The Impact of COVID-19 Pandemic on Oncological Disease Extent at Staging FDG PET/CT: the ONCOVIPET Study.

Purpose: To investigate whether the COVID-19 pandemic and national lockdown had an impact on the extent of cancer disease at staging using FDG PET/CT as surrogate marker.Methods: Retrospective observational study including cancer patients submitted to FDG PET/CT for staging purposes from June 1 to October 31, 2020, and June 1 to October 31, 2021, respectively. Data regarding primary tumour, nodal (N) status and number of involved nodal stations, presence and number of distant metastases (M) were collected. Each scan was classified in limited vs advanced status. Data were aggregated across the study population and tumour type. Bi-weekly frequencies of the observed events were analysed. Results: 611 patients were included in the study (240 in 2019 vs. 371 in 2020, respectively). A significant increase in the rate of advanced disease patients in 2020 compared to 2019 was found (rate 1.56, p<0.001) as well as in the rate of N+ or M+ patients (rate 1.84 and 2.09 respectively, p<0.001) and in the rate of patients with a greater number of involved N stations or M (rate 2.01 and 2.06 respectively, p<0.001). Analysis by tumour type showed a significant increase of advanced disease, N+ or M+ status and number of involved N stations or M in lung cancer and lymphoma in 2020 compared with 2019 (p<0.003). Advanced disease rate resulted also significantly increased in gynaecologic cancer and N rate was significantly increased in gastro-intestinal cancer (p<0.05). Conclusion: The rate of cancer patients with advanced disease at staging FDG PET/CT increased by 1.5-fold in 2020, following the national lockdown due to the COVID-19 pandemic, compared to 2019 with a significant increase of patients with N involvement or M. Targeted health interventions are needed to mitigate the effects of the pandemic on patient outcome.

An Appraisal of Malnutrition in Gynaecologic Cancer Patients Attending the Gynaecology Clinic in the University of Port Harcourt Teaching Hospital, Nigeria

Background: Malnutrition in cancer patients is associated with increased risk of adverse effects including mortality and thus requires special attention. Objective: The aim of this study was to determine the prevalence and factors affecting malnutrition amongst gynaecological cancer patients at the University of Port Harcourt teaching hospital (UPTH). Methodology: This was a prospective cross-sectional study involving 74 patients with histologically confirmed genital tract malignancies at the UPTH. A structured proforma was used to obtain nutritional history from the participants while the serum albumin level was used to determine the nutritional status. Data entry and analysis was conducted using SPSS version 25 software package. Results were presented in simple frequency tables and percentages. Chi square test was used to compare categorical variables and p value less than 0.05 was considered significant. Results: The prevalence of malnutrition was 39.19%. The age range of participants was 26-92 years with most (25.7%) in the 4th decade. Patients with cervical and ovarian malignancies were more at risk of malnutrition. Low socioeconomic status, advanced stage disease, and reduced food intake were significantly associated with malnutrition. Poor appetite and early satiety were associated with poor food intake. Conclusion: Malnutrition is highly prevalent amongst the study population. Cervical and ovarian cancer patients were more likely to suffer from malnutrition. Improvement in socioeconomic status and early detection of malignancy will improve the nutritional status of the study population.

Medical treatment of patients with gynecologic cancer during the COVID-19 pandemic

BackgroundDuring the COVID-19 pandemic, cancer care had to be reorganized; national and international recommendations were published to manage anticancer treatments safely and to reduce the risk of SARS-CoV-2 infection for patients and health workers.ObjectiveTo evaluate whether the adoption of recommendations for the management of patients with gynaecologic cancer receiving treatment during the pandemic resulted in containment of infections and continuing oncologic care.MethodsBased on the published recommendations, and according to the local Health Direction guidelines, we developed and drafted a security protocol to modify access of patients with gynaecologic cancer to the “Fondazione Policlinico Agostino Gemelli-IRCCS, Rome” between February 1 and April 30, 2020 and compared results with the corresponding 3 months of 2019.ResultsBetween February and April 2019, we registered 3254 admissions, including 2253 patients receiving intravenous chemotherapies, 298 receiving oral therapies, and 703 having hospital visits. Between February and April 2020, we registered 3213 admissions, including 2221 patients receiving intravenous chemotherapies, 401 receiving oral therapies, and 591 having hospital visits. Oral treatments and general visits were different in the two time periods (p<0.001). Despite the elevated patient flow, only one patient (0.1%) tested positive for COVID-19 and there were no cases among healthcare staff.ConclusionsBased on the adopted security protocol we provided continuity of care for all patients and limited the spread of the COVID-19 infection.

ROTEM Analyses of Low Molecular heparin effects with Vitro Induced Thrombocytopenia

Background: Thrombocytopenia is correlated to hemorrhagic complications in patients with low molecular weight heparin (LMWH) thromboprophylaxis. Aims: The aims of our study were to investigate an experimentally induced in vitro thrombocytopenia and then adding 2 types of LMWHs in vitro. Our hypothesis was that a platelet depleted whole blood sample could reflect a stronger synergistic anticoagulative effect of in vitro added LMWH than in the non-manipulated blood. Method: Two venous citrated blood samples were consecutively drawn from 8 patient’s gynaecologic cancer and normal routine coagulation laboratory analyses immediately preopewratively. One of the two samples had its buffy coat pipetted away into a separate tube. Half of the buffy coat was returned to the same sample (treated sample). 3x500 μl of blood from the non-treated sample was added to 3 separate microtubes and corresponding for the treated sample. Thromboprophylactic doses corresponding to an in vivo peak effect 0.5 anti-Xa international units/ml of tinzaparin and enoxaparin were added both to untreated and treated samples – 2 microtubes were unheparinized (treated/untreatedsample). All samples were analysed with rotational thromboelastometry (ROTEM). Results: Wilcoxon matched-pairs signed rank tests of the in-group differences between non-non-treated and treated samples showed no significant differences (p≤0.05) for any of the parameters analysed with the ROTEM-INTEM reagent regardless of heparinization or not. Calculation of non-parametric spearman correlation for clotting time (CT) vs. platelet count (PLC) were not significant for any group. Tinzaparin was clearly observed to prolong CT in the buffy-coat lowered blood from two patients. Conclusions: Our results corroborate previous research that ROTEM cannot detect anticoagulative effects of low dose LMWH in patients with normal PLC. In two patients there was a clear prolongation of clot initiation after tinzaparin that warrants further studies on a more developed in vitro induced thrombocytopenia model.

Immunohistochemical expression of P53 and Ki-67 on epithelial tumors of ovary

Background: Ovarian cancer is the third most common gynaecologic cancer and it is well known for its late presentation at advanced stage. Epithelial tumors of the ovary (EOT) are commonest of all ovarian neoplasms and their malignant forms represent about 90% of ovarian cancers. The determination of cell proliferation has been reported to be of diagnostic and prognostic significance. Over expression of p53 and Ki-67 has been claimed to be a marker of poor prognosis in epithelial ovarian tumors. Aim this study was to evaluate the biological significance of p53 and Ki-67 and their antigen expression in epithelial ovarian cancer.Methods: This is an observational study of 52 cases of ovarian tumors which were diagnosed and operated at Dept of Gynaecology, Prathima institute of medical sciences in South India, between August 2018 to July 2020.Results: The mean age of diagnosis for benign, borderline and malignant epithelial tumors was 42years, 49 years, 56years respectively. Most common histological type was serous epithelial tumors (50%). Highest p53 and Ki-67 immunoreactivity was seen in malignant tumors. Their co-expression was seen in 46.2% of the cases.Conclusions: Epithelial tumors and their malignant forms are common ovarian cancers, which are well known for its lethality and late presentation. Immunohistochemical markers p53 and Ki-67 frequently over expressed in epithelial tumors and has a prognostic role in determining the biologic tumor behaviour which further helps in planning the treatment.

Radiation Treatment of Synchronous Gynaecologic Cancer: a Clinical Case

Introduction. Recent years have witnessed an increased incidence of multiple neoplasms. In multiple combined cancer, the choice of treatment strategy remains challenging, as two or more tumours require treatment in the shortest perspective. However, an intense treatment may induce many and severe complications with co-located organs and systems. No universal protocol or treatment standard for managing multiple primary cancers is accepted in Russia or worldwide.Materials and methods. The clinical case describes radiation treatment of a female patient with synchronous gynaecologic cancer of vagina and endometrium at the “TOOD” medical facility’s radiotherapy unit. Our treatment was designed to maximise the dosage targeting at a minimal off-coverage of healthy tissues. The treatment was conducted in two steps on an Elekta Synergy Platform S instrument, with the total duration of 62 days.Results and discussion. After radiotherapy, the patient had an oncologic and gynaecologic observation for one year. A complete tumour regression in two localities was confirmed visually, cytologically and instrumentally.Conclusion. A treatment strategy in multiple primary cancers should be personalised. With unfeasible “standard therapy”, alternative approaches for the patient’s treatment are to be explored. We report a successful therapy in a woman with synchronous gynaecologic cancer by applying remote conformal radiation in regional uterine cancers with simultaneous integrated boost to the vaginal tumour during the first radiation step. Brachytherapy at the second step was replaced with stereotactic radiation due to vaginal constriction, pain syndrome and unfeasible applicator installation.

Sleep Disturbance in Gynaecologic Malignancies-an Overview

Sleep plays a pivotal role in maintaining homeostasis and one of a few foremost determinants of Quality of Life. Quality of life is a well-studied topic in oncology and various measures are taken to improve quality of life in this setting, in order to achieve therapeutic outcome and compliance in general in cancer patients. Sleep disturbances and disruption in circadian rhythm is among a few common presenting complaints of patients with malignancy and affects between 30% to 75% of newly diagnosed or recently treated cancer patients,1 which are reported as double that of the general population, paving the way for decreased compliance and inefficacy of therapy and pose as a detriment to general well-being, and quality of life. It is evident that mood disorders and sleep disturbances are more prevalent in females (1.3 to 1.8 times more than men),2 one may theorize that the prevalence of sleep disturbance in gynaecologic malignancies is greater than that of general population. Sleep disturbances in gynaecologic cancer patients often include difficulty in initiation of sleep, frequent awakening, difficulty in staying asleep, and restless leg syndrome. Systematic research on various sleeps disorders and their therapeutic approach in gynaecologic cancers in general is lacking. This article aims at elucidating and giving overview of sleep pattern changes in gynaecologic malignancies and therapeutic approaches to foster better sleep in this subset of population. This article also emphasizes the need to envisage the treatment strategies targeting cytokines and cortisol in improvement of sleep parameters in gynaecologic malignancies.