Niveditha Rajadevan

Mucinous ovarian carcinoma: A survey of practice in Australia and New Zealand

AbstractBackgroundMucinous ovarian carcinoma (MOC) is a rare ovarian cancer with limited evidence to support clinical care.AimsWe undertook a clinician survey to better understand current practice in treating MOC in Australia and New Zealand, and to determine any features associated with variation in care. In addition, we aimed to understand future research priorities.MethodsA RedCap survey was distributed to clinician members of the Australia New Zealand Gynaecological Oncology Group (ANZGOG). Questions included respondent demographics, three case studies and future research priorities. Clinicians were asked questions specific to their speciality.ResultsRespondents (n = 47) were commonly experienced gynae‐oncology specialists, most often surgical (38%) or medical (30%) oncologists. There was good consensus for surgical approaches for stage I disease; however, variation in practice was noted for advanced or recurrent MOC. Variation was also observed for medical oncologists; in early‐stage disease there was no clear consensus on whether to offer chemotherapy, or which regimen to recommend. For advanced and recurrent disease a wide range of chemotherapy options was considered, with a trend away from an ovarian‐type toward gastrointestinal (GI)‐type regimens in advanced MOC. This practice was reflected in future research priorities, with ‘Is a GI chemotherapy regimen better than an ovarian regimen?’ the most highly ranked option, followed by ‘Should stage 1C patients receive chemotherapy?’ConclusionsAlthough the number of respondents limited the analyses, it was clear that chemotherapy selection was a key point of divergence for medical oncologists. Future research is needed to establish well‐evidenced guidelines for clinical care of MOC.

Prognostic value of serum HE4 level in the management of endometrial cancer: A pilot study

BackgroundHuman epididymis protein 4 (HE4) has shown promising utility as a prognostic biomarker in endometrial cancer. Increased serum HE4 levels may be associated with deeper myometrial invasion, extrauterine disease and poorer prognosis.AimTo evaluate the use of serum HE4 level, compared to and alongside other investigations, to accurately guide management in apparent early‐stage endometrial cancer.Materials and MethodsThis is a single‐site prospective study of 100 patients with histologically confirmed endometrial cancer. All patients underwent preoperative measurements of HE4 and CA125 levels and a preoperative magnetic resonance imaging (MRI) to assess the depth of invasion, nodal status and tumour size. Correlation was sought between serum HE4 level, CA125 level, MRI findings and intra‐operative frozen section with tumour type, grade and stage.ResultsWhile both median HE4 and CA125 levels were higher with worsening clinicopathological features, serum HE4 level showed a more consistent association with high‐risk features. Patients with a low‐grade biopsy preoperatively and a low HE4 level (<70 pmol/L) demonstrated an 86.8% likelihood of having low‐risk disease on final histopathology. In comparison, preoperative MRI or intraoperative frozen section alongside a low‐grade biopsy demonstrated a similar likelihood of 86.2 and 87.7%, respectively.ConclusionsWhen used in conjunction with an initial low‐grade endometrial biopsy, serum HE4 level demonstrated a similar likelihood to both preoperative MRI and intraoperative frozen section in identifying low‐risk disease on final histopathology. As a triaging tool this may be significant given that a preoperative, serum‐based assay would likely be the least invasive, least resource‐intensive and most cost‐effective approach.