Ming-Yin Lin - Academia.edu (original) (raw)
Papers by Ming-Yin Lin
Leukemia & Lymphoma, 2009
Journal of Minimally Invasive Gynecology, 2008
Study Objective: Cervical cancer is a significant health problem in countries of the developing w... more Study Objective: Cervical cancer is a significant health problem in countries of the developing world. Although case series suggest advantages of total laparoscopic radical hysterectomy (TLRH) compared with total abdominal radical hysterectomy (TARH), no randomized controlled trial is currently available to establish TLRH as the new standard treatment. In this study, TLRH or total robotic radical hysterectomy (TRRH) will be performed without a vaginally assisted portion of the procedure. Design: A biphasic randomized controlled trial was designed to test feasibility of recruitment and equivalence in regard to disease-free survival (Canadian Task Force classification I). Setting: Tertiary referral hospital. Patients: Patients with histologically confirmed invasive squamous cell carcinoma or adenocarcinoma of the cervix, stage IA1 (with lymphovascular space invasion), IA2, and IB1 are eligible. Interventions: During the first phase, 100 patients will be randomized (1:1) to receive either TLRH/TRRH or TARH, with the primary end point being the rate of enrollment. During the second phase, recruitment will be extended by another 640 patients in a 1:1 TLRH/TRRH:TARH allocation, to determine equivalence with respect to disease-free survival with 80% power and a 5 0.05. Measurements and Main Results: Equivalence will be assumed if the difference in disease-free survival does not exceed 7% at 4 years. Secondary outcomes include treatment-related morbidity, costs and cost effectiveness, patterns of recurrence, quality of life, pelvic floor function, feasibility of intraoperative sentinel node sampling, and overall survival. All data from this multicenter study will be entered using online electronic case report forms, allowing real-time assessment of data completeness and patient follow-up. Conclusion: This prospective trial aims to show the equivalence of a TLRH/TRRH versus TARH approach for patients with early stage cervical cancer following a 2-phase protocol. This trial was developed and designed with the input and approval of the members of the Gynecologic Oncology Committee from the American Association of Gynecologic Laparoscopists.
Journal of Thoracic Oncology, 2014
Introduction: A recent meta-analysis suggested that patients with non-small-cell lung cancer (NSC... more Introduction: A recent meta-analysis suggested that patients with non-small-cell lung cancer (NSCLC) whose primary tumors have a higher standardized uptake value (SUV) derived from 18 F-fluorodeoxyglucose positron emission tomography (PET) have a worse prognosis in comparison with those with tumors with lower values. However, previous analyses have had methodological weaknesses. Furthermore, the prognostic significance over the full range of SUV values in patients treated nonsurgically remains unclear. The aim of this retrospective study was to investigate the relationship between survival and maximum SUV (SUV max) analyzed as a continuous variable, in patients with NSCLC, staged using PET/computed tomography (CT) and treated with radiotherapy with or without chemotherapy. Methods: Eligible patients had a histological diagnosis of NSCLC, were treated with radical radiotherapy with or without chemotherapy as their primary treatment, and had pretreatment PET/CT scans. SUV max , defined as the maximum pixel SUV value retrieved from the primary tumor, was analyzed primarily as a continuous variable for overall survival. Results: Eighty-eight patients met eligibility criteria: stage I, 19; stage II, 10; and stage III, 59. Median SUV max was 15.0 (range, 2.5-56). Higher stage was associated with higher SUV max values (p = 0.048). In univariate analysis, there was no evidence of a prognostic effect of SUV max (hazard ratio per doubling = 0.83; 95% confidence interval, 0.62-1.11; p = 0.22). Analyzing SUV max as a dichotomous variable (median cut point = 15.0), the hazard ratio (high: low) for risk of death was 0.71, with p = 0.18 (95% confidence interval, 0.44-1.15). Conclusions: In this cohort of patients, increasing SUV max derived from 18 F-fluorodeoxyglucose-PET/CT was associated with increasing tumor, node, metastasis (TNM) stage. We found no evidence of an association of increasing SUV max with a shorter survival. Previous reports of an association between prognosis and SUV max may partly be the result of methodological differences between this study and previous reports and an association between stage and SUV max .
Journal of Cancer Research and Therapeutics, 2022
Context: Cervix cancer is still a leading cause of death in developing countries. Concurrent chem... more Context: Cervix cancer is still a leading cause of death in developing countries. Concurrent chemoradiation (CCRT) over 5 weeks followed by brachytherapy is standard of care in locoregionally advanced cervix cancer. Such prolonged treatment may not be tolerated in medically compromised patients. High-dose interrupted hypofractionated Quad-Shot (QS) radiotherapy with brachytherapy treatment was well tolerated. Aims: This study aims to assess the locoregional tumor control in cervix cancer patients who were treated with QS regimen. Settings and Design: Retrospective. Subjects and Methods: Newly diagnosed histologically confirmed cervix cancer patients who were unfit for conventional CCRT and who were treated with QS protocol between 1999 and 2016 were analyzed. Tumor stage, treatment, and follow-up details were retrieved from an ethics-approved prospective departmental database. Statistical Analysis Used: Descriptive statistics and Kaplan–Meier method were used for estimating survival...
Indian Journal of Gynecologic Oncology, 2021
Aim The purpose of this study was to evaluate the overall survival (OS), relapse-free survival (R... more Aim The purpose of this study was to evaluate the overall survival (OS), relapse-free survival (RFS) and patterns of failure, in patients with SCC and ADC of cervix treated with definitive radiotherapy and to determine whether ADC should be treated differently. Methods Total of 494 patients treated between January 1996 and December 2012 with definitive radiotherapy were included for analysis. Survival probabilities were estimated using Kaplan-Meier method, and differences between the groups were compared using long-rank test. Cox proportional hazards models were used to determine the role of histology after adjusting for potential confounders impacting on survival. Results The 5-year RFS of node-negative SCC and ADC was 79% and 75% and of node-positive SCC and ADC was 51% and 37%, respectively. The 5-year OS was 74% for both node-negative SCC and ADC and 54% and 42% for node-positive SCC and ADC, respectively. This difference in RFS and OS among these four subgroups was not significant. The tumour volume (p = 0.005), corpus invasion (p = 0.022) and lymph node involvement (p \ 0.001) were significant predictors of RFS, whereas histology (p = 0.204) was not. Increasing age (p \ 0.001), ECOG performance score 2 (p = 0.04), tumour volume (p = 0.009) and lymph node involvement (p \ 0.001) were predictive for OS, but histology (p = 0.458) was not. There was no difference in pelvic and extra-pelvic failure of the two histological subtypes. Conclusion Both these histological types exhibit similar clinical behaviour and survival when matched for prognostic factors. Hence, current standard of care was equally effective in both histological types.
Indian Journal of Gynecologic Oncology, 2021
To investigate prognostic clustering based on lymphovascular space invasion (LVSI) in relation to... more To investigate prognostic clustering based on lymphovascular space invasion (LVSI) in relation to histological prognostic factors in endometrial cancer patients through patterns of failure and survival. A secondary objective was to develop iso-prognostic clusters of low-, intermediate- and high-risk patients . Patients with traditional intermediate, intermediate-high and high-risk endometrial cancer treated with primary surgery and staged as 1 to 3C, presented for adjuvant radiotherapy treatment sequentially between 1996 and 2014, were analysed (n = 1187). Histology included was endometrioid/mucinous, clear cell and serous. Distinct prognostic clusters were identified based on recurrence-free and overall survival (OS) using Cox proportional hazard models and Kaplan–Meier technique. Median follow-up period for the entire cohort was 5.4 (3.6–8.6) years. In the absence of LVSI and positive nodes, histology, grade, myometrial invasion and tumour size had no prognostic significance. LVSI...
Journal of Gynecologic Oncology, 2016
Best practice & research. Clinical obstetrics & gynaecology, Jan 4, 2015
Staging is necessary in determining the extent of disease, its prognosis and in the formulation o... more Staging is necessary in determining the extent of disease, its prognosis and in the formulation of optimal treatment protocols for patients with cancer. Clinical examination of patients and subsequent histopathological assessment when available has traditionally been used to determine the application of different primary and adjuvant treatment modalities. Over the years, surgery, radiotherapy and chemotherapy all have been used either singly or in combinations, and the resulting survival and patterns of failure studies have contributed much in the development of less toxic and more effective protocols. All three modalities of treatments work through separate mechanisms, and they are effective in different stages of cervix cancer. Even within the same stage, the extent of the disease, tumour volume, tissue infiltration and lymph-node metastases requires the use of differing protocols for the disease control. More recently, advances in magnetic resonance imaging (MRI) and positron emi...
Clinical Oncology, 2021
Radiotherapy and brachytherapy are the definitive treatments for locally advanced cervix cancer. ... more Radiotherapy and brachytherapy are the definitive treatments for locally advanced cervix cancer. The use of soft-tissue imaging, particularly magnetic resonance imaging, has enhanced their effectiveness and improved clinical outcomes. However, the use of magnetic resonance imaging is largely restricted to well-resourced centres in both the first and developing world and remains elusive to many less advantaged centres, particularly those in areas with a high burden of cervix cancer. Ultrasound is an accessible, affordable and accurate imaging modality that can be used throughout the brachytherapy procedure. Ultrasound is primarily used to ensure safe insertion of the applicator but can also be used to guide planning. The methods used to utilise ultrasound images for planning are described. Ultrasound is particularly useful as a verification aid to confirm applicator placement after patients are moved and transferred around the radiotherapy department. It can also be used to verify the dimensions of treatment volumes over the course of brachytherapy. There is a crucial unmet need for an accessible economical soft-tissue imaging modality in cervical brachytherapy. Ultrasound has the potential to meet this need.
There has been an ongoing quest to identify new prognostic factors in cervix cancer patients in a... more There has been an ongoing quest to identify new prognostic factors in cervix cancer patients in addition to FIGO stage, tumour volume and nodal involvement in order to tailor individualized patient management and improve survival. Positron Emission Tomography (PET)-Computer Tomography (CT) with 18-F-2-fluoro-2-deoxygluglose (FDG) has been shown to be invaluable in the diagnosis and staging of cervix cancers as well as many other malignancies. PET has demonstrated the ability to detect neoplastic involvement in lymph nodes of normal or borderline size and the advent of hybrid PET-CT has further improved its anatomic localisation of lesions of interest [1]. Several studies have demonstrated that FDG-PET is superior to conventional imaging methods for detecting metastatic disease especially those in the lymph nodes and is helpful in staging, restaging and treatment planning of patients with cervix cancer [2-4]. In addition to its efficacy in assessing nodal and metastatic disease, FDG-PET/CT is thought to have a potential role as a prognostic factor [5].
Aim The purpose of this study was to evaluate the overall survival (OS), relapse-free survival (R... more Aim The purpose of this study was to evaluate the overall survival (OS), relapse-free survival (RFS) and patterns of failure, in patients with SCC and ADC of cervix treated with definitive radiotherapy and to determine whether ADC should be treated differently. Methods Total of 494 patients treated between January 1996 and December 2012 with definitive radiotherapy were included for analysis. Survival probabilities were estimated using Kaplan-Meier method, and differences between the groups were compared using long-rank test. Cox proportional hazards models were used to determine the role of histology after adjusting for potential confounders impacting on survival. Results The 5-year RFS of node-negative SCC and ADC was 79% and 75% and of node-positive SCC and ADC was 51% and 37%, respectively. The 5-year OS was 74% for both node-negative SCC and ADC and 54% and 42% for node-positive SCC and ADC, respectively. This difference in RFS and OS among these four subgroups was not signific...
Journal of Clinical Oncology
Indian Journal of Gynecologic Oncology
Objectives The aim of this study was to quantify the shift in patients from the FIGO 2009 to the ... more Objectives The aim of this study was to quantify the shift in patients from the FIGO 2009 to the FIGO 2018 staging using a prospectively collected dataset where pre-treatment MRI and PET-CT were used. A secondary aim was to explore the distribution of known prognostic factors in both staging schema. Methods Prospectively collected dataset of 1047 cervix cancer patients staged with MRI and PET-CT, between 1996 and 2014, were redistributed using FIGO 2018 staging criteria. Standard deviation inter-quartile and contingency tables were used to present the distribution of patients according to FIGO 2009 and FIGO 2018 criteria. Logistic regression was used to evaluate the association of node positivity and nodal size. Results and Discussion In total, 853 patients were available for analyses. Based on MRI and PET findings, according to FIGO 2009, the incidence of lymph node metastasis was similar in (1) stages 1b1 and 2a1, (2) 1b, 2a2, 2b and 3a (3) 3b and 4a. Nodal metastases were found in 43% patients who were upstaged from FIGO 2009 to newly created FIGO 2018 stages 3c1 and 3c2. Contribution to stage 3c1 came from 31, 41, 29, 30, 32, 33 and 34% of stages 1b1, 1b2, 2a1, 2a2, 3a and 3b, respectively. FIGO 2009 stages 1b1 and 1b2 contributed 5 and 6%, stages 2a1, 2a2, 2b and 3a contributed 16, 15 and 15% to para-aortic nodes, while stage 3b contributed 24%. These findings will likely influence cervix cancer treatment policies.
International Journal of Gynecology & Obstetrics
Endometrial cancer is the most common gynecologic cancer in women today. It is surgicallystaged,a... more Endometrial cancer is the most common gynecologic cancer in women today. It is surgicallystaged,andwhilesurgeryistheprimarytreatmentmodality,theidentification ofdiseaseextent-inparticularextrauterinespread-priortosurgeryisimportantto optimizetreatmentdecisionmaking.UltrasoundandMRIareusefulforevaluatingthe extentoflocaldisease,whileCTandPETareusedfordetectinglymphnodeordistant metastases.Diffusion-weightedMRIhasalsobeenusedfordetectingsmallmetastatic depositsinlymphnodesandomentum.Extrauterinesofttissueinvolvementcanbe detected by ultrasound, CT, MRI, and PET. Recently, intraoperative visualization techniques, such as sentinel lymph node mapping, are increasingly used to avoid extensivesurgicalstagingwithoutcompromisingtreatment.Imagingisalsousedfor planning adjuvant treatment and detection of postoperative residual disease in high-riskpatients,monitoringanddetectingrecurrentdisease,andinpost-treatment surveillanceofasymptomaticpatientswithhighriskofrelapse.
Leukemia & Lymphoma, 2009
Journal of Minimally Invasive Gynecology, 2008
Study Objective: Cervical cancer is a significant health problem in countries of the developing w... more Study Objective: Cervical cancer is a significant health problem in countries of the developing world. Although case series suggest advantages of total laparoscopic radical hysterectomy (TLRH) compared with total abdominal radical hysterectomy (TARH), no randomized controlled trial is currently available to establish TLRH as the new standard treatment. In this study, TLRH or total robotic radical hysterectomy (TRRH) will be performed without a vaginally assisted portion of the procedure. Design: A biphasic randomized controlled trial was designed to test feasibility of recruitment and equivalence in regard to disease-free survival (Canadian Task Force classification I). Setting: Tertiary referral hospital. Patients: Patients with histologically confirmed invasive squamous cell carcinoma or adenocarcinoma of the cervix, stage IA1 (with lymphovascular space invasion), IA2, and IB1 are eligible. Interventions: During the first phase, 100 patients will be randomized (1:1) to receive either TLRH/TRRH or TARH, with the primary end point being the rate of enrollment. During the second phase, recruitment will be extended by another 640 patients in a 1:1 TLRH/TRRH:TARH allocation, to determine equivalence with respect to disease-free survival with 80% power and a 5 0.05. Measurements and Main Results: Equivalence will be assumed if the difference in disease-free survival does not exceed 7% at 4 years. Secondary outcomes include treatment-related morbidity, costs and cost effectiveness, patterns of recurrence, quality of life, pelvic floor function, feasibility of intraoperative sentinel node sampling, and overall survival. All data from this multicenter study will be entered using online electronic case report forms, allowing real-time assessment of data completeness and patient follow-up. Conclusion: This prospective trial aims to show the equivalence of a TLRH/TRRH versus TARH approach for patients with early stage cervical cancer following a 2-phase protocol. This trial was developed and designed with the input and approval of the members of the Gynecologic Oncology Committee from the American Association of Gynecologic Laparoscopists.
Journal of Thoracic Oncology, 2014
Introduction: A recent meta-analysis suggested that patients with non-small-cell lung cancer (NSC... more Introduction: A recent meta-analysis suggested that patients with non-small-cell lung cancer (NSCLC) whose primary tumors have a higher standardized uptake value (SUV) derived from 18 F-fluorodeoxyglucose positron emission tomography (PET) have a worse prognosis in comparison with those with tumors with lower values. However, previous analyses have had methodological weaknesses. Furthermore, the prognostic significance over the full range of SUV values in patients treated nonsurgically remains unclear. The aim of this retrospective study was to investigate the relationship between survival and maximum SUV (SUV max) analyzed as a continuous variable, in patients with NSCLC, staged using PET/computed tomography (CT) and treated with radiotherapy with or without chemotherapy. Methods: Eligible patients had a histological diagnosis of NSCLC, were treated with radical radiotherapy with or without chemotherapy as their primary treatment, and had pretreatment PET/CT scans. SUV max , defined as the maximum pixel SUV value retrieved from the primary tumor, was analyzed primarily as a continuous variable for overall survival. Results: Eighty-eight patients met eligibility criteria: stage I, 19; stage II, 10; and stage III, 59. Median SUV max was 15.0 (range, 2.5-56). Higher stage was associated with higher SUV max values (p = 0.048). In univariate analysis, there was no evidence of a prognostic effect of SUV max (hazard ratio per doubling = 0.83; 95% confidence interval, 0.62-1.11; p = 0.22). Analyzing SUV max as a dichotomous variable (median cut point = 15.0), the hazard ratio (high: low) for risk of death was 0.71, with p = 0.18 (95% confidence interval, 0.44-1.15). Conclusions: In this cohort of patients, increasing SUV max derived from 18 F-fluorodeoxyglucose-PET/CT was associated with increasing tumor, node, metastasis (TNM) stage. We found no evidence of an association of increasing SUV max with a shorter survival. Previous reports of an association between prognosis and SUV max may partly be the result of methodological differences between this study and previous reports and an association between stage and SUV max .
Journal of Cancer Research and Therapeutics, 2022
Context: Cervix cancer is still a leading cause of death in developing countries. Concurrent chem... more Context: Cervix cancer is still a leading cause of death in developing countries. Concurrent chemoradiation (CCRT) over 5 weeks followed by brachytherapy is standard of care in locoregionally advanced cervix cancer. Such prolonged treatment may not be tolerated in medically compromised patients. High-dose interrupted hypofractionated Quad-Shot (QS) radiotherapy with brachytherapy treatment was well tolerated. Aims: This study aims to assess the locoregional tumor control in cervix cancer patients who were treated with QS regimen. Settings and Design: Retrospective. Subjects and Methods: Newly diagnosed histologically confirmed cervix cancer patients who were unfit for conventional CCRT and who were treated with QS protocol between 1999 and 2016 were analyzed. Tumor stage, treatment, and follow-up details were retrieved from an ethics-approved prospective departmental database. Statistical Analysis Used: Descriptive statistics and Kaplan–Meier method were used for estimating survival...
Indian Journal of Gynecologic Oncology, 2021
Aim The purpose of this study was to evaluate the overall survival (OS), relapse-free survival (R... more Aim The purpose of this study was to evaluate the overall survival (OS), relapse-free survival (RFS) and patterns of failure, in patients with SCC and ADC of cervix treated with definitive radiotherapy and to determine whether ADC should be treated differently. Methods Total of 494 patients treated between January 1996 and December 2012 with definitive radiotherapy were included for analysis. Survival probabilities were estimated using Kaplan-Meier method, and differences between the groups were compared using long-rank test. Cox proportional hazards models were used to determine the role of histology after adjusting for potential confounders impacting on survival. Results The 5-year RFS of node-negative SCC and ADC was 79% and 75% and of node-positive SCC and ADC was 51% and 37%, respectively. The 5-year OS was 74% for both node-negative SCC and ADC and 54% and 42% for node-positive SCC and ADC, respectively. This difference in RFS and OS among these four subgroups was not significant. The tumour volume (p = 0.005), corpus invasion (p = 0.022) and lymph node involvement (p \ 0.001) were significant predictors of RFS, whereas histology (p = 0.204) was not. Increasing age (p \ 0.001), ECOG performance score 2 (p = 0.04), tumour volume (p = 0.009) and lymph node involvement (p \ 0.001) were predictive for OS, but histology (p = 0.458) was not. There was no difference in pelvic and extra-pelvic failure of the two histological subtypes. Conclusion Both these histological types exhibit similar clinical behaviour and survival when matched for prognostic factors. Hence, current standard of care was equally effective in both histological types.
Indian Journal of Gynecologic Oncology, 2021
To investigate prognostic clustering based on lymphovascular space invasion (LVSI) in relation to... more To investigate prognostic clustering based on lymphovascular space invasion (LVSI) in relation to histological prognostic factors in endometrial cancer patients through patterns of failure and survival. A secondary objective was to develop iso-prognostic clusters of low-, intermediate- and high-risk patients . Patients with traditional intermediate, intermediate-high and high-risk endometrial cancer treated with primary surgery and staged as 1 to 3C, presented for adjuvant radiotherapy treatment sequentially between 1996 and 2014, were analysed (n = 1187). Histology included was endometrioid/mucinous, clear cell and serous. Distinct prognostic clusters were identified based on recurrence-free and overall survival (OS) using Cox proportional hazard models and Kaplan–Meier technique. Median follow-up period for the entire cohort was 5.4 (3.6–8.6) years. In the absence of LVSI and positive nodes, histology, grade, myometrial invasion and tumour size had no prognostic significance. LVSI...
Journal of Gynecologic Oncology, 2016
Best practice & research. Clinical obstetrics & gynaecology, Jan 4, 2015
Staging is necessary in determining the extent of disease, its prognosis and in the formulation o... more Staging is necessary in determining the extent of disease, its prognosis and in the formulation of optimal treatment protocols for patients with cancer. Clinical examination of patients and subsequent histopathological assessment when available has traditionally been used to determine the application of different primary and adjuvant treatment modalities. Over the years, surgery, radiotherapy and chemotherapy all have been used either singly or in combinations, and the resulting survival and patterns of failure studies have contributed much in the development of less toxic and more effective protocols. All three modalities of treatments work through separate mechanisms, and they are effective in different stages of cervix cancer. Even within the same stage, the extent of the disease, tumour volume, tissue infiltration and lymph-node metastases requires the use of differing protocols for the disease control. More recently, advances in magnetic resonance imaging (MRI) and positron emi...
Clinical Oncology, 2021
Radiotherapy and brachytherapy are the definitive treatments for locally advanced cervix cancer. ... more Radiotherapy and brachytherapy are the definitive treatments for locally advanced cervix cancer. The use of soft-tissue imaging, particularly magnetic resonance imaging, has enhanced their effectiveness and improved clinical outcomes. However, the use of magnetic resonance imaging is largely restricted to well-resourced centres in both the first and developing world and remains elusive to many less advantaged centres, particularly those in areas with a high burden of cervix cancer. Ultrasound is an accessible, affordable and accurate imaging modality that can be used throughout the brachytherapy procedure. Ultrasound is primarily used to ensure safe insertion of the applicator but can also be used to guide planning. The methods used to utilise ultrasound images for planning are described. Ultrasound is particularly useful as a verification aid to confirm applicator placement after patients are moved and transferred around the radiotherapy department. It can also be used to verify the dimensions of treatment volumes over the course of brachytherapy. There is a crucial unmet need for an accessible economical soft-tissue imaging modality in cervical brachytherapy. Ultrasound has the potential to meet this need.
There has been an ongoing quest to identify new prognostic factors in cervix cancer patients in a... more There has been an ongoing quest to identify new prognostic factors in cervix cancer patients in addition to FIGO stage, tumour volume and nodal involvement in order to tailor individualized patient management and improve survival. Positron Emission Tomography (PET)-Computer Tomography (CT) with 18-F-2-fluoro-2-deoxygluglose (FDG) has been shown to be invaluable in the diagnosis and staging of cervix cancers as well as many other malignancies. PET has demonstrated the ability to detect neoplastic involvement in lymph nodes of normal or borderline size and the advent of hybrid PET-CT has further improved its anatomic localisation of lesions of interest [1]. Several studies have demonstrated that FDG-PET is superior to conventional imaging methods for detecting metastatic disease especially those in the lymph nodes and is helpful in staging, restaging and treatment planning of patients with cervix cancer [2-4]. In addition to its efficacy in assessing nodal and metastatic disease, FDG-PET/CT is thought to have a potential role as a prognostic factor [5].
Aim The purpose of this study was to evaluate the overall survival (OS), relapse-free survival (R... more Aim The purpose of this study was to evaluate the overall survival (OS), relapse-free survival (RFS) and patterns of failure, in patients with SCC and ADC of cervix treated with definitive radiotherapy and to determine whether ADC should be treated differently. Methods Total of 494 patients treated between January 1996 and December 2012 with definitive radiotherapy were included for analysis. Survival probabilities were estimated using Kaplan-Meier method, and differences between the groups were compared using long-rank test. Cox proportional hazards models were used to determine the role of histology after adjusting for potential confounders impacting on survival. Results The 5-year RFS of node-negative SCC and ADC was 79% and 75% and of node-positive SCC and ADC was 51% and 37%, respectively. The 5-year OS was 74% for both node-negative SCC and ADC and 54% and 42% for node-positive SCC and ADC, respectively. This difference in RFS and OS among these four subgroups was not signific...
Journal of Clinical Oncology
Indian Journal of Gynecologic Oncology
Objectives The aim of this study was to quantify the shift in patients from the FIGO 2009 to the ... more Objectives The aim of this study was to quantify the shift in patients from the FIGO 2009 to the FIGO 2018 staging using a prospectively collected dataset where pre-treatment MRI and PET-CT were used. A secondary aim was to explore the distribution of known prognostic factors in both staging schema. Methods Prospectively collected dataset of 1047 cervix cancer patients staged with MRI and PET-CT, between 1996 and 2014, were redistributed using FIGO 2018 staging criteria. Standard deviation inter-quartile and contingency tables were used to present the distribution of patients according to FIGO 2009 and FIGO 2018 criteria. Logistic regression was used to evaluate the association of node positivity and nodal size. Results and Discussion In total, 853 patients were available for analyses. Based on MRI and PET findings, according to FIGO 2009, the incidence of lymph node metastasis was similar in (1) stages 1b1 and 2a1, (2) 1b, 2a2, 2b and 3a (3) 3b and 4a. Nodal metastases were found in 43% patients who were upstaged from FIGO 2009 to newly created FIGO 2018 stages 3c1 and 3c2. Contribution to stage 3c1 came from 31, 41, 29, 30, 32, 33 and 34% of stages 1b1, 1b2, 2a1, 2a2, 3a and 3b, respectively. FIGO 2009 stages 1b1 and 1b2 contributed 5 and 6%, stages 2a1, 2a2, 2b and 3a contributed 16, 15 and 15% to para-aortic nodes, while stage 3b contributed 24%. These findings will likely influence cervix cancer treatment policies.
International Journal of Gynecology & Obstetrics
Endometrial cancer is the most common gynecologic cancer in women today. It is surgicallystaged,a... more Endometrial cancer is the most common gynecologic cancer in women today. It is surgicallystaged,andwhilesurgeryistheprimarytreatmentmodality,theidentification ofdiseaseextent-inparticularextrauterinespread-priortosurgeryisimportantto optimizetreatmentdecisionmaking.UltrasoundandMRIareusefulforevaluatingthe extentoflocaldisease,whileCTandPETareusedfordetectinglymphnodeordistant metastases.Diffusion-weightedMRIhasalsobeenusedfordetectingsmallmetastatic depositsinlymphnodesandomentum.Extrauterinesofttissueinvolvementcanbe detected by ultrasound, CT, MRI, and PET. Recently, intraoperative visualization techniques, such as sentinel lymph node mapping, are increasingly used to avoid extensivesurgicalstagingwithoutcompromisingtreatment.Imagingisalsousedfor planning adjuvant treatment and detection of postoperative residual disease in high-riskpatients,monitoringanddetectingrecurrentdisease,andinpost-treatment surveillanceofasymptomaticpatientswithhighriskofrelapse.