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1.
Ann Oncol ; 19(9): 1578-83, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18453518

RESUMO

OBJECTIVES: To evaluate the efficacy and toxicity of paclitaxel and cisplatin alternating with paclitaxel and etoposide doublet regimen (TP/TE), for salvage of patients with high-risk gestational trophoblastic neoplasia (GTN). PATIENTS AND METHODS: Twenty-four patients with GTN received TP/TE. Sixteen had failed previous chemotherapy including six with cisplatin-based regimens (group A) and eight changed to TP/TE because of prior treatment-induced toxic effects (group B). RESULTS: In group A, three patients (19%) achieved a complete response (CR) and five (31%) a partial response (PR). All CR and four PR patients remain alive with a median follow-up of 25 months (range 9-48). The eight patients failing TP/TE subsequently died. Thus, the overall survival of the 16 patients in group A was 44% (seven of 16), rising to 70% (seven of 10) if the six patients who had failed prior cisplatin-based chemotherapy were excluded. In group B, four patients were assessable for response (two CR, two PR) and six remain alive (median follow-up 19 months) giving an overall survival of 75%. TP/TE was well tolerated, with only one patient discontinuing therapy because of toxic effects. CONCLUSION: TP/TE is an effective, well-tolerated, salvage treatment for relapsed patients who are heavily pretreated for GTN. Further studies of this regimen are warranted.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Doença Trofoblástica Gestacional/tratamento farmacológico , Recidiva Local de Neoplasia/tratamento farmacológico , Complicações Neoplásicas na Gravidez/tratamento farmacológico , Terapia de Salvação , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Estudos de Coortes , Relação Dose-Resposta a Droga , Esquema de Medicação , Etoposídeo/administração & dosagem , Etoposídeo/efeitos adversos , Feminino , Seguimentos , Doença Trofoblástica Gestacional/mortalidade , Doença Trofoblástica Gestacional/patologia , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Paclitaxel/administração & dosagem , Paclitaxel/efeitos adversos , Gravidez , Complicações Neoplásicas na Gravidez/mortalidade , Complicações Neoplásicas na Gravidez/patologia , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida
2.
Br J Cancer ; 93(6): 620-1, 2005 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-16222307

RESUMO

We present retrospectively our experience in the use of high-dose chemotherapy and haematopoietic stem cell support (HSCS) for refractory gestational trophoblastic neoplasia (GTN) in the largest series so far reported. In all, 11 patients have been treated at three Trophoblast Centres between 1993 and 2004. The conditioning regimens comprised either Carbop-EC-T (carboplatin, etoposide, cyclophosphamide, paclitaxel and prednisolone) or CEM (carboplatin, etoposide and melphalan) or ICE (ifosfamide, carboplatin, etoposide). Two patients had complete human chorionic gonadotrophin responses, one for 4 and the other for 12 months. Three patients had partial tumour marker responses for 1-2 months. High-dose chemotherapy and HSCS for GTN is still unproven. Further studies are needed, perhaps in high-risk patients who fail their first salvage treatment.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Coriocarcinoma/terapia , Transplante de Células-Tronco de Sangue Periférico , Neoplasias Uterinas/terapia , Terapia Combinada , Feminino , Humanos , Recidiva Local de Neoplasia , Gravidez , Terapia de Salvação , Resultado do Tratamento
3.
Neuroradiology ; 47(8): 586-90, 2005 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15997391

RESUMO

A 49-year-old woman who had previously received treatment with cytotoxic drugs for metastatic gestational trophoblastic disease (GTD) presented with a witnessed tonic-clonic seizure, headache, confusion and blindness, 6 days after the uneventful administration of a general anaesthetic and 2 months after cessation of chemotherapy. Magnetic resonance imaging showed relatively symmetrical, subcortical, white matter abnormalities, predominantly affecting the occipital, posterior temporal and parietal lobes and the cerebellum. T2-dependent abnormalities and elevated regional apparent diffusion coefficient were present in a pattern typical for posterior reversible encephalopathy syndrome (PRES). The clinical and radiological manifestations were resolved completely with supportive therapy. This case of PRES may be a late complication of gemcitabine or cisplatin therapy precipitated by a general anaesthetic, or associated electrolyte or blood pressure disturbance.


Assuntos
Anestesia Geral/efeitos adversos , Antimetabólitos Antineoplásicos/efeitos adversos , Encefalopatias/etiologia , Encéfalo/patologia , Desoxicitidina/análogos & derivados , Antimetabólitos Antineoplásicos/uso terapêutico , Pressão Sanguínea , Desoxicitidina/efeitos adversos , Desoxicitidina/uso terapêutico , Imagem de Difusão por Ressonância Magnética , Feminino , Doença Trofoblástica Gestacional/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Gravidez , Síndrome , Equilíbrio Hidroeletrolítico
4.
Histopathology ; 45(2): 135-41, 2004 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15279631

RESUMO

AIM: To determine whether immunohistochemical staining for p57(KIP2), the product of the maternally expressed gene CDKN1C, can be used to differentiate between gestational trophoblastic tumours arising from a complete hydatidiform mole and those originating from non-molar pregnancies. METHODS: The immunohistochemical expression of p57(KIP2) was investigated in 23 cases of choriocarcinoma and 17 placental site trophoblastic tumours. Fourteen of the tumours examined were shown by DNA analysis to have arisen from complete hydatidiform moles and 26 from non-molar pregnancies. RESULTS: Five of 11 (45%) post-complete hydatidiform mole choriocarcinomas and two of three (67%) post-complete hydatidiform mole placental site trophoblastic tumours were found to be p57(KIP2)+ and showed similar immunostaining characteristics to tumours that developed from non-molar pregnancies. Although there was a statistically significant reduction in the proportion of cases showing positive p57(KIP2) staining in post-complete hydatidiform mole tumours compared with those originating in non-molar pregnancies [proportion difference 0.35 [95% confidence interval (CI) 0.05, 0.61], P = 0.02], immunostaining did not provide diagnostically useful information to differentiate between these tumours in clinical practice. There was no significant difference between the extent of staining in choriocarcinoma versus placental site trophoblastic tumours [proportion difference 0.17 (95% CI - 12, 42), P = 0.19]. The majority of both types of gestational trophoblastic tumour were positive for the presence of the p57(KIP2) protein irrespective of their genetic origin. CONCLUSION: Immunostaining for p57(KIP2) fails to discriminate between gestational trophoblastic tumours that have arisen from complete hydatidiform moles and those that have originated from other types of pregnancy.


Assuntos
Coriocarcinoma/metabolismo , Mola Hidatiforme/metabolismo , Proteínas Nucleares/metabolismo , Tumor Trofoblástico de Localização Placentária/metabolismo , Neoplasias Uterinas/metabolismo , Adulto , Biomarcadores Tumorais/metabolismo , Coriocarcinoma/genética , Coriocarcinoma/secundário , Inibidor de Quinase Dependente de Ciclina p57 , DNA de Neoplasias/análise , Diagnóstico Diferencial , Feminino , Humanos , Mola Hidatiforme/complicações , Mola Hidatiforme/patologia , Técnicas Imunoenzimáticas , Gravidez , Tumor Trofoblástico de Localização Placentária/genética , Tumor Trofoblástico de Localização Placentária/secundário , Neoplasias Uterinas/genética , Neoplasias Uterinas/patologia
6.
Br J Cancer ; 90(6): 1169-75, 2004 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-15026797

RESUMO

High-dose regimes containing etoposide, carboplatin and an oxazaphospharine can salvage 30-40% of patients with relapsed or refractory male germ cell tumours (GCTs). The additional benefit of paclitaxel in such high-dose therapy has not been tested. Between March 1995 and November 2002, 36 male GCT patients were treated with Carbop-EC-T (paclitaxel 75 mg x m(-2), etoposide 450 mg x m(-2), carboplatin AUC 10 on days -7, -5 and -3 and cyclophosphamide 60 mg x kg(-1) on days -5 and -3) followed by peripheral blood stem cell infusion (day 0). The 1-year overall survival rate for all patients is 67% (median follow-up 29 months). For the 24 patients with cisplatin-sensitive disease, the 1-year overall and event-free survivals are 88 and 64%, respectively. For those with cisplatin refractory or absolutely refractory disease, the 1-year overall survival is 25%. In all, 12 patients relapsed at a median duration of 5 months, 11 of whom have died. There were also six treatment-related deaths, five associated with pneumonitis. Pulmonary toxicity has been reported with paclitaxel in other high-dose regimes. Since altering our protocol so that paclitaxel is infused over 24 h with steroid prophylaxis, only one of 18 patients (13 testicular GCTs and five other tumour types) has had a treatment-related death. Our results suggest that Carbop-EC-T may enable a greater proportion of patients with relapsed and refractory GCTs to enter long-term remission.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Germinoma/tratamento farmacológico , Neoplasias Testiculares/tratamento farmacológico , Adulto , Idoso , Carboplatina/administração & dosagem , Ciclofosfamida/administração & dosagem , Resistencia a Medicamentos Antineoplásicos , Etoposídeo/administração & dosagem , Germinoma/patologia , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Paclitaxel/administração & dosagem , Transplante de Células-Tronco de Sangue Periférico , Terapia de Salvação , Análise de Sobrevida , Neoplasias Testiculares/patologia , Resultado do Tratamento
7.
Best Pract Res Clin Obstet Gynaecol ; 17(6): 905-23, 2003 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-14614889

RESUMO

Gestational trophoblastic neoplasia (GTN) comprises a spectrum of disease from low-risk disease which can be cured with simple relatively non-toxic treatment, to extremely aggressive tumours which require specialized management. The prognostic variables in patients with GTN are different from those in other gynaecological malignancies, and the major adverse prognostic variables include long interval from antecedent pregnancy, high concentrations of the pregnancy hormone, human chorionic gonadotrophin, metastases in brain and liver and failure of prior treatment. Patients who relapse after their prior treatment can also be categorized into different risk groups. Salvage treatment can vary from single agent actinomycin D to combination chemotherapy and, in selected cases, surgery. With appropriate management, the majority of patients can achieve long-term remission and, in most cases, preserve fertility. The late side-effects of more intensive treatment are a small risk of inducing second tumours and also of bringing forward the age of menopause.


Assuntos
Doença Trofoblástica Gestacional/tratamento farmacológico , Recidiva Local de Neoplasia/tratamento farmacológico , Antineoplásicos/efeitos adversos , Neoplasias do Sistema Nervoso Central/secundário , Gonadotropina Coriônica/sangue , Resistencia a Medicamentos Antineoplásicos , Feminino , Doença Trofoblástica Gestacional/genética , Humanos , Estadiamento de Neoplasias , Gravidez , Prognóstico , Fatores de Risco , Resultado do Tratamento , Tumor Trofoblástico de Localização Placentária/terapia , Neoplasias Uterinas/terapia
8.
Br J Cancer ; 89(10): 1849-54, 2003 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-14612891

RESUMO

The risk of chemotherapy-induced infertility in male and female germ cell tumour (GCT) survivors is unclear, but may correlate with cisplatin dose. Here, we examine a large series of GCT patients for the effect of chemotherapy on those attempting to have children. Our GCT database was screened for nonseminomatous GCT patients who had (1). received POMB/ACE chemotherapy (cisplatin, vincristine, methotrexate, bleomycin alternating with actinomycin D, cyclophosphamide and etoposide) and (2). stage I male GCT patients who were untreated between 1977 and 1996. Fertility was assessed by questionnaire and medical records. A total of 64 of 153 treated and 35 of 115 untreated men attempted to have children. In all, 28% (18 out of 64) receiving POMB/ACE were unsuccessful. Radiotherapy (six), atrophic remaining testis (one) or prior infertility (three) were implicated in 10 cases, so chemotherapy-induced infertility may have occurred in only 11% (eight out of 64). Strikingly, 26% (nine out of 35) of untreated stage I patients also failed to have children (three had radiotherapy, three prior infertility). Moreover, in treated men, no association was seen between cisplatin dose and infertility. In contrast, radiotherapy significantly increased male infertility (P=0.001). Of 28 treated women who attempted to have children, 25% (seven out of 28) were unsuccessful. One previously had infertility and one subsequently had successful IVF so chemotherapy-induced infertility potentially occurred in only 18% (five out of 28) and was not related to cisplatin dose. In conclusion, the risk of chemotherapy-induced infertility is low in both male and female GCT patients and does not clearly correlate with the cumulative cisplatin dose.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Germinoma/tratamento farmacológico , Infertilidade Feminina/induzido quimicamente , Infertilidade Masculina/induzido quimicamente , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Bleomicina/administração & dosagem , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Ciclofosfamida/administração & dosagem , Dactinomicina/administração & dosagem , Relação Dose-Resposta a Droga , Etoposídeo/administração & dosagem , Feminino , Seguimentos , Humanos , Masculino , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Vincristina/administração & dosagem
10.
Br J Cancer ; 89(2): 248-51, 2003 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-12865911

RESUMO

Temozolomide (TMZ) is an oral alkylating agent with a good safety profile and proven efficacy in the treatment of malignant glioma. Procarbazine (PCB) has been used for treating gliomas for many years and here both agents were combined in the treatment. This phase I study was designed to evaluate the efficacy and safety of TMZ alone (course 1) and TMZ in combination with PCB in subsequent courses in chemotherapy-naïve patients with malignant glioma. Patients with anaplastic astrocytoma (AA), glioblastoma multiforme (GBM) and low-grade glioma were treated with TMZ 200 mg m(-2) on days 1-5 on a 28-day cycle for course 1. Beginning with course 2, cohorts of patients received TMZ at full dose with escalating doses of PCB (50/75/100/125 mg m(-2) days 1-5 given 1 h prior to TMZ). A total of 28 patients were enrolled with three patients each at dose level 1 and 2, 16 patients at dose level 3 and six patients at dose level 4 received 182+ cycles of treatment and were included in this analysis. In all, 16 patients had GBM, seven patients had AA, five had grade 1 or 2 glioma and the median age was 47 years. The patients had received prior surgery and radiotherapy. Responses were seen at all dose levels. Overall, there were 10 (36%) responses lasting from 2 to 17+ months. Treatment was generally well tolerated with few grade 3 or 4 toxicities, except at dose level 4, where four patients had grade 3/4 had thrombocytopaenia at this dose and several patients had moderate-to-severe lethargy. TMZ 200 mg m(-2) and PCB 100 mg m(-2) were well tolerated on a daily 5 x and four weekly cycle in patients with malignant glioma and clearly had antitumour activity.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Astrocitoma/tratamento farmacológico , Neoplasias Encefálicas/tratamento farmacológico , Dacarbazina/análogos & derivados , Glioblastoma/tratamento farmacológico , Glioma/tratamento farmacológico , Administração Oral , Adolescente , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Astrocitoma/patologia , Neoplasias Encefálicas/patologia , Dacarbazina/administração & dosagem , Feminino , Glioblastoma/patologia , Glioma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Procarbazina/administração & dosagem , Fases do Sono , Temozolomida , Trombocitopenia/induzido quimicamente , Resultado do Tratamento
11.
BJOG ; 110(1): 22-6, 2003 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-12504931

RESUMO

OBJECTIVE: To determine pregnancy outcome, including the rate of repeat molar pregnancy, following histologically confirmed complete or partial hydatidiform mole. DESIGN: Retrospective review of a large supraregional database of registrations for gestational trophoblastic disease. SETTING: Supraregional Trophoblastic Disease Unit, London. SAMPLE: Women with pregnancies affected by complete or partial hydatidiform mole registered between 1992 and 1998. METHODS: All patients with a diagnosis of histologically confirmed complete or partial hydatidiform mole were identified and data on subsequent pregnancies compared between groups using comparison of proportion test. MAIN OUTCOME MEASURES: Pregnancy outcome by partial or complete mole subtype, with particular regard to risk of subsequent molar pregnancy. RESULTS: Of 2578 complete moles, the subsequent pregnancy was affected by hydatidiform mole in 27 (1.9%) cases, including 22 (81%) complete moles and 5 (19%) partial moles. Of 2627 partial moles, the subsequent pregnancy was also molar in 25 (1.7%) cases, including 17 (68%) partial moles and 8 (32%) complete moles. Overall recurrence risk for molar pregnancy was 1.8% (1 in 55), or a 20-fold increase compared with the background risk. Of 27 cases with repeat complete moles, three had further complete moles, suggesting the recurrence risk following two previous complete moles is approximately 10%. There were no other significant differences in pregnancy outcome between cases with previous complete or partial hydatidiform mole and that expected in an unselected obstetric population. CONCLUSIONS: Women having a pregnancy affected by a histologically confirmed complete or partial hydatidiform mole may be counselled that the risk of repeat mole in a subsequent pregnancy is about 1 in 60 and if this were to occur, the majority of cases will be of the same type of mole as the preceding pregnancy. However, >98% of women who become pregnant following a molar conception will not have a further hydatidiform mole and these pregnancies are at no increased risk of other obstetric complications.


Assuntos
Mola Hidatiforme/etiologia , Neoplasias Uterinas/etiologia , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Trabalho de Parto Prematuro/etiologia , Gravidez , Resultado da Gravidez , Recidiva , Estudos Retrospectivos , Fatores de Risco
12.
Clin Radiol ; 57(12): 1098-108, 2002 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-12475535

RESUMO

AIMS: To implement a multislice two-dimensional (2D) T2-weighted sequence suitable for subvoxel image registration and to assess its usefulness in detecting change in high-grade intracranial gliomas. MATERIALS AND METHODS: Twenty patients with high-grade gliomas were studied on two or more occasions. T2-weighted multislice pulse sequences with a Gaussian slice profile, 50% overlapping slices and nearly isotropic voxels were acquired. The images were registered and subtraction images were produced. The images were compared with three-dimensional (3D) T1-weighted registered images and conventional unregistered T2-weighted images. All images were scored for changes in the lesions and ventricular system. RESULTS: The 2D and 3D registered subtraction images were the most sensitive for detecting changes in both the lesions and other regions in the brain. The mean rank scores were significantly higher for the lesions (chi2=86.742; df=5, n=38, P<0.0001) and for the ventricles (chi2=63.837; df=5, n=35, P<0.0001) compared with the unregistered and registered anatomical images. The subtraction images were also most sensitive for detecting signal intensity changes irrespective of the direction of change. CONCLUSION: Rigid body subvoxel registration can be successfully performed with both multislice 2D and 3D imaging. In principle, virtually all forms of clinical MR images of the brain can be accurately registered and subtracted.


Assuntos
Neoplasias Encefálicas/diagnóstico , Glioma/diagnóstico , Imageamento por Ressonância Magnética/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
13.
J Clin Oncol ; 20(7): 1838-44, 2002 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-11919242

RESUMO

PURPOSE: We have simplified the treatment of gestational trophoblastic disease (GTD) in order to reduce the number of patients exposed to potentially carcinogenic chemotherapy. Patients who score 0 to 8 on the Charing Cross scoring system are classified as low-risk and receive methotrexate (MTX) and folinic acid (FA), whereas those who score higher than 8 are classified as high-risk and receive the etoposide, methotrexate, and dactinomycin (EMA)/cyclophosphamide and vincristine (CO) regimen. PATIENTS AND METHODS: Between 1992 and 2000, 485 women with GTD were commenced on MTX/FA at Charing Cross Hospital, London, United Kingdom. If patients developed MTX resistance or toxicity, treatment was altered according to the level of beta human chorionic gonadotropin (hCG). If serum hCG was < or = 100 IU/L, patients received dactinomycin; if hCG was greater than 100 IU/L, patients received EMA/CO. RESULTS: The median duration of follow-up was 4.7 years. Overall survival was 100% and the relapse rate was 3.3% (16 of 485 patients). hCG values normalized in 324 (66.8%) of 485 patients with MTX alone, whereas 161 (33.2%) of 485 patients required a change in treatment, 11 because of MTX toxicity and 150 because of MTX resistance. Sixty-seven patients changed to dactinomycin, of whom 58 achieved normal hCG values, and nine required third-line chemotherapy with EMA/CO. hCG values normalized in 93 (98.9%) of 94 patients who changed directly to EMA/CO from MTX. CONCLUSION: Single-agent dactinomycin has activity in patients with low-risk GTD who develop MTX resistance and whose hCG is low. Simplifying the stratification of GTD into two classes (low- and high-risk) does not compromise overall outcome and may reduce the risk of second tumors.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Gonadotropina Coriônica/sangue , Neoplasias Trofoblásticas/tratamento farmacológico , Neoplasias Uterinas/tratamento farmacológico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos Clínicos , Ciclofosfamida/administração & dosagem , Dactinomicina/administração & dosagem , Esquema de Medicação , Etoposídeo/administração & dosagem , Feminino , Seguimentos , Humanos , Leucovorina/administração & dosagem , Metotrexato/administração & dosagem , Gravidez , Risco , Análise de Sobrevida , Resultado do Tratamento , Neoplasias Trofoblásticas/sangue , Neoplasias Uterinas/sangue , Vincristina/administração & dosagem
14.
Br J Cancer ; 86(1): 26-30, 2002 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-11857007

RESUMO

Little literature exists on the safety of early pregnancy following chemotherapy. Here we assess the rate of relapse and foetal outcome in women who have completed single and multi-agent chemotherapy for gestational trophoblastic tumours. The records of 1532 patients treated for persistent gestational trophoblastic tumours at Charing Cross Hospital between 1969 and 1998 were reviewed. Patients were defined as receiving single agent or multi-agent treatment. Relapse rates and foetal outcome were reviewed in the 230 patients who became pregnant within 12 months of completing chemotherapy. In the single agent group 153 (22%) of 691 patients conceived early. Three subsequently relapsed. In the multi-agent group, 77 (10%) of 779 patients conceived early, two then relapsed. Relapse rates were 2% (3 out of 153) and 2.5% (2 out of 77) for each group compared to 5% and 5.6% in the comparative non-pregnant groups. Outcomes of 230 early pregnancies: 164 (71%) delivered at full term, 35 (15%) terminations, 26 (11%) spontaneous abortions, three (1.3%) new hydatidiform moles and two (1%) stillbirths. Early pregnancies were more common in the single agent group (P<0.001), but spontaneous miscarriages and terminations were more likely to occur in the multi-agent group (P=0.04 and 0.03, respectively). Of the full-term pregnancies, three (1.8%) babies were born with congenital abnormalities. Patients in either group who conceive within 12 months of completing chemotherapy are not at increased risk of relapse. Though, we still advise avoiding pregnancy within 12 months of completing chemotherapy, those that do conceive can be reassured of a likely favourable outcome. DOI: 10.1038/sj/bjc/6600041 www.bjcancer.comCopyright 2002 The Cancer Research Campaign


Assuntos
Neoplasias Trofoblásticas/tratamento farmacológico , Neoplasias Uterinas/tratamento farmacológico , Aborto Espontâneo/etiologia , Adolescente , Adulto , Anormalidades Congênitas/etiologia , Feminino , Morte Fetal/etiologia , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Gravidez , Estudos Retrospectivos , Neoplasias Trofoblásticas/complicações , Neoplasias Uterinas/complicações
15.
Histopathology ; 39(5): 447-54, 2001 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-11737301

RESUMO

AIMS: To describe the clinical and histological features of a series of cases of placentas originally diagnosed as partial moles in which the final diagnosis was that of placental stem villous hydrops, mesenchymal dysplasia or Beckwith-Wiedemann syndrome. METHODS AND RESULTS: We searched a computerized database containing cases of suspected or proven trophoblastic disease examined at the Trophoblastic Disease Unit at Charing Cross Hospital, London, to identify cases in which stem vessel hydrops was present without other histological features of partial mole. For each case, histological sections were examined and the histological features present recorded. There were 15 cases identified. Placental weight was above the 95th centile of the normal for gestation in all cases in which this information was documented. In an additional five cases the placenta was described as 'large'. All cases had marked stem vessel hydropic change with cyst formation and in the majority of cases some terminal villous hydrops was also present. In 13 of the 15 cases there was marked aneurysmal dilatation of stem villous vessels. Nine had focal chorioangiomatoid change and in four of these extramedullary haematopoiesis was focally present in these areas. No excessive trophoblast proliferation was noted in any case and no trophoblastic inclusions typical of partial mole were identified. CONCLUSIONS: This study has identified cases of stem villous hydrops, mesenchymal dysplasia or Beckwith-Wiedemann spectrum in pregnancies initially diagnosed as partial hydatidiform mole in the second half of pregnancy and has highlighted the need for detailed pathological examination and clinicopathological correlation in all such cases.


Assuntos
Mola Hidatiforme/patologia , Placenta/patologia , Neoplasias Uterinas/patologia , Adolescente , Adulto , Síndrome de Beckwith-Wiedemann/patologia , Diagnóstico Diferencial , Feminino , Humanos , Doenças Placentárias/patologia , Gravidez
16.
Clin Chem ; 47(2): 308-15, 2001 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-11159780

RESUMO

BACKGROUND: Patients with trophoblastic diseases produce ordinary and irregular forms of human chorionic gonadotropin (hCG; e.g., nicked hCG, hCG missing the beta-subunit C-terminal segment, hyperglycosylated hCG, and free beta subunit) that are recognized to differing extents by automated immunometric hCG (or hCG beta) assays. This has led to low or false-negative results and misdiagnosis of persistent disease. False-positive hCG immunoreactivity has also been detected, leading to needless therapy for trophoblastic diseases. Here we compare seven commonly used hCG assays. METHODS: Standards for five irregular forms hCG produced in trophoblastic diseases, serum samples from 59 patients with confirmed trophoblastic diseases, and serum samples from 12 women with previous false-positive hCG results (primarily in the Abbott AxSYM assay) were blindly tested by commercial laboratories in the Beckman Access hCG beta, the Abbott AxSYM hCG beta, the Chiron ACS:180 hCG beta, the Baxter Stratus hCG test, the DPC Immulite hCG test, the Serono MAIAclone hCG beta tests, and in the hCG beta RIA. RESULTS: Only the RIA and the DPC appropriately detected the five irregular hCG standards. Only the Beckman, DPC, and Abbott assays gave results similar to the RIA in the patients with confirmed trophoblastic diseases (values within 25% of RIA in 49, 49, and 54 of 59 patients, respectively). For samples that were previously found to produce false-positive hCG results, no false-positive results were detected with the DPC and Chiron tests (5 samples, median <2 IU/L), but up to one-third of samples were false positive (>10 IU/L) in the Beckman (1 of 5), Serono (2 of 9), and Baxter assays (1 of 5), and the hCG beta RIA (3 of 9; median for all assays, <5 IU/L). These samples, which produced false-positive results earlier in the Abbott AxSYM assay, continued to produce high values upon reassessment (median, 81 IU/L). CONCLUSIONS: Of six frequently used hCG immunometric assays, only the DPC detected the five irregular forms of beta hCG, agreed with the RIA, and avoided false-positive results in the samples tested. This assay, and similarly designed assays not tested here, seem appropriate for hCG testing in the diagnosis and management of trophoblastic diseases.


Assuntos
Gonadotropina Coriônica/sangue , Neoplasias Trofoblásticas/diagnóstico , Neoplasias Uterinas/diagnóstico , Coriocarcinoma/diagnóstico , Coriocarcinoma/terapia , Gonadotropina Coriônica Humana Subunidade beta/sangue , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Humanos , Mola Hidatiforme/diagnóstico , Mola Hidatiforme/terapia , Imunoensaio , Gravidez
17.
Med Oncol ; 18(2): 153-7, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11778762

RESUMO

Chylous pleural effusion, or chylothorax, usually results from obstruction to or disruption of the thoracic duct. Malignant etiologies are the most common cause of chylothorax, lymphoma accounting for the majority of non-traumatic chylous effusions. We report an unusual case of bilateral chylothorax associated with a retrosternal toxic multinodular goiter in a patient with non-Hodgkin's lymphoma. An ablative dose of 131I was administered with apparent initial clinical improvement. The pathogenesis of chylothorax and therapeutic considerations are discussed.


Assuntos
Quilotórax/etiologia , Bócio Nodular/complicações , Bócio Nodular/etiologia , Linfoma não Hodgkin/complicações , Idoso , Quilotórax/patologia , Feminino , Humanos , Radioisótopos do Iodo/uso terapêutico , Derrame Pleural/etiologia , Esterno/patologia , Resultado do Tratamento
18.
Eur J Cancer ; 36(15): 1925-32, 2000 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11000572

RESUMO

Between 1979 and 1996 303 men with stage I testicular germ cell tumours (120 seminoma and 183 non-seminomatous germ cell tumours (NSGCT)) were enrolled onto a programme of surveillance. In our institutions the frequency of computed tomography (CT) scans is reduced compared with other centres. For all 303 men, the median follow-up is 5.1 years (range: 0.1-21.7 years) and there have only been 3 deaths (1 from disease, 1 from neutropenic sepsis and 1 from secondary leukaemia). 52/183 (28%) patients with NSGCT and 18/120 (15%) patients with seminoma have relapsed. The relapse-free survival at 5 years is 82% for seminoma and 69% for NSGCT (Logrank P=0.004). All men who relapsed, except 1 man with NSGCT, were in the International Germ Cell Cancer Collaborative Group good or intermediate prognosis group at relapse. Half of the seminoma relapses presented with symptoms and 31% of the NSGCT relapses. The remaining relapses were detected serologically or radiologically by the surveillance programme. 5 men (2%) on surveillance, 3 with initial diagnosis of seminoma and 2 with NSGCT, have developed second contralateral testis tumours (all stage I seminomas). In a well motivated centre a policy of surveillance for stage I testicular germ cell tumours (both NSGCT and seminoma) is associated with a low mortality rate (3/303, 1%) and may have the advantage of sparing overtreatment with potentially toxic therapies in this group of young men.


Assuntos
Germinoma/cirurgia , Seminoma/cirurgia , Neoplasias Testiculares/cirurgia , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Criança , Pré-Escolar , Análise Custo-Benefício , Intervalo Livre de Doença , Seguimentos , Germinoma/tratamento farmacológico , Germinoma/patologia , Humanos , Lactente , Masculino , Recidiva Local de Neoplasia/diagnóstico , Segunda Neoplasia Primária/tratamento farmacológico , Orquiectomia/métodos , Avaliação de Programas e Projetos de Saúde , Seminoma/tratamento farmacológico , Seminoma/patologia , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/patologia
19.
Lancet ; 356(9223): 36-9, 2000 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-10892763

RESUMO

BACKGROUND: Partial hydatidiform moles (PMs) rarely require chemotherapy and have never previously been proven to transform into choriocarcinoma, the most malignant form of gestational trophoblastic disease (GTD). Consequently, some have questioned whether women with PMs need human chorionic gonadotropin (hCG) follow-up. Here, we investigate whether PMs can transform into choriocarcinomas. METHODS: Patients with a PM who developed a subsequent choriocarcinoma were identified from our GTD database. The histology of both PM and ensuing choriocarcinoma was reviewed and flow cytometry used to verify the triploid status of the PMs. To determine whether the choriocarcinoma arose from the PM, DNA from the PM and choriocarcinoma in each patient was compared using microsatellite polymorphisms. FINDINGS: Of the 3000 patients with PM, 15 required chemotherapy for persisting GTD. This was identified as choriocarcinoma in three cases. In one patient, the local pathologist could not differentiate between a PM or a hydropic abortion and neither central histological review nor hCG follow-up were obtained. This patient nearly died before the diagnosis of choriocarcinoma was made. Fortunately, the local pathologists correctly diagnosed PM in the two other patients who were then registered for hCG follow-up. Some months later, the hCG was rising and repeat uterine evacuation revealed choriocarcinoma. The PM was confirmed to be triploid in all three cases and genetic analysis showed that the subsequent choriocarcinomas contained identical single maternal and two paternal alleles at several independent loci. INTERPRETATION: Our results show that PMs can transform into choriocarcinoma. All patients with suspected PM should be reviewed centrally and, if confirmed, need hCG follow-up.


Assuntos
Transformação Celular Neoplásica/patologia , Coriocarcinoma/diagnóstico , Mola Hidatiforme/diagnóstico , Neoplasias Uterinas/diagnóstico , Adulto , Alelos , Coriocarcinoma/terapia , Gonadotropina Coriônica/sangue , Feminino , Citometria de Fluxo , Humanos , Mola Hidatiforme/terapia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/terapia , Masculino , Repetições de Microssatélites , Poliploidia , Gravidez , Neoplasias Uterinas/terapia
20.
J Pathol ; 191(1): 67-70, 2000 May.
Artigo em Inglês | MEDLINE | ID: mdl-10767721

RESUMO

The purpose of this study was to determine whether amniotic tissue found associated with cases of complete hydatidiform mole (CM) was genetically identical to the CM, and therefore part of the molar pregnancy, or genetically dissimilar to the CM, suggesting derivation from a twin pregnancy. DNA was prepared from formalin-fixed, paraffin-embedded blocks of tissue containing both CM and amnion. Maternal DNA was prepared from decidual tissue in the same blocks, or from a maternal blood sample. Fluorescent microsatellite genotyping was carried out to determine the origin of both the CM and the amniotic tissue. In one of six cases examined, the amniotic tissue was genetically different from the CM and was therefore likely to be derived from a twin pregnancy. In the five remaining cases, the amniotic tissue was genetically identical to the CM and was likely to be derived from the same conceptus. It is concluded that androgenetic CM can support the development of amniotic tissue and that some early embryonic development may occur in CM. The presence of amnion, or other fetal tissues, associated with molar tissue should not therefore always be considered indicative of a diagnosis of partial mole (PM).


Assuntos
Âmnio/patologia , Mola Hidatiforme/genética , Mola Hidatiforme/patologia , Gravidez Múltipla , Alelos , Feminino , Genótipo , Humanos , Repetições de Microssatélites , Reação em Cadeia da Polimerase , Polimorfismo Genético , Gravidez
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