Cervical Cancer

PET in cervical cancer – pro

Lay Summary: PET has become an accepted tool for determining the extent of newly diagnosed cervical cancer and for following effects of treatment NCCN recently (8/07) revised its staging recomendations and lists PET as a recommended staging modlity. Positron-emission tomography (PET) scan is no longer optional for ≥ stage IB2 disease and is now recommended as part of the workup. Whole-body positron emission tomography (PET) completed after cervical

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Second line chemo for cervical cancer – pro

l.Lay Summary: Single agents are the best choice for 2nd line chemotherapy of cervical cancer. Treatment is only palliative in patients with stage IVB disease, especially 2nd line, so quality of life and toxicity profiles must influence the choice of treatment. The only RCT to identify a chemotherapy regimen that gave these patients an overall survival advantage and that included quality of life measurements compared cisplatin with cisplatin plus

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TPF for cervical cancer – pro

Lay Summary: I review otions for metastatic cervical cancer with the focus on the TPF regimen. Although there have been important advances in the management of women with cervical cancer, the optimal treatment for patients with locally recurrent and metastatic disease is still problematic, and there are relatively few randomized trials to guide treatment decisions. There are a large number of chemotherapeutic agents with "activity" in metastatic

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PET for cervical cancer – pro

For a initial staging, PET scan is of limited utility. While it can well assess known lymphadenopathy, it is not a sensitive staging tool. Many studies have reported low sensitivities for the detection of nodal metastases, ranging from 25–73%. Chao et al. concluded that PET/CT has a limited role in staging for patients with early-stage disease and should not replace lymphadenectomy for the detection of lymph node metastases. Many studies have

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Electronic radiotherapy – pro

The Axxent® Electronic Brachytherapy System® utilizes a miniaturized high dose rate  X-ray source to apply radiation directly to the cancerous tumor bed. It was cleared for marketing by the FDA in December 2005. Unlike traditional high dose rate brachytherapy technologies, this form of brachytherapy is claimed not to require radioactive isotopes, heavy shielding, or major capital equipment. A number of posters and presentations, most of it in

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Chemoradiation for cervical cancer – pro

The standard of care now is chemoradiation with cisplatin alone in stage IIA cervical cancer. The value of adding cisplatin or cisplatin-based chemotherapy to radiation for treatment of locally advanced cervical cancer is strongly supported by randomized studies and meta-analyses. Over the last 20 years, a number of trials testing concurrent chemoradiation were performed in an attempt to improve treatment results. Despite this, in 1996 a National

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Small cell cervical cancer – pro

Small cell carcinoma of the cervix is a rare cancer, comprising less than 3% of all cervical neoplasms. It uniformly has a poor prognosis, and has a high mortality even with early stage disease. It can metastasise rapidly and metastatic sites include lung, liver, brain, bone, pancreas and lymph nodes. The largest retrospective review was form Korea and published in 2007. It concluded that : "results indicate primary radical surgery followed by adjuvant

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Chemotherapy for metastatic cervical cancer – pro

Metastatic cervical cancer responds moderately to chemotherapy and it can provide palliation. One guideline writes: "It is recommended that all patients, particularly those who have been previously treated with cisplatin as a radiosensitizer, be offered the opportunity to participate in randomized trials, if available, that evaluate the efficacy and toxicity of other single-agent or combination chemotherapy regimens. Until further evidence becomes

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Reirradiation of recurrent cervical cancer – pro

When cervical cancer recurrs after chemoradiation, options are limited and include surgical exenteration, chemotherapy of reirradiation. The latter option is not well studied.Several case series have been published but the results have not been impressive. Whether IMRT, hyperfractionated radiation or confomrmal modlalities are useful is not known. The role of radioprotectants, such as Amifostine, has not been studied. Kim JH, Choi TJ, Kim OB.Reirradiation

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