John E. Savage

Prognostic significance of the presence of human papillomavirus DNA in patients with invasive carcinoma of the cervix

Cases of invasive carcinoma of the uterine cervix were analyzed to determine whether the presence or absence of human papillomavirus (HPV) DNA in the neoplasms was a contributing factor to their outcome. The presence of HPV DNA was evaluated using in situ hybridization on formalin‐fixed, paraffin‐embedded tissue sections. Eighty‐five patients with cervical carcinoma who had been surgically evaluated were included in the study. Data from these patients was analyzed retrospectively to determine survival, recurrence, presence of nodal metastases, tumor grade, mode of therapy, peritoneal fluid cytologic results, and age in relation to presence or absence of HPV DNA. No significant statistical differences were found between the HPV‐16‐positive, HPV‐18‐positive, and HPV DNA‐negative patients.

The morbidity and utility of periaortic radiotherapy in cervical carcinoma

From 1971 through 1981, 81 women received 4350 to 5075 rad to the periaortic lymph nodes as part of their primary management for carcinoma of the uterine cervix. While two patients developed chronic small bowel damage, only one required surgical intervention. Five-year disease-free survival was 40%. Approximately one-third of the first recurrences were within the pelvic and periaortic radiation portals, with the remainder in the lungs, liver, bones, abdomen, and supraclavicular lymph nodes. Radiation dose and volume guidelines are presented in order to minimize enteric morbidity.

Adenocarcinoma of the endometrium with trophoblastic differentiation and metastases as choriocarcinoma: a case report

Nongestational choriocarcinoma is seldom observed outside of gonads or teratomas. No case of choriocarcinoma arising in endometrium is reported in the literature. Here we present a 70-year-old female with endometrial adenocarcinoma focally differentiating to choriocarcinoma, and metastasizing to liver, kidney, brain, and lung as pure choriocarcinoma. Foci of trophoblastic differentiation in the primary endometrial lesion and metastatic lesions are positive for hCG by immunocytochemical stain. This case is similar to gastrointestinal and lung carcinomas that contain trophoblastic change. Possible histogenesis of this tumor is discussed.

Prognostic importance of progesterone and estrogen receptors in cancer of the uterine cervix

Tissue levels of cytosolic estrogen receptors (ERc) and progesterone receptors (PRc) have been shown to have prognostic meaning in hormonally responsive cancers arising in the breast and endometrium. Although carcinomas of the uterine cervix rarely respond to hormonal manipulation, the normal cervical stroma and epithelia contain ERc and PRc. To study the prognostic value of these receptors, 65 cervical carcinomas for ERcand PRcwere assayed before initiation of surgical or radiation therapy. In premenopausal women, logistic models demonstrated that clinical stage, surgical stage, and receptor level independently predict survival. If confirmed in further studies, ERc and PRc may prove to be useful prognostic factors in the management of cervical carcinomas.

Effect of cis-platinum on tolerance to radiation therapy in advanced cervical cancer.

Women with advanced carcinoma of the uterine cervix are at high risk for the development of local, regional, and distant metastases. Thus, both effective systemic agents and radio-sensitizers could be useful adjuvants. However, because a substantial fraction of women with advanced cervical neoplasms are cured with radiation therapy, such experimental agents must not compromise the administration of conventional therapy. Cis-platinum is particularly appealing as it has both radiosensitizing properties and activity in metastatic cervical cancer. The present study examined the effect of weekly cis-platinum on radiation tolerance in 29 women with advanced cervical cancers. Although toxicity was acceptable, no marked enhancement in survival could be demonstrated.

Carcinoma of the cervix, FIGO Stage IB: Treatment failures

All patients with carcinoma of the cervix, FIGO Stage IB, treated at the University of Minnesota Hospitals during a 10-year period were reviewed. Of the 220 patients 31 (14.0%) developed recurrent disease and did not survive. Thirteen patients had pelvic wall recurrences, with concurrent cervical involvement. No patient had a resectable pelvic recurrence. Hysterectomy was subsequently performed on 10 of the 172 patients who received radiation therapy. Carcinoma was not present in any of the operative specimens although two patients with adenocarcinoma later died of metastatic cancer. Median time of recurrence was 9 months, with median survival following recurrence of 6 months. Cervical cytology was not of value in the early diagnosis of recurrent disease. The 5-year adjusted actuarial survival rate for patients with adenosquamous carcinoma was significantly lower than that for patients with squamous cell carcinoma. The median age of patients not surviving with adenosquamous carcinoma was significantly lower than that for patients not surviving with squamous cell carcinoma. Patients with invasive carcinoma presumably confined to the cervix may have disseminated disease. It is essential such selected patients receive primary treatment that includes systemic therapy.

Concurrent weekly cis-platinum and radiotherapy in advanced cervical cancer: A preliminary dose escalating toxicity study

Concurrent weekly cis-platinum in a dose escalating manner and conventional radiotherapy was evaluated in advanced cervical cancer. The toxicity of weekly cis-platinum given 2 hr before standard fractionation of radiotherapy was assessed using the modified GOG toxicity criteria. Sixteen patients having parameters indicating high risk for conventional therapy failure including positive pelvic and paraaortic nodes and intraperitoneal spread were entered. There was no life-threatening toxicity. The toxicity of the administered chemotherapy was only moderate. Patient compliance was good as at the 20 mg/m2 dose level, 79% of the prescribed doses were administered. The use of adjuvant cis-platinum in poor prognosis advanced cervical cancer merits further study.

Infectious morbidity in gynecologic cancer

Abstract A retrospective investigation of infectious morbidity in gynecologic oncology patients documented that 54 (11%) of 494 patients and 68 (6%) of 1204 patient admissions were complicated by a serious infection. The highest rate of infectious morbidity by admission was 21%, occurring in patients admitted for cancer of the vulva. The highest surgical infectious morbidity, 22%, occurred in patients admitted for cervical cancer. important factors in determining infection risk include multiple host factors, radical surgical procedures, factors inherent in the tumor itself, and additional irradiation and chemotherapy. These serious polymicrobial infections dictate intelligent selection of antimicrobials and appropriate monitoring to anticipate complications inherent in antimicrobial therapy. β-Lactamase induction, superinfection, nephrotoxicity, and necrotizing enterocolitis are documented problems in these patients.