Radiotherapy For Cervical Cancer Research Articles

Palliative Split-Course pelvic radiotherapy for symptomatic cervical cancer

Objective: Palliative pelvic RT effectively relieves significant health issues such as bleeding from the tumor, pain, discharge, or mass effect on the rectum genitourinary tract vessels and nerves in cervical cancer patients. There is no exact conclusion about an ideal palliative radiation treatment dose regimen. Thus we share the results of a commonly used split-course palliative pelvic RT regimen in our hospital. Material and Methods: For a retrospective study, 9 patients records treated between 2015 and 2019 were reviewed. The dose of prescribed irradiation for the target was 20Gy in 5 daily fractions. An additional 20Gy in 5 fractions was delivered after a 2-week time for recovery. Symptomatic improvement and treatment-related toxicity during and after RT were assessed from handwritten clinician reports. Results: Vast majority of patients enduring, and rapid symptomatic improvement was observed. Grade 3 to 5 treatment toxicity was not examined. Maximum acute toxicity was grade 1 GI or GU toxicity in 4 patients and G2 in two patients. Three patients had no acute side effects. All patients had complete symptom remission after treatment, one patient did not complete the second course of therapy due to deteriorating performance status, but local symptom relief was achieved. Conclusion: Split course regimen effectively improved symptoms without significant toxicity. The integrated 2-week break allowed doctors to assess patients for increased dose palliative radiation and balanced therapeutic benefits with possible adverse effects. This regimen is a reasonable strategy for patients who do not tolerate definitive treatment.

Importance of Aortic Bifurcation for Pelvic Radiotherapy in Cervical Cancer Patients

Purpose: Radiotherapy is a major modality for treating cervical cancer patients. Conventionally, superior border of treatment portal in cervical cancer is kept at L4-L5 intervertebral spaces; however, newer concepts suggest that aortic bifurcation should be the determining factor for the superior border. This study aims to observe the level of aortic bifurcation in cervical cancer patients. Methods and materials: A retrospective observational study was conducted in cervical cancer patients undergoing radiotherapy between July 2019 and August 2020 in B.P. Koirala Memorial Cancer Hospital, Bharatpur. Histologically confirmed International Federation of Gynecology and Obstetrics (FIGO) stages II and III carcinoma cervix patients referred for radiation therapy were included in the study. Baseline variables including age group, FIGO stages were noted from the hospital record. Computed Tomography (CT) simulation images were reviewed from the treatment planning system to detect the levels of aortic bifurcations. Results: Total 281 patients of carcinoma cervix were registered for the study with age ranging from 29 years to 87 years and the commonest age group being 51-60. The maximum patients were of stage IIB (46.6%). The aortic bifurcations levels varied from mid L3 to L5-S1 intervertebral space and the commonest level observed was mid L4 vertebra in 70 (24.9%) patients. Conclusion: Anatomical variation in the level of aortic bifurcation, considered as the superior CTV border in pelvic radiotherapy in cervical cancer, demands the conventional superior border, L4-L5 intervertebral space, to be shifted more superior to include common iliac nodes in the treatment field.

The dosimetric and clinical comparison between helical tomotherapy and fixed-field intensity-modulated radiotherapy in radical irradiation for cervical cancer

The dosimetric and clinical comparison between helical tomotherapy and fixed-field intensity-modulated radiotherapy in radical irradiation for cervical cancer

Cervical Cancer Radiotherapy Response in Dr. Hasan Sadikin General Center Hospital

Objective: To determine the response to radiation therapy based on the characteristics of cervical cancer patients who were given radiotherapy at Hasan Sadikin Hospital in 2020.Methods: The study was conducted using an observational analytic study method with a cross-sectional design, involving 75 cases of cervical carcinoma who were given complete radiation therapy but were not given neoadjuvant chemotherapy or surgery, which were recorded in the medical record at the Central General Hospital (RSUP) Dr. Hasan Sadikin. Results: Response to therapy had a significant relationship (p< 0.05) with age (p 0.030), histopathological type (p 0.009), and tumor mass size (p 0.042), but had no significant relationship to cervical cancer stage (p 0.055). Further analysis found that the response to radiation therapy at stage III was highly dependent on the size of the tumor mass (p<0.001). Based on the odds ratio calculation, the response to therapy was better in patients aged 35 years 3.44 times compared to patients aged 18-34 years, cervical cancer with squamous type histopathology 5.23 times compared to adenocarcinoma type histopathology, and cervical cancer with tumor mass size. <4 cm 2.86 times compared to tumor mass size 4 cm.Conclusion: The therapeutic response was better in cervical cancer patients who underwent complete radiation therapy in patients aged 35 years, stage III cervical cancer with tumor mass size <4 cm, squamous type histopathology, and tumor mass size <4cm.Respon Radioterapi pada Kanker Serviks di Rumah Sakit Umum Pusat Dr. Hasan Sadikin BandungAbstrakTujuan: Untuk mengetahui respon terapi radiasi berdasarkan karakteristik pasien kanker serviks yang diberikan radioterapi di Rumah Sakit Hasan Sadikin tahun 2020. Metode: Penelitian dilakukan menggunakan metode studi analitik observasional dengan desain potong lintang, melibatkan 75 kasus karsinoma serviks yang diberikan terapi radiasi komplit tetapi tidak diberikan kemoterapi neoadjuvant maupun tindakan operasi, yang tercatat pada rekam medis di Rumah Sakit Umum Pusat Dr. Hasan Sadikin.Hasil: Respon terapi memiliki hubungan yang signifikan (p<0,05) terhadap usia (p 0,030), tipe histopatologi (p 0,009), dan ukuran massa (p 0,042), tetapi memiliki hubungan yang tidak bermakna terhadap stadium kanker serviks (p 0,055). Analisis lebih lanjut didapatkan bahwa respon terapi radiasi pada stadium III sangat bergantung kepada ukuran massa tumor (p<0,001). Berdasarkan penghitungan odd ratio respon terapi lebih baik didapatkan pada pasien berusia ≥35 tahun 3,44 kali dibandingkan pada usia 18-34 tahun, kanker serviks dengan histopatologi tipe skuamosa 5,23 kali dibandingkan histopatologi tipe adenokarsinoma, dan kanker serviks dengan ukuran massa tumor <4 cm 2,86 kali dibandingkan ukuran massa tumor ≥4 cm.Kesimpulan: Respon terapi lebih baik pada pasien kanker serviks yang dilakukan terapi radiasi komplit pada pasien berusia ≥ 35 tahun, kanker serviks stadium III dengan ukuran massa tumor <4 cm, histopatologi tipe skuamosa, dan ukuran massa tumor <4cm.Kata kunci : respon terapi, radiasi, kanker serviks

Secondary cancers after carbon-ion radiotherapy and photon beam radiotherapy for uterine cervical cancer: Acomparative study.

BackgroundThere are limited studies on the risk of secondary cancers after carbon‐ion radiotherapy (CIRT). We assessed the incidence of secondary cancers in patients treated with CIRT for cervical cancer. We also evaluated the incidence of secondary cancers in patients who received standard photon radiotherapy (RT) throughout the same period.MethodsThis retrospective study included patients with cervical cancer who underwent curative RT at our hospital. All cancers discovered for the first time after RT were classified as secondary cancers. To compare the risk of secondary cancers among cervical cancer survivors to the general population, standardized incidence ratios (SIRs) were calculated.ResultsThe analysis included a total of 197 and 417 patients in the CIRT and photon RT groups, respectively. The total person‐years during the observation period were 1052.4 in the CIRT group and 2481.5 in the photon RT group. The SIR for all secondary cancers was 1.1 (95% confidence interval [CI], 0.6–2.1) in the CIRT group and 1.4 (95% CI, 1.0–2.1) in the photon RT group. The 10‐year cumulative incidence of all secondary cancers was 9.5% (95% CI, 4.0–21.5) in the CIRT group and 9.4% (95% CI, 6.2–14.1) in the photon RT group. The CIRT and photon RT groups were not significantly different in incidence (p = 0.268).ConclusionsThe incidence of secondary cancers after CIRT for cervical cancer was similar to that after photon RT. Validation of our findings after long‐term observation is warranted.

Clinical advantage and outcomes of computed tomography-based transvaginal hybrid brachytherapy performed only by sedation without general or saddle block anesthesia.

Three-dimensional image-guided brachytherapy is the standard of care in cervical cancer radiotherapy. In addition, the usefulness of the so-called "hybrid brachytherapy (HBT)" has been reported, which involves the addition of needle applicators to conventional intracavitary brachytherapy for interstitial irradiation. To evaluate the clinical outcomes of CT-based HBT consisting of transvaginal insertion of needle applicators (CT-based transvaginal HBT) and only intravenous sedation without general or saddle block anesthesia. This is a retrospective chart review of patients who received definitive radiotherapy, including CT-based transvaginal HBT, between February 2012 and July 2019. The inclusion criteria were as follows: (i) histologically diagnosed disease, (ii) untreated cervical cancer, (iii) International Federation of Gynecology and Obstetrics (FIGO) stage IB1-IVA disease in the 2008 FIGO staging system, and (iv) patients who underwent CT-based transvaginal HBT at least once in a series of intracavitary brachytherapy. Overall, 54 patients fulfilled the eligibility criteria in the present study. The median follow-up period was 32 (IQR, 19-44) months. No patient complained of symptoms such as persistent bleeding or abdominal pain after the treatment. The 3-year local control (LC), disease-free survival, and overall survival rates for all 54 patients were 86.6%, 60.3%, and 90.7% (95% CI [81.3%-100.0%]), respectively. The 3-year LC rate was 87.7% in patients with FIGO III-IVA and 90.4% in tumor size >6.0cm. The incidence rate of late adverse events, grade ≥3, in the rectum and bladder was 0% and 1.8%, respectively. In the dose-volume histogram analyses, transvaginal HBT increased the dose of HR-CTVD90 by ~7.5% without significantly increasing the dose of organs at risk. Considering the favorable clinical outcomes, CT-based transvaginal HBT may be a good option for treating cervical cancer.

Salicylic acid sensitizes cervical cancer cells to radiotherapy by activating AMPK/TSC2/mTOR pathway

ObjectiveTo investigate the radio-sensitizing effect of salicylic acid (SA) on human cervical cancer cells and its potential molecular mechanism. MethodsCervical cancer cells were treated with SA and ionizing radiation. The expression of γ-H2AX was evaluated by immunofluorescence (IF) assay. Cell cycle and apoptosis were analyzed by flow cytometry. Western blot was performed to detect the protein level of AMPK/TSC2/mTOR pathway. ResultsSA inhibited basal proliferation of cervical cancer cells in a dose and time dependent manner. In addition, SA increased radiation-induced DNA damage, promoted apoptosis, triggered a redistribution of cell cycle from G2-M phase to G1-S phase of cervical cancer cells, and hence increased cell sensitivity to radiation. Moreover, SA treatment elevated the expression levels of p-AMPKα(t ​= ​3.996, P ​< ​0.05) and p-TSC2(t ​= ​5.308, P ​< ​0.05), whereas the level of p-mTOR (t ​= ​10.160, P ​< ​0.05) was significantly decreased. ConclusionSA enhances the radiosensitivity of cervical cancer cells by targeting AMPK/TSC2/mTOR signaling pathway, and might serve as a promising therapeutic strategy to improve the efficacy of radiotherapy for cervical cancer.

Accelerate treatment planning process using deep learning generated fluence maps for cervical cancer radiation therapy

This study aims to develop a deep learning method that skips the time-consuming inverse optimization process for automatic generation of machine-deliverable intensity-modulated radiation therapy (IMRT) plans. Ninety cervical cancer clinical IMRT plans were collected to train a two-stage convolution neural network, of which 66 plans were assigned for training, 11 for validation, and 13 for test. The neural network took patients' computed tomography (CT) anatomy as the input and predicted the fluence map for each radiation beam. The predicted fluence maps were then imported into a treatment planning system and converted to multileaf collimators motion sequences. The automatic plan was evaluated against its corresponding clinical plan, and its machine deliverability was validated by patient-specific IMRT quality assurance (QA). There were no significant differences in dose parameters between automatic and clinical plans for all 13 test patients, indicating a good prediction of fluence maps and a decent quality of automatic plans. The average dice similarity coefficient of isodose volumes encompassed by 0%-100% isodose lines ranged from 0.94 to 1. In patient-specific IMRT QA, the mean gamma passing rate of automatic plans achieved 99.5% under 3%/3mm criteria, and 97.3% under 2%/2mm criteria, with a low dose threshold of 10%. The proposed deep learning framework can produce machine-deliverable IMRT plans with quality similar to the clinical plans in the test set. It skips the inverse plan optimization process and provides an effective and efficient method to accelerate treatment planning process.

Pretreatment Immune Status, Predicts Response to Definite Chemo Radiotherapy in Advanced Stages of Cervical Cancer Patients.

To evaluate the prognostic role of pretreatment CD4 + , CD8 + T lymphocytes in predicting response to definite chemo radiotherapy in advanced cervical cancer. Design: A hospital-based prospective one-year follow-up study. This observational study was conducted on 74 patients with advanced cervical cancer. Pretreatment CD4 + and CD8 + levels in cervical cancer tissue and peripheral blood was noted and quantitatively assessed in patients with complete remission or persistent disease after one year of follow-up. There was a statistically significant association of tumour volume with the remission or persistence of disease. In peripheral blood, mean CD4 + score and CD4 + /CD8 + ratio were significantly higher while mean CD8 + score is significantly lower in patients with remission. Similar results were seen in tumour tissue as well. On Receiver Operating Curve analysis, the cut-off value of CD4 + , CD8 + and CD4 + /CD8 + ratio in predicting remission or persistent disease in peripheral blood was 20.09, 18.51 and 0.41 while in tumor tissue was 19.71, 20.99 and 0.20, respectively. The patients with tumor volume < 100cm 2 have much higher chances of remission. The patients with higher CD4 + and CD4 + / CD8 + ratio, both in peripheral blood as well as tumor tissue, have higher chances of remission. The cut-off value of CD4 + , CD8 + and CD4 + /CD8 + ratio in predicting remission or persistent disease in peripheral blood was 20.09, 18.51 and 0.41 while in tumor tissue was 19.71, 20.99 and 0.20, respectively.

Stereotactic body radiotherapy in oligometastatic cervical cancer (MITO-RT2/RAD study): a collaboration of MITO, AIRO GYN, and MaNGO groups

ObjectiveThis retrospective, multicenter study analyzes the efficacy and safety of stereotactic body radiotherapy in a large cohort of patients with oligometastatic/persistent/recurrent cervical cancer.MethodsA standardized data collection from several radiotherapy centers...

Patterns of Relapse After Adjuvant Chemoradiation for Cervical Cancer in a Phase 3 Clinical Trial (PARCER): An Evaluation of Updated NRG Oncology/RTOG Target Delineation Guidelines

The Radiation Therapy Oncology Group (RTOG) under NRG Oncology recently published updated contouring guidelines for intensity modulated radiation therapy in postoperative treatment for endometrial and cervical cancer. The present study was designed to evaluate the implications ofnewly published guidelines. We recruited 300 patients in a phase 3 randomized controlled trial of adjuvant chemoradiation therapy for cervical cancer (NCT01279135) to understand patterns of relapse. For those patients with pelvic relapse, we imported radiation therapy structure sets, treatment plans, and diagnostic images atrelapse on the treatment planning system. We performed rigid registration with treatment planning images that contained the delineated planning target volume and radiation dose information. We delineated gross tumor volume at time of relapse on the diagnostic scans and superimposed it on the radiation therapy treatment scans. We categorized the site of pelvic relapse as "within field of old RTOG/[Postoperative Adjuvant Radiation in Cervical Cancer (PARCER)] target delineation guidelines" or "within field of new NRG/RTOG guidelines," or both, and compared proportions of recurrences contained within the 2 guidelines. We consider a P value of <.05 statistically significant. Additionally, we generated intensity modulated radiation therapy treatment plans based on the new guidelines for a limited set of patients to see if these new guidelines increased the organ at risk doses. Most common form of relapse was distant metastasis (15%). Pelvic relapse rate in our study was 8%. Overall, 9 out of 19 relapses were encompassed in the contouring guidelines of the old RTOG/ Postoperative Adjuvant Radiation in Cervical Cancer (PARCER) trial, and 12 out of 19 were encompassed within the new RTOG 2021 contouring guidelines. This corresponded to a further 1% reduction in local relapses (P=.007). Dose to rectum was marginally increased with the new contouring, with no difference in other organs at risk. Salvage treatment was offered in 25 out of 60 patients who relapsed. Patients who received local treatment after relapse had a mean survival after relapse of 27.2 months compared with 8 months among those who received supportive care alone. Our study supportsthe use of newly published NRG/RTOG contouring guidelines in patients with cervical cancer who have undergone hysterectomy. Further data are needed to ascertain if anterior extension of the clinical target volume is needed as in the Postoperative Adjuvant Radiation in Cervical Cancer trial.

Prevalence of long-term opioid use after radiotherapy for cervical cancer in a Brazilian cancer center.

This study aimed to describe the clinical and demographic profile of cervical cancer patients exploring risk factors for prolonged use of opioids. The database of the Brazilian National Cancer Institute was queried out and 214 women with cervical cancer diagnosed between January 2014 and December 2015 who underwent isolated external beam radiation therapy (EBRT) or chemoradiotherapy (CRT) with complete response were included. Patients who no longer used opioids 6months after completion of radiation therapy were classified as stoppers; patients who continued using opioids were non-stoppers. Variables were comparatively evaluated as risk factors for prolonged use of opioids. The median age was 49.4years. Most women were non-white (64.5%) and had ECOG Performance Status (PS) ≥ 1 (76.6%), International Federation of Gynecology and Obstetrics (FIGO) stage II-III (84.1%), and squamous cell carcinoma (82.7%). Smoking and alcohol consumption rates were, respectively, 44.9% and 39.7%. The median time from diagnosis to the onset of EBRT was 111days (interquartile range 66.2). Most patients underwent CRT (88.8%). The rate of non-stoppers was 65.0%. By multivariate analysis, prescription of strong opioids (p = 0.005) and disease recurrence (p < 0.001) were suggested as independent factors for prolonged use of opioids. The rate of prolonged use of opioids after radiotherapy is alarming. Prescription of strong opioids and disease recurrence might be independent risk factors for its persistent use. These results reveal an unmet and urgent need to implement public multiprofessional support programs with well-established protocols for dependence withdrawal, as well as stricter national measures of control in opioid prescription.

Advances in Radiation Oncology for the Treatment of Cervical Cancer.

Background: Over the past two decades, there has been significant advancement in the management of cervical cancer, particularly in the domain of definitive chemoradiotherapy for locally advanced cervical cancer (LACC). Indeed, radiation treatment paradigms have shifted from a two-dimensional (2D) approach solely based on anatomical bony landmarks, to an image-guided three-dimensional (3D) approach, with the goal of delivering doses more precisely to clinical targets with an increased sparing of organs-at-risk. Methods: This is a narrative review on the advances in radiation technologies for the treatment of cervical cancer. Using the PubMed database, we identified articles published in English up until November 18, 2021 on the treatment of LACC with external beam radiotherapy (EBRT) and brachytherapy. A search of the Clinicaltrials.gov and Clinicaltrialsregister.eu retrieved information on ongoing clinical trials on the topic of combined immunotherapy and radiotherapy in cervical cancer. Results: We highlight the historical evolution from the use of 2D radiotherapy to 3D-conformal radiotherapy, and then intensity modulated radiotherapy (IMRT) for the delivery of EBRT. We also discuss advances in brachytherapy, notably the transition to 3D image-guided adaptive brachytherapy (3D-IGABT). In this context, we highlight large cohort studies that were recently constructed and have shown significant improvement in local control and treatment-related toxicities with 3D-IGABT. Finally, we discuss other advances in the field, notably the use of stereotactic body radiotherapy (SBRT) as a substitute to brachytherapy, and the addition of immunotherapy to chemoradiation. Conclusions: The use of IG-IMRT and 3D-IGABT have considerably improved treatment outcomes and toxicity profiles for patients with LACC, and are now considered the gold standard in many countries. The use of SBRT boost as a replacement for brachytherapy has been associated with increased toxicity and decreased efficacy and should be used with caution in the context of clinical trials. New experimental approaches include the addition of immunotherapy to chemoradiation regimens.

Comparison of Cervical Cancer Radiation in Bladder Organs with 10 MV LINAC Energy Radiotherapy Using 3DCRT and IMRT Techniques at Sanglah Hospital Denpasar

A study has been conducted on comparative analysis of cervical cancer radiation to the bladder organ with 10 MV energy LINAC (Linear Accelerator) radiotherapy using the 3DCRT (Three Dimension Conformal Radiotherapy) technique and the IMRT (Intensity Modulated Radiation Therapy) technique at Sanglah Hospital, Denpasar. The 3DCRT and IMRT techniques were compared by analyzing the values ??of the HI (Homogeneity Index), CI (Conformity Index) and radiation dose distribution in the OAR (Organ At Risk), namely the bladder. The data used are 30 cervical cancer patient data with 10 MV photon beam radiotherapy planning and a total radiation dose of 5000 cGy. In calculating the HI and CI values, the data used were radiation dose of 98%, 50%, 2% of target volume and 95% volume on PTV and the average dose on Bladder organs. The data was obtained from the DVH (Dose Volume Histogram) statistics contained in the TPS (Treatment Planning System). The results of the HI value of 0.0818 for the 3DCRT technique and 0.0899 for the IMRT technique with statistical test results obtained the Asimp.Sig (2-tailed) value of 0.056&gt; 0.05 which means it is not significant, while for the results of the CI value of 0.9500 for the 3DCRT technique and 0.9499 for the IMRT technique with statistical test results obtained the Asimp.Sig (2-tailed) value of 0.970&gt; 0.05 which means it is not significant, meanwhile the percentage of the average dose in the bladder organ obtained an average result from the 3DCRT and IMRT irradiation techniques, 96% and 88%, respectively, with statistical test results, the Asimp.Sig (2-tailed) value was 0.000 &lt;0.05, which was significant. Cervical cancer radiation using the IMRT technique is better than the 3DCRT technique because the IMRT technique minimizes the absorbed dose in OAR, it can be seen from the percentage of the average dose in the bladder organ with the IMRT technique getting a smaller dose percentage.

Effect of Hyaluronate Acid Injection on Dose-Volume Parameters in Brachytherapy for Cervical Cancer

PurposeHyaluronate gel has been injected as a spacer into the rectovaginal fossa and vesicouterine fossa during brachytherapy for patients with cervical cancer at our institution. The effect of hyaluronate gel injection (HGI) on dose-volume parameters was investigated in this study. Methods and MaterialsBetween July 2008 to January 2020, a total of 104 patients (non-HGI group: 52 patients; HGI group: 52 patients) who underwent curative radiation therapy for cervical cancer were selected. The total doses of external beam radiation therapy and brachytherapy for high-risk clinical target volume (CTVHR) D90, bladder D2cc, and rectal D2cc were converted to the equivalent dose in 2 Gy fractions (EQD2) and were analyzed for association with HGI. ResultsMedian CTVHR D90 (EQD2) in the non-HGI group was 76.0 Gy (63.7-99.5 Gy), and in the HGI group it was 79.4 Gy (52.6-97.5 Gy) (P = .017). The median bladder D2cc and rectal D2cc (EQD2) were 62.9 Gy and 56.0 Gy in the non-HGI group and 63.7 Gy and 54.8 Gy in the HGI group, which had no significant difference. ConclusionsIn cases with HGI, a significant CTVHR D90 dose increase was obtained with sufficient bladder and rectal doses suppression.

Extracellular vesicles mediated proinflammatory macrophage phenotype induced by radiotherapy in cervical cancer

BackgroundRadiotherapy is a highly effective treatment for cervical cancer. Recent studies focused on the radiotherapy induced anti-tumor immunity. Whether tumor-derived extracellular vesicles (EVs) play roles in radiotherapy induced tumor associated macrophage (TAM) polarization remains unclear.Materials and MethodsThis study analysed the phenotype of macrophages in cancer tissue and peripheral blood of cervical cancer patients using flow cytometry analysis. The role of EVs from plasma of post-irradiated patients on M2-like transformed macrophages was assessed. The M1- and M2-like macrophages were assessed by expression of cell surface markers (CCR7, CD163) and intracellular cytokines (IL-10, TNFα and iNOS). The capacity of phagocytosis was assessed by PD-1 expression and phagocytosis of pHrodo Red E. coli bioparticles.ResultsOur results demonstrated that radiotherapy of cervical cancer induced an increase in the number of TAMs and a change in their subtype from the M2-like to the M1-like phenotype (increased expression of CCR7 and decreased expression of CD163). The EVs from plasma of post-irradiated patients facilitated the M2-like to the M1-like phenotype transition (increased expression of CCR7, TNFα and iNOS, and decreased expression of CD163 and IL-10) and increased capacity of phagocytosis (decreased PD-1 expression and increased phagocytosis of pHrodo Red E. coli bioparticles).ConclusionsOur data demonstrated that irradiation in cervical cancer patients facilitated a proinflammatory macrophage phenotype which could eventually able to mediate anti-tumor immune responses. Our findings highlight the importance of EV in the crosstalk of tumor cells and TAM upon irradiation, which potentially leading to an increased inflammatory response to cancer lesions.

Reliable detection of lymph nodes in whole pelvic for radiotherapy

Accurate detection of the lymph nodes in patients with cervical cancer enables more targeted treatment. For drainage or radiotherapy of postoperative adjuvant, clinicians will manually label the lymph nodes in Computed tomography (CT) images. However, due to the complex environment and wide area of pelvic, reliable detection of lymph nodes is challenging because of the changeable shapes, sizes, distributions. Furthermore, the confusion of blood vessels and tissues in CT images also causes difficulties when labeling lymph nodes. In this study, a reliable convolutional neural network (CNN) based detection approach is proposed to distinguish lymph nodes in the middle abdomen and pelvic cavity between CT image sequences. Combining both local and global contextual information in CT image sequences can avoiding complex three-dimensional (3D) computation. Different scale transformation and structural similarity-based processing method ensure the accuracy to distinguish lymph nodes and blood vessels. Experimental results compared with those given by radiologists and other CNN based methods proved that our proposed method could locate lymph nodes with 98.29% accuracy and 94.64% recall rate when detecting 22,846 clinical abdominal CT images, which proved its potential application value for radiotherapy of cervical cancer.

Clinical And Dermoscopical Hallmarks Of An Acquired Lymphangiectasia Following Surgery And Radiotherapy Of Breast Cancer

Acquired lymphangiectasia (AL) is a permanent dilation of lymphatics, which develops after a wide range of scarring processes. The etiopathogenesis of this entity is still unknown but mostly due to lymphatic damage. It was described essentially after surgery and/or radiotherapy for cervical or breast cancers. It is frequently associated with lymphedema. We report an AL in a 45-year-old woman who had undergone a radical mastectomy, radiotherapy, and chemotherapy. After 2 years of combined therapy, she developed multiple multi-colored vesicles and small papules without lymphoedema. Dermoscopy and skin biopsy confirmed the diagnosis of lymphangiectasia. Despite being a harmless condition, it arises worrisome thoughts for the patient and the doctor. Hence a deep comprehension of this entity is important to prompt the right diagnosis and comfort the patient.

Treatment and prevention of radiation complications during radiotherapy of cervical cancer

Treatment and prevention of radiation complications during radiotherapy of cervical cancer

A Novel Risk Factor for Para-Aortic Lymph Node Recurrence After Definite Pelvic Radiotherapy in Stage IIIB Cervical Cancer.

Background: Studies determining which patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIB disease benefit from prophylactic extended-field irradiation (EFRT), which can reduce para-aortic lymph node (PALN) failure rates, are limited. The study was designed to evaluate the value of the controlling nutritional status (CONUT) score as a risk factor for predicting PALN recurrence and identifying potential indications of prophylactic EFRT. Methods: From 2010 to 2015, a retrospective review was conducted among patients with FIGO stage IIIB cervical cancer who were treated with definitive pelvic radiotherapy or concurrent chemoradiotherapy. We analyzed para-aortic lymph node metastasis-free survival (PALNMFS) using Kaplan-Meier curves. Multivariate analyses were performed using Cox regression models. Results: A total of 116 patients with FIGO stage IIIB cervical cancer were included in the study and the median follow-up was 42.2 months (range: 3.5-104.2 months). Multivariate analysis revealed that the CONUT score (HR: 3.141; 95% CI: 2.321-5.436; P < .001) and ≥3 pelvic lymph node metastases (HR: 2.235; 95% CI: 1.428-11.242; P < .001) were independent risk predictors of PALNMFS. Compared with the low CONUT group (score<3), the high CONUT group (score≥3) was associated with a significantly worse 3-year disease-free survival rate (46.9 vs 69.5%, P = .001), a significantly lower 3-year overall survival rate (68.5 vs 79.7%, P = .016) and a significantly lower PALNMFS rate (74.8 vs 96.4%, P < .001). Conclusions: A high CONUT score (score≥3) and ≥3 pelvic metastatic lymph nodes were significant predictors of PALNMFS after pelvic radiation in FIGO stage IIIB cervical cancer patients. Patients with these risk factors might benefit from prophylactic EFRT.