Analysis of prognostic factors in stage I epithelial ovarian carcinoma: importance of degree of differentiation and deoxyribonucleic acid ploidy in predicting relapse.

OBJECTIVES: Our purpose was to identify prognostic factors in stage I epithelial invasive ovarian carcinoma. STUDY DESIGN: The traditional clinical and pathologic prognostic variables and deoxyribonucleic acid ploidy were analyzed in a group of 290 patients. RESULTS: A multivariate analysis identified degree of differentiation as the most powerful prognostic indicator of disease-free survival, followed by deoxyribonucleic acid ploidy and, finally, International Federation of Gynecology and Obstetrics (1986) stage. Tumors with clear cell carcinoma elements were not graded, and in this subgroup International Federation of Gynecology and Obstetrics (1986) stage was the most important prognostic characteristic. When the effects of the three most important factors were accounted for in graded tumors, then none of the following were prognostic: histologic type, dense adhesion, extracapsular growth, ascites, rupture during surgery, International Federation of Gynecology and Obstetrics (1973) stage, size of tumor, and age and type of adjuvant treatment. None of 77 patients with well differentiated deoxyribonucleic acid diploid tumors had relapses. CONCLUSION: Deoxyribonucleic acid ploidy is an important new independent prognostic factor in stage I ovarian carcinoma.

Intraperitoneal radioactive phosphorus therapy in ovarian carcinoma. Analysis of 313 patients treated primarily or at second-look laparotomy.

BACKGROUND: Intraperitoneal radioactive phosphorus (phosphorus-32) has been used in ovarian cancer during the last three decades. In the current study, the survival results, the patterns of recurrence, morbidity rates, and phosphorus-32 distribution scintigrams were reviewed in 313 patients treated with phosphorus-32 colloid. METHODS: Between July 1982 and July 1988, 245 patients with epithelial ovarian carcinoma were treated with phosphorus-32 as primary adjuvant treatment; 59 patients received phosphorus-32 as consolidating therapy after negative results during second-look surgery and 9, after positive findings during second-look laparotomy. Fifty patients with negative second-look findings were assigned randomly to receive phosphorus-32 or no treatment. The phosphorus-32 distribution was studied by scintigraphic imaging in 297 patients. RESULTS: The actuarial 5-year crude survival rate was 81% in the group treated with phosphorus-32 adjuvantly and 79% in the group treated after second-look surgery. Crude and disease-free survival rates were similar in both groups randomized at second-look surgery to receive either phosphorus-32 or no treatment. Phosphorus-32 scintigraphy showed major isotopic accumulations in 48 (16%) patients. There were two deaths (0.6%), which, at least partly, could be attributed to the phosphorus-32 treatment. Small bowel obstruction without tumor recurrence occurred in 22 (7%) patients (13 treated surgically and 9 medically) and was not related to any patient characteristic, including phosphorus-32 distribution. CONCLUSIONS: Phosphorus-32 therapy was associated with a considerable number of bowel complications. The occurrence of small bowel obstruction could not be predicted by any patient characteristic. Without an untreated observation group, the authors were unsure whether adjuvant phosphorus-32 treatment conferred a survival advantage.

Randomized trial comparing cisplatin with radioactive phosphorus or whole-abdomen irradiation as adjuvant treatment of ovarian cancer.

In this study, 347 patients with epithelial ovarian cancer without residual tumor after primary laparotomy, were assigned randomly to receive either intraperitoneal instillation of radioactive phosphorus (32P) or six courses of cisplatin (50 mg/m2). Patients randomized to receive 32P with extensive intraperitoneal adhesions were treated with whole-abdomen irradiation instead of 32P (n = 28). The median follow-up was 62 months. Crude and disease-free survival were similar in all groups. Late bowel complications occurred more often in patients treated with 32P compared with the cisplatin group. The estimated 5-year crude survival rate was as high as 95% in patients with borderline or well-differentiated tumors in Stage I. It is suggested that these patients can be treated adequately by operation alone. Patients with moderately or poorly differentiated cancers in Stage I disease had a 5-year crude survival rate of 75%. In these patients, the relapse risk was high enough to warrant postoperative treatment. The efficacy of adjuvant treatment in this subgroup of patients can only be established in a prospective randomized study comparing postoperative adjuvant treatment with a no-treatment arm. Because of the high number of late bowel complications after 32P treatment, it was recommended that cisplatin be used as standard adjuvant treatment for subsequent controlled studies.

Cutaneous periarteritis nodosa. A case report.

We studied a patient with severe ulcerations on the lower limbs due to cutaneous periarteritis nodosa. Chronic relapsing course during more than 12 years with no systemic involvement was documented.