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Biomedical subjects

S L Curry

Publications and source records attributed to S L Curry.

At least 37 records · Page 2Linked to original sources
PubMed1989

Hormonal contraception and trophoblastic sequelae after hydatidiform mole (a Gynecologic Oncology Group Study)

A prospective randomized study was undertaken to determine whether the administration of oral contraceptives after the evacuation of a hydatidiform mole affects the human chorionic gonadotropin serum level in a way that leads to an increased frequency in the diagnosis of postmolar trophoblastic disease. Between 1981 and 1988, 266 patients were randomly assigned to either oral contraceptives or barrier contraception after evacuation of a hydatidiform mole. Patients were followed up until serum levels of human chorionic gonadotropin were normal or until specific criteria for the diagnosis of postmolar trophoblastic disease were met. Twenty-three percent of patients receiving oral contraceptives had postmolar trophoblastic disease, whereas those using a barrier method had a rate of 33%. The median time to spontaneous regression in the oral contraceptives group was 9 weeks, whereas the median time to regression in the barrier group was 10 weeks. Twice as many patients in the barrier group became pregnant in the immediate follow-up period. We conclude that oral contraceptives are the preferred method of contraception after evacuation of a hydatidiform mole.

Chorionic Gonadotropin↗
PubMed1989

Extraperitoneal versus transperitoneal selective paraaortic lymphadenectomy in the pretreatment surgical staging of advanced cervical carcinoma (a Gynecologic Oncology Group study).

Two-hundred and eighty-eight patients with predominately stage IIB or IIIB cervical carcinoma underwent pretreatment surgical staging including selective paraaortic lymphadenectomy (SPAL), followed by pelvic irradiation with or without paraaortic irradiation (RT). Four patients were excluded from analysis (two received no RT and two were insufficiently documented). Of the remaining 284 patients, 128 underwent extraperitoneal (EP) SPAL and 156 transperitoneal (TP) SPAL procedures. Age, race, and stage (clinical and surgical), cell type, paraaortic nodal status, and peritoneal cytology findings were similar in both groups. Complications presumed to arise from operative staging were infection, which was similar for both groups, and vascular injury, which was higher in the TP group, although not statistically significant. Complications subsequent to RT fell into two categories: local-pelvic necrosis, vesicovaginal and rectovaginal fistulas, proctitis, etc., and regional-enterovaginal fistula, bowel obstruction, enteritis, bowel perforation, etc. The frequency of local complications was similar for both EP and TP patients. Utilizing univariant analysis, among regional complications, both bowel obstruction and nonobstructive enteric injuries were observed significantly more often in TP patients than in EP patients (11.5% vs 3.9%, P = 0.03, for both types). Multivariant analysis confirmed these observations. This report supports the conclusions that in advanced cervical carcinoma (1) EP- and TP-SPAL are of similar sensitivity in detecting nodal spread, (2) no significant differences in the frequency of surgical complications could be detected between EP- and TP-SPAL groups, and (3) TP-SPAL is associated with a higher frequency of certain postirradiation regional enteric complications.

Adult↗
PubMed1989

A prospective randomized comparison of methotrexate, dactinomycin, and chlorambucil versus methotrexate, dactinomycin, cyclophosphamide, doxorubicin, melphalan, hydroxyurea, and vincristine in "poor prognosis" metastatic gestational trophoblastic disease: a Gynecologic Oncology Group study.

In 1981, the Gynecologic Oncology Group initiated a prospective randomized study in which patients with poor-prognosis gestational trophoblastic disease received either standard MAC chemotherapy (methotrexate, dactinomycin, and chlorambucil) or the modified CHAMOMA regimen (methotrexate, dactinomycin, cyclophosphamide, doxorubicin, melphalan, hydroxyurea, and vincristine). The protocol was closed in May 1986 because the modified CHAMOMA regimen was significantly more toxic and possibly less effective. There were 42 patients entered, with 22 receiving MAC and 20 receiving modified CHAMOMA. There have been six deaths due to disease in the modified CHAMOMA group and none in the MAC group. Five MAC failures and one modified CHAMOMA failure have been rescued by surgery and/or chemotherapy. All six of the patients who died on the modified CHAMOMA regimen had developed disease following a previous term pregnancy, but none had prior chemotherapy. All seven patients who were treated for gestational trophoblastic disease after term pregnancy in the MAC group were cured of disease. With the modified CHAMOMA regimen, 44% of patients had life-threatening hematologic toxicity, as compared with only 9% of the MAC patients. Thus, the standard MAC regimen appears to be at least equally effective and much less toxic than the modified CHAMOMA regimen, indicating a more favorable therapeutic index.

Adult↗
PubMed1987

Phase III study on the treatment of women with cervical cancer, stage IIB, IIIB, and IVA (confined to the pelvis and/or periaortic nodes), with radiotherapy alone versus radiotherapy plus immunotherapy with intravenous Corynebacterium parvum: a Gynecologic Oncology Group Study.

A report on a study conducted under the auspices of the Gynecologic Oncology Group on the treatment of women with advanced carcinoma of the uterine cervix (stages IIB, IIIB, IVA) with radiotherapy alone versus radiotherapy plus immunotherapy (intravenous Corynebacterium parvum) is presented. There were 283 patients considered evaluable for analysis. Of these, 135 patients were randomized to radiotherapy plus C. parvum (120 patients received at least one course) and 148 were randomized to radiotherapy only. The two treatment regimens were similar for those adverse effects commonly associated with radiation therapy but for hematologic toxicity and fever and/or chills were significantly more frequent among those patients who received C. parvum. There was no statistical difference in the treatment regimens with regard to survival or progression-free interval. Of the 42 patients with positive periaortic nodes, 19% were alive at 3 years. No therapeutic value was demonstrated by combining C. parvum therapy with traditional radiation therapy in advanced cervical cancer. Because of the greater frequency of adverse effects in those patients receiving C. parvum, the further use of C. parvum at this dose and schedule does not appear to be indicated for treating cervical cancer patients.

Adenocarcinoma↗
PubMed1987

The role of second-look laparotomy in treatment of epithelial ovarian cancer.

Forty-two patients underwent a second-look laparotomy to assess response to systemic chemotherapy for epithelial ovarian cancer. In 20 cases the operation showed no histologic evidence of disease. None of these cases received additional treatment at the time of negative second-look laparotomy. There has only been one recurrence noted in an average follow-up interval of 38.5 months. The remaining 22 cases did have residual carcinoma and 16 have developed progressive carcinoma despite secondary treatment. We found second-look laparotomy to be a safe and reliable assessment tool. However, we could not demonstrate a medical benefit from the procedure.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Hematologic monitoring in patients with cancer. A study of the Gynecologic Oncology Group.

A retrospective review of four Gynecologic Oncology Group protocols involving aggressive chemotherapy was carried out to assess the following. Whether granulocyte determinations, which require a differential count resulting in extra cost and time, added pertinent clinical information to that obtained from the white blood cell count alone. If, there is a predictable relationship between the white blood cell count and the platelet count as a reflection of bone marrow toxicity, and whether one can predict when maximum myelosuppression will occur during a treatment program. This data revealed that the white blood count and granulocyte levels are closely related; that rarely is life-threatening thrombocytopenia noted in the absence of leukopenia; and that myelosuppression can occur during any course of treatment and is not predictable. Thus, for these treatment regimens in gynecologic malignancies, the white blood count is sufficient for monitoring toxicity and adjusting future courses of chemotherapy. Only when the white blood count is severely depressed is it necessary to monitor the granulocyte and platelet counts.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

Phase II trial of piperazinedione in patients with advanced or recurrent uterine sarcoma. A Gynecologic Oncology Group study.

Twenty patients with advanced or recurrent uterine sarcoma no longer amenable to control with surgery and/or radiotherapy were entered into study by Gynecologic Oncology Group institutions to receive piperazinedione 9 mg/m2 intravenously every 3 weeks. One patient was deemed to be ineligible for study. Among the 19 evaluable patients, only one response was observed, a partial response in a patient with leiomyosarcoma. Adverse effects consisted primarily of myelosuppression and were tolerable. Piperazinedione at the dose and schedule tested appears to have little activity against uterine sarcomas.

Adult↗
PubMed1985

The value of endocervical curettage as part of the standard colposcopic evaluation.

Whether to perform endocervical curettage (ECC) as part of a routine colposcopic examination in patients with an abnormal Papanicolaou smear remains controversial. Some studies consider ECC an essential part of a colposcopic examination regardless of the level of the squamocolumnar junction (SCJ); others consider it superfluous in cases where the SCJ can be visualized. Between January 1980 and December 1982, 278 new patients with abnormal Papanicolaou smears underwent colposcopy. Directed biopsies established the degree of cervical intraepithelial neoplasia (CIN) and ruled out invasive disease. ECC was done on every patient. A total of 51 patients (18%) had a positive ECC. Seven patients could not be evaluated because their records were incomplete. Of the 44 evaluable patients, 32 (73%) had satisfactory colposcopy. In the remaining 12 (27%) the upper limit of the transformation zone could not be seen clearly; in that group the degrees of CIN on colposcopic biopsy and ECC were in agreement in two cases; ECC revealed the degree to be less severe in four cases and more severe in six (50%). In the group with satisfactory examinations, 15 had the same degree of CIN on colposcopic biopsy and ECC; ten had less severe and seven (22%), more severe degrees of CIN on ECC. Of greatest clinical importance was that, overall, 11.5% had a positive ECC despite a satisfactory colposcopic examination. This study indicated that ECC provides unique and important information, justifying its inclusion as part of the standard evaluation of every patient undergoing colposcopy for abnormal cervical cytology.

Biopsy↗
PubMed1984

Ultrasound used for assessing the in situ position of intrauterine tandems.

Intracavitary radiation is an integral part of the treatment in many gynecologic cancers. The intrauterine tandem has a well-established role in treating both cervical and endometrial malignancies. The effectiveness of this therapy and its complications are directly related to the proper intracavitary position of the tandem. To date, there has been no objective technique appropriate for routine use in assessing the precise in situ location of these devices, apart from plain abdominal films. As such, little is known about the incidence or types of procedural complications and the sequelae associated with improper tandem placement. Here it is reported that ultrasound is an effective tool for evaluating the in situ position of the intrauterine tandem. Two cases are presented demonstrating important applications of this method.

Aged↗
PubMed1980

Analysis of factors contributing to treatment failures in stages IB and IIA carcinoma of the cervix.

Between April, 1971, and September, 1977, 98 patients with Stages IB and IIA cervical cancer who underwent surgical exploration prior to treatment at Hershey Medical Center were studied. Those who had bulky primary tumor (greater than or equal to 4 cm) had a higher incidence of nodal metastases (80% vs. 16%), local recurrences (40% vs. 5%), and distant metastases (40% vs. 1%). Patients who had positive nodes had more local recurrences (24% vs. 6%) and distant metastases (28% vs. 0%). Those with grossly positive nodes had more distant metastases (60% vs. 7%) than those with microscopically positive nodes. Those who had positive nodes, vascular invasion, and/or deep invasion of the cervix (greater than or equal to 70% of thickness) in the radical hysterectomy specimen had more nodal metastases and local recurrences. Postoperative radiation seemed to prevent local recurrences (40% vs. 6%) and improve the 2-year tumor-free survival rate (94% vs. 55%). Patients who had bulky primary tumors and/or grossly positive nodes at laparatomy may require systemic therapy in view of the high incidence of distant failures.

Adenocarcinoma↗