Prognostic factors in extraovarian primary peritoneal carcinoma.

OBJECTIVE: To determine the pathological, clinical, and therapeutic factors which had prognostic significance in women with extraovarian primary peritoneal carcinoma (EOPPC). METHODS: A retrospective, clinicopathologic study was conducted of 75 women diagnosed with EOPPC. Diagnosis and assessment of prognostic pathological factors were based on the Gynecologic Oncology Group (GOG) criteria. Univariate and multivariate analyses were used to assess the following factors for their effect on overall survival: age, parity, presenting symptoms and signs, ascites, CA 125 level, history of oophorectomy, maximum ovarian dimension, histologic type, architectural and nuclear grades, number of mitosis and psammoma bodies, depth of ovarian invasion, estrogen and progesterone receptors (positive, negative), p53 overexpression (present, absent), performance status (GOG criteria), stage (FIGO criteria for ovarian cancer), debulking surgery (optimal versus suboptimal), first-line chemotherapy (platin-based without paclitaxel versus platin/paclitaxel), secondary cytoreduction, and second-line chemotherapy (paclitaxel-based versus no paclitaxel). RESULTS: The median overall survival of all patients was 23.5 months (95% CI 18.6, 39.8 months). The 5-year survival was 26.5% (SE 6.7%). p53 overexpression and estrogen and progesterone receptor positivity were demonstrated in 42.4, 50.0, and 6.3%, respectively. In univariate analysis, performance status, primary debulking surgery, stage, and age were significant on overall survival (P < 0.001, <0. 001, 0.004, and 0.012, respectively). In multivariate analysis, only performance status (P < 0.001) and primary debulking surgery (P = 0. 03) were independent prognostic factors. Conclusions. Overall survival in women with EOPPC is affected significantly by performance status and primary debulking surgery as independent variables. To improve survival, efforts should be made to achieve optimal tumor cytoreduction at primary surgery.

Simple method for the management of hematuria caused by radiation or cytoxan.

A simple method of continuous bladder irrigation with two catheters is described for the management of hematuria caused by radiation or cytoxan. This simple method seems to be more effective than traditional irrigation with a three-way catheter.

Common peroneal nerve palsy associated with pelvic surgery for cancer. An analysis of 11 cases.

Eleven occurrences of common peroneal palsies following pelvic surgery for malignant conditions are reported. The patients' clinical course and possible mechanisms of nerve injury were reviewed. It was concluded that the current belief that all peripheral neuropathies occurring under general anesthesia are preventable may not be applicable to patients with pelvic cancer who must undergo tedious, lengthy, meticulous, extirpative surgery in the dorsal lithotomy position. In patients with tumors that are seemingly isolated to the pelvis, amenable for surgical resection, the possible risk of a peripheral nerve injury is superseded if beneficial effects are obtained by controlling the local manifestations of the tumor.

Recurrent endometrial adenocarcinoma with rearrangement of chromosomes 1 and 11.

A chromosome study was performed in a recurrent endometrial cancer. The cytogenetic analysis performed with a quinacrine-Hoechst banding technique revealed rearrangements of chromosomes #1 and #11 [i.e.: der(11),t(1;11)(q21;q23)], which was found in all metaphases. In addition, a deletion of chromosome 6(q21), trisomy of chromosomes #7 and #10, monosomy X, and -4 as the clonal changes. Partial trisomy for a long arm of chromosome #1 also was observed in almost all analyzed metaphases (11 of 12 cells). These data showed the association of rearrangement of 1q in endometrial cancer and/or redevelopment of tumor, and also suggest the possible participation of chromosome #11 on which the human proto-oncogene c-ets was mapped.

Adenocarcinoma of the colon masquerading as primary ovarian neoplasia. An analysis of ten cases.

This paper reviews the clinical characteristics of a group of patients in whom unsuspected primary adenocarcinoma of the colon presented with signs and symptoms of a primary ovarian neoplasia. In most patients, the ovaries were removed, the correct diagnosis was established at a later time, and a second surgery for resection of the primary adenocarcinoma of the colon was then performed. Preoperative use of colonoscopy or barium-enema examination would have helped. We compared these patients to a group of patients with similar clinical characteristics, but in whom the ovarian metastases were clinically apparent months after the resection of a primary colorectal cancer. We found that, in both groups, age of the patients, anatomic distribution of the primary tumor, histologic differentiation, serosal or mesenteric lymph node tumor involvement, and timing of the oophorectomy in relationship to removal of the primary colorectal tumor did not affect the overall survival. Once ovarian metastases were documented, patients died regardless of treatment, approximately 16 1/2 months after the diagnosis.

Specific cytogenetic changes in ovarian cancer involving chromosomes 6 and 14.

Cytogenetic studies were performed in 12 papillary serous adenocarcinomas of the ovary. Of the more than 19 clonal structural chromosome abnormalities observed in these cancers, 6q- and 14q+ were found to be the most frequent. Both markers coexisted in the cells of eight cases; in the other four cases, either a 6q- or 14q+ was present. In at least six cases, the additional segment on the long arm of chromosome 14 appeared to originate, on the basis of the chromosomal quantity and fluorescence pattern, from the missing part of chromosome 6. This suggested that the 6q- and 14q+ markers had arisen as a result of a reciprocal translocation at Bands q21 and q24, respectively, i.e., t(6;14)(q21;q24). However, it is uncertain in the remaining six cases whether an identical type of translocation was responsible for the formation of the markers. Thus, abnormalities involving chromosomes 6 and 14 seem to be specifically associated with papillary serous adenocarcinoma of the ovary.

Treatment, results and prognostic factors in stage I and II sarcomas of the corpus uteri.

One-hundred and four cases of Stage I and II uterine sarcomas treated at Rosewell Park Memorial Institute over a 27 year period are reviewed. Included are 30 cases of mixed mesodermal tumor, 27 cases of carcinosarcoma, 25 cases of endometrial stromal sarcoma, and 22 cases of leiomyosarcoma. Prognostic factors were found to include histologic classification, stage, uterine size, depth of myometrial invasion, and type of treatment. Endometrial stromal sarcomas had the best over-all prognosis. Radiation therapy alone was inadequate treatment, but was of adjunctive value to surgery in terms of increasing survival and decreasing pelvic recurrences in patients with endometrial stromal sarcoma, mixed mesodermal tumor, and carcinosarcoma. Patients with leiomyosarcoma did not benefit from adjunctive radiation therapy.

Primary treatment of advanced ovarian adenocarcinoma, stages III and IV.

In an attempt to improve the response rate and hopefully the survival rate in women with advanced ovarian adenocarcinoma, three new modalities of therapy for ovarian adenocarcinoma were undertaken in 97 women. Sequential therapy consisted of surgery followed by chemotherapy, second-look laparotomy, and subsequent whole abdominal radiation. Eight women exhibiting a complete clinical response to chemotherapy were subjected to this treatment. However, only one woman (12%) is surviving without evidence of tumor recurrence. Concomitant therapy consisted of external radiation and single alkylating agent chemotherapy in 23 women. Again, the survival was poor: a 5-year survival of 8% without tumor recurrence. The third treatment modality consisted of a randomized study of 66 patients in whom single agent therapy with melphalan was compared with multiple agent therapy consisting of cyclophosphamide, dactinomycin, and 5-fluorouracil. In those women with stage III and IV serous adenocarcinoma of the ovary, a 63% response rate was obtained in patients receiving triple chemotherapy as compared to a 45% response rate in those receiving melphalan. Moreover, 40% of the group given triple chemotherapy exhibited a complete response as compared to only 18% in the group given melphalan.