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Objective: This study aimed to analyse the effect of pelvic floor function exercises based on the enhanced recovery after surgery (ERAS) concept on lower urinary tract symptoms after radical hysterectomy for cervical cancer., Methods: The retrospective study was conducted using clinical data of patients admitted to our hospital from January 2021 to December 2022 and underwent radical hysterectomy for cervical cancer. In accordance with the nursing method, the patients were divided into the routine group (conventional care) and the ERAS pelvic floor function exercise group, for which ERAS concept-based pelvic floor function exercises were carried out on the basis of the former group. The confounders between the two groups were matched by propensity score, and the scores of urination, pelvic floor muscle strength, lower urinary tract symptoms and quality of life (QoL) were compared between the two groups after matching., Results: A total of 180 patients were included in the study, of whom 60 patients were identified after propensity score matching, consisting of 30 patients each in the ERAS and routine groups. The baseline characteristics of the two groups were balanced, and the difference was not statistically significant ( p > 0.05). Compared with the routine group, the observation group showed significantly shorter first spontaneous urination time, greater first urination volume ( p < 0.05), better pelvic floor muscle strength, considerably lower urinary tract symptoms and better QoL at discharge and 3 months after discharge ( p < 0.05)., Conclusions: Pelvic floor function exercises based on the ERAS concept can relieve lower urinary tract symptoms, accelerate urination and improve pelvic floor muscle strength and QoL after radical hysterectomy for cervical cancer., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s).)

Cervical cancer (CC) has been increasing in prevalence, imposing a high economic burden, that is a serious problem for health care system, despite the success of HPV vaccination and the use of screening programs. Additionally, studies on rehabilitation programs impact on anxiety and depression in patients after CC surgery remain limited., Objective: To evaluate the level of anxiety and depression in females undergoing various rehabilitation programs in the recovery period after surgery of early-stage CC., Material and Methods: The study included 103 female patients with CC divided into 2 groups: 1) undergoing multicomponent rehabilitation (CC-1, 51 patients) and 2) undergoing rehabilitation according to the principles of approved guidelines (CC-2, 52 patients). The level of anxiety and depression was evaluated before surgery and during 36 months after surgery according to the Hospital Anxiety and Depression Scale., Results: The anxiety level before surgery was in average 10.7±3.0 scores on the HADS in the CC-1 group and 10.9±2.0 scores in the CC-2 group. It decreased up to 7.1±3.3 scores at the 3 rd month and remained within 5.6±3.4-5.4±3.5 scores in the CC-1 group, while in CC-2 group it varied between 8.0±2.1-9.6±2.3 scores throughout the study period. The depression level before surgery was 9.7±2.3 scores on the HADS in the CC-1 group and 9.9±2.8 scores in the CC-2 group. It reached 5.2±2.4 scores at the 3 rd month in the CC-1 group remaining further within the range of 5.3±2.5-5.7±2.7 scores until the 36 th month. The depression level remained in the range of 7.8±3.1-10.2±3.0 scores throughout the study period in the CC-2 group., Conclusion: Multicomponent rehabilitation led to a faster and more pronounced reduction of anxiety and depression. This confirms the necessity of such programs application in the clinical practice in recovery period after surgery of early-stage CC.

Aim - to evaluate the rehabilitation program impact on the quality of life of оncogynecological patients and to introduce this approach in clinical practice. The study included93 reproductive-aged women, who underwent the cervical cancer treatment. Patients were divided into two groups: the experimental group, which received rehabilitation, and the control group. The thrombotic complications risk, lymphatic system condition, cognitive functions and anxiety level were assessed in all patients using special questionnaires, physical examination, and laboratory assessment. The lower limbs lymphedema was observed in 19.1% of cases in the control group and in 2.1% in the experimental group (p <0.05). According to the Moka test data, cognitive impairment level at the end of the study was 24.02 (17-30, CI: = 22.5-25.54) in the control group and 26.85 (19-30, CI: = 26.0 - 27.64) in the experimental group (p <0.05). The cognitive impairment subjective signs were significantly higher in the control group (p <0.05) as well. The anxiety level at the end of the study was 7.022 (1-19, CI: = 5.91-8.13) in the experimental group and 11.02 (4-22, CI: = 9.83-12.22) in the control group (p <0.05). At the end of the study, the following depression levels were obtained: 12.43 (5 - 21; CI: = 11.23 - 13.64) and 7.69 (1 -14; CI: = 6.77 - 8.62) in the control and the experimental group respectively (p <0.05). At the end of the study, deep vein thrombosis was observed in 21 patients in the control group (44.7%) and 7 patients in the experimental group (15.22%) (p <0.05). One patient from the control group had PATE. According to EORTC QLQ-C30, the quality of life and socialization level was significantly higher in the experimental group, while fatigue level was lower. At the end of the study, 36.2% and 76.0% of patients in the control and the experimental group respectively were employed. The rehabilitation program improves the emotional and cognitive functioning, induced menopause associated somatic disorders, quality of life, and work capacity.

Background: Despite significant advances in the screening, detection, and treatment of preinvasive cervical lesions, invasive cervical cancer is the fifth most common cancer in European women. There are large disparities in Europe and worldwide in the incidence, management, and mortality of cervical cancer., Objective: The European Society of Gynecological Oncology (ESGO), the European Society for Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP) jointly develop clinically relevant and evidence-based guidelines in order to improve the quality of care for women with cervical cancer across Europe and worldwide., Methods: The ESGO/ESTRO/ESP nominated an international multidisciplinary development group consisting of practicing clinicians and researchers who have demonstrated leadership and expertise in the care and research of cervical cancer (23 experts across Europe). To ensure that the guidelines are evidence based, the current literature identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 159 international reviewers, selected through ESGO/ESTRO/ESP and including patient representatives., Results: The guidelines cover comprehensively staging, management, and follow-up for patients with cervical cancer. Management includes fertility sparing treatment; stage T1a, T1b1/T2a1, clinically occult cervical cancer diagnosed after simple hysterectomy; early and locally advanced cervical cancer; primary distant metastatic disease; cervical cancer in pregnancy; and recurrent disease. Principles of radiotherapy and pathological evaluation are defined.

Purpose: Women treated for cervical cancer with radiotherapy and chemotherapy have reported serious bowel, vaginal, and sexual late effects. The purpose of this study was to describe late adverse effects, health-related quality of life, and self-efficacy in a representative Danish cervical cancer population in order to describe rehabilitation needs., Methods: Women, mean age 55 years, treated for cervical cancer from January 2010 to July 2013, who were alive and without known relapse/metastases were included in this cross-sectional study. EORTC QLQ C30 and CX24 and self-efficacy questionnaires were sent to all participants., Results: The participation rate was 85/107 (79%). Participants below 45 years had significantly more menopausal symptoms and lower body image scores compared to elderly women. The frequency of participants with menopausal symptoms decreased with time since diagnosis. Symptom experience was significantly higher in participants with locally advanced disease than in those with local disease. Self-efficacy was significantly lower in participants with locally advanced disease. The incidence of lymphedema was significantly higher among participants who were obese. Multiple analyses showed impaired quality of life, e.g., a lower body image and self-efficacy score, correlated with increasing BMI. Women who had surgery had greater risk of lymphedema, and women who received chemotherapy during treatment had a lower quality of life. All but one received radiotherapy., Conclusion: This study found that young, obese survivors with locally advanced cervical cancer and survivors who received chemotherapy may have a serious risk of developing late adverse effects; thus, rehabilitation should target these needs.

Objectives: Evaluate the obstetrical outcomes in the case of women with a history of conization. Determine the role of the cone length in the obstetrical issue., Materials and Methods: Retrospective case-control study including the patients (n=39) who had undergone a conization in a university hospital between January 2002 and January 2012. The obstetrical outcomes have been compared to those from a control group (n=78). Into the exposed group the obstetrical outcomes has been compared based on the cone length., Results: Thirty-one patients delivered after a conization (39 deliveries). The obstetrical outcomes have been significantly increased in the exposed group: preterm delivery before 37 weeks gestation (25.6% vs 7.7%, P=0.01), before 32 weeks gestation (15.4% vs 1.3%, P=0.005) and between 28 weeks gestation (10.2% vs 0%, P=0.01), premature onset of labor before 32 weeks gestation (12.8% vs 1.3%, P=0.01) and before 28 weeks gestation (12.8% vs 0%, P=0.01) and preterm premature rupture of membranes before 37 weeks gestation (20.5% vs 1.3%, P<0.001). There was no significant difference for a length cone more than 1.5cm., Conclusion: Our study showed that a history of conization is an obstetrical risk factor to consider in the management of a subsequent pregnancy., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Cervical cancer is the main cause of malignancy-related death among women living in developing countries. The aim of this study is to evaluate the quality of life (QOL) among Bangladeshi cervical cancer survivors and its relationships with demographic and disease related factors A cross-sectional study was carried out onlone hundred nine consecutive cervical cancer survivors in National Institute of cancer Research and Hospital, Dhaka from September 2014 to february 2015 using European organization-for Research and treatment of cancer core Questionnaires (QOL-C30 and QOL- CX24). Demographic condition like education level, occupation and disease related factors like stages, treatment modality and duration of follow-up time were taken as investigating factors against functional scales. Cronbach's alpha was calculated to asses' internal consistency among items. Cervical cancer survivors stated a moderate QOL. Sub-domains of QOL score and global health status were significantly associated with physical function(PF) scales (p=.000), fatigue (p=.045), nausea and vomiting (p=.000), Appetite loss (p=.001), constipation (p=.005), symptom experience (p=.005) and menopausal symptoms (p=.015). QOL mean score were negatively associated with emotional function(EF) scales, pain, fatigue, nausea, appetite loss and financial problems. Education level showed significant association with physical function(PF) (p=.001), emotional function(EF) (p=.027), Cognitive function(CF) (p=.000) and sexual function (p=.001). Duration (Follow-up) time was significance association with PF (p=.005), EF (p=.012), symptoms experience (p=.001). Although, the QOL in cervical cancer survivors was moderate, treatment of related symptoms and improvement of demographic condition can influence the QOL and survivors improve the care of cervical cancer. So, improve the QOL among cervical cancer survivors.

Background: Rehabilitation should be integrated in the routine cancer care of women treated for gynaecological cancers. Goal setting is expected to facilitate the process through patient involvement and motivation. Our knowledge about goal setting in cancer rehabilitation is, however, sparse., Objectives: This study aimed to: 1) analyse rehabilitation goals defined during hospital-based rehabilitation in patients with gynaecological cancer, with regard to number, category, changes over time, and differences between cancer diagnosis, and 2) analyse the association between health-related quality of life and goals defined for rehabilitation., Material and Methods: Consecutively, all patients treated surgically for endometrial, ovarian, and cervical cancer were invited for hospital-based rehabilitation at Odense University Hospital, Denmark, including two sessions at the hospital one and three months following surgery and two phone calls for follow-up. Questionnaires from the EORTC were used to prepare patients and facilitate individual goal setting with definitions of up to three goals. All goals were grouped into six categories., Results: A total of 151 (63%) patients accepted the invitation including 50 endometrial, 65 ovarian, and 36 cervical cancers patients. All patients defined goals at the first session, 76.4% defined three goals, 21.9% two, and 1.6% had one goal. Physical goals decreased over time but were the most frequent at both sessions (98% and 89%). At both sessions, the social and emotional categories were the second and third most frequent among patients with endometrial and ovarian cancer. Sexual issues were dominant among the cervical cancer patients. Regression analysis showed significant association between quality of life scores and goal setting within the social and emotional domains., Conclusion: Goal setting seemed feasible in all problem areas. The EORTC questionnaires were helpful during the process although expectations of the sub-scores being predictive of which areas to address were not convincing.

Purpose: Exercise improves numerous psychosocial outcomes in cancer survivors; however, few studies have examined posttraumatic growth. The primary objective of this study was to examine the association between exercise and posttraumatic growth in gynecologic cancer survivors (GCS)., Methods: Using the Alberta Cancer Registry, a random sample of endometrial, ovarian, and cervical cancer survivors were mailed a self-report survey that assessed demographic and medical variables, aerobic and strength exercise, and posttraumatic growth using the posttraumatic growth inventory, impact of cancer scale, and benefit finding scale., Results: Completed surveys were received from 621 (38 %) of the 1,626 eligible survivors. One-third (32.9 %) of GCS were meeting aerobic exercise guidelines and 19.0 % were meeting strength exercise guidelines. Multivariate analyses of covariance showed significant differences in the posttraumatic growth scales for aerobic exercise guidelines (p < 0.001) and combined (strength and aerobic) exercise guidelines (p < 0.001). Analyses of covariance indicated significant differences favoring those meeting the aerobic exercise guidelines for the negative impact of cancer scale (p < 0.001) and several of its subscales. Moreover, those meeting the combined exercise guidelines reported higher scores for the posttraumatic growth inventory (p = 0.014), the negative impact of cancer scale (p < 0.001), and several of their subscales compared to those meeting only one or neither guideline. Marital status moderated the association between exercise and posttraumatic growth with only unmarried GCS demonstrating the associations., Conclusion: Exercise is a modifiable lifestyle factor that is associated with posttraumatic growth in GCS. Randomized controlled trials testing the effects of exercise interventions on posttraumatic growth in this population are warranted.

Objectives: Quality of life (QoL) and sexual health have become increasingly important in cervical cancer survivors (CCSs). The aims of this review were to summarize research findings of QoL and sexual function in CCSs after treatment on the basis of self-reported questionnaires and to update the current knowledge of overall QoL and sexual function in CCSs., Methods: Studies from electronic database between May 1966 and May 2013 were rated on their internal validity as methodological assessment. Thirty-two studies were included, wherein 15 studies had a relatively good methodology., Results: Anorectal function, urinary symptoms, and lymphedema were commonly reported as physical symptoms. As to psychosocial domains, the studies illustrated that anxiety decreased with age, whereas depression generally increased with age. Sexual function was involved in most of the studies. Vaginal dryness, dyspareunia, short vagina, and sexual dissatisfaction were prominent issues of sexual dysfunction and vaginal changes in CCSs. In terms of treatment modality, radiotherapy was thought to be associated with worse QoL and sexual function in CCSs., Conclusions: The studies showed that QoL and sexual function in CCSs were compromised compared with the general population to different extents. Quality of life and sexual function should be paid with more attention in patients with cervical cancer after treatment.

Purpose: Building upon the findings of a recent qualitative investigation of women's experiences with rehabilitative vaginal dilator use, the primary goal of this article is to outline a set of preliminary clinical care recommendations that health care professionals may draw upon in addressing women's unique experiences with vaginal dilator use including their multifaceted struggles with the procedure, possibly enhancing adherence to this practice., Methods: Ten women participated in in-depth interviews regarding their experiences with using the dilator as prescribed by their health care providers. Following the analysis of these interviews, members of the interdisciplinary research team met to review and discuss the development of clinical care recommendations stemming from these findings., Results: Eight care recommendations aimed at addressing the concerns expressed by the women interviewed and at improving women's overall experiences with rehabilitative dilator use emerged: (1) introduce the dilator in a light and straightforward manner; (2) enhance dilator accessibility; (3) introduce the vaginal dilator early on in treatment; (4) emphasize health maintenance over intercourse as a benefit of dilator use; (5) explore and acknowledge women's values and views of sexuality; (6) increase awareness and sensitivity to emotional reactions; (7) enhance psychoeducational resources for supporting vaginal dilator use; and (8) ensure consistent institutional practice when introducing the dilator., Conclusion: The clinical care recommendations proposed here reflect the various challenges women may encounter when using the vaginal dilator--which vary from practical to, for some, profoundly emotional--and are designed to better position health care providers to help women navigate these challenges.

Objective: Cervical cancer is known to impair women's sexual function. This study aimed at investigating the attitudes and behavior of radiation oncologists regarding sexual functioning of female cervical cancer patients who receive radiation therapy., Methods: A total of 186 radiation oncologists were included. A self-reported questionnaire was used to investigate the attitudes and behavior of radiation oncologists. The oncologists were queried on their history of consultation on sexual issues, attitudes, and behavior toward sexual issues and considerations of sexual life for cervical cancer patients who receive radiotherapy., Results: Among 120 radiation oncologists who completed the questionnaires, 101 (84.2%) had been consulted on sexual issues, of whom only 29 (24.2%) were consulted by more than 10% of cervical cancer patients who received radiation therapy or their families. Compared with those without a history of consultation, radiation oncologists with a history of consultation were more likely to agree that "radiation oncologists should deal with a patient's sexual issues" (88.1% vs 68.4%) and disagree that "sex is private and should not be interfered with" (66.2% vs 44.5%). Five radiation oncologists (4.2%) had received special training to deal with the sexual issues of cervical cancer patients who receive radiotherapy, and 112 oncologists (93.3%) did not have any information on sexual functioning to give the their patients., Conclusions: History of consultation on sexual issues affects radiation oncologists' attitudes and behavior toward sexual issues of cervical cancer patients. Radiation oncologists should have a more positive attitude toward sexual issues and should receive more specific relevant training.

The purpose of this case study was to describe how the return-to-work process evolved in an employee with cancer in the Netherlands and how a work-directed intervention supported this process. The patient was a 35-year old female employee diagnosed with cervix carcinoma. After surgery, the patient experienced depression, fatigue, fear of recurrence, and low mental working capacity. Communication with the occupational physician was difficult. A social worker at the hospital provided three counselling sessions aimed to support return to work and sent letters to the occupational physician to improve the communication. The support by the social worker helped the patient to resume work gradually and the sending of information from the treating physician and social worker improved the communication with the occupational physician. This resulted in the patient being able to achieve lasting return to work. This work-directed intervention was highly valued by the patient and could be an important addition to usual psycho-oncological care for employees with cancer.

Objective: The objective of this study was to investigate the chronic toxicity, response to therapy, and survival outcomes of patients with cervical cancer treated with definitive pelvic irradiation delivered by helical tomotherapy (HT), with or without concurrent chemotherapy., Methods and Materials: There were 15 patients with a new diagnosis of cervical cancer evaluated in this study from April 2006 to February 2007. The clinical stages of their disease were Stage Ib1 in 3 patients, Ib2 in 3, IIa in 2, IIb in 4, IIIb in 2, and IVa in 1 patient. Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) simulation was performed in all patients. All patients received pelvic irradiation delivered by HT and high-dose-rate (HDR) brachytherapy. Four patients also received para-aortic irradiation delivered by HT. Thirteen patients received concurrent chemotherapy. Patients were monitored for chronic toxicity using the Common Terminology Criteria for Adverse Events version 3.0 criteria., Results: The median age of the cohort was 51 years (range, 29-87 years), and the median follow-up for all patients alive at time of last follow-up was 35 months. The median overall radiation treatment time was 54 days. One patient developed a chronic Grade 3 GI complication. No other Grade 3 or 4 complications were observed. At last follow-up, 3 patients had developed a recurrence, with 1 patient dying of disease progression. The 3-year progression-free and cause-specific survival estimates for all patients were 80% and 93%, respectively., Conclusion: Intensity-modulated radiation therapy delivered with HT and HDR brachytherapy with or without chemotherapy for definitive treatment of cervical cancer is feasible, with acceptable levels of chronic toxicity., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: To evaluate a strategy of laparoscopic excision of a cervical myoma (CM)., Design: Prospective study., Setting: University-affiliated hospital., Patient(s): Twenty-eight patients with CM underwent laparoscopic myomectomy. These cases were classified into five types according to the location: [1] anterior cervical myoma (ACM); [2] posterior cervical myoma (PCM); [3] central cervical myoma (CCM); [4] lateral cervical myoma [LCM]; and [5] deep-rooted cervical myoma (DCM)., Intervention(s): After preoperative assessment, patients underwent laparoscopic myomectomy. Ligation of the uterine artery and diluted vasopressin injection were performed to decrease bleeding during laparoscopy., Main Outcome Measure(s): Myoma numbers, myoma weight, operative time, estimated blood loss, hospital stay, complication rate., Result(s): Most of the lesions were ACM (43%) and PCM (32%). The mean operative time was 121 minutes, mean blood loss was 99 mL, and mean myoma weight was 287 g. The mean hospital stay was 2.2 days. There were no complications. Histopathologic examination showed that all lesions were leiomyoma. Hypermenorrhea, dysmenorrhea, and symptoms of compression improved after the operation. Two infertile patients conceived spontaneously at 1 and 7 months postoperatively, and successfully delivered infants by cesarean section at term., Conclusion(s): Surgical treatment of CM is empirically difficult. It is important that the approach be changed according to the location and size of the myoma., (Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Cytology remains the mainstay for cervical screening. The need to achieve effective management, limit complications, and preserve reproductive function led to the popularity of local treatment. Although the cure rates for ablative and excisional methods are similar, the excisional method provides a more reliable histopathological diagnosis. Recent evidence revealed increased perinatal morbidity after treatment that appears to be related to the proportion of cervix removed. The human papillomavirus (HPV) DNA test appears to enhance the detection of disease in primary screening, in the triage of minor cytological abnormalities, and in follow-up. Further research on the clinical application of a scoring system is ongoing. The vaccines are now available and appear to be safe, well tolerated, and highly efficacious in HPV naive women. A synergy of vaccination and screening will be required. Treatment for early cervical cancer is increasingly shifting toward more fertility-sparing surgical techniques. Careful selection of patients is essential., (© 2010 New York Academy of Sciences.)

Many cancer survivors experience unmet psychosocial needs related to their jobs, and women often fare worse than men in this regard. However, little research exists on ways to assist patients with cancer in preventing or managing common job problems. We conducted focus groups and a survey among 73 women who were employed at the time of presentation of a gynecologic cancer. We compared the findings with existing recommendations and professional standards for occupational rehabilitation. Participants described different cancer-related employment tasks in three time periods: just after diagnosis, during primary treatment, and after primary treatment is completed. The more difficult tasks included communicating with supervisors and coworkers, determining company policies, applying for employer-sponsored benefits, handling finances, managing symptoms on returning to work, finding effective solutions to cancer-related job problems, leaving the job with dignity if too sick or if the job ended, and making career plans. The cancer care team may be able to help meet the psychosocial needs of employed cancer survivors by screening for job concerns, providing information, formulating a return-to-work plan, treating symptoms, consulting with professionals who have employment-related expertise, and giving other forms of assistance.

Introduction: Evidence for the effectiveness of behavioral interventions are lacking for cervical cancer survivors (CCS). Disparities in survivorship outcomes exist for CCS, especially Latina-Americans. This study assessed the feasibility of implementing a culturally sensitive intervention delivered in a telephonic format., Methods: A convenience sample of 23 Latina-Americans diagnosed with stages 1-3 invasive cervical cancer who were 1-3 years post diagnosis and disease free participated. A random assignment, pre- and post-test design was used with 15 intervention and 8 control participants. Intervention group participants completed 6 sessions that included problem-focused, telephone counseling. The areas covered included family and partner concerns and communication; relaxation and stress management; psychological, medical and treatment concerns; and self-nurturing activities. Outcomes were measured by the FACT-G QOL scale., Results: Increases in physical well-being and overall QOL were observed for the intervention group only (p < 0.05). The intervention group showed a non significant trend towards improvements in family/social, emotional and functional well-being from pre- to post-test., Discussion: Results demonstrate the feasibility of implementing a culturally responsive, telephonic behavioral intervention. The intervention was associated with an improvement in physical and overall quality of life. A randomized controlled trial with a long term follow-up is warranted., Implications for Cancer Survivors: An ethnically sensitive, behaviorally based telephone counseling approach with Latina Americans cervical cancer survivors can achieve short term improvements in physical well-being and overall QOL.

Clinical trials have confirmed the safety of selectively oncolytic adenoviruses for treatment of advanced cancers. However, increasingly effective viruses could result in more toxicity and therefore it would be useful if replication could be abrogated if necessary. We analyzed viruses containing the cyclooxygenase-2 (Cox-2) or vascular endothelial growth factor (VEGF) promoter for controlling replication. Anti-inflammatory agents can lower Cox-2 protein levels and therefore we hypothesized that also the promoter might be affected. As Cox-2 modulates expression of VEGF, also the VEGF promoter might be controllable. First, we evaluated the effect of anti-inflammatory agents on promoter activity or adenovirus infectivity in vitro. Further, we analyzed the oncolytic potency of the viruses in vitro and in vivo with and without the reagents. Moreover, the effect of on virus replication was analyzed. We found that RGD-4C or Ad5/3 modified fibers improved the oncolytic potency of the viruses in vitro and in vivo. We found that both promoters could be downregulated with dexamethasone, sodium salicylate, or salicylic acid. Oncolytic efficacy correlated with the promoter activity and in vitro virus production could be abrogated with the substances. In vivo, we saw good therapeutic efficacy of the viruses in a model of intravenous therapy of metastatic cervical cancer, but the inhibitory effect of dexamethasone was not strong enough to provide significant differences in a complex in vivo environment. Our results suggest that anti-inflammatory drugs may affect the replication of adenovirus, which might be relevant in case of replication associated side effects.

Cervical cancer is a public health problem in Brazil, with annual incidence rates of 20-40 cases/100,000 women. Most patients with recurrent disease have symptoms from locoregional disease and may develop renal failure. This study aims to evaluate the outcome of patients with recurrent cervical cancer who underwent percutaneous nephrostomy (PN). We reviewed the medical records of 50 such patients who were referred to the Palliative Care Unit of the Brazilian National Cancer Institute from January 2002 to October 2006. Median age was 44 years (range, 26-67 years). Half the patients had improvement in pain or uremic symptoms, and seven (14%) had improved performance status (PS) after the procedure. Thirty patients (60%) had improvement of renal function; median creatinine levels before and after PN were 6.4 and 3.7mg/dL, respectively (P<0.05). Median overall survival after PN was 8.9 weeks (95% confidence interval [CI]: 7.4-10.3). Median survival was 9.9 weeks (95% CI: 8.7-11.0) in 40 patients with baseline PS 1-3 and one week (95% CI: 0.1-1.9) in 10 patients with PS 4 (log rank, P<0.0001). Median survival in patients with and without improvement of renal function after PN was 10.0 weeks (95% CI: 8.6-11.3) and 2.6 weeks (95% CI: 0-11.3), respectively (log rank, P=0.01). Twenty-nine patients (58%) died from renal failure. Complications were mainly urinary tract infection (n=10), catheter loss (n=9), and bleeding (n=1). These data suggest that PN can be of clinical benefit for carefully selected patients with recurrent cervical cancer.

The aim of this study is to determine the differences in sexual life of women with cervical cancer after surgery and radiation therapy. A total of 210 patients treated for cervical cancer at the Department of Obstetrics and Gynecology, School of Medicine, University of Zagreb, Croatia between March 2001 and March 2003 were asked to fill in the questionnaire. Sexual life had worsened in 42.86% of the surgical patients, as had in 25.00% of irradiated patients (p < 0.01). The main reason of sex life impairment was fear of pain (55.55% and 42.86%, respectively (p > 0.05)). More than 80% of patients didn't notice any changes in their partner's behavior. Almost every third woman felt certain change in her "body image", similar in both groups (p > 0.05). Need for consultations regarding sex life after diagnosis were recognized by 71.43% of patients. In conclusion we can say that considerable amount of attention should be given to psychological and sexual aspects of recovery of patients, because those aspects can significantly influence patients rehabilitation and prognosis.

There is an increasing number of long-term survivors of cervical and endometrial cancer for whom quality of life is of major importance. We interviewed 20 women (aged 19-64) to explore the dynamics and components of post-treatment sexual adjustment and its impact on quality of life. Stratification by treatment received (surgery alone, surgery plus external-beam radiation, surgery plus brachytherapy, and surgery plus external-beam radiation and brachytherapy) and time since treatment (immediately post treatment, during the next 2 years and thereafter) was undertaken, to ensure representation of all relevant experiences and views, and to allow time for any long-term side effects to appear. The NUD*IST software (Non-numerical Unstructured Data by Indexing, Searching and Theorising) was used to assist with the coding of audio-taped, transcribed interviews and to search for themes and segments. While the data supported findings reported in the literature, important new themes emerged in the course of the qualitative analysis. These included: (a). issues related to being 'feminine', (b). the role of intimacy in post-treatment adjustment and (c). the importance of communication between health professionals, patients and partners. A model is presented that integrates these issues and highlights the need for effective interventions to improve post-treatment outcomes. The provision of information, support and modification of rehabilitation devices is suggested., (Copyright 2002 John Wiley & Sons, Ltd.)

Hormonal replacement therapy in women following primary treatment for squamous cell carcinoma of the cervix uteri is harmless. In case of adenocarcinoma of the cervix, guidelines for hormonal replacement therapy according to those valid for endometrial cancer are recommended. In women treated for ovarian cancer, a combined cyclic or continuous estrogen/gestagen substitution - the latter also in hysterectomized women - is to be favored. Signs of androgen deficiency are to be respected. Short-term clinical, sonographical, and biochemical control investigations are recommended.

This article focuses on social, psychological and sexual experiences of 47 men before their partner was treated for cervical or endometrial cancer and 1 year later. As a complement to the interviews the men completed a symptom check-list. Before initiation of treatment, a great majority of the men were in psychological crisis. The number of psychological symptoms decreased from the first to the last interview. Symptoms with psychosomatic character increased, however, considerably. In the endometrial group, several had intrapsychic problems, while interpersonal problems were more common in the cervical group. Both groups found it difficult to know how to behave and how to communicate with their partner, friends and acquaintances. A majority had nobody to whom they could speak honestly, and most did not obtain basic information about their partner's disease. The experiences of intercourse were much more negative after completed treatment and a majority described impaired sexual desire. Provided that the woman herself desires it, the coping and rehabilitation of the woman, the man and the couple would improve if the male were integrated in the care program from the moment the diagnosis of cancer is made.

Eighty-three women, mean age 45 years, successfully treated by surgery (S) or radiotherapy (RT) for stage 1b cervical cancer were assessed a mean of 97 weeks post treatment. Forty to 50% reported persistent tiredness, lack of energy and weight gain. Sixty per cent had not resumed their full premorbid functional status. Mean scores for anxiety and depression were higher than general population means and this sample scored higher for psychological distress than published data quoted for disease free cancer patients. These women reported many concerns about cervical cancer, most commonly fear of recurrent disease (91%). More than one-third blamed themselves for the disease. There were no significant differences in functional outcome or psychological status between treatment groups or by age or time since treatment. Psychological distress scores were significantly correlated with physical complaints (P < 0.001) and functional outcomes (P < 0.02). For the 61 women who were sexually active, sexual function post-treatment was rated as significantly poorer than subjectively recalled premorbid sexual function (P < 0.005). RT treated patients were more likely to report pain on intercourse and loss of enjoyment. Psychological as well as physical problems were highly correlated with sexual outcome (P < 0.01) 44% were unable to talk adequately with their partners about their experience. The majority felt they needed more information about cervical cancer, its treatment and how to help themselves rehabilitate. Forty-nine per cent would have liked to have had counselling. Even with the same physical morbidity the functional, emotional and sexual status of these women could be improved by giving more attention to their psychological and sexual concerns.

Twenty-one women with cervical cancer Types I and II, treated by radiation were evaluated by comparing periods before cancer and after therapy in order to identify changes in sexual behavior; if so, whether they attributed the changes to therapy, or whether other factors were associated with being sexually dysfunctional or non-dysfunctional. Data were obtained through administration of a sexual behavior questionnaire, personal interviews and review of medical records. Statistically significant changes were found: decreased frequency of masturbation and intercourse, decreased frequency of orgasm through non-coital sexual activities, less satisfaction with sex, and less enjoyment of intercourse. The majority believed that changes were due to radiation therapy and reflected decreased feelings of self-esteem, sex desirability and attractiveness. Most of the women believed that cancer could be transmitted through intercourse. Women who did not follow advice regarding use of vaginal dilators and did not resume their pre-illness level of sex were more likely to develop physical and sexual changes. The subjects' need for sexual counselling concerning the effect of the illness and treatment on relationships with partners was strongly evident. Suggestions for preventing undesirable physical and psychological changes, and guidelines for counselling are provided.

Combined radiotherapy of patients with cervical carcinoma of stages IIb and IIIb was conducted. Hypoxia (8.0-8.5% of O2 in the respiratory mixture) was used in microfractionated (2 Gy) irradiation of metastatic spreading zones. When irradiating under conditions of hypoxia, the number of fractions was brought up to 28 as compared to 20 in control. Despite a 40%-increase of the dose, seriousness of radiation reactions and remote injuries remained at the same level. It is found that patients endure well the respiratory mixture for 6 min. necessary for irradiation.

The effects of therapy on the vita sexualis have a great importance in universal rehabilitation of patients with carcinomas. 168 treated women suffering from an invasive carcinoma of the cervix were consulted about their sex life and the relationship with their partner during the follow-up. Depending on the methods of therapy (radical operation, primary irradiation, combined treatment), loss of libido was seen in 53% of the patients, and loss of orgasm in 61%. The frequency of cohabitation decreased in 45% of the consulted persons. 10% of the women living in sexual partnership were of the opinion that severe disturbances in partner relations resulted therefrom. The least disturbance of the intimate relationship was found in women, who had a harmonious family background in life and who were informed to a sufficient degree.

The results of therapy of 2 groups of patients with microinvasive cervical carcinoma were analyzed. Intracavitary gamma-beam therapy at single doses of 5 and 10 Gy and cumulative doses of 40 and 30 Gy, respectively, with the Agat-B remote loading unit was applied to 95 patients (the 1st group). Wertheim's operation (radical hysterectomy) was performed on 62 patients (the 2nd group). Intracavitary gamma-beam therapy made it possible to deliver therapeutic dose levels to a tumor and to achieve high survival rates of cervical microcarcinoma patients with a low frequency and a weak degree of radiation reactions and complications.

The radicality of Okabayashi's radical hysterectomy for treatment of cervical cancer has been well-known. However, its radicality also brought up the disturbance of fertility, endocrine and sexual function as well as the dysfunction of micturition and defecation. As early cervical cancer cases have increased yearly, and social rehabilitation became more necessary nowadays, functional saving is important and must be considered as the responsibility of the oncologists. This report denotes the preservation of ovarian function, sexual rehabilitation as well as the fertility in the treatment of cervical cancer.

The report discusses the data on rehabilitation of 198 cases of cervical carcinoma in situ following conoid diathermoexcision versus the end results. Organ-saving procedures were shown to considerably cut down duration of treatment, to help restore working ability within relatively short period and to keep generative function intact.

Report about behaviour in sexuality of 201 patients after treatment of carcinoma cervicis at the Department of Gynecology of Karl-Marx-University Leipzig in 1965 to 1966. The data of interest were sexual behavior 2 years before treatment and that 5 years after. The informations were got by direct interrogation and with the help of a standardized form.