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A recent study on the use of cancer antigen 125 (CA-125) in follow-up of patients with epithelial ovarian cancer after complete response on primary treatment is critically reviewed. As it has been suggested to refrain from CA-125 altogether, this European Society of Gynaecologic Oncology report has also reviewed possible disadvantages, even possible harm, and potentially missed opportunities when such policy would be implemented. It is concluded that indeed routine use of CA-125 does not provide patient benefit in survival or quality of life. However, there may be other reasons for monitoring CA-125, which are discussed in this review. It is noted that the lack of benefit of CA-125 monitoring has only been proven for a specific subset of ovarian cancer patients with serous histology and frequent follow-up visits including imaging and in a clinical environment where, particularly, surgery for recurrent disease and clinical studies on new second-line agents will not be considered. A special warning is issued not to stop tumor marker follow-up in other than epithelial ovarian cancers and in follow-up of patients who not have been treated with chemotherapy.

In young patients with borderline ovarian tumor a conservative treatment approach does not seem to have a significant impact on survival, and the outcome regarding fertility is good in general. It can be considered even if noninvasive peritoneal implants are discovered at the time of the initial surgery. In contrast, in patients with epithelial ovarian cancer, conservative surgery should be considered only in adequately staged patients, with a stage IA grade 1 (and probably 2) serous, mucinous or an endometrioid tumor, including a careful follow-up. Such an approach could also probably be discussed in stage IC grade 1 disease. In patients with nonepithelial malignant ovarian tumors, conservative surgery is also feasible, particularly in patients with malignant germ cell tumors because of their high chemosensitivity leading to an excellent prognosis in general. Copyright © 2011 by IGCS and ESGO.

At the 4th Ovarian Cancer Consensus Conference of the Gynecologic Cancer InterGroup (GCIG) held in Vancouver, Canada, in June 2010, representatives of 23 cooperative research groups studying gynecologic cancers gathered to establish international consensus on issues critical to the conduct of large randomized trials. The process focused on 13 predetermined questions. Group A, 1 of the 3 discussion groups, addressed the first 5 questions, examining first-line therapies in newly diagnosed ovarian cancer patients. A1: What are the appropriate end points for different trials (maintenance, upfront chemotherapy trials including molecular drugs)? A2: Are there any subgroups defined by tumor biology who need specific treatment options/trials? A3: Is the 2004 GCIG-recommended standard comparator arm still valid? A4: What is the role of modifying dose, schedule, and delivery of chemotherapy? A5: What role does surgery play today? Copyright © 2011 by IGCS and ESGO.

Introduction: Endometrial cancer patients with high grade tumours, deep myometrial invasion or advanced stage disease have a poor prognosis. Randomised studies have demonstrated the prevention of loco-regional relapses with radiotherapy (RT) with no effect on overall survival (OS). The possible additive effect of chemotherapy (CT) remains unclear. Two randomised clinical trials (NSGO-EC-9501/EORTC-55991 and MaNGO ILIADE-III) were undertaken to clarify if sequential combination of chemotherapy and radiotherapy improves progression-free survival (PFS) in high-risk endometrial cancer. The two studies were pooled. Methods: Patients (n = 540; 534 evaluable) with operated endometrial cancer International Federation of Obstetrics and Gynaecology (FIGO) stage I-III with no residual tumour and prognostic factors implying high-risk were randomly allocated to adjuvant radiotherapy with or without sequential chemotherapy. Results: In the NSGO/EORTC study, the combined modality treatment was associated with 36% reduction in the risk for relapse or death (hazard ratio (HR) 0.64, 95% confidence interval (CI) 0.41-0.99; P = 0.04); two-sided tests were used. The result from the Gynaecologic Oncology group at the Mario Negri Institute (MaNGO)-study pointed in the same direction (HR 0.61), but was not significant. In the combined analysis, the estimate of risk for relapse or death was similar but with narrower confidence limits (HR 0.63, CI 0.44-0.89; P = 0.009). Neither study showed significant differences in the overall survival. In the combined analysis, overall survival approached statistical significance (HR 0.69, CI 0.46-1.03; P = 0.07) and cancer-specific survival (CSS) was significant (HR 0.55, CI 0.35-0.88; P = 0.01). Conclusion: Addition of adjuvant chemotherapy to radiation improves progression-free survival in operated endometrial cancer patients with no residual tumour and a high-risk profile. A remaining question for future studies is if addition of radiotherapy to chemo

Introduction: Surgery is the mainstay of staging and treatment of ovarian cancer. optimal quality of ovarian cancer surgery implies complete staging and removal of all macroscopic tumour with minimal harm to the patient in order to ensure best patient outcome. However, variation in the quality of ovarian cancer surgery is apparent. In order to assess and improve the quality of care, quality indicators can be used. Methods: To identify candidate quality indicators, a literature search was performed using relevant MESH terms. These were assessed for validity, feasibility and measurability. Results: Five quality indicators for staging of presumed early-stage ovarian cancer and six for primary debulking surgery for advanced disease are proposed. Conclusion: The defined quality indicators can be used to monitor and improve the quality of surgery for ovarian cancer. (C) 2008 Elsevier Ltd. All rights reserved.

PURPOSE: To describe radiotherapeutic practice of the treatment of endometrial cancer in members of the Gynecologic Cancer Intergroup (GCIG). METHODS: A survey was developed and distributed to the members of the GCIG. The GCIG is a global association of cooperative groups involved in the research and treatment of gynecologic neoplasms. RESULTS: Thirty-four surveys were returned from 13 different cooperative groups. For the treatment of endometrial cancer after hysterectomy, mean (SD) pelvic dose was 47.37 (2.32) Gy. The upper border of the pelvic field was L4/5 in 14 respondents, L5/S1 in 13 respondents, and not specified in 6 surveys. When vaginal brachytherapy (VBT) was used in conjunction with external beam radiotherapy, most groups used high dose rate versus low dose rate on 24 versus 5 respondents, respectively. Twenty-eight of the 34 respondents performed computed tomographic simulation. Intensity-modulated radiotherapy was used routinely in 3 of the 34 respondents. For a para-aortic field, the upper border was, most commonly, at the T12-L1 interspace (17 of the 28 respondents), and the mean (SD) dose was 46.15 (2.18) Gy. For VBT alone after hysterectomy, 23 groups performed high-dose-rate brachytherapy (27.57 [10.13] Gy in a mean of 4.3 insertions), and 5 groups used low-dose-rate brachytherapy (41.45 [17.5] Gy). Nineteen of the 28 respondents measured the doses to the bladder and the rectum when performing VBT. For brachytherapy, there was no uniformity in the fraction of the vagina treated or the doses and schedules used. CONCLUSIONS: Radiotherapy practices among member groups of the GCIG are similar in doses and dose per fraction with external beam. There is a moderate discrepancy in the brachytherapy practice after hysterectomy. There are no serious impediments to intergroup participation in radiation oncology practices among GCIG members with the use of external beam Udgivelsesdato: 2009/4