- Keiichi Fujiwara
- Sudeep Gupta
253O - Long-term results of treatment of patients with locally advanced cervical cancer after pelvic exenteration
- Nargiza Zakhirova
- Nargiza Zakhirova
- Mirzagoleb N. Tillashaykhov
- Odil M. Ahmedov
- Sayde Djanklich
- Yakov V. Ten
Abstract
Background
Cervical cancer has for many years ranked second in frequency among malignant neoplasms of the reproductive system in women. Patients with newly diagnosed malignant tumors of the small pelvis of the common stages reach 50-75%. 5-year survival after surgical treatment does not exceed 27.2%. For some time, small pelvic excretion has been the object of considerable criticism, it is now recognized as a method of choice for the treatment of those patients who will not benefit from other methods of therapy.
Methods
The retrospective study included 135 women who underwent anterior exenteration of small organs with various types of urine derivation in the Republican Cancer Research Center from 2005 to 2015 for locally advanced cervical cancer. The overall survival was assessed using the Kaplan-Meier method.
Results
Data analysis showed that in patients younger than 50 years, the annual overall survival (OS) was 68 ± 12.6%, 3-year-old - 36 ± 10.6% and 5-year-old - 14 ± 7.8% of cases, the average duration was 39.3 ± 3.6 months. It should be noted that the results of general and disease-free survival were affected by the radicality of the performed operation and the metastatic damage of the lymph nodes. Thus, in patients with a volume of R0, OS was 62.5 ± 11.9%, in patients with R1, one-year OS was 53.1% ± 15.6%, to ≥ 2 years no patients survived. Median survival in patients with metastatic lymph node involvement was only 9.4 months, in the absence of metastases, the average life expectancy of patients was 34.2 ± 1.6 months.
Conclusions
With locally advanced cervical cancer, anterior exenteration is a salvage operation and can improve overall and disease-free survival rates, which directly depends on the radical nature of the operation and the presence of metastatic lymph node involvement.
Legal entity responsible for the study
N. Zakhirova and M.N. Tillashaykhov.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
254O - Dysgerminoma Ovary : Clinical Features and Treatment Outcome
- Pallavi Nair
- Pallavi Nair
- Aswin Kumar
- Susan Mathews
- John Joseph
- S Suchetha
- Jagath Krishna
- FV James
Abstract
Background
Dysgerminomas constitute the majority of malignant germ cell tumours and appear to have an excellent outcome after surgery and chemotherapy irrespective of the stage of the disease.
Methods
Retrospective analysis of patients with dysgerminoma, treated at our centre over eleven years (January 2005 – December 2015) was carried out. Patient demographics, tumour characteristics, treatment details, pattern of recurrences, treatment offered for recurrences were recorded in a structured format and Disease-Free Survival (DFS) and Overall Survival (OS) were calculated.
Results
The case records of ninety two patients were included in the analysis. Sixty three patients had stage I disease and among them, 48 patients had stage IA disease. Seven patients had stage IV disease at presentation with metastasis to the lung, liver, axillary nodes and supraclavicular nodes. Nineteen patients (39.5%) with stage IA disease were kept on surveillance and the rest received adjuvant chemotherapy mostly with single agent carboplatin. The compliance for active surveillance was inadequate. Recurrences were reported in 5 patients. Two patients recurred in the paraaortic nodes, one in the lung, and one in the contralateral ovary. Four of them were successfully salvaged. The patients who recurred in the paraaortic nodes and lung were salvaged with chemotherapy and the patient who recurred in the contralateral ovary underwent surgery. There were two disease-related deaths, 1 which occurred following relapse and another which occurred due to chemotherapy related complications during primary treatment. The DFS of the entire group was 96.5% and OS was 98.9% at 3 years.
Conclusions
The incidence of dysgerminoma ovary remains relatively low with the majority being stage I disease. Most of the patients with tsage IA disease received adjuvant chemotherapy and single agent carboplatin which appeared to be the preferred choice. The patients with advanced stage disease were treated with bleomycin, cisplatin, etoposide (BEP) or etoposide and cisplatin (EP). The survival outcome appeared to be good with only two disease-related deaths in the 92 patients.
Legal entity responsible for the study
Regional Cancer Centre Thiruvananthapuram.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
255O - Achievement of complete response (CR) in metastatic or recurrent cervical cancer (MRCC): Does it matter?
- Juan Francisco Grau Béjar
- Juan Francisco Grau Béjar
- Victor Rodriguez Freixinos
- Lorena Fariñas Madrid
- Guillermo Villacampa
- Antonio Gil
- Ramona Verges
- Maria Asuncion Perez Benavente
- Angel García
- Rodrigo Dienstmann
- Ana Oaknin
Abstract
Background
MRCC is a devastating disease with poor long-term outcomes. The addition of bevacizumab (BEV) to chemotherapy (CT) significantly improved overall survival (OS) in MRCC patients (pts). Aim: to characterize clinico-pathologic features associated with CR and its impact on outcome of MRCC pts.
Methods
Single-institution prospective series of MRCC pts who were treated with 1st line CT between 2005 and 2018. CR was defined by Response Evaluation Criteria in Solid Tumors (RECIST v1). Prognostic and predictive value of “Moore criteria” was evaluated.
Results
98 pts (61% squamous; 29% adenocarcinoma; 8% others) with median age of 49 years (28-77) were investigated. 57 pts (58%) had prior CT-radiation; 73 pts (75%) had recurrent/persistent disease (39 pts > 12 months (m) disease free interval) and 23 pts (24%) were stage IVb at diagnosis (47% visceral involvement). Moore risk distribution: 9 high, 53 medium, 9 low risk. 70 pts (72%) platinum-based- CT (PCT) (46% Cisplatin; 26% Carboplatin); 24 pts (25%) received CT + BEV. After a median follow-up of 21.2 m, overall response rate (RR) was 59%, median PFS was 7 m (CI95% 6-9) and median OS 14 m (CI95% 11-24). Moore criteria correlated with prognosis (high-risk pts had significantly worse OS, HR = 25, p < 0.001). Higher RR was observed among low and intermediate risk pts (77% and 54%) as compared to high (11%, p < 0.001). CRs occurred in 21/94 (22%) evaluable pts (BEV group 5/23; non-BEV 16/71, p = 1). Factors associated with CR in univariate analysis: no visceral involvement (OR = 1.54, p < 0.01), no prior CT (OR = 1.85, p = 0.04) and Moore criteria low/intermediate (vs. high, OR = 2.36, p = <0.01). Median time to CR and median duration of CR were 4.6 m (4.1 – 5.3) and 7.4 m (3.6–NR), respectively. CR significantly impacted on PFS (14.6 m vs 6.5 m non-CR, p < 0.001) and OS (NR vs 11 m non-CR, p < 0.001). Nine pts discontinued treatment due to toxicity (1 pt had vesico-vaginal fistula related to BEV).
Conclusions
CR is a meaningful surrogate marker for improved PFS and OS in MRCC pts treated with 1st line CT. In our series, visceral involvement, prior CT and Moore criteria were identified as predictive markers for CR.
Legal entity responsible for the study
A. Oaknin.
Funding
Has not received any funding.
Disclosure
A. Oaknin: Cosulting or Advisory role: Pharmamar, Clovis, Roche, AstraZeneca. All other authors have declared no conflicts of interest.
256O - Barriers to early diagnostics of cervical cancer in Uzbekistan
- Viloyat Saydakhmedova
- Viloyat Saydakhmedova
- Nargiza Zakhirova
- Elnara Osmanova
- Odiljon Akhmedov
- Bekhruz Yusupov
- Sayde Djanklich
- Dilshod Egamberdiev
Abstract
Background
Studying barriers to early diagnosis of cervical cancer (CC) in Uzbekistan.
Methods
The questionnaire was analyzed in 3 directions: "patient delay", "doctor delay", "delay of treatment". 100 advanced stage cervical cancer patients surveyed, including: IIA-B stage - 17%; IIIA-B stage 80%; IVA stage - 3%.
Results
In the questionnaire analysis, the following results were obtained: 33% of patients have heard and 67% have not heard about the early symptoms of CC on mass media. Women’s lack of information about signs of CC: blood spotting - 12%, no - 88%; pain - 16%, no - 84%. Symptoms duration: months - 64%, weeks - 20%, days - 16%. Awareness of women about symptoms that may be signs of cervical cancer: yes - 6%, no - 94%. The fear of treatment: afraid to be treated - 18%, doubted to be treated - 12%, decided to be treated - 70%. Lack of faith in recovery, mistrust to doctor: did doctor’s recommendations in a month - 73%, did later than a month - 13%; did nothing - 10%; went to another doctor - 2%; went to medico - 2%. Told about CC: to husband - 47%, not - 53%, to children - 75%, not - 25%, to brothers or sisters - 72%, no - 28, to friends - 43%, no - 67%. To be anxious and panicking: yes - 91%, no - 9%. To be afraid about a bad disease: yes - 65%, no - 35%; There were other important cases (children, work) – yes - 35%, no - 65%. Doctor warned about the severity of the disease: yes - 63%, no - 37%. Women’s education: secondary education - 76%, higher - 24%. Religious issues: looking for a woman doctor: yes, very important - 39%, no difference - 48%, yes, somehow important - 13%.
Conclusions
The key barriers in the direction of "Patient delay": low level of public awareness of the media, weak oncological awareness of women, ignorance of primary signs and symptoms CC, panic and fear when mentioning "cancer", lack of faith in recovery, mistrust to doctor, psychological barriers to relatives (restraint, fear, misunderstanding, alienation), misunderstanding of the seriousness of the disease, the possible consequences of inactivity, the prevalence of family problems and finally the religious affiliation. Solving problems with the elimination of the above barriers will reduce the advanced CC and improve the results of treatment.
Legal entity responsible for the study
RSSPMCOR.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
LBA5 - Mainstreaming genetic counselling for genetic testing of BRCA1 and BRCA2 in ovarian cancer patients in Malaysia (MaGiC Study)
- Sook Yee Y. Yoon
- Sook Yee Y. Yoon
- Nor Syuhada Ahmad Bashah
- Siu Wan Wong
- Shivaani Mariapun
- Heamanthaa Padmanabhan
- Tiara Hassan
- Joanna Lim
- Shao Yan Lau
- Nazneen Rahman
- Meow Keong Thong
- Gaik Siew Ch'Ng
- Soo Hwang Teo
- Eveline Bleiker
- Yin Ling Woo
Abstract
Background
Identification of BRCA mutations in ovarian cancer patients is important for their medical management and preventative measures for their relatives. However, due to cost, lack of genetic counsellors, clinical geneticists and awareness among clinicians, there is inadequate genetic testing in most parts of Asia. Mainstreaming genetic counselling may improve access to BRCA genetic testing. The MaGiC study aims to determine the prevalence of BRCA1/BRCA2 mutations, feasibility of mainstreaming and the psychosocial impact of genetic testing in Malaysian ovarian cancer patients.
Methods
This is a prospective observational study of 800 patients with non-mucinous ovarian cancer irrespective of family history, recruited via mainstreaming or the traditional genetic pathway. Genetic Counselling Satisfaction Scale, Decisional Conflict Scale, Psychosocial Aspect of Hereditary Cancer (PAHC) and Cancer Worry Scale are used to measure the feasibility and psychosocial outcomes. Mainstreaming clinicians provide feedback on their experience and intention for mainstreaming through a questionnaire.
Expected Results
47 clinicians from 25 sites nationwide recruited 426 patients (46% Malay, 37% Chinese, 8% Indian, 9% Indigenous). 383 patients were tested. 52 (13.6%) pathogenic mutations, 52 (13.6%) VUS and 279 (72.8%) negatives were identified. Most patients were satisfied with their counselling experience. Most felt informed of benefits and risks, and felt less conflicted in making decision after counselling. However, the PAHC showed 72% of patients after pre-counselling and 55%, after result disclosure reported to have issue in at least one domain. 24% of patients reported to feel some distress after the pre-counselling. 77% of mainstreaming clinicians reported that they are confident of their BRCA knowledge to counsel patients and 80% would want to incorporate BRCA testing into their clinic.
Expected Conclusions
Interim results showed satisfaction in the genetic counselling services and reduction in the decisional conflict. Majority of the clinicians active in mainstreaming want to continue the service. Mainstreaming cancer genetics may be possible to improve access to genetic counselling and testing in Malaysia.
Legal entity responsible for the study
Cancer Research Malaysia.
Funding
AstraZeneca.
Disclosure
N. Rahman: Non-executive director of AstraZeneca. All other authors have declared no conflicts of interest.