National Cancer Institute®
Last Modified: April 1, 2002
UI - 11803143
AU - Rose PG
TI - Chemoradiotherapy for cervical cancer.
SO - Eur J Cancer 2002 Jan;38(2):270-8
AD - Division of Gynecologic Oncology, University Hospitals of Cleveland and The Ireland Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA. email@example.com
Cervical cancer remains a major health problem worldwide, despite advances in screening. For patients with locally advanced stage disease, failure to obtain local-regional control usually results in death. In an effort to improve local-regional tumour control, neoadjuvant and concurrent chemoradiation has been tested. Recently, five randomised trials performed by the Gynecologic Oncology Group (GOG), Radiation Therapy Oncology Group (RTOG) and the SouthWest Oncology Group (SWOG) studying cisplatin-based chemoradiation have demonstrated a significant survival advantage. Three of the trials compared cisplatin-based concurrent chemotherapy and radiation to radiation alone and two trials compared cisplatin-based concurrent chemotherapy and radiation to radiation with hydroxyurea. In all of the trials, cisplatin-based chemotherapy administered concurrently with radiation therapy was more effective at reducing the risk of death by 30-50%. Acute toxicities, principally neutropenia and gastrointestinal, were more common with chemoradiation, but were transient and the rates of late complications (complications that persisted or occurred for more than 60 days after the treatment) were similar. Based on the results of these five randomised trials, the National Cancer Institute (NCI) released a Clinical Announcement stating that cisplatin-based chemotherapy, as used in these trials (i.e. concurrently with radiation therapy), as the new standard of therapy for cervical cancer.
UI - 11899688
AU - el Mrabet F; Ferhati D; Berkhli S; el Hanchi Z; Rhrab B; Lakhdar A;
TI - Baidada A; Kettani F; Kharbach A; Chaoui A [Primary malignant non-Hodgkin's lymphoma of the cervix uteri]
SO - Presse Med 2002 Feb 23;31(7):318
UI - 11899675
AU - Gallocher O; Thomas L; Stockle E; Bussieres E; Floquet A; Avril A;
TI - Pigneux J [First surgery followed by vaginal curietherapy in small-volume uterine cervix cancer: an alternative to the association of uterovaginal curietherapy and surgery]
SO - Cancer Radiother 2002 Feb;6(1):10-4
AD - Service de radiotherapie, institut Bergonie, centre regional de lutte contre le cancer, 229, cours de l'Argonne, 33076 Bordeaux, France.
PURPOSE: Evaluate the results of the treatment of small uterine cervix cancer with the association of surgery and postoperative vaginal brachytherapy, without unfavourable prognostic factors. PATIENTS AND METHODS: After radical hysterectomy with lymphadenectomy, 29 women (mean age: 44 years) with carcinoma < 25 mm (26 stage IB1, 3 IIA, mean size: 15 mm) were treated by post-operative prophylactic vaginal brachytherapy using low dose rate. Ovarian transposition was performed at the surgical time in 14 young women (mean age 35 years). RESULTS: The actuarial specific survival rates at 5 and 10 years were 100% and 90% respectively, with a mean follow-up 75 months. Only one local recurrence was observed. The rate of grade 1 post-operative complication was 7%. The conservation rate of the ovarian function was 85% for young women. CONCLUSION: Treatment of small volume uterine cervix cancer using first surgery and post-operative vaginal brachytherapy is a reliable therapeutic option. The results in terms of specific survival and complications are the same with those after standard association of preoperative uterovaginal brachytherapy and surgery.
UI - 11865755
AU - Sipos N; Szantho A; Csapo Z; Balega J; Demeter A; Papp Z
TI - [Transposition of ovaries during radical hysterectomy for cervical cancer]
SO - Orv Hetil 2002 Jan 27;143(4):189-92
AD - Altalanos Orvostudomanyi Kar, I. Szuleszeti es Nogyogyaszati Klinika, Semmelweis Egyetem, Budapest.
INTRODUCTION: 422 radical hysterectomies were performed for cervical Department of Obstetrics and Gynecology, Semmelweis Medical University. At least one of the ovaries was conservated and suspended in 21 cases. AIM(S): The aim of this study is to preserve ovaries guaranteeing natural oestrogen production for young patients suffering in early stage cervical cancer, and to prove appropriate efficacy of their method. PATIENTS/METHOD(S): According to present examinations transposition of ovary (21 patients) and radiotherapy made as a part of the protocol can only slightly influence the endocrine function of ovary. RESULTS: Only in one case of 21 a hormonal substitution was needed for treating menopausal syndrome. Studying histopathologically ovaries removed during 422 radical hysterectomies the authors could not find any metastasis given by early stage (I/A2 or I/B) cervical cancer. Following and controlling their patients after ovarial transpositions for a long period they could not observe any pathological ovarial disorder (cyst). CONCLUSION(S): According to the data of international literature the authors conclude, that transposition of ovaries during radical hysterectomy for well-selected, younger aged, early staged cervical cancer cases can result only a low risk, but much better quality of life for the patients.
UI - 11917578
AU - Heber E; Schwint AE; Sartor B; Nishihama S; Sanchez O; Brosto M; Itoiz
TI - ME AgNORs as an early marker of sensitivity to radiotherapy in gynecologic cancer.
SO - Acta Cytol 2002 Mar-Apr;46(2):311-6
AD - Department of Radiobiology, National Atomic Energy Commission, Avenida del Libertador 8250 (1429), Buenos Aires, Argentina.
OBJECTIVE: To evaluate the changes induced in silver-stained nucleolar organizer regions (AgNORs) by the first fraction of a radiotherapy protocol for gynecologic cancer on exfoliated cytologic samples to predict the therapeutic success of the full protocol. STUDY DESIGN: Thirteen gynecologic cancer patients who were scheduled for radiotherapy were included in the study. Cell smears were taken from the affected area before and after the first fraction of a radiotherapy protocol and silver stained for AgNORs. AgNORs per nucleus were counted under a light microscope. Local disease control by the full radiotherapy protocol was assessed at one year by the Papanicolaou technique. RESULTS: Local success of radiotherapy was greater for lesions with higher pretreatment AgNOR counts and for lesions that underwent a greater percentage reduction in AgNOR counts after the first fraction. We correlated local success of the full radiotherapy protocol with a predictive index based on AgNOR counts obtained before and after the first fraction. CONCLUSION: A predictive index based on AgNOR counts can predict, as early as after the first fraction, the local control of disease by a full radiotherapy protocol. Knowledge of the probability of success long before the protocol is completed would allow reevaluation of therapeutic options.
UI - 11845768
AU - Petersen WO; Trapp MA; Vierkant RA; Sellers TA; Kottke TE; de Groen PC;
TI - Nicometo AM; Kaur JS Outcomes of training nurses to conduct breast and cervical cancer screening of Native American women.
SO - Holist Nurs Pract 2002 Jan;16(2):58-79
AD - Department of Health Sciences Research, Mayo Clinic Comprehensive Cancer Center, Rochester, Minnesota, USA.
Native WEB (Women Enjoying the Benefit) is a unique training program for nurses employed by the Indian Health Service (IHS), tribal clinics, and other clinics with large, underserved populations. It teaches nurses breast and cervix cancer screening techniques and trains them to administer and maintain high-quality screening programs that include patient outreach, education, and training. We review American Indian (AI)/Alaska Native (AN) women's need for screening services, identify some of the obstacles to screening, and present our evaluation of the Native WEB's impact on clinics, nurses, and patients. Findings show that Native WEB training is associated with increased screening activity at all three levels.
UI - 11919241
AU - Bloss JD; Blessing JA; Behrens BC; Mannel RS; Rader JS; Sood AK; Markman
TI - M; Benda J Randomized trial of cisplatin and ifosfamide with or without bleomycin in squamous carcinoma of the cervix: a gynecologic oncology group study.
SO - J Clin Oncol 2002 Apr 1;20(7):1832-7
AD - Division of Gynecologic Oncology, Ellis Fischel Cancer Center, University of Missouri Health Sciences Center, Columbia, USA.
PURPOSE: Phase II trial reports have suggested that the addition of bleomycin to the combination of cisplatin and ifosfamide may improve response rates and possible survival in squamous carcinoma of the cervix. This study prospectively evaluates the combination of bleomycin to this regimen in women with histologically proven advanced recurrent or persistent squamous cell carcinoma of the cervix. PATIENTS AND METHODS: Eligible women were randomized to receive either cisplatin (50 mg/m(2)), ifosfamide (5 g/m(2) over 24 hours), and mesna (6 g/m(2) during ifosfamide infusion and the following 12 hours) (CI) versus bleomycin 30 units over 24 hours on day 1 followed by cisplatin (50 mg/m(2)), ifosfamide (5 g/m(2) over 24 hours), and mesna (6 g/m(2) during ifosfamide infusion and the following 12 hours) (CIB). Three hundred three women were enrolled onto this trial, of which 287 were assessable. RESULTS: There were no significant differences between CI and CIB with regard to response rates (32% v 31.2%, respectively), progression-free survival (PFS), or overall survival. PFS and survival were associated with initial performance status (PS). Patients with a PS of 0 experienced a lower rate of failure (P =.013) and a lower risk of death (P =.009) compared with patients with PS of 2. The most frequent grade 3/4 toxicities were leukopenia, neutropenia, anemia, thrombocytopenia, and nausea and vomiting. Neither regimen was associated with a significant increase in incidence of these toxicities. CONCLUSION: The CI regimen was virtually identical to CIB with regard to response rate, PFS, survival, and toxicity profile. Thus, the addition of bleomycin in the dose-schedule employed to cisplatin and ifosfamide did not improve outcome in patients with advanced cervical cancer.
UI - 11012341
AU - Eifel PJ
TI - Chemoradiation for carcinoma of the cervix: advances and opportunities.
SO - Radiat Res 2000 Sep;154(3):229-36
AD - Division of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Although it is possible to cure many patients with locally advanced cervical cancer using radiation therapy alone, loco-regional relapse continues to be a component of most recurrences. To improve control rates, clinicians have investigated ways of combining chemotherapy and radiation for more than 30 years. Despite encouraging results from phase II trials of neoadjuvant chemotherapy, randomized trials failed to improve on the results with radiation therapy alone. For a number of reasons, early trials of concurrent chemoradiation were inconclusive. However, recent reports of five large prospective randomized trials demonstrated dramatic improvements in survival and local control rates when cisplatin-containing chemotherapy was given during radiation therapy. These results also suggest a number of avenues for future research.
UI - 11448246
AU - van der Zee J; Burger CW; Koper PC
TI - Comments on "Chemoradiation for carcinoma of the cervix: advances and opportunities" by Patricia Eifel (Radiat. Res. 154, 229-236, 2000).
SO - Radiat Res 2001 Aug;156(2):221-2
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 2001;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.
UI - 11818094
AU - Milojkovic M
TI - Residual and recurrent lesions after conization for cervical intraepithelial neoplasia grade 3.
SO - Int J Gynaecol Obstet 2002 Jan;76(1):49-53
AD - Department of Gynecology and Obstetrics, Clinical Hospital Osijek, Osijek, Croatia. firstname.lastname@example.org
OBJECTIVES: To evaluate the importance of regular and long-term follow-up of patients who had conization for cervical intraepithelial neoplasia grade 3 (CIN 3); and to assess the risk of residual/recurrent lesions of the cervix uteri. METHODS: Retrospective analysis of 934 patients with CIN 3 who underwent conization over the period 1 January involved resection margins and 896 (95.9%) patients who had free resection margins. RESULTS: Twenty-three out of 934 (2.5%) patients had another operation (reconization in 17 and hysterectomy in six) whereas one patient had a biopsy. Residual or recurrent lesion after conization was found in 23 patients out of 934 (2.5%). Three patients had invasive cervical cancer (0.3%), 19 had CIN 3 (2.0%) and one patient had CIN 1 (0.1%). One of the 24 patients (4.2%) was diagnosed with no lesion after repeated operation. Eleven patients out of 38 (28.9%) with involved resection margins during the first conization had residual/recurrent disease, compared with eight out of 896 patients (0.9%) who had free resection margins. CONCLUSION: Another operation is recommended only in cases when, on the basis of cytological, colposcopical and histological findings, the gynecologist suspect the residual/recurrent lesions.
UI - 11821606
AU - Park CT; Lim KT; Chung HW; Lee KH; Seong SJ; Shim JU; Kim TJ
TI - Clinical evaluation of laparoscopic-assisted radical vaginal hysterectomy with pelvic and/or paraaortic lymphadenectomy.
SO - J Am Assoc Gynecol Laparosc 2002 Feb;9(1):49-53
AD - Department of Obstetrics and Gynecology, Samsung Cheil Hospital and Women's Healthcare Center, Sungkyunkwan University, School of Medicine, 1-19, Mookjung-Dong, Chung-Ku, Seoul, Korea.
STUDY OBJECTIVE: To report our experience with radical laparoscopic-assisted vaginal hysterectomy (LAVH) with bilateral pelvic and/or paraaortic lymphadenectomy. DESIGN: Retrospective review (Canadian Task Force classification III). SETTING: University-affiliated hospital. PATIENTS: Fifty-two women with invasive carcinoma of the cervix, stage Ib1, smaller than 3 cm. INTERVENTION: Radical LAVH with pelvic and/or paraaortic lymphadenectomy. MEASUREMENTS AND MAIN RESULTS: Total operating time ranged from 230 to 650 minutes (mean 380 min). Major surgical complications were two cases of ureter injury, two cases of ureteral stricture, and one case of hematoma at the cannula site. Two cases were converted to laparotomy due to incomplete hemostasis of the uterine artery and obturator vein. The mean hemoglobin decrement was 1.7 g/dl the day after operation. Thirty patients received blood transfusion (mean 1.8 pints). Average numbers of pelvic and paraaortic lymph nodes removed were 27.7 (range 9-63) and 22.1 (range 6-52), respectively. After surgery, patients passed gas in 2.2 days and self-voided in 18.4 days on average. One woman had pelvic recurrence at 26 months after surgery. One died from brain metastasis 10 months after surgery. CONCLUSION: This technique is feasible for treatment of early cervical carcinoma. An experienced surgeon could shorten operating time and reduce complications.
UI - 11822986
AU - Moore DH
TI - The role of radical hysterectomy and neoadjuvant chemotherapy in carcinoma of the cervix.
SO - Curr Oncol Rep 2002 Mar;4(2):145-51
AD - Department of Gynecologic Oncology, Indiana University School of Medicine, 535 Barnhill Drive RT433, Indianapolis, IN 46202-5274, USA. email@example.com
The patient presenting with a bulky stage IB2 cervical cancer is a therapeutic challenge. None of the current surgical or radiation treatment strategies satisfactorily leads to a high rate of disease-free survival and a low risk of treatment-related complications including ovarian failure and psychosexual deficits. Neoadjuvant chemotherapy may allow for reductions in tumor bulk, thereby rendering radiation therapy more effective or surgery more feasible. Impressive clinical response rates to cisplatin-based neoadjuvant chemotherapy have been achieved with acceptable toxicity. Approximately 20% of patients achieve a complete clinical response, and many also experience a complete pathologic response. There are still too few comparative studies and phase III trials to assess the effectiveness of neoadjuvant chemotherapy and radical surgery relative to standard treatments.
UI - 11917288
AU - Small W Jr
TI - The potential role of amifostine in the treatment of carcinoma of the uterine cervix: a review.
SO - Semin Radiat Oncol 2002 Jan;12(1 Suppl 1):68-74
AD - Division of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611, USA.
Carcinoma of the uterine cervix affects approximately 13,000 women annually in the United States. Radiotherapy is a commonly applied therapy, either as definitive treatment or combined with surgery. Although highly effective, radiotherapy can be associated with significant complications. Amifostine has been shown to be an effective radioprotector in head and neck malignancies. Preliminary evidence suggests a role in cervical cancer. Copyright 2002, Elsevier Science (USA). All rights reserved.
UI - 8934049
AU - Hendry JH; Bentzen SM; Dale RG; Fowler JF; Wheldon TE; Jones B; Munro
TI - AJ; Slevin NJ; Robertson AG A modelled comparison of the effects of using different ways to compensate for missed treatment days in radiotherapy.
SO - Clin Oncol (R Coll Radiol) 1996;8(5):297-307
AD - Paterson Institute for Cancer Research, Christie Hospital NHS Trust, Manchester, UK.
There is much evidence for the detrimental effect on tumour control of missed treatment days during radiotherapy, amounting for example to approximately a 1.6% absolute decrease in local control probability per day of treatment prolongation in the case of head and neck squamous cell cancer. Various methods to compensate for missed treatment days are compared quantitatively in this article, using the linear-quadratic formalism. The overall time and fraction size can be maintained by either treating on weekend days (the preferred way (Method 1a), although with unsocial hours and at extra cost) or using two fractions per day to "catch up' (Method 1b). The latter might incur a small loss of tolerance regarding late reactions, when intervals of 6-8 h are used rather than 24 h, and there may be logistical/scheduling difficulties with larger numbers of patients in some centres when using this method. A second type of strategy retains overall treatment time, and also one fraction per day, but the size of the dose per fraction is increased. For example, this may be done for the same number of "post-gap' days as gap days (Method 2). However, with this method, calculated isoeffect doses regarding late reactions indicate a probable decrease in tumour control rate (Method 2a). Otherwise, isoeffective doses regarding tumour control result in an increase in late reactions (Method 2b). In addition, this method is unsuitable for short regimens already using high doses per fraction. To reduce this problem, overall treatment time can also be retained by using fewer fractions, all of greater size in the case of planned gaps (statutory holidays), or larger remaining fractions after unplanned gaps (Method 2c). The problem also with this method is that equivalence for tumour control gives an increase in late reactions. The least satisfactory strategy (Method 3) is to accept the protraction caused by the missed treatment days, and give either the same prescribed number of (slightly larger) fractions or the planned treatment followed by one (or more) extra fraction to compensate for the gap. This would retain the expected local control rate, but there would be an increase in late reactions. An example of this, using average parameter values, is that a 3-day gap (necessitating four extra days to complete treatment with one fraction of 2.4 Gy) might maintain a 70% local control rate for glottic carcinoma, but severe reactions might rise from 1% to 4% and minor/moderate reactions from 37% to 50%. In this example, the inclusion of an extra weekend would increase the required extra dose and hence may further increase the morbidity rates. A final point is that the effect of treatment interruptions for an individual patient is expected to be greater than that for a group of patients because of interpatient heterogeneity tending to flatten dose-response curves. Calculations show that the above value of 1.6% loss of local control per day for a group of patients may reflect values for individual patients that range around a median value of as much as 5% per day, so stressing further the importance of gaps in treatment. It is concluded that, wherever possible, treatment days should not be missed. If they are missed, it is important to compensate for them, preferably by one of the first of the above methods (1a or 1b), in order to keep as close as possible to the original/standard prescription in terms of total dose, dose per fraction and overall time.
UI - 11202086
AU - Denton AS; Bond SJ; Matthews S; Bentzen SM; Maher EJ; UK Link
TI - Gynaecology-Oncology Group National audit of the management and outcome of carcinoma of the cervix treated with radiotherapy in 1993.
SO - Clin Oncol (R Coll Radiol) 2000;12(6):347-53
AD - Mount Vernon Hospital, Northwood, Middlesex, UK.
The aim of the study was to investigate the UK prevalence of late, severe side-effects associated with radical radiotherapy for cancer of the cervix and try to identify associated factors. All patients treated for cancer of the cervix with radical radiotherapy in 1993 were identified and retrospective case notes studied to determine mortality and severe complications occurring following treatment. Of the 55 radiotherapy departments in the UK that were treating gynaecological malignancy in 1993, 53 participated in the study. There were 1558 patients with carcinoma of the cervix receiving radical radiotherapy as part of their treatment regimen in 1993, whose patterns of treatment were assessed. The main outcome measures were the development of late severe complications as defined by the Franco-Italian Glossary and mortality. Of the patients receiving surgery and radiotherapy, 58.5% underwent Wertheim's procedure. The crude rate of late severe complications in all patients with cervical cancer treated with radical radiotherapy in 1993 was 6.1% (actuarial rate 8%) at 5 years, and only four of the 91 patients who developed complications died as a result of their morbidity. There was no significant correlation of stage, centre size, surgery or radiotherapeutic approach with late morbidity in univariate analysis. The overall survival at 5 years was 47% and was lower than that of the European data from FIGO's 1990-92 cohort, for all stages. Increasing FIGO stage was the only factor significantly associated with mortality. The absence of variables that were significantly associated with late complications may well be related to the relatively low event rate compared to the sample size. Differences in surgical treatment prior to radiotherapy and radiation technique may be confounding the comparison of outcomes. The relatively poor survival for locally advanced disease and the difficulty with which these data were collated indicates that national prospective data collection is urgently required to monitor performance and hence derive best practice.
UI - 11687152
AU - Green J; Kirwan J; Tierney J; Symonds P; Fresco L; Williams C;
TI - Collingwood M Concomitant chemotherapy and radiation therapy for cancer of the uterine cervix.
SO - Cochrane Database Syst Rev 2001;(4):CD002225
AD - Clatterbridge Centre for Oncology, Clatterbridge Hospital, Merseyside, UK, L63 4JY. J.A.Green@liverpool.ac.uk stated that concomitant chemoradiotherapy should be considered for all patients with cervical cancer, based on evidence from five randomised controlled trials. OBJECTIVES: To review all known randomised clinical controlled trials (RCTs) comparing concomitant chemotherapy and radiation therapy with radiotherapy for locally advanced cervical cancer. SEARCH STRATEGY: We searched electronic databases, trials registers and reference lists of published trial reports and review articles were also searched. SELECTION CRITERIA: This review includes RCTs in cervical cancer comparing concomitant chemotherapy and radiotherapy with radiotherapy. In the experimental arm, further adjuvant chemotherapy was allowable. Hydroxyurea was considered inactive and allowable. Trials using radiosensitisers or radioprotectors in the experimental arm were excluded. DATA COLLECTION AND ANALYSIS: Two authors reviewed trials for inclusion and extracted data. For meta-analyses of time-to-event outcomes (survival, progression-free survival), a hazard ratio (HR) was extracted or estimated from trial reports, where possible. Only overall rates of local and distant recurrence were presented in many reports so only an odds ratios (OR) of recurrence rates could be calculated, which takes no account of time to recurrence or censoring. The HRs and ORs for individual trials were combined across all trials, using the fixed effect model. Few trials reported acute toxicity adequately. Data were therefore grouped and the number of toxic events was used to calculate a single OR for each site and grade. Late toxicity was rarely described so could only be reviewed qualitatively. MAIN RESULTS: Nineteen trials (17 published, two unpublished) were identified including 4580 patients, although due to patient exclusion and differential reporting 62-78% were available for the various analyses. The review strongly suggests chemoradiation improves overall survival and progression free survival, whether platinum was used or not with absolute benefits of 12% and 16% respectively. There was, however, statistical heterogeneity for these outcomes There was some evidence that the effect was greater in trials including a high proportion of stage I and II patients. Chemoradiation also showed significant benefit for both local and distant recurrence. Haematological and gastrointestinal toxicity was significantly greater in the concomitant chemoradiation group. Details of late morbidity were sparse. REVIEWER'S CONCLUSIONS: Concomitant chemotherapy and radiotherapy appears to improve overall survival and progression-free survival in locally advanced cervical cancer. It also reduces local and distant recurrence suggesting concomitant chemotherapy may afford cytotoxic and sensitisation effects. Some acute toxicity is increased, but data on long term side effects were sparse.
UI - 11836539
AU - Carvalho JP; Carvalho FM; Pincerato KM; Pereyra EA
TI - Conization, frozen section examination, and planned hysterectomy in the treatment of high-grade cervical intraepithelial neoplasia.
SO - Rev Hosp Clin Fac Med Sao Paulo 2001 Nov-Dec;56(6):169-72
AD - Department of Dermatology, Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo, Brazil.
PURPOSE: We tested the role of frozen section examination of the cone specimen in the evaluation of the resection margin status and to rule out invasion in patients with high-grade cervical intraepithelial neoplasia. METHODS: Twenty-five patients with cervical intraepithelial neoplasia underwent conization followed by frozen section examination and planned hysterectomy. The results of the definitive paraffin exam were compared with frozen section examination. RESULTS: In the evaluation of the margins by frozen section examination, 16 patients (64%) had positive cone margins and 9 (36%) had negative margins. The definitive paraffin examination of margin status was concordant in all the cases. Intraoperative diagnosis of invasion was made in 5 cases, and 1 of these was microinvasive. Among the remaining 20 cases, we detected 2 additional microinvasive carcinomas after paraffin study, so the diagnosis of the frozen section examination was concordant with the paraffin sections in 23/25 cases (92%). Two cases of microinvasive carcinoma were diagnosed as cervical intraepithelial neoplasia by frozen section examination and had less than 2 mm stromal invasion. CONCLUSIONS: In high-grade cervical intraepithelial neoplasia, frozen section examination can provide immediate and precise evaluation of the cone margin status in high-grade cervical intraepithelial neoplasia. It can identify frank invasion and permit adequate treatment in a one-stage procedure. In early microinvasive disease, frozen section examination fails to detect the area of invasion but reliably detects clear resection margins.
UI - 11766144
AU - Flowers LC; McCall MA
TI - Diagnosis and management of cervical intraepithelial neoplasia.
SO - Obstet Gynecol Clin North Am 2001 Dec;28(4):667-84, viii
AD - Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia 30322, USA. firstname.lastname@example.org
Ovarian cancer is the leading cause of death from malignancies arising in the female genital tract. More women die from ovarian cancer than cervical and endometrial cancer combined. All clinicians should understand the concepts of ovarian cancer biology and management. Approximately 90% of all ovarian cancers are epithelial in origin, and such cancers are the focus points of this article.
UI - 11766148
AU - Basil JB; Horowitz IR
TI - Cervical carcinoma: contemporary management.
SO - Obstet Gynecol Clin North Am 2001 Dec;28(4):727-42
AD - Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia 30322, USA. Jbasil@emory.edu
Cervical carcinoma is prevented easily with proper screening. Unfortunately, many women in industrialized countries continue to have poor access to adequate medical care. In many third-world countries, cervical cancer is one of the top malignancies diagnosed. Screening should be provided for all women to prevent or diagnose cervical cancer at an early, treatable stage.
UI - 11956305
AU - Kobamatsu Y; Yamamoto R; Kaneuchi M; Mitamura T; Minobe S; Todo Y;
TI - Takeda M; Okamoto K; Nomura E; Negishi H; Sakuragi N; Fujimoto S Comparison of the results of radical hysterectomy: sequential observations in each period.
SO - Jpn J Clin Oncol 2002 Mar;32(3):103-7
AD - Gynecology, Reproductive and Developmental Medicine, Division of Pathophysiological Science, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
BACKGROUND: The efficacy of drains and of antibiotics for prophylaxis of postoperative retroperitoneal infections following radical hysterectomy with systematic lymphadenectomy has not yet been adequately investigated. METHODS: Patients who had just undergone radical hysterectomy were divided into three groups. We used a retroperitoneal drain transvaginally for Groups A (n = 54) and B (n = 55) and transabdominally for Group C (n = 103). Group A was administered a first- and Groups B and C a second- or third-generation cephem antibiotic as the prophylactic antibiotic. We compared the surgery time, blood loss, fever index and febrile morbidity in these three groups. RESULTS: The average surgery time was Group A 344.2 +/- 13.7 min (mean +/- SE), Group B 425.6 +/- 11.0 min and Group C 528.2 +/- 10.9 min. A significant difference was observed among the groups (p < 0.05). In terms of blood loss during surgery, a significant increase (p < 0.05) occurred in Groups B (2400 +/- 196 g) and C (2373 +/- 130 g) compared with Group A (1820 +/- 122 g). For fever index, Group A showed a value of 36.1 +/- 2.7 dh, Group B 19.9 +/- 2.4 dh and Group C 8.8 +/- 1.5 dh. A significant difference was observed among the groups (p < 0.01). In terms of febrile morbidity, significant differences (p < 0.01, p < 0.0001) were observed between Groups B (14.6%) and C (8.7%) in comparison with Group A (44.4%), respectively. CONCLUSION: In radical hysterectomy with systematic lymphadenectomy, it may be preferable to choose transabdominal drains in the retroperitoneal space and second-generation cephem antibiotics for prophylaxis of postoperative retroperitoneal infections.
UI - 11906547
AU - Leborgne F; Leborgne JH; Zubizarreta E; Fowler JF; Maisonneuve J;
TI - Ferrari D; Curochquin R High-dose-rate brachytherapy at 14 Gy per hour to point A: preliminary results of a prospectively designed schedule for cancer of the cervix based on the linear-quadratic model.
SO - Int J Gynecol Cancer 2001 Nov-Dec;11(6):445-53
AD - Department of Radiation Oncology, Instituto de Radiologia y Centro de Lucha Contra el Cancer, Pereira Rossell Hospital, Montevideo, Uruguay. email@example.com
The objective of this study was to describe the results and complications of a prospectively designed high-dose-rate (HDR) brachytherapy schedule for early-stage cancer of the cervix, at 14 Gy/h to point A, based on the linear-quadratic model and our clinical experience. We used a combination of brachytherapy and external beam pelvic and parametrial irradiation in 88 consecutively seen patients with stage IB1-IIB treated by irradiation alone (1995-1998). The modeled HDR schedule consisted of three insertions on three treatment days separated by 10 days, with six 7 Gy planned brachytherapy fractions to point A, at 14 Gy/h, two on each treatment day with an interfraction interval of 6 h, plus an 18 Gy external whole-pelvic dose followed by additional parametrial irradiation. The calculated biologically effective dose (BED) was 92 Gy10 for tumor and 110 Gy3 for the rectum, equivalent to 77 and 66 Gy in 2 Gy fractions, respectively. The median overall treatment time was 41 days. The actuarial 4-year central recurrence-free rate, pelvic control, and disease-free survival rate were 97%, 93%, and 88% for stages IB-IIA and 79%, 75%, and 75% for stage IIB. The actuarial 4-year late complication rate for grades 2-3 was 4.7% (scale 0-3). We conclude that preliminary results of this HDR brachytherapy schedule for early-stage disease at a median follow-up of 52 months are as effective as the previously used low dose rate (LDR) at 0.44 Gy/h at point A. They are also as effective as medium-dose-rate schedules (MDR) at 1.6-1.5 Gy/h at this institution and do not require a further increase in fractionation of intracavitary treatments or in the whole-pelvic external beam irradiation dose common to standard HDR schedules. In addition, more patients per machine can be treated per day compared with MDR. Longer follow-up is required for a complete assessment of late complications.
UI - 11906552
AU - Park TK; Kim SN; Kwon JY; Mo HJ
TI - Postoperative adjuvant therapy in early invasive cervical cancer patients with histopathologic high-risk factors.
SO - Int J Gynecol Cancer 2001 Nov-Dec;11(6):475-82
AD - Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea.
The purpose of this study is to evaluate the efficacy of postoperative adjuvant therapy in preventing treatment failure after primary treatment with surgery in early invasive cervical cancer patients associated with the following histopathologic high-risk factors: lymph node metastasis (either macroscopic or microscopic), parametrial extension, lymphovascular permeation and depth of invasion > or =10 mm. Postoperative adjuvant concurrent chemoradiotherapy (PCCRT), postoperative adjuvant chemotherapy (PCT), or postoperative adjuvant radiotherapy (PRT) alone was administered to the 80 early invasive cervical cancers with at least one of the high-risk factors. Each of 61 patients received three to six cycles of chemotherapy at intervals of approximately 3 weeks. Twenty three patients were treated with PCCRT, 38 patients were treated with PCT alone, and 19 patients received PRT. The 5-year survival rates of patients with macroscopic lymph node metastasis were 66.7% and 35.7% in PCCRT and PRT, respectively. With microscopic lymph node metastasis, the 5-year survival rates were 83.3%, 60.0%, and 70.1% in PCCRT, PCT, and PRT, respectively. With parametrial extension, the 5-year survival rate was 58.1% in PCCRT. The 5-year survival rates of patients with lymphovascular permeation were 100%, 90.9%, and 66.7% in PCCRT, PCT, and PRT, respectively. With depth of invasion > or =10 mm, the 5-year survival rates were 100% and 91.3%, in PCCRT and PCT, respectively. PCCRT appears to be superior to PRT or PCT alone in early invasive cervical cancer patients with histopathologic high-risk factors.
UI - 11903183
AU - MacLeod C; O'Donnell A; Tattersall MH; Dalrymple C; Firth I
TI - Locally advanced cervix cancer: chemotherapy prior to definitive surgery or radiotherapy. A single institutional experience.
SO - Australas Radiol 2001 Nov;45(4):491-5
AD - Department of Radiation Oncology, Murray Valley Cancer Centre, Wodonga, Victoria, Australia. firstname.lastname@example.org
Primary or neoadjuvant chemotherapy prior to definitive local therapy has potential advantages for locally advanced cervix cancer. It can downstage a cancer and allow definitive local therapy to be technically possible (surgery), or potentially more effective (radiotherapy). It can also eradicate subclinical systemic metastases. This report reviews a single institution's experience of neoadjuvant chemotherapy prior to definitive local therapy for cervix cancer over a 13-year period. One hundred and six patients were treated with this intent. The patients were analysed for their response to chemotherapy, treatment received, survival, relapse and toxicity. The chemotherapy was feasible and the majority of patients had a complete or partial response (58.5%). Eight patients did not proceed to local treatment. Forty-six patients had definitive surgery and 52 had definitive radiotherapy. The 5-year overall survival was 27% and the majority of patients died with disease. The first site of relapse was usually in the pelvis (46.2%). Late complications that required ongoing medical therapy (n=6) or surgical intervention (n=2) were recorded in eight patients (7.5%). On univariate analysis stage (P=0.04), tumour size (P=0.01), lymph node status (P=0.003), response to chemotherapy (P=0.045) and treatment (P=0.003) were all significant predictors of survival. On multivariate analysis, tumour size (P < 0.0001) and nodal status (P=0.02) were significant predictors of survival. Despite the impressive responses to chemotherapy of advanced cervix cancer, there is evidence from randomized trials that it does not improve or compromise survival prior to radiotherapy. As its role prior to surgery remains unclear, it should not be used in this setting outside a prospective randomized trial.
UI - 11188007
AU - Solco-Innotech-Bulgermed.
TI - [Solcogyn - method for treatment of benign lesions of the uterine cervix with the best outcome]
SO - Akush Ginekol (Sofiia) 2000;39 Suppl 2():18-9
UI - 11913357
AU - Grigsby PW; Portelance L; Williamson JF
TI - High dose ratio (HDR) cervical ring applicator to control bleeding from cervical carcinoma.
SO - Int J Gynecol Cancer 2002 Jan-Feb;12(1):18-21
AD - Radiation Oncology Center, Mallinckrodt Institute of Radiology, Box 8224-21, Washington University School of Medicine, 4939 Children's Place-Suite 5500, St. Louis, Missouri 63110, USA. email@example.com
The objective of this study was to evaluate the use of the high dose rate (HDR) cervical ring applicator to control acute cervical bleeding from carcinoma of the uterine cervix. This study consists of 15 patients presenting with invasive carcinoma of the uterine cervix with acute vaginal bleeding requiring transfusion. Initial irradiation, delivered emergently because of vaginal bleeding, consisted of two fractions (5 Gy each fraction to the surface of the cervix) utilizing the HDR intracavitary vaginal ring applicator. Two fractions were administered at one week intervals for a total of 10 Gy to the surface of the cervix. Irradiation doses from the HDR ring applications were not considered into the composite total dose to point A. Diagnostic imaging evaluation and initiation of external irradiation were commenced during this initial weekly interval between fractions. Vaginal bleeding requiring no additional transfusions was achieved in 93% (14/15) of patients. No acute or long-term Grades 3, 4, or 5 bowel or bladder sequelae were noted. In conclusion, HDR cervical ring brachytherapy is effective in controlling acute vaginal bleeding and can be delivered without undue acute or long-term toxicity.
UI - 11860533
AU - Tyree WC; Cardenes H; Randall M; Papiez L
TI - High-dose-rate brachytherapy for vaginal cancer: learning from treatment complications.
SO - Int J Gynecol Cancer 2002 Jan-Feb;12(1):27-31
AD - Department of Radiation Oncology, Indiana University, 355 Barnhill Drive, RT 041, Indianapolis, Indiana, USA.
Historically, early stage vaginal cancer has been treated with low-dose-rate (LDR) brachytherapy with or without external beam radiation therapy (EBRT). Complication rates have been low and treatment efficacious. Although high-dose-rate (HDR) brachytherapy has been used for cervical cancer in many countries for over a decade, only more recently has it been integrated into treatment plans for vaginal cancer. This paper describes three patients treated with HDR brachytherapy who experienced significant late effects. Given the very limited amount of literature regarding the use of HDR brachytherapy in vaginal cancer, this analysis potentially contributes to an understanding of treatment-related risk factors for complications among patients treated with this modality.A focused review of hospital and departmental treatment records was done on three patients treated with HDR brachytherapy. Abstracted information included clinical data, treatment parameters (technique, doses, volume, combinations with other treatments) and outcomes (local control, survival, early and late effects). A review of the available literature was also undertaken. All patients had significant complications. Although statistical correlations between treatment parameters and complications are impossible given the limited number of patients, this descriptive analysis suggests that vaginal length treated with HDR brachytherapy is a risk factor for early and late effects, that the distal vagina has a lower radiation tolerance than the upper vagina with HDR as in LDR, and that combining HDR with LDR as done in our experience carries a high risk of late toxicity. Integration of HDR brachytherapy techniques into treatment plans for early stage vaginal cancers must be done cautiously. The etiology of the significant side effects seen here is likely to be multifactorial. For users of HDR brachytherapy in vaginal cancer, there is a need to further refine and standardize treatment concepts and treatment delivery. Ideally this will be based on continued careful observation and reporting of both favorable and unfavorable outcomes and experiences.
UI - 11942040
AU - Hansgen G; Kuhnt T; Pigorsch S; Strauss H; Dunst J
TI - [Adjuvant simultaneous radiochemotherapy after operated uterine cervix carcinoma in high risk situation. Results of a pilot study]
SO - Strahlenther Onkol 2002 Feb;178(2):71-7
AD - Klinik und Poliklinik fur Strahlentherapie, Martin-Luther-Universitat Halle/Wittenberg. firstname.lastname@example.org
BACKGROUND: The most important factors for prognosis of cervical cancers are age and histological criteria such as the tumor size, the involvement of lymph nodes, lympho-vascular space involvement as well as microvessel involvement and poor tumor differentiation (grading 3). Here we present the results of concomitant chemo-radiation at high-risk situation of patients with cervical cancer after surgery. PATIENTS AND METHODS: The study comprised 34 patients with median age of 40