Speciality
Spotlight

 




 


Obstetric & Gynaecology


 

 




Gynaecologic
Malignancies

   

  


  • Rose
    PG, Bundy BN, Watkins EB, et al [Case Western
    Reserve Univ, Cleveland, Ohio; Roswell Park Cancer
    Inst, Buffalo, NY; Walter Reed Army Med Ctr,
    Washington, DC; et al]

    Concurrent
    Cisplatin-based Radiotherapy and Chemotheapy for
    Locally Advanced Cervical Cancer

    N
    Engl J Med 340: 1144-1153, 1999

         

    The
    study of 526 patients with locally advanced cervical
    cancer from stage IIB to IVA were randomize to
    cisplatin 40mg/m2 per week for 6 weeks [
    group I] or cisplatin 50mg/m2 followed by
    5 fluorouracil 4g/m2 given as 96 hour
    infusion on day 1 and day 29 and 6 weeks [group 2]
    or 3gm/m2 of oral hydroxyurea twice
    weekly for 6 weeks.

     

    Both
    groups [group 1 and group 2] who received cisplatin
    had a significantly higher rate of progression free
    survival.  The
    overall survival rate was significantly higher for
    patients in group I & Group II.

        

  • Keys
    HM, Bundy BN, Stehman FB, et al [Albany Med College,
    NY: Rosewell Park Cancer Inst, Buffalo, NY; Indiana
    Univ, Indianapolis; et al]

    Cisplatin,
    Radiation, and Adjuvant Hysterectomy Compared with
    Radiation and Adjuvant Hysterectomy for Bulky Stage
    IB Cervival Carcinoma

    N
    Engl J Med 340: 1154-1161, 1999

      

    The
    optimal treatment for stage IB cervival carcinoma is
    controversial.

     

    This
    study of 369 patients with biopsy proven stage IB
    cervical cancer without lymphadenopathy underwent
    radiotheapy and hysterectomy. These were randomized
    to weekly cisplant during radiotherapy for 6 weeks
    or only radiotherapy.
    3-6 weeks after radiotherapy extrafascial
    hysterectomy
    was carried out. The rate of progression-free
    survival and overall survival were significantly
    higher in cisplatium group than in placebo group.
    This study has bought out that concurrent
    chemotherapy and radiotherapy as new standard
    of care for stage IB cervical cancer.

          

  • Morris
    M, Eifel PJ, Lu, J, et al [Univ of Texas MD Anderson
    Cancer Ctr, Houston; Radiation Therapy Oncology
    Group, Philadelphia; Washington Univ, St Louis; et
    al]

    Pelvic
    Radiation With Concurrent Chemotherapy Compared With
    Pelvic and Para-aortic Radiation for High-Risk
    Cervical Cancer

    N
    Engl J Med 340: 1137-1143, 1999

      

    Concomitant
    chemotherapy and radiotherapy has revealed increased
    survival in patients with locally advanced
    cervical cancer.

      

    This
    study of advanced cervical cancer stage IIB through
    IVA and a tumor diameter of at least 5 cm or
    involvement of pelvic nodes were assigned to pelvic
    radiotherapy [ 45Gy] 
    and para-aortic lymph nodes or 45 GY of
    pelvic radiotherapy plus 2 courses of 5 fluorouracil
    and cisplatin. The combined therapy had a higher
    reversible hematologic
    toxicity. The estimated cumulative rates of
    survival at 5 years for combined modality was 73%
    compare with 58% for radiotherapy alone.
    The rates of distant metastases and
    locoregional recurrence was also higher in patients
    treated with radiotherapy alone.

         

  • Sedlis
    A, Bundy BN, Rotman MZ, et al [ State Univ of New
    York, Brooklyn; Roswell Park Cancer Inst, Buffalo,
    NY; Bowman Gray School of Medicine, Winston-Salem
    NC; et al]

    A
    Randomized Trial of Pelvic Radiation Therapy Versus
    No Further Therapy in Selected Patients with Stage
    IB Carcinoma of the Cervix After Radical
    Hysterectomy and Pelvic Lymphadenectomy : A
    Gynecologic Oncology Group Study

    Gynecol
    Oncol 73: 177-183, 1999

     

    Stage
    I cervical cancer has a relatively favorable
    outlook. However, this study has brought out some
    risk factors within this favorable stage of cervical
    cancer. These
    risk factors are large tumor diameter, deep stormal
    invasion or presence of tumor in capillary lymphatic
    space. Adjuvant radiotherapy [i.e. after
    hysterectomy ] reduced the cancer recurrence among
    these patients with acceptable morbidity.

        

  • Knocke
    TH, Weitmann HD, Kucera H, et al [Univ of Vienna]

    Results
    of Primary and Adjuvant Radiotherapy in the
    Treatment of Mixed Mullerian Tumors of the Corpus
    Uteri

    Gynecol
    Oncol 73: 389-395, 1999

      

    The
    role of primary or adjuvant irradiation in the
    treatment of mixed mullerian tumor is undefined.

     

    The
    study of 63 patients with mixed mullerian 
    tumor received primary radiotherapy in 3
    patients and 50 received as adjuvant radiotherapy.
    This group of patients had improved local control
    and disease specific survival rates.
    The editor comments that the role of adjuvant
    radiation depends on the adequacy of surgical
    resection.

        

  • Papadimitriou
    CA, Sarris K, Moulopoulos LA, et al [ Univ of
    Athens, Greece; Aristotle Univ, Thessaloniki,
    Greece]

    Phase
    II Trial of Paclitaxel and Cisplatin in Metastatic
    and Recurrent Carcinoma of the Uterine Cervix

    J
    Clin Oncol 17: 761-766, 1999

     

    This
    study of 34 patients with metastatic or
    recurrent carcinoma of cervix were treated with
    injection paclitaxel 175 mg/m2 IV 3 hours infusion
    and IV cisplatinum 75 mg/m2 with granulocyte
    colony-stimulating factor, 47% of patient achieved
    an objective response. Neurotoxicity was the main
    adverse effect. The median duration of response is 5.5 month and overall survival 9
    months.

         

  • Tierney
    JF, Stewart LA, Parmar MKB [MRC Clinical Trials
    Unit, Cambridge England]

    Can
    the Published Data Tell Us About the Effectiveness
    of Neoadjuvant Chemotheapy for Locally Advanced
    Cancer of the Uterine Cervix?

    Eur
    J Cancer 35: 406-409, 1999

     

    This meta-analysis of all published reports of
    neoadjuvant chemotherapy in patients with locally
    advanced cancer of cervix did not have any
    conclusive evidence supporting the merits of an
    neoadjuvant chemotherapy.

        

  • Larson
    DM, Berg R, Shaw G, et al [Marshfield Clinic, Wis]

    Prognostic
    Significance of DNA Ploidy in Endometrial Cancer

    Gynecol
    Oncol 74: 356-360, 1999

       

    Endometrial
    cancer is a disease of obese and elderly and usually
    associated with medical problems thereby producing
    hindrances for an aggressive surgical approach.

      

    This
    study of 249 patients 
    with endometrial cancer underwent DNA ploidy
    assessment on patients staged surgically by standard
    protocol. Patients with aneuploid tumors had a
    significantly higher prevalence of pelvic node
    metastases and advanced surgical stage. It was also
    associated with increased risk of death from
    endometrial cancer.

        

  • Cook
    AM, Lodge N, Blake P [Royal Marsden Hosp, London]

    Stage
    IV Endometrial Carcinoma : A 10 Year Review of
    Patients

    Br
    J Radol 72: 485-488, 1999

     

    This study of 18 patients with stage IV
    endometrial carcinoma some underwent surgery,
    radiotherapy and some received chemotherapy and or
    hormonal therapy, progestogen. The overall median survival from the time of diagnosis was 12
    months or actuarial survival was 15%.
    The survival was similar with chemotherapy
    & hormonal therapy.
    The overall prognosis of stage IV is poor.

      

  • Barakat
    RR, Goldman NA, Patel DA, et al [ Mem
    Sloan-Kettering Cancer Ctr, New York, Mt Sinai Med
    Ctr, New York; Bronx Lebanon Hosp Ctr, New York]

    Pelvic
    Exenteration for Recurrent Endometrial Cancer

    Gynecol
    Oncol 75: 99-102, 1999

     

    This
    study of 44 patients with recurrent endometrial
    carcinoma underwent exenteration of
    which 80% 
    had major postoperative
    complications
    and overall median survival was 10.2 months
    even though the longterm survival is only 20%.
    This approach remains the only potentially
    curative option for the few patients with central
    recurrence of endometrial cancer in whom surgical
    and radiation therapy has failed.

         

  • Bristow
    RE, Montz FJ, Lagasse LD, et al [ Univ of California
    Los Angeles; Johns Hopkins Med Institutions,
    Baltimore, Md]

    Survival
    Impact of Surgical Cytoreduction in Stage IV
    Epithelial Ovarian Cancer

    Gynecol
    Oncol 72: 278-287, 1999

     

    This study of 84 patients with stage IV ovarian
    cancer underwent debulking of extra hepatic disease. The impact of debulking in a subgroup of patients with liver
    metastasis revealed optimal
    surgical debulking and good performance status were
    good prognostic factors and leading to significant
    survival advantage in this subgroup of patients.

         

  • Duska
    LR, Chang Y, Flynn CE, et al [Massachusetts Gen
    Hosp, Boston]

    Epithelial
    Ovarian Carcinoma in the Reproductive Age Group

    Cancer
    85: 2623-2629, 1999

     

    This
    study of women under 40 years of age with epithelial
    ovarian cancer was retrospectively analyzed to
    ascertain whether the patient age and tumor grade
    are prognostic factors for survival. Only tumor
    grade [with borderline tumors ] and stage were
    significant predictors of survival in multivariate
    analysis. Of the 92 epithelial tumors 50% had borderline tumors. The 5 year
    survival rate for patients with advanced epithelial
    ovarian carcinoma was 22.9%. Borderline tumors have
    an good prognosis
    with
    possibility of preserving fertility after cancer
    treatment which is mostly a surgical option.

        

  • Judson
    PL, Watson JM, Gehrig PA, et al [ Univ of North
    Carolina, Chjapel Hill]

    Cisplatin
    Inhibits Paclitaxel –Induced Apoptosis in
    Cisplatin-resistant Ovarian Cancer Cell Lines :
    Possible Explanation for Failure of Combination
    Therapy

    Cancer
    Res 59: 2425-2432, 1999

      

    This
    study of an human ovarian cancer cells are treated
    with cisplatin alone, paclitaxel alone or both
    agents and the percentage of cell survival was
    noted.

     

    Cisplatin
    appears to inhibit paclitaxel’s efficacy in
    cisplatin cell lines, blocking paclitaxel-induced
    apoptosis. Thus, paclitaxel is to be used as second
    line regimen in patients with cisplatin paclitaxel
    resistant ovarian cancer as per this is vitro study.
    The editor comments that the response in some
    patients to docetaxel who can labeled or resistant
    to paclitaxel.

         

  • Shinozuka
    T, Miyamoto T, Muramatsu T, et al [ Tokai Univ,
    Isehara, Kanagawa, Japan]

    High
    Dose Chemotherapy With Autologous Stem Cell Support
    in the Treatment of Patients With Ovarian Carcinoma:
    Long Term Results for 105 Patients

    Cancer
    85: 1555-1564, 1999

          

    This study of patients of ovarian carcinoma who
    had received  platinum
    therapy followed by debulking procedures and then
    high dose chemotherapy with stem cell support. The
    patient with advanced ovarian cancer who have small
    volume disease, platinum sensitivity and
    chemosensitive tumors prior to high dose
    chemotherapy had the best long term survival. The
    editor comments that this modality should not be
    used outside a phase III trial until we have data
    demonstrating its advantage over standard therapy.

      

      



 

 

Speciality Spotlight

 

 

Gynaecologic Malignancies
   

  

  • Rose PG, Bundy BN, Watkins EB, et al [Case Western Reserve Univ, Cleveland, Ohio; Roswell Park Cancer Inst, Buffalo, NY; Walter Reed Army Med Ctr, Washington, DC; et al]
    Concurrent Cisplatin-based Radiotherapy and Chemotheapy for Locally Advanced Cervical Cancer
    N Engl J Med 340: 1144-1153, 1999
         
    The study of 526 patients with locally advanced cervical cancer from stage IIB to IVA were randomize to cisplatin 40mg/m2 per week for 6 weeks [ group I] or cisplatin 50mg/m2 followed by 5 fluorouracil 4g/m2 given as 96 hour infusion on day 1 and day 29 and 6 weeks [group 2] or 3gm/m2 of oral hydroxyurea twice weekly for 6 weeks.
     
    Both groups [group 1 and group 2] who received cisplatin had a significantly higher rate of progression free survival.  The overall survival rate was significantly higher for patients in group I & Group II.
        

  • Keys HM, Bundy BN, Stehman FB, et al [Albany Med College, NY: Rosewell Park Cancer Inst, Buffalo, NY; Indiana Univ, Indianapolis; et al]
    Cisplatin, Radiation, and Adjuvant Hysterectomy Compared with Radiation and Adjuvant Hysterectomy for Bulky Stage IB Cervival Carcinoma
    N Engl J Med 340: 1154-1161, 1999
      
    The optimal treatment for stage IB cervival carcinoma is controversial.
     
    This study of 369 patients with biopsy proven stage IB cervical cancer without lymphadenopathy underwent radiotheapy and hysterectomy. These were randomized to weekly cisplant during radiotherapy for 6 weeks or only radiotherapy. 3-6 weeks after radiotherapy extrafascial hysterectomy was carried out. The rate of progression-free survival and overall survival were significantly higher in cisplatium group than in placebo group. This study has bought out that concurrent chemotherapy and radiotherapy as new standard of care for stage IB cervical cancer.
          

  • Morris M, Eifel PJ, Lu, J, et al [Univ of Texas MD Anderson Cancer Ctr, Houston; Radiation Therapy Oncology Group, Philadelphia; Washington Univ, St Louis; et al]
    Pelvic Radiation With Concurrent Chemotherapy Compared With Pelvic and Para-aortic Radiation for High-Risk Cervical Cancer
    N Engl J Med 340: 1137-1143, 1999
      
    Concomitant chemotherapy and radiotherapy has revealed increased survival in patients with locally advanced cervical cancer.
      
    This study of advanced cervical cancer stage IIB through IVA and a tumor diameter of at least 5 cm or involvement of pelvic nodes were assigned to pelvic radiotherapy [ 45Gy]  and para-aortic lymph nodes or 45 GY of pelvic radiotherapy plus 2 courses of 5 fluorouracil and cisplatin. The combined therapy had a higher reversible hematologic toxicity. The estimated cumulative rates of survival at 5 years for combined modality was 73% compare with 58% for radiotherapy alone. The rates of distant metastases and locoregional recurrence was also higher in patients treated with radiotherapy alone.
         

  • Sedlis A, Bundy BN, Rotman MZ, et al [ State Univ of New York, Brooklyn; Roswell Park Cancer Inst, Buffalo, NY; Bowman Gray School of Medicine, Winston-Salem NC; et al]
    A Randomized Trial of Pelvic Radiation Therapy Versus No Further Therapy in Selected Patients with Stage IB Carcinoma of the Cervix After Radical Hysterectomy and Pelvic Lymphadenectomy : A Gynecologic Oncology Group Study
    Gynecol Oncol 73: 177-183, 1999
     
    Stage I cervical cancer has a relatively favorable outlook. However, this study has brought out some risk factors within this favorable stage of cervical cancer. These risk factors are large tumor diameter, deep stormal invasion or presence of tumor in capillary lymphatic space. Adjuvant radiotherapy [i.e. after hysterectomy ] reduced the cancer recurrence among these patients with acceptable morbidity.
        

  • Knocke TH, Weitmann HD, Kucera H, et al [Univ of Vienna]
    Results of Primary and Adjuvant Radiotherapy in the Treatment of Mixed Mullerian Tumors of the Corpus Uteri
    Gynecol Oncol 73: 389-395, 1999
      
    The role of primary or adjuvant irradiation in the treatment of mixed mullerian tumor is undefined.
     
    The study of 63 patients with mixed mullerian  tumor received primary radiotherapy in 3 patients and 50 received as adjuvant radiotherapy. This group of patients had improved local control and disease specific survival rates. The editor comments that the role of adjuvant radiation depends on the adequacy of surgical resection.
        

  • Papadimitriou CA, Sarris K, Moulopoulos LA, et al [ Univ of Athens, Greece; Aristotle Univ, Thessaloniki, Greece]
    Phase II Trial of Paclitaxel and Cisplatin in Metastatic and Recurrent Carcinoma of the Uterine Cervix
    J Clin Oncol 17: 761-766, 1999
     
    This study of 34 patients with metastatic or recurrent carcinoma of cervix were treated with injection paclitaxel 175 mg/m2 IV 3 hours infusion and IV cisplatinum 75 mg/m2 with granulocyte colony-stimulating factor, 47% of patient achieved an objective response. Neurotoxicity was the main adverse effect. The median duration of response is 5.5 month and overall survival 9 months.
         

  • Tierney JF, Stewart LA, Parmar MKB [MRC Clinical Trials Unit, Cambridge England]
    Can the Published Data Tell Us About the Effectiveness of Neoadjuvant Chemotheapy for Locally Advanced Cancer of the Uterine Cervix?
    Eur J Cancer 35: 406-409, 1999
     
    This meta-analysis of all published reports of neoadjuvant chemotherapy in patients with locally advanced cancer of cervix did not have any conclusive evidence supporting the merits of an neoadjuvant chemotherapy.
        

  • Larson DM, Berg R, Shaw G, et al [Marshfield Clinic, Wis]
    Prognostic Significance of DNA Ploidy in Endometrial Cancer
    Gynecol Oncol 74: 356-360, 1999
       
    Endometrial cancer is a disease of obese and elderly and usually associated with medical problems thereby producing hindrances for an aggressive surgical approach.
      
    This study of 249 patients  with endometrial cancer underwent DNA ploidy assessment on patients staged surgically by standard protocol. Patients with aneuploid tumors had a significantly higher prevalence of pelvic node metastases and advanced surgical stage. It was also associated with increased risk of death from endometrial cancer.
        

  • Cook AM, Lodge N, Blake P [Royal Marsden Hosp, London]
    Stage IV Endometrial Carcinoma : A 10 Year Review of Patients
    Br J Radol 72: 485-488, 1999
     
    This study of 18 patients with stage IV endometrial carcinoma some underwent surgery, radiotherapy and some received chemotherapy and or hormonal therapy, progestogen. The overall median survival from the time of diagnosis was 12 months or actuarial survival was 15%. The survival was similar with chemotherapy & hormonal therapy. The overall prognosis of stage IV is poor.
      

  • Barakat RR, Goldman NA, Patel DA, et al [ Mem Sloan-Kettering Cancer Ctr, New York, Mt Sinai Med Ctr, New York; Bronx Lebanon Hosp Ctr, New York]
    Pelvic Exenteration for Recurrent Endometrial Cancer
    Gynecol Oncol 75: 99-102, 1999
     
    This study of 44 patients with recurrent endometrial carcinoma underwent exenteration of which 80%  had major postoperative complications and overall median survival was 10.2 months even though the longterm survival is only 20%. This approach remains the only potentially curative option for the few patients with central recurrence of endometrial cancer in whom surgical and radiation therapy has failed.
         

  • Bristow RE, Montz FJ, Lagasse LD, et al [ Univ of California Los Angeles; Johns Hopkins Med Institutions, Baltimore, Md]
    Survival Impact of Surgical Cytoreduction in Stage IV Epithelial Ovarian Cancer
    Gynecol Oncol 72: 278-287, 1999
     
    This study of 84 patients with stage IV ovarian cancer underwent debulking of extra hepatic disease. The impact of debulking in a subgroup of patients with liver metastasis revealed optimal surgical debulking and good performance status were good prognostic factors and leading to significant survival advantage in this subgroup of patients.
         

  • Duska LR, Chang Y, Flynn CE, et al [Massachusetts Gen Hosp, Boston]
    Epithelial Ovarian Carcinoma in the Reproductive Age Group
    Cancer 85: 2623-2629, 1999
     
    This study of women under 40 years of age with epithelial ovarian cancer was retrospectively analyzed to ascertain whether the patient age and tumor grade are prognostic factors for survival. Only tumor grade [with borderline tumors ] and stage were significant predictors of survival in multivariate analysis. Of the 92 epithelial tumors 50% had borderline tumors. The 5 year survival rate for patients with advanced epithelial ovarian carcinoma was 22.9%. Borderline tumors have an good prognosis with possibility of preserving fertility after cancer treatment which is mostly a surgical option.
        

  • Judson PL, Watson JM, Gehrig PA, et al [ Univ of North Carolina, Chjapel Hill]
    Cisplatin Inhibits Paclitaxel –Induced Apoptosis in Cisplatin-resistant Ovarian Cancer Cell Lines : Possible Explanation for Failure of Combination Therapy
    Cancer Res 59: 2425-2432, 1999
      
    This study of an human ovarian cancer cells are treated with cisplatin alone, paclitaxel alone or both agents and the percentage of cell survival was noted.
     
    Cisplatin appears to inhibit paclitaxel’s efficacy in cisplatin cell lines, blocking paclitaxel-induced apoptosis. Thus, paclitaxel is to be used as second line regimen in patients with cisplatin paclitaxel resistant ovarian cancer as per this is vitro study. The editor comments that the response in some patients to docetaxel who can labeled or resistant to paclitaxel.
         

  • Shinozuka T, Miyamoto T, Muramatsu T, et al [ Tokai Univ, Isehara, Kanagawa, Japan]
    High Dose Chemotherapy With Autologous Stem Cell Support in the Treatment of Patients With Ovarian Carcinoma: Long Term Results for 105 Patients
    Cancer 85: 1555-1564, 1999
          
    This study of patients of ovarian carcinoma who had received  platinum therapy followed by debulking procedures and then high dose chemotherapy with stem cell support. The patient with advanced ovarian cancer who have small volume disease, platinum sensitivity and chemosensitive tumors prior to high dose chemotherapy had the best long term survival. The editor comments that this modality should not be used outside a phase III trial until we have data demonstrating its advantage over standard therapy.
      

      

 

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