- Email: [email protected]
5-year experience of intraperitoneal 32P therapy in ovarian cancers
102
SOCIETY
OF GYNECOLOGIC
and lung localization at 24 hr was acceptably low (3.0 + I.&fold 9.0 2 1.6-fold, respectively). These data suggest that ““Tc-labeled 12.5 Fab’ is suitable for RIS.
and OC
107. The Role of DNA Cervical DONATO,
Index as a Prognostic Factor in Stage IB-IIA Cancers. H. NGUYEN, B. U. SEVIN, H. AVERETTE, D. P. GANJEI,* J. PERRAS, R. RAMOS, AND M. PENALVER,
Division of Gynecologic Oncology and *Department of Pathology, University of Miami School of Medicine, Miami, Florida 33101. The value of DNA ploidy as a prognostic factor for cervical cancers remains controversial. Most studies classified tumor DNA as hypoploid, diploid, aneuploid, tetraploid, and hyperploid. This classification might make it difficult to evaluate the prognostic role of DNA ploidy in cervical cancers. In this study, we investigated the direct use of DNA index as a prognostic factor in early cervical cancers. All patients who underwent radical hysterectomy for stage IB-IIA cervical cancers from l/1980 to 12/1985 were included; 149 patients qualified but only in 96 were we able to locate the paraffin blocks. Two 20-pm tissue sections were dewaxed in xylene, sequentially rehydrated in 100, 95, 70, and 50% alcohol, and washed in phosphate-buffered saline (PBS). Enzyme degradation was performed by incubation with 1 ml of 0.5% pepsin (pH 1.5) at 37°C for 1 hr. After washing with PBS, cells were subjected to dual-parameter flow cytometry. Formalin-fixed human lymphocytes were processed through the same steps and used as control. Microscopic slides were made from adjacent tissue sections for histologic confirmation. DNA index was calculated for each tumor as a ratio of tumor DNA to diploid DNA of control lymphocytes. The assay had an average CV of 4.5%. Results of DNA indices were then correlated with 5-year survival, stage, grade, tumor size, depth of invasion, and cell type. Of 96 cervical cancers, there were 1% hypoploid, 7.3% diploid, 72.9% aneuploid, 16.7% tetraploid, and 2.1% hyperploid. Multiregression analysis failed to establish DNA index as an independent prognostic factor. At the end of 5 years, there were 69 live patients and 27 dead with mean DNA indices of 1.5 f 0.3 and 1.7 2 0.3, respectively. 1 test analysis revealed that mean DNA indices of the dead patients were significantly higher than those of the alive group with P = 0.008. Among 27 dead patients, 17 or 63% had a DNA index of 1.7 or greater in comparison to a rate of 32% among live patients. Thus, a DNA index cutoff of 1.7 appeared to associate with a twofold increased risk of dying from disease. 108. Preliminary
Experience of a Modified Tenckhoff Catheter for Repetitive Intraperitoneal Chemotherapy. H. NGUYEN, H. AVERETTE, L. WYBLE, B. U. SEVIN, M. PENALVER, AND D. DONATO, Division
of Gynecoiogic Oncology, University of Miami School of Medicine, Miami, Florida 33101. Tenckhoff catheter is commonly used for intraperitoneal chemotherapy. A standard catheter is typically 14 French diameter, 13 in. long with 26 holes in the distal 5 in. Survey of literature revealed an average of 7.0% incidence of obstruction with this type of catheter. A modified Tenckhoff catheter was designed by H.A. in 1988 to be larger and longer, with bigger holes to reduce chances of obstruction. The modified Tenckhoff catheter (Norport-LS P4700 and P4705) was manufactured by Norfold Medical (Skokie, II) with the following specifications: 15 French diameter, 22 in. long, and 44 perfusion holes in the distal 11 in. This study reports our preliminary experience with the modified Tenckhoff catheter. All ovarian cancer patients who were explored and implanted with the modified Tenckhoff catheter from June 1988 to December 1990 were included. There were 137 catheters implanted in 125 patients, of which 116 were actually used for intraperitoneal chemotherapy. Twenty-one patients were excluded because the catheter was either used for intraperitoneal 3ZP or not used because of treatment refusal, deaths, or lack of pathology. A total of 559 cycles of intra-
ONCOLOGISTS-ABSTRACTS peritoneal chemotherapy was given with a range of 1 to 16 uses per catheter. Of 116 evaluable catheters, there were 4 infections (3.4%), 4 obstructions (3.4%), and 1 leakage (0.8%). In the 4 patients with catheter infection, 3 were found to have colonic perforation with fecal content in the aspirate. All 3 patients did not have bowel anastomosis at the time of catheter placement. One patient who presented with infusion-related leakage around her colostomy stoma was found to have adhesion creating a high pressure loculation around the colostomy site. While the incidence of infection and bowel perforation was similar to that of catheter systems, the obstruction rate (3.4%) was twice improved. Given these encouraging results, the modified Tenckhoff catheter deserves further evaluation. 109. 5-Year Experience of Intraperitoneal 32P Therapy in Ovarian Cancers. H. NGUYEN, H. AVERETTE, B. U. SEVIN, P. SEFCAFINI,* D. DONATO, AND M. PENALVER, Division of Gynecologic Oncology
and *Department of Nuclear Medicine, University of Miami School of Medicine, Miami, Florida 33101. Since the introduction of intraperitoneal 32P therapy, its role in the management of ovarian cancer patients has remained controversal. This study reports our 5-year experience with intraperitoneal “P. All stage I, II, and III ovarian cancer patients who received intraperitoneal “P after laparotomy from l/1986 to 12/1990 were included in this study. The control group consisted of ovarian cancer patients whose disease status matched that of the “P-treatment group but received no further therapy. There were 28 patients in the 32P group, of whom 13 were group A (stages I G3, IC, and II), 11 group B (stage III with negative second look), and 5 group C (stage III with positive second look but minimal residuals). These patients received a standard dose of 15 mCi 3zP after adequate distribution scan. There were 27 patients in the control group, of whom 6 were group A, 15 group B, and 6 group C. The mean ages were 55.3 c 11.5 and 59.2 + 10.8 years for the “P and control groups, respectively, with P = 0.17. Mean survivals of the “P patients were group A, 26.8 f 17.2; group B, 19.7 2 11.9; and group C, 19.4 f 15.8 months. Meanwhile, mean survivals of control group were group A, 20.7 + 13.6; group B, 23.7 2 12; and group C, 11.2 f 5.8 months, respectively. Comparison of the mean survivals by t tests revealed no significant effect of intraperitoneal “P in the 32P and control groups (P > 0.26). Within the “P-treatment group, there was no survival difference between stage III patients having negative second look and those with positive second look but minimal residuals. HOWever, in patients who received no further treatment (control group), there was a significantly shortened survival of stage III patients having positive second look and minimal disease when compared to those with negative second look (P = 0.02). In summary, although there was a trend toward improvement of survival, intraperitoneal ‘*P did not offer a distinct advantage. However, 32P therapy appeared to be beneficial to stage III ovarian cancer patients who had positive second look and minimal residual disease. 110. The Accuracy plasms.
of Frozen I. OBIAKOR, M.
Section in the Diagnosis of Ovarian NeoMAIMAN, AND R. DEMOPOULOUS, SUNY-
Health Science Center at Brooklyn, Brooklyn, New York 11203. To assessthe accuracy of frozen section (FS) pathological analysis in the diagnosis of ovarian neoplasms, the FS results of 311 patients from two institutions were retrospectively reviewed. FS results were compared to the permanent sections. Eighty-four of three hundred eleven (27%) cases were found to be malignant. Eighty-seven percent of these malignant cases were epithelial tumors, compared to thirty-five percent of benign tumors. The most common benign diagnosis was fibrothecoma. In 292 cases (93.9%), FS diagnosis and final diagnosis were concordant, while in 11 cases (3.5%) there was disagreement. In 8 cases (2.6%), FS diagnosis was deferred. Of the 11 cases with discordance., 6 involved
SOCIETY
OF GYNECOLOGIC
and lung localization at 24 hr was acceptably low (3.0 + I.&fold 9.0 2 1.6-fold, respectively). These data suggest that ““Tc-labeled 12.5 Fab’ is suitable for RIS.
and OC
107. The Role of DNA Cervical DONATO,
Index as a Prognostic Factor in Stage IB-IIA Cancers. H. NGUYEN, B. U. SEVIN, H. AVERETTE, D. P. GANJEI,* J. PERRAS, R. RAMOS, AND M. PENALVER,
Division of Gynecologic Oncology and *Department of Pathology, University of Miami School of Medicine, Miami, Florida 33101. The value of DNA ploidy as a prognostic factor for cervical cancers remains controversial. Most studies classified tumor DNA as hypoploid, diploid, aneuploid, tetraploid, and hyperploid. This classification might make it difficult to evaluate the prognostic role of DNA ploidy in cervical cancers. In this study, we investigated the direct use of DNA index as a prognostic factor in early cervical cancers. All patients who underwent radical hysterectomy for stage IB-IIA cervical cancers from l/1980 to 12/1985 were included; 149 patients qualified but only in 96 were we able to locate the paraffin blocks. Two 20-pm tissue sections were dewaxed in xylene, sequentially rehydrated in 100, 95, 70, and 50% alcohol, and washed in phosphate-buffered saline (PBS). Enzyme degradation was performed by incubation with 1 ml of 0.5% pepsin (pH 1.5) at 37°C for 1 hr. After washing with PBS, cells were subjected to dual-parameter flow cytometry. Formalin-fixed human lymphocytes were processed through the same steps and used as control. Microscopic slides were made from adjacent tissue sections for histologic confirmation. DNA index was calculated for each tumor as a ratio of tumor DNA to diploid DNA of control lymphocytes. The assay had an average CV of 4.5%. Results of DNA indices were then correlated with 5-year survival, stage, grade, tumor size, depth of invasion, and cell type. Of 96 cervical cancers, there were 1% hypoploid, 7.3% diploid, 72.9% aneuploid, 16.7% tetraploid, and 2.1% hyperploid. Multiregression analysis failed to establish DNA index as an independent prognostic factor. At the end of 5 years, there were 69 live patients and 27 dead with mean DNA indices of 1.5 f 0.3 and 1.7 2 0.3, respectively. 1 test analysis revealed that mean DNA indices of the dead patients were significantly higher than those of the alive group with P = 0.008. Among 27 dead patients, 17 or 63% had a DNA index of 1.7 or greater in comparison to a rate of 32% among live patients. Thus, a DNA index cutoff of 1.7 appeared to associate with a twofold increased risk of dying from disease. 108. Preliminary
Experience of a Modified Tenckhoff Catheter for Repetitive Intraperitoneal Chemotherapy. H. NGUYEN, H. AVERETTE, L. WYBLE, B. U. SEVIN, M. PENALVER, AND D. DONATO, Division
of Gynecoiogic Oncology, University of Miami School of Medicine, Miami, Florida 33101. Tenckhoff catheter is commonly used for intraperitoneal chemotherapy. A standard catheter is typically 14 French diameter, 13 in. long with 26 holes in the distal 5 in. Survey of literature revealed an average of 7.0% incidence of obstruction with this type of catheter. A modified Tenckhoff catheter was designed by H.A. in 1988 to be larger and longer, with bigger holes to reduce chances of obstruction. The modified Tenckhoff catheter (Norport-LS P4700 and P4705) was manufactured by Norfold Medical (Skokie, II) with the following specifications: 15 French diameter, 22 in. long, and 44 perfusion holes in the distal 11 in. This study reports our preliminary experience with the modified Tenckhoff catheter. All ovarian cancer patients who were explored and implanted with the modified Tenckhoff catheter from June 1988 to December 1990 were included. There were 137 catheters implanted in 125 patients, of which 116 were actually used for intraperitoneal chemotherapy. Twenty-one patients were excluded because the catheter was either used for intraperitoneal 3ZP or not used because of treatment refusal, deaths, or lack of pathology. A total of 559 cycles of intra-
ONCOLOGISTS-ABSTRACTS peritoneal chemotherapy was given with a range of 1 to 16 uses per catheter. Of 116 evaluable catheters, there were 4 infections (3.4%), 4 obstructions (3.4%), and 1 leakage (0.8%). In the 4 patients with catheter infection, 3 were found to have colonic perforation with fecal content in the aspirate. All 3 patients did not have bowel anastomosis at the time of catheter placement. One patient who presented with infusion-related leakage around her colostomy stoma was found to have adhesion creating a high pressure loculation around the colostomy site. While the incidence of infection and bowel perforation was similar to that of catheter systems, the obstruction rate (3.4%) was twice improved. Given these encouraging results, the modified Tenckhoff catheter deserves further evaluation. 109. 5-Year Experience of Intraperitoneal 32P Therapy in Ovarian Cancers. H. NGUYEN, H. AVERETTE, B. U. SEVIN, P. SEFCAFINI,* D. DONATO, AND M. PENALVER, Division of Gynecologic Oncology
and *Department of Nuclear Medicine, University of Miami School of Medicine, Miami, Florida 33101. Since the introduction of intraperitoneal 32P therapy, its role in the management of ovarian cancer patients has remained controversal. This study reports our 5-year experience with intraperitoneal “P. All stage I, II, and III ovarian cancer patients who received intraperitoneal “P after laparotomy from l/1986 to 12/1990 were included in this study. The control group consisted of ovarian cancer patients whose disease status matched that of the “P-treatment group but received no further therapy. There were 28 patients in the 32P group, of whom 13 were group A (stages I G3, IC, and II), 11 group B (stage III with negative second look), and 5 group C (stage III with positive second look but minimal residuals). These patients received a standard dose of 15 mCi 3zP after adequate distribution scan. There were 27 patients in the control group, of whom 6 were group A, 15 group B, and 6 group C. The mean ages were 55.3 c 11.5 and 59.2 + 10.8 years for the “P and control groups, respectively, with P = 0.17. Mean survivals of the “P patients were group A, 26.8 f 17.2; group B, 19.7 2 11.9; and group C, 19.4 f 15.8 months. Meanwhile, mean survivals of control group were group A, 20.7 + 13.6; group B, 23.7 2 12; and group C, 11.2 f 5.8 months, respectively. Comparison of the mean survivals by t tests revealed no significant effect of intraperitoneal “P in the 32P and control groups (P > 0.26). Within the “P-treatment group, there was no survival difference between stage III patients having negative second look and those with positive second look but minimal residuals. HOWever, in patients who received no further treatment (control group), there was a significantly shortened survival of stage III patients having positive second look and minimal disease when compared to those with negative second look (P = 0.02). In summary, although there was a trend toward improvement of survival, intraperitoneal ‘*P did not offer a distinct advantage. However, 32P therapy appeared to be beneficial to stage III ovarian cancer patients who had positive second look and minimal residual disease. 110. The Accuracy plasms.
of Frozen I. OBIAKOR, M.
Section in the Diagnosis of Ovarian NeoMAIMAN, AND R. DEMOPOULOUS, SUNY-
Health Science Center at Brooklyn, Brooklyn, New York 11203. To assessthe accuracy of frozen section (FS) pathological analysis in the diagnosis of ovarian neoplasms, the FS results of 311 patients from two institutions were retrospectively reviewed. FS results were compared to the permanent sections. Eighty-four of three hundred eleven (27%) cases were found to be malignant. Eighty-seven percent of these malignant cases were epithelial tumors, compared to thirty-five percent of benign tumors. The most common benign diagnosis was fibrothecoma. In 292 cases (93.9%), FS diagnosis and final diagnosis were concordant, while in 11 cases (3.5%) there was disagreement. In 8 cases (2.6%), FS diagnosis was deferred. Of the 11 cases with discordance., 6 involved