Day 2 :
Keynote Forum
Hirendra Banerjee
Elizabeth City State University, USA
Keynote: An investigation on the effect of novel rhenium compounds on breast, prostate, leukemic and brain cancer cell lines
Time : 09:45-10:25
Biography:
Hirendra Banerjee is a Professor of Natural Sciences. He has worked with a number of prominent scientists and researchers, including his PhD advisor Dr. S. Dutta, an “excellent mentor” who continues to teach and conduct research at the age of 80, Dr. Lawrence DeLucas, the Director of the Center for Biophysical Sciences and Engineering at the University of Alabama-Birmingham, who supported him and taught him to write grants in his lab and with whom he continues to collaborate till date and Dr. Günter Blobel, a Nobel prize winner for his discoveries in the field of hereditary genetics with whom he has worked at Rockefeller University.
Abstract:
Cancer is a class of diseases that results in an abnormal, uncontrolled growth of cells. According to the American Cancer Society, half of all men and one-third of all women in the United States will develop cancer at some point in their lifetime. Cisplatin, carboplatin, oxaliplatin and related metallodrugs are extensively being used in the treatment of a variety of cancers. Unfortunately these drugs are highly toxic and become drug-resistance. These circumstances have led researchers to look for new cytotoxic agents which exhibit less toxicity and are devoid of drug resistance. It is believed that cisplatin and related drugs directly bind to genomic DNA through purine bases. Synthesis of new metallodrugs which do not follow the above mechanism of action might yield better drugs with less toxicity and is devoid of drug resistance. Recently we have demonstrated that several anticancer rhenium compounds do not directly bind to DNA. The findings of this report suggests that these newly synthesized rhenium compounds shows bioactivity and cytotoxicity against human triple negative and receptor positive breast , prostate, leukemia and brain cancer cells as evidenced by Trypan Blue assay, MTT assay, Flow cytometric analysis, JC1 Mitochondrial potential assay and TUNEL assay. Initial ADME studies have shown very positive pharmacokinetic data. Further investigation is currently being pursued for in vivo studies in cancer model mice. These novel rhenium compounds have the potential to be cheaper, more readily available and better alternatives to platinum based drugs used in cancer therapy.rn
- Endometrial cancer
Ovarian cancer
Gynecologic Surgery
Session Introduction
Sandra S Hatch
University of Texas, USA
Title: The occurrence of reactive oxygen and nitrogen species in normal endometrial tissues might explain signature hotspot mutations found in the PTEN gene in endometrial adenocarcinoma
Biography:
Dr. Hatch has been a faculty physician with UTMB for over ten years, specializing in breast and gynecological cancers. She is board certified in Radiation Oncology by the American Board of Radiology (ABR) and an active member with the American Society for Therapeutic Radiology & Oncology (ASTRO). She received her doctorate in medicine from the University of Texas Health Science Center at Houston, TX and completed her residency in radiation therapy at Baylor College of Medicine as chief resident. Before entering medical school, Dr. Hatch received her degree in engineering from Tennessee Technological University, which served as a solid foundation for the technological demands found in the field of radiotherapy.
Abstract:
Endometrial cancer is the most prevalently diagnosed gynecological cancer. The majority of type I endometrial cancer cases are reported to have a mutated PTEN tumor suppressor gene. With respect to endometrial cancer cases, the PTEN suppressor gene, codon 130, is a hotspot for mutation involving a cytosine to guanine transversion mutation. The mechanism for the C to G transversion in endometrial cancer has not been previously explained. Codon 130 contains a CpG dinucleotide, which could be methylated to 5-methylcysoine. For the first time, we have shown that methylation is present on the coding and non-coding strand at codon 130 of the PTEN gene in normal endometrial tissues. The presence of 5-methylcytosine increases oxidation of the adjacent guanine. Oxidized guanine (8-oxo-G), in the presence of peroxynitrite, can form Guanidinohydantoin (Gh) and mispair with guanine. This mechanism may explain the unusually high level of codon 130 mutations in endometrial cancer cases. 8-oxo-G and peroxynitrite can be formed in tissues from Reactive Oxygen (ROS) and Nitrogen (RNS) Species. We have used immunohistochemistry and immunofluorescence to assess the presence of such markers of damage in benign human endometrial tissues. We show that markers of ROS and RNS damage are found in benign endometrial tissues. The generation of DNA damage in histologically normal endometrial tissue is in accord with the mutagenic mechanism described above. Further study will contribute to development of methods capable of diagnosing precursors of endometrial cancer and potentially reveal new pharmacological targets
Samir A. Farghaly
Cornell University, USA
Title: Mesothelin Expression in Ovarian Cancer and its potential as Targeted Ovarian cancer Immunotherapy
Biography:
Samir A Farghaly is a Physician/Scientist and national and international expert in Obstetrics and Gynecology at Joan and Sanford I. Weill College of Medicine and the New York Presbyterian Hospital/Weill Cornell Medical Center- Cornell University, New York, USA. He received his MD from London University and PhD degree in Molecular Biology from London University. He is the Founder and Editor-in Chief of Enliven: Challenges in Cancer Detection and Therapy Journal. He is serving as a Senior Editor/Editor and member of editorial boards and editorial advisory boards of 18 international medical journals on gynecological cancers, gene expression & therapy, women’s health and gynecology. He has published 99 articles in reputed peer review journals. He has written several book chapters.
Abstract:
Ovarian cancer is the fourth most common cause of cancer death in women. Most patients are diagnosed at stage III and IV, with resultant low relative-survival rates. The current treatments with conventional cytotoxic chemotherapy and novel surgical techniques have improved the oncologic outcome of this disease. However,recurrence is common. Current evidence suggests that the immune system and its ability to recognize and eliminate microscopic disease is of significant importance in preventing recurrence. Immunotherapy for ovarian cancer is to balance the activation of the immune system against this cancer while preventing the potential for toxicity elicited by immune modulation. Mesothelin, a glycosylphosphatidylinositol (GPI) anchored cell surface protein, is a potential target for antibody-based ovarian cancer immunotherapy due to its high expression in ovarian cancer. Mesothelin plays a role in cancer ovarian progression, through three possible mechanisms. First, mesothelin may aid in the peritoneal implantation and metastasis of tumors through its interaction with mucin MUC16 (CA125). Second, mesothelin may promote cancer cell survival and proliferation via the NF-κB signaling pathway. Third, mesothelin expression promotes resistance to certain chemotherapy drugs such as TNF-α, paclitaxel, and a combination of platinum and cyclophosphamide. Human monoclonal antibodies targeting mesothelin have been isolated by phage display technology and may provide opportunities for novel ovarian cancer immunotherapy. In addition, CRS-207, is live-attenuated Listeria monocytogenes (Lm), which has been genetically modified to be safe for human use while retaining its ability to stimulate an immune response against the protein mesothelin. It is considered an active form of immunotherapy. It utilizes a live attenuated facultative intracellular bacterium, Listeria monocytogenes, as a vehicle to deliver the mesothelin antigen to kupffer cells . Once the bacteria undergo phagocytosis, both innate and adaptive immune responses occur. Ultimately, this leads to mesothelin-specific T-cell response directed toward ovarian cancer cells overexpressing mesothelin.
Biography:
Michaela Huynh is a student in the MD/PhD Combined Degree program at UTMB, Galveston. She graduated at Magna Cum Laude, Texas A&M University and Century Scholars Scholarship Program, Texas A&M University. She is involved in a number of student organizations on campus, including Students Together for Service and the Graduate Student Organization. Her research interest includes Enzymology and DNA repair mechanisms.
Abstract:
Endometrial cancer is the most prevalently diagnosed gynecological cancer. The majority of type I endometrial cancer cases are reported to have a mutated PTEN tumor suppressor gene. With respect to endometrial cancer cases, the PTEN suppressor gene, codon 130, is a hotspot for mutation involving a cytosine to guanine transversion mutation. The mechanism for the C to G transversion in endometrial cancer has not been previously explained. Codon 130 contains a CpG dinucleotide, which could be methylated to 5-methylcysoine. For the first time, we have shown that methylation is present on the coding and non-coding strand at codon 130 of the PTEN gene in normal endometrial tissues. The presence of 5-methylcytosine increases oxidation of the adjacent guanine. Oxidized guanine (8-oxo-G), in the presence of peroxynitrite, can form Guanidinohydantoin (Gh) and mispair with guanine. This mechanism may explain the unusually high level of codon 130 mutations in endometrial cancer cases. 8-oxo-G and peroxynitrite can be formed in tissues from Reactive Oxygen (ROS) and Nitrogen (RNS) Species. We have used immunohistochemistry and immunofluorescence to assess the presence of such markers of damage in benign human endometrial tissues. We show that markers of ROS and RNS damage are found in benign endometrial tissues. The generation of DNA damage in histologically normal endometrial tissue is in accord with the mutagenic mechanism described above. Further study will contribute to development of methods capable of diagnosing precursors of endometrial cancer and potentially reveal new pharmacological targets.
Alok De
Kansas City VA Medical Center, USA
Title: E. officinalis attenuates ovarian cancer through anti-angiogenic effects on tumor physiology
Biography:
Alok De has received his PhD from University of Calcutta. He is a Research Biologist at Kansas City VA Medical Center. His research focuses on to use the extract of Emblica officinalis as an alternative or adjunct therapeutic agent in helping to fight ovarian cancer . He has published more than 45 papers in reputed journals. He has been serving as reviewers of many journals and as an Editorial Board Member of Cancer Cell and Microenvironment
Abstract:
Background: Most (>70%) ovarian cancers (OC) develop resistance to platinum- and taxane-based therapy. Tumor microenvironment supports OC progression principally through parallel angiogenesis. Naturally occurring plant extracts block tumor progression through their effect on tumor microenvironment. Recently, we have found that E. officinalis extract (AE) has anti-neoplastic effect on OC cells while sparing normal cells. Hypothesis: AE alters tumor microenvironment and physiology through microRNA (miR)-regulated anti-angiogenic mechanism(s). Methods: OC cells-SKOV3 and SKOV3-derived mouse xenograft tumor were treated with AE. Effect of AE on SKOV3 cell physiology was assessed by proliferation assay, LDH assay. The expression of miRNAs, proangiogenic receptor IGF1R and angiogenic marker CD31 were determined. Expression of miR-375 in exosomes released from SKOV3 cells was studied. Results: AE attenuated cell proliferation, migration, invasiveness in SKOV3 cells in vitro. AE increased miR375 expression (>2,000-fold) in SKOV3 cells as well as in exosomes derived from SKOV3 cells (P<0.01). AE decreased the gene and protein expression of proangiogenic IGF1R, a target of miR-375 (P<0.001). Additionally, AE significantly attenuated the growth of and the expression of IGF1R, CD31 and proteins in SKOV3-derived xenograft tumor in nude mice. Conclusion: Increased exosomes and exosomal miR-375 following AE treatment may drive paracrine mechanism(s) to control tumor growth in OC by altering the tumor microenvironment leading to arrested angiogenesis.
Karl R Aigner
Medias Klinikum GmbH & Co KG, Germany
Title: Platin-refractory recurrent FIGO stage IIIc and IV ovarian cancer responds to high exposure isolated abdominal perfusion with chemofiltration
Biography:
Karl Reinhard Aigner is Medical Director of the Department of Surgical Oncology in Medias Klinikum Burghausen (Bavaria) / Germany. He had his surgical training in cardiovascular surgery at Friedrich-Alexander University in Erlangen. At Justus-Liebig University Giessen he specialized in Surgical Oncology, focusing on vascular techniques of drug delivery such as Implantofix and Jet Port catheters, and in 1981 first performed a technique of isolated perfusion of the liver with heart-lung machine in man. Furtheron he developed various techniques of segmental vascular isolation of body segments and organs, and the stopflow technique with adequately designed catheters. In 1982, together with Prof. Stephens from Sydney, he initiated the biannual International Congress of Regional Cancer Treatment (ICRCT) and from 1987 to 1991 was president of the International Society for Regional Cancer Therapy. From 1985 to 1998 he was managing editor of the International Journal Regional Cancer Treatment. He is author of numerous publications and book chapters, lectured and performed teaching operations on vascular perfusion techniques and oncological surgery in Europe the United States and Asia.
Abstract:
Introduction: Recurrent metastatic ovarian cancer treated with extended cytoreduction and combination-chemotherapy based on platinum compounds relapses within two years in almost half of the patients who responded to initial treatment. The likelihood of a second response to platinum-based chemotherapy after a recurrence is closely correlated with the recurrence-free interval. The shorter the time interval is to tumor progression, the less likely are the chances of a response to further chemotherapy. Material & Methods: The patients included in this study were mainly at FIGO stage IIIc (71%) and FIGO IV (25%). 87.5% had a four-quadrant peritoneal carcinosis and 39% (n=31) showed a histologic grade of G3 malignancy. 79% of all patients were heavily pre-treated; 6 of them had already undergone third-line and one patient fourth-line therapies. Four cycles of isolated hypoxic abdominal perfusion with Cisplatin, Adriamycin and Mitomycin were conducted at four weekly intervals. After insertion of a venous and arterial 21 Ch. stopflow-catheter via a femoral access, the vena cava was blocked beneath the right atrium, the arterial catheter was blocked above the celiac axis in the aorta. Both thighs were blocked by pneumatic cuffs. Chemotherapy in a 70 kg patient consisted of 50 mg Cisplatinum, 30 mg Adriamycin and 20 mg Mitomycin. The agents were administered as a bolus via the aorta at the level of the diaphragm followed by 15 minutes of hypoxic abdominal perfusion via an external pump and subsequent chemofiltration for 45 minutes. Adriamycin and Mitomycin were used because of their up to tenfold increased cytotoxicity under hypoxic conditions. The procedure was done under general anesthesia. Primary endpoint of the study was overall survival and secondary endpoint was control of the ascites and quality of life. Results: Clinical and histological complete remissions were 25% and 13% respectively, partial remissions 39% and 35% respectively, resulting in an overall clinical response rate of 64% and histological response rate of 48%. Complete remission of ascites within two cycles was noted in 43% and substantial reduction of ascites in 19%, totally 62%. Median progression-free survival was 8 months and median overall survival 14 months. 74%, which is three out of four patients, reported a definite decrease in abdominal symptoms and clear improvement in their pain situation. Eight patients survived between 6 and 18 years, of four patients who have currently survived between 11 and 19 years, three of them originally had G3 tumors. Toxicity & Side-effects: Chemofiltration bone-marrow toxicity ranged between WHO grade 1 and 2 and in patients with previous third- or fourth-line chemotherapy it was WHO grade 3. The predominant clinical symptom in patients with posttherapeutic tumor necrosis (15 - 20% of all patients) was fever and fatigue. Conclusion: Isolated hypoxic abdominal perfusion with subsequent chemofiltration in platin-refractory recurrent FIGO IIIc and IV ovarian cancer is a valuable option to break through chemoresistence and improve quality of life due to reduction or resolution of malignant ascites.
Ines Vasconcelos
Charité Medical University of Berlin, Germany
Title: Borderline ovarian tumors (BOTs)
Biography:
Dr. Ines Vasconcelos has completed her medical degree with honors at the University of Coimbra in Portugal and her doctoral studies with Magna Cum Laude at the Charité Medical University in Germany. She has published in several international peer-reviewed high-impact journals and serves as a member of the editorial board of the journal Advances in Modern Oncology Research (AMOR). She is currently working at the Berlin Oncological Center Kurfürstendamm
Abstract:
Borderline ovarian tumors (BOTs) were first described by Taylor in 1929 and have been a challenge for both pathologists and oncologists. BOT is a disease of younger, fertile women, generally with a benign course; however, a minority of patients progress and eventually succumb to the disease. Although the corrected survival for patients with disease confined to the ovary is 100% at 15 years, 30% of patients with serous BOT with invasive implants will develop persistent or recurrent tumor, most commonly low-grade ovarian serous carcinoma. For the group of patients with invasive implants, there is no consensus regarding standard therapy. At present, chemotherapy is offered mostly to patients with invasive implants, regardless of histological subtype. However, response to these agents remains suboptimal with recurrence estimates for patients for patients with BOT with invasive implants undergoing adjuvant treatment remaining high at 44.0%. In this presentation we will discuss the current evidence, or lack of thereof, to support the use of adjuvant treatment in patients with invasive implants in the primary treatment setting.
Marek Lankosz
AGH University of Science and Technology, Poland
Title: Evaluation of biochemical biomarkers in ovarian cancers
Biography:
Marek Lankosz is working as a Professor in the Faculty of Physics and Applied Computer Science at the AGH University of Science and Technology, Krakow, Poland. He is a Head of the Chair of Medical Physics and Biophysics. His scientific activity mainly focused on XRF microanalysis, X-ray absorption micro-spectroscopy and infra-red micro-spectroscopy. His latest research interest includes application of synchrotron radiation in biological and medical research in relation to morbidities, with focus on tumor, Parkinson disease and amyotrophic lateral sclerosis. The results of his studies were published in numerous articles
Abstract:
The ovarian surface epithelial tumors are a heterogenic group of neoplasms in which a wide spectrum of clinical behavior can be observed. The histopathological scope of these tumors ranges from benign cystic tumors to malignant high-grade carcinomas. The carcinogenesis of the above is a multistep process in which varied genetic pathways can be triggered. This raises the question of possible molecular or elemental differences between various ovarian tumors and creates a need for investigation. The main goal of this study was to investigate the role of elements and molecules in pathogenesis of ovarian cancers as well as to elucidate the metabolic activity of the cystic epithelium and the mechanism that drives the enlargement of cyst by accumulation of only liquid or semiliquid substance inside. The proposed studies would help to know if concentrations of minor- and trace elements and selected molecules in the malignant tissues could be used for differentiation of ovarian tumors. The samples designed to elemental micro-imaging were taken intra operatively from ovarian tumors of different types and degree of malignancy. Fibroma, mucinous cystadenoma, endometrial adenocarcinoma, poorly differentiated carcinoma and borderline mucinous tumors were used in investigations. Samples of tissue were cut from the material for two purposes: to conduct histopathological analysis and to map the distribution of chemical elements and molecules. X-ray fluorescence micro spectroscopy (XRF) was applied for chemical elemental analysis. The infrared micro spectroscopy was used for investigation of molecular composition of ovarian cancer tissue. It was found that K, Cl, S, Br and Fe are the most significant elements in the general discrimination between types of ovarian cancers. Significant amounts of elements such as Na, P, S, Cl, K, Ca and Fe, were present in all tumor fluids analyzed. There were also small amounts of Mg, Ni, Mn, Ni, Cu, Zn and Se. Concentrations of elements are diversified in relation to type of tumor. Changes in metal distribution in the ovarian tissues have been linked to the type of ovarian cancer. With results obtained, it was found that trace metals could be used to correctly identify cancerous tissue and effectively classify the cancer stage. The higher distribution of amide B in cystic tissue compared to neoplastic tissue was found. The concentrations of amide I, amide II and phosphodiester bonds in cancer tissue was higher.
Kennedy Gonçalves Pacheco
Vascular Surgeon and Phlebologist, Brazil
Title: The prevalence of varicocele and ovarian varicose veins in patients with cancer and/or venous thrombosis
Biography:
Kennedy Gonçalves Pacheco is a Vascular Surgeon and phlebologist specializes in treating varicose veins with Dense foam guided Eco Color Doppler at the University Pierre et Marie Curie - Paris (France). He is a member of the Brazilian Society of Angiology and Vascular Surgery, Member of the French Society of Phlebology; specializing in the treatment of Varicose Veins Pelvic by the International Ruber Hospital - Madrid – Spain.
Abstract:
Background: Infertility and hormonal alterations can be associated with Cancer and venous thrombosis. Varicocele and ovarian varicose veins are related to infertility and venous thrombosis. The objective is to investigate the association between cancer and venous thrombosis with varicose veins beside the germinating glands. Methods: 152 patients were selected from my private practice in a retrospective observational study, 98 of them having been diagnosed with venous thrombosis and 54 of them having been diagnosed with cancer. The diagnosis of ovarian varicose veins and varicocele were made through eco-color-Doppler, considering the minimum diameter of the veins (4.0; 5.0 and 6.0 mm) next to the ovaries and next to the testicles (2.0; 2.5 and 3.0 mm), with a reflux of 0.5 s. Results: Of a total of 14,800 patient, 152 with cancer and profound venous thrombosis were selected (1, 02%). Among these patients 98 were venous thrombosis cases and 54were cancer cases. When we adopted the minimum diameter in varicocele as 2.0 mm, 2.5 mm and 3.0 mm, the rate was of 96.7%, 83.6% & 55.7% respectively and in ovarian varicose veins as 4.0 mm, 5.0 mm and 6.0 mm, the rate was of 83.5%, 61.5% and 39.6%. Conclusions: Varicose veins next to the testicles and the ovaries are associated to oxidative stress, which can interfere in the hypothalamic-pituitary-gonadal axis, in the immune system and in genetics. The high prevalence of varicose veins next to the germinating glands may play a determinant role in cancer and in venous thrombosis.
Katarina Jeremić
Belgrade University School of Medicine, Serbia
Title: Fertility sparing in young patients with early stages of endometrial cancer
Biography:
Katarina Jeremić finished Medical School University of Belgrade (1996), MD (2000), PhD (2006), and academic special studies Obstetrics and Gynecology (2001), with 20 years of clinical experiences, working at Clinic for Gynecology & Obstetrics Clinical Centre of Serbia, which is the biggest one in whole region. She worked as a gynecologist for 18 years. Her present position at the Clinis is Head of gynecologic oncology department, and also she is the member of many scientific projects such as Cancer and Pregnancy. At the Medical Faculty, University Belgrade, she works as a lecturer - Associate Professor of gynecology and obstetrics. Her representative publications are about 50 publications in CC/SCI expanded and JCR indexed, and she is an active participant on more than 50 international congresses, with total number of publication about 150.
Abstract:
Endometrial cancer is the most common cancer of the female genital tract and female patient less than 40 years may account for 3-14% of all endometrial cancers. The promising fact is that in women <45 years, the tumor is mostly low grade disease localised to the endometrium, whereas survival is almost about 100%. An individualized and multidisciplinary approach to each patient, intense follow-up, respecting the current recommendations for fertility sparing. Conservative approaches of early-stage endometrial carcinoma includes hormonal therapy in selected group of young patients with endometrial carcinoma age less than 45 years and wishes fertility, showing low grade 1 endometrioid adenocarcinomas (by 2 gynoncology pathologists review) is requested limited to the endometrium with MRI excluded myomaterial invasion, without evidence of limphovascul are space involvement or extra uterine disease. Carefully and accurately pretreatment assessment of patients considering conservative therapy includes radiologic imaging, hysteroscopy preferably but also contrast-enhanced radiologic imaging -MRI imaging of the ovary (5% of patients with endometrial cancer have synchronous primaries tumors). Repeating endometrial biopsies by hysteroscopy every 6 months has been recommended, until there is a complete response or achieving pregnancy. Surgery is recommended if there is no response after 6 months of medicational treatment. Hormonal therapy that could be applied is progestins inhibits the estrogenic effect and suppresses cell proliferation (medroxy progesterone acetate, megestrl acetate), GnRh analogues, but also local gestagens (IUD), oral natural progesterons, aromatase inhibitors, even three step endoscopic (hysteroscopic ) resection - remove tumour, surrounding endometrium, myometrium. Fertility after treatment is not guaranteed, even there had been recorded reduced fertility of those treated, and there is a significant need ART (18-60%).
Shujie Yang
University of Iowa, USA
Title: Systematic dissection of the mechanisms underlying progesterone receptor downregulation in endometrial cancer
Biography:
Shujie Yang is a Research Assistant Professor of Obstetrics and Gynecology - Reproductive Science Research. Education qualification is a Post Doctorate, Obstetrics and Gynecology, University of Iowa.
Abstract:
Progesterone, acting through its receptor, PR (progesterone receptor), is the natural inhibitor of uterine endometrial carcinogenesis by inducing differentiation. PR is downregulated in more advanced cases of endometrial cancer, thereby limiting the effectiveness of hormonal therapy. Our objective was to understand and reverse the mechanisms underlying loss of PR expression in order to improve therapeutic outcomes. Using endometrial cancer cell lines and data from The Cancer Genome Atlas, our findings demonstrate that PR expression is downregulated at four distinct levels. In well-differentiated cancers, ligand-induced receptor activation and downregulation are intact. miRNAs mediate fine tuning of PR levels. As differentiation is lost, PR silencing is primarily at the epigenetic level. Initially, recruitment of the polycomb repressor complex 2 to the PR promoter suppresses transcription. Subsequently, DNA methylation prevents PR expression. Appropriate epigenetic modulators reverse these mechanisms. These data provide a rationale for combining epigenetic modulators with progestins as a therapeutic strategy for endometrial cancer. Significance: Traditional hormonal therapy for women with endometrial cancer can be molecularly enhanced by combining progestins with epigenetic modulators, thereby increasing progesterone receptor expression and significantly improving treatment efficacy
Ahmed Abdel Aziz
Michigan State University, USA
Title: A large broad ligament uterine fibroid: Successful myomectomy with robotic assisted laparoscopic myomectomy
Biography:
Ahmed Abdelaziz, is an obstetrician/gynecologist in Flint, at Michigan. Clinical interest is General Gynecology. Completed Education at Hurley Medical Center - Michigan State University.
Abstract:
Uterine leiomyomata, or myomas, are one of the most common benign tumors of the reproductive tract, affecting more than 70% of women in their lifetime. Definitive surgical treatment of myoma is hysterectomy while myomectomy is the treatment for those women who have symptomatic myomas and desire uterine or fertility preservation. Leiomyomas can arise from any tissue including the broad ligament, the incidence of broad-ligament leiomyoma is <1%. Myomectomy of large broad ligament fibroid presents certain challenges due to anatomical distortion, leading to higher incidence of ureteric injury and excessive bleeding. Still most of the myomectomies are done abdominally, this is due to the complexity and the necessity of extensive suturing for the desired multi- layered uterine closure, which is technically hard to do laparoscopically. The introduction of robotic surgery has allowed more surgeons to perform complex laparoscopic procedures
Biography:
Hani Gabra is Professor and head of Medical Oncology, Deputy Head of the Division of Cancer and Director of the Ovarian Cancer Action Research Centre at Imperial College. He is also Associate Director and Lead of the Cancer Division (Division 1) of the NIHR Clinical Research Network for North West London
Abstract:
To identify therapeutic strategies for circumventing APR in OC, we utilised isogenically matched cell lines from platinum sensitive patients who then developed APR to undertake RNA expression microarray analysis to identify genes upregulated in APR. SiRNA knockdown revealed targets whose downregulation re-sensitised cells to platinum. Preclinical development identified that AKT and DNA-PK where strong candidates for inhibition strategies. A clinical phase Ib/II trial demonstrated a 40% RECIST response rate in APR patients receiving carboplatin and paclitaxel 3 weekly, in whom a response rate of <13% would be expected. This approach opens up new possibilities for treatment of recurrent OC.
Biography:
Ahmad M. Abu-Elhasan is a Professor in the Department of Obstetrics and Gynecology, as Faculty of Medicine, Ùat Assiut University. Qualifications include M.D. In obstetric and gynecology ( infertility ) , Faculty of Medicine, Assiut university
Abstract:
Objectives: Intra-abdominal adhesion is a common morbidity after laparotomic myomectomy. We tried to determine whether post-myomectomy intra-peritoneal wash with lactated Ringer's for 48 hours may reduce the incidence or degree of adhesions. Methods: A prospective, randomized trial that included 52 eligible participants for whom abdominal myomectomies were done. Participants were randomly allocated into a treatment group (n=26), which was subjected to continuous intra-peritoneal wash for 48 hours via two intra-peritoneal drains, and a control group (n=26) with no further postoperative intervention. The incidence of de novo adhesions, its severity and extent were scored at a second look laparoscopy 8-10 weeks postoperative. Adhesions were graded using Local Adhesion Barrier Scoring System (LABS) score. Adverse effects were also assessed and reported. Results: There was no statistically significant difference as regard duration of hospital stay or the incidence of adverse events. A significantly high proportion of adhesion-free patients was found in the treatment group [11/ 23, 47.8%] compared to control group [4/21, 19%] (P<0.01). The mean number of pelvic sites covered by adhesions was significantly low in treatment group compared to control group (2.2±0.3 versus 4.6±0.8, P<0.05). The total adhesion score was significantly low in treatment group compared with controls (2.1±0.5 versus 4.8±1.4, P<0.05). Also, adhesion score was significantly low at most of the individual anatomical sites in treatment group compared with controls. Conclusion: Our results suggest that application of postoperative intraperitoneal wash with lactated Ringer's solution for 48 hours may have a reasonable safety and efficacy in minimizing postoperative pelvic de novo adhesions following abdominal myomectomy.
Biography:
Junjun Qiu has completed his PhD from Fudan University in 2014. She is now working at the Obstetrics and Gynecology Hospital of Fudan University. Her research mainly focuses on long noncoding RNA and ovarian cancer progression and was supported by funding from the National Natural Science Foundation of China (81502240) and Shanghai Science and Technology Development Funds for the Talents (15YF1401400). She has published 8 SCI papers in recent three years
Abstract:
The long non-coding RNA HOTAIR promotes the proliferation of serous ovarian cancer cells through the regulation of cell cycle arrest and apoptosis: HOX Transcript Antisense RNA (HOTAIR) is a well-known Long Non-Coding RNA (lncRNA) whose dysregulation correlates with poor prognosis and malignant progression in many forms of cancer. Here, we investigate the expression pattern, clinical significance, and biological function of HOTAIR in Serous Ovarian Cancer (SOC). Clinically, we found that HOTAIR levels were overexpressed in SOC tissues compared with normal controls and that HOTAIR overexpression was correlated with an advanced FIGO stage and a high histological grade. Multivariate analysis revealed that HOTAIR is an independent prognostic factor for predicting overall survival in SOC patients. We demonstrated that HOTAIR silencing inhibited A2780 and OVCA429 SOC cell proliferation in vitro and that the anti-proliferative effects of HOTAIR silencing also occurred in vivo. Further investigation into the mechanisms responsible for the growth inhibitory effects by HOTAIR silencing revealed that its knockdown resulted in the induction of cell cycle arrest and apoptosis through certain cell cycle-related and apoptosis-related proteins. Together, these results highlight a critical role of HOTAIR in SOC cell proliferation and contribute to a better understanding of the importance of dysregulated lncRNAs in SOC progression.
Somashekhar S P
Manipal Hospital, Bangalore, India
Title: A prospective randomised study of open versus robotic assisted para aortic lymph node dissection in high risk endometrial carcinoma – A novel technique
Biography:
Somashekhar.S.P,MS,MCh(Onco),FRCS.Edinburgh,Chairman & HOD Surgical Oncology,Manipal Health Enterprise,Graduation year 1994, MS and MCh oncosurgery 2000 year,FRCS. Edinburgh Editor in chief Indian Journal of Gynec oncology Treasurer Association of Gynecological Oncology India Consultant Surgical & Gynec. Onco & Robotic Surgeon,,Manipal Comprehensive Cancer Center,India ,Had several national and intrenstio skPublication and has authored several text Books in gynec oncology
Abstract:
Introduction: To evaluate the technical feasibility and safety of robotic assisted para aortic lymphadenectomy in comparison with open surgery in terms of adequacy of staging, blood loss, lymph node harvest, hospital stay and complications. Material & Methods: A randomized prospective study was performed which included 180 patients diagnosed with endometrial carcinoma who were divided into two groups one open and other robotic. All patients underwent type I pan hysterectomy + B/L pelvic lymphadenectomy. The high risk patients (FIGO grade 3, Tumor > 2 cm, pelvic node positive and >50% myoinvasion) were taken up for para aortic lymphadenectomy. The para-aortic node dissection was performed upto renal veins. In the Da Vinci Robotic arm, a novel single docking technique using 30 degree camera with hot shears and bipolar fenestrated grasper was used. The split and roll technique was used to perform the pre-caval and pre-aortic lymphadenectomy. Results: Out of 180 patients included in study, 113 had high risk endometrial cancer (open arm 58 and robotic arm 55). The average blood loss in open arm was 134.6 ml vs. 41.2 ml in robotic arm. In open surgery, on average 11.6 nodes were harvested when compared to 17.5 nodes in robotic arm. Duration of hospital stay for open group was 5.54 days vs. 1.94 days for robotic arm. None of the patients in either arm had any major intra-operative or post-operative complications. 23 patients in the open arm had prolonged ileus while 4 patients had ileus in robotic arm. 7 patients in open arm developed wound infection. Conclusion: This study showed results which indicate that robotic assisted para-aortic lymphadenectomy had equal oncologic outcome as compared to open technique. Minimal blood loss and less pain helped in shorter hospital stay and early return to normal activities. Robotic assisted surgery had better clinical outcome and patient satisfaction when compared to open technique.
Tevfik Guvenal
Celal Bayar University School of Medicine, Turkey
Title: Effect of surgical staging on 539 patients with borderline ovarian tumors: A Turkish Gynecologic Oncology Group study
Biography:
Tevfik Guvenal Is graduated from Cumhuriyet University School of Medicine in 1989.Istanbul Goztepe Training and Research Hospital specialist started education in 1995. did military service as an obstetrician in Eskisehir Air Hospital.Cumhuriyet University Faculty of Medicine Department of Obstetrics and Gynecology in 1999 started Department in academic life. In 2000 Hacettepe University Obstetrics and Gynecology, Gynecologic Oncology, received training in the field. In 2003 became a professor in 2009 and since 2009 Celal Bayar University Department of Obstetrics and Gynecology, Gynecologic Oncology have been working as a responsible unit. Pelvic and vaginal surgery is my area of special interest outside of Gynecologic Oncology.Board member of the Turkish Association of Gynecologic Oncology Gynecologic Oncology, Journal of Turkish and have been responsible for writing duties as chief.
Abstract:
Objective. The objectives of this study were to examine demographic and clinicopathologic characteristics and to determine the effects of primary surgery, surgical staging and the extensiveness of staging. Methods. In a retrospective Turkishmulticenter study, 539 patients, from14 institutions,with borderline ovarian tumors were investigated. Some of the demographic, clinical and surgical characteristics of the cases were evaluated. The effects of type of surgery, surgical staging; complete or incomplete staging on survival rates were calculated by using Kaplan–Meier method. Results. The median age at diagnosis was 40 years (range 15–84) and 71.1% of patients were premenopausal. The most common histologic types were serous and mucinous. Majority of the staged cases were in Stage IA (73.5%). 242 patients underwent conservative surgery. Recurrence rates were significantly higher in conservative surgery group (8.3% vs. 3%). Of all patients in this study, 294 (54.5%) have undergone surgical staging procedures. Of the patientswho underwent surgical staging, 228 (77.6%) had comprehensive staging including lymphadenectomy. Appendectomy was performed on 204 (37.8%) of the patients. The median follow-up time was 36 months (range 1–120 months). Five-year survival rate was 100% and median survival time was 120 months. Surgical staging, lymph node sampling or dissection and appendectomy didn't cause any difference on survival. Conclusion. Comprehensive surgical staging, lymph node sampling or dissection and appendectomy are not beneficial in borderline ovarian tumors surgical management
Vineet Talwar
Rajiv Gandhi Cancer Institute and Research Centre, India
Title: Efficacy and safety of adjuvant intraperitoneal chemotherapy in carcinoma ovary: A prospective observational study
Biography:
Dr. Vineet Talwar earned his DM (Medical Oncology) from Adyar Cancer Institute, Chennai. He has more than 40 publications in National and International journals and is member of the European Society for Medical Oncology (ESMO), American Society of Clinical Oncology (ASCO), Indian Cooperative Oncology Network (ICON), Indian Society of Oncology (ISO).Dr. Talwar is a recipient of four orations from the Association Physician of India, Indian Academy of Clinical Medicine. He is also credited as a fellow of International Medical Sciences Academy (IMSA), Indian College of Physicians (FICP) and Fellow of Royal Society of Physicians (FRCP), UK.He is actively involved with the DNB Medical Oncology program which is being conducted at Rajiv Gandhi Cancer Institute and is a thesis guide as well. He actively participates in oncology updates, cancer detection camps, outreach clinics and drug trials (phase I, II, III) at the Institute.
Abstract:
Background: It has been demonstrated in few trials, that intraperitoneal and intravenous (IP/IV) chemotherapy improves survival in advanced stage ovarian cancer. But it has been associated with high treatment related toxicities leading to very low acceptance of this modality among medical oncologists. So, various modifications in treatment schedules have been tried to reduce toxicities. In this study, we decided to study the response and tolerability of IP paclitaxel on day 8 with IV paclitaxel on day 1 and IV cisplatin day 2 in carcinoma ovary, in view of paucity of data with this modification. Methods: In this prospective observational study, from March 2013 to June 2015, the efficacy and tolerability of adjuvant IP/IV chemotherapy in optimally cytoreduced stage III epithelial ovarian cancer patients were assessed. Treatment consisted of 135 mg/m2 of IV paclitaxel over a 3-hours period on day 1 followed by AUC 5 carboplatin IV on day 2 and 60 mg/m2 of IP paclitaxel on day 8 every 3 weekly for six cycles. Results: Total 40 patients were enrolled. The median age of patients was 53 yrs (32 yrs–67 yrs). Out of a total of 240 I/P cycles, 211 cycles (88%) were completed. 30 patients (76%) received all the 6 cycles by IP route. 6 out of those 30 patients had one or more adjustment including delay or dose reduction. After median follow up of 18 months, 5 patients (12.5%) had local or systemic recurrence, 2 patients (5%) had progression during treatment. Median progression free survival not reached yet. Catheter block was seen in 5 cases. Two cases had needle displacement and extravasations of drug around the port chamber. 6 patients had grade 3 abdominal pain and cramp. Grade 3/4 Leucopenia was experienced by 20 patients (50%) but Febrile Neutropenia occurred in only 4 (10%) patients. Renal complication present in 2 patients (5%) and transient transfusion reaction developed in 5 patients. Conclusions: In Indian patients, adjuvant chemotherapy with day 8 I/P paclitaxel in optimally cytoreduced epithelial ovarian cancer is associated with survival benefits comparable to western literature and better tolerated with very high treatment completion rate.