Oncology treatment improvement--our experience in Serbia

OBJECTIVES

To determine weather structural changes by a tumor board made any difference in quality of treatment for oncology patients.

MATERIAL AND METHOD

Current management of our hospital initiated structural changes in the tumor board in January 2010 and improvement was measured through comparing the clinical staging of cervical cancer to previous tumor board results.

RESULTS

365 patients were seen by a multidisciplinary tumor board from January to December of 2010. There were 146 cases of cervical cancer. 87 were staged as Ib-IIa for radical surgery, 59 patients were staged as advanced stage of disease and RT was proposed as well as combined radio-chemotherapy in some cases.

CONCLUSION

Structural changes in the tumor board have made a significant improvement in the oncology care of our patients, primarily because of a multidisciplinary approach to gynecological malignancies and additional imaging performed in all cases of cervical cancer for better insight in the spread of the disease.

Synchronous primary tumors: appendiceal and ovarian cancer--case report

A 64-year-old women was operated on for acute abdomen and both appendiceal and ovarian tumors were found. Histology revealed synchronous adenocarcinoma of the appendix and serous pappillary carcinoma of the right ovary. The patient was given adjuvant chemotherapy and received six cycles of cisplatinum. Regular follow-up showed no recurrence of the two synchronous primary tumors. A rare case of synchronous primary tumors of appendiceal and ovarian origin is reported. The tumors proved to be difficult to treat requiring several combined medical therapies, including surgery, chemo- and radiotherapy.

Cold-knife conization versus the loop electrosurgical excision procedure for treatment of cervical dysplasia

INTRODUCTION

Classical conization is a standard procedure for treatment of cervical lesions. Conization with loop diathermy is well established and lesions can be excised in more than 90% of cases.

OBJECTIVE

To compare two methods of conization for the treatment of cervical dysplasia.

METHOD

The study included 172 patients who had conization for diagnosed cervical dysplasia. A retrospective analysis was conducted on incidence of complications and presence of dysplasia on the specimen edges after classical conization compared to conization with loop diathermy. The possibilities for analyzing specimen edges were reviewed.

RESULTS

A significantly higher incidence of complications was found among patients who underwent classical conization compared to those who had the loop diathermy procedure. The loop procedure is sufficient for treatment of cervical dysplasias.

CONCLUSION

The authors suggest loop diathermy conization as the method of choice for treatment of cervical dysplasia.

Leiomyoma of the uterus and retroperitoneal angioleiomyoma: case report

Retroperitoneal angioleiomyoma is a benign mesenchymal neoplasm that is composed of smooth muscle cells and thick-walled vessels. In a 36-year-old patient a retrouterine and retroperitoneal tumor, 70 x 65 x 50 mm in size, was discovered during a surgical procedure due to uterine myoma. The tumor had a soft consistency and was completely removed. Histopathology showed features of angioleiomyoma. Angioleiomyoma is a rare benign entity; hence a benign course and good prognosis are expected.

[Successful treatment of primary myelofibrosis with thrombocytosis during pregnancy with alfa-interferon]

Primary myelofibrosis is predominantly a disease of old age, poor prognosis and no curable treatment. Thrombocytosis was observed in only 12% of patients. To our knowledge, there is only one reported case of a young woman with primary myelofibrosis who had a term pregnancy [1]. We report on a 29-year-old woman with thrombocytosis and medical history of two miscarriages in the last 2 years, the iirst at 30 weeks of gestation and the second at 27 weeks. Multiple placental infarctions were observed. She was without symptoms but with moderate splenomegaly 4.5 cm below left costal margin). The platelet count was 651 x 10(9)/L, WBC 7.2 x 10(9)/L with normal differential formula, and haemoglobin level 12 g/dl. Bone marrow biopsy showed fibrotic phase of primary myelofibrosis, with hyperplasia of megacaryocytes, decreased numbers of erythroid and granulocytic cells, and increased amounts of reticulin fibres. Cyctogenetic examination of the bone marrow showed normal female caryotype. Increased numbers of progenitors CFU-Mk, CFU-GM and BFU-E were observed in peripheral blood, and decreased numbers in bone marrow cultures. As the patient wished to become pregnant, the treatment with interferon-a (Roferon A) was started at a dose of 3 MU s.c., three times per week. The platelet count rapidly decreased at a level of 260-370 x 10(9)/L. The pregnancy was diagnosed 5 months later. At the 24 week of pregnancy, platelet count raised to 690 x 10(9)/l and the dose of interferon-a was augmented, 3 MU every day, until delivery. Foetal growth and placental circulation were monitored by serial ultrasonography. At the end of 34 weeks of pregnancy, it was noted that placental flow became insufficient, and after foetal lung maturity was stimulated with dexamethasone, Cesarean section was performed. Male baby was born, weighting 2000 g, with respiratory distress syndrome. This complication was successfully treated, and the child is now one year old, with normal growth and development. The mother is still on therapy with interferon-a, 3 MU, three times a week, and the last blood count was as follows: haemoglobin 10.7 g/dl, WBC 6.1 x 10(9)/L and platelet comt 437 x 10(9)/L. In conclusion, according to the clinical results of interferon-d in thrombocytosis and experimental studies which showed the absence of placental transfer of interferon-d, this therapy could be recommended to women with primary myelofibrosis who wish to have a baby.