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I197 Comparison of results with different treatment methods
Invited presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S1–S92
Eastern Europe. Fifty four countries accepted to participate and prepared a situational analysis and 43 of them had a plan of action approved by the government and the national Society. Plans of action are currently in full execution in most countries. During all this process FIGO has sought and obtained the collaboration of other institutions with similar purpose and global action, described in detail by other colleague in this session. I195 Introduction of misoprostol for incomplete abortion care in Latin America: Evidence from Ecuador M. Arellano, J. Durocher, W. Leon ´ 1 , R. Montesinos, M. Pena, ˜ 1 B. Winikoff. Hospital Gineco-Obst´etrico Isidro Ayora, Quito, Ecuador Introduction: In Latin America, legal access to abortion is essentially unavailable, resulting in a large volume of abortion complications in private and public health care settings. This study will assess the feasibility of introducing misoprostol for treatment of incomplete abortion. Methods: In Quito, Ecuador, women with diagnosed incomplete abortion were randomized to receive either 600 mcg misoprostol orally (n = 120) or manual vacuum aspiration (MVA) (n = 120). This study was conducted at a large tertiary-level maternity hospital and a small private family planning clinic. All study participants were requested to return for a follow-up visit on day 7 to determine that their abortion was complete. Women’s satisfaction with method and acceptability of side effects were documented at the follow-up visit. Results: Sixteen percent of women (39/242) did not return for their follow-up visit and their outcome is unknown. Among those who did, 94% (100/106) had successfully completed their abortion following treatment with misoprostol, compared with 100% (97/97) in the MVA group. Most women described their side effects posttreatment as tolerable (misoprostol 95% vs. MVA 91%). Majority of women reported being satisfied with their treatment (196/203); there were no differences in women’s reports of satisfaction by treatment received. Conclusions: A 600 mcg dose of oral misoprostol is an acceptable and effective non-surgical option for treating incomplete abortion. This study is the first of its kind in Ecuador and is facilitated by strong interest in seeing the method integrated into safe motherhood initiatives and training. I196 Mastodynia: Prevalence and patient care B. Letombe1 , P. De Reilhac2 , D. Serfaty3 , M.-C. De Lunardo4 , & F.N.C.G.M.. 1 CHRU Hˆ opital Jeanne De Flandre, Avenue Eug`ene Avin´ee, 59037 Lille Cedex; 2 3 place Ladmirault, 44000 Nantes; 3 9, rue Villersexel, 75007 Paris; 4 Laboratoire Th´eramex, 6 avenue Albert II, BP 59, 98007 Monaco Cedex, France Objectives: Estimate prevalence of mastodynia in France, among gynaecologists, excluding pregnant and lactating women, and know characteristics of these mastodynia and their care. Material and Methods: Cross study on a given day. Results: 347 gynaecologists included 5635 patients (mean age: 43.8+15.4 years), 32.9% of them were postmenopausal and 67.1% not (including 9.1% in perimenopause). Prevalence of mastodynia was 21.8%; it was higher before menopause (25.7%) than after (13.1%) (P < 0.0001) and significantly higher in perimenopause (33.7%) than before (24. 4%). Women have complained spontaneously in only 46.4%. Mastodynia were bilateral and cyclical (76.6% and 50.6% respectively). They lasted 7 days or less in 67.3% of women. They were moderate to severe (44.1%), isolated (62.1%). Their care included: reassuring words alone or in combination (64.8%), dietary guidelines (16.8%), local treatment (31.6%), systemic treatment (14.6%) including hormones (62.8% and especially progestogen (67.6%) or progesterone (32.4%)). Rate of use of several treatments
S49
was highest in severe intensity breast pain, from 31.6% (light) to 47.8% (severe). Conclusion: Mastodynia concerned over a fifth of this population. Systematic search of breast pain seems important, since the complaint was spontaneous in less than one out of two, to establish monitoring of women at risk. Care was multifaceted. I197 Comparison of results with different treatment methods J. Leveque The treatments of CIN2/3 are (a) conservative as laser ablation (visualisation of the entire TZ, no invasive/glandular disease, (b) excisional as Cold Knife Biopsy (CKB) and LEEP. The success rates of the different methods are from 90% to 95%: – CKB should be reserved for the case with suspicion of invasion or glandular lesions, – the gold standart is LEEP under local analgesia in case of exocervical lesions, – laser ablation is indicated in front of small CIN2 lesions of the exocervix. All the treatments have adverse pregnancy outcomes, especially CKB: number-needed-to-treat-to-observe-harm CKB vs LEEP: (a) perinatal morbidity 71/500; (b) preterm delivery 30/143; low birth weight <1500 g 36/670. The critical threshold in the amount of tissue removed by LEEP is 1 cm. The risk of recurrence of CIN2/3 is highest in 6 years after the treatment and the risk factors are the age of 40 years and older, the CIN grade, and perhaps the treatment (the risk is increasing from KNB to cryotherapy). On the contrary, the women treated for a CIN are at high and extended risk of invasive carcinoma whatever the grade and the treatment of the CIN. A long term surveillance after their therapy is needed. Reference(s) [1] Arbyn M. BMJ 2008;337:a1284. [2] Kalliala I. Gynecol Oncol 2007;105:228–33. [3] Kyrgiou M. Cancer Treat Rev 2006;32:516–23. [4] Martin-Hirsch PL. Cochrane Database Syst Rev 2000:CD001318. [5] Melnikow J. J Natl Cancer Inst 2009;101:721–8. [6] Soutter WP. Int J Cancer 2006;118:2048–55.
I198 Chemoradiation versus chemosurgery G. Lindeque Patients presenting with cervical cancer in FIGO Stage I is regarded as having early stage disease and is mostly treated with various forms of surgery. In Stage IB2 however the tumour volume poses a therapeutic problem and in many cases radical surgery would not constitute complete treatment. Patients presenting in all other FIGO stages are considered to have late stage disease. The standard of care for late stage disease is concurrent chemoradiation. Use of a platinum based chemotherapy plan together with external beam radiation has been shown to increase the absolute survival by at least 12% compared to treatment with radiotherapy alone. The use of neoadjuvant chemotherapy prior to radical surgery in patients with large volume local disease as well as in nonmetastatic advanced stage diseased has been studied and reported from many centres. There seems to be consensus that operability is achieved but there is no consensus that survival can be consistently improved. The concept thus remains that chemoradiation is regarded as standard practice for patients with late stage disease while neoadjuvant chemotherapy remains and experimental modality.
Eastern Europe. Fifty four countries accepted to participate and prepared a situational analysis and 43 of them had a plan of action approved by the government and the national Society. Plans of action are currently in full execution in most countries. During all this process FIGO has sought and obtained the collaboration of other institutions with similar purpose and global action, described in detail by other colleague in this session. I195 Introduction of misoprostol for incomplete abortion care in Latin America: Evidence from Ecuador M. Arellano, J. Durocher, W. Leon ´ 1 , R. Montesinos, M. Pena, ˜ 1 B. Winikoff. Hospital Gineco-Obst´etrico Isidro Ayora, Quito, Ecuador Introduction: In Latin America, legal access to abortion is essentially unavailable, resulting in a large volume of abortion complications in private and public health care settings. This study will assess the feasibility of introducing misoprostol for treatment of incomplete abortion. Methods: In Quito, Ecuador, women with diagnosed incomplete abortion were randomized to receive either 600 mcg misoprostol orally (n = 120) or manual vacuum aspiration (MVA) (n = 120). This study was conducted at a large tertiary-level maternity hospital and a small private family planning clinic. All study participants were requested to return for a follow-up visit on day 7 to determine that their abortion was complete. Women’s satisfaction with method and acceptability of side effects were documented at the follow-up visit. Results: Sixteen percent of women (39/242) did not return for their follow-up visit and their outcome is unknown. Among those who did, 94% (100/106) had successfully completed their abortion following treatment with misoprostol, compared with 100% (97/97) in the MVA group. Most women described their side effects posttreatment as tolerable (misoprostol 95% vs. MVA 91%). Majority of women reported being satisfied with their treatment (196/203); there were no differences in women’s reports of satisfaction by treatment received. Conclusions: A 600 mcg dose of oral misoprostol is an acceptable and effective non-surgical option for treating incomplete abortion. This study is the first of its kind in Ecuador and is facilitated by strong interest in seeing the method integrated into safe motherhood initiatives and training. I196 Mastodynia: Prevalence and patient care B. Letombe1 , P. De Reilhac2 , D. Serfaty3 , M.-C. De Lunardo4 , & F.N.C.G.M.. 1 CHRU Hˆ opital Jeanne De Flandre, Avenue Eug`ene Avin´ee, 59037 Lille Cedex; 2 3 place Ladmirault, 44000 Nantes; 3 9, rue Villersexel, 75007 Paris; 4 Laboratoire Th´eramex, 6 avenue Albert II, BP 59, 98007 Monaco Cedex, France Objectives: Estimate prevalence of mastodynia in France, among gynaecologists, excluding pregnant and lactating women, and know characteristics of these mastodynia and their care. Material and Methods: Cross study on a given day. Results: 347 gynaecologists included 5635 patients (mean age: 43.8+15.4 years), 32.9% of them were postmenopausal and 67.1% not (including 9.1% in perimenopause). Prevalence of mastodynia was 21.8%; it was higher before menopause (25.7%) than after (13.1%) (P < 0.0001) and significantly higher in perimenopause (33.7%) than before (24. 4%). Women have complained spontaneously in only 46.4%. Mastodynia were bilateral and cyclical (76.6% and 50.6% respectively). They lasted 7 days or less in 67.3% of women. They were moderate to severe (44.1%), isolated (62.1%). Their care included: reassuring words alone or in combination (64.8%), dietary guidelines (16.8%), local treatment (31.6%), systemic treatment (14.6%) including hormones (62.8% and especially progestogen (67.6%) or progesterone (32.4%)). Rate of use of several treatments
S49
was highest in severe intensity breast pain, from 31.6% (light) to 47.8% (severe). Conclusion: Mastodynia concerned over a fifth of this population. Systematic search of breast pain seems important, since the complaint was spontaneous in less than one out of two, to establish monitoring of women at risk. Care was multifaceted. I197 Comparison of results with different treatment methods J. Leveque The treatments of CIN2/3 are (a) conservative as laser ablation (visualisation of the entire TZ, no invasive/glandular disease, (b) excisional as Cold Knife Biopsy (CKB) and LEEP. The success rates of the different methods are from 90% to 95%: – CKB should be reserved for the case with suspicion of invasion or glandular lesions, – the gold standart is LEEP under local analgesia in case of exocervical lesions, – laser ablation is indicated in front of small CIN2 lesions of the exocervix. All the treatments have adverse pregnancy outcomes, especially CKB: number-needed-to-treat-to-observe-harm CKB vs LEEP: (a) perinatal morbidity 71/500; (b) preterm delivery 30/143; low birth weight <1500 g 36/670. The critical threshold in the amount of tissue removed by LEEP is 1 cm. The risk of recurrence of CIN2/3 is highest in 6 years after the treatment and the risk factors are the age of 40 years and older, the CIN grade, and perhaps the treatment (the risk is increasing from KNB to cryotherapy). On the contrary, the women treated for a CIN are at high and extended risk of invasive carcinoma whatever the grade and the treatment of the CIN. A long term surveillance after their therapy is needed. Reference(s) [1] Arbyn M. BMJ 2008;337:a1284. [2] Kalliala I. Gynecol Oncol 2007;105:228–33. [3] Kyrgiou M. Cancer Treat Rev 2006;32:516–23. [4] Martin-Hirsch PL. Cochrane Database Syst Rev 2000:CD001318. [5] Melnikow J. J Natl Cancer Inst 2009;101:721–8. [6] Soutter WP. Int J Cancer 2006;118:2048–55.
I198 Chemoradiation versus chemosurgery G. Lindeque Patients presenting with cervical cancer in FIGO Stage I is regarded as having early stage disease and is mostly treated with various forms of surgery. In Stage IB2 however the tumour volume poses a therapeutic problem and in many cases radical surgery would not constitute complete treatment. Patients presenting in all other FIGO stages are considered to have late stage disease. The standard of care for late stage disease is concurrent chemoradiation. Use of a platinum based chemotherapy plan together with external beam radiation has been shown to increase the absolute survival by at least 12% compared to treatment with radiotherapy alone. The use of neoadjuvant chemotherapy prior to radical surgery in patients with large volume local disease as well as in nonmetastatic advanced stage diseased has been studied and reported from many centres. There seems to be consensus that operability is achieved but there is no consensus that survival can be consistently improved. The concept thus remains that chemoradiation is regarded as standard practice for patients with late stage disease while neoadjuvant chemotherapy remains and experimental modality.