Hodgkin's lymphoma in adults: diagnosis, treatment and follow-up. Surgery in Recurrent Ovarian Cancer: The Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR Trial Complete cytoreductive surgery is feasible and maximizes survival in patients with advanced epithelial ovarian cancer: a prospective study. Multimodality therapy in the treatment of lung cancer. Neoadjuvant chemotherapy in advanced ovarian cancer: a case‐control study Asian Consensus Workshop Report: Expert Consensus Guideline for the Management of Intermediate and Advanced Hepatocellular Carcinoma in Asia Clinical trials of newer regimens for treating ovarian cancer: the rationale for Gynecologic Oncology Group Protocol GOG 182-ICON5. Evaluation of new platinum-based treatment regimens in advanced-stage ovarian cancer: a Phase III Trial of the Gynecologic Cancer Intergroup. Neoadjuvant chemotherapy for advanced ovarian cancer: long-term survival. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy as upfront therapy for advanced epithelial ovarian cancer: multi-institutional phase-II trial. Outcome of preventive surgery and screening for breast and ovarian cancer in BRCA mutation carriers. Sarcopenia in ovarian cancer patients, oncologic outcomes revealing the importance of clinical nutrition: review of literature. No benefit from combining HE4 and CA125 as ovarian tumor markers in a clinical setting. Evaluation of HE4, CA125, risk of ovarian malignancy algorithm (ROMA) and risk of malignancy index (RMI) as diagnostic tools of epithelial ovarian cancer in patients with a pelvic mass. Minimally invasive interval debulking surgery in ovarian neoplasm (MISSION trial-NCT02324595): a feasibility study. Feasibility study of neoadjuvant chemotherapy followed by interval debulking surgery for stage III/IV ovarian, tubal, and peritoneal cancers: Japan Clinical Oncology Group Study JCOG0206. Laparoscopy to predict the result of primary cytoreductive surgery in advanced ovarian cancer patients (LapOvCa-trial): a multicentre randomized controlled study “True” versus “apparent” stage I epithelial ovarian cancer: value of frozen section analysis Advanced epithelial ovarian cancer: 1998 consensus statements. Weekly cisplatin given for 2 months versus cisplatin plus cyclophosphamide given for 5 months after cytoreductive surgery for advanced ovarian cancer. Combination Chemotherapy With Mitoxantrone, Methotrexate, and Mitomycin (MMM Regimen) in Malignant Pleural Mesothelioma: A Phase II Study Primary chemotherapy in stage IV ovarian cancer. A prospective phase II study. Implications of serum pepsinogen I in early endoscopic diagnosis of gastric cancer and dysplasia. Helsinki Gastritis Study Group. Endoscopic ultrasonography in the preoperative staging of gastric cancer Risk of recurrence during follow-up for optimally treated advanced epithelial ovarian cancer (EOC) with a low-level increase of serum CA-125 levels. Cost-effective treatment of women with advanced ovarian cancer by cytoreductive surgery and chemotherapy directed by an in vitro assay for drug resistance. Does endoscopic ultrasound staging already allow individual treatment regimens in gastric cancer Updated Guidelines 2008 for the Diagnosis, Surveillance and Therapy of Barrett's Esophagus CA125 in ovarian cancer: European Group on Tumor Markers guidelines for clinical use Epidoxorubicin versus no treatment as consolidation therapy in advanced ovarian cancer: results from a phase II study Danish national guidelines for treatment of diverticular disease. Treatment of melanoma. Long-term survival and prognostic factors in advanced epithelial ovarian cancer with special emphasis upon the effects of protocol inclusion Phase III trial of intraperitoneal therapy with yttrium-90-labeled HMFG1 murine monoclonal antibody in patients with epithelial ovarian cancer after a surgically defined complete remission.
BACKGROUND With an incidence of 2 to 3 cases per 100 000 persons per year , Hodkgin 's lymphoma ( HL ) is rare , but nonetheless one of the most common cancers in young adults . Improved treatment has made HL curable even in advanced stages , but controversy still surrounds a number of issues in patient care . Current research focuses on the avoidance of long-term adverse effects and secondary malignancies . METHODS We selectively search ed MEDLINE , CENTRAL , and the Guideline International Network for publications about HL . Two experts independently screened the retrieved publications for pertinence and extracted data from potentially relevant meta-analyses , r and omized controlled trials ( RCTs ) , and cohort studies into evidence tables . RESULTS 32 key questions were answered with 160 recommendations on the basis of evidence from 43 RCTs , 21 meta-analyses , and 119 cohort studies . Patients in an early stage of HL should be treated with two cycles of ABVD followed by involved-field radiotherapy ( IF-RT ) at a dose of 20 Gy ( 5-year overall survival [ OS ] : 94 % ) . Patients in an intermediate ( early unfavorable ) stage should be treated with two cycles of BEACOPP escalated followed by two cycles of ABVD and 30 Gy IF-RT ( 5-year OS : 97.2 % ) . Patients in an advanced stage should be treated with six cycles of BEACOPP escalated , and the decision whether this should be followed by consolidating radiotherapy ( 30 Gy ) should be based on the findings of positron-emission tomography ( radiate in case of PET-positive residual tumor ; 5-year OS : 95.3 % ) . Depending on the treatment regimen , there may be adverse effects including infection , leukopenia , anemia , thrombocytopenia , secondary neoplasia , and fertility disorders . CONCLUSION Most questions in the treatment of HL can now be answered on the basis of sufficient evidence from the literature . This holds in particular for the potential benefit to be gained from PET , follow-up care , and lifestyle recommendations for patients Background The role of cytoreductive surgery in relapsed ovarian cancer is not clearly defined . Therefore , patient selection remains arbitrary and depends on the center ’s preference rather than on established selection criteria . The Descriptive Evaluation of preoperative Selection KriTeria for OPerability in recurrent OVARian cancer ( DESKTOP OVAR ) trial was undertaken to form a hypothesis for a panel of criteria for selecting patients who might benefit from surgery in relapsed ovarian cancer . Methods The DESKTOP trial was an exploratory study based on data from a retrospective analysis of hospital records . Twenty-five member institutions of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Committee ( AGO OC ) and AGO-OVAR boards collected data on their patients with cytoreductive surgery for relapsed invasive epithelial ovarian cancer performed in 2000–2003 . Results Two hundred and sixty-seven patients were included .  Complete resection was associated with significantly longer survival compared with surgery leaving any postoperative residuals [ median 45.2 vs. 19.7 months ; hazard ratio ( HR ) 3.71 ; 95 % confidence interval ( CI ) 2.27–6.05 ; P < .0001 ] . Variables associated with complete resection were performance status ( PS ) [ Eastern Cooperative Oncology Group ( ECOG ) 0 vs. > 0 ; P < .001 ] , International Federation of Gynecology and Obstetrics ( FIGO ) stage at initial diagnosis ( FIGO I/II vs. III/IV , P = .036 ) , residual tumor after primary surgery ( none vs. present , P < .001 ) , and absence of ascites > 500 ml ( P < .001 ) . A combination of PS , early FIGO stage initially or no residual tumor after first surgery , and absence of ascites could predict complete resection in 79 % of patients . Conclusions Only complete resection was associated with prolonged survival in recurrent ovarian cancer . The identified criteria panel will be verified in a prospect i ve trial ( AGO-DESKTOP II ) evaluating whether it will render a useful tool for selecting the right patients for cytoreductive surgery in recurrent ovarian cancer OBJECTIVE Despite correlation between the completeness of surgical cytoreduction and survival for patients with advanced ovarian cancer , relatively few undergo complete cytoreduction . This study was initiated to prospect ively determine the ability to surgically eliminate all visible disease in patients with stage IIIC and IV epithelial ovarian cancer and the associated impact on survival . METHODS Between 1990 and 1996 , 163 consecutive patients underwent primary cytoreduction .  The goal was the excision or ablation of all visible disease prior to initiation of systemic platinum-based combination chemotherapy . A multivariate analysis determined which clinical and pathologic variables influenced the probability of achieving complete cytoreduction ( logistic regression ) and survival ( Cox proportional hazards model ) . RESULTS One hundred thirty-nine patients ( 85.3 % ) underwent removal of all visible tumor , 22 ( 13.5 % ) had cytoreduction to < /=1 cm residual disease , and 2 ( 1.2 % ) had unresected bulky disease . The median and estimated 5-year survival for the entire cohort was 54 months and 48 % , respectively . The probability of achieving complete cytoreduction was influenced independently by the preoperative Gynecologic Oncology Group performance status ( 0 - 1 vs 2 - 3 , P = 0.04 ) , the number of mesenteric and intestinal serosal implants ( < /=75 vs > 75 implants , P = 0.005 ) , and stage ( IIIC vs IV , P = 0.006 ) . The probability of survival was independently influenced by age ( < /=61 vs > 61 years , P = 0.003 ) , volume of ascites ( < /=1 vs > 1 liter , P = 0.01 ) , stage ( IIIC vs IV , P = 0.04 ) , histology ( clear cell and mucinous vs all other , P = 0.03 ) , and the completeness of cytoreductive operation ( complete vs incomplete cytoreduction , P = 0.02 ) . CONCLUSIONS Complete cytoreduction is possible for the majority of patients and improves survival , even compared to operations with minimal ( < /=1 cm ) residual disease . Unless their medical condition prohibits anesthesia and surgery , patients with advanced epithelial ovarian cancer should undergo primary cytoreductive surgery with the intention of complete tumor removal Lung cancer is the leading cause of cancer death in the world , causing more than one million deaths each year . The incidence and mortality rates are highest in the United States and Europe and continue to increase in developing nations . Non-small cell lung cancer ( NSCLC ) accounts for 80 to 85 % of all new cases of lung cancer . The majority of patients with NSCLC present with advanced disease at the time of diagnosis . Although the prognosis of advanced NSCLC is very poor , current chemotherapy combinations have been shown to improve 1-year survival and quality of life for these patients . Approximately one third of patients with NSCLC are diagnosed with locally advanced disease . Although cure rates are modest and variable in locally advanced NSCLC , multimodality therapy ( chemotherapy in combination with surgery or radiotherapy ) has result ed in statistically significant improvement in 5-year survival when compared with surgery or radiotherapy alone . Patients with early-stage NSCLC have the best long-term survival rates following surgical resection ; however , systemic recurrences remain a problem in the majority of these patients . The rationale for treating patients with early-stage NSCLC with combined-modality therapy ( chemotherapy and surgery ) is compelling , and several r and omized trials are currently in progress . Although progress has been slow , when we consider the recent advances in smoking prevention , smoking cessation , staging classification , imaging and diagnostic techniques , screening and therapeutic modalities , and multidisciplinary care , as well as in the underst and ing of the molecular pathogenesis of lung cancer , the future , in my opinion , is very promising The aim of this study was to compare the outcome of patients with advanced ovarian carcinoma treated with neoadjuvant chemotherapy ( NACT )  with those treated conventionally with primary debulking surgery . From 1994 to 2003 , all consecutive cases of advanced-stage epithelial ovarian carcinoma treated with NACT at the University of Bari were identified . A well-balanced group of women who underwent primary debulking surgery followed by platinum-based chemotherapy was selected as controls .  Kaplan – Meier and Cox proportional hazards analyses were used to determine the predictors for survival . Thirty women with advanced-stage epithelial ovarian carcinoma were treated with NACT and compared to 30 patients who underwent primary debulking surgery .  Patients in the NACT were significantly older and had a poorer performance status compared to the controls . However , no statistical difference was observed in overall disease-specific survival ( P = 0.66 ) and disease-free survival ( P = 0.25 ) between the two groups . Although patients in the NACT group are significantly older and have a poorer performance status , this treatment modality does not compromise survival . Prospect i ve r and omized trials comparing NACT to conventional treatment to determine the quality of life and cost/benefit outcomes are now appropriate for women presenting advanced epithelial ovarian cancer Hepatocellular carcinoma ( HCC ) is a highly prevalent disease in many Asian countries , accounting for 80 % of victims worldwide . Screening programs improve the detection of early HCC and have a positive impact on survival , but the majority of HCC patients in Asia still present with advanced stage disease . The treatment outcomes of HCC are affected by multiple variables , including liver function , performance status of the patient , and tumor stage . Therefore , it is not easy to apply a multidisciplinary therapeutic approach for optimal management . At present , limited numbers of HCC patients are eligible for curative therapies such as surgery or ablation in Asia . Therefore , most patients are eligible for only palliative treatments . For optimal management , the treatment choice is guided by staging systems and treatment guidelines . Numerous staging systems have been proposed and treatment guidelines vary by region . According to the Barcelona Clinic Liver Cancer ( BCLC ) guideline based on evidence from r and omized clinical trials , only transarterial chemoembolization ( TACE ) is recommended for intermediate stage HCC and sorafenib for advanced stage HCC . However , treatment guidelines from Asian countries have adopted several other therapeutic modalities such as a surgical approach , hepatic arterial infusion chemotherapy , external radiation , and their combinations based on clinical experiences for intermediate and advanced stage HCC . Although TACE is the main therapeutic modality in the intermediate stage , overall therapeutic outcomes depend on the tumor size . In the advanced stage , the prognosis depends on the tumor status , e.g. major vessel invasion or extrahepatic spread . Thus , a new staging system representing prognoses suitable for Asian HCC patients and a corresponding optimal treatment algorithm should be further investigated using evidence -based data , which will finally bring about an Asian consensus for the management of intermediate and advanced stage HCC OBJECTIVES The current st and ard of chemotherapy for previously untreated patients with stage III/IV ovarian cancer who have undergone optimal or suboptimal cytoreductive surgery leaves room for improvement in terms of response rate and both progression-free and overall survival . Gynecologic Oncology Group ( GOG ) 182-ICON5 is a five-arm international collaborative study design ed to improve on the efficacy of st and ard platinum/taxane therapy by incorporating newer cytotoxic agents in sequential doublet and triplet combinations . METHODS The evolution of a st and ard regimen for treating advanced ovarian cancer is review ed , and the reasons for selecting carboplatin and paclitaxel for the control arm of the study are presented . Among the newer agents available for the experimental treatment arms , three stood out-gemcitabine , polyethylene-glycol (PEG)-liposomal doxorubicin , and topotecan-based on evidence of their activity demonstrated in previous phase I and II trials and , with appropriate dosage modifications , manageable toxicity when used in combination with platinum . RESULTS GOG 182-ICON5 is now in its second year of accrual .  Patient recruitment  , which is anticipated to grow to between 3400 and 4000 patients by the time the study is closed , is meeting expectations , and no problems have been encountered , except for the initial slow pace of recruitment outside of the United States . CONCLUSIONS Combination chemotherapy using newer cytotoxic agents with demonstrated activity in treating advanced-stage ovarian cancer and the ability to enhance platinum-based therapies appears to offer hope of prolonging life and reducing mortality from this disease PURPOSE To determine if incorporation of an additional cytotoxic agent improves overall survival ( OS ) and progression-free survival ( PFS ) for women with advanced-stage epithelial ovarian carcinoma ( EOC ) and primary peritoneal carcinoma who receive carboplatin and paclitaxel .  PATIENTS AND METHODS Women with stages III to IV disease were stratified by coordinating center , maximal diameter of residual tumor , and intent for interval cytoreduction and were then r and omly assigned among five arms that incorporated gemcitabine , methoxypolyethylene glycosylated liposomal doxorubicin , or topotecan compared with carboplatin and paclitaxel . The primary end point was OS and was determined by pairwise comparison to the reference arm , with a 90 % chance of detecting a true hazard ratio of 1.33 that limited type I error to 5 % ( two-tail ) for the four comparisons . RESULTS Accrual exceeded 1,200 patients per year . An event-triggered interim analysis occurred after 272 events on the reference arm , and the study closed with 4,312 women enrolled . Arms were well balanced for demographic and prognostic factors , and 79 % of patients completed eight cycles of therapy . There were no improvements in either PFS or OS associated with any experimental regimen . Survival analyses of groups defined by size of residual disease also failed to show experimental benefit in any subgroup . CONCLUSION Compared with st and ard paclitaxel and carboplatin , addition of a third cytotoxic agent provided no benefit in PFS or OS after optimal or suboptimal cytoreduction . Dual-stage , multiarm , phase III trials can efficiently evaluate multiple experimental regimens against a single reference arm . The development of new interventions beyond surgery and conventional platinum-based chemotherapy is required to additionally improve outcomes for women with advanced EOC PURPOSE The aim of this study was to compare the progression-free and overall survivals of women with advanced ovarian cancer treated with neoadjuvant chemotherapy followed by surgery  with those treated conventionally with cytoreductive surgery followed by cytotoxic chemotherapy . MATERIAL S AND METHODS Fifty-nine consecutive women with advanced malignancies compatible with ovarian cancer based on ( 1 ) physical examinations , ( 2 ) computerized tomography scans , and ( 3 ) cytologic or histologic specimens and treated with platinum-based combination chemotherapy , i.e. , neoadjuvant chemotherapy , were retrospectively review ed . Forty-one subsequently underwent cytoreductive surgery . Their overall and progression-free survivals were compared to those of 206 consecutive women with Stage IIIC and IV epithelial ovarian cancers treated with conventional cytoreductive surgery followed by platinum-based combination chemotherapy during the same era . RESULTS No statistical difference was observed in overall survival ( P = 0.1578 ) or in progression-free survival between the group treated with neoadjuvant chemotherapy and the conventionally treated group ( P = 0.5327 ) despite the neoadjuvant chemotherapy patients being statistically older ( median age 67 years [ range 44 to 85 years ] vs a median age of 60 years [ range 19 to 79 years ] for conventionally treated patients ; P < 0 . 001 ) and having a statistically poorer performance status ( P < 0 . 001 ) than the conventionally treated group . Women undergoing cytoreductive surgery following neoadjuvant chemotherapy had a statistically improved overall survival ( P < 0.0001 ) compared to those who did not undergo surgery . CONCLUSIONS Neoadjuvant chemotherapy does not compromise the survival of women treated for advanced ovarian cancer . Prospect i ve r and omized trials comparing neoadjuvant chemotherapy to conventional therapy to determine quality of life experiences and cost/benefit outcomes are now appropriate for women presenting with advanced ovarian cancer OBJECTIVE The primary end-point of this multi-institutional phase-II trial was to assess results in terms of overall survival after cytoreductive surgery ( CRS ) and hyperthermic intraperitoneal chemotherapy ( HIPEC ) in treatment-naive epithelial ovarian cancer ( EOC ) with advanced peritoneal involvement . Secondary end-points were treatment morbi-mortality and outcome effects of time to subsequent adjuvant systemic chemotherapy ( TTC ) . METHODS Twenty-six women with stage III-IV EOC were prospect ively enrolled in 4 Italian centers to undergo CRS and closed-abdomen HIPEC with cisplatin and doxorubicin . Then they received systemic chemotherapy with carboplatin ( AUC 6 ) and paclitaxel ( 175 mg/m(2 ) ) for 6 cycles . RESULTS Macroscopically complete cytoreduction was achieved in 15 patients ; only minimal residual disease ( ≤2.5 mm ) remained in 11 . Major complications occurred in four patients and postoperative death in one . After a median follow-up of 25 months , 5-year overall survival was 60.7 % and 5-year progression-free survival 15.2 % ( median 30 months ) . Excluding operative death , all the patients underwent systemic chemotherapy at a median of 46 days from combined treatment ( range : 29 - 75 ) . The median number of cycles per patient was 6 ( range : 1 - 8 ) . The time to chemotherapy did not affect the OS or PFS . CONCLUSIONS In selected patients with advanced stage EOC , upfront CRS and HIPEC provided promising results in terms of outcome . Morbidity was comparable to aggressive cytoreduction without HIPEC  . Postoperative recovery delayed the initiation of adjuvant systemic chemotherapy but not sufficiently to impact negatively on survival . These data warrant further evaluation in a r and omized clinical trial PURPOSE To prospect ively determine the impact of genetic counseling and testing on risk-reduction strategies and cancer incidence in a cohort of individuals at hereditary risk for breast and ovarian cancer . PATIENTS AND METHODS Two hundred fifty-one individuals with BRCA mutations were identified at a single comprehensive cancer center from May 1 , 1995 , through October 31 , 2000 . Uniform recommendations regarding screening and preventive surgery were provided in the context of genetic counseling . Patients were followed for a mean of 24.8 months ( range , 1.6 to 66.0 months ) using st and ardized question naires , chart review s , and contact with primary physicians . RESULTS Frequency of cancer surveillance by physical examinations and imaging studies increased after genetic counseling and testing . Twenty-one breast , ovarian , primary peritoneal , or fallopian tube cancers were detected after receipt of genetic test results . Among 29 individuals choosing risk-reducing mastectomy after testing , two were found to have occult intraductal breast cancers . Among 90 individuals who underwent risk-reducing salpingo-oophorectomy , one early-stage ovarian neoplasm and one early-stage fallopian tube neoplasm were found . Radiographic or tumor marker-based screening detected six breast cancers , five of which were stage 0/I , one early-stage primary peritoneal cancer , and three stage I or II ovarian cancers . Six additional breast cancers were detected by physical examination between radiographic screening intervals ; four of these six tumors were stage I. No stage III or stage IV malignancies were detected after genetic testing . CONCLUSION This study provides prospect i ve evidence that genetic counseling and testing increased surveillance and led to risk-reducing operations , which result ed in diagnosis of early-stage tumors in patients with BRCA1 and BRCA2 mutations INTRODUCTION Ovarian cancer is the leading cause of death among gynecological malignancies . Its usual clinical manifestation is at advanced stages , with nutritional impairment , weight loss , and a consequent decline in skeletal muscle mass and strength ( defined as sarcopenia ) . The relationship between sarcopenia and decreased survival was demonstrated not only in ovarian cancer but also in other cancer types , such as hepatocellular , pancreatic , lung , colon , cervical , metastatic breast , and renal cancer . The aim of this study is to review the current evidence regarding the relationship between sarcopenia and the surgical and oncological outcomes in ovarian cancer patients . METHODS The systematic search was performed according to the Preferred Reporting Items for Systematic Review s and Meta-Analyses ( PRSIMA ) statement . The terms " SARCOPENIA " AND " OVARIAN CANCER " were systematic ally used to search PubMed and Scopus data bases . Original reports in English language were identified , with the purpose to include all relevant papers regarding the role of sarcopenia and indicators of skeletal muscle quality assessment in gynecological ovarian cancer . RESULTS A total of 9 studies were considered eligible for the present review . The strength of recommendation was moderate and the level of evidence was low in all selected articles . No prospect i ve studies were conducted and most of the papers were case-control series comparing ovarian cancer sarcopenic population vs. non sarcopenic population . CONCLUSIONS Sarcopenia appears to have an important role in oncological outcomes of ovarian cancer patients . However , sarcopenia occurrence during disease history and mechanisms underlying the possible impairment in prognosis should be better investigated . Prospect i ve trials are awaited in order to obtain a better insight in this topic OBJECTIVE About 70 % of epithelial ovarian cancer patients ( EOC ) are diagnosed at advanced stage with a five-year survival rate of only 30 % . Whilst CA125 detects peritoneally-spread disease , it has limited sensitivity for early cancers , many of which are potentially curable . METHODS We compared the new commercially available tumor marker HE4 with CA125 individually , in combination , within the risk of malignancy index ( RMI ) and the newly defined risk of malignancy algorithm ( ROMA ) . Our prospect ively-collected cohort of 160 patients consisted of healthy controls , benign diseases , and borderline tumors/adenocarcinomas of ovarian , tubal , peritoneal and endometrial origin .  HE4 and CA125  were measured in serum using st and ardized ELISA . RESULTS Both markers showed similar diagnostic performance in the detection of EOC at clinical ly defined thresholds ( CA125 35U/ml ; HE4 70pM ) but HE4 was not elevated in endometriosis . Comparison of non-malignant diagnoses ( n=71 ) versus early stage ovarian and tubal cancers ( n=19 ) revealed that HE4 and ROMA displayed the best diagnostic performance ( AUC 0.86/0.87 , specificity 85.9%/87.3 % and sensitivity 78.9%/78.9 % , respectively ) . Whilst RMICA125 detects peritoneal cancer better than all other models ( AUC 0.99 , specificity 97.2 % , sensitivity 80.0 % ) , there is no other detection benefit from RMI compared to HE4 alone or included in ROMA . CONCLUSIONS The major advantage of HE4 lies in its specificity and improved detection of borderline tumors and early stage ovarian and tubal cancers . HE4 is superior to CA125 with or without RMI and ROMA indices . However , we see no benefit from combining both markers in clinical practice OBJECTIVE Diagnostic factors are needed to improve the currently used serum CA125 and risk of malignancy index ( RMI ) in differentiating ovarian cancer ( OC ) from other pelvic masses , thereby achieving precise and fast referral to a tertiary center and correct selection for further diagnostics . The aim was to evaluate serum Human Epididymis protein 4 ( HE4 ) and the risk of ovarian malignancy algorithm ( ROMA ) for these purpose s. METHODS Serum from 1218 patients in the prospect i ve ongoing pelvic mass study was collected prior to diagnosis . The HE4 and CA125 data were registered and evaluated separately and combined in ROMA and compared to RMI . RESULTS 809 benign tumors , 79 borderline ovarian tumors , 252 OC ( 64 early and 188 late stage ) , 9 non-epithelial ovarian tumors and 69 non-ovarian cancers were evaluated . Differentiating between OC and benign disease the specificity was 62.2 ( CA125 ) , 63.2 ( HE4 ) , 76.5 ( ROMA ) and 81.5 ( RMI ) at a set sensitivity of 94.4 which corresponds to RMI=200 . The areas under the curve ( AUC ) were 0.854 ( CA125 ) , 0.864 ( HE4 ) , 0,897 ( ROMA ) and 0.905 ( RMI ) for benign vs. early stage OC . For premenopausal benign vs. OC AUC were 0.925 ( CA125 ) , 0.905 ( HE4 ) , 0.909 ( ROMA ) and 0.945 ( RMI ) . CONCLUSION HE4 and ROMA helps differentiating OC from other pelvic masses , even in early stage OC . ROMA performs equally well as the ultrasound depending RMI and might be valuable as a first line biomarker for selecting high risk patients for referral to a tertiary center and further diagnostics . Further improvements of HE4 and ROMA in differentiating pelvic masses are still needed , especially regarding premenopausal women BACKGROUND Laparoscopy has acquired an increasing role in the management of ovarian cancer . Laparoscopic cytoreduction could represent a new frontier for selected patients after neoadjuvant chemotherapy ( NACT ) .  OBJECTIVE We sought to assess feasibility and early complication rate of minimally invasive ( MI ) interval debulking surgery ( IDS ) in stage III-IV epithelial ovarian cancer ( EOC ) patients after NACT .  STUDY DESIGN This is a phase II multicentric study in advanced EOC cases with clinical complete response after NACT , according to Gynecologic Cancer Intergroup and Response Evaluation Criteria In Solid Tumors criteria . Institutional review board approval was obtained and all patients signed written informed consent to be included in the protocol . The study was registered in clinical trials.gov ( NCT02324595 ) and was named " MISSION " trial . For patients meeting inclusion criteria , surgical procedures started with diagnostic laparoscopy to confirm preoperative findings and assess surgical complexity . MI-IDS included hysterectomy , bilateral salpingo-oophorectomy , appendectomy , omentectomy , peritonectomy , and bowel resection . Pelvic and /or aortic lymphadenectomy was not considered as st and ard procedure in these cases . Intraoperative and postoperative outcomes , time to restart chemotherapy , survival rate , and quality of life data were registered . RESULTS From December 2013 through February 2015 , of 184 advanced EOC patients considered eligible for IDS , 52 ( 28.2 % ) met inclusion criteria and were enrolled in the study . For 22 ( 12 % ) of them , st and ard laparotomic approach was preferred because of intraoperative surgeon evaluation . Thirty ( 16.3 % ) patients received the planned treatment of MI-IDS . Median age was 61 ( range 39 - 81 ) years and median body mass index was 24 ( range 20 - 31 ) kg/m(2 ) .  Median numbers of NACT cycles was 4 ( range 3 - 7 ) . Median operative time was 285 ( range 124 - 418 ) minutes and median estimated blood loss was 100 ( range 50 - 200 ) mL. Surgical procedures included 28 ( 93.3 % ) hysterectomy and bilateral salpingo-oophorectomy , 29 ( 96.6 % ) omentectomy , 2 ( 6.6 % ) appendectomy , 11 ( 36.6 % ) regional peritonectomy , and 1 ( 3.4 % ) bowel resection . A residual tumor of 0 cm was reached in 29 ( 96.6 % ) patients and 0.5 cm in only 1 ( 3.4 % ) case . The vast majority of patients were discharged on postoperative day 2 ( range 2 - 3 ) . No early postoperative complications were registered . Median time to restart chemotherapy was 20 ( 10 - 30 ) days and all patients successfully completed the cycles . Histological findings showed 3 ( 10 % ) complete response , 9 ( 30 % ) microscopic residual disease , and 18 ( 60 % ) evidence of macroscopic residual disease . With a median follow-up of 10.5 month , 5 peritoneal and 2 lymph nodal recurrences were observed . Psychometric test revealed moderate discomfort in the vast majority of patients ( 66.7 % ) . All patients are still alive . CONCLUSION Invasive-IDS in patients with clinical ly complete response to NACT seems to be feasible and safe in terms of perioperative outcomes , psycho-oncological impact , and survival rate . The equivalence between MI surgery and laparotomy needs to be confirmed with a longer follow-up and a larger number of patients BACKGROUND To assess the safety and efficacy of neoadjuvant chemotherapy ( NAC ) followed by interval debulking surgery ( IDS ) for müllerian carcinomas , such as ovarian , tubal , and peritoneal cancers , and to determine whether we can omit diagnostic laparoscopy before treatment initiation , a feasibility study was performed . METHODS Eligible patients had presumed stage III/IV müllerian carcinomas clinical ly diagnosed by imaging studies , cytology , and tumor markers . All patients underwent diagnostic laparoscopy to confirm the clinical diagnosis . Four cycles of paclitaxel and carboplatin were administered as NAC , followed by interval debulking surgery and an additional 4 cycles of chemotherapy . The primary end point was the proportion of patients achieving clinical complete remission ( cCR ) among all stage III/IV müllerian carcinomas confirmed by diagnostic laparoscopy . The major secondary end point was the positive predictive value ( PPV ) of clinical diagnosis . RESULTS Fifty-six patients were enrolled into the study . The PPV of overall clinical diagnosis for the tumor origin , histology , and stage was 95 % ( 53/56 ) . Fifty-three patients received the protocol treatment starting with NAC . IDS was performed in 89 % ( 47/53 ) of patients . Complete resection without residual tumors was achieved in 55 % ( 29/53 ) and residual tumors became < 1 cm in 17 % ( 9/53 ) of patients . Twenty-two patients ( 42 % ) achieved cCR after completion of the treatment . The median overall and progression-free survival was 45 and 14 months , respectively . CONCLUSION NAC without diagnostic laparoscopy for advanced müllerian carcinomas holds sufficient promise to be compared with direct surgery in a phase III trial Background St and ard treatment of advanced ovarian cancer is surgery and chemotherapy . The goal of surgery is to remove all macroscopic tumour , as the amount of residual tumour is the most important prognostic factor for survival . When removal off all tumour is considered not feasible , neoadjuvant chemotherapy ( NACT ) in combination with interval debulking surgery ( IDS ) is performed . Current methods of staging are not always accurate in predicting surgical outcome , since approximately 40 % of patients will have more than 1 cm residual tumour after primary debulking surgery ( PDS ) . In this study we aim to assess whether adding laparoscopy to the diagnostic work-up of patients suspected of advanced ovarian carcinoma may prevent unsuccessful primary debulking surgery for ovarian cancer . Methods Multicentre r and omized controlled trial , including all gynaecologic oncologic centres in the Netherl and s and their affiliated hospitals . Patients are eligible when they are planned for PDS after conventional staging . Participants are r and omized between direct PDS or additional diagnostic laparoscopy . Depending on the result of laparoscopy patients are treated by PDS within three weeks , followed by six courses of platinum based chemotherapy or with NACT and IDS 3 - 4 weeks after three courses of chemotherapy , followed by another three courses of chemotherapy . Primary outcome measure is the proportion of PDS 's leaving more than one centimetre tumour residual in each arm . In total 200 patients will be r and omized . Data will be analysed according to intention to treat . Discussion Patients who have disease considered to be resectable to less than one centimetre should undergo PDS to improve prognosis . However , there is a need for better diagnostic procedures because the current number of debulking surgeries leaving more than one centimetre residual tumour is still high . Laparoscopy before starting treatment for ovarian cancer can be an additional diagnostic tool to predict the outcome of PDS . Despite the absence of strong evidence and despite the possible complications , laparoscopy is already implemented in many countries . We propose a r and omized multicentre trial to provide evidence on the effectiveness of laparoscopy before primary surgery for advanced stage ovarian cancer patients .Trial registration Netherl and s Trial Register number The aim of this prospect i ve study was to determine the clinical benefits of introducing peroperative frozen section analysis into the surgical management policy of women referred with an adnexal mass suspicious of ovarian cancer . All women surgically managed at the Northern Gynaecological Oncology Centre , Gateshead , UK , between July 1 , 2002 , and June 30 , 2003 , where frozen section analysis had been utilized were included for analysis . Correlation was determined between cases surgically staged following the frozen section result and the clinical need for staging based on the pathologic diagnosis from the paraffin section . During the 12-month period , 130 women underwent frozen section analysis .  Paraffin section diagnoses included 74 benign tumors , 11 borderline tumors , 34 primary epithelial cancers , 5 nonepithelial cancers , and 6 metastatic tumors . All primary epithelial ovarian cancers were correctly identified as requiring a staging procedure based on the frozen section result . Four of seventy-four cases reported as benign on frozen section analysis were underdiagnosed ; two were later diagnosed on paraffin section as borderline tumors and a further two as malignant ( one low- grade adenosarcoma and one primary peritoneal cancer ) . Of the 130 cases , 55 ( 42.3 % ) underwent a staging procedure based on the frozen section result . The value of frozen section analysis in determining the need for the performance of a staging procedure had the following statistical test results : sensitivity = 92 % , specificity = 88 % , positive predictive value = 82 % , and negative predictive value = 95 % . Excluding the borderline tumors , metastatic tumors , and primary peritoneal tumor where staging did not impact subsequent clinical management , the statistical test results for frozen section analysis in determining the need for a staging procedure were sensitivity = 97 % , specificity = 95 % , positive predictive value = 90 % , and negative predictive value = 99 % . The clinical benefits of introducing frozen section analysis in the surgical staging policy of women with an adnexal mass suspicious of ovarian malignancy included avoidance of a surgical staging procedure in 95 % of cases identified on paraffin section analysis to be benign . This benefit was without compromising the avoidance of chemotherapy in true stage I epithelial ovarian cancer cases . Additional benefits included the confirmation of malignancy where extraovarian lesions were suggestive but not indicative of malignant disease , and the intraoperative identification of metastatic disease of nonovarian origin BACKGROUND During an international workshop held in September 1998 , a group of specialists in the field of ovarian cancer reached consensus on a number of issues with implication s for st and ard practice and for research of advanced epithelial ovarian cancer . METHODS Five groups of experts considered several issues which included : biologic factors , prognostic factors , surgery , initial chemotherapy , second-line treatment , the use of CA 125 , investigational drugs , intra-peritoneal treatment and high-dose chemotherapy . The group attempted to arrive at answers to questions such as : Are there prognostic factors , which help to identify patients who will not do well with current therapy ? What is the current best therapy for advanced ovarian carcinoma ? What directions should research take in advanced ovarian cancer ? These issues were discussed in a plenary meeting . RESULTS One of the major conclusions drawn by the consensus committee was that in previously untreated advanced ovarian cancer , cisplatin plus paclitaxel has been shown to be superior to previous st and ard therapy with cisplatin plus cyclophosphamide ( level I evidence ) . However , for many patients , carboplatin plus paclitaxel is a reasonable alternative because of toxicity and convenience considerations . Most participants felt that the benefits in terms of toxicity for the paclitaxel-carboplatin are such that its widespread adoption at this stage is justified . Until mature survival data are available a minority of investigators would recommend continued use of cisplatin plus paclitaxel , specifically for those patients with advanced disease with the best prognostic characteristics . For future clinical research in this area , new end points for r and omised clinical trials , together with a new Trials Network , are proposed PURPOSE To compare the efficacy of a treatment with cisplatin plus cyclophosphamide given for 5 months and a short treatment with cisplatin alone in advanced ovarian cancer , we conducted a multicenter r and omized clinical trial . PATIENTS AND METHODS Eligibility criteria were as follows : first diagnosis of histologically confirmed invasive epithelial ovarian cancer of International Federation of Gynecology and Obstetric ( FIGO ) stage III-IV , age younger than 75 years , and Eastern Cooperative Oncology Group ( ECOG ) performance status 0 , 1 , or 2 . Within 28 days of cytoreductive surgery , eligible women were r and omly assigned treatment with weekly cisplatin 50 mg/m2 for nine courses or cisplatin 75 mg/m2 plus cyclophosphamide 750 mg/m2 every 21 days for six courses . RESULTS A total of 607 women were entered onto the study . There was no difference in the response to treatment . Pathologic complete response ( CR ) was documented in 63 of the weekly cisplatin cases and 70 of the cisplatin plus cyclophosphamide group ( chi 1(2 ) = 1.43 ; P = .23 ) . The median follow-up time was 3 years . There were 151 and 148 deaths in the weekly cisplatin and cyclophosphamide plus cisplatin arms , respectively . Survival curves were similar in the two groups , with a 3-year percent survival estimate of 44.1 ( SE = 3.4 ) in the weekly cisplatin and 44.6 ( SE = 3.4 ) in the cisplatin plus cyclophosphamide group ( log-rank test chi 1(2 ) = 0.004 ; P = .96 ) . CONCLUSION This study found that 2-month monochemotherapy treatment with cisplatin was as effective as 5-month polychemotherapy including cisplatin at a similar doses but different dose-intensity plus cyclophosphamide The prognosis of malignant pleural mesothelioma is poor , with a median survival time from diagnosis of 7 to 17 months . At present there is no st and ardized treatment of this neoplasia . Between July 1995 and January 1999 , 22 patients with malignant pleural mesothelioma were enrolled in our study . The characteristics of patients were : 16 men and 6 women ; median age 61 years ( range , 49–77 years ) ; stage ( according to Butchart ) : 8 patients stage I , 10 stage II , 2 stage III , and 2 stage IV ; cytologic diagnosis in 5 cases and histologic diagnosis in 17 cases . The treatment consisted of mitoxantrone 10 mg/m2 intravenous ( IV ) or intrapleural ( IPL ) , methotrexate 35 mg/m2 IV , and mitomycin 7 mg/m2 IV on day 1 and repeated every 3 weeks , with mitomycin in alternate cycles ( MMM regimen ) . One complete response ( 4.5 % ) ( 42 months of duration ) and 6 partial responses ( 27.3 % ) ( 5 , 5 , 7 , 9 , 14 , and 19 months of duration ) were achieved ; the overall response rate ( ORR ) was 31.8 % ( 95 % CI , 12.4–51.3 % ) ; 7 patients were stable under this treatment ( 31.8 % ) . According to the pathologic type , ORR for the only epithelial type was 39.9 % ( 95 % CI , 15.2–64.8 % ) . Median time to progression was 6 months ( range , 1–22 ) . The overall median survival time was 13.5 months ( range , 1–50 ) ; the median survival time of responders significantly differed from that of nonresponders ( 18.0 versus 8.5 months;p = 0.017 ) . This treatment produced a considerable clinical benefit , with improvement of dyspnea ( 68.4 % ) and pain ( 33.3 % ) ; 15 of 19 patients ( 78.9 % ) with pleural effusion at the time of diagnosis showed an important reduction in pleural fluid during chemotherapy . Hematologic toxicity was the main side effect ; World Health Organization grade III to IV of neutropenia , anemia , and thrombocytopenia were observed in 81.8 % , 13.6 % , and 22.7 % of patients , respectively . From the data presented here , this regimen can be considered active in the treatment of malignant pleural mesothelioma BACKGROUND AND RATIONALE Non-curative surgical cytoreduction of advanced tumors is associated with increased proliferation of the remaining tumor cells . Thus , appropriate preoperative chemotherapy should prevent both cell proliferation and the increase of resistant cells . The aim of the present study was to evaluate the efficacy and toxicity of primary chemotherapy ( P-CT ) in previously untreated patients with stage IV ovarian cancer ( OC ) . PATIENTS AND METHODS Thirty-four patients with stage IV OC were treated from January 1993 to April 2000 with P-CT . Eligibility criteria included : histologically or cytologically confirmed , unresectable stage IV OC and performance status < or = 3 .  P-CT consisted of four courses of carboplatin , cyclophosphamide and epirubicin until October 1996 , and paclitaxel , carboplatin thereafter . Surgery followed P-CT . After the operation patients received two further courses of chemotherapy that were tailored according to their individual response . Median ( M ) age was 61 years , range 32 - 73 ; median performance status was 2 . A total number of 197 courses of CT were administered , median 5.7 per patient . RESULTS Complete or partial response ( CR , PR ) was observed in 28 patients ( response rate 82 % , 95 % CI : 65.4 % to 93.2 % ) , disease stability and progression ( SD , PD ) was observed in three and three patients , respectively . Median time to progression was 16.45 months ( range 4.8 - 90.4 + ) , median survival time was 28 months ( range 4.5 - 90.4 + ) : 1-year survival rate was 94 % . Toxicity according to WHO : nausea and vomiting grade ( G ) 2 , 30 % of patients ; gastrointestinal G 2 - 3 , 20 % of patients ; alopecia G 3 , 88 % of patients ; hematological G 3 - 4 , 73 % of patients ; neurologic G 2 , 12 % of patients . Nine pathological CRs were observed . CONCLUSION Neoadjuvant treatment with CBDCA with either CTX and EPI or Taxol is feasible and shows activity in OC BACKGROUND AND AIMS The risk of gastric cancer ( GCA ) is increased in atrophic gastritis . A low serum pepsinogen group I ( SPGI ) level is a good serologic indicator of atrophic gastritis of the gastric corpus and fundus , and can be used for diagnosis of subjects with atrophic gastritis and of increased risk for GCA . The present study was undertaken to investigate whether SPGI assay and a diagnostic gastroscopy could enable the diagnosis of GCA at an early stage . MATERIAL AND METHODS The study was carried out as part of the Alpha-Tocopherol , Beta-Carotene Cancer prevention study ( ATBC study ) in Finl and , in which 22,436 male smokers aged 50 - 69 years were screened by SPGI . Low SPGI levels ( < 25 microg/l ) were found in 2196 ( 9.8 % ) men . Upper GI endoscopy ( gastroscopy ) was performed in 1344 men ( 61 % ) and 78 % of these had moderate or severe atrophic corpus gastritis in endoscopic biopsies . A control series of 136 men from the ATBC study cohort with abdominal symptoms , but with SPGI > or = 50 microg/l were similarly endoscopied , and 2.2 % of these had corpus atrophy . RESULTS Neoplastic alterations were found in 63 ( 4.7 % ; 95 % CI : 3.6%-5.8 % ) of the 1344 endoscopied men with low SPGI levels . Of these , 42 were definite dysplasias of low grade , 7 dysplasias of high grade , 11 invasive carcinomas , of which 7 were ' early ' cancers , and 3 carcinoid tumors . In the control series , 1 man ( 0.7 % ) of the 136 men had a definite low- grade dysplasia . Thus , 18 ( 1.3 % ; 95 % CI 0.7%-2.0 % ) cases with ' severe ' neoplastic lesions ( 4 advanced cancers , 7 early cancers and 7 dysplasias of high grade ) were found in the low SPGI group , but there were none in the control group . All four patients with advanced cancer died from the malignancy within 5 years ( mean survival time 2.5 years ) , whereas surgical treatment in all those with early cancer or high- grade dysplasia was curative . One of the seven patients with early cancer and two of the seven with high- grade dysplasia died within 5 years , but none died from the gastric cancer . Thus , curative treatment was given to 14 of 18 men in whom a malignant lesion was found in gastroscopy . This is about 15 % of all gastric cancer cases ( 92 cases ) which were diagnosed within 5 years after SPGI screening in the 22,436 men . Among the gastric cancer cases of the main ATBC study , the 5-year survival rate was 33 % ( 85 % of the non-survivors died from gastric cancer ) . CONCLUSIONS We conclude that assay of SPGI followed by endoscopy is an approach which can enable the early diagnosis of gastric cancer at a curable stage Background Endoscopic ultrasonography ( EUS ) is a st and ard procedure in the preoperative staging of patients with gastric carcinomas . Herein we present our experience with EUS and discuss the results and their implication s for surgical therapy . Methods A total of 116 patients with histologically confirmed gastric adenocarcinoma were referred to EUS  and classified prospect ively by the TNM system . The results of the preoperative endosonographic staging were compared with the definitive histopathological results after the operation . Results The overall accuracy of  EUS  for determination of the T stage was 78 % . The accuracy for the T1 and T2 stages was 80 % and 63 % , respectively . With 20 % and 30 % , there was a relatively high rate of overstaging in these cases . The accuracy for T3 and T4 tumors was 95 % and 83 % , respectively . The accuracy of EUS  for determination of the N stage was 77 % , with a sensitivity of 91 % and a specificity of 84 % . Resectability was predicted correctly with a sensitivity of 94 % and a specificity of 83 % . Conclusions Generally accepted st and ards for the therapy of advanced gastric carcinomas do not exist . In cases where the therapeutic strategy is surgical exploration , no preoperative staging is necessary . In cases with differentiated treatment strategies , the accuracy of EUS is not sufficient for the selection of patients for endoscopic resection . Its accuracy for submucosal cancer invasion and for the detection of lymph node metastases needs to be further enhanced . If only multimodal therapy is considered , EUS staging seems to be absolutely m and atory . Patients classified preoperatively as T1 to T3 can be operated on primarily with sufficient security . In patients where radical resection of the tumor seems doubtful , we recommend that a diagnostic laparoscopy be performed to confirm the diagnosis BACKGROUND Our group evaluated the risk of recurrence for optimally treated advanced epithelial ovarian cancer ( adEOC ) in patients with a low-level rising serum CA-125 concentration within the normal range ( 0 - 35 kU/l ) . In addition , we tested the new proposed early CA-125 signal of progressive disease ( EPD ) criterion in the same study population . PATIENTS AND METHODS Patients treated from 1998 to 2006 for adEOC were identified at our institution . Inclusion criteria were as follows : CA-125 at time of diagnosis ( > 35 kU/l ) ; International Federation of Gynecology and Obstetrics stages III-IV treated with optimal primary treatment ; and complete response ( CR ) to primary treatment with normalization of CA-125 . RESULTS Median progression-free survival and overall survival for the recurrence group ( n = 60 ) were 17.7 and 38.2 months , respectively . The median follow-up time from CR to last contact was 40.2 months for patients in the nonrecurrence group ( n = 36 ) . An absolute increase in serum CA-125 levels of > or=5 kU/l compared with baseline CA-125 nadir values was significantly predictive of recurrence ( odds ratio for recurrence = 402.98 , P < 0.0001 ) . The progression date was pre date d by the EPD criterion in 77 % of patients with known progressive disease ( median , 58 days early ) with a sensitivity of 90 % , a positive predictive value of 96.4 % , and a false-positive rate of 5.6 % . CONCLUSIONS Among patients with optimally treated adEOC in complete remission , a low-level increase in serum CA-125 concentration within the normal range is a strong independent predictive factor for disease recurrence . In this patient population , future prospect i ve r and omized trials should consider the evaluation of the EPD criterion PURPOSE Epithelial ovarian cancer is the fourth leading cause of cancer-related death in women .  Five-year survival is about 25 % , and new approaches to the treatment of this disease are dearly warranted . This study was design ed to determine the feasibility of using an in vitro assay for drug resistance to guide treatment after cytoreductive surgery . We present preliminary results of this study after a median follow-up of 24 months . MATERIAL S AND METHODS We treated 66 patients with advanced ovarian cancer by use of a combination of cytoreductive surgery and chemotherapy . Patient inclusion criteria included histologic confirmation of epithelial ovarian cancer , International Federation of Gynecology and Obstectrics ( FIGO ) stage III , no prior chemotherapy or radiation therapy , no coexisting neoplasm , and optimal residual disease ( < 2 cm ) . Malignant tissue from the involved ovary of each patient was tested in vitro for drug resistance , and chemotherapy was directed individually by assay results . On the basis of the assay we treated 19 patients with platinum/paclitaxel ( TP ) and 47 with platinum/cyclophosphamide ( CP ) .  RESULTS Three-year survival ( Kaplan-Meier estimate ) was 69 % ; the 95 % confidence interval was 58 % to 80 % . There was no difference in 3-year survival between the 19 patients treated with TP ( 66 % ) and the 47 patients treated with CP ( 74 % ) . The cost-effectiveness of each treatment option was determined . It cost $ 4615 to achieve 3-year survival for patients receiving CP and $ 17,988 to obtain a similar survival with TP . The cost-effectiveness of assay-directed therapy was $ 9768 . DISCUSSION Because of the high recurrence rate and the poor long-term survival of women with advanced ovarian cancer , improved therapies for this disease are needed . After surgical debulking , we used results of an in vitro assay for drug resistance to individually select chemotherapy for the patients in this study . Although the 3-year survival of 69 % obtained in the present study appears good compared with previously published studies of optimally debulked patients , the results must be viewed with caution . Patients were not r and omized , and differences in prognostic factors , such as tumor grade , patient age , and performance status , could account in part for the higher survival found in the current study compared with previously published studies . Treatment with either CP or TP result ed in equivalent 3-year survival . The cost to achieve 3-year survival with this protocol , including the cost of the drug resistance assay , was $ 9768 . We believe that consideration of costs avoided by the elimination of ineffective treatments , needless toxicity , and loss of quality of life would likely increase the cost-effectiveness of assay-directed therapy compared with conventional therapy . This study demonstrates that it is feasible to use an in vitro assay in routine clinical practice to eliminate ineffective chemotherapeutic agents Summary AIM : The aim of our study was to evaluate the accuracy of preoperative TNM staging with endoscopic ultrasound ( EUS ) in gastric cancer patients in comparison with the pathohistological stage of the resected specimen , and to determine the possible implication s of EUS for individualized treatment of gastric cancer patients at our institution . PATIENTS AND METHODS : The study included 82 patients operated for resectable gastric cancer between January 1st 2001 and July 1st 2003 at the Maribor Teaching Hospital Department of Abdominal and General Surgery . The EUS stage was assessed preoperatively at the Endoscopical Unit , and the pathohistological stage in the resected specimen was determined postoperatively at the Department of Pathologic Morphology according to recommended st and ards . RESULTS : Comparison of EUS and pathohistological assessment s revealed accuracy of EUS staging for locoregional tumor infiltration ( category T ) in 68 % of patients . The accuracy of EUS staging was 68 % for T1 , 69 % for T2 , 69 % for T3 and 60 % for T4 . Lymph nodes ( category N ) were correctly staged with EUS in 57 % of cases . The EUS stage was correct for lymph nodes with no metastases ( N− ) in 40 % of cases , and for lymph nodes with metastases ( N+ ) in 90 % . There was no significant difference in accuracy of EUS staging with regard to tumor site ( P = 0.768 ) or tumor size ( P = 0.766 ) . CONCLUSIONS : According to our results the accuracy of EUS staging matched pathohistological staging with regard to tumor infiltration and lymph node stage in 68 % and 57 % of cases respectively . Underestimation of the final T2 and T3 stages as T1 stage by EUS presents a problem regarding the consistency of EUS examination at our institution , particularly with respect to individual treatment for early gastric cancer . The present uncertainty in EUS stage reliability makes it necessary to have a strategy of radical resection with D2 lymphadenectomy in patients within EUS stages T1–T3 , with additional CT examinations in more advanced EUS stages in order to visualize the circumstances of tumor growth . Nevertheless , EUS provides an opportunity for the surgeon to gain more insight into the loco-regional circumstances of the gastric tumor process . For development of individual modes of treatment based on EUS staging , a more reliable assessment of EUS stage is m and atory The guidelines for the diagnosis , surveillance and therapy of Barrett ’s esophagus were originally published by the American College of Gastroenterology in 1998 and up date d in 2002 . These and other guidelines undergo periodic review . Significant advances have occurred in the area of Barrett ’s esophagus over the past four years leading to another revision of the prior guidelines . These advances include the potential use of esophageal capsule endoscopy for the diagnosis and screening of Barrett ’s esophagus , data regarding the outcome of low- grade dysplasia , the treatment of high- grade dysplasia using photodynamic therapy , and the development of new ablation techniques such as radiofrequency ablation . These guidelines are intended to be applied by physicians who see Barrett ’s esophagus patients and are intended to indicate a preferred , but certainly not the only , acceptable approach . Physicians need to choose the course best suited to the individual patient and to the variables that exist at the time of decision making . The guidelines are for adult patients with the diagnosis of Barrett ’s esophagus , as defined herein . Both these and the original guidelines were developed under auspices of the American College of Gastroenterology and the Practice Parameters Committee and approved by the Board of Trustees . The world literature was review ed extensively for the original guidelines and once again review ed using the National Library of Medicine data base . Search terms used included Barrett ’s esophagus , esophageal neoplasm , esophagus , intestinal metaplasia , esophageal diseases , and adenocarcinoma , all appropriate studies and any additional ones found in reference to these papers were obtained and review ed . Evidence was available from a hierarchy of trials and r and omized controlled trials were given the greatest weight . Abstract s presented at national and international meetings were only used when unique data from ongoing trials were presented . When scientific data were lacking , recommendations are based on expert opinion . The recommendations made are based on the level of evidence found . Grade A recommendations imply that there is consistent level 1 evidence ( r and omized controlled trials ) , Grade B indicates that the evidence would be level 2 or 3 which are cohort studies or case control studies . Grade C recommendations are based on level 4 studies meaning case series or poor quality cohort studies , and Grade D recommendations are based on level 5 evidence meaning expert opinion CA125 is currently the most widely used tumor marker for ovarian epithelial cancer . The aim of this article is to provide guidelines for the routine clinical use of CA125 in patients with ovarian cancer . Due to lack of sensitivity for stage I disease and lack of specificity , CA125 is of little value in the detection of early ovarian cancer . At present , therefore , CA125 , either alone or in combination with other modalities , can not be recommended for screening for ovarian cancer in asymptomatic women outside the context of a r and omized controlled trial . Preoperative levels in postmenopausal women , however , may aid the differentiation of benign and malignant pelvic masses . Serial levels during chemotherapy for ovarian cancer are useful for assessing response to treatment . Although serial monitoring following initial chemotherapy can lead to the early detection of recurrent disease , the clinical value of this lead-time is unclear . CA125 is the ovarian cancer marker against which new markers for this malignancy should be judged To compare the effect of epidoxorubicin given for 4 months versus no treatment in the survival of patients with advanced ovarian cancer and complete pathologic response after first-line surgery and chemotherapy with platinum-based schedules , we conducted a multicenter r and omized clinical trial . Patients with histologic diagnosis of epithelial ovarian cancer FIGO stage III or IV at first diagnosis ; complete pathologic response at second-look laparotomy/laparoscopy or complete clinic response ; and those who have had first-line therapy including surgery and one regimen containing cisplatin or carboplatinum were eligible for the study and were r and omly allocated to epidoxorubicin 120 mg/sqm or no treatment . A total of 64 women were allocated to epidoxorubicin and 74 to no treatment . There were 20 and 19 deaths , respectively , in the epidoxorubicin and no-treatment groups . The 3-year percent overall survival was 79.0 % and 78.7 % , respectively , in the no-treatment and epidoxorubicin groups ( log-rank test , P= 0.93 ) In order to elaborate evidence -based , national Danish guidelines for the treatment of diverticular disease the literature was review ed concerning the epidemiology , staging , diagnosis and treatment of diverticular disease in all its aspects . The presence of colonic diverticula , which is considered to be a mucosal herniation through the intestinal muscle wall , is inversely correlated to the intake of dietary fibre . Other factors in the genesis of diverticular disease may be physical inactivity , obesity , and use of NSAIDs or acetaminophen . Diverticulosis is most common in Western countries with a prevalence of 5 % in the population aged 30 - 39 years and 60 % in the part of the population > 80 years . The incidence of hospitalization for acute diverticulitis is 71/100,000 and the incidence of complicated diverticulitis is 3.5 - 4/100,000 . Acute diverticulitis is conveniently divided into uncomplicated and complicated diverticulitis . Complicated diverticulitis is staged by the Hinchey classification 1 - 4 ( 1 : mesocolic/pericolic abscess , 2 : pelvic abscess , 3 : purulent peritonitis , 4 : faecal peritonitis ) . Diverticulitis is suspected in case of lower left quadrant abdominal pain and tenderness associated with fever and raised WBC and /or CRP ; but the clinical diagnosis is not sufficiently precise . Abdominal CT confirms the diagnosis and enables the classification of the disease according to Hinchey . The distinction between Hinchey 3 and 4 is done by laparoscopy or , when not possible , by laparotomy . Uncomplicated diverticulitis is treated by conservative means . There is no evidence of any beneficial effect of antibiotics in uncomplicated diverticulitis , but antibiotics may be used in selected cases depending on the overall condition of the patients and the severity of the infection . Abscess formation is best treated by US- or CT-guided drainage in combination with antibiotics . When the abscess is < 3 cm in diameter , drainage may be unnecessary , and only antibiotics should be instituted . The surgical treatment of acute perforated diverticulitis has interchanged between resection and non-resection strategies : The three-stage procedure dominating in the beginning of the 20th century was later replaced by the Hartmann procedure or , alternatively , resection of the sigmoid with primary anastomosis . Lately a non-resection strategy consisting of laparoscopy with peritoneal lavage and drainage has been introduced in the treatment of Hinchey stage 3 disease . Evidence so far for the lavage regime is promising , comparing favourably with resection strategies , but lacking in solid proof by r and omized , controlled investigations . In recent years , morbidity has declined in complicated diverticulitis due to improved diagnostics and new treatment modalities . Recurrent diverticulitis is relatively rare and furthermore often uncomplicated than previously assumed . Elective surgery in diverticular disease should probably be limited to symptomatic cases not amenable to conservative measures , since prophylactic resection of the sigmoid , evaluated from present evidence , confers unnecessary risks in terms of morbidity and mortality to the individual as well as unnecessary costs to society . Any recommendation for routine resection following multiple cases of diverticulitis should await results of r and omized studies . Laparoscopic resection is preferred in case of need for elective surgery . When malignancy is ruled out preoperatively , a sigmoid resection with preservation of the inferior mesenteric artery , oral division of colon in soft compliant tissue and anastomosis to upper rectum is recommended . Fistulae to bladder or vagina , or stenosis of the colon may be dealt with according to symptoms and comorbidity . Resection of the diseased segment of colon is preferred when possible and safe ; alternatively , a diverting stoma can be the best solution INTRODUCTION The incidence of melanoma has increased fivefold during the past three decades . Melanoma can no longer be classified as rare ; rather , it is now one of the more frequent tumors . METHODS Recommendations for the diagnosis and treatment of melanoma are laid out in the interdisciplinary S2 guidelines of the German Cancer Society , upon which the present review is based . The goal of this article is to present the clinical core recommendations for treatment in all disease stages . RESULTS The operative management of primary melanoma usually takes place in two steps . A complete excisional biopsy with a safety margin of about 2 mm is performed in order to establish the histopathological diagnosis . Definitive surgical excision is performed with a safety margin of 1 cm in tumors up to 2 mm thick , 2 cm in thicker tumors . In tumors more than 1 mm thick , sentinel lymph node biopsy should be performed to aid in tumor staging . Radiotherapy is indicated in inoperable tumors of all stages . Adjuvant immunotherapy with interferon alpha is recommended in tumors of thickness > 2 mm and in locoregional metastasis . If distant metastasis is present and R0 surgery is not an option , the treatment should primarily comprise monochemotherapy or alternatively the patient should be enrolled in a clinical trial . CONCLUSION The recommendations presented here are based predominantly on the results of prospect i ve r and omized trials The Danish Ovarian Cancer Study Group registered 722 patients in stages III and IV during the period 1981–1986 . The material included 85 % of all ovarian cancer patients in the catchment area of the group and patients allocated to protocol as well as patients treated outside protocol s. Five and 10-year survival were : stage III 17 % , and 8 % , respectively ; and stage IV 4 % and 2 % . Patients allocated to protocol had a significantly better survival than patients not included in protocol s even when only patients younger than 70 years were compared . All non- protocol patients had a poorer prognosis irrespective of the reason for exclusion . Five-year survival for stage III protocol patients was 25 % vs. 9 % , for non- protocol patients younger than 70 years . The 10-year survival was 11 % and 4 % for stage III protocol and non- protocol patients , respectively . A multivariate analysis showed that residual tumor , age , stage , and performance status had prognostic value . In non protocol patients histologic grade had an additional marginal prognostic impact . In conclusion the study showed that the statement that long-term survival in advanced ovarian cancer has been increased could not be proven by comparison of survival from r and omized studies performed in the early eighties with survival of stage III and IV patients before the introduction of cisplatinum chemotherapy . It is necessary to consider survival of all patients , protocol and non- protocol in a geographically well-defined region for evaluation of survival improvement PURPOSE This was a multinational , open-label , r and omized phase III trial comparing yttrium-90-labeled murine HMFG1 ( 90Y-muHMFG1 ) plus st and ard treatment versus st and ard treatment alone in patients with epithelial ovarian cancer ( EOC ) who had attained a complete clinical remission after cytoreductive surgery and platinum-based chemotherapy . PATIENTS AND METHODS In total , 844 International Federation of Gynecology and Obstetrics stage Ic to IV patients were initially screened , of whom 447 patients with a negative second-look laparoscopy ( SLL ) were r and omly assigned to receive either a single dose of 90Y-muHMFG1 plus st and ard treatment ( 224 patients ) or st and ard treatment alone ( 223 patients ) . Patients in the active treatment arm received a single intraperitoneal dose of 25 mg of 90Y-muHMFG1 ( target dose 666 MBq/m2 ) . The primary end point was length of survival ; secondary end points included time to relapse and safety . The study had an 80 % power to detect a 15 % change in survival . RESULTS After a median follow-up of 3.5 years ( range , 1 to 6 years ) , 70 patients had died in the active treatment arm compared with 61 patients in the control arm . Cox proportional hazards analysis of survival demonstrated no difference between treatment arms . In the study drug arm , 104 patients experienced relapse compared with 98 patients in the st and ard treatment arm . No difference in time to relapse was observed between the two study arms . Active therapy was associated with occasional grade 3 or 4 thrombocytopenia and neutropenia and grade 1 or 2 GI symptoms , abdominal discomfort , arthralgia , and myalgia . CONCLUSION A single IP administration of 90Y-muHMFG1 to patients with EOC who had a negative SLL after primary therapy did not extend survival or time to relapse
In regards to surgery it is recommended to perform total omentectomy since subclinic metastasis have been documented in 10 - 30 % of all cases , and systematic limphadenectomy , necessary to be able to obtain an adequate surgical staging .
Minimal invasion surgery is not a recommended procedure for the treatment of advanced ovarian cancer .
Radiotherapy can be used to palliate symptoms .
In the present , there is not a st and ardized screening method .
Diagnosis in early stages means a better survival .
Radiotherapy can be indicated to palliate symptoms
INTRODUCTION Ovarian cancer ( OC ) is the third most common gynecologic malignancy worldwide .
Most of cases it is of epithelial origin .
At the present time there is not a st and ardized screening method , which makes difficult the early diagnosis .
The 5-year survival is 90 % for early stages , however most cases present at advanced stages , which have a 5-year survival of only 5 - 20 % .
GICOM collaborative group , under the auspice of different institutions , have made the following consensus in order to make recommendations for the diagnosis and management regarding to this neoplasia .
Until now , laparoscopy for diagnostic-staging surgery is not well known as a recommended method .
In advanced stages , primary cytoreduction is recommended as initial treatment .