15 results on '"B Slangen"'
Search Results
2. Trends and Uncertainties of Regional Barystatic Sea-level Change in the Satellite Altimetry Era
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Carolina M. L. Camargo, Tim H. J. Hermans, Aimée A. B. Slangen, and Riccardo Riva
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Sea level change ,geography ,geography.geographical_feature_category ,business.industry ,Lead (sea ice) ,Water storage ,Distribution (economics) ,Glacier ,Climatology ,Satellite altimetry ,Range (statistics) ,Environmental science ,Ice sheet ,business - Abstract
Ocean mass change is one of the main drivers of present-day sea-level change (SLC). Also known as barystatic SLC, it is driven by the exchange of freshwater between the land and the ocean, such as melting of continental ice from glaciers and ice sheets, and variations in land water storage. While many studies have quantified the present-day barystatic contribution to global mean SLC, fewer works have looked into regional changes. This study provides a comprehensive analysis of regional barystatic SLC trends since 1993 (the satellite altimetry era), with a focus on the uncertainty budget. We consider three types of uncertainties: intrinsic (the uncertainty from the data/model itself); temporal (related to the temporal variability in the time series); and spatial-structural (related to the location/distribution of the mass change sources). We collect a range of estimates for the individual freshwater sources, which are used to compute regional patterns (fingerprints) of barystatic SLC and analyse the different types of uncertainty. When all the contributions are combined, we find that the barystatic sea-level trends regionally ranges from −0.43 to 2.55 mm year−1 for 2003–2016, and from −0.39 to 2.00 mm year−1 for 1993–2016, depending on the choice of dataset. When all types of uncertainties from all contributions are combined, the total barystatic uncertainties regionally range from 0.62 to 1.29 mm year−1 for 2003–2016, and from 0.35 to 0.90 mm year−1 for 1993–2016, also depending on the dataset choice. We find that the temporal uncertainty dominates the budget, although the spatial-structural also has a significant contribution. On average, the intrinsic uncertainty is almost negligible. The main source of uncertainty is the temporal uncertainty from the land water storage contribution, which is responsible for at least 50 % of the total uncertainty, depending on the region of interest. The second main contributions come from the spatial-structural uncertainty from Antarctica and land water storage, which show that different locations of mass change can lead to trend deviations larger than 20 %. As the barystatic SLC contribution and its uncertainty vary significantly from region to region, better insights into regional SLC are important for local management and adaptation planning.
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- 2021
3. EPV237/#541 Two-year effectiveness of topical imiquimod treatment of high-grade cervical intraepithelial neoplasia (TOPIC-3)
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N Hendriks, M. M. Koeneman, B Slangen, and A-J Krüse
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medicine.medical_specialty ,business.industry ,High Grade Cervical Intraepithelial Neoplasia ,medicine ,Topical imiquimod ,business ,Dermatology - Published
- 2021
4. O007/#202 Recurrence and survival after laparoscopy versus laparotomy in early-stage endometrial cancer: long-term outcomes of a randomised trial
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G. H. de Bock, Lasse Paulsen, Marlies Y. Bongers, P Van Kesteren, B Slangen, B Reijntjes, J. M. Woolderink, A Kraayenbrink, Pvd Hurk, Mirjam J.A. Apperloo, Jaf Huirne, D Boskamp, F Tummers, T Schukken, M Van Suijlichem, and Marian J.E. Mourits
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Laparotomy ,medicine.medical_treatment ,Endometrial cancer ,Long term outcomes ,Medicine ,Stage (cooking) ,business ,medicine.disease ,Laparoscopy ,Surgery - Published
- 2021
5. 446 Impact of COVID-19 pandemic on gynaecological oncology healthcare in the Netherlands: data from the prospective dutch gynaecological oncology audit
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Rfpm Kruitwagen, M.D. Algera, W.J. van Driel, Michel W.J.M. Wouters, and B Slangen
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Cervical cancer ,medicine.medical_specialty ,business.industry ,Endometrial cancer ,General surgery ,Incidence (epidemiology) ,Audit ,Perioperative ,medicine.disease ,Interim ,Health care ,Pandemic ,Medicine ,business - Abstract
Introduction/Background* The COVID-19 pandemic caused drastic healthcare changes worldwide. To date, the impact of these pandemic-induced alterations in gynaecological oncology healthcare is unknown. We assessed the impact of the COVID-19 pandemic on gynaecological oncology healthcare in the Netherlands by analysing data of the Dutch Gynaecological Oncology Audit (DGOA). Methodology All patients in The Netherlands undergoing surgery for ovarian, vulvar, endometrial or cervical cancer are registered in the DGOA since 2014. To evaluate whether the COVID-19 pandemic influenced care, we compared the following parameters that are available in the DGOA: surgical volume, time to first treatment (TTFT), length of hospital stay (LOHS), postoperative complications and 30-day mortality. Four periods were identified in 2020 based on incidence of COVID-19 infections in The Netherlands: ‘Pre-COVID-19’, ‘First wave’, ‘Interim period’ and ‘Second wave’. Using descriptive statistics, results from 2020 were compared with the same four periods of 2018-2019 combined. Result(s)* A total of 12.447 surgical procedures were analysed. Analysing the four periods in 2020, compared to the average volumes of 2018-2019, the surgical volume for the four tumour types decreased during the first COVID-19 wave and interim period (figure 1). This was due to a decrease in surgical volume for cervical cancer only (17.2% in 2020), while volumes for ovarian, vulvar and endometrial cancer remaining stable. Moreover, during the interim period, only 51% of the expected cervical cancer procedures were performed. A significantly shorter median TTFT was observed in all four malignancies in 2020, compared to 2018-2019 (table 1). No differences in LOHS, postoperative complications and 30-day mortality were observed (table 1). Conclusion* The COVID-19 pandemic clearly impacted gynaecological oncology healthcare in The Netherlands. During the first COVID-19 wave, surgical volume for gynaecological oncological procedures dropped considerably, mainly due to a substantial drop in surgical volume for cervical cancer. This is probably caused by the temporary interruption of the population screening program. During the COVID-19 pandemic, waiting time to start therapy was shorter. The quality of perioperative healthcare was not negatively impacted by the pandemic.
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- 2021
6. 760 Inflammatory immune microenvironment in cervical high-grade squamous intraepithelial lesions predicts response to topical imiquimod immunotherapy
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N Hendriks, M Van de Sande, J Piek, PJ de Vos van Steenwijk, B Slangen, Arnold-Jan Kruse, Ziena Abdulrahman, Emg Van Esch, Loes F. S. Kooreman, and S.H. van der Burg
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Myeloid ,business.industry ,medicine.medical_treatment ,T cell ,FOXP3 ,Imiquimod ,Immunotherapy ,medicine.disease ,Squamous intraepithelial lesion ,Immune system ,medicine.anatomical_structure ,medicine ,Cancer research ,business ,CD8 ,medicine.drug - Abstract
Introduction/Background* The treatment of cervical high-grade squamous intraepithelial lesion (cHSIL) by topical imiquimod (Aldara®) is investigated as an alternative for surgical large loop excision of the transformation zone (LLETZ), because of the latter‘s risk of causing cervical insufficiency and subsequent premature birth in following pregnancies. Imiquimod is effective in ~60% of cHSIL patients, at present we are not able to select women likely to succesfully respond. Therefore, studies on predictive biomarkers are needed to enable personalised therapy and to prevent unnecessary potential side effects. Here, we performed an in-depth analysis of the role of the pre-existing immune microenvironment in cHSIL in response to topical imiquimod. Methodology Histologically confirmed cHSIL of 35 patients biopsied before and 10 weeks after treatment with topical imiquimod were analyzed by two multispectral seven-color immunofluorescence panels to investigate the T cell (CD3, CD8, FOXP3, PD1, TBET, TIM3, DAPI) and Myeloid cell (CD68, CD163, CD11c, CD14, CD33, PDL1, DAPI) composition in relation to treatment response. All 70 samples were scanned with the Vectra multispectral imaging system. Cells were automatically identified using a deep learning multispectral image analysis approach (inForm software). Result(s)* Our data show that the immune microenvironment of complete responders (CR) prior to imiquimod therapy is characterized by a coordinated infiltration with T helper cells (activated PD1+/type 1 Tbet+) and pro-inflammatory M1 macrophages (CD68+CD163-) and dendritic cells (CD11c+). The lesions of non-responders (NR) lacked such a pro-inflammatory response and displayed an impaired influx of these pro-inflammatory lymphoid and myeloid cells. In contrast, the NR showed an increased infiltration by immunosuppressive regulatory T cells (CD3+FOXP3+). After 10 weeks of topical imiquimod application, the influx of pro-inflammatory CD4+ and CD8+ T cells was further increased in the CR but not in the NR patients, and the infiltration by macrophages was decreased. Conclusion* Response of cHSIL to topical imiquimod is associated with the presence of a pre-existing pro-inflammatory process, resulting in the coordinated influx of several types of immune cells, which is then further amplified. Our findings indicate major potential of the immune microenvironment as predictive biomarker for the selection of cHSIL patients responding to topical imiquimod immunotherapy.
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- 2021
7. 179 Cancer worry amongBRCA1/2pathogenic variant carriers choosing surgery to prevent tubal/ovarian cancer
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B Slangen, Mirjam J.A. Apperloo, M. van Beurden, Caroline Vos, Marian J.E. Mourits, H. C. van Doorn, M Van Bommel, J Custers, Katja N. Gaarenstroom, Judith B. Prins, M. M. A. Brood-van Zanten, L Van Lonkhuijzen, Jmj Piek, Joanna IntHout, Nicoline Hoogerbrugge, Miranda P. Steenbeek, Ronald P. Zweemer, R Hermens, J.A. de Hullu, and Sjors F.P.J. Coppus
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,media_common.quotation_subject ,Oophorectomy ,Cancer ,medicine.disease ,Surgery ,Breast cancer ,Salpingectomy ,medicine ,Worry ,skin and connective tissue diseases ,business ,Ovarian cancer ,media_common - Abstract
Introduction/Background* High cancer risks, as applicable to BRCA1 and BRCA2 pathogenic variant (PV) carriers, can induce significant cancer concerns. We examined the degree of cancer worry and the course of this worry among BRCA1/2-PV carriers opting for surgery to prevent ovarian cancer, and identified factors associated with high cancer worry. Methodology Cancer worry was evaluated as part of the multicentre, prospective TUBA-study (NCT02321228) in which BRCA1/2-PV carriers choose between the standard risk-reducing salpingo-oophorectomy or a novel strategy, risk-reducing salpingectomy with delayed oophorectomy. The Cancer Worry Scale was obtained before and three and twelve months after surgery. Cancer worry patterns were analysed using latent class growth analysis and factors associated with cancer worry were identified with regression analysis. Result(s)* Of all 577 BRCA1/2-PV carriers, 320 (55.5%) had high (≥14) cancer worry pre-surgery and 70.2% had higher cancer worry pre-surgery than post-surgery. Based on the course of cancer worry, BRCA1/2-PV carriers could be classified into three groups: persistently low cancer worry (56.4%), persistently high cancer worry (6.3%), and fluctuating cancer worry that mainly declined over time (37.3%). Factors associated with persistently high cancer concerns were: age below 35 (BRCA1) or 40 (BRCA2) years, unemployment, previous breast cancer diagnosis, lower education and more recent diagnosis with the BRCA-PV. Conclusion* High cancer worry is common among BRCA1/2-PV carriers and mainly declines after risk-reducing surgery. However, cancer worry remains high in 6% of the women and they should be identified and offered support. It should be realized that in this group, surgery does not reduce cancer concerns.
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- 2021
8. The role of multimodal adjuvant therapy for FIGO I-II carcinosarcoma of the uterus: a systematic review
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R L, van der Horst, O, van der Hel, L, Lutgens, M, van der Aa, B, Slangen, R, Kruitwagen, and R I, Lalisang
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Adjuvant chemoradiation ,Early stage high risk uterine malignancy ,PROGNOSTIC-FACTORS ,Carcinosarcoma ,RADIATION-THERAPY ,Humans ,Prospective Studies ,Neoplasm Staging ,Retrospective Studies ,Uterine mixed mullarian tumor ,Uterine carcinosarcoma ,Uterus ,Hematology ,ENDOMETRIAL CANCER ,Combined Modality Therapy ,STAGE-I ,Oncology ,Chemotherapy, Adjuvant ,Adjuvant multimodal treatment ,Uterine Neoplasms ,PHASE-II ,Female ,Radiotherapy, Adjuvant ,FEMALE GENITAL-TRACT ,MESODERMAL TUMORS ,MIXED MULLERIAN TUMORS ,PELVIC IRRADIATION - Abstract
The uterine carcinosarcoma (UCS) is a rare entity with poor prognosis. Treatment of FIGO I-II UCS usually consists of surgery with or without adjuvant treatment. Due to the high metastatic potential, aggressive combined modality adjuvant treatment approaches, consisting of chemo- and radiotherapy, have been of interest. Our systematic review aims to compare survival, disease control and toxicity profiles in patients receiving adjuvant chemoradiation to other adjuvant strategies (e.g.observation, chemotherapy or radiotherapy). A total of ten studies were included for a combined cohort size of 6520 patients. Generally, the studies showed a trend towards improved disease control and survival in patients undergoing adjuvant multimodal treatment, although statistical significance was often not reached. Selection bias and non-randomized treatment allocation pose serious challenges to extrapolate these outcomes to clinical practice. We recommend additional prospective research on the role of adjuvant chemoradiation in FIGO I-II UCS.
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- 2022
9. Lymph node density as a surrogate marker for positive lymph nodes
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T Van Gorp, B Slangen, Arnold-Jan Kruse, and Roy F.P.M. Kruitwagen
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Adult ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Uterine Cervical Neoplasms ,medicine ,Humans ,Radical surgery ,Cervix ,Lymph node ,Letter to the Editor ,Cervical cancer ,business.industry ,Cancer ,Middle Aged ,medicine.disease ,Prognosis ,Surgery ,Dissection ,medicine.anatomical_structure ,Oncology ,Lymphatic Metastasis ,Lymphadenectomy ,Female ,Lymph ,Lymph Nodes ,business - Abstract
British Journal of Cancer (2011) 104, 221–222. doi:10.1038/sj.bjc.6606000 www.bjcancer.comPublished online 23 November 2010& 2011 Cancer Research UKSir,We read with interest the paper by Polterauer et al (2010) inwhich they evaluated the prognostic value of lymph node density(LND) in patients with lymph node-positive cervical cancer. LNDis defined as the ratio of the number of metastatic lymph nodesto the total number of lymph nodes removed. They showed thatLND410% is associated with an impaired disease-free and overallsurvival. Lymph node involvement and lymph vascular spaceinvolvement have always been noted to be a poor prognostic factorin cancer of the cervix (Pecorelli, 2006), and thus this confirms thefact that the higher the number of lymph nodes involved,the worse the prognosis of the patient becomes. The benefit ofusing LND could be that it also incorporates the extent of surgicalstaging. Indeed, it is probably true that when you perform acomplete lymph node dissection instead of a sampling you havemore chance of finding all involved lymph nodes. However, thereis more to it than positive lymph nodes and surgical skills.Although the authors gave the mean/median number ofremoved lymph nodes and positive lymph nodes for all patients,we were not able to discern this information for the LNDp10% orLND410% group separately. We believe that this information ispivotal in a study that examines the ratio of both parameters. In aratio, both the numerator and denominator have an equal role. Theauthors state that they performed a systemic lymphadenectomy inall patients. This means that the mean/median number of removedlymph nodes cannot be statistically different in both groups. As aconsequence, only the denominator will become important, andthus the number of positive lymph nodes will become theprognostic factor. If for any reason the total number of lymphnodes removed in both groups is different, then one must questionthe reasons why. Did the surgeon stop the operation prematurelybecause during the operation he/she discovered bulky involvedlymph nodes? This would make a complete systemic lymphade-nectomy redundant, as the patient is already known to be lymphnode positive based on these few lymph nodes. This is generallyaccepted as an indication for (chemo-)radiotherapy, and thecombination of a radical surgery and pelvic (chemo-)radiotherapywill increase therapy-related morbidity (Quinn et al, 2006). Maybethe pathologist stopped looking intensively for other lymph nodesbecause he/she already found several positive lymph nodes.Second, with respect to the technique used, they referred to aprevious study in which a laparoscopic pelvic lymph node stagingwas described (Polterauer et al, 2008). In this study, patients wereincluded between 1995 and 2007 and, remarkably, the mediannumber of lymph nodes was 15, being more than 3 lymph nodesless than in the present study. Does this implicate a learning curverelated to the laparoscopic technique used? If yes, once more asurgical bias is introduced.Third, we question the cutoff value and how it was established.The authors mentioned that this was based on preliminary datafrom a study by Ooki et al (2007). We wonder how welloesophageal cancer can be compared with cervical cancer. Bothorgans are located in completely different anatomic regions, with adifferent lymph vessel drainage system and lymph node distribu-tion. Did the authors try different cutoff points or was the 10%cutoff the only value examined? If the authors tried different cutoffpoints, one could argue that the authors should have used anindependent validation set to validate this cutoff point.Fourth, with a median of 18.5 lymph nodes (range 12–27),Polterauer et al demonstrated that they routinely performedcomplete lymph node dissections. As the ratio of the mediannumber of involved lymph nodes (n¼2) to the median number ofremoved lymph nodes (n¼18.5) was 10.8%, removing one or twolymph nodes would more or less determine whether the patientbelonged to the category of patients with LNDp10% or LND410%. This would implicate that the surgeon could influence towhich prognostic group the patient will belong. After all, it sufficesto remove more lymph nodes to shift the patient from theLND410% group to the LNDp10% group. It is contradictory thatthe surgeon has to remove more ‘healthy’ lymph nodes to‘improve’ the prognosis of the patient. With more healthy lymphnodes the denominator will become bigger and thus the LNDsmaller. This strikes us as ironic.In conclusion, as LND is influenced by surgical technique,anatomic circumstances and the quality and accuracy of thepathological analysis, we believe that LND is not an objectiveparameter and should not influence the decision on what kind ofadjuvant treatment should be given to a patient. We believe thatthe number of positive lymph nodes is probably the true predictor,but as the number of patients in each of the different groups (1 vs 2vs 42) was low, the authors were unable to reach significance.Using a ratio solved this problem by creating two arbitrary groupsof patients and by using denominators that enlarged the differencePublished online 23 November 2010 between the numerators.*Correspondence: Dr T Van Gorp; E-mail: toon.van.gorp@mumc.nl
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- 2010
10. First step in implementation of opportunistic salpingectomy for prevention of ovarian cancer: Current care and its determinants.
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Gelderblom ME, Jaspers V, Akkermans RP, Slangen B, Oei ALM, van Ginkel AA, Ngo H, IntHout J, Hermens RPMG, de Hullu JA, and Piek JMJ
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- Humans, Female, Hysterectomy, Retrospective Studies, Salpingectomy, Ovarian Neoplasms prevention & control, Ovarian Neoplasms surgery, Gynecology
- Abstract
Introduction: Opportunistic salpingectomy (OS) refers to additional removal of the fallopian tubes during abdominal surgery performed for another medical indication, as prevention for ovarian cancer. As OS has been inconsistently implemented, its clinical practice varies worldwide. To reduce this variation, insight is required into current clinical practice and its determinants. Therefore, the study aim was to determine the implementation of counseling and performance of OS between 2015 and 2018, and its patient, surgical, physician, and hospital characteristics., Material and Methods: Retrospective study using electronic medical records from six different Dutch hospitals: two academic, two large teaching, and two non-teaching hospitals. Patients were considered eligible for OS if they underwent elective non-obstetric abdominal surgery for a gynecological indication from January 2015 through December 2018. Primary outcomes were uptake of counseling and performance of OS. Multilevel multivariable logistic regression analyses were conducted to identify characteristics associated with OS., Results: A total of 3214 patients underwent elective non-obstetric abdominal surgery for a gynecological indication and were eligible for OS. Counseling on OS increased significantly from 2.9% in 2015 to 29.4% in 2018. In this period, 440 patients were counseled on OS, of which 95.9% chose OS. Performance of OS increased significantly from 6.9% in 2015 to 44.5% in 2018. Counseling for and performance of OS were more likely in patients who had surgery by laparoscopic approach, were counseled by a gynecological resident, or had more than three contact moments before surgery. Additionally, OS was less likely in patients who had vaginal surgery., Conclusions: Although the uptake of OS increased from 2015 to 2018, the majority of patients who were eligible for OS were not counseled and did not undergo OS. Its clinical practice varies on patient, surgery, and physician characteristics. Therefore, an implementation strategy tailored to associated determinants is recommended., (© 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)
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- 2023
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11. The role of multimodal adjuvant therapy for FIGO I-II carcinosarcoma of the uterus: a systematic review.
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van der Horst RL, van der Hel O, Lutgens L, van der Aa M, Slangen B, Kruitwagen R, and Lalisang RI
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- Chemotherapy, Adjuvant, Combined Modality Therapy, Female, Humans, Neoplasm Staging, Prospective Studies, Radiotherapy, Adjuvant, Retrospective Studies, Uterus pathology, Carcinosarcoma drug therapy, Carcinosarcoma pathology, Uterine Neoplasms pathology
- Abstract
The uterine carcinosarcoma (UCS) is a rare entity with poor prognosis. Treatment of FIGO I-II UCS usually consists of surgery with or without adjuvant treatment. Due to the high metastatic potential, aggressive combined modality adjuvant treatment approaches, consisting of chemo- and radiotherapy, have been of interest. Our systematic review aims to compare survival, disease control and toxicity profiles in patients receiving adjuvant chemoradiation to other adjuvant strategies (e.g.observation, chemotherapy or radiotherapy). A total of ten studies were included for a combined cohort size of 6520 patients. Generally, the studies showed a trend towards improved disease control and survival in patients undergoing adjuvant multimodal treatment, although statistical significance was often not reached. Selection bias and non-randomized treatment allocation pose serious challenges to extrapolate these outcomes to clinical practice. We recommend additional prospective research on the role of adjuvant chemoradiation in FIGO I-II UCS., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)
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- 2022
- Full Text
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12. Sentinel lymph node identification in early stage ovarian cancer: is it still possible after prior tumor resection?
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Laven P, Kruitwagen R, Zusterzeel P, Slangen B, van Gorp T, van der Pol J, and Lambrechts S
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- Adult, Aged, Female, Humans, Middle Aged, Neoplasm Staging, Ovarian Neoplasms pathology, Sentinel Lymph Node pathology, Ovarian Neoplasms diagnosis, Sentinel Lymph Node surgery, Sentinel Lymph Node Biopsy methods
- Abstract
Objective: Sentinel lymph node (SLN) detection in ovarian cancer is feasible when tracers are injected before the pathological ovary is resected. This study aims to investigate whether the SLN identification is also feasible in patients whose ovarian tumor has already been resected with injection of the tracer into the ovarian ligaments stumps, i.e. in the event that a frozen section confirms malignancy., Methods: Patients who underwent laparotomy with frozen section confirming an ovarian malignancy, and those who underwent a second staging laparotomy after prior resection of a malignant ovarian mass, were included. Blue dye and a radioactive isotope were injected in the stumps of the ligamentum ovarium proprium and the ligamentum infundibulo-pelvicum. After an interval of at least 15-min, the sentinel node(s) were identified using either the gamma-probe and / or blue dye., Results: A total of 11 patients were included in the study, the sentinel node (SLN) procedure was completed in all 11 patients. At least one SLN was identified in 3 patients, resulting in a rather low detection rate of 27,3%., Conclusion: In this study we showed that SLN procedure after (previous) resection of the tumor seems inferior to detect sentinel nodes when compared to injection of the tracer in the ovarian ligaments before tumor resection., Trial Registration: NCT02540551., (© 2021. The Author(s).)
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- 2021
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13. The Paget Trial: A Multicenter, Observational Cohort Intervention Study for the Clinical Efficacy, Safety, and Immunological Response of Topical 5% Imiquimod Cream for Vulvar Paget Disease.
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van der Linden M, Meeuwis K, van Hees C, van Dorst E, Bulten J, Bosse T, IntHout J, Boll D, Slangen B, van Seters M, van Beurden M, van Poelgeest M, and de Hullu J
- Abstract
Background: Vulvar Paget disease is a rare skin disorder, which is most common in postmenopausal Caucasian women. They usually present with an erythematous plaque that may show fine or typical "cake icing" scaling or ulceration that may cause itching, pain, irritation, or a burning sensation. Although most cases are noninvasive, vulvar Paget disease may be invasive or associated with an underlying vulvar or distant adenocarcinoma. The histological evidence of so-called "Paget cells" with abundant pale cytoplasm in the epithelium confirms the diagnosis. The origin of these Paget cells is still unclear. Treatment of choice is wide local excision with negative margins. Obtaining clear surgical margins is challenging and may lead to extensive and mutilating surgery. Even then, recurrence rates are high, ranging from 15% to 70%, which emphasizes the need for new treatment options. A number of case reports, retrospective case series, and one observational study have shown promising results using the topical immune response modifier imiquimod., Objective: This study aims to investigate the efficacy, safety, and immunological response in patients with noninvasive vulvar Paget disease using a standardized treatment schedule with 5% imiquimod cream., Methods: Topical 5% imiquimod cream might be an effective and safe treatment alternative for vulvar Paget disease. The Paget Trial is a multicenter observational cohort study including eight tertiary referral hospitals in the Netherlands. It is ethically approved by the Medical-Ethical Committee of Arnhem-Nijmegen and registered in the Central Committee on Research Involving Human Subjects (CCMO) Register by as NL51648.091.14. Twenty patients with (recurrent) noninvasive vulvar Paget disease will be treated with topical 5% imiquimod cream three times a week for 16 weeks. The primary efficacy outcome is the reduction in lesion size at 12 weeks after end of treatment. Secondary outcomes are safety, immunological response, and quality of life. Safety will be assessed by evaluation of adverse events and tolerability of treatment. To evaluate the immunological response, various immunological markers will be tested on biopsy specimens taken before, during, and after treatment. Quality of life will be assessed with three questionnaires taken before, during, and after treatment., Results: First results are expected in the summer of 2018., Trial Registration: ClinicalTrials.gov NCT02385188; https://clinicaltrials.gov/ct2/show/NCT02385188 (Archived by WebCite at http://www.webcitation.org/6sXygHuhP)., (©Michelle van der Linden, Kim Meeuwis, Colette van Hees, Eleonora van Dorst, Johan Bulten, Tjalling Bosse, Joanna IntHout, Dorry Boll, Brigitte Slangen, Manon van Seters, Marc van Beurden, Mariëtte van Poelgeest, Joanne de Hullu. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 06.09.2017.)
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- 2017
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14. Predictive criteria for MRI-based evaluation of response both during and after radiotherapy for cervical cancer.
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Mongula J, Slangen B, Lambregts D, Bakers F, Mahesh S, Lutgens L, Van Gorp T, Vliegen R, Kruitwagen R, and Beets-Tan R
- Abstract
Purpose: For cervical carcinoma, the presence of persistent disease after radiotherapy (RT) is a significant predictor for survival. To date, no standard protocol is available to evaluate a response. This study was performed to assess magnetic resonance imaging (MRI) to evaluate presence of local residual disease during and after RT for Federation of Gynecology and Obstetrics (FIGO) stage Ib1-IVa cervical cancer., Material and Methods: Forty-two patients were included. Patients underwent MRI before external beam RT, at final intracavitary brachytherapy (BCT) and 2-3 months after completion of RT. Two blinded radiologists (observer 1: experienced, observer 2: less experienced) scored the likelihood of residual tumor. Magnetic resonance imaging was evaluated by means of (a) 'subjective' visual evaluation of T2 weighted MRI images, and (b) 'objective' visual evaluation of T2 weighted MRI images according to predefined imaging criteria., Results: Seven patients had residual disease. Area under the receiver operating characteristics curve (AUC) for 'subjective' visual assessment was 0.79/0.75 (observer 1/observer 2) after RT and 0.75/0.43 at final BCT. The combined 'objective' MRI criteria (isointense, nodular, and irregular) resulted in improved prediction of residual tumor (AUCs of 0.91/0.85 after RT). For the less experienced observer, the MRI criteria set significantly improved prediction of residual tumor compared to 'subjective' visual assessment. Observer dependency decreased, kappa of 0.41 compared to 0.84 for the MRI criteria set after RT., Conclusion: Compared to 'subjective' visual assessment, predefined 'objective' MRI criteria increase diagnostic performance and decrease observer dependency for assessing residual tumor after RT in cervical cancer.
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- 2016
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15. Abdominal swelling in two teenage girls: two case reports of massive ovarian tumours in puberty.
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Willems RP, Slangen B, and Busari JO
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- Adolescent, Biomarkers, Tumor blood, Cystadenoma, Mucinous surgery, Diagnosis, Differential, Female, Humans, Magnetic Resonance Imaging, Ovarian Neoplasms surgery, Teratoma surgery, Tomography, X-Ray Computed, Cystadenoma, Mucinous diagnosis, Ovarian Neoplasms diagnosis, Teratoma diagnosis
- Abstract
The following report describes two 15-year-old girls with a giant abdominal swelling. Signs and symptoms differed between those two girls, as serum tumour markers showed different elevation patterns. Additional investigations including a CT scan and a MRI scan were performed and revealed masses originating from the ovary. Histopathological evaluation after cystectomy showed a mature teratoma and a mucinous cystadenoma.
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- 2012
- Full Text
- View/download PDF
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