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Rassy E, Assi T, Boussios S, Kattan J, Smith-Gagen J, Pavlidis N. Narrative review on serous primary peritoneal carcinoma of unknown primary site: four questions to be answered. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1709. [PMID: 33490221 PMCID: PMC7812188 DOI: 10.21037/atm-20-941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Serous peritoneal papillary carcinoma (SPPC) represents a particular cancer of unknown primary (CUP) entity that arises in the peritoneal surface lining the abdomen and pelvis without a discriminative primary tumor site. In this review, we discuss the validity of SPPC as a distinct entity. Clinically, patients with SPPC are older, have higher parity and later menarche, are more often obese and probably have poorer survival compared to those with primary ovarian cancer. Pathologically, SPPC is more anaplastic and multifocal, unlike primary ovarian cancer which is commonly unifocal. Biologically, it presents a higher expression of proliferative signals and similar cell cycle and DNA repair protein expression. These differences hint towards SPPC and primary ovarian cancer being as a spectrum of disease. Patients with SPPC are traditionally managed similarly to stage III–IV ovarian cancer. The recommended approach integrates aggressive cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, and systemic chemotherapy to remove the macroscopic tumor, eradicate the microscopic residual disease, and control the microscopic metastasis. However, the available evidence lacks proper randomized or prospective studies on SPPC and is limited to retrospective series. The diligent identification of SPPC is warranted to design specific clinical trials that eventually evaluate the impact of the new therapeutics on this distinct entity.
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Affiliation(s)
- Elie Rassy
- Department of Cancer Medicine, Gustave Roussy Institut, Villejuif, France.,Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Tarek Assi
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Stergios Boussios
- Medway NHS Foundation Trust, Gillingham, Kent, UK.,AELIA Organization, 9th Km Thessaloniki-Thermi, Thessaloniki, Greece
| | - Joseph Kattan
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Julie Smith-Gagen
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
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Sebbag G, Shmookler BM, Chang D, Sugarbaker PH. Peritoneal Carcinomatosis from an Unknown Primary Site. Management of 15 Patients. TUMORI JOURNAL 2018; 87:67-73. [PMID: 11401209 DOI: 10.1177/030089160108700201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background Peritoneal carcinomatosis from an unknown primary site is a rare and ill-defined entity. This work attempts to identify clinical and pathological features of patients with this disease and report the results of an aggressive combined treatment modality. Methods Retrospective analysis was performed of medical records of 15 patients with peritoneal carcinomatosis with no primary site identified at a single institution between 1989 and 2000. A primary gastrointestinal cancer was ruled out after a thorough endoscopic and radiologic work-up and complete exploratory surgery. Results Four women and 11 men were identified; the average age was 49 years. All patients had cytoreductive surgery with peritonectomies; 4 patients underwent a second-look operation. Perioperative intraperitoneal chemotherapy was given to 10 of the 15 patients, and 9 patients received post-cytoreduction chemotherapy given intraperitoneally (1), systemically (7) or both intraperitoneally and systemically (1). Overall median survival from diagnosis was 19.0 months; 1 patient is alive with disease at 21 months; and 3 patients are disease-free at 17, 38, and 60 months from diagnosis. Significant positive predictive factors for survival were a small volume of ascites (P = 0.02), a large number of peritonectomies performed (P = 0.001), second-look cytoreduction (P = 0.003), perioperative intraperitoneal chemotherapy (P = 0.008) and postoperative chemotherapy (P = 0.01), either intraperitoneal or systemic. Conclusions Peritoneal carcinomatosis from an unknown primary site is a rare subset of primary peritoneal malignancy. Aggressive treatment may provide prolonged palliation with occasional long-term survival.
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Affiliation(s)
- G Sebbag
- The Washington Cancer Institute, DC 20010-2975, USA
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Wu YY, Chang JY, Chao TY. Paclitaxel and Carboplatin-Induced Complete Remission in Peritoneal Carcinomatosis of Unknown Origin: A Report of Two Cases and Review of the Literature. TUMORI JOURNAL 2018; 96:336-9. [DOI: 10.1177/030089161009600225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Peritoneal carcinomatosis is a common evolution of digestive-tract cancer with a poor prognosis. However, a small subgroup unrelated to the digestive tract or any other primary cancer has a relatively better prognosis, especially in women. There are no published data to recommend a treatment regimen for this distinct group. Here we present two women with peritoneal carcinomatosis of unknown origin, who responded to chemotherapy with paclitaxel plus carboplatin. One underwent an exploratory laparotomy and was confirmed to have no residual tumor. The other had complete resolution of ascites and omentum lesions confirmed by radiological examination. From this experience we propose that paclitaxel plus carboplatin is an effective combination regimen for this unique subset of patients. Further prospective trials should be conducted to substantiate this proposal in a larger patient cohort.
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Affiliation(s)
- Yi-Ying Wu
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jang-Yang Chang
- Institute of Cancer Research, National Health Research Institutes, Taiwan
| | - Tsu-Yi Chao
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Institute of Cancer Research, National Health Research Institutes, Taiwan
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Abstract
In cancer of unknown primary (CUP), metastases are clinically and histologically confirmed, but the primary tumor site remains elusive after extensive work-up. CUPs make up for 2-3% of all epithelial malignancies. The two prevailing histologies are adenocarcinomas and undifferentiated carcinomas, whereas squamous cell carcinomas, neuroendocrine carcinomas and rare histologies account for the remaining 10%. The diagnostic work-up in CUP relies strongly on a detailed immunohistological (IHC) analysis in order to characterize the tumor type, nowadays aided by molecular techniques. Diagnostics also include a thorough clinical examination, a basic lab draw with the most relevant tumor markers, and cross sectional imaging. Additional PET-CT is recommended in cervical lymph nodes suggestive of head and neck cancer and in limited metastases potentially treatable in curative intent. As for treatment, it is paramount to identify patients who fall into one of the six well defined "favorable" subset categories, namely extragonadal germ cell tumors, adenocarcinoma with isolated unilateral axillary lymph nodes in female patients, squamous cell carcinoma with neck lymph nodes, squamous cell carcinoma with inguinal lymph nodes, serous papillary peritoneal carcinomatosis in females and blastic bone metastasis in males with elevated PSA. These subsets are distinct both regarding the required treatment and the comparably favorable prognosis. Within the remaining "unfavorable" group, patients of colon and renal cancer type should be identified based on IHC and clinical picture, since the prognosis of these patients seems to improve with the use of therapy tailored to the presumed primary as well. For the few patients with limited metastases it should be assessed whether they are candidates for surgery, radiotherapy or surgery followed by irradiation in curative intent. The remaining majority of patients are treated with empiric palliative chemotherapy, typically a platinum - paclitaxel combination, though the level of evidence for this therapy recommendation is low. Gemcitabine alone or in combination can be used as an alternative. Decoding of the molecular profiles in CUP offers the prospect of targeted therapy with novel agents. However, there appears to be no uniform molecular pattern for CUP, and the observed molecular diversity thus poses a challenge to respective clinical trials.
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Affiliation(s)
- Tilmann Bochtler
- Clinical Cooperation Unit Molecular Hematology / Oncology, German Cancer Research Center (DKFZ) and Department of Medicine V, University of Heidelberg, Heidelberg, Germany; Department of Internal Medicine V, Hematology / Oncology, University of Heidelberg, Heidelberg, Germany
| | - Harald Löffler
- Clinical Cooperation Unit Molecular Hematology / Oncology, German Cancer Research Center (DKFZ) and Department of Medicine V, University of Heidelberg, Heidelberg, Germany; Department of Internal Medicine III, Oncology / Hematology / Palliative Care, Marienhospital Stuttgart, Stuttgart, Germany
| | - Alwin Krämer
- Clinical Cooperation Unit Molecular Hematology / Oncology, German Cancer Research Center (DKFZ) and Department of Medicine V, University of Heidelberg, Heidelberg, Germany; Department of Internal Medicine V, Hematology / Oncology, University of Heidelberg, Heidelberg, Germany.
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Dadayal G, Weston M, Young A, Graham J, Mehta K, Wilkinson N, Spencer J. Transvaginal ultrasound (TVUS)-guided biopsy is safe and effective in diagnosing peritoneal carcinomatosis and recurrent pelvic malignancy. Clin Radiol 2016; 71:1184-92. [DOI: 10.1016/j.crad.2016.06.119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 05/08/2016] [Accepted: 06/23/2016] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Cancer of unknown primary site (CUP) comprises a relatively frequently occurring group of heterogeneous malignant tumors in the clinical routine, which currently has an abysmal prognosis for affected patients. Based on the improved diagnostic tools it is now possible to identify subgroups of patients with different clinical prognoses. New therapies adapted to these identified subgroups are becoming increasingly more relevant. AIM This review aims to evaluate the role of surgery and different surgical options in the therapy of patients with CUP. RESULTS For the treatment of patients with CUP it is important to identify subgroups of patients with a better prognosis. Surgical resection of CUP metastasis is a therapy option leading to a prolonged survival in (1) women with papillary peritoneal adenocarcinomatosis, (2) women with axillary lymph node metastasis of adenocarcinoma, (3) patients with cervical lymph node metastasis of squamous cell carcinoma, (4) patients with inguinal lymph node metastasis, (5) patients with poorly differentiated carcinomas with midline distribution (e.g. extragonadal germ cell syndrome) and (6) patients with small resectable tumors. CONCLUSION Surgery is an important therapy option in different subgroups of patients with CUP. Together with multimodal therapy, adjusted according to the identified most likely origin of the primary tumor, it is possible to prolong patient survival.
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Affiliation(s)
- T Schmidt
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätklinikum Heidelberg, Im Neuenheimer Feld 110, 69117, Heidelberg, Deutschland
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Abstract
Carcinomas of an unknown primary origin (CUP) account for 3-5% of all malignancies and are thus among the ten most-frequent cancers worldwide. Having a specific and unique phenotype of early and usually aggressive metastatic dissemination with no identifiable primary tumor, CUP are a challenge for physicians. The diagnostic workup of patients with CUP includes a careful clinical and extensive histopathological examination, as well as the use of imaging techniques. CUP can be divided into favorable and unfavorable subsets. Patients with unfavorable CUP subsets have a poor prognosis with a median survival of approximately 8 months; the optimal chemotherapy regimen for these patients remains to be determined. Although studies have focused on the introduction of new cytotoxic agents with broad-spectrum clinical activity (such as gemcitabine, irinotecan, and taxanes), no randomized trial has provided clear evidence of a survival benefit. Molecular targeted therapies that are approved for other solid tumors are now considered for the treatment of patients with CUP. Molecular diagnostic tools, such as DNA microarray analysis, could help in the search for 'lost' CUP origins. In this Review, we describe the clinical evaluation of patients with CUP, and discuss treatment strategies and outcomes of patients with various CUP subsets.
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Spencer JA, Weston MJ, Saidi SA, Wilkinson N, Hall GD. Clinical utility of image-guided peritoneal and omental biopsy. Nat Rev Clin Oncol 2010; 7:623-31. [DOI: 10.1038/nrclinonc.2010.155] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Pentheroudakis G, Pavlidis N. Serous papillary peritoneal carcinoma: unknown primary tumour, ovarian cancer counterpart or a distinct entity? A systematic review. Crit Rev Oncol Hematol 2009; 75:27-42. [PMID: 19897383 DOI: 10.1016/j.critrevonc.2009.10.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 09/17/2009] [Accepted: 10/08/2009] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Serous peritoneal papillary carcinoma (SPPC), though managed according to ovarian cancer therapeutic principles, has been variably considered as an ovarian cancer counterpart, a peritoneal malignancy with distinct characteristics or a cancer of unknown primary (CUP). PATIENTS AND METHODS We systematically reviewed all publications studying molecular pathophysiology, clinical presentation, management and outcome of at least 10 patients with SPPC from 1980 to 2008 in anglophone medical journals and critically analysed the data. RESULTS Molecular profiling of CUP was performed in eight papers reporting on 211 patients with stage III/IV SPPC by means of immunohistochemistry or PCR-based assays. Twenty-five clinical series, mostly retrospective, reported management and outcome of 579 patients with SPPC, in several cases matched to advanced ovarian cancer controls. Though we did not identify statistically significant differences in molecular biology, clinical presentation, management and outcome of SPPC and ovarian cancer cases, some subtle differences emerged: patterns of loss of heterozygosity at several chromosomal loci differed from those seen in ovarian cancer, while the overexpression of the HER2 oncogene was encountered more often. Serous peritoneal tumours affected older patients and were more frequently multifocal or exhibited virulent clonal expansion in metastatic sites. Diffuse micronodular spread formed a high total load of malignancy in omental, peritoneal surfaces, difficult to debulk optimally. Despite effective chemotherapeutic cytoreduction and occasional long-term remissions, SPPC patients survived 2-6 months less than ovarian cancer patients. CONCLUSIONS Patients with SPPC should not be classified in the poor-risk CUP category, in view of the therapeutic and prognostic differences. Still, the assimilation of the SPPC entity by ovarian cancer hindered further research into its genotypic and phenotypic characteristics that may differ from ovarian cancer. Subgroup analyses of large ovarian cancer trials may shed light in this issue.
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Affiliation(s)
- George Pentheroudakis
- Department of Medical Oncology, Ioannina University Hospital, Niarxou Avenue, Ioannina, Greece
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Abstract
Patients with carcinoma of unknown primary site are heterogeneous with respect to clinical and pathologic features. Within this diverse group, specific clinical and/or pathologic features can be used to define several subsets with favorable prognoses. Specific subsets include women with peritoneal carcinomatosis, women with isolated axillary lymph node metastases, adenocarcinoma presenting as a single metastatic lesion, young men with features of extragonadal germ cell tumor, squamous carcinoma involving cervical or inguinal lymph nodes, and neuroendocrine carcinoma. Prospective identification of patients in these favorable subgroups allows the most effective treatment to be selected. This review summarizes current recommendations for the evaluation and treatment of patients in each of these favorable prognostic subsets.
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Eisenhauer EL, Sonoda Y, Levine DA, Abu-Rustum NR, Gemignani ML, Sabbatini PJ, Barakat RR, Chi DS. Platinum resistance and impaired survival in patients with advanced primary peritoneal carcinoma: matched-case comparison with patients with epithelial ovarian carcinoma. Am J Obstet Gynecol 2008; 198:213.e1-7. [PMID: 18226627 DOI: 10.1016/j.ajog.2007.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Accepted: 07/02/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of the study was to compare chemotherapy response and survival of patients with advanced primary peritoneal carcinoma (PPC) vs those with epithelial ovarian carcinoma (EOC). STUDY DESIGN From 1998 to 2004, 43 PPC patients were identified and matched to 129 patients with International Federation of Gynecology and Obstetrics stage IIIC-IV EOC by criteria abstracted from medical records. Primary endpoints were chemotherapy response, platinum resistance, progression-free survival (PFS), and overall survival (OS). RESULTS All patients received primary platinum-taxane chemotherapy. There was no significant difference in achieving a clinical complete response. PPC patients were more likely to be platinum resistant at 6 months and had significantly impaired PFS and OS. After multivariate analysis, PPC was independently associated with a worse prognosis for both survival endpoints. CONCLUSION PPC was associated with a similar initial response but a higher rate of platinum resistance and shorter PFS and OS. Consideration of these results may be useful for patient counseling, trial stratification, and molecular comparisons.
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Affiliation(s)
- Eric L Eisenhauer
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Spencer JA, Forstner R, Hricak H. Investigating women with suspected ovarian cancer. Gynecol Oncol 2007; 108:262-4. [PMID: 18023850 DOI: 10.1016/j.ygyno.2007.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Accepted: 10/05/2007] [Indexed: 10/22/2022]
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Briasoulis E, Fountzilas G, Bamias A, Dimopoulos MA, Xiros N, Aravantinos G, Samantas E, Kalofonos H, Makatsoris T, Mylonakis N, Papakostas P, Skarlos D, Varthalitis I, Pavlidis N. Multicenter phase-II trial of irinotecan plus oxaliplatin [IROX regimen] in patients with poor-prognosis cancer of unknown primary: a hellenic cooperative oncology group study. Cancer Chemother Pharmacol 2007; 62:277-84. [PMID: 17901952 DOI: 10.1007/s00280-007-0604-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Accepted: 09/10/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cancer of unknown primary (CUP) lacks established therapy although it affects 3% of cancer patients. We evaluated the irinotecan-oxaliplatin combination (IROX regimen) in previously untreated patients with non-favorable subsets of unknown primary carcinomas. METHODS This was a multicenter phase-II trial. Protocol treatment consisted of oxaliplatin 80 mg/m(2) followed by irinotecan 160 mg/m(2) administered every 3 weeks. The primary end points were response rate and toxicity, and secondary end points were time to progression and survival. RESULTS Forty-seven patients with liver, bone or multiple visceral metastases entered into the trial and received a median 6 chemotherapy cycles (1-11). The regimen was very well tolerated with one febrile neutropenia case and six cases with diarrhea grade 3 (16%). In intent-to-treat analysis the tumor response rate was 13% (95% CI = 4.8-25.7%) and 12 patients (27%, 95%CI 13.9-40.4%) had at least 4 months' duration of disease stabilization. The median time to progression was 2.7 months and the median survival was 9.5 months, with 40% of patients alive at 1 year. CONCLUSIONS The IROX regimen demonstrated similar efficacy and a favorable toxicity profile compared to other more toxic chemotherapy combinations in patients with poor-prognosis CUP.
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Yakushiji S, Ando M, Yonemori K, Kohno T, Shimizu C, Katsumata N, Fujiwara Y. Cancer of unknown primary site: review of consecutive cases at the National Cancer Center Hospital of Japan. Int J Clin Oncol 2006; 11:421-5. [PMID: 17180509 DOI: 10.1007/s10147-006-0599-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2006] [Accepted: 06/14/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cancer of unknown primary (CUP) is not a rare clinical entity, accounting for 3%-5% of all solid malignancies. METHODS We retrospectively reviewed 86 (38 male/48 female) patients with a diagnosis of CUP (exclusive of female patients with adenocarcinoma involving the axillary lymph nodes alone and patients with squamous cell carcinoma of the cervical lymph nodes) who were referred to the National Cancer Center Hospital between April 1996 and October 2002. RESULTS The median interval between the first visit to a local community hospital and referral to our hospital was 1 month (range, 1 to 45 months). The histological diagnosis was adenocarcinoma in 61 patients (71%), poorly differentiated carcinoma in 18 patients (21%), and squamous cell carcinoma in 4 patients (5%). Twenty-three female patients had peritoneal carcinomatosis of adenocarcinoma. Seventy-eight patients (91%) received platinum-containing chemotherapy. Sixty-one of the 86 patients (71%) were categorized as a subgroup of CUP without a specific therapy, and 55 of these 61 patients (90%) received platinum-containing regimens. The median survivals of all 86 patients and the 61 patients in the subgroup without a specific therapy in this series were 13 months and 11 months, respectively. CONCLUSION In this series, the survival of the patients in the CUP subgroup without a specific therapy did not seem worse than that in previous reports. Empirical chemotherapy with platinum-containing regimens may benefit some CUP patients in a subgroup without a specific chemotherapy.
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Affiliation(s)
- Satomi Yakushiji
- Breast and Medical Oncology Division, Department of Medical Oncology, National Cancer Center Hospital, 1-1 Tsukiji 5-Chome, Chuo-ku, Tokyo 104-0045, Japan
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Ayhan A, Taskiran C, Yigit-Celik N, Bozdag G, Gultekin M, Usubutun A, Guler N, Yuce K. Long-term survival after paclitaxel plus platinum-based combination chemotherapy for extraovarian peritoneal serous papillary carcinoma: is it different from that for ovarian serous papillary cancer? Int J Gynecol Cancer 2006; 16:484-9. [PMID: 16681715 DOI: 10.1111/j.1525-1438.2006.00590.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The purpose of this study was to compare the effect of paclitaxel plus platinum-based chemotherapy in the treatment of extraovarian peritoneal serous papillary carcinoma (EPSPC) and ovarian serous papillary cancer (OSPC). Only the patients treated with initial surgery plus postoperative adjuvant chemotherapy and having FIGO stage IIIC disease with omental and/or peritoneal involvement were analyzed. Thirty-two patients with EPSPC and 43 with OSPC were included in this study. The median age, mean CA-125, and volume of ascitis were higher in patients with EPSPC. There was no significant difference between the two groups with respect to other prognosticators. The median overall survival (OS) durations were 30 months (95% CI 24.8-35.3) in patients with EPSPC and 28 months (95% CI 21.1-34.9) in those with OSPC (P= 0.35). The 3-year OS rates in the patients and controls were 28% and 31%, respectively (P= 0.84). In patients with EPSPC, only optimal cytoreduction was significantly related to progression-free survival and OS durations as a prognostic factor. In the EPSPC group, 65.5% of the patients (19/29) had lymphatic involvement, compared to 88.4% (38/43) in the OSPC group (P= 0.02). As an adjuvant therapy, the paclitaxel plus platinum-based combination regimen had similar effects on survival in the EPSPC and OSPC groups.
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Affiliation(s)
- A Ayhan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
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Sève P, Stankovic K, Charhon A, Broussolle C. Les carcinomes de primitif inconnu. Rev Med Interne 2006; 27:532-45. [PMID: 16545500 DOI: 10.1016/j.revmed.2006.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Accepted: 01/06/2006] [Indexed: 10/25/2022]
Abstract
PURPOSE Carcinoma of unknown primary site is a common clinical syndrome, accounting for 2% of cancer patients. Diagnosis is a recurrent challenge for internists. Treatment is difficult and prognosis is still poor. This review presents one synthesis of diagnosis strategies and therapeutic trials. It envisages the interest of new molecular biology methods as well as therapeutic perspectives. CURRENT KNOWLEDGE AND KEY POINTS Pathologic examination completed with immunohistochemical tests, and, depending on cases, with electron microscopy, cytogenetics, and molecular biology is a key-point for diagnosis. Diagnosis work-up, based on histological type and on individualization of some clinical presentation, proceeds in three steps. Positron emission tomography is recommended when a curative treatment is planed, particularly in cases of isolated metastasis. Functional status analysed using the performance status and simple biologic parameters (serum lactate dehydrogenase, serum alkaline phosphatase) permit us to assess prognosis. Chemotherapy is offered for patients with a good general health status. FUTURE PROSPECTS AND PROJECTS Further evaluation of positron emission tomography, as well as cost-benefit analyses, is warranted. Further randomised trials are necessary to determine the optimal chemotherapy regimen in good-risk patients and the interest of chemotherapy in patients with poor-risk disease. Gene expression profiling and proteomic evaluation, as well as pharmacogenomic offer new investigation fields.
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Affiliation(s)
- P Sève
- Service de médecine interne, Hôtel-Dieu, hospices civils de Lyon, 1, place de l'Hôpital, 69288 Lyon cedex 02, France.
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Affiliation(s)
- J A Spencer
- St James's University Hospital, Leeds LS9 7TF, UK
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Angiogenesis in cancer of unknown primary: clinicopathological study of CD34, VEGF and TSP-1. BMC Cancer 2005; 5:25. [PMID: 15743540 PMCID: PMC555600 DOI: 10.1186/1471-2407-5-25] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2004] [Accepted: 03/03/2005] [Indexed: 01/22/2023] Open
Abstract
Background Cancer of unknown primary remains a mallignancy of elusive biology and grim prognosis that lacks effective therapeutic options. We investigated angiogenesis in cancer of unknown primary to expand our knowledge on the biology of these tumors and identify potential therapeutic targets. Methods Paraffin embedded archival material from 81 patients diagnosed with CUP was used. Tumor histology was adenocarcinoma (77%), undifferentiated carcinoma (18%) and squamous cell carcinoma (5%). The tissue expression of CD34, VEGF and TSP-1 was assessed immunohistochemically by use of specific monoclonal antibodies and was analyzed against clinicopathological data. Results VEGF expression was detected in all cases and was strong in 83%. Stromal expression of TSP-1 was seen in 80% of cases and was strong in 20%. The expression of both proteins was not associated with any clinical or pathological parameters. Tumor MVD was higher in tumors classified as unfavorable compared to more favorable and was positively associated with VEGF and negatively with TSP-1. Conclusion Angiogenesis is very active and expression of VEGF is almost universal in cancers of unknown primary. These findings support the clinical investigation of VEGF targeted therapy in this clinical setting.
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Ghosh L, Dahut W, Kakar S, Posadas EM, Torres CG, Cancel-Santiago R, Ghosh BC. Management of patients with metastatic cancer of unknown primary. Curr Probl Surg 2005; 42:12-66. [PMID: 15711508 DOI: 10.1067/j.cpsurg.2004.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Luna Ghosh
- Pathology, State University of New York-Brooklyn, Brooklyn, NY, USA
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Abstract
OBJECTIVE The purpose of this study was to determine the CT appearance of serous surface papillary carcinoma of the ovary. MATERIALS AND METHODS CT scans of 17 patients with histologically proven serous surface papillary carcinoma of the ovary were retrospectively reviewed. We evaluated the ovary size, omental or mesenteric involvement (none, mild, or severe), ascites (none, small, moderate, or large), and peritoneal thickening (none, smooth, or nodular). We also noted the presence of a cul-de-sac mass, lymphadenopathy, and calcification within the peritoneal mass. The preoperative serum level of cancer antigen (CA)-125 was assessed in all patients. RESULTS The diameter of ovaries was 3 cm or smaller in 14 patients (82%). All patients had omental or mesenteric involvement by the tumor (mild, n = 2; severe, n = 15) and ascites (small, n = 1; moderate, n = 3; large, n = 13). Peritoneal thickening (smooth, n = 5; nodular, n = 10) was noted in 15 patients (88%) and a cul-de-sac mass in 10 (59%). Lymphadenopathy was noted in five patients (29%) and calcification within the peritoneal mass in one (6%). Serum CA-125 level was elevated in all patients (168-63,300 U/mL). CONCLUSION Serous surface papillary carcinoma of the ovary should be suggested as a diagnosis in patients who have peritoneal carcinomatosis, relatively normal-sized ovaries, and a highly elevated serum CA-125 level.
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Affiliation(s)
- Hye Jin Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea
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Khalifeh I, Munkarah AR, Lonardo F, Malone JM, Morris R, Lawrence WD, Ali-Fehmi R. Expression of Cox-2, CD34, Bcl-2, and p53 and survival in patients with primary peritoneal serous carcinoma and primary ovarian serous carcinoma. Int J Gynecol Pathol 2004; 23:162-9. [PMID: 15084845 DOI: 10.1097/00004347-200404000-00011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objective of this study was to compare the immunohistochemical profile and clinical course of primary peritoneal serous carcinoma (PPC) and primary ovarian serous carcinoma (OSC). These entities are virtually indistinguishable morphologically, but their differential molecular and clinical features are incompletely characterized. Twenty-nine cases of high-grade, high-stage PPC and 96 cases of stage matched OSCs were compared. PPC was identified based on the criteria proposed by the Gynecologic Oncology Group. The tumors were staged according to International Federation of Gynecology and Obstetrics criteria for ovarian cancer and graded according to World Health Organization criteria. Expression of Cox-2, CD-34, bcl-2, and p53 was compared in the two tumors and correlated with clinical data including stage, age, race, and overall survival. Although the median survival, using Kaplan-Meier test, of patients with OSC (1060 days, 35.3 months) was longer than those with PPC (708 days, 23.6 months) the difference was not statistically significant. However, Cox-2 expression was correlated with microvessel density in PPC (p=0.026) and OSC cases (p=0.005), and high expression of Cox-2 correlated with lower survival rate in OSC cases (p=0.045) but not in PPC cases (p=0.12). These findings, coupled with the morphologic overlap existing between OSC and PPC, support the view that they represent related pathologic entities.
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Affiliation(s)
- Ibrahim Khalifeh
- Departments of Pathology and Gynecology Oncology, Harper University Hospital and Wayne State University School of Medicine, Detroit, Michigan 48201, USA
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Mintzer DM, Warhol M, Martin AM, Greene G. Cancer of unknown primary: changing approaches. A multidisciplinary case presentation from the Joan Karnell cancer center of pennsylvania hospital. Oncologist 2004; 9:330-8. [PMID: 15169988 DOI: 10.1634/theoncologist.9-3-330] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cancer of unknown primary is a common clinical syndrome, accounting for 2%-5% of cancer patients. A representative case is presented. This heterogenous group of disorders includes entities such as poorly differentiated carcinoma of unknown primary, adenocarcinoma of unknown primary, neuroendocrine carcinoma of unknown primary, squamous cell carcinoma of unknown primary, poorly differentiated (not otherwise specified) cancer of unknown primary, and melanoma of unknown primary. It is crucial to identify those treatment-responsive presentations of unknown primary with the greatest potential for long-term survival. This discussion emphasizes newer approaches to the diagnosis and treatment of unknown primary cancer, including advances in pathology with immunoperoxidase and molecular genetic techniques, positron emission tomography, and published chemotherapeutic trials. With the increased sophistication of pathologic and radiologic techniques, the frequency of unknown primary cancers will likely continue to decline. Further, as newer and more targeted therapies for specific types of cancer are identified, the previously held nihilism regarding the search for and identification of the primary may become less supportable.
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Affiliation(s)
- David M Mintzer
- Joan Karnell Cancer Center, Pennsylvania Hospital, Philadelphia, Pennsylvania 19106, USA.
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Balaña C, Manzano JL, Moreno I, Cirauqui B, Abad A, Font A, Mate JL, Rosell R. A phase II study of cisplatin, etoposide and gemcitabine in an unfavourable group of patients with carcinoma of unknown primary site. Ann Oncol 2003; 14:1425-9. [PMID: 12954583 DOI: 10.1093/annonc/mdg361] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim of this phase II study was to determine toxicity, response rate, time to progression, and overall survival of cisplatin, etoposide and gemcitabine in patients with carcinoma of unknown primary tumour site. PATIENTS AND METHODS Thirty patients with no previous chemotherapy and not belonging to a treatable group were treated with cisplatin 70 mg/m(2) on day 1, etoposide 70 mg/m(2) on days 1 and 2, and gemcitabine 700 mg m(2) on days 1 and 8, administered every 3 weeks. Stable or responding patients received a maximum of eight cycles. Twenty patients (67%) had more than three affected sites, and 25 patients (84%) had adenocarcinomas. RESULTS Overall response rate was 36.6% (11 patients), including four complete responses (13.3%) and seven partial responses (23.3%), with a 95% confidence interval of 19.9-56. Median survival was 7.21 months and eight patients remained alive for >1 year. Myelosuppression was the most important toxicity, with grade 3-4 neutropenia in 18 patients (60%) in 32% of the cycles: eight patients had neutropenic fever and 10 patients had thrombopenia in 11% of cycles. No non-haematological grade 4 toxicity occurred. CONCLUSIONS Cisplatin, etoposide and gemcitabine is an active combination, inducing objective responses in a subset of heavily advanced disease patients with carcinoma of unknown primary site. The role of adding gemcitabine to cisplatin and etoposide remains to be resolved as to the best schedule to diminish toxicity for the three-drug combination.
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Affiliation(s)
- C Balaña
- Medical Oncology Service, Pathology Service, Hospital Germans Trias i Pujol, Barcelona, Spain.
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Abstract
Cancer from an unknown primary site (CUP) is frequently encountered in clinical practice. This review is designed to help physicians identify those patients with CUP that benefit from specific therapeutic approaches. The utility of pathologic and diagnostic tests in patients with CUP will also be discussed, as will the prognosis and appropriate treatment of these patients.
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Bloss JD, Brady MF, Liao SY, Rocereto T, Partridge EE, Clarke-Pearson DL. Extraovarian peritoneal serous papillary carcinoma: a phase II trial of cisplatin and cyclophosphamide with comparison to a cohort with papillary serous ovarian carcinoma-a Gynecologic Oncology Group Study. Gynecol Oncol 2003; 89:148-54. [PMID: 12694669 DOI: 10.1016/s0090-8258(03)00068-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The goals of this study were first, to assess the clinical effectiveness of cisplatin and cyclophosphamide in a phase II study involving a well-defined group of women with extraovarian peritoneal serous papillary carcinoma (EPSPC); and second, to compare these results with those of a group of patients with papillary serous ovarian carcinoma (PSOC) who received identical therapy. METHODS After primary surgery, patients were treated with cisplatin 75 mg/m(2) and cyclophosphamide 750 mg/m(2) every 21 days for six cycles. Patient demographics, tumor characteristics, clinical and surgical response to treatment, progression-free survival, and overall survival were evaluated. These patients were then compared with patients with PSOC who received identical treatment on a separate protocol. RESULTS Women with a diagnosis of tended to be older that those with EPSPC PSOC (median age: 65.8 years vs 60.3 years, P = 0.04). The estimated probability of clinical response (complete and partial) to the treatment regimen for EPSPC was 65% (95% confidence interval [CI]: 41-85%) compared with 59% (95% CI: 47-71%) for women with PSOC. Surgical complete responses were similar (20% vs 19%) in the two patient groups. Additionally, the death rates did not significantly differ between the two groups (hazard ratio: 1.25, 95% CI: 0.834-1.88). CONCLUSION Women with EPSPC and PSOC exhibit a similar probability of response to cisplatin and cyclophosphamide and a similar overall survival. Based on these findings and the fact that results of ovarian cancer trials are frequently extrapolated to patients with EPSPC, it is reasonable to include EPSPC patients in future large-scale treatment trials involving patients with advanced ovarian cancer.
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Affiliation(s)
- Jeffrey D Bloss
- Department of Obstetrics and Gynecology, Ellis Fischel Cancer Center, University of Missouri Health Sciences Center, Columbia, MO 65203, USA.
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Song SY, Kim WS, Lee HR, Jung HS, Oh SY, Kim JH, Kim K, Nam EM, Oh YR, Jung CW, Yoon SS, Im YH, Lee HG, Kang WK, Park CH, Park K. Adenocarcinoma of unknown primary site. Korean J Intern Med 2002; 17:234-9. [PMID: 12647637 PMCID: PMC4531687 DOI: 10.3904/kjim.2002.17.4.234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Metastatic cancer of unknown primary site occupies 0.5-10% of all diagnosed cancer patients and includes various tumors with diverse responses to systemic chemotherapy. Adenocarcinoma of unknown primary site (ACUPS), the most common subtype, has no standard treatment, rarely responds to conventional treatment and has a poor survival rate. METHODS The retrospective study was performed to investigate the clinical characteristics and the treatment outcomes of ACUPS. RESULTS Eighty-one patients with ACUPS diagnosed at Samsung Medical Center from May 1995 to July 1999 were included. The median age was 58 years (range, 29-77). The common sites of metastases were the lymph node, liver, lung and bone in order. In 49 of 81 patients (60.5%), the dominant tumor location was below the diaphragm. The majority of patients (76 of 81) were initially treated with systemic chemotherapy including cisplatin. Responses were evaluable in 70 of 76. Eighteen of 70 patients (25.7%) responded to chemotherapy and complete remission was observed in 6 patients. The overall median survival of 81 patients was 5.6 months. The median survival of the responding patients was 18.3 months but the median survival of the nonresponding patients was 4.6 months (p < 0.01). In univariate and multivariate analysis, age, performance status and response to initial chemotherapy were significant prognostic factors for overall survival. CONCLUSION We observed poor response to the treatment and survival rate in ACUPS, but complete remission and long-term survival were observed in a small number of patients.
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Affiliation(s)
- Seo Young Song
- Department of Internal Medicine, College of Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | | | | | | | | | | | | | | | - Young Ryun Oh
- Diagnostic Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | - Keunchil Park
- Address reprint requests to : Keunchil Park, M.D., Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea, E-mail :
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Losa Gaspà F, Germá JR, Albareda JM, Fernández-Ortega A, Sanjosé S, Fernández Trigo V. [Metastatic cáncer presentation. Validation of a diagnostic algorithm with 221 consecutive patients]. Rev Clin Esp 2002; 202:313-9. [PMID: 12093395 DOI: 10.1016/s0014-2565(02)71065-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The use of a diagnostic algorithm for metastatic cancer presentation (MCP) might enhance the diagnosis of primary tumors amenable to treatment with considerable savings both in time and diagnostic examinations. MATERIALS AND METHODS From January 1992 to April 1997, all patients admitted with the diagnosis of MCP were prospectively studied. From each patient, a basic study consisting in a clinical interview, complete physical examination, standard blood testing with tumoral markers and chest X-ray were obtained. Patients with a negative basic study were classified as having a metastatic cancer of unknown origin (MUO); in these patients, a protocolized study (abdominal CT scan and mammography among women) were performed. Patients who after the application of the basic and protocolized studies had no primary tumor detected underwent an exhaustive investigation in order to validate the efficiency of the diagnostic algorithm. RESULTS Two hundred twenty-one patients were included in the study. The mean age of patients was 63 years (range: 23-82). The main symptom was of bone (30%), neurological (24%), thoracic (16%) and abdominal (16%) origin. The basic study was positive for 138 patients (62.4%), with chest X-ray and physical examination yielding the highest number of diagnoses among these patients. The histology of metastases contributed to the definite diagnosis in 31 patients. Only PSA had a high sensitivity and specificity. Eighty-three patients were classified as MUO. The protocolized study diagnosed the primary tumor in 24 patients (30%), 20 by abdominal CT scan and four by mammography; eight of these patients were deemed to be amenable to treatment. The remaining 59 patients underwent an exhaustive study, and a diagnosis was made in 13; nevertheless, none of them was considered candidate for a specific treatment. Finally, 47 patients (21%) remained undiagnosed. The predominant primary tumors included sites at the lung (42%), prostate (6%) and breast (6%). The most common metastatic locations included bone (42%), central nervous system and liver (24%), and the most common histological types were adenocarcinoma (61%) and undifferentiated carcinoma (15%). CONCLUSIONS Lung cancer and MUO represented 62% of MCP. The basic study oriented in two thirds of cases, and the physical examination and chest X-ray showed the highest diagnostic yield. The histology of metastases and PSA had a key, diagnostic relevance. A protocolized study based on abdominal CT scan and mammography (females) can identify the remaining treatable tumors.
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Affiliation(s)
- F Losa Gaspà
- Servicio de Oncología Médica, Institut Català d'Oncologia (ICO), Hospital Duràn i Reynals, L'Hospitalet, Barcelona, Spain.
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Macdonald AG, Nicolson MC, Samuel LM, Hutcheon AW, Ahmed FY. A phase II study of mitomycin C, cisplatin and continuous infusion 5-fluorouracil (MCF) in the treatment of patients with carcinoma of unknown primary site. Br J Cancer 2002; 86:1238-42. [PMID: 11953879 PMCID: PMC2375343 DOI: 10.1038/sj.bjc.6600258] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2001] [Revised: 02/15/2002] [Accepted: 02/25/2002] [Indexed: 11/24/2022] Open
Abstract
Carcinoma of unknown primary site remains a common clinical diagnosis, accounting for between 5 and 10% of all cancer patients. Numerous combination chemotherapy regimens have been used in the management of carcinoma of unknown primary site, resulting in response rates of 0-48%. We present the results of a single centre phase II study of the use of the combination of mitomycin C (7 mg m(-2) on day 1 of cycles 1, 3 and 5) cisplatin (60 mg m(-2) on day 1) and continuous infusion 5-fluorouracil (300 mg m(-2) daily), MCF, delivered as a 21-day cycle, in patients with carcinoma of unknown primary site. Thirty-one patients with a diagnosis of carcinoma of unknown primary site were treated in Aberdeen Royal Infirmary between 1997 and 2001 with MCF. In total, 136 cycles of MCF were delivered (median of 5 cycles per patient). Toxicity was acceptable, with 19% grade 3 or 4 neutropenia, 16% grade 3 or 4 thrombocytopenia and 13% grade 3 or 4 nausea and vomiting. No cases of neutropenic sepsis were seen and there were no treatment-related deaths, however, six patients developed thrombotic complications. The overall response rate was 27% (CR 3%; PR 23%). Median time to progression was 3.4 months (95% CI 1.1-5.6 months) and median overall survival was 7.7 months (95% CI 5.7-9.8 months). Survival at 1 year was 28%, and at 2 years, 10%. MCF is a tolerable regimen with comparable toxicity, response rates and survival data to most platinum-based combination chemotherapy regimens in use for this devastating disease.
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Saad ED, Abbruzzese JL. Prognostic stratification in UPC: a role for assessing the value of conventional-dose and high-dose chemotherapy for unknown primary carcinoma. Crit Rev Oncol Hematol 2002; 41:205-11. [PMID: 11856596 DOI: 10.1016/s1040-8428(01)00157-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
High-dose chemotherapy has been advocated by some investigators as a means to circumvent drug resistance, thereby improving treatment results in patients with solid tumors. For patients with unknown primary tumors, this hypothesis has only recently undergone limited testing. Two groups (one from the USA and one from Europe) have published their experience with higher doses of chemotherapy in the treatment of UPC. The results are not superior to those reported by other investigators using more standard doses of chemotherapy. Most importantly, chemotherapy trials for UPC are usually conducted in small populations made up of heterogeneous patient subsets with varying sensitivity to chemotherapy. It seems likely that progress in the management of patients with unknown primary cancers will occur as a result of efforts to improve the understanding of the natural history of this disease coupled with the assessment of novel agents targeted against specific biochemical abnormalities that will be demonstrated to be important in the development and maintenance of these malignancies.
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Affiliation(s)
- Everardo D Saad
- Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
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Planteamiento diagnóstico y terapéutico frente al cáncer de presentación metastásica y origen desconocido. Rev Clin Esp 2002. [DOI: 10.1016/s0014-2565(02)71159-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Metastatic Malignancies of Unknown Primary: The Medical Oncologist???s Point of View. AJSP-REVIEWS AND REPORTS 2001. [DOI: 10.1097/00132583-200107000-00007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cost Analysis for Pathologic Evaluation of Metastatic Carcinoma of Unknown Origin. AJSP-REVIEWS AND REPORTS 2001. [DOI: 10.1097/00132583-200107000-00006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sumi H, Itoh K, Onozawa Y, Shigeoka Y, Kodama K, Ishizawa K, Fujii H, Minami H, Igarashi T, Sasaki Y. Treatable subsets in cancer of unknown primary origin. Jpn J Cancer Res 2001; 92:704-9. [PMID: 11429061 PMCID: PMC5926750 DOI: 10.1111/j.1349-7006.2001.tb01151.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The purpose of this study was to investigate the treatable subsets in cancer of unknown primary origin (CUP). Fifty patients (27 males and 23 females; median age, 53 years) with CUP diagnosed between April 1992 and June 1999 were analyzed retrospectively. Of the 50 patients, 39 received chemotherapy: platinum-based in 31, non-platinum-based in 4, and clinical trials of new agents in 4. Of the 39 patients, 13 (33.3%; 95% confidence interval: 19.1 - 50.2%) showed objective responses, with 4 complete responders. Patients with poorly differentiated carcinomas in whom beta-subunit of human chorionic gonadotropin (beta-HCG) was elevated more than 10 mIU / ml and female patients with peritoneal adenocarcinomatosis achieved high response rates (83.3% and 80%, respectively) with platinum-based chemotherapy, as compared with only a 15.3% response rate in the remaining patients. Platinum-based chemotherapy provided promising results in patients with poorly differentiated carcinomas and in female patients with peritoneal adenocarcinomatosis. Significantly elevated serum levels of beta-HCG in patients with poorly differentiated carcinoma might predict a better response to platinum-based chemotherapy. However, the investigation of novel chemotherapeutic approaches is warranted for other groups of patients with CUP.
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Affiliation(s)
- H Sumi
- Division of Oncology and Hematology, National Cancer Center Hospital East, 6-5-1 Kashiwa-noha, Kashiwa, Chiba 277-8577, Japan
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Saghatchian M, Fizazi K, Borel C, Ducreux M, Ruffié P, Le Chevalier T, Théodore C. Carcinoma of an unknown primary site: a chemotherapy strategy based on histological differentiation--results of a prospective study. Ann Oncol 2001; 12:535-40. [PMID: 11398889 DOI: 10.1023/a:1011129429499] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To evaluate the efficacy and toxicity of a chemotherapy strategy based on histological differentiation, for patients with carcinoma of unknown primary site. PATIENTS AND METHODS Forty-eight patients were prospectively included in the trial. Thirty patients with poorly-differentiated carcinoma or poorly-differentiated adenocarcinoma (group A) received a combination of cisplatin and etoposide. Patients with a responsive or stable disease after two cycles received the same regimen plus bleomycin, ifosfamide and G-CSF. Eighteen patients with well- or moderately-differentiated carcinoma (group B) received cisplatin, continuous infusion 5-fluorouracil (5-FU) and alpha-interferon. Treatment was maintained in case of response or stable disease for up to six cycles. RESULTS The overall response rate (RR) for the entire group is 43% (95% confidence interval (CI): 35.9%-50.1%): seven CR and five PR in group A (RR = 40%) and six CR and two PR in group B (RR = 44%). Grade 4 leucopenia was observed in 22 (46%) patients and sepsis in 3 (6%). Median survival is 9.4 months (range 5-13.7 months) and 16.1 months (range 11.8 20.3 months), respectively. CONCLUSIONS This chemotherapy strategy is one way to achieve high response rates, particularly for patients with well- or moderately-differentiated adenocarcinoma usually considered poorly chemosensitive.
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Briasoulis E, Kalofonos H, Bafaloukos D, Samantas E, Fountzilas G, Xiros N, Skarlos D, Christodoulou C, Kosmidis P, Pavlidis N. Carboplatin plus paclitaxel in unknown primary carcinoma: a phase II Hellenic Cooperative Oncology Group Study. J Clin Oncol 2000; 18:3101-7. [PMID: 10963638 DOI: 10.1200/jco.2000.18.17.3101] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the efficacy of the carboplatin/paclitaxel combination in patients with carcinoma of unknown primary site (CUP). PATIENTS AND METHODS Seventy-seven consecutive CUP patients (45 women and 32 men; median age, 60 years) were treated with carboplatin at target area under the curve 6 mg/mL/min followed by paclitaxel 200 mg/m(2) as a 3-hour infusion and granulocyte colony-stimulating factor from days 5 to 12. Treatment courses were repeated every 3 weeks to a maximum of eight cycles. Forty-seven patients had adenocarcinomas, 27 had undifferentiated carcinomas, and three had squamous cell carcinomas. Thirty-three patients presented with liver, bone, or multiple organ metastases, 23 with predominantly nodal/pleural disease, and 19 (16 women) with peritoneal carcinomatosis. RESULTS The overall response rate by intent-to-treat analysis was 38.7% (95% confidence interval, 27.5% to 49.9%). There were no differences in response between adenocarcinomas and undifferentiated carcinomas, but efficacy varied among clinical subsets. The response rates and median survival times in the three clinically defined subsets were 47.8% and 13 months, respectively, for patients with predominantly nodal/pleural disease, 68.4% and 15 months, respectively, in women with peritoneal carcinomatosis, and 15.1% and 10 months, respectively, in patients with visceral or disseminated metastases. Chemotherapy was well-tolerated. CONCLUSION Carboplatin plus paclitaxel combination chemotherapy is effective in patients with predominantly nodal/pleural metastases of unknown primary carcinoma and in women with peritoneal carcinomatosis. However, in patients with liver, bone, or multiple organ involvement, the combination offers limited benefit. The investigation of novel treatment approaches is highly warranted for this group of patients.
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Affiliation(s)
- E Briasoulis
- Departments of Medical Oncology, Ioannina University Hospital, Greece.
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Lofts FJ, Gogas H, Mansi JL. Management of adenocarcinoma of unknown primary with a 5-fluorouracil-cisplatin chemotherapy regimen (CFTam). Ann Oncol 1999; 10:1389-92. [PMID: 10631472 DOI: 10.1023/a:1008309204979] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Adenocarcinoma of unknown primary comprises up to 10% of metastatic malignant disease. With few exceptions this diagnosis carries a very poor prognosis of a few months with minimal survival advantage to chemotherapy. However there is the possibility that chemotherapy can improve symptom control and quality of life. PATIENTS AND METHODS Forty-four patients with adenocarcinoma of unknown primary received CFTam chemotherapy regimen (5-FU 750 mg/m2/day by protracted infusion for five days, cisplatin 60 mg/m2 once and tamoxifen 20 mg daily on a 21-day cycle). Disease response and toxicity were collected and survival compared to patients who were not treated or who received different chemotherapy regimens. RESULTS Overall response to CFTam was 27% with a median duration of 10 months (range 4-26 months). The chemotherapy was well tolerated with no grade 4 non-haematological toxicity and only three patients (7%) grade 4 neutropaenia with only two (5%) patients developing sepsis. There were no toxic deaths. Performance status was maintained or improved in responders. CONCLUSIONS CFTam is a well tolerated chemotherapy regimen with similar efficacy to other regimens described in the treatment of adenocarcinoma of unknown primary. In the absence of a significant survival advantage there is a need to conduct randomised trials of chemotherapy versus best supportive care to quantify any improvement in quality of life or symptom control.
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Affiliation(s)
- F J Lofts
- Medical Oncology Department, St. George's Hospital, London, UK.
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Chu CS, Menzin AW, Leonard DG, Rubin SC, Wheeler JE. Primary peritoneal carcinoma: a review of the literature. Obstet Gynecol Surv 1999; 54:323-35. [PMID: 10234697 DOI: 10.1097/00006254-199905000-00023] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- C S Chu
- Department of Obstetrics and Gynecology, University of Pennsylvania Medical Center, Philadelphia 19104, USA.
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Culine S, Gazagne L, Ychou M, Romieu G, Fabbro M, Cupissol D, Dubois JB. [Carcinoma of unknown primary site. Apropos of 100 patients treated at the Montpellier regional center of cancer prevention]. Rev Med Interne 1998; 19:713-9. [PMID: 9827443 DOI: 10.1016/s0248-8663(98)80706-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Carcinomas of unknown primary site are frequent neoplasms which raise diagnostic and therapeutic problems in clinical practice. METHODS Clinical records of 100 patients with carcinoma of unknown primary site whose clinical management took place at the Centre Regional de Lutte Contre le Cancer de Montpellier were retrospectively reviewed. Initial clinical and biological characteristics, pre-treatment evaluation, therapies and outcome were recorded. RESULTS Three main histological types were observed: adenocarcinoma (66 patients), poorly differentiated carcinoma (19 patients), epidermoid carcinoma (11 patients). Bone, lung, lymph nodes and liver were the most frequently involved metastatic sites. Analysis of the investigations aimed at identifying the primary site (none of which being positive) showed 68 different combinations in 100 patients. Anemia (< 100 g/L) was observed in 10 patients, while serum alkaline phosphatase was increased in 42 patients. Seven patients died before any therapy. Chemotherapy or radiotherapy was advocated in 70 and 59 patients, respectively. Thirty-six patients had concomitant chemoradiotherapy. Chemotherapy included a platinum derivative in 53 patients. The median number of cycles was four. Nine objective responses were observed, six of which occurred in patients who were receiving platinum-based chemotherapy. Ninety-six deaths were encountered, 95 due to the disease progress and one due to an intercurrent cause. The median survival was 9 months. Univariate analysis identified two prognostic factors: the number of metastatic sites and the serum alkaline phosphatase. CONCLUSIONS This retrospective study confirms the difficulties in the management of patients with carcinomas of unknown primary site. A literature review suggests limited diagnostic investigations in clinical practice with the aim of identifying tumors of potential prognostic (breast and ovary) or therapeutic (prostate) value. Apart from specific subgroups of patients for whom specific therapy is recommended, there is no current standard chemotherapy.
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Affiliation(s)
- S Culine
- Centre régional de lutte contre le cancer Val d'Aurelle, Parc Euromédecine, Montpellier, France
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Piura B, Meirovitz M, Bartfeld M, Yanai-Inbar I, Cohen Y. Peritoneal papillary serous carcinoma: study of 15 cases and comparison with stage III-IV ovarian papillary serous carcinoma. J Surg Oncol 1998; 68:173-8. [PMID: 9701210 DOI: 10.1002/(sici)1096-9098(199807)68:3<173::aid-jso8>3.0.co;2-2] [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: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Peritoneal papillary serous carcinoma (PPSC) is histologically and clinically similar to stage III-IV ovarian papillary serous carcinoma (OPSC). The purpose of this study was to investigate the clinical findings, treatment, and outcome of PPSC patients compared with stage III-IV OPSC patients. METHODS Data from the files of 15 PPSC patients and 52 stage III-IV OPSC patients who were managed at the Soroka Medical Center between January 1991 and December 1997 were evaluated. RESULTS With regard to patients' characteristics, presenting signs and symptoms, type and extent of surgery, tumor response to first-line chemotherapy, recurrence-free interval, recurrence site, tumor response to second-line chemotherapy, and serum CA-125 levels, no significant differences were observed between the PPSC patients and the stage III-IV OPSC controls. The prevailing presenting symptoms were abdominal mass and ascites. The mainstay of treatment was debulking surgery followed by adjuvant platinum-containing chemotherapy. The objective response rate to first-line chemotherapy was 80%. The actuarial 5-year survival rate for the PPSC patients and stage III-IV OPSC patients was 52.0% and 20.5%, respectively (0.05 < P < 0.1). CONCLUSIONS The clinical and surgical characteristics of patients with PPSC are similar to those of patients with stage III-IV OPSC. When treatment strategies for stage III-IV OPSC are applied to PPSC, the survival of PPSC patients may be similar or even better than that of stage III-IV OPSC patients.
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Affiliation(s)
- B Piura
- Department of Obstetrics and Gynecology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Rigg A, Cunningham D, Gore M, Hill M, O'Brien M, Nicolson M, Chang J, Watson M, Norman A, Hill A, Oates J, Moore H, Ross P. A phase I/II study of leucovorin, carboplatin and 5-fluorouracil (LCF) in patients with carcinoma of unknown primary site or advanced oesophagogastric/pancreatic adenocarcinomas. Br J Cancer 1997; 75:101-5. [PMID: 9000605 PMCID: PMC2222694 DOI: 10.1038/bjc.1997.16] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Carcinoma of unknown primary site (CUPS) accounts for 5-10% of all malignancies. Forty patients with metastatic CUPS or advanced oesophagogastric/pancreatic adenocarcinomas were recruited. Eligibility included ECOG performance status 0-2, minimum life expectancy of 3 months and measurable disease. The regimen consisted of bolus intravenous 5 fluorouracil (5-FU) and leucovorin (20 mg m-2) days 1-5 and carboplatin (AUC5) on day 3. The leucovorin/carboplatin/5-FU (LCF) was repeated every 4 weeks. The starting dose of 5-FU was 350 mg m-2 day-1 with escalation to 370 and then 400 mg m-2 day -1 after the toxicity at the previous level had been assessed. The maximum tolerated dose (MTD) was defined as the dosage of 5-FU that achieved 60% grade 3/4 toxicity. In addition, objective and symptomatic responses, quality of life and survival were assessed. The MTD of 5-FU in the LCF regimen was 370 mg m-2. The predominant toxicity was asymptomatic marrow toxicity. The 350 mg m-2 level was then expanded. There were two toxic deaths due to neutropenic sepsis, one at 370 mg m-2 after one course and one at 350 mg m-2 after four courses. The objective response rate was 25% with one complete response (CR) and nine partial responses (PRs). The median duration of response was 3.4 months (range 1-10). The CR and eight of the nine PRs were in CUPS patients. Twelve patients developed progressive disease on LCF. Median survival for all 40 patients was 7.8 months (10 months median survival for those treated at 350 mg m-2). The majority of patients described a symptomatic improvement with LCF chemotherapy. The recommended dose of 5-FU for future studies is 350 mg m-2 combined with leucovorin 20 mg m-2 and carboplatin (AUC5).
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Affiliation(s)
- A Rigg
- GI Unit, Cancer Research Campaign Section of Medicine, The Royal Marsden Hospital, Institute of Cancer Research, Sutton, Surrey, UK
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Farrugia DC, Norman AR, Nicolson MC, Gore M, Bolodeoku EO, Webb A, Cunningham D. Unknown primary carcinoma: randomised studies are needed to identify optimal treatments and their benefits. Eur J Cancer 1996; 32A:2256-61. [PMID: 9038607 DOI: 10.1016/s0959-8049(96)00264-x] [Citation(s) in RCA: 8] [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
This is a retrospective review of 101 patients with unknown primary carcinoma (UPC) treated between 1989 and 1994, on whom data were collected prospectively. 92 patients received platinum-based chemotherapy and 9 had single agent 5-fluorouracil (5-FU). In the platinum group, an objective response rate of 37.2% was seen, with a median duration of 4.5 months (range 1.9-17.5). There were no responses with 5-FU alone, while median survival was 6.4 months and was not different from the platinum group (P = 0.09). Considerable symptomatic resolution was noted, although the contribution of chemotherapy alone to this is difficult to define. The impact of tumour response on quality of life and survival in UPC requires further elucidation in prospective studies with a "best supportive care' arm. The superiority of platinum-based treatments reported in selected subgroups cannot be applied to the whole spectrum of UPC.
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Affiliation(s)
- D C Farrugia
- Section of Medicine, Royal Marsden Hospital, Sutton, Surrey, U.K
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Rodríguez E, Pombo F. Peritoneal tuberculosis versus peritoneal carcinomatosis: distinction based on CT findings. J Comput Assist Tomogr 1996; 20:269-72. [PMID: 8606235 DOI: 10.1097/00004728-199603000-00018] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the utility of CT in distinguishing peritoneal tuberculosis (PT) from peritoneal carcinomatosis (PC). MATERIALS AND METHODS CT scans were retrospectively reviewed in 19 patients known to have PT and compared with scans in 19 patients known to have PC. CT images were evaluated for thickening (smooth versus irregular), enhancement, presence of nodules, and site of involvement on the parietal peritoneum. The existence of omental caking, nodules, and smudged patterns in the omentum, mesentery, and gastrocolic ligament was noted. The presence, distribution, and loculation of ascites were also evaluated. RESULTS Ascites was present in all cases of PT and PC, loculated in 10 cases (PT = 4, PC = 6), and located in the greater peritoneal sac (PT = 15, PC = 10) or in the greater and lesser sacs (PT = 4, PC = 9). Slight smooth thickening and pronounced enhancement of the parietal peritoneum were seen in 15 of 19 PT patients and in 5 of 19 PC patients (p<0.001), whereas irregular thickening was found in only 9 of 19 PC patients (p <0.001). Peritoneal nodules were present exclusively in PC (7/19) (p <0.01). The sites of the parietal peritoneum involvement were the pelvic (PT = 9, PC = 3) (p <0.05), paracolic gutters (PT = 5, PC = 6), juxtadiaphragmatic (PT = 0, PC = 9) (p <0.001), and perihepatic (PT = 6, PC = 8) regions. Omental cakes were found in 4 of 19 PT and in 7 of 19 PC patients. The smudged pattern was the most common abnormality in the omentum (PT = 9/19, PC = 11/19), gastrocolic ligament (PT = 5/19, PC = 11/19) (p <0.01), and mesentery (PT = 7/19, PC = 11/19). Isolated and discrete well defined nodules were exclusively found in the mesentery (PT = 5/19, PC = 3/19). CONCLUSION The most useful CT findings for distinguishing PT from PC were observed in the parietal peritoneum. The presence of a smooth peritoneum with minimal thickening and pronounced enhancement suggests PT, whereas nodular implants and irregular peritoneal thickening suggest PC.
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Affiliation(s)
- E Rodríguez
- Department of Radiology, Hospital Juan Canalejo, La Coruña, Spain
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Della-Fiorentina SA, Jaworski RC, Crandon AJ, Harnett PR. Primary peritoneal carcinoma: a treatable subset of patients with adenocarcinoma of unknown primary. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1996; 66:124-5. [PMID: 8602811 DOI: 10.1111/j.1445-2197.1996.tb01133.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The syndrome of adenocarcinoma of unknown primary (ACUP) is a frequent problem in both medical and surgical practice. The prognosis is poor, the median lifespan being 4 months. In general, multiple invasive procedures aimed at determining the primary tumour are not warranted due to the low frequency of detecting a tumour for which adequate treatment exists. In this paper we wish to highlight a subset of female patients presenting with malignant ascites and no evidence of a pelvic mass, who on laparotomy were found to have primary peritoneal papillary serous adenocarcinoma. These tumours must be regarded as a potentially treatable subset of patients with ACUP in view of their frequent response to chemotherapy and relatively good prognosis.
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Abstract
Despite the fact that effective therapy does not currently exist for the majority of patients presenting with metastases of unknown primary site, the last decade has witnessed significant advances in the approach to this heterogeneous disease. The use of modern pathologic techniques that frequently provide better diagnostic precision and the recognition of specific subgroups with a favorable prognosis and responsiveness to treatment has improved the outcome for some patients. Currently the diagnostic strategy should emphasize the rapid identification of patients likely to benefit from available therapy, whereas clinical research should focus on the development of more effective treatments for those patients with unresponsive tumors. In the future, continued improvements in the molecular characterization of these tumors will likely enhance understanding of the metastatic process, allow for more specific definitions of cell lineage, and provide insights for better therapy.
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Affiliation(s)
- B C Lembersky
- Division of Medical Oncology, University of Pittsburgh School of Medicine, Pennsylvania, USA
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Gemer O, Segal S, Barak F. Papillary Serous Carcinoma of the Peritoneum. J OBSTET GYNAECOL 1995. [DOI: 10.3109/01443619509020697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pavlidis N, Kosmidis P, Skarlos D, Briassoulis E, Beer M, Theoharis D, Bafaloukos D, Maraveyas A, Fountzilas G. Subsets of tumors responsive to cisplatin or carboplatin combinations in patients with carcinoma of unknown primary site. A Hellenic Cooperative Oncology Group Study. Ann Oncol 1992; 3:631-4. [PMID: 1450045 DOI: 10.1093/oxfordjournals.annonc.a058290] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
In this retrospective analysis 48 patients with metastatic undifferentiated carcinoma, adenocarcinoma and epidermoid carcinoma of unknown origin were studied. The purpose of this analysis was to evaluate both the response rate and the toxicity of combination chemotherapy containing cisplatin or carboplatin, and to attempt to identify certain clinical subsets of patients sensitive to these drugs. Four patients were not evaluable and 13 (29.5%), eight of the 34 treated with regimens containing cisplatin and 5/14 with carboplatin-based chemotherapy, responded to treatment. Six of the 23 with undifferentiated tumours, 4/17 with adenocarcinomas and 3/8 with epidermoid cancers responded to chemotherapy. Four of 6 women with adenocarcinoma of the peritoneal cavity, 5/11 with undifferentiated carcinomas with midline distribution and 3/5 with epidermoid carcinomas of the cervical nodes responded. Seven patients achieved complete and six partial remissions. The mean duration of response was nine months; a number of patients enjoyed prolonged and/or durable remissions. Toxicity was tolerable. We conclude that: (a) both cisplatin and carboplatin are active agents in this syndrome with one-third of the evaluable patients responding, and (b) there may be chemosensitive subgroups, such as patients with peritoneal adenocarcinomatosis, undifferentiated carcinoma with midline distribution and metastatic epidermoid carcinoma of the neck nodes. The effectiveness of carboplatin in these patients and the responsiveness of metastatic epidermoid carcinoma of unknown origin have not been adequately dealt with in the literature.
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Affiliation(s)
- N Pavlidis
- Dept of Medicine, University of Ioannina, Greece
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