Laparoscopic radical trachelectomy (LRT) with round ligament and ascending branches of uterine artery preservation: case report.

Fertility sparing surgery might be a benefit for young patients with early-stage cervical cancer. The authors herein describe a case of adenocarcinoma of cervix Stage IA2 treated with laparoscopic radical trachelectomy (LRT) with round ligament and uterine artery preservation.

Depot medroxyprogesterone acetate and epithelial ovarian cancer: a multicentre case-control study.

OBJECTIVE: To evaluate the effect of depot medroxyprogesterone acetate (DMPA) in protecting against epithelial ovarian cancer (EOC) and to evaluate factors associated with the risk of EOC. DESIGN: A multicentre, case-control study. SETTING: Twelve hospitals located across Thailand. POPULATION: Three hundred and thirty patients with EOC ('cases') and 982 matched controls were recruited from the 12 hospitals. Cases were newly diagnosed patients with EOC, demonstrated pathologically. Controls were age-matched patients admitted to different wards in the same hospital. METHODS: Cases and controls were interviewed by trained interviewers using a standardised pre-tested questionnaire. The factors associated with EOC were evaluated using univariate and multivariate analyses. MAIN OUTCOME MEASURES: The odds ratio (OR) and 95% confidence interval (95% CI) were calculated to assess the relationship between DMPA and EOC. RESULTS: The use of DMPA was found to be associated with a 39% reduction in the risk of EOC with an OR of 0.61 and a 95% CI of 0.44-0.85 (P = 0.002). A significant risk reduction (83%) was observed when the duration of DMPA use was >3 years (OR 0.17; 95% CI 0.07-0.39; P < 0.001). Other factors associated with a reduced risk of EOC were the use of combined oral contraceptive pills and breastfeeding. A factor associated with an increased risk of EOC was a family history of gynaecological cancer. CONCLUSIONS: The results suggest that DMPA may have a protective effect against EOC. If this effect is real, then it represents an important non-contraceptive benefit of DMPA.

Treatment options in bulky stage IB cervical carcinoma.

Cervical cancer is the most common female cancer in the developing countries. Treatments of bulky stage IB cervical cancer have been challenged as the local control is relatively poor compared to smaller stage I disease, whether treated by radical surgery or irradiation. The treatment options are definitive concurrent chemoradiation therapy or radical surgery with or without neoadjuvant or adjuvant therapy. The treatment decision is based on the patients' status and preferences, tumor characteristics, and experiences of clinician. This study will review and compare the treatment modalities and rationales of a combination of treatment including surgery, radiation therapy, and chemotherapy for bulky stage IB cervical carcinoma.

Modulation of soluble CD44 concentrations by hormone and anti-hormone treatment in gynecological tumor cell lines.

Serum levels of CD44 (sCD44) are increased in a variety of human diseases including gynecological malignancies showing hormone-dependent growth and proliferation. Very little is known about the mechanisms underlying the processing of soluble CD44 and influencing its release. Due to their major impact on gene transcription and cell proliferation steroid hormones or their antagonists might influence sCD44 processing. We investigated the effects of different hormonal conditions on overall soluble CD44 (sCD44std) concentrations in a subset of gynecological tumor cell lines. Established human breast and endometrium cancer cell lines were characterized for their membrane-bound CD44 protein, CD44 mRNA expression and steroid receptor status prior and after incubation with 17beta estradiol (E2), medroxyprogesterone acetate (MPA), 4-hydroxy-tamoxifen (4-OH-Tam) and the gonadotropin releasing hormone (GnRH) agonist busereline. An enzyme linked immuno-sorbent assay (ELISA) using a monoclonal antibody directed against an epitope common to all CD44 isoforms was used to determine sCD44 levels in the supernatants of the tested cell lines. Interestingly, a strong correlation between sCD44 levels and the receptor status of the cells was seen. However, membrane-bound CD44 expression was not influenced by the hormonal environment. Our results indicate that distinct steroid hormones can specifically influence concentrations of soluble CD44. How this effect is involved in the tumorigenesis of gynecological malignancies and whether it might contribute to the biological behavior of special tumors should be investigated in further studies.

Phase II study of concurrent gemcitabine and radiotherapy in locally advanced stage IIIB cervical carcinoma.

OBJECTIVE: The aims of this phase II study were to investigate the feasibility, efficacy, and safety of gemcitabine in combination with radiation in chemonaive patients with advanced cervical cancer. METHODS: Nineteen patients with advanced stage IIIB cervical cancer received 300 mg/m2 of gemcitabine once weekly with concurrent standard radiotherapy, 5000 cGy, for 5 weeks including one insertion of brachytherapy. RESULTS: A complete response was observed in 17 (89.5%) of the 19 eligible patients at the end of the third month after completing radiation therapy; 1 patient had a partial response while another showed no response. Adverse events of grade 3 or higher included 1 case each of diarrhea (1/19) and anemia (1/19). Other minor complications (grade 1/2) were cystitis in 8 cases (12 cycles), proctitis in 2 cases (4 cycles), nausea and vomiting in 8 cases (8 cycles), diarrhea in 8 cases (19 cycles), and anemia in 8 cases (40 cycles). At 1 year, 16 patients (84.2%) showed good control of disease, while 2 cases had residual disease and 1 had distant metastasis. Grade 3 cystitis and grade 1-2 proctitis were seen in 1 and 2 cases, respectively. After a median follow-up time of 19.9 months, the results show a disease-free survival of 84.2% and overall survival of 100%. CONCLUSIONS: Gemcitabine and concurrent radiation is well tolerated and effective for the treatment of cervical cancer. Further study of this regimen should concentrate on the dosage and the sequence of administration. The combination of gemcitabine with other chemotherapeutic agents should also be investigated.