Sanford Sall

Androstenedione metabolism in patients with endometrial cancer.

The plasma concentration of androstenedione and the instantaneous conversion of androstenedione to estrone was increased in patients with endometrial cancer as compared to postmenopausal control subjects. Moreover, the per cent of estrone derived from androstenedione was increased in the cancer group.

Extended field para-aortic radiation in cervical carcinoma: The case for prophylactic treatmentt

Abstract With the incidence of para-aortic metastases in Stage IIB through IVA varying between 12 and 50%, the risk-benefit ratio of extended field radiation in advanced disease is not clearly defined. A retrospective comparison study was made of 78 evaluable patients with Stages IIB through IVA disease who were treated with or without para-aortic radiation at the New York Medical College from 1971 to 1975. All patients were followed for a minimum of 2 years. Forty-nine patients were staged IIB and 29 of these received para-aortic radiation; 23 29 (79%) were alive at this writing. Of the 6 patients who died, 3 died of non-tumor related causes. Twenty patients received treatment to the pelvis alone and 2 of these were lost to follow-up. Of the 18 patients who were evaluated, 9 (50%) were alive at this writing. There was no significant difference in survival between the extended field and pelvic radiation groups in the Stage IIIA-IVA patients. Complications were not significantly increased with extended field radiation which delivered 4500 rad to the para-aortic nodes in 5 weeks. Severe complications were seen in patients who had post-irradiation surgery.

Limitations of adjunctive surgery in carcinoma of the cervix

Abstract This study analyzed 41 patients with bulky/barrel-shaped Stage IIB cervical carcinoma. Twenty patients were treated with radical radiation alone. Twenty one patients had post-radiation surgery; ten underwent total abdominal hysterectomy and lymphadenectomy and eleven underwent extrafascial hysterectomy. Histologic review of the submitted specimens showed complete tumor sterilization in all but two. One of these had a microscopic focus of residual tumor with changes suggesting radiation damage; the other had wide-spread disease. All but one of the submitted nodal specimens were negative. Among patients receiving radiation and surgery, there was a 15% incidence of fistulization. In addition these patients had an unusually high incidence (60%) of prolonged (more than 18 months) unilateral and bilateral obstructive uropathy. Patients managed by radiation alone showed a 5% incidence of fistulization and 30% incidence of obstructive uropathy. This high incidence of ureteral obstruction following radiation alone without concurrent disease has not been reported previously. This study questions the routine use of abdominal hysterectomy with or without lymphadenectomy following radical radiation therapy in the treatment of Stage IIB disease and outlines the criteria for the combination of the modalities.

Surgical treatment of stages IB and IIA invasive carcinoma of the cervix by radical abdominal hysterectomy.

From 1963 to 1977, 349 radical abdominal hysterectomies with bilateral pelvic lymphadenectomy were performed for Stage IB (331 patients) and Stage IIA (18 patients) cervical cancer at the New York Medical College, with no operative deaths. Definitive diagnosis was obtained from the biopsy specimen in 281 patients. Twenty-nine patients were pregnant when the diagnosis was established. The average operating time was 4 hours and 48 minutes with an average blood loss of 900 ml. Eleven fistulas were noted: ureterovaginal, 7; vesicovaginal, 3; rectovaginal, 1. Since 1972, there have been no fistulas in 130 radical hysterectomies. Metastatic carcinoma of the regional lymph nodes was discovered in 27 patients for an incidence of 7.7%. Postoperative total pelvic external irradiation was utilized in 40 patients (27 with positive nodes, 10 with microscopic carcinoma in vascular channels, and an additional three patients with an inadequate vaginal extirpation margin). A total of 62% of those patients with poor prognostic criteria receiving postoperative irradiation are alive and well. Two hundred nineteen patients have been followed up for at least 5 years and the survival rate was 90%. Our data support the view that radical abdominal hysterectomy with bilateral pelvic lymphadenectomy is the treatment of choice for patients with Stages IB and IIA cervical cancer in the nonpregnant state, unless there are major medical contraindications.

Glassy cell cervical carcinoma

Abstract Glassy cell cervical carcinoma is a poorly differentiated variety of adenosquamous tumor comprising 1.2% of cervical cancers. It is clinically significant because its biologic behavior is different from that of other cervical cancers, being extremely malignant and poorly responsive to both radiation and surgery. There appears to be a close temporal relationship of this tumor to pregnancy. The clinical-pathological features of seven cases of glassy cell cervical carinoma are reviewed. The development of invasive glassy cell carcinoma through a state of cervical intraepithelial neoplasia has not been noted in our series by cytohistologic evidence. This may depict extreme virulence of this tumor with rapid progression to invasion. Cytology of these lesions, at the time of diagnosis of invasion, is strikingly similar to their histologic appearance. Its biologic behavior suggests that treatment should be more aggressive, possibly including radical surgery, and postoperative irradiation.

A comparison of medroxyprogesterone serum concentrations by the oral or intramuscular route in patients with persistent or recurrent endometrial carcinoma.

A randomized study, comparing serum medroxyprogesterone concentrations by the oral and intramuscular routes, was performed on 22 patients with persistent or recurrent endometrial adenocarcinoma by six institutions of the Gynecologic Oncology Group. The oral group (11 patients) received cutaneous Provera (medroxyprogesterone), 50 mg three times a day, and the intramuscular group (11 patients) received 300 mg of Depo-Provera (medroxyprogesterone) weekly for at least 2 months. Serum levels were evaluated at 0, 2, 4, 6, 8, 10, and 12 hours after administration and every day for the first week and weekly thereafter for 8 weeks. The mean serum levels (nanograms per milliliter) of medroxyprogesterone in the oral group were consistently higher than the corresponding mean levels of the intramuscular group. In addition, from the first through eighth weeks, the measurements (medians) for the oral group were statistically higher than those for the intramuscular group. Although the study indicates a significant increase in serum levels achieved by the oral route, the follow-up period of patients under study is too early to evaluate its clinical effectiveness as compared to the intramuscular route.

The fate of cervical dysplasia

Abstract A total of 168 patients with cervical dysplasia were followed for from 6 weeks to 5 years. In 71 women (42 per cent), a regression of dysplasia was observed. In 59 patients (35 per cent), dysplasia persisted. Progression to or coexistence with carcinoma in situ was found in 30 women (18 per cent). In 8 patients (6 per cent), an invasive carcinoma has finally developed. In view of these findings it is recommended that the treatment of moderate or severe dysplasia should be sharp knife conization. Hysterectomy should be considered in older women and those of high parity.

Surgical management of invasive carcinoma of the cervix in pregnancy

Of 34 patients with invasive cervical cancer complicated by pregnancy, 28 of 29 patients with Stage Ib lesions treated by radical abdominal hysterectomy are alive and one patient with Stage IV disease treated by anterior exenteration is dead. Metastatic nodes were demonstrated in 10.4 per cent of Stage Ib patients. There were no fistulas or major complications. Uterine size and obvious pelvic hyperemia did not present technical difficulty or prevent adequate hemostasis. Because of infrequency of ovarian metastasis, ovarian conservation in this age group is recommended. Radical abdominal hysterectomy is an optimum and safe modality for treatment of Stage Ib cervical cancer complicated by pregnancy.

CERVICAL CARCINOMA IN PREGNANCY.

Abstract 1. 1. Sixty-four cases of cervical carcinoma in 18,200 deliveries are presented, 51 in situ and 13 invasive. 2. 2. Invasive cervical carcinoma, in the pregnant patient, is diagnosed 15 years earlier than in the general population. 3. 3. Full cervical examination in the prenatal patient is mandatory at any time of gestation including cytologic screening and necessary punch biopsies and conizations. 4. 4. Patients with carcinoma in situ of the cervix during pregnancy should be delivered vaginally. The only definitive therapy is total abdominal hysterectomy with a wide vaginal cuff. Any other therapy carries a potential risk. 5. 5. The treatment of invasive cervical carcinoma is dependent upon the stage of the lesion and the trimester of gestation. Delivery of the infant should be by classical cesarean section. 6. 6. Pregnancy only alters the prognosis of invasive cervical carcinoma if the lesion is not diagnosed prior to delivery.

Testosterone metabolism in endometrial cancer

Plasma testosterone (PCT), metabolic clearance (MCRT), and production rates (PRT) of testosterone and conversion ratio of testosterone to androstenedione (CRppTA) were performed on 11 patients with endometrial cancer and on a control group of five postmenopausal women. The PCT, MCRT, and PRT of patients with endometrial cancer are in the normal postmenopausal range. The conversion of testosterone to androstenedione in patients with endometrial cancer was significantly decreased.