The aim of the present study was to evaluate the clinical usefulness of the cytokeratin tumor marker tissue polypeptide antigen (TPA) in patients with vulvar cancer. This retrospective study comprises 41 patients with vulvar cancer FIGO stages I-III, 17 patients with vulvar intraepithelial neoplasia (VIN) III, and 40 healthy female controls. Serum concentrations of TPA were measured using a microparticle enzyme immunoassay. Results were correlated to clinical data. Median serum concentrations of TPA in healthy female controls, patients with VIN III, and patients with vulvar cancer were 42 U/l (range 12-192), 53 U/l (range 17-127.9) and 57 U/l (range 4.2-423), respectively (Mann-Whitney U test, p = 0.8). Serum concentrations of TPA were not associated with stage of disease, histological grade, and age at the time of diagnosis. In vulvar cancer patients, elevated serum concentrations of TPA prior to therapy were not associated with a shortened disease-free or overall survival (log-rank test: p = 0.5 and p = 0.9, respectively). In a multivariate Cox regression model comprising tumor stage and TPA, tumor stage, but not TPA revealed a statistically significant influence on disease-free (Cox proportional hazard regression model, p = 0.05 and p = 0.6, respectively) and overall (Cox proportional hazard regression model, p = 0.04 and p = 0.8, respectively) survival of patients with vulvar cancer. We conclude that cytokeratin expression, as reflected by serum concentrations of TPA, does not play a role in the natural history of vulvar cancer. The evaluation of serum concentrations of TPA prior to therapy is not recommended.

Age Factors↗

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P53 antibody response in patients with vulvar cancer.

BACKGROUND: Mutations in the p53 tumor suppressor gene are the most common genetic changes identified in cancer cells. Several studies report alterations of the p53 gene in vulvar cancer. As observed in a wide variety of human malignomas, mutant p53 protein may provoke a specific humoral immune response. The possible occurrence of p53 antibodies in patients with vulvar cancer has not been investigated so far. MATERIALS AND METHODS: We used a specific p53 antibody ELISA to investigate serum samples of 41 patients with vulvar cancer taken prior to therapy and serum samples of 17 healthy controls. RESULTS: Of the 41 patients with vulvar cancer, 4 (10%) were found to be positive for serum p53 antibodies, contrary to the 17 healthy volunteers without p53 serum antibodies (chi-square test, p = 0.2). No significant correlations were found between p53 antibody status and tumor stage (p = 0.64), histological grade (p = 0.89), and patients' age (p = 0.87). We found no significant association between the p53 serum antibody status in vulvar cancer patients and disease-free (p = 0.67) and overall survival (p = 0.7). CONCLUSIONS: In summary, it is the first time that p53 antibodies have been detected in the sera of patients with vulvar cancer. However, p53 serum antibodies did not serve as prognostic markers in vulvar cancer.

Adult↗

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Knowledge of tumor markers and the psychological consequences of tumor marker sampling in patients with gynecologic cancers.

BACKGROUND: The aim of this study was to investigate the extent of knowledge about serum tumor markers in patients suffering from gynecologic cancer. MATERIALS AND METHODS: 360 women with a median age of 60 years (range: 26-88 years) visiting the oncological outpatient clinic of the Department of Gynecology and Obstetrics of the University of Vienna, between February and July 1998, were asked to complete a self-report questionnaire. RESULTS: The majority of patients (85.2%) believed it was important to know about tumor markers and felt safe when they knew the recent level of the tumor marker (71.6%). On the other hand, many patients felt they were insufficiently informed (43%). 88.9% of the patients did not know the recent serum level of the tumor marker. The patients who had been informed by a physician were significantly better informed about tumor markers than women relying on other sources such as nurses, relatives or other patients (p < 0.001). Patients with an age of more than 65 years significantly less frequently knew the meaning of tumor markers (p < 0.001). Fewer women suffering from ovarian cancer were uninformed about tumor markers as compared to women suffering from other malignancies (p < 0.001). CONCLUSION: We conclude that the majority of patients in oncological follow-up are interested in tumor markers and want to be informed about these substances. Periodical serum tumor marker sampling is regarded as a safety measure by patients, but information about tumor markers should be improved.

Adult↗

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Paclitaxel/carboplatin as first-line chemotherapy in advanced ovarian cancer: efficacy and adverse effects with special consideration of peripheral neurotoxicity.

BACKGROUND: The aim of this study was to investigate the response and survival probability of patients with advanced ovarian cancer treated with a combination of paclitaxel and carboplatin as first-line chemotherapy. Additionally we investigated the extent of adverse effects due to chemotherapy with special consideration for peripheral neurotoxicity. MATERIALS AND METHODS: Thirty-seven women with epithelial ovarian cancer, treated with a combination chemotherapy consisting of paclitaxel and carboplatin, were included in the analysis. A total of 234 courses of paclitaxel/carboplatin were applied. Paclitaxel was administered at a dose of 175 mg/m2, infused over 3 hours, every 21 days. Carboplatin was administered at an area under the concentration-time curve (AUC) of 6. RESULTS: Thirty of the 37 patients responded to the chemotherapy, demonstrating an overall response of 81%. Seven patients died of the disease (19%). The mean overall survival was 20 months (25% quartile: 19, median and 75% quartile not reached). Thirteen patients (34%) developed peripheral neurotoxicity. In 10 cases (76%) neurotoxicity occurred after the fifth and sixth chemotherapy cycle. In all cases of severe neurotoxicity pathologic sensory nerve conduction-measurements were observed. In one patient a weakness of the left leg was observed. Apart from alopecia, other adverse effects were rare. CONCLUSION: This study confirmed the therapeutic benefit of the combination of paclitaxel and carboplatin as first-line chemotherapy in patients with ovarian cancer. Neurologic toxicity, increasing with every cycle of the chemotherapy, was a clinically significant adverse effect in our study. However, peripheral neuropathy mainly affected sensory fibers, without involving motor nerves.

Adenocarcinoma↗

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A paclitaxel-containing chemotherapy does not cause central nervous adverse effects: a prospective study in patients with ovarian cancer.

BACKGROUND: The objective of this study was to evaluate the possible effects of a paclitaxel containing chemotherapy on different neuropsychological parameters in women with ovarian cancer. MATERIALS AND METHODS: Twenty-eight women with histologically documented epithelial ovarian carcinoma and treated with a combination chemotherapy consisting of paclitaxel and carboplatin entered the study. The patients were tested with a battery of different neuropsychological tests before, after 3 cycles and at the end of the chemotherapy. RESULTS: Twenty of the 28 patients responded to the chemotherapy (71%). Eleven patients (39%) developed peripheral neurotoxicity. The median values of 6 tests performed before the first chemotherapy cycle scored out of the normal range. These patients with deviant test results at the beginning of the paclitaxel/carboplatin infusions did not deteriorate during chemotherapy. We found a statistically significant improvement of the alphabetical cross out test from the first to the third measurement (mean increase = 4.07; 95% confidence interval = [0.99; 7.15]) (p < 0.05), indicating an improvement of the short-term attention, the concentration and the constancy of working during chemotherapy. The other tests failed to show statistically significant changes during chemotherapy (p > 0.05). CONCLUSION: According to our results, a chemotherapy consisting of paclitaxel/carboplatin caused no signs of acute central nervous toxicity or neuropsychological deterioration.

Adenocarcinoma↗

PubMedDate not supplied

Paclitaxel-carboplatin chemotherapy does not cause encephalopathy in patients with ovarian cancer: a prospective EEG mapping study in 28 patients.

BACKGROUND: The objective of this study was to evaluate possible effects of a paclitaxel containing chemotherapy, on the central nervous system (CNS) in women with ovarian cancer. MATERIALS AND METHODS: Twenty-eight women with histologically documented epithelial ovarian carcinoma and treated with a combination chemotherapy consisting of paclitaxel and carboplatin entered the study. Patients were tested with resting EEG (R-EEG) before and after chemotherapy. RESULTS: Twenty of the 28 patients responded to the chemotherapy (71%). Eleven patients (39%) developed peripheral neurotoxicity. A decrease of beta power and an increase of delta and theta power as well as a deceleration of the total centroid frequency clearly demonstrated a reduced vigilance in patients with ovarian cancer compared to healthy controls. On the other hand, the observed increase of beta power, a decrease of delta and theta power, and an acceleration of the total centroid from pre- to post-treatment demonstrated an improvement of vigilance in patients with ovarian cancer after treatment with paclitaxel/carboplatin. CONCLUSIONS: The results of this study suggest that chemotherapy consisting of paclitaxel and carboplatin does not cause adverse effects on the central nervous system. Improved vigilance was measured in patients with ovarian cancer after chemotherapy.

Adenocarcinoma↗

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Serum levels of angiogenin (ANG) in invasive cervical cancer and in cervical intraepithelial neoplasia (CIN).

BACKGROUND: The propensity of malignant tumors to increase in size, to invade locally and to metastasize is dependent on angiogenesis, which is induced by a variety of proteins including the family of fibroblast growth factors, vascular endothelial growth factor and angiogenin (ANG). The aim of the present study was to measure the serum levels of ANG in patients with CIN and invasive cervical cancer and to evaluate a possible correlation between ANG and various clinicopathologic parameters. MATERIALS AND METHODS: Blood was collected from 62 patients with invasive cervical cancer and 47 patients with CIN. Serum samples of 30 age-matched healthy women acting as a control group were obtained. Determination of serum levels of ANG was performed using a quantitative human ANG immunoassay. RESULTS: The overall median ANG serum level was 272.0 pg/ml (range 101.6-869.2). The median serum levels of ANG were 248.9 (range 101.6-307.2) for healthy female controls, 246.8 (range 169.7-468.1) for patients with CIN and 308.1 pg/ml (range 180.1-869.2) for patients with invasive cervical cancer. Serum levels of ANG were significantly elevated in patients with invasive cervical cancer compared with patients with CIN (p < 0.05) as well as healthy female controls (p < 0.05). No difference was found between ANG serum levels in women with CIN, and healthy controls (p < 0.05). No correlations were found between serum levels of ANG and clinico-pathologic parameters (p > 0.05). CONCLUSIONS: Our data indicate the important role of ANG in tumor angiogenesis in invasive cervical cancer as ANG serum levels were significantly elevated in these patients. However, elevated ANG serum levels seem to occur only after the transformation from pre-invasive to invasive lesions.

Adenocarcinoma↗

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Prognostic parameters in carcinosarcomas of the uterus: a clinico-pathologic study.

BACKGROUND: Carcinosarcomas of the uterus are highly aggressive malignant neoplasms with early lymphatic and hematogenous spread. The most important prognostic factor in carcinosarcoma is the extent of the tumor at the time of diagnosis. The prognostic impact of other factors such as myometrial invasion, menopausal age, age, parity and adjuvant therapy is still being discussed controversially. MATERIALS AND METHODS: Nineteen patients with histologically proven carcinosarcoma were included in the analysis. The patients were staged according to a modification of the International Federation of Gynecology and Obstetrics (FIGO) staging system for endometrial cancer. For each patient, the histological material was reviewed by an experienced pathologist. Carcinosarcoma was defined histologically as any tumor of uterine origin composed of carcinomatous and sarcomatous components. RESULTS: The median follow-up time was 91 months (25% quartile, 47 months; 75% quartile, 145 months). The median overall survival of the 19 patients was 59 months, resulting in a 5-year overall survival rate of 43%. Three out of the nineteen (16%) patients demonstrated progressive disease while 6 out of 10 (32%) patients developed recurrent disease with a median disease free survival of 16 months (range 8-54). Eleven out of nineteen (58%) patients died of the disease. A univariate model revealed that early tumor stage (stage 1) (p<0.023), low myometrial invasion (p<0.017) and late onset of the menopause (p<0.050) were significantly associated with a lengthened overall survival in patients with carcinosarcoma. Age (p=0.34), parity (p=0.16) and adjuvant radiotherapy (p=0.45) did not influence overall survival of patients with carcinosarcoma. CONCLUSION: Early tumor stage, low myometrial invasion and late onset of the menopause are associated with a lengthened overall survival in patients with carcinosarcoma.

Adult↗

PubMedDate not supplied

Fibrosarcoma of the uterus: a case report.

BACKGROUND: This case report presents the management of a patient with fibrosarcoma of the uterus. Until recently, no cases of fibrosarcomas of the uterus have been reported in the literature. CASE REPORT: A 40-year-old woman presented with complaints of slight vaginal bleeding, watery, white discharge and abdominal pain of 3 weeks' duration. The patient underwent total abdominal hysterectomy. Intraoperative findings included an enlarged irregular-shaped uterus with lots of leiomyoma nodules. The largest leiomyoma nodule was about 8 cm in size and contained an area classified as a fibrosarcoma, presenting cellular immature-appearing fibroblasts growing in a fascicular arrangement. Because of the limited extension of the fibrosarcoma, no adjuvant therapy was performed. After surgical therapy the patient was followed without any evidence of disease for five years. CONCLUSION: Fibrosarcoma is a poorly-circumscribed infiltrative spindle soft tissue sarcoma, which is characterized by local growth and has a propensity for local recurrence. Metastases can occur, mostly to lung and bone. The treatment of choice is wide surgical excision usually followed by radiation therapy due to the high local recurrence rate.

Adult↗

PubMedDate not supplied

Does long-term application of granulocyte colony-stimulating factor adversely influence overall survival in patients with ovarian cancer? A clinical study.

The purpose of this study was to investigate the effect of long-term administration of G-CSF with regard to its impact on overall survival of patients with ovarian cancer. We report the results of a non-randomized trial on 64 patients with advanced ovarian cancer treated with 6 cycles of conventional chemotherapy. Chemotherapy comprised carboplatin 400 mg/m2 and epirubicin 70 mg/m2 on day 1 of each cycle and prednimustine 100 mg/m2 on days 3 to 7, every 28 days. Thirty-three patients received CEP chemotherapy with G-CSF support whereas 31 women received CEP chemotherapy alone. The schedule of G-CSF was 5 mg/kg/day subcutanously on days 8 to 21 of each cycle. The severity of reduction in white cells and neutrophil count was significantly different in the two treatment groups (p<0.05), with more toxicity in the non- G-CSF group. G-CSF users had a non significant 0.88-fold lower risk of dying from ovarian cancer (95% CI, 0.48-1.60, p=0.678). In a survival analysis using a Cox proportional hazards model, residual tumor remained as an independent prognostic factor. The increasing amount of residual tumor resulted in a 1.767-fold higher risk (95% CI, 1.23-2.53, p=0.002) of death secondary to the underlying disease. In conclusion, this trial has failed to demonstrate any negative impact on patients' overall survival for the additional use of G-CSF with platinum-based chemotherapy; our results were consistent with the beneficial effects of G-CSF treatment on cytotoxic chemotherapy-induced myelosuppression.

Adult↗

PubMedDate not supplied

Clinical experience with intraaortic balloon pumps.

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Aged↗