ABSTRACT
Since the introduction of uterine artery embolization as a treatment option for symptomatic leiomyomas, there has been a growing interest in expanding the role of interventional radiology (IR) in the evaluation and treatment of obstetrics and gynecology (OBGYN) patients. This review provides an overview of opportunities for collaboration between IR and OBGYN. This can include medically and/or surgically complex patients, efforts to reduce quantitative blood loss, obstetrical emergencies, and consideration of fertility or uterine preservation. Increased collaborative efforts between IR and OBGYN would allow for patients to be fully informed regarding the complete spectrum of surgical and nonsurgical treatment options available to them. The purpose of this review is to foster opportunities to improve outcomes and respect patient values.
Subject(s)
Leiomyoma/therapy , Patient Care Team , Postpartum Hemorrhage/therapy , Radiography, Interventional , Uterine Artery Embolization , Uterine Neoplasms/therapy , Adult , Cooperative Behavior , Female , Fertility Preservation , Humans , Interdisciplinary Communication , Leiomyoma/diagnostic imaging , Leiomyoma/pathology , Postpartum Hemorrhage/diagnostic imaging , Radiography, Interventional/adverse effects , Treatment Outcome , Uterine Artery Embolization/adverse effects , Uterine Neoplasms/diagnostic imaging , Uterine Neoplasms/pathologyABSTRACT
OBJECTIVE: We sought to evaluate the toxicity and tolerability of the intraperitoneal/intravenous regimen by comparing the modified regimen that is used at the Moffitt Cancer Center vs the published findings of the Gynecologic Oncology Group Study 172. STUDY DESIGN: Using the Moffitt database, we evaluated the outcomes of patients who underwent primary optimal cytoreduction for stage IIC-IV epithelial ovarian, tubal, and peritoneal carcinoma followed by the intent-to-treat with intraperitoneal/intravenous chemotherapy. National Cancer Institute Common Terminology Criteria for Adverse Events (version 3.0) was used to grade adverse events. RESULTS: We analyzed patient data from 2006-2011 and identified 69 patients who met our inclusion criteria. The most frequent grade 3/4 toxicities were neutropenia (48%), gastrointestinal (9%), metabolic (9%), and infection (5%). Remaining toxicities occurred in <5% of patients. Patients received a greater number of cycles compared with the Gynecologic Oncology Group Study 172 (4.28 vs 3.66, respectively; P = .0088). CONCLUSION: With the use of supportive care and the preemptive management of established side-effects, the associated toxicities and tolerability of intraperitoneal chemotherapy can be improved.
Subject(s)
Antineoplastic Agents/administration & dosage , Antineoplastic Combined Chemotherapy Protocols , Cisplatin/administration & dosage , Neoplasms, Glandular and Epithelial/drug therapy , Ovarian Neoplasms/drug therapy , Paclitaxel/administration & dosage , Adult , Aged , Aged, 80 and over , Antineoplastic Agents/adverse effects , Carcinoma, Ovarian Epithelial , Cisplatin/adverse effects , Drug Administration Schedule , Drug Tolerance , Fallopian Tube Neoplasms/drug therapy , Fallopian Tube Neoplasms/mortality , Female , Humans , Injections, Intraperitoneal , Injections, Intravenous , Middle Aged , Neoplasm Staging , Neoplasms, Glandular and Epithelial/mortality , Neoplasms, Glandular and Epithelial/pathology , Ovarian Neoplasms/mortality , Ovarian Neoplasms/pathology , Paclitaxel/adverse effects , Peritoneal Neoplasms/drug therapy , Peritoneal Neoplasms/mortality , Retrospective Studies , Survival Rate , Treatment OutcomeABSTRACT
UNLABELLED: Pregnant patients with maternal arrhythmias can be challenging and difficult to treat. Medication choices may be limited in patients who are pregnant. Pregnancy carries with it a unique and complex physiology, coupled with fetal concerns. We describe a pregnant patient with an arrhythmia to illustrate treatment thought process and options. We also present a comprehensive review of the literature in regard to treatment of maternal arrhythmias and their potential adverse fetal and maternal outcomes. These treatments include antiarrhythmic medications, electrical cardioversion, and radiofrequency ablation. Antepartum and intrapartum monitoring will also be addressed along with delivery planning and postpartum considerations. The most important aspect in treating these patients is the use of a multidisciplinary approach. The decision of what therapy to use must be addressed on a case-by-case basis with special attention to the patient's individual issues and concerns. TARGET AUDIENCE: Obstetricians and gynecologists, family physicians, emergency room physicians LEARNING OBJECTIVES: After completion of this educational activity, the obstetrician/gynecologist should be better able to assess and council patients on the risks and complications of maternal arrhythmias in pregnancy. Evaluate the current treatment options available for health care providers caring for pregnant patients with maternal arrhythmia, and manage the antepartum course, labor, and delivery in these patients.
Subject(s)
Arrhythmias, Cardiac/therapy , Pregnancy Complications, Cardiovascular/therapy , Adult , Anti-Arrhythmia Agents/therapeutic use , Arrhythmias, Cardiac/etiology , Catheter Ablation , Delivery, Obstetric , Electric Countershock , Female , Heart Septal Defects, Atrial/complications , Heart Septal Defects, Atrial/physiopathology , Heart Septal Defects, Atrial/surgery , Humans , Pregnancy , Pregnancy Complications, Cardiovascular/etiologyABSTRACT
⺠Neuroendocrine carcinoma of the cervix is a rare and aggressive malignancy. ⺠A multimodality approach must be individualized when diagnosed during pregnancy. ⺠We report the use of a therapeutic cervical cone and adjuvant chemotherapy.
