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1.
Medicina (Kaunas) ; 57(6)2021 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-34072478

RESUMO

Background and Objectives: In October 2018, the International Federation of Gynecology and Obstetrics (FIGO) revised its classification of advanced stages of cervical cancer. The main points of the classification are as follows: stage IIIC is newly established; pelvic lymph node metastasis is stage IIIC1; and para-aortic lymph node metastasis is stage IIIC2. Currently, in Japan, radical hysterectomy is performed in advanced stages IA2 to IIB of FIGO2014, and concurrent chemoradiotherapy (CCRT) is recommended for patients with positive lymph nodes. However, the efficacy of CCRT is not always satisfactory. The aim of this study was to compare postoperative adjuvant chemotherapy (CT) and postoperative CCRT in stage IIIC1 patients. Materials and Methods: Of the 40 patients who had undergone a radical hysterectomy at Iwate Medical University between January 2011 and December 2016 and were pathologically diagnosed as having positive pelvic lymph nodes, 21 patients in the adjuvant CT group and 19 patients in the postoperative CCRT group were compared. Results: The 5 year survival rates were 77.9% in the CT group and 74.7% in the CCRT group, with no significant difference. There was no significant difference in overall survival or progression-free survival between the two groups. There was no significant difference between CT and CCRT in postoperative adjuvant therapy in the new classification IIIC1 stage. Conclusions: The results of the prospective Japanese Gynecologic Oncology Group (JGOG) 1082 study are pending, but the present results suggest that CT may be a treatment option in rural areas where radiotherapy facilities are limited.


Assuntos
Neoplasias do Colo do Útero , Quimiorradioterapia , Quimiorradioterapia Adjuvante , Quimioterapia Adjuvante , Intervalo Livre de Doença , Feminino , Humanos , Japão , Estadiamento de Neoplasias , Estudos Prospectivos , Estudos Retrospectivos , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/terapia
2.
Rev Med Liege ; 76(5-6): 507-514, 2021 05.
Artigo em Francês | MEDLINE | ID: mdl-34080388

RESUMO

Cervical cancer is the fourth most common cancer in women and is linked in over 95 % of cases to papillomavirus infection, the incidence of which has fallen in recent years due to screening and vaccination. Almost half of these cancers are diagnosed at a locally advanced stage with an overall 5-year survival of around 65 %. In recent decades, the management strategy of these locally advanced cancers has changed considerably and has allowed the improvement of survival but above all of local control as well as the reduction of toxicity, due to the implementation of imaging. Standard treatment consists of external beam radiation therapy combined with concomitant chemotherapy followed by intrauterine brachytherapy. The role of neo-adjuvant and adjuvant chemotherapy is still being evaluated. New therapeutic approaches (particularly immunotherapy) in addition to standard treatment are also being studied.


Assuntos
Braquiterapia , Neoplasias do Colo do Útero , Quimioterapia Adjuvante , Feminino , Humanos , Estadiamento de Neoplasias , Dosagem Radioterapêutica , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/terapia
3.
J Transl Med ; 19(1): 222, 2021 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-34030694

RESUMO

BACKGROUND: The main limitation of current immune checkpoint inhibitors (ICIs) in the treatment of cervical cancer comes from the fact that it benefits only a minority of patients. The study aims to develop a classification system to identify immune subtypes of cervical squamous cell carcinoma (SCC), thereby helping to screen candidates who may respond to ICIs. METHODS: A real-world cervical SCC cohort of 36 samples were analyzed. We used a nonnegative matrix factorization (NMF) algorithm to separate different expression patterns of immune-related genes (IRGs). The immune characteristics, potential immune biomarkers, and somatic mutations were compared. Two independent data sets containing 555 samples were used for validation. RESULTS: Two subtypes with different immunophenotypes were identified. Patients in sub1 showed favorable progression-free survival (PFS) and overall survival (OS) in the training and validation cohorts. The sub1 was remarkably related to increased immune cell abundance, more enriched immune activation pathways, and higher somatic mutation burden. Also, the sub1 group was more sensitive to ICIs, while patients in the sub2 group were more likely to fail to respond to ICIs but exhibited GPCR pathway activity. Finally, an 83-gene classifier was constructed for cervical SCC classification. CONCLUSION: This study establishes a new classification to further understand the immunological diversity of cervical SCC, to assist in the selection of candidates for immunotherapy.


Assuntos
Carcinoma de Células Escamosas , Neoplasias do Colo do Útero , Biomarcadores Tumorais , Carcinoma de Células Escamosas/terapia , Feminino , Humanos , Fatores Imunológicos , Imunoterapia , Prognóstico , Neoplasias do Colo do Útero/terapia
4.
JCO Glob Oncol ; 7: 716-725, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33999708

RESUMO

PURPOSE: The COVID-19 pandemic has placed unprecedented demands on the health system. This led to delays in the initiation and completion of cancer treatment. We assessed the long-term health consequences because of the delay in diagnosis and treatment for cervical cancer due to COVID-19 in India. METHODS: We used a Markov-model-based analysis assessing the lifetime health outcomes of the cohort of women population at risk from cervical cancer in India. The decrease in survival for those with the treatment interruption was calculated based on the number of days the treatment was extended beyond the standard duration. Furthermore, to model the impact of late diagnosis and delayed treatment initiation, the patients were assumed to have upstaged during the delay period, as per natural progression of disease. RESULTS: We estimate 2.52% (n = 795) to 3.80% (n = 2,160) lifetime increase in the deaths caused by cervical cancer with treatment restrictions ranging from 9 weeks to 6 months, respectively, as compared to no delay. On the contrary, 88-238 deaths because of COVID-19 disease are estimated to be saved during this restriction period among the patients with cervical cancer. Overall, the excess mortality because of cervical cancer led to 18,159-53,626 life-years being lost and an increase of 16,808-50,035 disability-adjusted life-years. CONCLUSION: Delays in diagnosis and treatment are likely to lead to more cervical cancer deaths as compared to COVID-19 mortality averted among the patients with cervical cancer. Health systems must reorganize in terms of priority setting for provision of care, starting with prioritizing the treatment of patients with early-stage cervical cancer, increasing use of teleconsultation, and strengthening the role of primary care physicians in provision of cancer care.


Assuntos
COVID-19 , Diagnóstico Tardio , Progressão da Doença , Tempo para o Tratamento , Neoplasias do Colo do Útero , Feminino , Humanos , Índia/epidemiologia , Cadeias de Markov , Pandemias , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/terapia
5.
Eur J Radiol ; 141: 109787, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34051683

RESUMO

PURPOSE: Combined clinical prognostic factors and magnetic resonance imaging (MRI) parameters on predicting the prognosis after concurrent chemo-radiotherapy (CCRT)in patients with 2018 International Federation of Gynecology and Obstetrics (FIGO) IIICr stage patients. METHODS: A total of 117 patients with cervical cancer (2018 FIGO stage IIICr) who underwent CCRT were enrolled from Dec.2014 to Jul.2017. 47 patients developed outcome events, including 32 recurrences and 15 deaths. Clinical and MR parameters of primary tumors were analyzed, including apparent diffusion coefficient (ADC) values (ADCmean, ADCmin, and ADCmax) and dynamic contrast-enhanced MRI (DCE-MRI) parameters (Ktrans, Kep, Ve) were recorded. The short diameters of visible lymph nodes in the MRI and enhanced computed tomography (CT) images were measured. Progression-free survival (PFS) was compared by Kaplan-Meier analysis and independent predictors were identified using cox regression analysis. RESULTS: The median PFS was 35 months (6-68 month). The 1-year and 3-year PFS rates were was 90.4 %, 74.4 %, respectively. Multivariate analysis showed that 2018 FIGOIIIC2r stage (HR 2.701,95 %CI1.259to. 5.797; p = 0.011), Ktrans(HR 0.353;95 %CI 0.189 to 0.659; p = 0.001) and ADCmin (HR0.423,95 %CI0.229to0.783; p = 0.006) were highly correlated with poor PFS. CONCLUSION: In conclusion, we have identified IIIC2r stage, Ktrans value and ADCmin value as the most important factors in evaluating the survival rate and prognosis of patients with stage IIICr cervical cancer. For stage IIIC1r subgroup, Ktrans, ADCmin value and site of positive lymph node >2 were independent prognostic factors.


Assuntos
Neoplasias do Colo do Útero , Quimiorradioterapia , Feminino , Humanos , Imageamento por Ressonância Magnética , Recidiva Local de Neoplasia , Prognóstico , Estudos Retrospectivos , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/terapia
6.
BJOG ; 128(9): 1503-1510, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33982870

RESUMO

OBJECTIVE: To describe the immediate impact of the COVID-19 pandemic on cervical screening, colposcopy and treatment volumes in Ontario, Canada. DESIGN: Population-based retrospective observational study. SETTING: Ontario, Canada. POPULATION: People with a cervix age of 21-69 years who completed at least one cervical screening cytology test, colposcopy or treatment procedure for cervical dysplasia between January 2019 and August 2020. METHODS: Administrative databases were used to compare cervical screening cytology, colposcopy and treatment procedure volumes before (historical comparator) and during the first 6 months of the COVID-19 pandemic (March-August 2020). MAIN OUTCOME MEASURES: Changes in cervical screening cytology, colposcopy and treatment volumes; individuals with high-grade cytology awaiting colposcopy. RESULTS: During the first 6 months of the COVID-19 pandemic, the monthly average number of cervical screening cytology tests, colposcopies and treatments decreased by 63.8% (range: -92.3 to -41.0%), 39.7% (range: -75.1 to -14.3%) and 31.1% (range: -43.5 to -23.6%), respectively, when compared with the corresponding months in 2019. Between March and August 2020, on average 292 (-51.0%) fewer high-grade cytological abnormalities were detected through screening each month. As of August 2020, 1159 (29.2%) individuals with high-grade screening cytology were awaiting follow-up colposcopy. CONCLUSIONS: The COVID-19 pandemic has had a substantial impact on key cervical screening and follow-up services in Ontario. As the pandemic continues, ongoing monitoring of service utilisation to inform system response and recovery is required. Future efforts to understand the impact of COVID-19-related disruptions on cervical cancer outcomes will be needed. TWEETABLE ABSTRACT: COVID-19 has had a substantial impact on cervical screening and follow-up services in Ontario, Canada.


Assuntos
COVID-19/prevenção & controle , Colposcopia/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/terapia , Esfregaço Vaginal/estatística & dados numéricos , Adulto , Idoso , Bases de Dados Factuais , Atenção à Saúde/estatística & dados numéricos , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Ontário , SARS-CoV-2 , Adulto Jovem
7.
Cancer Radiother ; 25(5): 463-468, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34023215

RESUMO

PURPOSE: The 5-fraction scheme (5×5-5.5Gy) is a common High-Dose Rate (HDR) intracavitary brachytherapy regimen for locally advanced cervical cancer (LACC). Yet, its equivalence with Pulse-Dose rate (PDR) schemes remains unproved. The present study aimed at reporting on the outcome of LACC patients treated with 5-fraction HDR brachytherapy. MATERIALS AND METHODS: The medical records of all consecutive patients treated with curative-intent HDR brachytherapy for a LACC in a French Cancer Center were retrospectively reviewed. RESULTS: Thirty-eight LACC patients underwent a 5-fraction intracavitary HDR brachytherapy between 2015 and 2019 (median dose=25Gy/5 fractions, following external-beam radiotherapy). Median age at diagnosis was 60 (range: 29-87). Thirty-one patients (81.5%) underwent concurrent chemotherapy. Tumor stages ranged from 3 IB2 (7.8%), 4 IB3 (10.5%), 4 IIA2 (10.5%), 12 IIB (31.7%), 1 IIIA (2.6%), 2 IIIB (5.3%), 7 IIIC1 (18.5%), 4 IIIC2 (10.5%), 1 IVA (2.6%) (2018 FIGO). Median D90% to CTVHR reached 79.5Gy (EQD2). Median D90% to CTVIR reached 59.5Gy (EQD2). Median Bladder D2cc was 69.8Gy (EQD2). Median Rectum D2cc was 58.3Gy (EQD2). Acute/late grade 3 toxicity was reported in one patient (2.6%). No grade 4-5 toxicity occurred. At a median 38 months follow-up, 10 patients (26.3%) had local (n=7, 18.4%), nodal (n=6, 15.7%) and/or distant (n=7, 18.4%) relapse. Three-year overall survival rate was of 81.6%. CONCLUSION: The 5-fraction HDR scheme was well tolerated even in frail patients. Three-year local control was lower than expected. Treatment (absence of parametrial interstitial implants and use of cervical EBRT boost) and patients' characteristics (age, comorbidities) may explain such results.


Assuntos
Braquiterapia , Fracionamento da Dose de Radiação , Neoplasias do Colo do Útero/terapia , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adenocarcinoma/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Quimiorradioterapia , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Retrospectivos , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/patologia
8.
Medicine (Baltimore) ; 100(18): e24480, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950913

RESUMO

ABSTRACT: To explore the risk factors of lung metastasis in patients after laparoscopic radical hysterectomy (LRH) of cervical cancer (CC).The clinical data of CC patients with clinical stage of IA1-IIA2 diagnosed in our hospital from April 2007 to October 2015 were collected. According to the situation of metastasis, the patients were divided into lung metastasis (n = 73) and non-lung metastasis group (n = 2076). The clinical data were compared between 2 groups, and logistic stepwise regression model was used to analyze the risk factors of lung metastasis in patients with CC after LRH.The incidence of lung metastasis after LRH of CC was 3.39%, and 67.13% of patients with lung metastases had no obvious clinical symptoms. 15.06% patients had lung metastasis in the first year, 38.35% in the second year, 43.83% in the third year and later. The postoperative lung metastasis of CC was related to tumor diameter (P < .001), pathological type (P < .001), interstitial invasion depth (P < .001), pelvic lymph node metastasis (PLNM, P < .001), vascular tumor thrombus (P = .011), tumor uterine invasion (P = .002), and abnormal preoperative tumor markers (P = .015). However, it was not related to age, clinical stage, tumor growth pattern, tumor differentiation, and para-aortic lymph node metastasis (P > .05). Logistic regression analysis revealed non-squamous cell carcinoma (P = .022), tumor diameter ≥4 cm (P = .008), interstitial invasion depth >2/3 (P = .003), PLNM (P = .007), and tumor uterine invasion (P = .037) is an independent risk factor for lung metastasis after LRH of CC.Non-squamous cell carcinoma, tumor diameter ≥4 cm, tumor interstitial invasion depth >2/3, PLNM, and tumor uterine invasion are independent risk factors for lung metastasis after LRH of CC.


Assuntos
Carcinoma/epidemiologia , Histerectomia/métodos , Laparoscopia , Neoplasias Pulmonares/epidemiologia , Neoplasias do Colo do Útero/terapia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma/prevenção & controle , Carcinoma/secundário , Colo do Útero/patologia , Colo do Útero/cirurgia , Quimiorradioterapia Adjuvante/métodos , Feminino , Seguimentos , Humanos , Incidência , Neoplasias Pulmonares/prevenção & controle , Neoplasias Pulmonares/secundário , Invasividade Neoplásica , Estadiamento de Neoplasias , Período Pós-Operatório , Radioterapia Conformacional , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Carga Tumoral , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/patologia
9.
Crit Rev Oncol Hematol ; 162: 103343, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33930531

RESUMO

Uterine cervical cancer is the fourth most frequent gynecological tumor worldwide. The tumor microenvironment of cervical cancer is the result of persistent high-risk human papillomavirus infection together with stromal activation of estrogen receptor alpha and the pro-angiogenic and pro-inflammatory activity of immune cells, mainly T-helper 17 cells and tumor-associated macrophages. Therapeutic management (e.g., immunotherapy, especially in advanced cases) may be influenced by the translational implications of tumoral stroma crosstalk and an abundance of tumor-infiltrating lymphocytes within the tumor microenvironment. The prognosis of cervical cancer is inversely correlated with microvessel density, making anti-angiogenic strategies with agents such as bevacizumab crucial for improving both progression-free survival and overall survival in patients with advanced and recurrent tumors.


Assuntos
Neoplasias do Colo do Útero , Feminino , Humanos , Doença Iatrogênica , Linfócitos do Interstício Tumoral , Recidiva Local de Neoplasia , Prognóstico , Microambiente Tumoral , Neoplasias do Colo do Útero/terapia
10.
BMC Womens Health ; 21(1): 180, 2021 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-33906670

RESUMO

BACKGROUND: Cervical cancer treatment and care remains limited in Zimbabwe despite the growing burden of the disease among women. This study was aimed at investigating strategies to address barriers in accessing treatment and care by women with cervical cancer in Harare, Zimbabwe. METHODS: A qualitative inquiry was conducted to generate evidence for this study. Eighty-four (84) participants were purposively selected for interviews and participation in focus group discussions. The participants were selected from cervical cancer patients, caregivers of cervical cancer patients, health workers involved in the care of cervical cancer patients as well as relevant policy makers in the Ministry of Health and Child Care. Participants were selected in such as a way as to ensure different of characteristics to obtain diverse perspectives about the issues under study. Discussion and interview guides were used as data collection tools and discussions/interviews were audio-recorded, transcribed and translated into English. Inductive thematic analysis was conducted using Dedoose software. RESULTS: Salient sub-themes that emerged in the study at the individual patient level were: provision of free or subsidized services, provision of transport to treating health facilities and provision of accommodation to patients undergoing treatment. At the societal level, the sub-themes were: strengthening of health education in communities and training of health workers and community engagement. Salient sub-themes from the national health system level were: establishment of more screening and treatment health facilities, increasing the capacities of existing facilities, decentralization of some services, building of multidisciplinary teams of health workers, development and rolling out of standardized guidelines and reformation of Acquired Immunodeficiency Virus (AIDS) levy into a fund that would finance priority disease areas. CONCLUSION: This study revealed some noteworthy strategies to improve access to cervical cancer treatment and care in low-income settings. Improved domestic investments in health systems and reforming health policies underpinned on strong political are recommended.


Assuntos
Cuidados Paliativos , Neoplasias do Colo do Útero , Criança , Feminino , Grupos Focais , Acesso aos Serviços de Saúde , Humanos , Saúde Pública , Pesquisa Qualitativa , Neoplasias do Colo do Útero/terapia , Zimbábue
11.
BMC Cancer ; 21(1): 428, 2021 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-33882885

RESUMO

BACKGROUND: Malawi has the world's highest cervical cancer incidence and mortality due to high rate of HIV coupled with inadequate screening and treatment services. The country's cervical cancer control program uses visual inspection with acetic acid (VIA) and cryotherapy, but screening is largely limited by poor access to facilities, high cost of cryotherapy gas, and high loss-to-follow-up. To overcome these limitations, we implemented a community-based screen-and-treat pilot program with VIA and thermocoagulation. Through a qualitative study, we explore the experiences of women who underwent this community-based pilot screening program. METHODS: We implemented our pilot program in rural Malawi and conducted an exploratory qualitative sub-study. We conducted in-depth interviews with women who were treated with thermocoagulation during the program. We used semi-structured interviews to explore screen-and-treat experience, acceptability of the program and attitudes towards self-sampling for HPV testing as an alternative screening method. Content analysis was conducted using NVIVO v12. RESULTS: Between July - August 2017, 408 participants eligible for screening underwent VIA screening. Thirty participants had VIA positive results, of whom 28 underwent same day thermocoagulation. We interviewed 17 of the 28 women who received thermocoagulation. Thematic saturation was reached at 17 interviews. All participants reported an overall positive experience with the community-based screen-and-treat program. Common themes were appreciation for bringing screening directly to their villages, surprise at the lack of discomfort, and the benefits of access to same day treatment immediately following abnormal screening. Negative experiences were rare and included discomfort during speculum exam, long duration of screening and challenges with complying with postprocedural abstinence. Most participants felt that utilizing self-collected HPV testing could be acceptable for screening in their community. CONCLUSIONS: Our exploratory qualitative sub-study demonstrated that the community-based screen-and-treat with VIA and thermocoagulation was widely accepted. Participants valued the accessible, timely, and painless thermocoagulation treatment and reported minimal side effects. Future considerations for reaching rural women can include community-based follow-up, cervical cancer education for male partners and self-sampling for HPV testing.


Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , Neoplasias do Colo do Útero/epidemiologia , Adulto , Feminino , Humanos , Malaui/epidemiologia , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Vigilância em Saúde Pública , Pesquisa Qualitativa , Fatores de Risco , População Rural , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/terapia , Adulto Jovem
12.
Chin Med J (Engl) ; 134(8): 954-962, 2021 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-33840740

RESUMO

BACKGROUND: Recently, T-helper 17 (Th17) cells have been proved to play an important role in promoting cervical cancer. But, till now, few study has been carried out to understand the involvement of these cells in efficacy of anti-tumor treatments. This study aimed to investigate the alterations in the percentage of circulating Th17 cells and related cytokines in locally advanced cervical cancer (LACC) patients before and after concurrent chemoradiotherapy (cCRT) and to analyze the correlations between the alterations in Th17 cells and treatment efficacy. METHODS: A prospective study with 49 LACC (International federation of gynecology and obstetrics [FIGO] stage IIB-IIIB) patients and 23 controls was conducted. Patients received the same cCRT schedule and were followed up for 3 years. Circulating Th17 cells (CD3+CD8- interleukin [IL]-17+ T cells) and related cytokines IL-17, transforming growth factor-ß (TGF-ß), IL-10, IL-23, IL-6, and IL-22 were detected before and after cCRT. Correlations between alterations of circulating Th17 cells and treatment efficacy were analyzed. Kaplan-Meier analysis was used for overall survival (OS) and progression-free survival (PFS). RESULTS: We found that 40 patients finished the entire cCRT schedule and met the endpoint of this study. The percentage of circulating Th17 cells in the LACC patients was higher than that in the controls, and it significantly decreased after cCRT (P < 0.05). After cCRT, patients were divided into two groups based on the average of the Th17 cells declined. The subgroup of patients with a prominent decrease in circulating Th17 cells after cCRT had a higher treatment efficacy and longer PFS and OS times. Compared with the control patients, LACC patients had higher IL-6, IL-10, IL-22, TGF-ß levels and a lower IL-23 level (P < 0.05). After cCRT, IL-6, IL-10, IL-17, IL-23 level significantly increased and TGF-ß level significantly decreased compared with the levels before cCRT (P < 0.05). CONCLUSION: Circulating Th17 cells in the LACC patients (FIGO stage IIB-IIIB) were higher than those in the controls, but they generally decreased after cCRT. A more pronounced decrease in circulating Th17 cells after cCRT was correlated with better therapeutic effect and longer PFS and OS times.


Assuntos
Neoplasias do Colo do Útero , Quimiorradioterapia , Intervalo Livre de Doença , Feminino , Humanos , Estadiamento de Neoplasias , Estudos Prospectivos , Estudos Retrospectivos , Células Th17 , Resultado do Tratamento , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/terapia
13.
Anticancer Res ; 41(4): 1753-1760, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33813379

RESUMO

BACKGROUND/AIM: The chromosome translocation t(8;19)(p11;q13) has been reported in only six acute myeloid leukemia (AML) patients. We here present the genetic and clinical features of the seventh AML case with this aberration. MATERIALS AND METHODS: Cytogenetic and molecular genetic investigations were performed on leukemic bone marrow cells from a patient with therapy-related AML. RESULTS: A t(8;19)(p11;q13) was found leading to an in-frame fusion of exon 16 of the lysine acetyltransferase 6A gene (KAT6A) from 8p11 with exon 2 of the leucine twenty homeobox gene (LEUTX) from 19q13 resulting in expression of the otherwise silent LEUTX gene in the leukemic cells. The KAT6A-LEUTX protein is predicted to act as a histone acetyltransferase at its amino-terminal-KAT6A moiety but as a homeobox transcription factor at the LEUTX-carboxyl-terminal moiety. CONCLUSION: The present case is the second therapy-related AML, and the third AML overall, in which both a t(8;19)(p11;q13) and its molecular result, a KAT6A-LEUTX fusion gene, are described. The t(8;19)(p11;q13)/KAT6A-LEUTX deregulates transcription and induces leukemogenesis.


Assuntos
Biomarcadores Tumorais/genética , Quimiorradioterapia/efeitos adversos , Cromossomos Humanos Par 19 , Cromossomos Humanos Par 8 , Fusão Gênica , Histona Acetiltransferases/genética , Proteínas de Homeodomínio/genética , Leucemia Mieloide Aguda/etiologia , Translocação Genética , Idoso , Feminino , Regulação Leucêmica da Expressão Gênica , Humanos , Leucemia Mieloide Aguda/diagnóstico , Leucemia Mieloide Aguda/tratamento farmacológico , Leucemia Mieloide Aguda/genética , Resultado do Tratamento , Neoplasias do Colo do Útero/terapia
14.
BMC Cancer ; 21(1): 442, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33882876

RESUMO

BACKGROUND: To explore the feasibility of adjuvant surgery following concurrent chemoradiation therapy (CCRT) in stage IIB-IIIB (according to FIGO staging of 2009) cervical cancer and analyze risk factors of recurrence after surgery. METHODS: Forty-nine patients diagnosed with stage IIB-IIIB cervical cancer were reviewed retrospectively. We investigated the risk factors of recurrence after surgery using Chi-squared Test and further analyzed multiple factors affecting postoperative recurrence using the multi-factor logistic regression. Furthermore, the correlation of surgery outcomes (including operation time, bleeding, and hospitalization date and surgery complications) with the time which carried out between CCRT and completion surgery was analyzed. RESULTS: Tumor histology and residual tumor in the cervix were significantly associated with postoperative recurrence (P = 0.014 and P = 0.040, respectively). Logistic regression analysis demonstrated that the independent risk factors of postoperative recurrence were age and residual tumor in the cervix (P = 0.017 and P = 0.030, respectively). Complications (operation time, bleeding, hospitalization date) were compared between patients with an interval with radiotherapy less than 6 weeks and patients with an interval longer than 6 weeks. There were statistical differences in the amount of bleeding and postoperative complications between the two groups (P = 0.019 and P = 0.044, respectively). CONCLUSION: CCRT combined with surgery for stage IIB-IIIB cervical cancer was feasible, reduced the rate of postoperative recurrence and surgery complications were tolerated.


Assuntos
Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/terapia , Adulto , Idoso , Quimiorradioterapia , Terapia Combinada , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Prognóstico , Recidiva , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/mortalidade
15.
Int J Nanomedicine ; 16: 2879-2896, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33883896

RESUMO

Background: Effective treatment strategy for cervical carcinoma is subject to the limitation of its anatomical location and histological characteristics. Comprehensive imaging before cervical carcinoma treatment is of great significance for the patients. Current imaging methods cannot meet the requirements of high resolution, deep imaging depth and non-invasive imaging at the same time. Fortunately, Photoacoustic imaging (PAI) is a novel imaging method that combines rich optical contrast, high ultrasonic spatial resolution, and deep penetration depth in a single modality. Moreover, PAI-guided photothermal therapy (PTT) by aid of targeting nanoparticles is an emerging and effective cancer treatment in recent years. Methods: Here, strong near-infrared region (NIR) absorption-conjugated polymer PIIGDTS (PD) nanoparticles with folic acid (FA) modification (namely, PD-FA) that targeted at Hela cell were specifically designed as cervical tumor imaging contrast agents and photothermal agents. Results: The obtained PD-FA nanoparticles exhibited admirable photoacoustic contrast-enhancing ability and desirable PTT behavior with the photothermal conversion efficiency as high as 62.6% in vitro. Furthermore, the PAI performance and PTT efficiency were tested in HeLa tumor-bearing nude mice after injection of PD-FA nanoparticles. In vivo multi-scale, PAI provided B-san and 3D dimension imaging for intuitive and comprehensive information of Hela tumor. Moreover, the Hela tumor can be completely eliminated within 18 days after PTT, with no toxicity and side effects. Conclusion: In summary, PD-FA injection combined with PAI and PTT systems provides a novel powerful tool for early diagnosis and precise treatment of cervical cancer.


Assuntos
Lasers , Nanopartículas/química , Técnicas Fotoacústicas/métodos , Terapia Fototérmica , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/terapia , Animais , Células COS , Chlorocebus aethiops , Feminino , Ácido Fólico/química , Células HeLa , Humanos , Camundongos Endogâmicos BALB C , Camundongos Nus , Nanopartículas/administração & dosagem , Nanopartículas/ultraestrutura , Especificidade de Órgãos , Imagens de Fantasmas , Polímeros/química
16.
Orv Hetil ; 162(162 Suppl 1): 22-29, 2021 03 28.
Artigo em Húngaro | MEDLINE | ID: mdl-33774605

RESUMO

Összefoglaló. Bevezetés: A méhnyakdaganatok kérdése kiemelten fontos, megoldatlan népegészségügyi probléma. A betegség terhe magas, ami elsosorban az alacsony és közepes jövedelmu országokban éloknél jelentkezik. Célkituzés: Elemzésünk célja volt meghatározni a méhnyakdaganatok epidemiológiai és egészségbiztosítási betegségterhét Magyarországon a 2018-as évre vonatkoztatva. Adatok és módszerek: Elemzésünket a Nemzeti Egészségbiztosítási Alapkezelo (NEAK) finanszírozási adatbázisának 2018. évi adatai alapján végeztük az in situ (D06), a jóindulatú (D26.0) és a malignus (C53) méhnyakdaganatokra vonatkozóan. Az elemzés a NEAK által finanszírozott összes szolgáltatóra és ellátási formára kiterjed. Meghatároztuk az éves betegszámokat, a prevalenciát 100 000 lakosra, továbbá az éves egészségbiztosítási kiadásokat betegségcsoportonként és korcsoportos bontásban, valamennyi egészségbiztosítási ellátás tekintetében. Eredmények: A NEAK 2018-ban 1,276 milliárd Ft-ot (4,7 millió USD; 4,0 millió EUR) költött a méhnyakdaganatok kezelésére. A betegek és a finanszírozás dönto többsége a méhnyak rosszindulatú daganatához kapcsolható. A finanszírozásból a malignus méhnyakdaganatok részesedése 97%. Ellátási típusonként vizsgálva a legnagyobb kiadási tétel az aktívfekvobeteg-szakellátásban jelenik meg, éves szinten 763,9 millió Ft, ami az összköltség 59,9%-a. A 100 000 lakosra jutó prevalencia az aktívfekvobeteg-szakellátás igénybevételi adatai alapján 26/100 000 lakos. Következtetés: A méhnyakdaganatok kezelésének meghatározó költségeleme az aktívfekvobeteg-szakellátás. Hazánkban a szervezett méhnyakszurés korszerusítéseként az új szurési stratégiát megfelelo finanszírozási támogatással célszeru bevezetni, a szurovizsgálatoknak, a hozzájuk kapcsolódó további diagnosztikus kivizsgálásnak és terápiának a teljesítményvolumen-korlát alóli mentesítésével. Orv Hetil. 2021; 162(Suppl 1): 22-29. INTRODUCTION: Cervical cancer is a particularly important, unresolved public health problem. The burden of the disease is high, primarily in those living in low- and middle-income countries. OBJECTIVE: Our aim was to determine the annual epidemiological disease burden and health insurance cost of cervical cancer in Hungary in 2018. DATA AND METHODS: Our analysis was made according to the financial database of the National Health Insurance Fund Administration (NHIFA) of Hungary for the year 2018, which covers all service providers and maintenance forms financed by NHIFA. We analysed the in situ (D06), the benignant (D26.0) and the malignant (C53) cervical tumours. The data analysed included annual patient numbers and prevalence of care utilisation per 100 000 population furthermore annual health insurance costs calculated for disease and age groups. RESULTS: In 2018, NHIFA spent 1.276 billion HUF (4.7 million USD, 4.0 million EUR) on the treatment of patients with cervical cancer. The majority of patients and funding can be linked to malignant cervical cancer (97%). Acute inpatient care was the major cost driver: 763.9 million HUF (59.9% of the total health insurance expenditures) annually. The prevalence is 26 per 100 000 population based on acute inpatient care data. CONCLUSION: Acute inpatient care was the major cost driver. In Hungary, as a modernization of organized cervical screening, it is appropriate to introduce a new screening strategy with appropriate financial support, by exempting screening tests, associated additional diagnostic testing, and therapy from the performance volume limit. Orv Hetil. 2021; 162(Suppl 1): 22-29.


Assuntos
Efeitos Psicossociais da Doença , Neoplasias do Colo do Útero , Feminino , Humanos , Hungria/epidemiologia , Seguro Saúde/economia , Neoplasias do Colo do Útero/economia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/terapia
17.
BMC Health Serv Res ; 21(1): 286, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-33784992

RESUMO

BACKGROUND: HPV testing has been integrated in cervical cancer screening program. Patient-providers relationship is extremely important to improve cervical cancer screening outcomes. This qualitative study aims to understand HPV-positive women's needs and preferences about HCPs and patient-provider communication based on their experiences of accessing primary and specialized care. METHODS: We conducted 40 semi-structured interviews with HPV-positive women. Recorded interviews transcribed and analyzed using conventional content analysis approach. RESULTS: The analysis of the data led to the extraction of three main categories, including: provider's communication and counseling skills, commitment to professional principles, and knowledgeable and competent provider. Women needed understandable discussion about HPV, emotional support and acceptance, receiving HPV-related guidance and advice, and some considerations during clinical appointments. Women needed HCPs to treat them respectfully, gently and with non-judgmental attitude. "Precancerous" and "high-risk" words and watching colposcopy monitor during procedure had made women anxious. Weak referral system and limited interactions among gynecologists and other HCPs highlighted by participants. CONCLUSION: The results of this study, based on the experiences and perceptions of HPV women receiving health care, contain messages and practical tips to healthcare providers at the primary and specialized levels of care to facilitate patient-provider communication around HPV. Providers need to approach the discussion of HPV with sensitivity and take individual needs and preferences into account to improve the HPV-positive women's healthcare experience.


Assuntos
Infecções por Papillomavirus , Neoplasias do Colo do Útero , Comunicação , Detecção Precoce de Câncer , Feminino , Humanos , Infecções por Papillomavirus/diagnóstico , Gravidez , Pesquisa Qualitativa , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/terapia
18.
BMC Cancer ; 21(1): 243, 2021 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-33685404

RESUMO

BACKGROUND: It is very important to accurately delineate the CTV on the patient's three-dimensional CT image in the radiotherapy process. Limited to the scarcity of clinical samples and the difficulty of automatic delineation, the research of automatic delineation of cervical cancer CTV based on CT images for new patients is slow. This study aimed to assess the value of Dense-Fully Connected Convolution Network (Dense V-Net) in predicting Clinical Target Volume (CTV) pre-delineation in cervical cancer patients for radiotherapy. METHODS: In this study, we used Dense V-Net, a dense and fully connected convolutional network with suitable feature learning in small samples to automatically pre-delineate the CTV of cervical cancer patients based on computed tomography (CT) images and then we assessed the outcome. The CT data of 133 patients with stage IB and IIA postoperative cervical cancer with a comparable delineation scope was enrolled in this study. One hundred and thirteen patients were randomly designated as the training set to adjust the model parameters. Twenty cases were used as the test set to assess the network performance. The 8 most representative parameters were also used to assess the pre-sketching accuracy from 3 aspects: sketching similarity, sketching offset, and sketching volume difference. RESULTS: The results presented that the DSC, DC/mm, HD/cm, MAD/mm, ∆V, SI, IncI and JD of CTV were 0.82 ± 0.03, 4.28 ± 2.35, 1.86 ± 0.48, 2.52 ± 0.40, 0.09 ± 0.05, 0.84 ± 0.04, 0.80 ± 0.05, and 0.30 ± 0.04, respectively, and the results were greater than those with a single network. CONCLUSIONS: Dense V-Net can correctly predict CTV pre-delineation of cervical cancer patients and can be applied in clinical practice after completing simple modifications.


Assuntos
Colo do Útero/diagnóstico por imagem , Imageamento Tridimensional , Redes Neurais de Computação , Planejamento da Radioterapia Assistida por Computador/métodos , Neoplasias do Colo do Útero/terapia , Colo do Útero/patologia , Colo do Útero/cirurgia , Feminino , Humanos , Estadiamento de Neoplasias , Radioterapia Adjuvante/métodos , Tomografia Computadorizada por Raios X , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/patologia
19.
Medicine (Baltimore) ; 100(13): e25271, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787611

RESUMO

ABSTRACT: Cervical cancer represents a general health issue spread all over the globe, which prompts the surge of scientific survey toward the rise of survival and condition of life of these patients. American and European guidelines suggest the open surgery, laparoscopic, and robotic surgery are the main therapeutic approaches for radical hysterectomy for patients with cervical cancer. This is the first survey to analyze the long-term oncological outcome of an extensive series of subjects cared for with multimodality treatment, here comprising robotic surgery.This study intents to evaluate the long-term oncological result in patients diagnosed with cervical cancer treated with radiotherapy (±chemotherapy) and robotic surgery compared with open surgery. Medical files of 56 patients diagnosed with cervical cancer who underwent a robotic hysterectomy and radiotherapy ± chemotherapy were retrospectively analyzed.The median age at diagnosis was 50.5 (range: 23-70). Eleven patients (19.6%) presented in an early stage (IB-IIA) and 80.4% advanced stage (IIB-IVA). Overall response rate after radiotherapy and chemoradiotherapy was 96.2%. Pathologic complete response was obtained in 64% of patients. After a median follow-up of 60 months (range: 6-105 months), 8 patients (14.2%) presented local recurrence or distant metastases. Disease-free survival (DFS) was 92% at 2 years and 84% at 3 and 5 years. Overall survival (OS) rates at 2, 3, and 5 years for patients with robotic surgery were 91%, 78%, and 73%, median OS not reached. OS was lower in the arm of open surgery (2, 3, and 5 years 87%, 71%, and 61%, respectively; median OS was 72 months P = .054). The multivariate analysis regarding the outcome of patients revealed an advantage for complete versus partial response (P < .002), for early versus advanced stages (P = .014) and a 10% gained in DFS at 3 years for patients in whom chemoradiotherapy was administered (DFS at 3 years 75% vs 85%) in patients with advanced stages.Robotic surgery has a favorable oncological outcome when associated with multimodal therapy.


Assuntos
Antineoplásicos/uso terapêutico , Quimiorradioterapia/mortalidade , Histerectomia/mortalidade , Compostos de Platina/uso terapêutico , Procedimentos Cirúrgicos Robóticos/mortalidade , Neoplasias do Colo do Útero/mortalidade , Adulto , Idoso , Terapia Combinada , Intervalo Livre de Doença , Feminino , Humanos , Histerectomia/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Taxa de Sobrevida , Resultado do Tratamento , Neoplasias do Colo do Útero/terapia , Adulto Jovem
20.
BMC Cancer ; 21(1): 289, 2021 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-33736612

RESUMO

BACKGROUND: Cervical cancer is a gynecologic cancer type that develops in the cervix, accounting for 8% mortality of all female cancer patients. Infection with specific human papillomavirus (HPV) types is considered the most severe risk factor for cervical cancer. In the context of our socioeconomic conditions, an increasing burden of this disease and high mortality rate prevail in Bangladesh. Although several researches related to the epidemiology, HPV vaccination, and treatment modalities were conducted, researches on the mutation profiles of marker genes in cervical cancer in Bangladesh remain unexplored. METHODS: In this study, five different genomic regions within the top three most frequently mutated genes (EGFR, KRAS and PIK3CA) in COSMIC database with a key role in the development of cervical cancers were selected to study the mutation frequency in Bangladeshi patients. In silico analysis was done in two steps: nucleotide sequence analysis and its corresponding amino acid analysis. RESULTS: DNA from 46 cervical cancer tissue samples were extracted and amplified by PCR, using 1 set of primers designed for EGFR and 2 sets of primers designed for two different regions of both PIK3CA and KRAS gene. In total, 39 mutations were found in 26 patient samples. Eleven different mutations (23.91%), twenty-four different mutations (52.17%) and four mutations (8.7%) were found in amplified EGFR, PIK3CA and KRAS gene fragments, respectively; among which 1 (EGFR) was common in seven patient samples and 2 (PIKCA) were found in more than 1 patient. Our study shows that except for KRAS, the frequency of observed mutations in our patients is higher than those reported earlier in other parts of the world. Most of the exonic mutations were found only in the PIK3CA and EGFR genes. CONCLUSIONS: The study can be used as a basis to build a mutation database for cervical cancer in Bangladesh with the possibility of targetable oncogenic mutations. Further explorations are needed to establish future diagnostics, personalized medicine decisions, and other pharmaceutical applications for specific cancer subtypes.


Assuntos
Biomarcadores Tumorais/genética , Neoplasias do Colo do Útero/genética , Adulto , Antineoplásicos/farmacologia , Antineoplásicos/uso terapêutico , Bangladesh , Biomarcadores Tumorais/antagonistas & inibidores , Colo do Útero/patologia , Colo do Útero/cirurgia , Quimioterapia Adjuvante/métodos , Classe I de Fosfatidilinositol 3-Quinases/genética , Tomada de Decisão Clínica , Simulação por Computador , Análise Mutacional de DNA , Técnicas de Apoio para a Decisão , Receptores ErbB/genética , Feminino , Humanos , Histerectomia , Pessoa de Meia-Idade , Terapia de Alvo Molecular/métodos , Mutação , Proteínas Proto-Oncogênicas p21(ras)/genética , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/terapia
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