Queensland Center for Gynaecological Cancer

Australia

Queensland Center for Gynaecological Cancer

Australia

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McGrath S.,Royal Brisbane And Womens Hospital | McGrath S.,University of Queensland | Nicklin J.,University of Queensland | Nicklin J.,Queensland Center for Gynaecological Cancer
Australian and New Zealand Journal of Obstetrics and Gynaecology | Year: 2016

Objective: To describe the clinical features, treatment, clinical course and survival rates of women diagnosed with ovarian carcinoid tumours. Methods: A retrospective chart review was performed of all patients diagnosed with primary ovarian carcinoid tumours who were managed by the Queensland Centre for Gynaecological Cancer from 1982 to 2015. Results: Eighteen patients were identified with ovarian carcinoid tumours over the 32 years of the study period. Of the 18 patients, 14 were diagnosed with stage 1 disease, two were diagnosed with stage 3 disease and two were diagnosed with stage 4 disease. Carcinoid syndrome was present in two patients. All patients underwent surgical management. Follow-up strategies varied for early stage disease, but no patient with early stage disease received any adjuvant treatment and no patient developed recurrent disease. Patients with advanced stage disease were treated with cytoreductive surgery and chemotherapy. The five year survival was 100% for stage 1 disease, and 25% for stages 3 and 4 disease. Conclusions: The vast majority of carcinoid tumours are diagnosed as an incidental finding. Prognosis for early stage disease is excellent, whether conservative or more extensive surgery with staging was performed, and intensive follow up did not influence survival. Optimal treatment for advanced disease remains unknown and requires further study. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists


Jones I.S.C.,Royal Brisbane and Womens Hospital | Jones I.S.C.,University of Queensland | Crandon A.,University of Queensland | Crandon A.,Queensland Center for Gynaecological Cancer | Sanday K.,Queensland Center for Gynaecological Cancer
Gynecologic Oncology | Year: 2011

Objective: To review the clinical features, diagnosis, management, and outcomes for the 50 cases of Paget's disease (PD) of the vulva referred to Queensland Centre for Gynaecological Cancer between 1986 and 2009. Methods: Vulvar PD cases from QCGC were reviewed and analyzed using the computer software Statistical Package for the Social Sciences (SPSS) 11.0. Results: Paget's disease (PD) of the vulva is uncommon. Of the 50 patients, 2 have died of their PD, 1 patient that had coexisting PD died of squamous cell vulva cancer, and 11 died of unrelated causes. The mean age at diagnosis was 67.6 years (range, 31 to 91). All cases were Caucasian. Time from onset of symptoms to diagnosis averaged 21 months. Not until a biopsy was performed was the diagnosis made. The most common presenting complaint was pruritis (27 cases, 54%). There was no identifiable "favored" site on the vulva for PD. Positive groin lymph nodes were found in 4 of the 10 cases who underwent node biopsy. Two who had poorly differentiated carcinoma in the nodes and PD died of disease within a year of diagnosis, one is alive three years later. The fourth case had coincidental PD and vulvar squamous cell carcinoma with squamous carcinoma groin nodes. Initial treatment was surgical. Conclusions: The prognosis for primary extra-mammary PD of the vulva confined to the epidermis (IEP) is excellent. Early diagnosis and long term follow-up are the keys to successful management. The status of disease at the margins of surgical specimens does not reliably equate to patient long term outcomes. © 2011 Elsevier Inc. All rights reserved.


PubMed | Danish Cancer Society, Dr. Horst Schmidt Kliniken Wiesbaden, Duke University, Cedars Sinai Medical Center and 23 more.
Type: Journal Article | Journal: Oncotarget | Year: 2016

Women with epithelial ovarian cancer (EOC) are usually treated with platinum/taxane therapy after cytoreductive surgery but there is considerable inter-individual variation in response. To identify germline single-nucleotide polymorphisms (SNPs) that contribute to variations in individual responses to chemotherapy, we carried out a multi-phase genome-wide association study (GWAS) in 1,244 women diagnosed with serous EOC who were treated with the same first-line chemotherapy, carboplatin and paclitaxel. We identified two SNPs (rs7874043 and rs72700653) in TTC39B (best P=7x10-5, HR=1.90, for rs7874043) associated with progression-free survival (PFS). Functional analyses show that both SNPs lie in a putative regulatory element (PRE) that physically interacts with the promoters of PSIP1, CCDC171 and an alternative promoter of TTC39B. The C allele of rs7874043 is associated with poor PFS and showed increased binding of the Sp1 transcription factor, which is critical for chromatin interactions with PSIP1. Silencing of PSIP1 significantly impaired DNA damage-induced Rad51 nuclear foci and reduced cell viability in ovarian cancer lines. PSIP1 (PC4 and SFRS1 Interacting Protein 1) is known to protect cells from stress-induced apoptosis, and high expression is associated with poor PFS in EOC patients. We therefore suggest that the minor allele of rs7874043 confers poor PFS by increasing PSIP1 expression.


Baker J.,Queensland University of Technology | Janda M.,Queensland University of Technology | Gebski V.,University of Sydney | Forder P.,University of Newcastle | And 3 more authors.
Gynecologic Oncology | Year: 2015

Objective. To examine the association between preoperative quality of life (QoL) and postoperative adverse events in women treated for endometrial cancer. Methods. 760womenwith apparent Stage I endometrial cancerwere randomised into a clinical trial evaluating laparoscopic versus open surgery. This analysis includeswomen with preoperative QoLmeasurements, from the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire, andwho were followed up for at least 6 weeks after surgery (n= 684). The outcomes for this study were defined as (1) the occurrence of moderate to severe adverse events within 6 months (Common Toxicology Criteria (CTC) grade ≥3); and (2) any serious adverse event (SAE). The association between preoperative QoL and the occurrence of AEwas examined, after controlling for baseline comorbidity and other factors. Results. After adjusting for other factors, odds of occurrence of AE of CTC grade ≥3 were significantly increased with each unit decrease in baseline FACT-G score (OR = 1.02, 95% CI 1.00-1.03, p = 0.030), which was driven by physical well-being (PWB) (OR = 1.09, 95% CI 1.04-1.13, p = 0.0002) and functional wellbeing subscales (FWB) (OR=1.04, 95% CI 1.00-1.07, p=0.035). Similarly, odds of SAE occurrence were significantly increased with each unit decrease in baseline FACT-G score (OR = 1.02, 95% CI 1.01-1.04, p = 0.011), baseline PWB (OR = 1.11, 95% CI 1.06-1.16, p < 0.0001) or baseline FWB subscales (OR = 1.05, 95% CI 1.01- 1.10, p = 0.0077). Conclusion. Women with early endometrial cancer presenting with lower QoL prior to surgery are at higher risk of developing a serious adverse event following surgery. Funding. Cancer Council Queensland, Cancer Council NewSouthWales, Cancer Council Victoria, Cancer Council, Western Australia; NHMRC project grant 456110; Cancer Australia project grant 631523; The Women and Infants Research Foundation, Western Australia; Royal Brisbane and Women's Hospital Foundation; Wesley Research Institute; Gallipoli Research Foundation; Gynetech; TYCO Healthcare, Australia; Johnson and Johnson Medical, Australia; Hunter New England Centre for Gynaecological Cancer; Genesis Oncology Trust; and Smart Health Research Grant QLD Health. © 2015 Elsevier Inc. All rights reserved.


Wallwiener M.,University of Heidelberg | Koninckx P.R.,Catholic University of Leuven | Hackethal A.,Queensland Center for Gynaecological Cancer | Brolmann H.,VU University Amsterdam | And 4 more authors.
Gynecological Surgery | Year: 2014

The present survey was conducted among gynaecological surgeons from several European countries to assess the actual knowledge and practice related to post-surgical adhesions and measures for reduction. From September 1, 2012 to February 6, 2013, gynaecological surgeons were invited to answer an 18-item online questionnaire accessible through the ESGE website. This questionnaire contained eight questions on care settings and surgical practice and ten questions on adhesion formation and adhesion reduction. Four hundred fourteen surgeons participated; 70.8 % agreed that adhesions are a source of major morbidity. About half of them declared that adhesions represented an important part of their daily medical and surgical work. About two thirds informed their patients about the risk of adhesion. Most cited causes of adhesions were abdominal infections and extensive tissue trauma, and endometriosis and myomectomy surgery. Fewer surgeons expected adhesion formation after laparoscopy (18.9 %) than after laparotomy (40.8 %); 60 % knew the surgical techniques recommended to reduce adhesions; only 44.3 % used adhesion-reduction agents on a regular basis. This survey gives a broad picture of adhesion awareness amongst European gynaecological surgeons, mainly from Germany and the UK. The participants had a good knowledge of factors causing adhesions. Knowledge of surgical techniques recommended and use of anti-adhesion agents developed to reduce adhesions need to be improved. © 2013 The Author(s).


Baker J.,Queensland University of Technology | Janda M.,Queensland University of Technology | Belavy D.,University of Queensland | Obermair A.,Queensland Center for Gynaecological Cancer
Minimally Invasive Surgery | Year: 2013

Objectives. We compared postoperative analgesic requirements between women with early stage endometrial cancer treated by total abdominal hysterectomy (TAH) or total laparoscopic hysterectomy (TLH). Methods. 760 patients with apparent stage I endometrial cancer were treated in the international, multicentre, prospective randomised trial (LACE) by TAH (n=353) or TLH (n=407) (2005-2010). Epidural, opioid, and nonopioid analgesic requirements were collected until ten months after surgery. Results. Baseline demographics and analgesic use were comparable between treatment arms. TAH patients were more likely to receive epidural analgesia than TLH patients (33% versus 0.5%, P<0.001) during the early postoperative phase. Although opioid use was comparable in the TAH versus TLH groups during postoperative 0-2 days (99.7% versus 98.5%, P=0.09), a significantly higher proportion of TAH patients required opioids 3-5 days (70% versus 22%, P<0.0001), 6-14 days (35% versus 15%, P<0.0001), and 15-60 days (15% versus 9%, P=0.02) after surgery. Mean pain scores were significantly higher in the TAH versus TLH group one (2.48 versus 1.62, P<0.0001) and four weeks (0.89 versus 0.63, P=0.01) following surgery. Conclusion. Treatment of early stage endometrial cancer with TLH is associated with less frequent use of epidural, lower post-operative opioid requirements, and better pain scores than TAH. © 2013 Jannah Baker et al.


PubMed | University of Newcastle, Queensland Center for Gynaecological Cancer, Westmead Hospital, Queensland University of Technology and 2 more.
Type: Journal Article | Journal: Gynecologic oncology | Year: 2015

To examine the association between preoperative quality of life (QoL) and postoperative adverse events in women treated for endometrial cancer.760 women with apparent Stage I endometrial cancer were randomised into a clinical trial evaluating laparoscopic versus open surgery. This analysis includes women with preoperative QoL measurements, from the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire, and who were followed up for at least 6 weeks after surgery (n=684). The outcomes for this study were defined as (1) the occurrence of moderate to severe adverse events within 6 months (Common Toxicology Criteria (CTC) grade3); and (2) any serious adverse event (SAE). The association between preoperative QoL and the occurrence of AE was examined, after controlling for baseline comorbidity and other factors.After adjusting for other factors, odds of occurrence of AE of CTC grade3 were significantly increased with each unit decrease in baseline FACT-G score (OR=1.02, 95% CI 1.00-1.03, p=0.030), which was driven by physical well-being (PWB) (OR=1.09, 95% CI 1.04-1.13, p=0.0002) and functional well-being subscales (FWB) (OR=1.04, 95% CI 1.00-1.07, p=0.035). Similarly, odds of SAE occurrence were significantly increased with each unit decrease in baseline FACT-G score (OR=1.02, 95% CI 1.01-1.04, p=0.011), baseline PWB (OR=1.11, 95% CI 1.06-1.16, p<0.0001) or baseline FWB subscales (OR=1.05, 95% CI 1.01-1.10, p=0.0077).Women with early endometrial cancer presenting with lower QoL prior to surgery are at higher risk of developing a serious adverse event following surgery.Cancer Council Queensland, Cancer Council New South Wales, Cancer Council Victoria, Cancer Council, Western Australia; NHMRC project grant 456110; Cancer Australia project grant 631523; The Women and Infants Research Foundation, Western Australia; Royal Brisbane and Womens Hospital Foundation; Wesley Research Institute; Gallipoli Research Foundation; Gynetech; TYCO Healthcare, Australia; Johnson and Johnson Medical, Australia; Hunter New England Centre for Gynaecological Cancer; Genesis Oncology Trust; and Smart Health Research Grant QLD Health.


PubMed | Materials Center for Maternal Fetal Medicine and Queensland Center for Gynaecological Cancer
Type: Journal Article | Journal: Acta obstetricia et gynecologica Scandinavica | Year: 2016

Abnormally invasive placenta is a major cause of maternal morbidity and mortality. The aim of this study was to assess the effectiveness of a standardized operative approach performed by gynecological oncologists in the surgical management of abnormally invasive placenta.We performed a retrospective analysis of all cases of morbid placental adherence managed at the Mater Mothers Hospitals, Brisbane, Australia between January 2000 and June 2013. A standard operative approach involving extensive retro-peritoneal and bladder dissection before delivery of the fetus, was undertaken when a gynecological oncologist was present at the start of the procedure. Main outcome measures were estimated blood loss, transfusion requirements, and maternal and neonatal morbidity.The study includes 98 cases of histologically confirmed abnormally invasive placenta. Median estimated blood loss for the entire cohort was 2150 mL (range 300-11 500 mL). Women were divided into three groups, (1) those who had a gynecological oncologist present at the start of the procedure (group 1; n = 43), (2) those who had a gynecological oncologist called in during the procedure (group 2; n = 23), and (3) those who had no gynecological oncologist involved (group 3; n = 32). Group 2 had a significantly higher blood loss than the other groups (p = 0.001) (median 4400 mL). Transfusion requirements were higher in groups 2 and 3 compared with group 1 (p = 0.004). Other maternal and neonatal morbidity was similar across all three groups.This study supports the early presence of a gynecological oncologist at delivery when abnormally invasive placenta is suspected and demonstrates that a call if needed approach is not acceptable for these complex cases.


Kondalsamy-Chennakesavan S.,University of Queensland | Yu C.,Cleveland Clinic | Kattan M.W.,Cleveland Clinic | Leung Y.,University of Western Australia | And 10 more authors.
Gynecologic Oncology | Year: 2012

Objective: While there is ample literature on prognostic factors for uterine cancer, currently there are nomeans to estimate an individual's risk for recurrence or to differentiate the risk of loco-regional recurrence from distant recurrence. We addressed this gap by developing nomograms to individualize the risk of recurrence. Methods: A total of 2097 consecutive patients who underwent primary surgery between 1997 and 2007 were included. Sixteen covariates were evaluated for their prognostic significance and modeled using multivariable competing risks regression to predict three-year outcomes as part of a nomogram. Each covariate in the nomogram is assigned a value, and a sum of these values form the overall risk score from which three-year incidence probabilities can be predicted for each individual. Predictive accuracy was assessed with concordance index and then corrected for optimism. Results: The median follow-up time (inter-quartile range, IQR) was 50.0 (28.3-77.5) months and 221 patients developed a recurrence (127 patients with isolated loco-regional recurrence, 94 patients with distant recurrence). The nomograms included the following covariates: age at diagnosis, FIGO stage (2009), grade, lymphovascular invasion, histological type, depth of myometrial invasion, and peritoneal cytology. Concordance indices for isolated loco-regional and distant recurrences were 0.73 and 0.86, respectively. Conclusions: Our nomograms quantify an individual patient's risk of isolated loco-regional and distant recurrence, using factors that are routinely collected. They may assist clinicians to assess an individual's prognosis, individualize treatment and also assist in the risk stratification in prospective randomized clinical trials evaluating the effectiveness of treatments for uterine cancer. © 2012 Elsevier Inc. All rights reserved.


Crandon A.J.,Materials Hospital | Crandon A.J.,Queensland Center for Gynaecological Cancer
Medicine Today | Year: 2014

As there are no proven screening tests for ovarian cancer and initial symptoms are nonspecific, diagnosis requires a high index of suspicion. Women with unexplained suggestive symptoms should be assessed with measurement of cancer antigen 125 (CA-125), a pelvic ultrasound examination and calculation of the risk of malignancy index. © Molly Borman Biomedical Illustrations.

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