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1.
Obstet Gynecol ; 136(3): 533-542, 2020 09.
Article in English | MEDLINE | ID: covidwho-1455364

ABSTRACT

OBJECTIVE: To assess surgical, oncologic, and pregnancy outcomes in patients undergoing radical vaginal, abdominal, or laparoscopic trachelectomy for the treatment of early-stage cervical cancer, using a methodic review of published literature. DATA SOURCES: PubMed, EMBASE, and Cochrane Library sources, including ClinicalTrials.gov, were searched from 1990-2019 with terms "cervical cancer" and "(vaginal, abdominal, open, minimally invasive, or laparoscopic) radical trachelectomy." Grey literature and unpublished data were omitted. METHODS OF STUDY SELECTION: After removal of duplicates from a combined EndNote library of results, 490 articles were reviewed using Covidence software. Two reviewers screened titles and abstracts, and then screened full texts. Selection criteria included articles that reported radical trachelectomy with lymph node assessment as primary therapy for cervical carcinoma, with stated follow-up intervals and recurrences. TABULATION, INTEGRATION, AND RESULTS: Variables of interest were manually extracted into an electronic database. A total 47 articles that reported on 2,566 women met inclusion criteria. Most tumors were of squamous histology (68.5%), stage IB1 (74.8%), 2 cm or less (69.2%), and without lymphovascular invasion (68.8%). Of planned trachelectomies, 9% were converted intraoperatively to hysterectomy. Separated by route of trachelectomy, 58.1%, 37.2%, and 4.7% were performed using radical vaginal, abdominal, and laparoscopic approaches, respectively. With median follow-up of 48 months (range 2-202 months) across studies, median recurrence rate was 3.3% (range 0-25%); median time to recurrence was 26 months (range 8-44 months). Median 5-year recurrence-free and overall survival were 94.6% (range 88-97.3%) and 97.4% (range 95-99%), respectively. The posttrachelectomy pregnancy rate was 23.9%, with a live-birth rate of 75.1%. CONCLUSION: Radical trachelectomy for fertility-preserving treatment of cervical cancer is widely reported in the literature, though publications are mainly limited to case reports and case series. Reported follow-up periods infrequently meet standard oncologic parameters but show encouraging recurrence-free and overall survival rates and pregnancy outcomes. Higher-level evidence needed for meta-analysis is lacking. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42019132443.


Subject(s)
Trachelectomy , Uterine Cervical Neoplasms/surgery , Female , Humans , Neoplasm Staging , Pregnancy , Pregnancy Complications, Neoplastic/pathology , Pregnancy Complications, Neoplastic/surgery , Pregnancy Rate , Trachelectomy/methods , Treatment Outcome , Uterine Cervical Neoplasms/pathology
2.
BMJ Case Rep ; 13(12)2020 Dec 17.
Article in English | MEDLINE | ID: covidwho-1177537

ABSTRACT

Radiation-induced spinal glioblastoma is an extremely rare disease with only four previously published reports in the literature. We report the fifth case, a 69-year-old woman who previously underwent treatment with brachytherapy for cervical cancer, and thereafter presented with neurologic deficits from a conus medullaris tumour. Biopsy and histopathology confirm glioblastoma, not otherwise specified. Treatment of spinal glioblastoma consists of surgery, either biopsy or excision and chemoradiation. However, results are still unsatisfactory and prognosis remains poor.


Subject(s)
Brachytherapy/adverse effects , Glioblastoma/diagnosis , Neoplasms, Radiation-Induced/diagnosis , Spinal Cord Neoplasms/diagnosis , Uterine Cervical Neoplasms/radiotherapy , Aged , Biopsy , Cytoreduction Surgical Procedures , Female , Glioblastoma/etiology , Glioblastoma/pathology , Glioblastoma/surgery , Humans , Laminectomy , Magnetic Resonance Imaging , Neoplasms, Radiation-Induced/etiology , Neoplasms, Radiation-Induced/pathology , Neoplasms, Radiation-Induced/surgery , Spinal Cord/diagnostic imaging , Spinal Cord/pathology , Spinal Cord/radiation effects , Spinal Cord/surgery , Spinal Cord Neoplasms/etiology , Spinal Cord Neoplasms/pathology , Spinal Cord Neoplasms/surgery
3.
Prev Med ; 144: 106399, 2021 03.
Article in English | MEDLINE | ID: covidwho-1139631

ABSTRACT

WHO/UNICEF estimates for HPV vaccination coverage from 2010 to 2019 are analyzed against the backdrop of the 90% coverage target for HPV vaccination by 2030 set in the recently approved global strategy for cervical cancer elimination as a public health problem. As of June 2020, 107 (55%) of the 194 WHO Member States have introduced HPV vaccination. The Americas and Europe are by far the WHO regions with the most introductions, 85% and 77% of their countries having already introduced respectively. A record number of introductions was observed in 2019, most of which in low- and middle- income countries (LMIC) where access has been limited. Programs had an average performance coverage of around 67% for the first dose and 53% for the final dose of HPV. LMICs performed on average better than high- income countries for the first dose, but worse for the last dose due to higher dropout. Only 5 (6%) countries achieved coverages with the final dose of more than 90%, 22 countries (21%) achieved coverages of 75% or higher while 35 (40%) had a final dose coverage of 50% or less. When expressed as world population coverage (i.e., weighted by population size), global coverage of the final HPV dose for 2019 is estimated at 15%. There is a long way to go to meet the 2030 elimination target of 90%. In the post-COVID era attention should be paid to maintain the pace of introductions, specially ensuring the most populous countries introduce, and further improving program performance globally.


Subject(s)
COVID-19 , Papillomavirus Infections , Papillomavirus Vaccines , Uterine Cervical Neoplasms , Europe , Female , Humans , Immunization Programs , Papillomavirus Infections/prevention & control , SARS-CoV-2 , United Nations , Uterine Cervical Neoplasms/prevention & control , Vaccination , Vaccination Coverage , World Health Organization
4.
JNCI Cancer Spectr ; 5(2): pkab011, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1123321

ABSTRACT

The current global novel coronavirus disease 2019 (COVID-19) pandemic threatens to derail the uptake of human papillomavirus (HPV) vaccination in low- and lower-middle income countries with major disruptions to routine immunization and the introduction of new vaccines delayed. This has a major impact on the World Health Organization cervical cancer elimination strategy, where it is dependent on HPV vaccination as well as cervical cancer screening and treatment. We discuss current opportunities and barriers to achieve high uptake of HPV vaccination in low- and lower-middle income countries as well as the impact of COVID-19. Implementation of 4 key recommendations for HPV vaccination in low- and lower-middle income countries is needed: increased global financial investment; improved vaccine supply and accelerated use of a single-dose schedule; education and social marketing; and adoption of universal school-based delivery. With the commitment of the global health community, the adoption of these strategies would underpin the effective elimination of cervical cancer.


Subject(s)
Alphapapillomavirus/immunology , COVID-19/complications , Papillomavirus Infections/immunology , Papillomavirus Vaccines/immunology , Uterine Cervical Neoplasms/immunology , Vaccination/statistics & numerical data , Alphapapillomavirus/physiology , COVID-19/epidemiology , COVID-19/virology , Developing Countries , Female , Humans , Immunization Programs/economics , Immunization Programs/statistics & numerical data , Pandemics , Papillomavirus Infections/complications , Papillomavirus Infections/prevention & control , Papillomavirus Vaccines/administration & dosage , SARS-CoV-2/physiology , Uterine Cervical Neoplasms/prevention & control , Uterine Cervical Neoplasms/virology , Vaccination/methods
5.
Br J Radiol ; 94(1117): 20200686, 2021 Jan 01.
Article in English | MEDLINE | ID: covidwho-940045

ABSTRACT

COVID-19 pandemic has had a catastrophic impact on the society, economy and heath-care system all over the globe with virus showing no signs of losing potency. As the situation appears to worsen, extra burden on other specialities like oncology seems to increase. Specific recommendations are necessary for management of cervical cancer in the current context. All concerned specialities must work together in the best interest of the patient. Attempts should be made at managing cervical cancer while limiting the viral spread among the patients and health-care workers without the loss of opportunity. Surgical intervention for early cervical cancer should be postponed or alternative modalities be considered. In a locally advanced disease, concurrent chemoradiation is the treatment of choice. In addition, the following under mentioned suggestions aim to discuss ways of minimizing infection spread, workload rationalization and providing guidance for management of cervical cancer in the presence of COVID-19 infection.


Subject(s)
COVID-19 , Uterine Cervical Neoplasms/radiotherapy , COVID-19/prevention & control , COVID-19/transmission , Female , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control
6.
Hum Vaccin Immunother ; 17(3): 836-837, 2021 03 04.
Article in English | MEDLINE | ID: covidwho-786983

ABSTRACT

The Coronavirus Disease 2019 (COVID-19) pandemic has been growing, including in Japan where it has been estimated that as many as 3.1% of patients positive for new CoV strain SARS-CoV-2 might die of COVID-19-related respiratory failure. Meanwhile, human papillomavirus (HPV) is spreading in Japan. The fatality rate for HPV-associated cancers after infection with HPV is as much as that for COVID-19 in Japan, although the time to disease is much longer for HPV. Among advanced countries, the cervical cancer screening rate in Japanese females is very low. The Japanese Ministry of Health, Labor and Welfare (MHLW) suspended its official recommendation for HPV vaccination in June 2013 due to alleged adverse post-vaccination events in several young girls, such as chronic pain and motor impairment, which were repeatedly reported in the media. Subsequently, the rate for vaccinating girls plummeted from approximately 70% to the current rate of 1% or less. Women should accept HPV vaccination for the eventual prevention of cervical cancer with the same passion they are for COVID-19 testing.


Subject(s)
Alphapapillomavirus/immunology , COVID-19/immunology , Papillomavirus Infections/immunology , Papillomavirus Infections/prevention & control , Papillomavirus Vaccines/immunology , COVID-19/virology , Early Detection of Cancer/methods , Female , Humans , Japan , Uterine Cervical Neoplasms/immunology , Uterine Cervical Neoplasms/prevention & control , Uterine Cervical Neoplasms/virology , Vaccination/methods
8.
Ecancermedicalscience ; 14: 1067, 2020.
Article in English | MEDLINE | ID: covidwho-636411

ABSTRACT

The COVID-19 pandemic sweeping across the world has caused major disruptions in healthcare delivery and practice. A survey was conducted to assess the changes in the care of gynaecologic oncology patients in India. METHODS: An online survey enquiring about the patient volumes and surgical load, and changes in practice protocols for endometrial, ovarian, cervical and vulval cancers was conducted in May, 2020. RESULTS: The total number of responses received was 153. Barring duplicates, 148 were analysed. There was a significant drop in gynaecologic oncology patients attending government hospitals as compared to the non-government sector. The drop was not significantly different in areas having low versus high COVID-19 case volumes. The treatment of endometrial cancers remained the same although there was a marked shift from minimal access surgery to conventional surgery. Advanced ovarian cancer was mostly managed by neoadjuvant chemotherapy. Cervical and vulval cancer management remained the same, but radiotherapy protocols were modified by most. CONCLUSION: Based on clinician responses, it appears that most practices across India have suffered a fall in patient volumes. The responses from government sectors point towards a bigger hit in this segment of practice. While the management of endometrial cancers and cervical cancers was mostly unchanged, most cases of advanced ovarian cancer received neoadjuvant chemotherapy. Cervical cancer, when managed by chemoradiation, was likely to have altered radiation schedules.

9.
Radiother Oncol ; 148: 270-273, 2020 07.
Article in English | MEDLINE | ID: covidwho-401311

ABSTRACT

Cervical cancer is a deadly disease and the COVID-19 pandemic has the potential to further impact its lethality. Hypofractionated radiotherapy could mitigate this impact, however robust data in cervical cancer setting still is lacking. Information provided here could help institutions in reducing radiotherapy fractions for cervical cancer patients.


Subject(s)
Betacoronavirus , Coronavirus Infections , Pandemics , Pneumonia, Viral , Uterine Cervical Neoplasms/radiotherapy , COVID-19 , Female , Humans , Practice Guidelines as Topic , Radiation Dose Hypofractionation , SARS-CoV-2
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