Charles E. Welander

Laparoscopic radical hysterectomy with paraaortic and pelvic node dissection

We report the first case of a laparoscopic radical hysterectomy and paraaortic and pelvic lymphadenectomy to treat a stage IA2 carcinoma of the cervix. To our knowledge, a laparoscopic radical hysterectomy with laparoscopic paraaortic lymphadenectomy has not been previously described.

Four ovarian cancers diagnosed during laparoscopic management of 1011 women with adnexal masses

OBJECTIVES This study was conducted to assess the value of laparoscopic management of adnexal masses. Two concerns we wish to address are the failure to diagnose early ovarian cancer at laparoscopy and worsening the prognosis of stage I cancer by spilling fluid during surgery. STUDY DESIGN The setting is a predominantly referral-based, private subspecialty practice. All operations were preformed in the outpatient surgical suite of a large suburban hospital. After extensive patient screenings, which included history and physical examination, preoperative serum CA 125 levels (since 1988), and pelvic ultrasonography, 1209 adnexal masses were managed laparoscopically. RESULTS Of 1011 patients with surgical management, ovarian cancer was discovered intraoperatively in four. CONCLUSIONS Our findings indicate that with consistent use of frozen sections of all cyst walls and suspicious tissue, laparoscopic management did not alter the prognosis. Neither CA 125 level, pelvic ultrasonography, nor peritoneal cytologic testing had sufficient diagnostic specificity to predict malignancy. Experienced surgeons using intraoperative histologic sampling may safely evaluate adnexal mass laparoscopically.

Pretreatment laparotomy in carcinoma of the cervix.

Abstract In cases of advanced carcinoma of the uterine cervix, control of regional pelvic disease is not always equated with survival. While early disease often does remain localized within the pelvis, more advanced cervical cancers are observed to metastasize to paraaortic nodes and to distant sites. This study reports a surgical protocol designed to define extent of disease in patients having invasive cervical carcinoma prior to administering primary radiation therapy. Three questions have been raised: (1) Which individual patients have disease outside the pelvis? (2) Is it possible to modify therapy to control disease outside the pelvis and thereby influence survival? (3) Are positive paraaortic nodes found at pretreatment laparotomy indicative of systemic spread of disease? This pretreatment laparotomy was done on 127 patients, 31 of whom were found to have positive paraaortic nodes (24.4%). Sixteen patients had metastatic disease within the peritoneal cavity. Standard pelvic radiotherapy was subsequently given, supplemented with a paraaortic field in those cases with positive paraaortic nodes. Survival was not significantly different in patients with or without paraaortic nodal disease. It was further noted that 17 of the 31 patients (54.8%) who had positive paraaortic nodes later had distant metastases (median time 8 months), compared to 2496 (25.0%) with negative nodes having a median time to metastases of 10 months.

A phase II study of the efficacy of recombinant interferon gamma in relapsing ovarian adenocarcinoma.

Fourteen patients with relapsing ovarian cancer were treated with a regimen of intravenous interferon gamma (IFNγ). During an initial induction phase, patients received 2 mg/m2 IFNγ intravenously over 2 h daily for 5 days, repeated every 2 weeks for six courses. Patients who responded were continued on a maintenance phase, receiving 3 mg/m2 intravenously over 2 h, twice weekly every 2 weeks for 2 to 6 months. All patients had received prior cisplatin containing chemotherapy regimens. Of the 14 patients entered, 7 completed the six courses of the induction treatment. Four patients were clinical responders and continued on maintenance therapy. The most commonly reported toxicities included malaise, fever, and deteriorating performance status. There appears to be some clinically apparent antitumor activity demonstrated by this dosing schedule of interferon gamma in ovarian cancers.

A phase I trial of recombinant leukocyte alpha 2 interferon in patients with advanced malignancy.

Seventeen patients with advanced, previously treated malignancies were entered into a phase I trial utilizing recombinant DNA produced alpha 2 leukocyte interferon (rIFN-alpha 2). Sixteen patients were evaluable. Patients were to receive rIFN-alpha 2 by either the I.V. or I.M. route for 35 consecutive days. The dosage was identical by both routes, and patients were escalated from 3 X 10(6) to 10 X 10(6) to 30 X 10(6) to 50 X 10(6) and to 100 X 10(6) I.U. every 7 days. No patient was able to tolerate the consecutive treatment protocol as planned. Dose-limiting toxicity was a flu-like syndrome in 10 patients and was usually associated with a fall in performance status. Confusion resulted in study withdrawal for five patients, four receiving rIFN-alpha 2 by the I.M. route. Hematologic and liver function abnormalities were common, usually transient, and not associated with clinical sequelae. One patient with non-Hodgkins lymphoma showed substantial improvement; otherwise, all had stable or progressive disease. Pharmacologic studies indicated substantial serum levels at doses greater than or equal to 10 X 10(6) I.U. regardless of route. No consistent changes in NK activity, lymphocyte subpopulations, or immunoglobulin levels were noted, and no patient developed antibodies to rIFN-alpha 2. The dose and schedule used here indicate that high levels of serum rIFN-alpha 2 activity are obtainable by either the I.M. or I.V. route. Intermittent rather than daily dosage is more likely to be better tolerated and should be considered for phase II trials.

Laparoscopic radical hysterectomy with paraaortic andpelvic node dissection

We report the first case of a laparoscopic radical hysterectomy and paraaortic and pelvic lymphadenectomy to treat a stage IA2 carcinoma of the cervix. To our knowledge, a laparoscopic radical hysterectomy with laparoscopic paraaortic lymphadenectomy has not been previously described.

Growth of Gynecologic Neoplasms in Tissue Culture and as Heterografts

A major challenge to investigators studying human tumors is the development of a laboratory model in which the behavior and response of the tumor is the same or similar to that of the patient. Since the early part of this century [1,2], tissue culture of human cells, both benign and malignant, has been one of the approaches used to understand tumor behavior. The difficulties inherent in tissue culture techniques, particularly in the days before antibiotics were available, prompted investigators to look further, to the study of animal tumor model systems. Recognition of immunologically privileged sites in laboratory animals permitted the first successful growth of human tumors in another species (‘heterografts’) [37–41]. In addition to the use of such immunoprivileged sites for tumor transplantation, methods resulting in total body immunosuppression could be added to enhance the probability of tumor growth in a foreign host [42–45]. It was not until the discovery of the athymic nude mouse, however, that a widespread use of animal heterografts for the study of human cancers was possible [50, 51].