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Metastatic or Recurrent Cervical Cancer/treatment: The prognosis of metastatic or recurrent cervical cancer remains dismal. The poor chemosensitivity of this tumor- is an issue, especially in case of recurrence in irradiated fields. Still, chemotherapy has shown some efficacy, and mostly consists in platinum-based doublets. The addition of bevacizumab to chemotherapy has been recently validated. However, most of these patients present with complex clinical situations and the treatment strategy has to be discussed in multidisciplinary tumor boards., (© 2017 Elsevier Masson SAS. Tous droits réservés.)

Objective: The purpose of this review is to assess the preoperative management in case of recurrent cervical cancer, to assess patients for a surgical curative treatment., Methods: English publications were searched using PubMed and Cochrane Library., Results: In the purpose of curative surgery, pelvic exenteration required clear margins. Today, only half of pelvic exenteration procedures showed postoperative clear margins. Modern imaging (RMI and Pet-CT) does not allow defining local extension of microcopic disease, and thus postoperative clear margins. Despite the same generic term of pelvic exenteration, there is a wide heterogeneity in surgical procedures in published cohorts., Conclusion: Because clear margins are required for curative pelvic exenteration, but are not predictable by preoperative assessment. The larger surgery, i.e. the infra-elevator exenteration with vulvectomy, could be the logical surgical choice to increase the rate of clear margins and therefore, recurrent cervical carcinoma patient survival., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Objective: To investigate the expression of p53, p16(INK4A) and VEGF-C proteins in cervical cancer and their clinical importance., Methods: The expression of p53, p16(INK4A) and VEGF-C proteins in 125 cases of cervical sections were detected by two-step immunohistochemical EnVision method, and analyzed combined with the clinical and pathological data., Results: (1) The positive expression rates of p53, p16(INK4A) and VEGF-C proteins were 56.8%, 95.2% and 88%, respectively. (2) The positive expression rate of p53 protein was 75% in lymph node metastasis-positive cases and 48.24% in lymph node metastasis-negative cases (P<0.05). The presence of difference for positive significant p53 in squamous cell carcinoma and adenocarcinoma is intensively large (P<0.01), but its expression is not much influenced by age, degree of differentiation, parametric infiltration, vascular metastasis or clinical staging (P>0.05). (3) The p16(INK4A) expression in squamous cell carcinoma is 95.65%, and it is 93.94% in adenocarcinoma, the differential expression rates bears no statistically significant, but the strong expression of squamous cell carcinoma covers 55.43% of the total number of squamous cell carcinoma, while only 15.15% rates in adenocarcinoma (P<0.01). The p16(INK4A) protein expression was not significantly correlated to age, histological type, degree of differentiation, lymph node metastasis, parametric infiltration, vascular metastasis or clinical staging (P>0.05). (4) Among the cases of lymph node metastasis, there were 100% of VEGF-C-positive expression and 82.35% of VEGF-C-negative expression, and the difference was significant (P<0.05). Among the cases of vasculature-positive samples of cervical cancer, there were 98.4% of VEGF-C-positive expression; while among the vasculature-negative samples of cervical cancer, there were 76.27% of VEGF-C-positive expression; the difference was significant (P<0.01). VEGF-C protein expression was not significantly correlated to age, histological type, degree of differentiation, parametric infiltration or clinical staging (P>0.05)., Conclusions: The expression of some immune enzymes in cervical cancer has a reference value for early diagnosis and prognosis of cervical cancer, and has a certain guiding significance for development of the treatment program. However, a larger sample is needed for supporting the research of its significance., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Objective: To assess toxicity profile in two stage-IB1 cervical cancer treatment strategies: surgery with and without preoperative uterovaginal pulsed dose-rate brachytherapy., Methods: A retrospective study included 45 patients presenting stage-IB1 cervical cancer without pelvic lymph-node invasion, between 2009 and 2011: 25 treated by colpohysterectomy alone (group A) and 20 with preoperative uterovaginal pulsed dose-rate brachytherapy (group B). The median follow-up was 45 and 39 months (group A and B)., Results: Groups were comparable for age (median, 46.9 vs 47.6 years), histologic type (52% vs 65% squamous cell carcinoma) and tumor size (68% vs 60%, <2cm). In postoperative year 1, rates of urinary, digestive and gynaecological disorder were 39.1%, 8.7% and 15% respectively in group A versus 36.8%, 5.3% and 31.6% in group B and in year 2, 5.9%, 8.4% and 15% versus 5.6%, 5.1% and 27.8%., Discussion and Conclusion: The present study comparing two stage-IB1 cervical cancer treatment strategies found no significant difference in early or late complications. In 2 months, there was greater grade-3 urinary toxicity (21.1%) and sexual disorder (15.8%) with preoperative brachytherapy but no significant difference. Exclusive surgery is probably preferable for the patient's quality of life., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

The end of the production of 192 iridium wires terminates low dose rate brachytherapy and requires to move towards pulsed-dose rate or high-dose rate brachytherapy. In the case of gynecological cancers, technical alternatives exist, and many teams have already taken the step of pulsed-dose rate for scientific reasons. Using a projector source is indeed a prerequisite for 3D brachytherapy, which gradually installs as a standard treatment in the treatment of cervical cancers. For other centers, this change implies beyond investments in equipment and training, organizational consequences to ensure quality., (Copyright © 2014 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.)

Intensity modulated radiation therapy has demonstrated its ability to prevent xerostomia in the treatment of head and neck cancers, as well as post-radiation related proctitis in prostate cancer. In the management of cervical carcinomas, many published dosimetric studies have shown its ability to limit the irradiation of organs at risk. However, clinical data remain limited to comparisons of cohorts, mostly retrospective, but promising. This review aims to update the current state of knowledge., (Copyright © 2014 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.)

Background: To help prevent cervical cancer, three yearly opportunistic Pap smear screening is recommended in France for women aged 25-65 years. Pap smear screening coverage varies with age and socioeconomic level. The aim of this cross-sectional study was to identify factors associated with a low uptake of Pap smear screening among women with no limited access to healthcare., Methods: We analyzed data from women aged 25-65 living in the Rhône-Alpes region who completed a self-administered questionnaire given to them by general practitioners between June and August 2008. The questionnaire covered knowledge about cervical cancer and its prevention as well as the women's history of Pap smear screening and other health-related behaviors. The relationship between low uptake of Pap smear screening--defined as not having had the test within the past 3 years--and a range of possible contributing factors was investigated using logistic regression., Results: Of 1186 women with an intact uterus who completed the questionnaire, 89.1% said they had had a Pap smear within the past 3 years. On multivariate analysis, the 10.9% who had not were significantly more likely to live alone (1.76 [1.13-2.74]), to have no children (2.17 [1.31-3.62]), to have never used contraception (5.35 [2.98-9.62]), to have less knowledge about Pap smear screening (3.40 [1.55-7.49]), and to be unvaccinated against hepatitis B (0.55 [0.35-0.87])., Conclusion: Despite high overall compliance with Pap smear screening recommendations among women who consulted general practitioners, several factors were significantly associated with a low uptake of the service. Considering these factors may help to refine messages aimed at cervical cancer prevention., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)