Three studies examine a treatment, a diagnostic, and the risk of thromboembolism after pelvic surgery, respectively.
In the final day of the Society of Gynecologic Oncologists 41st Annual Meeting several interesting reports were presented. Brown and colleagues discussed a single institutional phase 2 trial experience with the combination of cisplatin plus gemcitabine in 20 evaluable patients with endometrial cancer. A 50% objective response was noted. Toxicity was significant, especially grade 3-4 bone marrow suppression (anemia, neutropenia, thrombocytopenia). Several patients experienced renal insufficiency and substantial fatigue. The activity of this regimen compared to what many consider to be the “standard” chemotherapy approach in this setting (carboplatin plus paclitaxel) is unknown. A randomized trial comparing the two strategies would be of potential interest.
Ueland and associates reported an experience with the use of the OVA1 test, a recently approved strategy in the preoperative assessment of pelvic masses. The paper described the outcome 516 evaluable women who participated in a prospective trial involving 27 centers in the United States (community and specialty settings). A total of 151 ovarian malignancies were discovered in this population. Use of the OVA1 test appeared to improve the ability of physicians to detect the presence of cancer. It should be noted this test was not specific for ovarian cancer, appearing to be commonly abnormal in the case of metastatic cancer to the ovary.
Peedicayil and associates described an interesting institutional experience with the risk of venous thromboembolism developing following pelvic surgery. A total of more than 4000 patients were included in the study’s database. The mean age of the patient population was 61 years, with ovarian, uterine, and cervical/vaginal/vulvar cancers representing 35%, 41% and 24% of the patients, respectively. Overall, venous thromboembolism was noted in 3% of the population within 90 days of surgery. Of considerable interest was that the majority of events (75%) developed more than 7 days following surgery and 43% were noted more than 3 weeks following the procedure. These data strongly suggest prophylactic measures in this patient population need to be continued for some time following surgery.