Dr. Leen Verleye completes Research Fellowship at EORTC Headquarters with the EORTC Gynecological Cancer Group

This past June, Dr. Leen Verleye completed a three year stay at EORTC Headquarters as a Research Fellow in the EORTC Gynecological Cancer Group (GCG). During her fellowship Dr. Verleye was involved in several studies conducted by the GCG, and the results of these studies will lead to improvements in the treatment and follow-up of patients with ovarian and cervical cancers. Support for her fellowship was provided by Fonds Cancer (FOCA) and the Dr. Vivien Piercy Memorial Fund.

In a study published in the European Journal of Cancer, Dr. Verleye and co-workers defined quality indicators that can be used to monitor and improve the quality of surgery for ovarian cancer. [1] Surgery is central in the treatment and staging of ovarian cancer, and optimal quality ovarian cancer surgery should be synonymous with complete staging and removal of all macroscopic tumors while limiting patient harm and ensuring best patient outcome. However, the quality of ovarian cancer surgery does vary, and quality indicators are necessary to assess and improve the quality of ovarian cancer care. The GCG researchers conducted a literature search using medical subject heading terms in order to identify candidate quality indicators. They defined five quality indicators for staging of presumed early-stage ovarian cancer and six quality indicators for primary debulking surgery for advanced disease that can be used to monitor and improve the quality of surgery for ovarian cancer patients. These indicators will enable valid comparisons to be made between clinical practice and outcome and have already been applied to surgery reports collected within the EORTC 55971 / NCIC-CTG OV13 trial. Preliminary results of that project were presented at the 12th Biennial meeting of the International Gynecological Cancer Society (IGCS) in Bangkok. In addition, the surgical pathology reports were audited, and the results of this audit were also presented at this meeting.

In another paper, Dr. Verleye and members of the GCG studied the factors influencing the quality of a radical hysterectomy and pelvic lymphadenectomy and proposed a set of quality indicators that can be used to audit and improve the quality of surgical care for patients with these stages of cervical cancer.[2] Radical hysterectomy combined with a pelvic lymphadenectomy or chemo-radiation is the accepted treatment for International Federation of Gynecology and Obstetrics (FIGO) stages Ia2–IIa cervical cancer. They found that the quality of a radical hysterectomy can be improved by assuring a sufficient number of operations per surgeon.  In addition, monitoring outcome parameters such as local recurrence rate, survival, and short- and long-term morbidity can identify areas in need of improvement. Lymph node count can be used as a quality assurance tool, and precise definition and description of the radicality of an operation will improve standardization. They noted that randomized trials have shown that the omission of peritoneal closure and retroperitoneal drainage and early bowel stimulation have a beneficial influence on perioperative morbidity.

Dr. Verleye was also involved in project to identify areas for improvement in radiotherapy treatment in the EORTC 55994 trial, a randomized trial involving FIGO stage Ib2, IIa >4cm and IIb cervical cancer patients who receive either concomitant chemoradiation or neoadjuvant chemotherapy and radical hysterectomy. In this trial, protocol radiotherapy consists of 45-50Gy external beam pelvic radiotherapy (EBRT) in fractions of 180-200 cGy and brachytherapy to a minimum total dose of 75 GyEQD2 to point A. Maximum treatment duration is 50 days. They found that for external beam therapy, overall treatment time and dose distribution within the planning target volume (PTV) should receive more attention. Data collection on brachytherapy appeared problematic, and they concluded that in order to improve the quality of chemoradiation for cervical cancer, standard protocols for the handling of treatment interruptions and individualized, image-guided treatment planning are indicated for both EBRT and brachytherapy. They also concluded that modern reporting methods will facilitate further optimization of therapy. Preliminary results of this project were presented at the 16th International Meeting of the European Society of Gynaecological Oncology (ESGO) meeting in Belgrade and will be published soon.

Quality of surgery is an important determinant of ovarian cancer patient outcome, and while at the EORTC, Dr. Verleye was instrumental in drafting guidance for establishing an expert center for advanced ovarian cancer surgery and highlighting the need to develop and implement evidence-based European surgical guidelines, provide surgical training for gynecological oncologists, and establish comprehensive cancer networks with sufficient resources. [3],[4] She also found time to actively participate in the translational research projects of the EORTC 55971/NCIC-CTG OV13 trial. Preliminary results of this work were also presented at the IGCS meeting in Bangkok.

Dr. Verleye received her Medical Degree cum laude from the Katholieke Universiteit Leuven, Belgium, where she subsequently followed specialty training in Obstetrics & Gynecology. She has a strong desire to further her knowledge in the field of gynecological oncology, and at St. Radboud University Nijmegen, the Netherlands, she is working towards her doctoral degree in Quality Assurance in that area.

Currently, Dr. Verleye is pursuing subspecialty training in gynecological oncology at the University Medical Center Utrecht. She will maintain her connections with the EORTC as a member of the GCG and will work closely with the Quality Assurance Committee of that group and EORTC Headquarters.

We wish Leen much future success in the field of gynecological oncology and look forward to a continuing working relationship.

John Bean

[1] L. VERLEYE, P.B. OTTEVANGER, W. VAN DER GRAAF, N.S. REED, I. VERGOTE, of the GYNAECOLOGICAL CANCER GROUP (GCG) OF EUROPEAN ORGANISATION FOR RESEARCH AND TREATMENT OF CANCER (EORTC). EORTC-GCG process quality indicators for ovarian cancer surgery. Eur J Cancer 45 (4): 517-526, 2009.
[2] L. VERLEYE, I. VERGOTE, N. REED, P.B. OTTEVANGER. Quality assurance for radical hysterectomy for cervical cancer: The view of the European Organization for Research and Treatment of Cancer – Gynecological Cancer Group (EORTC-GCG). Ann Oncol 20 (10): 1631-1638, 2009.
[3] L. VERLEYE, P.B. OTTEVANGER, I. VERGOTE. Surgical program building in advanced ovarian cancer: The European perspective. Gynecologic Oncology. Gynecol Oncol. 2009, 114(2suppl):S10-14.
[4] Verleye L et al., Patterns of care in surgery for ovarian cancer in Europe, Eur J Surg Oncol (2010), doi:10.1016/j. ejso.2010.06.006