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Interventional radiologic therapies for the treatment of ovarian metastases
Abstracts / Gynecologic Oncology 145 (2017) 2–220
abdominopelvic CT scan that included the lower chest within 90 days prior to surgery were eligible. Scans were reviewed by 2 blinded radiologists. We defined enlarged CPLNs as any supradiaphragmatic lymph nodes N10 mm on short axis with radiologic characteristics suspicious for involvement. Enlarged CPLNs detected on preoperative scans was not a criterion for stage IV disease. We compared overall survival (OS) with respect to residual disease and presence of enlarged CPLNs using the log rank test. Results: A total of 276 patients were eligible with a median age of 64 years. Most cases were serous histology (85.5%), and 66 (23.9%) had stage IV disease. CPLNs were more than 10 mm in 31 (11.2%) of patients. CPLNs were removed in only 1/31 cases as part of PDS. For women with no gross residual disease (NGR) abdominal disease, 9% (12/136) had enlarged CPLNs. For these women, OS was worse when enlarged CPLNs were present (median OS, 38.4 vs 69.6 months, respectively, P = 0.08). For women with gross abdominal residual disease (RD), 14% (19/140) had enlarged CPLNs. For these women, there was no impact on OS when compared to those without enlarged CPLNs (28.5 vs 26.6 months, P = 0.53). In the absence of enlarged CPLNs, NGR was associated with significantly improved OS (69.6 vs 26.6 months, P b 0.001). However, the presence of enlarged CPLNs lessened the survival benefit of NGR abdominal disease relative to patients with RD (38.4 vs 28.5 months, P = 0.71) (Fig. 1). Conclusion: Cytoreduction to NGR abdominal disease was associated with dramatically improved OS, but only in patients without enlarged CPLNs. This is consistent with prior studies and suggests that enlarged CPLNs should be removed as part of complete cytoreductive surgery given the minimal morbidity. Longer-term prospective studies on the impact of removal of these nodes will be required.
191
describes characteristics, complications, and outcomes of a patient cohort undergoing interventional radiologic (IR) procedures as an alternative to secondary surgical debulking. Method: We reviewed 19 patients who underwent 27 IR procedures for hepatic ovarian metastases between March 2011 and June 2016. Statistics were calculated with IBM SPSS Version 22.0. Medians are presented with the interquartile range (IQR). Results: The study observation interval had a median of 50.0 months (IQR 13.0–44.0 months). In total, 27 IR procedures were performed, 21 of which were for tumor eradication, including 11 radiofrequency ablations, 4 cryoablations, 4 microwave ablations, and 2 combined microwave/chemoembolizations. For palliation, 3 chemoembolizations and 3 radioembolizations occurred. Overall, patients had a median age of 69.0 years (IQR 58.0–71.0 years). All treated tumors were secondary recurrences: the median time from initial presentation to initial attempt at IR intervention was 35.0 months (IQR 6.0–264.0 months). The median tumor diameter was 2.0 cm (IQR 1.5–4.3 cm). Overall, 73.9% of patients had 1 metastasis; 17.4% had 2 metastases; and 8.7% had 3 metastases treated. The most common side effect was right upper quadrant pain, seen in 20.0% of patients, while pneumothorax occurred in 7.4% of patients. There was complete survivorship at 30 days. For the 21 patients with a goal of eradication, malignancy recurred in 76.2%. The median time to recurrence was 14.0 months (IQR 6.0–22.0 months). The median disease-free interval among patients who did not recur by the study’s end date was 18.0 months (IQR 11.5-32.0 months). Recurrent tumors arose in prior sites of intervention in 61.5% of cases, while 23.1% of recurrences arose in a separate area of the liver; 7.7% developed in the lung; and 7.7% occurred in the bowel. Conclusion: IR procedures represent a promising new treatment strategy for ovarian metastases to the liver. Although further study is required, initial data suggest that IR procedures have low morbidity and mortality and may offer patients progression- and disease-free survival. doi:10.1016/j.ygyno.2017.03.435
408 - Poster Session Enhanced recovery after surgery interactive audit system for gynecologic oncology surgery: Importance of measuring protocol element compliance (you don't know what you don't measure)! G. Nelsona, A.D. Altmanb. aTom Baker Cancer Centre, Calgary, AB, Canada, bWinnipeg Health Sciences Centre, Winnipeg, MB, Canada
Fig. 1. Kaplan- Meier curves of patients with and without enlarged CPLNs in groups with NGR and RD.
doi:10.1016/j.ygyno.2017.03.434
407 - Poster Session Interventional radiologic therapies for the treatment of ovarian metastases B.L. Manning-Geista, J. Levyb, B.B. Benignoc. aBrigham and Women's Hospital/Harvard Medical School, Boston, MA, USA, bNorthside Hospital, Atlanta, GA, USA, cUniversity Gynecologic Oncology, Atlanta, GA, USA Objective: Many gynecologic oncologists pursue secondary debulking of ovarian metastases, but complete resection can be difficult due to surgical inaccessibility, especially in hepatic sites. This study
Objective: Implementation of enhanced recovery after surgery (ERAS) pathways outside gynecology has resulted in a reduction in hospital length of stay (LOS) and surgical complications, the net result being cost savings to the health care system. With the recent publication of ERAS guidelines in gynecologic/oncology, centers are looking to obtain similar benefits with implementation. Auditing compliance, however, has proven to be essential to successful implementation of an ERAS program. The ERAS Interactive Audit System has been developed to measure compliance with the new guidelines. The objective of this study was to evaluate the new audit system and report on clinical outcomes and protocol compliance from 2 centers actively implementing an ERAS program. Method: Data from 52 patients undergoing laparotomy (26 debulking [Db]; 26 staging [Stg]) at 2 cancer centers were entered into EIAS. A total of 120 data fields were captured per patient spanning the pre-, intra-, and postoperative phases of surgical care. Average LOS, complications, and compliance with the guidelines were reported. Results: Average LOS for the Db and Stg groups was 10 and 5 days, respectively. More complications were observed in the Db group than in the Stg group (higher surgical, cardiovascular, and infectious
abdominopelvic CT scan that included the lower chest within 90 days prior to surgery were eligible. Scans were reviewed by 2 blinded radiologists. We defined enlarged CPLNs as any supradiaphragmatic lymph nodes N10 mm on short axis with radiologic characteristics suspicious for involvement. Enlarged CPLNs detected on preoperative scans was not a criterion for stage IV disease. We compared overall survival (OS) with respect to residual disease and presence of enlarged CPLNs using the log rank test. Results: A total of 276 patients were eligible with a median age of 64 years. Most cases were serous histology (85.5%), and 66 (23.9%) had stage IV disease. CPLNs were more than 10 mm in 31 (11.2%) of patients. CPLNs were removed in only 1/31 cases as part of PDS. For women with no gross residual disease (NGR) abdominal disease, 9% (12/136) had enlarged CPLNs. For these women, OS was worse when enlarged CPLNs were present (median OS, 38.4 vs 69.6 months, respectively, P = 0.08). For women with gross abdominal residual disease (RD), 14% (19/140) had enlarged CPLNs. For these women, there was no impact on OS when compared to those without enlarged CPLNs (28.5 vs 26.6 months, P = 0.53). In the absence of enlarged CPLNs, NGR was associated with significantly improved OS (69.6 vs 26.6 months, P b 0.001). However, the presence of enlarged CPLNs lessened the survival benefit of NGR abdominal disease relative to patients with RD (38.4 vs 28.5 months, P = 0.71) (Fig. 1). Conclusion: Cytoreduction to NGR abdominal disease was associated with dramatically improved OS, but only in patients without enlarged CPLNs. This is consistent with prior studies and suggests that enlarged CPLNs should be removed as part of complete cytoreductive surgery given the minimal morbidity. Longer-term prospective studies on the impact of removal of these nodes will be required.
191
describes characteristics, complications, and outcomes of a patient cohort undergoing interventional radiologic (IR) procedures as an alternative to secondary surgical debulking. Method: We reviewed 19 patients who underwent 27 IR procedures for hepatic ovarian metastases between March 2011 and June 2016. Statistics were calculated with IBM SPSS Version 22.0. Medians are presented with the interquartile range (IQR). Results: The study observation interval had a median of 50.0 months (IQR 13.0–44.0 months). In total, 27 IR procedures were performed, 21 of which were for tumor eradication, including 11 radiofrequency ablations, 4 cryoablations, 4 microwave ablations, and 2 combined microwave/chemoembolizations. For palliation, 3 chemoembolizations and 3 radioembolizations occurred. Overall, patients had a median age of 69.0 years (IQR 58.0–71.0 years). All treated tumors were secondary recurrences: the median time from initial presentation to initial attempt at IR intervention was 35.0 months (IQR 6.0–264.0 months). The median tumor diameter was 2.0 cm (IQR 1.5–4.3 cm). Overall, 73.9% of patients had 1 metastasis; 17.4% had 2 metastases; and 8.7% had 3 metastases treated. The most common side effect was right upper quadrant pain, seen in 20.0% of patients, while pneumothorax occurred in 7.4% of patients. There was complete survivorship at 30 days. For the 21 patients with a goal of eradication, malignancy recurred in 76.2%. The median time to recurrence was 14.0 months (IQR 6.0–22.0 months). The median disease-free interval among patients who did not recur by the study’s end date was 18.0 months (IQR 11.5-32.0 months). Recurrent tumors arose in prior sites of intervention in 61.5% of cases, while 23.1% of recurrences arose in a separate area of the liver; 7.7% developed in the lung; and 7.7% occurred in the bowel. Conclusion: IR procedures represent a promising new treatment strategy for ovarian metastases to the liver. Although further study is required, initial data suggest that IR procedures have low morbidity and mortality and may offer patients progression- and disease-free survival. doi:10.1016/j.ygyno.2017.03.435
408 - Poster Session Enhanced recovery after surgery interactive audit system for gynecologic oncology surgery: Importance of measuring protocol element compliance (you don't know what you don't measure)! G. Nelsona, A.D. Altmanb. aTom Baker Cancer Centre, Calgary, AB, Canada, bWinnipeg Health Sciences Centre, Winnipeg, MB, Canada
Fig. 1. Kaplan- Meier curves of patients with and without enlarged CPLNs in groups with NGR and RD.
doi:10.1016/j.ygyno.2017.03.434
407 - Poster Session Interventional radiologic therapies for the treatment of ovarian metastases B.L. Manning-Geista, J. Levyb, B.B. Benignoc. aBrigham and Women's Hospital/Harvard Medical School, Boston, MA, USA, bNorthside Hospital, Atlanta, GA, USA, cUniversity Gynecologic Oncology, Atlanta, GA, USA Objective: Many gynecologic oncologists pursue secondary debulking of ovarian metastases, but complete resection can be difficult due to surgical inaccessibility, especially in hepatic sites. This study
Objective: Implementation of enhanced recovery after surgery (ERAS) pathways outside gynecology has resulted in a reduction in hospital length of stay (LOS) and surgical complications, the net result being cost savings to the health care system. With the recent publication of ERAS guidelines in gynecologic/oncology, centers are looking to obtain similar benefits with implementation. Auditing compliance, however, has proven to be essential to successful implementation of an ERAS program. The ERAS Interactive Audit System has been developed to measure compliance with the new guidelines. The objective of this study was to evaluate the new audit system and report on clinical outcomes and protocol compliance from 2 centers actively implementing an ERAS program. Method: Data from 52 patients undergoing laparotomy (26 debulking [Db]; 26 staging [Stg]) at 2 cancer centers were entered into EIAS. A total of 120 data fields were captured per patient spanning the pre-, intra-, and postoperative phases of surgical care. Average LOS, complications, and compliance with the guidelines were reported. Results: Average LOS for the Db and Stg groups was 10 and 5 days, respectively. More complications were observed in the Db group than in the Stg group (higher surgical, cardiovascular, and infectious