Leon Adcock

Cisplatin, Vinblastine, and Bleomycin in Advanced and Recurrent Ovarian Germ-Cell Tumors: A Trial of the Gynecologic Oncology Group

STUDY OBJECTIVEnTo evaluate the efficacy of cisplatin-based combination chemotherapy in patients with advanced ovarian germ-cell tumors.nnnDESIGNnNonrandom prospective trial with endpoints of tumor response, results of repeat surgical exploration, progression-free interval, and survival.nnnSETTINGnCooperative university-based cancer study comprising 27 participating institutions.nnnPATIENTSnNinety-seven patients were treated and all were evaluable. Of these, 8 had dysgerminoma and 89 had other cell types.nnnINTERVENTIONSnPatients received 3 to 4 courses of cisplatin. vinblastine, and bleomycin (PVB). After chemotherapy, suitable patients had re-staging laparotomy. Maintenance vinblastine therapy was originally given but was discontinued for all patients in 1981. Patients with persistent or recurrent disease were treated with vincristine, dactinomycin, and cyclophosphamide (VAC) or etoposide plus cisplatin (EP).nnnRESULTSnOf 35 patients with tumors other than dysgerminoma who had clinically measurable disease, 15 (43%; CI, 26% to 61%) had complete responses. Forty of fifty-six second-look laparotomies (71%; CI, 58% to 83%) revealed no tumor or mature teratoma. Forty-seven patients are still disease-free and 59 are alive. The survival rate is 71% (CI, 62% to 89%) and the disease-free rate is 51% (CI, 41% to 62%) at 2 years. Eight patients had durable remissions with second- or third-line therapy. Seven of eight patients with dysgerminoma are also disease-free.nnnCONCLUSIONSnCisplatin-based chemotherapy is effective for patients with ovarian germ-cell tumors, is superior to previous regimens, and will cure a substantial number of 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.

Phase II study of ifosfamide and mesna in patients with previously-treated carcinoma of the cervix

SummaryThirty patients with advanced squamous carcinoma of the uterine cervix recurrent after radiotherapy or surgery and refractory to first-line chemotherapeutic agents were treated with ifosfamide in a dose of 1.2 grams/m2 IV daily for five days every four weeks and Mesna 300 mg/m2 IV every four hours for three doses daily for five days. One patient had an inadequate trial and two were inevaluable for response, leaving 27 patients evaluable for response. All but two patients had received prior radiotherapy and all but one prior cisplatin-based or cisplatin analog chemotherapy. Seventeen patients had prior surgery. All patients were Gynecologic Oncology Group performance status 0, 1, or 2. Partial responses were observed in three patients (11.1%), two with pelvic and one with extrapelvic disease. A 90% confidence interval for the true response rate is 4.5%–24.8%. Severe (grade 3 or 4) leukopenia and anemia were seen in nine and seven patients, respectively. Severe thrombocytopenia was not observed. Three patients had grade 3 or 4 neurotoxicity, and one had grade 3 renal impairment. Reversible alopecia was universal. This dose and schedule of ifosfamide and Mesna is active in patients with squamous carcinoma of the cervix failing platinum-based therapy. Phase II testing in untreated patients is currently underway.

Pseudomyxoma peritonei: a review

Pseudomyxoma peritonei is an uncommon clinical entity. It is characterized by massive abdominal distension by gelatinous material. It is produced by mucous-secreting peritoneal implants which are secondary, usually, to an ovarian or appendiceal neoplasm. Although remaining localized to the peritoneal cavity and hence thought to be a benign process, the clinical course of the disease, the association, in the majority of cases, with a malignant primary tumor, and the report of a small number of cases with extraperitoneal spread lends support to the belief that this is a malignant disease. Five-year survival is 68% with ten-year survival at 52%. Despite the utilization of numerous adjuvant therapies, the mainstay of treatment remains complete surgical debulking at initial presentation followed by palliative debulking for symptomatic relief.

Pseudomyxoma Peritonei ‐ Experience from a Tertiary Referral Centre

Summary: : Pseudomyxoma peritonei is a clinical diagnosis of massive abdominal swelling by a gelatinous material, produced usually from an ovarian or appendiceal primary. It is a rare entity that is usually histologically benign but behaves clinically in a malignant fashion with recurrent growth, although not demonstrating histological stromal invasion. The disease remains localized to the peritoneal cavity and the clinical course is one of repeated episodes of intestinal obstruction caused by extrinsic compression that seem only to be relieved by surgical debulking. Variable responses have been obtained with adjuvant chemo‐, radio‐ and immunotherapy, but these isolated responses are unable to be reproduced and so there is no accepted adjuvant treatment for this disease.