Vasant Linasmita

A PROSPECTIVE COMPARATIVE STUDY BETWEEN HYSTEROSALPINGOGRAPHY AND HYSTEROSCOPY IN THE DETECTION OF INTRAUTERINE PATHOLOGY IN PATIENTS WITH INFERTILITY

Aim:  To investigate the accuracy of hysterosalpingography (HSG) in comparison to hysteroscopy in the detection of intrauterine pathology in patients with infertility, where hysteroscopy is the gold standard.

Phase II study of high-dose megestrol acetate in platinum-refractory epithelial ovarian cancer.

Our objective was to determine the efficacy of megestrol acetate in the treatment of platinum-refractory epithelial ovarian cancer (EOC), and to evaluate the toxicities and quality of life (QOL) associated with this therapy. Patients with platinum-resistant epithelial ovarian cancer were treated with megestrol acetate (800 mg/day) orally for 28 days and then 400 mg/day for a minimum of 28 days before being assessed ready for evaluation of response to therapy. Patients who demonstrated a complete response (CR), partial response (PR) or stable disease were continued in the study until there was objective evidence of disease progression. All patients who went off study were followed up at regular intervals, every 2 months, to assess overall survival. Thirty-six patients were enrolled. Response was observed in seven of 36 patients (three CR and four PR). The response rate was 19.4% (95% CI 9-36). Four of the responders had the endometrioid cell type, while two were clear cell carcinoma and one was serouscystadenocarcinoma. All three CR patients had the histology of endometrioid carcinoma with the tumors located in the pelvis. Median survival of the study population was 5.8 months. Median survival in the responders was 12 months, while median survival in the non-responders was 5.5 months. Median progression-free survival in the responders was 8.3 months, while median progression-free survival in the non-responders was only 2 months. The majority of patients gained weight and had a fair quality of life score during treatment. The only toxicity observed was alopecia (grade 1) in four patients. We conclude that megestrol acetate has modest but definite activity in patients with platinum-refractory EOC, particularly in a small subset of the endometrioid subtype with limited disease in the pelvis. Only minimal toxicity was observed and the patients had a fair QOL score during the treatment.

A Study of Pegylated Liposomal Doxorubicin in Platinum-Refractory Epithelial Ovarian Cancer

Objectives: The purposes of this study were to determine the efficacy of pegylated liposomal doxorubicin (PLD), using a dose of 40 mg/m2 given every 3 weeks, in the treatment of platinum-refractory epithelial ovarian cancer (EOC) and to evaluate the toxicities. Methods: Fourteen patients with platinum-resistant EOC were treated with intravenous PLD 40 mg/m2 every 3 weeks. Tumor responses were assessed every 2–3 cycles by CT scan. Results: All 14 patients were evaluable for toxicity, but only 13 patients were evaluable for response because 1 patient who had grade 3 palmar-plantar erythrodysesthesia (PPE) refused to continue with the treatment. Three partial responses were observed in 13 patients. The overall response rate was 23% (95% confidence interval 10–38%). The median time to response was 2 months, and the median duration of response was 3 months. The median survival of the 13 patients was 14.5 months, and the median progression-free survival was 6 months. In this study, we had only 4 cases of grade 3 toxicity (2 cases of grade 3 leukopenia and 2 cases of grade 3 PPE). All toxicities that occurred were manageable. Conclusion: This is the first report of the use of a slightly modified dose schedule for PLD at a dose of 40 mg/m2 every 3 weeks, which is active in platinum-refractory EOC with manageable toxicities.

Sonohysterography in the Diagnosis of Abnormal Uterine Bleeding

Objective: The purpose of this study was to evaluate the value of sonohysterography in diagnosis of patients with abnormal uterine bleeding.

Detection of residual disease by cytology in patients with cervical intraepithelial neoplasia III post-large loop excision of the transformation zone

Objective: To evaluate the diagnostic accuracy of cytology in detecting residual disease in patients with cervical intraepithelial neoplasia (CIN) III post‐large loop excision of the transformation zone (LLETZ).

Recent management of malignant ovarian germ cell tumors: a study of 34 cases.

Objective: To review the outcome of the treatment in patients with malignant ovarian Germ cell tumors with respect to survival and surgical management at a single institution during 1990–1996.

Prognostic factors for survival of epithelial ovarian cancer.

Advanced stage, and macroscopic residual disease after primary surgery are generally accepted as poor prognostic factors. However, the prognostic significance of some of the readily available clinical and pathological factors such as age, tumor size, histological type, and grade has been debated w1–3x. We present a historical cohort study aimed to estimate the survival time of epithelial ovarian cancer (EOC) patients and identify factors that influence the survival time. There were 236 patients with EOC diagnosed and treated at Ramathibodi hospital between January 1993 and December 1997. Excluded were those patients having borderline tumor. Platinumbased (cisplatin or carboplatin) chemotherapy in combination with cyclophosphamide was given postoperatively to all patients except in patients with stage IA or IB, grade 1 or 2, non-clear cell histology that were treated with surgery alone. When recurrence occurred after 6 months from last chemotherapy, the patient would receive re-induction therapy with the same platinum-based regimen. And if the treatment failed or recurrence

cis-Platinum-based chemotherapy in management of malignant ovarian germ cell tumors

We present our experience of the adjuvant (postoperative) cp cisplatin, 75 mg/m2 IV over 60 min for 1 day with vigorous hydration before and after therapy; etoposide, 75 mg/m2/day IV over 30 min for 5 days; and vinblastine, 0.15 mg/kg/ day IV bolus for 2 days. All the combination chemotherapy regimens were given at 4-week