Showing papers in "International Journal of Gynecological Cancer in 1998"

Neoadjuvant chemotherapy in cervical carcinoma stage IIB: a randomized controlled trial

Abstract: Sardi JE, Sananes CE, Giaroli AA, Bermudez A, Ferreira MH, Soderini AH, Snaidas L, Guardado N, Anchezar P, Ortiz OC, di Paola GR. Neoadjuvant chemotherapy in cervical carcinoma stage IIB: a randomized controlled trial. Int J Gynecol Cancer. 1998; 8: 441–450. The aim of this study was to determine the feasibility and role of neoadjuvant chemotherapy (Nch), used before Wertheim Meigs operation (S) and conventional radiotherapy (RT) in Stage IIB cervical carcinoma. Two hundred ninety-five patients were randomized into four groups: first control group (N = 73) received RT of 50 Gy to whole pelvis + 35–40 Gy to point A, in one or two brachytherapy applications; the second control group received (N = 75) S + adjuvant RT to whole pelvis (50 Gy) the third group (N = 71) received Nch + RT; the fourth group received (N = 76) Nch + S + RT. The VBP scheme was used (3 courses of vincristine 1 mg/m2 on day 1, bleomycin 25 mg/m2 on days 1 to 3, and cisplatinum 50 mg/m2 on day 1, at 10 day intervals). No differences were found regarding age, tumor volume, parametrial involvement or response to Nch. Disease-free survival (DFS) and overall survival (OS) rates were calculated according to Kaplan-Meier tables and log-rank test. After seven years follow-up, statistically significant differences were found in OS between Nch + S (65%) and RT (48%, P 5 cm from 36% in RT to 66% in Nch + RT (P < 0.05). In both Nch groups no grades 3 or 4 toxicity was observed and OS was statistically better in chemotherapy responders. Nch + S is feasible, with no grades 3 or 4 toxicity. It is an alternative treatment to conventional radiation therapy with an increase in OS.

Primary non-Hodgkin's lymphoma of the nasal cavity: prognostic significance of paranasal extension and role of radiotherapy and chemotherapy

Abstract: BACKGROUND This study was conducted to determine whether the paranasal extension of a primary non-Hodgkin's lymphoma (NHL) of the nasal cavity has any deleterious effect on patient outcome. METHODS One hundred and seventy-five patients with previously untreated nasal NHL were reviewed. There were 2 with low grade, 107 with intermediate grade, 17 with high grade, and 49 with unclassifiable lymphomas. In 48 cases the immunophenotype was available and 46 were T-cell lymphoma. According to the Ann Arbor system, there were 133 patients with Stage IE, 28 with Stage IIE, 4 with Stage IIIE, and 10 with Stage IVE lymphomas. Stage IE was subdivided into limited Stage IE (i.e., confined to the nasal cavity [67 patients]) or extensive Stage IE (i.e., presenting with extension beyond the nasal cavity [66 patients]). For patients with limited Stage IE disease the treatment of choice was radiotherapy with or without chemotherapy. In patients with extensive Stage IE disease, treatment was comprised of a combination of chemotherapy and radiotherapy or radiotherapy alone. For patients with a more advanced stage of disease (IIE-IVE), chemotherapy was an integral part of the treatment and was completed by irradiation, especially for patients with Stage IIE disease. RESULTS The actuarial overall survival (OS) and disease free survival (DFS) rates at 5 years for the whole group were 65% and 57%, respectively. The 5-year OS and DFS rates were influenced by stage, with a gradual decrease from 75% and 68% for Stage IE disease to 35% and 28% for Stage IIE disease, and 31% and 19% for Stage IIIE/IVE disease. Patients with limited Stage IE disease survived significantly longer (90% 5-year OS) compared with those with extensive Stage IE disease (57% 5-year OS; P < 0.001). For 67 patients with limited Stage IE disease, the 5-year OS was 89% with radiotherapy alone and 92% with radiotherapy and chemotherapy, whereas for 66 patients with extensive Stage IE disease, the 5-year OS was 54% with radiotherapy and 58% with combined modality therapy or chemotherapy (P > 0.05). CONCLUSIONS The prognosis of patients with primary NHL of the nasal cavity is stage dependent. In this large cohort of Stage IE patients, it was demonstrated that the paranasal local extension was a significant prognostic factor associated with poorer treatment outcome. The authors believe that Ann Arbor Stage IE should be subclassified further into limited and extensive Stage IE. The addition of chemotherapy did not appear to modify significantly the survival of patients with either limited or extensive Stage IE disease. The extranodal progression observed in patients with extensive Stage IE and Stage IIE-IVE disease clearly illustrates the need for improvement of systemic treatment.

Recurrent cervical carcinoma after radical hysterectomy: an analysis of clinical aspects and prognosis.

Abstract: Samlal RAK, van der Velden J, van Eerden T, Schilthuis MS, Gonzalez Gonzalez D, Lammes FB. Recurrent cervical carcinoma after radical hysterectomy: an analysis of clinical aspects and prognosis. Int J Gynecol Cancer 1998; 8: 78-84. The purpose of the present study was to evaluate the clinical aspects and prognosis of patients with tumor recurrence in surgically treated stage IB and IIA cervical carcinoma patients. Two hundred and seventy-one stage IB and IIA cervical carcinoma patients underwent a Wertheim Okabayashi radical hysterectomy with pelvic lymphadenectomy. The median follow-up time was 60 months. Recurrence occurred in 27 patients (10%): 14 had a pelvic recurrence and 13, and extrapelvic recurrence. The site of recurrence was influenced by various pathological factors as well as by the primary treatment mode. 77% of recurrences were detected within three years after primary treatment. The median recurrence-free interval in patients with a pelvic recurrence was significantly shorter than in patients with an extrapelvic recurrence (14 months vs. 17 months, P = 0.03). The mortality rate of the group of patients with recurrent disease was 85% (23/27). Patients with a pelvic central recurrence had a significantly better outcome than did patients whose recurrences were located at the pelvic sidewall. Two patients with a pulmonary recurrence were treated with surgery and show no evidence of disease after 4 and 8 years respectively, of follow-up. The overall detection rate of recurrent disease by routine follow-up was only 36%. However, asymptomatic patients had a significantly better prognosis when compared with symptomatic patients. Therefore, we recommend frequent follow-up visits during the first 3 years after primary treatment to detect recurrence in an early stage.

The influence of upper abdominal surgery on perioperative morbidity and mortality in patients with advanced ovarian cancer FIGO III and FIGO IV

Abstract: Kuhn W, Florack G, Roder J, Schmalfeldt B, Pache L, Rust M, Ulm K, Spathe K, Janicke F, Siewert JR, Graeff H. The influence of upper abdominal surgery on peri-operative morbidity and mortality in patients with advanced ovarian cancer FIGO III and FIGO IV. Int J Gynecol Cancer 1998; 8: 56-63. Tumor debulking procedures are routinely performed in advanced ovarian cancer patients, however, data on perioperative morbidity and mOCtality due to specific organ-oriented procedures are few. In a retrospective analysis, peri-operative morbidity and mortality as well as overall survival were analyzed in patients with advanced ovarian cancer. 41 patients (group A) underwent upper abdominal surgery. In 66 patients (group B), standard debulking procedure without upper abdominal SUCgery was performed. All data of surgical and peri-operative intensive care therapy differed significantly in both groups (P 〈 0.01). The morbidity was also significantly different. In group A, serious complications (including mortality) were significantly more often seen in patients undergoing splenectomy, cholecystectomy and partial pancreatic resection (n = 23) than in patients requiring only resection of the diaphragmatiC peritoneum (n = 18) (P = 0.045). Tumor-free patients in both groups had a longer median survival time than patients with residual tumor (group A: 71 vs. 15 months; group B: 〉 60 vs. 17 months, P 〈 0.01). Resection of tumorous diaphragmatic peritoneum suggests that survival improves if complete tumor removal is feasible. Other forms of upper abdominal surgery, including splenectomy and partial pancreatic resection, have a high rate of morbidity and mortality and probably no benefit in terms of survival. Therefore the risk-benefit ratio of these latter procedures has to be evaluated separately in each case.

Prognostic factors in surgically treated stage IB–IIB carcinoma of the cervix with negative lymph nodes

Abstract: Comerci G, Bolger BS, Flannelly G, Maini M, de Barros Lopes A, Monaghan JM. Prognostic factors in surgically treated stage IB–IIB carcinoma of the cervix with negative lymph nodes. Int J Gynecol Cancer 1998; 8: 23–26. Two hundred and seventy-five females with stage IB–IIB negative lymph node cervical cancer, treated between January 1988 and December 1994 by radical hysterectomy and pelvic lymph node dissection, form the basis of this analysis. The clinical records were reviewed for all patients including histopathology, clinical features at presentation, and follow-up. Tumors were re-staged according to the 1995 FIGO classification. Median follow-up was 55 months and 85.8% were followed for longer than two years. There were 21 recurrences, 12 of which were true central recurrence (disease-free survival at 5 years: 91.66%). Fifteen of 25 deaths were due to cervical cancer (crude survival at 5 years: 93.27%). In univariate log-rank analysis, stage (P = 0.005), tumor size (P = 0.0002), and lymph-vascular space involvement (LVSI) (P = 0.01) appeared to be statistically significant factors for tumor recurrence. Other factors including age, histology type, differentiation, adjacent cervical intraepithelial neoplasia or cervical glandular intraepithelial neoplasia, and presence of intraepithelial disease at resection margin were not found to be statistically significant. In multivariate analysis (Cox regression) tumor size (P = 0.02) and LVSI (P = 0.03) were the only independent variables. In the presence of negative lymph nodes and complete surgical excision, tumor size and LVSI are important predictors of local recurrence.

Early ovarian cancer: Is there a role for systematic pelvic and para- aortic lymphadenectomy?

Abstract: Baiocchi G, Raspagliesi F, Grosso G, Fontanelli R, Cobellis L, di Re E, di Re F. Early ovarian cancer: Is there a role for systematic pelvis and para-aortic lymphadenectomy? Int J Gynecol Cancer 1998; 8: 103–108. In order to focus on the incidence and the clinical significance of lymphatic spread in patients with cancer apparently confined to the ovaries, we present our 20 year experience in a large series of patients with early ovarian cancer who had systematic pelvic and para-aortic lymphadenectomy. A retrospective study of 280 consecutive patients is presented. Systematic pelvic and para-aortic lymphadenectomy was performed in 205 cases (73.2%). Selective sampling and node biopsy were performed in 30 (10.7%) and 7 (2.5%), respectively. Node metastases were found in 32/242 patients (13.2%). The incidence of metastatic nodes was significantly higher in patients with serous adenocarcinomas and/or poorly-differentiated tumors. When few nodes were involved (1–3) lymphatic spread was most ipsilateral to the tumor. Even though the retrospective nature of the study has to be considered, univariate analysis revealed statistically significant differences in 5-year survival based on FIGO stage, histology, grade of differentiation, and node status. By contrast, using multivariate analysis, none of these risk factors was an independent variable for predicting long-term survival. However, node status closely approached the statistically significant level (P = 0.06). Only prospective and randomized studies can clarify the role of lymphadenectomy in early ovarian cancer. However, while awaiting these results, this surgical procedure should be a part of a research protocol.

Restricted surgical management of vulvar intraepithelial neoplasia 3: Focus on exclusion of invasion and on relief of symptoms.

Abstract: van Beurden M, van der Vange N, ten Kate FJW, de Craen AJM, Schilthuis MS, Lammes FB. Restricted surgical management of vulvar intraepithelial neoplasia 3: Focus on exclusion of invasion and on relief of symptoms. Int J Gynecol Cancer 1998; 8: 73-77. A study was undertaken to determine the effectiveness of extensive and restricted surgery for vulvar intraepithelial neoplasia (VIN) 3. All consecutive patients with VIN 3 admitted to a tertiary referral hospital were included. The main outcome measures were relief and recurrence of symptoms and progression to invasive disease in patients with VIN 3 after extensive or restricted surgery. Of every vulvoscopic visible lesion a biopsy was taken to establish extent and grade of VIN and to rule out invasive carcinoma. Patients with unifocal VIN 3 underwent extensive surgery. Patients with multifocal VIN 3 underwent extensive or restricted surgery or an expectant management was adopted, depending on the existence of symptoms and the presence of invasive vulvar carcinoma. Forty-seven patients were evaluated. Eighty-three percent of patients had a long history of symptoms. Eight patients (17%) had unifocal VIN 3. In 9% of the patients a superficially invasive vulvar carcinoma was found, ie with a depth of invasion of 1 mm or less. Only 20% of the extensively operated patients had free surgical margins. There was recurrence of symptoms in all of the extensively operated patients, in contrast to a 26% persistence or recurrence rate of symptoms in the restrictedly operated patients. In patients with multifocal VIN 3 who underwent restricted surgery, young age of the patient (P = 0.02) and large extension of VIN 3 (P = 0.02) were significant factors in predicting persistence or recurrence of symptoms. Only once was a superficially invasive vulvar carcinoma diagnosed during follow-up, and this was in an extensively operated patient. Vulvoscopically directed biopsies in VIN 3 are a safe method to exclude invasive disease. Restricted surgery is effective in relieving symptoms in multifocal VIN 3.

Endometrial carcinoma: two or three entities?

Abstract: Sivridis E, Fox H, Buckley CH. Endometrial carcinoma: two or three entities? Int J Gynecol Cancer 1998; 8: 183–188. A series of 304 surgically treated women with endometrial carcinoma was studied. These comprised 46 patients with endometrioid carcinomas associated with a hyperplastic endometrium, 209 women with endometrioid carcinomas associated with an atrophic endometrium and 49 patients with nonendometrioid carcinomas associated with an atrophic endometrium. Patients with nonendometrioid carcinomas had the worst survival rate while endometrioid carcinomas associated with an atrophic endometrium carried a worse prognosis than did those arising from a hyperplastic endometrium. The difference in prognosis for the two groups of endometrioid carcinomas was due largely to the greater proportion of G2 and G3 neoplasms among those arising from an atrophic endometrium, there being no statistically significant difference in survival rate between G1 carcinomas in the two groups. The demographic features of the two groups of patients with endometrioid carcinomas were similar but it is suggested that the pathogenesis of the two types of endometrioid carcinoma may differ.

Anatomical and pathological study of retroperitoneal nodes in endometrial cancer

Abstract: Benedetti-Panici P, Maneschi F, Cutillo G, D'Andrea G, Manci N, Rabitti C, Scambia G, Mancuso S. Anatomical and pathological study of retroperitoneal nodes in endometrial cancer. Int J Gynecol Cancer 1998; 8: 322–327. To assess the patterns of lymphatic spread in endometrial carcinoma, data from 91 endometrial cancer patients (surgical FIGO stage I: 59; II: 12; III–IV: 20) who underwent systematic pelvic and aortic lymphadenectomy were analyzed. The median number of nodes removed was 27 aortic (range 15–57) and 31 pelvic (range 20–68) nodes. Positive nodes were found in 16 patients (18%), seven having pelvic, one aortic, and eight both pelvic and aortic metastasis. The median number of positive nodes was three (range 1–29) aortic and two (range 1–18) pelvic nodes. Isolated pelvic node metastasis was observed in seven patients and aortic metastasis in one patient. Pre-paracaval, pre-paraortic and intercavoaortic, with superficial obturator, external iliac and common iliac were the node groups most frequently involved. These nodes may be considered primarily invaded by the tumor. The higher prevalence of pelvic with respect to aortic metastasis, and the low risk of isolated aortic spread, suggest that endometrial cancer spreads preferentially to the pelvic area. Multivariate analysis showed that depth of myoinvasion and adnexal metastasis were independent factors predicting the risk of lymphatic spread. The risk of aortic spread was also predicted by the pelvic node status. These data may be useful for tailoring lymphadenectomy.

Endometrial carcinoma Stage I-Grade II. Conservative treatment followed by a healthy twin pregnancy

Abstract: Zuckerman B, Lavie O, Neumann M, Rabinowitz R, Ben-Chetrit A, Voss E, Rosenmann E, Beller U. Endometrial carcinoma Stage I-Grade II. Conservative treatment followed by a healthy twin pregnancy. Int J Gynecol Cancer 1998; 8: 172–174. Endometrial cancer treatment is commonly based on hysterectomy as the first step, thus creating infertility. This approach troubles the young patient who desires future pregnancies. Hence, the well-known, yet seldom chosen, high-dose progesterone therapy might offer an adequate alternative treatment for a small, carefully selected group of young, early endometrial cancer patients. Presented is a 26-year-old multipara diagnosed, on resectoscopy, with Stage I moderately differentiated carcinoma of the endometrium. Treatment included high dose progesterone and residual disease was ruled out at follow-up. Twin gestation was terminated at term by a cesarean delivery of two healthy babies. We suggest that despite this successful case, this treatment should be offered only to selected patients who desire to preserve their fertility, and for whom close follow-up is possible to monitor the response to progestational therapy. In addition, we believe that at the completion of family planning of these patients, protective hysterectomy should be performed.

Human papillomavirus, lichen sclerosis and vulvar squamous cell carcinoma

Abstract: Scurry J, Flowers L, Wistuba I, Vanin K, Mulvany N, Reyes H, Gazdar A. Human papillomavirus, lichen sclerosis and vulvar squamous cell carcinoma. Int J Gynecol Cancer 1998; 8: 298–306. The objective of the study was to compare human papillomavirus (HPV) detection, adjacent lesions, age and prognosis in different histologic types of overtly invasive squamous cell carcinoma (SCC). One hundred and thirty consecutive cases of overtly invasive vulvar SCC were assayed for HPV DNA by the polymerase chain reaction (PCR). The carcinomas were classified into keratinizing and basaloid types, on the basis of cytoplasmic maturation and keratin production. Changes in the adjacent epidermis were recorded as lichen sclerosis, squamous cell hyperplasia, differentiated vulvar intraepithelial neoplasia (VIN), undifferentiated VIN or normal. Prognosis was assessed as unfavorable or favorable according to whether at least one of recurrence, groin node or distant metastasis was present. Results showed HPV DNA was present in 29 (22%) of SCCs and absent in 101 (78%), with HPV 16 being the commonest type, found in 23 cases. One hundred and four SCCs (80%) were classified as keratinizing and 26 (20%) as basaloid. Twelve (12%) of the keratinizing and 17 (65%) of the basaloid SCCs contained HPV DNA. Women with HPV-positive carcinomas had a mean age of 63 years compared with 73 in those with HPV-negative tumors. HPV-positive tumors were associated with undifferentiated VIN in the adjacent skin and HPV-negative with lichen sclerosis, squamous cell hyperplasia and differentiated VIN. HPV status and histologic type did not confer different prognosis. In conclusion, histologic classification of vulvar SCCs was of value in determination of etiology and some clinical features and is therefore likely to be of use in managing patients, epidemiological research and tumor registry surveillance. While this study showed no difference in prognosis with HPV detection and histologic type, it will be impossible to conclude definitively that different types of vulvar carcinoma have a similar prognosis without performing a large population-based study.

Primary signet ring cell carcinoma of the uterine cervix: A clinicopathologic study of two cases with review of the literature

Abstract: Haswani P, Arseneau J, Ferenczy A. Primary signet ring cell carcinoma of the uterine cervix: A clinicopathologic study of two cases with review of the literature. Int J Gynecol Cancer 1998; 8: 374–379. Signet ring cell carcinoma of the endocervix is most commonly considered to be metastatic in origin. We describe two cases of apparently primary cervical signet ring cell adenocarcinoma occurring in patients aged 33 and 38 years, respectively. Both patients had been treated previously for cervical “condylomas”. The lesions, occupying the posterior lip of the cervix, were formed predominantly of malignant neoplastic signet ring cells. One case was positive for HPV type 18 and coexisted with adenocarcinoma in situ and a high grade squamous intraepithelial lesion (HSIL). One patient died 18 months after the diagnosis of carcinoma with massive intra-abdominal metastasis; autopsy was not performed. The second patient is alive and well nine months postsurgery and undergoing pelvic radiotherapy for FIGO stage IB1 adenocarcinoma with one of the pelvic nodes containing a metastasis. Although in neither of the two cases was absolute proof obtained of the absence of a gastrointestinal tract tumor, the clinical presentation of the tumors, the history of previous HPV infection of the cervix, the coexistent in situ adenocarcinoma and HSIL and the detection of HPV type 18 in one case lent support for a primary cervical origin of this rare form of adenocarcinoma.

Prospective evaluation of the morbidity of complete lymphadenectomy in endometrial cancer

Abstract: Fanning S, Firestein S Prospective evaluation of the morbidity of complete lymphadenectomy in endometrial cancer Int J Gynecol Cancer 1998; 8: 270–273 The purpose of this study is to prospectively evaluate the morbidity of complete lymphadenectomy in endometrial cancer Eighty consecutive eligible patients with endometrial cancer underwent surgical staging consisting of total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal cytology, complete bilateral pelvic lymphadenectomy, and aortic lymphadenectomy We prospectively evaluated operative time, blood loss, and morbidity of lymphadenectomy The median number of pelvic lymph nodes resected was 21 and aortic lymph nodes was 7 Median time of lymphadenectomy was 24 min Median blood loss from lymphadenectomy was < 25 cc There was one complication from lymphadenectomy We conclude that, in this prospective study, complete pelvic and aortic lymphadenectomy in the surgical staging of endometrial cancer was performed quickly, with minimal blood loss and morbidity In endometrial carcinoma surgical staging, the majority of operative time, blood loss, and morbidity is secondary to hysterectomy/oophorectomy rather than lymphadenectomy

The yield of surgical staging in presumed early stage ovarian cancer: Benefits or doubts?

Abstract: Schueler JA, Trimbos JB, Hermans J. The yield of surgical staging in presumed early stage ovarian cancer: Benefits or doubts? Int J Gynecol Cancer 1998; 8: 95–102. Background and aim of the study: Since the introduction of the staging procedure for presumed early stage ovarian cancer, only relatively few studies have evaluated the yield and the morbidity of comprehensive surgical staging. We have reviewed our own experience with this procedure to assess whether surgical staging gives significant information to warrant the possible morbidity of the procedure and whether subsequent changes in stage alter therapy. Methods: The clinicopathologic records of all patients with presumed early stage ovarian cancer, including borderline tumors, between 1981 and 1996 were reviewed. A comprehensive surgical staging procedure was accomplished in all patients, either primarily or secondarily. No patient received adjuvant therapy before the staging procedure. The yield of the procedure in terms of upstaging and the correlation of upstaging with clinicopathologic features were assessed, as well as the morbidity of the staging laparotomy. Results: In 29% (13/45) of patients the staging laparotomy resulted in upstaging, with 54% of these finally diagnosed as stage III disease. The upstaging in all patients was caused by microscopic disease, without gross abnormalities being present. Upstaging was significantly correlated with histologic tumor type, serous lesions being more likely to be upstaged (P < 0.005). No relationship was seen with age or histologic grade. Intra- or postoperative complications occurred in 29% of the patients, and 69% of these were minor. The complication rate in secondary staging procedures was significantly higher than in primary procedures (77% vs. 23%) (P < 0. 05). If adjuvant treatment had been based on the original diagnosis, 63% of upstaged patients with frankly invasive ovarian cancer would have been denied treatment. Conclusions: In apparent early stage ovarian cancer the yield of upstaging justifies a comprehensive surgical staging. This procedure is best performed at the time of the initial surgery since intra- and postoperative complications are rare. Surgical staging might not be a prognostic factor in itself, and additional features of biologic behavior of the tumor should be included in future clinical research to tailor possible adjuvant treatment.

The predictive value of LEEP specimen margin status for residual/recurrent cervical intraepithelial neoplasia

Abstract: Robinson WR, Lund ED, Adams J. The predictive value of LEEP specimen margin status for residual/recurrent cervical intraepithelial neoplasia. Int J Gynecol Cancer 1998; 8: 109–112. The objective of this study was to determine the impact of margin status of LEEP specimens on the rate of recurrent/residual cervical intraepithelial neoplasia (CIN). Also, we determined the effect of other clinical or pathologic factors on recurrent/residual disease. In this prospective cohort study, 227 women underwent LEEP excision of the cervix using standard techniques. Data concerning clinical factors and pathologic and cytologic results were collected. Patients had follow-up at three month intervals with Pap smears and indicated colposcopy/biopsy. 145/227 were confirmed as having CIN in the LEEP specimen. 66/145 (45%) had involved (positive) margins, and 79/145 (55%) had noninvolved (negative) margins. 27/57 (47%) with positive margins had recurrent disease compared with 22/65 (34%) with negative margins. (P = 0.18) HIV infection was found in 8/227 (3.6%). 8/8 HIV-infected patients had involved margins and recurrent/residual disease. Endocervical curettage (ECC) was positive in 39 cases and negative in 106. 13/34 (38%) cases with a positive ECC had recurrent disease vs. 32/88 (36%) with a negative ECC. (P = 0.85) Also, 8/58 (14%) patients whose specimens did not show CIN were found to have CIN at follow-up. In conclusion, the risk of residual/recurrent CIN at follow-up after undergoing LEEP is not statistically different in margin positive vs. margin negative patients (47% vs. 34%) (P = 0.18) or ECC positive vs. ECC negative patients. (38% vs. 36%) (P = 0.85) If HIV infected patients are excluded, the rate of recurrent disease in the two groups is very similar. (39% vs. 34%) (P = 0.73) Follow-up is important for patients with negative LEEP specimens as 14% were later diagnosed with CIN.

Carboplatin hypersensitivity reactions in patients with ovarian and peritoneal carcinoma

Abstract: Rose PG, Fusco N, Fluellen L, Rodriguez M. Carboplatin hypersensitivity reactions in patients with ovarian and peritoneal carcinoma. Int J Gynecol Cancer 1998; 8:365–368. Platinum is the most active agent in the treatment of ovarian cancer and high response rates with platinum retreatment of patients with recurrent disease have been reported. However, cumulative toxicity of cisplatin and carboplatin allergic reactions may limit further therapy. We describe a retrospective review of patients developing carboplatin allergy from May 1995–May 1998. Fourteen patients with ovarian and peritoneal cancer with carboplatin allergy were identified. In all but one case, patients received paclitaxel immediately prior to the carboplatin therapy. Following carboplatin infusion durations of 5–60 min, patients developed symptoms of a cough, wheezing, flushing, angioedema, burning eyes, pruritus of the hands and tongue, and nausea. No deaths occurred. The median number of courses of carboplatin therapy before an allergic reaction occurred was 9 (range 2–14). Twelve patients were rechallenged with a platinum compound. The first patient was retreated with cisplatin 50 mg/m2 with only a minor allergic response controlled with diphenhydramine hydrochloride. The second patient was retreated with carboplatin but developed a recurrent allergic reaction despite premedication with steroids and diphenhydramine hydrochloride and a 4-hour carboplatin infusion. This patient was successfully rechallenged with a prolonged 16-h carboplatin infusion. Seven additional patients were treated successfully following premedication and the prolonged carboplatin infusion. However, 3 patients had recurrent severe carboplatin allergic reactions despite premedication and the prolonged carboplatin infusion. One of these patients was successfully retreated with cisplatin. Carboplatin allergies rarely have been reported and may be potentiated by coadministration of paclitaxel. Prolonged desensitization regimens are effective in the majority of patients with carboplatin hypersensitivity reactions. Alternatively, retreatment with cisplatin can be considered in the absence of cumulative cisplatin toxicity.

The effects of the adenovirus-mediated wild-type p53 delivery in human epithelial ovarian cancer cell line in vitro and in vivo.

Abstract: Hwang ES, Kim J, Kim JS, Kao C, Ko S-C, Chung L, Lee J-H. The effects of the adenovirus-mediated wild-type p53 delivery in human epithelial ovarian cancer cell lines in vitro and in vivo. Int J Gynecol Cancer 1998; 8: 27-36. The effect of p53 overexpression on the proliferation of various ovarian cancer cell lines was tested by using an adenovirus vector, Avp53, that expresses wild-type human p53. Cell lines SKOV3, 2774, and OVCAR3, which bear mutations in the endogenous p53 gene, were all affected by Avp53 treatment, undergoing growth suppression and apoptosis at a dose that had little effect on the growth of normal fibroblasts. In these cells, p21WAF1/CIP1 was readily induced and the hypophosphorylated pRb protein accumulated by the treatment of Avp53, suggesting that the growth inhibitory pathway can be activated in these cells by the expression of wild-type p53. However, in PA-1 cell line which endogenously expresses wild-type p53, p21WAF1/CIP1 was not induced by p53 transduction, although p53 was found transcriptionally active. These results indicate that the tested ovarian cancer cell lines bear defects either in p53 itself or in the responsiveness to p53. The cytocidal effect of Avp53 was also examined in vivo against tumors developed in the peritoneal cavity of nude mice. Avp53 administered intraperitoneally eradicated microscopic and small-sized tumor nodules, demonstrating that the intraperitoneal administration of Avp53 may serve as an effective adjuvant therapy for ovarian cancers.

Doxorubicin and/or cisplatin based chemotherapy for the treatment of endometrial carcinoma with retroperitoneal lymph node metastases

Abstract: Selman AE, Fowler JM, Martinez-Monge R, Copeland LJ Doxorubicin and/or cisplatin based chemotherapy for the treatment of endometrial carcinoma with retroperitoneal lymph node metastases Int J Gynecol Cancer 1998; 8: 423–429 The objective of this review was to assess the effect of adjuvant doxorubicin and/or platinum-based chemotherapy on the survival and patterns of recurrence, of women with completely resected, poor-prognosis endometrial carcinoma with retroperitoneal lymph node metastases A retrospective review of 31 cases of endometrial carcinoma with retroperitoneal lymph node metastases seen over a 10-year period at the James Cancer Hospital of The Ohio State University Medical Center is presented Only patients with histologically documented retroperitoneal lymph node metastases and treated with postoperative doxorubicin and/or platinum-based chemotherapy were included With a median follow-up of 53 months (range 5–107), 17 patients (55%) have experienced continuous control of their tumor Overall 5-year survival was 40% and 5-year disease free survival was 34% Post-operative chemotherapy with doxorubicin- and/or cisplatinum-containing regimens is well tolerated and provides results that appear to be as good as those achieved with surgery and radiotherapy in the treatment of endometrial carcinoma with nodal or other intra-abdominal metastases (Stages IIIC and IV) However, a randomized study is needed to establish a definitive comparison of these modalities

Para‐aortic lymph node evaluation in cervical cancer: the impact of staging upon treatment decisions and outcome

Abstract: Petereit DG, Hartenbach EM, Thomas GM. Para-aortic lymph node evaluation in cervical cancer: the impact of staging upon treatment decisions and outcome. Int J Gynecol Cancer 1998; 8:353–364. This article reviews both surgical and nonsurgical staging options for cervical cancer and determines the ultimate impact of these staging pathways. Surgical staging is the most sensitive method for detecting para-aortic lymph node metastases; however, a negative lymphangiogram precludes surgical staging since it is a highly sensitive and specific radiographic study. CT and MRI are not as sensitive for detecting para-aortic disease, therefore a false negative study would ultimately result in the loss of about 4 stage IIB and 5 stage IIIB patients out of 100. Judicious use of existing staging options will enhance the ultimate benefit to individual patients, rather than surgically staging all patients prior to radiotherapy.

Two‐year follow‐up of patients with endometrial carcinoma after preoperative fluid hysteroscopy

Abstract: Gucer F, Tamussino K, Reich O, Moser F, Arikan G, Winter R. Two-year follow-up of patients with endometrial carcinoma after pre-operative fluid hysteroscopy. Int J Gynecol Cancer 1998; 8:476–480. The aim of the present study was to analyze whether pretherapeutic hysteroscopy increases the recurrence rate in patients with endometrial cancer confined to the uterus. Between January 1993 and December 1995 a total of 33 patients with endometrial carcinoma underwent surgical staging following diagnostic fluid hysteroscopy and curettage at our department. Twenty-seven patients who had disease confined to the uterus without involvement of the uterine serosa formed the study group. Fifty-five patients with endometrial carcinoma confined to the uterus who had undergone surgery after diagnostic curettage without hysteroscopy during the same period were identified as controls. The median follow-up in the hysteroscopy group and the controls was 29 months (range 26–46) and 30 months (range 10–48), respectively. In the hysteroscopy group, no patient died of disease but one patient (3.7%) developed a local recurrence 37 months after primary treatment. In the control group, one patient (1.8%) had a local and para-aortic recurrence 20 months after primary treatment. Preceding diagnostic fluid hysteroscopy does not seem to increase the risk of early recurrence in patients with endometrial carcinoma histologically confined to the uterus.

Determination of genital human papillomavirus genotypes in women in Northern Australia using a novel, self-administered tampon technique

Abstract: Bowden FJ, Tabrizi SN, Paterson BA, Garland SM, Fairley CK. Determination of genital human papillomavirus genotypes in women in Northern Australia using a novel, self-administered tampon technique. Int J Gynecol Cancer 1998; 8:471–475. The age standardized death rate from cervical cancer in Aboriginal women in the Northern Territory (NT) for the period 1987 to 1993 was 11.5 times higher than the Australian average for the same period. This is the first study to determine HPV genotypes in both Aboriginal and non-Aboriginal women living in the Top End of the NT using a self-administered tampon technique for specimen collection. Women who attended sexually transmitted disease clinics and Family Planning Clinics in urban areas and community health centers in remote areas were asked to insert and immediately remove a tampon which was then tested for the presence of HPV genotypes using the polymerase chain reaction. A total of 646 female subjects were enrolled in the study. Subjects with HPV had a mean age of 26.1 years ( SD 8.5), while those without HPV had a mean age of 29.8 years ( SD 9.8) (P < 0.001). The oncogenic genotypes (16,18,31,33,35,39,45,51,52) accounted for 54.7%, while 23.1% of HPVs were untypable. The virus was detected in 161/287 (56.1%) of non-Aboriginal women and in 150/359 (41.8%) of Aboriginal women ( P < 0.001). More than one genotype was detected in 40 subjects (12.8%); of these seven had three or more genotypes present. This study is the first to document the HPV genotypes occurring in females in the Northern Territory and shows that HPV is a common infection in both the Aboriginal and non-Aboriginal population.

Cost-utility assessment of amifostine as first-line therapy for ovarian cancer

Abstract: Bennett CL, Golub R, Calhoun E, Weinstein J; Fishman D, Lurain J, Roland P, Medio F, Bukowski RM. Cost-utility assessment of amifostine as first-line therapy for ovarian cancer. Int J Gynecol Cancer 1998; 8: 64-72. Nearly 27,000 female patients were diagnosed with ovarian cancer in the United States in 1997. While chemotherapeutic agents are effective in prolonging the time to progression of disease, concerns exist over treatment- related toxicities. In addition to considerations related to effectiveness, the decision to prescribe new cytoprotective agents requires consideration of costs and cost-effectiveness. The objective of this study was to describe cost-utility estimates of a new supportive care agent, amifostine, and to illustrate these issues for patients with ovarian cancer. The phase III Food and Drug Administration (FDA) licensing trial found that pretreatment with amifostine prior to each cycle of chemotherapy resulted in reduction of cumulative toxicities with cyclophosphamide and cisplatinum. While amifostine use is approximately $3,146 more per patient, after adjustment for direct medical costs and potential health status changes from reductions in hematologic toxicity, neurotoxicity, and nephrotoxicity, its use was estimated to cost $36,161 in direct medical costs per quality-adjusted life year saved. Sensitivity analyses indicated that cost-effectiveness estimates of amifostine therapy ranged front $25,474 to $78,574. Based on the phase III FDA licensing trial, amifostine use is associated with a favorable cost-utility profile that is in the range associated with widely used cancer therapeutic and supportive care agents. The decision to use (or not use) amifostine in conjunction with cisplatin and cyclophosphamide for women with ovarian cancer should be based on clinical, not economic, considerations.

Survival after intestinal obstruction in patients with fatal ovarian cancer: Analysis of prognostic variables

Abstract: Gadducci A, Iacconi P, Fanucchi A, Cosio S, Miccoli P, Genazzani AR. Survival after intestinal obstruction in patients with fatal ovarian cancer: Analysis of prognostic variables. Int J Gynecol Cancer 1998; 8: 177–182. This study reviewed 67 ovarian cancer patients who developed progressive disease following initial treatment and who died with clinical evidence of tumor. Thirty-four (50.7%) patients developed an intestinal obstruction during the disease course, and 28 (41.8%) died of this complication. Median interval time from initial diagnosis to obstruction was 19.5 months (range, 6–77 months). Twenty-two patients were submitted to surgery, whereas 12 received conservative treatment. Median interval time from obstruction to death was 65.5 days (95% confidence interval, 45–99 days; range, 15–699 days). At univariate analysis, survival after obstruction was significantly related to the type of therapy (surgical vs nonsurgical; (P = 0.0011) and to the score based on the criteria proposed by Krebs and Goplerud (including age, nutritional status, tumor status, ascites, previous chemotherapy and previous irradiation; ≤6 vs >6, P = 0.0001), but not to interval time from diagnosis to obstruction, age, number of previous chemotherapy regimens or number of previous operations. Cox model showed that the score was the only independent prognostic variable (P = 0.0003). If a significant palliation from surgery is defined as a survival of at least two months, such benefit was obtained by 87.5% of the 16 patients with a score ≤6 compared to 16.7% of the six patients with a higher score. In conclusion, the decision regarding optimal management of bowel obstruction in ovarian cancer patients should be individualized; however, Krebs' and Goplerud's score seems to offer reliable eligibility criteria for those patients deemed surgical candidates at the time of obstruction.

Survival of patients with primary fallopian tube carcinoma.

Abstract: Vaughan MM, Evans BD, Weitzer MJ. Survival of patients with primary fallopian tube carcinoma. Int J Gynecol Cancer 1998; 8: 16–22. Thirty-seven patients with primary fallopian tube carcinoma (PFTC) presenting between 1952 and 1995 were studied. The mean age was 57 years. Seven patients had stage I disease, 20 stage II, 8 stage III, and 2 stage IV. Actuarial 5-year survivals were 73% for stage I, 33% for stage II and 0% for stage III. Stage was a significant predictor of survival at 5 years (Stage I vs. III, P = 0.0006; stage II vs. III, P = 0.0001), however, the majority of patients, even with early stage disease, died of progressive PFTC within 10 years. Grade appeared highly significant at 5 and 10 years (Grades 1 & 2 vs. 3, P = 0. 0023). Neither age nor lymphocytic infiltrate appeared definitely predictive of survival. Eleven of 22 stage II patients received adjuvant treatment. While their median and 5-year survivals were superior to those not receiving adjuvant treatment (51 vs. 30 months, 47% vs. 22%), the difference was not statistically significant. This retrospective analysis confirms the poor prognosis of patients with PFTC. The majority of patients, even with early stage tumors, eventually succumb to their disease. Larger studies may identify a group of patients potentially curable with surgery alone, and clarify the role of adjuvant therapy.

Mesenteric and mesocolic lymph node metastases from ovarian carcinoma: A clinicopathological analysis

Abstract: Lax SF, Petru E, Holzer E, Pertl AM, Ralph G, Greenspan DL, Berger A, Jatzko G. Mesenteric and mesocolic lymph node metastases from ovarian carcinoma: a clinicopathological analysis. Int J Gynecol Cancer 1998; 8:119–123. The aim of this study was to analyze the clinicopathological features of ovarian carcinomas with metastases to mesenteric or mesocolic lymph nodes. Thirty patients with primary ovarian carcinomas metastatic to the bowel were analyzed for the extent of bowel infiltration, lymph node involvement, lymphatic channel involvement, and the number of examined lymph nodes. Metastases to mesenteric or mesocolic lymph nodes were found in 20 of the 30 patients. Metastases to mesenteric/mesocolic lymph nodes were more frequently associated with lymph vascular invasion at the site of the bowel implants and metastatic involvement of multiple bowel segments compared to mesenteric/mesocolic node-negative cases ( P < 0.04). There was no significant difference between the mesenteric/mesocolic node-positive and node-negative patients with regard to FIGO stage, histologic type, tumor grade, residual tumor after surgery, gross pattern of bowel metastases, and involvement of retroperitoneal lymph nodes. While the presence of mesenteric/mesocolic lymph node metastases tended to be associated with shorter survival, this was not statistically significant. The prognostic and putative therapeutic importance of positive mesenteric/mesocolic lymph nodes in ovarian carcinoma awaits further evaluation in a larger number of cases.

Differential diagnosis of pelvic masses: Usefulness of CA125, transvaginal sonography and echo-Doppler

Abstract: Kusnetzoff D, Gnochi D, Damonte C, Sananes C, Giaroli A, di Paolo G, Sardi JE. Differential diagnosis of pelvic masses: Usefulness of CA125, transvaginal sonography and echo-Doppler. Int J Gynecol Cancer 1998; 8: 315–321. The aim of this study was to define the clinical value of physical examination, CA125, transvaginal sonography and echo-Doppler in the preoperative diagnosis of adnexal masses. One hundred thirty patients with adnexal masses were prospectively studied. Diagnostic tests were performed during the week before surgery. Pre- and postmenopausal patients were evaluated separately. Surgical specimens were the gold standard. The best cut-off points for CA125 and resistance index (RI) were defined with receiver operating characteristic curves. Sensitivities for transvaginal sonography (TVS) were: 87.5% and 82.6% for pre- and postmenopausal patients, while specifity was 75.4% and 64.7%, respectively. For premenopausal patients the CA125 cut-off point that provides the best clinical usefulnesses is 100 IU/ml, yielding 94.4% specificity and 53.3% sensitivity. In postmenopausal women 35 IU/ml provides the highest accuracy and sensitivity. RI cut-off point, defined at 0.40, provided 76% accuracy and 94.8% specificity, in spite of a lower sensitivity. For postmenopausal patients, the cut-off point, defined at 0.60, has the highest accuracy and the best sensitivity-specificity ratio. Combination of TVS and CA125 were: 100% specificity in premenopausal and 91.1% in postmenopausal patients. Sensitivity increased when both results were negative, 93.7% and 95.6% for pre- and postmenopausal patients, respectively. This study did not find the accuracy established by the use of CA125 and TVS is increased by echo-Doppler and this technique should be reserved for cases included in research protocols.

Microscopic surgical stage IIIc endometrioid adenocarcinoma of the endometrium: implications for bimodal adjuvant therapy

Abstract: Faught W, Fung Kee Fung M, Krepart GV, Lotocki RJ, Heywood MS, Genest P. Microscopic surgical stage IIIc endometrioid adenocarcinoma of the endometrium: implications for bimodal adjuvant therapy.Int J Gynecol Cancer 1998; 8: 41-45. The objective of this study was to examine the survival and patterns of recurrence of microscopic pelvic node stage IIlc cancer of the endometrium treated with systemic chemotherapy. A retrospective review was performed on patients surgically staged for cancer of the endometrium. Only those patients with endometrioid histology and microscopic stage IIlc disease who received adjuvant cisplatin, adriamycin, and cyclophosphamide (PAC) were included. PAC was given at 50 mg/m2, 50 mg/m2, and 500 mg/m2, respectively, every four weeks for an intended nine cycles. Five of 20 patients (25%) treated with PAC developed a clinical recurrence at a median of 12 months. All recurrences but one were in the pelvis. The estimated five-year survival was 70%. The overall survival data and the predominance of pelvic failure would suggest a potential role for both cytotoxic chemotherapy and pelvic radiation in pelvic node stage IIlc cancer of the endometrium. The combination of systemic chemotherapy and pelvic radiation may optimize patient survival in microscopic stage Illc pelvic node disease.

Tamoxifen in relapsed ovarian cancer: A systematic review

Abstract: Williams C. Tamoxifen in related ovarian cancer: A systematic review. Int J Gynecol Cancer 1998; 8: 89–94. This review examines the evidence for useful clinical activity of tamoxifen in women with ovarian carcinoma who have failed conventional cytotoxic chemotherapy. The optimized search strategy of the Cochrane Gynaecological Cancer Collaborative Review Group, together with citations provided by Zeneca (the manufacturer of tamoxifen), and authors of trials identified in this area were used. Selection criteria consisted of phase 2 trials, randomized or unrandomized, of tamoxifen in women with ovarian carcinoma, previously treated with cytotoxic chemotherapy. Phase 3 trials in similar patients were also sought. Trials were then assessed for inclusion in the study and data extracted by the author. There are no randomized controlled trials of tamoxifen alone vs best supportive care in patients with refractory or recurrent ovarian cancer. There is a series of phase 2 trials that report objective response rates and (in some) stable disease rates. Fifty-five of 503 patients (10.9%) were reported to have achieved an objective response and 59 of 291 patients (24%) achieved stable disease (for variable periods). Since only a subset of trials reported rates of stable disease, these may form a biased group favoring a high rate of disease stabilization. There were no analyzable data on duration of response or overall survival. There were no useful data presented on the palliative effects of tamoxifen, in terms of symptom control or quality of life. Tamoxifen demonstrates a modest degree of effectiveness in ovarian cancer refractory to cytotoxic chemotherapy. The overall objective response rate in all trials (503 patients) was about 11%. There is, however, a wide variation in the objective response rates in the different trials (0% to 56%). This may, in part, reflect varying criteria for selection of patients for inclusion in individual studies and different methods for recording responses and application of these methods. Some trials reported on rates of stabilization of disease, but these data may be biased as such information was only presented in selected studies. There is no useful analyzable data on the duration of responses or survival. There is also, importantly, virtually no data on the palliative effects of tamoxifen given in this situation, even though the intent of treatment was entirely palliative. Those studies that collected data on hormone receptors found no consistent correlation between the presence of receptors and an increased chance of response to tamoxifen.

Adenosarcoma of the uterus following tamoxifen treatment for breast cancer

Abstract: A 71-year-old patient developed an uterine adenosarcoma two months after two years of tamoxifen adjuvant treatment for early breast cancer. After curettage for postmenopausal bleeding, the patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy. Histologic examination revealed an adenosarcoma of the uterus without myometrial invasion or lymphatic spread. After four years of follow-up, there was no evidence of recurrent disease. The possible association between tamoxifen treatment and uterine sarcoma is discussed.

Magnetic resonance imaging of cervical cancer in pregnancy

Abstract: Zanetta G, Pellegrino A, Vanzulli A, Di Lelio A, Milani R, Mangioni C. Magnetic resonance imaging of cervical cancer in pregnancy. Int J Gynecol Cancer 1998; 8: 265–269. Six subjects with cervical cancer in pregnancy underwent magnetic resonance imaging (MRI) for the evaluation of the tumoral invasion. Three subjects with early stage IB tumors had no evidene of parametrial invasion or lymph nodal metastases. Two were followed until term and underwent cesarean section/radical hysterectomy. One subject underwent an excision of the tumor during pregnancy and delivered vaginally. Three subjects had locally advanced tumors with macroscopic lymph node metastases. Two of them received neoadjuvant chemotherapy followed by radical surgery, whereas one underwent radical hysterectomy after maturation of the pulmonary function of the fetus. Five of the subjects had an interval of more than two months between diagnosis and delivery and underwent a repeat MRI. In all but one subject a good correlation was observed between the staging based on the final MRI and the histopathological findings. All three subjects with a diagnosis of lymph node metastases at MRI had confirmed metastases at surgery. MRI allowed for tailored treatment planning. With a median follow-up of 42 months (range 23–57) from definitive treatment, four women are alive without tumor and one is alive with distant recurrence. Five infants were born without handicaps or malformations. One fetus died during pregnancy. MRI provides important information for the management of cervical cancer in pregnancy, either when an aggressive or an expectant policy is chosen. An expectant management, consisting of simple observation, of early cervical cancer does not seem to affect progression. Neoadjuvant chemotherapy in pregnancy deserves further investigation.