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ABSTRACT: Etwa 25% der Ovarialkarzinome werden im FIGO-Stadium I, etwa 7% im Stadium IIA diagnostiziert. Die Verdachtsdiagnose eines
Ovarialkarzinoms macht immer eine operative Abklärung mit histologischer Diagnosesicherung durch Laparotomie oder evtl. Laparoskopie
notwendig, da es präoperativ unmöglich ist, mit halbwegs akzeptabler Sicherheit abzuschätzen, dass es sich um ein Frühstadium
eines Ovarialkarzinoms handelt. Der Nachweis eines einzigen positiven Lymphknotens bedeutet, dass die Erkrankung einem FIGO-Stadium
IIIc zuzuordnen ist. Im klinischen Stadium I oder II liegt in 31% tatsächlich ein höheres Stadium vor, da sich intraoperativ
Metastasen im Omentum majus, Peritoneum oder den Lymphknoten finden. Die Primäroperation umfasst ein operatives Staging per
Abdominallängsschnitt und eine Radikaloperation mit dem Ziel der Feststellung des Ausmaßes der Erkrankung sowie einer primären
maximalen Tumorreduktion im Becken und Abdomen einschließlich pelviner und paraaortaler Lymphadenektomie. Ungünstige Prognosefaktoren
beim FIGO-Stadium I sind v.a. eine intraoperative Kapselruptur und ein Grading G3.
About 25% and 7% of ovarian cancer patients are diagnosed as having FIGO stage I or IIA disease, respectively. If the suspicion
of ovarian cancer exists, operative exploration and histologic confirmation are necessary. It is almost never possible to
preoperatively diagnose ovarian cancer at an early stage. For example, if only one positive lymph node in the paraaortic region
is diagnosed at final histology, the patient will be allocated to stageIIIC disease. In stages I and II disease in which
ovarian cancer is limited to the pelvis, accurate surgical staging leads to upstaging of the disease to stageIII in 31% of
cases because of subclinical metastases in the greater omentum, the peritoneum, and/or retroperitoneal lymph nodes. Primary
surgery comprises operative staging via midline laparotomy and radical surgery with the intent to accurately diagnose the
extent of the disease and to resect all visible disease in the pelvis and abdomen, including a pelvic and paraaortic lymphadenectomy.
Unfavorable prognostic factors in FIGO stageI disease mainly include intraoperative rupture of the capsule of the tumor as
well as tumor grading of G3.
Der Onkologe 05/2012; 14(11):1130-1139. · 0.17 Impact Factor
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ABSTRACT: There are few data in the literature as to whether findings at routine preoperative gynecologic examination of patients with primary endometrial cancer including cervical cytology, colposcopy and rectovaginal bimanual pelvic exam could predict cervical extension of the disease.
The present retrospective study was undertaken to preoperatively identify potential clinical parameters associated with the histological diagnosis of cervical involvement by primary endometrial cancer in the hysterectomy specimen. We reviewed the records of 104 patients with Stage II endometrial cancer treated at our institution between 1985 and 2005 by simple or radical abdominal hysterectomy with special emphasis on cervical Pap smear, colposcopy, cervical palpation as well as rectal parametrial assessment. Patients with Stage I disease operated on before and after each study patient were selected as controls (n = 208). Patients with more advanced disease were excluded.
Overall, 312 records of patients with primary endometrial cancer were reviewed. Patients with Stage II disease had a significantly lower prevalence (p < 0.0001) of endometrioid carcinomas and a significantly higher (p < 0.01) prevalence of G3 tumors compared to the control patients. Pap smears and colposcopic findings were abnormal in 39% of patients with Stage II and in 9% and 10% of patients with Stage I disease (p < 0.0001). Of patients with Stage II disease, 42% had a suspicious cervical palpation compared to only 4% of patients with Stage I disease (p < 0.0005). Parametrial assessment was suspicious in 16% of patients with Stage II disease and in no patient with Stage I disease (p < 0.001).
The four routine clinical parameters Pap smear, colposcopy, cervical palpation and rectal parametrial examination are significantly more often pathologic in patients with Stage II than in Stage I disease. The majority of patients with Stage II disease had at least one of these tests positive. Thus they may be useful to preoperatively detect cervical involvement by primary endometrial cancer.
European journal of gynaecological oncology 01/2009; 30(5):497-9. · 0.47 Impact Factor
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Regina Kroiss,
V Winkler,
K Kalteis,
D Bikas,
M Rudas,
M Tea,
C Fuerhauser,
D Muhr,
H Cerny,
S Glueck, E Petru,
H Concin,
E Kubista,
P Oefner,
T Wagner
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ABSTRACT: BRCA1 mutation carriers are at high risk for breast cancer (BC). The risk management strategy may include radiological investigations for early detection or prophylactic mastectomy (PM). For a mutation carrier, PM may be more significant than surveillance alone when pre-malignant and malignant changes occur increasingly in mastectomy specimens, given normal findings on radiological investigations. In the present study we retrospectively investigated the differences between histological findings in PM specimens of BRCA1 carriers and those of a control group.
Twenty-four healthy and 28 affected carriers in the presence of normal preoperative radiological findings were included in the study. To compare the frequency of pre-malignant and malignant lesions in PM specimens, a control group matched for age and disease status was included. T-tests for independent samples and Wilcoxon's signed-rank test were used for comparison of groups.
The entire study group differed significantly from the control group (42.3 vs. 5.8%; P < 0.001) in terms of the occurrence of pre-malignant and malignant lesions. Both, the sub-group comparison of healthy mutation carriers as well as diseased carriers with their controls, showed a significant difference in terms of the occurrence of pre-malignant and malignant changes (45.8 vs. 0%; P = 0.002; 39.3 vs. 10.7%; P = 0.03). In PM specimens of mutation carriers, carcinomas were identified in 5.8% (3/52) and pre-malignant changes in 36.5% (19/52).
BRCA1 mutation carriers should be informed of the fact that pre-malignant and even malignant changes are frequently found in PM specimens despite normal radiological findings.
Journal of Cancer Research and Clinical Oncology 04/2008; 134(10):1113-21. · 2.56 Impact Factor
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ABSTRACT: Thirty patients with tumors of the ovarian stroma (28 granulosa cell tumors, two androblastomas) and 12 women with germ-cell tumors (nine dysgerminomas, two teratomas, one endodermal sinus tumor) were treated at the Department of Obstetrics and Gynecology of the University in Graz between 1972 and 1989. Of the 28 patients with granulosa-cell tumors, 24 (86%) had stage I disease, 27 were primarily treated by surgery, and seven (25%) developed a recurrence (three stage I, three stage III and one stage IV). There were three recurrences in the peritoneal cavity and two in the paraaortic nodes; six of the seven patients died of recurrent disease.Four of nine patients with stage I dysgerminomas developed recurrences, two of which were located in the para-aortic nodes. Three patients with recurrence after stage Ia disease are currently alive without evidence of disease; one patient with stage Ib disease died 11 months after a paraaortic recurrence.Wider use of cytostatic combinations and careful surgical staging, including lymphadenectomy, may improve the survival of patients with stromal or germ-cell tumors.
International Journal of Gynecological Cancer 06/2007; 1(1):9 - 14. · 1.65 Impact Factor
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International Journal of Gynecological Cancer 09/2006; 16. · 1.65 Impact Factor
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Gynecologic Oncology 08/2006; 102(1):129; author reply 130. · 3.89 Impact Factor
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ABSTRACT: Platinum resistance is a significant problem in patients with ovarian cancer. The aim of this phase II study was to define the response rates, the progression-free survival and the toxicity profile of the combination of PEG liposomal doxorubicin (L-DXR) and gemcitabine (GEM).
Thirty one patients with histologically confirmed platinum-refractory or -resistant epithelial ovarian cancer were scheduled to receive 6 cycles of L-DXR 30 mg/m(2) on day 1 as well as GEM 650 mg/m(2) on days 1 and 8 every 28 days.
The median number of chemotherapy cycles given was 4. The mean dose intensity for L-DXR and GEM on day 1 was 96% and 97%, respectively. The mean dose intensity for GEM on day 8 was 93%. The overall response rate was 33% (10 of 30 evaluable patients; 20% complete responses). The median progression-free survival was 3.8 months, and the median overall survival was 15.8 months, respectively. Toxicity was acceptable. One quarter of patients developed grade 3 or 4 neutropenia, but none developed febrile neutropenia. Palmoplantar erythrodysesthesia (PPE) grades 2 and 3 occurred in 13% and 3% only, respectively, and no grade 4 PPE was observed. Grades 1 to 3 stomatitis was found in 58% of patients (10% grade 3).
The combination of L-DXR and GEM is an active and acceptably tolerated option in the treatment of patients with platinum-resistant and -refractory ovarian cancer. Dose reductions seem advisable in the case of > or =grade 2 stomatitis and/or PPE > or =grade 2.
Gynecologic Oncology 08/2006; 102(2):226-9. · 3.89 Impact Factor
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ABSTRACT: We have previously shown that interferon-gamma 1b (IFN-gamma) in combination with cyclophosphamide and cisplatin significantly prolongs progression-free survival in ovarian cancer. In this phase I/II study, we examined if administration of IFN-gamma is also safe in combination with the current standard treatment, paclitaxel and carboplatin. Thirty-four patients with newly diagnosed advanced epithelial ovarian cancer, FIGO stage III/IV, were treated for six to nine cycles with paclitaxel (175 mg/m(2)) and carboplatin (area under the curve [AUC] 5) every 3 weeks. IFN-gamma was administered in an escalating dose from 6 days/cycle with 0.025 mg sc up to 9 days/cycle with 0.1 mg sc. As expected, administration of IFN-gamma was associated with flu-like symptoms. Grade 3/4 neutropenia was observed in 74% (25 out of 34) of patients. Other side effects, in particular peripheral neuropathies, were within the previously observed ranges for the paclitaxel plus carboplatin combination. Overall response rate (complete or partial response) in patients who received either six or nine doses (0.1 mg) of IFN-gamma/cycle (n = 28) was 71%. IFN-gamma is safe in combination with carboplatin and paclitaxel for first-line treatment of patients with advanced ovarian cancer. This combination should be further evaluated as an immunotherapeutic treatment option for ovarian cancer.
International Journal of Gynecological Cancer 06/2006; 16(4):1522-8. · 1.65 Impact Factor
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Gynecologic Oncology 03/2005; 96(2):559; author reply 559-60. · 3.89 Impact Factor
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ABSTRACT: We describe a patient with wound rupture and burst abdomen after cesarean section with the Misgav-Ladach technique.
A 33-year-old woman underwent primary cesarean section at 36 + 5 weeks gestation for a fetal indication. The procedure was done according to the Misgav-Ladach technique, i.e. the uterus was closed with a one-layer continuous locking stitch and the visceral and parietal peritoneal layers were left open. The rectus sheath was stitched with a continuous nonlocking stitch, the skin was closed with a continuous intracutaneous suture. On the seventh postoperative day, omentum was seen extruding from the skin incision. Reexploration showed that the suture of the rectus sheath had ruptured. The further postoperative course was uneventful.
Although no general recommendations can be deduced from a single case, further reports on any complications of this technique will show whether it is as safe as believed until now.
Gynäkologisch-geburtshilfliche Rundschau 11/2004; 44(4):238-9.
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Gynecologic Oncology 09/2003; 90(2):494. · 3.89 Impact Factor
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ABSTRACT: PURPOSE OF THE ARTICLE: In patients recurring after primary therapy for cervical cancer, treatment remains palliative. In the present article we focus on treatment results with single cytostatic drugs or combinations in randomized trials in squamous cell cervical cancer. RESULTS: In one randomized trial, monotherapy with platinum analogues lead to overall remission rates between 11% and 15% only. The median overall survival ranged between 5.6 and 6.5 months. Various combinations lead to overall remission rates between 21% and 31% and the median overall survival ranged between 7.3 and 14.3 months. The most active combinations were cisplatin/bleomycin/mitomycin C/vindesine, cisplatin/paclitaxel, and cisplatin/irinotecan. There are several smaller studies with cystostatic therapy in cervical adenocarcinoma. However, using 5-fluoruracil, ifosfamide, paclitaxel, or cisplatinum, only response rates between 15 and 30% can be achieved. Predictors of a favorable chemotherapy response include a higher performance status, higher age, extrapelvic recurrence sites (especially lung metastases), a recurrence-free interval > 1 year, and no previous radiotherapy and chemotherapy. CONCLUSION: In conclusion, palliative cytostatic therapy with single agents has moderate activity. Combinations are more active but also more toxic. In general, chemotherapy needs to be used earlier in the course of disease when tissue vascularization is preserved.
European journal of gynaecological oncology 02/2003; 24(6):473-4. · 0.47 Impact Factor
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ABSTRACT: The aim of the study was to assess the effect of a birth-chair on obstetric outcome.
We reviewed the hospital records of 220 consecutive pregnant women who gave birth on a birth-chair at our institution. The control group consisted of 440 pregnant women who preceded and followed the index cases and who had spontaneous vaginal deliveries in the conventional dorsal supine position. The controls were matched for parity and for the attending mid-wife.
Patients who delivered in the birth-chair had significantly lower rates of episiotomy and manual separation of the placenta. The umbilical blood cord pH was significantly higher in neonates of the birth-chair group. The duration of labour, rate of perineal and vaginal injury, Apgar scores and rate of admission to a neonatal intermediate care unit were not influenced by the mode of delivery.
Our data support previous studies that a birth-chair delivery may be a safe alternative to conventional delivery in the supine position.
Wiener klinische Wochenschrift 10/2001; 113(17-18):695-7. · 0.81 Impact Factor
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ABSTRACT: Only five patients found to have brain metastasis preceding the diagnosis of endometrial cancer have been reported in the literature, and none of these survived beyond 38 months. The authors report on two patients with primary endometrial cancer who initially presented with cerebral metastasis. One of these patients died of disease 15 months after diagnosis. The other patient is still alive, with no evidence of disease, 171 months after she underwent radiosurgery for a solitary brain metastasis, aggressive cytoreductive abdominal and pelvic surgery, and doxorubicin-based chemotherapy. To the best of their knowledge, the authors believe that no similar observation has been made for any primary gynecological neoplasm, including endometrial, ovarian, or cervical cancer. This is the first report documenting that survival beyond one decade may be achieved after intensive multimodal therapy in selected patients in whom a solitary brain metastasis has been found before diagnosis of endometrial cancer. Aggressive therapy appears to be warranted in these patients.
Journal of Neurosurgery 06/2001; 94(5):846-8. · 2.96 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the behavior of endometrial stromal sarcomas (ESS) in relation to their clinical and pathologic features and to identify possible prognostic factors.
Thirty-one patients with histologically proven ESS were included in the analysis. Endometrial stromal sarcoma is characterized by proliferations composed of cells with endometrial stromal cell differentiation. A breakpoint of 10 mitoses per 10 high-power fields was used in the statistical analysis to distinguish between low-grade and high-grade endometrial stromal sarcoma and to evaluate the prognostic value of mitotic count in patients with ESS.
The median follow-up time was 72 months (range 34-110). The median overall survival of the 31 patients was 127 months, resulting in a 5-year overall survival rate of 62%. Adjuvant therapy was administered to 25 patients; among those, 20 patients received postoperative radiotherapy and 5 patients received chemotherapy. Ten of the irradiated patients and 3 patients undergoing chemotherapy developed disease recurrence. Concerning the response rate to adjuvant chemotherapy, 1 patient showed a complete response, 1 patient a partial response, 1 patient stable disease, and 2 patients progressive disease. Altogether, 14 patients developed recurrent disease with a median disease-free survival of 11 months (range 5-60). Twelve patients died of the disease. A univariate model revealed that early tumor stage (P < 0.0007), low myometrial invasion (P < 0.008), and low mitotic count (P < 0.005) were associated with a lengthened overall survival in patients with endometrial stromal sarcoma. Age and adjuvant therapy did not influence overall survival of patients with ESS.
Early tumor stage, low myometrial invasion, and low mitotic count are associated with a lengthened overall survival in patients with ESS.
Gynecologic Oncology 06/2001; 81(2):160-5. · 3.89 Impact Factor
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ABSTRACT: To define the normal ranges of umbilical cord blood oxygen saturation (SaO2) and acid-base status at birth and to evaluate the effect of gestational age on cord blood values in vigorous newborn infants following spontaneous vaginal birth from a vertex position.
Prospective study.
Department of Obstetrics and Gynaecology, University of Graz, Austria.
Cord blood samples from 1281 vigorous newborn infants.
Cord blood sampling was performed following on newborn infants following spontaneous vaginal birth in a vertex position. SaO2 was measured directly by a spectrophotometer and pH, base excess, pCO2 and pO2 by a pH/blood-gas analyser. Infants with a 5-minute Apgar score > or = 7 were considered vigorous. Subgroups were classified according to the gestational age: preterm, term and post-term (< 37, 37-42 and > 42 weeks, respectively).
The median umbilical artery SaO2 was 24.3% and the 2.5th centile was as low as 2.7%. The median umbilical artery values were pH = 7.25, base excess = -4.3 mmol/L and pO2 = 16 mmHg. The 2.5th centiles were 7.08, -11.1 mmol/L and 5 mmHg, respectively. The median umbilical artery pCO2 was 50 mmHg and the 97.5th centile was 75 mmHg. The mean umbilical artery and vein SaO2 values were not significantly influenced by gestational age. The umbilical artery SaO2 and base excess values were strongly skewed. The mean umbilical artery pH values in preterm infants were higher than in other subgroups. The mean umbilical artery and vein base excess values were lower in post-term newborn infants than in other subgroups.
The physiological range of oxygen saturation in umbilical cord of vigorous newborn infants at birth is wide and skewed. In contrast to pH and base excess, umbilical cord blood oxygen saturation is not influenced significantly by gestational age at birth.
BJOG An International Journal of Obstetrics & Gynaecology 08/2000; 107(8):987-94. · 3.41 Impact Factor
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ABSTRACT: It is unclear whether older primiparas are at increased risk for complications of pregnancy other than an increased cesarean section rate. The aim of this study was to compare the rate of complications of pregnancy and delivery of primiparas aged 40 years or older with those of primiparas aged 20 to 30 years.
We reviewed the maternal and neonatal hospital records of 59 consecutive primiparas aged 40 years or older who delivered at our institution between 1986 and 1995. A total of 118 primiparas aged 20 to 30 years who preceded and followed the cases served as controls.
The mean duration of gestation was significantly shorter in primiparas > or = 40 years of age. Induction of labor was more common and the cesarean delivery rate was higher (47 vs 12%) in older primiparas. The mean birth weight was significantly lower in the offspring of the cases. The perinatal mortality rate was 5% in the primiparas over 40 years and 0% in the control group; fetal malformations were found in 5% (vs 1%) of the children of older primiparas.
In our series, older primiparas were at increased risk for prematurity, preeclampsia, and perinatal mortality. The high rate of cesarean section in older primiparas is due mainly to a higher incidence of obstetric complications. These data suggest that the prenatal care of older primiparas in the third trimester should concentrate on the early detection of premature contractions and signs of preeclampsia.
Preventive Medicine 10/1999; 29(4):263-6. · 3.22 Impact Factor
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H. Amenitsch,
M. Rappolt,
P. Laggner,
S. Bernstorff,
R. Moslinger,
E. Fleischmann,
T. Wagner,
S. Lax, E. Petru,
K. Hudabiunigg,
L. Dalla Palma
Synchrotron Radiation News 09/1999; 12(5):32-34.
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ABSTRACT: The aim of this study was to retrospectively analyze the prognostic importance of age, histologic type and grade, ascites, lymph node status, size and type of postoperative residual disease, and radiation dose on disease-specific (DSS) and progression-free survival (PFS) in stage III epithelial ovarian cancer patients who had been treated with radical surgery, postoperative chemotherapy, and high-dose radiotherapy.
Consolidation radiotherapy including whole abdominal radiation, pelvic, and upper abdominal boosts was employed in 46 patients who showed no evidence of residual or progressive disease after completion of multiagent chemotherapy. The median follow-up for all patients was 36 months and 103 months for patients at risk. The prognostic impact of pretreatment and treatment parameters on DSS and PFS was tested in univariate and multivariate analyses.
The 5-year DSS and PFS rates for all patients were 38 and 33%, and for patients with 0-< or =2 cm residual tumor 65 and 61%, respectively. In univariate analysis, initial peritoneal seeding (both: P = 0.02), ascites (P = 0.03; 0.01), size of residual (0-< or =2 cm vs >2 cm), and residual miliary subdiaphragmatic (MDS) and localized peritoneal seeding (LPS) in the upper abdomen (P = 0.0002; 0.0003) were significantly correlated with DSS and PFS. Dose of radiation (< or =30 vs >30 Gy) correlated with DSS only (P = 0.02). In multivariate analysis size of residual disease (0-< or =2 cm vs >2 cm and/or MDS or LPS) remained the only independent prognostic factor for DSS and PFS (both; P = 0. 001).
Patients with localized peritoneal seeding who were rendered free of disease elsewhere had an outcome equally poor as that of patients with gross residuals (>2 cm) in the upper abdomen. If our findings can be confirmed, attempted resection of all localized seeding in patients who are otherwise cytoreducible to no or minimal residual disease may be considered in combination with Taxol-containing regimens as are now being utilized for patients with gross disease.
Gynecologic Oncology 09/1999; 74(3):400-7. · 3.89 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the behavior of uterine leiomyosarcomas in relation to their clinical and pathologic features and to identify possible prognostic factors.
Seventy-one patients with histologically proven uterine leiomyosarcoma were included in the analysis. Leiomyosarcomas were defined as uterine smooth-muscle tumors with five or more mitoses per 10 high-power fields and cytologic atypia. Cox proportional hazards regression model was used to identify independent prognostic factors.
The median follow-up time was 108 months; 5-year overall survival rate was 65%. Evaluating the correlation between several clinicopathologic parameters, tumors with vascular space involvement had a statistically significantly higher stage than tumors without vasular space involvement (P = 0.015). In a univariate Cox model early tumor stage (P < 0.0001), age <50 years (P < 0.0001), low mitotic count (P = 0.05), and the absence of vascular space involvement (P < 0.0005) were associated with good prognosis. In a multivariate analysis age (P = 0.002), tumor stage (P = 0.004), vascular space involvement (P = 0.003), and mitotic count in stage I tumors (P = 0.002) were found to be independent parameters for good prognosis in patients with uterine leiomyosarcoma.
Early tumor stage, age <50 years, and absence of vascular space involvement were independently associated with good prognosis. Mitotic count was detected to be a strong prognostic parameter in early tumor stage, but failed to act as an independent prognostic parameter in patients with tumor stage II-IV disease.
Gynecologic Oncology 08/1999; 74(2):196-201. · 3.89 Impact Factor
