ACROBATIC at Danish Cancer Research Days 2023
Several projects affiliated to ACROBATIC were presented at DKD2023
Denmark’s largest interdisciplinary cancer conference “Danish Cancer Research Days 2023” (Danske Kræftforskningsdage 2023/DKD2023) took place at ODEON in Odense on August 31st through September 1st 2023. Focusing on Danish cancer research, DKD2023 aims to innovate and improve treatment of the future through national and interdisciplinary projects – for the benefit of the patients.
Several interesting projects were presented at DKD2023, a status update on the decline in cancer cases in Denmark were given, great discussions were held about initiatives to the new “Kræftplan V”, and it was a lovely opportunity to network and catch up with colleagues.
Several of ACROBATIC’s members participated in the conference, and at ACROBATIC, we were proud to hear about the exciting updates from our affiliated projects. Sarah Marie Bjørnholt, Ph.D. student from Department of Gynecologi and Obstetrics, Aarhus Universiy hospital, presented her work as part of the “Exceptional Young Scientist” session. The title of the talk was “Risks and benefits of a national adoption of sentinel node mapping in low and intermediate risk endometrial cancer” (WP 2.8):
WP 2.8: WP leader Pernille Tine Jensen
Title: Risks and benefits of a national adoption of sentinel node mapping in low and intermediate risk endometrial cancer.
Introduction: Surgical staging of endometrial cancer (EC) serves to allocate women with lymph node metastases to adjuvant therapy. Sentinel lymph node (SLN) mapping is a sensitive staging procedure that identifies small-volume metastases. SLN mapping has shown high accuracy in women with EC with low- or intermediate-risk (LR or IR) of lymph node metastases. It remains unknown, whether a national adoption of SLN mapping with several centers and surgeons involved, to all women with LR and IR EC, prompts more benefits than harms.
Materials and methods: We undertook a national prospective study of SLN-mapping in women with LR and IR EC from March 2017- February 2022. The study was performed in a real-life clinical setting. SLN detection rate and the incidence of isolated tumor cells, micro- and macro-metastases were investigated. Peri- and postoperative complications were registered and classified according to Clavien-Dindo. Lymphedema was evaluated by validated patient-reported outcome measures at baseline and three months postoperatively. Lymphedema was assessed as a mean difference score and as an incidence of swelling and heaviness.
Results: 627 women were included in the analyses, 458 with LR- and 169 with IR EC. The overall incidence of lymph node metastases was 9.3% (58/627); 4.4% (20/458) in the LR- and 22.5% (38/169) in the IR group. Only 0.3% (2/627) experienced an intraoperative complication associated with SLN mapping. The incidence of postoperative complications was 8% (50/627). The mean difference score of lymphedema was below the threshold for importance 4.3/100 CI: (2.6-5.9), and the incidence of swelling and heaviness was 5.2% and 6.1%, respectively.
Conclusion: SLN mapping is a safe staging procedure in women with EC of LR and IR, carrying a very low risk of early lymphedema, peri- and postoperative complications. The study has led to a national change in clinical practice and contributed to a more correct treatment allocation for both groups.
Ida Hovdenak (WP 3.1), Caroline Lilja (WP 2.9), and Tine Engberg Damsgaard (WP 2.10) presented their projects affiliated to ACROBATIC at the poster session:
WP 3.1 – WP leader Therese Juul
Title: Quality of life and symptom burden after rectal cancer surgery. A randomised controlled trial comparing patient-led versus standard follow-up.
Introduction: After curatively intended rectal cancer (RC) surgery, new follow-up strategies are warranted, seeking more individualised care and targeting health-related quality of life (HRQoL) and functional outcomes. The FURCA trial aimed to investigate the effect of patient-led follow-up on HRQoL and symptom burden three years after surgery.
Materials and methods: RC patients from four Danish centres were randomised 1:1 to intervention (patient-led follow-up with patient education and self-referral to a specialist nurse) or control (standard follow-up with five routine doctor visits). Patients in both groups had a computed tomography (CT) at one and three years. The primary outcome (HRQoL) was assessed by the Functional Assessment of Cancer Therapy – colorectal (FACT-C) score [1]. Secondary outcomes were functional measures, patient involvement and satisfaction, and cancer recurrence at three years.
Results: From Feb 2016 to Aug 2018, 336 patients were included of whom 248 completed three years of follow-up. Between-group differences were found neither for the primary endpoint, nor for functional outcomes. The recurrence rate did not differ between the groups. Patient involvement and satisfaction were higher in the intervention group with statistical significance in almost half of the items.
Conclusions: We found no effect on HRQoL and symptom burden from patient-led follow-up, although it may improve patient-perceived involvement and satisfaction. The findings in this study suggest that patient-led follow-up is a more tailored approach to meet cancer survivors’ needs and might improve their ability to cope with survivorship.
WP 2.9: WP leaders Tine Engberg Damsgaard og Jens Ahm Sørensen
Title: Optimizing preoperative planning for lymphovenous anastomosis in breast cancer lymphedema.
Introduction: Lymphovenous anastomosis (LVA) is an increasingly popular procedure for treatment of lymphedema, with several surgical centres demonstrating that the operation can be performed. However, finding applicable vessels for anastomosis remains a challenge. The aim of this pilot study is to investigate and test if th:e combination of ultra-high frequency ultrasound and indocyanine green (ICG) lymphography, can resolve this obstacle, and improve LVA planning and optimize surgical success.
Materials & methods: Six female patients with breast cancer related lymphedema in their upper extremity have undergone LVA surgery planned with ultra-high frequency ultrasound and ICG lymphography. The number of identified vessels were noted and compared to the number rediscovered during surgery. Likewise, the number of anastomoses performed were compared to the number planned prior to surgery.
Secondary outcome measures of arm volume differences, health-related quality of life, body composition, and L-Dex score were assessed prior-to and three months after surgery.
Results: All targeted vessels were identified during surgery, and successful anastomoses were accomplished, using ultra-high frequency ultrasound and ICG lymphography. The patients’ post-operative courses were uneventful with no severe adverse events. Regarding the secondary outcome measures of arm volume differences, an improvement was registered in two patients at three months follow-up. Moreover, two patients reported an improvement in psychological function and all patients experienced a greater dissatisfaction with the compression sleeve after surgery. This is an ongoing study with an inclusion target of 10 patients. Results for more patients will be presented at the conference as the patients complete their follow-up.
Conclusion: Ultra-high frequency ultrasound and ICG lymphography has so far successfully targeted and identified venules and lymphatic vessels in close proximity for LVA surgery in all patients.
WP 2.10: WP leader Tine Engberg Damsgaard
Title: Determining the angiosome and localizing the perforator in oncoplastic breast surgery using ICG-angiography.
Introduction: Peroperative assessment of tissue perfusion by ICG-A is well-known for breast reconstructive surgery, but its clinical use in oncoplastic breast surgery (OBCS) has not yet been investigated. We conducted a prospective trial including volume displacement- and replacement OBCS to determine the angiosome and localize perforators intraoperatively. Furthermore, to investigate and correlate results of the peroperative ICG-A to postoperative surgical site infection, skin necrosis, epidermolysis and timely onset of adjuvant therapy.
Methods: ICG-A was performed 3 times during surgery; after removing the cancer, upon dissection of possible perforators and after wound closure. All patients were followed with clinical evaluations before surgery, 4 weeks, 4-6 and 12 months postoperatively.
Results: Of 11 included patients, 7 had volume displacement and 4 volume replacement OBCS (3 lateral intercostal artery perforator flaps and 1 muscle sparing latissimus dorsi flap). ICG-A was sufficient in localizing angiosomes and perforators and corresponded to clinical assessment demonstrating sufficient perfusion in all cases. No patients developed postoperative necrosis or loss of reconstruction. One patient developed postoperative infection and seroma of the breast and was treated conservatively. During follow-up 36.4% developed breast edema and was treated with compression therapy and manual drainage, all had undergone adjuvant radiotherapy.
Conclusion: We demonstrated the feasibility of applying ICG-A for OBCS assessing the peroperative perfusion and identifying perforators. Recent studies have shown survival benefit of breast conserving surgery compared with mastectomy, possibly resulting in an increased patient population suitable for
OBCS. Future studies applying ICG-A for OBCS in high-risk breast cancer patients could be a field of interest.