Review of invasive cervical cancer Montgomery, Alison; Durden, Andrew; Sundararajan, Srividya ...
Obstetrics, gynaecology and reproductive medicine,
October 2023, 2023-10-00, Letnik:
33, Številka:
10
Journal Article
Recenzirano
This review of invasive cervical cancer explores the aetiology with HPV infection and prevention through vaccination. Diagnosis, imaging studies and the most recent FIGO staging are discussed. ...Management of stages 1A1-1B2 with surgery and stages 1B3-IV with chemoradiation are outlined. Fertility-sparing approaches along with exenteration and palliative treatments are also summarised.
Pain management in cervical cancer Aguiar-Rosas, Sebastián; Plancarte-Sanchez, Ricardo; Hernandez-Porras, B Carolina ...
Frontiers in oncology,
04/2024, Letnik:
14
Journal Article
Recenzirano
Odprti dostop
Cervical cancer (CC) occupies the second place in incidence and mortality among women in México. Despite this, Cervical Cancer continues to have a late diagnosis which leads to a high rate of ...complications. Pain represents the most feared and disabling symptom, being present in up to 86% of patients with advanced disease. The approach to managing pain in this population has not been studied and described to a full extent. In addition, there is a pressing need to provide concise recommendations to promote adequate pain control. We performed a review of the literature in CC and had experts in the field of pain management evaluate the evidence found. We then issued relevant recommendations on pharmacology and interventional pain management. Thus, the approach to pain management must be comprehensive and individualized, considering the timely and appropriate use of pharmacologic treatment as well as interventional procedures.
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•Image guided adaptive brachytherapy (IGABT) is changing clinical practice.•The EMBRACE studies benchmark IGABT in cervix cancer.•A multi-parametric dose prescription protocol is ...being validated in EMBRACE II.•EMBRACE II is hypothesised to improve outcome: disease, morbidity, quality of life.
The publication of the GEC-ESTRO recommendations one decade ago was a significant step forward for reaching international consensus on adaptive target definition and dose reporting in image guided adaptive brachytherapy (IGABT) in locally advanced cervical cancer. Since then, IGABT has been spreading, particularly in Europe, North America and Asia, and the guidelines have proved their broad acceptance and applicability in clinical practice. However, a unified approach to volume contouring and reporting does not imply a unified administration of treatment, and currently both external beam radiotherapy (EBRT) and IGABT are delivered using a large variety of techniques and prescription/fractionation schedules.
With IGABT, local control is excellent in limited and well-responding tumours. The major challenges are currently loco-regional control in advanced tumours, treatment-related morbidity, and distant metastatic disease. Emerging evidence from the RetroEMBRACE and EMBRACE I studies has demonstrated that clinical outcome is related to dose prescription and technique. The next logical step is to demonstrate excellent clinical outcome with the most advanced EBRT and brachytherapy techniques based on an evidence-based prospective dose and volume prescription protocol.
The EMBRACE II study is an interventional and observational multicentre study which aims to benchmark a high level of local, nodal and systemic control while limiting morbidity, using state of the art treatment including an advanced target volume selection and contouring protocol for EBRT and brachytherapy, a multi-parametric brachytherapy dose prescription protocol (clinical validation of dose constraints), and use of advanced EBRT (IMRT and IGRT) and brachytherapy (IC/IS) techniques (clinical validation). The study also incorporates translational research including imaging and tissue biomarkers.
Background/Aims: Different optimization methods in brachytherapy treatment planning is used. The aim of this study is to evaluate dosimetric differences between manual optimization (MO) and inverse ...planning simulated annealing (IPSA) planning techniques commonly used in brachytherapy of cervical cancer. Methods: Fifteen cervical cancer patients were included in this study. Nucletron standard tandem-ovoid (TO) applicators were used for treatment. High-risk clinical tumor volume (HR-CTV), bladder, rectum, and sigmoid contouring were performed according to GEC-ESTRO recommendations. Two plans were created for each patient using IPSA and MO techniques. While a dose of 700 cGy was prescribed to the target volume during the planning phase, an effort was made to protect the organs at risk in the best way possible. IPSA and MO planning techniques were compared via dose volume histogram (DVH). Results: There was no significant difference between HR-CTV and CI values for MO and IPSA techniques. There was a significant difference between IPSA and MO techniques for the 2cm3 volume of the rectum (p= 0.002). It was observed that the bladder was better protected by the IPSA technique. There was a 6.26% dose difference between IPSA and MO for the bladder. A significant difference was found between IPSA and MO techniques for the 2cm3 volume of the sigmoid (p= 0.002). The IPSA technique was superior to the MO technique in terms of time. Conclusions: The IPSA technique was superior to the MO technique in terms of protecting organs at risk (OARs). IPSA provides a faster and higher quality plan in cervical brachytherapy.
Arkaplan/Hedefler: Brakiterapi tedavi planlamasında farklı optimizasyon yöntemleri kullanılmaktadır. Bu çalışmanın amacı, serviks kanserinin brakiterapisinde yaygın olarak kullanılan manuel optimizasyon (MO) ve ters planlama simüle edilmiş tavlama (IPSA) planlama teknikleri arasındaki dozimetrik farklılıkları değerlendirmektir. Yöntemler: Bu çalışmaya on beş serviks kanseri hasta dahil edildi. Tedavide Nucletron standart tandem-ovoid (TO) aplikatörler kullanıldı. Yüksek riskli klinik tümör hacmi (HR-CTV), mesane, rektum ve sigmoid şekillendirme GEC-ESTRO tavsiyelerine göre yapıldı. IPSA ve MO teknikleri kullanılarak her hasta için iki plan oluşturuldu. Planlama aşamasında hedef hacme 700 cGy doz reçete edilirken, risk altındaki organların en iyi şekilde korunmasına çalışıldı. IPSA ve MO planlama teknikleri doz hacim histogramı (DVH) aracılığıyla karşılaştırıldı. Bulgular: MO ve IPSA teknikleri için HR-CTV ve CI değerleri arasında anlamlı fark yoktu. Rektumun 2cm3 hacmi açısından IPSA ve MO teknikleri arasında anlamlı fark vardı (p= 0.002). IPSA tekniği ile mesanenin daha iyi korunduğu görüldü. Mesane için IPSA ve MO arasında %6,26 doz farkı vardı. Sigmoidin 2cm3 hacmi açısından IPSA ve MO teknikleri arasında anlamlı fark bulundu (p= 0.002). IPSA tekniği zaman açısından MO tekniğinden üstündü. Sonuç: IPSA tekniği risk altındaki organların (OARs) korunması açısından MO tekniğinden üstündü. IPSA, serviks brakiterapisinde daha hızlı ve kaliteli bir plan sağlar.
•Patient education and expansion of nontraditional screening programs for unscreened and underscreened populations.•Implement reduction in costs, government health programs, and school based programs ...for vaccinations.•Adhere to guidelines, ensure access to healthcare, and establish an ethnically similar physician workforce for all patients.•Improve training, work efficiencies, payment reform, and quality metrics.•Ensure widespread use of chemoradiation, identify targets, and develop mutation-specific trials.
One woman dies from cervix cancer every 2 min, adding up to over 270,000 deaths globally per year. This cancer affects a young population, and hence, the loss of life is staggering. There are many aspects of prevention, screening, and care that are suboptimal. A great deal is known about HPV induced carcinogenesis, yet clinical outcomes have been stagnant over decades. There has been no improvement in cervix cancer survival in the US since the mid-1970s 1. With increased knowledge of the disease and greater worldwide resources including prevention, screening, and improved therapeutics, there is significant promise for fewer women to die from this virally induced cancer. We focus here on the major problems in prevention, screening, and delivery of care for cervix cancer and provide concrete solutions. With appropriate focus, a major improvement in survival from cervix cancer could be achieved in a short time span.
Radiotherapy dose-escalation using intensity-modulated radiotherapy (IMRT) has been necessary to improve treatment results in cervical cancer.
This was a phase II prospective clinical trial. 88 ...patients with FIGO II-IVa cervical cancer were enrolled in a single center. They received high-dose (60 Gy) IMRT with weekly cisplatin to the primary tumor and clinically positive nodes followed by intracavitary radiation. The primary endpoint was 30-month PFS rate (Target; 82%, an increase of 20% compared to GOG 120 trial using standard-dose radiotherapy). Secondary endpoints were tumor response, toxicity, recurrence, distant metastasis, and overall survival.
Progression-free survival rate at 30 months was 82.8%. Overall survival, locoregional recurrence, distant metastasis, and para-aortic recurrence rates at 30 months were 93.6%, 8.2%, 9.2%, and 2.4%, respectively. Forty-five (51.1%) of 88 patients achieved downstaging on MRI during radiotherapy and 80 (90.9%) patients had clinically complete response at three months after high-dose IMRT and intracavitary radiotherapy. The 30-month recurrence-free survival (92.9% vs. 73.1%, P = 0.009) and overall survival (100% vs. 87.0%, P = 0.006) were significantly higher in the downstaged group than in the non-downstaged group during radiotherapy. Grade 3 or higher hematologic toxicity was found in 11 (12.5%) patients and grade 3 or higher non-hematologic toxicity was found in 3 (3.4%) patients. Fourteen had chronic urinary (8.0%), intestinal (5.7%) toxicity, pelvic insufficiency fracture (2.3%) or vesicovaginal fistula (2.3%).
High-dose (60 Gy) IMRT with concurrent weekly cisplatin in locally advanced cervical cancer yielded favorable progression-free survival outcome. Tumor response during radiotherapy can be a significant prognostic factor for PFS.
Clinical trial information: This prospective trial is registered at ClinicalTrials.gov Identifier: NCT02993653.
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•We evaluated the efficacy of high-dose (60 Gy) radiotherapy for cervical cancer in this prospective phase II trial.•PFS at 30 months was 82.8%, an increase of about 20% compared to GOG 120 using standard-dose radiotherapy.•Positive tumor response during radiotherapy can be a significantly favorable prognostic factor for PFS.•Acute toxicity after high-dose (60 Gy) IMRT with concurrent weekly cisplatin was acceptable.
Aim:Cervical cancer is a common and mostly fatal gynecological malignancy. HPV vaccination is a secure and efficient procedure to prevent cancer before the first sexual intercourse. Designed to ...prevent the majority of invasive cervical cancer, quadrivalent (HPV 6/11/16/18) and bivalent (HPV 16/18) vaccines have been available since 2006 and 2007. These vaccines can prevent most cases of cervical cancer if given before a girl or woman is exposed to the virus. The Advisory Committee on Immunization Practices- ACIP suggests that girls should be vaccinated around the age of 12 years, even series can be started at age of 9 years.Material and Method:Between the dates of 1 January – 28 February 2018 at Tekirdağ Namık Kemal University Medical Research Center 50 nurses who have daughters, answered the questions of knowledge level assesstment survey about HPV vaccination.Results:Although %88 of the nurses know how and why to screen cervical cancer, only %32 of them had regular gynecological examination and cervical cancer screening. The rate of informing patients about HPV vaccination at gynecologist appointments of these 50 nurses, is %15.Conclusion:Nurses, providing healthcare services and health education to the community, have sufficient knowledge about HPV vaccination, which is indispensable for preventing cervical cancer. However, their trust in HPV vaccines is at very low levels. Additionally, our research shows that gynecologists cannot inform their patients efficiently due to not having HPV vaccination on National Immunizations Programme and additional costs.
Objective: Taxus sumatrana (Miq.) de Laub. (cemara Sumatra) is one of the plants found in Indonesia and other countries known as a medicine plant. Taxus's bark, leaves, and shoots are used ...traditionally and massively for some diseases (cancer, etc.), so recently it has become a rare plant. The chemical constituents of T. sumatrana are alkaloids, steroids, tannins, and flavonoids. This study aimed to investigate the potential anticancer properties of T. sumatrana bark, leaves, and shoot extracts. Methods: The cytotoxic activity against the HELA, T47D, and MCF-7/HER2 cell lines was determined using the MTT assay. Each cell was cultured on 96 well plates treated with extract of T. sumatrana with concentrations of 100, 10, 1, and 0,1 µg/ml. Cells were incubated for 48 h at 37 °C, 5% CO2 and then given 100 µl MTT solution 0.5 mg/ml in PBS (Phosphate Buffer Saline) for 4 h. The results of the measurements were processed with the GraphPad Prism Program. Results: The bark, leaves, and shoots extracts have strong cytotoxic activity based on IC50 parameters. The mean IC50 of bark, leaves, and shoots on the HELA cell line consecutively 8.94; 5.93; and 4.08 μg/ml; on the T47D cell line 5.80, 4.86, and 4,11 μg/ml; and on MCF-7/HER2 cell line 7.46, 10.60, and 13.74 μg/ml). Conclusion: T. sumatrana bark, leaves, and shoots have potential anti-cancer properties.
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