Cervix

Cervix

     

• AJ
  Mundt, PP Connell, et al (Univ of Chicago) 
  Race and
  Clinical Outcome in Patients with Carcinoma of the
  Uterine Cervix Treated With Radiation Therapy.
  
  Gynecol Oncol 71: 151-158, 1998.
  
      
  
  The study included ninety-four white patients and
  316 black patients undergoing radiation therapy for
  cervical cancer.
  
      
  
  It
  was found that the 8-year cause-specific survival was
  60% in white patients and 47%.9% in black patients. 
  Survival differed significantly between races in
  the group with stage IIB to IVA disease (60% and 34%
  respectively).
  
     
  
  Conclusions
  – Many factors adversely affect the efficacy of
  radiation therapy in black patients with cervical
  cancer.  Race
  per se was not an independent risk factor for survival
  in these patients; instead, other factors, such as low
  hemoglobin levels and low socioeconomic status, were
  associated with poorer outcomes.
  
      

• MA
  Varia, BN Bundy, et al (Univ of North Carolina, Chapel
  Hill;  Roswell
  Park Cancer Inst, Buffalo, NY; Wayne State Univ,
  Detroit; et al)  Cervical
  Carcinoma Metastatic to Para-aortic Nodes: External
  Field Radiation therapy with Concomitant 5-Fluorouracil
  and Cisplatin Chemotherapy: A Gynecologic Onoclogy Group
  Study.
  
  Int J Radiat Oncol Biol Phys  42:1015-1023,
  1998.
  
     
  
  Method –
  Concomitant IV cisplatin and 96-hour 5-FU infusion
  during the first and fifth weeks of pelvic and PAN
  radiation therapy was administered to 95 patients
  followed by intracavitary radiation therapy and external
  beam parametrial boost.
  
      
  
  It
  was found that combination radiation and chemotherapy
  for cervical carcinoma metastatic to para-aortic nodes
  was effective for about one third of patients and was
  relatively well tolerated. 
  It is important that PAN metastases in these
  high-risk patients be detected and treated.
  
      
  
  This
  collaborative Gynecologic Oncology Group study shows
  that treatment of para-aortic node metastases can be
  effective.  All
  those treated had biopsy evidence of tumor in their para-aortic
  nodes.  They
  received external field radiation with chemotherapy
  (platinum + 5-FU). 
  Chemoradiation does offer therapeutic advantages
  over radiation alone. 
  Although there was a high proportion of severe
  complications of grade 3 or 4, there were meaningful
  3-year progression-free intervals of 34%, which is quite
  good for patients with biopsy-proven disease.
  
       

• N
  Sakuragi, C Satoh, et al (Hokkaido Univ, Sapporo, Japan)Incidence
  and Distribution Pattern of Pelvic and Para-aortic Lymph
  Node Metastasis in Patients With Stages IB, IIA, and IIB
  Cervical Carcinoma Treated with Radical Hysterectomy.
  
  Cancer 85:1547-1554, 1999.
  
      
  
  This
  is an interesting operative-anatomic study of the
  distribution of lymph node metastases in cases of
  cervical carcinoma. 
  Of 208 patients studied, 53 had lymph node
  metastases.  The
  message appears to be that lack of metastases to the
  obturator node usually meant that the para-aortic nodes
  were free.  The
  information appears to confirm the stepwise progression
  of metastatic cervical disease from pelvic to para-aortic
  nodes. These are the remarks of A.L.Herbst, M.D., editor
  of the Year Book.
  
      

• A
  Sedlis, BN Bundy, et al (State Univ of New York,
  Brooklyn; Roswell Park Cancer Inst, Buffalo, NY; Bowman
  Gray School of Medicine, Winston-Salem, NC; et al)A
  Randomized Trial of Pelvic Radiation Therapy Versus No
  Further Therapy in Selected Patients with State IB
  Carcinoma of the Cervix After Radical Hysterectomy and
  Pelvic Lymphadenectomy: A Gynecologic Oncology Group
  Study.
  
  Gynecol
  Oncol 73: 177-183, 1999.
  
      
  
  Conclusions
  – The results of this prospective, multicenter,
  randomized clinical trial indicate that adjunct
  radiotherapy is beneficial for patients with stage I
  cervical cancer with risk factors such as large tumor
  diameter, deep stromal invasion, and tumor in the
  capillary lymphatic spaces. 
  Adjunct radiotherapy reduced cancer recurrence in
  these patients, with acceptable morbidity.   
  
  
      

• HM
  Keys, BN Bundy, et al (Albany Med College, NY; Roswell
  Park Cancer Inst, Buffalo, NY; Indiana Univ,
  Indianapolis; et al) 
  Cisplatin,
  Radiation, and Adjuvant Hysterectomy Compared with
  Radiation and Adjuvant Hysterectomy for Bulky Stage IB
  Cervical Carcinoma.
  
  N Engl J Med 340:1154-1161, 1999
  
      
  
  Pelvic Radiation with Concurrent Chemotherapy Compared with Pelvic and
  Para-aortic Radiation for High-Risk Cervical Cancer.
  
  M Morris, PJ Eifel, et al (Univ of Texas MD Anderson
  Cancer Ctr, Houston; Radiation Therapy Oncology Group,
  Philadelphia; Washington Univ, St.Louis; et al)
  
  N Engl J Med 340:1137-1143, 1999.
  
      
  
  
  Of
  403 participants, 193 were available for evaluation in
  each group.   It
  was found that among women with locally advanced
  cervical cancer, survival was significantly improved
  with the addition of chemotherapy with fluorouracil and
  cisplatin to intracavitary radiotherapy.
  
        
  
  Editorial comment
  -This is one in a series of articles in the ‘New England
  Journal of Medicine’ from the Gynecologic Oncology Group
  after achievement of superior results in cervical
  carcinoma with chemoradiation (platinum plus 5 FU)
  compared with radiotherapy alone. 
  This improvement does come at a price, which in
  the acute phase resulted in markedly more hematologic
  effects, but the long-term complications (over 60 days)
  are fairly comparable. 
  Two cycles of chemoradiation were given 3 weeks
  apart along with another cycle at the second implant. 
  The results are impressive for locally advanced
  disease, which shows significantly better survival among
  those who receive chemoradiation. 
  Today most of us use weekly infusions of
  cisplatin, which appears to have similar results. 
  This comment is by A.L. Herbst, MD. 
  
  
       

• K
  Bergmark, E Avall-Lundqvist, et al (Karolinska Inst,
  Stockholm, Huddinge Hosp, Stockholm)Vaginal
  Changes and Sexuality in Women with a History of
  Cervical Cancer.
  
  N Engl J Med 340:1383-1389, 1999.
  
      
  
  The
  study group consisted of 256 women with a history of
  early-stage cervical cancer, who had been treated in
  1991 and 1992 at the 7 gynecology departments in Sweden. 
  The control group consisted of 350 randomly
  selected women from the Swedish Population Register,
  matched for age and place of residence.
  
     
  
  This
  Swedish study has shown what has generally been
  suspected for many years. Women who have been treated for cervical cancer
  have an increased frequency of lack of vaginal
  lubrication and accompanying sexual difficulties. The cancer group also reported a problem with a
  short and inelastic vagina, all of which led to more
  dyspareunia. In
  spite of these problems, the frequency of orgasm
  appeared to be comparable between the cancer and control
  groups. These
  patients were aged 51 to 52 at the time of the survey,
  and those who had only surgical treatment of cervical
  cancer seemed to have problems, including lack of
  vaginal lubrication, comparable to those of the rest of
  the cancer group. These findings are important to the physician who cares for
  patients who have been treated for cervical carcinoma
  and should be kept in mind when these patients are
  counseled.
  
        

• P
  Holowaty, AB Miller, et al (Univ of Toronto)
  
  Natural History of Dysplasia of
  the Uterine Cervix.
  
  J Natl
  Cancer Inst  91:
  252-258, 1999
  
      
  
  
  Although it is known that most cases of cervical
  dysplasia do not progress to invasive cancer, there is
  little information on the natural progression and
  regression of cervical dysplasia. 
  The Pap smear history of a cohort of Toronto
  women was related to the risk of subsequent cervical
  cancer.
  
      
  
  Methods
  – Screening histories were collected by the Ontario
  Cancer Registry between 1962 and 1980 and analyzed along
  with the outcomes and Pap smear histories of 17,217
  women given a diagnosis of dysplasia between 1970 and
  1980.
  
      
  
  They
  concluded the risks of progression increased with the
  degree of dysplasia. 
  Most patients with mild dysplasia regressed to a
  normal Pap smear within 2 years.
  
     
  

• N
  Ylitalo, P Sorensen, et al (Karolinska 
  Institute, Stockholm; Statens Serum Institut,
  Copenhagen; Uppsala Univ, Sweden; et al)Smoking and Oral Contraceptives
  as Risk Factors for Cervical Carcinoma in Situ.
  
  Int J Cancer 81:357-365, 1999.
  
     
  
  Background
  – Human papillomavirus (HPV) is probably requisite but
  is not sufficient to cause cervical carcinoma. 
  However, it is not clear which factors in
  addition to HPV contribute to the development of
  cervical carcinoma and its precursor lesions.
  
     
  
  It was
  found that after adjustment for covariates in a
  multivariate analysis, current smokers had a 2-fold
  greater risk than those who had never smoked. 
  This association appears to be limited to women
  younger than 45 years of age. 
  Current OC use was associated with a 4-fold
  increase in overall risk, with a monotonic increase as
  duration of use increased. 
  Number of sexual partners was significantly,
  positively correlated with risk among HPV negative women
  but not among HPV positive women.
  
     
  
  Conclusions – Smoking is associated with cervical carcinoma in-situ
  (CIS), possibly in an age-dependent fashion. 
  In addition, OC use is correlated with risk of
  cervical CIS. 
  
  
      
  

• NP
  Yost, JT Santoso, et al (Univ of Texas Southwestern Med
  Ctr, Dallas; Univ of Texas Med Branchm Galveston)Postpartum
  Regression Rates of Antepartum Cervical Intraepithelial
  Neoplasia II and III 
  Lesions.
  
  Obstet Gynecol 93:359-362, 1999.
  
     
  
  Abnormal
  Pap smears are obtained in 5% of pregnancies. 
  Whether caesarian delivery reduces cervical
  cancer is controversial. 
  The biopsy-proven, antepartum cervical
  intraepithelial neoplasia (CIN) II and III lesions and
  their regression and progression rates postpartum were
  studied, and the issue of the effect of caesarian
  section was resolved.
  
     
  
  Methods- 279
  pregnant women evaluated at Parkland Memorial Health
  Hospital and they were followed-up. 
  The effect of vaginal deliveries and caesarian
  section were reevaluated.
  
     
  
  Conclusion
  – Conservative management of pregnant women with CIN II
  and CIN III during pregnancy is warranted.
  
     
  
  Editorial
  comment: 
  This is a small, but useful, study showing the
  course of CIN II and III diagnosed antenatally to the
  postpartum period, it shows that most of the lesions
  regress regardless of the route of delivery. 
  As the authors correctly note, these lesions
  should be followed conservatively during pregnancy and
  evaluated post partum by means of cytology, colposcopy,
  and directed biopsy.
  
       

• AY
  EL-Bastawissi, TM Becker, (Swedish Med Ctr, Seattle;
  Oregon Health Sciences Univ, Portland)Effect of Cervical Carcinoma In Situ and its Management on Pregnancy
  Outcome.
  
  Obstet Gynecol 93:207-212, 1999.
  
     
  
  Cryosurgery, laser ablation, and cold-knife or laser
  conization are current treatments, with the loop
  electrosurgical excision the most-recent procedure of
  choice.
  
     
  
  Of
  1847 women diagnosed with cancer in situ during an
  8-year period.  312
  were diagnosed during pregnancy. 
  They were retrospectively reviewed and compared
  with a group of 9200 women without cancer in situ who
  gave birth during the same year.
  
    
  
  Results
  :
  A small increased risk of preterm delivery and no
  increased risk of a low birth weight infant was found
  with women with cancer in situ who were not treated with
  conization when compared with women without cancer in
  situ.  There
  was a greater likelihood 
  of delivering premature 
  infants among women with cancer in situ who had
  conization when compared with women without cancer in
  situ.
  
          

• Rose PG, Adler LP, Rodriguez M, et al [ Ireland Cancer
  Ctr, Cleveland, Ohio, Univ Hosps of Cleveland, Ohio; Case Western Reserve
  Univ, Cleveland, Ohio]
  
  Positron Emission Tomography for Evaluating Para-aortic Nodal Metastasis in Locally Advanced Cervical Cancer Before Surgical Staging: A Surgicopathologic Study
  
  J Clin Oncol 17: 41-45, 1999
  
     
  
  Locally advanced cancer of the cervix at presentation have para -aortic lymph node involvement in 25%, which becomes the most important indicator of recurrence.
  
    
  
  20mCi of 2-[18F] fluoro-2-deoxy -D-glucose [FDG] uptake in
  para-aortic LN by PET is seen in 91% of cervical tumors. Yielding a positive predictor value of 75% and negative predictor value of 92% and a relative risk of 9.0 for metastatic disease. The editor comments that identifying the
  para-aortic LN would allow modification of radiation therapy field to include such site of disease.