Clinical characteristics of clear cell ovarian cancer: A retrospective multicenter experience of 308 patients in South Korea.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17062-e17062
Author(s):  
Hee Yeon Lee ◽  
Ji Hyung Hong ◽  
Jae Ho Byun ◽  
Hee Jun Kim ◽  
Sun Kyung Baek ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Adjuvant Chemotherapy ◽  
South Korea ◽  
Clear Cell ◽  
Early Stage ◽  
Stage Iv ◽  
Stage Iii ◽  
Stage Ia ◽  
Optimal Debulking ◽  
Disease Free

e17062 Background: Clear cell ovarian cancer is rare, accounts for about 3-10% of epithelial ovarian carcinoma, and is known to be associated with endometriosis. This tumor type has poor prognosis due to inherent chemoresistance. We investigated clinical characteristics and prognostic factors of clear cell ovarian cancer in South Korea. Methods: We reviewed the medical records of 308 patients with clear cell histology ovarian cancer who underwent debulking surgery from 21 institutions in South Korea between 1995 and 2015. Results: Mean age was 51 years (range, 25-81) and 194 patients (63.7%) had stage I disease, 34 (11.1%) had stage II, 66 (21.6%) had stage III, and 11 (3.6%) had stage IV. 107 patients (34.9%) had endometriosis. 9 patients (2.9%) received neoadjuvant chemotherapy, 248 (80.5%) received postoperative chemotherapy, and among them, 238 (96%) received taxane-platinum chemotherapy. 275 patients (89.3%) achieved optimal debulking. 112 patients (37%) had recurrence, 182 (59.1%) was disease-free, and 12 (3.9%) lost follow up. Median value of CA-125 was 72.34 U/ml (range, 1.9-8930), 45.7 in stage I, 98.9 in stage II, 192.1 in stage III, and 634.8 in stage IV. 1-year, and 3-year rate of disease-free survival (DFS) was 70%, and 63%, respectively. 1-yr DFS rate was 90% in stage Ia and Ib, 88% in stage Ic and II, and 60% in stage III and IV. According to the same stage grouping, 3-year DFS rate was 82%, 70%, and 40%, respectively. Overall survival (OS) rate at 1 year was 97%, 99%, and 90%, and 97%, 96%, and 88% at 3 year. Multivariate analysis revealed optimal debulking (HR 6.62, p < 0.001) as a significant prognostic factor for DFS. Among the 94 patients with early stage (Ia and Ib), 17 patients (18.1%) received adjuvant chemotherapy, and there was no significant difference in DFS according to adjuvant chemotherapy (log rank p = 0.57). Conclusions: In patients with clear cell ovarian cancer, optimal debulking surgery was associated with improved DFS. And the role of adjuvant chemotherapy in early stage clear cell ovarian cancer is elusive and needs further study.

Accelerated hypofractionated hemithoracic intensity modulated radiation therapy (IMRT) followed by extrapleural pneumonectomy (EPP) for malignant pleural mesothelioma (MPM): Results of a phase I/II study.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 7526-7526
Author(s):  
Marc de Perrot ◽  
Ronald Feld ◽  
Natasha B. Leighl ◽  
Isabelle Opitz ◽  
Masaki Anraku ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Disease Free Survival ◽  
Stage Iv ◽  
Stage Iii ◽  
Extrapleural Pneumonectomy ◽  
Final Pathology ◽  
Concomitant Boost ◽  
Short Period ◽  
Disease Free

7526 Background: We developed a protocol with accelerated hypofractionated hemithoracic IMRT followed by EPP for MPM. Advantages include optimal delivery of radiation to the whole tumor bed in a short period limiting the risk of viable tumor cell spread during surgery. Methods: Patients with resectable clinical T1-3N0M0 histology proven MPM were eligible for the study. 25 Gy in 5 daily fractions over 1 week was delivered to the entire ipsilateral hemithorax by IMRT with concomitant boost of 5 Gy to volumes at high risk based on CT and PET scan findings. EPP was performed one week after the end of radiation. Adjuvant chemotherapy was offered to patients with ypN2 on final pathology. The primary end-point was treatment related mortality. Secondary endpoint included overall survival and disease-free survival (DFS). Initial sites of recurrence were also recorded. Results: Twenty five patients were accrued between 11/2008 and 10/2012. Patients had a median age of 64 years (range, 45-75), 76% were males, 64% had epithelioid histology. All patients completed IMRT and EPP. IMRT was well tolerated with no grade 3-5 toxicity. EPP was performed 6±2 days after completion of IMRT. Surgical complications occurred in 18 patients. One patient died from empyema at 88 days. All but one patient (stage IB) had stage III (n=11) or IV (n=13) disease on final pathology. Five out of 13 patients with ypN2 disease underwent adjuvant chemotherapy. After a median follow-up of 19 months (range, 3-51), the estimated 3-year survival reached 62%. Survival was significantly better in epithelioid compared to biphasic pathologic subtypes (83% survival at 3 years vs 19%, respectively; p=0.004). 14 patients remain disease free after a median follow-up of 17 months (range, 3-37). 2-year DFS was 85% in stage III and 37% in stage IV disease (p=0.03). Recurrences occurred in the ipsilateral chest only (n=2), ipsilateral chest and distant sites (n=2), and distant sites only (n=6). Conclusions: Accelerated hypofractionated hemithoracic IMRT followed by EPP is feasible. This treatment could improve survival in selected patients with epithelial subtype. Clinical trial information: NCT00797719.

Debulking Surgery and Intraperitoneal Chemotherapy Are Associated With Decreased Morbidity in Women Receiving Neoadjuvant Chemotherapy for Ovarian Cancer

2014 ◽  
Vol 24 (1) ◽  
pp. 43-47 ◽  
Author(s):  
William Robinson ◽  
Evelyn Cantillo
Keyword(s):  
Ovarian Cancer ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Neoadjuvant Chemotherapy ◽  
Length Of Stay ◽  
Stage Iv ◽  
Stage Iii ◽  
Duration Of Surgery ◽  
Optimal Debulking ◽  
Dose Reductions

ObjectiveThe aims of this study were to compare the rate of completion of optimal debulking and/or 6 cycles of intraperitoneal (IP) chemotherapy in women with International Federation of Gynecologists and Obstetricians stage III/IV ovarian cancer undergoing neoadjuvant chemotherapy (NACT) versus primary surgery (PS) and to compare morbidity between these 2 groups.MethodsNinety-six subjects with stage III/IV ovarian cancer who underwent either NACT or PS were identified. Data comparisons include rate of optimal debulking and completion rate of 6 cycles of IP chemotherapy. Other data collected included surgical times, length of stay, intensive care unit admissions, blood transfusions, bowel resections, major complications, and dose reductions. SigmaStat version 2.0 was used for statistical analysis.ResultsOf the 96 subjects, 38 received NACT and 58 had PS. All 14 subjects with stage IV disease received NACT, and all experienced resolution of pleural effusion, based on computed tomographic imaging. Thirty-five (92%) of 38 NACT subjects versus 47 (81%) of 58 PS subjects were optimally debulked (P= 0.08). Thirty-six (95%) of 38 NACT subjects versus 37 (64%) of 58 PS subjects completed IP chemotherapy (P< 0.001). Length of stay was 3.26 (NACT) versus 5.08 (PS) days (P< 0.001). Intensive care unit admissions were 1 of 38 (NACT) versus 12 of 58 (PS) (P< 0.001). Bowel resections were done in 2 of 38 (NACT) versus 14 of 38 (PS) (P< 0.05). Duration of surgery was 96 minutes (NACT) versus 138 minutes (PS) (P< 0.001). A trend to fewer dose reductions occurred in NACT (1/38) versus PS (8/58) (P= 0.056).ConclusionsThe NACT subjects were more likely to complete IP chemotherapy and had decreased length of stay, intensive care unit admissions, bowel resections, and duration of surgery. Both optimal debulking and dose reductions were numerically but not statistically associated with NACT versus PS. This likely reflects a relatively high overall rate of optimal debulking and low rate of dose reductions in these subjects and would require a larger group to determine significance.

Surgical stage IA clear cell ovarian cancer: Is adjuvant chemotherapy necessary?

2019 ◽  
Vol 154 ◽  
pp. 213
Author(s):  
D.A. Klein ◽  
J.K. Chan ◽  
D.S. Kapp ◽  
A.K. Mann ◽  
C.I. Liao
Keyword(s):  
Ovarian Cancer ◽  
Adjuvant Chemotherapy ◽  
Clear Cell ◽  
Stage Ia

Evaluation of the Safety of Ovarian Preservation at Early Stage of Endometrial Cancer in Premenopausal Women

2021 ◽  
Author(s):  
Elham Shirali ◽  
Mitra Modarres Gilani ◽  
Fariba Yarandi ◽  
Omid Hemmatian ◽  
Azar Ahmadzadeh ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Early Stage ◽  
Stage Iv ◽  
Premenopausal Women ◽  
Stage Ii ◽  
Stage Iii ◽  
Cross Sectional ◽  
Ovarian Preservation ◽  
Stage Ib ◽  
Stage Ia

Background: Endometrial cancer usually occurs at postmenopause stage of life but its incidence in younger patients is increasing in the last decades. The objective of the study was to evaluate the ovarian preservation in the early stage of endometrial cancer. Methods: In this cross-sectional study, 174 patients with endometrial cancer who underwent Total Abdominal Hysterectomy (TAH) and Bilateral Salpingo-oophorectomy in 5 years were included. Results: The results showed that 51.1% of the patients were at stage IA, 28.7% at stage IB, 6.9% at stage II, 11.5% at stage III and 1.7% at stage IV of endometrial cancer when they underwent surgery. One patient (1.12%) at stage IA of endometrial cancer, one patient (2%) at stage IB and one patient (8.3%) at stage II had micrometastasis in ovaries, and 8 patients (40%) at stage III and 2 patients (66.6%) at stage IV had micrometastasis and co-existing tumor. Conclusion: In conclusion, findings revealed the high safety of ovarian preservation in endometrial cancer at earlier stages of the endometrial cancer with low risk of ovarian involvement.

Screening for Familial Ovarian Cancer: Failure of Current Protocols to Detect Ovarian Cancer at an Early Stage According to the International Federation of Gynecology and Obstetrics System

2005 ◽  
Vol 23 (24) ◽  
pp. 5588-5596 ◽  
Author(s):  
Diane Stirling ◽  
D. Gareth R. Evans ◽  
Gabriella Pichert ◽  
Andrew Shenton ◽  
Elaine N. Kirk ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Early Stage ◽  
Transvaginal Ultrasound ◽  
Stage Iv ◽  
International Federation ◽  
Lifetime Risk ◽  
Stage Iii ◽  
Ca 125 ◽  
Gynecology And Obstetrics ◽  
Increased Risk

PurposeTo assess the effectiveness of annual ovarian cancer screening (transvaginal ultrasound and serum CA-125 estimation) in detecting presymptomatic ovarian cancer in women at increased genetic risk.Patients and MethodsA cohort of 1,110 women at increased risk of ovarian cancer were screened between January 1991 and March 2004; 553 were moderate-risk individuals (4% to 10% lifetime risk) and 557 were high-risk individuals (> 10% lifetime risk). Outcome measurements include the number and stage of screen-detected cancers, the number and stage of cancers not detected at screening, the number of equivocal screening results requiring recall/repetition, and the number of women undergoing surgery for benign disease.ResultsThirteen epithelial ovarian malignancies (12 invasive and one borderline), developed in the cohort. Ten tumors were detected at screening: three International Federation of Gynecology and Obstetrics (FIGO) stage I (including borderline), two stage II, four stage III, and one stage IV. Of the three cancers not detected by screening, two were stage III and one was stage IV; 29 women underwent diagnostic surgery but were found not to have ovarian cancer.ConclusionAnnual surveillance by transvaginal ultrasound scanning and serum CA-125 measurement in women at increased familial risk of ovarian cancer is ineffective in detecting tumors at a sufficiently early stage to influence prognosis. With a positive predictive value of 17% and a sensitivity of less than 50%, the performance of ultrasound does not satisfy the WHO screening standards. In addition, the combined protocol has a particularly high false-positive rate in premenopausal women, leading to unnecessary surgical intervention.

Patterns of care for women with ovarian cancer in the United States.

1997 ◽  
Vol 15 (11) ◽  
pp. 3408-3415 ◽  
Author(s):  
K A Muñoz ◽  
L C Harlan ◽  
E L Trimble
Keyword(s):  
Ovarian Cancer ◽  
Older Women ◽  
Early Stage ◽  
Stage Iv ◽  
The United States ◽  
Stage I ◽  
Stage Iii ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Platinum Based Chemotherapy

PURPOSE To characterize treatments for ovarian cancer, to determine if recommended staging and treatment were provided, and to determine factors that influence receipt of recommended staging and treatment. METHODS A total of 785 women diagnosed with ovarian cancer in 1991 were selected from the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) program. Type and receipt of recommended staging and treatment were examined using data on surgery and physician-verified chemotherapy. RESULTS Most women with presumptive stage I and II ovarian cancer were treated with surgery alone (58%), while women with stage III or IV disease were treated with surgery plus platinum-based chemotherapy (75% stage III, 56% stage IV). Approximately 10% of women with presumptive stage I and II, 71% with stage III, and 53% with stage IV disease received recommended staging and treatment. The absence of lymphadenectomy and assignment of histologic grade were the primary reasons women with presumptive stage I and II cancer did not receive recommended staging and treatment, whereas for stages III and IV, it was due to older women not receiving surgery plus platinum-based adjuvant chemotherapy. Age, stage, comorbidity, "other" race/ethnicity, and treatment at a facility with an approved residency training program were associated with whether recommended staging and therapy were received. CONCLUSION Older women with late-stage disease did not receive recommended treatment. The majority of women with early-stage disease did not receive recommended staging and treatment.

Clear cell endometrial cancer patients have an increased risk of venous thrombotic events

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5597-5597
Author(s):  
L. Garrett ◽  
L. M. Lee ◽  
E. Oliva ◽  
N. Horowitz ◽  
L. Duska
Keyword(s):  
Clear Cell ◽  
Early Stage ◽  
Gynecologic Oncology ◽  
Stage Iv ◽  
Tumor Stage ◽  
Stage Iii ◽  
Control Group ◽  
Vte Prophylaxis ◽  
Increased Risk ◽  
Endometrial Cancers

5597 Objective: To document the rate of clinically significant venous thromboembolism (VTE) in patients with clear cell carcinoma of the endometrium (CCC-E). Methods: Institutional review board (IRB) permission was obtained for retrospective record review. The pathology database at our institution located cases of CCCs over the time period 1994–2004. Controls with high grade endometrial cancers were matched for stage, age and date of diagnosis. All patients underwent surgical staging with gynecologic oncology staff surgeons and all patients received VTE prophylaxis peri-operatively. Records were reviewed and data were collected regarding patient age, tumor stage, body mass index, surgical procedure, adjuvant therapy, survival, and presence of VTE. All pathology was reviewed at the MGH. Results: Thirty-nine cases of CCC-E were identified. Complete clinical data were available for 29 cases. Age ranged from 38–85 (mean 64.6) years. 35% of patients had stage I tumors, 10% stage II, 27.5% stage III, and 27.5% had stage IV tumors. 58 age and stage matched controls were selected. The majority were grade 3 endometrioid cancers (50%) with the remainder being serous (35%), mixed histology (7%), carcinosarcoma (5%), and undifferentiated carcinoma (3%). The majority of the control patients had a higher BMI than the case patients. Overall there were 18 VTE events, 10 (34.5%) in those with CCC-E and 8 (13.8%) controls p = 0.046. A higher proportion of VTE occurred in those with stage III/IV disease (n=16) as compared to those with early stage (n =2) p =0.01. When considering the timing of VTE, the VTE observed in those with CCC-E occurred at presentation or with disease recurrence (8 vs 1) while nearly all VTE in the control group occurred in the postoperative period. (7 vs 2). This was statistically significant p =0.01 Conclusion: Patients with CCC-E are at increased risk of VTE compared to patients with other high- risk endometrial cancers. This is particularly true for those with advanced stage disease. Presentation with a VTE and postmenopausal bleeding should raise the suspicion for CCC-E. Likewise, in those with known CCC-E development of a VTE may be a harbinger of recurrence. Consideration should be given to extended prophylaxis in patients with CCC-E to prevent VTE. No significant financial relationships to disclose.

Systematic review of adjuvant therapy for early stage (epithelial) ovarian cancer

2003 ◽  
Vol 13 (4) ◽  
pp. 395-404 ◽  
Author(s):  
B. Winter-Roach ◽  
L. Hooper ◽  
H. Kitchener
Keyword(s):  
Systematic Review ◽  
Ovarian Cancer ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Early Stage ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Significant Difference ◽  
Well Differentiated ◽  
Platinum Chemotherapy

A systematic review and meta analysis has been undertaken in order to evaluate the effectiveness of adjuvant therapy following surgery for early ovarian cancer. Trials reported since 1990 have been of a higher quality enabling a meta analysis of adjuvant chemotherapy vs adjuvant radiotherapy and a meta analysis of adjuvant chemotherapy vs observation. There was no significant difference between radiotherapy and chemotherapy, though these comprised studies which demonstrated considerable heterogeneity. Chemotherapy did confer significant benefit over observation in terms of both overall and disease free survival. Except for women in whom adequate surgical staging has revealed well differentiated disease confined to one or both ovaries with intact capsule, platinum chemotherapy should be offered to reduce risk of recurrence.

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