Atthapon Jaishuen

Treatment outcomes of early‐stage endometrial cancer patients: A propensity score matching of vaginal brachytherapy versus pelvic radiotherapy

AbstractObjectivesThis study aimed to report the treatment outcomes of radiation therapy for early‐stage endometrial cancer patients. In addition, this study intended to identify high‐risk factors that require pelvic radiotherapy (PRT) in addition to vaginal brachytherapy (VBT) for intermediate‐risk endometrial cancer patients.MethodsPatients with early‐stage endometrial cancer receiving postoperative VBT alone or with PRT were included. Propensity score matching was used to balance the two study groups. The primary endpoint was locoregional recurrence (LRR). Age‐adjusted Charlson comorbidity index and substantial lymphovascular space invasion were selected for subgroup analyses to identify the benefits of PRT over VBT alone.ResultsFrom 2005 to 2017, a total of 288 patients underwent analysis following propensity score matching. Of these, 144 received VBT and 144 received PRT. There was no significant difference in 5‐year LRR between VBT and PRT for both intermediate (0% vs. 0%) and high‐intermediate risk patients (3.5% VBT vs. 5.4% PRT; HR 0.54: 0.05–6.00; p = 0.616). The subgroup analyses revealed no significant factors favoring PRT over VBT. Patients with high comorbidities may have higher risks of non‐cancer death after receiving PRT.ConclusionsPostoperative VBT alone is sufficient for early‐stage intermediate‐risk endometrial cancer patients.

Prospective comparative trial comparing O‐RADS, IOTA ADNEX model, and RMI score for preoperative evaluation of adnexal masses for prediction of ovarian cancer

AbstractIntroductionPreoperative assessment of ovarian tumors to distinguish between benign and malignant is important. At this time, many diagnostic models were available and the popularity of the risk of malignancy index (RMI) in Thailand is still high. The IOTA Assessment of Different NEoplasias in adneXa (ADNEX) model and the Ovarian‐Adnexal Reporting and Data System (O‐RADS) model were both new models with good performance.ObjectivesThe purpose of this study was to compare O‐RADS, RMI, and ADNEX models.DesignThis diagnostic study was performed using data from the prospective study.MethodsData from 357 patients from a previous study were included and calculated using the RMI‐2 formula then applied to the O‐RADS system and the IOTA ADNEX model. The diagnostic significance of the results was evaluated by receiver operating characteristic (ROC) analysis and pairwise comparison between models was made.ResultsThe area under the receiver operating characteristic curve (AUC) to distinguish an adnexal mass as a benign or malignant tumor was 0.975 (95% CI, 0.953–0.988) for the IOTA ADNEX model; 0.974 (95% CI, 0.960–0.988) for O‐RADS; 0.909 for RMI‐2 (95% CI, 0.865–0.952). There were no differences in pairwise AUC comparisons between the IOTA ADNEX and O‐RADS models, and both were better than those of RMI‐2.ConclusionsThe IOTA ADEX and O‐RADS models are excellent tools for distinguishing the adnexal mass in the preoperative assessment and were better than RMI‐2. The use of one of these models is recommended.

A comparison of high‐risk human papillomavirus DNA detection between urine and cervical sample testing in women with abnormal Pap smears

AbstractAimsTo compare the clinical performance of high‐risk human papillomavirus (hrHPV) DNA detection between urine and cervical samples collected from the same patient for the detection of CIN2+ lesions (high‐grade squamous intraepithelial lesions or cervical cancer lesions). The secondary objectives were to evaluate agreement among hrHPV genotypes and to compare patient satisfaction between urine and cervical sample collection.MethodsThis prospective cross‐sectional study enrolled 96 women with abnormal cervical cytology who attended the colposcopy clinic at Siriraj Hospital (Bangkok, Thailand) between July 2016 and January 2017. Self‐collected random‐voiding and first stream urine samples were collected into a universal sterile urine container and immediately mixing with preservative before the pelvic examination. Cervical tissue sampling was performed according to standard treatment guidelines. Both specimens were sent for extraction and detection of hrHPV by Anyplex II HPV high‐risk testing. Study patients were surveyed to compare patient satisfaction between urine and cervical sample collection.ResultsCarcinogenic hrHPV positive rate was 73% in urine samples and 81% in cervical samples. The sensitivity for HPV in the detection CIN2+ was high in both the urine and cervical groups at 86.2% and 94.8%, respectively. Agreement between the urine and cervical groups for HPV 16 or 18 detection was high, with kappa values of 0.86 for subtypes 16/18. Urine specimen collection had significantly higher satisfaction and acceptability than cervical specimen collection.ConclusionUrine hrHPV testing by real‐time polymerase chain reaction demonstrated high sensitivity and accuracy for the detection of CIN2+ lesions, with very good agreement when compared with cervical sample testing.