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Abramson Cancer CenterNCI CANCERLIT® Search: Therapy of Cervical Cancer - April 2002
National Cancer Institute®
Last Modified: April 1, 2002
Table of Contents
1
UI - 11803143
AU - Rose PG
TI -
Chemoradiotherapy for cervical cancer.
SO - Eur J Cancer 2002 Jan;38(2):270-8
AD - Division of Gynecologic Oncology, University Hospitals of Cleveland and
The Ireland Cancer Center, Case Western Reserve University, Cleveland,
OH 44106, USA. peter.rose@uhhs.com
Cervical cancer remains a major health problem worldwide, despite
advances in screening. For patients with locally advanced stage disease,
failure to obtain local-regional control usually results in death. In an
effort to improve local-regional tumour control, neoadjuvant and
concurrent chemoradiation has been tested. Recently, five randomised
trials performed by the Gynecologic Oncology Group (GOG), Radiation
Therapy Oncology Group (RTOG) and the SouthWest Oncology Group (SWOG)
studying cisplatin-based chemoradiation have demonstrated a significant
survival advantage. Three of the trials compared cisplatin-based
concurrent chemotherapy and radiation to radiation alone and two trials
compared cisplatin-based concurrent chemotherapy and radiation to
radiation with hydroxyurea. In all of the trials, cisplatin-based
chemotherapy administered concurrently with radiation therapy was more
effective at reducing the risk of death by 30-50%. Acute toxicities,
principally neutropenia and gastrointestinal, were more common with
chemoradiation, but were transient and the rates of late complications
(complications that persisted or occurred for more than 60 days after
the treatment) were similar. Based on the results of these five
randomised trials, the National Cancer Institute (NCI) released a
Clinical Announcement stating that cisplatin-based chemotherapy, as used
in these trials (i.e. concurrently with radiation therapy), as the new
standard of therapy for cervical cancer.
2
UI - 11899688
AU - el Mrabet F; Ferhati D; Berkhli S; el Hanchi Z; Rhrab B; Lakhdar A;
TI -
Baidada A; Kettani F; Kharbach A; Chaoui A
[Primary malignant non-Hodgkin's lymphoma of the cervix uteri]
SO - Presse Med 2002 Feb 23;31(7):318
3
UI - 11899675
AU - Gallocher O; Thomas L; Stockle E; Bussieres E; Floquet A; Avril A;
TI -
Pigneux J
[First surgery followed by vaginal curietherapy in small-volume uterine
cervix cancer: an alternative to the association of uterovaginal
curietherapy and surgery]
SO - Cancer Radiother 2002 Feb;6(1):10-4
AD - Service de radiotherapie, institut Bergonie, centre regional de lutte
contre le cancer, 229, cours de l'Argonne, 33076 Bordeaux, France.
PURPOSE: Evaluate the results of the treatment of small uterine cervix
cancer with the association of surgery and postoperative vaginal
brachytherapy, without unfavourable prognostic factors. PATIENTS AND
METHODS: After radical hysterectomy with lymphadenectomy, 29 women (mean
age: 44 years) with carcinoma < 25 mm (26 stage IB1, 3 IIA, mean size:
15 mm) were treated by post-operative prophylactic vaginal brachytherapy
using low dose rate. Ovarian transposition was performed at the surgical
time in 14 young women (mean age 35 years). RESULTS: The actuarial
specific survival rates at 5 and 10 years were 100% and 90%
respectively, with a mean follow-up 75 months. Only one local recurrence
was observed. The rate of grade 1 post-operative complication was 7%.
The conservation rate of the ovarian function was 85% for young women.
CONCLUSION: Treatment of small volume uterine cervix cancer using first
surgery and post-operative vaginal brachytherapy is a reliable
therapeutic option. The results in terms of specific survival and
complications are the same with those after standard association of
preoperative uterovaginal brachytherapy and surgery.
4
UI - 11865755
AU - Sipos N; Szantho A; Csapo Z; Balega J; Demeter A; Papp Z
TI -
[Transposition of ovaries during radical hysterectomy for cervical
cancer]
SO - Orv Hetil 2002 Jan 27;143(4):189-92
AD - Altalanos Orvostudomanyi Kar, I. Szuleszeti es Nogyogyaszati Klinika,
Semmelweis Egyetem, Budapest.
INTRODUCTION: 422 radical hysterectomies were performed for cervical
Department of Obstetrics and Gynecology, Semmelweis Medical University.
At least one of the ovaries was conservated and suspended in 21 cases.
AIM(S): The aim of this study is to preserve ovaries guaranteeing
natural oestrogen production for young patients suffering in early stage
cervical cancer, and to prove appropriate efficacy of their method.
PATIENTS/METHOD(S): According to present examinations transposition of
ovary (21 patients) and radiotherapy made as a part of the protocol can
only slightly influence the endocrine function of ovary. RESULTS: Only
in one case of 21 a hormonal substitution was needed for treating
menopausal syndrome. Studying histopathologically ovaries removed during
422 radical hysterectomies the authors could not find any metastasis
given by early stage (I/A2 or I/B) cervical cancer. Following and
controlling their patients after ovarial transpositions for a long
period they could not observe any pathological ovarial disorder (cyst).
CONCLUSION(S): According to the data of international literature the
authors conclude, that transposition of ovaries during radical
hysterectomy for well-selected, younger aged, early staged cervical
cancer cases can result only a low risk, but much better quality of life
for the patients.
5
UI - 11917578
AU - Heber E; Schwint AE; Sartor B; Nishihama S; Sanchez O; Brosto M; Itoiz
TI -
ME
AgNORs as an early marker of sensitivity to radiotherapy in gynecologic
cancer.
SO - Acta Cytol 2002 Mar-Apr;46(2):311-6
AD - Department of Radiobiology, National Atomic Energy Commission, Avenida
del Libertador 8250 (1429), Buenos Aires, Argentina.
OBJECTIVE: To evaluate the changes induced in silver-stained nucleolar
organizer regions (AgNORs) by the first fraction of a radiotherapy
protocol for gynecologic cancer on exfoliated cytologic samples to
predict the therapeutic success of the full protocol. STUDY DESIGN:
Thirteen gynecologic cancer patients who were scheduled for radiotherapy
were included in the study. Cell smears were taken from the affected
area before and after the first fraction of a radiotherapy protocol and
silver stained for AgNORs. AgNORs per nucleus were counted under a light
microscope. Local disease control by the full radiotherapy protocol was
assessed at one year by the Papanicolaou technique. RESULTS: Local
success of radiotherapy was greater for lesions with higher pretreatment
AgNOR counts and for lesions that underwent a greater percentage
reduction in AgNOR counts after the first fraction. We correlated local
success of the full radiotherapy protocol with a predictive index based
on AgNOR counts obtained before and after the first fraction.
CONCLUSION: A predictive index based on AgNOR counts can predict, as
early as after the first fraction, the local control of disease by a
full radiotherapy protocol. Knowledge of the probability of success long
before the protocol is completed would allow reevaluation of therapeutic
options.
6
UI - 11845768
AU - Petersen WO; Trapp MA; Vierkant RA; Sellers TA; Kottke TE; de Groen PC;
TI -
Nicometo AM; Kaur JS
Outcomes of training nurses to conduct breast and cervical cancer
screening of Native American women.
SO - Holist Nurs Pract 2002 Jan;16(2):58-79
AD - Department of Health Sciences Research, Mayo Clinic Comprehensive Cancer
Center, Rochester, Minnesota, USA.
Native WEB (Women Enjoying the Benefit) is a unique training program for
nurses employed by the Indian Health Service (IHS), tribal clinics, and
other clinics with large, underserved populations. It teaches nurses
breast and cervix cancer screening techniques and trains them to
administer and maintain high-quality screening programs that include
patient outreach, education, and training. We review American Indian
(AI)/Alaska Native (AN) women's need for screening services, identify
some of the obstacles to screening, and present our evaluation of the
Native WEB's impact on clinics, nurses, and patients. Findings show that
Native WEB training is associated with increased screening activity at
all three levels.
7
UI - 11919241
AU - Bloss JD; Blessing JA; Behrens BC; Mannel RS; Rader JS; Sood AK; Markman
TI -
M; Benda J
Randomized trial of cisplatin and ifosfamide with or without bleomycin
in squamous carcinoma of the cervix: a gynecologic oncology group study.
SO - J Clin Oncol 2002 Apr 1;20(7):1832-7
AD - Division of Gynecologic Oncology, Ellis Fischel Cancer Center,
University of Missouri Health Sciences Center, Columbia, USA.
PURPOSE: Phase II trial reports have suggested that the addition of
bleomycin to the combination of cisplatin and ifosfamide may improve
response rates and possible survival in squamous carcinoma of the
cervix. This study prospectively evaluates the combination of bleomycin
to this regimen in women with histologically proven advanced recurrent
or persistent squamous cell carcinoma of the cervix. PATIENTS AND
METHODS: Eligible women were randomized to receive either cisplatin (50
mg/m(2)), ifosfamide (5 g/m(2) over 24 hours), and mesna (6 g/m(2)
during ifosfamide infusion and the following 12 hours) (CI) versus
bleomycin 30 units over 24 hours on day 1 followed by cisplatin (50
mg/m(2)), ifosfamide (5 g/m(2) over 24 hours), and mesna (6 g/m(2)
during ifosfamide infusion and the following 12 hours) (CIB). Three
hundred three women were enrolled onto this trial, of which 287 were
assessable. RESULTS: There were no significant differences between CI
and CIB with regard to response rates (32% v 31.2%, respectively),
progression-free survival (PFS), or overall survival. PFS and survival
were associated with initial performance status (PS). Patients with a PS
of 0 experienced a lower rate of failure (P =.013) and a lower risk of
death (P =.009) compared with patients with PS of 2. The most frequent
grade 3/4 toxicities were leukopenia, neutropenia, anemia,
thrombocytopenia, and nausea and vomiting. Neither regimen was
associated with a significant increase in incidence of these toxicities.
CONCLUSION: The CI regimen was virtually identical to CIB with regard to
response rate, PFS, survival, and toxicity profile. Thus, the addition
of bleomycin in the dose-schedule employed to cisplatin and ifosfamide
did not improve outcome in patients with advanced cervical cancer.
8
UI - 11012341
AU - Eifel PJ
TI -
Chemoradiation for carcinoma of the cervix: advances and opportunities.
SO - Radiat Res 2000 Sep;154(3):229-36
AD - Division of Radiation Oncology, The University of Texas M. D. Anderson
Cancer Center, Houston 77030, USA.
Although it is possible to cure many patients with locally advanced
cervical cancer using radiation therapy alone, loco-regional relapse
continues to be a component of most recurrences. To improve control
rates, clinicians have investigated ways of combining chemotherapy and
radiation for more than 30 years. Despite encouraging results from phase
II trials of neoadjuvant chemotherapy, randomized trials failed to
improve on the results with radiation therapy alone. For a number of
reasons, early trials of concurrent chemoradiation were inconclusive.
However, recent reports of five large prospective randomized trials
demonstrated dramatic improvements in survival and local control rates
when cisplatin-containing chemotherapy was given during radiation
therapy. These results also suggest a number of avenues for future
research.
9
UI - 11448246
AU - van der Zee J; Burger CW; Koper PC
TI -
Comments on "Chemoradiation for carcinoma of the cervix: advances and
opportunities" by Patricia Eifel (Radiat. Res. 154, 229-236, 2000).
SO - Radiat Res 2001 Aug;156(2):221-2
10
UI - 11697821
AU - Ferrandina G; Filippini P; Ferlini C; Maggiano N; Stoler AB; Fruscella
TI -
E; Mozzetti S; Mancuso S; Freedman RS; Scambia G; Ranelletti FO
Growth inhibitory effects and radiosensitization induced by fatty
aromatic acids on human cervical cancer cells.
SO - Oncol Res 2001;12(9-10):429-40
AD - Department of Gynecology/Obstetrics, Catholic University, Rome, Italy.
Evidences have been reported that phenylacetic (PA) and phenylbutyric
(PB) fatty aromatic acids can exert tumor growth inhibition in vitro and
in vivo. Moreover, clinical trials also showed some activity for these
drugs to modulate the expression of genes implicated in tumor growth,
metastasis, immunogenicity, and to potentiate the efficacy of cytotoxic
agents. The aim of the study was to examine the effects of PA and PB on
the growth as well as sensitization to cisplatin and radiation in human
cervical cancer cells. The effects of PA and PB on the proliferative
activity and apoptosis induction in cervical tumor tissue was
investigated. Both PA and PB exhibited a time- and dose-dependent
antiproliferative activity in SW756 and ME180 cell lines: after 72-h
treatment, the IC50 (concentration able to inhibit 50% of cell growth)
of PB was 1.9 +/- 0.2 mM and 1.5 +/- 0.2 mM in SW756 and ME180 cells,
respectively, while the IC50 of PA was 13.0 +/- 1.7 mM and 10.0 +/- 1.2
mM in SW756 and ME180 cells, respectively. In tumor tissue biopsies
obtained from patients affected by squamous cervical cancer, both drugs
resulted in a marked reduction of the percentage of
bromodeoxyuridine-labeled cells compared with untreated samples [19.0
+/- 1.63% in untreated tissues with respect to 1.30 +/- 0.54% and 4.20
+/- 2.50% of stained cells after treatment with PA (30 mM) (P < 0.0001)
and PB (5 mM) (P < 0.0001), respectively]. Moreover, analysis of the
staining with M30 monoclonal antibody revealed that PA (30 mM) and PB (5
mM) were able to produce a marked increase in the number of stained
apoptotic nuclei with respect to untreated samples. Finally, PB and PA
were shown to enhance the sensitivity of SW756 to radiation and to exert
an additive effect when combined with cisplatin. A significant reduction
of the processed form of p21ras and rhoB proteins in the membrane
fraction of cells exposed to PA and PB was observed. When farnesol,
which is able to circumvent the enzymatic step inhibited by PA and PB,
was added to the medium only a partial reversal of the growth inhibition
and potentiation of sensitivity to radiation induced by PA and PB were
found. In conclusion, the growth inhibitory properties of fatty aromatic
acids suggest that these molecules could represent the prototype of a
new class of compounds with some therapeutic potential in cervical
cancer.
11
UI - 11818094
AU - Milojkovic M
TI -
Residual and recurrent lesions after conization for cervical
intraepithelial neoplasia grade 3.
SO - Int J Gynaecol Obstet 2002 Jan;76(1):49-53
AD - Department of Gynecology and Obstetrics, Clinical Hospital Osijek,
Osijek, Croatia. milojkovic_os@altavista.com
OBJECTIVES: To evaluate the importance of regular and long-term
follow-up of patients who had conization for cervical intraepithelial
neoplasia grade 3 (CIN 3); and to assess the risk of residual/recurrent
lesions of the cervix uteri. METHODS: Retrospective analysis of 934
patients with CIN 3 who underwent conization over the period 1 January
involved resection margins and 896 (95.9%) patients who had free
resection margins. RESULTS: Twenty-three out of 934 (2.5%) patients had
another operation (reconization in 17 and hysterectomy in six) whereas
one patient had a biopsy. Residual or recurrent lesion after conization
was found in 23 patients out of 934 (2.5%). Three patients had invasive
cervical cancer (0.3%), 19 had CIN 3 (2.0%) and one patient had CIN 1
(0.1%). One of the 24 patients (4.2%) was diagnosed with no lesion after
repeated operation. Eleven patients out of 38 (28.9%) with involved
resection margins during the first conization had residual/recurrent
disease, compared with eight out of 896 patients (0.9%) who had free
resection margins. CONCLUSION: Another operation is recommended only in
cases when, on the basis of cytological, colposcopical and histological
findings, the gynecologist suspect the residual/recurrent lesions.
12
UI - 11821606
AU - Park CT; Lim KT; Chung HW; Lee KH; Seong SJ; Shim JU; Kim TJ
TI -
Clinical evaluation of laparoscopic-assisted radical vaginal
hysterectomy with pelvic and/or paraaortic lymphadenectomy.
SO - J Am Assoc Gynecol Laparosc 2002 Feb;9(1):49-53
AD - Department of Obstetrics and Gynecology, Samsung Cheil Hospital and
Women's Healthcare Center, Sungkyunkwan University, School of Medicine,
1-19, Mookjung-Dong, Chung-Ku, Seoul, Korea.
STUDY OBJECTIVE: To report our experience with radical
laparoscopic-assisted vaginal hysterectomy (LAVH) with bilateral pelvic
and/or paraaortic lymphadenectomy. DESIGN: Retrospective review
(Canadian Task Force classification III). SETTING: University-affiliated
hospital. PATIENTS: Fifty-two women with invasive carcinoma of the
cervix, stage Ib1, smaller than 3 cm. INTERVENTION: Radical LAVH with
pelvic and/or paraaortic lymphadenectomy. MEASUREMENTS AND MAIN RESULTS:
Total operating time ranged from 230 to 650 minutes (mean 380 min).
Major surgical complications were two cases of ureter injury, two cases
of ureteral stricture, and one case of hematoma at the cannula site. Two
cases were converted to laparotomy due to incomplete hemostasis of the
uterine artery and obturator vein. The mean hemoglobin decrement was 1.7
g/dl the day after operation. Thirty patients received blood transfusion
(mean 1.8 pints). Average numbers of pelvic and paraaortic lymph nodes
removed were 27.7 (range 9-63) and 22.1 (range 6-52), respectively.
After surgery, patients passed gas in 2.2 days and self-voided in 18.4
days on average. One woman had pelvic recurrence at 26 months after
surgery. One died from brain metastasis 10 months after surgery.
CONCLUSION: This technique is feasible for treatment of early cervical
carcinoma. An experienced surgeon could shorten operating time and
reduce complications.
13
UI - 11822986
AU - Moore DH
TI -
The role of radical hysterectomy and neoadjuvant chemotherapy in
carcinoma of the cervix.
SO - Curr Oncol Rep 2002 Mar;4(2):145-51
AD - Department of Gynecologic Oncology, Indiana University School of
Medicine, 535 Barnhill Drive RT433, Indianapolis, IN 46202-5274, USA.
dhmoore@iupui.edu
The patient presenting with a bulky stage IB2 cervical cancer is a
therapeutic challenge. None of the current surgical or radiation
treatment strategies satisfactorily leads to a high rate of disease-free
survival and a low risk of treatment-related complications including
ovarian failure and psychosexual deficits. Neoadjuvant chemotherapy may
allow for reductions in tumor bulk, thereby rendering radiation therapy
more effective or surgery more feasible. Impressive clinical response
rates to cisplatin-based neoadjuvant chemotherapy have been achieved
with acceptable toxicity. Approximately 20% of patients achieve a
complete clinical response, and many also experience a complete
pathologic response. There are still too few comparative studies and
phase III trials to assess the effectiveness of neoadjuvant chemotherapy
and radical surgery relative to standard treatments.
14
UI - 11917288
AU - Small W Jr
TI -
The potential role of amifostine in the treatment of carcinoma of the
uterine cervix: a review.
SO - Semin Radiat Oncol 2002 Jan;12(1 Suppl 1):68-74
AD - Division of Radiation Oncology, Robert H. Lurie Comprehensive Cancer
Center, Northwestern University, Chicago, IL 60611, USA.
Carcinoma of the uterine cervix affects approximately 13,000 women
annually in the United States. Radiotherapy is a commonly applied
therapy, either as definitive treatment or combined with surgery.
Although highly effective, radiotherapy can be associated with
significant complications. Amifostine has been shown to be an effective
radioprotector in head and neck malignancies. Preliminary evidence
suggests a role in cervical cancer. Copyright 2002, Elsevier Science
(USA). All rights reserved.
15
UI - 8934049
AU - Hendry JH; Bentzen SM; Dale RG; Fowler JF; Wheldon TE; Jones B; Munro
TI -
AJ; Slevin NJ; Robertson AG
A modelled comparison of the effects of using different ways to
compensate for missed treatment days in radiotherapy.
SO - Clin Oncol (R Coll Radiol) 1996;8(5):297-307
AD - Paterson Institute for Cancer Research, Christie Hospital NHS Trust,
Manchester, UK.
There is much evidence for the detrimental effect on tumour control of
missed treatment days during radiotherapy, amounting for example to
approximately a 1.6% absolute decrease in local control probability per
day of treatment prolongation in the case of head and neck squamous cell
cancer. Various methods to compensate for missed treatment days are
compared quantitatively in this article, using the linear-quadratic
formalism. The overall time and fraction size can be maintained by
either treating on weekend days (the preferred way (Method 1a), although
with unsocial hours and at extra cost) or using two fractions per day to
"catch up' (Method 1b). The latter might incur a small loss of tolerance
regarding late reactions, when intervals of 6-8 h are used rather than
24 h, and there may be logistical/scheduling difficulties with larger
numbers of patients in some centres when using this method. A second
type of strategy retains overall treatment time, and also one fraction
per day, but the size of the dose per fraction is increased. For
example, this may be done for the same number of "post-gap' days as gap
days (Method 2). However, with this method, calculated isoeffect doses
regarding late reactions indicate a probable decrease in tumour control
rate (Method 2a). Otherwise, isoeffective doses regarding tumour control
result in an increase in late reactions (Method 2b). In addition, this
method is unsuitable for short regimens already using high doses per
fraction. To reduce this problem, overall treatment time can also be
retained by using fewer fractions, all of greater size in the case of
planned gaps (statutory holidays), or larger remaining fractions after
unplanned gaps (Method 2c). The problem also with this method is that
equivalence for tumour control gives an increase in late reactions. The
least satisfactory strategy (Method 3) is to accept the protraction
caused by the missed treatment days, and give either the same prescribed
number of (slightly larger) fractions or the planned treatment followed
by one (or more) extra fraction to compensate for the gap. This would
retain the expected local control rate, but there would be an increase
in late reactions. An example of this, using average parameter values,
is that a 3-day gap (necessitating four extra days to complete treatment
with one fraction of 2.4 Gy) might maintain a 70% local control rate for
glottic carcinoma, but severe reactions might rise from 1% to 4% and
minor/moderate reactions from 37% to 50%. In this example, the inclusion
of an extra weekend would increase the required extra dose and hence may
further increase the morbidity rates. A final point is that the effect
of treatment interruptions for an individual patient is expected to be
greater than that for a group of patients because of interpatient
heterogeneity tending to flatten dose-response curves. Calculations show
that the above value of 1.6% loss of local control per day for a group
of patients may reflect values for individual patients that range around
a median value of as much as 5% per day, so stressing further the
importance of gaps in treatment. It is concluded that, wherever
possible, treatment days should not be missed. If they are missed, it is
important to compensate for them, preferably by one of the first of the
above methods (1a or 1b), in order to keep as close as possible to the
original/standard prescription in terms of total dose, dose per fraction
and overall time.
16
UI - 11202084
AU - Symonds RP
TI -
Audit of treatment by radiotherapy of carcinoma of the cervix in the UK
in 1993: worse than expected results.
SO - Clin Oncol (R Coll Radiol) 2000;12(6):343-4
17
UI - 11202085
AU - Hunter RD
TI -
Morbidity in radiotherapy practice.
SO - Clin Oncol (R Coll Radiol) 2000;12(6):345-6
18
UI - 11202086
AU - Denton AS; Bond SJ; Matthews S; Bentzen SM; Maher EJ; UK Link
TI -
Gynaecology-Oncology Group
National audit of the management and outcome of carcinoma of the cervix
treated with radiotherapy in 1993.
SO - Clin Oncol (R Coll Radiol) 2000;12(6):347-53
AD - Mount Vernon Hospital, Northwood, Middlesex, UK.
The aim of the study was to investigate the UK prevalence of late,
severe side-effects associated with radical radiotherapy for cancer of
the cervix and try to identify associated factors. All patients treated
for cancer of the cervix with radical radiotherapy in 1993 were
identified and retrospective case notes studied to determine mortality
and severe complications occurring following treatment. Of the 55
radiotherapy departments in the UK that were treating gynaecological
malignancy in 1993, 53 participated in the study. There were 1558
patients with carcinoma of the cervix receiving radical radiotherapy as
part of their treatment regimen in 1993, whose patterns of treatment
were assessed. The main outcome measures were the development of late
severe complications as defined by the Franco-Italian Glossary and
mortality. Of the patients receiving surgery and radiotherapy, 58.5%
underwent Wertheim's procedure. The crude rate of late severe
complications in all patients with cervical cancer treated with radical
radiotherapy in 1993 was 6.1% (actuarial rate 8%) at 5 years, and only
four of the 91 patients who developed complications died as a result of
their morbidity. There was no significant correlation of stage, centre
size, surgery or radiotherapeutic approach with late morbidity in
univariate analysis. The overall survival at 5 years was 47% and was
lower than that of the European data from FIGO's 1990-92 cohort, for all
stages. Increasing FIGO stage was the only factor significantly
associated with mortality. The absence of variables that were
significantly associated with late complications may well be related to
the relatively low event rate compared to the sample size. Differences
in surgical treatment prior to radiotherapy and radiation technique may
be confounding the comparison of outcomes. The relatively poor survival
for locally advanced disease and the difficulty with which these data
were collated indicates that national prospective data collection is
urgently required to monitor performance and hence derive best practice.
19
UI - 11527305
AU - Jones B
TI -
Outcomes of cervix cancer treatments in 1993.
SO - Clin Oncol (R Coll Radiol) 2001;13(3):237-8
20
UI - 11687152
AU - Green J; Kirwan J; Tierney J; Symonds P; Fresco L; Williams C;
TI -
Collingwood M
Concomitant chemotherapy and radiation therapy for cancer of the uterine
cervix.
SO - Cochrane Database Syst Rev 2001;(4):CD002225
AD - Clatterbridge Centre for Oncology, Clatterbridge Hospital, Merseyside,
UK, L63 4JY. J.A.Green@liverpool.ac.uk
stated that concomitant chemoradiotherapy should be considered for all
patients with cervical cancer, based on evidence from five randomised
controlled trials. OBJECTIVES: To review all known randomised clinical
controlled trials (RCTs) comparing concomitant chemotherapy and
radiation therapy with radiotherapy for locally advanced cervical
cancer. SEARCH STRATEGY: We searched electronic databases, trials
registers and reference lists of published trial reports and review
articles were also searched. SELECTION CRITERIA: This review includes
RCTs in cervical cancer comparing concomitant chemotherapy and
radiotherapy with radiotherapy. In the experimental arm, further
adjuvant chemotherapy was allowable. Hydroxyurea was considered inactive
and allowable. Trials using radiosensitisers or radioprotectors in the
experimental arm were excluded. DATA COLLECTION AND ANALYSIS: Two
authors reviewed trials for inclusion and extracted data. For
meta-analyses of time-to-event outcomes (survival, progression-free
survival), a hazard ratio (HR) was extracted or estimated from trial
reports, where possible. Only overall rates of local and distant
recurrence were presented in many reports so only an odds ratios (OR) of
recurrence rates could be calculated, which takes no account of time to
recurrence or censoring. The HRs and ORs for individual trials were
combined across all trials, using the fixed effect model. Few trials
reported acute toxicity adequately. Data were therefore grouped and the
number of toxic events was used to calculate a single OR for each site
and grade. Late toxicity was rarely described so could only be reviewed
qualitatively. MAIN RESULTS: Nineteen trials (17 published, two
unpublished) were identified including 4580 patients, although due to
patient exclusion and differential reporting 62-78% were available for
the various analyses. The review strongly suggests chemoradiation
improves overall survival and progression free survival, whether
platinum was used or not with absolute benefits of 12% and 16%
respectively. There was, however, statistical heterogeneity for these
outcomes There was some evidence that the effect was greater in trials
including a high proportion of stage I and II patients. Chemoradiation
also showed significant benefit for both local and distant recurrence.
Haematological and gastrointestinal toxicity was significantly greater
in the concomitant chemoradiation group. Details of late morbidity were
sparse. REVIEWER'S CONCLUSIONS: Concomitant chemotherapy and
radiotherapy appears to improve overall survival and progression-free
survival in locally advanced cervical cancer. It also reduces local and
distant recurrence suggesting concomitant chemotherapy may afford
cytotoxic and sensitisation effects. Some acute toxicity is increased,
but data on long term side effects were sparse.
21
UI - 11836539
AU - Carvalho JP; Carvalho FM; Pincerato KM; Pereyra EA
TI -
Conization, frozen section examination, and planned hysterectomy in the
treatment of high-grade cervical intraepithelial neoplasia.
SO - Rev Hosp Clin Fac Med Sao Paulo 2001 Nov-Dec;56(6):169-72
AD - Department of Dermatology, Hospital das Clinicas, Faculty of Medicine,
University of Sao Paulo, Brazil.
PURPOSE: We tested the role of frozen section examination of the cone
specimen in the evaluation of the resection margin status and to rule
out invasion in patients with high-grade cervical intraepithelial
neoplasia. METHODS: Twenty-five patients with cervical intraepithelial
neoplasia underwent conization followed by frozen section examination
and planned hysterectomy. The results of the definitive paraffin exam
were compared with frozen section examination. RESULTS: In the
evaluation of the margins by frozen section examination, 16 patients
(64%) had positive cone margins and 9 (36%) had negative margins. The
definitive paraffin examination of margin status was concordant in all
the cases. Intraoperative diagnosis of invasion was made in 5 cases, and
1 of these was microinvasive. Among the remaining 20 cases, we detected
2 additional microinvasive carcinomas after paraffin study, so the
diagnosis of the frozen section examination was concordant with the
paraffin sections in 23/25 cases (92%). Two cases of microinvasive
carcinoma were diagnosed as cervical intraepithelial neoplasia by frozen
section examination and had less than 2 mm stromal invasion.
CONCLUSIONS: In high-grade cervical intraepithelial neoplasia, frozen
section examination can provide immediate and precise evaluation of the
cone margin status in high-grade cervical intraepithelial neoplasia. It
can identify frank invasion and permit adequate treatment in a one-stage
procedure. In early microinvasive disease, frozen section examination
fails to detect the area of invasion but reliably detects clear
resection margins.
22
UI - 11766144
AU - Flowers LC; McCall MA
TI -
Diagnosis and management of cervical intraepithelial neoplasia.
SO - Obstet Gynecol Clin North Am 2001 Dec;28(4):667-84, viii
AD - Department of Gynecology and Obstetrics, Emory University School of
Medicine, Atlanta, Georgia 30322, USA. 1flowe2@emory.edu
Ovarian cancer is the leading cause of death from malignancies arising
in the female genital tract. More women die from ovarian cancer than
cervical and endometrial cancer combined. All clinicians should
understand the concepts of ovarian cancer biology and management.
Approximately 90% of all ovarian cancers are epithelial in origin, and
such cancers are the focus points of this article.
23
UI - 11766148
AU - Basil JB; Horowitz IR
TI -
Cervical carcinoma: contemporary management.
SO - Obstet Gynecol Clin North Am 2001 Dec;28(4):727-42
AD - Department of Gynecology and Obstetrics, Emory University School of
Medicine, Atlanta, Georgia 30322, USA. Jbasil@emory.edu
Cervical carcinoma is prevented easily with proper screening.
Unfortunately, many women in industrialized countries continue to have
poor access to adequate medical care. In many third-world countries,
cervical cancer is one of the top malignancies diagnosed. Screening
should be provided for all women to prevent or diagnose cervical cancer
at an early, treatable stage.
24
UI - 11956305
AU - Kobamatsu Y; Yamamoto R; Kaneuchi M; Mitamura T; Minobe S; Todo Y;
TI -
Takeda M; Okamoto K; Nomura E; Negishi H; Sakuragi N; Fujimoto S
Comparison of the results of radical hysterectomy: sequential
observations in each period.
SO - Jpn J Clin Oncol 2002 Mar;32(3):103-7
AD - Gynecology, Reproductive and Developmental Medicine, Division of
Pathophysiological Science, Hokkaido University Graduate School of
Medicine, Sapporo, Japan.
BACKGROUND: The efficacy of drains and of antibiotics for prophylaxis of
postoperative retroperitoneal infections following radical hysterectomy
with systematic lymphadenectomy has not yet been adequately
investigated. METHODS: Patients who had just undergone radical
hysterectomy were divided into three groups. We used a retroperitoneal
drain transvaginally for Groups A (n = 54) and B (n = 55) and
transabdominally for Group C (n = 103). Group A was administered a
first- and Groups B and C a second- or third-generation cephem
antibiotic as the prophylactic antibiotic. We compared the surgery time,
blood loss, fever index and febrile morbidity in these three groups.
RESULTS: The average surgery time was Group A 344.2 +/- 13.7 min (mean
+/- SE), Group B 425.6 +/- 11.0 min and Group C 528.2 +/- 10.9 min. A
significant difference was observed among the groups (p < 0.05). In
terms of blood loss during surgery, a significant increase (p < 0.05)
occurred in Groups B (2400 +/- 196 g) and C (2373 +/- 130 g) compared
with Group A (1820 +/- 122 g). For fever index, Group A showed a value
of 36.1 +/- 2.7 dh, Group B 19.9 +/- 2.4 dh and Group C 8.8 +/- 1.5 dh.
A significant difference was observed among the groups (p < 0.01). In
terms of febrile morbidity, significant differences (p < 0.01, p <
0.0001) were observed between Groups B (14.6%) and C (8.7%) in
comparison with Group A (44.4%), respectively. CONCLUSION: In radical
hysterectomy with systematic lymphadenectomy, it may be preferable to
choose transabdominal drains in the retroperitoneal space and
second-generation cephem antibiotics for prophylaxis of postoperative
retroperitoneal infections.
25
UI - 11906547
AU - Leborgne F; Leborgne JH; Zubizarreta E; Fowler JF; Maisonneuve J;
TI -
Ferrari D; Curochquin R
High-dose-rate brachytherapy at 14 Gy per hour to point A: preliminary
results of a prospectively designed schedule for cancer of the cervix
based on the linear-quadratic model.
SO - Int J Gynecol Cancer 2001 Nov-Dec;11(6):445-53
AD - Department of Radiation Oncology, Instituto de Radiologia y Centro de
Lucha Contra el Cancer, Pereira Rossell Hospital, Montevideo, Uruguay.
flebor@adinet.com.uy
The objective of this study was to describe the results and
complications of a prospectively designed high-dose-rate (HDR)
brachytherapy schedule for early-stage cancer of the cervix, at 14 Gy/h
to point A, based on the linear-quadratic model and our clinical
experience. We used a combination of brachytherapy and external beam
pelvic and parametrial irradiation in 88 consecutively seen patients
with stage IB1-IIB treated by irradiation alone (1995-1998). The modeled
HDR schedule consisted of three insertions on three treatment days
separated by 10 days, with six 7 Gy planned brachytherapy fractions to
point A, at 14 Gy/h, two on each treatment day with an interfraction
interval of 6 h, plus an 18 Gy external whole-pelvic dose followed by
additional parametrial irradiation. The calculated biologically
effective dose (BED) was 92 Gy10 for tumor and 110 Gy3 for the rectum,
equivalent to 77 and 66 Gy in 2 Gy fractions, respectively. The median
overall treatment time was 41 days. The actuarial 4-year central
recurrence-free rate, pelvic control, and disease-free survival rate
were 97%, 93%, and 88% for stages IB-IIA and 79%, 75%, and 75% for stage
IIB. The actuarial 4-year late complication rate for grades 2-3 was 4.7%
(scale 0-3). We conclude that preliminary results of this HDR
brachytherapy schedule for early-stage disease at a median follow-up of
52 months are as effective as the previously used low dose rate (LDR) at
0.44 Gy/h at point A. They are also as effective as medium-dose-rate
schedules (MDR) at 1.6-1.5 Gy/h at this institution and do not require a
further increase in fractionation of intracavitary treatments or in the
whole-pelvic external beam irradiation dose common to standard HDR
schedules. In addition, more patients per machine can be treated per day
compared with MDR. Longer follow-up is required for a complete
assessment of late complications.
26
UI - 11906552
AU - Park TK; Kim SN; Kwon JY; Mo HJ
TI -
Postoperative adjuvant therapy in early invasive cervical cancer
patients with histopathologic high-risk factors.
SO - Int J Gynecol Cancer 2001 Nov-Dec;11(6):475-82
AD - Department of Obstetrics and Gynecology, Yonsei University College of
Medicine, Seoul, Korea.
The purpose of this study is to evaluate the efficacy of postoperative
adjuvant therapy in preventing treatment failure after primary treatment
with surgery in early invasive cervical cancer patients associated with
the following histopathologic high-risk factors: lymph node metastasis
(either macroscopic or microscopic), parametrial extension,
lymphovascular permeation and depth of invasion > or =10 mm.
Postoperative adjuvant concurrent chemoradiotherapy (PCCRT),
postoperative adjuvant chemotherapy (PCT), or postoperative adjuvant
radiotherapy (PRT) alone was administered to the 80 early invasive
cervical cancers with at least one of the high-risk factors. Each of 61
patients received three to six cycles of chemotherapy at intervals of
approximately 3 weeks. Twenty three patients were treated with PCCRT, 38
patients were treated with PCT alone, and 19 patients received PRT. The
5-year survival rates of patients with macroscopic lymph node metastasis
were 66.7% and 35.7% in PCCRT and PRT, respectively. With microscopic
lymph node metastasis, the 5-year survival rates were 83.3%, 60.0%, and
70.1% in PCCRT, PCT, and PRT, respectively. With parametrial extension,
the 5-year survival rate was 58.1% in PCCRT. The 5-year survival rates
of patients with lymphovascular permeation were 100%, 90.9%, and 66.7%
in PCCRT, PCT, and PRT, respectively. With depth of invasion > or =10
mm, the 5-year survival rates were 100% and 91.3%, in PCCRT and PCT,
respectively. PCCRT appears to be superior to PRT or PCT alone in early
invasive cervical cancer patients with histopathologic high-risk
factors.
27
UI - 11903183
AU - MacLeod C; O'Donnell A; Tattersall MH; Dalrymple C; Firth I
TI -
Locally advanced cervix cancer: chemotherapy prior to definitive surgery
or radiotherapy. A single institutional experience.
SO - Australas Radiol 2001 Nov;45(4):491-5
AD - Department of Radiation Oncology, Murray Valley Cancer Centre, Wodonga,
Victoria, Australia. cmacleod@radonvic.com.au
Primary or neoadjuvant chemotherapy prior to definitive local therapy
has potential advantages for locally advanced cervix cancer. It can
downstage a cancer and allow definitive local therapy to be technically
possible (surgery), or potentially more effective (radiotherapy). It can
also eradicate subclinical systemic metastases. This report reviews a
single institution's experience of neoadjuvant chemotherapy prior to
definitive local therapy for cervix cancer over a 13-year period. One
hundred and six patients were treated with this intent. The patients
were analysed for their response to chemotherapy, treatment received,
survival, relapse and toxicity. The chemotherapy was feasible and the
majority of patients had a complete or partial response (58.5%). Eight
patients did not proceed to local treatment. Forty-six patients had
definitive surgery and 52 had definitive radiotherapy. The 5-year
overall survival was 27% and the majority of patients died with disease.
The first site of relapse was usually in the pelvis (46.2%). Late
complications that required ongoing medical therapy (n=6) or surgical
intervention (n=2) were recorded in eight patients (7.5%). On univariate
analysis stage (P=0.04), tumour size (P=0.01), lymph node status
(P=0.003), response to chemotherapy (P=0.045) and treatment (P=0.003)
were all significant predictors of survival. On multivariate analysis,
tumour size (P < 0.0001) and nodal status (P=0.02) were significant
predictors of survival. Despite the impressive responses to chemotherapy
of advanced cervix cancer, there is evidence from randomized trials that
it does not improve or compromise survival prior to radiotherapy. As its
role prior to surgery remains unclear, it should not be used in this
setting outside a prospective randomized trial.
28
UI - 11188007
AU - Solco-Innotech-Bulgermed.
TI -
[Solcogyn - method for treatment of benign lesions of the uterine cervix
with the best outcome]
SO - Akush Ginekol (Sofiia) 2000;39 Suppl 2():18-9
29
UI - 11913357
AU - Grigsby PW; Portelance L; Williamson JF
TI -
High dose ratio (HDR) cervical ring applicator to control bleeding from
cervical carcinoma.
SO - Int J Gynecol Cancer 2002 Jan-Feb;12(1):18-21
AD - Radiation Oncology Center, Mallinckrodt Institute of Radiology, Box
8224-21, Washington University School of Medicine, 4939 Children's
Place-Suite 5500, St. Louis, Missouri 63110, USA. grigsby@netscape.net
The objective of this study was to evaluate the use of the high dose
rate (HDR) cervical ring applicator to control acute cervical bleeding
from carcinoma of the uterine cervix. This study consists of 15 patients
presenting with invasive carcinoma of the uterine cervix with acute
vaginal bleeding requiring transfusion. Initial irradiation, delivered
emergently because of vaginal bleeding, consisted of two fractions (5 Gy
each fraction to the surface of the cervix) utilizing the HDR
intracavitary vaginal ring applicator. Two fractions were administered
at one week intervals for a total of 10 Gy to the surface of the cervix.
Irradiation doses from the HDR ring applications were not considered
into the composite total dose to point A. Diagnostic imaging evaluation
and initiation of external irradiation were commenced during this
initial weekly interval between fractions. Vaginal bleeding requiring no
additional transfusions was achieved in 93% (14/15) of patients. No
acute or long-term Grades 3, 4, or 5 bowel or bladder sequelae were
noted. In conclusion, HDR cervical ring brachytherapy is effective in
controlling acute vaginal bleeding and can be delivered without undue
acute or long-term toxicity.
30
UI - 11860533
AU - Tyree WC; Cardenes H; Randall M; Papiez L
TI -
High-dose-rate brachytherapy for vaginal cancer: learning from treatment
complications.
SO - Int J Gynecol Cancer 2002 Jan-Feb;12(1):27-31
AD - Department of Radiation Oncology, Indiana University, 355 Barnhill
Drive, RT 041, Indianapolis, Indiana, USA.
Historically, early stage vaginal cancer has been treated with
low-dose-rate (LDR) brachytherapy with or without external beam
radiation therapy (EBRT). Complication rates have been low and treatment
efficacious. Although high-dose-rate (HDR) brachytherapy has been used
for cervical cancer in many countries for over a decade, only more
recently has it been integrated into treatment plans for vaginal cancer.
This paper describes three patients treated with HDR brachytherapy who
experienced significant late effects. Given the very limited amount of
literature regarding the use of HDR brachytherapy in vaginal cancer,
this analysis potentially contributes to an understanding of
treatment-related risk factors for complications among patients treated
with this modality.A focused review of hospital and departmental
treatment records was done on three patients treated with HDR
brachytherapy. Abstracted information included clinical data, treatment
parameters (technique, doses, volume, combinations with other
treatments) and outcomes (local control, survival, early and late
effects). A review of the available literature was also undertaken. All
patients had significant complications. Although statistical
correlations between treatment parameters and complications are
impossible given the limited number of patients, this descriptive
analysis suggests that vaginal length treated with HDR brachytherapy is
a risk factor for early and late effects, that the distal vagina has a
lower radiation tolerance than the upper vagina with HDR as in LDR, and
that combining HDR with LDR as done in our experience carries a high
risk of late toxicity. Integration of HDR brachytherapy techniques into
treatment plans for early stage vaginal cancers must be done cautiously.
The etiology of the significant side effects seen here is likely to be
multifactorial. For users of HDR brachytherapy in vaginal cancer, there
is a need to further refine and standardize treatment concepts and
treatment delivery. Ideally this will be based on continued careful
observation and reporting of both favorable and unfavorable outcomes and
experiences.
31
UI - 11942040
AU - Hansgen G; Kuhnt T; Pigorsch S; Strauss H; Dunst J
TI -
[Adjuvant simultaneous radiochemotherapy after operated uterine cervix
carcinoma in high risk situation. Results of a pilot study]
SO - Strahlenther Onkol 2002 Feb;178(2):71-7
AD - Klinik und Poliklinik fur Strahlentherapie, Martin-Luther-Universitat
Halle/Wittenberg. gabriele.haensgen@medizin.uni-halle.de
BACKGROUND: The most important factors for prognosis of cervical cancers
are age and histological criteria such as the tumor size, the
involvement of lymph nodes, lympho-vascular space involvement as well as
microvessel involvement and poor tumor differentiation (grading 3). Here
we present the results of concomitant chemo-radiation at high-risk
situation of patients with cervical cancer after surgery. PATIENTS AND
METHODS: The study comprised 34 patients with median age of 40
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