C.P. Morrow

The influence of surgical staging on the evaluation and treatment of patients with cervical carcinoma

Abstract Ninety-six patients with cervical cancer underwent surgical staging prior to radiation therapy. An equal number of patients were explored by transperitoneal and extraperitoneal surgery. Three different extraperitoneal approaches were utilized. All patients had bilateral paraaortic lymphadenectomy and selective pelvic nodal sampling. Intraperitoneal cytology and selected biopsies were performed. A 52% correlation existed between clinical and surgical staging. Radiotherapeutic treatment decisions were subsequently based on findings at operative staging. Nine percent of patients undergoing transperitoneal staging experienced a small bowel injury after radiation requiring surgical correction. No patients undergoing extraperitoneal surgery experienced postradiation small bowel morbidity. Extended field radiation was administered to 17% of patients, and a 30% five-year disease-free survival rate was observed. Although prognostic stratification is enhanced with surgical staging, using current radiotherapy techniques, the majority of patients with paraaortic nodal metastases will fail treatment. Based on our experience, only 2.5% of patients in a Stage IIB-IVA category will benefit from radiotherapeutic treatment decisions made as a consequence of Staging laparotomy.

A clinical and pathologic study of 30 cases of malignant mixed mullerian epithelial and mesenchymal ovarian tumors: A gynecologic oncology group study

Between November 1971 and June 1980, thirty patients with primary malignant mixed mullerian tumors of the ovary were entered into a Gynecologic Oncology Group registry and treatment protocol. The mean age of the patients is 60.4 years. Six were Stage II, twenty-three were Stage III, and one patient had Stage IV disease. Among the 30 cases, 15 were designated carcinosarcomas (CS) and 15 were mixed mesodermal sarcomas (MMS). Twenty-three of the thirty study patients died from 1 to 16 months following their initial surgery. Two of the seven living patients have persistent cancer at 11 and 54 months. Four patients were alive and well at 6, 11, 22, and 32 months at the close of the study. Of the 12 patients receiving vincristine, dactinomycin, and cyclophosphamide (VAC) with (8 cases) or without (4 cases) radiation therapy (RT), there were two clinical complete responses; both died with disease at 6 and 16 months. One of the six patients receiving adriamycin had a complete response (CR). She is alive with disease at 11 months. There was no apparent difference in the survival or stage distribution among the cases with CS and MMS. Survival was somewhat better for the patients with earlier stage disease or smaller residual tumor burden.

New classification system of radical hysterectomy: Emphasis on a three-dimensional anatomic template for parametrial resection

OBJECTIVE The international acceptance of a universal classification system for radical hysterectomy is one of the important challenges in gynecologic oncology. The recently published classification system by Querleu and Morrow is a relevant proposal that has been well received by the professional community. However, it does not include a description of parametrial resection in three dimensions, which mostly determines post-operative morbidity. METHODS The intention of this follow-up paper was to further develop the classification system based on the four proposed types of radical hysterectomy (A-D) into a three-dimensional model using standard anatomical landmarks for definition of resection margins in longitudinal and transverse dimensions and demonstrate it on pictures. RESULTS Resection margins were defined in longitudinal and transverse dimensions for each suggested type of radical hysterectomy on all three parts of the parametria. Besides precise description using stable anatomical landmarks, all resection lines have been shown on intra-operative photographs. CONCLUSION Four types of radical hysteretomy can be precisely defined on a three-dimensional anatomical template, including nerve sparing procedure. Our paper should contribute to better standardization (including nomenclature) of the radical hysterectomy, enhancing harmonization of clinical practice in gynecological oncology.

Basic fibroblast growth factor in retardation of doxorubicin extravasation injury

Extravasation of chemotherapeutic agents such as doxorubicin results in significant morbidity and remains a serious clinical problem. No single agent or combination of agents has proven to be completely effective in preventing the chronic avascular ulcerative wound. Basic fibroblast growth factor (bFGF) is one of many angiogenic agents and is strongly mitogenic for vascular endothelial cells in nanogram quantities. In a Sprague-Dawley rat model, bFGF was moderately effective in retarding the development of doxorubicin-induced skin ulceration.

Gravlee Jet Washer effectiveness as performed by obstetric/gynecologic paramedical personnel

Abstract The Gravlee Jet Washer has proved to be a safe and reliable technique for obtaining cell and tissue specimens for the detection of adenocarcinoma of the endometrium. The procedure was performed on a series of 141 patients by obstetric/gynecologic paramedical personnel with a success rate of 92.2 per cent. There were 11 cases of adenocarcinoma diagnosed during the study, and 9 of these were either diagnosed or detected by the jet wash. Cervical canal stenosis prevented performance of the technique in the 2 failures. The jet wash was ineffective in detecting uterine sarcomas. The diagnostic scheme was completed in from 5 to 7 minutes in almost all patients. Only a few patients required additional physician attendance during the procedure. Patient cost was therefore reduced, physician time was minimal, and the procedure was well accepted by the patients.

The Influence of Surgical Staging on the Evaluation and Treatment of Patients with Cervical Carcinoma

Ninety-six patients with cervical cancer underwent surgical staging prior to radiation therapy. An equal number of patients were explored by transperitoneal and extraperitoneal surgery. Three different extraperitoneal approaches were utilized. All patients had bilateral paraaortic lymphadenectomy and selective pelvic nodal sampling. Intraperitoneal cytology and selected biopsies were performed. A 52% correlation existed between clinical and surgical staging. Radiotherapeutic treatment decisions were subsequently based on findings at operative staging. Nine percent of patients undergoing transperitoneal staging experienced a small bowel injury after radiation requiring surgical correction. No patients undergoing extraperitoneal surgery experienced postradiation small bowel morbidity. Extended field radiation was administered to 17% of patients, and a 30% five-year disease-free survival rate was observed. Although prognostic stratification is enhanced with surgical staging, using current radiotherapy techniques, the majority of patients with paraaortic nodal metastases will fail treatment. Based on our experience, only 2.5% of patients in a Stage IIB-IVA category will benefit from radiotherapeutic treatment decisions made as a consequence of staging laparotomy.