Stage IIIB Squamous Cell Carcinoma Research Articles

Abstract 14138: A Rare Encounter With Unusual Metastasis: Metastatic Right Ventricular Tumor Secondary to Cervical Cancer

Background: Metastasis of cervical carcinoma to the heart is a rare and uncommon phenomenon. Cervical cancer most commonly metastasizes to the lungs, liver, bones, and lymph nodes in four ways: 1) hematogenous spread, 2) lymphatic spread, 3) transvenous extension, and 4) direct extension. We present a case of a patient with cardiac metastasis from cervical cancer who initially suffered nonspecific symptoms thought to be secondary to a pulmonary embolism. Case presentation: A 41-year-old African American woman with a history of stage IIIB squamous cell carcinoma (SCC) of the cervix was being evaluated in the hospital for exertional dyspnea and chest pain. She was tachycardic and lung auscultation revealed decreased breath sounds bilaterally. Laboratory results were unremarkable. Initially, there was concern for pulmonary embolism (PE), computed tomography angiography with contrast demonstrated no evidence of PE but a hypoenhancing defect within the right ventricle (RV) with multiple diffuse bilateral pulmonary nodules. Echocardiography revealed RV mass vs thrombus. A cardiac MRI revealed a large infiltrative irregular mass. These findings favored evidence of a tumor rather than a thrombus. Imaging findings are illustrated in Figure 1. The patient subsequently underwent a biopsy of the right lower lobe lung nodule. The biopsy revealed metastatic SCC positive for p16, p40, and PD-L1. The patient was being treated but the prognosis was poor. Conclusion: Metastasis from cardiac tumors with primary cervical cancer is uncommon with a poor prognosis and average life expectancy of less than 6 months when diagnosed. Only 4% of cases of cardiac metastasis from cervical cancer are diagnosed as antemortem. A multimodality approach with prompt diagnosis is necessary for improving prognosis.

Tumor-Associated Raynaud’s Phenomenon Exacerbated by Administration of Immune Checkpoint Inhibitors

A 78-year-old man with no history of diabetes or hematologic or cardiovascular diseases was diagnosed with having stage IIIB squamous cell carcinoma of the lung. Two months before this diagnosis, the patient complained of discoloration of the fingertips owing to cold temperature. A wide range of laboratory tests was performed, including those for hepatitis B and C viruses, human immunodeficiency virus, disseminated intravascular coagulation syndrome, antinuclear antibodies, rheumatoid factor, antineutrophil cytoplasmic antibodies, anticardiolipin and antiphospholipid antibodies, serum complement levels, cold agglutinin, and cryoglobin.

High Expression of SOD2 Protein Is a Strong Prognostic Factor for Stage IIIB Squamous Cell Cervical Carcinoma.

High superoxide dismutase 2 (SOD2) expression is associated with a poor prognosis at many cancer sites, the presence of metastases, and more advanced cervical cancer. This study aims to determine whether SOD2 protein expression is associated with the prognosis of stage IIIB cervical carcinoma. Methods: sixty-three patients with stage IIIB squamous cell cervical carcinoma were included. The evaluation of SOD2 expression by immunohistochemistry was based on a positive cell ratio score and the staining intensity score. Taking disease recurrence and death as endpoints, receiver operating characteristic curves were used to discriminate between high and low SOD2 expression. Results: high SOD2 expression was associated with recurrence (p = 0.001), distant recurrence (p = 0.002), and death (p = 0.005). A multivariate analysis showed that patients with high SOD2 expression had a threefold increased risk for recurrence (HR = 3.16; 1.33–7.51) and death (HR = 2.98; 1.20–7.40) compared with patients who had low SOD2 expression. Patients with high SOD2 expression had shorter disease-free survival (p = 0.001) and overall survival (p = 0.003) than patients with low SOD2 expression. Conclusion: high SOD2 expression is a strong prognostic factor for stage IIIB squamous cell carcinoma of the cervix and could be used as a prognostic marker in women with cervical carcinoma.

Analysis of target doses on various tissues in treatment of lung cancer: a simulation study

The success indicator of radiotherapy planning is that it can deliver a precise and maximum dose to the tumor, and at the same time, health tissues receive a minimum dose. The success can be achieved by understanding the density of the organs that go into the treatment beams because the dose distribution was directly affected by tissue inhomogeneity. Therefore, the study aimed to evaluate the tissue density of DICOM images and the homogeneity of the distribution of dose from treatment planning in lung cancer using 3D Slicer-SlicerRT. The method used in the study was used 3 data of CT and RT – Structures data from The Cancer Imaging Archive (TCIA), NSCLC-Radiomics with a diagnosis of stage IIIB squamous cell carcinoma, the location of right cancer, and only one nodule. The calculation of tissue density values using segment statistics in 3D Slicer was based on CT-DICOM information. While the treatment planning was built using 3D Slicer-SlicerRT with a prescription of 60 Gy/30 fractions. Treatment design used six fields, and optimization was done by combining a gantry angle and beam weight. The results represented that the calculation of tissue density was following the reference standard and relative electron density for each organ. Besides, the study had successfully designed a treatment planning system using 3D Slicer-SlicerRT that fulfilled the total dose standard, was excellent for OAR sparing, and had a homogeneity index for patient data ID 1 until 4 with values of 0.252, 0.009, 0.007, and 0.007, respectively.

Purple bag syndrome: a visual clue for infection

A 35-year-old woman with recurrent, progressive stage IIIB squamous cell carcinoma of the cervix presented with a complicated urinary tract infection and was found to have bilateral purple bag syndrome....

A fight-and-flight for life: A rare case of advanced cervical cancer in pregnancy

BackgroundAdvanced cervical cancer during pregnancy is an extremely rare event. We describe a case of at least stage IIIB cervical squamous cell carcinoma during pregnancy. This may possibly represent the longest gestation from time of diagnosis to delivery in a case of advanced cervical cancer, with potentially the most advanced gestational age at delivery and a relatively favorable outcome in the current literature.Case: A 29-year-old female at 20 0/7 weeks of gestation with at least stage IIIB squamous cell carcinoma of the cervix flew from Micronesia to Hawaii for oncologic treatment. After consultation with gynecologic oncology and maternal-fetal medicine, she opted to continue the pregnancy and began neoadjuvant chemotherapy with carboplatin and paclitaxel. At 33 2/7 weeks of gestation, she was admitted for preterm prelabor rupture of membranes and immediately underwent a cesarean delivery for heavy vaginal bleeding. Postpartum, she underwent cisplatin chemotherapy with concurrent radiation therapy. After 6 cycles of chemotherapy, the patient’s cancer had progressed to the point that hospice was recommended. She died 11 months after initial presentation. ConclusionAdvanced cervical cancer during pregnancy requires individualized treatment, shared decision making, and a multidisciplinary team approach. If the pregnancy is continued, antepartum chemotherapy should be strongly considered. Maternal prognoses tend to be poor, but neonatal outcomes appear to be favorable.

Activity of manganese superoxide dismutase (MnSOD) as a predictor of radiation therapy outcome in patients with stage IIIB squamous cell carcinoma cervical cancer

BACKGROUND Radiation is a standard therapy for cervical cancer. Unfortunately, not all patients undergoing radiation achieve a complete response. Previous studies have shown that manganese superoxide dismutase (MnSOD) acts against free radicals generated by radiation in cancer cells thus predicting worse outcome in radiation therapy. This study was aimed to assess and evaluate whether MnSOD activity can be used as a predictor of radiation therapy responses in patients with stage IIIB squamous cell carcinoma (SCC).
 METHODS A comparative cross-sectional study was conducted in the Gynecology Oncology Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta. The database from previous research was analyzed to identify positive and negative response samples. Measurement of MnSOD activity was done using spectrophotometry based on the McCord and Fridovich method using RanSOD® kit. The comparative data were obtained and then analyzed.
 RESULTS Among 76 samples, 49 (61.8%) patients had positive responses and 27 (38.2%) had negative responses. It is shown in this study that higher MnSOD activity is related to worse radiotherapy outcome in stage IIIB cancer patients. The relative risk value of having a worse outcome with high MnSOD activity is 1.849 (1.075–3.178, 95% CI).
 CONCLUSIONS Stage IIIB squamous cell carcinoma patients with high MnSOD activity are at higher risk of having a negative radiation therapy response compared with patients without high MnSOD activity.

Safe administration of bevacizumab combination chemotherapy for the patients with recurrent cervical cancer after pelvic radiotherapy: Two case reports.

In Japan, bevacizumab has not been proven either effective or safe for the treatment of recurrent cervical cancer. The present study reported two cases in which bevacizumab combination chemotherapy was safely administered for recurrent cervical cancer following pelvic radiotherapy. Case 1 was a 62-year-old woman with stage IIIB squamous cell carcinoma of the cervix who had received whole pelvic external beam radiotherapy (WPEBRT) at a dose of 50.4 Gy and high dose rate intra-cavitary brachytherapy at a dose of 24 Gy to the pelvis one year earlier. For recurrent cervical cancer, chemotherapy with paclitaxel, carboplatin and bevacizumab was administered for six cycles. Case 2 was a 52-year-old woman with stage IIB squamous cell carcinoma of the cervix who had received WPEBRT at a dose of 50.4 Gy to the pelvis 11 years earlier. For lymph node and liver metastases, chemotherapy with paclitaxel, cisplatin, and bevacizumab was administered for six cycles. Although grade 2 proteinuria was observed in one of these patients, there were no intestinal perforation, fistula, hypertension, proteinuria or thrombosis events, which are the characteristic adverse reactions associated with bevacizumab. Hematotoxicity was also manageable. Regarding the antitumor effect, case 1 demonstrated a complete response, whereas case 2 resulted in stable disease.

Cisplatin Chemoradiotherapy vs Radiotherapy in FIGO Stage IIIB Squamous Cell Carcinoma of the Uterine Cervix

The evidence for concurrent chemoradiotherapy (CT-RT) in International Federation of Gynecology and Obstetrics (FIGO) stage IIIB squamous cell carcinoma of the uterine cervix is not robust. This study reports the final results of a randomized clinical trial of concurrent cisplatin-based CT-RT and radiotherapy alone (RT) in women with FIGO stage IIIB squamous cell carcinoma of the uterine cervix. To investigate the benefit of concurrent CT-RT in FIGO stage IIIB squamous cell carcinoma of the uterine cervix. This phase 3 open-label randomized clinical trial accrued 850 women in Mumbai, India, between July 7, 2003, and September 22, 2011. Of 2121 screened, 850 women with FIGO stage IIIB squamous cell carcinoma of the uterine cervix suitable for concurrent cisplatin chemotherapy were randomly assigned to CT-RT and RT using block randomization (1:1). The data were updated for a minimum follow-up period of 5 years until December 2016. The final analyses were performed in February and March 2017. This single-institution study was conducted at a tertiary cancer center setting. Randomization to receive RT (RT arm), comprising a combination of external beam RT (50 Gy in 25 fractions over 5 weeks) and brachytherapy, or to receive in addition to the same RT concurrent weekly cisplatin chemotherapy (40 mg/m2 per week) (CT-RT arm). The primary end point was 5-year disease-free survival (DFS), defined as the time between the date of randomization and the date of any recurrence or death (whichever occurred first) in the intent-to-treat population. This trial included 424 women assigned to CT-RT (mean [SD] age, 49.4 [7.9] years) and 426 women assigned to RT (mean [SD] age, 49.3 [7.9] years). At a median follow-up of 88 months (interquartile range, 61.3-113.1 months), there were 222 recurrences and 213 deaths in the CT-RT arm and 252 recurrences and 243 deaths in the RT arm. The 5-year DFS was significantly higher in the CT-RT arm (52.3%; 95% CI, 52.2%-52.4%) compared with the RT arm (43.8%; 95% CI, 43.7%-43.9%), with a hazard ratio for relapse or death of 0.81 (95% CI, 0.68-0.98) (P = .03). Similarly, the 5-year overall survival (OS) was significantly higher in the CT-RT arm (54.0%; 95% CI, 53.9%-54.1%) compared with the RT arm (46.0%; 95% CI, 45.9%-46.1%), with a hazard ratio for death of 0.82 (95% CI, 0.68-0.98; P = .04). After adjusting for prognostic factors, CT-RT continued to be significantly superior to RT for DFS and OS. There was a higher incidence of acute hematological adverse effects in the CT-RT arm. Chemoradiotherapy using weekly cisplatin results in significantly better DFS and OS compared with RT in women with stage IIIB squamous cell carcinoma of the uterine cervix. This study provides level 1 evidence in the largest clinical trial reported so far in favor of concurrent weekly cisplatin chemotherapy in this setting. clinicaltrials.gov Identifier: NCT00193791.

362P - Evaluation of quality of life (QOL) and time without symptom and treatment toxicity of nimotuzumab vs chemotherapy (weekly cisplatin) concurrently with with radiotherapy in patients with head and neck squamous cell carcinoma

Background: The purpose of this study was to evaluate QOL and Time Without Symptom and Treatment Toxicity of Nimotuzumab vs chemotherapy (weekly cisplatin) along with Radiotherapy inpatients with stage IIIB or less Squamous cell carcinoma of Head and neck regions. Methods: This is a retrospective data analysis of single institution between 2012 to 2015 with two years of follow up. All patients were of Squamous cell carcinoma of Head and neck regions with stage IIIB or less. Case records from hospital were analyzed. Thirty six patients received Nimotuzumab and matched [for stage, age and other variables] records of another 36 patients receiving chemotherapy were retrieved as controls. Patients received Nimotuzumab 200 mg weekly for 6 weeks or chemotherapy (weekly cisplatin 40 mg/m2) for 6 weeks along with Radiotherapy (IMRT). The QOL questioner was a part of dissertation thesis was used for analysis along with clinical case records for adverse events, grade, survival and time with good QOL. Results: A total of 72 patients were analyzed. The objective response rate was significantly higher in the Nimotuzumab group than in the control group in the intent-to-treat population (88% versus 64.5%; P = 0.04). No significant differences in median progression-free survival and overall survival were observed. Nimotuzimab had maximum TWIST score of 567 + 245 (Mean+ SD) days and better overall QOL improvement 4.8 + 1.2 compared to the chemo arm [465 + 189 days and QOL improvement of 3.2 + 1.5 points]. Conclusions: Based on the results of this retrospective analysis, Nimotuzumab weekly as single agent appears as an attractive alternative regimen for patients with HNSCC receiving definitive Radiotherapy and had better QOL and TWIST. A prospective study was planned and submitted to the local ethics committee based on above results to validate these results. If the trends are proven, this could be a choice with patients having borderline renal function and poor performance status. Clinical trial indentification: CRF Continental Hospitals Legal entity responsible for the study: Suresh AVS Funding: None Disclosure: D. Pawar: Works for Pharmaceutical Company All other authors have declared no conflicts of interest.

Comparison of Neoadjuvant Intraarterial Chemotherapy Versus Concurrent Chemoradiotherapy in Patients With Stage IIIB Uterine Cervical Cancer.

BackgroundThe purpose of this study was to compare the long-term survival of patients with stage IIIB squamous cell carcinoma of the cervix treated with neoadjuvant intraarterial chemotherapy (IA-NAC) versus those treated with concurrent chemoradiotherapy (CCRT).MethodsWe retrospectively reviewed the clinical records of 38 patients with stage IIIB squamous cell carcinoma of the cervix admitted between January 1994 and December 1999 who received IA-NAC followed by abdominal radical hysterectomy (ARH) or radiotherapy (RT). IA-NAC consisted of bilateral infusion via the internal iliac artery of cisplatin, bleomycin and pirarubicin for 2-3 courses. A historical control group of 64 patients who underwent primary CCRT from January 2000 to September 2007 was used for comparison.ResultsIn the IA-NAC group, 12 patients (31.6%) with operable tumors underwent ARH, and the remaining 26 patients (68.4%) received RT. The response rates were 86.8% (12 complete response + 21 partial response) for IA-NAC and 98.4% (26 complete response + 37 partial response) for CCRT (P = 0.077), respectively. The 5-year overall survival and disease-free survival rates were 62.4 and 44.5% for IA-NAC and 51.1 and 46.9% for CCRT (P = 0.247 and 0.776), respectively. The 5-year overall survival and disease-free survival rates were 75.0 and 58.3% for the patients receiving IA-NAC followed by ARH, and 55.3 and 37.6% for the patients receiving IA-NAC followed by RT (P = 0.368 and 0.262), respectively.ConclusionsIn the present study, IA-NAC followed by ARH or RT and primary CCRT showed similar survival rates for stage IIIB squamous cell carcinoma of the cervix.

Brachytherapy for stage IIIB squamous cell carcinoma of the uterine cervix: survival and toxicity

To compare survival and toxicity of three different treatments for stage IIIB cervix cancer: low-dose-rate (LDR), high-dose-rate (HDR) brachytherapy and association of HDR and chemotherapy. Between 1985 and 2005, 230 patients with FIGO stage IIIB squamous cell carcinoma of the uterine cervix received 4-field pelvic teletherapy at doses between 40 and 50.4 Gy, with a different complementation in each group. The LDRB group, with 42 patients, received one or two insertions of LDR, with Cesium-137, in a total dose of 80 to 100 Gy at point A. The HDR group, 155 patients received HDR in 4 weekly 7 Gy fractions and 9 Gy to 14.4 Gy applied to the involved parametria. The CHT group, 33 patients, were given the same treatment as the HDR group and received 5 or 6 weekly cycles of cisplatin, 40 mg per m(2). The five-year progression-free survival (PFS) was 60% for the HDR group and 45% for the LDR group, and the two-year PFS for the CHT group was 65% (p = 0.02). The five-year Overall Survival (OS) was 65% for the HDR group and 49% for the LDR group. The two-year OS was 86% for the CHT group (p = 0.02). Rectum toxicity grade II was 7% for the LDR group, 4% for the HDR group and 7% for the CHT group that had one case of rectum toxicity grade IV. Patients that received HDR had better OS and PFS. The Chemotherapy-HDR association showed no benefit when compared to HDR only. Toxicity rates showed no difference between the three groups.

Image in Medicine: Squamous Cell Granulomas in Completely Regressed Stage IIIB Lung Cancer after Chemoradiation Therapy

A stage IIIB squamous cell carcinoma of the lung was treated with neoadjuvant chemoradiation therapy before pneumonectomy. The postsurgical specimen showed complete pathologic response with no viable tumor identified. However, extensive squamous cell granulomas were present in the previous tumor bed. Squamous cell granulomas can cause diagnostic difficulty, and have only been previously described in treated head and neck squamous carcinomas in the literature.

6개월간 산삼약침요법을 시행 받은 ⅢB기 편평세포폐암 환자에 대한 증례보고

Objective To derive further studies evaluating the effectiveness of Cultured Wild Ginseng Pharmacopuncture (CWGP) Therapy on squamous cell carcinoma as a first line. Methods Three cycles (4 weeks/cycle) of CWGP were administered as a dosage of 10 ml per day. Patient was diagnosed with stage IIIB squamous cell carcinoma and refused all therapy of conventional medicine because of old age and cardiac invasion of tumor. Intensive treatment of CWGP for 3 cycles was done on the patient. Computed Topography (CT) was performed to evaluate the therapeutic efficacy. Results After the intravenous infusion of 2 cycles of CWGP, chest CT revealed the mass size and pleural invasion sustained stable disease. After the point injection of 1 cycle of CWGP, chest CT revealed progressive disease. The disease free survival rate was 1 month. Conclusion This case may provide us the possibility that CWGP offers potential benefits for patients with squamous cell lung carcinoma. But this is a single case study and further case-series research should be compensated.

Randomized Phase II Study of Immunomodulator Z-100 in Patients with Stage IIIB Cervical Cancer with Radiation Therapy

To find the optimal dose of immunomodulator Z-100 in patients with stage IIIB squamous cell carcinoma of the cervix in combination with radiation therapy. The patients were randomly assigned to the dosage levels of 2, 20 or 40 mug of Z-100. Z-100 was subcutaneously injected twice a week during radiotherapy and once in two weeks during the maintenance period. The response rate after radiotherapy was evaluated, and the optimal clinical dosage was then determined. Safety of Z-100 was evaluated during the radiation therapy and maintenance therapy. Survival was also evaluated. A total of 116 patients were entered. The adverse reactions were not dose-dependent and no serious toxicities were observed. The response rates were 72.2% (26/36) in the 2 microg group, 84.6% (33/39) in the 20 microg group and 94.3% (33/35) in the 40 microg group (P = 0.006). However, the survival was not significantly different. The optimal dose of Z-100 was determined to be 40 mug in combination with radiation therapy for stage IIIB cervical cancer. However, impact of Z-100 on survival must be determined by the placebo controlled randomized trial, because survival benefit was not observed in this small population study.

Metastatic tumor extending through the inferior vena cava into the right atrium: a case report of carcinoma of the uterine cervix with para-aortic lymph node metastases

Carcinoma of the uterine cervix with cardiac metastasis is not uncommon in autopsy cases. However, an intraatrial tumor extending through the inferior vena cava (IVC) from the site of para-aortic lymph node metastasis has never been reported. A 57-year-old Japanese woman was admitted to an emergency care unit complaining of mild chest pain and shortness of breath. She had progressive multiple lymphatic metastases of stage IIIB squamous cell carcinoma of the uterine cervix that had initially been treated with concurrent chemoradiation. Echocardiogram showed pedunculated tumor in the right atrium (RA), and computed tomography demonstrated multiple pulmonary tumor embolism. Surgical specimen from the RA showed squamous cell carcinoma resembling the primary cervical tumor, and the peduncle appeared to originate from within the IVC. Postoperative ultrasonography showed severe stenosis of the abdominal IVC due to the invasive growth of para-aortic lymph node metastases. The stalk of the tumor originated from this lesion. We present an extremely unusual case of intraatrial metastatic tumor originating from the para-aortic lymph nodes of cervical cancer.

Phase III double-blind randomized trial of radiation therapy for stage IIIb cervical cancer in combination with low- or high-dose Z-100: Treatment with immunomodulator, more is not better

Background. To evaluate the efficacy of low or high-dose immunomodulator, Z-100, in combination with radiotherapy for cervical cancer. Methods. Between 1995 and 1999, 221 patients with stage IIIb squamous cell carcinoma of the cervix were randomly assigned to treatment with Z-100 either at 0.2 μg or 40 μg in a double-blind manner in combination with radiotherapy. Results. The 5-year survival of patients with high-dose and low-dose Z-100 was 41.5% (95% CI: 31.7–51.3%) and 58.2% (95% CI: 48.7–67.7%), respectively, showing a 30% reduction in the death rate (hazard ratio: 0.670 [95% CI: 0.458–0.980], P = 0.039). Survival of high-dose group was equivalent to the 4-year survival of the radiotherapy plus hydroxyurea arm (49.7%) of GOG120 study, and that of low-dose group was similar to the survival of the cisplatin-based chemoradiation arm. The progression-free survival was also significantly improved in favor of low-dose group (hazard ratio: 0.667 [95% CI: 0.447–0.997], P = 0.048). The survival of low-dose group was similar to the survival of the cisplatin-based chemoradiation arms of the GOG120 study. Conclusions. Unexpectedly, the survival of patients with advanced cervical cancer treated by lower dose of Z-100 in combination with radiotherapy was significantly better than those treated with higher dose Z-100, which was equivalent to the survival with radiotherapy alone. The hypothesis that lower dose of Z-100 enhances the efficacy of radiation therapy is now being tested by placebo-controlled randomized trial.

Isolated right ventricular metastasis of uterine cervical carcinoma

Isolated direct metastasis of uterine cervical carcinoma to the right ventricular endocardium is very rare. A 68-year-old woman was initially diagnosed as having stage IIIb squamous cell carcinoma of the uterine cervix, and was treated with radiation therapy. After 2 years, she developed heart failure and presented with a mass in the right ventricle. The results of further examinations were consistent with a tumor or a thrombus in the right ventricle. She underwent excision of the mass under cardiopulmonary bypass, and histopathologic examination of the resected tissue revealed metastatic squamous cell carcinoma of the uterine cervix. She was discharged 3 weeks after the operation, and underwent chemotherapy. However, she was readmitted with drug-induced interstitial pneumonia and died 5 months after the surgery. Patients with an intracardiac mass and a history of uterine cervical cancer should be suspected of having a myocardial metastasis until it is proven otherwise.

Expression of hypoxic-inducible factor 1α predicts metastasis-free survival after radiation therapy alone in stage IIIB cervical squamous cell carcinoma

Purpose Hypoxia-inducible factor-1α (HIF-1α) is an intrinsic marker of tumor hypoxia. It has been considered that the hypoxic status reduces radiosensitivity, but the role of HIF-1α in advanced cervical carcinoma is still unclear. The objective of this study was to clarify the impact of HIF-1α, human papillomavirus (HPV), and other molecular factors, such as p53, bax, bcl-2, and their correlations on the outcome of patients with Stage IIIB cervical carcinoma in radiation therapy. Methods and materials We analyzed 38 patients with FIGO Stage IIIB squamous cell carcinoma of the cervix treated with radiation therapy alone. All patients received the combination therapy of external beam irradiation and low-dose-rate intracavity brachytherapy. The tumor expressions of HIF-1α, p53, bax, and bcl-2 were examined by immunohistochemical staining of the pretreatment paraffin embedded specimens. HPV infection was also detected by polymerase chain reaction. The effects of these parameters on clinical outcomes were analyzed by univariate analysis. Results Of 38 patients, high expression of HIF-1α, p53, bax, and bcl-2 were seen in 17 (45%), 22 (58%), 15 (39%), and 15 (39%) patients, respectively, and 28 patients (74%) showed positive infection with HPV. There was a significant positive correlation between high HIF-1α expression and disease recurrence ( p < 0.05). Furthermore, HIF-1α had a significant correlation with the recurrence-free survival rate ( p = 0.04). No statistical correlation was noted between high HIF-1α expression and the local control rate ( p = 0.17), whereas the HIF-1α status predicted distant metastasis with strong significance ( p = 0.03). Conversely, other factors demonstrated no impact on the clinical outcome. Conclusions The present results suggest that HIF-1α is an important prognostic factor, especially for predicting future metastasis after radiation therapy for patients with Stage IIIB squamous cell carcinoma of the cervix.

Squamous cell carcinoma of the cervix presenting as lymphangitic carcinomatosis: a case report and review of the literature

Background. Lymphangitic carcinomatosis (LC) secondary to carcinoma of the cervix is rare. The presenting symptoms are misleading and nonspecific, which often leads to delayed diagnosis. Case. We present the case of a 24-year-old woman with dyspnea and lower back pain, who was found to have stage IIIb squamous cell carcinoma of the cervix complicated by pulmonary LC. Conclusions. Pulmonary LC is a rare but important manifestation of metastatic cervical cancer. Patients present with severe respiratory compromise, which mimics other, more common disease states. Diagnosis can be achieved by transbronchial biopsy. Optimal treatment of the patient with LC is not well defined, but a trial of chemotherapy and/or intravenous steroids may be warranted. Prognosis for this condition is poor.