6^th International Congress on Gynecology & Gynecologic Oncology July Rome, Italy

Ping Jiang is an Associate Professor in Radiation Oncology Department in Peking University 3rd Hospital. She works mainly in radiotherapy for malignant tumor, especially in domain of radiation on GYN and thoracic malignant tumor, HDR and LDR brachytherapy in recurrent GYN. She has published many papers as first author. Her research results are oral presented in ESTRO, JASTRO and ABS. She is the member of Youth committee of Chinese Medical Association Radiotherapy Branch and Youth committee of Beijing Medical Association Radiotherapy Branch. She is in charge of national important research and development project, digital diagnosis and treatment equipment research and development

Purpose: To evaluate the feasibility of 3D-printing individual template assisted interstitial brachytherapy for recurrence of

GYN aft er pelvic external beam irradiation.

Materials & Methods: 11 patients in our center from Aug 9, 2016 to Dec 1, 2017 diagnosed with central recurrence of GYN

aft er pelvic adjuvant EBRT or radical chemoradiotherapy, they all received 192Ir HDR interstitial brachytherapy under CT

guidance with 3D-printing template assisted. Th ey all fi rstly, undertook CT simulation with lithotomy position. Secondly,

preplan with virtual needle insertion and template with needle passage were designed 3D template would be printed and

verifi ed by both physicist and physician. Th irdly, the patients accept 192Ir HDR interstitial brachytherapy under anesthesia.

Among them, 5 cases under local anesthesia with 3D-printing vaginal insertion template and 6 cases under epidural anesthesia

with 3D-printing combined vaginal and perineal insertion template. GTV prescription doses are 5-6 Gy/f, 2-6 f, 1-2 f/W totally

45 fraction treatment of 11 patients. Dosimetry parameters of GTV V100, D100 and D90, organ at risk D2cc of rectum, bladder

and intestine were recorded and analyzed. Complications and early toxicities were analyzed.

Results: Totally 229 needles were inserted for 45 applications, median 6 (3-9) needles per fraction, mean inserting depth

was 8.3±3.4 cm (2-13.7 cm), mean CT scan 3 (1-5) times, during CT guidance procedure. Actual dosimetry parameters of

median V100,D100 and D90 were 83±4.5% 3.0±1.3 Gy and 5±1.7 Gy respectively per fraction; median D2cc of rectum and bladder

was 3.4±1.0 Gy and 3.55±2.15 Gy respectively per fraction. Th ere were no acute puncture side eff ects such as hemorrhea,

perforation of bowel and hematuria recorded. Early side eff ect of grade I/II urethritis were found in 45% patients and relieved

aft er symptomatic treatment.

Conclusion: 3D-printing individual template assisted interstitial brachytherapy for recurrence of GYN aft er pelvic external

beam irradiations under CT guidance have good dosimetry parameters. It is clinically feasible and high effi ciency with low

complications. However long-term clinical outcomes should be further investigated.

Wassil Nowicky is the Director of Nowicky Pharma and President of the Ukrainian Anti-Cancer Institute, Vienna, Austria. He has fi nished his study at the Radiotechnical Faculty of the Technical University of Lviv, Ukraine in 1955 with graduation in Diplom-Ingeniueur in 1960 with title nostrifi cated in Austria in 1975.

He became the very first scientist in the development of the anticancer protonic therapy and is the inventor of the preparation against cancer with a selective effect on basis of celandine alkaloids NSC-631570. He used the factor that cancer cells are more negative charged than normal cells and invented the celandine alkaloid with a positive charge thanks to which it accumulates in cancer cells very fast. He is an author of over 300 scientifi c articles dedicated to cancer research. He is a member of the New York Academy of Sciences, member of the European Union for Applied Immunology and of the American Association for scientifi c progress, Honorary Doctor of the Janka Kupala University in Hrodno, Doctor Honoris Causa of the Open International University on complex medicine in Colombo, Honorary Member of the Austrian Albert Schweitzer Society. He has received the award for merits of National guild of pharmacists of America; the award of Austrian Society of sanitary,hygiene and public health services and others.

In a controlled clinical study conducted at the University Grodno (Grodno, Belarus), aft er the therapy with NSC-631570 the

hardening of the tumor, a slight increase in the tumor size (5-10%) and proliferation of connective tissues were observed. Th e

tumours appeared harder and slightly enlarged aft er NSC-631570 therapy, and were easier to detect by ultrasound or radiological

examination. Metastatic lymph nodes were also hardened and sclerotic (fi brous). Tumours and metastatic lymph nodes were

clearly demarcated from healthy tissue and therefore easier to remove. Complications such as prolonged lymphorrhoea (leakage

of lymph onto the skin surface), skin necrosis (death of skin tissue), suppuration of the wound, and pneumonia, all occurred

in patients from the two NSC-631570 groups at only half the rate that they appeared in patients from the control group. Based

on the results of this study the scientists from Grodno recommended the use of NSC-631570, at the higher dosage, in all breast

cancer operations. Other parameters were also evaluated, e.g. hormones (T3, T4, cortisol, progesterone, estradiol, prolactin),

immune values (lymphocytes, immune globulins, complement, phagocytic activity, morphologic and cytochemical changes),

amino acids and their derivates in plasma and in the tumor tissue. Th e eff ect of NSC-631570 on the various parameters in

breast cancer patients has been studied. Best results were achieved with higher dosage of NSC-631570. Almost every patient

noted the improvement of the general well-being, sleep and appetite. During the surgery, the tumors as well as involved lymph

nodes were presented sclerotic and well demarcated from the surrounding tissue. Th is alleviated the surgical removal of the

tumor considerably. In the tumor tissue, increased concentration of the amino acid proline was revealed indicating augmented

production of connective tissue that demarcates the tumor from surrounding tissue. NSC-631570 improved also the amino

acid balance of patients. NSC 631570 is the very fi rst proton anticancer preparation and due to this aft er administration it

accumulates in tumors very fast that can be seen under the UV-light thanks to its the autofl uorescence. Besides this preparation

it can regenerate the immune system and works as an immunomodulating agent. Th e selective eff ect of the NSC 631570 has

been confi rmed by 120 universities and research centers in the world. Until now this preparation has been tested on over 100

cancer cell lines and on 12 normal cell lines. Th e researchers who conducted studies with the anticancer preparation NSC-

631570 concluded that the anticancer drug NSC-631570 exerts its cytotoxic eff ects on both mouse and human breast cancer

cell lines in a dose and time dependent manner. Weeks following NSC-631570 treatment, cells maintained a reduced capacity

to proliferate.

Paul H Sugarbaker has completed his college education at Wheaton College in Illinois. He graduated from Cornell University Medical College in New York (USA) and from there he went for his surgical training at the Peter Bent Brigham Hospital in Boston (MA, USA), now known as Brigham and Women’s Hospital. He received a Master’s degree in Immunology at the Harvard School of Arts and Sciences in 1983. At the NIH he was a Senior Investigator from 1976 to 1986. After a brief stay in Atlanta at the Emory Clinic he moved back to Washington (DC, USA) to become the Medical Director of the Washington Cancer Institute. He has been at the Washington Cancer Institute since 1989. Currently, he is the Director for the Program in Peritoneal Surface Oncology. His interests are in gastrointestinal cancer, gynecologic malignancy and mesothelioma. For many years his work focused on liver metastases. Currently, his clinical and investigative work is directed at the peritoneal surface component of gastrointestinal cancer dissemination, referred to as peritoneal metastases. He is a strong critic of surgical tradition; he believes that major changes in the technology of cancer resection are necessary. His theme, ‘it’s what the surgeon doesn’t see that kills the patient’, summarizes the concepts behind many of his publications both in the peer-reviewed medical literature and in the lay press. In his opinion, perioperative intravenous and intraperitoneal chemotherapy are an essential planned part of many cancer interventions

Background: Ovarian cancer presents in a majority of patients with cancer dissemination widely distributed on the peritoneal

surfaces of the abdomen and pelvis. In a substantial proportion of patient’s not only peritoneal metastases but also lymph nodal

metastases will be present at the time of diagnosis.

Methods: Th e procedures required for complete surgical removal of all clinical evidence of ovarian cancer is pursued using

complete cytoreductive surgery (CRS). Th is may be performed either before or aft er neoadjuvant systemic chemotherapy.

At the time of surgery hyperthermic intraperitoneal chemotherapy (HIPEC) is used to improve the control of peritoneal

metastases. As the patient recovers from CRS plus HIPEC, combined intraperitoneal and systemic chemotherapy are initiated

for a six month interval.

Results: Cytoreductive surgery is associated with marked improvement in survival especially when all visible evidence of

disease is removed. In addition, HIPEC has been shown in randomized controlled trials to improve survival, primarily by

limiting the recurrence of peritoneal metastases. Also, long-term normothermic intraperitoneal chemotherapy (NIPEC-LT)

combined with systemic chemotherapy has been shown in randomized trials to show signifi cant benefi ts.

Conclusions: Combinations of complete CRS, HIPEC combined in the operating room with CRS and then NIPEC-LT plus

systemic chemotherapy will optimize the long-term survival of patients with advanced ovarian malignancy. Th e clinical

evidence for these benefi ts can be organized into an evidence-based treatment plan for this disease.

Roshan Prajapati has pursued his MBBS from Chuvash State University Medical Academy, Russia. He completed her MD in Medical Oncology from Zhengzhou

University. Presently he is working as a Physician and Surgeon in Bhaktapur Cancer Hospital, Nepal. He received IMA Fellowship (Gynae Oncology) from Rajiv Gandhi Cancer Institute.

Background: Ovarian cancer oft en has no symptoms at the early stages, so the disease is generally advanced when it is

diagnosed. Ovarian cancer is the seventh most common cancer in women worldwide and 18 most common cancer overall.

Epithelial ovarian cancer (EOC) is the leading cause of death in women with gynecological malignancy. Due to inadequate

screening tools and a lack of early clinical symptoms, approximately 70% of women with EOC are diagnosed with advanced

stage of disease, which is associated with high morbidity and mortality.

Methods: All detailed data of ovarian carcinoma taken from hospital registry of 2017.

Result: Ovarian carcinoma is the 13th common cancer in Bhaktapur Cancer Hospital and second most common gynaecological

cancer aft er cervical carcinoma. It consists of 2.3% of all cancer in 2017. Out of which 40% were referred from other centres

for adjuvant chemotherapy and palliative chemotherapy. 60% had undergone surgery in Bhaktapur Cancer Hospital. Medium

age is 49 years (22-75). 10% had borderline tumours, 15% had mucinous cystadenocarcinoma and 51% had high grade serous

adenocarcinoma. 55% has received neo adjuvant chemotherapy followed by interval cytoreductive surgery.

Conclusion: Ovarian carcinoma has been found to be a second leading gynaecological malignancy. Patient usually presented

in advanced disease. Most common histopathological fi nding is high grade serous adenocarcinoma.

Ping Jiang is an Associate Professor in Radiation Oncology Department in Peking University 3rd Hospital. She works mainly in radiotherapy for malignant tumor, especially in domain of radiation on GYN and thoracic malignant tumor, HDR and LDR brachytherapy in recurrent GYN. She has published many papers as firstauthor. Her research results are oral presented in ESTRO, JASTRO and ABS. She is the member of Youth committee of Chinese Medical Association Radiotherapy Branch and Youth committee of Beijing Medical Association Radiotherapy Branch. She is in charge of national important research and development project, digital diagnosis and treatment equipment research and development

Purpose: To evaluate the feasibility of 192Ir HDR interstitial brachytherapy and125I LDR permanent implantation brachytherapy

for recurrence of GYN aft er pelvic external beam irradiation.

Materials & Methods: Pelvic recurrence of GYN includes central recurrence and pelvic sidewall recurrence, diff erent site of

relapse associate diff erent management in our center. In our study, all recurrence patients aft er pelvic adjuvant external beam

radiotherapy (EBRT) or radical chemoradiotherapy. 11 patients in our center diagnosed with central recurrence of GYN,

they received 192Ir HDR interstitial brachytherapy under CT guidance with 3D-printing template assisted. Among them, 5

cases under local anesthesia with vaginal insertion template and 6 cases under epidural anesthesia with combined vaginal and

perineal insertion template. GTV prescription dose was 5-6 Gy/f, 2-6 f, 1-2 f/W. Totally 45 fraction treatment of 11patients.

21 patients with pelvic sidewall recurrence received 125I seeds implantation under the CT guidance with 3D-PNCT assistant.

Prescription D90 of GTV was 120-150 Gy, Th e local control probabilities were calculated and complications and early toxicities

were analyzed by the Kaplan-Meier method (SPSS 16.0).

Results: 11 patients with central recurrence, totally 229 needles were inserted for 45 FDR applications, median 6 (3-9) needles

per fraction, mean inserting depth was 8.3±3.4 cm (2-13.7 cm), mean CT scan 3 (1-5) times, during CT guidance procedure.

Actual dosimetry parameters of median V100 were 83±4.5%. Early side eff ects of grade I/II urethritis were found in 45%

patients and relieved aft er symptomatic treatment. Totally response rate (1 month later) was 91%, 1 lesions had complete

remission CR (9%) and 9 had partial remission PR (82%). Among 21 patients with sidewall recurrence, 669 (median 47, 25-

113) seeds implanted, total 132 needles (median 9, 6-21) were implanted actually. Th e activity of 125 I seeds ranged from 0.3

mCi to 0.8 mCi (median: 0.69 mCi). Th e total number of seeds implanted ranged from 3 to 89 (median: 20). Actual dosimetry

parameters of median V100 were 93±4.5%. Totally response rate (1 month later) was 85%, 3 lesions had complete remission

CR (14%) and 15 had partial remission PR (71%). severe complications were not seen.

Conclusion: 192Ir HDR interstitial brachytherapy for central recurrence and 125I LDR permanent implantation for pelvic

sidewall recurrence of GYN under CT guidance have good dosimetry parameters. It is clinically feasible and high effi ciency

with low complications. However long-term clinical outcomes should be further investigated.

Sristee Shrestha Prajapati has pursued her MBBS from Dagestan State Medical Academy, Russia. She completed her MD in Obstetrics & Gynecology from

Zhengzhou University. Presently she is working as a Physician and Surgeon in Bhaktapur Cancer Hospital, Nepal. She received IMA Fellowship (Gynae Oncology) from Rajiv Gandhi Cancer Institute in 2015

(RT) in a locally advanced cervical cancer by eliminating of micrometastases and shrinking of the primary tumour bulk to

achieve radical operability. Th e aim of this study is to evaluate the effi cacy of NACT in the patients with locally advanced cancer

cervix (LACC), to determine the percentage of LACC patients who needed adjuvant radiation aft er treatment with NACT and

surgery and to evaluate the disease-free interval (DFI) at two years in these patients aft er this treatment.

Methods & Materials: From 2007 to 2013 a retrospective data collection of women undergoing radical hysterectomy for

cervical cancer FIGO Ib2 to IIb, aft er neo-adjuvant chemotherapy conducted at Rajiv Gandhi Cancer Institute and Research

Centre, New Delhi, India. Th e median age group was 52 years with the range of 30 to 80 years.

Results: Total of 103 women, received NACT, out of which 45 patients received TIP regimen (paclitaxel + ifosphamide +

cisplatin) and 58 received CP regimen (carboplatin + paclitaxel). Out of 103 patients, 5 (4.85%) patients were of adenocarcinoma,

7(6.79%) were of adenosquamous, and rest of 91 (94.1%) were of squamous cell carcinoma. 23 patients were presented with

stage IB2, 4 patients with stage IIA and 76 patients were in stage IIB. On the basis of MRI report and clinical examination,

the clinical effi cacy was evaluated, 28(27.18%) obtained complete response to NACT, 66(64%) obtained partial response, and

6(5.82%) were non-responder to NACT. Furthermore the effi cacy of NACT was measured in terms of optimal pathological

response, 16(15.53%) obtained complete response, 35(33.98%) obtained near complete response, and 52(50.48%) obtained

partial response. Adjuvant treatment was given for adverse factors in histopathology report, such as in 23 patients LVSI was

present, 20 patients had positive pelvic lymph nodes, 2 had parametium involvement, 3 got positive margins, and 35 patients

had more than 50% of stromal involvement. 8 out of 23 (34%) patients in stage IB2, 2 out of 4 patients (50%) in stage IIA, and

17 out of 76 patients (22%) in stage IIB were spared from the adjuvant radiotherapy as received optimal pathological response

to NACT followed by radical surgery. Recurrences were noted in 16(15.53%) patients i.e. 4(3.88%) with local recurrence and

12(11.65%) presented with distant recurrence.

Conclusion: NACT can eff ectively eliminate and downstage the locally advanced cervical cancer so that resectability improves

and increases the chances of wide surgical resection with tumor free margins which otherwise is not possible. With the judicious

use of NACT followed by radical surgery, adjuvant treatment can be avoided in patients with pathological cure, which can be

preserved for later salvage treatment, if recurrence occurs during follow up. Th e results of NACT followed by radical surgery

in LACC patients is encouraging, however, long term follow up and large randomized control trials should be carried out to

make this approach as standard of care within this group of the patients.

Oluwatosin Motunrayo Rotimi is currently a PhD (Public health) student at University of KwaZulu-Natal, Durban, South Africa. She qualifi ed as a medical doctor

at Ladoke Akintola University of Technology, Ogbomoso, Nigeria where she obtained her Bachelor of Medicine and Bachelor of Surgery (MBBS). She received a

diploma in Tropical Medicine and Health from the University of Pretoria, South Africa and Postgraduate Diploma in HIV management from Stellenbosch University,

South Africa. She obtained her Master’s Degree in Public Health at University of KwaZulu-Natal. She has worked extensively in medical research and also practiced

as a medical doctor. Her research interests are cervical cancer, cervical cancer screening, HIV and infectious diseases.

Cervical cancer continues to be a major cause of morbidity and mortality among women in the developing world. It is currently

the second most commonly reported cancer among women in South Africa. Approximately one in every 26 South African

women will develop cervical cancer during their lifetime. Organized cytology-based screening programs using Papanicolaou

smear testing continues to be the single most eff ective tool in reducing deaths due to cervical cancer. Despite the creation of

a national cervical cancer screening program, fi ndings have shown low level of knowledge of cervical cancer and screening

methods among university female students in South Africa. Th is study presents the assessment of the level of knowledge

of cervical cancer screening among fi rst year female students on the Howard College Campus (HCC) at the University of

KwaZulu-Natal (UKZN); to determine their attitudes towards cervical cancer screening and; to examine the factors infl uencing

their knowledge and attitude towards cervical screening. An observational cross-sectional study design with both descriptive

and analytic components was implemented. Th e study was conducted on the HCC at the UKZN. A proportional stratifi ed

random sampling technique was used to select 244 fi rst year female students aged 18 to 25 years. Data was collected using

a standardized structured self-administered questionnaire. Th e data was analyzed using descriptive and analytic statistics.

Th e results show fairly good level of awareness of cervical cancer (75.4%) and cervical cancer screening method (Pap smear)

(70.9%). However, knowledge of cervical cancer risk factors, symptoms, screening methods and treatment was poor.

Fahimeh Molaahmadi has completed her Midwifery degree from Iran University of Medical Sciences. Presently she is working in Royan Institute on infertility. She has international oral papers and publications.

Introduction: How are the couples undergoing assisted reproductive technologies perceptions and long-term emotional

adjustment to art? Several studies revealed eff ective coping depends on the characteristics of the stressor, meaning of infertility

and social support as predictors of the emotional adjustment to unsuccessful IVF and lack of adaptation in terms of the

inability to regain control, personality characteristics.

Materials & Methods: A total number of couples completed the adjustment of illness scale (AIS). Women fulfi lled the scale in

ovum pick-up day, but men completed the tool separately. Th e total mean score of this scale ranged from 0 to 72. Responses

were as 7-point Likert scale. Th e total mean score of 12 statements obtained by the couples was assessed according to clinical

and demographic characteristic. Th is was a cross-sectional study on 300 infertile couples referred to Royan Institute, a fertility

center, in Tehran, Iran within recruitment was done as convenience samples.

Results: Th e mean age of participants was 34.47±5.99. Nearly half of couples (43.6%) suff ered from male infertility. Most of

them (78%) did not report any history of abortion, but half had a history of failure of infertility treatment. One-way ANOVA

did not show any signifi cant diff erence between male and female in total mean score of AIS by cause of infertility (p=0.6) and

education level (p=0.27). Comparison of total mean score of couples with and without a history of failure and abortion did not

show any signifi cant diff erence between male and women (p=0.89 and p=0.89, respectively).

Conclusion: Th e total mean score of AIS was 42.59±9.93 (42.45±10.62 in males, 42.75±9.23 in females; p=0.72). Our fi ndings

indicated that all infertile clients need to have psychological interventions and counseling leading to upgrade their adjustment

with problem-oriented infertility.

Ama Afrah is Master of Philosophy in pathology from University of Ghana, Legon.She is certifi ed from American society for Colposcopy and cervical pathology.

Presently Ama afrah is working in Korle – Bu Teaching Hospital and Cray Med Lab Services.

cancer and cervical intraepithelial neoplasia in women. Criteria for grading of these lesions by pathologist based on digression

in growth and degree of invasiveness among other abnormalities have been aff ected by inter and intra-observer diff erences

resulting in poor reproducibility. Diagnosis disagreement in histopathology between colleague residents or between residents

and pathology consultants can result in over/unnecessary treatment that will incur more to a poor woman or under treatment

that will put the life of a woman with cervical lesion at risk of metastatic disease with low survival rate. Ki-67, a proliferative

marker is useful in grading of cervical cancer and cervical intraepithelial neoplasia by giving uniform and reliable outcome

independent of inter and intra-observer diff erences.

Aim: To demonstrate the level of expression of Ki-67 antigen in invasive cervical cancer and cervical intraepithelial neoplasia

in Ghanaian women by reducing observer diff erences.

Methodology: Using indirect immunohistochemical method, 116 diagnostic cervical samples with varying grades of cervical

intraepithelial neoplasia and invasive cancer selected retrospectively and randomly were analyzed for level of expression of

Ki-67. Kappa analysis was used to assess the level of agreement between resident colleagues as well as between residents and

consultants in histological diagnosis and immunohistochemistry.

Results: Th e levels of Ki-67 expression in malignant lesions were higher than in premalignant lesions which were also higher

than in normal cervix. Th e inter observer diff erences between consultants, pathologist and residents was higher than intra

observer diff erences. Th e levels of Ki-67 could distinguish post-menopausal atrophy from dysplasia.

Conclusion: Due to semi quantitation of Ki-67 protein there exist some level of inter observer diff erence using Ki-67 grading

of tumours but as compared to that which exist for histomorphological grading of tumours, the former is better. Inter observer

diff erence using Ki-67 grading as compared to histomorphological grading of tumours were better using kappa analysis. Ki-67

score can distinguish between reactive lesions and dysplasia. Ki-67 analysis therefore should serve compliment to histological

grading of tumour for the objective, reproducible, and reliable classifi cation of dysplastic changes in cervical epithelium

especially for proper patient management to increase chance of survival or reduce unnecessary treatment. However, the

fi ndings and conclusions of this study are limited by the small sample size of participants, and a much larger population-based

study would be required to validate our fi ndings.