Risk of malignancy index in the evaluation of patients with adnexal masses.

OBJECTIVE: To determine if the risk of malignancy index (RMI) can distinguish between benign and malignant adnexal masses in a population of women referred to a department of gynaecologic oncology for surgical resection of an adnexal mass. METHODS: We performed a retrospective review of the medical of charts of 259 consecutive patients. Ninety-six charts did not have data available to calculate the RMI, leaving a total of 163 for review. Three definitions of RMI were compared; each incorporated menopausal status of the patient, ultrasound characteristics of the adnexal mass, and serum CA-125 level. RESULTS: Of the masses resected, 105 were benign and 58 were malignant. The area under the ROC curve for all three definitions of RMI was 0.87. Using a cut-off of 120, the first RMI definition (RMI 1) had a sensitivity of 72% and a specificity of 87%; the second (RMI 2) had a sensitivity of 76% and a specificity of 81%; and the third (RMI 3) had a sensitivity of 74% and a specificity of 84%. These results are generally in agreement with published values. CONCLUSION: We have validated the use of RMI to predict the risk of malignancy in a Nova Scotia population of women with adnexal masses. This will aid in more selective referral of patients to specialized oncology centres for cancer surgery, allowing for appropriate management of health care resources and optimization of treatment for women with gynaecological malignancies.

Complementary and alternative medicine in gynaecologic oncology.

OBJECTIVES: To explore complementary and alternative medicine (CAM) use among gynaecologic oncology patients in Nova Scotia. METHODS: Over a 3-month period, 163 patients were asked to fill out a questionnaire concerning CAM. Those entering the study provided demographic information such as age, address, and employment status, as well as medical information and details of their use of alternative therapies. RESULTS: A total of 152 patients were entered into the study, giving a response rate of 93.3%. Of these, 116 had used at least one type of CAM, classifying them as users (76.3%). Women who considered themselves "more religious" were more likely to be CAM users (P = 0.001). There were no significant differences found between users and nonusers with respect to other patient characteristics reported. Patients with cervical cancer were less likely to use CAM than participants with another primary gynaecological malignancy (P = 0.040). The most frequent CAM therapy practised was spirituality/prayer (52.6%). Most women used CAM to improve their physical well-being, and 53.3% of the women were interested in receiving more information on CAM. CONCLUSION: A significant number of women undergoing conventional treatment for gynaecologic cancer in Halifax, Nova Scotia, also use CAM. Women are using CAM for numerous reasons and believe they are benefiting from CAM in many ways. Physicians need to be aware of this high usage rate and should explore their patients' attitudes to and opinions about CAM.

Randomized trial of two intravenous schedules of the topoisomerase I inhibitor liposomal lurtotecan in women with relapsed epithelial ovarian cancer: a trial of the national cancer institute of Canada clinical trials group.

PURPOSE: Liposomal lurtotecan (OSI-211) is a liposomal formulation of the water-soluble topoisomerase I inhibitor lurtotecan (GI147211), which demonstrated superior levels of activity compared with topotecan in preclinical models. We studied two schedules of OSI-211 in a randomized design in relapsed ovarian cancer to identify the more promising of the two schedules for further study. PATIENTS AND METHODS: Eligible patients had measurable epithelial ovarian, fallopian, or primary peritoneal cancer that was recurrent after one or two prior regimens of chemotherapy. Patients were randomly assigned to receive either arm A (OSI-211 1.8 mg/m(2)/d administered by 30-minute intravenous infusion on days 1, 2, and 3 every 3 weeks) or arm B (OSI-211 2.4 mg/m(2)/d administered by 30-minute intravenous infusion on days 1 and 8 every 3 weeks). The primary outcome measure was objective response, which was confirmed by independent radiologic review, and a pick the winner statistical design was used to identify the schedule most likely to be superior. RESULTS: Eighty-one patients were randomized between October 2000 and September 2001. The hematologic toxic effects were greater on arm A than on arm B (grade 4 neutropenia, 51% v 22%, respectively), as was febrile neutropenia (26% v 2.4%, respectively). Of the 80 eligible patients, eight patients (10%) had objective responses; six responders (15.4%; 95% CI, 6% to 30%) were in arm A and two responders (4.9%; 95% CI, 1% to 17%) were in arm B. CONCLUSION: The OSI-211 daily for 3 days intravenous schedule met the statistical criteria to be declared the winner in terms of objective response. This schedule was also associated with more myelosuppression than the schedule of OSI-211 administered in arm B.