Table of Contents
1
UI - 21353209
AU - Khunamornpong S; Raungrongmorakot K; Siriaunkgul S
TI -
Loop electrosurgical excision procedure (LEEP) at Maharaj Nakorn Chiang
Mai Hospital: problems in pathologic evaluation.
SO - J Med Assoc Thai 2001 Apr;84(4):507-14
AD - Department of Pathology, Faculty of Medicine, Chiang Mai University,
Thailand.
BACKGROUND: Loop electrosurgical excision procedure (LEEP) is widely
used in diagnosis and management of cervical lesions. Difficulties in
histopathologic evaluation of LEEP specimens, particularly for the
margin status, have been reported to be a significant disadvantage of
the procedure. METHOD: The histologic slides of the specimens from 163
patients who underwent LEEP at Maharaj Nakorn Chiang Mai Hospital from
degree of thermal artefact and the margin status. Follow-up data after a
6-month-period were correlated with the margin status. RESULTS: Thermal
artefact was present in all cases (mild 51.5%, moderate 36.2%, and
severe 12.3%). In only one case, histologic diagnosis of the lesion was
not possible due to severe thermal artefact. Nine cases (5.5%) had
non-evaluable margins due to either thermal artefact (7 cases) or
improper orientation of fragmented tissue (2 cases). Of 90 cases with
subsequent surgical specimens, residual diseases were present in 4 of 21
(19.0%) with negative LEEP margins, in 31 of 64 (48.4%) with positive
margins, and in 4 of 5 (80.0%) with non-evaluable margins. CONCLUSIONS:
Pathologic evaluation of the specimens from LEEP was limited in only a
minority of cases. Thermal artefact was not a critical disadvantage of
LEEP. The positive or negative margin status was correlated with the
risk of residual disease.
2
UI - 21406156
AU - Hellebust TP; Dale E; Skjonsberg A; Olsen DR
TI -
Inter fraction variations in rectum and bladder volumes and dose
distributions during high dose rate brachytherapy treatment of the
uterine cervix investigated by repetitive CT-examinations.
SO - Radiother Oncol 2001 Sep;60(3):273-80
AD - Department of Medical Physics, The Norwegian Radium Hospital, University
of Oslo, Box 20, 0310 Oslo, Norway.
PURPOSE: To evaluate variation of dose to organs at risk for patients
receiving fractionated high dose rate gynaecological brachytherapy by
using CT-based 3D treatment planning and dose-volume histograms (DVH).
MATERIALS AND METHODS: Fourteen patients with cancer of the uterine
cervix underwent three to six CT examinations (mean 4.9) during their
course of high-dose-rate brachytherapy using radiographically compatible
applicators. The rectal and bladder walls were delineated and DVHs were
calculated. RESULTS: Inter fraction variation of the bladder volume
(CV(mean)=44.1%) was significantly larger than the inter fraction
variation of the mean dose (CV(mean)=19.9%, P=0.005) and the maximum
dose (CV(mean)=17.5%, P=0.003) of the bladder wall. The same trend was
seen for rectum, although the figures were not significantly different.
Performing CT examinations at four of seven brachytherapy fractions
reduced the uncertainty to 4 and 7% for the bladder and rectal doses,
respectively. A linear regression analysis showed a significant,
negative relationship between time after treatment start and the whole
bladder volume (P=0.018), whereas no correlation was found for the
rectum. For both rectum and bladder a linear regression analysis
revealed a significant, negative relationship between the whole volume
and median dose (P<0.05). CONCLUSION: Preferably a CT examination should
be provided at every fraction. However, this is logistically unfeasible
in most institutions. To obtain reliable DVHs the patients will in the
future undergo 3-4 CT examinations during the course of brachytherapy at
our institution. Since this study showed an association between large
bladder volumes and dose reductions, the patients will be treated with a
standardized bladder volume.
3
UI - 21415883
AU - Krivak TC; Rose GS; McBroom JW; Carlson JW; Winter WE 3rd; Kost ER
TI -
Cervical adenocarcinoma in situ: a systematic review of therapeutic
options and predictors of persistent or recurrent disease.
SO - Obstet Gynecol Surv 2001 Sep;56(9):567-75
AD - Department of Obstetrics and Gynecology, Walter Reed Army Medical
Center, Washington, DC 20307-5001, USA. TomKrivak@aol.com
The incidence of cervical adenocarcinoma in situ is increasing in
frequency, and our limited knowledge about this lesion presents the
physician with a therapeutic dilemma. Treatment for this lesion has
included conservative therapy, large loop excision or cold-knife cone
biopsy, or definitive therapy consisting of hysterectomy. But, rates of
residual adenocarcinoma in situ after cone biopsy with negative margins
vary from 0% to 40%, and residual disease rates as high as 80% have been
noted when the margins are positive. Despite these recent data on
follow-up after conservative therapy such as cone biopsy, it seems that
this method is safe and gaining acceptance by many physicians and
patients. However, the short follow-up duration and small number of
patients limit the conclusions of many studies. The relative infrequency
of this diagnosis has precluded extensive clinical experience with the
natural history of this lesion.
4
UI - 21440169
AU - Manusirivithaya S; Isariyodom P; Charoeniam V; Pantusart A
TI -
Risk for radical hysterectomy failure.
SO - J Med Assoc Thai 2001 Jun;84(6):791-7
AD - Department of Obstetrics and Gynecology, Bangkok Metropolitan Medical
College and Vajira Hospital, Thailand.
underwent radical hysterectomy as their primary treatment for cervical
cancer and had optimal follow-up for at least three years were analyzed.
Fifty seven patients (8.3%) had pelvic nodes metastasis and received
postoperative whole pelvic radiation. Tumor recurrence was noted in 97
cases (14.2%). Nodal metastasis is the most significant prognostic
factor for tumor recurrence. Patients with nodal metastasis had 42.1 per
cent risk of recurrence compared to 11.6 per cent in those without nodal
metastasis. Furthermore; risk of recurrence significantly increased if
more than 1 node was involved. Other factors associated with a
significantly higher risk of recurrence in multivariate analysis were
tumor histology and clinical stage. Patients with nonsquamous cell
carcinoma and clinical stage IIa had disease recurrence in 24.4 per cent
and 30.3 per cent compared to only 11.7 per cent in squamous and 13.3
per cent in stage Ib. Tumor grade is the significant prognostic factor
only in adenocarcinoma cell type but not in squamous cell type.
5
UI - 21439113
AU - Ferrandina G; Ranelletti FO; Larocca LM; Maggiano N; Fruscella E; Legge
TI -
F; Santeusanio G; Bombonati A; Mancuso S; Scambia G
Tamoxifen modulates the expression of Ki67, apoptosis, and microvessel
density in cervical cancer.
SO - Clin Cancer Res 2001 Sep;7(9):2656-61
AD - Department of Gynecology/Obstetrics, Catholic University of Rome, Italy.
PURPOSE: The aim of the study was to investigate if a short-term
administration of high-dose Tamoxifen (Tam) could affect the expression
of biologically relevant biochemical parameters in cervical cancer
tissue. EXPERIMENTAL DESIGN: The study was conducted in 24 patients with
histologically confirmed cervical tumors. Biopsies were obtained by
colposcopy on day 0 in all patients, who then received either 80 mg/die
or 160 mg/die for 5 consecutive days until the second biopsy was
obtained. Immunohistochemistry was performed with antiestrogen receptor
(ER), anti-Ki67, anticaspase cleavage product of keratin 18 (M30), and
anti-CD31 monoclonal antibodies. RESULTS: Eleven (45.8%) of 24 cervical
tumors were ER positive. The percentage of Ki67-positive tumor cells in
pre-Tam biopsies was significantly higher than the percentage in the
corresponding posttreatment biopsies (z = 4.29, P = 0.0001). No
difference in the pretreatment percentage of Ki67-positive cells
according to ER status was found. The percentage of M30 positivity was
higher in post-Tam than in pre-Tam biopsies. Microvessel density values
in pre-Tam biopsies were significantly higher than corresponding values
in posttreatment tissues (z = -3.72, P = 0.0002). The reduction in the
percentage of Ki67-positive tumors was significantly (z = 3.58, P =
0.0003) higher in ER-positive than in ER-negative tumors, whereas no
difference in Tam-induced reduction of microvessel density values
according to ER status (z = -0.18, P = 0.85) was found. Tam treatment
did not induce any change of M30 positivity in ER-positive tumors,
whereas in ER-negative tumors, it produced a significant (P = 0.015)
increase in the percentage of M30-positive cells in post-Tam versus
pre-Tam biopsies. CONCLUSIONS: A short-term treatment with Tam at doses
4-8-fold higher than those in conventional schemes is associated with
modifications of biological parameters associated with tumor cell
proliferation, apoptosis, and neoangiogenesis in cervical cancer.
6
UI - 21445732
AU - Matsuura Y; Murakami N; Nagashio E; Toki N; Kashimura M
TI -
Glassy cell carcinoma of the uterine cervix: combination chemotherapy
with paclitaxel and carboplatin in recurrent tumor.
SO - J Obstet Gynaecol Res 2001 Jun;27(3):129-32
AD - Department of Obstetrics and Gynecology, University of Occupational and
Environmental Health, Kyushu, Japan.
Combination chemotherapy with paclitaxel and carboplatin every 4 weeks
for 3 cycles was administered for recurrent glassy cell carcinoma of the
uterine cervix in a 67-year-old Japanese female. The response rate was
56% under computed tomography (partial response). However, the effect
was transient even with follow-up radiotherapy, and further cases need
to be accumulated to determine a successful treatment modality.
7
UI - 21448902
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.
8
UI - 21420029
AU - Lertbutsayanukul C; Lertsanguansinchai P; Shotelersuk K; Khorprasert C;
TI -
Rojpornpradit P; Asavametha N; Pataramontree J; Suriyapee S; Tresukosol
D; Termrungruanglert W
Results of radiation therapy in stage 1B cervical carcinoma at King
Chulalongkorn Memorial Hospital: fifteen-year experience.
SO - J Med Assoc Thai 2001 Jun;84 Suppl 1():S216-27
AD - Department of Radiology, Faculty of Medicine, Chulalongkom University,
Bangkok, Thailand.
A retrospective study was performed on 131 patients with stage 1B
cervical carcinoma who were referred and treated with external beam
radiation and intracavitary brachytherapy at the Division of Radiation
Therapy, Department of Radiology, King Chulalongkorn Memorial Hospital
survival rate, progression free survival rate, recurrence, and
treatment-related complications. The treatment results from different
sources of intracavitary radiation therapy were secondary endpoints. The
number of patients treated with Ra-226, Cs-137, and Ir-192 intracavitary
irradiation were 12, 84, and 35 patients respectively. The median
follow-up times were 69, 59, and 21 months for Ra-226, Cs-137, and
Ir-192, respectively. Actuarial 5-year overall survival rate was 89 per
cent. The 5-year progression free survival rate was 80 per cent.
Actuarial 5-year survival and progression free survival rate were
comparable among different sources of intracavitary brachytherapy (p =
0.553 and p=0.793, respectively). The overall recurrent rate was 16.8
per cent. Of the recurrence; 40.9 per cent was locoregional, 54.6 per
cent was distant failure, and 4.5 per cent was combined locoregional and
distant failure. The overall complication rate was 25.95 per cent. The
severe complication rates (Grade III-V) from treatment occurred in the
urinary bladder (0.76%) and in the small bowel (0.76%.) These results
suggest that radiation therapy alone is an effective treatment for stage
1B cervical carcinoma. Additionally, all types of intracavitary
brachytherapy provide comparable clinical results.
9
UI - 21449841
AU - Liu HE; Ya SF
TI -
The immediate and short-term effects of an educational program for post
radical hysterectomy self-care of the lower urinary tract.
SO - Chang Gung Med J 2001 Jul;24(7):440-5
AD - School of Nursing, Chang Gung University, Taoyuan, Taiwan, R.O.C.
sarah@mail.cgu.edu.tw
BACKGROUND: Cervical cancer has recently become one of the major
malignancies of women in Taiwan. Patients receive radical hysterectomy
as a first step in treatment. Urinary tract infection is a potential
complication after surgery. To enhance the knowledge and Foley catheter
self-care ability are major tasks that patients need to learn during
hospitalization. Therefore, the impact of an educational program is
evaluated. METHOD: A post-test only design with nonequivalent groups was
selected to conduct the present study. Patients who had radical
hysterectomy were distributed into an experimental group (N = 11; taught
by the head nurse with extra written material) and a control group (N =
9; taught by nurses in sequence). Knowledge level, home performance, and
laboratory data (urinalysis and urine culture) were selected as
indicators for evaluation. Non-parametric statistics such as
Mann-Whitney U test and Wilcoxon signed-rank test were performed to
verify the impact of this educational program. RESULTS: In regard to the
immediate effects, the experimental group reported a higher level of
knowledge than the control group during the first assessment. However,
after clarification by the head nurse in a discharge interview, this
difference disappeared in the second assessment 2 weeks later
(short-term effects). Nevertheless, no significant difference was found
either in the performance at home, urinalysis, or urine culture.
CONCLUSION: Different position of the nurses and additional written
material had an impact on the knowledge level of patients. However, no
significant differences were found within the subjective and objective
indicators.
10
UI - 21453169
AU - Kavanagh BD; Fischer BA 4th; Segreti EM; Wheelock JB; Boardman C; Roseff
TI -
SD; Cardinale RM; Benedict SH; Goram AL
Cost analysis of erythropoietin versus blood transfusions for cervical
cancer patients receiving chemoradiotherapy.
SO - Int J Radiat Oncol Biol Phys 2001 Oct 1;51(2):435-41
AD - Department of Radiation Oncology, Medical College of Virginia Hospitals,
Virginia Commonwealth University, Richmond, Virginia, USA.
PURPOSE: Red blood cell (RBC) transfusions or erythropoietin (EPO) can
be used to evade the detrimental effects of anemia during radiotherapy,
but the economic consequences of selecting either intervention are not
well defined. The RBC transfusion needs during chemoradiotherapy for
cervix cancer were quantified to allow comparison of RBC transfusion
costs with the projected cost of EPO in this setting. METHODS AND
MATERIALS: For patients receiving pelvic radiotherapy, weekly cisplatin,
and brachytherapy, the RBC units transfused during treatment were
tallied. RBC transfusion costs per unit included the blood itself,
laboratory fees, and expected value (risk multiplied by cost) of
transfusion-related viral illness. EPO costs included the drug itself
and supplemental RBC transfusions when hemoglobin was not adequately
maintained. An EPO dosage based on reported usage in cervix cancer
patients was applied. RESULTS: Transfusions were given for hemoglobin
<10 g/dL. Among 12 consecutive patients, 10 needed at least 1 U of RBC
before or during treatment, most commonly after the fifth week. A total
of 37 U was given during treatment, for an average of 3.1 U/patient. The
sum total of the projected average transfusion-related costs was $990,
compared with the total projected EPO-related costs of $3869.
CONCLUSIONS: Because no proven clinical advantage has been documented
for EPO compared with RBC transfusions to maintain hemoglobin during
cervix cancer treatment, for most patients, transfusions are an
appropriate and appealingly less expensive option.
11
UI - 21453170
AU - Chou HH; Wang CC; Lai CH; Hong JH; Ng KK; Chang TC; Tseng CJ; Tsai CS;
TI -
Chang JT
Isolated paraaortic lymph node recurrence after definitive irradiation
for cervical carcinoma.
SO - Int J Radiat Oncol Biol Phys 2001 Oct 1;51(2):442-8
AD - Department of Obstetrics and Gynecology, Division of Gynecologic
Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
ma2012@adm.cgmh.org.tw
PURPOSE: To evaluate the clinical features of isolated paraaortic lymph
node (PALN) recurrence after definitive radiotherapy, and analyze the
prognostic factors and effect of salvage treatment. METHODS AND
MATERIALS: Of a total 876 patients who received pelvic radiotherapy
after the diagnosis of primary cervical carcinoma, 26 were found to have
isolated PALN recurrence as the first recurrent site, and these patients
enrolled in this study. Only those with primary-site carcinoma
controlled and who were free of other distant metastases were eligible.
Nineteen of the 26 patients accepted salvage therapy. Fourteen patients
accepted concurrent chemoradiation (CCRT), 1 accepted radiation to the
paraaortic region, and 4 accepted chemotherapy alone. Clinical
parameters evaluated included tumor markers (SCC and CEA) and image
studies. RESULTS: Seven of the 26 patients were alive and disease-free.
All 7 survivors had salvage treatment with radiation to the paraaortic
region and concurrent cisplatin-based chemotherapy. None of the patients
receiving chemotherapy or radiation alone enjoyed long-term,
disease-free survival. The 5-year survival rate for isolated PALN
recurrence of the 14 patients who accepted salvage concurrent
chemoradiation (CCRT) was 51.2%. The presence of a clinical symptom at
the time of PALN recurrence was analyzed. Seven of the 12 asymptomatic
patients and none of the 14 symptomatic patients survived without
disease after salvage treatment. The SCC levels at recurrence showed a
statistically significant relationship to disease-free survival.
CONCLUSIONS: An SCC level of < or = 4 ng/ml and a lack of symptoms at
the time of recurrence were good prognostic factors in isolated PALN
recurrence after primary radiation therapy. In addition to concurrent
CCRT, periodical surveillance with tumor markers and imaging studies
allowed early detection and salvage of those patients.
12
UI - 21461959
AU - Rubin SC
TI -
Cervical cancer: successes and failures.
SO - CA Cancer J Clin 2001 Mar-Apr;51(2):89-91
The decline in deaths from cervical cancer in the US, as well as the
improved survival of women with advanced disease have resulted,
according to Dr. Rubin, from widespread application of routine screening
with the Pap test, the emergence of gynecologic oncology as a distinct
medical subspecialty, and the completion of important clinical trials.
13
UI - 21461960
AU - Janicek MF; Averette HE
TI -
Cervical cancer: prevention, diagnosis, and therapeutics.
SO - CA Cancer J Clin 2001 Mar-Apr;51(2):92-114; quiz 115-8
AD - University of Miami School of Medicine, Miami, FL, USA.
Cervical cancer is a leading cause of cancer deaths in women worldwide.
Because of its association with human papilloma virus infection, as well
as the ability to screen for premalignant stages of the disease, it is
now largely a preventable disease. This article describes the molecular
basis for cervical cancer, and presents a clinical overview of current
treatment approaches and technological advances, emphasizing the unique
aspects of this viral disease as it relates to the immune system and
vaccination or other immunotherapeutic strategies.
14
UI - 21277674
AU - Velji K; Fitch M
TI -
The experience of women receiving brachytherapy for gynecologic cancer.
SO - Oncol Nurs Forum 2001 May;28(4):743-51
AD - Princess Margaret Hospital, Toronto, Ontario, Canada.
karima.velji@rmp.uhn.on.ca
PURPOSE/OBJECTIVES: To explore and document the lived experience of
receiving low-dose rate brachytherapy for gynecologic cancer. DESIGN:
Qualitative method based on phenomenology. SETTING: Radiation treatment
facility in a cancer-care setting in Toronto, Ontario, Canada. SAMPLE:
Ten women between the ages of 36 and 75 (x = 59.2) receiving low-dose
rate brachytherapy for cancer of the cervix or endometrium. METHODS:
Verbatim data were analyzed manually using Giorgi's method of analyzing
qualitative data. FINDINGS: Three themes emerged from the data: (a)
women's experiences with brachytherapy were embedded within the complete
context in which treatment was given, shaped by personal, environmental,
and treatment-related factors, (b) the discomfort that women experienced
during brachytherapy was perceived as a totality of symptoms including
but not limited to pain, and (c) the brachytherapy experience was
characterized by an intense focus on time and tensions embedded in
issues related to time. CONCLUSIONS: When dealing with the brachytherapy
treatment, women are concerned with the context in which the treatment
is provided and the care that is associated with the treatment.
Different and unique strategies assist women to get through treatment.
Supportive nursing interventions can be implemented easily in the
nursing care plan for women undergoing brachytherapy. IMPLICATIONS FOR
NURSING PRACTICE: The aspects of nursing care that women perceive as
positive, such as competence level of the nurse, symptom management, and
providing information in sensory terms, should be strengthened.
Alternatively, aspects of nursing care that are perceived negatively by
women should be changed. Nurses have to avoid situations that will
prolong the time of brachytherapy treatment. Nurses should support women
in using coping strategies that assist them in getting through the
brachytherapy treatment.
15
UI - 21466985
AU - Wang SY; Yang KW; Hsu YT; Chang CL; Yang YC
TI -
The differential inhibitory effects of genistein on the growth of
cervical cancer cells in vitro.
SO - Neoplasma 2001;48(3):227-33
AD - Department of Medical Research, Mackay Memorial Hospital, Taipei,
Taiwan. eugene@ms2.mmh.org.tw
The biological effect of genistein on cervical cancer was studied on two
cervical cancer cell lines with different cellular characteristics. Here
we report that genistein exhibits inhibitory effects on the growth of
HeLa and ME-180 cells. The IC50 was 35 microM and 60 microM for HeLa and
ME-180 cells, respectively. ME-180 cells showed obvious G2/M arrest with
genistein treatment while most of the HeLa cells were accumulated in S
phase. The underlying molecular mechanism was further elucidated by
apoptosis analysis and expression levels of cell cycle regulatory
proteins. Treatment of the cell lines with genistein also resulted in
suppression of invasion through a surrogate membrane in a dose-dependent
manner, particularly the HeLa cells. While the underlying mechanism
needs to be further studied, the higher suppressive effect on invasion
of HeLa cells, an adenocarcinoma cell line, are noteworthy. This in
vitro observation may have clinical implication to improve the treatment
of cervical adenocarcinoma.
16
UI - 21461195
AU - Hartz LE; Fenaughty AM
TI -
Management choice and adherence to follow-up after colposcopy in women
with cervical intraepithelial neoplasia 1.
SO - Obstet Gynecol 2001 Oct;98(4):674-9
AD - Reproductive Health Clinic, Division of Health and Human Services,
Municipality of Anchorage, Anchorage, Alaska, USA. lhartz@alaska.com
OBJECTIVE: To determine women's preference when given a choice of
management between cryotherapy and cytology surveillance and to compare
subsequent adherence to serial cytologic follow-up after being diagnosed
with cervical intraepithelial neoplasia grade 1 (CIN1). METHODS: Two
hundred nineteen low-income women with biopsy-proven CIN1 seen in a
offered cryotherapy or cytology surveillance, followed by cytologic
testing every 4 months until three consecutive results were normal.
Endpoints of the study were: successful completion of follow-up;
transferred or referred out of clinic; or lost to follow-up. RESULTS:
Ninety-four women (42.9%) chose cryotherapy, compared with 125 women
(57.1%) who chose cytology surveillance (P < .05). Cryotherapy patients
were more likely to return for at least one visit (their treatment
visit) after colposcopy compared with cytology surveillance patients (P
< .001). In contrast to their initial return for treatment of 98.9%,
cryotherapy patients were less likely to return for their first
follow-up cytology visit compared to surveillance-only patients (68.1%
and 83.2%, respectively, P < .01). Thirty-seven percent of the total
group successfully completed follow-up at the clinic, 30.1% transferred
or were referred, and 32.9% were lost to follow-up. CONCLUSION:
Successful completion of a commonly recommended protocol for serial
cytology follow-up was low. Management choice affected initial adherence
but not adherence to long-term follow-up.
17
UI - 93119995
AU - Murdoch JB; Morgan PR; Lopes A; Monaghan JM
TI -
Histological incomplete excision of CIN after large loop excision of the
transformation zone (LLETZ) merits careful follow up, not retreatment.
SO - Br J Obstet Gynaecol 1992 Dec;99(12):990-3
AD - Regional Department of Gynaecological Oncology, Queen Elizabeth
Hospital, Gateshead, Tyne and Wear, UK.
OBJECTIVE: To quantify and analyse the influence of a histological
report of incomplete excision of CIN after LLETZ on frequency of
detection of residual CIN. DESIGN: Review of a computerised database of
sequential women treated by LLETZ. Initial follow-up was three months
post-treatment. SETTING: The Colposcopy Clinic, Regional Department of
Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead, Tyne and
Wear, UK. SUBJECTS: 721 women with CIN diagnosed histologically on LLETZ
specimens. RESULTS: In spite of a first time treatment success rate of
95% at 3 months, only 56% of the women were reported to have complete
histological excision of CIN. A report suggesting incomplete excision
was more likely with more severe CIN, extensive lesions and involvement
of the endocervical canal. Furthermore, 21% with residual CIN had
apparent complete excision of CIN at LLETZ. CONCLUSIONS: A histological
report of incomplete excision of CIN at LLETZ does not equate with
residual disease. The high treatment success rate of LLETZ means that a
report of incomplete excision should stimulate close colposcopic and
cytologic follow-up to identify the small number of women with residual
CIN after therapy.
18
UI - 20479555
AU - Dobbs SP; Asmussen T; Nunns D; Hollingworth J; Brown LJ; Ireland D
TI -
Does histological incomplete excision of cervical intraepithelial
neoplasia following large loop excision of transformation zone increase
recurrence rates? A six year cytological follow up.
SO - BJOG 2000 Oct;107(10):1298-301
AD - Department of Gynaecology, Leicester Royal Infirmary, UK.
OBJECTIVE: To determine the risk of recurrent cervical intraepithelial
neoplasia (CIN) in women with complete or incomplete excision of
cervical intraepithelial neoplasia treated by large loop excision of
transformation zone (LLETZ). DESIGN: A retrospective study SETTING: One
consultant-led colposcopy clinic at Leicester Royal Infirmary
POPULATION: Three hundred and ninety-four women referred consecutively
to the colposcopy clinic between 1991 and 1992. MAIN OUTCOME MEASURES:
The histological recurrence rate of CIN, length of cytological follow up
following treatment related to degree of completeness of excision at
initial treatment. RESULTS: Three hundred and twenty-two women had
complete cytological or histological follow up. The mean length of
follow up was 73 months with a mean number of six smears. Women with
incomplete excision of CIN had a significantly higher risk of recurrent
CIN (relative risk 8.23) occurring in a significantly shorter time
compared with women with complete excision. CONCLUSIONS: This study
demonstrates that large loop excision of transformation zone is
successful in over 95% of cases. Cytological surveillance is
satisfactory for follow up of women who have complete excision of CIN.
Women with incomplete excision of CIN at initial LLETZ remain at
significant risk of developing further CIN and long term colposcopic and
cytological follow up is necessary.
19
UI - 21360339
AU - Redman CW
TI -
Does histological incomplete excision of cervical intraepithelial
neoplasia following large excision of transformation zone increase
recurrence rates? A six year cytological follow up.
SO - BJOG 2001 Jul;108(7):771-2
20
UI - 21360340
AU - Das S; Chin KA
TI -
Does histological incomplete excision of cervical intraepithelial
neoplasia following large excision of transformation zone increase
recurrence rates? A six year cytological follow up.
SO - BJOG 2001 Jul;108(7):772
21
UI - 21360341
AU - Naik R; de Barros Lopes A; Monaghan J
TI -
Does histological incomplete excision of cervical intraepithelial
neoplasia following large excision of transformation zone increase
recurrence rates? A six year cytological follow up.
SO - BJOG 2001 Jul;108(7):772
22
UI - 21309249
AU - Harris JE
TI -
Re: Comparison of three management strategies for patients with atypical
squamous cells of undetermined significance: baseline results from a
randomized trial.
SO - J Natl Cancer Inst 2001 Jun 20;93(12):950-1; discussion 951-2
23
UI - 21309251
AU - Strickler H; Shah K
TI -
Re: Comparison of three management strategies for patients with atypical
squamous cells of undetermined significance: baseline results from a
randomized trial.
SO - J Natl Cancer Inst 2001 Jun 20;93(12):951; discussion 951-2
24
UI - 21439164
AU - Shipman SD; Bristow RE
TI -
Adenocarcinoma in situ and early invasive adenocarcinoma of the uterine
cervix.
SO - Curr Opin Oncol 2001 Sep;13(5):394-8
AD - Department of Gynecology and Obstetrics, The Johns Hopkins Medical
Institutions, Baltimore, Maryland, USA.
As data continue to accumulate, the clinical characteristics of
preinvasive and early invasive glandular cervical neoplasia are becoming
progressively better defined. Cytologic screening for these lesions is
imprecise; however, modifications to current classification systems may
improve the overall accuracy. All glandular abnormalities on the
Papanicolaou smear, nevertheless, require judicious evaluation and
careful follow-up. Cervical conization is the most definitive means of
diagnosing adenocarcinoma in situ (ACIS). Because ACIS has been thought
to represent a multifocal process, with negative conization margins
having limited predictive value, conservative management protocols have
been difficult to endorse. Several large studies now indicate that the
surgical margin status may be a more reliable indicator of true disease
clearance than previously thought. For young patients desiring to
maintain reproductive capacity, ACIS appears to be safely managed by
cold-knife conization combined with diligent surveillance. Early
invasive adenocarcinoma of the uterine cervix is associated with an
excellent prognosis, and recent data suggest that radical surgery may be
unnecessary.
25
UI - 21469891
AU - Mariani A; Webb MJ; Keeney GL; Calori G; Podratz KC
TI -
Role of wide/radical hysterectomy and pelvic lymph node dissection in
endometrial cancer with cervical involvement.
SO - Gynecol Oncol 2001 Oct;83(1):72-80
AD - Department of Obstetrics and Gynecology, Mayo Clinic, Rochester,
Minnesota 55905, USA.
OBJECTIVE: The goal of this work was to assess retrospectively the role
of wide/radical hysterectomy (RH) and pelvic lymph node dissection (LND)
in endometrial cancer with cervical involvement. METHODS; From 1984 to
1993, 82 patients with endometrial cancer and cervical involvement were
surgically managed at our institution. Of 57 patients with stage II
(59%) or III (41%) disease receiving no preoperative therapy, 22 (39%)
had simple hysterectomy (SH) and 35 (61%) had RH. Forty-four patients
(77%) had pelvic LND, and 38 (67%) had adjuvant radiotherapy (RT).
Median follow-up was 70 months. RESULTS: The 5-year disease-related
survival (DRS) and recurrence-free survival (RFS) were 73 and 63%,
respectively. Five-year DRS and RFS were 68 and 50%, respectively, in
the SH group compared with 76% (P = 0.1) and 71% (P = 0.04) in the RH
group. Distant recurrences occurred in 45% of patients with SH and in
23% with RH (P = 0.08). Local recurrence rates did not differ
significantly. Considering only stage II tumors, we did not observe any
recurrence among patients with negative nodes who had RH, irrespective
of the administration of adjuvant RT. By contrast, adjuvant RT improved
local control (even if not significantly) in stage II patients who had
SH. Five-year DRS of stage III patients was 47%, but it was improved by
adjuvant RT in the subgroup of patients who had RH. Independent
variables associated with prognosis were stage III disease, deep
myometrial invasion, RH, and adjuvant RT. CONCLUSION: RH and adjuvant RT
appear to improve prognosis in endometrial cancer with cervical
involvement. In particular, radical surgery alone is therapeutic in
stage II patients with negative nodes, irrespective of the
administration of RT. By contrast, RT can possibly improve local control
in stage II patients who previously had SH. Overall, stage III patients
have a poor prognosis that can be improved by a combination of radical
surgery and adjuvant RT; however, associated therapy directed to
extrapelvic sites is probably needed in patients with extrauterine
disease. Copyright 2001 Academic Press.
26
UI - 21477747
AU - Creasman WT
TI -
Cancer and pregnancy.
SO - Ann N Y Acad Sci 2001 Sep;943():281-6
AD - Department of Obstetrics and Gynecology, Medical University of South
Carolina, Charleston 29425, USA. Creasman@musc.edu
Carcinoma of the cervix is the most frequently diagnosed cancer in
pregnancy. Still, it is an unusual situation. An abnormal Pap smear
during pregnancy is a much more common occurrence and fortunately one
that can be managed conservatively. Although definitive treatment for
intraepithelial disease can be delayed until the postpartum period,
diagnostic evaluation should be done when the abnormal Pap smear is
present. Invasive cancer management is dependent on gestational age of
the fetus. Pregnancy affords an excellent opportunity to screen for
cervical neoplasia.
27
UI - 89238087
AU - Gerber P; Coppleson M
TI -
Clinical research after Auckland.
SO - Med J Aust 1989 Mar 6;150(5):230-3
AD - Gynaecological Oncology Unit, Royal Prince Alfred Hospital, Sydney.
28
UI - 89238097
AU - McNeill PM
TI -
The implications for Australia of the New Zealand report of the cervical
cancer inquiry: no cause for complacency.
SO - Med J Aust 1989 Mar 6;150(5):264-8, 271
AD - School of Community Medicine, University of New South Wales, High
Street, Kensington.
The New Zealand Cervical Cancer Inquiry established that patients with
carcinoma-in-situ were left untreated in order to observe the natural
history of their disease. Many patients developed invasive carcinoma
unnecessarily and some died. The Inquiry found the research to have been
unethical in that: the risk of progression to invasive carcinoma was
known; the subjects had not consented to such study; and the study was
designed and conducted poorly. The Inquiry was critical of the lack of
proper review and the failure of responsible doctors and administrators
to intervene in the interests of the patients. This article considers
reasons for this failure and background issues of ethics and law. It is
concluded that there is no cause for complacency in Australia in that
provisions that are designed to protect patients may be ineffective. The
NZ recommendations for changes in communication with patients, in the
treatment of patients, in reviews of research, and in the training of
doctors should be examined for their possible adoption in Australia.
29
UI - 89001982
AU - Paul C
TI -
The New Zealand cervical cancer study: could it happen again?
SO - BMJ 1988 Aug 20-27;297(6647):533-9
AD - Department of Preventive and Social Medicine, University of Otago,
Dunedin, New Zealand.
30
UI - 21291622
AU - Duenas-Gonzalez A; Lopez-Graniel C; Gonzalez A; Reyes M; Mota A; Munoz
TI -
D; Solorza G; Hinojosa LM; Guadarrama R; Florentino R; Mohar A; Melendez
J; Maldonado V; Chanona J; Robles E; De la Garza J
A phase II study of gemcitabine and cisplatin combination as induction
chemotherapy for untreated locally advanced cervical carcinoma.
SO - Ann Oncol 2001 Apr;12(4):541-7
AD - Department of Medical Oncology, Instituto Nacional de Cancerologia,
Mexico City, Mexico. alduenas@dfl.telmex.net.mx
BACKGROUND: Cisplatin-based chemoradiation for locally advanced cervical
carcinoma is now the standard of care for most patients with cervical
carcinoma. However, induction chemotherapy followed by surgery,
particularly with newer agents or combinations remains to be explored.
This study was undertaken to evaluate the antitumor activity and
toxicity of gemcitabine in combination with cisplatin for untreated
locally advanced cervical carcinoma. PATIENTS AND METHODS: Open-label,
single center, phase II, non-randomized study of neoadjuvant gemcitabine
plus cisplatin. Forty-one patients with histologic diagnosis of cervical
carcinoma, with no previous treatment and staged as IB2 to IIIB, were
treated with three 21-day courses of cisplatin 100 mg/m2 day I and
gemcitabine 1000 mg/m2 days 1 and 8, followed by locoregional treatment
with either surgery or concomitant chemoradiation. Response and toxicity
were evaluated before each course and at the end of chemotherapy.
RESULTS: All patients were evaluated for toxicity and 40 for response.
The overall objective response rate was 95% (95% confidence interval
(CI): 88%-100%) being complete in 3 patients (7.5%) and partial in 35
(87.5%). A complete pathological response was found in 6 (26%) of the 23
patients that underwent surgery. Granulocytopenia grades 3-4 occurred in
13.8% and 3.4% of the courses, respectively, whereas non-hematological
toxicity was mild. CONCLUSIONS: Induction chemotherapy with the
combination of gemcitabine and cisplatin is highly active for untreated
cervical cancer patients and has an acceptable toxicity profile.
31
UI - 21464699
AU - Harima Y; Sawada S; Nagata K; Sougawa M; Ohnishi T
TI -
Chromosome 6p21.2, 18q21.2 and human papilloma virus (HPV) DNA can
predict prognosis of cervical cancer after radiotherapy.
SO - Int J Cancer 2001 Oct 20;96(5):286-96
AD - Department of Radiology, Kansai Medical University, 10-15 Fumizono-cho,
Morigushi City, Osaka 570-8507, Japan. harima@takii.kmu.ac.jp
Loss of heterozygosity (LOH) is one of the most important mechanisms for
inactivation of tumor-suppressor genes. Studies of LOH in patients with
cervical carcinoma have reported a high frequency of LOH on 3p21.3,
6p21.2, 17p13.1, and 18q21.2. Our study explored whether p53 status,
human papilloma virus (HPV), and LOH on chromosome 3p21.3, 6p21.2,
17p13.1, and 18q21.2 are associated with treatment outcome in 65
patients with cervical cancer after radiotherapy. Tumors and normal DNA
were analyzed by polymerase chain reaction (PCR) for genetic losses at
10 polymorphic microsatellite loci. The presence of HPV and its type
were analyzed by PCR-based assay using the consensus primers for E6, E7,
and L1 region. Mutations of the p53 gene were identified by a
single-strand conformation polymorphism analysis. Chromosomes 3p21.3,
6p21.2, 17p13.1, and 18q21.2 were involved in the LOH in 23.1%, 41.5%%,
33.8%, and 23.1% of the tumors in our study, respectively. HPV-positive
tumors were found in 73.8% of the patients and p53 mutation in 10.8%.
The patients with LOH on chromosome 6p21.2 and 18q21.2 survived
significantly shorter compared with those without LOH on chromosome
6p21.2 and 18q21.2 in both the overall survival (P = 0.006 and P =
0.007) and the disease-free survival (P = 0.005 and P = 0.008). The
HPV-negative patients survived significantly shorter compared with the
HPV-positive patients in both the overall survival (P = 0.01) and the
disease-free survival (P = 0.04). According to multivariate analysis,
HPV status (P = 0.0004, P = 0.01), LOH on 6p21.2 (P = 0.006, P = 0.02),
and LOH on 18q21.2 (in both P = 0.01) is a significant predictor of both
overall and disease-free survival time. The results of our study suggest
that absence of HPV infection, LOH on 6p21.2, and LOH on 18q21.2 are the
most important determinants of outcome of patients with cervical
carcinoma after radiotherapy. Copyright 2001 Wiley-Liss, Inc.
32
UI - 21464701
AU - Kim JY; Cho HY; Lee KC; Hwang YJ; Lee MH; Roberts SA; Kim CH
TI -
Tumor apoptosis in cervical cancer: its role as a prognostic factor in
42 radiotherapy patients.
SO - Int J Cancer 2001 Oct 20;96(5):305-12
AD - Department of Radiation Oncology, Gil Medical Center, Gachon Medical
College, Inchon, Korea.
To investigate tumor apoptosis as a prognostic factor for outcome
following radiation therapy, comparisons were made of apoptotic index
(AI) as a predictor of short- vs. long-term response and pretreatment
vs. radiation-induced apoptosis. Forty-two patients with proven squamous
cell carcinoma of the uterine cervix were treated by radiation alone.
Apoptosis was measured by light microscopic observation of hematoxylin
and eosin-stained sections from biopsies taken before treatment and 4
and 24 hr after 2 Gy. Patients were evaluated at the end of the external
radiation for determination of short-term response and for long-term
outcome as well (median follow-up of 27 months). Patients with high
spontaneous AI showed poor short-term response, local control, and
survival. The significance of AI as a predictor of short-term response
was lost after allowing for differences in tumor size. The positive
predictive value of AI for local control and survival was independent of
tumor size and stage. High AI was associated with poor local control and
long-term prognosis in advanced squamous cell carcinoma of the cervix.
The in vivo radiation-induced AI after 4 or 24 hr did not predict
radiation therapy outcome. Copyright 2001 Wiley-Liss, Inc.
33
UI - 21469523
AU - Gaffney DK; Holden J; Zempolich K; Murphy KJ; Dicker AP; Dodson M
TI -
Elevated COX-2 expression in cervical carcinoma: reduced cause-specific
survival and pelvic control.
SO - Am J Clin Oncol 2001 Oct;24(5):443-6
AD - Department of Radiation Oncology, University of Utah, Salt Lake City,
84132, USA.
The purpose of this study was to correlate the level of cyclooxygenase-2
(COX-2) expression in carcinoma of the cervix with the clinical
endpoints: local control, cause-specific survival, and patterns of
failure in patients treated with radiotherapy. Formalin-fixed,
paraffin-embedded tumor biopsies were stained for COX-2. Clinical
factors such as stage, grade, tumor size, pre- and posttreatment
hemoglobin level, and radiotherapy dose were also evaluated. Actuarial
local control rates and cause-specific survival were determined
according to the Kaplan-Meier method. COX-2 distribution staining was
the only prognostic factor that was associated with local control and
cause-specific survival. High COX-2 distribution staining was associated
with decreased local control and decreased cause-specific survival by
log rank comparison of Kaplan-Meier survival curves. The 5-year
cause-specific survival rates for tumors with low versus high COX-2
distribution values were 90% and 22%, respectively (p = 0.0003).
Actuarial pelvic control at 5 years was superior in patients with low
COX-2 distribution staining (92%) compared with high staining (42%, p =
0.005). COX-2 staining intensity was found to correlate positively with
tumor size (p = 0.02). These findings indicate that increased expression
of COX-2 yields reduced pelvic control and cause-specific survival in
patients with invasive carcinoma of the cervix treated with
radiotherapy. Previously, inhibition of COX-2 has been demonstrated to
sensitize tumors to radiation without effect on normal tissue. Taken
together, these data may support a novel therapeutic application of
COX-2 inhibitors in t
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