Cervix Cancer Patients Research Articles

Dosimetric impact of dwell time deviation constraint on inverse brachytherapy treatment planning and comparison with conventional optimization method for interstitial brachytherapy implants.

High-dose rate remote afterloading brachytherapy machine and advanced treatment planning system help in getting optimum dose to tumor and low dose to normal structures. Inverse planning simulated annealing (IPSA) optimization technique has a unique feature of dwell time deviation constraint (DTDC). In this study, six IPSA-based plans having different DTDC values with routinely practiced geometric plus graphical optimization (GO + GrO) have been compared using various dosimetric parameters. For this retrospective study, we have generated IPSA-optimized interstitial brachytherapy plans for ten cancer cervix patients. Routinely practiced GO + GrO-based plans were compared with six different IPSA plans having varying DTDC values from 0.0 to 1.0 using different dosimetric indices. Conformity index and homogeneity index (HI) were higher in GO + GrO plans, compared to IPSA-optimized plans. However, HI of IPSA plans was increasing with increasing DTDC values. High-dose volumes were well controllable using DTDC parameter in IPSA-optimized plans. Dose to the rectum and bladder was smaller for IPSA-optimized plans than GO + GrO plans. One of the benefits of applying DTDC in IPSA-optimized plan is that it reduces high-dose volumes. Another advantage is the reduction in rectum and bladder dose.

Comparison of ketofol versus propofol for procedural sedation and analgesia in cervical cancer brachytherapy: A prospective, randomized double blind study

Most common drug used for outpatient procedural sedation and analgesia is propofol, with limitations like systemic hypotension. Combining propofol with ketamine preserves sedation efficacy, minimizing their respective adverse effects. So, we aimed to compare ketofol (ketamine+propofol) versus propofol regarding their total drug consumption, recovery profile, effect on haemodynamic and respiratory parameters in brachytherapy patients. A prospective, randomized, controlled double blind study was carried out in 100 female patients between 20-60 years, 30-70kg, ASA I-III undergoing brachytherapy as outpatient procedure on elective basis, after ethical clearance from institutional committee. These were randomly divided into 2 groups (50 each). Group P-Injpropofol (10mg/ml) 2mg/kg for induction and 20mg as supplementation. Group K-Injketofol (10mg/ml) (ketamine 50mg+propofol 100mg, 1:2) 2mg/kg for induction and 20 mg as supplementation.The supplementation dose required was significantly higher in propofol group (800mg) as compared to ketofol group (20mg) (p=0.00). Also, the fall in SBP and DBP was significantly less in ketofol group than propofol group (p<0.01). The mean awakening time (time from end of procedure to MRSS =3) andmean recovery time (time from end of procedure to achievement of Aldrete score 10) was more in ketofol group than propofol group (p<0.003), the difference was less than 1-2 min, so it was clinically not significant. Ketamine-propofol combination in 1:2 ratio in a single syringe as ketofolis better alternative to propofol in providing sedation and analgesia with better haemodynamic stability, for outpatient brachytherapy procedure in cancer cervix patients.

Magnetic resonance imaging-based validation of the 2018 FIGO staging system in patients treated with definitive radiotherapy for locally advanced cervix cancer

ObjectiveTo validate the revised 2018 International Federation of Gynecologic and Obstetrics (FIGO) staging system in patients who underwent diagnostic magnetic resonance imaging (MRI) and radiotherapy (RT) for locally advanced cervix cancer. MethodsWe analyzed 677 patients who were diagnosed with pelvic MRI and treated with definitive (chemo-)RT for locally advanced cervix cancer (stage IB2/IIA2-IVA or N+) between 1992 and 2018. Patients were classified according to 2009 and 2018 FIGO staging, and survival outcomes were compared. We developed a nomogram to improve prediction of progression-free survival (PFS). ResultsPelvic and paraaortic lymph nodes were positive in 331 (48.9%) and 78 (11.5%) patients, respectively. At a median follow-up of 77.9 months, the 5-year PFS was 83.5%, 65.2%, 71.0%, 60.6%, 37.6% and 38.9% for IB, IIA, IIB, IIIA, IIIB and IVA according to FIGO 2009 and 88.9%, 60.0%, 73.8%, 66.7%, 36.3%, 68.9%, 43.6%, and 38.9% for IB, IIA, IIB, IIIA, IIIB, IIIC1, IIIC2, and IVA according to FIGO 2018, respectively. Survival of stage IIIC cervix cancer depended on the local extent of the tumor: the 5-year PFS of T1, T2, and T3 stages were 80.3%, 73.9%, and 45.5% for IIIC1 and 100%, 44.9%, and 23.4% for IIIC2. Histology, tumor size, node metastasis, FIGO 2009, and treatment modality were independent prognostic factors in the Cox regression analysis, and the nomogram incorporating these factors outperformed FIGO 2009 and FIGO 2018 (AUC 0.718 vs. 0.616 vs. 0.594). ConclusionsFIGO 2018 revision was associated with heterogenous outcomes among stage III cervix cancer patients. Our nomogram can assist the FIGO system in predicting PFS after definitive RT.

Role of free radicals and antioxidants in cervical cancer in southern part of Rajasthan

Introduction: Present study is conducted to measure the role of free radicals malondialdehyde and vitamin-C and vitamin-E in cervical cancer women in southern part of Rajasthan. Materials and Methods: Total 80 cases and controls were taken and level of MDA were determined by the Thiobarbituric acid (TBA) test which is the colorimetric reaction of MDA and TBA in acid solution. Vitamin C was determined by the method of Natelson, (1971). Vitamin E was determined by Baker and Frank method. Results: The serum level of malondialdehyde, vitamin-C and vitamin-E level in cervix cancer patients and controls using paired t-test for independent means and found that a statistically significant difference exist between case and controls. Conclusion: Present study concluded that serum levels of vitamin C and vitamin E decreases and level of MDA increases in cervix cancer patients. So the serum levels of these micronutrients as a marker in early diagnosis of cervix cancer as adjuvant to other methods as well as by providing supplementation of these micronutrients. Keywords: Cervix carcinoma, Malondialdehyde, Oxidative stress, Polyunsaturated fatty acid, Thiobarbituric acid reactive substances, Antioxidant vitamins.

A Retrospective Comparison of the Outcomes of Laparoscopic and Open Radical Hysterectomy for Early and Advanced Cancer of the Cervix, in the Post-LACC Era

Laparoscopic radical hysterectomy (LRH) is being performed for cervical cancer treatment in many centres worldwide for last three decades. Since the results of LACC trial came out, a number of centres are reverting back to conventional open radical hysterectomy. In this study, we compared the surgical and oncological outcomes of LRH and ORH performed in our centre. This is a retrospective study in which we included 171 cancer cervix patients who underwent LRH or ORH in our centre from December 2012 to march 2018. We included FIGO (2009 edition) stages IB1 to IIB cervical cancer. Patients with stages IB2, IIA2 and IIB received neo-adjuvant therapy with either chemotherapy alone or concurrent chemoradiotherapy. Their demography, surgical morbidity, recurrence and survival data were collected and analysed. The survival data for patients who had upfront surgery and those with surgery after neo-adjuvant therapy were compared separately. There was significant difference between the two arms only in the estimated blood loss during surgery (p = 0.03). The duration of surgery, post-operative length of hospital stay and lymph node harvest were similar between LRH and ORH. The incidence of intraoperative bladder injuries (p = 0.1) and post-operative vesico-vaginal and uretero-vaginal fistulas were higher (p = 0.3) in LRH; there was no statistical significance. There was a non-significant increase in the post-operative bladder dysfunction rates in the LRH arm. The progression-free survival and overall survival were similar (both in upfront surgery and surgery after neo-adjuvant therapy) for LRH and ORH. Our results are analogous to some of the previous retrospective studies showing comparable oncological outcomes of LRH to conventional open surgery. LRH confers the benefits of less blood loss, early recovery and shorter hospital stay. Further randomised trials with modifications in techniques are needed, and minimally invasive surgery should prosper.

PO-1696: Quantitative analysis of mean ADC in cervix cancer patients during chemoradiotherapy

PO-1696: Quantitative analysis of mean ADC in cervix cancer patients during chemoradiotherapy

Vaginal Dose Surface Maps and Morbidity in Cervical Cancer Brachytherapy

To develop a methodology for generating vagina dose-surface maps (DSMs) in cervix cancer patients. To investigate the association of dose level and spatial distribution with vaginal stenosis (St) and mucositis (Muc). A mono-institutional series of 31 patients, enrolled in the EMBRACE I study, with no vaginal St/Muc (CTCAE v3) at baseline were selected for this analysis. Patients were divided in 3 morbidity groups: 16 had St/Muc G0/1, 8 had St G≥2 (3 also had Muc G≥2), 10 had Muc G≥2 (3 also had St G≥2) within 24 months after treatment. 16 patients had vaginal involvement at diagnosis and 10 at BT. Patients received EBRT and 2 insertions and 4 fractions of HDR BT using tandem and ovoids. DSMs were generated from delineated contours of the vagina surface (VS). VS contours were unfolded by cutting them anteriorly through the urethra and inferiorly through the posterior–inferior border of the symphysis (PIBS). DSMs of EBRT and each BT fraction, converted to Gy EQD2 (α/β = 3), were added based on a system of homologous points, to generate cumulative DSMs. Dose D20cm2 (Gy), surface S60Gy (%), including their spatial location on the VS, rectovaginal (ICRU-RV) point dose, vaginal lateral 5 mm point dose and vagina length (VL measured from the vagina top to the PIBS) were compared between morbidity groups. Average/difference VS DSMs and one-way ANOVA statistical testing were used to compare between groups. A total of 96 DSMs (31 EBRT and 62 BT) were generated. Table shows mean/difference values for each parameter, according to morbidity groups. Patients in the St G≥2 and Muc G≥2 groups had significantly higher D20cm2 and ICRU-RV point doses compared to St/Muc G0/1 group. Moreover, average/difference DSMs showed that the most irradiated 20 cm2 in the St G≥2 group (mean dose 103 Gy EQD23) was spatially distributed over entire upper 1-2 cm VS circumference. St G≥2 vs St/Muc G0/1 patients had also larger S60Gy (by 27%) and shorter VL (by 9 mm). Muc G≥2 vs St/Muc G0/1 patients had significantly higher vaginal lateral 5mm point doses (by 14 Gy EQD23), while average/difference DSMs showed significant dose differences mainly in the latero-posterior area of the VS. Vaginal dose reporting is currently based on dose points. A novel method was developed to generate vaginal DSMs that incorporate 3D spatial information and new spatial dose descriptors for a more comprehensive view on vaginal doses and correlation with morbidity. St G≥2 patients had significantly higher doses over the whole VS circumference. Muc G≥2 patients showed higher D20cm2, ICRU-RV point and vagina lateral 5mm point doses. Generally, ventral vagina received lower dose than the dorsal and lateral vagina, in the majority of patients.Tabled 1Abstract 3029; TableSt/Muc G0/1 MeanSt G≥2 MeanMuc G≥2 MeanSt G≥2 - St/Muc G0/1Muc G≥2 - St/Muc G0/1Diff.pDiff.pD20cm2 (Gy)7910396240.0000*170.0031*S60Gy (%)376451270.0018*140.0176*ICRU-RV Point (Gy)637678130.0041*150.0015*Vag LAT-5mm (Gy)85909850.2465140.0085*VL (mm)595053-90.0501-60.1427 Open table in a new tab

Change in Expression of Biomarkers Bcl-2 and Survivin in Patients of Cancer Cervix Undergoing Chemo-radiotherapy

Change in Expression of Biomarkers Bcl-2 and Survivin in Patients of Cancer Cervix Undergoing Chemo-radiotherapy

Role of Radiomics and Advanced MR Imaging (Diffusion MRI) in Predicting Clinical Prognostication of Uterine Cervix Carcinoma

Radiation with concurrent chemotherapy forms the cornerstone of management for International Federation of Gynecology and Obstetrics (FIGO) stage IB2 to IVA uterine cervix carcinoma disease. Radiomics has emerged as a promising tool for imaging biomarker discovery in era of precision medicine. We explored potential of Radiomics alone and in combination with diffusion imaging derived quantitative parameter namely apparent diffusion co-efficient (ADC) using supervised classification algorithms in predicting outcomes and prognosis. Retrospective evaluation of the imaging was done for a study cohort of 52 patients of squamous cell carcinoma of uterine cervix who were candidates for radical treatment with chemo radiation. One radiologist having 6 years of experience manually drew the region of interest on the tumor for purposes of segmentation and textural analysis. ADC values were calculated from conventional from the darkest part of the tumor, both before (labelled ADC1) and post treatment (labelled ADC2) with chemo radiation. The segmented tumor was validated independently by two radiologists having 30 years of experience each. A total of 851 Radiomics features were extracted from the available imaging using slicer 3D software and open source software. Feature selection was done by taking the union of the features which had Pearson correlation > 0.35 for recurrence > 0.35 for lymph node and > 0.49 for Stage. Models were trained to predict the clinical outcomes using leave one out cross-validation and different algorithms. Using Radiomics features alone building a monotype multilayer perceptron neural network models for predicting recurrence we were able to achieve an accuracy of 85%. The Kappa score (0.55) and the area under the curve (AUC) was 0.80. Using baseline ADC values and change in ADC during treatment in combination with Radiomics features yielded better AUC of 0.82. Using Monotype multilayer perceptron neural network to determine stage (accuracy 60%, kappa 0.38 and AUC 0.75) were achieved when Radiomics was used alone. For predicting lymph node status, we used Nearest Shrunken Centroids model to achieve an accuracy of 81 % and AUC of 0.76 combining Radiomics, change of ADC and baseline ADC. Further on dividing the patients into 2 groups (based on extensive loco-regional disease with distant metastasis (18) vs good response (34) we found that 3 Radiomics wavelet features showed significant statistical difference. The study is an effort to bridge the unmet need of translational predictive biomarkers in stratification of uterine cervix cancer patients based on prognosis. Radiomics features on imaging could be vital in prognostication and prediction of recurrence.

Clinical Significance of Subclassification of Stage FIGO 1B from a Radiation Oncology Perspective

Previously, 2014 FIGO staging system divided stage IB into stage IB1 and IB2 for cervical cancer patients. Currently, the revised 2018 FIGO staging system further divides stage IB into stage IB1, IB2, and IB3, aiming to specify patients with small tumors who could receive surgery only, without additional radiotherapy (RT). This study aimed to evaluate the revised FIGO staging in stage IB cervical cancer patients and to suggest the optimal treatment strategies with surgery and/or RT. Medical data of cervical cancer patients who were treated with a curative aim between September 2001 and May 2018 were reviewed. A total of 350 patients were restaged according to the revised 2018 FIGO staging system. Treatment modalities included RT or chemoradiotherapy (CRT) in 71 patients, surgery ± adjuvant chemotherapy in 182 patients, and surgery followed by adjuvant RT/CRT in 97 patients. At a median follow-up of 67.0 months (range, 4.5–215.6 months), FIGO stage IB1 (n = 149), IB2 (n = 161), and IB3 (n = 40) patients showed 5-year progression-free survival (PFS) rates of 86.6%, 80.6%, and 78.3%, respectively, although not statistically significant (p = 0.335). The PFS curve showed a tendency of stage IB2 patients towards poor rates similar with stage IB3 patients as time increased. To further investigate these results, recurrence rates were analyzed depending on the treatment modality received. Among all the stages, stage IB2 patients who received surgery only showed significantly poorer recurrence rates compared to those who received RT or surgery with adjuvant RT (p = 0.017). In addition, the major first patterns of failure were local (36%) or regional recurrences (44%) for those who received surgery only, compared to distant failure as the major first pattern of failure in those who received RT or surgery with adjuvant RT (40% and 37.5%, respectively). Thus, patients who received surgery only were further evaluated. Low risk patients determined by simplified Sedlis criteria who did not receive adjuvant RT were analyzed (n = 100). By multivariate analysis, increasing tumor size was the only significant adverse factor for local recurrence (p = 0.047) and the cutoff value determined by the receiver operating characteristic curve was 2.5 cm. For regional recurrence, the only significant unfavorable factor was adenocarcinoma (p = 0.040). Although surgery without additional RT is generally preferred for revised FIGO stage IB1 and some IB2 patients, this study showed that size and adenocarcinoma pathology were significant factors for local and regional recurrences, respectively. Thus, adjuvant vaginal brachytherapy for those who have tumors larger than 2.5 cm and adjuvant external beam RT for those diagnosed with adenocarcinoma may be considered in stage IB cervix cancer patients undergoing surgery.

Patient Reported Outcomes, Physician-Reported Toxicity and Dosimetry in Cervix Cancer Patient Treated With Chemo-Radiation and MR-Guided Brachytherapy

Vaginal and sexual function is an important, yet often neglected, survivorship issue for cervical cancer patients. Our objective was to evaluate patient-reported outcomes (PROs), physician-reported vaginal toxicity and dosimetry in cervical cancer patients treated with definitive chemo-radiation (CRT) and brachytherapy (BT). Cervical cancer patients treated with definitive CRT and MR-guided HDR BT who were disease-free for > 3 months and attending routine follow-up were eligible. Consenting patients completed the following validated PROs: Female Sexual Distress Scale-Revised (FSDS-R; cut-off for distress >11)), Female Sexual Function Index (FSFI; cut-off for sexual dysfunction <26), EuroQol Group EQ-5D (index value range: 0 (death) to 1 (perfect health)), and Menopause Rating Scale (MRS; range: 0 (asymptomatic) to 44 (highest symptoms)), as well as a socio-demographics questionnaire. Oncologists scored vaginal toxicity using the CTCAE v4.0. Pt, treatment and dosimetric characteristics were collected and summarized using descriptive statistics. The association between PROs and dichotomized dosimetric characteristics were assessed using the Mann-Whitney test for continuous PROs and using Fisher’s exact test for categorical. The association between PROs and continuous dosimetric characteristics was tested using linear regression. The association between PROs and physician assessed toxicities were assessed using Fisher’s exact test. Between August 2018 and January 2020, 51 consenting patients were eligible for analysis. Median age at diagnosis was 46 (range: 23-73), 43% were FIGO 2B, 42% were lymph node positive and 50% had vaginal involvement clinically. Seventy-three percent were partnered, 76% were sexually active and 87% used a vaginal dilator post-treatment. The median HRCTV D90 was 92.1Gy (81-106.4), ICRU recto-vaginal (RV) point was 63.1Gy (52.6-85.8) and vaginal D2cc was 76.3Gy (54.5-133). Median FSDS-R score was 13 (0-48); 58% met criteria for sexual distress, median FSFI score was 15.6 (2-33.6); 83% met criteria for sexual dysfunction, median EQ5D index value was 0.8 (0.4-1) and median MRS score was 16 (0-33). There was a negative association between the ICRU RV point and EQ-5D (p = 0.02) and a positive correlation with MRS (p = 0.0027). A positive correlation was seen for FSDS-R (p = 0.021) when ICRU RV point was >65Gy. There was no significant correlation between PROs and physician assessed toxicity. Cervical cancer patients self-report high rates of sexual distress and dysfunction as well as menopausal symptoms. No association existed between PROs and physician-assessed toxicity, raising the possibility that physicians under-estimate the impact of patient symptoms. The patient experience was significantly correlated to dose, further validating the importance of the ICRU RV point as a surrogate for toxicity and quality of life.

Dose-Volume Effects and Risk Factors for Late Diarrhea in Cervix Cancer Patients After Radiochemotherapy With Image Guided Adaptive Brachytherapy in the EMBRACE I Study

To evaluate patient- and treatment-related risk factors associated with incidence and persistence of late diarrhea after radiochemotherapy and image guided adaptive brachytherapy (IGABT) in locally advanced cervical cancer. Of 1416 patients from the EMBRACE I study, 1199 were prospectively evaluated using physician-reported (Common Terminology Criteria for Adverse Events version 3 [CTCAEv3]) assessment for diarrhea; median follow-up 48 months. Patient-reported outcome (EORTC) was available in 900 patients. Incidence of CTCAE G≥2, G≥3, and EORTC "very much" diarrhea was analyzed with Cox proportional hazards regression. Binary logistic regression was used for analysis of persistent G≥1 and EORTC "quite a bit" - "very much" (≥"quite a bit") diarrhea, defined if present in at least half of all follow-ups. Crude incidences of G≥2 and G≥3 diarrhea were 8.3% and 1.5%, respectively, and 8% of patients reported "very much" diarrhea. Persistent G≥1 and ≥"quite a bit" diarrhea was present in 16% and 7%, respectively. Patient-related risk factors were baseline diarrhea, smoking, and diabetes with hazard ratios of 1.4 to 7.3. Treatment-related risk factors included prescribed dose, V43 Gy, V57 Gy (lymph node boost), and para-aortic irradiation for external beam radiation therapy (EBRT). G≥2 diarrhea at 3 years increased from 9.5% to 19.9% with prescribed dose 45 Gy versus 50 Gy, 8.7% to 14.0% with V43 Gy <2500 cm3 versus >3000 cm3 and 9.4% to 19.0% with V57 Gy <165 cm3 versus ≥165 cm3. Brachytherapy-related bowel and rectum D2cm3 were also associated with diarrhea. Dose and volume effects have been established for late diarrhea after radiochemotherapy and IGABT in both CTCAE and EORTC reporting. The risk of diarrhea was lower with a pelvic EBRT prescription of 45 Gy, and higher with larger lymph node boosts volumes (ie, ≥165 cm3). The importance of EBRT volumes as determinants of late toxicity underline the need for continuous quality assurance of target contouring, dose planning, and conformity. The findings of brachytherapy dosimetric factors related to the intestines may become more important with highly conformal EBRT.

The impact of cervical (GTVCRX) and parametrial (GTVLP, GTVRP) volumetric status on efficacy of radiotherapy for uterine cervix cancer in stage IIB and IIIB

Introduction. The impact of volumetric staging of cervix and parametria on treatment outcome after combined BRT and IMRT of 135 cervix cancer patients in stage IIB and IIIB is analysed. Material and methods. Cervical GTVCRX and parametrial (GTVLP, RP) volumes are subdivided into four subgroups. BRT with 30 Gy in three fractions was combined with IMRT 48 Gy in 24 fractions. For GTVCRX ≤35 cm3 5-year local control (LC) was 100%, which decreased to 87% for GTVCRX ≥130 cm3. Results. Cervix and parametrial local recurrence were not higher than 3%. Major failures were periaortal nodes metastases (PNM) occurring during 5-year follow-up. Dose of ≥60 izoGy2.0 effectively prevented the PNM. Underdosage 130 cm3. Conclusion. Although cervix and parametria volumetric status are highly heterogeneous, they turned out to be better prognostic predictors than traditional TNM grading.

Predictors of Minimally Invasive Surgery for Uterine and Cervix Cancer from 2000 – 2017 in Ontario, Canada

Objective: Minimally invasive surgery (MIS) has been shown to offer improved perioperative outcomes and uptake has increased across different specialties with significant implications for health systems and resource allocation. We sought to assess the uptake of MIS over time in uterine and cervix cancer patients in Ontario and evaluate associations between MIS rates and institutional, patient and provider factors.

Apparent Diffusion Coefficient in MRI Scan and Cervix Squamous Cell Carcinoma Histopathologic Grade: A Correlational Study

Background: Currently, MRI examination is the main radiological diagnostic examination option for determining cervical cancer staging. Apparent diffusion coefficient (ADC) predicts changes in cell density due to water quantity and diffusion. This study aims to determine the correlation between ADC value and cervix SCC. Methods: This is a correlation study with retrospective design that was conducted at Radiology Installation of Dr. Soetomo General Hospital, Surabaya, Indonesia for 2 years. Sample of this study was all cervix cancer patients at Dr. Soetomo General Hospital, Surabaya who met inclusion criteria. Histopathologic grades were collected from histopathologic archives and ADC values were collected through DWI sequence in MRI. Descriptive analysis was carried out to obtain sample characteristics then continued with ROC analysis to obtain ADC cut off value and non-parametric Spearman's rho correlation test was conducted to determine the correlation between ADC values in cervix cancer which was categorized according to their histopathologic grade. Results: Sample distribution based on cervix cancer histopathologic grade from 48 samples showed that 27 patients (56.3%) had grade I SCC, eight patients (16.7%) had grade II, and 13 patients (27.1%) had grade III. Apparent diffusion coefficient cut-off value for grade I cervix cancer was 0.90 ± 0.18 x 10-3mm2/s, grade II was 0.83 ± 0.14 x 10-3mm2/s, and grade III was 0.82 ± 0.12 x 10-3mm2/s. Spearman's rho correlation test result was -0.169 and p = 0.250 (p>0.05). Conclusion: There was a very weak negative and non-significant correlation between ADC value and cervix squamous cell carcinoma histopathologic grade.

Treatment Outcomes for Locally Advanced Cervix Cancer: A Single Institution Experience

Regular audits are a key component to a quality radiation treatment program. In an effort to understand current practice and plan for future state we performed an outcomes audit of our locally advanced cervix cancer patients treated with concurrent chemotherapy, external beam radiation therapy and brachytherapy. Our objective was to determine treatment outcomes and late toxicity

APPLICATION OF REVISED FIGO 2018 STAGING FOR CARCINOMA CERVIX- A SINGLE INSTITUITIONAL STUDY

Cervical cancer continues to be one of the most common cancers among females, being the fourth most common after breast, colorectal, and lung cancer[1]. The FIGO 2018 staging system has brought in various pathological and radiological parameters for stage classification to guide treatment related decision making and for better prognostication. OBJECTIVE: The purpose of this study is to analyse the results of stage redistribution by applying 2018 International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer patients in a tertiary care cancer centre, who were previously staged according to FIGO 2009. METHODS: Data of all cervical cancer patients who underwent various forms of treatment at our institute including surgery, radiotherapy and chemotherapy from Jan 2013 to Dec 2016 were collected from the Medical Records Department For this study, we re-staged all patients by the FIGO 2018 staging system RESULTS: The data of patients with carcinoma cervix diagnosed in the 4 years between 2013 &amp; 2016 was tabulated according to both 2009 FIGO staging as well as 2018 FIGO staging. Significant up-staging to Stage IIIC1 &amp; IIIC2 was noted. (Table 1&amp; 2) CONCLUSION: The current FIGO 2018 staging system for cervical cancer appears to be useful for predicting survival in patients considering radiological and pathological variables. As per our study, majority of the cancer cervix patients fall into a single subgroup – III C1; this, in a country were already most patients present with advanced disease, will skew the data further. Stage III C1 cervical cancer is not homogenous; sub classification within stage IIIC1 may result in better prognostication.

Education and training for image-guided adaptive brachytherapy for cervix cancer—The (GEC)-ESTRO/EMBRACE perspective

Image-guided adaptive brachytherapy (IGABT) has been shown to improve local/regional control and survival for cervix cancer patients while reducing morbidity. However, the technique is complex involving several conceptual, methodological, and technical innovations compared to conventional brachytherapy. The delivery of high-quality IGABT which will translate into improved outcomes is therefore critically dependent on effective education and training of all health professionals involved in the brachytherapy treatment process. This paper reviews the (GEC)-ESTRO/EMBRACE initiatives for education and training to promote the dissemination and implementation of IGABT for cervix cancer worldwide. The new skills required in different health professionals for successful implementation of IGABT are described. The achievements and challenges of current educational strategies for disseminating IGABT are discussed. Innovations to improve the effectiveness of current and future educational strategies are explored.

Haematological toxicity in cancer cervix patients treated with concurrent chemoradiation by conventional technique- correlation with bone marrow radiation dose

Introduction: The standard of care for treatment of cancer cervix is concurrent chemoradiation followed by brachytherapy in the majority of cases. Conventional radiotherapy with chemotherapy causes haematological toxicities which may be related to radiation to pelvic bone marrow. The present study aims to study the haematological toxicities and correlate with the mean dose to the bone marrow. Material and Methods: Retrospective data of cancer patients treated in the institute in the year 2019 was retrieved. Haematological toxicities were analyzed in terms of CTCAE criteria. Mean dose to bone marrow was calculated after the delineation in the CT scan. The correlation between haematological toxicity and mean bone marrow was done using a paired t-test for statistical significance. Results: The data of 20 patients were retrieved. Anaemia Grade, I and Grade II-IV was seen in 65% and 35% respectively. Leukopenia Grade I and Grade II-IV were seen in 85% and 15% respectively and Lymphopenia Grade I and Grade II-Iv were seen in 55% and 45% respectively. The mean dose to bone marrow did not show any statistical significance with the severity of haematological toxicity. There was no Grade II-IV toxicity of neutropenia and thrombocytopenia. Conclusion: Conventional radiotherapy can safely be practice for patients with cancer cervix with acceptable haematological toxicities.

Significant impact on the oncologic outcomes with intensity modulated radiotherapy and conformational radiotherapy over conventional radiotherapy in cervix cancer patients treated with radiotherapy.

We designed a retrospective cohort of women with cervix cancer treated by radiation therapy with an extended follow-up to evaluate if the incorporation of modern radiation techniques was a prognostic factor. We studied a cohort of patients with cervix cancer FIGO stage I-IVa treated in the last fifteen years. Patients were treated with radiotherapy alone (RT) or chemoradiation alone (CRT) using conventional radiotherapy (2DRT), conformational radiotherapy (3DRT), or intensity-modulated radiotherapy (IMRT) followed by high dose rate brachytherapy. Univariate and multivariate analysis was conducted to identify significant prognostic factors (p < 0.05). 228 patients with cervix cancer were included. The treatment groups were CRT (64.8%), and RT (34.2%), with 31.6% submitted to 2DRT and 68.4% to IMRT/3DRT. The median follow-up was 6.3 years, the OS in 5 years according to the treatment groups was 48% for CRT, and 27.8% for RT (p < 0.001). The early-stage I-IIa (p = 0.001), CRT, and IMRT/3DRT were significant factors for better overall survival (OS) in the multivariate analysis. For the cancer-specific survival (CSS), chemoradiation, age <60 years, and IMRT/3DRT were significant. Treatment with IMRT/3DRT was the only prognostic factor associated with event-free survival (EFS). In a long-term follow-up, chemoradiation, early-clinical stage, and age <60 years were significant factors associated with better OS and CSS at 5 and 8 years. The incorporation of new radiation techniques, such as IMRT/3DRT, over time has a significant impact on all endpoints (EFS, OS, and CSS) of this cohort. These outcomes are useful to decide about the radiation technique to achieve satisfactory oncological results outside a clinical trial.