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Fanning J, Colgrove M, Phibbs G. Cisplatin-paclitaxel-cyclophosphamide with G-CSF in primary advanced epithelial ovarian cancer. Gynecol Oncol 2000; 79:97-100. [PMID: 11006039 DOI: 10.1006/gyno.2000.5899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION In an attempt to increase survival, we performed a prospective trial of high-dose cisplatin-paclitaxel-cyclophosphamide with granulocyte colony-stimulating factor (G-CSF) for three cycles followed by carboplatin-paclitaxel for three cycles after cytoreduction of primary advanced epithelial ovarian cancer. MATERIALS AND METHODS Thirty consecutive women with Stage 3 or 4 invasive primary epithelial ovarian cancer were treated with cytoreductive surgery. Postoperatively patients received 100 mg/m(2) of cisplatin, 200 mg/m(2) of paclitaxel, and 500 mg/m(2) of cyclophosphamide IV q 21 days x 3 cycles with 300 microg of G-CSF daily x5 beginning the first day following chemotherapy. This was followed by carboplatin AUC-5 and 135 mg/m(2) of paclitaxel IV q 21 days x3. All administration was outpatient and paclitaxel was administered over 3 h. RESULTS Eighty percent of tumors were Stage 3C, 77% were serous, and 60% were Grade 3. Maximum cytoreduction to <2 cm was performed in 96%. Median follow-up is 30 months. Sixty-three percent of patients developed recurrence. Currently 50% of patients are alive with no evidence of disease. Estimated mean survival is 61 months and estimated mean progression-free survival is 29 months. No patient developed thrombocytopenia, neutropenic sepsis, significant neuropathy, or renal toxicity. CONCLUSION This treatment regimen resulted in minimal toxicity and, following aggressive cytoreduction, produced good progression-free and overall survival.
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Fanning J, Gangestad A, Andrews SJ. National Cancer Data Base/Surveillance Epidemiology and End Results: potential insensitive-measure bias. Gynecol Oncol 2000; 77:450-3. [PMID: 10831358 DOI: 10.1006/gyno.2000.5815] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Abstraction of data from National Cancer Data Base (NCDB)/Surveillance Epidemiology and End Results (SEER) for reasons other than incidence, mortality, and patterns of care has risen. A potential problem with these data is that insensitive-measure bias can exist because of possible inaccuracies in hospital tumor registry staging. The purpose of this study is to assess the accuracy of tumor registry staging from six community hospitals. METHODS Staging of 103 consecutive cancers operated on by a gynecologic oncologist (one of the authors) as a surgical consultant to a gynecologist or surgeon was reviewed. Hospital tumor registry staging forms were arbitrarily assigned to be completed by the nongynecologic oncologist versus the gynecologic oncologist by the medical records department. The authors reassessed cancer staging by medical chart review. The tumor registry staging was compared with the actual staging as determined by the authors. Major staging violations were defined as errors that would significantly change stage enough to alter prognosis or change recommended adjuvant treatment. All other violations were defined as minor. RESULTS Twenty-eight (27%) cancers were staged by the gynecologic oncologist and 75 (73%) by nongynecologic oncologists. Eighty (78%) cancers were endometrial and 14 (13%) ovarian. Eighty-three (81%) tumors were stage I or II. Major staging violations occurred in 0% of cancers staged by the gynecologic oncologist and 22% (16/75) by a nongynecologic oncologist (P = 0.002). Minor staging violations occurred in 14% (4/28) of cancers staged by the gynecologic oncologist and 42% (32/75) by a nongynecologic oncologist (P = 0. 005). Minor violations were due to omission of histologic subtype and/or grade. CONCLUSION The 22% major staging violation rate represents significant insensitive-measure bias. If additional studies produce similar results, abstraction of data from NCDB/SEER for reasons other than incidence, mortality, and patterns of care cannot be accepted as evidence-based scientific medicine.
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Kraus K, Fanning J. Prospective trial of early feeding and bowel stimulation after radical hysterectomy. Am J Obstet Gynecol 2000; 182:996-8. [PMID: 10819806 DOI: 10.1016/s0002-9378(00)70134-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE In an attempt to decrease hospital stay we performed a prospective trial of aggressive bowel stimulation and early postoperative feeding after radical hysterectomy. STUDY DESIGN In a prospective trial of 20 consecutive patients undergoing class 3 radical hysterectomy, feeding of a clear liquid diet and bowel stimulation with oral 66% sodium phosphate solution (Fleet Phospho-Soda) were instituted on postoperative day 1. Patients were discharged after passage of flatus or stool. RESULTS Median time to discharge was 3.5 days. No patient had emesis, ileus, or bowel obstruction. The decrease in hospital stay with respect to those in our previous trial with traditional postoperative feeding and our original study on postoperative bowel stimulation was statistically significant. CONCLUSION Aggressive bowel stimulation with Fleet Phospho-Soda and early feeding after radical hysterectomy resulted in early return of bowel function and early discharge without significant intestinal complication.
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Umhauer S, Ruch RJ, Fanning J. Gap junctional intercellular communication and connexin 43 expression in ovarian carcinoma. Am J Obstet Gynecol 2000; 182:999-1000. [PMID: 10819807 DOI: 10.1016/s0002-9378(00)70135-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Gap junctions, which are composed of subunits termed connexins, are plasma membrane channels that link the interior of adjacent cells and permit cells to directly exchange small molecules and ions. Loss or dysfunction of gap junctions appears to be important in allowing cancer cells to escape growth regulation. In a previous study we showed that human ovarian surface epithelial cells exhibited extensive gap junctions and expression of connexin 43. These were nearly absent in human ovarian adenocarcinoma cell lines. To ensure that this variation was not artificially produced by culturing techniques, this study evaluated gap junctions and connexin 43 expressions in normal ovaries and in ovarian adenocarcinomas. STUDY DESIGN Specimens of normal ovaries and ovarian adenocarcinomas were obtained at the time of surgery and flash-frozen in liquid nitrogen. Connexin 43 immunostaining was performed on all specimens. RESULTS Among the 11 normal ovaries an average of 59% of the surface epithelium stained positively for connexin 43. In contrast, among the 10 ovarian adenocarcinomas only 19% of each specimen stained positively for connexin 43 (P =.01). CONCLUSION Similar to our studies on human ovarian surface epithelial cells and ovarian adenocarcinoma cell lines, surgical specimens of normal ovary exhibited extensive connexin 43 expression, whereas connexin 43 expression was nearly absent in ovarian adenocarcinomas. It thus appears that the previously reported loss of gap junctions and connexin 43 was actually associated with a neoplastic process, rather than being artificially induced in the laboratory.
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Fanning J, Manahan KJ, McLean SA. Loop electrosurgical excision procedure for partial upper vaginectomy. Am J Obstet Gynecol 1999; 181:1382-5. [PMID: 10601916 DOI: 10.1016/s0002-9378(99)70379-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Partial upper vaginectomy consists of removal of the vaginal apex and is indicated for the diagnosis and treatment of vaginal intraepithelial neoplasia and recurrent cancer. We present a novel surgical approach to partial upper vaginectomy by use of the loop electrosurgical excision procedure. STUDY DESIGN A total of 15 consecutive patients with abnormal vaginal cytologic results were treated by the loop electrosurgical excision procedure for partial upper vaginectomy. After submucosal injection of local anesthetic, the loop electrode was used to resect the upper third of the vagina. An iodoform vaginal pack was placed for 24 hours. All patients with high-grade vaginal intraepithelial neoplasia received intravaginal 5-fluorouracil cream postoperatively. RESULTS The mean blood loss was 0 mL, and the mean surgical time was 30 minutes. A complication developed in 1 patient (7%). One case of invasive carcinoma was diagnosed. No recurrences have developed in any patients with vaginal intraepithelial neoplasia after hysterectomy. CONCLUSIONS The loop electrosurgical excision procedure for partial upper vaginectomy can be performed quickly, with minimal blood loss, minimal complications, and minimal recurrence of neoplasia, and it provides a histologic specimen for evaluation.
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Chadha M, Nanavati PJ, Liu P, Fanning J, Jacobs A. Patterns of failure in endometrial carcinoma stage IB grade 3 and IC patients treated with postoperative vaginal vault brachytherapy. Gynecol Oncol 1999; 75:103-7. [PMID: 10502434 DOI: 10.1006/gyno.1999.5526] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The vagina is the most common site of locoregional failure in surgical stage IB, IC, and II (occult) endometrial adenocarcinoma. The objective of this study is to evaluate the therapeutic efficacy of vaginal vault brachytherapy alone for surgical stage I patients with high-risk features. MATERIALS AND METHODS The study group consists of high-risk stage I patients with either stage IB grade (G) 3 or any grade IC disease. From February 1991 to August 1997, 124 patients with endometrial carcinoma were treated postoperatively with high-dose-rate vaginal vault brachytherapy as the only adjuvant treatment. All patients were surgically staged. Among them, 38 patients were identified as high risk. Twelve patients had stage IBG3, 14 had ICG1, 9 had ICG2, and 3 had ICG3 disease. The median age was 67 years (range 41 to 86 years). A dose of 21 Gy in three fractions of 7 Gy each was delivered to a prescription depth of 0.5 cm from the surface of the vaginal applicator using high-dose-rate brachytherapy. RESULTS The median follow-up was 30 months (range 7 to 91 months). No patient has developed a vaginal or pelvic recurrence. Three patients developed tumor recurrence in the upper abdomen at 11, 18, and 37 months. Two of the three patients with recurrent disease also had history of breast cancer. In one patient, breast cancer was diagnosed 4.8 years prior and in the second 3 years subsequent to the diagnosis of endometrial cancer. The 5-year actuarial overall survival and disease-free survival are 93 and 87%, respectively. There was no treatment-related grade 3 or 4 morbidity observed. CONCLUSIONS For patients with surgical stage IBG3 and IC, excellent local control and minimal morbidity has been observed with the selective use of vaginal brachytherapy alone. Further studies and longer follow-up are warranted.
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Fanning J. Treatment for early endometrial cancer. Cost-effectiveness analysis. THE JOURNAL OF REPRODUCTIVE MEDICINE 1999; 44:719-23. [PMID: 10483543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of treatment for early endometrial cancer. STUDY DESIGN Cost-minimization type of cost-effectiveness analysis with payer costs based on CPT (physician's current procedural terminology) and DRG (disease related group) codes. The six principles of cost-effectiveness analysis were evaluated. We compared the standard treatment protocol of selected lymphadenectomy/selective teletherapy (lymphadenectomy and postoperative teletherapy administered for high-risk tumors) as performed by the majority of gynecologic oncologists vs. an alternate treatment protocol of lymphadenectomy/selective brachytherapy (lymphadenectomy for all tumors, brachytherapy for high-risk tumors and teletherapy reserved for nodal metastasis) as performed by 10-12% of gynecologic oncologists. RESULTS In cost-minimization analysis, lymphadenectomy/selective brachytherapy was 12% less expensive than the standard treatment protocol of selective lymphadenectomy/teletherapy. CONCLUSION Although only 10-12% of gynecologic oncologists perform lymphadenectomy on all patients, deliver brachytherapy for high-risk tumors and reserve teletherapy for lymph node metastasis, it is a cost-effective treatment strategy for early endometrial cancer.
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Fanning J, Yu-Brekke S. Prospective trial of aggressive postoperative bowel stimulation following radical hysterectomy. Gynecol Oncol 1999; 73:412-4. [PMID: 10366469 DOI: 10.1006/gyno.1999.5401] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Postoperative traditional feeding protocols are not based on scientific studies, but rather on anecdotal evidence. We present the first prospective trial of aggressive postoperative bowel stimulation following radical hysterectomy in an attempt to determine its effect on the length of hospital stay. METHODS Twenty consecutive patients undergoing radical hysterectomy were entered onto a prospective trial of aggressive postoperative bowel stimulation, which consisted of 30 cc milk of magnesia p.o. b.i.d. starting on postoperative day 1 and biscolic suppositories q.d. starting on day 2. A clear liquid diet was begun following flatus or bowel movement and patients were discharged 12 h after tolerating a clear liquid diet. Diet was slowly advanced at home. RESULTS Median time to flatus was 3 days, bowel movement 3 days, and clear liquid diet 3 days. Median time to discharge was 4 days. No patients developed ileus or bowel obstructions and there were no readmissions for bowel complications. Our median time to discharge of 4 days represents a 50% reduction in hospital stay compared to our previous prospective study using traditional postoperative bowel management (8 days), which was statistically significant at P = 0.001. CONCLUSION Aggressive bowel stimulation with milk of magnesia and biscolic suppositories resulted in early return of bowel function and early discharge with no noticeable complications.
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Abstract
OBJECTIVE To evaluate urea nitrogen and creatinine levels in peritoneal fluid. METHODS We prospectively evaluated 20 consecutive women having radical hysterectomy with lymphadenectomy. On postoperative days 2 and 3, serum, urine, and peritoneal fluid samples were tested for urea nitrogen and creatinine. Using power analysis we calculated an adequate sample size to be 16 patients. RESULTS The mean urea nitrogen was 11 mg/dL in serum, 11 mg/dL in peritoneal fluid, and 469 mg/dL in urine. The mean creatinine was .9 mg/dL in serum, 1.0 mg/dL in peritoneal fluid, and 141 mg/dL in urine. Urea nitrogen and creatinine values in peritoneal fluid and serum were essentially identical. Urine urea nitrogen and creatinine values were significantly greater than serum and peritoneal values (47 to 157 times greater) (P < .011). On postoperative days 2 and 3, serial levels of serum, peritoneal fluid, and urine urea nitrogen and creatinine in the same subject showed no significant variation (P ranging from .19 to .31). CONCLUSION Normal reference values of urea nitrogen and creatinine in peritoneal fluid are equivalent to serum values and significantly less than urine levels.
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Fanning J, Lambert HC, Hale TM, Morris PC, Schuerch C. Paget's disease of the vulva: prevalence of associated vulvar adenocarcinoma, invasive Paget's disease, and recurrence after surgical excision. Am J Obstet Gynecol 1999; 180:24-7. [PMID: 9914572 DOI: 10.1016/s0002-9378(99)70143-2] [Citation(s) in RCA: 183] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Our aim was to determine the prevalence of associated vulvar adenocarcinoma, invasive Paget's disease, and recurrence of Paget's disease of the vulva. STUDY DESIGN A retrospective review of tumor and pathology registries at 8 institutions is presented. Patients with recurrent disease were excluded. Histologic slide review was performed. RESULTS The median age of the 100 patients was 70 years. The median duration of pruritus before surgery was 2 years. Thirty-four percent of patients experienced a recurrence at a median of 3 years. There was a 12% prevalence of invasive vulvar Paget's disease and a 4% prevalence of associated vulvar adenocarcinoma. One patient died of Paget's disease with associated vulvar adenocarcinoma. CONCLUSIONS Paget's disease of the vulva is rarely associated with an underlying vulvar adenocarcinoma or invasive Paget's disease, but there is a high recurrence rate.
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Fanning J, Neuhoff RA, Brewer JE, Castaneda T, Marcotte MP, Jacobson RL. Frequency and yield of postoperative fever evaluation. Infect Dis Obstet Gynecol 1998. [PMID: 9972487 PMCID: PMC1784817 DOI: 10.1002/(sici)1098-0997(1998)6:6<252::aid-idog6>3.0.co;2-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE In women undergoing major gynecologic surgery, we wish to determine the frequency and yield of blood culture, urine culture, and chest X-ray evaluation of postoperative fever. METHODS A retrospective review of 537 consecutive patients undergoing major gynecologic surgery was performed. In patients who developed postoperative fever, it was determined whether blood culture, urine culture, and/or chest X-ray were performed, and, if so, the frequency of positive results was evaluated. RESULTS Two hundred eleven patients (39%) developed postoperative fever. Blood cultures were obtained in 77 of 211 (37%) febrile patients, urine cultures in 106 of 211 (50%) febrile patients, and chest X-ray in 54 of 211 (26%) febrile patients. Zero of 77 blood cultures were positive, 11 of 106 (10%) urine cultures were positive, and 5 of 54 (9%) chest X-rays were positive. Logistic regression revealed that late onset fever predicted for positive urine cultures and early onset fever and advanced age predicted for pneumonia. Eighty percent of patients with pneumonia were symptomatic. In 92% of patients with postoperative fever, no infections or pathologic process were diagnosed. CONCLUSION Although postoperative fever is frequently evaluated by blood culture, urine culture, and chest X-ray, evaluation rarely yields positive results.
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Fanning J, Neuhoff RA, Brewer JE, Castaneda T, Marcotte MP, Jacobson RL. Frequency and yield of postoperative fever evaluation. Infect Dis Obstet Gynecol 1998; 6:252-5. [PMID: 9972487 PMCID: PMC1784817 DOI: 10.1002/(sici)1098-0997(1998)6:6<252::aid-idog6>3.0.co;2-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE In women undergoing major gynecologic surgery, we wish to determine the frequency and yield of blood culture, urine culture, and chest X-ray evaluation of postoperative fever. METHODS A retrospective review of 537 consecutive patients undergoing major gynecologic surgery was performed. In patients who developed postoperative fever, it was determined whether blood culture, urine culture, and/or chest X-ray were performed, and, if so, the frequency of positive results was evaluated. RESULTS Two hundred eleven patients (39%) developed postoperative fever. Blood cultures were obtained in 77 of 211 (37%) febrile patients, urine cultures in 106 of 211 (50%) febrile patients, and chest X-ray in 54 of 211 (26%) febrile patients. Zero of 77 blood cultures were positive, 11 of 106 (10%) urine cultures were positive, and 5 of 54 (9%) chest X-rays were positive. Logistic regression revealed that late onset fever predicted for positive urine cultures and early onset fever and advanced age predicted for pneumonia. Eighty percent of patients with pneumonia were symptomatic. In 92% of patients with postoperative fever, no infections or pathologic process were diagnosed. CONCLUSION Although postoperative fever is frequently evaluated by blood culture, urine culture, and chest X-ray, evaluation rarely yields positive results.
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Manahan KJ, Hudec J, Fanning J. Modified radical vulvectomy without lymphadenectomy under local anesthesia in medically compromised patients. Gynecol Oncol 1997; 67:166-7. [PMID: 9367701 DOI: 10.1006/gyno.1997.4866] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Our objective was to review our experience with vulvar cancer treated with modified radical vulvectomy without lymphadenectomy under local anesthesia and sedation. METHODS A retrospective review of surgical case lists revealed five patients who underwent modified radical vulvectomy without lymphadenectomy under local anesthesia with sedation. All patients had significant medical diseases which precluded regional or general anesthesia. Modified radical vulvectomy was performed in standard fashion under sedation and local anesthesia. Inguinal lymphadenectomy was not performed. RESULTS Median operative time was 1.5 h and median blood loss was 100 cc. Median diameter of tissue resected was 5 cm and median depth was 5 cm. Median length of hospital stay was 4 days. No patient complained of pain during the operative procedure. At a median follow-up of 2.5 years, there has been one local recurrence. CONCLUSION Five patients with symptomatic vulvar cancer who were not candidates for regional or general anesthesia underwent modified radical vulvectomy without lymphadenectomy under local anesthesia with sedation. The procedure was well-tolerated and produced minimal morbidity and adequate short-term local control.
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Horrigan TJ, Fanning J, Marcotte MP. Methotrexate pneumonitis after systemic treatment for ectopic pregnancy. Am J Obstet Gynecol 1997; 176:714-5. [PMID: 9077637 DOI: 10.1016/s0002-9378(97)70578-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Pneumonitis is an infrequent complication of methotrexate therapy. Described is a case of pneumonitis after treatment of an ectopic pregnancy. A 20-year-old white woman, gravida 3, para 0, ectopic pregnancy 2, was treated for her third ectopic pregnancy with 88 mg (50 mg/m2) of intramuscular methotrexate. Four days later acute dyspnea, tachypnea, fever, patchy infiltrates on chest x-ray films, and a PO2 of 30 mm Hg developed. Respiratory distress resolved over 48 hours. Pneumonitis should be suspected in any patient treated with methotrexate who has unexplained dyspnea.
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Fanning J. Lack of power. Am J Obstet Gynecol 1997; 176:494-5. [PMID: 9065207 DOI: 10.1016/s0002-9378(97)70527-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Fanning J, Hilgers RD. Prophylactic granulocyte colony-stimulating factor allows escalation of chemotherapeutic dose intensity in advanced epithelial ovarian cancer. Gynecol Oncol 1996; 63:323-7. [PMID: 8946866 DOI: 10.1006/gyno.1996.0330] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND In an effort to discover an effective regimen for use in Phase III evaluation of the efficacy of dose intensification in advanced ovarian cancer, we performed a Phase II trial of dose intensified cisplatin, etoposide, and ifosfamide with granulocyte colony-stimulating factor (G-CSF). METHODS Thirty patients with primary, FiGO Stage 3 or 4, epithelial ovarian cancer underwent intensified cytoreduction followed by cisplatin 105 mg/m2, etoposide 300 mg/m2 and ifosfamide/mesna 3 g/m2, q 28 days x 6 cycles with G-CSF 5 microg/kg q day for 7 days. The dose of etoposide and ifosfamide was escalated 20% in cohorts of three patients. RESULTS Intensified cytoreductive surgery was successful in resecting all gross tumor in 24 patients (80%). At the original dose of cisplatin, etoposide, and ifosfamide without G-CSF, 55% of cycles resulted in neutropenia and 38% in thrombocytopenia (dose intensity = 0.8). With the addition of G-CSF, neutropenia developed in 5% of cycles and thrombocytopenia in 38%. At a 20% escalation of etoposide and ifosfamide, neutropenia developed in 17% of cycles and thrombocytopenia in 50% (dose intensity = 1.2). At a 40% escalation of etoposide and ifosfamide, neutropenia developed in 33% of cycles and thrombocytopenia in 83%, which was dose limiting. The remaining 18 patients were treated at a 20% escalation and neutropenia developed in 14% of cycles and thrombocytopenia in 36%. CA125 response was 73%. At a 4.1-year median follow-up, median progression-free survival was 2.6 years and median survival was 3.0 years. CONCLUSION In 30 women with primary advanced ovarian cancer, G-CSF allowed a 50% dose escalation of etoposide and ifosfamide from 0.8 to 1.2 dose intensity. The maximum tolerated dose of this regimen is cisplatin 105 mg/m2, etoposide 360 mg/m2, and ifosfamide 3.6 g/m2 with G-CSF.
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Fanning J, Sweetland D, Hilgers R. A prospective randomized trial of ampicillin/sulbactam vs cefoxitin prophylaxis for radical gynecologic surgery. Int J Gynecol Cancer 1996. [DOI: 10.1046/j.1525-1438.1996.06040298.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Fanning J, Markuly SN, Hindman TL, Galle PC, McRae MA, Visnesky PM, Hilgers RD. False positive malignant peritoneal cytology and psammoma bodies in benign gynecologic disease. THE JOURNAL OF REPRODUCTIVE MEDICINE 1996; 41:504-8. [PMID: 8829063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the incidence of false positive malignant peritoneal cytology and psammoma bodies associated with benign gynecologic disorders. STUDY DESIGN Pelvic peritoneal fluid was prospectively collected for cytologic examination from 119 women undergoing laparoscopy for benign conditions (infertility, 67; pelvic pain, 35; elective sterilization, 17). The median age was 30. No patient had laparoscopic gross cancer or histologic evidence of cancer. RESULTS The peritoneal cytology of 2 of 119 cases (2%) contained cells with features suggestive of malignancy, and 6 of 119 cases (5%) contained psammoma bodies. Both cases of false positive peritoneal cytology and four of six with psammoma bodies were associated with endometriosis. All cases were followed for a minimum of two years, and no patient had developed cancer. CONCLUSION Peritoneal fluid from cases of benign gynecologic disorders, especially endometriosis, can contain psammoma bodies and cells suggestive of malignancy.
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Fanning J, Nanavati PJ, Hilgers RD. Surgical staging and high dose rate brachytherapy for endometrial cancer: limiting external radiotherapy to node-positive tumors. Obstet Gynecol 1996; 87:1041-4. [PMID: 8649687 DOI: 10.1016/0029-7844(96)00055-5] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate the efficacy and morbidity of surgical staging and high dose rate brachytherapy for women with stage I-IIIA endometrial cancer. METHODS Sixty consecutive patients underwent surgical staging consisting of total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal cytology, bilateral pelvic lymphadenectomy, periaortic lymphadenectomy, and omentectomy. High dose rate brachytherapy was delivered postoperatively in three fractions for a total of 2100 cGy. Only patients with nodal metastasis received external radiotherapy. RESULTS Twenty-two tumors (37%) were considered high-risk uterine disease because of deep invasion (stage IC), cervical involvement (stage II), positive peritoneal cytology (stage IIIA), or poor differentiation (grade 3). Lymph node metastases were detected in five patients. There was no surgical mortality, and morbidity from surgery and high dose rate brachytherapy was minimal. At a median follow-up of 3 years, there has been one recurrence. The conventional practice of postoperative external radiotherapy was altered in 23 of 60 patients (38%): 22 women with high-risk uterine factors did not receive external radiotherapy, and one patient with low-risk uterine factors (less than 50% myometrial invasion, grade 2) received external radiotherapy because of microscopic pelvic lymph node metastasis. CONCLUSION Surgical staging and high dose rate brachytherapy without external radiotherapy for stage I-IIIA endometrial cancer were associated with minimal morbidity and produced excellent survival.
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Fanning J, Hunt K, Sennello A, Schroeder P, Hilgers R. Postoperative delirium following radical gynecologic oncology surgery. Int J Gynecol Cancer 1996. [DOI: 10.1046/j.1525-1438.1996.06020094.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Fanning J, Hilgers RD, Kane C, Medrano C. Sequential granulocyte colony-stimulating factor increases cisplatin cytotoxicity in human epithelial ovarian cancer cell lines. Gynecol Oncol 1996; 60:450-3. [PMID: 8774656 DOI: 10.1006/gyno.1996.0072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND To determine the effect of granulocyte colony-stimulating factor (G-CSF) on tumor growth and cisplatin cytotoxicity in human epithelial ovarian cancer. METHODS Six human epithelial ovarian cancer cell lines were treated with media (control) for 24 hr, G-CSF for 24 hr, cisplatin for 24 hr, simultaneous cisplatin and G-CSF for 24 hr, media (control) for 48 hr, cisplatin for 24 hr and sequential media for 24 hr, cisplatin for 24 hr, and sequential G-CSF for 24 hr. Following incubation, the percentage cell lysis was determined by particle concentration fluorescein immunoassay chemosensitivity assay. RESULTS G-CSF resulted in tumor cell growth (7-19%) in three cell lines. Simultaneous G-CSF decreased cisplatin cytotoxicity in five cell lines (7-45%). Sequential G-CSF increased cisplatin cytotoxicity in all six cell lines (5-108%). CONCLUSIONS G-CSF may result in ovarian cancer proliferation. Simultaneous G-CSF may decrease cisplatin cytotoxicity, while sequential G-CSF appears to increase cisplatin cytotoxicity.
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Fanning J, Hilgers RD, Murray KP, Bolt K, Aughenbaugh DM. Conservative management of chemotherapeutic-induced thrombocytopenia in women with gynecologic cancers. Gynecol Oncol 1995; 59:191-3. [PMID: 7590471 DOI: 10.1006/gyno.1995.0006] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
During the course of four recent dose-intense chemotherapy trials, the routine practice of transfusing patients with platelet counts < 20,000/microliters was changed to a more conservative style of management limiting prophylactic transfusions to patients with platelet counts < 5000/microliters. One hundred seventy-nine episodes of thrombocytopenia in 46 patients enrolled in four dose-intense chemotherapy trials were evaluated. Thirty-two patients had advanced carcinoma of the ovary, 10 had pelvic sarcomas, and 4 had cervical cancer. Of the 179 episodes of thrombocytopenia evaluated, 100 exhibited severe thrombocytopenia (platelet count < 20,000/microliters). Of these 100 episodes, 30 received prophylactic platelet transfusions while 70 did not. Thirty-eight episodes of thrombocytopenia were 5000-10,000/microliters, 24 of which received prophylactic platelet transfusions while 14 did not. Eighteen episodes (10%) of thrombocytopenia resulted in minor bleeding and all occurred during severe thrombocytopenia. Minor bleeding occurred in 27% of episodes of severe thrombocytopenia receiving prophylactic platelet transfusions versus 14% not transfused (P = 0.2). Of the 38 episodes of thrombocytopenia 5000-10,000/microliters, minor bleeding occurred in 17% receiving prophylactic platelet transfusions versus 24% not transfused (P = 0.95). None of the 179 episodes of thrombocytopenia resulted in major bleeding, including 70 episodes of thrombocytopenia < 20,000/microliters not receiving prophylactic platelet transfusions which included 14 episodes of thrombocytopenia between 5000-10,000/microliters. In conclusion, in women with gynecologic cancer and chemotherapy-induced thrombocytopenia, we safely limited prophylactic platelet transfusions for episodes of thrombocytopenia < 5000/microliters. We hope our study will prompt prospective, randomized trials evaluating the need of prophylactic platelet transfusions for chemotherapy-induced thrombocytopenia in patients with solid tumors.
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Fanning J, Hilgers RD. Loop electrosurgical excision procedure for intensified cytoreduction of ovarian cancer. Gynecol Oncol 1995; 57:188-90. [PMID: 7729732 DOI: 10.1006/gyno.1995.1123] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The objective was to evaluate the loop electrosurgical excision procedure (LEEP) for intensified cytoreduction of ovarian cancer. Twenty consecutive women with residual epithelial ovarian cancer following maximum cytoreduction by standard surgical techniques were treated with LEEP-intensified cytoreduction. LEEP was employed to resect metastases involving intestines (18 patients), diaphragm (3 patients), liver (6 patients), spleen (3 patients), and peritoneal surface (18 patients). Median LEEP time was 9 min (range 3-27 min). Blood loss secondary to LEEP was minimal with no patient experiencing bleeding > 20 ml. Following LEEP-intensified cytoreduction, 17 of 20 patients (85%) had no gross residual disease. Seventeen of 18 patients (94%) had all intestinal metastases resected. All superficial liver (6 patients) and splenic metastases (3 patients) were completely resected. Peritoneal metastases were completely resected in all 18 patients. No patient experienced a complication directly related to LEEP. LEEP can be performed rapidly, with minimum blood loss, and results in intensified cytoreduction with minimal morbidity.
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Fanning J, Ladd C, Hilgers RD. Cisplatin, 5-fluorouracil, and ifosfamide in the treatment of recurrent or advanced cervical cancer. Gynecol Oncol 1995; 56:235-8. [PMID: 7896191 DOI: 10.1006/gyno.1995.1038] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We performed a prospective, phase II trial of cisplatin, 5-fluorouracil, and ifosfamide in the treatment of 30 women with recurrent or advanced cervical cancer. Median age was 47 years old. Twenty-one tumors were squamous and 83% of tumors were grade 2 or 3. Twenty-six patients (87%) received prior pelvic radiotherapy, and six patients (20%) received prior radiation sensitizing chemotherapy. Median time to recurrence was 6 months. In 11 patients (37%) tumor recurred in the pelvis. A combination of cisplatin 90 mg/m2, 5-fluorouracil 1500 mg/m2, and ifosfamide 3 g/m2 was administered intravenously in divided doses over 3 consecutive days every 28 days. Sixteen patients (53%) responded to chemotherapy with a complete response occurring in 5 patients (17%) and a partial response in 11 patients (36%). One of 11 patients (7%) with a pelvic recurrence responded compared to 15 of 19 (79%) with extrapelvic recurrence (P = 0.001). Tumors recurring after 6 months had a higher response rate (73%) compared to those recurring before 6 months (33%) (P = 0.05). Three of the six patients (50%) treated with prior radiation sensitizing chemotherapy responded. Seven of nine patients (78%) with adenocarcinoma responded. Median survival is 12 months (3-36 months). In conclusion, cisplatin, 5-fluorouracil, and ifosfamide resulted in a favorable response rate (53%) and a median survival of 12 months. As expected, patients with extrapelvic recurrence and recurrence after 6 months had an improved response rate while, surprisingly, those receiving prior radiation sensitizing chemotherapy and those with adenocarcinoma did not exhibit a less favorable response rate.
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