Eva Madsen - Academia.edu (original) (raw)

Papers by Eva Madsen

European Journal of Surgical Oncology, 2022

European Journal of Cancer Supplements, 2007

Background: Over the past two decades there has been a transition towards less invasive local tre... more Background: Over the past two decades there has been a transition towards less invasive local treatment of breast cancer, without altering survival rates. Nowadays minimally invasive techniques, such as radiofrequency ablation (RFA) are being studied as local treatment of invasive breast carcinoma. We performed ex vivo ultrasound-guided RFA of breast carcinoma lesions to determine the feasibility of this promising technique and evaluated the histological findings. Materials and Methods: Radiofrequency ablation was performed of invasive ductal carcinoma-diagnosed by core needle biopsyin postmenopausal women, immediately after the surgical procedure (lumpectomy or mastectomy). A needle was placed in the centre of the tumour using ultrasound guidence. Subsequently, the tumour was ablated for a period of 12 minutes. Pathologic evaluation of the specimen was performed using conventional hematoxilin-eosin (HE) staining as well as cytokeratin 8 staining and NADH diaphorase to assess cell viability. Results: Up to now, 15 patients with an average age of 67.2 years (range 56.5−77.8) were included in this study. The mean tumour size was 12.5 mm (range 7−23). All procedures were technically successful. Pathology revealed complete cell death in 13 lesions, but viable cells were found in two lesions. In one specimen cytokeratin 8 revealed a microscopic focus of viable tissue and viable cells were found along the needle tract in another lesion. In one case the target lesion was completely destroyed, but viable DCIS was found just outside the ablated area. Conclusions: Ultrasound-guided radiofrequency ablation can result in complete cell death in invasive breast cancer. These results support the use of RFA in the local treatment of breast carcinoma and an in vivo study has been initiated in our institution to determine the feasibility, safety and complications of this procedure. 2067 POSTER Cost-effectiveness of extended adjuvant letrozole after five years of tamoxifen increases with treatment duration

Pleura and Peritoneum

Objectives Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is ... more Objectives Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with postoperative gastroparesis and ileus. In 2015, our practice shifted from using percutaneous gastrostomy tubes (PGT), to nasogastric tubes (NGT) for prophylactic gastric decompression after CRS-HIPEC. This study aimed to compare these methods for length of stay (LOS) and associated complications. Methods Patients that underwent CRS-HIPEC for peritoneal metastases from colorectal cancer between 2014 and 2019 were included. Cases were grouped based on receiving NGT or PGT postoperatively. Multivariable linear regression determined the independent effect of decompression method on LOS, thereby adjusting for confounders. Results In total, 179 patients were included in the analyses. Median age was 64 years [IQR:54–71]. Altogether, 135 (75.4%) received a NGT and 44 (24.6%) received a PGT. Gastroparesis occurred significantly more often in the PGT group (18.2 vs. 7.4%, p=0.039)....

European Journal of Surgical Oncology

European Journal of Surgical Oncology

Background. Malignant peritoneal mesothelioma (MPM) is a rare and aggressive disease. Recently, f... more Background. Malignant peritoneal mesothelioma (MPM) is a rare and aggressive disease. Recently, focus has shifted toward a more aggressive and multimodal treatment approach. This study aimed to assess the patterns of care and survival for MPM patients in the Netherlands on a nationwide basis. Methods. The records of patients with a diagnosis of MPM from 1993 to 2016 were retrieved from the Dutch Cancer Registry. Data regarding diagnosis, staging, treatment, and survival were extracted. Cox regression analyses and Kaplan-Meier survival curves were used to study overall survival. Results. Between 1993 and 2016, MPM was diagnosed for 566 patients. Overall, the prognosis was very poor (24% 1-year survival). The most common morphologic subtype was the epithelioid subtype (88%), followed by the biphasic (8%) and sarcomatoid (4%) subtypes. Surgical treatment has become more common in recent years, which most likely has resulted in improved survival rates. In this study, improved survival was independently associated with hyperthermic intraperitoneal chemotherapy (hazard ratio [HR], 0.33; 95% confidence interval [CI], 0.21-0.55) and surgery with adjuvant systemic chemotherapy (HR, 0.33; 95% CI, 0.23-0.48). Nonetheless, most patients (67%) do not receive any form of anti-cancer treatment. Conclusion. This study indicated that MPM still is a rare and fatal disease. The survival rates in the Netherlands have improved slightly in the past decade, most likely due to more aggressive treatment approaches and increased use of surgery. However, most patients still do not receive cancer-directed treatment. To improve MPM management, and ultimately survival, care should be centralized in expert medical centers. Malignant peritoneal mesothelioma (MPM) is a rare and aggressive neoplasm arising from the serosal lining of the abdominal cavity. 1 It represents about 10-15% of all malignant mesothelioma cases, making it the second most common location. 2 Pleural mesothelioma is far more common, representing more than 80% of cases. Other, more rare, locations are the pericardium (\ 1%) and the tunica vaginalis of the testis (\ 1%). The main risk factor for the development of malignant mesothelioma is asbestos exposure. 3 Generally, MPM is predominantly known as a locally aggressive tumor. Malignant ascites and locoregional invasion cause morbidity and mortality, whereas metastatic lymph nodes (5-10%) and extraabdominal disease (3-5%) are rare. Patients experience nonspecific symptoms such as nausea, abdominal pain, weight loss, and abdominal distension. 4 Accordingly, diagnosing MPM is difficult and often delayed. As a result, MPM is mostly diagnosed when patients are in an advanced stage of the disease, leading to poor survival rates even after extensive treatment. 5 Nadine L. de Boer and Job P. van Kooten contributed equally to this manuscript.

BMJ Open

IntroductionCytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has b... more IntroductionCytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has become standard of care for patients with peritoneal metastases of colorectal origin with a low/moderate abdominal disease load. In case of a peritoneal cancer index (PCI) score >20, CRS-HIPEC is not considered to be beneficial. Patients with a PCI >20 are currently offered palliative systemic chemotherapy. Previous studies have shown that systemic chemotherapy is less effective against peritoneal metastases than it is against haematogenous spread of colorectal cancer. It is suggested that patients with peritoneal metastases may benefit from the addition of intraperitoneal chemotherapy to systemic chemotherapy. Aim of this study is to establish the maximum tolerated dose of intraperitoneal irinotecan, added to standard of care systemic therapy for colorectal cancer. Secondary endpoints are to determine the safety and feasibility of this treatment and to establish the pharmacokinetic...

BMC Cancer

Background: Approximately 20-30% of patients with pT4 colon cancer develop metachronous peritonea... more Background: Approximately 20-30% of patients with pT4 colon cancer develop metachronous peritoneal metastases (PM). Due to restricted accuracy of imaging modalities and absence of early symptoms, PM are often detected at a stage in which only a quarter of patients are eligible for curative intent treatment. Preliminary findings of the COLOPEC trial (NCT02231086) revealed that PM were already detected during surgical re-exploration within two months after primary resection in 9% of patients with pT4 colon cancer. Therefore, second look diagnostic laparoscopy (DLS) to detect PM at a subclinical stage may be considered an essential component of early follow-up in these patients, although this needs confirmation in a larger patient cohort. Furthermore, a third look DLS after a negative second look DLS might be beneficial for detection of PM occurring at a later stage. Methods: The aim of this study is to determine the yield of second look DLS and added value of third look DLS after negative second look DLS in detecting occult PM in pT4N0-2 M0 colon cancer patients after completion of primary treatment. Patients will undergo an abdominal CT at 6 months postoperative, followed by a second look DLS within 1 month if no PM or other metastases not amenable for local treatment are detected. Patients without PM will subsequently be randomized between routine follow-up including 18 months abdominal CT, or an experimental arm with a third look DLS provided that PM or incurable metastases are absent at the 18 months abdominal CT. Primary endpoint is the proportion of PM detected after a negative second look DLS and will be determined at 20 months postoperative. Discussion: Second look DLS is supposed to result in 10% occult PM, and third look DLS after negative second look DLS is expected to detect an additional 10% of PM compared to routine follow-up alone in patients with pT4 colon cancer. Detection of PM at an early stage will likely increase the proportion of patients eligible for curative intent treatment and subsequently improve survival, given the uniformly reported direct association between the extent of peritoneal disease and survival.

Annals of Surgical Oncology

Background Malignant peritoneal mesothelioma (MPM) is a rare and aggressive disease. Recently, fo... more Background Malignant peritoneal mesothelioma (MPM) is a rare and aggressive disease. Recently, focus has shifted toward a more aggressive and multimodal treatment approach. This study aimed to assess the patterns of care and survival for MPM patients in the Netherlands on a nationwide basis. Methods The records of patients with a diagnosis of MPM from 1993 to 2016 were retrieved from the Dutch Cancer Registry. Data regarding diagnosis, staging, treatment, and survival were extracted. Cox regression analyses and Kaplan–Meier survival curves were used to study overall survival. Results Between 1993 and 2016, MPM was diagnosed for 566 patients. Overall, the prognosis was very poor (24% 1-year survival). The most common morphologic subtype was the epithelioid subtype (88%), followed by the biphasic (8%) and sarcomatoid (4%) subtypes. Surgical treatment has become more common in recent years, which most likely has resulted in improved survival rates. In this study, improved survival was ...

The Lancet Gastroenterology & Hepatology

BMJ Open

IntroductionMalignant peritoneal mesothelioma (MPM) is an uncommon but aggressive neoplasm and ha... more IntroductionMalignant peritoneal mesothelioma (MPM) is an uncommon but aggressive neoplasm and has a strong association with asbestos exposure. MPM has low survival rates of approximately 1 year even after (palliative) surgery and/or systemic chemotherapy. Recent advances in treatment strategies focusing on cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have resulted in improved median survival of 53 months and a 5 year survival of 47%. However, recurrence rates are high. Current systemic chemotherapy in the adjuvant setting is of limited efficacy, while immunotherapy with dendritic cell based immunotherapy (DCBI) has yielded promising results in murine models with peritoneal mesothelioma and in patients with pleural mesothelioma.Methods and analysisThe MESOPEC trial is an open-label single centre phase II study. The study population are adult patients with histological/cytological confirmed diagnosis of epithelioid malignant peritoneal mesotheliom...

BMC Cancer

Background: Upfront cytoreductive surgery with HIPEC (CRS-HIPEC) is the standard treatment for is... more Background: Upfront cytoreductive surgery with HIPEC (CRS-HIPEC) is the standard treatment for isolated resectable colorectal peritoneal metastases (PM) in the Netherlands. This study investigates whether addition of perioperative systemic therapy to CRS-HIPEC improves oncological outcomes.

European Journal of Surgical Oncology

European Journal of Surgical Oncology

Ejc Suppl, 2007

imaging modalities. They noted tumour size and localization as well as suspicion of multifocal or... more imaging modalities. They noted tumour size and localization as well as suspicion of multifocal or multicentric disease. The information on the therapeutic strategy was retrieved from the patients' files. The size and extent of the tumour on MRI was used to plan the definite surgical treatment. Results: A change in therapeutic strategy was obtained in 16 (46%) of the 35 patients. In 4 patients MR imaging showed a lager tumour size than was measured on clinical examination, mammograpy and ultrasound. In 8 patients a change in therapeutic management was made because of a multifocal tumour, which was suggested at MR imaging. Two patients had a change in surgical strategy because the tumour was diffusely spread towards the skin. One patient was diagnosed with a contralateral tumour and in one patient the MR imaging showed suspect lymph nodes in the axilla an aso xillary dissection was indicated. Conclusion: In this series the initial surgical therapy was changed in 16 out of 35 patients with invasive lobular carcinoma because of additional findings on MRI. Therefore MRI should be a standard preoperative procedure in every patient with a lobular carcinoma. 2056 POSTER A cross-study verification of breast cancer gene signature in peripheral blood

Annals of surgical oncology, Jan 26, 2015

The introduction of the sentinel lymph node biopsy (SLNB) in breast cancer has renewed interest i... more The introduction of the sentinel lymph node biopsy (SLNB) in breast cancer has renewed interest in lymphatic drainage to the internal mammary (IM) nodes. The clinical impact of tumor positive IM nodes is not completely clear. This study evaluated the incidence and impact on overall survival of metastatic IM SLNs. Between 1997 and 2010, 3685 patients underwent surgery including SLNB for primary breast cancer following an intratumoral or peritumoral radioactive-tracer injection. The presence of lymph node metastases was categorized according to the TNM-classification. Cumulative overall survival was estimated and the influence of metastases in the IM nodes and other factors was assessed by Cox-regression-analysis. In 754 patients (20.5 %) ipsilateral IM lymph nodes were visualized on preoperative lymphoscintigraphy, retrieval rate of IM SLNs was 81.0 %. IM metastases were detected in 130 patients (21.3 % of retrieved SLNs and 3.5 % of all patients respectively). The presence of IM met...

European Journal of Cancer Supplements, 2007

imaging modalities. They noted tumour size and localization as well as suspicion of multifocal or... more imaging modalities. They noted tumour size and localization as well as suspicion of multifocal or multicentric disease. The information on the therapeutic strategy was retrieved from the patients' files. The size and extent of the tumour on MRI was used to plan the definite surgical treatment. Results: A change in therapeutic strategy was obtained in 16 (46%) of the 35 patients. In 4 patients MR imaging showed a lager tumour size than was measured on clinical examination, mammograpy and ultrasound. In 8 patients a change in therapeutic management was made because of a multifocal tumour, which was suggested at MR imaging. Two patients had a change in surgical strategy because the tumour was diffusely spread towards the skin. One patient was diagnosed with a contralateral tumour and in one patient the MR imaging showed suspect lymph nodes in the axilla an aso xillary dissection was indicated. Conclusion: In this series the initial surgical therapy was changed in 16 out of 35 patients with invasive lobular carcinoma because of additional findings on MRI. Therefore MRI should be a standard preoperative procedure in every patient with a lobular carcinoma. 2056 POSTER A cross-study verification of breast cancer gene signature in peripheral blood

European Journal of Surgical Oncology, 2022

European Journal of Cancer Supplements, 2007

Background: Over the past two decades there has been a transition towards less invasive local tre... more Background: Over the past two decades there has been a transition towards less invasive local treatment of breast cancer, without altering survival rates. Nowadays minimally invasive techniques, such as radiofrequency ablation (RFA) are being studied as local treatment of invasive breast carcinoma. We performed ex vivo ultrasound-guided RFA of breast carcinoma lesions to determine the feasibility of this promising technique and evaluated the histological findings. Materials and Methods: Radiofrequency ablation was performed of invasive ductal carcinoma-diagnosed by core needle biopsyin postmenopausal women, immediately after the surgical procedure (lumpectomy or mastectomy). A needle was placed in the centre of the tumour using ultrasound guidence. Subsequently, the tumour was ablated for a period of 12 minutes. Pathologic evaluation of the specimen was performed using conventional hematoxilin-eosin (HE) staining as well as cytokeratin 8 staining and NADH diaphorase to assess cell viability. Results: Up to now, 15 patients with an average age of 67.2 years (range 56.5−77.8) were included in this study. The mean tumour size was 12.5 mm (range 7−23). All procedures were technically successful. Pathology revealed complete cell death in 13 lesions, but viable cells were found in two lesions. In one specimen cytokeratin 8 revealed a microscopic focus of viable tissue and viable cells were found along the needle tract in another lesion. In one case the target lesion was completely destroyed, but viable DCIS was found just outside the ablated area. Conclusions: Ultrasound-guided radiofrequency ablation can result in complete cell death in invasive breast cancer. These results support the use of RFA in the local treatment of breast carcinoma and an in vivo study has been initiated in our institution to determine the feasibility, safety and complications of this procedure. 2067 POSTER Cost-effectiveness of extended adjuvant letrozole after five years of tamoxifen increases with treatment duration

Pleura and Peritoneum

Objectives Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is ... more Objectives Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with postoperative gastroparesis and ileus. In 2015, our practice shifted from using percutaneous gastrostomy tubes (PGT), to nasogastric tubes (NGT) for prophylactic gastric decompression after CRS-HIPEC. This study aimed to compare these methods for length of stay (LOS) and associated complications. Methods Patients that underwent CRS-HIPEC for peritoneal metastases from colorectal cancer between 2014 and 2019 were included. Cases were grouped based on receiving NGT or PGT postoperatively. Multivariable linear regression determined the independent effect of decompression method on LOS, thereby adjusting for confounders. Results In total, 179 patients were included in the analyses. Median age was 64 years [IQR:54–71]. Altogether, 135 (75.4%) received a NGT and 44 (24.6%) received a PGT. Gastroparesis occurred significantly more often in the PGT group (18.2 vs. 7.4%, p=0.039)....

European Journal of Surgical Oncology

European Journal of Surgical Oncology

Background. Malignant peritoneal mesothelioma (MPM) is a rare and aggressive disease. Recently, f... more Background. Malignant peritoneal mesothelioma (MPM) is a rare and aggressive disease. Recently, focus has shifted toward a more aggressive and multimodal treatment approach. This study aimed to assess the patterns of care and survival for MPM patients in the Netherlands on a nationwide basis. Methods. The records of patients with a diagnosis of MPM from 1993 to 2016 were retrieved from the Dutch Cancer Registry. Data regarding diagnosis, staging, treatment, and survival were extracted. Cox regression analyses and Kaplan-Meier survival curves were used to study overall survival. Results. Between 1993 and 2016, MPM was diagnosed for 566 patients. Overall, the prognosis was very poor (24% 1-year survival). The most common morphologic subtype was the epithelioid subtype (88%), followed by the biphasic (8%) and sarcomatoid (4%) subtypes. Surgical treatment has become more common in recent years, which most likely has resulted in improved survival rates. In this study, improved survival was independently associated with hyperthermic intraperitoneal chemotherapy (hazard ratio [HR], 0.33; 95% confidence interval [CI], 0.21-0.55) and surgery with adjuvant systemic chemotherapy (HR, 0.33; 95% CI, 0.23-0.48). Nonetheless, most patients (67%) do not receive any form of anti-cancer treatment. Conclusion. This study indicated that MPM still is a rare and fatal disease. The survival rates in the Netherlands have improved slightly in the past decade, most likely due to more aggressive treatment approaches and increased use of surgery. However, most patients still do not receive cancer-directed treatment. To improve MPM management, and ultimately survival, care should be centralized in expert medical centers. Malignant peritoneal mesothelioma (MPM) is a rare and aggressive neoplasm arising from the serosal lining of the abdominal cavity. 1 It represents about 10-15% of all malignant mesothelioma cases, making it the second most common location. 2 Pleural mesothelioma is far more common, representing more than 80% of cases. Other, more rare, locations are the pericardium (\ 1%) and the tunica vaginalis of the testis (\ 1%). The main risk factor for the development of malignant mesothelioma is asbestos exposure. 3 Generally, MPM is predominantly known as a locally aggressive tumor. Malignant ascites and locoregional invasion cause morbidity and mortality, whereas metastatic lymph nodes (5-10%) and extraabdominal disease (3-5%) are rare. Patients experience nonspecific symptoms such as nausea, abdominal pain, weight loss, and abdominal distension. 4 Accordingly, diagnosing MPM is difficult and often delayed. As a result, MPM is mostly diagnosed when patients are in an advanced stage of the disease, leading to poor survival rates even after extensive treatment. 5 Nadine L. de Boer and Job P. van Kooten contributed equally to this manuscript.

BMJ Open

IntroductionCytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has b... more IntroductionCytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has become standard of care for patients with peritoneal metastases of colorectal origin with a low/moderate abdominal disease load. In case of a peritoneal cancer index (PCI) score >20, CRS-HIPEC is not considered to be beneficial. Patients with a PCI >20 are currently offered palliative systemic chemotherapy. Previous studies have shown that systemic chemotherapy is less effective against peritoneal metastases than it is against haematogenous spread of colorectal cancer. It is suggested that patients with peritoneal metastases may benefit from the addition of intraperitoneal chemotherapy to systemic chemotherapy. Aim of this study is to establish the maximum tolerated dose of intraperitoneal irinotecan, added to standard of care systemic therapy for colorectal cancer. Secondary endpoints are to determine the safety and feasibility of this treatment and to establish the pharmacokinetic...

BMC Cancer

Background: Approximately 20-30% of patients with pT4 colon cancer develop metachronous peritonea... more Background: Approximately 20-30% of patients with pT4 colon cancer develop metachronous peritoneal metastases (PM). Due to restricted accuracy of imaging modalities and absence of early symptoms, PM are often detected at a stage in which only a quarter of patients are eligible for curative intent treatment. Preliminary findings of the COLOPEC trial (NCT02231086) revealed that PM were already detected during surgical re-exploration within two months after primary resection in 9% of patients with pT4 colon cancer. Therefore, second look diagnostic laparoscopy (DLS) to detect PM at a subclinical stage may be considered an essential component of early follow-up in these patients, although this needs confirmation in a larger patient cohort. Furthermore, a third look DLS after a negative second look DLS might be beneficial for detection of PM occurring at a later stage. Methods: The aim of this study is to determine the yield of second look DLS and added value of third look DLS after negative second look DLS in detecting occult PM in pT4N0-2 M0 colon cancer patients after completion of primary treatment. Patients will undergo an abdominal CT at 6 months postoperative, followed by a second look DLS within 1 month if no PM or other metastases not amenable for local treatment are detected. Patients without PM will subsequently be randomized between routine follow-up including 18 months abdominal CT, or an experimental arm with a third look DLS provided that PM or incurable metastases are absent at the 18 months abdominal CT. Primary endpoint is the proportion of PM detected after a negative second look DLS and will be determined at 20 months postoperative. Discussion: Second look DLS is supposed to result in 10% occult PM, and third look DLS after negative second look DLS is expected to detect an additional 10% of PM compared to routine follow-up alone in patients with pT4 colon cancer. Detection of PM at an early stage will likely increase the proportion of patients eligible for curative intent treatment and subsequently improve survival, given the uniformly reported direct association between the extent of peritoneal disease and survival.

Annals of Surgical Oncology

Background Malignant peritoneal mesothelioma (MPM) is a rare and aggressive disease. Recently, fo... more Background Malignant peritoneal mesothelioma (MPM) is a rare and aggressive disease. Recently, focus has shifted toward a more aggressive and multimodal treatment approach. This study aimed to assess the patterns of care and survival for MPM patients in the Netherlands on a nationwide basis. Methods The records of patients with a diagnosis of MPM from 1993 to 2016 were retrieved from the Dutch Cancer Registry. Data regarding diagnosis, staging, treatment, and survival were extracted. Cox regression analyses and Kaplan–Meier survival curves were used to study overall survival. Results Between 1993 and 2016, MPM was diagnosed for 566 patients. Overall, the prognosis was very poor (24% 1-year survival). The most common morphologic subtype was the epithelioid subtype (88%), followed by the biphasic (8%) and sarcomatoid (4%) subtypes. Surgical treatment has become more common in recent years, which most likely has resulted in improved survival rates. In this study, improved survival was ...

The Lancet Gastroenterology & Hepatology

BMJ Open

IntroductionMalignant peritoneal mesothelioma (MPM) is an uncommon but aggressive neoplasm and ha... more IntroductionMalignant peritoneal mesothelioma (MPM) is an uncommon but aggressive neoplasm and has a strong association with asbestos exposure. MPM has low survival rates of approximately 1 year even after (palliative) surgery and/or systemic chemotherapy. Recent advances in treatment strategies focusing on cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have resulted in improved median survival of 53 months and a 5 year survival of 47%. However, recurrence rates are high. Current systemic chemotherapy in the adjuvant setting is of limited efficacy, while immunotherapy with dendritic cell based immunotherapy (DCBI) has yielded promising results in murine models with peritoneal mesothelioma and in patients with pleural mesothelioma.Methods and analysisThe MESOPEC trial is an open-label single centre phase II study. The study population are adult patients with histological/cytological confirmed diagnosis of epithelioid malignant peritoneal mesotheliom...

BMC Cancer

Background: Upfront cytoreductive surgery with HIPEC (CRS-HIPEC) is the standard treatment for is... more Background: Upfront cytoreductive surgery with HIPEC (CRS-HIPEC) is the standard treatment for isolated resectable colorectal peritoneal metastases (PM) in the Netherlands. This study investigates whether addition of perioperative systemic therapy to CRS-HIPEC improves oncological outcomes.

European Journal of Surgical Oncology

European Journal of Surgical Oncology

Ejc Suppl, 2007

imaging modalities. They noted tumour size and localization as well as suspicion of multifocal or... more imaging modalities. They noted tumour size and localization as well as suspicion of multifocal or multicentric disease. The information on the therapeutic strategy was retrieved from the patients' files. The size and extent of the tumour on MRI was used to plan the definite surgical treatment. Results: A change in therapeutic strategy was obtained in 16 (46%) of the 35 patients. In 4 patients MR imaging showed a lager tumour size than was measured on clinical examination, mammograpy and ultrasound. In 8 patients a change in therapeutic management was made because of a multifocal tumour, which was suggested at MR imaging. Two patients had a change in surgical strategy because the tumour was diffusely spread towards the skin. One patient was diagnosed with a contralateral tumour and in one patient the MR imaging showed suspect lymph nodes in the axilla an aso xillary dissection was indicated. Conclusion: In this series the initial surgical therapy was changed in 16 out of 35 patients with invasive lobular carcinoma because of additional findings on MRI. Therefore MRI should be a standard preoperative procedure in every patient with a lobular carcinoma. 2056 POSTER A cross-study verification of breast cancer gene signature in peripheral blood

Annals of surgical oncology, Jan 26, 2015

The introduction of the sentinel lymph node biopsy (SLNB) in breast cancer has renewed interest i... more The introduction of the sentinel lymph node biopsy (SLNB) in breast cancer has renewed interest in lymphatic drainage to the internal mammary (IM) nodes. The clinical impact of tumor positive IM nodes is not completely clear. This study evaluated the incidence and impact on overall survival of metastatic IM SLNs. Between 1997 and 2010, 3685 patients underwent surgery including SLNB for primary breast cancer following an intratumoral or peritumoral radioactive-tracer injection. The presence of lymph node metastases was categorized according to the TNM-classification. Cumulative overall survival was estimated and the influence of metastases in the IM nodes and other factors was assessed by Cox-regression-analysis. In 754 patients (20.5 %) ipsilateral IM lymph nodes were visualized on preoperative lymphoscintigraphy, retrieval rate of IM SLNs was 81.0 %. IM metastases were detected in 130 patients (21.3 % of retrieved SLNs and 3.5 % of all patients respectively). The presence of IM met...

European Journal of Cancer Supplements, 2007

imaging modalities. They noted tumour size and localization as well as suspicion of multifocal or... more imaging modalities. They noted tumour size and localization as well as suspicion of multifocal or multicentric disease. The information on the therapeutic strategy was retrieved from the patients' files. The size and extent of the tumour on MRI was used to plan the definite surgical treatment. Results: A change in therapeutic strategy was obtained in 16 (46%) of the 35 patients. In 4 patients MR imaging showed a lager tumour size than was measured on clinical examination, mammograpy and ultrasound. In 8 patients a change in therapeutic management was made because of a multifocal tumour, which was suggested at MR imaging. Two patients had a change in surgical strategy because the tumour was diffusely spread towards the skin. One patient was diagnosed with a contralateral tumour and in one patient the MR imaging showed suspect lymph nodes in the axilla an aso xillary dissection was indicated. Conclusion: In this series the initial surgical therapy was changed in 16 out of 35 patients with invasive lobular carcinoma because of additional findings on MRI. Therefore MRI should be a standard preoperative procedure in every patient with a lobular carcinoma. 2056 POSTER A cross-study verification of breast cancer gene signature in peripheral blood