Bevacizumab Facilitates Surgery In Previously Inoperable Patients With Low Grade Serous Ovarian Cancer A Case Series

Introduction/Background:Low grade serous ovarian cancer (LGSOC) accounts for 10% of serous epithelial ovarian cancers. In contrast to high grade serous ovarian cancer (HGSOC), it is characterised by an early age of onset, indolent growth rate and relative resistance to cytotoxic chemotherapy. The use of Bevacizumab in ovarian cancer has mostly been investigated in HGSOC and is contra-indicated in patients with extensive disease associated with the bowel, due to risks of bowel perforation. Several single-institution studies have reported activity of Bevacizumab in LGSOC in the recurrent disease or adjuvant setting. We present a case series of two patients with advanced LGSOC and extensive serosal disease involving the bowel that were treated with Bevacizumab in the first-line setting.Methodology:Case notes, pathology results and CT scans were reviewed. Histology slides from initial biopsy and debulking surgery specimens were stained for H&E to assess chemotherapy-response scores.Results:Both patients had Stage IIIC disease, with extensive disease involving the bowel which prohibited surgery. No response was seen on CT scan or serum Ca125 levels after three cycles of Carboplatin and Paclitaxel in either case, but following the addition of Bevacizumab both patients had a marked reduction in disease volume enabling debulking surgery that was not previously feasible. Serum Ca125 levels reduced to near-normal values prior to surgery following three cycles of Bevacizumab in both cases (438 to 50 and 151 to 54). There were no adverse events associated with Bevacizumab use (18 cycles 7.5mg/kg). Conclusion:We propose that Bevacizumab is safe to use in our set of LGSOC patients with extensive bowel involvement, and can facilitate surgery in those patients that were previously inoperable. Further evaluation of its use in the first line setting, particularly in patients that have had no response to conventional chemotherapy agents, is recommended. We have commenced an observational study including all LGSOC patients receiving Bevacizumab.

Extensive and up-to-date resource on the full range of gynaecological cancers; practically-focused and essential for the MRCOG examination.

This practical reference book provides up-to-date, evidence-based multidisciplinary guidelines on the epidemiology, biology, diagnosis, and treatment of endometrial cancer. Individual chapters focus on topics such as hormonal interactions, cancer prevention, genetic classification and its clinical applications. Recent advances in diagnostic methods are described. The treatment-oriented chapters include coverage of the roles of lymphadenectomy and sentinel node dissection, surgical complications, radiation techniques, and chemotherapy in early-stage disease. Treatment options in advanced disease, including hormonal therapy and targeted therapy, are considered separately, as is the management of rare tumor types. The authors are international key opinion leaders. Summaries of the ESMO/ESGO/ESTRO guidelines on management are included. Each clinical chapter ends with a summary of recommendations with the level of evidence.

Written with the busy practice in mind, this book delivers clinically focused, evidence-based gynecology guidance in a quick-reference format. It explores etiology, screening, tests, diagnosis, and treatment for a full range of gynecologic health issues. The coverage includes the full range of gynecologic malignancies, reproductive endocrinology and infertility, infectious diseases, urogynecologic problems, gynecologic concerns in children and adolescents, and surgical interventions including minimally invasive surgical procedures. Information is easy to find and absorb owing to the extensive use of full-color diagrams, algorithms, and illustrations. The new edition has been expanded to include aspects of gynecology important in international and resource-poor settings.

Updated and expanded, the third edition of Surgery for Ovarian Cancer focuses on essential techniques for the effective management of ovarian cancer. It reflects the most contemporary science and surgical applications for the management of patients with ovarian cancer and related peritoneal surface malignancies. This new edition takes a step-by-step approach and includes new intraoperative photographs and videos illustrating surgical procedures. It is principally devoted to the technical aspects of cytoreductive surgery, with chapters divided according to anatomic region. The chapters cover relevant anatomical considerations, surgical challenges specific to each region, and operative approaches and techniques favored by the authors. The list of contributing authors has been expanded from the previous edition and includes international and world-renowned experts from the fields of gynecologic oncology and surgical oncology. The topics of minimally invasive surgery, secondary cytoreduction, palliative surgery, and postoperative care are also covered in detail. New to the third edition are chapters on preoperative risk stratification, regional therapeutics and peritonectomy procedures, and quality assurance relating to ovarian cancer surgery. This comprehensive text is essential reading for all practitioners working with patients with ovarian cancers.

Stereotactic body radiation therapy (SBRT) has emerged as an important innovative treatment for various primary and metastatic cancers. This book provides a comprehensive and up-to-date account of the physical/technological, biological, and clinical aspects of SBRT. It will serve as a detailed resource for this rapidly developing treatment modality. The organ sites covered include lung, liver, spine, pancreas, prostate, adrenal, head and neck, and female reproductive tract. Retrospective studies and prospective clinical trials on SBRT for various organ sites from around the world are examined, and toxicities and normal tissue constraints are discussed. This book features unique insights from world-renowned experts in SBRT from North America, Asia, and Europe. It will be necessary reading for radiation oncologists, radiation oncology residents and fellows, medical physicists, medical physics residents, medical oncologists, surgical oncologists, and cancer scientists.

This book presents the latest research pertaining to the diagnosis, therapy and management of diffuse low-grade gliomas (DLGG) in adults, with a particular focus on the path towards individualised therapy for this kind of tumour. Recent research on the natural history of DLGGs and their interaction with the brain has led to new diagnostic and therapeutic strategies which increase survival and quality of life of the patient, and these methods are described in this book.

Skeel's Handbook of Cancer Chemotherapy combines in one place the most current rationale and specific details necessary to safely administer chemotherapy for most adult cancers. The handbook is a practical, diseased-focused pocket reference that emphasizes the best current medical practice as it relates to the delivery of chemotherapeutic drugs. By focusing on specific plans for treatment, the book is an invaluable resource for the daily care of cancer patients.

It is challenging enough to be able to make a diagnosis in mammography, but the newer standards of care demand more than just providing a diagnosis. This book is an excellent resource to improve the understanding of breast diseases, recognize and manage problems encountered in breast imaging and clinical management of the breast diseases. With forty four chapters, this volume is divided into six sections on screening of breast cancer, imaging modalities, benign breast disorders, interventional procedures, pathological considerations and breast cancer. Breast Diseases: Imaging and Clinical Management is a crisp volume on clinical and multimodality breast imaging with emphasis on interventional procedures, pathology and the entire spectrum of breast cancers.

The ASCRS Textbook of Surgery of the Colon and Rectum offers a comprehensive textbook designed to provide state of the art information to residents in training and fully trained surgeons seeking recertification. The textbook also supports the mission of the ASCRS to be the world’s authority on colon and rectal disease. The combination of junior and senior authors selected from the membership of the ASCRS for each chapter will provide a comprehensive summary of each topic and allow the touch of experience to focus and temper the material. This approach should provide the reader with a very open minded, evidence based approach to all aspects of colorectal disease. Derived from the textbook, The ASCRS Manual of Surgery of the Colon and Rectum offers a “hands on” version of the textbook, written with the same comprehensive, evidence-based approach but distilled to the clinical essentials. In a handy pocket format, readers will find the bread and butter information for the broad spectrum of practice. In a consistent style, each chapter outlines the condition or procedure being discussed in a concise outline format – easy to read, appropriately illustrated and referenced.