Video-assisted genetic counseling in patients with ovarian, fallopian and peritoneal carcinoma.

OBJECTIVES: To compare the proportion of patients with ovarian, fallopian or peritoneal carcinoma who receive genetic testing after observing a genetic counseling video versus after traditional referral for genetic counseling and testing at physician discretion. METHODS: A retrospective chart review was performed of all patients seen at the West Cancer Center for evaluation of ovarian, fallopian or peritoneal carcinoma from 7/2014 to 8/2015. Patients seen between 7/2014 and 12/2014 were offered standard genetic counseling. We adopted a new standard of care from 3/2015 to 8/2015 involving the use of a genetic counseling video on a digital tablet. The video was shown to patients with ovarian, fallopian or peritoneal cancer, who were then given the option to undergo genetic testing at the end of the viewing. We compared the number and proportion of patients who received genetic testing in both groups. RESULTS: The initial group of 267 patients received referral and te\sting at the physician's discretion between 8/2014 and 12/2014. 77/267 (29%) of these patients underwent genetic testing. 295 patients viewed the condensed genetic counseling video with the option to receive testing the same day between 3/2015 and 8/2015. 162/295 (55%) of these patients received testing. The transition from a referral method to the video counseling method resulted in a significant increase of patients tested (p<0.001). CONCLUSION: Using a genetic counseling video and providing an immediate option for testing significantly increased the proportion of patients with ovarian, fallopian or peritoneal carcinoma who received genetic testing.

Hematometrocolpos in an adolescent female treated for pelvic Ewing sarcoma.

Radiation therapy is often used to achieve local control of pelvic Ewing sarcoma in children. The effects of radiation on the female reproductive tract have been well documented in adults with gynecological malignancies, but the long-term consequences of pelvic radiation in pre-pubertal or adolescent girls are not as well described. We report a case of hematometrocolpos developing in an adolescent previously treated with chemotherapy and radiation therapy for pelvic Ewing sarcoma. We describe the clinical presentation, radiographic features, gross pathology, treatment strategies, outcome, as well as putative predisposing factors and preventative interventions.

Phase I dosage finding and pharmacokinetic study of intravenous topotecan and oral erlotinib in adults with refractory solid tumors.

PURPOSE: Topotecan is widely used for refractory solid tumors but multi-drug resistance may occur due to tumor expression of ATP-binding cassette (ABC) transporters. Since erlotinib, an inhibitor of the epidermal growth factor receptor, also inhibits several ABC transporters, we performed a phase I study to evaluate the safety, efficacy, and pharmacokinetics of intravenous topotecan given in combination with erlotinib. METHODS: Patients received 150 mg of oral erlotinib daily and a 30 min intravenous infusion of topotecan on days 1-5 of a 21-day cycle. Dosage escalation of topotecan occurred with a starting dosage of 0.75 mg/m(2). The pharmacokinetics of topotecan was evaluated on day 1 of cycle 1 without erlotinib and on day 1 of cycle 2 or 3 with erlotinib. RESULTS: Twenty-nine patients were enrolled. The maximum tolerated dosage was determined to be 1.0 mg/m(2). Dose-limiting toxicities included neutropenia and thrombocytopenia. The average duration of treatment was 97 days. Two partial responses were observed. Topotecan clearance and exposure were similar with and without erlotinib. CONCLUSIONS: The combination of topotecan and erlotinib is tolerable at clinically effective doses. Erlotinib does not affect the disposition of topotecan to a clinically significant extent.

Uterine papillary serous carcinoma metastatic to the choroid.

PURPOSE: To report an unusual case of choroidal metastasis from uterine papillary serous carcinoma presenting as a choroidal hemorrhage. METHODS: A 70-year-old woman with a history of Stage IV endometrial cancer presented with sudden loss of vision and pain behind the right eye. Clinical examination revealed a choroidal hemorrhage with retinal detachment. The clinical findings, results of imaging studies, and pathologic findings are described. RESULTS: The patient underwent drainage of the choroidal hemorrhage but developed a painful, blind eye resulting from secondary glaucoma that was refractory to maximal medical therapy. Examination of the drained choroidal fluid showed no malignant cells. The patient elected for enucleation of the affected eye, and histopathologic analysis was consistent with uterine papillary serous carcinoma metastatic to the choroid. The patient tolerated the procedure well. However, she entered hospice shortly after surgery to receive palliative care for her metastatic disease. CONCLUSION: Rare cases of uterine cancer metastasizing to the uvea have been reported. To our knowledge, this is the first case of uterine papillary serous carcinoma with uveal metastasis. Metastatic disease involving the uvea should be considered in the differential diagnosis for a patient presenting with pain and sudden loss of vision, particularly when the patient has a known primary malignancy. Histopathology and cytology can assist in identifying a uveal mass as metastatic.