Improved control of invasive cervical cancer in Sweden over six decades by earlier clinical detection and better treatment.

1995 ◽  
Vol 13 (3) ◽  
pp. 715-725 ◽  
Author(s):  
P Sparén ◽  
L Gustafsson ◽  
L G Friberg ◽  
J Pontén ◽  
R Bergström ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Invasive Cervical Cancer ◽  
Local Treatment ◽  
Substantial Reduction ◽  
External Beam Radiation ◽  
Cervix Uteri ◽  
Beam Radiation ◽  
Clinical Detection ◽  
Cancer Of The Cervix ◽  
Incident Cases

PURPOSE Cancer of the cervix uteri can be controlled by cytologic screening for the detection of precursor lesions, but such intervention remains unrealistic in many countries in which this cancer is common. The possibility of reducing mortality by earlier clinical detection, followed by basic therapy, has never been properly assessed. PATIENTS AND METHODS We compiled records of incident cases of invasive cancer of the cervix diagnosed in a defined area of Sweden from 1930 through 1990. In a cohort of 6,044 women, we analyzed temporal trends in incidence and survival by clinical stage and age at diagnosis. Generalized proportional hazards models were used to study several factors simultaneously and quantify the overall reduction in mortality. RESULTS For each successive stage at diagnosis, the overall risk of dying increased 2.5-fold (95% confidence interval [CI], 2.4 to 2.7). From 1930, a marked improvement in stage distribution was accompanied by increasing survival rates in stages I and II disease. These changes largely took place before the introduction of screening and external-beam radiation. The 10-year relative survival rate increased from 33% in the 1930s to approximately 55% in the 1950s and thereafter. CONCLUSION Improvements in public and professional awareness of cervical cancer resulted in diagnoses at earlier clinical stages. The rate of cure in early stages improved when basic local treatment was introduced, but only little of the progress was attributable to the introduction of more advanced treatment technologies. These findings offer considerable hope for a substantial reduction in the mortality of cervical cancer without cytologic screening, even in countries with limited resources.

scholarly journals HIV Infection and Survival Among Women With Cervical Cancer

2016 ◽  
Vol 34 (31) ◽  
pp. 3749-3757 ◽  
Author(s):  
Scott Dryden-Peterson ◽  
Memory Bvochora-Nsingo ◽  
Gita Suneja ◽  
Jason A. Efstathiou ◽  
Surbhi Grover ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Hiv Infection ◽  
Cell Count ◽  
Invasive Cervical Cancer ◽  
Hazard Ratio ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Cd4 Cell Count ◽  
Women With Hiv ◽  
Cd4 Cell

Purpose Cervical cancer is the leading cause of cancer death among the 20 million women with HIV worldwide. We sought to determine whether HIV infection affected survival in women with invasive cervical cancer. Patients and Methods We enrolled sequential patients with cervical cancer in Botswana from 2010 to 2015. Standard treatment included external beam radiation and brachytherapy with concurrent cisplatin chemotherapy. The effect of HIV on survival was estimated by using an inverse probability weighted marginal Cox model. Results A total of 348 women with cervical cancer were enrolled, including 231 (66.4%) with HIV and 96 (27.6%) without HIV. The majority (189 [81.8%]) of women with HIV received antiretroviral therapy before cancer diagnosis. The median CD4 cell count for women with HIV was 397 (interquartile range, 264 to 555). After a median follow-up of 19.7 months, 117 (50.7%) women with HIV and 40 (41.7%) without HIV died. One death was attributed to HIV and the remaining to cancer. Three-year survival for the women with HIV was 35% (95% CI, 27% to 44%) and 48% (95% CI, 35% to 60%) for those without HIV. In an adjusted analysis, HIV infection significantly increased the risk for death among all women (hazard ratio, 1.95; 95% CI, 1.20 to 3.17) and in the subset that received guideline-concordant curative treatment (hazard ratio, 2.63; 95% CI, 1.05 to 6.55). The adverse effect of HIV on survival was greater for women with a more-limited stage cancer ( P = .035), those treated with curative intent ( P = .003), and those with a lower CD4 cell count ( P = .036). Advanced stage and poor treatment completion contributed to high mortality overall. Conclusion In the context of good access to and use of antiretroviral treatment in Botswana, HIV infection significantly decreases cervical cancer survival.

Population-Based Validation of the 2014 ISUP Gleason Grade Groups in Patients Treated With Radical Prostatectomy, Brachytherapy, External Beam Radiation, or no Local Treatment

The Prostate ◽  
2017 ◽  
Vol 77 (6) ◽  
pp. 686-693 ◽  
Author(s):  
Raisa S. Pompe ◽  
Helen Davis-Bondarenko ◽  
Emanuele Zaffuto ◽  
Zhe Tian ◽  
Shahrokh F. Shariat ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Local Treatment ◽  
Population Based ◽  
External Beam Radiation ◽  
Gleason Grade ◽  
External Beam ◽  
Beam Radiation ◽  
Grade Groups

Adjuvant Radiation for Gynecologic Cancers

2019 ◽  
Author(s):  
Joanne Jang
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Endometrial Cancer ◽  
Vulvar Cancer ◽  
Vaginal Cancer ◽  
External Beam Radiation ◽  
Adjuvant Radiation ◽  
Gynecologic Cancers ◽  
Beam Radiation ◽  
Postoperative Setting

Radiation therapy plays a significant role in the treatment of nearly all gynecologic cancers, including endometrial cancer, cervical cancer, vaginal cancer, and vulvar cancer. Radiotherapy can be given as the primary modality for curative treatment of gynecologic cancers, most often for cervical, vaginal, and vulvar cancers, but can also be used adjuvantly in the postoperative setting. Radiation can be delivered in the form of external beam radiation therapy or as gynecologic implants for brachytherapy, which is radiation that is delivered internally. This review highlights the data supporting radiation therapy for gynecologic cancers and explains the different methods of radiation delivery. This review contains 5 figures, and 4 tables, and 40 references.  Key Words: adjuvant treatment, brachytherapy, cervical cancer, endometrial cancer, IMRT, ovarian cancer, radiation therapy, vaginal cancer, vulvar cancer

scholarly journals Treatment Compliance as a Major Barrier to Optimal Cervical Cancer Treatment in Guatemala

2019 ◽  
pp. 1-5 ◽  
Author(s):  
Abigail S. Zamorano ◽  
Joaquin Barnoya ◽  
Eduardo Gharzouzi ◽  
Camaryn Chrisman Robbins ◽  
Emperatriz Orozco ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Access To Care ◽  
Cancer Treatment ◽  
Patient Population ◽  
Treatment Compliance ◽  
External Beam Radiation ◽  
Cervical Cancer Patient ◽  
Beam Radiation ◽  
Lost To Follow Up

PURPOSE Despite being the only hospital to provide comprehensive cervical cancer treatment to many medically underserved Guatemalan women, no assessment of the cervical cancer patient population at the Guatemala Cancer Institute has been performed. To understand the demographics of the patient population, their treatment outcomes, and access to care, we sought to assess treatment compliance of patients with cervical cancer at the Guatemala Cancer Institute and its effects on patient outcomes. METHODS A retrospective chart review was conducted of patients with cervical cancer between 2005 and 2007 and assessed for follow-up through December 2015. Demographics and clinical characteristics were tabulated. A Kaplan-Meier curve to model compliance was generated. RESULTS Ninety-two patients with invasive cancer were analyzed. Most presented with squamous cell carcinoma (73%) and at locally advanced stages (IIB, 51%; IIIB, 33%). Most (75 of 92, 81.5%) initiated treatment after diagnosis, but 18.5% (17 of 92) were lost to follow-up before treatment initiation. For treatment, 97% received external beam radiation, 84% brachytherapy, and 4% concomitant chemotherapy. Nearly 20% of patients were lost to follow-up in the first 6 months and 65% in the first 5 years. Of the 67 patients who completed treatment, only 15 (16% of the initial cohort) were diagnosed with a recurrence. No deaths were recorded. CONCLUSION The low recurrence rate and no documented deaths suggest a correlation with the low compliance rate and poor follow-up. This finding highlights the need to examine more fully the barriers to compliance and access to care among this population to optimize the treatment of cervical cancer.

Regional Therapies for Extremity Sarcoma

2018 ◽  
Author(s):  
Chiara Colombo ◽  
Sandro Pasquali
Keyword(s):  
Local Recurrence ◽  
Local Treatment ◽  
Tumor Resection ◽  
Treatment Strategies ◽  
Soft Tissue Sarcomas ◽  
Isolated Limb Perfusion ◽  
External Beam Radiation ◽  
Resection Margins ◽  
Beam Radiation ◽  
Limb Perfusion

Several regional therapies are used for the local treatment of patients with soft tissue sarcomas (STS), especially for tumors at high risk for local recurrence. Surgery with negative tumor resection margins is the main treatment for primary STS. External-beam radiation therapy is considered for deeply seated, large, and high-grade disease to lower the risk of local recurrence. A combination of preoperative chemo-radiation is associated with improved local control. TNF-α-based isolated limb perfusion is another regional chemotherapy strategy available at specialized surgical oncology units for unresectable STS. Other strategies suitable for management of advanced STS include cryoablation and radiofrequency. This review discusses these and other current regional treatment strategies.  This review contains 10 figures, 6 tables and 64 references Key words: cryoablation, extremity, hyperthermia, isolated limb perfusion, limb infusion, radiotherapy, regional therapy, sarcoma

Early-onset sigmoid colon perforation during concurrent chemoradiation in a patient with cervical cancer

2004 ◽  
Vol 14 (2) ◽  
pp. 381-383
Author(s):  
H. Lin ◽  
C.-L. Chang ◽  
E.-Y. Huang ◽  
C.-C. Changchien
Keyword(s):  
Cervical Cancer ◽  
Sigmoid Colon ◽  
Concurrent Chemoradiotherapy ◽  
Tissue Injury ◽  
Gynecological Cancer ◽  
Good Condition ◽  
External Beam Radiation ◽  
Colon Perforation ◽  
Beam Radiation ◽  
Sigmoid Colon Perforation

Radiation-induced colon perforation is a rare adverse effect caused by vascular and connective tissue injury to the rectosigmoid colon. It usually occurs a few months to years after radiotherapy for gynecological cancer. Herein, we present a patient who developed sigmoid colon perforation during concurrent chemoradiotherapy for cervical cancer. The patient was a 64-year-old clinical stage IIB woman who received concurrent chemoradiotherapy as a standard treatment. The chemotherapeutic protocol was cisplatin 50 mg/m2 and 5-fluorouracil 4000 mg, starting together with radiotherapy. After the completion of external beam radiation for 4500 cGy, the patient developed sigmoid colon perforation presenting with fecal peritoneum and sepsis. An emergency end ileostomy with resection of entire sigmoid colon was performed and the patient was discharged 3 months later in good condition. Clinicians must be highly suspicious of serious bowel perforation, even if the full dose of radiation has not been completed. Whether or not the chemotherapy was the trigger factor is in need of further clarification.

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