Umberto Villasanta

Complications of radiotherapy for carcinoma of the uterine cervix

Abstract A study was made of the complications found in a group of 641 service patients with carcinoma of the cervix, Stages I to III, who had original treatment by irradiation. Complications in a patient with persistent or recurrent cancer was considered due to malignancy and not to treatment. The most common complications were, in decreasing order: proctitis; vault necrosis; hemorrhagic cystitis; parametritis; rectovaginal fistula; ureteral obstruction; bowel necrosis, obstruction, and perforation; vesicovaginal fistula; etc. The incidence of complications and mortality rate was directly proportional to the amount of irradiation administered to the pelvis, even though a higher tumor dose resulted in a better 5 year survival. Proper application of radium and adequate separation of rectum and bladder from the active source appeared to be of utmost significance in the prevention of serious complications.

Management of adenoid cystic carcinoma of the uterine cervix (cylindroma): report of six cases and reappraisal of all cases reported in the medical literature.

We report 6 new cases of adenoid cystic carcinoma (cylindroma) of the uterine cervix (5, invasive cancer and 1, in situ cancer). All 6 patients were elderly women and 5 were hypertensive. Additionally, 3 (Patients 1, 2, and 4) were obese and 1 (Patient 3) had diabetes mellitus. Three patients were seen because of post‐menopausal vaginal bleeding and 3 were found to have malignant cells on routine exfoliative cytologic examination. Histologically, the tumor cells were relatively uniform, with scanty cytoplasms and a palisading pattern at the periphery of the tumor masses. Round cystic spaces were found in all 6 cases and hyaline nodules were present in some of the cystic spaces in 2. The tumors were found in Stages IA, IB, IIB, IIB, and IIIB (cases 1–4 and 6 respectively), and were treated with irradiation only. There have been only 38 cases of invasive adenoid cystic carcinoma of the cervix reported in the world medical literature. We review the treatment and survival for all 38 cases previously reported and add 5 new cases.

New cancers arising in 1,563 patients with carcinoma of the cervix treated by irradiation

Abstract This report is concerned with the incidence of multiple primary cancers developing in 1,563 patients treated for invasive carcinoma of the cervix. They were all treated by radium and/or external irradiation. Follow-up was complete with the exception of 69 patients (4.4 per cent). Total person years of observation was 8,323. Thirty second primaries of different organs and of different cell type were found. Skin cancers and multicentric squamous-celled cancers were excluded as were synchronous cancers. The observed number of second primary cancers (30) was compared to the expected number (29.2) derived from the Connecticut Cancer Registry, with the use of age- and site-specific incidence rates. No increased incidence of second cancer was found among the patients studied.

Operation, external irradiation, radioactive isotopes, and chemotherapy in treatment of metastatic ovarian malignancies

Abstract Of 169 patients with malignant ovarian tumors, 6 died of postoperative complications, 14 had disease limited to one ovary and were treated by operation only, 10 had disease extending outside the peritoneal cavity and received palliative therapy. The remaining were divided into two groups according to the extension of the disease: 70 patients had malignant growth extending to the pelvis only and 69 had cancer extending to the upper abdomen. Three modes of therapy were used in subsequent periods: (1) operation and external irradiation; (2) operation and irradiation plus radioactive colloidal gold; (3) operation, irradiation, and chemotherapy. Complications of treatment and survival were analyzed in relation to extension and histologic type of the tumor and type of therapy used.

Radium and external irradiation versus radium and operation for early invasive carcinoma of the uterine cervix

Abstract A comparison was made of three series of patients with carcinoma of the cervix, Stage IB, treated with three different methods: radium followed by orthovoltage external irradiation, supervoltage Co 60 external irradiation followed by radium, and radical operation with or without preliminary radium treatment. The group treated surgically had a higher 5 year survival, and a lower incidence of recurrence and complications. Patients treated with orthovoltage irradiation had lower survival and complications, but higher incidence of recurrence than those treated with the supervoltage technique. The incidence of complications, recurrence, and survival was proportional to the amount of irradiation administered. Only operation was found effective in treatment of carcinoma recurrent after irradiation. Statistical analysis has proved the significance of these differences.

Adenocarcinoma of the uterine corpus following irradiation for cervical cancer

Abstract A series of eight cases with an adenocarcinoma of the uterine corpus occurring 5 to 23 years following radiotherapy for cervical cancer is presented and the literature is reviewed. Abnormal vaginal bleeding was the presenting symptom in only 2 of 8 patients and in only 30.7% of 26 collected cases. In none of the 8 patients was the cancer confined to the uterine corpus. Intraabdominal spread or distant metastasis was documented in 5 of 8 patients and in 12 of 26 collected cases (46%). Survival was extremely poor. Regardless of treatment, all 8 patients died of cancer. The longest survival was 5 years and 1 month. Among 29 collected cases from the literature including present series, only 3 survived 5 years or longer without recurrence and 68.9% of those ( 20 29 ) died of the cancer at the time of publications. These unusual clinical features and the grave outcome may simply indicate the advanced cancer at diagnosis and are believed due to delay in diagnosis resulted from infrequent alarming symptom (vaginal bleeding) in these patients. Postradiation stenosis of the cervical canal and/or obliteration of the upper vagina appear to be the main obstacle.

A phase II trial of m-AMSA in the treatment of advanced gynecologic malignancies

THIRTY-TWO PATIENTS with advanced gynecologic malignancies were treated with m-AMSA, 120 mg/m2 intravenously every 3 weeks. Seventeen patients with advanced carcinoma of the cervix who were treated with m-AMSA had a median performance status (CALGB scale) of 2. There were two partial responses (PR) (14%) in 16 evaluable patients. The median duration of survival was 76 days following the initiation of m-AMSA treatment. In ovarian carcinoma, none of the nine evaluable patients who were treated responded. One PR occurred among four treated patients with endometrial adenocarcinoma. Toxicity was limited to myelosuppression (WBC < 2500/μl in 29/77 courses, WBC < 1500/μl in 16/77 courses, platelets < 100,000/μl in 10/77 courses, and drug-induced anemia in 7/77 courses) and mild to moderate nausea and vomiting (10/31 patients). Three patients required hospitalization for fever and granulocytopenia, and one patient died from drug-induced sepsis. Although toxicity was acceptable in this group of heavily pretreated patients, m-AMSA has limited activity in patients with advanced carcinoma of the cervix and no apparent activity in patients with advanced epithelial ovarian carcinomas. Continued trials are indicated in patients with adenocarcinoma of the endometrium.

Follow-up study of ovarian carcinoma by cytology of cul-de-sac aspirates.

Abstract Fifty-four patients with ovarian carcinoma were monitored during chemotherapy with cytology of cul-de-sac aspirates. All patients were then evaluated by laparoscopy and second look laparotomy. There was very good correlation between the cytology of cul-de-sac aspirates and the surgical exploration with the exception of two patients, one of which had only retroperitoneal lymph node metastases. Laporoscopy was found to be much less accurate in this group of patients.

Cyclophosphamide and floxuridine adjuvant chemotherapy for stage III and IV carcinoma of the ovary

Abstract A new combination of two drugs as adjuvant chemotherapy for advanced ovarian malignancies was used in 50 patients with Stage III and IV disease. Intravenous floxuridine and cyclophosphamide were administered in 5-day courses, every 3–4 weeks. There was good response, and this was related to the number of courses of treatment and the amount of residual tumor present after initial surgery. Toxicity was present in almost all patients, but very few had to be hospitalized because of it, and none died of it.

Malignant histiocytic lymphoma (reticulum cell sarcoma) in pregnancy

Abstract Malignant histiocytic lymphoma has been rarely found during pregnancy. The present case appears to be the eleventh reported in the world literature. Its management represented a diagnostic challenge because of the unusual symptoms. Surgery, external irradiation, and chemotherapy produced excellent and lasting results with complete recovery of the mother and an unaffected offspring.