Roar Sandvei

Randomized study on adjuvant chemotherapy in stage I high-risk ovarian cancer with evaluation of DNA-ploidy as prognostic instrument

Summary Purpose: Adjuvant chemotherapy versus observation and chemotherapy at progression was evaluated in 162 patients in a prospective randomized multicenter study. We also evaluated DNA-measurements as an additional prognostic factor. Patients and methods: Patients received adjuvant carboplatin AUC 7 every 28 days for six courses (n - 81) or no adjuvant treatment (n = 81). Eligibility included surgically staged and treated patients with FIGO stage I disease, grade 1 aneuploid or grade 2 or 3 non-clear cell carcinomas or clear cell carcinomas. Disease-free (DFS) and disease-specific (DSS) survival were end-points. Results: Median follow-up time was 46 months and progression was observed in 20 patients in the treatment group and 19 in the control group. Estimated five-year DFS and DSS were 70% and 86% in the treatment group and 71% and 85% in the control group. The hazard ratio was 0.98 (95% confidence interval (95% CI): 0.52-1.83) regarding DFS and 0.94 (95% CI: 0.37-2.36) regarding DSS. No significant differences in DFS or DSS could be seen when the log-rank test was stratified for prognostic variables. Therefore, data from both groups were pooled for the analysis of prognostic factors. DNAploidy (P = 0.003), extracapsular growth (P = 0.005), tumor rupture (P = 0.04), and WHO histologic grade (P = 0.04) were significant independent prognostic factors for DFS with P < 0.0001 for the model in the multivariate Cox analysis. FIGO substage (P = 0.01), DNA ploidy (P < 0.05), and histologic grade (P = 0.05) were prognostic for DSS with a P-value for the model < 0.0001. Conclusions: Due to the small number of patients the study was inconclusive as regards the question of adjuvant chemotherapy. The survival curves were superimposable, but with wide confidence intervals. DNA-ploidy adds objective independent prognostic information regarding both DFS and DSS in early ovarian cancer.

The incidence of ectopic pregnancy in Hordaland county, Norway 1976–1993

Objective. To gain longterm knowledge of incidence rates of ectopic pregnancy, as a basis for analysing risk factors.

Prospectively detected cancer in familial breast/ovarian cancer screening

BACKGROUND Early diagnosis and treatment are shown to improve survival of breast and ovarian cancer. Identification and medical follow-up of high-risk groups may be important for early diagnosis. METHODS A prospective study of 845 women from breast/ovarian- and ovarian cancer kindreds who were classified according to pre-set inclusion criteria (Table I), were offered genetic counseling and annual medical examinations of breasts and ovaries. The material consisted of three series: 1) 754 unaffected women, 2) 49 women with breast cancer, and 3) 42 women with ovarian cancer. RESULTS In series 1) nine ovarian cancers and 20 breast cancers, in series 2) seven ovarian cancers, and in series 3) three breast cancers were found. All but one of the ovarian cancers were 40 years or older, and 4/16 (25%) were Borderline cancer. All breast cancers were 30 years or older, and 89% were detected before spread. CONCLUSIONS This is to our knowledge the first prospective report of the combined breast/ovarian cancer findings in breast/ovarian cancer kindreds. A woman with both breast and ovarian cancer is the hallmark of inherited breast/ovarian cancer, and 50% of the ovarian cancers were detected in these families. Borderline ovarian cancer may represent a manifestation of this syndrome. If prophylactic oophorectomy prevents ovarian cancer, oophorectomy at age 45 would have prevented 75% of such cancers. Based on these results we revised our protocol for annual follow-up in these kindreds: 1) clinical breast examination and mammography (ultrasound/cytology if indicated) from 30 years of age, 2) gynecologic examination (including vaginal ultrasound, serum-CA125) from 35 years of age, and 3) discuss oophorectomy at 45 years of age.

High Hemoglobin Levels During Pregnancy and Fetal Risk

In a series of 24 apparently uncomplicated pregnancies with small‐for‐dates newborn at or below the tenth percentile, 15 women had hemoglobin (Hb) levels 2 SD above the mean value of normal distribution in late pregnancy. Among these 15 was the only case with intrauterine death of unknown cause. In a series of 15 cases with intrauterine fetal death of unknown cause, before start of labor 10 had Hb levels 2 SD above the mean, while in a series of 16 cases of late abortion where the fetus was alive until labor started, only one had a Hb level 2 SD above the mean. In three cases with serial Hb estimations, the levels were 2 SD above the mean one week or more before intrauterine fetal death. Two of these cases also had been observed during a successful pregnancy in which the Hb levels were within normal limits. It is concluded that high Hb levels during pregnancy may indicate a fetus at risk. High viscosity of the mothers blood may impede the uteroplacental circulation, causing placental infarction, growth retardation and ultimately fetal death.

Successful pregnancy following treatment of primary malignant lymphoma of the uterine cervix

A case of primary histiocytic lymphoma in the uterine cervix of a 22-year-old nulligravid woman is reported. To avoid surgical or radiological castration she received six courses of combination chemotherapy (cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2, vincristine 2 mg all iv on Day 1 and then together with oral prednisone 50 mg twice daily on Days 1-5). Approximately 20 months after therapy she delivered a healthy child. Six years have passed since primary treatment was initiated. No evidence of recurrent lymphoma has been observed.

Laser conization of cervical intraepithelial neoplasia grade 3, Free resection margins indicative of lesion-free survival

BACKGROUND Various grades of cervical intraepithelial neoplasia may occur following laser conization for grade 3 lesions. The aim of this study was to assess lesion-free survival after laser conization in cases with/without free resection margins, and to test whether detection of human papillomavirus infection and/or p53 expression in the cone lesion were useful predictors of lesion-free survival. METHODS In 598 women treated for cervical intraepithelial neoplasia grade 3 the state of the resection margins was recorded and related to the findings on follow-up, up to 15 years post-operatively. Lesion-free survival times were analyzed by the Kaplan-Meier method. The presence/absence of human papillomavirus infection and/or p53 expression in the primary lesion was investigated in every fifth case by in situ hybridization and immunohistochemistry respectively. RESULTS Lesion-free survival was significantly more common after complete than incomplete excision of cervical intraepithelial neoplasia. In the latter, lesions tended to appear shortly after surgery, indicating the presence of residual disease. The few lesions appearing later were evenly divided between those with and those without complete excision. The results of the human papillomavirus and p53 investigations added no further information. CONCLUSIONS The presence of cervical intraepithelial neoplasia in the cone margin gives strong indication of potential treatment failure. In its absence laser conization is highly effective in the treatment of cervical intraepithelial neoplasia, and has the advantage of providing a specimen suitable for the necessary histological investigation.

In situ characterization of leukocytes in the fallopian tube in women with or without an intrauterine contraceptice device

Histological evaluation of sections from the human fallopian tube revealed an inflammatory reaction in 21 of 31 women using an intrauterine contraceptive device (IUCD) and in four of 29 controls (non‐IUCD users). The inflammatory cells were mainly localized at the epithelium‐lamina propria interface and at the center of the mucosal folds.

RADIOIMMUNOASSAY OF HUMAN CHORIONIC GONADOTROPIN β-SUBUNIT AS AN EARLY DIAGNOSTIC TEST IN ECTOPIC PREGNANCY

Abstract. Serum HCG‐β has been assayed in 100 cases of ectopic pregnancy. Results above 10 IU/I were considered positive. Positive values were found in 97 cases, of which 23 were within the range of a normal pregnancy, one was above and 73 below the normal range.

Ovarian Pregnancy Associated with the Intra‐Uterine Contraceptive Device: A survey of two decades

Records of 25 cases of ovarian pregnancy in the period 1965 to 1984 were reviewed. Seventeen cases (68%), had an IUCD in situ, and 15 of these had occurred during the last decade. The ratio of ovarian pregnancy to all ec‐topic pregnancies was 1:13 in the IUCD group versus 1:78 in the non‐IUCD group (p<0.025). In contrast to patients with tubal pregnancies, those with ovarian pregnancy very seldom have a history of pelvic inflammatory disease (PID), infertility, or earlier pelvic operations. Subsequent fertility is good compared with patients with tubal pregnancies, for patients both with and without IUCD.

Fertility Following Ectopic Pregnancy with Special Reference to Previous USE of an Intra‐Uterine Contraceptive Device (IUCD)

A group of 304 women operated on for ectopic regnancy were followed up with respect to subsequent re‐roductive performance. The group was distributed into urrent users, earlier users and non‐users of an intra‐uterine ontraceptive device (IUCD). Pelvic inflammatory disease (PID) and infertility were more common among non IUCD sers. Reproductive performance was statistically signifi‐antly better in ever‐users of an IUCD than in never‐users, ‘he proportions of women wishing to become pregnant and’ ho later gave birth to a live baby in the three groups were 9.2%, 61.4% and 38.0% respectively.