p53 tumor suppressor gene mutation in ovarian cancer in Thai patients.

OBJECTIVES: To characterize molecular mutations of p53 gene in Thai ovarian cancer and compare the mutations with their pathological and clinical findings. MATERIAL AND METHOD: Direct DNA sequencing of hot spot region of p53 gene (exons 5 to 8) from 28 primary ovarian cancer tissues, 2 metastatic tumors and their paired blood samples was performed. The detected mutations were compared to the pathological and clinical findings and responsiveness to treatments after 36 months of follow-up. RESULTS: One insertion and 4 point mutations in exon 5 of p53 gene were found in 5 out of 28 (18%) ovarian cancer patients. There was no mutation in the paired blood samples. The histological types of the detected tumors were 3 endometrioids and 2 serous cystadenocarcinomas. All 5 patients were in stage I to IV disease and showed overall 4 out of 5 (80%) complete response until 36 months after surgery followed by chemotherapy, compared to 14 out of 28 (50%) of complete response in all cases of ovarian cancer. CONCLUSION: The authors found 5 cases of ovarian cancer patients with p53 gene mutations giving the same response to complete standard treatment as all cases. Significant factors affecting responsiveness of these patients depended more on stages, grades and histological cell types of the cancer.

Misoprostal use for therapeutic abortion in Siriraj Hospital: the year 2000.

OBJECTIVE: To evaluate the efficacy and the adverse effects of misoprostal usage for therapeutic abortion in Siriraj Hospital. STUDY DESIGN: Cross-sectional, descriptive study. MATERIAL AND METHOD: A consecutive series of 101 therapeutic abortions was performed in the Department of Obstetrics & Gynecology, Siriraj Hospital in the year 2000. The patients were interviewed for general information and registered, as well as in-patient data. Any adverse events were recorded and collected from the inpatient record file. All data were analyzed statistically. RESULTS: 42 therapeutic abortions were conducted in association with misoprostal usage. Misoprostal was used for cervical ripening in 8 patients with a good outcome. 31 therapeutic abortions were induced by misoprostal alone regimen. A higher success rate (74.1%) was correlated with higher gestational age. 27 out of 31 cases were second trimester abortion. The induction to abortion interval was 18.0+/-10.5 hours (range 5-48). No factor, including age, weight, total dose of misoprostal use, nulliparity and viability of the fetus, could be demonstrated to affect the misoprostal activity defined by induction to abortion interval. There was no serious adverse event, except for severe abdominal cramping (26.2%) and fever (14.3%). CONCLUSION: Misoprostal alone can be used with caution for abortion induction especially in second trimester abortion.

Evaluation of clinical significance of a new tumour marker, cyfra21-1, in diagnosios of squamous cell cervical cancer: A preliminary study.

The purpose of this study was to evaluate the significance of Cyfra21-1 as a new tumour marker in the diagnosis of squamous cell cervical cancer. Cyfra21-1 enzyme immunoassay was used for the determination of Cyfra21-1 levels in sera of 120 cervical cancer patients and 17 normal control cases. According to the International Federation of Gynaecology and Obstetrics (FIGO) stage, these cervical cancer patients were staged at CIN or CIS, stage I, stage II and stage III (19,17,42 and 42 cases, respec-tively). The 17 normal controls comprised five healthy women and 12 patients with benign gynaecological diseases and tumours that had presented negative results from Papanicolauo smears. We found that the normal value of serum Cyfra21-1 level was 0.99 + 0.28 ng/ml (mean+ 2SE). Serum Cyfra21-1 levels of the cervical cancer patients increased depending on the severity of the disease. Moreover, the Serum Cyfra12-1 levels of only the patients with FIGO stage III were significantly higher than those of the normal controls, and the patients in CIN or CIS and stage I (p=0.0055). The serum Cyfra21-1 levels of the normal controls the patients in CIN or CIS, stage I, and stage II differed insignificantly from one another. This test showed a sensitivity of 65 per cent and specificity of 82 per cent. The ROC curve was used to determine the cut-off value (1.3 ng/ml) of the increased levels. A prospective study should be further performed to evaluate the usefulness of this marker as a non-invasive modality for diagnosis and monitoring cervical cancer in the future.

Evaluation of new ovarian cancer markers, STN, CA 546 and CA 72-4 in Thai patients.

Ovarian cancer is the most fatal gynaecologic malignance. At present, there is no sensitive test to detect early stages of the disease. In our study of 32 ovarian cancer patients admitted in Siriraj Hospital, 3 new tumor makers, STN, CA 546 and CA 72-4 were selected to evaluate for their sensitivity as compared with CA 125 Kit. The best positive rate for non-mucinous type of ovarian cancer was 82% obtained from the CA 125 test while the result for mucinous type was 67% obtained from a combined test of CA 125 and STN. As a requirement for early diagnosis, tests using CA 125 or CA 72-4 showed best sensitivity of 33% in early stages of non-mucinous, while CA 546 test revealed the highest result of 33% for mucinous type. Thus, the combination of new tumor marker assay of STN, CA 546, CA 72-4 together with CA 125 would increase sensitivity in detecting ovarian cancer especially for the mucinous type which is more common in Thailand.

Additional megestrol acetate with cis-platinum combination regimens in treatment of advanced ovaian epithelial cancer.

Patients with advanced ovarian epithelial cancer were randomized for additional oral megestrol acetate 160 mg/day for 3 weeks and repeated simultaneously every cycle of the three cis-platinum combination regimens. Fifteen patients of AP and 18 cases of AP plus megestrol acetate showed a higher incidence of weight gain 26.66% versus 94.44% (P<0.05), lower incidence of nausea-vomiting 73.33% versus 22.22% (P<0.05), increase of appetite and sense of well being 26.66% versus 77.77% (P<0.05), and incidence of good performance 53.33% versus 66.66% (P>0.05). Fifteen cases of EP and 17 cases of EP plus megestrol acetate achieved a higher incidence of weight gain 20.00% versus 88.23% (P<0.05), incidence of nausea-vomiting 73.33% versus 41.17% (P>0.05), better incidence of good appetite and sense of well being 20.00% versus 70.58% (P<0.05), and incidence of good performance 26.66% versus 64.70% (P>0.05). Nineteen cases of CAP and 15 cases of CAP plus megestrol acetate achieved a higher incidence of weight gain 31.57% versus 86.66% (P<0.05), lower incidence of nausea-vomiting 89.47% versus 40.00% (P>0.05), incidence of good appetite and sense of well being 47.36% versus 80.00% (P>0.05), and incidence of good performance 57.89% versus 66.66% (P>0.05). The response rate of disease to the additional megestrol acetate of the three regimens showed no significant change.

Human papillomavirus deoxyribonucleic acid in Thai cervical cancer patients.

Cervical biopsies were taken from 55 new cases of invasive cervical cancer attending the tumour clinic for detection of human papillomavirus DNA by dot blot hybridization technique. There were 50 patients with squamous cell carcinoma, 4 with adenocarcioma and one with adenosquamous cell carcinoma. The human papillomavirus DNA were detected in 36 cases (65.4%), of which HPV type 16 were detected in 26 cases (47.3%) while type 18 in 10 cases (18.1%). The findings were similar to those of other reports.

Cyclophosphamide, adriamycin and cis-platinum in treatment of ovarian common epithelial cancer stage III-IV.

Twelve patients with ovarian common epithelial cancer stage III, IV were treated by post operative chemotherapy; combination of cyclophosphamide, adriamycin and cis-diamminedichloroplatinum. Their revealed overall response rate was 83.3%, clinical complete remission was 66.6%, with a follow-up period of 10.0-23.5 months, and was negative on second look operation 83.3%. The response rate was 77.7%, for residual cancer > 5.0 cm. with a clinical complete remission 55.5%, and was negative on second look operation 66.6%.