Human papillomavirus infection following radiation therapy or concurrent chemoradiation for invasive cervical cancer.

OBJECTIVE: To determine the prevalence of Human Papillomavirus (HPV) infection in patients with invasive cervical cancer after treatment by concurrent chemoradiation therapy. MATERIAL AND METHOD: Cervicovaginal mucous samples were collected from fifty-five patients with invasive cervical cancer two months after treatment completion and tested for HPV genotypes. RESULTS: Of the 55 patients, 31 (56.36%) were found to be positive for HPV among these 25 (45.46%) were positive for high-risk HPV. The most common high-risk HPV found was type 16 which accounted for 35.48% (11/31) of cases. Other high-risk HPV found were types 18 (16.13%), 52 (16.13%) and 58 (12.90%). Follow-up time for patients were 3 to 22 months with mean follow-up of 13 months. In patients positive for high-risk HPV 24.00% (6/25) were found to have persistent or recurrent disease. While 30 patients negative for high-risk HPV 3.33% (1/30) were found to have persistent or recurrent disease. CONCLUSION: The prevalence of HPV infection in cervical cancer patients with positive high-risk HPV after treatment by radiation or concurrent chemoradiation seems to be a risk factor for persistent and recurrent disease. Testing for high-risk HPV may be a useful modality for follow-up of these patients.

The treatment outcome of adenocarcinoma of uterine cervix at Phramongkutklao Hospital.

OBJECTIVE: To determine the survival rate of patients with adenocarcinoma of the cervix after completing treatment at Phramongkutklao Hospital. MATERIAL AND METHOD: Retrospective review of medical records of 229 patients with adenocarcinoma of the cervix who had completed treatment at Phramongkutklao Hospital between October 1991 to September 2006. RESULTS: Overall 2, 5 and 10-year survival for patients with adenocarcinoma of the cervix was 78.9%, 70.1% and 67.0%, respectively. The 5-year survival rates for stages I, II, III and IV were 94.6%, 76.1%, 49.2% and 0, respectively. Five-year survival of patients with locally advanced adenocarcinoma of the cervix treated with concurrent chemoradiation was comparable to that of patients treated with radiation alone (64.0 vs. 62.4%). Survival of group treated by radiation plus surgery was not significantly different to the group recieved radiation alone. There have been no serious complications from the treatments. CONCLUSION: Survival of patients with adenocarcinoma of the cervix shows a direct correlation with stage. The survival for each treatment modality was comparable. Adjuvant hysterectomy after radiation in adenocarcinoma of the cervix stage IIB and IIIB did not improve long-term survival.

Economic evaluation of computed radiography comparing to film method in quality control of general X-ray machine at Phramongkutklao Hospital.

OBJECTIVE: To evaluate the efficiency of quality control performance for a general x-ray machine between computed radiography (CR) and film method. MATERIAL AND METHOD: CR performance as a quality control method for a general x-ray machine was compared to the film method. Two raters independently analyzed the result of quality control from both methods. Economic evaluation was performed by cost-minimization analysis. All data (result for quality control and cost) were collected from Phramongkutklao Hospital from August 2007 to January 2008. RESULT: Quality control performances of a general x-ray machine by using CR and film method were equivalent. Interobserver agreement for analysis of quality control measurements was almost perfect. Unit cost, test performance time, radiation dose for quality control by CR were less than the film method (p < 0.001). CONCLUSION: The performances of quality control of a general x-ray machine done by the CR method are more efficient than the film method. Using the CR method for quality control performance of the general x-ray machines will save cost enormously.

Gemcitabine and radiotherapy in the treatment of uterine cervical cancer patients at Phramongkutklao Hospital.

OBJECTIVES: To determine response, complication and survival of uterine cervical cancer patients treated with concurrent gemcitabine radiotherapy. MATERIAL AND METHOD: A retrospective review of medical records of 41 patients with uterine cervical cancer patients, stage IIB and above treated with concurrent gemcitabine radiotherapy from August 2000 to August 2003. RESULTS: At 6 and 12 months of follow up, the complete response rate was 75.6% and 65.9%. The cumulative probability of survival at 6 and 12 months after treatment was 0.93 and 0.85. The main complications were mild hematologic and nonhematologic toxicities. CONCLUSION: Concurrent gemcitabine radiotherapy provided a satisfactory response in patients with uterine cervical cancer with mild toxicity. Long term follow up data is necessary to determine the recurrent rate of this regimen.

Prevalence and risk factors of urinary incontinence in Thai menopausal women at Phramongkutklao Hospital.

OBJECTIVE: To determine the prevalence and risk factors of urinary incontinence in menopausal women at Phramongkutklao Hospital. MATERIAL AND METHOD: The present cross sectional study was conducted in healthy women, with intact uterus and at least one ovary, attending the university hospital menopausal clinic. They had no history of pelvic mass, paralysis or using any diuretic. They completed the self-administered questionnaire regarding urinary incontinence symptoms and risks. RESULTS: Four hundred patients were enrolled. The prevalence of urinary incontinence was 75.3%. The prevalence of stress, urge and mixed urinary incontinence were 18.3%, 17.5% and 39.5%, respectively. Obesity was statistically significant in association with all types of urinary incontinence (OR 1.65, 95% CI 1.10-2.64) and mixed incontinence (OR 2.65, 95% CI 1.50-3.14). Previous vaginal delivery was only significantly related with mixed type (OR 2.11, 95% CI 1.17-3.55). But only 3.6% of the menopausal women had ever been treated for symptoms of urinary incontinence. CONCLUSION: While the prevalence of urinary incontinence is high, the percentage of the suffering patients, seeking medical services, is low. Therefore, more attention should be paid to these treatable problems. Obesity might be the risk factor for all types of urinary incontinence, while previous vaginal delivery was suggested to be a risk factor for the mixed type.

Colposcopic directed biopsy in the management of abnormal pap smear at Phramongkutklao Hospital.

OBJECTIVE: To evaluate agreement in pathologic diagnosis of tissue obtained by colposcopic directed biopsy (CDB) and conization or total abdominal hysterectomy (TAH) in the diagnosis of cervical intraepithelial neoplasia (CIN). MATERIAL AND METHOD: Medical records of women with abnormal cervical cytology referred for colposcopic examination from January 1, 1999 to December 31, 2003 were reviewed. Agreement in diagnosis of CIN in tissue obtained by CDB and tissue obtained by conization or TAH is defined as not more than one level of CIN disparity. RESULTS: Agreement between pathologic diagnosis of tissue from CDB and tissue from conization or TAH is 67.1% with a 95% confidence interval of 57-77%. Six cases of invasive cancer were not diagnosed from CDB but subsequently diagnosed from conization. CONCLUSION: Agreement between pathologic diagnosis of tissue obtained from CDB and tissue from conization or TAH in the present study was too low to accept CDB as a diagnostic modality for CIN in selected cases. Conization should be performed in these cases after diagnosis of CIN is made by CDB.