Gynecologic Oncology Associates

Newport Beach, CA, United States

Gynecologic Oncology Associates

Newport Beach, CA, United States

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Mendivil A.A.,Gynecologic Oncology Associates | Rettenmaier M.A.,Gynecologic Oncology Associates | Abaid L.N.,Gynecologic Oncology Associates | Brown J.V.,III | And 3 more authors.
Journal of the Society of Laparoendoscopic Surgeons | Year: 2015

Background and Objectives: The intent of this retrospective study was to assess the operative outcomes of morbidly obese endometrial cancer patients who were treated with either open surgery (OS) or a minimally invasive procedure. Methods: Morbidly obese (body mass index [BMI] > 40 kg/m2) patients with endometrial cancer who underwent OS, robotic-assisted laparoscopic surgery (RS), or conventional laparoscopic surgery (LS) were eligible. We sought to discern any outcome differences with regard to operative time, perioperative complications, and hospital stay. Results: Sixteen patients were treated with LS (BMI = 47.9 kg/m2), 13 were managed via RS (BMI = 51.2 kg/m2), and 24 underwent OS (BMI = 53.7 kg/m2). The OS (1.35 hours) patients had a significantly shorter operative duration than the LS (1.82 hours) and RS (2.78 hours) patients (P <.001); blood loss was greater in the OS (250 mL) group in comparison with the RS (100 mL) and LS (175 mL) patients (P =.002). Moreover, the OS (4 days) subjects had a significantly longer hospital stay than the LS (2 days) and RS (2 days) patients (P =.002). Conclusion: In the present study, we ascertained that minimally invasive surgery was associated with longer operative times but lower rates of blood loss and shorter hospital stay duration compared with treatment comprising an open procedure. © 2015 by JSLS, Journal of the Society of Laparoendoscopic Surgeons. Published by the Society of Laparoendoscopic Surgeons, Inc.


PubMed | Womens Cancer Research Foundation and Gynecologic Oncology Associates
Type: Case Reports | Journal: American journal of obstetrics and gynecology | Year: 2014

A hypersensitivity reaction attributed to platinum-based chemotherapy is a relatively common occurrence. Hyperthermic intraperitoneal chemotherapy potentially facilitates the safe retreatment of platinum therapy following this complication. We describe 3 ovarian cancer patients who were successfully retreated with carboplatin via hyperthermic intraperitoneal chemotherapy following hypersensitivity reaction.


PubMed | Womens Cancer Research Foundation and Gynecologic Oncology Associates
Type: Comparative Study | Journal: JSLS : Journal of the Society of Laparoendoscopic Surgeons | Year: 2015

The intent of this retrospective study was to assess the operative outcomes of morbidly obese endometrial cancer patients who were treated with either open surgery (OS) or a minimally invasive procedure.Morbidly obese (body mass index [BMI] > 40 kg/m(2)) patients with endometrial cancer who underwent OS, robotic-assisted laparoscopic surgery (RS), or conventional laparoscopic surgery (LS) were eligible. We sought to discern any outcome differences with regard to operative time, perioperative complications, and hospital stay.Sixteen patients were treated with LS (BMI = 47.9 kg/m(2)), 13 were managed via RS (BMI = 51.2 kg/m(2)), and 24 underwent OS (BMI = 53.7 kg/m(2)). The OS (1.35 hours) patients had a significantly shorter operative duration than the LS (1.82 hours) and RS (2.78 hours) patients (P < .001); blood loss was greater in the OS (250 mL) group in comparison with the RS (100 mL) and LS (175 mL) patients (P = .002). Moreover, the OS (4 days) subjects had a significantly longer hospital stay than the LS (2 days) and RS (2 days) patients (P = .002).In the present study, we ascertained that minimally invasive surgery was associated with longer operative times but lower rates of blood loss and shorter hospital stay duration compared with treatment comprising an open procedure.


Mendivil A.,Gynecologic Oncology Associates | Zhou C.,University of North Carolina at Chapel Hill | Cantrell L.A.,University of Virginia | Gehrig P.A.,University of North Carolina at Chapel Hill | And 4 more authors.
Reproductive Sciences | Year: 2011

Our goal was to evaluate the therapeutic potential of a novel antibody to the insulin growth factor-1 receptor (IGF-1-R; AMG 479) in endometrial cancer cells. The endometrial cancer cell lines, ECC-1/PRAB72 and RL-95-2, were used. Treatment with AMG 479 (0.02-200 nmol/L) resulted in inhibition of cell proliferation at 72 to 120 hours. Insulin growth factor-1 (0.15-7.5 nmol/L) stimulated growth in both cell lines (range of 15%-42%, P =.0025-.0445), which could be blocked by pretreatment with AMG 479 (mean of 29% for ECC-1/PRAB72, P =.006-.007; mean of 36% for RL-95-2, P =.0002-.0045). AMG 479 suppressed IGF-1-R kinase activity in a dose-dependent manner. Cells treated with AMG 479 underwent either G1 (ECC-1/PRAB72) or G2 (RL-95-2) arrest. AMG 479 decreased human telomerase reverse transcriptase (hTERT) mRNA expression in both endometrial cancer cell lines. Treatment with AMG 479 rapidly blocked IGF-1-induced phosphorylation of IFG-1-R, Akt, and p44/42. Thus, manipulation of the IGF-1-R pathway may serve as a promising therapeutic strategy for the treatment of endometrial cancer. © 2011 The Author(s).


Del Carmen M.G.,Harvard University | Micha J.,Gynecologic Oncology Associates | Small L.,Maine Medical Center | Street D.G.,Cancer Care Associates | And 2 more authors.
Gynecologic Oncology | Year: 2012

Objective: To assess the safety and efficacy of pegylated liposomal doxorubicin (PLD), carboplatin, plus bevacizumab in patients with ovarian, fallopian tube, or primary peritoneal cancer. Methods: Patients with platinum-sensitive, recurrent disease received PLD 30 mg/m 2 and carboplatin area under the curve (AUC) 5 on Day 1 plus bevacizumab 10 mg/kg on Days 1 and 15 of every 28-day cycle, for a maximum of 10 cycles. The primary endpoint was objective response rate (ORR) [complete + partial response]; additional endpoints were safety, duration of response, progression-free survival (PFS), and time to progression (TTP). Results: Of the 54 patients enrolled, 15 (27.8%) completed the study treatment as planned. Intent-to-treat (all enrolled patients) ORR was 72.2% (95% CI: 58.4, 83.5). Median duration of response was 11.9 months (95% CI: 9.3, not estimable) and median TTP was 13.9 months (95% CI: 11.4, 16.0). PFS was virtually the same as TTP. Three (5.6%) patients discontinued therapy due to disease progression, and another 3 (5.6 %) patients discontinued therapy due to serious adverse events (Grade 4 thrombocytopenia, Grade 3 small/large intestinal obstruction/small intestinal perforation, and Grade 3 abdominal abscess). Fifty (92.6%) patients had ≥ 1 adverse event of interest, most commonly neutropenia (42.6%), hypertension (37.0%), stomatitis (37.0%), proteinuria (37.0%), and palmar-plantar erythrodysesthesia (27.8%). No appreciable decreases in left-ventricular ejection fraction were observed. Conclusion: Most patients responded to PLD, carboplatin, and bevacizumab combination therapy. The safety profile was consistent with the known toxicities of these agents. These findings present a potential treatment option for women with ovarian, fallopian tube, or primary peritoneal cancer. © 2012 Elsevier Inc. All rights reserved.


PubMed | The Nancy Yeary Womens Cancer Research Foundation and Gynecologic Oncology Associates
Type: Journal Article | Journal: Surgical oncology | Year: 2016

Despite the alleged benefits conferred by a lymphadenectomy in the management of gynecologic malignancies, there are concerns regarding the development of postoperative lower-extremity lymphedema. The purpose of this study was to identify the incidence of lymphedema and associated risk factors in accordance with surgical staging during the management of endometrial and cervical cancer.We conducted a 5-year review of all endometrial and cervical cancer patients who underwent a lymphadenectomy. The subjects demographics, medical co-morbidities, diagnosis, surgical treatment, inclusion of adjuvant radiotherapy and incidence of lower-extremity lymphedema were noted.We identified 165 (135 endometrial cancer and 30 cervical cancer) subjects. Positive pelvic and para-aortic lymph nodes were present in 21 (12.7%) and 10 patients (6.1%), respectively. In the entire population, 6 (3.6% incidence) subjects developed post-operative lymphedema. Supplementary analyses revealed that a BMI >35kg/m(2) and possessing numerous (3) co-morbidities significantly correlated with the manifestation of lower-extremity lymphedema.In the current investigation, we observed a reasonably low, overall incidence of postoperative lower-extremity lymphedema. Nevertheless, when evaluating the potential for lymphedema in patients for whom a lymphadenectomy is indicated, specific risk factors should be considered in an effort to attenuate the development of this morbid condition.


PubMed | The Nancy Yeary Womens Cancer Research Foundation and Gynecologic Oncology Associates
Type: Comparative Study | Journal: Surgical oncology | Year: 2016

The purpose of this retrospective study was to assess the 5-year survival outcomes of cervical cancer patients who underwent an, open radical hysterectomy (ORH), robotic-assisted radical hysterectomy (RRH) or laparoscopic radical hysterectomy (LRH) for the treatment of their disease.We conducted a review of all cervical cancer patients who were managed with an ORH, RRH or LRH.Forty-nine patients were treated with LRH, 58 were managed via RRH and 39 patients underwent an ORH. The LRH (1.78 h) patients had a significantly shorter operative duration than the RRH (2.88 h) and ORH (2.39 h) subjects (p < 0.001). Blood loss was the highest in the ORH (475 cc) group (RRH = 207 cc and LRH = 312 cc) (P < 0.001). Moreover, the ORH (5.04 days) patients had a significantly longer hospital stay than the LRH (2.95 days) and RRH (2.50 day) subjects (P < 0.001). Kaplan-Meier survival analysis revealed a progression free survival (PFS) rate of 84.6% for the ORH group, 89.8% for the LRH group and 89.7% for the RRH patients (P = 0.271) at 60 months; overall survival was 92.3% for the ORH group, 95.9% for the LRH group and 96.6% for the RRH patients (P = 0.80).The results from this study suggest that, irrespective of operative approach, patients who underwent a radical hysterectomy for early stage cervical cancer attained similar 5-year disease free and overall survival outcomes.


Abaid L.N.,Gynecologic Oncology Associates | Rettenmaier M.A.,Gynecologic Oncology Associates | Brown J.V.,Gynecologic Oncology Associates | Micha J.P.,Gynecologic Oncology Associates | And 3 more authors.
Journal of Gynecologic Oncology | Year: 2012

Objective: The purpose of this retrospective study was to assess the tolerability and efficacy of sequential chemotherapy and radiotherapy for the treatment of high risk endometrial cancer. Methods: We conducted a retrospective study of previously untreated high risk endometrial cancer patients who received sequential chemotherapy and radiotherapy in accordance with the sandwich approach from June 2008 until June 2011. High risk endometrial cancer patients underwent complete surgical staging followed by adjuvant therapy encompassing sequential chemotherapy, radiation therapy and consolidation chemotherapy. Results: The study analysis comprised 32 endometrial cancer patients. All subjects were treated with carboplatin and paclitaxel chemotherapy; currently, 186 cycles have been administered and 94% of patients have completed the planned number of cycles. Grade 3 neutropenia developed in 1 (3.1%) patient; there was no incidence of grade 4 neutropenia. Moreover, we observed grade 3 anemia in four (12.5%) patients and grade 4 anemia in one (3.1%) patient. One (3.1%) patient developed grade 3 thrombocytopenia; grade 4 thrombocytopenia was not observed. Five patients exhibited progressive disease, three of whom have since expired; mean progression free survival and follow-up were 17.4 months and 18.9 months, respectively. Conclusion: The preliminary results from our study suggest that the sandwich approach to treating high risk endometrial cancer patients is feasible. Hematologic toxicity was well tolerated and non-hematologic toxicity was mild and easily managed. Further study of this novel regimen in a larger patient population with extended follow-up is necessary. © 2012. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology.


O'Hanlan K.A.,Gynecologic Oncology Associates | McCutcheon S.P.,Gynecologic Oncology Associates | McCutcheon J.G.,Gynecologic Oncology Associates
Journal of Minimally Invasive Gynecology | Year: 2011

Objective: To analyze surgical results of women having Type VII laparoscopic hysterectomy to determine whether differences in outcomes exist on the basis of uterine size. Methods: This is an analysis of data from 983 cases of type VII laparoscopic hysterectomy performed from September 1996 through August 2010. Demographic and surgical data were stratified by uterine weight (range 14-3,131 g) less than 250 g (n = 720) and 250 g or more (n = 263). Analyses were done by Pearson's χ2, Wilcoxon rank-sum, and Kruskal-Wallis tests with significance set at 2-sided (p<.05). Outcomes examined include estimated blood loss, skin-to-skin operative time, complications (non-reoperative and reoperative), and duration of hospital stay. Estimated blood loss, skin-to-skin operative time, and length of hospital stay were further analyzed using backwards, stepwise, multivariable, linear regression to control for and identify independent predictors affecting these outcomes. Baseline demographic data were included in the multivariable model. Only covariates that were significant in both multivariable and univariable analyses are presented as statistically significant. Design: A case-controlled, retrospective study (Canadian Task Force Classification II-2). Results: Median operating time varied by uterine weight, with a shorter duration of surgery in patients with uteri less than 250 g at 97 minutes (range 29-330), and patients with uteri greater than 250 g at 135 minutes (range 45-345) (p<.001). Median estimated blood loss was also less in patients with uteri less than 250 g at 50 mL, (range 0-1400), than in patients with uteri weighing 250 g or more, at 150 mL, (range 0-2100) (p<.001). There was no significant difference by uterine weight in median duration of hospital stay of 1 day (range 0-13), total complication rate (7.0%), reoperative complications (3.7%), or non-reoperative complications (3.4%). Duration of surgery, volume of blood lost, and length of hospital stay all decreased with the surgeon's increasing experience. Conclusions: Laparoscopic hysterectomy is feasible and safe, resulting in a short hospital stay, minimal blood loss, minimal operating time, and few complications for patients regardless of uterine weight. © 2011 AAGL.


PubMed | Gynecologic Oncology Associates
Type: Journal Article | Journal: International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group | Year: 2015

Hyperthermic intraperitoneal chemotherapy (HIPEC) involves the continuous heating and circulation of chemotherapy throughout the abdominal cavity in an attempt to enhance cytotoxicity. Despite the potential of this chemotherapy procedure, there are scant anatomical temperature distribution studies reporting on this therapeutic process.We prospectively evaluated the temperature of select anatomical (e.g. upper abdominal, mid-abdominal and supra-pubic) sites in 11 advanced stage ovarian cancer patients who were treated with consolidation HIPEC carboplatin (AUC 10). The temperature of the aforementioned anatomical regions and the inflow/outflow tubing was measured at baseline and at 15-min intervals until the procedures completion.The lowest observed mean composite temperature was 41.1C at the supra-pubic site whereas the highest temperature was 42.6C, in association with the inflow/outflow tubing. During the various time intervals we also ascertained that the lowest composite temperature was 40.9C at baseline (i.e. time 0), whereas the highest value (41.8C) occurred at multiple time periods (e.g., 15, 45 and 60min).The HIPEC temperature variation amongst the various abdominal sites and time intervals was minimal. We also discerned that uniform temperature distribution throughout the abdominal cavity was facilitated when the abdomen was both maximally distended with fluid and a high flow rate was maintained.

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