Thomas W. Castaldo

Intestinal operations in patients with ovarian carcinoma

Forty-two patients with epithelial ovarian carcinoma underwent intestinal operations at the University of California, Los Angeles, and the City of Hope National Medical Center during the course of the disease. The patients were divided into three groups for purposes of this analysis. The first group had intestinal surgery during their initial laparotomy. Patients in the second group underwent intestinal operation at the time of re-exploration for recurrent disease but had no preoperative signs or symptoms of intestinal tract dysfunction, while those in the third group underwent re-exploration for symptomatic intestinal involvement by tumor. Operative complications, postoperative morbidity, and effect of the resection on disease outcome are analyzed for each group in an attempt to define the indications for intestinal resection or bypass in patients with epithelial ovarian cancer.

Endodermal sinus tumor of the clitoris

Abstract A primary endodermal sinus tumor of the clitoris in a 2-year-old is discussed. The serum level of alpha fetoprotein was not elevated. A favorable outcome after exploratory laparotomy and wide local excision might relate to early diagnosis or less virulent patterns of spread secondary to the clitoral location.

Bleomycin-mitomycin C therapy for advanced squamous carcinoma of the cervix

Abstract Ten patients with recurrent or advanced squamous carcinoma of the cervix were treated with bleomycin and mitomycin C. Two of nine evaluable patients (22%) had a complete response to therapy while disease progressed in six and remained stable in one. Despite dose reduction, adverse effects of bleomycin were more common in patients with renal failure and included cutaneous toxicity, stomatitis, nausea, and vomiting. Myelosuppression was encountered in six patients but did not correlate with the functional status of the kidneys. None of the patients experienced pulmonary toxicity.

Verrucous carcinoma of the vulva

Three cases of verrucous carcinoma of the vulva are reported. This variant of epidermoid carcinoma can easily be misdiagnosed if correlation is not made between the clinical and histopathologic appearance. These tumors tend to invade locally and rarely metastasize. Anaplastic transformation has been reported after radiation therapy, making surgical excision the treatment of choice.

Radical vulvectomy and bilateral inguinal lymphadenectomy through separate groin incisions

One hundred patients underwent radical vulvectomy and bilateral inguinal lymphadenectomy using separate groin incisions. Forty-nine had stage I disease, 37 stage II, and 14 stage III. Corrected actuarial 5-year survival for each stage was 97.4, 86, and 49.2%, respectively. Inguinal lymph nodes were positive in 25% of cases: 10.2% of stage I, 27% of stage II, and 71.4% of stage HI cases. Major complications occurred in 21 patients, including major groin breakdown in 14. Thirty patients experienced no acute postoperative morbidity. The mean postoperative hospital stay was 19 days, and mean operative blood loss was 620 ml. No patients developed isolated metastases in either the groin or the inguinal skin bridge, but 2 stage III patients developed simultaneous metastases in the skin bridge and elsewhere. For appropriately selected patients, separate groin incisions for inguinal lymphadenectomy appear to result in lower morbidity than traditional methods, without compromising survival.

Adenocarcinoma of the Uterine Cervix

One hundred patients with primary adenocarcinoma of the uterine cervix were evaluated. Of the 48 Stage I patients, 13 were treated with radical surgery, 16 with radiation alone, and 19 with combination therapy. Life table analysis of Stage I patients showed no significant difference in survival for those treated with radical surgery or combination therapy. Both groups had a greater five-year survival (P less than 0.05) than those treated with radiation. Recurrences in Stage I were more frequent with primary radiation alone, both locally and at distant sites (P less than 0.01). Greater tumor size was related to poorer survival, and failures in patients with larger lesions were more common in those treated with radiation therapy. Survival for the 32 Stage II patients was greater for those treated with combination therapy. Higher tumor grade was associated with poorer survival for each stage, regardless of treatment. More complications were associated with radiation therapy than with radical surgery. Radiation therapy alone is not sufficient for patients with Stage I and II disease, and radical surgery may be appropriate treatment for Stage I disease.

Bleomycin pharmacology in relation to adverse effects and renal function in cervical cancer patients

Clinical toxicity is related to bleomycin pharmacology and renal function in patients with advanced squamous carcinoma of the cervix. Adverse effects were more frequent in patients with severe renal impairment than in patients with adequate renal function. Pharmacokinetic data were obtained in four patients. This information suggests treatment guidelines for the use of bleomycin in patients with renal failure that may reduce the risk of excessive adverse effects. Bleomycin dose reduction of 75% and administration not more often than every 3 days may permit the use of this drug in patients with creatinine clearances of less than 25 ml/min in whom alternative chemotherapy with cis-platinum is not possible.