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Objective: Usage of sentinel lymph-node (SLN) concept in locally advanced cervical cancers might help to individualise management. According to SLN status could be patients refered to neoadjuvant chemotherapy (NAC) with subsequent surgery or to primary chemoradiation. The aim of our study was to evaluate sensitivity of SLN detection in locally advanced cervical cancers and to assess the impact of NAC on frequency of their metastatic involvement., Design: Retrospective clinical study., Setting: Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Medical Faculty, Charles University, Prague., Materials and Methods: Included were patients with cervical cancer stages FIGO IB1 (> 3 cm), IB2, IIA2 and selected cases of stages IIB with incipient parametrial involvement. Patients were distributed into two different protocols - patients in group NAC-SLN were refered to radical hysterectomy with SLN biopsy after 3 cycles of NAC, other patients (group SLN) underwent SLN biopsy and NAC was administered only in SLN-negative cases., Results: Altogether 101 patients were included (group SLN = 62, group NAC-SLN = 39). Detection of SLN in whole cohort reached 90.1% per patient and 68.3% bilaterally. No differences were found between SLN group and NAC-SLN group in frequency of per patient SLN detection (90.3% vs 89.7%) and bilateral detection (69.4% vs 66.7%). Prevalence of macrometastases, micrometastases and ITC in the SLN group was 37.1% (23/62), 11.3% (7/62) and 8.1% (5/62), respectively. In the NAC-SLN group macrometastases in SLN were detected in 17.9% (7/39) patients, in 1 patient was detected micrometastis in SLN and no patient had ITC. Difference in frequency of metastases in SLN was significant (p = 0,013). No patient had progressed during NAC, complete response was seen in 15.1% (11/73) patients and reduction of tumour volume > 30% in 84.9% (62/73) patients., Conclusions: Detection of SLN in locally advanced cervical cancers reached comparable results to early stages. NAC did not influence frequency of SLN detection, but it significantly decreased prevalence of metastatic SLN involvement.

The majority of patients who suffer from an early-stage or advanced-stage of ovarian cancer complain about symptoms, mainly gastrointestinal ones. The pelvic examination in ovarian cancer detection is limited by the adnexal position in the pelvis and frequent extraovarian spread of disease. Recently, any reliable tumor biomarker (CA 125 and/or HE4), which can be used in differential diagnosis between benign and malignant ovarian tumors, does not exist. According the results of the largest multicenter International Ovarian Trial Analysis (IOTA), ultrasound if performed by an experienced sonologist is an ideal diagnostic method in differential diagnosis between benign and malignant ovarian tumors. The experienced examiner is also able to detect extraovarian tumor spread and to assess tumor operability. Magnetic resonance imaging (MRI) is used only to complement ultrasound in cases when high tissue resolution is needed. Computed tomography (CT) is a useful method for detection of extraovarian spread, especially in cases when an ultrasound examiner experienced in abdominal scanning is not available. Similarly, fusion of positron emission tomography with CT (PET/CT) is a highly accurate method for the detection of abdominal and extraabdominal tumor spread, but its use is limited by cost and the low availability of this method. On the other hand, PET/CT is not recommended for primary ovarian cancer detection because of its lower sensitivity in comparison to ultrasound and its high false positive rates as well.

Objective: To present structured guidelines to transabdominal ultrasound examination in gynecology., Subject: Practical guide., Setting: Oncogynecological Center, Department of Obstetrics and Gynecology, Charles University in Prague - First Faculty of Medicine and General Faculty Hospital, Prague., Subject and Method: After having gone over the now-a-days literature and summarized our experience, we present description of normal and more frequent and common pathological findings on transabdominal ultrasound., Conclusion: Entire examination takes usually a couple of minutes, but gives much more information to distinguish between potential causes of patient's difficulties and allows for focusing an adequate diagnostic and therapeutic management.

Objective: Sexual dysfunctions after surgery for gynaecologic cancer., Design: Review article., Setting: Department of Gynaecology and Obstetrics, 1st Medical Faculty, Charles University, Prague., Method: An overview of published data., Conclusion: Sexual functions are the basic part of quality of life. Even there exist just limited studies dedicated to postsurgical sexual morbidity, it is conclusive in most of them, that surgical therapy for gynaecologic malignant tumours is connected with long-lasting anatomical and physiological changes, which can cause sexual dysfunctions in women. These are often complex and some of them last for more than two years after the operation. Well-timed sexuological counseling and openness of health care providers in sexual topics are very important parts of complex care of oncogynaecologic patients and their partners.

Objective: Survey of contraceptive behaviour and attitude of Czech women towards different types of contraception., Design: Representative survey., Methods: Anonymous questionnaire survey of the sample of 1011 Czech women aged from 15 to 50., Results: More than half of the women of our sample used some form of contraception during their first sexual intercourse. Most of the women used condom (41%), only a small part used hormonal contraception or withdrawal. Eighty percent of Czech women use some form of contraception with their stable partner, most often hormonal contraception (51%). One sixth of Czech women use condom. Using contraception is influenced mostly by age and religious belief: younger respondents show more responsible contraceptive behaviour at their first sexual intercourse, they use hormonal contraception with their stable partner more often. Furthermore, atheists protect themselves by some form of contraception more often than believers. The most used form is hormonal contraception., Conclusion: Czech women show responsible contraceptive behaviour during their heterosexual intercourse. There is a significant increase of using hormonal contraception.

Objective: To analyze up-to-data knowledge in the field of molecular characterization of epithelial ovarian borderline tumors with respect to clinical management and prognosis., Design: Review., Setting: Oncogynecological Center, Department of Obstetrics and Gynecology, Charles University in Prague, First Faculty of Medicine, and General Faculty Hospital, Prague., Methods: Based on literature search and own experimental data in the field of molecular biology of ovarian cancer and borderline tumors of ovary, we summarize up-to-date knowledge of molecular differences and specific features of BTO with respect to implementation of these knowledge into the clinical management., Results and Conclusion: We suppose that spectrum of genomic changes (i.e. genetic and epigenetic) causing tumor transformation is limited and these changes take place in stem or progenitor cell. Analysis of genomic changes can help to define certain subtypes of BTO and, correlated to clinical characteristics, to identify subtypes with different biological behavior. Such molecular typing of BTO allows to individualize treatment.

Objective: The goal of this study was to compare the accuracy of magnetic resonance imaging (MRI)--a standard method--and transrectal ultrasound (TRUS) in the staging and determination of significant prognostic parameters in early-stage cervical cancer. The following prognostic parameters were evaluated: identification of residual tumor in the cervix after cone-biopsy, tumor volume, and early parametrial infiltration., Design: Prospective study., Setting: Oncogynecological Center, Department of Obstetrics and Gynecology, General Faculty Hospital of Charles University, Prague., Methods: Patients referred to Oncogynecological Center from January 2004 to February 2006, in whom early-stage cervical cancer (T1a1-T2a) was diagnosed by clinical examination, were prospectivelly enrolled in the study. Only those patients who were examined by both MRI and TRUS with following surgical treatment were included. Imaging results were compared with pathology findings., Results: Data from 95 patients were evaluated. The accuracy of tumor detection in 95 patients was 93.7% for TRUS and 83.2% for MRI (P < or = 0.006). In small tumors (< or = 1 cm3), the accuracy of tumor detection by TRUS was 90.5% and 81.1% by MRI (P < or = 0.049). The accuracy of parametrial infiltration detection by TRUS and MRI was 98.9% and 94.7%, respectively (P < or = 0.219). The accuracy was not influenced by body mass index values., Conclusion: Our results show TRUS achieving comparable or even higher accuracy than the more commonly used MRI in staging of early-stage cervical cancer.

Objective: The goal of this study was to evaluate the accuracy and safety of ultrasound-guided tru-cut biopsy in advanced abdomino-pelvic tumors in a sufficiently large cohort., Design: Prospective study., Setting: Oncogynecological Center, Department of Obstetrics and Gynecology, General Faculty Hospital of Charles University, Prague., Methods: Patients indicated for tru-cut biopsy were those with primarily inoperable tumors, with advanced tumors and compromised performance status preventing a primary surgical procedure, and with recurrent pelvic tumors requiring histological verification. All were referred to the Oncogynecological Center between January 2005 and June 2007. Tru-cut biopsy was taken either from pelvic tumor or from its metastatic sites transvaginally or transabdominally under ultrasound guidance. Sample adequacy was evaluated., Results: Altogether, 119 patients were referred for tru-cut biopsy during a study period. Only 4 cases were found unsuitable for tru-cut biopsy and the patients were referred for laparoscopy instead. Samples were obtained transvaginally in 67 patients (58.3%) and transabdominally in 48 patients (41.7%). The biopsy was taken from pelvic tumor in 59 patients (51.3%), omental cake in 14 patients (12.2%), from peritoneal visceral or parietal carcinomatosis in 37 patients (32.2%) and from other localities in 5 patients (4.3 %). The diagnostic adequacy of ultrasound-guided tru-cut biopsy reached 94.8% (95% CI, 94.17-99.40%). There were only two tru-cut biopsy-related complications: The first case involved bleeding from tumor in a patient with mild thrombocytopenia that required laparotomy; in the second case, diagnostic laparoscopy was indicated after a minor bleeding occurred in the biopsy site on ultrasound, however, no significant pelvic bleeding was confirmed by the procedure., Conclusion: Ultrasound-guided tru-cut biopsy is a safe, reliable, fast, and cost-effective diagnostic method for histological verification of both advanced primary and recurrent abdomino-pelvic tumors. It can be performed in an outpatient setting without the need for general anesthesia, causing a minimal discomfort to the patient in comparison with laparoscopy or laparotomy. The risk of complications is low and the main advantage is the acquirement of a sample adequate for further immunohistochemical examination, which is a necessary requirement for the choice of optimal oncological treatment.

Objective: Survey of knowledge of Czech and Romanian women about STIs and their perception of sources of the information., Design: Representative survey., Methods: Anonymous questionnare survey of the sample of 1011 Czech and 1001 Romanian women aged 15 to 50., Results: The doctor or the psychologist is considered to be the most reliable source of information about STIs, the Czech women prefer information from books and papers, Romanian women consider the close persons to be more better source of information than Czech women. The Czech women know better the realy effective methods of STI prevention and situations which are risky from the possible HIV/AIDS infection, Romanian ones more often believe in non effective methods of prevention and more often are afraid of situations, which are not dangerous and more often were not able to answer the questions at all., Conclusion: Romanian women have worse konwledge in the area of STIs than Czech ones. They are also more credulous to information from different sources, especially to those provided by experts or by close persons.

Objective: Survey of attitudes of Czech women toward abortions., Design: Representative survey., Methods: Anonymous questionnare survey of the sample of 1011 Czech women aged 15 to 50., Results: Number of induced abortions significantly increases with age; women with one or more children frequently undergo induced abortion; women using hormonal contraception have significantly less incidence of induced abortion in their case history; independently of age or place of residence Czech women have liberal attitudes towards the possibility for induced abortion, whereas the religious beliefs significantly increase the restrictive attitudes towards induced abortion., Conclusion: In spite of the very liberal attitudes of Czech women toward induced abortions their number is constantly decreasing--probably as a result of the increasing number of hormonal contraception users.

Objective: To present an overview of molecular characteristics and differences of and between preinvasive and invasive breast tumors., Design: Review., Setting: Oncogynecologic center, Clinic of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague and General Teaching Hospital, Prague., Material and Methods: Review of literature., Conclusion: Identification of genetic and epigenetic changes in preinvasive and invasive breast tumors can help to better classify these lesions and improve and tailor their clinical management. Due to completely different biological behavior of morphologically identical lesions, it is clear that the matter of classification and clarification of their clinical behavior is hidden inside the entire genome or proteome.

Objective: To analyze loss of heterozygosity (LOH), loss of expression and somatic mutations of BRCA1, BRCA2 and p53 genes in sporadic epithelial ovarian cancer samples., Design: Original paper., Setting: Oncogynecologic center, Clinic of Obstetrics and gynecology, First Faculty of Medicine, Charles University in Prague and General Teaching Hospital, Prague., Material and Methods: We used genomic DNA and total RNA from peripheral blood and fresh frozen tumor as a template for LOH, loss-of-expression and mutation analyses., Results: LOH in at least one region was found in 60% of tumors. Majority of these alterations occurred not solely, but in conjunction with other region deletions., Conclusion: Our study confirms high frequency of somatic alteration of BRCA1, BRCA2 and p53 genes in sporadic epithelial ovarian cancer.

Objective: Review recent knowledge concerning significance of detection of DNA HPV in regional lymph nodes in cervical cancer patients., Type of the Study: Literature review., Setting: Department of Obstetrics and Gyneacology, 1st Faculty of Medicine, Charles University and General Teaching Hospital, Prague., Results: Metastatic involvement of pelvic lymph nodes is the most important prognostic parameter in early stages cervical cancer. Still, almost 20% of patients with negative pelvic nodes experience recurrence. Detection of HPV DNA in lymph nodes might be a marker of occult metastatic involvement. However, published data are limited, mostly due to inconsistent methodology. Only 3 prospective studies evaluating HPV from fresh or frozen tissue were published till now, all other retrospective studies extracted HPV DNA from paraffin embedded samples. A few papers showed correlation between HPV DNA and metastatic involvement of pelvic lymph nodes. DNA HPV identification in histopatology-negative nodes was considered as a risk factor for recurrence. Presence of DNA HPV 18 in histopathology-negative pelvic nodes was described as a poor prognostic factor; however prognostic significance of individual genotype is still unclear., Conclusion: Detection of high risk HPV DNA in regional lymph nodes is a good candidate for prognostic parameter in early stages cervical cancers. The group of women with both absence of metastatic involvement and negative HPV DNA evaluation of regional lymph node should represent a cohort of patients with particularly good prognosis.

Objective: The aim of the study was to estimate genetic changes detected in ovarian and cervical cancer cells, in correlation with other available clinical and histopathological parameters, with impact upon cancer prognosis., Design: Original article., Setting: Department of Gynecology and Obstetrics, First Faculty of Medicine, Charles University in Prague and General Teaching Hospital, Prague., Methods: Sixty patients with ovarian cancer and twenty patients with cervical cancer were included in the study. A histopathologist examined the tumor samples in order to define the histological type and grade. MIB-1 and p53 were estimated using an immunohistochemical method. For genetic testing, both conventional and molecular methods were applied (direct culture and a G-banding technique, the FISH method with whole chromosome painting probes, and the CGH method). The results were submitted to statistical evaluation, using analysis of variances and X2 test., Results: Numerical and structural chromosomal aberrations were detected in more than 63% of the examined ovarian cancer cases and 29% of examined cervical cancer cases. Ovarian cancer patients with extensive chromosomal rearrangements were significantly younger. The most typical findings in ovarian cancer cells were amplifications 1q, 3q, 20q; and deletions 4p, 4q, 18p, 18q, 19q. The most typical findings in cervical tumor cells were amplifications 3q, 5p; and deletions 13q and isochromosome 5p. Some of the less frequent findings in our study were deletion 22q in 36% of all ovarian cancer samples, as well as amplifications of chromosome 2 and deletions of chromosome 10, 11p, 21q in cervical cancer cells. The activity of proliferative marker MIB-1 was significantly higher in women with a high p53 HSCORE (p < 0.01)., Conclusions: Chromosomal rearrangements, different for ovarian and cervical cancer, have been found, including several rare findings. The significant importance of genetic alterations and the activity of proliferative markers, including common correlations with an unfavorable outcome in ovarian tumors of younger women were found.

Objective: To compare per-operative and post-operative morbidity in patients undergoing radical surgery for carcinoma of the uterine cervix after administration of a neoadjuvant chemotherapy, and for primarily small cervical tumour., Type of the Study: A retrospective case-control study., Setting: Department of Obstetrics and Gyneacology, 1st Faculty of Medicine, Charles University and General Teaching Hospital, Prague., Methods: The study included 24 patients with squamous cell carcinoma of the uterine cervix who underwent radical hysterectomy including systematic pelvic lymphadenectomy after previous administration of neoadjuvant chemotherapy (NACT) during the period between 1/2004 and 6/2006. The control group of 24 patients was selected retrospectively from the population of women after radical surgery carried out in the same period, nevertheless, the controls underwent the surgery for primarily small carcinoma of the uterine cervix, stages IA2 or IB1. The tumour size consistent with the reduced tumour after NACT administration was the criterion for selection of the control group. The following parameters were monitored in both groups--duration of the surgery, blood loss objectivised by a difference in pre-operative and post-operative haemoglobin and haematocrit values, the need of blood transfusion, per-operative complications, early post-operative complications (up to 6 weeks after the surgery), duration of hospitalization and retaining the inserted epicystotostomy due to hypotonic bladder after discharge., Results: A therapeutic response allowing the radical surgery was achieved in 92% patients after NACT. After NACT the original tumour volume was reduced by 70% on the average (58% - 100%). No significant differences between the group of patients treated with NACT and undergoing subsequent radical hysterectomy and the control group were reported in terms of duration of the surgery (165 min. vs. 160 min.), blood loss (the difference in pre-operative and post-operative haemoglobin values 18 g/l vs. 19 g/l, the difference in pre-operative and post-operative haematocrit values 0.056 vs. 0.064), administration of blood transfusion (25% vs. 21%) and duration of hospitalization (9.5 days vs. 9.6 days). A significant difference was reported only in the need to retain the inserted epi-cystostomy after discharge (67% vs. 47%)., Conclusion: There were no significant differences in the evaluated parameters of per-operative and postoperative morbidity in patients after NACT and in control patients, except for the necessary duration of artificial urine derivation in patients after NACT due to the fact that their surgery was more radical in the parametria. Administration of NACT regimen involving ifosfamide/cisplatin (IP) improved surgical conditions in the bulky squamous cell carcinoma of the uterine cervix.

Objective: To summarize available data concerning adrenal hyperandrogenemia caused by 21-hydroxylase deficiency, non-classic adrenal hyperplasia (NCAH)., Design: Review article., Setting: Department of Gynecology and Obstetrics, General Faculty Hospital and 1st Medical Faculty, Prague., Methods: Compilation of published data from scientific literature., Conclusion: Although 21-hydroxylase deficiency is one of the most frequent autosomal recessive genetic disorders, prevalence of NCAH in the whole population and among hyperandrogenic women is very low. The measurement of 17OH-progesterone should be incorporated into the standard evaluation of all hyperandrogenic patients to establish or exclude the diagnosis of NCAH. There is no typical clinical sign of NCAH, and clinical symptoms are to similar to patients with PCOS. Corticoid substitution as a treatment modality of NCAH is derived from therapy of classic congenital adrenal hyperplasia (CAH). Anti-androgen therapy is effective in skin disorders (hirsutism). Due to normal cortisol value there is to use of combined oral contraceptives in the treatment of choice. An improvement of clinical symptoms is a key parameter for the evaluation of treatment effectiveness. There are no data about risk of late metabolic complications in NCAH patients.

Objective: Review of diagnostical and therapeutical methods in glandular premalignant lesions of the uterine cervix., Design: Review article., Setting: Department of Obstetrics and Gyneacology, 1st Medical Faculty, Charles University and General Faculty Hospital, Prague., Results: The incidence of invasive adenocarcinomas of the uterine cervix is increasing. Incidence ratio between adenocarcinomas and spinocellular carcinomas is approximately 1:5; however ratio of premalignant lesions reaches only about 1:80. Glandular premalignant disease is usually found in the specimen taken for squamous disease. The coincidence of both types of premalignant lesions, so called "mixed lesion", is revealed in about 46-72%. PAP-smear of AGC-NOS/-NEO or adenocarcinoma in situ (AIS) in combination with typical colposcopic appearance raise a suspicion of glandular lesion. Direct biopsy must be always performed to get definite diagnosis. Optimum biopsy technique requires cylindrical excision. A woman can be carefully followed if desires pregnancy and specimen margins are negative. Hysterectomy is indicated if reproductive plans are completed., Conclusion: Diagnosis of glandular premalignat lesion of the uterine cervix is more complicated in comparison to spinocellular one, however it is getting more significant due to increasing incidence. Colposcopy and cytology are less reliable. Any suspicion on glandular premalignat leasion requires more active approach and radical procedure (hysterectomy) if possible.

Objective: Review of literature concerning continuous regimen of combined hormonal contraception., Design: Review article., Setting: Department of Obstetrics and gynecology, Charles University, Prague., Methods: Review and critical assessment of published data., Conclusions: Attitude of gynecologists and women toward continuous use of combined hormonal contraception was liberalized within the last 15 years. Continuous regimen is well tolerated; number of spotting and bleeding days is increased in the first two cycles, with a substantial decrease afterwards. Total number of bleeding days is significantly lower in comparison to cyclic regimen. Continual use is not accompanied by any known health risk for users. Moreover, there are a few medical indications for such regimen.

Exenteration pelvic procedures are surgical options for treatment of locally advanced pelvic tumors. Due to the procedure's success rates, it has become a standard therapeutic procedure, when indicated. From the medical point of view, the following factors characterize the level of seriousness of these procedures: the fact that the procedure is extensive, its complicated reconstruction phase and high postoperative morbidity rates. From the patient's point of view, it is characterized by a principal change in the quality of life. In this case review the authors present their experience with a multidisciplinary approach to these procedures.

Objective: Review of reconstruction procedures following pelvic exenterations., Design: Review article., Setting: Department of Obstetrics and Gynecology, Department of Urology, 1st Department of Surgery, Faculty Teaching Hospital and 1st Medical Faculty of the Charles University, Prague., Methods: Review and critical assessment of published data., Conclusions: Reconstruction procedures are important part of pelvic exenterations. The procedures are crucial for following quality of life. Currently the most frequently used techniques for isolated pelvic floor support are omental flaps (carpets), for combined reconstruction of pelvic floor and vagina TRAM (transverse rectus abdominis musculocutaneus flap). Reconstructions prolong operation time; however they are accompanied with low morbidity and some techniques decrease total morbidity of exenterative procedure. Total and posterior exenterations require sigmoideostomy in vast majority of cases. Low rectal anastomosis might be used in cases of supralevator procedures. They cause high morbidity especially in patients following radiotherapy. In these patients temporary diverting colostomy is being recommended. A bowel segment is usually used for urinary diversion following total or anterior exenteration. Golden standard remain the incontinent ureteroenterostomies using ileum or colon transversum. Currently continent diversions are considered more often due to encouraging results and good quality of life. Heterotopic diversions, with continent conduit and cutaneous stoma, are frequently used. Risk of serious complications, especially fistulas and stoma stenosis, after all types of diversions is possible to reduce by using appropriate bowel segment not handicapped by previous radiotherapy.

Objective: Discussion of current experiences with abdominal radical trachelectomy in the treatment of early stages of cervical cancer in fertile women., Design: Case-reports., Setting: Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Medical Faculty, Charles University, Prague., Methods: Presentation of 4 cases of abdominal radical trachelectomy and pelvic lymphadenectomy. Discussion with published data., Results: Three cases of open abdominal and one case of laparoscopic abdominal radical trachelectomies together with pelvic lymphadenectomies are presented. All procedures were indicated for cervical cancer stages IA2-IB1. Frozen section of pelvic nodes and a slice of upper margin of cervix revealed no metastasis or infiltration. In total 22-43 pelvic nodes were removed, being negative in all cases. Operative time ranged between 148 and 270 min. in laparotomy and 250 min. in laparoscopy. Blood loss reached 350-3500 ml. There were no intraoperative complications, postoperatively one case of bladder atony was treated by suprapubic drainage for 30 days, one case of ileus was managed pharmacologically. Vaginal suture healed properly in all cases. No complications occurred within limited follow-up of 1-5 months., Conclusion: Abdominal radical trachelectomy with pelvic lymphadenectomy is a rational alternative in the treatment of stages IA2-IIA cervical cancer in women of fertile age. Standard radicality in parametria resection and easy incorporation into armamentarium of oncogynecological centers are main advantages of such approach. Laparotomy can be avoided using laparoscopy.

Objective: Review of literature concerning pelvic exenterative procedures., Design: Review article., Setting: Department of Obstetrics and Gynecology, Charles University, Prague., Methods: Review and critical assessment of published data., Conclusion: Pelvic exenterations are standard procedures in oncogynecology which have no alternative in certain indications. The most frequent indications are recurrences or progressions of cervical, vulva or vaginal cancers. Exenterative procedures might be used in primary treatment in some cases of locally advanced tumors. Mortality of current procedures reaches 5% to 10%, early and late postoperative morbidity is frequent (40-60%). Recently explorative laparoscopy is used in preoperative staging to decrease the number of aborted procedures due to distant metastasis or pelvic tumor inoperability. The procedure with high morbidity, causing impairment of quality of life, is justified due to good follow-up results--5-years overall survival is about 50-60%. It should be emphasized that with no treatment in these patients median of survival reaches about 6 months.

Objective: Review of advanced radicality in pelvic exenterations., Design: Review article., Setting: Department of Obstetrics and Gynecology, General Faculty Hospital and Ist Medical Faculty of the Charles University, Prague., Methods: Review and critical assessment of published data., Conclusions: More extensive radicality in pelvic exenterations make possible to use surgical treatment in some cases of lateral recurrences or central recurrences with the attachment to the pelvic side wall. One possible technique is a combination of en bloc exenteration with pelvic bone resection, most frequently sacrum. Experiences in gynecological tumours are so far limited. Laterally extended resection was described in lateral infrailiac pelvic wall recurrences. The only one presented paper related to laterally extended procedures showed a reasonable overall survival of patients; however follow-up is limited.

Objective: Discussion of experiences with pelvic exenterations., Design: Case-report., Setting: Department of Obstetrics and Gynecology, Department of Urology, Department of Surgery, Department of Pathology, Department of Clinical Oncology, General Teaching Hospital and Ist Medical Faculty of the Charles University, Prague, Czech Republic., Methods: Presentation of 4 cases of pelvic exenterations. Discussion with published data., Results: Altogether four cases of pelvic exenterations are presented, one case of supralevator total exenteration for recurrent cervical cancer, one case of infralevator total exenteration for recurrent vaginal cancer, one case of supralevator anterior exenteration in the treatment of locally advanced cancer of urinary bladder, and one case of supralevator posterior exenteration for recurrent vaginal cancer.