Dennis S Chi

Memorial Sloan-Kettering Cancer Center, New York City, New York, United States

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Publications (290)1052.06 Total impact

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    ABSTRACT: To assess the ability of preoperative computed tomography (CT) scan of the abdomen/pelvis and serum CA-125 to predict suboptimal (>1cm residual disease) primary cytoreduction in advanced ovarian, fallopian tube, and peritoneal cancer.
    Gynecologic oncology. 07/2014;
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    Gynecologic oncology. 07/2014; 134(1):6-9.
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    ABSTRACT: Objective To compare survival outcomes for patients with advanced epithelial ovarian cancer (EOC) who received primary intravenous/intraperitoneal (IV/IP) chemotherapy to those who received IV followed by consolidation (treatment given to patients in remission) IP chemotherapy. Methods Data were analyzed and compared for all patients with stage III–IV EOC who underwent optimal primary cytoreduction (residual disease ≤ 1 cm) followed by cisplatin-based consolidation IP chemotherapy (1/2001–12/2005) or primary IV/IP chemotherapy (1/2005–7/2011). Results We identified 224 patients; 62 (28%) received IV followed by consolidation IP chemotherapy and 162 (72%) received primary IV/IP chemotherapy. The primary IP group had significantly more patients with serous tumors. The consolidation IP group had a significantly greater median preoperative platelet count, CA-125, and amount of ascites. There were no differences in residual disease at the end of cytoreduction between both groups. The median progression-free survival (PFS) was greater for the primary IP group; however, this did not reach statistical significance (23.7 months vs 19.7 months; HR 0.78; 95% CI, 0.57–1.06; p = 0.11). The median overall survival (OS) was significantly greater for the primary IP group (78.8 months vs 57.5 months; HR 0.56; 95% CI, 0.38–0.83; p = 0.004). On multivariate analysis, after adjusting for confounders, the difference in PFS was not significant (HR 0.78; 95% CI, 0.56–1.11; p = 0.17), while the difference in OS remained significant (HR 0.59; 95% CI, 0.39–0.89; p = 0.01). Conclusions In our study, primary IV/IP chemotherapy was associated with improved OS compared to IV followed by consolidation IP chemotherapy in patients with optimally cytoreduced advanced EOC.
    Gynecologic Oncology 06/2014; · 3.93 Impact Factor
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    ABSTRACT: The amount of the largest diameter of visible residual tumor after cytoreductive surgery remains one of the strongest prognostic factors in advanced ovarian cancer. The implementation of a more aggressive surgical approach to increase the proportion of patients without visible residual tumor is, therefore, a rational concept. Thus, the surgical management of advanced ovarian, primary peritoneal and fallopian tube cancers now incorporates more comprehensive surgical procedures. However, these more extensive surgical procedures are associated with an increased risk of morbidity, which may have a negative impact on the oncologic outcome. In addition, it is unclear whether all patients benefit from a comprehensive surgical intervention in the same way or if there are patients whose disease course will not be influenced by this approach. The methodologic analysis of surgical effectiveness is complex and controversial owing to a lack of prospective surgical trials. This review acknowledges controversies and aims to discuss novel developments in the field of cytoreductive surgery for patients with ovarian, primary peritoneal and fallopian tube cancers. The focus of the review is to discuss the role of surgery at initial diagnosis. The role of secondary and tertiary surgery in the recurrent setting is beyond the scope of this review.
    Women s Health 03/2014; 10(2):179-90.
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    ABSTRACT: This study aimed to determine the feasibility of cervical conization and sentinel lymph node (SLN) mapping as a fertility-sparing strategy to treat stage I cervical cancer and to estimate the tumor margin status needed to achieve no residual carcinoma in the cervix. We identified all patients who desired fertility preservation and underwent SLN mapping with cervical conization for stage I cervical cancer from September 2005 to August 2012. Relevant demographic, clinical, and pathologic information was collected. Ten patients were identified. Median age was 28 years (range, 18-36 years). None of the patients had a grossly visible tumor. The initial diagnosis of invasive carcinoma was made either on a loop electrosurgical excision procedure or cone biopsy. All patients underwent preoperative radiologic evaluation (magnetic resonance imaging and positron emission tomography-computed tomography). None of the patients had evidence of gross tumor or suspicion of lymph node metastasis on imaging. Stage distribution included 7 (70%) patients with stage IA1 cervical cancer with lymphovascular invasion and 3 (30%) patients with microscopic IB1. Histologic diagnosis included 8 (80%) patients with squamous cell carcinoma, 1 (10%) patient with adenocarcinoma, and 1 (10%) patient with clear cell carcinoma. Nine patients underwent repeat cervical conization with SLN mapping, and 1 patient underwent postconization cervical biopsies and SLN mapping. None of the patients had residual tumor identified on the final specimen. The median distance from the invasive carcinoma to the endocervical margin was 2.25 mm, and the distance from the invasive carcinoma to the ectocervical margin was 1.9 mm. All collected lymph nodes were negative for metastasis. After a median follow-up of 17 months (range, 1-83 months), none of the patients' conditions were diagnosed with recurrent disease and 3 (30%) patients achieved pregnancy. Cervical conization and SLN mapping seems to be an acceptable treatment strategy for selected patients with small-volume stage I cervical cancer. Tumor clearance of 2 mm and above seems to correlate well with no residual on repeat conization. A larger sample size and longer follow-up is needed to establish the long-term outcomes of this procedure.
    International Journal of Gynecological Cancer 12/2013; · 1.94 Impact Factor
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    ABSTRACT: Primary cytoreductive surgery in patients with stage IIIC-IV epithelial ovarian cancer frequently includes diaphragm peritonectomy or resection, which can lead to symptomatic pleural effusions when the resection specimen is ≥10cm. Our objective was to evaluate whether the placement of an intraoperative thoracostomy tube decreased the incidence of symptomatic pleural effusions in these cases. We identified 156 patients who underwent primary debulking surgery involving diaphragm peritonectomy or resection for stage III-IV ovarian cancer from 1/01-12/09. Using standard statistical tests, the incidence of symptomatic pleural effusions and other variables were compared between patients who did and did not have intraoperative chest tubes placed. Forty-nine patients had a resected diaphragm specimen ≥10cm in largest dimension; 28 (57%) did not undergo chest tube placement (NCT group) while 21 (43%) did (CT group). Mediastinal lymph node dissection (0% vs 19%, P=0.028) and liver resections (11% vs 38%, P=0.037) were higher in the CT group. Postoperatively, 57% of the NCT group developed a moderate or large pleural effusion compared to 19% of the CT group (P=0.007). Thirteen patients (46%) in the NCT group developed respiratory symptoms requiring either placement of a postoperative chest tube or thoracentesis compared to 3 patients (14%) in the CT group (P=0.018). Diaphragm peritonectomy or resection can often lead to moderate or large pleural effusions that may become symptomatic. In these patients, intraoperative chest tube placement may be considered to decrease the incidence of symptomatic effusions and the need for postoperative chest tube placement or thoracentesis.
    Gynecologic Oncology 11/2013; · 3.93 Impact Factor
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    ABSTRACT: To describe the learning curve associated with training fellows in completing robotic assisted total laparoscopic hysterectomies. All patients scheduled to undergo a robotic procedure at our institution from 5/15/07-5/22/12 were identified. Fellow participation per procedure was documented. The learning curve of fellows for the time to complete a hysterectomy (from initiation of developing the retroperitoneal space to the completion of the colpotomy) was analyzed. Of the 1754 planned robotic cases, 1626 were completed robotically and 128 were converted to laparotomy. Fifty-seven fellows participated in 99.7% of the cases. Eleven gynecologic oncology fellows completed at least 1 robotic assisted total laparoscopic hysterectomy. From 7/7/08-5/21/12, 981 hysterectomies were completed robotically, 254 of these (25.9%) by the 11 fellows. Prior to completing a hysterectomy, the median number of hysterectomies in which a fellow participated was 16 (range, 11-40). Median amount of time for a fellow to complete a hysterectomy decreased from 60minutes in 2009 (N=27 cases) to 31minutes in 2011 (N=148 cases). Based on the recorded completion times in which the 11 fellows completed a hysterectomy, it required ~33 cases per fellow to be able to perform the hysterectomy and overcome the learning curve. The learning curve associated with hysterectomy requires completion of ~33 cases by the fellow after an initial median experience of 16 cases. Our data suggest that a minimum of 50 total cases is required during fellowship to complete a robotic hysterectomy.
    Gynecologic Oncology 11/2013; · 3.93 Impact Factor
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    ABSTRACT: Magnetic resonance imaging (MRI) is the modality of choice for staging gynecological cancers owing to its superb soft tissue resolution, whereas F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) allows the assessment of glycolytic activity within the tumor microenvironment. In this study, we evaluated the incremental value of fused MRI/PET over MRI or fluorodeoxyglucose PET/CT alone for assessing local disease extent in patients with recurrent gynecological cancers undergoing pelvic exenteration and determined the associations between imaging findings and clinical outcomes in this patient population. The institutional review board approved this retrospective, Health Insurance Portability and Accountability Act (HIPAA)-compliant study of 31 patients who underwent pelvic MRI and PET/CT 3 months or less before pelvic exenteration for recurrent cancers of the uterine cervix, corpus, or vulva/vagina. Using a 1 to 5 scale (1, definitely not present; 5, definitely present), 2 readers independently evaluated MRI, PET/CT, and fused MRI/PET images for the presence of bladder, rectum, and pelvic sidewall invasion. Surgical pathology constituted the reference standard. Measurements of diagnostic accuracy, interreader agreement, and associations between imaging findings and progression-free survival and overall survival were calculated. Compared with MRI or PET/CT, fused MRI/PET correctly improved readers' diagnostic confidence in detecting bladder, rectum, or pelvic sidewall invasion in up to 52% of patients. Interreader agreement was consistently in the highest ("almost perfect") range only for MRI/PET (κ = 0.84-1.0). The highest sensitivities (0.82-1.0), specificities (0.91-1.0), and predictive values (0.80-1.0) were consistently achieved with fused MRI/PET (although the differences were not statistically significant [P > 0.05]). Pelvic sidewall invasion on MRI/PET was the only finding significantly associated with both progression-free and overall survival for both readers (P = 0.0067-0.0440). In patients with recurrent gynecological cancers undergoing pelvic exenteration, fused MRI/PET served as a predictive biomarker and yielded greater diagnostic confidence and interreader agreement than either MRI or PET/CT.
    International Journal of Gynecological Cancer 10/2013; 23(8):1512-1519. · 1.94 Impact Factor
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    ABSTRACT: The objective of this study was to evaluate the risk factors and potential morbidity associated with intraoperative hypothermia (IH) during cytoreductive surgery (CRS) for advanced ovarian cancer. Demographic and perioperative data were collected for all patients with stage IIIC-IV ovarian, fallopian tube, and primary peritoneal carcinoma who underwent primary CRS at our institution from 2001-2010. Only patients with carcinomatosis and/or bulky upper abdominal disease and residual disease of <1cm were included. Intraoperative hypothermia was defined as temperature of <36.0(o) Celsius (C). Associations with 21 perioperative factors, 12 systems-based complications, and specific complications including but not limited to venous thromboembolism and surgical site infection were evaluated. Two hundred ninety-seven patients met the inclusion criteria. An intraoperative T <36(o) C was noted in 72.1% of patients, and a temperature <36(o) C at the time of abdominal closure was noted in 45.5%. Intraoperative vasopressors (P=0.02), epidural anesthesia (P=0.01), transfusion of fresh frozen plasma (P<0.05), and blood loss (P=0.01) were associated with IH. There was no association between IH and postoperative complications in general (P=0.48) or specifically grade 3-5 complications (P=0.34). Univariate analysis did show an association between hematologic complications and IH; however, this did not persist on multivariate analysis (P=0.14). In patients who underwent optimal primary CRS for advanced ovarian cancer, IH alone was not associated with the development of postoperative complications. Postoperative morbidity in these patients is multifactorial and further investigation into modifiable risk factors is warranted.
    Gynecologic Oncology 09/2013; · 3.93 Impact Factor
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    ABSTRACT: OBJECTIVE: It is well documented that recurrence after pelvic exenteration remains high (up to 50%), and patients may require a prolonged period of recuperation following this aggressive surgery. We conducted a retrospective review to evaluate the feasibility of administering adjuvant chemotherapy after pelvic exenteration for gynecologic malignancies. METHODS: We reviewed the medical records of patients with any gynecologic cancer who underwent exenterative surgery between January 2005 and February 2011 at our institution. Patients were referred for postexenteration adjuvant chemotherapy based on surgeon's discretion and/or presence of high-risk features: positive margins, positive lymph nodes, and/or lymphovascular space invasion. Suitability for chemotherapy was assessed by a gynecologic medical oncologist. Regimens consisted of 4 to 6 cycles of platinum-based doublet chemotherapy. Chemotherapy-related toxicities were assessed using the Common Terminology Criteria for Adverse Events version 4. RESULTS: We identified 42 patients who underwent pelvic exenteration during the study period. Eleven (26%) were referred for adjuvant chemotherapy. Three (27%) of the 11 patients did not receive chemotherapy because of delayed postoperative recovery or physician choice. Seven (88%) of the remaining 8 patients completed all scheduled chemotherapy. Grade 2 toxicities or greater were documented in 6 patients (75%), the most common being neutropenia, neuropathy, and fatigue. Median follow-up time was 25 months (range, 6-56 months). The 3-year progression-free and overall survival rates of the 8 patients who received chemotherapy were 58% (95% confidence interval, 18%-84%) and 54% (95% confidence interval, 13%- 83%), respectively. CONCLUSIONS: The administration of adjuvant chemotherapy is feasible for a select group of patients after pelvic exenteration for gynecologic malignancies. Our results need to be interpreted with caution because of the small and heterogeneous cohort of patients included.
    International Journal of Gynecological Cancer 06/2013; 23(5):923-928. · 1.94 Impact Factor
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    ABSTRACT: OBJECTIVES: Radical trachelectomy has enabled select women with stage I cervical cancer to maintain fertility after treatment. Tumor size greater than 2 cm has been considered a contraindication, and those patients denied trachelectomy. We report our trachelectomy experience with tumors measuring 2 to 4 cm. METHODS: We retrospectively reviewed the medical records of all patients planned for fertility-sparing radical trachelectomy. Largest tumor dimension was determined by physical examination, preoperative magnetic resonance imaging, or pathologic evaluation. No patient received neoadjuvant chemotherapy. RESULTS: Twenty-nine (26%) of 110 patients had stage IB1 disease with tumors 2 to 4 cm. Median age was 31 years (range, 22-40 years), and 83% were nulliparous. Thirteen patients (45%) had squamous cell carcinoma, 12 patients (41%) had adenocarcinoma, and 4 patients (14%) had adenosquamous carcinoma. Thirteen (45%) of 29 patients had positive pelvic nodes. All para-aortic nodes were negative. Owing to intraoperative frozen section, 13 patients (45%) underwent immediate hysterectomy and 1 patient (3%) definitive chemoradiation. Owing to high-risk features on final pathology, 6 patients (21%) who had retained their uterus received chemoradiation. Nine patients (31%) underwent a fertility-sparing procedure. At a median follow-up of 44 months (range, 1-90 months), there was one recurrence. CONCLUSIONS: Expanding radical trachelectomy inclusion criteria to women with 2- to 4-cm tumors allows for a fertility-sparing procedure in 30% of patients who would otherwise have been denied the option, with no compromise in oncologic outcome.
    International Journal of Gynecological Cancer 05/2013; · 1.94 Impact Factor
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    ABSTRACT: OBJECTIVES: To determine if extensive upper abdominal surgery (UAS) affected overall survival (OS) in patients left with ≤1cm but visible residual disease after undergoing primary cytoreductive surgery for ovarian cancer. Our secondary objective was to determine if leaving ≤1cm but visible residual throughout the small bowel (SB) conferred a worse prognosis. METHODS: All stage IIIB-IV ovarian cancer patients who had visible but ≤1cm residual disease at time of primary cytoreductive surgery from 2001-2010 were identified. Extensive UAS procedures and residual SB involvement were recorded. RESULTS: The 219 patients identified with ≤1cm but visible residual disease had a median OS of 51 months. In this cohort, 127 had extensive UAS performed, and 87 had residual disease involving the SB. Univariate OS analysis was performed. There was no significant difference in OS between patients who did or did not have extensive UAS (45 vs. 52 months, P=0.56), or between patients with or without residual SB disease (45 vs. 51 months, P=0.84). Factors that were significantly associated with OS were age, ASA score, family history, and stage. CONCLUSIONS: Patients cytoreduced to ≤1cm but visible residual disease who required UAS did not have a worse OS than those who did not require UAS. OS was similar if residual disease involved the SB or not. For ovarian cancer patients with disease not amenable to complete gross resection, extensive surgery should still be considered to achieve ≤1cm but visible residual disease status, including cases where the residual disease involves the SB.
    Gynecologic Oncology 05/2013; · 3.93 Impact Factor
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    ABSTRACT: PURPOSE: To determine the diagnostic performance of MRI in assessing local tumour extent and evaluate associations between MRI features and survival in patients undergoing MRI before pelvic exenteration for persistent or recurrent gynaecological cancers. METHODS AND MATERIALS: The study included 50 patients with persistent or recurrent gynaecological malignancies who underwent pelvic exenteration between January 1999 and December 2011 and had MRI at most 90 days before surgery. Two radiologists independently assessed invasion of adjacent organs (on a 5-point scale). Diagnostic accuracy, inter-reader agreement, and associations between organ invasion on MRI and patient survival were evaluated. RESULTS: Areas under receiver operating characteristic curves (AUCs) for invasion of the bladder, rectum and pelvic sidewall were 0.96, 0.90 and 0.98 for reader 1 and 0.95, 0.88 and 0.90 for reader 2. Corresponding sensitivities/specificities were 87.0 %/92.6 %, 81.3 %/97.0 % and 87.5 %/97.2 % for reader 1, and 87.0 %/100.0 %, 75.0 %/97.0 % and 75.0 %/94.4 % for reader 2. Inter-reader agreement was excellent for organ invasion (κ = 0.81-0.85). Pelvic sidewall invasion on MRI was associated with overall and recurrence-free survival (P = 0.01-0.04 for the two readers). CONCLUSION: Preoperative MRI is accurate in predicting organ invasion. It may guide surgical planning and serve as a predictive biomarker in patients undergoing pelvic exenteration for gynaecological malignancies. KEY POINTS: • MRI can accurately assess bladder and rectal wall invasion before major surgery. • MRI identifies patients requiring extended pelvic exenteration by detecting sidewall invasion. • Inter-reader agreement for detecting organ invasion and tumor size is excellent. • Pelvic sidewall invasion on MRI is associated with shorter overall and recurrence-free survival.
    European Radiology 05/2013; · 4.34 Impact Factor
  • Nisha Lakhi, Eli Serur, Dennis S Chi
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    ABSTRACT: An unexpected diagnosis of intravascular leiomyomatosis was made during a laparoscopic procedure. As the extent of the disease was unknown, the initial procedure was limited to laparoscopic hysterectomy and salpingo-oophorectomy. Postoperative computed tomography imaging demonstrated intravascular leiomyomatosis extending into the suprarenal inferior vena cava. The patient underwent exploratory laparotomy to excise residual tumor.
    American journal of obstetrics and gynecology 02/2013; · 3.28 Impact Factor
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    ABSTRACT: OBJECTIVE: The objective of this study was to compare morbidity and outcome following radical surgery with or without adjuvant radiation therapy (RT) in the treatment of stages IB1-IB2 cervical carcinoma. METHODS: We retrospectively identified 222 patients with stages IB1-IB2 cervical carcinoma treated initially with radical hysterectomy or radical trachelectomy with or without adjuvant RT from February 2000 to November 2009. All grade 3 or higher complications-those requiring interventional radiology, endoscopic evaluation, or operative intervention-were documented. RESULTS: One hundred fifty-eight patients (71%) underwent radical hysterectomy; 64 (29%) underwent radical trachelectomy. One hundred fifty-three patients (69%) underwent surgery alone; 69 (31%) received adjuvant radiation with or without chemosensitization. There was a statistically significant difference in the rate of total grades 1 to 5 late complications between the surgery-alone and surgery + RT groups (12% vs 32%, respectively; P < 0.001); however, the rate of grade 3 or higher complications was similar (5% vs 4%, respectively; P = 0.999). The progression-free and overall survival rates of the entire cohort were both 95%. The 5-year progression-free survival rates for the surgery-alone and surgery + RT groups were 93% and 90% (P = 0.172). The overall survival rates were 96% and 91%, respectively (P = 0.332). CONCLUSIONS: The majority of women with stages IB1-IB2 cervical cancer undergoing radical surgery do not require adjuvant RT, have excellent oncologic outcome, and have low severe complication rates. Nearly one third of our patients required postoperative radiation, with no statistically significant increase in severe complication rate and with similar oncologic outcomes compared with the surgery-only cohort. These data support the continued practice of radical surgery with individualized postoperative radiation for these patients.
    International Journal of Gynecological Cancer 02/2013; · 1.94 Impact Factor
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    ABSTRACT: OBJECTIVE: In patients undergoing pelvic exenteration for recurrent gynecological malignancies, we assessed the performance of [(18)F]-FDG PET/CT for delineating disease extent; and evaluated the association between quantitative FDG uptake metrics (SUV(max,) total lesion glycolysis [TLG] and metabolic tumor volume [MTV]) and progression-free survival (PFS) and overall survival (OS). METHODS: Retrospective study of patients undergoing pelvic exenteration for gynecologic malignancies between January 2002-November 2011 who had FDG PET/CT within 90days before surgery. Two readers (R1,R2) independently determined the presence of bladder, rectum, vagina, cervix and pelvic side wall invasion and measured SUV(max), TLG and MTV in each patient. Areas under the curve (AUCs), for detecting organ invasion were calculated. Kaplan-Meier graphs were used to determine associations between FDG uptake and PFS/OS. Inter-reader agreement was assessed. RESULTS: 33 patients(mean age 56years,range:28-81) were included; primary sites of disease were the cervix (n=18), uterus (n=8) and vagina/vulva (n=7). AUCs for organ invasion ranged from 0.74-0.96. There was a significant association between FDG uptake metrics incorporating tumor volume (TLG and MTV) and OS (p≤0.001) as well as between MTV and PFS (p=0.001). No significant association was identified between SUV(max) and OS/PFS (p=0.604/0.652). Inter-reader agreement for organ invasion was fair to substantial (k=0.36-0.74) and almost perfect for FDG quantification (ICC=0.97-0.99). CONCLUSION: In patients undergoing pelvic exenteration for recurrent gynecological malignancies, (18)F-FDG PET/CT is useful for preoperative assessment of disease extent. Furthermore, quantitative metrics of FDG uptake incorporating MTV serve as predictive biomarkers of progression-free and overall survival in this population.
    Gynecologic Oncology 01/2013; · 3.93 Impact Factor
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    ABSTRACT: Usual-type VIN is an HPV-associated premalignant condition that can affect immunocompromised patients and may have multifocal, multicentric involvement.Immunocompromised patients who may be poor surgical candidates, and in whom topical modalities may prove ineffective, treatment remains a challenge.We present such a patient in whom sinecatechin was successfully used as an alternative to less desired and effective treatment options.
    Gynecologic Oncology Case Reports. 01/2013; 6:10–12.
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    ABSTRACT: PURPOSE To determine the accuracy of preoperative pelvic MRI in the evaluation of organ invasion in patients with recurrent gynecologic malignancies scheduled to undergo pelvic exenteration with curative intent METHOD AND MATERIALS 41 patients with biopsy-proven recurrent gynecologic malignancies who underwent pelvic exenteration between January, 1999 and December, 2011, and who had preoperative pelvic MRI performed at 1.5 Tesla or higher within 60 days of surgery were included in this retrospective study. All preoperative MRI examinations were independently and retrospectively reviewed by two radiologists. Presence of organ invasion was graded on a 5-point scale (from 1 – no invasion to 5 – definite invasion). The diagnostic performance of MRI for organ invasion was determined by the area under the receiver operating characteristic curve (AUC) and calculation of sensitivity and specificity. Interobserver agreement was evaluated with simple kappa statistics. Final surgical pathology served as the standard of reference RESULTS Primary tumors included carcinoma of the cervix (n=25), uterus/endometrium (n=8), vagina/vulva (n=7), and adenosarcoma of the Mullerian origin (n=1). 28 patients underwent total exenteration, 12 patients – anterior, and 1 patient - posterior pelvic exenteration. 39/41 (95%) patients had prior radiation treatment. Resection with negative margins was achieved in 32/41 (78%) patients. Inter-reader agreement for organ invasion ranged from substantial for invasion of the bladder (k= 0.80) and rectum (k= 0.75) to moderate for invasion of the vagina (k=0.45). The AUCs for invasion of the bladder, rectum, and vagina were 0.96, 0.89, and 0.76 for reader 1 and 0.97, 0.86, and 0.61 for reader 2, respectively. Sensitivities and specificities for organ invasion were as follows: bladder - 88%/92%, 88%/100%, rectum - 82%/93%, 73%/93%, and vagina - 94%/60%, 97%/40% for readers 1 and 2, respectively CONCLUSION Preoperative MRI is accurate in predicting organ invasion in patients with recurrent gynecologic malignancies selected to undergo pelvic exenteration with curative intent CLINICAL RELEVANCE/APPLICATION In patients undergoing pelvic exenteration, MRI is a valuable preoperative examination for the evaluation of tumor extent and invasion of adjacent organs
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
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    ABSTRACT: OBJECTIVES: High-grade serous ovarian cancer (HGSOC) mostly presents at an advanced stage and has a low overall survival rate. However, a subgroup of patients are seemingly cured after standard initial therapy. We hypothesize that molecular profiles of these patients vary from long-term survivors who recur. METHODS: Patients with advanced HGSOC who underwent primary cytoreductive surgery and platinum-based chemotherapy were identified from The Cancer Genome Atlas (TCGA) and institutional (MSKCC) samples. A curative-intent group was defined by recurrence-free survival of >5years. A long-term recurrent group was composed of patients who recurred but survived >5years. RNA was hybridized to Affymetrix U133A transcription microarrays. The NanoString nCounter gene expression system was used for validation in an independent patient population. RESULTS: In 30 curative and 84 recurrent patients, class comparison identified twice as many differentially expressed probes between the groups than expected by chance alone. TCGA and MSKCC data sets had 19 overlapping genes. Pathway analyses identified over-represented networks that included nuclear factor kappa B (NFkB) transcription and extracellular signal-regulated kinase (ERK) signaling. External validation was performed in an independent population of 28 curative and 38 recurrent patients. Three genes (CYP4B1, CEPT1, CHMP4A) in common between our original datasets remained differentially expressed in the external validation data. CONCLUSIONS: There are distinct transcriptional elements in HGSOC from patients likely to be cured by standard primary therapy. Three genes have withstood rigorous validation and are plausible targets for further study, which may provide insight into molecular features associated with long-term survival and chemotherapy resistance mechanisms.
    Gynecologic Oncology 11/2012; · 3.93 Impact Factor
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    ABSTRACT: OBJECTIVE: Little prospective data exist on quality of life (QOL) after pelvic exenteration (PE). This ongoing study prospectively examines the QOL-changes following this radical procedure using a comprehensive battery of psychological instruments. METHODS: Since 2005, enrolled patients were interviewed (EORTC QLQ-C30, EORTC QLQ-CR38, EORTC QLQ-BLM30, BFI, BPI-SF, IADL, CES-D, IES-R) preoperatively and at 3, 6, and 12months after PE for physical/psychological symptoms. Data were examined using repeated measure ANOVA. RESULTS: Sixteen women (3 anterior, 1 posterior, and 12 total PE's), with more than 1 year of follow-up, completed all scheduled interviews. Median age was 58years (28-76). Overall QOL (F=6.3, p<0.02), ability to perform instrumental daily activities (F=6.8, p<0.02), body image (F=11.9, p<0.00) and sexual function (F=8.0, p<0.01) all declined at 3months but were near baseline by 12months after PE. Although, overall, physical function followed a similar trend (F=14.8, p<0.00), it did not return to baseline. At the 12-month interview, patients reported increased gastrointestinal symptoms (F=8.9, p<0.01) but significantly less stress-related ideation (F=6.1, p<0.03) compared to baseline. Pain levels did not change significantly during the study period (F=0.4, p<0.74). CONCLUSIONS: Although patients report lingering gastrointestinal symptoms and some persistent decline in physical function after PE, most adjust well, returning to almost baseline functioning within a year. Providers can counsel patients that many, though not all, symptoms in the first 3months following exenteration are likely to improve as they adapt to their changed health status. These preliminary results await confirmation of a larger analysis.
    Gynecologic Oncology 10/2012; · 3.93 Impact Factor

Publication Stats

5k Citations
1,052.06 Total Impact Points

Institutions

  • 1995–2014
    • Memorial Sloan-Kettering Cancer Center
      • • Gynecology Service
      • • Department of Radiology
      • • Department of Psychiatry & Behavioral Sciences
      • • Department of Surgery
      New York City, New York, United States
  • 2012
    • Harvard Medical School
      Boston, Massachusetts, United States
  • 2010
    • University of Cambridge
      • Department of Radiology
      Cambridge, ENG, United Kingdom
  • 2007–2010
    • Mayo Clinic - Rochester
      • Department of Obstetrics & Gynecology
      Rochester, Minnesota, United States
  • 2006–2010
    • University of Texas MD Anderson Cancer Center
      • Department of Gynecologic Oncology
      Houston, Texas, United States
    • Shaare Zedek Medical Center
      • Department of Obstetrics and Gynecology
      Jerusalem, Jerusalem District, Israel
  • 2006–2009
    • Johns Hopkins Medicine
      • • The Kelly Gynecologic Oncology Service
      • • Department of Gynecology & Obstetrics
      Baltimore, MD, United States
  • 2005
    • Albany Medical College
      • Department of Obstetrics and Gynecology
      Albany, NY, United States
    • State University of New York
      New York City, New York, United States
    • Rutgers New Jersey Medical School
      • Department of Obstetrics, Gynecology and Women's Health
      Newark, NJ, United States
  • 2004–2005
    • Crystal Run Healthcare
      Goshen, New York, United States
  • 2001
    • Stanford Medicine
      • Division of Gynecologic Oncology
      Stanford, California, United States
  • 1999
    • University of Pennsylvania
      Philadelphia, Pennsylvania, United States
  • 1998
    • Fox Chase Cancer Center
      • Department of Surgery
      Philadelphia, PA, United States