bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low dose radiation and chemotherapy significantly reduces hypoxic cell population in locally advanced cervix cancer-results of a phase II study
Authors: Das Saikat 
Published: February 2021

Introduction: Tumor hypoxia is one of the major causes of high incidence of treatment failures to chemoradiation which is the standard of care in locally advanced cervical cancer. The necessity of newer treatment options that can circumvent hypoxia is highly relevant in this group. Use of low dose radiation to enhance the efficacy of cell cycle specific chemotherapy by mechanism of chemopotentiation is one of the elegant approaches reported in the literature. We have already published the feasibility, efficacy and tolerance of low dose radiation and chemotherapy in neoadjuvant setting in cervical cancer. In this report we evaluated the role of this novel treatment regimen in reducing the hypoxic tumor cell population in cervical cancer.
Methods: Total 24 patients with stage IIB-IIIB squamous cell carcinoma cervix were treated with initial 2 cycles of paclitaxel and carboplatin and concurrent low dose radiotherapy prior to standard chemoradiation. Response was assessed clinically, radiologically (by MRI) and pathologically (four quadrant representative punch biopsy from the cervix) after 3 weeks of neoadjuvant treatment prior to chemoradiation. Immunohistochemistry of HIF-1a was done in the biopsy samples to determine the proportion, intensity and scoring of hypoxic cells.
Results: The proportion of positivity of base line HIF-1α was 42% (10 out of 24 patients). Low, moderate and high expressions were seen in 8%, 17% and 17% respectively. We observed nuclear positivity in 20%, and fine granular perinuclear cytoplasmic positivity in 80% cases. We failed to observe any association between expressions of HIF 1α in relation to the distance from blood vessels in tumor cord. The average age of patients in hypoxia positive and negative groups were 51.7 vs 48.36 yrs (p > 0.05). There was no difference of mean hemoglobin level (11.3 to 11.1, p > 0.05.) or MRI based tumor volume at baseline (57.1 vs. 52.4, p > 0.05) in HIF 1α positive and negative groups respectively. Low dose radiation and chemotherapy significantly reduced the tumor volume in bulky hypoxic tumors. The tumor volume reduction rate (TVRR) was significantly higher in hypoxic group (TVRR HIF_neg vs. TVRR HIF_pos 68.9 vs. 86.3, p = 0.02, t-test). There was significant improvement of diffusion MRI derived apparent diffusion coefficient (ADC) in hypoxic tumors with low dose radiation and chemotherapy (0.75 vs. 1.27, p = 0.12, Wilcoxon signed-rank test). Median score of percentage of hypoxic cells after neoadjuvant treatment were significantly higher in patients who developed subsequent local recurrence than the rest of the group (77% vs. 5% p = 0.009, Mann Whitney U test).
Conclusion: Overall all HIF 1 positivity was 42% in the present study. A predominantly perinuclear pattern of HIF 1 staining was found in cervix cancer. Low dose radiation and chemotherapy significantly reduced the hypoxic tumor bulk in cervical cancer.
Incremental Role of 18F-FDG PET with contrast enhanced CT (PET-CECT) in detection of recurrence of carcinoma cervix
Authors: Dash S. , Goel A. , Sogani S. 
Published: February 2021

Purpose: To evaluate the role of 18F-FDG PET with contrast enhanced CT (PET-CECT) in early detection of recurrence in follow up patients of carcinoma cervix.
Methods: Patients with histopathologically proven carcinoma cervix who underwent chemotherapy, radiotherapy and/or surgery and on follow up were recruited in the study. Fifty-two patients underwent 18F-FDG PET-CECT for detection of recurrence. The median age was 51.5 (average = 53.4) years. PET-CECT studies were evaluated and analyzed separately by an experienced nuclear medicine physician and a radiologist independently. The physicians were blinded for the patient history. PET-CECT results were validated with histopathological correlation, conventional radiologic imaging/follow up PET-CECT study and clinical follow up.
Results: Out of 52 patients, 34 patients were reported as positive for recurrence, 17 of these were having active local recurrence and 31 patients had regional lymph nodal metastases, 14 patients had distant metastases (out of them 6 patients had distant lymph node metastases, 6 had pulmonary metastases, 4 had skeletal metastases and two had liver metastases). Remaining 18 patients were reported as negative for recurrence. The lung was the most common site for distant metastasis. Patient were then further evaluated based on histopathological correlation, conventional radiologic imaging and follow up PET-CECT scan and five were found to be false positive and one patient was identified as false negative. The sensitivity, specificity, positive and negative predictive value were derived to be 96.7%, 77.3%, 85.3% and 94.4%, respectively. Accuracy was calculated to be 88.5%.
Conclusions: 18F-FDG PET-CECT is a very useful non-invasive modality for the early detection of recurrence and metastatic workup in patients with carcinoma cervix with a very high sensitivity and negative predictive value. It is also useful in targeting biopsy sites in suspected cases of recurrence.
Over view of clinical presentation, management and outcome of cervical cancer: A tertiary cancer centre experience
Authors: Shukla H. , Batra K. , Sekhon R. , Giri S. , Rawal S. 
Published: February 2021

Objectives: (a) To understand the profile of cervical cancer patients attending our hospital from January 2011 till January 2015. (b) To audit the type of care given to the patients with respect to their stage at presentation. (c) To compare the outcomes of open v/s robotic radical hysterectomy done for cervical cancer.
Methods: We prospectively analyzed all cases of cervical cancer from January 2011 to January 2015 presenting at our institute. Data was retrieved from patient’s records and institute’s tumor registry. We compared all patients undergoing open v/s robotic RH. All the data were analysed using SPSS version 21.
Results: A total of 562 patients were treated for cervical cancer during the time period between 2011-2015. Of these there were 316 (56%) cases taken up for surgery-212 robotic RH, 104 open radical hysterectomy and rest 246 (44%) patients received definitive CCRT. Most common age group was 40-54 yrs. IB1 stage was most common presenting stage. SCC was most common histology (75%). Immediate post op complication and oncological safety in terms of local recurrence was same in both groups. However length of stay and post operative blood requirement was significantly lower in robotic RH group. 45% of all patients who underwent surgery did not require adjuvant therapy in post op period while 35% patient required post op RT and 20% CCRT. 2.2% patient had local recurrence and most of the patients were in stage IIA1 at presentation.
Conclusion: Cervical cancer is the most common gynecological cancer in our hospital registry. Mostly women were in the age group of 40-54 years. Most common stage at presentation was 1B and the histology being SCC. Not many differences seen in open v/s robotic techniques of radical hysterectomy except for shorter hospital stay and less need of blood transfusion in the robotic group. Local recurrence rates are comparable in both open and robotic groups.
Sample survey of cancer awareness in health care workers
Authors: Shamsunder Saritha , Agarwal Kavita , Mishra Archana , Malik Sunita ,   Lalita
Published: February 2021

Objective: To see the awareness about cancer in women among ASHA workers.
Place of Study: Awareness Sessions at Safdarjung Hospital, New Delhi.
Background: ASHA workers are the first point of contact for women in the community & bridge the back between the hospital and women. They have been instrumental in the success of the family planning programme & polio eradication program in India.
Materials and Methods: A questionnaire about educational status, awareness about breast & cervical cancer statistics, methods of screening and diagnosis was distributed to Accredited Social Health Activists appointed by the government at two educational sessions organized at Safdarjung hospital.
Results: Of the 200 ASHA workers attending, 188 completed the questionnaire. Their educational status ranged from 7th standard to post-graduate, majority had studied up to 10th standard. Their sources of information were mostly television and mobile phones, 23% had knowledge about internet, 36% were using Whats app. Only 28% knew about the commonest cancer in Indian women. Regarding breast cancer, 63% were aware of self examination of breasts, 41% knew the frequency of self examination; awareness about symptoms of breast cancer was prevalent in 46%, 24% knew about risk factors of breast cancer. Regarding Cervical Cancer, 28% knew about risk factors, 22% knew about symptoms of cervical cancer; 19% knew about screening methods for cervical cancer, 9.5% knew the screening intervals.
Conclusion: Health education about cancer prevention should start at the primary school level. Special educational & motivational sessions for ASHA workers could help in cancer prevention programs.
Neo-adjuvant chemotherapy followed by surgery versus definitive chemo radiation as treatment for localized carcinoma cervix
Authors: Singh S. , Goel V. , Talwar V. , Raina S. , Mitra S. , Saxena U. , Shekhon R. , Rawal S. 
Published: February 2021

Background: Cervical cancer is ranked as the most common cancer in Indian women, second most common cancer worldwide and the leading cause of death in the developing countries. In the developing countries majority of the patients are diagnosed at locally advanced stages. The standard treatment of locally advanced cervical cancer is concomitant chemoradiation (CTRT) using platinum based chemotherapy. However, some randomized studies have shown improved results for patients receiving neoadjuvant chemotherapy (NACT) followed by surgical resection in comparison to patient receiving radiation alone. The present study was designed to compare response to the treatment and survival of and NACT followed by radical surgery (RS) with CTRT in the patients of uterine cervix of a tertiary cancer care centre.
Patients and Methods: Retrospective study was performed in locally advanced/advance stage patients of cervix UTERI registered in the institute between years 2009 to 2013. Patients were included in the two groups, group A consists of 89 patients who have received NACT + RS and 67 patients in group B who have received CTRT. Clinical records were reviewed with particular reference to presenting complaint, clinical stage, response to the therapy, disease free survival and overall survival. Statistical analysis was done using SPSS version 22.
Results: In the neoadjuvant group (group A) (n=89) the median age of patients was 53 years (range 31-80 years), most of the patients (70%) were presented with complaint of postmenopausal bleeding. Of the total patients, 69 (77.5%) underwent to radical surgery and 5 (8.5%) received radiotherapy after NACT. From 69 patients, who had undergone to surgery, 54 (78.3%) had also received radiation. The overall response to induction chemotherapy was 84%. In the chemo radiation group (group B) (n=65) median age was 56 years (33-75 years). Vaginal bleeding (34%) followed by postmenopausal bleeding (32%) was major presenting complaint in this group. Overall response to the complete treatment was 91%. The median follow up time was 14.3 months in group A and 12.2 months in group B. The disease free survival for NACT group was 32 months (95% CI 26.8-36.5) whereas for CTRT group it was 28 months (95% CI 23.5-33) with 12 and 13 recurrences per group (p = .226). In NACT group overall survival was 46.2 months (95% CI 44-48.3) and for CTRT group it was 38.3 months (95%CI 36.6-40) with 3 and 2 deaths per group (p=.883).
Conclusion: Present study shows comparable results, with no difference in survival between both the groups. However, NACT + RS group had showed better disease free and overall survival than another group. Further studies should be performed with larger number of patients and longer duration of follow up.
Image guided interstitial brachytherapy for locally advanced disease after external beam radiotherapy in a case of carcinoma cervix – our institutional experience
Authors: Tandon S. , Mitra S. , Sharma M. K. , Saxena U. , Ahlawat P. , Kaur I. , Chowdhary A. , Surkar P. 
Published: February 2021

Purpose/Objective: Cervical cancer is the third most common cancer in women worldwide. Definitive chemoradiation is the accepted standard of care for patients especially for locally advanced cervical cancers. Intracavitary brachytherapy (ICBT) is an important part of definitive radiotherapy shown to improve overall survival. Interstitial brachytherapy (ISBT) is generally reserved for patients either with extensive pelvic and/or vaginal residual disease after external beam radiotherapy (EBRT) or with anatomy not allowing ICBT with standard applicators in an attempt to improve local control. We have conducted an observational study for patients who underwent image guided HDR-ISBT at our institute.
Materials and Methods: Seven patients; diagnosed as a case of carcinoma cervix; were selected from the period of 2012 to 2015 who received EBRT by IMRT and for whom ICBT couldn’t be done for various reasons. These patients were then taken up for Martinez Universal Perineal Interstitial Template (MUPIT) image based ISBT. A descriptive analysis was done for doses received by HRCTV, bladder, rectum and sigmoid colon. At the end of treatment, early response at 3 months along with overall survival (OS) and disease free survival (DFS) was also calculated.
Results: All the patients recruited were locally advanced with 3 patients in IIB, 1 patient in IIIA and 3 patients belonging to IIIB. The mean dose received by 95% high risk CTV (HRCTV) by IMRT was 49.75 Gy. Out of 7 patients, 3 were taken up for ISBT due to anatomical restriction whereas remaining 4 patients were included because of lack of dose coverage by ICBT. The mean doses received by 90% of HRCTV, 2 cc bladder, 2 cc rectum and 2 cc sigmoid colon were 20.58 Gy, 2.73 Gy, 3.19 Gy and 2.82 Gy respectively. The early response at 3 months was 57.14%. The DFS at one year and OS at 3 year were 53.6% and 53.3% respectively.
Conclusions: Our descriptive analysis of seven patients being treated by image based ISBT have revealed that locally advanced cervical cancer patients for whom ICBT is unsuitable can achieve equitable LRC and OS with a combination of EBRT by IMRT and image based HDR-ISBT.
Breaking the myth: All carcinoma cervix presenting as pyometra will have only palliative treatment
Authors: Aarthi C. , Kumar A. C. Senthil , Sasireka P. 
Published: February 2021

Introduction: Carcinoma cervix is the second most common female carcinoma. Every year in India, 1,22,844 women are diagnosed with carcinoma cervix and of them 67,477 die. Carcinoma cervix rates among women in the age group between 30-64 has decreased by 1.8% per year on average but still date account for 16%. Of these, advanced carcinoma are about 80% and early are only 20%.
Case Series: We are reporting 5 consecutive early carcinoma cervix cases who presented with pyometra and got treated at our hospital from April 2015-September 2015. Cases of early carcinoma cervix presented with pyometra were treated by pyometra drainage, intravenous antibiotics and appropriate treatment in the form of surgery (4 cases underwent Wertheim’s hysterectomy and 1 case had radical chemo radiation as she opted for same in view of high cardiac risk for anaesthesia). All 5 of them are disease free at the end of treatment with follow up of minimum 4 months duration (range 4-10).
Conclusion: The idea is to emphasize that all carcinoma cervix with pyometra are not necessarily advanced and can still be given radical treatment like surgery or radiotherapy after pyometra drainage.
Comparative dosimetric study between point and volume based brachytherapy in definitive treatment of de novo carcinoma cervix
Authors: Hadi Rahat , Azam Mohammad , Gupta Pooja , Rath Satyajeet , Ali Mohammad , Prakash Chandra , Srivastava Anoop Kumar , Farzana S. 
Published: February 2021

Introduction: Cervical cancer has a high incidence in developing countries including India. Brachytherapy (BT) is an important component in the curative management of carcinoma of the cervix, and significantly improves survival. In gynaecologic BT, correlation between the radiation dose and the normal tissue effects have been assessed using point doses. Since 1985, these points have been defined in the international commission of radiation units and measurements (ICRU-38) report. However GEC-ESTRO recommended volume based treatment planning in their respective series (I-IV). For cervical cancer BT, the correlation of ICRU point doses and volume based treatment planning is investigational till date. Analysis becomes feasible when cross sectional image-based treatment planning for BT using computerized tomography (CT) or magnetic resonance imaging (MRI) is utilised as per GEC-ESTRO recommendation.
Methods: It is a retrospective pilot study includes patients (pts.) of carcinoma cervix treated with high dose rate (HDR) BT 9 Gy in 2 fractions 1 week apart. All volume based dosimeteric parameters regarding high risk clinical target volume (HRCTV), intermediate risk clinical target volume (IRCTV) like D90, D100 and for organ at risk (OAR) D 0.1 cc, D 1.0 cc and D 2.0 cc were delineated and dose coverage was analysed in point dose based planning.
Results: We have analysed twenty pts. of squamous cell carcinoma (SCC) cervix. The median age was 52 yrs. (41-65 yrs), stage II B 10 pts. & III B 10 pts. The mean value of D90 & D100 in HRCTV during I and II session were 8.64, 6.75 and 5.76, 4.36 Gy respectively. Same values for IRCTV were 6.31, 4.91 and 3.68, 3.15 Gy respectively. Analysis of OARs demonstrated that mean dose received by 0.1, volume of bladder during I and II session received 10.68, 9.47, by 1 cc volume 8.39, 7.57 and by 2 cc volume 6.84, 6.21 Gy respectively. The mean dose received by 0.1 cc of rectum were 11.59, 10.12, by 1 cc volume 9.53, 8.19 and by 2 cc volume 7.76, 6.81 Gy respectively. In point based analysis mean dose delivered to bladder point during I and II session were 5.63, 6.02 and to rectum point were 5.98, 5.46 Gy respectively. Doses to 0.1 cc volume of bladder and rectum were higher in volume based BT as compared to point based BT in respective fractions.
Conclusion: Both HRCTV and IRCTV had better dose coverage in 1st fraction as compared to 2nd fraction. Point doses to bladder and rectum is underestimated in point based (ICRU-38) BT. We need more number of pts in prospective randomized trial for more consistent result.
Carcinoma uterine cervix metastasis to the skin: A rare case report
Authors: Singh Gajender , Kataria Sant Parkash , Sen Rajeev 
Published: February 2021

Introduction: Most common site of metastasis from carcinoma cervix is lung, liver, bone and brain. Cutaneous metastasis is rare occurrence in carcinoma cervix. Incidence reported ranges from 0.1 to 2%. Common morphological pattern of skin metastases are nodules, plaques and inflammatory telangiectatic lesions.
Materials and Methods: A 68 years old postmenopausal female diagnosed as squamous cell carcinoma of cervix stage III B. She was given chemotherapy and radiotherapy and on regular follow up without no evidence of disease locally. After two years she presented with a sub cutaneous nodule of approximately 5x4 cm size just below the left scapula of one month duration. There was no similar swelling in any other region. It was rapidly increased in size and painful. The FNAC of the nodule showed metastatic from squamous cell carcinoma. PET scan showed metastases in bilateral lung and pelvic lymph node with no evidence of local disease. Excision biopsy of the nodule confirmed the diagnosis.
Conclusion: Cutaneous metastases from carcinoma cervix are rare. Differential diagnoses include benign dermatitis, subcutaneous phycomycosis, and plaque like mycosis fungoides.
Early stage adenocarcinoma of cervix with ovarian micrometastasis
Authors: Satyaprakash Mathur Neha , Singh Pratibha , Vyas Suyasha 
Published: February 2021

Introduction: Adenocarcinoma of cervix is a rare malignancy of cervix. It is an aggressive tumour with high incidence of metastasis. Ovarian metastasis in early stage adenocarcinoma is rare. Metastasis is usually seen when there is some other coexisting finding. In premenopausal patient and low risk category, ovarian metastasis is very rare.
Case Report: The present case is a 40 yrs old parous women, with complaints of discharge per vaginum. Her colposcopy showed an erosion on the lower lip. Radical hysterectomy with bilateral oophorectomy was planned. The histopathology was a well differentiated adenocarcinoma with surface ovarian metastasis on one side.
Discussion: Early stage adenocarcinoma of cervix can rarely present with ovarian metastasis. Thus radical surgery with oophorectomy is a an aggressive but practical approach in these patients.
Retrospective analysis of Ca cervix postoperative: An institutional study
Authors: Prakash Chandra 
Published: February 2021

Introduction: Carcinoma of cervix is one of the leading causes of death worldwide and in developing countries like India. Cervical cancer is third most common cancer among women however there is a good chance of curability if diagnosed in early stage.
Materials and Methods: We had analysed 78 patient of carcinoma of cervix post op who were registered from 2012 to 2015 at Dr. Ram Manohar Lohia Institute of Medical Sciences.
Results: We analysed 78 patients between age of 32-70 years and median age is 50 year. Among all patients squamous cell carcinoma is most common (65 patient), adenocarcinoma were 12 and lieomyosarcoma was 1 patient. Among all patient 12 were of adenocarcinoma, 1 of lieomyosarcoma and 65 patient of squamous cell carcinoma. On examination 55 patients were NAD and 23 were residual. Among squamous cell carcinoma 35 were moderate differentiated, 18 were well differentiated and 12 were of poorly differentiated. On examination 55 patients were NAD rest were having disease. Gap between EBRT and SORBO ranging from 3 to 99 days and median is 27 days and median is 29 days. Treatment length varies from 4 cm to 8 cm and median is 6 cm. Ovoide size ranges from 2.5 cm to 3.5 cm and median is 2.5 cm. Dose per fraction ranges from 5 Gy to 9 Gy and median was 9 Gy. Median fraction of session were 2. Out of 78 patients 2 were developed metastasis and 6 having residual disease. 28 patients were NAD and rest were referral and send back to parent hospital.
Conclusion: Due to lack of resources and awareness of disease maximum number of patient presented with advanced stage. The recommended treatment time could not be achieved due to scarcity of cancer centres, treatment time is prolonged. We have not found any relation between treatment length and outcome. We are still investigating to conclude to found out relation among these variables.