Advanced Stage Cervical Carcinoma Research Articles

Oncologic outcomes of surgical para-aortic lymph node staging in patients with advanced cervical carcinoma undergoing chemoradiation

ObjectivesWe aimed to evaluate the utilization and impact of surgical para-aortic lymph node staging on the survival of patients with locally advanced stage cervical carcinoma receiving definitive chemoradiation.MethodsWe identified patients...

Neoadjuvant chemotherapy for locally advanced stage (IB2-IIA2-IIB) cervical carcinoma: Experience of a tertiary center and comprehensive review of the literature

Objective:This study aimed to evaluate neoadjuvant chemotherapy (NACT) for locally advanced stage cervical carcinoma.Materials and Methods:Data of 43 patients with locally advanced cervical carcinoma who had NACT were reviewed. NACT protocols implemented included cisplatin/5-fluorauracil, cisplatin/UFT, and carboplatin/paclitaxel. After NACT, the patients were re-examined, and patients who had a tumor size ≤40 mm underwent Piver-Rutledge type III radical hysterectomy, while other patients received radiotherapy. Following NACT, clinical responses were assessed according to the criteria of the World Health Organization.Results:The mean age of the patients was 49.4 years, and the median follow-up duration was 48 (range, 5-228) months. The median tumor sizes were 50 and 30 mm before and after NACT, respectively. Complete clinical response was observed in 4 (9.3%) patients, partial clinical response in 8 (18.6%), and pathologic complete response in 3 (6.9%). Stable disease was noted in 30 (69.9%) patients and progression in 1 (2.3%) patient. After NACT, 31 patients have undergone radical surgical procedures. The 5-year disease-free survival rate was 72%, and the 5-year disease-specific survival rate was 91%. Age, International Federation of Gynaecology and Obstetrics 2009 stage, histopathologic type, NACT protocol, rate of decrease in tumor size after NACT, clinical response, number of courses, tumor size before NACT, tumor size after NACT, and lymph node metastasis were not associated with disease-free survival.Conclusion:Following NACT, a significant reduction in tumor dimension was observed, and the probability of radical surgery is increased. However, clinical response was not predictive of survival.

Advanced stage cervical carcinoma diagnosed one year after pregnancy: the importance of cervical cancer screening

<p class="abstract">Cervical cancer is the most common gynecological malignancy during pregnancy. The incidence of cervical cancer during pregnancy is 0.004-0.1%. Cervical cancer accompanied by pregnancy may have severe maternal and fetal consequences. In our case, our patient died approximately 1 year after giving birth and 2 months after being diagnosed with cervical cancer. Among the treatment options, chemotherapy, radiotherapy and surgical treatment options were available alone or in combination. Type of treatment needed to be individualized and depended on stage, type of histology and gestational age. The aim of our study was to emphasize the importance of vaginal examination and its method during pregnancy in the diagnosis of cervical cancer, which was among the preventable cancers in pregnancy.</p>

Impact of surgical para-aortic lymph node staging for patients with advanced-stage cervical carcinoma undergoing definitive chemoradiation

<h3>Objectives:</h3> Evaluate the utilization and impact of surgical para-aortic surgical staging on the survival of patients with locally advanced-stage cervical carcinoma receiving definitive chemoradiation. <h3>Methods:</h3> Patients diagnosed between 2004-2015 with advanced stage (IIA-IVA) squamous, adenocarcinoma, adenosquamous carcinoma of the cervix with no distant metastases who did not undergo hysterectomy and received primary chemoradiation (external beam with or without brachytherapy) with at least one month of follow-up were identified in the National Cancer Database. Two groups were formed based on the assessment method of the para-aortic lymph node status; radiologic assessment versus surgical lymphadenectomy (PaLND). Overall survival was compared with the log-rank test following generation of Kaplan-Meier curves and a Cox multivariate model was constructed to control for a priori selected confounders. <h3>Results:</h3> A total of 3610 patients who met the inclusion criteria were identified. Surgical para-aortic staging was performed for 287 (8%) patients. Patients who had PaLND were younger (median 49 vs 53 years, p<0.001) more likely to have private insurance (49.1% vs 35.2%, p<0.001), or stage II disease (63.4% vs 56.3%, p=0.019), and receive brachytherapy (74.2% vs 66.9%, p<0.001). Patients who underwent PaLND were also more likely to have LNs categorized as positive (16.1% vs 11.2%, p=0.014). There was no difference in OS between patients who underwent primary radiologic vs primary surgical para-aortic LN assessment, p=0.42; 5-year OS rates were 55.6% for both groups. After controlling for patient age, race, insurance status, stage, histology, presence of comorbidities, history of another tumor, and receipt of brachytherapy, performance of PaLND was not associated with a survival benefit (HR: 1.05, 95% CI: 0.86, 1.29). <h3>Conclusions:</h3> In a large cohort of patients with locally advanced stage cervical carcinoma, undergoing primary chemoradiation, staging PaLND was rarely performed and not associated with a survival benefit.

Prognostic Impact of Histopathology in Patients with Advanced Stage Cervical Carcinoma Treated with Radiotherapy

Introduction: Cervical cancer is the fourth most common cancer in women worldwidev . Most patients in developing countries including Bangladesh present at advanced stage. Histopathological types of cervical cancer influence the treatment outcome when treated by radiation therapy.&#x0D; Objective: To determine the disease free survival (DFS) in different histopathological types in advanced stage cervical carcinoma treated with radiotherapy.&#x0D; Methods: A prospective cohort study was conducted in Gynaecological oncology outpatient department (GOPD) of National institute of Cancer Research &amp; Hospital (NICRH), Dhaka for one year from September’2016 to July’2017. Advanced stage (IIB-IVB) cervical cancer who completed radiation therapy and histopathological type either squamous cell carcinoma or adenocarcinoma of cervix were included in this study.&#x0D; Results: The median follow-up time was 1.82 years; range was 8 to 24 months. Average disease free survival (DFS) was 1.53years in squamous cell carcinoma (SSC) and 1.51 years in adenocarcinoma (ADC). Local recurrences was higher in adenocarcinoma group (62.5%) than squamous cell carcinoma (30.5%) &amp; the difference was statistically significant (p = 0.001). Loco-regional recurrence and distal recurrence were also higher in ADC than SSC but results were not statistically significant (p=.345, p=.795). In multivariate analysis it was shown that histopathological type and stage of disease were found to be independently significant prognostic factors for DFS, hazard ratio were 1.766 (p=.018) and 2.173 (p=.006).&#x0D; Conclusion: Adenocarcinoma was a poor prognostic factor for patients with locally advanced cervical carcinoma. Advanced stage of disease was also significant predictor for disease free survival.&#x0D; J Bangladesh Coll Phys Surg 2019; 37(4): 175-180

EP18.02: Diffuse pelvic actinomycosis mimicking advanced stage cervical carcinoma: a case report

EP18.02: Diffuse pelvic actinomycosis mimicking advanced stage cervical carcinoma: a case report

The landscape of somatic mutations in Indonesian cervical cancer is predominated by the PI3K pathway

ObjectiveTo investigate the prevalence of somatic mutations in Indonesian cervical carcinoma patients in the context of histology and human papillomavirus (HPV) type. MethodsIn total 174 somatic hot-spot mutations in 13 genes were analyzed by mass spectrometry in 137 Indonesian cervical carcinomas. ResultsIn 66/137 tumors (48%) 95 mutations were identified. PIK3CA was most frequently mutated (24%), followed by FBXW7 (7%), CTNNB1 (6%), and PTEN (6%). In squamous cell carcinomas more often multiple mutations per sample (p=0.040), and more PIK3CA (p=0.039) and CTNNB1 (p=0.038) mutations were detected compared to adenocarcinomas. PIK3CA mutations were associated with HPV 16 positivity, CDKN2A mutations with HPV 52 positivity, and, interestingly, PTEN mutations with HPV negativity. Balinese tumor samples more often carried multiple mutations (p=0.019), and more CTNNB1, CDKN2A, and NRAS mutations compared to Javanese tumor samples. ConclusionsPotentially targetable somatic mutations occurred in 48% of Indonesian cervical carcinomas. The landscape of mutations is predominated by mutations concerning the PI3K pathway, and we prompt for more research on developing therapies targeting this pathway, explicitly for the more advanced stage cervical carcinoma patients.

An integrated strategy of biological and physical constraints in biological optimization for cervical carcinoma

BackgroundFor cervical carcinoma cases, this study aimed to evaluate the quality of intensity-modulated radiation therapy (IMRT) plans optimized by biological constraints. Furthermore, a new integrated strategy in biological planning module was proposed and verified.MethodsTwenty patients of advanced stage cervical carcinoma were enrolled in this study. For each patient, dose volume optimization (DVO), biological model optimization (BMO) and integrated strategy optimization (ISO) plans were created using same treatment parameters. Different biological models were also used for organ at risk (OAR) in BMO plans, which include the LKB and Poisson models. Next, BMO plans were compared with their corresponding DVO plans, in order to evaluate BMO plan quality. ISO plans were also compared with DVO and BMO plans, in order to verify the performance of the integrated strategy.ResultsBMO plans produced slightly inhomogeneity and less coverage of planning target volume (PTV) (V95=96.79, HI = 0.10: p < 0.01). However, the tumor control probability (TCP) value, both from DVO and BMO plans, were comparable. For the OARs, BMO plans produced lower normal tissue complication probability (NTCP) of rectum (NTCP = 0.11) and bladder (NTCP = 0.14) than in the corresponding DVO plans (NTCP = 0.19 and 0.18 for rectum and bladder; p < 0.01 for rectum and p = 0.03 for bladder). V95, D98, CI and HI values that were produced by ISO plans (V95 = 98.31, D98 = 54.18Gy, CI = 0.76, HI = 0.09) were greatly better than BMO plans (V95 = 96.79, D98 = 53.42Gy, CI = 0.71, HI = 0.10) with significant differences. Furthermore, ISO plans produced lower NTCP values of rectum (NTCP = 0.14) and bladder (NTCP = 0.16) than DVO plans (NTCP = 0.19 and 0.18 for rectum and bladder, respectively) with significant differences.ConclusionsBMO plans produced lower NTCP values of OARs compared to DVO plans for cervical carcinoma cases, and resulted in slightly less target coverage and homogeneity. The integrated strategy, proposed in this study, could improve the coverage, conformity and homogeneity of PTV greater than the BMO plans, as well as reduce the NTCP values of OARs greater than the DVO plans.

SU‐F‐T‐420: Dosimetry Comparison of Advanced External Beam Radiation Treatment Modalities to Brachytherapy Treatments in Patients with Cervical Cancer

Purpose:A retrospective comparison of dose distributions achievable by High dose rate brachytherapy (HDRBT), Helical TomoTherapy (TOMO), CyberKnife (CK) and RapidArc (RA) in locally advanced inoperable cervical cancer patients is presented.Methods:Five patients with advanced stage cervical carcinoma were selected for this study after a full course of external beam radiotherapy (EBRT), chemotherapy and HDR Brachytherapy. To highlight any significant similarities/differences in dose distributions, high‐risk clinical target volume (HRCTV) coverage, organs at risk (OAR) sparing, and machine specific delivery limitations, we used D90 (dose received by 90% of the volume) as the parameter for HRCTV coverage as recommended by the GEC‐ESTRO Working Group. We also compared both integral and differential dose volume histograms (DVH) between different dose distributions treatment modalities for HRCTV and OAR.Results:TOMO and RA provided the most conformal dose distributions to HRCTV. Median doses (in Gy) to organs at risk were; for rectal wall: 1.7±0.6, 2.5±0.6,1.2±0.3, and 1.5±0.6, and for bladder wall: 1.6±0.1, 2.4±0.4, 0.8±0.6, and 1.5±0.5, for HDRBT, TOMO, CK, and RA, respectively.Conclusion:Contemporary EBRT modalities might be able to replace brachytherapy treatments for cervix cancer. While brachytherapy dose distributions feature high dose gradients, EBRT modalities provide highly conformal dose distributions to the target. However, it is still not clear whether a highly conformal dose or high gradient dose is more clinically relevant for the HRCTV in cervix cancer patients.

SU‐F‐T‐257: Comparison Study of the Biological and Physical Optimization for Cervical Carcinoma

Purpose:In this study, IMRT optimization based on biological related models were applied in the clinic for cervical carcinoma cases and the results were compared with the traditional physical optimization. Methods: Twenty patients of advanced stage cervical carcinoma were selected in this study. The treatment plan was generated on each patient using both biological and physical optimized model respectively. Additionally, the biological optimization was based on two basic models for bladder and rectum: Poisson (adjustable parameters: alpha/beta, gamma, D50) and Lyman‐Kutcher‐Burman (adjustable parameters: m, n, D50). And then each optimized biological plan was compared with the corresponding physical plan. During this comparison, all biological and physical parameters, such as NTCP,TCP, target coverage and homogeneous index(HI), were evaluated by paired T‐test to verify IMRT plans quality.Results:The NTCP values by biological optimization were lower than the values from corresponding physical optimization. For the bladder and rectum, the detail of NTCP values are 0.144 and 0.178 with p=0.028 for bladder, and 0.108 and 0.186 with p= 7.97E‐5 for rectum respectively. The mean dose and V40 of bladder and rectum were comparable, and there was no significant difference between these two optimizations. For PTV, both optimized models achieved similar target coverage and homogeneous index (For example, D98=53.4 Gy and 54.6 Gy from biological optimization and physical optimization respectively with p=2.94E‐9), and there were no significant differences in the tumor control probability(TCP) values.Conclusion:IMRT optimization based on biological model did not decrease the plan quality, and could spare bladder and rectum with lower NTCP value much more compared with traditional physical optimization for cervical carcinoma. Our initial experiment demonstrated that the biological optimization could be a potential alternative method to the traditional physical one.We want to thank Dr. Lei Xing and Dr. Yong Yang in the Stanford University School of Medicine for this work. This work was jointly supported by NSFC (61471226), Natural Science Foundation for Distinguished Young Scholars of Shandong Province (JQ201516), and China Postdoctoral Science Foundation (2015T80739, 2014M551949).

The Best Dose Rate System of Intracavitary Brachytherapy for Cervical Carcinoma: A Comparative Study

Intracavitary brachytherapy (ICBT) is an essential part of the treatment for patients with cervical carcinoma. Different dose rate systems viz. low-dose-rate (LDR), high-dose-rate (HDR) and pulsed-dose-rate (PDR) are used for ICBT. Both LDR and HDR have shown comparable results but PDR is relatively a new and less experienced dose rate system, though individual studies have shown equally good results. Although HDR is most popular but there is no study in the literature comparing the three dose rate systems. Our study is a retrospective analysis with the aim of comparing the results of LDR, HDR and PDR ICBT in cervical carcinoma. This study is based on the data of 613 patients of cervical carcinoma treated with LDR- (271 patients), HDR- (259 patients), and PDR- (83 patients) ICBT following external beam radiation therapy (EBRT). The HDR/PDR patients were treated after the year 2004 when we abandoned the LDR practice. The exclusion criteria were: 1) previous surgery, 2) patients treated with palliative EBRT and 3) patients who did not complete the prescribed course of EBRT or ICBT. All patients received EBRT to whole pelvis to a dose of 40-50 Gy by conventional fractionation regime followed by ICBT. Chemotherapy was given to suitable patients but LDR patients did not receive chemotherapy (pre-chemotherapy era). The dose of ICBT was 30 Gy by LDR in a single session and 7Gy x 3 fractions (weekly fraction) by HDR. For PDR, a dose of 27 Gy was employed using an hourly pulse of 70 cGy. All the doses of ICBT were prescribed to Point A. Patients were followed up regularly to assess the disease status, survival and toxicity. Survival was calculated by Kaplan-Meier survival method. Each patient, who lost follow up after a certain period was censored at that point of time for survival analysis. Log rank test was used to find out the p value and a value of <0.5 was considered significant. Median age of the patients was 49 years (range 24-78). Stage III was the commonest presenting stage (54% patients). Median follow up period in LDR, HDR and PDR group was 60, 52 and 30 months respectively. Loco-regional control rate in LDR, HDR and PDR group was 74%, 75% and 77% respectively. Similarly the 5-year disease free survival (DFS) rates were comparable in three groups (63% vs 64% vs 68%). The 5-year DFS for stage III with LDR, HDR and PDR was 35%, 60% and 72% respectively (p value 0.038). Severe late toxicity rate was comparable in three groups (12% vs 8% vs 8.9%) respectively. Ours is the first ever study in the literature comparing the three dose rate systems of ICBT for cervical carcinoma. The results have shown comparable loco-regional control, survival and toxicity rates with three dose rate systems. For stage III disease, PDR-ICBT significantly improved 5-year DFS as compared to other dose rate systems. We, therefore, suggest that PDR-ICBT should be further studied for the advanced stage cervical carcinoma.

Pathway Profiling and Rational Trial Design for Studies in Advanced Stage Cervical Carcinoma: A Review and a Perspective

Multiple genetic abnormalities will have occurred in advanced cervical cancer and multiple targeting is likely to be needed to control tumor growth. To date, dominant therapeutic targets under scrutiny for cervical cancer treatment have been EGFR pathway and angiogenesis inhibition as well as anti-HPV vaccines. The potentially most effective targets to be blocked may be downstream from the membrane receptor or at the level of the nucleus. Alterations of the pathways involved in DNA repair and in checkpoint activations, as well as the specific site of HPV genome integration, appear worth assessing. For genetic mutational analysis, complete exon sequencing may become the norm in the future but at this stage frequent mutations (that matter) can be verified by PCR analysis. A precise documentation of relevant alterations of a large spectrum of protein biomarkers can be carried out by reverse phase protein array (RPPA) or by multiplex analysis. Clinical decision-making on the drug(s) of choice as a function of the biological alteration will need input from bio-informatics platforms as well as novel statistical designs. Endpoints are yet to be defined such as the loss (or reappearance) of a predictive biomarker. Single or dual targeting needs to be explored first in relevant preclinical animal and in xenograft models prior to clinical deployment.

Chemoradiation therapy in pregnant patients treated for advanced-stage cervical carcinoma during the first trimester of pregnancy: report of two cases

Two patients treated using chemoradiation therapy (CRT) (with fetus in utero) for advanced-stage squamous cell cervical carcinoma diagnosed during the first trimester of pregnancy are reported. One patient with a stage IVA disease diagnosed at 12 weeks of gestation was treated by exclusive CRT with the fetus in utero. She recurred 20 months after the end of the treatment. The second patient had a stage IIB disease diagnosed at 12 weeks of gestation and was treated by CRT with the fetus in utero followed by completion surgery (radical hysterectomy and para-aortic lymphadenectomy) due to the presence of a suspicious residual disease. No residual disease was observed during the histologic analysis of hysterectomy and nodes specimens. This patient is alive and free of disease 24 months after surgery. Our observations could suggest that CRT in pregnant patients with fetus in utero is feasible without major short-term toxicity. Such management could be proposed in patients with a bulky cervical cancer diagnosed during the first trimester of the pregnancy. Management of the uterine evacuation depends on the local tumor spread.

Phase II trial of the combination of bryostatin-1 and cisplatin in advanced or recurrent carcinoma of the cervix: a New York Gynecologic Oncology Group study

Objective. Bryostatin-1 is a macrocyclic lactone that has been shown to regulate protein kinase C (PKC) activity and thereby potentially inhibit tumor invasion, angiogenesis, cell adhesion, and multidrug resistance. In preclinical experiments, bryostatin-1 induces tumor growth inhibition and enhances cytotoxicity when combined with other agents including cisplatin in cervical cancer cells. It was therefore anticipated that combination bryostatin-1–cisplatin therapy would be effective in patients with cervical cancer. The current study was conducted to evaluate this therapeutic approach in patients with recurrent or advanced-stage cervical carcinoma. Methods. An IRB-approved New York Gynecologic Oncology Group (NYGOG) trial was activated for patients with a histological diagnosis of metastatic cervical cancer or in patients with recurrent disease not eligible for surgery or radiation. Enrolled patients received bryostatin-1 (50–65 μg/m 2) as a 1-h infusion followed by cisplatin (50 mg/m 2). The combined treatment was administered every 21 days. Results. Fourteen patients were enrolled. The majority of patients had squamous cell carcinoma. Ten out of fourteen patients had recurrent disease. Fifty percent of the patients received bryostatin at 50 μg/m 2 and 50% received bryostatin at 65 μg/m 2. Seventy-one percent completed two cycles of treatment. The most common grade II–III toxicities were myalgia, anemia, and nausea or vomiting. One patient developed a hypersensitivity reaction and one developed grade III nephrotoxicity. Seventy-one percent (10/14) of patients were evaluated for tumor response. Eight out of ten (80%) of patients had progressive disease and 2/10 (20%) had stable disease. There were no treatment responses. Conclusion. Despite promising preclinical data, this clinical trial indicates that the combination of cisplatin and bryostatin-1 at the doses and schedule used is not effective in patients with advanced-stage or recurrent cervical cancer. There is even the possibility of therapeutic antagonism. The development of a serum assay for bryostatin-1 and additional mechanistic studies would be useful for future bryostatin clinical trials.

温熱放射線治療抵抗性子宮頸癌に関与するHIF1A遺伝子

Microarray profiling is a powerful approach to identify individual genes that may have important functions of a neoplasm. To identify a set of genes related to thermoradioresistancy of cervical carcinoma, we investigated a total of 19 patients with Stage IIIA to Stage IVB cervical cancer who underwent definitive thermoradiotherapy between May 1995 and August 2001. We compared the expression profiles of 8 thermoradiosensitive and 11 thermoradioresistant tumors obtained by punch biopsy before treatment using a cDNA microarray consisting of 23, 040 human genes. We selected 35 genes on the basis of a clustering analysis. One of these genes in thermoradioresistant tumors was already known to be associated with hypoxia-inducible factor 1A (HIF1A) that regulates the expression of a variety of genes encoding proteins related to angiogenesis and to anaerobic metabolism of cells exposed to hypoxic stress.These results suggested that HIF1A gene might play a role of thermoradioresistancy in advanced-stage cervical carcinoma.

P53 and p21 Expression in Precancerous Lesions and Carcinomas of the Uterine Cervix: Overexpression of p53 Predicts Poor Disease Outcome

Objectives. Abnormal expression of the p53 and p21waf1/cip1 tumor suppressor genes has been observed in a variety of human tumors, but little is known about its expression during cervical tumorigenesis. To identify the potential implications of both genes in the development of cervical carcinoma and explore the clinical importance of changes in gene expression, we assessed the levels of both proteins in precancerous lesions and carcinomas of the cervix.Methods. In our study, 10 low-grade squamous intraepithelial lesions (LSIL), 35 high-grade squamous intraepithelial lesions (HSIL), 12 microinvasive carcinomas, and 103 invasive carcinomas were evaluated. The expression of p53 and p21 was studied by immunohistochemistry using monoclonal antibodies specific for these proteins.Results. p21 was expressed in all samples of normal epithelium, LSIL, and HSIL, and the mean values of expression were 50.3, 42.5, and 44.5%, respectively. Conversely, the expression of p21 was significantly reduced in microinvasive (30.7%) and invasive carcinomas (9.9%). p53 nuclear staining was not detected in normal epithelium samples or LSILs, while 4 (11.4%) of 35 HSILs, 1 (8.3%) of 12 microinvasive carcinomas, and 38 (36.9%) of 103 invasive carcinomas were positive for p53. Compared with the results of the control group, precancerous lesions, and microinvasive carcinoma, the mean value of p53 expression (4.8%) in invasive carcinoma was significantly higher. Furthermore, p53 overexpression was significantly associated with advanced stage of the tumor (P < 0.001) [16/67 (23.9%) stage I, 15/28 (53.6%) stage II, and 7/8 (87.5%) stage III/IV]. In univariate analysis, p53 overexpression was a significant predictor of poor survival, whereas it had no independent influence on overall survival using the Cox regression method. Our data also revealed that no association between p53 immunostaining and p21 expression was found.Conclusions. The trend of reduced p21 expression in microinvasive and invasive carcinomas suggests that p21 may play a tumor-suppressor function in neoplastic transformation in cervical epithelium and inactivation of p21 may be an early event in cervical carcinogenesis. Our results indicated that p53 overexpression was a significant predictor of poor disease outcome in univariate analysis. Moreover, significantly increased expression of p53 in advanced-stage cervical carcinoma implies that inactivation of p53 is associated with tumor progression. Finally, this study further supports the notion that induction of p21 expression can be regulated in a p53-independent manner.

Comparative genomic hybridization reveals non-random chromosomal aberrations in early preinvasive cervical lesions

We performed CGH analysis on 34 cervical lesions, which included 8 cases of koilocytosis, 6 mild dysplasias and 20 moderate dysplasias. Chromosome aberrations were detected in 11 cases of which 9 were moderate dysplasias. A total of 55 chromosome arms were involved. The most frequent aberrations were losses of 5p and Xq, each of which was present in 5/34 cases. Gain of 3q was detected in two moderate dysplasias. This aberration is the most frequent copy number change in advanced-stage cervical carcinoma. A considerable number of the aberrations found in the preinvasive cases of this study are frequently present in invasive cervical tumors. The presence of apparently non-random chromosome aberrations in early preinvasive cervical lesions has not previously been described.

High dose rate transperineal interstitial brachytherapy for cervical cancer: high pelvic control and low complication rates

Purpose: To report the clinical outcome for cervical carcinoma treated with external beam pelvic radiotherapy and interstitial high dose rate (IS-HDR) brachytherapy. Methods and Materials: Between July 1991 and June 1996, 62 patients with locally advanced stage cervical carcinoma or early stage carcinoma that precluded satisfactory tandem and ovoid insertion were treated. Most patients received 36 Gy (range: 25 Gy–45 Gy) external beam radiotherapy (EBRT) to the pelvis prior to brachytherapy implant. EBRT was continued, with central shielding, to a dose of 50 Gy to the pelvic sidewalls. HDR Iridium-192 brachytherapy was given in 6 fractions of 5.5 to 6.0 Gy. The mean follow-up was 40 months. Results: Stage distribution was: Stage IB (12), Stage IIA (1), Stage IIB (26), Stage IIIA (6), Stage IIIB (13), and Stage IVA (4). The overall local tumor control was 94%. Local control rates by FIGO stage were Stage I (12/12) 100%, Stage II (25/27) 93%, Stage III (18/19) 95%, and Stage IV (3/4) 75%. The regional pelvic control rates were overall 81%, Stage I (12/12) 100%, Stage II (22/27) 81%, Stage III (15/19) 79%, and Stage IV (1/4) 25%. Distant metastasis developed in 20 patients (32%). The actuarial 5-year disease-free survival was for all patients 48%, Stage I 81%, Stage II 47%, Stage III 39%, and Stage IV O%. Grade 3–4 delayed morbidity resulting from treatment, occurred in 6.5% (4/62) of patients. A fistula without local recurrence occurred in 1.6% (1/62) patients. Conclusions: We report excellent local and regional pelvic control results using a 6 fraction IS-HDR brachytherapy protocol for cervical carcinoma. The incidence of severe complications is low and suggests that a consistent brachytherapy technique and multiple HDR fractions are therapeutically advantageous to patients treated for cervical carcinoma.

Primary Surgical Cure of Stage III-B Cervical Carcinoma with Adnexal Metastasis

Management of patients with advanced stage cervical carcinoma remains suboptimal. Primary radiation therapy has been the standard treatment for years. Despite some changes in radiation technique, cure rates for advanced stage cervical cancer remain disappointing. Radiation complications in those patients can also be severe. We report here a case of a patient who presented with renal failure from bilateral ureteral obstruction from stage III-B cervical squamous carcinoma. The patient underwent a primary total pelvic exenteration with low rectosigmoid reanastomosis, urinary conduit construction, and cecal neovagina construction as definitive treatment. She was found to have metastasis to the broad ligament, ovary, and fallopian tube. Surgical margins and lymph nodes were negative. The patient did not receive any radiation therapy or chemotherapy. The patient is alive, healthy, and without evidence of disease 8 years following treatment.

88 Early results of exclusive radiotherapy which was given according to ICRU 38 in advanced stage cervical carcinoma

88 Early results of exclusive radiotherapy which was given according to ICRU 38 in advanced stage cervical carcinoma