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Objective: Cervical cancer affects survivors' overall coping. Yet, specifically emotional and behavioral expression patterns among cervical cancer survivors have barely been examined. In addition, no study has focused on survivors' experiences of sequences related to coping. Understanding these perceptions can help provide a tailored response and improve psycho-social interventions. The aim of this study was to gain a better understanding of the emotional and behavioral motives involved in coping with cervical cancer recovery. Methods: Qualitative interviews were conducted with 15 survivors of cervical cancer (stages I and II), using a semi-structured in-depth questionnaire. The interviews were recorded, transcribed, and analyzed by three researchers using thematic analysis. Results: Six main themes emerged: (i) Reasons and benefits for keeping the disease a secret or sharing it with others; (ii) "When you get used to despair, there's also room for hope": Despair alongside hope; (iii) Self-guilt following the disease, but also knowing how to forgive yourself; (iv) Deep loneliness alongside a significant need for support; (v) Finding the way from passivity to activity; and (vi) When meaning in life is missing, and the importance of meaning when it is present. There was a balance between negative emotions and behaviors (despair, confidentiality, guilt, loneliness, passivity, lack of meaning) and positive emotions and behaviors (hope, openness, forgiveness, significant support, activity, meaning). Significance of the results: The study revealed that in some cases cervical cancer coping during the recovery period moves across sequences. The women's narratives portray past difficulties as the reason for present psychological health, and their experience of a healthy present is intensified by their past difficulties. Implications for practice are discussed. [ABSTRACT FROM AUTHOR]

This study aims to compare tumor marker indicators, World Health Organization Quality of Life-Brief assessment (WHOQOL-BREF) scores and clinical outcomes between cervical cancer patients treated with paclitaxel + carboplatin versus those treated with paclitaxel + cisplatin. 66 cervical cancer patients admitted to our hospital were randomly selected and allocated equally into a control group (paclitaxel + cisplatin) and a study group (paclitaxel + carboplatin) using a randomized double-blinded approach. Tumor marker indices, WHOQOL-BREF scores, Karnofsky Performance Status (KPS) scores, clinical outcomes and adverse effects were assessed and compared before and after treatment. The study group was found to have lower carcino-embryonic antigen (CEA), Carbohydrate antigen (CA) 199, CA125 and CA50 levels, significantly higher WHOQOL-BREF scores, and significantly higher KPS scores at 7 days, 1 month, 2 months and 3 months post-treatment compared to the control group (all p < 0.05). However, we also observed that while the treatment effectiveness rate in the study group (75.76%) surpassed that in the control group (66.67%), the difference was statistically significant (p > 0.05). Patients in the study group had a statistically significant lower incidence of diarrhea (45.45%) and nausea and vomiting (48.48%) compared to the control group, whose corresponding rates were higher at 69.70% and 75.76%, respectively (χ² = 3.969, 5.215, p = 0.046, 0.022). Conversely, the incidence of bone marrow suppression in the study group (48.48%) was significantly higher than that in the control group (21.21%) (χ² = 4.405, p = 0.020). We conclude that the combination of paclitaxel and carboplatin was an effective treatment approach for cervical cancer patients, offering comparative advantages over paclitaxel + cisplatin, with reduced tumor marker levels, enhanced quality of life, and minimized adverse reaction occurrence. [ABSTRACT FROM AUTHOR]

Background: To investigate the capability of a not-yet commercially available fully automated lexicographic optimization (LO) planning algorithm, called mCycle (Elekta AB, Stockholm, Sweden), to further improve the plan quality of an already-validated Wish List (WL) pushing on the organs-at-risk (OAR) sparing without compromising target coverage and plan delivery accuracy. Material and Methods: Twenty-four mono-institutional consecutive cervical cancer Volumetric-Modulated Arc Therapy (VMAT) plans delivered between November 2019 and April 2022 (50 Gy/25 fractions) have been retrospectively selected. In mCycle the LO planning algorithm was combined with the a-priori multi-criterial optimization (MCO). Two versions of WL have been defined to reproduce manual plans (WL01), and to improve the OAR sparing without affecting minimum target coverage and plan delivery accuracy (WL02). Robust WLs have been tuned using a subset of 4 randomly selected patients. The remaining plans have been automatically re-planned by using the designed WLs. Manual plans (MP) and mCycle plans (mCP01 and mCP02) were compared in terms of dose distributions, complexity, delivery accuracy, and clinical acceptability. Two senior physicians independently performed a blind clinical evaluation, ranking the three competing plans. Furthermore, a previous defined global quality index has been used to gather into a single score the plan quality evaluation. Results: The WL tweaking requests 5 and 3 working days for the WL01 and the WL02, respectively. The re-planning took in both cases 3 working days. mCP01 best performed in terms of target coverage (PTV V95% (%): MP 98.0 [95.6–99.3], mCP01 99.2 [89.7–99.9], mCP02 96.9 [89.4–99.5]), while mCP02 showed a large OAR sparing improvement, especially in the rectum parameters (e.g., Rectum D50% (Gy): MP 41.7 [30.2–47.0], mCP01 40.3 [31.4–45.8], mCP02 32.6 [26.9–42.6]). An increase in plan complexity has been registered in mCPs without affecting plan delivery accuracy. In the blind comparisons, all automated plans were considered clinically acceptable, and mCPs were preferred over MP in 90% of cases. Globally, automated plans registered a plan quality score at least comparable to MP. Conclusions: This study showed the flexibility of the Lexicographic approach in creating more demanding Wish Lists able to potentially minimize toxicities in RT plans. [ABSTRACT FROM AUTHOR]

Background: A plethora of data supports HPV-based screening to be the preferred strategy for cervical cancer prevention. The shift to a more sensitive first-line test brings the need of effective triage up for discussion. Currently, most algorithms apply cytology as a triage of HPV-DNA positive women. This study compared the performance of a 7-type HPV-mRNA test to cytology. Methods: From 1 January 2019 until 31 December 2021, cervical samples from 58,029 women were examined at the University Hospital of North Norway. A total of 30.5% (17,684/58,029) fulfilled the criteria for HPV-DNA primary screening. All positive samples were triaged by cytology and followed-up according to national guidelines through 2022. Additionally, a 7-type HPV-mRNA test was applied. The study endpoint was a histologically confirmed high-grade lesion (CIN2+). Results: A total of 5.6% (990/17,684) had positive HPV-DNA test, 97.2% (962/990) with valid HPV-mRNA results. A total of 55.5% (534/962) had abnormal cytology (ASC-US+), and 35.1% (338/962) had a positive HPV-mRNA test. A total of 13.9% (134/962) had CIN2+. The sensitivity (CIN2+) of cytology versus the HPV-mRNA test was 76.1% (102/134) versus 73.1% (98/134), p = 0.67. The specificity was 47.8% (396/828) versus 71.0% (588/624), p < 0.001. PPV was 19.1% (102/534) and 29.0% (98/338), p < 0.001, respectively. The number of colposcopies per CIN2+ detected by cytology and HPV-mRNA test was 5.2 and 3.1. Conclusion: The 7-type HPV mRNA test was significantly more specific than cervical cytology in a triage of HPV-DNA positive women. Using this biomarker as the threshold for colposcopy may better balance the benefits and harms of screening. [ABSTRACT FROM AUTHOR]

Screening programs for early detection of cervical cancer are extremely important for better prognosis and long-term survival. This study was conducted to determine cervical cancer (CC) risk levels among women aged between 30-65 and the factors affecting having an HPV/Pap smear test that complies with national CC screening standards. A total of 1407 women in the 30-65 age group participated in this cross-sectional study. No sample selection procedure was conducted, and 1407 women who voluntarily agreed to participate in the study were included in the study group. Data were collected between January 2019 and March 2020. The questionnaire used in the study consisted of questions about women's sociodemographic characteristics, lifestyles, CC early diagnosis and screening behaviors, and the CC risk calculation model. Pearson chi-square test, chi-square test for trend, and logistic regression analysis were used in the study. The statistical significance level was accepted as p< 0.05. In the study, 58.9% of the women reported that they had a test within one to three years, 67.5% of those who did not have the test stated they did not know that it was necessary, and 46.2% stated that they neglected it. The CC risk level of 83.6% of women was "below average". The rate of having an HPV/PS test following the national CC screening standards was significantly higher in women who were in the 50-59 age group, smoked, had a childbirth experience, or did not regularly use a condom during sexual intercourse (p<0.05). As the calculated CC risk level increased, testing behaviors decreased statistically significantly (p<0.01). The time of the last screening test was more than five years in those with a calculated CC risk level of =average (p<0.01). The CC risk level of the women in the study was below average. There was a significant relationship between HPV/PS testing behavior and age, smoking, having a childbirth experience, and condom use. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the survival and influence factors of radiation therapy on primary tumors in patients with stage IVB cervical cancer. The data of 3129 stage IVB cervical cancer patients diagnosed from 2000 to 2018 in the Surveillance, Epidemiology and End Results (SEER) database were retrieved, and the propensity score matching (PSM) was used to balance variate and eliminate selection bias. The Kaplan-Meier (KM) method was used to plot surviving profile. Univariate and multivariate analyses were used to estimate influencing factors of surviving time of stage IVB cervical cancer. After screening the SEER database, 3129 stage IVB cervical cancer patients were selected, including 2166 cases (69.2%) cases with and 963 without primary radiotherapy. PSM analysis identified 860 pairs of patients were one-to-one matched and further enrolled of radiotherapy part as well as non-radiotherapy part (control group) respectively for survival analysis. The K-M curve was compared among the two groups, and radiation therapy was found to be associated with longer survival before (Hazard ratio (HR) = 0.54,95% confidence interval (95% CI): 0.50-0.59, p < 0.001) and after (HR = 0.71, 95% CI: 0.64-0.79, p < 0.001) PSM. Multivariate Cox analysis confirmed that patients treated with radiotherapy, chemotherapy and local surgery had greater survival benefits, while high-grade tumor lesions, bone metastases, liver metastases and lung metastases were associated with significantly increased mortality. The survival rates varied among different races and were statistically different (p < 0.05). Conclusion: Primary radiotherapy could prolong the overall survival (OS) of stage IVB cervical cancer patients. [ABSTRACT FROM AUTHOR]

This study was conducted to determine the associations between the socio-demographics, clinical profile and therapy options received by cervical cancer (CC) patients in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto and Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. The study used a prospective longitudinal design with retrieved data for 157 eligible CC patients. Pearson's correlation was used to test for association between patients' socio-demographics, clinical characteristics and number of therapy options received while comparisons of proportions were carried out using Pearson's Chi square. Results show that the mean age of the patients was 50.7±9.0 years and 43.3% of patients earned less than 50,000.00 per month. The results also reveal most of the 47.1% of patients presented with clinical stage III. Per Vaginal Bleeding (PVB) was the symptoms recorded for 88.5% of the patients while most patients (49.7%) received Chemotherapy (CT) as the major therapy option. There were significant associations between the level of income, (r=0.412, p<0.001), baseline number of symptoms, (r=0.200, p=0.012), number of symptoms after therapy, (r= -0.584, p<0.001) and the number of therapies received by the patients. Clinical disease-stage, baseline number of symptoms and level of income were found to be associated with the therapy options received by the patients. [ABSTRACT FROM AUTHOR]

We retrospectively investigated the significance of metastatic lymph nodes in patients with locally recurrent or persistent cervical cancer in a previously irradiated field and subsequently had salvage hysterectomy. Clinical data were obtained from a chart review, and the prognostic impact of the presence, number (1–2 versus ≥3), and location (pelvic versus pelvic plus para-aortic) of lymph node metastasis was investigated by comparing recurrence and survival. In total, 50 patients were included in this study, of which 21 (42.0%) showed pathological evidence of lymph node metastasis (node-positive group). Both the univariate and multivariate analyses showed that lymph node metastasis was an independent prognostic factor for postoperative recurrence (hazard ratio (HR) 5.36; 95% CI 1.41–6.66; p = 0.0020). The predominant sites of recurrence after salvage surgery were the visceral organs and lymph nodes in the node-negative and node-positive groups, respectively. Patients with ≥3 node metastases showed similar survival to those with 1–2 node metastases. Patients with pelvic node metastasis showed similar survival to those with pelvic and para-aortic node metastases. The presence, not number or location, of lymph node metastasis was an independent poor prognostic factor for post-operative recurrence in patients who developed locally recurrent or persistent cervical cancer treated with salvage hysterectomy plus lymphadenectomy. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is the second most common cancer and the third leading cause of death in Indonesia. Purpose: This study aims to identify the 3-year survival rate of cervical cancer patients and its prognostic factors in a referral hospital in Southern Sumatra, Indonesia. Methods: Cohort retrospective study using secondary data from medical records of cervical cancer patients from January 2014 until December 2016. Data of each patient was evaluated for 36 months since the patients were firstly diagnosed with cervical cancer. Kaplan Meier curve was used to determine the survival rate and identify the proportional hazard assumption. The Cox regression model was utilized to determine the survival rate and Hazard Ratio (HR). Results: There were 274 of 799 cervical cancer patients who met the inclusion criteria. The 3-year survival rate for cervical cancer patients at survival rate was around 65%, and prognostic factors related to the survival of cervical cancer patients with p-value <0.05, i.e. age (HR=0.51; 95%CI=0.29-0.90), metastasis (HR=2.43; 95%CI=1.28-4.61), and completeness of therapy (HR=7.23; 95%CI=3.82-13.71. The complication was a confounding factor with metastasis and survival rate. Conclusion: The 3-year survival rate for cervical cancer patients at Mohammad Hoesin Hospital Palembang (RSMH) was 65%. The prognostic factors for the survival rate were age, metastasis, and completeness therapy. It was essential for cervical cancer patients to adhere to the therapy program recommended by doctors to increase the survival rate. [ABSTRACT FROM AUTHOR]

Objective: This study aims to compare tumor diameters measured by transvaginal ultrasonography and MRI in cervical cancer. Materials and methods: The study includes 127 cervical cancer patients diagnosed and treated at Akdeniz University Faculty of Medicine between January 2002 and December 2019. Data were collected retrospectively using the electronic archive system of the hospital. Patients with pathologically unknown tumor diameters were excluded from the study. Data were tested for normal distribution, and the mean, standard deviation, median, min-max values, and frequencies were used as descriptive statistics. Categorical data were expressed as numbers and percentages (%). The Student's t-test, one of the parametric tests, was used to compare tumor diameters. Statistical Package for the Social Sciences (SPSS) 23 software (IBM Corp., Chicago, IL, USA) was used for data analysis. A p-value less than 0.05 was considered statistically significant in all tests. Results: The mean age of patients included in the study was 49.55 ± 11.67 years. Of all patients, 79.5% had a normal delivery. 87 (68%) of the patients were not using any contraceptive method, with 0.7%, condom protection was the least. Among the complaints of patients at admission, postcoital vaginal bleeding was the most common complaint with 42.5%, and asymptomatic patients were the second most common with 22%. Human papillomavirus (HPV) status was unknown in the vast majority of patients (91.3%). Regarding the stage status, stage 1b2 was the most frequently seen stage with 29 patients. Tumor histology revealed SCC in 80.3% and adenocarcinoma in 18.1%. The mean tumor diameter measured by transvaginal ultrasonography (TVS) was 3.30 ± 1.95, by magnetic resonance imaging (MRI) was 3.37 ± 2.03, and the pathologically measured tumor diameter was 3.17 ± 1.86. There was no statistically significant difference between the mean tumor diameter measured by TVS and MRI, MRI and pathology, and TVS and pathology (p: 0.769, p: 0.589, p: 0.891, respectively). Conclusion: When used by specialists experienced in the field of gynecological oncology, ultrasonography can be considered as effective as MRI, especially in tumor size measurement in cervical cancer, due to its ease of use, cheapness, and easy accessibility in regions with low socioeconomic status. [ABSTRACT FROM AUTHOR]

Women with criminal-legal system involvement bear a disproportionate burden of cervical cancer, indeed 4–5 times more than women without criminal-legal system involvement. While we also know that sexual minority identification (lesbian/gay, queer, bisexual, or not straight) is more common among women with criminal-legal system involvement, we lack understanding of the cervical cancer risk and prevention practices of this group of women. In 2019–2020, we used surveys to investigate cervical cancer risk and prevention practices among 510 women with criminal-legal system involvement in Kansas City (KS and MO), Oakland (CA), and Birmingham (AL). In a secondary data analysis, we compared sexual minority women (SMW defined as women who identified as lesbian/gay, bisexual, or other—19% of the sample, to women who identified as heterosexual or straight—81% of sample). SMW were less likely to have ever gotten a cervical cancer screening test, compared to straight women. Having a provider whom women felt they could rely on was associated with having an up-to-date cervical cancer screening test among SMW. SMW with criminal-legal system involvement are missing out on necessary cancer screenings. Further study to understand why and interventions to ensure this group receives preventive care are needed to prevent cervical cancer and reduce disparities. [ABSTRACT FROM AUTHOR]

The location of the tumor and the type of selected treatment are factors that determine the quality of life of patients. The incidence of neoplasms increases every year, with more and more patients successfully undergoing treatment processes but also struggling with the immediate and delayed effects of the disease and the treatment applied. A diagnosis of cancer is a critical situation in everyone's life, which may disturb their sense of agency, stability, and safety. Cancer significantly affects the lives of both patients and their families, and a diagnosis confirming cancer may disturb the sense of control over one's own health. According to numerous studies on the quality of life, depending on the location of the neoplasm, the reaction of patients to the course of treatment may have various psychological effects that will have an impact on the process of adaptation to the disease and psychosocial functioning. Neoplastic disease, depending on its location, may affect the assessment of one's own body and function in the sexual sphere. The location of the tumor not only causes changes in patients' bodies and health options related to their physicality but also affects their coping strategies, self-perception, sense of influence on one's own health, and the quality of social relations. The objective of this article is to assess the differences in the health-related quality of life among women suffering from breast and cervical cancers. [ABSTRACT FROM AUTHOR]

Background: The prevalence of smoking among cervical cancer survivors is strikingly high, yet no smoking cessation interventions to date have specifically targeted this population. This paper describes the study design, methods, and data analysis plans for a randomized clinical trial designed to evaluate the efficacy of a theoretically and empirically based Motivation And Problem Solving (MAPS) approach for promoting and facilitating smoking cessation among cervical cancer survivors. MAPS is a comprehensive, dynamic, and holistic intervention that incorporates empirically supported cognitive behavioral and social cognitive theory–based treatment strategies within an overarching motivational framework. MAPS is designed to be appropriate for all smokers regardless of their motivation to change and views motivation as dynamically fluctuating from moment to moment throughout the behavior change process. Objective: This 2-group randomized controlled trial compares the efficacy of standard treatment to MAPS in facilitating smoking cessation among women with a history of high-grade cervical dysplasia or cervical cancer. Methods: Participants (N=202) are current smokers with a history of high-grade cervical dysplasia or cervical cancer recruited nationally and randomly assigned to one of two treatment conditions: (1) standard treatment (ST) or (2) MAPS. ST consists of repeated letters referring participants to their state’s tobacco cessation quitline, standard self-help materials, and free nicotine replacement therapy when ready to quit. MAPS has all ST components along with 6 proactive telephone counseling sessions delivered over 12 months. The primary outcome is abstinence from tobacco at 18 months. Secondary outcomes include abstinence over time across all assessment points, abstinence at other individual assessment time points, quit attempts, cigarettes per day, and use of state quitlines. Hypothesized treatment mechanisms and cost-effectiveness will also be evaluated. Results: This study was approved by the institutional review boards at the University of Texas MD Anderson Cancer Center, the University of Oklahoma Health Sciences Center, and Moffitt Cancer Center. Participant enrollment concluded at Moffitt Cancer Center in January 2020, and follow-up data collection was completed in July 2021. Data analysis is ongoing. Conclusions: This study will yield crucial information regarding the efficacy and cost-effectiveness of a MAPS approach for smoking cessation tailored to the specific needs of women with a history of high-grade cervical dysplasia or cervical cancer. Findings indicating that MAPS has substantially greater efficacy than existing evidence-based tobacco cessation treatments would have tremendous public health significance. [ABSTRACT FROM AUTHOR]

We studied the incidence of HPV genotypes in mostly Black women with cervical carcinoma and correlated histopathologic tumor characteristics, immune markers and clinical data with survival. Disease-free survival (DFS) and overall survival (OS) were recorded for 60 months post-diagnosis. Fifty four of the 60 (90%) patients were Black and 36 (60%) were < 55 years of age. Of the 40 patients with typeable HPV genotypes, 10 (25%) had 16/18 HPV genotypes, 30 (75%) had one of the non-16/18 HPV genotypes, and 20 (50%) had one of the 7 genotypes (35, 39, 51, 53, 56, 59 and 68) that are not included in the nonavalent vaccine. Mixed HPV infections (≥ 2 types) were found in 11/40 (27.5%) patients. Patients infected with non-16/18 genotypes, including the most common genotype, HPV 35, had significantly shorter DFS and OS. PD-L1 (p = 0.003), MMR expression (p = 0.01), clinical stage (p = 0.048), histologic grade (p = 0.015) and mixed HPV infection (p = 0.026) were independent predictors of DFS. A remarkably high proportion of cervical cancer cells in our patients expressed PD-L1 which opens the possibility of the use of immune checkpoint inhibitors to treat these cancers. Exclusion of the common HPV genotypes from the vaccine exacerbates mortality from cervical cancer in underserved Black patients. [ABSTRACT FROM AUTHOR]

Human papilloma virus (HPV) related cervical cancer (CC) remains a significant cause of mortality, especially in developing nations. Practical, cheap, and responsive biomarkers are required to diagnose and prevent large-scale CCs and other cancers associated with HPV. This research aimed to investigate HPV-Human leukocyte Antigen-G (HLA-G) interaction with the cervical cancer immune modulation: Hypothesizing HPV-specific HLA markers might be accurate and costeffective preventive biomarkers. In addition to assessing the host immune response by immunophenotyping of CD57 natural killer T-cells. Forty-five DNA and serum samples of the patients were divided into two groups; twenty-three cases with HPV infection associated with cervical cancer and twenty-two controls with HPV infection without cervical cancer. Real-Time Quantitative polymerase chain reaction (RT-PCR) was used for HLA-G messenger RNA expression. Immunophenotyping by flow cytometry was carried out using specific monoclonal antibodies against CD57 expressed on CD8+ T-cells. The results indicated that 69.6% of the cases showed HLA-G expression compared to only 22.7% of the controls, and the difference was statistically significant at p<0.01. Cases have eight times the risk of expression among controls since odd ratio (OR) =7.8. Also, 65.2% of the cases showed CD57+ expression compared to 36.4% of the controls, and the difference was marginally significantly different at p= 0.053. Cases have nearly three times the risk of expression among controls since OR=3.3. Although the lower limit of the 95% confidence interval is <1, indicating that in the population, this increase in risk may not be present. HPV-specific HLA-G marker test might be an accurate and cost-effective preventive biomarker with potential application for cervical cancer. [ABSTRACT FROM AUTHOR]

Somatic genetic alteration analysis was performed for post-hysterectomy high-risk early-stage uterine cervical cancer patients who underwent post-operative radiation therapy. Post-operative radiation therapy was performed for patients with pathological features of pelvic lymph node metastasis, parametrium invasion, or positive vaginal margin, which corresponded to the post-operative high-risk category. DNA was extracted from paraffin-embedded surgical specimens, and 50 somatic hotspot genetic alternations were detected using Ion AmpliSeq Cancer Hotspot Panel. The existence of actionable mutation was assessed based on OncoKB evidence level > 3A. Between January 2008 and November 2019, 89 patients who underwent abdominal radical hysterectomy followed by post-operative radiation therapy were identified. The follow-up period for living patients was 82.3 months (range 9.3–153.9), and the 5-year relapse-free survival and overall survival rates were 72.6% and 85.9%, respectively. The most frequently detected somatic mutation was PIK3CA (26 [29.2%] patients); however, no prognostic somatic genetic alterations were identified. Actionable mutations were detected in 30 (33.7%) patients. Actionable mutations were detected in approximately one-third of patients, suggesting that precision medicine can be offered to patients with post-operative high-risk uterine cervical cancer in the near future. [ABSTRACT FROM AUTHOR]

In this study, a descriptive design was used to explain the supportive care needs of cervical cancer patients in the Northeast of Thailand. The purposive sample was recruited from inpatient and outpatient departments of a university hospital. A total of 144 patients with cervical cancer in stage I - IV or recurrent stage completed the Thai version of the Supportive Care Needs Survey-Short Form 34 (SCNSF-34 Thai version). Descriptive statistics were used to identify the domains and items of the greatest unmet need. Results showed that standardized five domain scores indicated that participant's unmet needs were highest in the health system and information domain (... = 2.95, S.D. = 1.15), and lowest in the sexuality domain (... = 1.63, S.D. = 0.94). The five most frequently endorsed items of moderate to high unmet need were all from the health system and information domain as follows: receiving information about things can do to help in recovering from illness (74.3 %), receiving information from documents, charts, or paintings about illness management and side effects that may occur at home (66 %), receiving information about cancer which is under control or in remission (63.2 %), support from at least one health care staff that can discuss illness, treatment, and follow up (63.2 %), receiving written information about the essential aspects of care (59.7 %), and receiving written information about the importance of care (59.7 %). It was clear that a large proportion of cervical cancer patients in Thailand reported unmet supportive care needs. Therefore, nurses should design nursing care services that are consistent with the supportive care needs. [ABSTRACT FROM AUTHOR]

Objectives: The incidence and mortality rates of cervical cancer in the world are 13.1/105 and 6.9/105, respectively. In India, it is estimated that there are 96,922 new cervical cancer cases and 60,078 deaths and ranked second among women cancers. The incidence and mortality rates are 14.7/105 and 9.2/105, respectively, although the incidence varies within Indian population. The majority of these cervical patients report at a late-stage of disease in health-care facility due to lack of awareness. A premier tertiary cancer hospital in Mumbai conducted the present survival-study. The aim of the study was to assess the various factors that determine the survival outcomes by age at diagnosis, role of comorbidities, stage of disease, and treatment. Material and Methods: The main source of information was patients' medical records from which the data were abstracted, and active follow-up was undertaken. 1678 cases diagnosed between the years 2006 and 2008 at Tata Memorial Hospital are analyzed using actuarial method for obtaining survival rates and log-rank tests for comparison of survival groups. Results: The 5-year survival rate was 76.0% for those aged =50 years, 73.3% for non-residents, 74.4% for literates, and 81.8% for Christians and 72.5% for those with squamous cell carcinoma histology; those with no comorbidities had marginally better survival than their counter-parts. The survival rates were 83.5%, 80.6%, 66.0%, and 37.1% for Stage I, Stage II, Stage III, and Stage IV, respectively. The best survival outcomes were for those treated with only surgery (95.6%), or in combination with either radiotherapy (90.6%) or with radiotherapy and chemotherapy (85.5%). Involvement of either nodes/sites had poorer survival than those with no-involvement. In the multivariate analysis, only stage of the disease emerged as a significant prognosis factor. Conclusion: The study concluded that younger patients, early stage of disease, non-involvement of any sites/nodes, and radiotherapy either alone or in combination with other treatment type provided better outcomes. Early detection and prevention strategies are keys to obtain better outcomes. [ABSTRACT FROM AUTHOR]

This study investigated incidence and risk factors for venous thromboembolism (VTE) in patients with cervical cancer. We selected 49,514 patients newly diagnosed with cervical cancer from the Korean Health Insurance Review and Assessment Service databases. During the total follow-up period and first 6 months after initiation of primary treatments, incidence of VTE, and association of risk factors with VTE occurrence were evaluated according to primary treatments or no treatment, surgery, radiotherapy, and chemotherapy. VTE occurred in 1.15% of patients with cervical cancer. Regardless of the period after initiation of primary treatments, and of VTE, the incidence of thromboembolism was highest in chemotherapy. During the first 12 months, monthly incidence of VTE was highest in chemotherapy and decreased with time in all primary treatments. Compared with no treatment, VTE risk significantly increased for all primary treatments (surgery: HR 1.492; 95% CI 1.186–1.877) (radiotherapy: HR 2.275; 95% CI 1.813–2.855) (chemotherapy: HR 4.378; 95% CI 3.095–6.193) and for chemotherapy during the first 6 months (HR 3.394; 95% CI 2.062–5.588). In this cohort study, incidence and risk of VTE in patients with cervical cancer were the highest when chemotherapy was the primary cancer treatment, and incidence of VTE decreased with time. [ABSTRACT FROM AUTHOR]

Cervical cancer is a malignant tumour that attacks the female genital area originating from epithelial metaplasia in the squamous protocol junction area. One method of diagnosis of cervical cancer is to do a Pap smear examination by taking a cervical cell smear from the woman's cervix and observing its cell development. However, examination of cervical cancer from Pap smear results usually takes a long time. This is because medical practitioners still rely on visual observations in the analysis of the results of Pap smear so that the results are subjective. Therefore, we need a programme that can help the classification process in establishing a diagnosis of cervical cancer with high accuracy results. In this study, a cervical cancer classification program was developed using a combination of the Grey Level Co-occurrence Matrix (GLCM) and Extreme Learning Machine (ELM) methods. There are three classes of cervical cell images classified, namely adenocarcinoma, High Squamous Intraepithelial Lesion (HSIL) and Squamous Cell Carcinoma (SCC). From the results of the training program obtained an accuracy 100% and from the testing program obtained an accuracy of 80%. [ABSTRACT FROM AUTHOR]

We compared predictive performance between dose volume histogram (DVH) parameter addition and deformable image registration (DIR) addition for gastrointestinal (GI) toxicity in cervical cancer patients. A total of 59 patients receiving brachytherapy and external beam radiotherapy were analyzed retrospectively. The accumulative dose was calculated by three methods: conventional DVH parameter addition, full DIR addition and partial DIR addition. |${D}_{2{cm}^3}$|⁠ , |${D}_{1{cm}^3}$| and |${D}_{0.1{cm}^3}$| (minimum doses to the most exposed 2 cm3, 1cm3 and 0.1 cm3 of tissue, respectively) of the rectum and sigmoid were calculated by each method. V50, V60 and V70 Gy (volume irradiated over 50, 60 and 70 Gy, respectively) were calculated in full DIR addition. The DVH parameters were compared between toxicity (≥grade1) and non-toxicity groups. The area under the curve (AUC) of the receiver operating characteristic (ROC) curves were compared to evaluate the predictive performance of each method. The differences between toxicity and non-toxicity groups in |${D}_{2{cm}^3}$| were 0.2, 5.7 and 3.1 Gy for the DVH parameter addition, full DIR addition and partial DIR addition, respectively. The AUCs of |${D}_{2{cm}^3}$| were 0.51, 0.67 and 0.57 for DVH parameter addition, full DIR addition and partial DIR addition, respectively. In full DIR addition, the difference in dose between toxicity and non-toxicity was the largest and AUC was the highest. AUCs of V50, V60 and V70 Gy were 0.51, 0.63 and 0.62, respectively, and V60 and V70 were high values close to the value of |${D}_{2{cm}^3}$| of the full DIR addition. Our results suggested that the full DIR addition may have the potential to predict toxicity more accurately than the conventional DVH parameter addition, and that it could be more effective to accumulate to all pelvic irradiation by DIR. [ABSTRACT FROM AUTHOR]

This updated meta-analysis sought to explore whether pretreatment neutrophil-to-lymphocyte ratio (NLR) could serve as an independent predictor for survival outcomes in patients with cervical cancer. We searched PubMed, Embase, Web of science and Scopus for studies on the association of pretreatment serum NLR with overall survival (OS) and progression-free survival (PFS) among patients with cervical cancer. Included studies with a hazard ratio (HR) and 95% confidence interval (CI) or a p-value were weighted by generic inverse-variance and pooled in a random effects meta-analysis. Subgroup analyses were conducted according to regions, NLR cut-off values and treatments. Publication bias was analyzed by Egger's and Begg's tests. A total of 14 studies comprising 6041 patients were included. The median cut-off value for NLR was 2.46 (range from 1.60 to 3.80). The higher NLR was associated to worse OS (HR 1.86, 95% CI 1.44–2.40) and PFS (HR 1.67, 95% CI 1.25–2.23), compared with lower NLR. This association still exited when analyzed according to regions, NLR cut-off values. Moreover, Significant association between NLR and OS was observed in studies which included patients with early stage disease and receiving radical surgeries. High NLR is independently associated with decreased OS and PFS in patients with cervical cancer. Pretreatment NLR is of independent value to predict the survival outcomes in patients with cervical cancer, regardless of regions and primary treatments. [ABSTRACT FROM AUTHOR]

Adjuvant external beam radiotherapy (EBRT) was shown to decrease pelvic relapses in patients with an early stage cervical cancer and intermediate-risk histopathological prognostic factors, at the cost of increased bowel morbidity. We examined the feasibility and results of adjuvant brachytherapy alone as an alternative to EBRT in this situation. Medical records of consecutive patients receiving adjuvant brachytherapy between 1991 and 2018 for an early stage cervical cancer were examined. Patients were included if they presented a pT1a2N0 or pT1b1N0 disease following radical colpohysterectomy. Adjuvant vaginal wall brachytherapy (without EBRT) was indicated because of a tumor size ≥ 2 cm and/or presence of lymphovascular space invasion (LVSI). Patients received 60 Gy to 5 mm of the vaginal wall, through low-dose or pulse-dose rate technique. Patients' outcome was examined for disease control, toxicities and prognostic factors. A total of 40 patients were included. Eight patients (20%) had LVSI, 26 patients (65%) had a tumor size ≥ 2 cm. With median follow-up time of 42.0 months, 90% of patients were in complete remission and four patients (10%) experienced tumor relapse, all in the peritoneal cavity, and associated with synchronous pelvic lymph node failure in 2/4 patients. No vaginal or isolated pelvic nodal failure was reported. At 5 year, overall survival was 83.6% (CI95%: 67.8–100%) and disease-free survival was 85.1% (CI95%: 72.6–99.9%). In univariate analysis, probability of relapse correlated with tumor size ≥ 3 cm (P = 0.004). No acute or late toxicity grade more than 2 was reported. Brachytherapy alone was a well-tolerated adjuvant treatment for selected patients with intermediate risk factors. The risk of relapse in patients with tumor size ≥ 3 cm was however high, suggesting that EBRT is more appropriate in this situation. [ABSTRACT FROM AUTHOR]

Introduction Estimation of health-related quality of life of cervical cancer patients in India is important in assessing the well-being of patients, monitor treatment outcomes, and conduct health technology assessments. However, health-related quality of life estimates for different stages of cervical cancer are not available for the Indian population. This study aims to generate stagespecific quality of life scores for cervical cancer patients in India. Methods A cross-sectional study using the EQ-5D EuroQol 5-dimensions) instrument, that consists of the EQ-5D-5L descriptive system and the EuroQol Visual Analog Scale (EQ-VAS) was conducted. A total of 159 cervical cancer patients were interviewed. Mean EQ-5D-5L quality of life scores (utility scores) were calculated using the EQ-5D-5L index value calculator across different stages of cervical cancer. The proportion of patients reporting problems in different attributes of EQ-5D-5L was assessed. The impact of socio-economic determinants on health-related quality of life was evaluated using multiple linear regression. Results The mean EQ-5D-5L and EQ-VAS utility scores among patients of cervical cancer were 0.64 95% CI=0.61--0.67] and 67.6 [95% CI=65.17--70.03], respectively. The most frequently reported problem among cervical cancer patients was pain/discomfort (61.88%), followed by difficulty in performing usual activities 53.81%), and anxiety/depression (41.26%). Conclusion Cervical cancer significantly impacts the health-related quality of life of the patients in India. Clinical interventions should focus on the control of pain and relief of anxiety. The measurement of health-related quality of life should be an integral component of the effectiveness of interventions as well as health technology assessment. [ABSTRACT FROM AUTHOR]

Objective Revised staging of patients with locally advanced cervical cancer is based on clinical examination, imaging, and potential surgical findings. A known limitation of imaging techniques is an appreciable rate of understaging. In contrast, surgical staging may provide more accurate information on lymph node involvement. The aim of this prospective study was to evaluate the impact of pre-treatment surgical staging, including removal of bulky lymph nodes, on disease-free survival in patients with locally advanced cervical cancer. Methods Uterus-11 was a prospective international multicenter study including patients with locally advanced cervical cancer who were randomized 1:1 to surgical staging (experimental arm) or clinical staging (control arm) followed by primary platinum-based chemoradiation. Patients with histologically proven squamous cell carcinoma, adenocarcinoma, or adenosquamous cancer International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IIB--IVA underwent gynecologic examination and pre-treatment imaging including abdominal computed tomography (CT) and/or abdominal magnetic resonance imaging (MRI). Patients had chest imaging (any of the following: X-ray, CT, or PET-CT). The primary endpoint was disease-free survival and the secondary endpoint was overall survival. An ad hoc analysis was performed after trial completion for cancerspecific survival. Randomization was conducted from February 2009 to August 2013. Results A total of 255 patients (surgical arm, n=130; clinical arm, n=125) with locally advanced cervical cancer were randomized. Of these, 240 patients were eligible for analysis. The two groups were comparable with respect to patient characteristics. The surgical approach was transperitoneal laparoscopy in most patients (96.6%). Laparoscopic staging led to upstaging in 39 of 120 (33%) patients. After a median follow-up of 90 months (range 1--123) in both arms, there was no difference in diseasefree survival between the groups (p=0.084). For patients with FIGO stage IIB, surgical staging is superior to clinical staging with respect to disease-free survival (HR 0.51, 95% CI 0.30 to 0.86, p=0.011). In the post-hoc analysis, surgical staging was associated with better cancer-specific survival (HR 0.61, 95% CI 0.40 to 0.93, p=0.020). Conclusion Our study did not show a difference in disease-free survival between surgical and clinical staging in patients with locally advanced cervical cancer. There was a significant benefit in disease-free survival for patients with FIGO stage IIB and, in a post-hoc analysis, a cancer-specific survival benefit in favor of laparoscopic staging. The high risk of distant metastases in both arms emphasizes the need for further evaluation. [ABSTRACT FROM AUTHOR]

Communication influences patient disclosure, treatment adherence, and outcome, adaptation to illness, and bereavement. Different cancer patients and caregivers communicate their various experiences in unique ways. These distinctive experiences are necessary to be told, because it empowers both the teller and everyone who hears and shares that experience. However, there is little research documenting the experiences of cervical cancer patients and caregivers in Kenya and the rest of Africa. This study therefore sought to assess the communication experience among cervical cancer patients and their caregivers. This study was a qualitative study employing the phenomenological method to obtain data from cervical patients and caregivers. It was carried out in Uasin Gishu County, Kenya, where a range of in-depth interviews were held with eight patients and eight caregivers purposively sampled. Data from the interviews were analysed thematically and presented in narrative form using paraphrases and quotations. Ethical issues such as informed consent, confidentiality and official authorisation were observed at all levels. To enrich this study, hermeneutic theory, which explains more about the individual's experience, was used. The findings of the study indicated that communication is therapeutic, although most of the patients and the caregivers were reluctant to talk about their illness. The findings of this study will be of interest to scholars, policy-makers and caregivers of terminally ill patients. [ABSTRACT FROM AUTHOR]

Objective There is recent evidence that demonstrates worse oncologic outcomes associated with minimally invasive radical hysterectomy when compared with open radical hysterectomy, particularly in patients with tumors >2 cm. The aim of our study was to retrospectively evaluate the oncological outcomes between laparoscopic and open radical hysterectomy in International Federation of Gynecology and Obstetrics(FIGO) 2009 stage IB1 (FIGO 2009) cervical cancer patients with tumor size =2 cm. Methods A retrospective review of medical records was performed to identify patients who underwent either laparoscopic or open radical hysterectomy during January 2010 and December 2018. Inclusion criteria were: (1) histologically confirmed cervical cancer including all histological types; (2) FIGO 2009 stage IB1; (3) tumor size =2 cm (determined by pelvic examination, magnetic resonance imaging or transvaginal ultrasound); (4) had undergone radical hysterectomy (type II or III) with pelvic and/or para-aortic lymphadenectomy as primary surgical treatment; (5) had follow-up information. Patients with FIGO 2009 stage IA1 or IA2, tumor size >2 cm, or who received neo-adjuvant chemotherapy before surgery, those with cervical cancer incidentally found after simple hysterectomy, or with insufficient data were excluded. Concurrent comparison between the laparoscopic and open cohorts was made for disease-free survival and overall survival. Results A total of 325 cervical cancer patients were included; of these, 129 patients underwent laparoscopic surgery and 196 patients had open surgery. The median follow-up times were 51.8 months (range 2-115) for laparoscopic surgery and 49.5 months (range 3-108) for open surgery. Patients in the laparoscopic group had significantly worse 5 year disease-free survival than those in the open group (90.4% vs 97.7%; p=0.02). There was no significant difference in 5 year overall survival between groups (96.9% vs 99.4%, p=0.33). The Cox proportional hazards regression analysis indicated that laparoscopic surgery was associated with lower disease-free survival compared with open surgery (adjusted hazard ratio 4.64, 95% CI 1.26 to 17.06; p=0.02). In patients with non-squamous cell carcinoma or with grade II-III, laparoscopic surgery had a significantly worse 5 year disease-free survival compared with the open surgery group (74% vs 100%, p=0.01, and 88.8% vs 98.0%, p=0.02, respectively). Conclusion Laparoscopic radical hysterectomy was associated with worse disease-free survival for stage IB1 (FIGO 2009) cervical cancer patients with tumor size =2 cm compared with open radical hysterectomy. Further studies may shed additional light on the impact of minimally invasive surgery in this low-risk patient population. [ABSTRACT FROM AUTHOR]

Introduction Sub-Saharan Africa has the highest global incidence of cervical cancer. Cervical cancer is the most common cause of cancer morbidity and mortality among women in Zambia. HIV increases the risk for cervical cancer and with a national Zambian adult HIV prevalence of 16%, it is important to investigate the impact of HIV on the progression of cervical cancer. We measured differences in cervical cancer progression between HIV-positive and HIV-negative patients in Zambia. Methods This study included 577 stage I and II cervical cancer patients seen between January 2008 and December 2012 at the Cancer Diseases Hospital in Lusaka, Zambia. The inclusion criteria for records during the study period included known HIV status and FIGO stage I and II cervical cancer at initial date of registration in the Cancer Diseases Hospital. Medical records were abstracted for clinical and epidemiological data. Cancer databases were linked to the national HIV database to assess HIV status among cervical cancer patients. Logistic regression examined the association between HIV and progression, which was defined as metastatic or residual tumor after 3 months of initial treatment. Results A total of 2451 cervical cancer cases were identified, and after exclusion criteria were performed the final analysis population totaled 537 patients with stage I and II cervical cancer with known HIV status (224 HIV-positive and 313 HIV-negative). HIV-positive women were, on average, 10 years younger than HIV-negative women who had a median age of 42, ranging between 25 and 72. A total of 416 (77.5%) patients received external beam radiation, and only 249 (46.4%) patients received the recommended treatment of chemotherapy, external beam radiation, and brachytherapy. Most patients were stage II (85.7%) and had squamous cell carcinoma (74.7%). HIV-positive patients were more likely to receive lower doses of external beam radiation than HIV-negative patients (47% vs 37%; P<0.05, respectively). The median total dose of external beam radiation for HIV-positive and HIV-negative patients was 46 Gy and 50 Gy, respectively. HIV positivity did not lead to tumor progression (25.4% in HIV-positive vs 23.9% in HIV-negative, OR 1.04, 95% CI [0.57, 1.92]). However, among a subset of HIV-positive patients, longer duration of infection was associated with lower odds of progression. Conclusion There was no significant impact on non-metastatic cervical cancer progression by HIV status among patients in Lusaka, Zambia. The high prevalence of HIV among cervical cancer patients suggest that HIV-positive patients should be a primary target group for HPV vaccinations, screening, and early detection. [ABSTRACT FROM AUTHOR]

Objective Standard treatment in locally-advanced cervical cancer is external beam radiotherapy concomitant with platinum-based chemotherapy, followed by brachytherapy. The goal of our study was to determine whether an intensity modulated radiation therapy (IMRT) boost is feasible in patients unfit for brachytherapy. Methods We retrospectively analyzed data of 25 patients unfit for brachytherapy with median age 55 years (range, 30-82) with locally-advanced/metastatic cervical cancer who underwent external beam radiotherapy to pelvis ±para-aortic lymph nodes and sequential IMRT boost between July 2014 and December 2017. Total dose of 45-50.4 Gy in 25-28 fractions (1.8 Gy/fraction) was administered to the cervix, uterus, parametria, ovaries, vaginal tissues (based on vaginal extension), involved lymph nodes, or relevant draining lymph-nodal groups. Para-aortic nodes were included if involved at radiological staging or if common iliac nodes were positive. The IMRT boost included all residual tumor after external beam radiotherapy identified on MRI. The Kaplan-Meier method was used to calculate 2 years' overall survival, 2 years' progression-free survival, and 2 years' local control. Overall survival- and progression-free survival were calculated considering the starting of radiotherapy or neo-adjuvant chemotherapy if prescribed, while local control was calculated from the end of radiotherapy. Results Median radiation dose to pelvis ±para-aortic lymph nodes was 50.4 Gy (45-50.4), boost treatment was homogeneously performed to a total dose of 25 Gy in five fractions every other day. After a median follow-up of 26 months (range, 4-77), tumor persistence at cervix at 6 months from the end of radiotherapy or local recurrence occurred in five women (20%), eight (32%) experienced a further distant progression (two of them had also tumor persistence). Two-year local control and overall survival rates for all stages were 78% and 67%, respectively. According to Common Terminology Criteria for Adverse Events v.4 scoring criteria, 10 patients experienced gastrointestinal and/or genitourinary grade G1-2 acute toxicity. G2 rectal late toxicity requiring laser-coagulation was registered in two patients, there were no gastrointestinal and/or genitourinary acute or late toxicities=G3. Conclusion The combination of external beam radiotherapy and brachytherapy remains the standard of care, however our preliminary data show the feasibility of IMRT boost in terms of toxicity with promising results in terms of local control and overall survival. [ABSTRACT FROM AUTHOR]

Objective Post-operative concurrent chemoradiotherapy has become the standard treatment for patients with positive lymph nodes after radical surgery. The aim of this study was to explore the efficiency and safety of consolidation chemotherapy in early-stage cervical cancer patients with lymph node metastasis after radical hysterectomy. Method We reviewed the medical records of patients with early-stage cervical cancer with lymph node metastasis after radical hysterectomy from January 2010 to January 2017. All patients underwent adjuvant concurrent chemoradiotherapy (n=49) or three cycles of platinum-based consolidation chemotherapy following concurrent chemoradiotherapy (n=89). The primary end points of the study were disease-free survival and overall survival. Results The median follow-up time was 51 months (range 10-109). No significant difference was noted in disease-free survival, overall survival, or grade 3/4 gastrointestinal disorder between the consolidation chemotherapy group (78.1% vs 83.1% vs 6.7%) and the concurrent chemoradiotherapy alone group (75.4% vs 75.3% vs 4.1%), (p=0.42, 0.26, 0.80, respectively). However, the grade 3/4 myelosuppression rate in the consolidation group was higher than in the concurrent chemoradiotherapy alone group (40.4% vs 22.4%, p=0.03). For patients with >3 positive lymph nodes or patients with >2 positive lymph nodes+lymphovascular space invasion/=1/3 stromal invasion, disease-free survival and overall survival were superior in the consolidation chemotherapy group compared with the concurrent chemoradiotherapy alone group (p<0.05). Conclusion In patients with >3 positive lymph nodes or patients with >2 positive lymph nodes, lymphovascular space invasion, and greater than 1/3 stromal invasion, disease-free survival and overall survival were superior with consolidation chemotherapy. However, consolidation chemotherapy was also associated with an increased grade 3/4 myelosuppression rate. [ABSTRACT FROM AUTHOR]

To analyze the authenticity and reliability of contrast-enhanced ultrasound (tvs-ceus) parameters in preoperative diagnosis of cervical cancer. Methods: the tvs-ceus images of 56 patients with cervical cancer admitted to our hospital from December 2018 to December 2019 were analyzed retrospectively. The uninjured cervix, myometrium and endometrium of the patients were taken as the control group. The contrast-enhanced ultrasound images of all patients with cervical cancer were analyzed. The nature, size range and preoperative stage of local lesions of all patients were evaluated, and compared with the postoperative pathological results to analyze the value of RSR and TTP in tvs-ceus in the preoperative diagnosis of cervical cancer Results: 56 cases of cervical cancer, 41 cases of endometrium and The tic curve of 24 cases of UN involved cervix showed that the UN involved cervix and myometrium began to show dot like vascular enhancement at 12.5-15s after the injection of contrast agent, and showed radial enhancement from the near serous side of the uterine wall to myometrium, with a peak time of about 32.5s, showing a uniform enhancement; at 17.5-25.5s, the endometrium began to increase, and the peak intensity was lower than that of the myometrium and cervix; the time of endometrium clearance was earlier In the muscularis and cervix. Type I cervical lesions showed synchronous enhancement with normal cervical tissues and decreased with surrounding tissues in the process of contrast enhancement, but the boundary between lesions and surrounding normal tissues was unclear, which was common in stage 0 and stage IA. In type E cervical cancer, the abnormal perfusion area is usually small piece with low or high enhancement, and the change of regression period is not obvious. In the early stage of enhancement with normal cervical tissues and decreased with surrounding tissues in the process ofmal uterine wall, mainly presenting as a whole mass, with the peak intensity higher than that of the normal uterine wall, with a clear boundary, which was more common in stage E cervical cancer In the early stage of contrast medium injection, the lesions of type W cervical cancer were rapidly enhanced, with irregular shape, irregular and non enhanced area in the center, and stage, and stage rly stage of enhancement with normal cervical tissuhwsr in cervical cancer were significantly higher than those in normal myometrium, and the levels of TTP, at, et and hwot were significantly lower than those in normal myometrium (P < 0.05). ROC curve analysis showed that AUC of RSR, TTP, EI, hwsr, at, et and hwot in the diagnosis of cervical cancer was > 0.05, which was statistically significant (P < 0.01). AUC of TTP in the diagnosis of cervical cancer was 0.995, the best cutoff value was 26.6s, the sensitivity was 95.60%, the specificity was 99.56%, and Youden index was 95.26%; AUC of RSR in the diagnosis of cervical cancer was 0.998, the best cutoff value was 1.97db/s, and the sensitivity was 98.51%, The specificity was 97.52%, and Youden index was 97.52%. Conclusion: tvs-ceus has abnormal expression in cervical cancer, and it has a certain value in the diagnosis of cervical cancer. TTP and RSR have the highest diagnostic value, which can be widely used in clinical. [ABSTRACT FROM AUTHOR]

Background The management of patients with intraoperative detection of lymph node involvement remains controversial. The most significant aspect is the decision regarding the completion of the cervical procedure, such as hysterectomy, radical hysterectomy, or a fertility sparing procedure. Primary objective The primary objective of the ABandoning RAd hyst in cerviX cancer (ABRAX) trial is to determine whether the completion of the cervical procedure (ie, radical hysterectomy) improves oncological outcome in patients with intraoperatively detected lymph node involvement before they are referred for definitive chemoradiation. Study hypothesis We hypothesize that, in patients with intraoperative lymph node involvement, completion of radical hysterectomy or other cervical procedure does not improve the oncological outcome of definitive chemoradiation. Trial design The ABRAX trial is a multicenter, retrospective, cohort study. Patients with negative lymph nodes in clinical staging, in whom lymph node involvement is detected intraoperatively, are included. Completion or abandonment of the planned cervical procedure stratifies the cohort into two subgroups in which oncological outcome and morbidity will be compared. Major Inclusion/Exclusion criteria Patients with early stage (pT1a-pT2b) cervical cancer, who did not have positive lymph nodes on preoperative imaging, who were scheduled for primary surgical treatment, and in whom metastatic involvement of pelvic lymph node was found during surgery either as a grossly (macroscopically) involved or on intraoperative pathology assessment will be enrolled. Patients can be included irrespective of surgical approach (minimal invasive surgery or laparotomy) and type of cervical procedure performed (hysterectomy, radical hysterectomy, or a fertility sparing procedure). Primary endpoint The primary endpoint of this retrospective study is a progression free survival in two subgroups with abandoned or completed cervical procedure followed by definitive chemoradiation in both groups. Sample size The assumed sample size is 718 patients (in total for both groups). [ABSTRACT FROM AUTHOR]

Objective The standard of care for early cervical cancer is radical hysterectomy; however, consideration of pre-operative brachytherapy has been explored. We report our experience using pre-operative brachytherapy plus Wertheim-type hysterectomy to treat early stage cervical cancer. This single-center study evaluated consecutive patients with histologically proven node-negative early stage cervical cancer (International Federation of Gynecology and Obstetrics 2009 stage IB1-IIB) that was treated using pre-operative brachytherapy and hysterectomy. Pre-brachytherapy staging was performed using magnetic resonance imaging (MRI) and pelvic lymph node assessment was performed using lymphadenectomy. The tumor and cervical tissues were treated using brachytherapy (total dose 60 Gy) followed by Wertheim-type hysterectomy. The study included patients from January 2000 to December 2013. Results A total of 80 patients completed a median follow-up of 6.7 years (range 5.4-8.5). The surgical specimens revealed a pathological complete response for 61 patients (76%). Patients with incomplete responses generally had less than 1 cm residual tumor at the cervix, and only one patient had lymphovascular space involvement. The estimated 5-year rates were 88% for overall survival (95% CI 78% to 94%) and 82% for disease-free survival (95% CI 71% to 89%). Toxicities were generally mild-to-moderate, including 26 cases (33%) of grade 2 late toxicity and 10 cases (13%) of grade 3 late toxicity. Univariate analyses revealed that poor disease-free survival was associated with overweight status (≥25 kg/m², HR 3.05, 95% CI 1.20 to 7.76, p=0.019) and MRI tumor size >3 cm (HR 3.05, 95% CI 1.23 to 7.51, p=0.016). Conclusions Pre-operative brachytherapy followed by Wertheim-type hysterectomy may be safe and effective for early stage cervical cancer, although poorer outcomes were associated with overweight status and MRI tumor size >3 cm. [ABSTRACT FROM AUTHOR]

Objective Small cell carcinoma of the uterine cervix is associated with a poor prognosis with a median overall survival that is quite low. The aim of this study was to determine the clinico-pathologic characteristics that have an impact on survival in patients with small cell carcinoma of the uterine cervix. A total of 93 patients were involved in this retrospective study. Inclusion criteria were patients diagnosed with histopathologically confirmed small cell carcinoma of the uterine cervix and then later treated at three participating centers, between June 2001 and March 2015. Those without complete available follow-up records were excluded. The endpoints of this study were disease-free survival and overall survival. Kaplan-Meier and Cox regression methods were used for analyses. Results There were statistical differences in overall survival between patients in early and in advanced stages by using the 2009 International Federation of Gynecology and Obstetrics (FIGO) clinical stage. There were 75 patients with FIGO stage I to IIA (56 patients stage I, 17 patients stage IIA, and two patients stage IB or IIA because of uncertainty as to whether the fornix was involved); and 18 patients with FIGO stage IIB and above (10 patients IIB stage, five patients stage III, and three patients stage IV). Among the 76 patients who had surgery, 73 (96%) had a radical hysterectomy with pelvic lymph node dissection and three (4%) patients had a simple hysterectomy without lymph node dissection. For early-stage patients, the 5 year disease-free survival rate was 52.7% compared with 32.4% in the advanced stage group (p=0.022). The disease-free survival for the early-stage group was 64.4% compared with 36.7% in the advanced-stage group (p=0.047). For factors affecting overall survival, age at diagnosis, tumor homology, tumor size, depth of stromal invasion, lymph node involvement, and treatment modality failed to reach significance in both univariate and multivariate analysis. Conclusion FIGO stage was a prognostic factor impacting survival--both overall survival and disease-free survival. Age at diagnosis, tumor histology (pure or mixed), tumor size, depth of stromal invasion, lymph node involvement, and treatment modality did not have an impact on overall survival. [ABSTRACT FROM AUTHOR]

Objective: Cervical cancer (CC) is the 4th most common cause of cancer-related deaths in women all over the world. The most important etiologic cause is HPV, and this allows tumor to have high chance of curing with early diagnosis by screening programs. However, information about long-term survival data of CC is limited in our country. In our study; we wanted to reveal the survival times of our patients with CC and the factors that predict these times. Methods: Seventy-three patients with CC, followed between 2000 and 2017 were analyzed retrospectively. Associations between clinical and histopathological parameters with overall survival (OS) and progression-free survival (PFS) were analyzed using Kaplan- Meier curves and compared by the log-rank test. Univariate and multivariate analysis were used to assess their prognostic values for PFS and OS. Results: The median age of the patients was 56 years. The most common histological subtype was squamous cell carcinoma (79.5%) followed by adenocarcinoma (16.4%).According to FIGO staging system, 31 (43.8%) of the patients were diagnosed as stage 1-2 and 42 (56.2%) were as stage 3-4.The median PFS and OS are 44 months and 78 months. The 5-year survival rate is 37.5% (12%-75%). Although there was no difference in length of life between histological subtypes, both PFS and OS were longer in patients with good ECOG performance score (0-1), early FIGO stage (1-2), tumor size <4 cm, and without parametrial and lymph node involvement. Multivariate analysis showed that ECOG performance score, parametrial involvement and lymph node involvement were independent prognostic factors for PFS and OS. Conclusion: The stage at time of diagnosis of CC patients in our region is more advanced and their 5-year survival rates are below the world average, so our women need to be better informed about this subject. [ABSTRACT FROM AUTHOR]

The objective of the present work is to explore the quality of life (QoL) among women affected by cervix cancer both before and after treatment with chemoradiotherapy, to investigate various factors influencing the QoLamong this women and to assess the effect of treatment modalities on the QoL. This prospective study covered thirty two newly diagnosed locally advanced carcinoma cervix patients (FIGO IB2-IVA) in the department of radiation oncology, Sri Venkateshwara Institute of Medical Sciences (SVIMS), Tirupati, India. Patients who met inclusion criteria were questioned with the structured questionnaire of QoL i.e European Organization for Research and Treatment of Cancer (EORTC) QLQ30, and its Cervical Cancer Module (Cx24) was employed to assess the QoL before treatment and four months after completion of the planned chemoradiotherapy treatment. Themean global health score, post treatment was 60.48 whereas pre-treatment score of 99.85. This is statistically significantly. Various measured parameters of QoL such as physical, role, emotional, cognitive and social functioning improved significantly (p<0.05) behind the treatment. Loss of appetite, fatigue, nausea, vomiting, pain, constipation, insomnia improved significantly (p<0.05), but no significant improvement observed for dyspnea. There was a significant change in cervical cancer related symptomscore (EORTC QLQ CX-24) such as decrease in burning micturition, sexual activity, and vaginal discharge after treatment which were statically significant. But the painful sexual activity did not change significantly. The Quality of life was improved significantly after using chemo-radiotherapy in newly diagnosed locally advanced carcinoma cervix patients. Improvement was also exhibited on the five functional scales of EORTC QLQ-C30. To facilitate further improvement of QoL, the proper psychological, social assistance and awareness about various self-limiting complications to allay fear and anxiety of the patients may be needed. [ABSTRACT FROM AUTHOR]

Introduction: Gynaecological cancers, including cervical cancer, often require a multidisciplinary approach that includes external beam radiotherapy, chemotherapy, and/or surgical treatment. Biological parameters of the tumour evaluated in 18F-FDG-PET/CT are used for target volume delineation in radiotherapy planning. The choice of segmentation method may affect the assessment of metabolic tumour volume (MTV) in 18F-FDG-PET/CT. Aim of the study: To find the optimal segmentation method for the assessment of primary MTV in 18F-FDG-PET/CT in cervical cancer patients for radiotherapy planning. Material and methods: Retrospective analysis was performed on a group of 30 patients with newly diagnosed, histologically confirmed cervical cancer. The primary MTVs were assessed by SUVmax and SUVmean values; three segmentation methods were used to assess the primary MTV: constant threshold of SUVmax of 2.5, threshold of SUVmax 35%, and threshold of SUV max 45%. The MTVs were compared with the tumour volumes obtained in magnetic resonance imaging (MRI), which was the "gold standard", to select the best optimal segmentation method reflecting the tumour size. Wilcoxon-Mann-Whitney and t-test were used for statistical analysis. Results: Depending on the segmentation method chosen, significant differences in the MTVs were obtained (p < 0.001). The highest volumes were obtained using the method based on constant SUVmax of 2.5, while the smallest in case of threshold of SUVmax of 45%. Regarding the volume determined by MRI, a 35% SUVmax threshold was chosen as the most reliable method. Conclusions: The choice of appropriate segmentation method has a significant impact on the primary MTV assessment in 18F-FDG-PET/CT in patients with cervical cancer. [ABSTRACT FROM AUTHOR]

This study aims to analyze the health care road that women with cervix cancer precursor lesions have gone through, the barriers they found to access to health services, and the screening they underwent under a prevention program in the Province of Cauca, Colombia. A qualitative descriptive-interpretative study was carried out with 16 women chosen after a sampling with typical cases; the selection criterion was the time taken to go from the living place to the closest health care provider with medium complexity service level. A content analysis was conducted together with a descriptive quantitative analysis in order to identify the time gaps between the screening and the health care provision. All the women interviewed herein, irrespective of their living place, faced a fragmented health care process with some indicators of non-articulation between the actors. The health services depend strongly on the legal agreements between insurance companies and health care providers, thus negatively affecting the patients and their access and continuity in the sequence of screening, diagnosis, treatment health care reprocessing, increase in the health costs and specific needs going under-/unserved. The findings bring into question the implementation of screening programs and whether they make sense in relation to the subsequent health care process. An effective prevention with a reduction in the morbidity-mortality rates for cervix cancer will be attain only by bridging the gap in the real availability and access to health services. [ABSTRACT FROM AUTHOR]

Introduction: Proximal oesophageal stent deployment continues to provide challenges due to the proximity of the upper oesophageal sphincter and the associated subsequent complications such as globus sensation and stent migration. Patients with cervical oesophageal cancer have previously had limited stenting options available to them with a paucity of the literature describing the radiological technique for successfully placing these high-risk stents. In this paper, we present our experience using the Taewoong Niti-S CERVICAL Oesophageal Stent.Materials and Methods: We describe our method for stent deployment highlighting the importance of pre-procedural planning in ensuring an adequate proximal landing zone for the short proximal flare of the stent. Furthermore, we outline how we have adapted our placement technique to incorporate a routine pre-dilatation stage which has optimised retrieval of the proximal to distal deployment system.Results: We have placed eight cervical oesophageal stents within our institution. Contrast swallows in all the patients following stent deployment have demonstrated free flow of contrast to the stomach with all patients reporting symptomatic relief and no foreign body/globus sensation. There has been one episode of stent migration but no incidence of oesophageal perforation or haemorrhage.Discussion: Evolution of stenting technique and the properties of the stents themselves are improving accuracy of stent placement in relation to the important landmark of the upper oesophageal sphincter.Conclusion: Stenting of cervical oesophageal malignancy has proved successful in our institution and provided symptom relief for a subset of palliative patients who were previously unable to benefit from oesophageal stenting. [ABSTRACT FROM AUTHOR]

Antibodies to the E6 and E7 oncoproteins of high-risk human papillomavirus (HPV) types are strongly associated with HPV-driven cancer, while antibodies against the capsid protein L1 are considered cumulative exposure markers. To test the hypothesis that L1 antibody levels are stable over time, whereas E6 and E7 levels undergo decay after cervical cancer (CxCa) treatment, we performed multiplex serology for HPV16 and 18 antigens E6, E7 and L1 in a post-treatment study of 184 patients with invasive CxCa that were characterized with a median follow-up time of 725 days, and 2-12 sera per patient. Antibody titers significantly decreased within the first six months for HPV16 E6 and E7 but not L1, and stabilized for the following 12 months on a high level, with few patients showing seroreversion. Of 67 patients seropositive for HPV16 E6 at diagnosis, 28 (41.8%) showed a decrease in antibody titers of at least 50% within the first 18 months. Similarly, of 50 HPV16 E7 seropositives, 33 (66.0%) showed decreasing antibody levels, whereas antibody decay was less frequent for HPV16 L1 (12 of 47, 25.5%). Using a power-law mathematical model to characterize antibody decay kinetics, the mean (+s.e.) durations to a 50% reduction in antibody titers within individual patients were estimated to be 56.9 (+26.1) and 56.3 (+19.0) days for HPV16 E6 and E7, respectively. In summary, HPV16 E6 and E7 antibodies undergo a slow but significant decrease in antibody titers within the first 6-18 months following CxCa treatment. However, larger studies are needed to confirm the utility of serology for prediction of disease progression and time to relapse based on antibody decay kinetics. This article is part of the theme issue 'Silent cancer agents: multidisciplinary modelling of human DNA oncoviruses'. [ABSTRACT FROM AUTHOR]

Background: Whether concurrent chemotherapy could bring about better oncological outcomes in elderly patients receiving definitive radiotherapy is still unknown. So, the purpose of this study was to find out whether it is essential for elderly patients to undergo concurrent chemotherapy. Methods: We performed a retrospective study of 246 elderly cervical cancer patients who were treated with definitive radiotherapy or chemo-radiation between August 2004 and August 2015. All patients were divided into two groups according to whether they were receiving concurrent chemotherapy or not. Overall survival (OS) and disease-free survival (DFS) were compared between the two groups. Recurrence patterns were also analyzed. Multivariate analysis was performed to explore clinical factors significantly associated with DFS, local recurrence-free survival, and distant metastasis-free survival (DMFS). Results: The 5-year OS in the radiotherapy and chemo-radiation groups were 72.89% and 82.25%, respectively. A significant difference was found between the two groups (P=0.016). The 5-year DFS in the radiotherapy and chemo-radiaton groups were 58.19% and 75.52%, respectively, also with a significant difference between the two groups (P=0.028). Further subgroup analysis showed that in patients with negative lymph nodes, there were no differences in both OS and DFS between patients who did and did not receive concurrent chemotherapy. However, in patients with positive lymph nodes, patients who received concurrent chemotherapy acquired better OS and DFS than those who did not. Multivariable analysis showed that concurrent chemotherapy was an independent predictor of DFS and DMFS. Conclusion: Concurrent chemotherapy could improve oncological outcomes in elderly cervical cancer patients with positive lymph nodes, but not in those with negative lymph nodes. [ABSTRACT FROM AUTHOR]

Objective: To compare the effects of oxycodone and fentanyl patient-controlled intravenous analgesia (PCIA) on postoperative pain, immune response and stress response in patients with cervical cancer. Methods: 110 patients with early cervical cancer who received radical hysterectomy in our hospital between January 2017 and January 2019 were divided into the control group (n=55) and the study group (n=55) by random number table method. Control group received postoperative fentanyl PCIA, and study group received postoperative oxycodone PCIA. The differences in visual analogue scale (VAS) as well as serum contents of pain mediators (5-hydroxytryptamine, substance P and prostaglandin), Th1/Th2 cytokines (interleukin-2, tumor necrosis factor β, interleukin-5 and interleukin-13) and stress hormones (cortisol, norepinephrine, angiotensin 1 and angiotensin 2) after surgery and 24 h after surgery were compared between the two groups immediately. Results: Immediately after surgery, there was no statistically significant difference in VAS as well as serum contents of pain mediators, Th1/Th2 cytokines and stress hormones between the two groups. Twenty-four after the surgery, the VAS of the study group was lower than that of the control group; serum levels of 5-hydroxytryptamine, substance P and prostaglandin were lower than those of the control group as well; serum levels of interleukin-2 and tumor necrosis factor βwere lower than those of the control group while the levels of interleukin-5 and interleukin-13 were higher than those of the control group; serum levels of cortisol, norepinephrine, angiotensin 1 and angiotensin 2 were lower than those of the control group. Conclusion: Compared with conventional fentanyl PCIA, oxycodone PCIA after cervical cancer surgery has more advantages in analgesia and homeostasis. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to validate previously developed radiomics models relying on just two radiomics features from 18F-fluorodeoxyglucose positron emission tomography (PET) and magnetic resonance imaging (MRI) images for prediction of disease free survival (DFS) and locoregional control (LRC) in locally advanced cervical cancer (LACC). Methods: Patients with LACC receiving chemoradiotherapy were enrolled in two French and one Canadian center. Pre-treatment imaging was performed for each patient. Multicentric harmonization of the two radiomics features was performed with the ComBat method. The models for DFS (using the feature from apparent diffusion coefficient (ADC) MRI) and LRC (adding one PET feature to the DFS model) were tuned using one of the French cohorts (n = 112) and applied to the other French (n = 50) and the Canadian (n = 28) external validation cohorts. Results: The DFS model reached an accuracy of 90% (95% CI [79–98%]) (sensitivity 92–93%, specificity 87–89%) in both the French and the Canadian cohorts. The LRC model reached an accuracy of 98% (95% CI [90–99%]) (sensitivity 86%, specificity 100%) in the French cohort and 96% (95% CI [80–99%]) (sensitivity 83%, specificity 100%) in the Canadian cohort. Accuracy was significantly lower without ComBat harmonization (82–85% and 71–86% for DFS and LRC, respectively). The best prediction using standard clinical variables was 56–60% only. Conclusions: The previously developed PET/MRI radiomics predictive models were successfully validated in two independent external cohorts. A proposed flowchart for improved management of patients based on these models should now be confirmed in future larger prospective studies. [ABSTRACT FROM AUTHOR]

Abstract Genetic variations among HR-HPV types lead to altered biological functions with possible clinical significance in different geographical locations. To explore intratype genetic variations of HPV51 E6, E7, L1 and L2 genes originating from Southwest China, a total of 5204 cervical scraped cell samples were collected for DNA extraction and HPV typing. And then the E6, E7, L1 and L2 genes of HPV51 (n = 79) were sequenced and compared to the reference sequence (M62877). The ConSurf server was used for identification of conserved structural and functional amino acids of the E6 and E7 oncogenes, and the changes of the secondary structure were analyzed by PSIPred software. Phylogenetic trees were constructed by the maximum likelihood method implemented in IQ-TREE. The selection pressure acting on the E6, E7, L1 and L2 genes was estimated by Datamonkey web server. 13 nucleotide polymorphism sites were observed in E6-E7 gene and the most common mutation sites were C395T (S100L), C756T (S66L), C796T, A832G. 36 nucleotide polymorphism sites were identified in full length L1 gene and the non-synonymous mutations T6311G, A6312T (V264G), G6313A (G265S) A5674C (I52L), A6335C (N272T), A6586C (T354P) and synonymous mutations A5649T, C6147T, A6435G, G6570A, A6651G, T6774C, A6784C, A6882G, C6918A, and G6984A were the most common mutations. 53 nucleotide variation sites were identified in full-length L2 gene including four insertion sites (4418A, 4670G, 4693A, 4694C) and one deletion site (A4430). Besides, the non-synonymous mutations G4227A (V32I), A4407G (I92V), G4945A (D271N), C4985A (T284K), T5260G (L376V), A5335C (T401P) and the synonymous mutations A4166G, G4229A, G4283A, T4453C, C4566A, T4596C, C4695T, C4830T, G4839A, A5160C, and T5286G were the most common mutations. Specially, a triallelic mutation site (G4461C/A) in L2 was identified, with 26% G4461C (E109D) being non-synonymous mutation. Selective pressure analysis showed that only codon site 66 in E7 and 52 in L1 were the positively selected sites and codon sites 72, 107, 342, 412, 427 were negatively selected sites in L2 gene. Our investigation also suggests that A2 and A4 were the most frequent HPV51 lineage in Southwest China. Highlights • It is the first study to identify the genetic variability of HPV51 E6, E7, L1 and L2 genes in Southwest China. • The majorly prevailing isolates and the major mutations of HPV51 E6, E7, L1 and L2 in Southwest China were identified. • The major nonsynonymous mutations identified in L1 were all located in immunodominant loop structures. • Several major mutations in L2 were discovered at conserved cross-reacting epitopes regions and other vital functional regions. • Some variations identified are predicted to result in functional protein changes, which could have clinical implications. [ABSTRACT FROM AUTHOR]

Abstract Objective Hospice services improve quality of life and outcomes for patients and caretakers, compared to inpatient mortality. This study identifies factors that exert the strongest influence on end-of-life care modalities in patients with cervical cancer. Methods Admissions with a diagnosis of cervical cancer that were discharged to hospice or died in-hospital were identified in the National Inpatient Sample years 2007–2011, excluding admissions coded for hysterectomy. Logistic regression models were used to examine differences in age, race, length of stay, primary payer, hospital region, admission type, hospital bedsize, hospital teaching status, income quartile, and Elixhauser comorbidity index score between the groups. Results 2073 admissions with a diagnosis of cervical cancer resulting in hospice discharge (n = 1290) or inpatient death (n = 783) were identified. Age (P = 0.01), hospital region (P = 0.01), length of hospitalization (P < 0.01), Elixhauser comorbidity index score (P = 0.03), and urban vs. rural location (P = 0.01) had a significant impact on disposition in univariate analysis. Admissions of patients categorized as Asian/Pacific Islander (OR = 2.24, 95% CI 1.11–4.49), hospitalizations lasting 0–3 days (OR = 1.57, 95% CI 1.21–2.03), and admissions in rural areas (OR = 1.62, 95% CI 1.12–2.36) had higher rates of in-hospital death compared to the reference groups. Patients aged 18–45 years (OR = 0.69, 95% CI 0.52–0.90) and those treated in the South (OR 0.59, 95% CI 0.45–0.77) and West (OR = 0.50, 95% CI 0.30–0.81) had lower odds ratios of inpatient mortality. Conclusion Modalities of care in terminal cervical cancer vary among sociodemographic and clinical factors. This data underscores the continued push for improved end-of-life care among cervical cancer patients and can guide clinicians in appropriate targeted counseling to increase utilization of hospice resources. Highlights • Admissions of Asian patients, in rural hospitals, with fewer comorbidities, and shorter stays had less hospice disposition. • Those younger, and in the South and West were more often discharged to hospice compared to reference groups. • Age, region, and Elixhauser score had a significant effect on univariate analysis of disposition outcome. • Hospital location (rural vs. urban) and teaching status also had univariate significance. • Primary payer, admission type, and hospital bedsize had no significant impact on disposition. [ABSTRACT FROM AUTHOR]

Abstract Objective It is uncommon for cervical cancer patients to be diagnosed without a human papillomavirus (HPV) infection. As prophylactic vaccines against high-risk HPV types are an ineffective preventive measure for these patients it is essential to identify differential biomarkers that may be associated with detection, prognosis and novel targeted therapies. The objective of this study was to compare the two entities, HPV+ and HPV− cervical cancers, based on TCGA public data. Methods We collected and analyzed clinical information of 299 cervical cancer patients as the first step, then identified differential expressed genes and conducted downstream analyses to characterize this tumor based on HPV status, including functional annotation, pathway mapping, survival analysis and comparative somatic mutation landscapes. We further inferred the likelihood of responding to traditional treatment including radiotherapy and chemotherapy. Results It was found that HPV− tumors were likely to occur at an older age and were often adenocarcinomas or adenosquamous carcinomas, and there was no significant overall survival difference between HPV+ vs. HPV− tumors. Gene expression profiles of HPV+ and HPV− tumors differed especially in ANKRD7 , SERPINB3 , EMX2 , MEI1 , RNF212 , RP11-13 K12.5 , RP11-325F22.2 and ZFR2 which were significantly relevant to cervical cancer prognosis. TP53 , ARID5B , ARID1A , CTNNB1 and PTEN were significantly differentially mutated between HPV+ and HPV− tumors. Results of radiotherapy analyses demonstrated that CDO1 , PCDHB2 and MYOD1 were different between the two subsets. In addition, RP11-299 L17.3 , SLC14A2 , FGF18 and OASL represented different drug-sensitivity to cisplatin between both. Conclusions These potential biomarkers may offer insights to further personalize therapeutic decision-making to improve survival in HPV− cervical cancer patients. Highlights • HPV− tumors were likely to occur at an older age and were often adenocarcinomas or adenosquamous carcinomas. • 5 genes were significantly differentially mutated between HPV+ and HPV− tumors. • CDO1 , PCDHB2 and MYOD1 demonstrated different response to radiotherapy between HPV+ and HPV− tumors. • 4 genes were different drug-response to cisplatin between HPV+ and HPV− cervical cancer tumors. [ABSTRACT FROM AUTHOR]

Purpose: SN-38, an active metabolite of irinotecan, is reabsorbed by the intestinal tract during excretion, causing diarrhoea and neutropenia. In addition, the association between blood levels of SN-38 and neutropenia has been reported previously, and the rapid excretion of SN-38 from the intestinal tract is considered to prevent neutropenia. Oral alkalization drugs are used as prophylactic agents for suppressing SN-38 reabsorption. The relationship between oral alkalization drugs and neutropenia, however, has not been well studied. The aim of this study was to investigate the relationship between oral alkalization drugs and neutropenia in irinotecan-treated patients.Methods and Results: Patients with cervical or ovarian cancer were administered irinotecan and investigated by medical chart reviews to determine whether oral alkalization drugs were effective at ameliorating irinotecan-induced neutropenia. The drug combination in the oral alkalization drugs-ursodeoxycholic acid, magnesium oxide, and sodium hydrogen carbonate-significantly improved neutrophil counts and reduced dose intensity compared with those of non-users. In the large-scale Japanese Adverse Drug Event Report database, the reporting odds ratio of irinotecan-induced neutropenia was significantly lower when irinotecan had been given in combination with oral alkalization drugs.Conclusions: These data indicate that oral alkalization drugs may reduce the frequency of neutropenia caused by irinotecan administration, making it possible to increase the dose safely. [ABSTRACT FROM AUTHOR]