Long term complications after radical hysterectomy with pelvic lymphadenectomy.

OBJECTIVE: To evaluate the incidence of long-term complications in stage IB and IIA cervical cancer patients undergoing radical hysterectomy with bilateral pelvic lymphadenectomy. MATERIAL AND METHOD: A retrospective review on 290 patients who were treated with primary type III radical hysterectomy with bilateral pelvic lymphadenectomy between January 1, 1997 and December 31, 2005. Long-term complications were classified in two categories, voiding dysfunction and complication from lymphadenectomy such as lymphocyst and lymphedema. RESULTS: Forty-two patients (14.5%) required urethral catheterization more than four weeks. Only four patients (1.4%) were diagnosed as neurogenic bladder and required permanent self-catheterization. Two hundred forty eight patients (85.5%) returned to normal voiding within 1 month postoperatively. The incidence of lymphocyst was 9.3%; however, almost of them were asymptomatic and resolved spontaneously within a few months. Only four patients (1.4%) had complicated lymphocyst and required hospitalization with intravenous antibiotic and drainage procedure. Six patients (2.1%) were diagnosed as lymphedema after exclusion of deep vein thrombosis and recurrent cervical carcinoma. Pelvic lymph node metastasis and postoperative adjuvant radiation were not significant risk factors for lymphocyst and lymphedema. CONCLUSION: Radical hysterectomy with lymphadenectomy is the treatment of choice in stage IB and IIA cervical cancer with excellent survival rate. However there are long-term complications such as voiding dysfunction, lymphocyst, and lymphedema. Although these complications are not life threatening, they can affect the quality of life.

Clinicopathologic variables and survival comparison of patients with synchronous endometrial and ovarian cancers versus primary endometrial cancer with ovarian metastasis.

OBJECTIVES: To determine the clinicopathologic variables and survival in the patients with synchronous endometrial and ovarian cancer (synchronous group) compared to the patients with primary endometrial cancer with ovarian metastasis (metastatic group). METHODS: The medical records of 423 endometrial cancer patients who received primary surgery were reviewed. Fourteen patients were diagnosed as synchronous group while 49 patients were diagnosed as metastatic group. RESULTS: The median age in synchronous group was significantly younger than metastatic group (47 versus 56 years). More nulliparous and premenopausal patients were demonstrated in synchronous group. Synchronous group had significantly higher incidence of low grade tumor and lower incidence of deep myometrial invasion. All patients in synchronous group presented in stage I endometrial cancer. Moreover, most patients (85.7%) presented in early stage ovarian cancer and only 14.3% in advanced stage ovarian cancer. Synchronous group had better disease free survival (DFS) and overall survival (OS) than metastatic group. Estimated 5 years DFS was 64.2% versus 41.5%, (P = 0.17) and 5 years OS was 92.8% versus 48.5% (P = 0.036). CONCLUSION: The patients in synchronous group were younger, more nulliparous and had a better prognosis than the patients in the metastatic group.

Prevalence of BRCA1 expression in epithelial ovarian cancer: immunohistochemical study.

The 99 formalin fxed paraffin-embedded ovarian tissue specimens of Epithelial Ovarian Cancer (EOC) patients treated at the Gynecologic Oncology Unit, King Chulalongkorn Memorial Hospital between January 1, 1996 and December 31, 1999, were immuno-stained with BRCA antibody using the immunohistochemical method. According to the criteria for BRCA1 immunohistochemical evaluation (neoplastic nuclear staining more than 10%), 12 (12.1%) of the 99 specimens showed positive BRCA1 expression. No associated statistical significance between clinicopathological variables and BRCA expression was detected. Survival analysis was performed in 87 patients who were followed-up for more than 6 months and recent status were available. During a median follow-up of 43 months, median survival time was 46 months (range 6-84 months). No association between BRCA1 expression and survival outcomes was found (Disease free survival and overall survival) in the presented patients.

Transient cortical blindness during chemotherapy (PVB) for ovarian germ cell tumor.

A 17 year-old female with stage IIIc endodermal sinus tumor of the ovary developed transient cortical blindness and severe hypertension after 5 cycles of PVB regimen consisting of cisplatin, vinblastine and bleomycin. Clinical and radiological findings were compatible with Posterior LeukoEncephalopathy (PLE). Her visual acuity and blood pressure completely recovered within a few days after supportive treatment with antihypertensive drug. This condition is unpredictable but it can be reversible without long term sequelae. Most reports suggested that this rare toxicity was from cisplatin therapy. However, the exact pathophysiogenesis of this condition was not known precisely. Prompt reduction in blood pressure and withdrawal of immunosuppressive agents might lead to rapid reversal of this syndrome and prevent permanent brain damage.

Outcome of recurrent and persistent disease of malignant ovarian germ cell tumor: a retrospective analysis at King Chulalongkorn Memorial Hospital.

Malignant ovarian germ cell tumor has one of the most successful treatment outcomes in gynecological malignancy. More than 80% of the patients can be cured from this rare type of tumor However, patients with recurrent and persistent disease after primary treatment are still the problem of management. The present study has reviewed the treatment outcome of this cancer in King Chulalongkorn Memorial Hospital during the 12 years periodfrom 1993 to 2004. The overall cases of malignant ovarian germ cell tumor were 71 cases, 8 cases had recurrent disease after primary treatment and all cases received platinum-based chemotherapy for the salvage treatment. All patients in this group received long-term survival with median survival time of 87 months. In patients with persistent disease, 10 cases that resisted to first line adjuvant chemotherapy. Cisplatin and Etoposide regimen was applied as second line treatment, but none of these patients received long term response. The survival outcomes in these 2 groups are significantly different. The overall survival from the treatment of malignant ovarian germ cell tumor in King Chulalongkorn Memorial Hospital was 85.1%. In conclusion, the outcome of treatment in patients with recurrent disease after non-platinum chemotherapy is excellent. Salvage therapy in this group should contain platinum-based regimen. Patients whose disease persisted after platinum-containing regimen had a poor survival outcome.