Type III radical hysterectomy after induction chemotherapy for patients with locally advanced cervical carcinoma.

Neoadjuvant chemotherapy followed by surgery is a promising approach in locally advanced cervical carcinoma. The aim of this study was to evaluate the feasibility, technical aspects, and clinical results of surgery after induction chemotherapy in this patient population. Forty-one untreated cervical carcinoma patients staged as IB2 to IIIB received three 21-day courses of cisplatin 100mg/m2 on day 1 and gemcitabine 1000 mg/m2 on days 1 and 8 followed by surgery or concomitant chemoradiation. The response to chemotherapy, operability, surgical/pathological findings, disease-free period, and survival of the surgically treated patients were evaluated. All 41 patients were evaluated for toxicity and 40 were evaluated for response. The overall objective response rate was 95% (95% confidence interval 88%-100%), and was complete in three patients (7.5%) and partial in 35 (87.5%). Granulocytopenia grades 3/4 occurred in 13.8% and 3.4% of the courses, respectively, whereas nonhematological toxicity was mild. Twenty-three patients underwent type III radical hysterectomy. Mean duration of surgery was 3.8 h (range 2:30-5:20), median estimated blood loss was 670 ml and median hospital stay was 5.2 days. Intraoperative complications occurred in one case (venous injury). In all but one case the resection margins were negative. Four patients (17%) had positive nodes (one node each); six (26%) had complete pathologic response, three (13%) had microscopic; and 14 (60%) macroscopic residual disease. At 24 months of maximum follow-up (median 20), the disease-free and overall survival rates were 59% and 91%, respectively. Induction chemotherapy with cisplatin/gemcitabine produced a high response rate and did not increase the difficulty of surgery. Operating time, blood loss, intraoperative complications, and hospital stay were all within the range observed for type III hysterectomy in early stage patients. We therefore conclude that type III radical hysterectomy is feasible in locally advanced cervical cancer patients who respond to chemotherapy.

Human cervical cancer-associated nuclear matrix proteins.

The nuclear matrix is the nonchromatin protein structural component of the nucleus that governs nuclear shape and also exerts regulatory control over higher order gene organization. Recent studies have documented the presence of tumor-associated nuclear matrix proteins in several human cancers. We used high-resolution two-dimensional gel electrophoresis to compare nuclear matrix protein patterns in cervical carcinomas with those from normal cervical tissue. Tumors obtained from 20 patients undergoing hysterectomy for clinically localized cervical cancer were compared with normal cervical tissue. We have identified five polypeptides (CvC-1: Mr = 69,408 Da, pI = 5. 78; CvC-2: Mr = 53,752 Da, pI = 5.54; CvC-3: Mr = 47,887 Da, pI = 5. 60; CvC-4: Mr = 46,006 Da, pI = 5.07; and CvC-5: Mr = 44,864 Da, pI = 6.61) in the nuclear matrix from cervical carcinomas that were present in 20 of 20 cervical tumors but 0 of 10 normal tissues. These data extend similar findings of cancer-associated nuclear matrix proteins in other human cancers and suggest that nuclear matrix proteins may represent a new class of cancer markers that could aid the diagnosis or management of some types of cancer.

[Descriptive epidemiology cancer in the National Cancer Institute of Mexico]. / Epidemiología descriptiva de cáncer en el Instituto Nacional de Cancerología de México.

OBJECTIVE: To analyze the descriptive epidemiology of cancer at the Instituto Nacional de Cancerología of Mexico, and describe the characteristics of the growing demand for medical care. MATERIAL AND METHODS: A review of the 10 year experience of the Hospital Cancer Registry from 1985 to 1994 was done. RESULTS: During the study period a total of 28591 patients was registered with the histological confirmation of cancer. There were 8984 (31.4%) men, being the testicle (8.3%), the lung (7.4%), non-Hodgkin's lymphoma (7.1%) and the prostate (5.5%) the more frequent malignancies. In women a total of 19597 (68.6%) cases were seen; together, invasive cervical cancer (30.6%) and breast cancers (20.6%) represent more than 50% of all patients. In 1996, 108876 outpatient services were given, 6492 hospitalizations, 36388 sessions of radiotherapy and 9116 of chemotherapy. Only 30% of this population comes from Mexico City, the remaining lives in the 31 different states of Mexico. CONCLUSIONS: Supporting the development of the Centros Estatales de Cancerología for the referral of patients is necessary, this will avoid the rapid saturation of medical care at the institute. Also, stimulate the development of hospital registries and collaborate with the Ministry of Health to improve the early cancer detection programmes in Mexico.

Simultaneous use of bleomycin and radiotherapy in malignant tumours of the head and neck.

Twenty cases originally diagnosed as epidermoid carcinoma were observed with a view to determining whether a combination of radiation and intravenous bleomycin promoted regression of the tumours and if so what effect this had on survival. Signs of local toxicity with this combination were also looked for. Five cases yielded what was considered to be an excellent response, nine cases gave a good response and six cases had a poor response. It is recommended that future studies be carried out in epidermoid carcinoma with this combination of radiotherapy and bleomycin.