RESUMEN

Introduction: Primary vaginal cancer is infrequent, corresponding to 1-2% of all female genital tract cancer diagnoses.Treatment for vaginal cancer varies depending on tumor histology, size, location and staging, and may include one or more of the following: surgical excision, radiation therapy and/or chemotherapy. All treatments negatively affect fertility/pregnancy outcomes.Pelvic radiation therapy, even in doses < 2 Gy, may extinguish up to 50% of immature oocytes. In addition, radiotherapy may cause modifications in cervical length, loss of uterine junctional zone anatomy and lead to myometrial atrophy and fibrosis, increasing the risk for adverse pregnancy outcomes. Methods: Case report of a patient who carried a pregnancy to term after surgery and brachytherapy for vaginal cancer. Results: A 28 year-old woman, presented with a 3 cm right midvagina wall tumor, diagnosed as grade 2, vaginal squamous cell carcinoma - FIGO 2009, stage IB. Computed tomography showed no evidence of lymph node involvement or distant metastasis. The patient underwent surgery followed by 4 fractions of vaginal brachytherapy, once a week, with a dose of 6 Gy at a 5 mm depth, amounting to a total dose of 24 Gy.One year and 9 months after treatment, the patient gave birth to a healthy child at 39 weeks pregnancy. A C-section was needed due functional dystocia during labor. Conclusion: This case report recounts a successful pregnancy carried to term after surgery and brachytherapy for squamous cell vaginal cancer.

RESUMEN

Freehand needles can be used with multichannel vaginal cylinders (MCVC) to cover vaginal cancer >7 mm thick or with supra-vaginal extension. We report our institutional outcomes using this novel hybrid technique. Patients with vaginal malignancies treated with HDR BT using MCVC plus freehand needles from 2014-2021 at our institution were identified. Clinical characteristics, details of brachytherapy, initial response, and overall local control (LC) outcomes were recorded. LC was analyzed via Kaplan-Meier method. 34 patients were identified with median follow-up 1.9 years. 19 patients had primary endometrial cancer with vaginal recurrence/disease, and remaining had primary vaginal cancer or other primaries. 7 patients had recurrence after previous RT course. 25 patients received EBRT with median dose 45 Gy in 25 fractions, and rest received BT alone. Median HR-CTV D90 for patients treated with EBRT plus BT was 77.4 Gy. 30 patients had complete local response to BT on initial examination and/or follow-up imaging. 1 and 2-year LC rates in patients without prior RT treated with EBRT + BT were 94.1% and 94.1%, respectively. 1 and 2-year LC rates for those without prior RT were 88.1% and 76.4%, respectively. 1 and 2-year LC rates for those with prior RT were 68.6% and 34.3%, respectively. 1 patient had vaginal laceration requiring surgical repair, and 1 patient developed small bowel obstruction 1 month after BT, with no additional acute grade 3+ toxicities identified. Our approach with MCVC plus freehand needles with MRI-based planning was feasible and safe, with excellent initial local response and low rate of serious toxicities.

Asunto(s)

Braquiterapia , Neoplasias Vaginales , Femenino , Humanos , Neoplasias Vaginales/diagnóstico por imagen , Neoplasias Vaginales/radioterapia , Braquiterapia/métodos , Dosificación Radioterapéutica , Agujas , Imagen por Resonancia Magnética

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PURPOSE: We report the feasibility, experience, and early outcomes of the combined intracavitary and interstitial dedicated applicator using the Kelowna GYN template (Varian, Palo Alto, CA). METHODS AND MATERIALS: The Kelowna GYN template is CT compatible and used for the treatment of gynecologic cancers. In cases with patients that have an intact uterus, a modified applicator system using the Kelowna GYN template and a 3D printed adapter piece allows for compatibility with an intrautaerine tandem. RESULTS: We reviewed the treatment course of 23 patients comprising of 86 fractions of HDR treatment. Median D90 for cervical tumors (n = 7) was 82.4 Gy (range 77.7-92.6); for postoperative cervical tumors (n = 2) was 73.9 Gy (range 72.0-5.8); for vaginal tumors (n = 4) was 85.8 Gy (range 79.8-88.1); for recurrent endometrial (n = 10) was 86.9 Gy (range 74.8-103.2). Median EQD2 D2cc for bladder was 72.4 Gy (range 47.7-99.4), for rectum was 61.2 Gy (range 52.4-80.6), and for sigmoid colon of 50.5 Gy (44.3-66.9). At a median follow-up of 12 months, 2 patients had a local recurrence. Two patients had distant recurrence: one with carcinomatosis at 6 months, and one with pulmonary metastases at 3 months. No patients had late grade three toxicities. CONCLUSIONS: Our single institutional experience supports the use of the Kelowna template as a robust system as a combined IC-IS applicator resulting in versatile and reproducible implants for a variety of gynecologic malignancies.

Asunto(s)

Braquiterapia , Neoplasias de los Genitales Femeninos , Neoplasias del Cuello Uterino , Femenino , Humanos , Braquiterapia/métodos , Neoplasias de los Genitales Femeninos/radioterapia , Dosificación Radioterapéutica , Neoplasias del Cuello Uterino/radioterapia , Neoplasias del Cuello Uterino/patología , Resultado del Tratamiento , Planificación de la Radioterapia Asistida por Computador/métodos

RESUMEN

Resumen La presente revisión narrativa fue realizada con el objeto de investigar y recopilar la información más reciente y relevante sobre la epidemiología del Virus del Papiloma Humano y su relación con las patologías asociadas a él, en especial la patología maligna del área genital femenina. La revisión de la literatura fue realizada electrónicamente en PubMed, Medline, ISI, DOAJ, Springer, Embase. Web of Knowledge, DOAJ, y Google Scholar para los artículos escritos en el idioma inglés. Los portales Scielo, Latindex, Imbiomed-L, Redalyc y Google Scholar fueron revisados en búsqueda de artículos escritos en el idioma español. La búsqueda incluyó las palabras claves: epidemiología del virus del papiloma humano, taxonomía viral, estructura del virus del papiloma humano, clasificación del virus del papiloma, nomenclatura del virus del papiloma humano, patologías asociadas al virus del papiloma humano, virus papiloma humano y cáncer del cuello uterino, virus del papiloma humano y cáncer de vulva, y virus del papiloma humano y cáncer de vagina. Se buscaron, revisaron y analizaron las publicaciones desde enero de 1987 hasta agosto de 2021. Esta revisión narrativa investigó la epidemiología del virus del papiloma humano y sus patologías asociadas, en especial las malignas del área genital femenina.

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Abstract The present narrative review was conducted to investigate and to compile the most recent and relevant information about the epidemiology of the Human Papilloma Virus and its relationship with the pathologies associated with it. Literature searches were performed electronically in PubMed, Medline, ISI, DOAJ, Springer, Embase. Web of Knowledge, DOAJ, and Google Scholar for original articles written in the English language and Scielo, Latindex, Imbiomed-L, Redalyc, and Google Scholar for original articles written in the Spanish language. The searches included the keywords: epidemiology of human papillomavirus, viral taxonomy, the structure of human papillomavirus, classification of human papillomavirus, the nomenclature of human papillomavirus, pathologies associated to human papillomavirus, human papillomavirus and cervical, human papillomavirus and vulvar cancer and human papillomavirus and vaginal cancer Publications from January 1987 to August 2021 reviewed. This narrative review researched the epidemiology of the human papillomavirus and its pathologies associated especially the female genital area.

Asunto(s)

Sarcoma , Femenino , Humanos , Sarcoma/cirugía , Vulva

RESUMEN

OBJECTIVE: Uterine transposition has emerged as an alternative for fertility preservation in women with pelvic malignancies that require radiotherapy. The goal of this study was to evaluate the short-term outcomes of patients undergoing uterine transposition after trachelectomy for cervical cancer or before chemoradiation for vaginal cancer. METHODS: We retrospectively evaluated patients with early stage cervical cancer after radical trachelectomy or with vaginal cancer with indication for pelvic radiation who had uterine transposition performed as fertility sparing strategy. RESULTS: Four patients with cervical cancer and one patient with vaginal cancer were included. Median age was 32 years (range 28-38). All patients had squamous cell carcinomas. All patients with cervical cancer had radical trachelectomies with sentinel lymph node dissection (SLN). Two of these patients also had pelvic lymphadenectomies. Indications for adjuvant radiotherapy was due to Sedlis criteria in two patients and to lymph node metastasis in the other two patients. The patient with stage IIB vaginal cancer was recommended primary chemoradiation. All patients underwent uterine transposition before radiotherapy. The median uterine transposition surgical time was 90 min (range 80-205) and no early complications (30 days) occurred. Average time from uterine transposition to start of radiotherapy was 16 days (10-28). After radiation, the uterus along with the ovaries and tubes were repositioned and the residual cervix sutured to the vagina. One patient declined uterine reimplantation after radiation and underwent a hysterectomy. After a median follow-up of 25 months (range 1-30), all patients were without evidence of disease. All patients with preserved uterus have normal menses after treatment. One patient has attempted to conceive with IVF techniques without success. CONCLUSIONS: Uterine transposition may be an option in selected patients with cervical and vaginal cancers who want to preserve fertility. However, further studies that address its oncological safety and obstetrical outcomes are encouraged.

Asunto(s)

Preservación de la Fertilidad/métodos , Neoplasias del Cuello Uterino/radioterapia , Útero/cirugía , Adulto , Carcinoma de Células Escamosas , Femenino , Humanos , Tempo Operativo , Estudios Retrospectivos , Neoplasias del Cuello Uterino/cirugía , Útero/patología , Neoplasias Vaginales/radioterapia

Asunto(s)

Colposcopía/métodos , Preservación de la Fertilidad/métodos , Leiomiosarcoma/cirugía , Neoplasias Vaginales/cirugía , Adulto , Femenino , Humanos , Leiomiosarcoma/diagnóstico por imagen , Leiomiosarcoma/patología , Tomografía Computarizada por Tomografía de Emisión de Positrones , Neoplasias Vaginales/diagnóstico por imagen , Neoplasias Vaginales/patología

RESUMEN

AIM: Describe characteristics and outcomes of three patients treated with pelvic radiation therapy after kidney transplant. BACKGROUND: The incidence of pelvic cancers in kidney transplant (KT) recipients is rising. Currently it is the leading cause of death. Moreover, treatment is challenging because anatomical variants, comorbidities, and associated treatments, which raises the concern of using radiotherapy (RT). RT has been discouraged due to the increased risk of urethral/ureteral stricture and KT dysfunction. MATERIALS AND METHODS: We reviewed the electronic health records and digital planning system of patients treated with pelvic RT between December 2013 and December 2018 to identify patients with previous KT. CASES DESCRIPTION: We describe three successful cases of KT patients in which modern techniques allowed full standard RT for pelvic malignances (2 prostate and 1 vaginal cancer) with or without elective pelvic nodal RT, without allograft toxicity at short and long follow-up (up to 60 months). CONCLUSION: When needed, RT modern techniques remain a valid option with excellent oncologic results and acceptable toxicity. Physicians should give special considerations to accomplish all OAR dose constraints in the patient's specific setting. Recent publications recommend KT mean dose <4 Gy, but graft proximity to CTV makes this unfeasible. We present 2 cases where dose constraint was not achieved, and to a short follow-up of 20 months renal toxicity has not been documented. We recommend the lowest possible mean dose to the KT, but never compromising the CTV coverage, since morbimortality from recurrent or progressive cancer disease outweighs the risk of graft injury.

RESUMEN

BACKGROUND: Advances in radiotherapy (RT) have led to improved oncologic outcomes for women with gynecologic cancers; however, the long-term effects and survivorship implications need further evaluation. The purpose of this study was to determine the incidence of pelvic fractures and changes in bone mineral density (BMD) after pelvic RT. METHODS: Two hundred thirty-nine women who had pelvic RT for cervical, endometrial, or vaginal cancer between 2008 and 2015 were prospectively studied. BMD scans and biomarkers of bone turnover were obtained at the baseline and 3 months, 1 year, and 2 years after RT. Imaging studies were assessed for pelvic fractures for up to 5 years. Patients with osteopenia, osteoporosis, or pelvic fractures at any point were referred to the endocrinology service for evaluation and treatment. RESULTS: The median age at diagnosis was 51 years; 132 patients (56%) were menopausal. The primary diagnoses were cervical (63.6%), endometrial (30.5%), and vaginal cancer (5.9%). Sixteen patients (7.8%; 95% confidence interval, 4.5%-12.4%) had pelvic fractures with actuarial rates of 3.6%, 12.7%, and 15.7% at 1, 2, and 3 years, respectively. Fractures were associated with baseline osteoporosis (P < .001), higher baseline bone-specific alkaline phosphatase (P < .001), and older age (P = .007). The proportion of patients with osteopenia/osteoporosis increased from 50% at the baseline to 58%, 59%, and 70% at 3 months, 1 year, and 2 years, respectively. CONCLUSIONS: A high proportion of women had significant decreases in BMD after pelvic RT, with 7.8% diagnosed with a pelvic fracture. BMD screening and pharmacologic intervention should be strongly considered for these high-risk women.

Asunto(s)

Densidad Ósea , Fracturas Óseas/epidemiología , Neoplasias de los Genitales Femeninos/radioterapia , Huesos Pélvicos/lesiones , Adulto , Anciano , Anciano de 80 o más Años , Quimioradioterapia/efectos adversos , Neoplasias Endometriales/radioterapia , Femenino , Humanos , Persona de Mediana Edad , Osteoporosis/complicaciones , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Radioterapia de Intensidad Modulada/efectos adversos , Neoplasias del Cuello Uterino/radioterapia , Neoplasias Vaginales/radioterapia , Adulto Joven

RESUMEN

Vaginal cancer has a low incidence in the female population. We present the case of a 77-year-old woman who was admitted to the hospital due to postmenopausal vaginal bleeding and initial diagnosis of cancer of the uterine cervix. Vaginal biopsy was performed from an ulcerated exophytic 3 x 2 cm lesion in the superior third of the posterior vaginal wall. Pathology reported a poorly differentiated squamous cell carcinoma of the vagina. The surgical specimen showed an infiltrating, nonkeratinizing, moderately differentiated squamous cell carcinoma of the vagina. We present a case where similarity of symptomatology with cancer of the cervix may have led to a wrong diagnosis or management, due to the anatomical proximity of both tissues.

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El cáncer de vagina tiene una baja incidencia en la población femenina. Una mujer de 77 años acudió al hospital con antecedentes de sangrado vaginal posmenopáusico y diagnóstico inicial de cáncer de cérvix. Se le realizó biopsia vaginal por lesión ulcerada exofítica de 3 x 2 cm en el tercio superior de la pared vaginal posterior, cuyo resultado patológico fue cáncer escamoso pobremente diferenciado de la vagina. La patología de la pieza operatoria mostró carcinoma de células escamosas, infiltrante, no queratinizante, medianamente diferenciado de vagina. Presentamos el caso, en el que pudo haber confusión en el diagnóstico y/o manejo por la similitud de la sintomatología con el cáncer de cuello uterino, debido a la localización anatómica y la proximidad de ambos tejidos.

RESUMEN

Introdução: Melanoma maligno de vagina é um tumor raro e agressivo com incidência de 0,46 casos a cada milhão de mulheres por ano, descrito pela primeira vez por Poronas, em 1887. São relatados aproximadamente 500 casos mundialmente.É umavariante mucosa do melanoma, acometendo regiões não expostas à radiação ultravioleta. Representa menos de 3% dos tumores primários malignos da vagina, de prognóstico ruim e taxa sobrevida em 5 anos de 5-25%. O tratamento preconizado é controverso e assunto de discussões. Existem poucos dados na literatura, justificando o relato deste caso, que contribuirá para novos estudos a fim de definir um melhor tratamento. Objetivo: Relatar um caso de melanoma primário de vagina invasor. Relato de caso: Paciente do sexo feminino, 78 anos, relatava sangramento vaginal há 6 meses e secreção serosanguinolenta de odor fétido. Ao exame ginecológico, visualizou-se lesão vegetante em parede vaginal esquerda, com sangramento ativo, friável e odor fétido, ausência de lesões em colo uterino e útero de volume habitual. A biópsia evidenciou à imunohistoquímica neoplasia de células epitelioides com atipias proeminentes com pigmento melânico associado à extensão pagetoide para camadas superficiais do epitélio, mitoses atípicas e positividade forte e difusa para Melan A e proteína S100, favorecendo a hipótese de Melanoma invasor primário de vagina. A ressonância magnética da pelve evidenciou linfonodo inguinal heterogêneo à esquerda. Desfecho: Paciente submetida à colpectomia com excisão de lesão neoplásica em parede anterior da vagina e ressecção de lesões suspeitas em paredes laterais da vagina e parede lateral direita da vulva, sem intercorrências cirúrgicas. Conclusão: O caso relatado fomenta a discussão de doença rara e que mesmo quando o diagnóstico e o tratamento são instituídos, tem seu prognóstico ainda muito imprevisível, no que diz respeito à cura e melhoria da qualidade de vida.

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Introduction: Malignant melanoma of the vagina is a rare tumor with 0.46 cases per one million women per year and first described by Poronas in 1887. There are 500 cases reported. It is a mucosal variant of melanoma wich affects regions not exposed to ultraviolet radiation. It represents less than 3% of vagina primary tumors, with a poor prognosis and five-year survival of 5-25%. The gold standard treatment is controversial and subject of discussions. There are few data in the literature, justifying the case report, which contribute to new studies. Objective: case report of primary invasive melanoma of the vagina. Case report: Female patient, 78 years old, reports vaginal bleeding for 6 months and serum blood secretion of foul-smelling. Gynecological examination revealed vegetation in the left vaginal wall, with active bleeding, friable and foul-smelling, no lesions in the cervix and uterus of normal volume. The biopsy followed by immunohistochemical test showed a neoplasia of epithelioid cells with prominent atypia with melanic pigment associated with pagetoid extension to superficial layers of the epithelium, atypical mitoses, and a strong and diffuse positivity for Melan A and protein S100, favoring the hypothesis of primary invasive melanoma of the vagina. The magnetic resonance imaging of the pelvis showed heterogeneous inguinal lymph node on the left. Results: Patient submitted to colpectomy with excision of anterior neoplastic lesion of the vagina and resection of suspicious lesions on side walls of the vagina and right lateral wall of the vulva, without surgical complications. Conclusion: The case reported encourages discussion of this pathology, and demonstrated that even if diagnosis and therapy are performed early, still has a very unpredictable prognosis, in terms of healing and improvement of the quality of life.

Asunto(s)

Humanos , Femenino , Anciano , Hemorragia Uterina , Vagina , Neoplasias Vaginales , Biopsia , Espectroscopía de Resonancia Magnética , Enfermedades Raras , Melanoma

RESUMEN

Abstract Vaginal cancer is a rare entity. The evidence on its management resides mostly in clinical cases or small case series. Of the histological types, the most frequent is the squamous cell carcinoma, followed by adenocarcinoma. But what to do when identifying an even more infrequent sarcoma in a premenopausal woman? In this study, we describe the case of a 53-year-old woman presenting with metrorrhagia for two months, who was evaluated after an intense episode. A necrotic and ulcerative vaginal swelling was documented and then submitted to biopsy, which revealed a vaginal sarcoma. The patient was referred to radiation therapy with 50 Gy (aiming to control the symptoms and to cause tumor reduction for posterior pelvic exenteration with intraoperative radiotherapy) and developed an extra-pelvic metastization at the end of the treatment, which caused a fast negative outcome. Despite the initial poor prognosis, a chemo-irradiation or primary surgery regimen might have achieved (although with greater side effects) a better survival. This case-report entails a discussion about the strategies to manage vaginal sarcoma in advanced stage and in premenopausal women.

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Resumo O cancro vaginal é uma doença rara. A evidência para a sua abordagem reside fundamentalmente em casos clínicos ou pequenas séries de casos. Dentre os tipos de cancro histológicos, o mais frequente é o carcinoma espinocelular, seguido do adenocarcinoma. Mas o que fazer em presença de um sarcoma ainda mais raro numa mulher pré-menopáusica? No presente estudo, descrevemos o caso de uma mulher de 53 anos apresentando metrorragia por dois meses, avaliada após um episódio intenso. Foi então documentada uma tumefacção vaginal necrótica e ulcerativa, submetida a biópsia, que revelou um sarcoma vaginal. A paciente foi encaminhada para radioterapia com50 Gy (comos objetivos de controlo da sintomatologia e de redução tumoral para posterior exenteração pélvica com radioterapia intraoperatória) e desenvolveu, ao final do tratamento, umquadro demestastização extra pélvica, que ocasionou um desfecho negativo rápido. Apesar do mau prognóstico inicial, um esquema de quimiorradiação ou cirurgia primária poderiam ter alcançado (ainda que com maiores efeitos laterais) uma maior sobrevivência. Este estudo de caso aborda uma discussão sobre as estratégias de abordagem do sarcoma vaginal em estádios avançados e na mulher pré-menopáusica.

Asunto(s)

Humanos , Femenino , Sarcoma/diagnóstico , Sarcoma/secundario , Sarcoma/terapia , Neoplasias Vaginales/diagnóstico , Neoplasias Vaginales/terapia , Premenopausia , Resultado Fatal , Persona de Mediana Edad

RESUMEN

O presente trabalho reporta as características clínicas e cirúrgicas de oito casos de cadelas portadoras de leiomioma vaginal, com histórico de aumento de volume na região perineal, aparecimento de massa pela vulva, disquezia, tenesmo e disúria. As pacientes foram submetidas à cirurgia de episiotomia para ressecção da massa neoplásica, e em quatro casos foi necessária a ovariossalpingo-histerectomia. Porém, uma delas apresentou recidiva, e, no segundo procedimento cirúrgico de exérese de neoformação, o histopatológico diagnosticou leiomiossarcoma. A paciente ainda apresentou mais duas recidivas, até o proprietário optar pela eutanásia. Decorridos quatro meses, as sete cadelas diagnosticadas com leiomioma não apresentaram recidiva, e os proprietários relataram ausência de sinais relacionados com a doença descrita. Conclui-se que a episiotomia para ressecção da massa vaginal e a ovariossalpingo-histerectomia nas cadelas inteiras nos casos de tumores vaginais benignos são tratamentos satisfatórios, com bom prognóstico, ao contrário do leiomiossarcoma.

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This study reports the clinical and surgical procedures of eight cases of bitches with vaginal leiomyoma. All animals presented increased volume in the perineal region, and exteriorization of the vulva, dyschezia, tenesmus and dysuria. The patients underwent episiotomy surgery for resection of the neoplastic mass, and ovariosalpingohisterectomy in four cases. However, one had recurrence on the second surgical procedure for removal of neoformation, histopathological diagnosed leiomyosarcoma, the patient also had two more relapses, until the owner chose euthanasia. After four months, the seven dogs diagnosed with leiomyoma showed no recurrence and the owners reported no signs of the disease described. We concluded that episiotomy for vaginal mass resection combined with ovariohysterectomy in cases of benign vaginal tumors have shown satisfactory treatment with good prognostic.

Asunto(s)

Animales , Femenino , Perros , Episiotomía/veterinaria , Leiomioma/cirugía , Leiomioma/diagnóstico , Leiomioma/rehabilitación , Leiomioma/veterinaria , Neoplasias Vaginales/veterinaria , Eutanasia Animal , Leiomiosarcoma/veterinaria , Perineo/anomalías

RESUMEN

O presente trabalho reporta as características clínicas e cirúrgicas de oito casos de cadelas portadoras de leiomioma vaginal, com histórico de aumento de volume na região perineal, aparecimento de massa pela vulva, disquezia, tenesmo e disúria. As pacientes foram submetidas à cirurgia de episiotomia para ressecção da massa neoplásica, e em quatro casos foi necessária a ovariossalpingo-histerectomia. Porém, uma delas apresentou recidiva, e, no segundo procedimento cirúrgico de exérese de neoformação, o histopatológico diagnosticou leiomiossarcoma. A paciente ainda apresentou mais duas recidivas, até o proprietário optar pela eutanásia. Decorridos quatro meses, as sete cadelas diagnosticadas com leiomioma não apresentaram recidiva, e os proprietários relataram ausência de sinais relacionados com a doença descrita. Conclui-se que a episiotomia para ressecção da massa vaginal e a ovariossalpingo-histerectomia nas cadelas inteiras nos casos de tumores vaginais benignos são tratamentos satisfatórios, com bom prognóstico, ao contrário do leiomiossarcoma.(AU)

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This study reports the clinical and surgical procedures of eight cases of bitches with vaginal leiomyoma. All animals presented increased volume in the perineal region, and exteriorization of the vulva, dyschezia, tenesmus and dysuria. The patients underwent episiotomy surgery for resection of the neoplastic mass, and ovariosalpingohisterectomy in four cases. However, one had recurrence on the second surgical procedure for removal of neoformation, histopathological diagnosed leiomyosarcoma, the patient also had two more relapses, until the owner chose euthanasia. After four months, the seven dogs diagnosed with leiomyoma showed no recurrence and the owners reported no signs of the disease described. We concluded that episiotomy for vaginal mass resection combined with ovariohysterectomy in cases of benign vaginal tumors have shown satisfactory treatment with good prognostic.(AU)

Asunto(s)

Animales , Femenino , Perros , Leiomioma/diagnóstico , Leiomioma/rehabilitación , Leiomioma/cirugía , Leiomioma/veterinaria , Episiotomía/veterinaria , Neoplasias Vaginales/veterinaria , Perineo/anomalías , Leiomiosarcoma/veterinaria , Eutanasia Animal

RESUMEN

PURPOSE: Multichannel vaginal cylinder brachytherapy (MCVCB) has the potential to sculpt dose distribution, although this is typically reserved for lesions <5-mm thick. The aim of this study was to investigate the dosimetric consequences of treating lesions with MCVCB of varying locations, ≥5 mm in thickness. METHODS AND MATERIALS: Patients previously treated with MCVCB were randomly selected to each fill one of six categories based on location (lateral, anterior, or vaginal cuff and/or apex) and size of cylinder (2.5 or 3.0 cm). Based on magnetic resonance image, each patient's target lesion was extended circumferentially into theoretical high-risk clinical target volumes measuring 5, 7, and 10 mm in thickness. Image-based brachytherapy treatment plans for each of the six patients' three target volumes were generated. Total 2 Gy per fraction equivalent dosages (EQD2) were calculated using an external beam radiation therapy dose of 45 Gy in 25 fractions in conjunction with a high-dose-rate brachytherapy dose of 25 Gy in five fractions. RESULTS: Maximum EQD2 vaginal surface doses in gray for 5-, 7-, and 10-mm targets were as follows (location-cylinder size): lateral-3.0 cm: 122/153/210, lateral-2.5 cm: 145/195/301, anterior-3.0 cm: 115/135/197, anterior-2.5 cm: 132/173/283, apex-3.0 cm: 173/241/367, and apex-2.5 cm: 349/461/706. Total rectal EQD2 D 2 cc ranged from 53.9 to 67.2 Gy. Total bladder EQD2 D 2 cc ranged from 51.5 to 71.2 Gy. CONCLUSIONS: The vaginal surface dose seems to be the dose-limiting structure for anterior, lateral, and apical vaginal lesions. Caution should be taken when treating lesions >5 mm in depth, with particular attention to vaginal surface dose, especially for apical lesions and with smaller cylinders. In such cases, interstitial brachytherapy should be given strong consideration.

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Braquiterapia/métodos , Carcinoma/radioterapia , Órganos en Riesgo , Dosis de Radiación , Vagina/efectos de la radiación , Neoplasias Vaginales/radioterapia , Carcinoma/patología , Fraccionamiento de la Dosis de Radiación , Femenino , Humanos , Membrana Mucosa/efectos de la radiación , Órganos en Riesgo/efectos de la radiación , Planificación de la Radioterapia Asistida por Computador , Recto/efectos de la radiación , Estudios Retrospectivos , Carga Tumoral , Vejiga Urinaria , Neoplasias Vaginales/patología

RESUMEN

PURPOSE: To investigate the clinical feasibility and treatment outcomes of image-based high-dose-rate (HDR) brachytherapy using an intracavitary multichannel vaginal cylinder for the definitive treatment of vaginal cancers. METHODS AND MATERIALS: A total of 41 patients with vaginal cancer (24% primary vaginal and 76% recurrence from other gynecologic primaries) treated with definitive radiotherapy ± chemotherapy including image-based HDR brachytherapy with a multichannel vaginal cylinder were included in the study. Image-based brachytherapy was completed using either CT- (41%) or MR-based planning (59%) with each fraction. The high-risk clinical target volume was defined based on the pre- and postexternal beam radiotherapy gross tumor volume. Doses were converted to equivalent dose of 2Gy per fraction. Endpoints examined were dose-volume parameters and early clinical outcomes. RESULTS: The median high-risk clinical target volume was 24.2 cc (interquartile range [IQR], 12.6), with a median dose to 90% (D90) of 77.1 Gy (IQR, 3.4). The median dose to 2 cc (D(2 cc)) for the bladder, rectum, and sigmoid were 59.4 Gy (IQR, 5.6), 58.2 Gy (IQR, 4.1), and 52.3 Gy (IQR, 5.5), respectively. After a median followup of 16 months (range, 3-35), complete clinical response was documented in 98% of the patients. The 2-year local, regional, and distant control; and disease-free and overall survival were 93%, 100%, 81%, 78%, and 88%, respectively. The 2-year actuarial rate of late Grade 3 or higher toxicity was 4% overall with 0%, 0%, 0%, and 4% for vaginal, bladder, urethral, and gastrointestinal, respectively. CONCLUSIONS: Image-based HDR brachytherapy using an intracavitary multichannel cylinder seems feasible in definitive vaginal cancer treatment. The described clinical implementation shows promising early clinical outcomes with high rates of local control and little toxicity, which should be validated with extended followup.

Asunto(s)

Braquiterapia/instrumentación , Neoplasias Vaginales/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Braquiterapia/efectos adversos , Braquiterapia/métodos , Colon Sigmoide/efectos de la radiación , Estudios de Factibilidad , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Recurrencia Local de Neoplasia/radioterapia , Órganos en Riesgo/efectos de la radiación , Dosis de Radiación , Dosificación Radioterapéutica , Planificación de la Radioterapia Asistida por Computador/métodos , Recto/efectos de la radiación , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vejiga Urinaria/efectos de la radiación , Neoplasias Vaginales/patología

RESUMEN

Os cânceres que acometem os órgãos genitais masculinos e femininos, em conjunto com o câncer de mama, são responsáveis por cerca de 20% dos óbitos por câncer no mundo. Conhecer os padrões de mortalidade por esses cânceres no Brasil, as mudanças que se produziram ao longo do tempo, os grupos mais vulneráveis e a carga de mortalidade que se apresentará no futuro são elementos básicos para a estruturação das ações assistenciais e de vigilância do câncer. O objetivo desse estudo foi analisar as tendências de mortalidade pelos cânceres que acometem órgãos que são específicos a cada gênero e projetar a mortalidade por esses cânceres até o ano de 2030, para o Brasil, regiões e estados da federação. Trata-se de um estudo ecológico de base populacional que analisou os óbitos, ocorridos no período 1996 a 2010, decorrentes dos cânceres de colo do útero, corpo do útero, mama feminina, ovários, vulva, vagina, próstata, pênis e testículos, registrados no Sistema de Informação sobre Mortalidade; as informações sobre população foram obtidas do Instituto Brasileiro de Geografia e Estatística. Foi aplicada a Regressão loglineal (Joinpoint regression) com taxas padronizadas (população mundial: ASR-W) para estimar o Annual Percentage Change (APC), o Average Annual Percentage Change (AAPC), o intervalo de confiança 95% e os pontos de inflexão da curva; as projeções foram calculadas através do programa Nordpred, inscrito no programa R, utilizando o modelo idade-período-coorte, analisando posteriormente se as mudanças que se produzirão no futuro serão decorrentes da exposição aos fatores de risco e/ou da estrutura da população exposta ao risco. Todas as análises também foram aplicadas para o conjunto de todos os óbitos por câncer (com exceção dos cânceres de pele não-melanoma).

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Para o Brasil, a mortalidade pelos cânceres de pênis (APC=1,5% IC95% 0,7;2,3 p<0,05), testículos (APC=1,6% IC95% 0,5;2,8 p<0,05) e ovários (APC=0,8% IC95% 0,1; 1,5 p<0,05), mostraram tendência de aumento, enquanto os cânceres de vulva e vagina (APC=-0,1% IC95% -0,9; 0,7 p=0,8), corpo de útero (APC= -0,3 IC95% -1,0; 0,5 p=0,4), mama (APC=0,4% IC95% -0,2;1,0 p=0,2) e de próstata (AAPC= 1,1% IC95% -0,2; 2,4 p=0,1) apresentaram tendência de estabilidade. A mortalidade por câncer de colo de útero apresentou tendência de redução (APC=-1,7% IC95%-2,2; -1,1 p<0,05). A análise do agrupamento de todos os óbitos por câncer observou tendência de aumento na mortalidade para o sexo masculino até o ano de 2006 (APC= 1,2% IC95% 0,6;1,8 p<0,01), seguido de um período de estabilidade. Para o sexo feminino, a tendência é de estabilidade (APC=0,4% IC95% -0,2;-1,8 p=0,2). As taxas de mortalidade para todos os cânceres analisados mostraram, de maneira geral, tendência de redução nas regiões sul e sudeste, tendência de aumento nas regiões norte e nordeste, e estabilidade para a região centro oeste. Na projeção da mortalidade para o ano 2030, as regiões norte e nordeste responderão pelas maiores taxas de mortalidade para os cânceres analisados; todavia, para as demais regiões, será observada redução nas taxas em comparação com o último período observado. Destacase o câncer de testículo, para o qual será observado aumento de 33% na carga da mortalidade até o ano 2030. Para os demais cânceres, não serão observadas variações consideráveis nas taxas de mortalidade para o Brasil entre o último período observado e o último período projetado. A estrutura e o tamanho da população brasileira serão os fatores que explicarão os padrões de mortalidade por esses cânceres no futuro, embora para a região nordeste, as variações serão explicadas, em maior medida, pelo aumento do risco para esses cânceres.

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Conclui-se, portanto, que existe uma marcante desigualdade na distribuição da mortalidade pelos cânceres específicos ao gênero no Brasil, onde as regiões mais pobres apresentam um quadro de aumento significativo do número de óbitos ao longo de uma série histórica, e que em 2030, essas regiões responderão pelas maiores taxas de mortalidade no país, com ênfase para os cânceres de pênis, testículos e ovários. (AU)

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Cancers that attack male and female genital organs, along with breast cancer, are responsible for approximately 20% of cancer-related deaths in the world. Knowledge on the mortality patterns for these cancers in Brazil, the changes produced throughout time, the most vulnerable groups and the mortality burden in the future are basic elements for structuring assistance and vigilance actions for cancer. The objective of this study was to analyze the mortality trends of cancers that attack gender-specific organs, and project mortality until the year 2030, for Brazil, its geographic regions, and federation states. A population-based ecological study is presented herein, which analyzed deaths occurring within the period 1996-2010, due to cancers of the uterine cervix, uterine corpus, female breast, ovary, vulva, vagina, prostrate, penis and testicles, registered in the Mortality Information System. Data on population was obtained from the Brazilian Institute of Geography and Statistics. Joinpoint regression was applied with standardized rates (world population: ASR-W) to estimate the Annual Percentage Change (APC), the Average Annual Percentage Change (AAPC), the confidence interval 95% and the inflection points of the curve. The projections were calculated by the Norpred program, inscribed within the R program, utilizing the age-period-cohort model, with posterior analysis of whether the changes produced in the future will be consequences of exposition to risk factors and/or structure of the population exposed to risk. The analyses were also applied to the set of all cancer-related deaths (with exception for non-melanoma skin cancers). For Brazil, mortality due to cancers of penis (APC=1.5% CI95% 0.7;2.3 p<0.05), testicles (APC=1.6% CI95% 0.5;2.8 p<0.05) and ovary (APC=0.8% CI95% 0.1; 1.5 p<0.05) showed increasing trends, while cancers of vulva and vagina (APC=-0.1% IC95% -0.9; 0.7 p=0.8), uterine corpus (APC=-0.3 CI95% - 1.0; 0.5 p=0.4), breast (APC=0.4% CI95% -0.2;1.0 p=0.2) and prostrate (AAPC= 1.1% CI95% -0.2; 2.4 p=0.1) presented stable trends. Mortality due to cervical cancer presented reducing trends (APC=-1.7% ICI95%-2.2; -1.1 p<0.05). Analysis of the grouping of all cancer-related deaths presented increasing mortality trends for the male gender until the year 2006 (APC= 1.2% CI95% 0.6; 1.8 p<0.01), followed by a stability period. For females, the trend was stable (APC=0.4% CI95% -0.2;-1.8 p=0.2). The mortality rates for all analyzed cancers revealed, generally, reducing trends for the South and Southeast regions, increasing trends for the North and Northeast regions, and stability for the Midwest region. Mortality projections for the year 2030 indicate that the North and Northeast regions will suffer the highest mortality rates for the analyzed cancers; however, for the remaining regions, reduced rates will be observed in comparison with the last period analyzed. It must be highlighted that, for testicle cancer, there will be an increase of 33% in mortality burden until the year 2030. For the remaining cancers, significant variations will not be observed in mortality rates for the last observed period and the last projected period in Brazil. The structure and size of the Brazilian population are the factors explaining the mortality patterns for these cancers in the future, although for the Northeast region, the variations will be explained mostly by the increase in risk for these cancers. It is concluded that there is a pronounced inequality in the distribution of gender-specific cancer mortality in Brazil, where the poorer regions present a significant increasing situation of the number of deaths throughout a historical series. In 2030, these regions will present the highest mortality rates in the country, with emphasis on penis, testicle and ovarian cancers. (AU)

Asunto(s)

Humanos , Masculino , Femenino , Brasil/epidemiología , Mortalidad/tendencias , Neoplasias Ováricas/diagnóstico , Neoplasias/epidemiología , Política Pública , Sistemas de Información en Salud , Análisis de Regresión , Estudios Ecológicos , Neoplasias del Pene , Neoplasias Testiculares , Neoplasias de la Mama , Neoplasias de la Próstata

RESUMEN

PURPOSE: To compare the three-dimensional (3D) image (CT/MR)-based planning with a multichannel vaginal cylinder (MVC) to a single-channel vaginal cylinder (SVC) for the treatment of vaginal cancer. METHODS AND MATERIALS: A total of 20 consecutive patients were treated with 3D CT/MR image-based high-dose-rate (HDR) brachytherapy using an MVC. All patients received external beam radiation therapy before HDR brachytherapy. A brachytherapy dose of 20-25Gy of more than five fractions was delivered to clinical target volume (CTV). Retrospectively, treatment plans for all patients were generated using the central channel only to mimic an SVC applicator. The SVC plans were optimized to match CTV coverage with MVC plans. Dose homogeneity index as well as bladder, rectum, sigmoid, and urethral doses were compared. RESULTS: The mean D90 for CTV was 74.2Gy (range: 48.8-84.1Gy). The mean (±standard deviation) of dose homogeneity index for MVC vs. SVC was 0.49 (±0.19) and 0.52 (±0.23), respectively (p=0.09). Mean bladder 0.1, 1, and 2cc doses for MVC vs. SVC were 69 vs. 71.2Gy (p=0.35), 61.4 vs. 63.8Gy (p=0.1), and 59.5 vs. 60.9Gy (p=0.31), respectively. Similarly, mean rectum 0.1, 1, and 2cc doses for MVC vs. SVC were 67.2 vs. 75.4Gy (p=0.005), 60.0 vs. 65.6Gy (p=0.008), and 57.3 vs. 62.0Gy (p=0.015), respectively, and mean sigmoid doses were 56.3 vs. 60.5Gy (p=0.10), 50.9 vs. 53.1Gy (p=0.09), and 49.1 vs. 50.7Gy (p=0.10), respectively. CONCLUSION: The 3D CT-/MR-based plan with MVC may provide better dose distribution in the management of certain clinical situations of vaginal cancer requiring intracavitary brachytherapy, especially in minimizing potential late rectal complications.

Asunto(s)

Braquiterapia/métodos , Neoplasias Vaginales/radioterapia , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Imagenología Tridimensional/métodos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/radioterapia , Radiometría , Dosificación Radioterapéutica , Radioterapia Guiada por Imagen/métodos , Recto , Estudios Retrospectivos , Terapia Recuperativa

RESUMEN

PIP: Samples of vaginal tissue were obtained from patients with a recorded history of exposure to nonsteroidal estrogens such as diethylstilbestrol (DES) in utero as well as from patients not exposed to DES but undergoing vaginal operations for other reasons. The tissue was removed from various sites within the vagina and divided into 2 segments, 1 fixed in 10% formalin and the other in 3.5% glutaraldehyde. The formalin series received routine histological analysis. The glutaraldehyde series was further prepared for scanning electron microscopy. As a result of exposure to DES several cervico-vaginal aberrations were noted, the most striking of which were those seen histologically. These have been classified into 5 groups: 1) complete epidermidization - complete replacement by metaplasia; 2) surface epidermidization - residual glands beneath and surface; 3) incomplete epidermidization - mixture of columnar epithelium on surface including crypts and glandlike elements; in-situ or invasive: and 5) squamous cell dysplasia. The differentiation of the early embryonic vaginal epithelium to that of the mature squamous epithelium of the newborn seems to be interfered with by the in utero exposure to nonsteroidal estrogens. It is not known whether this is due to inhibition with steroid estrogens or to some other enzymatic process. As a result of this exposure, vaginal adenosis develops. There is a natural tendency of the body to convert this adenosis to normal squamous epithelium through the process of metaplasia and the 5 states observed represent all phases of this process. In the group of patients in which the metaplastic process is incomplete or in a state of transition both columnar cells and squamous cells exist adjacent to each other and between them cells with variable degrees of metaplastic change. In a few patients these abnormal embryonic cell nests lead to the development of a malignancy, usually a mesonephromal clear-cell adenocarcinoma. Furthermore, within the areas of metaplastically converted squamous epithelium, anaplastic and dysplastic cellular changes also occur, with the potential danger of developing intraepithelial and possibly invasive squamous cell carcinomas of athe vagina.^ieng

Asunto(s)

Adenocarcinoma/patología , Enfermedades Vaginales/patología , Neoplasias Vaginales/patología , Femenino , Humanos , Microscopía Electrónica de Rastreo , Vagina/ultraestructura , Enfermedades Vaginales/clasificación