David Atallah - Academia.edu (original) (raw)

Papers by David Atallah

Journal of Lower Genital Tract Disease, 2022

Human papillomavirus (HPV) is responsible for a multitude of lesions with high psychosocial burde... more Human papillomavirus (HPV) is responsible for a multitude of lesions with high psychosocial burden. The "HPV Impact Profile" (HIP) questionnaire is one of the first and most specific tools evaluating the emotional impact of HPV. This study aimed to translate this questionnaire into Arabic and to validate it, in a sample of Lebanese female patients. The HIP questionnaire was translated to Arabic. It was then administered to 118 Lebanese women infected with HPV or screened for HPV-associated lesions, in parallel with the Hospital Anxiety and Depression Scale questionnaire. The psychometric properties of the questionnaire were studied in our sample population. The internal consistency of the HIP questionnaire was weak as Cronbach α coefficients of most of the domains were low. The study of the composite matrix resulted in the improvement of the internal consistency after the elimination of some items. Moreover, the "adapted domains" were created by reverse-scoring items with positive implications.The composite reliability and the average variance extracted of all the domains were analyzed. Analysis of discriminate validity through heterotrait-monotrait ratio of correlation ratio analyses of corresponding Hospital Anxiety and Depression Scale domains was also performed along with reliability analysis. There results were satisfying for the adapted domains. The adapted domains of the 27 items questionnaire with reverse scoring of 8 items presented with good psychometric properties, allowing their use in clinical trials and in clinical practice.

Le Journal médical libanais. The Lebanese medical journal, 2020

Le Journal médical libanais. The Lebanese medical journal, 2020

The SARS-Cov-2 virus pandemic causes an acute public health emergency with millions of infected p... more The SARS-Cov-2 virus pandemic causes an acute public health emergency with millions of infected patients and thousands of deaths The infection makes adults prone to severe and fatal consequences, especially when they suffer several comorbidities Our oncologic patients are the most susceptible to its severe repercussions because of their initial diagnosis and the immunosuppressive adjuvant and neoadjuvant treatments they receive The Chinese CDC reported a 5 6% risk of mortality among cancer patients compared to 0 9% in the general population;likewise, other studies showed a twofold higher risk of death in this patients’ subgroup In order to maintain the best quality of medical services during this crisis, along with the safety of healthcare providers, accurate triage of our oncologic patients must be done before any medical or surgical intervention to decide whether or not postponing treatments may be considered, without risking the disease progression and patients’ worsening outcomes, otherwise inpatient and outpatient special precautions must be followed whenever interventions are currently scheduled, according to each gynecologic cancer type The disease is worldwide but local and regional circumstances vary, thus practice guidelines must be individualized according to each country virus prevalence and available medical resources, in order to limit the burden of the COVID-19 infection on the health system during the crisis and the upcoming months after its resolution

Additional file 1: Table S1. Sequence of primers.

The Poster, 2020

Objectives HPV associated lesions heavily influence the patients’ psychological health. Merck and... more Objectives HPV associated lesions heavily influence the patients’ psychological health. Merck and coll. developed the HPV Impact profile (HIP) questionnaire to quantify this impact. Previously, while translating this questionnaire to Arabic and validating it in the Lebanese population, we had encountered several issues with its interpretation scheme. This article aims to study the psychometric properties of other proposed schemes found in the literature in order to choose the most adapted one for the Lebanese population. Methods The Arabic versions of the HIP and HADS questionnaires were administered to 118 Lebanese women presenting for an HPV related consultation. The psychometric properties of the initial domains were studied before and after reverse scoring 8 items carrying a positive connotation (‘adapted domains’) and compared to those of two other item distributions created by Santos et al. Results Most of the initial domains presented weak alpha Cronbach coefficients and inte...

The Poster, 2020

Introduction ‘HPV impact profile’ questionnaire, created by the team of Merck and coll. was one o... more Introduction ‘HPV impact profile’ questionnaire, created by the team of Merck and coll. was one of the first and most specific tools evaluating the psychological impact of the most frequent gynecological lesions linked to HPV. This study aimed to translate the ‘HIP’ questionnaire into Arabic and to study its validity in a sample of Lebanese females. Methods The HIP questionnaire was translated to Arabic following the scheme offered by Beaton et al. It was then administered to a sample of 118 Lebanese women infected with HPV or screened for HPV associated lesions, in parallel with the Hospital anxiety and depression scale (HADS) questionnaire. Results The internal consistency of the HIP questionnaire was weak as alpha Cronbach coefficients of most of the domains were low. Therefore, the study of the composite matrix resulted in the improvement of the internal consistency after elimination of some items. The ‘adapted domains’ were created after inversing the scores of items with posit...

Ovarian cancer, 2021

follow-up time was 30.4 months. There were no differences in progression free-survival (long-rank... more follow-up time was 30.4 months. There were no differences in progression free-survival (long-rank=0.069) or overall survival (long-rank=0.47) between the groups. Conclusion* Splenectomy in the course of debulking surgery for ovarian cancer does not seem to be associated with a higher rate of postoperative complications. Additionally, splenectomy does not have a deleterious influence before or during chemotherapy administration or a negative impact on oncological outcome.

Ovarian cancer, 2021

Introduction/Background* Advanced epithelial ovarian cancer (EOC) is a severe disease with high m... more Introduction/Background* Advanced epithelial ovarian cancer (EOC) is a severe disease with high mortality rate. Achieving complete cytoreduction (R=0; CCR) is crucial for the patient's prognosis. Extensive peritoneal carcinomatosis is often the limiting factor for achieving CCR in EOC and therefore is the deciding factor for therapy planning. The Peritoneal Cancer Index (PCI) after Sugarbaker has been an established tool to describe the extension of the disease. A patient presenting a PCI < 25 is considered to be operable 1. We examined the predictive power of various markers (CA-125, CTscans, PCI) for achieving complete cytoreduction after neoadjuvant chemotherapy (NACT). Methodology The data of 23 patients treated in our hospital between 01/2015 und 12/2020 with inoperable EOC were retrospectively analyzed. Clinical and radiological data were collected and statistically analysed (univariate analysis: Chi-Square Tests, Mann-Whitney U test and multivariate analysis: Binary logistic regression, ROC-curve). Result(s)* The reduction of the PCI itself after neoadjuvant chemotherapy showed to be a powerful predictor for complete cytoreduction (CCR), but it also showed to be significant even if the different PCI baseline values were considered. The reduction of the initial PCI score by minimum 8.5 points was a better predictor for CCR than the PCI < 25. Neither the RECIST analysis 2 of the CT-scans nor the reduction of the tumor marker CA-125 proved to be a significant predictor. Conclusion* Whether CCR can be achieved during debulking surgery, is best predicted by the reduction of the PCI. A combination of the three markers might be even more powerful. Larger studies are needed to confirm this.

Future Oncology, 2021

The current study was designed to compare oncological outcomes between oncoplastic (OBCS) and con... more The current study was designed to compare oncological outcomes between oncoplastic (OBCS) and conventional breast-conserving surgery (BCS). Data collected retrospectively from two groups of patients diagnosed with breast cancer, cases group (OBCS) and control group (BCS), were analyzed. A total of 277 women were included in the analysis: 193 (69.7%) in the cases group and 84 (30.3%) in the control group. Resected volume was larger in the OBCS group (438.05 ± 302.26 cm3 vs 223.34 ± 161.75 cm3; p < 0.001). Re-excision was required for 7.1% of patients receiving BCS versus 4.7% in the OBCS group (p = 0.402). After long-term follow up, no local recurrences occurred in the OBCS group, while 2.4% of patients receiving BCS had local relapse (p = 0.045). Compared with BCS, OBCS increases oncological safety in terms of re-excision rate and local recurrence.

Gynecologic Oncology, 2020

Ovarian metastases from breast cancer: series over a 20-years period at a Lebanese tertiary care ... more Ovarian metastases from breast cancer: series over a 20-years period at a Lebanese tertiary care center To report the characteristics and outcomes of patients presenting ovarian metastases from a breast cancer

ePoster, 2019

Introduction/Background Telomeres are DNA structures protecting the linear ends of eukaryotic chr... more Introduction/Background Telomeres are DNA structures protecting the linear ends of eukaryotic chromosomes against degradation and fusion, thereby maintaining genome stability. Telomerase is an enzyme that stabilizes the length of linear chromosomes by de novo synthesizing telomeric repeats during incomplete DNA replication, thus ensuring immortalization. This enzyme is expressed in 80% of cancers, including ovarian carcinoma. The human telomerase reverse transcriptase has been investigated as a detection marker for cancers in early stages, and a prognosis marker in late stages disease. The aim of this study is to investigate telomere length as a marker for survival and recurrence in ovarian carcinoma. Methodology 37 ovarian cancer biopsies have been isolated from Lebanese patients. The biopsies were subjected to DNA extraction, and then telomere length was assayed in cancer cells following the method elaborated by R. Cawthon (2002). Clinical data of each patient have been retrieved, including survival, recurrence, lymph node ratio, age, weight. Results The results obtained revealed a direct relation between telomere length and survival. In fact, patients with shorter survival rates (less than 1 year) exhibited 30% longer telomeres compared with patients with longer survival rates (3 to 5 years). Moreover, recurrence rates increased with longer telomeres. Higher ratios (35%) were detected in patients with early recurrence (less than 1 year) compared to patients with late or absent recurrence. However, no direct effect between telomere length and the other parameters was spotted. Conclusion Telomere length could be used as a prognostic marker in patients with ovarian cancer by predicting better survival and lower recurrence in case of shorter telomeres. This will be of a great value when making therapeutic decisions in a heterogeneous and aggressive disease as ovarian cancer. Disclosure Nothing to disclose.

ePoster, 2019

Introduction/Background To evaluate the potential impact on survival of residual tumor volume aft... more Introduction/Background To evaluate the potential impact on survival of residual tumor volume after chemoradiation and prior to brachytherapy initiation determined by magnetic resonance imaging in patients treated for locally advanced cervical cancer. Methodology MRI examinations were prospectively performed in patients with advanced cervical cancer (Stages IB2-IVA) after chemoradiation completion and prior to brachytherapy initiation. Region of interest-based 3D volumetry was derived on the treatment planning system by tracing the entire residual tumor region in each T2-weighted MRI slice. All patients received external beam radiation (EBRT) with concomitant weekly Cisplatin followed by high-dose rate endocavitary brachytherapy using volume-based planning. Cumulative EBRT and BT doses were calculated as the total equivalent dose in 2 Gy fractions (EQD2). Potential prognostic factors were selected based on non-parametric tests and then analyzed for survival with a Cox regression model. Results Median post-therapy follow-up was 27.4 months (range, 3–57.8). Thirty-seven patients were included. According to the FIGO classification, 8% were stage IB, 75% stage II, 11% stage III, and 6% stage IV. Overall survival was 86.5%. Of the patients evaluated, 29.7% had complete radiological remission and 18.9% were considered having local failure or distant disease. At bivariate analysis, residual volume >2 mL, D90 CTV-HR <84 Gy and excessive treatment time were all significant predictors of poor overall survival. At multivariate survival analysis, only the residual tumor volume persisted as a significant prognostic factor with survival rates of 95.8% and 69.2% for residual tumor ≤2 mL and >2 mL, respectively (p=0.005). Conclusion Our data suggest that residual tumor volume >2 mL at the time of brachytherapy is a predictor of poor survival. Disclosure Nothing to disclose. Abstract EP324 Figure 1 Overall survival curves according to residual tumor volume ≤2 mL and >2 mL

Oncology Letters, 2019

Although chemotherapy is the standard treatment for ovarian cancer (OC), recent studies have focu... more Although chemotherapy is the standard treatment for ovarian cancer (OC), recent studies have focused on its coupling with hypoglycemic drugs to decrease glucose availability. Similarly to cancer antigen 125 (Ca-125), telomerase, the key protein for telomere lengthening, is overexpressed in 90% of OC cases. The aim of the present study was to investigate the effect of the combination of glucose restriction and chemotherapy on telomere length and Ca-125 secretion in OC cells. SKOV-3, OVCAR-3 and Igrov-1 cells were treated with 20 µM cisplatin and 100 nM paclitaxel for 48 h in three different glucose concentrations: i) 4.5 g/l, ii) 1 g/l and iii) 0.5 g/l. The same treatment was repeated once per week for 6 consecutive weeks. The surviving cells were considered platinum-taxane escape (PTES) cells. The expression levels of telomerase and Ca-125 in treated and PTES cells were quantified by qPCR, and Ca-125 secretion by ELISA. Telomere length was evaluated by qPCR according to the Cawthon method. The modulation of Ca-125 by telomerase was assessed using inhibitors, small interfering RNA and transfection with human telomerase reverse transcriptase (hTERT) vectors. The implication of phosphatidylinositol-4,5-bisphosphate 3-kinase/protein kinase B/mechanistic target of rapamycin (PI3K/Akt/mTOR) in Ca-125 modulation was investigated using specific inhibitors. An increase in hTERT and Ca-125 expression levels (range, 1.5-3 fold) was observed in short-term treated cells. However, an opposite effect was detected in PTES cells, where the rate of decrease in the expression levels of hTERT and Ca-125 reached 60% after treatment in 0.5 g/l glucose. Moreover, telomere length was decreased by 30% in cells treated with 0.5 g/l glucose. Inhibition of hTERT expression significantly decreased Ca-125 secretion, suggesting a potential modulation of Ca-125 by hTERT. The inhibition of the PI3K/Akt/mTOR pathway also decreased Ca-125 secretion; however, the effect of this treatment was not enhanced when coupled with telomerase inhibitors. In conclusion, the combination of chemotherapy and glucose restriction was observed to decrease Ca-125 secretion and telomerase expression leading to shortening in telomere length. Thus, decreasing glucose availability for OC cells during treatment may lead to a better clinical outcome and potentially improve the prognosis of patients with OC.

The Breast, 2019

The positive predictive value (PPV) was 76.1% (71.1-80.6). The negative predictive value (NPV) wa... more The positive predictive value (PPV) was 76.1% (71.1-80.6). The negative predictive value (NPV) was 77.6% (75.6-79.1). On multivariate analysis including the covariates of pathological T factors (pT), nuclear grades, receptor subtypes and histological subtypes, the sensitivity was affected by pT factors (pT2: odds ratio 1.77(95%

Regional plenary, 2019

Conclusions mFI and high complexity surgery are predictive of Severe and Overall Complications. P... more Conclusions mFI and high complexity surgery are predictive of Severe and Overall Complications. Patients' pre-operative care profile evaluation may guide specialists in reducing, preventing and managing complications correctly. mFI seems to be effective in identify high-risk patients and represent a valuable tool to help health professionals in providing risk counseling and discussion of management for women undergoing surgery for gynecologic cancer.

E-Poster viewings, 2019

complications have occurred in 32% of cases. They were associated with neoadjuvant chemotherapy (... more complications have occurred in 32% of cases. They were associated with neoadjuvant chemotherapy (p = 0.009), elevated surgical complexity (p = 0.037), need for intraoperative transfusion and stay at intensive care unit more than 48 hours (p = 0.05). Complications were infectious, hemodynamic, pulmonary, digestive and surgical. Need for parenteral nutrition was significantly correlated with longer operative time and neoadjuvant chemotherapy. No correlation was found between occurrence of complications and the following parameters: age, stage, APACHE II score, Charlston Comorbidity index and preoperative albuminemia. Conclusions Cancer stage, neoadjuvant chemotherapy, high surgical complexity, need for transfusions, delayed extubation and stay at intensive care unit more than 48 hours were predictive factors of higher postoperative morbidity in patients receiving cytoreductive surgery for ovarian cancer.

Journal of Lower Genital Tract Disease, 2022

Human papillomavirus (HPV) is responsible for a multitude of lesions with high psychosocial burde... more Human papillomavirus (HPV) is responsible for a multitude of lesions with high psychosocial burden. The "HPV Impact Profile" (HIP) questionnaire is one of the first and most specific tools evaluating the emotional impact of HPV. This study aimed to translate this questionnaire into Arabic and to validate it, in a sample of Lebanese female patients. The HIP questionnaire was translated to Arabic. It was then administered to 118 Lebanese women infected with HPV or screened for HPV-associated lesions, in parallel with the Hospital Anxiety and Depression Scale questionnaire. The psychometric properties of the questionnaire were studied in our sample population. The internal consistency of the HIP questionnaire was weak as Cronbach α coefficients of most of the domains were low. The study of the composite matrix resulted in the improvement of the internal consistency after the elimination of some items. Moreover, the "adapted domains" were created by reverse-scoring items with positive implications.The composite reliability and the average variance extracted of all the domains were analyzed. Analysis of discriminate validity through heterotrait-monotrait ratio of correlation ratio analyses of corresponding Hospital Anxiety and Depression Scale domains was also performed along with reliability analysis. There results were satisfying for the adapted domains. The adapted domains of the 27 items questionnaire with reverse scoring of 8 items presented with good psychometric properties, allowing their use in clinical trials and in clinical practice.

Le Journal médical libanais. The Lebanese medical journal, 2020

Le Journal médical libanais. The Lebanese medical journal, 2020

The SARS-Cov-2 virus pandemic causes an acute public health emergency with millions of infected p... more The SARS-Cov-2 virus pandemic causes an acute public health emergency with millions of infected patients and thousands of deaths The infection makes adults prone to severe and fatal consequences, especially when they suffer several comorbidities Our oncologic patients are the most susceptible to its severe repercussions because of their initial diagnosis and the immunosuppressive adjuvant and neoadjuvant treatments they receive The Chinese CDC reported a 5 6% risk of mortality among cancer patients compared to 0 9% in the general population;likewise, other studies showed a twofold higher risk of death in this patients’ subgroup In order to maintain the best quality of medical services during this crisis, along with the safety of healthcare providers, accurate triage of our oncologic patients must be done before any medical or surgical intervention to decide whether or not postponing treatments may be considered, without risking the disease progression and patients’ worsening outcomes, otherwise inpatient and outpatient special precautions must be followed whenever interventions are currently scheduled, according to each gynecologic cancer type The disease is worldwide but local and regional circumstances vary, thus practice guidelines must be individualized according to each country virus prevalence and available medical resources, in order to limit the burden of the COVID-19 infection on the health system during the crisis and the upcoming months after its resolution

Additional file 1: Table S1. Sequence of primers.

The Poster, 2020

Objectives HPV associated lesions heavily influence the patients’ psychological health. Merck and... more Objectives HPV associated lesions heavily influence the patients’ psychological health. Merck and coll. developed the HPV Impact profile (HIP) questionnaire to quantify this impact. Previously, while translating this questionnaire to Arabic and validating it in the Lebanese population, we had encountered several issues with its interpretation scheme. This article aims to study the psychometric properties of other proposed schemes found in the literature in order to choose the most adapted one for the Lebanese population. Methods The Arabic versions of the HIP and HADS questionnaires were administered to 118 Lebanese women presenting for an HPV related consultation. The psychometric properties of the initial domains were studied before and after reverse scoring 8 items carrying a positive connotation (‘adapted domains’) and compared to those of two other item distributions created by Santos et al. Results Most of the initial domains presented weak alpha Cronbach coefficients and inte...

The Poster, 2020

Introduction ‘HPV impact profile’ questionnaire, created by the team of Merck and coll. was one o... more Introduction ‘HPV impact profile’ questionnaire, created by the team of Merck and coll. was one of the first and most specific tools evaluating the psychological impact of the most frequent gynecological lesions linked to HPV. This study aimed to translate the ‘HIP’ questionnaire into Arabic and to study its validity in a sample of Lebanese females. Methods The HIP questionnaire was translated to Arabic following the scheme offered by Beaton et al. It was then administered to a sample of 118 Lebanese women infected with HPV or screened for HPV associated lesions, in parallel with the Hospital anxiety and depression scale (HADS) questionnaire. Results The internal consistency of the HIP questionnaire was weak as alpha Cronbach coefficients of most of the domains were low. Therefore, the study of the composite matrix resulted in the improvement of the internal consistency after elimination of some items. The ‘adapted domains’ were created after inversing the scores of items with posit...

Ovarian cancer, 2021

follow-up time was 30.4 months. There were no differences in progression free-survival (long-rank... more follow-up time was 30.4 months. There were no differences in progression free-survival (long-rank=0.069) or overall survival (long-rank=0.47) between the groups. Conclusion* Splenectomy in the course of debulking surgery for ovarian cancer does not seem to be associated with a higher rate of postoperative complications. Additionally, splenectomy does not have a deleterious influence before or during chemotherapy administration or a negative impact on oncological outcome.

Ovarian cancer, 2021

Introduction/Background* Advanced epithelial ovarian cancer (EOC) is a severe disease with high m... more Introduction/Background* Advanced epithelial ovarian cancer (EOC) is a severe disease with high mortality rate. Achieving complete cytoreduction (R=0; CCR) is crucial for the patient's prognosis. Extensive peritoneal carcinomatosis is often the limiting factor for achieving CCR in EOC and therefore is the deciding factor for therapy planning. The Peritoneal Cancer Index (PCI) after Sugarbaker has been an established tool to describe the extension of the disease. A patient presenting a PCI < 25 is considered to be operable 1. We examined the predictive power of various markers (CA-125, CTscans, PCI) for achieving complete cytoreduction after neoadjuvant chemotherapy (NACT). Methodology The data of 23 patients treated in our hospital between 01/2015 und 12/2020 with inoperable EOC were retrospectively analyzed. Clinical and radiological data were collected and statistically analysed (univariate analysis: Chi-Square Tests, Mann-Whitney U test and multivariate analysis: Binary logistic regression, ROC-curve). Result(s)* The reduction of the PCI itself after neoadjuvant chemotherapy showed to be a powerful predictor for complete cytoreduction (CCR), but it also showed to be significant even if the different PCI baseline values were considered. The reduction of the initial PCI score by minimum 8.5 points was a better predictor for CCR than the PCI < 25. Neither the RECIST analysis 2 of the CT-scans nor the reduction of the tumor marker CA-125 proved to be a significant predictor. Conclusion* Whether CCR can be achieved during debulking surgery, is best predicted by the reduction of the PCI. A combination of the three markers might be even more powerful. Larger studies are needed to confirm this.

Future Oncology, 2021

The current study was designed to compare oncological outcomes between oncoplastic (OBCS) and con... more The current study was designed to compare oncological outcomes between oncoplastic (OBCS) and conventional breast-conserving surgery (BCS). Data collected retrospectively from two groups of patients diagnosed with breast cancer, cases group (OBCS) and control group (BCS), were analyzed. A total of 277 women were included in the analysis: 193 (69.7%) in the cases group and 84 (30.3%) in the control group. Resected volume was larger in the OBCS group (438.05 ± 302.26 cm3 vs 223.34 ± 161.75 cm3; p < 0.001). Re-excision was required for 7.1% of patients receiving BCS versus 4.7% in the OBCS group (p = 0.402). After long-term follow up, no local recurrences occurred in the OBCS group, while 2.4% of patients receiving BCS had local relapse (p = 0.045). Compared with BCS, OBCS increases oncological safety in terms of re-excision rate and local recurrence.

Gynecologic Oncology, 2020

Ovarian metastases from breast cancer: series over a 20-years period at a Lebanese tertiary care ... more Ovarian metastases from breast cancer: series over a 20-years period at a Lebanese tertiary care center To report the characteristics and outcomes of patients presenting ovarian metastases from a breast cancer

ePoster, 2019

Introduction/Background Telomeres are DNA structures protecting the linear ends of eukaryotic chr... more Introduction/Background Telomeres are DNA structures protecting the linear ends of eukaryotic chromosomes against degradation and fusion, thereby maintaining genome stability. Telomerase is an enzyme that stabilizes the length of linear chromosomes by de novo synthesizing telomeric repeats during incomplete DNA replication, thus ensuring immortalization. This enzyme is expressed in 80% of cancers, including ovarian carcinoma. The human telomerase reverse transcriptase has been investigated as a detection marker for cancers in early stages, and a prognosis marker in late stages disease. The aim of this study is to investigate telomere length as a marker for survival and recurrence in ovarian carcinoma. Methodology 37 ovarian cancer biopsies have been isolated from Lebanese patients. The biopsies were subjected to DNA extraction, and then telomere length was assayed in cancer cells following the method elaborated by R. Cawthon (2002). Clinical data of each patient have been retrieved, including survival, recurrence, lymph node ratio, age, weight. Results The results obtained revealed a direct relation between telomere length and survival. In fact, patients with shorter survival rates (less than 1 year) exhibited 30% longer telomeres compared with patients with longer survival rates (3 to 5 years). Moreover, recurrence rates increased with longer telomeres. Higher ratios (35%) were detected in patients with early recurrence (less than 1 year) compared to patients with late or absent recurrence. However, no direct effect between telomere length and the other parameters was spotted. Conclusion Telomere length could be used as a prognostic marker in patients with ovarian cancer by predicting better survival and lower recurrence in case of shorter telomeres. This will be of a great value when making therapeutic decisions in a heterogeneous and aggressive disease as ovarian cancer. Disclosure Nothing to disclose.

ePoster, 2019

Introduction/Background To evaluate the potential impact on survival of residual tumor volume aft... more Introduction/Background To evaluate the potential impact on survival of residual tumor volume after chemoradiation and prior to brachytherapy initiation determined by magnetic resonance imaging in patients treated for locally advanced cervical cancer. Methodology MRI examinations were prospectively performed in patients with advanced cervical cancer (Stages IB2-IVA) after chemoradiation completion and prior to brachytherapy initiation. Region of interest-based 3D volumetry was derived on the treatment planning system by tracing the entire residual tumor region in each T2-weighted MRI slice. All patients received external beam radiation (EBRT) with concomitant weekly Cisplatin followed by high-dose rate endocavitary brachytherapy using volume-based planning. Cumulative EBRT and BT doses were calculated as the total equivalent dose in 2 Gy fractions (EQD2). Potential prognostic factors were selected based on non-parametric tests and then analyzed for survival with a Cox regression model. Results Median post-therapy follow-up was 27.4 months (range, 3–57.8). Thirty-seven patients were included. According to the FIGO classification, 8% were stage IB, 75% stage II, 11% stage III, and 6% stage IV. Overall survival was 86.5%. Of the patients evaluated, 29.7% had complete radiological remission and 18.9% were considered having local failure or distant disease. At bivariate analysis, residual volume >2 mL, D90 CTV-HR <84 Gy and excessive treatment time were all significant predictors of poor overall survival. At multivariate survival analysis, only the residual tumor volume persisted as a significant prognostic factor with survival rates of 95.8% and 69.2% for residual tumor ≤2 mL and >2 mL, respectively (p=0.005). Conclusion Our data suggest that residual tumor volume >2 mL at the time of brachytherapy is a predictor of poor survival. Disclosure Nothing to disclose. Abstract EP324 Figure 1 Overall survival curves according to residual tumor volume ≤2 mL and >2 mL

Oncology Letters, 2019

Although chemotherapy is the standard treatment for ovarian cancer (OC), recent studies have focu... more Although chemotherapy is the standard treatment for ovarian cancer (OC), recent studies have focused on its coupling with hypoglycemic drugs to decrease glucose availability. Similarly to cancer antigen 125 (Ca-125), telomerase, the key protein for telomere lengthening, is overexpressed in 90% of OC cases. The aim of the present study was to investigate the effect of the combination of glucose restriction and chemotherapy on telomere length and Ca-125 secretion in OC cells. SKOV-3, OVCAR-3 and Igrov-1 cells were treated with 20 µM cisplatin and 100 nM paclitaxel for 48 h in three different glucose concentrations: i) 4.5 g/l, ii) 1 g/l and iii) 0.5 g/l. The same treatment was repeated once per week for 6 consecutive weeks. The surviving cells were considered platinum-taxane escape (PTES) cells. The expression levels of telomerase and Ca-125 in treated and PTES cells were quantified by qPCR, and Ca-125 secretion by ELISA. Telomere length was evaluated by qPCR according to the Cawthon method. The modulation of Ca-125 by telomerase was assessed using inhibitors, small interfering RNA and transfection with human telomerase reverse transcriptase (hTERT) vectors. The implication of phosphatidylinositol-4,5-bisphosphate 3-kinase/protein kinase B/mechanistic target of rapamycin (PI3K/Akt/mTOR) in Ca-125 modulation was investigated using specific inhibitors. An increase in hTERT and Ca-125 expression levels (range, 1.5-3 fold) was observed in short-term treated cells. However, an opposite effect was detected in PTES cells, where the rate of decrease in the expression levels of hTERT and Ca-125 reached 60% after treatment in 0.5 g/l glucose. Moreover, telomere length was decreased by 30% in cells treated with 0.5 g/l glucose. Inhibition of hTERT expression significantly decreased Ca-125 secretion, suggesting a potential modulation of Ca-125 by hTERT. The inhibition of the PI3K/Akt/mTOR pathway also decreased Ca-125 secretion; however, the effect of this treatment was not enhanced when coupled with telomerase inhibitors. In conclusion, the combination of chemotherapy and glucose restriction was observed to decrease Ca-125 secretion and telomerase expression leading to shortening in telomere length. Thus, decreasing glucose availability for OC cells during treatment may lead to a better clinical outcome and potentially improve the prognosis of patients with OC.

The Breast, 2019

The positive predictive value (PPV) was 76.1% (71.1-80.6). The negative predictive value (NPV) wa... more The positive predictive value (PPV) was 76.1% (71.1-80.6). The negative predictive value (NPV) was 77.6% (75.6-79.1). On multivariate analysis including the covariates of pathological T factors (pT), nuclear grades, receptor subtypes and histological subtypes, the sensitivity was affected by pT factors (pT2: odds ratio 1.77(95%

Regional plenary, 2019

Conclusions mFI and high complexity surgery are predictive of Severe and Overall Complications. P... more Conclusions mFI and high complexity surgery are predictive of Severe and Overall Complications. Patients' pre-operative care profile evaluation may guide specialists in reducing, preventing and managing complications correctly. mFI seems to be effective in identify high-risk patients and represent a valuable tool to help health professionals in providing risk counseling and discussion of management for women undergoing surgery for gynecologic cancer.

E-Poster viewings, 2019

complications have occurred in 32% of cases. They were associated with neoadjuvant chemotherapy (... more complications have occurred in 32% of cases. They were associated with neoadjuvant chemotherapy (p = 0.009), elevated surgical complexity (p = 0.037), need for intraoperative transfusion and stay at intensive care unit more than 48 hours (p = 0.05). Complications were infectious, hemodynamic, pulmonary, digestive and surgical. Need for parenteral nutrition was significantly correlated with longer operative time and neoadjuvant chemotherapy. No correlation was found between occurrence of complications and the following parameters: age, stage, APACHE II score, Charlston Comorbidity index and preoperative albuminemia. Conclusions Cancer stage, neoadjuvant chemotherapy, high surgical complexity, need for transfusions, delayed extubation and stay at intensive care unit more than 48 hours were predictive factors of higher postoperative morbidity in patients receiving cytoreductive surgery for ovarian cancer.