Recurrence of cervical carcinoma following radical hysterectomy and pelvic node dissection.

The aim of this report is to review the clinical pattern of the recurrent cases. From May 1969 to December 1988, 200 patients with cervical carcinoma stage IB were treated with radical hysterectomy and pelvic node dissection at the Department of Obstetrics and Gynaecology, Ramathibodi Hospital, Mahidol University. One hundred and eighty-two patients were included in this study. Twenty-one patients (11.5%) developed recurrent cervical carcinoma. Most of the recurrence were diagnosed within 3 years after surgery. The most common recurrent site was pelvic sidewall. Patients' complaint and abnormal physical findings accounted for 81 percent of the first evidence. Treatment of recurrences was radiation in 15, chemotherapy in 3 and symptomatic treatment in the remaining three. Nine patients died of the recurrent tumor. The median time from recurrence to death was 24 months (range 12-65). The majority of the deaths occurred in the first three years after detection of recurrence. Radiation may be beneficial in treatment of recurrent tumor and in regional control of tumor after surgery.

Prognostic factors associated with recurrence in stage IB cervical carcinoma after radical hysterectomy and pelvic lymphadenectomy.

Radical hysterectomy with pelvic lymphadenectomy is the treatment of choice for stage IB cervical carcinoma. Recurrence of disease usually results in poor prognosis. The prognostic factors associated with recurrence were analyzed in 182 patients with stage IB cervical carcinoma treated with radical hysterectomy with pelvic lymphadenectomy at Department of Obstetrics and Gynaecology, Ramathibodi Hospital from May 1969 to December 1988. Twenty-one patients (11.5%) developed recurrent cervical cancer. Factors which were found to have statistical significance associated with recurrence were positive lymph node, positive surgical margin and cervical lesion size of 3 cm or more. The application of these factors was discussed.

Uterine sarcomas at Ramathibodi Hospital (1969-1986).

Uterine sarcoma is a rare gynecological malignancy. This retrospective study covered a period of 18 years and during that time 15 cases of uterine sarcoma were treated in Ramathibodi Hospital. It represented an incidence of 6 per 10,000 gynecological admissions. There were 9 leiomyosarcomas, 3 endometrial stromal sarcomas, 2 mixed mullerian sarcomas, and one rhabdomyosarcoma. The average age of the patients was 45.67 years, 3 under 40 and five after menopause. The mean parity was 4. The most common presenting symptoms were vaginal bleeding and abdominal mass. The diagnostic curettage was positive in only 2 out of 7 cases. All were treated by hysterectomy and bilateral salpingo-oophorectomy. Two out of 4 cases who received adjuvant radiotherapy or chemotherapy were still-alive at 1 and 3 year follow-up. The crude survival rate was 40 per cent.

Cervical cancer survival at Ramathibodi Hospital 1979-1983.

Carcinoma of the cervix is the most common malignant neoplasm among the female population. The treatment is surgery for stage IB and radiotherapy for all stages of disease. In a developing country like Thailand, the percentage of lost to follow-up after complete treatment is usually high. The purpose of this study is to present the follow-up and survival rate of patients with carcinoma of the cervix at Ramathibodi Hospital. From 1979 to 1983 there were 323 patients with carcinoma of the cervix who had been treated at Ramathibodi Hospital. The majority of patients (51.9%) were in stage II. The 5-year follow-up rate was 87.73 per cent which is better than the previous reports from Thailand. The 5-year survival rate was 93.75 per cent for stage I, 63.12 per cent for stage II and 42.22 per cent for stage III with an overall survival rate of 61.65 per cent. The 5-year survival rate in this study is not different from other reports.

Primary carcinoma of the fallopian tube: a 20-year review at Ramathibodi Hospital.

Four cases of primary carcinoma of the fallopian tube treated at the Department of Obstetrics and Gynaecology, Ramathibodi Hospital, Mahidol University during a 20-year period were reviewed. The mean age was 54 years. The most common presenting symptoms were watery vaginal discharge, abnormal uterine bleeding and abdominal pain. A palpable abdominal or pelvic mass was also a common physical finding. The preoperative diagnosis was correct in three patients. The possibility of getting an early and correct preoperative diagnosis of this disease is also discussed. All of the patients in this report were in stage I & II. The initial treatment consisted of total abdominal hysterectomy and bilateral salpingo-oophorectomy with postoperative radiotherapy or chemotherapy.

Survival of patients with stage I epithelial ovarian carcinoma, 1981-1985 at Ramathibodi Hospital.

Thirty-one patients with stage I epithelial ovarian carcinoma were treated during 1981 and 1985. Fourteen cases were stage Ia, two stage Ib and fifteen stage Ic. Twenty-eight cases had at least a TAH with BSO. Postoperatively, twenty-one patients received melphalan as adjuvant chemotherapy (mean of 11 courses). There were 8 patients who received no adjunctive therapy. One patient had radiation treatment and the remaining one received hormonal treatment. Eighty-seven per cent (27 out of 31) of tumors were of borderline type or well differentiated, four were moderately well differentiated. Poorly differentiated tumor was not observed in our series. The follow-up (31 patients) ranged from 0-82 months with a median of 52 months. The overall 5-year survival was 95.4 per cent. There was one reported death whose tumor was stage Ic grade 1 and who had received melphalan postoperatively. No serious adverse effects were noted among patients who received melphalan.

Assessment of endocervical curettage in colposcopy.

Colposcopy has become an accepted diagnostic procedure in the management of patients with abnormal cervical cytology. To assess the value of the endocervical curettage in colposcopy, a retrospective review of 125 cases who had the procedure done during the 20-month period (January 1986-August 1988) was carried out. The ECC were positive in 3 out of 57 (5.3%) patients with satisfactory examination and 24 out of 68 (35.3%) patients with unsatisfactory examination. In all 27 cases, there was insufficient tissue to make a diagnosis of invasive carcinoma. Of the 125 patients studied seventy-two (29 in the satisfactory group and 43 in the unsatisfactory group) underwent conization and/or hysterectomy. Endocervical curettage did not eliminate the need for cone biopsy in all cases of unsatisfactory colposcopy. The tissue diagnosis on ECC did not increase the diagnostic accuracy derived from the colposcopic directed biopsies in either group. There were 20 cases of invasive carcinoma (13 MIC, 7 invasive) in this study, the ECC were positive in 9. We concluded that the ECC has limited value in colposcopy.

The risk factors in the development of persistent trophoblastic disease following hydatidiform mole.

Hydatidiform mole (HM) is not uncommon in our country. Its dangerous sequalae is the fatal persistent trophoblastic disease (PTD). The prognostic risk factors for the development of PTD were analyzed in 108 cases of HM treated in Ramathibodi Hospital from 1978 to 1986. Statistical univariate analysis was by calculation of relative risk (RR) and chi-square test. The incidence of PTD was 27.8 per cent. The significant risk factors were the presence of theca-lutein cyst, gestational age of less than 16 weeks, "large for date" uterus, and patients' age of 40 years or more. Their RR were 4.25, 3.11, 3.00 and 2.68 respectively. These findings were comparable with previous reports. The use of prophylactic chemotherapy in patients with these risk factors was suggested.