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Second malignancies in patients with invasive cancer of the cervix
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 The fourth patient had simultaneous squamous carcinomas of the cervix, vulva, vagina, and esophagus. Overall, the most common second neoplasms were colonic and breast tumors-the first and second most common tumors in women. The incidence of tobacco-associated lesions was unusually high, yet the incidence of therapy-induced neoplasms was surprisingly low. 9. Surgical Resection of Recurrent Leiomyosarcoma: Aggressive Intervention Can Result in Long-Term Survival. J. L. Cuaat~ AND N. B. ROSENSHEIN, The Johns Hopkins Hospital, Baltimore, Maryland 21205. Uterine leiomyosarcomas are infrequent but virulent pelvic neoplasms, with 5-year survival rates in early stage disease hovering near 25%. The role of reoperation in patients with recurrent disease is not established. We report seven patients with recurrent leiomyosarcoma who were aggressively surgically debulked and subsequently underwent chemotherapy. Average age of the patients at the time of original surgery was 52.6 years (range 31 to 71) and the interval from the original surgery to recurrence was 35.5 months (range 13 to 88 months). Five of the seven patients had been treated with adjuvant chemotherapy after original surgery. At the time of surgical reexploration, a portion of the urinary tract was resected in four patients (three partial cystectomies, one nephrectomy), segments of large or small bowel in three patients, and portions of anterior abdominal wall in two patients, one necessitating a Marlex graft. Operative complications, blood loss, and hospital stay were not excessive. Currently, four patients are NED, fully active, and on adjuvant chemotherapy at 5, 10, 15, and 22 months after surgical exploration. One patient is alive with disease 78 months after resection, while two patients died of disease at 10 and 70 months after the second surgery. Experience in this group of patients indicates that a subset of patients with recurrent leiomyosarcoma may benefit from an aggressive surgical approach followed by adjuvant chemotherapy.
10. Cisplatin-Based Chemotherapy for Metastatic Endometrial Adenocarcinoma: Possible Added Effects of Etoposide. J. FANNING, M. S. PIVER, AND S. B. LELE, Roswell Park Memorial Institute, Buffalo, New York 14263. In an effort to find an effective treatment for metastatic or recurrent endometrial adenocarcinoma, two sequential cisplatin-based trials were performed. From 6/83 to 12/86, 25 consecutive patients were treated with IP (induction cisplatin 1 mg/kg every week for 4 weeks) followed by CAP (cisplatin 40 mg/m’, Adriamycin 40 mg/m*, Cytoxan 400 mg/m’) for 28 days and Depo Provera 1 g im for 7 days. From 5/87 to l/89, 15 consecutive patients were treated with APE (cisplatin 20 mg/m’ daily for 3 days, VP-16 75 mg/m’ daily for 3 days, and Adriamycin 40 mg/m*) for 28 days and Megace 160mg daily. Median followup was 20 months for IP-CAP and 17 months for APE. There was no statistically significant difference between the groups in toxicity, grade, age, Karnofsky, or prior radiotherapy, chemotherapy, or hormonal treatment. The results are:
IP-CAP APE
Response rate
Complete response
Partial response
2-year survival
2-year PFS
42% 67%
26% 33%
21% 33%
31% 66%
11% 40%
There was excellent correlation between CA125 levels and disease status. APE appears to produce an increased response rate, survival, and progression-free survival compared to IP-CAP without increased toxicity. We believe a larger prospective study utilizing APE is warranted.
ONCOLOGISTS-ABSTRACTS
287
11. Aa’juvant Whole-Abdominal Radiation Therapy in Uterine Papillary Serous Carcinoma. A. H. FRANK, P. C. TSENG,B. HAFFTY, D. PAPADOPOULOS, B. M. KACINSKI, S. DOWLING, E. I. KOHORN, J. T. CHAMBERS, S. K. CHAMBERS, R. E. PESCHEL, AND P. E. SCHWARTZ, Yale University School of Medicine, New Haven, Connecticut 06510. Uterine papillary serous carcinoma is an aggressive subtype of endometrial carcinoma that has a poor prognosis and a high recurrence rate. There is a need for an effective adjuvant therapeutic regimen in patients who have had optimal surgical cytoreduction. Results with adjuvant combination chemotherapy at our institution have been disappointing. In an effort to improve the results of treatment, a program of adjuvant whole-abdominal radiation therapy (WART) was instituted. Eight patients with no residual disease after surgical treatment received WART between July 1987and February 1989.One patient was surgical Stage I, five were Stage II, and two were Stage III. WART was delivered to a mean dose of 2272 cGy (range 1540-2530) with conedown to the pelvis to a mean total dose of 4523 cGy (range 4140-4690). Treatment was tolerated without significant morbidity. There were four recurrences 5, 5, 7, and 16 months following completion of radiation therapy. One patient failed at the vaginal apex only. Three patients failed in the upper abdomen. Two of the latter failed locally as well. Two patients are dead of disease. These preliminary results suggest that WART should not be routinely recommended as adjuvant treatment for uterine papillary serous carcinoma. 12. Assessment of Depth of Myometrial Invasion in Endometrial Adenocarcinoma. B. GOFF, L. RICE, AND T. LEAVITT, JR., Brigham and Women’s Hospital, Boston, Massachusetts 02115. Depth of myometrial invasion in Stage I adenocarcinoma of the endometrium is recognized as a prognostic factor for lymph node metastasis and overall survival. To determine if depth of myometrial invasion estimated by gross examination correlated with final histologic depth of invasion, we retrospectively reviewed all cases of surgical Stage I endometrial adenocarcinoma treated at our institution between July 1985 and July 1988. Of 113 evaluable patients, 63 had grade 1 lesions, 37 grade 2 lesions, and 13grade 3 lesions. The depth of invasion was accurately determined by gross examination in 55 of 63 (87.3%) grade I lesions, 24 of 37 (64.9%) grade 2 lesions, and only 4 of 13 (30.8%) grade 3 lesions. Gross examination of fresh tissue to estimate depth of myometrial invasion in endometrial adenocarcinoma is less reliable as the grade of tumor increases. Alternative methods, such as frozen section, should be considered when evaluating depth of invasion, especially when this affects intraoperative decisions regarding lymph node sampling. 13. Preoperative Radiation Therapy followed by Extrafascial Hysterectomy as a Treatment Method in Patients with Stage II Endometrial Carcinoma. R. V. HIGGINS, J. R. VAN NAGELL, E. S. DONALDSON, H. H. GALLION, P. D. DEPRIEST, AND R. J. KRYSCIO, University of Kentucky, Lexington, Kentucky 40536. The efficacy of preoperative radiation therapy (RT) followed by extrafascial hysterectomy and para-aortic node dissection was evaluated in 74 patients with Stage II endometrial carcinoma. All patients had histologically confirmed carcinoma of the endometrium and endocervix. Sixty-four patients had adenocarcinoma, 9 patients adenosquamous carcinoma, and 1 patient clear cell carcinoma. The clinical characteristics of the patients were age 60 years (32-80 years), gravidity 3 (O-l l), and weight 168 lbs (99-344 Ibs). Preoperative radiation generally consisted of 5000 cGy (3570-6000 cGy) followed by intracavitary therapy providing approximately 2000 cGy (1166-4001 cGy) to point A. Surgery was performed 4-6 weeks after the completion of RT in 70 patients. The average hospital stay was 8 days (4-66 days) and no
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 The fourth patient had simultaneous squamous carcinomas of the cervix, vulva, vagina, and esophagus. Overall, the most common second neoplasms were colonic and breast tumors-the first and second most common tumors in women. The incidence of tobacco-associated lesions was unusually high, yet the incidence of therapy-induced neoplasms was surprisingly low. 9. Surgical Resection of Recurrent Leiomyosarcoma: Aggressive Intervention Can Result in Long-Term Survival. J. L. Cuaat~ AND N. B. ROSENSHEIN, The Johns Hopkins Hospital, Baltimore, Maryland 21205. Uterine leiomyosarcomas are infrequent but virulent pelvic neoplasms, with 5-year survival rates in early stage disease hovering near 25%. The role of reoperation in patients with recurrent disease is not established. We report seven patients with recurrent leiomyosarcoma who were aggressively surgically debulked and subsequently underwent chemotherapy. Average age of the patients at the time of original surgery was 52.6 years (range 31 to 71) and the interval from the original surgery to recurrence was 35.5 months (range 13 to 88 months). Five of the seven patients had been treated with adjuvant chemotherapy after original surgery. At the time of surgical reexploration, a portion of the urinary tract was resected in four patients (three partial cystectomies, one nephrectomy), segments of large or small bowel in three patients, and portions of anterior abdominal wall in two patients, one necessitating a Marlex graft. Operative complications, blood loss, and hospital stay were not excessive. Currently, four patients are NED, fully active, and on adjuvant chemotherapy at 5, 10, 15, and 22 months after surgical exploration. One patient is alive with disease 78 months after resection, while two patients died of disease at 10 and 70 months after the second surgery. Experience in this group of patients indicates that a subset of patients with recurrent leiomyosarcoma may benefit from an aggressive surgical approach followed by adjuvant chemotherapy.
10. Cisplatin-Based Chemotherapy for Metastatic Endometrial Adenocarcinoma: Possible Added Effects of Etoposide. J. FANNING, M. S. PIVER, AND S. B. LELE, Roswell Park Memorial Institute, Buffalo, New York 14263. In an effort to find an effective treatment for metastatic or recurrent endometrial adenocarcinoma, two sequential cisplatin-based trials were performed. From 6/83 to 12/86, 25 consecutive patients were treated with IP (induction cisplatin 1 mg/kg every week for 4 weeks) followed by CAP (cisplatin 40 mg/m’, Adriamycin 40 mg/m*, Cytoxan 400 mg/m’) for 28 days and Depo Provera 1 g im for 7 days. From 5/87 to l/89, 15 consecutive patients were treated with APE (cisplatin 20 mg/m’ daily for 3 days, VP-16 75 mg/m’ daily for 3 days, and Adriamycin 40 mg/m*) for 28 days and Megace 160mg daily. Median followup was 20 months for IP-CAP and 17 months for APE. There was no statistically significant difference between the groups in toxicity, grade, age, Karnofsky, or prior radiotherapy, chemotherapy, or hormonal treatment. The results are:
IP-CAP APE
Response rate
Complete response
Partial response
2-year survival
2-year PFS
42% 67%
26% 33%
21% 33%
31% 66%
11% 40%
There was excellent correlation between CA125 levels and disease status. APE appears to produce an increased response rate, survival, and progression-free survival compared to IP-CAP without increased toxicity. We believe a larger prospective study utilizing APE is warranted.
ONCOLOGISTS-ABSTRACTS
287
11. Aa’juvant Whole-Abdominal Radiation Therapy in Uterine Papillary Serous Carcinoma. A. H. FRANK, P. C. TSENG,B. HAFFTY, D. PAPADOPOULOS, B. M. KACINSKI, S. DOWLING, E. I. KOHORN, J. T. CHAMBERS, S. K. CHAMBERS, R. E. PESCHEL, AND P. E. SCHWARTZ, Yale University School of Medicine, New Haven, Connecticut 06510. Uterine papillary serous carcinoma is an aggressive subtype of endometrial carcinoma that has a poor prognosis and a high recurrence rate. There is a need for an effective adjuvant therapeutic regimen in patients who have had optimal surgical cytoreduction. Results with adjuvant combination chemotherapy at our institution have been disappointing. In an effort to improve the results of treatment, a program of adjuvant whole-abdominal radiation therapy (WART) was instituted. Eight patients with no residual disease after surgical treatment received WART between July 1987and February 1989.One patient was surgical Stage I, five were Stage II, and two were Stage III. WART was delivered to a mean dose of 2272 cGy (range 1540-2530) with conedown to the pelvis to a mean total dose of 4523 cGy (range 4140-4690). Treatment was tolerated without significant morbidity. There were four recurrences 5, 5, 7, and 16 months following completion of radiation therapy. One patient failed at the vaginal apex only. Three patients failed in the upper abdomen. Two of the latter failed locally as well. Two patients are dead of disease. These preliminary results suggest that WART should not be routinely recommended as adjuvant treatment for uterine papillary serous carcinoma. 12. Assessment of Depth of Myometrial Invasion in Endometrial Adenocarcinoma. B. GOFF, L. RICE, AND T. LEAVITT, JR., Brigham and Women’s Hospital, Boston, Massachusetts 02115. Depth of myometrial invasion in Stage I adenocarcinoma of the endometrium is recognized as a prognostic factor for lymph node metastasis and overall survival. To determine if depth of myometrial invasion estimated by gross examination correlated with final histologic depth of invasion, we retrospectively reviewed all cases of surgical Stage I endometrial adenocarcinoma treated at our institution between July 1985 and July 1988. Of 113 evaluable patients, 63 had grade 1 lesions, 37 grade 2 lesions, and 13grade 3 lesions. The depth of invasion was accurately determined by gross examination in 55 of 63 (87.3%) grade I lesions, 24 of 37 (64.9%) grade 2 lesions, and only 4 of 13 (30.8%) grade 3 lesions. Gross examination of fresh tissue to estimate depth of myometrial invasion in endometrial adenocarcinoma is less reliable as the grade of tumor increases. Alternative methods, such as frozen section, should be considered when evaluating depth of invasion, especially when this affects intraoperative decisions regarding lymph node sampling. 13. Preoperative Radiation Therapy followed by Extrafascial Hysterectomy as a Treatment Method in Patients with Stage II Endometrial Carcinoma. R. V. HIGGINS, J. R. VAN NAGELL, E. S. DONALDSON, H. H. GALLION, P. D. DEPRIEST, AND R. J. KRYSCIO, University of Kentucky, Lexington, Kentucky 40536. The efficacy of preoperative radiation therapy (RT) followed by extrafascial hysterectomy and para-aortic node dissection was evaluated in 74 patients with Stage II endometrial carcinoma. All patients had histologically confirmed carcinoma of the endometrium and endocervix. Sixty-four patients had adenocarcinoma, 9 patients adenosquamous carcinoma, and 1 patient clear cell carcinoma. The clinical characteristics of the patients were age 60 years (32-80 years), gravidity 3 (O-l l), and weight 168 lbs (99-344 Ibs). Preoperative radiation generally consisted of 5000 cGy (3570-6000 cGy) followed by intracavitary therapy providing approximately 2000 cGy (1166-4001 cGy) to point A. Surgery was performed 4-6 weeks after the completion of RT in 70 patients. The average hospital stay was 8 days (4-66 days) and no