Results of a prospective dose-intensive regimen in 27 patients with small cell carcinoma of the ovary of the hypercalcemic type.

BACKGROUND: The evaluation of first-line intensive combination therapy in small cell carcinoma of the ovary (SCCO). PATIENTS AND METHODS: Debulking surgery; four to six cycles of chemotherapy with cisplatin (P) 80 mg/m(2) day 1, adriamycin (A) 40 mg/m(2) day 1, vepeside (V) 75 mg/m(2)/day days 1-3, cyclophosphamide (EP) 300 mg/m(2)/day days 1-3, every 3 weeks and granulocyte colony-stimulating factor with, in case of a complete remission, high-dose chemotherapy with carboplatin, vepeside, cyclophosphamide and stem-cell support. RESULTS: Twenty-seven patients (median age 25 years); International Federation of Gynecology and Obstetrics stage: five I, four IIC, 17 IIIC-IV and one unknown. Twenty patients underwent complete surgery. Eight patients progressed under chemotherapy. Among 18 patients in complete response (CR), 10 received high-dose chemotherapy (CT) (three stem-cell collection failures, two protocol violations, two disease progression and one refusal). The main grade 3-4 toxic effects were hematologic. There were eight relapses among the 18 CR, four of which were pelvic alone. Among the 27 patients, 13 died and 10 patients are in CR1, three in CR2. The median follow-up is 37 months (8-166) and the median duration of the 18 CR is 30 months (5-111). Overall survival at 1 and 3 years is 58% [confidence interval (CI) 40% to 75%] and 49% (CI 30% to 67%). CONCLUSIONS: Initial dose-intensive therapy achieves interesting overall survival in SCCO.

[Vacuum-assisted stereotactic biopsy: experience of the regional cancer center of Caen]. / Macrobiopsies assistées par le vide: expérience du CRLCC François Baclesse de Caen.

PURPOSE: To report our experience with macrobiopsy under stereotaxy. MATERIALS AND METHODS: Retrospective study of 248 procedures in 236 patients for microcalcifications in 95% of cases. The macrobiopsies were performed under Mammotome for lesions graded ACR 3, ACR 4 and ACR 5 in 8.4%, 81.6% and 14.8% of cases respectively. RESULTS: From a technical point of view, 91% of procedures had no technical problem. The image guided excision was complete in 68% of cases with lesions less than 1 cm in size and in 6% of cases for lesions larger than 1 cm. The rate of a misdiagnosis of ductal carcinoma in situ for patients with invasive carcinoma was 27% whereas the rate of a misdiagnosis of atypical ductal hyperplasia in patients with ductal carcinoma in situ was 25% knowing that patients with atypical ductal hyperplasia for which all microcalcifications had been fully removed by macrobiopsy and without risk factors did not undergo surgery. CONCLUSION: Even if macrobiopsy of microcalcifications is a reliable method, its main limitation remains the risk of misdiagnosis of borderline lesions.

[Evaluation of predictive factors, particularly the Van Nuys index, of local recurrence in ductal carcinoma in situ of the breast: study of 166 cases with conservative treatment and review of the literature]. / In process citation.

Ductal carcinoma in situ (DCIS), a non metastazing lesion of the breast is more frequently observed due to the improvement of mammography and widespread use of screening. The most important risk of this disease is local recurrence. In about half of cases, it occurs as an infiltrating carcinoma. In a series of 166 DCIS treated by lumpectomy plus radiotherapy, we have studied clinico-pathological factors for the prognosis of local recurrences and particularly the Van Nuys Index criteria (nuclear grade, necrosis, size, margin width). After median follow up of 75 months, 21 recurrences were observed with 10 corresponding to an infiltrating carcinoma and one of them died. The size of DCIS evaluated on pathological documents (histological slides and shames), the Van Nuys Prognostic Index (VNPI) and the mitotic index were the main prognostic factors of local recurrence. We discuss these results and confront them to a review of the literature focalised on the delicate problem of the decision of conservative treatment. A multidisciplinary approach (Breast : Surgeon, Radiologist, Pathologist and Radiotherapist), a standardisation of pathological criteria (size, margin width) and the continuation of randomised trials are necessary to fine the best attitude of conservative therapy.

[Is mammography useful in Paget's disease of the breast?]. / La mammographie est-elle utile dans la maladie de Paget du sein?

PURPOSE: Interest of the mammogram in Paget's disease of the breast, especially for a therapeutic decision in otherwise asymptomatic women with Paget's disease, who would be candidates for conservative treatment. MATERIALS AND METHODS: 61 women with histological Paget's disease of the nipple, treated by mastectomy, were retrospectively analyzed with clinical, radiological and pathological correlations. RESULTS: An underlying carcinoma was found in 60 cases (98.4%), atypical epithelial hyperplasia in one. In the 24 women without breast palpable mass, 17 (71%) had a normal mammogram, 12 (50%) had carcinoma with an invasive component, 14 (58%) had a cancer at a distance from the nipple, 17 (71%) had a multifocal carcinoma. All 37 women with a palpable mass had a pathological mammogram, 36 of them had carcinoma with an invasive component, 35 (95%) a cancer at a distance from the nipple, 31 (84%) a multifocal carcinoma. CONCLUSION: Mammogram is of limited value in management of Paget's disease of the breast for women without breast palpable mass; it can not predict the site of malignancy, nor the invasive component.

High-dose platinum versus standard dose in advanced ovarian carcinoma: a randomized trial from the Gynecologic Cooperative Group of the French Comprehensive Cancer Centers (FNCLCC).

OBJECTIVE: The aim of this study was to evaluate the impact of platinum dose intensity on pathological response rate and overall survival in patients with advanced ovarian adenocarcinoma. METHODS: Between February 1992 and December 1996, 195 previously untreated patients with FIGO stage IIb-c, IIIb-c, or IV with macroscopic residual disease after suboptimal debulking surgery were randomized to receive CCC (100 mg/m(2) of cisplatin, 300 mg/m(2) of cyclophosphamide, 300 mg/m(2) of carboplatin, n = 96) or CC (100 mg/m(2) of cisplatin, 600 mg/m(2) of cyclophosphamide, n = 99) for six courses at 28-day intervals. A second-look laparotomy was planned at the end of chemotherapy. RESULTS: In the CCC arm, the platinum compound received dose intensity and relative total dose were 85 and 76%; in the CC arm, they were 94 and 85%. Grade 3-4 toxicity was more frequent in the CCC arm than in the CC arm for leukopenia (56% vs 26%, P < 0.001), febrile neutropenia (18% vs 4%, P = 0.002), anemia (31% vs 5%, P < 0.001), thrombopenia (55% vs 4%, P < 0.001), and ototoxicity (8% vs 0%, P < 0.001). The pathologic complete response rate was 22 and 14% in the CCC and CC arms, respectively (P = 0.19). With a median follow-up of 53 months, the median time to failure and the 3-year treatment failure-free survival rate were 17.4 months and 22% vs 13 months and 11% in the two arms, respectively (P = 0.01). The median survival time and the 3-year overall survival rate were, respectively, 30 months and 42% vs 25 months and 33% (P < 0.20). CONCLUSION: The platinum dose intensification (1.6-fold increase) obtained with the CCC association improves the treatment failure-free survival without significant impact on overall survival when compared with the CC regimen in suboptimal debulked ovarian adenocarcinoma. However, because of its high rate of hematologic toxicity and ototoxicity, this association cannot be recommended for routine practice.

Potentiation of cisplatin and carboplatin cytotoxicity by amphotericin B in different human ovarian carcinoma and malignant peritoneal mesothelioma cells.

An in vitro study of the combined cytotoxicity of either cisplatin (CDDP) or carboplatin and amphotericin B (AmB) was undertaken on a set of different ovarian carcinoma (IGROVI, IGROVI-C10, OAW42) and peritoneal malignant mesothelioma (CFB-CARP1) cell lines and ascitic cells freshly obtained from ovarian cancer patients so as to investigate the possibility of overcoming their resistance to platinum compounds. Growth-inhibition curves obtained 6 days after a 2-h period of exposure to the drugs showed that AmB at 5-10 mg/l allowed a 5- to 10-fold decrease in the 50% growth-inhibitory concentrations (IC50) of CDDP and carboplatin on either sensitive or resistant cells. Intracellular platinum assays with IGROVI cells showed that AmB acted by increasing dramatically the platinum uptake at a proportion that accounted for the increase in cytotoxicity. In the subline IGROVI-C10, a 10-fold resistant subline of IGROVI, AmB at 10 mg/l allowed recovery to the level of sensitivity seen in the parental cell line in the absence of AmB but not to the level observed in the presence of AmB. Acquisition of resistance mechanisms that are independent of the regulation of platinum uptake might be involved in this cell line. Thus, AmB might act by increasing the intracellular concentration of platinum without modifying the resistance mechanism involved downstream. However, in our models an increase in the intracellular level of platinum was always sufficient for the recovery of chemosensitivity in vitro. We also show that the phosphodiesterase inhibiting methylxanthines act synergistically with AmB. The latter drugs are weakly toxic and could also attenuate the nephrotoxicity of AmB.

[Ovarian goiter with hyperthyroidism. A case report]. / Goitre ovarien avec hyperthyroïdie. A propos d'un cas.

We report a case of ovarian goiter associated with hyperthyroidism. We insist upon their rarity and the difficulty of preoperatory diagnosis. Prognosis is good after surgery.

[Plea for quality cytological specimens in the screening of cervical cancer]. / Plaidoyer pour la qualité des prélévements cytologiques lors du dépistage du cancer du col.

In the context of a typical false negative cervical cancer test, the authors discuss the value of such screening tests and the various causes of a lack of success. A poor sample is the main cause of false negatives, and therefore involves everyone taking part in the procedures for this screening test.

[Cervical cancer in the young woman]. / Le cancer cervical de la femme jeune.

OBJECTIVE: To study the frequency, the histological type, the stages, and prognosis of cancer of the cervix in women under 35 years of age or less. METHOD: A retrospective analysis of a series of 1,024 cases notes of which 63 dealt with young women. The therapeutic modalities are the same throughout the whole duration of the study from 1975-1988. RESULTS: There was no increase in the incidence of cancer in young women. The incidence of epidermoid cancer dropped. However, mixed adenosquamous tumours were more frequent. There is a predominance of stages I cancers. The survival taking all stages together is at 5, 10 and 15 years better in young women. All the same, taking stage by stage there is no difference in the prognosis.

[The treatment of high-risk malignant gestational trophoblastic diseases]. / Le traitement des maladies trophoblastiques gestationnelles (MTG) malignes à haut risque.

Based on a review of the international literature the authors insist on the need of prognosis categorization of Gestational Trophoblastic Neoplasms (GTN) using the WHO scoring system. High risk GTN should be treated by sequential multi-drug chemotherapy like described by Bagshawe. The authors discuss surgical indications in GTN.

[Is the progesterone test a generalizable method of screening for neoplastic and preneoplastic lesions of the endometrium?]. / Le "test à la progestérone" est-il la méthode généralisable de dépistage des lésions néoplasiques et prénéoplasiques de l'endomètre?

A "progesterone test" has recently been proposed as a tentative method to detect early neoplastic and pre-neoplastic lesions of the uterus endometrium. At the time progesterone is stopped, a "deprivation" metrorragia demonstrates a remanent hyperoestrogenism, which represents a well-known risk factor for this type of lesion. The method has been evaluated in private practice; 389 patients were offered the test: 87% accepted. Metrorragias were observed in 28% of the cases; however, no neoplastic nor pre-neoplastic lesions could be detected in this group of patients. Moreover, one patient presented with an advanced endometrial cancer one year after a negative test. The reliability of such a test clearly needs further evaluation.

[Intraoperative abdominopelvic radiotherapy by single dose electrons]. / Radiothérapie abdomino-pelvienne per-opératoire par électrons à dose unique.

Thirty-four patients received, during laparotomy, a 15-20 Gy localized irradiation from a 10-13 MeV beam of electrons supplied by a linear accelerator and focalized by means of a localizer especially designed for this purpose. This technique is indicated for localized residual tumours of the pelvis and intra-operative irradiation of the lumbar aorta, as part of a chemo-radiotherapeutic programme in patients with advanced cancer of the cervix. It is too early to evaluate the medium-term results, but the technique is very well tolerated immediately.

[Operative mortality and morbidity in pelvic exenteration. Technical aspects]. / Mortalité et morbidité opératoires dans les exentérations pelviennes. Aspects techniques.

Postoperative complications in a continuous series of 23 pelvic exenterations for female genital tumor are analyzed, together with specific technical improvements capable of reducing morbidity and mortality of this major surgery. Emphasis is placed on the use of automatic suturing to improve hemostasis and to facilitate performance of digestive anastomoses. The preferred urinary bypass operation is ureterosigmoidostomy into an excluded loop, cutaneous ureterostomy being reserved for patients in a poor general condition. The only satisfactory procedure for filling of the pelviperineal cavity appears to be internal epiploplasty combined with perineal reconstruction by means of a musculus gracilis flap, which also allows the confection of a new vaginal cavity.

[Para-aortic lymphadenectomy in the surgical evaluation of ovarian cancer]. / La lymphadénectomie para-aortique dans le bilan chirurgical des cancers de l'ovaire.

Lymph node involvement was demonstrated by para-aortic lymphadenectomy in 6 out of 20 women treated for ovarian cancer with macroscopically limited lesions at first and second-look laparotomy. When added to those reported in the literature, these results suggest that 20% of stages I and II ovarian cancers involve the lymph nodes, which considerably influences the prognosis and treatment of cancers otherwise considered as limited. We therefore suggest that biopsy of the lumbar aortic lymph nodes should be systematically performed in the surgical evaluation of ovarian cancers at an early stage.

[Secondary cancers arising in mature benign cystic teratomas of the ovary (dermoid cysts). Review of the literature apropos of a new case]. / Cancérisation secondaire des tératomes matures kystiques bénins de l'ovaire (kystes dermoïdes). Revue de la littérature à propos d'un nouveau cas.

No new general review has appeared concerning the malignant changes that can occur in dermoid cysts of the ovary since the works of Peterson in 1957 and Climie and Heath in 1968. A personal case of epidermoid carcinoma--Stage II B--which occurred in a dermoid cyst gave us the opportunity of reviewing the 132 cases published between 1968 and 1985, which bring the total cases published to more than 400. The cancer arises in 1.78% of mature cystic teratomas. The mean age at diagnosis is 53 years and this pathological change is found five times more frequently after than before the menopause. Before laparotomy is carried out there is no clinical sign nor paraclinical evidence of the diagnosis over and above that of a benign cyst. There are all kinds of histological changes but the epidermoid carcinomas occur in 75% of cases. The survival rate for this kind of ovarian tumour is very poor, with 27% survival after 3 years, taking into account all states and all histological types. Epidermoid carcinomas seem to have a better prognosis than other histological types, and an important prognostic feature is the spread and the ability to remove the tumour surgically when it has extended beyond the capsule of the ovary. Although it is not easy to lay down the best therapy for this condition, by and large extended surgery followed by polychemotherapy or radiotherapy are apparently the only ways of improving the poor prognosis for these tumours.

[Rupture of the pregnant uterine horn following salpingectomy with resection of the interstitial portion. Report of 3 cases of which one followed in-vitro fertilization and embryo transfer]. / Rupture de corne utérine gravide après salpingectomie avec résection de la portion interstitielle. Rapport de trois cas dont un après fécondation in vitro et transfert d'embryon.

Uterine horn pregnancies are rare among ectopic pregnancies. Total salpingectomy with resection of the interstitial portion of the tube is usually recommended in order to prevent implantation in the interstitial stump. Three personal case histories of rupture of the uterine horn early in pregnancy, which all followed resection of the interstitial portion, have led the authors to discuss the physio-pathological mechanisms that lead to intra-mural implantations. The value of total salpingectomy in preventing these accidents is also considered. One of these three cases particularly interested the authors because it followed in vitro fertilisation and embryo transfer. This case has to be added to the twenty series already published of ectopic pregnancies after this treatment for sterility.

[Gracilis muscle flaps for covering losses of perineal substance in cancer surgery]. / Les lambeaux de droit interne dans la couverture des pertes de substance périnéale en chirurgie carcinologique.

Myocutaneous or purely muscular flaps were used in 14 patients after extended surgical excision in the perineal region. When taking out the flap, its one-pedicle and relatively weak blood supply must be taken into account. With this precaution, this technics can always be used for perineal resurfacing, particularly after total vulvectomy. In pelvic exenteration and amputation for anorectal cancer, it enables surgeons to fill the muscular gap, which seems to improve the post-operative course. It can also be used for vaginal, penile or sphincteric reconstruction.

[Uncomplicated pregnancies following recovery from acute pregnancy-related hepatic steatosis]. / Grossesses non compliquées après guérison d'une stéatose hépatique aiguë gravidique.

The authors report the case of a patient with acute yellow atrophy of the liver who subsequently had two uncomplicated pregnancies bringing the total number to 8 cases already published in the literature. After reviewing the diagnostic criteria, they discuss the risk of recurrence, considering the course of the illness, clinical, histological, and physiopathological features. The present risk of recurrence of AYAL must be considered to be very low.