PubMed Health⌕ Search

Biomedical subjects

M S Piver

Publications and source records attributed to M S Piver.

At least 91 records · Page 5Linked to original sources
PubMed1995

Severe radiation morbidity in carcinoma of the cervix: impact of pretherapy surgical staging and previous surgery.

PURPOSE: The purpose of this study is to delineate the factors which (a) contribute to an increase in the severe, radiation induced complication rate and (b) have a significant effect on survival in patients with International Federation of Gynecologists and Obstetricians (FIGO) Stage I-IVA cervical cancer undergoing pretherapy surgical staging. METHODS AND MATERIALS: From 1971-1991, 189 patients underwent pretherapy surgical staging via a retroperitoneal approach (67) or transperitoneal approach (122). Seventy-nine patients had previously experienced a laparotomy. Patients subsequently received a median of 85 Gy to point A. In patients receiving paraaortic radiation, a median of 45 Gy was administered. One hundred and thirty-two (69.8%) patients received hydroxyurea as a radiation sensitizer. RESULTS: Pretherapy surgical evaluation revealed that 21 of 89 (23.6%) Stage II patients and 32 of 85 (37.6%) Stage III patients had paraaortic lymph node metastases. Multivariate logistic regression analysis detailed the significant factors favorably influencing the radiation-induced complication rate to be a retroperitoneal approach of pretherapy surgical staging and no previous laparotomy. Survival was significantly prolonged in patients receiving hydroxyurea, evaluated via a retroperitoneal incision, with negative paraaortic lymph nodes, and with an early stage of disease. CONCLUSION: A retroperitoneal approach to pretherapy surgical staging and absence of previous surgery reduced the incidence of subsequent radiation-induced complications. Despite improvements in the detection of occult disease, prolonged survival is impaired when the therapeutic measures currently available are used.

Adenocarcinoma↗
PubMed1995

Taxol and platinum chemotherapy in the treatment of pancreatic and jejunal carcinoma.

Pancreatic cancer and jejunal cancer are aggressive diseases with grim prognoses. The long term survival of pancreatic carcinoma is still one of the worst of all cancers. Ninety-five percent of the patients die of their disease within 5 years [Wagener et al: Ann Oncol 5(Suppl 3): S87-S90, 1994]. Eighty-five percent of patients with jejunal carcinoma die of their disease within 5 years [Lioe, Biggart: J Clin Pathol 43:533-536, 1990]. To date, there are disappointingly few effective cytotoxic agents in the treatment of these cancers. We present a case of advanced-stage pancreatic carcinoma and a case of advanced stage jejunal carcinoma, each showing marked response to Taxol and platinum chemotherapy.

Adenocarcinoma↗
PubMed1995

Cisplatin, adriamycin, etoposide, megestrol acetate versus melphalan, 5-fluorouracil, medroxyprogesterone acetate in the treatment of endometrial carcinoma.

Fifty consecutive patients with documented advanced or recurrent endometrial carcinoma from 1978 through 1985 were prospectively treated with melphalan, 5-fluorouracil, medroxyprogesterone acetate (MFP) as first-line chemotherapy. From 1987 through 1993, 50 consecutive patients with documented advanced or recurrent endometrial carcinoma were prospectively treated with cisplatin, Adriamycin, etoposide, megestrol acetate (PAV-M) as first-line chemotherapy. Response rates for MFP versus PAV-M, 2- and 5-year survival, median survival, 2- and 5-year progression-free survival, and median progression-free survival were not statistically different. However, there was a significant improvement favoring PAV-M in 2-year (45 versus 14%), 5-year (30 versus 5%), and median survival (22.3 versus 8.7 months) (P = 0.008) compared to MFP in patients with primary advanced endometrial adenocarcinoma. Moreover, there was a significant improvement in 2- and 5-year and median survival (55 and 15% and 26.7 months) for PAV-M compared to MFP (7 and 0% and 7.3 months) (P = 0.002) for the more aggressive other adenocarcinomas (adenosquamous, clear cell, papillary serous, undifferentiated) compared to the more common endometrioid adenocarcinoma. The current data suggest that cisplatin- and adriamycin-based chemotherapy results in some long-term survival benefit for patients with primary advanced endometrial adenocarcinoma and the more aggressive nonendometrioid adenocarcinoma histologies.

Aged↗
PubMed1995

Intestinal perforation secondary to paclitaxel.

Three patients with colonic perforation following paclitaxel therapy are reported. This appears to be a direct drug effect causing mitotic arrest on the gastrointestinal epithelium. Eleven such patients with this complication have now been identified. While infrequent, this is a serious complication with a 57% mortality rate. The exact incidence of this complication is unknown and may have been previously underreported being attributed to progressive disease. A high index of suspicion of this complication should be considered for anyone presenting with abdominal pain following paclitaxel.

Adult↗
PubMed1995

Impact on progression-free survival of adjuvant cyclophosphamide, vincristine, doxorubicin (adriamycin), and dacarbazine (CYVADIC) chemotherapy for stage I uterine sarcoma. A prospective trial.

To assess the impact on progression-free survival of the use of the multiagent chemotherapy regimen of cyclophosphamide, vincristine, doxorubicin (Adriamycin), and dacarbazine (CYVADIC) as adjuvant treatment for patients with stage I uterine sarcoma: 20 evaluable patients who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy for stage I uterine sarcoma received adjuvant multiagent chemotherapy with vincristine sulfate 1 mg/m2 days 1 and 4, doxorubicin (Adriamycin) 40 mg/m2 and cyclophosphamide 400 mg/m2 day 2, and dacarbazine 200 mg/m2 days 1 through 4 for a total of 9 monthly cycles or until recurrence of disease was documented. Patients were followed for a median of 65 months (range: 5-116 months). Myelotoxicity was monitored by weekly complete blood counts, cardiac toxicity by monthly radionuclide angiography, and neurotoxicity by monthly physical examination. Survival and progression-free survival were calculated by the method of Kaplan and Meier (17). The Fisher exact test was employed to determine the significance of recurrence rates between histologic groups (18). These 20 patients received 172 of a planned 180 cycles of chemotherapy. Dose reductions in response to myelotoxicity were necessitated in four cycles among three patients. Mild neurotoxicity was observed in six patients (30%) and moderate neurotoxicity in one patient (5%). A decrease in cardiac ejection fraction of > 10% was observed in two patients (10%). No deaths ascribable to complications arising from chemotherapy were observed. Seven patients (35%) developed recurrence of disease. Recurrence rates for pure sarcomas and mixed mesodermal tumors did not differ significantly (P = .65). Progression-free survival for the population at 2 years was 80% and at 5 years was 65%. This study describes the largest prospective trial of adjuvant combination chemotherapy for patients with stage I uterine sarcoma reported to date. Adjuvant chemotherapy employing the combination of cyclophosphamide, vincristine, doxorubicin (Adriamycin), and dacarbazine (CYVADIC) failed to impact significantly on long-term survival in this group of patients with stage I uterine sarcoma.

Adult↗
PubMed1994

Long term survival by cytoreductive surgery to less than 1 cm, induction weekly cisplatin and monthly cisplatin, doxorubicin, and cyclophosphamide therapy in advanced ovarian adenocarcinoma.

BACKGROUND: Survival rates for patients with advanced epithelial ovarian cancer remain low despite improved chemotherapy regimens and cytoreductive surgery. METHODS: One hundred thirty-six patients with Stage III or IV ovarian cancer were treated with primary cytoreductive surgery followed by cisplatin induction, 1 mg/kg weekly x 4 followed by 10 cycles of cisplatin (50 mg/m2), doxorubicin (50 mg/m2), and cyclophosphamide (750 mg/m2). Second-look surgery was performed on those patients who were clinically without evidence of disease at the end of the planned chemotherapy course. Survival and progression-free survival were calculated, and prognostic factors regarding survival and progression-free survival were evaluated by both univariate and multivariate analyses. RESULTS: Cytoreductive surgery to less than or equal to 2 cm was performed on 83% of patients and to less than 1 cm in 40%. A surgical complete response (SCR) rate of 34.9% and surgical partial response (SPR) rate of 47.6% were noted. Of the SCRs, recurrences developed in 52.7% of the patients. Estimated 5- and 8-year survival for all 136 patients was 31.2% and 21.5%, and 5- and 8-year progression-free survival was 23.9% and 20.6%, respectively. Those patients with less than 1-cm residual disease after primary surgery had significantly improved survival compared with those with 1-2 cm or greater than 2 cm (P < 0.001). Multivariate analysis identified residual disease status and age as the most significant prognostic factors associated with survival and progression-free survival. CONCLUSION: Compared with those patients with greater than 1-cm residuum after initial surgery, a statistically significant improvement in long term survival was noted for those patients whose cancers were cytoreduced to less than 1-cm residuum.

Adenocarcinoma↗
PubMed1994

Evaluation of survival after second-line intraperitoneal cisplatin-based chemotherapy for advanced ovarian cancer.

BACKGROUND: The authors sought to evaluate survival of patients with ovarian cancer treated with second-line intraperitoneal cisplatin-based chemotherapy. METHODS: From August 1985 to September 1991, 63 patients with recurrent or persistent ovarian cancer after first-line cisplatin-based chemotherapy were on a protocol and treated with cisplatin, cytarabine, with or without bleomycin. Eligibility included Stage III/IV invasive adenocarcinoma of the ovary, documentation of the size of residual disease at reoperation, and prior treatment with first-line intravenous cisplatin-based chemotherapy. RESULTS: The median survival from intraperitoneal chemotherapy was 29 months. For patients who responded to first-line chemotherapy and second-line intraperitoneal chemotherapy, the 5-year survival was 60%, but for patients with response to first-line chemotherapy but no response to intraperitoneal chemotherapy the 5-year survival was only 17%, and no patient survived 5 years who did not have a response to first- or second-line therapy (P < 0.0001). There was significant improvement in the 2-year survival from initiation of intraperitoneal chemotherapy for patients with < or = 5 mm residual tumor in greatest dimension (74%), compared with patients with residual tumor larger than 5 mm and smaller than or equal to 2 cm (38%), and patients with residual tumor larger than 2 cm (0%) (P < 0.0001). CONCLUSION: Survival was increased for patients who (1) had a response to first-line intravenous chemotherapy and second-line intraperitoneal chemotherapy and (2) who had residual tumor 5 mm or smaller at the initiation of intraperitoneal therapy. The conclusion that the prolonged survival is secondary to cisplatin-based chemotherapy administered intraperitoneally must be made with caution because survival may have been secondary to the small residual disease at initiation of second-line chemotherapy or the systemic effect of cisplatin.

Adult↗
PubMed1994

Immunoscintigraphy using 111InCyt103 prior to second look laparotomy in ovarian cancer. A pilot study.

A prospective pilot study was performed in order to determine the efficacy of 111InCyt103 (ONCOScintr CR/OV) in the detection of the presence and location, or absence of disease among patients with epithelial ovarian cancer who demonstrated no clinical or biochemical (Ca 125: < 35 mu/ml) evidence of disease at the end of first-line therapy. Among 15 patients who underwent second-look laparotomy, the overall accuracy of the test was 60%. The test demonstrated a sensitivity of 62.5% and a specificity of 57.1%. The predictive value of a positive test was 62.5% and of a negative test was 57.1%. The correct location of disease was predicted in 57% of patients with macroscopically appreciable tumors. ONCOScintr CR/OV offers little appreciable advantage over current modalities in discriminating between the presence or absence of disease among patients with epithelial ovarian cancer who demonstrate no clinical evidence of disease at the end of first-line therapy.

Adult↗
PubMed1994

Lack of activity of 5-fluorouracil plus mitomycin-C as salvage therapy in cisplatin-resistant epithelial ovarian cancer: results of a phase II trial.

Twenty-five patients with progressive, cisplatin-resistant epithelial ovarian cancer received 5-Fluorouracil (5-FU) 500 mg/m2 days one through three and Mitomycin-C 10 mg/m2 every 28 days in a phase II trial. Myelotoxicity manifested as thrombocytopenia resulted in dose reduction, delay of therapy, or discontinuation of treatment in 24% of patients. Only two patients (8%) demonstrated a partial response to therapy. Neither response was durable. The majority of patients (76%) demonstrated progression of disease following a single course of therapy. As utilized in this trial, the combination of 5-FU and Mitomycin-C is not an active salvage regimen for patients with cisplatin-resistant, progressive epithelial ovarian cancer.

Adult↗
PubMed1993

Survival in patients with paraaortic lymph node metastases from endometrial adenocarcinoma clinically limited to the uterus.

PURPOSE: The purpose of this study was (a) to evaluate the incidence of paraaortic lymph node metastasis from adenocarcinoma of the endometrium clinically limited to the uterus (1971 FIGO Stages I and II) and (b) to report the 5 year disease-free survival of patients with histologically documented paraaortic lymph node metastasis from endometrial adenocarcinoma clinically limited to the uterus treated on two separate protocols. METHODS AND MATERIALS: From June 1979 to June 1990, 109 patients underwent staging paraaortic lymphadenectomy or paraaortic lymph node biopsy at the time of total abdominal hysterectomy and bilateral salpingo-oophorectomy for adenocarcinoma of the endometrium clinically limited to the uterus. Patients with histologically documented paraaortic lymph node metastasis were treated on two protocols: (a) pelvic radiation (5,040 cGy) plus progestins or (b) pelvic radiation therapy (5,040 cGy) plus paraaortic radiation (4,500 cGy). RESULTS: Paraaortic lymph node metastases was primarily associated with grade 3 tumors (34.4%) and deep myometrial invasion (42%) and was present in 17.4% (19) of 109 patients. None of the women treated with pelvic radiation therapy and progestins survived five years disease-free. In contrast, the 5 year disease-free survival was 27% for patients treated by pelvic and paraaortic radiation. CONCLUSIONS: Since all patients with macroscopic metastases to the paraaortic lymph nodes developed recurrent cancer and only a small percentage of those with microscopic metastases to the paraaortic lymph nodes survived disease-free at 5 years, improved survival for patients with paraaortic lymph node metastases will necessitate the addition of effective cytotoxic chemotherapy to pelvic and paraaortic radiation.

Adenocarcinoma↗
PubMed1993

Primary peritoneal carcinoma after prophylactic oophorectomy in women with a family history of ovarian cancer. A report of the Gilda Radner Familial Ovarian Cancer Registry.

BACKGROUND: According to previous reports, primary peritoneal carcinoma indistinguishable from primary ovarian adenocarcinoma had developed in five women with a history of familial ovarian cancer who had undergone prophylactic oophorectomy. METHODS: The records from the Gilda Radner Familial Ovarian Cancer Registry were reviewed for instances of prophylactic oophorectomy and cases of primary peritoneal carcinoma occurring after prophylactic oophorectomy. RESULTS: From 1981 through July 1992, the Gilda Radner Familial Ovarian Cancer Registry accessioned 931 families (a total of 2221 cases of familial ovarian cancer). Currently, 324 women in these families have undergone prophylactic oophorectomy as a preventive measure against the subsequent development of ovarian cancer. Primary peritoneal carcinoma indistinguishable histologically from primary ovarian adenocarcinoma has developed in six of these women 1-27 years after prophylactic oophorectomy. CONCLUSIONS: Based on this finding and other reports of such primary peritoneal carcinoma, a prospective international study is planned. This study will compare the incidence of peritoneal carcinoma in first- or second-degree relatives who underwent prophylactic oophorectomy because of a family history of ovarian cancer with that of those who did not undergo prophylactic oophorectomy.

Adenocarcinoma↗
PubMed1993

A phase II study of weekly cisplatin followed by cisplatin and ifosfamide in advanced or recurrent cervical carcinoma.

BACKGROUND: Ifosfamide is an active agent in cisplatin-resistant cervical cancer. To determine the response rate of the combination of cisplatin and ifosfamide, a Phase II study was conducted of the administration of the combination after weekly cisplatin induction therapy. METHODS: Forty-seven patients with advanced or recurrent cervical carcinoma were treated with 1 mg/kg of cisplatin weekly for six courses, followed by 20 mg/m2 of cisplatin and 1.2 g/m2 of ifosfamide daily for 3 days every 28 days. RESULTS: Objective responses were seen in 11 of 40 (27.5%) assessable patients (complete response, 20%; partial response, 7.5%). The duration of response ranged from 3 months to 26+ months (median, 9+ months). All of the patients who responded to the cisplatin-ifosfamide combination initially responded to weekly cisplatin induction therapy. None of the four patients who had previously received chemotherapy responded. Grade 3 or 4 hematologic toxic effects occurred in 17 of 43 patients (39%). Neurologic and urologic toxic effects were infrequent. The current response rates are not better than the prior experience of the authors with other cisplatin combinations. CONCLUSIONS: These results do not confirm the favorable reports of other authors with cisplatin-ifosfamide regimens in cervical carcinoma. The results of ongoing Phase III studies comparing cisplatin-ifosfamide with cisplatin alone in cervical carcinoma are awaited.

Adult↗
PubMed1993

Familial ovarian cancer. A report of 658 families from the Gilda Radner Familial Ovarian Cancer Registry 1981-1991.

BACKGROUND: Because of the small number of cases (five) reported between 1929 and 1969 and a significant increase reported in the decade of the 1970s, the Familial Ovarian Cancer Registry was established in 1981 to study the occurrence of familial ovarian cancer in the United States. METHODS: Any woman (with or without ovarian cancer herself) who contacted the Registry and demonstrated a familial history of ovarian cancer was added to the Registry as an index case. RESULTS: From 1981 through May 31, 1991, 658 families for a total of 1568 cases of familial ovarian cancer were accessioned into the Registry. Of the 219 mothers and 251 daughters with familial ovarian cancer, the mean (58.5 years) and median (57.0 years) age at diagnosis of the mothers was significantly older than the mean (49.8 years) and median (49.0 years) ages of their daughters with ovarian cancer. Significantly more index cases without ovarian cancer had used oral contraceptives as compared to index cases with ovarian cancer (P < 0.001). Significantly more index cases with ovarian cancer used other estrogens as compared to index cases without ovarian cancer (P < 0.001). The Registry cases exhibited a higher proportion of serous adenocarcinoma, poorly differentiated adenocarcinoma, borderline carcinoma, and gonadoblastoma as compared to the 1978 SEER data. Mother and a minimum of one daughter was the most common relationship and was represented in 49.5% of the families with familial ovarian cancer. Sister-sister relationships were the second most frequent and accounted for 38.5% of the 658 families. CONCLUSIONS: Familial ovarian cancer occurs most frequently in mother-daughter relationships followed by sister-sister and appears to be an autosomal dominant inheritance with variable penetrance.

Adult↗
PubMed1993

Predictive value of serum CA125 following optimal cytoreductive surgery during weekly cisplatin induction therapy for advanced ovarian cancer.

One hundred seventy-one patients with epithelial ovarian cancer were treated on a prospective protocol of weekly cisplatin induction (1 mg/kg weekly for four courses) followed by monthly cisplatin (50 mg/m2), Adriamycin (50 mg/m2), and cyclophosphamide (750 mg/m2). Seventy-five patients with FIGO stage III or IV disease who underwent optimal cytoreductive surgery (<2 cm residual disease) were treated on this protocol and had weekly as well as monthly serum CA125 levels measured. A retrospective analysis was performed in order to determine if a > or = 50% fall in elevated serum CA125 levels during weekly cisplatin induction therapy would be predictive of findings at second look operation, normalization of serum CA125 levels (< 35 u/ml) immediately prior to the third course of multiagent chemotherapy, and to determine the impact of such a decline on median progression-free interval. Positive predictive values for this parameter with respect to findings at second look operation ranged between 38% and 50% (P > 0.05). Positive predictive values for this parameter with respect to normalization of serum CA125 levels immediately prior to the third course of multiagent chemotherapy ranged between 64.2% and 89.6% (P > 0.05). Logistic regression analysis demonstrated that a > or = 50% fall observed in CA125 levels during four weekly courses of chemotherapy served as an independent predictor of normalization of serum CA125 levels (<35 u/ml) following two courses of multiagent chemotherapy (P = 0.009) and improved median progression-free interval (P = 0.04). Eighteen patients demonstrated a rise in serum CA125 levels during weekly induction cisplatin chemotherapy. Only one of these patients (5.5%) demonstrated a surgical complete response at the end of standard therapy.

Adult↗
PubMed1993

Vulvar carcinoma with 0.5 mm of invasion and associated inguinal lymph node metastasis.

A case of vulvar carcinoma with 0.5 mm of invasion treated by radical wide local excision only, which later developed ipsilateral inguinal lymph node recurrence, is presented. This represents the least amount of invasion reported resulting in inguinal lymph node metastasis. Review of the literature of stage I vulvar carcinoma with less than 1 mm of invasion indicates that this phenomenon occurs in only 1.6% of all patients who have undergone inguinal lymphadenectomy. Although this represents the second report of ipsilateral inguinal nodal metastasis associated with less than 1 mm of invasion, we continue to perform radical wide local excision without ipsilateral inguinal lymphadenectomy until more cases demonstrate a higher incidence of lymph node involvement.

Aged↗
PubMed1993

Intraoperative orthovoltage radiation therapy in the treatment of recurrent gynecologic malignancies.

A Phase I/II study was initiated to evaluate complications of orthovoltage intraoperative radiation therapy utilized in the treatment of patients with incompletely resected recurrent gynecologic malignancies. There were no osseous, vascular, neurologic, or ureteral complications. Of the 23 treated patients, 2 patients (8.7%) had complications outside the treated area. Survival of patients treated with intraoperative radiation therapy was highest among patients treated to a field of < or = 3 cm in greatest diameter and a tumor thickness of < or = 1 mm. A subgroup of patients (5) with microscopically positive margins following total pelvic exenteration demonstrated an absence of recurrence in the treated field. The role of intraoperative radiation therapy (IORT) in the treatment of recurrent and incompletely resectable gynecologic malignancies remains investigational.

Brachytherapy↗