Outcome in Advanced Ovarian Cancer following an Appropriate and Comprehensive Effort at Upfront Cytoreduction: A Twenty-Year Experience in a Single Cancer Institute.

Objectives. The purpose of this retrospective evaluation of advanced-stage ovarian cancer patients was to compare outcome with published findings from other centers and to discuss future options for the management of advanced ovarian carcinoma patients. Methods. A retrospective series of 340 patients with a mean age of 58 years (range: 17-88) treated for FIGO stage III and IV ovarian cancer between January 1985 and January 2005 was reviewed. All patients had primary cytoreductive surgery, without extensive bowel, peritoneal, or systematic lymph node resection, thereby allowing initiation of chemotherapy without delay. Chemotherapy consisted of cisplatin-based chemotherapy in combination with alkylating agents before 2000, whereas carboplatin and paclitaxel regimes were generally used after 1999-2000. Overall survival and disease-free survival were analyzed by the Kaplan-Meier method and the log-rank test. Results. With a mean followup of 101 months (range: 5 to 203), 280 events (recurrence or death) were observed and 245 patients (72%) had died. The mortality and morbidity related to surgery were low. The main prognostic factor for overall survival was postoperative residual disease (P < .0002), while the main prognostic factor for disease-free survival was histological tumor type (P < .0007). Multivariate analysis identified three significant risk factors: optimal surgery (RR = 2.2 for suboptimal surgery), menopausal status (RR = 1.47 for postmenopausal women), and presence of a taxane in the chemotherapy combination (RR = 0.72). Conclusion. These results confirm that optimal surgery defined by an appropriate and comprehensive effort at upfront cytoreduction limits morbidity related to the surgical procedure and allows initiation of chemotherapy without any negative impact on survival. The impact of neoadjuvant chemotherapy to improve resectability while lowering the morbidity of the surgical procedure is discussed.

Long-term results of low-dose proton beam therapy for circumscribed choroidal hemangiomas.

PURPOSE: To evaluate the long-term efficacy and outcome of low-dose proton beam irradiation in the treatment of symptomatic circumscribed choroidal hemangioma. PATIENTS AND METHODS: Retrospective review of 71 patients with symptomatic circumscribed choroidal hemangiomas treated by proton beam irradiation between September 1994 and October 2002 using a total dose of 20 Cobalt Gray Equivalent. RESULTS: The median follow-up was 52 months (8-133 months). Retinal reattachment was obtained in all cases. Tumor thickness decreased in all cases and a completely flat scar was obtained in 65 patients (91.5%). Visual acuity was improved by two lines or more in 37 of the 71 patients (52%), and in 30 of the 40 patients (75%) treated within 6 months after onset of the first symptoms. The main radiation complications detected during follow-up were cataract (28%) and radiation-induced maculopathy (8%). None of the 71 patients developed eyelid sequelae or neovascular glaucoma. CONCLUSION: Proton beam irradiation with a total dose of 20 Cobalt Gray Equivalent appears to be a valid treatment for circumscribed choroidal hemangiomas, inducing definitive retinal reattachment and decreasing tumor thickness. However, delayed radiation-induced maculopathy may occur. A successful functional outcome is dependent on a short interval between onset of the first symptoms and initiation of therapy.

Prophylactic salpingo-oophorectomy in a series of 89 women carrying a BRCA1 or a BRCA2 mutation.

BACKGROUND: Prophylactic salpingo-oophorectomy (SO), which is recommended in BRCA1/2 mutation carriers, still needs to be reappraised. METHODS: In all, 89 BRCA1/BRCA2 mutation carriers underwent SO between 1994-2004. Past medical and familial history, SO, results and survival after SO were analyzed. RESULTS: The series consisted of 56 BRCA1 and 33 BRCA2 mutation carriers. All but 1 had a family history of breast (BC) and/or ovarian cancer; 42 BRCA1 and 31 BRCA2 had a personal history of BC. The median age at SO was 44 (BRCA1) and 49.5 (BRCA2) years for women without previous BC (not significant) and 48 (BRCA1) and 53 BRCA2) years (P=.03) for women with previous BC. Occult ovarian (n=2) and/or fallopian (n=3) carcinomas were found in 4 patients (4.5%): 1 experienced recurrence (4 years), 2 are disease-free (26 and 38 months of follow-up), and 1 died from BC (12 months). Among the other 69 patients with previous BC (median follow-up, 42 months), 14 developed ipsilateral or contralateral BC and 8 developed metastatic disease. Among the 16 patients without previous BC (median follow-up, 27 months), 3 developed BC. Of the 89 patients, 85 are still alive: 3 died from BC and 1 died from pancreatic cancer. No peritoneal malignancy was observed. CONCLUSIONS: This study shows that prophylactic SO remains an important option for BRCA1/2 mutation carriers as asymptomatic ovarian/fallopian cancers were found in 4.5% of patients. However, a longer follow-up and larger series are required to more precisely evaluate the benefits of this procedure in terms of BC incidence, peritoneal malignancy, or recurrence.