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Fulltext Pet scan and gynaecological malignancies: Hospital Sultanah Bahiyah experience

Shahila T, Rushdan MN

Med J Malaysia, 2011 Oct;66(4):353-8.
PMID: 22299557 MyJurnal

The objective of this study was to evaluate the role of PET/CT in diagnosing and evaluating patients with suspected gynaecological tumour recurrence and persistent disease following treatment. This cross-sectional study involving 26 patients with gynaecological malignancies was carried out at Hospital Sultanah Bahiyah between 2006 and 2008. The standard imaging modalities disclosed possible tumour recurrence or persistent disease in 24 of the 26 patients (92.3%). Two patients with negative CT were subjected to PET/CT due to persistently elevated serum tumour markers. PET/CT confirmed tumour recurrence in 9 (34.6%) patients and was inconclusive in 2 (7.7%) patients. No abnormal uptake was observed in 15 (57.7%) patients. Of the 9 patients with positive PET/CT, 7 (77.8%) had a repeat PET/CT and 2 (22.2%) had a CT following subsequent treatment which confirmed no further evidence of disease. Patients with negative or inconclusive PET/CT were either continued with routine follow-up or had a close monitoring by either CT or serum tumour markers. With the availability of PET/CT, almost two-third of patients did not have to undergo unnecessary chemotherapy or radiotherapy. Integrated PET/CT imaging offers beneficial effects in both diagnosing and evaluating suspected tumour recurrence and persistent disease in gynaecological malignancies.
Fulltext The prevalence and risk factors of major depressive disorders in gynaecological cancer patients

Tee, B.C., Phang, C.K., Rasidi, A., Rushdan, M., Aliyasand, I., Hatta, S.

Malaysian Journal of Medicine and Health Sciences, 2013;9(2):53-61.
MyJurnal

Major Depressive Disorder (MDD) in gynaecological cancer patients is a disabling illness with significant mental and physical suffering. Determining the risk factors of MDD in cancer patients enables us to pay more attention to those who are vulnerable and to device effective strategies for prevention, early detection, and treatment. The objective of the study is to determine the prevalence of MDD and its associated risk factors in gynaecological cancer patients at Hospital Sultanah Bahiyah, Alor Star. This is a hospital-based cross-sectional descriptive study of 120 gynaecological cancer patients in Gynae-Oncology Unit in Hospital Sultanah Bahiyah, Alor Star. Mini International Neuropsychiatry Interview (MINI) was used for diagnosis of MDD. Socio-demographic data and clinical variables were collected. MVFSFI (Malay version Female Sexual Function Index) was used to determine sexual dysfunction, and WHOQOL-BREF (World Health Organization – Quality of Life-26) was performed to assess quality of life. The prevalence of MDD in gynaecological cancer patients in the study was 18%. The variables found to be significantly associated with MDD were lack of perceived social support, greater physical pain perception, presence of past psychiatric history, and poorer quality of life. Meanwhile, sexual dysfunction was not associated with MDD. Logistic regression analysis revealed that only the psychological health domain of QOL was significantly associated with MDD, and contributed to 60% of the variation in MDD. The prevalence of MDD in gynaecological cancer patients is higher than those in the general population. In view that MDD can compromise cancer prognosis and patient’s well-being, psychosocial intervention is recommended as a part of multi- disciplinary and comprehensive management of gynaecological cancer.
Fulltext Reproductive function after treatment of ovarian germ cell malignancy

Abdullah NA, Rushdan MN

Med J Malaysia, 2012 Feb;67(1):71-6.
PMID: 22582552 MyJurnal

This study was undertaken to evaluate the reproductive and oncologic outcomes of patients diagnosed with Ovarian Germ Cell Malignancy (OGCM) who underwent fertility preserving surgery and adjuvant chemotherapy treated in Gynaecology Oncology Unit, Sultanah Bahiyah Hospital, Kedah, Malaysia.
Tailoring the field and indication of adjuvant pelvic radiation for patients with FIGO stage Ib lymph nodes-negative cervical carcinoma following radical surgery based on the GOG score--a pilot study

Rushdan MN, Tay EH, Khoo-Tan HS, Lee KM, Low JH, Ho TH, et al.

Ann Acad Med Singap, 2004 Jul;33(4):467-72.
PMID: 15329758

INTRODUCTION: The traditional indications for adjuvant pelvic radiotherapy (RT) for International Federation of Obstetrics and Gynecology (FIGO) stage Ib1 lymph nodes-negative cervix carcinoma following radical surgery based on histopathological factors, such as deep stromal invasion and lymphovascular space invasion (LVSI), were often inconsistently applied. The perceived risk of relapse was subjectively determined. This pilot study attempts to determine if the treatment outcome will be affected when the indication for RT is based on the Gynecologic Oncology Group (GOG) Risk Score (RS) and the field of adjuvant RT is tailored to the RS.
MATERIALS AND METHODS: From 1997 to 1999, 55 patients with FIGO stage Ib1 lymph nodes-negative cervical carcinoma limited to the cervix were prescribed RT following radical surgery, based on their RS, as follows: RS <40, RT is omitted; RS >40 to <120, modified (smaller) field RT; and RS >120, standard field pelvic RT. Their incidence and site of recurrence were compared with a similar cohort of 40 patients who were treated prior to 1997.
RESULTS: Prior to 1997, of the 40 patients, 10 patients were given standard field RT. There were 2 (5%) recurrent diseases. The mean duration of follow-up was 61.6 months (range, 1 to 103 months). The RS of 23 of the 30 patients who were not given RT were available. The mean RS was 22 with 5 patients having a score of >40. From 1997 onwards, of the 55 patients, 28 (51%) did not require RT, 13 (23%) were treated with modified (smaller) field RT and 14 (26%) were given standard field RT. There were 2 (3.6%) cases of relapse. The mean duration of follow-up was 36.4 months (range, 5 to 60 months). All patients with a RS of <40 did not suffer any relapse. Their survival outcomes were better when compared to patients who did not have any RT in the GOG Study.
CONCLUSIONS: The results of this study indicated that postoperative adjuvant RT given to patients with a high GOG RS of >120, significantly improved their 5-year recurrence rate and disease-free survival, as compared with the similar group of patients who were without adjuvant therapy in the GOG study. Patients with a GOG risk-score of <40 may be safely spared from adjuvant pelvic RT. The current treatment protocol did not compromise the outcome in patients, compared with the use of a less precise treatment protocol in the past.