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Article ; Online: Clinical validation and comparison of the Comprehensive Complication Index and Clavien-Dindo classification in predicting post-operative outcomes after cytoreductive surgery in advanced ovarian cancer.

Kengsakul, Malika / Nieuwenhuyzen-de Boer, Gatske M / Udomkarnjananun, Suwasin / Kerr, Stephen J / van Doorn, Helena C / van Beekhuizen, Heleen J

International journal of gynecological cancer : official journal of the International Gynecological Cancer Society

2023 Volume 33, Issue 2, Page(s) 263–270

Abstract: Objective: The Comprehensive Complication Index (CCI) is an instrument used to measure cumulative post-operative complications. Our study aimed to validate the CCI after cytoreductive surgery for primary advanced-stage epithelial ovarian cancer, and to ... ...

Abstract	Objective: The Comprehensive Complication Index (CCI) is an instrument used to measure cumulative post-operative complications. Our study aimed to validate the CCI after cytoreductive surgery for primary advanced-stage epithelial ovarian cancer, and to compare its diagnostic performance with the Clavien-Dindo classification. Methods: This prospective cohort study classified post-operative complications according to the Clavien-Dindo classification and the CCI. Logistic regression was used to determine the association between both classifications with intensive care unit admission, prolonged length of hospital stay (defined as stays longer than the 75th percentile of all stays in this study), 30-day readmission, and time to initiating chemotherapy after surgery >42 days. Area under the receiver operating characteristic curves (AUC) were used to assess the discriminative performance of each classification. Results: A total of 300 patients were included in the analysis. Most patients (n=255, 85%) underwent interval cytoreductive surgery. Complete cytoreduction was achieved in 235 (78%) patients. Overall, 30-day post-operative complications classified by the Clavien-Dindo classification occurred in 147 (49%) patients. Severe complications (grade ≥3a) occurred in 51 (17%) patients. Approximately 30% (n=82) had multiple complications. The CCI showed an excellent correlation with the Clavien-Dindo classification ( Conclusions: Both the Clavien-Dindo classification and CCI showed significant associations with all surgical outcomes. However, the cumulative complications score of the CCI demonstrated a more superior discriminative performance than the Clavien-Dindo classification for prolonged length of hospital stay in advanced-stage epithelial ovarian cancer.
MeSH term(s)	Humans ; Female ; Cytoreduction Surgical Procedures/adverse effects ; Carcinoma, Ovarian Epithelial/surgery ; Prospective Studies ; Severity of Illness Index ; Postoperative Complications/etiology ; Ovarian Neoplasms/drug therapy ; Ovarian Neoplasms/surgery ; Ovarian Neoplasms/complications ; Retrospective Studies
Language	English
Publishing date	2023-02-06
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1070385-8
ISSN	1525-1438 ; 1048-891X
ISSN (online)	1525-1438
ISSN	1048-891X
DOI	10.1136/ijgc-2022-003998
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Article ; Online: In Reply.

Hemida, Reda / van Doorn, Helena C

Obstetrics and gynecology

2019 Volume 134, Issue 3, Page(s) 649

MeSH term(s)	Curettage ; Female ; Gestational Trophoblastic Disease ; Humans ; Pregnancy
Language	English
Publishing date	2019-08-23
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	207330-4
ISSN	1873-233X ; 0029-7844
ISSN (online)	1873-233X
ISSN	0029-7844
DOI	10.1097/AOG.0000000000003442
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Article: Survival of Women with Advanced Stage Cervical Cancer: Neo-Adjuvant Chemotherapy Followed by Radiotherapy and Hyperthermia versus Chemoradiotherapy.

Servayge, Jonathan / Olthof, Ester P / Mom, Constantijne H / van der Aa, Maaike A / Wenzel, Hans H B / van der Velden, Jacobus / Nout, Remi A / Boere, Ingrid A / van Doorn, Helena C / van Beekhuizen, Heleen J

Cancers

2024 Volume 16, Issue 3

Abstract: Aim: To investigate and compare overall survival (OS), disease-free survival (DFS) and toxicity of women who underwent either chemoradiotherapy with or without prior lymph node debulking or upfront chemotherapy followed by radiotherapy and hyperthermia ( ...

Abstract	Aim: To investigate and compare overall survival (OS), disease-free survival (DFS) and toxicity of women who underwent either chemoradiotherapy with or without prior lymph node debulking or upfront chemotherapy followed by radiotherapy and hyperthermia (triple therapy) for locally advanced cervical cancer (LACC) to identify a potential role for triple therapy. Methods: Women with histologically proven LACC and with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB2 and IIA2 to IVA were included. Cox regression analyses were used for calculating hazard ratios and to adjust for confounding variables. A multivariable logistic regression analysis was used to examine the influence of covariates on toxicity. Results: A total of 370 patients were included of whom 58% ( Conclusion: This study suggests that the toxicity and survival of TT is similar to CRT or LND-CRT.
Language	English
Publishing date	2024-02-01
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers16030635
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Article ; Online: Hormone replacement therapy in women with iatrogenic premature ovarian insufficiency after radiotherapy for cervical cancer: A retrospective cohort and survey study.

van der Hoef, Charlotte / Bawuah Dsane, Lawrencia / Schuur, Nicoline / Louwers, Yvonne V / Mens, Jan Willem / Hikary-Bhal, Nadia / van Doorn, Helena C

Maturitas

2024 Volume 185, Page(s) 108004

Abstract: Objectives: This study assessed the uptake of hormone replacement therapy (HRT) in cervical cancer patients with iatrogenic menopause. Survival in relation to HRT use was assessed via a retrospective chart study, and the severity of menopausal symptoms, ...

Abstract	Objectives: This study assessed the uptake of hormone replacement therapy (HRT) in cervical cancer patients with iatrogenic menopause. Survival in relation to HRT use was assessed via a retrospective chart study, and the severity of menopausal symptoms, motivations and barriers to starting HRT were examined via questionnaires. Study design: In total, 293 women under the age of 51 and treated with radiotherapy for cervical cancer between 2010 and 2020 were identified. Medical records were searched for information on HRT use. If still living, women were sent digital questionnaires addressing menopausal symptoms, quality of life (QoL) and potential barriers and motivations concerning HRT use. Univariable data were analysed using Mann-Whitney U, chi-square, and Fisher's exact test, while logistical regression was used to analyse relationships between certain variables and use of HRT and survival. Results: Overall HRT uptake was 78.1 %, which was related to age and Charlson Comorbidity Index, but independent of the duration of radiotherapy or FIGO stage. Overall survival was higher for HRT users (χ Conclusions: HRT prescription rate was inversely correlated with age. Survival was not negatively affected by HRT use. It is important to stress the benefits of HRT and address women's fears regarding its use.
Language	English
Publishing date	2024-04-20
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	80460-5
ISSN	1873-4111 ; 0378-5122
ISSN (online)	1873-4111
ISSN	0378-5122
DOI	10.1016/j.maturitas.2024.108004
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Zs.A 1432: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Avoid making a mountain out of an invasive hydatidiform mole: do a pregnancy test!

Hemida, Reda / van Doorn, Helena C

Lancet (London, England)

2019 Volume 394, Issue 10194, Page(s) e2

MeSH term(s)	Adult ; Biomarkers, Tumor/blood ; Chorionic Gonadotropin/blood ; Diagnosis, Differential ; Female ; Humans ; Hydatidiform Mole, Invasive/complications ; Hydatidiform Mole, Invasive/diagnosis ; Pregnancy ; Pregnancy Tests/methods ; Ultrasonography ; Uterine Hemorrhage/etiology ; Uterine Neoplasms/complications ; Uterine Neoplasms/diagnosis
Chemical Substances	Biomarkers, Tumor ; Chorionic Gonadotropin
Language	English
Publishing date	2019-07-22
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	3306-6
ISSN	1474-547X ; 0023-7507 ; 0140-6736
ISSN (online)	1474-547X
ISSN	0023-7507 ; 0140-6736
DOI	10.1016/S0140-6736(19)31635-6
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Ua VI Zs.5: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Recurrent postmenopausal bleeding: Pathological findings and predictive factors. A multicenter, prospective, observational study.

van Maldegem, Laura D P R / van der Zande, Johanna A / van Werkhoven, Lucy A / Ewing-Graham, Patricia C / Heemskerk-Gerritsen, Bernadette A M / van Doorn, Helena C

Acta obstetricia et gynecologica Scandinavica

2024

Abstract: Introduction: Recurrent postmenopausal bleeding (PMB) occurs in 6%-25% of postmenopausal women who have experienced a previous episode of PMB. The question of whether recurrent PMB leads to a higher risk of endometrial cancer (EC) in comparison to a ... ...

Abstract	Introduction: Recurrent postmenopausal bleeding (PMB) occurs in 6%-25% of postmenopausal women who have experienced a previous episode of PMB. The question of whether recurrent PMB leads to a higher risk of endometrial cancer (EC) in comparison to a single episode of PMB is, however, controversial. Furthermore, little is known about predictive factors for recurrent PMB. Material and methods: A multicenter prospective cohort study was conducted over a 5-year period in four hospitals in the Netherlands. Women with PMB undergoing endometrial sampling and aged 40 years and older were included. Occurrence of recurrent PMB was retrospectively determined. Primary outcomes included (1) the incidence of recurrent PMB and (2) differences in pathological findings between patients with a single episode versus recurrent PMB. Secondary outcomes included (1) the association between diagnosis of benign polyps at first PMB and pathological findings at recurrent PMB and (2) factors predictive for recurrent PMB. Results: A total of 437 women with PMB were included, of whom 360 were at risk of recurrent PMB. With a median follow-up of 61 months (IQR (Interquartile range) 44-73), 26.4% experienced recurrent PMB. Patients with recurrent PMB were more often diagnosed with benign polyps (34.7% vs. 25.1%, p-value 0.015) and less frequently with a malignancy (5.3% vs. 17.8%, p-value 0.015), compared to patients with a single episode of PMB. Benign polyps at initial PMB were not associated with a (pre)malignancy at recurrence (OR 4.16, 95% CI 0.75-23.03). Predictive factors for recurrent PMB included use of hormone replacement therapy (HRT) (OR 3.32, 95% CI 1.64-6.72), and benign polyps at initial PMB (OR 1.80, 95% CI 1.07-3.04). Conclusions: Recurrent PMB is common in women with a previous episode of PMB. Compared to patients with a single episode of PMB, patients with recurrent PMB and benign histological outcomes at accurate workup during their first episode were less often diagnosed with malignancies and more frequently with benign polyps. Benign polyps at first PMB are predictive for recurrent PMB, but not for a higher risk of (pre)malignancy.
Language	English
Publishing date	2024-05-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	80019-3
ISSN	1600-0412 ; 0001-6349
ISSN (online)	1600-0412
ISSN	0001-6349
DOI	10.1111/aogs.14851
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Um I Zs.168: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Collaboration Benefits All.

Hemida, Reda A / van Doorn, Helena C / Massuger, Leon F A G

JCO global oncology

2020 Volume 6, Page(s) 56–58

MeSH term(s)	Cooperative Behavior
Language	English
Publishing date	2020-02-07
Publishing country	United States
Document type	Journal Article
ISSN	2687-8941
ISSN (online)	2687-8941
DOI	10.1200/JGO.19.00237
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Article: Factors Predicting 30-Day Grade IIIa-V Clavien-Dindo Classification Complications and Delayed Chemotherapy Initiation after Cytoreductive Surgery for Advanced-Stage Ovarian Cancer: A Prospective Cohort Study.

Kengsakul, Malika / Nieuwenhuyzen-de Boer, Gatske M / Udomkarnjananun, Suwasin / Kerr, Stephen J / van Doorn, Helena C / van Beekhuizen, Heleen J

Cancers

2022 Volume 14, Issue 17

Abstract: Objective: The aim of this study was to evaluate factors associated with 30-day postoperative Clavien−Dindo classification (CDC) grade IIIa or greater complications and delayed initiation of chemotherapy after cytoreductive surgery (CRS) for primary ... ...

Abstract	Objective: The aim of this study was to evaluate factors associated with 30-day postoperative Clavien−Dindo classification (CDC) grade IIIa or greater complications and delayed initiation of chemotherapy after cytoreductive surgery (CRS) for primary advanced-stage epithelial ovarian cancer (AEOC). Methods: This was a prospective study involving 300 patients who underwent primary or interval CRS for AEOC between February 2018 and September 2020. Postoperative complications were graded according to the CDC. Logistic regression analysis was used to evaluate factors predicting CDC grade ≥IIIa and time to chemotherapy (TTC) >42 days. Results: Interval CRS was performed in 255 (85%) patients. CDC grade ≥IIIa occurred in 51 (17%) patients. In multivariable analysis, age (p = 0.036), cardiovascular comorbidity (p < 0.001), diaphragmatic surgery (p < 0.001), intraoperative urinary tract injury (p = 0.017), and upper-abdominal visceral injury (e.g., pancreas, stomach, liver, or spleen) (p = 0.012) were associated with CDC grade ≥IIIa. In 26% of cases, TTC was >42 days (median (IQR) 39 (29−50) days) in patients with CDC grade ≥IIIa versus 33 (25−41) days in patients without CDC grade ≥ IIIa (p = 0.008). The adjusted odds ratio of developing TTC >42 days was significantly higher in patients associated with WHO performance grade ≥2 (p = 0.045), intraoperative bowel injury (p = 0.043), upper-abdominal visceral injury (p = 0.008), and postoperative CDC grade ≥IIIa (p = 0.032). Conclusions: Patients with advanced age, with cardiovascular comorbidity, and who required diaphragmatic surgery had an increased adjusted odds ratio of developing CDC grade ≥IIIa complications. CDC grade ≥IIIa complications were independently associated with TTC >42 days. Proper patient selection and prevention of intraoperative injury are essential in order to prevent postoperative complications and delayed initiation of chemotherapy.
Language	English
Publishing date	2022-08-29
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers14174181
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Article ; Online: Topical imiquimod treatment of residual or recurrent cervical intraepithelial neoplasia lesions (TOPIC-2): A randomised controlled trial.

van de Sande, Anna J M / van Baars, Romy / Koeneman, Margot M / Gerestein, Cornelis G / Kruse, Arnold-Jan / van Esch, Edith M G / de Vos van Steenwijk, Peggy J / Muntinga, Caroline L P / Willemsen, Sten P / van Doorn, Helena C / van Kemenade, Folkert J / van Beekhuizen, Helene J

BJOG : an international journal of obstetrics and gynaecology

2024

Abstract: Objective: To investigate the efficacy of imiquimod in women with residual or recurrent cervical intraepithelial neoplasia (rrCIN), compared with large loop excision of the transformation zone (LLETZ).: Design: Randomised controlled non-inferiority ... ...

Abstract	Objective: To investigate the efficacy of imiquimod in women with residual or recurrent cervical intraepithelial neoplasia (rrCIN), compared with large loop excision of the transformation zone (LLETZ). Design: Randomised controlled non-inferiority trial. Setting: One academic and one regional hospital in the Netherlands. Population: Thirty-five women with rrCIN were included in the study between May 2016 and May 2021. Methods: Women were randomised to receive treatment with 5% imiquimod cream (12.5 mg) intravaginally (three times a week for a duration of 16 weeks) or a LLETZ procedure (standard treatment). Main outcome measures: The primary outcome was reduction to normal cytology at 6 months after starting treatment. Secondary outcomes were clearance of high-risk human papilloma virus (hr-HPV) in both groups and reduction to ≤CIN1 in the imiquimod group. Side effects were monitored. Results: Treatment success was 33% (6/18) in the imiquimod group versus 100% (16/16) in the LLETZ group (P < 0.001), whereas HPV clearance was 22% (4/18) in the imiquimod group versus 88% (14/16) in the LLETZ group (P < 0.001). After the randomisation of 35 women, the futility of treatment with imiquimod was proven and the trial was prematurely finished. In the follow-up period, three patients remained without additional treatment, whereas all other patients underwent LLETZ, conisation or hysterectomy. In the LLETZ group none of the patients received additional treatment during 2 years of follow-up. Conclusions: This is the first randomised controlled trial to show that topical imiquimod has a significantly lower success rate in terms of reduction to normal cytology and hr-HPV clearance, compared with LLETZ, in women with rrCIN. Additionally, imiquimod has numerous side effects and after using imiquimod most women with rrCIN still required additional surgical treatment.
Language	English
Publishing date	2024-03-31
Publishing country	England
Document type	Journal Article
ZDB-ID	2000931-8
ISSN	1471-0528 ; 0306-5456 ; 1470-0328
ISSN (online)	1471-0528
ISSN	0306-5456 ; 1470-0328
DOI	10.1111/1471-0528.17808
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Article ; Online: Can radical surgical treatment of the vulva be justified in the absence of a conclusive diagnosis of squamous cell carcinoma on biopsy? A retrospective 10-year cohort study.

Jonker, Lysanne W / Dasgupta, Shatavisha / Ewing-Graham, Patricia C / van Doorn, Helena C

European journal of obstetrics, gynecology, and reproductive biology

2020 Volume 248, Page(s) 238–244

Abstract: Objectives: The extent of surgical treatment for vulvar lesions is predominantly guided by the histopathologic diagnosis rendered on the pre-operative biopsy. For premalignant lesions, local excisions are performed, whereas for vulvar squamous cell ... ...

Abstract	Objectives: The extent of surgical treatment for vulvar lesions is predominantly guided by the histopathologic diagnosis rendered on the pre-operative biopsy. For premalignant lesions, local excisions are performed, whereas for vulvar squamous cell carcinoma (VSCC), more radical procedures are mandatory. However, even in the absence of a conclusive diagnosis of VSCC on biopsy, the surgeon may opt for a radical excision on grounds of strong clinical suspicion, with a view to avoiding repeat surgeries. We studied a retrospective, 10-year cohort of patients who underwent vulvar excisions, in the absence of a conclusive biopsy diagnosis of VSCC. We aimed to identify the factors predictive of VSCC in these patients, and assess their treatment. Study design: All patients who underwent vulvar excision (2005-2016) at Erasmus MC, without a definitive diagnosis of VSCC on the preoperative biopsy were included. Logistic regression analysis was performed to identify the factors predictive of a final diagnosis of VSCC. Surgical treatment was categorized as definitive, incomplete, or over-treatment, based on histopathology of the excision specimen and previous surgical history. Results: In 57 % (64/113) of all included patients, the final diagnosis was VSCC. Higher patient age (p = 0.03), and suspicion of VSCC on pre-operative biopsy (p < 0.001) were associated with a final diagnosis of VSCC on univariate analysis. Suspicion of VSCC on biopsy was the only significant predictor (p < 0.001) on multivariable analysis. For patients with a suspicion of VSCC on biopsy, radical treatment was more frequently performed (p < 0.001), which resulted in over-treatment in only 1 case. Where the surgeon had performed a limited excision despite a suspicion of VSCC on biopsy, high patient age, co-morbidities, location of the tumor close to the anus, and history of previous vulvar surgeries were factors which influenced the decision. The treatment administered was definitive for 72 %., i.e. additional surgeries were not required; 25 % received incomplete treatment and needed additional surgeries, and 3% received over-treatment. Conclusion: Suspicion of VSCC on biopsy is strongly predictive of a final diagnosis of carcinoma. In our cohort, radical treatment performed on patients with clinical and histopathological suspicion of VSCC resulted in minimal over-treatment, and helped avoid second surgeries.
MeSH term(s)	Age Factors ; Aged ; Biopsy ; Carcinoma, Squamous Cell/diagnosis ; Carcinoma, Squamous Cell/pathology ; Carcinoma, Squamous Cell/surgery ; Clinical Decision-Making ; Female ; Humans ; Middle Aged ; Retrospective Studies ; Vulvar Neoplasms/diagnosis ; Vulvar Neoplasms/pathology ; Vulvar Neoplasms/surgery
Language	English
Publishing date	2020-03-19
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	190605-7
ISSN	1872-7654 ; 0301-2115 ; 0028-2243
ISSN (online)	1872-7654
ISSN	0301-2115 ; 0028-2243
DOI	10.1016/j.ejogrb.2020.03.027
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