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Senobar Tahaei SA, Kulmány Á, Minorics R, Kiss A, Szabó Z, Germán P, Szebeni GJ, Gémes N, Mernyák E, Zupkó I. Antiproliferative and Antimetastatic Properties of 16-Azidomethyl Substituted 3- O-Benzyl Estrone Analogs. Int J Mol Sci 2023; 24:13749. [PMID: 37762056 PMCID: PMC10531082 DOI: 10.3390/ijms241813749] [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: 07/20/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
Four diastereomers of 16-azidomethyl substituted 3-O-benzyl estradiol (1-4) and their two estrone analogs (16AABE and 16BABE) were tested for their antiproliferative properties against human gynecological cancer cell lines. The estrones were selected for additional experiments based on their outstanding cell growth-inhibiting activities. Both compounds increased hypodiploid populations of breast cancer cells, and 16AABE elicited cell cycle disturbance as evidenced by flow cytometry. The two analogs substantially increased the rate of tubulin polymerization in vitro. 16AABE and 16BABE inhibited breast cancer cells' migration and invasive ability, as evidenced by wound healing and Boyden chamber assays. Since both estrone analogs exerted remarkable estrogenic activities, as documented by a luciferase reporter gene assay, they can be considered as promising drug candidates for hormone-independent malignancies.
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Affiliation(s)
| | - Ágnes Kulmány
- Institute of Pharmacodynamics and Biopharmacy, University of Szeged, H-6720 Szeged, Hungary
| | - Renáta Minorics
- Institute of Pharmacodynamics and Biopharmacy, University of Szeged, H-6720 Szeged, Hungary
| | - Anita Kiss
- Department of Inorganic, Organic and Analytical Chemistry, University of Szeged, H-6720 Szeged, Hungary
| | - Zoltán Szabó
- Department of Medicinal Chemistry, University of Szeged, H-6720 Szeged, Hungary
| | - Péter Germán
- Institute of Pharmacodynamics and Biopharmacy, University of Szeged, H-6720 Szeged, Hungary
| | - Gábor J. Szebeni
- Laboratory of Functional Genomics, Biological Research Centre, H-6726 Szeged, Hungary
| | - Nikolett Gémes
- Laboratory of Functional Genomics, Biological Research Centre, H-6726 Szeged, Hungary
| | - Erzsébet Mernyák
- Department of Inorganic, Organic and Analytical Chemistry, University of Szeged, H-6720 Szeged, Hungary
| | - István Zupkó
- Institute of Pharmacodynamics and Biopharmacy, University of Szeged, H-6720 Szeged, Hungary
- Interdisciplinary Centre of Natural Products, University of Szeged, H-6720 Szeged, Hungary
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2
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Ali H, Traj P, Szebeni GJ, Gémes N, Resch V, Paragi G, Mernyák E, Minorics R, Zupkó I. Investigation of the Antineoplastic Effects of 2-(4-Chlorophenyl)-13α-Estrone Sulfamate against the HPV16-Positive Human Invasive Cervical Carcinoma Cell Line SiHa. Int J Mol Sci 2023; 24:ijms24076625. [PMID: 37047597 PMCID: PMC10095317 DOI: 10.3390/ijms24076625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023] Open
Abstract
Cervical carcinoma is one of the most frequent malignant gynecological cancers in women of reproductive age. Because of the poor tolerability of currently available chemotherapeutic agents, efforts have been focused on developing innovative molecules, including steroids, that exert antineoplastic effects with a better safety profile. In addition to their endocrine properties, certain estrogens exhibit additional biological activities, such as antiangiogenic and anticancer effects. Based on previous studies, the antineoplastic properties of 13α-estrone sulfamate derivatives (13AES1-3) were investigated, and the mechanism of action for the most promising compound 13AES3 was explored. Based on their effects on the viability of different human adherent gynecological cancer cells, the SiHa cervical cell line was used for mechanistic experiments. The most active analog 13AES3 was shown to exert considerable proapoptotic effects, as evidenced by a colorimetric caspase-3 assay and fluorescent double staining. It also elicited antimigratory and anti-invasive effects in a concentration-dependent manner, as evidenced by wound healing and Boyden chamber assays, respectively. Regarding their mechanism of action, 13AES derivatives were shown to inhibit tubulin polymerization, and computer simulations provided a possible explanation for the importance of the presence of the chlorophenyl ring on the estrane skeleton. 13AES3 is considered to be the first 13α-estrone derivative with a significant antineoplastic potency against SiHa cancer cells. Therefore, it might serve as a valuable lead molecule for the design of anticancer agents targeting cervical carcinomas.
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Affiliation(s)
- Hazhmat Ali
- Institute of Pharmacodynamics and Biopharmacy, University of Szeged, H-6720 Szeged, Hungary
| | - Péter Traj
- Department of Inorganic, Organic and Analytical Chemistry, University of Szeged, H-6720 Szeged, Hungary
| | - Gábor J. Szebeni
- Laboratory of Functional Genomics, Biological Research Centre, H-6726 Szeged, Hungary
| | - Nikolett Gémes
- Laboratory of Functional Genomics, Biological Research Centre, H-6726 Szeged, Hungary
| | - Vivien Resch
- Department of Medical Chemistry, University of Szeged, H-6720 Szeged, Hungary
| | - Gábor Paragi
- Department of Medical Chemistry, University of Szeged, H-6720 Szeged, Hungary
- Institute of Physics, University of Pécs, H-7622 Pécs, Hungary
- Department of Theoretical Physics, University of Szeged, H-6720 Szeged, Hungary
| | - Erzsébet Mernyák
- Department of Inorganic, Organic and Analytical Chemistry, University of Szeged, H-6720 Szeged, Hungary
| | - Renáta Minorics
- Institute of Pharmacodynamics and Biopharmacy, University of Szeged, H-6720 Szeged, Hungary
| | - István Zupkó
- Institute of Pharmacodynamics and Biopharmacy, University of Szeged, H-6720 Szeged, Hungary
- Interdisciplinary Centre of Natural Products, University of Szeged, H-6720 Szeged, Hungary
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Qu X, Qiu J, Jiang L, Qi X, Zhang G, Feng W, Wang Y, Teng Y, Wang X, Guo X, Hua K. Intraoperative frozen pathology exam of Common iliac lymph nodes and Para-Aortic lymphadenectomy on the prognosis and quality of life for patients with IB2-IIA2 Cervical Cancer: trial protocol for a randomized controlled trial (C-PACC trial). J Gynecol Oncol 2023; 34:e13. [PMID: 36424705 PMCID: PMC9995868 DOI: 10.3802/jgo.2023.34.e13] [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: 09/13/2022] [Revised: 10/18/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The impact of para-aortic lymphadenectomy (PALD) on prognosis and quality of life (QoL) for IB2-IIA2 cervical cancer patients remain controversial. And whether intraoperative frozen pathology exam on common iliac lymph nodes could help predict para-aortic lymph node (PALN) metastasis was unanswered with high-level evidence. METHODS A multi-center, randomized controlled study is intended to investigate the effect of PALD on the prognosis and QoL in cervical cancer patients and to assess the value of intraoperative frozen pathological evaluation of common iliac nodes metastasis for the prediction of PALN metastasis. After choosing whether to receive intraoperative frozen pathological examination of bilateral common iliac lymph nodes, eligible patients will be randomly assigned (1:1) to receive PALD or not. The primary end point is 2-year progression-free survival (PFS). The secondary end points include 5-year PFS, 2-year overall survival (OS), 5-year OS, adverse events (AEs) caused by PALD, AEs caused by radiotherapy and QoL. A total of 728 patients will be enrolled from 8 hospitals in China within 3-year period and followed up for 5 years. TRIAL REGISTRATION Chinese Clinical Trial Register Identifier: ChiCTR2000035668.
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Affiliation(s)
- Xinyu Qu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Junjun Qiu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Lili Jiang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xiaorong Qi
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China
| | - Guonan Zhang
- Department of Gynecologic Oncology, Sichuan Cancer Hospital, Chengdu, China
| | - Weiwei Feng
- Department of Obstetrics and Gynecology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yudong Wang
- Department of Gynecologic Oncology, The International Peace Maternity & Child Health Hospital (IPMCH) of China Welfare Institute (CWI), Shanghai, China
| | - Yincheng Teng
- Department of Obstetrics and Gynecology, The Sixth Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xipeng Wang
- Department of Obstetrics and Gynecology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University of Medicine, Shanghai, China
| | - Xiaoqing Guo
- Department of Gynecology, First Maternity and Infant Hospital affiliated to Tongji University, Shanghai, China
| | - Keqin Hua
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
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Puga O, Retamales J, Saez N, Urzúa M, Saavedra M, Pérez MV, Acuña D, García K. The role of pre-treatment paraaortic surgical staging for cervical cancer in the EMBRACE criteria. Ecancermedicalscience 2022; 16:1463. [PMID: 36819821 PMCID: PMC9934876 DOI: 10.3332/ecancer.2022.1463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Indexed: 11/06/2022] Open
Abstract
Background The State-of-the-Art Treatment for Locally Advanced Cervical Cancer (LACC) is Definite Radio-Chemotherapy based on the Image-guided intensity modulated External beam radiochemotherapy and MRI-based adaptive BRAchytherapy (EMBRACE) trial, according to the FIGO staging. This staging is based on clinical examination and imaging studies; however, there are limitations of imaging techniques which may result in adverse events or death due to insufficient or overtreatment. The aim of the study was to evaluate the feasibility and outcomes of surgical staging in LACC prior to radiotherapy (RT) to personalise target volumes for radiotherapy. Methods From 2008 to 2018, 138 patients with FIGO 2018 stages IB3-IIIC2 cervical cancer underwent a pretherapeutic laparoscopic staging procedure. The pathological diagnosis was compared with the results of preoperative CT scan. Patients were treated with chemoradiotherapy tailored according to the staging results. Results The mean patient age was 43 years, the mean body mass index was 27 kg/m2; most lesions were squamous cervical cancer (92%). Staging CT scan had a 77% concordance with the histological findings. Sensitivity was 29%, specificity 85%, positive predictive value 21% and negative predictive value 89%. Surgical staging led to change of stage in 24% of cases. Para -aortic dissection led to change the initially planned radiotherapy fields in 47% of the cases. Major complications included involuntary section of the inferior mesenteric artery (IMA) without clinical repercussion, an infected retroperitoneal haematoma and a symptomatic lymphocele requiring laparoscopic drainage. Conclusion Laparoscopic staging before primary chemoradiation in patients with LACC was feasible, safe and reproducible, allowing reduction of the radiotherapy treatment volumes of patients.
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Affiliation(s)
- Oscar Puga
- Unidad Oncología Ginecológica, Complejo Asistencial Sótero del Río, Av Concha y Toro 3459 - 8207257, Santiago, Chile,Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Lira 40 - 8330023, Santiago, Chile
| | - Javier Retamales
- Unidad Oncología Ginecológica, Complejo Asistencial Sótero del Río, Av Concha y Toro 3459 - 8207257, Santiago, Chile,Chilean Cooperative Group for Oncologic Research, Av Jose Manuel Infante 125 Of. 11 - 7500650, Santiago, Chile
| | - Nicolás Saez
- Unidad Oncología Ginecológica, Complejo Asistencial Sótero del Río, Av Concha y Toro 3459 - 8207257, Santiago, Chile,Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Lira 40 - 8330023, Santiago, Chile
| | - Miguel Urzúa
- Unidad Oncología Ginecológica, Complejo Asistencial Sótero del Río, Av Concha y Toro 3459 - 8207257, Santiago, Chile,Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Lira 40 - 8330023, Santiago, Chile
| | - Miguel Saavedra
- Unidad Oncología Ginecológica, Complejo Asistencial Sótero del Río, Av Concha y Toro 3459 - 8207257, Santiago, Chile,Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Lira 40 - 8330023, Santiago, Chile
| | - María Victoria Pérez
- Unidad Oncología Ginecológica, Complejo Asistencial Sótero del Río, Av Concha y Toro 3459 - 8207257, Santiago, Chile,Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Lira 40 - 8330023, Santiago, Chile
| | - Dania Acuña
- Unidad Oncología Ginecológica, Complejo Asistencial Sótero del Río, Av Concha y Toro 3459 - 8207257, Santiago, Chile
| | - Karen García
- Unidad Oncología Ginecológica, Complejo Asistencial Sótero del Río, Av Concha y Toro 3459 - 8207257, Santiago, Chile,Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Lira 40 - 8330023, Santiago, Chile
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Soliman M, Guys N, Liu P, Moshiri M, Menias CO, Mellnick VM, Savas H, Badawy M, Elsayes KM, Gaballah AH. Multimodality imaging findings of infection-induced tumors. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:3930-3953. [PMID: 36069914 DOI: 10.1007/s00261-022-03651-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 01/18/2023]
Abstract
Several infections can predispose to certain malignancies in different body parts. These infections include viral, bacterial, and fungal pathogens. Imaging plays a vital role in the diagnosis, staging, and management of these neoplastic conditions. Furthermore, it can help in differentiating infection-related non-neoplastic processes that can mimic malignancies. Both radiologists and clinicians should be familiar with these conditions. This review discusses the epidemiology, pathogenesis, and imaging features of infection-related tumors.
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Affiliation(s)
- Moataz Soliman
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nicholas Guys
- Department of Diagnostic Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter Liu
- Department of Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Mariam Moshiri
- Department of Diagnostic Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Vincent M Mellnick
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Hatice Savas
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Ayman H Gaballah
- Department of Diagnostic Radiology, University of Missouri, Columbia, MO, USA.
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Gu A, Bao X. MiR-99a-5p Constrains Epithelial-Mesenchymal Transition of Cervical Squamous Cell Carcinoma Via Targeting CDC25A/IL6. Mol Biotechnol 2022; 64:1234-1243. [PMID: 35532870 DOI: 10.1007/s12033-022-00496-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/31/2022] [Indexed: 12/15/2022]
Abstract
MiR-99a-5p participates in processes and pathogenesis of varying diseases. However, the molecular mechanism of miR-99a-5p in human cervical squamous cell carcinoma (CSCC) remains unclear. Here, we found that miR-99a-5p was lowly expressed in CSCC cells and negatively associated with overall survival. In addition, cellular experiments including CCK8, wound healing, Transwell and flow cytometry assays disclosed that transfection of miR-99a-5p mimic could suppress the cell activity, cell migratory, and invasive abilities, and promote cell apoptosis, thus inhibiting the tumor progression of CSCC cells. Luciferase reporter gene assay indicated that miR-99a-5p targeted 3'-UTR of CDC25A. Also, enforced CDC25A level rescued the impact of miR-99a-5p on CSCC progression. Silencing CDC25A could restrain the mRNA and protein levels of IL-6 in CSCC. CDC25A overexpression or IL-6 treatment could attenuate inhibiting impact of miR-99a-5p overexpression on epithelial-mesenchymal transition (EMT). These findings suggested that miR-99a-5p may play an anti-tumor role in tumor metastasis by targeting CDC25A/IL6 to hamper EMT process, which revealed a novel molecular mechanism in CSCC.
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Affiliation(s)
- Ailing Gu
- Department of Obstetrics and Gynecology, Wuxi No. 2 Chinese Medicine Hospital, 390 Xincheng Road, Binhu District, Wuxi City, 214026, Jiangsu Province, China.
| | - Xudong Bao
- Department of Obstetrics and Gynecology, Wuxi No. 2 Chinese Medicine Hospital, 390 Xincheng Road, Binhu District, Wuxi City, 214026, Jiangsu Province, China
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Li H, Wang S, Liu Y, Wang T, Jin S, Liu Z. Prophylactic extended-field irradiation for locally advanced cervical cancer. Gynecol Oncol 2022; 166:606-613. [PMID: 35868881 DOI: 10.1016/j.ygyno.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/03/2022] [Accepted: 07/10/2022] [Indexed: 11/04/2022]
Abstract
Concomitant chemoradiotherapy is the standard treatment for locally advanced cervical cancer. Pelvic irradiation is commonly recommended for patients with negative para-aortic lymph nodes(PALNs). However, owing to the development of imaging-guided brachytherapy, distant failure has become the main failure pattern. The PALNs are a vital site of distant metastasis, and the para-aortic region may contain occult microscopic metastases that are barely detected owing to imaging technology restriction. The prognostic of patients who experienced PALN failure is dismal. Typically, there are four ways to decrease PALN failure. First, surgical staging can be performed to assess the occurrence of metastasis in the para-aortic region; however, the application of surgical staging is decreasing owing to controversial survival benefits and accompanying complications of surgery. Second, regular imaging surveillance and timely salvage of early recurrences could reduce PALN failure. Third, better systemic adjuvant therapy could be recommended since it has enormous potential to reduce distant metastases and improve overall survival. Fourth, performing prophylactic extended-field irradiation (EFI), including pelvic and para-aortic region irradiation, can sterilize occult microscopic metastases in the para-aortic region and improve survival. Prior investigations have revealed that prophylactic EFI could reduce PALN failure as well as distant metastasis and present the benefit of survival. Yet, owing to the serious morbidity induced by enlarged irradiation field in the era of conventional irradiation techniques, further research on EFI is stagnated. Nowadays, with the development of new technologies, intensity modulated radiation therapy can deliver a higher dose to tumors with acceptable toxicity. Prophylactic EFI regained attention. However, the inclusion criteria of prophylactic EFI in existing studies reveal great discrepancies. Thus, it is urgent to precisely identify indications for better survival and lower complications in patients with cervical cancer. In this review, we identify indications and summary guidelines for prophylactic EFI, which may provide a foundation for further trials and clinical applications.
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Affiliation(s)
- Huanhuan Li
- Department of radiation oncology, The Second affiliated Hospital of Jilin University, Changchun 130041, China
| | - Shu Wang
- Department of radiation oncology, The Second affiliated Hospital of Jilin University, Changchun 130041, China
| | - Yingying Liu
- Department of radiation oncology, The Second affiliated Hospital of Jilin University, Changchun 130041, China
| | - Tiejun Wang
- Department of radiation oncology, The Second affiliated Hospital of Jilin University, Changchun 130041, China
| | - Shunzi Jin
- NHC Key Laboratory of Radiobiology,Jilin University, Changchun 130021, China
| | - Zhongshan Liu
- Department of radiation oncology, The Second affiliated Hospital of Jilin University, Changchun 130041, China.
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Comparison of retroperitoneal and transperitoneal surgical routes in laparoscopic nodal staging for locally advanced cervical cancers (FIGO IB3-IVA). Eur J Surg Oncol 2022; 48:2061-2067. [DOI: 10.1016/j.ejso.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/25/2022] [Accepted: 05/06/2022] [Indexed: 11/21/2022] Open
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Zhang G, Wang C, Ma C, Miao L, He F, Fu C. A Novel Risk Factor for Para-Aortic Lymph Node Recurrence After Definite Pelvic Radiotherapy in Stage IIIB Cervical Cancer. Technol Cancer Res Treat 2022; 21:15330338221141541. [DOI: 10.1177/15330338221141541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Studies determining which patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIB disease benefit from prophylactic extended-field irradiation (EFRT), which can reduce para-aortic lymph node (PALN) failure rates, are limited. The study was designed to evaluate the value of the controlling nutritional status (CONUT) score as a risk factor for predicting PALN recurrence and identifying potential indications of prophylactic EFRT. Methods: From 2010 to 2015, a retrospective review was conducted among patients with FIGO stage IIIB cervical cancer who were treated with definitive pelvic radiotherapy or concurrent chemoradiotherapy. We analyzed para-aortic lymph node metastasis-free survival (PALNMFS) using Kaplan-Meier curves. Multivariate analyses were performed using Cox regression models. Results: A total of 116 patients with FIGO stage IIIB cervical cancer were included in the study and the median follow-up was 42.2 months (range: 3.5-104.2 months). Multivariate analysis revealed that the CONUT score (HR: 3.141; 95% CI: 2.321-5.436; P < .001) and ≥3 pelvic lymph node metastases (HR: 2.235; 95% CI: 1.428-11.242; P < .001) were independent risk predictors of PALNMFS. Compared with the low CONUT group (score<3), the high CONUT group (score≥3) was associated with a significantly worse 3-year disease-free survival rate (46.9 vs 69.5%, P = .001), a significantly lower 3-year overall survival rate (68.5 vs 79.7%, P = .016) and a significantly lower PALNMFS rate (74.8 vs 96.4%, P < .001). Conclusions: A high CONUT score (score≥3) and ≥3 pelvic metastatic lymph nodes were significant predictors of PALNMFS after pelvic radiation in FIGO stage IIIB cervical cancer patients. Patients with these risk factors might benefit from prophylactic EFRT.
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Affiliation(s)
- Guangyu Zhang
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, China
| | - Cong Wang
- Department of Gynecology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Changdong Ma
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, China
| | - Li Miao
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, China
| | - Fangfang He
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, China
| | - Chunli Fu
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
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10
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Wang D, Wang W, Liu X, Ren K, Liang Y, Zhu Q, Zhang F, Hu K. A modified delineation method of para-aortic nodal clinical target volume in patients with locally advanced cervical cancer. Cancer Med 2021; 11:28-39. [PMID: 34783168 PMCID: PMC8704148 DOI: 10.1002/cam4.4418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/21/2021] [Accepted: 10/26/2021] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To validate the nodal center coverage (NCC) of the three mainstream delineation methods of para-aortic nodal clinical target volume (CTV) and propose a modified delineation method of para-aortic nodal CTV in prophylactic extended-field irradiation (EFI) of cervical cancer. METHODS A total of 106 patients with para-aortic lymph nodes (PALNs) identified on PET/CT were included at Peking Union Medical College Hospital between 2011 and 2020. PALNs were classified as left lateral para-aortic (LLPA), aorto-caval (AC), and right para-caval (RPC). Distances from the nodal center to the aorta and inferior vena cava (IVC) were measured. The NCC of the three mainstream delineation methods of para-aortic nodal CTV (CTV-K, CTV-S, and CTV-D) and a modified CTV (CTV-M) was calculated. Radiotherapy plans were created based on 4 CTVs for 10 selected patients who received prophylactic EFI. The chi-squared test and the Student's t-test were performed. RESULTS We identified 344 PALNs (216 LLPA, 101 AC, and 27 RPC) in 106 patients. Mean distance from the nodal center to the aorta was 9.6 mm in the LLPA and 7 mm in the AC and from the nodal center to the IVC was 5.6 mm in the AC and 5.6 mm in the RPC. CTV-D improved the NCC of 98% compared with 92% for CTV-K (p = 0.002) and 95% for CTV-S (p = 0.046). CTV-M provided the same satisfactory NCC as CTV-D (97% vs. 98%, p = 0.485). The V50Gy to the duodenum, the Dmean to the bilateral kidneys, and the V45Gy to the small bowel were significantly lower on the CTV-M-based plan than on the CTV-D-based plan (p = 0.001, 0.011, and 0.001, respectively). CONCLUSION CTV-D provided more satisfactory NCC than CTV-K and CTV-S. CTV-M provided the same satisfactory NCC as CTV-D and reduced the dose to the critical structures.
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Affiliation(s)
- Dunhuang Wang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Weiping Wang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoliang Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kang Ren
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yongguang Liang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qizhen Zhu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Yoshida K, Kondo E, Matsumoto T, Maki S, Kaneda M, Nii M, Hirata T, Ikeda T. Laparoscopic retroperitoneal para-aortic lymph node biopsy in advanced cervical cancer with pelvic lymph node metastases: A single-center prospective study. J Obstet Gynaecol Res 2021; 47:3951-3957. [PMID: 34409672 DOI: 10.1111/jog.14990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/04/2021] [Accepted: 08/07/2021] [Indexed: 11/29/2022]
Abstract
AIM Extended-field concurrent chemoradiation therapy (Ex-CCRT) has been widely used for para-aortic lymph node (PAN) metastases confirmed by radiographic assessment without surgical exploration. The objective of this prospective study was to evaluate the clinical value of laparoscopic retroperitoneal PAN biopsy in locally advanced cervical cancer (LACC) with pelvic lymph node (PLN) metastases. METHODS From May 2017 to March 2020, stage IIB-IIIB cervical cancer patients who were diagnosed with PLN metastasis using positron emission tomography-computed tomography (PET-CT) with maximum standardized uptake value (SUVmax) ≥2.0 underwent laparoscopic retroperitoneal PAN biopsy. The radiation fields were extended to PAN areas with pathological metastases. RESULTS Fourteen patients were diagnosed with cervical squamous cell carcinoma of the International Federation of Gynecology and Obstetrics (FIGO) stage IIB (n = 7) and IIIB (n = 7). The median operating time was 138 min (range, 104-184 min). The median number of harvested PANs was 19 (range, 6-36). Three patients were positive for PAN metastasis on histological analysis. In this study, the sensitivity and specificity of PET-CT were 66.7% and 90.9%, respectively. CONCLUSION Our study is characterized by the use of more appropriate eligibility criteria for LACC with PLN metastases. Our results revealed that laparoscopic retroperitoneal PAN biopsy may be a useful approach to determine the radiation field for PANs during standard radiotherapy planning.
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Affiliation(s)
- Kenta Yoshida
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu, Mie, Japan
| | - Eiji Kondo
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu, Mie, Japan
| | - Tsuyoshi Matsumoto
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu, Mie, Japan.,Department of Obstetrics and Gynecology, Kuwana City Medical Center, Kuwana, Mie, Japan
| | - Shintaro Maki
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu, Mie, Japan
| | - Michiko Kaneda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu, Mie, Japan
| | - Masafumi Nii
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu, Mie, Japan
| | - Toru Hirata
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu, Mie, Japan.,Department of Obstetrics and Gynecology, Kuwana City Medical Center, Kuwana, Mie, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu, Mie, Japan
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12
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Wang Y, Zhang T, Peng S, Zhou R, Li L, Kou L, Yuan M, Li M. Patterns of Treatment Failure after Concurrent Chemoradiotherapy or Adjuvant Radiotherapy in Patients with Locally Advanced Cervical Cancer. Oncol Res Treat 2021; 44:76-85. [PMID: 33461197 DOI: 10.1159/000513170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/18/2020] [Indexed: 12/09/2022]
Abstract
OBJECTIVE To identify patterns of therapy failure after radiotherapy in Chinese patients with locally advanced cervical cancer (LACC). METHODS A retrospective study was conducted at a Chinese hospital from June 2012 to July 2018. All analyses were done using SPSS 26. RESULTS 105 patients with treatment failure were included. After a median follow-up of 27 months (range 10-82), the 3-year survival rate after therapy failure was 19.4%. In multivariate analysis, squamous cell carcinoma antigen (SCC-Ag) <4 ng/mL (p < 0.001) and disease-free interval >12 months (p = 0.013) showed significant survival benefits. We identified 3 types of failure: distant lymph node metastasis (n = 50), hematogenous metastasis (n = 53) and pelvic failure (n = 48). Most metastatic para-aortic lymph nodes (PALN) were inferior to the level of left renal hilum (84.8%, n = 28). A total of 80% of patients with supraclavicular lymph nodes (SCLN) metastasis ignored imaging on supraclavicular region. For solitary SCLN or lung metastasis, the prognosis was better than that combined with other sites failure, respectively (p = 0.005; p = 0.001). Many patients with central sites recurrence received insufficient doses of intracavitary brachytherapy (IBT) for low tolerance to pain. CONCLUSION The distribution of metastatic PALN is asymmetrical and optimizing clinical target volume to minimize toxicity of para-aortic radiation is necessary. The effect of ultrasonography as preliminary screening and follow-up means on SCLN metastasis can be expected. Pain management and psychological interventions are essential for patients receiving IBT.
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Affiliation(s)
- Yifei Wang
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tao Zhang
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Siyun Peng
- Department of Sociology, Indiana University, Bloomington, Indiana, USA
| | - Rui Zhou
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Longhao Li
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lingna Kou
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingyang Yuan
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Minmin Li
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,
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13
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Marnitz S, Tsunoda AT, Martus P, Vieira M, Affonso Junior RJ, Nunes J, Budach V, Hertel H, Mustea A, Sehouli J, Scharf JP, Ulrich U, Ebert A, Piwonski I, Kohler C. Surgical versus clinical staging prior to primary chemoradiation in patients with cervical cancer FIGO stages IIB-IVA: oncologic results of a prospective randomized international multicenter (Uterus-11) intergroup study. Int J Gynecol Cancer 2020; 30:1855-1861. [PMID: 33293284 PMCID: PMC7788482 DOI: 10.1136/ijgc-2020-001973] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 12/26/2022] Open
Abstract
Objective Revised staging of patients with locally advanced cervical cancer is based on clinical examination, imaging, and potential surgical findings. A known limitation of imaging techniques is an appreciable rate of understaging. In contrast, surgical staging may provide more accurate information on lymph node involvement. The aim of this prospective study was to evaluate the impact of pre-treatment surgical staging, including removal of bulky lymph nodes, on disease-free survival in patients with locally advanced cervical cancer. Methods Uterus-11 was a prospective international multicenter study including patients with locally advanced cervical cancer who were randomized 1:1 to surgical staging (experimental arm) or clinical staging (control arm) followed by primary platinum-based chemoradiation. Patients with histologically proven squamous cell carcinoma, adenocarcinoma, or adenosquamous cancer International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IIB–IVA underwent gynecologic examination and pre-treatment imaging including abdominal computed tomography (CT) and/or abdominal magnetic resonance imaging (MRI). Patients had chest imaging (any of the following: X-ray, CT, or PET-CT). The primary endpoint was disease-free survival and the secondary endpoint was overall survival. An ad hoc analysis was performed after trial completion for cancer-specific survival. Randomization was conducted from February 2009 to August 2013. Results A total of 255 patients (surgical arm, n=130; clinical arm, n=125) with locally advanced cervical cancer were randomized. Of these, 240 patients were eligible for analysis. The two groups were comparable with respect to patient characteristics. The surgical approach was transperitoneal laparoscopy in most patients (96.6%). Laparoscopic staging led to upstaging in 39 of 120 (33%) patients. After a median follow-up of 90 months (range 1–123) in both arms, there was no difference in disease-free survival between the groups (p=0.084). For patients with FIGO stage IIB, surgical staging is superior to clinical staging with respect to disease-free survival (HR 0.51, 95% CI 0.30 to 0.86, p=0.011). In the post-hoc analysis, surgical staging was associated with better cancer-specific survival (HR 0.61, 95% CI 0.40 to 0.93, p=0.020). Conclusion Our study did not show a difference in disease-free survival between surgical and clinical staging in patients with locally advanced cervical cancer. There was a significant benefit in disease-free survival for patients with FIGO stage IIB and, in a post-hoc analysis, a cancer-specific survival benefit in favor of laparoscopic staging. The high risk of distant metastases in both arms emphasizes the need for further evaluation.
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Affiliation(s)
- Simone Marnitz
- Department of Radiooncology, Medical Faculty of the University of Cologne, Cologne, Germany
| | | | - Peter Martus
- Institute for Clinical Epidemiology and Biometry, Eberhard Karls University Tübingen Faculty of Medicine, Tubingen, Germany
| | - Marcelo Vieira
- Department for Gynecologic Oncology, Hospital de Amor de Barretos, Barretos, Brazil
| | | | - João Nunes
- Gynecologic Oncology Department, Hospital Erasto Gaertner, Curitiba, Brazil.,Gynecologic Oncology Department, Instituto de Oncologia do Paraná, Curitiba, Brazil
| | - Volker Budach
- Department of Radiooncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Hermann Hertel
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Alexander Mustea
- Department of Gynecology and Gynecologic Oncology, University of Bonn, Bonn, Germany
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jens-Peter Scharf
- Department of Gynecology and Obstetrics, Sana-Clinics Berlin Lichtenberg, Berlin, Germany
| | - Uwe Ulrich
- Department of Gynecology and Obstetrics, Martin-Luther-Hospital Berlin, Berlin, Germany
| | - Andreas Ebert
- Outpatient Clinics for Women's Health, Berlin, Germany
| | - Iris Piwonski
- Institute of Pathology, Charite Medical Faculty Berlin, Berlin, Germany
| | - Christhardt Kohler
- Department of Gynecology, University of Cologne, Koln, Germany.,Department of Special Operative and Oncologic Gynecology, Asklepios-Clinic Hamburg-Altona, Asklepios Hospital Group, Hamburg, Germany
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14
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Muallem MZ, Diab Y, Jöns T, Sehouli J, Muallem J. Nerve-Sparing Systematic Lymph Node Dissection in Gynaecological Oncology: An Innovative Neuro-Anatomical and Surgical Protocol for Enhanced Functional Outcomes. Cancers (Basel) 2020; 12:E3473. [PMID: 33266391 PMCID: PMC7700575 DOI: 10.3390/cancers12113473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 11/29/2022] Open
Abstract
Whilst systematic lymph node dissection has been less prevalent in gynaecological cancer cases in the last few years, there is still a good number of cases that mandate a systematic lymph node dissection for diagnostic and therapeutic purposes. In all of these cases, it is crucial to perform the procedure as a nerve-sparing technique with utmost exactitude, which can be achieved optimally only by isolating and sparing all components of the aortic plexus and superior hypogastric plexus. To meet this purpose, it is essential to provide a comprehensive characterization of the specific anatomy of the human female aortic plexus and its variations. The anatomic dissections of two fresh and 17 formalin-fixed female cadavers were utilized to study, understand, and decipher the hitherto ambiguously annotated anatomy of the autonomic nervous system in the retroperitoneal para-aortic region. This study describes the precise anatomy of aortic and superior hypogastric plexus and provides the surgical maneuvers to dissect, highlight, and spare them during systematic lymph node dissection for gynaecological malignancies. The study also confirms the utility and feasibility of this surgery in gynaecological oncology.
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Affiliation(s)
- Mustafa Zelal Muallem
- Department of Gynecology with Center for Oncological Surgery, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Virchow Campus Clinic, Charité Medical University, 13353 Berlin, Germany; (J.S.); (J.M.)
| | - Yasser Diab
- Department of Gynecology, Portland Hospital, Portland, 3305 VIC, Australia;
| | - Thomas Jöns
- Department of Anatomy, Mitte Campus Clinic, Charité Medical University, 10117 Berlin, Germany;
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Virchow Campus Clinic, Charité Medical University, 13353 Berlin, Germany; (J.S.); (J.M.)
| | - Jumana Muallem
- Department of Gynecology with Center for Oncological Surgery, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Virchow Campus Clinic, Charité Medical University, 13353 Berlin, Germany; (J.S.); (J.M.)
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15
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Cho WK, Kim YJ, Kim H, Kim YS, Park W. Significance of para-aortic lymph node evaluation in patients with FIGO IIIC1 cervical cancer. Jpn J Clin Oncol 2020; 50:1150-1156. [PMID: 32577748 DOI: 10.1093/jjco/hyaa091] [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: 02/12/2020] [Accepted: 06/10/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study investigated the effect of para-aortic lymph node sampling or dissection in recently revised International Federation of Gynecology and Obstetrics IIIC1p cervical cancer treated with primary surgery and adjuvant radiation therapy with concurrent chemotherapy. METHODS We retrospectively reviewed the records of 343 patients with early-stage cervical cancer and pathologically proven pelvic lymph node metastasis following curative surgery from 2001 to 2014. No patient had imaging evidence of para-aortic lymph node involvement, and all patients received adjuvant concurrent chemotherapy with or without concurrent chemotherapy. We investigated the significance of para-aortic lymph node sampling or dissection on disease-free survival and overall survival. RESULTS After median follow-up of 58.3 months, 5-year disease-free survival and overall survival in all patients were 69.9 and 80.2%, respectively. Disease-free survival and overall survival did not differ between the para-aortic lymph node dissection group and the No para-aortic lymph node dissection group (P = 0.700 and P = 0.605). However, patients with para-aortic lymph node-positive disease had poorer disease-free survival and overall survival compared with those with para-aortic lymph node-negative disease (P < 0.001 and P < 0.001). CONCLUSIONS This study found no survival benefit of para-aortic lymph node evaluation among patients with International Federation of Gynecology and Obstetrics IIIC1p cervical cancer who were clinically para-aortic lymph node-negative. Although para-aortic lymph node metastasis is a poor prognosticator, the benefit of para-aortic lymph node dissection in terms of survival needs further investigation.
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Affiliation(s)
- Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yeon Joo Kim
- Department of Radiation Oncology, Asan Medical Center, Ulsan University School of Medicine, Seoul, Republic of Korea
| | - Hakyoung Kim
- Department of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young Seok Kim
- Department of Radiation Oncology, Asan Medical Center, Ulsan University School of Medicine, Seoul, Republic of Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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16
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Wang W, Zhou Y, Wang D, Hu K, Zhang F. Prophylactic Extended-Field Irradiation in Patients With Cervical Cancer: A Literature Review. Front Oncol 2020; 10:579410. [PMID: 33123482 PMCID: PMC7567016 DOI: 10.3389/fonc.2020.579410] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/14/2020] [Indexed: 11/13/2022] Open
Abstract
Currently, the standard radiation field for locally advanced cervical cancer patients without evidence of para-aortic lymph node (PALN) metastasis is the pelvis. Due to the low accuracy of imaging in the diagnosis of PALN metastasis and the high incidence of PALN failure after pelvic radiotherapy, prophylactic pelvic and para-aortic irradiation, also called extended-field irradiation (EFI), is performed for patients with cervical cancer. In the era of concurrent chemoradiotherapy, randomized controlled trials are limited, and whether patients with cervical cancer can benefit from prophylactic EFI is still controversial. With conformal or intensity-modulated radiation therapy, patients tolerate prophylactic EFI very well. The severe toxicities of prophylactic EFI are not significantly higher than those of pelvic radiotherapy. We recommend delivering prophylactic EFI to cervical cancer patients with common iliac lymph nodes metastasis. Clinical trials are needed to investigate whether patients with ≥3 positive pelvic lymph nodes and FIGO stage IIIB disease can benefit from prophylactic EFI. According to the distribution of PALNs, it is reasonable to use the renal vein as the upper border of the radiation therapy field for patients treated with prophylactic EFI. The clinical target volume expansion of the node from the vessel should be smaller in the right para-caval region than in the left lateral para-aortic region. The right para-caval region above L2 or L3 may be omitted from the PALN target volume to reduce the dose to the duodenum. More clinical trials on prophylactic EFI in cervical cancer are needed.
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Affiliation(s)
- Weiping Wang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuncan Zhou
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dunhuang Wang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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17
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Díaz-Feijoo B, Franco S, Torné A, Benito V, Hernández A, Lago V, Rovira R, Acosta Ú, Agustí N, Gil-Moreno A. Implications of extraperitoneal paraaortic lymphadenectomy to the left renal vein in locally advanced cervical cancer. A Spanish multicenter study. Gynecol Oncol 2020; 158:287-293. [PMID: 32467055 DOI: 10.1016/j.ygyno.2020.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/04/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Paraaortic lymph node involvement is an important prognostic factor in locally advanced cervical cancer (LACC), but the anatomic limit of aortic lymphadenectomy is controversial. We assessed the impact of extraperitoneal paraaortic lymphadenectomy up to the left renal vein in patients with LACC undergoing pretherapeutic staging. METHODS A retrospective, multicenter study of patients with LACC stages FIGO 2009 IB2 and IIA2-IVA treated in 10 Spanish reference hospitals in gynecological oncology between 2000 and 2016. Sites of metastatic paraaortic lymph nodes above or below the inferior mesenteric artery were evaluated. Procedural-related intraoperative and early and late complications were assessed. RESULTS We included 634 patients undergoing paraaortic lymphadenectomy, in 616 (97.2%) of which the left renal vein was the upper limit of dissection (laparoscopy 592, robotic-assisted 24). The median surgical time was 150 min (interquartile range (IQR) 120-180), blood loss was 50 mL (range 20-80), and the length of stay was 2 days (range 2-3). Metastatic paraaortic involvement was found in 114 patients (18.5%), with infrarenal metastases in 73 (64%) of them. There were 11 patients (9.6%) with infrarenal metastases only, whereas in the remaining 62 (54.4%) patients concomitant infrarenal and inframesenteric metastases were observed. Intraoperative, early, and late postoperative complications occurred in 3.6%, 7.0%, and 4.5% of patients, respectively. CONCLUSIONS In this study of patients with LACC undergoing surgical staging, paraaortic lymphadenectomy up to the left renal vein detected skip or isolated infrarenal metastasis in 9.6% of patients, with an acceptable surgical morbidity.
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Affiliation(s)
- Berta Díaz-Feijoo
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
| | - Silvia Franco
- Gynecological Oncology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Aureli Torné
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
| | - Virginia Benito
- Department of Gynecologic Oncology, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Alicia Hernández
- Department of Gynecology, Hospital Universitario La Paz, Madrid, Spain
| | - Víctor Lago
- Department of Gynecology Oncology, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - Ramón Rovira
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu i San Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Úrsula Acosta
- Gynecological Oncology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuria Agustí
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
| | - Antonio Gil-Moreno
- Gynecological Oncology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Cáncer, CIBERONC, Madrid, Spain.
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18
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Loverix L, Salihi RR, Van Nieuwenhuysen E, Concin N, Han S, van Gorp T, Vergote I. Para-aortic lymph node surgical staging in locally-advanced cervical cancer: comparison between robotic versus conventional laparoscopy. Int J Gynecol Cancer 2020; 30:466-472. [PMID: 32079714 DOI: 10.1136/ijgc-2019-000961] [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: 10/10/2019] [Revised: 12/26/2019] [Accepted: 01/10/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE With the expansion of the use of minimally invasive surgical techniques within the field of gynecological oncology, a robot assisted procedure seems to be an attractive technique for para-aortic lymph node sampling. The aim of this study was to compare robotic versus conventional laparoscopic para-aortic lymphadenectomy in patients with locally advanced cervical cancer. METHODS In this monocentric retrospective study, we included patients with locally-advanced cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB2-IVA or IB1 with suspicious pelvic lymph nodes), who underwent a para-aortic lymphadenectomy up to the inferior mesenteric artery between December 1994 and December 2016 (robotic technique starting from December 2012). RESULTS A total of 217 patients were included in the study (robotic, n=55 vs laparoscopic, n=162). When comparing conventional laparoscopic versus robotic para-aortic lymphadenectomy, the median age was 48 versus 49 years and the median body mass index was 24.4 vs 24.7 kg/m2, respectively. In the robotic or laparoscopic group, 85% and 83% were squamous carcinomas, respectively. Patients who underwent a robotic procedure had a higher American Society of Anesthesiologists (ASA) score (ASA2: 62% vs 56%, ASA3: 20% vs 2%, p<0.001), more prior major abdominal surgery (18% vs 6%, p=0.016), less estimated blood loss (median, 25 mL vs 62.5 mL, p<0.001), more para-aortic lymph nodes removed (11 vs 6, p<0.001), shorter postoperative stay (1.8 vs 2.3 days, p=0.002), and a higher, but non-significant, rate of metastatic para-aortic lymph nodes (13% vs 5%, p=0.065) compared with the laparoscopic procedure, respectively. There was no difference in complication rates between the two approaches. The most frequent complications were grade I and grade II according to the Clavien Dindo classification. No difference was observed in progression-free survival between robotic and laparoscopic para-aortic lymphadenectomy after 2 years (both groups 66%) (p=0.472). Also, 2 year overall survival was similar between the groups (77% vs 81% for robotic vs conventional laparoscopy group, respectively) (p=0.749). CONCLUSION Robotic para-aortic lymphadenectomy in patients with locally-advanced cervical cancer resulted in better perioperative outcomes and similar survival outcomes when compared with a conventional laparoscopic approach.
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Affiliation(s)
- Liselore Loverix
- Gynecological Oncology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Rawand Rokan Salihi
- Gynecological Oncology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Els Van Nieuwenhuysen
- Gynecological Oncology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Nicole Concin
- Department of Gynecology and Obstetrics; Innsbruck Medical Univeristy, Innsbruck, Austria
| | - Sileny Han
- Gynecological Oncology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Toon van Gorp
- Gynecological Oncology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Ignace Vergote
- Gynecological Oncology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
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19
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Horn LC, Brambs CE, Opitz S, Ulrich UA, Höhn AK. [The 2019 FIGO classification for cervical carcinoma-what's new?]. DER PATHOLOGE 2019; 40:629-635. [PMID: 31612260 DOI: 10.1007/s00292-019-00675-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Numerous therapeutic and prognostic studies of cervical carcinoma have necessitated a revision of the FIGO classification.For microinvasive carcinomas, the horizontal dimension is no longer considered and diagnosis and staging will solely be made by the depth of cervical stromal invasion. Lymphovascular invasion beyond the deepest point of stromal infiltration by tumor cells does not alter the stage.There will be a new subclassification of macroinvasive carcinoma confined to the uterine cervix, which will be made by largest tumor extension as follows: FIGO IB1/T1b1 - invasive carcinoma >0.5 cm depth of stromal invasion and ≤2 cm in largest dimension, FIGO IBII/T1b2: - invasive carcinoma >2 cm and ≤4 cm, FIGO IBII/T1b3 - invasive carcinoma >4 cm. Pelvic as well as para-aortic lymph nodes will be defined as regional nodes. Pelvic lymph node metastases only will be categorised as FIGO IIIC1/pN1a and para-aortic lymph node involvement with or without concomitant pelvic involvement will be FIGO IIIC2/pN1b. Uterine corpus as well as adnexal involvement are not relevant for staging purpose.
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Affiliation(s)
- L-C Horn
- Arbeitsgruppe Mamma‑, Gynäko- & Perinatalpathologie, Institut für Pathologie, Universitätsklinikum Leipzig AöR, Liebigstraße 26, 04103, Leipzig, Deutschland.
| | - C E Brambs
- Frauenklinik des Klinikums rechts der Isar, Technische Universität München, München, Deutschland
| | - S Opitz
- Arbeitsgruppe Mamma‑, Gynäko- & Perinatalpathologie, Institut für Pathologie, Universitätsklinikum Leipzig AöR, Liebigstraße 26, 04103, Leipzig, Deutschland
| | - U A Ulrich
- Klinik für Gynäkologie und Geburtshilfe, Martin-Luther-Krankenhaus, Berlin, Deutschland
| | - A K Höhn
- Arbeitsgruppe Mamma‑, Gynäko- & Perinatalpathologie, Institut für Pathologie, Universitätsklinikum Leipzig AöR, Liebigstraße 26, 04103, Leipzig, Deutschland
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20
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Abstract
OBJECTIVE. Imaging plays an important role in the diagnosis and staging of malignancies. Many common lymphoproliferative and other solid tumor malignancies can be viral-related. CONCLUSION. This review discusses the imaging findings that can be associated with common viral-induced malignancies. Knowledge of these imaging presentations can help narrow the differential diagnosis to reach a specific diagnosis through a precise workup and proper management.
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Qu D, Yang Y, Huang X. miR-199a-5p promotes proliferation and metastasis and epithelial-mesenchymal transition through targeting PIAS3 in cervical carcinoma. J Cell Biochem 2019; 120:13562-13572. [PMID: 30937952 DOI: 10.1002/jcb.28631] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/29/2019] [Accepted: 02/04/2019] [Indexed: 12/13/2022]
Abstract
Cervical carcinoma is the second most frequent gynecological malignancies in females worldwide. The objective of this study was to investigate the role of miR-199a-5p and protein inhibitor of activated signal transducer and activators of transcription 3 (PIAS3) in cervical carcinoma. Quantitative reverse transcription polymerase chain reaction was utilized to detect miR-199a-5p and PIAS3 expression in cervical carcinoma tissues and cells. 3-(4,5-Dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide Kit, transwell assay were used to explore the biological functions of miR-199a-5p in cervical carcinoma. Western blot analysis was applied to determine the expression level of epithelial-mesenchymal transition (EMT)-associated proteins and PIAS3 expression. The relationship between miR-199a-5p and PIAS3 was verified by luciferase activity reporter assay. We found that miR-199a-5p was upregulated in cervical carcinoma tissues and cell lines, and overexpression of miR-199a-5p promoted cell proliferation and metastasis in cervical carcinoma. In addition, Western blot analysis indicated that the enforced upregulation of miR-199a-5p enhanced mesenchymal markers vimentin and N-cadherin expressions, whereas reduced epithelial marker E-cadherin expressions. miR-199a-5p directly targeted PIAS3 and negatively regulated PIAS3 level in cervical carcinoma cells. And upregulation of PIAS3 reversed the effects of miR-199a-5p in cervical carcinoma. Collectively, our data provide evidence for miR-199a-5p function in cervical carcinoma growth, EMT, and metastasis; it may be act as a therapeutic strategy target for patients with cervical carcinoma.
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Affiliation(s)
- Dacheng Qu
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, People's Republic of China
| | - Yamei Yang
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, People's Republic of China
| | - Xiaoping Huang
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, People's Republic of China
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22
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Oh J, Seol KH, Choi YS, Lee JW, Bae JY. Clinical significance of lymph node size in locally advanced cervical cancer treated with concurrent chemoradiotherapy. Yeungnam Univ J Med 2019; 36:115-123. [PMID: 31620623 PMCID: PMC6784628 DOI: 10.12701/yujm.2019.00143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 11/05/2022] Open
Abstract
Background This study aimed to assess the in-field lymph node (LN) failure rate according to LN size and to investigate effect of LN size on the survival outcome of patients with locally advanced cervical carcinoma treated with concurrent chemoradiotherapy (CCRT). Methods A total of 310 patients with locally advanced cervical carcinoma treated with CCRT were enrolled in retrospective study. LN status was evaluated by magnetic resonance imaging. All patients received conventional external beam irradiation and high-dose rate brachytherapy, and concurrent cisplatin-based chemotherapy. In-field LN failure rate according to LN size was analyzed. Results The median follow-up period was 83 months (range, 3-201 months). In-field LN failure rate in patients with pelvic LN size more than 10 mm was significantly higher than that in patients with pelvic LN size less than 10 mm (p<0.001). A similar finding was observed in the in-field para-aortic LN (PALN) failure rate (p=0.024). The pelvic and PALN size (≥10 mm) was a significant prognostic factor of overall-survival (OS) and disease-free survival rate in univariate and multivariate analyses. The OS rate was significantly different between groups according to LN size (<10 mm vs. ≥10 mm). Conclusion A LN of less than 10 mm in size in an imaging study is controlled by CCRT. On the other hand, in LN of more than 10 mm in size, the in-field LN failure rate increase and the prognosis deteriorate. Therefore, a more aggressive treatment strategy is needed.
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Affiliation(s)
- Jinju Oh
- Department of Obstetrics and Gynecology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Ki Ho Seol
- Department of Radiation Oncology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Youn Seok Choi
- Department of Obstetrics and Gynecology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jeong Won Lee
- Department of Radiation Oncology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jin Young Bae
- Department of Obstetrics and Gynecology, Catholic University of Daegu School of Medicine, Daegu, Korea
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Poitevin Chacón A, Chavez-Nogueda J, Ramos-Prudencio R, Villavicencio-Queijeiro MA, Lozano-Ruiz F. The role of para-aortic nodal irradiation in cervical cancer. Rep Pract Oncol Radiother 2018; 23:540-546. [PMID: 30534018 DOI: 10.1016/j.rpor.2018.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 08/13/2018] [Accepted: 09/15/2018] [Indexed: 12/20/2022] Open
Abstract
The current standard of care for locally advanced cervical cancer is whole pelvis and para-aortic radiation when indicated, delivered concomitantly with chemotherapy and brachytherapy. Para-aortic node involvement is a predictor of survival in locally advanced disease but presence of metastases is difficult to determine because the currently available imaging methods lack enough sensitivity to be able to detect accurately para-aortic metastases when surgical staging is not feasible. The objective of this review is to describe the current status of para-aortic lymph node irradiation in locally advanced cervical cancer. It includes analysis of the diagnostic imaging and surgical approaches for assessment of para-aortic lymph node dissemination, together with indications for radiotherapy and radiotherapeutic techniques.
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Comparison of pelvic and para-aortic lymphadenectomy versus para-aortic lymphadenectomy alone for locally advanced FIGO stage IB2 to IIB cervical cancer using a propensity score matching analysis: Results from the FRANCOGYN study group. Eur J Surg Oncol 2018; 44:1921-1928. [DOI: 10.1016/j.ejso.2018.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/12/2018] [Accepted: 08/22/2018] [Indexed: 11/23/2022] Open
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25
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The analysis of the long-term outcomes in elderly women treated for locally advanced cervical cancer. J Contemp Brachytherapy 2018; 10:411-417. [PMID: 30479617 PMCID: PMC6251449 DOI: 10.5114/jcb.2018.79334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 10/05/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose Locally advanced cervical cancer (LACC) should be treated with a combination of external irradiation and brachytherapy with concurrent chemotherapy. However, as cervical carcinoma cells can disperse by way of the lymphatic system to either pelvic or para-aortic nodes, planning the extent of radiation requires precise information about the spread of the disease to the lymph nodes, especially to the para-aortic area. Material and methods All of the 75 women included in our study underwent chemoradiotherapy, which started with brachytherapy. Out of them, 54 have undergone radical hysterectomy with lymphadenectomy followed by chemoradiation. We have retrospectively analyzed the 5-year overall survival (OS) rates relative to the lymph node involvement, the type of lymphadenectomy performed (pelvic, para-aortic, or both), the size of the tumor (> or < 4 cm), the histological type, grading, and the age of patients. Results We observed significant differences in the OS rates relative to the age of the patients with LACC. We noted significant differences in the OS rates related to para-aortic lymphadenectomy and presence of lymph node metastases. Conclusions Para-aortic lymphadenectomy seems to have a positive influence on long-term outcomes in the LACC patients, and elderly patients may benefit more from applied therapy.
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Nishio S, Matsuo K, Yonemoto K, Shimokawa M, Hosaka M, Kodama M, Miyake TM, Ushijima K, Kamura T, Westin SN, Soliman PT, Coleman RL. Race and nodal disease status are prognostic factors in patients with stage IVB cervical cancer. Oncotarget 2018; 9:32321-32330. [PMID: 30190789 PMCID: PMC6122357 DOI: 10.18632/oncotarget.25962] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/27/2018] [Indexed: 11/25/2022] Open
Abstract
Background Patients presenting with stage IVB cervical cancer pose a significant clinical challenge. While previous studies described several poor prognostic factors, they were limited by small sample sizes. The aim of this study was to identify clinicopathological prognostic factors in a large sample of patients with stage IVB cervical cancer at a single institution. Methods Patients with primary stage IVB cervical cancer diagnosed between 1992 and 2011 were extracted from a search of the MD Anderson Cancer Center registry. Clinicopathological data retrieved from their medical records included demographics (age and race), tumor characteristics (primary lesion size, grade, and histology), TNM classification, and metastatic site (nodal/organ). Treatment approach (radiation, chemotherapy, or both) and intent (palliation or curative) were recorded. Survival rates were evaluated using the Kaplan-Meier method. Cox proportional hazards regression was used to model the association between key variables and overall survival (OS). Results Two hundred sixty-six patients with stage IVB cervical cancer were identified. Their median OS was 12.7 months. The hazard ratio for African-Americans vs. patients with other ethnicities was 1.76 (95% confidence interval [CI], 1.18-2.54, P = 0.0063), and that for patients with para-aortic nodes alone vs. more extensive metastases was 0.37 (95% CI, 0.26-0.51, P < 0.0001). Other clinicopathological factors were not significantly associated with survival. Conclusions African-American race was an independent adverse prognostic factor in this cohort. On the other hand, nodal disease in the para-aortic chain alone predicted a favorable prognosis.
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Affiliation(s)
- Shin Nishio
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX, USA.,Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Koji Yonemoto
- Biostatistics Center, Kurume University, Kurume, Fukuoka, Japan
| | | | - Masayuki Hosaka
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Michiko Kodama
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Takahito M Miyake
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Kimio Ushijima
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Toshiharu Kamura
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Shannon N Westin
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Pamela T Soliman
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Robert L Coleman
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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Xu LJ, Duan Y, Wang P, Yin HQ. MiR-199b-5p promotes tumor growth and metastasis in cervical cancer by down-regulating KLK10. Biochem Biophys Res Commun 2018; 503:556-563. [PMID: 29807015 DOI: 10.1016/j.bbrc.2018.05.165] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 05/25/2018] [Indexed: 12/12/2022]
Abstract
MiR-199 b-5p and kallikrein-related peptidase 10 (KLK10) are related to various disease processes and pathogenesis. However, little is known about the molecular mechanisms of miR-199 b-5p and KLK10 in human cervical cancer. In the present study, we found that miR-199 b-5p was highly expressed in cervical cancer tissues and cell lines, and was positively correlated with overall survival (OS) and progression-free survival (PFS), higher incidences of larger tumor sizes, late International Federation of Gynecology and Obstetrics (FIGO) stages and preoperative metastasis. Further, we found that transfecting miR-199 b-5p mimics into cervical cancer cells promoted tumor progression through enhancing the cell viability, migration, and suppressing apoptosis by using 3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide (MTT), wound healing and flow cytometry analysis. Luciferase reporter assays indicated that miR-199 b-5p targeted the 3'-untranslated region (3'-UTR) of KLK10. Over-expressing KLK10 reversed the role of miR-199 b-5p in accelerating cervical cancer progression. Suppressing miR-199 b-5p expressions improved apoptosis and reduced the cell viability, while the process was reversed in KLK10-knockdown cervical cancer cells. In vivo analysis verified the effects of miR-199 b-5p on promoting cervical cancer progression, accompanied with reduced KLK10 expressions. In summary, we identified that miR-199 b-5p played as a tumor promoter in cervical cancer cell growth by targeting KLK10, and miR-199 b-5p might function as a novel biomarker for diagnosis or therapeutic targets of human cervical cancer.
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Affiliation(s)
- Li-Juan Xu
- Clinical Laboratory of the First Affiliated Hospital to Zhengzhou University, No. 1 East Jianshe Road, Zhengzhou, Henan, 450052, China
| | - Yu Duan
- Clinical Laboratory of the First Affiliated Hospital to Zhengzhou University, No. 1 East Jianshe Road, Zhengzhou, Henan, 450052, China
| | - Peng Wang
- Center for Tumor Biotherapy, The First Affiliated Hospital and College of Public Health and Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan, 450052, China.
| | - Hui-Qing Yin
- Clinical Laboratory of the First Affiliated Hospital to Zhengzhou University, No. 1 East Jianshe Road, Zhengzhou, Henan, 450052, China.
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Lee J, Lin JB, Chang CL, Sun FJ, Wu MH, Jan YT, Chen YJ. Impact of para-aortic recurrence risk-guided intensity-modulated radiotherapy in locally advanced cervical cancer with positive pelvic lymph nodes. Gynecol Oncol 2018; 148:291-298. [PMID: 29269219 DOI: 10.1016/j.ygyno.2017.12.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/24/2017] [Accepted: 12/03/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES A previous study has suggested the benefit of sub-renal vein radiotherapy (SRVRT) for pelvic lymph node (PLN)-positive cervical cancer. In order to better select patients for SRVRT, this study aimed to evaluate the value of a risk-based radiation field based on PLN location and number in PLN-positive cervical cancer. METHODS We reviewed 198 patients with FIGO stage IB2-IVA cervical cancer, positive PLNs, and negative para-aortic lymph nodes (PALNs) from 2004 to 2015 at two tertiary centers. All patients underwent pelvic radiotherapy (PRT) or SRVRT with IMRT. The SRVRT extended the PRT field cranially to the level of the left renal vein. The prescribed doses were 45-50.4Gy in 1.8Gy per fraction. RESULTS Overall, 118 and 80 patients underwent PRT and SRVRT, respectively. The SRVRT group had more advanced disease based on FIGO stage, common iliac PLNs, and number of PLNs. The median follow-up was 63months (range: 7-151months). PALN failure was experienced by 28 patients (23.7%) in the PRT group and 1 patient (1.3%) in the SRVRT group (p<0.001). Compared with PRT, SRVRT significantly improved 5-year PALN recurrence-free survival (56.8% vs. 100%, p<0.001) and cancer-specific survival (56.5% vs. 93.9%, p<0.001) among patients with common iliac PLNs or ≥3 PLNs. No significant differences were observed in these outcomes among patients with PLNs below the common iliac bifurcation and 1-2 PLNs. The SRVRT did not increase severe toxicities. CONCLUSIONS Risk-based radiation field based on PLN location and number could optimize outcomes for PLN-positive cervical cancer.
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Affiliation(s)
- Jie Lee
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, Taiwan; Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan.
| | - Jhen-Bin Lin
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan
| | - Chih-Long Chang
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Meng-Hao Wu
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, Taiwan
| | - Ya-Ting Jan
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yu-Jen Chen
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, Taiwan.
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Tax C, Abbink K, Rovers MM, Bekkers RLM, Zusterzeel PLM. Para-aortic lymphadenectomy in advanced stage cervical cancer, a protocol for comparing safety, feasibility and diagnostic accuracy of surgical staging versus PET-CT; PALDISC trial. Pilot Feasibility Stud 2018; 4:27. [PMID: 29318031 PMCID: PMC5755440 DOI: 10.1186/s40814-017-0218-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 12/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Currently, a PET-CT is used to assess the need for extended field radiotherapy of para-aortic lymph nodes (PALN) in International Federation of Gynaecology and Obstetrics (FIGO) stage IB2, IIA2-IVA (locally advanced stage) cervical cancer. A small study established a sensitivity and specificity estimate for PALN metastases of 50% (95% CI; 7-93%) and 83% (95% CI; 52-98%), respectively. Surgical staging of PALN may lead to a higher diagnostic accuracy. However, surgical staging of para-aortic lymph nodes in locally advanced stage cervical cancer is not common practice. Therefore, a phase 2 randomised controlled trial is needed to assess its safety and feasibility. METHODS/DESIGN In addition to standard imaging (MRI or CT scan) with PET-CT, 30 adult women with FIGO stage IB2, IIA2-IVA cervical cancer will be randomised to receive either surgical staging or usual PET-CT staging. Administering extended field radiotherapy will be based on lymphadenectomy results for the intervention group and on the PET-CT results for the control group. Follow-up visits at 0, 3, 6, 9 and 12 months will assess health-related quality of life and progression-free survival.Primary safety and feasibility outcomes of surgical staging will be assessed by calculating means with 95% confidence intervals for duration of surgery, number of complications, blood loss, nodal yield after para-aortic lymphadenectomy and treatment delay due to surgical staging. Secondary patient-centred outcomes on quality of life and first year survival will be documented and compared between the two groups. Estimates of sensitivity, specificity and negative and positive predictive values of MRI, PET-CT and surgical staging will be presented with 95% CI.. All analysis will be performed according to the intention to treat principle. DISCUSSION This study will assess safety and feasibility, expressed as the number and severity of complications, effect on quality of life and the treatment delay due to surgically staging para-aortic lymph nodes in locally advanced cervical cancer. It will provide insight in the diagnostic accuracy of the PET-CT and detection rate of missed (micro)metastases due to surgical staging. This information will be used to assess the necessity for a phase 3 study on the diagnostic accuracy of the PET-CT and surgical staging. If a phase 3 study is deemed necessary, current data can be used for sample size calculation of such a phase 3 study. TRIAL REGISTRATION Nederlands Trial Register/Dutch Trial Registry (www.trialregister.nl), NTR4922. Registered on 24 November 2014.
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Affiliation(s)
- Casper Tax
- Department of Operating Rooms 715, Radboud University Medical Centre, Radboudumc Institute for Health Sciences, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Karin Abbink
- Department of Gynaecology, Radboud University Medical Centre, Radboudumc Institute for Health Sciences, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Maroeska M. Rovers
- Department of Operating Rooms 715, Radboud University Medical Centre, Radboudumc Institute for Health Sciences, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
- Department of Health Evidence, Radboud University Medical Centre, Radboudumc Institute for Health Sciences, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Ruud L. M. Bekkers
- Department of Gynaecology, Radboud University Medical Centre, Radboudumc Institute for Health Sciences, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Petra L. M. Zusterzeel
- Department of Gynaecology, Radboud University Medical Centre, Radboudumc Institute for Health Sciences, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
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30
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Zheng D, Mou HP, Diao P, Li XM, Zhang CL, Jiang J, Chen JL, Wang LS, Wang Q, Zhou GY, Chen J, Lin C, Yuan ZP. Chemoradiotherapy in combination with radical surgery is associated with better outcome in cervical cancer patients. Oncotarget 2017; 9:2866-2875. [PMID: 29416819 PMCID: PMC5788687 DOI: 10.18632/oncotarget.23165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/16/2017] [Indexed: 02/05/2023] Open
Abstract
Objectives To retrospectively assess the influence of radical surgery following concurrent chemoradiotherapy (CCRT) on outcomes in cervical cancer (CC) patients. Methods Patients diagnosed with cervical squamous cell carcinoma or adenocarcinoma (FIGO stages IB2 to IIB) at the Yinbin Second People's Hospital between September 2008 and September 2013, were included in this study. Patients were classified into 2 groups based on the treatment received: surgery group (CCRT plus radical surgery) and non-surgery groups (CCRT only). In addition to clinical information, inter-group differences with respect to local control rate (LCR), local recurrence rate (LRR), metastasis rate, overall survival (OS), progress free survival(PFS) and complications were assessed. Results A total of 314 patients were included in the analysis. Parametrial invasion, pelvic lymph node metastasis, tumor diameter > 4 cm and presence of residual disease were risk factors for recurrence in the non-surgery group. In patients with risk factors, radical surgery significantly improved their clinical outcome. The 3-year/5-year LCR in the surgery and non-surgery groups was 88.3%/87.4% and 82.3%/77.5%, respectively (P = 0.04). The 3-year/5-year OS rate in the two groups was 87.1%/81.7% and 72.8%/67.3%, respectively (P = 0.001). The 3-year/5-year LRR in the two groups were 11.7%/12.6% and 17.7%/22.5%, respectively (P = 0.04). The metastasis rates in the two groups were 19.9% and 24.8%, respectively (P = 0.09). Conclusions Surgery following CCRT could improve overall survival and progressfree survival. Radical surgery following CCRT appears to confer significant benefits including an increase in LCRs and decrease in LRR in CC patients with risk factors.
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Affiliation(s)
- Dan Zheng
- Department of Head and Neck and Mammary Gland Oncology, and Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China.,State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, The Cancer Center, Chengdu, Sichuan, 610041, P.R. China
| | - Hua-Ping Mou
- Department of Gynecology, The Second People's Hospital of Sichuan Province, Yibin City, Yibin, Sichuan, 644000, P.R. China
| | - Peng Diao
- Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, 3 University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, P.R. China
| | - Xiao-Ming Li
- Department of Hematology, The First Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, P.R. China
| | - Chuan-Li Zhang
- Department of Gynecology, The Second People's Hospital of Sichuan Province, Yibin City, Yibin, Sichuan, 644000, P.R. China
| | - Jing Jiang
- Department of Gynecology, The Second People's Hospital of Sichuan Province, Yibin City, Yibin, Sichuan, 644000, P.R. China
| | - Jia-Lian Chen
- Department of Gynecology, The Second People's Hospital of Sichuan Province, Yibin City, Yibin, Sichuan, 644000, P.R. China
| | - Li-Shuai Wang
- Department of Oncology, The Second People's Hospital of Sichuan Province, Yibin City, Yibin, Sichuan, 644000, P.R. China
| | - Qiu Wang
- Department of Oncology, The Second People's Hospital of Sichuan Province, Yibin City, Yibin, Sichuan, 644000, P.R. China
| | - Guang-Yuan Zhou
- Department of Oncology, The Second People's Hospital of Sichuan Province, Yibin City, Yibin, Sichuan, 644000, P.R. China
| | - Jie Chen
- Department of Oncology, The Second People's Hospital of Sichuan Province, Yibin City, Yibin, Sichuan, 644000, P.R. China
| | - Chuan Lin
- Department of Oncology, The Second People's Hospital of Sichuan Province, Yibin City, Yibin, Sichuan, 644000, P.R. China
| | - Zhi-Ping Yuan
- Department of Hematology, The First Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, P.R. China.,Department of Oncology, The Second People's Hospital of Sichuan Province, Yibin City, Yibin, Sichuan, 644000, P.R. China
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31
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Benito V, Carballo S, Silva P, Esparza M, Arencibia O, Federico M, Andújar M, Mori M, Medina N, Lubrano A. Should the Presence of Metastatic Para-Aortic Lymph Nodes in Locally Advanced Cervical Cancer Lead to More Aggressive Treatment Strategies? J Minim Invasive Gynecol 2017; 24:609-616. [DOI: 10.1016/j.jmig.2017.01.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/20/2017] [Accepted: 01/25/2017] [Indexed: 11/29/2022]
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Lee J, Lin JB, Chang CL, Jan YT, Sun FJ, Wu MH, Chen YJ. Prophylactic lower para-aortic irradiation using intensity-modulated radiotherapy mitigates the risk of para-aortic recurrence in locally advanced cervical cancer: A 10-year institutional experience. Gynecol Oncol 2017; 146:20-26. [PMID: 28457584 DOI: 10.1016/j.ygyno.2017.04.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 04/20/2017] [Accepted: 04/22/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the effects of prophylactic sub-renal vein radiotherapy (SRVRT) using intensity-modulated radiotherapy (IMRT) for cervical cancer. METHODS A total of 206 patients with FIGO stage IB2-IVA cervical cancer and negative para-aortic lymph nodes (PALNs) who underwent pelvic IMRT (PRT) or SRVRT between 2004 and 2013 at our institution were reviewed. SRVRT cranially extended the PRT field for PALNs up to the left renal vein level. The prescribed dose was consistent 50.4Gy in 28 fractions. RESULTS Overall, 110 and 96 patients underwent PRT and SRVRT, respectively. The SRVRT group had more advanced disease based on FIGO stage and positive pelvic lymph nodes (PLNs). The median follow-up time was 60months (range, 7-143). For the total study population, the 5-year PALN recurrence-free survival (PARFS) and overall survival (OS) for PRT vs. SRVRT were 87.6% vs. 97.9% (p=0.03) and 74.5% vs. 87.8% (p=0.04), respectively. In patients with FIGO III-IVA or positive PLNs, the 5-year PARFS and OS for PRT vs. SRVRT were 80.1% vs. 96.4% (p=0.02) and 58.1% vs. 83.5% (p=0.012), respectively. However, there were no significant differences in these outcomes for patients with FIGO IB-IIB and negative PLNs. In a multivariate analysis, only SRVRT was associated with better PARFS (HR, 0.21; 95% CI, 0.06-0.78; p=0.02). The SRVRT did not significantly increase severe late toxicities. CONCLUSION Prophylactic SRVRT using IMRT reduced PALN recurrence with tolerable toxicities, supporting the application of risk-based radiation fields for cervical cancer.
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Affiliation(s)
- Jie Lee
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, Taiwan; Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Jhen-Bin Lin
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan
| | - Chih-Long Chang
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ya-Ting Jan
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Meng-Hao Wu
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, Taiwan.
| | - Yu-Jen Chen
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, Taiwan.
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Gucer F, Misirlioglu S, Ceydeli N, Taskiran C. Robot-assisted laparoscopic transperitoneal infrarenal lymphadenectomy in patients with locally advanced cervical cancer by single docking: Do we need a backup procedure? J Robot Surg 2017; 12:49-58. [DOI: 10.1007/s11701-017-0685-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/12/2017] [Indexed: 10/20/2022]
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Lee J, Lin JB, Sun FJ, Chen YJ, Chang CL, Jan YT, Wu MH. Safety and efficacy of semiextended field intensity-modulated radiation therapy and concurrent cisplatin in locally advanced cervical cancer patients: An observational study of 10-year experience. Medicine (Baltimore) 2017; 96:e6158. [PMID: 28272204 PMCID: PMC5348152 DOI: 10.1097/md.0000000000006158] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Patients with locally advanced cervical cancer (LACC) are at risk of para-aortic lymph node (PALN) metastasis. Pelvic concurrent chemoradiotherapy, the current standard treatment for LACC, has a PALN failure rate of 9% according to the Radiation Therapy Oncology Group Trial 90-01, suggesting that it may not completely eliminate all microscopic tumors in the PALNs. To minimize the toxicities associated with conventional prophylactic extended-field radiotherapy, our institute use prophylactic semiextended field radiotherapy that includes only the PALNs below the level of the renal vessels. Use of intensity-modulated radiotherapy (IMRT) is another means of reducing the incidence of toxicity. This study evaluated the safety and efficacy of prophylactic semiextended field IMRT (SEF-IMRT) and concurrent cisplatin chemotherapy in patients with LACC.We retrospectively assessed survival and toxicity in 76 patients with stage IB2-IVA cervical cancer and negative PALNs who received prophylactic SEF-IMRT and concurrent weekly cisplatin (40 mg/m) between 2004 and 2013. The region targeted by SEF-IMRT included the PALNs below the level of the renal vessels, and the prescribed dose was 50.4 Gy in 28 fractions. Brachytherapy was administered at a dose of 30 Gy in 6 fractions. Survival outcomes were calculated by using the Kaplan-Meier method, and acute and late toxicities were scored according to the Common Terminology Criteria for Adverse Events, version 3.0.All patients completed the planned SEF-IMRT, as well as brachytherapy. Acute grade ≥3 gastrointestinal, genitourinary, and hematologic toxicities were observed in 2, 0, and 41 patients, respectively. The median follow-up time after SEF-IMRT was 55 (range, 11-124) months. Eight patients developed out-field distant recurrences without PALN failure, and 1 patient experienced out-field PALN failure with simultaneous distant metastasis. No patients had late genitourinary toxicities, and 3 patients had late grade 3 gastrointestinal toxicities. The 5-year overall survival, disease-free survival, local failure-free survival, regional failure-free survival, PALN failure-free survival, and distant metastasis-free survival rates were 85.0%, 84.4%, 96.0%, 97.3%, 98.6%, and 88.4%, respectively.For patients with LACC, prophylactic PALN irradiation up to the level of the renal vessels reduced PALN recurrence and resulted in favorable outcomes with few severe toxicities.
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Affiliation(s)
- Jie Lee
- Department of Radiation Oncology, MacKay Memorial Hospital
- Department of Medicine, MacKay Medical College, Taipei
| | - Jhen-Bin Lin
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua
| | - Fang-Ju Sun
- Department of Medical Research, MacKay Memorial Hospital
- MacKay Junior College of Medicine, Nursing and Management
| | - Yu-Jen Chen
- Department of Radiation Oncology, MacKay Memorial Hospital
- Department of Medicine, MacKay Medical College, Taipei
| | - Chih-Long Chang
- Department of Medicine, MacKay Medical College, Taipei
- Department of Obstetrics and Gynecology
| | - Ya-Ting Jan
- Department of Radiology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Meng-Hao Wu
- Department of Radiation Oncology, MacKay Memorial Hospital
- Department of Medicine, MacKay Medical College, Taipei
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Li H, Wu X, Cheng X. Advances in diagnosis and treatment of metastatic cervical cancer. J Gynecol Oncol 2016; 27:e43. [PMID: 27171673 PMCID: PMC4864519 DOI: 10.3802/jgo.2016.27.e43] [Citation(s) in RCA: 304] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/26/2016] [Accepted: 04/27/2016] [Indexed: 01/20/2023] Open
Abstract
Cervical cancer is one of the most common cancers in women worldwide. The outcome of patients with metastatic cervical cancer is poor. We reviewed the relevant literature concerning the treatment and diagnosis of metastatic cervical cancer. There are two types of metastasis related to different treatments and survival rates: hematogenous metastasis and lymphatic metastasis. Patients with hematogenous metastasis have a higher risk of death than those with lymphatic metastasis. In terms of diagnosis, fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) and PET-computed tomography are effective tools for the evaluation of distant metastasis. Concurrent chemoradiotherapy and subsequent chemotherapy are well-tolerated and efficient for lymphatic metastasis. As for lung metastasis, chemotherapy and/or surgery are valuable treatments for resistant, recurrent metastatic cervical cancer and chemoradiotherapy may be the optimal choice for stage IVB cervical cancer. Chemotherapy and bone irradiation are promising for bone metastasis. A better survival is achieved with multimodal therapy. Craniotomy or stereotactic radiosurgery is an optimal choice combined with radiotherapy for solitary brain metastases. Chemotherapy and palliative brain radiation may be considered for multiple brain metastases and other organ metastases.
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Affiliation(s)
- Haoran Li
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaohua Wu
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xi Cheng
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
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Xu X, Li Z, Qiu X, Wei Z. Diagnosis performance of positron emission tomography-computed tomography among cervical cancer patients. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2016; 24:531-536. [PMID: 27061798 DOI: 10.3233/xst-160569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE This study aims to investigate the value of PET/CT scanning in preoperative diagnosis of cervical carcinoma, especially for detecting lymph node metastasis. MATERIALS AND METHODS The approval of the ethics committee which was granted by our hospital was obtained beforehand. Patients with CC were collected into this investigation between January 2011 and October 2015. Each participant received surgeries, as well as pelvic and paraaortic systematic lymph node dissection. After operations, CC types were confirmed by pathological examinations. The tumor stages were assessed by 3 experienced radiologists independently, according to FIGO examinations and positron emission tomography-computed tomography (PET/CT), and these above diagnostic results were compared with postoperative biopsy pathology, respectively. Statistical analysis was done by SPSS 16.0, and the diagnostic performance of PET/CT was calculated. RESULTS 51 patients were identified in this investigation, and the mean age of these female individuals was 42.3±6.7 years (range, 34-58 years). Depending on statistical analysis, the staging accuracy of PET/CT to detect primary tumors was 84.31%, with sensitivity 88.00% and specificity 80.77%. With respect to lymph nodes, the accuracy could reach 76.47%, with sensitivity 82.61% and specificity 71.43%. On the other hand, FIGO staging performed poorly in detecting primary tumors, with sensitivity 44.12%, specificity 47.06% and accuracy 45.10%. In terms of testing lymph nodes, the diagnosis parameters were as followed, sensitivity 28.57%, specificity 8.70% and accuracy 19.61%. After statistical analysis, there was significantly different between two methods (P < 0.05). CONCLUSIONS PET/CT scanning may be valuable in detecting primary tumors and lymph nodes, and more accurate staging may lead to improving therapeutic planning in CC patients.
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Affiliation(s)
- Xianfeng Xu
- Department of Obstetrics and Gynecology, The Affiliated Clinical College Shenzhen Second People's Hospital, Anhui Medical University, Hefei, P. R. China
| | - Zhenzhou Li
- Department of Ultrasound, The Second People's Hospital of Shenzhen, Shenzhen, P. R. China
| | - Xixiong Qiu
- Department of Radiology, The Second People's Hospital of Shenzhen, Shenzhen, P. R. China
| | - Zhaolian Wei
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, P. R. China
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