ABSTRACT
En mujeres privadas de libertad de Uruguay existe un déficit asistencial en Salud Sexual y Reproductiva. El objetivo del estudio es mejorar el ejercicio de los Derechos Sexuales y Reproductivos en mujeres privadas de libertad, brindando acceso a servicios ginecológicos integrales dentro de las cárceles. Estudio descriptivo retrospectivo, se incluyeron todas las mujeres privadas de libertad en cárceles uruguayas. La intervención consistió en una consulta clínica ginecológica integral, se abordaron aspectos de salud sexual y reproductiva con diagnóstico y tratamiento. Las consultas se realizaron en cárceles de Montevideo e interior. Se realizó la consulta clínica a 513 mujeres privadas de libertad (83% del total) en 800hs de atención médica y 640hs de gestión, con participación de 52 profesionales médicos. Se realizaron 401 colpocitologías oncológicas, 74 patológicas (18%). Se realizaron 108 Test Virus Papiloma Humano, 16 positivos para Alto Riesgo oncogénico (14%). Se realizaron 103 colposcopías y detectando 11 lesiones escamosas de alto grado, realizándose tratamiento quirúrgico. En anticoncepción se realizaron acciones específicas en 166 pacientes: 55 implantes subdérmicos; 27 Dispositivos Intrauterinos, 62 anticonceptivos orales y 23 inyectables. En 61 mujeres se brindaron preservativos masculinos y femeninos. Se desarrolló una intervención en salud sexual y reproductiva al 83% de las mujeres privadas de libertad de Uruguay con especial abordaje en prevención del cancer genitomamario y anticoncepción. Puede ser un insumo para el desarrollo de políticas públicas en esta población.
Incarcerated women in Uruguay face a healthcare deficit in Sexual and Reproductive Health. The study's objective is to improve the exercise of Sexual and Reproductive Rights for incarcerated women by providing access to comprehensive gynecological services within prisons. This is a descriptive retrospective study. The target population was all incarcerated women in Uruguayan prisons. The intervention consisted of a comprehensive gynecological clinical consultation, addressing aspects of sexual and reproductive health with diagnosis and treatment. Consultations were conducted in prisons in Montevideo and other regions. Clinical consultations were conducted for 513 incarcerated women (83% of the total) over 800 hours of medical attention and 640 hours of management, with the participation of 52 medical professionals. A total of 401 oncological colpocytologies were performed, 74 of which were pathological (18%). Additionally, 108 Human Papillomavirus (HPV) tests were conducted, with 16 testing positive for high oncogenic risk (14%). 103 colposcopies were performed, detecting 11 high-grade squamous lesions, which were subsequently treated surgically. Specific contraception actions were taken for 166 patients: 55 subdermal implants, 27 intrauterine devices, 62 oral contraceptives, and 23 injectable contraceptives. Male and female condoms were provided to 61 women. A sexual and reproductive health intervention was developed for 83% of incarcerated women in Uruguay, with a special focus on the prevention of genital and breast cancer and contraception. This initiative can serve as a resource for the development of public policies targeting this population.
Mulheres privadas de liberdade no Uruguai enfrentam um déficit de assistência em Saúde Sexual e Reprodutiva. O objetivo do estudo é melhorar o exercício dos Direitos Sexuais e Reprodutivos em mulheres privadas de liberdade, proporcionando acesso a serviços ginecológicos integrales dentro das prisões. Estudo descritivo retrospectivo. A população-alvo foram todas as mulheres privadas de liberdade nas prisões uruguaias. A intervenção consistiu em uma consulta clínica ginecológica integral, abordando aspectos de saúde sexual e reprodutiva com diagnóstico e tratamento. As consultas foram realizadas em prisões de Montevidéu e do interior. Realizou-se a consulta clínica a 513 mulheres privadas de liberdade (83% do total) em 800 horas de atendimento médico e 640 horas de gestão, com a participação de 52 profissionais médicos. Foram realizadas 401 colpocitologias oncológicas, 74 patológicas (18%). Foram realizados 108 Testes de Vírus do Papiloma Humano, com 16 positivos para Alto Risco oncogênico (14%). Foram realizadas 103 colposcopias, detectando 11 lesões escamosas de alto grau, sendo realizado tratamento cirúrgico. Em anticoncepção, realizaram-se ações específicas em 166 pacientes: 55 implantes subdérmicos; 27 Dispositivos Intrauterinos, 62 anticoncepcionais orais e 23 injetáveis. Para 61 mulheres foram fornecidos preservativos masculinos e femininos. Foi desenvolvida uma intervenção em saúde sexual e reprodutiva para 83% das mulheres privadas de liberdade no Uruguai, com foco especial na prevenção do câncer genitomamário e na contracepção. Esta iniciativa pode servir como um recurso para o desenvolvimento de políticas públicas voltadas para essa população.
Subject(s)
Humans , Prisoners , Breast Neoplasms/prevention & control , Contraception , Genital Neoplasms, Female/prevention & control , Uruguay , Reproductive Health/statistics & numerical data , Sexual Health/statistics & numerical dataABSTRACT
Resumen Introducción : Objetivo: comparar sensibilidad diag nóstica de videocolposcopia con inteligencia artificial (IA) auxiliar, con la videocolposcopia común realizada por colposcopistas. Métodos : Estudio descriptivo de corte transversal retrospectivo, en 782 historias clínicas anonimizadas del Sistema Informático para el Tamizaje (SITAM), de mujeres a las cuales se les efectuaron videocolposcopia con IA y colposcopías con videocolposcopio común rea lizadas por especialistas, con sus biopsias (gold standard). Se evaluó la relación entre los resultados de videocol poscopia con IA y videocolposcopia común con resulta dos de las biopsias. Se calculó precisión global de cada procedimiento diagnóstico. Se determinó sensibilidad y concordancia de los resultados de la videocolposcopia con IA, con el gold standard. Resultados : Se analizaron 395 historias clínicas de pacientes con videocolposcopia con IA y 387 con vi deocolposcopia común. La precisión diagnóstica de resultados fue 80% (IC 95%: 75-83%) en videocolposco pias con IA y 65% (IC 95%: 60-69%) en videocolposcopia común (p<0.001). Los resultados de videocolposcopia con IA y colposcopia común se correlacionaron signifi cativamente con los resultados de las biopsias, rs=0.75 vs. rs=0.57 respectivamente (p<0.001). La sensibilidad de videocolposcopia con IA fue 96% (IC 95%: 94-98%), y 93% (IC 95%: 89-95%) en colposcopías comunes. La concordancia general de las impresiones colposcópicas clasificadas por videocolposcopia con IA y enfermedad fue mayor que la de la interpretación colposcópica de los colposcopistas (90% frente a 83%, Kappa 0.59 frente a 0.47, p<0.001). Conclusión : La alta precisión diagnóstica de video colposcopia con IA permite aumentar la sensibilidad del estudio y mejorar la detección precoz de lesiones precursoras de neoplasias cervicouterinas.
Abstract Introduction : To compare the diagnostic sensitivity of artificial intelligence (AI) assisted videocolposcopy with standard videocolposcopy performed by specialist colposcopists. Methods : A descriptive retrospective cross-sectional study, 782 anonymized medical records from the Com puterized System for Screening (SITAM) of women who underwent videocolposcopy with AI and colposcopy with common videocolposcopy performed by specialists, with their corresponding biopsies (gold standard) were analyzed. The relationship between the results of IA videocolposcopy and regular videocolposcopy and the results of biopsies was evaluated. The overall accuracy of each diagnostic procedure was calculated. The sensitiv ity and concordance of the results of AI videocolposcopy with the gold standard (biopsy) were determined. Results : A total of 395 patient records of patients with IA videocolposcopy and 387 with regular vi-deocolposcopy were analyzed. The accuracy of results was 80% (IC 95%: 75-83%) in IA videocolposcopy and 65% (IC 95%: 60-69%) in regular videocolposcopy (p<0.001). Videocolposcopy results with IA and com mon colposcopy were significantly correlated with bi opsy results, rs=0.75 vs. rs=0.57 respectively (p<0.001). The sensitivity of videocolposcopy with AI was 96% (95% CI: 94-98%), and 93% (95% CI: 89-95%) for regu lar colposcopy. The overall agreement of colposcopic impressions classified by videocolposcopy with AI and disease was higher than that of colposcopic interpretation by colposcopists (90% vs. 83%, Kappa 0.59 vs. 0.47, p<0.001). Conclusion : The high diagnostic accuracy of AI vi-deocolposcopy allows obtaining highly sensitive studies that help in the early detection of precursor lesions of cervical neoplasia.
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Resumen Objetivo: Identificar los factores que influyen en la autoeficacia para el uso del condón (AUC) en mujeres portadoras del Virus del Papiloma Humano (VPH) de la frontera norte de H. Matamoros, Tamaulipas. Materiales y métodos: Estudio descriptivo, transversal y correlacional en una población de mujeres portadoras del VPH, el muestreo fue por conveniencia, con un total de 201 mujeres. Los instrumentos aplicados fueron la cédula de datos personales y la dimensión autoeficacia para el uso del condón de la Escala de Autoeficacia para el Sida (SEA-27). Se aplicó al estadística descriptiva y correlacional a través del paquete SPSS 21. Resultados: mujeres con edad promedio de 30 años (DE=13.12), el 49.3% solteras, pero en una relación de sexual estable (75.1%). En cuanto a la AUC, tienden a estar de medio seguras para el uso del condón durante el acto sexual después de que la mujer y su pareja han estado bebiendo alcohol o han estado consumiendo o utilizando alguna droga. Así mismo reportan una media de 3,90 (DE=1,14) estar medio seguras de negarse a tener relaciones sexuales si su pareja no acepta usar condón. La edad tiene una relación estadísticamente significativa moderada y positiva con el estado civil (r s = .490, p< .001) y el tiempo de relación de pareja (r s = .456, p< .001); el estado civil mostró una correlación estadísticamente significativa moderada positiva con el tiempo de relación (r s = .516, p< .001) y muy baja negativa con la AUC (r s = -.141, p< .05) y la escolaridad se correlaciona en niveles muy bajos pero positivos con el nivel de AUC (r s = .196, p< .001). Conclusión: La población estudiada ha reportado una baja autoeficacia para el uso del condón y solo la escolaridad y el estado civil son los factores que se relacionan directamente con la variable.
Abstract Objective: To identify the factors that influence self-efficacy for condom use (AUC) in women carrying Human Papillomavirus (HPV) from the northern border of H. Matamoros, Tamaulipas. Materials and methods: descriptive, cross-sectional and correlational study in a population of women carrying HPV, sampling was by convenience, with a total of 201 women. The instruments applied were the personal data card and the self-efficacy dimension for condom use of the Self-Efficacy Scale for AIDS (SEA-27). Descriptive and correlational statistics were applied through the SPSS 21 package. Results: women with an average age of 30 years (SD=13.12), 49.3% single, but in a stable sexual relationship (75.1%). AUC, they tend to be moderately safe to use condoms during sexual intercourse after the woman and her partner have been drinking alcohol or have been consuming or using drugs. Likewise, they report an average of 3.90 (SD=1.14) to be half sure of refusing to have sexual relations if their partner does not agree to use a condom. Age has a moderate and positive statistically significant relationship with marital status (r s = .490, p< .001) and length of relationship (r s = .456, p< .001); marital status showed a statistically significant moderate positive correlation with the length of the relationship (r s = .516, p< .001) and a very low negative correlation with the AUC (r s = -.141, p< .05) and schooling is correlated at very low but positive levels with the AUC level (r s = .196, p< .001). Conclusion: The population studied has reported low self-efficacy for condom use and only education and marital status are the factors that are directly related to the variable.
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Resumen Introducción: El diagnóstico y tratamiento oportuno de las lesiones cervicales de alto grado es crucial para prevenir su progresión hacia cáncer. En Colombia, el cáncer de cérvix ocupa el cuarto lugar en incidencia, y a pesar de la implementación de medidas de prevención como la vacunación, la incidencia continúa siendo alta, incluso en mujeres menores de 30 años. Objetivo: Determinar la prevalencia de lesiones cervicales de alto grado en mujeres de 30 años o menos que acudieron a un hospital de Popayán entre 2010 y 2020, y los factores epidemiológicos relacionados con estas lesiones. Materiales y métodos: Estudio transversal; se incluyeron a todas las mujeres menores de 30 años que contaban con estudio citológico, colposcópico y reporte de biopsia. Se diseñó un formulario para recopilar la información de las historias clínicas. Resultados: De las 701 mujeres incluidas, el 12,27 % presentaba lesiones de alto grado en la histopatología. Al analizar los factores de riesgo, se observó que aproximadamente el 33 % de la muestra había iniciado relaciones sexuales a los 14 años, y el 69 % reportó haber tenido más de 3 compañeros sexuales. Conclusión: La detección de lesiones de alto grado en una citología indica una mayor probabilidad de confirmar la presencia de estas lesiones en estudios adicionales, como la colposcopia o biopsia. Sin embargo, una citología negativa no descarta la existencia de lesiones cervicales.
Abstract Introduction: Timely diagnosis and treatment of high-grade cervical lesions is crucial to prevent their progression to cancer. In Colombia, cervical cancer ranks fourth in incidence, and despite the implementation of prevention measures such as vaccination, the incidence remains high, even in women under 30 years of age. Objective: To determine the prevalence of high-grade cervical injuries in women aged 30 years or younger who attended a hospital in Popayan between 2010 and 2020, and the epidemiological factors related to these injuries. Materials and methods: Cross-sectional study, including all women who had cytological and colposcopic studies and biopsy reports. A form was designed to collect information from medical records. Results: Of the 701 women included, 12,27 % had high-grade lesions in histopathology. When analyzing risk factors, it was observed that approximately 33 % of the sample had initiated sexual intercourse by age 14, and 69 % reported having more than 3 sexual partners. Conclusion: Detection of high-grade lesions on cytology indicates a greater likelihood of confirming the presence of these lesions on additional studies, such as colposcopy or biopsy. However, a negative cytology does not rule out the existence of cervical lesions.
ABSTRACT
For optimal cervical cancer care pathway, effective communication among colposcopist professionals regarding colposcopic findings, diagnosis, and treatment of intraepithelial lesions is crucial; standardization of the colposcopic report may serve as a beneficial strategy for this purpose. Elaborate and validate the colposcopic report for screening intraepithelial lesions and cervical cancer using a committee of specialists. This validation study used the item-level content validity index (I-CVI) to verify the agreement of judges per item, and the scale-level content validity index (S-CVI) to determine the mean of the proportion of items classified as "no disagreement"; items with an I-CVI?0.80 and S-CVI?0.90 were considered approved. The binomial test was used to select the items that should be revised based on the p value of the proportion (rejecting the H0 if p?0.8); statistical significance was set at p<0.05. Results: Seven judges participated in this study. The 11 items of the Colposcopic Report were validated, but items classified as “disagreement” (1, 2, 5, and 9) or “neither agree nor disagree” (3, 10, and 11) were taken to a consensus meeting. Six of the seven judges of the first stage participated in the consensus meeting. Suggestions for modifying item nine were not accepted, and item 11 underwent a slight modification. The colposcopic report was validated and achieved greater reliability, suggesting its inclusion in the cancer information system.
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Resumen Introducción : Hay escasa evidencia sobre el impacto de la pandemia de COVID-19 en el cumplimiento del tratamiento de cáncer cervicouterino. Métodos : Se llevó a cabo un estudio poblacional de cohorte retrospectivo. -antes/después- de las pacientes con cáncer cervicouterino diagnosticadas en estable cimientos públicos de la provincia de Jujuy (n = 140), entre 2017 y 2020. Las pacientes diagnosticadas en 2020 se consideraron expuestas a la pandemia (n = 21). Utili zamos la regresión logística multivariada para analizar la asociación entre pandemia y cumplimiento del tra tamiento de cáncer. Además, se midió la duración del tratamiento en aquellas con indicación de braquiterapia y el tiempo hasta el inicio al tratamiento según estadio. Resultados : Comparadas con las mujeres diagnosti cadas en 2017-2019 el odds ratio de incumplimiento del tratamiento fue de 1.77 (IC95% 0.59-5.81; p = 0.32) para las diagnosticadas durante 2020. Se encontró un mayor riesgo de incumplimiento en pacientes con indicación de braquiterapia (OR 4.14; IC 95%:1.95-9.11; p < 0.001). La mediana de duración del tratamiento para aquellas con indicación de braquiterapia fue de 12.8 y 15.7 sema nas en 2017-2019 y 2020 respectivamente (p = 0.33). La mediana de tiempo hasta el inicio del tratamiento para pacientes con enfermedad en estadio temprano fue de 9 y 5 semanas durante 2017-2019 y 2020 respectivamente (p = 0.06), versus una mediana de 7.2 y 9 semanas en 2017-2019 y 2020 respectivamente (p=0.36) para las pa cientes con enfermedad en estadio IIB+. Conclusiones : El bajo acceso a la braquiterapia fue un factor determinante de incumplimiento de tratamiento de cáncer cervicouterino, independientemente del efecto de la pandemia.
Abstract Introduction : Little evidence exists on the impact of the COVID-19 pandemics on the compliance with cervi cal cancer treatment. Methods : We carried out a population-based, be fore-and-after retrospective cohort study of all cervical cancer patients diagnosed in the Jujuy province public health sector (n=140), Argentina, between 2017 and 2020. Patients diagnosed in 2020 were considered exposed to the COVID-19 pandemic (n=21). We used multivariable logistic regression to assess the relationship between the pandemics and compliance with treatment. We also measured treatment duration for women who were indicated brachytherapy and time to treatment initia tion by stage. Results : Compared with women diagnosed in 2017- 2019 the odds ratio of non-complying with treatment was 1.77 (95%CI 0.59-5.81; p = 0.32) for women diagnosed during 2020. An increased risk of non-compliance was found in patients with prescribed brachytherapy (OR 4.14. 95%CI 1.95-9.11; p < 0.001). Median treatment dura tion for women with prescribed brachytherapy was 12.8 and 15.7 weeks in 2017-2019 vs. 2020 (p = 0.33); median time to treatment initiation for women with early-stage disease was 9 and 5 weeks during 2017-2019 and 2020 respectively (p = 0.06), vs 7.2 and 9 weeks in 2017-2019 and 2020 respectively (p = 0.36) for patients with stages IIB+ disease. Conclusions : Low access to brachytherapy was a major determinant of non-compliance. irrespective of the effect of the pandemics.
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Introducción: la información en cáncer en poblaciones indígenas colombianas es escasa; de ahí que el objetivo de este estudio sea conocer las perspectivas comunitarias y de los prestadores de servicios de salud acerca del cáncer de cuello uterino (CaCU) en mujeres indígenas del Amazonas colombiano. Materiales y métodos: estudio cualitativo, derivado de una investigación de métodos mixtos de triangula-ción convergente. Se realizaron 40 entrevistas semiestructuradas que incluían profesionales de la salud y actores clave comunitarios representados en curacas, médicos tradicionales o chamanes, parteras, pro-motores de salud, auxiliares de salud pública, líderes y lideresas, abuelos, abuelas y mujeres indígenas en general. Para el análisis se utilizó la técnica de análisis de contenido. Resultados: emergieron cuatro categorías:1) concepciones y factores de riesgo alrededor del cáncer en general y el CaCU, 2) prácticas de cuidado y de atención occidentales y ancestrales para el CaCU, 3) dificultades socioculturales y del sistema de salud para la prevención y atención del CaCU y 4) recomendaciones para el fortalecimiento de la de prevención del CaCU. Conclusión: los participantes reconocen la citología cervicouterina como una forma de prevenir el cáncer y aunque los participantes mencionaron algunos aspectos culturales y personales que podrían constituirse en una barrera para la prevención y control del CaCU, se hizo hinca-pié en los problemas estructurales del sistema de salud, la falta de integración cultural y las dificultades de acceso al tamizaje, diagnóstico y tratamiento.
Introduction: Information on cancer in Colombian indigenous populations is scarce, the objective of this study was to know the community and health care providers' perspectives on cervical cancer (CaCU) in indigenous women of the Colombian Amazon. Materials and methods: Qualitative study, derived from a mixed methods research of convergent triangulation, 40 semi-structured interviews were conducted, including health professionals and key community actors represented by curacas, traditional doctors or shamans, midwives, health promoters, public health assistants, leaders, grandfathers, grandmothers, and indigenous women in general. The content analysis technique was used for the analysis. Results:Four categories emerged: (a) conceptions and risk factors surrounding cancer in general and CaCU; (b) western and ancestral care and attention practices for CaCU; (c) sociocultural and health system diffi-culties for the prevention and attention of CaCU, and (d) recommendations for strengthening CaCU pre-vention. Conclusion: Participants recognize cervical cytology as a way to prevent cancer and although participants mentioned some cultural and personal aspects that could constitute a barrier to cervical cancer prevention and control, the greatest emphasis was given to structural problems of the health system, lack of cultural integration and difficulties of access to screening, diagnosis and treatment.
Introdução: a informação sobre o câncer nas populações indígenas colombianas são escassas, o objetivo deste estudo foi conhecer as perspectivas da comunidade e dos prestadores de serviços de saúde sobre o câncer do colo do útero (CaCU), em mulheres indígenas da Amazônia colombiana. Materiais e méto-dos: estudo qualitativo, derivado de uma investigação de métodos mistos de triangulação convergente. Foram realizadas 40 entrevistas semiestruturadas que incluíram profissionais de saúde e principais atores comunitários representados em curacas, médicos tradicionais ou xamãs, parteiras, promotores de saúde, assistentes de saúde pública, lideranças, avôs, avós e mulheres indígenas em geral. Para a análise foi uti-lizada a técnica de análise de conteúdo. Resultados: emergiram quatro categorias, a) concepções e fatores de risco em torno do câncer em geral e do CaCU; b) cuidados e práticas de cuidado ocidentais e ancestrais para CaCU; c) dificuldades socioculturais e do sistema de saúde para a prevenção e cuidado do CaCU, e d) recomendações para fortalecer a prevenção de CaCU. Conclusão: as participantes reconhecem a citolo-gia cervical como forma de prevenção do câncer e embora as participantes tenham mencionado alguns aspectos culturais e pessoais que poderiam constituir uma barreira para a prevenção e controle do câncer do colo do útero, a maior ênfase foi dada aos problemas estruturais do sistema de saúde, a falta de integra-ção cultural e as dificuldades de acesso ao rastreio, ao diagnóstico e ao tratamento
Subject(s)
Humans , ColombiaABSTRACT
Perivascular epithelioid cell tumors constitute a family of mesenchymal tumors characterized by the concomitant expression of melanocytic and muscular markers. Gynecological perivascular epithelioid cell tumors are rare, encompassing about 25% of cases. Studies demonstrate an even rarer occurrence in the uterine cervix. In this article, we report a case of malignant perivascular epithelioid cell tumors of the uterine cervix in a young patient, managed with total hysterectomy with unilateral salpingo- oophorectomy (due to suspected neoplasic involvement of the right ovary) and bilateral pelvic lymphadenectomy. Due to limited data, diagnosing these tumors is challenging. Given the uncertain biological behavior of this neoplasm, they should be considered potentially malignant and require long-term follow-up, despite the potential for late local recurrence and distant metastases. Surgical treatment involving complete resection of the lesion with clear margins remains the recommended option for this type of tumor until more consistent evidence can support adjuvant treatments.
Os tumores perivasculares de células epitelióides constituem uma família de tumores mesenquimais caracterizados pela expressão concomitante de marcadores melanocíticos e musculares. Tumores perivasculares de células epitelióides ginecológicos são raros, abrangendo cerca de 25% dos casos. Estudos demonstram uma ocorrência ainda mais rara no colo uterino. Neste artigo, relatamos um caso de tumor perivascular de células epitelióides maligno do colo uterino em paciente jovem, tratado com histerectomia total com salpingo-ooforectomia unilateral (por suspeita de envolvimento neoplásico do ovário direito) e linfadenectomia pélvica bilateral. Devido aos dados limitados, diagnosticar esses tumores é um desafio. Dado o comportamento biológico incerto desta neoplasia, devem ser consideradas potencialmente malignas e requerem seguimento a longo prazo, apesar do potencial de recorrência local tardia e metástases à distância. O tratamento cirúrgico envolvendo ressecção completa da lesão com margens claras continua sendo a opção recomendada para esse tipo de tumor até que evidências mais consistentes possam apoiar tratamentos adjuvantes.
Subject(s)
Humans , Female , Adult , Ovary , Cervix Uteri , Perivascular Epithelioid Cell Neoplasms , Hysterectomy , Patients , Therapeutics , Diagnosis , Salpingo-oophorectomy , Lymph Node ExcisionABSTRACT
Introduction. Low-cost, accurate high-risk HPV tests are needed for cervical cancer screening in limited-resource settings. Objective. To compare the performance of the low-cost Hybribio-H13 test with the Hybrid Capture® 2 to detect cervical intraepithelial neoplasia grade 2 or 3 (CIN2 and CIN3). Materials and methods. Archived baseline samples tested by the Hybrid Capture® 2 from women of the ASCUS-COL trial, aged 20 to 69 years, with biopsy-colposcopy directed diagnosis of CIN2+ (n = 143), CIN3+ (n = 51), and < CIN2 (n = 632) were blindly tested by the Hybribio-H13 test. Results. Therelative sensitivity of the Hybribio-H13 test versus the Hybrid Capture® 2 for detecting CIN2+ was 0.89 (90% CI = 0,80-0,98; NIT = 0,66), and for CIN3+ was 0,92 (90% CI = 0,85-0,98; NIT = 0,35). Relative specificity was 1.19 (90% CI = 1.05-1.33; NIT < 0.00001). In the analysis restricted to women older than 30 years, the relative sensitivity of the Hybribio-H13 for CIN3+ was marginally below unity (ratio = 0.97; 90% CI = 0.95-0.99), and the specificity remained higher than the Hybrid Capture® 2 test. Conclusion. The Hybribio-H13 test was as specific as the Hybrid Capture® 2 for detecting CIN2+ or CIN3+ but less sensitive. Considering these results and the young age of the population recruited for screening because of ASCUS cytology, we suggest our results warrant the evaluation of the Hybribio-H13 for screening cervical cancer, especially in the evaluated population.
Introducción. Se necesitan pruebas para detectar genotipos de VPH de alto riesgo, precisas y de bajo costo, para la tamización del cáncer de cuello uterino en entornos de recursos limitados. Objetivo. Comparar el desempeño de la prueba de bajo costo Hybrid-H13 con la de Hybrid Capture® 2para detectar NIC2+ y NIC3+. Materiales y métodos. Se analizaron en ciego muestras de la línea base provenientes de mujeres del estudio ASCUS-COL, entre los 20 y los 69 años, con diagnóstico dirigido por biopsia-colposcopia de NIC2+ (n = 143), NIC3 + (n = 51) y < NIC2 (n = 632) con la prueba para detección de virus de papiloma humano Hybribio-H13. Estas muestras fueron previamente evaluadas con la prueba Hybrid Capture® 2. Resultados. La sensibilidad relativa de Hybribio-13 versus la de Hybrid Capture® 2 para detectar NIC2+ fue de 0,89 (IC90%: 0,80-0,98; NIT = 0,66) y para NIC3+ fue de 0,92 (IC90%: 0,85-0,98; NIT = 0,35). La especificidad relativa fue de 1,19 (IC90%: 1,05-1,33; NIT < 0,00001). En el análisis restringido a mujeres mayores de 30 años, la sensibilidad relativa de Hybribio-H13 para NIC3+ estuvo marginalmente por debajo de la unidad (proporción = 0,97; IC90%: 0,95-0,99) y la especificidad permaneció más alta que la de la prueba Hybrid Capture® 2. Conclusión. La prueba de Hybribio-H13 fue tan específica como la de Hybrid Capture® 2, pero menos sensible para detectar NIC2+ o NIC3+. Teniendo en cuenta estos resultados y la temprana edad de la población reclutada en la tamización por la presencia de ASCUS en la citología, se sugiere continuar con la evaluación de la prueba Hybribio-H13 para la detección de cáncer de cuello uterino en poblaciones con las mismas características que las de la aquí evaluada.
Subject(s)
Humans , Uterine Cervical Neoplasms , Human Papillomavirus DNA Tests , PapillomaviridaeABSTRACT
Objective: To analyze the coverage of cytopathological examination of the cervix in women between 25 and 64 years of age in Metropolitan Region I, State of Pará, from 2017 to 2021. Methodology: Secondary and public data, registered in the System, were extracted. Cancer Information, considering the historical series from 2017 to 2021. Results: A total of 150,424 uterine cervix exams were performed by women aged between 25 and 64 years. There was a variation in the offer of exams in the municipalities, with an increase in the years 2017, 2018 and 2019, while in the years 2020 and 2021, the numbers were reduced, without reaching the state goal agreed in most municipalities. Among the cytological changes in the exam, atypical ones in glandular cells predominated with 52.4%, followed by invasive squamous cell carcinoma with 31.1%. As for the type of intraepithelial lesion, a higher proportion of low-grade lesions was identified, with 82.5%. Conclusion: Weaknesses in Cervical Cancer (CC) screening may be correlated with low supply and demand for the test, as well as the unsatisfactory quality of the collected samples.
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El cáncer cérvico-uterino, o carcinoma del cuello uterino, es una enfermedad que ha provocado gran impacto en todas las esferas sociales contribuyendo a las altas tasas de morbilidad y mortalidad en el mundo entero, incluye las neoplasias malignas que se desarrollan en la porción fibromuscular inferior del útero. Es una enfermedad que es prevenible si las mujeres se realizan los chequeos oportunos. La parte más importante de un chequeo ginecológico es la prevención que nos permite dar tratamientos oportunos y tener manejos profilácticos para evitar lesiones malignas causadas por el virus de papiloma humano. En este sentido, la colposcopia continúa siendo importante en la detección oportuna de factores de riesgo y de lesiones que pudieran malignizarse. El propósito de este trabajo es reflexionar sobre la importancia de la colposcopia y mostrar algunos resultados de esta prueba en mujeres del municipio de Cumanayagua, en la provincia de Cienfuegos, Cuba.
Cervical cancer, or carcinoma of the cervix, is a disease that has caused great impact in all social spheres, contributing to the high rates of morbidity and mortality throughout the world, including malignant neoplasms that develop in the lower fibromuscular portion of the uterus. It is a disease that is preventable if women undergo timely check-ups. The most important part of a gynecological check-up is prevention, which allows us to give timely treatments and have prophylactic management to avoid malignant lesions caused by the human papillomavirus. In this sense, colposcopy continues to be important in the timely detection of risk factors and lesions that could become malignant. The purpose of this work is to reflect on the importance of colposcopy and show some results of this test in women from the municipality of Cumanayagua, in the province of Cienfuegos, Cuba.
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Objetivo: Identificar como ocorrem as práticas de prevenção e de rastreio do câncer de mama e de colo uterino realizadas por enfermeiros que atuam na Atenção Primária à Saúde do Rio Grande do Sul. Métodos: Trata-se de um estudo de abordagem qualitativa e de natureza analítica e compreensiva. Realizou-se entrevistas semiestruturadas. Os dados foram submetidos à análise de conteúdo do tipo temática proposta por Minayo. Os colaboradores foram 58 enfermeiros atuantes na Atenção Primária à Saúde. Resultados: Os resultados apontam que as práticas se desenvolvem em um contexto de crescente autonomia profissional e de protagonismo da Enfermagem. Aspectos como proximidade e vínculo com a comunidade, outros procedimentos e ações ofertadas nos atendimentos, incluindo a condução clínica/terapêutica, na vigência de sinais e sintomas de infecção, condizem com uma atenção mais ampla às necessidades de saúde e de cuidado às mulheres. Conclusão: O estudo evidencia a importância do respaldo de protocolos para a atuação segura das práticas dos enfermeiros da Atenção Básica, visando a prevenção e rastreio do câncer de mama e de colo uterino. Esses instrumentos devem ser de fácil acesso e constantemente atualizados a fim de garantir a padronização preconizada pelo Ministério da Saúde. (AU)
Objective: To identify how the breast and cervical cancer prevention and screening practices performed by nurses working in Primary Health Care in the state of Rio Grande do Sul occurs. Methods: This is a qualitative study with an analytical and comprehensive nature. The collaborators were 58 nurses working in Primary Health Care. Results: The results indicate that the practices are developed in a context of increasing professional autonomy and the role of Nursing. Aspects such as proximity and bonding with the community, other procedures and actions offered in the consultations, including clinical/therapeutic management in cases of signs and symptoms of infection, are consistent with a broader attention to women's health and care needs. Conclusion: The study highlights the importance of supporting protocols for the safe performance of Primary Care nurses' practices, aiming at the prevention and screening of breast and cervical cancer. These documents must be easily accessible and constantly updated in order to guarantee the standardization recommended by the Ministry of Health. (AU)
Objetivo: Identificar cómo las prácticas de prevención y detección del cáncer de mama y cervicouterino son realizadas por enfermeros que actúan en la Atención Primaria de Salud en Rio Grande do Sul. Métodos: Se trata de un estudio cualitativo de carácter analítico y comprensivo. Los colaboradores fueron 58 enfermeros que actuaban en la Atención Primaria de Salud. Resultados: Los resultados indican que las prácticas se desarrollan en un contexto de aumento de la autonomía profesional y del papel de la Enfermería. Aspectos como la proximidad y el vínculo con la comunidad, otros procedimientos y acciones que se ofrecen en las consultas, incluido el manejo clínico/terapéutico en casos de signos y síntomas de infección, son consistentes con una atención más amplia a las necesidades de salud y cuidado de las mujeres. Conclusión: El estudio destaca la importancia de protocolos para la actuación segura de las prácticas de los enfermeros de Atención Primaria, con el objetivo de la prevención y el tamizaje del cáncer de mama y de cuello uterino. Estos instrumentos deben ser de fácil acceso y constantemente actualizados para garantizar la estandarización recomendada por el Ministerio de Salud. (AU)
Subject(s)
Nursing Research , Breast Neoplasms , Uterine Cervical Neoplasms , Disease Prevention , Practice Patterns, Nurses'ABSTRACT
Introduction: Women living with HIV/AIDS have a higher frequency of anogenital neoplasms resulting from human papillomavirus (HPV) infection. The World Health Organization recommends that cervical cancer screening uses molecular tests that amplify viral genetic material, such as HPV-DNA. In addition to collection by health professionals, self-collection of vaginal samples is a useful tool for expanding access to testing. Objective: To describe the results of the pilot study that evaluated the acceptability of self-collection of vaginal samples and the applicability of offering HPV-DNA tests with self-collection of vaginal samples for women living with HIV/AIDS in Brazil. Methods: Descriptive cross-sectional study involving women living with HIV/AIDS treated in eight HIV-specialty healthcare facilities distributed in all regions of the country from May 2021 to May 2022 and a central laboratory. Vaginal self-collection was offered, and participants were interviewed about sociodemographic data and impressions of self-collection. Results: In total, 1,919 women living with HIV/AIDS with an average age of 45 years participated in the study. Some type of HPV was detected in 66% (1,267) of cases. The majority (71.9%) said they preferred self-collection to sample collection by health care professionals. Only 53.8% of participants underwent cytology at the appropriate frequency, as recommended by the protocol. Conclusion: The results may support the implementation of molecular biology tests to detect HPV in women living with HIV/AIDS, including the possibility of vaginal self-collection, promoting increased access to cervical cancer screening. (AU)
Introdução: Mulheres vivendo com HIV/AIDS possuem maior frequência de neoplasias anogenitais decorrentes da infecção pelo papilomavírus humano (HPV). A Organização Mundial da Saúde recomenda que o rastreio de câncer do colo do útero seja utilizado por testes moleculares que amplificam o material genético viral, como o HPV-DNA. Além da coleta por profissionais da saúde, a autocoleta de amostras vaginais consiste em uma ferramenta útil para ampliação do acesso à testagem. Objetivo: Descrever os resultados do estudo piloto que avaliou a aceitabilidade da autocoleta de amostra vaginal e aplicabilidade da oferta de testes HPV-DNA com autocoleta de amostras vaginais para mulheres vivendo com HIV/AIDS no Brasil. Métodos: Estudo transversal descritivo envolvendo mulheres vivendo com HIV/AIDS atendidas em oito serviços ambulatoriais distribuídos em todas as regiões do país no período de maio/2021 a maio/2022 e um laboratório central. Realizou-se a oferta de autocoleta vaginal e uma entrevista com as participantes sobre dados sociodemográficos e impressões da autocoleta. Resultados: No total, 1.919 mulheres vivendo com HIV/AIDS com média de 45 anos participaram do estudo. Houve detecção de algum tipo de HPV em 66% (1.267) dos casos. A maioria (71,9%) afirmou preferir a autocoleta à coleta de amostras por profissionais da saúde. Apenas 53,8% das participantes realizaram citologia na periodicidade adequada, conforme recomendação do protocolo. Conclusão:Os resultados poderão apoiar a implementação dos testes de biologia molecular para detecção de HPV em mulheres vivendo com HIV/AIDS, incluindo a possibilidade de autocoleta vaginal, promovendo a ampliação do acesso ao rastreamento de câncer do colo do útero. (AU)
Subject(s)
Humans , Female , Serologic Tests , HIV Seropositivity , HIV Long-Term Survivors , Quality of Health Care , Uterine Cervical Neoplasms , Mass Screening , PapillomaviridaeABSTRACT
Introducción. El virus del papiloma humano (VPH) es una infección viral más habitual del aparato reproductor y causa diversos trastornos, tanto en hombres como en mujeres, y se considera como el principal agente para el desarrollo del cáncer cervicouterino. Objetivo. Determinar el nivel de conocimiento sobre el VPH de las alumnas del segundo año de las diferentes carreras de la Universidad del Pacífico Sede Asunción en el año 2023. Materiales y Métodos. Se realizó un estudio observacional, descriptivo de corte transversal en alumnas del segundo año de las diferentes carreras de la Universidad del Pacifico en el 2023, mediante una encuesta de conocimiento, influencia y métodos para evitar el contagio del VPH. Se aplicó la estadística descriptiva utilizando el programa EpiDat 4.2. Resultados. Participaron 95 alumnas, el 49,92% conoce que el VPH es una infección viral, el 87,37% que su síntoma más común son las verrugas genitales, el 91,58% sabe que la infección por VPH afecta a ambos sexos, el 90,53% que se puede transmitir por vía sexual, 71,58% sabe que puede producir cáncer de cuello uterino y el 86,32% conoce que la vacunación es la principal medida de prevención. El 48% de las estudiantes tuvieron un buen nivel de conocimiento global sobre el VPH. Conclusión. El nivel insuficiente de conocimiento sobre VHP refleja la necesidad de realizar fortalecer el programa educativo universitario y campañas educativas con respecto al VPH y el cáncer de cuello uterino.
Introduction. Human papillomavirus (HPV) is the most common viral infection of the reproductive tract, causes various disorders in both men and women, and it is considered to be the main agent for the development of cervical cancer. Objective. To determine the level of knowledge about HPV among students in the second year of the different careers of the Universidad del Pacífico, Asunción, 2023. Materials and Methods. A cross-sectional, observational, descriptive study was carried out with 2nd year students of the different careers of the Universidad del Pacifico in 2023, by means of a survey of knowledge about HPV, influence, and methods to prevent infection. Descriptive statistics using EpiDat 4.2 software were applied. Results. Of the 95 female students surveyed, 49.92% knew that HPV was a viral infection, 87.37% knew that the most common symptom was genital warts, 91.58% knew that HPV disease affects both sexes, 90.53% knew that it can be transmitted sexually, 71.58% knew that it could cause cervical cancer, and 86.32% knew that vaccination was the main prevention measure, 48% of the students have a good global knowledge about HPV. Conclusion. The insufficient level of knowledge about HPV reflects the need to strengthen the university educational program and educational campaigns regarding HPV and cervical cancer.
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The occurrence of cervical cancer in women is closely related to high-risk HPV infection, and timely and effective interruption of high-risk HPV infection is of great significance to prevent the occurrence of cervical cancer. Huang Yuanyou's theory of "circular flow of Qi" emphasizes on the harmonization of the overall Qi flow, which can explain the physiopathology of women. The occurrence of high-risk HPV infection is related to the loss of spleen and earth transportation in the middle Jiao, poor circulation of Qi, and the low resistance of the body to evil, resulting in the malfunctioning of clear and turbid. Based on the theory of "circular flow of Qi" combined with the idea of "prevention treatment of disease", the author proposes to "prevent the disease before it occurs, regulate the middle earth to preserve the correct Qi" and "prevent the disease before it occurs". The principles of prevention and treatment of high-risk HPV infection are "prevent before the disease, regulate the middle earth to preserve the righteousness", "promote and descend to dispel the poisonous evil", and "prevent recurrence after the disease, balance yin and yang and harmonize Qi and blood", in order to provide reference for clinical treatment.
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Objective:To analyze and summarize the oncological outcomes after laparoscopic radical trachelectomy (LRT) for early stage cervical cancer.Methods:The clinical data and follow-up results of 148 patients with early stage cervical cancer who underwent LRT in Renji Hospital, School of Medicine, Shanghai Jiao Tong University from July 2014 to June 2023 were collected, while tumor outcomes and postoperative pregnancy were analyzed retrospectively.Results:(1) General situation: the median age of 148 patients with LRT was 33 years (range: 19-42 years). Pathological type: 111 cases of squamous cell carcinoma, 36 cases of adenocarcinoma, 1 case of adenosquamous carcinoma. International Federation of Gynecology and Obstetrics (2018) stage: 17 cases of stage Ⅰa1 with lympho-vascular space invasion, 25 cases of stage Ⅰa2, 102 cases of stage Ⅰb1, and 4 cases of stage Ⅰb2. (2) Tumor outcomes: 148 patients were followed up regularly after LRT, and the median follow-up time was 59 months (range: 2-104 months). During the follow-up period, 5 cases of tumor recurred (including 1 death), and the median recurrence time was 10 months (range: 4-33 months). Among them, there were 3 cases of pelvic metastasis, 1 case of distant metastasis, and 1 case of both pelvic and distant metastasis. Both 3-year and 5-year disease-free survival rates of 148 patients were 94.5%, and the 5-year overall survival rate was 98.9%. (3) Postoperative pregnancy: among 148 patients with LRT, 67 patients had pregnancy requirements, followed up for 1 year, and 20 of them were pregnant, with a pregnancy rate of 29.9% (20/67). Among the 20 pregnant patients, 2 cases early abortion, 1 case mid-term abortion, and 17 cases gave birth (including 4 cases of premature birth and 13 cases of full-term birth).Conclusion:Under the condition of strict control of surgical indications, guaranteed surgical scope and tumor-free operation, LRT in patients with early cervical cancer has a good outcome.
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Objective:To evaluate the surgery combined chemotherapy and radiation in locally advanced neuroendocrine carcinoma of the cervix (NECC) .Methods:This is a single-center retrospective cohort study. Locally advanced NECC patients admitted to Peking Union Medical College Hospital, Chinese Acadmy of Medical Sciences from January 2011 to April 2022 were enrolled. They were divided into concurrent chemoradiotherapy group, and surgery combined with chemotherapy and radiation group. The Kaplan-Meier method was used to analyze the progression free survival (PFS), overall survival (OS), recurrence rate, and mortality rate.Results:(1) Forty-six cases were included, 22 in concurrent chemoradiotherapy group, 24 in surgery combined chemotherapy and radiation group. With 16 patients (35%, 16/46) received neoadjuvant chemotherapy (NACT), the NACT effective rate was 15/16. (2) The median follow-up time was 27.5 months (range: 10-106 months), with 26 (57%, 26/46) experienced recurrences. There were 4 (9%, 4/46) pelvic recurrences and 25 (54%, 25/46) distant recurrences, and 3 (7%, 3/46) both pelvic and distant recurrences. Compared with concurrent chemoradiotherapy group, surgery combined chemotherapy and radiation group had lower pelvic recurrence rate [14% (3/22) vs 4% (1/24); χ2=1.296, P=0.255] but without statistic difference. Both groups had similar distant recurrence rate [55% (12/22) vs 54% (13/24); χ2=0.001, P=0.979] and overall recurrence rate [59% (13/22) vs 54% (13/24); χ2=0.113, P=0.736]. (3) During the follow-up period, 22 cases (48%, 22/46) died, with 11 cases (50%, 11/22) in concurrent chemoradiotherapy group and 11 cases (46%, 11/24) in surgery combined chemotherapy and radiation group, without significant difference ( χ2=0.080, P=0.777). The postoperative 3-year and 5-year OS rates were 62.3% and 36.9%. Compared with concurrent chemoradiotherapy group, the patients in surgery combined chemotherapy and radiation group showed an extended trend in PFS (17.0 vs 32.0 months) and OS (37.0 vs 50.0 months) but without statistic differences ( P=0.287, P=0.125). Both groups had similar 3-year OS rate (54.2% vs 69.9%; P=0.138) and 5-year OS rate (36.1% vs 38.8%; P=0.217). Conclusions:Our study supports the multi-modality treatment strategy (including surgery, chemotherapy and radiation) as an important component in the treatment of locally advanced NECC. The combination of surgery, chemotherapy and radiation seems to have advantages in the treatment of locally advanced NECC, but needs to be confirmed by further multicenter studies.
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Objective:To investigate the relationship between serum miR-501 and miR-195 levels and sensitivity to concurrent chemoradiotherapy in patients with locally advanced cervical cancer (LACC).Methods:Clinical data of 96 patients with LACC admitted to Nanyang Central Hospital from January 2020 to June 2022 were retrospectively analyzed and compared with those of 96 healthy subjects during physical examination in our hospital during the same period to compare the differences of serum miR-501 and miR-195 levels. Tumor status was reviewed at 6 months after concurrent chemoradiotherapy. Patients were divided into the sensitive and resistant groups according to the evaluation criteria of solid tumor efficacy. The relationship between serum miR-501 and miR-195 levels and the sensitivity to concurrent chemoradiotherapy in LACC patients was analyzed by univariate and multivariate analyses. The receiver operating characteristic (ROC) curve was also drawn to predict differential efficacy of concurrent chemoradiotherapy sensitivity in LACC patients. Multivariate analysis was conducted by binary logistic regression analysis. P<0.05 indicated statistically significant differences. Results:In LACC patients, serum miR-501 level was significantly higher, whereas serum miR-195 level was significantly lower than those in physical examination subjects (both P<0.05). Univariate analysis showed that serum miR-501 level at admission in the resistant group was significantly higher, whereas serum miR-195 level was significantly lower than those in the sensitive group (both P<0.05). Multivariate analysis showed that serum miR-501 and miR-195 levels were significantly correlated with the sensitivity to concurrent chemoradiotherapy in LACC patients. The area under the ROC curve (AUC) was 0.736 and 0.913, respectively. Conclusions:The higher the serum miR-501 level and the lower the serum miR-195 level before treatment, the higher the probability of resistance to concurrent chemoradiotherapy in LACC patients. Serum miR-501 and miR-195 levels of LACC patients before treatment have certain predictive value for the sensitivity to concurrent chemoradiotherapy.
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Objective:To evaluate the effect of tumor volume on the radiation dose and efficacy of locally advanced cervical cancer patients undergoing radical radiotherapy and chemotherapy.Methods:Clinical data of 126 patients who were diagnosed with cervical cancer (stage ⅡB-ⅣA) and underwent radical concurrent chemoradiotherapy in Guangxi Medical University Cancer Hospital from November 2019 to November 2022 were retrospectively analyzed. The cut-off values of tumor volume before (pre-TV) and after (post-TV) external radiotherapy and tumor volume reduction rate (TVRR) were calculated by Jamovi software. The effects of pre-TV, post-TV and TVRR on short-term efficacy, progression-free survival (PFS), brachytherapy (BT) mode , high-risk clinical target volume (HR-CTV) and organs at risk (OAR) dose were investigated by univariate and multivariate analyses.Results:Pre-TV≥67.03 cm 3 and post-TV≥14.88 cm 3 were poor prognostic factors for 6-month PFS and objective response rate (ORR) (both P<0.05), and post-TV was an independent prognostic factor. In the TVRR≥73.0% and <73.0% groups, no statistical differences were observed in the 6-month PFS and ORR. In the pre-TV≥67.03 cm 3 group, the cases number of intracavitary brachytherapy (ICBT) and intracavitary / interstitial brachytherapy (IC/IS-BT) was 36 (50.0%), while in the pre-TV<67.03 cm 3 group, the cases number of ICBT and IC/IS-BT was 41 (76%) and 13 (24%), respectively ( P=0.003). In the post-TV≥14.88 cm3 group, the cases number of ICBT and IC/IS-BT was 28 (47%) and 32 (53%), while 49 (72%) and 17 (26%) in the post-TV<14.88 cm3 group, respectively ( P=0.002). The dose of HR-CTV D 90% in the TVRR≥73.0% group was significantly higher than that in the TVRR<73.0% group ( P=0.014), but there was no significant difference in the dose of bladder D 2 cm3, rectal D 2 cm3 and small intestine D 2 cm3 (all P>0.05). The dose of HR-CTV D 90% in the post-TV<14.88 cm 3 group was significantly higher than that in post-TV≥14.88 cm 3 group ( P<0.001), and the dose of bladder D 2 cm3 in the post-TV≥14.88 cm 3 group was higher than that in the post-TV<14.88 cm 3 group ( P<0.05). There was no significant difference in the dose of rectal D 2 cm3 and small intestinal D 2 cm3 between two groups (both P>0.05). The number of concurrent chemotherapy (≥4 times vs.<4 times) had no statistical difference for 6-month PFS and TVRR. Conclusions:Pre-TV and post-TV are the influencing factors of short-term efficacy and BT mode selection for locally advanced cervical cancer. Post-TV is an independent prognostic factor and also indirectly affects the dose of HR-CTV D 90% and bladder D 2 cm3 Increasing the number of concurrent chemotherapy (≥4 times) does not improve TVRR and short-term efficacy.
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Objective:To design and evaluate the application value of intracavitary-interstitial brachytherapy (IC-ISBT) applicator template for locally advanced cervical cancer.Methods:MRI data of 100 patients with ⅡB-ⅣA stage cervical cancer (International Federation of Gynecology and Obstetrics 2018 staging system) before and after external beam radiation therapy (EBRT) admitted to Sun Yat-sen University Cancer Center from March 2019 to September 2020 were collected. The range of primary cervical lesions was retrospectively analyzed and compared. Based on the residual mass of patients, the corresponding high-risk clinical target volume (HR-CTV) was delineated, and the IC-ISBT applicator template was designed and initially applied to cervical cancer patients. Dosimetry analysis and efficacy evaluation were compared between the applicator template-guided ( n=37) and free-hand implantation groups ( n=63). Chi-square test or Fisher exact test was performed for categorical variables, and t-test or U-test for continuous variables. Results:The median distance between the residual tumor margin (clockwise 3, 6, 9, 12 o'clock) and the center of 100 patients with ⅡB-ⅣA stage cervical cancer after EBRT was 16.5, 14.0, 17.0 and 13.0 mm, respectively. The corresponding HR-CTV was superimposed to reconstruct the three-dimensional diagram, and the cylindrical IC-ISBT applicator template with mushroom-like head was designed and manufactured: the longest and shortest diameter of the head was 35 and 20 mm, respectively; the central channel was adapted to the uterine tube, the C1-C12 channels was arranged in inner circle, and the peripheral B1-B5 and A1-A4 pin channels were expanded bilaterally. In terms of dose coverage, there was no significant difference between the HR-CTV D 90% [(635.12±22.65) vs. (635.80±25.84) cGy], bladder D 2 cm3 [(473.79±44.78) vs. (463.55±66.43) cGy)], rectum D 2 cm3 [(396.99±73.54) vs. (408.00±73.94) cGy] and sigmoid colon D 2 cm3 [(293.07±152.72) vs. (311.31±135.77) cGy] between the template-guided and free-hand implantation groups (all P>0.05), but the HR-CTV D 98% was significantly higher [(544.78±32.07) vs. (536.78±32.04) cGy, P=0.007] and the rectum D 1 cm3 and D 0.1 cm3 were significantly lower [(438.62±69.65) vs. (453.97±67.89) cGy, P=0.016; (519.46±70.67) vs. (543.82±81.24) cGy, P=0.001] in the template-guided implantation group. In addition, there was no significant difference in the complete response rate between two groups (86% vs. 83%, P>0.05). Conclusions:This IC-ISBT applicator template is reasonably designed, and the therapeutic efficacy of the template-guided implantation is equivalent to that of free-hand implantation. The dose coverage of the target area meets the clinical demand with a better protection of the organs at risk. The applicator template has the potential to be widely used as a conventional template in clinical practice as the applicator-guided implantation is convenient to operate and repeat.