Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 28
Filtrar
1.
J Clin Oncol ; 15(4): 1309-17, 1997 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-9193322

RESUMO

PURPOSE: To examine the prognostic factors associated with prolonged progression-free survival (PFS) and overall survival (OS) in 100 consecutively treated women undergoing autologous stem-cell transplant for advanced ovarian cancer. PATIENTS AND METHODS: From October 1989 to February 1996, we transplanted 100 patients with ovarian cancer following chemotherapy with high-dose carboplatin, mitoxantrone, and cyclophosphamide with or without cyclosporine (n = 70); melphalan and mitoxantrone with or without paclitaxel (n = 25); or other regimens (n = 5). Their median age was 48 years (range, 23 to 65), 70% had papillary serous histology, 72% had grade III tumors, 66% were platinum-resistant, and 61% had > or = 1 cm bulk. The median number of prior regimens was two (range, one to six). Univariate and multivariate analyses were performed to examine age (< v > or = mean), stage, initial bulk, histology, grade, response to initial therapy, number of prior regimens, time from diagnosis to transplant, transplant regimen, platinum sensitivity, and bulk (< v > or = 1 cm) at transplant. RESULTS: The median PFS and OS times for the 100 patients were 7 and 13 months. A stepwise Cox proportional hazards model identified tumor bulk (P = .0001), and cisplatin sensitivity (P = .0249) as the best predictors of PFS. Age (P = .0017), bulk at transplant (P = .0175), and platinum sensitivity (P = .0330) provided the best prediction of OS. The median PFS and OS times for the 20 patients with platinum-sensitive, < or = 1-cm disease were 19 and 30 months. No differences in OS were seen when chemotherapy or surgery was used to achieve a minimal disease state. CONCLUSION: Before consideration of high-dose therapy for recurrent/persistent advanced ovarian cancer, patients should undergo debulking surgery or chemotherapy to achieve a minimal disease state. Patients with platinum-resistant, bulky disease should not be transplanted. The optimal patients for this therapy may be those with minimal disease responsive to initial chemotherapy.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Carcinoma/terapia , Transplante de Células-Tronco Hematopoéticas , Neoplasias Ovarianas/terapia , Adulto , Análise de Variância , Área Sob a Curva , Carcinoma/tratamento farmacológico , Carcinoma/patologia , Estudos de Coortes , Terapia Combinada , Análise Fatorial , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/patologia , Prognóstico , Reoperação , Análise de Sobrevida , Resultado do Tratamento
2.
Clin Cancer Res ; 7(3 Suppl): 876s-881s, 2001 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11300486

RESUMO

Therapeutic human papillomavirus (HPV) vaccines for cervical cancer depend on a competent immune system to be effective. However, cancer patients are often found to be immunosuppressed, which could be attributable to prior radiation, chemotherapy, or the tumor burden itself. This study investigated whether pelvic radiation or cisplatin treatment affected the efficacy of an HPV vaccine and how long these effects lasted. Mice were given pelvic radiation, 2 Gy/day to a total dose of 45 Gy, or 5 mg/kg/week of cisplatin for 3 weeks. Mice were then immunized with an HPV-16 peptide vaccine between 0 and 16 weeks after their treatment. An ELISPOT analysis revealed that a reduced level of peptide-specific, IFNgamma-producing spleen cells was present in immunized mice treated previously with pelvic radiation or cisplatin compared with immunized mice that had not been treated. However, when mice were challenged with HPV-16-expressing tumor cells, immunized mice developed no tumors, regardless of prior treatment, whereas nonimmunized mice did develop tumors. Our results suggest that pretreatment with pelvic radiation or cisplatin alone does not prevent the induction of an effective immune response by a peptide vaccine. These data will have important implications for immunotherapeutic treatment of pretreated cancer patients, especially in the adjuvant setting when immunosuppression by tumor burden would be low.


Assuntos
Vacinas Anticâncer , Cisplatino/efeitos adversos , Neoplasias/prevenção & controle , Papillomaviridae/metabolismo , Vacinas contra Papillomavirus , Radioterapia/efeitos adversos , Animais , Antineoplásicos/farmacologia , Relação Dose-Resposta a Droga , Relação Dose-Resposta à Radiação , Camundongos , Camundongos Endogâmicos C57BL , Proteínas Oncogênicas Virais/química , Proteínas Oncogênicas Virais/imunologia , Proteínas E7 de Papillomavirus , Peptídeos/química , Peptídeos/metabolismo , Radiossensibilizantes/farmacologia , Fatores de Tempo
3.
Clin Cancer Res ; 2(11): 1825-8, 1996 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-9816136

RESUMO

An impaired immune response is frequently observed in patients and experimental animals with advanced cancer. We and others have shown alterations in CD3-associated signal-transducing zeta molecules in tumor-infiltrating T cells and peripheral blood lymphocytes (PBLs) of patients with advanced cancer. By using flow cytometric analysis of permeabilized cells with a monoclonal antibody (TIA-2) that reacts with the cytoplasmic domain of the zeta chain, here we demonstrate a marked decrease (P < 0.01) in the expression of the signal-transducing CD3 zeta chain of PBLs in patients with cervical cancer (n = 22) as compared to PBLs from healthy donors (n = 21). In addition, PBLs isolated from patients (n = 23) with cervical intraepithelial neoplasia (CIN), to a lesser but significant (P < 0. 01) extent, expressed reduced CD3 zeta levels as compared to those from healthy donors. This decreased expression of zeta chains was also observed on CD16(+) natural killer cells in PBLs from patients with cervical cancer. Surface expression of CD3 epsilon on PBLs was also decreased in cervical cancer patients as compared to healthy donors, but not on PBLs from patients with CIN. CD3 zeta chain expression significantly (r = 0.53, P < 0.01) correlated with the ability of the PBLs to produce tumor necrosis factor in response to anti-CD3 stimulation. These findings suggest that alterations of signal-transducing zeta molecules commonly occur in patients with cervical cancer and to a lesser extent with CIN, and that they are associated with reduced cellular functions such as production of tumor necrosis factor.


Assuntos
Complexo CD3/metabolismo , Células Matadoras Naturais/metabolismo , Linfócitos T/metabolismo , Neoplasias do Colo do Útero/imunologia , Anticorpos Monoclonais/imunologia , Complexo CD3/imunologia , Feminino , Humanos , Linfócitos do Interstício Tumoral/metabolismo , Receptores de Antígenos de Linfócitos T/metabolismo , Receptores de IgG/metabolismo , Transdução de Sinais , Fator de Necrose Tumoral alfa/metabolismo
4.
Obstet Gynecol ; 78(1): 77-9, 1991 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-2047072

RESUMO

The complications of radical hysterectomy in patients 65 years and older were compared with those in women younger than 65. There was no statistical difference in complication rates between the two groups, although the older women had a significantly higher incidence of preoperative medical problems. No surgical deaths occurred in either group. Our data indicate that selected older women can tolerate radical hysterectomy as well as younger ones.


Assuntos
Histerectomia/efeitos adversos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Histerectomia/métodos , Complicações Pós-Operatórias/epidemiologia
5.
Arch Surg ; 121(11): 1262-4, 1986 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-3778198

RESUMO

The role of restaging laparotomy in the treatment of ovarian carcinoma is currently being reevaluated. This study was initiated to examine the predictive value of a negative outcome. Between November 1974 and October 1983, sixty-three patients with no clinical evidence of disease underwent 70 restaging laparotomies for ovarian carcinoma. The findings of 34 (49%) of these procedures were negative for residual disease. Patient follow-up ranged from 30 to 137 months. Twenty-eight patients are alive with no evidence of disease with a median follow-up of 62 months. Four patients have died of a second primary tumor. Only two patients had recurrence of their ovarian carcinoma following restaging laparotomy with negative findings (recurrence rate, 5.9%; 13.3% for patients with advanced disease). Patients with negative findings at restaging laparotomy have an excellent prognosis and a good chance of being cured of their disease.


Assuntos
Recidiva Local de Neoplasia/diagnóstico , Neoplasias Ovarianas/diagnóstico , Adulto , Idoso , Feminino , Seguimentos , Humanos , Laparotomia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/patologia , Prognóstico , Reoperação
6.
Am J Clin Oncol ; 17(6): 490-3, 1994 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-7977166

RESUMO

5-Fluorouracil (5-FU) is an antimetabolite chemotherapy, which selectively functions at the S phase of the cell cycle. It is a short-acting agent with a serum half-life of approximately 11 minutes. Increased efficacy with this drug could theoretically be provided by sustained infusion over the doubling time of a tumor. Ovarian cancer that recurs or persists after treatment with platinum-based chemotherapy has a poor prognosis. This study examines the use of long-term infusional 5-FU as a salvage chemotherapy for ovarian cancer. 14 patients with epithelial ovarian cancer were studied. All were stage III or IV disease and all were initially treated with platinum-based chemotherapy with either persistence or recurrence of disease. Patients received 5-FU as 300 mg/m2/day via a continuous infusion for a 10-week cycle with discontinuation occurring for severe toxicity or documented progression. The average infusion per patient was 8 weeks (3-10). Three patients had drug discontinued secondary to toxicity (severe mucositis) and 4 patients had progression prior to the completion of 10 weeks. All patients had progression by the end of the first cycle. The average survival post-5-FU was 8.9 months (range: 0.75-22 months). The lack of response in 14 patients indicates that, statistically, the likelihood of an overall response rate of 20% is less than 0.05. Infusional 5-FU appears to be ineffective as salvage therapy for ovarian cancer.


Assuntos
Fluoruracila/uso terapêutico , Neoplasias Ovarianas/tratamento farmacológico , Terapia de Salvação , Adulto , Idoso , Esquema de Medicação , Feminino , Fluoruracila/administração & dosagem , Humanos , Infusões Intravenosas , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Sobrevida
7.
J Reprod Med ; 38(2): 137-41, 1993 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-8445606

RESUMO

Colonic surgery is a critical part of gynecologic oncology care. A 12-year review of colonic surgery on a gynecologic oncology service was performed evaluating risk factors and their impact on postoperative morbidity. There were 124 procedures performed on 92 patients; 9 patients had no prior surgery, chemotherapy or radiation. Fifty-six percent of the patients were considered malnourished on the basis of a serum albumin level < 3.5 g/dL. The 124 procedures consisted of 57 colon resections with primary reanastomosis, 10 small bowel-colon bypass procedures and 57 colostomies. Of the 57 (67%) colostomy operations, 38 also had concomitant abdominal-pelvic procedures. There were 15 major bowel complications and 17 major systemic postoperative complications. Prior surgery and poor nutritional status significantly correlated with postoperative morbidity; however, prior radiation did not reveal an increased risk for postoperative complications.


Assuntos
Colo/cirurgia , Neoplasias dos Genitais Femininos/complicações , Complicações Pós-Operatórias , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Doenças do Colo/complicações , Doenças do Colo/cirurgia , Colostomia , Feminino , Humanos , Pessoa de Meia-Idade , Estado Nutricional , Estudos Retrospectivos , Fatores de Risco
8.
J Reprod Med ; 35(11): 1019-22, 1990 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-2177507

RESUMO

A study of 37 women with typical condylomas and so-called squamous micropapilloma was undertaken to determine their response to systemic interferon and/or podophyllin treatment. Thirty lesions were classified as condylomas and 9 as squamous micropapillomas; two women had both lesions. Twenty-six (87%) of 30 condylomas responded, whereas only 1 (11%) of the 9 cases of micropapillomatosis showed a partial response (P less than .001) to podophyllin and/or interferon. Twenty-six biopsies from condylomas in which sufficient DNA was available for analysis contained human papillomavirus (HPV) DNA sequences that hybridized to an HPV 6 + 16 probe mix under nonstringent conditions. In contrast, HPV DNA sequences could not be detected in any of the nine cases of micropapillomatosis. Immunoperoxidase studies performed on these lesions failed to demonstrate viral capsid antigen. Thus, despite certain similarities in the clinical presentation and microscopic features of condylomas and squamous micropapillomas, it is not clear at present whether micropapillomas are HPV-related lesions.


Assuntos
Condiloma Acuminado/terapia , Interferon Tipo I/uso terapêutico , Papiloma/terapia , Podofilina/uso terapêutico , Neoplasias Vulvares/terapia , Condiloma Acuminado/microbiologia , DNA Viral/análise , Quimioterapia Combinada , Feminino , Humanos , Recidiva Local de Neoplasia/terapia , Papiloma/microbiologia , Papillomaviridae/isolamento & purificação , Neoplasias Vulvares/microbiologia
9.
Gynecol Oncol ; 96(3): 701-4, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15721414

RESUMO

OBJECTIVES: Assess the role of involved field radiation therapy (IFRT) in recurrent ovarian cancer. METHODS: Thirty-five patients with a diagnosis of epithelial ovarian cancer received radiation therapy at LUMC between 1991 and 2001. Of these, 20 received tumor volume-directed IFRT for localized extraperitoneal recurrences (either as consolidation following debulking surgery or as attempted salvage if unresectable) and form the basis of this report. All patients were heavily pretreated with multiple chemotherapy regimens. Eleven patients had optimal debulking of their recurrences prior to radiation. IFRT was primarily with external beam (median dose 50.4 Gy). Appropriate statistical analyses evaluated association among disease-free (DFS), overall survival (OS), local recurrence-free (LRFS), and various prognostic factors. LRFS was defined as freedom from in-field recurrences and was considered as a measure of effectiveness of radiotherapy. RESULTS: Of 20 patients, 17 had a complete response after RT. The actuarial LRFS, OS, and DFS at 5 years from date of radiation were 66%, 34%, and 34%, respectively. The LRFS at 3 years was 89% for those with optimal resection vs. 42% for those with gross residual/unresectable tumor, which was significantly better (P = 0.04). The corresponding 3-year DFS was 72% vs. 22% and 5-year OS was 50% vs. 19%, respectively. Acute complication of RT was mild, half had Grade 1-2 gastrointestinal (GI) toxicity, three patients had Grade 3-4 late GI effects. CONCLUSION: IFRT is effective in controlling localized recurrences of ovarian cancer, especially after they are optimally debulked (89% local control and 50% 5-year overall survival in this subgroup), and is relatively well tolerated in these heavily pretreated patients.


Assuntos
Recidiva Local de Neoplasia/radioterapia , Neoplasias Ovarianas/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Intervalo Livre de Doença , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/cirurgia , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/cirurgia , Radioterapia/métodos , Estudos Retrospectivos , Taxa de Sobrevida
10.
Cancer ; 75(9): 2286-8, 1995 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-7712438

RESUMO

BACKGROUND: The Gynecologic Oncology Group (GOG) protocol #88 reported an 18.5% failure in inguinal lymph nodes of patients with vulvar cancer whose groins were treated with radiation alone. This high failure rate may be due to the study design. METHODS: In this study, the depths of inguinal lymph nodes were evaluated with computed tomography (CT) scans in 100 adult women without inguinal adenopathy or prior inguinal surgery. The dose that would have been delivered to the inguinal lymph nodes of these patients was determined using isodose curves constructed according to the guidelines in GOG protocol #88. RESULTS: Only 18% of women had all inguinal lymph nodes measured at a depth of 3 cm or less. CONCLUSIONS: More than one-half of all women in this study would have received less than 60% of the prescribed radiation dose because their inguinal lymph nodes were deeper than 5 cm, if the depth of their inguinal lymph nodes had not been measured before therapy.


Assuntos
Canal Inguinal/patologia , Linfonodos/patologia , Planejamento de Assistência ao Paciente , Neoplasias Vulvares/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Canal Inguinal/diagnóstico por imagem , Linfonodos/diagnóstico por imagem , Pessoa de Meia-Idade , Dosagem Radioterapêutica , Radioterapia de Alta Energia , Tomografia Computadorizada por Raios X , Falha de Tratamento
11.
Gynecol Oncol ; 56(2): 191-4, 1995 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-7896184

RESUMO

A surgical technique is presented which combines both the abdominal and vaginal approaches to radical hysterectomy with significant modifications to allow it to be named "retroperitoneal" radical hysterectomy. Small oblique skin incisions are made 1 cm superior to the inguinal ligament exposing the retroperitoneal structures. The round ligament, uterine artery, ovarian vessels, and cardinal ligament are divided without entering the peritoneal cavity. The remainder of the procedure is completed by a modified Schauta technique. Eight patients with Stage I cancer of the cervix underwent this operation. The expected surgery time should be 3 1/2-4 hr once the surgical team becomes familiar with the procedure, with a blood loss similar to that of the Meigs procedure. Patients tolerated the procedure with minimal discomfort. Total hospital days was limited to 4 days or less in all but the first patient. One patient was discharged on the evening of surgery. No significant complications were reported except some degree of bladder atony that required self-catheterization for a short period of time. We believe that this surgical procedure fulfills the principles of a radical abdominal hysterectomy with less operative time and shorter hospital stay, and employs conventional surgical skills.


Assuntos
Histerectomia/métodos , Neoplasias do Colo do Útero/cirurgia , Adulto , Feminino , Humanos , Histerectomia/efeitos adversos , Histerectomia Vaginal/métodos , Pessoa de Meia-Idade , Espaço Retroperitoneal
12.
Am J Obstet Gynecol ; 153(6): 642-5, 1985 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-4061533

RESUMO

The role of subclinical intrauterine infection in preterm labor was evaluated prospectively in 40 patients and appropriate control subjects. The 24 preterm labor patients (60%) with a negative C-reactive protein value responded to tocolysis 95.8% of the time, with a mean delay of delivery of 35.5 days and a mean gestational age of 36.9 weeks. The 16 patients (40%) with a positive C-reactive protein value responded to tocolysis only 37.5% of the time, with a mean delay of delivery of 14.4 days and a mean gestational age of 33.2 weeks. Pathologic evidence of chorioamnionitis was present in 32.9% of 310 preterm deliveries as compared to only 22.3% of 1631 term deliveries. The presence of subclinical infection must be considered in cases of preterm labor, especially among patients for whom tocolytic therapy is unsuccessful.


Assuntos
Proteína C-Reativa , Corioamnionite/complicações , Trabalho de Parto Prematuro/etiologia , Complicações Infecciosas na Gravidez , Adulto , Corioamnionite/diagnóstico , Feminino , Idade Gestacional , Humanos , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Estudos Prospectivos
13.
Am J Obstet Gynecol ; 164(2): 652-8, 1991 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-1992719

RESUMO

Wistar rats (five in each group) were given either 1 mg/kg of free cisplatin, 1 or 2 mg/kg of liposomal encapsulated cisplatin, or saline solution intraperitoneally biweekly for 15 injections. Rats in the free drug group showed significantly less weight gain; two rats died during the study. At necropsy, the free cisplatin--treated rats showed gross and microscopic evidence of peritoneal fibrosis that was not detected in any of the remaining groups. The free cisplatin--treated rats showed serum and histologic evidence of renal damage; all five rats had moderate or severe acute tubular necrosis. No renal abnormalities were detected in rats that received 1 mg/kg, and only focal or mild changes were found in rats that received 2 mg/kg of the liposomal preparation. Neurotoxicity, as determined by nerve conduction and inclined plane studies, developed in rats treated with free and liposomal cisplatin. These results are encouraging and warrant further investigation.


Assuntos
Cisplatino/toxicidade , Animais , Peso Corporal/efeitos dos fármacos , Cisplatino/administração & dosagem , Cisplatino/sangue , Portadores de Fármacos , Feminino , Fibrose/induzido quimicamente , Injeções Intraperitoneais/efeitos adversos , Rim/efeitos dos fármacos , Rim/patologia , Lipossomos , Condução Nervosa/efeitos dos fármacos , Peritônio/patologia , Ratos , Ratos Endogâmicos , Fatores de Tempo
14.
Gynecol Oncol ; 55(1): 21-4, 1994 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-7959260

RESUMO

The treatment of early vulvar carcinoma has moved toward less radical surgery with reconstruction. This report describes our preliminary experience with a mons pubis flap that is simple and appears safe, reliable, and gives excellent cosmetic and functional results following radical hemivulvectomy. Four patients have undergone this procedure with excellent results. The flap brings pliable, hair-bearing skin which authentically mimics the normal side, thus providing good sexual function. The mons pubis pedicle flap should be considered in patients undergoing radical hemivulvectomy where an excellent cosmetic result is desirable.


Assuntos
Retalhos Cirúrgicos , Vulva/cirurgia , Neoplasias Vulvares/cirurgia , Adulto , Idoso , Feminino , Humanos , Cirurgia Plástica
15.
Ann Plast Surg ; 32(6): 602-5, 1994 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-8074367

RESUMO

A mons pubis flap was used to reconstruct vulvar defects in 4 patients. This is an axial-pattern flap based on the superficial external pudendal vessels. Our cadaver injection studies demonstrated the vascular anatomy of the flap, which encompasses both a primary and a secondary vascular territory. Four patients were reconstructed, with excellent cosmetic results. The flap provides pliable, hair-bearing skin that resembles the normal vulva. The donor defect is inconspicuous and well hidden in the pubic hair. The flap is a reconstructive option for appropriate patients with full-thickness vulvar defects.


Assuntos
Retalhos Cirúrgicos , Vulva/cirurgia , Adulto , Idoso , Feminino , Humanos , Métodos , Neoplasias Vulvares/cirurgia
16.
Gynecol Oncol ; 60(2): 251-4, 1996 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-8631547

RESUMO

Two human squamous cell cervical carcinoma cell lines, C-33A (HTB 31) and MS751 (HTB 34), were exposed to either paclitaxel alone or paclitaxel for 24 hr followed by graded doses of Cs-137 radiation. Each was then analyzed for both clonogenic survival and alterations to cell cycle progression. No radiosensitization or affect on the cell cycle was seen using 1 x 10(-9) M paclitaxel. Each line was equally sensitive to the drug with approximately 50% cell lethality seen after 1 x 10(-8) M of paclitaxel. This concentration of paclitaxel also produced substantial G2M arrest, seen immediately after drug exposure and lasting up to 2 days. Gamma radiation delivered during the time of G2M arrest showed only a small degree of radiosensitization by paclitaxel for the relatively radioresistant MS751 line at 4 Gy (SF4 = 16.0 +/- 3.2% --> 5.7 +/- 1.1%, P = 0.049) but no sensitization using radiation doses of conventional fraction size [sensitizer enhancement ratios 1.1 (0.80-1.40) and 1.3 (0.95-1.65) for the C-33A and MS751 cell lines, respectively]. It is concluded that paclitaxel produces only a modest radiosensitization effect, indicating that this compound will have limited benefit as a radiosensitizer for the treatment of cervical cancer.


Assuntos
Carcinoma de Células Escamosas/radioterapia , Paclitaxel/farmacologia , Radiossensibilizantes/farmacologia , Neoplasias do Colo do Útero/radioterapia , Apoptose/efeitos dos fármacos , Apoptose/efeitos da radiação , Carcinoma de Células Escamosas/patologia , Ciclo Celular/efeitos dos fármacos , Ciclo Celular/efeitos da radiação , Relação Dose-Resposta à Radiação , Feminino , Fase G2/efeitos dos fármacos , Humanos , Doses de Radiação , Células Tumorais Cultivadas/efeitos dos fármacos , Células Tumorais Cultivadas/efeitos da radiação , Neoplasias do Colo do Útero/patologia
17.
Am J Obstet Gynecol ; 158(3 Pt 1): 493-8, 1988 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-3348310

RESUMO

Infertility was examined among 343 diethylstilbestrol-exposed and 303 unexposed daughters whose mothers participated in an evaluation of diethylstilbestrol use during pregnancy 35 years ago. Of the married individuals who were not using contraception and who were actively trying to conceive, a greater proportion of diethylstilbestrol-exposed women than unexposed subjects experienced primary infertility (33% versus 14%, p less than 0.001). Among those with primary infertility, abnormal hysterosalpingograms were observed in 46% of the diethylstilbestrol-exposed group and in none of the unexposed group (p less than 0.02), while tubal abnormalities were found in 42% of the exposed and in none of the unexposed (p = 0.02). First pregnancies were achieved by 40 (58%) women exposed to diethylstilbestrol and 18 (64%) unexposed subjects. Twenty-four (60%) of the exposed women and 15 (83%) of the unexposed individuals who conceived had a live-born infant who survived. The estimated cumulative rate of first pregnancy was 16% for the exposed group and 36% for the unexposed group at 12 months after the diagnosis of primary infertility (p less than 0.05).


Assuntos
Dietilestilbestrol/efeitos adversos , Infertilidade Feminina/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal , Adulto , Colo do Útero/patologia , Epitélio/patologia , Feminino , Humanos , Histerossalpingografia , Infertilidade Feminina/diagnóstico por imagem , Infertilidade Feminina/etiologia , Infertilidade Feminina/patologia , Gravidez , Fatores de Tempo , Vagina/patologia
18.
Cancer ; 82(2): 328-33, 1998 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-9445190

RESUMO

BACKGROUND: This study was conducted to determine the efficacy and safety of irinotecan (CPT-11) as second-line therapy in patients with advanced cervical carcinoma. METHODS: Sixteen patients with platinum-resistant squamous cell carcinoma were treated with CPT-11 as second-line therapy. CPT-11 was administered in repeated 6-week cycles comprised of the administration of CPT-11 once weekly for 4 weeks, followed by a 2-week rest. The starting dose of CPT-11 was 125 mg/M2 given intravenously over 90 minutes; subsequent doses were adjusted based on individual patient tolerance. RESULTS: The median age of the patients was 43 years (range, 27-69 years). Three patients had a baseline Eastern Cooperative Oncology Group performance score (PS) of 0, 8 had a PS of 1, and 5 had a PS of 2. All patients had received cisplatin-based chemotherapy and 13 of 16 patients (81.3%) had been treated with prior pelvic/abdominal radiation therapy. Fourteen patients were evaluable for response. There were no objective responses although subjective decreases in symptoms were observed in some patients. Grade 3 to 4 toxicities included diarrhea in three patients, nausea and emesis in one patient, leukopenia in six patients, and neutropenia in five patients. Eighteen of 25 cycles required dose reductions leading to a median dose intensity of only 59.4 mg/M2/week, which was 71% of the planned dose of 83.3 mg/M2/week. CONCLUSIONS: The amount of CPT-11 actually delivered to the patients under the conditions of this pilot study failed to result in an antitumor response. However, the marked subjective improvement of symptoms observed in this study and the significant activity reported by other investigators justify future studies of CPT-11 in patients with cervical carcinoma.


Assuntos
Antineoplásicos Fitogênicos/uso terapêutico , Camptotecina/análogos & derivados , Carcinoma de Células Escamosas/tratamento farmacológico , Neoplasias do Colo do Útero/tratamento farmacológico , Adulto , Idoso , Antineoplásicos/uso terapêutico , Antineoplásicos Fitogênicos/administração & dosagem , Antineoplásicos Fitogênicos/efeitos adversos , Camptotecina/administração & dosagem , Camptotecina/efeitos adversos , Camptotecina/uso terapêutico , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/secundário , Diarreia/induzido quimicamente , Esquema de Medicação , Resistencia a Medicamentos Antineoplásicos , Feminino , Humanos , Infusões Intravenosas , Irinotecano , Leucopenia/induzido quimicamente , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Recidiva Local de Neoplasia/tratamento farmacológico , Estadiamento de Neoplasias , Neutropenia/induzido quimicamente , Satisfação do Paciente , Projetos Piloto , Compostos de Platina/uso terapêutico , Indução de Remissão , Segurança , Neoplasias do Colo do Útero/radioterapia , Vômito/induzido quimicamente
19.
Gynecol Oncol ; 66(2): 202-8, 1997 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-9264563

RESUMO

We examined the in vivo effect of estrogen, progesterone, RU 486, and pregnancy on the upstream regulatory region (URR) of human papillomavirus (HPV) 18 transgenic mice. The mice contain the bacterial reporter beta-galactosidase gene under control of the HPV 18 URR. Pregnant transgenic mice were sacrificed on various days of gestation and the level of URR activation was determined. Another group of female transgenic mice was ovariectomized at 4 to 6 weeks of age. Pellets of estradiol, progesterone, progesterone + RU 486, or placebo were implanted 1 to 2 weeks after ovariectomy. Mice were sacrificed after pellet implantation to examine acute and chronic effects. Marked increases in URR activation during pregnancy were observed. Progesterone was found to activate the URR acutely. Significantly higher activation was demonstrated at 24 hr in the progesterone group compared to placebo (P < 0.01). Activation with progesterone at 24 hr was significantly higher than at any other time point (P < 0.001). A trend toward decreasing activation over time was demonstrated in the progesterone group (r = -0.87, P = 0.0001). RU 486 does not block the activation of progesterone in our model. Estradiol activates the URR acutely compared to placebo (P = 0.034). This in vivo model demonstrates activation of the URR in response to exogenous estrogen, progesterone, and pregnancy. These data may have clinical implications for women who harbor high-risk HPV.


Assuntos
DNA Viral/efeitos dos fármacos , Estrogênios/farmacologia , Mifepristona/farmacologia , Papillomaviridae/efeitos dos fármacos , Papillomaviridae/genética , Progesterona/farmacologia , Ativação Transcricional/efeitos dos fármacos , Animais , Feminino , Camundongos , Camundongos Transgênicos , Gravidez , beta-Galactosidase/metabolismo
20.
Gynecol Oncol ; 36(3): 401-4, 1990 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-2318452

RESUMO

Extended surgical staging (ESS) has been added to total hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) in patients with clinical Stage I endometrial cancer in order to better define patterns of metastatic spread and the response to treatment. Adjuvant radiotherapy has a demonstrated efficacy in decreasing central recurrence in Stage I disease. The combined use of radical surgery and pelvic radiotherapy for cervical cancer patients results in an increased incidence of complications. This study compares major complication rates in Stage I endometrial cancer patients who underwent either TAHBSO with ESS or TAHBSO alone followed by adjuvant external beam radiotherapy (RT). Records of 52 patients with clinical stage I endometrial cancer were reviewed. Thirty-two patients underwent TAHBSO plus ESS and 20 patients had TAHBSO alone. All patients received postoperative, whole pelvis external radiotherapy. Four patients suffered complications potentially related to treatment which required rehospitalization, and all 4 were in the group which had undergone ESS. A comparison of complication rates between the ESS + RT group (4/37 or 10.8%) and TAHBSO + RT group (0/20) suggested a trend toward significance (P less than 0.10). Treatment protocols using extended surgical staging prior to adjuvant radiotherapy in Stage I endometrial cancer should examine complications potentially related to this combination, to further define treatment risks and benefits.


Assuntos
Neoplasias Uterinas/terapia , Adulto , Idoso , Terapia Combinada/métodos , Feminino , Humanos , Histerectomia , Pessoa de Meia-Idade , Radioterapia/efeitos adversos , Neoplasias Uterinas/radioterapia , Neoplasias Uterinas/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA