Ken Atkinson

Extraovarian peritoneal serous papillary carcinoma. A clinicopathologic study of 31 cases

The rate and clinical features of patients admitted to King George V Hospital with extraovarian peritoneal serous papillary carcinoma during a 9‐year period were reviewed. In this time, 31 of 236 (13%) patients with an initial diagnosis of invasive serous ovarian carcinoma fulfilled the surgicopathologic criteria for this entity. All patients had disseminated tumor equivalent to ovarian Stage III and IV disease (International Federation of Gynecology and Obstetrics [FIGO]) and with predominantly high‐grade neoplasms. They were managed by surgical exploration, tumor debulking where possible, and postoperative chemotherapy. A comparison with a contemporaneous series of 139 patients with primary epithelial ovarian carcinoma matched for stage and grade of disease and managed similarly showed no difference in actuarial survival. The median survival times were 11.3 months for patients with extraovarian serous papillary carcinomas and 13.5 months for patients with equivalent primary ovarian neoplasms. The features of the disease and the treatment regimens used are discussed.

Cervical carcinoma: A drug-responsive tumor—experience with combined cisplatin, vinblastine, and bleomycin therapy

Thirty-five patients with advanced cervical cancer were treated with a combination chemotherapy regimen comprising cisplatin, vinblastine, and bleomycin (PVB). Sixty-six percent of 33 evaluable patients showed objective tumor response and complete remissions were seen in six (18%) patients. The median duration of tumor response in patients with recurrent cervical cancer was 24 weeks (range 8 to 104 weeks). Multivariate analysis of pretreatment variables including prior radiotherapy did not identify patients with a higher response probability. Nausea and vomiting were usual side effects of chemotherapy and there was one definite treatment-related death. Cervical cancer is responsive to cisplatin based combination chemotherapy. The role of chemotherapy in conjunction with radiotherapy or surgery in the treatment of locally advanced cervical cancer remains to be defined.

The integration of chemotherapy into the management of locally advanced cervical cancer: A pilot study

Chemotherapy has been traditionally reserved as a last-time treatment for cervical cancer patients and in this setting long-term remissions are unusual. Platinum-based combination chemotherapy has been associated with high tumor response rates in patients with advanced and metastatic cervical tumors and past experience encouraged evaluation of chemotherapy as a first-line treatment in patients with locally advanced tumors where there is a high likelihood of relapse with local treatment. Thirty patients were treated initially with three courses of cis-platinum, vinblastine, and bleomycin with an overall response rate of 67%, and then had either radiotherapy or surgical resection. The initial results have been encouraging and the integration of chemotherapy into the management of locally advanced cervical cancer warrants further investigation.

HIGH-DOSE-RATE BRACHYTHERAPY ALONE POST-HYSTERECTOMY FOR ENDOMETRIAL CANCER

PURPOSE To evaluate the outcome of post-hysterectomy adjuvant vaginal high-dose-rate (HDR) brachytherapy. METHODS AND MATERIALS A retrospective analysis was performed on a series of 143 patients with endometrial cancer treated with HDR brachytherapy alone post-hysterectomy from 1985 to June 1993. Of these patients, 141 received 34 Gy in four fractions prescribed to the vaginal mucosa in a 2-week period. The median follow-up was 6.9 years. Patients were analyzed for treatment parameters, survival, local recurrence, distant relapse, and toxicity. RESULTS Five-year relapse free survival and overall survival was 100% and 88% for Stage 1A, 98% and 94% for Stage IB, 100% and 86% for Stage IC, and 92% and 92% for Stage IIA. The overall vaginal recurrence rate was 1.4%. The overall late-toxicity rate was low, and no RTOG grade 3, 4, or 5 complications were recorded. CONCLUSION These results are similar to reported international series that have used either low-dose-rate or HDR brachytherapy. The biological effective dose was low for both acute and late responding tissues compared with some of the HDR brachytherapy series, and supports using this lower dose and possibly decreasing late side-effects with no apparent increased risk of vaginal recurrence.

Chronic Consumptive Coagulopathy With A Uterine Leiomyoma

Summary: A case of benign uterine leiomyoma presenting as chronic consumptive coagulopathy and microangiopathic haemolytic anaemia (MAHA) is reported. Resection of the tumour was followed by recovery of normal haemostatic function. The histological finding of extensive thrombosis of sinusoidal blood vessels within the large tumour suggested interesting pathogenetic relationships.

Gynaecology meets neurology: Paraneoplastic cerebellar degeneration

Paraneoplastic syndromes (PNS) are defined as a constellation of symptoms involving non-metastatic systemic effects which accompany malignant disease. Gynaecological tumours can manifest a variety of paraneoplastic sequelae including neurologic, haematopoietic, vascular, rheumatologic, dermal and endocrine disorders. Neurologic paraneoplastic phenomena occur in less then 1:20 0000 of the population per year. Cerebellar degeneration is a rare and frequently devastating paraneoplastic syndrome which can be associated with gynaecological malignancies amongst others. Despite this rarity, over 50% of those patients over the age of 50 with subacute cerebellar degeneration will be associated with a paraneoplastic phenomena. Overall 90% of all paraneoplastic cerebellar degeneration (PCD) is associated with either lymphoma, lung, breast, or ovarian cancers. The two cases reported here demonstrate the marked variation in clinical outcomes, salient points in workup and treatment for patients with this difficult clinical scenario.

A prospective study assessing patient satisfaction at a large tertiary gynecologic oncology/dysplasia unit.

Background: Patient satisfaction is an important quality assurance measure in the delivery of health care. We conducted a prospective study to assess patient satisfaction at a large tertiary oncology/dysplasia unit. Aims: To assess current patient satisfaction at a large tertiary oncology/dysplasia unit and identify potential areas for improvement. Methods: This was a prospective study of patients attending a tertiary oncology/dysplasia unit. Patients were invited to participate and, if they agreed, were given a validated questionnaire to complete at the end of their consultation. Descriptive statistics were then used to analyze the data and identify potential areas of improvement. Results: One hundred eighty-seven patients were recruited, and 96% of patients were satisfied with the overall level of care received. Significant positive features of the service included helpfulness of the staff, cleanliness of the facility, and measures implemented to respect patient privacy. Lack of patient parking, waiting times in the clinic, difficulties in contacting the service, and locating the building were identified as areas for improvement. Conclusion: Patients attending our facility were largely satisfied with the overall level of care received. Nonclinical factors including parking, waiting times, and access to the service were identified as areas for improvement.

High‐Dose‐Rate Brachytherapy in the Management of Carcinoma of the Cervix: An 8‐year Australian Experience

Summary: High‐dose‐rate brachytherapy was introduced at this hospital for the treatment of gynaecological malignancy in 1985. A retrospective analysis was performed of 103 patients with cervix cancer treated with this technique from 1985 to June, 1993. The patients were analyzed for treatment parameters, response, survival, relapse and toxicity. Five‐year survival was 78% for Stage 1B, 72% for Stage 2A, 42% for Stage 2B and 29% for Stage 3B. The severe late toxicity rate was 4.9%. These results are similar to reported international series that have used either low‐dose‐rate or high‐dose‐rate brachytherapy.

Ovarian carcinoma: Abdominopelvic irradiation following reexploration

Twenty patients with ovarian cancer, who following reexploration were left with residual disease nodules of less than 2 cm diameter, received abdominopelvic irradiation. Of these patients 18 had previous chemotherapy. Fifteen patients completed treatment, 13 of whom had prior chemotherapy. Six of the 18 patients with invasive tumors were alive and disease free 18-53 months postradiotherapy, while only 4 patients had died at the time of follow-up. No patient with residual nodules greater than 1 cm remained disease free. There was no difference in outcome between patients with microscopic or macroscopic less than 1 cm residuum. Complications were acceptable with 3/20 (15%) developing treatment-related intestinal obstruction.

Surgery and post‐operative radiotherapy for early stage cervical cancer

The use of post‐operative radiotherapy in the treatment of cervical cancer is controversial. The aim of this study was to document the results and toxicity of adjuvant irradiation in patients with Stage 1B and 2A cervical cancer.