The efficacy and toxicity of topotecan in combination with platinum in patients with recurrent epithelial ovarian cancer and primary peritoneal carcinomatosis / 대한산부인과학회지

OBJECTIVE: The aim of this study was to evaluate the efficacy and toxicity of topotecan, camptothecin analogue topoisomerase I inhibitor, as the combination therapy with platinum in patients with recurrent epithelial ovarian carcinoma and primary peritoneal carcinomatosis. METHOD: In this study, patients who were treated with topotecan between January 2000 and June 2007 at Asan Medical Center, Seoul, Korea were reviewed. Fifty-one patients with recurrent ovarian carcinoma and peritoneal carcinomatosis were included. These patients' data were analyzed by review of medical records and pathologic and laboratory reports retrospectively. Response was assessed by Response Evaluation Criteria in Solid Tumors (RECIST) criteria for patients with measurable disease and CA-125 response criteria for patients with non-measurable disease. The toxicities were evaluated according to NCI CTC (Common Toxicity Criteria) version 3.0. RESULTS: The mean age of patients was 53.4 years (ranged between 37 and 69). Forty-four patients had been evaluated by RECIST criteria. The overall response rate was 22.8% (10/44). Platinum-sensitive patients showed more favorable response rate (26.9%) than platinum-resistant patients (16.7%), however, it was not significant statistically (p=0.425). Platinum-sensitive group had significantly longer response duration (12.14 vs. 3.33 months, p=0.022) and time-to-progression (11.34 vs. 7.33 months, p=0.042) than platinum-resistant group. Heavily pretreated group, three or more prior regimens were used, had no significant differences from another group. The most common adverse effect of topotecan in combination with platinum was hematologic toxicity; grade 3/4 neutropenia was 30.6%, anemia was 42.7%, and thrombocytopenia was 8.37% in total 265 cycles of chemotherapy, however, it was tolerable. CONCLUSION: Topotecan in combination with platinum is considered as effective regimen with acceptable toxicity in treating recurrent epithelial ovarian carcinoma and primary peritoneal carcinomatosis who have failed previous treatment with platinum-containing chemotherapy.

A case of lymphoepithelioma-like carcinoma of the uterine cervix / 대한산부인과학회지

Lymphoepithelioma-like carcinoma (LELC) of the uterine cervix is a rare tumor with 0.7% of all primary cervical malignancies. It may grossly range from no visible cervical lesion to a large exophytic cervical mass and histologically similar neoplasms occur in the nasopharynx. It has been classified as a subtype of squamous cell carcinoma. But, after reviewing the literature, this tumor is a distinct carcinoma of the cervix that differs from squamous cell carcinoma. LELC is composed of undifferentiated cells surrounded by a marked inflammatory infiltrate, characterized by plasma cells and lymphocytes in the stroma. It may represent a better prognostic group than the more common squamous cell carcinoma of the cervix because of lack of lymph node metastasis. Typically affects a younger population of women, is more prevalent in noncaucasian population (especially, those of Asian descent). However, it is not clearly understood, Epstein-Barr virus play in the pathogenesis of cervical LELC while humam papilloma virus (HPV) is a risk factor for squamous cell carcinoma. The prognosis is good only by surgical treatment. Radiation therapy also appears to be effective in eradicating localized, low-stage disease (radiosensitive). The authors have experienced one case of LELC of the uterine cervix. We report a case with a brief review.

Effectiveness and safety of oral capecitabine in patients with gynecologic cancers / 부인종양

OBJECTIVE: To determine the efficacy and safety of capecitabine in patients with gynecologic cancers as adjuvant chemotherapy or maintenance treatment. METHODS: In this study, patients who were treated with capecitabine between January 2000 and June 2007 at Asan Medical Center, Seoul, Korea were reviewed. Thirty-one patients with gynecologic cancers were included 16 patients with recurrent ovarian cancer, 9 patients with cervical cancer after initial treatment, and 6 patients with recurrent cervical cancer. These patients' data were analyzed by review of medical records and pathologic and laboratory reports retrospectively. Response was assessed by both RECIST criteria for patients with measurable disease and CA 125 criteria in patients with ovarian cancer and National Cancer Institute criteria for progression, response, and toxicity were utilized in cervical cancer. RESULTS: Capcitabine was given at a dosage of 2,000-2,500 mg/m2/day orally in a divided dose daily for 14 days followed by a 7-day rest period in all patients. Nine patients with ovarian cancer were treated with more than 2 cycles and their median age was 49 years (43-67). Two patients showed a partial response and the median progression free survival was 3 months. Nine patients with cervical cancer after initial treatment were in the complete response state and their median progression free survival was 24.5 months. No partial or complete responses were seen in 6 patients with recurrent cervical cancer. There was no severe toxicity. CONCLUSION: Although capecitabine is a well-tolerated regimen, as a single agent, it produces minimal benefit in recurrent ovarian and cervical cancer population.

A case of sirenomelia diagnosed after amnioinfusion / 대한산부인과학회지

Sirenomelia, also known as the mermaid syndrome, is a rare and usually lethal congenital malformation of uncertain etiology. It is characterized by fusion of the lower limbs and commonly associated with severe urogenital and gastrointestinal malformations. Early antenatal sonogram allows for earlier, and less traumatic termination of pregnancy, but usually it is impared by severe oligohydramnios related to bilateral renal agenesis. We diagnosed a sirenomelia with severe oligohydramnios at early second trimester after amnioinfusion and terminated. We report a case with a brief review of the literature.

The Association of Concentration of Serum Estradiol and Bone Mineral Density with Auditory Function in Postmenopausal Women / 대한산부인과학회잡지

OBJECTIVE: To clarify whether hearing sensitivity in postmenopausal women is associated with serum estradiol level or bone mineral density (BMD) MATERIALS AND METHODS: From January 1999 to December 1999, serum concentration of estradiol, bone mineral densities of the lumbar vertebrae and femoral neck, and hearing sensitivity were measured in 1162 postmenopausal women. Serum concentration of estradiol was measured by radioimmunoassay. Dual energy X-ray absorptiometry (DEXA) was used to measure bone mineral densities of the lumbar vertebrae and femoral neck. Pure tone thresholds were evaluated by screening pure tone audiometry. All data were analyzed with Student's t-test, multiple logistic regression analysis, and multiple linear regression analysis. RESULTS: A total of 1155 patients were analyzed; 155 patients were in the hearing-loss group and 1000 patients were in the control group. On univariate analysis, significant differences were found in mean age, concentration of serum estradiol, and BMD of the femoral neck between the two groups (mean+/-SD, 58.1+/-5.2 vs 56.0+/-4.3, 11.6+/-6.0 vs 13.1+/-12.0, 0.67+/-0.11 vs 0.70+/-0.11; p-value: 0.0001, 0.01, 0.02). On multiple logistic regression analysis and multiple linear regression analysis, significant association was found between age and hearing loss and between age and pure tone threshold (p-value: 0.0001, 0.0001, respectively). However, neither seum concentration of estradiol nor BMD was associated with hearing loss or pure tone threshold. CONCLUSION: This study suggests that hearing sensitivity in postmenopausal women is not directly associated with serum estradiol level or BMD.