Thaïs Baert

Circulating Transcripts and Biomarkers in Uterine Tumors: Is There a Predictive Role?

Uterine cancer comprises endometrial carcinoma and the uterine sarcoma. Endometrial carcinomas are the most frequent variant and have early symptoms and a solid diagnostic work up, resulting in a rather fair prognosis. However, in case of advanced stage disease and relapse, treatment options are limited and prognosis is impaired. Uterine sarcomas are rare, often lacking symptoms and no diagnostic tool for correct pre-operative diagnosis are available. Prognosis is poor. Circulating biomarkers as a liquid biopsy could be beneficial as a diagnostic tool in uterine sarcomas. For both carcinomas and sarcomas, circulating biomarkers could be of use in predicting early disease recurrence. This review in endometrial carcinoma and uterine sarcoma focus on circulating biomarkers; such as proteins; circulating tumor cells; circulating tumor DNA; microRNA; and immune cells.

Predicting resectable disease in relapsed epithelial ovarian cancer by using whole-body diffusion-weighted MRI

To determine the diagnostic value of whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) to predict resectable disease at the time of secondary cytoreductive surgery for relapsed epithelial ovarian cancer with a platinum-free interval of at least 6 months. A retrospective cohort study between January 2012 and December 2021 in a tertiary referral hospital. Inclusion criteria were: (a) first recurrence of epithelial ovarian cancer; (b) platinum-free interval of ≥6 months; (c) intent to perform secondary cytoreductive surgery with complete macroscopic resection; and (d) WB-DWI/MRI was performed.Diagnostic tests of WB-DWI/MRI for predicting complete resection during secondary cytoreductive surgery are calculated as well as the progression-free and overall survival of the patients with a WB-DWI/MRI scan that showed resectable disease or not. In total, 238 patients could be identified, of whom 123 (51.7%) underwent secondary cytoreductive surgery. WB-DWI/MRI predicted resectable disease with a sensitivity of 93.6% (95% confidence interval [CI] 87.3% to 96.9%), specificity of 93.0% (95% CI 87.3% to 96.3%), and an accuracy of 93.3% (95% CI 89.3% to 96.1%). The positive predictive value was 91.9% (95% CI 85.3% to 95.7%).Prediction of resectable disease by WB-DWI/MRI correlated with improved progression-free survival (median 19 months vs 9 months; hazard ratio [HR] for progression 0.36; 95% CI 0.26 to 0.50) and overall survival (median 75 months vs 28 months; HR for death 0.33; 95% CI 0.23 to 0.47). WB-DWI/MRI accurately predicts resectable disease in patients with a platinum-free interval of ≥6 months at the time of secondary cytoreductive surgery and could be of complementary value to the currently used models.

Combined operative and radiotherapeutic treatment for locally recurrent gynaecologic cancer with pelvic wall invasion: A monocentric retrospective study

Managing locally recurrent gynecologic cancer with pelvic wall invasion, particularly after prior pelvic radiotherapy, presents a significant clinical challenge. Combined operative and radiotherapeutic treatment (CORT) is a potential curative approach. This study aims to evaluate the effectiveness and morbidity of this technique in this patient population as implemented within a single institution. A comprehensive, retrospective analysis was conducted on patients treated with CORT for recurrent gynecologic cancer with pelvic wall invasion after prior pelvic radiotherapy at the University Hospitals of Leuven between January 2000 and December 2023. A total of 21 patients were eligible for analysis. All patients underwent open surgical macroscopic tumor resection with intraoperative implantation of brachytherapy guiding tubes. The average radiation dose to 90% of the treatment volume (D90) was 45.6 Gy EQD2 (range 16.0 to 66.2 Gy). The median follow-up period was 37.8 months (range 3-230 months). Local control at 2 and 5 years was 87,4% and 77,8%; overall-survival at 2 and 5 years was 57,1% and 52,4%, respectively. Seventeen of the 21 patients experienced some form of adverse event, with 15 patients needing surgical re-intervention. Our retrospective analysis demonstrates high local control and favorable overall-survival outcomes in patients with recurrent gynecologic cancer involving the pelvic wall. However, the treatment is associated with a substantial risk of severe adverse events. Given the complexity and potential morbidity of this approach, CORT should be performed in specialized centers with experience in managing such cases.