Time-dependent changes of plasma ribonuclease activity in female Wistar rats under combination therapy of ovarian carcinoma.

Determinations of plasma ribonuclease were recommended in 1977 by Sheid et al. for laboratory diagnosis of ovarian carcinoma. We investigated the turnover of transfer ribonucleic acid (tRNA) as the substrate of the enzyme in healthy female inbred rats under the multistep-massive dose therapy of ovarian carcinoma usual at the Department of Gynecology, University of Giessen. Whereas mitopodozide, percutaneous irradiation of the abdomen and teniposide did not have any detectable influence on the enzyme activity, the enzyme was strongly suppressed by the other therapy steps: minima of tRNA turnover were observed on the 2nd day with adriamycine, on the 4th day with methotrexate and methotrexate/folinic acid, on the 6th day with cyclophosphamide and fractionated percutaneous irradiation with cyclophosphamide medication in the intervening periods. According to the results, a plasma ribonuclease determination to check the result of therapy should only be performed at an interval of 2 weeks after each therapy step.

Radio-chemotherapeutic treatment of advanced ovarian cancer.

BACKGROUND: The role of irradiation seems to be not very important in the post-operative treatment of cancer of the ovaries compared to chemotherapy although it has proved to be highly effective. MATERIALS AND METHODS: In a retrospective study 37 patients with advanced cancer of the ovaries Stages IIIb and IIIc (FIGO) undergoing post-operative consecutive radio-chemotherapy consisting of two series of whole abdominal radiation (WAR) applied in sandwich technique with 6 courses of cisplatin-epirubicin-cyclophosphamide (PEC) were evaluated. For the effectiveness of WAR and PEC-chemotherapy changes of CA 125 serum levels were noted. RESULTS: Both WAR and PEC-chemotherapy proved to be effective in 50.5% of the patients, either WAR and PEC-chemotherapy were effective in 16.2% neither one affected the course of disease in 8.1%. Statistical analysis shows a good correlation between the effectiveness of WAR and survival but no such correlation as to the effectiveness of PEC-chemotherapy. CONCLUSION: The role of irradiation in the treatment of ovarian cancer is underestimated. The addition of WAR at the beginning of the post-operative treatment can prolong the survival time in advanced stages of ovarian cancer.

Primary cancer of the fallopian tube. Treatment and results of 37 cases.

OBJECTIVE: A collective of 37 patients with primary cancer of the fallopian tube treated at the Gynecologic Clinic of the Justus Liebig University of Giessen, between 1976 and 1995 was retrospectively evaluated for stage, histo-pathology, treatment and results. PATIENTS: Median age was 61.5 years, FIGO stages: I 17 (45.9%), II 7 (18.9%,. III 12 (32.4%), and IV 1 (2.7%). Histopathology: adenocarcinoma 45.9%, papillary adenocarcinoma 27%, solid carcinoma 8.1%, undifferentiated carcinoma 5.4%, and others 13.6%. TREATMENT: 24 patients (64.9%) underwent complete bilateral salpingo-oophorectomy and hysterectomy (BSOH); 13 (35.1%) had incomplete surgery. POSTOPERATIVE TREATMENT: 31 patients (83.8%) had chemotherapy (since 1982 with platinum), 28 (75.7%) intraperitoneal radionuclides, 23 (62.2%) percutaneous irradiation, and 6 (16.2%) additional vaginal brachytherapy. RESULTS: The cumulative survival rates were 40% for the total of 37 patients, stage I 68%, stage II 29%, stage III 10%, stage IV 0%. From 1976 to 1985 the cumulative survival rate was 25%, from 1986 to 1995, 54%. Stage was a significant prognostic factor (p = 0.0001), surgery, age, chemotherapy and irradiation were not. Severe complications occurred in 7 patients (18.9%): 4 fistulas, 1 myelosuppression, 1 ileus, 1 peritonitis. CONCLUSION: Due to the long period of time and alterations in the mode of treatment the benefit of single treatment modalities could not be evaluated, but prognosis-dependent multimodality treatment (radical surgery, irradiation, platinum-containing chemotherapy) has resulted in higher 5-year survival rates for the last decade.

[Significance of determination of squamous cell carcinoma antigen in the follow up of patients with cancer of the uterine cervix]. / Squamosus sejtes carcinoma antigén vizsgálatának jelentösége cervix carcinomás betegek ellenörzése során.

The serum concentrations of squamous cell carcinoma antigen (SCC) were determined in 59 patients with invasive carcinoma of the uterine cervix, in 21 patients with benign cervical diseases. Pretherapeutic SCC levels were elevated (> 2.5 ng/ml) in 63% (34/54) of the patients with squamous cervical carcinoma. 5 patients with adenomatosus cervical carcinoma had not elevated levels. In 21 patients with benign cervical diseases, 4.8% (1/21) of SCC values were above the normal range. There were no correlation of SCC levels and the degree of the histological differentiation or clinical stages. Serial SCC determinations revealed a correlation with the clinical course of disease in 72.2% (26/36) with squamous cervical carcinoma. Rising levels were always associated with progression. The SCC level increased before clinical signs of progression with a median lead time of 3 months. Patients with cervical adenocarcinoma for follow up CA 125 determination was recommended. The determination of SCC is a useful tool checking the patients, detecting early progression of squamous cervical tumor.

[Ovarian carcinoma antigen (CA 125) and ovarian cancer (clinical follow-up and prognostic studies)]. / Ovarium carcinoma antigén (CA 125) és a petefészekrák. (Klinikai ellenörzö és prognosztikai vizsgálatok).

Serum concentrations of ovarian carcinoma antigen (CA 125) were determined by Abbot CA 125-EIA Monoclonal kit from 66 patients with malignant ovarian tumor. The preoperative serum levels of CA 125 were elevated (> 35.0 IU/ml) in 93% (27/29). After the laparotomy and before the irradiation or chemotherapy in 36% (24/36) of patients had elevated levels. No significant correlation was seen between elevated levels and histology, tumor grade and clinical stage. However, the rate of positive cases were significantly higher in advanced stages than in the 1st stage (p < 0.05). No significant correlation was found between the preoperative levels of CA 125 and the clinical course. The postoperative elevated levels indicated bad prognosis. Good conformity was found between CA 125 levels and the therapy response. Serological follow up revealed a correlation with the clinical course of ovarian carcinoma in 84% (44/52). In patients with tumor progression the CA 125 levels increased before clinical signs of progression with median lead time of 97 days. The second look laparotomy proved, that residual tumor larger than 2 cm of diameter cause elevated levels. Smaller tumors remained marker negatives. CA 125 determination before operation, during and after therapy provide a useful tool in detecting progression and persistence of ovarian carcinoma.

Adjuvant radiotherapy in carcinomas of the uterine cervix: the prognostic value of hemoglobin levels.

Anemia has been associated with a poorer treatment response and reduced survival in women undergoing primary radiotherapy (RT) or radiochemotherapy for advanced cervical carcinoma. This study aimed to determine the influence of anemia on outcome in patients with cervical carcinoma undergoing adjuvant RT. Medical records were reviewed for 183 cervical cancer patients who had received adjuvant RT because of risk factors after radical surgery (n= 109) or inadequate primary surgery (simple hysterectomy; n= 74). Kaplan-Meier and Cox regression analyses were used to study hemoglobin levels before and during adjuvant RT in relation to recurrence-free and overall survival. Hemoglobin values > or =11 g/dL were considered normal, while those <11 g/dL indicated anemia. Hemoglobin levels before RT influenced significantly overall survival and recurrence-free survival across the whole group (overall survival--log rank(all patients)= 7.5; df = 1; P= 0.006). However, subgroup analysis showed that the observed difference was mainly due to the group of women who had undergone inadequate primary surgery (overall survival--log rank(inadequate surgery)= 10.8; df = 1; P= 0.001). Multifactorial regression analyses comparing hemoglobin before RT with grading and tumor stage confirmed the prognostic value of hemoglobin values. Maintaining normal hemoglobin values before and during adjuvant RT seems to be important, especially in patients who have had inappropriate simple hysterectomy, which may resemble a therapeutic situation.

[The value of ossovenography in advanced female genital carcinoma. A contribution to diagnosis of combined obstructive edema (author's transl)]. / Der Wert der Ossovenographie beim fortgeschrittenen Genitalkarzinom der Frau. Ein Beitrag zur Diagnose des kombinierten Stauungsödems

The pertrochanteric ossovenography brought important results on the etiology of combined obstructive edema of the lower limb after genital carcinoma. Its advantage in comparison with other methods of phlebography is the lack of embolic danger for the patient, its suitability even in thrombosis of the V. femoralis and the optimal contrast staining of venous system and anastomoses. The combined obstructive edema is characterized by a block of pelvic veins and a complete or incomplete block of lymph vessels. The combined obstructive edema depends only on the venous block as is demonstrated. A report on therapy and prognosis of 30 cases is given.

[After care of ovarian carcinoma from gynecologic viewpoint]. / Die Nachsorge des Ovarialkarzinoms aus gynäkologischer Sicht. Referat auf Einladung auf dem 63. Röntgenkongress 20. bis 23.5 1982 in Berlin.

A co-operation between the different institutions and doctors and the tumor centre is indispensable for an adequate follow-up of the ovarial carcinoma. Besides diagnosis and therapy of side effects of the treatment as well as early diagnosis of recurrences, a psychical and social care is particularly necessary. The follow-up treatment aims at a full social rehabilitation of probably cured patients and, in case of incurable patients, at a relief of pain until death. The determination of t-RNA as a reliable tumor marker and the examinations necessary for routine controls (minimal and maximal programme) are indicated.

[Recent trends in the therapy of vaginal carcinoma]. / Neuere Gesichtspunkte in der Therapie des Vaginalkarzinoms.

The presented paper gives a historic review of the change from the contact therapy to the percutaneous irradiation. The dominating role of radiotherapy compared to surgery is pointed out. With the help of therapeutic planning in Giessen an aimed pendulum irradiation, a high-volume percutaneous irradiation, a modern high-intensity afterloading system (Buchler), and an interstitial therapy are reported. Recently published important cure rates are shown in a table. The 5-year survival rate of 78 patients in Giessen from 1957-1975 was 42.3%. The discussion concentrates on the tolerance dose of the vagina according to the different dose rates and fractionations.

[Radioactive gold treatment of primary carcinoma of the fallopian tube (author's transl)]. / Die Radiogoldtherapie des primären Tubenkarzinoms

20 cases of primary carcinoma of the fallopian tube from 1958 to 1974 are reported. An operation was performed in all cases. A post-operative intra-peritoneal installation of radioactive gold was done in 14 cases. 6 patients which had radioactive gold treatment survived for more than 5 years. None of the patients survived for more than 5 years who did not have radioactive gold treatment. The positive effect on treatment of carcinoma of the fallopian tube of a complete operation with post-operative intra-peritoneal administration of radioactive gold is discussed in detail.

[The optimal diagnosis of recurrence and metastases in female genital cancer by needle biopsy (author's transl)]. / Optimale Rezidiv- und Metastasendiagnostik beim Genitalkarzinom durch eine Stanzbiopsietechnik

The "true-cut" disposable biopsy needle was used for 95 needle biopsies in 42 patients who were suspected to have a recurrence or metastases of low lying gynaecological cancer. Up to 3 biopsies per patient were obtained. In 21 patients the clinical suspicion of malignant was verified by microscopic examination. The needle biopsies were done as often by the vaginal as by the rectal route. Because of the low incidence of complications the needle biopsy was recommended for the definite diagnosis and follow-up examination of suspicious low lying gynaecological tumors.

[Infantile and hypoplastic uterus: a contribution to overcome the confusion of terms (author's transl)]. / Infantiler und hypoplastischer Uterus. Ein Beitrag zur überwindung einer Begriffsverwirrung

The confusion of terms between the radiological literature and the gynaecological and anatomical literature regarding the definitions of the infantile and the hypoplastic uterus are described. The history of this confusion is traced. The two types of uterus were clearly defined by K. Menge and K.v. Oettingen in 1930. The infantile uterus shows an abnormal relationship between the length of the cervix and the length of the uterine cavity of 1:1 or 2:1, whereas the hypoplastic uterus shows a normal relationship between the length of the cervix and the length of the uterine cavity of approximately 1:2.

[Healing results of pseudomucinous ovarian carcinoma depending on therapy]. / Heilungsergebnisse beim Carcinoma pseudomucinosum ovarii in Abhängigkeit von der Therapie

A report is given on 57 patients with pseudomucinous ovarian carcinomas. The prognosis of the disease depends on two decisive factors, if the FIGO stages are not taken into consideration: 1. the operation which should be executed as radically as possible, 2. the intraperitoneal instillation of radiogold which shall be repeated two times. The following therapeutic results were realized under this treatment: a five-year survival rate of 76,9% and a ten-year survival rate of 72.7%. There were no serious side-effects of the radiogold therapy since the introduction of routine peritoneographies before instillation of 198Au.

[Experiences with enterally and parenterally applied leucovorin following therapy with high doses of methotrexate in malignant tumors (author's transl)]. / Enterale und parenterale Leucovorin-Medikation nach Methotrexat-Stossbehandlung maligner Tumoren

45 patients (43 ovarian carcinoma and 2 chorionepithelioma) were treated with high doses of methotrexate and intramuscularly application of leucovorin according to Mathé et al. In comparison a group of 19 patients (ovarian carcinoma only) was treated with methotrexate and leucovorin-tablets. The toxic effects on leucocytes and platelets were equal in both groups. Due to slightly different doses of leucovorin in both groups an enteral resorption rate of more than 90 p.c. is calculated. Because of the simple way of application the suggested high-dose therapy with methotrexate and leucovorin-tablets seems to be most convenient in the moment.

[The diagnosis and removal of obscure intrauterine devices (author's transl)]. / Zur Diagnostik und Entfernung okkulter Intrauterinpessare

When the thread of an intrauterine device cannot be seen in the cervical canal a diagnostic procedure to insure continued contraceptive effectiveness is mandatory. Hysteroscopy is the method of choice for localization of an intrauterine device even during pregnancy. Hysteroscopic removal is possible even during pregnancy. With this method we removed 16 obscure intrauterine devices and 7 devices during pregnancy. The advantages and disadvantages of other diagnostic and therapeutic methods are discussed.

PIP: When the thread of an IUD cannot be seen in the cervical canal, a diagnostic procedure to insure continued contraceptive effectiveness is mandatory. Hysteroscopy is the method of choice for localization of an IUD even during pregnancy. Hysteroscopic removal is possible during pregnancy. With this method, 16 obscure IUDs were removed, and 7 devices during pregnancy. The advantages and disadvantages of other diagnostic and therapeutic methods are discussed.

[Preliminary report on the treatment of ovarian cancer with adriamycin following full conventional treatment (author's transl)]. / Vorläufige Erfahrungen mit Adriamycin bei der Therapie ausbehandelter Ovarialkarzinome

In 22 cases with advanced ovarian cancer, chemotherapy with Adriamycin was employed. All patients had previous operation, triple drug pulsechemotherapy, intraperitoneal radioactive gold instillations and external radiation. A remission was achieved in 36.4% of the patients. The side effects and complication of treatment with Adriamycin are reported and discussed.

[The prognosis of female genital sarcomas of the adult woman with special reference to sarcomas of the uterine corpus (author's transl)]. / Zur Prognose der Genitalsarkome bei der erwachsenen Frau unter besonderer Berücksichtigung der Sarkome des Corpus uteri

Report on 88 cases of sarcomas of the female genital organs. The sarcomas were confined to the uterine body in 72 cases. The prognosis of this disease depends primarily on the adequacy of the treatment. The treatment consists of as radical an operation as possible followed by external radiation and intra-vaginal application of radium. The microscopic type of the sarcoma of the uterus is of secondary importance. Patients who survived for 3 years following this treatment have a good prognosis for a 5 year or a 10 year cure. Other sarcomas of the female genital tract are mentioned.

[Primary cancer of Bartholin's gland]. / Das primäre Karzinom der Bartholinischen Drüse.

Carcinoma of Bartholin's gland is an extremely rare tumour representing approximately between 1% and 7% of the cases of cancer of the vulva. The aetiology of the tumour, which can be subdivided by means of light microscopy into squamous cell carcinoma, adenocarcinoma, adenoid cystic carcinoma and adenoacanthoma, remains unknown. Surgical and radiotherapeutic treatment is possible also in combination. If primary operative therapy is chosen, inguinal lymphadenectomy is required as usually suggested in all cases of cancer of the vulva; the metastatic involvement of the inguinal lymph nodes is regarded as the main prognostic determinant: if only one inguinal node has microscopic metastases, a five-year survival rate between 60% and 70% can be achieved in a selected operative group of patients. If more than four positive groin nodes are histologically diagnosed the survival rate - according to current results, not subdivided into different alternatives of therapy - is below 20%.

[Hysterography with afterloading-applicator in place. A simple method for improving the treatment planning of uterine cancer]. / Die Hysterographie bei liegendem Afterloading-Applikator. Eine einfache Methode zur Verbesserung der Bestrahlungsplanung des Korpuskarzinoms.

Anatomical configurations often are an obstacle to a convenient dose-distribution in intracavitary afterloading irradiation. Multiple applicators (splay applicators, twin applicators) cannot be introduced in all cases because of the necessary cervix dilatation. In several cases can be demonstrated, that a defined intracavitary irradiation is possible only by hysterographic control of the intrauterine position of the applicator. By this control generally a mono-applicator is sufficient, which can be placed according the anatomy of the uterine cavity in each session. For this purpose a simple hysterographic method with applicator in position is demonstrated, which requires only few additional effort during intracavitary irradiation.