bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk factors for nodal metastasis in women with grade 3 endometrial cancer.
Authors: Clark Leslie Horn , Ko Emily Meichun , Bae-Jump Victoria Lin , Gehrig Paola A. 
Published: March 2020

e15511 Background: No studies have reported on the association of nodal metastases and lower uterine segment (LUS) in grade 3 endometrial cancer. Our study aimed to determine the frequency of nodal metastasis in these high-risk patients stratified by LUS involvement. Methods: A retrospective analysis was conducted on grade 3 endometrial cancer cases from 2005-2010. Statistical analyses were performed using summary frequencies and multivariate logistic regression analysis, with two-tailed p values of <0.05 considered significant. Results: 329 cases were identified. 80.9% women underwent retroperitoneal node dissection, of whom 95.1% underwent pelvic (P) node dissection and 85.3% underwent periaortic (PA) node dissection. Of the women who had nodal dissection, mean age was 65.3 and BMI 31.1. Histology included 33.5% endometrioid, 49.3% serous or clear cell, and 15.4% carcinosarcoma. Stage distribution included 57.6% stage I, 8.0% stage II, 29.8% stage III, and 4.6% stage IV. Of LUS+ cases, 42% (56/132) had nodal metastases, in contrast to 12.7% (17/134) of LUS- cases. Sensitivity of + nodes by LUS was 76.6%, with a specificity of 60.6%, positive predictive value of 42.4%, and negative predictive value of 87.3%. Of LUS+ cases, 49/123 (39.8%) had +P nodes; 27/106 (21.8%) +PA nodes; and 21/100 (21%) had both +P/PA nodes. Of LUS- cases, 15/130 (11.5%) had +P nodes; 7/121 (5.8%) +PA nodes; and 4/121(3.3%) had both +P/PA nodes. Confirming the above findings, when adjusting for myometrial invasion and lymphovascular invasion, overall nodal status, +P nodal status and PA nodal status were independently associated with LUS (p<0.000; p=0.001; p=0.003 respectively). Conclusions: There is debate regarding the utility of lymph node assessment in women with endometrial cancer. However, women with grade 3 endometrial cancer are at high risk for nodal involvement. This information is critical in determining post-operative adjuvant therapy. This data suggests women with grade 3 endometrial cancer, particularly those with lower uterine segment involvement, should undergo routine lymphadenectomy due to the high risk of nodal involvement.
In vitro chemoresponse assay for patients with cervical cancer.
Authors: Del Priore Giuseppe , Grigsby Perry Wayne , Gan Christine M. , Tillmanns Todd D. 
Published: March 2020

e15514 Background: Chemotherapy is used in cervical cancer as neoadjuvant, chemosensitization with radiation, and upon recurrence. This study reports the results of an in vitro chemoresponse assay (ChemoFx, Precision Therapeutics) in primary, metastatic, or recurrent cervical cancer. Methods: Between 8/8/06- 6/2/10, 557 tumor specimens were received and 353 (63%) were successfully assayed. Status (primary, metastatic or recurrent) and histology (squamous 58%; adenocarcinoma 20%; adenosquamous 6%; neuroendocrine 5%; and other12%) was confirmed in 273 for this report. Single agents tested included: carboplatin, cisplatin, paclitaxel, docetaxel, epirubicin, fluorouracil, 4-hydroxy ifosfamide, SN-38, topotecan, and vinorelbine. Doublets included carboplatin/paclitaxel (Carbo/Tax) and cisplatin/topotecan (Cis/Topo). Tumor response was determined from dose response curves and scored as responsive (R), intermediate response (IR), or nonresponsive (NR). Chemoresponse is reported as R+IR. Results: 273 tumor specimens were evaluable for response. Chemoresponse of primary cancers (n=151) to single agents was SN-38-75%; 4-hydroxy ifosfamide-71%; topotecan-62%; epirubicin-58%; and cisplatin-58%. Chemoresponse of primary tumors to doublets was 73%-carbo/Tax and 56%-Cis/Topo. Chemoresponse of metastatic cancers (n=66) to single agents was irinotecan-54%; ifosfamide-51%; epirubicin-44%; topotecan-41% and fluorouracil-40%. Chemoresponse of metastatic tumors to doublets was 53%-Carbo/Tax and 30%-Cis/Topo. Chemoresponse of recurrent cancers (n=56) to single agents was epirubicin-44%; ifosfamide-41%; vinorelbine-39%; paclitaxel-39%; and topotecan-36%. Chemoresponse of recurrent tumors to doublets was 46%-Carbo/Tax and 35%-Cis/Topo. Conclusions: In vitro chemoresponse analysis is feasible in cervical cancer. Overall chemoresponsiveness was greater in primary cancers (58%) than in recurrent cancers (35%); (p<0.0001). Chemoresponse to single agent cisplatin was lower than most other single agents in all three patient groups. Since many recurrent patients have prior platinum exposure, a chemoresponse assay will have further study possibilities in this setting.
Impact of the third and subsequent lines of chemotherapy in the cure rate of patients with high-risk gestational trophoblastic neoplasia (HR-GTN).
Authors: Jankilevich Gustavo , Bianconi Maria Ines , Otero Silvina , Alvarez Lucia , Storino Claudio 
Published: March 2020

e15521 Background: Successful chemotherapy is the backbone of the treatment of patients with HR-GTN. However a percentage of this patients will recur to first treatment attempt. It is not defined how many lines of chemotherapy are required to achieve complete reponse and wether to continue with different chemotherapy regimens is beneficial for achieving the cure. Methods: We performed a review of medical records of consecutive patients with diagnosis of gestational trophoblastic disease (GTD) and HR-GTN by FIGO-OMS criteria between 1990-2011. All were treated in our hospital. Results: 365 patients were registrated with GTD diagnosis. Thirty-four patients had HRNTG, 23 patients (67.6%) had complete reponse with first and second line chemotherapy (EMA PE and EMA CO). Eight of eleven patients had complete reponse with additional regimens. Three patients died, one due toxicity. The reponse rate of third and more lines was 72%. Overall disease free survival was 91%. Conclusions: In patients with HRNTG three or more lines of treatment achieves the cure in a high percentage of patients. In this setting the therapy should always be with curative intent, regardless of the number of lines required to achieve this objective.
Prognostic value of epithelial cell adhesion molecule (EpCAM) in patients with primary epithelial ovarian cancer.
Authors: Woopen Hannah , Pietzner Klaus , Richter Rolf , Fotopoulou Christina , Joens Thomas , Braicu Ioana , Mellstedt Hakan , Darb-Esfahani Silvia , Denkert Carsten , Sehouli Jalid 
Published: March 2020

e15531 Background: EpCAM, a well known cancer antigene is currently experiencing a renaissance in its use as a binding site for targeted oncologic therapy and prognostic marker in various epithelial carcinomas such as breast cancer or carcinomas of the oral cavity. Goal of this retrospective study was to identify EpCAM as a potential prognostic marker for patients with primary epithelial ovarian cancer (EOC). Methods: EpCAM expression was assessed in tumor tissue by immunohistochemistry using the Avidin-Biotin-Complex method on paraffin-embedded ovarian cancer tissue samples. EpCAM overexpression was defined as an expression of EpCAM as high as 76-100%. Clinical data as well as tumor tissue samples were collected within the validated “Tumor bank Ovarian Cancer Network (TOC)”. Results: Seventy-four patients with the primary diagnosis of EOC between 01/1994 and 12/2009 were included in this study. Median age at diagnosis was 56 years. The vast majority of the patients (75.4%) presented an advanced stage disease (FIGO III/IV). Forty-one (55.4%) patients were diagnosed with a serous, 19 (25.6%) a endometrioid and 14 (19%) a mucinous histology. EpCAM was overexpressed in 87.7% of the patients. Serous tumors expressed EpCAM in significantly higher rates than mucinous tumors ( p=0.045). EpCAM overexpression correlated in univariate analysis with a significantly better overall survival. Multivariate analysis including histological subtype identified EpCAM expression of 76-100% to be independently associated with a significantly better overall survival compared to a lower EpCAM expression of ≤50% (p=0.008). Conclusions: EpCAM overexpression in EOC appears to be associated with significantly higher overall survival rates. Larger, prospectively assessed multicenter studies are warranted to further evaluate and confirm these novel findings and possibly establish EpCAM as a potent therapeutic target in EOC.
Analysis of time from initial imaging study to definitive surgical diagnosis in patients with epithelial ovarian malignancies.
Authors: Bickley Thomas , Clegg Eericca , Nash John , Yan Xiaowei (Sherry) , Gogoi Radhika 
Published: March 2020

e15536 Background: It is well established that women diagnosed with advanced stage ovarian cancer have a significantly lower five-year survival rate. Often multiple imaging modalities are used in the initial evaluation. This is costly, often unnecessary, and may be a contributing factor to a delay in diagnosis. We sought to evaluate the time from initial imaging study to diagnosis. Methods: After IRB approval, a retrospective chart review was performed utilizing data from the electronic medical record at an integrated health care system. All patients who underwent surgery with a diagnosis of primary peritoneal, ovarian, or fallopian tube cancer between 7/2006 and 8/2011 were included. Data collected included age at time of surgery, number and dates of imaging studies performed within 180 days prior to surgery, primary cancer site, stage, and histology. Patients were excluded for recurrent disease, studies without dates, or imaging studies performed greater than 180 days prior to diagnosis. Statistical analysis was performed using the Cox Proportional Model. Results: A total of 146 patients were included in the study. The average number of imaging studies was 1.7 and the average time to diagnosis from initial imaging was 33.5 days. Time to diagnosis was shorter if patients ever had a CT scan (29.3 vs 73.3 days; P<0.001), and longer if patients ever had an ultrasound (40.4 vs 27.8 days; P=0.02). There was no difference in the overall number of imaging studies performed when controlling for stage <3C vs >3C. However, time to diagnosis was significantly less (29.1 vs 45.1 days; P=0.01) for more advanced stage disease. There was no difference in time to diagnosis or overall number of imaging studies performed when controlling for primary cancer site or age. Conclusions: The data suggest that performing a CT scan as the only imaging modality results in a significantly shorter time to diagnosis than when ultrasonography is included in the initial evaluation. Of patients who initially got an ultrasound most ultimately went on to have a CT scan, likely increasing the interval to diagnosis. We suggest that implementing an adnexal mass algorithm may allow patients quicker access to definitive diagnosis and treatment.
Radiation with cisplatin or carboplatin for locally advanced cervix cancer: The experience of a tertiary cancer center.
Authors: Au-Yeung George , Mileshkin Linda R. , Bernshaw David , Kondalsamy-Chennakesavan Srinivas , Rischin Danny , Narayan Kailash 
Published: March 2020

e15541 Background: Definitive treatment with concurrent cisplatin and radiation is the standard of care for locally advanced cervical cancer. The optimal management of patients with a contraindication to cisplatin has not been established. We conducted a retrospective audit of the impact of concurrent chemoradiation in a cohort of patients (pts) with locally advanced cervical cancer. Methods: All pts with locally advanced cervical cancer treated with definitive radiation were entered into a prospective database. Information regarding their demographics, stage, histology, recurrence and survival were recorded. Pharmacy records were reviewed to determine concurrent chemotherapy use. The primary endpoint was overall survival, and secondary endpoints were disease free survival and rates of primary, nodal or distant failure. Univariate and multivariate analyses were performed, incorporating known prognostic factors of age, FIGO stage, uterine body involvement, tumour volume on MRI and nodal involvement. Results: 442 pts were treated from Jan 1996 to Feb 2011. Median age was 59 (range 22-94); 89% had squamous histology and 64% node-negative disease. 269 pts received cisplatin, 59 received carboplatin because of a contraindication to cisplatin and 114 received no concurrent chemotherapy (most prior to 1999). Overall survival adjusted for other prognostic factors was significantly improved with use of concurrent cisplatin compared to radiation alone (HR 0.53, p=0.001), as was disease free survival and the rate of distant failure. Use of concurrent carboplatin was not associated with any significant benefit compared to radiation alone in terms of overall survival or disease free survival on univariate or multivariate analyses. Conclusions: The results of this audit are consistent with the known significant survival benefit with concurrent cisplatin chemoradiation. However, there did not appear to be any significant benefit associated with concurrent carboplatin although there are potential confounding factors in this small cohort. The available evidence in the literature favors the use of non-platinum chemotherapy rather than carboplatin in pts with contraindications to cisplatin.
Platinum-based combinations as first-line chemotherapy in advanced, persistent, or recurrent cervical cancer.
Authors: Limareva Svetlana Vladimirovna , Khokhlova Svetlana Victorovna , Odintsova Anastasiya Sergeevna , Cherkasova Marina Valerievna , Vinogradova Liliya Igorevna , Gorbunova Vera A. 
Published: March 2020

e15543 Background: Platinum compounds are the most active agents in cervical carcinoma. The aim of this study was to evaluate the activity and toxicity of platinum-based chemotherapy as first line treatment in patients with advanced/recurrent cervical cancer. Methods: Since 2005 to 2011years 68 pts were include in the pilot study. Patients with histological proven primary carcinoma, measurable tumors, age ≥ 18, PS of 0-1, adequate bone marrow, renal and hepatic functions were eligible for this trial. Prior chemotherapy was allowed only in the context of radiosensitization. Treatment consisted of 2 modes: PC - paclitaxel 175 mg/m2 3-h I.v. + cisplatin 75 mg/m2 or carboplatin AUC-6 ( 6 pts)- d1x 21d; IC – irinotecan 65 ìg/m2 + cisplatin 40 mg/m2 on d 1 and 8 x 21 d. Responses were assessed using RESIST. Results: 68 pts were identified. There were no differences between the groups in terms prior radiation or radiochemotherapy. Group PC: 28 pts were included. Efficacy and toxicity was available for 27. Two pts continue treatment. Median age 43,5 years (range 28-69). The ORR was 55.5% (CR - 5(18.5%) and PR -10(37.0%)). 8 pts (29.6%) SD and 4 (14.8%) PD. The median TTP was 7 months. Overall, 148 cycles were administered with a median of 5 (range 2-8) cycles. Major toxicities were as follows: GIII and GIV neutropenia in 22.2% and 11.1% pts; GIII anemia - in 2 pts; GI-II neuropathy in 45.9% pts. G III nausea/vomiting were in 3 pts (11.1%). Group IC: 40 pts were included, 38 were available for efficacy. Median age 49,8 years (range 25-67). The ORR was 47.3% (5 CR(13.2%) and 13 PR (34.2%)). 13 (34.2%) pts had SD and 7 (18.4%) - PD. The median TTP was 6 months. All 40 pts receved 254 cycles ( median 6.3 (range 1-11) cycles. GIII and IV neutropenia were in 40% and 10% pts; GIII anemia in 20% pts. G I-II neuropathy and G I-II diarrhea in 15% pts and 30%pts. G IV of diarrhea observed in 1 pt. GIII-IV nausea and vomiting were in 20% and 15%pts. There were no statistical differences in clinical outcome (OR(p= 0,69) and TTP(p=0,65)) between these 2 platinum-based regimes. Conclusions: Our data indicate that both regimes had high efficacy and well tolerated as first line treatment in patients with advanced/recurrent cervical cancer. The randomized study is necessary.
Use of liposome encapsulated doxorubicin citrate (LEDC) as a valid drug in patients affected by ovarian cancer suffering from chemotherapy side-effects.
Authors: Angelucci Michela , Plotti Francesco , Muzii Ludovico , Terranova Corrado , De Cicco Nardone Carlo , Montera Roberto , Damiani Patrizio , Cafà  Ester Valentina , Dugo Nella , Guzzo Federica , Ricciardi Roberto , Aloisi Alessia , Luvero Daniela , Miranda Andrea , Capriglione Stella , Lopez Salvatore , Scaletta Giuseppe , Linciano Francesca , Benedetti Panici Pierluigi , Angioli Roberto 
Published: March 2020

e15547 Background: Doxorubicin had a wide spectrum of cytotoxic activity in gynecological cancer. Moreover, this drug is associated with chronic cardiac toxicity, often irreversible, which limits lifetime dose. A new liposomal formulations has been developed in the past decades to limite side-effects of doxorubicin: liposome encapsulated doxorubicin citrate (LEDC). In this study we report our experience with LEDC in patients affected by advanced/recurrent gynaecological cancer, suffering from chemotherapy side effects. Methods: From 2000 to December 2008, 43 patients who showed palmoplantar erythrodysesthesia (PPE) during adjuvant or palliative setting treatment of metastatic/recurrent epithelial ovarian cancer. All patients enrolled in the study were treated with liposomal encapsulated doxorubicin citrate (LEDC), administered at the dose of 50 mg/mq every 3 weeks until disease progression or adverse effects. Results: We have enrolled 43 patients who suspended previously chemotherapy treatment for severe PPE. A total of 32 patients completed planned 6 cycles of chemotherapy. After 6 cycles of chemotherapy 3 out of 43 patients (6%) continued to show a complete response, 9 patients (20%) maintained partial response, 16 patients (37%) showed stable disease and 4 patients (9%) suffered disease progression. No severe G3–G4 hematologic toxicity was showed, but neutropenia and anemia continued to be the most common side effects. No cutaneous toxicity were reported. Conclusions: LEDC is a well tolerated drug and a valid alternative in patients affected by ovarian cancer suffering from cutaneous toxicity by other drugs.
Advanced endometrial cancer: Is there a benefit to neoadjuvant therapy?
Authors: Czok Sarah , Zechmeister Jenna R. , Jewell Andrea , Boyd Leslie R. 
Published: March 2020

e15548 Background: The majority of endometrial cancers present as early stage tumors, yet those that are advanced at diagnosis are associated with poor outcomes. The role of radical debulking surgery for endometrial cancer is not clear. However, the use of neoadjuvant chemotherapy is also unproven. We sought to evaluate if utilizing neoadjuvant chemotherapy for advanced endometrial cancer affected outcomes. Methods: A retrospective review from two hospitals served by one academic center from 2002 to 2011 was performed. All patients with stage 3 or 4 disease were identified. Patients with non-epithelial cell types, including carcinosarcoma, were excluded. Patients who received neoadjuvant treatment prior to surgery were identified. A case-control design was utilized matching patients 1:3 or 1:4 stratified by age, stage, grade, histology and performance status. Descriptive statistics and nonparametric analyses were utilized. Results: A total of 115 patients with advanced endometrial cancer were identified. 19 were excluded due to wrong cell type and 1 due to stage 3 disease based on positive cytology. 6 patients had a neoadjuvant treatment approach (NAs). 20 patients were identified as matched controls (CTRLs). The average age was 61 for the NAs, and 63 for the CTRLs. The average BMI was 26.9 for the NAs, and 27.4 for the CTRLs. NAs were more likely to have stage 4 disease—5/6 NAs versus 5/20 CTRLs. Both groups had a high proportion of grade 3 tumors—4/6 NAs versus 15/20 CTRLs. The performance status was similar in both groups. The median number of chemotherapy cycles was 11 in the NAs, and 4 in the CTRLs. 18/20 CTRLs received adjuvant treatment, and 17 included systemic chemotherapy. In the NAs, with a median follow-up of 17 months, 4 were alive with disease (AWD) and 2 were dead of disease (DOD). In the CTRLs, with a median follow-up of 14 months, 7 patients were NED, 8 were AWD, and 5 were DOD. Conclusions: Despite a small sample size, our results indicate that primary surgery remains the preferred strategy for patients with advanced endometrial cancer. However, prospective data is needed to determine to what extent neoadjuvant chemotherapy affects outcomes.
Use of carboplatinum as neoadjuvant setting for patients affected by locally advanced cervical cancer.
Authors: De Cicco Nardone Carlo , Plotti Francesco , Angelucci Michela , Montera Roberto , Damiani Patrizio , Cafà  Ester Valentina , Guzzo Federica , De Oronzo Maria Antonietta , Montone Eva , Ricciardi Roberto , Aloisi Alessia , Luvero Daniela , Portuesi Rosa Alba Valentina , Scaletta Giuseppe , Capriglione Stella , Lopez Salvatore , Miranda Andrea , Gennari Paolo , Benedetti Panici Pierluigi , Angioli Roberto 
Published: March 2020

e15553 Background: The aim of this study is to evaluate the efficacy and safety of the combination of carboplatin and paclitaxel as neoadjuvant chemotherapy (NACT) in patients affected by locally advanced cervical cancer. Methods: Between June 2007 to May 2009, all patients with diagnosis of IB2-IIB cervical cancer were considered eligible for this protocol. All enrolled patients received 3 cycles of carboplatin (AUC6) and paclitaxel at 175 mg/mq in neadjuvant setting. The chemotherapy induced toxicity and response to the treatment were evaluated according to World Health Organization criteria. Results: We have enrolled 23 patients with diagnosis of locally advanced cervical cancer. A total of 22 patients completed planned 3 cycles of neoadjuvant chemotherapy. After 3 cycles of chemotherapy 9 out of 23 patients (42%) showed a complete response, 7 patients (35%) partial response, 5 patients (16%) stable disease and 2 patients (11%) showed disease progression. The most common toxicity was haematologic (43%), extra haematologic toxicities were nausea/vomiting, neuropathy and alopecia, that occurred in 45%, 13% and 25% respectively. No renal and grade 3 and 4 haematologic toxicities were registered. Conclusions: Our results suggest that the use of carboplatin, in neadjuvant setting, is a well tolerated drug, produces manageable toxicity with a response rate similar to standard cisplatin. Then, it rappresents a valid alternative in patients affected by locally advanced cervical cancer.