Postoperative radiotherapy use and patterns of care analysis for node positive or parametria positive cervical cancer

The effect of refined psychological pain nursing combined with IMB nursing on the pain, sleep and quality of life of patients after cervical cancer surgery

To explore the effect of refined psychological pain nursing combined with information-motivation-behavioral (IMB) care model on the pain, sleep and quality of life of patients after cervical cancer surgery, so as to provide reference and basis for the nursing of patients after cervical cancer surgery. The clinical data of 798 postoperative cervical cancer patients who were nursing in our hospital from January 2018 to December 2022 were included in this retrospective study and divided into the control group (n = 382) and observation group (n = 416) according to the different care methods. The control group used refined psychological pain nursing, and on this basis, the observation group used IMB nursing to observe and compare the differences in pain, sleep and quality of life between the 2 groups. There was no significant difference in pain between the 2 groups before nursing (P > .05). After nursing, the pain of both groups was significantly improved. The scores of NRS, VAS, and PSEQ of the observation group were significantly better than those of the control group (P < .001). After nursing, the quality of life scores such as emotion, cognition, society, and overall health were significantly higher in the observation group than those of the control group, while physical, fatigue, nausea, vomiting, and pain were significantly lower than those of the control group (P < .05). The negative emotion score of the observation group was significantly lower than that of the control group (P < .001). The residual urine volume and urinary tract infection rate of the observation group were significantly lower than those of the control group (P < .05). The bladder function was significantly better than that of the control group (P < .05). The analgesic effect of refined psychological pain nursing combined with IMB nursing on patients after cervical cancer surgery is better than that of refined psychological pain nursing alone, which can promote pain recovery and further improve the quality of life and sleep quality of patients.

Number of paraaortic lymph node dissections as a prognostic factor in locally advanced cervical cancer

BACKGROUND

Lymph node (LN) metastases are the most important prognostic factor in locally advanced cervical cancer. Paraaortic lymphadenectomy is the only method able to confirm the presence of metastasis and thereby help to determine the most adequate treatment approach. There is no standard regarding the minimal number of LNs that should be removed in paraaortic lymphadenectomy. Women with undiagnosed positive paraaortic LNs (false negatives) due to a low LN count do not receive extended-field radiation therapy, which may lead to worse survival outcomes. The aim of this study is to confirm LN metastases as poor prognosis and to assess whether in cases of locally advanced CC with negative paraaortic LN status, the number of paraaortic LN laparoscopically removed carries a prognostic value.

METHODS

We analyzed 78 patients with locally advanced cervical cancer that underwent complete paraaortic lymphadenectomy.

RESULTS

Fifteen (19.2%) women had paraaortic LN metastases. The mean number of LN extracted was 11.1 (SD 7.5). Patients with paraaortic LN metastases presented a worse overall survival (127.1 months [95% CI 111.7-142.4] vs. 59.6 months [95% CI 31.2-87.9]; p<0.01). Nevertheless, there were no differences regarding disease-free survival. There were no prognostic differences according to the number of LNs resected in patients with negative lymphadenectomy.

CONCLUSIONS

Patients with locally advanced cervical cancer and paraaortic LN metastases present worse survival. In women with negative paraaortic LN, the number of LNs removed does not imply shorter survival.

Utilization of Postoperative Chemoradiotherapy Among Women in the United States With High-risk Cervical Cancer

OBJECTIVE

Prospective randomized data demonstrates that chemoradiotherapy (CRT) improves overall survival in women with high-risk pathologic features following radical hysterectomy. Despite this, not all high-risk patients receive adjuvant CRT and the patterns of care in this patient population are unknown. We sought to investigate the rates of adjuvant therapy utilization through analysis of the National Cancer Database.

MATERIALS AND METHODS

The National Cancer Database was queried for women with cervical cancer treated initially with hysterectomy from 2002 to 2012. Patients without high-risk pathologic features were excluded: pN, positive surgical margins, and parametrial invasion (Peters' criteria). Among the 5947 evaluable patients, univariable analysis and multivariable analysis were performed to investigate potential factors associated with CRT utilization and overall survival following diagnosis.

RESULTS

Adjuvant CRT was performed in 41.8% of women and adjuvant radiotherapy, chemotherapy, and no adjuvant therapy was utilized in 9.8%, 23.6%, and 24.8% of women, respectively. On multivariable analysis, CRT utilization was associated with younger age, race, lower facility volume, pN, parametrial invasion, and a negative surgical margin. Residence distance to treating facility, year of diagnosis, household income, insurance status, and facility type did not predict for CRT utilization.

CONCLUSIONS

Despite level I evidence supporting its use, less than half of women in this large US cohort with high-risk cervical cancer received adjuvant CRT. Use of adjuvant CRT for women did not significantly increase between 2002 and 2012. Patient age, race, and pathologic risk factors were associated with use of adjuvant CRT.

The Impact of Race and Partner Status on Patterns of Care and Survival in Young Women With Early-Stage Cervical Cancer

Objectives

Although outcomes for surgery versus radiotherapy (RT) for stage IB patients are similar, young women are often preferentially treated with surgery rather than RT. Adjuvant RT is indicated for high-risk patients after surgery. Our goal was to study the impact of race and partner status on patterns of care of young women with stage I cervical cancer.

Methods

We identified a cohort of 6586 women, aged 15 to 39 years, in the Surveillance, Epidemiology and End Results database diagnosed with stage I cervical cancer between 1988 and 2007.

Results

In our cohort, 93% (n = 5080) of white women had surgery, and 86.5% (n = 985) of nonwhite women had surgery as primary treatment. On multivariate analysis, higher FIGO (International Federation of Gynecology and Obstetrics) stage (IA2 odds ratio [OR] 3.09 [P = 0.01]; IB OR, 21.41 [P < 0.001]), widowed/single (OR, 1.39; P = 0.02), squamous histology (OR, 1.69; P < 0.001), diagnosis during 1993-1997 time period (OR, 1.69; P < 0.001), and nonwhite race (OR, 1.95; P ≤ 0.001) were more likely to receive RT as primary treatment. Of the surgical patients, 15.45% of white women versus 20.4% in the nonwhite women (P < 0.001) had high-risk disease, and 66% of the white women versus 71% of the nonwhite women received adjuvant RT (P = 0.136). Race and marital status were not significant predictors of receiving adjuvant RT on multivariate analysis. Predictors of worse overall survival included RT as primary treatment (hazard ratio [HR], 1.89; P < 0.001) and nonwhite race (HR, 1.6; P = 0.001). Marital status was not a significant predictor of overall survival. Race was a significant predictor of survival for women who received surgery as primary treatment (nonwhite HR, 1.93; P < 0.001).

Conclusions

Nonwhites are more likely than whites to have RT as primary treatment. This suggests that nonwhite women may have social/cultural barriers impacting their treatment decision making or may have a higher likelihood of other comorbidities that limit their surgical options.

RapidArc radiotherapy for whole pelvic lymph node in cervical cancer with 6 and 15 MV: a treatment planning comparison with fixed field IMRT

Dosimetric differences were investigated among single and dual arc RapidArc and fixed-field intensity-modulated radiotherapy (f-IMRT) treatment plans for whole pelvic irradiation of lymph nodes. A total of 12 patients who had undergone radical surgery for cervical cancer and who had demonstrated multiple pelvic lymph node metastases were treated with radiotherapy. For all 12 cases, 7-field IMRT, single-arc RapidArc and dual-arc RapidArc were applied with 6 MV and 15 MV X-ray energies. The radiation dosimetric parameters for the different plans were compared with one another. All the plans met the clinical requirements. The homogeneity, conformity and external volume indices of f-IMRT and dual-arc RapidArc were better than for single-arc RapidArc (P < 0.05), while the differences between f-IMRT and dual-arc RapidArc were not significant. There were no significant differences in the radiation dose to organs at risk, except for the small bowel receiving >40 Gy (f-IMRT and dual-arc < single-arc, P < 0.05). The differences in dose distributions between the two applied X-ray energies for each of the modality plans were not significant. RapidArc plans resulted in fewer monitor units than the corresponding f-IMRT plans. Also, there were no differences between the two photon energies, except for a reduction in the number of MUs for 15 MV (P > 0.05). Compared to f-IMRT, no significant dosimetric benefits were found using RapidArc for whole pelvic lymph node irradiation. However, RapidArc has been associated with shorter treatment time and fewer monitor units, supporting the case for its safety and efficacy for pelvic irradiation.