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: Laparoscopic-assisted radical vaginal hysterectomy (LARVH): prospective evaluation of 200 patients with cervical cancer

Authors: Minako Takushi, M.D., Hidehiko Moromizato, M.D., Ph.D., Kaoru Sakumoto, M.D., Ph.D., Koji Kanazawa, M.D., Ph.D.

Source: Gynecologic Oncology, Volume 90, Issue 3, September 2003, Pages 505-511.

Summary: The use of laparoscopy in the surgical treatment of cervical cancer is a topic that has been receiving increased attention over the past few years. In this article the authors describe their experience of treating 200 patients with LAVRH and LND. Surgery was performed on patients that had stage IAI to stage IV cervical cancer between August 1994 and June 2002. The majority had SCC, 77%, and most had stage Ia2 – Ib2 disease, 68%. The surgeons preformed para-aortic LND in 85% of cases and all of the patients underwent pelvic LND. With a mean follow-up of 40 months the authors report a projected 5-year survival of 83%. The prognostic factors associated with recurrence in patients treated with LAVRH were similar to those noted by Delgado in his landmark article describing factors associated treatment with abdominal radical hysterectomy (stage, LN involvement and LVSI). The authors also note that peri-operative and post-operative morbidities were similar to open techniques.  This large study supports the feasibility and safety of a laparoscopic approach to patients with gynecologic malignancies. 

Click here for abstract from Gynecologic Oncology

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Journal of Clinical Oncology - Mario Leitao

Title: Phase III Trial of Carboplatin and Paclitaxel Compared With Cisplatin and Paclitaxel in Patients With Optimally Resected Stage III Ovarian Cancer: A Gynecologic Oncology Group Study

Authors: Robert F. Ozols, Brian N. Bundy, Benjamin E. Greer, Jeffrey M. Fowler, Daniel Clarke-Pearson, Robert A. Burger, Robert S. Mannel, Koen DeGeest, Ellen M. Hartenbach, and Rebecca Baergen

Source: J Clin Oncol 2003 21: 3194-3200.

Summary: This is the published results of GOG 158 assessing equivalency of Carbo/Taxol to Cisplatin/Taxol as upfront adjuvant therapy in patients with optimally debulked stage III ovarian cancer. The regimens used were: (ARM 1) cisplatin 75mg/m2 plus 24 hour infusion of paclitaxel 135mg/m2; (ARM 2) carboplatin AUC 7.5 plus paclitaxel 175mg/m2 over 3 hours. The median PFS and OS were similar (19.4-20.7 and 48.7-57.4 months, respectively). Leukopenia, gastrointestinal, metabolic and genitourinary toxicities were greater in the cisplatin arm. There was greater thrombocytopenia seen with carboplatin. Neurologic toxicities were similar. This manuscript scientifically justifies the current practice of carboplatin instead of cisplatin as the standard of care in the upfront setting.

Click here for abstract from JCO

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Journal of the National Cancer Institute – Alan Schlaerth

Title: A Randomized Clinical Trial of Cisplatin/Paclitaxel Versus Carboplatin/Paclitaxel as First-Line Treatment of Ovarian Cancer

Authors: Du Bois A, Luck HJ, Meier W, Adams HP, Mobus, V, Cost S, Bauknecht T, Richter B, Warm M, Schroder W, Olbricht S, Nitz U, Jackisch C, Emons, Wagner U, Kuhn W, and J Pfisterer

Source: JNCI, Vol 95, No. 17 Sept 3, 2003. 1320-30

Summary: This European study randomized 798 patients with advanced ovarian cancer in a phase III non-inferiority trial comparing cisplatin/paclitaxel (PT) to carboplatin/paclitaxel (TC). These patients were stage IIB-IV and were randomly assigned to PT or TC every 3 weeks for 6 cycles. The number of patients without progression at 2 years was not statistically different between the PT and TC groups (40.0% vs. 37.5% respectively). TC and PT had similar median PFS (17.2 vs. 19.1 months) and median OS (43.3 vs.44.1 months, respectively). TC was associated with a higher frequency of hematologic toxicity, but a lower incidence of gastrointestinal and neurologic toxicity. Thus, TC had comparable efficacy to PT, but was associated with better tolerability.

Click here for abstract from JNCI

Title: Human Papillomavirus Infection and Time to Progression and Regression of Cervical Intraepithelial Neoplasia

Authors: Schlecht NF, Platt RW, Duarte-Franco E, Costa MC, Sobrinho JP, Prado, JD, Ferenczy A, Rohan TE, Villa LL, and EL Franco

Source: JNCI, Vol 95, No. 17, Sept 3, 2003. 1336-43

Summary: This Brazilian study estimated rates of progression and regression times for cervical squamous intraepithelial lesions according to HPV status. 2404 women had pap smears and HPV testing every 4-6 months for 8 years. 118 LSILs, 24 HSILs, and 173 ASCUS cytologies were detected. ASCUS to LSIL progression was 67.0 months in patients with oncogenic HPV subtypes and 88.0 months in patients without HPV subtype. LSIL to HSIL progression were 73.3 months in patients with oncogenic HPV and 83.5 months in patients without HPV detected. Half of the patients with LSIL regressed to normal or ASCUS within 6 months. Mean times for regression from ASCUS to normal, from LSIL to ASCUS/normal, and from HSIL to ASCUS/normal were longer for patients with oncogenic HPV subtypes (16.8 months, 13.8 months, and 17.1 months, respectively) than for patients with non-oncogenic subtypes (7.7 months, 7.8 months, and 8.9 months, respectively). The authors conclude that precursor lesions of the cervix persist longer and progress more quickly in women with oncogenic HPV infections than in women with non-oncogenic infection or without HPV.

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Obstetrics and Gynecology – Margrit Juretzka

Title: The effect of centralization of primary surgery on survival in ovarian cancer patients

Authors: Solveig Tingulstad, Finn Egil Skjeldestad,and Bjørn Hagen

Source: Obstetrics & Gynecology, Volume 102, Issue 3, Pages 441-665 (September 2003) 

Summary: This historical prospective study from Norway reports on the survival of 38 patients with ovarian cancer who had primary surgery by a gynecologic oncologist at a centralized teaching hospital compared with community gynecologists. 76 controls matched for stage and age were selected from patients who had undergone primary surgery at referral hospitals. Patients with advanced stage disease (III, IV) had a significant improvement in overall five year survival (26% vs 4%) and median survival (21 months vs 12 months) when surgery was performed by the gyn oncologist. Optimal cytoreduction was achieved in 48% of cases vs 24% of controls. One difficulty in choosing controls was the ability to match for stage when only 54% of the controls underwent a TAH/BSO/and omentectomy (100% of cases) and none underwent pelvic lymphadenectomy. This study underscores the importance of optimal cytoreduction and extent of primary surgery in advanced ovarian cancer.

Click here for abstract from Obstetrics & Gynecology

American Journal of Obstetrics and Gynecology – Sarah Ferguson

Nothing of interest this month

New England Journal of Medicine – Mario Leitao

Nothing of interest this month

Journal of the American Medical Association – Margrit Juretzka

Cancer – Destin Black

Nothing of interest this month

Lancet – Sarah Ferguson

Nothing of interest this month

Cancer Research – Destin Black

Authors: Satoshi Nishizuka, Sing-Tsung Chen, Fuad G. Gwadry, Jes Alexander, Sylvia M. Major, Uwe Scherf, William C. Reinhold, Mark Waltham, Lu Charboneau, Lynn Young, Kimberly J. Bussey, Sohyoung Kim, Samir Lababidi, Jae K. Lee, Stefania Pittaluga, Dominic A. Scudiero, Edward A. Sausville, Peter J. Munson, Emmanuel F. Petricoin, III, Lance A. Liotta, Stephen M. Hewitt, Mark Raffeld, and John N. Weinstein

Source: Cancer Res 2003 63: 5243-5250.