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PubMed1987

Ovarian metastases from stage IB adenocarcinoma of the cervix.

At the time carcinoma of the cervix is treated by radical surgery, it is believed that ovarian preservation is possible, and will prevent surgical menopause, with its risks of osteoporosis, vaginal dryness, and "hot flashes." However, the data originally used to justify ovarian preservation was based on clinical experience with squamous cell carcinoma of the cervix. Little if any data exist to justify this treatment rationale in patients with adenocarcinoma of the cervix. Two patients who presented with clinical Stage IB adenocarcinoma of the cervix, subsequently underwent radical surgical treatment. Pathologic review of the operative specimens revealed microscopic metastasis to the ovaries in both patients. It is suggested that ovarian preservation at the time of radical surgical treatment for adenocarcinoma of the cervix has not had its safety established, and that sacrificing the ovaries and providing hormonal replacement postoperatively may be a safer course.

Adenocarcinoma↗
PubMed1993

Metastatic adenocarcinoma to the uterine cervix from gastric cancer. A clinicopathologic analysis of 16 cases.

BACKGROUND: Metastatic adenocarcinoma to the uterine cervix from gastric cancer is rare, and the clinicopathologic features of this metastasis are unclear. METHODS: A clinicopathologic review of 16 patients with metastatic adenocarcinoma to the uterine cervix from gastric cancer was performed. RESULTS: The ages of the patients ranged from 29 to 57 years, and 81.3% of the patients were premenopausal. Nine of the patients had undergone gastrectomy previously. In 11 patients the histologic type of the gastric cancer was poorly differentiated adenocarcinoma and, in 5 patients, signet ring cell carcinoma. The cervical metastasis was diagnosed 11-121 months (mean, 57.5 months) after the diagnosis of the gastric cancer in 10 of the patients. In six patients, the cervical metastasis was discovered synchronously or before the diagnosis of the gastric cancer. The colposcopic findings were normal in 57.1%, but 56.3% had abnormal cervical smears. In all patients, tumor cells were present in the dilated lymphatics of the cervix. Metastases to the uterine body and bilateral ovaries were common, and half of the patients had metastases to the paraaortic lymph nodes. Extirpation of the cervix was performed in six patients. The prognosis was poor, regardless of the treatment method. CONCLUSIONS: The route of metastasis to the cervix is surmised to be retrograde lymphatic, and this extension is often slow. Periodic gynecologic examinations should be performed indefinitely for premenopausal female patients with advanced gastric cancer.

Adenocarcinoma↗
PubMed1995

Management and follow-up of patients with adenocarcinoma in situ of the uterine cervix.

Management of adenocarcinoma in situ (ACIS) of the uterine cervix is controversial and cervical conization has been proposed as conservative management in patients desirous of future fertility. The efficacy of conization as treatment for cervical ACIS is unproven, as is the ideal method of follow-up. The purpose of this study was to assess the adequacy of conization of the cervix as conservative management of ACIS, and to assess the ability to detect recurrent disease. Between January 1964 and August 1993, 28 patients with a diagnosis of ACIS made by cone biopsy were seen at Memorial Sloan-Kettering Cancer Center. Initial management was as follows: total abdominal hysterectomy, 11 (39%); radical hysterectomy, 2 (7%); repeat conization, 6 (21%); and close follow-up, 9 (32%). Of the 8 patients with positive margins who underwent a repeat cone biopsy or hysterectomy, 3 had residual ACIS in the subsequent surgical specimen and 1 patient was diagnosed with invasive adenocarcinoma. Four of 10 (40%) patients with negative margins who underwent hysterectomy or repeat cone biopsy had residual ACIS. In addition, one patient whose cone margins were inevaluable was found to have invasive adenocarcinoma in a repeat conization specimen. Fifteen patients were managed conservatively with repeat conization of the cervix or close follow-up. Seven of 15 (47%) have had a recurrent glandular lesion detected after conization; 2 of these recurrences have been invasive adenocarcinoma. Since ACIS is not reliably diagnosed by cervical cytology and colposcopy, patients undergoing conservative management have been typically followed by endocervical curettage (ECC) in combination with Papanicolaou smear. In our series, the ECC was positive in only 43% of patients with glandular lesions prior to conization of the cervix. This retrospective study raises questions about the safety of therapeutic conization as conservative management of patients with ACIS of the uterine cervix and also highlights the potential inadequacy of following patients with Pap smears in combination with ECC.

Adenocarcinoma↗
PubMed1998

Immunohistochemical demonstration of aberrant glycosylation and epidermal growth factor receptor in tubal metaplasia of the uterine cervix.

Tubal metaplasia (TM) of the uterine cervix may be confused with endocervical glandular dysplasia or adenocarcinoma of the uterine cervix in histologic specimens. TM is characterized histologically by architecturally normal endocervical glands containing ciliated or clear cells, nonciliated cells, and intercalated or peg cells, resembling normal tubal mucosa. Although several characteristics of TM are still undetermined, TM is considered a benign lesion. In this study, the expressions of epithelial-specific antigen (ESA), epidermal growth factor receptor (EGFR), and fucosyl SSEA1 (Le(y)) antigens were examined by an immunohistochemical method in 14 cases of TM in the uterine cervix (5 with normal endocervix, 5 with endocervical glandular dysplasia, 3 with adenocarcinoma in situ, and 1 with microinvasive adenocarcinoma). In the normal endocervical cells, expression of the EGFR antigen was rarely observed in the cytoplasm, and ESA staining was generally restricted to the basolateral membrane. Le(y) expression was occasionally observed in the cytoplasm of subcolumnar reserve cells. On the other hand, expression of EGFR, ESA, and Le(y) was observed in the cytoplasm of TM as well as in adenocarcinomas of the uterine cervix. These results suggest that TM in the uterine cervix might possess a neoplastic character.

ErbB Receptors↗
PubMed1999

A limited role for adjuvant radiotherapy after the Wertheim/Okabayashi radical hysterectomy for cervical cancer confined to the cervix.

BACKGROUND: The indications for radiotherapy after radical hysterectomy for early stage cervical cancer are changing. In the past only tumor outside the cervix was considered an indication for radiotherapy. Today adjuvant radiotherapy is also considered for an "intermediate-risk" group with tumor confined to the cervix but poor prognostic primary tumor parameters such as large tumor diameter, vascular space invasion, and deep stromal penetration. OBJECTIVE: The aims of this study were to determine the risk of isolated pelvic recurrences in an intermediate-risk group (GOG Study No. 92) and to analyze whether this group will theoretically benefit from adjuvant pelvic radiotherapy. PATIENTS AND METHODS: A retrospective analysis was performed on 271 patients with early cervical cancer treated by a radical hysterectomy in a uniform fashion in one institute. Radiotherapy was administered only when tumor was found outside the cervix. Tumor diameter, capillary lymphatic space invasion, and depth of stromal penetration were assessed in all patients. Recurrence pattern, disease-specific survival, and recurrence-free interval were determined in the intermediate-risk group and compared with the remaining patients of the group with tumor confined to the cervix. RESULTS: A significant difference in disease-specific survival (89% versus 97%, P < 0.03) and 5-year recurrence-free interval (86% versus 95%, P < 0.02) was noted in the intermediate-risk group (n = 56) compared with the total group with tumor confined to the cervix. Three patients in the intermediate-risk group died of disease with a pelvic recurrence. Two of these patients had a combined pelvic and distant recurrence. CONCLUSION: Our retrospective results fail to support a survival benefit of extending indications for adjuvant radiotherapy other than postive nodes, parametrial extension, and positive margins.

Female↗
PubMed1996

Sexual, reproductive, and other risk factors for adenocarcinoma of the cervix: results from a population-based case-control study (California, United States)

The incidence of adenocarcinoma of the cervix increased steadily in young women in the United States between the early 1970s and the mid-1980s. Despite this increase, little is known about the etiology of this cancer, although a role for risk factors for both squamous cell carcinoma of the cervix and endometrial adenocarcinoma has been suggested. Incident cases of adenocarcinoma of the cervix diagnosed in women born after 1935 (ages 42 to 56 at diagnosis) were identified from the Los Angeles (California) County Cancer Surveillance Program (LACCSP). Data from personal interviews with 195 cases and 386 controls (matched on age, race, and neighborhood) were analyzed. Compared with women in the highest categories of education and income, women in the lowest categories had a 2.5 and 3.1-fold elevated risk of adenocarcinoma of the cervix. Number of sexual partners, especially before age 20, was strongly predictive of risk (odds ratio = 5.6, 95 percent confidence interval = 1.4-22.0 for 10 or more compared with no partners before age 20). Smoking was not associated significantly with risk. Weight gain and long-term use of oral contraceptives increased risk, while long-term diaphragm use was protective. This study suggests that both sexual and hormonal factors are important etiologic factors for adenocarcinoma of the cervix.

Adenocarcinoma↗
PubMed2003

Vacuum application through a nonfully dilated cervix: a viable option.

The aim of this cross-sectional study was to assess the feasibility of vacuum delivery through a nonfully dilated cervix. The study group consisted of 39 women with vacuum deliveries through a nonfully dilated cervix larger than 9 cm and station of the head at S or more +2 cm. These were compared to a control group of 215 vacuum deliveries at a fully dilated cervix and 46 women who underwent cesarean section at a nonfully dilated cervix larger than 9 cm. The main indication for vacuum extraction in the study group was fetal distress and in the control groups prolonged 2nd stage, dysfunctional labor and fetal distress. Maternal and neonatal morbidity was low and not different between the groups. Neonatal well being, evaluated by cord pH and 5-min Apgar score, was not different. Based on predefined criteria, vacuum extraction through a nonfully dilated cervix is a viable alternative to emergency cesarean section and is apparently not associated with higher maternal or infant morbidity.

Apgar Score↗
PubMed2003

Altered expression of desmosomal components in high-grade squamous intraepithelial lesions of the cervix.

We have used immunohistochemistry to test the hypothesis that components of the desmosome are disrupted during neoplastic progression of squamous epithelial cells in the uterine cervix. Sections of normal cervix and squamous intraepithelial lesions (SILs) were immunostained for desmosomal proteins and glycoproteins, and results were assessed using a semi-quantitative grading system. No difference between normal cervix and low-grade SIL (LSIL) was found. A significant reduction in expression of desmogleins was seen between high-grade SIL (HSIL) and LSIL (P<0.01) and normal cervix (P<0.001). Desmocollin expression was not reduced significantly, although scores showed significantly greater variation in HSIL compared with LSIL (P<0.05) and normal cervix (P<0.05). There was no significant difference in desmoplakin expression among the three groups. The results suggest that there may be sequential disruption of desmosomal function during neoplastic progression of cervical squamous intraepithelial cells, with downregulation of desmogleins during the progression from LSIL to HSIL and loss of desmocollin expression occurring in some cases of established HSIL.

Biomarkers, Tumor↗
PubMed1980

Cushing's syndrome with small cell carcinoma of the uterine cervix.

A 28 year old white women was found to have a cervical tumor in the 25th week of pregnancy. Pathologic examination revealed a nonkeratinizing small cell carcinoma. After delivery by cesarean section, pelvic lymph node exploration was carried out, and all 15 nodes were free of tumor. Her condition was staged as II-A, and she was treated with local radiation. Metastatic disease became manifest almost a year later and was histologically similar to her primary disease. A Cushingoid appearance was noticed and plasma cortisol levels were elevated. Twenty-four hour urinary 17-hydroxycorticosteroid (17-OHCS) and 17-ketosteroid (17-KS) levels were elevated and failed to suppress with dexamethasone. Plasma adrenocorticotropin (ACTH) level was elevated. Electron microscopic examination of the tumor tissue revealed neurosecretory granules. Immunoperoxidase stains for ACTH were positive. The patient's course was one of progressive decline and eventual death. A literature review revealed two other cases in which carcinoma of the uterine cervix was considered to be the source of ectopic ACTH. Some small cell carcinomas of the cervix may arise from cells of the APUD series. Small cell carcinoma of the uterine cervix may behave differently from the more commonly encountered keratinizing and large cell nonkeratinizing carcinomas of the cervix and may not respond as well to standard therapy. Ectopic hormone production, production of abnormal peptides or of vasoactive amines may be more common in small cell carcinoma of the cervix than is currently recognized, and these products may be clinically useful as tumor markers.

17-Hydroxycorticosteroids↗
PubMed1976

Carcinoma in situ of the vagina following treatment for carcinoma of the cervix: a distinctive clinical entity.

A series of 10 patients who presented with carcinoma in situ of the vagina following treatment for carcinoma of the cervix were seen in a 3 year period and their clinical and histologic features reviewed. Vaginal lesions developed 1 to 22 years after diagnosis of carcinoma of the cervix was made. In three patients the vaginal lesions progressed to invasion. In the remaining patients repeated biopsies have revealed persistent carcinoma in situ. From this series of 10 patients we conclude that the biologic behavior of vaginal carcinoma in situ following carcinoma of the cervix resembles that of carcinoma in situ of the cervix and that carcinoma of the vagina following carcinoma of the cervix should be considered a separate clinical entity distinctive from primary invasive carcinoma of the vagina.

Adult↗
PubMed1977

The incompetent cervix and accelerated fetal lung maturation.

The incompetent cervix is an infrequent but identifiable cause of late midtrimester pregnancy loss. The early diagnosis and surgical treatment of these patients have resulted in successful outcomes in 70 to 80 per cent of patients treated. However, this closure of the cervix may be only partially successful, in that the pregnancy may continue beyond the age of fetal viability, but the fetus may be born prematurely. There are no reports in the literature of the neonatal respiratory status of these infants delivered between 24 and 33 weeks of gestation. Nineteen preterm infants of less than 3-4 weeks' gestation were born to mothers with an incompetent cervix. The incidence of the respiratory distress syndrome was significantly less in infants of mothers with an incompetent cervix than in control infants of similar gestation (p less than 0.001). The incomplete cervix appears to be related to maternal or fetal conditions which result in accelerated fetal lung maturation.

Female↗
PubMed1983

The relationship between plasma levels of estradiol-17beta, progesterone and the consistency of the cervix in the sow.

The object of this investigation was to estimate the peripheral plasma levels of estradiol-17beta and progesterone and the consistency of the cervix by rectal palpation of sows before, during and after post-weaning estrus. The tonicity of the cervix increased from approximately 4 days before the onset of heat, became firmest during estrus, and became softer again during the post-estrual period. The levels of estradiol increased before the onset of heat and reached maximum levels on the day preceding heat, then decreased to baseline. The progesterone levels remained low until post-estrus, then increased rapidly. One sow which did not come in heat constantly had a soft cervix and low hormone levels. It is concluded that estrogen might be implicated in the increased tonicity of the cervix and that rectal examination of the cervix provides valuable information on ovarian function.

Journal Article↗
PubMed2005

Elevation of cyclooxygenase-2 is related to lymph node metastasis in adenocarcinoma of uterine cervix.

In a previous study, we demonstrated that elevation of COX-2 is significantly associated with lymph node metastasis in squamous cell carcinoma (SCC) of cervix. The main objective of this study is to characterize the relationship between elevation of COX-2 and its possible clinical role in adenocarcinoma (AC) of cervix. Using immunohistochemistry, we examined COX-2 expression levels in 84 patients with AC of uterine cervix [71 ACs, 13 adenosquamous carcinomas (ASCs)]. Elevation of COX-2 was correlated with clinicopathological variables and p53 expression, as detected by immunohistochemistry. Elevation of COX-2 was detected in 13.0% (11 of 84) of the tumors. Elevation of COX-2 was significantly correlated with histologic type (AC 8.5% vs. ASC 38.5%, P=0.011). Both tumor stage and lymph node metastasis were correlated with elevation of COX-2 with a borderline significance (P=0.062 and 0.068, respectively). Elevation of p53 was not associated with elevation of COX-2. The association between lymph node metastasis and elevation of COX-2 was stronger in cases of AC than in cases of ASC (28.4 vs. 4.3%, P=0.023). According to the results of univariate analysis, elevation of COX-2 was significantly associated with decreased overall survival (P=0.003, log-rank test). However, multivariate analyses revealed that only tumor stage was independently associated with overall survival, suggesting that elevation of COX-2 itself may not be an independent prognostic factor. The present study shows that elevation of COX-2 may contribute to lymph node metastasis in AC of uterine cervix. This suggests that the potential therapeutic role of COX-2 inhibitors should be validated, not only in SCC, but also in AC of uterine cervix.

Adenocarcinoma↗
PubMed2004

Recurrent squamous cell carcinoma of cervix after definitive radiotherapy.

PURPOSE: To study retrospectively the characteristics and survival of patients with recurrent squamous cell carcinoma (SCC) of the cervix after definitive radiotherapy (RT) and to identify subsets of patients who might benefit from aggressive salvage treatment. METHODS AND MATERIALS: Between 1990 and 1999, 1292 patients with Stage I-IVA SCC of the cervix underwent full-course RT. Of the 1292 patients, 375 (29%) had either local or distant failure and were included in this analysis. The 35 patients (2.7%) with both pelvic and distant relapse were excluded. In the 162 patients with local failure, 71 (44%) had persistent disease and 91 (56%) had a relapse after complete tumor regression. Of these 162 patients, 47 (29%) received salvage surgery. In the 213 patients with distant failure, 46 (22%) had isolated para-aortic lymph node (PALN) metastasis, and 35 (76%) of them were treated with concurrent chemoradiotherapy/RT. Patients with supraclavicular lymph node (SCLN) relapse usually underwent concurrent chemoradiotherapy. Palliative chemotherapy and/or RT were given by decision of the responsible attending physician. RESULTS: The independent prognostic factors for local failure were advanced stage and young age (<45 years) and, for distant failure, were advanced stage, positive pelvic lymph nodes, and high serum SCC-antigen levels. The 5-year overall survival rate was 10% and 11%, respectively, for patients with local or distant failure. For local relapse, the 5-year overall survival rate was 29% vs. 3% (p = 0.0001) for patients with vs. without salvage surgery and 22% vs. 9% vs. 4% for patients with tumors confined to the cervix, tumors extending but not beyond the cervix and adjacent tissues, and tumor extending beyond adjacent tissues but contained within the pelvis (p = 0.005). The survival rates, either with or without salvage surgery, were nearly identical between patients with persistent disease and those with relapse after complete regression. The 3-year overall survival rate was 34%, 28%, and 5% (p = 0.001), respectively, for patients with PALN relapse alone, SCLN relapse with or without PALN relapse, and relapse other than PALN and SCLN. Of the patients with PALN relapse alone, 27% survived >5 years. CONCLUSION: For recurrent SCC of the cervix after RT, patients with isolated PALN relapse salvaged by RT or combined chemoradiotherapy or those with cervical relapse salvaged by surgery can achieve long-term survival. Early detection of relapse with aggressive salvage treatment is important for achieving better outcome. Patients with persistent disease or relapse after complete remission had similar outcomes. Patients with SCLN relapse had a longer survival time than those with other metastases (except PALN), and palliative RT might be beneficial.

Age Factors↗
PubMed2004

Expression of p53, Ki-67, and CD31 in the vaginal margins of radical hysterectomy in patients with stage IB carcinoma of the cervix.

OBJECTIVES: This study was undertaken to evaluate the expression of p53, Ki-67, and CD31 both in the tumor and in the vaginal margins of radical hysterectomy in patients with stage IB squamous cell carcinoma of the cervix, as an attempt to use these proteins as possible markers for residual tumor in cervical cancer. METHODS: Thirty patients with stage IB squamous cell carcinoma of the cervix were submitted to radical hysterectomy (study group), and thirty patients with uterine myoma were submitted to vaginal hysterectomy (control group) and were prospectively studied from November 2001 to September 2002. Tissue samples were taken from the tumor or cervix, anterior vaginal margin (AVM), and posterior vaginal margin (PVM) and were immunohistochemically evaluated by monoclonal antibodies for p53, Ki-67, and CD31. Vaginal samples in which the histological examination showed tumor involvement were excluded from the study. RESULTS: Patient's mean age was 48.7 +/- 10.4 years (27-73 years). The clinical stage was IB1 in 22 patients (73.3%) and IB2 in eight patients (26.7%). The expressions of p53, Ki-67, and CD31 were significantly higher in the tumor than in the benign cervix (P < 0.001). Higher expressions of these markers were noted in the vaginal margins of radical hysterectomy in patients with cervical carcinoma compared to the vaginal margins of control patients. This association was demonstrated for p53 in the AVM proximal (P = 0.045), for Ki-67 in AVM proximal (P < 0.001), AVM distal (P < 0.001), PVM proximal (P = 0.009), and PVM distal (P < 0.001), and for CD31 in AVM proximal (P = 0.003) and AVM distal (P = 0.018). There was no difference in p53, Ki-67, and CD31 expression between the proximal and distal regions of the vaginal margins in patients with carcinoma of the cervix. CONCLUSION: The expressions of p53, Ki-67, and CD31 were significantly higher in both the histologically positive (cervical tumor) and negative (vaginal margins) tissues of patients who had undergone radical hysterectomy for cervical cancer compared to the benign control tissues.

Adult↗
PubMed1998

Fast dynamic contrast-enhanced colour-coded MRI in uterine cervix carcinoma: useful for tumour staging?

OBJECTIVE: To quantify first-pass enhancement of cervix carcinoma using fast dynamic MRI. To assess the accuracy of dynamic contrast-enhanced colour-coded MRI for determining tumour invasion into surrounding pelvic tissues. METHODS: Gadolinium enhanced dynamic MRI at one image every 2 s was performed in 47 patients with cervical carcinoma and five controls. First-pass contrast enhancement of cervix carcinoma and surrounding pelvic tissues was quantified. Automated colour-coded images were constructed using the dynamic parameters slope, amplitude and timing of enhancement. Of 47 patients, 28 underwent surgery and colour coded images were correlated with histological findings. RESULTS: First-pass contrast enhancement imaging of cervix carcinoma required a temporal resolution of dynamic MRI of one image every 3-4 s. Cervix carcinoma first-pass was more rapid and intense than that of other pelvic tissues (P<0.001) with the exception of normal myometrium (P>0.05). Binary colour coding, however, was not reliable for tumour delineation or for accurate assessment of tumour invasion into the parametria or the bladder wall. Overestimation of the extent of tumour invasion occurred in 15, 16 and nine out of 28 patients, respectively, using amplitude, slope and timing of enhancement as parameters. CONCLUSION: Dynamic contrast-enhanced colour-coded MRI of cervix carcinoma has limited value for assessing the extent of tumour spread and tumour staging.

Adult↗
PubMed1977

The microspectrophotometric research of the content of ascorbic acid in carcinomas of the uterine cervix.

Taking into consideration the fact that the ascorbic acid takes an active part in the process of growth and reproduction of the cells, the authors have undertook the microspectrophotometric research of its content in 27 different structure cancerous tumours of the uterous cervix. The result of the research showed the decrease of the quantity of ascorbic acid in cancerous tumours of the uterous cervix in compare with norm. The content of ascorbic acid in carcinomas cancerous tumours of the uterine cervix depends on the degree of differentiation and histogenesis of the neoplasm. In less differential squamous cell cancers the quantity of ascorbic acid is more than in the mature ones. The least quantity of ascorbic acid is in adenogenic carcinomas of the uterine cervix. The micro-spectro-photometric research of the content of ascorbic acid in cancerous tumours of the uterine cervix may be used as test in practical activity of the pathologoanatomist for the differential diagnostic and prognosis.

Ascorbic Acid↗
PubMed2003

Prolonged oral etoposide in recurrent or advanced non-squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study.

OBJECTIVE: Previous studies by the Gynecologic Oncology Group have demonstrated a 7% response rate with bolus etoposide as second-line therapy in nonsquamous cell carcinoma of the cervix. Prolonged oral etoposide, which exploits the schedule dependency of this agent, has demonstrated increased activity in squamous carcinoma of the cervix compared with bolus administration. To evaluate prolonged oral etoposide in nonsquamous cell carcinoma of the cervix, the current phase II trial was conducted. METHODS: Eligibility included nonsquamous cell cancer of the cervix, measurable disease, no more than one prior chemotherapy regimen no prior etoposide, WBC > or = 3000/microl, platelets > or = 100,000/microl, serum creatinine < or = 2 mg%, and adequate hepatic function. The starting dose was 50 mg/m(2)/day (40 mg/m(2)/day for prior radiotherapy) for 21 days, every 28 days. Based on toxicity, dose escalation to a maximum dose of 60 mg/m(2)/day was prescribed. RESULTS: Fifty-two patients were entered on this study, with 47 evaluable for toxicity and 42 evaluable for response. A median of three (range: 1-12) courses were given. Thirty-four patients received prior radiation therapy and 15 received prior chemotherapy. Oral etoposide was well tolerated, with grade 4 neutropenia occurring in 29.8% and grade 4 thrombocytopenia occurring in 8.5% of patients. Three complete (7.1%) and two partial (4.8%) responses were observed. All of the responses were seen in chemotherapy-naïve patients (5/27); four of five had disease in nonirradiated sites. CONCLUSION: Prior radiation therapy significantly limited our ability to deliver prolonged oral etoposide. At this dose, this regimen is moderately active in chemotherapy-naïve patients with nonsquamous cell carcinoma of the cervix.

Adenocarcinoma↗