Value of chest CT scans in routine ovarian carcinoma follow-up.

OBJECTIVE: The purpose of our study was to examine the role of chest CT scans in routine follow-up of patients who had been treated for ovarian carcinoma. MATERIALS AND METHODS: The radiologic follow-up of 127 women with metatastic ovarian carcinoma who had undergone surgery and chemotherapy between 1985 and 1996 was reviewed. In reviewing each patient's medical record, we determined whether a chest CT scan had been obtained, and if so, how many had been obtained during the patient's follow-up period. For patients with a chest CT scan, an analysis of the presence of disease in the thorax and its relation to disease in the abdomen and pelvis, as revealed on CT images, was performed. RESULTS: Of the patients whose cases were examined, 82 (65%) had had at least one chest CT scan obtained, with more than 50% having had three or more scans. Thirty-two (39%) patients had no radiologic evidence of disease. Twenty-eight (34%) showed disease in the abdomen or pelvis but no disease in the chest. Eighteen (22%) had both chest and abdominal or pelvic CT scans that indicated disease. In all of these patients, abdominal or pelvic disease had appeared on scans before spreading to the chest. Four (5%) of the patients had isolated chest disease. The rate of lung metastases from ovarian carcinoma in our series was 6%. In all of these patients, pulmonary metastases were preceded either by abdominal or pelvic disease or by a rise in tumor markers. CONCLUSION: Pulmonary metastases in ovarian carcinoma are rare and usually preceded by recurrence of carcinoma in the abdomen or pelvis. We suggest that chest CT scanning could be eliminated in the routine follow-up of patients who have been treated for ovarian carcinoma; yet it should be performed for those patients with elevated serum tumor markers but without evidence of abdominal or pelvic disease.

Effect of pregnancy on overall survival after the diagnosis of early-stage breast cancer.

PURPOSE: To evaluate the impact of subsequent pregnancy on the prognosis of patients with early breast cancer. PATIENTS AND METHODS: One hundred eight patients who became pregnant after diagnosis of early-stage breast cancer were identified in institutions participating in International Breast Cancer Study Group (IBCSG) studies. Fourteen had relapse of breast cancer before their first subsequent pregnancy. The remaining 94 patients (including eight who relapsed during pregnancy) formed the study group reported here. A comparison group of 188 was obtained by randomly selecting two patients, matched for nodal status, tumor size, age, and year of diagnosis from the IBCSG database, who were free of relapse for at least as long as the time between breast cancer diagnosis and completion of pregnancy for each pregnant patient. Survival comparison used Cox proportional hazards regression models. RESULTS: Overall 5- and 10-year survival percentages (+/- SE) measured from the diagnosis of early-stage breast cancer among the 94 study group patients were 92% +/- 3% and 86% +/- 4%, respectively. For the matched comparison group survival was 85% +/- 3% at 5 years and 74% +/- 4% at 10 years (risk ratio, 0.44; 95% confidence interval, 0.21 to 0.96; P =.04). CONCLUSION: Subsequent pregnancy does not adversely affect the prognosis of early-stage breast cancer. The superior survival seen in this and other controlled series may merely reflect a healthy patient selection bias, but is also consistent with an antitumor effect of the pregnancy.

Multiple parenchymal liver metastases as the first site of recurrent ovarian carcinoma: a case report and review of the literature.

The incidence of clinically detectable parenchymal liver metastases in patients with recurrent ovarian carcinoma has been infrequently reported, but autopsy findings indicate that they are the second most common site of distant metastases in patients with epithelial ovarian carcinoma. The case of a 58-year-old patient who developed parenchymal liver metastases as the first site of recurrent ovarian carcinoma is presented. The different spreading routes of this malignancy, as well as a review of the incidence of liver metastases are discussed.

Neoadjuvant chemotherapy for locally advanced cervical cancer--where does it stand?: a review.

Platinum-based combination chemotherapy has been utilized in the neoadjuvant setting in locally advanced inoperable cervical cancer with the aim of improving response and survival. Neoadjuvant chemotherapy can be followed by either radiation therapy (RT) or by surgery in cases in which it seems to be appropriate. Available data indicate that preradiation chemotherapy yields no survival advantage over RT alone. However, presurgery chemotherapy may increase resectability in women with locally advanced cervical cancer to around 70 percent. Nonrandomized trials of neoadjuvant chemotherapy followed by surgery have shown some improvement in the outcome. Prospective randomized trials are needed to evaluate this approach as compared with RT alone and to define its precise role in locally advanced cervical cancer.

Carboplatin and etoposide as first-line chemotherapy in advanced epithelial ovarian cancer.

Carboplatin and etoposide are chemotherapeutic agents active in ovarian cancer, previously proved to have a synergistic activity in animal models. The objective of this phase II study was to determine the feasibility and the efficacy of the combination of carboplatin and etoposide in previously untreated patients with advanced epithelial ovarian cancer. Carboplatin, 400 mg m-2 day 1, and etoposide, 100 mg m-2 days 1-3 every 4 weeks were administered to 28 patients with advanced stage (III-IV) ovarian cancer and a performance status 0-2 (ECOG scale), as a firstline chemotherapy. Twenty-three patients were evaluable for response; 15 (65%) (95% CI: 45-81%) responded, 10 (43%) (95% CI: 25-63%) with clinical complete response. Pathologic complete response demonstrated during postchemotherapy laparotomy was noted in 5/23 (22%) (95% CI: 9-42%) patients. The median progression-free interval was 8.5 months, and median survival was 19.5 months. Toxicity, mainly hematologic, was severe. Nine (32%) patients experienced at least one episode of leucopenic fever, which consequently led to toxic deaths in two (7%) patients. The relatively low response and survival rates with increased toxicity rate are disappointing.

The role of brachytherapy in the treatment of stage III vaginal cancer. A report of 3 cases.

Advanced vaginal cancer has a grim prognosis: management is complicated. It may include surgery which needs to be exenterative if cure is intended, and/or radiation therapy (RT), the dose of which is limited by the radiosensitivity of adjacent structures. We report on 3 cases, in each of which the tumor was located in different anatomic sites, and we demonstrate how therapy was tailored to each situation. All 3 patients had Stage III, squamous cell carcinoma of the vagina. They received external beam irradiation (EBI) 4000-5000 cGy to the pelvis. This is the maximal tolerable dose by most pelvic organs, but is not curative. Therefore brachytherapy was combined with EBI. In one patient brachytherapy was given intraoperatively, following extensive removal of residual tumor in the pelvis. Two patients are alive and free of disease three and six and a half years later, and one patient died of disease five years following therapy. For eradication of advanced vaginal cancer, treatment includes the combination of EBI and brachytherapy with or without debulking surgery, the role of which was not previously described in this setting. Treatment strategy should be adapted to the anatomic location of the tumor, its intravaginal extension and the age of the patient.

Methylprednisolone as antiemetic treatment in breast-cancer patients receiving cyclophosphamide, methotrexate, and 5-fluorouracil: a prospective, crossover, randomized blind study comparing two different dose schedules.

The antiemetic response and side effects resulting from treatment with methylprednisolone (MPA) given on two different dose schedules were evaluated in 20 women with breast cancer who were undergoing chemotherapy consisting of cyclophosphamide, methotrexate and 5-fluorouracil (CMF). This randomized, crossover, double-blind study compared the antiemetic efficacy of a single dose of 125 mg MPN with that of two such doses. The study demonstrated the superiority of the latter protocol in preventing CMF-induced nausea and vomiting. The rate of antiemetic response to single vs double doses was as to follows: complete protection, 17% vs 30%; partial and minimal protection, 39% vs 55%; and no protection, 44% vs 15% of the courses, respectively (P = 0.0087). No difference in the antiemetic response rate was found between the first and the second course. Treatment with MPN was well tolerated, and no difference in the incidence of side effects was found between the single-dose and the double-dose schedule. We recommend the use of two doses of 125 mg MPN as prophylactic antiemetic treatment in breast-cancer patients receiving CMF chemotherapy.

Danazol in non-splenectomized patients with refractory idiopathic thrombocytopenic purpura.

Seven non-splenectomized patients with chronic refractory idiopathic thrombocytopenic purpura were treated with danazol 800 mg daily. All were glucocorticoid failures and four were refractory to all additional previous therapy. Five patients benefited from danazol and in two sustained normal platelet counts, for over 44 and 51 months, were observed. We conclude that danazol is useful for long term management of otherwise refractory idiopathic thrombocytopenic purpura. The advantage of danazol over splenectomy as a first line treatment in steroid failure is suggested.