Results and complications of operative staging in cervical cancer: Experience of the Gynecologic Oncology Group

A multiinstitutional study by the Gynecologic Oncology Group (GOG) has confirmed that clinical staging often is inaccurate in determining the extent of disease in patients with cervical cancer. The finding of positive paraaortic nodes in 29% of patients with Stage II, III, and IV tumors supports this conclusion. In this series, the incidence of paraaortic nodal metastases could not be correlated with the histologic grade of the tumors. With positive paraaortic nodes, conventional treatment limited to the pelvis can be expected to fail, but it is still not clear how many patients can be salvaged by treatment to extended paraaortic radiation fields. Longer periods of follow-up in patients whose treatment plans were based on surgical staging information will be required.     

Adverse effects of intraperitoneal fluorouracil in patients with optimal residual ovarian cancer after second-look laparotomy: a Gynecologic Oncology Group Study

Twenty-seven patients with ovarian cancer who had failed combination chemotherapy were offered intraperitoneal (IP) fluorouracil (5-FU) as salvage therapy in an attempt to ascertain the efficacy of such a therapeutic method. All patients had minimal residual epithelial cancer. The median number of treatment cycles was six. Major problems with dialysate inflow and egress occurred in ten patients and required discontinuation of therapy. An additional ten patients experienced hematologic toxicity with a median nadir WBC of 2,300/microL. Therapy was altered but not discontinued because of this complication. Other adverse sequelae, such as abdominal pain, were manageable with medication. IP 5-FU is technically feasible on a multiinstitutional basis in residual ovarian cancer, but its therapeutic role remains to be defined.     

Hypothalamic projections of medullary catecholamine neurons in the rabbit: A combined catecholamine fluorescence and HRP transport study

Injections of horseradish peroxidase into the rabbit hypothalamus, centered on the paraventricular nucleus, result in retrograde transport to A1 and A2 neurons in the medulla oblongata, in a bilateral distribution with ipsilateral predominance. Some HRP labeled cells in both A1 and A2 areas do not exhibit a positive histochemical reaction for catecholamines, but, in the Al area, nearly all HRP-positive neurons are catecholamine-containing A1 cells. Injection of radioisotope into the A1 area of the rabbit results in terminal labeling within the paraventricular and supraoptic nuclei. This study complements previous work showing that rabbit A1 and A2 cells have minimal projections to the spinal cord.     

Ventricular shunt therapy of the brain: long-term rubber-catheter- induced inflammation

Three cases of catheter-induced inflammation are presented, two of which involved brain parenchyma and the ventricular system and one that involved the soft tissues of the scalp. All of the catheters were composed of natural rubber and had been in place for several years. Abnormalities seen on computed tomographic scans in these patients were variable but included mass effect, vasogenic edema, catheter destruction, calcification, and abnormal contrast enhancement of the parenchyma adjacent to the catheters. Certain features on the scans of the two patients with intracranial disease, however, were common to both cases, allowing the correct preoperative diagnosis to be made in the second patient encountered.     

ICRF-159 (razoxane) in patients with advanced squamous cell carcinoma of the uterine cervix. For the Gynecologic Oncology Group

Thirty-one patients with advanced squamous cell carcinoma of the cervix were entered onto this phase II study evaluating the efficacy of ICRF-159 (razoxane). Three of these patients were excluded; one had no tumor, one had a second primary, and one received no therapy. ICRF-159 was administered orally at a dose of 2.5 g/m2 weekly until progression, unacceptable toxicity, or death. Adverse effects were primarily hematologic in nature. Twenty-three of the 28 patients exhibited leukopenia which in ten instances was severe (below 2000/mm3). Seven cases had thrombocytopenia (one case below 50,000/mm3). Other toxicity, including fever and anorexia, was mild to moderate. There was tumor response in five (18%) patients (one CR, four PRs) ranging from 1 to 5 months. Fifteen patients with stable disease and eight with progressive disease had a median survival duration of 3.8+ and 3.5+ months, respectively. ICRF-159 showed limited activity in this patient population. However, it might be considered for combination with other low myelosuppressive agents.     

A comparison of methylene blue and lymphazurin in breast cancer sentinel node mapping

BACKGROUND: When lymphazurin became unavailable to our institution, we elected to employ methylene blue to perform sentinel node mapping for patients with breast cancer. The purpose of this study was to compare methylene blue and lymphazurin for performing sentinel node mapping for breast cancer. METHODS: We evaluated our sentinel node mapping experience from April 1, 2001 to March 31, 2002. Patients were divided into two groups based on the dye used for lymphatic mapping. The two groups were compared to evaluate the results of the sentinel node mapping procedure. RESULTS: During the study period a total of 199 patients were evaluated with sentinel node mapping, 87 with lymphazurin and 112 with methylene blue. The two groups were similar in demonstrating the success of the sentinel node procedure, nodes identified per case, and technique used for node identification (colloid or dye, or both). CONCLUSIONS: In our initial experience, methylene blue appears to be equivalent to lymphazurin for sentinel node mapping in breast cancer.