Platinum, anthracycline, and alkylating agent-based chemotherapy for ovarian carcinosarcoma.

BACKGROUND: Ovarian carcinosarcoma (OCS) is a rare malignancy associated with a poor prognosis. Platinum, anthracyclines, and alkylating agents are the most effective antiblastic drugs for treatment of gynecologic epithelial and stromal tumors. The aim of this study was to determine response rate and overall survival (OS) of patients with OCS who were treated with a combination of these 3 drugs. METHODS: Forty-one women with OCS who were referred to the Department of Gynecologic Oncology of San Gerardo Hospital in Monza and European Institute of Oncology in Milan, between January 1995, and December 2006, and treated with a combination regimen of cisplatin, adriamycin, and cyclophosphamide or a combination regimen containing of cisplatin, epirubicin, and ifosfamide plus granulocyte colony-stimulating factor were considered for this study. RESULTS: Four women had OCS stage I; 7, stage II; 23, stage III; and 7, stage IV. Heterologous, homologous, and mixed stromal components were described in 17, 14, and 10 patients, respectively. Thirteen women were treated with a combination of cisplatin, adriamycin, and cyclophosphamide and 28 with a combination of cisplatin, epirubicin, and ifosfamide plus granulocyte colony-stimulating factor. Two women did not complete their treatment because of the rapid progression of their disease and severe toxicity. Among 22 women considered evaluable for response, 10 (46%) achieved a complete response and 3 (13%) achieved a partial response (global response rate, 59%). Overall progression-free survival was 11.8 months (range, 0.9-96 months) and 13.8 and 10.1 months in stage I-II and III-IV, respectively (P = 0.13). Median OS was 20 months (range, 1-123 months), not reached in stage I-II, and 19.7 months in stage III-IV (P = 0.07). No significant difference between homologous and heterologous sarcomatous components was observed (P = 0.95), whereas no significant trend of improved OS was noticed for stage IIIC-IV with optimal debulking surgery (n = 9), compared with suboptimal cytoreduction (n = 19; 32.6 vs 14.5 months, P = 0.14). CONCLUSION: The combination of anthracycline, alkylating agent, and cisplatin showed a good response rate but also a high toxicity. The prognosis of OCS remains poor. Optimal cytoreduction may improve survival, but new anticancer drugs or more effective regimens are awaited.

Harmonic scalpel versus conventional electrosurgery in the treatment of vulvar cancer.

OBJECTIVE: To compare differences in blood loss, operative time, and intra- and postoperative complications with the harmonic scalpel or conventional electrosurgery in the treatment of vulvar cancer. METHODS: Consecutive patients who underwent radical vulvectomy with inguinal lymphadenectomy using the harmonic scalpel (HS) or conventional electrosurgery (CE) were compared. RESULTS: A total of 42 patients were included, 22 in the HS group and 20 in the CE group. Mean blood loss was significantly less in the HS group compared with the CE group (127 mL vs 210 mL; P<0.05) and mean operative time was significantly shorter with the HS compared with CE (117 minutes vs 142 minutes; P<0.05). There were no significant differences between the 2 groups in postoperative complications. CONCLUSION: Use of the harmonic scalpel for surgical treatment of vulvar cancer is safe and has several advantages, including decreased operative time and blood loss, improved visibility in the operative field, and good postoperative outcome.

Case report: renal cell carcinoma presenting as hypertension in pregnancy.

Renal cell carcinoma is a rare, potentially fatal tumor that occasionally occurs during pregnancy. The probability of cure is directly related to the stage or degree of tumor dissemination. Surgical resection is the mainstay of treatment of this disease. A case of patient who was diagnosed with a renal mass in the second trimester of pregnancy is reported. She underwent left radical nephrectomy at 17 weeks' gestation.