• A phase II trial of pyrazoloacridine (PZA) in squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study.

• A modified intussuscepted nipple in the Kock pouch urinary diversion: assessment of perioperative complications and functional results.

• Retrospective analysis of postoperative radiotherapy for node-negative cervical carcinoma with stage IB-IIB disease.

• [Conization non in sano]

• Factors associated with awareness and knowledge of cervical cancer in a community: implication for health education programmes in developing

• Radical hysterectomy in the treatment of cervical cancer.

• Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives.

• Management of cervical intraepithelial neoplasia.

• A study of treatment failures following large loop excision of the transformation zone for the treatment of cervical intraepithelial

• A study of treatment failures following large loop excision of the transformation zone for the treatment of cervical intraepithelial

• [Standards, options and recommendations for the management of patients with invasive cancer of the cervix uterus (non-metastatic stage),

• Clinical application of intensity-modulated radiotherapy for locally advanced cervical cancer.

• Gynaecological cancer services: time for change.

• [Recommendations of GESIDA/Spanish National Plan of AIDS on diagnosis and treatment of Kaposi's sarcoma and cervical cancer in HIV-infected

• Chemotherapy with cisplatin and 5-fluorouracil chronomodulated infusion in locally advanced or metastatic/recurrent carcinoma of the cervix.

• Correspondence re: M. Follen et al., a randomized clinical trial of 4-hydroxyphenylretinamide for high-grade squamous intraepithelial

• Guidelines for the treatment of recurrent and metastatic cervical cancer.

• Neoadjuvant chemotherapy and radical surgery versus exclusive radiotherapy in locally advanced squamous cell cervical cancer: results

• Neoadjuvant chemotherapy followed by surgery in locally advanced cervical carcinoma.

• [An advanced cervical carcinoma coexisting with pregnancy in 19-years old primipara--a case report and review of current literature]

• The effect of overall treatment time on the survival and toxicity of radical radiotherapy for cervical carcinoma.

• The impact of patient positioning on the adequate coverage of the uterus in the primary irradiation of cervical carcinoma: a prospective analysis

• Urinary disturbance after therapy for cervical cancer: urodynamic evaluation and beta2-agonist medication.

• The impact of pre-therapy extraperitoneal surgical staging on the evaluation and treatment of patients with locally advanced cervical

• Lymphoma of the cervix. Imaging and transcatheter arterial embolization.

• Prophylaxis and treatment of bladder dysfunction after Wertheim-Meigs operation: the positive effect of early postoperative detrusor

• Detection of organ movement in cervix cancer patients using a fluoroscopic electronic portal imaging device and radiopaque markers.

1
UI - 12172981
AU - Plaxe SC; Blessing JA; Olt G; Husseinzadah N; Lentz SS; DeGeest K; Valea
TI - FA A phase II trial of pyrazoloacridine (PZA) in squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study.
SO - Cancer Chemother Pharmacol 2002 Aug;50(2):151-4
AD - Department of Reproductive Medicine, Medical Center, University of California, San Diego, 402 Dickinson Street, San Diego, CA 92103-8433, USA.
PURPOSE: The Gynecologic Oncology Group performed a phase II study to determine the response rate to pyrazoloacridine (PZA) in patients with advanced, persistent or recurrent squamous carcinoma of the cervix. METHODS: PZA was administered intravenously over 3 h every 3 weeks. A dose of 760 mg/m(2) was given to the first 11 patients and was reduced to 560 mg/m(2) for subsequent patients. The dose reduction was undertaken because of unexpected severe neutropenia among the initial patients. RESULTS: Among 24 evaluable patients, 21 of whom had prior chemotherapy, there was one, brief, complete response (4.2%) and no partial responses. The major toxicity was neutropenia. CONCLUSION: PZA at the dose and schedule employed, has insignificant activity in this population.

2
UI - 12175396
AU - Soulie M; Seguin P; Martel P; Vazzoler N; Mouly P; Plante P
TI - A modified intussuscepted nipple in the Kock pouch urinary diversion: assessment of perioperative complications and functional results.
SO - BJU Int 2002 Sep;90(4):397-402
AD - Department of Urologic Surgery and Andrology, Rangueil University Hospital, Institut Cludius Regaud, Toulouse, France. soulie.m@chu-toulouse.fr
OBJECTIVE: To assess the complications and continence of a modified intussuscepted nipple in Kock pouch urinary diversions. PATIENTS AND years, range 21-74) with bladder cancer (24), gynaecological tumours (eight) or previous lower tract reconstructive surgery (eight) underwent cystectomy and cutaneous continent urinary diversion using the Kock pouch procedure. The first 23 procedures (group I) used Henriet's technique, whereas a modified fixation of the intussuscepted efferent limb was applied in the last 17 (group II). Complications and functional results (focused on continence and the upper urinary tract) were reviewed. RESULTS: The median (range) follow-up was 47.6 (10-124) months; one patient died 4 weeks after surgery. Early complications occurred in 11 (28%) and re-operation was required in two (5%). Of the late complications reported (38%), extussusception (8%) and efferent nipple prolapse (3%) only occurred in group I and required surgical revision. Late complications were minor (15%) including two asymptomatic refluxes and four with stoma sclerosis. The continence rate at 6 months in groups I and II were 78% and 94%, respectively (P = 0.13). CONCLUSION: Efferent limb prolapse and extussusception of the Kock pouch were the main complications requiring surgical revision. Applying the modified nipple fixation the complications can be reduced and reservoir continence improved.

3
UI - 12324576
AU - Kodaira T; Fuwa N; Nakanishi T; Kuzuya K; Sasaoka M; Furutani K; Kamata
TI - M Retrospective analysis of postoperative radiotherapy for node-negative cervical carcinoma with stage IB-IIB disease.
SO - Jpn J Clin Oncol 2002 Jul;32(7):255-61
AD - Department of Radiation Oncology, Aichi Cancer Center, Nagoya, Japan. 109103@aichi-cc.jp
BACKGROUND: We performed retrospective analysis to evaluate the outcomes of postoperative radiotherapy for patients with cervical carcinoma without lymph node metastasis. METHODS: From 1981 to 1995, 68 stage I-II cervical carcinoma patients without nodal disease who received adjuvant pelvic radiotherapy were entered into the present analysis. Criteria for postoperative radiotherapy were (1) deep stromal invasion (> or = 1/2; n = 63), (2) positive parametrial invasion (n = 38) and (3) close or positive surgical margin (n = 21). The median patient age was 54.0 years (range, 29-69 years). The median dose of 45.3 Gy (range, 43.4-56.4 Gy) was delivered over the whole pelvis median 21.0 days (range 12-68 days) after surgery. RESULTS: The 5/10-year overall survival, disease-free survival, pelvic control and distant metastasis-free survival rates were 89.7/85.7, 85.3/83.2, 95.5/95.5 and 90.7/90.7%, respectively. Histology of adenocarcinoma (n = 4), large tumor size and prolonged period between operation and radiotherapy were significantly adverse prognostic factors of overall and disease-free survival by univariate analysis. The risk score referred from the GOG report correlated well with disease-free survival (P = 0.018), but showed only a tendency for overall survival as a prognostic factor (P = 0.07). Overall treatment time proved to be a significant variable for overall survival (P = 0.02), but not for disease-free survival (P = 0.056). Both risk score and overall treatment time proved to be significant prognostic factors in the multivariate model. Major adverse effects occurred in three patients (4.4%) without mortality. CONCLUSIONS: In this analysis, clinical outcome from adjuvant postoperative radiotherapy was thought to be feasible with both satisfactory pelvic control and acceptable lower toxicity.

4
UI - 1286317
AU - Lahousen M; Pickel H; Girardi F; Jager G
TI - [Conization non in sano]
SO - Gynakol Geburtshilfliche Rundsch 1992;32 Suppl 1():131
AD - Geburtsh.-gynakol. Univers.-Klinik Graz.

5
UI - 8410910
AU - Dhamija S; Sehgal A; Luthra UK; Sehgal K
TI - Factors associated with awareness and knowledge of cervical cancer in a community: implication for health education programmes in developing countries.
SO - J R Soc Health 1993 Aug;113(4):184-6
AD - Institute of Cytology and Preventive Oncology (ICMR), Maulana Azad Medical College Campus, New Delhi, India.
An attempt has been made to study the correlates of knowledge of cervical cancer in a community. The survey undertaken is a part of Knowledge, Attitude and Practice (KAP) study prior to initiation of cytological screening. Total women interviewed by KAP survey were 1411 selected through 2 stage stratified random sampling. Subjects for the present analysis consisted of a group of women who had reported previous gynaecological problems related to cervical cancer. The study brought out that younger women had better awareness and knowledge about cervical cancer and related information. Literacy status for education and exposure to family planning was influential in creating awareness about cervical cancer. Lastly, the earlier episodes of gynaecological problems, and treatment seeking behaviour lead to higher awareness (efforts may be made to innovate ways to reach older and illiterate women at risk of cervical cancer for better awareness in the community.

6
UI - 7377245
AU - Benedet JL; Turko M; Boyes DA; Nickerson KG; Bienkowska BT
TI - Radical hysterectomy in the treatment of cervical cancer.
SO - Am J Obstet Gynecol 1980 May 15;137(2):254-62
Two hundred and forty-one patients were treated with radical hysterectomy at our institution between 1949 and December, 1978. The corrected 5-year survival rate for all patients with squamous cell carcinoma of the cervix was 73%. Seventeen percent of patients with occult invasive carcinoma had positive lymph nodes at the time of operation. The corrected 5-year survival rate for patients with Stage IB carcinoma who had positive nodes was 66%. Operations for recurrent or persistent disease after radiotherapy resulted in a 5-year survival rate of 54%. Current indications for radical hysterectomy and lymphadenectomy at our center are discussed.

7
UI - 7064879
AU - Butterworth CE Jr; Hatch KD; Gore H; Mueller H; Krumdieck CL
TI - Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives.
SO - Am J Clin Nutr 1982 Jan;35(1):73-82
Forty-seven young women with mild or moderate dysplasia of the uterine cervix (cervical intraepithelial neoplasia) diagnosed by cervical smears, received oral supplements of folic acid, 10 mg, or a placebo (ascorbic acid, 10 mg) daily for 3 months under double-blind conditions. All had used a combination-type oral contraceptive agent for at least 6 months and continued it while returning monthly for follow-up examinations. All smears and a biopsy obtained at the end of the trial period were classified by a single observer without knowledge of treatment status using an arbitrary scoring system (1 normal, 2 mild, 3 moderate, 4 severe, 5 carcinoma in situe). Mean biopsy scores from folate supplemented subjects were significantly better than in folate-unsupplemented subjects (2.28 versus 2.92, respectively; p less than 0.05). Final versus initial cytology scores were also significantly better in supplemented subjects (1.95 versus 2.32, respectively; p less than 0.05), unchanged in patients receiving the placebo (2.27 versus 2.30, respectively). Before treatment the mean red cell folate concentration was lower among oral contraceptive agent users than nonusers (189 versus 269 ng/ml, respectively; p less than 0.01) and even lower among users with dysplasia (161 versus 269 ng/ml, respectively; p less than 0.001). Morphological features of megaloblastosis were associated with dysplasia and also improved in folate supplemented subjects. These studies indicate that either a reversible, localized derangement in folate metabolism may sometimes be misdiagnosed as cervical dysplasia, or else such a derangement is an integral component of the dysplastic process that may be arrested or in some cases reversed by oral folic acid supplementation.

8
UI - 10093973
AU - Cox JT
TI - Management of cervical intraepithelial neoplasia.
SO - Lancet 1999 Mar 13;353(9156):857-9
AD - Health Services, University of California, Santa Barbara 93106, USA.

9
UI - 9197876
AU - Flannelly G; Langhan H; Jandial L; Mana E; Campbell M; Kitchener H
TI - A study of treatment failures following large loop excision of the transformation zone for the treatment of cervical intraepithelial neoplasia.
SO - Br J Obstet Gynaecol 1997 Jun;104(6):718-22
AD - Wellbeing Centre for the Prevention of Cervical Cancer, Aberdeen Royal Hospitals NHS Trust, UK.
OBJECTIVE: To examine the long term efficacy of large loop excision of the transformation zone (LLETZ) in the treatment of cervical intraepithelial neoplasia (CIN) and to evaluate the relative diagnostic merits of colposcopy and cytology in the follow up of these women. DESIGN: A retrospective examination of cytology, colposcopy and histology records of the first 1000 women treated with LLETZ in Aberdeen from 1989 to 1991. SETTING: Colposcopy Clinic Aberdeen Royal Infirmary, Grampian Region, Scotland. RESULTS: Nine hundred and seventy-seven women (97.7%) were seen for follow up at least once and 317 were followed for as long as four years. This comprises 2812 woman years of follow up. The incidence of recurrent CIN was 27/1000 woman years and the cumulative rate of recurrence at four years was 10.1 per 100 women. Twenty-eight of the 59 women (47%) with abnormal colposcopy and proven CIN had a concurrent smear that did not show dyskaryosis. CONCLUSIONS: LLETZ is an effective from of treatment for CIN. Colposcopy was useful in the follow up of these women and expedited the treatment of persistent disease. We recommend that any follow up protocol should include a colposcopic assessment and cytological follow up for at least four years following treatment. Further data are required to determine the risk of recurrence beyond this time.

10
UI - 9386040
AU - Ong S; Lees DA
TI - A study of treatment failures following large loop excision of the transformation zone for the treatment of cervical intraepithelial neoplasia.
SO - Br J Obstet Gynaecol 1997 Nov;104(11):1325-6

11
UI - 12199049
AU - Resbeut M; Fondrinier E; Fervers B; Haie-Meder C; Bataillard A; Lhomme
TI - C; Asselain B; Basuyau JP; Bremond A; Castaigne D; Dubois JB; Houvenaeghel G; Lartigau E; Leblanc E; Sastre-Garau X; Ternier F; Sarradet A; Guastalla JP; Chauvergne J [Standards, options and recommendations for the management of patients with invasive cancer of the cervix uterus (non-metastatic stage), abridged version]
SO - Gynecol Obstet Fertil 2002 Jul-Aug;30(7-8):631-48
AD - Institut Paoli-Calmettes, Marseille.

12
UI - 12118391
AU - Kavanagh BD; Schefter TE; Wu Q; Tong S; Newman F; Arnfield M; Benedict
TI - SH; McCourt S; Mohan R Clinical application of intensity-modulated radiotherapy for locally advanced cervical cancer.
SO - Semin Radiat Oncol 2002 Jul;12(3):260-71
AD - Department of Radiation Oncology, University of Colorado Health Sciences Center, Aurora, CO 80010-0510, USA. Brian.Kavanagh@UCHSC.EDU
Intensity-modulated radiotherapy (IMRT) offers technical advantages over conventional external beam radiotherapy (CXRT) that might prove clinically advantageous in the management of gynecologic malignancies. Especially in the case of locally advanced cervical cancer, IMRT provides an opportunity to improve the therapeutic ratio by allowing a selective combination of normal tissue dose reduction and/or concomitant integrated boost dose to the tumor. The clinical and biologic rationale for IMRT in this setting is presented here, and pertinent technical considerations such as the delineation of relevant clinical and planning target volumes are discussed. The capacity for IMRT-mediated normal tissue sparing is illustrated by example and review of the literature. Furthermore, for a small cohort of patients with locally advanced or recurrent cervical cancer treated with concomitant integrated boost IMRT and concurrent chemotherapy, preliminary clinical observations of toxicity and tumor response are presented. Concomitant integrated boost IMRT appears clinically tolerable and efficacious in this setting, and formal clinical investigation is warranted as a means of exploiting the fraction-size dependence of radiosensitizers in common clinical use. Copyright 2002, Elsevier Science (USA). All rights reserved.

13
UI - 9442179
AU - Wolfe CD; Raju KS
TI - Gynaecological cancer services: time for change.
SO - Br J Obstet Gynaecol 1998 Jan;105(1):127

14
UI - 12049697
AU - Podzamczer D; Miralles P; La Calle Md M; Zarco C; Berenguer J; Lopez
TI - Aldeguer J; Valencia E; Rubio R; Ribera JM [Recommendations of GESIDA/Spanish National Plan of AIDS on diagnosis and treatment of Kaposi's sarcoma and cervical cancer in HIV-infected patients]
SO - Med Clin (Barc) 2002 Jun 1;118(20):788-95
AD - Ciutat Sanitaria de Bellvitge, L'Hospitalet, Barcelona, Spain. pmiralles@eresmas.net

15
UI - 12195758
AU - Miglietta L; Bruzzone M; Ghione G; Pepe A; Marenghi C; Ragni N; Boccardo
TI - F Chemotherapy with cisplatin and 5-fluorouracil chronomodulated infusion in locally advanced or metastatic/recurrent carcinoma of the cervix.
SO - Tumori 2002 May-Jun;88(3):204-8
AD - Professorial Unit of Medical Oncology, National Cancer Research Institute, Genoa, Italy.
AIMS AND BACKGROUND: The purpose of this study was to review our experience with the combination of circadian chronomodulated 5-fluorouracil infusion in association with cisplatin in patients with locally advanced or metastatic cancer of the cervix in order to assess the activity and tolerability of the combination. METHODS: Twenty patients with locally advanced disease and 21 patients with metastatic 5-fluorouracil (600 mg/m2, days 1 to 5) was administered by a continuous circadian-shaped infusion employing an external programmable portable pump; cisplatinum (20 mg/m2) was infused days 1 through 5 i.v. over a 2-hr period. Response to treatment was evaluated after 3 and 6 cycles of therapy. Patients with locally advanced disease who achieved a clinical shrinkage of their tumor or were at least stable were submitted to surgery; pelvic radiotherapy was administered to patients with disease progression. RESULTS: Seven patients with locally advanced disease achieved a partial clinical response (overall response, 35%; 95% CI, 15.4-59.2), and 12 of 20 patients were submitted to surgery. Median progression-free and overall survival were 17 months and 36 months, respectively. Objective responses were observed in 9 of 21 patients with metastatic/recurrent disease (7 partial plus 2 minor responses: overall response 43%; 95% CI, 21.8-65.9). Median time to progression and overall survival were 5 and 17 months, respectively. CONCLUSIONS: Cisplatinum plus 5-fluorouracil chronomodulated infusion showed a moderate but definite activity and was well tolerated in both groups of patients. In consideration of clinical results comparable to more toxic and expensive regimens reported in the literature, the combination appears to be a reasonable option especially for women with metastatic/recurrent cervical carcinoma and a promising treatment in combination with definitive radiotherapy in patients with locally advanced disease.

16
UI - 12006553
AU - Formelli F
TI - Correspondence re: M. Follen et al., a randomized clinical trial of 4-hydroxyphenylretinamide for high-grade squamous intraepithelial lesions of the cervix.
SO - Clin Cancer Res 2002 May;8(5):1310-2; discussion 1313

17
UI - 12185296
AU - Friedlander M; The U.S. Preventative Services Task Force
TI - Guidelines for the treatment of recurrent and metastatic cervical cancer.
SO - Oncologist 2002;7(4):342-7
AD - Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia. m.friedlander@unsw.edu.au
Although there have been important advances in the management of women with cervical cancer, the optimal treatment for patients with locally recurrent and metastatic disease is still problematic, and there are relatively few randomized trials to guide treatment decisions. This paper reviews the approach to management of patients who relapse after primary treatment for cervical cancer. Patients who are still potentially curable with radical treatment are identified, and the various treatment strategies are discussed. However, most women are treated with palliative intent, and the literature on palliative management is reviewed together with the levels of evidence.

18
UI - 11773168
AU - Benedetti-Panici P; Greggi S; Colombo A; Amoroso M; Smaniotto D;
TI - Giannarelli D; Amunni G; Raspagliesi F; Zola P; Mangioni C; Landoni F Neoadjuvant chemotherapy and radical surgery versus exclusive radiotherapy in locally advanced squamous cell cervical cancer: results from the Italian multicenter randomized study.
SO - J Clin Oncol 2002 Jan 1;20(1):179-88
AD - Campus Bio-Medico Free University, Via E Longoni, 8300155, Rome, Italy. p.panici@unicampus.it
PURPOSE: Neoadjuvant chemotherapy (NACT) and radical surgery (RS) have emerged as a possible alternative to conventional radiation therapy (RT) in locally advanced cervical carcinoma. In 1990, a phase III trial was undertaken to verify such a hypothesis in terms of survival and treatment-related morbidity. PATIENTS AND METHODS: Patients with squamous cell, International Federation of Gynecology and Obstetrics stage IB2 to III cervical cancer were eligible for the study. They received cisplatin-based NACT followed by RS (type III to V radical hysterectomy plus systematic pelvic lymphadenectomy) (arm A) or external-beam RT (45 to 50 Gy) followed by brachyradiotherapy (20 to 30 Gy) (arm B). RESULTS: Of 441 patients randomly assigned to NACT+RS or RT, eligibility was confirmed in 210 and 199 patients, respectively. Treatment was administered according to protocol in 76% of arm A patients and 72% of arm B patients. Adjuvant treatment was delivered in 48 operated patients (29%). There was no evidence for any significant excess of severe morbidity in one of the two arms. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 58.9% and 55.4% for arm A and 44.5% and 41.3% for arm B (P =.007 and P =.02), respectively. Subgroup survival analysis shows OS and PFS rates of 64.7% and 59.7% (stage IB2-IIB, NACT+RS), 46.4% and 46.7% (stage IB2-IIB, RT) (P =.005 andP =.02), 41.6% and 41.9% (stage III, NCAT+RS), 36.7% and 36.4% (stage III, RT) (P =.36 and P =.29), respectively. Treatment had a significant impact on OS and PFS. CONCLUSION: Although significant only for the stage IB2 to IIB group, a survival benefit seems to be associated with the NACT+RS compared with conventional RT.

19
UI - 12065571
AU - Duenas-Gonzalez A; Lopez-Graniel CM; Mota A; Mohar A
TI - Neoadjuvant chemotherapy followed by surgery in locally advanced cervical carcinoma.
SO - J Clin Oncol 2002 Jun 15;20(12):2908-9; discussion 2809-10

20
UI - 12152278
AU - Liro M; Olszewski J; Kobierski J; Emerich J; Lukaszuk K
TI - [An advanced cervical carcinoma coexisting with pregnancy in 19-years old primipara--a case report and review of current literature]
SO - Ginekol Pol 2002 Apr;73(4):325-30
AD - II Kliniki Poloznictwa i Ginekologii Instytutu Poloznictwa i Chorob Kobiecych AM w Gdansku.
In our case report we described an fatal outcome of very young, nineteen years old primipara with advanced, aggressive squamous cervical cancer associated with 20 weeks gestation. Despite of our intentions to abort the pregnancy and started immediate therapy, she decided to delay treatment to allow fetal maturity. After 12 weeks interval, she was readmitted to the hospital with symptoms of intestinal occlusions caused by fast progression of disease. In 33 week of gestation we performed classical caesarean section with Pivercs type III radical hysterectomy. She was delivered of viable female infant weighing 1800 g. Simultaneously, we extended operation of possible cytoreductive surgery. After that, patient received two courses of adjuvant chemotherapy (MIC-scheme) and supplemental external beam radiation. Unfortunately, despite of multidisciplinary, aggressive treatment, she experienced recurrence in pelvic side walls within 6 months of surgery. At last follow-up, she was receiving salvage therapy.

21
UI - 12065104
AU - Erridge SC; Kerr GR; Downing D; Duncan W; Price A
TI - The effect of overall treatment time on the survival and toxicity of radical radiotherapy for cervical carcinoma.
SO - Radiother Oncol 2002 Apr;63(1):59-66
AD - Department of Oncology, Western General Hospital, University of Edinburgh, Crewe Road, Edinburgh, UK.
BACKGROUND AND PURPOSE: Overall treatment time is an important factor in the outcome of radical radiotherapy in head and neck, bladder and lung cancer and in cervix cancer treated over more than 7 weeks. This study analysed the effect of prolongation of overall treatment time on survival and late morbidity for patients receiving radical radiotherapy for cervical cancer treated with a 4-week regimen. MATERIALS AND METHODS: Using the departmental SAS data-base we identified all patients with cervix cancer treated between 1974 and 1988 and investigated the 647 patients who received 20 fractions of external beam radiotherapy plus intracavitary therapy with a total dose to point A of at least 60Gy. A retrospective case-note review identified tumour and treatment-related variables. RESULTS: Four hundred and twenty-five (66%) patients had at least one gap in treatment. Seventy-nine gaps (11%) were due to unavoidable patient or treatment-related causes. We could not find an effect of a treatment gap (P=0.43) or an increased overall treatment time (P=0.79) on the cause specific survival of patients. There was significantly more grade 4 morbidity in those patients treated over a short period (29-32 days) compared to the rest (P=0.005), possibly related to the loss of radiotherapy-free days to weekend intracavitary insertions. CONCLUSIONS: We could not demonstrate a significant effect of overall treatment time in this series of patients, almost all of whom were treated in less than 7 weeks. Those patients treated over the shortest period had an increased incidence of late morbidity.

22
UI - 12065107
AU - Weiss E; Eberlein K; Pradier O; Schmidberger H; Hess CF
TI - The impact of patient positioning on the adequate coverage of the uterus in the primary irradiation of cervical carcinoma: a prospective analysis using magnetic resonance imaging.
SO - Radiother Oncol 2002 Apr;63(1):83-7
AD - Department of Radiotherapy, University of Goettingen, Robert-Koch Strasse 40, Goettingen, Germany.
BACKGROUND AND PURPOSE: The intention of this prospective study is to assess the influence of different patient positionings and the use of belly boards on the coverage of the uterus by standard radiation fields. MATERIAL AND METHODS: In 21 women with carcinoma of the uterine cervix magnetic resonance imaging (MRI) scans in prone patient position with and without belly board and computed tomography (CT) scans in supine position were analysed after superimposing standard pelvic box fields. Further, all patients underwent a second MRI field control in prone position with belly board to detect intraindividual variations in the uterus position during treatment. RESULTS: Standard portals did not completely cover the uterus in supine position in 7/21 (33%), in prone position with belly board in 7/21 (33%) and without belly board in 5/21 (24%). Insufficient uterine coverage was found only in the anteroposterior direction. The mean distance (+/- standard deviation) between the field borders of the lateral portals and the uterus was in supine position anteriorly 3.4 cm (+/-2.2 cm) and posteriorly 1.8 cm (+/-1.3 cm), in prone position with belly board anteriorly 2.2 cm (+/-2.7 cm) and posteriorly 2.6 cm (+/-1.6 cm), prone without belly board anteriorly 3.3 cm (+/-2.4 cm) and posteriorly 1.9 cm (+/-1.1 cm). The difference was statistically significant between supine and prone position with belly board and between prone position with and without belly board. Repeated MRI controls during therapy showed no significant changes compared to the MRIs at the beginning of therapy. CONCLUSIONS: The use of standard radiation fields results in a high percentage of geographical misfits. Three-dimensional treatment planning is a prerequisite for adequate uterus coverage.

23
UI - 10614971
AU - Hamada K; Kihana T; Kataoka M; Yoshioka S; Nishio S; Matsuura S; Ito M
TI - Urinary disturbance after therapy for cervical cancer: urodynamic evaluation and beta2-agonist medication.
SO - Int Urogynecol J Pelvic Floor Dysfunct 1999;10(6):365-70
AD - School of Medicine, Ehime University, Shigenobu, Onsen-gun, Japan.
Urinary disturbance frequently develops following therapy for cervical cancer; however, no effective medical treatment has so far been reported. Sixty-five patients who developed urinary disturbance after radiation therapy, radical hysterectomy or radical hysterectomy with radiation therapy for cervical cancer underwent urodynamic assessment. Those who underwent radical hysterectomy with radiation therapy experienced the most severe urine loss, as determined by the pad test. All patients showed markedly reduced bladder compliance. A beta2-agonist (mabuterol) significantly improved compliance, bladder capacity and flow rate. It is suggested that medication with mabuterol is a potential novel approach to the treatment of urinary disturbance after therapy for cervical cancer.

24
UI - 11766731
AU - Odunsi KO; Lele S; Ghamande S; Seago P; Driscoll DL
TI - The impact of pre-therapy extraperitoneal surgical staging on the evaluation and treatment of patients with locally advanced cervical cancer.
SO - Eur J Gynaecol Oncol 2001;22(5):325-30
AD - Department of Gynecological Oncology, Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
OBJECTIVE: The use of extraperitoneal surgical staging prior to treatment in patients with bulky or locally advanced cervical cancer allows the detection and treatment of disease beyond the standard pelvic radiation fields. This study was conducted to evaluate the impact of extraperitoneal surgical staging in the treatment and outcome of patients with locally advanced cervical cancer. METHODS: 51 patients with locally advanced cervical cancer treated between 1985 and 1998 were retrospectively reviewed. Information on morbidity, usefulness, and results of surgery and patterns of disease recurrence were obtained. Survival distributions were calculated by the Kaplan-Meier product limit method and compared with the log-rank test. RESULTS: All 51 women were surgically staged by an extra-peritoneal approach. Preoperative CT scans (n=27) when compared with surgical findings showed sensitivity for pelvic and para-aortic lymph node metastasis of 39%, specificity of 88%, positive predictive value of 39% and negative predictive value of 88%. Lymph node metastases were found in 30/51 patients (59%). There were no significant treatment delays or surgical morbidity as a result of extra-peritoneal surgical staging. In 21 patients (41%), the highest level of involved nodes was in the pelvis and they were treated with pelvic radiation. The para-aortic nodes were involved in nine patients (18%) and were treated with extended field radiation. All patients also received concurrent radiosensitization with chemotherapy. The estimated survival for the entire group was 60% at 5 years. For node negative patients, estimated 5-year survival was 67% while it was 54% for all node positive patients (p=0.17). Analysis according to anatomic site of involved nodes showed that the estimated 2-year and 5-year survival for those with pelvic nodal involvement was 81% and 64%, respectively. However, in the group of nine patients with para-aortic nodal disease, the estimated 2-year survival was 44%. Five (56%) were dead of disease with a median time to death of 16.0 months and four patients (44%) were alive with a median duration of follow up of 16.1 months. There was a statistically significant difference in survival for the group of patients with positive pelvic nodes only compared to the group with positive para-aortic nodes (p=0.03). The estimated 5-year survival by FIGO stage was 80%, 70% and 51% for stages Ib, II, III, disease, respectively. Factors that did not significantly affect survival included age, histology and type of chemotherapy. CONCLUSIONS: Pre-therapy extra-peritoneal surgical staging resulted in treatment modification in 18% of patients with locally advanced cervical cancer. The morbidity from surgery and subsequent radiation therapy was acceptable. The procedure is recommended to allow for individualization of treatment in patients with local-regional cervical cancer.

25
UI - 12225489
AU - Bode MK; Tikkakoski T; Johansson J; Johansson K; Kariniemi J;
TI - Apaja-Sarkkinen M; Tuominen H Lymphoma of the cervix. Imaging and transcatheter arterial embolization.
SO - Acta Radiol 2002 Jul;43(4):431-2
AD - Department of Radiology, Keski-Pohjanmaa Central Hospital, Kokkola, Finland.
A case of uterine cervix lymphoma with selective embolization after angiography is described. Chemotherapy and radiotherapy were carried out and surgery was avoided.

26
UI - 9449585
AU - Kemp B; Kitschke HJ; Goetz M; Heyl W
TI - Prophylaxis and treatment of bladder dysfunction after Wertheim-Meigs operation: the positive effect of early postoperative detrusor stimulation using the cholinergic drug betanecholchloride.
SO - Int Urogynecol J Pelvic Floor Dysfunct 1997;8(3):138-41
AD - Department of Obstetrics and Gynecology, Technical University Hospital, Aachen, Germany.
The efficacy of betanecholchloride in the postoperative treatment of bladder dysfunction is controversial. We therefore performed a comparative study on the effect of this therapy for the prophylaxis of detrusor hypotonia after Wertheim-Meigs operation. Forty patients with cervical cancer FIGO stage Ib/IIa were divided into two study groups. The control group (24 patients) only received betanecholchloride if the residual urine persisted above 50 ml after the 10th postoperative day. The study group (16 patients) received 50 mg betanecholchloride three times a day from the 3rd postoperative day onward. In this group postoperative catheter treatment, and consequently hospital stay, were significantly shorter (9.6 versus 13.3 days and 15.5 versus 18.6 days). The residual urinary volume normalized faster (8.0 versus 13.0 days) and the rate of cystitis was lower (18.8 versus 25%). According to our study, a prophylactic application of the parasympathomimetic drug betanecholchloride diminishes postoperative complications associated with bladder dysfunction after Wertheim-Meigs operation.

27
UI - 12243838
AU - Kaatee RS; Olofsen MJ; Verstraate MB; Quint S; Heijmen BJ
TI - Detection of organ movement in cervix cancer patients using a fluoroscopic electronic portal imaging device and radiopaque markers.
SO - Int J Radiat Oncol Biol Phys 2002 Oct 1;54(2):576-83
AD - Department of Radiation Oncology, University Hospital Rotterdam-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands. kaatee@kfih.azr.nl
PURPOSE: To investigate the use of a fluoroscopic electronic portal imaging device (EPID) and radiopaque markers to detect internal cervix movement. METHODS AND MATERIALS: For 10 patients with radiopaque markers clamped to the cervix, electronic portal images were made during external beam irradiation. Bony structures and markers in the portal images were registered with the same structures in the corresponding digitally reconstructed radiographs of the planning computed tomogram. RESULTS: The visibility of the markers in the portal images was good, but their fixation should be improved. Generally, the correlation between bony structure displacements and marker movement was poor, the latter being substantially larger. The standard deviations describing the systematic and random bony anatomy displacements were 1.2 and 2.6 mm, 1.7 and 2.9 mm, and 1.6 and 2.7 mm in the lateral, cranial-caudal, and dorsal-ventral directions, respectively. For the marker movement those values were 3.4 and 3.4 mm, 4.3 and 5.2 mm, 3.2 and 5.2 mm, respectively. Estimated clinical target volume to planning target volume (CTV-PTV) planning margins (approximately 11 mm) based on the observed overall marker displacements (bony anatomy + internal cervix movement) are only marginally larger than the margins required to account for internal marker movement alone. CONCLUSIONS: With our current patient setup techniques and methods of setup verification and correction, the required CTV-PTV margins are almost fully determined by internal organ motion. Setup verification and correction using radiopaque markers might allow decreasing those margins, but technical improvements are needed.

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