Consequences du traitement des neoplasies intraepitheliales cervicales par laser CO2 sur l'integrite anatomique et fonctionnelle du col uterin. [Consequences of laser CO2 treatment of cervical intraepithelial neoplasias on the anatomic and functional integrity of the cervix]

OBJECTIVES. Retrospective study to analyse objectively the effectiveness and anatomic and functional consequences for the cervix of conservative CO2 laser treatment for cervical intraepithelial neoplasia. PATIENTS AND METHODS. Analysis of therapeutic effectiveness and anatomic consequences of 1,114 treated patients followed at our colpolaparotomy surgery clinic for cervical dysplasia since 1987. Evaluation of function consequences by comparison with a group of patients who delivered after laser CO2 therapy for dysplasia (n = 56) and a group of control patients (n = 95) with a similar type of dysplasia after delivery and no treatment. The clinical course of the pregnancy and delivery were compared between the groups in search for risk of prematurity. RESULTS. Good preservation of cervical anatomy was achieved after a rigorous treatment protocol only applicable with CO2 laser. The preservation of the junctional zone facilitated diagnosis of recurrence. The risk of prematurity was low. Therapy was successful in 93.4% of the cases. CONCLUSION. The choice of conservative therapy is essential, not only when the patient desires a pregnancy but also in others since preserved anatomy facilitates diagnosis of recurrence. This findings implicate the need for an unagressive energy source and also accepting the early diagnosis and treatment

Salvage chemotherapy with mitomycin, vindesine, and cisplatin (MiViP) in recurrent carcinoma of the cervix.

The combination of mitomycin (8 mg/m(2), i.v., day 1), vindesine (3 mg /m(2), i.v., days 1 and 8), and cisplatin (60 mg/m(2), i.v., day 1) (MiViP) was evaluated in 12 patients with recurrent carcinoma of the cervix. The number of treatment courses ranged from two to eight, with a median of five. Three patients achieved complete remission and six patients showed partial remission, giving and overall response rate of 75%. The median survival was 18 months, with 22 months for responding patients, and 5 months for nonresponding patients (p < 0.01). The major toxicity was myelosuppression. We conclude that MiViP can effectively be used in recurrent carcinoma of the cervix