Comparative study of bulky stage IB and IA cervical cancer patients treated by radical hysterectomy with and without neoadjuvant chemotherapy: long-term follow-up.

One hundred and ninety patients with bulky (> 3 cm) stage IB and IIA cervical cancer who underwent radical hysterectomy between 1991 and 1994 at Maharaj Nakorn Chiang Mai Hospital were reviewed to determine whether neoadjuvant chemotherapy (NAC) with MVAC (Methotrexate, Vinblastine, Adriamycin, Cisplatin) improved survival. There were 42 patients treated with pre-operataive NAC (MVAC 1-3 courses) and 148 patients treated by primary surgery (PS). In the NAC group, the overall response rate from MVAC was 88.1 per cent with 31.0 per cent having complete clinical response and 7.1 per cent with complete pathological response. Pelvic lymph node metastasis was not significantly different between the NAC group (16.7%) and the PS group (18.2%). At a median follow-up of 64.5 months, 19.0 per cent in the NAC group and 18.2 per cent in the PS group had tumor recurrence. The 5-year progression free and overall survival was 80.8 per cent and 92.0 per cent respectively for the NAC group which was not significantly different from 80.2 per cent and 92.9 per cent respectively in the PS group. In conclusion, although NAC can decrease the tumor size and produce a high response rate, it does not improve survival in bulky stage IB and IIA cervical cancer patients.

Comparison of ondansetron-dexamethasone-lorazepam versus metoclopramide-dexamethasone-lorazepam in the control of cisplatin induced emesis.

The antiemetic effect of ondansetron-dexamethasone-lorazepam versus those of metoclopramide-dexamethasone-lorazepam were evaluated in 30 ovarian cancer patients undergoing treatment with the same chemotherapeutic regimen (cisplatin 60 mg/m2 and cyclophosphamide 700 mg/m2). Patients were randomly selected to receive either the ondansetron arm or the metoclopramide arm in their first cycle of chemotherapy, but were given an alternative combination in the second cycle. In the ondansetron arm, ondansetron was given 8 mg intravenously (i.v.) plus dexamethasone 20 mg i.v. and lorazepam 0.5 mg oral. For the metoclopramide arm, metoclopramide 10 mg was given i.v. plus dexamethasone 20 mg i.v. and lorazepam 0.5 mg oral. All antiemetics were given twice; 30 minutes before and 6 hours after chemotherapy. In the metoclopramide arm, metoclopramide 40 mg continuous infusion was also administered. During the acute phase, the ondansetron combination was significantly superior to the metoclopramide combination for all evaluation parameters. Complete control of emesis was 90 per cent vs 36.7 per cent, complete protection from nausea was 80 per cent vs 43.3 per cent, and complete protection from both nausea and vomiting was 73.3 per cent vs 30.0 per cent. Forty per cent of patients in the ondansetron arm did not complain of any adverse reaction compared to 13.4 per cent in the metoclopramide arm. It can be concluded, therefore, that a combination of ondansetron, dexamethasone and lorazepam appears to provide a significantly better emetic control with less adverse reaction than the metoclopramide combination in the acute nausea-vomiting phase after receiving cisplatin.

Risk for radical hysterectomy failure.

During the period from July 1983 to December 1996, 685 patients who underwent radical hysterectomy as their primary treatment for cervical cancer and had optimal follow-up for at least three years were analyzed. Fifty seven patients (8.3%) had pelvic nodes metastasis and received postoperative whole pelvic radiation. Tumor recurrence was noted in 97 cases (14.2%). Nodal metastasis is the most significant prognostic factor for tumor recurrence. Patients with nodal metastasis had 42.1 per cent risk of recurrence compared to 11.6 per cent in those without nodal metastasis. Furthermore; risk of recurrence significantly increased if more than 1 node was involved. Other factors associated with a significantly higher risk of recurrence in multivariate analysis were tumor histology and clinical stage. Patients with nonsquamous cell carcinoma and clinical stage IIa had disease recurrence in 24.4 per cent and 30.3 per cent compared to only 11.7 per cent in squamous and 13.3 per cent in stage Ib. Tumor grade is the significant prognostic factor only in adenocarcinoma cell type but not in squamous cell type.

Comparison of short versus long duration of ampicillin and gentamicin for radical hysterectomy.

Prophylactic antibiotic therapy for radical hysterectomy is still controversial. Although the efficacy of antibiotics have been demonstrated, there remains the question of duration of administration. In this study, we retrospectively reviewed 95 patients who underwent radical hysterectomy and pelvic lymphadenectomy for cervical cancer at our institute. The management was uniform except for the duration of antibiotic administration. Group I (34 cases) had ampicillin and gentamicin for 3 days while group II (61 cases) had the same regimen for 7 days. No significant difference was found in terms of postoperative infection (2.9% in group I and 1.6% in group II) or febrile morbidity (32.4% versus 50.8%). Other factors such as the patients' age, body weight, preoperative hemoglobin level, amount of blood loss and blood transfused, operative time, duration of retroperitoneal drain and duration of suprapubic cystostomy. Only operative time had a significant influence on febrile morbidity regardless of the duration of antibiotics administered. In conclusion, the antibiotic administration gave a radical hysterectomy and pelvic lymphadenectomy a very low incidence of postoperative infection. Longer duration of treatment did not appear to lessen postoperative infection nor febrile morbidity. Shorter duration of antibiotic administration needs further evaluation.

Granulosa cell tumor of the ovary.

From January 1984 to December 1994, 36 women with granulosa cell tumors of the ovary were treated at Maharaj Nakorn Chiang Mai Hospital, which accounted for 5.8 per cent of all 620 ovarian malignancies treated at this institute. Twenty patients were in stage I, 2 in stage II, 11 in stage III and the remaining 3 cases were in stage IV. Most patients had unilateral ovarian involvement while 6 (16.7%) had bilateral involvement. The diameter of the tumor ranged from 4 to 30 cm with the median of 14 cm. Treatment consisted of hysterectomy and bilateral salpingo-oophorectomy followed by chemotherapy in most cases. To date 10 patients have no evidence of disease while 9 died of the disease, others were lost to follow-up. The 5-year survival was 94 per cent in the early stages compared to 25 per cent in advanced stages. The overall survival rate was 62.7 per cent for all stages.