Jerome L. Belinson

Clinical Stage I adenocarcinoma of the endometrium—Analysis of recurrences and the potential benefit of staging lymphadenectomy

Two hundred forty-eight consecutive patients with clinical Stage I adenocarcinoma of the endometrium were seen between 8/77 and 8/88. Twenty-one were medically not operable and eleven others had papillary serous tumors. The remaining 216 were managed by a consistent operative protocol except that routine preoperative cesium was discontinued after 12/83. Patients received postoperative pelvic radiation on the basis of the depth of invasion, extrauterine pelvic disease, and/or cervix involvement. No patient underwent a pelvic lymphadenectomy. Only palpably suspicious nodes were removed. Twenty-one of these two hundred sixteen patients developed a recurrence. These 21 cases are analyzed for the probability of a staging lymphadenectomy having prevented their recurrence. Median follow-up of all 216 patients is 61 months with a mean time to recurrence of 26.5 months. No patient was lost to follow-up. Patients who recurred are analyzed by grade, depth of invasion, surgical stage, time to recurrence, site of recurrence, survival, protocol breaks, and frozen section discrepancies. No patient recurred on the pelvic side-wall. All patients found to have positive para-aortic nodes have died. No patient who received vaginal and/or pelvic radiation recurred in the pelvis. We conclude that staging lymphadenectomy would not have improved the outcome for these patients.

Uterine mullerian adenosarcoma following adenomyoma in a woman on tamoxifen therapy

The clinical and pathologic findings in a 53-year-old woman who developed a uterine adenosarcoma following an adenomyoma are described. During the interval between the diagnosis of adenomyoma and the subsequent diagnosis of adenosarcoma, the patient developed breast carcinoma and received adjuvant chemotherapy that included tamoxifen. The possible stimulatory effects of this drug upon the patients pre-existing adenomyoma are discussed in view of reports of tamoxifen-associated endometrial carcinoma and uterine sarcomas developing in the setting of estrogen excess.

Primary clear cell carcinoma of the peritoneum

A case of primary clear cell carcinoma of the pelvic and abdominal peritoneum which occurred in a 67-year-old woman and with histological characteristics of Mullerian derivation is presented. To our knowledge, this is the first report of such a case. Although clear cell carcinomas have been previously described in peritoneal or retroperitoneal locations, these have been mass lesions thought to arise from endometriosis. All other cases of diffuse primary peritoneal adenocarcinomas have been of the serous type.

Bleomycin, vincristine, mitomycin-C, and cisplatin in the management of gynecological squamous cell carcinomas

Twenty-one patients with squamous carcinoma of the genital tract were treated with bleomycin, Oncovin, mitomycin-C, and cisplatin (BOMP). Six patients received BOMP as primary therapy. Five of six responded with one patient having an autopsy-proven complete response after treatment for a disseminated adenosquamous carcinoma. Eight patients were treated for early recurrence, none responded. Seven patients were treated for late recurrences and one responded. We believe that BOMP has significant potential for primary treatment, but not for early or late recurrent disease.

Palliative benefit of radiation therapy in advanced ovarian cancer

Fifty-five courses of palliative radiation therapy were given to patients with recurrent epithelial ovarian cancer previously treated with platinum-based chemotherapy. The treatments were evaluated for their effectiveness in palliating a variety of symptoms (bowel obstructions, pulmonary metastases causing dyspnea, CNS metastases causing dizziness and mental status changes, lower-extremity edema, pain, and vaginal bleeding and discharge). In addition, the time commitment to therapy and the symptom-free interval relative to the patients survival from the initiation of radiation therapy were evaluated to assess true palliative benefit.

Management of epithelial ovarian neoplasms using a platinum-based regimen: A 10-year experience

Abstract One-hundred and twenty-four patients with primary advanced ( n = 103) and recurrent ( n = 21) ovarian carcinoma completed a course of platinum-based chemotherapy (cyclophosphamide/doxorubicin/cisplatin or cyclophosphamide/cisplatin) or developed progressive disease while on therapy and were evaluated. All patients were treated between August 1, 1977 and December 31, 1987. The 5-year survival for patients with primary disease was 27% for stage III ( n = 73) and 7% for stage IV ( n = 30). The 5-year survival based on residual disease was 91% for microscopic disease ( n = 13), 24% for disease n = 27), and 8% for disease ⩾2 cm ( n = 64). The 5-year survival for the patients treated with recurrent disease was 5% ( n = 21). Borderline tumors have been excluded. Long-term toxicity, including cardiac toxicity, renal toxicity, and a 5% incidence of second primary tumors, is evaluated.

Stage I carcinoma of the endometrium: A 5-year experience utilizing preoperative cesium

A treatment protocol for the management of stage I endometrial carcinoma utilizing preoperative cesium is evaluated. One hundred and twelve consecutive patients were treated according to this protocol over a 5-year period. Based on this experience and a literature review a new protocol is recommended. The significant changes include primary surgery without preoperative cesium, primary treatment based on grade without regard to uterine size, modified radical hysterectomy for G3 tumors, pelvic radiotherapy for clear cell carcinoma confined to the pelvis regardless of depth of invasion, cytoxan, adriamycin, and cis-platinum for papillary serous tumors, and postoperative vaginal cuff cesium for G2 and G3 tumors not requiring pelvic radiotherapy.

Coexistent breast and vaginal granulocytic sarcoma

A 34-year-old woman developed a granulocytic sarcoma of the breast coincident with the development of acute myelogenous leukemia. Subsequent to the induction of leukemia remission, marrow relapse was preceded by development of breast and vaginal granulocytic sarcomas on two separate occasions. Granulocytic sarcoma is occasionally reported to involve reproductive organs, but the coexistence in two such organs is indeed rare. When granulocytic sarcoma occurs at other sites, it often precedes the development of overt leukemia. For this reason, granulocytic sarcoma should be considered in the differential diagnosis of a pelvic mass especially in a patient in whom blood smears reveal unusual or early forms.

Glassy cell carcinoma of the endometrium responsive to megestrol acetate

A case of glassy cell carcinoma of the endometrium with pulmonary metastasis was responsive to treatment with a progestational agent. We believe this to be the first reported case of glassy cell carcinoma of the endometrium responsive to this form of therapy.

Serum albumin: Its relationship to marrow and renal toxicity from platinum-based combination chemotherapy

One hundred and three patients treated with CAP chemotherapy were evaluated to determine the relationship between low prechemotherapy serum albumin (less than 3 g/dl) and low WBC nadir (less than 2000 cells/mm3). Additionally, the relationship of serum albumin to renal toxicity (delta serum creatinine) was examined. Low prechemotherapy serum albumin appears to be a marker for advanced disease, but does not appear to predict marrow or renal toxicity.