Pathological prognostic indicators in cervical cancer with particular reference to patients under the age of 40 years

Citations from the Literature progoadk iodkators In CerviaI cancer with partkWrefeaatopatIatsunderthe~eof40years Buckley CH; Beards CS; Fox H Department of Pathology, University of Manrester, Manchester Ml3 9PL; UK British Journal of Obstetrics and Gynaecology/95/1 (4756)/1988/ The presence of lymph mode metastases in patients with cervical cancer is an important predictor of death and recurrence of disease. Lymph node metastases are more common in patients with mucus-secreting carcinomas than in women with pure squamous carcinomas even in what appears, clinically, to be early stage disease: such neoplasm6 are more frequent in women under the age of 40 years. The recognition of mucus secretion in a carcinoma and the detection of vascular permeation adjacent to the primary neoplasm identifies the patient at greatest risk of having pelvic lymph node metastases. Pab&gid

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Kumar J; Ilancheran A; Ratnam SS L%partment of Olxtetrics and Gynaecology. National Univerity of Singamm, Singapore 05I I; Singapore British Journal of Obstetrics and Gynaecology/95/1 (7074)/1988/ Metastatic gestational trophoblastic disease poses problems in diagnosis and management and has a poorer prognosis than the non-metastatic variant. The lung is the most common site of metastases. This paper reviews 97 patients with pulmonary metastasis developing after gestational trophoblastlc disease who were seen at one centre over 26 years. Most patients had an antecedent molar pregnancy but an associated choriocarcinomatous lesion in the uterus was absent in the majority. In many patients the pulmonary lesion was asymptomatic. Whilst chemotherapy was the treatmentof choice, selective thoracotomy in cases with solitary lung nodules reduced the treatment time and need for aggressive multi-drug combination regimens. The overall survival rate at 2 years after diagnosis was 65%. A higher mortality was found when the antecedent pregnancy ended at term, when the time interval between the preceding pregnancy and diagnosis of pulmonary metastases was > 1 year, when multiple pulmonary secondaries were present or when cerebral metastases occurred. The main causes of death were cerebral haemorrhage, respiratory failure and pulmonary embolism.

Weeldy Imtramuseolar methotrexate for nomr&astatk gestath=IVdIs== Home&y HD; Blessing JA; Rettemnaier M; Cap&i RL; Major FJ; Twlggs LB Section on Gynecologic Oncology, Department of Obstetrics and Gynecology, Bowman Gray School of Medicine, Wake

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Forest University, Winston-Salem. NC; USA Obstetrics and Gynecology/72/3 I (413418)/1988/ Patients with nomnetastatic gestational trophoblastic disease were entered into this Gynecologlc Oncology Group study to determine the efficacy, toxicity, and cost-effectiveness of weekly intramuscular (IM) methotrexate. Treatment was initiated with 30 mg/m* of weekly IM methotrexate. If no major toxicity was encountered, the weekly dose was escalated 5 mg/m* at three-week intervals until a maximum dose of 50 mg/m* each week was achieved. Complete response was defined as three normal beta-hCG values measured on consecutive weeks. Fifty-one of 63 evaluable patients (81%) had a complete response to weekly IM methoxtrexate. Duration of therapy ranged from three to 19 weeks, with a median of seven. No major toxicity occurred. Thirteen patients experienced leukopenia at a median of 3300/& with a range of 2300-3900. Three patients had platelet nadirs of 66,080, 127,000 and 135,OOO/~L. Eleven patients with weekly IM methotrexate failure had a complete response after one to eight courses of dactinomycin administered 0.5 mg/mz intravenously daily for five days; one refused therapy after three courses. Weekly IM methotrexate for nonmetastatic gestational trophoblastic disease is efficacious. minimally toxic. and cost-effective.

RI& of caueer amoug cldldreo exposed in utero to A-bomb radhtions, 1!80-84

Yoshimoto Y; Kato H; Schull WJ Department of Epidemiology, Radiation afects Research Foundation. Minami-ku, Hiroshima 732; Japan Lancet/2/8612 (665-669)/1988/ This study examines the risk of cancer (incidence) over 40 years among the in-utero exposed survivors of the atomic bombing of Hiroshima and Nagasaki, and adds eight years of follow-up to a previous report confmed to mortality. Only two cases of childhood cancer were observed among these survivors in the fist 14 years of life; both had been heavily exposed. Subsequent cancers have all been of the adult type. Not only did the observed cancers occur earlier in the 0.30 + Gy dose group than in the 0 Gy dose group but also the incidence continues to increase, and the crude cumulative incidence rate, 40 years after the Abombing, is 3.9fold greater in the 0.30 + Gy group. In the observation period 1950-84, based on the absorbed dose to the mother’s uterus as estimated by the 1986 dosimetry system (DS86), the relative risk of cancer at 1 Gy is 3.77 with a 95% confidence interval of 1.14-13.48. For the entire 0.01 + Gy dose group the average excess risk per 10’ person-year-gray is 6.57 (0.07-14.49) and the estimated attributable risk is 40.9% (2.9-90.2%). These results, when viewed in the perspective of fetus doses, suggest that SUSceptibility to radiation-induced cancers is higher in prenatally than in postnatally exposed survivors (at least those exposed as adults). However, definitive conclusions must await further follow-up studies. Int J Gynecoi Obstet 28