Good outcome associated with a standardized treatment protocol using selective postoperative radiation in patients with clinical stage I adenocarcinoma of the endometrium.

In 1982, a treatment protocol was instituted for the management of patients with clinical stage I adenocarcinoma of the endometrium. All pertinent historical, operative, and pathologic findings were reviewed by a multidisciplinary committee and 384 patients were prospectively assigned to either high- or low-risk categories. Patients were excluded from the study if they had clinically apparent extrauterine disease, clear cell or serous histologies, or microscopic ovarian metastasis. Patients were considered high-risk if they had one or more of the following factors: grade 3 tumor differentiation, myometrial invasion > 50% of the total wall thickness, pathologic cervical involvement, or adenosquamous histology. Two-hundred twenty-seven (59%) low-risk patients were followed without further treatment after surgery, while pelvic radiation was recommended for 157 (41%) high-risk patients. The 5-year relapse-free survival rates in the low- and high-risk groups were 95 and 81%, respectively. There were no treatment-related deaths. Severe or life threatening chronic radiotherapy complications occurred in 6 (5%) patients. Multivariate Cox analysis identified the following significant prognostic factors: grade, myometrial invasion, cervix involvement, and age. This treatment protocol represents a safe and effective method of managing patients with carcinoma of the endometrium and spares the need for radiation therapy in the low-risk patient.

The short-term reproductive toxicity of cyclophosphamide in the female rat.

Cyclophosphamide (CTX) is a potent ovarian toxicant. Previous studies of the acute effects of CTX in the rat have demonstrated widespread ovarian follicle atresia, reduced serum estradiol, and progesterone with normal serum LH and FSH. The present investigations demonstrate that a single injection of CTX induces ovarian toxicity that reflects the loss of growing ovarian follicles. CTX induces a sensitization of serum FSH in response to GnRH within 24 h; this sensitization is lost by 7 days, and after 14 days the animals are capable of normal mating behavior. The observed protection of primordial follicles from the acute administration of CTX under these experimental circumstances may be related to the stage of the granulosa cell cycle of these follicles.

Predictive value of CA 125 for ovarian carcinoma in patients presenting with pelvic masses.

Between November 1984 and May 1986, 56 patients presenting with a pelvic mass to the Gynecologic Oncology Service of McMaster University and the Hamilton Regional Oncology Center underwent laparotomy for possible ovarian cancer. All patients had blood drawn for CA 125 three days before operation. Levels above 35 U/mL were considered positive; CA 125 had a positive predictive value of 60%. False positives occurred in patients with nongynecologic malignancies and with benign gynecologic conditions. On the other hand, CA 125 had a negative predictive value of 100%, suggesting that this test may be useful in identifying those patients with pelvic masses at higher risk for malignancy, who may require transfer for surgery at a tertiary care center.

Adenocarcinoma in a cecal neovagina--complication of irradiation: report of a case and review of literature.

A 42-year-old woman is presented with her fifth primary pelvic carcinoma, occurring in an irradiated cecal neovagina. Previously reported neovaginal carcinomas are reviewed. The possible etiologies are examined. This is the first case of radiation-induced carcinoma arising in a cecal neovagina. Long-term follow-up is important in all patients with neovaginas.

Appendicitis masking as recurrent squamous cell carcinoma of the cervix.

The diagnosis of pelvic recurrent squamous cell carcinoma of the cervix is made on the basis of clinical assessment and radiologic confirmation. Occasionally the diagnosis is confused with sequelae of radiation therapy. The authors describe the symptoms and signs of appendicitis mimicking recurrent squamous cell carcinoma in a 43-year-old female. A 10-year search of the literature has failed to detect another case report or review. The authors believe that, if there is ever any doubt as to the diagnosis of pelvic recurrent squamous cell cancer, exploratory laparotomy and biopsies are warranted for confirmation.