The following articles appeared in this month's issues of the surveyed journals. Articles that seem to be of most interest to the practicing gynecologic oncologist are included. The journals that are surveyed are New England Journal of Medicine, Journal of Clinical Oncology, Gynecologic Oncology, Cancer, American Journal of Obstetrics and Gynecology, Lancet, Cancer Research, Obstetrics and Gynecology, Journal of the National Cancer Institute, Journal of the American Medical Association and American Journal of Surgical Pathology. The participants in this program are the active clinical fellows at Memorial Hospital: Mario Leitao, Christopher Awtrey, Sarah Ferguson, Alan Schlaerth, Destin Black and Margrit Juretzka. The managing editor is Douglas Levine. Comments, questions, complaints and suggestions are always welcome, please E-mail us at: VJC@smgo.org or click here.  To subscribe or unsubscribe to the VJC, click here.

Gynecologic Oncology – Christopher Awtrey

Title: Uterine papillary serous carcinoma (UPSC): a single institution review of 129 cases

Authors: Brian M. Slomovitz, Thomas W. Burke, Patricia J. Eifel, Lois M. Ramondetta, Elvio G. Silva, Anuja Jhingran, Jonathan C. Oh, E. Neely Atkinson, Russell R. Broaddus, David M. Gershenson and Karen H. Lu

Source: Gynecologic Oncology, Volume 91, Issue 3, December 2003, Pages 463-469.

Summary:  As is noted by Dr. Podratz in his editorial concerning this article 2,000 to 3,000 women will diagnosed with UPSC in the U.S. in 2003 and an estimated 55-65% will die of their disease. This accounts for approximately 18-24% of all endometrial cancer-related deaths. Slomovitz et al here review the experience of MDACC from 1989-2002. They identified 129 patients with UPSC who had undergone surgery; the majority of whom (52/129, 40%) had stage I disease. Of patients with stage IA disease 20% recurred.  In the absence of uterine invasion 37% were noted to have either stage III or IV disease.  The authors also found that in unselected cases of patients with stage III disease those that received chemotherapy did better than those that did not.  In all, this article contributes significantly to our basic understanding of this disease.

Click here for abstract from Gynecologic Oncology

Return to top of page

Journal of Clinical Oncology - Mario Leitao

Title: Adjuvant Treatment for Early Ovarian Cancer: A Randomized Phase III Trial of Intraperitoneal 32P or Intravenous Cyclophosphamide and Cisplatin--A Gynecologic Oncology Group Study

Authors: Young, Robert C., Brady, Mark F., Nieberg, Roberta K., Long, Harry J., Mayer, Allan R., Lentz, Samuel S., Hurteau, Jean, Alberts, David S.

Source: J Clin Oncol 2003 21: 4350-4355

Summary: These are the results of GOG 95 which was activated in 1986 and closed to accrual in 1994. Patients with comprehensively surgically staged stage IA/IB (grade 3), IC/II (any grade), and any clear cell ovarian (stage I/II) carcinoma were randomized to receive either IP 32P 15mCi once (10days-6weeks postop) or cisplatin (CDDP) 100 mg/m2 and cyclophosphamide 1g/m2 every 21 days for 3 cycles. There were 251 patients enrolled with 110 randomized to IP 32P and 119 to chemo. Of interest, clear cell carcinomas comprised 26% of the cases. Median follow-up for those patients who were alive was 10 years with 95% of these patients followed for at least 5 years. There was no statistical difference in 10yr recurrence rates or OS between the two groups. Patients who received IP 32P had a 10yr recurrence rate of 35% compared to 28% in those who received chemo (p=0.15). The OS reported as death rate of chemo/IP 32P was 0.83 (p=0.43) after adjustment for stage and grade. There was marginal significant difference in outcome between stage I and II case (p=0.05) and between patients with and without ascites (p=0.05). Patients with clear cell carcinomas did as well as patients with grade 1 tumors. There was inadequate distribution in 7% of patients in the IP arm and 3% developed an SBO. Although the myelosuppressive toxicity was greater with chemo, it was concluded that chemo would be preferable over IP therapy.

Click here for abstract from JCO

Title: Expanded Experience With an Intradermal Skin Test to Predict for the Presence or Absence of Carboplatin Hypersensitivity

Authors: Markman, Maurie, Zanotti, Kristine, Peterson, Gertrude, Kulp, Barbara, Webster, Kenneth, Belinson, Jerome

Source: J Clin Oncol 2003 21: 4611-4614

Summary: The current report includes the experience in 47 patients previously reported. From 10/98-3/03, 126 patients were identified who had received 6 or more prior platinum-based treatments. They all received at least one course of carboplatin-based chemo with preceding skin testing to predict carboplatin hypersensitivity. All received an intradermal injection of 0.02ml of an undiluted aliquot from the carboplatin preparation planned for subsequent infusion. A test was considered positive  if a wheal 5mm or greater in diameter developed within 30 minutes. Borderline positive was defined as any wheal less than 5mm. Overall, there were 717 tests administered with only 1 severe reaction which was successfully treated with diphenhydramine and corticosteroids. All positive tests developed within 30 minutes. 668 tests were interpreted as negative and in 10 occasions (among 7 patients), signs of hypersensitivity to subsequent carboplatin infusion were noted. This gives a false negative rate of 1.5%. These 10 reactions were mild to moderate and easily managed. There were 41 tests, among 39 patients, interpreted as positive. Of these, 7 patients elected to proceed with the carboplatin infusion. 6 (86%) developed a hypersensitivity reaction to the infusion but none were severe. Among the remaining 32 patients with a positive test, 7 subsequently elected to receive the infusion using a desensitization program and 6 were successful. There were 8 borderline tests and, in all, carboplatin was successfully infused. The authors conclude that this test needs to be further validated. However, a negative test appears to be helpful in reducing the rate of carboplatin hypersensitivity. The utility of a positive test is still unclear.

Click here for abstract from JCO

Return to top of page

Journal of the National Cancer Institute – Alan Schlaerth

Nothing of interest this month

Obstetrics and Gynecology – Margrit Juretzka

Title: Clinical significance of serum human papillomavirus DNA in cervical carcinoma

Authors: Keng-Fu Hsu, Soon-Cen Huang, Jenn-Ren Hsiao, Ya-Min Cheng, Saprina P. H. Wang and Cheng-Yang Chou

Source: Obstetrics & Gynecology, Volume 102, Issue 6, December 2003, Pages 1344-1351

Summary: The authors studied the association between serum HPV DNA and clinicopathologic prognostic factors in early stage cervical cancer. They extracted DNA from cervical tissue and serum in 112 patients with stage IB or IIA cervical cancer as well as 40 control patients with cervical carcinoma in situ or benign disease. Of 112 patients with cervical cancer, they found 27 positive serum samples. No HPV DNA was detected in sera from patients with carcinoma in situ or benign disease.  Positive HPV DNA was significantly associated with prognostic factors including lymphovascular invasion, deep stromal invasion, and pelvic lymph node metastasis. As a predictor of patients requiring adjuvant therapy, serum HPV DNA had a sensitivity of 45.2%, specificity of 88.6%, positive predictive value of 70.4%, and negative predictive value of 72.9%.

Click here for abstract from Obstetrics & Gynecology

American Journal of Obstetrics and Gynecology – Sarah Ferguson

New England Journal of Medicine – Mario Leitao

Journal of the American Medical Association – Margrit Juretzka

Nothing of interest this month

Cancer – Destin Black

Lancet – Sarah Ferguson

Cancer Research – Destin Black