ABSTRACT
Patients with advanced stage ovarian cancers commonly undergo hyperthermic intraperitoneal chemotherapy (HIPEC) following interval debulking via exploratory laparotomy. This video demonstrates the feasibility of HIPEC delivery via a minimally invasive approach with the use of a vaginal GelPoint® port. This video demonstrates a 56-year-old patient with Stage 3 bilateral fallopian tube cancer who underwent 3 cycles of neoadjuvant chemotherapy with cisplatin and paclitaxel. Prior to administration of HIPEC the patient underwent an uncomplicated robotic assisted radical hysterectomy, bilateral salpingo-oopherectomy and infracolic omentectomy. Additionally, the falciform ligament was transected. The vaginal cuff was then used for placement of the GelPoint® port. The inflow and outflow cannulas were placed at the level of the liver and pelvis robotically. To minimize risk of inadvertent spillage, robotic obturators were replaced. Prior to administration of HIPEC, 4 L of warm saline was administered. An additional safety check was performed with no areas of leak. Cisplatin was administered for 90 min followed by sodium thiosulfate and 3 L of normal saline. Confirmation of no residual fluid was noted laparoscopically. The patient was discharged 2 days postoperatively without postoperative complications. In this video we demonstrated the innovative technique of performing HIPEC via a minimally invasive approach, that typically requires an open procedure. With the use of a vaginal Gelpoint® we were able to safely administer intraperitoneal chemotherapy without risk to our patient. We were also able to minimize their length of hospital stay and expedite postoperative recovery. Further implementation of this technique may improve hospital resource allocation.
ABSTRACT
BACKGROUND: Radiotherapy is used to treat many adolescent and young adult (AYA) and childhood cancer patients and is a risk factor for secondary breast cancer. While premenopausal breast cancer is inherently more aggressive, no studies to date have evaluated the characteristics and breast cancer-specific survival (BCSS) of premenopausal secondary breast cancer after radiotherapy in AYA and childhood cancer survivors. METHODS: Female patients ages 12 to 50 diagnosed with primary breast cancer from 1988 to 2014 (n = 107,751) were obtained from the California Cancer Registry and compared with similar aged patients with secondary breast cancer who were treated with radiotherapy for their primary tumor (n = 1,147) from ages 12 to 39. We examined BCSS using multivariable Cox proportional hazards regression. RESULTS: The secondary breast cancer cohort was more likely to be Hispanic or Black, be 35 to 45 years of age, have earlier stage tumors, be higher grade, have no lymph node involvement, and be hormone receptor negative. All women showed worse BCSS for large tumor size, lymph node involvement, and hormone receptor-negative status. BCSS was worse for women with secondary breast cancer both overall (hazard ratio, 1.98; 95% confidence interval, 1.77-2.23) and in all subgroups considered. Associations were most pronounced in Hispanics, Asian/Pacific Islanders, and younger women, as well as those with earlier stage, lymph node-negative, and hormone receptor-positive disease. CONCLUSIONS: BCSS is significantly decreased among all survivors of childhood and AYA cancer treated with radiotherapy that develop a secondary breast cancer, including women with good prognostic features. IMPACT: Therefore, we may need to consider alternative and even more aggressive treatment in what were considered low-risk populations previously.
Subject(s)
Breast Neoplasms/radiotherapy , Adolescent , Adult , Cancer Survivors , Child , Humans , Middle Aged , Treatment Outcome , Young AdultABSTRACT
The phenolic profile and antioxidant activity of Cape Verde's Artemisia gorgonum Webb and Hyptis pectinata (L.) Poit. infusions before and after in vitro simulation of the gastrointestinal digestion were determined. The LC-UV/DAD fingerprinting analysis allowed the identification of 3-O-caffeoylquinic acid, chlorogenic acid, 3,5 dicaffeoylquinic acid, 4,5-dicaffeoylquinic acid and other caffeoylquinic acids derivatives on A. gorgonum infusion, and of caffeoylquinic acid and quercetin derivatives on H. pectinata infusion. Despite some decrease in the chromatographic area of several peaks, no relevant qualitative alterations on the chromatographic profile were observed between the digested and undigested herbal infusions. Results obtained showed a decrease on the antioxidant capacity of both tested herbal infusions after the in vitro digestion. This decrease was more pronounced for H. pectinata than for A. gorgonum and was also more pronounced regarding the radical scavenging capacity than regarding the reducing capacity. After complete digestion the superoxide anion and the DPPH-radical scavenging capacities decreased ≈ 43 and 75% for H. pectinata and ≈ 31 and 70% for A. gorgonum. Despite the observed differences before and after simulated gastrointestinal digestion, both infusions still had antioxidant activity at the end of this process. Thus, the antioxidant potential of A. gorgonum and H. pectinata infusions from Cape Verde, prepared as traditionally used, seems to be kept in some extend throughout the digestive system.