Effects of treatment on fertility in long-term survivors of childhood or adolescent cancer

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Citations from the Literature

Use of indium-111-labeled OC-12!! monocIonaI antibody in tbe detection of ovarian cancer Hunter RE; Doherty P; Griffin TW; et al Department of Obstetrics and Gynecology, University of Massachusetts Medical Center, Worcester, MA 01605, USA GYNECOL. ONCOL.; 27/3 (325-337)/1987/ This is a preliminary study to evaluate the utility of using the monoclonal antibody (CO-125) labeled with indium-111 to image recurrences of ovarian cancer. This technique has been investigated in 23 patients with ovarian cancer and the results have been compared with blood OC-125 levels, CT scans, and findings at second-look surgery. Following infusion of 1 mg of F(ab’), fragments (l-2 mCi “%t), quantitative SPECT and planar imaging was obtained daily for 72 hr along with analysis of serum. The nuclear medicine scans of the tumor site recurrences were technically excellent. When compared to second-look laparotomy, there were 2 true negatives, 2 false positives, 14 true positives, and 2 false negatives by nuclear imaging. CT scans correlated less well with surgery, but serum OC-125 levels correlate more closely with nucelar scans and second-look surgery. Those with multiple small metastatic implants showed a pattern of diffuse uptake which increased with time, whereas those with nodal or larger recurrences showed a more focal uptake. The combination of favourable biodistribution and positive images, especially in patients with normal antigen levels and negative CT scans, suggests a role for OC-125 monoclonal antibody imaging in their clinical management. However, further investigation is needed to determine whether nuclear scans can replace second-look surgery. If it can show that enough l%-labeled antibody accumulates in the tumor site to justify radioimmunotherapy, then 9oY (a pure beta emitter) could be exchanged for “‘In. This is potentially a method of radioimmunotherapy for recurrent ovarian carcinoma. Survival of ovarian carcinoma with or without lymph node metastasis Chen SS Department of Obstetrics and Gynecology, Long Island Jewish Medical Center, New Hyde Park, NY 11042, USA GYNEXOL. ONCOL.; 27/3 (368-372)/1987/ Because of the limited number of reports concerning the influence of retroperitoneal lymph node metastasis upon survival in patients with ovarian carcinoma, a prospective study was conducted between December 1975 and December 1982 to provide such information. This series consisted of 75 unselected patients with epithelial carcinoma of the ovary in all stages. Thirty-three patients had tumor-positive nodes and 42 had negative nodes. The two groups were compared with regard to stage of disease, grade of tumor, histology of tumor, residual disease after initial operation, finding at second-look laparotomy, and survival. All had initial maximal surgery and biopsy of para-aortic and pelvic nodes; most received postoperative chemotherapy. Follow-up was from 36 months to 10 years. Patients with positive nodes preferentially had more advanced disease (Stage III and IV), Grade 3 tumor, papillary serous cystadenocarcinoma, residual disease > 2%, low rate of second-look Iaparotomy, and death. Patients with negative Znt J Gynecol Obstet 27

nodes were connected with earlier disease (Stage I and II), nonserous tumor, minimal residual disease, high rate of secondlook laparotomy, and survival. No patient with isolated model metastasis to pelvic or para-aortic survived. Only 18.2% with concomitant para-aortic and pelvic node involvements are currently alive, opposed to 64.3% with negative node. The results indicate that tumor-positive nodes in ovarian carcinoma are a poor prognostic factor and current combination chemotherapy is not effective. Alternative treatment for these patients should be considered. EndolumInaI ultrasonic scanning in the staging of cervical carcinomas Dragsted J; Asmussen M; Gannnelgaard J; Bock JE Department of Gynecology and Obstetrics, Rigshospitalet. University of Copenhagen, Copenhagen, Denmark GYNECOL. ONCOL.; 28/l (l-7)/1987/ An accurate definition of the stages of cervical carcinomas is of extreme importance when regarding choice of treatment. According to WHO and FIGO, staging procedures include cystoscopy, rectoscopy, palpation under general anesthesia, and i.v. pyelography. According to Christensen and Fogelmann, in clinical staging the rate of error is 40 to 60% compared to the pathoanatomical findings during operations. The higher the stage, the more the rate of error is increased. Thus there is obviously a definite need to improve the clinical staging. A great number of methods are used, such as angiography, cavography, CT-scanning, and abdominal ultrasound scanning, without any significant improvements in staging. The following work introduces endoluminal rectal ultrasound scanning, which provides expectations for a better method of staging cervical carcinomas and thus optimizing the choice of treatment. Endoluminal rectal ultrasonic scanning is easily performed, giving high resolution display and close approach to the tumor, and may supplement the established methods of examination to such an extent that the clinical staging of cervical carcinomas and thus the specification of treatment may be improved. Effects of treatment on fertiIItyin long-term survivors of eMIdhood or adolescent cancer Byrne J; Mulvihill JJ; Myers MH; et al Clinical Epidemiology Branch, National Cancer Institute, NIH, Bethesda, MD 20892, USA NEW ENGL. J. MED.; 317/21(1315-1321)/1987/ In a retrospective cohort study of survivors of cancer and of controls, we estimated the risk of infertility after treatment for cancer during childhood or adolescence. We interviewed 2283 long-term survivors of childhood or adolescent cancer diagnosed in the period from 1945 through 1975, who were identified at five cancer centers in the United States. Requirements for admission to the study were diagnosis before the age of 20, survival for at least five years, and attainment of the age of 21. In addition, 3270 controls selected from among the survivors’ siblings were interviewed. Cox regression analysis showed that cancer survivors who married and were presumed to be at risk of pregnancy were less likely than their sibling controls to have ever begun a pregnancy (relative fertility. 0.85; 95 percent con-

Citations fromthe Literature

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tidence interval, 0.78 to 0.92). Radiation therapy directed below the diaphragm depressed fertility in both sexes by about 25 percent. Chemotherapy with alkyiating agents, with or without radiation to sites below the diaphragm, was associated with a fertility deficit of about 60 percent in the men. Among the women, there was no apparent effect of alkylating-agent therapy adminsitered alone (relative fertility, 1.02) and only a moderate fertility deficit when alkylating-agent therapy was combined with radiation below the diaphragm (relative fertility, 0.81). Relative fertility in the survivors varied considerably according to sex, site of cancer, and type of treatment; these factors should be taken into consideration in counseling survivors about the long-term consequences of disease.

yield reliable information concerning the beginning, peak and end of the fertile period, provided that the assays are accurate ahd performed on timed specimens of urine. We have developed such enzyme immunoassays for urinary estrogen and pregnanediol glucuronides than can be performed at home. In the early versions of the assays. enzyme reaction rates were measured by eye, but more recently, a simple photoelectronic rate meter has been used. The final problem to be solved is not technologic but whether women are sufficiently motivated to expend the same time and effort each day for 10 days a month, with less cost, on fertility awareness as they spend on making a cup of tea.

Cancer la offspring of long-term survivors of childhood and adolescent cancer Mulvihill JJ; Connelly RR; Austin DF; et al Clinical Epidemiology Branch, National Cancer Institute, Landow Building, Bethesda, MD 20892. USA LANCET; 2/8563 (813-817)/1987/ A multicentre retrospective cohort study of long-term survivors of childhood and adolescent cancer identified 7 cases of cancer among 2308 offspring (0.30%) of 2283 case-survivors and 11 cases among 4719 offspring (0.23%) of 3604 controls. Overall, the observed numbers of cases were not significantly different from those expected in the general population. Among offspring of case-survivors observed for the first 5 years of life, the group with the most person-years of followup, 5 cancers were reported (3 confirmed), compared with 1.7 expected, a significant excess due mostly to boys whose mothers survived cancer. Some offspring with cancer had known single-gene traits; others resembled previously recognised patterns of family cancer. The remainder may represent chance occurrences or new cancer family syndromes, such as an association with malignant melanoma. The study had an overall 79% power to detect a 3-fold excess of cancer among offspring of case-survivors, but no excess was observed. The number person-years of follow-up in the second decade of life, when most cases of cancer developed, was small.

In vitro fertllisntion: Legislation and problems of research Dawson K Centre for Human Bioethics, Monaslr University. CIuyton, Vie. 3168. Australia BR. MED. J.; 295/6607 (1184-1186)/1987/ The recent publication of a consuhation paper by the Department of Health and Social Security about human infertility services and research on embryos indicates that the recommendations of the Warnock report on human fertilisation and embryology may soon form the basis of legislation to regulate research on embryos and in vitro fertilisation in Britain. It is therefore timely to consider some of the problems that arise from enacting such legislation. In August 1986 the Infertility (Medical Procedures) Act 1984, based on the recommendations of a committee chaired by Professor Louis Waller, was partially proclaimed in the Australian state of Victoria. This act was the first in the world that regulated in vitro fertilisation and research on embryos, and it is important to examine the effects of the legislation and consider any problems it has created so that future legislation elsewhere may be drafted with these in mind. The intention of both the legislation and the Warnock report was to preserve existing clinical in vitro fertilisation programmes but to control their future direction and development by establishing a monitoring body with discretionary powers over research. For a biomedical scientist working in this research how realistic is this aim? Problems might arise concerning, firstly, the effects of the legislation on current research; secondly, its implications for clinical practice; and, thirdly, its ramifications for future progress. The act is now partially in force in Victoria, as is its monitoring body, the Standing Review and Advisory Committee; this provides the opportunity of examining the possible problems from the scientist’s point of view.

FERTILITY AND STERILITY Naturalfamily phuudng Brown JB; Blackwell LF; Eillings 35; et al Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Vie., Australia AM. J. OBSTET. GYNECOL.; 157/4 II (1082-1089)/1987/ It is now well accepted that a woman can conceive from an act of intercourse for a maximum of only about 7 days of her menstrual cycle. The refiability of natural family planning depends on identifying this window of fertility without ambiguity. Several symptomatic markers, cervical mucus and basal body temperature, have been used extensively and with considerable success in most women but failures occur. Ovarian and pituitary hormone production show characteristic patterns during the cycle. Urinary estrogen and pregnanediol measurements

!3electIvecontinuation ia gonadotropin-indaced multiple prego-w Birnholz JC; Dmowski WP; Binor 2; Radwanska E Department of Diagnostic Radiologv/Nuclear Medicine, RushPresbyterian-St. Luke’s Medical Center, Chicago, IL 66012, (ISA FERTIL. STERIL.; 48/S (873-876)/1987/ The diagnosis of multiple pregnancy can be made confidently in most instances 4 to 5 weeks after conception. The Int J Gynecol Obstet 27