Abnormal uterine cervical cytology in a large tertiary hospital in Bangkok metropolis: Prevalence, management, and outcomes.

OBJECTIVES: To determine the prevalence of abnormal cervical cytology, management, and association with clinical significant histopathology including cervical intraepithelial neoplasia II or adenocarcinoma in situ and more severe lesions. MATERIALS AND METHODS: Women with abnormal cervical cytology from January 2005 to December 2009 were identified from the archives of Department of Anatomical Pathology and Department of Obstetrics and Gynecology. Demographic data, type of abnormal cytology, management, and their associated histopathology were collected. RESULTS: During the study period: 2533/54,179 women (4.7%) had abnormal cervical Pap test. Squamous lesions were more common than glandular lesions: 2309 (4.3%) compared to 224 (0.4%). Atypical squamous cell (ASC) was most commonly found (1449 or 2.7%), whereas low‑grade squamous intraepithelial lesion (LSIL) and high‑grade squamous intra‑epithelial lesion (HSIL), or squamous cell carcinoma (SCC) were found in 648 (1.2%) and 212 (0.4%), respectively. Among abnormal glandular cytology, atypical glandular cell (AGC) was most commonly found (199 women or 0.4%) whereas adenocarcinoma and endometrial cell in woman aged >40 year were found in only 14 (0.02%) and 11 women (0.02%), respectively. Majority (77.3%) underwent further investigations. We found that 13.0% of ASC, 20.3% of LSIL, and 78.7% of HSIL and SCC had clinical significant histopathology. In glandular abnormalities: 14.9% of AGC, 33.3% of women aged >40 years with endometrial cell, and 66.7% of adenocarcinoma were histologically proven to be of clinical significant. CONCLUSIONS: ASC was the most common abnormal cervical cytology. Cytology abnormalities of HSIL and SCC had the highest association with clinical significant histopathology.

Survival rate of recurrent cervical cancer patients.

OBJECTIVES: To determine the survival rate of recurrent cervical cancer patients and factors influencing survival. MATERIAL AND METHOD: The subjects were identified from the Gynecologic Oncology Unit tumor registry record The pathological, clinical data including the follow-up information of recurrent cervical cancer patients who were treated in the Gynecologic Oncology Unit, Bangkok Metropolitan Administration Medical College and Vajira Hospital between 1992 and 2003 were retrospective reviewed. RESULTS: During the study period, 144 recurrent cervical cancer patients were identified. Mean age of the patients was 52 years. The median time from complete primary treatment to disease recurrence was 14.8 months. Seventy-two patients (50%) had previous stage III disease. The most common histopalogy was squamous cell carcinoma (72.9%). Approximately half of the recurrences were local (73 patients or 50.7%) and distal recurrences were encountered in 71 patients or 49.3%. Overall 109 patients received treatmentfor their recurrences, i.e. radiation alone (55 patients, 38.2%), chemotherapy (31 patients, 21.5%), chemotherapy and radiation (18 patients, 12.5%), surgery (5 patients, 3.5%), and 35 patients (24.3%) received only supportive treatment. Two-year survival rate of the group was 18.5%. Median survival was 8 months (95%CI, 7-10 months). The patients with only local recurrence had a 2-year survival rate of 22.2% compared to 14.6% in those with distant recurrence. (p = 0.245). Two-year survival rate of those who received any kind of treatment was 22.4% compared to 4.0% in those who received only supportive treatment (p = 0.014 and 0.017 in univariable and multivariable analysis respectively). CONCLUSION: Survival rate of recurrent cervical cancer was low, especially in those who received only supportive treatment.

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.