From 1969 to 1990, 649 patients with adenocarcinoma of the endometrium were surgically managed by gynecologic oncologists from the University of Alabama at Birmingham. All patients underwent TAH-BSO ...and washings. Two hundred twelve patients had multiple-site pelvic node sampling (mean number of nodes, 11), 205 patients had limited site pelvic node sampling (mean number of nodes, 4), and in 208 patients, nodes were not sampled. Historical prognostic features, including tumor grade, depth of invasion, adnexal metastasis, cervical involvement, and positive cytology, were equally distributed in the three groups. Mean follow-up was 3 years. Patients undergoing multiple-site pelvic node sampling had significantly better survival than patients without node sampling (P = 0.0002). When patients were categorized as low risk (disease confined to the corpus) or as high risk (disease in the cervix, adnexa, uterine serosa, or washings) multiple-site pelvic node sampling again provided a significant survival advantage compared to patients without node sampling (high risk, P = 0.0006; low risk, P = 0.026). In a comparison of patients receiving whole pelvic radiation for grade III lesions or deep myometrial invasion, patients with multiple-site pelvic node sampling had better survival than those in whom nodes were not sampled (P = 0.0027). The significant survival advantage for patients having multiple-site node sampling, overall and in high- and low-risk groups, strongly suggests a therapeutic benefit. Additionally, adjuvant therapy may be more appropriately directed in these patients.
A phase I trial was designed to examine the feasibility of combining interferon and Taxol with intraperitoneal radioimmunotherapy (177Lu-CC49). Patients with recurrent or persistent ovarian cancer ...confined to the abdominal cavity after first line therapy, Karnofsky performance status > 60, adequate liver, renal and hematologic function, and tumor that reacted with CC49 antibody were enrolled. Human recombinant alpha interferon (IFN) was administered as 4 subcutaneous injections of 3 x 10(6) U on alternate days beginning 5 days before RIT to increase the expression of the tumor-associated antigen, TAG-72. The addition of IFN increased hematologic toxicity such that the maximum tolerated dose (MTD) of the combination was 40 mCi/m2 compared to 177Lu-CC49 alone (45 mCi/m2). Taxol, which has radiosensitizing effects as well as antitumor activity against ovarian cancer, was given intraperitoneally (i.p.) 48 hrs before RIT. It was initiated at 25 mg/m2 and escalated at 25 mg/m2 increments to 100 mg/m2. Subsequent groups of patients were treated with IFN + 100 mg/m2 Taxol + escalating doses of 177Lu-CC49. Three or more patients were treated in each dose group and 34 patients were treated with the 3-agent combination. Therapy was well tolerated with the expected reversible hematologic toxicity. The MTD for 177Lu-CC49 was 40 mCi/m2 when given with IFN + 100 mg/m2 Taxol. Interferon increased the effective whole body half-time of radioactivity and the whole body radiation dose. Taxol did not have a significant effect on pharmacokinetic or dosimetry parameters. Four of 17 patients with CT measurable disease had a partial response (PR) and 4 of 27 patients with non-measurable disease have progression-free intervals of 18+, 21+, 21+, and 37+ months. The combination of intraperitoneal Taxol chemotherapy (100 mg/m2) with RIT using 177Lu-CC49 and interferon was well tolerated, with bone marrow suppression as the dose-limiting toxicity.
The association of cervicovaginal adenocarcinoma and in utero diethylstilbesterol exposure is well known. There is concern that offspring exposed in utero may be predisposed to develop other ...malignancies as well. Presented is a case of endometrial adenocarcinoma occurring in this clinical setting. To the best of the authors' knowledge this association has not been reported previously.
Thirty-seven patients with nonmetastatic gestational trophoblastic disease (NMGTD) were treated with one or more cycles of oral methotrexate following intramuscular methotrexate as part of induction ...chemotherapy. Remission was achieved in 31 patients (83.8%). All failures were readily cured with alternate regimens. Prospective studies using this safe, easily administered modality are needed to verify its apparent efficacy.
Consider a surface \(S\) and let \(M\subset S\). If \(S\setminus M\) is not connected, then we say \(M\) \emph{separates} \(S\), and we refer to \(M\) as a \emph{separating set} of \(S\). If \(M\) ...separates \(S\), and no proper subset of \(M\) separates \(S\), then we say \(M\) is a \emph{minimal separating set} of \(S\). In this paper we use methods of computational combinatorial topology to classify the minimal separating sets of the orientable surfaces of genus \(g=2\) and \(g=3\). The classification for genus 0 and 1 was done in earlier work, using methods of algebraic topology.
Two hundred twelve patients who underwent second-look laparotomy as part of their treatment for epithelial ovarian cancer were evaluated. Factors associated with positive second looks were initial ...stage, tumor grade, age, and residual disease (P less than 0.05). One factor not of significance was whether adjuvant therapy was platinum based. Initial stage only was associated with recurrence after a negative second look (P less than 0.001). When controlled for volume of disease no difference in survival between various salvage therapies could be demonstrated. Survival between patients with recurrence after negative second look and patients with microscopic residual disease was similar even though the former group was not treated until recurrence (P = 0.75). Second-look laparotomy does not improve survival with currently existing salvage modalities and should primarily be confined to those patients willing to participate in research protocols evaluating new second-line therapy.
Patients with eosinophilic nasal polyposis frequently require surgery, and recurrence rates are high.
We sought to assess the efficacy and safety of mepolizumab versus placebo for severe bilateral ...nasal polyposis.
This randomized, double-blind, placebo-controlled trial recruited patients aged 18 to 70 years with recurrent nasal polyposis requiring surgery. Patients received 750 mg of intravenous mepolizumab or placebo every 4 weeks for a total of 6 doses in addition to daily topical corticosteroid treatment. The primary end point was the number of patients no longer requiring surgery at Week 25 based on a composite end point of endoscopic nasal polyp score and nasal polyposis severity visual analog scale (VAS) score. Secondary end points included change in nasal polyposis severity VAS score, endoscopic nasal polyp score, improvement in individual VAS symptoms (rhinorrhea, mucus in throat, nasal blockage, and sense of smell), patient-reported outcomes, and safety.
One hundred five patients received mepolizumab (n = 54) or placebo (n = 51). A significantly greater proportion of patients in the mepolizumab group compared with the placebo group no longer required surgery at Week 25 (16 30% vs 5 10%, respectively; P = .006). There was a significant improvement in nasal polyposis severity VAS score, endoscopic nasal polyp score, all individual VAS symptom scores, and Sino-Nasal Outcome Test patient-reported outcome score in the mepolizumab compared with placebo groups. Mepolizumab's safety profile was comparable with that of placebo.
In patients with recurrent nasal polyposis receiving topical corticosteroids who required surgery, mepolizumab treatment led to a greater reduction in the need for surgery and a greater improvement in symptoms than placebo.
The anatomic, colposcopic, cytologic, and histologic findings of the cervix in 300 women exposed to diethylstilbestrol (DES) in utero are reported. Structural cervical abnormalities were found in ...51.7% of these patients and an abnormal colposcopic examination was present in 50.6%. The initial interpretation of the pathologic specimens revealed that 26.6% of patients had cytologic or histologic evidence of cervical dysplasia. A uniform pathologic review demonstrated that 10.8% of the cytologic specimens and 37.5% of the histologic specimens had been overread by the initial pathologist. A correlation of the review cytology and histology revealed that the Papanicolaou smear sensitivity for the prediction of abnormal histology was 83.9% and specificity was 86.3%. The probability of an atypical cytologic finding predicting an abnormal histologic pattern was highly significant (P less than .00001). Colposcopic and structural cervical abnormalities were not predictive of an abnormal histologic diagnosis. Of the 18 patients (6%) with histologic evidence of mild-moderate dysplasia, 12 have been followed with no treatment, and cytologic and colposcopic examination has been normal. Marked dysplasia-carcinoma in situ was found in 14 patients (4.7%). Their therapy is summarized. These data strongly suggest that women exposed to DES may be followed safely with Papanicolaou smears and colposcopic examinations provided that both cytopathologists and colposcopists are cognizant of the metaplastic changes in the DES progeny that distinguish them from patients with cervical intraepithelial neoplasia (CIN) who were not exposed to DES. Biopsy should be performed only if indicated by cytologic atypia, colposcopic evidence of advanced CIN, or the presence of an invasive lesion.
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