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Tong J, Yu H, Li J, Zhou J, Ma X, Yang J. Short-term recurrence and distant metastasis following robotic-assisted radical hysterectomy with pelvic lymphadenectomy and chemoradiotherapy for a stage IB1 cervical adenocarcinoma: A case report and literature review. Medicine (Baltimore) 2019; 98:e15387. [PMID: 31027131 PMCID: PMC6831419 DOI: 10.1097/md.0000000000015387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
RATIONALE Postoperative concurrent chemoradiotherapy (CCRT) is considered the standard treatment for patients with early stage cervical cancer with positive pelvic nodes, yet many patients with high-risk factors treated with CCRT still suffered from distant metastasis. PATIENT CONCERNS A 48-year-old woman presented with abnormal vaginal bleeding for 5 months. Thin prep liquid-based cytology test revealed low-grade squamous intraepithelial lesion and the human papillomavirus test (type 58) was positive. Magnetic resonance imaging showed a mass measuring 17 × 15 mm, located predominantly in the posterior lip of uterine cervix. Colposcopy biopsy reported adenocarcinoma of the cervix. DIAGNOSIS Cervical adenocarcinoma stage IB1. INTERVENTIONS A robotic-assisted radical hysterectomy with pelvic lymphadenectomy was performed followed by postoperative CCRT. OUTCOMES Distant metastasis was occurred shortly after postoperative CCRT and the patient died 9 months from initial diagnosis. LESSONS In cases of new nodule in bones, lower abdominal distension and bloating occurring shortly after CCRT in early stage cervical adenocarcinoma, clinicians should bear in mind that recurrence should be considered. Development of more effective treatment to improve the survival outcomes of patients with postoperative metastasis is needed.
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Affiliation(s)
- Jinfei Tong
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou
| | - Hailan Yu
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou
| | - Jianqiong Li
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou
| | - Jiena Zhou
- Zhibu Town Health Center, Zhuji, Zhejiang Province, China
| | - Xudong Ma
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou
| | - Jianhua Yang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou
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Bonin L, Devouassoux-Shisheboran M, Golfier F. [Focus on mucinous adenocarcinoma of the uterine cervix]. ACTA ACUST UNITED AC 2019; 47:352-361. [PMID: 30771514 DOI: 10.1016/j.gofs.2019.02.006] [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: 01/15/2019] [Indexed: 12/24/2022]
Abstract
Cancer of the uterine cervix is the fourth most common cancer in women worldwide, and the fourth leading cause of cancer death in women. Squamous cell carcinoma is the first type of cervical cancer (about 75% of cases), and adenocarcinoma the second. Adenocarcinoma of the uterine cervix were redefined in the 2014 WHO classification. Endocervical adenocarcinoma, usual type, is the mose common. Mucinous adenocarcinoma were classified by this classification into different subtypes: gatric type, intestinal type and signet-ring cell type. This literature review shows the caracteristics of these various subtypes of cervical cancer, little known. These are physiopathological, clinical, cytological histological, pronostic caracteristics, and their treatments.
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Affiliation(s)
- L Bonin
- Service de chirurgie gynécologique oncologique et obstétrique, CHU Lyon-Sud, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite, France.
| | - M Devouassoux-Shisheboran
- Service d'anatomie et de cytologie pathologiques, CHU Lyon-Sud, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite, France
| | - F Golfier
- Service de chirurgie gynécologique oncologique et obstétrique, CHU Lyon-Sud, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite, France
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Cervix Cancer: Epidemiological, Histological, Diagnostic, Therapeutic, and Prognostic Characteristics in Mohammed VI University Hospital of Marrakech, Morocco. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2017. [DOI: 10.1007/s40944-017-0138-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kundargi RS, Guruprasad B, Rathod PS, Shakuntala P, Shobha K, Pallavi V, Uma Devi K, Bafna U. Risk strata-based therapy and outcome in stage Ib-IIa carcinoma cervix: single-centre ten-year experience. Ecancermedicalscience 2013; 7:341. [PMID: 23983814 PMCID: PMC3749044 DOI: 10.3332/ecancer.2013.341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Indexed: 11/18/2022] Open
Abstract
Aim To review the outcome of stage (Ib, IIa), cervical cancer patients were primarily treated with radical hysterectomy and risk-based postoperative therapy. Material and methods Between January 2001 and December 2011, 601 cases underwent surgery followed by tailored therapy. Patients were classified into low risk (pelvic lymph node negative, tumour less than 4 cm, no evidence of lympho-vascular invasion, less than one-third of thickness of surgical stoma involved), intermediate risk (positive lympho-vascular space invasion, tumour size more than 4 cm, and deep invasion of cervical stroma), and high risk (pelvic lymph node involved, positive parametrial, or vaginal margins) groups. Postoperative adju-vant therapy in the form of radiotherapy alone to those with intermediate risk and chemo-radiotherapy to those with high risk was given to patients. The median follow-up was 60 months. Results The majority of patients had intermediate risk. The overall event-free survival (EFS) at five years was 74.37%, with EFS of 86.5% in those from the low-risk group, 73% in those from the intermediate-risk group, and 64% in those from the high-risk group. In conclusion, risk strata-based adjuvant postoperative therapy is able to provide a favourable outcome in patients with stage Ib–IIa cervical cancer with a nearly 11% improvement in survival compared with historical control.
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Affiliation(s)
- Rajshekar S Kundargi
- Department of Gynaec-oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka 560029, India
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Lee WM, Park SI, Kim BJ, Kim MH, Choi SC, Lee ED, Ryu SY. Clinicopathologic factors for central recurrence in patients with locally advanced bulky cervical cancer. Eur J Obstet Gynecol Reprod Biol 2012; 161:219-23. [PMID: 22326616 DOI: 10.1016/j.ejogrb.2011.12.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 11/22/2011] [Accepted: 12/20/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Locally advanced bulky cervical cancer (LABCC) is characterized by poor local control. The objective of this study was to identify the clinicopathologic variables associated with one-year central-only recurrence, which will serve as criteria for adjuvant hysterectomy after radiation (AHR) in patients with LABCC. STUDY DESIGN Between January 2000 and August 2007, we retrospectively evaluated outcomes in 225 patients with LABCC who were initially treated with radiation or chemoradiation. RESULTS Among the 225 patients with LABCC, there were 41 recurrences within one year after treatment (8 central-only and 33 pelvis and/or distant site recurrences). Age, stage, and treatment type were not associated with the one-year central-only recurrences, but tumor size ≥8cm had a statistically significant association based on multivariate analysis (OR, 5.39; 95% CI, 1.15-25.31; p=0.03). The combination of non-squamous cell (non-SCC) type and tumor size ≥8cm had a significantly higher rate of recurrence within one year (OR, 43.0; 95% CI, 4.78-386.68; p<0.01). CONCLUSIONS Of patients with LABCC, those with non-SCC tumors ≥8cm in size were at high risk for early central-only recurrence after cisplatin-based chemoradiation, and represent the subset of patients for whom AHR is beneficial.
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Affiliation(s)
- Won-Moo Lee
- Department of Obstetrics & Gynecology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, 215-4 Gongneung-dong, Nowon-gu, Seoul, Republic of Korea
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Kim JY, Nam BH, Lee JA. Is human papillomavirus genotype an influencing factor on radiotherapy outcome? Ambiguity caused by an association of HPV 18 genotype and adenocarcinoma histology. J Gynecol Oncol 2011; 22:32-8. [PMID: 21607093 PMCID: PMC3097332 DOI: 10.3802/jgo.2011.22.1.32] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 08/12/2010] [Accepted: 09/03/2010] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate whether human papillomavirus (HPV) genotype is associated with poor prognosis of uterine cervical cancer treated primarily with radiotherapy. Methods HPV genotyping was performed in 181 radiotherapy patients using SPF10 polymerase chain reaction and HPV reverse hybridization line probe assay. Univariate and multivariate Cox regression analysis was performed to explore the prognostic factors. Bivariate analysis was performed to investigate any association between HPV genotype and the rest of the prognostic factors. Results HPV type 18 was associated with poor disease-free survival on univariate analysis but the statistical significance was abolished when multivariate analysis was applied. Bivariate analysis was performed to examine the possible confounding factors influencing the effect of HPV 18 on prognosis. As a result, adeno/adenosquamous carcinoma histology reduced the prognostic importance of HPV 18 by 66% (2.4 to 1.6), and was the only factor which reduced the hazard ratio of HPV 18. When compared to non-18 squamous cell carcinoma, type 18 increased the risk of recurrence up to 4-fold in adeno/adenosquamous/HPV 18 and 3.7 in adeno/adenosquamous/non-18, and to 2-fold in squamous carcinoma/HPV 18, respectively. Conclusion Our data suggest that the prognostic significance of HPV 18 genotype is substantial on radiotherapy outcome, but can be underestimated because of the close association of the HPV 18 and adenocarcinoma/adenosquamous carcinoma histology. Both HPV 18 and histologic type should be regarded as strong prognostic factors in considering the treatment outcome of the uterine cervical cancer.
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Affiliation(s)
- Joo-Young Kim
- Research Institute and Hospital, National Cancer Center, Goyang, Korea
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Yeo SG, Kim JS, Cho MJ, Kim KH, Kim JS. Interstitial fluid pressure as a prognostic factor in cervical cancer following radiation therapy. Clin Cancer Res 2009; 15:6201-7. [PMID: 19773374 DOI: 10.1158/1078-0432.ccr-09-0560] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate tumor interstitial fluid pressure as a prognostic factor for recurrence-free survival in patients with cervical cancer following radiation therapy. EXPERIMENTAL DESIGN Tumor interstitial fluid pressure was measured in 55 cervical cancer patients who received radiation therapy between August 1998 and September 2002. Interstitial fluid pressure measurements were made before radiation therapy (pre-radiation therapy interstitial fluid pressure) and after a median of 28.8 Gy in 16 fractions (range, 25.2-30.6 Gy in 14-17 fractions) of radiation therapy (mid-radiation therapy interstitial fluid pressure), using a modified wick-in-needle technique. Median follow-up was 74 months (range, 2-118 months). The Kaplan-Meier method with the log-rank test and Cox's proportional hazard model were used in univariate and multivariate analyses, respectively, of prognostic factors for recurrence-free survival. RESULTS Median pre-radiation therapy and mid-radiation therapy interstitial fluid pressure were 29.0 mm Hg (range, 4.0-93.9 mm Hg) and 20.0 mm Hg (range, -1.2 to 29.6 mm Hg), respectively (P = 0.001). Pre-radiation therapy interstitial fluid pressure was significantly higher in adenocarcinomas than squamous cell carcinomas (P = 0.028). Significant reduction of interstitial fluid pressure was noted only in patients with complete responses (P = 0.002), and mid-radiation therapy interstitial fluid pressure was significantly lower in patients with complete responses (P = 0.036). In the multivariate analysis including interstitial fluid pressures and clinical variables, pre-radiation therapy interstitial fluid pressure was an independent prognostic factor for local and distant recurrence-free survival (P = 0.001 and 0.027, respectively). CONCLUSIONS Mid-radiation therapy interstitial fluid pressure measurement may be useful in predicting radiation therapy responses, and pre-radiation therapy interstitial fluid pressure was a significant prognostic factor for local and distant relapse-free survival in patients with cervical cancer after radiation therapy.
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Affiliation(s)
- Seung-Gu Yeo
- Department of Radiation Oncology, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
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Chargui R, Damak T, Khomsi F, Ben Hassouna J, Chaieb W, Hechiche M, Gamoudi A, Boussen H, Benna F, Rahal K. Prognostic factors and clinicopathologic characteristics of invasive adenocarcinoma of the uterine cervix. Am J Obstet Gynecol 2006; 194:43-8. [PMID: 16389008 DOI: 10.1016/j.ajog.2005.06.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Revised: 04/27/2005] [Accepted: 06/03/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the outcome of patients with cervical adenocarcinoma and to determine the characteristics and the prognostic factors of this entity. STUDY DESIGN This retrospective study was done in the Department of Surgical Oncology of the Salah Azaiz Institute of Tunis with 79 cases of invasive adenocarcinoma of the uterine cervix that were collected from 1990 to 1999. Survival was analyzed according to the Kaplan-Meier method. Univariate analysis of prognostic factors was performed with the test of log rank. Cox regression model was used in multivariate analysis of prognostic factors. RESULTS Mean age was 50 years, and metrorrhagia was mostly revealing in 73% of the cases. Early stages (I, IIa, IIb with 1/3 proximal parametrial invasion) and "pure" type adenocarcinoma were found in 78% and 87% of the cases, respectively. Treatment consisted of a radiosurgical combination in 52 cases; exclusive radiotherapy was practiced with 17 patients. The 5 year-overall and disease-free survival percentages were, respectively, 68% and 72.4%. Poor prognostic factors were age >50 years, tumor size >4 cm, advanced stage, tumor grade, and lymph nodes and lymph-vascular space involvement. With the use of multivariate analysis, only stage and lymph node metastases remained significant prognostic factors. CONCLUSION This report shows survival and prognostic factors that are similar to those found in previous studies, but unlike the Western countries, our results demonstrate a high rate of early stages and no increase in frequency of cervical adenocarcinoma.
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Affiliation(s)
- Riadh Chargui
- Department of Surgical Oncology, Salah Azaiz Institute of Tunis, Tunis, Tunisia
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