William E. Lucas

Intraperitoneal Cisplatin with Systemic Thiosulfate Protection

Seventeen patients with intraperitoneal tumors were treated by 4-hour intraperitoneal dialysis with cisplatin alone, or in combination with an intravenous neutralizing agent, sodium thiosulfate. Cisplatin alone, 90 mg/m2 body surface area intraperitoneally, produced nephrotoxicity. When intraperitoneal cisplatin therapy was combined with intravenous thiosulfate treatment, the dose of cisplatin could be escalated to 270 mg/m2 body surface area without causing an increase in serum creatinine levels or undue myelosuppression. Even at doses up to 270 mg/m2, no local toxicity occurred. The peak peritoneal concentration of free reactive cisplatin averaged 21-fold higher than the plasma level, and the area under the peritoneal cisplatin elimination curve averaged 12-fold more than the area under the plasma curve. Neither of these ratios varied significantly with cisplatin dose. Regression of intraperitoneal tumor masses was observed in patients with far-advanced ovarian carcinoma, mesothelioma, and malignant carcinoid.

Effect of oophorectomy on circulating testosterone and androstenedione levels in patients with endometrial cancer

Abstract With the use of specific radioimmunoassays, serum testosterone (T) and androstenedione (Δ) levels were measured before and 6 to 8 weeks after oophorectomy in 5 premenopausal and 16 postmenopausal patients with endometrial cancer. In the premenopausal patients, the mean base-line (± standard error) T and Δ levels were 274 ± 15 and 1,811 ± 95 pg. per milliliter, respectively, and fell to 118 ± 13 (T) and 911 ± 97 (Δ) pg. per milliliter. In the postmenopausal patients, the preoperative T and Δ levels were significantly lower (P

Infectious peritonitis in patients receiving intraperitoneal chemotherapy

A total of 32 episodes of infectious peritonitis developed in 90 patients receiving intraperitoneal chemotherapy. Staphylococcus epidermidis was the organism most commonly cultured, accounting for 65 percent of isolates. Result of initial gram stain was positive in 35 percent of cases. The development of fever and abdominal pain as well as rising peripheral and peritoneal fluid white blood cell counts was helpful in the making of a diagnosis of infectious peritonitis. Seventy-five percent of patients were cured with antibiotic therapy alone whereas one quarter also required removal of the semi-permanent catheter. Patients treated with intraperitoneal chemotherapy delivered by dialysis exchange over several days exhibited significantly more episodes of infection than patients treated by a single-drug instillation each month. Although the development of bacterial peritonitis remains a problem during intracavitary chemotherapy, the use of subcutaneous ports and meticulous sterile technique during catheter manipulation will hopefully decrease the risk of occurrence of this potentially avoidable complication.

Adenocarcinoma of the uterine cervix

Fifty patients with adenocarcinoma of the uterine cervix were evaluated retrospectively. Treatment was based on the stage and size of tumors and the overall medical condition of the patient. Radical surgery or surgery in combination with radiation therapy was employed whenever possible. The overall survival rate was 50%, with Stage IB survival 74%. Survival in Stage IB patients was adversely affected by increasing tumor grade and size. This closely correlated with a tendency of the tumors to dedifferentiate as they increased in size. Lymph node involvement increased with increasing grade of tumor as well. Survival in patients with advanced disease was dismal. Survival increased with aggressive management which should, if possible, include surgery in Stage I and II disease.

THE PROBLEM OF POSTTERM PREGNANCY.

Abstract 1. 1. The effect of prolonged pregnancy (past 41 weeks) on fetal and neonatal survival has been analyzed in 63,370 single pregnancies, including 6,624 postterm pregnancies during a recent 2 year period. 2. 2. The perinatal mortality rate at term was 0.7 per cent and postterm was 1.5 per cent. 3. 3. The proportion of infants weighing over 4,000 grams and the incidence of primary cesarean sections done because of cephalopelvic disproportion both doubled postterm. 4. 4. In nulliparas and elderly multiparas there were significant increases in perinatal deaths when pregnancy was prolonged, with the greatest increase occurring in intrapartum fetal deaths in nulliparous patients. 5. 5. Hypertensive disorders and prolonged labor adversely affected the outcome for the postterm fetus. 6. 6. Perinatal death rates directly and indirectly attributable to anoxia more than doubled postterm compared to death rates caused by anoxia at term. 7. 7. The number of postterm infants potentially salvagable by a uniformly safe method of induction of labor at an arbitrary postterm date is relatively small. An inordinately large number of inductions of labor in nulliparas would be required to achieve this result. 8. 8. Induction of labor or cesarean section solely because pregnancy has become prolonged, and in the absence of generally accepted obstetrical indications, would not appear to be justified by the data presented here.

Preoperative whole pelvic external irradiation in stage I endometrial cancer

Between 1966 and 1978, 201 patients with adenocarcinoma of the endometrium were treated at two hospitals in San Diego. Of these patients, 161 had disease limited to the corpus at the time of diagnosis. The majority of these patients received external whole‐pelvic irradiation, followed as soon as possible by simple extrafascial hysterectomy and bilateral salpingo‐oophorectomy. When this treatment method was used, actuarial survivals of 95% for Stage I disease were achieved. Also reported is the low incidence of wound complications in the group of patients operated soon after cessation of irradiation. The patients treated in this fashion had good survival rates, little morbidity from the adjunctive irradiation, and fewer wound complications than previously anticipated.

A study of endocrine and metabolic variables in postmenopausal women with endometrial carcinoma.

Abstract Although an underlying endocrine-metabolic disorder has been implicated as causally related to the development of endometrial carcinoma, data to support such an association are ambiguous and/or contradictory. In this prospective study of 16 consecutive nonobese postmenopausal women with endometrial carcinoma and 16 cancer-free postmenopausal women matched for age and weight, fasting values for growth hormone (GH), insulin, prolactin, follicle-stimulating hormone, luteinizing hormone, estrone (E 1 ), and estradiol (E 2 ) were measured on 3 consecutive days. Intravenous glucose tolerance, pituitary GH release in response to arginine infusion, hyperglycemia, and hypoglycemia, and insulin secretion in response to arginine infusion and to hyperglycemia were analyzed. Our data show that these endocrine-metabolic profiles were not significantly different between the cancer patients and control subjects, suggesting that the postmenopausal woman with endometrial cancer who is not obese exhibits no accountable endocrine or metabolic disorders.

Delayed erosion of intraperitoneal chemotherapy catheters into the bowel. Report of two cases

Erosion of a silastic catheter into the small bowel occurred in two patients who previously had received multiple courses of uncomplicated intraperitoneal (IP) chemotherapy. Although bowel perforation is a recognized complication at the time of Tenckhoff catheter insertion, late erosion of the catheter into the bowel after its use for IP chemotherapy has not been previously reported. Catheter injection with radiographic contrast confirmed the diagnosis, evidence for which included nonspecific clinical findings of intraabdominal infection and pain during chemotherapy infusion.

Estrogen--a cause of gynecologic cancer?

For many years before the first case‐control studies showing an increased risk of endometrial cancer among menopausal estrogen users were published, a considerable body of circumstantial evidence accumulated suggesting a tumor‐promoting role for estrogens in specific target organs. In regard to endometrial cancer, an “estrogen hypothesis” has evolved based on observations such as an increased incidence of endometrial cancer in patients with chronic anovulation and in patients with estrogen‐secreting ovarian tumors; development of endometrial cancer in certain estrogen treated animals; and successful treatment of some metastatic endometrial cancer with progesterone. Since 1975, a number of case‐control studies have appeared relating estrogen treatment of menopausal women to a rising incidence of endometrial cancer. The same cannot be said, with a few exceptions, of studies of breast and ovarian cancer. An understanding of the physiology of the estrogens, particularly in obese women, aids in understanding the possible role of estrogen in promoting endometrial neoplasia. Although the case for estrogens promoting some forms of endometrial cancer is strong, at the present time it cannot unequivocally be stated that estrogens cause any form of cancer in humans.