الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Cancer cervix is the fourth most common malignancy in females worldwide, with an estimated 527,600 new cases worldwide (Farley et al., 2012), it remains a leading reason of cancer-related death for females in developing countries. Cancer cervix remains a significant cause of morbidity and mortality in females. The highest incidence rates were in Central and South America and sub-Saharan Africa. The lowest rates were in the Middle East, Northern America, Australia and New Zealand, China, and Western Europe (Farley et al., 2012). Cancer cervix is decreasing in the United States of America due to the wide use of screening. But it is increasing in developing countries (275,000 deaths/year), since screening is not available to many females. Effective treatment for cancer cervix including surgery and concurrent chemo-radiation can cure about 80 percent of females with early stage disease (stages I–II) & about 60 percent of females with stage III disease. The hope is that immunization against HPV using vaccines will prevent persistent infection with the HPV types against which the vaccine is designed &will therefore prevent specific HPV cancer in females (Arbyn et al., 2007) & (Chan et al., 2007) & (Rambout et al., 2007).
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This study is a retrospective analysis conducted over 69 female patients diagnosed with invasive cervical cancer presented to Clinical oncology department at Ain-Shams University hospitals. All patients’ records in the period from January 2011 & June 2016 were reviewed allowing overall survival and progression free survival follow up.
The mean patients’ age was 53.8 years (range from 31 to 80 years). Stage IIIB was the most prevalent. Sqaumous cell carcinoma was the most common pathological subtype.
Regarding the response to CCRth: six patients (16.7%) were complete response, 11 patients (30.6%) were partial response, one patient (2.8%) were stable disease, and 18 patients (50%) were progressive disease.
Survival analysis using Kaplan- Meier method for overall survival (OS) according to TTC demonstrated that the median overall survival for the patients who completed the treatment (36 patients) was not reached and the estimated mean OS was 42.2 months.
The analysis has also performed the progression free survival in which the estimated median progression free survival (PFS) for the patients who completed tratment (36 patients) was 11.97 months.
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Worse PFS was associated with patients with age group more than 60 yrs with estimated median PFS (7.63 months) (95% confidence interval 4.9-19) with a significant P value 0.024.There was no significant difference for menopausal state (pre and post), performance status, stage of tumor and Hemoglobin level with the estimated median PFS. As regard the brachy-therapy ; the estimated median PFS was not reached in the 12 patients who underwent brachy-therapy, while in the patients who didnt underwent brachy-therapy, the estimated median PFS was 7.6 months (95% confidence interval 7-8.3) with a significant P value 0.006.
To sum up cancer cervix is usually diagnosed at an advanced stage, & outcomes are still poor. The use of concurrent chemo-radiotherapy followed by brachy-therapy & the treatment duration were the most important prognostic factors identified in our study.
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Recommendations
To reduce the incidence and mortality of cancer cervix in Egypt, we should educate & inform females about risk factors & prevention. Also it is recommended to educate patients and their families about the nature of the disease, the importance of follow up and its impact on their outcomes