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PubMed1982

Subsequent malignancies associated with carcinoma of the uterine cervix: including an analysis of the effect of patient and treatment parameters on incidence and sites of metachronous malignancies.

The incidence and sites of metachronous malignancies were retrospectively determined from the records of 763 patients seen at Yale University medical Center and affiliated hospitals with previously untreated, invasive carcinoma of the uterine cervix from 1953-1972. These patients were treated predominantly with radiation therapy; follow-up status was known for periods of 5-25 years or until time of death in over 96% of the patients. Forty-four patients had second malignancies noted at least 6 months after the initial cervical cancer was diagnosed. The expected incidence of second malignancies was determined from the Connecticut State Tumor Registry data controlling for year of diagnosis of the cervical cancer, patient age, sex, and time at risk (person-years exposure). To correct for any error in estimation of second malignancies introduced by the existence of a latency period for the development of a second cancer, the expected incidence of malignancies was also computed for 5-year time intervals following the cervical cancer. No significant increase in second malignancies was found (observed/expected-44/36) for the entire follow-up period nor for any individual 5-year interval. However, a statistically significant increase in lung cancer and vulva-vaginal cancer was noted and a significant decrease in breast cancer was observed. Cox regression analyses were performed to study the effect of total radium exposure and total external beam treatment, adjusting for other factors. No statistically significant increased risks were found.

Adenocarcinoma↗
PubMed2005

Pelvic irradiation-induced eosinophilia is correlated to prognosis of cervical cancer patients and transient elevation of serum interleukin 5 level.

PURPOSE: To determine the significance of eosinophilia and serum interleukin 5 (IL-5) levels induced by radiotherapy in patients with gynecological cancer. MATERIALS AND METHODS: First, we examined changes in the number of eosinophils before and during radiotherapy in 145 patients with cervical cancer who underwent external radiotherapy and brachytherapy. Eosinophilia was defined as > or =10% eosinophils or > or =500 eosinophils/mm3. Next, we determined serum IL-5 levels prospectively in 20 patients, comprising 18 cases of cervical cancer, one of uterine corpus cancer, and one of vaginal cancer. RESULTS: Eosinophilia was seen in 88 patients (61%). Patients with advanced disease stage IV showed 32% eosinophila, lower than those of stage I (63%), II (69%), and III (65%) disease patients (p=0.03). The 5-year cause-specific survival rate was 76% for patients with eosinophilia (+) and 53% for patients without eosinophilia (p=0.0003). Thus, eosinophilia correlates to stage classification and a good prognosis. Of the 20 patients studied prospectively, the six with elevated serum IL-5 level at one week (6/20=30%) all showed eosinophilia (100%), whereas only six of the other 14 patients had eosinophilia (43%, p=0.04). CONCLUSION: Radiotherapy induced transient elevation of serum IL-5 levels and is related with eosinophilia, which is correlated to prognosis.

Adult↗
PubMed1991

Management of radionecrosis of the vulva and distal vagina.

Twelve patients were seen between January 1983 and June 1989 with the clinical diagnosis of radionecrosis of the vulva or distal vagina. Seven patients received radiation for vulvar cancer, three for distal vaginal cancer, and two for recurrent endometrial cancer. No patient healed spontaneously and the mean delay in surgical therapy was 8.5 months. The radionecrotic site was treated with local therapy, radical local excision (with or without colostomy), or exenteration. The operative defect was closed primarily in three patients and covered with local flaps or myocutaneous flaps in seven patients. The two patients with local care still have radionecrotic ulcers. One of three patients who were closed primarily continues to have an ulcer. All other patients have healed satisfactorily except one who died after two attempts to correct the problem. Radionecrosis of the vulva and distal vagina should generally be treated surgically.

Adult↗
PubMed2003

Complications of indwelling venous access devices in patients with gynecologic malignancies.

OBJECTIVE: The purpose of this study was to evaluate the complication rates associated with indwelling venous access devices in patients with gynecologic malignancies. METHODS: Following IRB approval, a computerized database identified women that had indwelling access devices placed for chemotherapy from March 1999 to June 2001. A retrospective chart review identified 116 venous access devices that were placed in 104 patients. All devices were silicone and had a closed tip design with a three-position valve. Data were collected on patient demographics, clinicopathologic features, type of venous device, and complications. The chi(2) test was used for statistical analysis. RESULTS: Of the 104 patients, 79 had ovarian cancer, 11 had uterine cancer, 10 had cervical cancer, 2 had fallopian tube cancer, and 2 had vaginal cancer. The median age was 61 years. There were a total of 116 venous devices placed: 65 external catheters (EC) and 51 subcutaneous ports (SP). Seventy-nine percent of the patients were administered low-dose coumadin (1 mg/day) for catheter clot prophylaxis. There were three operative complications in the EC group and two in the SP group (P = NS). The most common postoperative complications were infection and thrombosis. Nineteen patients in the EC group experienced a catheter-related infection versus 5 in the SP group (P = 0.025). In the EC group, there were 11 cases of site infection and 8 cases of line sepsis. In contrast, there were 3 cases of exit site infection and 2 cases of line sepsis in the SP group. Deep vein thrombosis occurred in 5 patients with EC and 3 patients with SP (P = NS). Twenty-seven patients with EC had the device removed for catheter-related complications versus 2 patients with SP (P = 0.001). Six patients inadvertently removed their EC. CONCLUSION: There is a significantly higher postoperative complication rate in gynecologic oncology patients with external catheters versus subcutaneous ports. Infection and catheter-related malfunction are more common in patients with external catheters. We recommend the use of subcutaneous ports in the majority of patients with gynecologic malignancies.

Adult↗
PubMed2005

Formation of functional neovagina with vertical rectus abdominis musculocutaneous (VRAM) flap after total pelvic exenteration.

BACKGROUND: Pelvic exenteration may be the only curative option for women with recurrent pelvic malignancies. After total pelvic exenteration, the resultant perineal defect heals slowly if left to do so by secondary intention. Reconstruction with the vertical rectus abdominis musculocutaneous (VRAM) flap brings a generous bulk of healthy tissue into the defect, speeding recovery by facilitating primary healing. METHODS: Six women underwent reconstruction of a neovagina using a vertical rectus abdominis musculocutaneous flap. All 6 had total pelvic exenteration for advanced gynecologic malignancy. Primary diagnosis was cervical carcinoma (n = 3), vulvar carcinoma (n = 1), nonsmall cell vaginal cancer (n = 1), and vaginal melanoma (n = 1). Four patients had received adjuvant radiotherapy preoperatively. RESULTS: All flaps remained 100% viable postoperatively. There were no cases of fistula, infection, or bowel obstruction. Two patients died of cardiovascular arrest postoperatively. The 4 other patients report satisfaction with reconstruction. Three had vaginal intercourse with orgasm. CONCLUSION: The inferiorly based vertical rectus abdominis musculocutaneous flap is a dependable source of tissue for pelvic reconstruction and is the flap of choice in the Division of Plastic Surgery. In addition to facilitating healing, the VRAM flap (neovagina) improves a woman's psychosocial well-being.

Carcinoma↗
PubMed1999

Gastrostomy tubes in patients with recurrent gynaecological cancer and intestinal obstruction.

OBJECTIVE: Women with recurrent gynaecological cancers who are not suitable for exenterative surgery commonly present with gastrointestinal dysfunction. This paper is a retrospective review of the use of gastrostomy tubes in such women. METHODS: We performed a chart review of women with recurrent gynaecological cancer who had a gastrostomy tube placed between January 1991 and April 1998. RESULTS: Thirty-nine women (mean age 53.2 years, range 17-82) had a gastrostomy tube placed. Twenty-eight (72%) had ovarian cancer, eight (21%) had cervical cancer, two had endometrial cancer and one had vaginal cancer. In 14 women a gastrostomy tube was placed as the sole procedure for palliation (11 elective, 3 emergency). In the remaining 25 women, who underwent major surgery, a gastrostomy tube was placed in anticipation of, or in the presence of, significant intestinal distension and expected prolonged post-operative ileus. Eleven women (28%) died without leaving hospital after their operation (median 11 days, range 2-36). All but one of the 28 women who left hospital had satisfactory oral intake. Twenty-one women (54%) died with the gastrostomy tube in place (median 28 days, range 2-157) and 18 (46%) had the gastrostomy tube removed (median 14.5 days, range 9-180), 13 of whom (33%) have since died (median 167 days, range 77 days-7 years). Five women (13%) are alive (median 2.2 years, range 10 months-4.5 years). There were no problems which required the gastrostomy tube to be removed. CONCLUSION: Gastrostomy tubes have an important role in the treatment of women with recurrent gynaecological cancer, allowing gastric drainage and decompression without the disadvantages of nasogastric tubes.

Acute Disease↗
PubMed1998

[Hyperbaric oxygen therapy for radiation-induced hemorrhagic cystitis].

BACKGROUND: Radiation therapy has widely been used for cancers in the pelvis. Radiation cystitis, one of the late complications, presents often as hemorrhagic cystitis, which is refractory to the conventional therapy and may threaten the patient's life. We used hyperbaric oxygen therapy on patients with radiation cystitis to test its potential benifit. METHODS: Ten patients aged from 46 to 81 years with a mean of 62 years underwent one or more courses of hyperbaric oxygen therapy according to their symptoms, consisting of 20 sessions (3 to 5 sessions a week) at the Department of Hyperbaric Medicine, the University of the Ryukyus Hospital in the 9-year period from 1985 to 1994. They included 8 patients having a history of cervical cancer, one with external genital cancer and one with vaginal cancer. During the 75 min hyperbaric oxygen therapy patients received 100% oxygen at 2 absolute atmosphere pressure in the Multiplace Hyperbaric Chamber. RESULTS: Hematuria subsided and subjective symptoms including urinary frequency improved in seven patients. Cystoscopic findings including mucosal edema, redness, and capillary dilation were partially improved. The procedure subjectively and objectively palliated the 10 patients in a favorable manner. CONCLUSIONS: To date we have not armed any active procedure to control radiation-induced refractory hemorrhagic cystitis in terms of efficacy, invasiveness, and adverse effects. Therefore, in consideration of our clinical results, hyperbaric oxygen therapy appears to be useful for radiation cystitis.

Aged↗
PubMed2000

[Pelvic exenteration of advanced gynecological malignacies: a report of 18 cases].

OBJECTIVE: To investigate the role of pelvic exenteration in the treatment of advanced gynecological malignances. METHODS: Eighteen patients with cervical cancer in 8, vulvar cancer in 8, and vaginal cancer in 2, who underwent pelvic exenteration at the Cancer Hospital of Shanghai Medical University between 1970 and 1990 were retrospectively analyzed. RESULT: Median age was 52 years (range 27-65). One woman received surgery of total pelvic exenteration, 10 anterior and 7 posterior exenteration. The 3,5-year survival rates were 72%, 50%, respectively. Postoperative morbidity was 16%, and the surgical mortality was 0%. Bowel obstruction occurred in 2 of 18 cases, one of them was treated surgically. CONCLUSIONS: (1) Patients with advanced central type pelvic neoplasms can be successfully treated with exenteration; (2) The patients should be properly selected prior to and in operation, and the procedures must be performed specifically, particularly in exploration stage.

Adult↗