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R R Barakat

Publications and source records attributed to R R Barakat.

At least 37 records · Page 2Linked to original sources
PubMed1999

The accuracy of frozen-section diagnosis in metastatic breast and colorectal carcinoma to the adnexa.

OBJECTIVE: The objective of our study was to describe the accuracy of intraoperative frozen-section diagnosis of carcinoma metastatic to the adnexa in women with a history of breast or colorectal carcinoma. METHODS: We conducted a retrospective chart review of all patients with a history of breast or colorectal carcinoma who developed histologically proven pelvic or abdominal metastases between 1988 and 1995. In those patients whose final histologic review revealed carcinoma metastatic to the adnexa, the accuracy of the intraoperative frozen-section diagnosis of the adnexal tumor was compared to the final diagnosis. RESULTS: Forty-three patients were identified and in 36 patients the frozen section was obtained from the adnexa. Twenty-one patients (58.3%) had metastatic breast carcinoma and 15 (41.7%) had metastatic colorectal carcinoma to the adnexa. Carcinoma in the adnexa was correctly diagnosed by frozen section in 35 of 36 patients (97.2%). Metastatic carcinoma was identified at frozen section in 17 of 21 patients (81%) with metastatic breast cancer and 13 of 15 patients (86.7%) with metastatic colorectal cancer. In 3 of 21 patients (14.3%) with metastatic breast cancer and in 2 of 15 patients (13.3%) with metastatic colorectal cancer, the frozen-section diagnosis was carcinoma of uncertain origin. One patient had a false-negative frozen section because the small focus of metastatic breast cancer was not sampled at the time of frozen section. CONCLUSION: Intraoperative frozen-section evaluation correctly diagnosed carcinoma in the adnexa in 97% of patients, and in over 80% of cases, the carcinoma was diagnosed as being metastatic in origin.

Adnexa Uteri↗
PubMed1999

Pelvic exenteration for recurrent endometrial cancer.

Pelvic exenteration is generally not considered an operation with curative value for women with recurrent endometrial carcinoma. We reviewed our experience with pelvic exenteration performed in patients with recurrent endometrial adenocarcinoma from 1947 through 1994. A total of 44 patients were identified, with a mean age of 60 years (range 35-69 years). Primary therapy usually consisted of total abdominal hysterectomy with bilateral salpingo-oophorectomy, with most receiving either pre- or postoperative radiotherapy. Prior to exenteration, 10 of 44 (23%) patients had never received any form of radiotherapy. The median interval between initial surgery and exenteration was 28 months (range 2-189 months). The type of exenteration performed was total in 23 patients (52%), anterior in 20 patients (46%), and posterior in 1 patient. Major postoperative complications occurred in 35 patients (80%) and included urinary/intestinal tract fistulas, pelvic abscess, septicemia, pulmonary embolism, and cerebrovascular accident. Median survival for the entire group of patients was 10.2 months. Nine patients (20%) achieved long-term survival (>5 years). Pelvic exenteration for recurrent endometrial cancer is associated with a high operative morbidity and poor overall survival. Although only 20% of patients achieved long-term survival, this procedure remains the only potentially curative option for the few patients with central recurrence of endometrial cancer who have failed surgical and radiation therapy.

Adenocarcinoma↗
PubMed1999

Primary intravenous paclitaxel and platinum chemotherapy for high-risk Stage I epithelial ovarian carcinoma.

OBJECTIVE: To evaluate the efficacy of intravenous (i.v.) paclitaxel and platinum chemotherapy in patients with high-risk Stage I epithelial ovarian carcinoma. METHODS: We performed a retrospective chart review of all patients with Stage I ovarian cancer treated at our institution between March 1993 and June 1995. RESULTS: Twenty patients received adjuvant paclitaxel-containing chemotherapy for Stage I ovarian carcinoma after comprehensive surgical staging. Five patients (25%) had Stage IA disease and 15 patients (75%) had Stage IC disease. Tumor grades were: 1, five patients (25%); 2, nine patients (45%); and 3, six patients (30%). Histologic cell types were: clear-cell, ten (50%); endometrioid, five (25%); mucinous, three (15%); and serous, two (10%). Nineteen patients (95%) were treated with i.v. paclitaxel and platinum chemotherapy. One patient (5%) received i.v. paclitaxel alone. Eighteen patients (90%) had five cycles of chemotherapy, while two patients (10%) had three. The 96 total cycles were associated with nine episodes (9%) of significant toxicity: fever, four (4%); severe nausea and vomiting, two (2%); Clostridium difficile enteritis, one (1%); congestive heart failure, one (1%); and anemia, requiring blood transfusion, one (1%). With a median follow-up of 36 months (range 24-50 mos), all 20 patients are alive, and 19 (95%) are disease-free. The one patient (5%) treated with i.v.++paclitaxel alone developed an abdominal recurrence 22 months after diagnosis. CONCLUSION: Primary i.v.++paclitaxel and platinum chemotherapy in patients with high-risk Stage I epithelial ovarian carcinoma is reasonably well tolerated and may improve survival. Larger studies with long-term follow-up are needed.

Adenocarcinoma↗
PubMed1998

A phase II trial of intraperitoneal cisplatin and etoposide as consolidation therapy in patients with Stage II-IV epithelial ovarian cancer following negative surgical assessment.

PURPOSE: To determine the efficacy of three courses of intraperitoneal (i.p.) cisplatin (CDDP) and etoposide (VP-16) as consolidation therapy following pathologically negative second-look surgical reassessment for Stage IIC-IV epithelial ovarian cancer (EOC). PATIENTS AND METHODS: Between September 1988 and April 1996, 40 patients were treated with three cycles of i.p. CDDP (100 mg/m2)/VP-16 (200 mg/m2) as consolidation therapy. Survival was compared to that of a group of 46 contemporaneous patients undergoing observation only. RESULTS: Median age of the 36 eligible patients was 52 years (range 30-70 years). Stage distribution was II (3), III (31), and IV (2); histologic grade was 1 (2), 2 (7), 3 (25), and not recorded (2); and residual disease at completion of initial surgery was none/microscopic in 13/36 (36%) patients. Median age of the 46 patients who did not receive consolidation was 52 years (range, 27-80 years); stage distribution was II (18), III (26), and IV (2); histologic grade was 1 (5), 2 (12), 3 (28), and not recorded (1). With a median follow-up of 36 months in both groups, 14/36 (39%) of the protocol group have recurred compared with 25/46 (54%) of those undergoing observation alone. Median disease-free survival (DFS) for the observed patients is 28.5 months and has not been reached in the consolidation group. Disease-free survival distribution between the two groups was compared using the log-rank test and was found to be significant (P = 0.03). Multivariate analysis revealed that the only significant predictor of improved DFS was protocol treatment (P < 0.01). CONCLUSION: Intraperitoneal consolidation with CDDP/VP-16 following negative second-look reassessment in patients with advanced EOC resulted in a significant increase in DFS compared to nonprotocol patients treated concurrently who underwent observation alone.

Adult↗
PubMed1998

Gastrointestinal toxicity and Clostridium difficile diarrhea in patients treated with paclitaxel-containing chemotherapy regimens.

OBJECTIVE: The objective of this study was to determine the incidence of grade 3 and 4 gastrointestinal toxicity and the prevalence of Clostridium difficile-associated diarrhea (CDAD) in patients with gynecologic malignancies treated with paclitaxel-based chemotherapy regimens. METHODS: We retrospectively reviewed the medical records of all patients treated on the Gynecology Service at Memorial Sloan-Kettering Cancer Center from January 1, 1993 to July 1, 1996. We identified all patients treated with paclitaxel during this period and determined the total number of patients hospitalized for symptoms of gastrointestinal toxicity, including nausea, vomiting, diarrhea, and dehydration, within 4 weeks of chemotherapy, as well as the incidence of CDAD among these patients. RESULTS: Six hundred and twenty-four patients were treated with paclitaxel-containing chemotherapy regimens during the study period, including 55 patients who were treated on a "dose-dense" high-dose protocol for advanced ovarian cancer. Among these, 149 patients (24%) were hospitalized for symptoms of gastrointestinal toxicity. During the study period, a total of 40 cases of CDAD were reported among hospitalized patients on the Gynecology Service and 24 (60%) of these cases occurred in patients who had received paclitaxel within the prior 4 weeks. CONCLUSIONS: The occurrence of CDAD in patients receiving paclitaxel-containing chemotherapy is not rare and can result in severe dehydration requiring hospitalization. The risk of C. difficile colitis appears to be 2.2% in patients receiving standard-dose regimens and as high as 20% in patients receiving high-dose regimens. This etiology should be considered and treated early in patients presenting with symptoms of gastrointestinal toxicity subsequent to chemotherapy treatments.

Anti-Bacterial Agents↗
PubMed1997

Stage IV ovarian cancer: impact of surgical debulking.

OBJECTIVE: To evaluate the influence of surgical debulking performed on patients with Stage IV ovarian cancer and to determine prognostic factors which identify pts who may benefit from aggressive initial surgical debulking. METHODS: A retrospective chart review was conducted (1/1/87-12/31/93). Eligible patients included all women with FIGO Stage IV ovarian cancer. Clinical information abstracted included age at diagnosis, histology type, tumor grade, criteria for Stage IV classification, surgical procedure performed, and tumor residuum. Optimal surgical status was defined as < or = 2 cm residual disease. Chemotherapy treatment was recorded, as was follow-up. Survival estimates were computed by Kaplan-Meier method with differences in survival calculated by the log-rank test. The Cox proportional hazards regression model was used to identify independent variables which were associated with an improved survival rate. RESULTS: One hundred five women were found in our database with Stage IV ovarian cancer and 97 had complete information available. Median age of the patients was 57 years (range 24-81 years). Papillary-serous histology was found in 55/97 patients (57%) and 50 patients (52%) had grade 3 tumors. Forty-one of 97 patients (42%) had malignant pleural effusion and 20/97 (21%) had liver metastases. Ninety-two patients underwent a primary attempt at surgical debulking and 40/92 were optimally debulked. Twenty-one of 41 patients (51%) with pleural effusion were optimally debulked compared to 20/51 (39%) with other criteria for Stage IV disease (P = NS). Overall median survival was 21 months; optimally debulked patients' median survival was 40 months compared to 18 months for patients with bulky residual disease (P = 0.01). The survival advantage for optimally debulked patients was statistically significant for the two subgroups of patients with and without malignant pleural effusion. In the multivariate analysis only age less than 65 years and optimal debulking were independent predictors of outcome. CONCLUSIONS: Surgical debulking appears to be an important determinant of prognosis in women with Stage IV ovarian cancer, including patients with malignant pleural effusion.

Adult↗
PubMed1997

Chemotherapy and total parenteral nutrition for advanced ovarian cancer with bowel obstruction.

We retrospectively reviewed the medical records of 21 patients with advanced epithelial ovarian carcinoma treated with intravenous chemotherapy in an attempt to restore intestinal function following small-bowel obstruction. All patients had a drainage gastrostomy tube placed for palliation of vomiting, and 11 patients received concomitant total parenteral nutrition (TPN). Eight (38%) patients were treated with single-agent paclitaxel, 7 (33%) received platinum-based regimens, and 6 (29%) received other second-line chemotherapy. The median survival for all patients post-gastrostomy tube placement was 84 days. The median survival for patients with recurrent ovarian cancer who received salvage chemotherapy and TPN was 89 days, longer than for patients who received salvage chemotherapy alone (71 days) (P = 0.031). Two of three patients with newly diagnosed ovarian cancer and concomitant bowel obstruction had sufficient temporary response from chemotherapy with resolution of obstruction and removal of the gastrostomy tube. Chemotherapy was ineffective in restoring bowel function in heavily pretreated patients with recurrent disease.

Adult↗
PubMed1997

Metastatic breast carcinoma to the abdomen and pelvis.

OBJECTIVE: The role of surgical resection of metastatic breast cancer to the abdomen and pelvis is controversial. The objective of this study is to describe the characteristics, surgical management, and outcome of women with a history of breast adenocarcinoma who developed abdominal or pelvic metastases during follow-up. METHODS: We retrospectively reviewed the medical records of 40 female patients with documented invasive breast cancer who were referred to the Gynecology Service between 1986 and 1995 and were found to have metachronous abdominal and/or pelvic metastases. RESULTS: The median patient age at exploration by the Gynecology Service was 53.5 years (range 27-79 years), and the median interval from breast cancer diagnosis to exploration was 80 months (range 9-264 months). The majority of patients, 32 (80%), had a preoperative diagnosis of a new pelvic mass or suspected abdominal carcinomatosis. With a median follow-up of 14.2 months following the diagnosis of abdominal or pelvic metastasis, the median survival for all patients was 24.1 months. Patients who had no gross residual disease in the abdomen or pelvis after surgery had a median survival of 41.6 months, which did not significantly differ from those with gross residual < or =2 cm (16.1 months) or >2 cm (18.4 months) (P = 0.624). CONCLUSION: Metachronous abdominal and pelvic metastases from breast cancer may appear many years following initial diagnosis and are often operated on by gynecologists because of their clinical presentation. Surgical resection may be indicated in some symptomatic patients; however, the survival advantage of surgical cytoreduction remains to be determined.

Abdominal Neoplasms↗
PubMed1997

Hepatic resection for metastatic gynecologic carcinomas.

OBJECTIVE: To report a series of cases of hepatic resection for metastatic gynecologic carcinomas. METHODS: We reviewed the records of all patients who underwent hepatic resection for metachronous liver metastases from gynecologic carcinomas at our institution from 1986 to 1996. RESULTS: Twelve patients were identified with a median age of 60 years (range 30-73 years). The primary sites of carcinoma were as follows: ovary, 7 (58%); cervix, 2 (17%); endometrium, 2 (17%); and fallopian tube, 1 (8%). The median disease-free interval before the diagnosis of liver metastasis was 32 months (range 1-243 months). The types of liver resections were as follows: trisegmentectomy, 4 (33%); lobectomy, 4 (33%); segmentectomy, 3 (25%); and wedge resection, 1 (8%). To remove all visible tumor with adequate margins, additional surgery included the following: resection of a portion of the diaphragm, 5 (42%); wedge resection of the right lung, 3 (25%); resection of a portion of the pericardium, 2 (17%); and adrenalectomy, 1 (8%). One patient (8%) had pulmonary wedge resections of bilateral pulmonary metastases. There was no perioperative mortality. Ten patients (83%) received additional chemotherapy. With a median follow-up of 25 months (range 8-94 months), the median survival time is 27 months. Three patients (25%) have no evidence of tumor recurrence at 8, 17, and 38 months of follow-up. Nine patients (75%) have had tumor recurrence at a median of 12 months from the time of surgery. CONCLUSIONS: Hepatic resection of metachronous metastases from gynecologic carcinomas can be performed safely and may help prolong survival in carefully selected patients.

Adult↗
PubMed1997

The role of surgical cytoreduction in Stage IV endometrial carcinoma.

OBJECTIVE: To evaluate the impact of surgical cytoreduction in patients (pts) with Stage IV endometrial adenocarcinoma. METHODS: We performed a retrospective chart review of all pts with Stage IV endometrial carcinoma treated at our institution from January, 1977, to February, 1995. RESULTS: Fifty-five patients who underwent surgery as part of their primary treatment for Stage IV endometrial carcinoma were identified. They were divided into three groups: Group I consisted of 24 pts (44%) who underwent optimal surgical cytoreduction (diameter of largest residual tumor nodule < or = 2 cm); Group II contained 21 pts (38%) who underwent suboptimal surgical cytoreduction (> 2 cm residual disease); Group III consisted of 10 pts (18%) who had unresectable carcinomatosis and had no cytoreduction at all. There were no statistically significant differences between the three groups with respect to median age at diagnosis, tumor grade, histologic subtype, or the presence of extra-abdominal metastases. The median survival rates for the three groups were I, 31 months; II, 12 months; and III, 3 months (P < 0.01). Within Group I, there was no statistically significant difference in survival between the 8 pts who were found at laparotomy to have metastatic disease < or = 2 cm and the 16 pts who initially had metastatic disease > 2 cm and were subsequently cytoreduced to optimal status. On multivariate analysis only the extent of surgical cytoreduction had prognostic significance on survival. CONCLUSION: The prognosis of Stage IV endometrial carcinoma is poor. However, the data in this series suggest that aggressive tumor cytoreduction may improve survival in these patients.

Adenocarcinoma↗
PubMed1997

Ovarian and uterine disease in women with colorectal cancer.

OBJECTIVE: To identify the nature of adnexal and uterine disease in women with a history of colorectal adenocarcinoma who develop new pelvic masses or uterine cancers during follow-up. METHODS: We conducted a retrospective chart review of the Memorial Hospital Gynecology Service database and identified 50 women, each with a history of colorectal carcinoma who underwent a hysterectomy or adnexectomy between January 1, 1977, and February 29, 1996. Subject characteristics, indications for re-operation, and findings at surgery were recorded. RESULTS: The mean age at re-operation was 66 years (range, 37-76), with a median interval from initial diagnosis to re-operation of 25 months (range, 3-444). Indications for re-operation were: 1) new pelvic mass in 35 women, and 2) cancer on endometrial or cervical biopsy in 15. Twenty-six of the 35 (74%) women who presented with a pelvic mass had a malignancy in the ovary, with metastatic colon cancer noted in 20 of 26 (77%) women, and epithelial ovarian cancer in six of 26 (23%). The mean ovarian tumor size for metastatic colorectal carcinoma, ovarian cancer, and benign tumors was 15, 8, and 6 cm, respectively. Fifteen women underwent hysterectomy for a newly diagnosed cancer in the uterus, with the majority, 11 (73%), having endometrial adenocarcinoma, followed by metastatic colon cancer to the endometrium or cervix in three (20%) women, and primary cervical carcinoma in one. CONCLUSION: Women with a history of colorectal cancer who underwent adnexectomy for a new pelvic mass had metastatic colon cancer to the ovary in 57%, benign ovarian neoplasm in 26%, and primary ovarian cancer in 17% of cases. Women who underwent hysterectomy for a newly diagnosed carcinoma in the uterus had primary endometrial adenocarcinoma in 73% and metastatic colon cancer in 20% of cases.

Adenocarcinoma↗
PubMed1997

Endometrial thickness in tamoxifen-treated patients: correlation with clinical and pathologic findings.

OBJECTIVE: This study was performed to evaluate sonographic measurements of endometrial thickness in postmenopausal breast cancer patients being treated with tamoxifen and to correlate endometrial thickness with pathology, symptoms, and duration of tamoxifen treatment. MATERIALS AND METHODS: Pelvic sonograms and medical records of 91 postmenopausal breast cancer patients being treated with tamoxifen were retrospectively reviewed. Histologic results were available in 46 patients (51%). Endometrial thickness was measured in anteroposterior dimension and was considered normal when less than 8 mm. Endometrial thickness was then correlated with histopathologic findings, symptoms, and duration of tamoxifen treatment. RESULTS: Forty-seven examinations (52%) showed endometrial thickness of less than 8 mm and 44 examinations (48%) showed endometrial thickness of 8 mm or more. Endometrial biopsy was performed in 10 women (21%) in whom the endometrial thickness was less than 8 mm, revealing seven normal endometria, one endometrial polyp, and two insufficient samples. Endometrial biopsy was performed in 36 women (82%) in whom endometrial thickness was 8 mm or more, revealing three cases with more than one diagnosis. In this group, diagnoses included 14 normal endometria, 12 endometrial polyps, four endocervical polyps, three hyperplasias, two endometrial cancers, one papillary syncytial metaplasia, one cystic change, one inflammatory debris, and one insufficient sample. Postmenopausal bleeding prompted 20 studies, 12 of which revealed endometrial thickness of 8 mm or more. We found no difference in endometrial thickness of patients who had bleeding versus those who had no bleeding. Endometrial thickness increased with the duration of tamoxifen treatment. Seventy-three women being treated with tamoxifen for less than 5 years had a median endometrial thickness of 5 mm, and 44% of biopsies yielded abnormal results. Eighteen women receiving tamoxifen 5 years or longer had a median endometrial thickness of 14 mm, and 58% of endometrial biopsies in this group were abnormal. The two endometrial cancers occurred in women who were treated with tamoxifen for 6 years. Correlation between duration of tamoxifen use and endometrial thickness was significant (p < .026). CONCLUSION: The majority of women being treated with tamoxifen were asymptomatic, but 48% of sonograms revealed an endometrial thickness of 8 mm or more. Endometrial polyps, the most common abnormality, were diagnosed in 33% of biopsies performed for endometrial thickness of 8 mm or more. Endometrial thickness showed no correlation with symptoms, but we found a statistically significant correlation between increased endometrial thickness and duration of tamoxifen treatment that was longer than 5 years.

Antineoplastic Agents, Hormonal↗
PubMed1997

Benign and hyperplastic endometrial changes associated with tamoxifen use.

For nearly 20 years, tamoxifen has been successfully used in the management of breast cancer. Tamoxifen is a mixed estrogen agonist/antagonist that has a proliferative effect on the endometrium. The drug has been associated with a higher percentage of endometrial polyps and hyperplasia than in control patients as well as slightly increased risk of endometrial cancer. Although patients need to undergo annual gynecologic exams and abnormal vaginal bleeding needs to be aggressively followed up, the utility of routine gynecologic screening of tamoxifen patients has not been established and requires further study. Transvaginal sonography is a useful tool for detecting endometrial proliferation; however, an appropriate cut-off point for further intervention must be established. A cut-off point that is too low for abnormal endometrial thickness would result in a large number of unnecessary endometrial biopsies. Routine office endometrial biopsy needs further study as a screening method for breast cancer patients on tamoxifen.

Clinical Trials as Topic↗
PubMed1997

Salvage intraperitoneal therapy of advanced epithelial ovarian cancer: impact of retroperitoneal nodal disease.

PURPOSE: The objective of this study was to evaluate the impact of retroperitoneal lymph node disease on the efficacy of salvage intraperitoneal (IP) chemotherapy for advanced epithelial ovarian cancer. METHODS: We retrospectively reviewed the records of 41 patients with advanced epithelial ovarian cancer treated between 9/83-7/95, who had undergone retroperitoneal nodal sampling prior to salvage intraperitoneal chemotherapy. RESULTS: Of the 41 patients treated with debulking surgery and platinum-based chemotherapy, 19 (46%) had disease noted in retroperitoneal lymph nodes at initial surgery or at reassessment laparotomy, while 22 (54%) had biopsy-proven negative nodes. The mean age of the node-positive group was 49 years. Residual disease prior to initiation of IP therapy was optimal (< or = 2 cm) in 16 patients and suboptimal in 3. Twenty-two patients with a mean age of 55 were found to be node-negative. Residual disease prior to initiation of intraperitoneal therapy was optimal (< or = 2 cm) in all 22 patients. All patients received salvage intraperitoneal chemotherapy. With a median follow-up of 26 months since surgical reassessment, the median survival in the node-positive group is 31 months compared to 40 months for the node-negative group (p = 0.47). CONCLUSIONS: The presence of retroperitoneal nodal disease does not appear to be a contraindication to the use of salvage IP chemotherapy in advanced ovarian cancer.

Adult↗
PubMed1997

A case-case analysis of factors related to overexpression of p53 in endometrial cancer following breast cancer.

We studied 54 patients diagnosed with endometrial cancer between 1981 and 1994 following a diagnosis of breast cancer. We used a case-case analysis, comparing tumors with and without overexpression of the p53 gene product to evaluate the association of putative p53 mutations with tamoxifen use and other risk factors for endometrial cancer. Twenty-four % of the tumors showed strong positive staining for the p53 gene product. Tumors in a more advanced stage (stage 2, 3, or 4, compared to stage 1) were more likely to overexpress p53 [odds ratio (OR) = 4.2; 95% confidence interval (CI), 1.1-16.2], as were tumors with serous or clear cell, compared to endometrioid, histology (OR = 5.8; 95% CI, 1.3-26.5). There was a small association between p53 overexpression and treatment with tamoxifen for breast cancer (OR = 2.6; 95% CI, 0.69-9.8). There was a strong relationship between overexpression of p53 and having a first-degree relative with breast cancer (OR = 12.3; 95% CI, 2.6-57.4) and between overexpression of p53 and having an additional cancer, i.e., at sites other than breast or endometrium (OR = 7.9; 95% CI, 1.6-40.1). In this group of women, genetic predisposition to cancer, as reflected in family history of breast cancer and personal history of an additional primary cancer, was strongly associated with overexpression of p53 in endometrial tumors. The results suggest that use of tamoxifen may be associated with an increase in tumors that overexpress p53, although the results could be due to chance.

Adult↗