Hyperthermic intrathoracic chemotherapy with cisplatin for ovarian cancer with pleural metastasis

Intrathoracic metastasis of ovarian cancer has poor prognosis regardless of treatment modality. Recent development of surgical techniques and the new concept of direct infusion of chemotherapeutic agents with hyperthermia could help with the treatment of disseminated diseases in ovarian cancer. Using video-assisted thoracoscopic surgery and intracavitary chemotherapy with hyperthermia, we tried hyperthermic intrathoracic chemotherapy for a case of stage IV high-grade serous ovarian cancer with pleural metastasis. There was no high-grade complication related to the procedure. The patient is alive without disease at 32 months after initial treatment.

Single-port laparoscopic transperitoneal infrarenal para-aortic lymphadenectomy as part of staging operation for early ovarian cancer and high grade endometrial cancer / 부인종양

OBJECTIVE: The aim of this paper was to demonstrate the techiniqes of single-port laparoscopic transperitoneal infrarenal paraaortic lymphadenectomy as part of surgical staging procedure in case of early ovarian cancer and high grade endometrial cancer. METHODS: After left upper traction of rectosigmoid, a peritoneal incision was made caudad to inferior mesenteric artery. Rectosigmoid was mobilized, and then the avascular space of the lateral rectal portion was found by using upward traction of rectosigmoid mesentery. Inframesenteric nodes were removed without injury to the ureter and the left common iliac nodes were easily removed due to the upward traction of the rectosigmoid. The superior hypogastric plexus was found overlying the aorta and sacral promontory, and presacral nodes were removed at subaortic area. Peritoneal traction suture to right abdomen was needed for right para-aortic lymphadenectomy. After right lower para-aortic node dissection, operator was situated between the patient's legs. After upper traction of the small bowel, left upper para-aortic nodes were removed. To prevent chylous ascites, we used hemolock or Ligasure application (ValleyLab Inc.) to upper part of infrarenal and aortocaval nodes. RESULTS: Single-port laparoscopic transperitoneal infrarenal para-aortic lymphadenectomy was performed without serious perioperative complications. CONCLUSION: Even though the technique of single-port surgery is still a difficult operation, the quality of single-port laparoscopic transperitoneal infrarenal para-aortic node dissection is excellent, especially mean number of para-aortic nodes. In cases of staging procedures for ovary and endometrial cancer, single-port transperitoneal para-aortic lymphadenectomy is acceptable as an oncologic procedure.

YS knot: A new technique for a tension-controlled slip knot using a trocar

The Yoon Soon (YS) knot is a laparoscopic extracorporeal slip knot that is easy to learn and apply. Our new technique, which uses the trocar as a knot pusher, is simpler, faster, and has more tension than conventional knot methods. The YS knot will help surgeons save operative time and perform tension-controlled knot-tying during laparoscopic surgery.

Is there any clinical significance of compression of left common iliac vein? / 부인종양

No abstract available.

Survival benefit of laparoscopic surgical staging-guided radiation therapy in locally advanced cervical cancer / 부인종양

OBJECTIVE: This study was designed to evaluate the survival benefit of laparoscopic surgical staging (LSS)-guided tailored radiation therapy (RT) in locally advanced cervical cancer (LACC). METHODS: We retrospectively reviewed 89 LACC patients' medical records who primarily received non-surgical treatment, of which pretreatment LSS was performed in 20 (LSS group) and primary chemoradiation therapy (CCRT) without LSS (CCRT group) was carried out in 69 from January 2000 to January 2006. We analyzed clinical characteristics, pretreatment imaging study results and survival outcomes including disease free survival (DFS) and overall survival (OS) to compare them between the two groups. RESULTS: There were as many as eight cases (40%) of LSS related complications. The mean time interval between LSS and RT or CCRT was 26.6 days (+/-18.8 days). Six out of twenty (30%) in LSS group and 10 out of 69 (14.5%) in CCRT group received extended field RT when paraaortic lymph nodes (LNs) were positive based on the pathologic findings after LSS and the results of imaging studies, respectively. Three-year DFS and OS were both better in 33 imaging-negative CCRT group patients than those in 4 imaging-negative/pathology-positive (false negative) patients after LSS (3-year DFS, 50% vs. 87%, p=0.022; 3-year OS, 50% vs. 84%, p=0.033). The 5-year DFS rates were 52% and 55% in LSS group and in CCRT group, respectively (p=0.28). The 5-year OS rates were 68% in LSS group and 62% in CCRT group without significant difference between the two groups (p=0.79). CONCLUSION: We found that LSS-based RT tailoring did not show survival benefit in LACC despite inaccuracy of imaging-based RT tailoring. Further studies are required to find new method to overcome this inaccuracy and improve survival outcomes.

Asian society of gynecologic oncology workshop 2010 / 부인종양

This workshop was held on July 31-August 1, 2010 and was organized to promote the academic environment and to enhance the communication among Asian countries prior to the 2nd biennial meeting of Australian Society of Gynaecologic Oncologists (ASGO), which will be held on November 3-5, 2011. We summarized the whole contents presented at the workshop. Regarding cervical cancer screening in Asia, particularly in low resource settings, and an update on human papillomavirus (HPV) vaccination was described for prevention and radical surgery overview, fertility sparing and less radical surgery, nerve sparing radical surgery and primary chemoradiotherapy in locally advanced cervical cancer, were discussed for management. As to surgical techniques, nerve sparing radical hysterectomy, optimal staging in early ovarian cancer, laparoscopic radical hysterectomy, one-port surgery and robotic surgery were introduced. After three topics of endometrial cancer, laparoscopic surgery versus open surgery, role of lymphadenectomy and fertility sparing treatment, there was a special additional time for clinical trials in Asia. Finally, chemotherapy including neo-adjuvant chemotherapy, optimal surgical management, and the basis of targeted therapy in ovarian cancer were presented.

Pregnancy outcomes of IgA nephropathy / 대한산부인과학회지

OBJECTIVE: We performed this study to evaluate maternal and fetal outcomes of pregnancies with IgA nephropathy. METHODS: We reviewed 20 pregnancies occurred in 14 women who were diagnosed as IgA nephropathy with the method of renal biopsy between 1997 and 2006. We used clinical and laboratory data from medical records and statistic analysis using SPSS 15.0. RESULTS: Of 20 prenancies, there were 17 live births and 3 spontaneous abortions. There was no stillbirth and congenital anomaly. We found severe preeclampsia in 47%, low birth weight in 53% and preterm birth (comprising medical indications) in 59%. But most were late preterm birth and all were alive. Blood pressure was elevated after delivery compared with pre-pregnancy. CONCLUSION: Although pregnancy is not contraindicated in IgA nephropathy, it is associated with significant complications comprising preeclampsia, preterm birth and low birth weight.

A case of massive serous ascites following radical hysterectomy with bilateral pelvic lymphadenectomy for cervical adenocarcinoma stage IB2 / 부인종양

Ascites following radical hysterectomy with retroperitoneal lymphadenectomy for invasive cervical cancer has been reported previously. Most of these reports described chylous ascites. The chylous ascitic fluid is milky; further, chylous ascites leads to nutritional problems. Authors present the case of a patient who developed serous ascites following radical hysterectomy with bilateral pelvic lymphadenectomy. The amount of ascites was approximately 18,000 ml over 52 days. The patient had no nutritional problems or complications. Although the etiology could not be determined, Authors surmise that the ascites may have been due to massive drainage from injured lymphatic channels below the cisterna chyli. Authors could not found any literatures which described massive serous ascites following surgery in gynecologic malignancy and reports this case with review of literatures.

The prevalence of endometriosis in cases of total hysterectomy / 대한산부인과학회지

OBJECTIVE: We investigated whether surgical methods, age, parity and obesity were correlated to endometriosis in patients who had hysterectomy. METHODS: This research was surveyed and reviewed of patients who underwent total abdominal hysterectomy, laparoscopic hysterectomy and vaginal hysterectomy in Kyungpook National University Hospital from 1999 to 2006, based on clinical recordings and pathologic reports. Based on these data, we investigated whether age, parity, obesity and pathologic diagnosis were correlated to prevalence rate of endometriosis. Also we investigated the correlations with anatomic lesion of endometriosis and surgical methods. SPSS version 12.0 chi- square test was conducted as the statistical data. RESULTS: The total 4,830 cases of hysterectomy were undergone. Out of these, endometriosis was found at 125 cases (2.5%). Among them, 76 cases of endometriosis were found at 2,260 cases of abdominal hysterectomy (3.3%). 31 cases of endometriosis were found at 1,589 cases of vaginal hysterectomy (1.95%), and 18 cases of endometriosis were found at 981 cases of laparoscopic hysterectomy (1.83%). The correlation with laparoscopic hysterectomy and endometriosis had the statistically significant high rate (P0.05). CONCLUSION: Even the prevalence of endometriosis was low (2.5%) in total cases of hysterectomy, laparoscopic hysterectomy had more prevalence rate of endometriosis than other types of hysterectomy. because suspicious lesions were inspected carefully, Magnified laparoscopic view make us to identify suspicious endometriotic lesion more clearly than other type of hysterectomy.

Trocar-site metastasis after laparoscopic gynecologic oncologic surgery / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the incidence of abdominal-wall tumor implantation after laparoscopic procedure in patients with gynecologic malignancies. METHODS: The records of 184 patients who had a laparoscopic operations or laparotomy after laparoscopic diagnostic procedures from Aug. 1994 to Aug. 2003 in our hospital were reviewed. The presence of metastasis at trocar site of laparoscopic surgery and incision site of laparotomy was examined. RESULTS: Abdominal-wall tumor implantations were developed at two port site in one patient. This result showed an incidence of 0.24% (2/819), as 2 ones in 819 abdominal trocar sites and 0.5% (1/184), as 1 in 184 procedures. This patient had a FIGO stage III a, grade2 adenocarcinoma of endometrium and underwent laparoscopic modified radical hysterectomy with both pelvic lymphadenectomy. In addition, tumor implantation was occurred at laparotomy skin incision site in one patient, a incidence of 2.2% (1/45), as 1 in 45 laparotomy procedures. This patient had a stage II, squamous cell carcinoma of the vagina, who had received second courses of Ifosfamide-Cisplantin neoadjuvant chemotherapy and open laparotomy with radical hysterectomy with upper vaginectomy was followed by laparoscopic pelvic lymphadenectomy due to fixed grossly metastatic nodes. CONCLUSION: Recently, the use of laparoscopic procedure in oncology was increased, the new complication such as abdominal-wall implantation at trocar site was introduced. The abdominal-wall implantation at trocar site could be prevented by patients selection, intraperitoneal and port-site lavage, surgical modification. And all patients should have careful follow up with special attention to the trocar sites. Port site implantation was rare, but could be occurred in the incidence of 0.5% per procedure.

Expression of c-Met in ovarian epithelial tumor / 부인종양

OBJECTIVE: This study was performed to evaluate the expression of c-Met in epithelial ovarian carcinoma. METHODS: Paraffin-embedded tissues from 50 epithelial ovarian adenocarcinomas were stained immunohistochemically for c-Met expression. The expression of c-Met was correlated with clinicopathologic parameters including, histologic type, tumor size, and tumor stage. RESULTS: c-Met expression was found in 29 cases (58%) among 50 ovarian cancers. In clinicopathologic study, c-Met expression of epithelial ovarian carcinomas did not show the correlation with clinicopathologic parameters such as histologic type, tumor size and stage. CONCLUSION: c-Met expression might be a potential prognostic marker for patients with advanced stage epithelial ovarian cancers. However, larger population-based studies should be performed to determine the prognostic potential of c-Met expression in advanced ovarian carcinoma.

A differential gene expression profiles by cDNA microarrays in endometrioid endometrial carcinoma: a preliminary study / 부인종양

OBJECTIVE: Endometrial carcinoma is the most common gynecological malignant disease in industrialized countries. However, the molecular bases for endometrial tumoriogenesis are not clearly elucidated. Our hypothesis is that there may be some difference in gene expression patterns between normal endometrium and endometrial cancer lesion. In this study, we analyzed the difference of gene expression profile with cDNA microarray. METHODS: Normal endometrial tissues and cancer lesions were gathered from three patient with endometrioid endometrial cancer. cDNA microarray technique (KNU 4.8K chip) was applied to screen the different gene expression profiles. RESULTS: Many genes such as interleukin-1 receptor-associated kinase 1 (IRAK1), bifunctional apoptosis regulator (BFAR), paraneoplastic antigen MA2 (PNMA2), zinc finger protein 257 (ZNF257), ras homolog gene family, member F (in filopodia) (ARHF), cell division cycle 27 (CDC27) were over-expressed in the endometrial cancer tissue. The genes were down-regulated in the endometrial cancer samples included fibronectin 1 (FN1), meiotic checkpoint regulator (MCPR), transforming growth factor beta-stimulated protein TSC-22 (TSC22), programmed cell death 4 (neoplastic transformation inhibitor) (PDCD4), transcript variant 2, matrix metalloproteinase 2 (MMP2), insulin-like growth factor binding protein 4 (IGFBP4), retinoblastoma binding protein 7 (RBBP7), insulin-like growth factor binding protein 3 (IGFBP3), downregulated in ovarian cancer 1 (DOC1). CONCLUSION: The result of this analysis supports the hypothesis that the endometrial cancer tissue has distinct gene expression profile from normal endometium. But, the vaildation of gene expression with RT-PCR and the further study are needed.

PTEN expression and single nucleotide polymorphisms in epithelial tumors of the ovary / 부인종양

OBJECTIVE: Phosphate and tensin homolog deleted on chromosome 10 (PTEN) is a potent tumor suppressor gene, localized to chromosome 10q23, and shows extensive homology with auxilin and tension. PTEN has variety roles involved in cell proliferation, invasion, and migration in tumorigenesis of solid tumors. In this study, the expression of the PTEN in the ovarian epithelial tumors, including benign, borderline malignancy, and adenocarcinomas was investigated. METHODS: Immunohistochemical expression of PTEN were analyzed in formalin fixed tumor tissues of 20 benign cystadenomas, 22 borderline tumors, and 49 malignant ovarian cancer. In the same tissue extracts, single nucleotide polymorphism were studied. RESULTS: Most of benign and borderline ovarian tumors revealed strong positive reaction, but a few cases showed negative reaction or weak positive reaction. In adenocarcinomas, 33% of cases was negative, and 43% was focal weakly staining, grade 1. The remainder of adenocarcinomas showed strong nuclear staining. In SNP assay, A/A allele of rs1234213 shows low frequency, but A/G allele reveals high frequency. C/C allele of rs701848 shows high frequency, and rs9651492 is not detected polymorphism. CONCLUSION: These results suggest that loss of PTEN expression is associated with tumorrigenesis of ovarian epithelial tumors, and is related with single nucleotide polymorphism.

A case of severe hydronephrosis due to ureteral stricture from endometriosis / 대한산부인과학회지

Endometriosis is a relatively common disease, affecting 5-10% of women of reproductive age. But, endometriosis affecting the urinary tract is very rare entity. Involvement of urinary tract by endometriosis occurs in about 1% of women with pelvic endometriosis. Ureteral endometriosis is mostly asymptomatic for a long time, and associated with nonspecific symptoms at clinical presentation and difficult preoperative diagnosis. The involvement of the ureter is rarely intrinsic by implantation of endometrial tissue in the wall of the ureter, but rather due to external compression by adjacent endometriosis and its attendant inflammation and fibrosis. We have experienced a case of right severe hydroureteronephrosis due to ureteral stricture from endometriosis. Laparoscopic nephrectomy was done due to renal atrophy. At the same time, laparoscopic total hysterectomy with right salpingo-oophorectomy was performed because of the uterine adenomyosis and right ovarian endometrioma. So, we report that with a brief review of literatures.

A Case of Leiomyomatosis Peritonealis Disseminata / 대한산부인과학회지

Leiomyomatosis peritonealis disseminata (LPD) is a rare condition characterized by multiple subperitoneal nodules of benign smooth muscle. Wilson and Peale were the first to describe the multiple peritoneal leiomyomas, while Taubert et al. clearly delineated the features of the lesion and named it LPD. Approximately 100 cases of this disease have been reported in the world literature. High levels of exogenous and endogenous female gonadal steroids is associated with LPD, it suggests that estrogen and progesterone play important role in the pathogenesis of LPD. We report a case of leiomyomatosis peritonealis disseminata with review of literature.

Genetic Alteration of p16INKA4A Promoter Region in Endometrial Carcinoma / 부인종양

OBJECTIVE: This study was performed to evaluate the status of p16 tumor suppressor gene in 25 endometrial carcinomas (ECs) and to correlate the loss of heterozygosity (LOH) at p16 locus, the presence of inactivating mutations, the methylation status of the promotor, and the expression of p16 protein with clinicopathological parameters. METHODS: Methylation-specific PCR (MSP) distinguishes unmethylated from methylated alleles in a given gene on sequence changes produced after bisulfite treatment of DNA. Allelic losses were determined at two polymorphic dinucleotide repeat microsatellite markers of the p16 gene on chromosome 9p21 that included D9S974 and D9S1748 at CDKN2A. Mutations were analyzed by exons 1 and 2 of p16 PCR-SSCP. Immunohistochemical staining for p16 protein was performed. The associations between genetic alterations of the p16 and the clinicopathological parameters of ECs were evaluated by chi-squared or Fisher's extraction tests. RESULTS: The median age of the 25 cases was 52 years, ranging from 32 to 72. The median tumor size was 3.6 cm, ranging from 0.8 to 9.5 cm. Histologically, the ECs were 21 endometrioid, 2 adenosquamous, 1 secretory and 1 papillary serous types. Nine cases of p16 protein staining were negative or minimal positive in 25 ECs (36%). Allelic losses were found in 6 loci (66.7%) of 5 ECs without p16 protein expression (Fisher's extraction test, p=0.0029), In this study, only 2 of 25 ECs (8%) disclosed mutations. Non-endometrioid (secretory and adenosquamous) carcinomas showed more frequent mutation and methylation than endometrioid carcinomas (p=0.043) and high grades (G3, p=0.018) showed more frequent mutation and methylation than low grade ECs. CONCLUSION: This study suggests that methylation of p16 promoter region seems not to be common (only 9.5% in our present series) and not to be associated with loss of nuclear p16 protein expression. Loss of p16 protein indicates a higher frequency of LOH, which contributes to the development of high grade or aggressive ECs. The mechanism of p16 inactivation is not clear, so other genetic or nongenetic mechanisms for inactivation should be further studied.

In Vitro Interaction of Taxol with Other Antitumor Drugs in the Established Choriocarcinoma Cell Lines / 대한산부인과학회잡지

OBJECTIVE: Taxol (Bristol-Myers Squibb)(paclitaxel) has been shown to be a potent inhibitor of cell growth for a variety of tumors. The aim of this study was to evaluate the interaction of five different combinations of drugs: taxol and cisplatin, topotecan, actinomycin D, methotrexate, and etoposide in two established choriocarcinoma cancer cell lines to identify potential synergistic combinations of chemotherapy for patients with choriocarcinoma. METHODS: Six antitumor drugs were tested for synergism and antagonism in combination studies using human choriocarcinoma cell lines, JAR and BeWo. Cytotoxic effects were determined by 3-(4,5- dimethylthiazol-2-ly)-2,5-diphenyl-tetrazolium bromide (MTT) assay. Synergic interactions were determined by the median effect principle in which Combination lndex (CI) of less than one suggest a synergic interaction. RESULTS: Proliferation of JAR and BeWo cells was inhibited by taxol and 2.7 to 86 nmol/L was needed to achieve 50% growth reduction. Combination effect of taxol/cisplatin (fixed ratio of 8 nM: 0.8 ug and 333 nM: 0.8 ug) and taxol/actinomycin-D (fixed ratio of 8 nM: 0.17 nM and 300 nM: 0.003 nM) in JAR and BeWo cell lines showed a synergistic effect at the intermediate and high level of cytotoxicity in both cell lines. Combination effect of taxol/topotecan at all fixed ratio of 8 nM: 1.7 ug showed a synergistic effect at the intermediate and high level of cytotoxicity in JAR cell line. Combination effect of taxol/etoposide at fixed ratio of 8 nM: 0.83 ug and 333 nM: 1.67 ug in JAR and BeWo cell lines showed an antagonistic effect at all level of cytotoxicity in both cell lines. CONCLUSION: These results suggest that taxol is synergistic with cisplatin, actinomycin-D in both cell lines tested and synergistic with topotecan, methotrexate in one cell line. However the most active drug against trophoblastic disease, etoposide, was antagonistic with taxol in both cell lines. Clinical trials using taxol/ cisplatin or taxol/topotecan combination are warranted to determine whether there is a survival advantage in refractory choriocarcinoma or high risk group and a survival can be achieved with taxol in combination with these drugs.

Two Cases of Malignant Melanoma in Vulva / 대한산부인과학회잡지

Vulvar melanomas are account for 4-10% of all malignant tumors of the vulva and are the second most common cause of the vulvar malignancy with the highest frequency in the sixth and seventh decades and rare with incidence of 0.1 to 0.19 per 100,000 women. The most common presentation is a vulvar mass, although pruritis and bleeding also are frequent. In some cases, the melanoma has arisen from a pre-existing benign or atypical pigmented lesion. Vulvar melanomas appear to behavior as other cutaneous melanomas. Both the level of invasion of a malignant melanoma and its thickness have prognostic significance. Vascular space invasion and tumor necrosis also are associated with a poorer prognosis. Recently the radical vulvectomy dose not appear to improve survival when compared to wide local excision with bilateral inguinofemoral lymphadenectomy. We had 2 cases of vulvar melanoma treated with wide local excision and laparoscopic inguinofemoral lymphadenectomy.

Clinical Comparisons of Laparoscopic Assisted Vaginal Hysterectomy and Total Abdominal Hysterectomy in the Huge Uterine Myoma / 대한산부인과학회잡지

OBJECTIVE: This study is to evaluate the effectiveness and the value of laparoscopic assisted vaginal hysterectomy (LAVH) and the possibility of replacing total abdominal hysterectomy (TAH) to LAVH. METHODS: Retrospective study of 25 cases of LAVH and 157 cases of TAH for huge uterine myoma (uterus weight 500 gram) in Dept. of OB/GYN, Kyungpook National University Hospital from Jan. 1998 to May. 2000 was carried out and postoperative results were compared between 2 methods. Statistical analysis was performed using x2 test and Student t-test as appropriate. Statistical significance was defined as p0.05). The mean operating time was 126+/-53 (range 53-240) min vs 109+/-29 (range 60-250) min (p>0.05). The mean weight of uterus was 719+/-389 (range 500-2414) gram vs 791+/-541 (range 500- 4700) gram (p>0.05). The mean of hospital stay was 4.3+/-1.1 (range 3-8) days vs 6.9+/-3.4 (range 4-25) days (p0.05). Postoperative hospital stay was significantly shorter in LAVH than TAH. CONCLUSION: Even though fewer cases have been done, there was no episode of changing the surgery from LAVH to TAH in huge uterine myoma operation. For the more, neither was increase of morbidity compared to TAH. In huge uterine myoma operation, LAVH may replace the role of TAH in limited number of cases we have experienced. The advantages of LAVH are cosmetic superiority and early hospital discharge. In hands of experienced laparoscopic operator, huge uterine myoma is not an absolute contraindication of LAVH.

Effect of Topotecan in Combication with Other Antitumor Drugs in Vitro / 대한부인종양콜포스코피학회잡지

OBJECTIVES: The aims of this study were to evaluate the interaction of topotecan with adriamycin, etoposide, 5 fluorouracil (5 FU) and mitomycin C in the established four ovarian cancer cell lines and three cervical cancer cell lines and to establish whether the combination of topotecan with other antitumor drugs would be a synergism for chemotherapy in patients with ovarian and cervical cancer, METHODS: Five antitumor drugs were tested for synergism and antagonism in combination studies in four ovarian cancer cell lines (A2780, A2780 cisplatin resistant variant, A2780 taxol resistant variant, SKOV3) and three cervical cancer cell lines (HeLa, SiHa, ME180). Cytotoxic effects were determined by MTT assay. Synergic interaction was calculated by the median effect principle in which combination index (CI) of less than one suggest a synergic interaction. RESULTS: Dm value of topotecan against SKOV3 (2.07 ug/ml), HeLa (3.32 ug/ml), SiHa cell lines (2.5 ug/ml) were above peak plasma concentration of topotecan (0.5 ug/ml) but most antitumor drugs tested in combinations index were within clinically relevant range. Combination with topotecan showed a synergic effect (CI<1) in seven cancer cell lines at a intermediate or high level of cytotoxicity especially with mitomycin C (6/7), etoposide (6/7), 5 FU (6/7) and adriamycin (4/7). Most striking findings were that a synergic effect was shown in all ovarian cancer cell lines to topotecan/mitomycin C, topotecan/5 FU and topotecan/esoposide combination showed a synergic effect in all cervical cancer cell lines. Topotecan/adriamycin combination showed synergism at an intermediate or high level of cytotoxicity in cisplatin or Taxol resistant ovarian cancer cell lines (A2780CP, A2780TX, SKOV3). CONCLUSION: These results suggested that topotecan showed a synergic effect with a wide range of antitumor drugs: adriamycin, etoposide, 5 FU, mitomycin C in ovarian and cervical cancer cell lines. Combinations of topotecan/mitomycin C, topotecan/5 FU and topotecan/adriamycin for ovarian cancer and a combination of topotecan/etoposide for cervical cancer seemed worthy of consideration for clinical application.