A phase II study of outpatient first-line paclitaxel, carboplatin, and bevacizumab for advanced-stage epithelial ovarian, peritoneal, and fallopian tube cancer.

The purpose of this study was to assess the response rate and toxicity of paclitaxel, carboplatin, and bevacizumab (PCB) primary induction therapy for the treatment of advanced-stage ovarian carcinoma. Twenty patients were treated with paclitaxel (175 mg/m(2)), carboplatin (AUC of 5 IV), and bevacizumab (15 mg/kg) of body weight; q21 days for six cycles. Bevacizumab was administered at cycles two through six. Patients received 116 cycles of PCB chemotherapy (median = 6, range 2-6) and were evaluable for toxicity assessment. Grade 3 and 4 neutropenia developed in 23.3% and 25% of cycles, with no incidence of grades 3/4 thrombocytopenia or anemia. Prior to cycle six, one patient was removed from the study due to grade 3 neuropathy and another patient was excluded due to clinical deterioration. There was no incidence of gastrointestinal perforations, and only two patients demonstrated grade 3 hypertension (HTN). No grade 4 HTN was observed. Eighteen patients were evaluated for response following induction therapy. Six demonstrated a complete response (30%) and ten exhibited a partial response (50%), resulting in a total response rate of 80%. One patient exhibited stable disease (5%), and one demonstrated disease progression (5%). The lack of bowel perforations and wound complications should mitigate some concerns regarding these side effects. This study suggests that first-line treatment with PCB can be safely administered to previously untreated advanced-stage ovarian carcinoma patients. The favorable toxicity results and reasonable response rate warrant additional study in a larger patient population.

Are antioxidant levels measured immediately postoperatively an indicator of magnitude of injury?

BACKGROUND: Little is known about the changes that occur in antioxidant levels in response to surgical trauma. The antioxidant system may influence recovery and healing after operation. Miller et al described a reliable assay for total antioxidant capacity of serum. We studied changes in antioxidant levels secondary to operation using this assay. METHODS: Twenty-seven patients were studied: 14 abdominal and 13 breast cancer operations. Initial blood samples were obtained when starting the preoperative intravenous line, the second in the recovery room, and every 6 hours thereafter. RESULTS: Levels did not correlate with diagnosis, extent of operation, age, body mass index, or complications. Differences between preoperative and postoperative values in the down and up groups were significant at P = 0.002 and P = 0.023, respectively. Differences in initial levels between the down and up groups were significant at P = 0.005. Levels 12 hours after operation were stable. CONCLUSIONS: Rapid return to a baseline of approximately 1 micromole/L, regardless of the direction of initial response, supports the concept of a set point for regulation of serum's antioxidant capacity.

Dermal lymphangiomata of the vulva and laser therapy: a case report and literature review.

Dermal lymphangioma of the vulva is a rare disorder of the lymphatic system. The mainstay of therapy has been vulvectomy. A 65-year-old woman with a remote history of cervical cancer who successfully underwent CO2 laser vaporization for extensive vulva lymphangiomata, and a literature review inclusive of all 28 previously reported cases are described. Ten (35.7%) of these patients had previously received pelvic radiation for cervical cancer, 8 of whom (80%) had also undergone radical hysterectomy. Including the present case, 5 patients, 3 of whom had previously received radiation therapy, have been treated successfully with laser therapy. These data support laser vaporization with retreatment of persistent or recurrent focal disease as the treatment of choice for dermal lymphangiomata. Surgical excision should be reserved for treatment failures. Radical hysterectomy in association with postoperative pelvic radiation therapy appears to be an important, previously unrecognized risk factor for its development.

The rectus abdominis myocutaneous flap: modifications, complications, and sexual function.

BACKGROUND: Vaginal, perineal, and pelvic floor reconstruction is being performed with increasing frequency in conjunction with radical pelvic surgery. Although the vertical rectus abdominis myocutaneous flap is ideally suited to such procedures, little information exists regarding risks or complications associated with it. METHODS: A chart review of all patients who underwent this procedure at two institutions was performed, and the results were compared with existing series. Surviving patients were asked to describe their satisfaction with the procedure and their sexual function. RESULTS: Between 1990 and 1997, 22 patients underwent placement of a rectus abdominis myocutaneous flap for vaginal/pelvic floor reconstruction, 21 (95.5%) at the time of pelvic exenteration. Attachment of the graft was complete in 20 patients (90.9%) and partial in 1 (4.5%), and 1 patient experienced complete loss that resulted in total vaginal stenosis. Four patients (18.2%) developed mild vaginal stenosis that was corrected with dilators. Donor site complications included wound separation (above the fascia) in three patients and one delayed abdominal closure. There were no cases of bowel obstruction, dehiscence, hernia, or death. The only statistically significant identifiable risk factors for graft necrosis included prior abdominal surgery and operative time. Thirteen of 22 (59.1%) of the patients are cancer free (median progression free interval, 42.2 months), 11 (84.6%) of whom reported having had vaginal intercourse since surgery. CONCLUSIONS: The rectus abdominis myocutaneous flap can be safely used with excellent results and acceptable morbidity, and in this series it restored sexual function in the majority of cancer survivors. Because previous abdominal surgery (transverse incisions or colostomy) may compromise blood supply to the flap, alternative sites should be considered in such cases.