Optimal Debulking Research Articles

Usefulness of human epididymis protein 4 in predicting cytoreductive surgical outcomes for advanced ovarian tubal and peritoneal carcinoma.

Human epididymis protein 4 (HE4) is a promising biomarker of epithelial ovarian cancer (EOC). But its role in assessing the primary optimal debulking (OD) of EOC remains unknown. The purpose of this study is to elucidate the ability of preoperative HE4 in predicting the primary cytoreductive outcomes in advanced EOC, tubal or peritoneal carcinoma. We reviewed the records of 90 patients with advanced ovarian, tubal or peritoneal carcinoma who underwent primary cytoreduction at the Department of Obstetrics and Gynecology of Peking University People's Hospital between November 2005 and October 2010. Preoperative serum HE4 and CA125 levels were detected with EIA kit. A receiver operating characteristic (ROC) curve was used to determine the most useful HE4 cut-off value. Logistic regression analysis was performed to identify significant preoperative clinical characteristics to predict optimal primary cytoreduction. OD was achieved in 47.7% (43/48) of patients. The median preoperative HE4 level for patients with OD vs. suboptimal debulking was 423 and 820 pmol/L, respectively (P<0.001). The areas under the ROC curve for HE4 and CA125 were 0.716 and 0.599, respectively (P=0.080). The most useful HE4 cut-off value was 473 pmol/L. Suboptimal cytoreduction was obtained in 66.7% (38/57) of cases with HE4 ≥473 pmol/L compared with only 27.3% (9/33) of cases with HE4 <473 pmol/L. At this threshold, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for diagnosing suboptimal debulking were 81%, 56%, 67%, and 73%, respectively. Logistic regression analysis showed that the patients with HE4 ≥473 pmol/L were less likely to achieve OD (odds ratio =5.044, P=0.002). Preoperative serum HE4 may be helpful to predict whether optimal cytoreductive surgery could be obtained or whether extended cytoreduction would be needed by an interdisciplinary team.

Toxicity of intraperitoneal chemotherapy and risk factors for severe toxicity in optimally debulked ovarian cancer patients

ObjectiveTo assess the effect and toxicity of intraperitoneal (IP) chemotherapy for epithelial ovarian cancer and to determine the risk factors for severe toxicity. Materials and methodsPatients who received IP chemotherapy after optimal debulking surgery for ovarian cancer between 2006 and 2012 were retrospectively reviewed. Clinical characteristics were compared between patients with none/Grade 1 or Grade 2 toxicity and those with Grade 3 or Grade 4 toxicity. ResultsIn 41 patients, the mean number of IP cycles administered was 5.6 and most patients (80.5%) completed at least six cycles. The reasons for discontinuation were catheter-related problems (30%), disease progression (20%), or drug-related adverse effects (30%). Grade 3 or Grade 4 toxicity was observed in 30 patients (73.2%). The rate of neoadjuvant chemotherapy was higher in the patients with Grade 3 or Grade 4 toxicity (37%) than in the patients without Grade 3 or Grade 4 toxicity (9%), however, this difference was not significant (p = 0.128). During a mean follow-up period of 33.6 months, tumor recurrence occurred in 20 (48.8%) patients and the median progression-free survival was 30.0 months. ConclusionDespite the high rate of adverse events, IP chemotherapy can be delivered with a high completion rate and manageable toxicity to patients with optimally debulked ovarian cancer. Toxicity should be closely monitored in patients who have received neoadjuvant chemotherapy until a large prospective study can be performed to determine its influence.

Does a standardized preoperative algorithm of clinical data improve outcomes in patients with ovarian cancer? A quality improvement project.

To evaluate the potential impact of a standardized preoperative algorithm on outcomes of patients with suspected ovarian cancer. From January 1 to December 31, 2013, patients with suspected ovarian cancer were triaged to primary debulking surgery or neoadjuvant chemotherapy/interval debulking surgery (NACT/IDS) based on a comprehensive review of preoperative clinical data as part of a quality improvement project. Demographics, surgical, and postoperative data were collected. A total of 110 patients with newly diagnosed ovarian cancer were identified: 68 (62%) underwent PDS with an 85% optimal debulking rate. The 30-day readmission rate was 14.7% with a 2.9% 60-day mortality rate. Forty-two patients (38%) underwent NACT. Two patients (4.8%) died before receiving NACT. Thirty-five patients have undergone IDS with an 89% optimal debulking rate. The 30-day readmission rate was 8.5% with a 5.7% 60-day mortality rate after IDS. Although it is difficult to predict which patients will undergo optimal debulking at the time of PDS, surgical morbidity and mortality can be decreased by using NACT in select patients. The initiation of a quality improvement project has contributed to an improvement in patient outcomes at our institution.

Cytokine profiling of ascites at primary surgery identifies an interaction of tumor necrosis factor-α and interleukin-6 in predicting reduced progression-free survival in epithelial ovarian cancer

ObjectivesEpithelial ovarian cancer (EOC) typically presents with advanced disease. Even with optimal debulking and response to adjuvant chemotherapy, the majority of patients will have disease relapse. We evaluated cytokine and chemokine profiles in ascites at primary surgery as biomarkers for progression-free survival (PFS) and overall survival (OS) in patients with advanced EOC. MethodsRetrospective analysis of patients (n =70) who underwent surgery at Roswell Park Cancer Institute between 2002 and 2012, followed by platinum-based chemotherapy. ResultsThe mean age at diagnosis was 61.8 years, 85.3% had serous EOC, and 95.7% had stage IIIB, IIIC, or IV disease. Univariate analysis showed that ascites levels of tumor necrosis factor (TNF)-α were associated with reduced PFS after primary surgery. Although the ascites concentration of interleukin (IL)-6 was not by itself predictive of PFS, we found that stratifying patients by high TNF-α and high IL-6 levels identified a sub-group of patients at high risk for rapid disease relapse. This effect was largely independent of clinical prognostic variables. ConclusionsThe combination of high TNF-α and high IL-6 ascites levels at primary surgery predicts worse PFS in patients with advanced EOC. These results suggest an interaction between ascites TNF-α and IL-6 in driving tumor progression and resistance to chemotherapy in advanced EOC, and raise the potential for pre-treatment ascites levels of these cytokines as prognostic biomarkers. This study involved a small sample of patients and was an exploratory analysis; therefore, findings require validation in a larger independent cohort.

Optimal debulking surgery in patients with advanced uterine carcinosarcoma: A multi-institutional retrospective study from the Japanese Gynecologic Oncology Group.

5591 Background: The benefit of cytoreductive surgery for uterine carcinosarcoma (CS) is unknown. The objective of this study was to assess the impact of optimal debulking surgery on survival of ad...

Carboplatin and paclitaxel dose dense as neoadjuvant chemotherapy follow by interval cytoreduction in advanced ovarian cancer.

e16553 Background: Neoadjuvant chemotherapy with Carboplatin and Paclitaxel every 3 weeks show higher rates in optimal debulking surgery compared with those primarily operated. We explored Carboplatin and Paclitaxel dose-dense as neoadjuvant treatment for advanced ovarian carcinoma. Methods: Patients with primarily unresectable epithelial ovarian cancer was treated with carboplatin (AUC 6) day 1 plus paclitaxel 80 mg/m2 every week, Days 1-8-15 every 21 days for three cycles follow by interval cytoreduction and adjuvant chemotherapy for three more cycles. The main objective was rate of optimal cytoreduction and secondary objectives: pathologic response rate, time to progression, progression-free survival (PFS), overall survival (OS) and toxicity profile. Results: Between Jan-2011 and Dec-2013, 39 patients received neoadjuvant treatment, median age: 58 years (47-73), status performance, ECOG 1: 24 (61.5%). EC III-C/IV = 26/13. High grade serous adenocarcinoma 26 (66.7%), unspecified serous 10 (25.6%), Mucin...

Atypical presentation of a schwannoma mimicking recurrence of primary peritoneal cancer

In August 2013, a woman aged 59 years with known stage IIIC primary peritoneal cancer underwent robotic hysterectomy, bilateral salpingo-oophorectomy, lymph node dissection, omentectomy, and optimal debulking. She did not smoke and had never been pregnant. Her medical history included asthma, nephrolithiasis, heart murmur, and diethylstilbestrol exposure in utero. She had completed her sixth cycle of intravenous and intraperitoneal carboplatin and paclitaxel. She planned on joining the GOG212 study (NCT00108745), which is a randomized phase 3 trial comparing paclitaxel, polyglutamate paclitaxel, and observation only in patients with stage III or stage IV ovarian epithelial, peritoneal, or fallopian tube cancer. During work-up for the study, a restaging computed tomography (CT) scan on January 7, 2014, revealed a 3-cm left iliac retroperitoneal mass, suspicious for recurrent cancer in an enlarged lymph node. The mass had not been identified on a CT scan performed 3 weeks before her initial surgery. Cancer antigen 125 levels were within normal range. The patient underwent an uncomplicated robotic-assisted laparoscopic resection of the retroperitoneal mass and left pelvic lymph node dissection; cryosection was performed to rule out persistent disease. Intraoperative evaluation of the mass revealed a low-grade spindle cell tumor. Evaluation of a permanent section revealed that the mass was S100 positive, and actin and desmin negative—findings consistent with schwannoma. The remaining peritoneal biopsy samples were negative. After surgery, she developed neuropathy of the left lower leg, with weakness on hip flexion, and intermittent numbness of the left foot. She could walk without difficulty. The deficit improved slowly, and the patient declined physical therapy. As of January 2015, there were no residual symptoms remaining. The findings of the surgery were discussed with the patient. The GOG212 study was no longer recruiting patients at this point, so maintenance chemotherapy with paclitaxel was resumed. The patient provided informed consent for publication of the present report. Retroperitoneal schwannomas are uncommon, but have been reported in the literature. The point of interest in the case reported here is the nature of the tumor, mimicking a recurrence of the patient’s cancer. The patient was on chemotherapy during the time of diagnosis, usually indicating recurrence with metastases. Two cases of retroperitoneal schwannomas mimicking metastatic seminomas have been previously reported [1,2]. Both were treated with chemotherapy, without a response. Excision of the lesions revealed a pathologic diagnosis of benign schwannoma requiring no further treatment. Schwannomas are difficult to diagnose without surgical evaluation, but should be considered in the differential diagnosis when a mass is not responsive to chemotherapy. A misdiagnosis could potentially cause overtreatment and unnecessary adverse effects.

Metastatic collision tumour: A case report

Abstract Background Collision tumours are extremely rare. They are defined by the presence of two tumours of different histological origin in the same organ. Clinical case A 71-year-old female with history of a carcinoid tumour removed 20 years ago without any recurrence. The patient was admitted with intestinal occlusion symptoms secondary to a right flank abdominal tumour. An exploratory laparotomy was performed, removing the tumour and applying optimal debulking. The histopathological study reported bilateral ovary adenocarcinoma, as well as metastatic collision tumour of two histological types: well differentiated adenocarcinoma and a mixed malignant mesodermic Mullerian tumour. The patient was treated with adjuvant chemotherapy with poor results (death in 24 months). Conclusions The presence of collision tumours is extremely rare. There are no statistics or specific treatment reported. Diagnosis is made with histopathology. At the moment, no similar cases have been reported.

Oncologic Concerns regarding Laparoscopic Cytoreductive Surgery in Patients with Advanced Ovarian Cancer Submitted to Neoadjuvant Chemotherapy

Background: Presently, the use of laparoscopy in advanced ovarian cancer (AOC) is extremely controversial. In the era of neoadjuvant chemotherapy (NACT), endoscopic debulking surgery could be a reasonable alternative for selected patients with primarily unresectable disease. Objectives: To evaluate the feasibility as well as the operative and oncologic safety of laparoscopic debulking surgery in patients with AOC submitted to NACT. Methods: This is a pilot observational study on initially unresectable, high-grade serous ovarian cancer treated with a sequence of 6 cycles of carboplatin and paclitaxel followed by debulking surgery performed by laparoscopy (group 1) or laparotomy (group 2). The inclusion criteria were clinical complete response, CA-125 normalization, imaging without disease in critical areas, and optimal cytoreduction. Results: From January 2011 to March 2014, 21 patients were included. Ten women underwent laparoscopy and 11 laparotomy. No epidemiological or oncologic differences were observed between the groups. No surgery-related casualties, intraoperative complications, conversion to laparotomy, or excessive blood loss or transfusion was detected in the laparoscopic procedures. The mean time of operation was 292 min. The length of hospital stay averaged 3.6 days. Two women in group 1 developed relevant complications. After a mean follow-up of 20 months, the recurrence rates were similar, i.e. 80% in group 1 versus 88% in group 2. Although statistical significance was not reached, the mortality related to cancer was considerably higher (20 vs. 0%; p = 0.086) and the mean chemotherapy-free interval was markedly shorter in group 1 (13.3 vs. 20.5 months; p = 0.288). Conclusion: Laparoscopic optimal debulking surgery after NACT is feasible and effective in selected patients. Nevertheless, laparoscopy was substantially associated with inferior oncologic results. Endoscopic cytoreduction in AOC should be cautiously suggested until larger prospective trials confirm the observed results.

Advanced endocervical adenocarcinoma metastatic to the ovary presenting as primary ovarian cancer

Dear Editor,Cervical squamous cell carcinoma (SCC) and adenocarcinomamay involve the ovary. Although it is not difficult to diagnose inmost cases, on very rare occasions the presentation may showsymptoms related to an ovarian mass, with the cervical cancerbeing undetected, especially endocervical adenocarcinoma [1,2].This is important because the challenge of diagnosing primaryendocervical adenocarcinoma occurs especially in women whoshow no symptoms, and have a grossly normal cervix and anegative Pap smear [3]. The spread of cervical malignancy (bothSCC and adenocarcinoma) is often through lymphatic drainage ordirect invasion [4]; except some reports show that endocervicaladenocarcinoma carries a higher risk of ovarian metastases thanSCC of the cervix [5]. There is an apparent difference in the treat-ment strategy for advanced cervical cancers and ovarian cancers[6,7]. Therefore, making an accurate diagnosis before planningtherapy is of paramount importance. The following is a case reportof advanced cervical adenocarcinoma metastatic to the ovarymimicking primary ovarian cancer.A 54-year-old menopausal woman (G3P3) visited the emer-gency room due to acute sudden onset of abdominal pain afterseveral weeks of abdominal fullness. Her past medical history wasunremarkable. She did not have any Pap smears since the birth ofherlastchild(28yearspreviously).Physicalexaminationrevealedaprotuberant and tense abdomen, but the cervix was essentiallynormal. Transvaginal ultrasound revealed a 15 cm complex cysticmass lesion located at the right adnexal area accompanied withmassive ascites, but the uterus and the left ovary seemed to benormal.Computedtomographyidentifiedandconfirmed theabovefinding (Fig. 1). Serum tumor markers, including CA 125, CA 199,and CEA were 286.0 U/mL, 209.0 U/mL, and 226.0 ng/mL, respec-tively. Other investigations, including hematological andbiochemical tests, a chest X-ray, and upper and lower gastrointes-tinal (GI) tract evaluations were within normal limits.Under the diagnosis of ovarian malignancy, the patient under-went a laparotomy. During surgery, a right ovarian cystic complexmass with a mucinous component (Fig. 2) accompanied withmassive ascites (7000 mL) and peritoneal carcinomatosis wasfound. The immediate frozen pathology report favored a diagnosisof adenocarcinoma-mucinous type. Therefore, the patient under-went an optimal debulking surgery, including total hysterectomy(Fig. 3), bilateral salpingo-oophorectomy, infracolic omentectomyand retroperitoneal lymph node sampling, and multiple biopsies.However, the final pathologic report was primary uterine endo-cervical adenocarcinoma.Pathologic features included hyperchromatic dysplasia of themucinous glandular cells of the uterine endocervix; the mucinoustumor occupied the whole layer of the endocervix and extended tothe lower segment of the uterine body. Other sections of the rightovary, appendix, omentum, abdominal wall, and mesentery allshowed tumor metastases with floating mucinous tumor cellswithin an extensive mucin pool.The patient was treated with adjuvant systemic chemotherapy(8 cycles of topotecan [Hycamtin Injection, GlaxoSmithKline, San

Effect of Endometriosis on the Prognosis of Ovarian Clear Cell Carcinoma: A Two-Center Cohort Study and Meta-analysis.

Whether endometriosis affects the prognosis of ovarian clear cell carcinoma (OCCC) remains controversial despite the relationship between OCCC and endometriosis. A two-center cohort study and meta-analysis were performed to investigate the effect of endometriosis on the prognosis of OCCC. The study reviewed the clinicopathologic data of 109 patients with OCCC arising (n=47) or not arising (n=62) in endometriosis between 1997 and 2012 at two tertiary medical centers. Tumor response and survival were compared between the two groups. For further evaluation, PubMed, EmBase, and the Cochrane Library were searched, and a meta-analysis was conducted using 10 cohort studies published from March 1996 to May 2014, including the current cohort study. Complete response did not differ between the patients with OCCC arising in endometriosis and those without endometriosis (77.5 vs. 87.3%; P=0.444). Early-stage disease and optimal debulking surgery were the only independent factors that reduced the risk of noncomplete response (adjusted odds ratios 0.203 and 0.038; 95% confidence intervals [CIs] 0.045-0.920 and 0.006-0.226, respectively). Progression-free survival (PFS) and overall survival (OS) did not differ between the two groups. Early-stage disease and optimal debulking surgery were the only favorable factors that improved PFS (adjusted hazard ratios [HRs] 0.216 and 0.332; 95% CIs 0.099-0.469 and 0.150-0.732, respectively) and OS (adjusted HRs 0.099 and 0.339; 95% CIs 0.039-0.252 and 0.141-0.815, respectively). Furthermore, crude and subgroup meta-analyses showed no effect of endometriosis on PFS or OS in OCCC patients. Endometriosis may not affect the tumor response or the prognosis of OCCC patients.

CRT-310 Intravascular Ultrasound Assessment of the Optimal Number of Runs Using the JetStream Navitus Device to Achieve Maximum Tissue Debulking in Femoral Artery in-Stent Restenosis Porcine Model

The JetStream Navitus (JS) atherectomy device (Boston Scientific) is a rotational cutter with aspiration capability to treat infrainguinal arterial obstructive disease. Intravascular ultrasound (IVUS) assessment of the number of blades up (BU) runs needed to achieve optimal tissue debulking in in-

Increased Notch1 expression is associated with poor overall survival in patients with ovarian cancer.

Despite improvements in surgery and chemotherapy, ovarian cancer remains a deadly disease in need of improved therapies. We have previously shown that Notch1 intracellular domain (NICD) is highly expressed in ovarian cancer. We have also shown that NICD inhibition can lead to growth arrest in ovarian cancer cells. The objective of the current study was to delineate whether NICD expression correlates with prognosis of women with ovarian cancer. After the institutional review board approval, patients with a diagnosis of primary ovarian cancer between the years 2001 and 2007 who underwent surgery at our institution were identified. Paraffin blocks from the primary ovarian tumor were analyzed, and core samples were obtained to build a tissue microarray. Cytoplasmic NICD expression was assessed by quantitative immunofluorescent morphometry using the automated quantitative analysis system. These results were correlated with clinical and pathology data retrieved from the patient records. We identified 328 patients with primary ovarian cancer during this period. Seventeen percent of patients had stage I, 11% had stage II, 59% had stage III, and 13% had stage IV disease. Most patients (70%) had papillary serous histology, and most (86%) underwent optimal debulking to less than 1 cm of residual disease. High NICD expression was found to correlate strongly with low overall survival (P = 0.001). This effect remained in multivariate analysis (P = 0.023). High expression of NICD in the primary tumor of women with ovarian cancer is an independently poor prognostic factor for overall survival. Further research into the therapeutic inhibition of the Notch1 pathway is warranted.

Modulation of intraperitoneal (IP) chemotherapy in ovarian cancer

The standard platinum-based treatment of previously untreated advanced ovarian cancer continues to evolve because despite high response rates to first-line treatment, a majority of patients relapse. Several randomized multicenter phase III clinical trials demonstrated that intraperitoneal (IP) chemotherapy is superior to standard intravenous (IV) chemotherapy following primary optimal debulking surgery. However, the challenge of further improving efficacy and reducing toxicity remains. The underlying rationale for use of IP therapy is based on the pharmacologic principle that peritoneal tumors can be exposed to higher doses of drug for longer periods of time than can be accomplished with systemic delivery. IP drug delivery to tumors is hampered by poor drug penetration which is multifactorial. Research addressing mechanisms by which improved drug penetration or direct delivery to tumors can be achieved are key areas of interest. This review will discuss the potential role of consolidation with platinum based IP chemotherapy during interval debulking surgery following neoadjuvant chemotherapy for patients with advanced disease.

Gonadal vein leiomyosarcoma: A case report with radiological findings

A 56 year old postmenopausal lady presented with a rapidly enlarging pelvis mass. Clinical and ultrasonographic features were compatible with a rapidly enlarging fibroid with possible sarcomatous changes, and hence, computated tomography (CT) scan was performed to further delineate the nature and extent of the disease. However, CT scan revealed a huge tumour arising from the retroperitoneal space along the course of the left gonadal vein with typical radiological features of a gonadal vein leiomyosarcoma which were described in previous literatures. With joint collaboration with the surgeons, radical surgery with optimal debulking was subsequently performed for the patient and the diagnosis was confirmed intra-operatively and histologically.

Immunotherapy for ovarian cancer.

All work referenced herein relates to treatment of epithelial ovarian carcinomas, as their treatment differs from ovarian germ cell cancers and other rare ovarian cancers, the treatments of which are addressed elsewhere. Fallopian tube cancers and primary peritoneal adenocarcinomatosis are also generally treated as epithelial ovarian cancers. The standard of care initial treatment of advanced stage epithelial ovarian cancer is optimal debulking surgery as feasible plus chemotherapy with a platinum plus a taxane agent. If this front-line approach fails, as it too often the case, several FDA-approved agents are available for salvage therapy. However, because no second-line therapy for advanced-stage epithelial ovarian cancer is typically curative, we prefer referral to clinical trials as logistically feasible, even if it means referring patients outside our system. Immune therapy has a sound theoretical basis for treating carcinomas generally, and for treating ovarian cancer in particular. Advances in understanding the immunopathogenic basis of ovarian cancer, and the immunopathologic basis for prior failures of immunotherapy for it and other carcinomas promises to afford novel treatment approaches with potential for significant efficacy, and reduced toxicities compared with cytotoxic agents. Thus, referral to early phase immunotherapy trials for ovarian cancer patients that fail conventional treatment merits consideration.

The feasibility of administering varying high-dose consolidation hyperthermic intraperitoneal chemotherapy with carboplatin in the treatment of ovarian carcinoma

Hyperthermic intraperitoneal chemotherapy (HIPEC) is an intriguing method of delivery wherein the cytotoxic agent is continuously heated and circulated throughout the peritoneum in an attempt to bolster drug efficacy. Despite HIPEC's potential, ascertaining the optimal dose without compromising patient tolerability remains indeterminate. We retrospectively evaluated 52 advanced stage ovarian cancer patients who were treated with consolidation HIPEC with carboplatin at varying doses (e.g., AUC 6, 8 or 10) subsequent to optimal debulking surgery and the attainment of a clinical complete response to their primary chemotherapy regimen. The following patient and operative characteristics were abstracted: demographics, surgery and pathology data, chemotherapy regimen, intraoperative results, toxicity, postoperative complications, length of hospital stay and survival data. Twelve patients received HIPEC carboplatin at an AUC 6, 15 subjects were treated with carboplatin at an AUC 8 and 25 underwent carboplatin at an AUC 10. There were no intraoperative complications during the administration of HIPEC; mean estimated blood loss was 50 mL and length of hospital stay was 1.65 days. In the overall study population, 5 patients developed grade 3/4 anemia and 33 subjects exhibited grade ≤2 thrombocytopenia and neutropenia. Thirteen patients also developed grade ≤2 nausea on postoperative day 1, which was successfully addressed with anti-emetic therapy; there were no hospital readmissions. The results from the current evaluation suggest that consolidation hyperthermic intraperitoneal chemotherapy with carboplatin is both feasible and reasonably tolerated, even at an AUC of 10. However, additional, randomized study of this procedure incorporating chemotherapy dose escalation with a more extensive patient population is warranted.

Ovarian cancer: imaging in treatment selection and planning with FIGO update

The International Federation of Gynecologists and Obstetricians (FIGO) has recently revised the staging of ovarian cancer [1]. It includes a revision of the stage III patients and allotment to stage IIIA1 is based on spread to the retroperitoneal lymph nodes without intraperitoneal dissemination, because an analysis of these patients indicates that their survival is significantly better than those who have intraperitoneal dissemination [1]. The FIGO staging system for ovarian cancer is surgically based. It does not formally include imaging but the FIGO committee encourages the use of imaging techniques if available to assess the important prognostic factors such as disease resectability and lymph node status. The standard of care for patients with newly diagnosed advanced ovarian cancer has been comprehensive staging laparotomy and primary optimal surgical cytoreduction followed by adjuvant chemotherapy. However, the use of neoadjuvant chemotherapy followed by interval debulking surgery (IDS) as a suitable alternative is supported by multicenter randomized controlled trials [2]. Imaging is therefore of paramount importance in helping triage patients for appropriate management by accurately evaluating the extent and anatomical location of peritoneal spread, which in turn dictates the feasibility of cytoreductive surgery and predicts the likelihood of optimal primary cytoreduction. Optimal cytoreductive surgery (residual disease <1 cm) is a very strong predictor of survival, and even after the threshold for optimal cytoreduction has been reached, it is important to remove as much of the residual tumor as possible. CT is the primary imaging modality used to stage ovarian cancer. It is complimentary to surgical staging identifying possible sites of unsuspected disease such as pelvic peritoneum, paraaortic nodes, diaphragm and chest [3,4]. The thorax frequently harbors undiagnosed pleural disease at the time of the initial diagnosis which is likely to affect survival even in cases of optimal debulking [5,6]. Accurate imaging helps guide the surgeon to areas of disease that may be difficult to identify surgically. Relative criteria for non-optimally resectable disease have been developed [7]. They include lymph node enlargement above the renal hilum, presence of abdominal wall invasion, parenchymal liver and subcapsular liver metastases, peritoneal implants of >2 cm along the diaphragm, lesser sac, porta hepatis, intersegmental fissure, gall bladder fossa, gastrosplenic, gastrohepatic ligament and small bowel mesentery. However, it is important to realize that these criteria may vary and will depend on the aggressiveness of the surgical procedure and on the performance status of the patient. Therefore, they should only be used as a basis for a multidisciplinary consensus. It is important to note that upper abdominal disease and pleural metastases can be surgically resected, but this requires careful planning as it involves a team of surgeons (e.g. liver surgeons for hepatic resection). There has been a growing awareness of the potential of diffusion weighted magnetic resonance imaging (DW-MRI) in improving the mapping of the extent of ovarian cancer [8,9]. There is also growing evidence that FDG-PET/CT may play a role in pre-operative staging of patients with advance ovarian cancer [10].

Comparative study of ovarian clear cell carcinoma with and without endometriosis in People's Republic of China

To analyze and compare the clinicopathological features and prognosis of ovarian clear cell carcinoma (CCC) with or without endometriosis in Chinese patients. Comparative study based on a retrospective review of medical charts. A general university hospital. Two hundred ten patients diagnosed and treated with ovarian CCC between 2000 and 2012. Patients were divided into two groups depending on coexisting endometriosis. A comparison of clinicopathological characteristics was performed. The Kaplan-Meier model and Cox regression were employed in survival analysis. Clinicopathological parameters and survival outcomes. Of 210 patients, 79 (37.6%) were confirmed to have concurrent endometriosis. Patients with endometriosis were 8 years younger than those without. They were more likely to present at early stage (78.5%) with resectable tumors in primary surgery (with optimal cytoreduction rate at 89.9%) and platinum-sensitive disease (51.7%). Median overall survival for patients with endometriosis was 115 months, an increase of 52 months when compared with 63 months for patients without endometriosis. The 5-year survival rate in patients with endometriosis was 70.2%, while it was 52.6% for those without. Univariate and multivariate analysis showed that coexisting endometriosis was not an independent predictor of survival outcome. Tumor stage and optimal debulking were the independent prognostic factors for both overall survival and progression-free survival. Patients with ovarian CCC and coexisting endometriosis had distinct clinicopathological features and better survival outcome. However, endometriosis per se did not confer improved survival.

902P - Ovarian Carcinosarcoma Management: a Retrospective Analysis of the Royal Marsden Experience

ABSTRACT Aim: The optimal management of ovarian carcinosarcoma (OCS) is not established and prospective evidence is limited due to its rarity. The aim was to determine the effectiveness of treatment and explore potential factors predicting clinical outcome. Methods: A retrospective analysis of patients (pts) with OCS consecutively treated at The Royal Marsden Hospital between 2003 and 2012 was performed. Results: 66 pts were identified (mean age 65.3 years (42.4-86), FIGO stage III/IV at diagnosis 83%). 88% (58 pts) underwent surgery (41 primary, 17 interval) and optimal debulking was achieved in 65.5%. 94% (62 pts) received first line chemotherapy (38 adjuvant, 17 neoadjuvant, 7 without surgery). 3 pts had rapid progression resulting in death before chemotherapy. Platinum-based chemotherapy was used in 98% of pts. Radiological best response rate (RR) was 63%, with no significant difference between regimens (carboplatin/pegylated liposomal doxorubicin 67%, carboplatin/paclitaxel 60%, carboplatin 57%). 45 pts (73%) developed relapse/progression after first line chemotherapy (9 (20%) platinum-refractory, 23 (51%) platinum-resistant and 13 (29%) platinum-sensitive). 34 pts received further systemic treatment (radiological RR platinum-sensitive 42%, resistant 27%, refractory 0%). The median total number of systemic treatment lines from diagnosis was 2 (range 0-8). The median time from diagnosis to progression was 11.7 months (95%CI 10.1-13.5) for all patients and only 5.4 months for stage IV. In univariate analysis FIGO stage (p = 0.002), surgery (p Conclusions: OCS is a challenging disease. Clinical outcomes are poor compared to high grade serous carcinoma. Surgery and platinum-based chemotherapy are important management options for OCS. Rare cancers registries and randomised trials including OCS are needed to define optimal therapy. Disclosure: All authors have declared no conflicts of interest.