Intact Cervical Cancer Research Articles

Assessment of the relative contribution of cellular components to the acetowhitening effect in cell cultures and suspensions using elastic light-scattering spectroscopy

We aim to investigate the mechanism of acetowhitening upon which the colposcopic diagnosis of cervical cancer is based. The changes in light scattering induced by acetic acid in intact cervical cancer cells and cellular components were studied using elastic light-scattering spectroscopy. After adding acetic acid to intact cancer cell culture samples (cell suspensions and attached monolayer cell cultures), a slight decrease in small-angle forward scattering was observed, while the large-angle scattering increased by a factor of 5-9, indicating that acetowhitening signals are mainly contributed from small-sized intracellular scattering structures. The cellular components of different sizes and masses were isolated to investigate their individual contribution to the changes of light scattering induced by acetic acid. The study provided the evidence that the cellular components of diameter smaller than 0.2 microm in the cytoplasm are the major contributors to the acetowhitening effect in whole cells, while the light scattering from the mitochondria are not sensitive to the acetic acid.

74: Combined IMRT and Brachytherapy in the Treatment of Intact Cervical Cancer

74: Combined IMRT and Brachytherapy in the Treatment of Intact Cervical Cancer

Patterns of radiotherapy practice for patients with carcinoma of the uterine cervix: A patterns of care study

To determine the influence of research findings and evolving technology on the practice of radiotherapy in patients with carcinoma of the cervix. Radiation oncology facilities were randomly selected from two strata: those that treated <500 and those that treated >/=500 new cancer patients annually. Patient records were randomly selected from lists of eligible patients treated between 1996 and 1999 at each institution. A total of 442 patient records were reviewed at 59 facilities (55 with eligible patients). National estimates were made using weights that reflected the relative contribution of each institution and of each patient within the sampled institutions. Most estimates were based on the 383 patients who had received their initial therapy at a surveyed facility (excluding the 59 patients who were referred for brachytherapy only after initial treatment at another facility). The estimates of brachytherapy practice were based on the 408 patients who had received their brachytherapy at a surveyed facility. The data were compared with those obtained from a similar 1992-1994 survey. Overall, 40.5%, 25.4%, and 33.9% of patients had Stage IA-IIA, IIB, or IIIA-IVA disease, respectively. CT was the most common method of nodal evaluation, with surgical evaluation performed in only 12% of patients. Of the 55 facilities with eligible patients, 32 had treated <==8 eligible patients during the 4-year study period. We estimated that 27.5% of patients were treated at facilities that treated <==2 patients with intact cervical cancer annually; 43% were treated at facilities that treated <500 new patients annually. Patients treated at small facilities were significantly more likely to have received a total dose to Point A of <80 Gy, to have had their treatment protracted to >70 days, and to have undergone adjuvant hysterectomy or chemotherapy. In large facilities, radiotherapy was less likely to be protracted to >70 days in the 1996-1999 survey than in the 1992-1994 survey (p < 0.0001); however, in small facilities, treatment was more likely to be protracted than in the earlier survey (p = 0.06), contributing to increasing disparities between the treatments given in large and small facilities. Overall, 92.4% of patients treated with nonpalliative intent were treated with brachytherapy. Of the patients who received brachytherapy, 16.4% had at least part of their brachytherapy delivered at a high dose rate; this was not significantly greater than the proportion treated with high-dose-rate brachytherapy in the 1992-1994 survey (9.1%; p = 0.3). The proportion of patients receiving chemotherapy as part of their initial treatment in 1996-1999 (34.6%) was not significantly different statistically from that in 1992-1994 (25.6%; p = 0.3). However, in 1999, 63% of patients had received chemotherapy compared with 19%, 28%, and 26% in 1996, 1997, and 1998, respectively. The details and confirmation of chemotherapy administration were rarely documented in the radiation oncology clinic notes and hospital records. The sharp increase in the use of chemotherapy in 1999 suggested rapid application of the results from randomized trials. However, considerable heterogeneity in practice patterns remains, particularly in the use of brachytherapy. The practice at small facilities appears to differ significantly from that at larger facilities in several respects, with a statistically significantly larger proportion of treatments at small facilities failing to meet current guidelines for optimal treatment.

Patterns of radiotherapy practice for patients with squamous carcinoma of the uterine cervix: patterns of care study

Purpose: To determine the impact of research findings and evolving technology on the patterns of radiotherapy practice for patients with carcinoma of the uterine cervix. Methods and Materials: Sixty-two radiation therapy facilities participated in the study after having been selected from a random sample, proportionally stratified according to practice type, of all United States facilities. Each facility submitted a list of patients treated during 1992–1994 with radiation for squamous carcinoma of the cervix. Cases for review were randomly selected from each institution after excluding those of patients who had distant metastases or initial hysterectomy. A total of 471 patients’ records were reviewed in the treating institutions to obtain information about patients’ characteristics, diagnostic evaluation, tumor extent, treatment approach, and radiotherapy techniques. Results: Of the 61 facilities that treated eligible cases of intact cervical cancer during the 3-year survey period, 35 (57%) treated fewer than three eligible patients per year. Thirty-four (83%) of 41 non-academic facilities vs. 1 (5%) of 20 academic facilities treated fewer than three patients per year. FIGO stages were I, II, III, and IV in 32%, 40%, 24%, and 3% of patients, respectively. Computed tomography (CT) was the most common method of lymph node evaluation, but surgical evaluation, which was performed in 76 (16%) patients, had increased from previous surveys. Fields were designed using a dedicated simulator in 95% of patients; a dedicated CT unit was used for treatment planning in 119 (30%) cases. External beam irradiation was most often given using a four-field technique at 180 cGy per day on a 10–20 MV linear accelerator. The average daily fraction size had decreased from previous surveys, and 13% of patients were treated with daily doses of 170 cGy or less. Most patients were treated with a combination of external beam and low dose-rate (LDR) intracavitary irradiation. Of 425 patients who had treatment with curative intent that included brachytherapy, 362 (85%) had LDR brachytherapy, 45 (11%) had high dose-rate (HDR) brachytherapy, 3 had a combination of HDR and LDR, and 15 had incomplete information about the brachytherapy dose-rate. Forty-six (23%) of 197 patients with Stages I–IIA disease were treated with radiation followed by extrafascial hysterectomy. Of 111 patients treated with curative intent for Stage III–IV disease, 72 (65%) had a combination of external beam and intracavitary radiation therapy, 22 (20%) had external beam plus interstitial brachytherapy, and 17 (15%) were treated with external beam irradiation only. For patients who completed treatment with curative intent and did not have adjuvant hysterectomy or HDR brachytherapy, the median total dose at point A was 82.5 Gy. For all patients who completed treatment with radiation alone, the median total duration of treatment was 63 days; more than 70 days were taken to complete treatment in 33% of cases. Twenty-nine percent of patients received chemotherapy, usually concurrent with their radiation therapy. Only 27% of these patients were on investigational protocols. Conclusions: Greater participation in well-designed prospective trials might help clinicians address important clinical questions and reduce current inconsistencies in the use of adjuvant treatments. Radiation oncologists should take steps to avoid unnecessary treatment protraction and to improve patient compliance. Future studies will be needed to determine whether the small number of cases being treated in most nonacademic facilities will influence the outcome for patients with invasive cervical carcinoma.