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Biomedical subjects

C L Edwards

Publications and source records attributed to C L Edwards.

At least 73 records · Page 4Linked to original sources
PubMed1996

Leuprolide acetate for treating refractory or persistent ovarian granulosa cell tumor.

OBJECTIVE: To evaluate leuprolide acetate for treating refractory or persistent ovarian granulosa cell tumor (GCT). STUDY DESIGN: We treated six patients who had recurrent or persistent ovarian GCT with monthly intramuscular injections of a depot formulation of leuprolide acetate, 7.5 mg. Four patients had received prior cisplatin-based chemotherapy. Initially these patients' tumors had responded to the cisplatin, but then the disease had progressed in all cases. One of these four patients also had received prior therapy with tamoxifen that had resulted in three months of stable disease. Two patients had received no prior chemotherapy. RESULTS: Responses could be evaluated in five of the six patients; in the sixth patient, only survival was evaluable. Among the five evaluable patients, two achieved partial responses lasting 3 and 11 months, with disease progression-free intervals of 4 and 12 months. The other three patients (60%; 95% confidence interval [CI], 20-95%), including two whose disease had progressed on chemotherapy, had stable disease with disease progression-free intervals of 3+, 3+ and 13+ months. The objective response rate was 40% (two of five patients; 95% CI, 10-90%). Cessation of disease progression was noted in all five of the evaluable patients (100%; 95% CI, 40-100%). The sixth patient, whose disease could not be evaluated, was treated with leuprolide acetate for 24 months and at this writing had no clinical evidence of disease. The therapy was convenient to administer, and no major side effects were noted. Leuprolide acetate thus appears to have activity in patients with refractory GCT, and it may prolong the disease progression-free interval. Further trials of this relatively nontoxic and convenient therapy are warranted.

Adult↗
PubMed1996

Two synchronous primary tumors of the ovary and kidney: a case report.

Multiple malignancies in the same patient account for 1.84% to 3.9% of all cancers. However, multiple synchronous primary tumors in the same patient are extremely rare. Most synchronous double primary cancers are seen in both the genitourinary and gastrointestinal tracts. Synchronous double primary tumors involving kidney and ovary have been reported once in the Japanese literature; however, there are no reported cases in the English literature. This 66-year-old woman underwent radical nephrectomy for her renal cancer and optimal tumor-reductive surgery for her ovarian cancer. She was started on carboplatin and cyclophosphamide therapy for her residual ovarian cancer. On follow-up after 8 months, the patient is alive and well with no evidence of disease. In this report we present the first case in the English language literature of synchronous primary cancers in the right ovary and right kidney.

Carcinoma, Renal Cell↗
PubMed1996

Prolonged stabilization of progressive platinum-refractory ovarian cancer with paclitaxel: brief report.

Platinum-based chemotherapy is the standard treatment for ovarian cancer, with response rates of 70-80% and pathologic complete remissions of 20-25%. Salvage therapy with paclitaxel has an established role in patients with platinum-refractory ovarian cancer. In non-randomized trials, high doses have tended to be more effective. In this report, we describe two patients with platinum-refractory ovarian cancer who received paclitaxel and had long-term stabilization of their disease. One patient received 250 mg/m2 paclitaxel for 38 cycles; the other 135 mg/m2 for 30 cycles. Both patients received granulocyte colony-stimulating factor (G-CSF) support to prevent severe granulocytopenia; neither experienced cumulative hematopoietic nor neurologic toxicity. Their quality of life was good throughout the treatment.

Adult↗
PubMed1996

Unusual presentation of a metastatic choriocarcinoma following a full term pregnancy: a case report.

Choriocarcinoma most commonly follows a molar pregnancy, but it may develop after any gestational event. If choriocarcinoma follows a term pregnancy, it is associated with an unfavorable outcome and a 60% survival rate. A 33 year female who had delivered a normal girl 4 months before, presented with a nodule on the scalp behind the right ear. The pathologic diagnosis was compatible with metastatic choriocarcinoma. This tumor did not respond to chemotherapy, and she died a year later of multiple liver and pulmonary metastases. The development of a choriocarcinoma following a full term pregnancy is associated with a poor prognosis. We suggest that patients who do not achieve a clinical or serological remission after EMA-CO treatment be considered for high dose chemotherapy such as transplant.

Adult↗
PubMed1996

Sarcoma botryoides of the uterine endocervix: long-term results of conservative surgery.

Sarcoma botryoides, a variant of embryonal rhabdomyosarcoma, is the most common neoplasm of the lower genital tract in girls under 16 years of age. This neoplasm more frequently has a vaginal location in patients younger than 4 years, whereas a cervical location has its peak incidence in the second decade. Although the recommended therapy has been radical surgery alone or combined with other modalities, the use of neoadjuvant chemotherapy has changed the surgical approach to one employing a less radical procedure such as a simple hysterectomy or local excision. We present the case of a 12-year-old girl diagnosed with an embryonal rhabdomyosarcoma of the endocervix who received vincristine-Adriamycin-cyclophosphamide combination chemotherapy followed by a simple hysterectomy. The patient exhibits no evidence of disease 8 years after the initial diagnosis.

Adult↗
PubMed1996

Remission of recurrent mixed germ cell tumor of the ovary after treatment with vincristine, carboplatin, fluorouracil, and ifosfamide: a case report and review of the literature.

Mixed germ cell tumors represent about 8% of all malignant germ cell tumors of the ovary. Although there is much information in the literature on primary therapy for malignant ovarian germ cell tumors, little has been reported on salvage therapy for such tumors when they are recurrent. Based on reports of studies in testicular cancer, the preferred salvage therapy is a combination of etoposide, vinblastine, ifosfamide, and cisplatin. We describe here the case of a patient who received the combination of vincristine, carboplatin, fluorouracil, and ifosfamide as salvage therapy for recurrent malignant mixed germ cell tumor, to our knowledge this is the first report of such case treated with this combination. She has been in remission for 6 years.

Adult↗
PubMed1996

Characteristics of patients with vulvar cancer: an analysis of 94 patients.

Vulvar cancer is uncommon, accounting for 3 to 5% of all female genital cancers. Because this cancer is so rare, not much is known about the characteristics of this patient group. The purpose of this study was to determine these characteristics in a group of 94 women with vulvar cancer. We retrospectively analyzed the condition associated with vulvar cancer in 94 women who were treated with surgery and irradiation or irradiation alone. In these patients, hypertension (found in 40% of patients) was the most prevalent conditions associated with vulvar cancer. Our results confirm those of previous studies; chronic dermatologic diseases, chronic metabolic diseases such as cardiovascular illnesses, hypertension, diabetes, and smoking are the most frequent medical conditions found in this patient group.

Adenocarcinoma↗
PubMed1996

Transcatheter arterial embolization for the control of life-threatening pelvic hemorrhage in a patient with locally advanced cervix carcinoma.

A woman with a refractory locally advanced recurrent cervical cancer was brought to the emergency room because of a life-threatening vaginal hemorrhage from the tumor. She presented with a compromised hemodynamic status that necessitated multiple blood transfusions and large volume of fluid resuscitation. An arteriogram revealed the site of bleeding from the uterine branch of the right internal iliac artery. The branches of anterior and posterior internal iliac artery were embolized with Gelfoam, Ivalon and coils. This emobolization successfully controlled the bleeding and stabilized the hemodynamic status of the patient. The treatment options in patients with massive pelvic hemorrhage are reviewed and discussed.

Angiography↗
PubMed1996

Remission of recurrent cervical cancer with paclitaxel and carboplatin: a case report and review of literature.

We report the case of a patient with recurrent squamous cell carcinoma of the cervix, that metastasized to the paraaortic and supraclavicular lymph nodes and the lungs after primary radiotherapy for stage IIB. The tumor was refractory to multiple drug regimens. A combination of paclitaxel (135 mg/m2 intravenous infusion over 24) hours and carboplatin with a target area under the curve of 7.5 mg-min/mL were then administered and repeated every 4 weeks. The patient tolerated the chemotherapy well with myeloprotection from granulocyte colony-stimulating factor and the disease went into remission. Thus, the combination of paclitaxel and carboplatin may have antitumor activity in advanced or recurrent squamous cell carcinoma of the cervix.

Adult↗
PubMed1996

Phase II study of docetaxel in patients with epithelial ovarian carcinoma refractory to platinum.

We analyzed the efficacy and toxicity of docetaxel in patients with ovarian cancer who failed previous chemotherapy with platinum. Fifty-five patients with measurable ovarian cancer were entered in this Phase II study at The University of Texas M. D. Anderson Cancer Center. Treatment consisted of 100 mg/m2 docetaxel given i.v. every 3 weeks. Because of hypersensitivity reactions, premedication with steroids and antihistamine was initiated during the study. Twenty-two (40%) patients responded (there were 3 complete responders and 19 partial responders). Twenty-one (38%) patients had stable disease. The median survival was 10 months. The main toxicity was neutropenia (98% of patients), with 13 episodes of neutropenic fever. Cumulative fluid retention was the main reason for dose modification and required a combination of diuretics and steroids for palliation. Other side effects were alopecia (100%); anemia (87%); dermatitis (67%); gastrointestinal disorders (53%); stomatitis (49%); neurotoxicity (45%); excessive lacrimation (33%); and hypersensitivity reactions (11%), which in one case were life threatening (loss of consciousness, fluid resuscitation). Docetaxel as a single agent proved to be active in heavily pretreated ovarian cancer patients but is associated with significant side effects. Objective toxicity consisted mainly of neutropenia and fluid retention. Neutropenia was dose limiting and required therapy with granulocyte colony-stimulating factor. Fluid retention was improved but not eliminated by diuretics and corticosteroids. Additional studies of docetaxel in ovarian carcinoma are indicated to define the activity in relation to paclitaxel and in platinum combination therapy.

Adult↗
PubMed1996

Activity of paclitaxel in advanced or recurrent squamous cell cancer of the cervix.

Twenty-six patients with squamous cell cancer of the cervix were treated with i.v. paclitaxel, 250 mg/m2 over 3 h every 21 days. They received steroid, H1 and H2 blocker premedications, and granulocyte-colony-stimulating factor (G-CSF) support (5 microgram/kg/day). No prior chemotherapy, except as a radiation sensitizer, was allowed. The median age was 50 (range, 36-81) years, and performance status Zubrod was 1 (range, 0-2). Eight (33%) patients had prior surgery, and 22 (92%) had prior radiation therapy. Twenty-four patients were evaluable for response; 2 were later found to be ineligible. Five patients had partial responses (21%; 95% confidence interval, 6-40%), and 14 (58%; 95% confidence interval, 35-78%) had stable disease. The median duration of response was 10 (range, 3-27+) weeks. The responses were within the radiation port (four responses) and outside of it (one response). The median interval from the start of irradiation to the start of paclitaxel in responding patients was 94 weeks, whereas in patients with stable disease it was 68 weeks, and in patients whose disease progressed it was 46 weeks. Eighty-eight percent of the 105 cycles of paclitaxel were administered at a dose of 250 mg/m2 or higher. Granulocytopenia was brief and noncumulative, with grades 3 and 4 experienced by 5 and 3 patients, respectively. G-CSF was used for a median of 7 (range, 2-14) days/cycle. Anemia was mild, with G3 noted in 3 patients, and thrombocytopenia was not significant. Infections and musculoskeletal pain were mild and infrequent. Sensory (14 patients G1 or G2 and 2 patients G3) and motor (4 patients G1 or G2 and 1 patient G3) neurotoxicity was noted. There was no significant cardiovascular toxicity. Paclitaxel is active in patients with squamous cell cancer of the cervix and is well tolerated at this dose schedule with G-CSF support.

Adult↗
PubMed1995

A trial of lobaplatin (D-19466) in platinum-resistant ovarian cancer.

Long-term survival in epithelial ovarian cancer remains problematic despite multimodality therapy. A fundamental difficulty is the development of tumor resistance to platinum compounds. Analogs have been developed that demonstrate activity in platinum-resistant cell lines both in vitro and in vivo. Lobaplatin (D-19466), a third-generation compound, demonstrates significant activity in carboplatin and cisplatin-resistant cell lines. Lobaplatin was given to 17 assessable patients with platinum-refractory ovarian cancer. The drug was initially administered at a dose of 50 mg/m2 but was later reduced to 40 mg/m2 because of excessive thrombocytopenia. Nine patients required red cell transfusions during therapy. Cycles were repeated every 21-35 days (median cycle length 28 days). No objective responses were observed. Lobaplatin has no activity in platinum-resistant epithelial ovarian cancer.

Adult↗
PubMed1995

Prolonged oral etoposide for refractory advanced uterine leiomyosarcoma.

The case of a patient with a uterine leiomyosarcoma (LMS) that rapidly recurred in the pelvis following primary surgery is reported. The tumor was refractory to conventional multiagent chemotherapy that included intravenously administered etoposide (VP-16). Etoposide was then administered orally in a prolonged schedule; this resulted in a sustained partial response with palliation of symptoms. Thus, prolonged oral administration of etoposide may have antitumor activity against LMS despite that tumor's resistance to short-term infusion schedules of etoposide.

Administration, Oral↗
PubMed1995

Primary fallopian tube adenocarcinoma: clinical complete response after salvage treatment with high-dose paclitaxel.

This Case Report describes a patient with primary fallopian tube cancer who had a late recurrence of pelvic disease following adjuvant chemotherapy for early-stage disease. Secondary cytoreductive surgery was suboptimal. The bulky residual disease was refractory to platinum-based therapy. Extension of the disease to the retroperitoneum resulted in obstructed venous return, ureteral obstruction, and renal infection. The latter necessitated a third laparotomy and a nephrectomy. Upon recovery from surgery and failure of platinum reinduction, the patient was treated with high-dose paclitaxel. The large pelvic mass regressed rapidly and completely. Current chemotherapy for fallopian tube cancer is briefly reviewed.

Adenocarcinoma↗
PubMed1995

Phase II study of cisplatin, 5-fluorouracil and interferon-alpha in recurrent carcinoma of the cervix.

Standard cytotoxic regimens have failed to prolong survival in patients with recurrent cervical cancer; therefore, new agents or combinations of agents are necessary to improve outcome. Cisplatin and 5-fluorouracil are one of the most active regimens currently available for recurrent cervical cancer. Interferon-alpha and potentiate the in vitro and in vivo activity of both agents. Therefore, we sought to define the feasibility and activity of adding interferon-alpha to the cisplatin-5-fluorouracil regimen. Patients with histologically proven recurrent cervical carcinoma received interferon-alpha (5 x 10(6) units/m2/day for 5 days) combined with cisplatin (75 mg/m2 on day 1) plus 5-fluorouracil (500 mg/m2/day for 5 days) in recurrent cervical cancer. Twenty-six patients were included in this study and received a total of 95 courses of therapy. All 26 had prior radiotherapy and five had prior chemotherapy. This regimen was relatively well tolerated as toxicity was comparable to that of cisplatin plus 5-fluorouracil alone. Major response occurred in 8 patients (31%) and 5 (19%) had complete responses. The median response duration was 6 months (range, 2-34 months) and the median survival duration was 9 months (range, 2-38 months). The addition of interferon-alpha to cisplatin plus 5-fluorouracil is feasible. Further studies will be necessary to determine if the addition of interferon-alpha to this regimen is superior to cisplatin plus 5-fluorouracil alone.

Adult↗
PubMed1995

Leuprolide acetate and intravascular leiomyomatosis.

BACKGROUND: Intravascular leiomyomatosis is an uncommon uterine tumor characterized by grossly visible intravascular proliferation of benign smooth muscle. Based on its role in reducing the size of leiomyomas, leuprolide acetate was given as induction therapy for extensive inoperable intravascular leiomyomatosis. CASE: A 44-year-old woman, gravida 1, para 1-0-0-1, presented in July 1992 with abnormal uterine bleeding. Pelvic examination and ultrasonography revealed the presence of a large irregular pelvic mass. At laparotomy, uterine and bilateral adnexal masses were noted extending up to the pelvic inlet and into the broad and infundibulopelvic ligaments. This tumor was not resectable. Based on histologic and immunoperoxidase studies, the lesion was interpreted as a plexiform epithelioid smooth-muscle tumor of uncertain malignant potential. Leuprolide acetate depot therapy (7.5 mg every 4 weeks) was begun in September 1992 and continued for a total of 20 months. Maximal tumor regression was achieved after 9 months. Subsequent reexploration at 20 months revealed a resectable tumor. Resection was accomplished successfully, leaving no apparent residual disease. CONCLUSION: Leuprolide acetate induced tumor regression and rendered debulking surgery feasible in a patient with previously unresectable, widespread, retroperitoneal intravascular leiomyomatosis. Primary hormone therapy may provide alternative therapeutic options for certain cases of intravascular leiomyomatosis.

Adult↗
PubMed1995

Effects of interleukin-1 alpha administration on pituitary-adrenal and pituitary-thyroid axes function of patients with ovarian cancer.

We monitored pituitary, adrenal, and thyroid function in 21 women who had recurrent ovarian cancer and who received interleukin-1 alpha (IL-1 alpha) before and after carboplatin. Serum cortisol, corticotropin, thyroxine, and thyrotropin were measured in the morning before and at the end of each treatment cycle. Serum corticotropin levels were suppressed in many patients despite a normal simultaneous serum cortisol; thyrotropin tended to rise with declining thyroxine levels after prolonged IL-1 alpha administration. However, serum cortisol and thyroxine remained within the normal range at all times, in all patients. Thyroid dysfunction consistent with thyroiditis was seen in one patient. We conclude that administration of IL-1 alpha as currently used in clinical studies does not create significant thyroid or adrenocortical dysfunction.

Female↗