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P DiSaia

Publications and source records attributed to P DiSaia.

17 recordsLinked to original sources
PubMed1996

Retrospective review of gynecologic oncology patients with therapy-induced neutropenic fever.

We reviewed the course and outcome of gynecologic oncology patients with neutropenic fever (NF), and identified low-risk patients who might be candidates for outpatient management. Charts from patients with the discharge diagnosis of NF from 1990 to 1994 were reviewed for variables related to the febrile neutropenic episode. Outcome was evaluated in terms of the duration of neutropenia, length of hospital stay, NF treatment result, incidence of positive blood cultures, dose reduction in the subsequent course of chemotherapy, and death. Statistical associations between variables and outcome parameters were examined by the Student t test and chi 2 or Fisher's exact tests as indicated. Multivariate analysis by logistic regression was done to determine independent significance of variables. Forty-five episodes of NF were identified involving 40 patients. The median duration of neutropenia following the diagnosis of NF was 2.5 days. The source of fever was unexplained by exam or cultures in 25/45 (56%) episodes. There were two (4%) deaths. In 16/45 episodes, patients had been treated with at least one prior regimen of chemotherapy (median, eight courses). Episodes of NF in patients receiving second-line chemotherapy were associated with a prolonged time of neutropenia (> 3 days, P = 0.058); however, this did not translate into increased hospital stay, treatment failure, or death. Thirteen of 45 (29%) NF episodes developed in patients while already hospitalized for medical or surgical conditions. In this group, cultures were positive in 64% of cases. The remaining 32 NF episodes developed in patients while at home. Patients who developed outpatient NF (ONF) had positive cultures in 23% of cases (P = 0.08) and had a median hospital stay of 4 days. No patient with ONF who remained hemodynamically stable during the first 12 hr of admission suffered serious morbidity. In a multivariate analysis, only bacteremia approached statistical significance in predicting a longer hospital stay (P = 0.07), and no variable studied was predictive of prolonged NF in the ONF group. Our retrospective analysis indicates that patients with ONF who remain stable during the initial 12 hr of hospitalization might safely be discharged home with appropriate antibiotics. Prospective study of outpatient management of NF is required to confirm these findings.

Adult↗
PubMed1995

Endometrioid adenocarcinoma of the ovary and its relationship to endometriosis.

In order to better understand the clinical presentation and biologic behavior of ovarian carcinomas arising in endometriosis, we performed a historical cohort study of all women with endometrioid adenocarcinoma of the ovary (ECO) diagnosed between 1979 and 1991 at our institutions. A review of pathology reports determined the presence or absence of coexisting endometriosis. Cancers adjacent to endometriosis on the same ovary or arising within endometriosis were labeled endometriosis-associated endometrioid adenocarcinoma (EAEA), while all others were considered typical endometrioid adenocarcinoma (TEA). Associations between tumor type and clinicopathologic variables were analyzed by chi 2 and Fisher's exact tests as indicated. Disease-free interval (DFI) and overall survival were estimated using the Kaplan-Meier method. The independent prognostic significance of clinicopathologic variables was determined by multivariate analysis using the Cox proportional hazards regression model. Of 91 ECO patients identified, 63 (69%) had TEA and 28 (31%) had EAEA. Significant differences between TEA and EAEA existed for age at diagnosis (greater than 55 years; 56 vs 32%, P = 0.039), nulliparity (19 vs 46%, P = 0.007), stage (I and II combined; 37 vs 70%, P = 0.004), and disease status at completion of primary surgery (complete tumor resection; 47 vs 70%, P = 0.04). Synchronous atypical endometrial hyperplasia or uterine carcinoma was found in 7/63 (11%) TEA versus 7/28 (25%) EAEA cases (P = 0.054). Estimated 5-year DFI by life table analysis was significantly longer in the EAEA than in the TEA cohorts (57 vs 25%, P = 0.02); however, the 5-year survival difference was not significant (59 vs 45%, P = 0.18). Multivariate analysis identified only stage as an independent prognostic factor in predicting both DFI and survival. In conclusion, women with EAEA are significantly younger, present with earlier stage disease, and have a longer disease-free survival than those with TEA. These factors may reflect a more favorable biologic behavior of ECO when arising in association with endometriosis.

Adult↗
PubMed1995

Metastatic small cell carcinoma to the masseter muscle originating from the uterine cervix.

Metastatic tumors to the head from infraclavicular primaries are relatively uncommon. The vast majority of primary tumors that metastasize to the head originate from the lung and breast. Tumors metastatic to the masseter are exceedingly rare with only one other case being reported in the literature. The case of a 34-year-old woman with a history of surgically-treated small cell carcinoma of the uterine cervix is presented. This case and our review of the literature illustrates the unusual nature of metastatic patterns in the head and their diagnostic complexity. Masses localized to the buccomasseteric region are usually considered to be of parotid origin. The differential diagnosis for masses in this area is generally limited to cogenital, inflammatory, or neoplastic lesions. Though uncommon, metastatic tumors from non-head and neck primary malignancies should be considered in the diagnosis as they may herald the onset of a new disease or the recurrence of cancer.

Adult↗
PubMed1994

What is a normal CA125 level?

CA125 is a coelomic epithelial antigen which is widely used to monitor residual disease in patients undergoing chemotherapy for ovarian cancer. Interpretation of serum CA125 levels has been based on a normal value of 35 U/ml which was derived by screening a young, general population of blood donors which included women with intact reproductive systems. This study addresses the issue of what constitutes a normal serum CA125 level following successful surgical therapy for gynecologic malignancy. Three hundred ninety-three CA125 values were measured in 145 patients after an elapsed time of at least 1 year following completion of surgical therapy for early-stage endometrial or cervical adenocarcinoma. All patients were without evidence of recurrent disease. The mean duration of followup was 4.3 years with a median of 3.7 years. Sixty-seven percent of the CA125 values were less than 10 U/ml; 95% were less than or equal to 20 U/ml. The median value for this patient population was 7.5 U/ml with a mode of 7.1 U/ml. There was no correlation between patient age and CA125 levels. These data suggest that the normal value for CA125 used for patient follow-up after treatment for gynecologic adenocarcinoma needs to be redefined. Our data support an upper limit of normal of 20 U/ml and encourage further study on the clinical impact of this new definition.

Adenocarcinoma↗
PubMed1993

Failure to enhance the in vivo killing of human ovarian carcinoma by sequential treatment with dequalinium chloride and tumor necrosis factor.

Dequalinium chloride (DECA) is a cationic, lipophilic compound with structure similar to the dye rhodamine 123. DECA is selectively accumulated and retained within the mitochondria of carcinoma cells where it acts as a mitochondrial poison by blocking mitochondrial enzymes which can then disrupt cellular energy production, eventually resulting in cell death. In this manner it is similar to the antimitochondrial effects observed with tumor necrosis factor (TNF). We have previously shown that DECA can synergize the in vitro antitumor effects of TNF against a panel of human ovarian cancer cell lines. Those drug studies have been extended to a xenogenic tumor system with a resultant increase in animal survival. Athymic mice were injected intraperitoneally with 2.0 x 10(7) PA-1 human ovarian cancer cells and DECA +/- TNF treatments begun either on Days 3 or 7 postinjection. Peritoneal tumor implantation was not histologically confirmed by Day 3 postinjection but confirmed by Day 7 following tumor cell injection. Single-agent DECA (5 mg/kg; qod) increased animal survival by 37% (P = 0.002) whereas recombinant human TNF (0.5 micrograms/mouse; qod) only increased survival by 13% (P = 0.27) relative to control animals for those animals treated 3 days post-tumor-injection. Sequential DECA/TNF enhanced animal survival by 45% (P = 0.0002) in similarly treated animals. When drug treatment was initiated 7 days following tumor injection, DECA increased survival by 23% (P = 0.04) while TNF had no effect on prolonging animal survival (3% increase; P = 0.79). Combination DECA/TNF increased survival by 23% (P = 0.04). In the UCI-101 ovarian tumor model, single-agent DECA increased survival by 28% (P = 0.04) while TNF treatment stimulated tumor growth (11% decrease in survival; P = 0.006). Combination DECA + TNF resulted in a 41% increase in survival (P = 0.003). No statistical differences were detected between survival rates for single-agent DECA vs DECA + TNF except for the UCI-101 tumor which showed potentiation due to the in vivo stimulatory effects of TNF.

Animals↗
PubMed1993

Measurement of the soluble membrane receptors for tumor necrosis factor and lymphotoxin in the sera of patients with gynecologic malignancy.

The shed portion of the 55 and 75 kDa membrane receptors for tumor necrosis factor (TNF) and lymphotoxin (LT) have been described in the serum of patients with cancer. This study was designed to determine whether serum levels of the 55 and 75 kDa soluble TNF/LT receptors (sTNFr) had clinical significance in patients with gynecologic malignancies. Serum samples from 79 patients with ovarian, endometrial, or cervical cancer were assayed for CA 125 levels by RIA and the 55 and 75 kDa sTNFr levels by ELISA. Receptor and CA 125 levels were also analyzed with respect to disease status and response to treatment in banked serum samples from 14 patients with epithelial ovarian cancer who had been followed clinically for 1-3 years. Patients resulted were compared to serum samples tested from normal donors. We found that serum levels of both sTNFr's were elevated in the 79 patients with various gynecologic malignancies [55 kDa of 3.07 +/- 3.79 ng/ml (P < 0.02) and 75 kDa of 2.93 +/- 1.27 ng/ml (P < 0.001)] compared to 16 normal controls (55 kDa of 0.65 +/- 0.22 ng/ml and 75 kDa of 1.62 +/- 0.37 ng/ml). Serum levels of 55 and 75 kDa TNF/LT receptors were a more sensitive indicator of active cancer and had greater predictive value for detecting tumor in patients with ovarian cancer than CA 125. The sTNFr's were also more sensitive than CA 125 in detecting persistent or recurrent tumor and measuring response to therapy. These preliminary results suggest that measurement of serum levels of 55 and 75 kDa sTNFr's, even though not tumor specific, may be a uniquely new method for identifying and monitoring patients with gynecologic malignancy.

Adult↗
PubMed1992

Comparison of adenocarcinoma and squamous cell carcinoma of the uterine cervix: a population-based epidemiologic study.

OBJECTIVE: Our objective was to compare epidemiologic and clinical characteristics of adenocarcinoma with those of squamous cell carcinoma of the cervix, with respect to risk by ethnic group, age at diagnosis, stage of disease at diagnosis, and survival. STUDY DESIGN: All data were obtained from the Cancer Surveillance Program of Orange County, California, from 1984 through 1989. A total of 152 cases of adenocarcinoma and 457 of squamous cell carcinoma of the uterine cervix were included. RESULTS: Adenocarcinoma of the cervix was diagnosed at a younger age and an earlier stage than squamous cell carcinoma. Hispanics have the highest risk for squamous cell carcinoma, whereas Asians have the highest risk for adenocarcinoma compared with whites. No differences were observed between the two histologic types in prognosis and survival. CONCLUSION: Differences between the two histologic types of cervix cancer were found in the age at diagnosis, the extent of disease, and the ethnic distribution. In spite of these differences, prognosis and survival were not affected by histologic type.

Adenocarcinoma↗
PubMed1992

Immunotherapy of ovarian cancer. II. In vitro generation and characterization of lymphokine-activated killer T cells from the peripheral blood of recurrent ovarian cancer patients.

We examined the in vitro sensitivity of continuous ovarian cancer cells to lymphokine-activated killer T cells (T-LAK) alone or in combination with cytokines. Lymphocyte viability in T-LAK cultures generated from normal donors and ovarian cancer patients declined in the first 2 to 4 days; however, the remaining cells in these cultures maintained a constant rate of proliferation for long periods in vitro. These cells became 90-95% CD3+ TCR+ -alpha/beta T-cells after 7-10 days in culture. The T-LAK cells from normal donors and cancer patients expressed an equal ability to induce lysis of a panel of human target cells (NK-sensitive K562, NK-insensitive RAJI, and two human ovarian tumor lines, SKOV-3 and OVCAR-3), demonstrating that they are nongenetically restricted killers. Preincubation of either the effector or target cells with tumor necrosis factor or interferon-gamma or addition of these cytokines directly to cytolytic assays did not alter the degree of cell lysis in vitro. This is a method for generating large numbers of autologous, cytolytically active T-LAK cells from the blood of ovarian cancer patients that could be employed in adoptive intraperitoneal immunotherapy.

Cell Division↗
PubMed1989

A prospective surgical pathological study of stage I squamous carcinoma of the cervix: a Gynecologic Oncology Group Study.

Thirty-three institutions collaborating in the Gynecologic Oncology Group gathered surgical and pathological data on 1125 patients with primary, previously untreated, histologically confirmed stage I cervical carcinoma with more than 3 mm of invasion who were selected to undergo radical hysterectomy and paraaortic and pelvic lymphadenectomy. Of the 940 eligible, evaluable patients, 732 had squamous carcinoma. Of the study group, 87 (12%) did not undergo radical hysterectomy because of gross disease beyond the uterus or microscopic aortic node involvement documented at exploratory laparotomy. Among the 645 patients undergoing pelvic and paraaortic lymphadenectomy and radical hysterectomy, five risk factors were significantly associated with microscopic pelvic lymph node metastasis: depth of invasion (P = 0.0001), parametrial involvement (P = 0.0001), capillary-lymphatic space invasion (P = 0.0001), tumor grade (P = 0.01), and gross versus occult primary tumor (P = 0.009). The factors identified as independent risk factors for pelvic lymph node metastasis by multivariate analysis were capillary-lymphatic space involvement (P less than 0.0001), depth of invasion (P less than 0.0001), parametrial involvement (P = 0.0005), and age (P = 0.02). The model was used to predict the chance of a patient having nodal metastasis for any combination of risk factors.

Adult↗
PubMed1987

Rotated hypoplastic hemipelvis: a cause of obstructive dyspareunia.

Repeat Chiari innominate osteotomy in a young woman with traumatic monoplegia and subsequent hypoplasia of the hemipelvis and leg resulted in rotation of the pubic ramus into the vagina, causing obstructive dyspareunia. Resection of the inferior pubic ramus through a transperineal approach allowed successful intromission with resolution of her dyspareunia.

Adult↗
PubMed1985

Morphine: continuous intravenous infusion versus intramuscular injections for postoperative pain relief.

Postoperative pain was controlled in 42 patients with either continuous intravenous (iv) or scheduled intramuscular morphine following surgery for gynecologic cancers. In this double-blind study, no statistical differences were found in pain control or rate of complications between the two methods of administration. Both routes were effective in controlling pain without producing major toxicity. Initial doses were based on the patient's weight and then adjusted every 4 hr. We conclude that both methods are safe and effective but that continuous iv infusion is the preferred route because of the ease of administration, elimination of multiple intramuscular injections, and possibly more even pain control.

Adult↗
PubMed1984

Response of psoriasis to red laser light (630 nm) following systemic injection of hematoporphyrin derivative.

Systemically injected hematoporphyrin derivative (HPD) in combination with red laser light (630 nm) was used to treat a patient with intraepithelial neoplasia of the vulva. Since the patient had psoriasis in the mons pubis area this region also was exposed to the red light. The psoriasis treatment area was divided into two regions receiving 40 and 20 J/cm2. Both psoriatic zones responded vigorously to the HPD + light treatment, forming eschars by 1 week postirradiation. All three treatment zones (the neoplastic area and the two psoriatic areas) underwent normal reepithelialization by 17 days.

Adult↗
PubMed1984

Survival and patterns of recurrence in cervical cancer metastatic to periaortic lymph nodes (a Gynecologic Oncology Group study).

Ninety-eight of 621 evaluable patients (16%) with cervical cancer enrolled into Gynecologic Oncology Group protocols were found to have periaortic lymph node metastases at staging laparotomy or at exploration for definitive operative management. As expected there was a progressive increase in the prevalence of periaortic metastases including 5% of 150 patients with Stage IB, 16% of 222 patients with Stage II, and 25% of 135 patients with Stage III. Periaortic lymph node metastases in the absence of pelvic lymph node metastases was an infrequent occurrence in patients so evaluated. The median survival of patients with periaortic metastases was 15.2 months with a survival probability of 25% at 3 years. The median duration of survival following recurrence was only 5 months. Recurrences were divided approximately equally between the pelvis and distant sites.

Adenocarcinoma↗
PubMed1979

A comparison of medroxyprogesterone serum concentrations by the oral or intramuscular route in patients with persistent or recurrent endometrial carcinoma.

A randomized study, comparing serum medroxyprogesterone concentrations by the oral and intramuscular routes, was performed on 22 patients with persistent or recurrent endometrial adenocarcinoma by six institutions of the Gynecologic Oncology Group. The oral group (11 patients) received cutaneous Provera (medroxyprogesterone), 50 mg three times a day, and the intramuscular group (11 patients) received 300 mg of Depo-Provera (medroxyprogesterone) weekly for at least 2 months. Serum levels were evaluated at 0, 2, 4, 6, 8, 10, and 12 hours after administration and every day for the first week and weekly thereafter for 8 weeks. The mean serum levels (nanograms per milliliter) of medroxyprogesterone in the oral group were consistently higher than the corresponding mean levels of the intramuscular group. In addition, from the first through eighth weeks, the measurements (medians) for the oral group were statistically higher than those for the intramuscular group. Although the study indicates a significant increase in serum levels achieved by the oral route, the follow-up period of patients under study is too early to evaluate its clinical effectiveness as compared to the intramuscular route.

Adenocarcinoma↗
PubMed1977

Chemotherapy for mustard-resistant ovarian adenocarcinoma: a randomized trial for CCNU and methyl-CCNU.

In view of the need for drugs which have antitumor activity in alkylating agent-resistant ovarian cancer or which might be more potent than standard agents, a randomized trial of two nitrosoureas, CCNU and methyl-CCNU, has been conducted. Of 31 evaluable patients who received at least one dose of CCNU (100 mg/m2 orally every 6 weeks), there were only two patients who experienced even transient improvement; 18 of these patients had two or more doses over a trial period of greater than or equal to 12 weeks. Of 26 evaluable patients who received at least one dose of methyl-CCNU (150 mg/m2 orally every 6 weeks), there was one patient who experienced transient improvement; this group included 14 patients receiving at least two doses and whose trial lasted greater than or equal 12 weeks. All patients had been previously treated with mustard-type alkylating agents. None of the responses were clinically useful. Thus, women with ovarian adenocarcinoma who have a history of prior chemotherapy are not likely to benefit from treatment with these nitrosoureas.

Adenocarcinoma↗