Clinical Application Effect of Paclitaxel Combined with Cisplatin Neoadjuvant Chemotherapy in Treatment of Early and Mid Stage Cervical Cancer

Objective:To study the application effect and value of paclitaxel combined with cisplatin neoadjuvant chemotherapy in treatment of early and mid stage cervical cancer.Methods:A total of 92 patients with early and mid stage cervical cancer admitted to our department from 2016 to 2018 were enrolled in the study.The patients were divided into two groups according to random number table.Reference group(n=46)was treated with cervical cancer radical resection combined with postoperative chemotherapy.On the same basis,experimental group(n=46)was given neoadjuvant chemotherapy regimen of paclitaxel combined with cisplatin.Total effective rate,adverse reaction and score of life quality of the two groups were compared.Results:Total effective rate of experimental group was 76.09%which was higher than reference group,41.30%.Score of life quality of the experimental group was higher than that of reference group,the comparison between two groups showed P<0.05.There was no difference in incidence of adverse reaction between the two groups,P>0.05.Conclusion:Application of neoadjuvant chemotherapy of paclitaxel combined with cisplatin had ideal tumor controlling effect for early and mid stage cervical cancer with lesser adverse reaction.Postoperative quality of life was high.It should be promoted in clinics.

Effect of Zhenwu decoction combined with paclitaxel neoadjuvant chemotherapy on the malignant degree of cervical cancer

Objective:To study the effect of Zhenwu decoction combined with paclitaxel neoadjuvant chemotherapy on the malignant degree of cervical cancer.Methods: Patients with cervical cancer who accepted neoadjuvant chemotherapy in Nanchong Central Hospital and Suining Central Hospital between March 2015 and June 2017 were selected and randomly divided into two groups, the observation group received neoadjuvant chemotherapy combined with Zhenwu decoction therapy, and the control group received neoadjuvant chemotherapy. Before chemotherapy and after 2 courses of chemotherapy, the serum was collected to detect the contents of tumor markers;after chemotherapy, the surgically removed cervical cancer lesion was collected to detect the mRNA expression of proliferation genes, tumor suppressor genes and invasion genes.Results: After 2 course of chemotherapy, CA12-5, bFGF and SCC-Ag levels in serum of both groups were lower than those before treatment, and CA12-5, bFGF and SCC-Ag levels in serum as well as Ki-67, TK-1, SOX-2, CyclinD1, S100A6, N-cadherin, Gal-3, CatL and CatD mRNA expression in cervical cancer lesion of observation group were lower than those of control group whereas p53, p16, FHIT, NF2-1 and LATS1 mRNA expression in cervical cancer lesions were higher than those of control group.Conclusion:Zhenwu decoction combined with paclitaxel neoadjuvant chemotherapy can be more effective than neoadjuvant chemotherapy alone to kill cervical cancer cells and reduce the malignancy of cervical cancer.

Effects of preoperative neoadjuvant chemotherapy on malignant biological characteristics in the lesions of patients with ⅠB-ⅡB cervical cancer

Objective: To investigate the effects of preoperative neoadjuvant chemotherapy on malignant biological characteristics in the lesions of patients with ⅠB-ⅡB cervical cancer. Methods:Patients who were diagnosed with ⅠB-ⅡB cervical cancer and underwent surgical treatment in Navy General Hospital of PLA between February 2015 and May 2017 were selected as the research subjects and randomly divided into the neoadjuvant chemotherapy group who underwent preoperative neoadjuvant chemotherapy and the control group who underwent routine preoperative preparation. After surgical resection, the mRNA expression of tumor suppressor genes, proliferation genes as well as migration and invasion genes in cervical cancer tissue were determined by fluorescence quantitative PCR. Results: After surgical resection, tumor suppressor genes THBS2, PTEN, LAST1 and eIF4E3 mRNA expression in cervical cancer tissue of adjuvant chemotherapy group were significantly higher than those of routine surgery group whereas proliferation genes RUNX2, CyclinD1, ALEX1, ALDH1 and ABCG2 as well as migration and invasion genes CXCL12, CXCR4, MMP9, S100A6 and N-cadherin mRNA expression were significantly lower than those of routine surgery group. Conclusion:Preoperative neoadjuvant chemotherapy can inhibit the proliferation, migration and invasion of cancer cells within the lesions of patients with ⅠB-ⅡB cervical cancer.

Efficacy of Oncoxin-Viusid on the Reduction of Adverse Reactions to Chemotherapy and Radiotherapy in Patients Diagnosed with Cervical Cancer and Endometrial Adenocarcinoma

Introduction: Oncoxin-Viusid (OV) has shown antioxidant, immunomodulatory and anti-tumour capabilities in experimental studies on humans and animal subjects. Acute toxicity of Radiation Therapy (RT) and Chemotherapy (CT) in patients with cervical cancer and endometrial adenocarcinoma impact quality of life and, therefore, outcomes of these therapies. Objective: To identify Oncoxin-Viusid’s efficacy in reducing acute toxicity produced by onco-specific treatments in patients with cervical cancer and endometrial adenocarcinoma. Materials and Methods: A controlled, randomised double-blind phase II clinical trial was performed with a sample size of 63 patients distributed into 2 groups: one receiving the standard treatment plus the Oncoxin-Viusid nutritional supplement (OV group) and another receiving the standard treatment and placebo (P group). The primary efficacy variable is the proportion of secondary disruptions to acute adverse reactions produced by RT and CT. Results: The number of patients suffering adverse events from chemotherapy was 20.6% less in the OV group (70.0%) than in the placebo group (90.6%) (p = 0.04). We recorded consistently normal values of haemoglobin (-6.2 OV group vs -8.3 P group, p = 0.009), platelet count (-17.4 OV group vs -27.6 P group, p = 0.009) and leukocytes (-31.8 OV group vs -41.4 P group, p = 0.025) in the OV group, tolerating 4 more cytostatic doses on average than the placebo group. Significant increase in quality of life (QLQ-30) was registered in the OV group with a large effect size on such issues as emotional and social function (Cohen’s d = 0.9), as well as in the reduction of symptoms like dyspnea 60%, insomnia 15% and anorexia 30% (item CX-2), (Cohen’s d = 0.98), which were higher than the placebo group. Conclusions: OV administration reduces onco-specific adverse events and improves quality of life in patients diagnosed with cervical cancer and endometrial adenocarcinoma undergoing radiation therapy and chemotherapy.

Role of Neoadjuvant Chemotherapy in Treatment of Cervical Cancer: A Case Series of Thirty-Eight Patients Treated at Bangabandhu Sheikh Mujib Medical University in Dhaka, Bangladesh

Background: Cervical cancer is the second most common malignancy of women in Bangladesh. Surgery is the mainstay of treatment of patients with early invasive cancer confined to cervix. While the five-year survival rate after surgery for stage IB1 disease exceeds 90%, it is only 60% - 70% for stage IB2 and IIA2 (tumor size > 4 cm). To improve the outcome of treatment, two to three cycles of Neoadjuvant Chemotherapy (NACT) has been evaluated as a treatment strategy in stage IB2 and IIA2 diseases. Objectives: This study aimed to evaluate the role of neoadjuvant chemotherapy (NACT) followed by Radical Surgery (RS) among the patients with early bulky cervical cancer (Stage IB2 & IIA2) to reduce the tumor size to achieve radical resectibility. Methods: This study was carried out at the Gynaecological Oncology Division of the Department of Obstetrics and Gynecology at Bangabandhu Sheikh Mujib Medical University (BSMMU) during the period July 2015 to December 2015. Thirty-eight patients with early bulky cervical cancer without any prior medical or surgical treatment received NACT using intravenous paclitaxel 175 mg/m2 and cisplatin 75 mg/m2 followed by radical surgery. The primary outcome measure assessed the response to NACT to reduce the size of the tumor. Secondary outcome measures assessed the resectibility of tumor and compared the preoperative clinical stage to the postoperative pathological stage. This study also assessed the relationship of intraoperative and postoperative complications including the adverse effects of postoperative radiotherapy and chemoradiotherapy. Results: Clinical response to NACT was 94.7% (84.2% complete response + 10.5% partial response). Progressive disease was found in two cases (5.3%). Duration of surgery was less than 2 hours in 81.6% cases and greater than 3 hours in 13.2% cases only. All women lived 5 to 10 hours away from Dhaka and could not return for in person follow-up. It was possible to get telephone follow-up on twenty-four women (63%). Seven (29%) had died from their cancers within one year of their surgery. Seventeen women were alive and disease free two years after completeion of their treatment. Conclusion: NACT is a feasible approach for improving the resectability of early stage bulky cervical cancer at BSMMU.

Image-based brachytherapy for cervical cancer

Cervical cancer is the third most common cancer in women worldwide; definitive radiation therapy and concurrent chemotherapy is the accepted standard of care for patients with node positive or locally advanced tumors > 4 cm. Brachytherapy is an important part of definitive radiotherapy shown to improve overall survival. While results for two-dimensional X-ray based brachytherapy have been good in terms of local control especially for early stage disease, unexplained toxicities and treatment failures remain. Improvements in brachytherapy planning have more recently paved the way for three-dimensional image-based brachytherapy with volumetric optimization which increases tumor control, reduces toxicity, and helps predict outcomes.Advantages of image-based brachytherapy include:improved tumor coverage(especially for large volume disease), decreased dose to critical organs(especially for small cervix), confirmation of applicator placement, and accounting for sigmoid colon dose. A number of modalities for image-based brachytherapy have emerged including: magnetic resonance imaging(MRI),computed tomography(CT), CT-MRI hybrid, and ultrasound with respective benefits and outcomes data. Forpractical application of image-based brachytherapy the Groupe Europeen de Curietherapie-European Society for Therapeutic Radiology and Oncology Working Group and American Brachytherapy Society working group guideline serve as invaluable tools, additionally here-in we outline our institutional clinical integration of these guidelines. While the body of literature supporting image-based brachytherapy continues to evolve a number of uncertainties and challenges remain including: applicator reconstruction, increasing resource/cost demands, mobile four-dimensional targets and organs-at-risk, and accurate contouring of "grey zones" to avoid marginal miss. Ongoing studies, including the prospective EMBRACE(an international study of MRI-guided brachytherapy in locally advanced cervical cancer) trial, along with continued improvements in imaging, contouring, quality assurance, physics, and brachytherapy delivery promise to perpetuate the advancement of image-based brachytherapy to optimize outcomes for cervical cancer patients.

Effect of neoadjuvant chemotherapy in combined with laparoscopy on the molecular markers and immune function in patients with locally advanced cervical cancer

Objective: To explore the efficacy of paclitaxel plus cisplatin (TP) neoadjuvant chemotherapy in combined with laparoscopy in the treatment of locally advanced cervical cancer and their effect on the molecular markers and immune function. Methods: A total of 92 patients with locally advanced cervical cancer were included in the study and divided into the control group (n=46) and the treatment group (n=46) according to the admission number. The patients in the control group were given 5- fluorouracil plus cisplatin (PF);neoadjuvant chemotherapy in combined with laparoscopic radical hysterectomy. The patients in the treatment group were given TP neoadjuvant chemotherapy in combined with laparoscopic radical hysterectomy. The clinical efficacy in the two groups was compared. The levels of molecular markers and the change of immune function in the two groups were detected and compared. The adverse reactions in the two groups were observed and compared. Results: After chemotherapy;in the treatment group;CR was 39.13%;PR was 41.30%;NC was 13.04%;PD was 6.52%;and the total effective rate was 80.43%;while those in the control group were 21.74%;26.09%;30.43%;21.74%;and 47.83%;respectively. The total effective rate in the treatment group was significantly higher than that in the control group. The comparison of the occurrence rate of adverse reactions between the two groups was not statistically significant. CEA;SCC-Ag;CYFRA21-1;and CA125 levels 2 weeks after operation in the two groups were significantly reduced when compared with before treatment;and those in the treatment group were significantly lower than those in the control group. MMP-2;TIMP-2;VEGF-C;and VEGF-D levels 2 weeks after operation in the two groups were significantly reduced when compared with before treatment;and those in the treatment group were significantly lower than those in the control group. CD3+;CD4+;and CD8+ 2 weeks after operation in the two groups were significantly reduced when compared with before treatment;while CD4+/CD8+was significantly elevated;but the comparison between the two groups was not statistically significant. Conclusions: Given TP neoadjuvant chemotherapy in combined with laparoscopy in patients with locally advanced cervical cancer can obviously enhance the patient's clinical efficacy;reduce the molecular markers in the body;effectively improve the patient's immune functionwith less adverse reactions and accurate efficacy;therefore;they are safe and reliable.

Neoadjuvant chemotherapy for locally advanced cervical cancer reduces surgical risks and lymph-vascular space involvement

Neoadjuvant chemotherapy(NACT),which can reduce the size and therefore increase the resectability of tumors,has recently evolved as a treatment for locally advanced cervical cancer.NACT has been reported to decrease the risk of pathologic factors related to prognosis of cervical cancer.To further assess the effects of NACT on surgery and the pathologic characteristics of cervical cancer,we reviewed 110 cases of locally advanced cervical cancer treated with radical hysterectomy with or without NACT at the People's Hospital of Peking University between January 2006 and December 2010.Of 110 patients,68 underwent platinum-based NACT prior to surgery(NACT group) and 42 underwent primary surgery treatment(PST group).Our results showed 48 of 68(70.6%) patients achieved a complete response or partial response to NACT.Estimated blood loss,operation time,and number of removed lymph nodes during surgery,as well as complication rates during and after surgery were not significantly different between the NACT group and the PST group.The rates of deep stromal invasion,positive parametria,positive surgical vaginal margins,and lymph node metastasis were not significantly different between the two groups.However,the rate of lymph-vascular space involvement(LVSI) was significantly lower in the NACT group than in the PST group(P = 0.021).In addition,the response rate of NACT was significantly higher in the patients with chemotherapeutic drugs administrated via artery than via vein.Our results suggest that NACT is a safe and effective treatment for locally advanced cervical cancer and significantly decreases the rate of LVSI.

Changes in three-dimensional power Doppler ultrasound features before and after neoadjuvant chemotherapy for cervical cancer and their relationship with malignant molecule expression

Objective:To study the changes in three-dimensional power Doppler ultrasound features before and after neoadjuvant chemotherapy for cervical cancer and their relationship with malignant molecule expression.Methods: The patients who were diagnosed with cervical cancer and received neoadjuvant chemotherapy in Wuhan Red Cross Hospital between March 2015 and October 2017 were selected as the cervical cancer group, and the patients who received cervical biopsy and were diagnosed with stage I cervical intraepithelial neoplasia by pathological findings during the same period were selected as the control group. Before biopsy, three-dimensional power Doppler ultrasonography was performed to measure VI, FI and VFI;the tissues of cervical cancer group before and after chemotherapy as well as the biopsy tissues of control group were collected to measure the expression of proliferation genes, invasion genes and angiogenesis genes.Results: The VI, FI and VFI levels as well as the Piwil2 gene (Piwil2), CyclinD1, N-Myc downstream regulated gene 3 (NDRG3), CXC chemokine ligand 5 (CXCL5), cathepsin-L (CAT-L), EGF-containing fibulin-like extracellular matrix protein 1 (EFEMP1), angiotensin (Ang)1, Ang2 and angiopoietin-like protein 4 (ANGPTL4) mRNA expression levels in the tissues of cervical cancer group before and after chemotherapy were all significantly higher than those of control group whereas the thrombospondin 2 (THBS2), Smac gene (Smac), large tumor suppressor kinase 1 (LATS1), reversion-inducing-cysteine-rich protein with kazal motifs (RECK) and plas minogen activator inhibitor 1 (PAI-1) mRNA expression levels in the tissues were all significantly lower than those of control group, and the VI, FI and VFI levels as well as the Piwil2, CyclinD1, NDRG3, CXCL5, CAT-L, EFEMP1, Ang1, Ang2 and ANGPTL4 mRNA expression levels in the tissues of cervical cancer group after chemotherapy were all significantly lower than those before chemotherapy whereas the THBS2, Smac, LATS1, RECK and PAI-1 mRNA expression levels were all significantly higher than those before chemotherapy;the VI, FI and VFI levels in cervical cancer tissues were positively correlated with the Piwil2, CyclinD1, NDRG3, CXCL5, CAT-L, EFEMP1, Ang1, Ang2 and ANGPTL4 mRNA expression levels, and negatively correlated with the THBS2, Smac, LATS1, RECK and PAI-1 mRNA expression levels.Conclusion: The changes in the three-dimensional power Doppler ultrasound parameters before and after neoadjuvant chemotherapy for cervical cancer can reflect the changes in proliferation, invasion and angiogenesis gene expression in the lesions.

APOPTOSIS AND PROLIFERATION OF TUMOR CELLS IN LOCALLY ADVANCED CERVICAL CANCER AFTER NEOADJUVANT INTRAARTERIAL CHEMOTHERAPY

Objective: Through observing the clinical response toneoadjuvant intraarterial chemotherapy in locally advanced cervical cancer and investigating the changes of p53 proteinexpression, proliferation and apoptosis of tumor cells afterchemotherapy, to study the relationship between biological markers and chemotherapeutic response. Methods: 20women with locally advanced squamous cervical cancerreceived consecutive infusion chemotherapy of five days ofcisplatin and adriamycin via the superselective uterineartery. The response to chemotherapy was evaluated bygynecologic examination and ultrasonography 3 weeks after chemotherapy. The changes of apoptotic index (AI), proliferation index (PI) and p53 expression of tumor cellswere detected by immunohistochemical technique.Results: The clinical response rate of locally advancedsquamous cervical cancer to uterine artery infusionchemotherapy was 70%. No change of PI was found 3 weeks after treatment, but AI significantly increased from2.79?.76 to 4.29?.13 (P<0.01), and AI/PI from 5.68?.21 to 9.00?.95 (P<0.05). On the contrary, the expression of p53was significantly decreased (P<0.05). Patients whoresponded to chemotherapy showed higher PI before chemotherapy and significantly increased AI and AI/PIafter chemotherapy than non-responders (P<0.05).Conclusion: Higher PI was an indication for neoadjuvantintraarterial chemotherapy. One more cycle ofchemotherapy should be given to those who have significantly increased AI or AI/PI after chemotherapy, while definite treatment such as surgery or/and radiotherapy should be immediately given to those patients without increased AI or AI/PI.

Pharmacokinetic comparison between ultraselection of uterine artery and peripheral vein chemotherapy of carboplatin in cervical cancer

Objective:The present study is to compare pharmacokinetics difference of carboplatin by using ultraselection uterine artery with by using peripheral vein in cervical cancer.Methods:Thirteen patients with locally advanced cervical cancer who had been proved by pathobiology were randomly divided into two groups:the ultraselection uterine artery group(group A, n = 6) and the peripheral vein(group B, n = 7).Carboplatin was administered by infusing into artery or vein in both groups at the dosage of 300 mg/m2.Tissues from the cervical tumor were collected at different times after infusion in both groups and then analyzed.Results:The peak concentration of platinum in tumor tissue was about 2.79 times higher in group A than that of group B(P < 0.05).The platinum concentrations in tumor in group A reached its peak levels immediately after infusion.But, group B had delayed time.While, for the time point of 0 min, when the administration finished immediately, the platinum concentration in tumor was significantly higher when compared with group B(P < 0.05).The tumor tissue area under the concentration(AUC) of carboplatin was about 2 times higher in group A than that of group B(P < 0.05).Conclusion:We observed the pharmacological advantages of chemotherapy by using ultraselection uterine artery administration of chemotherapeutic agent carboplatin in tumor tissue which provided theoretical basis and laboratory parameters of the intra-arterial chemotherapy for gynecologic malignancy.

Adjuvant chemotherapy for early-stage cervical cancer

The aim of this review is to address the current status of adjuvant chemotherapy alone in early-stage cervical cancer treatments in the literature. At present, the therapeutic effect of adjuvant chemotherapy alone after radical surgery （RS） has not yet been established, and radiation therapy （RT） or concurrent chemoradiotherapy （CCRT） is recommended as the standard adjuvant therapy after RS for early-stage cervical cancer in various guidelines. The main purpose of adjuvant therapy after RS, however, should be to reduce extrapelvic recurrence rather than local recurrence, although adjuvant RT or CCRT has survival benefits for patients with intermediate- or high-risk factors for recurrence. Moreover, several studies reported that adjuvant therapies including RT were associated with a higher incidence of complications, such as lymphedema, bowel obstruction and urinary disturbance, and a lower grade of long-term quality of life （QOL） or sexual functioning than adjuvant chemotherapy alone. The effect of adjuvant chemotherapy alone for early-stage cervical cancer with intermediate- or high-risk factors for recurrence were not fully investigated in prospective studies, but several retrospective studies suggest that the adjuvant effects of chemotherapy alone are at least similar to that of RT or CCRT in terms of recurrence rate, disease-free survival, or overall survival （OS） with lower incidence of complications. Whereas cisplatin based combination regimens were used in these studies, paclitaxel/cisplatin （TP） regimen, which is currently recognized as a standard chemotherapy regimen for patients with metastatic, recurrent or persistent cervical cancer by Gynecologic Oncology Group （GOG）, had also survival benefit as an adjuvant therapy. Therefore, it may be worth considering a prospective randomized controlled trial （RCT） of adjuvant chemotherapy alone using TP regimen versus adjuvant RT as an alternative adjuvant therapy. Because early-stage cervical cancer is a curable condition, it is necessary that the therapeutic strategies should be improved with considering adverse events and QOL for long-term survivors.

Effects of different administration routes of neoadjuvant chemotherapy on cancer cell growth signal pathway function in cervical cancer

Objective:To study the effects of different administration routes of neoadjuvant chemotherapy on cancer cell growth signal pathway function in cervical cancer.Methods: Patients with cervical cancer who received neoadjuvant chemotherapy in Fufeng People's Hospital between July 2008 and July 2016 were selected as the research subjects and randomly divided into intervention group and intravenous group who accepted the neoadjuvant interventional arterial chemotherapy and neoadjuvant intravenous chemotherapy respectively. After surgical resection, the contents of PI3K/AKT/mTOR, Wnt/β-catenin and MEK/ERK signaling pathway in cervical cancer lesions were determined.Results:p-PI3K, p-AKT, mTOR, MMP2, VEGF,β-catenin, CyclinD1, Twist, Slug, Snail, MEK1, MEK2, ERK1/2 and Bcl-2 protein levels in cervical cancer lesion of intervention group were significantly lower than those of intravenous group whereas E-cadherin and Bax protein levels were significantly higher than those of intravenous group.Conclusion: Neoadjuvant interventional arterial chemotherapy can be more effective than neoadjuvant intravenous chemotherapy to inhibit the cancer cell growth mediated by PI3K/AKT/mTOR, Wnt/β-catenin and MEK/ERK signaling pathway in cervical cancer.

Californium-252 neutron brachytherapy combined with external pelvic radiotherapy plus concurrent chemotherapy for cervical cancer: a retrospective clinical study

Background:Cervical cancer is the sixth most common cancer in Chinese women.A standard treatment modal?ity for cervical cancer is the combination of surgery,chemotherapy,external?beam radiotherapy and intracavitary brachytherapy.The aim of this study was to retrospectively assess the long?term treatment outcomes of patients with cervical cancer who were treated with californium?252 neutron brachytherapy combined with external?beam radio?therapy plus concurrent chemotherapy.Methods:We retrospectively analyzed the medical records of 150 patients with primary stages IB?IVB cervical cancer who received neutron brachytherapy combined with external?beam radiotherapy concurrently with cisplatin chemo?therapy.All patients were followed up.Using an actuarial analysis,patient outcomes and treatment?related adverse effects were evaluated and compared.Results:The median overall survival(OS)was 33.2 months.The 3?year progression?free survival rates for patients with stages I–II,III,and IV diseases were 81.0%(68/84),65.0%(39/60),and 0%(0/6),respectively;the 3?year OS rates were 90.5%(76/84),85.0%(51/60),and 16.7%(1/6),respectively.Vaginal bleeding was controlled within the median time of4.0 days.One month after treatment,97.3%of patients achieved short?term local control.The local recurrence rates for patients with stages I–II,III,and IV disease were 4.8%(4/84),11.7%(7/60),and 33.3%(2/6),respectively,and the occurrence rates of distant metastasis were 16.7%(14/84),25.0%(15/60),and 100.0%(6/6),respectively.Cancer stage,tumor size,and lymph node metastasis were identified as prognostic risk factors,but only lymph node metastasis was found to be an independent prognostic factor.The most common adverse effects during treatment were grades 1 and 2 irradiation?related proctitis and radiocystitis.Conclusion:For patients with cervical cancer,neutron brachytherapy combined with external?beam radiotherapy plus concurrent chemotherapy produces a rapid response and greatly improves local control and long?term survival rates with tolerable adverse effects.

Effect of anxiety and depression on serum neurotransmitters and immune function in patients with cervical cancer chemotherapy

Objective:To study the effect of anxiety and depression on serum neurotransmitters and immune function in patients with cervical cancer chemotherapy.Methods:Patients with advanced cervical cancer who received chemotherapy in the First Affiliated Hospital of Chengdu Medical College between May 2014 and June 2016 were selected, HAMA scores and HAMD scores were used to assess anxiety and depression and divide the patients into control group, depression group, anxiety group and depression + anxiety group. The contents of monoamine neurotransmitters and immune cytokines in serum as well as the expression of immune transcription factors in peripheral blood mononuclear cells were detected.Results:Serum NE, E, 5-HT, 5-HIAA and DOPAC contents of depression group and depression + anxiety group were significantly lower than those of control group, and serum NE, E, 5-HT, 5-HIAA and DOPAC contents of anxiety group were significantly higher than those of control group;peripheral blood T-bet mRNA expression as well as serum IFN-γ and TNF-α contents of depression group, anxiety group and depression + anxiety group were significantly lower than those of control group while GATA3, Foxp3 and RORγt mRNA expression as well as serum IL-4, TGF-β and IL-17 contents were significantly higher than those of control group;peripheral blood T-bet mRNA expression as well as serum IFN-γ and TNF-α contents of depression + anxiety group were significantly lower than those of depression group and anxiety group while GATA3, Foxp3 and RORγt mRNA expression as well as serum IL-4, TGF-β and IL-17 contents were significantly higher than those of depression group and anxiety group. Conclusion: Anxiety and depression in patients with cervical cancer chemotherapy can affect the secretion of monoamine neurotransmitters, the differentiation of CD4+T cell subsets and the antitumor immune response mediated by them.

Comparison of efficacy and safety between late-course and simultaneous integrated dose-increasing intensity-modulated radiation therapy for cervical cancer complicated with pelvic lymph node metastasis

Objective This study aimed to compare and analyze the clinical efficacy and safety of late-course and simultaneous integrated dose-increasing intensity-modulated radiation therapy(IMRT) for cervical cancer complicated with pelvic lymph node metastasis. Methods Sixty patients with cervical cancer complicated with pelvic lymph node metastasis who were admitted to our hospital from January 2013 to January 2015 were enrolled. The patients were randomly divided into the late-course dose-increasing IMRT group and the simultaneous integrated dose-increasing IMRT group, with 30 cases included in each group, respectively. All patients were concurrently treated with cisplatin. After treatment, the clinical outcomes of the two groups were compared. Results The remission rate of symptoms in the simultaneous integrated dose-increasing IMRT group was significantly higher than that in the late-course dose-increasing IMRT group(P < 0.05). The follow-up results showed that the overall survival time, progression-free survival time, and distant metastasis time of patients in the simultaneous integrated dose-increasing IMRT group were significantly longer than those in the late-course dose-increasing IMRT group(P < 0.05). The recurrent rate of lymph nodes in the radiation field in the simultaneous integrated dose-increasing IMRT group was significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group. There was no significant difference in the incidence of cervical and vaginal recurrence and distant metastasis between the two groups(P > 0.05). The radiation doses of Dmax in the small intestine, D1 cc(the minimum dose to the 1 cc receiving the highest dose) in the bladder, and Dmax in the rectum in the simultaneous integrated dose-increasing IMRT group were significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group. There was no significant difference in intestinal D2 cc(the minimum dose to the 2 cc receiving the highest dose) between the two groups(P > 0.05). The incidence of bone marrow suppression in the simultaneous integrated dose-increasing IMRT group was significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group.Conclusion The application of simultaneous integrated dose-increasing IMRT in the treatment of cervical cancer patients complicated with pelvic lymph node metastasis can significantly control tumor progression, improve the long-term survival time, and postpone distant metastasis time with high safety.

Perioperative chemotherapy strategies in diffuse gastric cancer

This study reviews the findings of a recent study by Li et al,which demonstrated that perioperative chemotherapy benefits patients with diffuse-type gastric cancer compared to surgery alone.Despite potential biases,the study supports the inclusion of perioperative chemotherapy in treatment guidelines.Neoadjuvant and adjuvant chemotherapy may also provide similar survival outcomes,allowing for flexible treatment planning.

Analysis on the medication rules and mechanisms of action of traditional Chinese medicine in treating cervical cancer

Objective: To summarize the rule of application of traditional Chinese medicine (TCM) in the prevention and treatment of cervical cancer, and to explore the molecular mechanism of the compatibility of core herbs. Methods: Collect relevant literatures on cervical cancer in Chinese National Knowledgey Ifrastructure (CNKI), use TCM inheritance platform system (TCMISSV2.5) for association rules and complex system entropy clustering analysis;use BATMAN-TCM online analysis tools to construct target-pathway-disease network to reveal the underlying mechanisms of action. Results: Among the 78 prescriptions selected, a total of 172 Chinese medicines were used, and the five most frequently used herbs were Huang-bo (Phellodendri Chinrnsis Cortex), Fu-ling (Poria Cocos), Huang-qi (Hedysarum Multijugum Maxim.), Bai-hua-she-she-cao (Hedyotis Diffusae Herba) and Gan-cao (Licorice). Bai-hua-she-she-cao (Hedyotis Diffusae Herba) and Huang-qi (Hedysarum Multijugum Maxim.), Bai-hua-she-she-cao (Hedyotis Diffusae Herba) and Fu-ling (Poria Cocos), Bai-zhu (Atractylodes Macrocephala Koidz.) and Fu-ling (Poria Cocos) are the three most commonly used medicine match. In addition, through cluster analysis, a total of 4 core herbs compatibility and 2 new prescriptions were excavated. Herbs in the new prescriptions which are used to clearing heat-toxin and removing dampness were most frequently used. Through the analysis of the signal pathway of high frequency Chinese medicines, we found that neuroactive ligand-receptor interaction pathway may play important roles. Conclusion: The core Chinese medicines for the prevention and treatment of cervical cancer are mainly clearing heat-toxin and removing dampness. The core Chinese medicines may play their anti-cervical cancer by interfering with the neuroactive ligand-receptor interaction signaling pathway.

Metastatic appendiceal cancer treated with Yttrium 90 radioembolization and systemic chemotherapy:A case report

BACKGROUND Primary appendiceal cancers are rare,and they generally present with liver and/or peritoneal metastases.Currently there are no guidelines to treat metastatic appendiceal cancer,and hence they are treated as metastatic colorectal cancer.Combining Yttrium 90(Y-90)radioembolization(RE)with systemic chemotherapy early in the treatment of right sided colon cancers has been shown to improve survival.Based on this data,a combination of systemic chemotherapy and Y-90 RE was used to treat a case of metastatic appendiceal cancer.CASE SUMMARY A 76-year-old male presented to the emergency room with progressive right lower quadrant pain.A Computed Tomography of the abdomen and pelvis was performed which showed acute appendicitis and contained perforation.Urgent laparoscopic appendectomy was then followed by histological analysis,which was significant for appendiceal adenocarcinoma.After complete workup he underwent right hemicolectomy and lymph node dissection.He received adjuvant chemotherapy as the local lymph nodes were positive.Follow-up imaging was significant for liver metastasis.Due to rapid growth of the liver lesions and new peritoneal nodules,the patient was treated with a combination of Y-90 RE and folinic acid,fluorouracil,and irinotecan with bevacizumab and not microwave ablation as previously planned.Follow up imaging demonstrated complete response of the liver lesions.At 12-mo follow-up,the patient continued to enjoy good quality of life with no recurrent disease.CONCLUSION Utilization of Y-90 RE concomitantly with systemic chemotherapy early in the treatment of appendiceal cancer may provide improved control of this otherwise aggressive cancer.

Integration of Cervical Cancer Screening Services in the Routine Examinations Offered in the Kenyan Health Facilities: A Systematic Review

Cervical cancer is the second most common cancer among women and the leading cause of deaths among women worldwide. In Kenya, uptake of screening services is at 3.2% below the targeted of 70%. Therefore, there is need to study the factors that lead to low uptake of the screening services. One way of increasing the uptake of the screening services is its integration with other routine services, thus leading to a reduction in morbidity and mortality rates associated with the disease. The objective of this study was to review and examine the importance of integrating cervical cancer screening services in the routine examinations offered in the Kenyan health facilities. A retrospective study design was adopted by this study. The review of articles, journals, strategic plans was done from the year 2012 to 2017. Data sources included Medline, PMC, Library, Pubmed, Google scholar, cancer prevention plans and strategies. About 28 data sources were reviewed with 78.5% indicating that increased knowledge and creation of awareness on cervical cancer would greatly improve the utilization of the screening services. More than 87% of the information collected among published work in Kenya demonstrated that knowledge on importance cervical cancer screening is inadequate. The primary results of this study suggest that all women of reproductive age (WRA) should undergo cervical cancer screening as a routine service. An integration approach should be adopted, to enhance knowledge on cervical cancer and the importance of screening, causes, preventive and treatment options. The study recommends that, the Government of Kenya through the Ministry of health should include cervical cancer screening as a routine procedure for all WRA.