METHODS:Patients scheduled for gynaecological surgery involving unilateral or bilateral adnexectomy were prospectively enrolled in the Quality of Opportunistic Salpingectomy (QOS) study at two hospitals in Flanders. During the procedure, adnexectomy was performed in two steps: first salpingectomy, followed by oophorectomy. Pathologists examined the ovarian surface both macroscopically and microscopically to determine the presence of residual fimbrial tissue. For pathological analysis, the Sectioning and Extensively Examining the Fimbria (SEE-FIM) protocol or a modified SEE-FIM protocol was used. The predefined sample size was 192 adnexa. Patient enrolment occurred between January 2023 and April 2025. RESULTS:A total of 201 adnexa from 115 patients were analysed. Macroscopic fimbrial tissue on the ovarian cortex was suspected in six cases (2.7%), of which four were microscopically confirmed. Overall, residual microscopic fimbrial tissue was identified in 15 adnexa (7.4%) from 14 patients (12.2%). In one patient, both fallopian tubes were incompletely resected. No serous tubal intraepithelial carcinoma (STIC) lesions were detected. CONCLUSIONS:Opportunistic salpingectomy was surgically complete in almost nine out of ten patients. Residual fimbrial tissue could not be predicted by clinical or surgical factors, underscoring the importance of a meticulous surgical technique and standardized pathological assessment. The clinical impact of remnant fimbrial tissue on ovarian cancer risk reduction remains uncertain, particularly in the context of risk-reducing salpingectomy with delayed oophorectomy.

Introduction/BackgroundVulvar cancer is a rare malignancy. Treatment in the early stages consists of a broad excision and sentinel node procedure. Tumour excision remains challenging due to the high risk of local recurrence (43%) associated with positive tumour margins. Therefore, a precise method to preserve healthy tissue and detect tumour positive margins intra-operatively, is needed. Direct intra-operative assessment would avoid the need for re-operation and their psychological, technical, and financial consequences. Currently, intra-operative margin assessment can only be done by frozen section, a technique not commonly used due to many disadvantages such as time-consuming, disruption of the workflow and interference with final assessment. In this study a submillimetric 3D Positron Emission Tomography – Computed Tomography (PET-CT) specimen imager, is introduced: a novel approach to assess tumour margins intra-operatively.MethodologyThe aim of this open label pilot study is to test the feasibility of using a micro-PET-CT, the AURA 10 (XEOS, Ghent, Belgium), intra-operatively to visualize 18F-FDG-uptake in resected specimens obtained during vulvar surgery. Therefore, one single low-dose intravenous injection of 0.8 MBq/kg 18F-FDG is administered before surgery. The primary objective is to investigate the feasibility of the AURA 10 to detect positive excision margins. The margins on these images will be analysed by the surgeons and compared to the gold standard of sectional histopathological evaluation. The diagnostic performance will be reported in sensitivity, specificity and accuracy. If positive margins are suspected, the surgeon can immediately do a precise re-excision. The secondary objective is to investigate the ability to detect cancer cells in the sentinel lymph nodes. 30 patients will be included with vulvar cancer, vulvar intra-epithelial neoplasia (VIN) or Paget disease, who were eligible for vulvectomy.Results/Conclusion/DisclosuresNone

Abstract Background Chemoradiotherapy (CRT) followed by brachytherapy (BT) is the standard treatment for locally advanced cervical cancer (LACC), but replacement of BT by surgery (CRT-S) could be an acceptable alternative. The main concern is the risk of operative morbidity. The aim is to report on therapeutic morbidity, OS, PC, and LC of CRT-S. Methods This was a single tertiary center retrospective cohort study in patients treated with CRT-S. A type II Wertheim hysterectomy was performed 6–8 weeks after CRT. Acute and chronic radiotherapy-related and surgical morbidity was classified according to the CTCAE v4.0. OS, and DFS, PC, and LC were calculated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazard models were performed to determine variables with a prognostic role. Results A total of 130 consecutive LACC patients were treated with CRT, and 119 underwent completion surgery. The median follow-up was 53 months. Five-year OS rate, local control, pelvic control, and 5-year DFS rate were 73%, 93%, 90%, and 74%, respectively. The 5-year OS rate was 92%/72%/67%/56% for FIGO (2009) stage I/II/III/IV, respectively. The five-year OS rate was 79% and 71% for adenocarcinoma and squamous cell carcinoma (p > 0.05), respectively. There was no intra- and perioperative mortality. Intraoperative and early postoperative complication rates were 7% and 20% (3% ≥ G3), respectively; they resolved within 3 months. The late postoperative complication rate was 9% (7% ≥ G3). Acute/late radiotherapy-related G3 side effects were 5%/3% for gastrointestinal and 3%/7% for genitourinary side effects. Conclusions CRT-S is safe with an acceptable rate of complications for both the CRT and completion surgery and shows encouraging outcome data for stage III/IV and adenocarcinoma patients.

Introduction/Background The `Laparoscopic Approach to Carcinoma of the Cervix` (LACC) trial (2018), described oncological results in favor of laparotomy compared to minimally invasive surgery (MIS) in the management of early-stage cervical cancer. Aim of our study was to assess the impact of those results on the choice of surgical approach of the Belgian Gynecologic Oncologists. Methodology An electronic survey using the REDCap platform was sent in December 2020 to 81 individual Belgian Gynecologic Oncologists, consisting of several topics: characteristics of their practice, day-to-day practice and surgical approaches of early-stage cervical cancer, measures to minimize spill during the operation and ratio of the types of procedures (open vs laparoscopic vs robot-assisted), before and after the LACC-trial. Results Twenty-seven surveys (Response Rate of 33.3%) were collected from January to May 2021. After the LACC-trial, 16 of 25 (64%) individual Belgian Gynecologic Oncologists still performed MIS. Change in type of surgery is shown in figure 1. More than half (56.3%) indicate to having modified their practice when performing a radical hysterectomy (RH) for early-stage cervical cancer, in terms of indication and measures to minimize spill. In order to minimize spill, specific precautions were taken by those performing MIS. The use of a uterine manipulator decreased with about 18% (43 to 25%), the use of a vaginal cuff more than doubled (15 to 62%) and the use of an endobag increased with approximately 44% (56 to 100%). Conclusion The LACC-trial led to a change in surgical practices for early-stage cervical cancer in Belgium, although still two thirds of the participating Belgian Gynecologic Oncologists perform RH through MIS techniques. This is in contrast with international guidelines. More than half of the responding Belgian Gynecologic Oncologists modified their practice by taking precautions to minimize spill. Disclosures none

Background:The VVOG (Flemish Society of Obstetrics and Gynaecology) published a consensus statement promoting opportunistic bilateral salpingectomy (OBS).Objectives:The aim of the study was to obtain insight into the current opinion and general practice of Flemish gynaecologists to counsel and perform OBS.Materials and Methods:A questionnaire was distributed to Flemish gynaecologists three months following publication.Main outcome measures:The drawbacks and incentives to counsel and perform OBS were questioned.Results:Complete response rate was obtained from 99 gynaecologists (17%) and 37 trainees (19%). The majority of respondents (77%) always counselled for OBS in patients scheduled for hysterectomy without oophorectomy. Eighteen per cent counselled only above a certain age cut off and/or if patient was already menopausal. The most important incentive to counsel in cases of hysterectomy by the abdominal approach and vaginal hysterectomy (VH) was the opportunity to prevent ovarian cancer. The yet-undetermined risk of premature ovarian failure was mentioned as the most important barrier in counselling women for OBS in those undergoing hysterectomy by the abdominal approach. For VH, the respondents saw the risk of complications and increased surgical time as the most important barriers. Sixty-one percent of gynaecologists preferred to perform bilateral salpingectomy as sterilisation method.Conclusions:Our study suggests that the concept of OBS is already well known in Flanders. There is a positive attitude towards the routine implementation of OBS, although some barriers and doubts about an age cut-off still exist in practice.

Objective. The spleen represents an important contributor to tumor immune escape, but the relevance of increased splenic metabolic activity remains to be fully elucidated. Methods. We retrospectively measured the spleen-to-liver standard uptake value (SLR) on F-18-FDG PET/CT examinations of 92 consecutive patients with FIGO stage IB1 to IVA cervical cancer and integrated the results with survival, response to treatment, tumor immune infiltrate, and baseline characteristics. Results. SLRmax > 0.92 (p=.026) and SLRmean > 0.94 (p=.005) were significantly associated with decreased DFS in univariable analysis. Multivariable models were built using best subset selection;.SLRmax and either SLRmax or SLRmean were consistently selected, strongly reinforcing the association between SLR variables and DFS in relation to potential confounders (all models p =.002). Independent associations were found for SLRmax using multivariable Cox regression models for DFS (all p =.003). Further, uniand multivariable analyses demonstrated the negative impact of higher SLR values on pathological complete response. A statistically significant higher proportion of patients with high SLRmax had a dense infiltrate of CD20+ (p =.036) and CD68(+) (p = .015) immune cells, as well as PD-L1+ tumor cells (p = .019) as compared to those with low SLRmax. Finally, high SLRmax status was neither associated with systemic inflammatory markers (except for an increased white blood cell count; p =.038), nor with clinically overt infection. Conclusion. This hypothesis-generating study provides the first evidence that increased splenic metabolic activity is a negative prognostic and predictive biomarker in locally advanced cervical cancer. In addition, it might help to discriminate immunologically 'hot' from ' cold' cervical tumors. (C) 2020 Elsevier Inc. All rights reserved.

We investigated the potential of tumor‐infiltrating immune cells (ICs) as predictive or prognostic biomarkers for cervical cancer patients. In total, 38 patients treated with (chemo)radiotherapy and subsequent surgery were included in the current study. This unique treatment schedule makes it possible to analyze IC markers in pretreatment and posttreatment tissue specimens and their changes during treatment. IC markers for T cells (CD3, CD4, CD8 and FoxP3), macrophages (CD68 and CD163) and B cells (CD20), as well as IL33 and PD‐L1, were retrospectively analyzed via immunohistochemistry. Patients were grouped in the low score or high score group based on the amount of positive cells on immunohistochemistry. Correlations to pathological complete response (pCR), cause‐specific survival (CSS) and metastasis development during follow‐up were evaluated. In analysis of pretreatment biopsies, significantly more pCR was seen for patients with CD8 = CD3, CD8 ≥ CD4, positive IL33 tumor cell (TC) scores, IL33 IC < TC and PD‐L1 TC ≥5%. Besides patients with high CD8 scores, also patients with CD8 ≥ CD4, CD163 ≥ CD68 or PD‐L1 IC ≥5% had better CSS. In the analysis of posttreatment specimens, less pCR was observed for patients with high CD8 or CD163 scores. Patients with decreasing CD8 or CD163 scores between pretreatment and posttreatment samples showed more pCR, whereas those with increasing CD8 or decreasing IL33 IC scores showed a worse CSS. Meanwhile, patients with an increasing CD3 score or stable/increasing PD‐L1 IC score showed more metastasis during follow‐up. In this way, the intratumoral IC landscape is a promising tool for prediction of outcome and response to (chemo)radiotherapy.

Background Inflammation has a significant impact on cervical cancer (CC) development and therapy response. We sought to determine if splenic metabolic activity reflects host immune status and could improve prognostic and predictive categorization of CC. Methods Ninety-two consecutive patients with FIGO stage IB1 to IVB CC who received neo-adjuvant (chemo)radiation (NA-CRT) with curative intent were included. PET scans were performed at diagnosis and after completion of the NA-CRT. PET images were retrospectively assessed for pretreatment spleen-to-liver SUV ratio (preSLR), posttreatment spleen-to-liver SUV ratio (postSLR) and ΔSLR (post-pre) on Oasis Nuclear Medicine Workstations. (Δ)SLR was calculated as both (Δ)SLRmaxand (Δ)SLRmean. The prognostic (DFS) and predictive (pCR) abilities of these variables together with established predictors were calculated by C-index and ROC analysis, respectively. The optimal long-rank statistic and Youden index determined cutoff values. Multivariate Cox proportional hazard regression models were ranked based on their Akaike information criterion (AIC). Clinicopathological differences between patients with low or high SLR were performed by chi-square and Mann-Whitney U tests. Results For preSLRmaxand preSLRmean, association with DFS was found for preSLRmax>0.92 with HR = 2.25 (95% CI (1.08-4.66); p = 0.026) and for preSLRmean>0.94 with HR = 2.79 (95% CI (1.33-5.86); p = 0.005), respectively. The selected multivariate model consisted of three factors: preSLRmax, ΔSLRmaxand parametrial invasion (dichotomized; HR = 6.40 95% CI (2.70-15.20); p Conclusions SLR is a promising prognostic and predictive biomarker in CC and is associated with the tumor immune infiltrate. Legal entity responsible for the study Ghent University Hospital. Funding Research Foundation-Flanders (FWO). Disclosure E.A. De Jaeghere: Travel / Accommodation / Expenses: PharmaMar. F. Laloo: Honoraria (institution): Bayer. K. De Man: Travel / Accommodation / Expenses: Bayer. H. Denys: Honoraria (institution), Travel / Accommodation / Expenses: Pfizer; Honoraria (institution), Research grant / Funding (institution), Travel / Accommodation / Expenses: Roche; Honoraria (institution), Travel / Accommodation / Expenses: PharmaMar; Travel / Accommodation / Expenses: Teva; Honoraria (institution), Travel / Accommodation / Expenses: AstraZeneca; Honoraria (institution): Eli Lilly and Company; Honoraria (institution): Novartis; Honoraria (institution): Amgen; Honoraria (institution): Tesaro. K. Vandecasteele: Travel / Accommodation / Expenses: PharmaMar. All other authors have declared no conflicts of interest.

BackgroundPrevious studies on cervical cancer reported a worse outcome for adenocarcinoma (AC) compared with squamous cell carcinoma (SCC). Nevertheless, standard treatment remains identical. Insight in the impact of histological types on biological behavior and pathological complete response rates might result in a treatment paradigm shift.MethodsClinicopathological characteristics, survival rates and relapse patterns were compared between AC (n=36) and SCC (n=143) cervical cancer patients. Pathological response to treatment was evaluated in the patient subgroup treated with neo-adjuvant chemoradiation followed by surgery (NA-CRT group; n=84).ResultsIn the entire cohort, 5y Disease Specific Survival (DSS) was 97.1 and 84% for AC and SCC respectively (p=0.150). In the NA-CRT group 5y DSS was 100 and 75.5% for AC and SCC respectively (p=0.059). Relapse patterns did not differ significantly between AC and SCC in the entire cohort, or in the NA-CRT group. Adenocarcinoma patients treated with NA-CRT showed significantly less pathological complete response compared with SCC patients (AC=7%, SCC=43%, p=0.027).ConclusionsThere were no statistically significant differences regarding relapse and DSS rates between SCC and AC in the entire cohort, or the NA-CRT group. However, a trend to better 5y DSS of AC in the NA-CRT group was observed. This analysis showed significant differences in treatment responses after NA-CRT: patients with AC responded remarkably less to chemoradiation, resulting in a significantly lower pathological complete response rate. These findings imply a need for a paradigm shift in the treatment of cervical AC patients.

Definitive chemoradiotherapy is standard of care in locally advanced cervical cancer (LACC). Both toxicity and local relapse remain major concerns in this treatment. We hypothesize that a magnetic resonance imaging (MRI) based redefining of the radiotherapeutic target volume will lead to a reduction of acute and late toxicity. In our center, chemoradiotherapy followed by hysterectomy was implemented successfully in the past. This enables us to assess the safety of reducing the target volume but also to explore the biological effects of chemoradiation on the resected hysterectomy specimen.

DNA repair mechanisms play a key role in oncogenesis and cancer progression in women with BRCA mutation-positive (BRCAm) ovarian cancer (OC). The BRCA1/2 and poly(ADP-ribose) polymerase (PARP) proteins are considered the foremost mediators among the various components of double-strand and single-strand repair, respectively. A series of new therapeutic drugs that target PARP have been developed for BRCAm OC. This class of agents provokes tumour-specific cytotoxicity with minimal side effects by inducing synthetic lethality, of which they are the first clinical example. The European Medicines Agency granted accelerated licensing approval for the first-in-class-drug that inhibits PARP, olaparib (Lynparza™, AstraZeneca). Olaparib can be used as a monotherapeutic maintenance treatment in patients with platinum-sensitive relapsed (germline and/or somatic) BRCAm high-grade serous epithelial ovarian, fallopian tube or primary peritoneal cancer responsive to platinum-based chemotherapy. Seen in light of these recent events, this review article will focus on (a) how PARP-inhibitors exploit cancer-specific defects in the homologous recombination repair apparatus and (b) how BRCA testing is implemented in routine clinical care.

There has been a marked decrease in the incidence of cervical cancer thanks to cytological screening with the Pap smear test. In Belgium, this screening is rather opportunistic. Over 39% of Belgian women between 25 and 64 years of age are never or only rarely screened by cytological tests. Moreover, there is an excess use of Pap smears because of women who rely on their yearly cervical smear and because many Pap smears are obtained from women beyond the target age range of 25 to 64 years. Sexually active adolescents are increasingly being recognized as a population distinct from adult women. They are at a high risk of acquiring the human papillomavirus (HPV), but most infections and cervical intraepithelial lesions caused by HPV are efficiently cleared by the immune system. We present a description of cervical cancer screening in Belgium using the database of the National Health Insurance Institute (RIZIV/INAMI) and the Belgian Health Care Knowledge Centre (KCE). We describe why elimination of Pap testing in the adolescent population reduces costs and harms without increasing cervical cancer rates. Expectant management, education on the risk factors for cervical cancer and HPV persistence, and HPV vaccination are very important in adolescents and young adults.

Borstkanker bij de man is een zelden voorkomende ziekte die relatief onbekend is bij de algemene bevolking. Hierdoor wordt de diagnose vaak in een later stadium van de ziekteprogressie gesteld, wat op zijn beurt de prognose beinvloedt. Na correctie voor de leeftijd en het ziektestadium is de overleving voor mannelijke patienten dezelfde als voor vrouwelijke. Belangrijke risicofactoren voor mannelijke borstkanker zijn testiculaire afwijkingen (cryptorchidie, orchitis, enz.), het syndroom van Klinefelter en familiale belasting (BRCA2-genmutatie). Wegens de afwezigheid van terminale lobuli is de overgrote meerderheid van de tumoren histopathologisch geclassificeerd als een ductaal carcinoom. De diagnostiek van mannelijke borstkanker loopt parallel met die van vrouwelijke borstkanker (borstonderzoek, beeldvorming en histopathologie). De behandeling van mannelijke borstkanker is in grote lijnen dezelfde als voor vrouwelijke borstkanker. Belangrijke verschillen zijn bij de chirurgische therapie de gemodificeerde radicale mastectomie als standaard en in een adjuvante setting is er heden nog geen plaats voor het gebruik van aromataseremmers.

Poster: ECR 2013 / C-0980 / MRI and FDG-PET-CT to assess the resectability after chemoradiation of primary irresectable cervical cancer: study update by: L. J. Delrue , B. Lambert, K. Vandecasteele, A. Makar, K. Lambein, G. Villeirs, P. Tummers, H. Denys, G. De Meerleer; Ghent/BE

Introduction Since the addition of chemotherapy to radiotherapy, the survival rates of locally advanced cervical cancer (LACC) have improved but are still disappointing. Therefore, the idea of surgery after chemoradiation in case of LACC or bulky disease was adopted. One of the concerns regarding surgery following chemoradiotherapy is surgery-related morbidity. Aim The objectives of this study were to investigate the feasibility of surgery after advanced radiotherapy techniques such as intensity-modulated arc therapy (IMAT) and to describe the morbidity. Methods This was a prospective study of primary inoperable LACC patients primary treated with IMAT, in most cases combined with weekly cisplatin. Then the resectability was reevaluated. If resectable patients were treated with Wertheim type 2 surgery ± pelvic lymphadenectomy (on positron emission tomography–computed tomography indication). If tumor is not resectable, patients were treated with brachytherapy. Results Since 2006, 41 consecutive patients were included. After neoadjuvant IMAT, 34 were considered resectable and underwent surgery, whereas 7 proceeded with brachytherapy. The operative mortality rate was nil. There were no major perioperative complications. No ureter, bladder, or bowel injuries occurred. No postoperative urinary/digestive fistulae or stenoses were noted. Eleven patients had postoperatively urinary retention problems. At the time of discharge, 5 patients still needed self-catheterization. All problems resolved within 3 months. In 4 cases, we saw significant lymphoceles. In all patients intended to treat, overall survival and disease-free survival at 3 years were 63% and 74%. In the Wertheim group, overall survival and disease-free survival at 3 years were 81% and 91%. Conclusions Completing surgery after chemoradiation therapy (with IMAT) for LACC or bulky disease is feasible, and complication rates are comparable with those of primary surgery for cervical cancer.