Simultaneous integrated or sequential boost to clinically involved lymph nodes in patients with locally advanced cervical cancer treated with definitive chemoradiotherapy

OBJECTIVE

The optimal treatment of metastatic lymph nodes (LNs) in locally-advanced cervical cancer (LACC) is controversial. With the widespread use of modern radiotherapy (RT) techniques, it is become possible to perform dose escalation in clinically involved LNs. This study aimed to evaluate the oncologic outcomes of dose escalation to the involved LNs with the simultaneous-integrated (SIB) or sequential boost (SEB) techniques as a part of definitive chemoradiotherapy (CRT) for patients with LACC.

METHODS

The data of 47 patients treated with definitive CRT with either a SIB or SEB technique to the metastatic LNs between 2015 and 2021 were retrospectively analyzed. All patients received 50.4 Gy/28 fractions of external-beam RT and 28 Gy/4 fractions of brachytherapy.

RESULTS

The number of boosted LNs was 146. The median size of the LNs was 2 cm (range, 1-5 cm). The median cumulative equivalent dose in 2-Gy fractions for the LNs was 64.2 Gy (range, 57.6-71.2 Gy). During the median 30 months of follow-up (range, 14-91 months), no boosted LNs recurred and the local control (LC) rate was 100%. The 2-year overall, disease-free, local recurrence-free, and distant metastasis-free survival rate was 83.1%, 70.5%, 77.5%, and 74.4%, respectively. In multivariate analysis, the non-squamous cell histology was the only negative independent prognostic factor for DFS and DMFS. Treatment was well tolerated without any serious acute toxicity. Serious late toxicity developed in three (6%) patients as ureteral stenosis, rectal bleeding and pelvic fracture in one patient each.

CONCLUSIONS

RT dose escalation provides excellent LC for the clinically involved LNs, even for bulky ones, with a low toxicity profile. Routine LN dissection may not be necessary. However, randomized trials are needed to determine the optimal treatment approach.

Ovarian Carcinoma Presenting With a Large Cervical Mass

Cervical metastasis in ovarian cancer is a rare entity. Therefore, care should be taken in the differential diagnosis of cervical masses as it may mimic a primary tumor. This report aimed to emphasize the importance of a multidisciplinary approach in these tumors. We present a case of a 73-year-old female who presented with post-menopausal vaginal bleeding and cervical mass. The patient was diagnosed with ovarian carcinoma with a multidisciplinary approach. Although cervical metastasis of ovarian cancer is rare, the possibility of secondary cancer should be kept in mind, especially in cervical tumors with atypical clinical course.

The frailty and falling in related with functional performance, balance and physical activity in elderly during Covid-19 pandemics

Funding Acknowledgements

Type of funding sources: None.

Background

Falls and frailty are main causes of morbidity and frequenty associated with functional performance, balance and physical activity. The restrictions imposed by the COVID-19 pandemic force the elderly to spend most of their time at home which may cause further functional problems. Therefore, identifying the risk factors during the pandemic can help to prevent the elderly from frailty and falls. Aim: Our aims are to investigate the clinical frailty profile and falls in relation to functional performance, balance, fear of falling and physical activity and to compare these parameters of the elderly with and without falling history during the COVID-19 pandemics. Method: Thirty-three participants aged 65-85 (mean = 71.33 ± 5.35/years, 20 women, 13 men) who have never had COVID-19 were included in the study. The participants were invited to an online video-conference based assessment. The number of falls during the last year were asked. Clinical frailty severity was assessed with Clinical Frailty Scale. The fear of falling were assessed using Falls Efficacy Scale (FES). The functional performance of the participants were tested with 30 seconds Sit-to-Stand test. The balance and mobility was evaluated with Timed-Up and Go test in a 3 meter corridor. The physical activity level of the participants were questioned using International Physical Activity Questionnaire-Short Form (IPAQ-SF) and vigorous level of physical activity (VPA), moderate level of physical activity (MPA) and walking were also calculated. Results: The mean scores of the outcomes among participants were shown in Table 1. Clinical frailty was significantly higher in women compared to men (p = 0.08). Clinical frailty score, fear of falling and sit to stand performance were significantly worse in fallers. There were negative weak to moderate correlations between frailty and sit to stand performance (p = 0.001) and MPA (p = 0,016). The clinical frailty was also positively correlated with FES (p < 0.001). FES showed positive correlation with Time-Up and Go performance (p = 0.001) and negative correlation with sit to stand performance (p < 0.001) and MPA (p = 0,036). Conclusion: Our results demonstrated that; clinical frailty, fear of falling and sit to stand performance were associated with the fall history in elderly. In addition, clinical frailty score were higher in women. Our results indicate that, people who have fall history may tend to be frailer and may have lower functional performance, balance and physical activity. The encouragement of the elderly to increased physical activity and exercise program may decrease the frailty score and falling risk especially in elderly women during COVID-19 pandemics.