Reducing malignant ascites accumulation by repeated intraperitoneal administrations of a Viscum album extract.

BACKGROUND: Malignant ascites is a major problem in the management of advanced stages of certain malignancies. The possibility of reducing the accumulation of ascites by intraperitoneal injections of a Viscum album extract (Iscador M) was evaluated. PATIENTS AND METHODS: Twenty-three patients, with end-stage malignancies of varying histology, requiring repeated peritoneal punctures, were eligible for analysis. The time-interval between the first two punctures was measured and defined as the baseline. Following each subsequent puncture, Iscador M 10 mg was injected intraperitoneally. The intervals between later punctures were compared to previous intervals. RESULTS: Following the first injection, the median time-interval between injections increased from 7 to 12 days, reaching 13 days after the second injection. No toxicity was observed. CONCLUSION: This phase II study suggests that installation of Iscador M into the peritoneal cavity may reduce the need for repeated punctures. A randomized trial is needed to confirm these promising preliminary results.

The role of hybrid PET/CT in the evaluation of patients with cervical cancer.

OBJECTIVE: To assess the role of hybrid PET/CT in the evaluation of patients with cervical cancer. METHODS: 75 patients divided into 3 groups. Group 1 consisted of 16 patients prior to radical surgery. Group 2 consisted of 31 patients prior to pelvic radiotherapy. Group 3 had 28 patients who underwent the examination secondary to suspected recurrent disease. Whole body PET and CT were performed respectively on the same device 1 h after injection of 10 mCi FDG. PET/CT results were correlated to histological, radiological and clinical follow-up data. Only women with >6 months follow-up were included. RESULTS: In 33 patients, pathohistological examinations for extra cervical lesions were obtained. Correlation with PET/CT examination revealed levels of sensitivity (60%), specificity (94%), positive (90%) and negative predictive values (74%). The examination indicated 21 patients with extrapelvic and/or metastatic disease. The follow-up data of this group revealed that 20 patients either died or were alive with active disease, and only one patient was in clinical remission. PET/CT yielded an improved diagnosis for both PET and CT in 43% of the cases by providing better localization and definition of abnormal FDG uptake. CONCLUSIONS: Hybrid PET/CT was found to be of value for detection of cervical cancer metastases, decision-making and planning of irradiation therapy. Using this modality may reduce unnecessary surgical interventions, help modify radiation fields and change therapeutic approaches. Detection of advanced diseases on PET/CT correlates with poor prognosis. However, this examination is less accurate in detecting microscopic diseases and lesions smaller than 1.5 cm.

Expression of cell cycle regulatory proteins in ovaries prophylactically removed from Jewish Ashkenazi BRCA1 and BRCA2 mutation carriers: correlation with histopathology.

OBJECTIVES: Prophylactic oophorectomy in Ashkenazi Jewish women with BRCA mutations represents a unique opportunity to search for premalignant changes in ovaries. Reports on the presence of dysplastic lesions in these ovaries are contradictory. Our aim was to study the expression of cell cycle regulatory proteins--p53, Skp2, p27, Ki67, Bcl2 and p16--in correlation with histopathological changes. p16(INK4A) was not studied before in prophylactically removed ovaries. METHODS: Ninety-four ovaries from 50 Ashkenazi Jewish BRCA carriers were compared with 42 ovaries removed for reasons unrelated to cancer and with 16 ovarian carcinomas. RESULTS: Three (6%) patients from the high-risk group had an occult carcinoma. A significant association was found between BRCA-positive expression and the presence of atypical changes in the superficial ovarian epithelium (P = 0.014) as well as the presence of epithelial cortical clefts (P = 0.042). Expression of p53 in cortical inclusions was significantly higher in the BRCA-positive cases than in the benign control group (P = 0.03). The high-risk and the benign control group did not differ significantly by the expression of p16, BCL2, Ki67, p27 and SKP2 (P > 0.05). However, both groups significantly differed from the carcinoma group (P < 0.0001). A significant positive correlation was found between the expression of Ki67, and the grade of atypia in the high-risk group (R = 0.3, P = 0.01) and in the benign control group (R = 0.5, P = 0.02). CONCLUSIONS: BRCA mutation carriers had more atypical changes in the superficial epithelium (P = 0.014) and more epithelial cortical clefts (P = 0.042) compared to the benign control group. The histopathology changes were not supported by significantly altered expressions of the proteins used in our study. Additional molecular studies could contribute to the disclosure of precancerous ovarian lesions.

Growing Teratoma syndrome treated by interferon alpha-2beta: case report and literature review.

A 14-year old girl was diagnosed as suffering from an immature teratoma. As removal of the teratoma was technically unfeasible, the patient was started on interferon alpha2beta, 3 MU/day, 5 days per week. On this therapy, the growth of the teratoma was stopped and the patient has been well for the past 50 months. She continues to be treated with interferon alpha2beta, with almost no side effects and no restrictions of her everyday activities, with a good quality of life. She is able to attend school regularly, travels abroad frequently, and participates fully in everyday activities normal for her age and social conditions. Her Karnofsky performance status is 100. This case demonstrates the efficacy of interferon alpha2beta therapy in certain instances of growing teratoma syndrome, even when the tumorous mass is initially quite large.