Nina Einhorn

Adenocarcinoma of the uterine cervix

Between 1958 and 1969, 251 patients were treated at Radiumhemmet in Stockholm for adenocarcinoma of the uterine cervix. The histologic specimens were reevaluated. In the 211 cases of pure adenocarcinoma, the 5‐year survival rate was compared with that in the total of cervical epithelial malignancies. The rate was lower in the adenocarcinoma cases, with respective crude 5‐year survival rates of 84%, 50%, and 9% in Stages I, II, and III. Two modes of treatment, irradiation alone or irradiation plus radical surgery, were used in Stages IB and IIA. The combined treatment gave significantly improved 5‐year survival rates.

Long-Term Follow-Up and Prognostic Factors in Ovarian Carcinoma: The Radiumhemmet series 1958 to 1973

Between 1958 and 1973, 2412 women with epithelial ovarian carcinoma were treated at Radiumhemmet. Of these tumors, 14.5 per cent were of borderline malignancy. The 5-year relative survival rate was 34 per cent among the patients with true malignant tumor and 93 per cent in the borderline cases. Even in advanced stages (IIb-IV) the 5-year survival rate was 78 per cent in the borderline cases. Advanced stage and high age at diagnosis, true malignancy and tumors of serous, clear cell or anaplastic type were associated with poor prognosis. The 5-year relative survival rate of patients with epithelial ovarian carcinoma in an early stage improved during the period, from 67 to 81 per cent.

Cohort Study of the Long-Term Effect of Irradiation for Carcinoma of the Uterine Cervix: Second primary malignancies in the pelvic organs in women irradiated for cervical carcinoma at Radiumhemmet 1914–1965

The risk of second primary malignancy arising after therapeutic irradiation was evaluated in the Radiumhemmet series of carcinoma of the uterine cervix treated in 1914-1965. Only tumours appearing more than 10 years after irradiation were taken into account. Comparisons of observed with expected incidence showed excess of malignancies in urinary bladder, endometrium, ovaries and rectum, but not of colon carcinoma. Comparisons were made with cohorts from the Swedish Cancer Registry.

Systemic Interferon Alpha Treatment of Human Condylomata Acuminata

Condyloma acuminatum is one of a group of human papillomas whose viral origin was demonstrated more than 70 years ago (4). The causal virus has the ability to induce papillomatous proliferation in skin and mucosa. Infectious papillomas are basically of three types the common wart (verruca vulgaris), the flat wart (verruca plana) and the condylomatous type. Cell-mediated immune mechanisms seem to play a major part in spontaneous regression or progression of papillomatous warts. This is indicated by enhanced proliferation of papilloma after immunosuppression or in congenital immunodeficiency of cell-mediated responses ( 5 , 10, 11, 12). Frequent sites of condylomata acuminata are the vulva, vagina and penis. In exceptional cases the growth occurs within the urethra, bladder and ureter. The usual treatment is with podophyllin or surgery combined with diathermy. Condylomata acuminata occasionally become resistant to therapy, most commonly in patients with immune deficiency. There are numerous case reports of malignant conversion of persistent genital warts in humans, and it would seem that at least 5% of vulva1 carcinomas arise within such warts (1, 8, 9, 14). For this reason, and because of the inconvenience experienced by the patients, treatment of genital condylomata is important. Local application of impure IFN preparations on condylomata acuminata has been used with promising results. Systemic interferon (IFNa) treatment has been successfully used in other disorders probably caused by human papilloma virus plantar warts and juvenile laryngeal papillomatosis (2, 6, 7, 13). These results prompted us to try systemic IFNa treatment for persistent and severe condylomata acuminata in a young woman. PREPARATION OF INTERFERON

Frequency of Severe Complications After Radiation Therapy for Cervical Carcinoma

An analysis of a material of 265 patients treated by radiation therapy for cervical carcinoma was performed with respect to severe complications. The complication rate in patients free of recurrence was 1.9 per cent and in those with recurrence 23 per cent, which indicates that severe complications are often caused by recurrence of the tumour.

INCREASE IN ANTIBODY TITER AGAINST THE EBV-ASSOCIATED MEMBRANE ANTIGEN COMPLEX IN BURKITT'S LYMPHOMA AND NASOPHARYNGEAL CARCINOMA AFTER LOCAL IRRADIATION.

Sera of 2 African patients with Burkitts lymphoma and 3 with nasopharyngeal carcinoma were examined for antibodies against the EBV‐associated membrane antigen complex by titrating their blocking activity against an FITC‐conjugated reference immunoglobulin (F‐Mutua)derived from a case of Burkitts lymphoma in long‐term remission. The sera were tested beforeat the terminationand 6‐9 weeks after applying local radiotherapy to the tumor. Burkitt lymphoma‐derivedEBV‐carrying lymphoblastoid cell lines were used as target cells. Three patients with other tumors receiving radiotherapy served as controls (a case of Hodgkins diseaselaryngeal carcinoma and lymphosarcomarespectively). Six to 9 weeks after irradiation of the tumorthere was a significant increase in the titer of membrane‐reactive antibodiesin both cases of Burkitts lymphomaand in all 3 cases of nasopharyngeal carcinomabut not in the “control” tumors.

Effect of Radiation Therapy on the Mitogenic Response of in vitro Irradiated Human Lymphocytes to Phytohaemagglutinin

Irradiation of human peripheral lymphocytes in vitro reduces their capacity to be triggered to DNA-synthesis by PHA in a two-dose shaped fashion suggesting the presence of one relatively radiation sensitive and one relatively resistant cell population. Intracavitary and external radiation therapy for carcinoma of the uterus and vagina, which reduced the lymphocyte counts by approximately 66 per cent, did not significantly change the ratio of these subpopulations, indicating that PHA-reactive cells cannot be grouped into radiation sensitive and resistant subpopulations.

Aspiration Biopsy of Intrapelvic Metastases of Cervical Carcinoma

The findings at aspiration biopsy of palpable intrapelvic lesions were reviewed in 316 patients who had previously received radiation therapy for carcinoma of the uterine cervix. A cytologic diagnosis of malignant spread had been made in 55 cases. The crude five-year survival rate in these patients was 4 per cent, as compared with 51 per cent among the patients who received a negative cytologic report. Aspiration biopsy was positive in only about 48 per cent of the patients in whom follow-up observations suggested intrapelvic spread of carcinoma. The factors that may have influenced the diagnostic accuracy are discussed. Use of a screw (0.5 mm thick) technique instead of the 22-gauge needle may enhance the diagnostic accuracy.

TREATMENT OF ADVANCED CONDYLOMATA ACUMINATA WITH SEMI-PURIFIED AND PURIFIED HUMAN LEUKOCYTE INTERFERON

Twelve patients with advanced condylomata acuminata were treated by systemic human leukocyte interferon (IFN) therapy. Semi-purified and purified preparations were both able to affect condylomatous growth. Treatment of the patients at various periods of their disease resulted in one complete remission, 6 partial remissions, 4 minimal responses while one case showed progressive disease. Side-effects were unexpectedly common in these advanced patients and 4 of them had to stop IFN treatment.

Prophylactic Salpingo‐Oophorectomy in Cancer of the Cervix

Abstract. It is considered that the presence of infection during the course of treatment for cancer of the cervix can have a bearing of the prognosis (3, 5, 6, 7, 9, 14, 22). In a number of series the survival rate has been lower for such patients suffering from pelvic infection than it has for those without such infection. That agressive treatment of infection during the therapy can greatly improve the survival rate was observed by Heyman (9) and Kottmeier (14). Irrespective of the stage reached in the treatment of the cervical cancer, Kottmeier recommended immediate salpingo‐oophorectomy in patients with acute salpingitis (15). He reported that this measure improved the 5‐year survival rate for these patients from 14 to 66% (15). He also reported 5‐year survival rates of 21 and 56% for patients with and without infection, respectively (14).