Effectiveness of oral etoposide in recurrent or refractory epithelial ovarian cancer, primary peritoneal cancer and fallopian tube cancer.

The aim of treatment in recurrent or refractory epithelial ovarian cancer is palliation. In a patient with platinum-resistant status, several chemotherapy regimens have been reported with similar response rates. Among these agents, the oral etoposide holds an advantage of the route of administration and management in the out-patient setting. This retrospective study was conducted to evaluate the effectiveness of oral etoposide. Data of patients with recurrent or refractory epithelial ovarian, primary peritoneal and fallopian tube cancer who received oral etoposide treatment in Ramathibodi Hospital, Mahidol University from January 1997 to December 2017 were collected. Progression-free survival (PFS) and overall survival (OS) were primary and secondary outcomes, respectively. The oral etoposide at a dose of 50 mg/m2 was prescribed. Sixty-six records were analysed. Median OS and median PFS were 8.3 months (95% confidence interval (CI): 6.8, 10.4) and 3.1 months (95%CI: 2.3, 3.9), respectively. Other factors including age, body mass index (BMI), histopathology subtype, primary treatment, result of the primary surgery, platinum status, site and size of recurrent cancer, treatment after discontinuation of oral etoposide and the line of chemotherapy regimen were not associated with the prognosis. The initial cancer stage was the only independent poor prognostic factor. The main toxicity was neutropenia. Impact StatementWhat is already known on this subject? After the recurrence of epithelial ovarian cancer, peritoneal cancer or fallopian tube cancer, the aim of treatment in this setting is palliation with accentuating on symptomatic control and enhancing the quality of life. According to previous clinical trials, the chemotherapy regimens which were considered as a second-line or beyond the second-line therapy have been reported with similar response rates. Among these agents, the oral etoposide could be administrated by oral route. There were several articles reported the effectiveness of oral etoposide in different dosage.What do the results of this study add? This study adds that administration of oral etoposide at a dose of 50 mg/m2 showed fairish oncologic outcomes with manageable toxicity.What are the implications of these findings for clinical practice and/or further research? The results will provide evidence that the oral etoposide can be considerate as a choice of palliative chemotherapy because of an advantage of the route of administration and management in the out-patient setting.

Preoperative clinical characteristics between uterine sarcoma and leiomyoma in patients with uterine mass, a case-control study.

OBJECTIVES: To determine the preoperative clinical characteristics associated with uterine sarcoma in patients with uterine mass. STUDY DESIGN: We retrospectively reviewed medical records of patients who presented with uterine mass undergoing surgery at Ramathibodi Hospital, with a pathologically confirmed diagnosis, from April 1, 2000 to October 31, 2019. The cases are patients with uterine sarcoma, whereas the controls are patients with leiomyoma diagnosed in the same year, with a proportion of 1 case per 4 controls. The association between preoperative clinical characteristics and uterine sarcoma were analyzed. RESULTS: There were 18,218 patients with uterine mass undergoing surgery at Ramathibodi Hospital during the study period. Uterine sarcoma was diagnosed in 68 patients. Thus, the incidence of uterine sarcoma was 0.37%. Following multivariate regression analysis, the following factors seemed to be independently associated with increased risk of uterine sarcoma. Patients with uterine mass, age ≥ 40 years old, postmenopause, postmenopausal bleeding, abnormal uterine bleeding, palpable mass, recognition of rapid growing mass, and with single uterine mass identified by ultrasonography were more likely to be diagnosed with uterine sarcoma with adjusted odds ratio (95% confidence interval) of 3.30 (1.29-8.43), 8.57 (2.38-30.82), 35.35 (2.94-425.13), 3.39 (1.40-8.23), 4.50 (1.78-11.36), 6.91 (2.08-22.91) and 4.70 (1.91-11.60), respectively. CONCLUSIONS: Clinical characteristics, ie, age ≥ 40 years old, postmenopause, postmenopausal bleeding, abnormal uterine bleeding, palpable mass, mass with rapid growth, or single uterine nodule identified by ultrasonography were considered the independently strong association with uterine sarcoma in women who presented with uterine mass.

Limited Impact of Music Therapy on Patient Anxiety with the Large Loop Excision of Transformation Zone Procedure - a Randomized Controlled Trial.

BACKGROUND: Many studies have pointed to strategies to cope with patient anxiety in colposcopy. Evidence shows that patients experienced considerable distress with the large loop excision of transformation zone (LLETZ) procedure and suitable interventions should be introduced to reduce anxiety. This study aimed to investigate the effects of music therapy in patients undergoing LLETZ. MATERIALS AND METHODS: A randomized controlled trial was conducted with patients undergoing LLETZ performed under local anesthesia in an out patient setting at Ramathibodi Hospital, Bangkok, Thailand, from February 2015 to January 2016. After informed consent and demographic data were obtained, we assessed the anxiety level using State Anxiety Inventory pre and post procedures. Music group patients listened to classical songs through headphones, while the control group received the standard care. Pain score was evaluated with a visual analog scale (VAS). Statistical analysis was conducted using Pearson Chi-square, Fisher's Exact test and T-Test and p-values less than 0.05 were considered statistically significant. RESULTS: A total of 73 patients were enrolled and randomized, resulting in 36 women in the music group and 37 women in the non-music control group. The preoperative mean anxiety score was higher in the music group (46.8 VS 45.8 points). The postoperative mean anxiety scores in the music and the non-music groups were 38.7 and 41.3 points, respectively. VAS was lower in music group (2.55 VS 3.33). The percent change of anxiety was greater in the music group, although there was no significant difference between two groups. CONCLUSIONS: Music therapy did not significantly reduce anxiety in patients undergoing the LLETZ procedure. However, different interventions should be developed to ease the patients' apprehension during this procedure.