Denny Depetrillo - Academia.edu (original) (raw)

Papers by Denny Depetrillo

Research paper thumbnail of Methotrexate, hydroxyurea, and vincristine: Combination chemotherapy in squamous carcinoma of the female genitalia

Gynecologic Oncology, Dec 1, 1973

Abstract Concurrent multiple drug regimens have proved superior to single agent therapy in a numb... more Abstract Concurrent multiple drug regimens have proved superior to single agent therapy in a number of malignancies. Currently available oncolytic agents when used alone have been largely ineffective in managing recurrent and disseminated squamous carcinoma of the female genitalia. Rationally designed combination drug therapy could produce improved objective and subjective benefits for these patients. The results obtained in 15 evaluable patients treated with systemic methotrexate, hydroxyurea, and vincristine are presented and discussed. Only one objective response was obtained. The problems of managing recurrent cervical carcinoma with drug therapy are reviewed.

Research paper thumbnail of The early history of the International Gynecologic Cancer Society (IGCS)

International Journal of Gynecological Cancer, Oct 28, 2022

Research paper thumbnail of Évolution de la surspécialisation en gynécologie oncologique au Canada et de la Société de gynéco-oncologie du Canada (GOC)

Journal of obstetrics and gynaecology Canada, Dec 1, 2019

Research paper thumbnail of The Evolution of the Subspecialty of Gynaecologic Oncology in Canada and the GOC

Journal of Obstetrics and Gynaecology Canada, 2019

Research paper thumbnail of Évolution de la surspécialisation en gynécologie oncologique au Canada et de la Société de gynéco-oncologie du Canada (GOC)

Journal of Obstetrics and Gynaecology Canada, Dec 1, 2019

Research paper thumbnail of In memorium: C Paul Morrow (1935–2022)

International Journal of Gynecological Cancer, Oct 13, 2022

Research paper thumbnail of Methotrexate, hydroxyurea, and vincristine: Combination chemotherapy in squamous carcinoma of the female genitalia

Concurrent multiple drug regimens have proved superior to single agent therapy in a number of mal... more Concurrent multiple drug regimens have proved superior to single agent therapy in a number of malignancies. Currently available oncolytic agents when used alone have been largely ineffective in managing recurrent and disseminated squamous carcinoma of the female genitalia. Rationally designed combination drug therapy could produce improved objective and subjective benefits for these patients. The results obtained in 15 evaluable patients treated with systemic methotrexate, hydroxyurea, and vincristine are presented and discussed. Only one objective response was obtained. The problems of managing recurrent cervical carcinoma with drug therapy are reviewed.

Research paper thumbnail of Histopathologic score predicts recurrence free survival after radical surgery in patients with stage IA2–IB1–2 cervical carcinoma

Cancer, 2003

An analysis was conducted of a prospective radical surgery cervical carcinoma data base. A Cox pr... more An analysis was conducted of a prospective radical surgery cervical carcinoma data base. A Cox proportional hazards regression analysis was done for each of the individual factors to estimate individual risk ratios using all available data for each factor. Stepwise and best-model ...

Research paper thumbnail of Is radical trachelectomy a safe alternative to radical hysterectomy for patients with Stage IA–B carcinoma of the cervix?

Cancer, 1999

All patient information was collected prospectively and was subsequently extracted from the cervi... more All patient information was collected prospectively and was subsequently extracted from the cervical cancer surgery database of the Division of Gynecologic Oncology at the University of Toronto. Patients treated by RVT + LPL for fertility preservation were compared with two ...

Research paper thumbnail of A snapshot of waiting times for cancer surgery provided by surgeons affiliated with regional cancer centres in Ontario

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 21, 2001

There is evidence that delays in treatment result in increased psychosocial morbidity for patient... more There is evidence that delays in treatment result in increased psychosocial morbidity for patients diagnosed with cancer. We evaluated waiting times for care among cancer patients treated by surgeons affiliated with regional cancer centres in Ontario. Dates for 5 key events related to the surgical management of a patient with cancer were collected by a convenience sample of surgeons who treat breast, gynecologic, colorectal, head and neck, thoracic and urologic cancers. The key events were initial referral, first surgical visit, main treatment decision, major surgery and receipt of postoperative pathology report. The surgeons were also asked to judge the appropriateness of the waiting times for the intervals studied and to identify factors associated with inappropriate delays. A total of 62 surgeons affiliated with 8 regional cancer centres participated; data were collected for 1456 patients who underwent assessment and whose surgical visit occurred between Jan. 31 and May 31, 2000....

Research paper thumbnail of Feasibility study of multidisciplinary oncology rounds by videoconference for surgeons in remote locales

BMC medical informatics and decision making, Jan 19, 2003

This study was undertaken to assess the feasibility of using videoconferencing to involve communi... more This study was undertaken to assess the feasibility of using videoconferencing to involve community-based surgeons in interactive, multidisciplinary oncology rounds so they may benefit from the type of community of practice that is usually only available in academic cancer centres. An existing videoconference service provider with sites across Ontario was chosen and the series was accredited. Indirect needs assessment involved examining responses to a previously conducted survey of provincial surgeons; interviewing three cancer surgeons from different regions of Ontario; and by analyzing an online portfolio of self-directed learning projects. Direct needs assessment involved a survey of surgeons at videoconference-enabled sites. A surgical, medical and radiation oncologist plus a facilitator were scheduled to guide discussion for each session. A patient scenario developed by the discussants was distributed to participants one week prior to each session. Direct and indirect needs ass...

Research paper thumbnail of Do single and partnered women with gynecologic cancer differ in types and intensities of illness- and treatment-related psychosocial concerns? A pilot study

Journal of Psychosomatic Research, 2007

We compared the psychosocial and psychosexual concerns of single and partnered women with gynecol... more We compared the psychosocial and psychosexual concerns of single and partnered women with gynecologic cancer, since relationship status and psychosocial context are known to affect sexuality, a life domain commonly affected by this cancer. A cross-sectional convenience sample of 49 women (68% response), with ovarian (n=31), endometrial (n=12), and cervical (n=6) cancer, responded to a 72-item self-report Cancer Concerns Questionnaire and additional psychosocial questionnaires. Single (n=13) and partnered women (n=36) similarly reported prognosis as their highest concern, but single women (26% of the sample) reported that communication with the treatment team, treatment side effects, and prognosis were of greater salience to them than did partnered women. The latter group had greater sexuality and partner relationship concerns. These preliminary findings suggest that relationship status, whether partnered or single, influences current psychosocial concerns among women with gynecologic cancer, despite similar levels of illness- and treatment-related intrusions on important life domains.

Research paper thumbnail of Consolidative abdominopelvic radiotherapy after surgery and carboplatin/paclitaxel chemotherapy for epithelial ovarian cancer

International Journal of Radiation Oncology*Biology*Physics, 2005

Purpose: To assess the feasibility and morbidity of sequential cytoreductive surgery, carboplatin... more Purpose: To assess the feasibility and morbidity of sequential cytoreductive surgery, carboplatin/paclitaxel chemotherapy, and consolidative abdominopelvic radiotherapy (APRT) in ovarian cancer. Methods and Materials: Between 1998 and 2000, 29 patients with optimally cytoreduced epithelial ovarian cancer were treated with carboplatin (135 mg/m 2 ) and paclitaxel (area under the curve [AUC] of 6) followed by APRT in a prospective protocol. All patients were clinically, radiographically, and biochemically (CA-125) free of disease at the completion of chemotherapy. Abdominopelvic radiotherapy was delivered using 6 MV anteriorposterior photon fields to encompass the peritoneal cavity. Median follow-up was 4 years. Results: Two patients experienced Radiation Therapy Oncology Group Grade 3 gastrointestinal toxicity during APRT; 6 patients, Grade 3 or 4 neutropenia; and 3 patients, Grade 3 or 4 thrombocytopenia. Overall, 10 patients had Grade 3 or 4 acute toxicity. All of the acute side effects resolved after treatment was completed, and there were no serious consequences such as sepsis or hemorrhage. Abdominopelvic radiotherapy was abandoned prematurely in 3 patients. Late side effects were seen in 5 patients, including 1 small bowel obstruction, 2 symptomatic sacral insufficiency fractures, 1 case of severe dyspareunia, and 1 case of prolonged fatigue. All resolved with supportive management. The 4-year actuarial disease-free survival was 57%, and the overall survival was 92%. Eleven of 12 patients who relapsed received salvage chemotherapy, which was well tolerated. Conclusions: Abdominopelvic radiotherapy after optimal surgery and carboplatin/paclitaxel chemotherapy is associated with an acceptable risk of acute and late side effects and does not limit subsequent salvage chemotherapy. Consolidative APRT warrants further investigation as a means of improving the outcome of patients with ovarian cancer.

Research paper thumbnail of Concurrent radiation and chemotherapy for carcinoma of the cervix recurrent after radical surgery

Gynecologic Oncology, 1987

Results of salvage therapy in patients with carcinoma of the cervix, recurrent after primary surg... more Results of salvage therapy in patients with carcinoma of the cervix, recurrent after primary surgery, have been dismal even when disease was apparently confined to the pelvis. Further surgery or radiation therapy cured only some with central pelvic disease alone who had recurred at intervals longer than 6 months after primary therapy. To try to improve the results of salvage therapy, we used a combination of concurrent chemotherapy, 5-Fluorouracil with or without Mitomycin-C, and radiation therapy. Seventeen patients were treated. Recurrent disease was present in the pelvis or pelvis and paraaortic nodes after radical surgery for Stage IB carcinoma of the cervix. Eight of seventeen (47%) are alive, disease-free, 21 to 58 months after therapy. Seven of the eight had biopsy proven recurrence. Five of eight had recurred within 9 months of primary surgery and 7/8 had a component of pelvic side wall disease. Thus the survivors had unfavorable prognostic features. Nevertheless, the use of concurrent radiation and chemotherapy produced an exceptionally high proportion of sustained complete remissions and possible cures.

Research paper thumbnail of Is radical trachelectomy a safe alternative to radical hysterectomy for patients with Stage IA-B carcinoma of the cervix?

Cancer, 1999

All patient information was collected prospectively and was subsequently extracted from the cervi... more All patient information was collected prospectively and was subsequently extracted from the cervical cancer surgery database of the Division of Gynecologic Oncology at the University of Toronto. Patients treated by RVT + LPL for fertility preservation were compared with two ...

Research paper thumbnail of Does histology influence prognosis in patients with early-stage cervical carcinoma?

Cancer, 2001

BACKGROUND. The objective of this study was to examine the influence of histology on the outcome ... more BACKGROUND. The objective of this study was to examine the influence of histology on the outcome of patients with surgically treated, Stage IA-IB carcinoma of the uterine cervix.

Research paper thumbnail of Histopathologic score predicts recurrence free survival after radical surgery in patients with stage IA2–IB12 cervical carcinoma

Cancer, 2003

BACKGROUND. The authors evaluated clinical and pathologic factors that predicted for recurrence a... more BACKGROUND. The authors evaluated clinical and pathologic factors that predicted for recurrence after patients underwent radical surgery for International Federation of Gynecology and Obstetrics (FIGO) Stage IA 2 -IB 1-2 cervical carcinoma and developed a simple method of scoring those predictive factors to quantify outcome.

Research paper thumbnail of Treatment of early stage epithelial ovarian cancer with chemotherapy and abdomino-pelvic radiotherapy: Results of a prospective treatment protocol

International Journal of Radiation Oncology*Biology*Physics, 1998

Purpose/Objeetive: To test the hypothesis that combined modality treatment with chemotherapy and ... more Purpose/Objeetive: To test the hypothesis that combined modality treatment with chemotherapy and abdomino-pelvie radiotherapy (APRT) reduces abdomino-pelvic and distant recurrences and improves survival in patients with ovarian carcinoma. Materials and Methods: From 1991 to 1994, 93 patients with early stage, optimally debulked epithelial ovarian carcinoma were treated with combined chemotherapy and APRT following TAH-BSO and surgical staging. The patients ranged in age from 19 to 83 (median 57) years. There were 27 FIGO stage 1 tumors, 49 stage II tumors, and 17 stage III tumors. Patients with dense adherence of tumor in the pelvis and no evidence otherwise ofextra-ovatian disease were classified as having stage II tumors based on previous results from this center. The histologic type was endometrioid in 32, serous in 23, clear cell in 19, mucinous in 10, and other in 9. There were 14 grade 1 tumors, 47 grade 2 tumors, 31 grade 3 tumors, and grade was not recorded in 1 case. Ascites was present in 40 patients. Eight patients had residual pelvic tumor <2 cm in size after surgery. None of the patients had residual tumor in the abdomen. Treatment was assigned using a prognostic classification derived from a previous cohort of patients with ovarian cancer who were treated with APRT alone. Patients with stage 1, grade 1 tumors (2) received no adjuvant treatment. Patients with stage II, grade I tumors (9) were assigned to treatment with APRT alone. Patients with stage 1 or II, grade 2 or 3 completely resected tumors or stage 3, grade 1 tumors (66) were assigned to treatment with 2 cycles ofcisplatinum 50 mg/m 2 followed by APRT (DDP+APRT). Patients with stage II, grade 2 or 3 tumors with pelvic residuum or patients with stage 3, grade 2 or 3 tumors (16) were assigned to treatment with cyelophosphamide 500 mg/m 2 and eisplatinum 50 mg/m 2 followed by APRT (CP+APRT). APRT consisted o f22.5 Gy in 22 daily fractions to the abdomen, and 45 Gy in 29 daily fractions to the pelvis using 6°Co or 6 MV photons. The follow-up ranged from 0.8 to 6.1 (median 3.6) years. Results: There were 22 recurrences of ovarian cancer following treatment: 15 of these (68%) were in the abdomen or pelvis alone without involvement of distant sites. Nine patients died (8 of disease), 14 were alive with disease, and 70 were free of disease. The disease-free and overall actuarial survivals at 3 years for the entire cohort were 78% and 91% respectively. Only treatment group assignment significantly predicted disease-flee survival by univariate analysis (p=0.03). Patients assigned to receive RT alone had a 3 year DFS of 78%, DDP+APRT 84%, and CP+APRT 56%. There was no significant effect on outcome of age, stage (p"~0.07), grade, pelvic residuum, pelvic adherence (p=0.08), sta-face excrescences (p=0.06), rupture, or ascites. There was no significant difference in outcome between the present series and an historical group of patients treated with APRT alone (3 year DFS of 78% vs. 71% respectively, p=0.5). Thirteen patients (16%) had an unplanned interruption ofAPRT, 8 for neutropenia or thrombocytopenia and 3 for other reasons. The delay was limited to 1 or 2 days in 6 of these patients. APRT was abandoned entirely in 3 patients (4%). Erythrocyte transfusion was required in 7 patients (9%). Two patients (3%) developed bowel obstruction after DDP+APRT that resolved with conservative management. Conclusions: These results confirm that APRT is a safe, effective treatment for carefully selected, early stage, optimally debulked patients with epithelial ovarian cancer. The addition ofcisplafinum-based chemotherapy to APRT does not significantly improve outcome and may contribute to an increase in acute hematologic toxicity. Tumor most commonly recurs in the abdomen or pelvis following APRT, and this is not altered by the addition o fcisplatinum chemotherapy. Further study of APRT combined with newer cytotoxic drugs such as paclitaxel, or novel agents such as angiogenesis inhibitors, is warranted with the aim of enhancing abdomino-pelvic tumor control and survival.

Research paper thumbnail of Methotrexate, hydroxyurea, and vincristine: Combination chemotherapy in squamous carcinoma of the female genitalia

Gynecologic Oncology, Dec 1, 1973

Abstract Concurrent multiple drug regimens have proved superior to single agent therapy in a numb... more Abstract Concurrent multiple drug regimens have proved superior to single agent therapy in a number of malignancies. Currently available oncolytic agents when used alone have been largely ineffective in managing recurrent and disseminated squamous carcinoma of the female genitalia. Rationally designed combination drug therapy could produce improved objective and subjective benefits for these patients. The results obtained in 15 evaluable patients treated with systemic methotrexate, hydroxyurea, and vincristine are presented and discussed. Only one objective response was obtained. The problems of managing recurrent cervical carcinoma with drug therapy are reviewed.

Research paper thumbnail of The early history of the International Gynecologic Cancer Society (IGCS)

International Journal of Gynecological Cancer, Oct 28, 2022

Research paper thumbnail of Évolution de la surspécialisation en gynécologie oncologique au Canada et de la Société de gynéco-oncologie du Canada (GOC)

Journal of obstetrics and gynaecology Canada, Dec 1, 2019

Research paper thumbnail of The Evolution of the Subspecialty of Gynaecologic Oncology in Canada and the GOC

Journal of Obstetrics and Gynaecology Canada, 2019

Research paper thumbnail of Évolution de la surspécialisation en gynécologie oncologique au Canada et de la Société de gynéco-oncologie du Canada (GOC)

Journal of Obstetrics and Gynaecology Canada, Dec 1, 2019

Research paper thumbnail of In memorium: C Paul Morrow (1935–2022)

International Journal of Gynecological Cancer, Oct 13, 2022

Research paper thumbnail of Methotrexate, hydroxyurea, and vincristine: Combination chemotherapy in squamous carcinoma of the female genitalia

Concurrent multiple drug regimens have proved superior to single agent therapy in a number of mal... more Concurrent multiple drug regimens have proved superior to single agent therapy in a number of malignancies. Currently available oncolytic agents when used alone have been largely ineffective in managing recurrent and disseminated squamous carcinoma of the female genitalia. Rationally designed combination drug therapy could produce improved objective and subjective benefits for these patients. The results obtained in 15 evaluable patients treated with systemic methotrexate, hydroxyurea, and vincristine are presented and discussed. Only one objective response was obtained. The problems of managing recurrent cervical carcinoma with drug therapy are reviewed.

Research paper thumbnail of Histopathologic score predicts recurrence free survival after radical surgery in patients with stage IA2–IB1–2 cervical carcinoma

Cancer, 2003

An analysis was conducted of a prospective radical surgery cervical carcinoma data base. A Cox pr... more An analysis was conducted of a prospective radical surgery cervical carcinoma data base. A Cox proportional hazards regression analysis was done for each of the individual factors to estimate individual risk ratios using all available data for each factor. Stepwise and best-model ...

Research paper thumbnail of Is radical trachelectomy a safe alternative to radical hysterectomy for patients with Stage IA–B carcinoma of the cervix?

Cancer, 1999

All patient information was collected prospectively and was subsequently extracted from the cervi... more All patient information was collected prospectively and was subsequently extracted from the cervical cancer surgery database of the Division of Gynecologic Oncology at the University of Toronto. Patients treated by RVT + LPL for fertility preservation were compared with two ...

Research paper thumbnail of A snapshot of waiting times for cancer surgery provided by surgeons affiliated with regional cancer centres in Ontario

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 21, 2001

There is evidence that delays in treatment result in increased psychosocial morbidity for patient... more There is evidence that delays in treatment result in increased psychosocial morbidity for patients diagnosed with cancer. We evaluated waiting times for care among cancer patients treated by surgeons affiliated with regional cancer centres in Ontario. Dates for 5 key events related to the surgical management of a patient with cancer were collected by a convenience sample of surgeons who treat breast, gynecologic, colorectal, head and neck, thoracic and urologic cancers. The key events were initial referral, first surgical visit, main treatment decision, major surgery and receipt of postoperative pathology report. The surgeons were also asked to judge the appropriateness of the waiting times for the intervals studied and to identify factors associated with inappropriate delays. A total of 62 surgeons affiliated with 8 regional cancer centres participated; data were collected for 1456 patients who underwent assessment and whose surgical visit occurred between Jan. 31 and May 31, 2000....

Research paper thumbnail of Feasibility study of multidisciplinary oncology rounds by videoconference for surgeons in remote locales

BMC medical informatics and decision making, Jan 19, 2003

This study was undertaken to assess the feasibility of using videoconferencing to involve communi... more This study was undertaken to assess the feasibility of using videoconferencing to involve community-based surgeons in interactive, multidisciplinary oncology rounds so they may benefit from the type of community of practice that is usually only available in academic cancer centres. An existing videoconference service provider with sites across Ontario was chosen and the series was accredited. Indirect needs assessment involved examining responses to a previously conducted survey of provincial surgeons; interviewing three cancer surgeons from different regions of Ontario; and by analyzing an online portfolio of self-directed learning projects. Direct needs assessment involved a survey of surgeons at videoconference-enabled sites. A surgical, medical and radiation oncologist plus a facilitator were scheduled to guide discussion for each session. A patient scenario developed by the discussants was distributed to participants one week prior to each session. Direct and indirect needs ass...

Research paper thumbnail of Do single and partnered women with gynecologic cancer differ in types and intensities of illness- and treatment-related psychosocial concerns? A pilot study

Journal of Psychosomatic Research, 2007

We compared the psychosocial and psychosexual concerns of single and partnered women with gynecol... more We compared the psychosocial and psychosexual concerns of single and partnered women with gynecologic cancer, since relationship status and psychosocial context are known to affect sexuality, a life domain commonly affected by this cancer. A cross-sectional convenience sample of 49 women (68% response), with ovarian (n=31), endometrial (n=12), and cervical (n=6) cancer, responded to a 72-item self-report Cancer Concerns Questionnaire and additional psychosocial questionnaires. Single (n=13) and partnered women (n=36) similarly reported prognosis as their highest concern, but single women (26% of the sample) reported that communication with the treatment team, treatment side effects, and prognosis were of greater salience to them than did partnered women. The latter group had greater sexuality and partner relationship concerns. These preliminary findings suggest that relationship status, whether partnered or single, influences current psychosocial concerns among women with gynecologic cancer, despite similar levels of illness- and treatment-related intrusions on important life domains.

Research paper thumbnail of Consolidative abdominopelvic radiotherapy after surgery and carboplatin/paclitaxel chemotherapy for epithelial ovarian cancer

International Journal of Radiation Oncology*Biology*Physics, 2005

Purpose: To assess the feasibility and morbidity of sequential cytoreductive surgery, carboplatin... more Purpose: To assess the feasibility and morbidity of sequential cytoreductive surgery, carboplatin/paclitaxel chemotherapy, and consolidative abdominopelvic radiotherapy (APRT) in ovarian cancer. Methods and Materials: Between 1998 and 2000, 29 patients with optimally cytoreduced epithelial ovarian cancer were treated with carboplatin (135 mg/m 2 ) and paclitaxel (area under the curve [AUC] of 6) followed by APRT in a prospective protocol. All patients were clinically, radiographically, and biochemically (CA-125) free of disease at the completion of chemotherapy. Abdominopelvic radiotherapy was delivered using 6 MV anteriorposterior photon fields to encompass the peritoneal cavity. Median follow-up was 4 years. Results: Two patients experienced Radiation Therapy Oncology Group Grade 3 gastrointestinal toxicity during APRT; 6 patients, Grade 3 or 4 neutropenia; and 3 patients, Grade 3 or 4 thrombocytopenia. Overall, 10 patients had Grade 3 or 4 acute toxicity. All of the acute side effects resolved after treatment was completed, and there were no serious consequences such as sepsis or hemorrhage. Abdominopelvic radiotherapy was abandoned prematurely in 3 patients. Late side effects were seen in 5 patients, including 1 small bowel obstruction, 2 symptomatic sacral insufficiency fractures, 1 case of severe dyspareunia, and 1 case of prolonged fatigue. All resolved with supportive management. The 4-year actuarial disease-free survival was 57%, and the overall survival was 92%. Eleven of 12 patients who relapsed received salvage chemotherapy, which was well tolerated. Conclusions: Abdominopelvic radiotherapy after optimal surgery and carboplatin/paclitaxel chemotherapy is associated with an acceptable risk of acute and late side effects and does not limit subsequent salvage chemotherapy. Consolidative APRT warrants further investigation as a means of improving the outcome of patients with ovarian cancer.

Research paper thumbnail of Concurrent radiation and chemotherapy for carcinoma of the cervix recurrent after radical surgery

Gynecologic Oncology, 1987

Results of salvage therapy in patients with carcinoma of the cervix, recurrent after primary surg... more Results of salvage therapy in patients with carcinoma of the cervix, recurrent after primary surgery, have been dismal even when disease was apparently confined to the pelvis. Further surgery or radiation therapy cured only some with central pelvic disease alone who had recurred at intervals longer than 6 months after primary therapy. To try to improve the results of salvage therapy, we used a combination of concurrent chemotherapy, 5-Fluorouracil with or without Mitomycin-C, and radiation therapy. Seventeen patients were treated. Recurrent disease was present in the pelvis or pelvis and paraaortic nodes after radical surgery for Stage IB carcinoma of the cervix. Eight of seventeen (47%) are alive, disease-free, 21 to 58 months after therapy. Seven of the eight had biopsy proven recurrence. Five of eight had recurred within 9 months of primary surgery and 7/8 had a component of pelvic side wall disease. Thus the survivors had unfavorable prognostic features. Nevertheless, the use of concurrent radiation and chemotherapy produced an exceptionally high proportion of sustained complete remissions and possible cures.

Research paper thumbnail of Is radical trachelectomy a safe alternative to radical hysterectomy for patients with Stage IA-B carcinoma of the cervix?

Cancer, 1999

All patient information was collected prospectively and was subsequently extracted from the cervi... more All patient information was collected prospectively and was subsequently extracted from the cervical cancer surgery database of the Division of Gynecologic Oncology at the University of Toronto. Patients treated by RVT + LPL for fertility preservation were compared with two ...

Research paper thumbnail of Does histology influence prognosis in patients with early-stage cervical carcinoma?

Cancer, 2001

BACKGROUND. The objective of this study was to examine the influence of histology on the outcome ... more BACKGROUND. The objective of this study was to examine the influence of histology on the outcome of patients with surgically treated, Stage IA-IB carcinoma of the uterine cervix.

Research paper thumbnail of Histopathologic score predicts recurrence free survival after radical surgery in patients with stage IA2–IB12 cervical carcinoma

Cancer, 2003

BACKGROUND. The authors evaluated clinical and pathologic factors that predicted for recurrence a... more BACKGROUND. The authors evaluated clinical and pathologic factors that predicted for recurrence after patients underwent radical surgery for International Federation of Gynecology and Obstetrics (FIGO) Stage IA 2 -IB 1-2 cervical carcinoma and developed a simple method of scoring those predictive factors to quantify outcome.

Research paper thumbnail of Treatment of early stage epithelial ovarian cancer with chemotherapy and abdomino-pelvic radiotherapy: Results of a prospective treatment protocol

International Journal of Radiation Oncology*Biology*Physics, 1998

Purpose/Objeetive: To test the hypothesis that combined modality treatment with chemotherapy and ... more Purpose/Objeetive: To test the hypothesis that combined modality treatment with chemotherapy and abdomino-pelvie radiotherapy (APRT) reduces abdomino-pelvic and distant recurrences and improves survival in patients with ovarian carcinoma. Materials and Methods: From 1991 to 1994, 93 patients with early stage, optimally debulked epithelial ovarian carcinoma were treated with combined chemotherapy and APRT following TAH-BSO and surgical staging. The patients ranged in age from 19 to 83 (median 57) years. There were 27 FIGO stage 1 tumors, 49 stage II tumors, and 17 stage III tumors. Patients with dense adherence of tumor in the pelvis and no evidence otherwise ofextra-ovatian disease were classified as having stage II tumors based on previous results from this center. The histologic type was endometrioid in 32, serous in 23, clear cell in 19, mucinous in 10, and other in 9. There were 14 grade 1 tumors, 47 grade 2 tumors, 31 grade 3 tumors, and grade was not recorded in 1 case. Ascites was present in 40 patients. Eight patients had residual pelvic tumor <2 cm in size after surgery. None of the patients had residual tumor in the abdomen. Treatment was assigned using a prognostic classification derived from a previous cohort of patients with ovarian cancer who were treated with APRT alone. Patients with stage 1, grade 1 tumors (2) received no adjuvant treatment. Patients with stage II, grade I tumors (9) were assigned to treatment with APRT alone. Patients with stage 1 or II, grade 2 or 3 completely resected tumors or stage 3, grade 1 tumors (66) were assigned to treatment with 2 cycles ofcisplatinum 50 mg/m 2 followed by APRT (DDP+APRT). Patients with stage II, grade 2 or 3 tumors with pelvic residuum or patients with stage 3, grade 2 or 3 tumors (16) were assigned to treatment with cyelophosphamide 500 mg/m 2 and eisplatinum 50 mg/m 2 followed by APRT (CP+APRT). APRT consisted o f22.5 Gy in 22 daily fractions to the abdomen, and 45 Gy in 29 daily fractions to the pelvis using 6°Co or 6 MV photons. The follow-up ranged from 0.8 to 6.1 (median 3.6) years. Results: There were 22 recurrences of ovarian cancer following treatment: 15 of these (68%) were in the abdomen or pelvis alone without involvement of distant sites. Nine patients died (8 of disease), 14 were alive with disease, and 70 were free of disease. The disease-free and overall actuarial survivals at 3 years for the entire cohort were 78% and 91% respectively. Only treatment group assignment significantly predicted disease-flee survival by univariate analysis (p=0.03). Patients assigned to receive RT alone had a 3 year DFS of 78%, DDP+APRT 84%, and CP+APRT 56%. There was no significant effect on outcome of age, stage (p"~0.07), grade, pelvic residuum, pelvic adherence (p=0.08), sta-face excrescences (p=0.06), rupture, or ascites. There was no significant difference in outcome between the present series and an historical group of patients treated with APRT alone (3 year DFS of 78% vs. 71% respectively, p=0.5). Thirteen patients (16%) had an unplanned interruption ofAPRT, 8 for neutropenia or thrombocytopenia and 3 for other reasons. The delay was limited to 1 or 2 days in 6 of these patients. APRT was abandoned entirely in 3 patients (4%). Erythrocyte transfusion was required in 7 patients (9%). Two patients (3%) developed bowel obstruction after DDP+APRT that resolved with conservative management. Conclusions: These results confirm that APRT is a safe, effective treatment for carefully selected, early stage, optimally debulked patients with epithelial ovarian cancer. The addition ofcisplafinum-based chemotherapy to APRT does not significantly improve outcome and may contribute to an increase in acute hematologic toxicity. Tumor most commonly recurs in the abdomen or pelvis following APRT, and this is not altered by the addition o fcisplatinum chemotherapy. Further study of APRT combined with newer cytotoxic drugs such as paclitaxel, or novel agents such as angiogenesis inhibitors, is warranted with the aim of enhancing abdomino-pelvic tumor control and survival.