Shaoul O. Anteby

The multimodal approach to the treatment of stage III ovarian carcinoma

A multimodal therapy which consists of aggressive sequential surgery, combination chemotherapy, second look laparotomy and whole abdominal radiotherapy is described. Side effects of the irradiation, which was administered in fractionated doses over seven weeks, included nausea, vomiting, diarrhea and a mild and transient leukopenia and thrombocytopenia. One patient developed an obstruction two months after completion of radiotherapy. Third-look laparotomy revealed small bowel adhesions. Actuarial survival at 2.5 years from initiation of chemotherapy was 84%, a significant improvement compared to a control group of Stage III patients treated with adriamycin and cyclophosphamide. (JMT)

CA-125 is present in significant concentrations in periovulatory follicles of in vitro fertilization patients

OBJECTIVE To evaluate the presence of CA-125 in follicular fluid (FF) and its possible correlation to FF estradiol (E2), progesterone (P) and testosterone (T) and in vitro fertilization and embryo transfer (IVF-ET) outcome. DESIGN Twenty-eight patients undergoing IVF-ET were randomly chosen and 123 FF were sampled. SETTING Clinical IVF-ET program and immunology laboratory for tumor diagnosis in a university tertiary care center. PATIENTS Pure tubal factor patients treated by midluteal (long) gonadotropin-releasing hormone agonist protocol coupled with follicular phase human menopausal gonadotropin. INTERVENTIONS Transvaginal follicular aspiration followed 48 hours later by ET. MAIN OUTCOME MEASURES The 28 treatment cycles resulted in six gestations including five take-home infants. The mean levels (+/- SD) were 30.1 +/- 66.0 U/ML for CA-125, 28.5 +/- 58.1 ng/ML for E2, 2,360.5 +/- 2,846.3 ng/ML for P, and 7.22 +/- 7.08 ng/ML for T. The FF CA-125 levels were found to be widely divergent in different follicles of the same patient. There was no significant correlation between FF CA-125 and E2, P, T, oocyte fertilization, embryo quality, and pregnancy rates. CONCLUSIONS CA-125 exists in significant amounts in FF of periovulatory follicles of IVF-ET patients. Intrafollicular CA-125 secretion is neither interrelated to follicular steroidogenesis nor is correlated to the outcome of IVF-ET.

Combined modality treatment for stage III ovarian carcinoma.

Thirty-eight Stage III ovarian carcinoma patients were treated with a combined modality protocol consisting of sequential initial surgery with a maximal tumor reduction, CHAD combination chemotherapy, second look reductive surgery and whole abdominal irradiation. Sixteen patients (42%) had minimal residual tumors (less than 2 cm) after initial surgery (Stage IIIA) and 22 (58%) had large residual tumors (greater than 2 cm) (Stage IIIB). The patients received 3-14 courses of CHAD combination chemotherapy, with a response rate (CR + PR) in the evaluable (Stage IIIB) patients of 91%. Twenty-eight patients had a second attempt of cytoreductive operation (10 Stage IIIA patients and 18 Stage IIIB patients). In 10 patients no residual tumor was found. In another 12 patients residual tumor (less than 2 cm) was found and completely resected, whereas in six patients a complete resection of large residual tumors (greater than 2 cm) was not possible. Twenty-one of the patients also completed a course of whole abdominal radiotherapy. Radiation was well-tolerated with the usual expected amounts of nausea, vomiting, diarrhea and transient leukopenia and thrombocytopenia. 11/21 (52%) of the patients relapsed within the first 18 months after completion of radiotherapy. The actuarial relapse-free survival at 36 months from completions of radiotherapy was 44%. The actuarial survival for the whole group from diagnosis was 43% at 3 years (70% for Stage IIIA and 41% for Stage IIIB). The data indicated that this combined modality protocol is both feasible and well-tolerated but its curative potential for patients with advanced ovarian carcinoma is as yet unknown.

Castleman disease in pregnancy.

Background Castleman disease, a rare disorder characterized by benign proliferation of lymphoid tissues, generally presents as a solitary mediastinal mass. We report the first case of this disease during pregnancy. Case A 32-year-old woman presented with a large abdominal mass and vaginal bleeding during the second trimester of pregnancy. Abdominal ultrasound demonstrated a large, retroperitoneal solid mass of mixed echogenicity and increased vascularity. The patient underwent explorative laparotomy that revealed a mesenteric mass, histologically consistent with Castleman disease of the hyaline-vascular type. The mass was excised completely, and the immediate postoperative course was uneventful, although the patient went into spontaneous preterm labor during the 29th week of pregnancy. Conclusion Castleman disease should be considered one of the benign etiologies for an abdominal or retroperitoneal mass during pregnancy.

Characterization of ovarian cancer cell metabolism and response to chemotherapy by (31)p magnetic resonance spectroscopy.

We aimed to characterize the (31)P magnetic resonance spectra of various ovarian cancer cell lines exhibiting differences in cytotoxic drug resistance. We examined the metabolic profile of three different ovarian cancer cell lines, OC238, A2780, and A2780-cisplatin resistant (A2780cisR), including their response to various cytotoxic drugs (paclitaxel, cisplatin, and carboplatin) by (31)P magnetic resonance spectroscopy (MRS) in vitro. In the OC238 cell line, there were higher levels of phosphorylcholine, phosphodiesters, and uridine diphosphosugar (UDPS) + nicotinamide adenine dinucleotide phosphate (NADP). In A2780 and A2780cisR cell lines, phosphocreatine gave a high signal, which was absent in the OC238 cell line. In the OC238 cell line, a significant decrease in the glycerophosphoethanolamine, glycerophosphocholine, NADP, and UDPS signals was detected following cytotoxic drug treatment, mainly in response to paclitaxel. A significant increase in the glycerophosphocholine signal was detected following exposure to paclitaxel in both A2780 and A2780cisR cell lines. NADP and UDPS signals increased in response to all drugs in the A2780 cell line; however, in the cisplatin-resistant cell line A2780cisR, no significant change in those signals was detected following cisplatin treatment. We conclude that different ovarian cancer cell lines show characteristic (31)P MRS fingerprints and specific metabolic changes in response to cytotoxic drug treatment.