Treatment Of Uterine Cervical Cancer Research Articles

Japan Society of Gynecologic Oncology 2022 guidelines for uterine cervical neoplasm treatment.

The Japan Society of Gynecologic Oncology (JSGO) Guidelines 2022 for the Treatment of Uterine Cervical Cancer are revised from the 2017 guideline. This guideline aimed to provide standard care for cervical cancer, indicate appropriate current treatment methods for cervical cancer, minimize variances in treatment methods among institutions, improve disease prognosis and treatment safety, reduce the economic and psychosomatic burden of patients by promoting the performance of appropriate treatment, and enhance mutual understanding between patients and healthcare professionals. The guidelines were prepared through the consensus of the JSGO Guideline Committee, based on a careful review of evidence gathered through the literature searches and the medical health insurance system and actual clinical practice situations in Japan. The guidelines comprise seven chapters and 5 algorithms. The main features of the 2022 revision are as follows: 1) added discussed points at the final consensus meeting; 2) revised the treatment methods based on the International Federation of Gynecology and Obstetrics 2018 staging system; 3) examined minimally invasive surgery based on Laparoscopic Approach to Cervical Cancer trial; 4) added clinical question (CQ) for treatments of rare histological types, gastric type, and small-cell neuroendocrine carcinoma; 5) added CQ for intensity-modulated radiation therapy; 6) added CQ for cancer genomic profiling test; and 7) added CQ for cancer survivorship. Each recommendation is accompanied by a classification of recommendation categories based on the consensus reached by the Guideline Committee members. Here, we present the English version of the JSGO Guidelines 2022 for the Treatment of Uterine Cervical Cancer.

Early prediction of distant metastasis in patients with uterine cervical cancer treated with definitive chemoradiotherapy by deep learning using pretreatment [ 18 F]fluorodeoxyglucose positron emission tomography/computed tomography.

A deep learning (DL) model using image data from pretreatment [ 18 F]fluorodeoxyglucose ([ 18 F] FDG)-PET or computed tomography (CT) augmented with a novel imaging augmentation approach was developed for the early prediction of distant metastases in patients with locally advanced uterine cervical cancer. This study used baseline [18F]FDG-PET/CT images of newly diagnosed uterine cervical cancer patients. Data from 186 to 25 patients were analyzed for training and validation cohort, respectively. All patients received chemoradiotherapy (CRT) and follow-up. PET and CT images were augmented by using three-dimensional techniques. The proposed model employed DL to predict distant metastases. Receiver operating characteristic (ROC) curve analysis was performed to measure the model's predictive performance. The area under the ROC curves of the training and validation cohorts were 0.818 and 0.830 for predicting distant metastasis, respectively. In the training cohort, the sensitivity, specificity, and accuracy were 80.0%, 78.0%, and 78.5%, whereas, the sensitivity, specificity, and accuracy for distant failure were 73.3%, 75.5%, and 75.2% in the validation cohort, respectively. Through the use of baseline [ 18 F]FDG-PET/CT images, the proposed DL model can predict the development of distant metastases for patients with locally advanced uterine cervical cancer treatment by CRT. External validation must be conducted to determine the model's predictive performance.

Identification of predictive biomarkers for diagnosis and radiation sensitivity of uterine cervical cancer using wide-targeted metabolomics.

Uterine cervical cancer (UCC) is the fourth most common cancer in women, responsible for more than 300 000 deaths worldwide. Its early detection, by cervical cytology, and prevention, by vaccinating against human papilloma virus, greatly contribute to reducing cervical cancer mortality in women. However, penetration of the effective prevention of UCC in Japan remains low. Plasma metabolome analysis is widely used for biomarker discovery and the identification of cancer-specific metabolic pathways. Here, we aimed to identify predictive biomarkers for the diagnosis and radiation sensitivity of UCC using wide-targeted plasma metabolomics. We analyzed 628 metabolites in plasma samples obtained from 45 patients with UCC using ultra-high-performance liquid chromatography with tandem mass spectrometry. The levels of 47 metabolites were significantly increased and those of 75 metabolites were significantly decreased in patients with UCC relative to healthy controls. Increased levels of arginine and ceramides, and decreased levels of tryptophan, ornithine, glycosylceramides, lysophosphatidylcholine, and phosphatidylcholine were characteristic of patients with UCC. Comparison of metabolite profiles in groups susceptible and non-susceptible to radiation therapy, a treatment for UCC, revealed marked variations in polyunsaturated fatty acid, nucleic acid, and arginine metabolism in the group not susceptible to treatment. Our findings suggest that the metabolite profile of patients with UCC may be an important indicator for distinguishing these patients from healthy cohorts, and may also be useful for predicting sensitivity to radiotherapy.

Moesin Serves as Scaffold Protein for PD-L1 in Human Uterine Cervical Squamous Carcinoma Cells.

Immune checkpoint blockade (ICB) therapy targeting the programmed death ligand-1 (PD-L1)/PD-1 axis has emerged as a promising treatment for uterine cervical cancer; however, only a small subset of patients with uterine cervical squamous cell carcinoma (SCC) derives clinical benefit from ICB therapies. Thus, there is an urgent unmet medical need for novel therapeutic strategies to block the PD-L1/PD-1 axis in patients with uterine cervical SCC. Here, we investigated the involvement of ezrin/radixin/moesin (ERM) family scaffold proteins, which crosslink several plasma membrane proteins with the actin cytoskeleton, on the plasma membrane localization of PD-L1 in BOKU and HCS-2 cells derived from human uterine cervical SCC. Immunofluorescence analysis showed that PD-L1 colocalized with all three ERM proteins in the plasma membrane. Gene knockdown of moesin, but not ezrin and radixin, substantially reduced the plasma membrane expression of PD-L1, with limited effect on mRNA expression. An immunoprecipitation assay demonstrated the molecular interaction between PD-L1 and moesin. Moreover, phosphorylated, i.e., activated, moesin was highly colocalized with PD-L1 in the plasma membrane. In conclusion, moesin may be a scaffold protein responsible for the plasma membrane expression of PD-L1 in human uterine cervical SCC.

Age-Dependent Hematologic Toxicity Profiles and Prognostic Serologic Markers in Postoperative Radiochemotherapy Treatment for Uterine Cervical Cancer.

Introduction: In the adjuvant setting for cervical cancer, classical risk factors for postoperative radiochemotherapy have been established. However, data on laboratory changes during therapy and the prognostic value of serological markers are limited and further knowledge is needed to optimize the toxic trimodal regimen. Methods: We retrospectively identified 69 women who underwent weekly postoperative radiochemotherapy with 40 mg/m2 of cisplatin for cervical cancer between 2010 and 2021 at a single center. Laboratory parameters were recorded before, at each cycle and after radiochemotherapy. Kaplan-Meier and log-rank analyses were used to calculate and compare survival, groups were compared using the Mann–Whitney U, χ2, and variance tests. Results: With a median follow-up of 17.7 months, the 1- and 5-year local control rates were 94.0% and 73.7%, respectively, with significantly better rates for more chemotherapy cycles and negative resection margins. Only 68.1% of patients completed all cycles. The most common reasons for early discontinuation were persistent asymptomatic leukopenia in women aged ≤ 50 years, and limiting infections in women aged > 50 years. Leukopenia was more likely to occur after the third cycle. Significantly worse survival was observed for post-radiochemotherapy elevated C-reactive-protein and lactate dehydrogenase levels, low pre-radiochemotherapy nutritional index, and raised C-reactive-protein-levels; the latter were also predictable for local control. The Glasgow prognostic score did not reliably predict survival. Conclusion: Incomplete application of simultaneous chemotherapy leads to inferior local control, and age-dependent limiting factors should be identified at an early stage. In addition to classical risk factors, serological markers (C-reactive-protein, lactate dehydrogenase, nutritional index) show prognostic significance.

MicroRNA-101 Promotes the Proliferation, Migration, and Invasion of Uterine Cervix Cancer Cells by Targeting Cyclin-Dependent Kinase 8

Uterine cervical cancer (UCC), or carcinoma of the uterine cervix, is a familiar malignancy in gynecology. The expression of multiple microRNAs is abnormal in UCC. Research has demonstrated that the level of microRNA-101 (miR-101) was decreased in UCC, but the mechanism by which miR-101 regulates UCC is still unclear. The TargetScan software predicted that one of the target genes of miR-101 was CDK8. This study aims to explore whether miR-101 affects the migration, invasion, and proliferation of UCC cells through CDK8. First, nanoparticle-assisted PCR was used to determine the levels of miR-101 and CDK8 in UCC tissues, normal adjacent tissues, and two UCC cell lines, C-33A and Siha. Compared to the normal tissues, the level of miR-101 was decreased in UCC tissues, while the level of CDK8 was increased. The dual-luciferase reporter experiments confirmed that miR-101 directly interacted with the binding site in CDK8 3’UTR to regulate luciferase activity. The UCC cells were transfected with the MIR101 mimic construct to overexpress miR-101. It was demonstrated that cell migration, invasion, and proliferation was reduced in C-33A cells overexpressing miR-101. In the cells co-transfected with CDK8 and MIR101, the overexpression of CDK8 reversed the effect of MIR101 overexpression on cell migration, invasion, and proliferation. Therefore, miR-101 can regulate the migration, invasion, and proliferation of UCC cells by targeting CDK8. Therefore, miR-101 has potential applications in the treatment of UCC.

Erratum to: A multi-institutional survey of the quality of life after treatment for uterine cervical cancer: a comparison between radical radiotherapy and surgery in Japan.

Erratum to: A multi-institutional survey of the quality of life after treatment for uterine cervical cancer: a comparison between radical radiotherapy and surgery in Japan.

Cytotoxic Activity of Cu/TiO₂ Nanoparticles on Uterine-Cervical Cancer Cells.

Nanoparticles based on metal oxides serve as carrier matrices for molecules of biological interest. In this work, we used different copper complexes that were coupled to TiO₂ nanoparticles. Nanoparticles were prepared with the sol-gel method. The Cu/TiO₂ nanoparticles were characterized through ultraviolet-visible and Fourier transform infrared spectroscopy, differential scanning calorimetry, thermogravimetric analysis, nitrogen physisorption analysis, and scanning electron microscopy. Their biological activity was determined through DNA degradation and their cytotoxic effect on HeLa cells. The Cu/TiO₂ nanoparticles presented a pore size between 2 and 6 nm, the size of nanoparticles agglomerates was between 100 and 500 nm. The nanoparticles of Cu/TiO₂ degraded DNA starting at 15 min. The half maximal inhibitory concentration in HeLa cells depends on the used cooper complexes, the kinetics of cell death is of first order. Results revealed that these nanoparticles could be applied in uterine-cervical cancer treatment.

Relationship between Uterine Cervical Cytopathology and Histopathology in Mongolia

Objectives: This study aimed to evaluate the correlation between uterine cervical squamous cell abnormalities by conventional cytology and corresponding histopathology, and to assess the accuracy between them. Methods: A total of 192 cytological smears of patients with squamous cell abnormalities who underwent colposcopy examination from April – December 2015 were included in this study. The final agreement between cytology and histopathology was defined by the evaluation of histology as a golden standard. Results: The agreement between cytology and histopathology evaluation was 65.6%, and the discrepancy was 33.6% (k=0.512). When the classes of cytology were evaluated for accuracy, it was discovered that NILM* had a higher sensitivity of 77.0%, a specificity of 87.0%, a false positive of 23% and a false negative of 13.0% (k=0.711). Among the LSIL cases a sensitivity was discovered of 39.0%, a specificity of 82.7%, a false positive of 61.0% and a false negative of 17.3% (k=0.392. However, in HSIL sensitivity dropped to 37.8%, specificity increased to 91.6%, false positive were 62.0% and false negative were 8.4% (k=0.501). Conclusion: The agreement for diagnosis of uterine cervical cytology and histopathology was 65.6% (n = 126) and the discrepancy was 33.6% (n = 64) (p = 0.001). The correlation between cervical cytology and histopathology remained moderate (kappa=0.512). Thus, it is proposed that an appropriate quality control system for the cytopathological confirmation may contribute to the further detection and treatment for uterine cervical cancer in Mongolia.

Association between radiotherapy-induced alteration of programmed death ligand 1 and survival in patients with uterine cervical cancer undergoing preoperative radiotherapy

To evaluate radiotherapy-induced changes in the expression of programmed death ligand1 (PD-L1), programmed death1 (PD-1), and human leukocyte antigen classI (HLA-1) in patients with uterine cervical cancer, as well as infiltration of CD8+ and Forkhead box P3+ (FoxP3+)Tlymphocytes into tumor tissue and the prognostic value of these parameters. We performed immunohistochemical analysis of pre-radiotherapy biopsies and corresponding post-radiotherapy resected tissues in 104 uterine cervical cancer patients undergoing preoperative chemoradiotherapy or radiotherapy alone. We scored the expression of various proteins to distinguish positive from negative samples. PD-L1-expressing tumor cells (PD-L1 TC) increased significantly after chemoradiotherapy (p = 0.043). CD8+Tcell infiltration (p = 0.002) and FoxP3+Tcell infiltration (p = 0.003) decreased significantly after chemoradiotherapy. Expression of PD‑1, PD-L1-expressing immune cells (PD-L1 IC), and HLA‑1 did not change after chemoradiotherapy. In biopsy specimens obtained before chemoradiotherapy or radiotherapy, greater infiltration of CD8+Tcells (p = 0.001) and FoxP3+Tcells (p = 0.003) were significant predictors of better overall survival (OS). In surgical specimens obtained after chemoradiotherapy or radiotherapy, greater infiltration of PD-L1 TC was the only significant predictor of better OS (p < 0.001) and was related to asignificantly lower probability of out-of-field recurrence (p = 0.005). Chemoradiotherapy induced an immunologic shift that increased PD-L1 TC. Chemoradiotherapy has immunological effects that can influence the results of treatment for uterine cervical cancer.

The Application of Arsenic Trioxide in Ameliorating ABT-737 Target Therapy on Uterine Cervical Cancer Cells through Unique Pathways in Cell Death.

ABT-737, a B cell lymphoma-2 (Bcl-2) family inhibitor, activates apoptosis in cancer cells. Arsenic trioxide is an apoptosis activator that impairs cancer cell survival. The aim of this study was to evaluate the effect of a combination treatment with ABT-737 and arsenic trioxide on uterine cervical cancer cells. MTT (3-(4,5-dimethylthiazol-2-yl)-25-diphenyltetrazolium bromide) assay revealed that ABT-737 and arsenic trioxide induced a synergistic effect on uterine cervical cancer cells. Arsenic trioxide enhanced ABT-737-induced apoptosis and caspase-7 activation and the ABT-737-mediated reduction of anti-apoptotic protein Mcl-1 in Caski cells. Western blot assay revealed that arsenic trioxide promoted the ABT-737-mediated reduction of CDK6 and thymidylate synthetase in Caski cells. Arsenic trioxide promoted ABT-737-inhibited mitochondrial membrane potential and ABT-737-inhibited ANT expression in Caski cells. However, ABT-737-elicited reactive oxygen species were not enhanced by arsenic trioxide. The combined treatment induced an anti-apoptosis autophagy in SiHa cells. This study is the first to demonstrate that a combination treatment with ABT-737 and arsenic trioxide induces a synergistic effect on uterine cervical cancer cells through apoptosis. Our findings provide new insights into uterine cervical cancer treatment.

Japan Society of Gynecologic Oncology guidelines 2017 for the treatment of uterine cervical cancer.

The Japan Society of Gynecologic Oncology (JSGO) Guidelines 2017 for the Treatment of Uterine Cervical Cancer are for the purpose of providing standard treatment strategies for cervical cancer, indicating treatment methods currently considered appropriate for cervical cancer, minimizing variances in treatment methods among institutions, improving the safety of treatment and prognosis of diseases, reducing the economic and psychosomatic burden of patients by promoting performance of appropriate treatment, and enhancing mutual understanding between patients and healthcare professionals. The guidelines were prepared through consensus of the JSGO Guideline Committee, based on careful review of evidence gathered through the literature searches and in view of the medical health insurance system and actual clinical practice situations in Japan. The guidelines comprise eight chapters and five algorithms. The main features of the 2017 revision are as follows: (1) evidence was collected using a search formula and with cooperation of the Japan Library Association. The bibliographical search formula was placed at the end of the book; (2) regarding clinical questions (CQs) where evidence or clinical inspection in Japan was lacking, opinions of the Guidelines Committee were described as "proposals for future directions"; (3) cervical intraepithelial neoplasia (CIN) 3 and adenocarcinoma in situ (AIS) were treated as a cervical precancerous lesion; (4) the CQs of endoscopic surgery, radical trachelectomy, and sentinel node biopsy were newly added in Chapter3, "primary treatment for stage IB-II cervical cancer"; and (5) the CQ about hormone replacement therapy after cancer treatment was newly established. Each recommendation is accompanied by a classification of recommendation categories based on the consensus reached by the Guideline Committee members. Here, we present the English version of the JSGO Guidelines 2017 for the Treatment of Uterine Cervical Cancer.

Anti-glypican-1 antibody-drug conjugate exhibits potent preclinical antitumor activity against glypican-1 positive uterine cervical cancer.

Glypican-1 (GPC1) is highly expressed in solid tumors, especially squamous cell carcinomas (SCCs), and is thought to be associated with disease progression. We explored the use of a GPC1-targeted antibody-drug conjugate (ADC) as a novel treatment for uterine cervical cancer. On immunohistochemical staining, high expression levels of GPC1 were detected in about 50% of uterine cervical cancer tissues and also in a tumor that had relapsed after chemoradiotherapy. Novel anti-GPC1 monoclonal antibodies were developed, and clone 01a033 was selected as the best antibody for targeted delivery of the cytotoxic agent monomethyl auristatin F (MMAF) into GPC1-positive cells. The anti-GPC1 antibody was conjugated with MMAF. On flow cytometry, HeLa and ME180 cervical cancer cells highly expressed GPC1, however, RMG-I ovarian clear cell cancer cell line showed weak expression. The GPC1-ADC was rapidly internalized into GPC1-expressing cells in vitro and was potently cytotoxic to cancer cells highly expressing GPC1. There were no inhibitory effects on cancer cells with low expression of GPC1. In a murine xenograft model, GPC1-ADC also had significant and potent tumor growth inhibition. GPC1-ADC-mediated G2/M phase cell cycle arrest was detected, indicating that the dominant antitumor effect in vivo was MMAF-mediated. The toxicity of GPC-ADC was tolerable within the therapeutic dose range in mice. Our data showed that GPC1-ADC has potential as a promising therapy for uterine cervical cancer.

Serum Androgen Levels and Sexual Function Before and One Year After Treatment of Uterine Cervical Cancer: A Pilot Study

Radiotherapy or radical hysterectomy with salpingo-oophorectomy (SOE) as treatment for uterine cervical cancer causes estrogen deprivation in premenopausal women. The effects on androgen production have rarely been examined but could be relevant for survivors of cervical cancer because insufficiency has been associated with low sexual function. To investigate the effects of pelvic radiotherapy, hysterectomy with SOE, or surgery without SOE on androgen levels and to explore potential associations with sexual function. Patients with cervical cancer (N= 60) were prospectively examined through blood sampling and questionnaires before and 1 year after treatments. Serum testosterone (measured by liquid chromatography and tandem mass spectrometry), sex hormone-binding globulin, androstenedione, dehydroepiandrosterone sulfate, follicle-stimulating hormone, luteinizing hormone, and estradiol levels and Female Sexual Function Index scores. In women treated with radiotherapy (n= 38), median total and free testosterone levels were significantly decreased at 1-year follow-up compared with baseline in premenopausal women (n= 16; total testosterone-29%, P= .01; free testosterone-22%, P= .007) and postmenopausal women (n= 22; total testosterone-25%, P = .03; free testosterone-29%, P= .03). Androstenedione was decreased in premenopausal women only and dehydroepiandrosterone sulfate was decreased in postmenopausal women only after radiotherapy. In womentreated with hysterectomy and SOE (n= 10), testosterone levels were lower but not significantly lower, andthere was no change in those having surgery without SOE (n= 12). Female Sexual Function Index scores lowerthan 26.5 in sexually active women were reported by 80% 1 year after radiotherapy, by 44% after hysterectomy with SOE, and by 40% after surgery without SOE, with no significant differences compared with baseline values. No direct correlation between androgen levels and Female Sexual Function Index scores were found at 1-year follow-up. Total and free testosterone levels decreased slightly but significantly after pelvic radiotherapy in pre- and postmenopausal women. The clinical importance of this decrease is unclear, but androgen levels were not directly related to sexual function in this pilot setting.

Hormone therapy after uterine cervical cancer treatment: a Swedish population-based study.

This study aims to assess use of hormone therapy (HT) after cervical cancer treatment in women of premenopause age. We identified 837 women aged 45 years or younger at diagnosis of cervical cancer in the Swedish Cancer Register from January 1, 2005 to September 30, 2009 with a minimal follow-up of 1.5 years. Information on cancer treatment (surgical operation, radiotherapy, and/or chemotherapy) was obtained through the National Patient Register. Use of HT was estimated through HT dispensing during follow-up as recorded in the Prescribed Drug Register. Percentage of recommended dose was assessed by frequency of HT dispensing at half-year intervals up to April 1, 2011 or a maximal age of 50 years. A total of 257 women (31%) received acute estrogen deprivation due to bilateral salpingo-oophorectomy and/or radiotherapy. Among these women, 171 (67%) of 257 had at least one dispensing of HT during the period 0.5 to 1 year after diagnosis, and 118 (46%) of 257 were dispensed 75% or more of the recommended dose. Proportion users decreased to 39% at 4.5 to 5 years after diagnosis (21% with ≥ 75% of the recommended dose). Women younger than 40 years had a higher prevalence of HT use at 0.5 to 1 year (79%), decreasing to 45% after 4.5 to 5 years. The results did not vary by cancer histology. Fewer than half of cervical cancer survivors with therapy-induced early menopause used HT at or close to the recommended dose, and the use decreased during follow-up. Increased awareness of the health benefits of HT for this patient group is needed among professionals and women.

Japan Society of Gynecologic Oncology guidelines 2011 for the treatment of uterine cervical cancer.

The second edition of the Japan Society of Gynecologic Oncology guidelines for the treatment of uterine cervical cancer was published in 2011. The guidelines comprise eight chapters and five algorithms. They were prepared by consensus among the members of the Japan Society of Gynecologic Oncology Guidelines Formulation Committee and Evaluation Committee and are based on a careful review of the evidence obtained from the literature, health insurance system, and actual clinical settings in Japan. The highlights of the 2011 revision are (1) the recommended grades have been changed to five stages--A, B, C1, C2, and D; (2) the revisions are consistent with the new International Federation of Gynecology and Obstetrics staging system; (3) the roles are shared between the 'Japanese classification of cervical cancer' and the new guidelines; (4) clinical questions related to adenocarcinoma have been revised; and (5) a clinical question regarding cervical cancer in pregnant patients has been added. Each chapter includes a clinical question, recommendations, background, objectives, explanations, and references. Each recommendation is accompanied by a classification of recommendation categories. The objective of these guidelines is to update the standard treatment strategies for cervical cancer, thus eliminating unnecessary and insufficient treatment.

A study of high-dose-rate intracavitary brachytherapy boost for curative treatment of uterine cervical cancer.

PurposeThis study assessed the trial of boost intracavitary brachytherapy (ICBT) for the patients of uterine cervical cancer with residual malignant cells detected at the final stage of ICBT.Material and methodsThis is a retrospective analysis of 75 patients with cervical cancer treated radically with external beam radiotherapy and high-dose-rate intracavitary brachytherapy between August 2004 and December 2008. Eighteen patients (24%) out of 75 received one additional ICBT and five patients (7%) had two additional ICBT. All 75 patients were retrospectively analyzed. The median follow-up time was 30 months. The median age was 59 years (range 28-85 years). There were 12 patients (16%) in stage IB, 27 (36%) stage II, 22 (29%) stage III, and 14 (19%) stage IV.ResultsThe 5-year overall survival rate was 65%. Non-hematological toxicities greater than grade 2 occurred in 12 patients (16%). Of these, only two patients received on additional ICBT. No significant difference was found in grade 3 toxicity between patients who did and did not receive additional ICBT (p = 0.8).ConclusionsThe method to perform dose escalation should be examined depending on the treatment response.

Anti‐Müllerian hormone in premenopausal women following treatment of uterine cervical cancer

In this longitudinal study we prospectively enrolled 32 premenopausal women (ages 23-44years) with stage I-III uterine cervical cancer undergoing surgery and/or chemoradiation. Serum levels of anti-Müllerian hormone, follicle-stimulating hormone and estradiol were examined at baseline and 1year after treatment. As expected, serum anti-Müllerian hormone was undetectable after salpingo-oophorectomy or chemoradiation. After radical hysterectomy and pelvic lymphadenectomy with ovarian preservation serum anti-Müllerian hormone declined from a mean value of 2.0±1.4μg/L to 1.1±0.8μg/L (p=0.01), representing a 45% reduction, whereas there was no significant change in serum levels of follicle-stimulating hormone and estradiol. This implies that ovarian function may be affected not only by castrating treatment but also by radical hysterectomy with ovarian preservation. The risk of premature menopause and the potential need of hormone replacement therapy among these women may be overlooked since they no longer menstruate.

High-dose-rate brachytherapy in the treatment of uterine cervical cancer using cobalt-60 radionuclide source: Three years treatment outcome

Background: The Iridium-192 radionuclide source is commonly used for high-dose-rate brachytherapy of uterine cervical cancer. The cobalt-60 radionuclide source, which is more economical, is now available with dosimetric properties similar to iridium-192. Objective: To evaluate late gastrointestinal and genitourinary complications, and also the survival pattern in cervical cancer patients treated with cobalt-60 high-dose-rate brachytherapy, three years after treatment. Materials and Methods: Seventy patients, who were treated with high-dose-rate brachytherapy using the cobalt-60 radionuclide source were followed up for three years. All the patients received 45 Gy of external beam radiotherapy in 22 daily fractions, with 19.5 Gy from high-dose-rate brachytherapy, in three fractions, over three weeks, using the cobalt-60 radio nuclide source. The patients also received concurrent cisplatin-based chemotherapy. Late complications were assessed every three months, using Radiation Therapy Oncology Group (RTOG) late toxicity criteria. The pattern of disease control was also assessed. Results: Late complications in the bowel were, six (9%) grade 1, four (6%) grade 2, one (1%) grade 3, and one (1%) grade 4. The late complications affecting the bladder were 5 (7%) grade 1 and 1 (1%) grade 4. Twenty-eight patients (40%) were alive without disease, seven (10%) were alive with disease, seven (10%) died of persistent disease, four (6%) died of metastatic disease, while 24 (34%) were lost to follow-up. Conclusion: The late complications were similar to those reported for Iridium-192 as a source of high-dose brachytherapy. Cobalt-60 high-dose-rate brachytherapy is tolerable, effective, and economical for low resource settings.

Effect of the systematised critical pathway protocol on emptying failure as a secondary complication of radical hysterectomy due to uterine cervix cancer

To evaluate the usefulness of this pathway in managing postoperative emptying failure as a secondary complication of radical hysterectomy. Postoperative urological management after radical hysterectomy has not been effective. We designed and prospectively applied a critical pathway for effective postoperative urological management after radical hysterectomy, based on early catheter removal and application of clean intermittent catheterisation. Retrospective qualitative study. Retrospective review of results from a database of patients who underwent radical hysterectomy and pelvic lymphadenectomy for the treatment of uterine cervical cancer from 2004-2008 and analysis of questionnaires from ward nurses (Appendix 1) who were directly involved in patient care for measuring the clinical effectiveness. Data from a total of 185 patients were analysed. Mean period of the indwelling catheter was 8·3 (SD 1·1), 13·0 (SD 1·1) and 13·1 (SD 3·3) days in the critical pathway (CP), parallel control (PC) and historical control (HC) groups, respectively. Among CP, HC and PC groups, the overall hospital stays were 14·1 (SD 4·8), 20·2 (SD 10) and 18·2 (SD 8·8) days and the periods of time for the indwelling catheters were 8·31 (SD 1·1), 13·1 (SD 3·3) and 13·0 (SD 1·1) days, respectively. Significant differences in the overall hospital stay and the postoperative hospital stay were observed between CP group and the other groups. Analysis of the questionnaires showed that 67% of nurses agreed that the critical pathway was more effective than the previous management pathway system. Our results demonstrated that CP is an effective treatment modality for the management of postoperative emptying failure after radical hysterectomy. Our critical pathway may be applicable to postoperative urological management of radical pelvic surgeries. It may help patients in understanding their hospital course of treatment and encourage patients to participate in their postoperative care.