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He H, He M, Zhou Q, Tang Y, Wang J, Li X, Zou D. Genetic analysis of cervical cancer with lymph node metastasis. J Gynecol Oncol 2024; 35:35.e102. [PMID: 38710532 DOI: 10.3802/jgo.2024.35.e102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/30/2023] [Accepted: 04/15/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVE To find out the differences in gene characteristics between cervical cancer patients with and without lymph node metastasis, and to provide reference for therapy. METHODS From January 2018 to June 2022, recurrent cervical cancer patients 39 cases with lymph node metastasis and 73 cases without lymph node metastasis underwent testing of 1,021 cancer-related genes by next-generation sequencing. Maftools software was used to analyze somatic single nucleotide/insertion-deletion variation mutation, co-occurring mutation, cosmic mutation characteristics, oncogenic signaling pathways. RESULTS EP300 and FBXW7 were significantly enriched in lymph node-positive patients. Lymph node-positive patients with EP300 or FBXW7 mutations had lower overall survival (OS) after recurrence. Both lymph node-positive and -negative patients had plenty of co-occurring mutations but few mutually exclusive mutations. Lymph node-positive co-occurring mutation number ≥6 had lower OS, while lymph node-negative co-occurring mutation number ≥3 had lower OS after recurrence. The etiology of SBS3 was defects in DNA double strand break repair by homologous recombination, which exclusively exist in lymph node-positive patients. There was no difference in median tumor mutation burden (TMB) between positive and negative lymph nodes, but TMB was significantly associated with PIK3CA mutation. CONCLUSION The somatic SNV/Indels of EP300 and FBXW7, SBS3 homologous recombination-mediated DNA repair defect were enriched in lymph node-positive patients. For lymph node-positive patients, EP300 or FBXW7 mutations predicted poor prognosis. No matter lymph node-positive or negative, more co-occurring mutation number predicted poor prognosis. PIK3CA mutation may account for the higher TMB and help identify patients who benefit from immunotherapy.
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Affiliation(s)
- Hao He
- Department of Gynecologic Oncology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
| | - Misi He
- Department of Gynecologic Oncology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
- Chongqing Specialized Medical Research Center of Ovarian Cancer, Chongqing, China
- Organoid Transformational Research Center, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Qi Zhou
- Department of Gynecologic Oncology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
- Chongqing Specialized Medical Research Center of Ovarian Cancer, Chongqing, China
| | - Ying Tang
- Department of Gynecologic Oncology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
- Chongqing Specialized Medical Research Center of Ovarian Cancer, Chongqing, China
| | - Jing Wang
- Department of Gynecologic Oncology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
| | - Xiuying Li
- Department of Gynecologic Oncology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
| | - Dongling Zou
- Department of Gynecologic Oncology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
- Chongqing Specialized Medical Research Center of Ovarian Cancer, Chongqing, China
- Organoid Transformational Research Center, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China.
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Fujiwara R, Yano M, Matsumoto M, Higashihara T, Tsudaka S, Hashida S, Ichihara S, Otani H. Two cases of strangulated bowel obstruction due to exposed vessel and nerve after laparoscopic and robot-assisted lateral lymph node dissection (LLND) for rectal cancer. Surg Case Rep 2024; 10:85. [PMID: 38619675 PMCID: PMC11018568 DOI: 10.1186/s40792-024-01889-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 04/05/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND The majority of small bowel obstructions (SBO) are caused by adhesion due to abdominal surgery. Internal hernias, a very rare cause of SBO, can arise from exposed blood vessels and nerves during pelvic lymphadenectomy (PL). In this report, we present two cases of SBO following laparoscopic and robot-assisted lateral lymph node dissection (LLND) for rectal cancer, one case each, of which obstructions were attributed to the exposure of blood vessels and nerves during the procedures. CASE PRESENTATION Case 1: A 68-year-old man underwent laparoscopic perineal rectal amputation and LLND for rectal cancer. Four years and three months after surgery, he visited to the emergency room with a chief complaint of left groin pain. Computed tomography (CT) revealed a closed-loop in the left pelvic cavity. We performed an open surgery to find that the small intestine was fitted into the gap between the left obturator nerve and the left pelvic wall, which was exposed by LLND. The intestine was not resected because coloration and peristalsis of the intestine improved after the hernia was released. The obturator nerve was preserved. Case 2: A 57-year-old man underwent a robot-assisted rectal amputation with LLND for rectal cancer. Eight months after surgery, he presented to the emergency room with a complaint of abdominal pain. CT revealed a closed-loop in the right pelvic cavity, and he underwent a laparoscopic surgery with a diagnosis of strangulated SBO. The small intestine was strangulated by an internal hernia caused by the right umbilical arterial cord, which was exposed by LLND. The incarcerated small intestine was released from the gap between the umbilical arterial cord and the pelvic wall. No bowel resection was performed. The umbilical arterial cord causing the internal hernia was resected. CONCLUSION Although strangulated SBO due to an exposed intestinal cord after PL has been a rare condition to date, it is crucial for surgeons to keep this condition in mind.
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Affiliation(s)
- Ryota Fujiwara
- Department of Gastroenterology and General Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahimachi, Takamatsu, Kagawa, 760-8557, Japan.
| | - Masaaki Yano
- Department of Gastroenterology and General Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahimachi, Takamatsu, Kagawa, 760-8557, Japan
| | - Makoto Matsumoto
- Department of Gastroenterology and General Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahimachi, Takamatsu, Kagawa, 760-8557, Japan
| | - Tomoaki Higashihara
- Department of Gastroenterology and General Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahimachi, Takamatsu, Kagawa, 760-8557, Japan
| | - Shimpei Tsudaka
- Department of Gastroenterology and General Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahimachi, Takamatsu, Kagawa, 760-8557, Japan
| | - Shinsuke Hashida
- Department of Gastroenterology and General Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahimachi, Takamatsu, Kagawa, 760-8557, Japan
| | - Shuji Ichihara
- Department of Gastroenterology and General Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahimachi, Takamatsu, Kagawa, 760-8557, Japan
| | - Hiroki Otani
- Department of Gastroenterology and General Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahimachi, Takamatsu, Kagawa, 760-8557, Japan
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Hall J, Wilson J, Shumway J, Yanagihara TK, Tepper J, Calvo B, Wang AZ, Pearlstein K, Wang K, Kim HJ. Outcomes of surgical resection and intraoperative electron radiotherapy for patients with para-aortic recurrences of gastrointestinal and gynecologic malignancies. Radiat Oncol 2023; 18:94. [PMID: 37268927 DOI: 10.1186/s13014-023-02289-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/25/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Para-aortic lymph node (PALN) metastases from primary pelvic malignancies are often treated with resection, but recurrence is common. We report toxicity and oncologic outcomes for patients with PALN metastases from gastrointestinal and gynecologic malignancies treated with resection and intraoperative electron radiotherapy (IORT). METHODS We retrospectively identified patients with recurrent PALN metastases who underwent resection with IORT. All patients were included in the local recurrence (LR) and toxicity analyses. Only patients with primary colorectal tumors were included in the survival analysis. RESULTS There were 26 patients with a median follow up of 10.4 months. The rate of para-aortic local control (LC) was 77% (20/26 patients) and the rate of any cancer recurrence was 58% (15/26 patients). Median time from surgery and IORT to any recurrence was 7 months. The LR rate for those with positive/close margins was 58% (7/12 patients) versus 7% (1/14 patients) for those with negative margins (p = 0.009). 15% (4/26 patients) developed surgical wound and/or infectious complications, 8% (2/26 patients) developed lower extremity edema, 8% (2/26 patients) experienced diarrhea, and 19% (5/26 patients) developed an acute kidney injury. There were no reported nerve injuries, bowel perforations, or bowel obstructions. For patients with primary colorectal tumors (n = 19), the median survival (OS) was 23 months. CONCLUSIONS We report favorable LC and acceptable toxicity for patients receiving surgical resection and IORT for a population that has historically poor outcomes. Our data show disease control rates similar to literature comparisons for patients with strong risk factors for LR, such as positive/close margins.
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Affiliation(s)
- Jacob Hall
- Department of Radiation Oncology, University of North Carolina School of Medicine, 101 Manning Drive CB #7512, Chapel Hill, NC, 27514, USA.
| | - Jessica Wilson
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - John Shumway
- Department of Radiation Oncology, University of North Carolina School of Medicine, 101 Manning Drive CB #7512, Chapel Hill, NC, 27514, USA
| | - Ted K Yanagihara
- Department of Radiation Oncology, University of North Carolina School of Medicine, 101 Manning Drive CB #7512, Chapel Hill, NC, 27514, USA
| | - Joel Tepper
- Department of Radiation Oncology, University of North Carolina School of Medicine, 101 Manning Drive CB #7512, Chapel Hill, NC, 27514, USA
| | - Benjamin Calvo
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Andrew Z Wang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kevin Pearlstein
- Department of Radiation Oncology, University of North Carolina School of Medicine, 101 Manning Drive CB #7512, Chapel Hill, NC, 27514, USA
| | - Kyle Wang
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, USA
| | - Hong Jin Kim
- Division of Surgical Oncology, Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
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He M, Guo M, Zhou Q, Tang Y, Zhong L, Liu Q, Fan X, Zhao X, Zhang X, Chen G, Shen Y, Xu Q, Chen X, Li Y, Zou D. Efficacy of lymph node dissection on stage IIICr of cervical cancer before CCRT: study protocol for a phase III, randomized controlled clinical trial (CQGOG0103). J Gynecol Oncol 2023; 34:e55. [PMID: 36998225 PMCID: PMC10157346 DOI: 10.3802/jgo.2023.34.e55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/27/2023] [Accepted: 02/25/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Cervical cancer is still present a major public health problem, especially in developing countries. In International Federation of Gynaecology and Obstetrics 2018, allowing assessment of retroperitoneal lymph nodes by imaging and/or pathological findings and, if deemed metastatic, the case is designated as stage IIIC (with r and p notations). Patients with lymph node metastases have lower overall survival (OS), progression free survival (PFS), and survival after recurrence, especially those who have unresectable macroscopical positive lymph nodes. Retrospective analysis suggests that there may be a benefit to debulking macroscopic nodes that would be otherwise difficult to sterilize with standard doses of radiation therapy. However, there are no prospective study reporting that resecting macroscopic nodes before concurrent chemoradiation therapy (CCRT) would improve PFS or OS of cervical cancer and no guidelines for surgical resection of bulky lymph nodes. The CQGOG0103 study is a prospective, multicenter and randomized controlled trial (RCT) evaluating lymph node dissection on stage IIICr of cervical cancer. METHODS Eligible patients are histologically confirmed cervical squamous cell carcinoma, adenocarcinoma, adeno-squamous cell carcinoma. Stage IIICr (confirmed by computed tomography [CT]/magnetic resonance imaging/positron emission tomography/CT) and the short diameter of image-positive lymph node ≥15 mm. 452 patients will be equally randomized to receive either CCRT (pelvic external-beam radiotherapy [EBRT]/extended-field EBRT + cisplatin [40 mg/m²] or carboplatin [the area under curve=2] every week for 5 cycles + brachytherapy) or open/minimally invasive pelvic and para-aortic lymph node dissection followed by CCRT. Randomization is stratified by status of para-aortic lymph node. The primary endpoint is PFS. Secondary endpoints are OS and surgical complications. A total of 452 patients will be enrolled from multiple hospitals in China within 4 years and followed up for 5 years. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04555226.
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Affiliation(s)
- Misi He
- Department of Gynecology Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Mingfang Guo
- Department of Gynecology Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Qi Zhou
- Department of Gynecology Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Ying Tang
- Department of Gynecology Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Lin Zhong
- Department of Gynecology Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Qing Liu
- Gansu Provincial Maternity and Child-Care Hospital/Gansu Provincial Central Hospital, Lanzhou, China
| | - Xiaomei Fan
- Fourth Hospital of Hebei Medical University, Hebei, China
| | - Xiwa Zhao
- Fourth Hospital of Hebei Medical University, Hebei, China
| | - Xiang Zhang
- Department of Gynecologic Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Institute of Cancer and Casic Medicine (IBMC), Chinese Academy of Science, Hangzhou, China
- Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Gang Chen
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanming Shen
- Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qin Xu
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Xiaojun Chen
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - Yuancheng Li
- Cancer Hospital of Shantou University Medicine College, Shantou, China
| | - Dongling Zou
- Department of Gynecology Oncology, Chongqing University Cancer Hospital, Chongqing, China.
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Dumitraşcu MC, Nenciu AE, Nenciu CG, Ursu C, Ilieşiu A, Baroş A, Secară D, Cîrstoiu MM. Stadializarea clinică şi chirurgicală a pacientelor cu cancer de col uterin – studiu retrospectiv privind corelaţiile dintre diagnosticul iniţial, opţiunile de tratament şi rezultatele histopatologice. GINECOLOGIA.RO 2023. [DOI: 10.26416/gine.39.1.2023.7788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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6
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Puga O, Retamales J, Saez N, Urzúa M, Saavedra M, Pérez MV, Acuña D, García K. The role of pre-treatment paraaortic surgical staging for cervical cancer in the EMBRACE criteria. Ecancermedicalscience 2022; 16:1463. [PMID: 36819821 PMCID: PMC9934876 DOI: 10.3332/ecancer.2022.1463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Indexed: 11/06/2022] Open
Abstract
Background The State-of-the-Art Treatment for Locally Advanced Cervical Cancer (LACC) is Definite Radio-Chemotherapy based on the Image-guided intensity modulated External beam radiochemotherapy and MRI-based adaptive BRAchytherapy (EMBRACE) trial, according to the FIGO staging. This staging is based on clinical examination and imaging studies; however, there are limitations of imaging techniques which may result in adverse events or death due to insufficient or overtreatment. The aim of the study was to evaluate the feasibility and outcomes of surgical staging in LACC prior to radiotherapy (RT) to personalise target volumes for radiotherapy. Methods From 2008 to 2018, 138 patients with FIGO 2018 stages IB3-IIIC2 cervical cancer underwent a pretherapeutic laparoscopic staging procedure. The pathological diagnosis was compared with the results of preoperative CT scan. Patients were treated with chemoradiotherapy tailored according to the staging results. Results The mean patient age was 43 years, the mean body mass index was 27 kg/m2; most lesions were squamous cervical cancer (92%). Staging CT scan had a 77% concordance with the histological findings. Sensitivity was 29%, specificity 85%, positive predictive value 21% and negative predictive value 89%. Surgical staging led to change of stage in 24% of cases. Para -aortic dissection led to change the initially planned radiotherapy fields in 47% of the cases. Major complications included involuntary section of the inferior mesenteric artery (IMA) without clinical repercussion, an infected retroperitoneal haematoma and a symptomatic lymphocele requiring laparoscopic drainage. Conclusion Laparoscopic staging before primary chemoradiation in patients with LACC was feasible, safe and reproducible, allowing reduction of the radiotherapy treatment volumes of patients.
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Affiliation(s)
- Oscar Puga
- Unidad Oncología Ginecológica, Complejo Asistencial Sótero del Río, Av Concha y Toro 3459 - 8207257, Santiago, Chile,Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Lira 40 - 8330023, Santiago, Chile
| | - Javier Retamales
- Unidad Oncología Ginecológica, Complejo Asistencial Sótero del Río, Av Concha y Toro 3459 - 8207257, Santiago, Chile,Chilean Cooperative Group for Oncologic Research, Av Jose Manuel Infante 125 Of. 11 - 7500650, Santiago, Chile
| | - Nicolás Saez
- Unidad Oncología Ginecológica, Complejo Asistencial Sótero del Río, Av Concha y Toro 3459 - 8207257, Santiago, Chile,Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Lira 40 - 8330023, Santiago, Chile
| | - Miguel Urzúa
- Unidad Oncología Ginecológica, Complejo Asistencial Sótero del Río, Av Concha y Toro 3459 - 8207257, Santiago, Chile,Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Lira 40 - 8330023, Santiago, Chile
| | - Miguel Saavedra
- Unidad Oncología Ginecológica, Complejo Asistencial Sótero del Río, Av Concha y Toro 3459 - 8207257, Santiago, Chile,Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Lira 40 - 8330023, Santiago, Chile
| | - María Victoria Pérez
- Unidad Oncología Ginecológica, Complejo Asistencial Sótero del Río, Av Concha y Toro 3459 - 8207257, Santiago, Chile,Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Lira 40 - 8330023, Santiago, Chile
| | - Dania Acuña
- Unidad Oncología Ginecológica, Complejo Asistencial Sótero del Río, Av Concha y Toro 3459 - 8207257, Santiago, Chile
| | - Karen García
- Unidad Oncología Ginecológica, Complejo Asistencial Sótero del Río, Av Concha y Toro 3459 - 8207257, Santiago, Chile,Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Lira 40 - 8330023, Santiago, Chile
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Li H, Wang S, Liu Y, Wang T, Jin S, Liu Z. Prophylactic extended-field irradiation for locally advanced cervical cancer. Gynecol Oncol 2022; 166:606-613. [PMID: 35868881 DOI: 10.1016/j.ygyno.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/03/2022] [Accepted: 07/10/2022] [Indexed: 11/04/2022]
Abstract
Concomitant chemoradiotherapy is the standard treatment for locally advanced cervical cancer. Pelvic irradiation is commonly recommended for patients with negative para-aortic lymph nodes(PALNs). However, owing to the development of imaging-guided brachytherapy, distant failure has become the main failure pattern. The PALNs are a vital site of distant metastasis, and the para-aortic region may contain occult microscopic metastases that are barely detected owing to imaging technology restriction. The prognostic of patients who experienced PALN failure is dismal. Typically, there are four ways to decrease PALN failure. First, surgical staging can be performed to assess the occurrence of metastasis in the para-aortic region; however, the application of surgical staging is decreasing owing to controversial survival benefits and accompanying complications of surgery. Second, regular imaging surveillance and timely salvage of early recurrences could reduce PALN failure. Third, better systemic adjuvant therapy could be recommended since it has enormous potential to reduce distant metastases and improve overall survival. Fourth, performing prophylactic extended-field irradiation (EFI), including pelvic and para-aortic region irradiation, can sterilize occult microscopic metastases in the para-aortic region and improve survival. Prior investigations have revealed that prophylactic EFI could reduce PALN failure as well as distant metastasis and present the benefit of survival. Yet, owing to the serious morbidity induced by enlarged irradiation field in the era of conventional irradiation techniques, further research on EFI is stagnated. Nowadays, with the development of new technologies, intensity modulated radiation therapy can deliver a higher dose to tumors with acceptable toxicity. Prophylactic EFI regained attention. However, the inclusion criteria of prophylactic EFI in existing studies reveal great discrepancies. Thus, it is urgent to precisely identify indications for better survival and lower complications in patients with cervical cancer. In this review, we identify indications and summary guidelines for prophylactic EFI, which may provide a foundation for further trials and clinical applications.
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Affiliation(s)
- Huanhuan Li
- Department of radiation oncology, The Second affiliated Hospital of Jilin University, Changchun 130041, China
| | - Shu Wang
- Department of radiation oncology, The Second affiliated Hospital of Jilin University, Changchun 130041, China
| | - Yingying Liu
- Department of radiation oncology, The Second affiliated Hospital of Jilin University, Changchun 130041, China
| | - Tiejun Wang
- Department of radiation oncology, The Second affiliated Hospital of Jilin University, Changchun 130041, China
| | - Shunzi Jin
- NHC Key Laboratory of Radiobiology,Jilin University, Changchun 130021, China
| | - Zhongshan Liu
- Department of radiation oncology, The Second affiliated Hospital of Jilin University, Changchun 130041, China.
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8
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Strangulated small bowel obstruction caused by isolated obturator nerve and pelvic vessels after pelvic lymphadenectomy in gynecologic surgery: two case reports. Surg Case Rep 2022; 8:104. [PMID: 35644816 PMCID: PMC9148868 DOI: 10.1186/s40792-022-01459-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 05/24/2022] [Indexed: 01/06/2023] Open
Abstract
Abstract
Background
Although small bowel obstruction (SBO) is a major complication occurring after abdominal surgery, few reports have described strangulated SBO after pelvic lymphadenectomy (PL). This report describes two cases of strangulated SBO caused by a skeletonized obturator nerve and pelvic vessels after laparoscopic PL during gynecologic surgery.
Case presentation
Case 1: A 57-year-old woman with endometrial cancer underwent a laparoscopic semi-radical total hysterectomy with PL. Nine months after the operation, she visited our emergency room complaining about subacute pain spreading in the right groin, right buttock, and dorsal part of the right thigh. She had no abdominal pain. Although her symptoms were not typical, computed tomography (CT) revealed strangulated SBO in the right pelvis. Laparoscopic surgery revealed that the small bowel was ischemic. Then we converted to open surgery. We transected the right obturator nerve and umbilical artery, which constructed an internal hernia orifice in the right pelvis, followed by resection of the ischemic small bowel. Fortunately, during 6-month follow-up, she showed only slight difficulty in walking as a postoperative complication. Case 2: A 62-year-old woman with cervical cancer underwent laparoscopic radical hysterectomy with PL. Six months after the operation, she visited our hospital emergently because of sudden onset of abdominal pain and vomiting. CT showed strangulated SBO. Urgent laparoscopic surgery exhibited the incarcerated small bowel at the right pelvis. Consequently, we converted to open surgery. The terminal ileum was detained into the space constructed by the right umbilical artery. We cut the umbilical artery and performed ileocecal resection. After the surgery, she was discharged with no complication or sequela.
Conclusion
When examining a patient after PL who complains of severe pain or symptoms, one should consider the possibility of PL-related SBO, even if the pain is apparently atypical for SBO.
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Zhou Y, Rassy E, Coutte A, Achkar S, Espenel S, Genestie C, Pautier P, Morice P, Gouy S, Chargari C. Current Standards in the Management of Early and Locally Advanced Cervical Cancer: Update on the Benefit of Neoadjuvant/Adjuvant Strategies. Cancers (Basel) 2022; 14:2449. [PMID: 35626051 PMCID: PMC9139662 DOI: 10.3390/cancers14102449] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 12/04/2022] Open
Abstract
Globally, cervical cancers continue to be one of the leading causes of cancer-related deaths. The primary treatment of patients with early-stage disease includes surgery or radiation therapy with or without chemotherapy. The main challenge in treating these patients is to maintain a curative approach and limit treatment-related morbidity. Traditionally, inoperable patients are treated with radiation therapy solely and operable patients undergo upfront surgery followed by adjuvant (chemo) radiotherapy in cases with poor histopathological prognostic features. Patients with locally advanced cervical cancers are treated with concurrent chemoradiotherapy followed by an image-guided brachytherapy boost. In these patients, the main pattern of failure is distant relapse, encouraging intensification of systemic treatments to improve disease control. Ongoing trials are evaluating immunotherapy in locally advanced tumours following its encouraging efficacy reported in the recurrent and metastatic settings. In this article, clinical evidence of neoadjuvant and adjuvant treatments in cervical cancer patients is reviewed, with a focus on potential strategies to improve patients' outcome and minimize treatment-related morbidity.
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Affiliation(s)
- Yuedan Zhou
- Department of Radiation Oncology, Centre Hospitalier Universitaire, 80000 Amiens-Picardie, France; (Y.Z.); (A.C.)
| | - Elie Rassy
- Department of Medical Oncology, Gustave Roussy Comprehensive Cancer Centre, 94800 Villejuif, France; (E.R.); (P.P.)
| | - Alexandre Coutte
- Department of Radiation Oncology, Centre Hospitalier Universitaire, 80000 Amiens-Picardie, France; (Y.Z.); (A.C.)
| | - Samir Achkar
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Centre, 94800 Villejuif, France; (S.A.); (S.E.)
| | - Sophie Espenel
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Centre, 94800 Villejuif, France; (S.A.); (S.E.)
| | - Catherine Genestie
- Department of Pathology, Gustave Roussy Comprehensive Cancer Center, 94800 Villejuif, France;
| | - Patricia Pautier
- Department of Medical Oncology, Gustave Roussy Comprehensive Cancer Centre, 94800 Villejuif, France; (E.R.); (P.P.)
| | - Philippe Morice
- Department of Surgery, Gustave Roussy Comprehensive Cancer Center, 94800 Villejuif, France; (P.M.); (S.G.)
| | - Sébastien Gouy
- Department of Surgery, Gustave Roussy Comprehensive Cancer Center, 94800 Villejuif, France; (P.M.); (S.G.)
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Centre, 94800 Villejuif, France; (S.A.); (S.E.)
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Kaźmierczak K, Cholewiński W, Nowakowski B. Comparison of positron emission tomography with computed tomography examination with histopathological assessment of pelvic lymph nodes in patients with cervical cancer treated surgically. Contemp Oncol (Pozn) 2021; 25:160-167. [PMID: 34729035 PMCID: PMC8547176 DOI: 10.5114/wo.2021.109209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/13/2021] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION According to the literature, fluor-18-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG-PET-CT) is the most effective technique for the examination and detection of metastases in the lymph nodes in patients with cervical cancer. This study aimed to compare the diagnostic value of the preoperative evaluation using 18F-FDG-PET-CT with a histopathological examination of the lymph nodes removed during radical hysterectomy and pelvic lymph node dissection in patients with cervical cancer. MATERIAL AND METHODS Retrospective analysis covered the medical records of 42 patients with cervical cancer (stage IA-IB according to International Federation of Gynaecology and Obstetrics 2009) treated with radical Piver type III hysterectomy and pelvic lymph node dissection. The preoperative diagnosis was made using a PET/CT examination. Results: The result of the 18F-FDG-PET-CT examination highlighted a suspicion of lymph node metastases in 13 patients (31%). The histopathological examination confirmed this in 12 patients (29%). Metastatic lymph nodes were correctly diagnosed using 18F-FDG-PET-CT in 8 out of the 12 cases confirmed by the histopathological examination. In the patient-based study, sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 66.8%, 83.3%, 61.5%, 86.2 % and 78.6%, respectively. CONCLUSIONS We confirmed the usefulness of PET in the preoperative assessment of cervical cancer advancement, especially in correlation with the new 2018 International Federation of Gynaecology and Obstetrics staging system.
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Affiliation(s)
- Kamila Kaźmierczak
- Surgical, Oncological and Endoscopic Gynaecology Department, Greater Poland CancerCentre, Poznań, Poland
| | - Witold Cholewiński
- Electroradiology Department, Poznan University of Medical Sciens, Poznań, Poland
- Nuclear Medicine Department, Greater Poland Cancer Center, Poznań, Poland
| | - Błażej Nowakowski
- Surgical, Oncological and Endoscopic Gynaecology Department, Greater Poland CancerCentre, Poznań, Poland
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Strategies for the Treatment of Cervical Cancer with Bulky Pelvic Lymph Nodes: An Overview of the Current Evidence. J UOEH 2021; 42:317-325. [PMID: 33268608 DOI: 10.7888/juoeh.42.317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Cervical cancer commonly metastasizes first to the pelvic lymph nodes and then subsequently spreads to distant organs, making lymph node metastases the most significant prognostic factor in cervical cancer, and the strategy for its treatment directly influences prognosis. This review focuses on the treatment strategies for cases of cervical cancer with bulky pelvic lymph nodes. Concurrent chemoradiotherapy is the standard treatment modality for patients with pelvic lymph node metastases, but it is inadequate for bulky pelvic lymph nodes. Accordingly, surgical resection of the bulky lymph nodes has been attempted, and its therapeutic significance has been reported. If the bulky lymph nodes are unresectable, definitive concurrent chemoradiotherapy is performed. If it yields an inadequate degree of lymph node shrinkage, boosted radiation should be considered. The addition of chemotherapy after concurrent chemoradiotherapy has also been reported to be effective in patients with lymph node metastases and is currently being evaluated in clinical trials.
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12
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Zhang A, Song J, Ma Z, Chen T. Application of apparent diffusion coefficient values derived from diffusion-weighted imaging for assessing different sized metastatic lymph nodes in cervical cancers. Acta Radiol 2020; 61:848-855. [PMID: 31615267 DOI: 10.1177/0284185119879686] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Lymph nodes metastasis is an important factor affecting survival rate and recurrence in cervical cancer patients. Currently, diagnosis of metastatic lymph nodes is mainly based on morphological changes on imaging. However, it is difficult to differentiate normal-sized metastatic lymph nodes with short axis of 5-10mm. PURPOSE To assess the diagnostic value of apparent diffusion coefficient (ADC) for discriminating different-sized metastatic lymph nodes in patients with cervical cancers. MATERIAL AND METHODS Pathologically confirmed cervical cancer patients were documented from January 2013 to July 2018 in our hospital. A total of 133 patients who underwent conventional MRI and diffusion-weighted imaging with complete pathology were finally enrolled. A total of 157 lymph nodes were harvested and analyzed. All lymph nodes were divided into three groups according to pathology and their short axis (S) measured on axial T2-weighted imaging: normal-sized (5 mm<S<10 mm) benign lymph nodes (Group 1); normal-sized (5 mm<S<10 mm) metastatic lymph nodes (Group 2); enlarged (S≥10 mm) metastatic lymph nodes (Group 3). Mean ADC (ADCmean), minimum ADC (ADCmin), and maximum ADC (ADCmax) values of lymph nodes were analyzed and compared among the three groups. RESULTS ADCmean of Groups 1 and 2 were significantly larger than those of Group 3 (P<0.001, P=0.005, respectively). ADCmin of Group 1 were significantly larger than those of Groups 2 and 3 (P<0.001, P<0.001, respectively). ADCmax was not statistically different among the three groups. ADCmean had the relatively highest area under the curve (AUC) of 0.644 for assessing enlarged metastatic lymph nodes, with a sensitivity of 64.4% and specificity of 67.9%. ADCmin had the highest AUC of 0.758 for assessing normal-sized metastatic lymph nodes, with a sensitivity of 84.7% and specificity of 60.7%. CONCLUSION Diffusion-weighted imaging can be used to differentiate enlarged metastatic lymph nodes from benign lymph nodes, and ADCmin can be further used to identify micro-metastasis in normal-sized lymph nodes.
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Affiliation(s)
- Aining Zhang
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Jiacheng Song
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Zhanlong Ma
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Ting Chen
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
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Leray H, Gabiache E, Courbon F, Brenot-Rossi I, Colineaux H, Lepage B, Lambaudie E, Martinez A, Voglimacci M, Weyl A, Deslandres M, Ducassou A, Motton S, Vaysse C, Chantalat E. 18F-FDG PET/CT Identifies Predictors of Survival in Patients with Locally Advanced Cervical Carcinoma and Paraaortic Lymph Node Involvement to Allow Intensification of Treatment. J Nucl Med 2020; 61:1442-1447. [PMID: 32034109 DOI: 10.2967/jnumed.119.238824] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/28/2020] [Indexed: 11/16/2022] Open
Abstract
Our objective was to use 18F-FDG PET/CT to identify a high-risk subgroup requiring therapeutic intensification among patients with locally advanced cervical cancer (LACC) and paraaortic lymph node (PALN) involvement. Methods: In this retrospective multicentric study, patients with LACC and PALN involvement concurrently treated with chemoradiotherapy and extended-field radiotherapy between 2006 and 2016 were included. A senior nuclear medicine specialist in PET for gynecologic oncology reviewed all 18F-FDG PET/CT scans. Metabolic parameters including SUVmax, metabolic tumor volume, and total lesion glycolysis (TLG) were determined for the primary tumor, pelvic lymph nodes, and PALNs. Associations between these parameters and overall survival (OS) were assessed with the Cox proportional hazards model. Results: Sixty-eight patients were enrolled in the study. Three-year OS was 55.5% (95% confidence interval, 40.8-68.0). When adjusted for age, stage, and histology, pelvic lymph node TLG, PALN TLG, and PALN SUVmax were significantly associated with OS (P < 0.005). Conclusion: 18F-FDG PET/CT was able to identify predictors of survival in the homogeneous subgroup of patients with LACC and PALN involvement, thus allowing therapeutic intensification to be proposed.
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Affiliation(s)
- Hélène Leray
- Department of Surgical Oncology, IUCT-Oncopole, Toulouse, France
| | - Erwan Gabiache
- Department of Nuclear Medicine, IUCT-Oncopole, Toulouse, France
| | | | | | - Hélène Colineaux
- Department of Epidemiology, University Hospital Centre Rangueil, Toulouse, France
| | - Benoît Lepage
- Department of Epidemiology, University Hospital Centre Rangueil, Toulouse, France
| | - Eric Lambaudie
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
| | | | - Marie Voglimacci
- Department of Surgical Oncology, IUCT-Oncopole, Toulouse, France
| | - Ariane Weyl
- Department of Surgical Oncology, IUCT-Oncopole, Toulouse, France
| | | | - Anne Ducassou
- Department of Radiation Oncology, IUCT-Oncopole, France
| | - Stéphanie Motton
- Department of Surgical Oncology, IUCT-Oncopole, Toulouse, France
| | - Charlotte Vaysse
- Department of Surgical Oncology, IUCT-Oncopole, Toulouse, France
| | - Elodie Chantalat
- Department of Surgical Oncology, IUCT-Oncopole, Toulouse, France
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Lee J, Kim CK, Park SY. Histogram analysis of apparent diffusion coefficients for predicting pelvic lymph node metastasis in patients with uterine cervical cancer. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2019; 33:283-292. [DOI: 10.1007/s10334-019-00777-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/29/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
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The diagnostic performance of PET/CT scans for the detection of para-aortic metastatic lymph nodes in patients with cervical cancer: A meta-analysis. PLoS One 2019; 14:e0220080. [PMID: 31318962 PMCID: PMC6638976 DOI: 10.1371/journal.pone.0220080] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/07/2019] [Indexed: 12/18/2022] Open
Abstract
Objective We performed a meta-analysis to evaluate the diagnostic value of positron emission tomography/computed tomography (PET/CT) in the detection of para-aortic lymph node metastasis in cervical cancer. Methods We searched the PubMed, Embase, Web of Science, Cochrane Library, Chinese Biological Medicine (CBM), Chinese National Knowledge Infrastructure (CNKI), Wanfang and VIP databases in all languages from their inception to September 2018. Stat15.0 software was used to obtain pooled estimates of sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) as well as a summary receiver operating characteristic (SROC) curves. Deek‘s funnel plot was used to assess publication bias. QUADAS-2 was used to evaluate the quality of the studies. The protocol for this meta-analysis is registered in PROSPERO (CRD42019115330). Results We obtained 14 studies, and the pooled estimates for sensitivity and specificity of PET/CT were 0.71 (95% confidence interval (CI) = 0.54–0.83) and 0.97 (95% CI = 0.93–0.98), respectively. Pooled PLR and NLR were 21.53 and 0.30, respectively. The diagnostic odds ratio (DOR) was70.59, and the area under the curve (AUC) was 0.95. Conclusion PET/CT is an effective and important imaging method for the diagnosis of para-aortic lymph node metastasis in early cervical cancer.
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Aslan K, Meydanli MM, Oz M, Tohma YA, Haberal A, Ayhan A. The prognostic value of lymph node ratio in stage IIIC cervical cancer patients triaged to primary treatment by radical hysterectomy with systematic pelvic and para-aortic lymphadenectomy. J Gynecol Oncol 2019; 31:e1. [PMID: 31788991 PMCID: PMC6918892 DOI: 10.3802/jgo.2020.31.e1] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/30/2019] [Accepted: 06/06/2019] [Indexed: 12/11/2022] Open
Abstract
Objective The aim of this study was to determine the prognostic value of lymph node ratio (LNR) in women with 2018 International Federation of Gynecology and Obstetrics stage IIIC cervical cancer. Methods In this retrospective dual-institutional study, a total of 185 node-positive cervical cancer patients who had undergone radical hysterectomy with systematic pelvic and para-aortic lymphadenectomy were included. All of the patients received adjuvant chemoradiation after surgery. LNR was defined as the ratio of positive lymph nodes (LNs) to the total number of LNs removed. The patients were categorized into 2 groups according to LNR; LNR <0.05 and LNR ≥0.05. The prognostic value of LNR was evaluated with univariate log-rank tests and multivariate Cox regression models. Results A total of 138 patients (74.6%) had stage IIIC1 disease and 47 (25.4%) patients had stage IIIC2 disease. With a median follow-up period of 45.5 months (range 3–135 months), the 5-year disease-free survival (DFS) rate was 62.5% whereas the 5-year overall survival (OS) rate was 70.4% for the entire study population. The 5-year DFS rates for LNR <0.05 and LNR ≥0.05 were 78.2%, and 48.4%, respectively (p<0.001). Additionally, the 5-year OS rates for LNR <0.05 and LNR ≥0.05 were 80.6%, and 61.2%, respectively (p=0.007). On multivariate analysis, LNR ≥0.05 was associated with a worse DFS (hazard ratio [HR]=2.12; 95% confidence interval [CI]=1.15–3.90; p=0.015) and OS (HR=1.95; 95% CI=1.01–3.77; p=0.046) in women with stage IIIC cervical cancer. Conclusions LNR ≥0.05 seems to be an independent prognostic factor for decreased DFS and OS in stage IIIC cervical carcinoma.
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Affiliation(s)
- Koray Aslan
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey.
| | - Mehmet Mutlu Meydanli
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Murat Oz
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Yusuf Aytac Tohma
- Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Ali Haberal
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Ali Ayhan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
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Bauer E, Mazul A, Chernock R, Rich J, Jackson RS, Paniello R, Pipkorn P, Oppelt P, Gay H, Daly M, El-Mofty S, Thorstad W, Adkins D, Zevallos J. Extranodal extension is a strong prognosticator in HPV-positive oropharyngeal squamous cell carcinoma. Laryngoscope 2019; 130:939-945. [PMID: 31077394 DOI: 10.1002/lary.28059] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/29/2019] [Accepted: 04/22/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To comprehensively examine the prognostic significance of extranodal extension (ENE) in human papillomavirus-positive oropharyngeal squamous cell carcinoma (HPV-positive OPSCC). METHODS Retrospective cohort of cases diagnosed with HPV-positive OPSCC from 2010 to 2015 in the National Cancer Database. Inclusion of all OPSCC HPV-positive cases with appropriate International Classification of Diseases-0-3 codes that received surgery with a neck dissection. Univariate and multivariable analyses were conducted. Hazard ratios (HR) for the independent effects of ENE and N stage on overall survival were estimated by Cox proportional hazards regression. RESULTS Cases that were ENE-negative had the highest 5-year survival (92.6%; 95% confidence interval [CI]: 90.5%-94.7%). ENE-positive cases had the lowest 5-year survival (84.0%; 95% CI: 80.7%-87.4%). After adjusting for confounding variables, ENE-positivity was associated with almost twice the hazard of death (HR = 1.90; 95% CI: 1.35-2.67) compared to ENE-negative cases. Nodal (N) category 1, ENE-positive status was associated with an increased risk of death (HR = 1.88; 95% CI: 1.26-2.80) compared with N1, ENE-negative status. Compared to N1/ENE-negative cases, N2/ENE-positive cases had the poorest survival (HR: 2.93; 95% CI: 1.94-4.43). Both microscopic and macroscopic ENE were associated with worse outcomes compared to node-positive/ENE-negative status. CONCLUSION The implementation of the American Joint Committee on Cancer 8th edition staging system provides a much-improved framework to develop and discuss treatment plans for HPV-positive OPSCC. We feel that careful consideration should be given to the importance of ENE in patients with HPV-positive OPSCC. LEVEL OF EVIDENCE 4 Laryngoscope, 130:939-945, 2020.
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Affiliation(s)
- Eric Bauer
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Angela Mazul
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Rebecca Chernock
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Jason Rich
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Randal Paniello
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Peter Oppelt
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Hiram Gay
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Mackenzie Daly
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Samir El-Mofty
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Wade Thorstad
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Douglas Adkins
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Jose Zevallos
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
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Yan DD, Tang Q, Tu YQ, Chen JH, Lv XJ. A comprehensive analysis of the factors of positive pelvic lymph nodes on survival of cervical cancer patients with 2018 FIGO stage IIIC1p. Cancer Manag Res 2019; 11:4223-4230. [PMID: 31123422 PMCID: PMC6511237 DOI: 10.2147/cmar.s204154] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/29/2019] [Indexed: 02/02/2023] Open
Abstract
Objective: To evaluate the factors associated with positive pelvic lymph nodes (LNs) on the survival of patients with 2018 FIGO stage IIIC1p cervical cancer. Methods: We retrospectively analyzed 155 patients with pelvic lymph node metastasis (LNM) confirmed by pathology after radical resection of cervical cancer treated at Zhejiang Cancer Hospital, China, between March 2008 and October 2011. We analyzed the influence of the factors associated with positive pelvic LNs on the survival of patients. Results: The 5-year progress-free survival (PFS) and overall survival (OS) of patients were 78.1% and 81.9%, respectively. The 5-year PFS and OS of patients with more than 2 LNM were worse compared with patients with 1 or 2 LNM (68.4% vs 83.7%, p=0.013; 72.4% vs 87.6%, p=0.017, respectively). The 5-year PFS and OS of patients with more than 2 LNM sites were worse than that of patients with 1 or 2 LNM sites (60.0% vs 82.4%, p=0.008; 70.0% vs 84.8%, p=0.045, respectively). The 5-year PFS and OS of patients with common iliac LNM was poorer than that of patients without common iliac LNM (60.7% vs 81.9%, p=0.008; 67.9% vs 85.0%, p=0.020, respectively). Compared with other patients, the survival of patients with these three factors (more than 2 LNM, more than 2 LNM sites, and common iliac LNM) was the worst (p<0.05). Conclusion: More than 2 LNM, more than 2 LNM sites, and common iliac LNM were predictive factors of poor survival in stage IIIC1p cervical cancer patients. Survival of patients with stage IIIC1p cervical cancer declined with increasing presence of such factors. The combined evaluation of the factors associated with positive pelvic LNs is a more comprehensive and pragmatic approach in evaluating the prognosis of cervical cancer.
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Affiliation(s)
- Ding-Ding Yan
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| | - Qiu Tang
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| | - Ye-Qiang Tu
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| | - Jian-Hong Chen
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| | - Xiao-Juan Lv
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
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Zhu Y, Zhang GN, Shi Y, Cui L, Leng XF, Huang JM. Perineural invasion in cervical cancer: pay attention to the indications of nerve-sparing radical hysterectomy. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:203. [PMID: 31205921 DOI: 10.21037/atm.2019.04.35] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Perineural invasion (PNI) in early-stage cervical cancer, is associated with multiple high-risk factors and represents a poor outcome in the patients. For nerve-sparing radical hysterectomy (NSRH) to become a standard and widely used treatment for cervical cancer, we need to define its oncological safety, and to establish standardized surgical procedures and indications of NSRH. Here, we review the definition and mechanisms, and clinical significance of PNI in cervical cancer, and discuss the indications of NSRH. PNI should be regarded as one of the main pathological features of cervical cancer and a factor affecting prognosis. A deeper understanding of PNI in cervical cancer, hopefully, will provide clear indications of NSRH.
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Affiliation(s)
- Yi Zhu
- Department of Gynecologic Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Cancer Hospital affiliate to School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China.,Department of Ultrasound, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Cancer Hospital affiliate to School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Guo-Nan Zhang
- Department of Gynecologic Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Cancer Hospital affiliate to School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Yu Shi
- Department of Gynecologic Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Cancer Hospital affiliate to School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Ling Cui
- Department of Gynecologic Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Cancer Hospital affiliate to School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Xue-Feng Leng
- Department of Thoracic Surgery, the Affiliated Hospital of Chengdu University, Chengdu 610000, China
| | - Jian-Ming Huang
- Department of Biochemistry & Molecular Biology, Sichuan Cancer Hospital & Institute, Cancer Hospital Affiliated to School of Medicine, University of Electronic Science and Technology of China, Chengdu 610000, China
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Yoshida K, Kajiyama H, Yoshihara M, Ikeda Y, Yoshikawa N, Nishino K, Utsumi F, Niimi K, Suzuki S, Kikkawa F. Does postoperative prophylactic irradiation of para-aortic lymph nodes reduce the risk of recurrence in uterine cervical cancer with positive pelvic lymph nodes? Int J Clin Oncol 2019; 24:567-574. [PMID: 30612268 DOI: 10.1007/s10147-018-1376-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/02/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND In cervical cancer, para-aortic lymph nodes are common sites of metastasis. The purpose of the study was to evaluate the clinical benefits of prophylactic irradiation as postoperative therapy. METHODS A retrospective cohort study was conducted during 2001-2015 at a single institution. Patients with a high risk of para-aortic lymph nodes recurrence were eligible for this study, and we identified patients who had pelvic lymph node metastasis and underwent radical surgery and concurrent chemo-radiotherapy. As a result, 33 and 46 patients were included in the treatment (prophylactic irradiation) and non-treatment groups, respectively. Baseline differences between the two groups were adjusted with the inverse probability of treatment weighting using propensity scores composed of the independent variables including age, stage, tumor size, pathological findings, lymph node status, and pathological subtypes. RESULTS In the 68-month median follow-up period (range 6-178 months), 25 patients experienced recurrence, and 17 patients were dead. After adjustment with the inverse probability of treatment weighting, the recurrence rates tended to decrease in the treatment group, but there was no significant difference between the two groups [treatment vs. non-treatment, 29.4% and 44.3%, respectively; hazard ratio, 0.593 (95% CI 0.320-1.099); P = 0.097]. However, adjusted para-aortic lymph nodes recurrence rates were not significantly different [treatment vs. non-treatment, 7.8% and 11.4%, respectively; odds ratio, 0.660 (95% CI 0.187-2.322); P = 0.558]. Moreover, Kaplan-Meier curves showing post-recurrence survival revealed no significant difference between the two groups (P = 0.141). CONCLUSIONS Prophylactic para-aortic lymph nodes irradiation did not reduce the risk of recurrence.
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Affiliation(s)
- Kosuke Yoshida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Tsuruma-cho 65, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Tsuruma-cho 65, Showa-ku, Nagoya, 466-8550, Japan.
| | - Masato Yoshihara
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Tsuruma-cho 65, Showa-ku, Nagoya, 466-8550, Japan
| | - Yoshiki Ikeda
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Tsuruma-cho 65, Showa-ku, Nagoya, 466-8550, Japan
| | - Nobuhisa Yoshikawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Tsuruma-cho 65, Showa-ku, Nagoya, 466-8550, Japan
| | - Kimihiro Nishino
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Tsuruma-cho 65, Showa-ku, Nagoya, 466-8550, Japan
| | - Fumi Utsumi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Tsuruma-cho 65, Showa-ku, Nagoya, 466-8550, Japan
| | - Kaoru Niimi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Tsuruma-cho 65, Showa-ku, Nagoya, 466-8550, Japan
| | - Shiro Suzuki
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Tsuruma-cho 65, Showa-ku, Nagoya, 466-8550, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Tsuruma-cho 65, Showa-ku, Nagoya, 466-8550, Japan
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Matsuo K, Grubbs BH, Mikami M. Quality and quantity metrics of pelvic lymph node metastasis and risk of para-aortic lymph node metastasis in stage IB-IIB cervical cancer. J Gynecol Oncol 2019; 29:e10. [PMID: 29185268 PMCID: PMC5709520 DOI: 10.3802/jgo.2018.29.e10] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 10/16/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA. .,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Brendan H Grubbs
- Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan.
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The analysis of the long-term outcomes in elderly women treated for locally advanced cervical cancer. J Contemp Brachytherapy 2018; 10:411-417. [PMID: 30479617 PMCID: PMC6251449 DOI: 10.5114/jcb.2018.79334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 10/05/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose Locally advanced cervical cancer (LACC) should be treated with a combination of external irradiation and brachytherapy with concurrent chemotherapy. However, as cervical carcinoma cells can disperse by way of the lymphatic system to either pelvic or para-aortic nodes, planning the extent of radiation requires precise information about the spread of the disease to the lymph nodes, especially to the para-aortic area. Material and methods All of the 75 women included in our study underwent chemoradiotherapy, which started with brachytherapy. Out of them, 54 have undergone radical hysterectomy with lymphadenectomy followed by chemoradiation. We have retrospectively analyzed the 5-year overall survival (OS) rates relative to the lymph node involvement, the type of lymphadenectomy performed (pelvic, para-aortic, or both), the size of the tumor (> or < 4 cm), the histological type, grading, and the age of patients. Results We observed significant differences in the OS rates relative to the age of the patients with LACC. We noted significant differences in the OS rates related to para-aortic lymphadenectomy and presence of lymph node metastases. Conclusions Para-aortic lymphadenectomy seems to have a positive influence on long-term outcomes in the LACC patients, and elderly patients may benefit more from applied therapy.
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Lee J, Lin JB, Chang CL, Sun FJ, Wu MH, Jan YT, Chen YJ. Impact of para-aortic recurrence risk-guided intensity-modulated radiotherapy in locally advanced cervical cancer with positive pelvic lymph nodes. Gynecol Oncol 2018; 148:291-298. [PMID: 29269219 DOI: 10.1016/j.ygyno.2017.12.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/24/2017] [Accepted: 12/03/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES A previous study has suggested the benefit of sub-renal vein radiotherapy (SRVRT) for pelvic lymph node (PLN)-positive cervical cancer. In order to better select patients for SRVRT, this study aimed to evaluate the value of a risk-based radiation field based on PLN location and number in PLN-positive cervical cancer. METHODS We reviewed 198 patients with FIGO stage IB2-IVA cervical cancer, positive PLNs, and negative para-aortic lymph nodes (PALNs) from 2004 to 2015 at two tertiary centers. All patients underwent pelvic radiotherapy (PRT) or SRVRT with IMRT. The SRVRT extended the PRT field cranially to the level of the left renal vein. The prescribed doses were 45-50.4Gy in 1.8Gy per fraction. RESULTS Overall, 118 and 80 patients underwent PRT and SRVRT, respectively. The SRVRT group had more advanced disease based on FIGO stage, common iliac PLNs, and number of PLNs. The median follow-up was 63months (range: 7-151months). PALN failure was experienced by 28 patients (23.7%) in the PRT group and 1 patient (1.3%) in the SRVRT group (p<0.001). Compared with PRT, SRVRT significantly improved 5-year PALN recurrence-free survival (56.8% vs. 100%, p<0.001) and cancer-specific survival (56.5% vs. 93.9%, p<0.001) among patients with common iliac PLNs or ≥3 PLNs. No significant differences were observed in these outcomes among patients with PLNs below the common iliac bifurcation and 1-2 PLNs. The SRVRT did not increase severe toxicities. CONCLUSIONS Risk-based radiation field based on PLN location and number could optimize outcomes for PLN-positive cervical cancer.
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Affiliation(s)
- Jie Lee
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, Taiwan; Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan.
| | - Jhen-Bin Lin
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan
| | - Chih-Long Chang
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Meng-Hao Wu
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, Taiwan
| | - Ya-Ting Jan
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yu-Jen Chen
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, Taiwan.
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Zhu Y, Zhang G, Yang Y, Cui L, Jia S, Shi Y, Song S, Xu S. Perineural invasion in early-stage cervical cancer and its relevance following surgery. Oncol Lett 2018; 15:6555-6561. [PMID: 29755594 DOI: 10.3892/ol.2018.8116] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 04/06/2017] [Indexed: 01/02/2023] Open
Abstract
Perineural invasion (PNI) is the neoplastic invasion of nerves by cancer cells, a process that has attracted attention as a novel prognostic factor for cancer. The present study aimed to investigate the prognostic value of PNI in patients with early-stage cervical cancer (International Federation of Gynecology and Obstetrics stage IA2-IIA). A total of 210 patients who underwent radical hysterectomy and pelvic lymphadenectomy between 2007 and 2012 were included in the current study, of whom 8.57% (18/210) exhibited PNI. Patients with PNI were more likely to exhibit adverse histopathological features, such as increased tumor size, depth of stromal invasion, parametrial invasion, lymphovascular space invasion and lymph nodes metastases (all P<0.05). Patients with PNI exhibited shorter disease-free and overall survival (P=0.002 and P=0.017, respectively). However, PNI was not identified as an independent risk factor for either recurrence or death by multivariate analysis. Furthermore, 88.9% (16/18) of patients with PNI received adjuvant therapy following surgery. PNI was significantly associated with well-established indicators for adjuvant therapy. In conclusion, PNI was associated with multiple high-risk factors and its presence was indicative of a poor outcome in patients with early-stage cervical cancer, which may influence management decisions regarding adjuvant therapy.
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Affiliation(s)
- Yi Zhu
- Department of Gynecological Oncology, Sichuan Cancer Hospital & Institute, Cancer Hospital Affiliated to School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610041, P.R. China.,Department of Ultrasound, Sichuan Cancer Hospital & Institute, Cancer Hospital Affiliated to School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610041, P.R. China
| | - Guonan Zhang
- Department of Gynecological Oncology, Sichuan Cancer Hospital & Institute, Cancer Hospital Affiliated to School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610041, P.R. China.,Graduate School, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China.,Department of Gynecology, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610057, P.R. China
| | - Yan Yang
- Graduate School, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Ling Cui
- Department of Gynecological Oncology, Sichuan Cancer Hospital & Institute, Cancer Hospital Affiliated to School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610041, P.R. China
| | - Shijun Jia
- Department of Pathology, Sichuan Cancer Hospital & Institute, Cancer Hospital Affiliated to School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610041, P.R. China
| | - Yu Shi
- Department of Gynecological Oncology, Sichuan Cancer Hospital & Institute, Cancer Hospital Affiliated to School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610041, P.R. China
| | - Shuiqin Song
- Department of Gynecological Oncology, Sichuan Cancer Hospital & Institute, Cancer Hospital Affiliated to School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610041, P.R. China
| | - Shiqiang Xu
- Department of Gynecological Oncology, Sichuan Cancer Hospital & Institute, Cancer Hospital Affiliated to School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610041, P.R. China
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Completing or Abandoning Radical Hysterectomy in Early-Stage Lymph Node-Positive Cervical Cancer: Impact on Disease-Free Survival and Treatment-Related Toxicity. Int J Gynecol Cancer 2018; 27:1015-1020. [PMID: 28498252 DOI: 10.1097/igc.0000000000000974] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Management regarding completing hysterectomy in case of intraoperative finding of positive lymph nodes in early-stage cervical cancer differs between institutions. The aim of this study was to compare survival and toxicity after completed hysterectomy followed by adjuvant (chemo-)radiotherapy versus abandoned hysterectomy and primary treatment with chemoradiotherapy (CRT). METHODS A retrospective multicenter cohort study was performed. All patients were scheduled for radical hysterectomy with pelvic lymphadenectomy (RHL). In the RHL group, hysterectomy was completed followed by adjuvant (chemo-)radiotherapy. In the second group, hysterectomy was abandoned, and CRT was conducted. Primary outcomes were disease-free survival (DFS) and overall survival. A multivariable analysis on DFS was performed. Toxicity was scored according to the National Cancer Institute CTCAE (Common Terminology Criteria for Adverse Events) v4.03. RESULTS A total of 121 patients were included (RHL, n = 89; CRT, n = 32). There was no difference in overall survival (84% vs 77%). Five-year DFS was in favor of completing RHL (81% vs 67%). Multivariable analysis showed that, corrected for lymph node variables, treatment regimen was not associated with DFS. After RHL, pelvic recurrence rate was significantly lower compared with CRT (2% vs 16%). CTCAE grade 3-4 toxicity rates were higher in the CRT compared with the RHL group (59% vs 30%), mainly because of differences in chemotherapy-related hematologic toxicity. CONCLUSIONS In patients with clinically N0 early-stage cervical cancer with intraoperative detection of positive nodes, completing RHL followed by adjuvant (chemo-)radiotherapy may result in a better pelvic control compared with abandoning hysterectomy and treatment with chemoradiotherapy. However, if corrected for lymph node variables, treatment (RHL or CRT) was not associated with DFS.
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Matsuo K, Shimada M, Saito T, Takehara K, Tokunaga H, Watanabe Y, Todo Y, Morishige KI, Mikami M, Sugiyama T. Risk stratification models for para-aortic lymph node metastasis and recurrence in stage IB-IIB cervical cancer. J Gynecol Oncol 2018; 29:e11. [PMID: 29185269 PMCID: PMC5709521 DOI: 10.3802/jgo.2018.29.e11] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/15/2017] [Accepted: 10/15/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine the surgical-pathological predictors of para-aortic lymph node (PAN) metastasis at radical hysterectomy, and for PAN recurrence among women who did not undergo PAN dissection at radical hysterectomy. METHODS This is a retrospective analysis of a nation-wide cohort study of surgically-treated stage IB-IIB cervical cancer (n=5,620). Multivariate models were used to identify independent surgical-pathological predictors for PAN metastasis/recurrence. RESULTS There were 120 (2.1%) cases of PAN metastasis at surgery with parametrial involvement (adjusted odds ratio [aOR]=1.65), deep stromal invasion (aOR=2.61), ovarian metastasis (aOR=3.10), and pelvic nodal metastasis (single-node aOR=5.39 and multiple-node aOR=33.5, respectively) being independent risk factors (all, p<0.05). Without any risk factors, the incidence of PAN metastasis was 0.9%, while women exhibiting certain risk factor patterns (>20% of the study population) had PAN metastasis incidences of ≥4%. Among 4,663 clinically PAN-negative cases at surgery, PAN recurrence was seen in 195 (4.2%) cases that was significantly higher than histologically PAN-negative cases (2.5%, p=0.046). In clinically PAN-negative cases, parametrial involvement (adjusted hazard ratio [aHR]=1.67), lympho-vascular space invasion (aHR=1.95), ovarian metastasis (aHR=2.60), and pelvic lymph node metastasis (single-node aHR=2.49 and multiple-node aHR=8.11, respectively) were independently associated with increased risk of PAN recurrence (all, p<0.05). Without any risk factors, 5-year PAN recurrence risk was 0.8%; however, women demonstrating certain risk factor patterns (>15% of the clinically PAN-negative population) had 5-year PAN recurrence risks being ≥8%. CONCLUSION Surgical-pathological risk factors proposed in this study will be useful to identify women with increased risk of PAN metastasis/recurrence.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Muneaki Shimada
- Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan.
- Department of Gynecology, Tohoku University Hospital, Miyagi, Japan
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology, School of Medicine, Sapporo Medical University, Hokkaido, Japan
| | - Kazuhiro Takehara
- Department of Gynecologic Oncology, Shikoku Cancer Center, Matsuyama, Japan
| | - Hideki Tokunaga
- Department of Gynecology, Tohoku University Hospital, Miyagi, Japan
| | - Yoh Watanabe
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yukiharu Todo
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Hokkaido, Japan
| | - Ken Ichirou Morishige
- Department of Obstetrics and Gynecology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan
| | - Toru Sugiyama
- Department of Obstetrics and Gynecology, Iwate Medical University, Iwate, Japan
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Lee J, Lin JB, Chang CL, Jan YT, Sun FJ, Wu MH, Chen YJ. Prophylactic lower para-aortic irradiation using intensity-modulated radiotherapy mitigates the risk of para-aortic recurrence in locally advanced cervical cancer: A 10-year institutional experience. Gynecol Oncol 2017; 146:20-26. [PMID: 28457584 DOI: 10.1016/j.ygyno.2017.04.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 04/20/2017] [Accepted: 04/22/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the effects of prophylactic sub-renal vein radiotherapy (SRVRT) using intensity-modulated radiotherapy (IMRT) for cervical cancer. METHODS A total of 206 patients with FIGO stage IB2-IVA cervical cancer and negative para-aortic lymph nodes (PALNs) who underwent pelvic IMRT (PRT) or SRVRT between 2004 and 2013 at our institution were reviewed. SRVRT cranially extended the PRT field for PALNs up to the left renal vein level. The prescribed dose was consistent 50.4Gy in 28 fractions. RESULTS Overall, 110 and 96 patients underwent PRT and SRVRT, respectively. The SRVRT group had more advanced disease based on FIGO stage and positive pelvic lymph nodes (PLNs). The median follow-up time was 60months (range, 7-143). For the total study population, the 5-year PALN recurrence-free survival (PARFS) and overall survival (OS) for PRT vs. SRVRT were 87.6% vs. 97.9% (p=0.03) and 74.5% vs. 87.8% (p=0.04), respectively. In patients with FIGO III-IVA or positive PLNs, the 5-year PARFS and OS for PRT vs. SRVRT were 80.1% vs. 96.4% (p=0.02) and 58.1% vs. 83.5% (p=0.012), respectively. However, there were no significant differences in these outcomes for patients with FIGO IB-IIB and negative PLNs. In a multivariate analysis, only SRVRT was associated with better PARFS (HR, 0.21; 95% CI, 0.06-0.78; p=0.02). The SRVRT did not significantly increase severe late toxicities. CONCLUSION Prophylactic SRVRT using IMRT reduced PALN recurrence with tolerable toxicities, supporting the application of risk-based radiation fields for cervical cancer.
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Affiliation(s)
- Jie Lee
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, Taiwan; Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Jhen-Bin Lin
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan
| | - Chih-Long Chang
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ya-Ting Jan
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Meng-Hao Wu
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, Taiwan.
| | - Yu-Jen Chen
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, Taiwan.
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Robotic Surgery in Patients With Locally Advanced Cervical Cancer After Neoadjuvant Chemotherapy: Survival Outcomes. Int J Gynecol Cancer 2016; 26:521-7. [PMID: 26825842 DOI: 10.1097/igc.0000000000000632] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIM To evaluate the survival outcomes of consecutive patients with locally advanced cervical cancer (LACC) who underwent comprehensive robotic surgery after neoadjuvant chemotherapy (NACT). MATERIALS AND METHODS Since 2009, patients with LACC (FIGO [International Federation of Gynecology and Obstetrics] stages IB2-IIB) were submitted to robotic surgical staging after 3 cycles of NACT. Clinical objective tumor response was assessed according to the Response Evaluation Criteria in Solid Tumors, whereas pathologic responses were defined according to the criteria of the European study SNAP01. Univariable and multivariable analyses were performed to assess potential clinicopathologic prognostic factors affecting progression-free survival and overall survival (OS). RESULTS During the study period, 32 patients meeting the inclusion criteria were managed. The median (range) age and body mass index were 47.3 (8.6-75.5) years and 22.7 (17.5-37.1) kg/m(2), respectively. Overall, 28.0 (range, 12-58) lymph nodes were retrieved. According to the final pathologic examination, 6 (18.8%) women had positive pelvic lymph nodes, whereas 16 (50.0%) patients achieved an optimal pathological response. After a median follow-up of 36.3 (range, 5.2-71.1) months, 6 (18.8%) patients had a recurrence and subsequently died of disease.Positive nodal status was the only independent predictor of both progression-free survival (12.5 [2.3-69.1]; P < 0.0001) and OS (12.0 [2.0-60.4]; P < 0.0001) at multivariable analysis. CONCLUSIONS Nodal status represents the strongest predictor of survival in women with LACC. Similarly, NACT including 3 agents (TIP [paclitaxel 175 mg/m(2) + ifosfamide 5 g/m(2) + cisplatin 75 mg/m(2)] and TEP [paclitaxel 175 mg/m(2) + epirubicin 80 mg/m(2) + cisplatin 75 mg/m(2)] regimens) warranted better OS than those achieved by other schedules.
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CPE overexpression is correlated with pelvic lymph node metastasis and poor prognosis in patients with early-stage cervical cancer. Arch Gynecol Obstet 2015; 294:333-42. [PMID: 26695643 DOI: 10.1007/s00404-015-3985-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/07/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE Elevated carboxypeptidase E (CPE) levels play crucial roles in tumorigenesis and metastasis. This study investigated the expression and clinicopathological significance of CPE in early-stage cervical cancer. METHODS Elevated carboxypeptidase E expression was analyzed using quantitative polymerase chain reaction and western blotting in normal cervical tissue, cervical cancer cell lines, and in cervical cancer tissues and adjacent noncancerous tissues (ANTs) from the same patient. Immunohistochemistry (IHC) was used to examine CPE expression in tissue samples from 112 patients with early-stage cervical cancer (FIGO stages Ia2-IIa2), 60 patients with cervical intraepithelial neoplasia, and 19 patients with normal cervical tissues (NCTs). Associations between CPE expression and prognostic and diagnostic factors were evaluated statistically. RESULTS CPE expression was significantly higher in cervical cancer cell lines and tissues than in normal tissues and ANTs. Semi-quantitative analysis of IHC indicated that CPE gradually increased from CIN I to cervical cancer, but was absent in NCTs. CPE expression was seen in 40.2 % (45/112) of the cervical cancer samples. CPE expression was significantly associated with FIGO stage (P = 0.003), tumor size (P = 0.012), stromal invasion (P < 0.001), lymphovascular space invasion (P = 0.016), parametrial infiltration (P = 0.027), vaginal involvement (P = 0.007), postoperative adjuvant therapy (P = 0.024), recurrence (P < 0.001), survival (P < 0.001), and pelvic lymph node metastasis (PLNM) (P < 0.001), and it was significantly higher in tissues from patients with PLNM than without PLNM. Logistic regression analysis identified high-level CPE expression as an independent risk factor for PLNM (P = 0.001). Patients with higher CPE expression had shorter overall survival duration than patients with lower CPE expression. Univariate and multivariate Cox-regression analyses suggested that high-level CPE expression is an independent prognostic factor for overall survival in early-stage cervical cancer. CONCLUSIONS High-level CPE expression was associated with a poor prognosis in early-stage cervical cancer. CPE may serve as a biomarker for predicting PLNM and survival in these patients.
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Somashekhar SP. Does debulking of enlarged positive lymph nodes improve survival in different gynaecological cancers? Best Pract Res Clin Obstet Gynaecol 2015; 29:870-83. [PMID: 26043964 DOI: 10.1016/j.bpobgyn.2015.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 04/20/2015] [Accepted: 04/28/2015] [Indexed: 11/26/2022]
Abstract
Lymph-node-positive gynaecological cancers remain a pharmacotherapeutic challenge, and patients with lymph-node-positive gynaecological cancers have poor survival. The purpose of this review is to determine whether a survival advantage arises from surgical debulking of enlarged positive lymph nodes in different types of gynaecological cancers. Information from studies published on the survival benefits from debulking lymph nodes in gynaecological cancers was investigated. Pertaining to therapeutic lymphadenectomy, survival benefit can be analysed in two ways, direct survival benefit following therapeutic lymphadenectomy of bulky positive metastatic lymph nodes and indirect survival benefit, which results after a sequela of systematic lymphadenectomy, proper, accurate staging of disease and stage migration and tailor-made adjuvant treatment. The direct hypothesis of therapeutic lymphadenectomy and survival benefit has been prospected in cervical cancers and vulval cancers and in post-chemotherapy residual paraarotic nodal mass in germ cell ovarian cancer. The indirect survival benefit of therapeutic paraarotic lymphadenectomy in high-risk endometrial cancers and advanced epithelial ovarian cancers needs to be tested in randomized controlled trials. More randomized controlled trials are required to investigate this research question. Further, indirect benefit due to tailor-made adjuvant treatment, secondary to accurate staging achieved as a sequela of systematic lymphadenectomy, needs to be analysed in future trials.
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Affiliation(s)
- S P Somashekhar
- Manipal Comprehensive Cancer Center, Manipal Hospital, Bangalore 560017, India.
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Role of a Double Docking to Improve Lymph Node Dissection: When Robotically Assisted Laparoscopy for Para-aortic Lymphadenectomy Is Associated to a Pelvic Procedure. Int J Gynecol Cancer 2015; 25:331-6. [DOI: 10.1097/igc.0000000000000338] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
ObjectiveThe objective of this study was to demonstrate that robotically assisted laparoscopy for aortic lymph node dissection was improved when double docking (DD) of the Da Vinci system is used for combined surgical procedures [defined by the combination of a pelvic procedure and a para-aortic lymphadenectomy (PAL)].MethodsFrom February 2007 to February 2013, 41 patients underwent combined procedures including PAL up to the left renal vein in 2 cancer centers. We used 2 different approaches as follows: a single docking (SD) of the Da Vinci system (transperitoneal PAL and pelvic surgery) during the first period (22 patients) and a DD during the second period (19 patients). We recorded retrospectively the lymph node count (main criteria), operative time, estimated blood loss, hospital stay, and postoperative complications.ResultsWe observed a statistical difference between SD and DD concerning aortic lymph node count (5.86 vs 10.89,P< 0.005). Operative time is longer in the DD group (326.1 vs 239.4 minutes,P< 0.05). No difference was observed concerning estimated blood loss. Hospital stay was longer in the DD group (4.9 vs 3.2 days,P< 0.05). Only 1 conversion to open was described in the SD group.ConclusionsIn our experience of robotically assisted laparoscopy, when PAL is combined to a pelvic procedure, the use of a DD seems to improve aortic lymph node count.Despite a longer operative time compared to SD, DD seems to be a good solution to combine the advantages of robotic assistance to our quality criteria of aortic dissection.SynopsisWe compare 2 techniques to realize robotic assisted para-aortic lymphadenectomy combined with pelvic procedure. Double docking seems to improve histological results compared to single docking.
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32
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Comment on 'Pre-operative nomogram for the identification of lymph node metastasis in early cervical cancer'. Br J Cancer 2014; 111:2370-1. [PMID: 25121954 PMCID: PMC4264425 DOI: 10.1038/bjc.2014.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Narayan K, Mileshkin L, van Dyk S, Bernshaw D, Khaw P, Kondalsamy Chennakesavan S. We should not settle for low-level evidence but should always use the best available evidence. J Gynecol Oncol 2014; 25:349-51. [PMID: 25310034 PMCID: PMC4195307 DOI: 10.3802/jgo.2014.25.4.349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kailash Narayan
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
| | - Linda Mileshkin
- Division of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Sylvia van Dyk
- Division of Radiation Therapy, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - David Bernshaw
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Pearly Khaw
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Srinivas Kondalsamy Chennakesavan
- Rural Clinical School, The University of Queensland School of Medicine and Centre for Rural and Remote Area Health, University of Southern Queensland, Toowoomba, QLD, Australia
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Batista TP, Bezerra ALR, Martins MR, Carneiro VCG. How important is the number of pelvic lymph node retrieved to locorregional staging of cervix cancer? EINSTEIN-SAO PAULO 2014; 11:451-5. [PMID: 24488383 PMCID: PMC4880381 DOI: 10.1590/s1679-45082013000400008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 11/06/2013] [Indexed: 11/26/2022] Open
Abstract
Objective: To explore how important is the number of pelvic lymph nodes dissected for the nodal staging in FIGO IA2-IB2 cervical cancer, submitted to radical surgical treatment. Methods: A cross-sectional study was carried out on patients who underwent Piver class II radical hysterectomy and pelvic lymphadenectomy, in two centers in the state of Pernambuco, from January, 2001 to December, 2008. The analysis of the area under the ROC curve was adopted as a summary-measure of discriminatory power of the number of nodes dissected in predicting the pelvic nodal status. Additionally, we also confirm our findings using logistic regression and the Fisher's exact test. Results: The postoperative pathological study included 662 pelvic lymph nodes dissected (median per-patient=9, q25=6 − q75=13) from 69 patients. The ROC curve analysis revealed AUC=0.642, for the discriminatory value of the number of nodes dissected in predicting the pelvic nodal status. Similar findings were found after categorization using 10 and 15 lymph nodes as cut-offs (AUC=0.605 and 0.526, respectively). Logistic regression revealed odds ratio of 0.912 (95% CI=0.805-1.032; p=0.125) for the predictive value of the number of nodes dissected, and a number of nodes ≥10 or ≥15 lymph nodes was not significantly associated with the nodal status by the Fischer's exact test (p=0.224 and p=0.699, respectively). Conclusion: The number of pelvic lymph nodes dissected did not correlate with pelvic lymph node metastatic involvement. This study suggests that dissection of a greater number of lymph nodes does not increase locoregional nodal staging in cervical cancer.
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Abstract
We report a case of a patient with presumed stage IB1 squamous cell carcinoma of the cervix in which FDG PET/CT scan revealed 1 hypermetabolic left iliac node suggestive to be malignant. Lymphoscintigraphy and SPECT/CT studies previous to sentinel node (SLN) biopsy revealed unilateral drainage in the right pelvis. Intraoperative pathological assessment of the SLN showed no tumoral involvement, and the hypermetabolic node revealed macrometastasis. Tumor node invasion can lead to a lymphatic blockage and become false-negative for SLN technique. Although FDG PET/CT has lower sensitivity than surgical staging, this case shows its value as a preoperative imaging technique.
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Narayan K, van Dyk S, Bernshaw D, Khaw P, Mileshkin L, Kondalsamy-Chennakesavan S. Ultrasound guided conformal brachytherapy of cervix cancer: survival, patterns of failure, and late complications. J Gynecol Oncol 2014; 25:206-13. [PMID: 25045433 PMCID: PMC4102739 DOI: 10.3802/jgo.2014.25.3.206] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 05/13/2014] [Accepted: 05/13/2014] [Indexed: 12/04/2022] Open
Abstract
Objective The aim of this study was to report on the long-term results of transabdominal ultrasound guided conformal brachytherapy in patients with cervical cancer with respect to patterns of failures, treatment related toxicities and survival. Methods Three hundred and nine patients with cervical cancer who presented to Institute between January 1999 and December 2008 were staged with magnetic resonance imaging and positron emission tomography and treated with external beam radiotherapy and high dose rate conformal image guided brachytherapy with curative intent. Follow-up data relating to sites of failure and toxicity was recorded prospectively. Results Two hundred and ninety-two patients were available for analyses. The median (interquantile range) follow-up time was 4.1 years (range, 2.4 to 6.1 years). Five-year failure free survival and overall survival (OS) were 66% and 65%, respectively. Primary, pelvic, para-aortic, and distant failure were observed in 12.5%, 16.4%, 22%, and 23% of patients, respectively. In multivariate analysis, tumor volume and nodal disease related to survival, whereas local disease control and point A dose did not. Conclusion Ultrasound guided conformal brachytherapy of cervix cancer has led to optimal local control and OS. The Melbourne protocol compares favorably to the more technically elaborate and expensive GEC-ESTRO recommendations. The Melbourne protocol's technical simplicity with real-time imaging and treatment planning makes this a method of choice for treating patients with cervical cancer.
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Affiliation(s)
- Kailash Narayan
- Peter MacCallum Cancer Centre and University of Melbourne, East Melbourne, VIC, Australia
| | - Sylvia van Dyk
- Radiation Therapy Services, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
| | - David Bernshaw
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
| | - Pearly Khaw
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
| | - Linda Mileshkin
- Division of Medical Oncology, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
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Can Pelvic Lymphadenectomy be Omitted in Stage IA2 to IIB Uterine Cervical Cancer? Int J Gynecol Cancer 2014; 24:1072-6. [DOI: 10.1097/igc.0000000000000163] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectivesThe aims of this study were to predict pelvic lymph node metastasis in uterine cervical cancer before surgery and to evaluate the potential efficacy of omitting pelvic lymphadenectomy.Materials and MethodsA total of 163 patients with invasive uterine cervical cancer in FIGO stage IA2 to IIB, all of whom underwent primary radical hysterectomy with pelvic lymphadenectomy, participated in this study.ResultsThe incidences of pelvic lymph node metastasis in stage IA2, stage IB1, stage IB2, stage IIA, and stage IIB cervical cancer were 0% (0/12), 17% (13/76), 22% (6/27), 33% (8/24), and 63% (15/24), respectively. A significant difference was observed in overall survival with nodal metastasis status (P< 0.0001). Univariate analysis revealed that parametrial invasion (P< 0.0001), tumor markers (P= 0.0006), tumor size greater than 2 cm (P< 0.0001), tumor size less than 3 cm (P= 0.0009), and tumor size greater than 4 cm (P= 0.0024) were correlated with pelvic lymph node metastasis. However, multivariate analysis revealed that parametrial invasion (P= 0.01; odds ratio, 3.37; 95% confidence interval, 1.31–9.0) and tumor size greater than 2 cm (P= 0.005; odds ratio, 4.93; 95% confidence interval, 1.54–22.01) were independently associated with nodal metastasis.ConclusionsPelvic lymphadenectomy may be avoided in patients with negative parametrial invasion and a tumor size less than 2 cm, thereby minimizing postoperative complications.
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Laparoscopic lymphadenectomy in advanced cervical cancer: prognostic and therapeutic value. Int J Gynecol Cancer 2014; 23:1675-83. [PMID: 24172103 DOI: 10.1097/igc.0000000000000000] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Clinical benefit of surgical staging in locally advanced cervical cancer has not yet been proved. The goal of this study was to analyze the prognostic and therapeutic value of laparoscopic para-aortic lymphadenectomy with selective excision of suspicious pelvic nodes in patients with locally advanced cervical cancer. METHODS This is a retrospective study including 109 women treated in a single institution from 2000 to 2009. The International Federation of Gynecology and Obstetrics stage was IB2 in 12 women, IIB in 58 women, and IIIB in 39 women. None had suspicious para-aortic nodes by presurgical imaging evaluation. All patients underwent extraperitoneal para-aortic laparoscopic lymphadenectomy with selective excision of enlarged pelvic nodes and received pelvic radiotherapy with concomitant chemotherapy. Extended lumboaortic radiation therapy was added to patients with metastatic para-aortic nodes. The mean ± SD follow-up time was 43.1 ± 33.7 months. RESULTS Metastatic lymph nodes were identified in 23 (21.1%) of 109 patients in the para-aortic area and in 24 (53.3%) of 45 patients who underwent selective excision of pelvic nodes. Patients with nodal metastases had increased risk of mortality than those with negative nodes independently of the location (pelvic and/or para-aortic) of the metastases (hazard ratio, 4.07; 95% confidence interval, 1.36-12.16 for patients with pelvic metastases [P = 0.012]; and 3.73; 95% confidence interval, 1.38-10.09 for patients with para-aortic metastases [P = 0.010]). In the subset of women with para-aortic metastases treated by extended lumboaortic radiation therapy, neither the number of lymph nodes removed nor the number of positive nodes were associated with survival (P = 0.556 and P = 0.195, respectively). CONCLUSION Para-aortic and pelvic lymphadenectomy provides valuable information about mortality risk in patients with locally advanced cervical cancer.
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Vizza E, Corrado G, Zanagnolo V, Tomaselli T, Cutillo G, Mancini E, Maggioni A. Neoadjuvant chemotherapy followed by robotic radical hysterectomy in locally advanced cervical cancer: A multi-institution study. Gynecol Oncol 2014; 133:180-5. [DOI: 10.1016/j.ygyno.2014.02.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 02/18/2014] [Accepted: 02/23/2014] [Indexed: 11/16/2022]
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Preoperative nomogram for the identification of lymph node metastasis in early cervical cancer. Br J Cancer 2013; 110:34-41. [PMID: 24231954 PMCID: PMC3887306 DOI: 10.1038/bjc.2013.718] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 10/16/2013] [Accepted: 10/21/2013] [Indexed: 01/11/2023] Open
Abstract
Background: The objective of this study is to construct a preoperative nomogram predicting lymph node metastasis (LNM) in early-cervical cancer patients. Methods: Between 2009 and 2012, 493 early-cervical cancer patients received hysterectomy and pelvic/para-aortic lymphadenectomy. Patients who were diagnosed during 2009–2010 were assigned to a model-development cohort (n=304) and the others were assigned to a validation cohort (n=189). A multivariate logistic model was created from preoperative clinicopathologic data, from which a nomogram was developed and validated. A predicted probability of LNM<5% was defined as low risk. Results: Age, tumour size assessed by magnetic resonance imaging, and LNM assessed by positron emission tomography/computed tomography were independent predictors of nodal metastasis. The nomogram incorporating these three predictors demonstrated good discrimination and calibration (concordance index=0.878; 95% confidence interval (CI), 0.833−0.917). In the validation cohort, the discrimination accuracy was 0.825 (95% CI, 0.736−0.895). In the model-development cohort, 34% of them were classified as low risk and negative predictive value (NPV) was 99.0%. In the validation cohort, 38% were identified as low risk and NPV was 95.8%. Integrating the model-development and validation cohorts, negative likelihood ratio was 0.094 (95% CI, 0.036−0.248). Conclusion: A robust nomogram predicting LNM in early cervical cancer was developed. This model may improve clinical trial design and help physicians to decide whether lymphadenectomy should be performed.
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The equivalent dose contribution from high-dose-rate brachytherapy to positive pelvic lymph nodes in locally advanced cervical cancer. Brachytherapy 2013; 12:555-9. [DOI: 10.1016/j.brachy.2013.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 05/29/2013] [Accepted: 06/07/2013] [Indexed: 11/23/2022]
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Kuji S, Hirashima Y, Komeda S, Tanaka A, Abe M, Takahashi N, Takekuma M, Asakura H, Harada H, Nishimura T. Feasibility of extended-field irradiation and intracavitary brachytherapy combined with weekly cisplatin chemosensitization for IB2–IIIB cervical cancer with positive paraaortic or high common iliac lymph nodes: a retrospective review. Int J Clin Oncol 2013; 19:341-7. [DOI: 10.1007/s10147-013-0551-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 03/12/2013] [Indexed: 10/27/2022]
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Gouy S, Morice P, Narducci F, Uzan C, Gilmore J, Kolesnikov-Gauthier H, Querleu D, Haie-Meder C, Leblanc E. Nodal-staging surgery for locally advanced cervical cancer in the era of PET. Lancet Oncol 2012; 13:e212-20. [PMID: 22554549 DOI: 10.1016/s1470-2045(12)70011-6] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Chemoradiation therapy is deemed the standard treatment by many North American and European teams for treatment of locally advanced cervical cancer. The prevalence of para-aortic nodal metastasis in these tumours is 10-25%. PET (with or without CT) is the most accurate imaging modality to assess extrapelvic disease in such tumours. The true-positive rate of PET is high, suggesting that surgical staging is not necessary if uptake takes place in the para-aortic region. Nevertheless, false-negative results (in the para-aortic region) have been recorded in 12% of patients, rising to 22% in those with uptake during PET of the pelvic nodes. In such situations, laparoscopic surgical para-aortic staging still has an important role for detection of patients with occult para-aortic spread misdiagnosed on PET or PET-CT, allowing optimisation of treatment (extension of radiation therapy fields to include the para-aortic area). Complications of the laparoscopic procedure were noted in 0-7% of patients. Survival of individuals (missed by PET) with para-aortic nodal metastasis of 5 mm or less (and managed by extended field chemoradiation therapy) seems to be similar to survival of those without para-aortic spread, suggesting a positive therapeutic effect of the addition of staging surgery. Nevertheless, the effect on survival of potential delay of chemoradiation owing to use of PET and staging surgery, and acute and late complications of surgery followed by chemoradiation therapy (particularly in case of extended field chemoradiation to para-aortic area), need to be studied.
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Affiliation(s)
- Sebastien Gouy
- Department of Gynaecological Surgery, Institut Gustave Roussy, Villejuif, France
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OULDAMER LOBNA, FICHET-DJAVADIAN SARA, MARRET HENRI, BARILLOT ISABELLE, BODY GILLES. Upper margin of para-aortic lymphadenectomy in cervical cancer. Acta Obstet Gynecol Scand 2012; 91:893-900. [DOI: 10.1111/j.1600-0412.2012.01443.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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[Left renal vessels as an upper margin of para-aortic lymphadenectomy in cervical cancer: because we could or because we should?]. ACTA ACUST UNITED AC 2012; 40:69-70. [PMID: 22266394 DOI: 10.1016/j.gyobfe.2011.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kato H, Todo Y, Suzuki Y, Ohba Y, Minobe SI, Okamoto K, Yamashiro K, Sakuragi N. Re-consideration of lymphadenectomy for stage Ib1 cervical cancer. J Obstet Gynaecol Res 2012; 38:420-6. [DOI: 10.1111/j.1447-0756.2011.01727.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Intra-operative detection of nodal metastasis in early stage cervical cancer: A survey of the practice patterns of SGO members. Gynecol Oncol 2011; 121:143-7. [DOI: 10.1016/j.ygyno.2010.12.337] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 12/13/2010] [Accepted: 12/15/2010] [Indexed: 11/22/2022]
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Place de la chirurgie avant et après radiochimiothérapie des cancers du col localement évolués : à propos de 102 cas. ACTA ACUST UNITED AC 2011; 40:11-21. [DOI: 10.1016/j.jgyn.2010.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Revised: 10/10/2010] [Accepted: 10/18/2010] [Indexed: 11/30/2022]
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Fagotti A, Gagliardi ML, Moruzzi C, Carone V, Scambia G, Fanfani F. Excisional cone as fertility-sparing treatment in early-stage cervical cancer. Fertil Steril 2010; 95:1109-12. [PMID: 21122837 DOI: 10.1016/j.fertnstert.2010.11.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 10/16/2010] [Accepted: 11/03/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe a case series of early-stage cervical cancer patients treated with excisional cone instead of radical trachelectomy as fertility-sparing surgery. DESIGN Prospective study. SETTING University hospital. PATIENT(S) Early-stage cervical cancer (International Federation of Gynecology and Obstetrics stage IA2-IB1), age ≤ 45 years, tumor ≤ 20 mm. INTERVENTION(S) Cold-knife conization and laparoscopic pelvic lymphadenectomy. MAIN OUTCOME MEASURE(S) Recurrence and pregnancy rate. RESULT(S) There were 17 patients: 4 (23.5%) IA2, 13 (76.5%) IB1; 12 (70.5%) squamous cell carcinoma, 4 (23.5%) adenocarcinoma, and 1 (6%) glassy cell tumor. Four cases (23.5%) involved lymphovascular space invasion. The median number of lymph nodes removed was 18 (range 13-51). None of the patients received neoadjuvant chemotherapy, and two patients (12%) received three courses of adjuvant chemotherapy. No recurrences were observed after a median follow-up of 16 months (range 8-101 months). Two of five patients (40%) attempting to conceive had a spontaneous pregnancy and delivery. CONCLUSION(S) In selected and informed patients, conization and laparoscopic pelvic lymphadenectomy seems to be feasible as a fertility-sparing surgical approach.
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Affiliation(s)
- Anna Fagotti
- Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
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Morbidité de la chirurgie de clôture après radio-chimiothérapie chez des patientes atteintes d’un cancer du col de stade avancé. ACTA ACUST UNITED AC 2010; 39:624-31. [DOI: 10.1016/j.jgyn.2010.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Revised: 09/16/2010] [Accepted: 09/21/2010] [Indexed: 11/17/2022]
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