Anaesthesia for brachytherapy.

PURPOSE OF REVIEW: The demand for anaesthesia in brachytherapy is increasing. Patients often present with high-risk factors and multiple comorbidities. To achieve a stable position of the implants, immobility is often mandatory. Duration of brachytherapy varies greatly and may exceed the duration of single-shot regional anaesthesia. Transportation of anaesthetized patients is a typical challenge. This review gives information about anaesthesia techniques in brachytherapy on the basis of the literature and the authors' experiences. RECENT FINDINGS: The choice of anaesthesia technique depends on the body region, the type of brachytherapy and the local infrastructure. Topical or local anaesthesia is used by radiotherapists. For brachytherapy of the lower body, regional anaesthesia provides effective and safe conditions. Catheter techniques are used for longer procedures and for high-risk patients, allowing excellent ongoing epidural patient-controlled analgesia. General anaesthesia is safely utilized for brachytherapy of the upper body or as an alternative to regional techniques. However, the effort under the typical conditions of the brachytherapy setting may be higher. Sedation is regarded as an alternative to general anaesthesia in less painful and short procedures. SUMMARY: In conclusion, anaesthesiologists play a key role in the ongoing challenge to provide safe and pain-free conditions for an optimum brachytherapy treatment effect.

Inguinal sentinel lymph node dissection vs. complete inguinal lymph node dissection in patients with vulvar cancer.

BACKGROUND: The aim of this retrospective study was to ascertain the postoperative morbidity in patients with vulvar cancer undergoing sentinel lymph node vs. complete inguinal lymph node dissection. PATIENTS AND METHODS: In total 29 and 46 patients with vulvar cancer, were treated by the technique of inguinal sentinel lymph node dissection or complete inguinal lymph node dissection, respectively. RESULTS: Inguinal sentinel lymph node dissection was associated with a shorter operation time, a reduced rate of inguinal seromas, wound breakdown and wound infection, fewer days of inguinal drainage, and reduced postoperative lymphatic secretion. CONCLUSION: Evidence of reduced peri- and postoperative morbidity with the sentinel lymph node technique for inguinal lymph node dissection in patients with vulvar cancer was demonstrated.

Prevalence of human papillomavirus types 6, 11, 16 and 18 in young Austrian women - baseline data of a phase III vaccine trial.

INTRODUCTION: Cervical cancer is the second most common cancer among women worldwide. In the absence of changing risk or intervention, it is projected that in comparison with 2002 there will be a 40% increase in the number of new cases of cervical cancer by 2020. HPV types 16 and 18 cause 70% of cervical cancers worldwide, 50% of high-grade cervical intraepithelial neoplasias and 25% of low-grade neoplasias. HPV types 6 and 11 are the causative agent of > 90% of genital warts. The aim of this study was to assess the baseline prevalence of infection with HPV 6, 11, 16 and 18 in young Austrian women. METHODS: Austrian females aged 16-24 (n = 123) were enrolled in a double-blind, placebo-controlled, randomized phase III trial of a quadrivalent HPV (types 6, 11, 16, 18) vaccine (FUTURE I, ClinicalTrials.gov number NCT00092521). Healthy women who were not pregnant and had no prior history of genital warts or abnormal results on cervical cytologic testing and had fewer than five lifetime sex partners were eligible for enrollment. The study sub-population was recruited primarily from university settings. RESULTS: Analysis of the sexual history of the Austrian subjects showed that 92.7% (114/123) were non-virgins and 46.3% were current smokers. At enrollment, 15 (13.5%) had positive serological or PCR tests for HPV 6, 11, 16 or 18. Serologically, 14 (12.3%) of women were positive to HPV 6, 11, 16 or 18: of these, 13 (11.4%) were positive for HPV 16, four (3.5%) were positive for HPV 18, and one (0.9%) for HPV 6. By PCR all were negative for HPV 6 and 11, whereas seven (6.1%) were positive for HPV 16 and one (0.9%) for HPV 18. Abnormal cytology was observed in 12 (10.3%) women. DISCUSSION: Although the prevalence of vaccine HPV types among young Austrian women with fewer than five lifetime sexual partners was lower than in international data, we observed a high prevalence of abnormal cytology and smoking. These data suggest that a substantial number of Austrian women are at risk for HPV-related disease.

C-reactive protein serum levels are closely associated with lymph node status, but not with prognosis in patients with vulvar cancer.

OBJECTIVE: To evaluate whether C-reactive protein (CRP) serum levels can be used as prognostic parameter in patients with vulvar cancer. STUDY DESIGN: CRP serum levels were measured at the time of first diagnosis of squamous cell vulvar cancer. Sixty-seven patients were enrolled; results were correlated to clinical data. RESULTS: Mean CRP serum levels in patients with vulvar cancer were 0.8 (0.80)mg/dL. CRP serum levels were significantly associated with lymph node involvement (p=0.003), but not with tumor stage (p=0.03), histological grade (p=0.86) and patients' age (p=0.64). Univariate analysis showed lymph node involvement, tumor stage and histological grade, but not CRP serum levels and patients' age to be associated with overall survival. A multivariable analysis determined only lymph node involvement as independent prognostic parameter for disease-free interval and overall survival. CONCLUSION: CRP serum levels are closely associated with lymph node status but cannot be used as prognostic parameter in patients with vulvar cancer.

Groin metastasis after extensive microinvasive vulvar cancer. A case report.

BACKGROUND: An increasing incidence of vulvar intraepithelial neoplasia and microinvasive vulvar cancer is being observed in younger patients. The treatment of choice is wide local excision. CASE: A 53-year-old woman had HPV-related disease for more than 20 years. Following several operations for cervical and vulvar intraepithelial lesions (CIN 3 and VIN 3) and genital warts, she presented with extensive, multifocal VIN 3 and microinvasion at the age of 50. Since a radical approach was not feasible, combined excision and laser therapy was performed, preceded by mapping of the abnormal areas of the vulva. Two years after surgery the patient presented with a mass in the right groin. Histopathologic examination following excision revealed a groin metastasis. Postoperative radiotherapy was performed. Three years after the last vulvar surgery and 1 year after groin excision, the patient was well and disease free. CONCLUSION: In high-risk patients with recurrent HPV-related disease of the lower genital tract and extensive microinvasive vulvar carcinoma, removal of the groin nodes should be considered. The sentinel node approach might be appropriate in the future.

A polymorphism in the matrix metalloproteinase-1 gene promoter is associated with the prognosis of patients with ovarian cancer.

OBJECTIVE: The enzyme matrix metalloproteinase (MMP)-1 is involved in ovarian carcinogenesis. A common guanine insertion-deletion promoter polymorphism within the gene encoding MMP-1 (MMP1) has been suggested to be a candidate gene for ovarian cancer. We investigated whether this common polymorphism can also serve as independent prognostic parameter in a large series of affected women. METHODS: The MMP1 promoter polymorphism was examined in 151 Caucasian patients with epithelial ovarian cancer using polymerase chain reaction. Results were correlated with clinical data. RESULTS: No associations were ascertained between the MMP1 polymorphism and tumor stage (P = 1.0, odds ratio [OR] 1.08), lymph node involvement (P = 1.0, OR 0.8), tumor grading (P = 0.2, OR 0.5), and patient's age at diagnosis (P = 1.0, OR 1.04). Besides the clinically established prognosticators, tumor stage and histological grade, presence of the MMP1 polymorphism was associated with a shortened disease-free and overall survival in a univariate Kaplan-Meier analysis (P = 0.01) and a multivariate Cox regression model (P = 0.04). CONCLUSION: Presence of the MMP1 gene promoter polymorphisms was found to be a negative prognostic parameter in patients with ovarian cancer.

A common interleukin-6 promoter polymorphism in patients with vulvar cancer.

OBJECTIVE: Besides its important role in immune response and inflammatory processes the cytokine interleukin-6 (IL-6) is crucially involved in carcinogenesis. A common polymorphism within the gene encoding IL-6 (IL6) is known to alter IL-6 protein expression and has been associated with patients' prognosis in various malignancies. No data are available with respect to vulvar cancer. Therefore, we determined the prognostic potential of the common -174(G-->C) single nucleotide polymorphism in the promoter region of IL6 in a series of patients with this disease. METHODS: The IL6 promoter polymorphism was investigated in 81 Caucasian patients with surgically treated squamous cell vulvar cancer using pyrosequencing. Results were correlated with clinical data. RESULTS: No association was ascertained between the IL6 promoter polymorphism and the investigated clinicopathologic parameters, ie, tumor stage, lymph node involvement, tumor grade, and patient's age at diagnosis. In an univariate analysis, lymph node involvement and patients' age at diagnosis were associated with patient prognosis. In a multivariate analysis, including tumor stage and lymph node involvement as established prognostic factors and the IL6 promoter polymorphism, lymph node involvement, and the presence of at least one mutant allele, but not tumor stage, were associated with increased disease-free and overall survival. CONCLUSION: Our data suggest that the IL6 -174(G-->C) promoter polymorphism might serve as an additional prognostic parameter in patients with vulvar cancer.