Five-year survival (with no evidence of disease) in patients with biopsy-confirmed aortic node metastasis from cervical carcinoma

Thirty-one women with biopsy-confirmed aortic node metastases from carcinoma of the uterine cervix were treated with pelvic and para-aortic irradiation. The intestinal complication rate in those patients who received 6,000 rads of split-course irradiation in 8 weeks was 61.9% and only 10.0% in the patients who received primarily 4,400 to 5,000 rads in 4 1/2 to 5 weeks. The 5 year survival rate with no evidence of disease (NED) was only 9.6%, with death rates of 16.1% from complications NED and 74.1% from cancer. Of the nine women with microscopic evidence of aortic node metastasis in clinically negative aortic nodes, two are surviving NED after 5 years and seven have died. Six women had a single, clinically positive aortic node metastasis, and one patient is alive after 5 years NED and five are dead. All 16 women with multiple aortic node metastases died of cervical cancer, including six patients who had 100% resection of the multiple para-aortic node metastases. A plan of management for surgical staging and para-aortic irradiation is outlined.

Cyclophosphamide, hexamethylmelamine, doxorubicin, and cisplatin (CHAD) as second-line chemotherapy for ovarian adenocarcinoma

Twenty women with recurrent ovarian adenocarcinoma received a monthly four-drug combination of cyclophosphamide, hexamethylmelamine, doxorubicin, and cisplatin as second-line chemotherapy. There were no objective responses to this regimen. This is in contrast to the 49% response rate reported by Kane et al using these four drugs and the 63% response rate reported by Vogl et al using three of these drugs as second-line chemotherapy. The differences in the three regimens are reviewed; however, we could not identify reasons sufficient to account for the disparity in response rates.

Delayed hypersensitivity reactions vs chemotherapy and immunotherapy responses in women with ovarian adenocarcinoma

Fifty-one previously untreated women with FIGO Stages III and IV ovarian adenocarcinoma underwent sequential monthly skin testing utilizing Keyhole Limpet Hemocyanian, Varidase, mumps, monilia, and a purified protein derivative Tuberculin (PPD) prior to each course of systemic chemotherapy (with or without Corynebacterium parvum). The purpose of the study was to evaluate the patients' ability to demonstrate a delayed cutaneous hypersensitivity reaction to these sensitizing antigens and response to therapy. There was no statistically significant correlation with response to therapy and: 1) Positive pretherapy skin test reactions vs anergy to pretherapy skin tests. 2) Negative pretherapy and positive post-therapy skin tests. 3) Anergy pre- and post-therapy vs positive skin test pre- or post-therapy. 4) Age of the patient vs skin test reactivity. 5) Skin test reactivity to any one of the five antigens tested. 6) Skin test reactivity in response to therapy in those women also receiving Corynebacterium parvum. It is concluded that the battery of skin tests utilized do not predict the patient's response to systemic chemotherapy in advanced ovarian adenocarcinoma.

High-dose methotrexate with "RESCUE" plus cyclophosphamide as initial chemotherapy in ovarian adenocarcinoma. A randomized trial with observations on the influence of C parvum immunotherapy

In a prospective randomized study, the chemotherapeutic combination of high-dose methotrexate-citrovorum factor rescue plus cyclophosphamide (MECY) has been shown to be statistically significantly superior to the combination of 5-fluorouracil plus cyclophosphamide (FUCY) in the treatment of Stage III-IV ovarian adenocarcinoma. With MECY, an overall objective remission rate of 67% and a complete remission rate of 48% were achieved. All patients had undergone no treatment except for surgery. In addition to the chemotherapy, patients were randomly allocated to receive or not receive nonspecific immunotherapy with Corynebacterium parvum; this immunotherapy had no apparent effect on the chemotherapeutic response. The study demonstrates a high degree of activity for the MECY regimen, and a comparison between the results with MECY in this study and melphalan in an earlier prospective randomized study provides statistical evidence favoring MECY over single-agent melphalan in the treatment of this disease.

Melphalan, 5-fluorouracil, and medroxyprogesterone acetate in metastatic or recurrent endometrial carcinoma. Preliminary report

The purpose of this study was to evaluate therapy with melphalan, 5-fluorouracil (5-FU), and medroxyprogesterone acetate combination (MFP) in women with metastatic or recurrent endometrial carcinoma not amenable to surgery or radiation therapy, as compared to progesterone therapy alone. Previously, the authors have treated 114 women with progesterone therapy and achieved a 15.8% objective response rate; 7.0% were complete responders. Thirteen women with documented recurrent or metastatic endometrial carcinoma were entered into the MFP study. Thirteen were evaluable for toxicity and 11 for response (2 had no measureable parameter). Treatment consisted of melphalan 0.2 mg/kg/day for 4 days every 4 weeks; 5-FU 15 mg/kg/day for 4 days every 4 weeks; and medroxyprogesterone acetate 1.0 g intramuscularly weekly. Two of the first 3 patients who were treated with this regimen developed severe thrombocytopenia (platelets, 25,000 and 17,000/mm3). Therefore, the remaining 10 patients received 5-FU at a dose of 10 mg/kg/day for 4 days every 4 weeks. Except for 1 patient who devloped thrombophlebitis, there was no other significant toxicity in the 90 courses of therapy received by the 13 women. Of the 11 women evaluable for respone, 6 (54.5%) responded (2 complete responders, 4 partial responders), 2 for stationary disease, and 3 progressed after having had stationary disease for 3, 6, and 9 months, respectively. Of special interest was that the 2 women with adenosquamous carcinoma responded and 1 additional patient with adenocarcinoma maintained a complete response with 5-FU therapy alone.

Second-look laparoscopy prior to proposed second-look laparotomy

A prospective study was carried out to evaluate the use of second-look laparoscopy in patients in complete clinical remission after prolonged chemotherapy for advanced ovarian adenocarcinoma. Twenty-two patients with FIGO stages IIB, III, and IV ovarian adenocarcinoma underwent second-look laparoscopy after a median of 23 months of therapy. Eight (36.3%) patients had documented evidence of persistent ovarian cancer and were thus spared second-look laparotomy. Moreover, in 4 patients (18.1%), malignant cells in cytologic washings were the only laparoscopic evidence of persistent ovarian cancer. The absence of visible tumor and malignant cells in cytologic washings allows for the use of second-look laparotomy while the patient is under 1 anesthesia; the presence of tumor or malignant cells in cytologic washings spares the patient second-look laparotomy at that time.

Cystadenocarcinoma of the ovary in a 4-year-old: benign transformation during therapy

Ovarian tumors comprise only 1% of all tumors in females below the age of 17 years. Of these, the epithelial tumors are the least common, being particularly rare before puberty and then increasing in frequency with advancing age after puberty. The youngest girl previously reported in the literature with an epithelial ovarian tumor was a 9-year-old child with an ovarian papillary cystadenocarcinoma. This is the only case thus far reported of a malignant ovarian epithelial tumor occurring before puberty. Only histologically benign appearing glands were detected in the resected tumor masses, on a second-look laparotomy following the use of multiagent chemotherapy.

Doxorubicin, cyclophosphamide, and 5-fluorouracil in patients with carcinoma of the cervix or vagina

Thirty-six evaluable patients with carcinoma of the uterine cervix or vagina not amenable to surgery or radiation therapy were treated with doxorubicin, cyclophosphamide, and 5-fluorouracil; 16.5% of the patients responded, with 2.7% having a complete response. Only four (11.17%) of the 36 patients are alive, all with persistent malignancy, and none of the responders are alive. Because of the low response and survival rates, this combination is not recommended for women with recurrent cervical or vaginal carcinoma.

Medroxyprogesterone acetate (Depo-Provera) vs. hydroxyprogesterone caproate (Delalutin) in women with metastatic endometrial adenocarcinoma

A prospective trial was initiated in 1972 utilizing Depo-Provera in women with metastatic or recurrent endometrial adenocarcinoma to evaluate if the objective response and survival would be significantly improved in comparison to patients previously treated with Delalutin at a similar dose. One hundred fourteen patients were included in the study: 70 received Delalutin and 44 Depo-Provera. There was no significant increase in the objective response or survival between the Delalutin or Depo-Provera patients. Of the 114 patients, 15.8% achieved an objective response, with 7.0% being complete responders. There was no significant increase in objective response to Delalutin or Depo-Provera in relationship to the size of the tumor masses, the number of metastases, site of metastases, histologic grade of the primary, histologic grade of recurrence or metastases, or prior radiation therapy. The only significant correlate was that patients whose disease recurred 3 or more years after the initial therapy had a significant (P = 0.01) increase in response (33.3%) compared to those with recurrence less than 3 years after their original treatment (8.3%).

Weekly cis-diamminedichloroplatinum(II): active third-line chemotherapy in ovarian carcinoma--a preliminary report

Ten evaluable patients with progressive ovarian adenocarcinoma received third-line chemotherapy consisting of weekly cisplatin (cis-diamminedichloroplatinum[II]) at a dose of 1 mg/kg weekly for a maximum of 6 weeks followed by 60 mg/m2 every 3 weeks. There was no life-threatening toxicity. Seven patients (70%) achieved an objective partial response. This is the highest response rate achieved, to date, by third-line chemotherapy in women with advanced ovarian adenocarcinoma. Weekly cisplatin therefore warrants a trial as first-line therapy.

Para-aortic node biopsy in staging women with cervical, ovarian and endometrial carcinoma: a review

In women with gynecologic malignancies the para-aortic lymph nodes are not routinely treated. However, pretherapy surgical staging has now disclosed an incidence of para-aortic node metastasis of 10.3% for presumed stage I and II ovarian cancer, 8.0% for stage I endometrial carcinoma, and 23.5% for stage II, III, and IV cervical cancer. Prospective trials to evaluate therapy directed to the para-aortic nodes in women with early ovarian and endometrial carcinoma have not been carried out. Moreover, the results of high dose irradiation to biopsy proven metastasis to the aortic lymph nodes from cervical cancer has resulted in only 11.9% survival without recurrence at two years.

Postirradiation squamous cell carcinoma in situ of the vagina: treatment by topical 20 percent 5-fluorouracil cream

Eight patients with squamous cell carcinoma in situ of the vagina were treated with monthly 5 day courses of 20% 5-fluorouracil cream applied to the vagina. Seven (87.5%) of the women had an initial complete response; however, three subsequently developed recurrence after the treatment was stopped. They were retreated, and two of these three patients achieved a subsequent complete response. The overall response to therapy was 75% (6/8) with six women off therapy from 1.1 to 6.9 years. Total follow-up of all patients was 3.1 to 6.9 years with no patients having developed invasive carcinoma. Because of the high success rate with no associated serous sequelae, this is believed to be a satisfactory method of therapy for women with squamous cell carcinoma in situ of the vagina occurring after pelvic irradiation.

A prospective trail comparing hysterectomy, hysterectomy plus vaginal radium, and uterine radium plus hysterectomy in stage I endometrial carcinoma

From 1958 to 1967, a prospective randomized trial was conducted in 189 women with stage I, group I endometrial adenocarcinoma, comparing treatment by hysterectomy alone, preoperative uterine radium followed by hysterectomy, and hysterectomy and postoperative vaginal radium. All women have been followed for a minimum of 10 years. The actual survival rate at 5 years for all patients was 94.5% and at 10 years, 92.6%, with no statistical significance among the 3 treatment groups. Ther was also no statistical significance in survival rate in relation to size of uterine or myometrial invasion. There was a statistically significant difference in survival between grade I and grade III lesions (P less than 0.01) and between grade II and grade III lesions (P less than 0.05).

Treatment and immunodiagnosis of advanced ovarian adenocarcinoma: a preliminary report

High-dose methotrexate with leucovorin rescue plus cyclophosphamide resulted in a 66.6% objective response rate with a 50% complete response rate. These preliminary results are higher than our previous results with melphalan alone or actinomycin D, 5-fluorouracil, and cyclophosphamide in women with advanced ovarian adenocarcinoma. Circulating ovarian cystadenocarcinoma-associated antigen serum levels were positive in 69.8% of patients and correlated with response to chemotherapy in 70% of patients. To date, all of the patients with advanced ovarian adenocarcinoma were found to have elevated galactosyltransferase levels. Galactosyltransferase levels correlated with response to therapy in the first five patients followed serially.

Adriamycin in localized and metastatic uterine sarcomas

Seventeen women with metastatic uterine sarcomas were treated with Adriamycin chemotherapy. Only one (6%) had an objective response. In addition, 12 patients with early uterine sarcomas were randomized to Adriamycin versus no adjuvant chemotherapy in order to evaluate the effect of Adriamycin in reducing the incidence of subsequent distant recurrences. Of those women receiving Adriamycin, two developed distant metastasis and two developed life-threatening congestive heart failure. Also, two of the six women who did not receive Adriamycin developed distant metastasis. Therefore, continuation of the randomized trial was considered unjustified.

Incidence of subclinical metastasis in stage I and II ovarian carcinoma

The incidence of unsuspected metastasis to the diaphgram, retroperitoneal lymph nodes, and omentum as well as malignant cytologic peritoneal washings in women with presumed localized ovarian cancer is presented. Of the women with presumed Stage I ovarian cancer, from our clinical experience and those reported in the literature, 11.3% were found to have diaphragmatic metastases, 13.3% had aortic lymph node metastases, 8.1% had pelvic lymph node metastases, 3.2% had omental metastases, and 32.9% had malignant peritoneal washings. In Stage II ovarian cancer, 23% were found to have diaphgragmatic metastases, 10.0% had aortic lymph node metastases, 0% had omental metastases, and 12.5% had malignant peritoneal washings.