Comparison of concurrent chemoradiotherapy with cisplatin plus 5-fluorouracil versus cisplatin plus paclitaxel in patients with locally advanced cervical carcinoma / 부인종양

OBJECTIVE: The aim of this study was to compare survival outcomes and toxicities between concurrent radiotherapy with cisplatin plus 5-fluorouracil and that with cisplatin plus paclitaxel in patients with locally advanced cervical carcinoma. METHODS: We retrospectively reviewed data from 93 locally advanced cervical carcinoma patients (stage IB to IVA) who had been treated by concurrent radiotherapy with cisplatin plus 5-fluorouracil (CF, n=45) vs. cisplatin plus paclitaxel (CP, n=48) as primary therapy. Toxicities and survival outcomes were compared. RESULTS: In the CP group, there were higher frequencies of severe (grade 3 or 4) leukopenia (79.2%, as compared to 11.1% in the CF group), severe neutropenia (77.1%, as compared to 8.9% in the CF group) and severe peripheral neuropathy (12.5%, as compared to 2.2% in the CF group). In the CF group, there were higher frequencies of severe nausea (33.3%, as compared to 14.6% in the CP group) and severe hyponatremia (11.1%, as compared to 0% in the CP group). Five-year DFS of the CF and CP groups was 67.4% and 79.1%, respectively (p=NS). Five year OS of the CF and CP groups was 79.6% and 80.9%, respectively (p=NS). CONCLUSION: Concurrent radiotherapy with cisplatin plus paclitaxel showed increased leukopenia, neutropenia and peripheral neuropathy, but less gastrointestinal toxicity (nausea) than that with cisplatin plus 5-fluorouracil. Survival outcome between these two groups was not statistically different in this study. Large prospective randomized controlled studies will be needed to confirm this result.

The Relationship between the Expression of Cytokeratins, Ki-67, and the Infection of Human Papillomavirus 16, 18 Type in the Carcinogenic Progression of the Uterine Cervical Epithelium / 대한산부인과학회잡지

OBJECTIVE: To evaluate the relationship between the expression of cytokeratins, Ki-67 and the infection of human papillomavirus 16, 18 type in the carcinogenic progrssion of the uterine cervical epithelium. METHODS: Investigation the expression patterns of CKs and Ki-67 monoclonal antibody, and compared them with the incidence of HPV infection in 120 patients including 30 cases of normal cervical epithelium, 30 cases of LSIL, 30 cases of HSIL and 30 cases of SCC, to possible relationship between them. RESULTS: The expression of CK 14, and Ki-67 increased as the cervical lesions progressed from normal to SILs and SCC. In contrast, CK 13 is decreased as the cervical lesions progressed from normal to SILs and SCC. Statistical analysis revealed significant corelations between the CK 14 and spinal layer, between CK 13 and basal layer, between Ki-67 and all layers. HPV was detected in 16.7% of normal cervical tissue, 50.0% of LSIL, 70.0% of HSIL, 80.0% of SCC with PCR technique. The labelling indices of Ki-67 were significantly higher in HSIL than in normal cervical tissue and LSIL. The labelling indices were also higher in groups with positive reactions to CK 14, 13, and HPV than in groups with negative reactions to them. CONCLUSION: It was postulated that examination of patterns of immunoreactivity of CK 14, 13, and Ki- 67 could be a useful and convenient tool to explain the trasition from normal cervical epithelium to SCC via LSIL and HSIL and thereby predict the differentiation potential of the studies for lesions.

A Case of Vulvar Paget's Disease Associated with Adenocarcinoma Occurred in Young Woman / 대한산부인과학회잡지

Extramammary Pagets disease of the vulva is an uncommon vulvar neoplasm with a high rate of recurrence. We report a young woman in whom vulval Paget's disease occurred in association with local adenocarcinoma. The patient presented at the age of 28 years with slowly growing vulval mass which had some mucoid discharge. Biopsy of the mass showed Paget's disease with associated local adenocarcinoma. This patient received modified radical vulvectomy with unilateral inguinofemoral lymphadenectomy. Until now she is under follow up without evidence of recurrence for 24 months. According to our medline research from 1980 to 2000, this case is the youngest asian patient yet recorded. We recommend that abnormally growing vulvar mass need to be biopsied eventhough she is young.

The Value of Laparoscopic Assistance in Total Vaginal Hysterectomy / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate value of laparoscopic assistance during total vaginal hysterectomy, and its implications for hysterectomy method. METHODS: Between January 2001 and December 2001, 236 patients underwent transvaginal hysterectomy (TVH) or Laparoscopic assisted vaginal hysterectomies (LAVH) for benign disease. We compared the results of the two methods, taking account of age, parity, past history of abdominal surgery, surgical indication, operation time, blood loss, presence of pelvic adhesion, weight of uterus, and intra- and post- operative complications and hospital stays. RESULTS: There was no difference in patients' mean age, parity, or menopausal status. Previous operation history was similar between the two groups, except previous cesarean section history. Indications for surgery were similar between the two group. There was no statistical difference on preoperative hemoglobin, postoperative hemoglobin, and 1st day hemoglobin drop. However, mean blood loss checked in operation room was greater for the LAVH group (TVH:113.7+/-83.9 cc, LAVH:146.1+/-113.3 (p<0.05). Uterine weight was heavier in the laparoscopic (249.6 gm) than the vaginal group (214.8 gm) (p<0.05). Mean operating time was shorter in the vaginal (46.5 min) than the laparoscopic group (84.9 min). In laparoscopic group, 15 patients had pelvic adhesions. Four of the 15 patients had adhesions between the posterior surface of the uterus and the bowel, and successful laparoscopic adhesiolysis was achieved in all four cases. CONCLUSION: LAVH have longer operation times and hopital stays than vaginal hysterectomies, but can be safer procedures in patients with possible pelvic adhesions.

A Case of Incisional Recurrence of a Cervical Carcinoma / 대한산부인과학회잡지

Incisional metastases following surgery for cervical cancer are extremely rare. We report a case of a recurrence which occurred at a incisional site following radical hysterectomy and pelvic lymphadenectomy for squamous cell carcinoma of the cervix. The recurrence was found at the incisional site just below umbilicus that was not included for post-operative adjuvant radiotherapy. We performed wide local excision and postoperative adjuvant radiotherapy for 5 weeks. She has been under follow up until now, and there is no evidence of recurrence.