Table of Contents
1
UI - 11723421
AU - Di Roma E; Parlavecchio E; Vettraino G; Corosu R
TI -
[CIN: multicentric study of therapeutic strategies]
SO - Minerva Ginecol 2001 Dec;53(6):379-2
AD - I Clinica Ostetrica e Ginecologica, IV Divisione, Policlinico Umberto I,
Universita degli Studi La Sapienza, Rome, Italy.
BACKGROUND: Cervical Intraepithelial Neoplasia (CIN) is a dysplastic
lesion that precedes cervical cancer. The diagnosis is made by
colposcopic, cytologic and bioptic exams. Therapy may be physical,
pharmacological or surgical. METHODS: We prepared a model of interview
(consisting of 9 questions) for 33 colposcopic centers in the Lazio
region. Our aim was to evaluate their therapeutic strategies for CIN and
cervical condylomata. We referred to SIGO 1999 guidelines for CIN
therapy and to European guidelines for cervical condylomata therapy.
RESULTS: The centers used drugs more for HPV infections (57%) than for
dysplasia (33%). Drug therapy was used more in the past (66.67%).
Actually they prefer treating CIN I with electrocoagulation diathermy
(DTC), CIN II with loop electrosurgical excision procedures (LEEP) or
Laser, CIN III with cold knife conization or LEEP, cervical condylomata
with laser or DTC. CONCLUSIONS: The results show that the centers prefer
physical therapy. Therapeutic strategies comply with SIGO 1999
guidelines for therapy of CIN and with European guidelines for cervical
condylomata partially.
2
UI - 11544829
AU - Zorin AV; Tsodikov AD; Khanin LG; Zharinov GM; Zaikin GV; Iakovlev AIu
TI -
[Parametric survival analysis in patients with cervical cancer following
fractionated radiotherapy: a new procedures and results]
SO - Vopr Onkol 2001;47(3):307-11
AD - Central Research Institute of Roentgeno-Radiology, Ministry of Health of
the RF, St. Petersburg.
A recent theoretical result of Kendal (1998) enabled us to develop a
survival model which allows for proliferation of tumor clonogenic cells
in the course of fractionated radiotherapy. We explored this model
during an analysis of clinical data on survival of 982 patients with
cancer of the cervix uteri. The model provided a good description of
survival patterns in different groups of patients. The estimated cure
probability did not correlate with the rates of cell proliferation
between exposures to radiation. Also, our results showed that this
parameter cannot be estimated from survival data. Some light has been
thrown on the relationship of cell proliferations taking place between
exposures, on the one hand, and end-results of treatment for cancer of
the cervix uteri, on the other.
3
UI - 11544838
AU - Vishnevskaia EE; Okeanova NI; Shelkovich SE; Matylevich OP
TI -
[Evaluation of combined treatment in stage-II cervical cancer in terms
of morphologic structure of the tumor]
SO - Vopr Onkol 2001;47(3):355-9
AD - N.N. Alexandrov Research Institute of Oncology and Medical Radiology,
Minsk, Belarus.
The efficacy of stage II cervical cancer (CC) treatment was evaluated in
two groups: squamous cell carcinoma--151, cervical adenocarcinoma
(CAC)--49. All the patients received combined treatment (preoperative
large-fraction brachytherapy + surgery + postoperative radiation). A
comparison of the results highlighted the role of morphological pattern
of tumor as a factor of cure. Five-year survival rates for CAC stage II
patients were lower by 12.4% while the incidence of distant lymphogenous
metastases and those to organs, responsible for failed therapy, was 2.7
times as high.
4
UI - 11564482
AU - Green JA; Kirwan JM; Tierney JF; Symonds P; Fresco L; Collingwood M;
TI -
Williams CJ
Survival and recurrence after concomitant chemotherapy and radiotherapy
for cancer of the uterine cervix: a systematic review and meta-analysis.
SO - Lancet 2001 Sep 8;358(9284):781-6
AD - Department of Medicine, University of Liverpool, L69 3GA, Liverpool, UK.
J.A.Green@liverpool.ac.uk
BACKGROUND: The US National Cancer Institute alert in February, 1999,
stated that concomitant chemotherapy and radiotherapy should be
considered for all patients with cervical cancer. Our aim was to review
the effects of chemoradiotherapy on overall and progression-free
survival, local and distant control, and acute and late toxicity in
patients with cervical cancer. METHODS: With the methodology of the
Cochrane Collaboration, we did a systematic review of all known
randomised controlled trials done between 1981 and 2000 (17 published,
two unpublished) of chemoradiation for cervical cancer. FINDINGS: The
trials included 4580 randomised patients, and 2865-3611 patients
(62-78%) were available for analysis. Cisplatin was the most common
agent used. The findings suggest that chemoradiation improves overall
survival (hazard ratio 0.71, p<0.0001), whether platinum was used (0.70,
p<0.0001) or not (0.81, p=0.20). A greater beneficial effect was seen in
trials that included a high proportion of stage I and II patients
(p=0.009). An improvement in progression-free survival was also seen
with chemoradiation (0.61, p<0.0001). Thus, the absolute benefit in
progression-free and overall survival was 16% (95% CI 13-19) and 12%
(8-16), respectively. A significant benefit of chemoradiation on both
local (odds ratio 0.61, p<0.0001) and distant recurrence (0.57,
p<0.0001) was also recorded. Grade 3 or 4 haematological (odds ratio
1.49-8.60) and gastrointestinal (2.22) toxicities were significantly
greater in the concomitant chemoradiation group than the control group.
There was insufficient data to establish whether late toxicity was
increased in the concomitant chemoradiation group. INTERPRETATION:
Concomitant chemotherapy and radiotherapy improves overall and
progression-free survival and reduces local and distant recurrence in
selected patients with cervical cancer, which may give a cytotoxic and
sensitisation effect.
5
UI - 11813150
AU - Nori D; Dasari N; Allbright RM
TI -
Gynecologic brachytherapy I: Proper incorporation of brachytherapy into
the current multimodality management of carcinoma of the cervix.
SO - Semin Radiat Oncol 2002 Jan;12(1):40-52
AD - Department of Radiation Oncology, New York Presbyterian Hospital, Weill
Medical College of Cornell University, New York, NY 10021, USA.
The incidence of carcinoma of the cervix has continuously declined over
the past decades because of effective screening. The International
Federation of Gynecology and Obstetrics (FIGO) clinical staging, though
universally used, is considered inadequate either to determine the type
of treatment or to predict treatment outcome. Over the last 10 years,
treatment of cervical cancer has become increasingly sophisticated with
advances in external beam and brachytherapy in the radiotherapeutic
management of this carcinoma. In particular, brachytherapy plays a major
role in enhancing both local control and survival. Experience to date
suggests that either high-dose-rate (HDR) or low-dose-rate (LDR)
brachytherapy, when properly applied, can be effective and give similar
rates of local control with minimal complications. This article analyzes
the current literature regarding treatment techniques of radiotherapy
with special emphasis on brachytherapy integration to optimize
radiotherapy treatment outcome. Copyright 2002 by W.B. Saunders Company
6
UI - 11830237
AU - Willemse PH; de Vries EG; Pras E; Maduro JH
TI -
Treatment of cervical cancer.
SO - Lancet 2002 Jan 26;359(9303):357-8
7
UI - 11830236
AU - van der Zee J; Koper PC; Lutgens LC; Burger CW
TI -
Treatment of cervical cancer.
SO - Lancet 2002 Jan 26;359(9303):357; discussion 358
8
UI - 11853297
AU - Manusirivithaya S; Chareoniam V; Pantusart A; Isariyodom P; Srisomboon J
TI -
Comparative study of bulky stage IB and IA cervical cancer patients
treated by radical hysterectomy with and without neoadjuvant
chemotherapy: long-term follow-up.
SO - J Med Assoc Thai 2001 Nov;84(11):1550-7
AD - Department of Obstetrics and Gynecology, Bangkok Metropolitan Medical
College and Vajira Hospital, Thailand.
One hundred and ninety patients with bulky (> 3 cm) stage IB and IIA
cervical cancer who underwent radical hysterectomy between 1991 and 1994
at Maharaj Nakorn Chiang Mai Hospital were reviewed to determine whether
neoadjuvant chemotherapy (NAC) with MVAC (Methotrexate, Vinblastine,
Adriamycin, Cisplatin) improved survival. There were 42 patients treated
with pre-operataive NAC (MVAC 1-3 courses) and 148 patients treated by
primary surgery (PS). In the NAC group, the overall response rate from
MVAC was 88.1 per cent with 31.0 per cent having complete clinical
response and 7.1 per cent with complete pathological response. Pelvic
lymph node metastasis was not significantly different between the NAC
group (16.7%) and the PS group (18.2%). At a median follow-up of 64.5
months, 19.0 per cent in the NAC group and 18.2 per cent in the PS group
had tumor recurrence. The 5-year progression free and overall survival
was 80.8 per cent and 92.0 per cent respectively for the NAC group which
was not significantly different from 80.2 per cent and 92.9 per cent
respectively in the PS group. In conclusion, although NAC can decrease
the tumor size and produce a high response rate, it does not improve
survival in bulky stage IB and IIA cervical cancer patients.
9
UI - 11872302
AU - Hsu IC; Speight J; Hai J; Vigneault E; Phillips T; Pouliot J
TI -
A comparison between tandem and ovoids and interstitial gynecologic
template brachytherapy dosimetry using a hypothetical computer model.
SO - Int J Radiat Oncol Biol Phys 2002 Feb 1;52(2):538-43
AD - Department of Radiation Oncology, University of California at San
Francisco, San Francisco, CA 94143-1708, USA. hsu@radonc17.ucsf.edu
PURPOSE: To evaluate the dose distribution within the clinical target
volume between two gynecologic brachytherapy systems---the tandem and
ovoids and the Syed-Neblett gynecologic template---using a hypothetical
computer model. METHODS AND MATERIALS: Source positions of an
intracavitary system (tandem and ovoids) and an interstitial system (GYN
template) were digitized into the Nucletron Brachytherapy Planning
System. The GYN template is composed of a 13-catheter implant (12
catheters plus a tandem) based on the Syed-Neblett gynecologic template.
For the tandem and ovoids, the dwell times of all sources were evenly
weighted to produce a pear-shaped isodose distribution. For the GYN
template, the dwell times were determined using volume optimization. The
prescribed dose was then normalized to point A in the intracavitary
system and to a selected isodose line in the interstitial system. The
treated volume in the two systems was kept approximately the same, and a
cumulative dose-volume histogram of the treated volume was then
generated with the Nucletron Brachytherapy Planning System to use for
comparison. To evaluate the dose to a hypothetical target, in this case
the cervix, a 2-cm-long, 3-cm-diameter cylinder centered along the
tandem was digitized as the clinical target volume. The location of this
hypothetical cervix was based on the optimal application of the
brachytherapy system. A visual comparison of clinical target coverage by
the treated volume on three different orthogonal planes through the
treated volume was performed. The percentage dose-volume histograms of
the target were generated for comparison. Multiple midline points were
also placed at 5-mm intervals away from the tandem in the plane of the
cervix to simulate the location of potential bladder and rectal dose
points. Doses to these normal structures were calculated for comparison.
RESULTS: Although both systems covered the hypothetical cervix
adequately, the interstitial system had a better coverage of the region
lateral to the cervix. Smaller volumes of the vagina and uterine fundus
received the full dose from the interstitial implant. The cumulative
dose-volume histograms revealed larger high-dose regions within the
treatment volume for the intracavitary system. The volumes receiving >
or = 180% of the prescription dose were 31 cc and 17 cc for the
intracavitary system and interstitial system, respectively. The isodose
lines showed that most of this difference results from the high-dose
region around the tandem. The percentage dose-volume histograms showed
that a larger percentage of cervix received a higher dose in the
intracavitary system. Fifty-two percent of the target volume received
200% or higher of the prescription dose with tandem and ovoids, compared
with only 20% with the template system. Analysis of dose points outside
of the 100% isodose lines showed a slightly more rapid dose drop-off
with the interstitial system compared to the intracavitary system. Point
doses at 20, 25, and 30 mm from the tandem in the interstitial system
were 100%, 69%, and 51% of prescribed dose, and from the intracavitary
system were 101%, 76%, and 58%, respectively. CONCLUSIONS: Our
dosimetric analysis revealed a better coverage in the parametrial
regions, but underdosage of the central cervical region, for the
interstitial system. On the other hand, because of the increased
distance of source to dose point, there is a more rapid dose drop-off
outside the treated volume with the interstitial system, which has the
potential to improve tissue sparing. Based on this analysis, we caution
against using a radiotherapy system with a homogeneous central dose
distribution when treating cervical cancer with an intact uterus. We
recommend differential loading of the implant catheters with the
majority of dose delivered from the tandem when using an interstitial
GYN template with remote afterloader.
10
UI - 11136561
AU - Landoni F; Maneo A; Cormio G; Perego P; Milani R; Caruso O; Mangioni C
TI -
Class II versus class III radical hysterectomy in stage IB-IIA cervical
cancer: a prospective randomized study.
SO - Gynecol Oncol 2001 Jan;80(1):3-12
AD - Clinica Ostetrico-Ginecologica, University of Milan, Bicocca, Monza,
Italy.
OBJECTIVE: The objective of this study was to determine the role of the
extent of the radicality in the treatment of stage IB-IIA cervical
carcinoma with respect to survival, pattern of relapse, and morbidity.
METHODS: Two-hundred forty-three patients with cervical carcinoma (FIGO
stages IB and IIa) were enrolled in a prospective randomized study
comparing two types of radical hysterectomy (Piver-Rutledge-Smith class
evaluable. Disease-free survival, overall survival, pattern of
recurrences, and morbidity were the endpoints of this study. RESULTS:
Mean operative time was significantly (P = 0. 05) shorter in the group
of patients undergoing class II hysterectomy (135 min vs 180 min),
whereas mean blood loss (530 ml vs 580 ml) and number of patients
requiring transfusions (35% vs 43%) were similar in the two arms of
treatment. Complications unrelated to the extent of the surgical
dissection and mean postoperative stay were similar in the two arms of
treatment. Late morbidity was significantly lower in patients in the
class II arm (especially urologic morbidity, 13% vs 28%). Postoperative
radiotherapy was administered to 64 patients (54%) in class II and to 65
patients (55%) in the class III arm. Recurrence rate (24% class II vs
26% class III) and number of patients dead of disease (18% class II vs
20% class III) were not significantly different in the two groups of
treatment. Overall 5-year survival was 81 and 77% and disease-free
survival was 75 and 73%, respectively. Multivariate analysis confirms
that survival does not depend on the type of operation. CONCLUSIONS:
Class II and class III radical hysterectomies are equally effective in
surgical treatment of cervical carcinoma, but the former is associated
with a lesser degree of late complications. Copyright 2001 Academic
Press.
11
UI - 11812088
AU - Lea JS; Sheets EE; Duska LR; Miller DS; Schorge JO
TI -
Early-stage cervical adenocarcinoma treated by surgical intent: the role
of para-aortic lymph node dissection.
SO - Gynecol Oncol 2002 Feb;84(2):285-8
AD - Division of Gynecologic Oncology, University of Texas Southwestern,
Dallas, Texas 75390, USA.
OBJECTIVE: Previous reports suggest that cervical adenocarcinomas have a
unique pattern of spread and are more apt to metastasize to para-aortic
lymph nodes. The purpose of this study was to further define the node of
para-aortic lymph node dissection in early-stage cervical adenocarcinoma
treated by surgical intent. METHODS: Institutional review board approval
was obtained to perform a computerized search of the data of all women
diagnosed with cervical adenocarcinoma between 1982 and 2000. Hospital
charts were retrospectively reviewed. Follow-up was obtained from the
tumor registry, medical records, and correspondence with health care
providers. RESULTS: Three hundred (87%) of 345 early-stage (FIGO
IA(1)-IIA) cervical adenocarcinoma patients were primarily treated by
surgical intent. Two hundred seventy-six underwent pelvic and
para-aortic node dissection (n = 69) or pelvic node dissection only (n =
207); 24 had no lymph node dissection. The median number of lymph nodes
removed was 13 pelvic (range, 1-58) and 3 para-aortic (range, 1-17).
Three (4%) of 69 patients had para-aortic nodal metastases. Each had
either grossly evident para-aortic adenopathy (n = 2) or an adnexal
metastasis. Thirty-six of 40 women developing recurrent disease had at
least some component of pelvic recurrence; 4 had only extrapelvic
disease. Three patients undergoing para-aortic node dissection developed
an isolated extrapelvic recurrence despite originally negative
para-aortic nodes (n = 2) or treatment by extended-field radiation for
para-aortic metastases. One woman undergoing only pelvic node dissection
had an isolated extrapelvic recurrence despite originally negative
nodes. CONCLUSIONS: Early-stage cervical adenocarcinoma primarily
treated by surgical intent has a very low risk of para-aortic
metastases. These were detected only when there was gross evidence of
nodal or adnexal disease. B)2002 Elsevier Science.
12
UI - 11812089
AU - Nakamoto Y; Eisbruch A; Achtyes ED; Sugawara Y; Reynolds KR; Johnston
TI -
CM; Wahl RL
Prognostic value of positron emission tomography using
F-18-fluorodeoxyglucose in patients with cervical cancer undergoing
radiotherapy.
SO - Gynecol Oncol 2002 Feb;84(2):289-95
AD - Division of Nuclear Medicine, Johns Hopkins University, Baltimore,
Maryland 21287-0817, USA.
OBJECTIVE: The purpose of this study was to determine whether positron
emission tomography (PET) using F-18-fluorodeoxyglucose (FDG) before and
after radiotherapy would predict whether local control of cervical
cancer had been achieved. METHODS: FDG-PET scans were performed prior to
therapy and at a mean of 4.6 months after radiation in 20 patients (pts)
with histologically proven uterine cervical cancer who were undergoing a
"curative" course of radiation therapy. FDG uptake was interpreted
visually by two readers using a 5-point grading system (0 = normal, 1 =
probably normal, 2 = equivocal, 3 = probably abnormal, and 4 =
definitely abnormal). The standardized uptake values corrected by lean
body mass (SUL) were calculated for suspicious areas. The percentage of
residual activity (%RA) for the posttherapy SUL was also evaluated as a
percentage of the pretherapy SUL. RESULTS: At baseline before
irradiation, 17 of 20 (85.0%) primary tumors were detected. Following
irradiation, no or low (grade 0-2) uptake was observed in 9 pts, and
none of these had local recurrence. Among the remaining 11 pts with
grade 3 or 4 uptake, the correct diagnosis was made for 5 pts with
active tumor; SULs (mean +/- SD = 4.17 +/- 2.52) and %RAs (57.9 +/-
16.8). Six patients without active tumor showed relatively low SULs
(2.67 +/- 0.69) and %RAs (43.0 +/- 18.3). No significant differences
were observed between the recurrent and nonrecurrent groups for these
parameters. Overall, sensitivity, specificity, and accuracy were 100,
60, and 70%, respectively. CONCLUSION: These preliminary data indicate
that FDG-PET is a sensitive tool for detecting active cervical cancer
after radiation, however, the method, without anatomic correlation had
suboptimal specificity. B)2002 Elsevier Science.
13
UI - 11812094
AU - Hasenburg A; Salama JK; Van TJ; Amosson C; Chiu JK; Kieback DG
TI -
Evaluation of patients after extraperitoneal lymph node dissection and
subsequent radiotherapy for cervical cancer.
SO - Gynecol Oncol 2002 Feb;84(2):321-6
AD - Department of Obstetrics and Gynecology, Baylor College of Medicine,
Houston, Texas 77030, USA. ahasenb@frk1.ukl.uni-freiburg.de
OBJECTIVE: The presence of nodal metastases is the most important
prognostic factor in cervical cancer. To adjust our therapy based on the
true extent of the patient's disease, we performed an extraperitoneal
lymph node dissection (EPLND) in all patients with cervical cancer prior
to radiotherapy (RT) or radical hysterectomy. METHODS: Thirty-three
patients with carcinoma of the cervix underwent EPLND. The value of this
procedure as a diagnostic tool for monitoring the extension of the
disease was determined. Additionally, EPLND/RT-associated treatment
complications were monitored. RESULTS: The combined treatment approach
of EPLND with RT or chemotherapy/RT was without major complications.
Nineteen patients showed a temperature elevation, but only one patient
had a fever of greater than 39.0 degrees C. Fourteen (48.3%) of 29
patients experienced some degree of proctitis or diarrhea and 3 (10.3%)
experienced cystitis during the course of RT. No grade 3 or 4 acute or
late genitourinary or gastrointestinal toxicities were noted. EPLND
changed the clinical management for 6 patients from a radical
hysterectomy to RT and for 7 patients from standard-field RT to
extended-field RT. Without EPLND these 7 patients would have received RT
with standard pelvic fields that would not have treated involved lymph
node areas at high risk for subsequent failure. CONCLUSION: Thirteen
(44.8%) of 29 patients received a different treatment than would
otherwise have been administered with standard treatment planning.
Therefore, we suggest that EPLND should be performed in all patients
with cervical cancer prior to radical surgery or RT. B)2002 Elsevier
Science.
14
UI - 11812095
AU - Trudeau M; Stuart G; Hirte H; Drouin P; Plante M; Bessette P; Dulude H;
TI -
Lebwohl D; Fisher B; Seymour L
A phase II trial of JM-216 in cervical cancer: an NCIC CTG study.
SO - Gynecol Oncol 2002 Feb;84(2):327-31
AD - National Cancer Institute of Canada Clinical Trials Group, Kingston,
Ontario, Canada. marc.trudeau@muhc.mcgill.ca
OBJECTIVE: BMS-182751 (JM-216) is an orally bioavailable platinum
compound with activity in platinum-sensitive and platinum-resistant
preclinical models. The objective was to determine its activity in
recurrent/metastatic squamous cell carcinoma of the cervix. METHODS: We
conducted a phase II study of BMS-182751 given at a dose of 30 mg/m(2)
daily for 14 days every 5 weeks. RESULTS: Eighteen patients (pts) with
advanced/recurrent squamous cancer of the cervix not amenable to
curative therapy with measurable disease who had received no prior
chemotherapy for systemic disease were entered, all of whom are
evaluable for response and toxicity. Median age was 47 years (35-74
years); all pts had received prior pelvic irradiation (RT); 4 pts had
received cisplatin as adjustment therapy with radiation; PS was 0 (6
pts), 1 (7 pts), and 2 (5 pts); sites of disease included nodes (10
pts), pelvis (5 pts), lung (4 pts), and bone (3 pts). Median number of
cycles was two (1-6) with 8 pts receiving three or more cycles. Toxicity
was modest and usually grade 1 or 2 in severity with the most frequent
drug related toxicity being nausea (56%), fatigue (50%), anorexia (39%),
diarrhea (39%), vomiting (39%), constipation (28%), and altered taste
(22%). Six pts had grade 3 or 4 granulocytopenia and only 1 pt, grade 3
or 4 thrombocytopenia. Two pts had grade 2 or 3 creatinine increases.
There were no treatment-related deaths. One pt with a treatment-free
interval of 30 years achieved a partial response, while 12 pts had a
best response of stable disease. CONCLUSIONS: BMS-182751 is generally
well tolerated, but has limited activity in pts with recurrent cervical
cancer. B)2002 Elsevier Science.
15
UI - 11817998
AU - Elhanafy OA; Das RK; Paliwal BR; Migahed MD; Sakr HA; Elleithy M
TI -
Anatomic variation of prescription points and treatment volume with
fractionated high-dose rate gynecological brachytherapy.
SO - J Appl Clin Med Phys 2002 Winter;3(1):1-5
AD - Department of Human Oncology, University of Wisconsin, Madison,
Wisconsin, USA.
The purpose of this report is to evaluate the geometric movement
(relative to the bony pelvis) and dose variation of brachytherapy
reference points in the same patient at repeated high-dose rate (HDR)
intracavitary implants. A study was also concluded to find the variation
in treatment volume from repeated fractions. Twenty-five consecutive
cervical cancer patients (all stages) treated with external beam and
fractionated HDR intracavitary implants at the University of Wisconsin
were reviewed. Each brachytherapy insertion had a different plan
generated prior to treatment delivery. ICRU #38 prescription points (A,
B, P, bladder, and rectum) were used. Dose volume histogram was
generated and treated volume to the prescription dose was recorded for
each fraction. Motion analysis of the various points (from a common
origin) in subsequent fractions relative to the first fraction revealed
a shift of 2-9 mm in a single plane. Vector analysis revealed the
magnitude of the average shift ranged from 10-13 mm. These shifts
resulted in a dose difference of >20% for the bladder and rectum points,
but < than 8% for the other points. Dose volume histograms revealed that
with the change in the anatomy of the cervix and upper vagina during a
patient's course of treatment, the treatment volume changes
considerably. Thirty-six percent of all patients (9/16) had a reduction
in the size of the ovoid during the treatment course. Sixty percent of
all patients (15/25) had volume changes <10%. Sixty-two and one half
percent of patients (10/16) who did not undergo a reduction of avoid
size during the entire course of the treatment had volume change <10%.
Since there is a change in the anatomy of the cervix and upper vagina
during the course of a treatment along with the irreproducibility of the
packing, there is movement of the absolute position of the prescription
points between fractions, thus emphasizing the importance of individual
dosimetry. Moreover, due to the same reasons, there are significant
changes in the treatment volume among implants for the same patient.
Volume reduction caused by reduction in ovoid size alone could not be
extracted from this study.
16
UI - 11849783
AU - Kodaira T; Fuwa N; Kamata M; Furutani K; Kuzuya K; Ogawa K; Toita T;
TI -
Sasaoka M; Nomoto Y
Clinical assessment by MRI for patients with stage II cervical carcinoma
treated by radiation alone in multicenter analysis: are all patients
with stage II disease suitable candidates for chemoradiotherapy?
SO - Int J Radiat Oncol Biol Phys 2002 Mar 1;52(3):627-36
AD - Department of Radiation Oncology, Aichi Cancer Center, Aichi, Japan.
yra05712@nifty.ne.jp
PURPOSE: From recent randomized trials, patients with Stage II cervical
carcinoma are thought to be candidates for chemoradiotherapy. To refine
the strategy for Stage II patients, we performed a retrospective
multi-institutional analysis using MRI. METHODS AND MATERIALS: From
three institutions, 84 patients with Stage II cancer diagnosed by MRI
were entered into the study. All patients received intracavitary
brachytherapy with (n = 83) or without (n = 1) external beam
radiotherapy. Uni- and multivariate analyses were performed to identify
the prognostic factors for overall survival (OAS), disease-free survival
(DFS), pelvic control (PC), and distant metastasis-free survival (DMFS).
RESULTS: The 5-year DFS rate of patients with maximal tumor size
(D(max)) > or =50 mm (46.2%) was significantly lower than that for
patients with D(max) <50 mm (88.0%; p <0.0001). Large size or volume and
lymph node swelling were also significant prognostic factors of OAS,
DFS, PC, and DMFS. In the multivariate model, size or volume was a
significant prognostic factor of OAS, DFS, PC, and DMFS, and lymph node
swelling was a prognostic factor for DFS, PC, and DMFS. Using these two
prognostic factors, patients were divided into 3 subgroups. The 5-year
DFS rate of patients with risk 0 (D(max) <50 mm and negative lymph node
swelling), 1 (D(max) > or =50 mm or positive lymph node swelling), and 2
(D(max) > or =50 mm and positive lymph nodes) was 93.2%, 53.3%, and
25.0%, respectively (p <0.0001). CONCLUSION: In this stage-limiting
analysis, we clarified the stratification according to clinical risk
with the aid of MRI. For patients with low-risk factors, especially for
elderly patients, radiation alone would probability be a feasible
option. In the future, a randomized trial using criteria with MRI would
help to identify the optimal strategy for patients with Stage II
disease.
17
UI - 11707645
AU - Rein DT; Kurbacher CM
TI -
The role of chemotherapy in invasive cancer of the cervix uteri: current
standards and future prospects.
SO - Anticancer Drugs 2001 Nov;12(10):787-95
AD - Department of Gynecology and Obstetrics, University of Dusseldorf
Medical Center, 40001 Dusseldorf, Germany. Rein@med.uni-duesseldorf.de
For many decades, invasive cervical cancer has been considered more or
less chemoresistant and chemotherapy has been limited to patients
presenting with overt metastatic disease or those suffering from pelvic
recurrences which could not be advised to secondary local treatments.
However, more than 20 different single agents are considered active in
cervical cancer. Recent cooperative clinical trials have demonstrated
the superiority of multi-modality strategies for patients with high-risk
cervical cancer. These studies integrating chemotherapy as part of the
primary therapeutic concept have provided the most significant
improvement of locally advanced disease in more than three decades. This
review summarizes current standards of chemotherapy for invasive
cervical cancer and shows new developments which may improve systemic
treatment of the disease.
18
UI - 11707654
AU - Tsuda H; Tanaka M; Manabe T; Nakata S; Ishiko O; Yamamoto K
TI -
Phase I-II study of neoadjuvant chemoradiotherapy followed by radical
surgery in locally advanced cervical cancer.
SO - Anticancer Drugs 2001 Nov;12(10):853-8
AD - Department of Obstetrics and Gynecology, Osaka City General Hospital,
Miyakojima, Osaka 534-0021, Japan. tsud777@ocgh.hospital.city.osaka.jp
The usefulness of neoadjuvant chemotherapy (NAC) regimens has been
reported; however, the effect of NAC for advanced stages (especially
stage III-IVA) is thought to be insufficient. We conducted a phase I-II
study of neoadjuvant chemoradiotherapy consisting of intra-arterial
(i.a.) infusion of carboplatin and intracavitary brachytherapy in
patients with locally advanced cervical cancer to achieve the new NAC
method. Sixteen eligible patients included those with previously
untreated stage IIB, III or IVA cancer with bulky tumor. Brachytherapy
using iridium-192 was performed with concurrent i.a. chemotherapy with
carboplatin (200, 300 and 400 mg/m2). Treatment was repeated every 4
weeks for a total of two cycles. Both hematologic and non-hematologic
toxicities were generally mild. Grade 4 hematologic toxicity was
observed in 12.5% and there were no grade III or IV non-hematologic
toxicities. The optimal dose of carboplatin was determined to be 400
mg/m2. Among 16 patients, six showed complete response (37.5%) and nine
showed partial response (56.3%), for an overall response rate of 93.8%.
All 15 responding patients underwent radical surgery with a pelvic
lymphadenectomy and postoperative radiotherapy. The combination of
brachytherapy and i.a. chemotherapy with carboplatin is a promising
regimen for NAC in locally advanced cervical cancer.
19
UI - 11161872
AU - Marana HR; de Andrade JM; da Silva Mathes AC; Duarte G; da Cunha SP;
TI -
Bighetti S
Chemotherapy in the treatment of locally advanced cervical cancer and
pregnancy.
SO - Gynecol Oncol 2001 Feb;80(2):272-4
AD - Department of Gynecology and Obstetrics of the Medical School of
Ribeirao Preto, University of Sao Paulo, SP 14.049-900, Brazil.
heitorrcm@highnet.com.br
BACKGROUND: Carcinoma of the cervix is the most common malignant tumor
associated with pregnancy. The initial stages and premalignant lesions
apparently present the same prognosis in pregnant and nonpregnant women;
however, there are limited data regarding outcome for locally advanced
cervical cancer in pregnancy. CASE: A 26-year-old woman, gravida 4, para
3, at 14 weeks and 4 days' gestation, was diagnosed with a FIGO stage
IIB squamous cell carcinoma of the cervix, treated by primary
chemotherapy with cisplatin and bleomycin, until pregnancy resolution at
38 weeks. The newborn infant is currently 3 years old and presents no
evidence of abnormalities in neuropsychomotor development. CONCLUSION:
The present case demonstrates that chemotherapy was harmless for the
child up to the present time. However, a longer follow-up is needed to
determine the safe outcome of this child.
20
UI - 11531309
AU - Rose PG
TI -
Chemotherapy in the treatment of locally advanced cervical cancer during
pregnancy.
SO - Gynecol Oncol 2001 Aug;82(2):409-10
21
UI - 11531312
AU - Barton DP; Butler-Manuel S; Buttery LD; A'Hern R; Polak JM
TI -
Radical hysterectomy for early stage cervical cancer and resulting
morbidity.
SO - Gynecol Oncol 2001 Aug;82(2):410-1
22
UI - 11844807
AU - Rose PG; Bundy BN
TI -
Chemoradiation for locally advanced cervical cancer: does it help?
SO - J Clin Oncol 2002 Feb 15;20(4):891-3
23
UI - 11844818
AU - Pearcey R; Brundage M; Drouin P; Jeffrey J; Johnston D; Lukka H; MacLean
TI -
G; Souhami L; Stuart G; Tu D
Phase III trial comparing radical radiotherapy with and without
cisplatin chemotherapy in patients with advanced squamous cell cancer of
the cervix.
SO - J Clin Oncol 2002 Feb 15;20(4):966-72
AD - Department of Oncology, University of Alberta, Edmonton, Canada.
robertpe@cancerboard.ab.ca
PURPOSE: To test the hypothesis that cisplatin (CDDP) administered
concurrently with standard radiotherapy (RT) would improve pelvic
control and survival in patients with advanced squamous cell cancer of
the cervix. PATIENTS AND METHODS: A total of 259 patients with
International Federation of Gynecology and Obstetrics stage IB to IVA
squamous cell cervical cancer with central disease greater-than-or-equal
5 cm or histologically confirmed pelvic lymph node involvement were
randomized to receive RT (external-beam RT plus brachytherapy) plus
weekly CDDP chemotherapy (40 mg/m(2)) (arm 1) or the same RT without
chemotherapy (arm 2). RESULTS: A total of 253 patients were available
for analysis. Median follow-up was 82 months. No significant difference
was found in progression-free survival (P =.33). No significant
difference in 3- and 5-year survival rates was found (69% v 66% and 62%
v 58%, respectively; P =.42). The hazard ratio for survival (arm 2 to
arm 1) was 1.10 (95% confidence interval, 0.75 to 1.62). CONCLUSION:
This study did not show a benefit to either pelvic control or survival
by adding concurrent weekly CDDP chemotherapy in a dose of 40 mg/m(2) to
radical RT as given in this trial. Careful attention to RT details is
important for achieving optimum outcome for patients with this disease.
24
UI - 11855888
AU - Moutardier V; Christophe M; Lelong B; Houvenaeghel G; Delpero JR
TI -
Iliac atherosclerotic occlusive disease complicating radiation therapy
for cervix cancer: a case series.
SO - Gynecol Oncol 2002 Mar;84(3):456-9
AD - Paoli-Calmettes Institute, Marseilles, France.
BACKGROUND: Diagnosis and management of atherosclerotic occlusive
disease complicating radiation therapy for squamous carcinoma of the
cervix (SCC) are not well known. CASES: A series of four patients who
underwent medical or surgical treatment of radiation-induced artery
disease were identified. Chronic right iliac artery occlusion was seen
in one patient 7 years after external irradiation for SCC and was
treated by a femorofemoral bypass. Acute arterial occlusion was seen in
three patients. One patient developed right foot ischemia 2 years after
external irradiation for SCC which was treated by a right axillofemoral
bypass. One patient developed a left toe necrosis 2 years after external
irradiation for a recurrence of SCC which was treated by a percutaneous
artery dilatation. One patient developed, 3 years after external
irradiation for SCC, a subacute ischemia of the left leg on the first
postoperative day after a rectal resection. It was treated by
vasodilators, calcium inhibitors, and anticoagulants. CONCLUSIONS:
Diagnosis of radiation-induced atherosclerotic occlusive disease
complicating radiation therapy for SCC is easy but treatment is
difficult. Long-term results of arterial dilatation are limited and
extraanatomic bypass with allograft is the treatment of choice whenever
feasible. However, because of poor long-term results, surgery should be
attempted only in the case of severe ischemia.
25
UI - 11855896
AU - Shukunami K; Kotsuji F
TI -
Implication of a reflected image illustration for pelvic lymphadenectomy
on uterine cervical cancer with situs inversus totalis.
SO - Gynecol Oncol 2002 Mar;84(3):538
26
UI - 11890098
AU - Kim RY
TI -
Recent advances in the treatment of gynecologic malignancies: an
overview of the GOG phase III trials.
SO - Gan To Kagaku Ryoho 2002 Feb;29 Suppl 1():125-40
AD - Department of Radiation Oncology, Comprehensive Cancer Center,
University of Alabama at Birmingham, Birmingham, Alabama, USA.
27
UI - 11890099
AU - Yuan CC; Ng HT; Wang PH
TI -
New strategies and advances in the management of cervical carcinoma.
SO - Gan To Kagaku Ryoho 2002 Feb;29 Suppl 1():143-9
AD - Department of Obstetrics and Gynecology, Taipei-Veterans General
Hospital, National Yang-Ming University School of Medicine, Taipei,
Taiwan, R.O.C. ccyuan@vghtpe.gov.tw
BACKGROUND: Carcinoma of the cervix is still common female cancer in
Taiwan. A large portion of patients die of the disease in spite of
various kinds of therapies and even the combination of multi-modality
treatment. METHODS: The current review includes a comprehensive review
of the literature. Many new strategies and advanced in the management of
cervical carcinoma have been the subject of this intense study and
include assisted systems to improve sensitivity and specificity of Pap
smear, human papillomavirus (HPV), and its vaccination, operation,
radiation, chemotherapy, and combination of these strategies. Because of
the constant failure rate, a systemic and critical review of the disease
and management should be considered. RESULTS: With improvement of
detection rate of pre-invasive cancer and popularity of screening
protocol, the prevalence rate of cervical carcinoma decreases
progressively. However, although new strategies in managing cervical
carcinoma focus on combination therapy, the life quality and survival
rate of these patients with cervical carcinoma only show beneficial in
certain group patients. CONCLUSION: As to the complexity of both disease
nature and various combinations in the diagnosis and treatment of
cervical cancer, comprehensive quality control programs and large
prospective multicenter trials are mandatory for establishing the
"standard of care" adhered to the principles of evidence-based medicine.
28
UI - 11905696
AU - Sharma D C
TI -
Indian centre develops teletherapy machine for cervical cancer.
SO - Lancet Oncol 2000 Sep;1(1):9
29
UI - 11821449
AU - Levenback C; Coleman RL; Burke TW; Lin WM; Erdman W; Deavers M;
TI -
Delpassand ES
Lymphatic mapping and sentinel node identification in patients with
cervix cancer undergoing radical hysterectomy and pelvic
lymphadenectomy.
SO - J Clin Oncol 2002 Feb 1;20(3):688-93
AD - Department of Gynecologic Oncology, The University of Texas M.D.
Anderson Cancer Center, Houston 77030, USA. clevenba@mdanderson.org
PURPOSE: The purpose of this study was to determine the feasibility of
sentinel node identification in patients with invasive cervix cancer
undergoing radical hysterectomy and pelvic lymphadenectomy using
preoperative and intraoperative lymphatic mapping. PATIENTS AND METHODS:
Thirty-nine patients at two institutions were enrolled onto this
institutional review board-approved study. All underwent preoperative
lymphoscintigraphy and intraoperative lymphatic mapping with blue dye
and a handheld gamma probe. Radical hysterectomy was aborted in four
patients because metastatic disease was discovered on frozen section
analysis of the sentinel node. RESULTS: Preoperative lymphoscintigraphy
revealed at least one sentinel node in 33 patients (85%), including 21
(55%) with bilateral sentinel nodes. All 39 patients had at least one
sentinel node identified intraoperatively. Eighty percent of sentinel
nodes were in three pelvic locations: iliac, obturator, and parametrial
(in descending order of frequency). The remaining sentinel nodes were in
the common iliac and para-aortic nodal basins. A total of 132 nodes were
identified clinically as sentinel nodes; 65 (49%) were both blue and
hot, 35 (27%) were blue only, and 32 (24%) were hot only. Eight patients
(21%) had metastatic disease. In five of these patients, sentinel nodes
were the only positive lymph nodes. One patient had false-negative
sentinel nodes. She had four microscopically positive parametrial nodes
that were resected in continuity with the uterus. The sensitivity of the
sentinel node was 87.5% and the negative predictive value was 97%.
CONCLUSION: Preoperative lymphoscintigraphy and intraoperative lymphatic
mapping were highly successful at identifying sentinel nodes in patients
undergoing radical hysterectomy.
30
UI - 11876009
AU - Durdevic S; Visnjevac V; Kermeci K
TI -
[The Wertheim-Meigs radical hysterectomy in surgical treatment of
cervical carcinoma]
SO - Med Pregl 2001 Sep-Oct;54(9-10):465-9
AD - Klinicki centar, Novi Sad. Winter@PTT.YU
INTRODUCTION: Wertheim from Vienna was the first to introduce the
technique of radical hysterectomy into surgical practice in treatment of
uterine cervix carcinoma associated with partial lymphadenectomy (1989).
In concern to the level of surgical extensiveness, radical hysterectomy
can be divided into 5 classes (after Piver-Rutledge). MATERIAL AND
METHODS: At the Department of Obstetrics and Gynaecology in Novi Sad 55
patients with invasive cervical cancer (FIGO st. IB1-IIB) underwent
surgery during the period from 1991 to 2001. All patients underwent
radical hysterectomy after Wertheim-Meigs technique. The aim of this
study was to present operative techniques of radical hysterectomy and
complications following surgery. RESULTS: Distribution by stage of the
disease was as follows: IB1 = 39 (70.9%), IB2 = 6 (10.9%), IIA = 7
(12.7%) and IIB = 3 (5.5%). On average, there were 15 lymph nodes
removed, out of which 9 (16.4%) cases were positive. Postoperative
complications were recorded in 19 (34.5%) patients, whereas the
incidence of urinary fistulas and intrahospital mortality rate have been
reduced to the minimum (0%). Recurrence was evident in 3 (5.4%) patients
and 5-year survival rate was 92.3% (in patients operated up to 1997).
DISCUSSION AND CONCLUSION: In relation to previously published results
of treatment at the Department, there is an evident increase in the
number of stage I patients and a decrease in stage II patients, as well
as a reduced incidence of postoperative urinary fistulas, total number
of complications, but an increase in the 5-year survival rate.
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