Laurence Bernard

Tamoxifen for nodal recurrence of serous borderline ovarian tumour − a case report

Combined Interval Cytoreductive Surgery and Carboplatin-Based Hyperthermic Intraperitoneal Chemotherapy in Advanced Primary High-Grade Serous Ovarian Cancer

Combining interval cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) improves survival in advanced epithelial ovarian carcinoma (EOC). Although limited, growing evidence regarding carboplatin-based HIPEC highlights its potential. This retrospective study included all patients with advanced primary high-grade serous ovarian cancer who underwent interval CRS combined with carboplatin-based HIPEC at our Canadian tertiary care center between 2014 and 2020. We identified 40 patients with a median age of 61 years. The median peritoneal cancer index was 13 and complete cytoreduction was achieved in 38 patients (95%). Median hospital stay was 13 days and there were four admissions to the intensive care unit (10%) and six readmissions (15%). Severe adverse events occurred in eight patients (20%) and there was no perioperative death. Recurrence was seen in 33 patients (82%) with a median DFS of 18.0 months and a median overall survival of 36.4 months. Multivariate analyses showed that age, peritoneal cancer index, completeness of cytoreduction, occurrence of severe complications, and bowel resection did not significantly impact DFS or OS in our cohort. Interval CRS combined with carboplatin-based HIPEC for advanced primary EOC is associated with acceptable morbidity and oncological outcomes. Larger studies are required to determine the long-term outcomes.

Appendectomy at the time of ovarian cancer staging increases infectious complications: a National Surgical Quality Improvement Program (NSQIP) propensity score-stratified analysis

Despite evidence that routine elective appendectomy at the time of staging surgery for ovarian cancer is not warranted, it remains common practice in gynecology oncology. The objective of this study was to compare the surgical complication rates of women undergoing surgery for suspected early-stage ovarian malignancy with concurrent appendectomy to those who did not undergo appendectomy. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) 2010-2017 data were used to analyze the patient characteristics and outcomes of women undergoing staging surgeries for suspected early ovarian cancer. Women with pre-operative ascites, disseminated cancer, concurrent bowel surgery, or cytoreductive surgery were excluded. Multivariate logistic regression and propensity score stratification were used to assess 30-day post-operative outcomes. Three hundred and fifty-one of 2100 women (16.7%) underwent concurrent appendectomy at time of surgery, and the post-operative infection rate was 7.8%. Women with concurrent appendectomy had twice the odds of post-operative infection (OR 2.03, 95% CI 1.26 to 3.27) after controlling for clinically important risk factors. The increased odds of infection remained significant after propensity score stratification (OR 2.04, 95% CI 1.27 to 3.3). No association was observed with length of hospital stay, readmission, return to the operating room, or post-operative death. Appendectomy at time of surgery for suspected early-stage ovarian cancer is associated with significantly elevated odds of post-operative infection. Unless there is clinical suspicion for involvement, routine appendectomy should be abandoned in clinical practice.

Role of primary care enrolment in advanced cervical cancer diagnosis: a population-based case–control study

The elimination of cervical cancer will only be achievable through primary and secondary prevention. The aim of this study was to determine the effect of primary care enrolment on the prevention of advanced cervical cancer. Using a population-based case-control study, all women (n=5548) above 18 years of age who were diagnosed with cervical cancer between January 2006 and December 2015 in Ontario, Canada were selected for the analysis. The controls were women (n=27 740) above 18 years of age and without a diagnosis of cervical cancer. Five controls were matched to each case by year of birth. Descriptive statistics were used to compare the patients and controls. Multiple imputations and logistic regression were used to estimate the correlation between enrolment with a primary care provider and diagnosis of cervical cancer. A total of 44% of advanced cervical cancer patients and 56% of controls had a screening test 10 years before the index date. The odds of having had a Pap test in the 3 and 10 years before were higher when patients were enrolled with a primary care provider (OR 3.5 and 5.1, p<0.001). The correlation between screening and advanced cervical cancer (stage II-IV) incidence was modified by primary care enrolment: if the patient was enrolled with a primary care provider and had at least one screen in the previous 10 years, the OR of developing advanced cervical cancer was 0.42 (95% CI 0.40 to 0.43); if the patient was not enrolled the OR was 0.78 (95% CI 0.72 to 0.84). Primary care enrolment is an effect modifier of cervical cancer screening on advanced cervical cancer incidence. Efforts should be made to increase the capacity of primary care providers to offer screening in order to eradicate cervical cancer.

Safety of vaginal surgery for early-stage cervical cancer: A retrospective multicenter cohort study.

Abdominal Radical hysterectomy (ARH) with pelvic lymph node assessment is considered the standard treatment for early-stage cervical cancer. Accepted routes have previously included laparoscopic or robotic approaches (LRH). Laparoscopy-assisted vaginal or vaginal radical hysterectomy (LVRH) are performed in some centers. The objective of this study is to compare surgical and oncological outcomes of LVRH, to laparoscopic and abdominal approaches. A retrospective multicenter analysis of consecutive cervical cancer cases who underwent a radical hysterectomy between 2007 and 2017 in eleven regional cancer centers across Canada. A comparison of patients stratified by surgical technique was undertaken. T-test, Wilcoxon rank-sum and chi-square were used to compare patient characteristics. Log-rank tests and Cox proportional hazards models were employed to compare recurrence and survival across surgical groups. A total of 1071 patients with cervical cancer stage IA1 with lymphovascular invasion to stage IIIC (FIGO 2018) <4 cm were identified. Postoperative complication rate was lowest for women undergoing LVRH (9.1 %, vs 18.3 % and 22.1 % for minimally invasive and open respectively). During follow up, 114 women recurred, and 70 women died. 5-year recurrence-free survival was 85.4 % for LRH, 89.4 % for ARH and 92.2 % for LVRH. LVRH was not found to be associated with a higher risk of recurrence or death than ARH on multivariable analysis (aHR for recurrence 0.62, CI 0.21-1.77; aHR for death 0.63, CI 0.14-2.77) CONCLUSION: In this retrospective study, vaginal or laparoscopy-assisted vaginal radical hysterectomy for cervical cancer was associated with favorable perioperative and oncological outcomes.

The Progesterone Challenge Test as a Functional Biomarker of Endometrial Cancer Risk: Results from a Prospective Feasibility Study

Abstract Endometrial cancer incidence continues to increase globally, driven mainly by obesity. Current diagnostic pathways rely on symptom presentation; no validated approach exists to identify asymptomatic individuals who may benefit from targeted prevention. The progesterone challenge test (PCT) is a physiologic assessment of endometrial hormonal responsiveness that could pragmatically guide endometrial cancer prevention interventions. The RESToRE study (NCT05651282) prospectively assessed the feasibility of the PCT as a community-based risk-stratification tool for endometrial cancer prevention in British Columbia, Canada, between 2023 and 2024. Asymptomatic postmenopausal participants, defined by the absence of vaginal bleeding, with body mass index ≥34.9 kg/m2 and an intact uterus, completed a 10-day course of oral medroxyprogesterone acetate (MPA) 10 mg daily. Feasibility, tolerability, and acceptability were evaluated. Of 96 eligible individuals, 68 enrolled, 53 initiated, and 51 completed the PCT. Sixteen participants experienced withdrawal bleeding (+PCT; 30.2% of those with evaluable results). All +PCT individuals were referred to a gynecologist for standard-of-care evaluation, including an endometrial biopsy. Among the 15 who underwent biopsy, two had a proliferative endometrium, and one had simple hyperplasia. Participants and providers found the test acceptable, citing its simplicity and low administrative burden. Side effects of the PCT were mild (median severity ≤three of 10), resulting in 3.8% (two of 53) of participants discontinuing the MPA. The PCT was feasible, well-tolerated, and acceptable among higher-risk postmenopausal individuals, supporting its use as a physiologic, functional biomarker of endometrial responsiveness. These findings provide early evidence for a scalable, low-cost strategy to identify individuals likely to benefit from targeted endometrial cancer prevention. Prevention Relevance: This study demonstrates that the PCT is feasible and acceptable as a functional biomarker associated with the risk of endometrial cancer in asymptomatic postmenopausal individuals with obesity. As a low-cost, scalable, community-deliverable approach, our findings support validation of this test in the context of endometrial cancer precision prevention.