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Antegrade cystoscopy - An innovative approach to managing acute urinary retention following vulvar reconstruction flap stenosis [Case Report]

Agrawal, Surbhi; Brandon, Caroline; Salame, Ghadir
Vulvar reconstruction can be performed following radical vulvectomy and is known to be associated with urologic complications. We describe the use of antegrade cystoscopy to manage acute urinary retention secondary to an obliterated urethral meatus following radical vulvectomy and reconstruction for radiation dermatitis. Antegrade cystoscopy was performed by applying the surgical concepts for suprapubic catheterization and general laparoscopy. Antegrade cystoscopy is a simple and safe approach for female patients with distorted pelvic anatomy from radical surgery and reconstructions for vulvar cancer.
PMID: 33426256
ISSN: 2352-5789
CID: 4762552

Treating through the surge: institutional experience of definitive management of cervical cancer patients at an urban institution during the COVID-19 pandemic [Meeting Abstract]

Lee, Sarah; Boyd, Leslie; Hacker, Kari; Salame, Ghadir; Pothuri, Bhavana; Schiff, Peter B. Schiff; Lymberis, Stella
ISSN: 0090-8258
CID: 4990762

Factors associated with delay in treatment initiation of locally advanced cervical cancer [Meeting Abstract]

Lee, S S; Berger, A A; Ishaq, O; Curtin, J P; Salame, G M; Pothuri, B; Schiff, P B; Boyd, L R; Lymberis, S
Objective: We aimed to explore the disparities associated with the delay of initiating chemoradiation therapy (CRT) and brachytherapy (BT) beyond the recommended 8 weeks for patients with cervical cancer and the effect on outcomes.
Method(s): Patients with FIGO stage IB2-IVA cervical cancer treated at an academic medical center and an urban public hospital by the same team of gynecologic and radiation oncologists with definitive CRT and BT from July 2009 to September 2017 were included. Patients received CRT followed by BT (7 Gy x 4 fractions) delivered via 2 insertions 1 week apart with image-guided CT/MR delineation. Patients who initiated CRT within 8 weeks from diagnosis as recommended (rCRT) were compared across demographic and cancer outcomes to patients who received delayed CRT after 8 weeks (dCRT). Disease-free survival (DFS) and overall survival (OS) were analyzed using adjusted Cox regression analysis (P < 0.05).
Result(s): In our cohort of 97 patients, 72 (75.0%) had rCRT and 24 (25.0%) had dCRT. At a median follow-up of 31.5 months, overall local control was achieved in 94.8% of patients. Patients with dCRT were more likely to be African-American (37.5% vs 17.8%, P = 0.046) and be uninsured or on Medicaid (87.5% vs 61.6%, P = 0.023). There were no differences in stage and grade. Patients with dCRT were more likely to recur or progress (OR = 2.65, 95% CI 1.02-6.86). Of those who recurred, 35.0% of rCRT patients had locoregional recurrence versus 66.7% of dCRT patients (P = 0.144). When controlling for age, race, insurance, referring hospital, and stage, patients with dCRT had lower DFS than patients with rCRT (50.6 vs 63.2 months, aHR = 6.11, 95% CI 2.00-18.62). However, there were no differences in OS.
Conclusion(s): Patients receiving delayed CRT tended to have worse recurrence and DFS than those initiating CRT by 8 weeks from diagnosis. African-American and uninsured patients were more likely to experience a delay in care. Navigator and social work services may help improve access to treatments for these patients.
ISSN: 0090-8258
CID: 4638422

Serous carcinoma of a prolapsed fallopian tube: A rare cause of a vaginal apex mass [Case Report]

Woodard, Tyler J; Margolis, Benjamin; Lee, Sarah; Salame, Ghadir
Background/UNASSIGNED:The differential diagnosis for women who present with a vaginal mass after undergoing a hysterectomy is dependent on the indication, type and timing of the hysterectomy. The differential diagnosis includes cervical dysplasia, malignancy, nabothian cysts, prolapsed endocervical polyp/fibroid, abscess, hematoma, granulation tissue, or dehiscence with organ evisceration. Case/UNASSIGNED:We introduce a case of a woman who presented with a vaginal apex mass and had a remote history of a total hysterectomy for an unknown indication. She was ultimately diagnosed with high grade serous carcinoma of a prolapsed fallopian tube. Conclusion/UNASSIGNED:This is the first reported case of serous carcinoma of a prolapsed fallopian tube and highlights the importance of maintaining a wide differential diagnosis for women who present with vaginal apex masses.
PMID: 32885015
ISSN: 2352-5789
CID: 4615462

Intraoperative Ultrasound Guided Intracavitary Brachytherapy: Improving Toxicity and Precision of Tandem Applicator Placement in Cervical Cancer [Meeting Abstract]

Domogauer, J. D.; Duckworth, T.; Osterman, S.; Pothuri, B.; Boyd, L.; Salame, G.; Kehoe, S.; Schiff, P. B.; Lymberis, S. C.
ISSN: 0360-3016
CID: 4686282

Patterns of Care and Survival Outcomes of Locally Advanced Endometrial Cancer: An Analysis of the National Cancer Database [Meeting Abstract]

Yan, S. X.; Wu, S. P. P.; Boyd, L.; Salame, G.; Schiff, P. B.; Lymberis, S. C.
ISSN: 0360-3016
CID: 3493332

Extent of lymph node dissection and overall survival in patients with uterine carcinosarcoma, papillary serous and endometrioid adenocarcinoma: A retrospective cohort study

Alagkiozidis, Ioannis; Weedon, Jeremy; Grossman, Allison; Wang, Pengfei; Mize, Benjamin; Wilson, Kirstie; Shah, Tana; Economos, Katherine; Salame, Ghadir; Abulafia, Ovadia; Lee, Yi-Chun
OBJECTIVE: To evaluate the interaction between extent of lymph node dissection (LND) and overall survival (OS) in patients with various histologic types of uterine cancer. METHODS: We retrospectively identified 834 patients who had primary surgery in our institution for uterine carcinosarcoma (CS), papillary serous (UPSC) and endometrioid adenocarcinoma between 1984 and 2009. Stage, grade, total lymph node count (LNC), positive LNC, adjuvant therapy, age, race and OS were collected. OS was calculated using the Kaplan-Meier method. Predictive factors were compared with the log rank test and Cox regression analysis. RESULTS: Our cohort included 158 patients with CS, 115 patients with UPSC and 561 patients with endometrioid adenocarcinoma. Of the cohort, 38% of the patients had Stage III or IV disease. LND was performed in 73% of patients with CS, 68% of patients with UPSC and 79% of patients with endometrioid adenocarcinoma. LND was performed in 82% of Stage I-II and in 68% of Stage III-IV cases. The median total LNC was 13 (range 1-75) and there was no significant difference in the total LNC between the different histologies. Median OS was 21 months for CS, 18 months for UPSC and 200 months for patients with endometrioid adenocarcinoma. A positive association between the total and positive LNC was present in all three histologic types (Spearman coefficient, p < 0.001). The cohort was divided in quartiles based on the total LNC and a Kaplan-Meier survival analysis was performed. A continuum of improved OS was noted in correlation with increased LNC. OS was 27 months for the group with 0 nodes, 112 months for the group with 1-8 nodes, 117 months for the group with 9-16 nodes and 196 months for the group with >17 nodes. Doubling the total LNC was associated with 28% risk of death reduction (HR 0.724, CI 0.66-0.794, p < 0.001) for the first year and 14% risk reduction (HR 0.858, CI 0.761-0.967, p = 0.012) for the second year. CONCLUSIONS: In our cohort, the performance of LND is associated with improved OS. This effect appears to be uniform across pathology types. The extent of the LND is inversely correlated with the risk of death for the first 2 years.
PMID: 26476418
ISSN: 1743-9159
CID: 1924082

Peripartum Primary Prophylaxis Inferior Vena Cava Filter Placement in a Patient with Stage IV B-Cell Lymphoma Presenting with a Pathologic Femur Fracture

Sherer, David M; Dalloul, Mudar; Behar, Henry James; Salame, Ghadir; Holland, Roy; Zinn, Harry; Abulafia, Ovadia
Background Pulmonary embolus (PE) remains a leading etiology of maternal mortality in the developed world. Increasing utilization of retrievable inferior vena cava (IVC) filter placement currently includes pregnant patients. Case A 22-year-old woman at 27 weeks' gestation was diagnosed with Stage IV high-grade malignant B cell lymphoma following pathologic femur fracture. Significant risk factors for PE led to placement of primary prophylaxis IVC filter before cesarean delivery, open reduction and internal fixation of the fractured femur, and chemotherapy. Conclusion This case supports that primary prophylaxis placement of IVC filters in highly selected pregnant patients may assist in decreasing PE-associated maternal mortality.
PMID: 26495170
ISSN: 2157-6998
CID: 1924072

Survival impact of cytoreduction to microscopic disease for advanced stage cancer of the uterine corpus: a retrospective cohort study

Alagkiozidis, Ioannis; Grossman, Allison; Tang, Nancy Z; Weedon, Jeremy; Mize, Benjamin; Salame, Ghadir; Lee, Yi-Chun; Abulafia, Ovadia
OBJECTIVE: To assess the impact of cytoreduction to no gross residual disease (R0) on overall survival (OS) in patients with stage III-IV uterine carcinosarcoma (CS), papillary serous/clear cell (UPSC/CC) and endometrioid carcinoma (EC). METHODS: We retrospectively identified 168 patients who underwent primary surgery for advanced uterine cancer between 1984 and 2009 in two teaching hospitals in Brooklyn, New York. Histology, stage, grade, residual disease (RD), adjuvant therapy, age, race and OS were collected. OS was calculated using the Kaplan-Meier method. Predictive factors were compared using the log-rank test and Cox regression analysis. RESULTS: Our cohort included 54 patients with CS (stage III, n = 32; stage IV, n = 22), 54 patients with UPSC/CC (stage III, n = 20; stage IV, n = 34) and 60 patients with EC (stage III, n = 45; stage IV, n = 15). R0 was achieved in 64% of patients with CS, in 53% of patients with UPSC/CC and in 68% of patients with EC. There was no interaction between histologic subtype and feasibility of complete cytoreduction (p = 0.39). R0 was associated with a median OS of 25 months (95% CI [18, 33]) versus 13 months (95% CI [8, 18]) in patients with gross RD (p = 0.03). This effect was uniform among histologic subtypes. On multivariate analysis, predictors of increased mortality were gross residual disease (HR = 2.0, 95% CI [1.1, 3.7], p = 0.01), stage IV (HR = 1.8, 95% CI [1.1, 3.1], p = 0.02) and age (HR = 1.04 per year of age, 95% CI [1.02, 1.07], p = 0.002). CONCLUSION: Cytoreductive surgery to R0 is associated with improved OS in advanced uterine cancer. This effect is uniform among histologies. There is no interaction between histologic subtype and feasibility of complete cytoreduction.
PMID: 25576762
ISSN: 1743-9159
CID: 1924092

Ex vivo Efficacy of Anti-Cancer Drug PNC-27 in the Treatment of Patient-Derived Epithelial Ovarian Cancer

Sarafraz-Yazdi, Ehsan; Gorelick, Constantine; Wagreich, Allison R; Salame, Ghadir; Angert, Mallorie; Gartman, Charles H; Gupta, Vinita; Bowne, Wilbur B; Lee, Yi-Chun; Abulafia, Ovadia; Pincus, Matthew R; Michl, Josef
OBJECTIVE: Despite an 80% response rate to chemotherapy, epithelial ovarian cancer has the highest case fatality rate of all gynecologic malignancies. Several studies have shown the efficiency of anticancer peptides PNC-27 and PNC-28 in killing a variety of cancer cells selectively in vitro and in vivo. The purpose of this study was to evaluate the efficacy of PNC-27 against human primary epithelial ovarian cancer. METHODS: We established primary cultures of freshly isolated epithelial ovarian cancer cells from patients with newly diagnosed ovarian cystadenocarcinomas. Two cell lines were obtained, one from mucinous cystadenocarcinoma, and the other from high-grade papillary serous carcinoma. The cancerous properties of these cells were characterized in vitro morphologically, by their growth requirements and serum independence. Treatment effects with PNC-27 were followed qualitatively by light microscopy, and quantitatively by measuring inhibition of cell growth using the MTT cell proliferation assay and direct cytotoxicity by measuring lactate dehydrogenase (LDH). RESULTS: PNC-27 inhibits in a dose-dependent manner the growth of and is cytotoxic to human primary cancer cells that had been freshly isolated from two ovarian epithelial cancers. The results further show that the control peptide PNC-29 has no effect on the primary cancer cells. Our results also show that PNC-27 is cytotoxic to cells from long-established and chemotherapy-resistant human ovarian cancer cell lines. CONCLUSION: These findings show, for the first time, the efficacy of PNC-27 on freshly isolated, primary human cancer cells. Our results indicate the potential of PNC-27 peptide as an efficient alternative treatment of previously untreated ovarian cancer as well as for ovarian cancers that have become resistant to present chemotherapies.
PMID: 26663795
ISSN: 1550-8080
CID: 1924062