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Borghi C, Biagioli E, Mauro J, Roberto A, Borghese M, Buda A. Neoadjuvant chemotherapy prior to radical hysterectomy in locally advanced cervical cancer: a systematic review and meta-analysis. Int J Gynecol Cancer 2023:ijgc-2023-004863. [PMID: 38011989 DOI: 10.1136/ijgc-2023-004863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE The objective of this systematic review was to evaluate the effect of different types of neoadjuvant chemotherapy regimens, in terms of optimal pathological response and oncological outcomes, in patients with locally advanced cervical cancer. METHODS A systematic search of the literature was performed. MEDLINE through PubMed and Embase databases were searched from inception to June 2023. The study was registered in PROSPERO (ID number CRD42023389806). All women with a pathological diagnosis of locally advanced cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) 2009 classification stages IB2-IVA), any age or histology, who underwent intravenous neoadjuvant chemotherapy before radical surgery, and articles only in English language, were included. We conducted a meta-analysis for optimal pathological response after surgery and survival outcomes. The risk of bias was assessed using the Newcastle-Ottawa scale and the Risk of Bias 2 (RoB) tools. The review methods and results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS 25 studies with a total number of 1984 patients fulfilled the eligibility criteria of our review and were included for data extraction and efficacy analysis. When compared with a two-drug regimen, the three-drug combination including cisplatin, paclitaxel, and ifosfamide or anthracyclines showed superior efficacy in terms of optimal pathological response with an odds ratio of 0.38 (95% CI 0.24 to 0.61, p<0.0001), with no difference in disease-free survival (hazard ratio (HR) 0.72, 95% CI 0.50 to 1.03, I2=0%, p=0.07) and higher overall survival (HR 0.63, 95% CI 0.41 to 0.97, I2=0%, p=0.03). CONCLUSIONS The three-drug combination of cisplatin, paclitaxel, and ifosfamide or anthracyclines showed a higher rate of complete or optimal partial response, with the triple regimens having an advantage over the platinum-based schedules in terms of overall survival. Neoadjuvant chemotherapy followed by radical surgery should not be considered a standard of care in locally advanced cervical cancer.
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Affiliation(s)
- Chiara Borghi
- Division of Gynecology Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Piedmont, Italy
| | - Elena Biagioli
- Research, Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milan, Italy
| | - Jessica Mauro
- Division of Gynecology Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Piedmont, Italy
- University of Udine, Udine, Italy
| | - Anna Roberto
- Research, Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milan, Italy
| | - Martina Borghese
- Division of Obstetrics and Gynecology, Ospedale Santa Croce, Cuneo, Piemonte, Italy
| | - Alessandro Buda
- Division of Gynecology Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Piedmont, Italy
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Kasius JC, van der Velden J, Denswil NP, Tromp JM, Mom CH. Neo-adjuvant chemotherapy in fertility-sparing cervical cancer treatment. Best Pract Res Clin Obstet Gynaecol 2021; 75:82-100. [PMID: 33752979 DOI: 10.1016/j.bpobgyn.2021.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/31/2021] [Indexed: 12/20/2022]
Abstract
The current review provides a literature overview of studies assessing the oncological and fertility outcomes of treatment with neo-adjuvant chemotherapy followed by fertility-sparing surgery in patients with cervical cancer >2 cm. Six cohort studies were included showing severe heterogeneity regarding patient selection, chemotherapy regimen, and surgical approach. In total, 111 patients were studied, with overall favorable characteristics. Patients were on average 29 years old, had a tumor of 36 mm, no lymph node metastasis, and response to chemotherapy. In approximately 5-year follow-up, the recurrence rate was 13% (0%-21%) and overall death rate 2.7% (0%-10%). Three patients were alive with recurrent disease (2.7% and 0%-11%). Of the 111 patients, 90 underwent successful fertility-sparing treatment (83%). Roughly one-third conceived and one-fourth had a healthy live-born child. More research is essential to determine proper selection criteria for fertility-sparing treatment of cervical cancer >2 cm and the optimal treatment management.
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Affiliation(s)
- Jenneke C Kasius
- Gynecologic Oncology, Amsterdam University Medical Centre, Amsterdam, Centre for Gynecologic Oncology, Amsterdam, the Netherlands.
| | - Jacobus van der Velden
- Gynecologic Oncology, Amsterdam University Medical Centre, Amsterdam, Centre for Gynecologic Oncology, Amsterdam, the Netherlands
| | | | - Jacqueline M Tromp
- Gynecologic Oncology, Amsterdam University Medical Centre, Amsterdam, Centre for Gynecologic Oncology, Amsterdam, the Netherlands
| | - Constantijne H Mom
- Gynecologic Oncology, Amsterdam University Medical Centre, Amsterdam, Centre for Gynecologic Oncology, Amsterdam, the Netherlands
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3
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Chen B, Wang L, Ren C, Shen H, Ding W, Zhu D, Mao L, Wang H. The Effect of Neoadjuvant Chemotherapy on Lymph Node Metastasis of FIGO Stage IB1-IIB Cervical Cancer: A Systematic Review and Meta-Analysis. Front Oncol 2020; 10:570258. [PMID: 33251136 PMCID: PMC7675063 DOI: 10.3389/fonc.2020.570258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/23/2020] [Indexed: 12/27/2022] Open
Abstract
Objectives This study aimed to assess the effect of neoadjuvant chemotherapy (NACT) on the rate of lymph node metastasis (LNM) in FIGO stage IB1-IIB cervical cancer patients and compare the LNM between NACT plus surgery and surgery only. Methods We identified 34 eligible studies in PubMed, Web of Science, Cochrane Library, and EMBASE from inception to July 27, 2019. Data analyses were performed by Stata (version 13) and Revman (version 5.3). Results In these 34 included studies, the pooled incidence of LNM was estimated as 23% (95% CI, 0.20-0.26; I2 = 79.6%, P<0.001). In the subgroup analysis, we identified five factors, including study type, year of publication, continents from which patients came, histological type and the FIGO stage. When taking FIGO stage into consideration, the LNM rate was 13% in stage IB (95% CI: 0.10-0.15; I2 = 5.5%, P=0.385), 23% in stage IIA (95% CI: 0.18-0.28; I2 = 0%, P=0.622), and 27% in stage IIB (95% CI: 0.20-0.33; I2 = 0%, P=0.898), respectively. Through the comparison between NACT plus surgery and surgery only based on the six randomized controlled trials, the incidence of positive lymph nodes was lower in patients receiving NACT plus surgery than surgery only (RR=0.57, 95% CI: 0.39-0.83; I2 = 60.5%, P=0.027). The 5-year OS was higher in the NACT + surgery group than surgery-only group (RR=1.13, 95% CI: 1.03-1.23; I2 = 0.0%, P=0.842). Conclusions Among cervical cancer in stage IB1-IIB, the preoperative NACT plus radical surgery resulted in a 23% probability of LNM, which was lower than those receiving radical surgery only. In stage IIA and IIB, the effect of NACT to reduce LNM was more obvious.
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Affiliation(s)
- Bingxin Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liming Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ci Ren
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Shen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wencheng Ding
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Da Zhu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lu Mao
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Della Corte L, Barra F, Foreste V, Giampaolino P, Evangelisti G, Ferrero S, Bifulco G. Advances in paclitaxel combinations for treating cervical cancer. Expert Opin Pharmacother 2020; 21:663-677. [DOI: 10.1080/14656566.2020.1724284] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino – IST, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Genoa, Italy
| | - Virginia Foreste
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy
| | - Pierluigi Giampaolino
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giulio Evangelisti
- Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino – IST, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Genoa, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino – IST, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Genoa, Italy
| | - Giuseppe Bifulco
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy
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Rozario SD, Silva IFD, Koifman RJ, Silva IFD. Characterization of women with cervical cancer assisted at Inca by histological type. Rev Saude Publica 2019; 53:88. [PMID: 31596321 PMCID: PMC6776112 DOI: 10.11606/s1518-8787.2019053001218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 12/26/2018] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To determine the distribution of sociodemographic, reproductive, clinical and lifestyle habits in the cohort of women diagnosed with cervical cancer, assisted at Inca between 2012 and 2014, according to the histological type. METHODS Retrospective observational study of a hospital cohort of 1,004 women diagnosed with cervical cancer. Data were obtained from the Inca hospital cancer registry, physical and electronic records. RESULTS The most frequent histological type was squamous cell carcinoma (83.9%). Approximately 70% of the women aged more than 40 years. The study includes non-white women (67.4%), with less than 8 years of education (51.9%), with onset of sexual activity up to 16 years of age (40.7%), who were pregnant before (95.5%), with more than one pregnancy (82.9%), and more than two children (52.7%); 45.8% of the women were smokers or former smokers. Cervical adenocarcinoma was positively associated with earlier staging (IA-IIA) (OR = 1.79; 95%CI 1.03–3.13), as well as women with ≥ 12 years of education (OR = 6.30; 95%CI 1.97–20,13), who had no children (OR = 3.81; 95%CI 1.20 – 12,08) or who had up to two children (OR = 1.74; 95%CI 1.05 – 2,87). CONCLUSIONS The difference between histological types is highlighted, suggesting that women with cervical adenocarcinoma may represent a distinct clinical entity of cervical neoplasia, which may require different approaches from those used in squamous cell carcinoma.
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Affiliation(s)
- Suelem do Rozario
- Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Auroca. Programa de Saúde Pública e Meio Ambiente. Rio de Janeiro, RJ, Brasil
| | - Iléia Ferreira da Silva
- Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Auroca. Programa de Saúde Pública e Meio Ambiente. Rio de Janeiro, RJ, Brasil
| | - Rosalina Jorge Koifman
- Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Auroca. Departamento de Epidemiologia e Métodos Quantitativos em Saúde. Rio de Janeiro, RJ, Brasil
| | - Ilce Ferreira da Silva
- Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Auroca. Departamento de Epidemiologia e Métodos Quantitativos em Saúde. Rio de Janeiro, RJ, Brasil
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Varan C, Şen M, Sandler N, Aktaş Y, Bilensoy E. Mechanical characterization and ex vivo evaluation of anticancer and antiviral drug printed bioadhesive film for the treatment of cervical cancer. Eur J Pharm Sci 2019; 130:114-123. [PMID: 30690187 DOI: 10.1016/j.ejps.2019.01.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/23/2019] [Accepted: 01/24/2019] [Indexed: 01/10/2023]
Abstract
As research progresses on personalized medicines, it is clear that personalized and flexible formulations can provide effective treatment with reduced side effects especially for diseases like cancer, characteristic of high patient variability. 2D and 3D printers are frequently reported in the literature for the preparation of pharmaceutical products with adjusted dose and selected drug combinations. However, in-depth characterization studies of these formulations are rather limited. In this paper, ex vivo and mechanical characterization studies of antiviral and anticancer drug printed film formulations designed for personalized application were performed. Effects of the printing process with pharmaceutical formulations such as paclitaxel (PCX):cyclodextrin (CD) complex or cidofovir (CDV) encapsulated into poly(ethylene glycol)-polycaprolactone (PEG-PCL) nanoparticles on the films were evaluated through a series of mechanical characterization studies. Inkjet printing process was found to cause no significant change in the thicknesses of the film formulations, while mechanical strength and surface free energy increased and nano-sized voids in the film structure decreased. According to the mechanical characterization data, the unprinted film had maximum force (Fmax) value of 15.6 MPa whereas Fmax increased to 43.8 MPa for PCX:CD complex printed film and to 37.7 MPa for the antiviral CDV-PEG-PCL nanoparticle printed film. In the light of ex vivo findings of sheep cervix-uterine tissue, bioadhesive properties of film formulations significantly improved after inkjet printing with different drug formulations. It has also been shown that the anticancer formulation printed on the film was maintained at the cervix tissue surface for >12 h. This study has shown for the first time that inkjet printing process does not adversely affect the mechanical properties of the bioadhesive film formulations. It has also been shown that durable bioadhesive film formulations for personalized dosing can be prepared by combining nanotechnology and inkjet printing.
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Affiliation(s)
- Cem Varan
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, 06100, Sıhhiye, Ankara, Turkey.
| | - Murat Şen
- Department of Chemistry, Faculty of Science, Hacettepe University, 06800, Beytepe, Ankara, Turkey
| | - Niklas Sandler
- Pharmaceutical Sciences Laboratory, Faculty of Science and Engineering, Åbo Akademi University, 20520 Turku, Finland
| | - Yeşim Aktaş
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Erciyes University, 38039, Kayseri, Turkey
| | - Erem Bilensoy
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, 06100, Sıhhiye, Ankara, Turkey
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Folate Receptor Alpha Expression in Platinum Resistant/Refractory Ovarian Carcinomas and Primary Endocervical Adenocarcinomas. Appl Immunohistochem Mol Morphol 2018; 26:567-572. [DOI: 10.1097/pai.0000000000000476] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Impact of Blood Transfusions on Survival of Locally Advanced Cervical Cancer Patients Undergoing Neoadjuvant Chemotherapy Plus Radical Surgery. Int J Gynecol Cancer 2018; 27:514-522. [PMID: 28129238 DOI: 10.1097/igc.0000000000000902] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Transfusions represent one of the main progresses of modern medicine. However, accumulating evidence supports that transfusions correlate with worse survival outcomes in patients affected by solid cancers. In the present study, we aimed to investigate the effects of perioperative blood transfusion in locally advanced cervical cancer. METHODS Data of consecutive patients affected by locally advanced cervical cancer scheduled to undergo neoadjuvant chemotherapy plus radical surgery were retrospectively searched to test the impact of perioperative transfusions on survival outcomes. Five-year survival outcomes were evaluated using Kaplan-Meier and Cox models. RESULTS The study included 275 patients. Overall, 170 (62%) patients had blood transfusion. Via univariate analysis, we observed that transfusion correlated with an increased risk of developing recurrence (hazard ratio [HR], 2.2; 95% confidence interval [CI], 1.09-4.40; P = 0.02). Other factors associated with 5-year disease-free survival were noncomplete clinical response after neoadjuvant chemotherapy (HR, 2.99; 95% CI, 0.92-9.63; P = 0.06) and pathological (P = 0.03) response at neoadjuvant chemotherapy as well as parametrial (P = 0.004), vaginal (P < 0.001), and lymph node (P = 0.002) involvements. However, via multivariate analysis, only vaginal (HR, 3.07; 95% CI, 1.20-7.85; P = 0.01) and lymph node involvements (HR, 2.4; 95% CI, 1.00-6.06; P = 0.05) correlate with worse disease-free survival. No association with worse outcomes was observed for patients undergoing blood transfusion (HR, 2.71; 95% CI, 0.91-8.03; P = 0.07). Looking at factors influencing overall survival, we observed that lymph node status (P = 0.01) and vaginal involvement (P = 0.06) were independently associated with survival. CONCLUSIONS The role of blood transfusions in increasing the risk of developing recurrence in LAAC patients treated by neoadjuvant chemotherapy plus radical surgery remains unclear; further prospective studies are warranted.
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9
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Varan C, Wickström H, Sandler N, Aktaş Y, Bilensoy E. Inkjet printing of antiviral PCL nanoparticles and anticancer cyclodextrin inclusion complexes on bioadhesive film for cervical administration. Int J Pharm 2017; 531:701-713. [PMID: 28432016 DOI: 10.1016/j.ijpharm.2017.04.036] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/10/2017] [Accepted: 04/16/2017] [Indexed: 11/28/2022]
Abstract
Personalized medicine is an important treatment approach for diseases like cancer with high intrasubject variability. In this framework, printing is one of the most promising methods since it permits dose and geometry adjustment of the final product. With this study, a combination product consisting of anticancer (paclitaxel) and antiviral (cidofovir) drugs was manufactured by inkjet printing onto adhesive film for local treatment of cervical cancers as a result of HPV infection. Furthermore, solubility problem of paclitaxel was overcome by maintaining this poorly soluble drug in a cyclodextrin inclusion complex and release of cidofovir was controlled by encapsulation in polycaprolactone nanoparticles. In vitro characterization studies of printed film formulations were performed and cell culture studies showed that drug loaded film formulation was effective on human cervical adenocarcinoma cells. Our study suggests that inkjet printing technology can be utilized in the development of antiviral/anticancer combination dosage forms for mucosal application. The drug amount in the delivery system can be accurately controlled and modified. Moreover, prolonged drug release time can be obtained. Printing of anticancer and antiviral drugs on film seem to be a potential approach for HPV-related cervical cancer treatment and a good candidate for further studies.
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Affiliation(s)
- Cem Varan
- Department of Nanotechnology and Nanomedicine, Graduate School of Science and Engineering, Hacettepe University, Ankara, Turkey
| | - Henrika Wickström
- Pharmaceutical Sciences Laboratory, Faculty of Science and Engineering, Åbo Akademi University, Turku, Finland
| | - Niklas Sandler
- Pharmaceutical Sciences Laboratory, Faculty of Science and Engineering, Åbo Akademi University, Turku, Finland
| | - Yeşim Aktaş
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Erciyes University, Kayseri, Turkey
| | - Erem Bilensoy
- Department of Nanotechnology and Nanomedicine, Graduate School of Science and Engineering, Hacettepe University, Ankara, Turkey; Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey.
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10
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Zutshi V, Makkar B, Garg A, Batra S. Transvaginal Sonography Versus Cystoscopy for Detecting Urinary Bladder Invasion in Early Stage Cervical Cancer. J Clin Diagn Res 2017; 11:QC01-QC03. [PMID: 28384936 DOI: 10.7860/jcdr/2017/21791.9343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/26/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Cervical cancer is a major cause of mortality from cancer among women. In it's early stage pre operative staging with cystoscopy is a standard procedure for the detection of urinary bladder involvement. AIM The present study was conducted with the aim to compare the efficacy of Transvaginal Sonography (TVS) and cystoscopy in diagnosing bladder involvement in early stage cervical cancer patients by confirming it intraoperatively and further by histopathologic examination. MATERIALS AND METHODS A prospective partially blinded study was conducted between March 2006 and September 2008 on 30 patients with early stage cervical cancer (Stage I and IIa) who were planned to undergo radical hysterectomy. Pre operatively, these patients underwent both TVS and cystoscopy to diagnose bladder involvement. Presence or absence of bladder involvement was then confirmed intra operatively and by histopathologic examination. RESULTS In all the 30 patients studied, no bladder involvement was seen on cystoscopy where as TVS showed bladder involvement in three patients. Involvement of the bladder in these three patients was confirmed intra operatively and by histopathologic examination. Thus, in our study, TVS was 100% sensitive in detecting bladder involvement. CONCLUSION TVS is highly sensitive in diagnosing bladder involvement in early stage cervical cancer and could potentially detect cases missed with a cystoscopy.
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Affiliation(s)
- Vijay Zutshi
- Senior Specialist, Department oif Obstetrics and Gynecology, Safdarjung Hospital , New Delhi, India
| | - Binni Makkar
- Clinical Associate, Department of Obstetrics and Gynecology, Fortis Hospital , Shalimar Bagh, New Delhi, India
| | - Anju Garg
- Director, Head of Department and Professor, Department of Radiology, Maulana Azad Medical College , New Delhi, India
| | - Swaraj Batra
- Head of Department, Department of Obstetrics and Gynecology, Hamdard Institute of Science and Medical Research , New Delhi, India
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Martinelli F, Signorelli M, Bogani G, Ditto A, Chiappa V, Perotto S, Scaffa C, Lorusso D, Raspagliesi F. Is aortic lymphadenectomy indicated in locally advanced cervical cancer after neoadjuvant chemotherapy followed by radical surgery? A retrospective study on 261 women. Eur J Surg Oncol 2016; 42:1512-8. [PMID: 27378160 DOI: 10.1016/j.ejso.2016.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 05/02/2016] [Accepted: 06/09/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of this study was to estimate the rate of aortic lymph nodes (LN) metastases/recurrences among patients affected by locally advanced stage cancer patients (LACC), treated with neoadjuvant chemotherapy (NACT) and radical surgery. METHODS Retrospective evaluation of consecutive 261 patients affected by LACC (stage IB2-IIB), treated with NACT followed by radical surgery at National Cancer Institute, Milan, Italy, between 1990 and 2011. RESULTS Stage at presentation included stage IB2, IIA and IIB in 100 (38.3%), 50 (19.2%) and 111 (42.5%) patients, respectively. Squamous cell carcinoma accounted for more than 80%, followed by adenocarcinoma or adenosquamous cancers (20%). Overall, 56 women (21.5%) had LN metastases. Four out of 83 women (5%) who underwent both pelvic and aortic LN dissection had aortic LN metastases, and all women had concomitant pelvic and aortic LN metastases. Only one woman out of 178 (0.5%) who underwent pelvic lymphadenectomy only, had an aortic LN recurrence. Overall 2% of women (5/261) had aortic LN metastases/recurrence. CONCLUSIONS Our data suggest that aortic lymphadenectomy at the time of surgery is not routinely indicated in LACC after NACT, but should reserved in case of bulky LN in both pelvic and/or aortic area. The risk of isolated aortic LN relapse is negligible. Further prospective studies are warranted.
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Affiliation(s)
- F Martinelli
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
| | - M Signorelli
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - G Bogani
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
| | - A Ditto
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - V Chiappa
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - S Perotto
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - C Scaffa
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - D Lorusso
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - F Raspagliesi
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
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12
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Optimal pathological response indicated better long-term outcome among patients with stage IB2 to IIB cervical cancer submitted to neoadjuvant chemotherapy. Sci Rep 2016; 6:28278. [PMID: 27325186 PMCID: PMC4915007 DOI: 10.1038/srep28278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 05/31/2016] [Indexed: 12/31/2022] Open
Abstract
The role of pathological response in long-term outcome is still unclear in cervical cancer patients treated with neoadjuvant chemotherapy (NACT) in China. This study aimed to investigate the effect of optimal pathologic response (OPR) on survival in the patients treated with NACT and radical hysterectomy. First, 853 patients with stage IB2-IIB cervical cancer were included in a retrospective analysis; a Cox proportional hazards model was used to investigate the relationship between pathological response and disease-free survival (DFS). In the retrospective database, 64 (7.5%) patients were found to have achieved an OPR (residual disease <3 mm stromal invasion); in the multivariate Cox model, the risk of death was much greater in the non-OPR group than in the OPR group (HR, 2.61; 95%CI, 1.06 to 6.45; P = 0.037). Next, the role of OPR was also evaluated in a prospective cohort of 603 patients with cervical cancer. In the prospective cohort, 56 (9.3%) patients were found to have achieved an OPR; the log-rank tests showed that the risk of recurrence was higher in the non-OPR patients than in the OPR group (P = 0.05). After combined analysis, OPR in cervical cancer was found to be an independent prognostic factor for DFS.
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Peng YH, Wang XX, Zhu JS, Gao L. Neo-adjuvant chemotherapy plus surgery versus surgery alone for cervical cancer: Meta-analysis of randomized controlled trials. J Obstet Gynaecol Res 2016; 42:128-35. [PMID: 26807961 DOI: 10.1111/jog.12896] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 09/08/2015] [Accepted: 10/05/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Yun-Hua Peng
- First Hospital of Lanzhou University; Lanzhou City Gansu Province China
| | - Xin-Xiu Wang
- General Hospital of Lanzhou Petrochemical Company; Lanzhou City Gansu Province China
| | - Jing-Song Zhu
- First Hospital of Lanzhou University; Lanzhou City Gansu Province China
| | - Li Gao
- First Hospital of Lanzhou University; Lanzhou City Gansu Province China
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14
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Papadia A, Bellati F, Bogani G, Ditto A, Martinelli F, Lorusso D, Donfrancesco C, Gasparri ML, Raspagliesi F. When Does Neoadjuvant Chemotherapy Really Avoid Radiotherapy? Clinical Predictors of Adjuvant Radiotherapy in Cervical Cancer. Ann Surg Oncol 2015; 22 Suppl 3:S944-51. [PMID: 26268452 DOI: 10.1245/s10434-015-4799-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of this study was to identify clinical variables that may predict the need for adjuvant radiotherapy after neoadjuvant chemotherapy (NACT) and radical surgery in locally advanced cervical cancer patients. METHODS A retrospective series of cervical cancer patients with International Federation of Gynecology and Obstetrics (FIGO) stages IB2-IIB treated with NACT followed by radical surgery was analyzed. Clinical predictors of persistence of intermediate- and/or high-risk factors at final pathological analysis were investigated. Statistical analysis was performed using univariate and multivariate analysis and using a model based on artificial intelligence known as artificial neuronal network (ANN) analysis. RESULTS Overall, 101 patients were available for the analyses. Fifty-two (51 %) patients were considered at high risk secondary to parametrial, resection margin and/or lymph node involvement. When disease was confined to the cervix, four (4 %) patients were considered at intermediate risk. At univariate analysis, FIGO grade 3, stage IIB disease at diagnosis and the presence of enlarged nodes before NACT predicted the presence of intermediate- and/or high-risk factors at final pathological analysis. At multivariate analysis, only FIGO grade 3 and tumor diameter maintained statistical significance. The specificity of ANN models in evaluating predictive variables was slightly superior to conventional multivariable models. CONCLUSIONS FIGO grade, stage, tumor diameter, and histology are associated with persistence of pathological intermediate- and/or high-risk factors after NACT and radical surgery. This information is useful in counseling patients at the time of treatment planning with regard to the probability of being subjected to pelvic radiotherapy after completion of the initially planned treatment.
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Affiliation(s)
- Andrea Papadia
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy
| | - Filippo Bellati
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy. .,Department of Gynecology Obstetrics and Urology, 'Sapienza' University of Rome, Rome, Italy.
| | - Giorgio Bogani
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy
| | - Antonino Ditto
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy
| | - Fabio Martinelli
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy
| | - Domenica Lorusso
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy
| | - Cristina Donfrancesco
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy.,Department of Gynecology Obstetrics and Urology, 'Sapienza' University of Rome, Rome, Italy
| | - Maria Luisa Gasparri
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy.,Department of Gynecology Obstetrics and Urology, 'Sapienza' University of Rome, Rome, Italy
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15
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Martinelli F, Bogani G, Ditto A, Carcangiu M, Papadia A, Lecce F, Chiappa V, Lorusso D, Raspagliesi F. How often parametrial involvement leads to post-operative adjuvant treatment in locally advanced cervical cancer after neoadjuvant chemotherapy and type C radical hysterectomy? Eur J Surg Oncol 2015; 41:1089-96. [DOI: 10.1016/j.ejso.2015.03.228] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/04/2015] [Accepted: 03/18/2015] [Indexed: 01/22/2023] Open
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16
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Gui T, Shen K, Xiang Y, Pan L, Lang J, Wu M, Huang H, Cao D, Yang J. Neoadjuvant chemotherapy in locally advanced cervical carcinoma: which is better, intravenous or intra-arterial? Onco Targets Ther 2014; 7:2155-60. [PMID: 25473297 PMCID: PMC4251753 DOI: 10.2147/ott.s67633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of our study is to investigate the differences in therapeutic effects and clinical significance between intravenous systematic chemotherapy and intra-arterial interventional chemotherapy in stage Ib2–IIb cervical carcinomas. Methods A retrospective analysis was performed on 93 cases of intravenous and 118 cases of intra-arterial neoadjuvant chemotherapy for stage Ib2–IIb cervical carcinomas treated in Peking Union Medical College Hospital from the year 2001 to 2010. Results After neoadjuvant chemotherapy, the overall response rate was 84.9% versus (vs) 88.2% and the operability rate was 77.4% vs 81.4%, for intravenous vs intra-arterial (P>0.05). There were no significant differences in toxicities, surgical duration, perioperative blood loss, and operative complications between these two groups. Postoperative pathological examination revealed a significantly lower parametrial infiltration in the intra-arterial group (12.5% vs 38.1%, P<0.05), while the positive vaginal margin, lymph node metastasis, and intravascular tumor embolus showed no significant differences. The intravenous group and the intra-arterial group had similar recurrence rate (16.0% vs 12.3%), distant metastasis rate (9.1% vs 8.5%), and 5 year survival rate (79.5% vs 84.9%), without significant differences. Conclusion Neoadjuvant chemotherapy with cisplatin and 5-fluorouracil are safe and effective for patients with locally advanced cervical carcinomas. The intravenous and the intra-arterial approaches present with similar chemotherapy efficacy and clinical outcome. Since it is more simple and economical, the intravenous systematic approach shows greater value in clinical application.
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Affiliation(s)
- Ting Gui
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Lingya Pan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Jinghe Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Ming Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Huifang Huang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
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