Assessment of Adult Women With Ovarian Masses and Treatment of Epithelial Ovarian Cancer: ASCO Resource-Stratified Guideline.

PURPOSE: To provide expert guidance to clinicians and policymakers in three resource-constrained settings on diagnosis and staging of adult women with ovarian masses and treatment of patients with epithelial ovarian (including fallopian tube and primary peritoneal) cancer. METHODS: A multidisciplinary, multinational ASCO Expert Panel reviewed existing guidelines, conducted a modified ADAPTE process, and conducted a formal consensus process with additional experts. RESULTS: Existing sets of guidelines from eight guideline developers were found and reviewed for resource-constrained settings; adapted recommendations from nine guidelines form the evidence base, informing two rounds of formal consensus; and all recommendations received ≥ 75% agreement. RECOMMENDATIONS: Evaluation of adult symptomatic women in all settings includes symptom assessment, family history, and ultrasound and cancer antigen 125 serum tumor marker levels where feasible. In limited and enhanced settings, additional imaging may be requested. Diagnosis, staging, and/or treatment involves surgery. Presurgical workup of every suspected ovarian cancer requires a metastatic workup. Only trained clinicians with logistical support should perform surgical staging; treatment requires histologic confirmation; surgical goal is staging disease and performing complete cytoreduction to no gross residual disease. In first-line therapy, platinum-based chemotherapy is recommended; in advanced stages, patients may receive neoadjuvant chemotherapy. After neoadjuvant chemotherapy, all patients should be evaluated for interval debulking surgery. Targeted therapy is not recommended in basic or limited settings. Specialized interventions are resource-dependent, for example, laparoscopy, fertility-sparing surgery, genetic testing, and targeted therapy. Multidisciplinary cancer care and palliative care should be offered.Additional information can be found at www.asco.org/resource-stratified-guidelines. It is ASCO's view that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.

Abscopal Effect of Radiotherapy in Imatinib-resistant Dermatofibrosarcoma Protuberans.

Local tumor control and symptom relief have been the major advantage of radiotherapy in clinical practice. In the past years, the systemic anti-tumor effect of radiotherapy, also known as the abscopal effect, has been reported with limited studies. With the advent of immunotherapy, the frequency of the abscopal effect has increased in patients who receive sequential treatment with radiotherapy and immunotherapy or patients who receive radiotherapy after acquiring resistance to immunotherapy. A novel cancer treatment modality, such as molecular targeted therapy, has been associated with the immune response within the tumor but its systemic anti-tumor effect, when combined with radiotherapy, is yet to be documented. There have been few studies to date assessing the immunological effects of imatinib on tumors; however, the mechanism of tumor regression or resistance acquisition is poorly understood. We present a 56-year-old male diagnosed with dermatofibrosarcoma protuberans (DFSP) who developed resistance to imatinib after five months of treatment. Following subsequent local radiotherapy to the primary tumor, he had complete clinical remission of the primary and metastatic lesions.

Pilot Survey of Breast Cancer Management in Sub-Saharan Africa.

PURPOSE: To understand the current state of breast cancer management in sub-Saharan Africa. METHODS: We conducted an anonymous online survey of breast cancer management among African Organization for Research and Treatment in Cancer (AORTIC) members by using a 42-question structured questionnaire in both English and French in 2013. RESULTS: Twenty members from 19 facilities in 14 countries responded to the survey. Twelve members (60%) belonged to a multidisciplinary breast cancer team. Radiotherapy equipment was available in seven facilities (36%), but equipment had down time at least once a week in four facilities. Available chemotherapy drugs included methotrexate, cyclophosphamide, fluorouracil, anthracyclines, and vincristine, whereas trastuzumab, taxanes, vinorelbine, and gemcitabine were available in few facilities. Core-needle biopsy was available in 16 facilities (84%); mammogram, in 17 facilities (89%); computed tomography scan, in 15 facilities (79%); magnetic resonance imaging, in 11 facilities (58%); and bone scans, in nine facilities (47%). It took an average of 1 to 3 weeks to report histopathology. Immunohistochemistry was available locally in eight facilities (42%), outside hospitals but within the country in seven facilities (37%), and outside the country in four facilities (21%). Thirteen facilities (68%) performed axillary node dissections as part of a breast protocol. Neoadjuvant chemotherapy was the most common therapy for locally advanced breast cancer in 13 facilities (68%). In three facilities (16%), receptor status did not influence the prescription of hormone treatment. CONCLUSION: This pilot survey suggests that AORTIC members in sub-Saharan Africa continue to make gains in the provision of access to multidisciplinary breast cancer care, but the lack of adequate pathology and radiotherapy services is a barrier. Focused attention on in-country and regional training needs and improvement of health systems deliverables is urgently needed.

Case Report: A Neocystostomy Perforation Presenting as a Gallstone.

An 83-year-old man, with a surgical history of radical cystectomy with simultaneous construction of a neobladder 13 years ago, presented clinically and radiologically as acute cholecystitis. Upon emergent exploratory laparotomy for his acute deterioration, a perforated neobladder was identified with its spilled stones in the gallbladder fossa, mimicking acute cholecystitis. This is the first case report of this presentation. Neobladder perforations should be considered in any patient who has undergone orthotopic bladder substitution, no matter how long it has been since the original reconstruction.