Objective To analyze the clinical and histopathologic characteristics and prognostic factors for primary carcinoma of the vagina managed with radiotherapy at a single institution . Methods Eighty-three patients with primary vaginal carcinoma were treated with definitive radiation therapy between 1980 and 2007 were retrospectively analyzed. Radiotherapy was delivered with external beam radiation alone in 11 patients, intracavitary after-loading radiation alone in 7 patients, and external beam combined with After-loading radiation in 65 patients. The median radiation dose was 75 Gy. Fifty-one patients received more than 75 Gy. Thirty-one patients received combined chemotherapy. Of them, 16 received intravenous neoadjuvant or adjuvant chemotherapy, 8 received intra-arterial chemotherapy and 7 received concomitant chemotherapy. Patients were staged acoording to FIGO staging system. Nineteen patients had stage Ⅰ ;31 had stage Ⅱ, 25 had stage Ⅲ and 8 had stage Ⅳ diseases. Fifty-three patients had squamous cell carcinoma, 22 had adenocarcinoma, 2 had adenosquamous cell carcinoma,3 had papillary serous carcinoma,2 had clear-cell carcinoma and 1 had undifferentiated carcinoma. Thirty-nine patients had grade 1 and 44 had grade 2 and/or grade 3 diseases. Results The follow-up rate was 89%. Thirty-five and 31 patients had minimum followed-up time of 3 and 5 years respectively. The 3-and 5-year overall survival rates were 51% and 42% respectively. Univariate analysis showed that FIGO stage ( x2 = 11.30,P= 0. 010), histopathology type (x2=5.76,P=0.016),pathologic grade (x2=5.76,P=0.016), tumor size (x2=4.81,P=0. 020), tumor site ( x2=23.50,P =0. 000), external beam combined with intracavitary irradiation ( x2 =29. 76,P =0. 000) correlated with overall survival rate. Cox multivariate analysis showed only FIGO stage ( x2 = 5.93, P = 0. 015 ) and tumor size ( x2 = 8.48, P= 0. 004 ) were independent prognostic factors affecting overall survival. Serious complications were developed in 12% ( 10/83 ) of the patients. One patient suffered from vesicovaginal fistula and 3 from rectovaginal fistula. Twenty-eight patients had local or distant relapses, and the 3-year overall survival rate was 14% after salvage therapy. Conclusions Radiotherapy is effective for early stage primary vaginal carcinoma. FIGO stage and tumor size were independent prognostic factors affecting overall survival. The role of chemotherapy for advanced disease needs further study.

Objective To investigate the clinical features, treatments and prognostic factors of rhabdomyosarcoma (RMS) in the female genital tract. Methods A retrospective analysis was performed on 13 cases of RMS in the female genital tract. Clinical characteristics, treatments and prognosis were compared and analyzed statistically. Results The median age was 21.0 years (range, 6 to 54 years). There were 6 cases vaginal RMS and 7 cases cervical RMS, included 11 cases of embryonal RMS (ERMS) and 2 cases of alveolar RMS (ARMS). According to the Federation International of Gynecology and Obstetrics (FIGO)staging system,there were 6 cases of stageⅠ, 3 cases of stageⅡ, 1 case of stageⅢand 3 cases of stage Ⅳ, the median survival time were respectively 112.5, 153.0, 9.0 and 3.5 months. According to the Intergroup Rhabdomyosarcom Study Group (IRSG) staging system, there were 10 cases of stageⅠ and 3 cases of the stage Ⅳ, and their median survival time were respectively 112.5 and 3.5 months. Nine patients received surgery and the median survival time was 108.0 months (range, 9 to 228 months), 6 of them received chemotherapy after surgery and the median survival time was 152.0 months (range, 9 to 228 months), the other 3 cases did not receive any therapy after surgery and the median survival time was 25.0 months (range, 9 to 108 months). Four patients did not receive surgery and the median survival time was 6.3 months (range, 1 to 117 months). There were 2 cases received combined treatment included radiotherapy and the survival time were respectively 4 and 198 months. There were 8 cases who was survival without disease and 5 cases died of cancer. The median survival time in 13 patients was 25.0 months (range, 1 to 228 months) and the 5-year overall survival rate was 58.6%. Conclusions The prognosis of early stage of RMS in the female genital tract is good. While, the prognosis of advanced stage is poor. The standard treatment strategy is combination of surgery and chemotherapy,whether radiotherapy could improve the prognosis still need further study.

Objective To investigate the efficacy and prognostic factors in patients with stage Ⅰ b and Ⅱ a cervical carcinoma by radical radiotherapy.Methods Between January 1999 and January 2012,108 patients with stage Ⅰ b and Ⅱ a cervical carcinoma received radical radiotherapy in Cancer Hospital,Chinese Academy of Medical Sciences were included and analyzed retrospectively.Patients of stage Ⅰ b1,Ⅰ b2,Ⅱa1 and Ⅱa2 were 18 (16.7％,18/108),38 (35.2％,38/108),33 (30.6％,33/108) and 19 (17.6％,19/108),respectively.Results The 5-year overall survival rate was 76.2％ and the 5-year disease free survival rate was 75.6％.Totally 25 (23.1％,25/108) patients developed recurrent disease,16 of them (64％,16/25) had local recurrences,6 (24％,6/25) had distant metastases and 3 cases had both local recurrence and distant metastases.Among patients with recurrent disease,23 died and 2 survive with tumor.Totally 24 patients died,23 of them died due to tumor recurrence and the other one died of other reason.The univariate analysis showed that,lymph node metastasis,squamous cell carcinoma antigen (SCC) levels before treatment,SCC levels after treatment 1 month had relation with overall survival time in patients with stage Ⅰ b and Ⅱ a cervical carcinoma (all P ＜ 0.05).The multivariate analysis showed that,lymph node metastasis and SCC levels after treatment 1 month were the independent prognostic factors for overall survival time for the cervical squamous cell carcinoma (OR =2.5,4.4 ; all P ＜ 0.05).Conclusions By means of radical radiotherapy,stage Ⅰ b and Ⅱ a cervical carcinoma patients with lymph node metastasis and SCC levels≥ 1.5 mg/L after treatment one month have poor prognosis.While,stage Ⅰ b and Ⅱ a patients with concurrent chemoradiotherapy after neoadjuvant chemotherapy did not affect the prognosis.The 5-year survival rate with concurrent chemoradiotherapy was higher than that of radiotherapy.

Objective:To approach the clinicopathologic characteristics, treatment modalities, and prognosis of the patients with double primary carcinoma of endometrial carcinoma and colorectal carcinoma and analyze the relationship between this disease and Lynch syndrome. Methods:The clinicopathologic and follow-up data of 34 cases with double primary carcinoma of endometrial carci-noma and colorectal carcinoma treated in Cancer Hospital of Chinese Academy of Medical Sciences were reviewed. Results:The medi-an age of the 34 patients was 51.5 years old (ranging from 39 to 76). Twenty-two of the total cases (22/34, 64.7%) had tumor family his-tory. The pathologic results indicated that 79.4%(27/34) was endometrioid adenocarcinoma. In the 34 cases, 33 were treated by surgical procedure. Of the 33 cases undergoing surgery, 17 patients with endometrial carcinoma and 19 with colorectal carcinoma received fur-ther adjuvant treatment of chemotherapy and/or radiotherapy. The 2-and 5-year survival rates were 84.3%and 63.1%in the 34 cases, respectively. Conclusion:The age of onset is earlier in the patients with double primary carcinoma than in those with sporadic colorec-tal carcinoma. Some cases have cancer family history, and their survival rates are similar to those of the patients with sporadic colorec-tum carcinoma. Diagnosis of some patients with double primary carcinoma may be in line with Lynch syndrome.

Objective To evaluate septin-9 and clusterin protein levels in the peripheral blood samples from epithelial ovarian cancer patients, and explore its clinical significance. Methods Clinical data of 200 patients in Cancer Hospital,Chinese Academy of Medical Sciences from Jan. 29, 2008 to Feb. 1,2010 were collected. The peripheral blood samples were obtained from 137 epithelial ovarian cancer patients, 12 borderline ovarian tumor patients, 10 benign ovarian tumor patients, 41 benign pelvic lesion patients and 58 healthy women. The septin-9 and clusterin protein levels in the plasma were measured by double antibody sandwich ELISA or ELISA. The clinical significance of clusterin and septin-9 in plasma was analyzed. The diagnostic efficacy of septin-9 and clusterin protein in the detection of ovarian cancer was evaluated by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. Results Double antibody sandwich ELISA showed: the mean levels of plasma septin-9 in epithelial ovarian cancer patients or benign pelvic lesion patients were significantly higher than that in healthy women detedted by double antibody sandwich ELISA (P<0.01). The mean levels of plasma septin-9 in epithelial ovarian carcinoma patients with tumor family history or distance metastasis were significantly higher than those patients without (P<0.05). While the expression level of septin-9 protein in peripheral blood of ovarian cancer patients was not related to the patient age, pathologic stage, pathologic differentiation, smoking history, treatment history (including surgery, radiotherapy and chemotherapy) and lymph node metastasis (all P>0.05). ELISA showed: the mean level of plasma clusterin in epithelial ovarian cancer patients was significantly higher than that in healthy women deteded by ELISA (P=0.021). The expression level of clusterin protein in peripheral blood of ovarian cancer patients was not related to the above clinical pathological parameters (all P>0.05). To distinguish between ovarian cancer patients and healthy women by septin-9 protein expression level in plasma, when AUC was 0.712 and cut off was 0.28, the sensitivity of detection ovarian cancer by septin-9 protein expression was 82.5%, and the specificity was 50.0%. To distinguish between ovarian cancer patients and healthy women by clusterin protein expression level in plasma, when AUC was 0.636 and cut off was 87.96 pg/L, the sensitivity of detection ovarian cancer by clusterin protein expression was 71.5%, and the specificity was 41.4%. Conclusions The expression of septin-9 and clusterin protein in peripheral blood of ovarian cancer patients is increased, especially the expression level of septin-9 protein with related to the distant metastasis. The study results shown that the detection of septin-9 and clusterin in plasma has a certain diagnosis value in ovarian cancer, which may be a potential markers for ovarian cancer.

Objective To evaluate the outcomes and the prognostic factors for advanced squamous cervical cancer after concurrent chemoradiotherapy (CCRT).Methods Totally 172 patients with International Federation of Gynecology and Obstetrics stage Ⅱ b-Ⅳ who were treated in Cancer Hospital,Chinese Academy of Medical Sciences between January 2007 and December 2008 were retrospectively analyzed.Patients were received external radiotherapy,high-dose rate brachytherapy and cisplatin-based chemotherapy concurrently.Results The median follow-up period was 54.5 months.The 2-year and 5-year overall survival (OS) were separately 81.5％ and 68.8％.The 2-year and 5-year progress-free survival (PFS) were separately 69.2％ and 63.1％.Using univariate analysis followed with multivariate analysis,the results showed that these clinicopathological factors including stage (Ⅲ and above versus Ⅱ b; P =0.021,HR =1.95 ; P =0.020,HR =1.86),maximum diameter of local tumor size (＞4 versus ≤4 cm; P =0.009,HR =2.55 ; P =0.033,HR =1.94),squamous cell carcinoma antigen (SCC) level before treatment (＞3 versus ≤3 μg/L; P =0.010,HR =2.47; P =0.013,HR =2.09) and retroperitoneal lymph node status on imaging (para-aortic lymph node positive versus negative,P =0.009,HR =3.00,P=0.010,HR =2.74; pelvic lymph node positive only versus negative,P =0.044,HR =1.98,P =0.033,HR =1.92) had the significant effect on OS and PFS.Patients with no above adverse prognostic factor were assigned to Group A (n =18),those with one factor were assigned to Group B (n =43),and those with no less than two factors were assigned to Group C (n =1 11).Among three groups,the 2-year OS were separately 94.1％,97.7％ and 73.1％,the 5-year OS were separately 81.4％,90.1％ and 58.6％,the 2-year PFS were separately 88.2％,90.4％ and 57.9％,the 5-year PFS were 82.4％,87.9％ and 50.0％.The results showed that group C was significant difference from Group A or B in OS and PFS (all P ＜ 0.05),while Group A had no significant difference from Group B in OS and PFS (P ＞ 0.05).Conclusions Stage Ⅲ or above,maximum diameter of local tumor size ＞ 4 cm,SCC level ＞ 3 μg/L before treatment and positive retroperitoneal lymph nodes on imaging are four independent adverse factors for prognosis of squamous cervical cancer of advanced stage after CCRT.The treatment of patients with no less than two adverse factors should be considered to be improved.

To investigate the effect of Aloe polysaccharide on proliferation and hyaluronic acid and hydroxyproline secretion of human fibroblasts in vitro.

Objective To investigate the clinicopathologic characteristics,therapy and prognostic factors of small cell carcinoma of the cervix.Methods Clinical and pathological data of eight patients were analyzed retrospectively.Results Eight patients all presented with symptoms of abnormal vaginal bleeding or postcoital spotting.One patient had stage Ⅰ b1 disease,2 had stage Ⅰ b2 disease.2 had stage Ⅱ b disease and 3 had stage Ⅲ b disease.Histopathologic findings showed the small tumor cells had scant cytoplasm,round nuclei,absence of nucleoli,and finely dispersed chromatin.Immunohistochemical findings were positive in 7 cases for neuron-specific enolase.Three patients with stage Ⅰ b disease and 1patient with stage Ⅲb disease underwent radical hysterectomy and postoperative chemotherapy.with or without radiotherapy,and the survival period was 64,22,14 and 6 months respectively.Two patients with stage Ⅱ b disease and 2 with stage Ⅲ b disease underwent chemotherapy and radiotherapy,and the survival period was 25,9,10 and 5 months respectively.Conclusions Immunohistochemical analysis using several kinds of neuroendocrine markers is helpful in establishing the correct diagnosis in addition to focusing on characteristic histopathological features.It is necessary to use comprehensive treatment including surgery,chemotherapy and radiotherapy for patients with small cell carcinoma of the cervix.Chemotherapy may play an important role in the treatment.

Objective To investigate the impact of squamous cell carcinoma antigen(SCCAg)in patients with recurrent squamous cell carcinoma of the uterine cervix.Methods Totally 72 patients with recurrent squamous cell carcinoma of the uterine cervix treated at the Cancer Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,between 1999 and 2005 were retrospectively analyzed to investigate the impact of SCCAg on diagnosis and prognosis by univariate and multivariate analysis.Results This study included 30 patients with recurrent disease after primary radical surgery and 42 patients with recurrent cervical cancer after radio-chemotherapy.Sixty one patients(85%)had serum SCCAg elevated (≥1.5 pg/L),and 20 of these(28%)had an increase of SCCAg before clinical manifestation of relapse.The median leading time was 3 months(range:1-13 months).Forty five patients had no symptoms with only SCCAg elevation,and 15 patients experienced leg edema and(or)sciatic pain,7 patients suffered from irregular bleeding and 5 patients had symptoms resulting from distant metastasis.Thirty three patients were diagnosed by histology biopsy and (or) cytology,39 patients were diagnosed with SCCAg elevation and clinical and radiological examinations,29 of these patients were diagnosed only by SCCAg elevation and CT or MRI.Fourteen patients recurred limited to the cervix or to the cervix and adjacent tissues(central recurrence),31 cases recurred at pelvis,and 20 patients with distant metastasis and 7 patients suffered from Pelvic recurrence and distant metastasis.Twenty three cases received salvage therapy including surgery for patients recurring after definitive radiotherapy and radiotherapy and or conform radiotherapy for patients after primary radical surgery,46 patients were given palliative chemotherapy and or radiotherapy,and 3 patients refused any treatment.The median and mean survival time were 11 months and 23 months respectively(2-62 months).The 3-year,5-year overall survival rate were 25%and 19%respectively.Univariate analysis showed SCCAg elevation before primary treatment,grade,recurrent site,treatment method,SCCAg≥10pg/L,SCCAg elevation during treatment,and SCCAg not within normal after treatment were correlated with 3-year survival rate.Twenty patients had an increase of SCCAg before clinical manifestation of relapse compared with other patients who did not,and the 3-year survival rate was not significantly different (22% vs 27%). Multivariate analysis revealed that only grade and treatment methods were independent risk factors. Conclusion The impact of the SCCAg in recurrent squamous cell carcinoma of the uterine cervix needs further study.

Objective To compare the homogeneity and conformity of dose distribution in the target and the dose to the organs at risk among 3-dimensional conformal radiation therapy (3DCRT), intensity modulated radiation therapy (IMRT) and simplified intensity modulated radiation therapy (sIMRT), and then to evaluate the clinical value of sIMRT for cervical cancer. Methods Ten patients with cervical canc-er receiving radical radiotherapy and brachytherapy were enrolled. Before radiotherapy, CT was performed and target volumes were delineated. The clinical target volume (CTV) included supravaginal portion, cervi-cal stump, paracervical tissue, common iliac lymph nodes, internal and external iliac lymph nodes, obtura-tor lymph nodes, sacral lymph nodes, and the surrounding tissues. If the vagina was involved, the target vol-ume included the whole vagina. Margins between planning target volume (PTV) and CTV were 10 mm in the anterior direction, and 5 mm in other directions. The prescribed dose was 95% PTV receiving 45 Gy in 25 fractions of 1.8 Gy. The dose volume histogram, conformity index, homogeneity index and treatment time per faction were compared. Results Among the three radiotherapy techniques, 3DCRT had the best homo-geneity of dose distribution, while there was no significant difference between IMRT and slMRT. According to the conformity of dose distribution, sIMRT was better than 3DCRT, but worse than IMRT. Comparing the bladder sparing, IMRT was the best followed by sIMRT. The volume of the small intestine receiving high dose was increased significantly with slMRT when compared with IMRT. And the treatment time per faction was4, 10 and 18 minutes for3 DCRT, sIMRT and IMRT, respectively. Conclusions sIMRT could re-duce the work intensity of the staff, shorten the treatment time per fraction, and simplify the authenticate procedure, which is cost-effective and suitable in the treatment of cervical cancer.