Photodynamic therapy in gynecologic malignancies

SOCIETY OF GYNECOLOGIC distant metastases. Severe complications developed in two patients: 1 avascular hip necrosis, 1 proctitis requiring defunctioning colostomy. The observed efficacy of RT-CT suggests that it may contribute to enhanced loco-regional control in recurrent or advanced vulvar cancer, and may allow preservation of normal anatomy in selected patients with primary cancer. 122. Photodynamic Therapy in Gynecologic Malignancies. S. B. LELE, M. S. PIVER, T. MANG, T. DOUGHERTY,AND M. TOMCZAK,Department of Gynecologic Oncology and Radiation Biology, Roswell Park Memorial Institute, Buffalo, New York 14263. Twenty patients with recurrent gynecologic malignancies were treated with photodynamic therapy (PDT) using photofrin I or II and argon dye laser. There were 3 vaginal, 5 vulvar, 6 cervical, 3 ovarian, and 3 endometrial recurrences. Seven out of 20 had cutaneous lesions which were treated for local palliation only. All patients had photofrin injected iv at a dose of l-2 mg/kg 48-72 hr prior to application of dye laser. Laser was delivered using a lens or implanted fibers as per our protocol with escalation of light dose from 38 to 104J/cm’. Some of the patients received more than one treatment. All the patients treated for cutaneous metastasis had an excellent response in the form of tumor necrosis. Of the 9 patients with cervical and vaginal recurrence, there are 2 complete responses (CR) lasting 2 years or more and 2 partial responses (PR), 1 lasting for 2 months and the other for 3 years. There was no mortality from this therapy with morbidity varying from mild to severe pain in the immediate post-therapy period and cutaneous sensitivity to sunlight for 1 month. Of interest are the 2 patients who are continued CR, had refused exenteration, and elected PDT. PDT can be an alterative therapy for those patients with recurrent cervical and vaginal cancers who are not candidates for extenterative therapy or refuse it. It can also be used for palliation of cutaneous lesions. 123. The Value of DNA Flow Cytometry in Low Grade Stromal Sarcoma. C. J. DUNTON,S. E. BROOKS, M. J. VIGLIONE, M. L. KELSTEN,J. A. CARLSON,AND J. J. MIKUTA, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104. DNA flow cytometry data and estrogen receptor (ER) and progesterone receptor (PR) status were studied in three cases of low-grade stromal sarcoma (LGSS). One case was a primary presentation and the remaining two cases were recurrent tumors. All data was performed on fresh pathological material. DNA flow cytometry showed a DNA index equal to 1.00 for all specimens, consistent with a diploid cell population. Growth fractions were low in two cases (8.0% and 12.7%). In the third case, a patient with several recurrences, the growth fraction was increased to 20.3%. These findings are consistent with the clinical nature of LGSS in their propensity for indolent growth, long intervals between recurrences, and generally favorable prognosis. DNA flow cytometry may be helpful in predicting clinical response in cases where mitotic counts are between 5 and 10 mitoses per 10 high powered fields. Growth fraction information may be useful in predicting which patients are more likely to have recurrences. Receptor data was obtained by dextrancoated charcoal assay. All tumors showed a high ER (average 316 mol/mg protein) and high PR (average 753 mol/mg protein). ER and PR data are consistent with other reports and the usual clinical response to progestational therapy. 124. The Signijicance cervical

Margins:

of Positive Endocervical Curettage and EndoA Review of 183 Cone Biopsies. S. E. BROOKS,

C. J. DUNTON,ANDJ. J. MIKUTA, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104. Results of colposcopy and cone biopsy in 183patients were reviewed to determine the significance of positive endocervical margins and the role of endocervical curettage (ECC) in the diagnostic evaluation of

123

ONCOLOGISTS-ABSTRACTS

dysplasia. A positive ECC was the most common single reason for conization, accounting for 42% of the cases. Seventy-six patients had positive endocervical curettage at time of colposcopy. Of the patients with adequate colposcopy who had positive ECC 11.4% had more severe lesions on their cone biopsies than was predicted by colposcopy or biopsy alone. Endocervical curettage in 46 cases of inadequate colposcopy did not change diagnosis or patient management in any case. The status of the endocervical margins at time of conization was compared with the follow-up postoperative cytologic smears. Thirtyseven patients had positive margins on their cone specimens. No correlation was seen between the status of the endocervical margins and postoperative positive cytologic follow-up (P > 0.10). We conclude that an ECC should be omitted in cases of inadequate colposcopy. In none of our cases did the ECC eliminate the need for cone biopsy. In addition, we believe that ECC will add to the accuracy of diagnosis in cases of adequate colposcopy. The status of endocervical margins has no predictive value in relation to subsequent cytologic follow-up. All patients should be followed closely after conization regardless of the status of their margins and conservative therapy is possible even in patients with positive margins. 125. The Prognostic

Signijicance of Abnormal Therapy for Cervical Cancer.

Cervical

Cytology

after

H. GALLION,J. R. VAN NAGELL, JR., E. S. DONALDSON,R. V. HIGGINS,D. F. POWELL, AND R. KRYSCIO,University of Kentucky, Lexington, Kentucky 40536.

Radiation

From I%3 to 1983,389 patients (pts) received regular cervical cytologic examinations following radiation therapy for invasive carcinoma of the cervix. The mean age of the pts was 53 years (range 23-88 years) and the mean gravidity was 5 (range O-14). The most common cell type was large cell nonkeratinizing cancer (252 pts), followed by large cell keratinizing cancer (94 pts), small cell cancer (20 pts), adenocarcinoma (18 pts), and adenosquamous cancer (15 pts). Stages of disease were as follows: Stage I, 97; Stage II, 190; Stage III, 89; and Stage IV, 13. Cytologic examinations obtained within 3 months of radiation therapy were excluded from evaluation. Two hundred ninety-nine patients (77%) had consistently negative cytology and 90 pts (23%) had at least one abnormal cytologic examination. The mean interval from radiation to abnormal cytology was 20 months (4-270). Patients were grouped according to the first abnormal cytologic examination as follows: atypia (22 pts), dysplasia (38 pts), suspicious for malignancy (19 pts), and malignancy (11 pts). Cytologic evidence of atypia/dysplasia spontaneously regressed in 67% of the cases. Following completion of radiation, pts were followed for a mean duration of 7.4 years (range l-24 years) or until death due to recurrent disease. Isolated pelvic recurrence developed in 23% of pts with atypia/dysplasia and 50% of pts with suspicious/malignant cytology (P < 0.01). Patients with abnormal cervical cytology following radiation therapy should be thoroughly evaluated to establish histologic evidence of recurrence, since many of these cases will have potentially curable disease. 126. Detoxifying

Enzymes in Human Ovarian Tumors: Implications for the Selection of Chemotherapy. Z. DJURIC,V. K. MALVIYA, G. DEPPE,W. D. LAWRENCE,D. L. MCGUNAGLE,S. A. ARMOR,

ANDJ. M. MALONE,JR., Wayne State University, Detroit, Michigan 48201. We have examined the biochemical factors which may modulate the response to chemotherapeutic drugs in homogenates of human ovarian tumors. Eight tumor samples were large enough for preparation of microsomal enzymes known to activate numerous drugs. The levels of cytochrome P450 were very low and metabolism of quinone-containing drugs (Adriamycin and mitomycin C) and cyclophosphamide was low with ovarian microsomes. Detoxifying enzymes were quantified in cy-