Photodynamic therapy effectively palliates gynecologic malignancies.

BACKGROUND: There is a need for novel therapies for women with recurrent gynecologic malignancies. In this paper, the authors report their experience with photodynamic therapy (PDT). PDT involves administering a systemic injection of Photofrin II, a selective tumor photosensitizer hematoporphyrin derivative, followed by exposure of tumor tissue to visible light at 630 nm. The photodynamic destruction of tumor exhibits both cytocidal and vascular effects that may contribute to the tumoricidal effects observed. MATERIALS AND METHODS: Patients were injected intravenously with two mg/kg Photofrin II. Approximately 48 hours post-injection, the tumor was exposed to red light (wavelength 630 nm +/- 2 nm) from a laser through a flexible 400-um quartz fiber with an attached microlens to produce a spot of uniform intensity and/or diffuser tip fiber to uniformly illuminate the cavity. RESULTS: Thirty-two patients with recurrent gynecologic malignancies were treated with photodynamic therapy using Photofrin II dye and laser. A total of 45 PDT treatments were given; 25 patients received only one treatment, five patients received two treatments, two patients received three treatments, and one patient received four treatments. There were nine cervical, six vulvar, six vaginal, five ovarian, five endometrial carcinomas, and one recurrent pagets of the anal canal. Nine out of 11 (82%) patients with metastatic cutaneous lesions had a complete response. Five out of 21 patients (24%) with vaginal, cervical or anal recurrences had a complete response to therapy with median response time of 28 months. Toxicity associated with treatment was limited to burning sensation, pain, and edema at treatment site. There were no treatment related deaths. CONCLUSIONS: PDT is an effective therapy in patients with recurrent gynecologic malignancies and limited treatment options. PDT is an alternative therapy that offers the possibility of complete response in select groups of patient populations. Specifically, it provides palliation for superficial recurrent lesions of skin, cervix, vagina and vulva, in the absence of distant disease.

Chemoresistance in ovarian cancer linked to expression of microRNAs.

We evaluated the differential expression of several microRNAs (miRNAs) among malignant cells in ascites and matched omental metastasis in patients with epithelial ovarian cancer (EOC). Ascites and omental tumors were collected prospectively from five patients who were undergoing primary surgical cytoreduction. Patient samples were processed and treated with carboplatin, paclitaxel and combination chemotherapy. Cell viability was evaluated and miRNA profiling was performed on both tumor cells from ascites fluid and omental cake. Quantitative real-time PCR (RT-q-PCR) and western blots were used to evaluate expressions of miRNA-21 and miRNA -214 and associated proteins. Malignant cells in ascites showed greater cell viability when treated with carboplatin compared to omental metastasis. A significant up-regulation of miRNA-21 and miRNA-214 was observed in malignant cells of ascites compared to omental metastasis; this was confirmed by both cell viability assay and RT-q-PCR. Ours is the first report that demonstrates significant up-regulation of miRNA-21 and miRNA-214 in tumor cells from ascites of patients with EOC compared to omental metastasis. This finding has important implications for intrinsic carboplatin resistance in these patients.

Adjuvant treatment for uterine leiomyosarcoma.

The aims of this study were to evaluate outcomes in women diagnosed with uterine leiomyosarcoma (LMS). A retrospective chart review was conducted. Fifty-eight women with LMS were identified. Of the evaluable 52 patients (six patients were excluded), 73% had Stage I/II disease, and 27% had Stage III/IV disease. Sixty-three percent of patients received chemotherapy (97% doxorubicin-based therapy), eight percent received radiation alone, and 29% received no therapy. For patients with Stage I/II disease, no improvement in OS was demonstrated when adjuvant therapy was administered. There was a significant difference in OS (p = 0.0005) for patients with advanced Stage (III/IV) disease that received adjuvant chemotherapy. OS of the entire group, when adjusted for stage, failed to reveal a significant survival advantage for those receiving chemotherapy-based (p = 0.22). The present findings suggest further research into the role of chemotherapy in early stage disease is needed to better refine optimal treatment.