). For borderline vs stage I malignancy, no proteins were promising. For stage I vs II-IV malignancy, CA125, HE4, CA72.4, CA15.3 and LAP had univariable AUCs ≥0.80. CONCLUSIONS The results confirm the dominant role of CA125 for identifying malignancy, and suggest that other markers (HE4, CA72.4, CA15.3 and LAP) may help to distinguish between stage I and stage II-IV malignancies. However, further research is needed, also to investigate the added value over clinical and ultrasound predictors of malignancy, focusing on the differentiation between subtypes of malignancy.
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Affiliation(s)
- C Landolfo
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; Department of Oncology, Laboratory of Tumor Immunology and Immunotherapy, ImmunOvar Research Group, KU Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Queen Charlotte's and Chelsea Hospital, Imperial College, London, UK
| | - E T L Achten
- Department of Oncology, Laboratory of Tumor Immunology and Immunotherapy, ImmunOvar Research Group, KU Leuven, Leuven, Belgium
| | - J Ceusters
- Department of Oncology, Laboratory of Tumor Immunology and Immunotherapy, ImmunOvar Research Group, KU Leuven, Leuven, Belgium
| | - T Baert
- Department of Oncology, Laboratory of Tumor Immunology and Immunotherapy, ImmunOvar Research Group, KU Leuven, Leuven, Belgium; Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen Mitte (KEM), Essen, Germany
| | - W Froyman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - R Heremans
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - A Vanderstichele
- Department of Gynecology and Obstetrics, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, Laboratory of Gynecologic Oncology, KU Leuven, Leuven, Belgium
| | - G Thirion
- Department of Oncology, Laboratory of Tumor Immunology and Immunotherapy, ImmunOvar Research Group, KU Leuven, Leuven, Belgium
| | - A Van Hoylandt
- Department of Oncology, Laboratory of Tumor Immunology and Immunotherapy, ImmunOvar Research Group, KU Leuven, Leuven, Belgium
| | - S Claes
- Department of Microbiology, Immunology and Transplantation, Laboratory of Virology and Chemotherapy (Rega Institute), Belgium
| | - J Oosterlynck
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - A S Van Rompuy
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - D Schols
- Department of Microbiology, Immunology and Transplantation, Laboratory of Virology and Chemotherapy (Rega Institute), Belgium
| | - J Billen
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - B Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
| | - T Bourne
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Queen Charlotte's and Chelsea Hospital, Imperial College, London, UK; Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - T Van Gorp
- Department of Gynecology and Obstetrics, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, Laboratory of Gynecologic Oncology, KU Leuven, Leuven, Belgium
| | - I Vergote
- Department of Gynecology and Obstetrics, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, Laboratory of Gynecologic Oncology, KU Leuven, Leuven, Belgium
| | - D Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - A Coosemans
- Department of Oncology, Laboratory of Tumor Immunology and Immunotherapy, ImmunOvar Research Group, KU Leuven, Leuven, Belgium.
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Meys EMJ, Jeelof LS, Achten NMJ, Slangen BFM, Lambrechts S, Kruitwagen RFPM, Van Gorp T. Estimating risk of malignancy in adnexal masses: external validation of the ADNEX model and comparison with other frequently used ultrasound methods. Ultrasound Obstet Gynecol 2017; 49:784-792. [PMID: 27514486 PMCID: PMC5488216 DOI: 10.1002/uog.17225] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/21/2016] [Accepted: 08/05/2016] [Indexed: 05/17/2023]
Abstract
OBJECTIVES To validate externally the performance of the Assessment of Different NEoplasias in the adneXa (ADNEX) model and compare this model with other frequently used models in the differentiation between benign and malignant adnexal masses. METHODS In this retrospective diagnostic accuracy study, we assessed data collected prospectively from patients with adnexal pathology who underwent real-time transvaginal or transrectal ultrasound by a single expert ultrasonographer in a tertiary care hospital between July 2011 and July 2015. The presence of a malignancy was determined by subjective assessment and use of four prediction models: the ADNEX model, simple ultrasound-based rules (simple rules), Logistic Regression model 2 (LR2) and the Risk of Malignancy Index (RMI), of which three different variants were assessed. Pathology was the clinical reference standard. RESULTS In total, 851 consecutive patients underwent ultrasound examination for an adnexal mass. For 326 patients (128 premenopausal and 198 postmenopausal), pathology results were available (211 (64.7%) benign; 115 (35.3%) malignant) and these were included in the analysis. The area under the receiver-operating characteristics curve (AUC) of the ADNEX model for the discrimination between benign and malignant tumors was 0.93 (95% CI, 0.89-0.95). AUCs for the subtypes of malignancy (i.e. borderline, Stage I-IV and metastatic adnexal tumors) ranged between 0.60 and 0.90. Only subjective assessment (AUC, 0.96 (95% CI, 0.93-0.98)) was superior to the ADNEX model (P = 0.01) in differentiating malignant from benign tumors. AUCs for the other models were 0.92 (95% CI, 0.89-0.95) for LR2, 0.85 (95% CI, 0.81-0.89) for RMI-I, 0.82 (95% CI, 0.77-0.86) for RMI-II and 0.84 (95% CI, 0.80-0.88) for RMI-III. At the proposed cut-off of ≥ 10%, the ADNEX model had the highest sensitivity (0.98 (95% CI, 0.93-1.00)) but the lowest specificity (0.62 (95% CI, 0.55-0.68)) compared with the other models. Both subjective assessment (sensitivity, 0.90 (95% CI, 0.83-0.95); specificity 0.91 (95% CI, 0.86-0.94)) and the simple rules model with inconclusive cases classified by subjective assessment (sensitivity, 0.89 (95% CI, 0.81-0.94); specificity, 0.90 (95% CI, 0.85-0.94)) had lower sensitivity, but their sensitivity and specificity were better balanced. CONCLUSIONS Although the test performance of subjective assessment by an expert remains superior, the ADNEX model can help in the differentiation between benign and malignant ovarian tumors. The advantage of the ADNEX model as a polytomous model remains to be shown. © 2016 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E. M. J. Meys
- Department of Obstetrics and GynaecologyMaastricht University Medical Center + (MUMC+)MaastrichtThe Netherlands
- GROW – School for Oncology and Developmental BiologyMaastrichtThe Netherlands
| | - L. S. Jeelof
- Department of Obstetrics and GynaecologyMaastricht University Medical Center + (MUMC+)MaastrichtThe Netherlands
| | - N. M. J. Achten
- Department of Obstetrics and GynaecologyMaastricht University Medical Center + (MUMC+)MaastrichtThe Netherlands
| | - B. F. M. Slangen
- Department of Obstetrics and GynaecologyMaastricht University Medical Center + (MUMC+)MaastrichtThe Netherlands
- GROW – School for Oncology and Developmental BiologyMaastrichtThe Netherlands
| | - S. Lambrechts
- Department of Obstetrics and GynaecologyMaastricht University Medical Center + (MUMC+)MaastrichtThe Netherlands
- GROW – School for Oncology and Developmental BiologyMaastrichtThe Netherlands
| | - R. F. P. M. Kruitwagen
- Department of Obstetrics and GynaecologyMaastricht University Medical Center + (MUMC+)MaastrichtThe Netherlands
- GROW – School for Oncology and Developmental BiologyMaastrichtThe Netherlands
| | - T. Van Gorp
- Department of Obstetrics and GynaecologyMaastricht University Medical Center + (MUMC+)MaastrichtThe Netherlands
- GROW – School for Oncology and Developmental BiologyMaastrichtThe Netherlands
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Koeneman MM, Kruse AJ, Kooreman LFS, Zur Hausen A, Hopman AHN, Sep SJS, Van Gorp T, Slangen BFM, van Beekhuizen HJ, van de Sande M, Gerestein CG, Nijman HW, Kruitwagen RFPM. TOPical Imiquimod treatment of high-grade Cervical intraepithelial neoplasia (TOPIC trial): study protocol for a randomized controlled trial. BMC Cancer 2016; 16:132. [PMID: 26897518 PMCID: PMC4761416 DOI: 10.1186/s12885-016-2187-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 02/16/2016] [Indexed: 11/10/2022] Open
Abstract
Background Cervical intraepithelial neoplasia (CIN) is the premalignant condition of cervical cancer. Whereas not all high grade CIN lesions progress to cervical cancer, the natural history and risk of progression of individual lesions remain unpredictable. Therefore, high-grade CIN is currently treated by surgical excision: large loop excision of the transformation zone (LLETZ). This procedure has potential complications, such as acute haemorrhage, prolonged bleeding, infection and preterm birth in subsequent pregnancies. These complications could be prevented by development of a non-invasive treatment modality, such as topical imiquimod treatment. The primary study objective is to investigate the efficacy of topical imiquimod 5 % cream for the treatment of high-grade CIN and to develop a biomarker profile to predict clinical response to imiquimod treatment. Secondary study objectives are to assess treatment side-effects, disease recurrence and quality of life during and after different treatment modalities. Methods/design The study design is a randomized controlled trial. One hundred forty women with a histological diagnosis of high-grade CIN (CIN 2–3) will be randomized into two arms: imiquimod treatment during 16 weeks (experimental arm) or immediate LLETZ (standard care arm). Treatment efficacy will be evaluated by colposcopy with diagnostic biopsies at 20 weeks for the experimental arm. Successful imiquimod treatment is defined as regression to CIN 1 or less, successful LLETZ treatment is defined as PAP 1 after 6 months. Disease recurrence will be evaluated by cytology at 6, 12 and 24 months after treatment. Side-effects will be evaluated using a standardized report form. Quality of life will be evaluated using validated questionnaires at baseline, 20 weeks and 1 year after treatment. Biomarkers, reflecting both host and viral factors in the pathophysiology of CIN, will be tested at baseline with the aim of developing a predictive biomarker profile for the clinical response to imiquimod treatment. Discussion Treatment of high-grade CIN lesions with imiquimod in a selected patient population may diminish complications as a result of surgical intervention. More knowledge on treatment efficacy, side effects and long-term recurrence rates after treatment is necessary. Trial registration EU Clinical Trials Register EU-CTR2013-001260-34. Registered 18 March 2013. Medical Ethical Committee approval number: NL44336.068.13 (Medical Ethical Committee Maastricht University Hospital, University of Maastricht). Affiliation: Maastricht University Hospital. Registration number ClinicalTrials.gov: NCT02329171.
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Affiliation(s)
- M M Koeneman
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, Post box 5800, 6202 AZ, Maastricht, The Netherlands. .,GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - A J Kruse
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, Post box 5800, 6202 AZ, Maastricht, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - L F S Kooreman
- Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A Zur Hausen
- Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A H N Hopman
- GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Molecular Cell Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S J S Sep
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - T Van Gorp
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, Post box 5800, 6202 AZ, Maastricht, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - B F M Slangen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, Post box 5800, 6202 AZ, Maastricht, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - H J van Beekhuizen
- Department of Obstetrics and Gynaecology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - M van de Sande
- Department of Obstetrics and Gynaecology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - C G Gerestein
- Department of Obstetrics and Gynaecology, Meander Medical Center, Amersfoort, The Netherlands
| | - H W Nijman
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, Groningen, The Netherlands
| | - R F P M Kruitwagen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, Post box 5800, 6202 AZ, Maastricht, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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11
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Rohr I, Zeilinger R, Heinrich M, Richter R, Concin N, Vergote I, Mahner S, Van Gorp T, Trillsch F, Cacsire-Tong D, Chekerov R, Sehouli J, Braicu EI. Role of IGF1 in primary ovarian cancer – a study of the OVCAD European Consortium. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388347] [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: 10/24/2022] Open
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12
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Kleppe M, Bruls J, Van Gorp T, Massuger L, Slangen B, Van de Vijver K, Kruse A, Kruitwagen R. Mucinous borderline tumours of the ovary and the appendix: A retrospective study and overview of the literature. Gynecol Oncol 2014; 133:155-8. [DOI: 10.1016/j.ygyno.2014.02.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 02/04/2014] [Accepted: 02/08/2014] [Indexed: 11/24/2022]
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13
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Kleppe M, Amkreutz LCM, Van Gorp T, Slangen BFM, Kruse AJ, Kruitwagen RFPM. Lymph-node metastasis in stage I and II sex cord stromal and malignant germ cell tumours of the ovary: a systematic review. Gynecol Oncol 2014; 133:124-7. [PMID: 24440833 DOI: 10.1016/j.ygyno.2014.01.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 11/04/2013] [Revised: 01/09/2014] [Accepted: 01/10/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this systematic review is to determine the incidence of lymph-node metastasis in clinical stage I and II sex cord stromal tumours and germ cell tumours of the ovary. METHODS Relevant articles were identified from MEDLINE and EMBASE and supplemented with citations from the reference lists of the primary studies. Eligibility was determined by two authors. Included studies were prospective or retrospective cohort and cross-sectional studies analysing at least ten patients with clinical early-stage non-epithelial ovarian cancer who underwent lymphadenectomy or lymph-node sampling as part of a staging laparotomy. RESULTS For sex cord stromal tumours, five articles including 578 patients were analysed and lymph-node metastasis was not detected in the 86 patients who underwent lymph-node removal. The median number of removed lymph nodes was 13 (range 9-29). For malignant germ cell tumours, three articles were eligible including 2436 patients of whom 946 patients underwent lymph-node resection. The mean number of removed nodes was 10 (range 2-14) with a mean incidence of lymph-node metastasis of 10.9% (range 10.5-11.8%). CONCLUSIONS The incidence of lymph-node metastasis in patients with clinical stage I and II sex cord stromal tumours is low, whereas the incidence in patients with clinical stage I-II germ cell tumours is considerable, although limited data are available.
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Affiliation(s)
- M Kleppe
- Maastricht University Medical Centre, Department of Obstetrics and Gynaecology, Maastricht, The Netherlands
| | - L C M Amkreutz
- Maastricht University Medical Centre, Department of Obstetrics and Gynaecology, Maastricht, The Netherlands
| | - T Van Gorp
- Maastricht University Medical Centre, Department of Obstetrics and Gynaecology, Maastricht, The Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - B F M Slangen
- Maastricht University Medical Centre, Department of Obstetrics and Gynaecology, Maastricht, The Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - A J Kruse
- Maastricht University Medical Centre, Department of Obstetrics and Gynaecology, Maastricht, The Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - R F P M Kruitwagen
- Maastricht University Medical Centre, Department of Obstetrics and Gynaecology, Maastricht, The Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht, The Netherlands.
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Kaijser J, Van Gorp T, Smet ME, Van Holsbeke C, Sayasneh A, Epstein E, Bourne T, Vergote I, Van Calster B, Timmerman D. Are serum HE4 or ROMA scores useful to experienced examiners for improving characterization of adnexal masses after transvaginal ultrasonography? Ultrasound Obstet Gynecol 2014; 43:89-97. [PMID: 23828371 DOI: 10.1002/uog.12551] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 06/07/2013] [Accepted: 06/11/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To determine whether serum human-epididymis protein-4 (HE4) levels or Risk of Ovarian Malignancy Algorithm (ROMA) scores are useful second-stage tests for tumors thought to be difficult to characterize as benign or malignant on the basis of ultrasound findings by experienced examiners, and to investigate whether adding information on serum HE4 levels or ROMA scores to ultrasound findings improves diagnostic performance. METHODS This was a prospective cross-sectional diagnostic accuracy study conducted in a tertiary referral center that enrolled consecutive women with a known adnexal mass scheduled for surgery. Experienced level III examiners classified each mass as certainly or probably benign, difficult to classify, or probably or certainly malignant after preoperative ultrasound examination. Serum HE4 and CA 125 levels were measured before surgery. RESULTS The final database comprised 360 women, of whom 216 (60%) had benign and 144 (40%) had malignant disease. Examiners were highly confident in 196 cases (54%), moderately confident in 135 (38%) and completely uncertain about their diagnosis in 29 (8%) cases. With a sensitivity of 67% and specificity of 70%, subjective assessment outperformed HE4 and ROMA in the subgroup of difficult tumors. Both tests had low discriminatory capacity with poor areas under the receiver-operating characteristics curve of 0.536 (95% CI, 0.302-0.771) and 0.565 (95% CI, 0.294-0.836), respectively. A strategy that incorporates sequential testing of serum HE4 or ROMA scores after transvaginal ultrasonography resulted in a deterioration in overall test performance. CONCLUSION Measurement of serum HE4 or calculating scores using the ROMA as secondary tests does not seem useful for classifying adnexal tumors after subjective assessment with transvaginal ultrasonography.
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Affiliation(s)
- J Kaijser
- KU Leuven Department of Development and Regeneration, Leuven, Belgium; Department of Obstetrics and Gynecology and Leuven Cancer Institute, University Hospitals, KU Leuven, Leuven, Belgium
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15
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Kaijser J, Van Gorp T, Sayasneh A, Vergote I, Bourne T, Van Calster B, Timmerman D. Differentiating stage I epithelial ovarian cancer from benign disease in women with adnexal tumors using biomarkers or the ROMA algorithm. Gynecol Oncol 2013; 130:398-9. [DOI: 10.1016/j.ygyno.2013.04.472] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 04/08/2013] [Indexed: 11/26/2022]
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16
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Amkreutz LCM, Mertens HJMM, Nurseta T, Engelen MJA, Bergmans M, Nolting E, Van Gorp T, Kruitwagen RFPM. The value of imaging of the lungs in the diagnostic workup of patients with endometrial cancer. Gynecol Oncol 2013; 131:147-50. [PMID: 23838035 DOI: 10.1016/j.ygyno.2013.06.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 04/30/2013] [Revised: 06/18/2013] [Accepted: 06/25/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Imaging of the lungs is part of the routine diagnostic workup of patients with endometrial cancer. The present study aimed to determine the incidence of lung metastases in patients with endometrial cancer and to evaluate the clinical relevance of preoperative chest imaging in this population. METHODS A retrospective cross-sectional study was performed in four regional and one university hospital in the southeastern part of the Netherlands. A total of 784 patients with epithelial endometrial cancer diagnosed between 2002 and 2010 in five hospitals were included. Patients were followed up for at least 1 year. RESULTS Of 784 patients, 541 (69.0%) underwent thoracic imaging and 11 showed findings suspicious for metastases perioperatively or during the 1-year follow-up period. In eight patients, the thoracic metastases were related to their endometrial cancer, resulting in an overall incidence of 1.0% (8/784, 95% CI=0.3-1.7%). These eight patients had high-risk subtypes of endometrial cancer (serous, clear cell or poorly differentiated endometrioid), and the incidence was 4.1% (8/193, 95% CI=1.9-8.3%) for these subtypes. Lung metastases were not detected in any of the patients with low-risk subtypes of endometrial cancer (n=566) at the time of diagnosis (95% CI=0-0.8%). CONCLUSIONS The probability of detecting thoracic metastases during the diagnostic workup of patients with endometrial cancer is low. The present data suggest that thoracic imaging could be omitted from the diagnostic workup of patients with low-risk endometrial cancer.
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Affiliation(s)
- L C M Amkreutz
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Polterauer S, Vergote I, Concin N, Braicu I, Chekerov R, Mahner S, Woelber L, Cadron I, Van Gorp T, Zeillinger R, Cacsire Castillo-Tong D, Sehouli J. Prognostische Bedeutung des postoperativen Tumorrests bei Patientinnen mit epithelialem Ovarialkarzinom FIGO IIA-IV: Analyse der OVCAD Daten. Geburtshilfe Frauenheilkd 2012. [DOI: 10.1055/s-0032-1309228] [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: 10/28/2022] Open
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18
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Aust S, Pils D, Cacsire Castillo-Tong D, Hager G, Obermayr E, Heinze G, Kohl M, Schuster E, Wolf A, Schiebel I, Sehouli J, Braicu I, Vergote I, Van Gorp T, Mahne S, Concin N, Speiser P, Zeillinger R. Eine kombinierte Blut-basierte Gen-Expressions und Plasma-Protein Signatur für die Diagnose von epithelialem Ovarialkarzinom - Eine Studie des OVCAD Konsortiums. Geburtshilfe Frauenheilkd 2012. [DOI: 10.1055/s-0032-1309219] [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: 10/28/2022] Open
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Brouckaert O, Van Belle V, Berteloot P, Amant F, Leunen K, Van Gorp T, Wildiers H, Paridaens R, Vergote I, Neven P. 0139 Why 28% of ER-negative/PR-negative breast cancer (BC) patients did not get chemotherapy (CT). Breast 2009. [DOI: 10.1016/s0960-9776(09)70170-5] [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: 10/20/2022] Open
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20
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Devolder K, Amant F, Neven P, Van Gorp T, Leunen K, Vergote I. Role of diaphragmatic surgery in 69 patients with ovarian carcinoma. Int J Gynecol Cancer 2008; 18:363-8. [DOI: 10.1111/j.1525-1438.2007.01006.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Diaphragmatic stripping or coagulation is a technique aiming to optimally cytoreduce ovarian cancer. We investigated the complications, the overall survival, and the relapse rate following this procedure. Records of 69 patients with diaphragmatic involvement who underwent debulking surgery between September 1993 and December 2001 were reviewed. A total of 69 patients underwent diaphragmatic surgery as part of cytoreductive surgery for epithelial ovarian cancer. In 17 cases, the diaphragmatic tumors were stripped from the muscle, in 22 cases coagulated, and in 30 cases stripped and coagulated. Postoperative complications were pleural effusion (41 cases, 3 needed a chest drain, 7 needed a pleural puncture, 1 needed both) and pneumothorax (4 cases, 1 needed a chest drain). In one case of bilateral pleural effusion, the patient developed pneumonia. In one case of pleural effusion on the right side, the patient needed a pleural puncture and developed a partial atelectasis of the middle lobe of the right lung. The median overall survival was 66 months in the stripping group compared with 49 months in the coagulation group. In 56 cases (81%), the patient developed a relapse, and the first site of relapse was the diaphragm in 11 cases (20%). We conclude that diaphragmatic resection is an important part of optimal debulking surgery with an acceptable morbidity.
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Van Gorp T, Amant F, Neven P, Berteloot P, Leunen K, Vergote I. The role of neoadjuvant chemotherapy versus primary surgery in the management of stage III ovarian cancer. Cancer Treat Res 2007; 134:387-402. [PMID: 17633068 DOI: 10.1007/978-0-387-48993-3_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- T Van Gorp
- Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, University Hospitals, Katholieke Universiteit, Leuven, Belgium
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Vergote I, Amant F, Leunen K, Van Gorp T, Berteloot P, Neven P. Metastatic breast cancer: sequencing hormonal therapy and positioning of fulvestrant. Int J Gynecol Cancer 2007; 16 Suppl 2:524-6. [PMID: 17010064 DOI: 10.1111/j.1525-1438.2006.00687.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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: 11/29/2022] Open
Abstract
Fulvestrant, a novel estrogen receptor (ER) antagonist with no agonist effects, binds, blocks, and degrades the ER, thereby downregulating cellular ER levels, which in turn leads to reduced expression of the progesterone receptor. Due to this specific working mechanism, fulvestrant is an important addition to the armamentarium of endocrine agents in advanced breast cancer (ABC). Fulvestrant has been shown to be equally effective as the third-generation aromatase inhibitor (AI) anastrozole in postmenopausal patients with hormone-sensitive ABC progressing prior to tamoxifen. In another randomized phase III trial, it was shown that fulvestrant had similar efficacy to tamoxifen in the first-line treatment of postmenopausal women with hormone receptor-positive ABC. When comparing the side effects of fulvestrant with tamoxifen and anastrozole, it was shown that fulvestrant is well tolerated compared with these agents and is associated with a lower incidence of joint disorders. Clinical benefit on fulvestrant treatment after AI therapy has been reported in a substantial number of patients (28-46%). On the other hand, it was also shown that sensitivity to further endocrine therapy is retained following progression on first-line or second-line fulvestrant (57% and 46% clinical benefit, respectively). In conclusion, fulvestrant provides us with an additional endocrine treatment option making it possible to prolong the time that patients with ABC can be treated with endocrine therapy.
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Affiliation(s)
- I Vergote
- Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, University Hospitals, Katholieke Universiteit Leuven, Belgium.
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Van Gorp T, Amant F, Neven P, Berteloot P, Leunen K, Vergote I. The position of neoadjuvant chemotherapy within the treatment of ovarian cancer. Minerva Ginecol 2006; 58:393-403. [PMID: 17006426] [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] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
It is clear that primary debulking remains the standard of care within the treatment of advanced ovarian cancer (International Federation of Gynaecology and Obstetrics, FIGO, stage III and IV). Debulking surgery should be performed by a gynaecologic oncologist without any residual tumour load, or so called optimal debulking'. Over the last decades, interest in the use of neoadjuvant chemotherapy together with an interval debulking has increased. Open laparoscopy is probably the most valuable tool for evaluating the operability primarily or at the time of interval debulking surgery. Neoadjuvant therapy can be used for patients that are primarily suboptimally debulked due to an extensive tumor load. In this situation, based on the randomized EORTC-GCG trial, interval debulking by an experienced surgeon improves survival in some patients who did not undergo optimal primary debulking surgery. Based on the GOG 152 data, interval debulking surgery does not seem to be indicated in patients who underwent primarily a maximal surgical effort by a gynecological oncologist. Neoadjuvant chemotherapy can also be used as an alternative to primary debulking. In retrospective analyses neoadjuvant chemotherapy followed by interval debulking surgery does not seem to worsen prognosis compared to primary debulking surgery followed by chemotherapy. However, we will have to wait for the results of future randomized trials to know whether neoadjuvant chemotherapy followed by interval debulking surgery is a good alternative to primary debulking surgery in stage IIIc and IV patients.
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Affiliation(s)
- T Van Gorp
- Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology University Hospitals, Katholieke Universiteit Leuven, Belgium
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Van Gorp T, Vergote IB, Pochet NLMM, Amant F. Methodology in plasma proteomic pattern experiments. Int J Gynecol Cancer 2006; 16:1951-2; author reply 1953. [PMID: 17009999 DOI: 10.1111/j.1525-1438.2006.00721.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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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25
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De Smet F, Pochet NLMM, Engelen K, Van Gorp T, Van Hummelen P, Marchal K, Amant F, Timmerman D, De Moor BLR, Vergote IB. Predicting the clinical behavior of ovarian cancer from gene expression profiles. Int J Gynecol Cancer 2006; 16 Suppl 1:147-51. [PMID: 16515583 DOI: 10.1111/j.1525-1438.2006.00321.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [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: 11/29/2022] Open
Abstract
We investigated whether prognostic information is reflected in the expression patterns of ovarian carcinoma samples. RNA obtained from seven FIGO stage I without recurrence, seven platin-sensitive advanced-stage (III or IV), and six platin-resistant advanced-stage ovarian tumors was hybridized on a complementary DNA microarray with 21,372 spotted clones. The results revealed that a considerable number of genes exhibit nonaccidental differential expression between the different tumor classes. Principal component analysis reflected the differences between the three tumor classes and their order of transition. Using a leave-one-out approach together with least squares support vector machines, we obtained an estimated classification test accuracy of 100% for the distinction between stage I and advanced-stage disease and 76.92% for the distinction between platin-resistant versus platin-sensitive disease in FIGO stage III/IV. These results indicate that gene expression patterns could be useful in clinical management of ovarian cancer.
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Affiliation(s)
- F De Smet
- Department of Electrical Engineering ESAT-SCD, K.U.Leuven, Leuven-Heverlee, Belgium
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Amant F, Vandenput I, Van Gorp T, Vergote I, Moerman P. Endometrial carcinosarcoma with osteoclast-like giant cells. EUR J GYNAECOL ONCOL 2006; 27:92-4. [PMID: 16550981] [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: 05/07/2023]
Abstract
We encountered a case of endometrial cancer with a poorly differentiated epithelial component, accompanied by a compact proliferation of atypical spindle cells and osteoclast-like giant cells. Immunohistochemically, the epithelial component was EMA and prekeratin positive with vimentin-positive spindle cells, whereas the osteoclast-like giant cells were strongly immunoreactive for CD68. The description of osteoclast-like giant cells adds to the knowledge of endometrial carcinosarcoma tumor biology.
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Affiliation(s)
- F Amant
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of Leuven, Leuven, Belgium
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27
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De Smet F, Pochet NL, Engelen K, Van Gorp T, Van Hummelen P, Marchal K, Amant F, Timmerman D, De Moor BL, Vergote IB. Predicting the clinical behavior of ovarian cancer from gene expression profiles. Int J Gynecol Cancer 2006. [DOI: 10.1136/ijgc-00009577-200602001-00024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We investigated whether prognostic information is reflected in the expression patterns of ovarian carcinoma samples. RNA obtained from seven FIGO stage I without recurrence, seven platin-sensitive advanced-stage (III or IV), and six platin-resistant advanced-stage ovarian tumors was hybridized on a complementary DNA microarray with 21,372 spotted clones. The results revealed that a considerable number of genes exhibit nonaccidental differential expression between the different tumor classes. Principal component analysis reflected the differences between the three tumor classes and their order of transition. Using a leave-one-out approach together with least squares support vector machines, we obtained an estimated classification test accuracy of 100% for the distinction between stage I and advanced-stage disease and 76.92% for the distinction between platin-resistant versus platin-sensitive disease in FIGO stage III/IV. These results indicate that gene expression patterns could be useful in clinical management of ovarian cancer.
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