Female ; Humans ; Leukemia, Myeloid, Acute ; complications ; etiology ; Middle Aged ; Myelodysplastic Syndromes ; complications ; etiology ; Uterine Cervical Neoplasms ; complications ; drug therapy ; radiotherapy

PURPOSE: The purpose of this study was to test the hypothesis that neoadjuvant chemotherapy (NACT) does not increase morbidity in patients undergoing radical hysterectomy with lymphadenectomy for locally advanced cervical cancer. MATERIALS AND METGODS: A retrospective study was undertaken of 140 patients with locally advanced cervical cancer (FIGO stage Ia to IIb) who underwent radical hysterectomy with lymphadenectomy by the same surgeon at the same hospital. Among the 140 patients, 39 received NACT followed by radical hysterectomy with pelvic lymphadenectomy (NACT group). This group received three cycles consisting of cisplatin 100 mg/m2/day on day 1 and 5-fluorouracil 1000 mg/m2/day from day 1 to 5. The NACT group was compared, in terms of intraoperative morbidity and postoperative morbidity, with the other 101 patients who underwent radical hysterectomy with lymphadenectomy but without chemotherapy (surgery-only group). RESULTS: There were no significant differences in mean age, body weight or height between the two groups. The only significant difference was that the NACT patients had higher stages of cancer. The incidence of intraoperative morbidity did not differ between the NACT and surgery only patients. We considered the operation duration, amount of blood loss and need for transfusion as indicators of intraoperative morbidity. We could not find any significant differences in the duration of suprapubic catheterization, days of hemovac drainage, amount of drained hemovac fluid, days of hospitalization or postoperative febrile morbidity between the NACT and surgery-only groups. Patients in the surgery-only group had more postoperative complications (ureteral obstruction, intestinal obstruction, lymphocyst, lymphedema, and death) than the NACT group, although not to a statistically significant degree (P>0.05). CONCLUSION: In this retrospective review, there was no evidence that NACT increased intraoperative or postoperative morbidity in patients with locally advanced cervical cancer. As this was a retrospective study, other prospective, randomized studies are needed to confirm these results.
Body Weight ; Catheterization ; Catheters ; Cisplatin ; Drainage ; Drug Therapy* ; Fluorouracil ; Hospitalization ; Humans ; Hysterectomy ; Incidence ; Intestinal Obstruction ; Lymph Node Excision ; Lymphedema ; Postoperative Complications ; Retrospective Studies ; Uterine Cervical Neoplasms

In 2013, 10 topics were selected for major clinical research advances in gynecologic oncology; these included three topics regarding cervical cancer, three regarding ovarian cancer, two regarding endometrial cancer, and one each regarding breast cancer and radiation oncology. For cervical cancer, bevacizumab was first demonstrated to exhibit outstanding clinical efficacy in a recurrent, metastatic setting. Regarding cervical cancer screening, visual inspections with acetic acid in low-resource settings, p16/Ki-67 double staining, and the follow-up results of four randomized controlled trials of human papillomavirus-based screening methods were reviewed. Laparoscopic para-aortic lymphadenectomy before chemoradiation for locally advanced cervical cancer was the final topic for cervical cancer. Regarding front-line ovarian cancer therapies, dose-dense paclitaxel and carboplatin, intraperitoneal chemotherapy, and other targeted agents administered according to combination or maintenance schedules were discussed. Regarding recurrent ovarian cancer treatment, cediranib, olaparib, and farletuzumab were discussed for platinum-sensitive disease. The final overall survival data associated with a combination of bevacizumab and chemotherapy for platinum-resistant disease were briefly summarized. For endometrial cancer, the potential clinical efficacy of metformin, an antidiabetic drug, in obese patients was followed by integrated genomic analyses from the Cancer Genome Atlas Research Network. For breast cancer, three remarkable advances were reviewed: the long-term effects of continued adjuvant tamoxifen for 10 years, the effects of 2-year versus 1-year adjuvant trastuzumab for human epidermal growth factor receptor 2-positive disease, and the approval of pertuzumab in a neoadjuvant setting with a pathologic complete response as the surrogate endpoint. Finally, the recent large studies of intensity-modulated radiotherapy for gynecologic cancer were briefly summarized.
Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Biomedical Research/*methods ; Early Detection of Cancer/methods ; Endometrial Neoplasms/therapy ; Female ; Genital Neoplasms, Female/*therapy ; Humans ; Lymph Node Excision/methods ; Ovarian Neoplasms/drug therapy ; Papillomavirus Infections/complications/diagnosis ; Uterine Cervical Neoplasms/diagnosis/virology

Cervical cancer is the fourth most common cancer in women worldwide, and the human papillomavirus (HPV) is the main causative agent for its development. HPV is a heterogeneous virus, and a persistent infection with a high-risk HPV contributes to the development of cancer. In recent decades, great advances have been made in understanding the molecular biology of HPV, and HPV\'s significance in cervical cancer prevention and management has received increased attention. In this review, we discuss the role of HPV genotyping in cervical cancer by addressing: clinically important issues in HPV virology; the current application of HPV genotyping in clinical medicine; and potential future uses for HPV genotyping.
DNA, Viral/*analysis ; Early Detection of Cancer/*methods ; Female ; *Genome, Viral ; Genotype ; Humans ; Papillomaviridae/classification/*genetics ; Papillomavirus Infections/complications/drug therapy/*virology ; Papillomavirus Vaccines/therapeutic use ; Uterine Cervical Neoplasms/diagnosis/drug therapy/*virology

OBJECTIVETo detect the effect of Nocardia rubra cell wall skeleton (Nr-CWS) on tumorigenicity induced by TC-1 cells and to clinically study anti-human papillomavirus effect of Nr-CWS in lower genital tract of women.

METHODSTumor model was established by injecting TC-1 cells subcutaneously in SCID mice, then divided them into 3 groups randomly and injected with isovolumetric physiological saline, 60 micrograms/ml Nr-CWS and 120 micrograms/ml Nr-CWS respectively, the growth of tumors was measured one week later. Nr-CWS was applied on 45 HPV positive women whose TCT test was normal and without cervical erosion 2-3 days after menstruation. HPV was detected again 3 months later to explore the effect of Nr-CWS on HPV infection in female lower genital tract.

RESULTSThe animal experiment showed the weight of transplanted tumors in treated group was less than that of control group (chi2=12.5, P= 0.002). The tumor inhibition rate was 59.1 percent and 84.2 percent in the groups treated with Nr-CWS 60 and 120 micrograms/ml Nr-CWS; the results of HPV detection in 23 out of the 45 cases (51.1 percent) became negative after the 3-month treatment; the viral load was reduced in 9, and there was no change in viral load in 13 cases. Significant difference was found between the rates of undetectable viral load and the natural viral disappearance rate (P less than 0.05).

CONCLUSIONNr-CWS has an inhibitory effect to TC-1 cell tumorigenesis and clinical application of Nr-CWS may eliminate the HPV infection in lower genital tract of a considerable proportion of women with HPV infection.

Adult ; Animals ; Cell Wall Skeleton ; therapeutic use ; Cervix Uteri ; virology ; DNA, Viral ; analysis ; Female ; Humans ; Mice ; Mice, SCID ; Middle Aged ; Papillomavirus Infections ; complications ; drug therapy ; Uterine Cervical Neoplasms ; drug therapy ; virology ; Viral Load

OBJECTIVE: To evaluate the relationship between type 2 diabetes mellitus (DM) and oncological outcomes in early stage cervical cancer patients who underwent radical surgical resection. METHODS: Patients with early stage cervical cancer diagnosed between 2001 and 2014 were retrospectively enrolled. We assessed the outcomes of 402 non-DM and 42 DM patients with cervical cancer. We tested the prognostic value of DM via Cox proportional hazard modeling. RESULTS: Patients with DM were more likely to be older and overweight. In the DM group, 20 and 22 patients were and were not taking metformin, respectively. The 5-year recurrence-free survival (RFS) and 5-year overall survival (OS) rate for the whole study population were 88.49% and 96.34%, respectively. In the DM group, there was no evidence that metformin affected the RFS (p=0.553) or the OS (p=0.429). In multivariate analysis, age (p=0.007), histology (p=0.006), and deep stromal invasion (p=0.007) were independent adverse prognostic factors for RFS. There was a borderline significant association of increased RFS with DM (p=0.051). However, a time-varying-effect Cox model revealed that the DM was associated with a worse RFS (hazard ratio, 11.15; 95% CI, 2.00 to 62.08, p=0.022) after 5 years. DM (p=0.008), age (p=0.009), and node status (p=0.001) were the only 3 independent prognostic factors for OS. CONCLUSION: Early stage cervical cancer patients with type 2 DM have a poorer oncological outcome than patients without DM.
Adult ; Age Factors ; Diabetes Mellitus, Type 2/*complications/drug therapy ; Female ; Humans ; Hypoglycemic Agents/therapeutic use ; *Hysterectomy ; Metformin/therapeutic use ; Middle Aged ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Survival Analysis ; Uterine Cervical Neoplasms/*complications/diagnosis/surgery

OBJECTIVE: To evaluate the outcomes of laparoscopico-vaginal (modified) radical hysterectomy and to compare surgical parameters and recurrence rate of these with those of conventional abdominal radical hysterectomy. METHODS: From October 1997 to March 2002, we have performed 37 cases of LVMRH (laparoscopico- vaginal modified radical hysterectomy) +PLND (pelvic lymph node dissection) and 47 cases of LVRH (laparoscopico-vaginal radical hysterectomy) with paraaortic lymph node sampling +PLND. Inclusion criteria for laparoscopic group were patients with FIGO stage IA1 to IB1 which exocervical mass size was less than 2 cm clinically. As a control group, we selected 46 cases for the MRH group and 96 cases for the RH group. These groups had the same FIGO stage and the same tumor size less than 2 cm or tumor volume calculated by MRI being less than 4.2 cm3, while the age for each group were identically matched with the laparoscopic group. RESULTS: The mean duration of surgery, the number of lymph nodes and the rate of perioperative and postoperative complications were similar in both the laparoscopic and the conventional laparotomy group. The mean duration of hospital stay was significantly shorter in patients treated by laparoscopic surgery (LVMRH vs. MRH; 9 vs. 15, LVRH vs. RH; 13 vs. 21 days). No lymph node metastasis was reported in both LVMRH and MRH group. No recurrences but only one patient in MRH group were found in both groups during the median follow up of 34.5 and 43.5 months, respectively. The positive rates of pelvic lymph node metastasis in both RH groups were similarly 6.4%. Four (8.5%) of 47 LVRH patients and two (2.1%) of 96 RH patients had recurrences. However, in patients who had tumor volume being less than 4.2 cm3, recurrence rate was 2.5% (1/40) and 42.9% (3/7) in those with tumor volume larger than 4.2 cm3. There was one death in a patient with pulmonary metastasis who took LVRH in spite of vigorous chemotherapy. Three year progression free survival rates were 96.7% in LVRH group (tumor volume<4.2 cm3) and 97.9% in RH group (p=0.81). CONCLUSION: Laparoscopic surgery for treatment of early small volume cervical cancer, especially stage IA is safe and effective alternatives in terms of operative morbidity and mortality. However, patients with large volume disease (>4.2 cm3) who were treated by LVRH had higher recurrence rate compared to those by conventional RH. It is concluded that laparoscopic surgery for the treatment of cervical cancer would be better to be limited to patients with early disease who have the largest tumor diameter less than 2 cm or tumor volume less than 4.2 cm3 carefully measured by MRI.
Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Hysterectomy* ; Laparoscopy ; Laparotomy ; Length of Stay ; Lymph Nodes ; Magnetic Resonance Imaging ; Mortality ; Neoplasm Metastasis ; Postoperative Complications ; Recurrence ; Tumor Burden ; Uterine Cervical Neoplasms*

Administration, Rectal ; Adult ; Aged ; Anti-Inflammatory Agents ; administration & dosage ; therapeutic use ; Dexamethasone ; administration & dosage ; therapeutic use ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Middle Aged ; Phytotherapy ; Powders ; Proctitis ; drug therapy ; etiology ; Radiation Injuries ; complications ; drug therapy ; Rectum ; drug effects ; pathology ; radiation effects ; Uterine Cervical Neoplasms ; radiotherapy

Pulmonary toxicity is one of the most serious adverse effects associated with a quick course of vincristine, bleomycin, and cisplatin neoadjuvant chemotherapy (NAC-VBP). The aim of this study was to evaluate pulmonary toxicity related to a quick course NAC-VBP. A total of consecutive 61 patients, who underwent at most 3 cycles of NAC-VBP every 10 days in the International Federation of Gynecology and Obstetrics (FIGO) stage IB-IIB cervical cancer from 1995 to 2007, were retrospectively analyzed. Of the 61 study subjects, 7 (11.5%) were identified to have pulmonary toxicity and 2 (3.3%) died of pulmonary fibrosis progression despite aggressive treatment and the use of a multidisciplinary approach. No factor predisposing pulmonary toxicity was identified. Initial symptoms were non-specific, but bronchiolitis obliterans organizing pneumonia and interstitial pneumonitis were characteristic findings by high-resolution computed tomography of the chest. The benefit of steroid therapy was uncertain and was associated with steroid-induced diabetes mellitus requiring insulin therapy in two patients. Fatal pulmonary toxicity is a major concern of a quick course NAC-VBP. In conclusion, these patients require special monitoring for bleomycin-induced pulmonary toxicity.
Aged ; Antineoplastic Combined Chemotherapy Protocols/administration & dosage/*adverse effects/therapeutic use ; Bleomycin/administration & dosage/*adverse effects/therapeutic use ; Cisplatin/administration & dosage/*adverse effects/therapeutic use ; Female ; Humans ; Lung Diseases/*chemically induced/pathology ; Middle Aged ; *Neoadjuvant Therapy ; Pulmonary Fibrosis/chemically induced/mortality/pathology ; Retrospective Studies ; Tomography, X-Ray Computed ; Uterine Cervical Neoplasms/complications/*drug therapy ; Vincristine/administration & dosage/*adverse effects/therapeutic use