Wanda Hinshaw

Radical Surgery Versus Radiotherapy for Adenocarcinoma of the Prostate

AbstractThere were 97 patients with clinical stage A2 or B (T1-2N0M0) prostatic adenocarcinoma and normal serum prostatic acid phosphatase levels, negative isotopic bone scans and no pelvic nodal extension as determined by staging pelvic lymphadenectomy assigned randomly to either radical prostatectomy or megavoltage radiation therapy. While 56 patients received radiation, 41 underwent radical prostatectomy. With time to first evidence of treatment failure used as the end point for determination of treatment efficacy, radical prostatectomy was shown to be more effective than megavoltage radiation in establishing disease control.

Influence of cytoplasmic steroid receptor content on prognosis of early stage endometrial carcinoma

The clinicopathologic associations and effect on prognosis of cytoplasmic steroid receptor content were studied in 168 patients with clinical Stage I and II endometrial carcinoma. Cytoplasmic estrogen receptor status was associated (p less than 0.01) with histologic differentiation, nuclear differentiation, and histologic documentation of extrauterine metastases. Progesterone receptor status was related (p less than 0.05) to histologic differentiation and histologic cell type, and combined estrogen receptor/progesterone receptor status was associated (p less than 0.05) with histologic differentiation, peritoneal cytology, extrauterine metastases, and histologic cell type among the 105 patients who had determination of both estrogen and progesterone receptors. Single-factor analysis revealed significant (p less than 0.05) effects of estrogen receptor status, progesterone receptor status, and estrogen receptor/progesterone receptor status on disease-free survival. All other clinicopathologic features significantly (p less than 0.05) affected prognosis, except for peritoneal cytology. With use of stepwise regression analysis of proportional hazards, estrogen receptor, progesterone receptor, and combined estrogen receptor/progesterone receptor status were significant independent prognostic factors, replacing histologic assessment of glandular or nuclear differentiation in the models. These data suggest that receptor status of primary endometrial carcinomas provides important information relevant to tumor behavior which complements the information provided by conventional clinicopathologic analysis.

Prognosis of patients with stage D1 prostatic adenocarcinoma.

Of 44 patients with clinically localized prostatic adenocarcinoma and regional lymphatic metastases proved by staging pelvic lymphadenectomy 11 were treated by radical prostatectomy, 20 received extended field radiation and 13 were assigned to delayed hormonal therapy. The median survival for the entire group was 39.5 months. None of the 3 treatments appeared superior in prolonging survival. Furthermore, no enhancement of disease control could be demonstrated in either treatment group. Patients with prostatic adenocarcinoma and positive nodes appear to have equivalent adverse biological potential and should be candidates for treatments designed to produce systemic effect.

Venous thromboembolism prophylaxis in gynecologic oncology: A prospective, controlled trial of low-dose heparin

One hundred eighty-five patients undergoing operation for gynecologic malignancy participated in a randomized controlled trial of low-dose heparin prophylaxis. Prospective surveillance for deep venous thrombosis was performed with daily fibrinogen 125I counting in the legs and impedance plethysmography. Twelve of 97 (12.4%) patients in the control group and 13 of 88 (14.8%) patients in the low-dose heparin group developed a venous thromboembolic complication. There was no statistical difference in the incidence of proximal deep vein thrombosis, calf vein thrombosis, or pulmonary emboli between the control and low-dose heparin groups. Low-dose heparin does not afford any prophylactic benefit to patients undergoing major pelvic operative procedures for gynecologic malignancy.

Extended Field Radiation Therapy Versus Delayed Hormonal Therapy in Node Positive Prostatic Adenocarcinoma

This study was undertaken to determine the disease control and survival advantage of either extended field megavoltage irradiation or delayed androgen ablation in a randomized clinical trial. Comparison of the 2 treatments, using either time-to-first evidence of treatment failure or survival, demonstrates an advantage to extended field radiation.

The natural history of postoperative venous thromboemboli in gynecologic oncology: A prospective study of 382 patients

Three hundred eighty-two patients who underwent major operations for gynecologic malignancy were studied prospectively to determine the natural history of postoperative venous thromboemboli. Iodine 125-labeled fibrinogen leg counting, to diagnose deep venous thrombosis, was performed daily. Sixty-three patients (17%) developed postoperative venous thromboembolic complications. Deep venous thrombosis initially arose in the calf veins in 52 patients. Twenty-seven percent of these thrombi lysed spontaneously. Four percent of thrombi in the calf veins progressed to deep venous thrombosis in the femoral vein, and 4% resulted in pulmonary emboli. Nine other patients developed proximal deep venous thrombosis without prior thrombosis in the calf veins. One patient with proximal deep venous thrombosis also had a pulmonary embolus. Two patients with no evidence of deep venous thrombosis on prospective 125I-labeled fibrinogen leg counting developed pulmonary emboli, including one fatal pulmonary embolus that was found at autopsy to have arisen from the internal iliac veins. Fifty percent of all venous thromboemboli were detected within 48 hours of operation, although two patients developed significant deep venous thrombosis and pulmonary emboli after discharge from the hospital. These results add important information to our understanding of this disease process, and raise issues related to appropriate treatment and prophylaxis of venous thromboembolism in patients after gynecologic operations.

Perioperative external pneumatic calf compression as thromboembolism prophylaxis in gynecologic oncology: Report of a randomized controlled trial☆

Postoperative venous thromboembolic complications are a major problem for the gynecologic oncologist. External pneumatic calf compression (EPC), when applied intraoperatively and left on the patients legs for 5 days postoperatively, has been previously demonstrated to significantly reduce the incidence of venous thromboembolic complications in patients undergoing surgery for pelvic malignancies. The purpose of this study is to evaluate whether a short perioperative course of EPC is also effective in preventing venous thromboembolic complications. One hundred ninety-four patients participated in a randomized controlled trial of perioperative external pneumatic calf compression. 125I-labeled fibrinogen scanning and impedance plethysmography were used as prospective surveillance methods in both groups. Venous thromboembolic complications were diagnosed in 12.4% of control group patients and in 18.6% of EPC group patients. External pneumatic calf compression when used only in the perioperative period appears to be of no benefit in reducing the incidence of postoperative venous thromboembolic complications.

Leiomyosarcoma of the uterus: Clinicopathologic study of 21 cases

A detailed clinicopathologic study of 21 patients with uterine leiomyosarcoma was undertaken. The diagnosis of leiomyosarcoma was made for those uterine smooth muscle tumors showing cellular atypia and 5-9 mitoses per 10 high-powered fields (M/10 HPF) and those with 10 or more M/10 HPF. Using these strict pathologic criteria to define leiomyosarcoma, menopausal status, margin type (pushing vs infiltrating), tumor size, grade, location, and the presence of vascular invasion and/or hemorrhage were not associated with prognosis. The 5-year survival rate was 25%. Survival rates were not improved by the use of adjuvant chemotherapy in those patients rendered free of gross disease by initial surgery.

Cytoplasmic estrogen and progesterone receptor content of uterine sarcomas

Analyses of cytoplasmic estrogen receptor and progesterone receptor were performed on tumor specimens from 32 patients with uterine sarcomas. While the median and maximal quantitative levels of binding were lower than those observed in endometrial carcinomas, examples of estrogen receptor- and progesterone receptor-positive as well as estrogen receptor- and progesterone receptor-negative tumors were observed in all histologic categories of sarcomas. The presence of significant levels of estrogen receptor binding correlated (p less than 0.05) with the presence of progesterone receptor. The receptor binding status did not correlate with the histologic type of sarcoma, clinical stage, primary or metastatic tumor, presence of extrauterine metastases, age, previous exogenous estrogen therapy, mitotic count, or overall differentiation or nuclear differentiation of the sarcoma. The overall and nuclear differentiation of the carcinomatous elements of homologous mixed müllerian tumors did not correlate with receptor status. The presence of significant levels of estrogen receptor did demonstrate a trend (p less than 0.10) favoring enhanced survival through short-term follow-up, but this trend was not demonstrated with survival beyond 36 months. Steroid receptor status did not otherwise affect prognosis or disease-free survival. No correlation between receptor content and response to hormonal therapy or chemotherapy was observed.

Radiation Therapy Versus Delayed Androgen Deprivation for Stage C Carcinoma of the Prostate

Seventy-three patients with prostatic adenocarcinoma who were believed to have disease limited to the pelvis without evidence of node or bone extension were assigned randomly to either full-field pelvic radiation (40) or delayed hormonal therapy (33). The interval to first evidence of treatment failure was used as the end point of the study. Failures occurred in 13 patients who received radiation therapy and 11 who received delayed hormonal therapy. No difference in disease response could be identified between the 2 treatment groups.