- Email: [email protected]
Prevention of infection and wound breakdown with split thickness skin graft reconstruction following radical vulvectomy
286
SOCIETY OF GYNECOLOGIC
patients (pts) with ovarian cancer using Indium-11 1 conjugated to a monoclonal IgG antibody to the glycoprotein TAG-72, expressed in a high percentage of ovarian adenocarcinomas. Radiolabeled antibody (l-2 mg) was injected intraperitoneally (ip) at 4-5 mCi activity. Gamma camera immunoscintography (ISG) was obtained at 24, 48, and 72 hr after injection, prior to surgery. Mean pt age was 59 years. Five pts had stage III disease, and one had stage IV. Mean interval from diagnosis to antibody scanning was 19 months. All six pts are alive with mean survival of 28 months, four disease free and two alive with disease. There was no toxicity from ip antibody. Two pts were clinically free of disease at study. One had negative ISG and negative second-look laparotomy. Serum levels of TAG-72 were slightly elevated, and tissue TAG-72 immunoperoxidase was negative (false positive) and the second pt had negative serum TAG-72, a positive ISG, and tumor found at surgery which contained TAG-72 (false negative serum TAG). Four pts had suspected disease. A false negative CT scan occurred in one. All four had negative serum TAG72 levels. Three had positive ISGs and all had positive TAG-72 expression in tumor surgically removed. One had a negative ISG with no intra-abdominal tumor but carcinoma found in the chest at surgery, which did not express TAG-72. Thus two pts with negative ISGs had negative laparotomy and four pts with positive ISGs had tumor found at surgery. In conclusion, ip administration of “‘In-CYT-103 accurately predicted disease status at laparotomy in 6/6 pts. Immunoscintography was more accurate than either serum TAG-72 or CT scan. 5. Primary Vtdvar Malignant Melanoma: Review and Evaluation of Surgical Management. S. C. P. BRYSON, B. A. JOHNSTON, AND G. M. LICKIWH, Toronto General Hospital, Toronto, Ontario, Canada MSG 2C4. Twenty-two previously unreported cases of primary malignant melanoma are retrospectively analyzed for clinical and pathological features, management, and outcome. Also, an English language literature review is summarized. Results show clinical parameters corresponding to previous reports: mean age is 58 years, 2/3 of lesions involve the vulvar mucosa, most are pigmented lesions, and overall actuarial 5year survival is 46%. Parity, pregnancy, oral contraception, or postmenopausal hormone therapy are not associated factors. Similar to cutaneous melanomas, the Breslow classification of tumor thickness is a more significant prognosticator in vulvar melanoma than stage or Clark’s level of invasion. Histologically positive inguinal nodes are found in 33% (versus average of 25%) with a clinical false positive rate of 4% and a clinical false negative rate of 6%. Primary spread is to the inguinal nodes even with central lesions. Although statistical analysis is precluded by the retrospective review, management by radical surgery versus wide local excision neither decreases local, regional, or distant metastases nor improves overall survival. Also, prophylactic inguinal and pelvic node dissection are of no proven benefit. These data are supported by analysis of previous reports. 6. Prospective Treatment of Advanced or Recurrent Endometrial Carcinoma with Cisplatin, Doxorubicin, and Cyclophosphamide (PAC). T. W. BURKE, C. A. STRINGER, R. S. FREEDMAN, D. M. GERSHENSON, J. J. KAVANAGH, M. MORRIS, AND C. L. EDWARDS. The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030. Both single-agent cisplatin and the combination of doxorubicin and cyclophosphamide demonstrated moderate activity against endometrial carcinoma in earlier salvage trials. Since January 1979, 102 patients with advanced primary (n = 42) or recurrent (n = 60) endometrial carcinoma were prospectively treated with cisplatin (50 mg/m*), doxorubicin (50 mg/m’), and cyclophosphamide (500 mg/m*). Initial dose reductions were made for patients with prior pelvic irradiation. PAC was administered monthly until progression or toxicity precluded additional therapy. Patients received a median of five treatment cycles
ONCOLOGISTS-ABSTRACTS (range 1-13). In 87 patients with measurable disease, complete clinical response (CR) was seen in 12 and partial clinical response (PR) in 27 patients for an overall objective response rate of 45%. No significant differences in response rates between primary and recurrent disease patients were noted. Median time to response was 2.5 months with a median response duration of 4.8 months. Nonresponders (NR) included 33 patients with stable disease and 15 with disease progression. Median survivals were 16.4 months for CR, 11.7 months for PR, and 6.4 months for NR groups. These differences were significant (P = 0.0001). Dose escalation was possible in 25% of patients; however, 52% of patients required dose reductions during treatment. Clinically significant toxicities included neutropenia (65%), anemia (47%), emesis (21%), nephrotoxicity (17%), and neurotoxicity (4%). PAC has significant activity in patients with endometrial cancer. Enthusiasm for this regimen should be tempered by the limited duration of response and substantial treatment toxicity. 7. Prevention of Infection and Wound Breakdown with Split Thickness Skin Graft Reconstruction following Radical Vulvectomy. H. CAGLAR, M. S. PIVER, AND M. M. HRESHCHYSHYN, University at Buffalo, SUNY, Buffalo, New York 14222. Radical vulvectomy with inguinal lymphadenectomy has high morbidity with related psychosexual impacts. Reported range of incidence of wound breakdown and/or infection is 18 to 91% and mostly attributable to tension caused by the approximation of wound edges. Modified and/or radical vulvectomies with separate groin incisions have been recommended to promote wound healing. To avoid tension and related wound breakdown and/or infection, 18 split thickness skin graft reconstruction procedures were performed on 17 patients following modified and/or radical excisions of the vulva and adjacent structures (vulva, vagina, perineum, anus, rectum). Fourteen had squamous carcinoma, 1 had sarcoma, and 2 had Paget’s disease. In 2 gracilis and in 1 pedicle skin grafts were applied in addition to the skin graft. The 2 patients with gracilis flap had necrosis at the distal end of the graft and 2 patients had wound breakdown in the right groin. In none of the 18 procedures has wound infection and/or breakdown occurred. To our knowledge there are no published data regarding the use of skin graft reconstruction in radical vulvectomies. Technically it is a procedure with low complications (when patients are mobilized early) with excellent cosmetic and functional outcome and zero incidence of wound infection and/or breakdown in the skin graft site. In the authors’ experience it is highly recommended for all young and in the majority of elderly patients undergoing radical (modified or extensive) excisions of the vulva. 8. Second Malignancies in Patients with Invasive Cancer of the Cervix. A. CALKINS, J. RADER, N. ROSENSHEIN, J. POST, AND J. L. CURRIE, Johns Hopkins Hospital, Baltimore, Maryland 21205. Forty-nine of 536 women (9.1%) with invasive cancer of the cervix treated with curative intent at our institution between January 1, 1975 and December 31, 1985 developed other primary cancers. In 15, the other primary developed prior to the index cervical lesion. In 18 patients, the second primary arose following treatment of the cervical tumor. Only one of these, a squamous carcinoma of the anal canal, arose within the previously irradiated field 2 years after cervical irradiation. Two leukemias occurred and 1 patient developed a lymphoma. However, none of these 3 patients had received chemotherapy or radiation. In 20 patients, the second primary was diagnosed at the same time as the cervical tumor. Four of these patients presented with multiple separate sites of disease without any identifiable risk factors. One patient had simultaneous primaries of the cervix, vulva, vagina, and anus. Another had endometrial cervical and ovarian tumors. A third patient had simultaneous cancers of the cervix, ovary, and breast and subsequently developed an additional breast tumor 1 year later.
SOCIETY OF GYNECOLOGIC
patients (pts) with ovarian cancer using Indium-11 1 conjugated to a monoclonal IgG antibody to the glycoprotein TAG-72, expressed in a high percentage of ovarian adenocarcinomas. Radiolabeled antibody (l-2 mg) was injected intraperitoneally (ip) at 4-5 mCi activity. Gamma camera immunoscintography (ISG) was obtained at 24, 48, and 72 hr after injection, prior to surgery. Mean pt age was 59 years. Five pts had stage III disease, and one had stage IV. Mean interval from diagnosis to antibody scanning was 19 months. All six pts are alive with mean survival of 28 months, four disease free and two alive with disease. There was no toxicity from ip antibody. Two pts were clinically free of disease at study. One had negative ISG and negative second-look laparotomy. Serum levels of TAG-72 were slightly elevated, and tissue TAG-72 immunoperoxidase was negative (false positive) and the second pt had negative serum TAG-72, a positive ISG, and tumor found at surgery which contained TAG-72 (false negative serum TAG). Four pts had suspected disease. A false negative CT scan occurred in one. All four had negative serum TAG72 levels. Three had positive ISGs and all had positive TAG-72 expression in tumor surgically removed. One had a negative ISG with no intra-abdominal tumor but carcinoma found in the chest at surgery, which did not express TAG-72. Thus two pts with negative ISGs had negative laparotomy and four pts with positive ISGs had tumor found at surgery. In conclusion, ip administration of “‘In-CYT-103 accurately predicted disease status at laparotomy in 6/6 pts. Immunoscintography was more accurate than either serum TAG-72 or CT scan. 5. Primary Vtdvar Malignant Melanoma: Review and Evaluation of Surgical Management. S. C. P. BRYSON, B. A. JOHNSTON, AND G. M. LICKIWH, Toronto General Hospital, Toronto, Ontario, Canada MSG 2C4. Twenty-two previously unreported cases of primary malignant melanoma are retrospectively analyzed for clinical and pathological features, management, and outcome. Also, an English language literature review is summarized. Results show clinical parameters corresponding to previous reports: mean age is 58 years, 2/3 of lesions involve the vulvar mucosa, most are pigmented lesions, and overall actuarial 5year survival is 46%. Parity, pregnancy, oral contraception, or postmenopausal hormone therapy are not associated factors. Similar to cutaneous melanomas, the Breslow classification of tumor thickness is a more significant prognosticator in vulvar melanoma than stage or Clark’s level of invasion. Histologically positive inguinal nodes are found in 33% (versus average of 25%) with a clinical false positive rate of 4% and a clinical false negative rate of 6%. Primary spread is to the inguinal nodes even with central lesions. Although statistical analysis is precluded by the retrospective review, management by radical surgery versus wide local excision neither decreases local, regional, or distant metastases nor improves overall survival. Also, prophylactic inguinal and pelvic node dissection are of no proven benefit. These data are supported by analysis of previous reports. 6. Prospective Treatment of Advanced or Recurrent Endometrial Carcinoma with Cisplatin, Doxorubicin, and Cyclophosphamide (PAC). T. W. BURKE, C. A. STRINGER, R. S. FREEDMAN, D. M. GERSHENSON, J. J. KAVANAGH, M. MORRIS, AND C. L. EDWARDS. The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030. Both single-agent cisplatin and the combination of doxorubicin and cyclophosphamide demonstrated moderate activity against endometrial carcinoma in earlier salvage trials. Since January 1979, 102 patients with advanced primary (n = 42) or recurrent (n = 60) endometrial carcinoma were prospectively treated with cisplatin (50 mg/m*), doxorubicin (50 mg/m’), and cyclophosphamide (500 mg/m*). Initial dose reductions were made for patients with prior pelvic irradiation. PAC was administered monthly until progression or toxicity precluded additional therapy. Patients received a median of five treatment cycles
ONCOLOGISTS-ABSTRACTS (range 1-13). In 87 patients with measurable disease, complete clinical response (CR) was seen in 12 and partial clinical response (PR) in 27 patients for an overall objective response rate of 45%. No significant differences in response rates between primary and recurrent disease patients were noted. Median time to response was 2.5 months with a median response duration of 4.8 months. Nonresponders (NR) included 33 patients with stable disease and 15 with disease progression. Median survivals were 16.4 months for CR, 11.7 months for PR, and 6.4 months for NR groups. These differences were significant (P = 0.0001). Dose escalation was possible in 25% of patients; however, 52% of patients required dose reductions during treatment. Clinically significant toxicities included neutropenia (65%), anemia (47%), emesis (21%), nephrotoxicity (17%), and neurotoxicity (4%). PAC has significant activity in patients with endometrial cancer. Enthusiasm for this regimen should be tempered by the limited duration of response and substantial treatment toxicity. 7. Prevention of Infection and Wound Breakdown with Split Thickness Skin Graft Reconstruction following Radical Vulvectomy. H. CAGLAR, M. S. PIVER, AND M. M. HRESHCHYSHYN, University at Buffalo, SUNY, Buffalo, New York 14222. Radical vulvectomy with inguinal lymphadenectomy has high morbidity with related psychosexual impacts. Reported range of incidence of wound breakdown and/or infection is 18 to 91% and mostly attributable to tension caused by the approximation of wound edges. Modified and/or radical vulvectomies with separate groin incisions have been recommended to promote wound healing. To avoid tension and related wound breakdown and/or infection, 18 split thickness skin graft reconstruction procedures were performed on 17 patients following modified and/or radical excisions of the vulva and adjacent structures (vulva, vagina, perineum, anus, rectum). Fourteen had squamous carcinoma, 1 had sarcoma, and 2 had Paget’s disease. In 2 gracilis and in 1 pedicle skin grafts were applied in addition to the skin graft. The 2 patients with gracilis flap had necrosis at the distal end of the graft and 2 patients had wound breakdown in the right groin. In none of the 18 procedures has wound infection and/or breakdown occurred. To our knowledge there are no published data regarding the use of skin graft reconstruction in radical vulvectomies. Technically it is a procedure with low complications (when patients are mobilized early) with excellent cosmetic and functional outcome and zero incidence of wound infection and/or breakdown in the skin graft site. In the authors’ experience it is highly recommended for all young and in the majority of elderly patients undergoing radical (modified or extensive) excisions of the vulva. 8. Second Malignancies in Patients with Invasive Cancer of the Cervix. A. CALKINS, J. RADER, N. ROSENSHEIN, J. POST, AND J. L. CURRIE, Johns Hopkins Hospital, Baltimore, Maryland 21205. Forty-nine of 536 women (9.1%) with invasive cancer of the cervix treated with curative intent at our institution between January 1, 1975 and December 31, 1985 developed other primary cancers. In 15, the other primary developed prior to the index cervical lesion. In 18 patients, the second primary arose following treatment of the cervical tumor. Only one of these, a squamous carcinoma of the anal canal, arose within the previously irradiated field 2 years after cervical irradiation. Two leukemias occurred and 1 patient developed a lymphoma. However, none of these 3 patients had received chemotherapy or radiation. In 20 patients, the second primary was diagnosed at the same time as the cervical tumor. Four of these patients presented with multiple separate sites of disease without any identifiable risk factors. One patient had simultaneous primaries of the cervix, vulva, vagina, and anus. Another had endometrial cervical and ovarian tumors. A third patient had simultaneous cancers of the cervix, ovary, and breast and subsequently developed an additional breast tumor 1 year later.