Pelvic Cancer Research Articles

Do Bacteria Provide an Alternative to Cancer Treatment and What Role Does Lactic Acid Bacteria Play?

Cancer is one of the leading causes of mortality and morbidity worldwide. According to 2022 statistics from the World Health Organization (WHO), close to 10 million deaths have been reported in 2020 and it is estimated that the number of cancer cases world-wide could increase to 21.6 million by 2030. Breast, lung, thyroid, pancreatic, liver, prostate, bladder, kidney, pelvis, colon, and rectum cancers are the most prevalent. Each year, approximately 400,000 children develop cancer. Treatment between countries vary, but usually includes either surgery, radiotherapy, or chemotherapy. Modern treatments such as hormone-, immuno- and antibody-based therapies are becoming increasingly popular. Several recent reports have been published on toxins, antibiotics, bacteriocins, non-ribosomal peptides, polyketides, phenylpropanoids, phenylflavonoids, purine nucleosides, short chain fatty acids (SCFAs) and enzymes with anticancer properties. Most of these molecules target cancer cells in a selective manner, either directly or indirectly through specific pathways. This review discusses the role of bacteria, including lactic acid bacteria, and their metabolites in the treatment of cancer.

Interferon regulatory factor 1-triggered free ubiquitin protects the intestines against radiation-induced injury via CXCR4/FGF2 signaling.

Radiation‐induced intestinal injury is a serious concern during abdominal and pelvic cancers radiotherapy. Ubiquitin (Ub) is a highly conserved protein found in all eukaryotic cells. This study aims to explore the role and mechanism of free Ub against radiogenic intestinal injury. We found that free Ub levels of irradiated animals and human patients receiving radiotherapy were upregulated. Radiation‐induced Ub expression was associated with the activation of interferon regulatory factor 1 (IRF1). Intraperitoneal injection of free Ub significantly reduced the mortality of mice following 5–9 Gy total body irradiation (TBI) through the Akt pathway. Free Ub facilitates small intestinal regeneration induced by TBI or abdominal irradiation. At the cellular level, free Ub or its mutants significantly alleviated cell death and enhanced the survival of irradiated intestinal epithelial cells. The radioprotective role of free Ub depends on its receptor CXCR4. Mechanistically, free Ub increased fibroblast growth factor‐2 (FGF2) secretion and consequently activated FGFR1 signaling following radiation in vivo and in vivo. Thus, free Ub confers protection against radiation‐induced intestinal injury through CXCR4/Akt/FGF2 axis, which provides a novel therapeutic option.

Risk and prognosis of secondary bladder cancer after radiation therapy for pelvic cancer.

BackgroundRadiation therapy (RT) is a crucial modality for the local control of pelvic cancer (PC), but the effect of pelvic RT on the development of secondary malignancy is still unclear. This study aimed to identify the relationship between radiation therapy received for the treatment of primary PC and subsequent secondary bladder cancer (SBC).MethodsThe Surveillance, Epidemiology, and End Results (SEER) database (from 1975 to 2015) was queried for PC. Fine-gray competing risk regression and Cox regression analyses were employed to assess the cumulative incidence of SBC. Poisson regression and multiple primary standardized incidence ratios (SIR) were used to evaluate the radiotherapy-associated risk for patients receiving RT. Subgroup analyses of patients stratified by latency time since PC diagnosis, calendar year of PC diagnosis stage, and age at PC diagnosis were also performed. Overall survival (OS) was compared among different treatment groups with SBC by Kaplan–Meier analysis.ResultsA total of 318,165 observations showed that the primary cancers were located in pelvic cavity, 256,313 patients did not receive radiation therapy (NRT), 51,347 patients who underwent external beam radiation therapy (EBRT), and 10,505 patients receiving a combination of EBRT and brachytherapy (EBRT–BRT) who developed SBC. Receiving two types of radiotherapy was strongly consistent with a higher risk of developing SBC for PC patients in Fine-Gray competing risk regression (NRT vs. EBRT, adjusted HR= 1.71, 95% CI: 1.54-1.90, P<0.001; NRT vs. EBRT–BRT, adjusted HR= 2.16, 95% CI: 1.78-2.63, P<0.001). The results of the dynamic SIR and Poisson regression analysis for SBC revealed that a slightly increased risk of SBC was observed after RT in the early latency and was significantly related to the variations of age at PC diagnosis and decreased with time progress. For OS, the SBC after NRT, SBC after EBRT, and SBC after EBRT-BRT of 10-year survival rates were 37.9%, 29.2%, and 22.2%, respectively.ConclusionRadiotherapy for primary PC was associated with higher risks of developing SBC than patients unexposed to radiotherapy. Different pelvic RT treatment modalities had different effects on the risk of SBC.

Progesterone Resistance in Endometriosis

Endometriosis is characterised by the presence of endometrium-like tissue on the pelvis and other organs. Progesterone resistance due to suppressed progesterone receptor (PGR) expression and action is a general feature of endometriosis and is a cause of endometriosis-associated chronic pelvic pain, infertility, inflammatory disorders, and cancer. It appears that progesterone receptor polymorphisms may not be associated with the susceptibility to endometriosis. On the other hand, PGR expression and activity in target cells is significantly dysregulated in both eutopic and ectopic tissues compared with control endometrium. However, the underlying epigenetic mechanisms for PGR suppression in the eutopic tissue are different from ectopic tissue. The aim of this paper was to present an overview of different aspects of progesterone resistance and its application in endometriosis. Finally, this article also presents a few important, unmet questions related to the failure of progesterone treatment in alleviating clinical conditions in endometriosis.

Omentoplasty and omentopexy post-pelvic lymph node dissection in surgical management of gynecological tumors

Background: Lymphadenectomy is staging procedure used in studied cases with pelvic gynaecological cancer, however, pelvic lymphadenectomy was associated with morbidities like lymphedema &amp; lymphocysts, Omentoplasty-omentopexy has been utilized for prevention of lymphocysts that develop following pelvic lymphadenectomy. Patients and methods: This study is randomized controlled trial. 41 consecutive patients who were candidates for pelvic lymphadenectomy during radical hysterectomy for cancer cervix or endometrium were enrolled in this research &amp; were allocated to 2 groups. Intervention group (Omentoplasty-Omentopexy (A) group) included twenty-one patients who underwent omentoplasty-omentopexy. Control group (B) group included twenty patients who did not underwent omentoplasty-omentopexy. The two groups were compared regarding development of lymphocyst. The study was done at National Cancer Institute, Cairo University from January 2020 to June 2021. Results: Forty-one consecutive studied cases were enrolled in this research from January 2020 to June 2021. With an average age 58.9±12.4 years,no statistically significant variation between the Omentoplasty-Omentopexy (A) &amp; control group (B) regarding tumor site and histopathologic tumor types and tumor grade. No significant difference was found regarding primary tumor location either endometrial or cervical and its effect on post operative complications.

Comparative Study between Ultrasound-Guided Quadratus Lumborum Block Type 2 Versus Lumbar Epidural Analgesia as a Perioperative Analgesic Technique for Pelvic Cancer Surgeries

Background: The effect of the quadratus lumborum block (QLB) is believed to result from a spread of LA from its lumbar deposition cranially into the thoracic paravertebral space.The aim of this study is to compare the analgesic efficacy of an Ultrasound-guided quadrates lumborum type II block versus lumbar epidural analgesia or conventional analgesia after pelvic cancer surgeries regarding intraoperative fentanyl consumption, postoperative pain scores and morphine consumption in the first 24 hours.Methods: This study was conducted on 90 patients of American Society of Anesthesia (ASA) physical status II scheduled for elective pelvic cancer operations. Patients were randomized into three equal groups of 30 patients: Group Q: received bilateral QLB by 20ml of 0.25% bupivacaine in each side, Group E: received continuous lumbar epidural block analgesia ((0.125 % bupivacaine at infusion rate of 6ml/hour for 24 hours). Group C (Control group): were transferred to operation room without further intervention.Results: End tidal sevoflurane was significantly decreased in group Q than group C and in group E than group C at all time measurements. VAS at 0.5, 1, 8. 16 and 24 hours was significantly increased in group C than Group Q and group E. Time to first rescue dose of morphine was significantly increased in Group E than Group Q (P1 &lt;0.001) and was significantly decreased in group C than Group Q (P2 &lt;0.001) and was significantly decreased in group C than Group E (P3 &lt;0.001). Total dose of morphine in 1st 24 hours was significantly increased at group C than group Q and group E (P &lt;0.001) but there was an insignificant difference between Group Q and E.Conclusion: When compared to the control group, QLB and epidural block resulted in decreased VAS, intraoperative sevoflurane and fentanyl use and postoperative morphine consumption with a greater level of patient satisfaction. Epidural block, on the other hand, resulted in less intraoperative sevoflurane usage than QLB.

Total Pain and Illness Acceptance in Pelvic Cancer Patients: Exploring Self-Efficacy and Stress in a Moderated Mediation Model.

Cancer patients experience pain not only in its physical dimension, but also in a broader context that includes psychological, social, and spiritual aspects due to a higher level of anxiety and stress. The present prospective, longitudinal study examined the relationship between total pain and illness acceptance among pelvic cancer patients, taking into consideration the moderated mediation effects of self-efficacy and stress. The study involved a sample of pelvic cancer patients receiving radiotherapy treatment. Assessments were completed at T1 (before radiotherapy), T2 (after 3–4 weeks), and T3 (after radiotherapy) to assess the psychosocial dynamics of illness acceptance (N = 267). The more physical, psychological, social, and spiritual pain symptoms the patients experienced, the less they accepted negative health conditions and the effects of their illness. Stress moderated the indirect effect between total pain dimensions and illness acceptance through self-efficacy, but it did not moderate the relationship between total pain and illness acceptance. The relationships between total pain dimensions and illness acceptance thus depend on both the mediating effect of self-efficacy and the moderating effect of stress. This highlights the need to control one’s motivation and behavior and manage emotional strain or tension.

Sexual health and wellbeing among female pelvic cancer survivors following individualized interventions in a nurse-led clinic

PurposeTreatment-induced sexual and intestinal dysfunctions coexist among women after pelvic radiotherapy. We aimed to explore if sexual health and wellbeing may be improved after radiotherapy following nurse-led interventions and if an association exists between improved intestinal health and sexual health.MethodsA population-based cohort of women treated with pelvic radiotherapy underwent interventions at a nurse-led clinic at Sahlgrenska University Hospital, Sweden, from 2011 to 2017. Self-reported questionnaires were used, pre- and post-intervention, to compare self-reported changes in sexual health and wellbeing. A regression model was performed to explore the association between intestinal and wellbeing variables.ResultsAmong the 260 female pelvic cancer survivors included in the study, more women reported increased than decreased satisfaction with overall sexual health post-intervention (26.0% vs. 15.3%, p = 0.035). They also reported significantly reduced superficial genital pain (25.8% vs. 13.1%, p ≤ 0.025), reduced deep genital pain (23.1% vs. 8.0%, p ≤ 0.001), increased QoL (42.7% vs. 22.4%, p < 0.001), and reduced levels of depression (43.1% vs. 28.0%, p = 0.003) or anxiety (45.9% vs. 24.4%, p < 0.001) post-intervention. We found a significant association between reduced urgency to defecate and improved satisfaction with overall sexual health (RR 3.12, CI 1.27–7.68, p = 0.004) and between reduced urgency to defecate with fecal leakage and reduced anxious mode (RR 1.56, CI 1.04–2.33, p = 0.021).ConclusionSexual health and wellbeing can be improved by interventions provided in a nurse-led clinic focusing on physical treatment-induced late effects. Further research to optimize treatment strategies in female pelvic cancer survivors is needed.

Managing female sexual dysfunction.

Provide an overview of sexual dysfunction in female urologic cancer patients, approaches for assessing sexual problems, and interventions to treat sexual dysfunction in this patient population. A review of the literature in urologic oncology was conducted. Research on other female pelvic cancers with similar treatments was also reviewed. Sexual health is an important element of women's quality of life that is often not discussed and problems remain unaddressed. Urologic cancer treatments commonly result in sexual dysfunction (e.g., dyspareunia, vaginal dryness, problems with orgasm) in female patients, although more research is necessary to understand the impact of non-surgical treatments (e.g., radiation, chemotherapy, immunotherapy). As such, provider teams should complete necessary screening for sexual dysfunction during and after treatment. The 5 A's model (i.e., Ask, Advise, Assess, Assist, Arrange Follow-Up) provides a helpful guide for communicating about and addressing sexual health concerns with patients during the screening process. If it is determined that referral for further assessment and treatment of sexual dysfunction is needed, a number of non-pharmacologic (e.g., pelvic floor physical therapy; psychosexual counseling) and pharmacologic treatment approaches are available. Sexual dysfunction is common in female urologic cancer survivors. Routine assessment and appropriate referral are essential for high quality patient care.

Kynurenic acid as chronic pain biomarker for future cancer pain management

The prevalence of chronic pain ranges from 30-50% in patients with cancer undergoing active therapy. Kynurenic acid, xanthurenic acid, and quinolinic acid are significant biomarkers for assessing pain objectively. This study aims to investigate the scientific evidence of the effect of serum kynurenic acid levels on the severity and duration of chronic cancer pain. It is a cross-sectional study with 80 subjects consisting of 19 male and 61 female patients in the palliative outpatient clinic of Dr Soetomo Hospital. The pain assessment was performed using the NRS, and the biochemical analysis of serum kynurenic acid was assessed using the ELISA method. Of the total of 80 subjects, 26 patients had pelvic organ cancer (33.7%), 24 patients had respiratory organ cancer (30.1%), 17 patients had breast cancer (21.7%), 9 patients had abdominal organ cancer (9.6%), 3 patients had malignant melanoma (3.6%), and 1 patient had sternal bone cancer (1.2%). Kynurenic acid significantly correlated with the severity of pain (p = 0.043), with (r) of -0.218. However, kynurenic acid showed no significant correlation with the duration of pain (p = 0.052). Kynurenic acid affected the severity of pain but did not affect the duration of pain in chronic cancer pain patients.

Perspectives on Sexual Health Among Women who Underwent Pelvic Radiation Therapy: A Qualitative Analysis

ABSTRACT Introduction Impaired sexual function significantly decreases quality of life in female survivors of pelvic cancer who receive radiation therapy (RT). The literature estimates that 40-100% of gynecologic cancer survivors and 18-59% of rectal cancer survivors experience sexual dysfunction. Despite this prevalence, many patients report being insufficiently informed before treatment about potential sexual side effects of RT. Objective The primary goal of the present study was to understand patients’ perceptions of how prepared they felt for the presence of sexual toxicity after RT, how informed they felt about sexual toxicity management approaches, and what they would have liked to have known before beginning RT treatment. Methods Semi-structured interviews, in English and Spanish, were conducted with 20 women who received radiation to the pelvis as part of cancer care treatment. Patients responded to advertisements or were referred by providers. All interviews were conducted virtually by two medical students between June - October 2021. Thematic analysis was conducted using NVivo. Patients also completed an online demographics survey on REDCap. Results We identified four primary themes: 1) “I'm not a woman anymore” - all respondents felt these side effects had a negative impact on their life, including lower self esteem and no longer feeling sexy, nor like a woman. The women who were not properly informed about their side effects felt blindsided and embarrassed about their symptoms, 2) “Past sexuality influences current information preferences” - The unique experiences each woman had with sexual activity before undergoing RT impacted on how much they wanted to discuss sexual toxicity with their radiation oncologist. Yet nearly across the board, participants did want their doctor to be the one to initiate the discussion; 3) “When the internet is more useful than my providers” - many patients reported turning to the internet rather than their doctors for answers once they began experiencing symptoms if the symptoms had not been discussed with their doctor a priori, and found both information, normalization, and community online; 4) “Setting accurate expectations is key” - The women who were properly informed about sexual dysfunction expressed gratitude, and felt that while the sexual dysfunction was physically difficult, they were not surprised or frightened by the side effects and reported that this was psychologically helpful. Conclusions The results indicate that patients want physicians to initiate conversations about sexual function and to provide significantly more information about sexual dysfunction prior to RT. They also want radiation oncologists to be more active and directive in providing concrete symptom management strategies. Participants emphasized the importance of taking a thorough sexual history early on in the clinical encounter in order to monitor sexual dysfunction and to identify individual patient priorities surrounding sex and quality of life post treatment. Patients might also benefit from suggestions of online communities where sexual issues are discussed openly and productively. Overall, these findings provide radiation oncology providers with important information about patients’ unmet sexual information needs prior to RT, and patient preferences for how to help them feel more prepared and less distressed when sexual dysfunction occurs. Disclosure No

Female Sexual Dysfunction Following Pelvic Radiation for Anal Cancer: A Systematic Review

ABSTRACT Introduction Female cancer patients subjected to pelvic radiation often present post-treatment with genitourinary symptoms. Anal cancer is more common in women, and the mainstays of treatment are radiation and chemotherapy. There is minimal focus in the current literature on the sexual pathophysiology that specifically affects female anal cancer patients as a result of radiation therapy. Assessing the data from existing female anal cancer studies may elucidate the impact of pelvic radiation on female sexual dysfunction (FSD). Objective To evaluate the current literature on FSD in anal cancer patients who received pelvic radiation without surgical intervention. Methods A search strategy with concept groups inclusive of female pelvic cancers, FSD, and radiation or radiotherapy was iteratively developed by two librarians, and peer reviewed by a third. We conducted a search of the databases MEDLINE via Pubmed, Embase, Scopus, CINAHL Complete, PsycINFO, and Cochrane CENTRAL. After deduplication, 5,142 citations were assessed by two independent screeners during the initial title and abstract screening. 4,488 were deemed to not fit the inclusion/exclusion criteria. Exclusion criteria included: animal studies, feasability studies, secondary research studies, populations that were entirely male or did not separate results by sex, who underwent surgical intervention, or consisted entirely of HIV/AIDS patients. Of the 654 items selected for full-text review we filtered for the word “anal” which resulted in 76 articles to screen at the full-text level. Results Our search identified 76 papers of which 10 met inclusion criteria, 23 are not yet categorized. Of the included studies, 6 were cross sectional, 3 were prospective longitudinal, and 1 consisted of qualitative interviews. Studies were published from 1996-2021, with the majority (n=8) being published after 2013. While total population of anal cancer patients in each study was small, with 9 out of 10 study populations ≤100 subjects, females comprised the majority of patients without exception. The EORTC QLQ CR38/CR29 was employed in 3 studies while the remaining 7 relied on independent questionnaires or interviews, often utilizing CTCAE grading scale. These 7 studies focused on similar symptoms of FSD after radiotherapy. The most common were dyspareunia, impacting 0.037%-35% of patients (3 studies), vaginal/vulvar pain impacting 10-53% of patients (2 studies), vaginal dryness impacting 7-45% of patients (3 studies), and vaginitis impacting 17-33.3% of patients (3 studies). A major limitation to several studies was the proportion of women who were not sexually active after radiation therapy. Conclusions Assessing the association between pelvic radiation and FSD in anal cancer patients is challenging due to the lack of detailed, validated sexual function questionnaire data, such as the FSFI. With few studies available on this topic and variability of FSD symptoms between the existing studies, additional research is required to more accurately predict adverse outcomes of anal cancer treatment related to FSD. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: GenesisCare

O094 Novel technique and cohort study: Stoppa approach to sciatic notch clearance in locally advanced / recurrent pelvic cancer pelvic cancer

Abstract Introduction Locally advanced / recurrent pelvic cancers (LARC) extending into the greater sciatic notch represent a significant clinical challenge. Conventional surgical resection is associated with high rates of R1/2 resection, while locoregional oncological treatments often fail to control the disease. In this study we present the first report of a modified Stoppa approach that facilitates en bloc excision of pelvic sidewall structures with LARC. Methods This is a retrospective review of patients who underwent surgery for LARC with the novel Stoppa approach between 2016 and 2020 in our centre. Result 7 patients (6 female and 1 male) were identified from the institutional database with Median age of 66 (37–74). Three separate tumour types were included in the cohort: rectal adenocarcinoma - 4 (57%), anal squamous cell carcinoma - 2 (29%), and prostate adenocarcinoma - 1 (14%). 3 (42%) patients developed Clavien Dindo Class III complications (2 returned to theatre for minor flap revisions; 1 pre-sacral collection required radiological drainage). All patients lost active ipsilateral foot dorsiflexion due to planned nerve root transection. Median hospital stay was 46 days (17–114). All resections were R0. Conclusion This is the first report of a novel Stoppa approach for en bloc pelvic sidewall excision. The presented pathological resection results are promising; however, this procedure is associated with significant morbidity. Future studies will be necessary to confirm the presented oncological results and determine if the associated morbidity can be decreased. Take-home message Modified Stoppa technique is feasible to achieve Sciatic Notch tumour clearance in primary or recurrent locally advanced pelvic cancer. Further research needed to assess long term oncological outcome and reduce post operative morbidity.

Prognostic impact of stromal periostin expression in upper urinary tract urothelial carcinoma

BackgroundPeriostin is an extracellular matrix protein that has been known to be implicated in fibrillogenesis and cell migration, including cancer metastasis. Periostin overexpression in cancer cells and/or intervening stroma is usually related to tumor progression and poor patient outcomes in various human cancers; however, its role in urothelial carcinoma, especially upper urinary tract urothelial carcinomas (UTUCs), remains inconclusive.MethodsSamples from 126 consecutive cases of invasive UTUC (69 renal pelvic cancers and 57 ureteral cancers) were histologically reviewed and analyzed for periostin expression using immunohistochemistry. The intensities of immunoreactivity and the fraction of positive cancer cells and stroma (i.e., epithelial and stromal expression, respectively) were classified into four categories each (intensity, 0–3; fraction, 0–25% = 1; 26–50% = 2; 51–75% = 3; and > 75% = 4). The overall score was determined by multiplying both scores, and overall scores ≥ 6 were considered to indicate high periostin expression.ResultsAmong 126 UTUCs, 55 (44%; 27 renal pelvic and 28 ureteral cancers) showed high stromal periostin expression. None of the cases were considered to have high epithelial periostin expression. High stromal periostin expression was associated with non-papillary gross findings, higher pathological T category, lymphovascular invasion, concomitant carcinoma in situ, subtype histology, lymph node metastasis, positive surgical margins, high tumor budding, and high tumor-associated immune cell status. Multivariate analysis revealed that high stromal periostin expression was an independent predictor of overall survival (p = 0.00072, hazard ratio = 3.62), and lymphovascular invasion and high stromal periostin expression were independent predictors of cancer-specific survival (p = 0.032 and 0.020, hazard ratio = 2.61 and 3.07, respectively).ConclusionsStromal periostin expression was often observed in invasive UTUCs with adverse clinicopathological factors and may be a useful predictor of patient outcomes.

Translated article] Validation of patient-specific 3D impression models for pelvic oncological orthopedic surgery

IntroductionPelvic ring tumours pose a challenge due to the difficulty in obtaining adequate surgical margins. Tools such as surgical navigation or 3D printing for the fabrication of patient-specific surgical positioning templates help in preoperative planning and intraoperative execution. Their correct positioning is essential in complex locations such as the pelvis, so it is necessary to identify positioning errors. The aim of this study is to demonstrate the reliability of 3D template placement for pelvic ring osteotomies. Material and methodsExperimental study in cadaver with 10 hemipelvis. CT was performed to obtain the three-dimensional model, planning of osteotomies, design of positioning templates in ischiopubic (I), iliopubic (P), supracetabular (S) and iliac crest (C) branches; and a positioning marker (rigid-body) on the C and S templates for navigation. The templates and rigid-body are 3D printed and positioned according to pre-planning. Navigation allows the final position of the inserts and osteotomies to be checked. ResultsThe positioning of the templates with respect to the preoperative planning varied depending on the location, being greater the error in those of the iliac crest. Using navigation the mean error of distance to the cutting plane is 3.5mm, except in pubis (5–8mm), being conditioned by the position of the rigid body. ConclusionThe use of patient-specific templates printed in 3D is a reliable tool for performing osteotomies in pelvic cancer surgery.

Epidemiological analysis of second primary malignant neoplasms in cancer survivors aged 85 years and older: a SEER data analysis (1975–2016)

Cancer burden in patients aged 85 years and older has rapidly increased accompanying the decrease in mortality, which is raising the concern of developing second primary malignant neoplasms (SPM). This study aimed to investigate the epidemiology of the SPM in this population in the US by using the surveillance, epidemiology, and end results database (1975–2016). The cumulative incidence of developing a SPM was calculated by the Fine and Gray model. Standardized incidence ratios (SIR) were calculated via Poisson regression. The relative post-SPM survival rate was calculated by the Kaplan–Meier method. Male patients with skin melanoma, kidney and renal pelvis and urinary bladder cancers had high cumulative incidences (15.32%, 13.55%, and 12.26%, respectively) and increased SIRs (1.47, 1.44, and 1.16, respectively) for developing SPMs. Female patients with skin melanoma and urinary bladder cancers had high cumulative incidences (10.18% and 7.87%, respectively) and increased SIRs (1.34 and 1.18, respectively). In general, the incidence of SPM cases increased over time. The median latency ranged from 17 to 37 months. A less than 50% of patients had 1-year post-SPM survival. In conclusion, some of these patients had an increased risk of the SPM, with poor survival.

Effect of TENS and stabilization exercises on pelvic pain in pelvic cancer survivors following multimodal treatment: A clinical trial.

Pelvic floor muscle (PFM) dysfunction and pain are common complications seen in pelvic cancers including the gynecological and genitourinary systems before and after treatments such as chemotherapy, radiotherapy, and surgeries and may contribute to significant morbidity as the survival rates increase in these patients. The objective of the clinical trial was to evaluate the effect of transcutaneous electrical nerve stimulation (TENS) and stabilization exercises on pelvic pain in pelvic cancer survivors following multimodal treatment. Thirty-one patients including both male and female adults treated for pelvic cancers were recruited in the study. Outcome measures in terms of pain were assessed at baseline and at the end of the study by the visual analog scale and genitourinary pain index (GUPI) scale, abdominal muscle strength by pressure biofeedback unit for transverse abdominal (TrA) muscle, and quality of life (QOL) by functional assessment of cancer therapy general questionnaire. Pelvic stabilization exercises and TENS were administered once daily approximately 30 min during the acute hospitalization. Pelvic stabilization exercises and TENS demonstrated to be effective in ameliorating pelvic pain (P < 0.001) and improving in the GUPI scores of pain, incontinence, increasing strength of TrA musculature (P < 0.001), and improving overall QOL (P < 0.005). The trial suggests that a combination of pelvic stabilization exercises and conventional TENS may be used as a strategic tool to reduce pain and improve PFM strength after multimodal treatments in pelvic cancer survivors in the clinical setup of an Indian Scenario.

P14-4 A case of renal pelvic cancer treated with afatinib after reconsidering pathological diagnosis based on findings of CGP

One of the purposes for conducting comprehensive genome profile (CGP) is treatment optimization. CGP might provide a new treatment option and via reconsidering the diagnosis. We experienced a case of renal pelvic cancer (RPC) whose diagnosis was changed based on findings of CGP test.

Fertility sparing approach in young women with endometrial cancer

The incidence of endometrial cancer in young women is increasing, especially in developed countries. Although it is predominantly a disease of peri- and postmenopausal women, there is an absolute increase in younger women of childbearing age who, with today's lifestyle and pushing back maternal needs, do not have fulfilled reproductive plans. About 67% of cancers are diagnosed in the early stages. For these women, fertility-preserving procedures can be considered until reproductive plans are fulfilled. Subsequently, however, definitive management is appropriate even in the absence of carcinoma. This article discusses the most common gynecologic pelvic cancer, endometrial adenocarcinoma, and the possibility of fertility-preserving procedures.

Abstract CT542: Preliminary safety and efficacy results of KN046 in combination with KN026 in patients with locally advanced unresectable or metastatic HER2-positive solid cancer

Abstract Except breast cancer and gastric cancer, HER2 gene amplification or overexpression is also expressed in other solid tumors, including but not limited to colorectal cancer (CRC), non-small cell lung cancer (NSCLC), gallbladder cancer, renal pelvis cancer and pancreatic cancer. The reports of immunotherapy combined with HER2-targeted therapy are limited. KN046 is a novel bispecific antibody that blocks both PD-L1 interaction with PD-1 and CTLA4 interaction with CD80/CD86. KN026 is a novel bispecific antibody that simultaneously binds to two distinct HER2 epitopes. Here the preliminary safety and efficacy results of KN046 in combination KN026 were reported in patients with locally advanced unresectable or metastatic other solid tumors who received ≥ 1 line prior systemic therapy. Methods: HER2-positive locally advanced unresectable or metastatic other solid tumors with progression after ≥ 1 line of prior systemic therapy were recruited, including 14 CRC patients, 4 NSCLC patients, 4 gallbladder cancer patients, 1 renal pelvis cancer patient and 1 pancreatic cancer patient. These patients were by KN046 (iv. 5 mg/kg Q3W) plus KN026 (iv. 30 mg/kg Q3W, loading on C1D1, D8) until progression, unacceptable toxicity, or patient withdrawal. Efficacy was assessed according to RECIST 1.1 Q6W. The primary endpoint was objective response rate (ORR). Results: As of the August 10th, 2021, 24 non-breast or non-gastric cancer patients with the median age of 56 years (range: 37-66) were enrolled. 20 and 24 patients were evaluable for overall response and safety, respectively. The ORR was 55.0% (11 of 20, 95% CI: 31.5-76.9). And the disease control rate (DCR) was 85.0% (17 of 20, 95% CI 62.1-96.8). The 6-month progression-free survival (PFS) rate was 84.1%. 11 CRC patients were evaluable for overall response. The ORR and DCR in CRC was 45.5% (5 of 11, 95% CI: 16.7-76.6) and 90.9% (10 of 11, 95% CI 58.7-99.8), respectively. Twenty of total 24(87.9%) patients suffered from treatment-related adverse events (TRAEs) of any grade. Total 4 of 24 (16.7%) patients had experienced ≥grade 3 TRAEs, including 4 cases related to KN046 and 3 cases related to KN026. The most common (≥10%) TRAEs were infusion related reaction (29.2%), diarrhea (19.4%), alanine aminotransferase increased (16.7%), aspartate aminotransferase increased (16.7%), vomiting(12.5%) and decreased appetite (12.5%). No treatment-related deaths were observed. Conclusion: This chemotherapy-free regimen of KN046 in combination with KN026 has shown promising clinical efficacy and manageable toxicity in HER2-positive non-breast and non-gastric solid tumors with ≥ 1 line prior systemic therapy. The trial is currently ongoing. ClinicalTrials.gov Number, NCT04521179 Citation Format: Jifang Gong, Lei Chen, Meili Sun, Yanming Zhang, Jieer Ying, Xiangcai Wang, Mingli Ni, Zhixiang Zhuang, Baohong Guo, Long Xiao, Summer Xia, Lin Shen. Preliminary safety and efficacy results of KN046 in combination with KN026 in patients with locally advanced unresectable or metastatic HER2-positive solid cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT542.