Radiation Oncology/Cervix/Preinvasive

Overview

 * Typically managed with close surveillance / cytology / HPV testing / LEEP / colposcopy
 * Hysterectomy if repeat colposcopy / LEEP not feasible
 * Role of radiation is somewhat controversial, particularly as older literature used "carcinoma in situ", which is no longer in the cytologic classification vocabulary

Radiation

 * Yonsei University, Korea; 2012 (1868-2005) PMID 22901420 -- "High-dose-rate intracavitary radiotherapy in the management of cervical intraepithelial neoplasia 3 and carcinoma in situ presenting with poor histologic factors after undergoing excisional procedures." (Kim YB, Int J Radiat Oncol Biol Phys. 2012 Sep 1;84(1):e19-22. doi: 10.1016/j.ijrobp.2012.02.045.)
 * Retrospective. 166 patients with CIN3 (n=15) or CIS (n=151), diagnosed by conization or biopsy. Endocervical gland involvement (81%), positive margin (44%), ECC positive (31%). Treated with HDR tandem & ovoids. Point A. Dose 30/6 fxs (range 30-52). Median F/U 12.7 years
 * Outcome: recurrence 2/166 patients
 * Toxicity: 1 rectal bleeding, managed with conservative management
 * Conclusion: HDR effective for CIN3/CIS, in patients with poor histologic features after excision