Sompol Sanguanrungsirikul

Comparison of treatment outcomes between squamous cell carcinoma and adenocarcinoma in locally advanced cervical cancer.

OBJECTIVE To compare the treatment outcomes between squamous cell carcinoma (SCC) and adenocarcinoma (ACA) in locally advanced cervical cancer patients. METHODS All medical records of stages IIB-IVA of cervical cancer patients who had completed treatment between 1995 and 2008 were reviewed. ACA 1 case was matched for SCC 2 cases with clinical stage, tumor size, treatment modalities (radiation therapy (RT) vs concurrent chemoradiation (CCRT)). Treatment outcomes including response to RT/CCRT, time to complete response (CR), patterns of treatment failure and survival outcomes were analyzed. RESULTS A total of 423 patients with stages IIB-IVA (141 ACA: 282 SCC) were included. Most of the patients (about 60%) had stage IIB. The overall complete responses (CR) between ACA and SCC were 86.5% and 94.7%, respectively (p=0.004). Median time to clinical CR from RT/CCRT of ACA were 2 months (0-5 months) compared with 1 month (0-4 months) for SCC (p=0.001). Pelvic recurrence and distant failure were found in 2.1% and 14.9% in ACA, and corresponding with 3.9% and 15.6% in SCC. The 5-year overall survival rates of ACA compared to SCC were 59.9% and 61.7% (p=0.191), respectively. When all prognostic factors are adjusted, clinical staging was the only factor that influenced overall survival. CONCLUSION ACA in locally advanced cervical cancer had poorer response rate from treatment and also used longer time to achieve CR than SCC. However, these effects were not determinants of survival outcomes.

Exercise intolerance in obese children and adolescents

Abstract Background: Abnormal lung function has been reported in the obese population and is associated with the severity of obesity. Objectives: To identify abnormal lung function in obese children and adolescents, and examine the cardiopulmonary response of those who have abnormal lung functions during exercise, and to reveal predictors of exercise intolerance in this population. Methods: Fifty obese participants aged 8–18 years (56% male; mean age 13.2 ± 2.0 years; mean BMI 33.0 ± 3.6 kg/m2, mean BMI z score 3.1 ± 0.3) underwent spirometry, lung volume evaluation, and a cardiopulmonary exercise test. Results: Lung function abnormalities and exercise intolerance because of pulmonary limitations were found in 36% and 74% of the participants, respectively. A comparison of participants with normal and abnormal lung functions revealed a lower breathing reserve and a higher ventilatory equivalent for CO2 production (VE/VCO2) during exercise in those who had lung function abnormalities (18 ± 15 vs 30±10%, P <0.001 and 30.3 ± 3.3 vs 29.6 ± 3.1; P = 0.02, respectively). Exercise intolerant participants had a higher BMI z score compared with those who were not (3.1 ± 0.3 vs 2.9 ± 0.3; P = 0.03). BMI z score ≥ 2.84 had an 80% sensitivity and 67% specificity for predicting exercise intolerance in this population. Conclusions: Evaluations of lung function and exercise capacity should be included in the follow-up planning for obese children and adolescents. A BMI z score ≥ 2.84 was most sensitive for predicting exercise intolerance in this population.