phosphorus-radioisotopes and Uterine-Neoplasms

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

Topics: Adenosine Triphosphate; Adult; Aged; Cobalt Radioisotopes; DNA; Dose-Response Relationship, Radiation; Epithelium; Female; Humans; Middle Aged; Phosphorus Radioisotopes; Radiation Effects; Radiotherapy Dosage; Radium; RNA; Time Factors; Uterine Neoplasms; Vagina

The cycle of phospholipid turnover has been found to be under the negative control of hormonal cytostatics (progesterone) and under the positive control of proliferation stimulants (17 beta-estradiol, epidermal growth factor). Specific changes in the synthesis of phospholipids are shown when tamoxiphen, an antiestrogen and an inhibitor of protein kinase C, was used. The findings suggest that changes in the turnover rate of phospholipids are one of the key stages of steroid action on target cells and may be regarded as an additional criterion of tumor genetic sensibility.

Topics: Adenocarcinoma; Breast Neoplasms; Drug Screening Assays, Antitumor; Epidermal Growth Factor; Estradiol; Female; Humans; Phospholipids; Phosphorus Radioisotopes; Progesterone; Protein Kinase C; Tamoxifen; Tumor Cells, Cultured; Uterine Neoplasms

The in vitro effects of the epidermal growth factor (EGF) and progesterone on phospholipid turnover in cells of 19 human adenocarcinomas (postsurgical material) have been studied. In 58% of tumours EGF increased the 32P incorporation into two basic cell phospholipids--phosphatidylcholine and phosphoinositides. In EGF-insensitive cells progesterone induced no noticeable changes in the basal level of phospholipid metabolism. However, in 10 out of 11 positively responding to EGF adenocarcinomas progesterone inhibited the EGF-dependent activation of 32P incorporation into the phospholipids already on the 15th min after its addition to the cells. Analysis of effects of EGF and the anti-estrogen drug tamoxifen on phospholipid turnover in 22 human mammary tumours did not reveal any significant differences in tamoxifen effect on tumour cells differing in their sensitivity to EGF. Independently of cell sensitivity to EGF, tamoxifen caused some decrease in the 32P incorporation into phosphatidylcholine but increased the label incorporation into phosphoinositides. Tamoxifen added to tumour cells prestimulated with EGF or 17 beta-estradiol failed to abrogate the effect of these compounds on phospholipid turnover. At the same time, treatment of cells with the protein kinase C activator 12-O-tetradecanoyl-phorbol-13-acetate fully inhibited the effect of tamoxifen on phospholipid metabolism. The results obtained suggest that the EGF-dependent activation of intracellular phospholipid turnover is under the negative control of progesterone. As for tamoxifen, its effect on cells is independent of EGF and consists, apparently, in the inhibition of protein kinase C activity.

Topics: Adenocarcinoma; Breast Neoplasms; Chromatography, Thin Layer; Epidermal Growth Factor; Estradiol; Female; Humans; Phospholipids; Phosphorus Radioisotopes; Progesterone; Tamoxifen; Tetradecanoylphorbol Acetate; Tumor Cells, Cultured; Uterine Neoplasms

Topics: Adult; Aged; Biopsy, Needle; False Negative Reactions; Female; Humans; Hysterosalpingography; Middle Aged; Phosphorus Radioisotopes; Precancerous Conditions; Ultrasonography; Uterine Neoplasms

Between 1978 and 1986, 243 patients (all stages) had peritoneal fluid cytology performed while undergoing total abdominal hysterectomy for endometrial carcinoma; 39 (16%) were found to be positive. At 3 years (median follow-up of 30 months) the disease-free survival (DFS) for the 165 negative cytology clinical Stage I patients was 91% compared to only 56% for the 25 positive cytology patients (p less than .001). Of the 25 Stage I positive cytology patients, 14 with greater than one-third myometrial invasion had a DFS of 30% at 3 years as compared to 87% for negative cytology patients with comparable depth of invasion (p less than .001). There was no difference in DFS between the negative and positive cytology Stage I patients who had one-third or less myometrial invasion. Stage I patients with histologic Grade 2 and 3 had a lower 3 year DFS when cytology positive, 49% and 22%, versus 92% and 79% when cytology negative (p less than .001 and p = .03 respectively). In clinical Stage II patients the 3-year DFS was 21% for those with a positive cytology and 59% with a negative cytology. Fourteen of the 25 clinical Stage I positive cytology patients received 15 mCi of intraperitoneal 32P. At 3 years they had a 68% DFS as compared to 27% for those not receiving 32P (p = 0.01). All 11 patients with superficial myometrial invasion (9 received 32P) remained disease-free. The 4 Stage I patients with deep invasion who received 32P therapy had an improvement in abdominal/pelvic control and DFS when compared to 9 similar patients who did not receive 32P (p = .02). For histologic Grade 2 and 3 patients, there was a 64% 3-year DFS in the 32P treated group and 16% for those not receiving 32P (p = 0.02). Although 32P therapy improved DFS in Stage I positive cytology patients its use along with pelvic radiation therapy can lead to complications. Of 9 Stage I patients receiving 32P as well as pelvic irradiation, 4 experienced serious bowel complications requiring surgery. None of the 5 patients receiving 32P only had a complication.

Topics: Ascitic Fluid; Chromium; Chromium Compounds; Combined Modality Therapy; Female; Humans; Hysterectomy; Injections, Intraperitoneal; Phosphates; Phosphorus Radioisotopes; Prognosis; Uterine Neoplasms

The report deals with a retrospective analysis of applications of different in vivo and in vitro methods of radionuclide studies (1863) in patients with gynecological tumors in 1972-1985. The said methods were employed for making primary diagnosis, assessing tumor extension as well as for evaluating the effects of tumor growth and the efficacy of radiation and surgical treatment. Apart from offering considerable advantages as diagnostic procedures, radionuclide studies may be used in planning treatment modalities and schemes of rehabilitation of cancer patients. The results also suggest a wider application of nuclear procedures in addressing the diagnostic problems of practice of oncology.

Topics: Female; Genital Neoplasms, Female; Gold Colloid, Radioactive; Humans; Iodine Radioisotopes; Methods; Phosphorus Radioisotopes; Radionuclide Imaging; Uterine Cervical Neoplasms; Uterine Neoplasms; Vaginal Neoplasms

Malignant peritoneal cytology in patients with endometrial carcinoma is a poor prognostic feature, identifying patients at high risk for early intra-abdominal recurrence. Between 1977 and January, 1983, 65 women with endometrial carcinoma who had malignant peritoneal cytology were treated with adjuvant intraperitoneal radioactive chromic phosphate P 32 suspension. Fifty-three patients (80%) were clinical Stage I, nine (14%) were Stage II, and three (7%) were clinical Stage III. Life-table estimates of disease-free survival were 89% for clinical Stage I patients and 94% for surgical Stage I patients beyond 24 months. One patient developed an intraperitoneal recurrence, four had simultaneous intraperitoneal and extraperitoneal recurrences, and six developed recurrences outside of the peritoneal cavity. Few significant acute complications occurred after therapy with radioactive chromic phosphate P 32 suspension. Chronic intestinal morbidity that required surgical correction was encountered in five of 17 patients (29%) who received adjuvant pelvic radiation, compared to none of the 48 patients (0%) who received only radioactive chromic phosphate P 32 suspension (p less than 0.001). Intraperitoneal instillation of radioactive chromic phosphate P 32 suspension is effective therapy for patients with malignant peritoneal cytology from endometrial carcinoma. Caution should be exercised when radioactive chromic phosphate P 32 suspension and external radiation therapy are combined.

Topics: Adenocarcinoma; Brachytherapy; Catheters, Indwelling; Chromium; Chromium Compounds; Female; Follow-Up Studies; Humans; Hysterectomy; Injections, Intraperitoneal; Neoplasm Recurrence, Local; Neoplasm Staging; Peritoneal Neoplasms; Phosphates; Phosphorus Radioisotopes; Prognosis; Uterine Neoplasms

Systemic distribution of radioactive colloidal chromic phosphate P 32 after intraperitoneal instillation was studied in 10 patients with ovarian or endometrial malignancies. Seven patients without ascites received chromic phosphate P 32 for positive peritoneal washings, rupture of the capsule of the cyst during operation, or minimal Stage III disease. Three patients received chromic phosphate P 32 for recurrent ascites after multiple abdominal paracenteses. Blood and urine radioactivity measurements were performed at selected intervals. There was a clear statistically significant difference (p less than 0.01) between chromic phosphate P 32 activity levels in whole blood, red blood cells, and plasma in patients with and without ascites.

Topics: Adult; Aged; Ascites; Brachytherapy; Chromium; Chromium Compounds; Female; Humans; Kinetics; Middle Aged; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes; Uterine Neoplasms

Topics: Adnexa Uteri; Female; Humans; Ovarian Neoplasms; Phosphorus Radioisotopes; Precancerous Conditions; Radionuclide Imaging; Uterine Neoplasms; Uterus

A 64-year-old patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy in October, 1978 for a Stage IA, grade 2 papillary adenocarcinoma of the endometrium. Peritoneal washings contained numerous malignant cells, although the tumor invaded the myometrium only superficially. Two weeks after operation, 12 mCi of P32 were instilled into the peritoneal cavity. In May, 1979, laparotomy was performed for clinical obstruction of the small intestine and revealed diffuse peritoneal, omental, and hepatic metastases. Radiation changes involved the terminal ileum, ascending and sigmoid colon; an ileorectal fistula was also identified. The factors that might cause malignant cells to be present in the peritoneal cavity and the ideal treatment of such patients have yet to be determined. THe risk of intraperitoneal P32 might outweigh its benefits.

Topics: Adenocarcinoma, Papillary; Ascitic Fluid; Female; Humans; Liver Neoplasms; Middle Aged; Peritoneal Neoplasms; Phosphorus Radioisotopes; Uterine Neoplasms

Topics: Female; Humans; Intraoperative Care; Ovarian Cysts; Ovarian Neoplasms; Phosphorus Radioisotopes; Radioisotope Dilution Technique; Uterine Neoplasms

One hundred sixty-seven patients with clinical State I carcinoma of the endometrium were treated primarily by operation consisting of total abdominal hysterectomy, bilateral salpingo-oophorectomy, selective pelvic and para-aortic lymphadenectomy, and cytologic testing of peritoneal washings. Twenty-six (15.5%) of the 167 patients had malignant cells identified on cytologic examinations of peritoneal washings. Recurrence developed in 10 of these 26 (34.0%) compared to 14/141 (9.9%) patients with negative cytologic testing. Of the 26 patients, 13 (50%) had disease outside of the uterus at operation and seven have died of disease (54%). Thirteen patients had malignant cells in the peritoneal washings but no disease outside of the uterus and six (46%) of these have died of disseminated intra-abdominal carcinomatosis. On the basis of the poor outcome of those patients who had malignant cells in the peritoneal washings in the 167 patients studied, a plan of treating such patients with intraperitoneal radioactive chromic phosphate suspension (P-32) was instituted. Twenty-three subsequent patients with clinical Stage I carcinoma of the endometrium were found to have malignant cells in the peritoneal fluid. All 23 received intra-abdominal P-32 suspension instillation after operation. There have been three recurrences with two patients dying of disease. All of the three recurrences appeared at sites distant from the abdominal cavity. Peritoneal cytologic examination appears to be an important factor in the prognosis of endometrial cancer and, when the washings are positive for malignant cells, intraperitoneal chronic phosphate therapy appears to be efficacious.

Topics: Adenocarcinoma; Ascitic Fluid; Chromium; Chromium Compounds; Female; Humans; Lymphatic Metastasis; Neoplasm Metastasis; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes; Prognosis; Uterine Cervical Neoplasms; Uterine Neoplasms

With an Anger camera for scintigraphic recording of bremsstrahlung radiation from phosphorus-32, the distribution of intraperitoneal colloidal chromic phosphate was followed in patients with gynecologic tumors. Sequential pelvic, abdominal, and thoracic scintiphotos over a three-week period revealed rapid and persistent focal aggregation of the radiocolloid with no change in pelvic or peritoneal radionuclide distribution patterns. Visualization of intrathoracic lymph node uptake did not correlate with the presence of diaphragmatic tumor. This study demonstrates the utility of scintigraphy for monitoring the distribution of intraperitoneal beta emitters and the need for developing alternative methods of administering these therapeutic agents to achieve more uniform patterns of distribution.

Topics: Brachytherapy; Female; Humans; Ovarian Neoplasms; Peritoneal Cavity; Phosphorus Radioisotopes; Radionuclide Imaging; Tissue Distribution; Uterine Neoplasms

Topics: Adult; Ambulatory Care; Endometrium; Female; Humans; Middle Aged; Phosphorus Radioisotopes; Precancerous Conditions; Radionuclide Imaging; Uterine Neoplasms

Topics: Adult; Aged; DNA; Female; Humans; Middle Aged; Phosphorus Radioisotopes; Precancerous Conditions; Radionuclide Imaging; RNA; Uterine Neoplasms; Vaginal Smears

Topics: Female; Humans; Phosphorus; Phosphorus Radioisotopes; Phosphorus, Dietary; Radioactivity; Uterine Cervical Neoplasms; Uterine Neoplasms

Topics: Diagnostic Tests, Routine; Female; Humans; Phosphorus; Phosphorus Radioisotopes; Phosphorus, Dietary; Radioactivity; Radioisotopes; Uterine Neoplasms

Topics: Endometrial Neoplasms; Endometrium; Female; Gold Radioisotopes; Humans; Neoplasms; Phosphorus; Phosphorus Radioisotopes; Radioisotopes; Uterine Neoplasms

Topics: Autoradiography; Female; Humans; Phosphorus; Phosphorus Radioisotopes; Phosphorus, Dietary; Radioactivity; Uterine Neoplasms

Topics: Breast; Breast Neoplasms; Female; Humans; Phosphorus; Phosphorus Radioisotopes; Radioactivity; Uterine Neoplasms

Topics: Cobalt; Cobalt Radioisotopes; Female; Humans; Iodine; Iodine Radioisotopes; Neoplasms; Nucleic Acids; Phosphorus; Phosphorus Radioisotopes; Radioactivity; Uterine Neoplasms