RESUMO
Adjuvant chemoradiotherapy was administered to 26 patients with stage Ic-IV ovarian cancer after radical cytoreductive surgery. All patients received six cycles of carboplatin, epirubicin, and prednimustine and had no evidence of disease after completion of chemotherapy. They received whole-abdominal radiation and radiation to the retroperitoneal lymph nodes. Five (23%) of the patients were discontinued on this protocol because of myelosuppression, progressive disease, or withdrawal. One patient had a small bowel obstruction due to intraperitoneal adhesions. The survival of 10 Stage III ovarian cancer patients who received chemoradiotherapy and were evaluable for assessment of treatment efficacy was retrospectively compared with the survival of 11 Stage III patients who received chemotherapy only. At 36 months, a slight advantage of the chemoradiotherapy versus the chemotherapy-only group was observed (p = 0.11). These preliminary results suggest that adjuvant chemoradiotherapy may prolong the "no evidence of disease" interval of radically operated ovarian cancer patients. Toxicity is acceptable when second-look surgery is avoided and when subsequent radiotherapy is limited to patients with no clinical evidence of disease.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carboplatina/uso terapêutico , Neoplasias Ovarianas/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carboplatina/administração & dosagem , Terapia Combinada , Epirubicina/administração & dosagem , Feminino , Doenças Hematológicas/etiologia , Humanos , Estadiamento de Neoplasias , Neoplasias Ovarianas/mortalidade , Projetos Piloto , Prednimustina/administração & dosagem , Taxa de SobrevidaRESUMO
Adjuvant chemoradiotherapy was administered to 26 patients with stage Ic-IV ovarian cancer after radical cytoreductive surgery. All patients received six cycles of carboplatin, epirubicin, and prednimustine and had no clinical evidence of disease after completion of chemotherapy. They received whole-abdominal radiation and radiation to the retroperitoneal lymph nodes. This protocol was discontinued for five (23%) patients because of myelosuppression, progressive disease, or withdrawal. One patient had a small bowel obstruction due to intraperitoneal adhesions. The survival of ten stage-III ovarian cancer patients, who received chemoradiotherapy and were evaluable for assessment of treatment efficacy, was retrospectively compared with the survival of 11 stage-III patients who received chemotherapy only. At 36 months, a slight advantage of the chemoradiotherapy versus the chemotherapy-only group was observed (p = 0.11). These preliminary results suggest that adjuvant chemoradiotherapy may prolong the "no evidence of disease" interval of radically operated ovarian cancer patients. Toxicity is acceptable when second-look surgery is avoided and when subsequent radiotherapy is limited to patients with no evidence of disease.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/radioterapia , Carboplatina/administração & dosagem , Quimioterapia Adjuvante , Terapia Combinada , Epirubicina/administração & dosagem , Feminino , Humanos , Irradiação Linfática , Neoplasias Ovarianas/cirurgia , Prednimustina/administração & dosagem , Indução de RemissãoRESUMO
A prospective, randomized study comparing single dose intravenous antibiotic prophylaxis with multiple-dose regimen in patients undergoing radical surgery for gynecologic malignancy was carried out. The majority of patients had cervical cancer. Thirty-seven patients in group A received one dose of 4 g piperacillin and 800 mg tinidazole 30 minutes before surgery. Twenty-nine patients in group B additionally received 4g piperacillin 8 hours and 4g piperacillin and 800 mg tinidazole 16 hours after the first dose. There were no significant differences between groups A and B with regard to median patient age, performance status, cardiologic and pulmonary status, or frequency of diabetes. There were also no significant differences between either group with regard to the parameters documented postoperatively, such as median hospital stay, leukocyte values, or febrile episodes. Forty-three per cent of patients in group A and 48% of patients in group B had no complications (p > 0.05). Twenty-three per cent of patients in group A and 31% of patients in group B developed infections (p > 0.05), 85% of which occurred in the urinary tract. The data suggest that a single dose of intravenous antibiotics is as effective as multiple dose administration in the perioperative prophylaxis in radical gynecologic surgery.
Assuntos
Antibacterianos/administração & dosagem , Neoplasias dos Genitais Femininos/cirurgia , Pré-Medicação , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos ProspectivosRESUMO
Ninety patients with cervical intraepithelial neoplasia (CIN) were randomly assigned to loop excision (n = 38) or cold-knife conization (n = 52). All specimens were well evaluable at histology. Compared with cold-knife conization, loop excision removes less healthy tissue without reducing the chances for cure.
Assuntos
Eletrocirurgia/instrumentação , Displasia do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/cirurgia , Adulto , Colo do Útero/patologia , Feminino , Humanos , Estudos Prospectivos , Instrumentos Cirúrgicos , Neoplasias do Colo do Útero/patologia , Displasia do Colo do Útero/patologiaAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Ovarianas/tratamento farmacológico , Adulto , Idoso , Carboplatina/administração & dosagem , Cisplatino/administração & dosagem , Terapia Combinada , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Epirubicina/administração & dosagem , Feminino , Humanos , Histerectomia/métodos , Tábuas de Vida , Excisão de Linfonodo , Pessoa de Meia-Idade , Neoplasias Ovarianas/mortalidade , Neoplasias Ovarianas/cirurgia , Ovariectomia/métodos , Prednimustina/administração & dosagem , Taxa de SobrevidaAssuntos
Carcinoma Papilar/cirurgia , Neoplasias Peritoneais/cirurgia , Carcinoma Papilar/tratamento farmacológico , Carcinoma Papilar/mortalidade , Quimioterapia Adjuvante , Terapia Combinada , Feminino , Seguimentos , Humanos , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Peritoneais/mortalidade , Taxa de SobrevidaAssuntos
Neoplasias da Mama/secundário , Carcinoma de Células Pequenas/secundário , Neoplasias Pélvicas/secundário , Neoplasias do Colo do Útero/terapia , Adulto , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Carcinoma de Células Pequenas/patologia , Carcinoma de Células Pequenas/terapia , Terapia Combinada , Feminino , Seguimentos , Humanos , Histerectomia , Estadiamento de Neoplasias , Neoplasias Pélvicas/patologia , Neoplasias Pélvicas/terapia , Neoplasias do Colo do Útero/patologiaAssuntos
Carcinoma de Células Escamosas/patologia , Neoplasias Vulvares/patologia , Idoso , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/terapia , Terapia Combinada , Feminino , Seguimentos , Humanos , Metástase Linfática , Estadiamento de Neoplasias , Taxa de Sobrevida , Neoplasias Vulvares/mortalidade , Neoplasias Vulvares/terapiaRESUMO
Patients with tumours of the lower pelvis were submitted to a biopsy of the scalene fat pad. The primary tumour was a carcinoma of the ovary in 32, of the cervix in 4, and of the body of the uterus in 2 cases. Microscopic metastases in the pre-scalene lymph nodes were found in 7 of the 32 cases of ovarian carcinoma (21.8%), but in none of the patients with carcinoma of the uterus. Since a histologically positive finding of a scalene lymph node influences the treatment, biopsy of the scalene fat pad is recommended as part of the pre-operative investigation of patients with ovarian carcinoma.
Assuntos
Neoplasias de Cabeça e Pescoço/secundário , Linfonodos/patologia , Neoplasias Ovarianas/patologia , Neoplasias do Colo do Útero/patologia , Neoplasias Uterinas/patologia , Tecido Adiposo/patologia , Biópsia , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Metástase Linfática , Estadiamento de NeoplasiasRESUMO
The question was posed, whether a relationship could be established between prenatal and perinatal events and subsequent sudden infant death. The birth records of eighty mothers, whose infants died of sudden infant death syndrome (SIDS) between 1982 and 1987, were reviewed for obstetric complications. The records immediately following the respective SIDS cases served as controls. A family history of SIDS was found significantly more often in the SIDS group than in the control group (p less than 0.001). Oxytocin was administered significantly more often in the SIDS group than in the control group: 54/80 (= 68%) and 20/80 (= 25%, p less than 0.001), respectively. Smoking, hypotension requiring treatment and the administration of tocolytic agents were found significantly more frequently in the SIDS group than in the control group (p less than 0.01, p less than 0.001, and p less than 0.05). Transient fetal hypoxia, as a result of reduced flow in the uterine artery, seems possibly to be connected to the vasoactive agent Oxytocin when occurring in the three above named groups. Whether these situations are connected to a later development of SIDS, has not, to date, been confirmed.
Assuntos
Complicações do Trabalho de Parto/etiologia , Complicações na Gravidez/etiologia , Morte Súbita do Lactente/etiologia , Peso ao Nascer , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Trabalho de Parto Induzido , Masculino , Ocitocina/administração & dosagem , Gravidez , Fatores de Risco , Morte Súbita do Lactente/genéticaRESUMO
To study scalene lymph node involvement in ovarian cancer, 37 patients with this disease underwent pretherapeutic open sampling of the left scalene fat tissue. Only 1 patient had a palpable supraclavicular mass. Positive scalene nodes were found in 7 (22%) of 32 patients with stage III or IV disease. Three of four patients with positive scalene nodes also had both positive pelvic and positive paraaortic nodes; one patient with stage IV disease had negative pelvic and paraaortic nodes. Demonstration of scalene node involvement per se currently does not alter the management of patients with ovarian cancer, although patients with occult involvement of the scalene nodes could be considered ineligible for intraperitoneal chemotherapy.
Assuntos
Linfonodos/patologia , Neoplasias Ovarianas/patologia , Adulto , Idoso , Biópsia , Feminino , Humanos , Metástase Linfática/patologia , Pessoa de Meia-Idade , PescoçoRESUMO
Ninety patients with cervical intraepithelial neoplasia (CIN) were randomly assigned to loop excision (n = 38) or cold-knife conization (n = 52). All specimens were well evaluable at histology. The average width of the lesions at histology was 10.2 and 9.7 mm, respectively (ns). The average weight of the specimens was 2.6 and 5.6 g (P < 0.01) and the average depth was 9.2 and 15.8 mm (P < 0.01), respectively. The distance between the cervical resection margin and CIN was 14 mm after loop excision and 24 mm after cold-knife conization (P < 0.06). The margins of the specimen were not clear of disease in 8 patients after loop excision and in 12 patients after conization (ns). Two patients after loop excision and in three patients after cold-knife conization had postoperative bleeding. The results suggest that, compared with cold-knife conization, loop excision removes less healthy tissue without reducing the chances for cure.
Assuntos
Criocirurgia , Eletrocirurgia , Displasia do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/cirurgia , Adulto , Perda Sanguínea Cirúrgica , Distribuição de Qui-Quadrado , Criocirurgia/efeitos adversos , Criocirurgia/métodos , Eletrocirurgia/efeitos adversos , Eletrocirurgia/métodos , Feminino , Humanos , Estudos Prospectivos , Neoplasias do Colo do Útero/patologia , Displasia do Colo do Útero/patologiaRESUMO
We review our experience with 82 patients with nongenital cancers metastatic to the ovary. All patients were referred for evaluation of an ovarian mass. The patients had primary carcinoma of the breast (n = 28), colon (n = 23), stomach (n = 22), pancreas (n = 7), or gallbladder (n = 2). The overall actuarial 5-year survival rate was 10%. Five-year survival in patients with metastatic colon cancer was significantly higher (23%) than that in patients with metastatic cancer of the breast, stomach, gallbladder, or pancreas, all of whom died within 58 months (P less than 0.05). Patients with unilateral metastatic ovarian involvement had a 5-year survival significantly better than that of those with bilateral involvement (28% vs 5%; p = 0.003). Five-year survival in patients with disease limited to the pelvis was significantly higher than that in those with abdominal spread (22% vs 6%; P less than 0.04). The 5-year survival of patients with residual disease less than 2 cm or greater than 2 cm in diameter was 18% or 4%, respectively (P = 0.002). This pattern applied mainly to differences in patients with primary cancer of the breast or colon (P less than 0.008). These data suggest that an aggressive surgical effort seems to be indicated in colon cancer metastatic to the ovary, as some of these patients may survive 5 years.
Assuntos
Neoplasias da Mama/patologia , Neoplasias do Colo/patologia , Neoplasias da Vesícula Biliar/patologia , Neoplasias Ovarianas/secundário , Neoplasias Pancreáticas/patologia , Neoplasias Gástricas/patologia , Neoplasias da Mama/cirurgia , Neoplasias do Colo/cirurgia , Feminino , Seguimentos , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Neoplasias Pancreáticas/cirurgia , Neoplasias Gástricas/cirurgiaRESUMO
A total of fourteen patients with primary papillary serous carcinoma of the peritoneum (PPSCP) were treated at the Department of Obstetrics and Gynaecology of the University of Graz between 1980 and 1991. The presence of tumours from other sites, particularly the pancreas and the ovary, had been excluded. Due to extensive spreading of the disease mainly in the upper abdomen, only seven of the 14 patients underwent exploratory laparotomy. The median overall survival time was 10 months (range, 1-28 months). These results are due to the extent of spreading of the disease at diagnosis, and also to the fact, that optimal cytoreductive surgery was possible only in four of the 14 patients. The four patients with optimal cytoreduction showed a better survival than those, who underwent less radical surgery. These results seem to indicate, that, as in primary ovarian cancer, the amount of residual disease may be an important prognostic determining factor in PPSCP.
Assuntos
Carcinoma Papilar/cirurgia , Neoplasias Peritoneais/cirurgia , Adulto , Idoso , Carcinoma Papilar/tratamento farmacológico , Carcinoma Papilar/mortalidade , Carcinoma Papilar/patologia , Quimioterapia Adjuvante , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Peritoneais/mortalidade , Neoplasias Peritoneais/patologia , Peritônio/patologia , Taxa de SobrevidaRESUMO
There is no general recommendation with regard to a certain age, after which prophylactic oophorectomy should be performed at the time of hysterectomy. We investigated how many patients who were treated for ovarian cancer at the University Clinic of Obstetrics and Gynecology in Graz between 1980 and 1989, had a history of hysterectomy because of benign uterine disease. In 42 of 382 patients with ovarian cancer (11%), a hysterectomy had been performed 2 to 43 years before the diagnosis of ovarian cancer. 12 of the 42 patients with ovarian cancer and previous hysterectomy (29%) additionally had unilateral oophorectomy because of benign tumors of the ovary. In 79% of patients, hysterectomy was carried out before the 45th year of age and in 86% of patients before the 50th year of age. Thus, prophylactic extirpation of sound ovaries before the age of 50 years does not seem to be generally indicated in patients with retained ovarian function who undergo hysterectomy. However, the rare genetically determined ovarian cancer is the exception to the rule.
Assuntos
Histerectomia , Neoplasias Ovarianas/prevenção & controle , Ovariectomia , Adulto , Idoso , Envelhecimento/fisiologia , Feminino , Humanos , Pessoa de Meia-Idade , Cistos Ovarianos/cirurgia , Neoplasias Ovarianas/fisiopatologia , Fatores de RiscoRESUMO
Between 1982 and 1991, 76 of 322 (24%) patients with primary endometrial adenocarcinoma and morphologic risk factors underwent surgery including systematic pelvic lymphadenectomy (LA). A mean number of 37 lymph nodes per patient was removed. The number of removed nodes did not differ with respect to mode of LA, FIGO stage, depth of myometrial invasion, and histologic subtype or grade. Twenty-seven of 76 (36%) patients had lymph node metastases; 37% of lymph node metastases were < or = 2 mm in diameter. The incidence of lymph node metastases correlated significantly with the depth of myometrial invasion but not with histologic subtype and grade. Twenty-four patients with positive nodes who had stage I disease according to the clinical classification (FIGO 1971) were upstaged to stage IIIc according to the surgical staging system (FIGO 1988). This study underlines the need for complete, systematic LA and the need for thorough histologic processing with step-serial sections for correct staging of patients with endometrial cancer.