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AAGO Top Ten #012017


 [1] G. D. Aletti and W. A. Cliby, “Time for centralizing patients with ovarian cancer : what are we waiting for ?,” Gynecol. Oncol., vol. 142, no. 2, pp. 209–210, 2016.

Editorial. Importancia en la centralizacion de las pacientes con cancer de ovario

 [2] N. Colombo, C. Creutzberg, F. Amant, T. Bosse, A. González-martín, J. Ledermann, C. Marth, R. Nout, D. Querleu, M. Raza, C. Sessa, T. Esmo, E. Estro, E. Consensus, and C. Working, “ESMO – ESGO – ESTRO consensus conference on endometrial cancer : Diagnosis , treatment and follow-up q,” Radiother. Oncol., vol. 117, pp. 559–581, 2015.


The first joint European Society for Medical Oncology (ESMO), European SocieTy for Radiotherapy & Oncology (ESTRO) and European Society of Gynaecological Oncology (ESGO) consensus conference on endometrial cancer was held on 11–13 December 2014 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of endometrial cancer. Before the conference, the expert panel prepared three clinically-relevant questions about endometrial cancer relating to the following four areas: Prevention and screening, surgery, adjuvant treatment and advanced and recurrent disease. All rel- evant scientific literature, as identified by the experts, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. Results of this consensus conference, together with a summary of evidence supporting each rec- ommendation, are detailed in this article. All participants have approved this final article. ? 2015 The Authors. Published by Elsevier Ireland Ltd. Radiotherapy and Oncology 117 (2015) 559–581 This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc- nd/4.0/)


Consenso de expertos sobre cancer de endometrio: diagnosis, tratamiento y seguimiento.
Vale la pena como referencia.

 [3] S. M. Crafton, K. Bixel, and J. L. Hays, “PARP inhibition and gynecologic malignancies : A review of current literature and on-going trials,” Gynecol. Oncol., vol. 142, no. 3, pp. 588–596, 2016.


The poly (ADP-ribose) polymerase (PARP) family of enzymes isimportant in severalDNArepairpathways. Drugs that inhibit these enzymes have been investigated inmany types of cancer, but their application in the treatment of gynecologic malignancies has rapidly evolved – as manifested by the 2014 FDA approval for olaparib in the treatment of recurrent ovarian cancer associatedwith a germline BRCA mutation (gBRCA). In efforts to broaden their efficacy, current clinical trials have demonstrated benefit of olaparib, and other PARP inhibitors (PARPi), as single agents and in combination with cytotoxic chemotherapy and biologic agents, in wide ranging populations. Although themajority of data for PARPi in gynecologicmalignancies has been specifically regarding ovarian can- cer, their role in thetreatment of uterine and cervical cancer is currently being investigated. This reviewwill serve as a synopsis of seminal trials to date, summarize the breadth of clinical application in on-going studies, query how these results may change future practice, and reflect on questions yet to be answered.


Revisión de la literatura y trials actuales sobre PARP inhibitions

 [4] P. Dahm-kähler, C. Palmqvist, C. Staf, E. Holmberg, and L. Johannesson, “Centralized primary care of advanced ovarian cancer improves complete cytoreduction and survival - A population-based cohort study,” Gynecol. Oncol., vol. 142, no. 2, pp. 211–216, 2016.


Objective. To evaluate centralized primary care of advanced ovarian and fallopian tube cancers in a complete populationcohort in relationto complete cytoreduction, timeinterval fromsurgery to chemotherapy andrelative survival. Methods. A regional population-based cohort study of women diagnosed with primary ovarian and fallopian tube cancers and included in the Swedish Quality Registry (SQR) during 2008–2013 in a regionwhere primary care of advanced stages was centralized in 2011. Surgical, oncological characteristics, outcomes, follow-ups and relative survivals were analyzed. Results. There were 817 women diagnosed with ovarian and fallopian tube cancers during 2008–2013 and 523 were classified as FIGO stage III-IV and further analyzed. Primary debulking surgery (PDS) was performed in 81% and neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) in 11%. Complete cytoreduction at PDSwas performed in 37% before compared to 49% after centralization (p b 0.03). The chemo- therapy protocols were identical in the cohorts and they received and completed the planned chemotherapy equally. The time interval between PDS and chemotherapy was 36 days (median) before compared to 24 days after centralization (p b 0.01). The relative 3-year survival rate inwomen treated by PDS was 44% compared to 65% after centralization and the estimated excess mortality rate ratio (EMRR) was reduced (RR 0.58; 95% CI 0.42–0.79). Comparing the complete cohorts before and after centralization, regardless primary treatment, the relative 3-year survival rate increased from40% to 61%with reduced EMRR (RR 0.59; 95% CI 0.45–0.76). Conclusion. Centralized primary care of advanced ovarian and fallopian tube cancers increases complete cytoreduction, decreases time interval fromPDS to chemotherapy and improves relative survival significantly.


Estudio de una cohorte de pacientes con cancer de ovario y trompa en un solo centro con respecto a la cirugia de citoreducción, tiempo de intervalo y sobrevida.

[5] L. Elit, “Cervical cancer screening in women over 65 . PRO : Are we asking the right question ?,” Gynecol. Oncol., vol. 142, no. 3, pp. 381–382, 2016.


Editorial: screening en cancer cervical en mayores de 65 años. PRO.

 [6] V. Gallotta, M. Petrillo, C. Conte, G. Vizzielli, A. Fagotti, G. Ferrandina, F. Fanfani, B. Costantini, V. Carbone, and G. Scambia, “Laparoscopic Versus Laparotomic Surgical Staging for Early-Stage Ovarian Cancer : A Case-Control Study,” J. Minim. Invasive Gynecol., vol. 23, no. 5, pp. 769–774, 2016.


Study Objective: To evaluate the oncologic outcomes of patients with early-stage ovarian cancer (eOC) managed by lapa- roscopy or laparotomy in a single high-volume gynecologic cancer center. Design: Retrospective case-control study (Canadian Task Force classification II-2). Setting: Catholic University of the Sacred Hearth, Rome, Italy. Patients: Data of consecutive women with eOC undergoing comprehensive laparoscopic staging between 2007 and 2013 were matched with a cohort of patients undergoing open surgery between 2000 and 2011. Four-year survival outcomes were analyzed using the Kaplan-Meier method. Measurements and Results: Sixty women undergoing staging via laparoscopy were compared with a cohort of 120 patients undergoing open surgery. Baseline characteristics were similar between groups. Seventy percent of patients underwent adju- vant platinum based chemotherapy without differences between the 2 groups. Operative time (p5.01), estimated blood loss (p5.032), and median hospital stay (p5.001) were higher in patients submitted to laparotomic versus laparoscopic staging. As of October 2015, median duration of follow-up was 38 months (range, 24 -48), recurrent disease was documented in 16 patients (13.3%) in the laparotomic group and in 5 patients (8.3%) in the laparoscopic group (p5.651), without differences in the pattern of recurrence presentation. Four-year progression-free survival (PFS) and overall survival (OS) rates were 89% and 92% in the laparoscopic group, respectively, and 81% and 91% in the laparotomic group, without any statistical significant difference between the groups (4-year PFS p 5 .651; 4-year OS p 5 .719). Conclusion: The findings of the present study suggests that in the surgical treatment of FIGO stage I ovarian cancer, laparoscopy is associated with equivalent oncologic outcome compared with a conventional abdominal approach.


Estudio retrospectivo caso control que evalua los resultados oncológicos en pacientes con cancer de ovario incial manejados por laparoscopia vs laparotomia en un solo centro.

 [7] M. Kamrava, “Intensity modulated radiation therapy for women with gynecologic cancers : this horse is also already out of the barn,” Gynecol. Oncol., vol. 143, no. 1, pp. 1–2, 2016.


Editorial. El uso de IMRT en cánceres ginecológicos.

 [8] S. Kehoe, J. Hook, M. Nankivell, G. C. Jayson, H. Kitchener, T. Lopes, D. Luesley, T. Perren, and S. Bannoo, “Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer ( CHORUS ): an open-label , randomised , controlled , non-inferiority trial,” Lancet, vol. 386, no. 9990, pp. 249–257, 2015.


Background The international standard of care for women with suspected advanced ovarian cancer is surgical debulking followed by platinum-based chemotherapy. We aimed to establish whether use of platinum-based primary chemotherapy followed by delayed surgery was an eff ective and safe alternative treatment regimen. Methods In this phase 3, non-inferiority, randomised, controlled trial (CHORUS) undertaken in 87 hospitals in the UK and New Zealand, we enrolled women with suspected stage III or IV ovarian cancer. We randomly assigned women (1:1) either to undergo primary surgery followed by six cycles of chemotherapy, or to three cycles of primary chemotherapy, then surgery, followed by three more cycles of completion chemotherapy. Each 3-week cycle consisted of carboplatin AUC5 or AUC6 plus paclitaxel 175 mg/m², or an alternative carboplatin combination regimen, or carboplatin monotherapy. We did the random assignment by use of a minimisation method with a random element, and stratifi ed participants according to the randomising centre, largest radiological tumour size, clinical stage, and prespecifi ed chemotherapy regimen. Patients and investigators were not masked to group assignment. The primary outcome measure was overall survival. Primary analyses were done in the intention-to-treat population. To establish non-inferiority, the upper bound of a one-sided 90% CI for the hazard ratio (HR) had to be less than 1·18. This trial is registered, number ISRCTN74802813, and is closed to new participants. Findings Between March 1, 2004, and Aug 30, 2010, we randomly assigned 552 women to treatment. Of the 550 women who were eligible, 276 were assigned to primary surgery and 274 to primary chemotherapy. All were included in the intention-to-treat analysis; 251 assigned to primary surgery and 253 to primary chemotherapy were included in the per-protocol analysis. As of May 31, 2014, 451 deaths had occurred: 231 in the primary-surgery group versus 220 in the primary-chemotherapy group. Median overall survival was 22·6 months in the primary-surgery group versus 24·1 months in primary chemotherapy. The HR for death was 0·87 in favour of primary chemotherapy, with the upper bound of the one-sided 90% CI 0·98 (95% CI 0·72–1·05). Grade 3 or 4 postoperative adverse events and deaths within 28 days after surgery were more common in the primary-surgery group than in the primary-chemotherapy group (60 [24%] of 252 women vs 30 [14%] of 209, p=0·0007, and 14 women [6%] vs 1 woman [<1%], p=0·001). The most common grade 3 or 4 postoperative adverse event was haemorrhage in both groups (8 women [3%] in the primary-surgery group vs 14 [6%] in the primary-chemotherapy group). 110 (49%) of 225 women receiving primary surgery and 102 (40%) of 253 receiving primary chemotherapy had a grade 3 or 4 chemotherapy related toxic eff ect (p=0·0654), mostly uncomplicated neutropenia (20% and 16%, respectively). One fatal toxic eff ect, neutropenic sepsis, occurred in the primary-chemotherapy group. Interpretation In women with stage III or IV ovarian cancer, survival with primary chemotherapy is non-inferior to primary surgery. In this study population, giving primary chemotherapy before surgery is an acceptable standard of care for women with advanced ovarian cancer.


CHORUS trail: estudio controlado y randomizado cirugia primaria vs cirugia del intervalo en cancer de ovario avanzado

 [9] H. Mahdi, B. Nutter, F. Abdul-karim, S. Amarnath, and P. G. Rose, “The impact of combined radiation and chemotherapy on outcome in uterine papillary serous carcinoma compared to chemotherapy alone,” J. Gynecol. Oncol., vol. 27, no. 2, pp. 1–11, 2016.


Objective: To investigate the impact of pelvic radiation on survival in patients with uterine serous carcinoma (USC) who received adjuvant chemotherapy. Methods: Patients with stage I-IV USC were identified from the Surveillance, Epidemiology, and End Results program 2000 to 2009. Patients were included if treated with surgery and chemotherapy. Patients were divided into two groups: those who received chemotherapy and pelvic radiation therapy (CT_RT) and those who received chemotherapy only (CT). Kaplan- Meier curves and Cox regression proportional hazard models were used. Results: Of the 1,838 included patients, 1,272 (69%) were CT and 566 (31%) were CT_ RT. Adjuvant radiation was associated with significant improvement in overall survival (OS; p<0.001) and disease-specific survival (DSS; p<0.001) for entire cohort. These findings were consistent for the impact of radiation on OS (p<0.001) and DSS (p<0.001) in advanced stage (III-IV) disease but not for early stage (I–II) disease (p=0.21 for OS and p=0.82 for DSS). In multivariable analysis adjusting for age, stage, race and extent of lymphadenectomy, adjuvant radiation was a significant predictor of OS and DSS for entire cohort (p=0.003 and p=0.05) and in subset of patients with stage III (p=0.02 and p=0.07) but not for patients with stage I (p=0.59 and p=0.49), II (p=0.83 and p=0.82), and IV USC (p=0.50 and p=0.96). Other predictors were stage, positive cytology, African American race and extent of lymphadenectomy. Conclusion: In USC patients who received adjuvant chemotherapy, adjuvant radiation was associated with significantly improved outcome in stage III disease but not for other stages. Positive cytology, extent of lymphadenectomy and African race were significant predictors of outcome.


Estudio comparativo entre la combinación de radioterapia pelviana y quimioterapia vs quimioterapia sola en pacientes con carcinoma seroso papilar de endometrio en cuanto a sobrevida.

 [10] G. Nelson, A. D. Altman, A. Nick, L. A. Meyer, P. T. Ramirez, C. Achtari, J. Antrobus, J. Huang, M. Scott, L. Wijk, N. Acheson, O. Ljungqvist, and S. C. Dowdy, “Guidelines for pre- and intra-operative care in gynecologic / oncology surgery : Enhanced Recovery After Surgery ( ERAS ® ) Society recommendations — Part I,” Gynecol. Oncol., vol. 140, no. 2, pp. 313–322, 2016.


We provide evidence supporting pre- and intra-operative management of patients undergoing gynecologic/oncology surgery. • This guideline will help integrate knowledge into practice, align perioperative care, and encourage future investigations.


Guia ERAS Parte 1: para el cuidado del pre e intra operatorio