604 Significant variation in treatment and survival outcomes in stage 2–4 ovarian cancer in england: results from the national ovarian cancer feasibility audit pilot

Abstract

OR "Angiomyofibroblastoma of the vulva with sarcomatous transformation". Results A total of 69 reported cases were found. In our knowledge, the case presented is the first report of AMFB in Colombia. The age of the patients ranged between 16 and 82 years, with an average of 43 years. The main presenting symptom was the presence of a non-painful vulvar mass, although some of the patients in the reported cases reported pain and dyspareunia (8/69). The evolution time varied between 1 month and 9 years with an average of 21 months, and the size between 1 and 37 centimeters with an average of 7 centimeters. Of the cases taken to immunohistochemical study, 86% were positive for estrogen receptors and 80% for progesterone receptors, 88% were positive for desmin and 98% for vimentin, 92% were negative for S100 and the cases that were positive corresponded to the lipomatous variant, 43% were positive for a-SMA and 34% for CD 34. Definitive diagnosis is based on histological findings. In this reviewed cases, only one relapse was reported. The universal treatment is excision and only one case of relapse was reported, which corresponded to the only reported case of malignant transformation. Conclusion Vulvar AMFB is a rare mesenchymal tumor, with exclusive surgical treatment and excellent prognosis, although it may have malignant transformation. The reported case could represent the second case of AMFB with malignant transformation.

Residual Disease Threshold After Primary Surgical Treatment for Advanced Epithelial Ovarian Cancer, Part 1: A Systematic Review and Network Meta-Analysis

“…These studies assessed survival after primary cytoreductive surgery followed by adjuvant platinum-based chemotherapy in women with advanced EOC. The Sundar et al 13 underpinning the NMA and the results of our updated analysis provides more precise and reliable estimates than seen in previous studies and reviews in this area, 6,8–12,97 which should enable more informed decisions to be made. Although the findings do not enable us to determine whether the survival benefit is a direct effect of the surgical intervention, they may encourage the surgical community to strive toward improving rates of complete cytoreduction and perhaps more centers adopting a more aggressive approach to attempt to improve rates of complete cytoreduction.…”

“…Despite the obvious challenges, this should be considered more than feasible because on average only around half of women with stage II–IV and unstaged ovarian cancer receive surgery in England. 13 Existing trials have shown conflicting results when further surgery was performed as an interval procedure after suboptimal cytoreduction at primary surgery. 111 Therefore, it seems best to increase attempts at optimizing to lower levels of RD at first surgery.…”

“…A recently published National Ovarian Cancer Audit feasibility pilot report, by a British Gynaecological Cancer Society action group, highlights the need for more attempts at cytoreductive surgery in the United Kingdom. 13 In addition, some centers may not have the expertise to achieve complete cytoreduction, potentially leading to some patients not achieving optimal results for their individual surgery. The results from the Ovarian Cancer Audit feasibility pilot shows that on average only 51% of women with stage 2–4 and unstaged ovarian cancer receive surgery in England.…”

“…The results from the Ovarian Cancer Audit feasibility pilot shows that on average only 51% of women with stage 2–4 and unstaged ovarian cancer receive surgery in England. 13 There are large disparities between surgeons and centers in their optimal and complete cytoreduction rates. 14–17 The development of these skills requires a shift in the surgeon's approach to surgery but, given that the additional procedures can be learned over a relatively short period, this could lead to increases in optimal or complete cytoreduction rates with no significant increases in perioperative morbidity.…”