Nothing of interest this month

Authors: ASCUS-LSIL Traige Study (ALTS) Group.

Source:  Am J Obstet Gynecol 2003 Jun;188(6):1383-92.

Summary: A total of 3488 women with community-based ASCUS interpretation were randomized to 3 management arms. The 2 year cumulative diagnosis of CIN 3 was 8 to 9% between all three arms. The immediate colposcopy (IC) group detected 53.6% of CIN3 with a 100% referral rate for colposcopy. This compared to a 72.3% sensitivity with 55.6% referral rate for HPV triage group. The conservative management group had a sensitivity for detecting CIN3 of 54.6% while referring only 12.3% to colposcopy. A single HPV test identified 92% of women with CIN3 whereas serial cytology would have required two tests to achieve a detection rate of 95.4%, however 67.1% of women would have been referred for colposcopy. In conclusion HPV triage is as sensitive as the IC option for detecting CIN3 but refers half as many women to colposcopy.

Title: A randomized trial on the management of low-grade squamous intraepithelial lesion cytology interpretations.

Authors: ASCUS-LSIL Traige Study (ALTS) Group.

Source:  Am J Obstet Gynecol 2003 Jun;188(6):1393-400.

Summary: The objective of this study was to compare alternative initial strategies for LSIL cytology. A total of 1572 women were randomized to 3 management arms. The main endpoint was 2-year cumulative diagnosis of CIN 3. A total of 15% of women in each arm had CIN3 by the end of 2 years. The HPV triage arm was closed b/c more than 80% were HPV positive. Conservative management (CM) of repeat cytology with referral to colposcopy for HSIL referred 19% of women while detecting 49% of CIN3. Immediate colposcopy (IC) arm detected 56% of CIN3. They concluded that LSIL cytology is highly reproducible and most are oncogenic HPV positive thus HPV testing for initial management should be avoided. In addition CM was not sensitive for timely detection of CIN 3. The conclusion of the paper was to refer for IC because no efficient triage management strategy was identified to detect CIN2/3.

Nothing of interest this month

Title: Laparoscopic Sentinel Lymph Node Procedure Using a Combination of Patent Blue and Radioisotope in Women with Cervical Cancer

Authors: Emmanuel Barranger, Dany Grahek, Annie Cortez, Jean Noel Talbot, Serge Uzan, Emile Darai

Source:  Cancer, Volume 97, Issue 12, 2003. Pages: 3003-3009.

Summary: Thirteen women with early-stage cervical cancer underwent a laparoscopic sentinel lymph node (SN) procedure after both radioactive isotopes and patent blue injections.  After the procedure, all patients underwent laparoscopic pelvic lymphadenectomy and either laparoscopic radical hysterectomy or the Schauta-Amreich operation. SNs were detected in 12 of the 13 patients.  No lymph node involvement was detected in sentinel nodes with hematoxylin and eosin staining.  However, immunohistochemical studies identified four metastatic SNs in two patients.  No metastatic lymph nodes were found when the sentinel nodes were negative. The data suggest that SN detection with a combination of radiocolloid and patent blue is feasible in patients with cervical carcinoma using a minimally invasive approach.

Click here for abstract from Cancer

Title: Paclitaxel plus platinum-based chemotherapy versus conventional platinum-based chemotherapy in women with relapsed ovarian cancer: the ICON4/AGO-OVAR-2.2 trial

Authors: The ICON and AGO Collaborators

Source:  Lancet 2003; 361: 2099-106

Summary: This study was a multicenter international trial combining two parallel trials run between January 1996 and March 2002 to determine the effect of paclitaxel plus a platinum-based chemotherapy compared to platinum-therapy alone in platinum-sensitive recurrent ovarian cancer.  There were 802 patients randomized and over 72% were treated with six cycles of chemotherapy. The two groups were similar for multiple important characteristics. After a median follow-up was 42 months, the absolute difference in 1-year PFS was 10% in favor of paclitaxel plus platinum (HR = 0.76, 95% CI=0.66-0.89, p=0.0004). The authors concluded that paclitaxel plus platinum chemotherapy seems to improve survival and progression-free survival among patients with relapsed platinum-sensitive ovarian cancer compared with conventional platinum-based chemotherapy.

[Ed. Note - This study does not address the use of platinum and paclitaxel as sequential therapy in the recurrent setting.  While it appears clear that the combination is superior to platinum alone, based upon the data presented, it is not clear if this combination would be superior to the same drugs given in sequence.  As well, not all patients received paclitaxel as part of their upfront therapy and some of those pts were then randomized to platinum alone resulting in a subset of patient who were never given the benefit of paclitaxel based therapy as any part of their treatment]

Click here for abstract from The Lancet

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Cancer Research – Destin Black

Title: An Interleukin-6 Gene Promoter Polymorphism Influences the Biological Phenotype of Ovarian Cancer

Authors:  Lukas A. Hefler, Christoph Grimm, Sven Ackermann, Sabine Malur, Amir R. Radjabi-Rahat, Sepp Leodolter, Matthias W. Beckmann, Robert Zeillinger, Heinz Koelbl, and Clemens B. Tenpfer

Source:  Cancer Res 2003 63: 3066-3068.

Summary: Interleukin (IL)-6 is thought to be involved in the pathogenesis of ovarian cancer.  The authors genotyped 121 patients with ovarian cancer for the -174 C IL-6 polymorphism.  Presence of at least one variant allele was associated with early tumor stage as well as improved disease free and overall survival with a dose-dependent effect regarding the carriage of 0, 1, and 2 variant alleles.  The authors concluded that the variant -174 C allele of IL6 influences the biological phenotype of ovarian cancer.

Click here for abstract from Cancer Research

Title: Contribution of ATM Mutations to Familial Breast and Ovarian Cancer

Authors:  Yvonne R. Thorstenson, Adriane Roxas, Regina Kroiss, Mark A. Jenkins, Kristine M. Yu, Thomas Bachrich, Daniela Muhr, Tierney L. Wayne, Gilbert Chu, Ronald W. Davis, Teresa M. U. Wagner, and Peter J. Oefner

Source:  Cancer Res 2003 63: 3325-3333.

Summary: A cohort of 270 hereditary breast and ovarian cancer families that had been previously analyzed for BRCA1 and BRCA2 mutations were identified to evaluate the prevalence of ATM mutations.  There were 137 different sequence alterations of ATM identified, including seven pathogenic mutations.  This study indicates that there is significant prevalence of ATM mutations in breast and ovarian cancer families suggesting that ATM mutations may confer increased susceptibility to breast cancer.

Click here for abstract from Cancer Research

Title: Noninvasive and Invasive Micropapillary (Low-Grade) Serous Carcinoma of the Ovary--A Clinicopathologic Analysis of 135 Cases.

Authors:  Smith-Sehdev AE, Sehdev PS, and RJ Kurman.

Source:  American Journal of Surgical Pathology 27(6): 725-736, 2003.

Summary: This retrospective analysis of 135 patients examined the behavior of invasive micropapillary serous carcinomas (MPSCs) of the ovary and their relationship to noninvasive MPSCs and atypical proliferative serous tumors (APSTs). Survival for stage I noninvasive and invasive MPSCs was 100%. Survival for stage II and III noninvasive and invasive MPSCs with noninvasive implants was 80%. However, 5 and 10 year survival worsened with the presence of invasive implants. For stage II and III non-invasive MPSCs with invasive implants the 5 and 10 year survival was 85% and 55%, respectively. For stage II and III invasive MPSCs with invasive implants the 5 and 10 year survival was 55% and 45%, respectively. The median time from diagnosis to death in all MPSCs with invasive implants was 60 months. In part, the authors suggest an indolent, stepwise progression from APST to noninvasive MPSC to, ultimately, invasive MPSC that can be correlated clinically. The clinical behavior of these tumors contrasts with the more aggressive conventional serous carcinomas.

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Title: Metastatic Tumors of the Vulva--A Clinicopathologic Study of 66 cases.

Authors:  Neto AG, Deavers MT, Silva EG, and A Malpica.

Source:  American Journal of Surgical Pathology 27(6): 799-804, 2003.

Summary: This retrospective study presents the clinicopathologic features of 66 cases of metastatic vulvar tumors seen over a 57-year period (1944-2001). The most common presentations at diagnosis were mass (39 patients), pain (7 patients), and ulceration (5 cases). 46.9% of case noted the primary tumor to be gynecologic in origin, of which cervical carcinoma was the most common (48.3%). The most frequent metastatic site was the labium majus (44 cases). Of the available follow-up, 86.6% of patients died of their disease within a median of 7.5 months. This is the largest series of metastatic vulvar tumors from a single U.S. institution reported to date.

Click here for Am J of Surg Path