FIGO 2018 staging of cervical cancer and related issues / 中华肿瘤杂志

Globally, cervical cancer continues to be one of the most common cancers among females. Although screening for cervical cancer has been gradually carried out, the incidence and mortality of cervical cancer in China are still at a high level. So the prevention and treatment of cervical cancer in China still has lots of work to do. The International Federation of Obstetrics and Gynecology (FIGO) gynecological oncology committee revised the staging of cervical cancer in 2018. The new staging changed in terms of stage ⅠB and stage Ⅲ compared with previous FIGO staging. FIGO also provided prevention and treatment strategies and the treatment regimens of each stage, which had an important impact on the prevention and treatment of cervical cancer as well as an important enlightenment for China.

Value of high-definition magnetic resonance imaging in preoperative evaluation of stage b -Ⅱb cervical cancer / 第二军医大学学报

Objective To explore the application value of high-definition magnetic resonance imaging (MRI) in the assessment of preoperative stage B-ⅡB cervical cancer. Methods A retrospective analysis was conducted on 94 patients with cervical cancer who had received preoperative pelvic examination in Changhai Hospital of Navy Medical University (Second Military Medical University) from Mar. 2015 to Jun. 2017. Fifty-eight of them received conventional MRI examination and 36 received high-definition MRI examination. The accuracy, sensitivity and specificity of the three methods for vaginal and parametrial invasion were evaluated using the postoperative pathological assessments as the gold standard. And the Kappa test was used to perform consistency analysis. Results For vaginal invasion, the accuracy, sensitivity and specificity of pelvic examination were 63.8% (60/94), 53.7% (29/54) and 77.5% (31/40), respectively; those of conventional MRI examination were 58.6% (34/58), 48.5% (16/33) and 72.0% (18/25), respectively; and those of high-definition MRI examination were 83.3% (30/36), 76.5% (13/17) and 89.5% (17/19), respectively. Kappa test showed that the consistency of pathology and pelvic examination and high-definition MRI examination assessments was good in evaluating vaginal invasion (Kappa＝0.297, 0.664; P＝0.002, 0.001). For parametrial invasion, the accuracy, sensitivity and specificity of pelvic examination were 79.8% (75/94), 20.0% (1/5) and 83.1% (74/89), respectively; those of conventional MRI examination were 74.1% (43/58), 31.2% (5/16) and 90.5% (38/42), respectively; and those of high-definition MRI examination were 86.1% (31/36), 60.0% (6/10) and 96.1% (25/26), respectively. Kappa test showed that the consistency of pathology and conventional MRI examination and high-definition MRI examination assessments was good in evaluating parametrial invasion (Kappa＝0.251, 0.618; P＝0.040, 0.001). Conclusion High-definition MRI examination and pathological examination have a good consistency in preoperative assessment of cervical cancer at stage B-ⅡB, and can be a common method for preoperative evaluation of cervical cancer.

Long-term effects of pelvic autonomic nerve preservation on anorectal function after radical hysterecto-my / 中国综合临床

Objective To investigate the long?term effect of nerve?spring radical hysterectomy( NSRH) on anorectal function after radical hysterectomy. Methods Fifty?six cases of uterine cervical carcinoma patients who met the criteria were selected for the study and were randomly divided into RH group and NSRH group. Defecation functional and anorectal manometry were compared at 1 year after surgery. Results There were 2 patients were excluded both in the two groups, and 26 cases were included in the follow up of each group. Compared with RH group, NSRH group had a lower constipation and chronic diarrhea incidence ( 2 (7. 7%),8(30. 8%);1(3. 8%),6(23. 1%);χ2=4. 457,4. 127P<0. 05),a better self?evaluation bowel func?tion(no significant change:10(38. 5%),5(19. 2%);poor:7(26. 9%),3(11. 5%);very poor:9(34. 6%),18 (69. 2%);χ2=6. 267,P=0. 044;P<0. 05),a higher level of maximal anal squeeze pressure((132. 7±43. 6) mmHg,(119. 5±45. 3) mmHg;t=2. 116,P<0. 05),a lower level of threshold perception of distension((38. 6 ±10. 5) mmHg,(45. 8±12. 4) mmHg;t=2. 326,P<0. 05) and threshold perception of evacuative stimulus ((78. 3±33. 2) mmHg,(90. 6±40. 9) mmHg;t=2. 208,P<0. 05). Conclusion RH may cause more serious long?term anorectal dysfunction,while NSRH help to protect defecation function.

High-risk HPV genotyping for cervical intraepithelial neoplasia grade 2 or worse:A comparison of single types and type combinations / 中国癌症杂志

Background and purpose:Risk of invasive cervical carcinoma (ICC) and its precancerous lesions following high risk human papillomavirus (hrHPV) infection may vary according to HPV types and geographic regions. Analyzing HPV-type distribution in cervical samples from local women aged 30 years and older, this study aimed to identify HPV types with higher risk of developing CIN2+, and to compare diagnostic performance for CIN2+using these types and type combinations. Methods:Cervical samples with histology follow-up from patients of a tertiary cancer center in Shanghai were collected for HPV genotyping by PCR-RDB. The risk associations of HPV types with CIN2+were estimated by logistic regression analysis, and ROC curves were plotted for diagnostic performance evaluation. Results:A total number of 413 specimens were obtained, including 38 CIN1, 184 CIN2/3, 126 ICC patients and 65 negative control people. The 4 most common HPV types in CIN2+were HPV16, 58, 33 and 18, in descending order. And only HPV16 (P<0.000 1), 58 (P=0.002), 33 (P=0.015) were signiifcantly associated with CIN2+lesions. Besides, the area under the ROC curve of the HPV16/18/33/58 test scored statistically higher than the HPV16/18 test did (P=0.006 6). Conclusion:A combined test of HPV16/18/33/58 may offer better performance for detecting CIN2+lesions in our geographic region.

Radiation sigmoiditis mimicking sigmoid colon cancer after radiation therapy for cervical cancer: the implications of three-dimensional image-based brachytherapy planning / 부인종양

External-beam radiation therapy with intracavitary high-dose-rate brachytherapy is the standard treatment modality for advanced cervical cancer; however, late gastrointestinal complications are a major concern after radiotherapy. While radiation proctitis is a well-known side effect and radiation oncologists make an effort to reduce it, the sigmoid colon is often neglected as an organ at risk. Herein, we report two cases of radiation sigmoiditis mimicking sigmoid colon cancer after external-beam radiation therapy with intracavitary high-dose-rate brachytherapy for uterine cervical cancer with dosimetric consideration.

Radioterapia lumboaórtica en pacientes con cáncer de cuello uterino: experiencia del Instituto Nacional del Cáncer / Paraortic radiotherapy in patients with uterine cervical carcinoma: Instituto Nacional del Cáncer experience

Antecedentes: El cáncer de cérvicouterino continúa siendo una enfermedad prevalente en Chile. Es frecuente recibir pacientes en etapas IIB y IIIB donde el riesgo de compromiso ganglionar pelviano y lumbo-aórtico es elevado y el tratamiento es radioquimioterapia. Objetivo: Análisis retrospectivo de pacientes con cáncer cérvicouterino que recibieron radioterapia que incluía los territorios lumboaórticos. Método: Revisión de pacientes con cáncer cérvicouterino tratadas entre 1995 y 2007 en el Instituto Nacional del Cáncer, Santiago, Chile. En 39 pacientes el tratamiento incluyó las cadenas lumboaórticas. Se analizó toxicidad y evolución. Se utilizaron dos técnicas de radioterapia: la primera durante la década del 90, donde se empleaban dos campos paralelos y opuestos (anterior y posterior) y una segunda actual, donde se irradian en conjunto la pelvis y los lumboaórticos a través de 4 campos (laterales y AP-PA). Resultados: El análisis dosimétrico de las dos técnicas confirma un mayor volumen irradiado de tejidos normales con la técnica de dos campos, fundamentalmente intestino delgado. La toxicidad fue significativamente diferente, siendo la que utilizamos hoy menos tóxica y con bajas complicaciones gastrointestinales, a pesar de recibir un tratamiento de radio-quimioterapia concomitante (55 por ciento vs 0 por ciento). Conclusión: La radioterapia lumboaórtica es un tratamiento con una tolerancia aceptable incluso con quimioterapia concomitante. Esta revisión nos obliga a elaborar un nuevo trabajo para evaluar si la radioterapia lumboaórtica reduce el riesgo de recidiva y aumenta la sobrevida.

Background: Uterine cancer is still a prevalent disease in Chile. Is common to treat patients with tumors in stages IIB and IIIB where the risk of pelvic and paraortic limph node involvement is very high. Its treatment is radio-chemotherapy. Objective: To present a retrospective analysis of patients that suffered cervix-uterine cancer who were treated with radiotherapy including the aortic-lumbar area. Methods: From the revision of patients who were treated of cervix-uterine cancer between the years 1995 and 2007, 39 were treated including aortic-lumbar chains. Evolution and toxicity were analyzed. Two radiotherapy techniques were used. The first one, during the nineties, included two parallel previous and later and opposed fields, and a second technique, currently used, where pelvis and paraortic are radiated at the same time through four lateral (AP-PA) fields. Results: The dosimeter analysis of both techniques shows that there is a higher volume of radiated normal tissue with the two fields techniques, mainly in the small bowel. On the other hand, the toxicity was significantly different being today's technique less toxic and showing low gastrointestinal side effects, despite receiving a simultaneous radio-chemotherapy (55 percent vs 0 percent). Conclusion: The paraortic radiotherapy treatment has an acceptable level of tolerance even under simultaneous radio-chemotherapy. Given the results of this study, we see the need for undergoing a new research project in order to evaluate if the aortic-lumbar radiotherapy may reduce the risk of relapse and increase in survival rate.

Treatment of Early Glassy Cell Carcinoma of Uterine Cervix / 대한방사선종양학회지

PURPOSE: The purpose of this study was to investigate the clinical findings, treatment, and outcome of patients with glassy cell carcinoma of cervix. MATERIALS AND METHODS: We reviewed all cases of glassy cell carcinima of the uterine cervix confirmed and treated at the Dongsan Medical Center, Keimyung University, between January 1993 and December 2005. There were 7 cases with histopathologically confirmed gassy cell carcinoma. A tumor was diagnosed as glassy cell carcinoma if over 50% of the tumor cell type displayed glassy cell features. Six patients with stage IB had radical hysterectomy and bilateral pelvic node dissection, and 2 of them received adjuvant external pelvic irradiation with concurrent chemotherapy. Remaining one patient with stage IIA had curative concurrent chemoradiotherapy with external pelvic irradiation and brachytherapy. RESULTS: There were 7 patients diagnosed as glassy cell carcinoma among the 3,745 (0.2%) patients of carcinoma of uterine cervix. The mean age of 7 patients was 44 years with range of 35 to 53 years of age. The most frequent symptom was vaginal bleeding (86%). By the punch biopsy undertaken before treatment of 7 cases, 2 only cases could diagnose as glassy cell carcinoma of uterine cervix, but remaining of them confirmed by surgical pathological examination. The mean follow up duration was 73 months with range of 13 to 150 months. All 7 patients were alive without disease after treatment. CONCLUSION: Glassy cell carcinoma of the uterine cervix is a distinct clinicopathologic entity that demonstrates an aggressive biologic behavior. However for early-stage disease, we may have more favorable clinical outcome with radical surgery followed by chemoradiothery.

Clinical Characteristics and Treatment Results of Neuroendocrine Carcinoma of Uterine Cervix / 대한방사선종양학회지

PURPOSE: To evaluate the clinical findings, prognosis and treatment strategy of patients with neuroendocrine carcinoma of cervix. MATERIALS AND MEHTODS: Thirteen patients with neuroendocrine carcinoma of cervix were included in this study, as confirmed histologically and immunohistochemically at the Dongsan Medical Center, Keimyung University, between May 1944 and October 2001. The mean age of patients was 56 years with a range of 32 to 78 years of age. According to the FIGO staging system, there were 5 patients with stage IB carcinoma, 5 patients with IIA, and 3 patients with stage IIB. Four patients underwent radical hysterectomy with pelvic lymphadenectomy, 3 of these patients also received postoperative radiotherapy, and one patient underwent extrafascial hysterectomy after radiotherapy. Primary radiotherapy was done in 9 patients, and 3 were irradiated postoperatively. Nine patients received chemotherapy, 7 received neoadjuvant and 2 received concurrent chemoradiotherapy. The radical purpose of radiotherapy consisted of external irradiation to the whole pelvis (4,500~5,400 cGy) and intracavitary irradiation (3,000~3,500 cGy). RESULTS: The mean follow up duration was 36 months with a range of 3 to 104 months. The overall 5-year survival rate was 61.5% and the 5-year survival rates for stage IB, IIA, IIB were 60.0%, 60.0%, and 66.7% respectively (p=0.99). Eight patients are still alive without disease, and all of the 5 patients with recurrence are dead due to distant metastasis. CONCLUSION: Neuroendocrine carcinoma of cervix is highly aggressive, with early lymphatic dissemination and a high rate of distant recurrence. Therefore, an aggressive therapeutic strategy is required to obtain pelvic and distant disease control. Multimodal therapy should be considered at the time of initial diagnosis.

Prediction of Prognosis using Pretreatment FDG PET in Uterine Cervical Carcinoma / 대한핵의학회잡지

PURPOSE: In uterine cervical cancer, it is clinically important to predict prognosis on initial staging. We investigated whether abnormally increased FDG uptake of lymph nodes and peak SUV of primary tumor on initial FDG PET can predict prognosis after treatment in cervical cancer patients. MATERIALS AND METHODS: Subjects were 74 newly diagnosed cervical cancer patients (50+/-12yr). Whole body PET was performed after an injection of F-18 FDG. Peak SUV was measured in the primary cervical tumor. Images were interpreted by two nuclear medicine physicians. Follow-up for the disease-free survival was done in all patients. Survival analysis was done by using the Kaplan-Meier method, and a Logrank test was used to compare survival. Cox regression analysis was followed to find independent predictive factors. RESULTS: Recurrence occurred in 13 patients. In univariate analysis, advanced FIGO stage, large size of primary tumor, positive lymph node on MRI or CT, and positive lymph node on PET were significant prognostic factors to predict recurrence. Peak SUV and cell type of tumor failed to show any significant correlation with disease-free survival. In multivariate analysis, positive lymph node on PET (Exp (beta) =6.416, p=0.002) and on CT or MRI (Exp (beta) =5.711, p=0.026) were independent prognostic factors for predicting recurrence. CONCLUSION: In uterine cervical cancer, lymph node metastasis of pretreatment FDG PET is the best independent prognostic factor for predicting recurrence. But, peak SUV was not significant prognostic factor.

Results of Curative Radiotherapy Alone in Patients with Uterine Cervical Carcinomas / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: To evaluate the role of curative radiotherapy alone in the treatment of uterine cervical carcinomas, by a retrospective analysis with respects to survival and pelvic control, and to find any risk factors of failure MATERIALS AND METHODS: Between Jan. 1990 and Dec. 1995, a total of 187 patients, diagnosed with uterine cervical carcinomas in FIGO stages greater than IA, were treated by curative radiotherapy alone with no chemotherapy. The ages of the patients ranged from 26 to 80 years, with a median of 60 years. The number of patients diagnosed with squamous cell carcinomas were 183 (97.9%). The number of patients with FIGO stage IB1, IB2, IIA, IIB, IIIA, IIIB and IVA were 61 (32.6%), 7 (3.7%), 43 (23.0%), 62 (33.3%), 3 (1.6%), 7 (3.7%) and 4 (2.1%), respectively. External radiotherapy was performed with 6 MV or 10 MV X-rays, with a dose range of 19.8 Gy~ 50.4 Gy (median; 30.6), to whole pelvis. Intracavitary radiation (ICR) was then performed using a high-dose rate remote controlled afterloader with radioisotopes of Co-60 and Cs-137. The fraction size of the ICR was 5 Gy twice a week, and was delivered up to total doses of 10 Gy~ 55 Gy (median; 40). After the ICR, additional pelvic external radiotherapy with midline shielding width of 4 cm was performed with the dose range of 0~30.6 Gy (median; 19.8), and the resultant total doses of A points ranged between 49.8 Gy and 86.0 Gy (median; 70.6). RESULTS: The five-year overall survival rates of FIGO IB1, IB2, IIA, IIB, III and IVA were 88.3%, 83.3%, 86.1%, 65.2%, 60.0% and 50.0%, respectively (p=0.005). The pelvic control rates of each stage were 90.1%, 85.7%, 86.1%, 69.4%, 68.6% and 50.0%, respectively (p=0.03). From the multivariate analysis, the radiation response and tumor diameter were found to be significant factors affecting the overall survival. The significant factors influencing pelvic control were the radiation response and pre-treatment hemoglobin level. CONCLUSION: The radiation response and tumor diameter were significant factors affecting survival, so patients with tumor diameters greater than 4 cm should be considered for a combined modality, such as concurrent chemoradiotherapy.

Acupuncture Treatment in a Patient with Impaired Defecation and Urination After Radical Operation for Uterine Cervical Cancer / 全日本鍼灸学会雑誌

A patient with uterine cervical cancer underwent radical operation and radiotherapy in 1956 and subsequently began to suffer from impaired bowel movements. For the next 40 years, a large amount of cathartics was used to induce defecation, a urination was induced by applying abdominal pressure, but a large volume of urine remained. In this patient, the effects of acupuncture treatment were evaluated using the vesical residual urine volume as measured by abdominal ultrasonography. After acupuncture treatment, defecation became easily, and the amount of cathartics could be reduced. Simultaneously, spontaneous urination became possible, and residual urine disappeared.

Flow Cytometric Analysis of DNA patterns in Carcinoma of the Uterine Cervix / 대한부인종양콜포스코피학회잡지

OBJECTIVE: Flow cytometric deoxyribonucleic acid (DNA) content analysis has been shown to be of prognostic importance in some cancers. In this study, DNA patterns obtained by flow cytometry in patients with cervical cancer have been shown to be related to a prognostic importance in cervical carcinoma. METHODS AND MATERIALS: We retrospectively reviewed 59 cervical cancer patients who admitted to the department of obstetrics and gynecology, Samsung Medical Center firom January 1995 to May 1997. RESULTS: A total of 59 archival paraffin-embedded blocks were proc 42.4 percent were found to be DNA content aneuploid (DNA-A) and 57.6 percent DNA content diploid (DNA-D). The S-phase fraction was significantly increased with stage. The incidences of aneuploid and relative DNA index were not significantly increased with the stage(P=0.280) and age of patients(P=0.088). The results had no significant differences between the squamous cell carcinoma and adenocarcinoma, and no relationship between the groups with keratinizing cell type and nonkeratinizing type(P=0.409). The DNA ploidy patterns were not significantly correlated with metastasis to lymph node(P=0.179), tumor size(P=0.109), invasion depth(P=0.361) and recurrent group(P=0.285). High S-phase fraction had a tendency to correlate with the invasion depth(P=0,011), size(P=0.027), lymph node metastasis(P=0.039) and recurence(P=0.099) of cervical cancer. CONCLUSION: Flow cytometric DNA content analysis is being used more frequently in the management of different malignant tumors. Our study shows that DNA content analysis may not serve as an important biological indicator in determining the prognosis in cervical carcinoma, but High S-phase fraction has been connected with more aggressive tumors.

p16INK4A and p15 INK4B Gene Alterations in Primary Uterine Cervical Carcinoma Tissues and Cervical Carcinoma Cell Lines / 대한암학회지

PURPOSE: Alterations of the p15(INK4B) and p16(INK4A) gene which are separated by 25 kb on chromosome 9p21 have been reported in various tumor derived cell lines and primary tumors, but the role of these genes in cervical cancer is unknown. MATERIAL AND METHOD: To determine the frequency of deletions and point mutations of these genes in human cervical cancer, we examined 57 primary tumors and matched normal tissues, and 3 cervical cancer derived cell lines. All the tumor tissues and cell lines were human papil- INK48 lomavirus (HPV)-positive. Deletions or point mutations of exon 2 of the pl5 gene and exons 1, 2, and 3 of the p16(INK4A) gene were examined by polymerase chain reaction (PCR) and direct sequencing, respectively. RESULT: Our data indicate no evidence for intragenic homozygous deletion or point mutation in the cervical cancer or cervical cancer derived cell lines. INK48 INK4A CONCLUSION: Deletions or point mutations in the p15 or p16 gene may not be required for the development of HPV-positive cervical cancer or for establishment of cervical cancer cell lines.

Expression of Apoptosis, bcl-2, and PCNA in Uterine Cervical Intraepithelial Neoplasia and Invasive Carcinoma

This study was undertaken to know the extent of apoptosis, expression of bcl-2 and proliferating cell nuclear antigen (PCNA) in uterine cervical intraepithelial neoplasia (CIN; 15 cases) and invasive carcinoma (27 cases) and to evaluate them as a prognostic marker. Apoptosis was analysed by using the in situ apoptosis detection kit and bcl-2 and PCNA were detected by the immunohistochemical method. The results were as follows: Apoptotic indices (AI) in the invasive carcinoma (mean: 4.3) were 10-times higher than that in the CIN (mean: 0.43). Bcl-2 was expressed 60% of the cases in the dysplastic cells of the CIN II and CIN III, 33.3% of cases in the invasive carcinoma and not expressed in the CIN I except basal cells. The expression of the PCNA was increased by the grades of CIN and was strong in invasive carcinoma. The mean survival time of the patient with invasive carcinoma was significantly decreased in the higher AI index (above 4.3) than in the lower AI index (below 4.3). There was no significant correlation between the extent of apoptosis and the expression of bcl-2. According to the above results, AI are able to be used as an independent prognostic marker in the invasive cervical carcinoma, and bcl-2 and PCNA have an important role in the tumorigenesis of uterine cervical carcinoma.

Clinical Profiles of Telemerase Activety in Uterine Cervical Carcinoma / 대한산부인과학회잡지

A current hypothesis gaining prominence proposes that activation of the telomerase is necessarey for cells to become immortal, or be capable of proliferating indefinitely. The theory suggersts that that almost all cancer cells must attain immortality for progression to malingnant state and, hence, require activation of telomerase. To assess the role of telomerase in the development of mailignant transformation of the uterine cervical carcinoma, telomerase activeiy was measured by using a recently developed sensitive RPR-based telomerase assay(telomeric repeat amplification protocol; TRAP)in benign uterine condition and invasive uterine cervical carcinoma tissues revealed to be telomerase positive (14/16, 88%) which represents a characteristic 6 bp ladder pattern, while none of the 4 cervical tissues with the nonspecific pathologic findings or just chronic cervictis which were obtained by simple bysterenctomy under the diagnoses of benign myoma or uterine prolapse showed any telomerase actiovity. These findings suggest that this enzyme activity may play a key role in the establishment and progression of the uterine cervical carcinoma. This activity of telomerase may influence from the initial stage of tumorigenesis of uterine cervical carcinoma because poitive findings were noticed from the early stage (stage Ia1) to the advanced stage. The results of neoadjuvant chemotherpy which were revealed in final histopathologic specimens following radical hysterectomuy, pelvic and raraaortic lymph nodes dissection (suggestion by Rosen et al,) were one grade IV wiht telomerase poistive, 2 grade III with all positivie, 5grade II with 3 positive 2 negative. The two cases of pelvic lymph node metastasis belong to the group of grade II and their activeities of telomerase were 1 positive and 1negative. The situation of apoptosis induced by antineoplastic chemotherapy has not been related to that of telomerase activeity. Furthemore, the late recurrences has been noticed over 5years follow-up following neoadjuvant chemotherapy and radical surgery for the management of the high risk group of patients (not shown in this study) This measn that the nowday's regimen for induction tumoricidals may have been operating as dual effects (partial restoring and redamaging) to the cell cycle chekpoint. Therefore if telomerase inhibitor will be applied combined whit the induction chemotherapy, unexpected benefits mignt be obtained for the patient with the advanced uterine cervical carcinoma.

Clinical Profiles of Telemerase Activety in Uterine Cervical Carcinoma / 대한산부인과학회잡지

A current hypothesis gaining prominence proposes that activation of the telomerase is necessarey for cells to become immortal, or be capable of proliferating indefinitely. The theory suggersts that that almost all cancer cells must attain immortality for progression to malingnant state and, hence, require activation of telomerase. To assess the role of telomerase in the development of mailignant transformation of the uterine cervical carcinoma, telomerase activeiy was measured by using a recently developed sensitive RPR-based telomerase assay(telomeric repeat amplification protocol; TRAP)in benign uterine condition and invasive uterine cervical carcinoma tissues revealed to be telomerase positive (14/16, 88%) which represents a characteristic 6 bp ladder pattern, while none of the 4 cervical tissues with the nonspecific pathologic findings or just chronic cervictis which were obtained by simple bysterenctomy under the diagnoses of benign myoma or uterine prolapse showed any telomerase actiovity. These findings suggest that this enzyme activity may play a key role in the establishment and progression of the uterine cervical carcinoma. This activity of telomerase may influence from the initial stage of tumorigenesis of uterine cervical carcinoma because poitive findings were noticed from the early stage (stage Ia1) to the advanced stage. The results of neoadjuvant chemotherpy which were revealed in final histopathologic specimens following radical hysterectomuy, pelvic and raraaortic lymph nodes dissection (suggestion by Rosen et al,) were one grade IV wiht telomerase poistive, 2 grade III with all positivie, 5grade II with 3 positive 2 negative. The two cases of pelvic lymph node metastasis belong to the group of grade II and their activeities of telomerase were 1 positive and 1negative. The situation of apoptosis induced by antineoplastic chemotherapy has not been related to that of telomerase activeity. Furthemore, the late recurrences has been noticed over 5years follow-up following neoadjuvant chemotherapy and radical surgery for the management of the high risk group of patients (not shown in this study) This measn that the nowday's regimen for induction tumoricidals may have been operating as dual effects (partial restoring and redamaging) to the cell cycle chekpoint. Therefore if telomerase inhibitor will be applied combined whit the induction chemotherapy, unexpected benefits mignt be obtained for the patient with the advanced uterine cervical carcinoma.

Solitary Cerebellar Metastasis from Primary Uterine Cervical Carcinoma: A Case Report

Brain metastasis from primary uterine cervical carcinoma have been described but are extremely rare and usually occur in the presence of widely disseminated diseases. The authors report a case of solitary cerebellar metastasis from uterine cervical carcinoma, which was confirmed by histopathological examination. The patient has shown no evidence of metastatic lesions elsewhere, thus far, but had undergone a radical hysterectomy under the diagnosis of uterine cervical carcinoma 52 months prior to the surgical excision of the cerebellar metastasis.