Cervical Cancer Among Women With HIV in South Carolina During the Era of Effective Antiretroviral Therapy.

OBJECTIVES: We aimed to determine whether women with HIV (WWH) and cervical cancer were more likely to experience cancer-related death and to be diagnosed with cervical cancer at a younger age and in more advanced stages. MATERIALS AND METHODS: This is a retrospective cohort study of all women diagnosed with cervical cancer in South Carolina from 1998 to 2018. Deidentified data were obtained from 2 statewide databases. A survival analysis was performed to evaluate differences in cancer survival between women with and without HIV. Wilcoxon rank sum test was used to determine differences in the median age at cancer diagnosis. χ2 test was used to assess differences in cancer stage according to HIV status. RESULTS: Four thousand three hundred fourteen women were diagnosed with cervical cancer, and 53 (1.2%) had HIV infection. Survival time in months was similar between WWH and HIV-negative women (86 months [interquartile range {IQR} = 32-146] and 62 months [IQR = 18-153], p = .37; log-rank p = .26). Compared with HIV-negative women, WWH were less likely to experience cervical cancer-related death (36% vs. 19%, p = .005). Women with HIV were diagnosed with cervical cancer at a younger age (44 [IQR = 37-54] vs. 49 [IQR = 39-61], p = .02). Cervical cancer stage was similar at diagnosis between groups (tumor node metastasis stage, p = .97, and Surveillance, Epidemiology, and End Results summary stage, p = .41). CONCLUSIONS: Women with HIV were younger at diagnosis than HIV-negative women, but they were no more likely to die from or have more advanced cervical cancer. Women with HIV were not more likely to develop cervical cancer before the age of 21 years and earlier screening is likely unnecessary.

Radiotherapy-induced reactivation of neurotrophic human herpes viruses: Overview and management.

PURPOSE: Infection by Human Herpes Viruses (HHV) types 1-3, are prevalent throughout the world. It is known that radiotherapy can reactivate HHVs, but it is unclear how and to what extent reactivations can interact with or affect radiotherapeutic efficacy, patient outcomes and mortality risk. Herein, we aim to summarize what is known about Herpes Simplex Virus (HSV)-1,2 and Varicella Zoster Virus (VZV) pathophysiology as it relates to tumor biology, radiotherapy, chemo-radiotherapy, diagnosis and management so as to optimize cancer treatment in the setting of active HHV infection. Our secondary aim is to emphasize the need for further research to elucidate the potential adverse effects of active HHV infection in irradiated tumor tissue and to design optimal management strategies to incorporate into cancer management guidelines. MATERIALS AND METHODS: The literature regarding herpetic infection, herpetic reactivation, and recurrence occurring during radiotherapy and that regarding treatment guidelines for herpetic infections are reviewed. We aim to provide the oncologist with a reference for the infectious dangers of herpetic reactivation in patients under their care and well established methods for prevention, diagnosis, and treatment of such infections. Pain management is also considered. CONCLUSIONS: In the radiotherapeutic setting, serologic assays for HSV-1 and HSV-2 are feasible and can alert the clinician to patients at risk for viral reactivation. RT-PCR is specific in identifying the exact viral culprit and is the preferred diagnostic method to measure interventional efficacy. It can also differentiate between herpetic infection and radionecrosis. The MicroTrak® HSV1/HSV2/VZV staining kit has high sensitivity and specificity in acute lesions, is also the most rapid means to confirm diagnosis. Herpetic reactivation and recurrences during radiotherapy can cause interruptions, cessations, or prolongations of the radiotherapeutic course, thus decreasing the biologically effective dose, to sub-therapeutic levels. Active HHV infection within the treatment volume results in increased tumor radio-resistance and potentially sub-therapeutic care if left untreated. Visceral reactivations may result in fatality and therefore, a high index of suspicion is important to identify these active infections. The fact that such infections may be mistaken for acute and/or late radiation effects, leading to less than optimal treatment decisions, makes knowledge of this problem even more relevant. To minimize the risk of these sequelae, prompt anti-viral therapy is recommended, lasting the course of radiotherapy.

Cervical esophageal cancer: a population-based study.

BACKGROUND: The purpose of this study was to present our analysis of outcomes, prognostic factors, and treatment for cervical esophageal carcinoma using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS: A query of the SEER database from 1998 to 2008 was performed for patients with nonmetastatic adenocarcinoma or squamous cell carcinoma (SCC) of the cervical esophagus. Disease-specific survival (DSS) rates were calculated using Kaplan-Meier method, and predictive factors were analyzed by Cox proportional hazards regression. RESULTS: We identified 362 patients; 92% of the patients had SCC, 16% received no definitive therapy, 5% received surgery, 71% received radiation therapy (RT), and 8% received both. Chemotherapy data were not available. Median DSS was 49 months for adenocarcinoma and 15 months for SCC. On multivariate analysis, histology (p = .02), RT (p < .001), and surgery plus RT (p < .001) were associated with DSS. CONCLUSION: Survival in patients with cervical esophageal carcinoma remains poor. Further studies should define the use of RT, surgery, and chemotherapy.

Definitive chemoradiotherapy for esophageal carcinoma.

Radiation therapy plays an important role in the treatment of esophageal cancer. Radiation therapy may be combined with chemotherapy, used as a component of induction therapy, used in the adjuvant setting, or used for palliation of advanced disease. Chemotherapy is also occasionally used as a solitary treatment modality for patients with esophageal cancer. Current treatment protocols include multiple agents, and agents directed against specific molecular targets have been investigated in clinical trials. This article discusses future directions related to the selection of radiation treatment protocols, novel targeted chemotherapeutic agents, and the selection of patients for surgery.

Neuroscience curriculum changes and outcomes: medical university of South Carolina, 2006 to 2010.

OBJECTIVES: To develop future neurologists and translational neuroscientists, we created a neurosciences pathway throughout our medical school curriculum that included early exposure to clinical neurosciences decision-making and added variety to the choices of later clinical neurosciences experiences. METHODS: Our curricular innovation had 3 parts: (1) integrating basic neurosciences content into an explicit clinical context in a College of Medicine (COM) first year of medical school; (2) expanding pathophysiological principles related to neurosciences in COM second year of medical school; and (3) creating a variety of 3-week clinical neurosciences selectives in COM third year of medical school and 4-week electives/externships for interested learners in COM fourth year of medical school. These new changes were evaluated (1) by comparing national standardized examinations including Neurology Subject examination scores for students choosing clinical neurosciences selectives; (2) by student satisfaction Graduate Questionnaires; and (3) by the total number of our graduates matching in US neurosciences disciplines. RESULTS: Students taking neuroscience selectives demonstrated a nonsignificant trend toward higher Step 2 Clinical Knowledge scores. The students' Neurology Subject examination scores were comparable with those scores reported nationally for other US COM third year of medical school students on 4-week rotations. Student-reported satisfaction in clinical neurology teaching improved from 43.9% (before) to 81.8% (after). The percentage of students matching into clinical neuroscience disciplines rose from 2% (before) to 6% (after). CONCLUSIONS: Our neurosciences curricular innovation increased graduating student satisfaction scores, had a mild positive impact on Step 2 Clinical Knowledge scores, and increased the number of students choosing careers in the clinical neurosciences. This model may be a consideration for other medical schools who wish to integrate neurosciences teaching throughout their curriculum.