ABSTRACT
BACKGROUND: Cisplatin is considered safe to use during the second and third trimesters of pregnancy in patients with cancer. CASE: A 34-year-old pregnant woman was diagnosed with cervical cancer. She received five weekly dosages of cisplatin and paclitaxel, starting at 26 5/7 weeks of gestation. An elective cesarean delivery was performed at 34 4/7 weeks of gestation. After birth, the neonate was diagnosed with severe bilateral perceptive hearing loss. CONCLUSION: Cisplatin during the second and third trimesters of pregnancy may lead to fetal ototoxicity.
Subject(s)
Antineoplastic Agents/adverse effects , Carcinoma, Squamous Cell/drug therapy , Cisplatin/adverse effects , Hearing Loss, Bilateral/chemically induced , Pregnancy Complications, Neoplastic/drug therapy , Uterine Cervical Neoplasms/drug therapy , Adult , Female , Hearing Loss, Bilateral/congenital , Humans , Infant, Newborn , Male , Pregnancy , Severity of Illness IndexABSTRACT
BACKGROUND: Standard treatment of advanced ovarian cancer is surgery and chemotherapy. The goal of surgery is to remove all macroscopic tumour, as the amount of residual tumour is the most important prognostic factor for survival. When removal off all tumour is considered not feasible, neoadjuvant chemotherapy (NACT) in combination with interval debulking surgery (IDS) is performed. Current methods of staging are not always accurate in predicting surgical outcome, since approximately 40% of patients will have more than 1 cm residual tumour after primary debulking surgery (PDS). In this study we aim to assess whether adding laparoscopy to the diagnostic work-up of patients suspected of advanced ovarian carcinoma may prevent unsuccessful primary debulking surgery for ovarian cancer. METHODS: Multicentre randomized controlled trial, including all gynaecologic oncologic centres in the Netherlands and their affiliated hospitals. Patients are eligible when they are planned for PDS after conventional staging. Participants are randomized between direct PDS or additional diagnostic laparoscopy. Depending on the result of laparoscopy patients are treated by PDS within three weeks, followed by six courses of platinum based chemotherapy or with NACT and IDS 3-4 weeks after three courses of chemotherapy, followed by another three courses of chemotherapy. Primary outcome measure is the proportion of PDS's leaving more than one centimetre tumour residual in each arm. In total 200 patients will be randomized. Data will be analysed according to intention to treat. DISCUSSION: Patients who have disease considered to be resectable to less than one centimetre should undergo PDS to improve prognosis. However, there is a need for better diagnostic procedures because the current number of debulking surgeries leaving more than one centimetre residual tumour is still high. Laparoscopy before starting treatment for ovarian cancer can be an additional diagnostic tool to predict the outcome of PDS. Despite the absence of strong evidence and despite the possible complications, laparoscopy is already implemented in many countries. We propose a randomized multicentre trial to provide evidence on the effectiveness of laparoscopy before primary surgery for advanced stage ovarian cancer patients. TRIAL REGISTRATION: Netherlands Trial Register number NTR2644.
Subject(s)
Laparoscopy , Ovarian Neoplasms/diagnosis , Ovarian Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Female , Humans , Middle Aged , Neoplasm, Residual , Netherlands , Ovarian Neoplasms/drug therapy , Ovarian Neoplasms/mortality , Ovarian Neoplasms/pathology , Prospective Studies , Quality of Life , Survival Analysis , Young AdultABSTRACT
OBJECTIVE: To assess the interobserver agreement on interpreting hand drawings as a colposcopic image recording technique in women with borderline cytology and to assess the correlation between colposcopic impression and histological outcome. METHODS: We used colposcopic documentation and histology from a cohort study of women with borderline dyskaryosis. Four gynecologists and four residents scored the same 30 colposcopic documentation forms. RESULTS: There is a good interobserver agreement on classifying colposcopic hand drawings as high-grade lesions (average kappa 0.58). The interobserver agreement on interpreting colposcopic image was higher for the more highly experienced gynecologists than for the residents. The agreement between colposcopic impression and histological outcome is poor (kappa 0.17) among the observers. CONCLUSIONS: Hand drawings are a reliable recording technique of interpreting colposcopic impression documented as high-grade lesion. However, the correlation between colposcopic impression and histological outcome is still poor in women with minor cytological abnormalities.
Subject(s)
Clinical Competence , Colposcopy , Documentation/standards , Precancerous Conditions/diagnosis , Uterine Cervical Dysplasia/diagnosis , Uterine Cervical Neoplasms/diagnosis , Cohort Studies , Female , Gynecology , Humans , Internship and Residency , Observer Variation , Physicians , Precancerous Conditions/pathology , Sensitivity and Specificity , Uterine Cervical Dysplasia/pathology , Uterine Cervical Neoplasms/pathologyABSTRACT
BACKGROUND: (1) To assess the prevalence of histologically confirmed cervical intraepithelial neoplasia in patients with cervical smears diagnosed as atypical squamous or glandular cells of undetermined significance. (2) To evaluate the role of colposcopy and the presence of human papillomavirus in detecting underlying cervical intraepithelial neoplasia. MATERIALS AND METHODS: In this prospective cohort, 148 women with atypical squamous or glandular cells of undetermined significance were evaluated by colposcopy, histological sampling, and human papillomavirus deoxyribonucleic acid testing. RESULTS: Histological diagnosis of >/= cervical intraepithelial neoplasia II was found in 10/148 women. Women with a histological >/= cervical intraepithelial neoplasia II had a higher prevalence of >/= two abnormal quadrants (90% vs. 38%/= cervical intraepithelial neoplasia II.
