Gynecologic Oncology Clinical
We are fortunate to have over 95% of our clinical and research activity centralized at the University of Wisconsin Hospital and Clinic (UWHC). The academic offices of the faculty and fellows are located on the 6th floor of the H module. The gynecologic oncology laboratory space and the clinical trials office conveniently reside in this same space. The inpatient gynecology unit is down the hall on the 6th floor of the F module. University of Wisconsin Carbone Cancer Center administrative offices (UWCCC) are located down another hall on the 6th floor of the K module. Directly below the academic offices (on the 2nd floor) is the Gyn Oncology Clinic, located in the UWCCC clinic space. The chemotherapy administration area for the entire cancer center is directly adjacent to our clinic.
The remainder of major shared clinical areas at UWHC (ICU, OR, ER) is located centrally in the hospital for easy access. The Health Science Learning Center (housing the School of Medicine and Public Health, the Ebling Library for Heath Sciences, and an array of meeting facilities) is attached by a bridge to UWHC on the 1st floor.
The Division of Gynecologic Oncology strives to minimize surgical morbidity by providing appropriate, innovative, minimally invasive options. Prospectively researching such techniques, along with following and reporting outcomes are critical elements to insuring patient safety. There exists a core group of laparoscopic/robotic surgeons in the Division, dedicated to minimally invasive surgery and education. Our Division actively enrolled patients on the GOG Lap 2 trial—the 6th most of any GOG institution.
In order to learn radical laparoscopic cervix cancer surgery, the Department supported Dr. Kushner to complete an apprenticeship at the Université Laval in Québec, Canada, under the instruction of Drs. Michel Roy and Marie Plante. The University of Wisconsin soon became one of the first centers in the United States to offer these options for patients. We performed the region’s first laparoscopic radical vaginal hysterectomy, laparoscopic sentinel lymph node mapping, and laparoscopic-assisted radical vaginal trachelectomy.
Our division has a robust quality of life research program. Dr. David Kushner serves on the quality of life committee for the GOG, and has been instrumental in leading the newly formed national network to advance sexual health in female cancer survivors. Lori Seaborne, PA-C, has also played a pivotal role in this endeavor, and is a nationally recognized sexual health educator and frequently lectures on this topic. We have completed a sexual health study on female cancer survivors that was presented nationally and recently published, and recently studied a vibrating wand intervention trial for women recovering from side effects of treatment.
Dr. Rose’s research has a broad quality of life reach. He recently published the first report of the role of humor in the lives of women with recurrent ovarian cancer, and is currently planning a trial with first year fellow Ryan Spencer on a humorous intervention during chemotherapy for women with gynecologic cancer. He and Dr. Spencer’s trial of a mindfulness program intervention while undergoing chemotherapy is currently in the accrual stage.
Dr. Ahmed Al-Niaimi’s research interests are in surgical quality. He presented a plenary session on his work on surgical site infection rates at the 2012 SGO, and is currently working on a comprehensive gynecologic oncology database that will incorporate morbidity as well as quality of life measures on our patients. He is a nationally recognized surgical quality leader and will join with Dr. Robert Bristow in upcoming surgical debulking courses as an instructor.
Dr. Lisa Barroilhet's research interest is in drug development and clinical trials. Current projects include a phase I trial of an anti-prolactin infusion in women with leiomyoma. This drug has already shown clinical activity in breast and prostate cancers, and she is examining its activity in gynecologic malignancies. She has also submitted an investigator initiated proposal for a phase II study of BIBF 1120 (a tyrosine kinase inhibitor) with weekly paclitaxel in patients with recurrent ovarian cancer.
The Gynecologic Oncology division was the primary site for a Phase I clinical trial to investigate the use of the immunocytokine (antibody-cytokine conjugate) huKS-IL2 for the treatment of ovarian cancer. We have also conducted molecular analysis that has allowed us to investigate the mechanisms that allow huKS-IL2 and other immunocytokines to produce their potent anti-cancer effects. In recent studies, we examine the anti-cancer properties of natural products. Trans10,cis12 conjugated linoleic acid is a lipid found in dairy and red meat. We have demonstrated that this fatty acid inhibits the proliferation and invasion and migration of ovarian cancer cells. In addition, we have also identified that terpenoid molecules present in ginger (Zingiber officinales) induce apoptosis in endometrial and ovarian cancer cells by activating the p53 signaling pathways. Dr. Barroilhet will continue to work with the Gynecologic Oncology lab to bring these agents into clinical trials.
A major focus of the gynecologic oncology division is to improve the quality-of-life of our patients. Behavioral and chemical interventions are being investigated to achieve this goal. Clinical studies are underway to determine the influence of meditation, yoga, and humor on the quality-of-life of patients. Patients are being monitored using established clinical measurements to gauge the success of these interventions. In addition, molecular studies are also planned to identify the effect of these behavioral interventions on inflammation and immunity.
Studies are also underway to determine the effect of N-acetylcarnitine and lithium in alleviation of chemotherapy-induced neuropathic pain. Laboratory research has shown that N-acetylcarnitine does not induce ovarian cancer cell proliferation and also does not interfere with standard chemotherapy . Similar studies are currently being conducted to determine the impact of lithium on gynecologic cancer cells.
The Division continues to embrace innovation. We were instrumental in the organization and introduction of robotic surgery at the University of Wisconsin Hospital. We now have four robotic-trained faculty and are regularly performing both endometrial cancer staging and radical cervical cancer procedures with the robot. We have reported on our first robotic-assisted radical vaginal trachelectomy. We follow our outcomes closely, and these procedures are now being performed in the same amount of time as conventional laparoscopy.
A multitude of research opportunities exist related to endoscopy. We have recently finished a prospective trial of laparoscopic sentinel lymph node mapping in cervical cancer and are currently performing a similar study in patients with endometrial cancer. We also have published on specific tools and curriculum for endoscopic education. This topic is of critical importance to Gyn Onc Fellowship, given the variance in resident education along with the complicated nature of the radical procedures being taught. Our Department has a dedicated Minimally Invasive Educational Curriculum (administered through Gyn Onc) as well as animal and dry-lab practice facilities.
The Department of Ob/Gyn, and particularly the Gynecologic Oncology Division, enjoys a long-term outstanding relationship with the other surgical specialties. The shared mission is to provide the best quality of care for women treated for gynecologic malignancies. To that end, the Division has been performing a wide-array of upper abdominal, gastrointestinal, reconstructive, and urologic surgeries for decades at a high level of proficiency. Nonetheless, consultation is requested for more complicated surgical and medical issues related to such procedures. Patients benefit from the expertise that these subspecialty services can provide. The fellows will also benefit greatly from the history of collegiality, as they are welcomed on these high-volume surgical services to enhance their educational opportunities.