Effect of manual lymph drainage in addition to guidelines and exercise therapy on arm lymphoedema related to breast cancer: randomised controlled trial

Objective To determine the preventive effect of manual lymph drainage on the development of lymphoedema related to breast cancer

Robot-Assisted Radical Hysterectomy in Cervical Carcinoma: The Belgian Experience.

peer reviewed[en] OBJECTIVE: The purpose of this study was to report the experience and oncological outcome of robot-assisted radical hysterectomies (RRHs) for cervical cancer performed in Belgium. METHODS: Patients undergoing RRH for cervical cancer (n = 109) were prospectively collected between July 2007 and April 2014 in the 5 Belgian centers performing RRH for cervical cancer. RESULTS: The median age of the patients was 46 years (range, 31-80 years). Histological types included squamous cell carcinoma in 61 patients, adenocarcinoma in 22 patients, adenosquamous in 8 patients, endometrioid carcinoma in 2 patients, and other types (n = 16). The International Federation of Gynecology and Obstetrics stage distribution was IA (n = 9), stage IB1 (n = 71), stage IB2 (n = 4), stage II (n = 24), and unknown (n = 1). Twenty-four patients received adjuvant therapy, 17 patients underwent radiochemotherapy, and 7 underwent adjuvant radiation. Eighteen patients relapsed, and 5 died of disease. The median follow-up was 27.5 months (range, 3-82 months). The 2- and 5-year overall survivals were 96% and 89%, respectively. The 2- and 5-year disease-free survivals (DFSs) were 88% and 72%, respectively. The 2-year DFS per stage was 100% for IA, 88% for IB1, 100% for IB2, and 83% for II. The 5-year DFS per stage was 100% for stage IA and 75% for IB1. The complications were as expected for radical hysterectomy. CONCLUSIONS: This series confirms the feasibility and safety of RRH not only in cervical cancer stage IA to IB1, but also after neoadjuvant chemotherapy in stage IB2 to IIB

Common germline polymorphisms associated with breast cancer-specific survival

Abstract Introduction Previous studies have identified common germline variants nominally associated with breast cancer survival. These associations have not been widely replicated in further studies. The purpose of this study was to evaluate the association of previously reported SNPs with breast cancer-specific survival using data from a pooled analysis of eight breast cancer survival genome-wide association studies (GWAS) from the Breast Cancer Association Consortium. Methods A literature review was conducted of all previously published associations between common germline variants and three survival outcomes: breast cancer-specific survival, overall survival and disease-free survival. All associations that reached the nominal significance level of P value <0.05 were included. Single nucleotide polymorphisms that had been previously reported as nominally associated with at least one survival outcome were evaluated in the pooled analysis of over 37,000 breast cancer cases for association with breast cancer-specific survival. Previous associations were evaluated using a one-sided test based on the reported direction of effect. Results Fifty-six variants from 45 previous publications were evaluated in the meta-analysis. Fifty-four of these were evaluated in the full set of 37,954 breast cancer cases with 2,900 events and the two additional variants were evaluated in a reduced sample size of 30,000 samples in order to ensure independence from the previously published studies. Five variants reached nominal significance (P <0.05) in the pooled GWAS data compared to 2.8 expected under the null hypothesis. Seven additional variants were associated (P <0.05) with ER-positive disease. Conclusions Although no variants reached genome-wide significance (P <5 x 10−8), these results suggest that there is some evidence of association between candidate common germline variants and breast cancer prognosis. Larger studies from multinational collaborations are necessary to increase the power to detect associations, between common variants and prognosis, at more stringent significance levels

BRCA mutations in the Belgian population

Summary BRCA1/2 mutations are the most commonlyidentified germ line gene mutations in patients with hereditary breast and ovarian cancer (HBOC). The BRCA genes have plethora of critical cellular functions, including repair of DNA double-strand breaks, explainingthe susceptibility for tumor development at young age and clustered in families seen the autosomal dominant inheritance. Over the years, knowledge about these genes and their function is steadily growing. Integration of this information in daily clinical practice permits a better follow-up of this group of patients. However, still many questions remain unresolved and continuing research in this topic remains compulsory. In this doctoral thesis, based on a database of nearly 1800 patients (982 HBOC families) tested at the University Hospital Leuven, we tried to get more insight in some topics with clinical relevance in this wide field concerning BRCA related tumors. Because of the broad population specific mutation spectrum of these genes, we were interested in the mutations identified at our center. We were able to list the most frequently present mutations and demonstrated that some of them were quite specific for our Belgian population andpotentially founder mutations. Moreover, collecting all clinical available data of these tested patients, permitted to look for the pathologic features of these tumors and their clinical presentation. The data made us believe in a certain genotype/phenotype correlation. If confirmed in larger studies, this can help us in the future in better counseling our patients. Collection of breast and ovarian tissue retrieved at preventive surgery offered the opportunity to perform further investigations of precursor lesions. This precursor lesions can learn us a lot about the pathogenesis and behavior of the tumors, which could be reflected than again to our clinical practice. Besides collection of preventively removed specimens, availability of tumor samples from these BRCA patients also permits histologic and molecular analysis. Indeed, performing array analysis from sporadic andBRCA1 related ovarian cancer tissues, allowed us to investigate and compare the pathways involved in the pathogenesis of these tumors. Thosepathways are the cornerstone in the development of new (target) therapies and can help in the decision on treatment strategies in function of the presence/absence of a BRCA mutation. In conclusion, in this doctoral thesis we investigated on BRCA related tumors at 3 different levels. Firstly we aimed to describe the mutations presenting in our population and correlated clinical data to these genetic information. In a second part we evaluated preventive strategiesand presence of precursor lesions in order to optimize our counseling and treatment options. In the last part, a molecular study was performed aiming the identification of distinct pathways in these BRCA related tumors compared to the sporadic ones. These 3 parts howevermerge into one another and all contributed to a better counseling, preventive and therapeutic approach of our BRCA related patients in daily clinical practice.status: publishe

Staging with Unilateral Salpingo-Oophorectomy and Expert Pathological Review Result in No Recurrences in a Series of 81 Intestinal-Type Mucinous Borderline Ovarian Tumors

Recent studies suggest that mucinous borderline ovarian tumors (MBOTs) belong to a high-risk group that is more likely to develop an invasive recurrence. The objective is to determine these risk factors.status: publishe

Fertility Preservation Is Safe for Serous Borderline Ovarian Tumors

This study aimed to determine the overall survival (OS) and progression-free interval and the influence of fertility-preserving surgery (FPS) versus radical surgery (RS) in patients with serous borderline ovarian tumor (BOT).status: publishe

Neoadjuvant Weekly Paclitaxel-Carboplatin Is Effective in Stage I-II Cervical Cancer

Neoadjuvant chemotherapy (NACT) followed by surgery in cervical cancer is widely studied with paclitaxel-ifosfamide-cisplatinum 3 weekly (TIP). Although the response rates with TIP are high, the toxicity is substantial. Therefore, this study evaluates dose-dense paclitaxel-carboplatin (TC) as an alternative.status: publishe