Trends in the use of neoadjuvant chemotherapy for low-grade serous ovarian cancer in the United States.

OBJECTIVE: To describe trends in neoadjuvant chemotherapy (NACT) use for low-grade serous ovarian carcinoma (LGSOC) and to quantify associations between NACT and extent of cytoreductive surgery. METHODS: We identified women treated for stage III or IV serous ovarian cancer in a Commission on Cancer accredited program between January 2004-December 2020. Regression models were developed to evaluate trends in NACT use for LGSOC, to identify factors associated with receipt of NACT, and to quantify associations between NACT and bowel or urinary resection at the time of surgery. Demographic and clinical factors were used for confounder control. RESULTS: We observed 3350 patients who received treatment for LGSOC during the study period. The proportion of patients who received NACT increased from 9.5% in 2004 to 25.9% in 2020, corresponding to an annual percent change of 7.2% (95% CI 5.6-8.9). Increasing age (rate ratio (RR) 1.15; 95% CI 1.07-1.24), and stage IV disease (RR 2.66; 95% CI 2.31-3.07) were associated with a higher likelihood of receiving NACT. For patients with high-grade disease, NACT was associated with a decrease in likelihood of bowel or urinary surgery (35.3% versus 23.9%; RR 0.68, 95% CI 0.65-0.71). For LGSOC, NACT was associated with a higher likelihood of these procedures (26.6% versus 32.2%; RR 1.24, 95% CI 1.08-1.42). CONCLUSION: NACT use among patients with LGSOC has increased from 2004 to 2020. While NACT was associated with a lower rate of gastrointestinal and urinary surgery among patients with high-grade disease, patients with LGSOC receiving NACT were more likely to undergo these procedures.

Robotic resection of isolated ovarian cancer recurrence in the lesser sac.

In recurrent ovarian cancer patients the addition of surgical cytoreduction is associated with prolonged overall survival compared to chemotherapy treatment alone when complete cytoreduction is achieved (Harter et al., 2021, Shi et al., 2021, Coleman et al., 2019). In the appropriate surgical candidates, a minimally invasive approach may be used to achieve complete cytoreduction of isolated lesions with proper exposure and surgical planning. This video demonstrates safe robotic entry into the lesser sac and resection of recurrent high-grade serous ovarian carcinoma near the pancreatic neck. The patient is a 78-year-old BRCA negative female with a history of a stage IIIC high-grade serous carcinoma. She previously underwent cytoreductive surgery and adjuvant chemotherapy in 2018 and presented 24 months later with a normal CA 125 and CT findings of an isolated lesion near the porta hepatis. An MRI was obtained preoperatively to further characterize the location of the lesion demonstrating a 2.2 × 1.6 cm hypoechoic mass adjacent to the pancreatic neck. Given the patient's prolonged disease-free interval, fitness for surgery and single site of disease, she met strict inclusion criteria for recent studies demonstrating clinical benefit with secondary cytoreduction (Harter et al., 2021, Shi et al., 2021). She was taken for a robotic secondary cytoreduction. At subsequent follow up 7 months later, our patient was still disease free and continues surveillance. In this video, we demonstrate the careful dissection of this isolated lesion from the omental bursa. We review important pre-procedural and anatomic considerations for robotic surgery in the lesser sac.

COVID-19 Vaccination in Pregnancy and Lactation: Current Research and Gaps in Understanding.

The COVID-19 pandemic has demonstrated the urgent need to develop vaccine strategies optimized for pregnant people and their newborns, as both populations are at risk of developing severe disease. Although not included in COVID-19 vaccine development trials, pregnant people have had access to these vaccines since their initial release in the US and abroad. The rapid development and distribution of novel COVID-19 vaccines to people at risk, including those who are pregnant and lactating, presents an unprecedented opportunity to further our understanding of vaccine-induced immunity in these populations. In this review, we aim to summarize the literature to date on COVID-19 vaccination in pregnancy and lactation and highlight opportunities for investigation that may inform future maternal vaccine development and implementation strategies.