Phase II study of concurrent cisplatinum with ifosfamide and radiotherapy in locally advanced squamous cell cervical carcinoma.

Objective: To evaluate the efficacy and toxicities of cisplatinum and ifosfamide administered concomitantly with radiation therapy in the treatment of locally advanced squamous cell cervical carcinoma (LASCC). Methods: Twenty patients with biopsy-proven squamous cervical carcinoma, FIGO stage II A to III B were entered into this study. All patients received standard radiotherapy (50 Gy in 25 fractions and brachytherapy at a dose of 268-28 Gy). Cisplatinum 70 mg/m2 plus ifosfamide 3 gm/m2 were administered totally for three cycles on Day 1, 21 and 42, concomitant with the radiotherapy schedule. Response and toxicities of treatment were evaluated and long term follow up was performed for disease free survival. Results: All patients received a course of concomitant chemoradiotherapy. Sixteen patients (80%) were able to receive a full course of chemotherapy, the remaining received 1-2 courses because of severe toxicities. The clinical complete response rate was 90% and overall 4 years survival rate was 85%. Grade 3 and 4 leucopenia occurred in 2 cases with one febrile neutropenia. Late complication revealed 2 cases of grade 3 cystitis. Conclusion: This study showed that concomitant chemoradiotherapy with cisplatinum plus ifosfamide was feasible for patients with LASCC. Further study of this regimen should be compared in randomized control trial (RCT) with cisplatinum alone and in the other histologic type of cervical cancer such as adenocarcinoma.

The prospective study of the value of extraperitoneal pelvic lymph node dissection for patients with stage IB2-IIB cervical cancer.

Objective: To evaluate the value of extraperitoneal pelvic node dissection as a new diagnostic tool for evaluation of retroperitoneal pelvic node status in cervical cancer stage IB2-IIB patients after neoadjuvant chemotherapy. Complications of the procedure were also evaluated. Methods: Patients with cervical cancer stage IB2-IIB received neoadjuvant chemotherapy for 3 cycles. After that the patients underwent extraperitoneal pelvic node dissection and the nodes were sent for frozen section. If the frozen section was negative for metastases, radical hysterectomy was performed. If the frozen section was positive, radical hysterectomy was abandoned and the patients were treated by radiation. The value of extraperitoneal pelvic node dissection as a diagnostic tool for evaluating the extent of the disease was compared to that of transperitoneal pelvic node dissection as historical control. Results: Twenty-three patients were included in the study. Nineteen patients (83%) underwent radical hysterectomy after extraperitoneal node dissection; however, the procedure was abandoned in 3 patients (13%) due to positive frozen section of the lymph nodes. The frozen section lymph node yielded a false negative result in one patient (4%). The operative time, lymph node yield and the incidence of postoperative complications were not statistically different between extraperitoneal approach and transperitoneal approach. Conclusion: Extrapertoneal pelvic node dissection seems more suitable than transperitoneal pelvic node dissection for the evaluation of retroperitoneal pelvic node status in cervical cancer patients.

Transabdominal ultrasound in the assessment of postvoid residual urine volume in patients after hysterectomy.

OBJECTIVE: To evaluate the correlation between assessment of postvoid residual urine by transabdominal ultrasound and catheterization in patients after radical or transvaginal hysterectomy. MATERIAL AND METHOD: A cross-sectional study was conducted and 46 patients were enrolled after they had radical and transvaginal hysterectomy. After surgery, urinary catheter was indwelled. After catheter removal and the 3rd private voiding, the patients were sent for transabdominal ultrasound assessment of PVR at the Division of Maternal-Fetal Medicine. Complete drainage of bladder with standard catheterization was then performed and catheterized urine volume was recorded. PVR was calculated from previously published equation and compared with actual PVR from catheterization. RESULTS: Mean age of the patients was 55.9 years. The most common diagnoses were procidentia uteri (23.9%), Carcinoma of cervix stage 1b1 (23.9%), and prolapsed uteri grade 2 (21.7%). Radical hysterectomy with pelvic node dissection and vaginal hysterectomy with anterior colporhaphy and posterior colpoperiniorhaphy was performed each in 50% of cases. Mean duration of urinary catheter indwelling was 7.17 days for those underwent radical hysterectomy and 5 days for vaginal hysterectomy. The calculated PVR was significantly correlated with catheterized urine volume with correlation coefficient 0.93 (p < 0.001). If the usual cutoff of PVR > 100 ml was used to determine the necessity of re-indwelling catheter, among those with calculated PVR from ultrasound measurement < 100 ml, still 30% actually had actual PVR of > 100 ml. Among those with calculated PVR from ultrasound measurement >100 ml, all actually had actual PVR of > 100 ml. CONCLUSION: PVR estimation by ultrasound significantly correlated with actual PVR. This could reduce the process of repeat catheterization and give more comfort to the patients when the PVR is > 100 ml.

Preliminary study of abdominal distention management program for gynecological patients receiving abdominal surgery: To define the severity of the symptom.

Objective: Gynecological patients receiving abdominal surgery commonly experience bowel symptoms which result from impairment of bowel motility after the surgery. The purpose of this study was to identify abdominal distention symptom in gynecological patients receiving abdominal surgery. Methods: Gynecological patients who received elective abdominal surgery at Gynecological Unit, Obstetrics and Gynecological Department, Siriraj Hospital from December 2003 to February 2004 were recruited in this study. The data were collected five days after surgery by using Abdominal Distention Assessment Record for Gynecological Patient Receiving Abdominal Surgery which was applied from Abdominal Distention Assessment Record by Wattanawetch (2002). Abdominal distention was defined as belching, flatus excretion, perception of fullness, bowel sound, and difference of abdominal girth. The total score is ranged from 1 to 20 points. The severity of abdominal distention symptom is presented as: 1-10 points= mild abdominal distention; 10-15 points= moderate abdominal distention; 16-20 points= severe abdominal distention. The data were analyzed by using descriptive statistics. Results: All participants were hospitalized three days after surgery while 15.4% and 42.3% of them were discharged on the forth and the fifth day after surgery. Since the first through the third day after surgery, most of the participants experienced moderate to severe abdominal distention (PO day 1= 98.7%; PO day 2=93.6%; PO day 3= 67.9%). Most of the participants had no belching (61.5%) and no flatus excretion (83.3%), with mild to severe perception of fullness (50.0%); their bowel sound was less than three times per minute (88.5%), and the difference of abdominal girth was less than 1.3 centimeters (61.5%) on the first day after surgery. On the second day after surgery most of them were belching 1-5 times in the last 4 hours (55.1%), no flatus excretion (46.2%), with mild to severe perception of fullness (66.4%); their bowel sound was less than 3 times per minute (53.8%), and the difference of abdominal girth was less than 1.3 centimeters (57.7%). On the third day most of them were belching 1-5 times in the last 4 hours (59.0%); their flatus excretion was 1-3 times in the last 4 hours (50.0%), with mild perception of fullness (60.3%); their bowel sound was 3-5 times per minute (51.3%), and the difference of abdominal girth was less than 1.3 centimeters (73.1%). On the forth and on the fifth day after surgery, 1.3% and 2.6% of the participants still experienced severe abdominal distention symptom while 41% and 15.4% of them had moderate distention score. Conclusion: This study revealed that more than a half of the gynecological patients receiving abdominal surgery had moderate to severe abdominal distention after surgery. This indicates the need for an improvement of abdominal distention management program for gynecological patient receiving abdominal surgery.

Hemostatic control for intractable bleeding from advanced cancer of the uterine cervix by collagen fleece coated with fibrin glue: A report of 3 cases.

We report 3 cases of advanced cervical cancer with intractable vaginal bleeding. They had all been initially managed by vaginal packing which had failed on 2 occasions. In all cases, bleeding could be controlled by a collagen fleece coated with fibrin glue (Tacho Combฎ) without adverse side effect. Applying a collagen fleece coated with fibrin glue may be an alternative method of bleeding control in selected patients.

Borderline epithelial ovarian tumor: A study of 48 cases.

Borderline epithelial ovarian tumor is a special entity of ovarian tumor. Compared with invasive epithelial ovarian cancer, borderline tumors have a much more favorable prognosis. Several issues remain unclear in the management of patients with borderline ovarian tumor. Objective : To review the clinical features, treatment and survival status of patients with borderline epithelial ovarian tumors. Materials and methods : A retrospective review of the records of 48 patients with borderline epithelial ovarian tumors registered at the Gynaecologic Oncology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University from January 1, 1986 - December 31, 1998 was performed. Results : Ninety percent of the patients had stage I disease. Mucinous cell type was found in 77.1% and serous cell type was found in 22.9%. All the patients received surgery and most of the patients received adjuvant chemotherapy. Mean follow up time was 38.94 months and the 10 - year survival rate was 97.92%. Three patients had recurrence of disease. All patients with recurrence did so within 12 months. Conclusion : The prognosis of patients with borderline epithelial ovarian tumor is good. Conservative surgery should be performed for stage I patients who wish to remain fertile.