phosphorus-radioisotopes and Cystadenocarcinoma--Serous

A phase II study was conducted to evaluate the role of adjuvant intraperitoneal radioactive phosphorus (32P) and vaginal brachytherapy in patients with uterine papillary serous carcinoma (UPSC) and clear cell carcinoma (CCC), after complete surgical staging.. Patients were required to have undergone complete surgical staging including maximal surgical resection. Residual < or =3 mm intraperitoneal disease, and pelvic and para-aortic lymph node dissection with negative nodes, were required. A dose of 15 mCi of intraperitoneal 32P was administered within 8 weeks of surgery. Vaginal brachytherapy was delivered using either high dose rate, total dose of 2100 cGy in 3 fractions (700 cGy per fraction prescribed to 0.5 cm depth from the vaginal surface) or low dose rate to 6500 cGy (prescribed to the vaginal surface) in 1-2 fractions.. For the 21 evaluable patients, distribution by FIGO stage was as follows: Stages I-IIB (17), Stages III-IV (4). The median follow-up was 39.6 months (range: 5-63 months). No patients experienced grade 2-4 complications from their adjuvant therapy. Five patients suffered a recurrence: intraperitoneal [n = 2], distal vaginal [n = 2], and one at the surgical scar. Following the 2 distal vagina recurrences early in the trial, the entire length of the vagina was treated with intracavitary brachytherapy. No additional vaginal recurrences were observed. The two-year overall survival, cause-specific survival, and disease-free survival for the entire series were 89.2%, 89.2%, and 79.7%, respectively.. Adjuvant therapy for UPSC and CCC with intraperitoneal 32P and vaginal brachytherapy after comprehensive surgical staging is feasible, well tolerated, and warrants further study on a larger scale.

Topics: Adult; Aged; Brachytherapy; Carcinoma, Papillary; Cystadenocarcinoma, Serous; Female; Humans; Hysterectomy; Lymph Node Excision; Middle Aged; Neoplasm Staging; Phosphorus Radioisotopes; Prospective Studies; Radiotherapy, Adjuvant; Uterine Neoplasms

To conduct a prospective study of intraperitoneal radioactive chromic phosphate (32P) versus cyclophosphamide-cisplatin (CP) in women with early ovarian cancer at high risk for recurrence (International Federation of Gynecology and Obstetrics stage Ia or Ib grade 3 or Ic or stage II, no macroscopic residual disease) and to compare cumulative incidence of recurrence, overall survival, and relative toxicity.. A total of 251 patients were randomly assigned to treatment with 32P or CP. Twenty-two (8.7%) were ineligible following centralized pathology review. Of the 229 patients included in the analysis, 110 received 32P, and 119 received CP.. The cumulative incidence of recurrence at 10 years was 35% (95% CI, 27% to 45%) for patients receiving 32P and 28% (95% CI, 21% to 38%) for those receiving CP. Patients receiving CP had a recurrence rate 29% lower than that of those receiving 32P (P =.15, two-tail test). The death rate for patients treated with CP was 17% lower than that for patients treated with 32P (difference not significant). Combining both arms, the 10-year cumulative incidence of recurrence for all stage I patients was 27% (95% CI, 20% to 34%) compared with 44% (95% CI, 32% to 56%) for stage II patients (P =.01). Both regimens were reasonably well tolerated, but problems with inadequate distribution (7%) and small-bowel perforation (3%) make the otherwise less toxic 32P less acceptable.. Although there are no statistically significant differences in survival, the lower cumulative recurrence seen with CP and complications of 32P administration make platinum-based combinations the preferred adjuvant therapy for early ovarian cancer patients at high-risk for recurrence.

Topics: Adenocarcinoma, Mucinous; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Endometrioid; Chemotherapy, Adjuvant; Chromium Compounds; Cisplatin; Combined Modality Therapy; Cyclophosphamide; Cystadenocarcinoma, Serous; Disease-Free Survival; Female; Humans; Injections, Intraperitoneal; Middle Aged; Neoplasm Recurrence, Local; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes; Prospective Studies; Survival Rate; Treatment Outcome