Papers by Dr Steven A Vasilev MD
International Journal of Gynecological Cancer, Mar 1, 2006
The purpose of the study was to evaluate tamoxifen-associated changes in the vagina and uterus in... more The purpose of the study was to evaluate tamoxifen-associated changes in the vagina and uterus in postmenopausal breast cancer patients. Between June 1994 and December 1998, 45 patients enrolled in a prospective study before commencing tamoxifen therapy. Patients with endometrial thickness .5 mm or neoplasia were excluded. Transvaginal ultrasonography, vaginal maturation indexes (VMI), and endometrial biopsy were performed at baseline and repeated at 6 months (n ¼ 42), 1 year (n ¼ 39), 2 years (n ¼ 32), 3 years (n ¼ 26), 4 years (n ¼ 19), and 5 years (n ¼ 15). For the 39 patients followed for 1 year, VMI
Gynecologic Oncology, Sep 1, 1994
ABSTRACT Serial serum progesterone and beta human chorionic gonadotropin (beta hCG) levels were m... more ABSTRACT Serial serum progesterone and beta human chorionic gonadotropin (beta hCG) levels were measured during surveillance of 24 women at risk for development of gestational trophoblastic neoplasia (GTN) following evacuation of complete molar gestations. Six of the 24 patients developed post-molar GTN. The initial median progesterone level of 76 ng/ml in these six patients drawn at evacuation was significantly higher than the median of 18 ng/ml in those not developing GTN (P = 0.026). Additionally, the serum progesterone decreased to < 5 ng/ml within a week of evacuation in 16/18 patients without GTN. In 5/6 GTN cases, levels of progesterone remained > 5 ng/ml for > or = 3 weeks of the surveillance period (P < 0.05). Serum beta hCG levels required 4-11 weeks of surveillance to distinguish between non-persistent cases and GTN. We conclude that serial serum progesterone levels measured during post-molar surveillance parallel beta hCG regression.
Gynecologic and Obstetric Investigation, 1989
Serum cancer antigen 125 was measured in subjects with intrauterine pregnancy (n = 44), ectopic p... more Serum cancer antigen 125 was measured in subjects with intrauterine pregnancy (n = 44), ectopic pregnancy (n = 76) and in nonpregnant controls (n = 17). Values were appreciably elevated only in ruptured tubal gestations.
Gynecologic Oncology, Jun 1, 1999
The purpose of this study was to examine ovarian histopathology in tamoxifen-treated breast cance... more The purpose of this study was to examine ovarian histopathology in tamoxifen-treated breast cancer patients undergoing oophorectomy. We reviewed the records and ovarian histopathology of 152 breast cancer patients who underwent oophorectomy at a single institution between January 1980 and October 1996. At the time of oophorectomy, 99 patients had never received tamoxifen, 44 patients were currently receiving tamoxifen, and 9 patients had previously received tamoxifen. Patient demographic and medical data and indication for oophorectomy were examined. Ovarian histopathology was classified as normal, functional ovarian cyst, benign ovarian tumor, endometriosis, ovarian cancer, and metastatic cancer. Patient characteristics and indication for oophorectomy did not differ significantly based on tamoxifen exposure. There was no difference in the occurrence of benign ovarian tumors, functional ovarian cysts, or metastatic breast cancer based on tamoxifen exposure. Tamoxifen-treated patients were less likely to have ovarian cancer, 0 of 53 patients (95% confidence interval (CI): 0.0%, 6.7%) compared with 10 of 99 patients (95% CI: 5.0%, 17.8%) patients not receiving tamoxifen (P = 0.015). Endometriosis was slightly more common in patients currently receiving tamoxifen, but the difference was not statistically significant. In women undergoing oophorectomy, there was no evidence that tamoxifen exposure was associated with an increase in benign or malignant primary or metastatic ovarian neoplasm or in functional ovarian cysts. Further study is necessary to better define any association between tamoxifen and endometriosis and the effect of tamoxifen on ovarian cancer risk.
Gynecologic Oncology, Jul 1, 1995
The purpose of this study was to estimate the response rate, response duration, and survival of p... more The purpose of this study was to estimate the response rate, response duration, and survival of patients with advanced ovarian cancer treated with a 132-hr continuous infusion of high-dose calcium leucovorin in combination with five consecutive daily bolus doses of 5-fluorouracil (5-FU) and to correlate changes in CA-125 levels with clinical and radiologic assessment of disease progression. Forty-six heavily pretreated patients [median number of previous chemotherapy regimens, 2.5 (range 1-7)] with advanced ovarian cancer received 132-hr continuous infusions of calcium leucovorin (500 mg/m2/day) for 5 1/2 days, with daily bolus doses of 5-FU (370 mg/m2/day) for 5 days beginning 24 hr after initiation of the calcium leucovorin. Twenty-three patients had clinically measurable disease and 23 had evaluable disease; CA-125 levels were performed prior to each treatment course and after the final course of therapy. One of 42 patients had a partial response to combination chemotherapy (duration, 8.9 months); 16/42 had stable disease [median duration, 4.9 months (range, 2.4-9.0 months)]. Toxicity of combination therapy included mild myelosuppression and stomatitis, similar to previously reported toxicity profiles for the 5-FU and calcium leucovorin combinations. Sensitivity of CA-125 levels as a single indicator of disease progression was 55%. The combination of infusional high-dose calcium leucovorin and 5-FU has little activity in refractory ovarian cancer. CA-125 levels incorrectly predict clinical disease activity in about one-third of cases and should not be the sole criterion for determination of clinical response when evaluating chemotherapeutic efficacy in heavily pretreated patients.
Gynecologic Oncology, Jun 1, 1998
Cervical carcinoma frequently metastasizes to the paraaortic region, necessitating extended field... more Cervical carcinoma frequently metastasizes to the paraaortic region, necessitating extended field radiotherapy to effect a cure. As imaging modalities are unreliable in identifying all cases of paraaortic nodal metastases (PAN), surgical staging is often utilized prior to radiotherapy. This study was aimed at identifying factors predictive of survival in women with cervical carcinoma and paraaortic metastases. In particular, survival based on extent of paraaortic disease was examined. The study group consisted of 43 women (stages IB-IVB) identified between 1982 and 1993 who were treated with extended field radiation for cervical carcinoma with histologically confirmed paraaortic metastases. The estimated 5-year survival for the study population was 24% with a median survival of 18 months. Pelvic tumor size had a significant impact on survival with the median survival being 34 months if the primary lesion was <6 cm compared to 14 months if >6 cm (P ؍ 0.01). Eight of the 26 (31%) women without residual PAN disease after surgical staging remain alive and disease free (mean followup, 74 months). In contrast, only 1 of the 17 (6%) women with gross residual PAN is alive 71 months after treatment (P ؍ 0.05). However, a comparison of Kaplan-Meier survival curves did not show a statistically significant advantage to the surgical excision of grossly involved PAN (P ؍ 0.98). Although long-term survival among women with grossly involved, unresected paraaortic metastases is uncommon, further study is necessary to elucidate the role of surgical excision of bulky aortic disease in women with cervical cancer.
Gynecologic Oncology, Feb 1, 1992
Extravasation of chemotherapeutic agents such as doxorubicin results in significant morbidity and... more Extravasation of chemotherapeutic agents such as doxorubicin results in significant morbidity and remains a serious clinical problem. No single agent or combination of agents has proven to be completely effective in preventing the chronic avascular ulcerative wound. Basic fibroblast growth factor (bFGF) is one of many angiogenic agents and is strongly mitogenic for vascular endothelial cells in nanogram quantities. In a Sprague-Dawley rat model, bFGF was moderately effective in retarding the development of doxorubicin-induced skin ulceration.
American Journal of Obstetrics and Gynecology, Apr 1, 1996
OBJECTIVE: Our purpose was to determine the importance of the rate of decline of CA 125 relative ... more OBJECTIVE: Our purpose was to determine the importance of the rate of decline of CA 125 relative to conventional prognosticators of ovarian cancer survival to develop a cost effective management algorithm that supports clinical trial research. STUDY DESIGN: By use of a retrospective chart review the slope of the CA 125 exponential regression curve was calculated for 126 women undergoing combination chemotherapy for epithelial ovarian cancer. Univariate and multivariate survival analyses evaluated conventional parameters including age, grade, stage, histologic features, time to initial chemotherapy, dose and treatment intensity, number of cycles to normal CA 125 levels, the intercept from the regression equation, and the slope of the exponential curve. RESULTS: The ideal CA 125 regression rate was calculated at 7.6 days (95% confidence interval 5.9 to 10.7). Univariate analysis determined slope of the CA 125 exponential regression curve (p = 0.0003), number of cycles to normal CA 125 levels (p = 0.0001), residual disease (p = 0.0006), and platinum treatment intensity (p = 0.0001) as the most important predictors of survival. Cox proportional-hazard regression analysis identified slope of the CA 125 exponential regression curve and number of cycles to normal CA 125 levels as the most significant factors for actuarial survival, replacing such conventional parameters as patient age, stage, grade, chemotherapy intensity, and residual disease. None of the factors investigated predicted treatment outcome for patients without residual disease. Multiple linear regression analysis of the slope of the CA 125 exponential regression curve identified intercept of the regression equation, stage, age, and time to initial chemotherapy as important determinants of the slope. CONCLUSION: The slope of the CA 125 exponential regression curve is the single most important prognosticator of actuarial survival for the patient with a CA 125-positive ovarian carcinoma. Treatment algorithms based on this slope may be helpful in developing novel cost-effective clinical trials. (AM J
Obstetrical & Gynecological Survey, Feb 1, 1996
ABSTRACT To describe the attributes of colposcopy and a low-power, magnified examination that uti... more ABSTRACT To describe the attributes of colposcopy and a low-power, magnified examination that utilizes chemiluminescent illumination (speculoscopy) in the visualization of cervical epithelium in a predefined, high-risk population and to compare how the two tests predict cervical histology. During this multicenter, prospective study, 395 women who were referred to our colposcopy clinic underwent a repeat cervical smear and speculoscopy followed immediately by colposcopy. Abnormal colposcopic lesions were biopsied and endocervical curettage performed when indicated. Histologic diagnoses were compared with cytology, speculoscopy and colposcopy results. Colposcopy was more sensitive than speculoscopy in the detection of cervical neoplasia (97% vs. 82%) (P &lt; .001) and was superior in visualizing focal lesions and vascular patterns. An antecedent acetowhite abnormality detected during speculoscopy was highly predictive of subsequent abnormal colposcopy (97% positive predictive value). The &quot;overall&quot; rate of acetowhite lesions during speculoscopy was nearly half the rate during colposcopy (P &lt; .001). Colposcopy is better suited than speculoscopy to the follow-up of patients with abnormal cervical cytology because it facilitates lesion grading and assists in directing biopsies. Speculoscopy is best utilized as a dichotomous screening test based on the presence or absence of at least one well-demarcated acetowhite lesion and may be more suitable than colposcopy as an adjunct to cervical cancer screening due to its lower overcall rate. The biophysical properties of blue-white chemiluminescent light as it relates to the diagnosis of cervical neoplasia are discussed.
Journal of Lower Genital Tract Disease, Jul 1, 1997
BACKGROUND Cervical carcinoma is a leading cause of mortality from cancer among women worldwide, ... more BACKGROUND Cervical carcinoma is a leading cause of mortality from cancer among women worldwide, accounting for approximately 160,000 deaths annually. Prognosis in patients with this disease is dependent on several well-established clinical features (stage of disease and age of patient) and pathologic features (lymph node status, grade of tumor, and depth of invasion). Although the features associated with poor clinical outcome have been well studied, molecular markers such as human papillomavirus (HPV) type that may reflect the underlying biologic basis for clinical behavior are poorly understood. PURPOSE To test the hypothesis that differences in survival among patients with cervical carcinoma are associated with HPV DNA type, we conducted a historical cohort study of patients treated at our institutions over a 10-year period. METHODS Fresh primary tumor tissue samples from 291 women with all stages of cervical carcinoma diagnosed from April 1983 through August 1993 were rapidly frozen and stored at -70 degrees C until analysis. High-molecular-weight DNA was extracted and purified by homogenization, proteinase K digestion, phenol extraction, ammonium acetate salt displacement, ethanol precipitation, and ribonuclease treatment. HPV nucleotide sequences were amplified from tumor DNA samples by polymerase chain reaction with the use of both consensus L1 (MY09/MY11) primers that recognize more than 25 HPV types and modifications of type-specific primers developed for HPV types 16, 18, and 6. Clinical data were abstracted from hospital, office, and tumor registry records. Univariate analysis was conducted using Student's t test and chi-squared tests. Survival curves were estimated by use of the Kaplan-Meier method; differences between groups were examined by the logrank test. Multivariate survival analysis was performed according to the Cox proportional hazards model. RESULTS HPV DNA was detected in 247 (85%) of 291 tumors: HPV16 in 52%, HPV18 in 20%, other HPV types in 13%, and no HPV DNA in 15%. Eighty-eight percent of squamous tumors contained HPV DNA compared with 79% of adenocarcinomas, the latter harboring predominantly HPV18. Women 45 years old or younger with a history of cigarette smoking tended to have HPV DNA in their tumors, but the HPV type was not associated with established prognostic factors such as stage, grade, lymph node metastasis, or depth of stromal invasion. After a median follow-up of 38.9 months, among potential prognostic factors of patient age, histologic cell type, grade, and HPV DNA status, only stage was predictive of survival in the entire study population. However, among the 171 patients treated with type III radical hysterectomy (removal of uterus and upper vagina along with other tissues extending to the pelvic wall) and pelvic lymphadenectomy (removal of all lymphatic tissue in the pelvis), multivariate analysis determined that lymph node status (adjusted risk ratio [RR] = 3.12; 95% confidence interval [CI] = 1.35-7.21), depth of stromal invasion (adjusted RR = 3.14; 95% Cl = 1.05-9.34), and the presence of HPV18 DNA (adjusted RR = 2.59; 95% CI = 1.08-6.22) were statistically significant predictors of survival. CONCLUSION HPV18 DNA type is an independent prognostic factor in patients with cervical carcinomas treated with radical hysterectomy and pelvic lymphadenectomy. IMPLICATIONS The use of molecular markers such as HPV DNA type may allow the identification of patients with early stage cervical cancer at high risk for disease recurrence.
Bone Marrow Transplantation, Nov 1, 2001
This study was performed in order to evaluate the toxicities, progression-free and overall surviv... more This study was performed in order to evaluate the toxicities, progression-free and overall survival of patients with responsive residual or recurrent ovarian cancer treated with high-dose chemotherapy. Twenty-seven patients were treated. Doxorubicin, 165 mg/m 2 over 96 h (days −12 to −8), etoposide 700 mg/m 2 every day ×3 (days −6 to −4), and cyclophosphamide 4.2 g/m 2 on d −3 was followed by stem cells and granulocyte colonystimulating factor. The median days of granulocyte count Ͻ500/l was 14 (range 10-42) and platelets Ͻ20 000/l was 13 (range 2-80). Median numbers of red cell and platelet transfusions were 15 (5-16) and 14 (4-103). Toxicity included mucositis requiring narcotic analgesia in all patients. Asymptomatic decreases in ejection fraction to values Ͻ50% were observed in four patients. No clinical congestive heart failure was observed. One death due to sepsis was observed. Median progression-free survival is 7.5 months (1.0-56 months); five patients remain alive, two of whom remain progression-free at 19.5 and 24.5 months post transplant. Median overall survival is 14.0 months (1-68 months). We conclude that high-dose anthracyclines may be safely administered to ovarian cancer patients. The short overall and progression-free survivals observed in our population suggest that this combination is not optimal.
American Journal of Clinical Oncology, Oct 1, 1996
Sixty-one patients with FIGO IB cervical cancer treated with planned preoperative radiotherapy (d... more Sixty-one patients with FIGO IB cervical cancer treated with planned preoperative radiotherapy (dose to point A: 52-93 Gy, mean 73 Gy) and hysterectomy from 1969 to 1993 were retrospectively reviewed. Patient characteristics and treatment parameters and their association with residual tumor in the hysterectomy specimen were analyzed. Glandular (adenocarcinoma and adenosquamous) tumors were smaller than squamous tumors: 6/11 (55%) were &lt; 6 cm in diameter, versus 12/50 (24%) squamous tumors (p = 0.03). Glandular tumors had a higher incidence of residual disease: 10/11 (91%) versus 24/50 (48%) (p = 0.01). There was no association between presence of pathologic residual disease in the hysterectomy specimen and tumor size, morphology (endophytic vs. exophytic), patient age, dose to point A, time to deliver radiotherapy, or interval between radiotherapy and hysterectomy. Overall 34/61 (56%) patients had residual disease in their hysterectomy specimens after planned preoperative radiotherapy. There were significantly more glandular tumors than squamous tumors with residual disease, even though glandular tumors were a group of smaller tumors.
PubMed, Jul 1, 1995
Objective: To describe the attributes of colposcopy and a low-power, magnified examination that u... more Objective: To describe the attributes of colposcopy and a low-power, magnified examination that utilizes chemiluminescent illumination (speculoscopy) in the visualization of cervical epithelium in a predefined, high-risk population and to compare how the two tests predict cervical histology. Study design: During this multicenter, prospective study, 395 women who were referred to our colposcopy clinic underwent a repeat cervical smear and speculoscopy followed immediately by colposcopy. Abnormal colposcopic lesions were biopsied and endocervical curettage performed when indicated. Histologic diagnoses were compared with cytology, speculoscopy and colposcopy results. Results: Colposcopy was more sensitive than speculoscopy in the detection of cervical neoplasia (97% vs. 82%) (P < .001) and was superior in visualizing focal lesions and vascular patterns. An antecedent acetowhite abnormality detected during speculoscopy was highly predictive of subsequent abnormal colposcopy (97% positive predictive value). The "overall" rate of acetowhite lesions during speculoscopy was nearly half the rate during colposcopy (P < .001). Conclusion: Colposcopy is better suited than speculoscopy to the follow-up of patients with abnormal cervical cytology because it facilitates lesion grading and assists in directing biopsies. Speculoscopy is best utilized as a dichotomous screening test based on the presence or absence of at least one well-demarcated acetowhite lesion and may be more suitable than colposcopy as an adjunct to cervical cancer screening due to its lower overcall rate. The biophysical properties of blue-white chemiluminescent light as it relates to the diagnosis of cervical neoplasia are discussed.
PubMed, Mar 1, 1993
Since up to 45% of patients with atypical Papanicolaou smears have been shown to have significant... more Since up to 45% of patients with atypical Papanicolaou smears have been shown to have significant pathology, women with persistent atypia are usually referred for colposcopy. This study evaluated the use of a new adjunctive screening test, speculoscopy, in selecting women with atypical Papanicolaou smears who would most benefit from referral for colposcopy. Both screening and referral patients were evaluated with the Papanicolaou smear, speculoscopy and colposcopy at 10 study centers. Biopsies were obtained from most women with positive colposcopy. The results in patients with atypical smears were used to perform a cost-benefit analysis of each of three management protocols. Using the results of speculoscopy to select women with atypical Papanicolaou smears for colposcopy provided a cost-effective alternative to performing colposcopy either on all women or on those with persistent atypia following treatment. Even when all women undergo speculoscopy at the time of screening, this protocol provides a cost savings of up to 24% and no significant loss of diagnostic accuracy. These data suggest that speculoscopy performed at the time of initial screening can accurately select women with atypical Papanicolaou smears who require colposcopy for diagnostic biopsy in a cost-effective manner.
Wiley-Liss eBooks, 2000
GENERAL PRINCIPLES. Introduction (S. Vasilev). Evidence--Based Medicine and Decision Support (S. ... more GENERAL PRINCIPLES. Introduction (S. Vasilev). Evidence--Based Medicine and Decision Support (S. Vasilev). Vascular Access and Other Invasive Procedures (P. Koonings). Radiology of the Abdomen, Pelvis, Spine, and Central Nervous System (A. Deutsch & R. Gordon). Radiology of Postoperative Pulmonary Complications (S. Heinze, et al.). Perioperative Cardiorespiratory Monitoring and Management (S. Vasilev). Fluids, Electrolytes, and Nutrition (H. Silberman). PERIOPERATIVE MANAGEMENT OF GYNECOLOGIC SURGERY. Preoperative Evaluation (P. Lin). Postoperative Surveillance and Perioperative Prophylaxis (H. Smith, et al.). Perioperative Anesthetic Emergencies (J. Christie & R. Cane). Perioperative Infections: Prevention and Therapeutic Options (S. Roy & S. Vasilev). Intraoperative and Perioperative Considerations in Laparoscopy (S. Vasilev). ONCOLOGIC PERIOPERATIVE DECISION MAKING. Endometrial and Cervical Carcinoma (B. Monk & R. Burger). Pelvic Masses and Ovarian Carcinoma (J. Schlaerth). Molar Gestation (S. Vasilev & C. Morrow). Perioperative Issues in the Management of Vulvar Carcer (K. McGonigle & L. Lagasse). ONCOLOGIC THERAPY COMPLICATIONS MANAGEMENT. Bowel Complications Management and Radiation Enteritis (K. McGonigle). Chemotherapy Complications (L.Rosen & G. Schiller). SUPPORTIVE CARE. Perioperative Psychosocial Considerations (J. McKay). Pain Management in Gynecologic Oncology (L. Galffy & C. Varga). Index.
International Journal of Gynecologic Cancer, Sep 1, 2004
International Journal of Gynecologic Cancer, Oct 1, 2006
John Wiley & Sons, Inc. eBooks, Apr 28, 2011
John Wiley & Sons, Inc. eBooks, Apr 28, 2011
Page 1. Chapter 8 Intraoperative and Perioperative Considerations in Laparoscopy Steven A. Vasile... more Page 1. Chapter 8 Intraoperative and Perioperative Considerations in Laparoscopy Steven A. Vasilev and Scott E. Lentz INTRODUCTION Ott and Kelling developed laparoscopy at the turn of the century1, 2 and Jacobaeus&amp;#x27; soon ...
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Papers by Dr Steven A Vasilev MD