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Biomedical subjects

F B Stehman

Publications and source records attributed to F B Stehman.

At least 55 records · Page 3Linked to original sources
PubMed1989

A phase II evaluation of mitolactol in patients with advanced squamous cell carcinoma of the cervix: a Gynecologic Oncology Group Study.

Sixty patients with advanced squamous cell carcinoma of the cervix (SCC) who had received no prior chemotherapy were entered onto a study of mitolactol (dibromodulcitol [DBD]). The drug was administered orally at an initial dose of 180 mg/m2 per day for 10 days and repeated every 4 weeks. There were 55 evaluable patients, of whom one (2%) had a complete response (CR), and 15 (27%) had a partial response (PR), (CR plus PR, 29%). A 95% confidence interval for the true response rate is 18.8% to 42.1%. Myelosuppression was appreciable at this dose and schedule, with 13 patients experiencing life-threatening thrombocytopenia and two drug-related deaths. The level of activity in this disease encourages us to determine a tolerable dose of this drug in combination with cisplatin for further study.

Adult↗
PubMed1989

Ten-year follow-up of patients receiving cisplatin, doxorubicin, and cyclophosphamide chemotherapy for advanced epithelial ovarian carcinoma.

Fifty-six patients were randomly assigned to receive either one-day cisplatin, doxorubicin, and cyclophosphamide (PAC) chemotherapy (PAC-I) or five-day PAC (PAC-V) for advanced epithelial ovarian carcinoma. Follow-up has been 120+ months or to death. Ninety-one percent had either suboptimal stage III or stage IV disease and 55% had grade 2 or 3 lesions. Two patients died of toxicity and were free of disease at autopsy. A third patient died of congestive heart failure with no disease at 103 months. Additionally, eight patients had a negative second-look laparotomy, and three (37.5%) are alive with no evidence of disease (NED) 133 to 144 months after diagnosis. Five patients (62.5%) died of disease 2 to 123 months after negative second-look. Patients with optimal stage III disease had a longer median progression-free interval (PFI) and survival (33.3 and 44.5 months, respectively) than those with suboptimal or stage IV disease (16.4 and 22.5 months, respectively), and the difference in median PFI is significant (P less than .02). Patients with ascites at diagnosis had a shorter median PFI and survival (14.7 and 18 months) than those without ascites (30.0 and 33.0 months). Both differences were significant (PFI, P less than .04; survival, P = .005). PAC produces response rates that are superior to those obtained historically with single-agent alkylating therapy. Late recurrences after negative second-look laparotomy suggest that 5-year survival data may be inadequate in ovarian carcinoma.

Adult↗
PubMed1988

Osteosarcoma of the uterine cervix associated with hyperplastic and atypical mesonephric rests.

The authors describe a unique case of osteosarcoma associated with atypical mesonephric rests occurring in the right lateral wall of the uterine cervix. The tumor was examined histologically, cytologically, immunohistochemically, and ultrastructurally and was compared with another osteosarcoma that filled an entire uterine cavity. Comparison with other neoplasms of the uterine cervix indicates that the lesion should be classified separately. Previously reported neoplasms associated with mesonephric rests within the cervix are also reviewed.

Aged↗
PubMed1988

Steroid receptors and clinical outcome in patients with adenocarcinoma of the endometrium.

Progesterone receptor content was measured in tissue samples from 175 patients with endometrial adenocarcinoma by use of the dextran-charcoal method. The estradiol receptor content was determined in 138 of these samples. Ninety-two tumors (52.6%) tested positive for progesterone receptors (greater than 50 fmol/mg cytosol protein) and 111 (80.4%) tested positive for estradiol receptors (greater than 6 fmol/mg). Median follow-up was 27.3 months (range 1 to 152 months). Progesterone receptor status correlated significantly with grade, histology, adnexal spread, age, and recurrence rate in stage I cancer. There was no correlation between progesterone receptor status and clinical stage, myometrial invasion, peritoneal cytology, retroperitoneal lymph node involvement, or spread to the cervix. Estradiol receptor status correlated with adnexal spread and recurrence rate. Recurrence in patients with stage I disease was significantly more common if tumors were negative for progesterone receptor (16 of 43, 37.2%) than if they were positive (four of 57, 7%; p less than 0.001). Recurrence was also more common if tumors were negative for estradiol receptor (seven of 17, 41.2%) than if they were positive (eight of 63, 12.7%; p = 0.02). In recurrent or advanced disease, response to progestin was independent of estradiol receptor content, but tumors positive for progesterone receptors responded significantly more often than those lacking progesterone receptors. Overall survival was superior for patients with progesterone receptor-positive tumors (p = 0.001). Although survival in clinical stages I and II was also superior in patients with lesions positive for progesterone receptors (p = 0.13), there was no statistical difference in survival between patients with progesterone receptor-positive or -negative cancers and surgical stages I and II disease (p = 0.12). Estradiol receptor status had no apparent correlation with survival.

Adenocarcinoma↗
PubMed1988

A randomized trial of hydroxyurea versus misonidazole adjunct to radiation therapy in carcinoma of the cervix. A preliminary report of a Gynecologic Oncology Group study.

Between June 1981 and December 1985, 296 evaluable patients with carcinoma of the cervix (stages IIB, III, or IVA) were randomized to radiation therapy and either hydroxyurea (139 patients) or misonidazole (157 patients). All patients had undergone clinical, radiographic, and surgical staging. Patients with metastasis to periaortic nodes were ineligible for study. Patients received external radiation therapy to the pelvis and either one or two intracavitary applications. Hydroxyurea was given in a dose of 80 mg/kg each Monday and Thursday during external radiation therapy. Misonidazole was given in a dose of 1 gm/m2 in the same schedule, not to exceed 12 gm/m2. Of the evaluable patients, 60.8% had stage IIB disease and 33.8% had stage IIIB disease. Negative pelvic lymph nodes were found in 79.2% of the patients. Median age was 49 years (first and third quartiles 40 and 60, respectively). There were 51 patients who had severe and 15 patients who had life-threatening adverse effects (including two treatment-related deaths). As of February 1987 half the patients have either failed or been followed-up for at least 43 months. The group treated with hydroxyurea had a longer progression-free interval, bordering on statistical significance, than those treated with misonidazole (p = 0.08). The median progression-free interval for all patients randomized to hydroxyurea is 42.9 months and for misonidazole it is 40.4 months. The median progression-free interval for patients with stage III and IV disease who received hydroxyurea has not been reached and for the misonidazole group it was 10.1 months. There have been 120 recurrences, 51 (36.7%) in the hydroxyurea group and 69 (43.9%) in the misonidazole group; 51.7% of the recurrences have been limited to the pelvis or vagina. Failure limited to the pelvis occurred in 18.0% of patients receiving hydroxyurea and 23.6% of patients receiving misonidazole. There were 108 deaths, 47 (33.8%) in the hydroxyurea group and 61 (38.9%) in the misonidazole group; survival does not differ statistically between the two regimens at this point in follow-up (p = 0.25). Hydroxyurea has more short-term gastrointestinal and marrow toxicity, but is free of long-term neurotoxicity. Preliminary analyses indicate that there is no role for radiation therapy with misonidazole in cervical carcinoma.

Adenocarcinoma↗
PubMed1988

A comparison of findings at second-look laparotomy with preoperative computed tomography in patients with ovarian cancer.

Prior to undergoing second-look laparotomy, 57 patients with ovarian cancer were evaluated with computed axial tomography (CT). All patients were clinically free of disease following chemotherapy. At laparotomy, 25 patients had visible evidence of disease, 9 had microscopic disease only, and 23 were free of cancer. Tumor was correctly identified on CT in 9 of the 25 patients (36%) with macroscopic disease. Tumors smaller than 2 cm in size were not detected by CT. CT suggested disease in 8 of the 32 patients (25%) who were free of macroscopic disease. CT provides useful information when it is abnormal. Fine needle aspiration of suspicious areas can spare some patients laparotomy. However, CT has a significant false-negative rate due to its inability to detect small volume disease. Patients with negative CT will continue to require reexploration and tissue confirmation to assess the need for further therapy.

Adolescent↗
PubMed1988

The importance of peritoneal cytology in endometrial carcinoma.

From 1971-1986, peritoneal washings were obtained for cytologic examination at the time of primary exploratory laparotomy in 340 patients with endometrial adenocarcinoma. Seventy-two samples (21.2%) contained malignant cells. The finding of malignant cytology increased with stage of disease: stage I, 17%; stage II, 19.5%; stage III, 68.7%; and stage IV, 85.7% (P less than .001). In 248 patients with clinical stage I disease for whom uterine evaluation was complete, there was an increasing incidence of malignant cytology with increasing grade (P = .002), depth of myometrial invasion (P = .003), and adnexal spread (P less than .001). Twelve of 41 patients (29.3%) with clinical stage I and positive cytology developed recurrent disease, compared with six of 207 (2.9%) with negative cytology (P less than .001). Survival for all stages together was poorer in patients with positive washings than in those with negative washings (P less than .001). This difference in survival was also observed in patients with clinical stage I disease (P less than .001). Among patients with surgical stage I disease, disease-free survival was also superior in the group with negative cytology. In both clinical and surgical stage I, intra-abdominal recurrences were more common among patients with malignant peritoneal cytology.

Adenocarcinoma↗
PubMed1987

Primary carcinoma of the fallopian tube: evidence for activity of cisplatin combination therapy.

The records of 23 patients with confirmed carcinoma of the fallopian tube, treated between 1966 and 1983, were reviewed. Patients ranged in age from 41 to 88 years. A pelvic mass was the most common preoperative finding (61%), followed by abnormal bleeding (43%), and pain (39%). Fifteen patients had stage I or II disease, 8 had Stage III or IV disease. In patients with metastatic disease, involvement of the peritoneal surfaces, bowel, and omentum were noted most often. Lymph nodes were the most common site(s) of recurrent disease. Twelve evaluable patients with measurable disease were treated with cisplatin and cyclophosphamide (PC) +/- doxorubicin (PAC). There were 9 complete and 2 partial responses, a 92% response rate. Incorporation of cisplatin therapy appears to have resulted in improved short-term survival.

Adenocarcinoma↗
PubMed1987

Malignant papillary lesions of the endometrium.

In a review of 440 patients treated for endometrial adenocarcinoma at this center since 1974, 21 patients with tumors of papillary histology were identified. Eleven (2.5%) lesions contained histologic changes characteristic of uterine papillary serous carcinoma: complex papillary architecture, high nuclear/cytoplasmic ratio, and irregular epithelial tufting. Ten lesions (2.3%) containing areas of papillary morphology but lacking the criteria for the diagnosis of papillary serous tumors were termed papillary endometrioid adenocarcinoma. Patient age, stage, and the presence of obesity, hypertension, and diabetes were similar in both groups and reflected those characteristics well established for endometrial adenocarcinoma in general. Fewer papillary serous tumors (16.7%) and papillary endometrioid tumors (33.3%) contained progesterone receptors than did other adenocarcinomas (52.3%). In clinical stage I, surgical findings indicating a more advanced stage were present in 40% of patients with papillary serous tumors compared to 10% in papillary endometrioid tumors and 12.5% in nonpapillary adenocarcinomas (P = 0.03, Fisher's exact test). Recurrences were observed in 50% of patients with papillary serous lesions compared to 42.9% in papillary endometrioid lesions and 24.3% in other adenocarcinomas. Survival for clinical stage I papillary serous tumors was worse than that for nonpapillary grade 3 controls (P = 0.042) and survival for papillary endometrioid lesions was not different from that of the same controls. These findings support those of J. L. Chen, D. C. Trost, and E. J. Wilkinson (Int. J. Gynecol. Pathol. 4, 279-288 (1985)) that papillary serous and papillary endometrioid adenocarcinomas represent two distinct subtypes of papillary endometrial neoplasia.

Adenocarcinoma, Papillary↗
PubMed1987

Poorly differentiated (small cell) carcinoma of the ovary in young women: evidence supporting a germ cell origin.

The clinical and pathologic features, including immunohistochemistry and electron microscopy, of six cases of poorly differentiated carcinoma of the ovary (small cell carcinoma) are presented. These tumors occurred in six young patients ranging in age from 10 to 24 years. Two patients had hypercalcemia. All tumors were unilateral, and four patients had advanced stage disease at presentation. Histologic features included sheets, nests, and cords of cells in a fibrous stroma, focal microcysts, and a dimorphic population of small and large cells. Eosinophilic, hyaline globules occurred in five cases, intercellular basement membrane-like substance in two cases, and glycogen in all cases. Five of six cases stained strongly for cytokeratin and vimentin; intracytoplasmic laminin was identified in three cases; and three cases were believed to show faint positivity for alpha-1-antitrypsin. Stains for alpha-fetoprotein were negative. Ultrastructural examination of two cases showed granular material in dilated rough endoplasmic reticulum, intermediate filaments, intracytoplasmic dense globules, maculae adherens, and extracellular basement membrane-like material. All of the cases proved rapidly fatal despite various therapies, as did a histologically similar testicular tumor that was admixed with seminoma and teratoma. We interpret these findings to indicate that this ovarian cancer is most likely of germ cell origin, and it may be related to yolk sac tumor, although it is clearly distinct from the classical yolk sac tumor.

Adolescent↗
PubMed1987

Ovarian carcinoma: adjuvant treatment with P-32.

Twenty-eight patients with ovarian carcinoma received 555 MBq of labeled chromic phosphate (P-32) intraperitoneally. Indications for treatment included a high-grade tumor, extracapsular involvement, positive cytologic findings, or residual tumor. Fifteen patients (group 1) had stage I, II, or III completely resected tumor; 13 patients (group 2) had microscopic or less than 3-mm lesions at second-look laparotomy following combination chemotherapy. A major complication occurred in one patient; two patients had minor complications. Overall, 24 of 28 patients (85.7%) were alive at 11-77 months; 23 (82.1%) had no evidence of tumor. Fifteen of 15 (100%) group 1 patients and eight of 13 (61.5%) group 2 patients did not have tumor relapse after 30 months and 28 1/2 months, respectively. P-32 was found to be an effective adjuvant treatment in a select group of patients with ovarian carcinoma who were at high risk for intraabdominal recurrence.

Brachytherapy↗
PubMed1987

Pitfalls in interpretation of computed tomography prior to second-look laparotomy in patients with ovarian cancer.

Fifty-seven patients with ovarian cancer were assessed with computed tomography (CT) prior to undergoing second-look laparotomy. All patients were clinically free of disease following chemotherapy. Patients were scanned from the top of the liver to the symphysis pubis using oral, rectal and intravenous contrast medium. Tumour was correctly identified on CT scan in nine of 25 patients who had visible evidence of cancer at laparotomy. However, in the remaining 16 patients peritoneal studding was present and was not detected. Tumours smaller than 1.5 cm in size were not found by CT scanning. Computed tomography showed abnormality in eight of 32 patients subsequently found to be free of disease. Fine-needle aspiration cytology, bolus contrast injection and repeat scanning with additional oral contrast medium could have assisted in these circumstances. As persistent disease is by definition, a contraindication to second-look laparotomy, aggressive pre-operative assessment will spare some patients unnecessary surgery. However, CT cannot detect the small nodules often present in ovarian cancer, and thus, normal scans cannot replace surgical restaging.

False Positive Reactions↗
PubMed1987

Human papillomavirus deoxyribonucleic acid in lesions of the female genital tract: evidence for type 6/11 in squamous carcinoma of the vulva.

Tissue specimens from 51 patients with genital condyloma acuminata or invasive cervical or vulvar carcinomas were analyzed for the presence of human papillomavirus deoxyribonucleic acid (DNA) using the dot blot technique. Of ten condylomas, 80% contained DNA related to human papillomavirus 6 or 11. Sixty percent had evidence of DNA related to human papillomavirus 16, and 30% contained DNA related to human papillomavirus 18. Of 24 squamous cervical carcinomas, 58% had human papillomavirus type 16-related DNA, 33% had type 6- or 11-related DNA, and 4% had type 18-related DNA. Nine primary or recurrent vulvar carcinomas were analyzed. Seventy-eight percent contained human papillomavirus type 6- or 11-related DNA, 33% type 16-related DNA, and 22% type 18-related DNA. Whereas invasive cervical carcinomas predominantly contained DNA related to human papillomavirus 16 or 18, invasive vulvar carcinomas predominantly contained DNA related to types 6 or 11. Thus, human papillomavirus type alone cannot distinguish benign from malignant epithelial disease in the female genital tract.

Adult↗
PubMed1987

Biopsy of the scalene fat pad in carcinoma of the cervix uteri metastatic to the periaortic lymph nodes.

Fifty-five patients with squamous cell carcinoma of the cervix uteri metastatic to high common iliac or periaortic lymph nodes underwent biopsy of the left scalene fat pad as part of a prospective clinical trial. Patients without metastasis to the scalene nodes were subsequently treated with extended field radiation therapy and were then eligible for a randomized trial of systemic chemotherapy. Only four patients were found to have micrometastases to the scalene fossa. This figure is appreciably lower than that reported in previous literature. While geographic failure continues to be a problem for this group of patients, routine use of left scalene fat pad biopsy before treatment is not recommended.

Adipose Tissue↗
PubMed1986

A phase II study of carboplatin in advanced squamous cell carcinoma of the cervix (a Gynecologic Oncology Group Study).

The Gynecologic Oncology Group conducted a Phase II trial of carboplatin in patients with measurable advanced squamous cell carcinoma of cervix. No prior therapy with cytotoxic drugs was permitted in patients entered into this study. Patients entered were GOG performance status 2 or better. Carboplatin 400 mg/m2 (340 mg/m2 in patients who had had prior pelvic radiotherapy with subsequent escalation to 400 mg/m2 if bone marrow tolerance was good) was administered as a 15-minute IV infusion. Treatments were repeated every four weeks until disease progressed or until toxicity prohibited further therapy. Thirty-nine evaluable patients were treated. Two complete and nine partial responses were observed (response rate 28.2%). No neurotoxicity and only mild reversible nephrotoxicity was seen. Gastrointestinal toxicity was severe in three patients (7.7%). Dose limiting toxicity was myelosuppression. Carboplatin is active against squamous cell carcinoma of cervix and appears to be less nephrotoxic, neurotoxic, and nauseogenic than cisplatin. Randomized studies of this drug against cisplatin are indicated to determine the role of carboplatin in the therapy of squamous cell carcinoma of cervix.

Anemia↗
PubMed1986

Adenocarcinoma corpus et colli: analysis of diagnostic variables.

Between January 1973 and December 1983, 469 patients with carcinoma of the endometrium were seen at this institution. Eighty-one patients were identified with adenocarcinoma involving both the uterine body and the cervix. Patients were divided into three groups for evaluation. Group A (n = 58) had a positive cervical biopsy or endocervical curettage, but a normal-appearing cervix at clinical examination. Group B (n = 18) had gross tumor involving the cervix which was confirmed by biopsy. Group C (n = 5) had unsuspected cervical involvement revealed at hysterectomy. Fourteen Group A patients received preoperative radiation therapy. Thirty of the 44 Group A patients (68.2%) who did not receive preoperative radiation, had no involvement of the cervix by tumor in the hysterectomy specimen. Seventy-six patients were eligible for follow-up of at least 18 months. There were 24 recurrences among these 76 patients. Recurrence was more common with advancing grade and with increasing myometrial invasion. Pelvic failures occurred with comparable frequency in both Groups A and B. Only 4 of 11 patients who were found to have extrauterine disease at surgery are still alive. In this study, we found that endocervical curettage has a significant false-positive rate, both histologic grade and volume of cervical involvement should be considered in treatment planning, primary operation should be considered in the management of selected patients with Stage II endometrial carcinoma, and extrauterine disease is a grave prognostic factor.

Adenocarcinoma↗