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Changes in the cervical microbiota of cervical cancer patients after primary radio-chemotherapy
  1. Anastasia Tsakmaklis1,
  2. Maria Vehreschild1,2,3,
  3. Fedja Farowski1,2,3,
  4. Maike Trommer4,
  5. Christhardt Kohler5,6,
  6. Jan Herter4 and
  7. Simone Marnitz7
  1. 1Department I of Internal Medicine, University Hospital Cologne, Cologne, Germany
  2. 2German Center for Infection Research, Partner Site Bonn-Cologne, University of Cologne, Cologne, Germany
  3. 3Department of Internal Medicine, Infectious Diseases, Goethe University Frankfurt, Frankfurt am Main, Germany
  4. 4Department of Radiation Oncology, CyberKnife and Radiotherapy, University Hospital Cologne, Cologne, Germany
  5. 5Department of Gynecology, University Hospital Cologne, Cologne, Germany
  6. 6Department of Special Operative and Oncologic Gynecology, Asklepios-Clinic Hamburg-Altona, Asklepios Hospital Group, Hamburg, Germany
  7. 7Department of Radiooncology, Medical Faculty of the University of Cologne, Cologne, Germany
  1. Correspondence to Professor Simone Marnitz, Department of Radiooncology, Medical Faculty of the University of Cologne, Cologne 50937, Nordrhein-Westfalen, Germany; simone.marnitz-schulze{at}


Objective Several recent studies have identified a potential interaction between the vaginal microbiota and gynecological cancers, but little is known about the cervical microbiota and its changes during cancer treatment. Therefore, the aim of the study was to evaluate the quantitative and qualitative changes of cervical microbiota in patients undergoing concurrent chemotherapy and radiation treatment for locally advanced cervical cancer.

Methods Cervical cytobrush samples of 15 cervical patients undergoing chemoradiation treatment were collected 1 day before starting external beam radiation therapy and on the day of the last fraction of brachytherapy. After DNA extraction, 16S rRNA amplicon sequencing of the V3–V4 region was performed on the MiSeq platform, followed by data processing and statistical analyses concerning the alpha and beta diversity of 16 samples (7 samples were excluded because of incomplete sample sets).

Results The amount of amplicon yield after polymerase chain reaction analysis in post-radiation samples was significantly lower compared with the baseline samples (pre 31.49±24.07 ng/µl; post 1.33±1.94 ng/µl; p=0.007). A comparison of pre-treatment and post-treatment samples did not show significant differences regarding beta diversity (weighted UniFrac). There was no significant difference in alpha diversity, which is used to characterize species diversity within a particular community and takes into account both number and abundance (Shannon Diversity Index pre-treatment samples: 2.167±0.7504 (95% CI 1.54 to 2.79); post-treatment samples: 1.97±0.43 (95% CI 1.61 to 2.33); p=0.38). Interindividual differences in patients could partly explain some variation of the samples (permutational multivariate analysis of variance).

Conclusion There was a strong reduction in cervical bacterial loads after chemoradiation. Neither alpha nor beta diversity varied significantly when baseline samples were compared with post-treatment samples.

  • uterine cervical neoplasms
  • radiotherapy dosage

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  • Contributors SM, MV, AT: concept and manuscript writing. JH, CK, and MT: manuscript writing. AT, and FF: laboratory work.

  • Funding This study was funded by Deutsche Forschungsgemeinschaft (DFG grant HE-6810/3-1) to JH.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The analysis was approved by the local ethics committee (ISI Study, ethics committee No 08–160).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or available upon reasonable request.

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