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- Volume 7, Issue 2, 2015
Southern African Journal of Gynaecological Oncology - Volume 7, Issue 2, 2015
Volume 7, Issue 2, 2015
Author Greta DreyerSource: Southern African Journal of Gynaecological Oncology 7 (2015)More Less
It is well known that HIV positive women with cervical cancer are younger and have more squamous histology than the HIV negative group. Data describing outcomes of radiation treatment of HIV positive patients, suggests increased toxicity, but survival data for cervical cancer in these patients is scarce. In a retrospective comparative trial reported in this issue, short and long term outcomes of HIV positive and HIV negative women are compared regarding clinical and tumour characteristics, treatment prescription and completion, toxicity and survival.
Source: Southern African Journal of Gynaecological Oncology 7, pp 44 –51 (2015)More Less
Background : The objective of the study was to compare patient characteristics, treatment toxicity and interruptions, and survival in human immunodeficiency virus (HIV)-positive and HIV-negative cervical cancer patients receiving radiation as primary or adjuvant treatment.
Method : Demographics, clinical and tumour characteristics, and the outcomes of 51 HIV-positive and 47-HIV negative consecutive cervical cancer patients were assessed and compared, including co-morbidities, performance status, treatment type and toxicities, and survival.
Results : HIV-positive women were 13 years younger (p < 0.001), more often had anaemia (p 0.021) and needed pretreatment blood transfusion (p 0.037) more often than HIV-negative women. Performance status, kidney function, International Federation of Gynecology and Obstetrics stage, histology types and treatment intent and planning did not differ between the two groups. Treatment interruptions (p 0.004), transfusion during treatment (p 0.012), treatment toxicities (p 0.040) and average deficit (p 0.021) occurred significantly more in HIV-positive patients. Survival was significantly worse in HIV-positive women (p 0.029) and was associated with insufficient radiation (p < 0.001) and treatment interruptions (p 0.051).
Conclusion : In spite of being younger, the pretreatment correction of anaemia and the prescription of sufficient radiation dosages, HIV-infected cervical cancer patients experienced poorer survival. Treatment interruption and incomplete radiation contributed to poor outcomes.
An original risk of ovarian malignancy index and its predictive value in evaluating the nature of ovarian tumour : original researchSource: Southern African Journal of Gynaecological Oncology 7, pp 52 –59 (2015)More Less
Background : We carried out this study to evaluate the predictive value of an original risk of ovarian malignancy index (ROMI) devised by us.
Method : Our ROMI was the simple sum of points from the three-stage gradation of serum cancer antigen 125 (CA-125), data from the patientâ??s familial and personal history and the ultrasound characteristics of the tumour (i.e. tumour size ≥ 6 cm, multilocularity, tumour with ≥ ¼ solid areas, dense and opalescent liquid, septum or papillary vegetation ≥ 3 mm), ascites, bilaterality, an unclear margin with respect to the surrounding tissue and thickness of the capsule ≥ 3 mm. Its originality lay in the three-stage CA-125 gradation, namely < 35 U/ml (1 point), 35-129 U/ml (3 points) and ≥ 130 U/ml (5 points). The study group comprised 274 patients divided into a group with benign tumours (BOT) (n = 205), and a group with malignant tumours (MOT) (n = 69). Both groups were subdivided into three subgroups of ROMI ≤ 11 (low risk), ROMI 12-14 (unclear risk) and ROMI ≥ 15 (high risk).
Results : The cut-off ROMI of ≤ 11 showed high sensitivity, specificity and area under the curve (AUC) of 0.74, 0.93 and 0.83, respectively. The cut-off ROMI of ≤ 14 demonstrated extremely high specificity of 0.985, but lower sensitivity and AUC, of 0.57 and 0.78, respectively.
Conclusion : Our newly devised ROMI and its cut-off of ≤ 11 is very effective in excluding, as well as confirming, ovarian cancer.
Cobalt-60 is a logical, economical and comparable alternative to Ir-192 : analysis and institutional experience from western India : original researchSource: Southern African Journal of Gynaecological Oncology 7, pp 60 –63 (2015)More Less
Objectives : The objective of the study was to examine the dosimetry of intracavitary radiotherapy (ICRT) in carcinoma of the cervix using cobalt-60 (Co-60) as source of ICRT, and as an alternative to iridium-192 (Ir-192).
Design : This was a retrospective study.
Subjects and setting : The study was on 80 ICRT patients attending the radiotherapy department at Maharana Bhupal Government Hospital, Udaipur, India.
Outcome measures : The dosimetry of ICRT was studied retrospectively in 80 related applications. The dose to point A, 60 Gy isodose reference volume, and bladder and rectum maximum and mean doses were defined.
Results : It was found that dosimetry with Co-60 as a brachytherapy source was consistent with the International Commission on Radiation Units (ICRU 38) recommendations.
Conclusion : Co-60 is a logical alternative to Ir-192 in low socio-economic settings when repeated changing of the source is not an option.
Source: Southern African Journal of Gynaecological Oncology 7, pp 64 –66 (2015)More Less
According to the older literature, leiomyosarcoma (LMS) is the most common sarcoma of the uterus. But in 1993, the Gynecologic Oncology Group (GOG) found that the proportion of LMS of the uterus was only 16% of uterine sarcomas. However, sarcomas comprise less than 1% of all cervical malignancies, of which LMS is an extremely rare tumour, which follows an aggressive course. As per the world literature, only 22 cases have been described. To our knowledge only two cases have been reported in the Indian literature. We present a case study on a 40-year-old woman of Indian origin, who was diagnosed with cervical LMS.
Transvaginal colour Doppler ultrasound in predicting response to chemoradiation in patients with carcinoma of the cervix : short communicationSource: Southern African Journal of Gynaecological Oncology 7, pp 68 –72 (2015)More Less
Background : The objective of the study was to evaluate the potential role of transvaginal colour Doppler ultrasound (TVCDUS) in predicting response to chemoradiotherapy in patients with locally advanced cervical cancer.
Method : TVCDUS was used in 56 patients with histologically proven cervical carcinoma (stage IIA-IIIB) before the start of chemoradiation, and after one and three months of therapy. Resistive index (RI) and pulsatality index (PI) were calculated using TVCDUS. Tumour response to chemotherapy was determined. Complete response was when no residual tumour was found, partial response if the tumour volume decreased by more than 50%, and no response when there was no appreciable change in the size of tumour, or the tumour volume decreased to less than 50% of the original volume.
Results : A statistically significant increase in RI and PI was demonstrated with TVCDUS following treatment in patients who had a complete and partial response to chemoradiation, compared to those who had no response.
Conclusion : TVCDUS is useful in predicting clinical response to concurrent chemoradiation in patients with locally advanced cervical cancer. Thus, it is recommended during the pretreatment evaluation and follow-up.