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Ledermann JA, Matias-Guiu X, Amant F, Concin N, Davidson B, Fotopoulou C, González-Martin A, Gourley C, Leary A, Lorusso D, Banerjee S, Chiva L, Cibula D, Colombo N, Croce S, Eriksson AG, Falandry C, Fischerova D, Harter P, Joly F, Lazaro C, Lok C, Mahner S, Marmé F, Marth C, McCluggage WG, McNeish IA, Morice P, Nicum S, Oaknin A, Pérez-Fidalgo JA, Pignata S, Ramirez PT, Ray-Coquard I, Romero I, Scambia G, Sehouli J, Shapira-Frommer R, Sundar S, Tan DSP, Taskiran C, van Driel WJ, Vergote I, Planchamp F, Sessa C, Fagotti A. ESGO-ESMO-ESP consensus conference recommendations on ovarian cancer: pathology and molecular biology and early, advanced and recurrent disease. Ann Oncol 2024; 35:248-266. [PMID: 38307807 DOI: 10.1016/j.annonc.2023.11.015] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/17/2023] [Accepted: 11/28/2023] [Indexed: 02/04/2024] Open
Abstract
The European Society of Gynaecological Oncology, the European Society for Medical Oncology (ESMO) and the European Society of Pathology held a consensus conference (CC) on ovarian cancer on 15-16 June 2022 in Valencia, Spain. The CC panel included 44 experts in the management of ovarian cancer and pathology, an ESMO scientific advisor and a methodologist. The aim was to discuss new or contentious topics and develop recommendations to improve and harmonise the management of patients with ovarian cancer. Eighteen questions were identified for discussion under four main topics: (i) pathology and molecular biology, (ii) early-stage disease and pelvic mass in pregnancy, (iii) advanced stage (including older/frail patients) and (iv) recurrent disease. The panel was divided into four working groups (WGs) to each address questions relating to one of the four topics outlined above, based on their expertise. Relevant scientific literature was reviewed in advance. Recommendations were developed by the WGs and then presented to the entire panel for further discussion and amendment before voting. This manuscript focuses on the recommendation statements that reached a consensus, their voting results and a summary of evidence supporting each recommendation.
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Affiliation(s)
- J A Ledermann
- Department of Oncology, UCL Cancer Institute, University College London, London, UK.
| | - X Matias-Guiu
- CIBERONC, Madrid; Department of Pathology, Hospital Universitari Arnau de Vilanova, IRBLLEIDA, University of Lleida, Lleida; Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Barcelona, Spain.
| | - F Amant
- Department of Gynaecologic Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium; Department of Gynecology, Center for Gynecological Oncology Amsterdam, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - N Concin
- Department of Obstetrics and Gynaecology, Medical University of Innsbruck, Innsbruck, Austria; Department of Gynaecology and Gynaecologic Oncology, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - B Davidson
- Department of Pathology, Norwegian Radium Hospital, Oslo University Hospital, Oslo; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - C Fotopoulou
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - A González-Martin
- Department of Medical Oncology and Program in Solid Tumours-Cima, Cancer Center Clínica Universidad de Navarra, Madrid, Spain
| | - C Gourley
- Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - A Leary
- Department of Medicine, Institut Gustave Roussy, Villejuif, France
| | - D Lorusso
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome; Department of Woman, Child and Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - S Banerjee
- The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - L Chiva
- Department of Gynaecology and Obstetrics, Cancer Center Clínica Universidad de Navarra, Navarra, Spain
| | - D Cibula
- Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - N Colombo
- Department of Gynecologic Oncology, Istituto Europeo di Oncologia IRCCS, Milan; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - S Croce
- Department of Biopathology, Bergonié Institut, Bordeaux, France
| | - A G Eriksson
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Gynecologic Oncology, Division of Cancer Medicine, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - C Falandry
- Institute of Aging, Hospices Civils de Lyon, Lyon; CarMeN Laboratory, INSERM U1060/Université Lyon 1/INRAE U1397/Hospices Civils Lyon, Pierre-Bénite, France
| | - D Fischerova
- Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - P Harter
- Department of Gynaecology and Gynaecologic Oncology, Evang. Kliniken Essen-Mitte, Essen, Germany; Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) Study Group, Germany
| | - F Joly
- GINECO Group, Department of Medical Oncology, Centre François-Baclesse, University of Caen Normandy, Caen, France
| | - C Lazaro
- Hereditary Cancer Program, Catalan Institute of Oncology (ICO-IDIBELL-CIBERONC), L'Hospitalet de Llobregat, Barcelona, Spain
| | - C Lok
- Department of Gynecology, Center for Gynecological Oncology Amsterdam, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S Mahner
- Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) Study Group, Germany; Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich
| | - F Marmé
- Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) Study Group, Germany; Department of Obstetrics and Gynecology, University Hospital Mannheim, Mannheim; Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - C Marth
- Department of Obstetrics and Gynaecology, Medical University of Innsbruck, Innsbruck, Austria
| | - W G McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK
| | - I A McNeish
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - P Morice
- Department of Gynecologic Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - S Nicum
- Department of Oncology, UCL Cancer Institute, University College London, London, UK
| | - A Oaknin
- Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona
| | - J A Pérez-Fidalgo
- Department of Medical Oncology, Hospital Clínico Universitario - INCLIVA, CIBERONC, Valencia, Spain
| | - S Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori di Napoli, IRCCS Fondazione Pascale, Napoli, Italy
| | - P T Ramirez
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, USA
| | - I Ray-Coquard
- Department of Medical Oncology, Centre Léon Bérard, University Claude Bernard, Lyon, France
| | - I Romero
- Department of Medical Oncology, Instituto Valenciano Oncologia, Valencia, Spain
| | - G Scambia
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome; Department of Woman, Child and Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - J Sehouli
- North-Eastern German Society of Gynecological Oncology (NOGGO), Berlin; Department of Gynecology with Center for Oncological Surgery, Charité Berlin University of Medicine, Berlin, Germany
| | | | - S Sundar
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham; Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
| | - D S P Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National University of Singapore (NUS) Centre for Cancer Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cancer Science Institute, National University of Singapore, Singapore; Department of Haematology-Oncology, National University Cancer Institute Singapore, National University Hospital, Singapore, Singapore
| | - C Taskiran
- Department of Gynecologic Oncology, School of Medicine, Koç University, Istanbul, Turkey
| | - W J van Driel
- Department of Gynecology, Center for Gynecological Oncology Amsterdam, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - I Vergote
- Department of Gynaecologic Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | | | - C Sessa
- Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
| | - A Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome; Department of Woman, Child and Public Health, Catholic University of Sacred Heart, Rome, Italy.
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Loibl S, Azim HA, Bachelot T, Berveiller P, Bosch A, Cardonick E, Denkert C, Halaska MJ, Hoeltzenbein M, Johansson ALV, Maggen C, Markert UR, Peccatori F, Poortmans P, Saloustros E, Saura C, Schmid P, Stamatakis E, van den Heuvel-Eibrink M, van Gerwen M, Vandecaveye V, Pentheroudakis G, Curigliano G, Amant F. ESMO Expert Consensus Statements on the management of breast cancer during pregnancy (PrBC). Ann Oncol 2023; 34:849-866. [PMID: 37572987 DOI: 10.1016/j.annonc.2023.08.001] [Citation(s) in RCA: 2] [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] [Received: 05/03/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/14/2023] Open
Abstract
The management of breast cancer during pregnancy (PrBC) is a relatively rare indication and an area where no or little evidence is available since randomized controlled trials cannot be conducted. In general, advances related to breast cancer (BC) treatment outside pregnancy cannot always be translated to PrBC, because both the interests of the mother and of the unborn should be considered. Evidence remains limited and/or conflicting in some specific areas where the optimal approach remains controversial. In 2022, the European Society for Medical Oncology (ESMO) held a virtual consensus-building process on this topic to gain insights from a multidisciplinary group of experts and develop statements on controversial topics that cannot be adequately addressed in the current evidence-based ESMO Clinical Practice Guideline. The aim of this consensus-building process was to discuss controversial issues relating to the management of patients with PrBC. The virtual meeting included a multidisciplinary panel of 24 leading experts from 13 countries and was chaired by S. Loibl and F. Amant. All experts were allocated to one of four different working groups. Each working group covered a specific subject area with two chairs appointed: Planning, preparation and execution of the consensus process was conducted according to the ESMO standard operating procedures.
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Affiliation(s)
- S Loibl
- GBG c/o GBG Forschungs GmbH, Neu-Isenburg; Centre for Haematology and Oncology Bethanien, Frankfurt am Main, Frankfurt; Goethe University Frankfurt, Frankfurt am Main, Frankfurt, Germany.
| | - H A Azim
- Breast Cancer Center, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - T Bachelot
- Department of medical oncology, Centre Léon Bérard, Lyon, France
| | - P Berveiller
- Department of Gynecology and Obstetrics, Poissy-Saint Germain Hospital, Poissy; UMR 1198 - BREED, INRAE, Paris Saclay University, RHuMA, Montigny-Le-Bretonneux, France
| | - A Bosch
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund; Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - E Cardonick
- Cooper Medical School at Rowan University, Camden, USA
| | - C Denkert
- Philipps-University Marburg and Marburg University Hospital (UKGM), Marburg, Germany
| | - M J Halaska
- Department of Obstetrics and Gynaecology, Third Faculty of Medicine, Charles University in Prague and Universital Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - M Hoeltzenbein
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Embryotox Center of Clinical Teratology and Drug Safety in Pregnancy, Berlin, Germany
| | - A L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Cancer Registry of Norway, Oslo, Norway
| | - C Maggen
- Department of Obstetrics and Prenatal Medicine, University Hospital Brussels, Brussels, Belgium
| | - U R Markert
- Placenta Lab, Department of Obstetrics, Jena University Hospital, Jena, Germany
| | - F Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - P Poortmans
- Iridium Netwerk, Antwerp; University of Antwerp, Antwerp, Belgium
| | - E Saloustros
- Department of Oncology, University General Hospital of Larissa, Larissa, Greece
| | - C Saura
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - P Schmid
- Cancer Institute, Queen Mary University London, London, UK
| | - E Stamatakis
- Department of Anesthesiology, 'Alexandra' General Hospital, Athens, Greece
| | | | - M van Gerwen
- Gynecologic Oncology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam; Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, University of Amsterdam; Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - V Vandecaveye
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - G Pentheroudakis
- European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - G Curigliano
- Division of Early Drug Development, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - F Amant
- Gynecologic Oncology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam; Division Gynaecologic Oncology, UZ Leuven, Belgium
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De Wispelaere W, Annibali D, Tuyaerts S, Messiaen J, Antoranz A, Baiden-Amissah R, Van Brussel T, Schepers R, Philips G, Boeckx B, Baietti M, Ho Wang Yin K, Bayon E, Van Rompuy AS, Leucci E, Tabruyn S, Bosisio F, Lambrechts D, Amant F. 17P Exploiting the immune-modulatory effects of PI3K/mTOR inhibitors to enhance response to immune-checkpoint blockade in uterine leiomyosarcoma. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101038] [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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Vrede SW, Hulsman AMC, Reijnen C, Van de Vijver K, Colas E, Mancebo G, Moiola CP, Gil-Moreno A, Huvila J, Koskas M, Weinberger V, Minar L, Jandakova E, Santacana M, Matias-Guiu X, Amant F, Snijders MPLM, Küsters-Vandevelde HVN, Bulten J, Pijnenborg JMA. The amount of preoperative endometrial tissue surface in relation to final endometrial cancer classification. Gynecol Oncol 2022; 167:196-204. [PMID: 36096975 DOI: 10.1016/j.ygyno.2022.08.016] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate whether the amount of preoperative endometrial tissue surface is related to the degree of concordance with final low- and high-grade endometrial cancer (EC). In addition, to determine whether discordance is influenced by sampling method and impacts outcome. METHODS A retrospective cohort study within the European Network for Individualized Treatment of Endometrial Cancer (ENITEC). Surface of preoperative endometrial tissue samples was digitally calculated using ImageJ. Tumor samples were classified into low-grade (grade 1-2 endometrioid EC (EEC)) and high-grade (grade 3 EEC + non-endometroid EC). RESULTS The study cohort included 573 tumor samples. Overall concordance between pre- and postoperative diagnosis was 60.0%, and 88.8% when classified into low- and high-grade EC. Upgrading (preoperative low-grade, postoperative high-grade EC) was found in 7.8% and downgrading (preoperative high-grade, postoperative low-grade EC) in 26.7%. The median endometrial tissue surface was significantly lower in concordant diagnoses when compared to discordant diagnoses, respectively 18.7 mm2 and 23.5 mm2 (P = 0.022). Sampling method did not influence the concordance in tumor classification. Patients with preoperative high-grade and postoperative low-grade showed significant lower DSS compared to patients with concordant low-grade EC (P = 0.039). CONCLUSION The amount of preoperative endometrial tissue surface was inversely related to the degree of concordance with final tumor low- and high-grade. Obtaining higher amount of preoperative endometrial tissue surface does not increase the concordance between pre- and postoperative low- and high-grade diagnosis in EC. Awareness of clinically relevant down- and upgrading is crucial to reduce subsequent over- or undertreatment with impact on outcome.
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Affiliation(s)
- S W Vrede
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, the Netherlands; Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands.
| | - A M C Hulsman
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, the Netherlands
| | - C Reijnen
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, the Netherlands
| | - K Van de Vijver
- Department of Pathology, Ghent University Hospital, Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - E Colas
- Biomedical Research Group in Gynaecology, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, CIBERONC, Barcelona, Spain
| | - G Mancebo
- Department of Obstetrics and Gynaecology, Hosepital del Mar, PSMAR, Barcelona, Spain
| | - C P Moiola
- Biomedical Research Group in Gynaecology, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, CIBERONC, Barcelona, Spain
| | - A Gil-Moreno
- Gynaecological Department, Vall d'Hebron University Hospital, CIBERONC, Barcelona, Spain; Pathology Department, Vall d'Hebron University Hospital, CIBERONC, Barcelona, Spain
| | - J Huvila
- Department of Pathology, University of Turku, Turku, Finland
| | - M Koskas
- Obstetrics and Gynaecology Department, Bichat-Claude Bernard Hospital, Paris, France
| | - V Weinberger
- Department of Gynaecology and Obstetrics, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - L Minar
- Department of Gynaecology and Obstetrics, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - E Jandakova
- Institute of Pathology, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - M Santacana
- Department of Pathology and Molecular Genetics and Research Laboratory, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, CIBERONC, Lleida, Spain
| | - X Matias-Guiu
- Department of Pathology and Molecular Genetics and Research Laboratory, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, CIBERONC, Lleida, Spain
| | - F Amant
- Department of Oncology, KU Leuven, Leuven, Belgium; Department of Gynaecological Oncology Amsterdam, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M P L M Snijders
- Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | | | - J Bulten
- Department of Pathology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - J M A Pijnenborg
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, the Netherlands
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Lof P, van de Vrie R, Korse C, van Gent M, Mom C, Rosier - van Dunné F, van Baal W, Verhoeve H, Hermsen B, Verbruggen M, Hemelaar M, van de Swaluw A, Knipscheer H, Huirne J, Westenberg S, van der Noort V, Amant F, van den Broek D, Lok C. Can serum human epididymis protein 4 (HE4) support the decision to refer a patient with an ovarian mass to an oncology hospital? Gynecol Oncol 2022; 166:284-291. [DOI: 10.1016/j.ygyno.2022.05.025] [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] [Received: 01/28/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022]
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Salama M, Lambertini M, Christianson MS, Jayasinghe Y, Anazodo A, De Vos M, Amant F, Stern C, Appiah L, Woodard TL, Anderson RA, Westphal LM, Leach RE, Rodriguez-Wallberg KA, Patrizio P, Woodruff TK. Installing oncofertility programs for breast cancer in limited versus optimum resource settings: Empirical data from 39 surveyed centers in Repro-Can-OPEN Study Part I & II. J Assist Reprod Genet 2022; 39:505-516. [PMID: 35032286 PMCID: PMC8760079 DOI: 10.1007/s10815-022-02394-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/05/2022] [Indexed: 01/09/2023] Open
Abstract
PURPOSE As a further step to elucidate the actual diverse spectrum of oncofertility practices for breast cancer around the globe, we present and discuss the comparisons of oncofertility practices for breast cancer in limited versus optimum resource settings based on data collected in the Repro-Can-OPEN Study Part I & II. METHODS We surveyed 39 oncofertility centers including 14 in limited resource settings from Africa, Asia & Latin America (Repro-Can-OPEN Study Part I), and 25 in optimum resource settings from the United States, Europe, Australia and Japan (Repro-Can-OPEN Study Part II). Survey questions covered the availability of fertility preservation and restoration options offered to young female patients with breast cancer as well as the degree of utilization. RESULTS In the Repro-Can-OPEN Study Part I & II, responses for breast cancer and calculated oncofertility scores showed the following characteristics: (1) higher oncofertility scores in optimum resource settings than in limited resource settings especially for established options, (2) frequent utilization of egg freezing, embryo freezing, ovarian tissue freezing, GnRH analogs, and fractionation of chemo- and radiotherapy, (3) promising utilization of oocyte in vitro maturation (IVM), (4) rare utilization of neoadjuvant cytoprotective pharmacotherapy, artificial ovary, and stem cells reproductive technology as they are still in preclinical or early clinical research settings, (5) recognition that technical and ethical concerns should be considered when offering advanced and innovative oncofertility options. CONCLUSIONS We presented a plausible oncofertility best practice model to guide oncofertility teams in optimizing care for breast cancer patients in various resource settings.
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Affiliation(s)
- Mahmoud Salama
- Oncofertility Consortium, Michigan State University, 965 Wilson Road, Room A626B, East Lansing, MI 48824-1316 USA
| | - M. Lambertini
- Department of Medical Oncology, UOC Clinica Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - MS Christianson
- Division of Reproductive Endocrinology and Infertility, Johns Hopkins Fertility Center, Johns Hopkins University School of Medicine, 10751 Falls Road, Suite 280, Lutherville, MD 21093 USA
| | - Y. Jayasinghe
- Royal Children’s Hospital, Flemington Rd, Parkville, Melbourne, Vic 3054 Australia
- Department of Obstetrics & Gynecology, Royal Womens Hospital Melbourne, Parkville, Australia
| | - A. Anazodo
- Fertility Research Centre, Royal Hospital for Women, Barker Street, Sydney, Australia
| | - M. De Vos
- Centre for Reproductive Medicine of UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - F. Amant
- Department of Oncology, KU Leuven, Leuven, Belgium
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - C. Stern
- Fertility Preservation Service, Reproductive Services Unit, Royal Women’s Hospital, Parkville, 3051 Australia
- Fertility Preservation Service, Melbourne IVF, East Melbourne, 3002 Australia
| | - L. Appiah
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO USA
| | - T. L. Woodard
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Oncofertility Program, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - R. A. Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - L. M. Westphal
- Stanford University Hospital, 300 Pasteur Drive, Stanford, CA USA
| | - R. E. Leach
- Oncofertility Consortium, Michigan State University, 965 Wilson Road, Room A626B, East Lansing, MI 48824-1316 USA
| | - K. A. Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska University Hospital, 14186 Stockholm, Sweden
- Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska University Hospital, 14186 Stockholm, Sweden
| | - P. Patrizio
- Yale Fertility Center and Yale Fertility Preservation Program, 200 West Campus Dr, Orange, CT 06477 USA
| | - Teresa K. Woodruff
- Oncofertility Consortium, Michigan State University, 965 Wilson Road, Room A626B, East Lansing, MI 48824-1316 USA
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Lof P, Van de Vrie R, Korse T, Van Gent M, Mom S, Rosier-van Dunné F, Van Baal M, Verhoeve H, Hermsen B, Verbruggen M, Hemelaar M, Van de Swaluw J, Knipscheer H, Huirne J, Westenberg S, Van der Noort V, Amant F, Van den Broek D, Lok C. 1069 Can serum human epididymis protein 4 (HE4) support the decision to refer a patient with a pelvic mass to an oncology center? Diagnostics (Basel) 2021. [DOI: 10.1136/ijgc-2021-esgo.108] [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: 11/04/2022] Open
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8
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Vrede SW, van Weelden WJ, Visser NCM, Bulten J, van der Putten LJM, van de Vijver K, Santacana M, Colas E, Gil-Moreno A, Moiola CP, Mancebo G, Krakstad C, Trovik J, Haldorsen IS, Huvila J, Koskas M, Weinberger V, Bednarikova M, Hausnerova J, van der Wurff AA, Matias-Guiu X, Amant F, Snijders MPLM, Küsters-Vandevelde HVN, Reijnen C, Pijnenborg JMA. Immunohistochemical biomarkers are prognostic relevant in addition to the ESMO-ESGO-ESTRO risk classification in endometrial cancer. Gynecol Oncol 2021; 161:787-794. [PMID: 33858677 DOI: 10.1016/j.ygyno.2021.03.031] [Citation(s) in RCA: 6] [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] [Received: 02/20/2021] [Accepted: 03/30/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Pre-operative immunohistochemical (IHC) biomarkers are not incorporated in endometrial cancer (EC) risk classification. We aim to investigate the added prognostic relevance of IHC biomarkers to the ESMO-ESGO-ESTRO risk classification and lymph node (LN) status in EC. METHODS Retrospective multicenter study within the European Network for Individualized Treatment of Endometrial Cancer (ENITEC), analyzing pre-operative IHC expression of p53, L1 cell-adhesion molecule (L1CAM), estrogen receptor (ER) and progesterone receptor (PR), and relate to ESMO-ESGO-ESTRO risk groups, LN status and outcome. RESULTS A total of 763 EC patients were included with a median follow-up of 5.5-years. Abnormal IHC expression was present for p53 in 112 (14.7%), L1CAM in 79 (10.4%), ER- in 76 (10.0%), and PR- in 138 (18.1%) patients. Abnormal expression of p53/L1CAM/ER/PR was significantly related with higher risk classification groups, and combined associated with the worst outcome within the 'high and advanced/metastatic' risk group. In multivariate analysis p53-abn, ER/PR- and ESMO-ESGO-ESTRO 'high and advanced/metastatic' were independently associated with reduced disease-specific survival (DSS). Patients with abnormal IHC expression and lymph node metastasis (LNM) had the worst outcome. Patients with LNM and normal IHC expression had comparable outcome with patients without LNM and abnormal IHC expression. CONCLUSION The use of pre-operative IHC biomarkers has important prognostic relevance in addition to the ESMO-ESGO-ESTRO risk classification and in addition to LN status. For daily clinical practice, p53/L1CAM/ER/PR expression could serve as indicator for surgical staging and refine selective adjuvant treatment by incorporation into the ESMO-ESGO-ESTRO risk classification.
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Affiliation(s)
- S W Vrede
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, the Netherlands; Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands.
| | - W J van Weelden
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, the Netherlands
| | - N C M Visser
- Department of Pathology, Stichting PAMM, Eindhoven, the Netherlands; Department of Pathology, Radboud university medical center, Nijmegen, the Netherlands
| | - J Bulten
- Department of Pathology, Radboud university medical center, Nijmegen, the Netherlands
| | - L J M van der Putten
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, the Netherlands
| | - K van de Vijver
- Department of Pathology, Ghent University Hospital, Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - M Santacana
- Department of Pathology and Molecular Genetics and Research Laboratory, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, CIBERONC, Lleida, Spain
| | - E Colas
- Biomedical Research Group in Gynaecology, Vall Hebron Institute of Research, Universitat Autònoma de Barcelona, CIBERONC, Barcelona, Spain
| | - A Gil-Moreno
- Gynecological Department, Vall Hebron University Hospital, CIBERONC, Barcelona, Spain; Pathology Department, Vall Hebron University Hospital, CIBERONC, Barcelona, Spain
| | - C P Moiola
- Biomedical Research Group in Gynaecology, Vall Hebron Institute of Research, Universitat Autònoma de Barcelona, CIBERONC, Barcelona, Spain
| | - G Mancebo
- Department of Obstetrics and Gynaecology, Hospital del Mar, PSMAR, Barcelona, Spain
| | - C Krakstad
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway; Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - J Trovik
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | - I S Haldorsen
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway; Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - J Huvila
- Department of Pathology, University of Turku, Turku, Finland
| | - M Koskas
- Department of Obstetrics and Gynaecology Department, Bichat-Claude Bernard Hospital, Paris, France
| | - V Weinberger
- Department of Obstetrics and Gynaecology, University Hospital in Brno and Masaryk University, Brno, Czech Republic
| | - M Bednarikova
- Department of Internal Medicine, Hematology and Oncology, University Hospital in Brno and Masaryk University, Brno, Czech Republic
| | - J Hausnerova
- Department of Pathology, University Hospital in Brno and Masaryk University, Brno, Czech Republic
| | - A A van der Wurff
- Department of Pathology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - X Matias-Guiu
- Department of Pathology and Molecular Genetics and Research Laboratory, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, CIBERONC, Lleida, Spain
| | - F Amant
- Department of Oncology, KU Leuven, Leuven, Belgium; Department of Gynaecologic Oncology, Netherlands Cancer Institute and Amsterdam Medical Centers, Amsterdam, the Netherlands
| | | | - M P L M Snijders
- Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | | | - C Reijnen
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, the Netherlands
| | - J M A Pijnenborg
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, the Netherlands
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9
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Friedlander M, Benson C, O'Connell RL, Reed N, Clamp A, Lord R, Millan D, Nottley S, Amant F, Steer C, Anand A, Mileshkin L, Beale P, Banerjee S, Bradshaw N, Kelly C, Carty K, Divers L, Alexander L, Edmondson R. Phase 2 study of anastrozole in patients with estrogen receptor/progesterone receptor positive recurrent low-grade endometrial stromal sarcomas: The PARAGON trial (ANZGOG 0903). Gynecol Oncol 2021; 161:160-165. [PMID: 33608144 DOI: 10.1016/j.ygyno.2021.02.016] [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] [Received: 12/18/2020] [Accepted: 02/08/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Aromatase inhibitors are standard of care for low-grade endometrial stromal sarcomas (LGESS), based on very high response rates reported in retrospective studies. We evaluated the activity of anastrozole in recurrent/metastatic LGESS patients enrolled in PARAGON, a basket trial of anastrozole in estrogen receptor (ER±)/progesterone receptor (PR+) gynecological cancers. METHOD An investigator-initiated, single-arm, prospective open-label trial of anastrozole 1 mg/day in patients with ER ± PR + ve LGESS with measurable disease, treated until progressive disease or unacceptable toxicity. Primary endpoint was clinical benefit (complete/partial response + stable disease) rate (CBR) at 3 months. Secondary endpoints include progression-free survival (PFS), quality of life and toxicity. RESULTS 15 eligible patients were enrolled. CBR at 3 months was 73% (95% CI: 48-89.1%); unchanged at 6 months. Best response was 26.7%, including complete response in one (6.7%; 95% CI 1.2-29.8%), partial response in three (20%, 95% CI 7.1-45.2%) and stable disease in seven (46.7%). Four patients ceased treatment by 3 months due to progression. Median PFS was not reached (25th percentile: 2.9 months (95% CI: 1.2-NR)). PFS was 73.3%, 73.3% and 66% at 6, 12, and 18 months, respectively. Six patients remained on treatment for an average of 44.2 months (range 34.5-63.6) up until data cut. Toxicity was as expected, with 3 patients stopping due to adverse effects. CONCLUSION The 26.7% objective response rate with anastrozole is lower than reported in retrospective series, but the CBR was high and durable. The results underscore the importance of prospective trials in rare cancers.
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Affiliation(s)
- M Friedlander
- Royal Hospital for Women/Prince of Wales Hospital and Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
| | - C Benson
- The Royal Marsden NHS Foundation Trust, London, UK
| | - R L O'Connell
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - N Reed
- Beatson Oncology Centre, Gartnavel General Hospital, Glasgow, UK
| | - A Clamp
- The Christie NHS Foundation Trust and University of Manchester, Manchester, UK
| | - R Lord
- The Clatterbridge Cancer Centre, Liverpool and Wirral, UK
| | - D Millan
- Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - S Nottley
- Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - F Amant
- Division of Gynecologic Oncology, University Hospitals Gasthuisberg, Leuven, Belgium
| | - C Steer
- Border Medical Oncology, Albury-Wodonga Regional Cancer Centre, Albury, NSW, Australia
| | - A Anand
- Nottingham City Hospital, Nottingham, UK
| | - L Mileshkin
- Peter MacCallum Cancer Centre and The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - P Beale
- Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - S Banerjee
- The Royal Marsden NHS Foundation Trust, London, UK
| | - N Bradshaw
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - C Kelly
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, UK
| | - K Carty
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, UK
| | - L Divers
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, UK
| | - L Alexander
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, UK
| | - R Edmondson
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary''s Hospital, Manchester, UK; Department of Obstetrics and Gynaecology, Manchester Academic Health Science Centre, St Mary''s Hospital, Central Manchester NHS Foundation Trust; Manchester Academic Health Science Centre, Level 5, Research, Oxford Road, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary''s Hospital, Manchester, UK; Department of Obstetrics and Gynaecology, Manchester Academic Health Science Centre, St Mary''s Hospital, Central Manchester NHS Foundation Trust; Manchester Academic Health Science Centre, Level 5, Research, Oxford Road, Manchester, UK
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10
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Lambertini M, Peccatori FA, Demeestere I, Amant F, Wyns C, Stukenborg JB, Paluch-Shimon S, Halaska MJ, Uzan C, Meissner J, von Wolff M, Anderson RA, Jordan K. Fertility preservation and post-treatment pregnancies in post-pubertal cancer patients: ESMO Clinical Practice Guidelines †. Ann Oncol 2020; 31:1664-1678. [PMID: 32976936 DOI: 10.1016/j.annonc.2020.09.006] [Citation(s) in RCA: 211] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 01/18/2023] Open
Affiliation(s)
- M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy; Department of Medical Oncology, UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - F A Peccatori
- Fertility and Procreation Unit, Division of Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - I Demeestere
- Research Laboratory on Human Reproduction, Fertility Clinic, CUB-Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - F Amant
- Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek and Amsterdam University Medical Centers, Amsterdam, The Netherlands; Department of Oncology, KU Leuven, Leuven, Belgium
| | - C Wyns
- Department of Gynecology and Andrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - J-B Stukenborg
- NORDFERTIL Research Lab Stockholm, Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Solna, Sweden
| | - S Paluch-Shimon
- Division of Oncology, Sharrett Institute of Oncology, Hadassah University Hospital, Jerusalem, Israel
| | - M J Halaska
- Department of OB/GYN, 3(rd) Medical Faculty, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - C Uzan
- Department of Breast and Gynecologic Surgery, APHP, Hospital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - J Meissner
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Germany
| | - M von Wolff
- University Women's Hospital, Division Gynecological Endocrinology and Reproductive Medicine, Bern, Switzerland
| | - R A Anderson
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - K Jordan
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Germany
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11
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Blommaert J, Radwan A, Sleurs C, Maggen C, van Gerwen M, Wolters V, Christiaens D, Peeters R, Dupont P, Sunaert S, Van Calsteren K, Deprez S, Amant F. The impact of cancer and chemotherapy during pregnancy on child neurodevelopment: A multimodal neuroimaging analysis. EClinicalMedicine 2020; 28:100598. [PMID: 33294813 PMCID: PMC7700909 DOI: 10.1016/j.eclinm.2020.100598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study applies multimodal MRI to investigate neurodevelopment in nine-year-old children born to cancer-complicated pregnancies. METHODS In this cohort study, children born after cancer-complicated pregnancies were recruited alongside 1:1 matched controls regarding age, sex and gestational age at birth (GA). Multimodal MRI was used to investigate whole-brain and subcortical volume, cortical structure (using surface-based morphometry), white matter microstructure (using fixel-based analysis) and functional connectivity (using resting-state blood-oxygen-level-dependant signal correlations). Graph theory probed whole-brain structural and functional organization. For each imaging outcome we conducted two group comparisons: 1) children born after cancer-complicated pregnancies versus matched controls, and 2) the subgroup of children with prenatal chemotherapy exposure versus matched controls. In both models, we used the covariate of GA and the group-by-GA interaction, using false-discovery-rate (FDR) or family-wise-error (FWE) correction for multiple comparisons. Exploratory post-hoc analyses investigated the relation between brain structure/function, neuropsychological outcome and maternal oncological/obstetrical history. FINDINGS Forty-two children born after cancer-complicated pregnancies were included in this study, with 30 prenatally exposed to chemotherapy. Brain organization and functional connectivity were not significantly different between groups. Both cancer and chemotherapy in pregnancy, as compared to matched controls, were associated with a lower travel depth, indicating less pronounced gyrification, in the left superior temporal gyrus (pFDR ≤ 006), with post-hoc analysis indicating platinum derivatives during pregnancy as a potential risk factor (p = .028). Both cancer and chemotherapy in pregnancy were related to a lower fibre cross-section (FCS) and lower fibre density and cross-section (FDC) in the posterior corpus callosum and its tapetal fibres, compared to controls. Higher FDC in the chemotherapy subgroup and higher FCS in the whole study group were observed in the anterior thalamic radiations. None of the psycho-behavioural parameters correlated significantly with any of the brain differences in the study group or chemotherapy subgroup. INTERPRETATION Prenatal exposure to maternal cancer and its treatment might affect local grey and white matter structure, but not functional connectivity or global organization. While platinum-based therapy was identified as a potential risk factor, this was not the case for chemotherapy in general. FUNDING This project has received funding from the European Union's Horizon 2020 research and innovation program (European Research council, grant no 647,047), the Foundation against cancer (Stichting tegen kanker, grant no. 2014-152) and the Research Foundation Flanders (FWO, grants no. 11B9919N, 12ZV420N).
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Affiliation(s)
- J. Blommaert
- Department of Oncology, KU Leuven, Leuven, Belgium
| | - A. Radwan
- Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | - C. Sleurs
- Department of Oncology, KU Leuven, Leuven, Belgium
| | - C. Maggen
- Department of Oncology, KU Leuven, Leuven, Belgium
| | - M. van Gerwen
- Department of Gynecology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, Netherlands
- Princess Máxima Center for pediatric oncology, Utrecht, Netherlands
| | - V. Wolters
- Department of Gynecology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - D. Christiaens
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
- Department of Electrical Engineering, ESAT/PSI, KU Leuven, Leuven, Belgium
| | - R. Peeters
- Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - P. Dupont
- Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - S. Sunaert
- Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - K. Van Calsteren
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, Unit Woman and child, KU Leuven, Leuven, Belgium
| | - S. Deprez
- Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | - F. Amant
- Department of Oncology, KU Leuven, Leuven, Belgium
- Center for Gynaecologic Oncology Amsterdam, Netherlands Cancer Institute and University Medical Centers, Amsterdam, Netherlands
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12
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De Jaeghere E, Laloo F, Lippens L, De Man K, Van Bockstal M, Van de Vijver K, Tummers P, Makar A, De Visschere P, De Wever O, Amant F, Denys H, Vandecasteele K. Splenic metabolic activity as biomarker in cervical cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz239.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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13
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Maggen C, Van Calsteren K, Cardonick E, Shmakov R, Gziri M, Garcia A, Fruscio R, Lok C, Halaska M, Boere I, Zola P, Ottevanger P, de Groot C, Scarfone G, Fumagalli M, Painter R, de Haan J, Amant F. Update of the registry of young women with cancer by the International Network of Cancer, Infertility and Pregnancy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz265.076] [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: 11/14/2022] Open
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14
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Amant F, Berveiller P, Boere IA, Cardonick E, Fruscio R, Fumagalli M, Halaska MJ, Hasenburg A, Johansson ALV, Lambertini M, Lok CAR, Maggen C, Morice P, Peccatori F, Poortmans P, Van Calsteren K, Vandenbroucke T, van Gerwen M, van den Heuvel-Eibrink M, Zagouri F, Zapardiel I. Gynecologic cancers in pregnancy: guidelines based on a third international consensus meeting. Ann Oncol 2019; 30:1601-1612. [PMID: 31435648 DOI: 10.1093/annonc/mdz228] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [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] [Indexed: 02/06/2023] Open
Abstract
We aimed to provide comprehensive protocols and promote effective management of pregnant women with gynecological cancers. New insights and more experience have been gained since the previous guidelines were published in 2014. Members of the International Network on Cancer, Infertility and Pregnancy (INCIP), in collaboration with other international experts, reviewed existing literature on their respective areas of expertise. Summaries were subsequently merged into a manuscript that served as a basis for discussion during the consensus meeting. Treatment of gynecological cancers during pregnancy is attainable if management is achieved by collaboration of a multidisciplinary team of health care providers. This allows further optimization of maternal treatment, while considering fetal development and providing psychological support and long-term follow-up of the infants. Nonionizing imaging procedures are preferred diagnostic procedures, but limited ionizing imaging methods can be allowed if indispensable for treatment plans. In contrast to other cancers, standard surgery for gynecological cancers often needs to be adapted according to cancer type and gestational age. Most standard regimens of chemotherapy can be administered after 14 weeks gestational age but are not recommended beyond 35 weeks. C-section is recommended for most cervical and vulvar cancers, whereas vaginal delivery is allowed in most ovarian cancers. Breast-feeding should be avoided with ongoing chemotherapeutic, endocrine or targeted treatment. More studies that focus on the long-term toxic effects of gynecologic cancer treatments are needed to provide a full understanding of their fetal impact. In particular, data on targeted therapies that are becoming standard of care in certain gynecological malignancies is still limited. Furthermore, more studies aimed at the definition of the exact prognosis of patients after antenatal cancer treatment are warranted. Participation in existing registries (www.cancerinpregnancy.org) and the creation of national tumor boards with multidisciplinary teams of care providers (supplementary Box S1, available at Annals of Oncology online) is encouraged.
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Affiliation(s)
- F Amant
- Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek and Amsterdam University Medical Centers, the Netherlands; Department of Oncology, KU Leuven, Leuven, Belgium.
| | - P Berveiller
- Department of Obstetrics and Gynecology, Centre Hospitalier de Poissy-Saint-Germain-en-Laye, Poissy, France
| | - I A Boere
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - E Cardonick
- Department of Obstetrics and Gynecology, Cooper University Health Care, Camden, USA
| | - R Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan Bicocca, San Gerardo Hospital, Monza, Italy
| | - M Fumagalli
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - M J Halaska
- Department of Obstetrics and Gynaecology, 3rd Medical Faculty, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - A Hasenburg
- Department of Obstetrics and Gynecology, Mainz University Medical Center, Mainz, Germany
| | - A L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - M Lambertini
- Department of Medical Oncology, IRCCS Policlinico San Martino Hospital, Genova, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - C A R Lok
- Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek and Amsterdam University Medical Centers, the Netherlands
| | - C Maggen
- Department of Oncology, KU Leuven, Leuven, Belgium
| | - P Morice
- Department of Gynecologic Surgery, Institute de Cancérologie Gustave Roussy, Villejuif, France
| | - F Peccatori
- Department of Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - P Poortmans
- Department of Radiation Oncology, Institut Curie and Paris Sciences & Lettres - PSL University, Paris, France
| | - K Van Calsteren
- Department of Development and Regeneration, University Hospitals Leuven, Leuven, Belgium
| | | | - M van Gerwen
- Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek and Amsterdam University Medical Centers, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - F Zagouri
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, University of Athens, Athens, Greece
| | - I Zapardiel
- Department of Gynecologic Oncology, La Paz University Hospital, Madrid, Spain
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15
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Amant F, Maggen C, Dierickx D, Lugtenburg E, Laenen A, Cardonick E, Shmakov R, Bellido Casado M, Garcia A, Gziri M, Halaska M, Ottevanger P, Van Calsteren K, L’Hauglin A, Polushkina E, Van Dam L, Vandenberghe P, Woei-A-Jin S. Obstetric and maternal outcome of 134 patients with Hodgkin lymphoma diagnosed during pregnancy: Results from the INCIP registry. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz251.004] [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: 11/14/2022] Open
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16
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Vandenbroucke T, Verheecke M, van Gerwen M, Van Calsteren K, Halaska M, Fumagalli M, Fruscio R, Veening M, Lagae L, Ottevanger P, Voigt JU, de Haan J, Gziri M, Gandhi A, Maggen C, Mertens L, Naulaers G, Claes L, Amant F. Child development at 6 years after maternal cancer diagnosis and treatment during pregnancy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz265.075] [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: 11/13/2022] Open
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17
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Kocián P, de Haan J, Cardonick EH, Uzan C, Lok CAR, Fruscio R, Halaska MJ, Amant F. Management and outcome of colorectal cancer during pregnancy: report of 41 cases. Acta Chir Belg 2019; 119:166-175. [PMID: 30010511 DOI: 10.1080/00015458.2018.1493821] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 12/16/2022]
Abstract
BACKGROUND Colorectal cancer in pregnancy is rare, with an incidence of 0.8 per 100,000 pregnancies. Advanced disease (stage III or IV) is diagnosed more frequently in pregnant patients. We aimed to review all cases of colorectal cancer in pregnancy from the International Network on Cancer, Infertility and Pregnancy database in order to learn more about this rare disease and improve its management. METHODS Data on the demographic features, symptoms, histopathology, diagnostic and therapeutic interventions and outcomes (obstetric, neonatal and maternal) were analysed. RESULTS Twenty-seven colon and 14 rectal cancer cases were identified. Advanced disease was present in 30 patients (73.2%). During pregnancy, 21 patients (51.2%) received surgery and 12 patients (29.3%) received chemotherapy. Thirty-three patients (80.5%) delivered live babies: 21 by caesarean section and 12 vaginally. Prematurity rate was high (78.8%). Eight babies were small for gestational age (27.6%). Three patients (10.7%) developed recurrence of disease. Overall 2-year survival was 64.4%. CONCLUSION Despite a more frequent presentation with advanced disease, colorectal cancer has a similar prognosis in pregnancy when compared with the general population. Diagnostic interventions and treatment should not be delayed due to the pregnancy but a balance between maternal and foetal wellbeing must always be kept in mind.
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Affiliation(s)
- P. Kocián
- Department of Surgery, 2nd Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - J. de Haan
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, Netherlands
- Department of Oncology, KU Leuven, Leuven, Belgium
| | - E. H. Cardonick
- Department of Obstetrics and Gynaecology, Division Maternal Fetal Medicine, Cooper Medical School at Rowan University, Camden, United States of America
| | - C. Uzan
- Department of Gynaecological Surgery, Institute Gustave Roussy, Villejuif, France
- Department of Gynaecology and Breast Surgery, Pitié Salpêtrière Hospital, Institut Universitaire de Cancérologie, Sorbonne University, Paris, France
| | - C. A. R. Lok
- Center for Gynaecologic Oncology Amsterdam, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, Netherlands
| | - R. Fruscio
- Division of Obstetrics and Gynaecology, San Gerardo Hospital, University of Milan-Bicocca, Monza, Italy
| | - M. J. Halaska
- Department of Obstetrics and Gynaecology, 3rd Medical Faculty, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - F. Amant
- Department of Oncology, KU Leuven, Leuven, Belgium
- Center for Gynaecologic Oncology Amsterdam, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, Netherlands
- Division of Gynaecologic Oncology, University Hospitals Leuven, Leuven, Belgium
- Centre for Gynaecologic Oncology Amsterdam, Academic Medical Centre, Amsterdam, Netherlands
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18
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de Lange NM, Ezendam NPM, Kwon JS, Vandenput I, Mirchandani D, Amant F, van der Putten LJM, Pijnenborg JMA. Neoadjuvant chemotherapy followed by surgery for advanced-stage endometrial cancer. ACTA ACUST UNITED AC 2019; 26:e226-e232. [PMID: 31043831 DOI: 10.3747/co.26.4655] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 12/13/2022]
Abstract
Background Data showing the value of neoadjuvant chemotherapy (nact) followed by interval debulking surgery (ids) in the management of advanced-stage serous endometrial carcinoma (eca) are limited; the aim of the present study was to expand the knowledge about that treatment strategy in patients with advanced eca, including endometrioid eca. Methods Data were collected retrospectively from all patients with advanced-stage eca treated with nact between 2005 and 2014 at 3 oncology referral centres. Primary outcomes were the radiologic response to nact and achievement of optimal or complete ids. Secondary outcomes were recurrence rate and progression-free and overall survival. Results Of 102 eca cases included, a complete radiologic response was achieved in only 4 cases, with a partial response being achieved in 72% (64% of endometrioid cases, 80% of serous cases). Complete ids was achieved in 62% of the endometrioid cases and in 56% of the serous eca cases, with optimal ids achieved in 31% and 28% of those cases respectively. Survival rates were calculated for all patients with complete and optimal ids; recurrence was observed in 56% and 67% of the cases respectively, and progression-free survival was 18 months and 13 months respectively. Median survival duration was 24 months for endometrioid eca and 28 months for serous eca. Conclusions For patients with advanced eca who are not suitable for primary debulking, nact followed by ids can be considered regardless of histologic subtype. The treatment options for this group of patients are limited and have to be explored.
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Affiliation(s)
- N M de Lange
- Formerly: Department of Obstetrics and Gynaecology, Catharina Hospital Eindhoven, Eindhoven, Netherlands; Currently: Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, Netherlands
| | - N P M Ezendam
- Tilburg University and Comprehensive Cancer Centre, Tilburg, Netherlands
| | - J S Kwon
- Department of Obstetrics and Gynaecology, BC Cancer, University of British Columbia, Vancouver, BC
| | - I Vandenput
- Department of Obstetrics and Gynaecology, AZ Turnhout, Turnhout, Belgium
| | - D Mirchandani
- Department of Oncology, BC Cancer-Sindi Ahluwalia Hawkins Centre for the Southern Interior, Kelowna, BC
| | - F Amant
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven, Belgium.,Centre for Gynaecologic Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - L J M van der Putten
- Formerly: Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Netherlands; Currently: Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, Hertogenbosch, Netherlands
| | - J M A Pijnenborg
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Netherlands.,Radboud Institute for Health Sciences, Nijmegen, Netherlands
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19
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Lenaerts L, Vandenberghe P, Brison N, Che H, Neofytou M, Verheecke M, Leemans L, Maggen C, Dewaele B, Dehaspe L, Vanderschueren S, Dierickx D, Vandecaveye V, Amant F, Vermeesch J. Genomewide copy number alteration screening of circulating plasma DNA: potential for the detection of incipient tumors. Ann Oncol 2019; 30:85-95. [DOI: 10.1093/annonc/mdy476] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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20
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Lenaerts L, Brison N, Neofytou M, Che H, Dehaspe L, Verheecke M, Maggen C, Dewaele B, Vanderschueren S, Vandecaveye V, Vandenberghe P, Vermeesch J, Amant F. Unbiased genomewide screening of circulating plasma DNA for cancer detection. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy294] [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: 11/14/2022] Open
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21
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Fonnes T, Trovik J, Edqvist PH, Fasmer KE, Marcickiewicz J, Tingulstad S, Staff AC, Bjørge L, Amant F, Haldorsen IS, Werner H, Akslen LA, Tangen IL, Krakstad C. Asparaginase-like protein 1 expression in curettage independently predicts lymph node metastasis in endometrial carcinoma: a multicentre study. BJOG 2018; 125:1695-1703. [PMID: 29989298 DOI: 10.1111/1471-0528.15403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Correct preoperative identification of high-risk patients is important to optimise surgical treatment and improve survival. We wanted to explore if asparaginase-like protein 1 (ASRGL1) expression in curettage could predict lymph node metastases and poor outcome, potentially improving preoperative risk stratification. DESIGN Multicentre study. SETTING Ten hospitals in Norway, Sweden and Belgium. POPULATION Women diagnosed with endometrial carcinoma. METHODS ASRGL1 expression in curettage specimens from 1144 women was determined by immunohistochemistry. MAIN OUTCOME MEASURES ASRGL1 status related to disease-specific survival, lymph node status, preoperative imaging parameters and clinicopathological data. RESULTS ASRGL1 expression had independent prognostic value in multivariate survival analyses, both in the whole patient population (hazard ratio (HR) 1.63, 95% CI 1.11-2.37, P = 0.012) and in the low-risk curettage histology subgroup (HR 2.54, 95% CI 1.44-4.47, P = 0.001). Lymph node metastases were more frequent in women with low expression of ASRGL1 compared with women with high ASRGL1 levels (23% versus 10%, P < 0.001), and low ASRGL1 level was found to independently predict lymph node metastases (odds ratio 2.07, 95% CI 1.27-3.38, P = 0.003). CONCLUSIONS Low expression of ASRGL1 in curettage independently predicts lymph node metastases and poor disease-specific survival. TWEETABLE ABSTRACT Low ASRGL1 expression in curettage predicts lymph node metastasis and poor survival in endometrial carcinoma.
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Affiliation(s)
- T Fonnes
- Department of Clinical Science, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | - J Trovik
- Department of Clinical Science, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | - P-Hd Edqvist
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.,Science for Life Laboratory, Uppsala, Sweden
| | - K E Fasmer
- Department of Radiology, Centre for Nuclear Medicine/PET, Haukeland University Hospital, Bergen, Norway.,Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - J Marcickiewicz
- Department of Gynaecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynaecology, Halland's Hospital Varberg, Varberg, Sweden
| | - S Tingulstad
- Department of Gynaecology, St Olav's Hospital, Trondheim, Norway
| | - A C Staff
- Department of Gynaecology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - L Bjørge
- Department of Clinical Science, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | - F Amant
- Department of Gynaecologic Oncology, UZGasthuisberg, KU Leuven, Leuven, Belgium.,Centre for Gynaecologic Oncology, Netherlands Cancer Institute and Academic Medical Centre, Amsterdam, the Netherlands
| | - I S Haldorsen
- Department of Radiology, Haukeland University Hospital, Bergen, Norway.,Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hmj Werner
- Department of Clinical Science, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | - L A Akslen
- Section for Pathology, Department of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - I L Tangen
- Department of Clinical Science, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | - C Krakstad
- Department of Clinical Science, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
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22
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Verheecke M, Cortès Calabuig A, Finalet Ferreiro J, Brys V, Van Bree R, Verbist G, Everaert T, Leemans L, Gziri MM, Boere I, Halaska MJ, Van Houdt J, Amant F, Van Calsteren K. Corrigendum to 'Genetic and microscopic assessment of the human chemotherapy-exposed placenta reveals possible pathways contributive to fetal growth restriction'[YPLAC 64C (2018) 61-70]. Placenta 2018; 69:117. [PMID: 30054016 DOI: 10.1016/j.placenta.2018.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M Verheecke
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | | | | | - V Brys
- Genomics Core, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - R Van Bree
- Department of Reproduction and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - G Verbist
- Genomics Core, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - T Everaert
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - L Leemans
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - M M Gziri
- Department of Obstetrics and Gynecology, Cliniques Universitaires St. Luc, Hippokrateslaan 10, 1200 Brussels, Belgium
| | - I Boere
- Department of Medical Oncology, Erasmus MC Cancer Institute, 's-Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
| | - M J Halaska
- Department of Obstetrics and Gynaecology, 3rd Medical Faculty, Charles University, Faculty Hospital Kralovske Vinohrady, Srobarova 1150/50, 100 34, Prague 10, Czech Republic
| | - J Van Houdt
- Genomics Core, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - F Amant
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Gynaecologic Oncology, Center for Gynaecologic Oncology, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
| | - K Van Calsteren
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Reproduction and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
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23
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Verheecke M, Cortès Calabuig A, Finalet Ferreiro J, Brys V, Van Bree R, Verbist G, Everaert T, Leemans L, Gziri MM, Boere I, Halaska MJ, Vanhoudt J, Amant F, Van Calsteren K. Genetic and microscopic assessment of the human chemotherapy-exposed placenta reveals possible pathways contributive to fetal growth restriction. Placenta 2018; 64:61-70. [PMID: 29626982 DOI: 10.1016/j.placenta.2018.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 03/06/2018] [Accepted: 03/07/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Fetal growth restriction (FGR) carries an increased risk of perinatal mortality and morbidity. A major cause of FGR is placental insufficiency. After in utero chemotherapy-exposure, an increased incidence of FGR has been reported. In a prospective cohort study we aimed to explore which pathways may contribute to chemotherapy-associated FGR. METHODS Placental biopsies were collected from 25 cancer patients treated with chemotherapy during pregnancy, and from 66 control patients. Differentially expressed pathways between chemotherapy-exposed patients and controls were examined by whole transcriptome shotgun sequencing (WTSS) and Ingenuity Pathway Analysis (IPA). Immunohistochemical studies for 8-OHdG and eNOS (oxidative DNA damage), proliferation (PCNA) and apoptosis (Cleaved Caspase 3) were performed. The expression level of eNOS, PCNA and IGFBP6 was verified by real-time quantitative Reverse Transcription Polymerase Chain Reaction (RT-qPCR). RESULTS Most differential expressed genes between chemotherapy-exposed patients and controls were related to growth, developmental processes, and radical scavenging networks. The duration of chemotherapy exposure had an additional impact on the expression of genes related to the superoxide radicals degeneration network. Immunohistochemical analyses showed a significantly increased expression of 8-OHdG (P = 0.003) and a decreased expression of eNOS (P=0.015) in the syncytiotrophoblast of the placenta of cancer patients. A decreased expression of PCNA was detected by immunohistochemistry as RT-qPCR (NS). CONCLUSION Chemotherapy exposure during pregnancy results in an increase of oxidative DNA damage and might impact the placental cellular growth and development, resulting in an increased incidence of FGR in this specific population. Further large prospective cohort studies and longitudinal statistical analyses are needed.
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Affiliation(s)
- M Verheecke
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | | | | | - V Brys
- Genomics Core, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - R Van Bree
- Department of Reproduction and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - G Verbist
- Genomics Core, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - T Everaert
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - L Leemans
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - M M Gziri
- Department of Obstetrics and Gynecology, Cliniques Universitaires St. Luc, Hippokrateslaan 10, 1200 Brussels, Belgium
| | - I Boere
- Department of Medical Oncology, Erasmus MC Cancer Institute, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - M J Halaska
- Department of Obstetrics and Gynaecology, 3rd Medical Faculty, Charles University, Prague 5, Faculty Hospital Kralovske Vinohrady, Srobarova 1150/50, 100 34, Prague 10, Czech Republic
| | - J Vanhoudt
- Genomics Core, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - F Amant
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Gynaecologic Oncology, Center for Gynaecologic Oncology, Amsterdam, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - K Van Calsteren
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Reproduction and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
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24
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Ray-Coquard I, Trama A, Seckl MJ, Fotopoulou C, Pautier P, Pignata S, Kristensen G, Mangili G, Falconer H, Massuger L, Sehouli J, Pujade-Lauraine E, Lorusso D, Amant F, Rokkones E, Vergote I, Ledermann JA. Rare ovarian tumours: Epidemiology, treatment challenges in and outside a network setting. Eur J Surg Oncol 2017; 45:67-74. [PMID: 29108961 DOI: 10.1016/j.ejso.2017.09.025] [Citation(s) in RCA: 14] [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] [Received: 06/27/2017] [Revised: 09/26/2017] [Accepted: 09/30/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE OF THE REVIEW More than 50% of all gynaecological cancers can be classified as rare tumours (defined as an annual incidence of <6 per 100,000) and such tumours represent an important challenge for clinicians. RECENT FINDINGS Rare cancers account for more than one fifth of all new cancer diagnoses, more than any of the single common cancers alone. Reviewing the RARECAREnet database, some of the tumours occur infrequently, whilst others because of their natural history have a high prevalence, and therefore appear to be more common, although their incidence is also rare. Harmonization of medical practice, guidelines and novel trials are needed to identify rare tumours and facilitate the development of new treatments. Ovarian tumours are the focus of this review, but we comment on other rare gynaecological tumours, as the diagnosis and treatment challenges faced are similar. FUTURE This requires European collaboration, international partnerships, harmonization of treatment and collaboration to overcome the regulatory barriers to conduct international trials. Whilst randomized trials can be done in many tumour types, there are some for which conducting even single arm studies may be challenging. For these tumours alternative study designs, robust collection of data through national registries and audits could lead to improvements in the treatment of rare tumours. In addition, concentring the care of patients with rare tumours into a limited number of centres will help to build expertise, facilitate trials and improve outcomes.
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Affiliation(s)
- I Ray-Coquard
- Dpt of Medical Oncology, Centre Leon Berard, University Claude Bernard LyonI, Lyon, France.
| | - AnnaLisa Trama
- AnnaLisa Trama, Fondazione IRCCS istituto nazionale dei tumori Milan, Italy
| | - M J Seckl
- Charing Cross Hospital, Campus of Imperial College London, Fulham Palace Rd, W68RF London, UK
| | - C Fotopoulou
- Dept of Surgery and Cancer, Imperial College London, UK
| | - P Pautier
- Medical Oncology, Dpt Gustave Roussy Institution, Villejuif, France
| | - S Pignata
- Medical Oncology, Department of Urology and Gynecology, Istituto Nazionale Tumori - IRCSS - Fondazione G. Pascale, Naples Italy
| | - G Kristensen
- Dept of Gynecologic Oncology, Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway
| | - G Mangili
- Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Milan, Italy
| | - H Falconer
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet/University Hospital, 171 76 Stockholm, Sweden
| | - L Massuger
- Department of Obstetrics and Gynaecology, Radboudumc, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - J Sehouli
- Department of Gynecology with Center for Oncological Surgery, European Competence Center for Ovarian Cancer, Campus Virchow Klinikum, Medical University of Berlin, Germany
| | | | - D Lorusso
- Gynecologic Oncology Unit, Fondazione IRCCS istituto nazionale dei tumori Milan, Italy
| | - F Amant
- Center Gynaecologic Oncology Amsterdam (CGOA), Netherlands Cancer Institute, University of Amsterdam & Gynaecologic Oncology KU Leuven, The Netherlands
| | - E Rokkones
- Dept. of Gynaecological Oncology, The Norwegian Radium Hospital, Division of Cancer Medicine Oslo University Hospital, PO Box 4950 Nydalen, 0424 Oslo, Norway
| | - I Vergote
- Gynaecological Oncologist, University Hospital Leuven, European Union, Herestraat 49, B-3000 Leuven, Belgium
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Hecq JD, Vastrade CH, Perrad J, Garcous R, Amant F, Artoisenet CH, Michel C, Pirlot C, Dive A. [Standardisation of methods for dilution of intravenous medications in hospital]. J Pharm Belg 2016:26-35. [PMID: 30281228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Introduction The administration of intravenous medications in hospital is a common practice. Although it may seem almost insignificant, this practice remains no less an act which involves risks, due to many factors identified. It is therefore important to gather, clarify and communicate the updated information on the modalities of the administration of these injections in order to facilitate and secure the work of the teams of care with a view of an optimal and standardized administration of intravenous medications. Method The tables of standardization of injectable drugs have been made on several occasions in the past and distributed in the care units. The latest version of these documents was reviewed and updated in the light of the recent editions of several sources. The data concerning each individual injectable medicine have individual as well been systematically updates. The updated data have been integrated into the electronic prescription of medicines, a standardized dilution is now proposed by default to the prescriber. For some drugs, special modalities of administration have been planned to meet the specific needs of patients hospitalized in the Intensive Care Unit (ICU). Results The methods for dilution of injections in classical hospitalization have been integrated in the electronic prescribing software (238 "packages" in total. The specific dilutions used in the ICU (48 in total, have been validated but may not be used in the conventional care units. Conclusion All of the information relating to the methods of preparation and administration have been gathered and clarified in order to facilitate and secure the work of the teams of care and thus enable optimal administration of intravenous medications. The information is accessible on paper file and via the internal computer network, the PC of intensive care units and the software Computerized prescription.
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Borowski E, Poppe A, Laenen A, Remmerie C, Van Asten K, Nevelsteen I, Smeets A, Weltens C, Peeters S, Leunen K, Berteloot P, Amant F, Vergote I, Van Limbergen E, Christiaens MR, Wildiers H, Floris G, Poppe W, Neven P. Abstract P6-09-12: Breast cancer characteristics and the levonorgestrel intrauterine device. A monocentric retrospective study. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-09-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
OBJECTIVE: The levonorgestrel-intrauterine device (LNG-IUD) is a widely used contraceptive method. It is not clear if LNG-IUD users are more likely to develop breast cancer. Breast cancer growth through the estrogen and/or the human epidermal growth factor receptor 2 (HER2) pathway could be influenced by a continuous low systemic dose of levonorgestrel. In this study, we compare breast cancer characteristics and the receptor expression of estrogen (ER), progesterone (PR) and HER2 in women with and without a LNG- IUD at the time of diagnosis.
METHODS: In this retrospective, observational study, we included 2599 consecutive breast cancer patients who were younger than 55 years at diagnosis and treated between 2000 and 2014 in the University Hospitals Leuven for a primary invasive, non-metastatic tumor. The non LNG-IUD group was matched by age and parity at diagnosis. ER, PR and HER2 status were reported according to ASCO/CAP guidelines. The Chi-square test was used to compare receptor status between groups. All tests were two-sided, and a 5% significance level was assumed. An additional analysis was performed to detect the occurrence of HER 2 expression with or without intake of oral contraception by diagnosis in the control group.
RESULTS: 366 LNG-IUD users and 2233 women without a LNG-IUD were included. Compared to the control group, the LNG-IUD users had a lower Nottingham prognostic index (4.2 vs 4.4; p=0.048), more PR expression (79.2% vs 73.4%; p=0.021) but less HER2 expression (11.6% vs 17.2%; p=0.009). A significant higher rate of ER+PR+HER2- was observed in the LNG-IUD group (63.26 % vs 73.46%; p<0.001). These differences in receptor expression were mainly observed in the age group 45-49 years at diagnosis. Additionally, a trend of more HER2 positivity associated with oral contraceptive use was noticed in the control group.
CONCLUSION: We found in a breast cancer population, matched for age and parity, significant differences in the PR and HER2 expression according to use of LNG-IUD at time of diagnosis. ER positive, PR positive and HER2 negative breast cancers are more frequently seen in LNG-IUD users. There is a trend of less HER 2 positivity in LNG-IUD users and it is more common seen in oral contraception users.
Citation Format: Borowski E, Poppe A, Laenen A, Remmerie C, Van Asten K, Nevelsteen I, Smeets A, Weltens C, Peeters S, Leunen K, Berteloot P, Amant F, Vergote I, Van Limbergen E, Christiaens M-R, Wildiers H, Floris G, Poppe W, Neven P. Breast cancer characteristics and the levonorgestrel intrauterine device. A monocentric retrospective study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-09-12.
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Affiliation(s)
- E Borowski
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - A Poppe
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - A Laenen
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - C Remmerie
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - K Van Asten
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - I Nevelsteen
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - A Smeets
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - C Weltens
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - S Peeters
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - K Leunen
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - P Berteloot
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - F Amant
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - I Vergote
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - E Van Limbergen
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - M-R Christiaens
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - H Wildiers
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - G Floris
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - W Poppe
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - P Neven
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
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Poppe A, Brouckaert O, Laenen A, Soubry A, Remmerie C, Floris G, Leunen K, Berteloot P, Amant F, Vergote I, Nevelsteen I, Smeets A, Christiaens MR, Weltens C, Peeters S, Van Limbergen E, Wildiers H, Neven P. Abstract P6-09-11: Independent prognostic value of age depends on breast cancer subtype. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-09-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Young women present more often with aggressive breast cancer phenotypes and have worse prognosis. It remains controversial whether age is an independent prognostic factor in early stage breast cancer. Arbitrarily chosen age cut-off values have been proposed in different studies. Furthermore, few studies have examined the impact of breast cancer subtypes on the prognostic value of age. This abstract represents an update of a prior analysis (San Antonio Breast Cancer Symposium, December 4-8 2012, P06-07-29).
Methods: We included all primary operable female breast cancer patients from our prospectively managed database in UZ Leuven, Belgium. We assessed the effect of age on locoregional free interval (LRRFI), distant metastasis interval (DMFI) and breast cancer specific survival (BCSS). In univariate analysis, using Cox regression models, we determined the best categorization of age at diagnosis into two or three age groups by considering all possible combinations of cut-off values. Best categorization was obtained with three age groups. We further determined, using multivariate analysis (correcting for phenotype, tumor size, nodal status, adjuvant chemo -, hormone – and radiotherapy, type of surgery and procedure of axillary staging), whether age at diagnosis remains an independent predictor of outcome (LRRFI, DMFI and BCSS). We further explored whether age at diagnosis is an independent predictor of event risk (LRRFI, DMFI and BCSS) in different breast cancer subtypes. Luminal A-like (grade I or II, ER and/or PR positive, HER 2 positive), Luminal B-like (idem but grade III), Luminal HER 2 like (ER and/or PR positive, HER 2 positive), HER 2 like (ER/PR negative, HER 2 positive), triple negative (ER/PR negative, HER 2 negative).
Results: We included 4180 patients with a mean/median age of 58/57 year and with a median follow up of 8.9 year. Multivariate analysis confirmed age as an independent prognostic variable for LRRFI, DMFI and BCSS.
Results multivariable analysis with age in 3 groups (HR (95% CI) P-VALUE) LRRFIDMFIBCSSYoungest versus middle1.61 (1.18-2.18) 0.00251.54 (1.23-1.93) 0.00021.72 (1.26-2.36) 0.0007Youngest versus oldest3.45 (1.85-6.45) 0.00011.25 (0.89-1.77) 0.19821.31 (0.85-2.02) 0.2220Middle versus oldest2.15 (1.22-3.79) 0.00820.81 (0.61-1.09) 0,17060.76 (0.55-1.06) 0.1014
We found optimal cut-off values for LRRFI at 44y and 72y, for DMFI at 47y and 71y and for BCSS at 41y and 70y.
In an exploratory analysis, with age as continuous variable, by subtype we found a significant independent association between age and LRRFI (P=0.0169), DMFI (P=0.0344) in luminal A-like, LRRFI (P=0.0022) in luminal B-like and DMFI (P=0.0010) and BCSS (P=0.0053) in triple negative breast cancer. No significant associations were found in luminal HER2 and HER2 like breast cancers.
Conclusion:
This study has shown that young age is an independent prognostic factor for LRRFI, DMFI and BCSS after correction for the most important clinical prognostic factors. The prognostic effect is most important in luminal A and triple negative subtypes. Additional analyses for subtypes with age as a categorical variable will be performed and optimal cut off values will be defined.
Citation Format: Poppe A, Brouckaert O, Laenen A, Soubry A, Remmerie C, Floris G, Leunen K, Berteloot P, Amant F, Vergote I, Nevelsteen I, Smeets A, Christiaens M-R, Weltens C, Peeters S, Van Limbergen E, Wildiers H, Neven P. Independent prognostic value of age depends on breast cancer subtype. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-09-11.
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Affiliation(s)
- A Poppe
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Jan Yperman Ziekenhuis, Ieper, West Vlaanderen, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - O Brouckaert
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Jan Yperman Ziekenhuis, Ieper, West Vlaanderen, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - A Laenen
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Jan Yperman Ziekenhuis, Ieper, West Vlaanderen, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - A Soubry
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Jan Yperman Ziekenhuis, Ieper, West Vlaanderen, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - C Remmerie
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Jan Yperman Ziekenhuis, Ieper, West Vlaanderen, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - G Floris
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Jan Yperman Ziekenhuis, Ieper, West Vlaanderen, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - K Leunen
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Jan Yperman Ziekenhuis, Ieper, West Vlaanderen, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - P Berteloot
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Jan Yperman Ziekenhuis, Ieper, West Vlaanderen, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - F Amant
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Jan Yperman Ziekenhuis, Ieper, West Vlaanderen, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - I Vergote
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Jan Yperman Ziekenhuis, Ieper, West Vlaanderen, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - I Nevelsteen
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Jan Yperman Ziekenhuis, Ieper, West Vlaanderen, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - A Smeets
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Jan Yperman Ziekenhuis, Ieper, West Vlaanderen, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - M-R Christiaens
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Jan Yperman Ziekenhuis, Ieper, West Vlaanderen, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - C Weltens
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Jan Yperman Ziekenhuis, Ieper, West Vlaanderen, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - S Peeters
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Jan Yperman Ziekenhuis, Ieper, West Vlaanderen, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - E Van Limbergen
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Jan Yperman Ziekenhuis, Ieper, West Vlaanderen, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - H Wildiers
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Jan Yperman Ziekenhuis, Ieper, West Vlaanderen, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
| | - P Neven
- University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium; Jan Yperman Ziekenhuis, Ieper, West Vlaanderen, Belgium; Catholic University Leuven, Leuven, Vlaams Brabant, Belgium
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Brouckaert O, Poppe A, Laenen A, Floris G, Leunen K, Berteloot P, Amant F, Vergote I, Smeets A, Weltens C, Peeters S, Van Limbergen E, Wildiers H, Christiaens MR, Neven P. Abstract P6-10-06: The impact of body mass index on age at breast cancer diagnosis and breast cancer phenotype. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-10-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Evidence suggests that premenopausal obesity decreases and postmenopausal obesity increases breast cancer risk. While it has been hypothesized that carcinogenesis may be accelerated by a disrupted metabolic homeostasis in obese women, it is unclear why this dual relationship is observed. We here study whether body mass index (BMI) affects (a) age at breast cancer diagnosis and (b) the probability of being diagnosed with a specific breast cancer phenotype, taking menopausal status into account.
Patients and methods
All patients with non-metastatic operable breast cancer from UZ Leuven diagnosed between January 1, 2000 and December 31, 2013 were included (n=7020). Luminal A like (= grade 1 or 2, ER and/or PR positive, HER2 negative), Luminal B like (= grade 3 ER and/or PR positive, HER2 negative), Luminal HER2 like (ER and/or PR positive, HER2 positive), HER2 like (ER and PR negative, HER2 positive) and triple negative breast cancer (TNBC = ER and PR and HER2 negative). For statistical analysis, linear models and logistic regression were used to study respectively the association between BMI and age at diagnosis and BMI and breast cancer phenotype by menopausal status.
Results
There was a quadratic relationship between BMI and age at breast cancer diagnosis studying the overall population (p<0.0001). A 5kg/m2 increase in BMI was associated with the following increases in age at diagnosis: +1.8y (95% CI 1.4-2.3y) at BMI=18, +1.2y (95% CI 0.95-1.5y) at BMI=23 and +0.6y (95% CI 0.4-0.9y) at BMI=28 (corrected for menopause). This relationship was independent of the menopausal status, ER or HER2 status, histology and breast cancer phenotype.
We observed a linear relationship between BMI and the probability of being diagnosed with Luminal B like, Luminal HER2 like and HER2 like breast cancer (table 1). This linear relationship interacts with menopausal status for Luminal B like and HER2 like breast cancers (table 1).
Table 1: Probability of being diagnosed with a certain breast cancer phenotype by BMI (linear model) and the impact of menopausal status.Effect of BMI on the probabilityLinear modelof being diagnosed withp-valueeffectLuminal A like0.4430n/aLuminal B like0.0276BMI +5kg/m2 OR 1.07 (95% CI 1.01-1.14)Luminal HER2 like0.0367BMI +5kg/m2 OR 0.91 (95% CI 0.83-1.00)HER2 like0.0219BMI +5kg/m2 OR 0.88 (95% CI 0.78-0.98)TNBC0.5454n/aInteraction with menopausal statusp-valueeffectLuminal A0,2204n/aLuminal B0,0487Premenopausal OR 0,996 (CI 0,974-1,019), p=0,7449; Postmenopausal OR 1,023 (CI 1,008-1,038), p=0.0023Luminal HER20,2571n/aHER2 like0,0031Premenopausal OR 1,020 (CI 0,983-1,059), p=0,2923; Postmenopausal OR 0,947 (CI 0,919-0,976), p=0.0004TNBC0,1638n/a
Conclusion
We could not confirm the hypothesis that increasing BMI decreases (increases) age at diagnosis in postmenopausal (premenopausal) women. Obesity does affect the probability of being diagnosed with certain breast cancer phenotypes, but for certain breast cancer phenotypes an interaction with menopause was observed. We presume a potential biological link through BMI between Luminal B and HER2 like breast cancer that needs further exploration.
Citation Format: Brouckaert O, Poppe A, Laenen A, Floris G, Leunen K, Berteloot P, Amant F, Vergote I, Smeets A, Weltens C, Peeters S, Van Limbergen E, Wildiers H, Christiaens M-R, Neven P. The impact of body mass index on age at breast cancer diagnosis and breast cancer phenotype. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-10-06.
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Affiliation(s)
- O Brouckaert
- Jan Yperman Hospital, Ypres, Belgium; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium
| | - A Poppe
- Jan Yperman Hospital, Ypres, Belgium; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium
| | - A Laenen
- Jan Yperman Hospital, Ypres, Belgium; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium
| | - G Floris
- Jan Yperman Hospital, Ypres, Belgium; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium
| | - K Leunen
- Jan Yperman Hospital, Ypres, Belgium; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium
| | - P Berteloot
- Jan Yperman Hospital, Ypres, Belgium; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium
| | - F Amant
- Jan Yperman Hospital, Ypres, Belgium; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium
| | - I Vergote
- Jan Yperman Hospital, Ypres, Belgium; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium
| | - A Smeets
- Jan Yperman Hospital, Ypres, Belgium; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium
| | - C Weltens
- Jan Yperman Hospital, Ypres, Belgium; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium
| | - S Peeters
- Jan Yperman Hospital, Ypres, Belgium; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium
| | - E Van Limbergen
- Jan Yperman Hospital, Ypres, Belgium; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium
| | - H Wildiers
- Jan Yperman Hospital, Ypres, Belgium; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium
| | - M-R Christiaens
- Jan Yperman Hospital, Ypres, Belgium; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium
| | - P Neven
- Jan Yperman Hospital, Ypres, Belgium; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium
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Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J, Marth C, Nout R, Querleu D, Mirza MR, Sessa C, Altundag O, Amant F, van Leeuwenhoek A, Banerjee S, Bosse T, Casado A, de Agustín L, Cibula D, Colombo N, Creutzberg C, del Campo JM, Emons G, Goffin F, González-Martín A, Greggi S, Haie-Meder C, Katsaros D, Kesic V, Kurzeder C, Lax S, Lécuru F, Ledermann J, Levy T, Lorusso D, Mäenpää J, Marth C, Matias-Guiu X, Morice P, Nijman H, Nout R, Powell M, Querleu D, Mirza M, Reed N, Rodolakis A, Salvesen H, Sehouli J, Sessa C, Taylor A, Westermann A, Zeimet A. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: diagnosis, treatment and follow-up. Ann Oncol 2015; 27:16-41. [PMID: 26634381 DOI: 10.1093/annonc/mdv484] [Citation(s) in RCA: 685] [Impact Index Per Article: 76.1] [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: 07/17/2015] [Accepted: 10/05/2015] [Indexed: 12/27/2022] Open
Abstract
The first joint European Society for Medical Oncology (ESMO), European SocieTy for Radiotherapy & Oncology (ESTRO) and European Society of Gynaecological Oncology (ESGO) consensus conference on endometrial cancer was held on 11-13 December 2014 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of endometrial cancer. Before the conference, the expert panel prepared three clinically relevant questions about endometrial cancer relating to the following four areas: prevention and screening, surgery, adjuvant treatment and advanced and recurrent disease. All relevant scientific literature, as identified by the experts, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. Results of this consensus conference, together with a summary of evidence supporting each recommendation, are detailed in this article. All participants have approved this final article.
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Affiliation(s)
- N Colombo
- Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy
| | - C Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - F Amant
- Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam
| | - T Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - A González-Martín
- Department of Medical Oncology, GEICO Cancer Center, Madrid Department of Medical Oncology, MD Anderson Cancer Center, Madrid, Spain
| | - J Ledermann
- Department of Oncology and Cancer Trials, UCL Cancer Institute, London, UK
| | - C Marth
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
| | - R Nout
- Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - D Querleu
- Department of Surgery, Institut Bergonié, Bordeaux, France Department of Gynecology and Obstetrics, McGill University Health Centre, Montreal, Canada
| | - M R Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - C Sessa
- Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
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Michielsen K, Vergote I, Amant F, Leunen K, Dymarkowski S, De Keyzer F, Vandecaveye V. Pre-treatment ADC histogram-analysis at whole body diffusion-weighted MRI predicts disease free survival in ovarian cancer. Cancer Imaging 2015. [PMCID: PMC4601648 DOI: 10.1186/1470-7330-15-s1-s5] [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: 11/10/2022] Open
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Dresen RC, Han SN, Michielsen K, De Keyzer F, Gziri MM, Amant F, Vandecaveye V. Whole-body diffusion-weighted MRI for staging of women with cancer during pregnancy: a pilot study. Cancer Imaging 2015. [PMCID: PMC4601647 DOI: 10.1186/1470-7330-15-s1-p50] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Michielsen K, Vergote I, Vanslembrouck R, Mussen E, Amant F, Leunen K, Moerman P, Fieuws S, De Keyzer F, Souverijns G, Dymarkowski S, Vandecaveye V. Tumour characterisation, staging and operability assessment in ovarian carcinoma: whole body diffusion-weighted MRI versus CT. Cancer Imaging 2015. [PMCID: PMC4601752 DOI: 10.1186/1470-7330-15-s1-p40] [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: 11/11/2022] Open
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Han S, Amant F, Michielsen K, Keyzer FD, Dresen E, Gziri MM, Vandecaveye V. 705 Whole-body diffusion-weighted MRI for staging of women with cancer during pregnancy: A pilot study. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30375-6] [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: 10/22/2022]
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Vanderstraeten A, Tuyaerts S, Amant F. The immune system in the normal endometrium and implications for endometrial cancer development. J Reprod Immunol 2015; 109:7-16. [DOI: 10.1016/j.jri.2014.12.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 12/22/2014] [Indexed: 12/26/2022]
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de Haan J, Verheecke M, Amant F. Management of ovarian cysts and cancer in pregnancy. Facts Views Vis Obgyn 2015; 7:25-31. [PMID: 25897369 PMCID: PMC4402440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Adnexal masses during pregnancy are not uncommon. Ovarian cysts or masses during pregnancy should be accurately evaluated to identify the patients who need surgical interventions from those where a 'wait-and-see' strategy can be followed. Ultrasound and MRI are safe diagnostic tools to distinguish between benign and malignant lesions. Treatment options (surgical procedures) should be discussed for each patient individually. Both open surgery and laparoscopy can be performed considering the tumour diameter, gestational age and surgical expertise. A multidisciplinary approach is necessary in case of high suspicion of malignancy and preferably patients should be referred to centres with specialized experience.
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Michielsen K, Vergote I, Op de beeck K, Amant F, Leunen K, Dymarkowski S, Moerman P, De Keyzer F, Vandecaveye V. Whole-body diffusion-weighted MRI versus CT for detection, restaging and operability assessment of recurrent ovarian carcinoma. Cancer Imaging 2014. [PMCID: PMC4241886 DOI: 10.1186/1470-7330-14-s1-s7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Aerts L, Christiaens M, Enzlin P, Neven P, Amant F. Sexual functioning in women after mastectomy versus breast conserving therapy for early-stage breast cancer: A prospective controlled study. Breast 2014; 23:629-36. [DOI: 10.1016/j.breast.2014.06.012] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 05/26/2014] [Accepted: 06/10/2014] [Indexed: 11/12/2022] Open
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Amant F, Vandenbroucke T, Verheecke M, Ottevanger P, Fumagalli M, Mertens L, Han S, van Calsteren K, Claes L. Cancer During Pregnancy: a Case-Control Analysis of Mental Development and Cardiac Functioning of 38 Children Prenatally Exposed to Chemotherapy. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu438.4] [Citation(s) in RCA: 1] [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: 11/14/2022] Open
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Amant F, Uzan C, Han S, Fruscio R, Steffensen KD, Škultéty J, Giuliani D, Mephon A, Rouzier R, Witteveen P, Locatelli A, Rob L, Halaska M. Matched Cohort Study on Patients with Cervical Cancer Diagnosed During Pregnancy. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu338.49] [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: 11/13/2022] Open
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Amant F, Lundgren C, Kridelka F, Ferrero A, Greggi S, Soliman P, Mirza M. A Phase III Trial of Postoperative Chemotherapy or No Further Treatment for Patients with Node- Negative Stage I-Ii Intermediate or High Risk Endometrial Cancer. Engot-En2-Dgcg / Eortc 55102. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu338.64] [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] Open
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41
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van Peer S, Han S, Steffensen K, Halaska M, Gziri M, van Calsteren K, Amant F. Unplanned Pregnancy During Cancer Treatment - on Behalf of the International Network of Cancer, Infertility and Pregnancy (Incip). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu438.63] [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: 11/14/2022] Open
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Vergote I, Debruyne P, Kridelka F, Berteloot P, Amant F, Honhon B, Lybaert W, Leunen K, Geldhof K, Verhoeven D, Forget F, Vuylsteke P, D'Hondt L, Huizing M, Van den Bulck H, Laenen A. Weekly G-Csf Improves the Tolerability of Weekly Paclitaxel-Carboplatin. a Phase Ii Study of the Belgian Gynaecological Oncology Group (Bgog-Ov5). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu338.17] [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: 11/14/2022] Open
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Han S, Amant F, Sangalli C, Loibl S, Gheysens O, Lok C, Dahl Steffensen K, Halaska M, Peccatori F, Gentilini O. Sentinel Lymph Node Biopsy for Breast Cancer Treatment During Pregnancy - on Behalf of the International Network of Cancer, Infertility and Pregnancy (Incip) and the German Breast Group (Gbg). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu438.3] [Citation(s) in RCA: 3] [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: 11/13/2022] Open
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44
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Amant F, Vandenbroucke T, Verheecke M, Gziri M, Han S, van den Heuvel F, Lagae L, Willemsen M, Kapusta L, Ottevanger P, Mertens L, Claes L, van Calsteren K. Long-Term Neuropsychological and Cardiac Follow-Up of Children and Adults Who Were Antenatal Exposed to Radiotherapy. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu438.61] [Citation(s) in RCA: 1] [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: 11/13/2022] Open
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45
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van Hasselt JGC, van Calsteren K, Heyns L, Han S, Mhallem Gziri M, Schellens JHM, Beijnen JH, Huitema ADR, Amant F. Optimizing anticancer drug treatment in pregnant cancer patients: pharmacokinetic analysis of gestation-induced changes for doxorubicin, epirubicin, docetaxel and paclitaxel. Ann Oncol 2014; 25:2059-2065. [PMID: 24713311 DOI: 10.1093/annonc/mdu140] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [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: 11/13/2022] Open
Abstract
BACKGROUND Pregnant patients with cancer are increasingly treated with anticancer drugs, although the specific impact of pregnancy-induced physiological changes on the pharmacokinetics (PK) of anticancer drugs and associated implications for optimal dose regimens remains unclear. Our objectives were to quantify changes in PK during pregnancy for four frequently used anticancer agents doxorubicin, epirubicin, docetaxel and paclitaxel, and to determine associated necessary dose adjustments. PATIENTS AND METHODS A pooled analysis of PK data was carried out for pregnant (Pr) and nonpregnant (NPr) patients for doxorubicin (n = 16 Pr/59 NPr), epirubicin (n = 14 Pr/57 NPr), docetaxel (n = 3 Pr/32 NPr) and paclitaxel (n = 5 Pr/105 NPr). Compartmental nonlinear mixed effect models were used to describe the PK and gestational effects. Subsequently, we derived optimized dose regimens aiming to match to the area under the concentration-time curve (AUC) in nonpregnant patients. RESULTS The effect of pregnancy on volumes of distribution for doxorubicin, epirubicin, docetaxel and paclitaxel were estimated as fold-change of <1.32, <2.08, <1.37 and <4.21, respectively, with adequate precision [relative standard error (RSE) <37%]. For doxorubicin, no gestational effect could be estimated on clearance (CL). For epirubicin, docetaxel and paclitaxel, a fold-change of 1.1 (RSE 9%), 1.19 (RSE 7%) and 1.92 (RSE 21%) were, respectively, estimated on CL. Calculated dose adjustment requirements for doxorubicin, epirubicin, docetaxel and paclitaxel were +5.5%, +8.0%, +16.9% and +37.8%, respectively. Estimated changes in infusion duration were marginal (<4.2%) except for paclitaxel (-21.4%). CONCLUSION Clinicians should be aware of a decrease in drug exposure during pregnancy and should not a priori reduce dose. The decrease in exposure was most apparent for docetaxel and paclitaxel which is supported by known physiological changes during pregnancy. The suggested dose adaptations should only be implemented after conduct of further confirmatory studies of the PK during pregnancy.
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Affiliation(s)
- J G C van Hasselt
- Department of Clinical Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Pharmacy, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - K van Calsteren
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - L Heyns
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - S Han
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - M Mhallem Gziri
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - J H M Schellens
- Department of Clinical Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Pharmaceutical Sciences, Division of Clinical Pharmacology and Pharmacoepidemiology, Faculty of Science, Utrecht University, JE Utrecht, The Netherlands
| | - J H Beijnen
- Department of Pharmacy, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Pharmaceutical Sciences, Division of Clinical Pharmacology and Pharmacoepidemiology, Faculty of Science, Utrecht University, JE Utrecht, The Netherlands
| | - A D R Huitema
- Department of Pharmacy, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - F Amant
- Gynecologic Oncology University Hospitals Leuven; Department of Oncology, Leuven Cancer Institute, KU Leuven, Leuven, Belgium.
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Vanoppen M, Brouckaert O, Laenen A, Fontanella C, Wildiers H, Paridaens R, Leunen K, Amant F, Berteloot P, Smeets A, Loibl S, Floris G, Christiaens MR, Vergote I, Neven P. Abstract PD2-3: High body mass index (BMI) and worse response to neoadjuvant chemotherapy (NACT) by breast cancer phenotype: Own data and external validation on German breast group (GBG) patients. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-pd2-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
It remains controversial to what extent BMI predicts pathologic complete response (pCR) following NACT. We evaluated pCR by ‘BMI category’ in different breast cancer subtypes and validated our findings in a larger dataset from the GBG.
Patients and methods
A retrospective study from UZL with consecutive breast cancer patients treated between 01-01-2000 and 31-12-2011 with different types of NACT +/- trastuzumab (dose capping BSA≥2m2) followed by surgery. pCR1 (ypT0N0) and pCR2 (ypT0/isN0) were reported in each of the intrinsic breast cancer subtypes based on ER and HER-2 expression. The effect of BMI [BMI 1(≤25kg/m2), BMI 2 (>25-29,9 kg/m2) and BMI 3 (≥ 30 kg/m2)] on both pCR definitions was analyzed in univariate (Chi square test) and multivariate (logistic regression) model. Negative ER and HER-2 status were defined according to ASCO/CAP guidelines (e.g. <1% ER positive tumor cells). Data were validated by GBG using different NACT +/- trastuzumab regimen (no dose capping BSA≥2m2) and similar biomarkers for defining breast cancer subtypes although ER-negative status was defined as <10% ER positive tumor cells.
Results
We included 267 breast cancer cases while the GBG validation was done in 8874 cases. Multivariate model for UZL patients didn't retain ‘BMI category’ as a predictor for any of the pCR definitions. However, univariate analysis found a significant association between BMI and pCR2 (p = 0,048). The tables show the numerical differences for pCR2 in each BMI category by breast cancer subtype for UZL and GBG patients. UZL data suggest a numerical trend with lower pCR2 rate in obese women, which seems more pronounced in ER-negative breast cancer. Results from the much larger GBG dataset with more power to assess ‘BMI category’ for pCR2 in different breast cancer subtypes using a multivariate model are presented in another abstract.
Conclusion
Despite the small cohort of patients, our data suggest a lower pCR rate in obese women. External validation by GBG confirms a significant association between BMI and pCR2 in uni- and multivariate model, which is also significant for luminal A/B breast cancer. The most obvious reason for our observation was dose capping but based on the GBG dataset where dose capping was avoided where possible, we speculate that immunologic factors, the microenvironment or alternative signaling pathways may affect sensitivity to NACT +/- trastuzumab.
Numerical pCR2 differences by BMI category and breast cancer subtype for UZL patients Luminal A/BLuminal HER2HER 2 likeTNBCTotalUZLn = 111n = 40n = 39n = 75n = 267BMI 16.6% (4/61)35.0% (7/20)63.2% (12/19)31.4% (11/35)25.2% (34/135)BMI 23.1% (1/32)50.0% (7/14)56.3% (9/16)27.3% (6/22)27.3% (23/84)BMI 30% (0/18)33.3% (2/6)50.0% (2/4)15.8% (3/19)16.6% (8/48)
Numerical pCR2 differences by BMI category and breast cancer subtype for GBG patients Luminal A/BLuminal HER2HER 2 likeTNBCTotalGBGn = 3250n = 1077n = 806n = 1570n = 8847BMI 111.6%(187/1618)26.7%(147/550)47.3%(191/404)38.9%(300/772)22.5%(982/4358)BMI 210.5%(128/1026)24.9% (81/325)44.2%(111/251)37.4% (187/500)21.2%(596/2813)BMI 37.9% (48/606)22.8%(46/202)41.1%(62/151)31.9%(95/298)18.3%(312/1703)
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr PD2-3.
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Affiliation(s)
- M Vanoppen
- University Hospitals, Leuven, Belgium; Interuniversity Center for Biostatistics and Statistical Bioinformatics, Leuven, Belgium; German Breast Group, Neu-Isenburg, Germany; University Hospital of Udine, Italy
| | - O Brouckaert
- University Hospitals, Leuven, Belgium; Interuniversity Center for Biostatistics and Statistical Bioinformatics, Leuven, Belgium; German Breast Group, Neu-Isenburg, Germany; University Hospital of Udine, Italy
| | - A Laenen
- University Hospitals, Leuven, Belgium; Interuniversity Center for Biostatistics and Statistical Bioinformatics, Leuven, Belgium; German Breast Group, Neu-Isenburg, Germany; University Hospital of Udine, Italy
| | - C Fontanella
- University Hospitals, Leuven, Belgium; Interuniversity Center for Biostatistics and Statistical Bioinformatics, Leuven, Belgium; German Breast Group, Neu-Isenburg, Germany; University Hospital of Udine, Italy
| | - H Wildiers
- University Hospitals, Leuven, Belgium; Interuniversity Center for Biostatistics and Statistical Bioinformatics, Leuven, Belgium; German Breast Group, Neu-Isenburg, Germany; University Hospital of Udine, Italy
| | - R Paridaens
- University Hospitals, Leuven, Belgium; Interuniversity Center for Biostatistics and Statistical Bioinformatics, Leuven, Belgium; German Breast Group, Neu-Isenburg, Germany; University Hospital of Udine, Italy
| | - K Leunen
- University Hospitals, Leuven, Belgium; Interuniversity Center for Biostatistics and Statistical Bioinformatics, Leuven, Belgium; German Breast Group, Neu-Isenburg, Germany; University Hospital of Udine, Italy
| | - F Amant
- University Hospitals, Leuven, Belgium; Interuniversity Center for Biostatistics and Statistical Bioinformatics, Leuven, Belgium; German Breast Group, Neu-Isenburg, Germany; University Hospital of Udine, Italy
| | - P Berteloot
- University Hospitals, Leuven, Belgium; Interuniversity Center for Biostatistics and Statistical Bioinformatics, Leuven, Belgium; German Breast Group, Neu-Isenburg, Germany; University Hospital of Udine, Italy
| | - A Smeets
- University Hospitals, Leuven, Belgium; Interuniversity Center for Biostatistics and Statistical Bioinformatics, Leuven, Belgium; German Breast Group, Neu-Isenburg, Germany; University Hospital of Udine, Italy
| | - S Loibl
- University Hospitals, Leuven, Belgium; Interuniversity Center for Biostatistics and Statistical Bioinformatics, Leuven, Belgium; German Breast Group, Neu-Isenburg, Germany; University Hospital of Udine, Italy
| | - G Floris
- University Hospitals, Leuven, Belgium; Interuniversity Center for Biostatistics and Statistical Bioinformatics, Leuven, Belgium; German Breast Group, Neu-Isenburg, Germany; University Hospital of Udine, Italy
| | - M-R Christiaens
- University Hospitals, Leuven, Belgium; Interuniversity Center for Biostatistics and Statistical Bioinformatics, Leuven, Belgium; German Breast Group, Neu-Isenburg, Germany; University Hospital of Udine, Italy
| | - I Vergote
- University Hospitals, Leuven, Belgium; Interuniversity Center for Biostatistics and Statistical Bioinformatics, Leuven, Belgium; German Breast Group, Neu-Isenburg, Germany; University Hospital of Udine, Italy
| | - P Neven
- University Hospitals, Leuven, Belgium; Interuniversity Center for Biostatistics and Statistical Bioinformatics, Leuven, Belgium; German Breast Group, Neu-Isenburg, Germany; University Hospital of Udine, Italy
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Boussios S, Han S, Fruscio R, Halaska M, Ottevanger P, Peccatori F, Koubková L, Pavlidis N, Amant F. Lung cancer in pregnancy: Report of nine cases from an international collaborative study. Lung Cancer 2013; 82:499-505. [DOI: 10.1016/j.lungcan.2013.09.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 08/28/2013] [Accepted: 09/04/2013] [Indexed: 11/16/2022]
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Werbrouck J, Bouche G, de Jonge E, Jacomen G, D'Hondt V, Denys H, Van Limbergen E, Vandermeersch B, De Schutter H, Van Eycken E, Goffin F, Amant F. Evaluation of the quality of the management of cancer of the corpus uteri--selection of relevant quality indicators and implementation in Belgium. Gynecol Oncol 2013; 131:512-9. [PMID: 24103471 DOI: 10.1016/j.ygyno.2013.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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: 07/19/2013] [Revised: 09/30/2013] [Accepted: 10/01/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Describe the methodology and selection of quality indicators (QI) to be implemented in the EFFECT (EFFectiveness of Endometrial Cancer Treatment) project. EFFECT aims to monitor the variability in Quality of Care (QoC) of uterine cancer in Belgium, to compare the effectiveness of different treatment strategies to improve the QoC and to check the internal validity of the QI to validate the impact of process indicators on outcome. METHODS A QI list was retrieved from literature, recent guidelines and QI databases. The Belgian Healthcare Knowledge Center methodology was used for the selection process and involved an expert's panel rating the QI on 4 criteria. The resulting scores and further discussion resulted in a final QI list. An online EFFECT module was developed by the Belgian Cancer Registry including the list of variables required for measuring the QI. Three test phases were performed to evaluate the relevance, feasibility and understanding of the variables and to test the compatibility of the dataset. RESULTS 138 QI were considered for further discussion and 82 QI were eligible for rating. Based on the rating scores and consensus among the expert's panel, 41 QI were considered measurable and relevant. Testing of the data collection enabled optimization of the content and the user-friendliness of the dataset and online module. CONCLUSIONS This first Belgian initiative for monitoring the QoC of uterine cancer indicates that the previously used QI selection methodology is reproducible for uterine cancer. The QI list could be applied by other research groups for comparison.
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Affiliation(s)
- J Werbrouck
- Belgian Cancer Registry, Koningsstraat 215 bus 7, 1210 Brussel, Belgium.
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Gziri MM, Goffin F, Debieve F, Amant F. [Cancer diagnosis during pregnancy: importance of a national and European registration]. Rev Med Liege 2013; 68:527-530. [PMID: 24298727] [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: 06/02/2023]
Abstract
Cancer during pregnancy is relatively rare, but its incidence has been increasing over recent years. A European study has been launched in 2005 by F. Amant (KUL) to register all pregnant patients with a cancer diagnosis with or without treatment during pregnancy (surgery, chemotherapy and/or radiotherapy). All infants exposed to chemotherapy and/or radiotherapy are also followed up by pediatricians, neurologists, cardiologists and psychologists. In Belgium, French- and Dutch- language hospitals are working in close collaboration to follow these pregnant patients. The national results are summarized in this paper.
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Affiliation(s)
- M Mhallem Gziri
- Dienst Gynaécologie en Verloskunde, KUL, UZ Leuven, Belgique.
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Garçous R, Remy G, Bary M, Amant F, Cauwe F, De Beusscher L, Bouzette A, De Coster P, Hecq JD. [Implementation of computerized phisician order entry in a hospital setting: what are the keys to success?]. J Pharm Belg 2013:32-38. [PMID: 23798184] [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: 06/02/2023]
Abstract
INTRODUCTION A software of computerized physician order entry [CPOE] was developed by a data-processing company in collaboration with the Mont-Godinne University Hospital By 2006, parallel to the evolution of the software, the progressive implementation of CPOE was carried out, and currently covers 16 wards, the emergency room, the recovery rooms and the center of medical care [day hospital] as well as the day surgical center OBJECTIVES Complete computerization of the drug supply chain, including the regulation by the physician, the pharmaceutical validation, the delivery and the follow-up of stocks by pharmacy, the validation of the administration by the nurse and the tariffing of the drugs. METHOD AND RESULTS In 2006, a working group was created in order to validate specifications allowing the development of a software of CPOE, Linked to the computerized medical record. A data-processing company was selected in order to develop this software. Two beds were computerized in the pneumology ward, in order to test and validate the software. From 2007 to 2009, 3 additional wards were computerized [geriatrics, neurosurgery, revalidation]. A steering committee of CPOE, composed of various members (direction, doctors, pharmacists, nurses, data processing specialistsl is created. This committee allows the installation of the means necessary to the deployment of CPOE in the Institution. Structured teams for the deployment are created: medical and nurse coaches. From 2009 to 2012, the deployment of the software is carried out, covering 16 wards, the emergency room, the recovery room and the day-hospitals. CONCLUSION The computerization of the drug supply chain is a challenge which concerns the institutional level. The assets of our hospital and our project were: - a strong management committee, making of this project a priority entering the strategical planning of the institution; - a steering committee allowing each type of actor to express his needs, and of prioriser requests; - a closer medical coaching; - teams of nurses coaches, accompanying each ward, during and after the deployment; - a dynamic IT team allowing a relay between the Institution and the data-processing company. These points appeared essential and are as many keys for a successful deployment.
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Affiliation(s)
- R Garçous
- Département de pharmacie Université Catholique de Louvain, CHU UCL de Mont-Godinne Dinant 5530 Yvoir, Belgique
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