DNA flow cytometry and morphometry as prognostic indicators in advanced ovarian cancer: A step forward in predicting the clinical outcome

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Citations from the Literature

Management of quintuplet pregaancy by selective embryoclde Farquharson DF; Wittmann BK; Hansmann M; et al Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada AM. J. OBSTET. GYNPCOL.; 15812 (413416)/1988/ Selective embryocide was performed as a two-stage procedure in a patient with a quintuplet pregnancy in the first trimester. No complications occurred. and the patient was delivered of healthy twins at term. This procedure may be offered to selected patients with pregnancies with > five embryos. Endocrine response to selecttve embryocide ln a gonadotropininduced qutntuplet pregnancy O’Keane JA; Ho Yuen B; Farquharson DF; Wittmann BK Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Britirlr Columbia, Vancouver, BC V6H3 VS. Canada AM. J. OBSTET. GYNECOL.; 15812 (364-367)/1988/ With the increase of medical induction of ovulation, the incidence of grand multiple pregnancy is becoming more frequent. We report the endocrine response of a quintuplet pregnancy that was reduced at 9 weeks’ gestation to a twin pregnancy by selective embryocide and compared with quadruplet, triplet and twin pregnancies. The human chorionic gonadotropin titer declined fourfold, but there were no clinically significant changes in the progesterone or e&radio1 levels. We conclude that. despite the drop in human chorionic gonadotropin, the placenta had attained adequate secretory maturation to prevent any significant decline in progesterone and estradiol levels, which demonstrates the efficacy of this procedure at this gestational age. Preoperative ad&ant chemotherapy in tbe treatment of cervical cancer stage Ib, Da, and Db with bulky tumor Doe Sang Kim; Hyung Moon; Yeoun Yeoung Hwang; Sam Hyun Cho Division of Gymxologic Oncology. Department of Obstetric and Gynecology, The School of Medicine, The Hanyang University, Seoul 133, South Korea GYNRCOL. ONCOL.; 2913 (321-332)/1988/ Thirty-five previously untreated patients with stage Ib, Da, and IIb squamous cell carcinoma of uterine cervix with bulky mass (more than 4 cm) were treated with initial chemotherapy of tiblastine, bleomycin, and cis-platinum combined regimen (VBP, one to five courses) and subsequent radical surgery. The effectiveness of the preoperative chemotherapy was evaluated in the surgical specimen. The overall clinical response rate was 89% and included a complete response in 16 (46%) and a partial response in IS patients (43%). There were no differences in the response rate by age, stage, or the geographic contour of the tumor. The number of chemotherapeutic courses correlated well with the response of the primary tumor (P = 0.0004) up to threecourses.Histologic examination of the resected primary tumor revealed no evidence of disease (Grade IV) in 44% of complete responders, microscopic foci (Grade III) in 38% (a), and macroscopic disease (Grade II) in 18% (3). Of I5 patients with stage IIb, 11 (73qo) had a stage-down. Lymphnode metasInt J Gynecol Obstet 27

tases after chemotherapy were found in 26% (s/35) of the patients. All nodal metastases were found among the patients who had a partial response or a stable disease, and none was found in those with a complete response (P = 0.0029). This preliiary study suggests that initial chemotherapy before surgery is effective in reducing tumor volume or stage of the disease. providing better circumstances for surgery, offers selection of high-risk groups of patients requiring additional chemotherapy, and might be able to eliminate effectively diseases in lymphnodes and possibly micrometastases. This regimen is now being evaluated to test its impact on survival.

Cisplatln, vlncrlstlne, methotrexate and bleomydn (POW) as initial or palllatlve chemotherapy for cardnoma of the cervix Rustin GJS; Newlands ES; Southcott BM; Singer A Department of Medical Oncology, Charing Cross Hospital, London W6, UK BR. J. OBSTRT. GYNAEEOL.; 94112 (120%1211)/1987/ Chemotherapy was given as initial therapy to 12 women with very advanced squamous cell carcinoma of the cervix and to 19 women with recurrent disease. They received a median of four courses of POMB which comprised vincristine 1.O mg/mz and methotrexate 300 mg/m* followed by folinic acid response, bleomycin 30 mg as a 48-h infusion or intramuscular injection and cisplatin 100 mg/mf as a 12-h infusion. Two of the 14 assessable patients with recurrent disease (14%) had a complete response with no disease found histologically in one, and seven (SOOro)had a partial response. Although the actuarial median survival of all 19 patients with recurrent dissease was 8 months, five patients have remained free from tumour progression for a median of 17 months from start of chemotherapy. Six of the 10 assessable patients receiving initial chemotherapy (60%) had a complete response (confiied histologically in two) and two (20%) had a partial response. Nine patients had additional treatment with radiotherapy and or surgery. Although only four of the patients remain disease-free at 61. 51. 7 and 4 months, all but two were initially FIG0 stage IV. Although cisplatin-induced emesis is controllable and the side-effects of methotrexate can be avoided, the POMB regimen remains potentially toxic. The small number of patients with very advanced disease who are long-term survivors prompts us to study further the role of aggressive chemotherapy as the initial treatment of patients with visceral or nodal involvement from carcinoma of the cervix.

DNA flow cytometry and morphometry as prognostic indlcatom in advanced ovarian cancer: A step forward in predtcttng tbe clhdcal outcome Rodenburg CJ; Cornelisse CJ; Hermans J; Fleuren GJ Department of Pathology, Leiden University Hospital, Leiden, Netherlands GYNRCOL. ONCOL.; 2912 (176187)/1988/ In 74 patients with advanced ovarian cancer, the value of DNA flow cytometry and morphometry was evaluated and compared with histological grading and clinical outcome. By

Citations from the Literature means of both DNA flow cytometry and morphometry a clear distinction was found between a favorable group of 15 patients, with a median survival of more than 60 months, and the remaining patients, of whom the majority died during the same follow-up period. The levels of significance for DNA flow cytometry (P = 0.0002) and morphometry (P = 0.0001) with respect to survival of the favorable and unfavorable groups of patients were higher than for histological grading (P = 0.02). In a multivariate analysis it was demonstrated that morphometry proved to be the factor of most relevance for survival, although the effect of DNA flow cytometry was almost as good. Data such as presence of ascites, the size of the residual tumor mass, choice of chemotherapy. FIGG stage, and histological grade were not of additional prognostic relevance in this analysis. It is concluded that both morphometry and DNA flow cytometry are a step forward in identifying favorable and unfavorable groups of patients with advanced ovarian cancer. For the daily practice of management of ovarian cancer patients, morphometry may be an attractive support of visual grading. Primacy adenocardnoma of the cervix: Treatment nod results Raju KS; Bates TD, Taylor RW LIepartment of Obstetrics and Gynecology, United Medical and Dental School% St Thomas’s Hospita& London SW1 7EH, UK BR. J. OBSTBT. GYNABCOL.; 94/12 (1212-1217)/1987/ Between 1972 and 1983, 49 patients with adenocarcinoma of the cervix were treated in four ways: (i) radiotherapy alone, (ii) pre- or postoperative radiotherapy and a total abdominal hysterectomy and bilateral salpingo-oophorectomy, (iii) Wertheim’s hysterectomy, and (iv) pre- or postoperative pelvic radiotherapy and Wertheim’s hysterectomy. The S-year survival results for patients with FIGG Stage I disease was 90%; with Stage II disease 60%; with Stage III disease 11% and none survived with Stage IV disease. All the patients, except one (Stage III), with well-differentiated tumours are alive and disease-free, irrespective of the type of treatment they received whereas only one patient out of the 13 who had poorly differentiated tumour is alive and disease-free. Three patients had bowel damage, one after radiotherapy alone and two after Wertheim’s hysterectomy and postoperative radiotherapy. No major surgical complications occurred in this series.

Bawd &shctioa is patknts with ovarian cancer: A search for progaostk factors Fernandes JR; Seymour RJ; Suissa S apartment of Obstetrics and Gynaecology, McGill University, Montreal, Que., Canada AM. J. OBSTET. GYNECOL.; 158/Z (244-249)/1988/ Patients with concomitant ovarian cancer and bowel obstruction were studied in an effort to find objective prognostic factors predictive of patient outcome. A total of 62 patients were followed from 31 to 354 weeks. and a total of 20 variables were considered in the analyses. At the end of the study 49 patients were dead of their disease, and 13 were alive (six dis-

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ease free and seven with persistent disease). Survival probabiities of the sample were 79% at 6 weeks, 48% at 20 weeks. and 24% at 104 waks. Univariate analyses reveaIed no significant difference in the survival times of medically versus surgically treated patient& age > 60 years at diagnosis of cancer, presence of ascites, low serum albumin levels, elevated blood urea nitrogen levels, elevated alkaline phosphatase levels, lack of previous radiotherapy (P < 0.002 for ail). advanced tumor stage, normal/ileus x-ray results, and a short diagnosis to obstruction interval (P < 0.04 for all) resulted in lower survival probabiities.

with plimary neWologicai preaalltation Ilancheran A; Ratnam SS; Baratham G Deportment of Obstetrics and Gynecology, National University Harpital, Singapore, Singapore GYNBCOL. ONCOL.; 2913 (361-364)/1988/ Metastitic choriocarcinoma can present in bizarre fashions. Two cases with prhnary neurological presentations are reviewed. Cerebral meta&ses in choriocarcinoma generally denote a poor prognosis. Howwer, in solitary metastasw in the brain, craniotomy and excision followed by chemotherapy may be curative as illustrated by the following two cases. The first patient was diagnosed to have brain metastases 1.5 years after an evacuation of her molar pregnancy while the other patient developed cerebral chorlocarcinoma 5 months following a spontaneous first trimester abortion. Both presented with neurological symptoms. Both patients are alive and well now, 9 and 5 years respectively after craniotomy and chemotherapy. A brief review of current considerations in the management of cerebral metastases in gestational trophoblastic disease is presented. Metalltatlc eeahral cbolioeadloma

Invasive sqnamous all carehtoma of the carvia in women less than 35 years old: Ru!umnt versus lloluacunmt disease Fedorkow DM; Robertson DI; Duggan MA, et al DeZmrtment of Obstetrics and Gynecology, Tom Baker Cancer Centre, Foothi& Hospital, Calgaty, Alta. TzN2i9, Canada AM. J. OBSTET. GYNECOL.; 158/2 (307-311)/1988/ Invasive cervical squamous cell carcinoma was diagnosed in 45 patients < 35 years old from 1980 to 1985. Thirty-two cases were Stage IB; 10, Stage IIB; and three, Stage IIIB. Twentytwo patients developed persistent or recurrent disease. Only one of these is now alive with no evidence of tumor. The mean interval from diagnosis to recurrence was 8.7 months (median of 7.0) and from diagnosis to death was 14.7 months (median of 12.0). Eleven of 32 patients with Stage IB disease developed a recurrence; the intervals to recurrence in Stage IB disease were similar to those for more advanced stages. Factors predicting recurrence included advanced stage of the disease and tumor bulk (maximum size. depth of invasion, and number of involved quadrants) as well as an exophytic or ulcerative tumor and a symptomatic presentation. These factors may identify the patient at high risk for recurrence who would benefit from adjuvant therapy. Znt J Gynecol O&et 27