Multiple primary or secondary malignancies after anticancer therapy were recently reported to be increasing in frequency. The authors describe a case of metachronous metastatic pulmonary basaloid carcinoma to the central nervous system that was discovered after chemotherapy and radiation therapy for cervical uterine carcinoma. Two different types of cancer developed within some interval. There's the possibility that a secondary pulmonary neoplasm developed after the chemotherapy and radiotherapy conducted as cervical cancer treatment.
Central Nervous System ; Drug Therapy* ; Lung Neoplasms ; Neoplasm Metastasis* ; Neoplasms, Second Primary ; Radiotherapy ; Uterine Cervical Neoplasms

PURPOSE: The locoregional failure rate remain high in advanced cervical carcinoma. Chemotherpy(CT) was added to radiotherapy(RT) in order to improve therapeutic result. We performed this study to evaluate the response rate, toxicities and survival benefit of neoadjuvant chemotherapy and to investigate potential role of neoadjuvant chemotherapy in treatment of cervical cancer. METHODS AND MATERIALS: The patients(68 cases of cervical cancer) were divided into two groups ; The one group was neoadjuvant chemotherapy followed by radiotherapy(n=30) and the other was the radiotherapy(n=38) group. The patients were maintained by regular follow-up and evaluated with regards to treatment related toxicity and effectiveness by response using World Health Organization criteria and 5-year survival rate. RESULTS: 30 patients were assigned to receive neoadjuvant chemotherapy. After chemotherpy, the overall clinical response rate was 46.7%. The response rate of neoadjuvant chemotherapy followed radiotherapy was higher than that of the radiotherapy in cervical cancer (100% vs 84.2%). The 5-year survival rate of patients was not different between two groups(p>0.05). Toxicities of chemotherapy were generally tolerable and usually well resolved with conservative treatment. CONCLUSION: Neoadjuvant chemotherapy followed radiotherapy help to improve response rate but did not affect survival benefit in the cervical cancer in this study. However, well controlled long-term prospective study will be need to get firm conclusion.
Drug Therapy* ; Follow-Up Studies ; Humans ; Radiotherapy* ; Survival Rate ; Uterine Cervical Neoplasms* ; World Health Organization

Uterine cervical cancer is the most common malignancy in Korean women. In spite of recent development of early diagnostic and therapeutic modalities, about 40% of treated patient will develop relapse. So more aggressive local treatment such as more extensive surgery and higher radiation dose and administration of systemic chemotherapy will promote the curability but treatment related complications cannot be avoidable. We used 22 cases of early cervical cancer, treated with surgery and post-operative radiotherapy, clinical data of these patients were analyzed to determine relationship between clinical parameters and final outcome. Three out of 22 cases revealed relapse and one patient showed rectovaginal fistula and another patient showed small bowel obstruction and the other patient showed rectal obstruction. Two out of three recurrence were stage IIa and the other one case was stage Ib adenocarcinoma with lymphovascular involvement. Nineteen out of 22 cases were followed without remarkable side effect or treatment related complication or sequelae. We concluded that out treatment policy was safe and effective to eradicate high risk postoperative cervical cancer with acceptable side effects or complication.
Adenocarcinoma ; Drug Therapy ; Female ; Humans ; Radiotherapy* ; Rectovaginal Fistula ; Recurrence ; Uterine Cervical Neoplasms*

BACKGROUNDVolumetric-modulated arc therapy (VMAT) can only be implemented on the new generation linacs such as the Varian Trilogy® and Elekta Synergy®. This prevents most existing linacs from delivering VMAT. The purpose of this study was to investigate the feasibility of using a conventional linear accelerator delivering constant dose rate and constant angular spacing intensity-modulated arc therapy (CDR-CAS-IMAT) for treating cervical cancer.

METHODSTwenty patients with cervical cancer previously treated with intensity-modulated radiation therapy (IMRT) using Varian Clinical 23EX were retreated using CDR-CAS-IMAT. The planning target volume (PTV) was set as 50.4 Gy in 28 fractions. Plans were evaluated based on the ability to meet the dose volume histogram. The homogeneity index (HI), target volume conformity index (CI), the dose to organs at risk, radiation delivery time, and monitor units (MUs) were also compared. The paired t-test was used to analyze the two data sets. All statistical analyses were performed using SPSS 19.0 software.

RESULTSCompared to the IMRT group, the CDR-CAS-IMAT group showed better PTV CI (0.85 ± 0.03 vs. 0.81 ± 0.03, P = 0.001), clinical target volume CI (0.46 ± 0.05 vs. 0.43 ± 0.05, P = 0.001), HI (0.09 ± 0.02 vs. 0.11 ± 0.02, P = 0.005) and D95 (5196.33 ± 28.24 cGy vs. 5162.63 ± 31.12 cGy, P = 0.000), and cord D2 (3743.8 ± 118.7 cGy vs. 3806.2 ± 98.7 cGy, P = 0.017) and rectum V40 (41.9 ± 6.1% vs. 44.2 ± 4.8%, P = 0.026). Treatment time (422.7 ± 46.7 s vs. 84.6 ± 7.8 s, P = 0.000) and the total plan Mus (927.4 ± 79.1 vs. 787.5 ± 78.5, P = 0.000) decreased by a factor of 0.8 and 0.15, respectively. The IMRT group plans were superior to the CDR-CAS-IMAT group plans considering decreasing bladder V50 (17.4 ± 4.5% vs. 16.6 ± 4.2%, P = 0.049), bowel V30 (39.6 ± 6.5% vs. 36.6 ± 7.5%, P = 0.008), and low-dose irradiation volume; there were no significant differences in other statistical indexes.

CONCLUSIONSPatients with cervical cancer treated with CDR-CAS-IMAT using Varian Clinical 23EX can get equivalent or superior dose distribution compared to those treated with IMRT. CDR-CAS-IMAT has a less treatment time and MU, which can reduce the uncertainty factor and patient discomfort in treatment.

BACKGROUND: The basic treatment of malignant tumors is surgery, radiotherapy, chemotherapy. Even though, the object of these treatments is to kill cancer cells, they have limitations. So, in future studies of treatment of cancer, we should look into increasing human immune response using gene therapy in order to induce damage to tumor cells. OBJECTIVE: The cell growth inhibitory effect of cervical cancer cells was investigated by direct transfection using liposome(pRcCMVp53/lipofectin). and by indirect transfection using Adenovirus(AdCMVp53). METHODS: The cervical cancer cell lines we used in this study were HPV16 positive, having inhibitory gene, wild p53 gene, CaSki, SiHa, HPV18 positive HeLa, HeLaS3 and HPV negative C33A, HT3, LacZ gene was used as the marker gene for the transfection efficacy. Direct transfection was done by using lipofectin (pRcCMVp53/lipofectin) and indirect transfection was done by using virus, AdCMVp53. The effect of tumor cell growth inhibition was measured by cell counting assay. RESULT: Inhibition of growth of cervical cancer cells in cell counts of direct transfection was CaSki(88.5%), SiHa(59.1%), HeLa(86.0%), HeLaS3(78.0%), C33A(91.3%) and HT3(74.0%). Inhibition of growth of cervical cancer cells in cell counts of indirect transfection was CaSki(97.4%), SiHa(91.6%), HeLa(95.8%), HeLaS3(99.7%), C33A(97.3%) and HT3(87.4%). CONCLUSION: The inhibition of cell growth of cervical cancer cells by direct and indirect transfection was significantly reduced, and showed little differences depending on the type of cells. These results will have a great meaning in treating cervical cancer patients using gene therapy by direct or indirect transfection
Adenoviridae* ; Cell Count ; Cell Line ; Drug Therapy ; Genes, p53 ; Genetic Therapy* ; Humans ; Lac Operon ; Plasmids* ; Radiotherapy ; Transfection ; Uterine Cervical Neoplasms*

OBJECTIVE: The aim of this study was to evaluate the prognostic significance of primary tumor volume and uterine corpus invasion assessed by MRI in stage II uterine cervical cancer patients treated by concurrent chemotherapy and radiotherapy. METHODS: Fifty-two patients diagnosed with stage II cervical carcinoma were entered into the study. The tumor volume was calculated by the equation (Volume=widthXlengthXheightXpi/6) as an ellipsoid approximation. Univariate and multivariate analyses were performed to identify the prognostic factors for overall survival (OS), disease-free survival (DFS), pelvic control (PC), and distant metastasis-free survival (DMFS). RESUITS: The 5-year OS, DFS, PC, and DMFS rates were 65.8%, 59.3%, 72.6%, and 79.9%, respectively. The average volume of primary cervical tumor on MRI was 29.5 ml (5-109) and volume was not correlated with stage (p=0.180). Corpus invasion was exhibited in 50.0% and 93.8% of patients with small tumor volume (<30 ml) and large tumor volume (> or =30 ml), respectively; and strongly correlated with tumor volume (p<0.001). By univariate analyses, larger clinical tumor diameter (p=0.031), positive pelvic lymph node (p=0.033), uterine corpus invasion (p=0.045), and larger tumor volume (p=0.003) showed a statistically significantly relation to worse survival. In multivariate analyses, dividing patients according to whether the tumor volume was more or less than 30 ml predicted OS (p=0.048) and uterine corpus invasion also predicted DFS (p=0.042). CONCLUSION: Tumor volume and uterine corpus invasion determined by pre-treatment MRI examinations were significant prognostic factors for patients with invasive cervical carcinoma treated with concurrent chemotherapy and radiotherapy.
Disease-Free Survival ; Drug Therapy ; Humans ; Lymph Nodes ; Magnetic Resonance Imaging* ; Multivariate Analysis ; Radiotherapy ; Tumor Burden* ; Uterine Cervical Neoplasms*

OBJECTIVE: To assess the toxicity of delivering extended field intensity-modulated radiotherapy (EF-IMRT) and concurrent cisplatin chemotherapy for locally advanced cervical carcinoma. METHODS: Forty-five patients who underwent EF-IMRT and concurrent cisplatin chemotherapy for the treatment of stage IB2 to IIIB cervical cancer were retrospectively reviewed. The clinical target volume included all areas of gross and potentially microscopic disease and regional lymph node regions. All patients underwent high-dose-rate brachytherapy. The acute and late toxicity were scored using the Common Terminology Criteria for Adverse Events and the Radiation Therapy Oncology Group late radiation morbidity scoring criteria, respectively. RESULTS: The median follow-up was 28 months (range, 5 to 62 months). Forty-two patients had a complete response, and three had a persistent disease. Of those 42 patients, 15 patients (35.7%) had recurrence. The regions of recurrence were in-field in 2 patients and out-field in 13 patients. Acute grade > or =3 gastrointestinal, genitourinary and hematologic toxicity occurred in 3, 1, and 9 patients, respectively. Three patients (6.7%) suffered from late grade 3 toxicities. Seven patients experienced ovarian transposition, 5 of those patients (71%) maintained ovarian function. Thirty-eight patients (84.4%) were alive at the last follow-up. CONCLUSION: Concurrent cisplatin chemotherapy with EF-IMRT was safe. The acute and late toxicities are acceptable. EF-IMRT provides an opportunity to preserve endocrine function for patients with ovarian transposition.
Brachytherapy ; Cisplatin* ; Drug Therapy ; Follow-Up Studies ; Humans ; Lymph Nodes ; Radiotherapy, Intensity-Modulated* ; Recurrence ; Retrospective Studies ; Uterine Cervical Neoplasms*

Despite recent advances in the early detection method and treatment modalities (surgery and/or radiation and/or chemotherapy), cervical cancer is still an important malignant disease in women. Almost half a million new cases occur every year in the world. The management of recurrent cervical cancers depends on primary treatment, the extent of disease, and performance status. Patients who received primary surgical treatment without radiotherapy (RT) may undergo curative RT. However, most recurrences occur in patients with advanced-stage disease already treated by primary RT. For patients who failed primary RT or surgery plus adjuvant RT and had central relapse without pelvic sidewall recurrence, pelvic exenteration may be necessary. For patients who had pelvic sidewall recurrences, pelvic exenteration is usually not an option with curative intent. In such situation, combined operative and radiotherapeutic treatment (CORT), and laterally extended endopelvic resection (LEER), intraoperative radiotherapy (IORT) have been executed with some success. Simple or radical hysterectomy can be considered for patients who had small uterine and/or vaginal recurrences, but the high frequency of associated morbidities such as urinary and bowel tract injury or fistula is the problem. Patients with multiple or distant metastases are destined to receive cisplatin-based palliative chemotherapy. Recently there was a GOG 179 study that had firstly shown a statistically significant improvement on the overall response rate, median progression-free survival, and median survival. Until now, however, the role of chemotherapy has been very limited.
Diagnosis* ; Disease-Free Survival ; Drug Therapy ; Female ; Fistula ; Humans ; Hysterectomy ; Neoplasm Metastasis ; Pelvic Exenteration ; Radiotherapy ; Recurrence ; Uterine Cervical Neoplasms*

OBJECTIVE: To characterize prognostic factors in patients with pulmonary metastasis in recurrent cervical cancer. METHODS: The records of 2,042 patients treated for cervical cancer from 1994 to 2004 at two institutions were retrospectively reviewed. Twenty-five (1.04%) patients had pulmonary lesions consistent with metastatic cervical cancer. The data were analyzed retrospectively and reviewed for patient characteristics. RESULTS: Patients were treated with chemotherapy, radiotherapy only, chemoradiotherapy, surgery, and conservative treatment. There were no significant differences in survival rates between each treatment method (p=0.3410). Mean survival after treatment of pulmonary metestasis was 23 months. Histologic type, lymph node metastasis, other organ metastasis, and pretreatment SCC level were not significant prognostic factors, but FIGO stage (p=0.039) and disease-free interval (p=0.033) were significant factors. CONCLUSION: This study revealed that FIGO stage and disease-free interval were independent prognostic factors of pulmonary metestasis in recurrent cervical cancer.
Chemoradiotherapy ; Drug Therapy ; Humans ; Lymph Nodes ; Neoplasm Metastasis* ; Prognosis ; Radiotherapy ; Retrospective Studies ; Survival Rate ; Uterine Cervical Neoplasms*

PURPOSE: Despite a development fo therapeutic machines and advance in modern radiation therapy techniques, locally advanced cervical carcinoma has shown high rate of local failure and poor survival rate. Combination of chemotherapy and radiotherapy demonstrated benefit in improving local control and possibly the overall survival. Our study was performed to evaluate effect of concurrent chemoradiation on locally advanced uterine cervical cancer. METHODS AND MATERIALS: Twenty six patients with locally advanced stage(FIGO stage IIB with > or = 5 cm in diameter, III, IVA) were treated with combination of radiation therapy and concurrent cisplatinum between May of 1988 and Septermber of 1993 at our hopital. Radiation therapy consisted of external irradiation and 1-2 sessions of intracavitary irradiation, Cisplatinum was administered in bolus injection of 25mg/m(2) at weekly intervals during the course of external radiation therapy. RESULTS: Of the 26 patients, twenty-five patients were evaluable for estimation of response. Median follow-up period was 25 months with ranges from 3 to 73 months. Stage IIB, III, and IVA were 16, 5,4 patients, respectively. Twenty patients were squamous cell carcinoma. Response was noted in all 25 patients: complete response(CR) in 17/25(68%), partial response(PR) in 8/25(32%). Of the 24 patients except one who died of sepsis at 3 months follow-up, seventeen patients(70.8%) maintained local control in the pelvis: 16/17(94.1%) in CR, 1/17(14.3%) in PR. Fourteen of the 17 patients with CR are alive disease free on the completion of follow-up. Median survival is 28 months for CR and 15 months for PR. Analysis of 5-year survival by stage shows 11/16(59.8) in IIB, 3/5(60.6%) in III, and 1/4(25.0%) in IVA. Overall 5-year survival rate was 55.2%. Ten Patients recurred: 4 at locoegional,3 in distant metastasis and 3 with locoregional and distant site. Toxicity by addition of cisplatinum was not excessive. CONCLUSION: Although the result of this study was obtained from small number of patients, it is rather encouraging in view of markedly improved response rate compared with the results of historical group.
Carcinoma, Squamous Cell ; Drug Therapy ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Pelvis ; Radiotherapy ; Sepsis ; Survival Rate ; Uterine Cervical Neoplasms*