bluuebunny/crossref_metadata_2025_split huggingface dataset:
New approaches to high‐risk cervical cancer: Advanced cervical cancer
Authors: Jones Walter B. 
Published: March 2011

AbstractBackground. The role of chemotherapy in the surgical management of high‐risk cervical cancer has not yet been defined. Based on the ability of numerous cytotoxic agents to induce regressions in advanced and recurrent cervical cancer, there is now a trend toward early use of these drugs. The efficacy of cisplatin‐containing regimens in particular suggests that new strategies combining chemotherapy and surgery may result in improved survival rates in patients with high‐risk cervical cancer.Methods. In this review of the literature, two groups of patients who may benefit from this approach to therapy are discussed. In the first group are patients with local or regionally advanced cervical carcinoma who receive chemotherapy (neoadjuvant) with the goal of reducing tumor bulk and thus allowing surgical treatment in normally inoperable cases. The second group consist of patients with identifiable adverse risk factors after radical hysterectomy and pelvic lymphadenectomy who receive postoperative chemotherapy (adjuvant) in an effort to decrease local and distant recurrences.Results. The administration of neoadjuvant chemotherapy to patients with local and locally advanced cervical cancer allows radical surgery to be performed in many patients who otherwise would be considered inoperable. In these patients, there also appears to be a decrease in the incidence of pelvic and distant recurrences and possibly an improvement in survival rates. Adjuvant chemotherapy after radical surgery for patients at high risk for recurrence appears to provide a survival advantage in some high‐risk patients.Conclusions. Preliminary results in the new approaches to therapy that combine chemotherapy with surgery in patients with high‐risk cervical cancer are encouraging. Randomized prospective trials are warranted to identify the most active chemotherapeutic regimens and to determine the patient selection criteria most likely to result in improved survival rates.
Endometrial carcinoma: Influence of prognostic factors on radiation management
Authors: Rotman Marvin , Aziz Hassan , Halpern Joshua , Schwartz David , Sohn Chul , Choi Kwang 
Published: March 2011

AbstractThe earliest intracavitary radium treatment for uterine cancer was reported in 1908. Refinements reported during the next 20 years, using an intrauterine tube and colpostats or radium capsules, established a treatment philosophy of preoperatively irradiating uterine and parauterine tissues. Thus, preoperative intracavitary irradiation became entrenched as therapy for all endometrial cancers for the better part of four decades. In the 1950s and 1960s, the ability of external irradiation to eradicate cancer in regional lymphatic vessels prompted the use of pelvic field irradiation in Stage II and III and recurrent disease. The results of surgical exploratory studies in the 1970s established more refined criteria for preoperative or postoperative external pelvic irradiation in high‐grade infiltrating Stage I cancers. In the 1980s, it became apparent that, for tumors with lymphovascular invasion, clear cell, and serous papillary histologic types, the disease spread to the upper abdomen and the paraaortic nodes might benefit from extended field and/or whole abdominal irradiation, with or without systemic bolus or concomitant continuous‐infusion chemotherapy. In the 1980s, a subset of patients was identified with high‐grade lymphovascular invasion clear cell and papillary serous histologic types or with positive peritoneal cytologic findings who were at high risk of failing in the paraaortic nodes and/or the upper abdomen for whom extended field or whole abdominal irradiation have been advocated. Given the fraction and dose limitation for a large abdominal field, the addition of systemic concomitant bolus or continuous infusion of chemotherapy currently is proposed to improve the control of intraabdominal failure in these high‐risk patients.
Epidemiology of breast cancer: Findings from the nurses' health study
Authors: Colditz Graham A. 
Published: March 2011

AbstractBackground. The epidemiology of breast cancer was reviewed in the context of hormonal, hereditary, histologic, and dietary risk factors.Methods. Literature review.Results. Late age at menarche and early age at first birth decrease the risk of breast cancer as does an early age at menopause. These risk factors relate to the lifetime exposure of the breast tissue to ovarian hormones. Although an early first birth is associated with a transient increase in the risk of breast cancer, perhaps as a result of the breast's exposure to high levels of hormones before terminal differentiation, in older women, parity is associated with a decreased risk of breast cancer. Among postmenopausal women, obesity is associated with higher levels of estrogens and an increased risk of breast cancer. Within the strata of breast cancer stages at diagnosis, obesity is associated with increased mortality, again supporting the influence of endogenous estrogens on this disease's incidence, recurrence, and survival rates. Consistent with these relationships, current use of estrogen therapy among postmenopausal women is associated with an increased risk of breast cancer. A family history of breast cancer is associated with approximately a twofold increase in the risk of breast cancer, and this risk is greater if the diagnosis was made when the woman's mother was young, although even a diagnosis in an older mother is associated with an increased risk in her daughters. The follow‐up of women with a history of benign breast biopsy results shows that atypical hyperplasia is associated with a fourfold increase in risk compared with a biopsy specimen without proliferative changes. Atypia doubles the risk. These data support the concept of atypia as a precursor lesion for breast cancer and may warrant its use as a marker in further studies. Consistent data from retrospective and prospective studies show a positive association between moderate alcohol intake and the risk of breast cancer. This may reflect the increase in estrogen levels observed among women who consume alcohol. Data from prospective studies do not support a relationship between dietary fat intake and the risk of breast cancer either in premenopausal or postmenopausal women.Conclusions. Few of these associations offer the potential for intervention to reduce the breast cancer risk.
Breast cancer: Challenge and responsibility
Authors: Marchant Douglas J. 
Published: March 2011

AbstractThe diagnosis and treatment of breast cancer has changed dramatically during the last quarter century, a fact perhaps not fully appreciated by many primary care physicians.Breast cancer presents a number of challenges for the obstetrician/gynecologist. The disease is common and the mortality rate is second only to lung cancer. The appropriate role for the obstetrician/gynecologist is one of surveillance, including taking a history and physical examination and selected diagnostic studies, and as a resource for patients, including a discussion of risk factors and treatment alternatives.Because of the increasing involvement of obstetrics and gynecology in molecular genetics and hormone interactions, basic research in genetic alterations and hormonal therapy directed toward decreasing morbidity from cardiovascular disease and osteoporosis is recommended.
Surgical staging and cytoreductive surgery of epithelial ovarian cancer
Authors: Hoskins William J. 
Published: March 2011

AbstractBackground. Surgery remains the cornerstone of the treatment for epithelial ovarian cancer. In early ovarian cancer, the initial operation is a complete assessment of the spread of disease. In this staging operation, 33% of patients thought to have either Stage I or II tumors will be found to have advanced‐stage disease. The correct diagnosis of advanced disease prevents improper treatment of patients originally thought to have early disease. For patients with advanced disease, the initial cytoreductive operation reduces tumor bulk and produces increased sensitivity to chemotherapy for the remaining tumor. The principles of cellular kinetics provide good theoretic evidence for the benefit of cytoreductive surgery.Methods. Current studies relating to primary and secondary surgical cytoreduction of epithelial ovarian cancer were reviewed.Results. Current indirect evidence indicates a significant survival benefit for patients with epithelial ovarian cancer who undergo successful surgical cytoreduction. Several recent studies also have shown the importance of the biology of the tumor, the extent of tumor spread, the location of the tumor, the cell type, the histologic grade, and the age of the patient. Although the literature contains fewer reports of secondary cytoreductive surgery than of primary cytoreductive surgery at the time of second‐look, surgical reassessment appears to provide a survival benefit.Conclusions. The potential benefit of secondary cytoreduction will be increasingly important as new salvage therapies become available.
Mechanisms and modulation of resistance to chemotherapy in ovarian cancer
Authors: Perez Raymond P. , Hamilton Thomas C. , Ozols Robert F. , Young Robert C. 
Published: March 2011

AbstractChemotherapy for advanced ovarian cancer remains sub‐optimal. Despite the improvements in objective response rates realized with cisplatin‐based combination chemotherapeutic regimens, most patients still die of refractory cancer. Drug resistance has emerged as the single most important determinant of treatment outcome. Laboratory studies have provided substantial insights into the cellular mechanisms of resistance to the commonly used chemotherapeutic agents. Decreased drug accumulation, metabolic drug inactivation, and repair or tolerance to drug‐induced cellular injury all contribute to resistance at the cellular level. Identification of these mechanisms has facilitated the development of specific treatment strategies, many of which are in or nearing clinical trials. These strategies include dose intensification, inhibition of P‐glycoprotein function, inhibition of cellular glutathione synthesis, and inhibition of cellular DNA repair. The initial results from clinical trials that use these strategies provide reasonable grounds for optimism. In addition, efforts to identify new drugs with activity against resistant cells continue. One such drug, taxol, has significant activity in tumors refractory to conventional therapy. These approaches offer hope that intensive laboratory and clinical efforts ultimately will translate into real improvements in the efficacy of chemotherapy for ovarian cancer.
Cell growth regulation in epithelial ovarian cancer
Authors: Bast Robert C. , Boyer Cinda M. , Jacobs Ian , Xu Feng Ji , Wu Shu , Wiener Jon , Kohler Matt , Berchuck Andrew 
Published: March 2011

AbstractBackground. As in the case of other epithelial neoplasms, most ovarian cancers arise from single clones of cells that have undergone multiple genetic alterations. A comparison of normal and malignant ovarian epithelium has identified several differences in growth regulation by peptide growth factors, protooncogenes, and tumor suppressor genes.Methods. Recent articles and abstracts have been reviewed.Results. The malignant ovarian epithelial phenotype has been associated with (1) autocrine growth stimulation by transforming growth factor‐alpha, (2) loss of autocrine growth inhibition by transforming growth factor‐beta, (3) mutation or amplification of ras in 2–12% of cases, (4) amplification of myc in 23% of specimens, (5) expression of fms in 56% of cases with potential autocrine stimulation by macrophage colony stimulating factor, (6) paracrine stimulation by macrophage products including interleukin‐1, interleukin‐6 and tumor necrosis factor, (7) overexpression of c‐erhB‐2 (HER‐2/neu) in 30% of cases, and (8) mutation with consequent overexpression of p53 in 50% of advanced ovarian cancers. A poor clinical prognosis is associated with expression or overexpression of the epidermal growth factor receptor, fms, and HER‐2/neu. Antibodies against the extracellular domain of the HER‐2/neu gene product p185 inhibit the growth of tumor cells that overexpress HER‐2/neu and are associated with marked decreases in diacyl‐glycerol levels. The intracellular kinase domain is required for growth inhibition. Antibodies that inhibit growth stimulate phosphorylation of intracellular substrates. Ricin A chain monoclonal antibody conjugates that react with p185 also inhibit the growth of tumor cells that overexpress p185. The intracellular kinase region is not required for immunotoxin‐mediated killing. Coexpression of HER‐2/neu and the epidermal growth factor receptor has been observed in 65% of epithelial ovarian cancers and in a limited number of normal tissue from a fraction of donors.Conclusions: Multiple alterations in growth factors, protooncogenes and growth factors have been detected in different epithelial ovarian cancers. Inappropriate signalling from receptor tyrosine kinases may be particularly important for ovarian oncogenesis. Drugs that affect tyrosine kinase and phosphatase activity deserve attention as potential therapeutic agents for ovarian cancer. The extracellular domains of the HER‐2/neu gene product p185 and the epidermal growth factor receptor may provide useful targets for serotherapy.
Monoclonal antibodies in the management of ovarian cancer: A clinical perspective
Authors: Rubin Stephen C. 
Published: March 2011

AbstractDespite recent advances in the conventional management of ovarian cancer, this disease remains the leading cause of death among the gynecologic malignancies, killing more American women each year than all other gynecologic cancers combined. As a tumor arising from a nonessential organ that remains primarily confined to the peritoneal cavity, ovarian cancer makes an attractive target for monoclonal antibodies (MoAb). Several MoAb have been developed that have actual or potential clinical use in the management of ovarian cancer. Serum assays using a MoAb against an ovarian cancer‐associated antigen (CA 125) are currently in routine clinical use for monitoring the course of disease in women with known ovarian cancer. Such assays may play a role in multi‐technique screening programs. Radiolabeled antibodies are under study for use in external imaging or intraoperative detection of ovarian cancer. Isotope‐labeled antibodies also are being evaluated in the treatment of ovarian cancer as are antibodies coupled to drugs or biologic toxins. Some antibodies may have direct antitumor effects through binding to biologically active receptors or through immune effector functions. The use of antibody fragments, chimeric antibodies, human antibodies, and genetically engineered antibodies is under active investigation. MoAb have important potential for improving the diagnosis, monitoring of response to therapy, and treatment of ovarian cancer.
Diagnosis and management of gestational trophoblastic disease
Authors: Lewis John L. 
Published: March 2011

AbstractGestational trophoblastic disease is a term that describes a group of tumors that share several characteristics as follows: (1) they arise in fetal chorion, (2) they produce human chorionic gonadotropin (hCG), and (3) they respond extremely well to chemotherapy. Although rare, they have received a disproportionate amount of attention because they were the first metastatic solid tumor to be cured using chemotherapy. Also, hCG was the first reliable tumor marker. Finally, because they arise in fetal tissue, they have the potential for a strong immune response against paternal antigens in the tumor. This potential for immunologic rejection was thought initially to explain the success of chemotherapy in this disease. The early detection of gestational trophoblastic disease is successful in patients who have had a hydatidiform mole as the pregnancy event that begins the process but unsuccessful in the early detection of the development of choriocarcinoma after a normal term delivery, abortion (spontaneous or elective), or ectopic pregnancy. Surveillance after evacuation of a molar pregnancy (whether complete or a partial mole) consists of regular evaluation of hCG production and the detection of metastatic disease. However, the development of gestational choriocarcinoma after term pregnancy or an abortion (no molar tissue can develop as a consequence of these pregnancies) is detectable only by signs or symptoms of metastatic disease in any of the many organs to which this tissue can spread. Unlike most staging classifications in gynecologic cancers, which are based on histologic findings and tumor location, the classification used in gestational trophoblastic disease stresses other features that are more useful for treatment selection. Both the National Institutes of Health and the World Health Organization classifications emphasize the importance of recognizing factors that predict the likelihood of a tumor responding to chemotherapy. Currently available treatment can cure all patients except those who are in the very high‐risk group, which usually is characterized by metastasis to the brain or liver or a history of prior chemotherapy. Even in this category, approximately 80% of patients are curable.
New advances in radiation oncology for gynecologic cancer
Authors: Brady Luther W. , Rotman Marvin , Calvo Felipe A. 
Published: March 2011

AbstractIn 1992, the American Cancer Society anticipates that there will be 1,130,000 new cases of invasive cancer diagnosed in the United States. About 66,500 will be invasive cancers of the cervix, uterus, and ovary. About 22,400 patients will die during 1992, with 50–60% of those deaths being due to persistent local regional disease. Data are available to suggest that a reduction in local failure will be reflected by an increase in survival free of disease. In 1992, major efforts are being made to reduce the incidence of local failure. Three areas in this regard are innovative uses of brachytherapy, intraarterial chemotherapy and radiation therapy, and continuous infusion chemotherapy and radiation therapy.These new techniques show significant reduction in local failure with associated improvement in survival. The data will be presented to illustrate the impact of these techniques.
Conservative management of early vulvar cancer
Authors: Hacker Neville F. , Van Der Velden Jacobus 
Published: March 2011

AbstractThere is a definite trend toward vulvar conservation and individualized management of patients with early vulvar cancer. This approach initially was used only for patients with T1 disease, but with increasing experience with conservative surgery and the integration of postoperative adjuvant radiation when appropriate, some investigators have broadened the indications to include carefully selected patients with T2 lesions. A recent literature review suggests that the local invasive recurrence rate for T1 disease is 7.2% (12 of 165) after radical local excision compared with 6.3% (23 of 365) after radical vulvectomy (P = 0.85). Surgical margins must be at least 1 cm, and the rest of the vulva must be healthy if an increased local recurrence rate is to be avoided. Local recurrences usually can be treated successfully if diagnosed early, but recurrence in the groin is usually fatal. Inguinal‐femoral lymphadenectomy should be done on all patients if the primary tumor is more than 2 cm in diameter and in patients with T1 disease in whom the depth of invasion is greater than 1 mm. Separate groin incisions may be used, but pelvic and groin irradiation should be given if there is at least one large node replaced with tumor or multiple nodes containing micrometastases. Careful patient selection is critical if modified operations are used, or an increased rate of recurrence will follow.
Prognostic factors in early‐stage uterine sarcoma: A gynecologic oncology group study
Authors: Major Francis J. , Blessing John A. , Silverberg Steven G. , Morrow C. Paul , Creasman William T. , Currie John L. , Yordan Edgardo , Brady Mark F. 
Published: March 2011

AbstractBackground. A clinicopathologic evaluation of clinical Stage I and II uterine sarcoma was done by the Gynecologic Oncology Group from 1979–1988.Methods. After all eligibility criteria were met, 453 cases were evaluable and analyzed for prognostic factors.Results. Of the 301 mixed mesodermal tumors (MMT), 167 were homologous (HO), and 134 were heterologous (HE). Fifty‐nine tumors were leiomyosarcomas (LM). The remaining 93 sarcomas were predominantly stromal cell and adenosarcomas. For this study, only the MMT or LM tumors were analyzed. The recurrence rate for all MMT was 53% (HO, 44%; HE, 63%). The recurrence rate for LM was 71%. The site of the first recurrence included the pelvis in 21% of MMT and 14% in LM. Factors significantly related to progression‐free interval (PFI) by univariate analysis among MMT were adnexal spread, lymph node metastases, tumor size, lymphatic‐vascular space involvement, histologic grade, cell type, age, peritoneal cytologic findings, and depth of uterine tumor site of invasion. The prognostic factors based on multivariate analysis were adnexal spread, lymph node metastases, histologic cell type (HO versus HE), and grade of sarcoma. For LM, the mitotic index was the only factor significantly related to PFI.
Integrating radiation therapy into the management of ovarian cancer
Authors: Thomas Gillian M. , Dembo Alon J. 
Published: March 2011

AbstractSeveral studies during the last 15 years have elucidated the role of postoperative external beam radiation therapy as curative management of some subsets of patients with ovarian cancer. Despite this, the use of radiation therapy in patients with ovarian cancer has remained a controversial subject. Substantially improved cure rates have not been realized during the past decade despite the early promise of high response rates to cisplatin chemotherapy. Thus, it is important that all currently effective therapies be used for maximum therapeutic gain. This article will review the evidence that radiation therapy is curative in ovarian cancer and highlight the criteria, including stage and grade of disease and tumor residuum, by which patients suitable for such therapy are selected. The rationale for the use of whole abdominopelvic irradiation rather than pelvic or lower abdominal treatment will be discussed, as will the optimal radiation technique and its attendant morbidity. Limited data pertinent to the controversy over the use of radiation therapy versus chemotherapy in early disease, will be reviewed. The possible benefits of consolidation abdominopelvic radiation therapy after chemotherapy in highly selected patients with well‐differentiated microscopic residual disease at second‐look laparotomy or with no residual disease but high a risk for relapse will be considered.