ABSTRACT
Objective: To evaluate the efficacy and toxicities of cisplatinum and ifosfamide administered concomitantly with radiation therapy in the treatment of locally advanced squamous cell cervical carcinoma (LASCC). Methods: Twenty patients with biopsy-proven squamous cervical carcinoma, FIGO stage II A to III B were entered into this study. All patients received standard radiotherapy (50 Gy in 25 fractions and brachytherapy at a dose of 268-28 Gy). Cisplatinum 70 mg/m2 plus ifosfamide 3 gm/m2 were administered totally for three cycles on Day 1, 21 and 42, concomitant with the radiotherapy schedule. Response and toxicities of treatment were evaluated and long term follow up was performed for disease free survival. Results: All patients received a course of concomitant chemoradiotherapy. Sixteen patients (80%) were able to receive a full course of chemotherapy, the remaining received 1-2 courses because of severe toxicities. The clinical complete response rate was 90% and overall 4 years survival rate was 85%. Grade 3 and 4 leucopenia occurred in 2 cases with one febrile neutropenia. Late complication revealed 2 cases of grade 3 cystitis. Conclusion: This study showed that concomitant chemoradiotherapy with cisplatinum plus ifosfamide was feasible for patients with LASCC. Further study of this regimen should be compared in randomized control trial (RCT) with cisplatinum alone and in the other histologic type of cervical cancer such as adenocarcinoma.
ABSTRACT
A 34 year-old Thai female woman who had a previous history of recurrent pelvic inflammatory disease or recurrent pelvic inflammatory disease (PID), presented with recurrent pelvic pain and high grade fever. She was admitted and a diagnosis of tubo ovarian abscess was made. Physical examination and ultrasonographic examination demonstrated high grade fever, adnexal tenderness and a right mixed solid cystic mass compatible with tubo ovarian abscess. Despite prescription of combined parenteral antibiotic, her symptoms did not improve. An exploratory laparotomy showed a left ovarian abscess with a kinked fallopian tube behind the uterus. A left salpingectomy with partial oophorectomy was performed. Cultured pus was identified as group B streptococci. Antibiotics therapy was continued until clinical improvment and she was discharged on the seventh post operative day. Tubo ovarian abscess or tubo ovarian abscess (TOA) is a serious consequence of PID. The streptococcus group B infection is a rare cause of TOA. There is a discussion about diagnosis, medical treatment and surgical treatment. Although medical treatment with broad-spectrum antibiotics has allowed patients to avoid operations, some of them who failed medical treatment required surgical treatment. Especially in women who need childbearing potential in future, conservative surgery has become the initial approach as well as this case report.