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It has been recognized over the past years that women form a distinct subpopulation within patients with coronary heart disease. This phenomenon should be acknowledged in the management and in the assessment of coronary heart disease. Over the past years remarkable progress has been made concerning our knowledge of cardiovascular risk factors related to gender. For instance, diabetes, high density lipoproteins and triglycerides levels have been found to have a greater impact on coronary heart disease risk in women compared to men. On the other hand, evidence showing that lipoprotein (a) is a cardiovascular risk factor seems to be stronger in men than in women. For optimal treatment and prevention of coronary heart disease it is necessary to acknowledge that it is not self-evident that women and men show simular responses to risk factors or to treatment. This review article addresses the role of cardiovascular risk factors focusing on the differential impact they might have on men and women. [Copyright &y& Elsevier]

Session: Optimising outcome in cervix BT OC-1049: Dose-effect relationship between vaginal dose points and vaginal stenosis in cervical cancer H. Westerveld, K. Kirchheiner, R.A. Nout, K. Tanderup, J.C. Lindegaard, S. Spampinato, A. Sturdza, N. Nesvacil, K. Bruheim, T.P. Hellebust, B.R. Pieters, I.M. Jürgenliemk-Schulz, R. Pötter, A. De Leeuw. [Extracted from the article]

Objective: Endogenous sex hormones can be measured in plasma and urine. We determined the extent to which these two methods provide different information on hormonal status by relating them to lipid profile in postmenopausal women. Methods: Thirty healthy postmenopausal women collected one 24-h urine sample and a blood sample was taken. Urinary estrone (UE), plasma estrone (PE) and serum lipids were measured. Sex hormone levels were measured with specific radioimmunoassays. Linear regression analysis was used to determine associations between estrone levels and lipids. Results are presented as β-coefficients in mmol/l per standard deviation (SD) of endogenous estrone levels, adjusted for body mass index (BMI) and smoking (95% confidence interval). A stratified analysis for obese (BMI≥27 kg/m2) versus lean women was performed. Results: Mean levels of endogenous sex hormones were (SD): PE, 90.1 pmol/l (37.3); and UE, 7757 pmol/24 h (2659). PE showed significant associations with HDL-cholesterol (0.18 mmol/l, 95% CI: 0.06; 0.30), triglycerides (−0.25 mmol/l, 95% CI: −0.49; −0.009) and very-low-density-lipoprotein (VLDL-cholesterol) (−0.11 mmol/l, 95% CI: −0.22; −0.003), but not with total and low-density-lipoprotein (LDL-cholesterol). UE was inversely associated with total (−0.41 mmol/l, 95% CI: −0.85; 0.02) and LDL-cholesterols (−0.42 mmol/l, 95% CI: −0.83; −0.005), but not with HDL-cholesterol, triglycerides and VLDL-cholesterol. All associations appeared to be stronger in lean women. Conclusion: Both plasma and UE levels appear to be associated to serum lipids in healthy postmenopausal women. However, this relation appears to be different for estrone levels in plasma and urine. Depending on the research question, either blood samples or urine samples may be preferred. [Copyright &y& Elsevier]

Castro Cabezas M, De Bruin TWA, Westerveld HE, Meijer E, Erkelens DW (Departments of Internal Medicine and Endocrinology, University Hospital Utrecht and University Hospital Maastricht, The Netherlands). Delayed chylomicron remnant clearance in subjects with heterozygous familial hypercholesterolaemia. J Intern Med 1998; 244: 299–307. Objectives To study the role of the LDL receptor in the clearance of chylomicron remnants in humans. Design Chylomicron remnant clearance was studied in five untreated subjects with heterozygous familial hypercholesterolaemia (FH) and nine normolipidaemic controls, by oral retinyl palmitate-fat loading tests. Fasting plasma triglycerides (TG), which are important determinators of chylomicron and remnant clearance, were not significantly different between FH (1.76 ± 0.32 mmol L-1 , mean ± SEM) and controls (1.26 ± 0.18 mmol L-1 ). Chylomicrons (Sf > 1000) and their remnants (Sf < 1000) were separated by flotation and their clearance was estimated by calculating the area under the 24 h-retinyl palmitate curve (AUC-RP). The factors determining chylomicron and remnant clearance were studied by univariate and multiple regression analysis. Results Triglyceride clearance in plasma, Sf > 1000 fractions and Sf < 1000 fractions was not significantly different between FH subjects and controls. In subjects with heterozygous FH, chylomicron remnant clearance was two-fold delayed (AUC-RP, 49.39 ± 11.61 h.mg L-1 ) compared to controls (27.45 ± 3.95 h.mg L-1 ; P = 0.048). Moreover, 28.4% higher fasting plasma TG in FH resulted in 44.4% higher areas under the remnant-curves compared to controls. The clearance of chylomicron RP was associated to plasma apo E (β= 0.73, P = 0.011), plasma LDL cholesterol (β= 0.62, P = 0.018) and plasma TG (β= 0.58, P = 0.029). The clearance of remnant RP was associated to the diagnosis (FH vs. non-FH), but not to the well-known... [ABSTRACT FROM AUTHOR]

• Quality assurance is essential for uniform treatment in multi-institutional radiotherapy trials. • At dummy run, 71.4% of the brachytherapy plans needed revisions to fulfil trial protocol requirements. • At annual QA, 18.5% of the reviewed brachytherapy plans showed major protocol deviations. • Annual QA contributes to protocol compliance, ensuring high-quality VBT. The PORTEC-4a trial investigates molecular-integrated risk profile guided adjuvant treatment for endometrial cancer. The quality assurance programme included a dummy run for vaginal brachytherapy prior to site activation, and annual quality assurance to verify protocol adherence. Aims of this study were to evaluate vaginal brachytherapy quality and protocol adherence. For the dummy run, institutes were invited to create a brachytherapy plan on a provided CT-scan with the applicator in situ. For annual quality assurance, institutes provided data of one randomly selected brachytherapy case. A brachytherapy panel reviewed and scored the brachytherapy plans according to a checklist. At the dummy run, 15 out of 21 (71.4%) institutes needed adjustments of delineation or planning. After adjustments, the mean dose at the vaginal apex (protocol: 100%; 7 Gy) decreased from 100.7% to 99.9% and range and standard deviation (SD) narrowed from 83.6–135.1 to 96.4–101.4 and 8.8 to 1.1, respectively. At annual quality assurance, 22 out of 27 (81.5%) cases had no or minor and 5 out of 27 (18.5%) major deviations. Most deviations were related to delineation, mean dose at the vaginal apex (98.0%, 74.7–114.2, SD 7.6) or reference volume length. Most feedback during the brachytherapy quality assurance procedure of the PORTEC-4a trial was related to delineation, dose at the vaginal apex and the reference volume length. Annual quality assurance is essential to promote protocol compliance, ensuring high quality vaginal brachytherapy in all participating institutes. [ABSTRACT FROM AUTHOR]

Background: In an interprofessional training ward (ITW), students from different health professions collaboratively perform patient care with the goal of improving patient care. In the past two decades, ITWs have been established world-wide and studies have investigated their benefits. We aimed to compare ITWs with respect to their logistics, interprofessional learning outcomes and patient outcomes. Methods: We explored PubMed, CINAHL, Web of Science and EMBASE (1990–June 2017) and included articles focusing on interprofessional, in-patient training wards with student teams of medical and other health professions students. Two independent reviewers screened studies for eligibility and extracted data. Results: Thirty-seven articles from twelve different institutions with ITWs were included. ITWs world-wide are organized similarly with groups of 2–12 students (i.e. medical, nursing, physiotherapy, occupational therapy, and pharmacy) being involved in patient care, usually for a period of two weeks. However, the type of clinical ward and the way supervisors are trained differ. Conclusions: ITWs show promising results in short-term student learning outcomes and patient satisfaction rates. Future ITW studies should measure students' long-term interprofessional competencies using standardized tools. Furthermore, a research focus on the impact of ITWs on patient satisfaction and relevant patient care outcomes is important. [ABSTRACT FROM AUTHOR]

Transarterial chemoembolization (TACE) is the most widely used local treatment option for patients with hepatocellular carcinoma (HCC) who are not eligible for surgery or ablation and whose disease is confined to the liver. However, local control after TACE is limited. Although stereotactic body radiation therapy (SBRT) has demonstrated high local tumor control, there have been no randomized comparisons of the two techniques. TACE delivered with drug eluting beads (TACE-DEB) was therefore compared with SBRT in a multicenter randomized trial. Patients were potential candidates for the study if they were eligible for TACE but ineligible for surgery or ablation. They could also be recruited if they required treatment prior to liver transplantation. Other inclusion criteria were ECOG 0-1, cirrhosis Child Pugh A, and 1-3 tumors up to a cumulative diameter of ≤6cm. Exclusion criteria were macrovascular invasion, ascites, and untreated esophageal varices grade 3-4. A maximum of 4 TACE-DEB procedures and ablation after incomplete TACE were both allowed. SBRT was delivered in 6 fractions of 8-9Gy. Primary end point was time to progression (TTP). Secondary endpoints were local control (LC) (mRECIST); overall survival (OS); response rate (RR) (mRECIST); toxicity (CTCAE v4.03); and quality of life (QoL) (EORTC QLQ-C30, EORTC QLQ-HCC 18 and EuroQoL-5D). The calculated sample size was 100 patients. Between May 2015 and April 2020, 30 patients were randomized to the study. Due to slow accrual the trial was prematurely closed. Two patients in the SBRT arm were considered ineligible (low thrombocyte count, >3 tumors in the liver), leaving 16 patients in the TACE arm and 12 in the SBRT arm. One patient randomized for SBRT was subsequently treated with TACE (implanted fiducials used for SBRT tumor tracking not detectable on the Linac). Median follow-up was 28.1 months. In the intention-to-treat analyses, median TTP was 12 months for TACE and 19 months for SBRT (p=0.15). Median LC was 12 months for TACE and >40 months (not reached) for SBRT (p=0.056). Median OS was 36.8 months for TACE and 44.1 months for SBRT (p=0.36). Post-hoc analyses per protocol showed 100% for SBRT 1- and 2-year LC, and 54.4% and 43.6% for TACE (p=0.02). Both treatments resulted in RR>80%. Three episodes of possibly related toxicity grade ≥3 were observed after TACE. No episodes were observed after SBRT. QoL remained stable after both treatment arms. SBRT showed higher local antitumoral activity than TACE-DEB in this small group of HCC patients, and no detrimental effects on TTP, OS, toxicity and QoL. But, to overcome poor accrual in randomized trials including SBRT, to validate our results, and to generate the evidence needed to include SBRT in HCC treatment guidelines, international cooperation is needed. [ABSTRACT FROM AUTHOR]

Abstract Objective The Post-Operative Radiation Therapy in Endometrial Carcinoma (PORTEC)-4a trial is a randomized trial for women with high-intermediate risk endometrial cancer (EC), comparing individualized adjuvant treatment based on a molecular-integrated risk profile to standard adjuvant treatment; vaginal brachytherapy. To evaluate patient acceptability and pathology logistics of determining the risk profile, a pilot phase was included in the study. Methods PORTEC-4a is ongoing and the first 50 patients enrolled were included in the pilot phase. Primary endpoints of the pilot phase were patient acceptance, evaluated by analyzing the screening logs of the participating centers, and logistical feasibility of determination of the risk profile within 2 weeks, evaluated by analyzing the pathology database. Results In the first year, 145 eligible women were informed about the trial at 13 centers, of whom 50 (35%) provided informed consent. Patient accrual ranged from 0 to 57% per center. Most common reasons for not participating were: not willing to participate in any trial (43.2%) and not willing to risk receiving no adjuvant treatment (32.6%). Analysis of the pathology database showed an average time between randomization and determination of the molecular-integrated risk profile of 10.2 days (1–23 days). In 5 of the 32 patients (15.6%), pathology review took >2 weeks. Conclusions The PORTEC-4a trial design was proven feasible with a satisfactory patient acceptance rate and an optimized workflow of the determination of the molecular-integrated risk profile. PORTEC-4a is the first randomized trial to investigate use of a molecular-integrated risk profile to determine adjuvant treatment in EC. Highlights • Molecular-integrated risk profiling holds promise to improve individualization of treatment in endometrial cancer (EC). • PORTEC-4a is the first randomized clinical trial investigating molecular profile-based adjuvant treatment in EC. • The trial design was proven feasible with a good patient acceptance rate and logistical feasibility; accrual is ongoing. [ABSTRACT FROM AUTHOR]

Poster: Physics track: Imaging acquisition and processing PO-1730: Development of a framework to quantify bowel motility in 3D using MRI D. Barten, Z. Van Kesteren, J. Visser, J. Laan, H. Westerveld, A. Bel. [Extracted from the article]

Proffered Papers: Proffered papers 28: Gynaecology OC-0568: The effect of external beam radiotherapy on bowel motility in gynaecological cancer patients J. Laan, D. Barten, Z. Van Kesteren, B. Pieters, A. Bel, H. Westerveld. [Extracted from the article]

Polycystic ovary syndrome (PCOS) is strongly associated with metabolic abnormalities in Western women. However, data from other populations and geographical regions are scarce. This study evaluated cardiovascular and metabolic risk factors in Chinese infertile women diagnosed with PCOS using the 2003 Rotterdam consensus criteria. A total of 615 women representing the four PCOS phenotypes (oligo- or anovulation (AO) + hyperandrogenism (HA) + polycystic ovaries (PCO), AO + HA, AO + PCO and HA + PCO) underwent standardized metabolic screening including a 75 g oral glucose tolerance test. All groups presented with similar reproductive characteristics, with the only difference being a significantly higher Ferriman-Gallwey score for hirsutism (P = 0.01) in the subgroup characterized by HA + PCO. Overall, the prevalence of metabolic syndrome was 6.4%, with no difference among the four groups (range of 2.3-12.2%). Metabolic syndrome was associated with body mass index (P < 0.001), waist/hip ratio (P = 0.002), index of insulin resistance (P = 0.005) and fasting insulin (P = 0.009) in multivariate analysis. Compared with Caucasians and Chinese women in Westernized societies, mainland Chinese women with PCOS have a low risk of metabolic syndrome and its presence does not vary across the specific PCOS phenotypes. [ABSTRACT FROM AUTHOR]

Abstract Background Recent evidence indicates that remnant lipoprotein particles (RLPs) may play a role in atherosclerosis. Remnant lipoprotein particles have been suggested to be the most atherogenic particles among the triglyceride-rich lipoproteins. In particular, these triglyceride-rich particles were identified as an independent risk factor for cardiovascular diseases (CVD) in women. Postmenopausal hormone replacement therapy (HRT) beneficially affects lipid profile, although total triglyceride levels often increase. Evidence on the effects of HRT on RLPs is limited. We determined whether 3 months’ treatment of postmenopausal women with Tibolone or conjugated oestrogens combined with medroxyprogesterone acetate (CEE + MPA) affects RLP-cholesterol (RLP-C). Materials and methods One hundred and five healthy postmenopausal women were randomized to either 2·5 mg of Tibolone, 0·625 mg of CEE + 2·5 mg of MPA or placebo. At baseline and after 3 months the lipid profile was determined. For assessment of RLP-C we used an immunoseparation-based method. Results Treatment with CEE + MPA significantly reduced RLP-C (-0·03 mmol L-1 , P -value = 0·01) and appeared to increase triglycerides (0·15 mmol L-1 , P -value = 0·20) compared with placebo. Tibolone did not significantly change RLP-C (-0·01 mmol L-1 , P -value = 0·35) and significantly decreased triglycerides (-0·35 mmol L-1 , P -value = 0·004). Conclusions Treatment of postmenopausal women with conjugated oestrogens and medroxyprogesterone acetate reduced RLP-C, without a reduction in total triglycerides, whereas Tibolone did affect triglyceride levels, but not RLP-C. These observations may be relevant for explaining the effect of HRT on cardiovascular risk in healthy postmenopausal women. [ABSTRACT FROM AUTHOR]

Poster: Physics track: Imaging acquisition and processing PO-1729: Quality assurance of deformable image registration for bowel motility quantification K.J. Nelissen, D.L.J. Barten, J.J. Laan, H. Westerveld, A. Bel, Z. Van Kesteren. [Extracted from the article]