Cancer Research and Treatment

Review Article

Intensity-Modulated Radiation Therapy for Uterine Cervical Cancer to Reduce Toxicity and Enhance Efficacy – an Option or a Must?: A Narrative Review: Sea-Won Lee, Aeran Kim, Sung Jong Lee, Sung Hwan Kim, Jong Hoon Lee; Cancer Res Treat. 2024;56(1):1-17. Published online August 30, 2023; DOI: https://doi.org/10.4143/crt.2023.562

Radiotherapy (RT) is a fundamental modality in treatment of cervical cancer. With advancement of technology, conventional RT used for external beam radiotherapy (EBRT) for over half a century has been rapidly replaced with intensity-modulated radiation therapy (IMRT) especially during the last decade. This newer technique is able to differentiate the intensity of radiation within the same field, thus reduces the inevitable exposure of radiation to normal organs and enables better dose delivery to tumors. Recently, the American Society for Radiation Oncology has released a guideline for RT in cervical cancer. Although a section of the guideline recommends IMRT for the purpose of toxicity reduction, a thorough review of the literature is necessary to understand the current status of IMRT in cervical cancer. This narrative review updates the recent high-level evidences regarding the efficacy and toxicity of IMRT and provides a better understanding of the most innovative techniques currently available for EBRT enabled by IMRT.

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Can knowledge-based planning models validated on ethnically diverse patients lead to global standardisation of external beam radiation therapy for locally advanced cervix cancer?
Jeevanshu Jain, Monica Serban, Marianne Sanggaard Assenholt, Varsha Hande, Jamema Swamidas, Yvette Seppenwoolde, Joanne Alfieri, Kari Tanderup, Supriya Chopra
Radiotherapy and Oncology.2025; 204: 110694. CrossRef
Prediction of recurrence risk of cervical cancer after radiotherapy using multi-sequence MRI radiomics
Jie Chen, Lou Liu, Yi Fu, Lu Zhang, Shuyue Li, Juying Zhou, Chenying Ma
Radiation Medicine and Protection.2025; 6(3): 169. CrossRef
Analysis of risk factors for acute radiation toxicity in cervical cancer patients in FIGO IIIC1 and IIIC2 stages treated with definitive chemoradiation
Marija Živković Radojević, Jasmina Jovanović Mirković, Slađana Pirić, Christos Aleksopoulos, Neda Milosavljević
The European Physical Journal Special Topics.2025;[Epub] CrossRef
Comparative impact of supine vs prone positioning on dose distribution, acute toxicity, and setup error in postoperative radiotherapy for cervical cancer: a multidimensional propensity-matched cohort study
Nanjie Xiao, Cuiyun Yuan, Tianshu Zhao, Tie Xu, Jiaomei Zhou, Junfang Liao, Miao Peng, Chenbin Liu, Zhijian Chen, Jing Jin
Frontiers in Oncology.2025;[Epub] CrossRef
Long term clinical outcomes of cervical cancer patients who were recommended surgery but did not undergo it: A SEER database study
Zhaoming Zhang, Hongfu Zhao, Guanghui Cheng
European Journal of Surgical Oncology.2024; 50(10): 108572. CrossRef
Treatment of secondary uterine malignancy following radiotherapy for cervical cancer: a study based on the SEER database
Xiaojing Tong, Yunyun Xiao, Haozhen Li, Hang Zhang, Jiawen Li
BMC Women's Health.2024;[Epub] CrossRef

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Original Articles

Postoperative Radiotherapy Alone Versus Chemoradiotherapy in Stage I-II Endometrial Carcinoma: An Investigational and Propensity Score Matching Analysis: Jong Hoon Lee, Hyo Chun Lee, Sung Hwan Kim, Mi Joo Chung, Song Mi Jeong, Sung Jong Lee, Joo Hee Yoon, Dong Choon Park; Cancer Res Treat. 2015;47(2):298-305. Published online September 15, 2014; DOI: https://doi.org/10.4143/crt.2014.038

Abstract PDF PubReader ePub

Purpose
The purpose of this study was to compare the results of postoperative adjuvant radiotherapy (RT) and concurrent chemoradiotherapy (CRT) in stage I-II endometrial carcinoma. Materials and Methods We analyzed a total of 64 patients with surgically staged I-II endometrial carcinoma who were treated with postoperative adjuvant RT or concurrent CRT between March 1999 and July 2013. Thirty-two patients who received postoperative RT alone were matched with those who received postoperative CRT (n=32) in accordance to age, stage, and tumor histology. Overall survival and relapse-free survival, as well as toxicity of the RT and CRT arms were evaluated and compared. Results The 5-year overall survival rate was 90.0% for the RT arm and 91.6% for the CRT arm. There was no significant difference in overall survival between the two treatment arms (p=0.798). The 5-year relapse-free survival rate was 87.2% in the RT arm and 88.0% in the CRT arm. Again, no significant difference in relapse-free survival was seen between the two arms (p=0.913). In a multivariate analysis, tumor histology was an independent prognostic factor for relapse-free survival (hazard ratio, 3.67; 95% of CI, 2.34 to 7.65; p=0.045). Acute grade 3 or 4 hematologic toxicities in the CRT arm were significantly higher than in the RT alone arm (6.2% vs. 31.2%, p=0.010). Conclusion Adjuvant pelvic concurrent chemoradioherapy did not show superior results in overall survival and relapse-free survival compared to RT alone in stage I-II endometrial carcinoma.

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Impacts of Postoperative Adjuvant Therapies on the Survival of Women with High-Risk Early-Stage Endometrial Cancer: A Cohort Study
Hee Joong Lee, Banghyun Lee
Cancers.2025; 17(2): 187. CrossRef
Adjuvant Therapy Use and Survival in Stage II Endometrial Cancer
Nataniel H. Lester-Coll, Melissa R. Young, Henry S. Park, Elena S. Ratner, Babak Litkouhi, Shari Damast
International Journal of Gynecological Cancer.2017; 27(9): 1904. CrossRef

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The Increasing Frequency of Cervical Cancer in Korean Women under 35: Chan Hee Han, Hyun Jung Cho, Sung Jong Lee, Jeong Hoon Bae, Seog Nyen Bae, Sung Eun Namkoong, Jong Sup Park; Cancer Res Treat. 2008;40(1):1-5. Published online March 31, 2008; DOI: https://doi.org/10.4143/crt.2008.40.1.1

Abstract PDF PubReader ePub

Purpose

The goal of this study was to determine the clinical and epidemiological trends of cervical cancer in young Korean women. Social behavior including sexual habits has changed in Korean women, with sexual activity commencing at a younger age. These changes are likely to influence certain risk factors of cervical cancer, resulting in changing trends in the occurrence of the disease.

Materials and Methods

The incidence of cervical cancer in women less than 35 years-old between January 1990 and December 2006 was analyzed, and available medical records from January 1996 to December 2006 were reviewed. The clinical, pathological and epidemiologic characteristics and changing trends among these young patients were analyzed.

Results

Over the last two decades, the incidence of young (< 35 years) cervical cancer patients increased, more patients had an aggressive form of the disease, and there was a higher rate of women with more advanced education. Human papillomavirus (HPV) infection was detected in 94.0% of the women (63/67) tested. HPV 16 (82.5%) and HPV 18 (12.7%) were the two most common viral infections detected throughout the study period.

Conclusions

The changing trends and risk factors identified suggest a need for more active education of young women about cervical cancer prevention strategies. In addition, young women are strongly recommended to undergo a regular screening test and HPV vaccination.

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Successful Treatment of Synchronous Double Lung Primary Malignancies and Colon Cancer
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WITHDRAWN: Polymerase chain reaction technique for molecular detection of HPV16 infections among women with cervical cancer in Dhi-Qar Province
Abduladheem Turki Jalil, Ali Hussein Demin Al-Khafaji, Aleksandr Karevskiy, Saja Hussain Dilfy, Zaman K. Hanan
Materials Today: Proceedings.2021;[Epub] CrossRef
Current Status of Human Papillomavirus Infection and Introduction of Vaccination to the National Immunization Program in Korea: an Overview
Min-A Kim, Gwan Hee Han, Jae-Hoon Kim, Kyung Seo
Journal of Korean Medical Science.2018;[Epub] CrossRef
Management for locally advanced cervical cancer: new trends and controversial issues
Oyeon Cho, Mison Chun
Radiation Oncology Journal.2018; 36(4): 254. CrossRef
Trends and Age-Period-Cohort Effects on the Incidence and Mortality Rate of Cervical Cancer in Korea
Eun-Kyeong Moon, Chang-Mo Oh, Young-Joo Won, Jong-Keun Lee, Kyu-Won Jung, Hyunsoon Cho, Jae Kwan Jun, Myong Cheol Lim, Moran Ki
Cancer Research and Treatment.2017; 49(2): 526. CrossRef
Factors associated with participation in cervical cancer screening among young Koreans: a nationwide cross-sectional study
Ha Kyun Chang, Jun-Pyo Myong, Seung Won Byun, Sung-Jong Lee, Yong Seok Lee, Hae-Nam Lee, Keun Ho Lee, Dong Choon Park, Chan Joo Kim, Soo Young Hur, Jong Sup Park, Tae Chul Park
BMJ Open.2017; 7(4): e013868. CrossRef
Molecular Detection and Typing of Human Papillomaviruses in Paraffin-Embedded Cervical Cancer and Pre-Cancer Tissue Specimens
Pezhman Mahmoodi, Hossein Motamedi, Masoud Reza Seyfi Abad Shapouri, Mahjabin Bahrami Shehni, Mohammad Kargar
Iranian Journal of Cancer Prevention.2016;[Epub] CrossRef
Cervical cancer in north-eastern Libya: 2000–2008
F. Ben Khaial, Z. Bodalal, A. Elramli, F. Elkhwsky, A. Eltaguri, R. Bendardaf
Journal of Obstetrics and Gynaecology.2014; 34(6): 523. CrossRef
Current status of the National Cancer Screening Program for cervical cancer in Korea, 2009
Young Hwa Lee, Kui Son Choi, Hoo-Yeon Lee, Jae Kwan Jun
Journal of Gynecologic Oncology.2012; 23(1): 16. CrossRef
Laparoscopic versus open radical hysterectomy in early-stage cervical cancer: long-term survival outcomes in a matched cohort study
J.-H. Nam, J.-Y. Park, D.-Y. Kim, J.-H. Kim, Y.-M. Kim, Y.-T. Kim
Annals of Oncology.2012; 23(4): 903. CrossRef
The safety of conization in the management of adenocarcinomain situof the uterine cervix
Mi-La Kim, Ho-Suap Hahn, Kyung-Taek Lim, Ki-Heon Lee, Hy-Sook Kim, Sung-Ran Hong, Tae-Jin Kim
Journal of Gynecologic Oncology.2011; 22(1): 25. CrossRef
Human papillomavirus 16/18 AS04-adjuvanted cervical cancer vaccine: immunogenicity and safety in 15-25 years old healthy Korean women
Seung Cheol Kim, Yong Sang Song, Young-Tae Kim, Young Tak Kim, Ki-Sung Ryu, Bhavyashree Gunapalaiah, Dan Bi, Hans L Bock, Jong-Sup Park
Journal of Gynecologic Oncology.2011; 22(2): 67. CrossRef
Prognostic value of metabolic tumor volume measured by FDG-PET/CT in patients with cervical cancer
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Gynecologic Oncology.2011; 120(2): 270. CrossRef

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Polymorphisms of p53, p21 and IRF-1 and Cervical Cancer Susceptibility in Korean Women: Sung Jong Lee, Sung Eun Namkoong, Won Chul Lee, Jae Woong Sul, Sun Ha Jee, Youn Kyoung You, Jong Eun Lee, Jong Sup Park; Cancer Res Treat. 2002;34(5):357-364. Published online October 31, 2002; DOI: https://doi.org/10.4143/crt.2002.34.5.357

Abstract PDF

PURPOSE
The aim of this study was to identify gene- gene and gene-environmental factor on cervical carcinogenesis in Korean women.
MATERIALS AND METHODS
We evaluated 185 women patients who had cervical cancer with 345 normal control healthy women. The single nucleotide polymorphisms (SNPs) of the p53 codon 72, the p21 codon 31 and the IRF-1 intron 6 were evaluated from extracted DNA of peripheral blood with an automatic DNA sequencer. The difference of each SNP, gene-gene and gene-environmental interaction between normal controls and patients, were evaluated in an adjusted environmental background.
RESULTS
With regard to environmental factors, the cervical cancer increased in the women with a lower level of education, a younger age at first sexual intercourse and with the increased number of children borne. The women who had p53 (Arg/Arg), IRF-1 (T/T) and an education of less than 6 years showed a 14.7 fold increased risk of cervical cancer than those women who had p53 (~Pro), IRF-1 (~C) and an education of more than 15 years. The women who had p53 (Arg/Arg), p21 (Ser/Ser) and more than 3 children showed a 6.4 fold increased risk of cervical cancer than those women who had p53 (~Pro), p21 (~Arg) and had borne no child. The women who had p53 (Arg/Arg), IRF-1 (T/T) and had experience of first sexual intercourse before the age of 22-years showed a 5.5 fold increased risk of cervical cancer than those women who had p53 (~Pro), IRF-1 (~C) and had experience of first sexual intercourse after the age of 26-years.
CONCLUSION
We found that the level of education, the age at first intercourse, and the number of children borne, were independent risk factors in cervical carcinogenesis. The specific combination of p53, p21 and IRF-1 gene-gene and gene-environmental interactions were significantly noted in the cervical carcinogenesis of Korean women.

Citations

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Distinctive cell cycle regulatory protein profiles by adenovirus delivery of p53 in human papillomavirus-associated cancer cells
H.-S. JIN, S.-M. BAE, Y.-W. KIM, J.-M. LEE, S.-E. NAMKOONG, B.-D. HAN, Y.-J. LEE, C.-K. KIM, H.-J. CHUN, W.-S. AHN
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Cell Cycle Regulatory Protein Expression Profiles by Adenovirus p53 Infection in Human Papilloma Virus-associated Cervical Cancer Cells
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Cellular process classification of human papillomavirus-16-positive SiHa cervical carcinoma cell using Gene Ontology
W. S. Ahn, M.-J. Seo, S. M. Bae, J. M. Lee, S. E. Namkoong, C. K. Kim, Y.-W. Kim
International Journal of Gynecological Cancer.2005; 15(1): 94. CrossRef
Cellular process classification of human papillomavirus-16-positive SiHa cervical carcinoma cell using Gene Ontology
W.S. Ahn, M.-J. Seo, S.M. Bae, J.M. Lee, S.E. Namkoong, C.K. Kim, Y.-W. Kim
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Adenoviral p53 effects and cell-specific E7 protein–protein interactions of human cervical cancer cells
Jeong-Woo Choi, Woong Shick Ahn, Su Mi Bae, Doo-Bong Lee, Yong-Wan Kim
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