Successfully conservative treatment of large cervical choriocarcinoma with profuse vaginal bleeding.

Primary choriocarcinoma of the uterine cervix is a rare disease. The accurate diagnosis of such a disease is difficult to achieve because of its rarity. Furthermore, the majority of cases presented with abnormal vaginal bleeding that could be caused by other more common conditions including, threatened abortion, cervical polyp, cervical pregnancy, or cervical cancer. In the present report, the authors present a case of large cervical choriocarcinoma with life-threatening vaginal bleeding, which was initially misdiagnosed as a cervical cancer The active cervical bleeding was successfully controlled with selective uterine arterial embolization. Remission of cervical choriocarcinoma was accomplished with combination chemotherapy without the need of hysterectomy.

Radical surgery for T1 and T2 squamous cell carcinoma of the vulva through separate incisions.

OBJECTIVES: The aim of the study was to retrospectively evaluate treatment results in patients with T1 and T2 vulvar carcinoma. MATERIAL AND METHOD: The medical records of 46 patients with T1 and T2 SCC of the vulva undergoing radical excision of the tumor and groin node dissection at Chiang Mai University Hospital between January 1998 and December 2004 were reviewed. The tumor size, histologic grade, nodal status, lymph-vascular space invasion, lesion location, surgical marginal status, complications, recurrence and survival were analyzed. RESULTS: Mean age of the 46 patients (T1 = 15, T2 = 31) was 59 years with a range of 34-84 years. The incidence of lymph node metastases for T1 lesions was 13% compared to 35% for T2 lesions. Twenty nine patients (63%) experienced surgical complications, the most common one was lymphedema (16) while wound breakdown was noted in only 1 patient. With a median follow-up of 15 months, 14 patients (30%) developed recurrence, 3 (20%) and 11 (35%) in patients with T1 and T2 lesions respectively. The overall 5-year disease-free survival and 5-year survival were 37% and 40%, respectively. The 5-year survival of patients with T1 lesion was significantly higher than that of patients with T2 lesion (64% vs 31%, P = 0.04). Patients with negative nodes had significantly better survival than those with positive nodes (56% vs 18%, P = 0.02). In multivariable analysis, only the status of groin node remained as independent prognostic factors for survival. CONCLUSION: Radical excision and groin node dissection through separate incision for T1 and T2 squamous cell carcinoma of the vulva in this study has a less favorable survival outcome compared with the literature.

Extent of lymphovascular space invasion and risk of pelvic lymph node metastases in stage IB1 cervical cancer.

OBJECTIVE: To evaluate whether the extent of lymphovascular space invasion (LVSI) is a risk factor for pelvic lymph node metastases in stage IBI cervical cancer. MATERIAL AND METHOD: The clinicopathological data of 397 patients with stage IB1 cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy (RHPL) at Chiang Mai University Hospital between January 1998 and December 2002 were analyzed. The histology, tumor grade, depth of stromal invasion, uterine corpus involvement, parametrial invasion and LVSI were analyzed for their association with pelvic node metastases. The extent of LVSI was classified as negative, minimal (< 10 LVSI/cervical specimen), and extensive (> or = 10 LVSI/cervical specimen). RESULTS: Of the 397 patients, 146 (36.8%) had tumors containing LVSI, 82 (20.7%) and 64 (16.1%) had minimal and extensive LVSI, respectively. Fifty nine (14.9%) patients had pelvic node metastases. Using multivariable analysis, LVSI (p < 0.001), depth of stromal invasion (p < 0.001), tumor grade (p < 0.001), and parametrial invasion (p < 0.001) were significant predictors of pelvic node metastases. The extent of LVSI either minimal or extensive degree significantly influenced pelvic node metastases. CONCLUSION: The presence of LVSI especially extensive involvement was significantly associated with the risk of pelvic node metastases in stage IB1 cervical cancer.

Treatment results of methotrexate and folinic acid as primary chemotherapy for nonmetastatic gestational trophoblastic neoplasia.

OBJECTIVE: To evaluate the efficacy and toxicity of methotrexate and folinic acid (MTX-FA) chemotherapy in patients with nonmetastatic gestational trophoblastic neoplasia (NMGTN). MATERIAL AND METHOD: Between 1997 and 2003, a total of 67 patients with NMGTN received treatment at the Chiang Mai University Hospital. Of the 67 patients, 55 were initially treated with methotrexate 1.0 mg/kg intramuscularly (IM) on day 1, 3,5, and 7 and folinic acid 0.1 mg/kg IM on day 2, 4, 6 and 8. Treatment courses were repeated every 14 days. Clinical characteristics and outcomes were analyzed RESULTS: All 55 patients with NMGTN were cured. Of the 55 patients initially treated with MTX-FA, 49 (89%) achieved complete remission. Six (11%) patients developed methotrexate resistance, 3 were cured with actinomycin D, 1 were cured with 5-fluorouracil followed by etoposide, 2 required hystertectomy to attain remission. No serious toxicity was noted CONCLUSION: Methotrexate and folinic acid chemotherapy is highly effective and well-tolerated in treating patients with nonmetastatic gestational trophoblastic neoplasia.

Comparison of oral versus intravenous ramosetron in prevention of acute cisplatin-induced emesis: a randomized controlled trial.

OBJECTIVE: To compare the antiemetic efficacy of a single oral versus intravenous (i.v.) ramosetron, a new class of selective 5-HT3 receptor antagonists, in gynecologic cancer patients receiving high-dose cisplatin. METHOD: Between February 2003 and July 2003, 109 patients with gynecologic cancer scheduled to receive single agent cisplatin chemotherapy at a dose of 75 mg/m2 were randomized to receive either 0.2 mg oral (51 cases) or 0.3 mg i.v. (58 cases) ramosetron 1 h and 30 min respectively before chemotherapy. Patients were evaluated for 24 h after chemotherapy. The number of nausea and vomiting including adverse events were recorded every 6 h. RESULTS: 51 and 58 patients received oral and i.v. ramosetron respectively. Both groups were similar regarding age, performance status, body mass index and diagnosis of gynecologic cancer. 95 per cent of cases were cervical cancer. Antiemetic effect was significantly higher in the oral group when compared with the i.v. group during the first 6 hours and during the period of 18 to 24 hours after administration of cisplatin chemotherapy. Overall in 24 h, patients receiving oral ramosetron experienced no emesis slightly higher than that of the i.v. group (55% and 36% respectively, p = 0.05). Adverse events were mild and transient and were not significantly different in both groups, except tiredness which was more frequent in the i.v. group. CONCLUSION: Oral ramosetron at a dosage of 0.2 mg is as effective as 0.3 mg of intravenous ramosetron in prevention of acute emesis in patients receiving 75 mg/m2 of cisplatin chemotherapy.