Disease-adapted relapse therapy for ovarian cancer: results of a prospective study.

Primary therapy of advanced ovarian cancer is standardized, the therapy in relapsed ovarian cancer however is still controversial. In a prospective study the benefit of secondary surgery and/or second-line chemotherapy were evaluated. 139 patients with relapsed ovarian cancer were stratified according to a treatment plan: patients with early relapse (recurrence-free interval 12 months) or primary progression during chemotherapy (n=43) were treated chemotherapeutically with etoposide (p.o. vs. i.v.). Patients with late relapse (recurrence-free interval >12 months, n=96) were referred, if possible, to a secondary debulking operation, followed by a platinum-based chemotherapy. Remission-rate, toxicity and survival time were analyzed. Median survival time in the group was 15 months compared to 30 months in patients with late relapse (p=0.0004). Within the group patients with secondary debulking and chemotherapy (n=59) had a statistically significant survival advantage compared to patients who had only chemotherapy (n=37) (38 vs. 12 months, p<0.0001). The unfavorable group of patients with early relapse should be treated chemotherapeutically, whereas in patients with late relapse a secondary debulking seems to improve prognosis.

Laparoscopy-assisted radical vaginal hysterectomy modified according to Schauta-Stoeckel.

In laparoscopy-assisted radical vaginal hysterectomy, laparoscopy is used to develop the paravesical and pararectal spaces. The cardinal ligament is isolated and cut after bipolar coagulation to the level of the deep uterine vein. By the vaginal approach, the ureters are identified before their entry into the bladder pillar. The uterine vessels are pulled down until their laparoscopically coagulated ends become visible. After incision of the vesicocervical reflection, the uterine fundus is grasped and developed (Döderlein maneuver). The lower cardinal and uterosacral ligaments are exposed by pulling the cervix and fundus uteri to the contralateral side. The cardinal and uterosacral ligaments are dissected and ligated, and the specimen is removed. We combined laparoscopic lymphadenectomy with radical vaginal hysterectomy in 33 women with cervical cancer. The mean operating time was 80 minutes for the vaginal phase and 215 minutes for the laparoscopic phase, including paraaortic and pelvic lymphadenectomy and preparation of the cardinal ligaments. Blood transfusions were necessary in four women. Three patients sustained injury to the bladder, one patient to the left ureter, and another patient to the left internal iliac vein. Repair was achieved at primary surgery for all intraoperative complications. No fistula was observed. The patients had fully recuperated after a mean of 28 days. The laparoscopy-assisted Schauta-Stoeckel approach may prove to be a safe alternative to conventional radical abdominal hysterectomy.

[Laparoscopic para-aortic and pelvic lymph node excision--initial experiences and development of a technique]. / Laparoskopische paraaortale und pelvine Lymphonodektomie--erste Erfahrungen und Entwicklung einer Technik.

It was the aim of this study to establish and analyze the laparoscopic technique of para-aortic and pelvic lymphadenectomy. During a one year period (from August 1994 till July 1995) 42 patients underwent pelvic and para-aortic laparoscopic lymphadenectomy. In 29 cases cervical cancer, in 11 cases endometrial cancer and in 2 cases tumors of low malignant potential of the ovary were the indication for lymphadenectomy which was combined with radical vaginal hysterectomy in 19 patients or simple vaginal hysterectomy in 13 patients. During the observation period the mean operating time for para-aortic and pelvic lymphadenectomy decreased and the efficiency of the lymphadenectomy increased significantly: the mean operating time for the first 10 para-aortic lymphadenectomies was 52 minutes and for the pelvic lymphadenectomies 141 minutes, respectively. For the last 10 procedures the para-aortic part took 35 minutes and the pelvic part 110 minutes. Whereas at the beginning of the study a mean of 25 lymph nodes were removed, a mean of 36 lymph nodes were sampled during the last 10 procedures. In 3 patients operative injuries to major vessels were encountered of which two were followed by laparotomy. In 3 other patients laparotomy due to postoperative hemorrhage was necessary. These 6 complications occurred during the first half of the study and were not encountered during the following operations by changing from monopolar to bipolar coagulation and by modifying the regimen for perioperative thrombosis prophylaxis. In the first half of the study in 9 women blood transfusions were necessary and in the second half only 4 patients had to be transfused. In the first 10 patients the mean intraoperative blood loss was 1300 cc, in the last 10 patients 300 cc. After a short learning curve laparoscopic para-aortic and pelvic lymphadenectomy is a safe and effective technique for staging cervical, endometrial, and early ovarian cancers. Though this technique is no standard procedure results of this pilot study warrant prospective studies comparing this technique with conventional procedures.

[MSA--a new sensitive tumor marker in breast carcinoma]. / MSA--ein neuer sensitiver Tumormarker beim Mammakarzinom.

Mammary serum antigen (MSA) serum levels were evaluated for its association with histopathologic outcome of breast biopsies. 212 women were undergoing a diagnostic extirpation for suspicious lesions of the breast. Invasive breast cancer was found in 24.5%, in-situ-carcinomas in 7.1% respectively. 56.1% of the women were diagnosed with proliferating benign breast diseases and normal breast tissue was found in 12.3% of the patients. In all women pretherapeutic MSA-serum levels were measured by Inhibition-ELISA using the monoclonal antibody 3E1.2. The positivity-rates of MSA, CA15-3, TPA and CEA were compared separately and in combination. MSA was positive in 25% of breast cancer patients when a cut-off level of 55 U/ml was applied. The addition of CA15-3, TPA or CEA increased the sensitivity to 42.3% and the increment of the positivity-rate was smaller by addition of CA15-3, when compared with TPA or CEA. The highest MSA serum levels and positivity-rates were associated with malignant tumours, but there was no significant difference compared with benign epithelial proliferations (19.5% positivity rate). The lowest positivity-rate was detected in mesenchymal proliferations of the breast (4.8%, p = 0.02). To sum up one can say that MSA serum levels do not allow to discriminate benign from malignant breast diseases and MSA is 2.5 to 3 times more sensitive for the prediction of early stages breast cancer compared to CA15-3, TPA and CEA.

[Laparoscopic management of a ureteral lesions in Schauta-Stoeckel radical vaginal hysterectomy]. / Laparoskopische Versorgung einer Ureterläsion bei radikaler vaginaler Hysterektomie nach Schauta-Stoeckel.

We report on the laparoscopic repair of an ureteral injury during radical vaginal hysterectomy according to Schauta-Stoeckel combined with laparoscopic paraaortic and pelvic lymphadenectomy. A 0.5 cm long oval incision of the left ureter 4 cm from the bladder was noticed during laparoscopic inspection at the final stage of the operation. The injury was repaired through a transvesical ureteral stent under laparoscopic guidance with laparoscopic intracorporeal suturing. On postoperative day 10 the ureteral stent was removed. An intravenous urogram taken 4 weeks after the operation showed normal conditions. Therefore primary laparoscopic repair of an ureteral injury is possible and effective.

[Preserving fertility in early cervix carcinoma: trachelectomy with laparoscopic lymphadenectomy]. / Erhaltung der Fertilität bei frühem Zervixkarzinom: Trachelektomie mit laparoskopischer Lymphonodektomie.

We report two cases of trachelectomy with laparoscopic paraaortic and pelvic lymphadenectomy in young women with early cervical cancer. Surgery took 225 and 275 minutes, respectively. A total of 49 and 27 lymph nodes were resected. Both patients were discharged on postoperative day 5. Preservation of fertility in such young women with early disease seems feasible.

[Compliance in gynecologic screening and causes for delayed tumor diagnosis in East Thüringen]. / Compliance für gynäkologische Vorsorgeuntersuchungen und Ursachen von Tumorverschleppung in Ostthüringen.

The public health service of the former GDR paid special attention to early recognition and the registration of malignancies. Due to this efforts the staging of cervical cancer moved to more low-staged tumours admitted to our hospital from the eastthuringian region. In spite of this around 35% of our patients with malignant diseases had stage II or higher staged tumours ad admission. The causes for delayed perception were analysed. Campaign-like preventive actions formerly supported by factories and public health service will not take place again. The responsibility for secondary prevention has to be taken over by practicing gynaecologist in cooperation with the general practitioner. A pilot study revealed that only 11% of the women followed a written invitation for a preventive gynaecological examination. But a general practitioner concerning the patients individuality persuaded 75% of his patients letting perform such a check up. The family doctors direct advice to consult a gynaecologist is the most effective way to get the patients compliance for a preventive examination. The epidemiology and results of therapy will become evident by duty of notification and central registration of malignancies. Relatively centralized therapy and obligatory follow up under the responsibility of the treatment center for about five years enhance the therapeutic results. The positive experience of gynaecological oncology of the eastern part of the Federal Republic of Germany ought to be maintained and should be developed.

[Importance of psychometric studies in gynecological tumor follow-up care]. / Wertigkeit psychometrischer Untersuchungen in der gynäkologischen Tumornachsorge.

100 patients successfully treated for gynecological tumors and 100 females who never had suffered from a malignant disease were investigated for neurosis by means of a special questionnaire according Höck and Hess. 52% out of the tumours patients and 42% of the control group demonstrated symptoms and signs of neurosis. The difference was not significant. Patients with tendency to depression or neurosis can be detected with psychometric methods and treated accordingly.

[Effects of various oxygen concentrations on metabolic performance of in vitro perfused human placentas]. / Auswirkungen unterschiedlicher Sauerstoffkonzentrationen auf metabolische Leistungen der in vitro perfundierten menschlichen Plazenta.

The aim of the experiments was the in vitro-investigation of metabolic reactions of human placentae under different oxygen supply, particularly when oxygenation followed a period of hypoxia. A perfusion system was used with both circuits of a whole placenta being recirculated over 2 hours with blood-containing perfusate. In group A 17 placentae were perfused under normoxic conditions; in group B 10 perfusions were carried out under hypoxia. In group C 8 placentae were oxygenated after 60 minutes of hypoxic perfusion. (All results are given in mumol/g wet weight/h). In group B glucose uptake (2.95 +/- 1.11) was slightly increased compared to group A (2.59 +/- 1.68), while lactate production was markedly higher (7.69 +/- 1.04 versus 3.56 +/- 1.53 in group A). Oxygen consumption was smaller under hypoxia. Pyruvate showed no significant changes over the 2 hours in all groups. In group C the results of the first hour resembled those of group B. After reoxygenation these placentae showed a smaller oxygen consumption compared to group A, but the highest glucose uptake (4.35 +/- 0.72), whereas lactate production (5.26 +/- 1.86) was lowered compared to group B. The smaller oxygen consumption could be explained by a deterioration of mitochondriae and hence a decreased capacity of oxydative metabolism. The higher glucose uptake could reflect the ability of placental tissue to restore other energy-sources (e.g. proteins) which were affected under the previous hypoxia. Further investigations are required to answer questions of placental function and its disturbances.

[Cycloplatin (LACHEMA) in ovarian carcinoma. Results of a registered study]. / Cycloplatin (LACHEMA) beim Ovarialkarzinom. Ergebnisse einer Registrierungsstudie.

A short report is given on the first results of the Carboplatin registration trial in ovarian cancer. CR 3/10 pat. PR 4/10 pat. remission time 10 ms in average. In comparison with cisplatin the efficacy is similar. The side effects are different particularly the bone marrow was more affected in contrast to cisplatin. The nephrotoxic side effects can be neglected.

[Effectiveness of cisplatin alone and in combination within the scope of primary therapy of ovarian cancer. Results of a prospective multicenter study]. / Die Effektivität von Cisplatin allein und in Kombination im Rahmen der Primärtherapie des Ovarialkarzinoms. Ergebnisse einer prospektiven Multizenterstudie.

The efficiency of cis Platin (DDP) alone and in combination with Adriamycine (ADM) and Cyclophosphamid (CTX) were evaluated in a prospective randomized trial containing 173 pat. suffering from advanced ovarian cancer (FIGO III/IV). Therapeutic schedule and results: (table; see text) The most side effects concerned vomiting (WHO Grad 2) in 90%, nausea (WHO Grad 2) in 95% and alopecia in 50% out of all pat.

[Results of therapy of endometrial carcinoma and analysis of risk factors in comparison with a control group]. / Therapieergebnisse beim Endometriumkarzinom und Risikofaktorenanalyse im Vergleich mit einer Kontrollgruppe.

Overall 1,021 patients with endometrial carcinoma were treated between 1965 and 1982 at the Department of Obstetrics and Gynecology and the Department of Radiology, Friedrich-Schiller-University, Jena. The 5-year-survival rate of all patients amounted to 63%. The 5-year-survival probability with primary surgery was 76.1%, with primary irradiation 34.4%. The frequency of risk factors in the patient group was compared with an age adjusted group of patients who underwent a D & C due to irregular bleeding of benign causes. Overweight and infertility were evaluated as significantly more frequent risk factors in cancer patients. There was no significant difference between the two groups concerning the factors hypertension, diabetes, heart-diseases, irregular bleeding and history of carcinoma in the family.

[Comparison of the progesterone test and uterus sonography as screening procedures in the detection of patients at risk of endometrial cancer]. / Vergleich von Progesterontest und Uterussonographie als screening-Verfahren zur Erkennung von Risikopatientinnen hinsichtlich Endometriumkarzinom.

The increasing incidence of endometrial cancer requires more attention to early detection. Postmenopausal women without symptoms were examined by progesterone challenge test (96 diabetics, 111 without diabetes) and by sonography (44 diabetics, 74 without diabetes) in order to recognize proliferation of the endometrium. The application of progesterone induced a bleeding in 4% of the women. The diagnostic curettage performed 4-6 weeks after this test revealed almost always atrophic endometrium. We found a good correspondence between abnormalities of the uterine cavity detected by sonography and the results of the pathological examination after notice pathological changes of the endometrium.

[Results of treatment of ovarian cancer patients at the Jena University Gynecological Clinic 1974-1983]. / Behandlungsergebnisse bei Ovarialkarzinom-Patientinnen an der Universitäts-Frauenklinik Jena in den Jahren 1974-1983.

In a retrospective analysis 228 patients suffering from ovarian carcinoma were investigated. They had been treated at the Dept. of Gynecology of Jena from 1974 up to 1983. We determined remission rate, remission time, and 5-year survival. Conclusions of our analysis are the following: The incidence and 5-year survival of patients suffering from ovarian cancer are nearly constant during the time interval obtained in this study. Survival will be determined by 38%. Early stages (I and II) were treated only by operation while patients suffering from higher stages (III and IV) were undergone chemotherapy and/or radiotherapy. We obtained value of the remission rate and the 5-year survival rate, comparable to these reported in literature.

[Urinary enzyme excretion in cephalothin therapy in pregnancy]. / Harnenzymausscheidung während einer Therapie mit Cephalothin in der Schwangerschaft.

A damage of the kidney, particularly of the proximal tubular cells, can be indicated by an increased concentration of distinct enzymes in urine. During cephalothin treatment of pyelonephritis in pregnant women the daily excretion of 4 brush-border enzymes was measured, to detect a tubulotoxic effect of this drug. The present results do not demonstrate a marked alteration of tubular cells. The use of cephalothin during pregnancy is possible, but the risk of nephrotoxic side effects should be considered.

[Therapy and treatment results of cervical cancer in the Medical School of the Friedrich Schiller University of Jena from 1965 to 1976 (report on 1453 cases)]. / Therapie und Behandlungsergebnisse beim Zervixkarzinom am Bereich Medizin der Friedrich-Schiller-Universität Jena in den Jahren 1965 bis 1976 (Bericht über 1453 Fälle).

In this paper, therapeutic results of 1,453 cervical cancer patients stage T1-T4 who have been treated at the Gynaecological Hospital and the Radiological Hospital of Jena University are reported. The overall Five-Year Survival Rate amounted to 68.4 per cent. Surgical and radiological therapeutic measures are demonstrated with regard to their development and to side effects between 1965 and 1983. As a consequence of the results obtained the necessity for treating cervical cancer patients in a cancer center has to be stressed.

[Effect of pethidine administration on transcutaneous oxygen pressure in the fetus and pulmonary adaptation post natum]. / Auswirkung der Pethidinapplikation auf den transkutanen Sauerstoffdruck des Fetus und die pulmonale Adaptation post natum.

After application of Pethidine to the mother for the purpose of obstetric analgesia we couldn't find any changes in the fetal tcPO2-behaviour. As well 95 term infants with and without previous Pethidine-application to the mother showed no disturbance of cardio-pulmonary adaptation in hyperoxia-test.

[Results of treatment of cervical malignancies at the Medical Department of the Friedrich Schiller University in Jena 1965-1976. III. Comparison of results of telecobalt postoperative radiotherapy with conventional roentgen irradiation]. / Ergebnisse der Behandlung des Zervixmalignoms am Bereich Medizin der Friedrich-Schiller-Universität Jena in den Jahren 1965-1976. III. Mitteilung: Vergleich der Ergebnisse der postoperativen Strahlentherapie mit Telekobalt und konventioneller Röntgenstrahlung.

Results and secondary effects of postoperative radiation therapy by telecobalt and conventional x-rays at 589 female patients with malignoma of the cervix are discussed. Advantages and disadvantages of both methods are analysed critically. The 5-years-survival rates are 78,6% respectively 87,0%.