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Improved palliation of cerebral metastases in epithelial ovarian cancer using a combined modality approach including chemotherapy, radiation therapy, and surgery
104
SOCIETY
OF GYNECOLOGIC
nursing personnel, forearm reservoir placement has been more aesthetically acceptable to our patients. Satisfactory initial P.A.S. Port system placement was accomplished in 23 patients (96%). No catheters were removed for sepsis. One catheter occluded and was replaced. All systems have been used until completion of planned parenteral therapy or death. 115. The Role of Routine
Postoperative
Intravenous
Pyelography
fol-
Hysterectomy. R. K. POTKUL, E. A. OLAH, J. F. BARTER, W. A. BARNES, AND G. DELGADO, Georgetown University, Washington, D.C. 20057. lowing
Type 111 Radical
This study was undertaken to evaluate the role of intravenous pyelogram (IVP) for routine postoperative evaluation of the urinary system after radical hysterectomy. Postoperative IVPs in 155 patients with Stage IB cervical cancer who had undergone type III radical hysterectomy and pelvic lymphadenectomy were reviewed over a lo-year period. The pyelograms were performed between Days 3 and 16 prior to removal of the Foley catheter. One hundred fifty-four pyelograms were interpreted as normal and one was noted to have right hydronephrosis secondary to obstruction at the pelvic brim. At the time of this study on Postoperative Day 12, the patient was noted to have a temperature of 38.6”C with right-sided Rank and abdominal pain. Ultrasound evaluation revealed a probable hematoma that subsequently resolved with conservative therapy. All asymptomatic patients had normal postoperative radiographic studies. Our series does not support the routine use of postoperative IVPs for evaluation of ureteral injury in asymptomatic patients undergoing radical hysterectomy. 116. Preoperative Serum CA-125 Levels in Borderline Tumors of the Ovary. L. W. RICE, J. M. LACE, R. S. BERKOWITZ, A. GOODMAN, M. G. MUTO, R. C. KNAPP, AND D. A. BELL, Harvard Medical School, Boston, Massachusetts 02115. Preoperative serum CA-125 levels were evaluated in 46 patients who underwent primary surgery for epithelial ovarian tumors of borderline malignancy at the Brigham and Women’s Hospital and Massachusetts General Hospital between 1981 and 1990. Surgical staging revealed 28 (60.8%) patients with Stage I, 3 (6.5%) with Stage II, 14 (30.4%) with Stage III, and 1 (2.2%) with Stage IV disease. The mean sizes of mutinous and serous ovarian tumors were 20.8 and 11.7 cm, respectively (P = 0.002; Wilcoxon two-sample test). Thirty-six patients (78.3%) underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy. Ten patients (21.7%) underwent some type of conservative procedure, with preservation of some ovarian tissue. All 14 patients (100.0%) with mutinous tumors had Stage I disease, while only 14 (45.2%) of 31 patients with serous tumors were Stage I. When all cell types are combined, only 5 (17.2%) of 28 patients with Stage I disease had an elevated preoperative CA-125 level, while 3 (100.0%) of 3, 13 (92.9%) of 14, and 1 (100.0%) of 1 patients with Stage II, III, and IV disease, respectively, had increased preoperative levels. Among patients with serous tumors, only 1 (7.2%) of 14 Stage I patients had an elevated preoperative CA-125 level, while 16 (94.1%) of 17 Stage II-IV tumors had elevated levels (P < 0.0001). These data suggest that preoperative CA-125 level is highly correlated with stage of disease in patients with serous borderline ovarian tumors, and that this test may have a role in predicting disease recurrence.
ONCOLOGISTS-ABSTRACTS Recent reports suggest an increasing incidence of central nervous system (CNS) metastases in patients with ovarian cancer (OVCA). A retrospective review at Duke University Medical Center identified 12 patients from 1976 to 1990 with CNS metastases and epithelial OVCA. Seven of the twelve patients presented between 1988 and 1990. Median age at diagnosis of CNS metastases was 57 years, The median interval between the diagnosis of OVCA and the identification of brain metastases was 15.5 months. Ten patients had previously received platinumbased combination chemotherapy. All patients presented with neurologic symptoms and all lesions were identified by computed tomography. Four patients had solitary metastases, three of whom underwent surgical resection prior to receiving whole brain radiation therapy. Eight patients had multifocal metastases and were treated primarily with radiation therapy. Ten patients were treated with chemotherapy either concurrently with or subsequent to initiation of radiation therapy. Of these 10, 8 received one or more platinum-based regimens. All patients had some amelioration of their neurologic symptoms. To date, follow-up has been complete. Nine patients have died of ovarian cancer; three patients are alive with disease. No patient has died as a direct consequence of their central nervous system metastases. The median survival in this series after the diagnosis of brain metastases is 9 months. This compares favorably with other previously reported series. Ovarian CNS metastases can be successfully palliated using an aggressive approach, including chemotherapy, radiation, and surgery. 118. Phase II Trial of Ifosfamide current
Squamous
Carcinoma
and cis-Platinum of the Cervix:
in Advanced Preliminary
or ReReport.
M. RODRIGUEZ,K. LOOK, M. CALLAGAN, AND G. SUTTON, Indiana University Medical Center, Indianapolis, Indiana 46202. Between November of 1989 and June of 1991, 11 patients with advanced or recurrent squamous cell carcinoma of the cervix received ifosfamide (5 g/m’/24 hrs) and &-platinum (50 mg/m’) every 3 weeks for six courses or until unacceptable toxicity or disease progression. Ten patients had received prior pelvic radiation and three, prior chemotherapy with an inactive phase II drug. Median age for the group was 46 years (range, 35-72). The median GOG performance status was 2 (range, l-4). An average of 4.8 courses of chemotherapy was given (range, 2-6). The median granulocyte nadir was 1600/mm3 (range, 3003100/mm’) and the median platelet nadir was 126,000/mm3 (range, 12,000-303,0OO/mm’). There were four cases of grade III encephalopathy. Two cases of anemia required transfusion, one grade II and one grade III. One reversible grade IV renal toxicity caused discontinuation of the therapy. Five patients had thrombocytopenia, two grade II and three grade III. Partial responses were seen in six patients (54%). Response durations were 1,2,4,6,7, and 8 months (median, 5 months). These preliminary results suggest this regimen is active against advanced or recurrent squamous cell lesions of the cervix, and that further studies are warranted.
of Frozen I and II Endometrial
119. Accuracy
Section Diagnosis Carcinoma. J.
at Surgery
in Clinical
Stage
K. SHIM, M.D., P. G. ROSE, M.D., F. R. REALE, M.D., H. SOTO M.D., W. K. TAK, M.D., AND R. E. HUNTER, M.D., University of Massachusetts Medical Center, Worcester, Massachusetts 01655.
Certain pathologic findings in endometrial carcinoma, including deep myometrial invasion, tumor grade, cervical invasion, adnexal involvement, and histologic type, are predictive of pelvic and paraaortic nodal metastasis. Frozen section (FS) pathology at surgery may identify these 117. Improved Palliation of Cerebral Metastases in Epithelial Ovarian pathologic factors determining patients at high risk for nodal metastasis. Cancer Using a Combined Modality Approach Including Chemotherapy, Radiation Therapy, and Surgery. G. C. RODRIGUEZ,J. T. The pathology of 199 patients with clinical stage I and II endometrial SOPER,A. BERCHUCK,J. R. OLESON, AND D. L. CLARKE-PEARSON, carcinoma who had FS at surgery was compared to the permanent Duke University, Durham, North Carolina 27710. section (PS) diagnosis to determine the accuracy of the FS diagnosis.
SOCIETY
OF GYNECOLOGIC
nursing personnel, forearm reservoir placement has been more aesthetically acceptable to our patients. Satisfactory initial P.A.S. Port system placement was accomplished in 23 patients (96%). No catheters were removed for sepsis. One catheter occluded and was replaced. All systems have been used until completion of planned parenteral therapy or death. 115. The Role of Routine
Postoperative
Intravenous
Pyelography
fol-
Hysterectomy. R. K. POTKUL, E. A. OLAH, J. F. BARTER, W. A. BARNES, AND G. DELGADO, Georgetown University, Washington, D.C. 20057. lowing
Type 111 Radical
This study was undertaken to evaluate the role of intravenous pyelogram (IVP) for routine postoperative evaluation of the urinary system after radical hysterectomy. Postoperative IVPs in 155 patients with Stage IB cervical cancer who had undergone type III radical hysterectomy and pelvic lymphadenectomy were reviewed over a lo-year period. The pyelograms were performed between Days 3 and 16 prior to removal of the Foley catheter. One hundred fifty-four pyelograms were interpreted as normal and one was noted to have right hydronephrosis secondary to obstruction at the pelvic brim. At the time of this study on Postoperative Day 12, the patient was noted to have a temperature of 38.6”C with right-sided Rank and abdominal pain. Ultrasound evaluation revealed a probable hematoma that subsequently resolved with conservative therapy. All asymptomatic patients had normal postoperative radiographic studies. Our series does not support the routine use of postoperative IVPs for evaluation of ureteral injury in asymptomatic patients undergoing radical hysterectomy. 116. Preoperative Serum CA-125 Levels in Borderline Tumors of the Ovary. L. W. RICE, J. M. LACE, R. S. BERKOWITZ, A. GOODMAN, M. G. MUTO, R. C. KNAPP, AND D. A. BELL, Harvard Medical School, Boston, Massachusetts 02115. Preoperative serum CA-125 levels were evaluated in 46 patients who underwent primary surgery for epithelial ovarian tumors of borderline malignancy at the Brigham and Women’s Hospital and Massachusetts General Hospital between 1981 and 1990. Surgical staging revealed 28 (60.8%) patients with Stage I, 3 (6.5%) with Stage II, 14 (30.4%) with Stage III, and 1 (2.2%) with Stage IV disease. The mean sizes of mutinous and serous ovarian tumors were 20.8 and 11.7 cm, respectively (P = 0.002; Wilcoxon two-sample test). Thirty-six patients (78.3%) underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy. Ten patients (21.7%) underwent some type of conservative procedure, with preservation of some ovarian tissue. All 14 patients (100.0%) with mutinous tumors had Stage I disease, while only 14 (45.2%) of 31 patients with serous tumors were Stage I. When all cell types are combined, only 5 (17.2%) of 28 patients with Stage I disease had an elevated preoperative CA-125 level, while 3 (100.0%) of 3, 13 (92.9%) of 14, and 1 (100.0%) of 1 patients with Stage II, III, and IV disease, respectively, had increased preoperative levels. Among patients with serous tumors, only 1 (7.2%) of 14 Stage I patients had an elevated preoperative CA-125 level, while 16 (94.1%) of 17 Stage II-IV tumors had elevated levels (P < 0.0001). These data suggest that preoperative CA-125 level is highly correlated with stage of disease in patients with serous borderline ovarian tumors, and that this test may have a role in predicting disease recurrence.
ONCOLOGISTS-ABSTRACTS Recent reports suggest an increasing incidence of central nervous system (CNS) metastases in patients with ovarian cancer (OVCA). A retrospective review at Duke University Medical Center identified 12 patients from 1976 to 1990 with CNS metastases and epithelial OVCA. Seven of the twelve patients presented between 1988 and 1990. Median age at diagnosis of CNS metastases was 57 years, The median interval between the diagnosis of OVCA and the identification of brain metastases was 15.5 months. Ten patients had previously received platinumbased combination chemotherapy. All patients presented with neurologic symptoms and all lesions were identified by computed tomography. Four patients had solitary metastases, three of whom underwent surgical resection prior to receiving whole brain radiation therapy. Eight patients had multifocal metastases and were treated primarily with radiation therapy. Ten patients were treated with chemotherapy either concurrently with or subsequent to initiation of radiation therapy. Of these 10, 8 received one or more platinum-based regimens. All patients had some amelioration of their neurologic symptoms. To date, follow-up has been complete. Nine patients have died of ovarian cancer; three patients are alive with disease. No patient has died as a direct consequence of their central nervous system metastases. The median survival in this series after the diagnosis of brain metastases is 9 months. This compares favorably with other previously reported series. Ovarian CNS metastases can be successfully palliated using an aggressive approach, including chemotherapy, radiation, and surgery. 118. Phase II Trial of Ifosfamide current
Squamous
Carcinoma
and cis-Platinum of the Cervix:
in Advanced Preliminary
or ReReport.
M. RODRIGUEZ,K. LOOK, M. CALLAGAN, AND G. SUTTON, Indiana University Medical Center, Indianapolis, Indiana 46202. Between November of 1989 and June of 1991, 11 patients with advanced or recurrent squamous cell carcinoma of the cervix received ifosfamide (5 g/m’/24 hrs) and &-platinum (50 mg/m’) every 3 weeks for six courses or until unacceptable toxicity or disease progression. Ten patients had received prior pelvic radiation and three, prior chemotherapy with an inactive phase II drug. Median age for the group was 46 years (range, 35-72). The median GOG performance status was 2 (range, l-4). An average of 4.8 courses of chemotherapy was given (range, 2-6). The median granulocyte nadir was 1600/mm3 (range, 3003100/mm’) and the median platelet nadir was 126,000/mm3 (range, 12,000-303,0OO/mm’). There were four cases of grade III encephalopathy. Two cases of anemia required transfusion, one grade II and one grade III. One reversible grade IV renal toxicity caused discontinuation of the therapy. Five patients had thrombocytopenia, two grade II and three grade III. Partial responses were seen in six patients (54%). Response durations were 1,2,4,6,7, and 8 months (median, 5 months). These preliminary results suggest this regimen is active against advanced or recurrent squamous cell lesions of the cervix, and that further studies are warranted.
of Frozen I and II Endometrial
119. Accuracy
Section Diagnosis Carcinoma. J.
at Surgery
in Clinical
Stage
K. SHIM, M.D., P. G. ROSE, M.D., F. R. REALE, M.D., H. SOTO M.D., W. K. TAK, M.D., AND R. E. HUNTER, M.D., University of Massachusetts Medical Center, Worcester, Massachusetts 01655.
Certain pathologic findings in endometrial carcinoma, including deep myometrial invasion, tumor grade, cervical invasion, adnexal involvement, and histologic type, are predictive of pelvic and paraaortic nodal metastasis. Frozen section (FS) pathology at surgery may identify these 117. Improved Palliation of Cerebral Metastases in Epithelial Ovarian pathologic factors determining patients at high risk for nodal metastasis. Cancer Using a Combined Modality Approach Including Chemotherapy, Radiation Therapy, and Surgery. G. C. RODRIGUEZ,J. T. The pathology of 199 patients with clinical stage I and II endometrial SOPER,A. BERCHUCK,J. R. OLESON, AND D. L. CLARKE-PEARSON, carcinoma who had FS at surgery was compared to the permanent Duke University, Durham, North Carolina 27710. section (PS) diagnosis to determine the accuracy of the FS diagnosis.