Surgical staging of ovarian tumours: the individual and integrative roles of the oncologist and pathologist.
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Female↗
Biomedical subjects
L L Adcock
Publications and source records attributed to L L Adcock.
Pretreatment surgical staging in cervical carcinoma: therapeutic efficacy of pelvic lymph node resection.
Pretreatment surgical staging in cervical carcinoma has been studied extensively to define a group for extended field radiation or adjuvant chemotherapy. A theoretical, but as yet unproved, benefit from this surgery is the resection of large, presumably radioresistant, pelvic nodal metastases before radiation therapy. One hundred fifty-six patients were divided by pelvic nodal status after surgical staging with excision of pelvic lymph nodes: group A, negative (n = 81); group B, microscopic metastases only (n = 18); group C, macroscopic nodal metastases resected (n = 48); and group D, unresectable nodal metastases (n = 9). The 5-year recurrence-free survival in group C (51%) approached that of group B (57%) and was significantly better than that of group D (0%). The groups are compared by International Federation of Gynecology and Obstetrics stage, grade, histology, and incidence of paraaortic metastases. Patterns of recurrence imply improved pelvic control in patients undergoing resection of pelvic nodal metastases. Surgical removal of pelvic nodal metastases before radiation therapy is recommended.
Carcinoma↗
Prognostic significance of steroid receptors measured in primary metastatic and recurrent endometrial carcinoma.
Forty-two cases of recurrent and 14 cases of advanced clinical stage (III and IV) endometrial carcinoma are presented, in which progesterone and estrogen receptors from the metastatic sites were measured. Mean survival time (time from recurrence or, in advanced stages, from the time of diagnosis to death or last follow-up), mean total survival time (time from diagnosis to death or last follow-up), and mean time to recurrence (time from diagnosis of primary tumor to the time of recurrence) were positively correlated with positive progesterone and estrogen receptor status and with histologic grade of tumor. No correlation was found with age, clinical stage, depth of myometrial invasion, or site of metastasis. However, when multiple variables were considered with the Cox regression model, the combination most highly correlated with survival included progesterone receptor, grade of tumor, and site of metastasis (pelvis vs. other sites). All differences were statistically significant (p less than 0.05). We conclude that measurement of progesterone and estrogen receptors in metastatic or recurrent endometrial tumors may be used as an additional prognostic variable.
Adult↗
The role of surgical debulking in cancer of the uterine cervix.
From 1978 to 1985, 159 women with advanced cervical cancer received definitive radiation therapy following extraperitoneal surgical staging including pelvic lymph node dissection and periaortic lymph node sampling. Relapse-free survival was a strong function of peritoneal and nodal metastases but was independent of clinical stage. The 5-year relapse-free rate fell from 86% in women without pelvic node metastases to 0% in those with unresectable pelvic node metastases. Women with microscopically positive pelvic node metastases had virtually the same (56%) relapse-free rate as those with grossly positive but completely resected metastases (57%). The overall pelvic failure rate was 16.4% and was significantly higher in women with unresectable pelvic node metastases. Periaortic and peritoneal metastases substantially increased the probability of recurrence. Although histologic grade was prognostically significant, histopathologic category was not. Severe enteric morbidity occurred in 3.6% of patients treated solely to the pelvis and in 7.9% of patients treated to the pelvis and periaortics. Therapeutic implications of debulking pelvic node metastases are discussed.
Female↗
Fibromatosis of the female pelvis.
Fibromatosis is a benign, infiltrating, nonmetastasizing neoplasm which is rarely completely resected. Therefore, the incidence of recurrence is high. Fibromatosis is more common in females and is frequently diagnosed during pregnancy. Inasmuch as fibromatosis of the female pelvis appears to be a discrete entity, management poses significant problems for the gynecologist. Radiation therapy, frequently used following incomplete resection or for recurrence, is undesirable due to the loss of ovarian function and fertility. Hormonal manipulation and combination chemotherapy are alternatives which have been effective in some reports. Three patients with pelvic fibromatosis, referred within 1 year, are reported. The various aspects of this neoplasm and the diagnostic procedures are discussed. Treatment modalities whose effects are reversible are recommended for recurrent fibromatosis. Radiation therapy can be reserved for patients in the older age groups or for those with progressive disease not responding to other therapy.
Adult↗
Tolerance and preliminary results of simultaneous therapy with radiation and cisplatin for advanced cervical cancer.
From 1982 through 1985, 49 women with advanced cervical cancer were treated with concurrent radiation and cisplatin to assess tolerance to the combined modality regimen and its efficacy in comparison to historical controls at the same institution. Eligibility criteria included clinical stage IV disease; para-aortic lymph node metastases; and bilateral, unresectable, and/or multiple (greater than 3) pelvic node metastases. Nodal status was assessed by extraperitoneal surgical staging in the majority of patients with clinical stage I-IVA disease. There was no increase in acute or chronic toxicity compared to historical controls. No patient required reduction of the planned dose of radiation because of acute toxicity. Comparison with historical controls suggests a modest improvement in relapse-free survival in the cisplatin-treated group with positive para-aortic nodes (59% vs. 54% at 2 yr and 59% vs. 42% at 3 yr). We conclude that adjuvant cisplatin can be given simultaneously with radiation for advanced cervical cancer without excessive toxicity or compromise of the radiation regimen. However, confirmation of the modest improvement in relapse-free survival rates for patients with positive para-aortic nodes and identification of other subsets of patients who may benefit will require a prospective randomized trial.
Adult↗
Infectious morbidity in gynecologic cancer.
A retrospective investigation of infectious morbidity in gynecologic oncology patients documented that 54 (11%) of 494 patients and 68 (6%) of 1204 patient admissions were complicated by a serious infection. The highest rate of infectious morbidity by admission was 21%, occurring in patients admitted for cancer of the vulva. The highest surgical infectious morbidity, 22%, occurred in patients admitted for cervical cancer. Important factors in determining infection risk include multiple host factors, radical surgical procedures, factors inherent in the tumor itself, and additional irradiation and chemotherapy. These serious polymicrobial infections dictate intelligent selection of antimicrobials and appropriate monitoring to anticipate complications inherent in antimicrobial therapy. beta-Lactamase induction, superinfection, nephrotoxicity, and necrotizing enterocolitis are documented problems in these patients.
Adult↗
Cytosolic estrogen and progesterone receptors as prognostic parameters in stage IB cervical carcinoma.
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Adenocarcinoma↗
Vulvar basal cell carcinoma: an infrequently metastasizing neoplasm.
A case of metastasizing basal cell carcinoma (BCC) of the vulva is presented and compared with 10 nonmetastasizing tumors of the same histologic type by various clinicopathologic parameters. The former neoplasm manifested several features that distinguished it from most of the nonmetastasizing tumors, such as vaginal bleeding at presentation; advanced clinical stage; invasion of subcutaneous fat, urethra, and vagina; tumor thickness greater than 1 cm; and a morphealike pattern of growth. This series, in conjunction with previously published observations, would suggest that vulvar BCC behaves much like its counterpart in sites other than the vulva, locally recurring but metastasizing only on rare occasion. Simple wide excision of the tumor is curative in the majority of cases. More aggressive surgery may be warranted for large tumors that are locally destructive and extend into the subcutaneous fat, like our metastasizing case and the two other examples of metastasizing vulvar BCC in the literature. In this report, treatment options for vulvar BCC are discussed, as well as the use of the term "basosquamous" carcinoma, and whether vulvar BCC may be a manifestation of a more generalized syndrome of cutaneous basal cell neoplasia in some cases.
Aged↗
Prognostic importance of progesterone and estrogen receptors in cancer of the uterine cervix.
Tissue levels of cytosolic estrogen receptors (ERc) and progesterone receptors (PRc) have been shown to have prognostic meaning in hormonally responsive cancers arising in the breast and endometrium. Although carcinomas of the uterine cervix rarely respond to hormonal manipulation, the normal cervical stroma and epithelia contain ERc and PRc. To study the prognostic value of these receptors, 65 cervical carcinomas for ERc and PRc were assayed before initiation of surgical or radiation therapy. In premenopausal women, logistic models demonstrated that clinical stage, surgical stage, and receptor level independently predict survival. If confirmed in further studies, ERc and PRc may prove to be useful prognostic factors in the management of cervical carcinomas.
Adenocarcinoma↗
Choriocarcinoma with brain metastases. Successful management of increased intracranial pressure with barbiturates.
Choriocarcinoma is a potentially curable neoplasm. Although the presence of intracranial metastases worsens the ultimate prognosis, several reports have shown successful response to therapy. This clinical report outlines a method by which the appropriate therapy may be initiated in a patient with intracranial metastases, who otherwise may not have survived the interval necessary for the induction of successful therapy.
Adult↗
Concurrent weekly cis-platinum and radiotherapy in advanced cervical cancer: a preliminary dose escalating toxicity study.
Concurrent weekly cis-platinum in a dose escalating manner and conventional radiotherapy was evaluated in advanced cervical cancer. The toxicity of weekly cis-platinum given 2 hr before standard fractionation of radiotherapy was assessed using the modified GOG toxicity criteria. Sixteen patients having parameters indicating high risk for conventional therapy failure including positive pelvic and paraaortic nodes and intraperitoneal spread were entered. There was no life-threatening toxicity. The toxicity of the administered chemotherapy was only moderate. Patient compliance was good as at the 20 mg/m2 dose level, 79% of the prescribed doses were administered. The use of adjuvant cis-platinum in poor prognosis advanced cervical cancer merits further study.
Brachytherapy↗
Pregnancy following treatment of endodermal sinus tumor of the ovary with combination chemotherapy, including cis-platinum.
A 16-year-old woman with endodermal sinus tumor of the ovary underwent conservative surgical debulking and combination chemotherapy and had a recurrence documented by a rise in alpha-fetoprotein. She had a complete response to a second chemotherapy regimen, including cis-platinum. Subsequently, she became pregnant. The case emphasizes the management of endodermal sinus tumor, including conservative surgery, combination chemotherapy, and monitoring serum alpha-fetoprotein levels. This is the second report of pregnancy following cis-platinum administration.
Adolescent↗
Therapy of stage III (optimal) epithelial carcinoma of the ovary with melphalan or melphalan plus Corynebacterium parvum (a Gynecologic Oncology Group Study).
A randomized prospective therapy trial in patients with stage III optimal epithelial carcinoma of the ovary was accomplished by the Gynecologic Oncology Group. Therapy with melphalan or melphalan plus immuno-adjuvant, Corynebacterium parvum (C. parvum), was utilized as adjuvant treatment following surgical therapy. One hundred eight-five patients were eligible for evaluation with 87 patients in the melphalan group and 98 patients in the melphalan plus C. parvum group. The comparison of the treatment regimens showed no differences with respect to either progression-free interval or survival. However, it should be noted that a 50% 3-year survival was obtained. A group was identified, using four prognostic factors that had 80% survival at 3 years. Maximum size of the residual tumor, as well as performance status, was not prognostically significant. This study demonstrates a lack of efficacy of the addition of C. parvum to melphalan for this patient population.
Adult↗
Germ cell tumors of the ovary-lymph node metastases.
There is a controversy concerning the value of second look surgery and lymph node sampling for patients with germ cell tumors of the ovary. A patient is presented with endodermal sinus tumor in a mixed germ cell tumor of the ovary. The elevated serum alpha-fetoprotein (AFP) became normal. At second look surgery microscopic lymph node metastases were present. The disease progressed, AFP became elevated, and the patient did not survive. Second look surgery with lymph node sampling is necessary for such patients for endodermal sinus tumor may not produce AFP, inadequate tumor volume may not elevate the AFP, and malignant elements not producing tumor markers may be identified only by histologic evaluation. With microscopic persistence of disease further therapy could possibly result in cure.
Adult↗
Effect of cis-platinum on tolerance to radiation therapy in advanced cervical cancer.
Women with advanced carcinoma of the uterine cervix are at high risk for the development of local, regional, and distant metastases. Thus, both effective systemic agents and radiosensitizers could be useful adjuvants. However, because a substantial fraction of women with advanced cervical neoplasms are cured with radiation therapy, such experimental agents must not compromise the administration of conventional therapy. Cis-platinum is particularly appealing as it has both radiosensitizing properties and activity in metastatic cervical cancer. The present study examined the effect of weekly cis-platinum on radiation tolerance in 29 women with advanced cervical cancers. Although toxicity was acceptable, no marked enhancement in survival could be demonstrated.
Adult↗
Therapeutic implications of the natural history of advanced cervical cancer as defined by pretreatment surgical staging.
From 1978 to 1983, 112 women with advanced cervical carcinomas received radiotherapy after pretreatment surgical staging. Five-year actuarial relapse-free survival rates were a strong function of lymphatic spread: 40% with periaortic node metastases, 50% with pelvic node metastases, and 84% without node metastases. Primary treatment failure had a distant component in 75% of recurrences (50% of recurrences with negative nodes and 85% of recurrences with positive nodes). It was concluded that adjuvant systemic therapy is necessary to substantially raise the probability of cure.
Adult↗
Role of whole abdominal radiation therapy in the management of endometrial cancer; prognostic importance of factors indicating peritoneal metastases.
From 1973 through 1983, 27 women received postoperative open-field external beam abdominal radiotherapy as primary treatment of endometrial carcinoma. The 5-year survival rate was 71%. Two distinct prognostic groups were demonstrated. Patients with spread to the adnexa, peritoneal fluid, or both, had a 5-year relapse-free rate of 90%. Patients with macroscopic spread of cancer beyond the adnexa had a 5-year relapse-free rate of 0%. Guidelines are suggested for the radiotherapeutic management of endometrial cancer metastatic to the peritoneal cavity.
Adenocarcinoma↗