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Response of ovarian cancer to combined cytotoxic agents in the subrenal capsule assay: Part I
Citations from the Literature From 1970 to 1985, 53 patients with malignant nondysgerminomatous germ cell tumors of the ovary underwent second-look laparotomy after initial surgery and combination chemotherapy. Twenty-two patients had immature teratoma, IS had endodermal sinus tumor, 15 had mixed germ cell tumor, and one patient had embryonal carcinoma. Thirty-one of the neoplasms were stage I, four were stage II, 17 were stage III, and one was stage IV. Two patients received a combination of actinomycin-D S-fluorouracil, and cyclophosphamide; four patients received vinblastine, bleomycin, and cisplatin; 44 patients received vincristine, actinomycin-D, and cyclophosphamide; and three patients received a combination of the last two regimens. Secondlook findings were negative in 52 patients and positive in one patient who was subsequently salvaged with further chemotherapy. One patient with stage I endodermal sinus tumor relapsed nine months after a negative second-look laparotomy and died. Two patients with negative findings subsequently died of leukemia. Of 53 patients undergoing second-look laparotomy, three are dead (one of cancer and two of leukemia), and SO patients are surviving without disease. Although the precise role of second-look laparotomy in patients with malignant germ cell tumors is yet to be established, possible indications are discussed.
The CA 125 assay as a predictor of clinical recurrence in epithelial ova&n cancer Niloff JM; Knapp RC; Lavin PT; et al. Division of Gynecology and Oncology, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA 02115. USA AM. J. OBSTET. GYNECOL.; 155/l (56-60) 1986 Serum CA 125 levels were obtained from 55 women with epithelial ovarian cancer before a second-look surgical procedure and serially thereafter. All patients were clinically and radiographically free of tumor at the time of the secondlook operation and were followed to clinical recurrence. Median follow-up was 12 months. CA 125 levels obtained at the second-look operation had a sensitivity and specificity for predicting clinical recurrence of 94% and 88%, respectively. Patients with an elevated CA 125 level (> or = 35 U/ml) had a 60% chance of clinical recurrence within 4 months, while patients with levels <3S U/ml had a 5% chance of clinical recurrence over the same time period. Serial CA 125 levels obtained after second-look operations were strong predictors of clinical outcome, and distinctly different monitoring profiles were observed among those patients remaining clinically free of tumor and those suffering clinical recurrence. The CA 125 assay became elevated (> or = 35 U/ml) before clinical recurrence in 94% of 35 cases with a median lead time of 3 months. The CA 125 assay identifies patients destined to suffer a clinical recurrence and provides a warning measurable in months. This may have important implications for therapy.
Cytoreductive surgery in ovarian carcinoma: and morbidity Heintz APM; Hacker NF; Berek JS; et al.
Feasibility
19
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, UCLA School of Medicine, Los Angeles, CA, USA OBSTET. GYNECOL.; 6716 (783-788) 1986 Between 1974 and 1984, 70 patients underwent primary cytoreductive surgery for ovarian carcinoma at the University of California at Los Angeles. During the period of January 1974 to December 1978, optimal cytoreduction was achieved in 56.4% of the patients. With increased experience, this figure improved to 87.1% in the period of January 1979 to December 1983. The most common morbidity associated with the procedure was fever and prolonged ileus. Bowel resection was required in 20% of the patients and was not associated with increased morbidity. More liberal use of the end-toend anastomosis stapling device facilitated low colon reanastomosis without colostomy. which contributed to the improved patient acceptance. Response of ovarian cancer to combined cytotoxic agents in the subrenal capsule assay: Part I Maenpaa J; Kangas L; Gronroos M Department of Obstetrics and Gynecology, University of Turku, Turku, Finland OBSTET. GYNECOL.; 66/S (708-7 13) 1985 The subrenal capsule assay in normal immunocompetent mice was used to test the responsiveness of ovarian cancer to combination chemotherapy. Of the assays, 42 were of untreated tumors and 19 of previously treated tumors. Fifty-nine (97’;/) of the assays were evaluable. The previously treated tumors were less sensitive than the untreated ones. Of the treated tumors 44%~ were sensitive, 33% intermediately sensitive, and 22% resistant versus 56, 44, and O%, respectively, of the untreated tumors (P < .Ol). Repeat assays for the tumors of seven patients were performed successfully after five to eight courses of therapy with the combination of doxorubicin, cyclophosphamide, and cisplatin. The responsiveness to this combination had weakened significantly (P < .Ol); the response of only one tumor remained unchanged. The rates of resistance to the drug combinations doxorubicincyclophosphamide-cisplatin, doxorubicin-cyclophosphamide-tegafur, and cyclophosphamidevincristine were 11, 10, and 21%,, respectively; there was, however, considerable interindividual variation in tumor responses to these combinations. Of other combinations, hexamethylmelamine combined with 4epidoxorubicin, aclarubicin, or chlorambucil and cisplatin had effect, whereas the combinations of cisplatin and etoposide and of tegafir and methotrexate or mitomycin were quite ineffective, of the subrenal as measured by the assay. The reliability capsule assay in normal immunocompetent mice is discussed, and it is concluded that the assay can be used to assess the response of ovarian cancer to chemotherapy, including multidrug therapy, without routine histologic control. Subrenal capsule assay aa a predictor of clinical rcqonae of ovarian cancer to chemotherapy: part II Maenpaa J Department of Obstetrics and Gynecology, University of Turku, Turku, Finland OBSTET. GYNECOL.; 66/S (714-7 18) 1985
Int J Gynaecol Obstet 25
The CA 125 assay as a predictor of clinical recurrence in epithelial ova&n cancer Niloff JM; Knapp RC; Lavin PT; et al. Division of Gynecology and Oncology, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA 02115. USA AM. J. OBSTET. GYNECOL.; 155/l (56-60) 1986 Serum CA 125 levels were obtained from 55 women with epithelial ovarian cancer before a second-look surgical procedure and serially thereafter. All patients were clinically and radiographically free of tumor at the time of the secondlook operation and were followed to clinical recurrence. Median follow-up was 12 months. CA 125 levels obtained at the second-look operation had a sensitivity and specificity for predicting clinical recurrence of 94% and 88%, respectively. Patients with an elevated CA 125 level (> or = 35 U/ml) had a 60% chance of clinical recurrence within 4 months, while patients with levels <3S U/ml had a 5% chance of clinical recurrence over the same time period. Serial CA 125 levels obtained after second-look operations were strong predictors of clinical outcome, and distinctly different monitoring profiles were observed among those patients remaining clinically free of tumor and those suffering clinical recurrence. The CA 125 assay became elevated (> or = 35 U/ml) before clinical recurrence in 94% of 35 cases with a median lead time of 3 months. The CA 125 assay identifies patients destined to suffer a clinical recurrence and provides a warning measurable in months. This may have important implications for therapy.
Cytoreductive surgery in ovarian carcinoma: and morbidity Heintz APM; Hacker NF; Berek JS; et al.
Feasibility
19
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, UCLA School of Medicine, Los Angeles, CA, USA OBSTET. GYNECOL.; 6716 (783-788) 1986 Between 1974 and 1984, 70 patients underwent primary cytoreductive surgery for ovarian carcinoma at the University of California at Los Angeles. During the period of January 1974 to December 1978, optimal cytoreduction was achieved in 56.4% of the patients. With increased experience, this figure improved to 87.1% in the period of January 1979 to December 1983. The most common morbidity associated with the procedure was fever and prolonged ileus. Bowel resection was required in 20% of the patients and was not associated with increased morbidity. More liberal use of the end-toend anastomosis stapling device facilitated low colon reanastomosis without colostomy. which contributed to the improved patient acceptance. Response of ovarian cancer to combined cytotoxic agents in the subrenal capsule assay: Part I Maenpaa J; Kangas L; Gronroos M Department of Obstetrics and Gynecology, University of Turku, Turku, Finland OBSTET. GYNECOL.; 66/S (708-7 13) 1985 The subrenal capsule assay in normal immunocompetent mice was used to test the responsiveness of ovarian cancer to combination chemotherapy. Of the assays, 42 were of untreated tumors and 19 of previously treated tumors. Fifty-nine (97’;/) of the assays were evaluable. The previously treated tumors were less sensitive than the untreated ones. Of the treated tumors 44%~ were sensitive, 33% intermediately sensitive, and 22% resistant versus 56, 44, and O%, respectively, of the untreated tumors (P < .Ol). Repeat assays for the tumors of seven patients were performed successfully after five to eight courses of therapy with the combination of doxorubicin, cyclophosphamide, and cisplatin. The responsiveness to this combination had weakened significantly (P < .Ol); the response of only one tumor remained unchanged. The rates of resistance to the drug combinations doxorubicincyclophosphamide-cisplatin, doxorubicin-cyclophosphamide-tegafur, and cyclophosphamidevincristine were 11, 10, and 21%,, respectively; there was, however, considerable interindividual variation in tumor responses to these combinations. Of other combinations, hexamethylmelamine combined with 4epidoxorubicin, aclarubicin, or chlorambucil and cisplatin had effect, whereas the combinations of cisplatin and etoposide and of tegafir and methotrexate or mitomycin were quite ineffective, of the subrenal as measured by the assay. The reliability capsule assay in normal immunocompetent mice is discussed, and it is concluded that the assay can be used to assess the response of ovarian cancer to chemotherapy, including multidrug therapy, without routine histologic control. Subrenal capsule assay aa a predictor of clinical rcqonae of ovarian cancer to chemotherapy: part II Maenpaa J Department of Obstetrics and Gynecology, University of Turku, Turku, Finland OBSTET. GYNECOL.; 66/S (714-7 18) 1985
Int J Gynaecol Obstet 25