Advanced Treatment Options Research Articles

Blood-based gene expression profiling to reveal potential response biomarkers for immunotherapy in advanced lung cancer.

e15155 Background: Novel immunotherapies are becoming a viable option for advanced lung cancer treatment. High-throughput gene expression profiling (GEP) has enabled better understanding of patient responsiveness to targeted immunotherapy. However, non-invasive blood-based signatures are needed to monitor and predict response. Methods: To evaluate the predictive and prognostic role of blood-based GEP, we designed a longitudinal study by enrolling 15 patients with advanced lung cancers. A total of 65 samples were collected for RNA sequencing, ~4 blood specimens per patient, before and during anti-PD-1 treatment. We used multiple analyses, including time-course differential gene expression, principal component, lymphocyte compartment deconvolution, and genetic mutation, to search for and assess potential predictive and prognostic aspects. Results: Of 15 patients, 11 were classified as Responders (partial responders) and four were Non-Responders (one stable and three progressive diseases). Our analyses demonstrated: 1) By comparing baseline GEPs from Responders vs. Non-Responders before the first treatment, we identified potential markers (e.g., LY6E is significantly lower expressed in Responders, with Log2 Fold change = -3.44 and p = 1.83E-04) that can be used as predictors of responsiveness of the patients; 2) Immunoglobulin subunits- and T cell receptor complex-related genes were differentially expressed in Responders (DAVID analysis, p = 6.7E-3 and 2.1E-2, respectively), but not in Non-responders; 3) γδ T cells in the lymphocyte compartment were relatively increased in Responders; 4) Despite a different set of genes differentially expressed at different time points, the biggest GEP changes were at ~ week 6, after the second treatment. Additionally, we observed certain genes consistently up- or down-regulated through the whole course of treatment. Furthermore, after the first treatment, genes in the immune response pathway were regulated to different directions in Responders and Non-Responders. For example, interleukin receptor genes, such as IL18R1 and IL18RAP, and CD24 were down-regulated in Responders, but up-regulated in Non-Responders (p = 0.042, 0.023 and 0.044 respectively, t-test for the differential expression in these two groups). Conclusions: The utility of blood GEP to identify predictive and prognostic factors for precision immunotherapy is encouraging. Nevertheless, these results, predictive of the anti-PD-1 clinical response, are preliminary and need to be validated in a larger cohort.

The Integration of Mental Health Care in Rural Iran

Iran’s rural mental health care system emerged in a context that included experiments in health care prior to the 1979 Revolution and the establishment of a primary health care (PHC) system after the Revolution. Beginning in the 1980s, Iran integrated mental health care into the existing PHC system by treating mental illness much like a communicable disease. Iran advanced treatment options compatible with the existing system, added new training for existing care providers, and incorporated specialists. The integration of mental health care led to the rapid improvement of health outcomes. The integration also created the unintended consequence of privileging pharmaceutical treatments and overlooking mental illnesses affected by somatization.

Wake-up Stroke: New Opportunities for Acute Stroke Treatment

This review summarizes the current science underpinning the treatment of patients with ischemic stroke who awaken with stroke symptoms. This large subset of stroke patients has historically been precluded from treatment with disability-limiting reperfusion therapies such as intravenous thrombolysis. Recent advances in neuroimaging have shifted the paradigm of treatment based upon rigid time-based criteria to treatment guided by evidence of salvageable ischemic penumbra on advanced imaging. Several recent randomized controlled trials provide evidence that imaging-guided treatment of wake-up and uncertain onset stroke patients is feasible and effective. Thrombectomy trials have demonstrated dramatic clinical benefit for this treatment modality as many as 24 h from the time patients were last known to be well. Furthermore, appropriately selected wake-up stroke patients beyond 4.5 h from last known well may also benefit from intravenous thrombolysis. The evaluation and optimal treatment of patients with ischemic stroke is rapidly evolving, creating a moving target for stroke systems of care. Incorporating this new evidence into practice requires re-examination of how patients with stroke symptoms are evaluated and will challenge regional systems to design mechanisms to ensure rapid access to advanced imaging and treatment options.

Exploring the antineoplastic effect of phytochemicals from Ipomea sepiaria against matrix metallopeptidases: a pharmacoinformatics approach

Cancer is one of the leading causes of death worldwide. Though advanced treatment options are available, a cure for this disease is still unidentified. This work is aimed at the identification of drugs to target the matrix metallopeptidase, a major protein overexpressed in this disease. Two hundred and forty seven active phytochemicals from the medicinal plant Ipomea sepiaria were taken as the lead drugs and molecular docking analysis as well as interaction studies were carried out. The binding affinity for each ligand with the target was determined along with Molecular dynamic simulation of the complex to determine the stability of the complex in the system. Thus eight drugs namely Tetradecanoic acid, Nerolidol, Ipomeanine, Dibutyl phthalate, Cis-Caffeic acid, Caffeic acid, Moupinamide and N-Cis-Feruloyltyramine were found to be the most promising drugs for treating cancer. They outperformed the scores of four different drugs available in the market.

Efficacy of posaconazole for treatment of basal cell carcinoma

Background: Basal cell carcinoma (BCC) is the most commonly diagnosed skin cancer, with increasing incidence each year. Although the treatment of BCC is typically surgical, a non-surgical approach is highly desirable for patients with non-aggressive BCC recurrence, multiple tumors, poor general health, or with lesions in vulnerable areas. In the last few years, advanced cancer treatment options have targeted the Hedgehog pathway, known to regulate the proliferation of cancer stem cells and increase tumor invasiveness. Preliminary studies show that posaconazole may present a safer clinical alternative than current methods in the management of BCC. Therefore, this study aims to analyze the efficacy of posaconazole as a safe therapeutic option for nodular BCC lesions. Proven efficacy may have a significant impact on public health, as well as the substantially reduced medical and economic burden resulting from this disease prevalence. Methods: This study is designed as a single center, randomized, double-blinded, placebo controlled trial. Before undergoing surgical excision, 170 patients (1:1 allocation) will be randomized to receive 800 mg daily of posaconazole or placebo for four weeks. Discussion: The main strengths of this study are the potential to increase general understanding of the therapeutic and metabolic impact of posaconazole. The results from this trial may also provide valuable insights to guide a larger clinical trial of posaconazole for inoperable BCC. The main limitations of the study consist of the limited intervention time frame of 4 weeks and the sample representativeness since it is a single-center study of patients with nodular BCC.

Electrochemical methods to enhance osseointegrated prostheses.

Osseointegrated (OI) prosthetic limbs have been shown to provide an advantageous treatment option for amputees. In order for the OI prosthesis to be successful, the titanium implant must rapidly achieve and maintain proper integration with the bone tissue and remain free of infection. Electrochemical methods can be utilized to control and/or monitor the interfacial microenvironment where the titanium implant interacts with the biological system (host bone tissue or bacteria). This review will summarize the current understanding of how electrochemical modalities can influence bone tissue and bacteria with specific emphasis on applications where the metallic prosthesis itself can be utilized directly as a stimulating electrode for enhanced osseointegration and infection control. In addition, a summary of electrochemical impedance sensing techniques that could be used to potentially assess osseointegration and infection status of the metallic prosthesis is presented.

"I Just Feel Like I Always Did": Inotropic Dependency at End of Life.

Patients not considered for mechanical circulatory support or heart transplant may be dependent on inotropic therapy at end of life. End-of-life conversations in advanced heart failure can be challenging for providers, but guidelines recommend frequent goals-of-care conversations when inotropes are used as a palliative treatment. The purpose of this study was to identify aspects of care pertinent for health-care professionals working with patients in end-stage heart failure who are receiving continuous inotropic support. Qualitative analysis was used to examine 3 audio-recorded semistructured interviews with 1 patient, her family, and her cardiologist. The selected patient was an older adult, diagnosed with advanced heart failure, and dependent on continuous inotropic therapy with no other advanced treatment options available. The analysis revealed that (1) reliance on others, (2) contending with uncertainty, and (3) deciding when to discontinue inotropic support were identified as themes central to the patient's and provider's experience. This study offers insight into how to best support and communicate with patients having advanced heart failure who are dependent on continuous inotropic therapy at end of life.

ACTR-28. A CALL FOR INCREASED ROLE OF NEUROSURGEONS IN SURGICAL TRIALS FOR NON-GLIOMATOUS PRIMARY CNS TUMORS: A SYSTEMATIC REVIEW OF THE CLINICALTRIALS.GOV DATABASE

Abstract BACKGROUND Surgery continues to be part of the mainstay of therapy for most primary CNS tumors. However, neurosurgical innovations advancing treatment options have stagnated. An understanding of past and current investigational trends is necessary to catalyze innovation in surgical trials. OBJECTIVE To evaluate the landscape of surgical clinical trials for non-diffusely infiltrating primary CNS tumors. METHODS ClinicalTrials.gov was searched on May 14th, 2019 for surgical/procedural trials based on non-diffusely infiltrating primary CNS tumors, with a focus on meningiomas, ependymomas, medulloblastomas, pituitary adenomas, vestibular scwhannomas, and chordomas. Key trial design parameters were extracted. Purely surgical interventions were classified as “technical” while fluorescence-guided and other intraoperative imaging modalities were classified as image-guided surgery. Any invasive mode of drug delivery (e.g. intra-arterial or intra-ventricular, local chemotherapy wafers, and oncolytic virus injection) was considered. RESULTS Among 944 total trial records (257 medulloblastomas, 254 ependymomas, 179 meningiomas, 156 pituitary adenomas, 56 vestibular schwannomas, and 48 chordomas) only 54 (5.7%) were procedural in nature. Ependymomas had the highest absolute number (18/254, 7%) while vestibular schwannomas had the highest percentage (6/56, 10.7%) of surgical trials. The majority of records were not randomized (41/54, 75.9%), not industry-funded (45/54, 83.3%), and were early Phase (30/54, 55.6%); there were only three Phase III trials. The relative number of new surgical trial registrations has not changed significantly over time (1990s: 5, 2000s: 19, and 2010s: 30). Approaches integrated with other disciplines, such as image-guided surgery (16/54, 29.6%) and local drug delivery (16/24, 29.6%), were among the leading categories of trials. CONCLUSIONS Despite the clinical role of surgery in management of non-diffusely infiltrating primary CNS tumors, a paucity of innovative surgical trials has been put forth. Multi-disciplinary approaches appear to be necessary for pushing the therapeutic envelope for individuals affected by these tumors, with imaging and drug development at the forefront.

Sonic Hedgehog Pathway Inhibition in the Treatment of Advanced Basal Cell Carcinoma.

Advanced basal cell carcinoma (BCC) represents a small proportion of BCCs that are not amenable to standard therapies due to lack of efficacy, high recurrence risk, and excessive morbidity. Implication of the Sonic hedgehog (Shh) pathway in the development of BCC has led to the development of systemic Shh pathway inhibitors, providing patients with advanced BCCs new treatment options and improved survival. There are currently two Food and Drug Administration (FDA)-approved Shh inhibitors, vismodegib and sonidegib, for advanced basal cell carcinomas. Vismodegib has approval for locally advanced BCCs (laBCC) and metastatic BCC (mBCC), while sonidegib has approval for laBCC. These agents have also been used for prevention in nevoid basal cell carcinoma syndrome and as neoadjuvant therapy before surgery, and we feel that there is a growing role of Shh inhibitors in these settings. Head-to-head randomized controlled trials comparing vismodegib to sonidegib are lacking. Adverse events can limit the utility of these medications by leading to treatment discontinuation in a large proportion of patients, and it is thus essential that prescribers be able to anticipate and manage the most frequent side effects of muscle spasms, alopecia, dysgeusia, nausea, and weight loss. Other Shh inhibitors, including the antifungal itraconazole, have been investigated in small trials, but further research is needed before recommending their routine clinical use. Additionally, there are several new agents under investigation that may have improved efficacy for resistant tumors by utilizing different mechanisms of action than the two currently approved medications.

Genetic and Genomic Advances in Breast Cancer Diagnosis and Treatment

Advances in genetic testing for people at high risk for cancer and in targeted gene therapy for breast cancer are rapidly emerging, including newly developed key hormone receptor–targeted therapies and individualized molecular fusion identification and treatment options. These advances are contributing to a new era in cancer treatment modalities and care delivery. As more innovative and advanced treatment options emerge, women's health outcomes and survival rates may improve. Nursing professionals in primary care and women’s health specialties must be aware of the latest options for testing, referrals, and treatment modalities.

Central venous disease in hemodialysis patients

Central venous disease (CVD) is difficult to treat and often resistant to treatment. In CVD, hemodialysis vascular access should sometimes be abandoned, or in serious cases, the patient's life may be threatened. Therefore, prevention is ideal. However, as the prevalence of chronic kidney disease (CKD) has increased steadily with population aging, CKD patients with a peripherally inserted central catheter (PICC) are encountered frequently. PICCs can cause CVD, and the basilic vein, which is regarded as the important last option for native arteriovenous fistula (AVF) creation in end-stage renal disease (ESRD) patients, is destroyed frequently after its use as the entry site of PICC. The most well-established risk factors for CVD are a history of central venous catheter (CVC) insertion and its duration of use. Therefore, to reduce the incidence of CVD, catheterization in the central vein (CV) should be minimized, along with its duration of use. In this review, we will first explain the basic territories of the CV and introduce its pathophysiology, clinical features, and advanced treatment options. Finally, we will emphasize prevention of CVD.

Myasthenia gravis

Myasthenia gravis (MG) is an autoimmune disorder caused by antibodies against acetylcholine receptors (AChR) or other structural proteins of the neuromuscular junction. This diminishes cholinergic transmission, thus leading to exercise-induced fatigue and sometimes manifest muscle weakness, including the bulbar and ocular musculature. Whereas ocular MG is as a rule initially symptomatically treated with acetylcholine esterase inhibitors, generalized MG requires long-term immunosuppression. The thymus plays aparticular role in the pathophysiology of AChR antibody-positive MG, which can also manifest as aparaneoplastic disorder in the context of athymoma. This article reviews the basic and advanced treatment options of the different disease subtypes including plasma exchange and immunoglobulins for treatment in a myasthenic crisis. Recently, clinical approval of eculizumab, acomplement inhibitor, enriched the pharmacological armamentarium for AChR antibody-positive MG patients not appropriately responding to immunosuppression alone.

Abstract 869: Molecular characterization of a pediatric high-grade glioma (pHGG) mouse model harboring the H3.3 G34R mutation

Abstract Pediatric high-grade glioma (pHGG) accounts for 8-12% of central nervous system tumors and has a 90% mortality rate. Consequently, novel therapies are needed to advance treatment options and improve survival rates. A means to do this is through designing a mouse model that accurately mirrors pHGG in humans to further study this type of pHGG and design treatment options. We focused on the analysis of pHGG harboring mutations on histone H3.3 at glycine 34 (H3.3 G34R) in combination with ATRX and TP53 mutations. We generated a mouse model for pHGG using the sleeping-beauty transposase system and the delivery of plasmids into the sub-ventricular zone of neonatal mice. This results in the transposon-mediated integration of the genetic lesions into the brain cells, thereby allowing the generation of tumors with the desired molecular alterations. Two groups of mice have been developed; the control group (WT H3.3 group) bears tumors generated with the NRASV12 overexpression and two shRNA that target the Tp53 and Atrx genes. The H3.3 G34R group of mice harbors tumors generated with NRASV12 expression, sh-TP53, sh-ATRX, and H3.3 G34R expression. RNA-sequencing was carried out to analyze the transcriptome signature associated with the H3.3 G34R tumor phenotype. Several genes related to the activation of the immune response were differentially upregulated in the H3.3 G34R tumors, such as Ciita, CD74, and Irfl, amongst others. Some of these deregulated genes were validated by immunohistochemistry. Understanding the tumor transcriptome and characterizing the tumor’s immune microenvironment are crucial for the development of gene and immune therapies designed to target H3.3 G34R pHGG. Citation Format: Matthew J. Whalen, Maria B. Garcia-Fabiani, Felipe J. Núñez, Pedro R. Lowenstein, Maria G. Castro. Molecular characterization of a pediatric high-grade glioma (pHGG) mouse model harboring the H3.3 G34R mutation [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 869.

Geriatric chest wall injury: is it time for a new sense of urgency?

Geriatric trauma has become an increasingly recognized management concern for trauma centers, and hospitals alike, on a national scale. The population of the United States is aging, as life expectancy rates have demonstrated a steady climb to an average of 78.8 years of expected life. With pervasive efforts of medical screening, prevention and chronic medical condition management, more elderly people will lead more active lifestyles and will be more predisposed to injury. As best practice guidelines specific for the geriatric trauma population have yet to be developed, many researchers have identified management strategies that have offset complications and mortality rates inherent to this patient population after injury. The impact of rib fractures in the 65-year and older patient population has been well documented, as have the mortality and pneumonia rates yet, historically, little attention has been directed to curtailing these adverse outcomes with more advanced treatment options. With the advent of rib plating for rib fracture fixation and chest wall stabilization, the practice paradigm for rib fracture management is shifting, as a viable operative intervention now exists. In this review, we focus on the characteristics of the geriatric trauma patient, areas of management where improvement opportunities have been identified, chest wall injury in the elderly patient, rib plating as a treatment option and offer our data to facilitate a better understanding of rib plating's impact in the geriatric trauma patient.

Patient-centered engagement and symptom/toxicity monitoring in the new era of tumor next-generation sequencing and immunotherapy: The OncoTool and OncoPRO platforms.

The growing use of tumor next‐generation sequencing and immunotherapy has led to an increasing need among providers and patients for educational resources and supportive resources for remote and routine symptom and toxicity monitoring. This article describes the development of the OncoTool and OncoPRO platforms, which have been designed to provide easy‐to‐comprehend patient education about advanced cancer treatment options, generate more accurate expectations about tumor next‐generation sequencing and treatment toxicities, and conduct remote and routine monitoring of patient‐reported symptoms, toxicities, and quality of life.

Bioactive Compounds in the Ethanol Extract of Marine Sponge Stylissa carteri Demonstrates Potential Anti-Cancer Activity in Breast Cancer Cells

Objective:Despite advanced treatment options available, drug resistance develops in breast cancer (BC) patients requiring novel effective drugs. Stylissa carteri, a marine sponge predominantly living in Indonesia territories, has not been extensively studied as anti-cancer. Therefore, this study targeted to assess the anti-tumor activity of the ethanol extract of S. carteri in BC cells. Methods: S. carteri was collected from Pramuka Island, at Kepulauan Seribu National Park, Jakarta, Indonesia and extracted using ethanol. Different BC cells including MDA MB 231, MDA MB 468, SKBR3, HCC-1954 and MCF-7 cells were treated with this extract for cytotoxic analysis using MTT assay. Spheroid growth assay and apoptosis assay were conducted in HCC-1954 cells. In addition, cell migration analysis and synergistic activity with doxorubicin or paclitaxel were conducted in MDA MB 231 cells. This extract was subjected also for GC-MS analysis. Results:The results show that ethanol extract of S. carteri demonstrated a cytotoxic activity in BC cells. The IC50 of this extract was lower 15 μg/ml in MDA MB 231, MDA MB 468, SKBR3, and HCC-1954 cells. Moreover, this extract inhibited spheroids growth and induced apoptosis in HCC-1954 cells. It inhibited cell migration and demonstrated a synergistic activity with doxorubicin or paclitaxel on triggering cell death in MDA MB 231 cells. Furthermore, GC-MS analysis indicated that this extract contained 1,2-Benzenediol, Dibutyl phthalate and 9,12-Octadecadienoic acid, ethyl ester. Conclusion:Our preliminary data indicate a potential anti-tumor activity of ethanol extract of S. carteri in breast cancer cells.

312 First Vascularized Composite Allotransplantations in Rats after 6 Hours of Ex Vivosubnormothermic Machine Perfusion Using an Hemoglobin Oxygen Carrier: A Proof of Concept Study

Vascularized composite allotransplantation (VCA) remains the most advanced treatment option to restore motor function and aesthetics in patients living with devastating disfigurements. However, the current method of organ preservation (static cold storage), successfully used in solid organ transplantation, can jeopardize the quality of VCA grafts and could accelerate the risk of chronic rejection. Ex vivo subnormothermic oxygenated machine perfusion (SNMP) is a novel method of preservation demonstrated to improve the quality of solid organs prior to transplantation. The aim of this study was to transplant a VCA (heterotopic hind limb model) after 6 hours of SNMP. Seven rodent hind limbs were procured after systemic heparinization (300 IU). All limbs were perfused for 6 hours via the femoral artery using a pressure-controlled system, and the venous outflow was prepared for sample collection. The perfusion solution base consisted of a mixture of muscle media with growth factors, bovine serum albumin, polyethylene glycol and an acellular oxygen carrier. Arterial flow and vascular resistance were monitored. Lactate levels and oxygen consumption were evaluated as markers of viability of muscle tissue. After 6 hours of SNMP, 5 limbs were prepared for biopsy collection. Muscle biopsies analyzed with liquid chromatography-mass spectrometry for energetic cofactors, referred to as energy charge. In solid organ transplantation, peri-transplant energy status significantly correlates with post-transplant outcome. Furthermore, muscle biopsies were prepared for cell culture to assess viability. Two limbs were transplanted in a heterotopic fashion. Arterial outflow and vascular resistance remained stable throughout perfusion, between 0.5-3.0 mL/min and 20-40 mmHg/mL/min respectively. During 6 hours of perfusion, lactate levels decreased while potassium levels and oxygen consumption remained stable. Energy charge levels were comparable to fresh controls. After 6 hours of perfusion muscle biopsy had 80% viability and cells grew great in culture with no signs of contamination. Median post-operative follow up was 48 hours and grafts showed no signs of early graft failure or infection. This study demonstrates that 6 hours ex vivo SNMP of rat hind limbs is feasible and viability of the grafts are confirmed with both cell culture and in a transplant model. Current studies are investigating superiority of SNMP over SCS in our transplant model. Perfusion before re-plantation may allow sufficient time for wounded soldiers to be treated and stabilized before undergoing complex reconstructive surgery.

Negative Pressure Wound Therapy: An Asset When Treating Pediatric Osteoarticular Infection

Pediatric osteoarticular infection can lead to serious sequelae and permanent disability. The purpose of this study was to describe use of Negative Pressure Wound Therapy (NPWT) as an advantageous treatment option for pediatric patients with osteoarticular infection. NPWT has not been used in pediatric articular infections and has only been published in animal models.

Perfluorooctanoic Acid (PFOA): Environmental Sources, Chemistry, Toxicology, and Potential Risks

ABSTRACT Attention regarding perfluoroalkyl and polyfluoroalkyl substances (PFAS) has increased in recent years, due to recognition of widespread environmental presence, recognition of a chemical structure that confers resistance to degradation, and reported health concerns. Historical common exposure sources include food, drinking water, occupational circumstances, and products in commerce (e.g., carpeting, clothing, paper products). Early-2000’s data showed perfluorooctanoic acid (PFOA) was present in blood samples from nearly all the U.S. general population (>99%). Alterations in industrial manufacturing processes, increased regulatory scrutiny, and advanced water treatment options have reduced the reported human body burden of PFAS in the U.S., including for PFOA. Human serum concentrations of PFOA, which do not identify the source(s) of exposure, have exhibited a substantial decrease (~63%) between the 1999–2000 and the 2013–2014 NHANES monitoring by the Centers for Disease Control and Prevention (CDC). With respect to both noncancer and potential cancer effects that may be associated with reported serum levels of PFOA, conclusions regarding an absence of effects, or insufficient information to suggest adverse effects, prevent a consistent conclusion about the occurrence and magnitude of human health effects. In the last several years, a number of state and federal agencies have developed health advisories or guideline values for drinking water exposure that are in the sub-ppb range. In 2016, a USEPA Health Advisory of 0.07 ppb was released, which stands in contrast to 2016 Health-based Values from Health Canada ranging from 0.2 ppb (PFOA) to 30 ppb, and a few other U.S. states with values even less than that of USEPA (e.g., MN, NJ, VT). Further work is necessary to distinguish in transparent fashion between drinking water levels that intentionally are set on a conservative basis to protect human health vs exposure levels that may be associated with tangible adverse effects.

Mind the Gap Between Scientific Literature Recommendations and Effective Implementation. Is There Still a Role for Surgery in the Treatment of Locally Advanced Cervical Carcinoma?

According to evidence accumulated in the last years, many cancer centers recommend a treatment plan based solely on chemo-radiotherapy and exclude surgery from the treatment options in locally advanced cervical cancer (LACC). In Romania, surgery was at the forefront of therapeutic options. Nevertheless, current data shows that in fact, a large number of patients are still referred to surgery in various stages of diagnosis and treatment. It was noted that recommendations may differ, in spite of the wide dissemination of the literature data.Works published so far, discussing the role of surgery in LACC treatment shows a lack of consensus. A group of experts in oncology (SURCECAN research group - Surgery of Cervical Cancer) met for a session of the Romanian Surgical Society (Bucharest) on April 18, 2018. They found that LACC therapeutic strategy in Romania may differ somewhat from the European recommendations.On top of that, late enrolement to RT and low acces to specialized centers are the problem. Performing surgery not only allows the evaluation of the pathological response to chemo-radiotherapy, but also achieves a better local control. In conclusion, there is still a place for surgery within locally advanced cervical cancer treatment options. More trials need to be carried out in order to confirm the findings and establish high levels of confidence for each piece of information provided.