Interval De-Bulking surgery in advanced stage ovarian cancer

Primary de-hulking surgery, a crucial step in the management of epithelial ovarian cancer, is not always possible in patients with advanced stage disease [stage Ill to IV]. In some circumstances, surgery may have been attempted but generally does not yield good results with residual tumor masses> 1-2 cm [so called suboptimal therapy]. Induction or neo-adjuvant chemotherapy followed by interval dehulking surgery [IDS] may have an alternative role in this setting. To study the results of interval de-bulking surgery [IDS] in patients treated for 'unresectable' advanced stage ovarian cancer compared with primary dc-hulking surgery [PDS] followed by chemotherapy. Our study includes a group of 20 patients who underwent IDS and were matched to a control group of 20 patients treated with PDS. Optimal cytoreductive surgery was achieved in 18 patients [90%]. The rates of post-operative morbidity, blood transfusion andmedian length of hospitalization were significantly reduced in the study [IDS] group, but survival did not diffec n both groups. Interval de-bulkrng surgery [IDS] in patients with advanced stage ovarian cancer gives the same survival advantage as primary de-bulking surgery [PDS], but it is better tolerated, and with better quality of life

Breast conserving-surgery after neoadjuvant chemotherapy for locally advanced breast cancer

Tumor down-staging by preoperative neoadjuvant chemotherapy in patients with locally advanced breast tumors allows breast conservation in women who were previously candidates for mastectomy. However, lumpectorny success in such cases cannot be fully achieved. The aim of this study was to create a quantitative tool for preoperative evaluation of the success of breast conservation in such patients. The study population included 57 consecutive patients with stage II and III breast cancer who were designated for lumpectomy. All patients received neoadjuvant therapy. Breast-conserving surgery was offered in accordance with clinical and esthetic criteria. Demographic details and clinical, imaging, and pathologic information were collected from medical files. Three factors were found to be the main predictors for successful breast conservation: absence of diffuse micro-calcifications as seen in the pretreatment mammogram, a post-chemotherapy tumor size of<25 mm and the existence of a circumscribed lesion on mammography. Breast conservation after neoadjuvant chemotherapy is feasible in most patients with locally advanced breast cancer. For surgical planning, tumor characteristics and response to neoadjuvant chemotherapy should be taken into account. Improved breast-imaging modalities are necessary to improve detection of residual disease after neoadjuvant chemotherapy, especially when breast cancer is of lobular invasive histology. Margin assessment by intraoperative frozen-section analysis is helpful to avoid reoperation. To achieve an optimal result, an interdisciplinary surgical approach is important: The use of these criteria as a basis for decision on the type of surgery may decrease the performance of unnecessary procedures