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The aim of the study was to compare health-related quality of life (QoL) and oncological outcome between gynaecological cancer patients undergoing pelvic exenteration (PE) and extended pelvic exenteration (EPE). EPEs were defined as extensive procedures including, in addition to standard PE extent, the resection of internal, external, or common iliac vessels; pelvic side-wall muscles; large pelvic nerves (sciatic or femoral); and/or pelvic bones.Data from 74 patients who underwent PE (42) or EPE (32) between 2004 and 2019 at a single tertiary gynae-oncology centre in Prague were analysed. QoL assessment was performed using EORTC QLQ-C30, EORTC CX-24, and QOLPEX questionnaires specifically developed for patients after (E)PE.No significant differences in survival were observed between the groups (P0.999), with median overall and disease-specific survival in the whole cohort of 45 and 49 months, respectively. Thirty-one survivors participated in the QoL surveys (20 PE, 11 EPE). No significant differences were observed in global health status (P = 0.951) or in any of the functional scales. The groups were not differing in therapy satisfaction (P = 0.502), and both expressed similar, high willingness to undergo treatment again if they were to decide again (P = 0.317).EPEs had post-treatment QoL and oncological outcome comparable to traditional PE. These procedures offer a potentially curative treatment option for patients with persistent or recurrent pelvic tumour invading into pelvic wall structures without further compromise of patients´ QoL.

Objectives The primary aim was to investigate the diagnostic accuracy of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) in the mapping of deep pelvic endometriosis (DE) in a diseased population. The secondary aim was to offer first insights into the clinical applicability of the new International Deep Endometriosis Analysis group (IDEA) consensus for sonographic evaluation, which was also adapted for MRI and surgical reporting in this study. Methods The study was a prospective observational cohort study. In this study, consecutive women planned for surgical treatment for DE underwent preoperative mapping of pelvic disease using TVS and MRI (index tests). The results were compared against the intraoperative findings with histopathological confirmation (reference standard). In case of disagreement between intraoperative and pathology findings, the latter was prioritised. Index tests and surgical findings were reported using a standardised protocol based on the IDEA consensus. Results The study ran from 07/2016 to 02/2018. One-hundred and eleven women were approached, but 60 declined participation. Out of the 51 initially recruited women, two were excluded due to the missing reference standard. Both methods (TVS and MRI) had the same sensitivity and specificity in the detection of DE in the upper rectum (UpR) and rectosigmoid (RS) (UpR TVS and MRI sensitivity and specificity 100%; RS TVS and MRI sensitivity 94%; TVS and MRI specificity 84%). In the assessment of DE in the bladder (Bl), uterosacral ligaments (USL), vagina (V), rectovaginal septum (RVS), and overall pelvis (P), TVS had marginally higher specificity but lower sensitivity than MRI (Bl TVS sensitivity 89%, specificity 100%, MRI sensitivity 100%, specificity 95%; USL TVS sensitivity 74%, specificity 67%, MRI sensitivity 94%, specificity 60%; V TVS sensitivity 55%, specificity 100%, MRI sensitivity 73%, specificity 95%; RVS TVS sensitivity 67%, specificity 100%, MRI sensitivity 83%, specificity 93%; P TVS sensitivity 78%, specificity 97%, MRI sensitivity 91%, specificity 91%). No significant differences in diagnostic accuracy between TVS and MRI were observed except USL assessment (p=0.04) where MRI was significantly better and pouch of Douglas obliteration (p=0.04) where MRI was significantly better and pouch of Douglas obliteration (κ) = 0.727 [p=0.04) where MRI was significantly better and pouch of Douglas obliteration (κ) = 0.727 [p=0.04) where MRI was significantly better and pouch of Douglas obliteration (p=0.04) where MRI was significantly better and pouch of Douglas obliteration ( Conclusion We found that both imaging techniques had overall good agreement with the reference standard in the detection of deep pelvic endometriosis. This is the first study to date involving the IDEA consensus for ultrasound, its modified version for MRI, and intraoperative reporting of deep pelvic endometriosis in clinical practice.

Objectives Low-grade serous ovarian carcinomas (LGSOC) have historically low chemotherapy responses. Alterations affecting the MAPK pathway, most commonly KRAS/BRAF, are present in 30–60% of LGSOC. A phase II study of the MEK inhibitor selumetinib showed promising response rate of 15% in LGSOC and binimetinib, a potent MEK1/2 inhibitor, has demonstrated activity across multiple cancers. Methods MILO (MEK-Inhibitor in Low-grade Serous Ovarian Cancer)/ENGOT-ov11 was an open-label, 2:1-randomized study of binimetinib (45-mg BID) vs PCC in LGSOC. Eligible patients had recurrent or persistent measurable LGSOC following ≥1 prior platinum-based chemotherapy, ≤3 prior chemotherapy lines, and no prior MEK-or BRAF-inhibitor. The primary endpoint was progression-free survival (PFS) by blinded central review; additional assessments: overall survival (OS), overall response rate (ORR), duration of response (DOR), clinical-benefit rate, biomarkers, and safety.(NCT01849874). Results 303 patients were randomized (201 binimetinib,102 PCC). Median PFS was 9.1 months (95% CI:7.3,11.3) for binimetinib and 10.6 months (95% CI:9.2,14.5) for PCC (HR:1.21(0.79,1.86);closed early for futility). Secondary efficacy endpoints were similar in the two groups: ORR 16%(complete/partial responses[CR/PRs]=32) vs 13%(CR/PRs=13); median DOR 8.1 (range:0.3–12.0+ months) vs 6.7 (0.3–9.7+ months); and median OS 25.3 vs 20.8 months, for binimetinib and PCC, respectively. Safety results were consistent with known safety profile of binimetinib; most common ≥grade 3 events were blood CK increased(20%) and hypertension(20%). Post-hoc analysis suggests a possible association between KRAS mutation and response to binimetinib. Conclusions Although MILO did not meet its primary endpoint, binimetinib showed activity in LGSOC across the efficacy endpoints evaluated. Chemotherapy responses were higher than predicted. Further evaluation is warranted.

Background Data from a randomized Phase II trial (NCT00628251) of olaparib (capsules, 200 or 400 mg bid, n=32 per arm) vs pegylated liposomal doxorubicin (PLD, n=33) in gBRCAm OC pts with recurrence ≤12 months after prior platinum therapy indicated efficacy for olaparib (Kaye et al. JCO 2012). However, the efficacy of PLD was higher than previously reported in this setting. We led a confirmatory Phase III, open-label study of olaparib vs non-platinum chemotherapy in gBRCAm PSR OC pts (NCT02282020). Methods Pts were randomized (2:1) to olaparib tablets (300 mg bid) or chemotherapy treatment of physician’s choice (TPC) (paclitaxel [P; 80 mg/m2 on day 1 (D1), D8, D15, D22 every 4 weeks (q4w)], topotecan [T; 4 mg/m2 D1, D8, D15 q4w], gemcitabine [G; 1000 mg/m2 D1, D8, D15 q4w] or PLD [50 mg/m2 D1 q4w]) until progression, stratified by: TPC, prior lines of chemotherapy (2–3 vs ≥4) and platinum-free interval (6–12 vs >12 months). Primary endpoint: ORR (blinded independent central review [BICR]). Secondary endpoints included PFS and safety. Results 266 gBRCAm PSR OC pts were randomized (olaparib, n=178; TPC, n=88 [PLD, n=47; P, n=20; G, n=13; T, n=8]); 12 in the TPC arm withdrew before receiving study treatment. 223 pts (84%) had baseline BICR measurable disease (olaparib, n=151; TPC, n=72). ORR was 72% with olaparib vs 51% with TPC (OR 2.53, 95% CI 1.40–4.58; P=0.002). HR for PFS by BICR was 0.62 (95% CI 0.43–0.91; P=0.013; median 13.4 vs 9.2 months [olaparib vs TPC]) and by investigator assessment was 0.49 (95% CI 0.35–0.70; P Conclusions Pts with gBRCAm PSR OC receiving olaparib monotherapy had a significant, clinically relevant improvement in ORR and PFS vs TPC, with no new safety signals.

In 2018 three European societies have joined to create clinically relevant guidelines on the diagnosis and management of cervical cancer. The European Society of Gynaecological Oncology (ESGO), the European Society for Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP) agreed on diagnostic approaches in cervical cancer staging.Review article.Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague.A literature review of published data on cervical cancer staging.Physical examination with biopsy still has its place in histological confirmation of malignancy but doesnt offer much information on the extent of the disease. It is historically the first time when transvaginal/transrectal ultrasound (TVS/TRS) is recommended as an alternative to the magnetic resonance (MRI) in a primary workup. Both imaging modalities offer excellent soft tissue contrast resolution, which is crucial in tumour detection and evaluation of local extent of tumour, including the depth of tumour infiltration in the bladder and rectal wall. These new advances in imaging rendered the use of cystoscopy and rectoscopy redundant. Similarly, with the implementation of modern imaging in pretreatment staging, intravenous urography has lost its role in the staging. Apart from the local extent of the disease, it is necessary to accurately evaluate the lymph node status in order to plan optimal treatment. The detection rate of imaging reflects the prevalence of lymph node metastases depending on tumor stage and size of metastasis. In the early stage disease (T1a, T1b1, T2a1) with negative lymph nodes on TVS/TRS or MRI, surgicopathological staging of pelvic lymph nodes is a method of choice for detection of small volume metastases. Both imaging modalities might not detect small metastatic lesions within non-enlarged lymph nodes, but by identifying the characteristic changes of the infiltrated lymph nodes they have very low rate of false positives. In locally advanced cervical cancer (T1b2 and higher, except T2a1) or early stages with positive lymph nodes detected on ultrasound or MRI, computed tomography (CT) or CT in combination with positron emission tomography (PET-CT) are recommended to assess distant spread including paraaortic lymph nodes and chest. PET-CT is the preferred option in cases indicated for primary chemoradiation. Unfortunatelly no imaging method is accurate enough to exclude small volume metastasis in paraaortic nodes. In the cases with negative paraaortic lymph nodes on CT or PET-CT, surgicopathological staging with dissection of the paraaortic lymph nodes may be considered. In order to reduce false positive findings by imaging methods, it is recomended to obtain an ultrasound or CT-guided tru-cut biopsy from any equivocal extrauterine lesion to avoid inappropriate treatment.This review offers scientific evidence that led to the recent changes in the cervical cancer staging.

Summary Background Patients who are immunocompromised because of malignancy have an increased risk of herpes zoster and herpes zoster-related complications. We aimed to investigate the efficacy and safety of an inactivated varicella zoster virus (VZV) vaccine for herpes zoster prevention in patients with solid tumour or haematological malignancies. Methods This phase 3, two-arm, randomised, double-blind, placebo-controlled, multicentre trial with an adaptive design was done in 329 centres across 40 countries. The trial included adult patients with solid tumour malignancies receiving chemotherapy and those with haematological malignancies, either receiving or not receiving chemotherapy. Patients were randomly assigned (1:1) to receive four doses of VZV vaccine inactivated by γ irradiation or placebo approximately 30 days apart. The patients, investigators, trial site staff, clinical adjudication committee, and sponsor's clinical and laboratory personnel were masked to the group assignment. The primary efficacy endpoint was herpes zoster incidence in patients with solid tumour malignancies receiving chemotherapy, which was assessed in the modified intention-to-treat population (defined as all randomly assigned patients who received at least one dose of inactivated VZV vaccine or placebo). The primary safety endpoint was serious adverse events up to 28 days after the fourth dose in patients with solid tumour malignancies receiving chemotherapy. Safety endpoints were assessed in all patients who received at least one dose of inactivated VZV vaccine or placebo and had follow-up data. This trial is registered ( NCT01254630 and EudraCT 2010-023156-89). Findings Between June 27, 2011, and April 11, 2017, 5286 patients were randomly assigned to receive VZV vaccine inactivated by γ irradiation (n=2637) or placebo (n=2649). The haematological malignancy arm was terminated early because of evidence of futility at a planned interim analysis; therefore, all prespecified haematological malignancy endpoints were deemed exploratory. In patients with solid tumour malignancies in the modified intention-to-treat population, confirmed herpes zoster occurred in 22 of 1328 (6·7 per 1000 person-years) VZV vaccine recipients and in 61 of 1350 (18·5 per 1000 person-years) placebo recipients. Estimated vaccine efficacy against herpes zoster in patients with solid tumour malignancies was 63·6% (97·5% CI 36·4 to 79·1), meeting the prespecified success criterion. In patients with solid tumour malignancies, serious adverse events were similar in frequency across treatment groups, occurring in 298 (22·5%) of 1322 patients who received the vaccine and in 283 (21·0%) of 1346 patients who received placebo (risk difference 1·5%, 95% CI −1·7 to 4·6). Vaccine-related serious adverse events were less than 1% in each treatment group. Vaccine-related injection-site reactions were more common in the vaccine group than in the placebo group. In the haematological malignancy group, VZV vaccine was well tolerated and estimated vaccine efficacy against herpes zoster was 16·8% (95% CI −17·8 to 41·3). Interpretation The inactivated VZV vaccine was well tolerated and efficacious for herpes zoster prevention in patients with solid tumour malignancies receiving chemotherapy, but was not efficacious for herpes zoster prevention in patients with haematological malignancies. Funding Merck & Co, Inc.

Osteopontin (OPN) is a novel biomarker of various cancers including ovarian carcinoma. OPN is a promising adjunct to a major biomarker of ovarian cancer, CA125, in diagnosis, differential diagnosis and prognosis. The aim of our study was to measure the plasma level of OPN and CA125 in patients with borderline ovarian tumours (BOTs), serous ovarian carcinoma, and controls to determine its potential role in the differential diagnosis between serous ovarian carcinoma and BOT. The plasma samples of 66 women were analysed using Luminex technology, designed to simultaneously measure multiple specific protein targets. The mean OPN plasma level for the control group was 23.3 ng/ml; for BOT 26.3 ng/ml; and for patients with serous ovarian carcinoma 59.5 ng/ml. Specifically, there was a significant difference between the OPN levels in patients with ovarian carcinoma and BOT (P0.001) as well as controls (P0.001). There was no difference between the mean levels of OPN in patients with BOT and the control group (P = 0.286). Using the receiver operating characteristic (ROC), we determined the utility of OPN and CA125 to differentiate between BOT and serous ovarian carcinoma. The area under the ROC curve (AUC) for OPN was 0.793 (95% confidence interval (CI) 0.669-0.917, P0.001) and for CA125 0.766 (95% CI 0.626-0.907, P = 0.002). Based on our data, we suggest that OPN can be used as a possible differential diagnostic biomarker to distinguish between malignant serous ovarian carcinoma and BOT.

To analyze the accuracy of ultrasound in assessing pelvic and intra-abdominal spread in patients with ovarian cancer.This prospective study enrolled all consecutive patients referred to a single gynecological oncology center for suspected ovarian cancer. We analyzed only data from patients with histologically confirmed primary ovarian cancer who were evaluated following predefined preoperative ultrasound, intraoperative and pathology protocols. We evaluated the agreement of depth of infiltration of the rectosigmoid wall, tumor spread in different peritoneal compartments and presence of metastatic retroperitoneal and inguinal lymph nodes, as determined at ultrasound, with intraoperative and histopathological findings.In total, 578 patients were enrolled between March 2008 and January 2013, of whom 394 met the study inclusion criteria and were analyzed; 74% of these suffered from advanced-stage cancer. Our results showed excellent agreement between ultrasound and histology in assessment of rectosigmoid wall infiltration (kappa value, 0.812; area under the receiver-operating characteristics curve, 0.898). The overall accuracy in evaluating different peritoneal compartments, retroperitoneal and inguinal lymph nodes and depth of rectosigmoid wall infiltration was 85.3%, 84.8%, 99.7% and 91.1%, respectively. Ultrasound showed high sensitivity only in the assessment of rectosigmoid wall infiltration (83.1%), peritoneal spread into the pelvis (81.4%) and omentum (67.3%), and inguinal metastatic lymph nodes (100%). The specificity of ultrasound in detection of all evaluated parameters was 90%.This is the largest imaging study to date on ovarian cancer staging. Ultrasound can be used as the method of choice to plan rectosigmoid wall resection and dissection of infiltrated inguinal lymph nodes. In assessing different peritoneal and retroperitoneal compartments, ultrasound was accurate and highly specific. However, similar to other modern imaging techniques, it had relatively low sensitivity, further supporting the role of comprehensive surgical staging. Copyright © 2016 ISUOG. Published by John WileySons Ltd.

Supplemental digital content is available in the text., The first joint European Society for Medical Oncology (ESMO), European SocieTy for Radiotherapy & Oncology (ESTRO) and European Society of Gynaecological Oncology (ESGO) consensus conference on endometrial cancer was held on 11–13 December 2014 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of endometrial cancer. Before the conference, the expert panel prepared three clinically-relevant questions about endometrial cancer relating to the following four areas: prevention and screening, surgery, adjuvant treatment and advanced and recurrent disease. All relevant scientific literature, as identified by the experts, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. Results of this consensus conference, together with a summary of evidence supporting each recommendation, are detailed in this article. All participants have approved this final article.

To examine prospectively the accuracy of ultrasound in predicting rectosigmoid tumor infiltration in patients with epithelial ovarian cancer.Patients referred for a suspicious pelvic mass between 2012 and 2014 were examined by ultrasound following the standard protocol for assessment of tumor infiltration. Of the 245 patients examined, 191 had proven ovarian cancer and underwent primary surgery and were included in the analysis. Patients with apparently benign or inoperable disease were excluded. Rectosigmoid infiltration was evaluated by histopathology or according to perioperative findings. Clinical, pathological and laboratory parameters were analyzed as factors potentially affecting the sensitivity and specificity of sonography.The sensitivity of ultrasound in detecting rectosigmoid infiltration in patients with ovarian cancer was 86.3%, with specificity of 95.8%, positive predictive value of 92.6%, negative predictive value of 91.9% and overall accuracy of 92.1%.Ultrasound is a highly accurate method for detecting rectosigmoid tumor infiltration in ovarian cancer patients, and thus, can be used for planning adequate management, including patient consultation, surgical team planning, suitable operating time and postoperative care. Copyright © 2016 ISUOG. Published by John WileySons Ltd.

Objective: The purpose of this study was to assess the efficacy and safety of a new low-dose oral contraceptive containing ethinylestradiol 20μg and drospirenone 3mg (EE 20μg/drsp 3mg). Methods: This was an open-label, non-comparative, multicentre study conducted at 33 centres in Germany and Switzerland. The combined contraceptive was administered over 26 cycles of treatment, with each cycle consisting of once-daily treatment for 21 consecutive days followed by a 7-day hormone-free interval. Results: A total of 527 women were randomised, of whom 516 (97.9%) started treatment and had at least one study observation. Two pregnancies occurred during 11 165 cycles of treatment, giving a Pearl Index of 0.23 (upper limit of 97.5% CI 0.84). The corresponding 2-year cumulative pregnancy rate was 0.44% (95% CIs 0, 1.05). One of the two pregnancies was attributed to non-compliance with treatment, giving an adjusted Pearl Index of 0.12 (upper limit of 97.5% CI 0.67) over 10 827 compliant cycles. Only three (0.6%) women discontinued treatment because of bleeding problems in this long-term study, suggesting an acceptable bleeding profile. Overall, the study drug was well tolerated and adverse events experienced were typical of hormonal contraceptive use. The majority of women who responded (435 of 501; 86.8%) were satisfied or very satisfied with the study treatment and most (367 of 501; 73.3%) would continue with it if given the choice. Conclusion: The EE 20μg/drsp 3 mg combined oral contraceptive is an effective and well tolerated contraceptive with an acceptable bleeding pattern.

BACKGROUND This paper explores recent developments in female contraception, using them to illustrate how adaptation of existing methods, improved service delivery and understanding contraceptive behaviour might increase contraceptive uptake and correct and consistent use, and how the development of new methods holds some promise for capitalizing on the potential non-contraceptive benefits. METHODS Searches were performed in Medline and other databases. Selection criteria included high-quality studies and studies relevant to clinical reproductive medicine. Summaries were presented and discussed by the European Society of Human Reproduction and Embryology (ESHRE) Workshop Group. RESULTS The topics discussed include: adapted regimens for combined oral contraceptive pills, non-invasive methods of female sterilization, the need to improve the awareness of pregnancy risk to increase the use of emergency contraception, improvements in the evidence base for the safety and service delivery of intrauterine methods, emphasis on the potential benefits of combined oral contraceptives for women with hirsutism and acne, the potential of female sterilization to prevent ovarian cancer, and the promise of anti-progesterones and new approaches to dual protection. CONCLUSIONS Although great strides have been made in recent years in increasing contraceptive use among women in many countries where contraceptive prevalence is low or there is a high unmet need for contraception, much more can, and needs to, be done.

To summarize new data which can help in decision on tailoring treatment of cervical precancerosis.Review article.Department of Gynaecology and Obstetrics, First Faculty of Medicine, Charles University and Hospital Na Bulovce in Prague; Oncogynaecological Center, First Faculty of Medicine, Charles University and General University Hospital in Prague.Precancerous lesions of the cervix are represented by squamous cervical intraepithelial neoplasias (CIN) and glandular adenocarcinomas in situ (AIS). The usual treatment of cervical precancerosis is conisation. However, some complications, particularly subsequent adverse pregnancy outcomes, follow all surgical treat-ments of cervix. The treatment could be postponed in women who wish to conceive and who suffer from CIN with a low risk of transformation to invasive cancer. The presence of modifying factors can help to stratify CIN lesions according to their malignant potential. The determination of detected HPV genotypes may help in this decision, because the fate of CIN 2/3 depends on the genotype of associated HPV infection. Cervical lesions associated with HPV 16, 18 or 45 are at a much higher risk of rapid progression to invasive cancers than lesions associated with other HR HPV genotypes. Surgical treatment of CIN 2/3 in women with a desire for future child-bearing can be postponed in cases non-associated with HPV 16, 18 and 45, on a case by case basis. Attempts are made to improve evaluation of the lesions by using biological and molecular markers, especially p16INK4a staining. Younger age, ongoing pregnancy, favourable colposcopic findings, negative p16INK4a staining and immunocompetency are independent factors supporting the choice of conservative management. Adenocarcinoma in situ management substantially differs from the management of CIN.It is important both to assess all modifying factors correctly and to minimize any harm from unnecessary surgical treatment or overtreatment of cervical precancer lesions.cervical intraepithelial neoplasia, adenocarcinoma in situ, conisation, tailoring treatment, human papillomavirus genotype, p16.

Polycystic ovary syndrome (PCOS) is connected with insulin resistance (IR), and often with the hypersecretion of adrenal androgens. Mutual relationships between IR and adrenal and ovarian steroidogenesis were investigated in the group of 19 oligo/amenorhoeic women with PCOS. The age and body mass index (BMI) of the patients were 21+/-4.7 years and 26.4+/-5 kg/m2 (average+/-SD), respectively. All underwent a 60-minute adrenocorticotrophic hormone (ACTH) stimulation test, a gonadoliberin analogue (GnRHa) test with buserelin and an oral glucose tolerance test (oGTT) in the early follicular phase of the menstrual cycle. When absolute stimulated steroid levels after GnRHa were studied, a significant positive correlation between DHEA and area under curve during oGTT for C peptide (AUC-CP) (r=0.477, p= 0.039) and a borderline negative correlation (r=-0.404, p= 0.087) between AUC-CP and 17-OH progesterone, were found. Considering steroid values after ACTH, a significant positive correlation of IR index was found only with 17-OH-progesterone (r=0.499, p= 0.03). When stimulated enzymatic activities (expressed as product/ precursor ratios) were analyzed using factor analysis, a positive relationship between IR and ovarian C17,20-lyase in both delta4 and delta5 pathway was revealed. On the other hand, no relationship was confirmed between IR and enzymatic activities in the adrenals. The authors conclude that insulin resistance and/or hyperinsulinemia is probably not the primary factor responsible for the exaggerated adrenal androgen secretion found in a great number of patients with PCOS.

To identify major factors in the under- and overestimation of cervical and myometrial invasion by endometrial cancer at preoperative staging by ultrasound.This prospective study involved all patients with histologically confirmed endometrial cancer referred consecutively for surgical staging between January 2009 and December 2011. All patients underwent transvaginal ultrasound examination, obtaining metric and perfusion data, and the results were compared with final histology: myometrial invasion was defined at histology in the final pathology report as being eitheror ≥ 50%, while cervical stromal invasion was reported as being either present or absent, and sonographic over-/underestimation was determined relative to these.Enrolled prospectively into the study were 210 patients. The proportion of cases with sonographic underestimation, relative to final histology, of myometrial invasion (i.e. false-negative estimation of no or superficial invasion 50%) and of cervical invasion (i.e. false-negative finding of absence of stromal invasion) was comparable: 8.6% (n = 18) and 10.5% (n = 22), respectively. Myometrial invasion was overestimated by ultrasound (i.e. false-positive estimation of deep invasion ≥ 50%) in 15.7% (n = 33) of cases, and cervical invasion was overestimated (i.e. false-positive finding of presence of stromal invasion) in 4.8% (n = 10) of cases. These outcomes correspond to positive and negative predictive values of 67.6% (95% CI, 57.7-76.6) and 83.3% (95% CI, 74.9-89.8), respectively, for the subjective assessment of myometrial invasion, and 60.0% (95% CI, 38.2-79.2) and 88.1% (95% CI, 82.5-92.4), respectively, for that of cervical stromal invasion. The staging error in subjective assessment was not related to body mass index (BMI), to the position of the uterus in the pelvis or to image quality. Cervical and myometrial invasion were more often underestimated in well-differentiated endometrial cancers that were smaller in size, with thick minimum tumor-free myometrium and lower perfusion, and more often overestimated in moderately and poorly differentiated cancers that were larger in size, with thin minimum tumor-free myometrium and richer perfusion.The accuracy of subjective assessment of myometrial and cervical invasion by ultrasound was significantly influenced by tumor size, density of tumor vascularization, tumor vessel architecture and histological grading, while it was not significantly affected by BMI, uterine position and image quality.

The incidence of cervical cancers increases with age. Due to the trend of increasing age of first pregnancy, abnormal Pap smears including those classified as atypical glandular cells (AGC) are being found more often in early pregnancy. Once invasive cancer is excluded, conservative management of squamous intraepithelial lesions (SIL) in pregnancy is considered safe; however, optimal management of AGC is not well established. The aim of our study was to evaluate the outcome of patients with AGC diagnosed from smears during pregnancy.The study included 17 patients referred to us in early pregnancy with Pap smears reported as AGC: 11 not otherwise specified (AGC-NOS), five favour neoplasia (AGC-FN) and one adenocarcinoma in situ (AIS). Thirty-one with high-grade SIL (HSIL) Pap smears confirmed on punch biopsy in early pregnancy comprised a control group. Human papillomavirus (HPV) positivity was found in seven patients with persistent AGC-NOS (including all four who had CIN3 postpartum). All the women were initially examined by expert colposcopy and those with AGC-FN or AIS smears also by transrectal ultrasound to exclude invasive endocervical cancer. Follow-up controls were carried out every 8-12 weeks and, if there were no signs of progression, revaluation was scheduled 6-8 weeks after delivery.The mean age of the women was 31.4 years. Conization in one patient in the study group was performed in the 16th week of pregnancy due to colposcopic signs of microinvasive squamous cell cancer confirmed on histology. Progression to invasive cancer was not found in any of the other 16 patients in the study group or in the control group. Cervical intraepithelial neoplasia or AIS was confirmed postpartum by conization or punch biopsy in 47.1% (8/17) of patients in the study group and, in 77.4% (24/31) of patients in the control group.Conservative management of women with AGC in pregnancy is safe where invasive cancer is excluded. As histological verification of glandular pre-cancerous lesions by punch biopsy is not reliable and the postpartum regression rate cannot be determined precisely, conization should be performed in all cases with AGC-FN or AIS. Triage of persistent AGC-NOS with HPV testing is useful in distinguishing significant underlying lesions.

Survey of contraceptive behaviour and attitude of Czech women towards different types of contraception.Representative survey.Anonymous questionnaire survey of the sample of 1011 Czech women aged from 15 to 50.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.Czech women show responsible contraceptive behaviour during their heterosexual intercourse. There is a significant increase of using hormonal contraception.

Malignant vulvar tumors must be treated by radical removal of the tumor as well as a sufficient amount of surrounding healthy tissue. The resulting defects can be resolved by skin transplants, local transfers, skin flaps, muscle flaps or free tissue transfers. We describe the case history of a patient who underwent radical vulvectomy for a malignant tumor with immediate reconstruction by local flaps from the area of inner thighs and mons pubis. The advantages and disadvantages of this method are compared to other reconstructive surgery methods.

Survey of knowledge of Czech and Romanian women about STIs and their perception of sources of the information.Representative survey.Anonymous questionnare survey of the sample of 1011 Czech and 1001 Romanian women aged 15 to 50.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.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.

Survey of attitudes of Czech women toward abortions.Representative survey.Anonymous questionnare survey of the sample of 1011 Czech women aged 15 to 50.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.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.

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.Original article.Department of Gynecology and Obstetrics, First Faculty of Medicine, Charles University in Prague and General Teaching Hospital, Prague.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.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 (p0.01).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.

The aim of the study was to estimate genetic alterations detected in ovarian cancer cells in correlation with other available parameters of histopathological and clinical character and to find important relations with impacts on the cancer prognosis. Additionally, we wanted to compare methods for evaluating genetic changes. Sixty patients with ovarian cancer were included in the study. The histological type and grade were defined, MIB-1 and p53 were estimated using an immunohistochemical method. For genetic testing, both conventional and molecular methods were applied - direct culture and G-banding technique, FISH method with whole chromosome painting probes, and CGH method. The results were submitted to statistical evaluation, using analysis of variances and chi2 test, with Bonnferroni correlations of the significance level. Numerical and structural aberrations have been detected in more than 63 % examined ovarian cancer cases. Patients with extensive chromosomal rearrangements were significantly younger. Specific genetic alterations, including some rare findings such as deletion 22q in 36 % of all ovarian cancer samples, have been found, together with associations between particular prognostic factors.

To summarize available data concerning adrenal hyperandrogenemia caused by 21-hydroxylase deficiency, non-classic adrenal hyperplasia (NCAH).Review article.Department of Gynecology and Obstetrics, General Faculty Hospital and 1st Medical Faculty, Prague.Compilation of published data from scientific literature.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.

Review of literature concerning continuous regimen of combined hormonal contraception.Review article.Department of Obstetrics and gynecology, Charles University, Prague.Review and critical assessment of published data.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.

Review of reconstruction procedures following pelvic exenterations.Review article.Department of Obstetrics and Gynecology, Department of Urology, 1st Department of Surgery, Faculty Teaching Hospital and 1st Medical Faculty of the Charles University, Prague.Review and critical assessment of published data.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.

Discussion of current experiences with abdominal radical trachelectomy in the treatment of early stages of cervical cancer in fertile women.Case-reports.Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Medical Faculty, Charles University, Prague.Presentation of 4 cases of abdominal radical trachelectomy and pelvic lymphadenectomy. Discussion with published data.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.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.

Review of advanced radicality in pelvic exenterations.Review article.Department of Obstetrics and Gynecology, General Faculty Hospital and Ist Medical Faculty of the Charles University, Prague.Review and critical assessment of published data.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.

Review of literature concerning pelvic exenterative procedures.Review article.Department of Obstetrics and Gynecology, Charles University, Prague.Review and critical assessment of published data.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.

Analysis of contemporary knowledge of proteomics and its aplication in diagnostics of ovarian cancer and other malignant tumours.Review article.Department of Gynecology and Obstetrics, 1st Faculty of Medicine, Charles University, Prague.An overview of published data.Proteomics deals with the analysis of proteins present in the organism in normal and pathologic conditions. Protein expression is characteristic of particular types of cells and tissues. The main improvement of protein analysis in clinical practice is early diagnostics of oncological diseases and specification of prognosis.

Analysis of 10-year clinical series of borderline ovarian tumors (BLT) and literature review.Retrospective clinical study.Department of Obstetrics and Gynaecology, 1st Medical Faculty, Charles University and General Faculty Hospital, Prague.Analysis of 38 patients from years 1994-2003 regarding age, histological types, tumor duplicities, role of frozen section, Ca125 levels, operation methods, adjuvant treatment, relaps occurrence, follow-up and survival.Median follow-up was 18.5 months (3-122), median age 51 (16-78).23 serous, 12 mucinous (1 microinvasion), 2 cystadenofibromas and 1 endosalpingiosis. 26 patients of stage IA, 3 of IB, 6 of IC, 1 of IIA, 1 of IIC and 1 IIIB. 3 cases were underestimated by frozen section. 6 tumor duplicities were revealed. Ca125 marker was elevated in 10/23 (43.5%) cases. 12 patients underwent conservative surgery, 3 of them with complete staging including lymphadenectomy. 26 patients had radical operation, 9 of them with full staging. No one lymphonode was positive. 7 patients had primary laparoscopic approach, 6 had more than one operation. Adjuvant chemotherapy was indicated in 3 cases: PTX-CBDCA (IC and IIC) and CBDCA-CFA (IC). 4 patients were lost of evidence. 2/34 evaluated patients (5.9%) had a frank carcinoma recurrence after 3 and 7 years. Both relapsed patients and all 34 evaluable patients live without evidence of disease at present. Our results as well as literature date generate some controversies. Do we need staging lymphadenectomy in all cases (inclusive T1a)? Which parameters identify high-risk group and which patients will benefit from adjuvant (and which one) therapy? Are there not recurrencies of BLT rather second primary malignancies?In spite of 2 recurrences in a group of 34 evaluated cases all patients live without evidence of disease at present. Some management questions are therefore raised.

The authors present a survey of available pharmacological possibilities of treatment of nausea and vomiting aimed at their application in oncological therapy of gynecological neoplastic diseases.A review article. NAME AND ADDRESS OF THE INSTITUTION: Gynecological-Obstetrical Clinic, First Medical Faculty, Charles University and General Faculty Hospital, Praha. SUBJECT AND METHOD OF THE STUDY: A survey of published data from the Czech and foreign professional literature.5-HT3 receptor antagonists take up the most important position in the antiemetic treatment of oncological patients. They efficiently prevent and treat vomiting induced by anticancer drugs with high and very high emetogenic effect. They have been used as monotherapy or in combination with corticoids. In the treatment of nausea and vomiting or vomiting induced by anticancer drugs with medium or light emetogenic effect, antiemetic preparations from the corticoid series and dopamine receptor antagonists may be recommended. In the treatment of anticipation vomiting, benzodiazepines are indicated for their anxiolytic and psychosedative influence.