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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2005.04.044 Byline: John K. Chan (a), Vera Loizzi (b), Alessandra Magistris (b), Mark I. Hunter (b), Joanne Rutgers (c), Philip J. DiSaia (b), Michael L. Berman (b) Abstract: Primary lymphoma of the uterine cervix is rare, with less than 60 cases reported. We present a series of 6 patients with cervical lymphoma and review the literature. Author Affiliation: (a) Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford Cancer Center, Stanford University School of Medicine, Stanford, CA (b) Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chao Family Comprehensive Cancer Center, University of California, Irvine Medical Center, Orange, CA (c) Department of Pathology, Long Beach Memorial Medical Center, Long Beach, CA Article History: Received 17 December 2004; Revised 13 March 2005

A series of cases of 6 patients with cervical lymphoma is presented. Results show that primary lymphoma of the uterine cervix is a rare malignancy and women with localized disease typically respond to various combinations of surgery, chemotherapy and radiotherapy while combination chemotherapy with tailored radiotherapy appears to be preferred treatment option in women with advanced disease.

Interstitial brachytherapy may be effective in women with cancer of the vulva. This form of radiation treatment is delivered through needles that can be inserted into the skin and tissues. This allows the radiation to be delivered to a smaller area, with fewer side effects.

Estrogen replacement therapy may not be contraindicated in women who have survived stage I or II endometrial cancer. The endometrium is the inner layer of the uterus. Researchers reviewed the outcomes of 123 women treated for stage I and II endometrial cancer, 62 of whom took estrogen replacement therapy after cancer treatment. Women who took estrogen had a similar death rate from recurrences of endometrial cancer (1.6%) as women who did not take estrogen. Estrogen therapy lowers the risk of cardiovascular disease and osteoporosis, both of which may outweigh the risk of cancer recurrence.

Byline: Julia A. Chapman, Philip J. DiSaia, Kathryn Osann, Pat D. Roth, Doug L. Gillotte, Michael L. Berman Keywords: Endometrial cancer; estrogen replacement Abstract: OBJECTIVE: Our purpose was to evaluate our experience with estrogen replacement in women with a history of early-stage endometrial cancer and to determine whether it increased the risk for recurrence or death. STUDY DESIGN: A retrospective review was performed of 123 women with surgical stage I and II endometrial adenocarcinoma treated between 1984 and 1994; 62 had received estrogen replacement therapy after cancer therapy. Sixty-one women received no estrogen. Variables analyzed included age, parity, surgical stage, grade, depth of myometrial invasion, presence of intercurrent illnesses, duration of follow-up, and duration of estrogen replacement, if applicable. Outcome variables assessed included recurrence rate, time to recurrence, and disease-free interval. RESULTS: The estrogen replacement therapy group had earlier stage disease (p = 0.04) and less severe depth of invasion (p = 0.003); however, the total number of deaths in each group was not significantly different. The disease-free survival in the estrogen replacement therapy group did not differ significantly compared with those not receiving estrogen replacement therapy. The data are suggestive of improved disease-free survival in the estrogen replacement therapy group, which may be related to differences in age, stage, grade, and depth of invasion. The overall recurrence rate was 6.5%, with an overall death rate of 1.6%. CONCLUSIONS: There is no evidence to suggest that estrogen decreased the disease-free interval or increased the risk for recurrence in early-stage disease. (Am J Obstet Gynecol 1996;175:1195-200.) Author Affiliation: Kansas City, Kansas, and Orange and Long Beach, California Article History: Received 27 December 1995; Revised 13 March 1996; Accepted 28 May 1996 Article Note: (footnote) [star] From the Division of Gynecology Oncology, Department of Obstetrics and Gynecology, University of Kansas Medical Center,a the Division of Gynecology Oncology, Department of Obstetrics and Gynecology, b and the Department of Medicine, c University of California Irvine Medical Center, and Women's Hospital, Long Beach Memorial Medical Center. d , [star][star] Reprints not available from the authors., a 0002-9378/96 $5.00 + 0 6/1/75448

Background: Cervical carcinoma is a leading cause of mortality from cancer among women worldwide, accounting for approximately 160 000 deaths annually. Prognosis in patients with this disease is dependent on several well-established clinical features (stage of disease and age of patient) and pathologic features (lymph node status, grade of tumor, and depth of invasion). Although the features associated with poor clinical outcome have been well studied, molecular markers such as human papillomavirus (HPV) type that may reflect the underlying biologic basis for clinical behavior are poorly understood. Purpose: To test the hypothesis that differences in survival among patients with cervical carcinoma are associated with HPV DNA type, we conducted a historical cohort study of patients treated at our institutions over a 10-year period. Methods: Fresh primary tumor tissue samples from 291 women with all stages of cervical carcinoma diagnosed from April 1983 through August 1993 were rapidly frozen and stored at -70 [degrees] until analysis. High-molecular-weight DNA was extracted and purified by homogenization, proteinase K digestion, phenol extraction, ammonium acetate salt displacement, ethanol precipitation, and ribonuclease treatment. HPV nucleotide sequences were amplified from tumor DNA samples by polymerase chain reaction with the use of both consensus L1 (MY09/MY11) primers that recognize more than 25 HPV types and modifications of type-specific primers developed for HPV types 16, 18, and 6. Clinical data were abstracted from hospital, office, and tumor registry records. Univariate analysis was conducted using Student's t test and chi-squared tests. Survival curves were estimated by use of the Kaplan-Meier method; differences between groups were examined by the logrank test. Multivariate survival analysis was performed according to the Cox proportional hazards model. Results: HPV DNA was detected in 247 (85%) of 291 tumors: HPV16 in 52%, HPV18 in 20%, other HPV types in 13%, and no HPV DNA in 15%. Eighty-eight percent of squamous tumors contained HPV DNA compared with 79% of adenocarcinomas, the latter harboring predominantly HPV18. Women 45 years old or younger with a history of cigarette smoking tended to have HPV DNA in their tumors, but the HPV type was not associated with established prognostic factors such as stage, grade, lymph node metastasis, or depth of stromal invasion. After a median follow-up of 38.9 months, among potential prognostic factors of patient age, histologic cell type, grade, and HPV DNA status, only stage was predictive of survival in the entire study population. However, among the 171 patients treated with type III radical hysterectomy (removal of uterus and upper vagina along with other tissues extending to the pelvic wall) and pelvic lymphadenectomy (removal of all lymphatic tissue in the pelvis), multivariate analysis determined that lymph node status (adjusted risk ratio [RR] = 3.12; 95% confidence interval [CI] = 1.35-7.21), depth of stromal invasion (adjusted RR = 3.14; 95% CI = 1.05-9.34), and the presence of HPV18 DNA (adjusted RR = 2.59; 95% CI = 1.08-6.22) were statistically significant predictors of survival. Conclusion: HPV18 DNA type is an independent prognostic factor in patients with cervical carcinomas treated with radical hysterectomy and pelvic lymphadenectomy. Implications: The use of molecular markers such as HPV DNA type may allow the identification of patients with early stage cervical cancer at high risk for disease recurrence.

Background: It has been suggested that identified risk factors for endometrial cancer operate through a single etiologic pathway, i.e., exposure to relatively high levels of unopposed estrogen (estrogen in the absence of progestins). Only a few studies, however, have addressed this issue directly. Purpose: We assessed the risk of developing endometrial cancer among both premenopausal and postmenopausal women in relation to the circulating levels of steroid hormones and sex hormone-binding globulin (SHBG). The independent effect of hormones was assessed after adjustment for other known risk factors. Methods: The data used in the analysis are from a case-control study conducted in five geographic regions in the United States. Incident cases were newly diagnosed during the period from June 1, 1987, through May 15, 1990. The case patients, aged 20-74 years, were matched to control subjects by age, race, and geographic region. The community control subjects were obtained by random-digit-dialing procedures (for subjects 20-64 years old) and from files of the Health Care Financing Administration (for subjects [greater than or equal to]65 years old). Additional control subjects who were having a hysterectomy performed for benign conditions were obtained from the participating centers. Women reporting use of exogenous estrogens or oral contraceptives within 6 months of interview were excluded, resulting in 68 case patients and 107 control subjects among premenopausal women and 208 case patients and 209 control subjects among postmenopausal women. The hormone analyses were performed on blood samples obtained from case patients or from hysterectomy control subjects before surgery. The odds ratios (ORB) and 95% confidence intervals (CIs) were estimated by use of an unconditional logistic regression analysis after we controlled for matching variables and potential confounders. All P values were two-sided. Results: High circulating levels of androstenedione were associated with 3.6-fold and 2.8-fold increased risks among premenopausal and postmenopausal women, respectively, after adjustment for other factors (P for trend = .01 and

Pelvic adhesions, a common complication of pelvic surgery, are the most common cause of intestinal obstruction in the industrialized world, and the more extensive the pelvic surgery, the more likely the development of adhesions. Pelvic adhesions form when the peritoneal membrane, which lines the pelvic cavity and covers organs, attempts to heal in the face of an insufficient blood supply. To minimize adhesion formation, surgeons should handle tissues gently, control bleeding, copiously wash the operating field, treat with antibiotics to prevent infection, limit foreign body reaction, and minimize heat injury from the cautery instruments used to control bleeding. Several techniques, including anti-inflammatory medication, dissolving adhesions once they have formed, and fabric barriers, are under investigation in animal models, but more research is needed before any can be recommended.

Background. Cyclosporin has been demonstrated to reverse resistance to several antineoplastic agents including cisplatin in vitro. The purpose of this Phase I trial was to study the potential clinical application of cyclosporin modulation of cisplatin and to establish a tolerable dose of cyclosporin whon combined with a standard dose of cisplatin of 75 mg/[m.sup.2]. Methods. A course of therapy consisted of two cyclosporin infusions over 2 hours each, 24 hours apart, with cisplatin given 6 hours after the first dose. Treatment was repeated every 21 days. Cyclosporin was studied in a Phase I fashion at five different levels, from 1-5 mg/kg per dose. Twenty patients with refractory gynecologic cancer received 81 courses of therapy. All patients had received extensive prior chemotherapy containing cisplatin. Results. Grade 4 nephrotoxicity was seen in 4 of 20 patients: 1 treated at 1 mg/kg, 1 at 2 mg/kg, and 2 at 5 mg/kg of cyclosporin. The patient treated at the 1 mg/kg level was a partial clinical responder and tolerated six courses. The patient at the 2 mg/kg level had received 14 prior courses of cisplatin and tolerated only two additional courses before a Grade 4 renal toxicity developed. Grade 4 nephrotoxicity developed in the two patients receiving 5 mg after two courses of chemotherapy. Two of the 20 patients achieved a complete response (CR) and 3 patients achieved a partial response (PR), for a total response rate of 25% (5 of 20). The two women who achieved CR started treatment with symptomatic ascites; one of whom also had multiple pulmonary lesions that were no longer evident after three courses of therapy. Conclusions. Cyclosporin at a dose of 4 mg/kg per day given for 2 consecutive days in association with 75 mg/[m.sup.2] of cisplatin can be given with reasonable assurance of safety.

Cancer of the ovary ranks fourth as a cause of death among women in the US. Surgical removal of the tumor and treatment with the anticancer agent cisplatin have increased the survival time of women with ovarian cancer. CA 125 is a substance released by the epithelial form of ovarian cancer and can be used to assess the progression of disease and response to treatment. Increased levels of CA 125 suggest progression of the cancer or lack of response to chemotherapy. However, in most cases, the effectiveness of chemotherapy is assessed by surgery, in which the abdomen is examined for any residual cancer cells following treatment. Measurement of CA 125 levels before repeat surgery is not very effective in predicting disease progression in advanced cases of epithelial ovarian cancer. However, CA 125 levels may be useful in evaluating the initial response of tumor cells to chemotherapy and to compare the effectiveness of different drug regimens. A model was developed in which CA 125 levels decline with decreasing numbers of tumor cells. The average time for initial CA 125 levels to decrease by 50 percent following surgery to remove the tumor was 10.4 days. It was predicted that the response of tumor cells to drug therapy was greater with high doses of cisplatin compared with lower doses. This initial response of tumor cells as indicated by CA 125 may be used to predict the outcome of repeat surgery and overall survival. (Consumer Summary produced by Reliance Medical Information, Inc.)