[Value of microfertilization for repeated in vitro fertilization failures: the role of female parameters]. / Place de la microfécondation dans les échecs répétés de fécondation in vitro: le rôle des paramètres féminins.

UNLABELLED: Microfertilization technics as SUZI (sub-zonal insemination) can be indicated in cases of repeated in vitro fertilization (IVF) failure. Feminine parameters seem to play however an important role in optimalization of results. We studied 27 couples (32 IVF-SUZI cycles) who had previously presented 2 to 4 in vitro fertilization failures. These 32 cycles were divided in 2 groups according to women's age: group A < or = 35 and group B > 35 years. RESULTS: basal FSH levels were higher in group B (6.6 +/- 3.1 mIU/ml) in comparison to group A (3.7 +/- 1.5 mIU/ml). The amount of hMG necessary to accomplish ovarian stimulation was also higher in group B (39 +/- 21 ampules) than in group A (26 +/- 11 ampules). Maximal plasma estradiol levels were higher in group A (2,775 +/- 872 pg/ml) than in group B (1,824 +/- 559 pg/ml) such as the mean number of oocytes collected and micro-injected: 11.6 +/- 4.5 versus 4.7 +/- 2.2 in groups A and B, respectively. Eight pregnancies (44%), of which 7 were ongoing pregnancies, were obtained in group A. No pregnancy was obtained in group B. CONCLUSIONS: SUZI seems to be an available technic for treatment of repeated IVF failures; our results seem to indicate a decrease in SUZI results with age of the women (> 35 years old); they suggest the opportunity of a complete investigation of feminine parameters prior to each SUZI-IVF cycle.

Randomized comparison of cyclophosphamide, doxorubicin and cisplatin (CAP) versus cyclophosphamide and doxorubicin (CA) for the treatment of advanced ovarian cancer (ADOVCA). A EORTC Gynecological Cancer Cooperative Group Study.

The possible advantage of adding cisplatin (P) to cyclophosphamide (C) + adriamycin (A) in the management of stages III and IV ovarian cancer of epithelial origin was tested in a trial in which 149 patients were randomized to receive, after initial surgery, either CAP (C = 600 mg/sqm, A = 45 mg/sqm, P = 50 mg/sqm) or CA (C = 600 mg/sqm, A = 45 mg/sqm) every 4 weeks for 6 to 12 cycles, at which time follow-up laparotomoy was to be performed in responding or clinically disease-free patients. Fifteen patients were not included in the final analysis and the remaining 134 patients were considered fully or partially evaluable and are used in analysis of response and survival. The complete and partial response rates were 45.6% in the CAP arm and 45.4% in the CA arm, but the CAP regimen is of special importance in patients with bulky disease. Median survival CAP = 24 m and CA = 24.2 m), time to progression and survival was found not significantly different when CAP and CA were compared. However, more patients in the CA regimen had no macroscopic disease left after surgery than in CAP regimen (11 versus 6) and more patients in the CAP arm dose reductions and schedule delays than in the CA arm (61.1% versus 38.2%).

Cisplatin, vinblastine, and bleomycin combination in the treatment of resistant high-risk gestational trophoblastic tumors.

Eight patients with high-risk gestational trophoblastic tumors (GTT) resistant to multiagent chemotherapy were treated with the combination of cisplatin, vinblastine, and bleomycin (PVB). All patients had a metastatic disease including three patients with two metastatic sites and two patients with brain metastases. Four patients achieved complete remission (CR) with the PVB regimen (50%). Three additional patients had partial remission (PR) of whom two were converted into CR by surgery of resistant residual lesions. One patient relapsed and the remaining five patients in CR were cured (62%). A multimodal approach was necessary in most patients as five of them had hysterectomy and two patients had a whole-brain irradiation. Toxicity was mild with no treatment related deaths.

["After-reintervention" in ovarian cancer]. / L' "après-réintervention" dans le cancer de l'ovaire.

Reoperation in ovarian cancer, following the initial surgery and the subsequent general chemotherapy, is currently agreed upon by most authors: it permits to evaluate the results of chemotherapy; when new lesions appear or lesions that have been left in place increase in size, re-operation enables excision of these lesions. But, after this surgical stage, opinions regarding treatment differ. In the case of complete remission, macroscopic and microscopic, it is possible to do nothing, to resume chemotherapy, to perform an abdomino-pelvic radiotherapy in limited doses. In the case of an incomplete microscopic remission and the persistence or aggravation of previous lesions, only a different type of chemotherapy is performed. Its chances of success are very remote. On the whole, chemotherapy is seldom used; chemotherapy may and must be used, especially in case of minor lesions. It must be emphasized that remission does not mean cure, and that incomplete remission does not obligatorily imply a poor prognosis.

Combination cyclophosphamide, adriamycin, and cis-platinum in recurrent and metastatic cervical carcinoma.

Thirty evaluable patients with recurrent and/or metastatic cervical cancer were treated with a combination of cyclophosphamide, adriamycin, and cis-platinum. We observed no complete response and three partial responses (10%). One year survival rate was 45%. CAP combination did not prove to be more effective than single agent cis-platinum.

New treatment procedure for stage I endometrial adenocarcinoma.

A series of 80 Stage I adenocarcinomas of the endometrium is described. Treatment is based on a more frequent use of surgery and there is greater individualization of the treatment procedure, which combines vaginal or uterovaginal Curie therapy and surgery. Overall 5 year survival rates are 82%, compared with 91.5% for patients having been treated with Curie therapy plus surgery. The patient's age and the size of the uterus were found to be significant from the prognostic standpoint. However, other factors, such as histological type and grade, penetration into the myometrium, and lymph node involvement did not seem especially important. Treatment described here appears to give better results than that used previously; survival rates are higher and complications of treatment are negligible.

[Advanced cancer of the ovary. Treatment and results]. / Le cancer de l'ovaire étendu. Traitement et résultats.

The management of advanced ovarian carcinoma (stages IIb, III, IV) is presented together with the results of treating a series of 65 patients at Gustave-Roussy Institute. The response rate was 43 p. cent with 16 complete remissions and 12 partial remissions out of 65 patients. Fourth year survival without recurrences was 12/65; 9/16 after complete remission at 2nd look, and 3/12 after partial remission. Treatment was by surgery--chemotherapy--2nd look surgery; radiotherapy and/or chemotherapy are decided on after 2nd look surgery. Each treatment should be agressive, prolonged, and multi-disciplinary.

[Randomized comparative trial of a new anti-emetic: nabilone, in cancer patients treated with cisplatin]. / Essai comparatif randomisé d'un nouvel anti-émétique: la nabilone, chez des malades cancéreuses traitées par le cis-platinum.

A randomized, double-blind controlled trial of nabilone versus chlorpromazine was performed in 20 patients with advanced gynaecological cancer who received chemotherapy including cis-platinum. Each patient served as his own control. Nabilone was administered at a dose of 3 mg given orally three times a day, starting the day before cis-platinum and ending the day after. Chlorpromazine was administered at a dose of 12.5 mg given IM, 15 minutes before the start of cis-platinum. Nabilone, in comparison with chlorpromazine did not significantly reduce the number of vomiting. Ten patients preferred nabilone, 5 preferred chlorpromazine and 3 were undecided. Predominant side effects noted by patients were similar for both agents and included somnolence, dry mouth and orthostatic hypotension. No other intervention besides reassurance of the patient was necessary to treat these adverse reactions.

Absence of systemic hormonal effects in an oestradiol diether topically active on the vaginal mucosa.

The women in this study were either post-menopausal or ovariectomised for at least 1 yr prior to the study. They had also been treated for cancer of the cervix (27 women), endometrium (5), ovaries (5) or breast (1). All women presented with sexual troubles, mainly genital discomfort (dyspareunia or vaginism). In a double-blind fashion, gynaecological capsules containing either an oestradiol diether (ICD: promestriene) or only the excipient were administered for 40 consecutive days. At the end of the treatment, the FSH, LH, oestrone (E1) and oestradiol (E2) plasma levels were not found to be significantly different from the pre-therapeutic values. These results suggest that promestriene acts on the vaginal mucosa, therefore not being converted back into the hormone from which it was derived. Also, in its dietheroxide form, promestriene is incapable of crossing the malpighian (vaginal or epidermal) epithelium and of reaching the general blood circulation. This discrepancy between the local anti-atrophic effects and the inability to exert systemic oestrogen activities singles out promestriene and justifies its therapeutic use when hormonally active oestrogens are contra-indicated, as in patients who have an oestrogen-sensitive cancer in their medical history.

[Ovarian cancer. Pretherapeutic evaluation and post-therapeutic follow-up]. / Cancers de l'ovaire: bilan préthérapeutique et surveillance en cours de traitement.

The number, the variety and the complexity of investigations for diagnosis and follow-up of ovarian carcinoma are related to the diversity of possible involvement and the insufficiency of the reliability of each of the applied methods. Cytologic examination, sonography and CT scanning are of first line importance, as well as the different roentgenologic methods. However, none allows dispensing surgical exploration and pathological examination. Moreover, as one speaks of therapeutic strategy, diagnostic strategy lead by a homogeneous and well coordinated team, is worthy of mention as well, for it is the only guarantee for efficiency and valuable results.