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Volume 2, Number 11 – November, 2003 |
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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: Laterally extended endopelvic resection: Novel surgical treatment of locally recurrent cervical carcinoma involving the pelvic side wall Authors: Michael Höckel Source: Gynecologic Oncology, Volume 91, Issue 2, November 2003, Pages 369-377. Summary: Very seldom are novel surgical procedures described in current literature, however in this month’s Gynecologic Oncology Dr. Hockel describes the clinical course of patients with recurrent cervical cancer extending to the pelvic side wall who have undergone a laterally extended endopelvic resection (LEER). Historically these patients were not eligible for total pelvic exenteration; however in this procedure complete surgical resection of disease is achieved when the viscera en bloc with the pelvic, side wall muscles and major vessels are removed. The author describes the clinical course of 36 patients treated with this procedure, 29 of whom had recurrent disease. In addition the majority had prior RT, n=24, and the majority had cervical carcinoma, n=29. The LEER procedure led to tumor-free margins in 34 of 36 patients. The five year survival for the group was 49%. In conclusion the author reports that the LEER procedure can be offered as novel surgical salvage therapy to a select subset of patients with locally advanced and recurrent cervical carcinoma involving the pelvic sidewall. Click here for abstract from Gynecologic Oncology Journal of Clinical Oncology - Mario Leitao Title: Markers of Coagulation and Angiogenesis in Cancer-Associated Venous Thromboembolism Authors: Neil Goldenberg, Susan R. Kahn, Susan Solymoss Source: J Clin Oncol 2003 21: 4194-4199 Summary: Patients with malignancy are felt to be hypercoagulable. This group objectively investigated the coagulation/angiogenic profile in patients with malignancy. Plasma levels of hemostatic and angiogenic factors were analyzed and compared in 32 patients with an acute DVT and cancer, 36 patients with cancer but no DVT and 58 patients with an acute DVT but no evidence of cancer. There were some differences between patient groups in terms of demographics. There was no difference in median plasma levels of fibrinogen, plasminogen activator inhibitor-1, tissue factor, VEGF, PDGF, and bFGF among the study groups. Median levels of thrombin-antithrombin, prothrombin fragments 1 and 2, and von Willebrand factor were significantly greater in the DVT + cancer group. Also, median levels of plasma C activity were lower and TPA were higher in this group as compared to the other two groups. These data objectively support the hypercoagulable state seen in patients with malignancy. These data should lead to further investigation of the hypercoagulable state of malignancy with putative markers to help predict which patients may be at highest risk for the development of DVT. Click here for abstract from JCO Title: Fallopian Tube and Primary Peritoneal Carcinomas Associated With BRCA Mutations
Authors: Source: J Clin Oncol 2003 21: 4222-4227 Summary: The aims of this study were to determine the incidence of BRCA mutations among Ashkenazi Jewish patients with fallopian tube carcinoma (FTC) or primary peritoneal carcinoma (PPC), to study the clinicopathologic features of these cancers, and to estimate the risks of these cancers in association with a BRCA mutation. A retrospective review of 29 Jewish patients with FTC and 22 Jewish patients with PPC genotyped for the three Ashkenazi Jewish founder mutations identified five in 29 patients with FTC (17%) and nine in 22 patients with PPC (41%). Mutation carriers had a younger mean age at diagnosis than patients without a mutation (60 v 70 years; P = .002). The overall median survival was 148 months for mutation carriers and 41 months for patients without a mutation (P = .04). For BRCA mutation carriers, the lifetime risks of FTC and PPC were 0.6% and 1.3%, respectively. Substantial proportions of Ashkenazi Jewish patients with FTC or PPC are BRCA mutation carriers. Patients with BRCA-associated FTC or PPC are younger at diagnosis and have improved survival compared with patients without a BRCA mutation. Although the lifetime risks of FTC or PPC for BRCA heterozygotes are greater than those for the general population, the absolute risks seem relatively low. Click here for abstract from JCO Journal of the National Cancer Institute – Alan Schlaerth Nothing of interest this month Obstetrics and Gynecology – Margrit Juretzka Title: Trends in gestational choriocarcinoma: a 27-year perspective Authors: Harriet O. Smith, Clifford R. Qualls, Beth A. Prairie, Luis A. Padilla, William F. Rayburn and Charles R. Key Source: Obstetrics & Gynecology, Volume 102, Issue 5, November 2003, Pages 978-987. Summary: The authors computed trends in incidence and survival rates for gestational choriocarcinoma using the SEER program public-use database. They identified 450 cases between 1973 and 1999. The annualized age-adjusted incidence rate for choriocarcinoma was 0.133 per 100,000 woman-years and decreased by 49.7%. Five year relative survival rate was 89.5%. Blacks had an increased relative risk compared with whites but a lower censored survival (whites 92.4%, blacks 84.9%, others 87.1%, P = .045). Patients with advanced disease and increasing age at diagnosis also had a significantly lower censored survival. The authors conclude that gestational choriocarcinoma incidence rates have declined and survivals have improved, but blacks continue to have higher incidence and lower survival rates Click here for abstract from Obstetrics & Gynecology American Journal of Obstetrics and Gynecology – Sarah Ferguson Title: Survival outcomes in patients with recurrent ovarian cancer who were treated with chemoresistance assay–guided chemotherapy Authors: Vera Loizzi, MD, John K. Chan, MD, Kathryn Osann, PhD, Fabio Cappuccini, MD, Philip J. DiSaia, MD, Michael L. Berman, MD Source: American Journal of Obstetrics and Gynecology, Volume 189, Issue 5, November 2003, Pages 1301-1307 Summary: This retrospective study determined the outcomes in women with recurrent ovarian cancer after extreme drug resistance (EDR) assay-directed therapy. Women with platinum-sensitive (PS) disease who were treated with second-line chemotherapy based on EDR ( n=31) were compared to empiric treatment (n = 31). Outcomes in women with platinum-resistant disease (PR) who were treated with chemotherapy based on EDR (n = 19) were compared to women treated empirically (n = 19). The decision to perform EDR assay was physician dependent. For PS patients, the overall response rate (ORR) was 65 % in the EDR group compared to 35 % in the control group (P = 0.02). The overall and progression-free survival in women with PS recurrent ovarian cancer was 38 and 15 months in the EDR group compared with 21 and 7 months in the control group (P = 0.005; P = 0.002). There was no significant different in response rate, overall or progression free survival in the patients with PR disease between EDR- and empirically–directed therapies. Click here for abstract from Am J Ob/Gyn Title: Pregnancy outcomes in patients after radical trachelectomy Authors: Marcus Bernardini, MD, Jon Barrett, MD, Gareth Seaward, MD, Allan Covens, MD Source: American Journal of Obstetrics and Gynecology, Volume 189, Issue 5, November 2003, Pages 1378-1382 Summary: This study reviewed the fertility and pregnancy outcomes of 80 women who had undergone radical trachelectomy for invasive cervical cancer. Of 39 women who had attempted to conceive there were 22 pregnancies from 18 patients. The actuarial conception rate was 55% by 36 months. The median time to conception was 6 months. Sixteen had a diagnosis of infertility due to anovulation (2), cervical factor (12) or unexplained (2). The pregnancies outcomes included 3 first trimester spontaneous abortions (14%) and five PPROMs (22%). There were a total of 18 viable pregnancies with 6 (33 %) delivered between 24 and 36 weeks gestational age. There appeared to be a significant increase risk of infertility secondary to cervical factors. However the majority were able to conceive on their own or with assisted reproductive technologies. The authors concluded that pregnancy is a safe and realistic outcome for women undergoing radical trachelectomy. Click here for abstract from Am J Ob/Gyn New England Journal of Medicine – Mario Leitao Nothing of interest this month Journal of the American Medical Association – Margrit Juretzka Nothing of interest this month Cancer – Destin Black [Ed Note: Cancer Volume 98 contains a supplement covering the proceedings of the Second International Conference on Cervical Cancer. Summaries address screening, chemoprevention, imaging, and basic biology. The TOC for this supplement can be found here.] Title: K-ras mutation in tamoxifen-related endometrial polyps Authors: Toru Hachisuga, M.D., Takashi Miyakawa, M.D., Hiroshi Tsujioka, M.D., Shinji Horiuchi, M.D., Makoto Emoto, M.D., Tatsuhiko Kawarabayashi, M.D. Source: Cancer, Vol.98, Number 8; Pages 1890-1897
Summary: The authors investigated mutations in codon 12 of K-ras
in endometrial polyps obtained from women who had received tamoxifen as
adjuvant therapy for breast carcinoma. Eleven frozen polypectomy specimens
were analyzed using the mutant allele-specific amplification and evaluated
for correlation with immunohistochemical data obtained using antibodies
against estrogen receptor Click here for abstract from Cancer Lancet – Sarah Ferguson Nothing of interest this month Cancer Research – Destin Black Title: Distribution of Human Papillomavirus Types 16 and 18 Variants in Squamous Cell Carcinomas and Adenocarcinomas of the Cervix
Authors: Source: Cancer Res 2003 63: 7215-7220 Summary: This multicenter case-control study evaluated the distribution of intratypic variants of HPV16 and HPV18 observed in squamous cell carcinomas (SCC) and adenocarcinomas (AC). A total of 85 HPV16 and/or HPV18 positive individuals were included. HPV16-positive individuals and HPV18-positive individuals were classified into phylogenetic-based lineage groups (European, Asian-American, African1, and African2) based on DNA sequencing. Non-European HPV16 and/or HPV18 intratypic variants were observed in 42% of ACs compared with 16% of SCCs and 18% of population controls (P = 0.04). This increased prevalence of non-European variants seen among individuals diagnosed with AC was restricted primarily to infections with variants from the Asian-American lineage. The differences observed between AC and SCC cases were strongest for non-European variants of HPV16. The authors concluded that cervical AC and SCC differ with respect to intratypic variants observed. Click here for abstract from Cancer Res Title: Cytoplasmic HuR Expression Correlates with Poor Outcome and with Cyclooxygenase 2 Expression in Serous Ovarian Carcinoma
Authors: Source: Cancer Res 2003 63: 7591-7594 Summary: COX-2 expression has been shown to associate with poor prognosis in ovarian cancer, and an mRNA stability protein HuR has been shown to enhance expression of COX-2 in tissue culture. Cytoplasmic immunoreactivity for HuR protein was found in 52% (233 of 445) of serous-type ovarian carcinoma specimens, and it associated with high COX-2 expression (P = 0.0045) and with clinicopathological variables, including poor prognosis (P < 0.0001) and high grade (P < 0.0001). In ovarian cancer cells in vitro, a small interfering RNA against HuR and leptomycin B, an inhibitor of nucleocytoplasmic translocation of HuR, inhibited COX-2 expression. The results show that cytoplasmic HuR expression associates with poor outcome in ovarian cancer, and one plausible explanation for this finding may be related to the ability of HuR to induce COX-2 expression. Click here for abstract from Cancer Res American Journal of Surgical Pathology – Alan Schlaerth Title: Immunoprofile of Ovarian Tumors With Putative Transitional Cell (Urothelial) Differentiation Using Novel Urothelial Markers: Histogenetic and Diagnostic Implications Authors: Sanjay Logani, MD; Esther Oliva, MD; Mahul B. Amin, MD; Andrew L. Folpe, MD; Cynthia Cohen, MD; Robert H. Young, MD Source: Am J Surg Path 2003; 27:1434-1441. Summary: This study analyzed a panel of antibodies uroplakin III (UROIII), thrombomodulin (THR), cytokeratin 7 (CK7), cytokeratin 20 (CK20), and Wilms' tumor protein (WT1) to assess urothelial differentiation in transitional cell tumors of the ovary. Most Brenner tumors showed positivity with UROIII (82%) and THR (76%), supporting true urothelial differentiation in these tumors. Although TCC-O has considerable morphologic overlap with TCC-B, they had only partial immunophenotypic overlap. TCC-O rarely expressed UROIII (6%) and THR (18%) and none expressed CK20. In contrast, nearly 40% of invasive TCC-B expressed UROIII, 61% expressed THR, and 50% expressed CK20. Nearly 82% of TCC-O expressed WT1, which was negative in all TCC-B. These results may have diagnostic value in distinguishing TCC-O (CK20-, UROIII-/+, WT1+) and invasive TCC-B (CK20+, UROIII+/-, WT1-) metastatic to the ovary. They also indicate that the morphologic similarity between TCC-O and TCC-B does not indicate any histogenic similarity and, as others have noted, TCC-O is a variant morphology in the spectrum of surface epithelial carcinomas. Click here for abstract from Am J Surg Path Title: Use of Oxytocin Receptor Expression in Distinguishing Between Uterine Smooth Muscle Tumors and Endometrial Stromal Sarcoma Authors: Christoph Loddenkemper, MD; Sylvia Mechsner, MD; Hans-Dieter Foss, MD; Friederike E. Dallenbach, MD; Ioannis Anagnostopoulos, MD; Andreas D. Ebert, MD, PhD; Harald Stein, MD Source: Am J of Surg Pathol 2003; 27:1458-1462. Summary: This study assessed oxytocin receptor (OTR) expression in the normal uterus, uterine smooth muscle tumors and endometrial stromal sarcomas (ESS). OTR is expressed in normal and neoplastic uterine smooth muscle cells, but not in ESS. 5 of 8 cases of LMS showed moderate to strong OTR expression in 100% of the tumor cells, whereas 3 cases were weakly positive in 10-20% of the tumor cells. All 9 ESSs were negative for OTR, except in regions of smooth muscle differentiation. Thus, the authors conclude that OTR expression can be useful in differentiating between ESS and uterine smooth muscle tumors. |
and 
,
progesterone receptors A and B, and Ki-67. Mutations in codon 12 of K-ras
were observed in 7 of 11 TAM-related endometrial polyps and high
expression levels of ER-Copyright ©2003, SMGO, All Rights Reserved.