National Cancer Institute®
Last Modified: March 1, 2002
UI - 11723421
AU - Di Roma E; Parlavecchio E; Vettraino G; Corosu R
TI - [CIN: multicentric study of therapeutic strategies]
SO - Minerva Ginecol 2001 Dec;53(6):379-2
AD - I Clinica Ostetrica e Ginecologica, IV Divisione, Policlinico Umberto I, Universita degli Studi La Sapienza, Rome, Italy.
BACKGROUND: Cervical Intraepithelial Neoplasia (CIN) is a dysplastic lesion that precedes cervical cancer. The diagnosis is made by colposcopic, cytologic and bioptic exams. Therapy may be physical, pharmacological or surgical. METHODS: We prepared a model of interview (consisting of 9 questions) for 33 colposcopic centers in the Lazio region. Our aim was to evaluate their therapeutic strategies for CIN and cervical condylomata. We referred to SIGO 1999 guidelines for CIN therapy and to European guidelines for cervical condylomata therapy. RESULTS: The centers used drugs more for HPV infections (57%) than for dysplasia (33%). Drug therapy was used more in the past (66.67%). Actually they prefer treating CIN I with electrocoagulation diathermy (DTC), CIN II with loop electrosurgical excision procedures (LEEP) or Laser, CIN III with cold knife conization or LEEP, cervical condylomata with laser or DTC. CONCLUSIONS: The results show that the centers prefer physical therapy. Therapeutic strategies comply with SIGO 1999 guidelines for therapy of CIN and with European guidelines for cervical condylomata partially.
UI - 11544829
AU - Zorin AV; Tsodikov AD; Khanin LG; Zharinov GM; Zaikin GV; Iakovlev AIu
TI - [Parametric survival analysis in patients with cervical cancer following fractionated radiotherapy: a new procedures and results]
SO - Vopr Onkol 2001;47(3):307-11
AD - Central Research Institute of Roentgeno-Radiology, Ministry of Health of the RF, St. Petersburg.
A recent theoretical result of Kendal (1998) enabled us to develop a survival model which allows for proliferation of tumor clonogenic cells in the course of fractionated radiotherapy. We explored this model during an analysis of clinical data on survival of 982 patients with cancer of the cervix uteri. The model provided a good description of survival patterns in different groups of patients. The estimated cure probability did not correlate with the rates of cell proliferation between exposures to radiation. Also, our results showed that this parameter cannot be estimated from survival data. Some light has been thrown on the relationship of cell proliferations taking place between exposures, on the one hand, and end-results of treatment for cancer of the cervix uteri, on the other.
UI - 11544838
AU - Vishnevskaia EE; Okeanova NI; Shelkovich SE; Matylevich OP
TI - [Evaluation of combined treatment in stage-II cervical cancer in terms of morphologic structure of the tumor]
SO - Vopr Onkol 2001;47(3):355-9
AD - N.N. Alexandrov Research Institute of Oncology and Medical Radiology, Minsk, Belarus.
The efficacy of stage II cervical cancer (CC) treatment was evaluated in two groups: squamous cell carcinoma--151, cervical adenocarcinoma (CAC)--49. All the patients received combined treatment (preoperative large-fraction brachytherapy + surgery + postoperative radiation). A comparison of the results highlighted the role of morphological pattern of tumor as a factor of cure. Five-year survival rates for CAC stage II patients were lower by 12.4% while the incidence of distant lymphogenous metastases and those to organs, responsible for failed therapy, was 2.7 times as high.
UI - 11564482
AU - Green JA; Kirwan JM; Tierney JF; Symonds P; Fresco L; Collingwood M;
TI - Williams CJ Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis.
SO - Lancet 2001 Sep 8;358(9284):781-6
AD - Department of Medicine, University of Liverpool, L69 3GA, Liverpool, UK. J.A.Green@liverpool.ac.uk
BACKGROUND: The US National Cancer Institute alert in February, 1999, stated that concomitant chemotherapy and radiotherapy should be considered for all patients with cervical cancer. Our aim was to review the effects of chemoradiotherapy on overall and progression-free survival, local and distant control, and acute and late toxicity in patients with cervical cancer. METHODS: With the methodology of the Cochrane Collaboration, we did a systematic review of all known randomised controlled trials done between 1981 and 2000 (17 published, two unpublished) of chemoradiation for cervical cancer. FINDINGS: The trials included 4580 randomised patients, and 2865-3611 patients (62-78%) were available for analysis. Cisplatin was the most common agent used. The findings suggest that chemoradiation improves overall survival (hazard ratio 0.71, p<0.0001), whether platinum was used (0.70, p<0.0001) or not (0.81, p=0.20). A greater beneficial effect was seen in trials that included a high proportion of stage I and II patients (p=0.009). An improvement in progression-free survival was also seen with chemoradiation (0.61, p<0.0001). Thus, the absolute benefit in progression-free and overall survival was 16% (95% CI 13-19) and 12% (8-16), respectively. A significant benefit of chemoradiation on both local (odds ratio 0.61, p<0.0001) and distant recurrence (0.57, p<0.0001) was also recorded. Grade 3 or 4 haematological (odds ratio 1.49-8.60) and gastrointestinal (2.22) toxicities were significantly greater in the concomitant chemoradiation group than the control group. There was insufficient data to establish whether late toxicity was increased in the concomitant chemoradiation group. INTERPRETATION: Concomitant chemotherapy and radiotherapy improves overall and progression-free survival and reduces local and distant recurrence in selected patients with cervical cancer, which may give a cytotoxic and sensitisation effect.
UI - 11813150
AU - Nori D; Dasari N; Allbright RM
TI - Gynecologic brachytherapy I: Proper incorporation of brachytherapy into the current multimodality management of carcinoma of the cervix.
SO - Semin Radiat Oncol 2002 Jan;12(1):40-52
AD - Department of Radiation Oncology, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, NY 10021, USA.
The incidence of carcinoma of the cervix has continuously declined over the past decades because of effective screening. The International Federation of Gynecology and Obstetrics (FIGO) clinical staging, though universally used, is considered inadequate either to determine the type of treatment or to predict treatment outcome. Over the last 10 years, treatment of cervical cancer has become increasingly sophisticated with advances in external beam and brachytherapy in the radiotherapeutic management of this carcinoma. In particular, brachytherapy plays a major role in enhancing both local control and survival. Experience to date suggests that either high-dose-rate (HDR) or low-dose-rate (LDR) brachytherapy, when properly applied, can be effective and give similar rates of local control with minimal complications. This article analyzes the current literature regarding treatment techniques of radiotherapy with special emphasis on brachytherapy integration to optimize radiotherapy treatment outcome. Copyright 2002 by W.B. Saunders Company
UI - 11830236
AU - van der Zee J; Koper PC; Lutgens LC; Burger CW
TI - Treatment of cervical cancer.
SO - Lancet 2002 Jan 26;359(9303):357; discussion 358
UI - 11853297
AU - Manusirivithaya S; Chareoniam V; Pantusart A; Isariyodom P; Srisomboon J
TI - Comparative study of bulky stage IB and IA cervical cancer patients treated by radical hysterectomy with and without neoadjuvant chemotherapy: long-term follow-up.
SO - J Med Assoc Thai 2001 Nov;84(11):1550-7
AD - Department of Obstetrics and Gynecology, Bangkok Metropolitan Medical College and Vajira Hospital, Thailand.
One hundred and ninety patients with bulky (> 3 cm) stage IB and IIA cervical cancer who underwent radical hysterectomy between 1991 and 1994 at Maharaj Nakorn Chiang Mai Hospital were reviewed to determine whether neoadjuvant chemotherapy (NAC) with MVAC (Methotrexate, Vinblastine, Adriamycin, Cisplatin) improved survival. There were 42 patients treated with pre-operataive NAC (MVAC 1-3 courses) and 148 patients treated by primary surgery (PS). In the NAC group, the overall response rate from MVAC was 88.1 per cent with 31.0 per cent having complete clinical response and 7.1 per cent with complete pathological response. Pelvic lymph node metastasis was not significantly different between the NAC group (16.7%) and the PS group (18.2%). At a median follow-up of 64.5 months, 19.0 per cent in the NAC group and 18.2 per cent in the PS group had tumor recurrence. The 5-year progression free and overall survival was 80.8 per cent and 92.0 per cent respectively for the NAC group which was not significantly different from 80.2 per cent and 92.9 per cent respectively in the PS group. In conclusion, although NAC can decrease the tumor size and produce a high response rate, it does not improve survival in bulky stage IB and IIA cervical cancer patients.
UI - 11872302
AU - Hsu IC; Speight J; Hai J; Vigneault E; Phillips T; Pouliot J
TI - A comparison between tandem and ovoids and interstitial gynecologic template brachytherapy dosimetry using a hypothetical computer model.
SO - Int J Radiat Oncol Biol Phys 2002 Feb 1;52(2):538-43
AD - Department of Radiation Oncology, University of California at San Francisco, San Francisco, CA 94143-1708, USA. firstname.lastname@example.org
PURPOSE: To evaluate the dose distribution within the clinical target volume between two gynecologic brachytherapy systems---the tandem and ovoids and the Syed-Neblett gynecologic template---using a hypothetical computer model. METHODS AND MATERIALS: Source positions of an intracavitary system (tandem and ovoids) and an interstitial system (GYN template) were digitized into the Nucletron Brachytherapy Planning System. The GYN template is composed of a 13-catheter implant (12 catheters plus a tandem) based on the Syed-Neblett gynecologic template. For the tandem and ovoids, the dwell times of all sources were evenly weighted to produce a pear-shaped isodose distribution. For the GYN template, the dwell times were determined using volume optimization. The prescribed dose was then normalized to point A in the intracavitary system and to a selected isodose line in the interstitial system. The treated volume in the two systems was kept approximately the same, and a cumulative dose-volume histogram of the treated volume was then generated with the Nucletron Brachytherapy Planning System to use for comparison. To evaluate the dose to a hypothetical target, in this case the cervix, a 2-cm-long, 3-cm-diameter cylinder centered along the tandem was digitized as the clinical target volume. The location of this hypothetical cervix was based on the optimal application of the brachytherapy system. A visual comparison of clinical target coverage by the treated volume on three different orthogonal planes through the treated volume was performed. The percentage dose-volume histograms of the target were generated for comparison. Multiple midline points were also placed at 5-mm intervals away from the tandem in the plane of the cervix to simulate the location of potential bladder and rectal dose points. Doses to these normal structures were calculated for comparison. RESULTS: Although both systems covered the hypothetical cervix adequately, the interstitial system had a better coverage of the region lateral to the cervix. Smaller volumes of the vagina and uterine fundus received the full dose from the interstitial implant. The cumulative dose-volume histograms revealed larger high-dose regions within the treatment volume for the intracavitary system. The volumes receiving > or = 180% of the prescription dose were 31 cc and 17 cc for the intracavitary system and interstitial system, respectively. The isodose lines showed that most of this difference results from the high-dose region around the tandem. The percentage dose-volume histograms showed that a larger percentage of cervix received a higher dose in the intracavitary system. Fifty-two percent of the target volume received 200% or higher of the prescription dose with tandem and ovoids, compared with only 20% with the template system. Analysis of dose points outside of the 100% isodose lines showed a slightly more rapid dose drop-off with the interstitial system compared to the intracavitary system. Point doses at 20, 25, and 30 mm from the tandem in the interstitial system were 100%, 69%, and 51% of prescribed dose, and from the intracavitary system were 101%, 76%, and 58%, respectively. CONCLUSIONS: Our dosimetric analysis revealed a better coverage in the parametrial regions, but underdosage of the central cervical region, for the interstitial system. On the other hand, because of the increased distance of source to dose point, there is a more rapid dose drop-off outside the treated volume with the interstitial system, which has the potential to improve tissue sparing. Based on this analysis, we caution against using a radiotherapy system with a homogeneous central dose distribution when treating cervical cancer with an intact uterus. We recommend differential loading of the implant catheters with the majority of dose delivered from the tandem when using an interstitial GYN template with remote afterloader.
UI - 11136561
AU - Landoni F; Maneo A; Cormio G; Perego P; Milani R; Caruso O; Mangioni C
TI - Class II versus class III radical hysterectomy in stage IB-IIA cervical cancer: a prospective randomized study.
SO - Gynecol Oncol 2001 Jan;80(1):3-12
AD - Clinica Ostetrico-Ginecologica, University of Milan, Bicocca, Monza, Italy.
OBJECTIVE: The objective of this study was to determine the role of the extent of the radicality in the treatment of stage IB-IIA cervical carcinoma with respect to survival, pattern of relapse, and morbidity. METHODS: Two-hundred forty-three patients with cervical carcinoma (FIGO stages IB and IIa) were enrolled in a prospective randomized study comparing two types of radical hysterectomy (Piver-Rutledge-Smith class evaluable. Disease-free survival, overall survival, pattern of recurrences, and morbidity were the endpoints of this study. RESULTS: Mean operative time was significantly (P = 0. 05) shorter in the group of patients undergoing class II hysterectomy (135 min vs 180 min), whereas mean blood loss (530 ml vs 580 ml) and number of patients requiring transfusions (35% vs 43%) were similar in the two arms of treatment. Complications unrelated to the extent of the surgical dissection and mean postoperative stay were similar in the two arms of treatment. Late morbidity was significantly lower in patients in the class II arm (especially urologic morbidity, 13% vs 28%). Postoperative radiotherapy was administered to 64 patients (54%) in class II and to 65 patients (55%) in the class III arm. Recurrence rate (24% class II vs 26% class III) and number of patients dead of disease (18% class II vs 20% class III) were not significantly different in the two groups of treatment. Overall 5-year survival was 81 and 77% and disease-free survival was 75 and 73%, respectively. Multivariate analysis confirms that survival does not depend on the type of operation. CONCLUSIONS: Class II and class III radical hysterectomies are equally effective in surgical treatment of cervical carcinoma, but the former is associated with a lesser degree of late complications. Copyright 2001 Academic Press.
UI - 11812088
AU - Lea JS; Sheets EE; Duska LR; Miller DS; Schorge JO
TI - Early-stage cervical adenocarcinoma treated by surgical intent: the role of para-aortic lymph node dissection.
SO - Gynecol Oncol 2002 Feb;84(2):285-8
AD - Division of Gynecologic Oncology, University of Texas Southwestern, Dallas, Texas 75390, USA.
OBJECTIVE: Previous reports suggest that cervical adenocarcinomas have a unique pattern of spread and are more apt to metastasize to para-aortic lymph nodes. The purpose of this study was to further define the node of para-aortic lymph node dissection in early-stage cervical adenocarcinoma treated by surgical intent. METHODS: Institutional review board approval was obtained to perform a computerized search of the data of all women diagnosed with cervical adenocarcinoma between 1982 and 2000. Hospital charts were retrospectively reviewed. Follow-up was obtained from the tumor registry, medical records, and correspondence with health care providers. RESULTS: Three hundred (87%) of 345 early-stage (FIGO IA(1)-IIA) cervical adenocarcinoma patients were primarily treated by surgical intent. Two hundred seventy-six underwent pelvic and para-aortic node dissection (n = 69) or pelvic node dissection only (n = 207); 24 had no lymph node dissection. The median number of lymph nodes removed was 13 pelvic (range, 1-58) and 3 para-aortic (range, 1-17). Three (4%) of 69 patients had para-aortic nodal metastases. Each had either grossly evident para-aortic adenopathy (n = 2) or an adnexal metastasis. Thirty-six of 40 women developing recurrent disease had at least some component of pelvic recurrence; 4 had only extrapelvic disease. Three patients undergoing para-aortic node dissection developed an isolated extrapelvic recurrence despite originally negative para-aortic nodes (n = 2) or treatment by extended-field radiation for para-aortic metastases. One woman undergoing only pelvic node dissection had an isolated extrapelvic recurrence despite originally negative nodes. CONCLUSIONS: Early-stage cervical adenocarcinoma primarily treated by surgical intent has a very low risk of para-aortic metastases. These were detected only when there was gross evidence of nodal or adnexal disease. B)2002 Elsevier Science.
UI - 11812089
AU - Nakamoto Y; Eisbruch A; Achtyes ED; Sugawara Y; Reynolds KR; Johnston
TI - CM; Wahl RL Prognostic value of positron emission tomography using F-18-fluorodeoxyglucose in patients with cervical cancer undergoing radiotherapy.
SO - Gynecol Oncol 2002 Feb;84(2):289-95
AD - Division of Nuclear Medicine, Johns Hopkins University, Baltimore, Maryland 21287-0817, USA.
OBJECTIVE: The purpose of this study was to determine whether positron emission tomography (PET) using F-18-fluorodeoxyglucose (FDG) before and after radiotherapy would predict whether local control of cervical cancer had been achieved. METHODS: FDG-PET scans were performed prior to therapy and at a mean of 4.6 months after radiation in 20 patients (pts) with histologically proven uterine cervical cancer who were undergoing a "curative" course of radiation therapy. FDG uptake was interpreted visually by two readers using a 5-point grading system (0 = normal, 1 = probably normal, 2 = equivocal, 3 = probably abnormal, and 4 = definitely abnormal). The standardized uptake values corrected by lean body mass (SUL) were calculated for suspicious areas. The percentage of residual activity (%RA) for the posttherapy SUL was also evaluated as a percentage of the pretherapy SUL. RESULTS: At baseline before irradiation, 17 of 20 (85.0%) primary tumors were detected. Following irradiation, no or low (grade 0-2) uptake was observed in 9 pts, and none of these had local recurrence. Among the remaining 11 pts with grade 3 or 4 uptake, the correct diagnosis was made for 5 pts with active tumor; SULs (mean +/- SD = 4.17 +/- 2.52) and %RAs (57.9 +/- 16.8). Six patients without active tumor showed relatively low SULs (2.67 +/- 0.69) and %RAs (43.0 +/- 18.3). No significant differences were observed between the recurrent and nonrecurrent groups for these parameters. Overall, sensitivity, specificity, and accuracy were 100, 60, and 70%, respectively. CONCLUSION: These preliminary data indicate that FDG-PET is a sensitive tool for detecting active cervical cancer after radiation, however, the method, without anatomic correlation had suboptimal specificity. B)2002 Elsevier Science.
UI - 11812094
AU - Hasenburg A; Salama JK; Van TJ; Amosson C; Chiu JK; Kieback DG
TI - Evaluation of patients after extraperitoneal lymph node dissection and subsequent radiotherapy for cervical cancer.
SO - Gynecol Oncol 2002 Feb;84(2):321-6
AD - Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas 77030, USA. email@example.com
OBJECTIVE: The presence of nodal metastases is the most important prognostic factor in cervical cancer. To adjust our therapy based on the true extent of the patient's disease, we performed an extraperitoneal lymph node dissection (EPLND) in all patients with cervical cancer prior to radiotherapy (RT) or radical hysterectomy. METHODS: Thirty-three patients with carcinoma of the cervix underwent EPLND. The value of this procedure as a diagnostic tool for monitoring the extension of the disease was determined. Additionally, EPLND/RT-associated treatment complications were monitored. RESULTS: The combined treatment approach of EPLND with RT or chemotherapy/RT was without major complications. Nineteen patients showed a temperature elevation, but only one patient had a fever of greater than 39.0 degrees C. Fourteen (48.3%) of 29 patients experienced some degree of proctitis or diarrhea and 3 (10.3%) experienced cystitis during the course of RT. No grade 3 or 4 acute or late genitourinary or gastrointestinal toxicities were noted. EPLND changed the clinical management for 6 patients from a radical hysterectomy to RT and for 7 patients from standard-field RT to extended-field RT. Without EPLND these 7 patients would have received RT with standard pelvic fields that would not have treated involved lymph node areas at high risk for subsequent failure. CONCLUSION: Thirteen (44.8%) of 29 patients received a different treatment than would otherwise have been administered with standard treatment planning. Therefore, we suggest that EPLND should be performed in all patients with cervical cancer prior to radical surgery or RT. B)2002 Elsevier Science.
UI - 11812095
AU - Trudeau M; Stuart G; Hirte H; Drouin P; Plante M; Bessette P; Dulude H;
TI - Lebwohl D; Fisher B; Seymour L A phase II trial of JM-216 in cervical cancer: an NCIC CTG study.
SO - Gynecol Oncol 2002 Feb;84(2):327-31
AD - National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada. firstname.lastname@example.org
OBJECTIVE: BMS-182751 (JM-216) is an orally bioavailable platinum compound with activity in platinum-sensitive and platinum-resistant preclinical models. The objective was to determine its activity in recurrent/metastatic squamous cell carcinoma of the cervix. METHODS: We conducted a phase II study of BMS-182751 given at a dose of 30 mg/m(2) daily for 14 days every 5 weeks. RESULTS: Eighteen patients (pts) with advanced/recurrent squamous cancer of the cervix not amenable to curative therapy with measurable disease who had received no prior chemotherapy for systemic disease were entered, all of whom are evaluable for response and toxicity. Median age was 47 years (35-74 years); all pts had received prior pelvic irradiation (RT); 4 pts had received cisplatin as adjustment therapy with radiation; PS was 0 (6 pts), 1 (7 pts), and 2 (5 pts); sites of disease included nodes (10 pts), pelvis (5 pts), lung (4 pts), and bone (3 pts). Median number of cycles was two (1-6) with 8 pts receiving three or more cycles. Toxicity was modest and usually grade 1 or 2 in severity with the most frequent drug related toxicity being nausea (56%), fatigue (50%), anorexia (39%), diarrhea (39%), vomiting (39%), constipation (28%), and altered taste (22%). Six pts had grade 3 or 4 granulocytopenia and only 1 pt, grade 3 or 4 thrombocytopenia. Two pts had grade 2 or 3 creatinine increases. There were no treatment-related deaths. One pt with a treatment-free interval of 30 years achieved a partial response, while 12 pts had a best response of stable disease. CONCLUSIONS: BMS-182751 is generally well tolerated, but has limited activity in pts with recurrent cervical cancer. B)2002 Elsevier Science.
UI - 11817998
AU - Elhanafy OA; Das RK; Paliwal BR; Migahed MD; Sakr HA; Elleithy M
TI - Anatomic variation of prescription points and treatment volume with fractionated high-dose rate gynecological brachytherapy.
SO - J Appl Clin Med Phys 2002 Winter;3(1):1-5
AD - Department of Human Oncology, University of Wisconsin, Madison, Wisconsin, USA.
The purpose of this report is to evaluate the geometric movement (relative to the bony pelvis) and dose variation of brachytherapy reference points in the same patient at repeated high-dose rate (HDR) intracavitary implants. A study was also concluded to find the variation in treatment volume from repeated fractions. Twenty-five consecutive cervical cancer patients (all stages) treated with external beam and fractionated HDR intracavitary implants at the University of Wisconsin were reviewed. Each brachytherapy insertion had a different plan generated prior to treatment delivery. ICRU #38 prescription points (A, B, P, bladder, and rectum) were used. Dose volume histogram was generated and treated volume to the prescription dose was recorded for each fraction. Motion analysis of the various points (from a common origin) in subsequent fractions relative to the first fraction revealed a shift of 2-9 mm in a single plane. Vector analysis revealed the magnitude of the average shift ranged from 10-13 mm. These shifts resulted in a dose difference of >20% for the bladder and rectum points, but < than 8% for the other points. Dose volume histograms revealed that with the change in the anatomy of the cervix and upper vagina during a patient's course of treatment, the treatment volume changes considerably. Thirty-six percent of all patients (9/16) had a reduction in the size of the ovoid during the treatment course. Sixty percent of all patients (15/25) had volume changes <10%. Sixty-two and one half percent of patients (10/16) who did not undergo a reduction of avoid size during the entire course of the treatment had volume change <10%. Since there is a change in the anatomy of the cervix and upper vagina during the course of a treatment along with the irreproducibility of the packing, there is movement of the absolute position of the prescription points between fractions, thus emphasizing the importance of individual dosimetry. Moreover, due to the same reasons, there are significant changes in the treatment volume among implants for the same patient. Volume reduction caused by reduction in ovoid size alone could not be extracted from this study.
UI - 11849783
AU - Kodaira T; Fuwa N; Kamata M; Furutani K; Kuzuya K; Ogawa K; Toita T;
TI - Sasaoka M; Nomoto Y Clinical assessment by MRI for patients with stage II cervical carcinoma treated by radiation alone in multicenter analysis: are all patients with stage II disease suitable candidates for chemoradiotherapy?
SO - Int J Radiat Oncol Biol Phys 2002 Mar 1;52(3):627-36
AD - Department of Radiation Oncology, Aichi Cancer Center, Aichi, Japan. email@example.com
PURPOSE: From recent randomized trials, patients with Stage II cervical carcinoma are thought to be candidates for chemoradiotherapy. To refine the strategy for Stage II patients, we performed a retrospective multi-institutional analysis using MRI. METHODS AND MATERIALS: From three institutions, 84 patients with Stage II cancer diagnosed by MRI were entered into the study. All patients received intracavitary brachytherapy with (n = 83) or without (n = 1) external beam radiotherapy. Uni- and multivariate analyses were performed to identify the prognostic factors for overall survival (OAS), disease-free survival (DFS), pelvic control (PC), and distant metastasis-free survival (DMFS). RESULTS: The 5-year DFS rate of patients with maximal tumor size (D(max)) > or =50 mm (46.2%) was significantly lower than that for patients with D(max) <50 mm (88.0%; p <0.0001). Large size or volume and lymph node swelling were also significant prognostic factors of OAS, DFS, PC, and DMFS. In the multivariate model, size or volume was a significant prognostic factor of OAS, DFS, PC, and DMFS, and lymph node swelling was a prognostic factor for DFS, PC, and DMFS. Using these two prognostic factors, patients were divided into 3 subgroups. The 5-year DFS rate of patients with risk 0 (D(max) <50 mm and negative lymph node swelling), 1 (D(max) > or =50 mm or positive lymph node swelling), and 2 (D(max) > or =50 mm and positive lymph nodes) was 93.2%, 53.3%, and 25.0%, respectively (p <0.0001). CONCLUSION: In this stage-limiting analysis, we clarified the stratification according to clinical risk with the aid of MRI. For patients with low-risk factors, especially for elderly patients, radiation alone would probability be a feasible option. In the future, a randomized trial using criteria with MRI would help to identify the optimal strategy for patients with Stage II disease.
UI - 11707645
AU - Rein DT; Kurbacher CM
TI - The role of chemotherapy in invasive cancer of the cervix uteri: current standards and future prospects.
SO - Anticancer Drugs 2001 Nov;12(10):787-95
AD - Department of Gynecology and Obstetrics, University of Dusseldorf Medical Center, 40001 Dusseldorf, Germany. Rein@med.uni-duesseldorf.de
For many decades, invasive cervical cancer has been considered more or less chemoresistant and chemotherapy has been limited to patients presenting with overt metastatic disease or those suffering from pelvic recurrences which could not be advised to secondary local treatments. However, more than 20 different single agents are considered active in cervical cancer. Recent cooperative clinical trials have demonstrated the superiority of multi-modality strategies for patients with high-risk cervical cancer. These studies integrating chemotherapy as part of the primary therapeutic concept have provided the most significant improvement of locally advanced disease in more than three decades. This review summarizes current standards of chemotherapy for invasive cervical cancer and shows new developments which may improve systemic treatment of the disease.
UI - 11707654
AU - Tsuda H; Tanaka M; Manabe T; Nakata S; Ishiko O; Yamamoto K
TI - Phase I-II study of neoadjuvant chemoradiotherapy followed by radical surgery in locally advanced cervical cancer.
SO - Anticancer Drugs 2001 Nov;12(10):853-8
AD - Department of Obstetrics and Gynecology, Osaka City General Hospital, Miyakojima, Osaka 534-0021, Japan. firstname.lastname@example.org
The usefulness of neoadjuvant chemotherapy (NAC) regimens has been reported; however, the effect of NAC for advanced stages (especially stage III-IVA) is thought to be insufficient. We conducted a phase I-II study of neoadjuvant chemoradiotherapy consisting of intra-arterial (i.a.) infusion of carboplatin and intracavitary brachytherapy in patients with locally advanced cervical cancer to achieve the new NAC method. Sixteen eligible patients included those with previously untreated stage IIB, III or IVA cancer with bulky tumor. Brachytherapy using iridium-192 was performed with concurrent i.a. chemotherapy with carboplatin (200, 300 and 400 mg/m2). Treatment was repeated every 4 weeks for a total of two cycles. Both hematologic and non-hematologic toxicities were generally mild. Grade 4 hematologic toxicity was observed in 12.5% and there were no grade III or IV non-hematologic toxicities. The optimal dose of carboplatin was determined to be 400 mg/m2. Among 16 patients, six showed complete response (37.5%) and nine showed partial response (56.3%), for an overall response rate of 93.8%. All 15 responding patients underwent radical surgery with a pelvic lymphadenectomy and postoperative radiotherapy. The combination of brachytherapy and i.a. chemotherapy with carboplatin is a promising regimen for NAC in locally advanced cervical cancer.
UI - 11161872
AU - Marana HR; de Andrade JM; da Silva Mathes AC; Duarte G; da Cunha SP;
TI - Bighetti S Chemotherapy in the treatment of locally advanced cervical cancer and pregnancy.
SO - Gynecol Oncol 2001 Feb;80(2):272-4
AD - Department of Gynecology and Obstetrics of the Medical School of Ribeirao Preto, University of Sao Paulo, SP 14.049-900, Brazil. email@example.com
BACKGROUND: Carcinoma of the cervix is the most common malignant tumor associated with pregnancy. The initial stages and premalignant lesions apparently present the same prognosis in pregnant and nonpregnant women; however, there are limited data regarding outcome for locally advanced cervical cancer in pregnancy. CASE: A 26-year-old woman, gravida 4, para 3, at 14 weeks and 4 days' gestation, was diagnosed with a FIGO stage IIB squamous cell carcinoma of the cervix, treated by primary chemotherapy with cisplatin and bleomycin, until pregnancy resolution at 38 weeks. The newborn infant is currently 3 years old and presents no evidence of abnormalities in neuropsychomotor development. CONCLUSION: The present case demonstrates that chemotherapy was harmless for the child up to the present time. However, a longer follow-up is needed to determine the safe outcome of this child.
UI - 11531312
AU - Barton DP; Butler-Manuel S; Buttery LD; A'Hern R; Polak JM
TI - Radical hysterectomy for early stage cervical cancer and resulting morbidity.
SO - Gynecol Oncol 2001 Aug;82(2):410-1
UI - 11844818
AU - Pearcey R; Brundage M; Drouin P; Jeffrey J; Johnston D; Lukka H; MacLean
TI - G; Souhami L; Stuart G; Tu D Phase III trial comparing radical radiotherapy with and without cisplatin chemotherapy in patients with advanced squamous cell cancer of the cervix.
SO - J Clin Oncol 2002 Feb 15;20(4):966-72
AD - Department of Oncology, University of Alberta, Edmonton, Canada. firstname.lastname@example.org
PURPOSE: To test the hypothesis that cisplatin (CDDP) administered concurrently with standard radiotherapy (RT) would improve pelvic control and survival in patients with advanced squamous cell cancer of the cervix. PATIENTS AND METHODS: A total of 259 patients with International Federation of Gynecology and Obstetrics stage IB to IVA squamous cell cervical cancer with central disease greater-than-or-equal 5 cm or histologically confirmed pelvic lymph node involvement were randomized to receive RT (external-beam RT plus brachytherapy) plus weekly CDDP chemotherapy (40 mg/m(2)) (arm 1) or the same RT without chemotherapy (arm 2). RESULTS: A total of 253 patients were available for analysis. Median follow-up was 82 months. No significant difference was found in progression-free survival (P =.33). No significant difference in 3- and 5-year survival rates was found (69% v 66% and 62% v 58%, respectively; P =.42). The hazard ratio for survival (arm 2 to arm 1) was 1.10 (95% confidence interval, 0.75 to 1.62). CONCLUSION: This study did not show a benefit to either pelvic control or survival by adding concurrent weekly CDDP chemotherapy in a dose of 40 mg/m(2) to radical RT as given in this trial. Careful attention to RT details is important for achieving optimum outcome for patients with this disease.
UI - 11855888
AU - Moutardier V; Christophe M; Lelong B; Houvenaeghel G; Delpero JR
TI - Iliac atherosclerotic occlusive disease complicating radiation therapy for cervix cancer: a case series.
SO - Gynecol Oncol 2002 Mar;84(3):456-9
AD - Paoli-Calmettes Institute, Marseilles, France.
BACKGROUND: Diagnosis and management of atherosclerotic occlusive disease complicating radiation therapy for squamous carcinoma of the cervix (SCC) are not well known. CASES: A series of four patients who underwent medical or surgical treatment of radiation-induced artery disease were identified. Chronic right iliac artery occlusion was seen in one patient 7 years after external irradiation for SCC and was treated by a femorofemoral bypass. Acute arterial occlusion was seen in three patients. One patient developed right foot ischemia 2 years after external irradiation for SCC which was treated by a right axillofemoral bypass. One patient developed a left toe necrosis 2 years after external irradiation for a recurrence of SCC which was treated by a percutaneous artery dilatation. One patient developed, 3 years after external irradiation for SCC, a subacute ischemia of the left leg on the first postoperative day after a rectal resection. It was treated by vasodilators, calcium inhibitors, and anticoagulants. CONCLUSIONS: Diagnosis of radiation-induced atherosclerotic occlusive disease complicating radiation therapy for SCC is easy but treatment is difficult. Long-term results of arterial dilatation are limited and extraanatomic bypass with allograft is the treatment of choice whenever feasible. However, because of poor long-term results, surgery should be attempted only in the case of severe ischemia.
UI - 11855896
AU - Shukunami K; Kotsuji F
TI - Implication of a reflected image illustration for pelvic lymphadenectomy on uterine cervical cancer with situs inversus totalis.
SO - Gynecol Oncol 2002 Mar;84(3):538
UI - 11890098
AU - Kim RY
TI - Recent advances in the treatment of gynecologic malignancies: an overview of the GOG phase III trials.
SO - Gan To Kagaku Ryoho 2002 Feb;29 Suppl 1():125-40
AD - Department of Radiation Oncology, Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA.
UI - 11890099
AU - Yuan CC; Ng HT; Wang PH
TI - New strategies and advances in the management of cervical carcinoma.
SO - Gan To Kagaku Ryoho 2002 Feb;29 Suppl 1():143-9
AD - Department of Obstetrics and Gynecology, Taipei-Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C. email@example.com
BACKGROUND: Carcinoma of the cervix is still common female cancer in Taiwan. A large portion of patients die of the disease in spite of various kinds of therapies and even the combination of multi-modality treatment. METHODS: The current review includes a comprehensive review of the literature. Many new strategies and advanced in the management of cervical carcinoma have been the subject of this intense study and include assisted systems to improve sensitivity and specificity of Pap smear, human papillomavirus (HPV), and its vaccination, operation, radiation, chemotherapy, and combination of these strategies. Because of the constant failure rate, a systemic and critical review of the disease and management should be considered. RESULTS: With improvement of detection rate of pre-invasive cancer and popularity of screening protocol, the prevalence rate of cervical carcinoma decreases progressively. However, although new strategies in managing cervical carcinoma focus on combination therapy, the life quality and survival rate of these patients with cervical carcinoma only show beneficial in certain group patients. CONCLUSION: As to the complexity of both disease nature and various combinations in the diagnosis and treatment of cervical cancer, comprehensive quality control programs and large prospective multicenter trials are mandatory for establishing the "standard of care" adhered to the principles of evidence-based medicine.
UI - 11821449
AU - Levenback C; Coleman RL; Burke TW; Lin WM; Erdman W; Deavers M;
TI - Delpassand ES Lymphatic mapping and sentinel node identification in patients with cervix cancer undergoing radical hysterectomy and pelvic lymphadenectomy.
SO - J Clin Oncol 2002 Feb 1;20(3):688-93
AD - Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA. firstname.lastname@example.org
PURPOSE: The purpose of this study was to determine the feasibility of sentinel node identification in patients with invasive cervix cancer undergoing radical hysterectomy and pelvic lymphadenectomy using preoperative and intraoperative lymphatic mapping. PATIENTS AND METHODS: Thirty-nine patients at two institutions were enrolled onto this institutional review board-approved study. All underwent preoperative lymphoscintigraphy and intraoperative lymphatic mapping with blue dye and a handheld gamma probe. Radical hysterectomy was aborted in four patients because metastatic disease was discovered on frozen section analysis of the sentinel node. RESULTS: Preoperative lymphoscintigraphy revealed at least one sentinel node in 33 patients (85%), including 21 (55%) with bilateral sentinel nodes. All 39 patients had at least one sentinel node identified intraoperatively. Eighty percent of sentinel nodes were in three pelvic locations: iliac, obturator, and parametrial (in descending order of frequency). The remaining sentinel nodes were in the common iliac and para-aortic nodal basins. A total of 132 nodes were identified clinically as sentinel nodes; 65 (49%) were both blue and hot, 35 (27%) were blue only, and 32 (24%) were hot only. Eight patients (21%) had metastatic disease. In five of these patients, sentinel nodes were the only positive lymph nodes. One patient had false-negative sentinel nodes. She had four microscopically positive parametrial nodes that were resected in continuity with the uterus. The sensitivity of the sentinel node was 87.5% and the negative predictive value was 97%. CONCLUSION: Preoperative lymphoscintigraphy and intraoperative lymphatic mapping were highly successful at identifying sentinel nodes in patients undergoing radical hysterectomy.
UI - 11876009
AU - Durdevic S; Visnjevac V; Kermeci K
TI - [The Wertheim-Meigs radical hysterectomy in surgical treatment of cervical carcinoma]
SO - Med Pregl 2001 Sep-Oct;54(9-10):465-9
AD - Klinicki centar, Novi Sad. Winter@PTT.YU
INTRODUCTION: Wertheim from Vienna was the first to introduce the technique of radical hysterectomy into surgical practice in treatment of uterine cervix carcinoma associated with partial lymphadenectomy (1989). In concern to the level of surgical extensiveness, radical hysterectomy can be divided into 5 classes (after Piver-Rutledge). MATERIAL AND METHODS: At the Department of Obstetrics and Gynaecology in Novi Sad 55 patients with invasive cervical cancer (FIGO st. IB1-IIB) underwent surgery during the period from 1991 to 2001. All patients underwent radical hysterectomy after Wertheim-Meigs technique. The aim of this study was to present operative techniques of radical hysterectomy and complications following surgery. RESULTS: Distribution by stage of the disease was as follows: IB1 = 39 (70.9%), IB2 = 6 (10.9%), IIA = 7 (12.7%) and IIB = 3 (5.5%). On average, there were 15 lymph nodes removed, out of which 9 (16.4%) cases were positive. Postoperative complications were recorded in 19 (34.5%) patients, whereas the incidence of urinary fistulas and intrahospital mortality rate have been reduced to the minimum (0%). Recurrence was evident in 3 (5.4%) patients and 5-year survival rate was 92.3% (in patients operated up to 1997). DISCUSSION AND CONCLUSION: In relation to previously published results of treatment at the Department, there is an evident increase in the number of stage I patients and a decrease in stage II patients, as well as a reduced incidence of postoperative urinary fistulas, total number of complications, but an increase in the 5-year survival rate.
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