The Society of Gynecologic Oncologists' 41st Annual Meeting on Women's Cancer, held from March 14 to 17 in San Francisco, attracted over 1,800 participants from around the world. The conference focused on advances in the diagnosis, prevention and management of gynecologic cancers. Highlights included presentations on advances in chemotherapy, cancer screening, and radiation and surgical approaches, as well as a special session highlighting five late-breaking abstracts focusing on improving patient outcomes.
"We are on the same mission, like the politics of today, we are trying to keep costs down and improve outcomes," said Joan Walker, M.D., of the University of Oklahoma Health Sciences Center in Oklahoma City.
In one study, Walker and colleagues showed that laparoscopic surgery for uterine cancer does not result in an inferior outcome for recurrence or survival, as compared to laparotomy. The researchers randomized 2,616 patients with clinical stage I to IIA uterine cancer to laparoscopy or laparotomy for procedures such as hysterectomy, salpingo-oophorectomy, pelvic cytology, and pelvic and para-aortic lymphadenectomy.
The researchers showed that the three-year overall survival was similar for laparoscopy and laparotomy (89.8 and 89.9 percent, respectively). To date, there have been a total of 345 deaths (227 laparoscopy and 118 laparotomy), with 207 of those deaths attributed to the disease (142 laparoscopy and 65 laparotomy).
"We can be confident that laparoscopy is just as effective as laparotomy. We validated recurrence rates and found that laparoscopy recurrence rates are in line with laparotomy. We don't have to be uncomfortable offering laparoscopy to our patients, as the approach presents with fewer complications and patients are typically in the hospital for 24 to 48 hours, with similar survival and recurrence rates as laparotomy," Walker said.
A study presented by Andreas Obermair, M.D., of the Queensland Centre for Gynaecological Cancer in Brisbane, Australia, showed that up to six months post surgery, quality of life (QoL) improved in patients who underwent total laparoscopic hysterectomy (TLH) as compared to total abdominal hysterectomy (TAH).
A QoL sub-study of the Laparoscopic Approach to Carcinoma of the Endometrium (LACE) trial evaluated 332 patients from October 2005 to April 2008, with enrollment for disease-free survival from 2005 to 2010. Randomization was 2:1 (TLH:TAH) for the first 180 patients and 1:1 for the rest of the study, with 191 patients undergoing TLH and 141 receiving TAH. QoL was measured using the Functional Assessment of Cancer Therapy questionnaire (FACT-G) plus a supplementary endometrial cancer specific subscale, the body image scale (BIS), and the Euro-QoL visual analogue scale.
Up to four weeks after surgery, the researchers found that patients who underwent TLH showed a significantly greater improvement from baseline QoL compared to those who underwent TAH (ranging from a 14 percent improvement in functional well-being to a 2 percent improvement in social well-being). In addition, improvements in QoL up to six months post surgery continued to favor patients who underwent TLH compared to those who received TAH, especially for functional well-being (6 percent) and body image (5.4 percent).
"This is the first trial of TLH versus TAH with sufficient statistical power and a low rate of conversions to show that, up to six months post surgery, Qol is better in patients who received TLH as compared to TAH," the authors concluded.
In another study presented during the late-breaking abstract session, Warner Huh, M.D., of the University of Alabama at Birmingham, and colleagues showed that women previously treated with surgery for high-grade cervical intraepithelial neoplasia (CIN) grade 2/3, vulvar intraepithelial neoplasia (VIN), vaginal intraepithelial neoplasia (VaIN), and genital warts (GWs) benefited from HPV (human papillomavirus) 6/11/16/18 vaccination.
The researchers evaluated 17,622 women 15 to 26 years of age enrolled in one of two placebo controlled trials. HPV6/11/16/18 vaccination or placebo was given on day one, at two months and at six months, with pap smear testing done on day one and then every six to 12 months.
In the combined trials, 587 patients who received HPV vaccination and 763 who received placebo underwent cervical definitive therapy. In this population, the vaccination significantly reduced the risk of developing further HPV-related disease irrespective of causal HPV type. In protocol 013, 222 patients who received HPV vaccination and 306 who received placebo were treated for VIN, VaIN or GWs. In this protocol, the vaccination also significantly reduced the risk of developing further HPV-related disease irrespective of causal HPV type. Vaccine effectiveness for any disease following surgery was 45 percent for the combined trials and 38.6 percent for protocol 013.
"These results demonstrate that women who have been treated previously for CIN, VIN, VaIN or GWs benefit from the HPV6/11/16/18 vaccine, as there was a statistically and clinically significant reduction in HPV-related disease post-treatment," the authors concluded.
Rowan T. Chlebowski, M.D., of the Los Angeles Biomedical Research Center in Torrance, Calif., and colleagues, showed that use of conjugated equine estrogen alone did not increase incidence of, or deaths from, lung cancer, as previously seen with estrogen plus progestin in the Women's Health Initiative (WHI) randomized controlled trial.
The researchers conducted post-hoc analyses in the separate WHI trial that evaluated 10,739 postmenopausal women 50 to 79 years of age who previously underwent hysterectomy. Participants were randomly assigned to once-daily 0.625 mg conjugated equine estrogen or placebo.
After a mean of 7.1 years of intervention and 7.9 years of follow-up, the researchers found that 61 women in the estrogen-only group were diagnosed with lung cancer, as compared with 54 in the placebo group. Deaths from lung cancer did not differ between the estrogen-only and placebo groups (34 versus 33 deaths). In addition, deaths from non-small cell lung cancer were slightly lower in the estrogen-only group as compared to the placebo group (25 versus 29). There was also a lower number of poorly differentiated cancers in the estrogen-only group, while the number of cancers with distant metastases was the same in both groups.
"Unlike estrogen plus progestin, which increased deaths from lung cancer, use of conjugated equine estrogen alone did not increase incidence or deaths from lung cancer," the authors concluded.
In a Gynecologic Oncology Group (GOG) study, Jamie L. Lesnock, M.D., of the University of Pittsburgh, and colleagues showed that BRCA1 polymorphisms in five loci are associated with a shorter progression-free survival of 10 months in patients with epithelial ovarian cancer undergoing treatment with platinum-based chemotherapy. The combination of these single nucleotide polymorphisms may be a biomarker for prediction of clinical outcomes in this patient population, the authors concluded.
In two phase I GOG studies, researchers helped establish safety and dosing data for abdominal administration of carboplatin, including data determining the maximum tolerated dose and dose-limiting toxicity. The two separate studies, led by Natalie S. Gould, M.D., of Carilion Clinic in Roanoke, Va., and Mark A. Morgan, M.D., of the Fox Chase Cancer Center in Philadelphia, evaluated combinations of intravenously-administered paclitaxel and abdominally-administered carboplatin. In addition, the study led by Gould included a course of intraperitoneal paclitaxel on the eighth day of the treatment cycle.
Both studies showed that abdominal administration of carboplatin doses of area under the curve 6 could be safely administered for six cycles, with intravenous paclitaxel dosages ranging from 135 mg/m2 in the study lead by Gould to 175 mg/m2 in the study led by Morgan. In addition, both studies indicated that adding growth factors to the regimen might counteract chemotherapy's toxic effects on blood cells.
In another study, Brook A. Saunders, M.D., of the University of Kentucky Medical Center in Lexington, and colleagues demonstrated that certain tumor types may be safely monitored with transvaginal sonography (TVS) for years without potentially increasing ovarian cancer risk.
The study evaluated 29,829 women from 1987 to 2009, including 1,319 with complex cystic ovarian tumors with septation. Within the subgroup of 1,319 women, researchers found 2,870 complex septated cystic tumors. TVS indicated the tumors had no solid areas or papillary projections. Therefore, patients completed a follow-up TVS every four to six months. Overall, 38.8 percent of tumors resolved, while the rest persisted. The researchers removed 128 complex septated cystic tumors but did not remove the other 2,742 tumors, tracking them with TVS. All patients, except for one, remained cancer-free for an aggregate total of 7,642 follow-up years.
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