Validation of the FIGO 2018 staging system of cervical cancer: Retrospective analysis of FIGO 2009 stage IB1 cervical cancer with tumor under 2 cm.

AIM: The International Federation of Gynecology and Obstetrics (FIGO) revised the cervical cancer staging system in 2018. This study aims to validate the revised staging system in patients with tumors <2 cm in size who were classified as FIGO 2009 stage IB1. METHODS: We evaluated 62 women with stage IB1 cervical cancer (FIGO 2009) who underwent radical hysterectomy as the initial treatment between November 2004 and August 2018 in our institution. The patients with FIGO 2009 stage IB1 and tumors <2 cm in size were enrolled. We reclassified their stage according to the FIGO 2018 staging system and analyzed their clinicopathological data retrospectively. RESULTS: Twenty-five patients met the inclusion criteria. According to the FIGO 2018 classification, 9 (36.0%) patients were classified as stage IA, 13 (52.0%) as stage IB1, and 3 (12.0%) as stage IIIC, respectively. One (11.1%), six (46.2%), and three (100%) patients with lymphovascular space invasion were classified as stage IA, IB1, and IIIC, respectively. No significant differences were found in the 5-year overall survival or progression-free survival among the three stages. CONCLUSIONS: As many as 36.0% of patients classified as FIGO 2009 stage IB1 with a tumor <2 cm in size were classified as stage IA in the FIGO 2018 classification. For these cases, a treatment less invasive than radical hysterectomy or radiotherapy might be sufficient. Our results suggest that cervical cancer patients with tumors <2 cm should be carefully diagnosed by performing cervical conization and assessed the pathological findings before hysterectomy.

Complete response to paclitaxel, ifosfamide, and cisplatin therapy in a case of ovarian ependymoma.

There are many reports on paclitaxel, ifosfamide, and cisplatin (TIP) therapy, following standard bleomycin, etoposide, and cisplatin (BEP) therapy, for salvage treatment of testicular malignant germ cell tumors, but there are no reports on its use for ovarian malignant tumors. We report here that a patient with primary ependymoma of the ovary, who was resistant to BEP therapy, achieved a complete response to a combined therapy, including TIP therapy as the second-line chemotherapy and surgery. This important case, combined with published studies, suggests that TIP therapy is effective for both testicular and ovarian malignant tumors and indicates that TIP therapy can be used as an effective second-line therapy for malignant tumors resistant to BEP therapy.

Protective effects of melatonin on gamma-ray induced intestinal damage.

PURPOSE: To examine the protective effects of melatonin on intestinal damage induced by gamma-rays. MATERIALS AND METHODS: Six-week-old Slc:ICR male mice were used. Mice were given whole-body irradiation at various exposure doses (7-21 Gy) with (137)Cs gamma-rays (0.98 Gy/min). The mice were orally administered 1 ml of either 1% carboxymethyl cellulose sodium salt (CMC) or melatonin (1, 5, 10 or 20 mg/ml) freshly prepared as a uniform suspension in CMC before or after irradiation. The concentrations of plasma melatonin were determined by the radioimmunoassay (RIA) method. The mice were killed at 3.5 days after the exposure. The jejunum was removed, fixed in formalin and then stained with hematoxylin and eosin. The numbers of crypts per transverse circumference were counted using a microscope for 10 histological sections of each mouse. RESULTS: The intestinal damage caused by gamma-ray irradiation was prevented by melatonin correlating to dosage. The D(0) (slope of the dose-survival curve) value significantly (p < 0.05) increased from 1.55 +/- 0.19 (mean +/- SD) Gy to 1.98 +/- 0.16 Gy by orally administering 20 mg melatonin 30 min before irradiation. The radioprotective effect of melatonin continued for 6 h after the administration. CONCLUSIONS: Melatonin is judged to be a potential protector against intestinal damage associated with radiotherapy. Further experimental and clinical studies on this subject are needed to allow its use for radiotherapy.

Glycine betaine, a beer component, protects radiation-induced injury.

Human whole-blood was exposed to 137Cs gamma-rays or 50 keV/microm carbon ions in the presence or absence of glycine betaine, a beer component in vitro. The dicentrics of chromosome aberrations in human lymphocytes were significantly (p < 0.05) reduced by glycine betaine after irradiation with 4 Gy of either gamma-rays or carbon ions. The maximum protection by glycine betaine for gamma-rays or carbon ions was 37% and 20%, respectively. C3H/He female mice, aged 14 weeks, received an i.p. injection of glycine betaine 15 min before whole-body irradiation with gamma-rays or 50 keV/microm carbon ions. Glycine betaine significantly (p < 0.05) increased the percent survival of irradiated mice with either gamma-rays or carbon ions. In conclusion, glycine betaine is a potent protector against damages caused by low- and high-LET radiation.