Azodi M, Chambers SK, Rutherford
TJ, et al. Adenocarcinoma in situ
of the cervix: management and outcome. Gynecol Oncol. 1999;73:348-353.
A retrospective review was conducted on 40 women
with adenocarcinoma in situ of the uterine cervix to evaluate the significance
of endocervical cone margin status. They had residual disease in 31% of cases
with negative margins in cone biopsies and/or negative endocervical curetting
and in 56% of cases with positive endocervical margins. Loop electrosurgical
excision procedure (LEEP) cones had higher rate of positive endocervical margins
compared to cold knife cone (CKC) and laser cone. If maintaining reproductive
capacity is desired, the authors recommend CKC, but this does not guarantee
absence of the disease.
Sedlis A, Bundy BN, Rotman MZ,
et al. A randomized trial of pelvic radiation therapy versus no further therapy
in selected patients with stage IB carcinoma of the cervix after radical hysterectomy
and pelvic lymphadenectomy: a Gynecologic Oncology Group study. Gynecol Oncol.
1999;73: 177-183.
Adjuvant pelvic radiotherapy following radical
surgery reduces the number of recurrences in women with stage IB cervical cancer
at the cost of 6% grade 3/4 adverse events vs 2.1% in the group with no further
therapy.
Morris M, Eifel PJ, Lu J, et al.
Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic
radiation for high-risk cervical cancer. N Engl J Med. 1999;340:1137-1143.
The addition of chemotherapy with fluorouracil
and cisplatin to treatment with external-beam and intracavitary radiation significantly
improved survival among women with locally advanced cervical cancer.
Rose PG, Bundy BN, Watkins EB,
et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally
advanced cervical cancer. N Engl J Med. 1999; 340:1144-1153.
Regimens of radiotherapy and chemotherapy that
contain cisplatin improve the rates of survival and progression-free survival
among women with locally advanced cervical cancer.
Orr JW Jr, Holimon JL, Orr PF.
Stage I corpus cancer: is teletherapy necessary? Am J Obstet Gynecol.
1997;176:777-789.
Extensive surgical staging including lymphadenectomy
can be performed safely. The authors suggest that the risk of pelvic recurrence
is not increased, and the risk of survival is not compromised in those women
not receiving adjunctive teletherapy.
Trimble EL, Kosary C, Park RC.
Lymph node sampling and survival in endometrial cancer. Gynecol Oncol.
1998;71:340-343.
In their review of SEER data on women with stage
I-II endometrial cancer, lymph node sampling was associated with increased survival
among patients with stage I, grade 3 disease but not grade 1 or 2. The observed
survival benefit may be due to identification of women with more advanced endometrial
cancer. Accurate determination of grade and extent of tumor is necessary to
delineate which patients may benefit from lymph node sampling at hysterectomy.
Berek JS, Bertelsen K, du Bois
A, et al. Advanced epithelial ovarian cancer: 1998 consensus statements. Ann
Oncol. 1999;10(suppl 1):87-92.
Among the conclusions from a recent consensus committee
was that in previously untreated advanced ovarian cancer, cisplatin plus paclitaxel
has been shown to be superior to previous standard therapy with cisplatin plus
cyclophosphamide. However, for many patients, carboplatin plus paclitaxel is
a reasonable alternative because of toxicity and convenience issues. The benefits
in terms of toxicity for the paclitaxel-carboplatin combination indicate that
its widespread adoption at this stage is justified.
Sessa C, ten Bokkel Huinink WW,
du Bois A. Oxaliplatin in ovarian cancer. Ann Oncol. 1999;10 (Suppl 1):55-57.
The antitumor activity so far observed in phase
II studies in which oxaliplatin was given for ovarian cancer ranged between
15% and 30% and has confirmed the preclinical data. These results support the
need for additional studies in patients with tumor primarily resistant to cisplatin
to establish a role of oxaliplatin in ovarian cancer. Neurotoxicity is the most
important side effect.
Frank TS, Manley SA, Olopade OI,
et al. Sequence analysis of BRCA1 and BRCA2: correlation of mutations with family
history and ovarian cancer risk. J Clin Oncol. 1998;16:2417-2425.
Because mutations in BRCA1 and BRCA2 in women with
breast cancer are associated with an increased risk of ovarian cancer, analysis
of these genes should be considered for women diagnosed with breast cancer who
have a high probability of carrying a mutation according to the statistical
model developed with these data.
Greten TF, Jaffee EM. Cancer vaccines.
J Clin Oncol. 1999;17: 1047-1060.
Improved molecular biology techniques and a greater
understanding of the mechanisms involved in the activation of T cells have allowed
the design of more specific cancer vaccine approaches. These advances have resulted
in improved systemic antitumor immune responses in animal models.