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Mishra R, Pandey A, Mishra H, Singh S, Jain P, Singh TB, Mandal A, Singh PK. Survival outcome and prognostic factors post inadvertent hysterectomy in carcinoma cervix treated with salvage chemo-radiation. J Cancer Res Clin Oncol 2023; 149:12355-12364. [PMID: 37434094 DOI: 10.1007/s00432-023-05081-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 06/29/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION The standard of care for treating early invasive cervical cancer is radical hysterectomy or radiation alone while chemo-radiation is a definitive treatment for advanced disease. Occasionally, a simple hysterectomy is performed in the cancer cervix and these patients merit adjuvant treatment in view of the high chances of loco-regional recurrences. The aim of the study was to analyze the survival outcome of these patients treated with salvage chemo-radiotherapy and also to determine the prognostic factors affecting survival. MATERIALS AND METHODS The medical records of all patients with cervical cancer post simple hysterectomy outside and who received salvage treatment in our department between 2014 and 2020 were retrieved. The data regarding clinical, treatment details and survival were analyzed. RESULTS A total of 198 patients were included. Median follow-up duration was 45.5 months. Gross disease and lymphadenopathy were seen in 60% and 28% patients, respectively. The 5-year progression-free survival(PFS) and overall survival(OS) was 75% and 76%, respectively. Concurrent chemotherapy alone or in combination with induction chemotherapy using three-drug regimens showed better survival compared to those treated by radiation alone. On multivariate analysis, factors found to be adversely affecting OS and PFS were lymph node (LN) size of more than 2 cm, non-squamous histology, overall treatment time(OTT) of more than 12 weeks and use of non three-drug chemotherapy regimen. CONCLUSION Subtotal hysterectomy results in a higher incidence of local recurrence of disease. Factors that impair the outcome in this sub-group of patients are gross lymphadenopathy, non-squamous histology and prolong OTT.
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Affiliation(s)
- Ritusha Mishra
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ankita Pandey
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Himanshu Mishra
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
| | - Shreya Singh
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Pallavi Jain
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Tej Bali Singh
- NMHP, Centre of Excellence, Department of Psychiatry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Abhijit Mandal
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Pramod Kumar Singh
- Department of Radiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Abstract
Since the publication of the 2018 FIGO Cancer Report, giant strides have been made in the global effort to reduce the burden of cervical cancer, with the World Health Organization (WHO) rolling out a global strategy for cervical cancer elimination, aiming for implementation by 2030. In over 130 countries, including low- and middle-income countries, HPV vaccination is now included in the national program. Screening has seen major advances with wider implementation of HPV testing. These interventions will take a few years to show their impact. Meanwhile, over half a million new cases are added each year. FIGO's revised staging of cervical cancer (2018) has been widely implemented and retrospective analyses of data based on the new staging have been published. Minimally invasive surgery has been shown to be disadvantageous in women with cervical cancer. This chapter discusses the management of cervical cancer based on the stage of disease, including attention to palliation and quality of life issues.
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Affiliation(s)
- Neerja Bhatla
- Department of Obstetrics and GynecologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Daisuke Aoki
- Department of Obstetrics and GynecologyKeio University School of MedicineTokyoJapan
| | - Daya Nand Sharma
- Department of Radiation OncologyAll India Institute of Medical SciencesNew DelhiIndia
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Durmuş Y, İşçi Bostancı E, Duru Çöteli AS, Kayıkçıoğlu F, Boran N, Köse MF. Complementary surgery for cervical cancer patients inadequately treated with extrafacial hysterectomy. J Gynecol Obstet Hum Reprod 2020; 49:101800. [PMID: 32416274 DOI: 10.1016/j.jogoh.2020.101800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate surgical outcomes and survival outcomes of cervical cancer patients who underwent complementary surgery after an extrafacial hysterectomy METHODS: Patients with cervical cancer, who underwent extrafacial hysterectomy initially and thereafter underwent complementary surgery were reviewed retrospectively. Complementary surgery consisted of radical parametrectomy, proximal vaginectomy and pelvic lymphadenectomy. RESULTS Twenty patients were evaluated. Histopathologic subtype was squamous cell carcinoma in twelve patients, adenocarcinoma in six patients and adenosquamous carcinoma in two patients. Route of surgery was laparotomy in 19 patients and laparoscopy in one patient. Two patients were staged as stage 1A2, nine were staged as stage 1B1, four were staged as stage 1B2, one was staged as stage 2A1, one was staged as stage 2B and three were staged as stage 3C1. The median tumor size was 16.5 (Range, 4-40) mm. Grade ≥ 3 complications related to surgery occured in 8 (40%) patients. Four of them were managed intraoperatively and recovered problem free. Remaining four (20%) needed reoperation. Pathology reports revealed involvement of parametrium in one (5%) patient, involvement of the proximal vagina in one (5%) patient, matastasis to pelvic lymph nodes in 3 (15%) patients. Five (25%) patients received adjuvant radiotherapy. Consequently, 5-year and 10-year cumulative survival was calculated as 94%. CONCLUSION Complementary surgery and radiotherapy show similar oncologic outcomes in patients with early-stage cervical cancer who had undergone simple hysterectomy initially. Complementary surgery is associated with slightly higher rate of morbidity compared with radiotherapy, however significant proportion of complications can be noticed and repaired intraoperatively.
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Affiliation(s)
- Yasin Durmuş
- University Of Health Sciences, Etlik Zubeyde Hanim Women's Health Teaching And Research Hospital, Gynecological Oncology Department, Ankara, Turkey.
| | - Esra İşçi Bostancı
- University Of Health Sciences, Etlik Zubeyde Hanim Women's Health Teaching And Research Hospital, Gynecological Oncology Department, Ankara, Turkey
| | - Ayşe Sinem Duru Çöteli
- University Of Health Sciences, Etlik Zubeyde Hanim Women's Health Teaching And Research Hospital, Gynecological Oncology Department, Ankara, Turkey
| | - Fulya Kayıkçıoğlu
- University Of Health Sciences, Etlik Zubeyde Hanim Women's Health Teaching And Research Hospital, Gynecological Oncology Department, Ankara, Turkey
| | - Nurettin Boran
- University Of Health Sciences, Etlik Zubeyde Hanim Women's Health Teaching And Research Hospital, Gynecological Oncology Department, Ankara, Turkey
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MRI- and PET-Guided Interstitial Brachytherapy for Postsurgical Vaginal Recurrences of Cervical Cancer: Results of Phase II Study. Int J Radiat Oncol Biol Phys 2019; 106:310-319. [PMID: 31682968 DOI: 10.1016/j.ijrobp.2019.10.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE This phase II study evaluated the utility of magnetic resonance imaging (MRI) and positron emission tomography for planning radiation and brachytherapy in patients with postsurgical recurrence of cervical cancer. METHODS AND MATERIALS The study (NCT01391065) recruited patients with residual or recurrent disease after hysterectomy. Patients underwent baseline T2 weighted (T2W) MRI, 18F-flouro-deoxyglucose (18F-FDG), 18F-flouro thymidine (18F-FLT) and 18F-flouromisonidazole (18F-F Miso) positron emission tomography (PET) and received external radiation (50 Gy/25 fractions for 5 weeks) and weekly cisplatin (40 mg/m2). MRI was performed at brachytherapy and used for delineation of clinical target volume (CTV). Patients with parametrial disease at baseline received interstitial brachytherapy (16-20 Gy/4-5 fractions) and those with vaginal disease received intracavitary brachytherapy (12-14 Gy/2-4 fractions). Kaplan-Meier analysis was performed to evaluate locoregional relapse, disease free survival, and overall survival. Common Toxicity Criteria for adverse event reporting (CTCAE) v4.1 was used for toxicity scoring and European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questtionaire Core 30 (QLQC-30) and Cx 24 for quality-of-life reporting. RESULTS Between January 2011 and February 2016, 60 patients were included, of which 50 received study treatment. The mean gross tumor volume on T2 W MR was 20 (IQR 3.6-90) cc. The metabolic tumor volume was 15 (interquartile range [IQR] 2.1-56.1) cc. The median FLT volume was 10 (IQR 0-48) cc. A total of 8 patients had 18-F F Miso uptake. The median CTV at brachytherapy was 38 (12-85) cc. The median CTVD90 and D 98 was 71 (53-74) and 74 (53-74) Gy. At a median follow-up of 60 (5-93) months, the 5-year local control, disease free survival, and overall survival were 84%, 73%, and 74.5%, respectively. Grade III and IV proctitis and cystitis were observed in 4% and 2% of patients. On multivariate analysis baseline tumor volume, on T2 W MR impacted disease free (91% vs 65%, P = .03) and overall survival (96% vs 77%, P = .06). CONCLUSIONS Image-guided assisted radiation and brachytherapy are associated with good to excellent local control and survival in patients with vaginal recurrences of cervical cancer.
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Abstract
Since the publication of the last FIGO Cancer Report there have been giant strides in the global effort to reduce the burden of cervical cancer, with WHO announcing a call for elimination. In over 80 countries, including LMICs, HPV vaccination is now included in the national program. Screening has also seen major advances with implementation of HPV testing on a larger scale. However, these interventions will take a few years to show their impact. Meanwhile, over half a million new cases are added each year. Recent developments in imaging and increased use of minimally invasive surgery have changed the paradigm for management of these cases. The FIGO Gynecologic Oncology Committee has revised the staging system based on these advances. This chapter discusses the management of cervical cancer based on the stage of disease, including attention to palliation and quality of life issues.
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Affiliation(s)
- Neerja Bhatla
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Daya Nand Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
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Ali N, Valimohammad AT, Abbasi AN, Mansha MA, Hafiz A, Qureshi BM. Chemoradiation and the Role of Adjuvant Chemotherapy in Lymph Nodal-Metastatic Cervical Cancer. J Glob Oncol 2018; 4:1-4. [PMID: 30241186 PMCID: PMC6180839 DOI: 10.1200/jgo.2017.009852] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To report the long-term outcome in lymph nodal–metastatic cervical
squamous cell cancer after chemoradiation followed by adjuvant
chemotherapy. Patients and Methods Between 2010 and 2013, five patients were diagnosed with advanced cervical
cancer with clinically involved para-aortic lymph nodes (ie, International
Federation of Gynecology and Obstetrics stage IVB). These patients were
treated with concurrent chemoradiation therapy followed by adjuvant
chemotherapy. Concurrent chemoradiation consisted of cisplatin given once
per week concomitantly with extended-field radiation therapy followed by
high-dose-rate brachytherapy. Adjuvant chemotherapy comprised four courses
of carboplatin and paclitaxel given every three weeks. The primary outcomes
were local and distant failures. Results None of the patients had local recurrence or distal failure after a minimum
follow-up time of 3 years. Conclusion Adjuvant chemotherapy after chemoradiation has a probable role in the
management of lymph nodal–metastatic cervical cancer.
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Affiliation(s)
- Nasir Ali
- All authors: Aga Khan University Hospital, Karachi, Pakistan
| | | | | | | | - Asim Hafiz
- All authors: Aga Khan University Hospital, Karachi, Pakistan
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Bai H, Cao D, Yuan F, Wang H, Chen J, Wang Y, Shen K, Zhang Z. Occult invasive cervical cancer after simple hysterectomy: a multi-center retrospective study of 89 cases. BMC Cancer 2016; 16:507. [PMID: 27439407 PMCID: PMC4955116 DOI: 10.1186/s12885-016-2480-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 07/01/2016] [Indexed: 11/11/2022] Open
Abstract
Background Occult invasive cervical cancer (OICC) is sometimes incidentally found in surgical specimens after a simple hysterectomy (SH). This study was aimed at identifying a subset of patients with OICC who have a favorable prognosis. This patient group may not require adjuvant radiotherapy and other procedures. Methods The medical records of women in whom OICC was detected after an inadvertent SH were retrospectively reviewed. The relevant data, including clinicopathological characteristics, treatment and clinical outcome were evaluated. The primary and secondary endpoints were overall survival (OS) and relapse-free survival (RFS), respectively. Results Eighty-nine patients who met the inclusion criteria were included for analysis, and the risk of OICC was found to be 1.9 %. Finding an invasive cancer in a hysterectomy specimen after a conization procedure that shows positive margins was the most common reason (41.6 %) for the performance of inadvertent SH. In the univariate analysis, a tumor width > 20 mm, deep stromal invasion, and lymph node metastasis (LNM) were adversely associated with relapse (P < 0.001, < 0.001, and = 0.001, respectively) and survival (P = 0.003, 0.004, and 0.027, respectively), although these parameters were not independently associated with patient prognoses in the multivariate analysis. In patients with a tumor width ≤ 20 mm and superficial stromal invasion in the observation subgroup, the 5-year RFS and 5-year OS were both 100 %, whereas they were 57.1 % and 66.7 %, respectively, in patients with a tumor size > 20 mm and deep stromal invasion in the radiotherapy or chemotherapy subgroup (P < 0.001, and = 0.008, respectively). Conclusions Simple observation after a lymphadenectomy procedure may be feasible in OICC patients with a tumor width ≤ 20 mm, superficial stromal invasion, a negative section margin in hysterectomy specimens, and no LNM.
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Affiliation(s)
- Huimin Bai
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fang Yuan
- Department of Obstetrics and Gynecology, the Affiliated Hospital of Medical College Qingdao University, Qingdao, China
| | - Huilan Wang
- Department of Obstetrics and Gynecology, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jie Chen
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yue Wang
- Department of Pathology, Beijing Chao-Yang Hospital Affiliated China Capital Medical University, Beijing, China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Zhenyu Zhang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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Choudhary S. Impact of Induction Chemotherapy Followed by Radiotherapy in Patients of Invasive Cervical Carcinoma with Inadvertent Hysterectomy: A Retrospective Study. J Clin Diagn Res 2015; 9:XC01-XC04. [PMID: 26557599 DOI: 10.7860/jcdr/2015/15739.6640] [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: 07/15/2015] [Accepted: 09/03/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND The standard of care for patients who undergo an inadvertent hysterectomy for invasive cervical carcinoma is not well established. AIM The aim of this study was to evaluate the role of induction chemotherapy followed by external beam radiotherapy and brachytherapy in patients who had an inadequate hysterectomy for carcinoma of the cervix. MATERIALS AND METHODS Patients with history of inadequate hysterectomy with no residual disease at presentation to our outpatients department of Radiotherapy and registered between October 2011 to June 2014 were retrospectively analyzed. Most of these patients had received three cycles of induction chemotherapy using Paclitaxel and Carboplatin regime. Thereafter, these patients had received external beam radiotherapy and vaginal brachytherapy. The primary end points were overall survival and disease-free survival. Survival analysis was done using Kaplan-Meier method and the differences in survival rates were compared using log-rank test. RESULTS A total of 34 patients were eligible for the study. Overall survival and Disease-free survival at 3-years were 70% and 68%. Patients who had Taxane-based chemotherapy had significantly better survival outcomes than their counterparts. Vaginal vault boost with brachytherapy had a significant impact on prognosis of these patients. CONCLUSION Induction chemotherapy using Paclitaxel and Carboplatin followed by external beam radiotherapy and brachytherapy is a good treatment option for patients of carcinoma of the cervix who have undergone inadvertent hysterectomy.
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Affiliation(s)
- Sunil Choudhary
- Assistant Professor, Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University , Varanasi, India
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Koh HK, Jeon W, Kim HJ, Wu HG, Kim K, Chie EK, Ha SW. Outcome Analysis of Salvage Radiotherapy for Occult Cervical Cancer Found After Simple Hysterectomy. Jpn J Clin Oncol 2013; 43:1226-32. [DOI: 10.1093/jjco/hyt137] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Khosla D, Patel F, Rai B, Chakraborty S, Oinam A, Sharma S. Dose Escalation by Intensity-modulated Radiotherapy Boost after Whole Pelvic Radiotherapy in Postoperative Patients of Carcinoma Cervix with Residual Disease. Clin Oncol (R Coll Radiol) 2013; 25:e1-6. [DOI: 10.1016/j.clon.2012.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 06/26/2012] [Accepted: 07/26/2012] [Indexed: 10/28/2022]
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Weber RS, Jabbour N, Martin RCG. Anemia and transfusions in patients undergoing surgery for cancer. Ann Surg Oncol 2007; 15:34-45. [PMID: 17943390 PMCID: PMC7101818 DOI: 10.1245/s10434-007-9502-9] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Revised: 06/03/2007] [Accepted: 06/05/2007] [Indexed: 12/13/2022]
Abstract
Preoperative, operative, and postoperative factors may all contribute to high rates of anemia in patients undergoing surgery for cancer. Allogeneic blood transfusion is associated with both infectious risks and noninfectious risks such as human errors, hemolytic reactions, transfusion-related acute lung injury, transfusion-associated graft-versus-host disease, and transfusion-related immune modulation. Blood transfusion may also be associated with increased risk of cancer recurrence. Blood-conservation measures such as preoperative autologous donation, acute normovolemic hemodilution, perioperative blood salvage, recombinant human erythropoietin (epoetin alfa), electrosurgical dissection, and minimally invasive surgical procedures may reduce the need for allogeneic blood transfusion in elective surgery. This review summarizes published evidence of the consequences of anemia and blood transfusion, the effects of blood storage, the infectious and noninfectious risks of blood transfusion, and the role of blood-conservation strategies for cancer patients who undergo surgery. The optimal blood-management strategy remains to be defined by additional clinical studies. Until that evidence becomes available, the clinical utility of blood conservation should be assessed for each patient individually as a component of preoperative planning in surgical oncology.
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Affiliation(s)
- Randal S Weber
- University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
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