Concurrent carboplatin and paclitaxel with pelvic radiation therapy in the primary treatment of cervical cancer.

OBJECTIVE: The objective of the study was to determine the feasibility of weekly carboplatin/paclitaxel with radiation therapy (RT) in the primary treatment of cervical cancer. STUDY DESIGN: Women diagnosed with stage IB-1 to stage IVA untreated primary cervical cancer were eligible. Carboplatin (area under the curve = 2.0) and paclitaxel 40 mg/m2 were administered weekly for 6 weeks with pelvic RT. Brachytherapy was completed after pelvic RT. Acute toxicities and response to treatment were assessed. RESULTS: Twenty-two evaluable patients were enrolled. The median duration of follow-up was 23 months. Carboplatin (mean dose 245 mg) and paclitaxel (mean dose 70 mg) were successfully administered in 97% and 90% of planned treatments, respectively. Median time to complete external radiation therapy was 36.6 days (25-57 days). Grade 3/4 hematologic or gastrointestinal toxicity was unusual. The complete response rate 3 months after completion of therapy was 91%. The estimated 3-year progression-free survival is 70% and overall survival is 65%. CONCLUSION: Weekly carboplatin/paclitaxel and RT is a reasonable treatment regimen for cervical cancer.

Marginal zone B-cell lymphoma in children and young adults.

We describe the clinicopathologic findings of 48 cases of marginal zone B-cell lymphoma (MZL) in children and young adults, a disease that has been recognized previously only rarely in this age group. Patients ranged in age from 2 to 29 years, with pediatric patients (< or =18 years) comprising 52% of the cases. As in adults, both primary nodal (N) and extranodal (E) MZL were observed. However, primary NMZL comprised the majority of the cases (67%) and demonstrated distinctive clinical and histologic features. NMZL occurred most commonly in young males (median 16 years, male/female ratio 5.4:1), with no underlying disease, presenting as localized adenopathy (90% stage I), with excellent prognosis and low rate of recurrence. In contrast, EMZL were much less common, and patients were older (median 24.5 years), with only a slight male predominance (male/female ratio 1.2:1). Most patients had localized disease (73% stage I) with excellent prognosis and infrequent recurrences. In addition, an association with autoimmune disease was observed in 19% of the EMZL. Both primary NMZL and EMZL in young patients shared similar morphologic and immunophenotypic findings to those described in adults and were monoclonal B-cell proliferations with monoclonality demonstrated in 94% of the cases. A common morphologic feature in NMZL was disruption of residual follicles resembling progressive transformation of germinal centers (PTGC), observed in 66% of the cases. Although the precise relationship of primary NMZL and the PTGC-like changes is unclear, it is possible that NMZL arises in a background of PTGC, as florid PTGC often occurs in young males. We conclude that EMZL in children and young adults are similar to EMZL of mucosa-associated lymphoma tissue occurring in older patients. However, pediatric NMZL appear to have distinctive clinical and histologic features.