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OBJECTIVE: The purpose of this study was to determine if computed tomography in cervical cancer staging resulted in treatment modifications leading to improved survival. STUDY DESIGN: Medical records of 246 consecutive women treated over a 3-year period for primary cervical cancer were reviewed. Frequency of recurrence was the outcome measure of interest and subjected to χ 2 analysis. RESULTS: Only eight patients had improved survival from treatment modifications based on computed tomography findings. Eight patients underwent additional surgical procedures because of computed tomography findings that proved to be erroneous. CONCLUSIONS: Considering the high cost and limited benefit, computed tomography for cervical cancer staging is not recommended.

The purpose of this study was to compare outcomes in women who underwent endometrial cancer staging by different surgical techniques.Three hundred twenty-two women underwent endometrial cancer staging: 138 by laparotomy (TAH); 81 by laparoscopy (TLH) and 103 by robotic technique (TRH).The TRH cohort had a higher body mass index than the TLH cohort (P = .0008). Lymph node yield was highest for TRH (P.0001); hospital stay (P.0001) and estimated blood loss (P.0001) were lowest for this cohort. Operative time was longest for TLH (213.4 minutes) followed by TRH (191.2 minutes) and TAH (146.5 minutes; P.0001. Postoperative complication rates were lower for TRH, compared with TAH (5.9% vs 29.7%; P.0001). Conversion rates for the robotic and laparoscopic groups were similar.TRH with staging is feasible and preferable over TAH and may be preferable over TLH in women with endometrial cancer. Further study is necessary to determine long-term oncologic outcomes.

OBJECTIVE: The purpose of this study was to determine and compare the expression of the α 2 -, α 3 -, α 4 - and α 5 -subunits of the β 1 -family of integrins in both the normal and the carcinomatous cervix. STUDY DESIGN: A total of 22 solid tissue specimens (18 cancer and 4 normal) were analyzed immunohistochemically. The double-stain technique used an avidin-biotin complex kit to identify the various integrins and alkaline phosphatase-anti-alkaline phosphatase kit to identify the epithelial cells. Staining intensity, the main outcome measured, was graded as absent, weak, moderate, or strong. Statistical analysis was performed with the Wilcoxon rank sum test for no nonparametric data. RESULTS: The α 2 - and α 3 -integrins stained the normal cervix epithelilum more intensely than the stroma ( p = 0.03). The α 4 - and α 5 -integrins stained both the stroma and the normal epithelium similarly. The α 2 -integrin was absent in the stroma of all 18 cancer specimens despite being present in the epithelial regions of 14 to 18 cancers. The α 3 -integrin had a greater staining intensity in the stroma of the cancers than in the epithelial regions ( p = 0.002). Both α 4 - and α 5 -integrins were absent in the epithelial regions of the cancers but present in the stroma. CONCLUSIONS: The distribution and intensity of integrin expression in cervical cancer differ from their expression in the normal cervix. In particular, the fibronectin receptors, α 4 and α 5 , were absent in the epithelial regions of the cervical cancers, and α 3 also had diminished expression in the malignant epithelium. These changes correlate well with the changes expected in malignant transformation.

Amplification of the c-erbB-2 protooncogene has been associated with a poor prognosis in human breast and ovarian cancers. Our study was undertaken to examine whether amplification, rearrangement, or overexpression of c-erbB-2 and other protooncogenes was frequently observed in epithelial ovarian cancers. c-erbB-2 was expressed in 87% of 22 ovarian cancers analyzed, but expression was significantly increased in only one of the 22 tumor specimens. In this case elevated c-erbB-2 expression was associated with dramatic amplification of the gene. In another tumor a 3.8 kb EcoRI fragment was found, in addition to the usual 4.4 and 6.0 kb fragments; this is consistent with a possible gene rearrangement or a restriction fragment length polymorphism. To place these results in perspective, expression of several other protooncogenes has been examined in ovarian carcinomas. The c-fos, c-myc, n-myc, c-fms, and c-Ha-ras protooncogenes were expressed in different fractions of tumors, but expression of l-myc, c-erbB, c-myb, c-sis, and c-mos was not detectable. Aside from c-erbB-2, neither amplification nor rearrangement was observed among the other protooncogenes studied. Expression of c-erbB-2, c-fms, c-myc, n-myc, c-fos, and c-Ha-ras deserves further evaluation as a prognostic factor in ovarian cancer.

The purpose of this study was to determine the activity and toxicity of hexamethylmelamine chemotherapy in patients with persistent or recurrent epithelial ovarian cancer. Forty-nine women received hexamethylmelamine 100 to 150 mg/day for 14 days, repeated at 4-week intervals. All patients had previously received at least one chemotherapy regimen, and 46 (94%) had received cisplatin. Among 25 patients with clinically measurable disease there were three complete and two partial responses, for an objective response rate of 20%. The mean progression-free interval for responders was 38.6 months versus 9.6 months for nonresponders or patients with nonmeasurable disease (p < 0.001). Thirteen patients are alive, eight with no clinical evidence for disease. Only four patients discontinued therapy because of toxic reactions. Hexamethylmelamine appears to be a well-tolerated drug with activity against ovarian cancer previously treated with cisplatin. (Am J Obstet Gynecol 1991;165:573-6.)

Objective The purpose of this study was to compare robotically assisted hysterectomy (RAH) with open (ORH) type III radical hysterectomy in the treatment of early-stage cervical cancer. Study Design The outcomes of 51 consecutive patients who underwent RAH were compared with the outcomes of 49 patients who underwent ORH. Results There were no differences with regard to patient demographics. There were significant differences between the groups with regard to operative blood loss ( P P = .0002), and lymph node retrieval ( P = .0003), all of which were in favor of the RAH cohort. All patients with RAH were discharged on postoperative day 1, compared with a 3.2-day average hospitalization for the cohort with ORH. The incidence of postoperative complications was 7.8% and 16.3% for the RAH and ORH cohorts, respectively ( P = .35). Conclusion Robotic type III radical hysterectomy with pelvic node dissection is feasible and may be preferable over open radical hysterectomy in patients with early-stage cervical cancer. Further study will determine procedure generalizability and long-term oncologic outcomes.

A prospective flow cytometric examination of ovarian epithelial tumors was undertaken to further characterize aneuploid (including triploid and tetraploid) tumor cell populations according to expression of ovarian tumor antigen CA125 and to expression of class I (normally present in ovarian epithelium) and class II (normally absent in ovarian epithelium) major histocompatibility complex antigens. Samples from thirty-two of 42 patients (76%) exhibited at least one aneuploid population of tumor cells. Separate analysis of the aneuploid and diploid components of samples with aneuploid populations revealed between-tumor variation: seven of 23 aneuploid populations (30%) were positive for CA125; eight of 22 aneuploid populations (40%) exhibited substantial decreases in major histocompatibility complex class I expression, compared with corresponding diploid components of the same samples; and eight of 22 aneuploid populations (36%) exhibited substantial expression of major histocompatibility complex class II antigens. The frequencies of aneuploid populations and of the foregoing antigen expression categories were independent of tumor cell type, stage, and grade. The significance of these results for prognosis remains to be determined.

Percutaneous nephrostomy is a useful method of supravesical diversion when ureteral obstruction occurs at initial diagnosis of gynecologic cancer or recurrence of disease. Although survival is prolonged, the attendant quality of life would indicate that percutaneous nephrostomy should be performed only in those cases in which there is a reasonable chance for palliation or a hope for cure or when temporization is needed to define adequately the etiology of ureteral obstruction following therapy.

Endometrial cancer risk associated with exposure to exogenous estrogen was evaluated for 256 cases, 224 gynecology controls, and 321 community controls. The pathologic diagnosis on all cases and a sample of gynecology controls was verified independently by two outside pathologists. Data on estrogen use were obtained from interviews of patients or their relatives, physicians' office records, and hospital records. Consistent patterns of relative risks appeared with both control groups. Black women revealed no differences in estrogen use between cases and either set of controls. White women exhibited risks of 3.6 and 4.1 after 3½ years or more of estrogen use. No increased risk was observed for shorter durations of use, irrespective of dose, type of estrogen, mode of administration, stage or grade of cancer. Obese women, who presumably produce increased amounts of endogenous estrogen, did not have their risk increased further by exogenous estrogen. Nonobese, nonhypertensive women had the highest risks of 5 to 8 after 3½ years or more of estrogen use. A minimum latency period of 3 to 6 years subsequent to the first administration of estrogen was demonstrated, and an estrogen-free interval of 2 years was sufficient to reduce elevated risks to nonuser levels. These short latency and recency intervals are consistent with carcinogenic promoter rather than an initiator action. With estrogen use of long duration, risks of cancer were high for Stage IA and grade 1 lesions, and either small or not significant for more advanced disease. Increased medical surveillance that resulted in earlier diagnosis, or less aggressive biologic lesions, may account for these findings.

The management of the patient with advanced gynecologic malignancies presents multiple problems for the gynecologic and radiation oncologists involved in their care. When palliative management only is indicated, conventional treatment protocols occupy a significant portion of the patient's remaining life span, often times with associated morbidity. Single-fraction external radiation therapy, consisting of 1,000 rads to the whole pelvis, was used in 30 patients with advanced gynecologic malignancies to palliate locally advanced pelvic disease. Alleviation of symptoms and maintenance of a reasonable quality of life were obtained in all patients. No untoward acute side effects were observed. Thirteen patients are alive from 2 to 19 months after treatment, with a mean overall survival after treatment of 8.4 months. It is concluded that this regimen should be considered as the palliative therapy of choice for certain patients with advanced gynecologic malignancies.

Described is the treatment of carcinoma of the vulva by means of the tensor fascia lata myocutaneous graft in the resurfacing of the surgical defect of radical vulvectomy and groin node dissection. Its use has been associated with a reduced rate of morbidity and hospital stay (11 days) in patients who undergo this procedure.

A series of 877 patients with invasive squamous carcinoma of the cervix was evaluated to determine the value of chest films, intravenous pyelograms, barium enemas, cystoscopies, and sigmoidoscopies prior to treatment. It was found that intravenous pyelograms are the most important study for prognostic purposes and that both chest films and intravenous pyelograms are exceedingly important as base lines for follow up of treated cancer patients. Cystoscopies, sigmoidoscopies, and barium enemas are valuable primarily in patients with stage III or IV pelvic findings and use of these particular studies should be individualized to the situation of the particular patient.