National Cancer Institute®
Last Modified: July 1, 2002
UI - 12067139
AU - Adachi S; Ogasawara T; Tsubamoto H; Oku H; Hori Y; Tsuji Y; Takemura T;
TI - Koyama K Intravenous nedaplatin and intraarterial cisplatin with transcatheter arterial embolization for patients with locally advanced uterine cervical cancer.
SO - Int J Clin Pharmacol Res 2001;21(3-4):105-10
AD - Department of Obstetrics and Gynecology, Hyogo College of Medicine, Japan. firstname.lastname@example.org
Nedaplatin is a platinum analog that has less renal toxicity and higher efficacy for uterine cervical cancer than cisplatin. Intraarterial cisplatin has been shown to be more effective than intravenous cisplatin in the treatment of cervical cancer. To improve the prognosis of cervical cancer, we studied combination chemotherapy of intravenous nedaplatin and intraarticular cisplatin with transcatheter arterial embolization (TAE). The criteria for selecting patients for this study were as follows: age 16-75 years, stage Ib2-IV according to the classification of the International Federation of Gynecology and Obstetrics (FIGO), performance status between 0 and 2, a creatinine clearance of >40 ml/min, adequate bone marrow and adequate renal and hepatic function. Thirty-two patients, aged 29-72 years (median: 55) were treated. FIGO stage was Ib2 in seven patients, IIa in seven patients, IIb in four, IIIa in one, IIIb in seven and IVa in six. Twenty-four patients had squamous cell carcinoma, three had adenocarcinoma and five had adenosquamous carcinoma. Written informed consent was obtained from all patients. Nedaplatin (30-70 mg/m2) was administered intravenously on day 1 and cisplatin (70 mg/m2) was administered intraarticularly via both uterine arteries on day 3 using the Seldinger method. TAE was then performed. This course of treatment was repeated every 3 weeks for 2-3 cycles. Response to the therapy was defined by magnetic resonance imaging. Partial response was found in 59% patients (19/32) and complete response in 34% (11/32), with an overall response rate of 94% (30/32). Myelosuppression was manageable. No grade 2 neurotoxicity was observed. The median follow-up was 32 months (6-53 months), with 84% of patients showing an overall survival of 1 year and 77% showing an overall survival of 2 years. These results show that this combination chemotherapy effected a high response rate. However, its influence on long-term survival remains to be determined.
UI - 12065571
AU - Duenas-Gonzalez A; Lopez-Graniel CM; Mota A; Mohar A
TI - Neoadjuvant chemotherapy followed by surgery in locally advanced cervical carcinoma.
SO - J Clin Oncol 2002 Jun 15;20(12):2908-9; discussion 2809-10
UI - 12066092
AU - Dowdy SC; Boardman CH; Wilson TO; Podratz KC; Hartmann LC; Long HJ
TI - Multimodal therapy including neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) for stage IIB to IV cervical cancer.
SO - Am J Obstet Gynecol 2002 Jun;186(6):1167-73
AD - Section of Gynecologic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
OBJECTIVE: The purpose of this study was to determine the survival rates and toxicity levels that are associated with multimodal therapy (including neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin [MVAC]) in patients with stage IIB to IVB cervical cancer. STUDY DESIGN: We retrospectively reviewed the cases of 49 patients who were treated between 1989 and 1997 with neoadjuvant MVAC for advanced cervical cancer. RESULTS: The clinical response rate was 90% (27 partial responders, 17 complete responders). Grade 3 or greater toxicity was mostly limited to neutropenia; no deaths were attributed to MVAC. Combined therapy after MVAC included operation in 34 patients (69%) and radiation in 41 patients (84%). Twenty-one patients (43%) had <2 cm residual tumor at histologic evaluation. Pelvic control was achieved in 86% of patients. Five-year disease-specific survival for patients with stage III disease was 60%. CONCLUSION: For patients with advanced cervical cancer, neoadjuvant MVAC had a high response rate (90%) and an acceptable toxicity level. Compared with historic control subjects, multimodal treatment may be associated with improved rates of pelvic control.
UI - 12051015
AU - Chen CA; Cheng WF; Wei LH; Su YN; Hsieh CY
TI - Radical hysterectomy alone or combined with neoadjuvant chemotherapy in the treatment of early stage bulky cervical carcinoma.
SO - J Formos Med Assoc 2002 Mar;101(3):195-202
AD - Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.
BACKGROUND AND PURPOSE: Early-stage bulky cervical carcinoma treated with conventional surgery or radiotherapy has a higher rate of recurrence compared to smaller tumors at the same stage. Whether neoadjuvant chemotherapy prior to radical hysterectomy can improve survival in early-stage bulky cervical carcinoma remains unclear. This study was designed to answer this question. METHODS: Fifty-eight women with early-stage bulky cervical cancer were included in this retrospective study. Thirty-one had received neoadjuvant chemotherapy before radical hysterectomy, and the other 27 patients underwent surgery alone. The chemotherapeutic regimen was a combination of cisplatin, vincristine, and bleomycin with a 10-day interval for two to three courses. RESULTS: The age, parity, and tumor diameter before treatment in the two groups were similar. The mean tumor diameter was significantly decreased after neoadjuvant chemotherapy (4.6 +/- 0.8 vs 3.4 +/- 1.5 cm, P = 0.003). Patients without neoadjuvant chemotherapy had a significantly higher incidence of parametrial invasion (14/27 vs 7/31, P = 0.022). More involved lymph nodes were found during surgery in patients without neoadjuvant chemotherapy (23.1 +/- 10.5 vs 17.4 +/- 7.1, P = 0.024), but the incidence of lymph node metastasis was not different between the two groups (18/31 vs 17/27, P = 0.71). The response rate of primary tumor to chemotherapy was 48.4% (15/31). No significant differences in clinical and pathologic parameters were found between responders and non-responders. Deep stromal invasion (> or = 3/4 thickness of cervical stroma) was the only independent prognostic factor for disease-free survival (DFS) and overall survival (OS) in the 58 patients and in the 31 patients who received neoadjuvant chemotherapy. Neither neoadjuvant chemotherapy nor the response to it was an independent prognostic factor for DFS or OS. CONCLUSIONS: Neoadjuvant chemotherapy could reduce the incidence of local invasion for bulky early-stage cervical carcinoma but did not improve the DFS or OS in our patients. Without further randomized study of the effects of neoadjuvant chemotherapy, this treatment should be chosen carefully.
UI - 11820462
AU - van d; Gonzalez GD
TI - The Dutch Deep Hyperthermia Trial: results in cervical cancer.
SO - Int J Hyperthermia 2002 Jan-Feb;18(1):1-12
AD - Department of Radiation Oncology, University Hospital, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands. email@example.com
BACKGROUND: Radiotherapy plus hyperthermia was compared to radiotherapy alone in the Dutch Deep Hyperthermia Trial, in patients with advanced bladder, cervical, and rectal tumours. The overall results, published elsewhere, demonstrate that addition of hyperthermia to radiotherapy improves both pelvic control and overall survival rates. The therapeutic gain appeared especially worthwhile in locally advanced cervical tumours. Here, the results in patients with cervical cancer are summarized and discussed, and further details provided. METHODS: From 1990-1996, 114 patients with cervical cancer were entered into this prospective randomized trial. RT was applied to a median total dose of 68 Gy. HT was given once weekly. The median follow-up time was 43 months. All randomized patients were included in the statistical analysis, which was done by intention to treat. The primary end points of the trial were complete response (CR) and duration of pelvic control (PC), secondary end points were overall survival (OS) and toxicity. Besides, an economic evaluation was performed. RESULTS: CR rates were 57% following RT and 83% following RT + HT(p = 0.003). The difference in PC was maintained during follow-up, with 3-year LC rates of 41% following RT and 61% following RT + HT. The 3-year OS rates were 27% and 51% following RT and RT + HT, respectively (p = 0.009). When the patients were divided into two subgroups by whether or not the planned RT was completed, a beneficial effect of hyperthermia was observed in both subgroups. Radiation toxicity was not enhanced by HT. Additional hyperthermia proved to be cost-effective, with maximum discounted cost-per-life-year gained of about Euro 4000. CONCLUSION: Hyperthermia in addition to standard radiotherapy of locally advanced cervical tumours results in therapeutic gain and is cost-effective.
UI - 11820463
AU - Prosnitz L; Jones E
TI - Counterpoint: test the value of hyperthermia in patients with carcinoma of the cervix being treated with concurrent chemotherapy and radiation.
SO - Int J Hyperthermia 2002 Jan-Feb;18(1):13-8
AD - Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA.
Major advances in the treatment of locally advanced cervical carcinoma were reported in 1999-2000 in five studies from the Gynecologic Oncology Group, Radiation Therapy Oncology Group and Southwestern Oncology Group. Collectively these trials reported a decrease in the risk of recurrence or death from cervical cancer ranging from 30-50% with the use of concurrent chemoradiation, as compared with radiation alone. On the basis of these trials the National Cancer Institute in 1999 issued a clinical alert concluding 'Strong consideration should be given to the incorporation of concurrent cisplatin-based chemotherapy with radiation therapy in women who require radiation therapy for treatment of cervical cancer.' Concurrently with these publications there appeared the publication in the Lancet in 2000 of the Dutch Deep Hyperthermia Group trial of radiotherapy alone versus combined radiation and hyperthermia for locally advanced pelvic tumors including carcinoma of the cervix. This multi-center phase III trial demonstrated an approximate doubling of the three year survival from 27 to 51% for the addition of hyperthermia to radiotherapy in patients with locally advanced cervical carcinoma. Additional trials to test the value of hyperthermia in patients with cervical carcinoma treated with concurrent chemotherapy and radiation are imperative and take precedence over a trial to investigate the value of chemotherapy in patients treated with hyperthermia and radiation.
UI - 11824390
AU - van der Zee J; Koper PC; Lutgens LC; Burger CW
TI - Point-counterpoint: what is the optimal trial design to test hyperthermia for carcinoma of the cervix? Point: addition of hyperthermia or cisplatin to radiotherapy for patients with cervical cancer; two promising combinations--no definite conclusions.
SO - Int J Hyperthermia 2002 Jan-Feb;18(1):19-24
AD - University Hospital Rotterdam--Daniel den Hoed Cancer Center, Hyperthermia Unit.
Randomized trials have shown that results of radiotherapy in patients with cervical cancer can be improved by combining the treatment with either cisplatin based chemotherapy, or hyperthermia. The studies on both the combination of radiotherapy with chemotherapy, and the combination on radiotherapy with hyperthermia, leave several important questions unanswered. At present, no definite conclusions can be drawn with regard to which combination results in the best therapeutic ratio. Therefore, on both ethical and scientific grounds, the next logical step would be to compare the two types of combined treatment to each other, and each combination with a treatment including all three modalities, in a randomized fashion.
UI - 11820464
AU - Dahl O; Mella O
TI - Referee: hyperthermia alone or combined with cisplatin in addition to radiotherapy for advanced uterine cervical cancer.
SO - Int J Hyperthermia 2002 Jan-Feb;18(1):25-30
AD - Department of Oncology, Haukeland Hospital, University of Bergen, Norway. firstname.lastname@example.org
There are two evidence based therapeutic options for locally advanced cervical cancer: Radiotherapy and concurrent chemotherapy (cisplatin alone or combined with other drugs) or radiation and hyperthermia, documented in randomised trials. The weight of evidence is less for the most advanced stages. Combination of all three options are currently tested in several centres with good clinical response and acceptable toxicity. Based on a pragmatic approach we propose to proceed with a trial selecting cisplatin concurrent with radiation therapy as the standard arm to be compared with the same regimen with the addition of hyperthermia once a week.
UI - 12094548
AU - Comerci JT Jr; Goldberg GL
TI - Current diagnosis and management of cervical cancer.
SO - Cancer Invest 2002;20(4):524-30
AD - Division of Gynecologic Oncology, Magee Women's Hospital, Pittsburgh, Pennsylvania, USA.
UI - 11838307
AU - Fanning J; Padratzik J
TI - Cold knife conization vs. LEEP. Are they the same procedure?
SO - J Reprod Med 2002 Jan;47(1):33-5
AD - Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Ohio, Richard D. Ruppert Health Center, Toledo, OH 43614-5809, USA.
OBJECTIVE: To prospectively evaluate the amount of tissue removed at loop electrosurgical excision procedure (LEEP) vs. cold knife conization. STUDY DESIGN: Forty consecutive LEEP or cold knife conization specimens were prospectively measured and weighed by a single pathology technician. Diameter, length and weight of the specimens were compared using Student's t test. RESULTS: Mean diameter of cold knife cone specimens was 2.6 vs. 2.2 cm for LEEP (P = .07). Mean length of cold knife cone specimens was 1.5 vs. 1.0 cm for LEEP (P = .001). Mean weight for cold knife cone specimens was 4.4 vs. 2.0 g for LEEP (P = .001). CONCLUSION: In a prospective evaluation, cold knife cone specimens were 50% longer and 100% heavier than LEEP specimens.
UI - 11965730
AU - Gorchev G; Vasilev D; Tomov S; Georgiev A
TI - [A case of invasive cervical carcinoma associated with pregnancy]
SO - Akush Ginekol (Sofiia) 1999;38(1):71-3
The cervical cancer is the most usual neoplastic disease, which takes place during the pregnancy. The prognosis for the women depends mostly of the clinical stage and the presence of nodal metastasis. The principes of the treatment do not differ from the standard oncologic therapy in nonpregnant women. Differencies exist in the way and the time of the terminanation of the pregnancy. The authors present y case of pregnancy and invasive cervical adenocarcinoma diagnosticated in m. 1.X. immeadiately after cesarean section an extended hysterectomy y modo Piver 111 with pelvic nodal dissection is done.
UI - 12051867
AU - Michalas S; Rodolakis A; Voulgaris Z; Vlachos G; Giannakoulis N;
TI - Diakomanolis E Management of early-stage cervical carcinoma by modified (Type II) radical hysterectomy.
SO - Gynecol Oncol 2002 Jun;85(3):415-22
AD - First Department of Obstetrics and Gynecology, Alexandra Hospital, Athens, Greece.
OBJECTIVE:. Surgical management of cervical carcinoma by radical hysterectomy has been proven a highly effective method in treating early-stage disease. The purpose of this study was to evaluate the efficacy and safety of modified (Type II) radical hysterectomy for the treatment of early-stage (I-IIA) cervical carcinoma. METHODS: A retrospective analysis of data on 435 patients with cervical carcinoma who were managed by modified radical hysterectomy was performed. In 145 cases a multimodal approach was used due to the presence of one or more risk factors such as lymph node metastasis, CLS involvement, bulky tumor, and exocervical extension of disease. Preoperative irradiation was offered to 62 patients, whereas adjuvant irradiation was offered to 101 patients. RESULTS: The mean age of the patients was 42.5 years. The majority of the patients had squamous cell cancer (81.6%). The patients were clinically staged as IA (3.2%), IB (86.7%), and IIA (10.1%). Positive pelvic lymph nodes were noted in 65 patients (14.9%). Operative morbidity was minimal, whereas adjuvant radiation treatment had no impact on the disease but caused genitourinary morbidity in terms of ureteral stricture and postoperative bladder dysfunction (P < 0.001). The overall 5-year survival was 88.7%. The most significant predictors related to 5-year survival were nodal metastasis (P < 0.001), adenomatous histology (P < 0.001), lesion size (P < 0.001), and CLS involvement (P = 0.004). Adjuvant radiation resulted in better local pelvic control of the disease. CONCLUSION: The results of our study support the concept that less radical procedures could be effectively applied to early-stage cervical carcinoma 4 cm or smaller with optimal surgical margins.
UI - 12051877
AU - Dimopoulos MA; Papadimitriou CA; Sarris K; Aravantinos G; Kalofonos C;
TI - Gika D; Gourgoulis GM; Efstathiou E; Skarlos D; Bafaloukos D Combination of ifosfamide, paclitaxel, and cisplatin for the treatment of metastatic and recurrent carcinoma of the uterine cervix: a phase II study of the Hellenic Cooperative Oncology Group.
SO - Gynecol Oncol 2002 Jun;85(3):476-82
AD - Department of Clinical Therapeutics and Radiotherapy, Alexandra Hospital, Athens, Greece. email@example.com
OBJECTIVE: Ifosfamide, paclitaxel, and cisplatin have moderate single-agent activity in patients with metastatic or recurrent cancer of the uterine cervix. We administered a combination of these three agents to a large number of patients with metastatic or recurrent cervical cancer to evaluate its activity. METHODS: Sixty patients were treated on an outpatient basis with Ifosfamide (I) 1500 mg/m(2) intravenously over 1 h on Days 1-3, paclitaxel (T) 175 mg/m(2) as a 3-h intravenous infusion on Day 1, and cisplatin (P) 75 mg/m(2) intravenously over 2 h on Day 2 with granulocyte colony-stimulating factor (G-CSF) support. The chemotherapy was repeated every 4 weeks for a maximum of six courses. RESULTS: Fifty-seven patients received at least two courses of treatment and are evaluable for response. Twenty-six patients (46%) achieved an objective response, including 19% complete and 27% partial responses. The median duration of response was 11.5 months and the median time to progression and survival for all patients were 8.3 and 18.6 months, respectively. Patients with excellent performance status, with disease recurrence outside the radiation field, and with nonsquamous tumors had the highest response rate and best survival. Some degree of neurotoxicity occurred in 44% of patients. Grade 3 or 4 toxicity included granulocytopenia in 26% of patients, anemia in 13%, thrombocytopenia in 7%, and neurotoxicity in 3%. CONCLUSION: The ITP regimen is relatively well tolerated and moderately active in patients with metastatic carcinoma of the uterine cervix. Patients more likely to benefit are those with nonsquamous histology, with excellent performance status, and with disease recurrence outside the radiation field.
UI - 12051890
AU - Mendez LE; Penalver M; McCreath W; Bejarano P; Angioli R
TI - Radical vaginal trachelectomy after supracervical hysterectomy.
SO - Gynecol Oncol 2002 Jun;85(3):545-7
AD - Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Miami School of Medicine, Jackson Memorial Medical Center, Miami, Florida, USA.
BACKGROUND: Radical vaginal trachelectomy (RVT) is an acceptable approach when applied toward a select group of patients with early stage cervical carcinoma. It is less invasive, can maintain fertility, and can be ideal in patients with significant comorbid factors compared to abdominal approaches. A small subset of patients with a previous supracervical hysterectomy can pose a surgical dilemma. CASE: An 81-year-old woman with a history of severe cardiac disease on routine gynecological examination was found to have adenocarcinoma in situ with a focus suspicious for invasion of the cervical stump diagnosed by cone biopsy. She previously had a supracervical hysterectomy for benign disease of the uterus. A RVT was performed as definitive treatment and the patient recovered without complications. CONCLUSION: In the rare case that presents with a history of supracervical hysterectomy, RVT with some technical modifications can still be considered as a therapeutic option for early stage cervical carcinoma.
UI - 12070578
AU - Pharaon SR; Al-Saleh WM
TI - A new method to aid complete lymphadenectomy in radical treatment of cancer of the cervix.
SO - Saudi Med J 2002 May;23(5):546-7
AD - Zahrawi Maternity Hospital, Damascus, Syria. firstname.lastname@example.org
OBJECTIVE: A simple, new and not previously reported method to improve the complete ablation of the pelvic lymph nodes in the surgical treatment of cervical cancer is briefly reported. METHODS: Fourteen patients had been operated upon at Zahrawi Maternity Hospital, Damascus, Syria using radical Wertheim hysterectomy for surgical treatment. Five to 10 days prior to surgery, patients are given intramuscular iron injections that help easy visualization of the lymph nodes during operation. RESULTS: In all the 14 cases treated with this simple pre-operative medication, pelvic lymph nodes were easily identified and completely removed. CONCLUSION: Pre-operative iron injections help in better identification of even the smallest pelvic lymph nodes and improve their complete removal.
UI - 12057052
AU - Lu KH; Burke TW
TI - Early cervical cancer.
SO - Curr Treat Options Oncol 2000 Jun;1(2):147-55
AD - Department of Gynecologic Oncology, M.D. Anderson Cancer Center, Box 67, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
Early cervical cancer includes a broad range of disease, from clinically undetectable microinvasive cancer to large, bulky tumors that replace the entire cervix. Further subgrouping of this category is therefore necessary to define the optimal treatment approach for individual cases. The International Federation of Gynecology and Obstetrics (FIGO) staging system stratifies stage I tumors into two broad categories, stage IA (microinvasive) and stage IB (gross tumor). Management of women with stage IA disease is controversial. In the United States, patients with stromal invasion of less than 3 mm and no lymphvascular involvement are usually treated conservatively with simple hysterectomy. In selected patients who desire fertility, cone biopsy with negative surgical margins is also considered. Patients with invasion of more than 3 mm or lymphvascular space involvement are at risk for pelvic lymph node metastasis and are most often treated with radical hysterectomy and pelvic lymphadenectomy. Stage IB1 cervical cancer is managed by either radical surgery or radiotherapy with equivalent recurrence and survival rates. In patients with tumors less than 4 cm in diameter, the decision between radical surgery and radiotherapy is guided by patients' overall health and treatment preferences. For younger women, radical surgery is preferred because ovarian function can be preserved and vaginal stenosis secondary to radiation can be avoided. Radiation therapy is preferred for women who may not tolerate radical surgery. We always prefer primary radiation therapy for patients with tumors larger than 4 cm in diameter. Recent data convincingly demonstrate that the addition of cisplatin-based chemotherapy significantly improves overall survival rates in cervical cancer patients who undergo radiation therapy.
UI - 12057053
AU - Gibbons SK; Keys HM
TI - Advanced cervical cancer.
SO - Curr Treat Options Oncol 2000 Jun;1(2):157-60
AD - Department of Radiation Oncology, MC-95, Albany Medical Center, 43 New Scotland Avenue, Albany, NY 12208, USA.
Several large, prospectively randomized clinical trials run by multi-institutional cooperative groups have established that the best treatment for advanced cancer of the cervix is primary radiotherapy with concurrent, cisplatin-based chemotherapy. In fact, patients with earlier stage cervix cancer with poor prognostic indicators (large, bulky tumors, positive pelvic lymph nodes, or unexpected parametrial disease at the time of surgery) also show a survival benefit with this approach. Adequate radiation dosing (both external beam and intracavitary) is essential. The additional benefit of periaortic lymph node irradiation is debated, but generally accepted, for patients with locally advanced disease or pelvic lymph node involvement.
UI - 12118541
AU - Ling CC; Smith AR; Hanlon AL; Owen JB; Brickner TJ; Hanks GE
TI - Treatment planning for carcinoma of the cervix: a patterns of care study report.
SO - Int J Radiat Oncol Biol Phys 1996 Jan 1;34(1):13-9
AD - Memorial Sloan Kettering Cancer Center, New York, NY, USA.
PURPOSE: The Patterns of Care Study (PCS) of patients treated in 1988-89 included "patterns of treatment planning" for radiotherapy of carcinoma of the uterine cervix. A Consensus Committee of radiation physicists and oncologists established current guidelines and developed questionnaires to assess the treatment planning process (i.e., the general structure, methodology, and tools) of institutions involved in the Patterns of Care Study. This paper reports the findings of the assessment. METHODS AND MATERIALS: The PCS surveyed 73 radiotherapy facilities, of which 21 are academic institutions (AC), 26 hospital-based facilities (HB), and 26 free-standing centers (FS). In total, 242 cases were assessed with 39% from academic centers, 33% from hospital-based centers, and 28% from free-standing centers. The survey collected treatment planning information such as the use of computed tomography (CT), simulation procedure, contouring of patient outline, tumor or target delineation, identification of critical structures, method of dose prescription (point or isodose), etc. Data was also obtained concerning implant boosts, e.g., radioisotope used, use of midline block for external beam treatment, availability of remote afterloader, practice of interstitial implants, combination with hyperthermia, etc. RESULTS: There is a high degree of compliance relative to the basic treatment planning standards. For example, 171 cases (out of 173) from AC and HB institutions included simulation and 169 used port film; for cases from FS centers, 61 out of 69 involved simulation and 66 out of 69 included port film. Most institutions used linacs (231 out of 242); in five cases, Co-60 units and in six cases betatron was used. In terms of treatment planning, 53% used skin contours, but only 14% had target volume delineation, with AC and HB being slightly more conscientious in these efforts. Critical organs did not appear to be explicitly considered in external beam treatment planning, with only 3% outlining the bladder, 5% the rectum, and less than 1% the small bowel. Only 11% of the centers used CT in treatment planning, and none reported the use of magnetic resonance imaging (MRI). For patients receiving implants, about 40% had midline blocking during external beam treatment, of which one out of three were shielded by standard blocks and two out of three with customized ones. About 11% of the patients receiving implants were treated with remote afterloading devices, 5% received interstitial implants, and none were treated in combination with hyperthermia. CONCLUSION: The treatment planning aspects of radiotherapy of carcinoma of the cervix have been established by this Patterns of Care Study Survey. There is a high level of uniformity in the approach. Some variations exist among centers in the different strata.
UI - 12118547
AU - Bonin SR; Lanciano RM; Corn BW; Hogan WM; Hartz WH; Hanks GE
TI - Bony landmarks are not an adequate substitute for lymphangiography in defining pelvic lymph node location for the treatment of cervical cancer with radiotherapy.
SO - Int J Radiat Oncol Biol Phys 1996 Jan 1;34(1):167-72
AD - Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
PURPOSE: Curative radiotherapy (RT) for carcinoma of the cervix requires adequate irradiation of regional lymph node groups. The best nonsurgical method of defining lymph node anatomy in the pelvis remains the lymphangiogram (LAG). This study was designed to determine if bony landmarks could accurately substitute for LAG as a means of determining lymph node position for the purpose of pelvic RT treatment planning. METHODS AND MATERIALS: The post-LAG simulation films of 22 patients treated at the Fox Chase Cancer Center for cervical cancer were examined. On anterior/posterior (A/P) simulation films, the distance of lymph nodes was determined from the top, middle, and bottom of the sacroiliac joint, and at the pelvic rim, 1 and 2 cm above the acetabulum. On lateral (LAT) simulation films, lymph node position was measured at points 0, 4, and 8 cm along a line from the bottom of L5 to the anterior aspect of the pubic symphysis. Positive values represent lateral and anterior distances relative to the reference point on A/P and LAT films, respectively. Negative values represent distances in the opposite direction. The adequacy of standard pelvic fields as defined by the Gynecologic Oncology Group (GOG) (A/P: 1.5 cm margin on the pelvic rim; LAT field edge is a vertical line anterior to the pubic symphysis) was also examined. Data are expressed as the mean +/- two standard deviations, (i.e. 95% confidence level). RESULTS: On A/P simulation films, the distance of visualized lymph nodes had mean values of -1.6 +/- 1.7 cm (range -4.1 to -0.4 cm), -1.3 +/- 1.5 cm (range -3.4 to 0.0 cm), and 1.2 +/- 1.8 cm (range -1.0 to 2.6 cm) from the sacro-iliac (SI) joint at the superior, middle, and inferior points, respectively. The mean distance of the nodes from the pelvic rim at points 1 and 2 cm above the acetabulum was 0.3 +/- 1.2 cm (range -0.6 to 1.8 cm) and 0.2 +/- 1.8 cm (range -1.6 to 2.1 cm), respectively. On LAT simulation films, the distance of lymph nodes from points 0, 4, and 8 cm from the previously described reference line had mean values of 2.0 +/- 1.0 cm (range 1.3 to 3.0 cm), 0.9 +/- 3.9 cm (range -1.9 to 5.1 cm), and 1.8 +/- 2.1 cm (range -0.8 to 3.5 cm), respectively. Ten of 22 (45%) patients would have had inadequate nodal irradiation if their fields had been designed according to standard GOG parameters. In all cases, these incompletely irradiated lymph nodes were from the lowest of the lateral external iliac group. CONCLUSION: Great variability in pelvic lymph node location is demonstrated when LAG is used to directly visualize their location. Bony structures are inaccurate landmarks for pelvic lymph node position. The GOG standard pelvic fields are not consistently adequate to cover all lateral external iliac lymph nodes, although the clinical significance of this subgroup of lymph nodes is not known. At this time, LAG remains the ideal radiographic modality to define anatomic location of regional lymph nodes for pelvic RT treatment planning. The clinical importance of the most lateral group of external iliac lymph nodes in various stages of cervical cancer represents a potential area of future research.
UI - 12118553
AU - Mahe MA; Gerard JP; Dubois JB; Roussel A; Bussieres E; Delannes M;
TI - Guillemin F; Schmitt T; Dargent D; Guillard Y; Martel P; Richaud P; Cuilliere JC; De Ranieri J; Malissard L Intraoperative radiation therapy in recurrent carcinoma of the uterine cervix: report of the French intraoperative group on 70 patients.
SO - Int J Radiat Oncol Biol Phys 1996 Jan 1;34(1):21-6
AD - Department of Radiation Therapy, Centre Rene Gauducheau, Nantes, France.
PURPOSE: To evaluate the feasibility and oncologic results of intraoperative radiation therapy (IORT) for recurrent uterine cervical carcinoma in a cohort of patients treated in seven French institutions. METHODS AND MATERIALS: From 1985 to 1993, 70 patients with pelvic recurrences underwent IORT with/ without external radiation therapy (ERT) and chemotherapy (CT). Treatment modalities for recurrence were IORT alone (40 out of 70), IORT + ERT (30 out of 70), additional chemotherapy (20 out of 70). Gross complete resection (CR) was performed in 30 out of 70 cases, partial resection (PR) in 37 out of 70, and unspecified surgery in 3 out of 70. Sixty-five patients had electron beam IORT and 5, 100 KV photon IORT. Mean IORT cone size, electron beam energy, and dose (calculated at the 90% isodose line) were, respectively, 75 mm (40 to 90), 12 MeV (6 to 20), and 18 Gy (10 to 25) after CR and 80 mm (45 to 100), 15 MeV (7 to 24), and 19 Gy (10 to 30) after PR. RESULTS: Mean follow-up after IORT was 15 months (2 to 69). One, 2- and 3-year overall survival rates were 47, 17, and 8%, respectively; median survival was 11 months and local control, 21%. Median survival and local control rates increased after CR (13 months, 27%) vs. PR (10 months, 17%) and when initial treatment consisted of surgery (S) alone (15 months, 25%) vs. radiation therapy (RT +/- S) (10 months, 16%). However, these differences were not statistically significant. No death-related toxicity was observed. Grade 2 or 3 toxicity was observed in 19 out of 70 patients (27%), including 9 not directly IORT-related complications (13%) (three digestive tract fistulas, one rectal stricture, three urinary fistulas, two infections) and 10 directly IORT-related complications (14%) (five neuropathies, four ureteral obstructions, and one rectal stricture). CONCLUSION: This retrospective study demonstrates the feasibility of IORT. The usefulness of IORT still needs to be evaluated in primary treatment of advanced stages of cervical carcinoma.
UI - 12118562
AU - Perez CA; Grigsby PW; Castro-Vita H; Lockett MA
TI - Carcinoma of the uterine cervix. II. Lack of impact of prolongation of overall treatment time on morbidity of radiation therapy.
SO - Int J Radiat Oncol Biol Phys 1996 Jan 1;34(1):3-11
AD - Radiation Oncology Center, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO 63108, USA.
PURPOSE: Several reports document a negative impact of prolongation of overall treatment time in a course of irradiation on tumor control and survival. A correlation has been documented of incidence of significant treatment sequelae with increasing doses of irradiation, volume of the specific organ, and dose per fraction. However, no data were found on the potential correlation of overall irradiation treatment time with significant sequelae. METHODS AND MATERIALS: Records were reviewed of 1,269 patients with carcinoma of the cervix (Stage IB to HI) treated with definitive irradiation (combination of external beam and two intracavitary insertions). Follow-up was obtained in 97% of patients (median, 12 years; minimum, 3 years; maximum, 28 years). The relationships between overall treatment time and time of brachytherapy and incidence of treatment sequelae were analyzed for each stage. RESULTS: Overall incidence of Grades 2 (moderate) sequelae was 7% and of Grade 3 (severe) sequelae, 11%. There was no significant correlation of various incidences of Grade 2 and 3 sequelae with overall treatment times (8% in patients treated in less than 7 weeks, 9% in 7.1 to 9 weeks, and 12% when treatment time was longer than 9 weeks) (p = 0.08). In patients with Stage IB and IIA tumors, incidence of rectal toxicity (mostly proctitis) was comparable in patients treated in less than 7 or 7.1 to 9 weeks (4.1 and 6%, respectively) and slightly higher in those treated in longer periods (11.5%) (p = 0.24). In patients with Stage IIB and III, the incidence of Grade 2 and 3 small bowel morbidity was 2% in those treated in less than 7 weeks, 6% for 7.1 to 9 weeks, and 4.9% for longer times (p < or = 0.01). This increased morbidity was also correlated with total dose of irradiation to the lateral pelvic wall: 5 of 257 (2%) for less than 60 Gy and 21 of 438 (4.8%) for higher doses (p < or = 0.01). There was no significant correlation between the timing of brachytherapy (usually two low dose rate intracavitary insertions performed within 4.5 to 6.5 weeks of initiation of external beam therapy) and significant treatment sequelae. CONCLUSIONS: We observed a varied average incidence of Grade 2 and 3 morbidity in the bladder, rectum, and small intestine with different overall treatment times, without a definite pattern to suggest an impact of prolongation of treatment time on morbidity. Likewise, there was no significant correlation with the timing of intracavitary insertions and morbidity of therapy. Because prolongation of the overall treatment time has a well-documented detrimental effect on pelvic tumor control and survival in carcinoma of the cervix with no significant impact on morbidity, it is imperative to deliver radiation therapy in the shortest possible time and without schedule interruptions.
UI - 12092247
AU - Kojs Z; Urbanski K; Fabisiak W; Reinfuss M
TI - [Prognostic factors in the primary invasive vaginal carcinoma]
SO - Ginekol Pol 2002 Mar;73(3):163-6
In the period 1965-1988, 125 women with primary invasive vaginal carcinoma were treated with radiotherapy. 53 (42.4%) survived 5-year without evidence of disease. In the Cox multivariate analysis three variables were independently related to survival: age of the patients, grade of differentiation of tumor and the clinical stage of illness.
UI - 12112978
AU - Morris R; Baker VV
TI - Is less more? Rethinking the extent of surgery for invasive cervical cancer.
SO - Curr Womens Health Rep 2002 Feb;2(1):15-9
AD - Division of Gynecologic Oncology, Wayne State University, 3990 John R. Road, Harper Hospital, 2 Webber North, Suite 2217, Detroit, MI 49201, USA.
The surgical treatment of early-stage cancer of the cervix is undergoing renewed scrutiny in an effort to minimize complications, preserve fertility when desired by the patient, and yet avoid any compromise of therapeutic efficacy. With regard to radical hysterectomy, the extent of the parametrial resection and lymphadenectomy are two topics of particular interest. A review of the relevant literature concerning radical hysterectomy and cervical cancer that supports a less radical approach is discussed. For women with stage I cervical cancer, a less radical resection appears to offer more when considered in the context of fewer immediate and long-term complications and comparable long-term survival.
UI - 11606081
AU - Aoki Y; Tomita M; Sato T; Watanabe M; Kase H; Fujita K; Kurata H; Tanaka
TI - K Neoadjuvant chemotherapy for patients younger than 50 years with high-risk squamous cell carcinoma of the cervix.
SO - Gynecol Oncol 2001 Nov;83(2):263-7
AD - Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi dori, Niigata, 951-8510, Japan. email@example.com
OBJECTIVE: To evaluate the response rate and toxicity and to improve survival, neoadjuvant chemotherapy (NAC) was utilized in patients younger than 50 years with locally advanced cervical squamous cell carcinoma. METHODS: Twenty-one patients were treated with preoperative NAC. Eligibility included patients with previously untreated stage IB or IIA with deep stromal invasion assessed by magnetic resonance imaging or bulky tumor or IIB squamous cell carcinoma who were younger than 50 years. The NAC consisted of cisplatin (60 mg/m(2)) on day 1, vinblastine (4 mg/m(2)/day) on days 1 and 2, and peplomycin (10 mg/day) on days 1, 8, and 15 (PVP). Treatment was repeated every 3 weeks for a total of two cycles. All 21 patients underwent radical hysterectomy following NAC. Postoperative radiotherapy was given to 18 patients. We used 21 patients who underwent radical hysterectomy and postoperative radiation therapy as a nonrandomized control group. RESULTS: The response rate for NAC was 86% (18/21). Two patients required discontinuation of PVP treatment after one administration because of grade 4 neutropenia and thrombocytopenia, and decreased carbon monoxide diffusion capacity, respectively. In the NAC group, stromal invasion was significantly reduced (P = 0.0103), and the incidence of lymph node metastasis was decreased. No patients had positive parametrial and vaginal margins. The overall 5-year survival rate was 84.0% in the NAC group, which was significantly better than that in the control group (58.9%) (P = 0.0434). CONCLUSIONS: NAC for younger patients with locally advanced cervical carcinoma is thought to be safe, well tolerated, effective, and useful for increasing operability, decreasing pathological risk factors, and improving survival. Copyright 2001 Academic Press.
UI - 11838749
AU - Stamatopoulos P; Kasapis M; Koliopoulos G; Paraskevaidis E
TI - Outcomes of carbon dioxide laser conization for the treatment of cervical intraepithelial neoplasia grade III.
SO - Clin Exp Obstet Gynecol 2001;28(4):243-5
AD - Department of Obstetrics and Gynecology, Aristoteleion University of Thessalonika, Greece.
PURPOSE: The aim of this study was to determine the rates of incomplete excision of cervical intraepithelial neoplasia (CIN) III after carbon dioxide laser conization, and the risk of reappearance of CIN depending on the excision margins. METHODS: A total of 153 women who underwent carbon dioxide laser conization for CIN III between 1988 and 1998 at our hospitals were eligible for inclusion in the study and their notes were retrospectively studied. RESULTS: Histological examination of the excision margins revealed complete excision in 134 (87.6%), uncertain margins in one, and extension of CIN to the margins in 18 (11.8%) cases. The treatment failure rate in the cases with clear margins was 2.2% (3 of 134), and in the cases with involved margins 44.4% (8 of 18) (p < .001). CONCLUSION: Carbon dioxide laser conization despite the worldwide use of LLETZ still has a place in the treatment of CIN. Very high rates of complete excision were achieved. As incomplete excision does not always result in treatment failure, neither do clear margins always indicate eradication of the disease.
UI - 12062615
AU - Sood BM; Gorla G; Gupta S; Garg M; Deore S; Runowicz CD; Fields AL;
TI - Goldberg GL; Anderson PS; Vikram B Two fractions of high-dose-rate brachytherapy in the management of cervix cancer: clinical experience with and without chemotherapy.
SO - Int J Radiat Oncol Biol Phys 2002 Jul 1;53(3):702-6
AD - Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210 Street, Bronx, NY 10461, USA.
PURPOSE: In recent years, high-dose-rate brachytherapy has become popular in the management of carcinoma of the uterine cervix, because it eliminates many of the problems associated with low-dose-rate brachytherapy. However, the optimum time-dose-fractionation remains controversial. Two fractions of high-dose-rate brachytherapy are convenient for patients, but most radiation oncologists in the United States do not use them, because of fear that they could lead to excessive rectal or bladder toxicity. Here we present our experience, which suggests that a two-fraction regimen is indeed safe and effective. METHODS: We treated 49 patients with Stages I-III biopsy-proven carcinoma of the uterine cervix by external beam radiation therapy (EBRT), plus two fractions of high-dose-rate brachytherapy. The histology was squamous cell carcinoma in 43 patients (88%) and nonsquamous in 6 (12%). The median size of the primary tumor was 6 cm (range: 3-10 cm). Each patient received EBRT to the pelvis to a median dose of 45 Gy (range: 41.4-50.4 Gy), followed by a parametrial boost when indicated. Thirty patients (61%) also received irradiation to the para-aortic lymph nodes to a dose of 45 Gy. After EBRT, each patient underwent two applications of high-dose-rate brachytherapy, 1 week apart. The dose delivered to point A was 9 Gy per application for 49 applications (50%) and 9.4 Gy for 43 applications (44%), and it varied from 7 to 11 Gy for the rest (6%). The total dose to the rectum from both high-dose-rate brachytherapy applications ranged from 4.7 to 11.7 Gy (median: 7.1 Gy), and the total dose to the bladder from 3.8 to 15.5 Gy (median: 10.5 Gy). Twenty-five of the 49 patients (51%) received concomitant chemotherapy (cisplatin 20 mg/m(2)/day for 5 days) during the first and fourth weeks of EBRT and once after the second high-dose-rate brachytherapy application. Chemotherapy was not assigned in a randomized fashion. The use of chemotherapy increased during the time period spanned by this study as increasing evidence supporting the use of chemotherapy began to appear. RESULTS: The observed survival rates after 2, 3, and 5 years were 83%, 78%, and 78%, respectively. The surviving patients have been followed up for a median of 3 years (range: 2-6 years). Eight of the 49 patients suffered local failures. Among patients treated without chemotherapy, the 3-year local control rate was 77%; it was 88% among those receiving chemotherapy. There have been no regional failures. Four patients developed distant metastases. At 3 years, 91% of the patients in each group were free of distant metastases. Ten of the 49 patients (20%) suffered Grade 3 acute toxicity; 11 (22%) had Grade 4. Among the 24 patients treated without chemotherapy, only 1 (4%) suffered Grade 3 toxicity. Among the 25 patients receiving chemotherapy, in contrast, 8 (32%) suffered Grade 3 and 12 (48%) Grade 4 acute toxicity. Only 2 patients suffered late toxicity: One suffered Grade 2 and the other Grade 3 late toxicity. The actuarial risk of Grade 2 or worse late toxicity was 5%, with or without chemotherapy. CONCLUSIONS: Our experience suggests that two fractions of high-dose-rate brachytherapy are safe and effective in the management of cervix cancer, even in conjunction with concomitant cisplatin. The fears that the use of two fractions would lead to excessive rectal or bladder toxicity proved unfounded. Guidelines for ensuring a low complication rate are discussed.
UI - 11937252
AU - Chen HH; Lee BF; Guo HR; Su WR; Chiu NT
TI - Changes in bone mineral density of lumbar spine after pelvic radiotherapy.
SO - Radiother Oncol 2002 Feb;62(2):239-42
AD - Department of Radiation Oncology, National Cheng Kung University Hospital, Tainan, Taiwan.
Bone mineral densities (BMDs) of L2 to L5 were measured on 40 cervical cancer patients with radiotherapy and 40 matched controls. We found no significant difference in the BMDs between the two groups and no significant change in BMDs 1-7 years after the therapy in the patient group.