- Email: [email protected]
Chemotherapy-induced neutropenia and fever in patients receiving cisplatin-based chemotherapy for ovarian malignancy
C’;/trrions
Because of the high degree of selection bias no valid comparisons can be made of recurrence-free interval in these groups. The 5-year recurrence-free interval for patients with negative surgicalpathological risk factors (other than grade and myoinvasion) was 92.7% involvement of the isthmus/cervix 69.8% positive pelvic cytology 56.0%: vascular space invasion 55.0%; pelvic node or adnexal metastases 57.8%; and aortic node metastases or gross laparotomy findings 41.2%. It is not clear that cervix invasion per se diminishes survival, because it is more often associated with poor tumor differentiation (34.7% versus 24.0%. grade 3) and deep myoinvasion (47.0% vs 18.6%)) than cases without cervix invasion. The relapse rate among cases with grade 3 lesions and dramatically different (48.8% vs failures which were vaginal/pelvic
cervix-positive and -negative deep myoinvasion is not 39.8%). The proportion of (34.6% for the surgery only
group compared to 12.5% of the RT group) appears to favor the use of adjuvant radiation for patients with more than onethird myoinvasion and grade 2 or 3 tumor. There were 97 patients in the study group with malignant cytology of which 29.1% had regional/distant failure, which compares to 10.5% of the cytology-negative patients. These data seem to implicate malignant cytology as a serious adverse finding, especially with respect to the risk for regional/distant and abdominal failure Treatment
of malignant ovarian germ cell tumors with preserva-
tion of fertility:
A &port
of 28 cases
Wu PC; Huang
RL; Lang JH; Huang
HF; Lian L-J: Tang M-Y
Department of Obstetrics and Gynecology. Peking Union Medicul College Hospital Beuing 100730,
GYNECOL Preservation
and Chinese Academy
of Medicul
Sciences.
CHN
ONCOL
1991 40/l (2-6)
of fertility
was carried
/ram rhe
Li/e,orwc
353
The value of squamous cell carcinoma antigen in patients with locally advanced cervical cancer undergoing neoadjuvant chemotherapy
Scambia G; Benedetti Panici P: Baiocchi E: Greggi S; Mancuso S
G: Amoroso
M; Foti
Depor/rmw/ c~f’G~~,tec~ok~~~~~, Cirrholic Uuiwr.si/j~. Ltrr,qo A. Gwwlli. 8. 00/6X-Romtr.
ITA
AM J OBSTET GYNECOL 1991 I6412 (631-636) Serum levels of squamous cell carcinoma antigen
were
measured in 688 samples from I I9 patients with cervical cancer. Ninety-seven patients had primary tumors and 22 had rccurrcnt disease. Serum samples were obtained before each cycle of chemotherapy. before surgery, at least 4 weeks after surgery. and at 2- to 3-month
intervals
during
follow-up
from 78 of the
pa-
tients with locally advanced cervical cancer who wcrc receiving neoadjuvant chemotherapy. Squamous cell carcinoma antigen serum levels were elevated (>2.5 ng/ml) in 7l’K of the patients with primary tumors and in 77% of the patients with recurrent carcinomas. The percentage of positivity increased significantly with stage (p = 0.03) and was higher in squamous ccl1 tumors than in adenocarcinomas (p < 0.001). Pretreatment squamous cell carcinoma antigen levels were not predictive of ncoadjuvant chemotherapy response: however, the serial measurcmcnt during chemotherapy showed a good correlation with clinical response. In the patients who had surgery. squamous ccl1 carcinoma antigen positivity did not correlate to pathologic lindings (lymph node status. cervical and parametrial inliltration). Diseabcfree survival was significantly longer in patients with squamous cell carcinoma antigen pretreatment values that were lower than 5 @ml. compared with patients with marker higher than 5 ng/ml (p < 0.01). Abnormal squamous cell carcinoma antigen scru,,, levels preceded the clinical detection of recurrence in eight of I I patients with a median lead time of 5 months.
out in 28 young patients
with malignant germ cell tumors of the ovary from 1962 through 1987. The pathologic diagnosis was immature teratoma in 16, endodermal sinus tumor in 7. dysgerminoma in 2, and germ cell tumor of mixed type in 3. At laparotomy. I6 patients were proved to have stage I disease, I had stage II disease, 9 had stage
Chemotherapy-induced
neutropenia and fever in patients receiv-
ing cisplatin-based chemotherapy
for ovarian malignancy
Curtin JP: Hoskins WJ: Rubin SC; Jones WB: Hakes TB: Markman MM: Reichman B: Almadrones L: Lewis JL Jr. Memorio/
Sk,tnl-kc/rc,rirlg
C’trwcv Cu~/cv. N~II, York. N Y /fife.?/.
I11 disease, and 2 had stage IV disease. The tumor was confined to one ovary in all 22 cases treated for the first time, and the preserved ovary and uterus were normal in all 6 referred cases
GYNECOL ONCOL 1991 4011 (17-70) Fifty-six episodes of chemotherapy-induced
with recurrent diseases. Postoperative chemotherapy was given to all patients except two with stage I immature teratoma. Persistent remission was achieved in 22 patients; 5 patients died and I was lost to follow-up. Thk duration of follow-up was more than
fever occurred in forty-three patients receiving cisplatin-based combination chemotherapy for ovarian cancer. All patients wcrc treated with broad-spectrum antibiotics including gcntamicin. Twelve of fifty-six episodes were associated with positive cultures:
I year for all surviving patients, more than 3 years in 16 cases (72.7X), and more than 5 years in I3 cases (59.1%). The menstrual periods were normal in all except 3 cases, of whom 2 were below the age of I2 and one failed to menstruate at the age of 21 with
in six patients a single organism was isolated. and the other six patients had polymicrobial infection. The mean duration cTantibiotic therapy was 6.5 days. One patient died of sepsis. Fiftyfive episodes had a successful outcome. There was no aatibiotic-
a hypoplastic uterus and underdeveloped secondary sex characters. Among I2 married patients, 7 of IO desirous of childbirth became pregnant during follow-up. Of these. 6 had a normal term delivery and I is currently pregnant. The prelimi-
related morbidity. Based on this review WC recommend brondspectrum antibiotic therapy for chemotherapy-induced neutropenia with fever. The regimen of gentamicin plus ticarcillin and clavulanic acid (ceftazidime for penicillin-allergic pa-
nary conclusion is that preservation of fertility for young patients with malignant germ cell tumors of the ovary, regardless of the stage of the disease, is a safe and practicable procedure in the absence of involvement of the contralateial ovary and uterus.
tients) is effective as initial therapy. Additional agents (i.e.. vancomycin) may be necessary in culture-positive patients hased on sensitivity testing of bacterial isolates. Gentamicin can hc safely administered to patients receiving cisplatin-based
USA
neutropcnia
and
354
Citations from the Literature
chemotherapy without compromising ability to continue cisplatin therapy in subsequent treatment cycles.
patients had a S-year survival of 50%; patients between 61 and 75 years of age, 41.2%; and those 76 years of age or older. 34.3%. Patients with presenting symptoms had a cure rate of 36.9%.
Radiation management of primary carcinoma of tbe vagina: Clinical
whereas 61. I’% of asymptomatic cases survived. best results (60%) were obtained when the lesion was in the upper third of the vagina: only 37% of patients with lesions of the middle third and lower third survived more than 5 years. Well-differentiated tumors
and histopathological variables associated with survival
Kucera
H; Vavra N
Gynecologic
Rudiorherupy
Depurrment.
Universir?, of Viennu.
Spitulgusse 23, 1090 Vienno: A UT
GYNECOL ONCOL 1991 40/I (12-16) Data are presented on 434 patients treated at the Gynecologic Radiotherapy Department of the University of Vienna for invasive primary carcinoma of the vagina between 1952 and 1984: data on 110 patients treated in the last few yearsare more detailed. In stage I, 5-year survival was 76.7%; in stage II, 44.5%: in stage III. 31%: and in stage IV. 18.2%. The overall uncorrected 5-year survival rate was 39.%. The disease is primarily one of the elderly as 78% were found
to be older than 60 years of age. Younger
Inr J Gynecol Obstet 36
were associated with a 5-year survival of 62.5%; and poorly differentiated tumors, with a rate of 34.9%. Our results indicate that stage of disease is the most significant prognostic factor, but age of the patient, location of lesion in the vagina. and differentiation of the tumor
influence
outcome
too. The majority
of pa-
tients were managed by a combination ofexternal pelvic irradiation and local application of radium. In stage I and II patients treated with radium alone. good results were obtained, but no patient with stage Ill or IV disease survived nal irradiation was not performed.
5 years when exter-
Because of the high degree of selection bias no valid comparisons can be made of recurrence-free interval in these groups. The 5-year recurrence-free interval for patients with negative surgicalpathological risk factors (other than grade and myoinvasion) was 92.7% involvement of the isthmus/cervix 69.8% positive pelvic cytology 56.0%: vascular space invasion 55.0%; pelvic node or adnexal metastases 57.8%; and aortic node metastases or gross laparotomy findings 41.2%. It is not clear that cervix invasion per se diminishes survival, because it is more often associated with poor tumor differentiation (34.7% versus 24.0%. grade 3) and deep myoinvasion (47.0% vs 18.6%)) than cases without cervix invasion. The relapse rate among cases with grade 3 lesions and dramatically different (48.8% vs failures which were vaginal/pelvic
cervix-positive and -negative deep myoinvasion is not 39.8%). The proportion of (34.6% for the surgery only
group compared to 12.5% of the RT group) appears to favor the use of adjuvant radiation for patients with more than onethird myoinvasion and grade 2 or 3 tumor. There were 97 patients in the study group with malignant cytology of which 29.1% had regional/distant failure, which compares to 10.5% of the cytology-negative patients. These data seem to implicate malignant cytology as a serious adverse finding, especially with respect to the risk for regional/distant and abdominal failure Treatment
of malignant ovarian germ cell tumors with preserva-
tion of fertility:
A &port
of 28 cases
Wu PC; Huang
RL; Lang JH; Huang
HF; Lian L-J: Tang M-Y
Department of Obstetrics and Gynecology. Peking Union Medicul College Hospital Beuing 100730,
GYNECOL Preservation
and Chinese Academy
of Medicul
Sciences.
CHN
ONCOL
1991 40/l (2-6)
of fertility
was carried
/ram rhe
Li/e,orwc
353
The value of squamous cell carcinoma antigen in patients with locally advanced cervical cancer undergoing neoadjuvant chemotherapy
Scambia G; Benedetti Panici P: Baiocchi E: Greggi S; Mancuso S
G: Amoroso
M; Foti
Depor/rmw/ c~f’G~~,tec~ok~~~~~, Cirrholic Uuiwr.si/j~. Ltrr,qo A. Gwwlli. 8. 00/6X-Romtr.
ITA
AM J OBSTET GYNECOL 1991 I6412 (631-636) Serum levels of squamous cell carcinoma antigen
were
measured in 688 samples from I I9 patients with cervical cancer. Ninety-seven patients had primary tumors and 22 had rccurrcnt disease. Serum samples were obtained before each cycle of chemotherapy. before surgery, at least 4 weeks after surgery. and at 2- to 3-month
intervals
during
follow-up
from 78 of the
pa-
tients with locally advanced cervical cancer who wcrc receiving neoadjuvant chemotherapy. Squamous cell carcinoma antigen serum levels were elevated (>2.5 ng/ml) in 7l’K of the patients with primary tumors and in 77% of the patients with recurrent carcinomas. The percentage of positivity increased significantly with stage (p = 0.03) and was higher in squamous ccl1 tumors than in adenocarcinomas (p < 0.001). Pretreatment squamous cell carcinoma antigen levels were not predictive of ncoadjuvant chemotherapy response: however, the serial measurcmcnt during chemotherapy showed a good correlation with clinical response. In the patients who had surgery. squamous ccl1 carcinoma antigen positivity did not correlate to pathologic lindings (lymph node status. cervical and parametrial inliltration). Diseabcfree survival was significantly longer in patients with squamous cell carcinoma antigen pretreatment values that were lower than 5 @ml. compared with patients with marker higher than 5 ng/ml (p < 0.01). Abnormal squamous cell carcinoma antigen scru,,, levels preceded the clinical detection of recurrence in eight of I I patients with a median lead time of 5 months.
out in 28 young patients
with malignant germ cell tumors of the ovary from 1962 through 1987. The pathologic diagnosis was immature teratoma in 16, endodermal sinus tumor in 7. dysgerminoma in 2, and germ cell tumor of mixed type in 3. At laparotomy. I6 patients were proved to have stage I disease, I had stage II disease, 9 had stage
Chemotherapy-induced
neutropenia and fever in patients receiv-
ing cisplatin-based chemotherapy
for ovarian malignancy
Curtin JP: Hoskins WJ: Rubin SC; Jones WB: Hakes TB: Markman MM: Reichman B: Almadrones L: Lewis JL Jr. Memorio/
Sk,tnl-kc/rc,rirlg
C’trwcv Cu~/cv. N~II, York. N Y /fife.?/.
I11 disease, and 2 had stage IV disease. The tumor was confined to one ovary in all 22 cases treated for the first time, and the preserved ovary and uterus were normal in all 6 referred cases
GYNECOL ONCOL 1991 4011 (17-70) Fifty-six episodes of chemotherapy-induced
with recurrent diseases. Postoperative chemotherapy was given to all patients except two with stage I immature teratoma. Persistent remission was achieved in 22 patients; 5 patients died and I was lost to follow-up. Thk duration of follow-up was more than
fever occurred in forty-three patients receiving cisplatin-based combination chemotherapy for ovarian cancer. All patients wcrc treated with broad-spectrum antibiotics including gcntamicin. Twelve of fifty-six episodes were associated with positive cultures:
I year for all surviving patients, more than 3 years in 16 cases (72.7X), and more than 5 years in I3 cases (59.1%). The menstrual periods were normal in all except 3 cases, of whom 2 were below the age of I2 and one failed to menstruate at the age of 21 with
in six patients a single organism was isolated. and the other six patients had polymicrobial infection. The mean duration cTantibiotic therapy was 6.5 days. One patient died of sepsis. Fiftyfive episodes had a successful outcome. There was no aatibiotic-
a hypoplastic uterus and underdeveloped secondary sex characters. Among I2 married patients, 7 of IO desirous of childbirth became pregnant during follow-up. Of these. 6 had a normal term delivery and I is currently pregnant. The prelimi-
related morbidity. Based on this review WC recommend brondspectrum antibiotic therapy for chemotherapy-induced neutropenia with fever. The regimen of gentamicin plus ticarcillin and clavulanic acid (ceftazidime for penicillin-allergic pa-
nary conclusion is that preservation of fertility for young patients with malignant germ cell tumors of the ovary, regardless of the stage of the disease, is a safe and practicable procedure in the absence of involvement of the contralateial ovary and uterus.
tients) is effective as initial therapy. Additional agents (i.e.. vancomycin) may be necessary in culture-positive patients hased on sensitivity testing of bacterial isolates. Gentamicin can hc safely administered to patients receiving cisplatin-based
USA
neutropcnia
and
354
Citations from the Literature
chemotherapy without compromising ability to continue cisplatin therapy in subsequent treatment cycles.
patients had a S-year survival of 50%; patients between 61 and 75 years of age, 41.2%; and those 76 years of age or older. 34.3%. Patients with presenting symptoms had a cure rate of 36.9%.
Radiation management of primary carcinoma of tbe vagina: Clinical
whereas 61. I’% of asymptomatic cases survived. best results (60%) were obtained when the lesion was in the upper third of the vagina: only 37% of patients with lesions of the middle third and lower third survived more than 5 years. Well-differentiated tumors
and histopathological variables associated with survival
Kucera
H; Vavra N
Gynecologic
Rudiorherupy
Depurrment.
Universir?, of Viennu.
Spitulgusse 23, 1090 Vienno: A UT
GYNECOL ONCOL 1991 40/I (12-16) Data are presented on 434 patients treated at the Gynecologic Radiotherapy Department of the University of Vienna for invasive primary carcinoma of the vagina between 1952 and 1984: data on 110 patients treated in the last few yearsare more detailed. In stage I, 5-year survival was 76.7%; in stage II, 44.5%: in stage III. 31%: and in stage IV. 18.2%. The overall uncorrected 5-year survival rate was 39.%. The disease is primarily one of the elderly as 78% were found
to be older than 60 years of age. Younger
Inr J Gynecol Obstet 36
were associated with a 5-year survival of 62.5%; and poorly differentiated tumors, with a rate of 34.9%. Our results indicate that stage of disease is the most significant prognostic factor, but age of the patient, location of lesion in the vagina. and differentiation of the tumor
influence
outcome
too. The majority
of pa-
tients were managed by a combination ofexternal pelvic irradiation and local application of radium. In stage I and II patients treated with radium alone. good results were obtained, but no patient with stage Ill or IV disease survived nal irradiation was not performed.
5 years when exter-