Medical abortion as an alternative to vacuum aspiration: first experiences with the 'abortion pill' in The Netherlands

Objective: To establish to what extent medical abortion is desired as a supplement to existing care provision in The Netherlands and to establish the (dis)advantages of medical abortion versus surgical vacuum aspiration. Methods: The research project began in November 1999 and ended in September 2000. In two abortion clinics, the clients were asked to answer some questions about their expectations (before treatment) and their experiences with the treatment (at the post-treatment check-up). At the post-treatment check-up, the clients were also asked to fill out the Hopkin's Symptom Checklist (HSCL) which is an objective measure for the psychological and physical well-being of the clients during the previous week. Results: One hundred and thirty-one clients who chose medical abortion and 131 clients who chose surgical vacuum aspiration participated in the study. The failure rate was 3.3% for medical abortion and 1.5% for surgical vacuum aspiration. Of the medical abortion clients, 80.2% reported they were satisfied with this treatment and 68.1% said they would choose the same treatment procedure in the future. For vacuum aspiration, these figures were 92.9% and 83.2%, respectively. The most reported advantage of medical abortion was the fact that it was a pill, and no surgical procedures were necessary. The most reported disadvantages of medical abortion were the amount of blood loss and insecurity concerning the time of abortion. Conclusions: Medical abortion seems to be a good supplement to the existing care provision in The Netherlands and should be offered in other clinics.     

Primary radiation therapy as an alternative to mastectomy for early-stage breast cancer

Breast conservation surgery followed by radiation therapy for definitive treatment of patients with early stage (limited extent) breast cancer (Stage I and Stage II) has been reported by several retrospective and prospective randomized trials to provide comparable local control, disease-free survival, and overall survival to patients treated with mastectomy. Excisional biopsy of the breast lump and associated axillary dissection are required prior to initiation of radiation therapy in order to remove all known tumor and to reduce the dose of radiation required for cure. The axillary dissection is therapeutic for extension into the axillary volume as well as a prognosticator that aids in the selection of patients for adjuvant systemic therapy. Although certain patients may be adequately served without radiation therapy by excisional removal of the tumor and a margin of surrounding normal breast tissue, this population still needs to be defined. Adequate patient selection and the use of good surgical and radiation therapy techniques results in good to excellent cosmesis in 80 to 90 per cent of treated patients. The treatment alternatives, if presented to patients deemed as appropriate candidates, will aid the patients in making an informed consent decision. Wider application and availability of this alternative to mastectomy may have a significant positive impact on our female population by encouraging women to seek detection of breast cancer through breast self-examination and mammography because the desirable alternative reduces the fear of loss of the breast and self image.     

Medical abortion as an alternative to vacuum aspiration: first experiences with the 'abortion pill' in The Netherlands.

OBJECTIVE: To establish to what extent medical abortion is desired as a supplement to existing care provision in The Netherlands and to establish the (dis)advantages of medical abortion versus surgical vacuum aspiration. METHODS: The research project began in November 1999 and ended in September 2000. In two abortion clinics, the clients were asked to answer some questions about their expectations (before treatment) and their experiences with the treatment (at the post-treatment check-up). At the post-treatment check-up, the clients were also asked to fill out the Hopkin's Symptom Checklist (HSCL) which is an objective measure for the psychological and physical well-being of the clients during the previous week. RESULTS: One hundred and thirty-one clients who chose medical abortion and 131 clients who chose surgical vacuum aspiration participated in the study. The failure rate was 3.3% for medical abortion and 1.5% for surgical vacuum aspiration. Of the medical abortion clients, 80.2% reported they were satisfied with this treatment and 68.1% said they would choose the same treatment procedure in the future. For vacuum aspiration, these figures were 92.9% and 83.2%, respectively. The most reported advantage of medical abortion was the fact that it was a pill, and no surgical procedures were necessary. The most reported disadvantages of medical abortion were the amount of blood loss and insecurity concerning the time of abortion. CONCLUSIONS: Medical abortion seems to be a good supplement to the existing care provision in The Netherlands and should be offered in other clinics.     

Adherence to treatment recommendations and outcomes for women with ovarian cancer at first recurrence

Objective

Treatment selection for recurrent ovarian cancer is typically based on the duration of time between the completion of adjuvant, platinum-based therapy and the time of recurrence, the platinum free interval (PFI). We examined the use of, and outcomes associated with platinum-based chemotherapy based on the PFI in women with recurrent ovarian cancer.

Initial experiences with the myocutaneous swing flap-plasty as an expanded possibility for treatment of vulvar cancer

Reconstructive formation of tissue defects following radical vulrectomy has been performed on six patients by myocutaneous flaps using the tensor muscle of ascia lata (TFL).     

Adjunctive chemotherapy as an alternative to ovarian ablation in premenopausal women with carcinoma of the breast

The beneficial effects observed from adjunctive chemotherapy in premenopausal women with carcinoma of the breast may be due only to ovarian ablation. Beneficial effects of chemotherapy induced amenorrhea was noted in four of five reported adjunctive trials. Chemotherapy appears to delay recurrence but has only minimal effect on survival rates. The results of four of five studies comparing ovarian ablation with controls show a consistent, but modest, prolongation of disease-free survival rates from oophorectomy similar to that observed from adjunctive chemotherapy. The benefits are accomplished with less morbidity from ovarian ablation. Additional trials are needed to prove whether or not chemotherapy is more beneficial than adjunctive ovarian ablation in delaying recurrence and if either prolong survival time. Such trials should compare intensive adjunctive chemotherapy with either minimal or no adjunctive therapies. Therapy to be given at the time of recurrence should be defined at the outset to assure comparable over-all treatment among groups.     

Late breast cancer recurrence to the uterine cervix with a review of the literature.

The cervix is a possible site of metastasis from any primary malignancy, but no specific indication on follow-up examination is present. We present an asymptomatic patient with isolated breast cancer cervical recurrence diagnosed by colposcopy after 11 years from primary disease. After a PubMed search and a review of current guidelines, no indication to follow-up examination regarding the cervix is present. The adoption of colposcopy in cancer survivors might be an aid to gynecologists in diagnosing cancer recurrence. Cancer survivors might benefit from a more thorough gynecologic examination as compared with the simple Papanicolaou test.     

The levonorgestrel intrauterine system as an alternative to hysterectomy for the treatment of idiopathic menorrhagia

Aim of the study.?Prospective, observational study to determine the percentage of hysterectomies cancelled after a year of treatment with levonorgestrel intrauterine system (LNG-IUS) among women diagnosed with idiopathic menorrhagia.

Main findings.?Eighty-two women with a mean age of 44.3 ± 4.9 were enrolled. Throughout 1-year follow-up, progressive and significant reduction was observed in number of days of bleeding (8.9 ± 4.0 vs. 5.0 ± 5.4), number of sanitary measures (29.3 ± 19.4 vs. 8.1 ± 10.8) and percentage of patients having intense/very intense bleeding (98.8%vs. 6.4%). Duration of menstrual cycle significantly increased from 26.9 ± 5.5 to 52.6 ± 33.6 days. Significant improvement in overall health-related quality of life was achieved. Patient satisfaction was good/very good in 70.7%. Considering only women who attended 12-month visit satisfaction reached 91.2%. 75.6% of scheduled hysterectomies were cancelled. Adverse effects were recorded in less than 40% of patients with no significant differences between visits. Adverse effects led to premature discontinuation of treatment in seven cases. No serious adverse effects were encountered.

Interpretation of results.?LNG-IUS meets the effectiveness and tolerability criteria for being considered as a first choice treatment option for women with idiopathic menorrhagia. Its use may contribute to decrease the large number of hysterectomies scheduled in Spain.     

Evaluation of scintimammography as an additional test to conventional mammography in detection of breast cancer

OBJECTIVES AND DESIGN: Scintimammography using Tc-99m MIBI is becoming established as a second line diagnostic test for the detection of breast cancer in patients with suspected primary disease. Though most published clinical studies compare scintimammography (SMM) with mammography (XMM), in clinical practice they are likely to be used sequentially with the scintimammography following the mammography. MATERIALS AND METHODS: To determine the possible accuracy of such an approach, receiver operator characteristic (ROC) curves were produced for SMM, XMM and a combination of both studies performed over 2 years period on 162 suspicious lesions in 154 patients with no previous history of breast cancer. Each scan was reported in 5 grades: 1-normal or definitely benign; 2-possibly normal or possibly benign; 3-equivoval; 4-probably cancer; 5-definitely cancer. The results have been verified by pathological examination of biopsy material obtained from each suspicious mass. RESULTS: There were 102 malignant breast tumours and 60 non-malignant breast lesions. SMM correctly diagnosed 89 breast cancers, and was false negative in 13 cases. It was true negative in 36 benign breast lesions. The sensitivity of SMM was 87%, specificity 65%, PPV 81% and NPV 75%. XMM diagnosed correctly 70 malignant tumours. The sensitivity, specificity, PPV and NPV for XMM were respectively: 69%, 72%, PPV 81% and NPV 57%. However, if a combination of the two methods is used the overall diagnostic accuracy was as follows: 92%, 80%, 89% and 86%. Evaluation of index area under ROC curve allows in both diagnostic methods XMM and SMM results as follows: 0.79 and 0.83. Additional sequence imaging allows 0.94. Combined XMM and SMM in suspected primary breast cancer patients has higher diagnostic accuracy than each method separately (p < 0.05). CONCLUSION: This study shows that the combination of mammography and scintimammography produces more accurate results than either modality alone this is how these test should be performed in clinical practice.     

Recurrent ovarian cancer metastatic to the sternum, costae, and thoracic wall after prolonged treatment with platinum-based chemotherapy: a case report and review of the literature

Abstract.   Pavlakis G, Mountzios G, Terpos E, Leivaditou A, Papadopoulos G, Papasavas P. Recurrent ovarian cancer metastatic to the sternum, costae and thoracic wall after prolonged treatment with platinum-based chemotherapy: a case report and review of the literature. Int J Gynecol Cancer 2006; 16(Suppl. 1): 299–303.
Sternal and costal metastases from ovarian cancer are extremely rare. We present here a case of a 47-year-old woman with thoracic wall metastasis from serous–papillary ovarian carcinoma that occurred 3 years after the initial diagnosis, although the patient had received various regimens of intense platinum-based chemotherapy. Special emphasis is given to the effects of alkylating agents, such as cisplatin and carboplatin, on the pattern of tumor spread. We also discuss the possible mechanisms through which the biologic and metastatic behavior of this tumor is expressed.     

Intraoperative pathological monitorization of surgical margins: a method to reduce recurrences after conservative treatment for breast cancer

INTRODUCTION: Local recurrences after conservative surgical treatment for breast cancer are not uncommon and cause negative influences on the oncological prognosis and quality of life of the patients. Aiming to avoid this problem, we have developed a method of intraoperative pathological monitoring of surgical margins (IPMSM), in order to assure adequacy of resection. MATERIALS AND METHODS: IPMSM is based on radiological. macroscopic, cytological and histological examination of frozen sections of the breast specimens in the operating room during the surgery. We evaluated 98 women with 100 tumors clinical stage I-II breast cancer for whom we planned conservative surgery. The margins were oriented by the surgeon and inked by the pathologist in different colors to retain orientation. RESULTS AND DISCUSSSION: According to the histological or cytological results, immediate re-excision was indicated and performed in 40 (40.8%) cases. In six of these, we had to perform a mastectomy. The indications for additional resections were: insufficient margins in 23 cases, extensive intraductal component in eight, multifocality in four, atypical proliferative lesion at the margin in four and diffuse tumor in one. Permanent histological sections confirmed all intraoperative results. These patients were followed by a median period of 42 months (range 3 to 99 months) and we observed 1% of local recurrence and 5.1% of distant metastasis. We compared this group of patients with a control group represented by 149 cases of breast cancer stages I-II treated by conservative surgery, but not submitted to IPMSM. In the control group, we observed 17 (11.4%) local recurrences and 49 (32.9%) distant metastases after a follow-up period from 14 to 213 months (median of 126 months). CONCLUSION: The IPMSM proved to be a safe and accurate method to prevent additional surgery for insufficient margins and to reduce the recurrence rate.     

An assessment of the use of interphase FISH with chromosome specific probes as an alternative to cytogenetics in prenatal diagnosis

We have assessed the effects that would have been observed if we had changed from standard prenatal diagnosis to interphase fluorescence in situ hybridization (FISH) on our amniocentesis samples. We aimed to estimate the number of cases with aberrations other than chromosomes 13, 18, 21, X and Y, which would not have been detectable by FISH and to assess the potential clinical implications for these cases. In 1687 prenatal diagnoses, 111 cases had abnormal cytogenetic reports (6.5% aneuploidy rate). Out of those 111 cases, 14 had chromosomal abnormalities not detectable by FISH but four of these had major structural abnormalities diagnosed on ultrasound, which would have lead to counselling of a very poor prognosis anyway. In 10 cases without abnormal ultrasound findings, if FISH had been used rather than cytogenetics, it appears that there may have had no detrimental effects on the clinical outcomes of the cases studied. Out of those 10 cases, two pregnancies were terminated because of abnormal cytogenetic results (one was due to maternal age and the second one was due to abnormal biochemical screening) (mosaic 46,XY, /47,XY,+mar and 46,X,del(8)(p21) respectively) and their post-mortem results also did not show any abnormalities. One pregnancy was continued in spite of a de novo chromosomal rearrangement and resulted in an apparently normal live birth. Five cases (including a set of twins) with inherited balanced translocations resulted in four normal live births and one unexplained intrauterine death at 32 weeks' gestation and post-mortem was declined. One case with a paternally derived abnormal chromosome 21, decided to continue the pregnancy and resulted in a normal live birth. The last case in this group resulted in a rhesus related intrauterine death in the second trimester, and although an abnormal chromosome 13 insertion (paternally derived known aberration) there was no abnormality found at post-mortem. Therefore, we suggest that it is reasonable to use FISH as an alternative prenatal diagnosis for indications such as advanced maternal age and abnormal maternal serum biochemical screening when high quality ultrasound scanning is performed, but FISH should only be used as an additional test to conventional cytogenetics for the other indications, especially when abnormalities are found on ultrasound scan.     

Scintillation counting as an in vitro method for assessing the pretherapeutic effectiveness of planned tumor chemotherapy in patients with ovarian cancer

In vitro testing methods to obtain information about the proliferation of the tumour, which we want to treat by chemotherapy, have been vindicated by the biological individuality of ovarian cancer cells. The determination of the incorporation rate of 3H-thymidine in cells of ovarian cancer by scintillation counting may be recommended as a prognostic factor in regard of success of chemotherapy in patients with this disease.