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. The participants in this program are the active clinical fellows at Memorial Hospital: Bhavana Pothuri, Mario Leitao, Christopher Awtrey, Sarah Ferguson, Alan Schlaerth and Rami Eitan. 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 – Mario Leitao

Title: Clinical implications of a rising serum CA-125 within the normal range in patients with epithelial ovarian cancer: a preliminary investigation

Authors: James L. Wilder, Edward Pavlik, John M. Straughn, Tyler Kirby, Robert V. Higgins, Paul D. DePriest, Frederick R. Ueland, Richard J. Kryscio, Ronald J. Whitley and John van Nagell.

Source: Gynecologic Oncology, Volume 89, Issue 2, May 2003, Pages 233-235.

Summary: To determine the clinical implications of a progressively rising serum CA-125 level in the normal (< 35 U/ml) range in ovarian cancer patients with complete response to therapy a multi-institutional investigation was undertaken.  Eleven patients with rising serum CA-125 levels in the normal range were identified. All developed recurrent ovarian cancer.  The mean time from the third early rising serum CA 125 value to clinical or radiographic confirmation of recurrence was 189 days (range = 84–518). In patients with a history of ovarian cancer, three progressively rising serum CA-125 values in the normal range (< 35 U/ml) at 1- to 3-month intervals are associated with a high likelihood of tumor recurrence.

Click here for abstract from GYN Oncology

Title: Stage IC adenocarcinoma of the endometrium: survival comparisons of surgically staged patients with and without adjuvant radiation therapy.

Authors: J. Michael Straughn, Jr. , Warner K. Huh, James W. Orr, Jr. , F. Joseph Kelly, Phillip Y. Roland, Michael A. Gold, Matthew Powell, David G. Mutch et al.

Source: Gynecologic Oncology, Volume 89, Issue 2, May 2003, Pages 295-300.

Summary: To determine the outcomes of stage IC endometrial carcinoma patients who are managed with and without adjuvant radiation therapy after comprehensive surgical staging patients with FIGO stage IC adenocarcinoma of the endometrium diagnosed from 1988 to 1999 were identified from tumor registry databases at four institutions. Of the 220 stage IC patients, 56 (25%) patients received adjuvant brachytherapy (BT), 19 (9%) received whole-pelvis radiation (WPRT), and 24 (11%) received both WPRT and BT. One hundred twenty-one patients (55%) did not receive adjuvant radiation. There were 6 recurrences (6%) in the radiated group and 14 (12%) in the observation group (P = 0.20). There was a statistical difference in 5-year disease-free survival between the radiated and observation groups (93% vs 75%, P = 0.013). However, the 5-year overall survival was similar in the two groups (92% vs 90%, P = 0.717). Adjuvant radiation therapy improves disease-free survival in surgical stage IC patients; however, overall survival is not improved with adjuvant radiation therapy since the majority of local recurrences in conservatively managed patients can be salvaged with radiation therapy.

Click here for abstract from GYN Oncology

Journal of Clinical Oncology - Bhavana Pothuri

Title: Use of Genetic Testing and Prophylactic Mastectomy and Oophorectomy in Women With Breast or Ovarian Cancer From Families With a BRCA1 or BRCA2 Mutation

Authors: Meijers-Heijboer, Hanne, Brekelmans, Cecile T.M., Menke-Pluymers, Marian, Seynaeve, Caroline, Baalbergen, Astrid, Burger, Curt, Crepin, Ellen, van den Ouweland, Ans W.M., van Geel, Bert, Klijn, Jan G.M.

Source: J Clin Oncol 2003 21: 1675-1681

Summary:  The use of genetic testing, prophylactic mastectomy, and oophorectomy among women with breast and/or ovarian cancer was examined from a prospective consecutive series of 112 high-risk families. Overall, 192 of 220 women (87%) with primary tumors who had no metastatic disease  underwent genetic testing. Eleven of these 192 tested women (6%) appeared not to carry the family-specific BRCA1/BRCA2 mutation. Among eligible women, 35 of 101 (35%) requested bilateral or contralateral mastectomy, and 47 of 95 (49%) requested oophorectomy. In a clinical setting, there is a high demand for BRCA1/BRCA2 testing and for prophylactic surgery by women with breast and/or ovarian cancer from high-risk families.

Click here for abstract from JCO

Journal of the National Cancer Institute – Rami Eitan

Nothing of interest this month

Obstetrics and Gynecology – Alan Schlaerth

Click here for abstract from Obstetrics & Gynecology

Click here for abstract from Obstetrics & Gynecology

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American Journal of Obstetrics and Gynecology – Chris Awtrey

Title: Expression of cyclooxygenase-2 in cervical, endometrial, and ovarian malignancies.

Authors: ElleLanden CN Jr, Mathur SP, Richardson MS, Creasman WT

Source:  Am J Obstet Gynecol 2003;188:1174-6.

Summary: This study looked at the presence of COX-2 levels between normal and malignant cervical, endometrial and ovarian tissue as measured by at semi-quantitative immunofluorescent antibody assay. The authors found that normal cervical tissue expressed a non significant increase in COX-2 expression in comparison to malignant cervical tissue ( 50% vs 23% ). The authors found that COX -2 was not seen in normal ovarian tissue (0%) and rarely found in endometrial tissue (7%).  However it was present in 69% of endometrial adenocarcinomas and in 89% of ovarian cystadenocarcinomas. The authors conclude that COX-2 is more common in endometrial adenocarcinoma and ovarian serous cystadenocarcinoma, but not in cervical squamous carcinoma, compared with normal tissue.

Click here for abstract from Am J Ob Gyn

New England Journal of Medicine – Bhavana Pothuri

Title: Effects of Estrogen plus Progestin on Health-Related Quality of Life

Authors: Hays, Jennifer, Ockene, Judith K., Brunner, Robert L., Kotchen, Jane M., Manson, JoAnn E., Patterson, Ruth E., Aragaki, Aaron K., Shumaker, Sally A., Brzyski, Robert G., LaCroix, Andrea Z., Granek, Iris A., Valanis, Barbara G., the Women's Health Initiative Investigators.

Source:  N Engl J Med 2003 348: 1839-1854

Journal of the American Medical Association – Rami Eitan

There were three important articles in the May 28th issue of JAMA highlighting yet more concerns about combination hormone replacement therapy (HRT), this time in relation to cognitive/neurologic function.  As gynecologic oncologists are frequently faced with questions regarding HRT, these articles are important.

Cancer – Sarah Ferguson

Title: Improved survival in women with BRCA-associated ovarian carcinoma

Authors: Ilana Cass, M.D., Rae Lynn Baldwin, Ph.D., Taz Varkey, M.D., Roxana Moslehi, Ph.D., Steven A. Narod, M.D., Beth Y. Karlan, M.D.

Source:  Cancer, Volume 97, Issue 9, 2003. Pages: 2187-2195.

Summary: The clinical characteristics and treatment response of 71 Ashkenazi Jewish women with epithelial ovarian carcinoma were examined according to BRCA mutations status.  Thirty-four patients (48%) had germline BRCA mutations.  BRCA heterozygotes were younger compared with Jewish patients and BRCA1 heterozygotes were younger compared with BRCA2 heterozygotes (48 years vs. 57 years, respectively; P = 0.01).  BRCA heterozygotes with advance-stage disease had improved survival compared with patients who had advanced stage sporadic carcinoma (91 months vs. 54 months, respectively; P = 0.046).  BRCA heterozygotes had a better response to platinum chemotherapy compared with women who had sporadic disease, which may have contributed to their improved prognosis.

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Title: Adenosquamous histology predicts a poor outcome for patients with advanced-stage, but not early-stage, cervical carcinoma

Authors: John H. Farley, M.D., Kimberly W. Hickey, M.D., Jay W. Carlson, D.O., G. Scott Rose, M.D., Edward R. Kost, M.D., Terry A. Harrison, M.D.

Source:  Cancer, Volume 97, Issue 9, 2003. Pages: 2196-2202.

Summary: To compare survival between patients with adenocarcinoma and patients with adenosquamous carcinoma of the cervix the authors reviewed cases from a centralized tumor registry between 1988 and 1999.  Of 273 women identified, 185 had adenocarcinoma (AC) and 88 had adenosquamous carcinoma (ASC).  Patients with ASC had a significantly decreased 5-year survival rate compared to patients with AC (65% vs. 83%; P < 0.002). There was no difference in the 5-year survival among early-stage patients,  (AC, 89%; ASC, 86%; P = 0.644). However, for patients with advanced-stage disease, ASC was associated with a significant decrease in median and overall survival (P = 0.01). The 5-year survival rate for patients with Grade 1 AC was 93%, compared with 50% for patients with Grade 1 ASC (P < 0.01).  ASC histology appears to be an independent predictor of poor outcome in women with advanced-stage cervical carcinoma.

Click here for abstract from Cancer

In the supplement to Cancer this month there was supplement on epidemiologic issues of ovarian cancer in the United States from 1992-1997. The articles explore ethnic and racial differences in incidence, stage of diagnosis and mortality in ovarian cancer. In addition, there are reports on the regional variation of ovarian cancer and the incidence of ovarian cancer in children and young adults.

Click here to access the supplement from Cancer

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Lancet – Chris Awtrey

Nothing of interest this month

Cancer Research – Sarah Ferguson

Title: Molecular Description of Evolving Paclitaxel Resistance in the SKOV-3 Human Ovarian Carcinoma Cell Line

Authors: Lamendola, Diana E., Duan, Zhenfeng, Yusuf, Rushdia Z., Seiden, Michael V.

Source:  Cancer Res 2003 63: 2200-2205 .

Summary: Paclitaxel-resistant ovarian cancer cell lines were established by exposing SKOV-3 cell lines to increasing concentrations of paclitaxel. The sublines selected represented early (0.003 um), intermediate (0.03 um) and late (0.3 um) paclitaxel resistance. Oligonucleotide microarray using Affymetrix HG-U95Av2 arrays with over 9600 transcripts were used to compared expression patterns of these cell lines and the parent cell line. Cell lines that had increasing paclitaxel resistance phenotype had gene expression profiles that differed from the sensitive paclitaxel SKOV-3 parental line. Using self-organizing maps they were able to identify novel genes involved in paclitaxel resistance. They concluded that analysis using microarray technology may be able to define candidate genes involved in early-drug resistance.

Click here for abstract from Cancer Research

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