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KU Leuven (2)


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dissertation (2)


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English (2)


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2023 (1)

2018 (1)

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Dissertation
Predicting resectable disease in relapsed epithelial ovarian cancer by using whole-body diffusion-weighted MRI (WB-DWI/MRI)

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Abstract

Objective To determine the diagnostic value of whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) to predict resectable disease at the time of secondary cytoreductive surgery (SCS) for relapsed epithelial ovarian cancer (EOC) with a platinum-free interval (PFI) of at least 6 months. Methods A retrospective cohort study between January 2012 and December 2021 in a tertiary referral hospital. Inclusion criteria were: (a) first recurrence of EOC; (b) PFI of ≥6 months; (c) intent to perform SCS with complete macroscopic resection; and (d) WB-DWI/MRI was performed. Diagnostic tests of WB-DWI/MRI for predicting complete resection during SCS are calculated as well as the progression-free (PFS) and overall survival (OS) of the patients with a WB-DWI/MRI that showed resectable disease or not. Results In total, 238 patients could be identified, of which 123 (51.7%) underwent an SCS. WB-DWI/MRI predicted resectable disease with a sensitivity of 93.6% (95% confidence interval [CI] 87.3 – 96.9%), specificity of 93.0% (95%CI 87.3 – 96.3%), and an accuracy of 93.3% (95%CI 89.3 – 96.1%). The positive predictive value was 91.9% (95%CI 85.3 – 95.7%). Prediction of resectable disease by WB-DWI/MRI correlated with improved PFS (median 19 months vs. 9 months; hazard ratio [HR] for progression 0.36; 95%CI 0.26 – 0.50) and OS (median 75 months vs. 28 months; HR for death 0.33; 95%CI 0.23 – 0.47). Conclusion WB-DWI/MRI accurately predicts resectable disease in patients with a PFI ≥6 months at the time of SCS and could be of complementary value to the currently used models.

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Dissertation
Organoids of epithelial ovarian cancer as a novel preclinical in vitro tool

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BACKGROUND: Epithelial ovarian cancer (EOC) is the most lethal gynecological cancer in developed countries mainly due to diagnosis at an advanced stage and frequent recurrences. Organoids, a novel in vitro 3D cell structure grown from stem cells, could provide an interesting in vitro preclinical platform to address these issues and could lead to a next step in personalized medicine. OBJECTIVES: The first objective was to provide an overview of current therapies of EOC, including clinical trials. The second objective was to gain insight into organoids. Furthermore, by focusing on current literature regarding organoids of ovarian tissue and ovarian cancer, we wanted to explore possible future clinical applications of EOC organoids. METHODS: A MEDLINE and Embase search was conducted to identify relevant reviews about the different treatment modalities of EOC and about organoids. MEDLINE, Embase, Web of Science and the Cochrane library were searched for literature about organoids of ovarian tissue and ovarian cancer. Additionally, a manual selection of current clinical trials in treatment of ovarian cancer was performed using the International Clinical Trials Registry Platform. RESULTS: Out of 539 recent reviews of the treatment of EOC, 35 were included. 458 reviews about organoids were found, 57 were finally selected. Only 10 articles about organoids of EOC could be included. Lastly, the methodical selection of clinical trials resulted in 1275 unique clinical trials out of 2312 retrieved from the database. CONCLUSIONS: Current standard-of-care therapies for EOC are still evolving, with new drugs studied, predominantly for the treatment of recurrent cancer. Organoids are an interesting novel 3D platform for modeling disease, drug testing and screening, and other applications. However, organoids have limitations, primarily due to their lacking micro-environment. By using organoids of EOC, insights into pathogenesis and discovery of new diagnostic markers could be possible. This platform might also allow for drug screening and development and may ultimately provide a tool for highly-personalized medicine.

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