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Antigenic heterogeneity in epithelial ovarian (EOC) cancer
294
SOCIETY OF GYNECOLOGIC
40. Primary Fallopian Tube Cancer-The Roswell Park Experience. PETERG. ROSE,M. STEVENPIVER,AND Y. TSUKADA.Departments of Gynecologic Oncology and Pathology, Roswell Park Memorial Institute (RPMI), Buffalo, New York 14263. Sixty-four patients with primary fallopian tube cancer treated at RPM1 from 1964 to 1987 underwent retrospective clinical pathologic review. In 40 patients fallopian tube cancer was the only primary, but in 24 patients it was part of a multifocal genital tract malignancy. Of the 40 patients with unifocal disease the median survival was 28 months. Only 15% of patients are alive and disease-free with followup ranging from 24 to 141 months (median, 90.5 months). Survival was not associated with stage of disease, tumor histology, grade, or depth of invasion. Fourteen patients who received cisplatin-based chemotherapy were evaluable for response. Three patients (21%) responded; 2 complete and 1 partial. Twelve patients without clinical evidence of disease underwent second look procedures. Four of 10 second look laparotomies SLL were negative. Secondary debulking was performed in 3 of 4 patients with gross disease, 1 of which achieved negative third look laparotomy. Negative look laparotomy, second or third, was associated with improved survival, P = 0.016. One of two second look laparoscopies were negative but the patient recurred. In the remaining 24 patients cancer of the fallopian tube was part of a multifocal genital tract malignancy. In 12 patients tubal disease was invasive and in 12 it was in situ. Separate primaries occurred in the ovary, N = 16; ovary and uterus, N = 3; ovary, uterus, and cervix, N = 1; uterus, N = 3; and cervix, N = 1. This represents 1.3% of ovarian malignancies treated at RPM1 during the study period. Fallopian tube cancer seems as virulent as ovarian cancer with few long-term survivors. It is associated with upper genital tract malignancy. SLL is an important predictor of survival. 41. Prognostic Significance of Estrogen and Progesterone Receptors in Epithelial Ovarian Cancer. PETERG. ROSE,M.D.,* FRANK R. REALE, M.D.,t CHRISTOPHER LONGCOPE,M.D.,* AND RICHARDE. HUNTER, M.D.* Departments of *Obstetrics and Gynecology and tpathology, University of Massachusetts Medical Center, Worcester, Massachusetts 01655. One hundred twenty-three patients with epithelial ovarian cancer who underwent estrogen and progesterone tumor assays were analyzed to determine prognostic significance of receptor results. In 110 patients (89%) assays were performed at diagnosis, and in 13 patients (11%) assays were performed after prior therapy. Seventy-five percent of first assays were performed from the ovary but in 25% assays were obtained from the omentum, intestine, or peritoneum. Estrogen receptor determinations were positive (>lO fmole/mg) in 75 patients (61%), progesterone receptor determinations were positive (>3 fmole/mg) in 35 patients (28%), and both receptors were positive in 20 patients (16%). Progesterone receptors were more frequently positive (53%) in endometrioid ovarian cancer (P = 0.01). Thirty-one patients had a second receptor assay. Estrogen receptors were positive in 16 patients (48%), progesterone receptors were positive in 5 patients (16%), and both receptors were positive in 5 patients (16%). Synchronous and metachronous receptor assays were in agreement in 60-79% of cases. By multivariate analysis of the primary assay, positive estrogen receptor, progesterone receptor, or both were not predictive of response to chemotherapy, negative second look findings, or survival. Thirty-one patients received hormonal therapy, with 26 patients evaluable. One of 26 patients (3%) had a partial response and 4 of 26 patients (13%) maintained stable disease 6 months or longer (6-21 months). Positive receptors were not predictive of hormonal response or disease stabilization in this series. 42. Management of Stage II Endometrial Adenocarcinoma. S. C. RUBIN, W. J. HOSKINS, D. NORI, B. MYCHALCZAK, L. ALMADRONES,
ONCOLOGISTS-ABSTRACTS D. CHAPMAN,ANDJ. L. LEWIS,JR. Memorial Sloan-Kettering Cancer Center (MSKCC), New York, New York 10021. From 1968-1982 80 patients with stage II endometrial adenocarcinoma were seen at MSKCC. Mean age was 62 years, with 85% postmenopausal. Distribution by histologic grade was 1, 24%; 2, 41%; and 3, 35%. Seventy-five patients underwent definitive treatment; 5 palliative, due to age or refusal of treatment. Preferred treatment during this period consisted of preop external pelvic radiotherapy (ERT) of 4000 cGy, modified radical hysterectomy and bilateral salpingooophorectomy (MRHBSO), and postop vaginal brachytherapy (IVRT) of 2100 cGy. This therapy (33/75 patients) was well tolerated. Twenty-six patients underwent similar radiotherapy with TAHBSO. With a mean follow-up among survivors of 95 months, disease-free survival (all patients treated for cure) is 72%. Mean time to relapse was 19 months, with 90% of relapses occurring within 36 months. Initial sites of relapse included abdomen, 9 (12%); lungs, 8 (11%); brain, 2 (2.6%); lateral pelvis, 2 (2.6%); and vagina, 1 (1.3%). Clinicopathologic variables significantly related to risk of relapse included gross cervical involvement (P = 0.005), and depth of myometrial invasion (P = 0.01). For the group undergoing our preferred treatment, disease-free survival was 82%, as compared with 64% in all other evaluable patients (N = 42). Selection of treatment was attributed to physician preference; there were no differences in clinical or pathologic features between these groups. Our preferred treatment of preop ERT and MRHBSO and postop IVRT is well tolerated and results in an excellent disease-free survival and an extremely low rate of pelvic relapse. 43. Antigenic Heterogeneity in Epithelial Ovarian (EOC) Cancer. S. C. RLJBIN, C. L. FINSTAD, W. J. HOSKINS, D. M. PROVENCHER, P. E. SAIGO, M. G. FEDERICI, K. 0. LLOYD, AND J. L. LEWIS, JR. Memorial Sloan-Kettering Cancer Center, New York, New York 10021. The extent to which the antigenic phenotype of human EOC varies among primary and metastatic sites must be better understood to assess the potential of antibody-directed imaging and therapy. We have obtained tumor specimens from at least two separate sites during operations on 11 patients with EOC and typed these specimens with a panel of 19 monoclonal antibodies to cell surface glycoprotein and carbohydrate antigens, including blood group antigens. Antibodies with relatively high specificity for malignant cells as well as those detecting more widely distributed epithelial antigens were used. A total of 34 specimens was studied. Distribution by cell type was as follows: serous, 7; undifferentiated, 2; endometriod, 1; and clear cell, 1. Frozen sections of tumor specimens were stained with the antibodies by the indirect immunoperoxidase technique, and the total of almost 700 slides were graded blindly by a single individual. Antigenic phenotypes were not found to be related to the tumor grade and cell type. Most significantly, little difference was seen in antigenic expression among tumors obtained from various sites in the same patient for either the cell surface or blood group markers. Intratumoral antigentic heterogeneity was seen, but this was quite consistent within a given patient’s specimens. As anticipated, variations were seen in antigen expression from patient to patient. The antigenic phenotype of the tumor specimens in a given patient as determined immunohistochemically by our panel of antibodies showed only minor variation among primary and metastatic sites. 44. Intraperitoneal Chromic Phosphate in the Treatment of Ovarian Carcinoma. W. S. SPANOS, T. DAY, A. ABNER, B. JOSE, AND S. F?JRSELL. University af Louisville, Louisville, Kentucky 40292. Forty-one patients with ovarian carcinoma were treated with intraperitoneal chromic P-32 at the University of Louisville between 1982 and 1987. There were 10 stage 1, 3 stage 2, 24 stage 3, and 4 recurrent stage 1 patients treated with a minimum follow-up of 24 months. For
SOCIETY OF GYNECOLOGIC
40. Primary Fallopian Tube Cancer-The Roswell Park Experience. PETERG. ROSE,M. STEVENPIVER,AND Y. TSUKADA.Departments of Gynecologic Oncology and Pathology, Roswell Park Memorial Institute (RPMI), Buffalo, New York 14263. Sixty-four patients with primary fallopian tube cancer treated at RPM1 from 1964 to 1987 underwent retrospective clinical pathologic review. In 40 patients fallopian tube cancer was the only primary, but in 24 patients it was part of a multifocal genital tract malignancy. Of the 40 patients with unifocal disease the median survival was 28 months. Only 15% of patients are alive and disease-free with followup ranging from 24 to 141 months (median, 90.5 months). Survival was not associated with stage of disease, tumor histology, grade, or depth of invasion. Fourteen patients who received cisplatin-based chemotherapy were evaluable for response. Three patients (21%) responded; 2 complete and 1 partial. Twelve patients without clinical evidence of disease underwent second look procedures. Four of 10 second look laparotomies SLL were negative. Secondary debulking was performed in 3 of 4 patients with gross disease, 1 of which achieved negative third look laparotomy. Negative look laparotomy, second or third, was associated with improved survival, P = 0.016. One of two second look laparoscopies were negative but the patient recurred. In the remaining 24 patients cancer of the fallopian tube was part of a multifocal genital tract malignancy. In 12 patients tubal disease was invasive and in 12 it was in situ. Separate primaries occurred in the ovary, N = 16; ovary and uterus, N = 3; ovary, uterus, and cervix, N = 1; uterus, N = 3; and cervix, N = 1. This represents 1.3% of ovarian malignancies treated at RPM1 during the study period. Fallopian tube cancer seems as virulent as ovarian cancer with few long-term survivors. It is associated with upper genital tract malignancy. SLL is an important predictor of survival. 41. Prognostic Significance of Estrogen and Progesterone Receptors in Epithelial Ovarian Cancer. PETERG. ROSE,M.D.,* FRANK R. REALE, M.D.,t CHRISTOPHER LONGCOPE,M.D.,* AND RICHARDE. HUNTER, M.D.* Departments of *Obstetrics and Gynecology and tpathology, University of Massachusetts Medical Center, Worcester, Massachusetts 01655. One hundred twenty-three patients with epithelial ovarian cancer who underwent estrogen and progesterone tumor assays were analyzed to determine prognostic significance of receptor results. In 110 patients (89%) assays were performed at diagnosis, and in 13 patients (11%) assays were performed after prior therapy. Seventy-five percent of first assays were performed from the ovary but in 25% assays were obtained from the omentum, intestine, or peritoneum. Estrogen receptor determinations were positive (>lO fmole/mg) in 75 patients (61%), progesterone receptor determinations were positive (>3 fmole/mg) in 35 patients (28%), and both receptors were positive in 20 patients (16%). Progesterone receptors were more frequently positive (53%) in endometrioid ovarian cancer (P = 0.01). Thirty-one patients had a second receptor assay. Estrogen receptors were positive in 16 patients (48%), progesterone receptors were positive in 5 patients (16%), and both receptors were positive in 5 patients (16%). Synchronous and metachronous receptor assays were in agreement in 60-79% of cases. By multivariate analysis of the primary assay, positive estrogen receptor, progesterone receptor, or both were not predictive of response to chemotherapy, negative second look findings, or survival. Thirty-one patients received hormonal therapy, with 26 patients evaluable. One of 26 patients (3%) had a partial response and 4 of 26 patients (13%) maintained stable disease 6 months or longer (6-21 months). Positive receptors were not predictive of hormonal response or disease stabilization in this series. 42. Management of Stage II Endometrial Adenocarcinoma. S. C. RUBIN, W. J. HOSKINS, D. NORI, B. MYCHALCZAK, L. ALMADRONES,
ONCOLOGISTS-ABSTRACTS D. CHAPMAN,ANDJ. L. LEWIS,JR. Memorial Sloan-Kettering Cancer Center (MSKCC), New York, New York 10021. From 1968-1982 80 patients with stage II endometrial adenocarcinoma were seen at MSKCC. Mean age was 62 years, with 85% postmenopausal. Distribution by histologic grade was 1, 24%; 2, 41%; and 3, 35%. Seventy-five patients underwent definitive treatment; 5 palliative, due to age or refusal of treatment. Preferred treatment during this period consisted of preop external pelvic radiotherapy (ERT) of 4000 cGy, modified radical hysterectomy and bilateral salpingooophorectomy (MRHBSO), and postop vaginal brachytherapy (IVRT) of 2100 cGy. This therapy (33/75 patients) was well tolerated. Twenty-six patients underwent similar radiotherapy with TAHBSO. With a mean follow-up among survivors of 95 months, disease-free survival (all patients treated for cure) is 72%. Mean time to relapse was 19 months, with 90% of relapses occurring within 36 months. Initial sites of relapse included abdomen, 9 (12%); lungs, 8 (11%); brain, 2 (2.6%); lateral pelvis, 2 (2.6%); and vagina, 1 (1.3%). Clinicopathologic variables significantly related to risk of relapse included gross cervical involvement (P = 0.005), and depth of myometrial invasion (P = 0.01). For the group undergoing our preferred treatment, disease-free survival was 82%, as compared with 64% in all other evaluable patients (N = 42). Selection of treatment was attributed to physician preference; there were no differences in clinical or pathologic features between these groups. Our preferred treatment of preop ERT and MRHBSO and postop IVRT is well tolerated and results in an excellent disease-free survival and an extremely low rate of pelvic relapse. 43. Antigenic Heterogeneity in Epithelial Ovarian (EOC) Cancer. S. C. RLJBIN, C. L. FINSTAD, W. J. HOSKINS, D. M. PROVENCHER, P. E. SAIGO, M. G. FEDERICI, K. 0. LLOYD, AND J. L. LEWIS, JR. Memorial Sloan-Kettering Cancer Center, New York, New York 10021. The extent to which the antigenic phenotype of human EOC varies among primary and metastatic sites must be better understood to assess the potential of antibody-directed imaging and therapy. We have obtained tumor specimens from at least two separate sites during operations on 11 patients with EOC and typed these specimens with a panel of 19 monoclonal antibodies to cell surface glycoprotein and carbohydrate antigens, including blood group antigens. Antibodies with relatively high specificity for malignant cells as well as those detecting more widely distributed epithelial antigens were used. A total of 34 specimens was studied. Distribution by cell type was as follows: serous, 7; undifferentiated, 2; endometriod, 1; and clear cell, 1. Frozen sections of tumor specimens were stained with the antibodies by the indirect immunoperoxidase technique, and the total of almost 700 slides were graded blindly by a single individual. Antigenic phenotypes were not found to be related to the tumor grade and cell type. Most significantly, little difference was seen in antigenic expression among tumors obtained from various sites in the same patient for either the cell surface or blood group markers. Intratumoral antigentic heterogeneity was seen, but this was quite consistent within a given patient’s specimens. As anticipated, variations were seen in antigen expression from patient to patient. The antigenic phenotype of the tumor specimens in a given patient as determined immunohistochemically by our panel of antibodies showed only minor variation among primary and metastatic sites. 44. Intraperitoneal Chromic Phosphate in the Treatment of Ovarian Carcinoma. W. S. SPANOS, T. DAY, A. ABNER, B. JOSE, AND S. F?JRSELL. University af Louisville, Louisville, Kentucky 40292. Forty-one patients with ovarian carcinoma were treated with intraperitoneal chromic P-32 at the University of Louisville between 1982 and 1987. There were 10 stage 1, 3 stage 2, 24 stage 3, and 4 recurrent stage 1 patients treated with a minimum follow-up of 24 months. For