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Abramson Cancer CenterNCI CANCERLIT® Search: Therapy of Cervical Cancer - May 2002
National Cancer Institute®
Last Modified: May 1, 2002
Table of Contents
1
UI - 11883300
AU - Panek G; Bidzinski M
TI -
[Adenocarcinoma of the cervix--stage IB: results of treatment and
prognostic factors]
SO - Ginekol Pol 2001 Dec;72(12A):1478-84
AD - Kliniki Nowotworow Narzadow Plciowych Kobiecych Centrum
Onkologii-Instytutu w Warszawie.
The study presents the results of treatment of 63 women with stage IB
adenocarcinoma of the cervix. The treatment consist of radical
Wertheim-Meigs hysterectomy with adjuvant brachytherapy or external beam
irradiation. A statistical analysis with Kaplan-Meier and cox model was
conducted to assess the influence of selected prognostic factors on
survival. After 5-year long follow-up 73.4% of patients were alive
without recurrence. The results of univariate analysis showed that
metastatic pelvic nodes, cervical tumor size of more than 4 cm and the
presence of microscopic parametrial infiltration had a statistically
significant negative influence on survival. In a multivariate analysis
tumor size of more than 4 cm and microscopic parametrial involvement had
an independent negative impact on survival (relative risk of death--12.1
and 15.7).
2
UI - 11883309
AU - Jedryka M; Pochwalowski M; Goluda C; Kuryllo M
TI -
[Hematometra in 76-year-old woman followed by DIC and the result of the
carcinoma of cervix--a case report]
SO - Ginekol Pol 2001 Dec;72(12A):1530-3
AD - II Katedry i Kliniki Ginekologii Akademii Medycznej we Wroclawiu.
This is a case report of a 76-year-old women with hematometra due to
cervical cancer followed by DIC. To the authors' knowledge this is the
first report of such case.
3
UI - 11925127
AU - Iwasaki M; Nishikawa A; Fujimoto T; Akutagawa N; Manase K; Endo T;
TI -
Yoshida K; Maekawa R; Yoshioka T; Kudo R
Anti-invasive effect of MMI-166, a new selective matrix
metalloproteinase inhibitor, in cervical carcinoma cell lines.
SO - Gynecol Oncol 2002 Apr;85(1):103-7
AD - Department of Obstetrics and Gynecology, Sapporo Medical University,
Sapporo, 060-8543, Japan.
OBJECTIVES: The aim of our study was to evaluate the anti-invasive
effect of MMI-166, a new matrix metalloproteinase (MMP) inhibitor in
cervical carcinoma cell lines. METHODS: We analyzed the invasive
activities of cervical carcinoma cell lines (CAC-1, CaSki, and SiHa) and
the gene expression of various matrix proteinases (matrix
metalloproteinase-1 [MMP-1], MMP-2, MMP-9, membrane-type MMP type 1
[MT1-MMP], MT2-MMP, and MT3-MMP) and their inhibitors (tissue inhibitor
of metalloproteinase type 1 [TIMP-1] and TIMP-2). The effect of MMI-166
was analyzed by in vitro invasion assay. The cytotoxicity of MMI-166 was
determined by MTT assay. The gelatinase activity was analyzed by gelatin
zymography. RESULTS: Cervical carcinoma cell lines, which produced both
MMP-2 and MT1-MMP, showed invasive capacity in the in vitro invasion
assay. The invasion of cervical carcinoma cells was suppressed by
MMI-166. No remarkable suppression of the proliferation by MMI-166 was
observed in the MTT assay. Gelatin zymography revealed complete
suppression of MMP-2 activity by MMI-166. CONCLUSIONS: MMI-166 inhibited
the MMP-2 activity in cervical carcinoma cells and it is useful for the
regulation of cervical carcinoma cell invasion.
4
UI - 11925130
AU - Costa S; De Nuzzo M; Infante FE; Bonavita B; Marinelli M; Rubino A;
TI -
Rambelli V; Santini D; Cristiani P; Bucchi L
Disease persistence in patients with cervical intraepithelial neoplasia
undergoing electrosurgical conization.
SO - Gynecol Oncol 2002 Apr;85(1):119-24
AD - Department of Obstetrics and Gynecology, University of Bologna, Bologna.
OBJECTIVE: Cone margin status has been reported to be the most important
predictor of residual disease in patients with cervical intraepithelial
neoplasia (CIN) undergoing electrosurgical excisional treatment. The
primary aim of this study of patients treated with electrosurgical
conization was to evaluate the association of cone margin status and
other clinical and pathologic factors with the probability of residual
disease. METHODS: The study population comprised 699 patients with at
least one follow-up visit within 12 months of conization. Residual
disease was defined as a histology diagnosis of CIN within 3 years of
conization. Multivariate associations were evaluated with multiple
logistic regression analysis. RESULTS: Attendance to follow-up was 97%
for the second visit and 34% for the third visit. Residual disease was
detected in a total of 38 patients (5.4%). The detection rate was 3.3%
at the first visit, 2.1% at the second visit, and 0.4% at the third
visit. An increased probability of residual disease was associated with
a referral Pap smear reported as high-grade squamous intraepithelial
neoplasia and carcinoma (odds ratio, 2.9; reference category, low-grade
squamous intraepithelial neoplasia). A decreased probability was
associated with a squamocolumnar junction entirely visible at the first
follow-up visit (odds ratio, 0.2; reference category, squamocolumnar
junction not visible). Patient age, time period, lesion size, lesion
site, grade of CIN, cone width, cone depth, and margin status had no
influence. CONCLUSIONS: The determinants of residual disease in this
study differed from those generally reported so far. Factors associated
with effectiveness of electrosurgical treatment of CIN need further
research.
5
UI - 11925136
AU - Querleu D; Narducci F; Poulard V; Lacaze S; Occelli B; Leblanc E; Cosson
TI -
M
Modified radical vaginal hysterectomy with or without laparoscopic
nerve-sparing dissection: a comparative study.
SO - Gynecol Oncol 2002 Apr;85(1):154-8
AD - Department of Gynecologic Oncology, University of Lille II, Centre Oscar
Lambret, 2 avenue Frederic Combemale, Lille, 59020, France.
d-querleu@o-lambret.fr
OBJECTIVE: Nerve-sparing dissection of the lateral portion of the
cardinal ligament (paracervical lymphadenectomy) has been recently
developed with the goal of reducing the late urinary adverse effects of
radical hysterectomy without impairing the outcome. This work has been
carried out in order to investigate the influence of additional
paracervical lymph node dissection at the time of laparoscopically
assisted modified radical hysterectomy on outcome and urinary sequelae.
METHODS: A total of 95 patients underwent a modified radical
hysterectomy using a combined laparoscopic and vaginal approach since
1991. In 47 of these patients treated since 1996 an additional
laparoscopic paracervical lymphadenectomy was performed. The operative,
postoperative, and survival outcomes were assessed. In 60 patients, 32
and 28 in the groups of patients with or without paracervical
dissection, respectively, a careful interview on urinary symptoms was
conducted by an independent investigator. RESULTS: Paracervical
dissection involves no operative complication and lenghthens the
postoperative urinary retention, but has no adverse influence on
long-term urinary discomfort. The yield of paracervical dissection is
negligible for small tumors: no positive node was found in 38 patients
with tumors less than 2 cm in diameter. The outcome of patients after
minimal access surgery for tumors less than 2 cm is excellent whether or
not a paracervical dissection has been performed. CONCLUSION:
Paracervical dissection does not worsen the late urinary symptoms after
vaginal radical hysterectomy. It has a limited value in the surgical
management of small-size (less than 2 cm) cervical cancers, although it
may prevent long-term lateropelvic recurrences.
6
UI - 11925142
AU - Dunton CJ; King SA; Neufeld J; Tolosa J; Perez G; Avila A; Underhill K
TI -
Phase I study of topotecan and radiation therapy in advanced cervical
cancer.
SO - Gynecol Oncol 2002 Apr;85(1):185-7
AD - Division of Gynecologic Oncology, Jefferson Medical College,
Philadelphia, Pennsylvania 19107, USA. charles.dunton@mail.tju.edu
OBJECTIVE: The goal of this study was to determine the maximal tolerated
dose (MTD) of topotecan given with external-beam radiotherapy in
advanced cervical cancer. METHODS: A prospective Phase I trial of
topotecan given with standard external-beam radiotherapy was performed
in patients with advanced squamous cell carcinoma of the cervix.
Patients were treated with a starting dose of 0.5 mg/m(2) and escalated
by 0.25 mg/m(2). Nine patients were treated. Hematologic and
nonhematologic toxicity were measured. RESULTS: Patients were treated
with 1.0 mg/m(2) daily for 5 days on Days 1-5 and 22-26 concomitantly
with radiotherapy without significant toxicity. Grade III anemia in one
case and Grade II leukopenia in two cases were seen in the three
patients at this dose level. Dose-limiting toxicity was not reached.
CONCLUSION: Topotecan can be safely administered at a dose of 1.0
mg/m(2) during external-beam radiotherapy for advanced cervical cancer.
7
UI - 11925148
AU - Behtash N; Ghaemmaghami F; Yarandi F; Ardalan FA; Khanafshar N
TI -
Cutaneous metastasis from carcinoma of the cervix at the drain site.
SO - Gynecol Oncol 2002 Apr;85(1):209-11
AD - Department of Obstetrics & Gynecology, Tehran University of Medical
Sciences, Tehran, 14194, Iran. valrec2@yahoo.com
BACKGROUND: Metastasis to the skin occurs rarely in gynecologic cancer,
especially in cervical carcinoma. Although carcinoma of the cervix is
the second to the fourth most common malignancy in women, cutaneous
involvement originating from cervical cancer is particularly unusual,
even in the terminal stage of the disease. CASE: We present a case of
cervical cancer recurrence with skin metastasis. The extensive skin
lesion on the abdominal wall occurred 4 years after radical surgery and
postoperative radiotherapy. This was a biopsy-proven metastasis from the
patient's primary cervical carcinoma. CONCLUSION: As far we know this is
the second case (after Copas et al., Gynecol Oncol 1995;56:102-4) of
skin and subcutaneous tissues metastasis from cervical carcinoma at the
drain site. Palliative chemotherapy and radiotherapy have a useful role
in controlling symptoms.
8
UI - 11925151
AU - Scribner DR Jr; Benbrook DM
TI -
Retinoids enhance cisplatin-based chemoradiation in cervical cancer
cells in vitro.
SO - Gynecol Oncol 2002 Apr;85(1):223-5
AD - Department of Obstetrics and Gynecology, University of Oklahoma Health
Sciences Center, Oklahoma City, Oklahoma 73190, USA.
OBJECTIVE: The aim of this study was to determine whether
receptor-dependent and receptor-independent retinoids sensitize cervical
cancer cells to clinically relevant doses of concurrent radiation and
cisplatin. METHODS: The clonogenic assay was performed on SiHa cervical
carcinoma cultures treated with 5 microM 9-cis-retinoic acid (RA) or 3
microM 4-HPR for 3 days prior to and following concurrent treatment with
3 microM cisplatin and 2 Gy of Co(60) radiation. RESULTS: Neither
9-cis-RA nor 4-HPR significantly decreased survival for radiation only
or cisplatin only (t test: P < 0.05), but both significantly decreased
survival of cultures receiving concurrent chemoradiation (t test:
9-cis-RA P = 0.045; 4-HPR P = 0.027). CONCLUSIONS: Both
receptor-dependent and receptor-independent retinoids enhance concurrent
chemoradiation effects in vitro.
9
UI - 11925152
AU - Hall J
TI -
The role of less radical surgery in selected cervical cancers.
SO - Gynecol Oncol 2002 Apr;85(1):226; discussion 226-7
10
UI - 11925121
AU - Padilla LA; Leung BS; Carson LF
TI -
Evidence of an association between human papillomavirus and impaired
chemotherapy-induced apoptosis in cervical cancer cells.
SO - Gynecol Oncol 2002 Apr;85(1):59-66
AD - Division of Gynecologic Oncology, University of Minnesota, Minneapolis,
Minnesota 55455, USA. lupadilla@salud.unm.edu
OBJECTIVES: The aim of this study was to determine cervical cancer cell
sensitivity to chemotherapy-induced apoptosis based on human
papillomavirus (HPV) status. METHODS: CaSki (HPV-positive) and C33A
(HPV-negative) cells were treated with camptothecin or cisplatin.
Cellular viability was determined by trypan blue exclusion. Apoptotic
indexes were determined by flow cytometric analysis of annexin V
labeling and morphological changes. Mitochondrial release of cytochrome
c was determined by immunofluorescence using confocal microscopy.
Caspase 3 activation and bax expression were assessed by immunoblotting.
RESULTS: CaSki cells displayed chemoresistance to both camptothecin and
cisplatin. Low response to apoptogenic stimuli was evidenced by a
marginal increase in the apoptotic cell fraction after camptothecin
treatment (22.9 +/- 2.56%) compared with control (17.8 +/- 1.95%).
Cisplatin (14.8 +/- 1.01%) caused a slight decrease in apoptosis.
Mitochondrial release of cytochrome c and cleavage of caspase 3 could
not be demonstrated in CaSki cells after treatment. Despite p53
mutation, C33A cells were sensitive to the antiproliferative effects of
camptothecin and cisplatin. Mean apoptotic events were 17.5 +/- 0.33 for
control, 42 +/- 1.76 for cisplatin, and 38.1 +/- 0.75 for camptothecin.
An intact cytochrome c pathway was demonstrated in C33A cells leading to
cleavage of caspase 3 after camptothecin treatment. The constitutive bax
expression demonstrated in both cell lines displayed no change after
camptothecin treatment. CONCLUSION: HPV-positive cervical cancer cells
have an inherent resistance to chemotherapy-induced apoptosis.
HPV-dependant inactivation of apoptotic regulators such as p53 and
blockage of downstream events such as cytochrome c release and caspase 3
activation might be elemental to this cellular survival advantage
provided by high-risk oncogenic papillomavirus.
11
UI - 11925124
AU - Schlaerth JB; Spirtos NM; Carson LF; Boike G; Adamec T; Stonebraker B
TI -
Laparoscopic retroperitoneal lymphadenectomy followed by immediate
laparotomy in women with cervical cancer: a gynecologic oncology group
study.
SO - Gynecol Oncol 2002 Apr;85(1):81-8
AD - Women's Cancer Center at Pasadena, Pasadena, California 91107, USA.
Group undertook a study of women with cancer of the cervix (Stage IA,
IB, and IIA) who were about to undergo radical abdominal hysterectomy,
pelvic lymphadenectomy, and aortic lymph node sampling. Immediately
before this surgery, laparoscopy was performed and removal of the lymph
nodes was attempted. There were two objectives: (1) to obtain
information on the adverse effects and difficulties associated with
laparoscopic lymph node removal and (2) to determine the adequacy of the
lymph node removal. METHODS: Four methods determined the adequacy of the
lymph node removal: (1) the surgeon's opinion during laparoscopy, (2) a
photographic record reviewed by two independent observers, (3)
inspection of the surgical sites at laparotomy, and (4) lymph node
count. RESULTS: Seventy-three women were entered onto the study. Four
patients were judged ineligible; 2 did not undergo laparoscopy and 17
women did not complete laparoscopic surgery because of metastatic lymph
nodes judged unresectable or complications. Ten women were inevaluable.
The remaining 40 women were completely evaluable for protocol
objectives. All cases of bilateral laparoscopic aortic lymph node
sampling were judged adequate by all four methods of evaluation. For
laparoscopic pelvic lymphadenectomy 6 were judged incomplete at
laparotomy, 3 of which were judged incomplete by independent reviewers.
The mean number of right pelvic nodes removed was 16.6; left pelvic
nodes 15.5; right aortic nodes 6.2; and left aortic nodes 5.9.
CONCLUSIONS: Laparoscopic bilateral aortic lymph node sampling appeared
to be reasonably safe and feasible. Laparoscopic therapeutic bilateral
pelvic lymphadenectomy, although having a reasonable complication rate,
demonstrated problems regarding adequacy, which are probably
correctable.
12
UI - 11925125
AU - Fiorica J; Holloway R; Ndubisi B; Orr J; Grendys E; Boothby R; DeCesare
TI -
S; LaPolla J; Hoffman M; Patel J
Phase II trial of topotecan and cisplatin in persistent or recurrent
squamous and nonsquamous carcinomas of the cervix.
SO - Gynecol Oncol 2002 Apr;85(1):89-94
AD - H. Lee Moffitt Cancer Center, Tampa, Florida 33612-9497, USA.
Fiorica@moffitt.usf.edu
OBJECTIVE: Cisplatin is a standard treatment in advanced, recurrent
cervical cancer. Because topotecan is an established treatment in
gynecologic malignancies such as ovarian cancer and exhibits
nonoverlapping toxicity with cisplatin, a phase II trial was conducted
to evaluate the tolerability and antitumor activity of a
cisplatin/topotecan doublet in persistent or recurrent cervical cancer
patients. METHODS: Patients with bidimensionally measurable persistent
or recurrent squamous cell and non squamous cell cervical cancer and
adequate bone marrow were enrolled. Patients received 50 mg/m(2) of
cisplatin intravenously over 1 h on Day 1 and 0.75 mg/m(2) of topotecan
intravenously over 30 min on Days 1, 2, and 3 of 21-day cycles for six
cycles or until disease progression. Tumor response and regimen toxicity
were assessed using established Gynecologic Oncology Group criteria.
RESULTS: Thirty-two of 35 enrolled patients were evaluable for toxicity
and tumor response. All but 2 evaluable patients had received previous
radiotherapy. No patient received prior chemotherapy. The
cisplatin/topotecan doublet was well tolerated, with 77 and 78% of
courses given without interruption or delay and at full doses,
respectively. As anticipated, the most common toxicity was hematologic,
with grade 3/4 neutropenia and thrombocytopenia reported in 30 and 10%
of cycles, respectively. The overall response rate was 28% (9/32), with
3 complete and 6 partial responses. The antitumor response in
nonirradiated fields (30%) was similar to the response observed in
previously irradiated fields (33%), suggesting good drug penetration.
Median duration of response was 5 months (range, 2 to 15+ months). An
additional 9 (28%) patients achieved stable disease. Median survival was
10 months, with 3 patients in lasting remission. CONCLUSIONS: These
results demonstrate that the cisplatin/topotecan combination is safe,
well tolerated, and active in persistent or recurrent cervical cancer
patients. A phase III, multicenter trial is under way
(cisplatin/topotecan versus cisplatin) based on these favorable results
to confirm the safety and efficacy profile in this patient population.
13
UI - 11935219
AU - D'Agostino G; Distefano M; Greggi S; Salerno M; Ferrandina G; Poerio A;
TI -
Mancuso S; Scambia G
Neoadjuvant treatment of locally advanced carcinoma of the uterine
cervix with epirubicin, paclitaxel and cisplatin.
SO - Cancer Chemother Pharmacol 2002 Mar;49(3):256-60
AD - Department of Gynaecology, Catholic University of the Sacred Heart,
Largo Agostino Gemelli 8, 00168 Rome, Italy.
PURPOSE: The present study was conducted to explore whether neoadjuvant
chemotherapy with a combination of epirubicin, paclitaxel and cisplatin
could improve the operability and pathological response rate in locally
2000, 42 patients with carcinoma of the uterine cervix, FIGO stage
Ib(2)-IVa, were treated with two or three 21-day cycles of an epirubicin
100 mg/m(2), paclitaxel 175 mg/m(2), cisplatin 100 mg/m(2) regimen.
RESULTS: All patients were eligible for evaluation of toxicity and
response. A total of 92 courses of therapy were administered. Three
patients had a 20% reduction from the starting dose due to
haematological toxicity. Grade 3-4 leukopenia was observed in 15% of
cycles, requiring G-CSF support in half of them. Major
non-haematological toxicity consisted of grade 3 alopecia (100%), and
grade 3 nausea and vomiting (40%). A total of 33 clinical responses
(78.5%, 95% CI 63.8-93.2) were recorded, 8 complete responses (CR) and
25 partial responses (PR). Of the 42 patients, 32 (76.2%) underwent
radical surgery. At pathological examination 8 complete or microscopic
pathological responses, 17 PRs, and 9 patients with stable disease were
observed. The median follow-up time was 17 months for the 42 patients
enrolled (range 3-62 months). Among the patients submitted to radical
surgery, five recurrences were observed, with a median disease-free
survival of 47 months. Median overall survival had not been reached at
the time of this report. These results appear to be in the range
reported for other neoadjuvant cisplatin-based regimens not including
paclitaxel. CONCLUSIONS: Neoadjuvant chemotherapy with the epirubicin,
paclitaxel and cisplatin combination followed by radical surgery proved
to be a safe and effective approach to advanced cervical cancer.
14
UI - 11973965
AU - Jalkanen J
TI -
[Chemotherapy improves the treatment results of cervical cancer]
SO - Duodecim 1999;115(22):2417-8
15
UI - 11955746
AU - Mundt AJ; Lujan AE; Rotmensch J; Waggoner SE; Yamada SD; Fleming G;
TI -
Roeske JC
Intensity-modulated whole pelvic radiotherapy in women with gynecologic
malignancies.
SO - Int J Radiat Oncol Biol Phys 2002 Apr 1;52(5):1330-7
AD - Department of Radiation and Cellular Oncology, University of Chicago
Priztker School of Medicine, Chicago, IL 60637, USA.
mundt@rover.uchicago.edu
PURPOSE: To describe our initial clinical experience with
intensity-modulated whole pelvic radiotherapy (IM-WPRT) in women with
fabrication of customized immobilization, all patients underwent
contrast-enhanced CT, and a clinical target volume was contoured
consisting of the upper vagina, parametria, uterus (if present), and
presacral and pelvic lymph node regions. The clinical target volume was
expanded by 1 cm to create a planning target volume (PTV). Using
commercially available software, 7- or 9-field, 6-MV, coplanar IM-WPRT
plans were generated for all patients. The worst acute gastrointestinal
and genitourinary toxicity during treatment was scored on a 4-point
scale: 0, none; 1, mild, no medications required; 2, moderate,
medications required; and 3, severe, treatment breaks or cessation,
hospitalization. As a comparison, acute toxicities in 35 previously
treated conventional WPRT patients were analyzed. No significant
differences were noted in the clinicopathologic and treatment factors
between the two groups. RESULTS: IM-WPRT plans provided excellent PTV
coverage, with considerable sparing of the surrounding normal tissues.
On average, 98.1% of the PTV received the prescription dose. The average
percentage of the PTV receiving 110% and 115% of the prescription dose
was 9.8% and 0.2%, respectively. IM-WPRT was well tolerated, with no
patient developing Grade 3 toxicity. Grade 2 acute gastrointestinal
toxicity was less common in the IM-WPRT group (60 vs. 91%, p = 0.002)
than in the conventional WPRT group. Moreover, the percentage of IM-WPRT
and WPRT patients requiring no or only infrequent antidiarrheal
medications was 75% and 34%, respectively (p = 0.001). Although less
Grade 2 genitourinary toxicity was seen in the IM-WPRT group (10% vs.
20%), this difference was not statistically significant (p = 0.22).
CONCLUSION: IM-WPRT is a promising approach in gynecology patients. IMRT
planning resulted in excellent PTV coverage, with considerable sparing
of normal tissues. Treatment was well tolerated and associated with less
acute gastrointestinal sequelae than conventional WPRT. Longer follow-up
and more patients are needed, however, to evaluate the full merits of
this novel approach.
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The above citations and abstracts reflect those newly added to CANCERLIT for the month and topic listed in the title. The citations have been retrieved from CANCERLIT using a predefined search strategy of indexed subject terms. Although the search strategy has been refined as best as possible, citations may appear that are not directly related to the topic, and occasionally relevant references may be omitted.
UI - 11955747
AU - Lee SW; Suh CO; Chung EJ; Kim GE
TI -
Dose optimization of fractionated external radiation and high-dose-rate
intracavitary brachytherapy for FIGO stage IB uterine cervical
carcinoma.
SO - Int J Radiat Oncol Biol Phys 2002 Apr 1;52(5):1338-44
AD - Department of Radiation Oncology, Asan Medical Center, University of
Ulsan College of Medicine, Songpa-Gyu, Seoul, Korea. ccrt@korea.com
PURPOSE: To determine the optimal dose combination scheme of external
beam radiotherapy (EBRT) and high-dose-rate (HDR) intracavitary
radiation (ICR) for maximizing tumor control while conferring an
acceptable late complication rate in the treatment of Stage IB uterine
cervical cancer. METHODS AND MATERIALS: We retrospectively analyzed 162
patients with International Federation of Gynecology and Obstetrics
(FIGO) Stage IB squamous cell carcinoma of the uterine cervix who
HDR-ICR, all patients received EBRT to a total dose of 40-46 Gy (median
45), administered during 4-5 weeks to the whole pelvis. HDR-ICR was
given 3 times weeks to a total dose of 24-51 Gy (median 39) at point A,
using a dose of 3 Gy/fraction. Central shielding from EBRT was begun
after the delivery using 20-45 Gy (median 40) of the external dose. The
total dose to point A, calculated by adding the EBRT biologically
effective dose (BED) and the ICR BED to point A, was 74.1-118.1 Gy (mean
95.2). The rectal point dose was calculated at the anterior rectal wall
at the level of the cervical os. The local control rate, survival rate,
and late complication rate were analyzed according to the irradiation
dose and BED. RESULTS: The initial complete response rate was 99.4%. The
overall 5-year survival rate and 5-year disease-free survival rate was
91.1% and 90.9%, respectively. The local failure rate was 4.9%, and the
distant failure rate was 4.3%. Late complications were mild and occurred
in 23.5% of patients, with 18.5% presenting with rectal complications
and 4.9% with bladder complications. The mean rectal BED (the sum of the
external midline BED and the ICR rectal point BED) was lower in the
patients without rectal complications than in those with rectal
complications (125.6 Gy vs. 142.7 Gy, p = 0.3210). The late rectal
complication rate increased when the sum of the external midline BED and
the rectal BED by ICR was >or=131 Gy (p = 0.1962). However, 5-year
survival rates did not increase with the external midline BED (p =
0.4093). The late rectal complication rate also increased, without a
change in the survival rate, when the sum of the external midline BED
and the ICR point A BED was >90 Gy. CONCLUSION: In treating Stage IB
carcinoma of the uterine cervix with HDR-ICR, using fractions of 3 Gy,
it is crucial to keep the point A BED at
UI - 11955748
AU - Harima Y; Sawada S; Nagata K; Sougawa M; Ohnishi T
TI -
Human papilloma virus (HPV) DNA associated with prognosis of cervical
cancer after radiotherapy.
SO - Int J Radiat Oncol Biol Phys 2002 Apr 1;52(5):1345-51
AD - Department of Radiology, Kansai Medical University, Moriguchi City,
Osaka, Japan. harima@takii.kmu.ac.jp
PURPOSE: The importance of human papilloma virus (HPV) infection in the
outcome of cervical cancer after radiotherapy remains unknown. Our study
explored whether the HPV status of tumors is associated with the outcome
of radiotherapy in patients with cervical cancer. METHODS AND MATERIALS:
A total of 84 patients with cervical cancer (6 Stage I, 10 Stage II, 49
Stage III, and 19 Stage IV) who underwent definitive radiotherapy
samples were obtained from all patients by punch biopsy before
radiotherapy. The presence of HPV and its type were analyzed by
polymerase chain reaction (PCR) based assay using the consensus primers
for E6 and L1 regions. Actuarial methods were used to calculate overall
survival and disease-free survival. RESULTS: A total of 42 patients
(50%) had cancer recurrence after radiotherapy. HPV-positive tumors were
found in 76.2% (64 cases) of patients. HPV-negative patients survived
for significantly shorter time periods compared to the HPV-positive
patients in the overall survival (p = 0.007) and the disease-free
survival (p = 0.005). According to multivariate analysis, HPV status is
a significant predictor of both overall (p = 0.02) and disease-free
survival time (p = 0.005). CONCLUSION: The results of this study suggest
that HPV-negative patients with cervical carcinoma have a significantly
poorer prognosis after radiotherapy, and HPV status may be used as a
marker to optimize the treatment of patients with this type of cancer.
UI - 11955755
AU - Low DA; Grigsby PW; Dempsey JF; Mutic S; Williamson JF; Markman J; Chao
TI -
KS; Klein EE; Purdy JA
Applicator-guided intensity-modulated radiation therapy.
SO - Int J Radiat Oncol Biol Phys 2002 Apr 1;52(5):1400-6
AD - Department of Radiation Oncology, Mallinckrodt Institute, St. Louis, MO
63110, USA. low@castor.wustl.edu
PURPOSE: We are introducing a novel method for delivering highly
conformal dose distributions to cervical cancer tumors using external
beam intensity-modulated radiation therapy. The method, termed
applicator-guided intensity-modulated radiation therapy (AGIMRT), will
use an applicator substitute placed in the vagina and uterus to provide
spatial registration and immobilization of the gynecologic organs. The
main reason for the applicator substitute will be to localize the
fornices, cervix, and uterus with the expectation that the other nearby
organs will also be reproducibly positioned with respect to the
applicator substitute. Intensity-modulated radiation therapy (IMRT) dose
distributions will be used as a substitute for high-dose-rate
intracavitary brachytherapy procedures. The flexibility of IMRT will
enable customized dose distributions that have the potential to reduce
complications and improve local control, especially for locally advanced
disease. METHODS AND MATERIALS: To test the advantages of IMRT over
intracavitary brachytherapy, volumetric scans of three cervical cancer
patients were obtained with implanted CT-compatible applicators. IMRT
dose distribution simulations using tomotherapy, were compared against
intracavitary brachytherapy using cesium tubes to investigate the
dosimetric differences of the two modalities. Because these tumor
volumes do not image well on CT, the target volumes were defined as the
isodose surface containing the traditional point A, defined as 2 cm
superior to the vaginal fornices and 2 cm lateral to the intrauterine
canal. One patient had a uterus that wrapped superior and anterior to
the bladder. For this case, the cervix and uterus were selected as the
target volume. To determine the potential for using an applicator
substitute to localize internal organs, the posterior bladder and
anterior rectal surfaces were localized relative to the colpostats.
Comparisons of the colpostat-localized surfaces were conducted for two
scan studies for 3 patients. RESULTS: The IMRT distributions covered the
point-A isodose surfaces while reducing doses to the bladder and rectum.
Brachytherapy showed extensive underdose regions in the target volume
for the wrapped-around target. Spatial positioning was better than 0.7
and 1.3 cm in the rectum and bladder, respectively, indicating the
potential that an applicator substitute may be able to localize these
structures. CONCLUSIONS: AGIMRT has the potential for improving critical
structure avoidance while maintaining highly reproducible and accurate
internal organ registration found with brachytherapy.
UI - 11975325
AU - Dargent D
TI -
[Radical trachelectomy: an operation that preserves the fertility of
young women with invasive cervical cancer]
SO - Bull Acad Natl Med 2001;185(7):1295-304; discussion 1305-6
AD - Hopital Edouard Herriot, Place d'Arsonval, 69437 Lyon.
Surgery for epithelial cancer is more and more getting a tailored
surgery: wide local excision of the primary and focused retrieval of the
regional lymph nodes. As far as cancer of the cervix is concerned such a
strategy is avoidable: laparosopic pelvic lymphadenectomy and radical
trachelectomy. This operation is a variant of the classical Schauta
operation. The difference is the uterus is divided underneath the
isthmus which is, at the end of the operation, stitched to the vagina. A
personal series of 82 cases gathered between 1987 and 2000 is reported.
The number of recurrences is three. All of them have been registered in
the population of 21 patients who were affected by a cancer two cm or
more large. Among the 38 patients who wanted and were able to become
pregnant 29 succeeded. Among the 47 registered pregnancies 35 went on
after the 14th week and 27 finished with the birth of a living baby.
UI - 11757297
AU - Khoronenko VE; Osipova NA; Petrova VV; Sergeeva IE; Donskova IuS;
TI -
Zhelezkina NV; Ivanova LM
[General intravenous anesthesia with spontaneous respiration for
noncavitary interventions in cancer]
SO - Anesteziol Reanimatol 2001 Sep-Oct;(5):36-40
Two new variants of total intravenous anesthesia with spontaneous
respiration were used in 307 female patients subjected to noncavitary
interventions for cancer and gynecological cancer. The patients were
divided into 2 groups: 1) total anesthesia with midasolam, fentanyl, and
calipsol and 2) the same + propofol. Preventive analgesia by
preoperative injections of peripheral analgesics was carried out in both
groups. Both methods proved to be effective, ensuring good protection
from traumatic noncavitary oncological operations. Balanced anesthesia
with two hypnotics midasolam and propofol should be preferred, as they
mutually potentiate their effects and therefore can be used in the
minimum doses, thus preventing the probable side effects, minimizing the
use of central analgesics, and ruling out the probability of respiration
depression.
UI - 11995272
AU - Todd RW; Wilson S; Etherington I; Luesley D
TI -
Effect of nurse colposcopists on a hospital-based service.
SO - Hosp Med 2002 Apr;63(4):218-23
AD - Department of Obstetrics and Gynaecology, City Hospital NHS Trust,
Birmingham B18 7QH.
The number of colposcopies performed annually in the UK is increasing.
Nurse colposcopists have been introduced by many units to cope with this
workload. The small amount of evidence to support the introduction of
nurse colposcopists suggests that nurses are viable alternative
providers of colposcopy. This study compares the performance of nurse
colposcopists with that of doctors.
UI - 11509878
AU - Gissmann L; Osen W; Muller M; Jochmus I
TI -
Therapeutic vaccines for human papillomaviruses.
SO - Intervirology 2001;44(2-3):167-75
AD - DeutschesKrebsforschungszentrum, Forschungsschwerpunkt Angewandte
Tumorvirologie, Heidelberg, Deutschland. L.Gissmann@dkfz.de
Although papillomavirus infections are not very immunogenic there is
evidence that the immune system controls the spread of virus and the
development of diseases associated with such infections. Certain types
of human papillomaviruses (HPV) are the major cause of premalignant and
malignant diseases of the anogenital tract, most notably cancer of the
uterine cervix, a major health care problem worldwide. Since the viral
oncoproteins E6 and E7 are constitutively expressed within the tumor
cells, they are considered as suitable targets for attack by T
lymphocytes. Several approaches to specifically trigger a cell-mediated
immune response have been successful in experimental animals, leading to
suppression of HPV-induced tumors. First clinical trials have been
completed which raise hopes that a similar effect can also be achieved
by therapeutic vaccination of humans. Copyright 2001 S. Karger AG, Basel
UI - 11904476
AU - Girardi F; Pickel H; Joura EA; Breitenecker G; Gitsch G; Graf AH;
TI -
Neunteufel W
[Guidelines for diagnosis and therapy of intraepithelial neoplasia and
early invasive carcinoma of the female lower genital system (cervix
uteri, vagina, vulva) established by the AGK (Colposcopy Work Group in
the OGGG [Austrian Society of Gynecology and Obstetrics])]
SO - Gynakol Geburtshilfliche Rundsch 2001;41(3):197-200
AD - Abteilung fur Gynakologie und Geburtshilfe, A. o. KH Baden, Osterreich.
UI - 12013158
AU - Dey P; Gibbs A; Arnold DF; Saleh N; Hirsch PJ; Woodman CB
TI -
Loop diathermy excision compared with cervical laser vaporisation for
the treatment of intraepithelial neoplasia: a randomised controlled
trial.
SO - BJOG 2002 Apr;109(4):381-5
AD - Centre for Cancer Epidemiology, Withington, Manchester, UK.
OBJECTIVE: To determine whether loop diathermy excision of the
transformation zone and laser vaporisation are equally effective in the
treatment of cervical intraepithelial neoplasia. DESIGN: Randomised
controlled trial. POPULATION: Women referred for evaluation of
cytological abnormality who were considered suitable for outpatient
local destructive treatment. SETTING: Seven colposcopy units in the
North West Region. METHODS: Loop diathermy excision of the
transformation zone and laser vaporisation. MAIN OUTCOME MEASURE: Smear
reported as moderate dyskariosis or worse following treatment. RESULTS:
Of 289 women randomised, 285 had one or more smears following treatment.
Women were more likely to have a smear reported as moderate dyskariosis
or worse following laser vaporisation [hazard ratio 3.01 (95% CI 1.27 to
7.12)]. The cumulative risk of a smear reported as moderate dyskariosis
or worse was 6.0% at six months and 12.1% at three years in those
allocated laser vaporisation, and 2.0% at six months, and 3.3% at three
years in those allocated loop diathermy excision of the transformation
zone. CONCLUSIONS: Loop diathermy excision is a more effective treatment
of cervical intraepithelial neoplasia than laser vaporisation.
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