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J E Sardi

Publications and source records attributed to J E Sardi.

9 recordsLinked to original sources
PubMed2001

Neoadjuvant chemotherapy in gynecologic oncology.

The use of neoadjuvant chemotherapy in conjunction with surgery in squamous carcinoma of the uterine cervix can reduce the surgical treatment extent (to be confirmed) in small-volume tumors (diameter < 4 cm) and increase overall survival and disease-free interval in localized median-volume tumors (< or = 8 cm) and improve the quality of life of patients with large, locally advanced tumors, due to longer disease-free period. These issues have yet to be completely resolved (three randomized trials have confirmed these data), but in the meantime, neoadjuvant chemotherapy could be used as an alternative treatment in locally advanced tumors or large localized tumors. It is necessary to use high-dose chemotherapy to achieve a good tumor response and satisfactory "down-staging." Surgical treatment after neoadjuvant chemotherapy seems to be the most appealing option, especially in patients with poor response to chemotherapy. The proper extension of surgery after neoadjuvant chemotherapy is an unexplored matter for the gynecologic oncologist, and no trial has been developed to address this issue, but it seemingly must be performed according to the initial size and extension of the tumor (prior to neoadjuvant chemotherapy) despite the tumor response to it.

Female↗
PubMed1997

Long-term follow-up of the first randomized trial using neoadjuvant chemotherapy in stage Ib squamous carcinoma of the cervix: the final results.

OBJECTIVE: To determine if three courses consisting of 50 mg/m2 cis-platinum, 1 mg/m2 vincristine, and 25 mg/m2 bleomycin (day 1-3) at 10-day intervals can improve survival before Wertheim-Meigs + radiotherapy. MATERIAL: Two hundred five unselected stage Ib patients (having tumors > 2 cm in diameter) were divided into two groups at random: (1) The group control consisted of 103 patients (56 bulky, > 4 cm diameter) treated with Wertheim-Meigs (if the tumor was resectable with free surgical margins) + adjuvant radiotherapy to whole pelvis (extended field radiation was used only in patients with paraaortic lymph node metastases). When the tumor was unresectable, a surgical staging was performed and radiotherapy was the chosen treatment. (2) Neoadjuvant (102 patients, 61 bulky) had neoadjuvant chemotherapy and then the same treatment as the control patients. RESULTS: After 67 (31-102) months of follow-up, no difference was seen in tumors > 2 and < 4 cm in both groups (C = 77% vs N = 82%), but statistically significant differences were seen in survival and disease-free survival, in bulky tumors, and between patients with neoadjuvant chemotherapy + Wertheim-Meigs + radiotherapy (80%) and the control (61%). This was due to an increased operability that was substantially improved in bulky tumors in the neoadjuvant chemotherapy group (61/61, 100%) vs control (48/56, 85%; P < 0.01). After 7 years of follow-up, the outcome of the unresectable bulky control group of patients is significantly worse (14%) than that of the resectable group (69%; P < 0.001). With regard to recurrences, a significant decrease in pelvic failures in the neoadjuvant chemotherapy group was observed (P < 0.001). Survival was improved in bulky resectable cases (N = 81% vs C = 69%, P < 0.05). Pathological findings for the surgical specimens revealed differences between both groups because all the risk factors such as parametrial and lymph node metastases, tumor bulk, and vascular embolism had been decreased (P < 0.001). CONCLUSION: Neoadjuvant chemotherapy can improve survival because of increased operability with free survival margins and a decrease in pathologic risk factors in unselected, bulky (> 4 cm diameter) stage Ib patients.

Adult↗
PubMed1990

Lymph node metastases in carcinoma of the cervix uteri: response to neoadjuvant chemotherapy and its impact on survival.

One hundred and sixty-nine patients with squamous cancer of the cervix uteri treated with three courses of neoadjuvant chemotherapy with the modified VBP scheme are presented. All were subjected to a Wertheim-Meigs operation with paraaortic lymph-adenectomy. The incidence of lymph node metastases is analyzed according to clinical stage, tumor volume, residual tumor in the surgical specimen, and clinical response to neoadjuvant chemotherapy. A significant decrease in the incidence of lymph node involvement was observed in good responders. Survival rates, after 2 years of follow-up, improved in those cases with small residual tumor, negative parametria, and negative nodes.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

Results of a phase II trial with neoadjuvant chemotherapy in carcinoma of the cervix uteri.

Results of a Phase II trial with neoadjuvant chemotherapy in carcinoma of the cervix uteri (VBP modified scheme) show that 85.7% of patients given this therapy were NED in Stage IIb versus 54% of a nonrandomized control group given conventional therapy. In Stage IIIb the averages are 66.6% vs. 31% in the control group. Analysis of the ecographic data has shown that if a critical prechemotherapy volume (120 cm3) is exceeded, the prognosis is unfavorable, especially in cases treated with radiotherapy as second-line treatment.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Epithelial ovarian cancer: do all metastases present similar chemosensitivity?

Three cases of advanced epithelial ovarian carcinoma Stage III-IV which could not be submitted to classical surgical and oncological treatment (BSO-TH) are presented. After a year of chemotherapy a complete remission was observed. Myometrial and myocervical micrometastases were found in a specimen from the hysterectomy, carried out during second-look, that was negative. These micrometastases, when they are present, apparently show a different chemosensitivity, as compared with other metastasis localization. The causes of this phenomenon are analyzed.

Female↗
PubMed1986

A possible new trend in the management of the carcinoma of the cervix uteri.

Thirty-three patients with locally advanced carcinoma of the cervix were treated with chemotherapy as first line treatment. Great emphasis was applied to document, in the most objective manner, the tumor size response. The first 8 patients received a conventional scheme composed of vincristine, bleomycin and cis-platinum (VBP) at 21-day intervals. The results were not as satisfactory as expected. In the other 25 patients a more aggressive VBP scheme was used, at 10-day intervals. Surprisingly satisfactory results and tolerance were observed. In many instances verified tumor reduction allowed surgical radical treatment in prechemotherapy inoperable cases.

Adenocarcinoma↗
PubMedDate not supplied

Favorable clinical behavior in young ovarian carcinoma patients: a rationale for conservative surgery?

The objective of this study was to analyze prognostic factors and epidemiologic data in young women with invasive epithelial cancer (YWEOC). Forty consecutive cases were selected from our database, treated according to current standards. A control group with older patients (>40 years) was created using concurrent cohort technique (n= 114). Median follow-up was 95 months in YWEOC and 84 months in elder patients. They were grouped by FIGO stages, histologic type, and tumor grade. Oncologic family history was compared in both cohorts. Survival was calculated using Kaplan-Meier curves. Chi-square, log rank test, uni- and multivariate analyses were used for statistical comparison. Family history was obtained in 25 of 40 of YWEOC, and 7 had first-line relatives with hematologic tumors, while this was observed in 1 of 80 of the elder patients (OR 9.8; 1.2-74.7). Due to these findings, a <40-years control healthy group selected from the gynecology office was rated and when compared with YWEOC, statistically significant differences were observed (OR 39.2; 4.5-338). Tumors were more differentiated, compared to the elder group (G(1): 68% vs 7%, P < 0.0001); stage I was more frequent (70% vs 19%, P < 0.0001) as well as mucinous and endometroid histologic types (P < 0.03). Survival was higher among younger patients (81% vs 35%, P < 0.0001) and decreased by decade, especially after 41 years. In advanced cases, optimal cytoreduction was more frequently performed, and survival was significantly higher. Multivariate analysis revealed that the only independent prognostic factor was residual disease in both groups. Age is not an independent prognostic factor for ovarian cancer but it has a different biologic behavior. An interesting association with hematologic tumors was observed, suggesting another pathway for ovarian cancer oncogenesis.

Adult↗