Prognostic significance of peritoneal cytology in patients with endometrial cancer and preliminary data concerning therapy with intraperitoneal radiopharmaceuticals.

One hundred sixty-seven patients with clinical State I carcinoma of the endometrium were treated primarily by operation consisting of total abdominal hysterectomy, bilateral salpingo-oophorectomy, selective pelvic and para-aortic lymphadenectomy, and cytologic testing of peritoneal washings. Twenty-six (15.5%) of the 167 patients had malignant cells identified on cytologic examinations of peritoneal washings.

Surgical aspects of cervical carcinoma.

The surgical therapy of cancer of the cervix has historically been a mainstay of treatment for this malignancy. This manuscript reviews the historical development of surgical therapy for cervix cancer and discusses the role of this modality in modern medicine. Stage I and Stage IIA disease is adequately treated with a radical hysterectomy.

Treatment of women with disseminated or recurrent advanced ovarian cancer with melphalan alone in combination with 5-fluorouracil and dactinomycin or with the combination of cytoxan, 5-fluorouracil and dactinomycin.

The purpose of this study was to determine the efficacy of single and multiple drug chemotherapeutic regimens in the treatment of patients with advanced or recurrent, Stage III and IV, ovarian epithelial carcinoma. Patients were randomly assigned to one of four treatment regimens postoperatively, or at the time of recurrence: Regimen I--Melphalan (MEL) 0.2 mg/kg/day for five days every four weeks; regimen II--MEL as in Regimen I plus 5-fluorouracil (FU) 15 mg/kg/day for five days every four weeks; regimen III--MEL and FU as in regimen II plus dactinomycin (AC) 0.

Value of immune monitoring in gynecologic cancer patients receiving immunotherapy.

Immunotherapy with nonspecific immunopotentiators such as Corynebacterium parvum is under study in several areas of gynecologic oncology. The efficacy of this new modality awaits the results of carefully done clinical trials designed to measure an improved effect on survival when this and similar agents are added to conventional therapy. This report deals with an attempt to demonstrate enhancement of the cell-mediated immune response in a small number of patients with advanced ovarian (18 patients) and cervical (12 patients) cancer who were treated with intravenous C.

A comparison of medroxyprogesterone serum concentrations by the oral or intramuscular route in patients with persistent or recurrent endometrial carcinoma.

A randomized study, comparing serum medroxyprogesterone concentrations by the oral and intramuscular routes, was performed on 22 patients with persistent or recurrent endometrial adenocarcinoma by six institutions of the Gynecologic Oncology Group. The oral group (11 patients) received cutaneous Provera (medroxyprogesterone), 50 mg three times a day, and the intramuscular group (11 patients) received 300 mg of Depo-Provera (medroxyprogesterone) weekly for at least 2 months. Serum levels were evaluated at 0, 2, 4, 6, 8, 10, and 12 hours after administration and every day for the first week and weekly thereafter for 8 weeks.

An alternate approach to early cancer of the vulva.

Early invasive squamous cell carcinoma of the vulva has emerged as a controversial issue in recent literature. Reports illustrating metastatic disease in the inguinal lymph nodes have conflicted with other reports suggesting local treatment only. The morbidity produced by radical vulvectomy to both body image and sexual function make this issue worthy of serious consideration.

Chemoimmunotherapy in the management of primary stage III ovarian cancer: a Gynecologic Oncology Group study.

The effectiveness of chemoimmunotherapy was evaluated in 45 previously untreated stage III ovarian cancer patients. Response rate, progression-free interval, and survival were considerably better than in a similar group of 63 patients treated with a single alkylating agent alone.

Laparoscopy in the evaluation of gynecologic cancer.

Laparoscopy was used to evaluate 60 patients with a variety of known or suspected gynecologic neoplasms. Diagnostic laparoscopy was performed on 18 patients to confirm benign or malignant pelvic masses or to confirm peritoneal carcinomatosis. Ten of these 18 patients (56%) were found to have unresectable carcinomatosis or benign disease which did not require further surgery.

Toxicity manifestations following intravenous Corynebacterium parvum administration to patients with ovarian and cervical carcinoma.

Manifestations of clinical toxicity were evaluated following 341 courses of intravenous Corynebacterium parvum adjuvant immunotherapy in patients with ovarian and cervical carcinoma. Most patients exhibited symptoms of minor toxicity, which decreased in intensity as subsequent courses of therapy were administered. Temperature elevations to 38.

A temporary response of recurrent granulosa cell tumor to adriamycin.

A case is reported of recurrent granulosa cell tumor of the ovary that had failed irradiation therapy and alkylating agent plus antimetabolite chematherapy. Of particular note is the dramatic complete response to single-agent therapy with Adriamycin.

Chemotherapy for mustard-resistant ovarian adenocarcinoma: a randomized trial for CCNU and methyl-CCNU.

In view of the need for drugs which have antitumor activity in alkylating agent-resistant ovarian cancer or which might be more potent than standard agents, a randomized trial of two nitrosoureas, CCNU and methyl-CCNU, has been conducted. Of 31 evaluable patients who received at least one dose of CCNU (100 mg/m2 orally every 6 weeks), there were only two patients who experienced even transient improvement; 18 of these patients had two or more doses over a trial period of greater than or equal to 12 weeks. Of 26 evaluable patients who received at least one dose of methyl-CCNU (150 mg/m2 orally every 6 weeks), there was one patient who experienced transient improvement; this group included 14 patients receiving at least two doses and whose trial lasted greater than or equal 12 weeks.

Clinical and laboratory correlates of molar pregnancy and trophoblastic disease.

From January 1, 1970 to July 1, 1976, 128 women had hydatidiform moles evacuated at the Los Angeles County-University of Southern California Women's Hospitals. Of the 121 patients with follow-up, persistent trophoblastic disease (TD) was diagnosed in 32 (26.4 per cent).

Carcinoembryonic antigen in cancer of the female reproductive system. Serial plasma values correlated with disease state.

The results of plasma carcinoembryonic antigen (CEA) determinations done over 600 patients with gynecologic malignancy will be presented. It would appear from this extensive survey that the likelihood of a patient having a positive value is increased with advancing stage and bulk of disease. The incidence of positive values in patients with clinical recurrence is quite impressive and presents a possible mode of follow-up for patients after standard treatment techniques have been administered for cervical cancer.

Management of carcinoma in situ of the vulva.

Concern about multicentricity and occult invasion has led authorities to recommend total vulvectomy in the management of carcinoma in situ of the vulva (VCIS). Of these considerations, only occult invasion has sufficient import to contraindicate a more conservative therapeutic approach. VCIS is being diagnosed with increasing frequency in young women for whom the deforming and sexually crippling effects of vulvectomy are especially repugnant.

Chemotherapeutic retroconversion of immature teratoma of the ovary.

There has been a growing interest in treating malignant germ cell tumors of the ovary with adjuvant chemotherapy following appropriate surgery. This is a report of 3 patients treated in this manner. Of interest is the finding in all 3 patients of residual mature metastatic teratomatous tissue representing many tissue types.

Pelvic celiotomy in the obese patient.

We have responded to the challenge of surgery in the overweight patient by promoting it to an area of special interest. These individuals should not be deprived of good medical care although their obesity makes the physician's task more arduous and increases the risk of a poor result. With the use of intensive preoperative preparation, including prophylactic antibiotics and heparinization, a modified operative technique, and an active recovery regimen, a more sanguine view toward the surgical care of obese women can be taken.