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Restaino S, Pellecchia G, Arcieri M, Bogani G, Taliento C, Greco P, Driul L, Chiantera V, Ercoli A, Fanfani F, Fagotti A, Ciavattini A, Scambia G, Vizzielli G. Management for Cervical Cancer Patients: A Comparison of the Guidelines from the International Scientific Societies (ESGO-NCCN-ASCO-AIOM-FIGO-BGCS-SEOM-ESMO-JSGO). Cancers (Basel) 2024; 16:2541. [PMID: 39061181 PMCID: PMC11274772 DOI: 10.3390/cancers16142541] [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: 06/26/2024] [Revised: 07/11/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Cervical cancer continues to have a significant incidence, despite global efforts in HPV vaccination campaigns. Managing this condition involves a diverse team of healthcare professionals. Research in this field is undergoing a period of great revolution in multiple areas, and international guidelines will soon have to adapt to new scientific evidence. This could be true mainly in locally advanced stages, and it could also be true for minimal invasive surgery. This paper aims to summarize and compare the most recent recommendations published by international gynecological oncological societies for patients with cervical cancer. From their comparison, common aspects and disagreements emerged, especially in the diagnostic pathway and follow-up strategies. Several issues that remain to be debated in the literature were addressed and compared, highlighting similarities and differences, from the role of the sentinel lymph node in early stages to that of the adjuvant hysterectomy in locally advanced tumors. On the surgical side, for this last subset of patients, currently, a laparotomic approach is recommended. At the same time, the advent of immunotherapy has just opened up new and promising scenarios in systemic treatment for locally advanced cervical cancer, and international guidelines will soon introduce it into their algorithms.
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Affiliation(s)
- Stefano Restaino
- Clinic of Obstetrics and Gynecology, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (S.R.); (G.P.); (L.D.); (G.V.)
- PhD School in Biomedical Sciences, Gender Medicine, Child and Women Health, University of Sassari, 07100 Sassari, Italy
| | - Giulia Pellecchia
- Clinic of Obstetrics and Gynecology, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (S.R.); (G.P.); (L.D.); (G.V.)
- Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Martina Arcieri
- Clinic of Obstetrics and Gynecology, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (S.R.); (G.P.); (L.D.); (G.V.)
| | - Giorgio Bogani
- Gynaecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy;
| | - Cristina Taliento
- Department of Medical Sciences, Obstetrics and Gynecology Unit, University of Ferrara, 44121 Ferrara, Italy; (C.T.); (P.G.)
- Department of Development and Regeneration, Woman and Child, KU Leuven, 3000 Leuven, Belgium
| | - Pantaleo Greco
- Department of Medical Sciences, Obstetrics and Gynecology Unit, University of Ferrara, 44121 Ferrara, Italy; (C.T.); (P.G.)
| | - Lorenza Driul
- Clinic of Obstetrics and Gynecology, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (S.R.); (G.P.); (L.D.); (G.V.)
- Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy;
- Unit of Gynecologic Oncology, National Cancer Institute, IRCCS, Fondazione “G. Pascale”, 80131 Naples, Italy
| | - Alfredo Ercoli
- Department of Human Pathology in Adult and Childhood “G. Barresi”, University of Messina, 98122 Messina, Italy;
| | - Francesco Fanfani
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.F.); (A.F.); (G.S.)
| | - Anna Fagotti
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.F.); (A.F.); (G.S.)
| | - Andrea Ciavattini
- Woman’s Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60121 Ancona, Italy;
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.F.); (A.F.); (G.S.)
| | - Giuseppe Vizzielli
- Clinic of Obstetrics and Gynecology, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (S.R.); (G.P.); (L.D.); (G.V.)
- Department of Medicine, University of Udine, 33100 Udine, Italy
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Hong SS, Li Y, Lin YY, Wu SG, Chen LY, Zhou J. Disparities in Survival Outcomes Between Locally Advanced Cervical Squamous Cell Carcinoma and Adenocarcinoma Treated with Chemoradiotherapy. Int J Womens Health 2024; 16:401-410. [PMID: 38463686 PMCID: PMC10924845 DOI: 10.2147/ijwh.s450457] [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: 11/29/2023] [Accepted: 02/25/2024] [Indexed: 03/12/2024] Open
Abstract
Purpose To determine the disparities in survival outcomes between stage IIB-IVA cervical squamous cell carcinoma (SCC) and adenocarcinoma (AC) treated with chemoradiotherapy. Methods Patients diagnosed between 2004 and 2015 were retrospectively included from the Surveillance, Epidemiology, and End Results databases. Propensity score matching (PSM) was used in this study. The primary endpoints were cervical cancer-specific survival (CCSS) and overall survival (OS). Results A total of 2752 patients were identified, including 87.5% (n=2408) were SCC and 12.5% (n=344) were AC. Patients with AC had inferior 5-year CCSS (67.5% vs 54.8%, P<0.001) and OS (58.4% vs 47.2%, P<0.001) compared to those with the SCC subtype. The hazard curve of cervical cancer-related death in AC peaked at 2 years (19%) and still small peaks in the 7 and 11 years of follow-up. Regarding SCC, cervical cancer-related deaths peaked at 2 years (15%) and the hazard rate was 2.0% during the six years of follow-up. The multivariate Cox regression analyses indicated that histology was an independent prognostic factor associated with survival outcomes. Patients with AC had significantly poor CCSS (P<0.001) and OS (P<0.001). Similar results were found after PSM. Conclusion Our study demonstrates a significantly better prognosis for cervical SCC patients compared to those with cervical AC undergoing chemoradiotherapy. These results highlight the importance of histological subtyping in predicting treatment outcomes and tailoring therapeutic strategies.
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Affiliation(s)
- Shan-Shan Hong
- Department of Obstetrics and Gynecology, Quanzhou Women's and Children's Hospital, Quanzhou, 362000, People's Republic of China
| | - Yang Li
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, 350122, People's Republic of China
| | - Yu-Yi Lin
- Department of Radiation Oncology, the Second Affiliated Hospital of Xiamen Medical College, Xiamen, 361021, People's Republic of China
| | - San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361003, People's Republic of China
| | - Li-Ying Chen
- Department of Obstetrics and Gynecology, Quanzhou Women's and Children's Hospital, Quanzhou, 362000, People's Republic of China
| | - Juan Zhou
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361003, People's Republic of China
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Santero M, de Mas J, Rifà B, Clavero I, Rexach I, Bonfill Cosp X. Assessing the methodological strengths and limitations of the Spanish Society of Medical Oncology (SEOM) guidelines: a critical appraisal using AGREE II and AGREE-REX tool. Clin Transl Oncol 2024; 26:85-97. [PMID: 37368198 PMCID: PMC10761528 DOI: 10.1007/s12094-023-03219-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/16/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND The Spanish Society of Medical Oncology (SEOM) has provided open-access guidelines for cancer since 2014. However, no independent assessment of their quality has been conducted to date. This study aimed to critically evaluate the quality of SEOM guidelines on cancer treatment. METHODS Appraisal of Guidelines for Research and Evaluation II (AGREE II) and AGREE-REX tool was used to evaluate the qualities of the guidelines. RESULTS We assessed 33 guidelines, with 84.8% rated as "high quality". The highest median standardized scores (96.3) were observed in the domain "clarity of presentation", whereas "applicability" was distinctively low (31.4), with only one guideline scoring above 60%. SEOM guidelines did not include the views and preferences of the target population, nor did specify updating methods. CONCLUSIONS Although developed with acceptable methodological rigor, SEOM guidelines could be improved in the future, particularly in terms of clinical applicability and patient perspectives.
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Affiliation(s)
| | - Júlia de Mas
- Universitat Autònoma Barcelona (UAB), Barcelona, Spain
| | - Berta Rifà
- Universitat Autònoma Barcelona (UAB), Barcelona, Spain
| | - Inés Clavero
- Universitat Autònoma Barcelona (UAB), Barcelona, Spain
| | - Irene Rexach
- Universitat Autònoma Barcelona (UAB), Barcelona, Spain
| | - Xavier Bonfill Cosp
- Universitat Autònoma Barcelona (UAB), Barcelona, Spain
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Cibula D, Akilli H, Jarkovsky J, van Lonkhuijzen L, Scambia G, Meydanli MM, Ortiz DI, Falconer H, Abu-Rustum NR, Odetto D, Klát J, Dos Reis R, Zapardiel I, Di Martino G, Presl J, Laky R, López A, Weinberger V, Obermair A, Pareja R, Poncová R, Mom C, Bizzarri N, Borčinová M, Aslan K, Salcedo Hernandez RA, Fons G, Benešová K, Dostálek L, Ayhan A. Role of adjuvant therapy in intermediate-risk cervical cancer patients - Subanalyses of the SCCAN study. Gynecol Oncol 2023; 170:195-202. [PMID: 36706646 PMCID: PMC10281542 DOI: 10.1016/j.ygyno.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The "intermediate-risk" (IR) group of early-stage cervical cancer patients is characterized by negative pelvic lymph nodes and a combination of tumor-related prognostic risk factors such as tumor size ≥2 cm, lymphovascular space invasion (LVSI), and deep stromal invasion. However, the role of adjuvant treatment in these patients remains controversial. We investigated whether adjuvant (chemo)radiation is associated with a survival benefit after radical surgery in patients with IR cervical cancer. METHODS We analyzed data from patients with IR cervical cancer (tumor size 2-4 cm plus LVSI OR tumor size >4 cm; N0; no parametrial invasion; clear surgical margins) who underwent primary curative-intent surgery between 2007 and 2016 and were retrospectively registered in the international multicenter Surveillance in Cervical CANcer (SCCAN) study. RESULTS Of 692 analyzed patients, 274 (39.6%) received no adjuvant treatment (AT-) and 418 (60.4%) received radiotherapy or chemoradiotherapy (AT+). The 5-year disease-free survival (83.2% and 80.3%; PDFS = 0.365) and overall survival (88.7% and 89.0%; POS = 0.281) were not significantly different between the AT- and AT+ groups, respectively. Adjuvant (chemo)radiotherapy was not associated with a survival benefit after adjusting for confounding factors by case-control propensity score matching or in subgroup analyses of patients with tumor size ≥4 cm and <4 cm. In univariable analysis, adjuvant (chemo)radiotherapy was not identified as a prognostic factor in any of the subgroups (full cohort: PDFS = 0.365; POS = 0.282). CONCLUSION Among patients with IR early-stage cervical cancer, radical surgery alone achieved equal disease-free and overall survival rates to those achieved by combining radical surgery with adjuvant (chemo)radiotherapy.
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Affiliation(s)
- David Cibula
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital (Central and Eastern European Gynecologic Oncology Group, CEEGOG), Prague, Czech Republic.
| | - Huseyin Akilli
- Baskent University School of Medicine Department of Gynecology and Obstetrics Division of Gynecologic Oncology, Ankara, Turkey
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Luc van Lonkhuijzen
- Amsterdam University Medical Centers, Center for Gynaecologic Oncology Amsterdam, Amsterdam, the Netherlands
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Mehmet Mutlu Meydanli
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - David Isla Ortiz
- Gynecology Oncology Center, National Institute of Cancerology Mexico, Mexico
| | - Henrik Falconer
- Department of Pelvic Cancer, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Diego Odetto
- Department of Gynecologic Oncology, Hospital Italiano de Buenos Aires, CABA, Buenos Aires, Argentina
| | - Jaroslav Klát
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital and University of Ostrava, Ostrava, Czech Republic
| | - Ricardo Dos Reis
- Department of Gynecological Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | - Giampaolo Di Martino
- Gynaecologic Surgical Unit, ASST-Monza, San Gerardo Hospital,University of Milano-Bicocca, Monza, Italy
| | - Jiri Presl
- Department of Gynaecology and Obstetrics, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Rene Laky
- Gynecology, Medical University of Graz, Graz, Austria
| | - Aldo López
- Department of Gynecological Surgery, National Institute of Neoplastic Diseases, Lima, Peru
| | - Vit Weinberger
- University Hospital Brno, Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Andreas Obermair
- Queensland Centre for Gynaecological Cancer; The University of Queensland, Australia
| | - Rene Pareja
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Renata Poncová
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital (Central and Eastern European Gynecologic Oncology Group, CEEGOG), Prague, Czech Republic
| | - Constantijne Mom
- Amsterdam University Medical Centers, Center for Gynaecologic Oncology Amsterdam, Amsterdam, the Netherlands
| | - Nicolò Bizzarri
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Martina Borčinová
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital (Central and Eastern European Gynecologic Oncology Group, CEEGOG), Prague, Czech Republic
| | - Koray Aslan
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health and Research Hospital, University of Health Sciences, Ankara, Turkey
| | | | - Guus Fons
- Amsterdam University Medical Centers, Center for Gynaecologic Oncology Amsterdam, Amsterdam, the Netherlands
| | - Klára Benešová
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lukáš Dostálek
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital (Central and Eastern European Gynecologic Oncology Group, CEEGOG), Prague, Czech Republic
| | - Ali Ayhan
- Baskent University School of Medicine Department of Gynecology and Obstetrics Division of Gynecologic Oncology, Ankara, Turkey
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Pujade-Lauraine E, Tan DSP, Leary A, Mirza MR, Enomoto T, Takyar J, Nunes AT, Chagüi JDH, Paskow MJ, Monk BJ. Comparison of global treatment guidelines for locally advanced cervical cancer to optimize best care practices: A systematic and scoping review. Gynecol Oncol 2022; 167:360-372. [PMID: 36096973 DOI: 10.1016/j.ygyno.2022.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Survival outcomes for cervical cancer differ between countries and world regions. Locally advanced cervical cancer (LACC) is associated with poorer outcomes than early-stage disease. Country-specific variations in diagnostic and treatment recommendations might contribute to differences in LACC outcomes among countries. OBJECTIVE We compared international and country-specific guidelines for LACC diagnostic imaging and treatment recommendations. METHODS A systematic literature review and targeted search were used to identify cervical cancer treatment guidelines published between January 1999-August 2021. Guidelines were identified via literature databases, health technology assessment databases, disease-specific websites, and health organization websites. The targeted search included guidelines from countries in regions known to have high cervical cancer prevalence or mortality. Non-English guidelines were translated by native speakers or online translation services. RESULTS Forty-six guidelines from 31 countries, regions, and international organizations were compared (41/46 using staging criteria, 27 of which used 2009 FIGO). Most guidelines recommended imaging tests for diagnosis and staging. Chest X-ray, intravenous pyelogram, CT, and MRI were commonly recommended for diagnosis and staging while MRI and PET-CT were recommended for the assessment of lymph node status and distant metastases, with a preference for PET-CT over MRI. There was global consensus for cisplatin-based concurrent chemoradiation as primary treatment for stages IIB to IVA, with few exceptions. Treatment recommendations for stages IB2 to IIA2 varied. Most guidelines agreed on adjuvant concurrent chemoradiation after radical hysterectomy when there is a high recurrence risk, and adjuvant radiotherapy when there is an intermediate recurrence risk. Recommendations for other adjuvant and neoadjuvant therapies varied among the guidelines. CONCLUSIONS Differences among treatment guidelines by LACC stage might be influenced by staging criteria used, resource availability, and prevention program effectiveness. Addressing these areas may unify guidelines and improve global outcomes. Review and update of guidelines will be important as novel LACC therapies become available.
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Affiliation(s)
- Eric Pujade-Lauraine
- ARCAGY-GINECO, Medical Oncology, 1, place du Parvis-Notre-Dame, 75181 Paris, France.
| | - David S P Tan
- Department of Haematology-Oncology, National University Cancer Institute Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, Cancer Science Institute of Singapore, National University of Singapore, Singapore 119074, Singapore.
| | - Alexandra Leary
- Gustave Roussy Cancer Center, INSERM U981, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Gynecological Unit, 114 Rue Edouard Vaillant, 94805 Villejuif, France.
| | - Mansoor Raza Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 København, Denmark.
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi Campus 757 Ichibancho, Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan.
| | - Jitender Takyar
- Parexel International, Evidence Evaluation HEOR, DLF Building, Tower F, 2nd Floor, Chandigarh Technology Park, Chandigarh 160101, India.
| | - Ana Tablante Nunes
- Merck, 126 East Lincoln Avenue, P.O. Box 2000, Rahway, NJ 07065, United States of America..
| | | | - Michael J Paskow
- AstraZeneca, Global Medical Affairs, 1 Medimmune Way, Gaithersburg, MD 20878, United States of America..
| | - Bradley J Monk
- HonorHealth Research Institute, University of Arizona College of Medicine, Creighton University School, 350 West Thomas Road, Phoenix, AZ 85013, United States of America..
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Cibula D, Borčinová M, Kocian R, Feltl D, Argalacsova S, Dvorak P, Fischerová D, Dundr P, Jarkovsky J, Höschlová E, Slama J, Scambia G. CERVANTES: an international randomized trial of radical surgery followed by adjuvant (chemo) radiation versus no further treatment in patients with early-stage, intermediate-risk cervical cancer (CEEGOG-CX-05; ENGOT-CX16). Int J Gynecol Cancer 2022; 32:ijgc-2022-003918. [PMID: 36100282 DOI: 10.1136/ijgc-2022-003918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The role of adjuvant treatment in the intermediate-risk group of patients with early-stage cervical cancer is controversial and is supported by a single randomized Gynecologic Oncology Group (GOG) 92 study performed more than 20 years ago. Recent retrospective studies have shown excellent local control in this group of patients after radical surgery with no additional adjuvant treatment. PRIMARY OBJECTIVE To evaluate if adjuvant (chemo)radiation is associated with a survival benefit after radical surgery in patients with intermediate-risk cervical cancer. STUDY HYPOTHESIS Radical surgery alone is non-inferior to the combined treatment of radical surgery followed by adjuvant (chemo)radiation in disease-free survival in patients with intermediate-risk cervical cancer. TRIAL DESIGN This is a phase III, international, multicenter, randomized, non-inferiority trial in which patients with intermediate-risk cervical cancer will be randomized 1:1 into arm A, with no additional treatment after radical surgery, and arm B, receiving adjuvant external beam radiotherapy±brachytherapy ± concomitant chemotherapy. Patient data will be collected over 3 years post-randomization of the last enrolled patient for primary endpoint analysis or for 6 years for the overall survival analysis. MAJOR INCLUSION/EXCLUSION CRITERIA Patients with intermediate-risk early-stage cervical cancer (IB1-IIA), defined as lymph node-negative patients with a combination of negative prognostic factors (tumor size >4 cm; tumor size >2 cm and lymphovascular space invasion; deep stromal invasion >2/3; or tumor-free distance <3 mm) with squamous cell carcinoma or human papillomavirus (HPV)-related adenocarcinoma, are eligible for the trial. PRIMARY ENDPOINT Disease-free survival defined as time from randomization to recurrence diagnosis. SAMPLE SIZE 514 patients from up to 90 sites will be randomized. ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS It is estimated that the accrual will be completed by 2027 (with 3 additional years of follow-up) and primary endpoint results will be published by 2031. Estimated trial completion is by 2034. TRIAL REGISTRATION NCT04989647.
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Affiliation(s)
- David Cibula
- Gynaecologic Oncology Centre, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
- Central and Eastern European Gynecologic Oncology Group (CEEGOG), Prague, Czech Republic
| | - Martina Borčinová
- Gynaecologic Oncology Centre, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
- Central and Eastern European Gynecologic Oncology Group (CEEGOG), Prague, Czech Republic
| | - Roman Kocian
- Gynaecologic Oncology Centre, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
- Central and Eastern European Gynecologic Oncology Group (CEEGOG), Prague, Czech Republic
| | - David Feltl
- Department of Oncology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Sona Argalacsova
- Department of Oncology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Pavel Dvorak
- Department of Oncology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Daniela Fischerová
- Central and Eastern European Gynecologic Oncology Group (CEEGOG), Prague, Czech Republic
- Department of Oncology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Pavel Dundr
- Central and Eastern European Gynecologic Oncology Group (CEEGOG), Prague, Czech Republic
- Department of Pathology, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Eva Höschlová
- Department of Psychology, Faculty of Arts, Charles University in Prague, Prague, Czech Republic
| | - Jiri Slama
- Gynaecologic Oncology Centre, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
- Central and Eastern European Gynecologic Oncology Group (CEEGOG), Prague, Czech Republic
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
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Comparison of contrast-enhanced ultrasonography and magnetic resonance imaging in the evaluation of tumor size and local invasion of surgically treated cervical cancer. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2928-2936. [PMID: 35670876 DOI: 10.1007/s00261-022-03558-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES This retrospective study aimed to compare the performance of contrast-enhanced ultrasound (CEUS) and magnetic resonance imaging (MRI) in staging surgically treated early-stage cervical cancer. METHODS Patients with surgically treated cervical carcinoma confirmed by post-operative pathological findings were included between December 2016 and December 2018. All included patients underwent both CEUS and MRI examinations before the surgery. Post-operative pathology was used as the gold standard. The κ values were calculated to assess the agreements of CEUS and MRI in staging cervical carcinoma in comparison with post-operative pathology. RESULTS Complete data were available for 39 patients. CEUS showed great inter-observer reproducibility in tumor measurement [Intra-class Correlation Coefficient (ICC) 0.831] and moderate inter-observer reproducibility in the evaluation of vaginal infiltration and parametrial invasion (Cohen's κ 0.692 and 0.624). Tumor size was comparable as measured by CEUS and MRI (ICC 0.769). Both CEUS and MRI presented good concordance with post-operative pathology in staging cervical cancer (weighted κ 0.732 and 0.761). CONCLUSION CEUS was comparable to MRI in staging surgically treated cervical cancer and might be considered in the pre-treatment work-up for cervical cancer.
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Shao X, An L, Liu H, Feng H, Zheng L, Dai Y, Yu B, Zhang J. Cervical Carcinoma: Evaluation Using Diffusion MRI With a Fractional Order Calculus Model and its Correlation With Histopathologic Findings. Front Oncol 2022; 12:851677. [PMID: 35480091 PMCID: PMC9036957 DOI: 10.3389/fonc.2022.851677] [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: 01/10/2022] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The objective of the study is to investigate the feasibility of using the fractional order calculus (FROC) model to reflect tumor subtypes and histological grades of cervical carcinoma. Methods Sixty patients with untreated cervical carcinoma underwent multi-b-value diffusion-weighted imaging (DWI) at 3.0T magnetic resonance imaging (MRI). The mono-exponential and the FROC models were fitted. The differences in the histological subtypes and grades were evaluated by the Mann–Whitney U test. Receiver operating characteristic (ROC) analyses were performed to assess the diagnostic performance and to determine the best predictor for both univariate analysis and multivariate analysis. Differences between ROC curves were tested using the Hanley and McNeil test, while the sensitivity, specificity, and accuracy were compared using the McNemar test. P-value <0.05 was considered as significant difference. The Bonferroni corrections were applied to reduce problems associated with multiple comparisons. Results Only the parameter β, derived from the FROC model could differentiate cervical carcinoma subtypes (P = 0.03) and the squamous cell carcinoma (SCC) lesions exhibited significantly lower β than that in the adenocarcinoma (ACA) lesions. All the individual parameters, namely, ADC, β, D, and μ derived from the FROC model, could differentiate low-grade cervical carcinomas from high-grade ones (P = 0.022, 0.009, 0.004, and 0.015, respectively). The combination of all the FROC parameters showed the best overall performance, providing the highest sensitivity (81.2%) and AUC (0.829). Conclusion The parameters derived from the FROC model were able to differentiate the subtypes and grades of cervical carcinoma.
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Affiliation(s)
- Xian Shao
- Department of Anesthesiology, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Li An
- Department of Anesthesiology, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Hui Liu
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hui Feng
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Liyun Zheng
- MR Collaboration, Central Research Institute, United Imaging Healthcare, Shanghai, China
| | - Yongming Dai
- MR Collaboration, Central Research Institute, United Imaging Healthcare, Shanghai, China
| | - Bin Yu
- Department of Emergency, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jin Zhang
- Department of Anesthesiology, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
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Zhao Q, Yan C, Dan M, Jia H. Efficacy and safety of acupuncture for urinary retention after hysterectomy: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26064. [PMID: 34087850 PMCID: PMC8183752 DOI: 10.1097/md.0000000000026064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 04/28/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy and safety of acupuncture in the treatment of urinary retention after hysterectomy in women. METHODS This research searched for 6 database documents, and the deadline is July 23, 2020. This study included a randomized controlled trial of women with urinary retention after hysterectomy. These randomized controlled trials compare acupuncture with bladder function training or other nonacupuncture treatments, and measure urodynamics, effectiveness (BR), and urinary tract infection rates (UIR). Four independent reviewers participated in data extraction and evaluation. Assess the risk of bias in each article, and conduct a meta-analysis according to the type of acupuncture. The result is expressed as a mean difference (MD) or relative risk (RR) with a 95% confidence interval (CI). RESULTS The meta-analysis contains 12 studies. Most studies indicate low risk or unknown risk, but the GRADE scores of the combined results show low or moderate levels. After the combined analysis, we found that acupuncture versus bladder function exercise and other nonacupuncture therapies can significantly improve the values of post voided residual urine (PVR) (MD = -25.29; 95% CI [-30.45 to -20.73]), maximal cystometric capacity (MD = 39.54; 95% CI [10.30-68.78]), bladder capacity for first voiding desire (MD = -61.98; 95% CI [-90.69 to -33.26]) and maximal flow rate (MFR) (MD = 7.58; 95% CI [5.19-9.97]). And compared with the control group, acupuncture still has advantages in BR (RR = 1.36; 95% CI [1.18-1.56]) and UIR (RR = 0.22; 95% CI [0.08-0.82]). These heterogeneities have been resolved through subgroup analysis, and their main sources are related to different intervention times, the time to start the intervention, and different PVR requirements. CONCLUSIONS There is insufficient evidence that acupuncture can increase the patient's MFR, BR, and UIR. However, acupuncture can effectively improve the PVR, maximal cystometric capacity, and bladder capacity for first voiding desire values of patients with urinary retention after hysterectomy. Although limited due to the quality and methodological limitations of the included studies, acupuncture can still be used as an effective and safe treatment for women with urinary retention after hysterectomy. REGISTRATION The research has been registered and approved on the PROSPERO website. The registration number is CRD42019119238.
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Affiliation(s)
- Qinyu Zhao
- College of Acupuncture and Tuina
- Institute of Acupuncture-moxibustion
| | | | - Meng Dan
- Institute of Chinese Medical Literature and Culture, Shandong University of Traditional Chinese Medicine
| | - Hongling Jia
- Department of Acupuncture, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, P. R. China
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Risk Factors for Recurrence after Robot-Assisted Radical Hysterectomy for Early-Stage Cervical Cancer: A Multicenter Retrospective Study. Cancers (Basel) 2020; 12:cancers12113387. [PMID: 33207627 PMCID: PMC7696424 DOI: 10.3390/cancers12113387] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/05/2020] [Accepted: 11/14/2020] [Indexed: 12/24/2022] Open
Abstract
Simple Summary In 239 women with early-stage cervical cancer (≤IB1 or IIA1, FIGO 2009) undergoing robot-assisted radical hysterectomy in Spanish and Portuguese centers between 2009 and 2018, the overall survival rate was 94.1% after a median follow-up of 51 months. Recurrence was diagnosed in 26 patients. In the multivariate analysis, independent risk factors for recurrence were tumor size > 20 mm, adenocarcinoma as histological type, presence of positive pelvic lymph nodes, tumor grades 2 and 3, and not performing sentinel lymph node biopsy. The present oncological and surgical results surpassed the target of quality indicators in cervical cancer proposed by the European Society of Gynecology Oncology. When selecting a robot-assisted surgical approach to perform radical hysterectomy in the surgical treatment of primary early-stage cervical cancer, it is recommended to take into account the tumor grade and histological type, results of the sentinel lymph node biopsy, and the size of the tumor. Abstract This retrospective analysis aimed to assess the risk factors for recurrence in patients diagnosed with early-stage cervical cancer (≤IB1 or IIA1, FIGO 2009) undergoing robot-assisted radical hysterectomy in Spain and Portugal between 2009 and 2018. A second primary objective was to audit the oncological outcomes according to quality indicators (QI) proposed by the European Society of Gynecology Oncology (ESGO). The study population included 239 women. After a median follow-up of 51 months, recurrence occurred in 26 patients (10.9%). Independent factors for recurrence were clinical tumor size > 20 mm (hazard ratio (HR) 2.37), adenocarcinoma as histological type (HR 2.51), positive pelvic lymph nodes (HR 4.83), tumor grade 2 (HR 4.99), tumor grade 3 (HR 8.06), and having not performed sentinel lymph node biopsy (SLNB) (HR 4.08). All 5 QI selected were surpassed by our results. In patients with early-stage cervical cancer undergoing robotic radical hysterectomy, clinicians should be aware that tumor grade 2 and 3, tumor size > 20 mm, adenocarcinoma, positive pelvic nodes, and lack of performance of SLNB are risk factors for recurrence. Fulfillment of QI targets of the ESGO might be considered as an objective oncological outcome indicator supporting the minimally invasive approach for early-stage cervical cancer treatment.
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AKR1C1 Contributes to Cervical Cancer Progression via Regulating TWIST1 Expression. Biochem Genet 2020; 59:516-530. [PMID: 33170398 DOI: 10.1007/s10528-020-10014-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 10/30/2020] [Indexed: 01/04/2023]
Abstract
Cervical cancer (CC) is a common gynecological malignancy, accounting for 10% of all gynecological cancers. Recently, targeted therapy for CC has shown unprecedented advantages. To improve CC patients' prognosis, there are still urgent needs to develop more promising therapeutic targets. Aldo-keto reductase 1 family member C1 (AKR1C1) is a type of aldosterone reductase and plays a regulatory role in a variety of key metabolic pathways. Several studies indicated that AKR1C1 was highly expressed in a series of tumors, and participated in the progression of these tumors. However, the possible effects of AKR1C1 on CC progression remain unclear. Herein, we revealed AKR1C1 was highly expressed in human CC tissues and correlated with the clinical characteristics of patients with CC. AKR1C1 could regulate the proliferation and invasion of cervical cancer cells in vitro. Further experiments showed that AKR1C1 could regulate TWIST1 expression and AKT pathway. In summary, we confirmed the involvement of AKR1C1 in CC progression, and therefore AKR1C1 may have the potential to be a molecular target for CC treatment.
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Redondo A, Colombo N, McCormack M, Dreosti L, Nogueira-Rodrigues A, Scambia G, Lorusso D, Joly F, Schenker M, Ruff P, Estevez-Diz M, Irahara N, Donica M, Gonzalez-Martín A. Primary results from CECILIA, a global single-arm phase II study evaluating bevacizumab, carboplatin and paclitaxel for advanced cervical cancer. Gynecol Oncol 2020; 159:142-149. [PMID: 32763109 DOI: 10.1016/j.ygyno.2020.07.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Adding bevacizumab to cisplatin-paclitaxel for advanced cervical cancer significantly improves overall and progression-free survival. We evaluated bevacizumab with a widely used carboplatin-paclitaxel backbone. METHODS Patients with metastatic/recurrent/persistent cervical cancer not amenable to curative surgery and/or radiotherapy received 3-weekly bevacizumab 15 mg/kg, paclitaxel 175 mg/m2, and carboplatin AUC 5 until progression or unacceptable toxicity. Maintenance bevacizumab was allowed. Patients with ongoing bladder/rectal involvement, prior cobalt radiotherapy, a history of fistula/gastrointestinal perforation, or recent bowel resection/chemoradiation were excluded. The primary objective was to determine incidences of gastrointestinal perforation/fistula, gastrointestinal-vaginal fistula, and genitourinary fistula. RESULTS Among 150 treated patients, disease at study entry was persistent in 21%, recurrent in 56%, and newly diagnosed metastatic in 23%. After 27.8 months' median follow-up, median bevacizumab duration was 6.7 months; 57% received maintenance bevacizumab. Seventeen patients (11.3%; 95% CI: 6.7-17.5%) experienced ≥1 perforation/fistula event: gastrointestinal perforation/fistula in 4.7% (1.9-9.4%), gastrointestinal-vaginal fistula in 4.0% (1.5-8.5%), and genitourinary fistula in 4.7% (1.9-9.4%). Of these, 16 were previously irradiated, several with ongoing radiation effects. The most common grade 3/4 adverse events were neutropenia (25%), anemia (19%), and hypertension (14%). Five patients (3%) had fatal adverse events. Objective response rate was 61% (95% CI: 52-69%), median progression-free survival was 10.9 (10.1-13.7) months, and median overall survival was 25.0 (20.9-30.4) months. CONCLUSIONS Bevacizumab can be combined with carboplatin-paclitaxel in the CECILIA study population. The fistula/gastrointestinal perforation incidence is in line with GOG-0240; efficacy results are encouraging. TRIAL REGISTRATION NUMBER NCT02467907 (ClinicalTrials.gov).
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Affiliation(s)
| | - Nicoletta Colombo
- European Institute of Oncology, IRCCS, University of Milan-Bicocca, Milan, Italy
| | - Mary McCormack
- Department of Oncology, University College London Hospitals, London, UK
| | - Lydia Dreosti
- Department of Medical Oncology, University of Pretoria, Pretoria, South Africa
| | - Angelica Nogueira-Rodrigues
- Medical Oncology Department, Federal University of Minas Gerais Brazil and Brazilian Group of Gynecologic Oncology, Belo Horizonte, Brazil
| | | | - Domenica Lorusso
- Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy; Istituto Nazionale Tumori IRCCS, Milan, Italy
| | | | | | - Paul Ruff
- Division of Medical Oncology, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Maria Estevez-Diz
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Natsumi Irahara
- Product Development Medical Affairs, F Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Margarita Donica
- Pharma Development Biostatistics Oncology, F Hoffmann-La Roche Ltd, Basel, Switzerland
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2019 SEOM guidelines (the end of a decade). Clin Transl Oncol 2020; 22:169-170. [DOI: 10.1007/s12094-020-02309-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
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