Objectives.:KW-2170 is a novel DNA intercalating agent whose mechanism of action is similar to doxorubicinHCl,yet is associated with less cardiac toxicity. The objective of this study was to evaluate the activity and ...Objectives.:KW-2170 is a novel DNA intercalating agent whose mechanism of action is similar to doxorubicinHCl,yet is associated with less cardiac toxicity. The objective of this study was to evaluate the activity and toxicity of this novel chemotherapeutic agent in patients with recurrent ovarian carcinoma. Methods.:A prospective phase II trial was performed in patients with persistent or recurrent epithelial ovarian or primary peritoneal carcinoma and measurable disease. Patients could have platinum-sensitive or refractory disease and could have received any number of prior treatments. One treatment cycle consisted of KW-2170 administered at a dose of 18 mg/m2 weekly for 3 weeks followed by a 21-day rest period. Toxicity was assessed using the NCI Common Toxicity Criteria (Version 2.0),and dose reduction was allowed for significant toxicity. Response to therapy was assessed in patients who completed at least 2 cycles using RECIST criteria. Results.:A total of 28 patients were enrolled in this phase II trial at 5 separate centers. Of the 28 patients evaluated,all had stage III/IV disease at initial diagnosis. The median number of prior therapeutic regimens in these patients was 4 (range 1-8). The median number of KW-2170 cycles administered was 2 (range 1-5). Treatment-related toxicity in this heavily pretreated population was acceptable as only 6 patients (21%) had grade 3-4 neutropenia. Dose reductions occurred in 6 patients (21%) for grades 1-4 neutropenia,and no patient had febrile neutropenia. Four patients completed less than 1 cycle; 3 secondary to progressive disease,and one due to Gram-positive sepsis. Of patients receiving at least 2 full cycles,10 patients (55%) had stable disease with a median of 4.5 months (range 3-10) to disease progression. All other patients were removed from the study after 1-2 cycles of therapy with no significant clinical effect noted. Conclusions.:Although associated with relatively little toxicity,KW-2170 at the dose and schedule evaluated demonstrated little clinical activity in this heavily pretreated population of recurrent ovarian cancer patients. Whether KW-2170 would have greater clinical activity in a more treatment naive group of patients at an increased dose awaits clinical trial evaluation.展开更多
To determine the impact of an aborted radical hysterectomy on morbidity and overall survival in patients undergoing surgical treatment for early stage cervical carcinoma. Following IRB approval, a computerized databas...To determine the impact of an aborted radical hysterectomy on morbidity and overall survival in patients undergoing surgical treatment for early stage cervical carcinoma. Following IRB approval, a computerized database identified 304 women treated with radical surgery for early stage cervical carcinoma from 1994 to 2000 of which 23 (8% ) had an aborted radical hysterectomy. Of the 23 patients, 17 patients had a IB1 lesion, 4 patients had a IB 2 lesion, and 2 patients had a IIA lesion. Median age was 42 years (range 28- 60). Twenty- one patients had squamous cell carcinoma and two patients had adenocarcinoma. Radical hysterectomywas aborted for the following reasons: 11 patients had pelvic extension, seven had positive pelvic nodes, and five patients had positive paraaortic nodes. All 23 patients received postoperative radiation therapy; additionally, 12 patients received concurrent chemotherapy consisting of platinum with or without 5- FU. There were four operative complications (17% ) including deep vein thrombosis, wound infection, blood transfusion, and an ileus. Four patients (17% ) had radiationassociated complications. Six of 23 (26% ) patients experienced a recurrence. The 5- year overall survival was 83% with a median follow- up of 59 months (range 12- 107 months). A small percentage of patients (8% ) with early stage cervical carcinoma will have an aborted radical hysterectomy for pelvic extension or positive nodes. Fortunately, these patients still have a favorable prognosis with postoperative radiation therapy. Aborted radical surgery does not significantly increase overall complications.展开更多
BACKGROUND: Shortness of breath is a common symptom reported by patients after gynecologic procedures. Delayed traumatic diaphragmatic rupture is a rare cause of shortness of breath. CASE: This report describes the di...BACKGROUND: Shortness of breath is a common symptom reported by patients after gynecologic procedures. Delayed traumatic diaphragmatic rupture is a rare cause of shortness of breath. CASE: This report describes the diagnosis and management of a patient with a delayed presentation of a ruptured right hemidiaphragm after a laparotomy for a pelvic mass. CONCLUSION: Although rare, delayed presentation of traumatic diaphragmatic rupture should be considered in patients with a history of blunt chest or abdominal trauma as a possible cause of shortness of breath in the postoperative setting.展开更多
文摘Objectives.:KW-2170 is a novel DNA intercalating agent whose mechanism of action is similar to doxorubicinHCl,yet is associated with less cardiac toxicity. The objective of this study was to evaluate the activity and toxicity of this novel chemotherapeutic agent in patients with recurrent ovarian carcinoma. Methods.:A prospective phase II trial was performed in patients with persistent or recurrent epithelial ovarian or primary peritoneal carcinoma and measurable disease. Patients could have platinum-sensitive or refractory disease and could have received any number of prior treatments. One treatment cycle consisted of KW-2170 administered at a dose of 18 mg/m2 weekly for 3 weeks followed by a 21-day rest period. Toxicity was assessed using the NCI Common Toxicity Criteria (Version 2.0),and dose reduction was allowed for significant toxicity. Response to therapy was assessed in patients who completed at least 2 cycles using RECIST criteria. Results.:A total of 28 patients were enrolled in this phase II trial at 5 separate centers. Of the 28 patients evaluated,all had stage III/IV disease at initial diagnosis. The median number of prior therapeutic regimens in these patients was 4 (range 1-8). The median number of KW-2170 cycles administered was 2 (range 1-5). Treatment-related toxicity in this heavily pretreated population was acceptable as only 6 patients (21%) had grade 3-4 neutropenia. Dose reductions occurred in 6 patients (21%) for grades 1-4 neutropenia,and no patient had febrile neutropenia. Four patients completed less than 1 cycle; 3 secondary to progressive disease,and one due to Gram-positive sepsis. Of patients receiving at least 2 full cycles,10 patients (55%) had stable disease with a median of 4.5 months (range 3-10) to disease progression. All other patients were removed from the study after 1-2 cycles of therapy with no significant clinical effect noted. Conclusions.:Although associated with relatively little toxicity,KW-2170 at the dose and schedule evaluated demonstrated little clinical activity in this heavily pretreated population of recurrent ovarian cancer patients. Whether KW-2170 would have greater clinical activity in a more treatment naive group of patients at an increased dose awaits clinical trial evaluation.
文摘To determine the impact of an aborted radical hysterectomy on morbidity and overall survival in patients undergoing surgical treatment for early stage cervical carcinoma. Following IRB approval, a computerized database identified 304 women treated with radical surgery for early stage cervical carcinoma from 1994 to 2000 of which 23 (8% ) had an aborted radical hysterectomy. Of the 23 patients, 17 patients had a IB1 lesion, 4 patients had a IB 2 lesion, and 2 patients had a IIA lesion. Median age was 42 years (range 28- 60). Twenty- one patients had squamous cell carcinoma and two patients had adenocarcinoma. Radical hysterectomywas aborted for the following reasons: 11 patients had pelvic extension, seven had positive pelvic nodes, and five patients had positive paraaortic nodes. All 23 patients received postoperative radiation therapy; additionally, 12 patients received concurrent chemotherapy consisting of platinum with or without 5- FU. There were four operative complications (17% ) including deep vein thrombosis, wound infection, blood transfusion, and an ileus. Four patients (17% ) had radiationassociated complications. Six of 23 (26% ) patients experienced a recurrence. The 5- year overall survival was 83% with a median follow- up of 59 months (range 12- 107 months). A small percentage of patients (8% ) with early stage cervical carcinoma will have an aborted radical hysterectomy for pelvic extension or positive nodes. Fortunately, these patients still have a favorable prognosis with postoperative radiation therapy. Aborted radical surgery does not significantly increase overall complications.
文摘BACKGROUND: Shortness of breath is a common symptom reported by patients after gynecologic procedures. Delayed traumatic diaphragmatic rupture is a rare cause of shortness of breath. CASE: This report describes the diagnosis and management of a patient with a delayed presentation of a ruptured right hemidiaphragm after a laparotomy for a pelvic mass. CONCLUSION: Although rare, delayed presentation of traumatic diaphragmatic rupture should be considered in patients with a history of blunt chest or abdominal trauma as a possible cause of shortness of breath in the postoperative setting.
