Invasive Uterine Cervical Carcinoma Research Articles

High-dose-rate Intra-cavitary Brachytherapy Combined with External Beam Radiation Therapy for Under 40-Year-old Patients with Invasive Uterine Cervical Carcinoma: Clinical Outcomes in 118 Patients in a Japanese Multi-institutional Study, JASTRO

The current study was designed to evaluate the clinical outcomes of curative intent radiation therapy for young patients with invasive uterine cervical carcinoma in Japan. One hundred and eighteen patients aged ≤40 were registered in the multi-institutional study of the Japanese Society of Therapeutic Radiology and Oncology (JASTRO) from 26 major institutions in Japan. The age range was 24-39 years and the maximum tumor diameter was 2.0-9.2 cm. The International Federation of Gynecology and Obstetrics clinical stages were Ib, IIa, IIb, IIIa, IIIb and IVa in 17, 6, 40, 2, 50 and 3, respectively. Curative intent radiation therapy consisted of the combination of external beam radiation therapy and high-dose rate intra-cavitary brachytherapy. The total dose of external beam radiation therapy ranged between 44 and 68 Gy. Both the median and mode of total high-dose-rate intra-cavitary brachytherapy dose to point A were 24 Gy in four fractions. Ninety-six patients (58%) received chemotherapy. The 5-year overall survival rate and local control rate of all patients were 61 and 65%, respectively. The 5-year overall survival rates of International Federation of Gynecology and Obstetrics Stage Ib, IIa, IIb, IIIa, IIIb and IVa were 88, 100, 75, 100, 37 and 0%, respectively. The 5-year local control rates of International Federation of Gynecology and Obstetrics Stage Ib, IIa, IIb, IIIa, IIIb and IVa were 82, 75, 75, 100, 51 and 0%, respectively. Sixteen patients experienced grade 3 or greater late radiation morbidity. The 5-year overall survival rate of young patients with Stage IIIb was comparatively low at 37%.

Curative intended radiation therapy for young patients with invasive uterine cervical carcinoma: Clinical outcomes in 105 patients in a Japanese multi-institutional study

e16558 Background: Recently, the number of young patients with invasive uterine cervical carcinoma is increasing in Japan because of earlier sexual activity and low rate of receiving screening test of uterine cervical carcinoma in Japan. However, no large studies have been performed so far to evaluate the clinical outcomes of curative intended radiation therapy for young patients with invasive uterine cervical carcinoma in Japan. Then, the current study was designed. Methods: One hundred and five patients under 40 years old were registered in the mulitiinstitutional study. The median age was 34.5 years old (range: 24–39 years old). According to FIGO, clinical stage was as follows. Stage Ib/IIa/IIb/IIIa/IIIb/IVa were 10/4/38/2/47/3, respectively. The median maximal tumor diameter was 5.5 cm (range: 2–9.2 cm). Curative intended radiation therapy was the combination of high-dose rate intracavitary brachytherapy (HDR-ICBT) combined with external beam radiation therapy (ERT). The total dose of ERT ranged from 44 Gy to 68 Gy. The total dose of HDR-ICBT to point A ranged from 12 Gy to 48 Gy. Eighty five patients received chemotherapy. Results: The 5-year overall survival rate and local control rate of all patients was 58.4 % and 59.3 %, respectively. The 5-year overall survival rates of stage Ib/IIa/IIb/IIIa/IIIb/IVa were 90.0 %/not available (NA)/73.8%/100%/37.4%/0%, respectively. The 5-year local control rates of Stage Ib/IIa/IIb/IIIa/IIIb/IVa were 80.0 %/50.0 %/73.8 %/100 %/54.6 %/NA, respectively. Sixteen patients experienced grade 3 or greater late radiation morbidity. Conclusions: Clinical outcomes of stage I-II in the young were equivalent to the Japanese standard treatment results of all ages. However, clinical outcomes of stage IIIb and IVa in the young were worse than those of all ages (5-year OS of all ages in Japan: IIIb: 50 %, IVa: 25 %). No significant financial relationships to disclose.

Relationship between the expression of telomerase and human papillomavirus infection in invasive uterine cervical carcinoma

Telomerase activity was examined in invasive cervical carcinoma to assess whether it is activated during cervical malignant transformation and to look for its possible association with human papillomavirus (HPV) infection. Histologically confirmed invasive cervical carcinomas and benign cervices were assayed for telomerase activity by using a modified telomere repeat amplification protocol (TRAP). The same cases were subjected to polymerase chain reaction (PCR) detection of HPV by using consensus primers and type-specific (HPV types 16 and 18) primers. Telomerase activity was detected in 40 of 45 (88.9%) invasive cervical carcinomas and 2 (all chronic cervicitis) of 50 (4%) benign cervical lesions. HPV was detected in 36 (24 HPV-16 and 4 HPV-18 cases) of 45 (80%) invasive cervical carcinomas and 20 (11 HPV-16 and 1 HPV-18 cases) of 50 (40%) benign cervical changes. There was a significant correlation between the expression of telomerase with histological grade (omega=0.44, P<0.005), but no correlation was found between telomerase expression and HPV-18 (P>0.05). Although larger sample studies are needed, there seems to be a clear association between telomerase upregulation and HPV status, mainly HPV-16 infection.

Long-term progression-free survival of invasive uterine cervical carcinoma infected with human immunodeficiency virus: a case report

We report the case of a patient with invasive uterine cervical carcinoma, who is also infected with human immunodeficiency virus. This patient has had the longest progression-free survival of any with acquired immunodeficiency syndrome uterine cervical carcinoma. She was found to be human immunodeficiency virus positive in February 1996 and found to have uterine cervical carcinoma stage IB in July 1996. Shortly thereafter, she underwent radiation therapy. She died of renal and liver failure in January 1999. However, no residual tumor existed at that time. The longest progression-free survival in this case may be attributable to maintenance of the CD4 cell count from the onset of uterine cervical carcinoma to death, which meant the patient's immune system to the cancer cells worked.

Long-term progression-free survival of invasive uterine cervical carcinoma infected with human immunodeficiency virus: a case report

We report the case of a patient with invasive uterine cervical carcinoma, who is also infected with human immunodeficiency virus. This patient has had the longest progression-free survival of any with acquired immunodeficiency syndrome uterine cervical carcinoma. She was found to be human immunodeficiency virus positive in February 1996 and found to have uterine cervical carcinoma stage IB in July 1996. Shortly thereafter, she underwent radiation therapy. She died of renal and liver failure in January 1999. However, no residual tumor existed at that time. The longest progression-free survival in this case may be attributable to maintenance of the CD4 cell count from the onset of uterine cervical carcinoma to death, which meant the patient's immune system to the cancer cells worked.

Phase III randomized trial comparing LDR and HDR brachytherapy in treatment of cervical carcinoma

Purpose Intracavitary brachytherapy plays an important role in the treatment of cervical carcinoma. Previous results have shown controversy between the effect of dose rate on tumor control and the occurrence of complications. We performed a prospective randomized clinical trial to compare the clinical outcomes between low-dose-rate (LDR) and high-dose-rate (HDR) intracavitary brachytherapy for treatment of invasive uterine cervical carcinoma. Methods and materials A total of 237 patients with previously untreated invasive carcinoma of the uterine cervix treated at King Chulalongkorn Memorial Hospital were randomized between June 1995 and December 2001. Excluding ineligible, incomplete treatment, and incomplete data patients, 109 and 112 patients were in the LDR and HDR groups, respectively. All patients were treated with external beam radiotherapy and LDR or HDR intracavitary brachytherapy using the Chulalongkorn treatment schedule. Results The median follow-up for the LDR and HDR groups was 40.2 and 37.2 months, respectively. The actuarial 3-year overall and relapse-free survival rate for all patients was 69.6% and 70%, respectively. The 3-year overall survival rate in the LDR and HDR groups was 70.9% and 68.4% ( p = 0.75) and the 3-year pelvic control rate was 89.1% and 86.4% ( p = 0.51), respectively. The 3-year relapse-free survival rate in both groups was 69.9% ( p = 0.35). Most recurrences were distant metastases, especially in Stage IIB and IIIB patients. Grade 3 and 4 complications were found in 2.8% and 7.1% of the LDR and HDR groups ( p = 0.23). Conclusion Comparable outcomes were demonstrated between LDR and HDR intracavitary brachytherapy. Concerning patient convenience, the lower number of medical personel needed, and decreased radiation to health care workers, HDR intracavitary brachytherapy is an alternative to conventional LDR brachytherapy. The high number of distant failure suggests that other modalities such as systemic concurrent or adjuvant chemotherapy might lower this high recurrence, especially in Stage IIB and IIIB.

Telomerase activation and human papillomavirus infection in invasive uterine cervical carcinoma in a set of Malaysian patients

Telomerase activity was studied in invasive uterine cervical carcinoma to assess whether it was activated during cervical malignant transformation and to look for a possible association with human papillomavirus (HPV) infection in a set of Malaysian patients. Histologically confirmed invasive cervical carcinoma and benign cervices were assayed for telomerase activity using a commercial telomerase polymerase chain reaction (PCR) enzyme linked immunosorbent assay kit. The same cases were subjected to PCR detection of HPV using type specific (HPV types 6b, 11, 16, and 18) followed by L1 open reading frame (ORF) consensus primers. HPV was detected in 18 (13 HPV-16, one HPV-6b, four only L1 ORF) of 20 invasive cervical carcinoma and one (only L1 ORF) of 19 benign cervices. Raised telomerase activity (A(450 nm) > 0.215) was detected in 11 cervical carcinomas, with A(450 nm) ranging between 0.238 and 21.790 (mean, 3.952) in positive squamous carcinomas, whereas A(450 nm) was only 0.222 in the one positive adenosquamous carcinoma. Five of 11 cervical carcinomas in stage I, three of six in stage II, both in stage III, and the only case in stage IV showed telomerase activation. Increased telomerase activity was noted in five of the 12 lymph node negative, five of the seven lymph node status unknown cases, and the one case with presumed lymph node metastasis. Ten of 18 HPV positive and one of two HPV negative cervical carcinomas showed telomerase upregulation. Telomerase is activated in invasive cervical carcinoma. Although larger studies are needed, there seems to be no clear association between telomerase upregulation and HPV status, although there is a suggestion of increased telomerase activity in squamous carcinomas and late stage disease.

BASEMENT MEMBRANE IN THE UTERINE CERVIX

Abstract A basement membrane could not be demonstrated with any degree of consistency in specimens of human cervix by means of the Ritter-Oleson staining technique, even though this technique demonstrated the membrane satisfactorily in control sections of normal breast and kidney tissue. The use of the term “basement membrane” and associated phrases such as “extension through” and “disruption of” in describing criteria for diagnosing invasive uterine cervical carcinoma is ill-advised. From our study, the existence of a basement membrane in the human cervix is more apparent than real. The criteria for distinguishing in situ from invasive carcinoma in the cervix should be the same as those used for such a distinction in any other organ. The Ritter-Oleson stain seems to have no practical value in facilitating this differentiation.

Basement membrane in the uterine cervix

A basement membrane could not be demonstrated with any degree of consistency in specimens of human cervix by means of the Ritter-Oleson staining technique, even though this technique demonstrated the membrane satisfactorily in control sections of normal breast and kidney tissue. The use of the term “basement membrane” and associated phrases such as “extension through” and “disruption of” in describing criteria for diagnosing invasive uterine cervical carcinoma is ill-advised. From our study, the existence of a basement membrane in the human cervix is more apparent than real. The criteria for distinguishing in situ from invasive carcinoma in the cervix should be the same as those used for such a distinction in any other organ. The Ritter-Oleson stain seems to have no practical value in facilitating this differentiation.