No abstract available.
Cervix Neoplasms/*radiotherapy ; Female ; Human ; Neoplasm Metastasis ; Pregnancy

In brachytherapy of uterine cervical cancer using a high dose rate remote afterloading system, it is of prime importance to deliver a accurate dose in each fractionated treatment by minimizing the difference between the pre-treatment planned and post-treatment calculated doses. The post-treatment calculated point A dose was not much different from the pretreatment planned dose (500 cGy). The average+/-standard deviation was 500+/-18 cGy and 84 percent of 82 intracavitary radiotherapy was within the range of 500+/-25 cGy.
Brachytherapy ; Cervix Uteri* ; Female ; Radiotherapy* ; Uterine Cervical Neoplasms

Commercially available rectal retractors can be used in high dose rate intracavitary brachytherapy (HDR ICR) as one of the methods for reducing the rectal dose in radiotherapy for a uterine cervical cancer. However, the extent of the rectal protection achieved using these rectal retractors has not been reported. The aim of the study was to examine the effect of a rectal retractor on reducing the rectal dose in HDR ICR. Thirty patients were treated with HDR ICR using rectal retractors. Tandem and ovoids were applied in 15 patients and ovoids only were used in the other 15 patients. During the simulation, the rectum was filled with barium, and anteroposterior and lateral radiographs were then taken with and without the rectal retractor. Along the anterior rectal wall outlined, 4 to 8 points (median 6) were chosen to calculate the dose for each patient including the rectal point (RP), which is an author-defined rectal point modified from the definition of the rectal reference point in the ICRU report 38. The length of the measured rectum was 3-7 cm (median 5 cm). The bladder point (BP) dose was measured as recommended by the ICRU. The prescription doses to point A varied from 3.5 to 5 Gy (median 4 Gy). Paired comparisons were made on the individual patients by calculating the normalized mean doses of the RP, the maximal point (MP), and the longitudinal average (LA) with and without the rectal retractor. The doses to the bladder points (BP) were also calculated in parallel to the rectal points. The anterior rectal walls were displaced posteriorly after inserting the rectal retractor. In the tandem and ovoids group, the number of patients with a reduced dose in the RP, MP and LA were 14 (93.3%), 12 (80.0%) and 13 (86.7%), respectively. In the ovoids only group, the corresponding figures were 14 (93.3%), 14 (93.3%) and 14 (93.3%). In the tandem and ovoids group, the reduced dose in the RP, MP, and LA dose were 0.52 Gy (13.0%), 0.50 Gy (12.5%), and 0.39 Gy (9.8%), respectively (p < 0.05). In the ovoids only group, the RP, MP, and LA dose were reduced by 0.62 Gy (15.5%), 0.92 Gy (23.0%), and 0.54 Gy (13.5%), respectively (p < 0.05). There was no significant change in the bladder point doses when the rectal retractor was applied, although the mean BP dose were 0.27 Gy and 0.09 Gy lower for the tandem and ovoids group and for ovoids only group, respectively (p > 0.05). The mean RP, MP, and LA dose reduction rates of the patient subgroup where the RP dose was < 70% of the prescription dose were compared with the subgroup where the RP dose was > 70%. The effect of the rectal dose reduction was significant only in the subgroup of patients who received > 70% of the prescription dose (p < 0.05). The use of the rectal retractor was a simple and an effective method for reducing the rectal dose. It was also considered to be a highly reproducible method, which can replace the time-consuming vaginal gauze packing in HDR-ICR.
Brachytherapy/*instrumentation/methods ; Cervix Neoplasms/*radiotherapy ; Female ; Human ; Radiotherapy Dosage ; *Rectum ; Surgical Instruments ; Vagina

It is well known that intracavitary radiotherapy (ICR), either alone or in combination with external-beam radiotherapy (EBRT) is an essential component of the radiation treatment of uterine cervical cancer. Although low-dose-rate (LDR) brachytherapy has been successfully applied to the management of such patients, several radiation oncologists have experience of using high-dose-rate (HDR) brachytherapy with promising clinical results over the past 4 decades. However, there has been a considerable reluctance by radiation oncologists and gynecologists in North America to employ the HDR remote afterloading technique instead of the more firmly established LDR treatment modality. In contrast, the HDR-ICR system is rapidly gaining acceptance in Korea since the introduction of the Ralstron, remotely controlled afterloading system using HDR Co-60 sources, at the Yonsei Cancer Center in 1979. According to brachytherapy statistics reported by the Korean Society of Therapeutic Radiology and Oncology, in 1997, brachytherapy was performed upon 1,758 Korean patients with uterine cervical cancer, of whom approximately 83% received HDR brachytherapy. In this review, we present our experiences of HDR-ICR for the treatment of uterine cervical cancer. In addition, we discuss the controversial points, which are raised by those considering the use of HDR-ICR for uterine cervical cancer; these issues include physical and radiobiological considerations, and the prospect of future technical improvements.
Brachytherapy/*methods ; Cervix Neoplasms/*radiotherapy ; Dose Fractionation ; Female ; Human ; Radiotherapy Planning, Computer-Assisted

Neoplastic plexopathy is usually associated with advanced systemic cancer, regional progression of the primary tumor and complication of cancer treatment including radiotherapy. Lumbosacral plexopathy is most commonly found in colorectal cancer and its symptom begins with leg pain, and thereafter numbness and weakness develops. Radiotherapy is generally considered as the 1st line therapy for metastatic plexopathy and it is also a way to relieve pain. We experienced one case of recurrent cervix cancer with lumbosacral nerve root metastasis after radical abdominal hysterectomy without additional radiation therapy and then we report it together with a brief review of literatures.
Cervix Uteri* ; Colorectal Neoplasms ; Female ; Hypesthesia ; Hysterectomy ; Leg ; Neoplasm Metastasis* ; Radiotherapy ; Uterine Cervical Neoplasms*

PURPOSE: To evaluate the significance of serum SCC for the monitoring of treatment response and the early detection of distant metastasis during radiotherapy (RT). MATERIALS AND METHODS: In 13 patients with histologically proven primary squamous cell carcinoma of uterine cervix, serum SCC values were checked in pre-RT point, weekly during RT, and in post-RT point. RESULTS: In 4 of 13 cases, metastasis appeared at the end of external RT, so that intracavitary radiation couldn't be performed. Of these 4 cases, 3 with elevated pre-RT SCC level, who resulted in lung metastasis on chest PA at the end of external RT showed decreased post-RT SCC value despite of metastasis. Of all 10 cases with elevated pre-RT SCC value (including 3 with metastasis at the end of external RT), SCC value was higher than pre-RT value in 7 at 9 Gy and the difference was statistically significant. At 18 Gy, SCC was higher in 4 and lower in 6 than pre-RT value. After 18 Gy, SCC value decreased continuously to the end of RT in all 10 cases. CONCLUSION: During RT, SCC value increased initially at 9 Gy. To 18 Gy, SCC value decreased to the nearly same with pre-RT value. After 18 Gy, to the end of RT, SCC value decreased continuously and normalized in completely responded cases. In cases with appearance of lung metastasis, SCC value also decreased with the disappearance of main mass of uterine cervix despite of metastasis.
Carcinoma, Squamous Cell* ; Cervix Uteri* ; Female ; Humans ; Lung ; Neoplasm Metastasis ; Radiotherapy* ; Thorax ; Uterine Cervical Neoplasms

From September 1985 through September 1989, 56 patients with stage IIIB carcinoma of the cervix were treated with radiation therapy with curative aim. The overall survival at 5 year was 38%. The survival rate was better for patients treated with combined external radiotherapy and high dose rate intracavitary radiotherapy than with external radiotherapy alone. No significant survival difference was observed between the unilateral and bilateral parametrial extension of the tumor. Seventeen patients experienced recurrence within the irradiated field with a loco-regional recurrence rate of 30%. Ten patients had complications (18%). The complications were mild in three, moderate in four, and severe in three patients. A study was made on the relationship between the fraction numbers of intracavitary radiotherapy, vaginal packing and the complication rate, respectively. In this analysis author observed that the significant treatment factor influencing the survival of cervical cancer was the use of intracavitary radiation, and meticulous vaginal packing could decrease the late complication rate of radiotherapy of the conical cancer.
Cervix Uteri* ; Female ; Humans ; Radiotherapy ; Recurrence ; Survival Rate ; Uterine Cervical Neoplasms*

OBJECTIVE: The aim of this study is to clarify the relationship between COX expressions and radioresistance in cervical cancer. METHODS: Patients with cervical cancer treated by primary radiotherapy were selected from the tumor registry of our institution. According to the response to radiotherapy during and after a month of radiation, poor responder and good responder was defined. Immunohistochemical staining was performed by the ABC method using formalin-fixed, paraffin-embedded tissue sections and monoclonal anti-COX-1,2 antibodies. Correlation of COX expression and response to radiation was analyzed. Cell lines derived from human cervical tumors were used: HeLa, HT3, and C33A. Using western blot, COX-1,2 expressions were identified in each cell line. The sensitivity of the cervix cancer cells to radiation was measured using a clonogenic assay. RESULTS: COX-1 and COX-2 expressions were higher in poor responders than good responders. The difference of COX-1 expression between two groups had marginal statistical significance (p=0.099, Fisher's exact test) and COX-2 expression was significantly higher in poor responders (p=0.034, Fisher's exact test). In the clonogenic assay, survival fraction of HeLa and HT-3 cell lines, which have COX-1 and COX-2 activity, was significantly higher than C33A cell line which has no COX activity (p<0.001). CONCLUSION: Our results suggest that the expression of COX in cervical cancer might be deeply associated with the effect of radiation therapy.
Antibodies ; Blotting, Western ; Cell Line ; Cervix Uteri* ; Female ; Humans ; Prostaglandin-Endoperoxide Synthases* ; Radiotherapy ; Uterine Cervical Neoplasms

PURPOSE: This study evaluated early bowel complications in cervix cancer patients, following external radiotherapy (ERT) and high dose rate intracavitary radiation (HDR ICR). Factors affecting the risk of developing early bowel complications and its incidence are analyzed and discussed. MATERIALS AND METHODS: The study is the retrospective review of 66 patients who received radiotherapy at Chungbuk National University Hospital from April 1994 to December 1998. The patients underwent 41.4 or 50.4 Gy ERT according to FIGO stage and tumor size, then A point dose was boosted to 71.4 or 74.4 Gy using a remotely controlled afterloading Buchler HDR ICR. The EORTC/RTOG morbidity criteria were used to grade early bowel complications, which are valid from day 1, the commencement of therapy, through day 90. The actuarial incidence, severity of complications were investigated and clinical pretreatment factors relevant to complications were found through univariate (Wilcoxon) and multivariate (Cox proportional hazard model) analysis. RESULTS: Of the 66 patients, 30 patients (46%) developed early bowel complications; 25 patients (38%) with grade 1 or 2, 4 patients (6%) with grade 3 and 1 patient (2%) with grade 4. The complications usually began to occur 3 weeks after the commencement of radiotherapy. The actuarial incidence of early bowel complications was 41% at 10 weeks. The early bowel complications were associated significantly with an old age and a history of previous abdomino-pelvic surgery. All three patients who had a protracted overall treatment time (about 2 weeks) due to severe bowel complication, suffered from pelvic recurrences. CONCLUSION: Forty six percent of patients experienced early bowel complications, most of which were grade 1 or 2 and relieved spontaneously or by medication. The patients with an old age or a previous surgery have a high probability of early complications and they may be less compliant with planned radiotherapy. So more careful precaution is necessary for these patients.
Cervix Uteri* ; Chungcheongbuk-do ; Female ; Humans ; Incidence ; Radiotherapy* ; Recurrence ; Retrospective Studies ; Uterine Cervical Neoplasms

PURPOSE: In radiotherapy for cervix cancer, both 3-dimensioal radiotherapy (3D-CRT) and intensity-modulated radiation therapy (IMRT) could reduce the dose to the small bowel (SB), while the small bowel displacement system (SBDS) could reduce the SB volume in the pelvic cavity. To evaluate the effect of the SBDS on the dose to the SB in 3D-CRT and IMRT plans, 3D-CRT and IMRT plans, with or without SBDS, were compared. MATERIALS AND MEHTODS: Ten consecutive uterine cervix cancer patients, receiving curative radiotherapy, were accrued. Ten pairs of computerized tomography (CT) scans were obtained in the prone position, with or without SBDS, which consisted of a Styrofoam compression device and an individualized custom-made abdominal immobilization device. Both 3D-CRT, using the 4-field box technique, and IMRT plans, with 7 portals of 15 MV X-ray, were generated for each CT image, and prescribed 50 Gy (25 fractions) to the isocenter. For the SB, the volume change due to the SBDS and the DVHs of the four different plans were analyzed using paired t-tests. RESULTS: The SBDS significantly reduced the mean SB volume from 522 to 262 cm3 (49.8% reduction). The SB volumes that received a dose of 10~50 Gy were significantly reduced in 3D-CRT (65~80% reduction) and IMRT plans (54~67% reduction) using the SBDS. When the SB volumes that received 20~50 Gy were compared between the 3D-CRT and IMRT plans, those of the IMRT without the SBDS were significantly less, by 6~7%, than those for the 3D-CRT without the SBDS, but the volume difference was less than 1% when using the SBDS. CONCLUSION: The SBDS reduced the radiation dose to the SB in both the 3D-CRT and IMRT plans, so could reduce the radiation injury of the SB.
Cervix Uteri* ; Female ; Humans ; Immobilization ; Prone Position ; Radiation Injuries ; Radiotherapy ; Uterine Cervical Neoplasms*