Major causes of impractical brachytherapy in elderly patients with uterine cervical cancer.

AIM: Incomplete brachytherapy is a major risk factor for recurrence. However, high-dose-rate intracavitary brachytherapy has not been assessed adequately in elderly patients with invasive cervical cancer. The present study investigated the clinical importance of intracavitary brachytherapy and risk factors of incomplete intracavitary brachytherapy in elderly patients with cervical cancer. MATERIAL AND METHODS: Subjects were 76 patients aged 70-89 years old with invasive cervical cancer. All subjects were recruited between January 1997 and September 2010, and were planning to receive external beam radiation therapy followed by high-dose-rate intracavitary brachytherapy. Survival rates and the incidence of complications were compared between the 70s and 80s age groups. Risk factors for recurrence in elderly patients were evaluated using multivariate analysis, and risk factors for impractical intracavitary brachytherapy were also estimated. RESULTS: No significant differences were observed in 3-year progression-free survival rates or the incidence of complications in the two age groups. Cox multivariate analysis showed that histology (non-squamous cell carcinoma), incomplete intracavitary brachytherapy, and lymph node swelling were significant prognostic factors for recurrence. Impractical application was the major reason for incomplete treatment. Multiple logistic regression analysis revealed that a previous history without vaginal births (P = 0.016) was an independent risk factor for the impractical application, independent of tumor diameter ≥ 4 cm (P = 0.007). CONCLUSIONS: Incomplete intracavitary brachytherapy decreased the survival rates of elderly patients. Larger tumors and patients without a history of vaginal births were the two major causes of impractical intracavitary brachytherapy, which may be fatal, especially in elderly patients with bulky tumors.

Relative contribution of weight-bearing and non-weight-bearing effect of adipose tissue to bone mineral density in postmenopausal women.

AIM: To investigate the relative contributions of weight-bearing and non-weight-bearing effects of adipose tissue to bone mineral density (BMD) in postmenopausal women. MATERIAL AND METHODS: The subjects were 228 postmenopausal women aged 50-75 years. Age, years since menopause (YSM), height, body weight, and body mass index were recorded. Trunk fat mass, body fat mass, bilateral leg BMD and lean (muscle) mass were measured by whole body scanning with dual-energy X-ray absorptiometry. The relationships of BMD to trunk and body fat mass were investigated using uni- and multivariable analyses. RESULTS: The amount of trunk fat mass and body fat mass were 8.7 ± 3.6 kg and 19.0 ± 5.9 kg, respectively. On Pearson's correlation test, right leg BMD was positively correlated with trunk fat mass (r=0.268, P<0.001) and body fat mass (0.299, P<0.001). On multiple linear regression analysis, trunk fat mass (t-value = 3.500, P<0.001), age (-2.431, P<0.05), and YSM (-2.564, P<0.01) were independent significant predictors of right leg BMD. However, body fat mass was not a predictor of BMD (-0.465, P=0.642). These relationships remained significant after further adjusting for right leg muscle mass. CONCLUSION: Trunk fat mass rather than body fat mass is a significant predictor of leg BMD at the most weight-bearing site, despite being less than half the amount of body fat mass. Thus, adipose tissue contributes more to BMD through non-weight-bearing effect rather than weight-bearing effect.

Difference in non-weight-bearing effects on bone mineral density between trunk and peripheral fat mass in women with polycystic ovary syndrome.

AIM: To investigate the difference in non-weight-bearing effects on bone mineral density (BMD) between trunk and peripheral fat mass in women with polycystic ovary syndrome (PCOS). METHODS: Subjects were 123 amenorrheic PCOS women with right side dominance. Age, height, body weight, and body mass index were recorded. Trunk, peripheral (extremities), trunk-leg fat ratio as an index of body fat distribution, left arm (non-weight-bearing site) lean mass and BMD were measured by dual-energy X-ray absorptiometry. Serum testosterone and estradiol levels were measured. Relationships of BMD with trunk, peripheral fat mass, and sex hormones levels were investigated. RESULTS: Trunk fat mass amount was 9.8 + or - 6.7 kg and was lower than the peripheral fat mass amount (12.2 + or - 4.4 kg, P < 0.01). On Pearson's correlation test, trunk fat mass and left arm lean mass were positively correlated with arm BMD (r = 0.359, P < 0.001 and r = 0.501, P < 0.0001, respectively), while peripheral fat mass and serum testosterone levels were not correlated with BMD (r = 0.083 and 0.114, respectively, NS). On multiple regression analysis, trunk fat mass was positively correlated with BMD (t-value = 3.465; P < 0.001), independent of age and height. However, this relationship disappeared after additionally adjusting for left arm lean mass. CONCLUSION: Trunk fat mass, despite the smaller amount, is more associated with arm BMD than peripheral fat mass is through its non-weight-bearing effects.

New hemostatic method using Mohs' paste for fatal genital bleeding in advanced cervical cancer.

► Mohs' paste is made of a mixture of zinc chloride paste. ► Recent reports show that hemostasis could be achieved in various kinds of cancer. ► Mohs' paste can save a patient's life from fatal genital bleeding.

Clinical usefulness of Mohs' paste for genital bleeding from the uterine cervix or vaginal stump in gynecologic cancer.

BACKGROUND: Atypical genital bleeding due to gynecologic cancer not only impairs patients' quality of life (QOL), but also becomes a major causative factor of death. We report the clinical usefulness of Mohs' paste for genital bleeding from the uterine cervix or vaginal stump in patients with recurrent gynecologic cancer. METHOD AND RESULTS: Eight patients with gynecologic cancer were enrolled between January 2010 and March 2012. Mohs' paste was directly applied to the bleeding tumor. In patients with recurrent genital bleeding after the application of Mohs' paste, the technique was repeated. The effect of this procedure continued for 4 days to 1 year. The effect of Mohs' paste continued for 3 months or more in three patients. None of the eight patients have died of genital bleeding. CONCLUSIONS: The use of Mohs' paste is safe and convenient for massive genital bleeding from the uterine cervix or vaginal stump due to recurrent gynecologic cancer. However, our study does have some limitations including the small number of enrolled subjects and heterogeneous cancer types.

Giant ovarian cancer weighing 100 kg with poor prognosis.

We encountered a patient with giant ovarian cancer with a tumor weight of 100 kg. The patient's girth measured 198 cm after approximately 4 years' duration, and she complained of dyspnea and inability to walk. Adnectomy was performed with intensive intraoperative monitoring. The ovarian cancer was entirely adherent to the parietal peritoneum. However, 10 h after adnectomy, she died of massive abdominal bleeding from extremely redundant parietal peritoneum caused by disseminated intravascular coagulation.

Severe leg compartment syndrome associated with dorsal lithotomy position during radical hysterectomy.

We encountered a female patient with left-leg compartment syndrome; a devastating complication, probably associated with prolonged dorsal lithotomy position during radical hysterectomy using intermittent pneumatic compression. This patient was intensively treated and fortunately recovered. However, leg compartment syndrome is poorly understood by gynecologists. We must always consider the potential risk of this life-threatening complication when patients are placed in the dorsal lithotomy position for a prolonged period during extended surgery using intermittent external compression.