[Ovulation induction therapy and malignant ovarian cancer]

In the authors' institute 1097 patients received treatment for ovarian cancer between the 1st of January, 1960 and the 31st of December, 1997. 92 of them had malignant granulosa cell tumor. In this study the link between ovulation induction therapy and ovarian cancer was analyzed with retrospective questionnaire. 236 questionnaires were shared out among patients with malignant ovarian tumor, who were treated between 1990 and 1997. 7 of 113 patients, who gave correct answers to the questions (6.2%) received ovulation induction therapy. Epithelial ovarian cancer developed in 2 of the cases during, and in 5 cases just 6-16 years after the clomiphene-citrate treatment. None of the 45 patients with granulosa cell tumors received induction therapy. The number of patients admitted because of malignant ovarian tumor before and after the induction therapy was also compared. There was no significant increase in the occurrence of the malignancy. Since 1986 in the in vitro fertilization program of the clinic nearly 1,500 patients were treated with effected ovulation induction drugs causing superovulation. The authors don't know of any development of malignant ovarian tumor, and 732 woman have confirmed this fact. The number of patients deceased in consequence of ovarian cancer in different age groups, and the distribution of the women population in every age group in Hungary, from the year of 1979 was also analyzed. There was no significant increase found in the number of deceased among the studied age groups, moreover a significant decrease among them could be observed. The link between ovulation induction therapy and ovarian cancer can neither be strengthen, nor deny by the result of the study, however the close relationship which seemed to be logical can be queried. To give an exact answer for the question a vast, long-term, prospective of retrospective follow-up case-control study is needed.

[Therapeutic results in patients with malignant granulosa cell tumors at the Gynecologic Clinic of the city of Pécs]

In the Department of Obstetrics and Gynecology, University Medical School of Pecs, Hungary 92 patients had been treated with malignant human granulosa cell tumor between 1960-1997. The youngest patient was 14 years old, the oldest 77. The average age was 52.5 years. The disease occurred mostly in 50-60 year old women, and most of them have never given birth before. In 64 cases (69%) metrorrhagia and low abdominal pain were the leading symptoms. 61% of cases the disease was diagnosed in the 1st stage, 14% in the 2nd, 18.5% in the 3rd, and 6.5% in the 4th stage. According to the endometrial histologic examination, data of increased estradiol production was found in 75% of the patients. Along with granulosa cell tumor breast cancer occurred in 2 cases, endometrial carcinoma was diagnosed in 4 cases, and atypical endometrial hyperplasia in 6 cases. After the operation 67 patients received radiation therapy, 5 chemotherapy and 16 combined radiation and chemotherapy. The 2 year survival rate of the 87 patients treated between 1960-1994 was 87.4% the 5 year survival rate was 64.4%. In the stage 1 had 92.4% of patients lived 2 years tumor free, 83.0% lived 5 years without recurrence of tumor. The cleaned 5 year survival rate was found in 88%. With the survey of the youngest patient's case the authors pointed out the highly malignant, rapid course, and the changing of the sera hormones during the therapy.

[Quality assurance, audit and quality control of radiotherapy at radiology departments in Hungary]

The first quality assurance, audit and control system in the Hungarian "'health" care industry" is described for the medical specialty of radiotherapy. The prerequisites of the elaboration of the programme were an exact knowledge of the current Hungarian infrastructural and staffing conditions, and the radiotherapeutic activities. The recommendations cover the 5 medical universities including the national institute (the Debrecen, Pécs, Semmelweis, Szent-Györgyk Albert Medical Universities, and Haynal Imre University of Health Sciences) and the 5 regional oncological centres in hospitals (Jósa András, Markusovszky, Petz Aladár, Szentpéteri kapu and Uzsoki Hospitals). The departmental functions (patient care, teaching-education, research work and scientific organizing activity) and the structure (organization, infrastructure, staffing conditions, etc.) are described first, followed by the therapeutic principles and clinical process (patient referral and selection, decision-making, priorities in therapy initiation, treatment preparation and execution, etc.). The informal daily/weekly quality assurance programme long applied in the routine patient care has been formalized and supplemented with a weekly audit conference. In the course of the medical audit, all relevant clinical data are reviewed and scored by an internal or an external expert (not participating directly in the treatment process), e.g. for the adequacy of the medical decision preparative process, conformation to the institutional treatment protocol, equipment selection, treatment planning, simulation and portal film, etc. If a major deviation is detected, an immediate correction is initiated; minor deviations need analysis and then preventive and correcting action. As concern the audit of the other activities of the departments, the important indicators and their minimally desirable level are defined. The final goal of the implementation of this programme is high-precision radiotherapy with the best achievable treatment result.

[Treatment of patients with advanced ovarian cancer at the Gynecological Clinic of Pécs Medical University]

Treatment protocols for advanced ovarian tumors (stages III-IV), applied at the author's institute, are presented. Giving a short survey the outcome with single agent cyclophosphamide therapy (C; n = 82), combinations without cisplatin (CMV, CAV; n = 83) or combination with cisplatin (CAP; n = 41) has been compared. A significant difference between C and CMV/CAV groups could be found only in regards with remission period (p = 0.0004 and 0.0001). By the use of CAP the result became better not only in the extent and the duration of remission but in the survival as well as compared to that of the other groups. The importance of the extent of residual tumor is emphasized. Because of serious side effects of particularly cisplatin based, three drug combinations the use of combinations consisting of two drugs only can be recommended in accordance with literary data. By the estimation of the usefulness of second look operation's findings the radiotherapy with its consolidationary effect and also the significance of a maintaining or a second line cytostatic treatment are pointed out.

[Treatment of cervical cancer using the Wertheim-Latzko radical operation at the Gynecology Clinic of Pécs]

The authors performed 119 Wertheim--Latzko operations from July 1, 1975 to December 31, 1988. 108 patients are still alive. The 5 years survival rate of patients operated on before 1984 was 89.8%. Radical hysterectomy involving careful removal of regional lymphnodes was carried out after lymphography and preoperative irradiation. Postoperative irradiation was made on radiologist's indication. Significance of combined surgical and radiotherapy is emphasised in the management of cervical cancer in stages IB and IIA. Surgery is especially important in adenocarcinomas that are less sensitive to irradiation, in cases of large and necrotic tumors with the barrel formation of endocervical cavity and in cases not showing appropriate regression after radiotherapy. Surgical tumor removal appears to be of much value in young patients, in cases of anaplastic tumors in suspicious lymphographic findings, and in those patients, whose recovery may be expected only from operation and supplementary radiotherapy. Very important condition for obtaining good recovery results and low rate of surgical complications are the team of experienced surgeons and organized regional centres for radical hysterectomies.

Herpes simplex virus-specific antigens in exfoliated cervical cells from women with and without cervical anaplasia

By the indirect immunofluorescence technique the presence of herpes simplex virus-specific antigens was investigated in cervical cells of 530 women with normal cervical epithelium, 175 with bland disorders, 52 with dysplasias, and 38 with invasive cervical carcinomas of the uterine cervix. Antigens were present in 9% of samples from women with normal cervical epithelium; they were present in 41% of the samples from women with bland disorders, 61% of those from dysplasia patients, and 94% of those from invasive carcinoma patients. The testing of 3 consecutive imprints of 68 antigen-positive and 232 antigen-negative women at 6-month intervals revealed that, in cervical cells, herpesvirus-specific antigens persisted throughout the 1-year period of the follow-up.