Gunter Deppe

Improved chemotherapy for ovarian cancer with cis-diamminedichloroplatinum and adriamycin

In a prospective controlled randomized trial, patients with advanced ovarian carcinoma (FIGO Stage III or IV) were treated with cis‐diamminedichloroplatinum (II), (DDP), alone, DDP and Adriamycin (ADM), or Triethylenethiophosphoramide (ThioTEPA) and methotrexate (MTX). DDP alone produces objective responses in 31% of evaluable patients, ThioTEPA and MTX in 36%. The combination of DDP and ADM produces the best response rate, 80% (.01 2 cm, residual tumors failed to produce their usual adverse effect on prognosis when patients were treated with the two DDP regimens. Patients with poorly differentiated tumors or tumors of unknown grade treated with platinum or DDP‐ADM experienced better survival than similar patients treated with ThioTEPA (P = .01).

The rare indication for splenectomy as part of cytoreductive surgery in ovarian cancer

Advanced ovarian carcinoma is being treated with aggressive debulking surgery including complete removal of the tumor whenever possible followed by adjuvant therapy. Secondary debulking including splenectomy in a patient with recurrent ovarian carcinoma is reported. It is suggested that splenectomy may have a place in the management of a few patients with ovarian cancer. The technique and complications of splenectomy are described.

Combination chemotherapy for mixed Müllerian tumor of the fallopian tube

A patient with mixed müllerian tumor of the fallopian tube was treated with cyclophosphamide and cisplatin. The regimen achieved a complete remission. No severe drug‐related toxicity occurred.

Non‐puerperal traumatic vulvar hematoma

Two patients with non‐puerperal traumatic vulvar hematoma due to physical assault are presented. Based on a review of the literature and our experience, a protocol for treatment is described with individualization of therapy emphasized.

Sciatic Nerve Injury

Abstract. A case is presented of injury to the sciatic nerve at the time of resection of a retroperitoneal lipoma. The diagnosis, treatment and prognosis of this surgical complication are discussed.

Multiple primary neoplasms of the upper female genital tract

Abstract Synchronous multifocal primary malignant neoplasms of the upper female reproductive system are becoming more commonplace. Although their origin is in dispute, an embryological etiology has been postulated. An unusual combination of ovarian carcinoid, ovarian cystadenocarcinoma, and uterine adenosquamous carcinoma is reported, lending support to the theory of area response of embryologically related organs in the genesis of multiple multicentric gynecological neoplasms.

Serum lactic dehydrogenase (SLDH) in germ cell malignancies of the ovary

Serum lactic dehydrogenase may be elevated in patients with various neoplasms. In this report the authors describe four patients with ovarian germ cell malignancies who had elevated serum lactic dehydrogenase prior to treatment. There was a consistent correlation between these marker levels and the course of the disease. These preliminary data suggest that measurement of lactic dehydrogenase in sera of patients with ovarian germ cell malignancies may be helpful in assessing the effect of therapy.

TREATMENT OF ADVANCED ENDOMETRIAL CARCINOMA WITH CISPLATIN, CYCLOPHOSPHAMIDE AND DOXORUBICIN

Abstract. A patient with advanced adenocarcinoma of the endometrium was treated with cisplatin, cyclophosphamide and doxorubicin. This regimen achieved surgically proved complete remission. No severe drug‐related toxicity occurred.

Carcinoembryonic Antigen as a Clinical Tumor Marker

Human tumors may produce isoenzymes, isohormones, or a variety of other substances. These tumor cell products are commonly referred to as tumor markers. With the development of radioimmunoassay systems most of these products can be measured in serum, urine, and tissue preparations. One group of tumor-derived products is the oncofetal antigens, of which the carcinoembryonic antigen (CEA) has been the most extensively studied. Carcinoembryonic antigen is a perchloric acid-soluble glycoprotein, which has a molecular weight of approximately 200,000. Gold and Freedman introduced the term CEA to describe an antigen detected with a heterologous antiserum in tissue extracts from adenocarcinoma of the colon. Carcinoembryonic antigen was also present in the fetal gut during the first and second trimesters of pregnancy but absent in the third trimester and in extracts of normal adult colon. An adult-type normal colon antigen appeared to replace CEA in the fetal colon during the third trimester. However, in the presence of a carcinoma of the large intestine CEA was found to be elevated. Initially it was thought that the presence of CEA in the adult might provide a method for identifying patients with colorectal cancer. But increasingly sensitive methods for measurement of CEA have demonstrated elevated CEA levels in many benign conditions (inflammatory bowel disease, chronic heavy smoking, liver disease, etc) and in many neoplasms arising outside the gastrointestinal tract, including bladder, ovarian, endometrial, cervical, breast, and lung. Because of this overlap in the distribution of CEA values in patients with benign conditions and tumors of different origin, CEA is not useful in the screening of an asymptomatic population to detect cancer. However, in a symptomatic patient a CEA value greater than five to ten times the upper limit of the reference normal range is suggestive for the presence of neoplasia. In that particular patient further work-up is necessary to rule out the absence of cancer. In this issue of the AJRI Cillari and his associates report findings suggesting that measurement of serum CEA can be used as an adjuvant test to monitor patients with metastatic and nonmetastatic breast cancer. Cillari et al describe a correlation between the trend of serial CEA values and response to therapy and development of metastases. However, they show that the correlation between rising CEA levels and progressive breast cancer is not always perfect and that metastases occur in CEA-negative patients. In light of these findings and findings by other changes in CEA titers may be of value in reflecting response to chemotherapy in patients with metastatic breast cancer. Carcinoembryonic antigen is elevated in about 50% of patients with gynecologic malignancie~.~ Following therapy, progressively rising plasma CEA titers usually indicate tumor recurrence and may necessitate a work-up to identify metastases. At present the role of CEA in posttherapeutic monitoring is most convincing in patients with colorectal ~ a n c e r . ~ Measurement of plasma CEA is the best available noninvasive technique to detect recurrence of colorectal cancer and it may have a role in selecting patients for second-look laparotomy.6 More trials are needed to evaluate the exact role of CEA determinants for initiating or changing therapy in patients with other types of cancer; but CEA has already established itself as a valuable adjunct in the management of cancer. As further advances are made in the diagnosis and treatment of cancer, CEA and other tumor cell markers will become even more useful for the oncologist.