Radiation therapy for pelvic lymph node metastasis from uterine cervical cancer

Objectives

This study aimed to evaluate the efficacy of radiation therapy for pelvic lymph node metastasis from uterine cervical cancer and identify an optimal radiation regimen.

Methods

A total of 111 metastatic pelvic lymph nodes, ranging from 11 to 56 mm (median, 25 mm) on CT/MRI, in 62 patients with uterine cervical cancer were treated initially with curative radiation therapy, with 46 patients receiving concurrent chemotherapy. Total radiation doses ranged from 45 to 61.2 Gy (median, 50.4 Gy) in 1.8–2 Gy (median, 1.8 Gy) fractions.

Results

At a median follow-up of 33 months, 46 of the 62 patients survived. Only 2 irradiated lymph nodes, 24 and 28 mm in diameter, in 1 patient progressed after irradiation alone with 50.4 Gy in 1.8 Gy fractions. All 33 metastatic lymph nodes ≥ 30 mm in diameter were controlled by irradiation at a median dose of 55.8 Gy. The 3-year lymph node-progression free rates were 98.2% in all 62 patients and 98.0% in all 111 metastatic lymph nodes. Except for transient hematologic reactions, 2 patients developed grade ≥ 3 therapy-related toxicities, 1 with an ulcer and the other with perforation of the sigmoid colon. In addition, 2 patients experienced ileus after irradiation.

Conclusions

Radiation therapy effectively controlled pelvic lymph node metastases in patients with uterine cervical cancer, with most nodes < 24 mm in diameter controlled by total doses of 50.4 Gy in 1.8 Gy fractions and larger nodes controlled by 55.8 Gy, particularly with concurrent chemotherapy. Higher doses to metastatic lymph nodes may increase intestinal toxicities.     

宫颈癌术后螺旋断层放疗与常规加速器调强放疗的剂量学比较

Objective To compare the dosimetric characteristics of helical tomotherapy(HT)and step-and-shoot intensity modulated radiotherapy(IMRT)for post-operative cervix cancer patients. Methods Ten patients with post-operative cervix cancer were enrolled in this study.HT and IMRT plans were developed for each patient.The dose distributions of the targets,organs at risk(OARs),CI and HI were analyzed and compared.The prescribed dose was 60 Gy/25 f for CTV1,50 Gy/25 f for CTV2.The iso-dose line of 50 Gy was used.Results The homogeneity indexes(HI)(0.94±0.03),conformity index(C1)(1.28±0.02)in HT group were better than in IMRT group(0.85±0.01 and 1.36±0.03),respectively(t=5.12,-6.34,P<0.001).The Dmean of PTV in HT group(51.77 Gy)was lower than that in IMRT group(54.53 Gy)(t=-8.01,P<0.05).The Dmax ,Dmean,V30,V40 and V50 of bladder、rectum and small bowel were lower in HT group than those in IM RT group.The Dmax,Dmean,V30 and V40 of right and left femoral head were lower in HT group than those in IMRT group.Conclusion Helical tomotherapy treatment plan has a better homogeneity,steeper dose gradient,and a better protection for organs at risk.     

小剂量顺铂增敏CCRT治疗Ⅱb-Ⅳ期宫颈癌临床观察

目的探讨小剂量顺铂CCRT与单纯放射治疗中晚期宫颈癌的疗效和毒副作用。方法 2006~2009年收治的67例经病理确诊的Ⅱb-Ⅳ期宫颈癌患者,随机分为同步放化疗组35例和单纯放疗组32例,同步放化疗组给予顺铂400 mg/（次.w）行放疗增敏,两组同样放疗剂量。比较两组的治疗效果和不良反应。结果 CCRT组完全缓解率77.1%,单纯放疗组43.8%;总有效率：CCRT组94.3%,单纯放疗组71.9%;3年生存率：CCRT组88.6%,单纯放疗组68.8%,两组差异有统计学意义（P〈0.05）。结论小剂量顺铂增敏CCRT治疗晚期宫颈癌可显著提高有效率和生存率,急性不良反应与单纯放疗组相比无明显增加。     

子宫颈病变中HPV L1蛋白和p16的表达

目的 研究HPV L1蛋白和p16在子宫颈各种病变中的表达情况,探讨它们在子宫颈病变进展中的预测价值.方法 应用免疫组化方法检测41例各种子宫颈病变(CIN1级18例、CIN2级9例、CIN3级8例和浸润性鳞状细胞癌6例)中HPV L1蛋白和p16的表达.结果 HPV L1蛋白在各种子宫颈病变中的阳性率为26.8%.其中HPV L1在CIN1中的阳性表达率为38.9%,CIN2为44.4%,CIN3和浸润性鳞状细胞癌均无表达.p16在各种子宫颈病变中的阳性率为68.3%,其在CIN1中的阳性表达率为38.9%,CIN2为77.8%,CIN3和浸润性鳞状细胞癌均表达阳性.100%CIN3和浸润性鳞状细胞癌为p16+/HPV L1-,而61.1% CIN1中为p16-/HPV L1+或p16-/HPV L1-.结论 随着子宫颈病变的进展,HPV L1阳性表达率降低而p16阳性表达率增高.p16+/HPV L1-提示子宫颈鳞状上皮内瘤变有进展的可能,而p16-/HPV L1+和p16-/HPV L1-可能为无进展的或潜在消退的子宫颈病变.     

Prognostic impact of mitotic index of proliferating cell populations in cervical cancer patients treated with carbon ion beam

BACKGROUND:

The authors previously reported that the mitotic index of a proliferating cell population (pMI) was a potent prognostic factor in cervical cancer patients treated with photon beam therapy. In this study, they investigated whether the pMI accurately predicted prognosis in cervical cancer patients treated with carbon ion beam.

METHODS:

Tissue sections were obtained from 27 consecutively treated patients with stage IIIB bulky (19 patients) and stage IVA (8 patients) squamous cell carcinomas of the cervix treated with carbon ion beam at the National Institute of Radiological Sciences, Japan, as a phase I/II study with dose escalation methodology (52.8‐72 grays equivalent radiation dose/24 fractions). The mitotic index (MI) and Ki‐67 labeling index (Ki‐67‐LI) were determined by hematoxylin and eosin staining and immunohistochemical staining, respectively. The pMI was calculated using the following formula: pMI = MI/Ki‐67‐LI.

RESULTS:

The pMI ranged from 0.6 to 8.9 (mean, 3.9 ± 2.6; median, 3.2). Twelve of the 27 specimens had a pMI >3.5. The local control rate in tumors with a pMI >3.5 was 17%, significantly lower than the 73% in the tumors with a pMI <3.5 (P = .005). Multivariate analysis indicated that the pMI had the strongest impact on local control (standard regression coefficient = 0.48, P = .002) among the variables, including clinical stage, irradiated dose, age, and tumor volume.

CONCLUSIONS:

These results suggest that a high pMI is an indication of a poorer prognosis, and is a powerful prognostic factor in patients with squamous cell carcinomas of the cervix treated with carbon ion beam therapy. Cancer 2009. © 2009 American Cancer Society.     

宫颈鳞状上皮病变组织中乳头状瘤病毒和Ki-67及p16INK4a蛋白表达意义的研究

目的:探讨Ki-67、p16INK4a和人乳头状瘤病毒(HPV)在不同程度宫颈鳞状上皮病变组织中的表达及临床病理意义.方法: 采用原位分子杂交及免疫组化方法,检测HPV的不同亚型、Ki-67、p16INK4a蛋白在182例不同程度宫颈病变组织中的表达.结果: HPV在不同程度病变中总检出率52.19%(95/182);在宫颈高级别上皮内瘤变及鳞癌组中检出最多的感染类型为HPV16/18,而HPV6/11在尖锐湿疣组检出率87.50%(21/24)最高;随着宫颈病变严重程度的增加,级别升高,Ki-67、p16INK4a阳性程度呈递增趋势.Ki-67、p16INK4a与HPV16/18型感染关系密切,χ2=11.779 8, P<0.01;Ki-67也与HPV6/11型有关.结论: HPV16/18型及Ki-67、p16INK4a 在宫颈高级别上皮内瘤变及鳞癌中表达明显升高,可能对宫颈鳞癌的发生、发展具有协同作用.     

A case of neutrophilia related to a cytokine-producing relapsed squamous cell carcinoma of the uterine cervix arising from the rectovaginal septum

Paraneoplastic neutrophilia caused by a squamous cell carcinoma of the uterine cervix has been seen rarely. We report a case of relapsed squamous cell carcinoma of the uterine cervix with severe neutrophilia, rapid tumor growth and aggressive clinical course, possibly due to autocrine stimulation of cell growth by G-CSF and IL-6 without other possible causes of neutrophilia.     

8-硝基白杨素对人宫颈癌Hela细胞增殖和凋亡的影响

目的：观察8-硝基白杨素(8-NOChR)抑制体外培养人宫颈癌Hela细胞增殖和诱导凋亡作用。方法：体外培养人宫颈癌Hela细胞系细胞。MTT比色法测定Hela细胞增殖活性。软琼脂培养克隆形成法检测Hela细胞集落形成能力。AO/EB染色荧光显微镜观察Hela细胞凋亡形态学改变。DNA凝胶电泳观察梯形DNA条带。结果：MTT比色测定显示,8-NOChR抑制Hela细胞增殖,呈剂量依赖性。软琼脂培养克隆形成法检测表明,8-NOChR显著抑制Hela细胞集落形成,呈剂量依赖性。AO/EB染色荧光显微镜观察发现,8-NOChR诱导Hela细胞呈现典型凋亡细胞形态特征。8-NOChR（30μmol/L）处理Hela细胞72h,琼脂糖凝胶电泳出现“梯形”DNA条带。结论：8-NOChR具有抑制人宫颈癌Hela细胞增殖和诱导细胞凋亡作用     

宫保散联合LEEP治疗宫颈癌前病变合并HPV感染的临床效果分析

目的:探讨分析宫保散联合高频电波刀(LEEP)对宫颈癌前病变合并人乳头瘤病毒(HPV)感染的临床效果。方法:将我院2013年2月至2015年6月收治的宫颈癌前病变合并HPV感染患者74例按照病床单双号分为试验组和对照组,每组各37例。对照组患者在常规治疗基础上给予LEEP治疗,试验组在对照组基础上给予宫保散局部涂抹治疗,比较两组疗效,分析宫保散联合LEEP治疗宫颈癌前病变合并HPV感染价值。结果:两组手术时间、术中出血量无显著差异(P0.05),而试验组住院时间和医疗费用均较对照组显著降低(P0.05);两组治疗前HPV病毒载量无显著差异(P0.05),治疗后均显著降低(P0.05),且试验组远低于对照组(P0.05);试验组HPV转阴率和总有效率(86.49%和91.89%)均明显高于对照组(51.35%和64.86%)(P0.05);两组不良反应发生率差异无统计学意义(P0.05)。结论:宫保散联合LEEP治疗宫颈癌前病变合并HPV感染效果确切,可以显著减少HPV病毒载量,提高HPV转阴率和总有效率,且安全可靠。     

Long-term results of sequential postoperative treatment with vincristine, bleomycin, mitomycin c, cis-platin and radiotherapy after surgery for high-risk patients with cervical carcinoma stage IB–IIA

Adjuvant treatment of patients with risk factors after surgery for cervical carcinoma remains unsatisfactory. A combination of radiotherapy and chemotherapy might improve the control of microscopic metastases. In this prospective study, 28 patients with risk factors after surgery for cervical carcinoma underwent a sequential treatment consisting of two courses of chemotherapy with vincristine, bleomycin, mitomycin c and cis-platin (VBMP), followed by radiotherapy with 54 Gy to the pelvis and the aortic nodes. Risk factors mainly consisted of nodes metastases (25 patients), but patients with parametrial invasion or histologic evidence of neoplastic vascular permeation outside the tumor were also included in the study. The treatment was well tolerated and all patients received the planned dose of chemotherapy and radiotherapy; in the follow-up one patient died of ileal necrosis and one died of pulmonary embolism after being medically treated for subocclusion. With a minimal follow-up of 70 months, 15 patients are alive and free of disease, two have died of complications (one with local recurrence), one has died of intercurrent disease and 10 have died of disease (six distant, four local). The site of recurrence was outside the field of irradiation in six cases (lungs in two cases, liver and para-aortic nodes in one and distant nodes in three). This treatment is feasible but control of distant metastases in high-risk patients after surgical treatment remains unsatisfactory.