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M S Piver

Publications and source records attributed to M S Piver.

At least 73 records · Page 4Linked to original sources
PubMed1997

Primary peritoneal adenocarcinoma metastatic to the brain.

Primary peritoneal adenocarcinoma is a relatively newly identified disease entity whose clinical behavior is not fully recognized. We report a case of a patient with progressive primary peritoneal adenocarcinoma who developed brain metastases and died shortly afterward. The incidence of central nervous system metastases in 72 patients with documented primary peritoneal adenocarcinoma was 1.4%. The risk factors, clinical behavior, and prognosis of patients with primary peritoneal adenocarcinoma metastatic to the central nervous system seem to be similar to those of patients with epithelial ovarian cancer metastatic to the central nervous system.

Adenocarcinoma↗
PubMed1997

The inferior gluteal flap in the difficult vulvar and perineal reconstruction.

OBJECTIVE: The objective was to study the feasibility and complications of the use of the inferior gluteal flap in the difficult vaginal, perineal, and vulvar reconstruction among women treated for gynecologic cancers. METHODS: A prospective pilot study is reported. Between October 1994 and May 1996, seven patients underwent either unilateral (n = 3) or bilateral (n = 4) inferior gluteal flaps for primary reconstruction of extensive vulvar, perineal, and vaginal defects. RESULTS: The median age of the patients was 59 years (range, 40-70). The indications for the construction of the flaps were radical resection of recurrent vulvar cancer (n = 2), radical resection of stage IV vulvar cancer (n = 2), resection of recurrent Paget's disease of the vulva (n = 1), resection of perineal recurrence of cancer of the cervix (n = 1), and resection of enteroperineal fistula following total pelvic exenteration (n = 1). The median surface area of the vulvar and perineal defect was 113 cm2 (range, 10.5-448 cm2). The median operative time for both the extirpative and the reconstructive procedures was 270 min (95-685 min) and the median estimated blood loss was 200 mL (50-950 mL). The median postoperative hospital stay was 15 days (9-29). None of the patients experienced complete graft loss. Two patients suffered necrosis of the tip of the flap that resulted in minimal wound dehiscence which healed by secondary intention, and one patient suffered graft separation which required graft revision and reconstruction. The patients were followed for a median of 11 months (3-26 months). No late complications of the reconstructive surgery were recorded. CONCLUSIONS: The inferior gluteal flap can be safely used for the reconstruction of the difficult and extensive vulvar, perineal, and vaginal defects with excellent results.

Adult↗
PubMed1997

Two sequential studies for primary peritoneal carcinoma: induction with weekly cisplatin followed by either cisplatin-doxorubicin-cyclophosphamide or paclitaxel-cisplatin.

OBJECTIVES: The aim of the current study is to evaluate the results of therapy with induction with weekly cisplatin followed by the combination of cisplatin-doxorubicin-cyclophosphamide (PAC) or the combination paclitaxel-cisplatin (TP) as first-line chemotherapy in patients with primary peritoneal adenocarcinoma (PPA). METHODS: Between October 1988 and July 1996, 46 patients with PPA were treated with PAC (n = 25) or TP (n = 21) following cytoreductive surgery in two sequential trials. In trial 1, patients received induction with weekly cisplatin (1 mg/kg) x 4 followed by monthly cisplatin (50 mg/m2), cyclophosphamide (750 mg/m2), and doxorubicin (50 mg/m2) for 10 cycles. In trial 2, patients received induction with weekly cisplatin (1 mg/kg) x 4 followed by monthly cisplatin (75 mg/m2) and paclitaxel (135 mg/m2) over 24 hr for 6 cycles. Surgical assessment of response was performed in 15 (60.0%) and 13 (61.9%) patients in the PAC and TP trials, respectively. Estimated survival and progression-free survival distributions were calculated by the method of Kaplan and Meier. Survival curves were compared using the log rank test. RESULTS: There were no significant differences between patients in either treatment arm with respect to median age, substage, percentage of patients undergoing optimal cytoreductive surgery, median preoperative CA125 values, performance status, proportion of patients who had second-look procedures, or median cumulative doses of cisplatin. The incidence of nausea and vomiting as well as peripheral neuropathy was significantly higher among patients who received TP (P = 0.005 and 0.022, respectively). The overall response, surgical response, and complete surgical response were not statistically different among patients who received PAC and those who received TP (62.5% versus 70.0%, P = 0.75, 73.3% versus 76.9%, P = 0.1, and 13.3% versus 23.1%, P = 0.64, respectively). Patients who underwent optimal cytoreductive surgery demonstrated higher response than patients whose tumors could not be optimally cytoreduced (76.7% versus 42.9%, P = 0.04). There was no statistically significant difference in overall survival or time to progression/recurrence between the PAC and TP groups (median 21.5 versus 24.0 months, P = 0.68, and 17.3 versus 24.0 months, P = 0.59, respectively). In both treatment groups combined, 18 of 32 patients whose tumors were optimally cytoreduced and 3 of 14 patients whose tumors were suboptimally cytoreduced had surgically verified response. Patients who underwent optimal cytoreductive surgery exhibited longer survival than those who underwent suboptimal cytoreductive surgery (median 29.4 versus 18.6 months, P = 0.008). CONCLUSIONS: Both PAC and TP regimens are effective combinations in patients with PPA. The median survival was similar following PAC and TP but the responses and time to recurrence/progression were nonsignificantly better in the paclitaxel combination.

Adenocarcinoma↗
PubMed1997

Second-look laparotomy in advanced ovarian cancer: a critical assessment of morbidity and impact on survival.

BACKGROUND: The routine inclusion of second-look laparotomy in the management of patients with epithelial ovarian cancer is controversial. At issue is the justification of morbidity incumbent upon surgery and the possible survival benefit of secondary cytoreduction. METHODS: The rate of major complications of surgery was assessed among 100 consecutive patients with FIGO stage III or IV epithelial ovarian cancer who underwent second-look laparotomy. All patients demonstrated a complete clinical and biochemical (CA125 < 35 U/ml) response to first-line therapy. Patients were stratified based on findings at surgery. Patients in group 1 (n = 37) had a negative second-look laparotomy. Patients in group 2 (n = 35) had only microscopically appreciable disease. Patients in group 3 (n = 28) had macroscopic disease. Cytoreductive efforts aimed at resection of all macroscopic disease were carried out for patients in group 3. RESULTS: Thirteen patients (13%) had 15 major complications at surgery. Comparison of the complication rates for patients in groups 1, 2, and 3, of 10%, 8.5%, and 21.4%, respectively, did not achieve statistical significance (p = 0.228). The estimated 5-year survival for patients in groups 1, 2, and 3 of 63.9%, 39.8%, and 14.2%, did differ significantly (p < 0.0001). Cytoreductive efforts resulted in the resection of all macroscopic disease in 18 of 28 patients (64.2%) in group 3. The median survival for this group of 18 patients was 33 months, and estimated 5-year survival was 20%. These values do not differ significantly from those observed for patients in group 2. CONCLUSION: The major complication rate associated with second-look laparotomy is not prohibitive Secondary cytoreductive efforts may result in improved survival for patients with epithelial ovarian cancer.

Adenocarcinoma↗
PubMed1997

Hormone replacement therapy as a risk factor for epithelial ovarian cancer: results of a case-control study.

OBJECTIVE: To evaluate the role of hormone replacement therapy (HRT) as a risk factor for the development of epithelial ovarian cancer. METHODS: A case-control study was performed that used 491 patients with epithelial ovarian cancer frequency matched for age at diagnosis (+/-5 years) with a control population of 741 patients with malignancies of nonestrogen-dependent tissues. The odds ratio (OR) for the development of epithelial ovarian cancer was estimated using logistic regression analysis with adjustment for age at diagnosis, parity, oral contraceptive use, smoking history, family history of epithelial ovarian cancer, age at menarche, menopausal status, income, and education. RESULTS: One hundred of 491 patients (20.4%) in the study population had ever used HRT, and 160 of 741 patients (21.6%) in the control population had ever used HRT (OR 0.85; 95% confidence interval [CI] 0.62, 1.2). A significant association between HRT and specific histologic subtypes of epithelial ovarian cancer was not demonstrable for serous cystadenocarcinoma (OR 1.2, 95% CI 0.8, 1.7), Clear cell carcinoma (OR 1.1, 95% CI 0.4, 3.4), or endometrioid carcinoma (OR 0.4; 95% CI 0.2, 1.2). A significant association between duration of use of HRT and the risk of developing epithelial ovarian cancer was not demonstrable for under 5 years (OR 0.8; 95% CI 0.5, 1.2), 5-9 years (OR 0.6; 95% CI 0.3, 1.1), or 10 or more years (OR 0.6; 95% CI 0.3, 1.4). CONCLUSION: A significant association between the use of HRT and the risk of developing epithelial ovarian cancer, even with prolonged exposure, is not demonstrable.

Case-Control Studies↗
PubMed1997

Identical, unique p53 mutations in a primary ovarian mucinous adenocarcinoma and a synchronous contralateral ovarian mucinous tumor of low malignant potential suggest a common clonal origin.

The origin of malignant ovarian epithelial tumors is uncertain and has been the subject of considerably controversy. Some favor the theory of origin in precursor lesions such as benign cystadenomas or tumors of low malignant potential (LMP; borderline tumors), whereas others favor the concept of an independent origin of carcinomas from the ovarian surface epithelium or inclusion cysts. Recently, the demonstration of identical molecular alterations in morphologically benign and malignant areas within the same ovarian tumor have suggested the possibility that the malignant epithelium had undergone differentiation to a benign appearance. Because both areas were present in the same tumor, however, the possibility of progression of the morphologically benign component could not be excluded. We present a case of simultaneous mucinous carcinoma and contralateral tumor of LMP which exhibited identical, unique mutations of the p53 gene, suggesting a clonal origin. Because these were separate and distinct tumors, we believe this case provides strong support for the differentiation hypothesis. We also provide evidence for markedly different levels of p53 expression in areas with identical p53 mutations.

Adenocarcinoma, Mucinous↗
PubMed1997

The addition of bleomycin and dose-escalated ifosfamide to the combination of cisplatin plus ifosfamide does not improve survival in advanced or recurrent cervical carcinoma.

Twenty patients with advanced or recurrent cervical cancer were treated with bleomycin 30 U, ifosfamide 5 g/m2, and cisplatin 50 mg/m2 (BIP) every 28 days in a phase II trial. The primary purpose of this study was to compare response rate, survival, and toxicity of this regimen with results obtained in a similar group of patients treated with cisplatin 1 mg/kg per week for six courses followed by cisplatin, 20 mg/m2, plus ifosfamide 1.2 g/m2 daily for 3 days every 28 days. Four of 17 evaluable patients (23.5%) treated with BIP demonstrated a response to therapy (complete response 11.7%; partial response 11.7%). The median duration of response was 8.5+ months (range, 6+ to 24 months). These data do not differ significantly (P = 0.76) from a response rate of 27.5% among patients treated with cisplatin plus ifosfamide (PI). A significant (P = 0.003) increase in myelotoxicity was observed among patients treated with BIP versus those treated with PI. The median survival of patients treated with BIP of 13.5+ months (range, 8+ to 24 months) does not differ significantly from the median survival of 9+ months (3 to 26+ months) among patients treated with PI. The addition of bleomycin and dose-escalated ifosfamide did not significantly improve response rate or survival among patients with advanced or recurrent cervical cancer and resulted in a significant increase in myelotoxicity.

Adult↗
PubMed1997

Expression of the p53 induced tumor suppressor p21waf1/cip1 in ovarian carcinomas: correlation with p53 and Ki-67 immunohistochemistry.

Mutations of the p53 gene are the most common genetic alteration in malignant human tumors, including ovarian carcinomas of surface epithelial origin. A cyclin-dependent kinase inhibitor, p21waf1/cip1, is thought to be an important mediator of p53-induced cell cycle arrest. Although numerous studies have reported p53 expression and mutation in ovarian tumors, none have correlated p53 expression with that of its downstream effector, p21waf1/cip1. We studied p53 and p21waf1/cip1 expression by immunohistochemistry in 44 ovarian carcinomas of different histologic types and correlated these findings with each other and with proliferation as measured by expression of the Ki-67 nuclear antigen. Fifty percent of tumors expressed p53, whereas 34% expressed p21waf1/cip1. Clear cell carcinomas expressed p21waf1/cip1 significantly more often than other histologic types, and tumors with squamous differentiation showed higher p21waf1/cip1 expression in these areas. There was no correlation of p21waf1/cip1 expression with p53 expression, p53 mutation, or Ki-67 expression. p21waf1/cip1 appears to be induced independently of p53 in these tumors and may be associated with differentiation rather than proliferation.

Cell Differentiation↗
PubMed1997

Tubal ligation and the risk of ovarian carcinoma.

To assess the relationship of tubal ligation and risk of ovarian carcinoma, we conducted a case-control, retrospective analysis of 300 ovarian carcinoma cases and 606 nonmalignant disease controls, seen between 1982 and 1988 at Roswell Park Cancer Institute, Buffalo, New York. Women who had a tubal ligation had reduced risk for the development of ovarian cancer. This relative risk was 0.52, with a 95% confidence interval 0.31 to 0.85 (p = 0.0076). Controls were matched by age. Multivariate analysis adjusted for socioeconomic level, marital status, parity, age at first pregnancy, menarche age, menopause age, irregular menses, breast-feeding duration, body habitus, and oral contraceptive use. Suggested explanations for this observation are offered.

Age Factors↗
PubMed1996

Lack of improved survival plus increase in thromboembolic complications in patients with clear cell carcinoma of the ovary treated with platinum versus nonplatinum-based chemotherapy.

BACKGROUND: This study was conducted to evaluate survival rates for patients with clear cell ovarian carcinoma who had platinum-based chemotherapy versus nonplatinum-based chemotherapy and the risk of thromboembolic complications. METHODS: One hundred and eleven evaluable patients with clear cell ovarian carcinoma who underwent primary surgery and postoperative therapy were retrospectively evaluated. Median follow-up was 21.3 months (range, 3-280 months). Patients treated with platinum-based chemotherapy and nonplatinum-based chemotherapy were evaluated according to stage, age, grade, extent of surgery, and development of thromboembolic complications. Patient populations were compared using the chi-square test. Estimated 5- and 10-year survivals for each group were calculated using the method of Kaplan and Meier. Differences in survival rates were calculated using the log rank test. The frequency of thromboembolic complications in the clear cell ovarian carcinoma group was compared with its frequency in a matched-control group of 109 patients with epithelial nonclear cell ovarian carcinoma. RESULTS: Seventy-one patients were treated with nonplatinum-based chemotherapy and 40 patients were treated with platinum-based chemotherapy. There was no statistically significant difference in the characteristics of patient populations treated with platinum-based chemotherapy or nonplatinum-based chemotherapy. The estimated 5-year survival for clear cell ovarian carcinoma patients treated with platinum-based chemotherapy did not differ significantly from the estimated 5-year survival for patients with clear cell ovarian carcinoma treated with nonplatinum-based chemotherapy (36% vs. 32%; P = 0.23). Twelve patients with clear cell ovarian carcinoma developed thromboembolic complications remote from primary surgery, whereas in a matched-control group of patients with nonclear cell ovarian carcinoma treated with platinum-based chemotherapy, no patients developed a thromboembolic complications (P = 0.0004). Eight of 40 patients (20%) with clear cell ovarian carcinoma treated with platinum-based chemotherapy developed thromboembolic complications, whereas 4 of 71 patients (6%) treated with nonplatinum-based chemotherapy developed thromboembolic complications (P = 0.03). Multivariate logistic regression analysis demonstrated that the development of a thromboembolic complication was significantly related to clear cell ovarian carcinoma and platinum-based chemotherapy and had a significant (P = 0.009) negative impact on survival. CONCLUSIONS: Platinum-based chemotherapy did not appear to improve survival compared with nonplatinum-based chemotherapy of patients with clear cell ovarian carcinoma. The combination of platinum-based chemotherapy and clear cell ovarian carcinoma significantly increases the risk for thromboembolic complications and has a significant negative impact on survival.

Adenocarcinoma, Clear Cell↗
PubMed1996

Paclitaxel and cisplatin combination chemotherapy in recurrent epithelial ovarian cancer.

The objective of this study was to assess the efficacy of chemotherapy in recurrent epithelial ovarian cancer using the sequential combination of 24-hr paclitaxel followed by cisplatin. All patients presenting to the Department of Gynecologic Oncology at Roswell Park Cancer Institute between April 1993 and May 1995 with recurrent epithelial ovarian cancer were offered enrollment in a prospective trial utilizing paclitaxel 135 mg/m2 administered in a continuous 24-hr intravenous infusion, followed by intravenous cisplatin 50 mg/m2. Forty-nine patients were entered into the study. Of 38 patients evaluable for response, there were 14 complete responders and 6 partial responders for an overall response rate of 53%. Median survival was >23 months for responders and 12 months for the entire study group. All complete responders were still alive with a median follow-up of 23 months. Of 12 evaluable patients whose tumors had progressed on single-agent paclitaxel, 4 achieved an objective response with the addition of cisplatin. Response rates and survival were similar in patients with platinum-resistant tumors compared to patients with platinum-sensitive tumors, and in patients who had received one, two, or multiple prior chemotherapy regimens. The combination of paclitaxel administered in a 24-hr infusion followed by cisplatin is highly active in recurrent epithelial ovarian cancer, even in patients who have previously failed single-agent paclitaxel or cisplatin-based chemotherapy.

Adenocarcinoma↗
PubMed1996

Pretreatment transperitoneal laparoscopic staging pelvic and paraaortic lymphadenectomy in large (> or = 5 cm) stage IB2 cervical carcinoma: report of a pilot study.

Twelve patients with large stage IB2 (5-8 cm) cervical carcinoma underwent transperitoneal laparoscopically directed pelvic and paraaortic lymph node dissection prior to the initiation of radiation therapy. The mean length of operation was 176 min and the mean estimated blood loss was 60 cc. An average of 25 lymph nodes were retrieved from each patient: 18 pelvic lymph nodes and 7 paraaortic lymph nodes. No patients were hospitalized for more than 24 hr. No operative complications were observed. Pelvic nodal metastases were diagnosed in three patients, all of whom had negative computerized tomography (CT) scans prior to surgery. All patients began radiation therapy within 1 week of surgery. Laparoscopically directed lymphadenectomy for patients with stage IB2 cervical carcinoma is technically feasible, is associated with minimal morbidity, short hospital stay, and minimal delay prior to radiation therapy, and can add valuable information to radiation treatment planning.

Adenocarcinoma↗
PubMed1996

The curative potential of radiation therapy in the treatment of primary vaginal carcinoma.

The outcome of 55 patients with primary vaginal carcinoma treated with radiation therapy at Roswell Park Cancer Institute was retrospectively reviewed. Forty-four (80%) had a squamous cell carcinoma and 11 (20%) had an adenocarcinoma. The median age was 61 years and the median dose of radiation administered, external beam and brachytherapy, was 7,040 cGy. Fifteen percent of patients developed severe radiation-induced complications, and 36% developed recurrence of disease. The overall 5-year survival and 5-year disease-free survival for the entire group was 49 and 58%, respectively. Variables positively influencing survival included younger age, early stage, involvement of the upper vagina, total radiation dosage > 7,500 cGy, and the use of combination external beam and brachytherapy. However, only age acted as an independent prognostic factor affecting survival. The pelvis was the site of disease in the majority of patients who suffered recurrence.

Adenocarcinoma↗
PubMed1996

Characteristics of familial ovarian cancer: a report of the first 1,000 families in the Gilda Radner Familial Ovarian Cancer Registry.

BACKGROUND: To determine the demographics of the first 1,000 families in the Gilda Radner Familial Ovarian Cancer Registry. METHODS: Any woman with a family history of two or more first or second degree relatives with ovarian cancer who was referred to the Registry was entered into a database. The demographics of the Registry population were analyzed, including total number of ovarian cancer cases, cases per family, age at diagnosis, prevalence of other malignancies, and histology. Comparisons were made to expected norms in the general population using the most recent surveillance, Epidemiology, and End Results data from the National Cancer Institute. RESULTS: There were 2,425 reported cases of ovarian cancer among the 1,000 registered families. The number of cases per family ranged from 2-10 with 72.4% of the families having two cases of ovarian cancer and 27.6% with three or more cases of ovarian cancer. The mean age at diagnosis was 53.5 years, significantly younger than the 60.8 years reported in the general population (p < 0.1). The mean age at diagnosis was even younger, 52.1 years, in the subset of patients with a family history of three or more cases of ovarian cancer. Moreover, in the mother/daughter pairs of ovarian cancer where age of onset of ovarian cancer was known, the mean age of the mothers was 58.8 compared to a mean age of 50.2 among the daughters (p < 0.01). There was a significantly larger proportion of serous adenocarcinoma (40%) and a significantly smaller proportion of mucinous adenocarcinoma (3%) and stromal cell tumor (0%) when compared to the general population (p < 0.01). Breast and colon cancer were the two most common other cancers reported. CONCLUSIONS: given the limits of the study due to the voluntary nature of the Registry, the data suggests that familial ovarian cancer occurs at a younger age than the general population, daughters of mothers with ovarian cancers develop ovarian cancer at an age significantly younger than their mothers, mucinous and stromal tumors occurred significantly less often than in the general population, and the most common associated other cancers are female breast cancer and female and male colon cancer.

Adolescent↗
PubMed1995

Risks of cancer among members of families in the Gilda Radner Familial Ovarian Cancer Registry.

BACKGROUND: Increasing scientific and public interest in hereditary cancer syndromes has created a need for estimates of lifetime cancer risks among members of families with such syndromes. METHODS: Data from the Gilda Radner Familial Ovarian Cancer Registry were used to evaluate risk for cancers of the breast, cervix, uterus, colorectum, and prostate in members of 143 families containing three or more reported cases of ovarian cancer among first- or second-degree relatives. These risks were compared with those that were expected based on general population rates obtained from the Connecticut Tumor Registry. RESULTS: Overall, family members' risk of cancer at any nonovarian site was 1.5 times that of the general population (P < 0.001). Among female members, risk for cancer of the breast was 2.5 times that of the general population. Risk for cancer of the uterus was 5 times that of the general population and increased with increasing number of first-degree relatives with ovarian cancer. Among male family members having three or more first-degree relatives with ovarian cancer, prostate cancer risk was 4.5 times that of the general population. No excess risks were observed for cancer of the colorectum. CONCLUSIONS: These data support previous reports of coaggregation of cancer of the breast, uterus and ovary, and suggest coaggregation between cancer of the ovary and prostate. Differences in cancer risk profiles observed in these families with multiple ovarian cancer and in carriers of the gene BRCA1 suggest that hereditary ovarian cancer is genetically heterogeneous.

Female↗