Ming Yin Lin

Carcinoma of the cervix in elderly patients treated with radiotherapy: patterns of care and treatment outcomes

Objective The aim of this analysis was to examine the management of cervix cancer in elderly patients referred for radiotherapy and the results of treatment in terms of overall survival (OS), relapse-free survival (RFS), and treatment-related toxicities. Methods Patients were eligible if they were aged ≥75 years, newly diagnosed with cervix cancer and referred for radiotherapy as part of their treatment. Patient details were retrieved from the gynaecology service database where clinical, histopathological treatment and follow-up data were prospectively collected. Results From 1998 to 2010, 126 patients aged ≥75 years, met selection criteria. Median age was 81.5 years. Eighty-one patients had definitive radiotherapy, 10 received adjuvant radiotherapy and 35 had palliative radiotherapy. Seventy-one percent of patients had the International Federation of Gynecology and Obstetrics stage 1b–2b disease. Median follow-up was 37 months. OS and RFS at 3 years among those treated with curative intent were 66.6% and 75.9% respectively with majority of patients dying without any evidence of cervix cancer. Grade 2 or more late toxicities were: bladder 5%, bowel 11%, and vagina 27%. Eastern Cooperative Oncology Group (ECOG) status was a significant predictor of OS and RFS with each unit increment in ECOG score increased the risk of death by 1.69 times (p<0.001). Conclusion Following appropriate patient selection, elderly patients treated curatively with radiotherapy for cervix cancer have good disease control. Palliative hypofractionated regimens are well tolerated in patients unsuitable for radical treatment.

Staging for cervix cancer: Role of radiology, surgery and clinical assessment.

Staging is necessary in determining the extent of disease, its prognosis and in the formulation of optimal treatment protocols for patients with cancer. Clinical examination of patients and subsequent histopathological assessment when available has traditionally been used to determine the application of different primary and adjuvant treatment modalities. Over the years, surgery, radiotherapy and chemotherapy all have been used either singly or in combinations, and the resulting survival and patterns of failure studies have contributed much in the development of less toxic and more effective protocols. All three modalities of treatments work through separate mechanisms, and they are effective in different stages of cervix cancer. Even within the same stage, the extent of the disease, tumour volume, tissue infiltration and lymph-node metastases requires the use of differing protocols for the disease control. More recently, advances in magnetic resonance imaging (MRI) and positron emission tomography/computerised tomography (PET/CT) have made it possible to examine many of the prognostic factors non-invasively. In addition to clinical assessment, surgical and radiological staging has enabled us to triage patients far more accurately for surgery or for primary radiotherapy, such as unnecessary multimodality treatments are avoided. Only patients with poor prognosis are subjected to a combined modality treatment. Those with poorer prognosis still can be selected for clinical studies exploring new treatment.

Role of imaging in the routine management of endometrial cancer

Endometrial cancer is the most common gynecologic cancer in women today. It is surgically staged, and while surgery is the primary treatment modality, the identification of disease extent—in particular extrauterine spread—prior to surgery is important to optimize treatment decision making. Ultrasound and MRI are useful for evaluating the extent of local disease, while CT and PET are used for detecting lymph node or distant metastases. Diffusion‐weighted MRI has also been used for detecting small metastatic deposits in lymph nodes and omentum. Extrauterine soft tissue involvement can be detected by ultrasound, CT, MRI, and PET. Recently, intraoperative visualization techniques, such as sentinel lymph node mapping, are increasingly used to avoid extensive surgical staging without compromising treatment. Imaging is also used for planning adjuvant treatment and detection of postoperative residual disease in high‐risk patients, monitoring and detecting recurrent disease, and in post‐treatment surveillance of asymptomatic patients with high risk of relapse.

Patterns of failure and outcomes of patients with node positive vulva carcinoma treated with radiotherapy

Objectives: To evaluate the accuracy and safety of sentinel lymph node (SLN) mapping in patients with endometrial cancer using TC99m colloid and blue dye, and to evaluate the contribution of preoperative mapping by planar lymphoscintigraphy (PLSG) and SPECT/CT. Methods: Retrospective analysis of patients who underwent SLN mapping as part of their primary surgery for endometrial cancer from January 2013 until November 2014. Patients underwent preoperative SLN mapping by PLSG and later with additional SPECT/CT. Intraoperative mapping was performed by using both Tc99m colloid and blue dye by cervical injections. SLNs were sent separately to pathologic evaluation with ultrastaging. Results: Fifty three patients were included in this study. Successful preoperative mapping was achieved in 31 of 37 patients (84.5%) undergoing SPECT/CT, compared to only 30 of 45 patients (67%) undergoing PLSG. SPECT/CT localizations of SLNs were accurate in 91% of cases. Intraoperative detection of at least one SLN was 77%, while bilateral detection rate was 49%. Failed mapping was more prevalent in patients with advanced age (p=o.o41).Six cases of nodal metastasis were diagnosedFour by positive SLN, including two cases by ultrastaging only, and two more cases with failed mapping were diagnosed using side-specific full dissection according to the SLN algorithm. There were no cases of false negative results. Conclusions: SLN mapping using a cervical injection with combined Tc99m colloid and blue dye is feasible, safe and accurate in patients with endometrial cancer. Preoperative SPECT/CT has high detection rate and provides accurate anatomic location of the SLN. Copyright