Julian P. Smith

Carcinoma of the vulva

Carcinoma of the vulva is a relatively uncommon malignancy and accounts for 3%–5% of all gynecologic malignancies in the United States. Preservation of function, as well as anatomy, can be paramount in the decision-making process for the treatment of vulvar cancer. Except for diseases with very limited volume and extent that can be treated with surgical excision only, the majority of cases require multidisciplinary management. Radiation therapy plays a major role in the treatment of vulva cancer. Adjuvant radiotherapy is indicated in patients with certain risk factors of locoregional recurrence after surgery. For locally advanced disease or lesions with extension to the midline structures, concurrent chemotherapy +/- surgery is usually the preferred treatment choice.

Cell-mediated immunity to human malignant cells: A brief review and further studies with two gynecologic tumors

Abstract A growing interest in cell-mediated immune response to human malignant tumors is reflected in the recent reports of several investigators. Some of these are briefly reviewed. In addition, evidence is presented that patients with advanced squamous cell carcinoma of the uterine cervix and adenocarcinoma (serous) of the ovary circulate presensitized peripheral blood lymphocytes which in vitro produce a prompt cytotoxic effect on allogenic tumor cells in tissue culture. Lymphocytes from normal donors were cytocidal only after a “learning” period of 48 to 96 hours. The presence of tumor-specific antigens in these two malignancies is suggested. Observations on the interaction of tumor cells and lymphoid cells are described. A “blocking” or enhancing antibody could not be demonstrated in 22 patients studied with progressive disease.

Review of ovarian cancer at the University of Texas Systems Cancer Center, M. D. Anderson Hospital and Tumor Institute

The records of 2,115 patients with ovarian cancer who were treated at the M.D. Anderson Hospital and Tumor Institute in Houston, Texas, during the 30 year period from 1944 to 1973 were reviewed. Ninety percent of the patients had an epithelial cancer of the ovary. The important prognostic factors include stage and grade of tumor and the presence or absence of ascites. Probably the most important prognostic factor, however, was the size of the largest tumor mass that remained after initial surgery. The patients age and socioeconomic level were also influencing factors in the survival rate in this series of patients. Most of the patients had advanced disease when first examined and received some type of adjunctive postoperative treatment. The survival of patients who received postoperative irradiation, when compared by stage and size of the largest residual tumor mass, was improved over those who received chemotherapy.

Chemotherapy in the treatment of cancer of the ovary

Most of the ovarian cancer patients referred to The University of Texas M. D. Anderson Hospital and Tumor Institute at Houston are not suitable for either curative operation or irradiation because their cancers are too advanced; however, about one-half profit from chemotherapy with l -phenylalanine mustard and about one-half who are not benefitted by l -PAM, will have regression of their cancers with more intensive chemotherapy of actinomycin-D, 5-fluorouracil, and cyclophosphamide. Such chemotherapy often affords sufficient regression of ovarian cancer to allow resection or irradiation or both, and occasionally causes complete and sustained remissions of such cancers.

Second-look operation in ovarian carcinoma: postchemotherapy.

One hundred and three patients with advanced ovarian cancer underwent a second‐look operation following chemotherapy. Patients should have ten or more courses of chemotherapy before second‐look operation. Those patients with no evidence of disease at the second laparotomy should discontinue their chemotherapy. Patients who continued chemotherapy after the second‐look operation did better than those who were treated with radiation after surgery. Only patients with clinical remission benefit from the second‐look procedure. Advantages of second‐look operations following chemotherapy are discussed.

Chemotherapy of ovarian cancer. New Approaches to Treatment

In an effort to develop a more effective treatment regimen for patients with advanced epithelial cancers of the ovary, patients treated with single agent chemotherapy with an alkylating agent; a three‐drug combination of actino‐mycin D, 5‐fluorouracil, and cyclophosphamide; chemotherapy followed by irradiation, and chemotherapy followed by surgery were compared. Only patients treated with chemotherapy followed by surgery had an improved survival over patients treated with a single alkylating agent.

Malignant gynecologic tumors in children: Current approaches to treatment

Abstract Although at one time malignant gynecologic tumors in pediatric patients were almost always lethal, today, with better understanding of the behavior of these tumors and the use of radical measures, some success can be achieved. Specifically, our experience with 33 patients indicated that: (1) location and treatment with adequate irradiation of the sites of metastatic disease may afford the patient with dysgerminoma of the ovary a chance for cure; (2) intensive chemotherapy used in addition to the indicated surgical procedure may benefit children with embryonal carcinoma of the ovary; (3) children with sarcoma botryoides, once a uniformly fatal disease, may be cured with pelvic exenteration; and (4) the combination of chemotherapy and irradiation for patients with rhabdomyosarcoma of the pelvis may prove to be the most effective treatment.

Salmonellosis complicating neoplastic diseases.

The incidence and clinical manifestations of salmonellosis in the population of patients with malignant diseases were studied. Thirty‐three patients with salmonella infections were found among 38,675 new admissions between 1960 and 1968. Fourteen patients had minor infections, and 4 of these were asymptomatic. The remaining 19 patients were seriously ill with salmonellosis: 7 with gastroenteritis, 3 with peneumonia, and 9 with septicemia. Salmonella infections in patients with malignant disease of the hematopoietic system were particularly ominous. Seven of these 16 patients died. All but 3 of the 17 patients, however, with various other tumors, survived their infections.

Systemic chemotherapy for carcinoma of the cervix

Abstract Of 107 patients with recurrent or disseminated carcinoma of the cervix, 19 per cent obtained an objective response to an alkylating agent administered systemically, and 31 per cent obtained a subjective response. Patients who obtain a response to chemotherapy survive approximately 4 months longer than those who fail to do so. Whether a carcinoma of the cervix will respond to a chemotherapeutic agent cannot be determined from the age or race of the patient, or the histologic appearance of the original tumor. Cyclophosphamide is the safest and most easily administered of the chemotherapeutic agents we have employed for recurrent or disseminated carcinoma of the cervix.

Cell-mediated immune reaction to two gynecologic malignant tumors

Peripheral blood lymphocytes extracted from patients with advanced squamous cell carcinoma of the cervix and adenocarcinoma of the ovary were demonstrated to be cytotoxic in vitro to malignant cells of the same origin as grown in tissue culture. The two malignant tumors studied appear to have tumor‐specific surface antigens which behave in a manner similar to transplantation antigens. The interactions between lymphocytes and malignant cells were observed and recorded. Evidence is presented suggesting that patients bearing these malignancies have presensitized peripheral blood lymphocytes capable of immediate interaction in vitro as compared with lymphocytes from normal healthy individuals which exhibit a delayed cytotoxic effect.