More on the women's health initiative.
Explore the source record for details and available documents.
Breast Neoplasms↗
Biomedical subjects
C D Runowicz
Publications and source records attributed to C D Runowicz.
Single-use percutaneous catheters for intraperitoneal P32 therapy.
BACKGROUND: Intraperitoneal (IP) radioactive chromic phosphate (P32) remains investigational in the treatment of patients with ovarian and/or endometrial cancer. Single-use percutaneously placed catheters offer the advantage of therapy without additional surgery. METHODS: Between August, 1986 and October, 1992, 25 patients underwent bedside percutaneous catheter placement under local anesthesia without ultrasonographic or radiologic guidance, using a specialized central venous catheter. RESULTS: Catheter insertion was successful in 22 of 25 patients (88%) with good IP distribution. Of these, 18 of 22 patients (82%) underwent successful catheter placement with one attempt and 4 of 22 (18%) after one to three additional attempts. The technical failure rate was 12%. Multiple catheter placement attempts were associated with an increased incidence of complications (r = 0.63). Bowel entry occurred in 4 of 25 patients (16%) during 5 of 43 attempts at catheter placement (12%) but was without clinical sequelae. The likelihood of bowel entry significantly increased with more than two attempts (P = 0.02). A median of 39 days (range, 7-156 days) elapsed between the preceding laparotomy and catheter insertion. CONCLUSIONS: Percutaneous catheter placement is successful and well tolerated in the majority of patients and should be considered for patients receiving IP P32.
Adult↗
Early detection of abdominal pregnancy by maternal serum AFP+ screening.
Explore the source record for details and available documents.
Adult↗
Lipid-soluble antioxidants: beta-carotene and alpha-tocopherol levels in breast and gynecologic cancers.
Free radical-induced damage is etiologically implicated in many chronic diseases including cancer. Epidemiologic data suggest an association between increased dietary intake of nutrients that are high in antioxidant vitamins and protection against the incidence of some human cancers. The purpose of this study was (a) to determine whether specific tissue antioxidants (beta-carotene and alpha-tocopherol) and any differences in their levels were measurable in randomly selected human breast and gynecologic malignant neoplasms and nonneoplastic tissue samples obtained from the same patient and (b) to establish normal ranges of these two antioxidant levels in human female reproductive tract tissues. Tissue samples were excised immediately from surgical specimens and released by staff pathologists from a spectrum of human female cancers. Neoplastic and adjacent nonneoplastic tissues samples were obtained from the same patient. Normal reproductive tract tissue samples were obtained from women undergoing hysterectomy for benign gynecologic conditions. Breast carcinoma and adjacent nonmalignant tissue specimens were obtained from women undergoing mastectomy. The concentrations of beta-carotene and alpha-tocopherol were measured by high-pressure liquid chromatography. In the same patient, beta-carotene levels were significantly lower in the cervical (P < 0.01) and endometrial (P < 0.005) carcinoma tissues than the levels detectable in adjacent nonneoplastic sites. In contrast, beta-carotene levels were higher in the ovarian (P < 0.05), breast (P < 0.005), and vulva (P < 0.05) carcinoma tissues. The alpha-tocopherol concentrations were significantly higher in the cancer tissues of cervix (P < 0.01) and endometrium (P < 0.001) than those in adjacent noninvolved tissue sites. The tissue concentrations of alpha-tocopherol in malignant and adjacent normal sites in breast, ovary, and vulva were comparable. For the first time, the ranges for beta-carotene and alpha-tocopherol levels in the normal female reproductive tract tissues were also established. The present findings of contrasting tissue levels of the antioxidants (beta-carotene and alpha-tocopherol) in breast, cervix, endometrium, ovary, and vulva cancers and in nonneoplastic tissues of the same patient suggest an organ-specific and heterogenous distribution. These antioxidants appear to be essential nutritional requirements of the human female reproductive tract and breast and are implicated in the pathophysiology and carcinogenesis of these human organs. The findings require further study of the role of these antioxidant nutrients in epithelial cell proliferation, maturation, and differentiation.
Antioxidants↗
Cecal cancer in a teenager presenting with a pelvic mass: a case report and review of the literature.
Colorectal cancer generally affects men and women in the later decades of life. Typically patients present with bowel obstruction and/or chronic anemia. The epidemiology, presentation, and prognosis of cecal carcinoma, the third most common colorectal cancer, is similar to other cancers of the large bowel. Cecal and other colorectal cancers rarely present in adolescence. In this case report, we describe a 19-year-old woman presenting with a pelvic mass and elevated tumor markers with the presumed diagnosis of ovarian cancer, who was found to have cecal carcinoma at laparotomy. This case illustrates that colorectal cancer, although rare, should be considered in the differential diagnosis of a pelvic mass in young women who present with anemia, constitutional symptoms, and elevated tumor markers.
Adult↗
Clinical impact of chemotherapy-induced thrombocytopenia in patients with gynecologic cancer.
PURPOSE AND METHODS: This retrospective analysis of 501 patients with gynecologic cancer treated with chemotherapy evaluates the relationship between platelet count and clinical bleeding, as well as the clinical effects of platelet transfusion therapy. Thrombocytopenic patients were divided into six groups according to platelet counts, and major or minor bleeding manifestations were documented. Thrombocytopenia was defined as a platelet count less than 100,000/microL. RESULTS: Thrombocytopenia occurred in 182 (36.3%) patients over 808 of 1,546 chemotherapy cycles (52%). No intracranial or life-threatening bleeding occurred in any patient. The majority of patients (139 [76.4%]) had no clinical bleeding. Minor bleeding, such as purpura, occurred in 34 patients (18.7%) and 44 cycles (5.4%). Major bleeding occurred in nine patients (4.9%) and 10 cycles (1.3%). Five major bleeding events occurred in 49 patients with platelet counts between 0 and 10,000/microL. Forty-three of these patients received platelet transfusions. Thirty-eight of 43 transfused patients (88.3%) had no bleeding. Of the remaining five patients, two were transfused prophylactically with no effect. Three major bleeding events occurred in patients with platelet counts that ranged from 11,000 to 20,000/microL, but these were due to chronic instrumentation or trauma. In patients with platelet counts more than 20,000/microL, major bleeding occurred only from necrotic metastatic lesions. Random-donor platelet transfusions provided inconsistent increments in platelet counts. Overall, 27.5% of patients achieved the expected increase in platelet number based on units of platelet concentrate transfused. The use of single-donor or human leukocyte antigen (HLA)-matched platelets did not provide greater increments in those patients who were refractory to random-donor platelets. CONCLUSION: Platelet counts > or = 10,000/microL are not associated with spontaneous major bleeding. Prophylactic platelet transfusions in patients with gynecologic malignancies and chemotherapy-induced thrombocytopenia should be limited to those with platelet counts < or = 10,000/microL, provided they are not bleeding and have no major anatomic or pathophysiologic precursors of bleeding.
Antineoplastic Agents↗
Dose escalation combination carboplatin/cyclophosphamide chemotherapy for epithelial ovarian cancer.
Dose intensification chemotherapy is currently under investigation in ovarian cancer. In order to establish an optimum dose for future colony stimulating factor trials, 16 patients with ovarian cancer were treated with dose-escalation combination carboplatin plus cyclophosphamide chemotherapy without growth factors. The initial carboplatin dose, 300 mg/m2, was increased to a maximum dose of 400 mg/m2. The initial cyclophosphamide dose, 600 mg/m2, was increased to a maximum dose of 1200 mg/m2. Of 10 patients completing 6 cycles, six patients (60%) were escalated to carboplatin 400 mg/m2 and cyclophosphamide 600-1200 mg/m2. Myelosuppression was severe, with all 6 patients requiring platelet and/or packed red blood cell transfusions. Based on these results, carboplatin 400 mg/m2 with cyclophosphamide 600 mg/m2 was selected as the starting dose with hematopoietic growth factors.
Adult↗
Taxol in ovarian cancer.
Taxol is a structurally complex natural plant product with a novel mechanism of action. The supply of this drug is limited by its low abundance in the bark of the slow-growing yew tree from which it is extracted. The chemical complexity of taxol has hampered the development of a feasible process to synthesize large quantities. Analogues are being made from a precursor found in the needles of the yew tree. However, there is a need to develop a more efficient method to provide adequate supplies of this drug. This review article summarizes the preclinical and clinical studies of taxol in ovarian cancer. Phase I studies have identified the drug's toxicities. Neutropenia has been the dose-limiting toxicity in most trials, and premedications and longer infusion schedules have been used to reduce the incidence and severity of hypersensitivity reactions. The intraperitoneal administration of taxol in Phase I studies showed a pharmacologic advantage with acceptable toxicity. Its activity in ovarian cancer was noticed first in Phase I trials at the Albert Einstein College of Medicine and Johns Hopkins University. These observations led to Phase II testing, which documented response rates of 20-35% in patients with relapsed or refractory ovarian cancer. Phase III trials of taxol and cisplatin versus cyclophosphamide and cisplatin in untreated patients with ovarian cancer are in progress. Studies combining taxol with colony-stimulating factors and cisplatin are ongoing. Taxol is an important new drug in ovarian cancer. Its unique mechanism of action and toxicities make it an attractive agent to use in combination with currently active drugs. Future studies will determine the role of taxol in the management of this disease, but the widespread availability of this drug will depend on the development of a feasible synthetic process.
Antineoplastic Agents, Phytogenic↗
Platinum chemotherapy during pregnancy for serous cystadenocarcinoma of the ovary.
Ovarian carcinoma in pregnancy remains a rare event. Although concern regarding the gestation complicates therapy, platinum drug-based combination chemotherapy is often deemed warranted in such cases. We report the antepartum use of cisplatin, followed by carboplatin, for an ovarian serous cystadenocarcinoma. During this treatment, serial sonographic assessment of fetal morphometric parameters and biophysical profiles with fetal heart rate monitoring were performed to document fetal well being. Platinum-DNA adducts were measured in maternal blood, placenta, fetal amniotic cells, and cord blood. This report represents an attempt to define platinum drug transfer in utero and fetal growth and development during therapy and to document the first use of carboplatin in pregnancy.
Adult↗
To P32 or not to P32, that is the question.
Explore the source record for details and available documents.
Female↗
Cancer screening for women older than 40 years of age.
As women's doctors, we have a commitment and responsibility to promote effective cancer screening for cervical cancer and breast cancer. At present, the screening tests for ovarian cancer cannot be applied to the mass population. For an individual patient, however, the role of sonography, tumor markers, and physical examination need to be individualized. Clinicians need to look to the future for advances in screening for this dreaded disease. This article reviews and discusses the available cancer screening for cervical, breast, and ovarian cancer.
Adult↗
Multimodality therapy in locally advanced cervical cancer.
In the past decade, neoadjuvant and concomitant multimodality therapies have been studied in patients with cervical cancer. The past year has witnessed more pilot studies confirming the feasibility of multimodality therapy. It is now time to move to prospective randomized clinical trials to determine the effects on disease-free intervals, to examine survival rates, and to define the ideal chemotherapeutic regimen and relationship to radiation therapy or surgery.
Chemotherapy, Adjuvant↗
Ovarian carcinoma of low malignant potential, infertility, and induction of ovulation--is there a link?
Three cases of ovarian carcinoma of low malignant potential associated with infertility and ovulation induction are reported. The natural history of ovarian epithelial tumors is possibly being interrupted with earlier intervention and diagnosis in patients who may have presented 10 to 15 years later with disseminated ovarian carcinoma.
Adult↗
Lymph node sampling in patients with epithelial ovarian carcinoma.
Lymph node sampling is part of the FIGO staging of patients with ovarian carcinoma and is usually part of a meticulous second look operation. We analyzed the primary lymph node status of patients and compared this to the lymph node status at second look operation. From 3/86-3/91, 97 patients with epithelial ovarian tumors were treated at this institution. Seventy-one of the 97 patients (73.2%) had lymph node sampling at primary surgery. Thirty of the 71 patients had positive lymph nodes (42.2%) and 41 patients were lymph node negative (57.8%). Of the initial 97 patients, 58 were eligible for second look operation (59.8%), and 48 of these patients had lymph nodes sampled at second look operation. Nine of the 48 patients had positive lymph nodes (18.7%) and 39 had negative lymph nodes at second look operation (81.3%). Of the patients with negative lymph nodes at primary surgery, 25 patients had second look operation and 24 of these patients had lymph node sampling at second look operation. All patients with negative lymph nodes at primary surgery had negative lymph nodes at second look operation. Of the 30 patients with positive lymph nodes at primary surgery, 12 underwent second look operation. Four patients had persistent positive lymph nodes and 8 patients had negative lymph nodes. Our data suggest that patients with negative lymph nodes at primary surgery are unlikely to have positive lymph nodes at second look operation. Therefore, we believe that lymph node sampling under these circumstances is unnecessary.
Adolescent↗
Phase II study and long-term follow-up of patients treated with taxol for advanced ovarian adenocarcinoma.
PURPOSE: Based on the results of our phase I study that demonstrated the antitumor activity of taxol in a previously treated patient with ovarian cancer, a phase II study was conducted to evaluate the efficacy of taxol in patients with metastatic ovarian cancer and to evaluate further the toxicity of taxol in this group of patients. PATIENTS AND METHODS: Thirty-four patients with metastatic ovarian cancer received taxol (180 to 250 mg/m2) as a 24-hour continuous infusion. A premedication regimen was used to reduce the likelihood of an acute hypersensitivity reaction. RESULTS: Six of 30 assessable patients demonstrated complete responses (one patient) or partial responses (five patients; 20%; 95% confidence interval [CI], 6% to 34%; range, 2 to 30 months). Additionally, one patient had a less than partial objective response (2 months), and two patients had stable disease for 6 and 15 months. Those responders had a median survival of 27 months, and the nonresponders had a median survival of 6 months (P = .0001). Myelosuppression was the most significant toxicity. Other adverse effects included alopecia and peripheral neuropathy. CONCLUSION: Taxol has significant activity in ovarian cancer and should be studied in combination with other active agents earlier in this disease.
Adenocarcinoma↗
CA-125: a potential prognostic indicator in patients with cervical cancer?
We evaluated 104 patients with newly diagnosed carcinoma of the cervix. Pre- and post-therapy and follow-up CA-125 levels were measured in 64 patients. Fifty-five patients (86%) had squamous cell carcinoma and 9 (14%) had adenocarcinoma of the cervix. At initial presentation 19 (30%) had CA-125 levels greater than 35 U/ml, 12 (19%) had levels of 16-35 U/ml, and 33 (51%) had levels less than 16 U/ml. Of the 11 patients who had pre- and post-treatment levels greater than 35 U/ml, 10 are dead of the disease and 1 is alive with persistent or recurrent disease. Of the 20 patients with elevated CA-125 levels at presentation who reverted to normal after therapy, 19 are clinically without evidence of disease at 14-46 months (median 27 months). Of the 33 patients with normal pre- and post-therapy CA-125 levels, 31 are clinically without evidence of disease. Two of these thirty-three patients had increasing CA-125 levels during routine follow-up and both have disease recurrence confirmed. There was no apparent correlation between CA-125 level and tumor type, tumor grade, or stage of disease. Our data suggest that patients with initially elevated CA-125 levels that revert to normal after therapy have a favorable prognosis. Persistent elevation of CA-125 levels during and after therapy in patients with carcinoma of the cervix was associated with a poor prognosis.
Adenocarcinoma↗
Adjuvant therapy for neuroendocrine small cell carcinoma of the cervix: review of the literature.
Neuroendocrine cell carcinoma of the cervix is a virulent tumor associated with an extremely poor prognosis. Even in clinical Stage I disease, there may be subclinical hematogenous and lymphatic metastases with frequent recurrences. Adjuvant postoperative external pelvic radiotherapy has been reported to offer some degree of local control; however, most patients succumb to distant disease. Following radical abdominal hysterectomy and pelvic lymphadenectomy, with confirmation of the neuroendocrine tumor by electron microscopy and immunohistochemical staining, two patients were given adjuvant systemic chemotherapy with concurrent pelvic radiotherapy, employing regimens with documented activity against small cell carcinoma of the lung of neuroendocrine origin. Despite severe myelotoxicity and persistent neuropathy, both patients are alive without clinical evidence of disease at 28+ and 47+ months.
Adult↗
Heterogeneity in hormone receptor status in primary and metastatic endometrial cancer.
The rationale for endocrine therapy in patients with advanced endometrial carcinoma may be based on the presence of estrogen or progesterone receptors in the primary tumor. A study was designed to evaluate tumor cell heterogeneity of steroid hormone receptors in the primary and metastatic sites in endometrial cancer. Primary endometrial cancer tissue samples from 10 patients and 16 metastatic tumor sites were simultaneously analyzed for estrogen and progesterone receptors, using a radioligand biochemical assay. The primary tumor was estrogen receptor (ER) and progesterone receptor (PR) positive in 70 and 60% of the patients, respectively. The metastatic sites were ER positive in 63% and PR positive in 25%. The primary tumor tissue and the metastatic disease showed an identical ER and PR status in only 25 and 19%, respectively. Four patients had multiple metastatic sites analyzed. In two of four patients the PR values, and in three of four patients the ER values, in these metastatic sites were discordant. These data support the concept of tumor cell heterogeneity for steroid hormone receptors in endometrial cancer. To optimize treatment planning, it may be important to biopsy primary, metastatic, and recurrent tumor sites for individual analysis of receptor activity.
Adenocarcinoma↗