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Khebbeb S, Rathat G, Serrand C, Bourdon A, Ferrer C, Duraes M. Interest of para-aortic lymphadenectomy for locally advanced cervical cancer in the era of PET scanning. Eur J Obstet Gynecol Reprod Biol 2022; 272:234-239. [PMID: 35397374 DOI: 10.1016/j.ejogrb.2022.03.042] [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: 12/12/2021] [Revised: 02/25/2022] [Accepted: 03/28/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES Treatment of locally advanced cervical cancer (LACC) involves pelvic chemoradiotherapy, using an extended field in the case of para-aortic involvement. 18-Fluoro-D-glucose positron emission tomography combined with computer tomography (PET-CT) is an accurate method for the detection of metastatic nodes. The objective of this study was to evaluate the performance of PET-CT for lymph node staging of LACC. METHODS This bicentric retrospective study included patients with LACC who had a PET-CT scan followed by para-aortic lymphadenectomy between January 2015 and December 2019. Based on pathological findings, sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and false-negative (FN) rates of PET-CT for para-aortic node involvement were evaluated. RESULTS Seventy-one patients who had undergone laparoscopic lymphadenectomy were included in this study. The intraoperative complication rate was 2.8%. Sensitivity, specificity, NPV and PPV for PET-CT were 55% [95% confidence interval (CI) 44.6-67.1], 84% (95% CI 75-92), 93% (95% CI 87-99) and 33% (95% CI 22-44), respectively. FN rates in the case of negative or positive pelvic PET-CT were 5.7% and 9.5%, respectively. CONCLUSIONS Para-aortic lymphadenectomy is recommended for lymph node staging in the case of negative para-aortic PET-CT. In view of the low FN rate of PET-CT, surgical staging should be discussed regardless of pelvic status if the patient presents high surgical risk, or if this delays the commencement of chemoradiotherapy.
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Affiliation(s)
- Sirine Khebbeb
- Department of Gynaecological and Breast Surgery, Montpellier University Hospital, Montpellier, France
| | - Gauthier Rathat
- Department of Gynaecological and Breast Surgery, Montpellier University Hospital, Montpellier, France
| | - Chris Serrand
- Clinical Research and Epidemiology Unit, Nimes University Hospital, Nimes, France
| | - Aurélie Bourdon
- Department of Nuclear Medicine, Montpellier University Hospital, Montpellier, France
| | - Catherine Ferrer
- Department of Gynaecological and Breast Surgery, Nimes University Hospital, Nimes, France
| | - Martha Duraes
- Department of Gynaecological and Breast Surgery, Montpellier University Hospital, Montpellier, France.
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Höhn AK, Brambs CE, Erber R, Hiller GGR, Mayr D, Schmidt D, Schmoeckel E, Horn LC. [Reporting and handling of lymphonodectomy specimens in gynecologic malignancies and sentinel lymph nodes]. DER PATHOLOGE 2021; 42:319-327. [PMID: 32700061 PMCID: PMC8084808 DOI: 10.1007/s00292-020-00805-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Die Aufarbeitung von Lymphonodektomiepräparaten gynäkologischer Malignome orientiert sich an den nationalen AWMF-Leitlinien und internationalen Empfehlungen. Die Definition von Mikrometastasen und isolierten Tumorzellen entspricht den Festlegungen der UICC(Union Internationale Contre le Cancer)/TNM(TNM-Klassifikation maligner Tumoren). Deren Nachweis soll im Befundbericht erwähnt werden sowie in die Tumorklassifikation einfließen. Alle übersandten Lymphknoten (LK) sollen untersucht werden mit vollständiger Einbettung aller LK bis 0,3 cm und Lamellierung aller größeren Lymphknoten parallel zu ihrer kurzen Achse in ca. 0,2 cm dicken Scheiben. Bestandteile des histologischen Befundberichtes sind: Zahl der befallenen LK im Verhältnis zur Zahl der entfernten/untersuchten LK entsprechend der Entnahmelokalisationen, metrische Ausdehnung der größten LK-Metastase, Fehlen/Nachweis einer extrakapsulären Ausbreitung. Zuschnitt und Einbettung von Sentinel-LK mit oder ohne Schnellschnittuntersuchung erfolgt in Analogie zu Nicht-Sentinel-LK mit Anfertigung von ca. 3 HE-gefärbten Stufenschnitten in einem Abstand von ca. 200 µm sowohl vom Gefrier- als auch Paraffinblock. Stellen sich die Sentinel-LK in der HE-Färbung negativ dar, soll ein immunhistochemisches Ultrastaging erfolgen.
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Affiliation(s)
- Anne Kathrin Höhn
- Institut für Pathologie, Arbeitsgruppe Mamma‑, Gynäko- & Perinatalpathologie, Universitätsklinikum Leipzig AöR, Liebigstraße 26, 04103, Leipzig, Deutschland.
| | - Christine E Brambs
- Frauenklinik des Klinikums rechts der Isar, Technische Universität München, München, Deutschland
| | - Ramona Erber
- Pathologisches Institut, Universitätsklinikum Erlangen, Comprehensive Cancer Center EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Grit Gesine Ruth Hiller
- Institut für Pathologie, Arbeitsgruppe Mamma‑, Gynäko- & Perinatalpathologie, Universitätsklinikum Leipzig AöR, Liebigstraße 26, 04103, Leipzig, Deutschland
| | - Doris Mayr
- Pathologisches Institut, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Dietmar Schmidt
- MVZ für Histologie, Zytologie und Molekulare Diagnostik Trier, Trier, Deutschland
| | - Elisa Schmoeckel
- Pathologisches Institut, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Lars-Christian Horn
- Institut für Pathologie, Arbeitsgruppe Mamma‑, Gynäko- & Perinatalpathologie, Universitätsklinikum Leipzig AöR, Liebigstraße 26, 04103, Leipzig, Deutschland
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Martinez A, Angeles MA, Querleu D, Ferron G, Pomel C. How should we stage and tailor treatment strategy in locally advanced cervical cancer? Imaging versus para-aortic surgical staging. Int J Gynecol Cancer 2020; 30:1434-1443. [PMID: 32788263 DOI: 10.1136/ijgc-2020-001351] [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: 03/11/2020] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 12/24/2022] Open
Abstract
Para-aortic lymph node status at initial assessment is the most important prognostic factor and a key point for the therapeutic strategy in patients with locally advanced cervical cancer. Undiagnosed lymph node metastasis is a major clinical problem as the finding of positive para-aortic lymph nodes leads to treatment modification, with a possible impact on disease free survival. When aortic lymph node disease is discovered, radiotherapy is extended to the para-aortic area, and other treatment modalities may be considered. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) is the most accurate imaging examination to assess para-aortic extension in patients with locally advanced cervical cancer. The gold standard to identify para-aortic extension remains histologic evaluation of the lymph nodes. Indeed, PET/CT fails to detect approximately 10-15% of patients with negative PET/CT aortic nodes who have lymph node metastasis on pathologic staging. Patients with positive pelvic lymph nodes have para-aortic extension in 25-30% of cases, and surgical staging will lead to treatment modification and probably to improved para-aortic and distant control. Surgical staging also avoids unnecessary toxicity associated with extended field radiation in approximately 75% of patients with pelvic lymph node metastasis. The best modality to identify para-aortic extension is histological evaluation of the lymph nodes, but the survival benefit of surgical staging remains controversial. On the other hand, current studies include a majority of patients without pelvic lymph node spread, who are likely to be those who will benefit the least from surgical staging.
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Affiliation(s)
- Alejandra Martinez
- INSERM CRCT Team 1, Tumor Immunology and Immunotherapy, Toulouse, France .,Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole - Institut Claudius Regaud, Toulouse, France
| | - Martina Aida Angeles
- Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole - Institut Claudius Regaud, Toulouse, France
| | - Denis Querleu
- Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
| | - Gwenael Ferron
- Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole - Institut Claudius Regaud, Toulouse, France.,INSERM CRCT Team 19, ONCOSARC - Oncogenesis of sarcomas, Toulouse, France
| | - Christophe Pomel
- Department of Surgical Oncology, Institut Jean Perrin, Clermont-Ferrand, France
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Rychlik A, Angeles MA, Migliorelli F, Croce S, Mery E, Martinez A, Ferron G, Guyon F, Querleu D. Frozen section examination of sentinel lymph nodes can be used as a decisional tool in the surgical management of early cervical cancer. Int J Gynecol Cancer 2020; 30:358-363. [PMID: 31911532 DOI: 10.1136/ijgc-2019-000904] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/24/2019] [Accepted: 12/03/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Sentinel lymph node (SLN) detection has been shown to be accurate in detecting lymph node involvement in early-stage cervical cancer. The objective of this study was to evaluate the accuracy of frozen section examination in the assessment of SLN status, with the aim of adequately driving the intra-operative decision. METHODS We designed a retrospective study including patients from two comprehensive cancer centers between January 2001 and December 2018 with early-stage cervical cancer (IA1-IB2 according to International Federation of Gynecology and Obstetrics (FIGO) 2018) undergoing SLN dissection. The SLN procedure was performed using a cervical injection with technetium-99m combined with blue dye or indocyanine green in most cases. RESULTS A total of 176 patients fulfilled inclusion criteria. Bilateral mapping was detected in 153 (86.7%) of them. Nineteen of these patients (12.4%) had SLN involvement: 13 with macrometastases, three with micrometastases and three with isolated tumor cells (ITC). Macrometastatic disease was missed on frozen section in 3/13 FIGO 2018 stage IIIC patients. The three patients with ITC were also missed by frozen section examination.Considering only macrometastases as lymph node involvement, frozen section sensitivity was 76.9% (95% CI 49.7 to 91.8) and negative predictive value (NPV) was 97.9% (95% CI 94.0 to 99.3) in patients with bilateral detection. Including micrometastases, sensitivity was 81.2% (95% CI 57.0 to 93.4) and NPV remained at 97.9% (95% CI 93.9 to 99.3). CONCLUSIONS With a prevalence of final-stage IIIC in patients with pre-operative early-stage cervical cancer of the order of 10% in this series, the NPV of frozen section examination of SLN is very high, with an inferior limit of the CI superior to 94%. Diagnostic accuracy remains acceptable even if micrometastases are considered. The impact of missed ITC has not been established. Frozen section examination can be incorporated in the intra-operative decision algorithm.
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Affiliation(s)
| | - Martina Aida Angeles
- Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Federico Migliorelli
- Department of Women, Children and Adolescents, Hopitaux Universitaires de Geneve, Geneva, Switzerland
| | - Sabrina Croce
- Pathology, Institut Bergonié, Bordeaux, Aquitaine, France
| | - Eliane Mery
- Pathology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Alejandra Martinez
- Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Gwenael Ferron
- Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Frederic Guyon
- Surgical Oncology, Institut Bergonié, Bordeaux, Aquitaine, France
| | - Denis Querleu
- Surgical Oncology, Institut Bergonié, Bordeaux, Aquitaine, France
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Management of Para-aortic Lymph Node Disease in Patients With Cervical Cancer: What Is the Best Approach? Int J Gynecol Cancer 2018; 27:543-549. [PMID: 28107261 DOI: 10.1097/igc.0000000000000914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Cervical cancer remains a prevalent and deadly disease in low-income countries, especially among young and otherwise healthy women. Multimodality treatment has led to a significant improvement in outcomes for patients with locally advanced disease, and this is mainly because of the incorporation of platinum-based chemoradiotherapy in current treatment protocols. However, locally advanced tumors are associated with a greater risk for para-aortic lymph node (PALN) involvement, which is an important adverse prognostic factor. Most staging techniques have low accuracy for detection of disease in this area, which could lead to understaging and undertreatment. Meanwhile, patients with PALN disease are underrepresented in trials addressing the treatment of advanced cervical cancer and a few studies have been directed at this population. The aim of this review is to analyze the current data regarding staging and treatment of cervical cancer with PALN disease to determine which strategy is best when managing these patients.
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Horn LC, Beckmann MW, Follmann M, Koch MC, Mallmann P, Marnitz S, Schmidt D. [S3 guidelines on diagnostics and treatment of cervical cancer: Demands on pathology]. DER PATHOLOGE 2016; 36:585-93. [PMID: 26483249 DOI: 10.1007/s00292-015-0114-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Between 2011 and the end of 2014 the former consensus S2k guidelines for the diagnostics and treatment of cervical cancer were updated and upgraded to S3 level, methodologically based on the regulations of the German Cancer Society (DKG). The present article summarizes the relevant aspects for the sectioning, histopathological workup, diagnostics and reporting for the pathology of invasive cancer of the uterine cervix. The recommendations are based on the most recent World Health Organization (WHO) and TNM classification systems and consider the needs of the clinician for appropriate surgical and radiotherapeutic treatment of patients. Detailed processing rules of colposcopy-guided diagnostic biopsies, conization and trachelectomy as well as for radical hysterectomy specimens and lymph node resection (including sentinel lymph node resection) are given. In the guidelines deep stromal invasion in macroinvasive cervical cancer is defined for the first time as tumor infiltration of > 66% of the cervical stromal wall. Furthermore, morphological prognostic factors for microinvasive and macroinvasive cervical cancer are summarized.
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Angioli R, Luvero D, Aloisi A, Capriglione S, Gennari P, Linciano F, Li Destri M, Scaletta G, Montera R, Plotti F. Adjuvant chemotherapy after primary treatments for cervical cancer: a critical point of view and review of the literature. Expert Rev Anticancer Ther 2014; 14:431-9. [PMID: 24483847 DOI: 10.1586/14737140.2014.866520] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cervical cancer is the second most frequent female malignancy worldwide. Concurrent chemoradiotherapy represents the standard of care for patients with advanced stage cervical cancer, while radical surgery (RS) and radiotherapy is widely used for treating early stage cervical cancer. However, the poor control of micrometastasis, declining operability, the lack of radiotherapy departments and the high incidence of long-term complications due to radiotherapy have brought about the development of different therapeutic approaches such as neoadjuvant chemotherapy followed by RS. Unfortunately, treatment results are still unsatisfactory due to a high recurrence rate and several authors have studied the possibility to add an adjuvant treatment to primary therapy. We reviewed the literature concerning the role of adjuvant chemotherapy in advanced cervical cancer after neoadjuvant chemotherapy followed by RS and after chemoradiotherapy.
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Affiliation(s)
- Roberto Angioli
- Department of Obstetrics and Gynaecology, Campus Bio Medico University of Rome, Via Alvaro del Portillo, 200 - 00128 Rome, Italy
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Lee YY, Kim TJ, Kim JY, Choi CH, Do IG, Song SY, Sohn I, Jung SH, Bae DS, Lee JW, Kim BG. Genetic profiling to predict recurrence of early cervical cancer. Gynecol Oncol 2013; 131:650-4. [DOI: 10.1016/j.ygyno.2013.10.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 10/02/2013] [Accepted: 10/03/2013] [Indexed: 11/17/2022]
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Frumovitz M, Querleu D, Gil-Moreno A, Morice P, Jhingran A, Munsell MF, Macapinlac HA, Leblanc E, Martinez A, Ramirez PT. Lymphadenectomy in locally advanced cervical cancer study (LiLACS): Phase III clinical trial comparing surgical with radiologic staging in patients with stages IB2-IVA cervical cancer. J Minim Invasive Gynecol 2013; 21:3-8. [PMID: 23911560 DOI: 10.1016/j.jmig.2013.07.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 07/12/2013] [Accepted: 07/12/2013] [Indexed: 01/17/2023]
Abstract
Radiation treatment planning for women with locally advanced cervical cancer (stages IB2-IVA) is often based on positron emission tomography (PET). PET, however, has poor sensitivity in detecting metastases in aortocaval nodes. We have initiated a study with the objective of determining whether pre-therapeutic laparoscopic surgical staging followed by tailored chemoradiation improves survival as compared with PET/computed tomography (CT) radiologic staging alone followed by chemoradiation. This international, multicenter phase III trial will enroll 600 women with stages IB2-IVA cervical cancer and PET/CT findings showing fluorodeoxyglucose-avid pelvic nodes and fluorodeoxyglucose-negative para-aortic nodes. Eligible patients will be randomized to undergo either pelvic radiotherapy with chemotherapy (standard-of-care arm) or surgical staging via a minimally invasive extraperitoneal approach followed by tailored radiotherapy with chemotherapy (experimental arm). The primary end point is overall survival. Secondary end points are disease-free survival, short- and long-term morbidity with pre-therapeutic surgical staging, and determination of anatomic locations of metastatic para-aortic nodes in relationship to the inferior mesenteric artery. We believe this study will show that tailored chemoradiation after pre-therapeutic surgical staging improves survival as compared with chemoradiation based on PET/CT in women with stages IB2-IVA cervical cancer.
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Affiliation(s)
- Michael Frumovitz
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Denis Querleu
- Department of Surgical Oncology, Claudius Regaud Comprehensive Cancer Center, Toulouse, France
| | - Antonio Gil-Moreno
- Department of Gynecologic Oncology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Philippe Morice
- Department of Surgery, Institut Gustave Roussy, Paris, France
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark F Munsell
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Homer A Macapinlac
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eric Leblanc
- Department of Gynecologic Oncology, Oscar Lambret Cancer Center, Lille, France
| | - Alejandra Martinez
- Department of Surgical Oncology, Claudius Regaud Comprehensive Cancer Center, Toulouse, France
| | - Pedro T Ramirez
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Accuracy of intraoperative pathological examination of SLN in cervical cancer. Gynecol Oncol 2013; 130:525-9. [PMID: 23500089 DOI: 10.1016/j.ygyno.2013.01.023] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 01/17/2013] [Accepted: 01/24/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Early cervical cancer patients with pelvic lymph node metastasis do not benefit from radical hysterectomy. Assessment of the SLN status is thus crucial before deciding to perform a radical hysterectomy as opposed to aortic dissection only followed by definitive radiation therapy. Accuracy of frozen section of SLN has been questioned and deserves further investigation. METHODS Stage IA-IB1 cervical cancer patients who underwent SLN then full pelvic dissection at the Claudius Regaud Cancer Center in Toulouse, France, were included. RESULTS At least one SLN was identified in all 94 patients. Bilateral detection rate was 80.8%. Ectopic drainage area was found in 19 patients (20.2%). Sentinel lymph node involvement was found in 11 patients (11.7%). Sensitivity and NPV of frozen section pathological examination for the detection of macrometastatic disease was 100%, sensitivity for the detection of macro and micrometastatic disease, excluding ITC, was 88.9%, and NPV was 98.8%. Micrometastasis and isolated tumor cells (ITC) undetected at frozen section examination were found in 1 patient (1.06%) and 2 lymph nodes (1.24%), and in 2 patients (2.13%) and 2 lymph nodes (1.24%), respectively. Final pathology sensitivity of SLN was 100% for both macro and micrometastatic disease, including ITC. CONCLUSION In our institution, intraoperative frozen examination of SLN accurately predicts the status of pelvic lymph nodes and is effective for selecting intraoperatively the group of patients who benefit from radical hysterectomy. In addition, our results suggest that patients with small tumors and bilateral detection of SLN can be spared full pelvic lymphadenectomy.
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Angioli R, Plotti F, Montera R, Aloisi A, Luvero D, Capriglione S, Terranova C, De Cicco Nardone C, Muzii L, Benedetti-Panici P. Neoadjuvant chemotherapy plus radical surgery followed by chemotherapy in locally advanced cervical cancer. Gynecol Oncol 2012; 127:290-6. [PMID: 22819938 DOI: 10.1016/j.ygyno.2012.07.104] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 07/11/2012] [Accepted: 07/13/2012] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To evaluate the efficacy, in terms of safety, overall survival and progression free survival of neoadjuvant chemotherapy followed by radical surgery plus adjuvant chemotherapy in patients affected by locally advanced cervical cancer (stage IB2-IIB) with or without node metastases. METHODS Between June 2000 and February 2007, all patients with diagnosis of locally advanced cervical cancer referred to the Division of Gynecologic Oncology of the University Campus Bio-Medico of Rome were eligible for this protocol. All enrolled patients received 3 cycles of platinum-based chemotherapy every 3 weeks according to the scheme Cisplatin 100mg/mq and Paclitaxel 175 mg/mq. After neoadjuvant chemotherapy all patients with stable or progressive disease were excluded from the protocol, the others were submitted to classical radical hysterectomy, bilateral salpingo-oophorectomy and bilateral systematic pelvic lymphadenectomy and 4 cycles of adjuvant treatment with platinum based chemotherapy were executed. RESULTS Concerning intention to treat basis analysis, 5 year overall survival (OS) and disease-free survival (DFS) are 77% and 61%, respectively. The 5-year OS of patients with positive pelvic nodes and those with negative nodes metastases was respectively 60% and 87%. Concerning the according to protocol analysis, the 5-year OS and DFS are 81% and 70% respectively. The 5-year OS in patient with positive and negative lymph nodes is 75% and 88% respectively. CONCLUSIONS The adjuvant chemotherapy regimen after neoadjuvant chemotherapy and radical surgery represents a valid treatment for patients with locally advanced cervical cancer.
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Affiliation(s)
- Roberto Angioli
- Department of Obstetrics and Gynaecology, Campus Bio Medico University of Rome, Italy.
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Martínez A, Mery E, Querleu D. Reponse to ultrastaging for micrometastases in para-aortic lymph nodes in patients with carcinoma of the uterine cervix. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Horn LC, Kellner C, Scherling R, Höckel M, Einenkel J. Ultrastaging for micrometastases in para-aortic lymph nodes in patients with carcinoma of the uterine cervix. Gynecol Oncol 2011; 124:374-5; author reply 375-6. [PMID: 22040833 DOI: 10.1016/j.ygyno.2011.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 10/06/2011] [Indexed: 12/30/2022]
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Zand B, Ramirez PT. Re: “Rate of para-aortic lymph node micrometastasis in patients with locally advanced cervical cancer”. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2011.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Martinez A, Mery E, Querleu D. Response to micrometastases in para-aortic lymph nodes in advanced cervical cancer patients are a true predictor of recurrence at this level? Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cabrera S, Gil-Moreno A. Micrometastases in para-aortic lymph nodes in advanced cervical cancer patients--are a true predictor of recurrence at this level? Gynecol Oncol 2011; 121:639; author reply 639-40. [PMID: 21190725 DOI: 10.1016/j.ygyno.2010.12.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 12/06/2010] [Indexed: 10/18/2022]
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Chéreau E, Ballester M, Daraï E. Re: "Rate of para-aortic lymph node micrometastasis in patients with locally advanced cervical cancer". Gynecol Oncol 2011; 122:689; author reply 690. [PMID: 21620449 DOI: 10.1016/j.ygyno.2011.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 04/29/2011] [Indexed: 10/18/2022]
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