Academic Center for Gynaecological Tumors

The ACE gynaecological tumours connects regional professionals and medical specialists at the Erasmus MC, to assure that all women with gynaecological cancer in the south west of the Netherlands receive state of the art treatment. Patient care, research and education of fellow doctors and nurses are the key to further improvement of care.

Academic Center of Excellence

Research Activities

The ACE Gynaecological tumours focus on diagnostics, novel (surgical) treatment strategies and hereditary tumours.

We are a NFU knowledge centre for hyperthermia and hereditary tumours.

Diagnostics:

  • Translational research on the mechanisms of hyperthermia (induction of BRCA ness)
  • Circumventing therapy resistance in ovarian cancer (OVCAM)
  • Archipelago of Ovarian Cancer Research; structural collection and analyses of clinical data and material in ovarian cancer patient
  • Study on free margins in pre-malignant cervical dysplasia and cervical cancer surgery using Gamma Glutamyl Transpeptidase
  • Raman spectroscopy in vulvar cancer
  • Vulvar pathology; discern premalignant and malignant disease, understanding oncogenetic pathways in vulvar cancer
  • the applicability of the EIN classification in endometrial pathology

Novel treatments:

  • The PlaComOV study is a study on the effectiveness of the plasma jet device in ovarian cancer surgery in a multicentre randomized trial. Disciplines that are involved are: radiology (systemic reading of CT scans), histology (depth of destruction of tissue, molecular diagnostics), health economy (cost-effectiveness).
  • The Vaccin study: a large multicentre study on the use of nonavalent HPV vaccine after surgery for cervical dysplasia. Does it reduce the change of recurrence?
  • TOPIC trials, the use of imiquimod in (recurrent) cervical dysplasia.
  • Further development of the sentinel node (SN) procedure for vulvar cancer. Use of a new technique (fluorescence) and broadening of the indication (SN in recurrent disease).
  • Evaluation and improving the treatment schedules for women with cervical cancer, with emphasis on sexuality and quality of life (the SPARC study).
  • In collaboration with the Technical University of Eindhoven MRI guided hyperthermia planning is developed further. This is part of the “Technology for Oncology” project of STW en KWF.
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Hereditary cancer:

  • The ACE participates in large cohort studies concerning mutation carriers, both BRCA and Lynch related. (HOVON, HEBON, CIMBA)
  • BRCA1- and BRCA2-associated epithelial ovarian cancer: aiming at personalized counselling and therapy.
  • HARMony: Favourable and unfavourable effects of RRSO in women at high genetic risk of ovarian cancer.
  • HIRISE: RCT on HRT after RRSO in BRCA1 and BRCA2 carriers
  • Lynch Syndrome diagnoses: Adherence to the guideline in endometrial cancer, cost effectiveness studies.
  • Others:
  • Final analyses of the OMEGA study, a long lasting epidemiological study on the effect of IVF on gynaecological cancers and childhood cancer are expected soon.
  • Outcome of carcinosarcoma of the endometrium
  • INCIP: International collaboration is needed to answer questions related to pregnancy and cancer. Our members are active in the international network of cancer and pregnancy and members of the Dutch Advisory Board: “Advies kanker in zwangerschap”
  • Trophoblast disease: under supervision of the ACE a RCT was performed in Egypt on re-curettage or not. Our members are part of the Dutch workforce and actively involved in studies on

Type of

Collaborations

We participate actively in (international) study groups (EORTC, GROINSS-V), concerning several gynecological tumor entities.

The ACE is related to the ACEs “genome repair targeted cancer treatment” the “Academic Centre for Innovative Oncological Surgery” and the ACE breast cancer.

The ACE is related to the ACEs “genome repair targeted cancer treatment” the “Academic Centre for Innovative Oncological Surgery” and the ACE breast cancer.

Educational

Contributions

We collaborate in the Bachelor curriculum, providing lecturing, coaching and small-scale interactive education (vaardigheidsonderwijs).
During the MSc curriculum the gynaecology department hostess regular and advanced junior house officers. Prior to working as a junior house officer, the ICK (introductory course for clinical work) is offered. Currently we are involved in the development of the ‘Dedicated Schakeljaar’, in the 3rd year of Msc.

The most recent external audit was in January 2015. We provide an extended residency program (differentiation) for the 6th year trainee (AIOS) into gynaecologic oncology in collaboration with the departments of medical oncology, genetics and radiotherapy. One staff member is Director Gynaecologic and Obstetric Residency Program, and on behalf of this board member of the COCR (Centrale Opleidingscommissie) and board member of The (National) Federation Medical Specialists.

Education is yearly monitored with SET Q and D-RECT. Based on these feedback reports the staff is personally coached and advised on points for enhancement, and improvements in the learning environment is implemented (i.e. reinforcement of AIOS peer groups, amendments of the morning report, and supporting the residents after traumatic experiences).

Several participants of the ACE contribute to gynaecological subjects of the OMBO course.

We train fellows in Gynaecological oncology.

 

Six PhD candidates are related to the gynaecological oncology department, three of them are graduated as a gynaecologist, including an Egyptian colleague.

One of our members is in the board of the Working Party International Safe Motherhood and Reproductive Health of the NVOG and is involved in development of a minor (LUMC) and a summer school (UMCU).

Patient

Care Activities

All women with gynecological cancer in the south west of the Netherlands should receive state of the art treatment. To achieve this we developed a regional protocol for endometrial cancer (www.oncoline.nl, endometriumcarcinoom, "regionale toevoeging") and strict guidelines concerning ovarian cancer care (Clinical Cancer Network (CCN) Ovarian cancer South West Holland).

Gynaecologist are detached to 3 satellite hospitals for dedicated surgery. In accordance with the National Guidelines gynaecological cancers are treated in an academic center, most women get multidisciplinairy treatment. At the Erasmus MC more than 80% of the care can be labeled academic. In the very near future the ambition of the GT is to develop the laparoscopic / robotic skills of the staff, and to investigate and implement new treatments modalities (sentinel node procedures in vulvar, cervical and endometrial cancer) in daily practice.

Currently all treated patients are registered in the national DICA system. This implies that the patients are asked to fill in the related PROMS. Unfortunately the results are not shared at patient level, but only at the level of the clinic. Clinical pathways are currently developed. It is expected that with the system Gems Tracker outcome measures can be obtained and a program for track and improvement will be developed. The GT acknowledges the need to reduce the postoperative stay of patients in our clinic, for long postoperatively the patient is transferred as quickly as possible to a specialized rehabilitation center for care (Laurens Intermezzo Zuid).

Societal Relevance to Research, Education and Patient Care

A member was involved in the development of a web- based program for patients with gestational trophoblastic disease (www.voorhetgesprek.nl).

The training of residents is structured in such a way that the trainee is educated on an individual basis as well as competency based. We offer a special program for the need to differentiate in gynaecologic oncology (innovation and curriculum)

The GT hosted an Egyptian colleague, which resulted in the elaboration of a modern gynaecology-oncology unit at the Mansouri University Clinic in Egypt. The collaboration further gave rise to writing and implementing a RCT on trophoblastic disease. In Gondar (Ethiopia) we are involved in training of local gynaecological oncologist.

The ACE-GT founded the CCN Ovarian cancer South West Holland. This stands for excellent, uniform, efficient and multidisciplinary care in ovarian cancer in our region. So, for all patients the care complies with all requirements and standards; the patient receives the best care in the right place. Similarly, the ACE has structured a guideline for endometrial cancer with - and for the region. Several member recently or currently participate(d) in the development of national guidelines and working committees (oncoline, NVOG, SWAB)

Viability of Research, Education and Patient Care

Within the ACE GT there is a close collaboration between diagnostic and treatment focused professionals: all cases are discussed at the weekly tumour board. To remain state of the art, regular meetings of the GT take place, discussing treatment protocols and (novel ideas for) research. Within the regional network (CCN ovarian cancer) meetings are organized to update regional protocols, and harmonize treatment. (i.e. second line chemotherapy for ovarian cancer, BRCA testing etc).

One of the key elements of the GT is hereditary cancer. Therefore, the GT is involved in the tumour group hereditary tumours, including collaborative clinical and research projects. There is a strong connection with Aruba with regard to treatment of women with a gynaecological malignancy: for radical surgery all women are referred to the Erasmus MC.

One member of the GT is active in the Dutch Working Party Safe Motherhood and Reproductive Health (NVOG) and actively involved in a project in Gondar, Ethiopia, to put on the training of gynaecologists to gynaecologic oncologist. In addition, she is involved in a project to develop a course in gynaecological emergencies for Third World countries.

Key and relevant publications of the last five years

  • van der Burg ME, Onstenk W, Boere IA, Look M, Ottevanger PB, de Gooyer D, Kerkhofs LG, Valster FA, Ruit JB, van Reisen AG, Goey SH, van der Torren AM, ten Bokkel Huinink D, Kok TC, Verweij J, van Doorn HC. Long-term results of a randomised phase III trial of weekly versus three-weekly paclitaxel/platinum induction therapy followed by standard or extended three-weekly paclitaxel/platinum in European patients with advanced epithelial ovarian cancer. Eur J Cancer. 2014 Oct;50(15):2592-601
  • van der Burg ME, Vergote I, Onstenk W, Boere IA, Leunen K, van Montfort CA, van Doorn HC. Long-term results of weekly paclitaxel carboplatin induction therapy: an effective and well-tolerated treatment in patients with platinum-resistant ovarian cancer. Eur J Cancer. 2013 Apr;49(6):1254-63.
  • van Beekhuizen HJ, Auzin M, van den Einden LC, de Hullu JA, van der Velden J, Wildhagen MF, van Doorn HC. Lymph node count at inguinofemoral lymphadenectomy and groin recurrences in vulvar cancer. Int J Gynecol Cancer. 2014 May;24(4):773-8.
  • Thomeer MG, Gerestein C, Spronk S, van Doorn HC, van der Ham E, Hunink MG. Clinical examination versus magnetic resonance imaging in the pretreatment staging of cervical carcinoma: systematic review and meta-analysis. Eur Radiol. 2013 Jul;23(7):2005-18.
  • Heijkoop ST, Franckena M, Thomeer MG, Boere IA, Van Montfort C, Van Doorn HC. Neoadjuvant chemotherapy followed by radiotherapy and concurrent hyperthermia in patients with advanced-stage cervical cancer: a retrospective study. Int J Hyperthermia. 2012;28(6):554-61
  • Koeneman MM, Kruse AJ, Kooreman LF, Zur Hausen A, Hopman AH, Sep SJ, Van Gorp T, Slangen BF, van Beekhuizen HJ, van de Sande M, Gerestein CG, Nijman HW, Kruitwagen RF. TOPical Imiquimod treatment of high-grade Cervical intraepithelial neoplasia (TOPIC trial): study protocol for a randomized controlled trial. BMC Cancer. 2016 Feb 20;16:132.
  • Buis CC, van Leeuwen FE, Mooij TM, Burger CW; OMEGA Project Group. Increased risk for ovarian cancer and borderline ovarian tumours in subfertile women with endometriosis. Hum Reprod. 2013 Dec;28(12):3358-69
  • Spaan M, van den Belt-Dusebout AW, Burger CW, van Leeuwen FE; OMEGA-project group. Risk of Colorectal Cancer After Ovarian Stimulation for In Vitro Fertilization. Clin Gastroenterol Hepatol. 2016 May;14(5):729-737
  • van Doorn HC, van Beekhuizen HJ, Gaarenstroom KN, van der Velden J, van der Zee AG, Oonk MH, de Hullu JA. Repeat sentinel lymph node procedure in patients with recurrent vulvar squamous cell carcinoma is feasible. Gynecol Oncol. 2016 Mar;140(3):415-9
  • 2 Boere I, Lok C, Vandenbroucke T, Amant F. Cancer in pregnancy: safety and efficacy of systemic therapies. Curr Opin Oncol. 2017 Sep;29(5):328-334.

PhD theses of the last five years

  • Mw dr. L.A.M. Santegoets, Erasmus MC, 21 oktober 2011; Molecular and immunological mechanisms of epithelial disorders of the vulva
  • Mw dr. A. Terlou, Erasmus MC, 18 november 2011; Immune regulation in premalignant vulvar and vaginal disorders
  • Mw dr. M. Kocken, Erasmus MC, 2 mei 2012; Risk assessment of cervical disease by hrHPV testing and cytology
  • Dr. P. van der Horst, Erasmus MC, 27 september 2013; Initiation and progression of Müllerian duct derived malignancies
  • Mw dr D. Boll, Erasmus MC, 20 december 2013; Corpus Uteri Malignancies in The Netherlands since the 1980’s: Registry-based studies of variation in incidence and outcome
  • Mw dr A. Roos, Erasmus MC, 28 april 2014; Sexual Dysfunction in Urogynaecology
  • Mw dr P.M.L.H. Vencken, Erasmus MC, 19 september 2014; BRCA1- and BRCA2-Associated Ovarian Cancer: different diseases?
  • Mw dr R. van Baars, Erasmus MC, 1 oktober 2014; Improving Cervical Cancer Prevention by HPV Self-sampling, Colposcopy and Biomarkers
  • Mw. Dr. A. Baalbergen, Erasmus MC, 7 oktober 2014; Adenocarcinoma of the Uterine Cervix and its Precursor Lesion
  • Mw. Dr. S. T. Heijkoop, Erasmus MC, 25 oktober 2017; Plan-of-the-Day Adaptive Radiotherapy for Locally Advanced Cervical Cancer
  • Mw. Dr. A Goverde, Erasmus MC, 26 september 2018, Lynch Syndrome. Improving diagnostics and surveillance.
  • Dr. M. Thomeer, Erasmus MC, 21 november 2018; Abdominal MRI in women’s health: advanced imaging

Non-scientific publications related to the ACE

Principal coordinator(s)

Last updated: 365 days ago.