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ICRU89

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arunmp's version from 2016-12-15 16:24

2.12 KeyMessages

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Cervical cancer is the ---- most common cause of female cancer mortality.third
Recently updated part of figo staging(IIA1and IIA2).
For FIGO staging, clinical examination,----- &----- are usedchest x ray, and IVP
The TNM classification is based onall available clinical and imaging information to be usedfor actual treatment decisions.
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  Lymph-node involvement is related to stage, with
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15 % to 20 % Stage IB
30 %Stage IIB
more than from 40 % to 50 %Stage III.
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Gold standard for tumor assessmentMRI
Best available non-invasive examination to assess nodal and distant diseasePET
Disadvantage of pet low ------- for lymph nodessensitivity
The most accurate lymph node diagnosis is bypathohistological examination after laparoscopic sampling.
Prognostic factors include tumor size, stage, node, lympho-vascular space involvement,and histological subtype.
Most significant negative prognostic factorNodal status
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Local failure is about from
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10 % to 15 %Stage IB2/IIB proximal disease
40 %Stage IIB distal disease/IIIB/IVA
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5-year survival rates
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90 % patients with negative pelvic and para-aortic nodes
50 % to 60 % pelvic nodes positive
20 % to 45 % para-aortic positive nodes.
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In advanced cervix cancer (IB1-IVA), external beam radiotherapy is combined with brachytherapy aiming at a high total dose
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(EQD2) to the CTVHR in the tumor-bearing area75–85 Gydependent on stage of disease
EQD2 doses for EBRT (including lymph-node boost) are between44 Gy and 65 Gy
EQD2 doses for brachytherapy Point A or for the CTVHR in IGBT between20 Gy and 50Gy
Overall radiotherapy treatment time should bewithin 55 days.
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If using Image-guided adaptive brachytherapy for cervix cancer, 85 Gy(EQD2) is delivered then 3 year local control rates are
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Stage I/II >90%
Stage III/IV85 %
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TREATMENT OF CA CERVIX
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In low stages (FIGO IA)surgery, conisation, trachelectomy, or simple hysterectomy
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5-year DFS
rates of from 96 % to 100 %. In Sage IB1, there is no
standard treatment with options for surgery or definitive
radiotherapy or combined brachytherapy and
surgery. In higher stages (IB2–IVA), concomitant
radio-chemotherapy represents the standard, with a 6
% improvement in absolute 5-year survival (60 % to
66 %). Five-year survival and pelvic failure rates decrease
with stage. Loco-regional failure remains essential,
in particular in advanced Stage II, III, and
IVA. The benefit from radio-chemotherapy may be
more pronounced for patients with advanced Stage
IB2–IIA/B compared with III–IVA. The most
common regimen is cisplatin mono-therapy 40 mg/m2
on aweekly schedule. The role of adjuvant chemotherapy
after concomitant radio-chemotherapy remains
unclear
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Intensity-modulated radiotherapy in conjunctionwith brachytherapy for cervical cancer is considered to decrease radiation-associated morbidity ;Is it true or falsestill under investigation
Radiation dose correlates withlocal control.
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