• Growth inhibitory effects and radiosensitization induced by fatty aromatic acids on human cervical cancer cells.

• Optimal surgery and diagnostic approach of stage IA2 squamous cell carcinoma of the cervix.

• [Fertility preserving surgery for carcinoma of the cervix is now possible]

• Quantification of intracavitary brachytherapy parameters and correlation with outcome in patients with carcinoma of the cervix.

• Evaluation of morbidity after external radiotherapy and intracavitary brachytherapy in 771 patients with carcinoma of the uterine cervix or

• [Cervix cancer]

• Cancer of the cervix.

• [Latest information on the treatment of uterine cervical cancer]

• Selection of surgery or radiotherapy as the appropriate single modality of treatment for Stage 1B and 2A carcinoma of the cervix.

• Vinorelbine and cisplatin for the treatment of recurrent and/or metastatic carcinoma of the uterine cervix.

• A classification system and reconstructive algorithm for acquired vaginal defects.

• Type III radical hysterectomy after induction chemotherapy for patients with locally advanced cervical carcinoma.

• Type III radical hysterectomy induction chemotherapy for patients with locally advanced cervical carcinoma.

• Correlation of smoking history and other patient characteristics with major complications of pelvic radiation therapy for cervical cancer.

• Isotretinoin for low-grade cervical dysplasia in human immunodeficiency virus-infected women.

• ACOG practice bulletin. Diagnosis and treatment of cervical carcinomas, number 35, May 2002.

• A nerve-sparing radical hysterectomy: guidelines and feasibility in Western patients.

• A nerve-sparing radical hysterectomy: guidelines and feasibility in Western patients.

• Laparoscopic radical hysterectomy (type III) with aortic and pelvic lymphadenectomy in patients with stage I cervical cancer: surgical

• Adjuvant pelvic irradiation in patients with node-negative carcinoma of the uterine cervix.

• Management of female prisoners with abnormal cervical cytology.

• Overstating overtreatment?

• Retinoids, cisplatin and interferon-alpha in recurrent or metastatic cervical squamous cell carcinoma: clinical results of 2 phase II trials.

• Pregnancy following radical trachelectomy and pelvic lymphadenectomy for Stage I cervical adenocarcinoma.

• Long-term follow-up of RTOG 88-05: twice-daily external irradiation with brachytherapy for carcinoma of the cervix.

• Evaluation of the effect of routine packed red blood cell transfusion in anemic cervix cancer patients treated with radical radiotherapy.

• Long-term results of low-dose-rate interstitial-intracavitary brachytherapy in the treatment of carcinoma of the cervix.

• A prospective randomized study comparing retroperitoneal drainage with no drainage and no peritonization following radical hysterectomy and

• Pathologic complete remission after preoperative intracavitary radiotherapy of cervical cancer stage Ib and IIa is a strong prognostic

• [Chemoradiotherapy in locally advanced cancers of the uterine neck. Retrospective study of 92 patients treated at the Institute Curie

• Treatment-related morbidity and hospital league tables: experience from a national audit of radiotherapy-induced morbidity in cervical

• Radiation therapy for cervix carcinoma: benefits of individualized dosimetry.

• The American Brachytherapy Society recommendations for low-dose-rate brachytherapy for carcinoma of the cervix.

• ACOG practice bulletin. Diagnosis and treatment of cervical carcinomas. Number 35, May 2002. American College of Obstetricians and

• Expression of cIAP1, a target for 11q22 amplification, correlates with resistance of cervical cancers to radiotherapy.

• Pelvic insufficiency fracture after pelvic irradiation in uterine cervix cancer.

• Shortcomings and deficits in surgical treatment of gynecological cancers: a German problem only?

• Further study of the management of cervical adenocarcinoma in situ.

• Adenocarcinoma in situ of the cervix: a prospective study of conization as definitive treatment.

• Chylous ascites following treatment for gynecologic malignancies.

1
UI - 11697821
AU - Ferrandina G; Filippini P; Ferlini C; Maggiano N; Stoler AB; Fruscella
TI - E; Mozzetti S; Mancuso S; Freedman RS; Scambia G; Ranelletti FO Growth inhibitory effects and radiosensitization induced by fatty aromatic acids on human cervical cancer cells.
SO - Oncol Res 2000;12(9-10):429-40
AD - Department of Gynecology/Obstetrics, Catholic University, Rome, Italy.
Evidences have been reported that phenylacetic (PA) and phenylbutyric (PB) fatty aromatic acids can exert tumor growth inhibition in vitro and in vivo. Moreover, clinical trials also showed some activity for these drugs to modulate the expression of genes implicated in tumor growth, metastasis, immunogenicity, and to potentiate the efficacy of cytotoxic agents. The aim of the study was to examine the effects of PA and PB on the growth as well as sensitization to cisplatin and radiation in human cervical cancer cells. The effects of PA and PB on the proliferative activity and apoptosis induction in cervical tumor tissue was investigated. Both PA and PB exhibited a time- and dose-dependent antiproliferative activity in SW756 and ME180 cell lines: after 72-h treatment, the IC50 (concentration able to inhibit 50% of cell growth) of PB was 1.9 +/- 0.2 mM and 1.5 +/- 0.2 mM in SW756 and ME180 cells, respectively, while the IC50 of PA was 13.0 +/- 1.7 mM and 10.0 +/- 1.2 mM in SW756 and ME180 cells, respectively. In tumor tissue biopsies obtained from patients affected by squamous cervical cancer, both drugs resulted in a marked reduction of the percentage of bromodeoxyuridine-labeled cells compared with untreated samples [19.0 +/- 1.63% in untreated tissues with respect to 1.30 +/- 0.54% and 4.20 +/- 2.50% of stained cells after treatment with PA (30 mM) (P < 0.0001) and PB (5 mM) (P < 0.0001), respectively]. Moreover, analysis of the staining with M30 monoclonal antibody revealed that PA (30 mM) and PB (5 mM) were able to produce a marked increase in the number of stained apoptotic nuclei with respect to untreated samples. Finally, PB and PA were shown to enhance the sensitivity of SW756 to radiation and to exert an additive effect when combined with cisplatin. A significant reduction of the processed form of p21ras and rhoB proteins in the membrane fraction of cells exposed to PA and PB was observed. When farnesol, which is able to circumvent the enzymatic step inhibited by PA and PB, was added to the medium only a partial reversal of the growth inhibition and potentiation of sensitivity to radiation induced by PA and PB were found. In conclusion, the growth inhibitory properties of fatty aromatic acids suggest that these molecules could represent the prototype of a new class of compounds with some therapeutic potential in cervical cancer.

2
UI - 11858897
AU - Kodama J; Mizutani Y; Hongo A; Yoshinouchi M; Kudo T; Okuda H
TI - Optimal surgery and diagnostic approach of stage IA2 squamous cell carcinoma of the cervix.
SO - Eur J Obstet Gynecol Reprod Biol 2002 Mar 10;101(2):192-5
AD - Department of Obstetrics and Gynecology, Okayama University Medical School, 2-5-1 Shikata-cho, 700-8558, Okayama, Japan. kodama@cc.okayama-u.ac.jp
BACKGROUND: Most patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA2 squamous cell carcinoma of the cervix, opt for radical surgery at present. Objective: To review surgical and diagnostic approaches in such patients. STUDY DESIGN: Our patient population consisted of 394 patients with a diagnosis of stage I squamous cell cervical carcinoma (with depth of stromal invasion 10mm or less) according to the 1995 FIGO definition. Biopsy and surgical specimen slides were reassessed retrospectively in all cases. The findings of T2-weighted MR imaging were available from the individual medical charts. RESULTS: None of the patients with stromal invasion of 5mm depth or less showed pelvic lymph node metastasis. However, metastasis to the parametrial connective tissue was found in one case with stage IA1 exhibiting marked lymph-vascular space involvement. There were no deaths due to disease in cases with stromal invasion of 5mm depth or less. The lesions were detected in all 20 cases exhibiting stromal invasion of greater than 5mm in depth. In contrast, the lesions were not detected with T2 imaging in four of six cases (67%) with stage IA2. CONCLUSION: Simple or modified radical hysterectomy with pelvic lymph node dissection may be sufficient for cases of stage IA2 cervical squamous cell carcinoma where lymph-vascular space involvement is absent. T2-weighted MR imaging with no detectable tumor would prove beneficial in the selection of these patients.

3
UI - 12101616
AU - Ottosen C
TI - [Fertility preserving surgery for carcinoma of the cervix is now possible]
SO - Lakartidningen 2002 Jun 6;99(23):2630-4
AD - Kvinnokliniken, Universitetssjukhuset i Lund samt Affarsomradet barn-familj-kvinnosjukvard, Helsingborgs Lasarett AB. christian.ottosen@helsingborgslasarett.se
This article describes the first Swedish experience with fertility preserving surgery according to the technique of Dargent. Minimally invasive methods gain acceptance in the treatment of other tumours and this method seems to treat adequately and preserve function. The literature is reviewed and discussed. In Sweden about 25-40 women under 30 years of age are each year diagnosed with cancer of the cervix. Three women with early cancer of the cervix were treated and one successful pregnancy reported.

4
UI - 11121642
AU - Katz A; Eifel PJ
TI - Quantification of intracavitary brachytherapy parameters and correlation with outcome in patients with carcinoma of the cervix.
SO - Int J Radiat Oncol Biol Phys 2000 Dec 1;48(5):1417-25
AD - Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
PURPOSE: To quantify the M. D. Anderson criteria for acceptable implant geometry; to relate our system of intracavitary radiotherapy (ICRT) prescription to Manchester and ICRU reference doses; and to correlate these parameters with outcome measures. METHODS AND MATERIALS: The relationships between intracavitary applicators and normal structures were measured directly from localization films of 808 applications performed in 396 patients who completed definitive treatment for cervical cancer between 1990 and 1994. The distances between applicators and tissue landmarks and the doses to Manchester and normal tissue reference points were correlated with outcome. RESULTS: The median distance from the tandem to the sacrum was 4.0 cm, or one-third the distance from the pubis to the sacrum. The mean distance between the vaginal ovoids and cervical marker seeds was 7 mm, and the median distance between the tandem and the posterior edge of the ovoids was 50% of the ovoid length. In 92% of insertions, vaginal packing was posterior to or within 5 mm of a line that passed through the posterior edge of the ovoids, parallel to the tandem. The median doses to Point A and rectal, bladder, and vaginal surface reference points were 87 Gy, 68 Gy, 70 Gy, and 125 Gy, respectively. Although these reference doses were not routinely used to prescribe treatment, consistent applicator geometry and source selection resulted in a relatively narrow range of delivered doses. The average ratios between the doses at bladder or rectal reference points and Point A were somewhat greater when smaller vaginal applicators were used. Patients received a median of 5600 mgRaEq-h from ICRT. The total mgRaEq-h were correlated with but were not proportional to the dose at Point A. There were no significant correlations between the doses to standard reference points and the rates of central recurrence or major complications. CONCLUSION: When ICRT implants are carefully placed, relatively high paracentral doses can be delivered that yield a high rate of central disease control with an acceptable rate of complications. The narrow range of doses delivered to standard reference points and their inconsistent correlation with the maximum doses delivered to normal tissues probably contributed to a lack of correlation between reference doses and outcome.

5
UI - 11876395
AU - Yalman D; Arican A; Ozsaran Z; Celik OK; Yurut V; Esassolak M;
TI - Haydaroglu A Evaluation of morbidity after external radiotherapy and intracavitary brachytherapy in 771 patients with carcinoma of the uterine cervix or endometrium.
SO - Eur J Gynaecol Oncol 2002;23(1):58-62
AD - Ege University, Faculty of Medicine, Department of Radiation Oncology, Izmir, Turkey.
PURPOSE: The aim of the present study was to evaluate early and late radiation morbidity and to assess the factors influencing morbidity in patients with cervical or endometrial cancer treated by a combination of external radiotherapy (ERT) and intracavitary brachytherapy (IBRT). MATERIALS AND METHODS: Early and late radiation morbidity were evaluated retrospectively using RTOG/EORTC criteria and Franco-Italian glossary in Four hundred and seven patients (52.8%) had endometrial carcinoma and 364 (47.2%) had carcinoma of the cervix. One hundred and fifty-four patients with cervical carcinoma were inoperable. In patients with endometrial carcinoma total doses at the vagina, bladder and rectum were 60.36 Gy, 56.2 Gy and 55.6 Gy respectively. Biologically equivalent doses (BED) for the same points were 79.35, 68.63 and 67.37, respectively for early effects and 123.67, 97.65 and 94.85, respectively for late effects. One hundred and sixty-nine patients (41.5%) developed acute morbidity, grade I and II bladder morbidity being the most common type and 85 patients (20.9%) developed late morbidity, grade I and II vaginal morbidity being the most common type. No grade IV morbidity was recorded. Total doses at the vagina, bladder and rectum in operated cervix cancer patients were 60.51 Gy, 56.53 Gy and 55.67 Gy, respectively. BED for the same points were 79.77, 69.36 and 67.52, respectively for early effects and 124.74, 99.3 and 95.17, respectively for late effects. Eighty patients (38.1%) developed early morbidity. Grade I and II bladder morbidity was the most common type. Sixty-five patients (30.9%) developed late morbidity, vaginal morbidity being the most common type. Total doses at the vagina, bladder and rectum in inoperable patients were 70.92 Gy, 66.71 Gy and 62.38 Gy, respectively. BED for the same points were 97.43, 89.64 and 81.63, respectively for early effects and 159.3, 143.16 and 126.56, respectively for late effects. Sixty patients (39%) developed acute morbidity which was grade I or II bladder morbidity in 95%. Ninety-five patients (61.7%) developed late morbidity which was grade I-III vaginal morbidity in 94%. CONCLUSION: Patients with cervical or endometrial cancer can be treated safely by a combination of ERT and IBRT. However the patients should be assessed before, during and after treatment and at every period of follow-up using a standard and well-defined system in order to define and predict the morbidity rate.

6
UI - 12082862
AU - Jakobsen AK; Engelholm SA; Knudsen JB
TI - [Cervix cancer]
SO - Ugeskr Laeger 2002 Jun 3;164(23):3059-62
AD - Onkologisk afdeling, Vejle Sygehus, DK-7100 Vejle.

7
UI - 12184042
AU - Fischer M
TI - Cancer of the cervix.
SO - Semin Oncol Nurs 2002 Aug;18(3):193-9
AD - University Hospital, SUNY at Stony Brook, Stony Brook, NY, USA.
OBJECTIVES: To review the advances in the diagnosis, evaluation, staging, and treatment of cervical cancer that have been made in the past 10 years, and identify the work that still needs to be done. DATA SOURCES: Journal and review articles, book chapters, and research studies. CONCLUSIONS: Although cervical cancer has a preinvasive component and should be easily preventable, it has not been eradicated. Issues that prevent access to health care need to be addressed. IMPLICATIONS FOR NURSING PRACTICE: Nurses now have a more extended role in screening patients and educating them regarding the importance of preventive care. As new treatments are developed, the nurse is the one who will monitor the patient for side effects and assist with minimizing them. When all treatments fail in advanced disease, the nurse will assist the patient to deal with end-of-life issues and symptom control.

8
UI - 12214464
AU - Watanabe Y; Ueda H
TI - [Latest information on the treatment of uterine cervical cancer]
SO - Gan To Kagaku Ryoho 2002 Aug;29(8):1377-82
AD - Department of Obstetrics and Gynecology, Kinki University School of Medicine, 377-2 Ohno-Higashi, Osakasayama, Osaka 589-8511, Japan.
We investigated the role of hemoglobin level in chemoradiation therapy for patients with advanced cervical cancer by reviewing the literature for current therapeutic information. We found that anemia during chemoradiation therapy is an important physiological factor in determining the long-term prognosis of patients with advanced cervical cancer.

9
UI - 9521399
AU - MacLeod C; Fowler A; O'Brien P
TI - Selection of surgery or radiotherapy as the appropriate single modality of treatment for Stage 1B and 2A carcinoma of the cervix.
SO - Aust N Z J Obstet Gynaecol 1998 Feb;38(1):85-6, discussion 86-7

10
UI - 12187068
AU - Gebbia V; Caruso M; Testa A; Mauceri G; Borsellino N; Chiarenza M;
TI - Pizzardi N; Palmeri S Vinorelbine and cisplatin for the treatment of recurrent and/or metastatic carcinoma of the uterine cervix.
SO - Oncology 2002;63(1):31-7
AD - Institute of Internal Medicine, University of Palermo, Palermo, Italy. vittorio.gebbia@tin.it
BACKGROUND: To test the clinical activity and toxicity profile of the combination regimen of vinorelbine and cisplatin in a series of patients with carcinoma of the cervix uteri with de novo metastatic disease or recurrent disease after previous therapy. The main aims of the study included analysis of objective response rates, toxicity, and time to progression. PATIENTS AND METHODS: Forty-two eligible patients were enrolled into the trial and treated with cisplatin 80 mg/m(2) on day 1 and vinorelbine 25 mg/m(2) on day 1 and 8. This regimen was repeated every 21 days upon resolution of toxicity for 3 cycles before response assessment. Enrolled patients had a median age of 53 years, a median ECOG performance status of 1, and mostly a squamous cell histology (86%). Sixteen patients (38%) were treatment-naive since first diagnosed with widespread metastatic disease, 7% had only previous surgery, 31% radiotherapy, and 24% both radiation and surgical therapy. In previously radiated patients, 21% of patients had disease only within the radiation fields, 21% only outside the radiation fields, and 12% both inside and outside the radiotherapy portals. RESULTS: All patients were evaluable for response analysis. A complete response was achieved in 5 patients (12%), and a partial response in 15 cases (36%) for an overall response rate of 48% (95% CL 22-52%). Patients with recurrent disease within the previous radiation field (including those also with disease outside the radiation fields) showed a 28% overall response rate with no complete response, while patients with disease previously untreated with radiotherapy or with tumour deposits only outside of ratiation portals yielded a 57% overall response rate with a 18% complete response rate. Only 1 out of 8 patients with performance status 2 showed a major response (12%). Median time to progression was 5.6 months (range 2.0-14 months). The median overall survival of the whole series was 9.1 months. Hematological toxicity was the most frequent side-effect. Grade 3 vomiting was recorded in 9 patients (21%), and mild mucositis in 14% of patients. Grade 3 neutropenia was observed in 21% of patients, while grade 4 in 12% of cases with neutropenic fever was seen in 4 cases. Sixteen patients (38%) complained of grade 1-2 constipation, while grade 1-2 peripheral neuropathy was seen in 8 patients (19%). CONCLUSIONS: The results achieved in this trial suggest that the combination regimen of vinorelbine and cisplatin may be safely given to patients with metastatic and/or recurrent carcinoma of the uterine cervix. This regimen is active at least in terms of objective response rates. Although satisfactory results are still lacking, these results suggest that the vinorelbine-cisplatin regimen is worthy of further studies and may represent the basis for the development of new active regimens. Copyright 2002 S. Karger AG, Basel

11
UI - 12198418
AU - Cordeiro PG; Pusic AL; Disa JJ
TI - A classification system and reconstructive algorithm for acquired vaginal defects.
SO - Plast Reconstr Surg 2002 Sep 15;110(4):1058-65
AD - Department of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. cordeirp@mskcc.org
Although multiple flaps have been used for vaginal reconstruction, a logical approach to reconstruction of these often complex defects has not been described. The objective of this study was to establish a classification system for acquired vaginal defects and to develop a reconstructive algorithm derived from this system. This study is a retrospective review of a 7-year experience with 51 flaps in 37 consecutive vaginal reconstructions. Twenty-two partial defects and 15 circumferential defects were reconstructed in 35 patients. Average patient age was 48 years (range, 19 to 69 years). Of the 22 patients with partial vaginal defects, six involved primarily the anterior and lateral wall and 16 the posterior vaginal wall. Among the 15 patients with circumferential defects, four included only the upper two-thirds of the vagina and 11 encompassed the entire vagina. On the basis of these defects, a classification system was developed. Partial defects involving the anterior or lateral vaginal wall were classified as type IA defects and were reconstructed primarily with pedicled Singapore fasciocutaneous flaps. Partial defects involving the posterior wall were classified as type IB and were reconstructed with pedicled rectus abdominis myocutaneous flaps. Circumferential defects involving the upper two-thirds of the vagina were classified as type IIA defects and were reconstructed with a rolled rectus flap or, less commonly, sigmoid colon (one patient). Total circumferential defects, type IIB, were reconstructed largely with bilateral gracilis flaps. Six patients had major complications, including one perioperative death, one complete flap loss, one partial flap loss, and three pelvic abscesses. Three patients had minor complications that included delayed wound healing and donor-site infection. Vaginal defects can be categorized into one of four types on the basis of the location and extent of resection. Flap selection is determined on the basis of the type of defect. Using this algorithm, immediate vaginal reconstruction with pedicled regional flaps can be performed with minimal patient morbidity and few surgical complications.

12
UI - 11437927
AU - Lopez-Graniel C; Reyes M; Chanona G; Gonzalez A; Robles E; Mohar A;
TI - Lopez-Basave H; De La Garza JG; Duenas-Gonzalez A Type III radical hysterectomy after induction chemotherapy for patients with locally advanced cervical carcinoma.
SO - Int J Gynecol Cancer 2001 May-Jun;11(3):210-7
AD - Department of Gynecology, Instituto Nacional de Cancerologia, UNAM, Mexico, D.F. Lgraniel@data.net.mx
Neoadjuvant chemotherapy followed by surgery is a promising approach in locally advanced cervical carcinoma. The aim of this study was to evaluate the feasibility, technical aspects, and clinical results of surgery after induction chemotherapy in this patient population. Forty-one untreated cervical carcinoma patients staged as IB2 to IIIB received three 21-day courses of cisplatin 100mg/m2 on day 1 and gemcitabine 1000 mg/m2 on days 1 and 8 followed by surgery or concomitant chemoradiation. The response to chemotherapy, operability, surgical/pathological findings, disease-free period, and survival of the surgically treated patients were evaluated. All 41 patients were evaluated for toxicity and 40 were evaluated for response. The overall objective response rate was 95% (95% confidence interval 88%-100%), and was complete in three patients (7.5%) and partial in 35 (87.5%). Granulocytopenia grades 3/4 occurred in 13.8% and 3.4% of the courses, respectively, whereas nonhematological toxicity was mild. Twenty-three patients underwent type III radical hysterectomy. Mean duration of surgery was 3.8 h (range 2:30-5:20), median estimated blood loss was 670 ml and median hospital stay was 5.2 days. Intraoperative complications occurred in one case (venous injury). In all but one case the resection margins were negative. Four patients (17%) had positive nodes (one node each); six (26%) had complete pathologic response, three (13%) had microscopic; and 14 (60%) macroscopic residual disease. At 24 months of maximum follow-up (median 20), the disease-free and overall survival rates were 59% and 91%, respectively. Induction chemotherapy with cisplatin/gemcitabine produced a high response rate and did not increase the difficulty of surgery. Operating time, blood loss, intraoperative complications, and hospital stay were all within the range observed for type III hysterectomy in early stage patients. We therefore conclude that type III radical hysterectomy is feasible in locally advanced cervical cancer patients who respond to chemotherapy.

13
UI - 11975688
AU - Narayan K
TI - Type III radical hysterectomy induction chemotherapy for patients with locally advanced cervical carcinoma.
SO - Int J Gynecol Cancer 2002 Mar-Apr;12(2):232; discussion 232-3

14
UI - 12202666
AU - Eifel PJ; Jhingran A; Bodurka DC; Levenback C; Thames H
TI - Correlation of smoking history and other patient characteristics with major complications of pelvic radiation therapy for cervical cancer.
SO - J Clin Oncol 2002 Sep 1;20(17):3651-7
AD - Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA. peifel@mdanderson.org
PURPOSE: The purpose of this study was to identify patient-related factors that influence the risk of serious late complications of pelvic radiation therapy. PATIENTS AND METHODS: The records of 3,489 patients treated with radiation therapy for International Federation of Gynecology and Obstetrics stage I or II carcinoma of the cervix were reviewed for information about patient characteristics, treatment details, and outcomes. Any complication occurring or persisting more than 3 months after treatment that required hospitalization, transfusion, or an operation or caused severe symptoms or the patient's death was considered a major late complication. Complication rates were calculated actuarially. The median duration of follow-up was 85 months, and 99% of patients were followed for at least 3 years or until they died. RESULTS: Heavy smoking was the strongest independent predictor of overall complications (multivariate hazard ratio, 2.30; 95% confidence interval [CI], 1.84 to 2.87). The most striking influence of smoking was on the incidence of small bowel complications (hazard ratio for smokers of one or more packs per day, 3.25; 95% CI, 2.21 to 4.78). Hispanics had a significantly lower rate of small bowel complications than whites, and blacks had higher rates of bladder and rectal complications than whites. Thin women had an increased risk of gastrointestinal complications, and obese women were more likely to have serious bladder complications. CONCLUSION: Complications of pelvic radiation therapy are strongly correlated with smoking, race, and other patient characteristics. These factors should be considered before the results of clinical studies are generalized to different cultural and racial groups.

15
UI - 11978287
AU - Robinson WR; Andersen J; Darragh TM; Kendall MA; Clark R; Maiman M
TI - Isotretinoin for low-grade cervical dysplasia in human immunodeficiency virus-infected women.
SO - Obstet Gynecol 2002 May;99(5 Pt 1):777-84
AD - Harrington Cancer Center/Texas Tech University, Amarillo, Texas, USA.
OBJECTIVE: To estimate the efficacy of isotretinoin for prevention of progression of low-grade squamous intraepithelial lesions (SIL) of the cervix to high-grade lesions or invasive cervical cancer; to estimate the regression rate of low-grade SIL with isotretinoin and the toxicity of isotretinoin in this setting; and to correlate serum CD4 levels with progression of low-grade SIL. METHODS: A randomized, phase III, observation-controlled, multicenter trial was performed in which 117 human immunodeficiency virus (HIV)-positive women with low-grade SIL of the cervix received either oral isotretinoin at 0.5 mg/kg per day for 6 months or observation. Papanicolaou smears and colposcopy/biopsy were done at regular intervals during follow-up. The primary endpoint was progression to high-grade SIL or cervical cancer. RESULTS: Twenty-one of 102 women (20.6%) completing follow-up experienced progression to high-grade SIL, 13 in the observation group and eight in the isotretinoin group. This difference was not significant (P =.29). No cases of invasive cancer were seen. Baseline CD4 levels were lower than anticipated (median 329 cells/mm(3)), but not associated with time to progression (P =.36). Most subjects (63 of 102, 61.7%) used highly active antiretroviral therapy. Subjects under age 30 were more likely to progress than those older than 30 (P =.046). CONCLUSION: Isotretinoin was not associated with longer time to progression of low-grade SIL. This appears to be a chronic condition in HIV-positive women, with a low risk of progression and significant rate of resolution. As in the general population, observation without excisional therapy may be appropriate for HIV-positive women with low-grade SIL.

16
UI - 11978302
AU - Committee on Practice Bulletins-Gynecology
TI - ACOG practice bulletin. Diagnosis and treatment of cervical carcinomas,
SO - Obstet Gynecol 2002 May;99(5 Pt 1):855-67
Invasive cervical carcinoma, once the most common reporductive-tract cancer in the United States, has recently fallen to the rank of third most common. Globally, cervical cancer is a major health problem, with a yearly incidence of 371,000 cases and an annual death rate of 190,000 (1). The International Federation of Gynecology and Obstetrics (FIGO) recently revised its staging criteria. In addition, new evidence has documented conclusively that survival rates for women with cervical cancer improve when radiotherapy is combined with cisplatin-based chemotherapy. This document will describe staging criteria and treatment for cervical carcinoma. For practical purposes, it will focus on the squamous and adenocarcinoma histologies only.

17
UI - 12164138
AU - Murakami G; Yabuki Y; Kato T
TI - A nerve-sparing radical hysterectomy: guidelines and feasibility in Western patients.
SO - Int J Gynecol Cancer 2002 May-Jun;12(3):319-21; discussion 321

18
UI - 12060457
AU - Barton DP; Butler-Manuel SA; Buttery LD; A'Hern RP; Polak JM
TI - A nerve-sparing radical hysterectomy: guidelines and feasibility in Western patients.
SO - Int J Gynecol Cancer 2002 May-Jun;12(3):319; discussion 321

19
UI - 12193922
AU - Spirtos NM; Eisenkop SM; Schlaerth JB; Ballon SC
TI - Laparoscopic radical hysterectomy (type III) with aortic and pelvic lymphadenectomy in patients with stage I cervical cancer: surgical morbidity and intermediate follow-up.
SO - Am J Obstet Gynecol 2002 Aug;187(2):340-8
AD - Palo Alto Women's Cancer Center, CA 94304, USA.
OBJECTIVE: The purpose of this study was to determine the risk of recurrence and to quantify morbidity and mortality rates in patients with cervical cancer who consented to undergo laparoscopic radical hysterectomy (type III) and retroperitoneal lymphadenectomy. STUDY DESIGN: Seventy-eight consecutive patients with stage IA(2) and IB cervical cancer with at least 3 years of follow-up consented to undergo this surgical procedure with argon beam coagulation and endoscopic staplers. All patients had a Quetelet index of <35. The average age was 41.5 years (range, 26-62 years). Sixty-eight patients had squamous cell carcinomas; 8 patients had adenocarcinomas, and 2 patients had adenosquamous carcinomas of the cervix. RESULTS: All but 5 surgical procedures were completed laparoscopically. The average operative time was 205 minutes (range, 150-430 minutes). The average blood loss was 225 mL (range, 50-700 mL). One patient (1.3%) had transfusion. Operative cystotomies occurred for 3 patients: 2 cystotomies were repaired laparoscopically, and 1 cystotomy required laparotomy. One patient underwent laparotomy because of equipment failure, and another patient underwent laparotomy to pass a ureteral stent. Two other patients underwent laparotomy to control bleeding sites. The average lymph node count was 34 (range, 19-68). Nine patients (11.5%) had positive lymph nodes. All surgical margins were macroscopically negative, but 3 patients had microscopically positive and/or close surgical margins. One patient had a ureterovaginal fistula after the operation that required reoperation. Follow-up has been provided every 3 months. There have been 4 documented recurrences (5.1%), with a minimum of 3 years of follow-up. CONCLUSION: Laparoscopic radical hysterectomy (type III) can be successfully completed in patients with early-stage cervical cancer with acceptable morbidity. Intermediate-term follow-up validates the adequacy of this procedure.

20
UI - 12168928
AU - Uno T; Ito H; Yasuda S; Aruga T; Isobe K; Kawakami H; Mitsuhashi A;
TI - Tanaka N; Yamazawa K; Suzuka K; Sekiya S; Itami J; Shigematsu N; Kubo A Adjuvant pelvic irradiation in patients with node-negative carcinoma of the uterine cervix.
SO - Anticancer Res 2002 Mar-Apr;22(2B):1213-6
AD - Department of Radiation Oncology, Chiba University, School of Medicine, Chiba City, Japan. unotakas@ho.chiba-u.ac.jp
BACKGROUND: To assess the role of post-operative pelvic radiotherapy in cervical cancer patients without lymph node metastases. MATERIALS AND METHODS: The records of 61 patients with cervical cancer treated with radical hysterectomy and bilateral pelvic lymphadenectomy followed by pelvic irradiation were reviewed. The distribution of FIGO stage was IB in 34, II4 in 5 and IIB in 22. The patients were treated with 10-18 MV X-rays using a fractional daily dose of 1.8-2.0 Gy to a median total dose of 50 Gy. RESULTS: The actuarial 5-year pelvic control rate was 95%. There was no isolated pelvic lymph node recurrence. The overall 5-year survival of the entire group was 89%. The mean age of the patients who developed recurrence was lower than the other patients (46 years vs. 53 years, p=0.07). CONCLUSION: The results indicated that post-operative pelvic irradiation was effective in preventing pelvic recurrence in patients with node-negative cervical cancer.

21
UI - 8019252
AU - Downey GP; Gabriel G; Deery AR; Crow J; Curtis P; Walker PG
TI - Management of female prisoners with abnormal cervical cytology.
SO - BMJ 1994 May 28;308(6941):1412-3
AD - Royal Free Hospital and School of Medicine, London.

22
UI - 8019253
AU - Taylor PJ
TI - Overstating overtreatment?
SO - BMJ 1994 May 28;308(6941):1413-4
AD - Special Hospitals Service Authority, London.

23
UI - 11956030
AU - Braud AC; Gonzague L; Bertucci F; Genre D; Camerlo J; Gravis G;
TI - Goncalves A; Moutardier V; Viret F; Maraninchi D; Viens P Retinoids, cisplatin and interferon-alpha in recurrent or metastatic cervical squamous cell carcinoma: clinical results of 2 phase II trials.
SO - Eur Cytokine Netw 2002 Jan-Mar;13(1):115-20
AD - Department of Medicine, Institut Paoli-Calmettes, 232 boulevard Sainte-Marguerite, 13273 Marseille Cedex 9, France.
BACKGROUND: There is no standard treatment for inoperable recurrent or metastatic cancer of the uterine cervix. Retinoids and interferon, in combination with cytotoxic compounds, have been shown to be active in squamous cell carcinoma (SCC). This phase II trial sought to estimate the response rate and the tolerance to a 3-month treatment combining cisplatin, interferon-alpha (IFN-alpha) and all-trans-retinoic (tRA) or 13 cis retinoic acid (13Cis), in women with recurrent or metastatic 1996, 33 patients, who had previously received aggressive treatment, and with metastatic and/or bulky disease were enrolled: 22 received tRA(40 mg/m(2)/day), 11 received 13Cis (1 mg/kg/day) in combination with IFN-alpha (6.106 UI/day SC) for 84 days plus cisplatin (40 mg/m(2)IV, days 1, 28 and 56). RESULTS: All patients were evaluable for response and/or toxicity. Toxicities were easily manageable and were never life-threatening, with major grade 3/4 vomiting (54%) and asthenia (54%). Seventeen patients (52%) stopped or reduced treatment because of toxicity or progression. Six objective responses (18%) were observed. No complete response was recorded. Median response duration was 4 months. Time to progression was 9 months [range 3.3 to 20.9] for responders and 7 months [range 1.7 to 32] for all patients. CONCLUSIONS: Regarding toxicity, this regimen should no longer be recommended in previously treated, advanced uterine SCC. However, the consistent response rate reported here may warrant further investigations in an early setting. Retinoid-based treatment with cytokines remains a promising field of research.

24
UI - 12174169
AU - Alexopoulos E; Efkarpidis S; Fay TN; Williamson KM
TI - Pregnancy following radical trachelectomy and pelvic lymphadenectomy for Stage I cervical adenocarcinoma.
SO - Acta Obstet Gynecol Scand 2002 Aug;81(8):791-2
AD - Department of Obstetrics and Gynecology, Nottingham City Hospital, UK.

25
UI - 12182974
AU - Grigsby P; Winter K; Komaki R; Marcial V; Eifel P; Doncals D; Stevens R;
TI - Rotman M; Gaffney D Long-term follow-up of RTOG 88-05: twice-daily external irradiation with brachytherapy for carcinoma of the cervix.
SO - Int J Radiat Oncol Biol Phys 2002 Sep 1;54(1):51-7
AD - Department of Radiation Oncology, Washington University School of Medicine, 4939 Children's Place, Suite 5500, St. Louis, MO 63110, USA. grigsbyp@netscape.net
PURPOSE: To evaluate the efficacy and toxicity of twice-daily external irradiation to the pelvis with brachytherapy for carcinoma of the cervix in a long-term follow-up study. METHODS AND MATERIALS: This study was designed to administer twice-daily irradiation doses of 1.2 Gy to the pelvis, 5 d/wk. Radiotherapy also included one or two low-dose-rate intracavitary implants, to deliver a total minimal dose of 85 Gy to point A and 65 Gy to the lateral pelvic lymph nodes. RESULTS: Eighty-one patients with clinical Stage IB-IVA carcinoma of the cervix were enrolled in this prospective, single arm, Phase I/II study. Hyperfractionated irradiation was completed in 88%. Brachytherapy was given in two implants in 46% and in one implant in 54%. Six patients had acute Grade 3 toxicities. The cumulative rate of Grade 3 and 4 late effects for patients with Stage IB2, IIA, and IIB disease was 7% at 3 years, 7% at 5 years, and 10% at 8 years. For patients with Stage III and IVA disease, the rate of late toxicities (Grades 3 and 4) was 7% at 3 years and 12% at 5 years. The site of first failure was in the pelvis in 41%, para-aortic or supraclavicular lymph nodes in 6%, and other distant metastatic sites in 14%. The absolute survival rate was 61% at 3 years, 48% at 5 years, and 45% at 8 years. The disease-free survival rate was 43% at 3 years, 38% at 5 years, and 33% at 8 years. CONCLUSION: The results suggest that, combined with brachytherapy, hyperfractionated irradiation to total parametrial doses about 10% greater than doses administered with standard fractionation pelvic irradiation was tolerated and at least appears to be as effective as standard fractionation pelvic irradiation.

26
UI - 12182975
AU - Kapp KS; Poschauko J; Geyer E; Berghold A; Oechs AC; Petru E; Lahousen
TI - M; Kapp DS Evaluation of the effect of routine packed red blood cell transfusion in anemic cervix cancer patients treated with radical radiotherapy.
SO - Int J Radiat Oncol Biol Phys 2002 Sep 1;54(1):58-66
AD - Department of Radiation Oncology, Karl-Franzens University Medical School, Auenbruggerplatz 32, 8036-Graz, Austria. karin.kapp@kfunigraz.ac.at
PURPOSE: It is well established that anemia predicts diminished radiocurability in cervix cancer. However, the therapeutic benefit of measures to correct the anemia remains controversial. The objective of this study was to determine the impact of routine transfusion in patients with hemoglobin level (hb-l) < or =11 g/dl. METHODS AND MATERIALS: Since 1985, it has been departmental policy to attempt to correct hb-l < or =11 g/dl before and/or during radiotherapy by red blood cell transfusion (RBCT) in patients undergoing radical radiotherapy for primary cervix cancer. To assess the benefit of RBCT, the charts of 204 patients (FIGO: IB-IV) treated until 1997 were reviewed. Parameters analyzed for their impact on disease-specific survival (DSS), pelvic control (PC), and metastases-free survival (MFS) included pretreatment hb-l, treatment hb-l, stage, tumor size, and lymph node status. To determine any differences in outcome according to type of anemia, a separate analysis was performed, grouping patients by cause of anemia (tumor vs. other medical illness related). RESULTS: Each of the parameters tested was significantly correlated with the end points studied in univariate analysis. Patients whose hb-l were corrected (18.5%) had an outcome that did not differ significantly from that of nontransfused patients, whereas DSS, PC, and MFS (all: p < 0.001) were significantly decreased in nonresponders to RBCT. Subgroup analysis showed no impact of hb-l in patients with other medical illness-related anemia (n = 12). In multivariate analysis treatment, but not pretreatment, hb-l remained predictive for DSS, PC, and MFS. Persistent anemia was associated with a significantly increased risk of death (relative risk: 2.1) and pelvic failure (relative risk: 2.4) compared with nontransfused patients. If only patients with tumor anemia were considered, the respective risks increased (2.7; 3.6). None of the patients with other causes of anemia recurred, whether or not their hb-l was maintained. Assessment of the therapeutic gain in patients who responded to RBCT showed improved PC (p = 0.02) and a trend toward increased DSS (p = 0.06), but no effect on MFS after adjustment for tumor size and lymph node status. CONCLUSION: Treatment hb-l, in addition to tumor size and lymph node status, independently predicted outcome. Although our final multivariate analysis showed a therapeutic benefit for patients whose hb-l was corrected, the response to RBCT was disappointing. Results of our subgroup analysis suggest that the cause of anemia in patients with cervical cancer warrants in-depth investigation.

27
UI - 12182976
AU - Syed AM; Puthawala AA; Abdelaziz NN; el-Naggar M; Disaia P; Berman M;
TI - Tewari KS; Sharma A; Londrc A; Juwadi S; Cherlow JM; Damore S; Chen YJ Long-term results of low-dose-rate interstitial-intracavitary brachytherapy in the treatment of carcinoma of the cervix.
SO - Int J Radiat Oncol Biol Phys 2002 Sep 1;54(1):67-78
AD - Department of Radiation Oncology, Long Beach Memorial Medical Center, 2801 Atlantic Avenue, Long Beach, CA 90806, USA. nsyed@memorialcare.org
PURPOSE: Brachytherapy plays a major role in the treatment of patients with carcinoma of the cervix. However, routine intracavitary brachytherapy may not be feasible or adequate to treat locally advanced disease. The purpose of this retrospective study (spanning a 20-year period) was to determine the outcome of interstitial low-dose-rate brachytherapy in the treatment of bulky or locally advanced cervical cancer. The long-term survival and safety of this technique were evaluated, along with its impact on local and locoregional control, disease-free survival, and complications. METHODS AND MATERIALS: A total of 185 previously untreated patients with cervical cancer were treated between 1977 and 1997. According to the International Federation of Gynecology and Obstetrics classification, 21 patients had Stage IB (barrel), 77 Stage II, 77 Stage III, and 10 Stage IV disease. All patients were treated by a combination of external megavoltage irradiation to the pelvis to a dose of 5040 cGy followed by interstitial-intracavitary implants to a dose of 40-50 Gy to the implanted volume in two applications. RESULTS: Clinical local control was achieved in 152 (82%) of the 185 patients. A 5-year disease-free survival rate of 65%, 67%, 49%, and 17% was achieved for patients with Stage IB, II, III, and IV disease, respectively. Eighteen (10%) of the 185 patients developed Radiation Therapy Oncology Group Grade 3 or 4 late complications. CONCLUSION: Patients with locally advanced cervical cancer, or with distorted anatomy, may be treated adequately with interstitial brachytherapy to achieve excellent locoregional control and a reasonable chance of cure with acceptable morbidity.

28
UI - 12214830
AU - Srisomboon J; Phongnarisorn C; Suprasert P; Cheewakriangkrai C; Siriaree
TI - S; Charoenkwan K A prospective randomized study comparing retroperitoneal drainage with no drainage and no peritonization following radical hysterectomy and pelvic lymphadenectomy for invasive cervical cancer.
SO - J Obstet Gynaecol Res 2002 Jun;28(3):149-53
AD - Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Thailand. jsrisomb@mail.med.cmu.ac.th
OBJECTIVE: To evaluate the postoperative morbidity and lymphocyst formation in invasive cervical cancer patients undergoing radical hysterectomy and pelvic lymphadenectomy (RHPL) with no drainage and no peritonization compared with retroperitoneal drainage and with stage IA-IIA cervical cancer undergoing RHPL in Chiang Mai University Hospital were prospectively randomized to receive either no peritonization and no drainage (Group A = 48 cases) or retroperitoneal drainage and peritonization (Group B = 52 cases). Perioperative data and morbidity were recorded. Transabdominal and transvaginal sonography were performed at 4, 8 and 12 weeks postoperatively to detect lymphocyst formation. RESULTS: Both groups were similar regarding age, size and gross appearance of tumor, tumor histology and stage. There was no difference between groups in respect of operative time, need for blood transfusion, intraoperative complications, hospital stay, number of nodes removed, nodal metastases, and need for adjuvant radiation and chemotherapy. Asymptomatic lymphocysts were sonographically detected at 4, 8 and 12 weeks postoperatively in 3 (6.8%), 2 (4.6%), and 3 (7.7%) of 44, 43, and 39 patients, respectively in Group A, whereas none was found in Group B (P = 0.2). No significant difference was found in term of postoperative morbidity in the two groups. CONCLUSION: Routine retroperitoneal drainage and peritonization after RHPL for invasive cervical cancer can be safely omitted.

29
UI - 11975675
AU - Beskow C; Agren-Cronqvist AK; Granath F; Frankendal B; Lewensohn R
TI - Pathologic complete remission after preoperative intracavitary radiotherapy of cervical cancer stage Ib and IIa is a strong prognostic factor for long-term survival: analysis of the Radiumhemmet data 1989-1991.
SO - Int J Gynecol Cancer 2002 Mar-Apr;12(2):158-70
AD - Department of Gynecologic Oncology, Radiumhemmet, Karolinska Hospital, S-171-76 Stockholm, Sweden.
The purpose of this study was to evaluate the treatment results of preoperative brachytherapy and the prognostic value of pathologic complete remission after preoperative intracavitary irradiation in patients with stage Ib and IIa cervical carcinoma in relation to recurrence rate and survival. The clinical records of 185 patients with stage Ib (129 patients) and IIa (56 patients) cervical carcinoma, 1991 were reviewed. The median follow-up time was 71 months. In 121 patients the treatment consisted of uterovaginal intracavitary irradiation, according to the Stockholm technique, followed by surgery. Tumor remission assessed in the surgical specimen was classified as pathologic complete remission (pCR) if no microscopic tumor was found or incomplete pathologic remission (non-pCR) if microscopic residual tumor was found. Postoperative external beam radiation was added to cases with metastases in pelvic nodes or residual tumor in the resection margins. The disease-specific 5-year survival was 87% and 75% for stage Ib and IIa, respectively, for the patient population treated with preoperative intracavitary radiotherapy and surgery. After intracavitary radiation, 79% of the patients obtained pCR of the primary tumor. Five-year survival in those with pCR was 95%, compared with 46% in those with non-pCR (P < 0.0001). Patients with pCR and no lymph node metastases had a 98% 5-year survival as compared to a 5-year survival of 64% in patients with non-pCR and node negativity (P < 0.0001). Locoregional relapses were diagnosed in 2% of the patients with pCR compared to 54% in patients with non-pCR (P < 0.0001). Multivariate analysis revealed non-pCR (RR = 6.42) and node positivity (RR = 4.59) as nonfavorable factors for survival, while tumor size was not found to be of independent significance for survival. Pathologic complete remission after intracavitary irradiation is a strong favorable prognostic factor in node-negative patients. The combination of preoperative intracavitary radiotherapy and surgery results in a high cure rate and aids in identifying patients at risk for relapse who might be subject to adjuvant therapy.

30
UI - 12224486
AU - Nguyen D; de la Rochefordiere A; Chauveinc L; Cosset JM; Clough KB;
TI - Beuzeboc P; Mouret-Fourme E; Guyonnet M [Chemoradiotherapy in locally advanced cancers of the uterine neck. Retrospective study of 92 patients treated at the Institute Curie between 1986 and 1998]]
SO - Cancer Radiother 2002 Jun;6(4):201-8
AD - Departement de radiotherapie, institut Curie, 26, rue d'Ulm 75005 Paris, France. d.nguyen@chr-metz-thionville.rss.fr
PURPOSE: The prognosis of locally advanced cervix cancers is poor wi

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