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Di Donna MC, Cucinella G, Giallombardo V, Sozzi G, Bizzarri N, Scambia G, Pecorino B, Scollo P, Berretta R, Capozzi VA, Laganà AS, Chiantera V. Urinary, Gastrointestinal, and Sexual Dysfunctions after Chemotherapy, Radiotherapy, Radical Surgery or Multimodal Treatment in Women with Locally Advanced Cervical Cancer: A Multicenter Retrospective Study. Cancers (Basel) 2023; 15:5734. [PMID: 38136280 PMCID: PMC10741503 DOI: 10.3390/cancers15245734] [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: 11/09/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Different strategies have been proposed for the treatment of locally advanced cervical cancer (LACC), with different impacts on patient's quality of life (QoL). This study aimed to analyze urinary, bowel, and sexual dysfunctions in a series of LACC patients who underwent chemotherapy, radiotherapy, radical surgery, or a combination of these treatments. METHODS Patients with LACC who underwent neoadjuvant radio-chemotherapy (NART/CT; n = 35), neoadjuvant chemotherapy (NACT; n = 17), exclusive radio-chemotherapy (ERT/CT; n = 28), or upfront surgery (UPS; n = 10) from November 2010 to September 2019 were identified from five oncological referral centers. A customized questionnaire was used for the valuation of urinary, gastrointestinal, and sexual dysfunctions. RESULTS A total of 90 patients were included. Increased urinary frequency (>8 times/day) was higher in ERT/CT compared with NACT/RT (57.1% vs. 28.6%; p = 0.02) and NACT (57.1% vs. 17.6%; p = 0.01). The use of sanitary pads for urinary leakage was higher in ERT/CT compared with NACT/RT (42.9% vs. 14.3%; p = 0.01) and NACT (42.9% vs. 11.8%; p = 0.03). The rate of reduced evacuations (<3 times a week) was less in UPS compared with NACT/RT (50% vs. 97.1%; p < 0.01), NACT (50% vs. 88.2, p < 0.01), and ERT/CT (50% vs. 96.4%; p < 0.01). A total of 52 women were not sexually active after therapy, and pain was the principal reason for the avoidance of sexual activity. CONCLUSIONS The rate and severity of urinary, gastrointestinal, and sexual dysfunction were similar in the four groups of treatment. Nevertheless, ERT/CT was associated with worse sexual and urinary outcomes.
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Affiliation(s)
- Mariano Catello Di Donna
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, 90127 Palermo, Italy; (M.C.D.D.); (V.G.)
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, 90133 Palermo, Italy
| | - Giuseppe Cucinella
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, 90133 Palermo, Italy
- Gynecologic Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy
| | - Vincenzo Giallombardo
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, 90127 Palermo, Italy; (M.C.D.D.); (V.G.)
| | - Giulio Sozzi
- Department of Obstetrics and Gynecology, Fondazione Istituto G. Giglio, 90015 Cefalù, Italy;
- Dipartimento della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Nicolò Bizzarri
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito 1, 00168 Rome, Italy; (N.B.); (G.S.)
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito 1, 00168 Rome, Italy; (N.B.); (G.S.)
- Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Basilio Pecorino
- Maternal and Child Department, Obstetrics and Gynecology, Cannizzaro Hospital, 95100 Catania, Italy; (B.P.); (P.S.)
- Maternal and Child Department, University of Enna “Kore”, 94100 Enna, Italy
| | - Paolo Scollo
- Maternal and Child Department, Obstetrics and Gynecology, Cannizzaro Hospital, 95100 Catania, Italy; (B.P.); (P.S.)
- Maternal and Child Department, University of Enna “Kore”, 94100 Enna, Italy
| | - Roberto Berretta
- Department of Obstetrics and Gynecology, University of Parma, 43125 Parma, Italy; (R.B.); (V.A.C.)
| | - Vito Andrea Capozzi
- Department of Obstetrics and Gynecology, University of Parma, 43125 Parma, Italy; (R.B.); (V.A.C.)
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, 90127 Palermo, Italy;
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy
| | - Vito Chiantera
- Gynecologic Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy
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Mauro GP, de Aquino Calheiros V, Vonsowski MS, Avelar T, de Andrade Carvalho H. Curative treatment for stage IIIC2 cervical cancer: what to expect? Rep Pract Oncol Radiother 2023; 28:332-339. [PMID: 37795398 PMCID: PMC10547400 DOI: 10.5603/rpor.a2023.0036] [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: 02/26/2023] [Accepted: 06/05/2023] [Indexed: 10/06/2023] Open
Abstract
Background Since the GOG125 study, treating radically patients with positive para-aortic lymph nodes has been a valid approach. Nevertheless, literature lacks data on how to better treat these patients since they are usually excluded from trials. In this study, we aimed to report the outcomes of patients with advanced cervical cancer and positive para-aortic lymph nodes (PAN) treated in a single tertiary/academic institution and try to identify variables that may impact survival. Materials and methods We retrospectively reviewed patients with positive para-aortic lymph nodes treated in our institution. Demographic variables and treatment options were assessed and their impact on overall survival (OS), locorregional control, distant metastasis free survival, and para-aortic lymph node progression was analyzed. Results We assessed 65 patients treated from April 2010 to May 2017. Median OS was 38.7 months. Median locorregional and para-aortic progression free survivals were not reached. Median distant metastasis progression-free survival was 64.3 months. Better ECOG performance status (p > 0.001), concurrent chemotherapy (p = 0.031), and brachytherapy (p = 0.02) were independently related to better overall survival. Conclusion Patients with current stage IIIC2 cervix cancer may present long term survival. Treating positive PAN cervical cancer patients with concurrent chemoradiation including brachytherapy with curative intent should be standard. Poor PS and more advanced pelvic disease may represent a higher risk for worse outcomes. Distant metastases are still a challenge for disease control.
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Affiliation(s)
- Geovanne Pedro Mauro
- Department of Radiology and Oncology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Santa Cruz Oncology Center, Santa Cruz Japanese Hospital, São Paulo, SP, Brazil
| | - Vinicius de Aquino Calheiros
- Department of Radiology and Oncology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Matheus Sorgi Vonsowski
- Department of Radiology and Oncology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Talita Avelar
- Department of Radiology and Oncology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Heloisa de Andrade Carvalho
- Department of Radiology and Oncology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Santa Cruz Oncology Center, Santa Cruz Japanese Hospital, São Paulo, SP, Brazil
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Re GL, Cucinella G, Zaccaria G, Crapanzano A, Salerno S, Pinto A, Casto AL, Chiantera V. Role of MRI in the assessment of cervical cancer. Semin Ultrasound CT MR 2023; 44:228-237. [DOI: 10.1053/j.sult.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Martinez A, Lecuru F, Bizzarri N, Chargari C, Ducassou A, Fagotti A, Fanfani F, Scambia G, Cibula D, Díaz-Feijoo B, Gil Moreno A, Angeles MA, Muallem MZ, Kohler C, Luyckx M, Kridelka F, Rychlik A, Gerestein KG, Heinzelmann V, Ramirez PT, Frumovitz M, Ferron G, Betrian S, Filleron T, Fotopoulou C, Querleu D. PARa-aOrtic LymphAdenectomy in locally advanced cervical cancer (PAROLA trial): a GINECO, ENGOT, and GCIG study. Int J Gynecol Cancer 2023; 33:293-298. [PMID: 36717163 DOI: 10.1136/ijgc-2022-004223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Positron emission tomography/computed tomography (PET/CT) fails to detect approximately 25% of aortic lymph node metastasis in patients with PET/CT stage IIIC1 cervical cancer. Surgical staging could lead to treatment modification and to improved para-aortic and distant control. PRIMARY OBJECTIVES To demonstrate if chemoradiation with tailored external beam radiation field based on surgical staging and pathologic examination of the para-aortic lymph node is associated with improved 3-year disease-free survival compared with patients staged with PET/CT staging only. STUDY HYPOTHESIS Surgical staging followed by tailored chemoradiation will improve disease-free survival while avoiding unnecessary prophylactic extended-field chemoradiation in patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC1 cervical cancer. TRIAL DESIGN This is an international multicenter, randomized, phase III study. Eligible patients will be randomized 1:1 between PET/CT staging followed by chemoradiation (control arm), or surgical staging followed by tailored chemo-radiation (experimental arm). Randomization will be stratified by tumor stage according to TNM classification, center, and adjuvant treatment. MAJOR INCLUSION/EXCLUSION CRITERIA Main inclusion criteria are histologically proven PET/CT FIGO stage IIIC1 cervical cancer. Main exclusion criteria include unequivocal positive common iliac or para-aortic lymph node at pre-therapeutic imaging PET/CT. PRIMARY ENDPOINTS The primary endpoint is disease-free survival defined as the time from randomization until first relapse (local, regional, or distant), or death from any cause. SAMPLE SIZE 510 eligible patients ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS: The estimated date for completing accrual will be Q2 2027. The estimated date for presenting results will be Q4 2030. TRIAL REGISTRATION NUMBER NCT05581121.
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Affiliation(s)
- Alejandra Martinez
- Surgical Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
- Centre de Recherches en Cancérologie de Toulouse, INSERM UMR 1037, Toulouse, France
| | - Fabrice Lecuru
- Breast, Gynecology and Reconstructive Surgery Unit, Institute Curie, Paris, France
| | - Nicolò Bizzarri
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Cyrus Chargari
- Radiotherapy Department, Hôpital Pitié-Salpêtrière AP-HP, Paris, France
| | - Anne Ducassou
- Radiotherapy Department, Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse Oncopole, France, Toulouse, France
| | - Anna Fagotti
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Francesco Fanfani
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - David Cibula
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital (Central and Eastern European Gynecologic Oncology Group CEEGOG), Prague, Czech Republic
| | - Berta Díaz-Feijoo
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institutd'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Antonio Gil Moreno
- Gynecologic Oncology, Department of Obstetrics and Gynecology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Martina Aida Angeles
- Gynecologic Oncology, Department of Obstetrics and Gynecology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mustafa Zelal Muallem
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christhardt Kohler
- Department of Special Operative and Oncologic Gynecology, Asklepios-Clinic Hamburg-Altona, Asklepios Hospital Group, Hamburg, Germany
| | - Mathieu Luyckx
- Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Frederic Kridelka
- Department of Obstetrics and Gynecology, University of Liège, Liege, Belgium
| | - Agnieszka Rychlik
- Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, Warsaw, Poland
| | - K G Gerestein
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Viola Heinzelmann
- Obstetric and Gynaecology, University of Basel Faculty of Medicine, Zurich, Switzerland
| | - Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael Frumovitz
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Gwenael Ferron
- Surgical Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Sarah Betrian
- Medical Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Thomas Filleron
- Biostatistics & Health Data Science Unit, Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Christina Fotopoulou
- Gynaecologic Oncology, Imperial College London Faculty of Medicine, London, London, UK
| | - Denis Querleu
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
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Cui H, Huang Y, Wen W, Li X, Xu D, Liu L. Prognostic value of lymph node ratio in cervical cancer: A meta-analysis. Medicine (Baltimore) 2022; 101:e30745. [PMID: 36281189 PMCID: PMC9592518 DOI: 10.1097/md.0000000000030745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The role of the lymph node ratio (LNR) in the existing tumor node metastasis classification system should be verified as one of the prognosis prediction factors. This work evaluated LNR's performance in predicting cervical cancer (CC) prognosis through a meta-analysis. METHOD Related studies were retrieved from the Cochrane Library, EMBASE, and PubMed databases. The language was restricted to English. The combined hazard ratios (HRs) were utilized to analyze the prognostic value of LNR. RESULTS Our study included 8 articles with 3325 subjects published after 2015. Based on our analysis, high LNR was the adverse prognostic factor for overall survival (OS, HR = 1.45; 95% CI = 1.23-1.73; P = .238) and disease-free survival (DFS, HR = 2.69; 95% CI = 1.98-3.66; P = .597) among the CC cases. Furthermore, as revealed by subgroup analysis, in CC patients, median LNR of about 0.0625 and 0.066 served as the prominent risk factor for DFS and OS. CONCLUSIONS The current work illustrates that elevated LNR is related to the dismal prognosis of CC. More well-designed clinical studies are warranted for assessing whether LNR is a factor independently predicting the prognosis of CC.
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Affiliation(s)
- Haixia Cui
- Department of Clinical Laboratory, Yanbian University hospital, Yanji, Jilin Province, China
| | - Yuan Huang
- Center of Morphological Experiment, Medical College of Yanbian University, Yanji, Jilin Province, China
| | - Weibo Wen
- Department of Nuclear Medicine, Yanbian University Hospital, Yanji, Jilin Province, China
| | - Xiangdan Li
- Center of Morphological Experiment, Medical College of Yanbian University, Yanji, Jilin Province, China
| | - Dongyuan Xu
- Center of Morphological Experiment, Medical College of Yanbian University, Yanji, Jilin Province, China
| | - Lan Liu
- Department of Pathology, Yanbian University Hospital, Yanji, Jilin Province, China
- *Correspondence: Lan Liu, Department of Pathology, Yanbian University Hospital, Yanji, Jilin Province 133000, China (e-mail: )
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Zhang H, Kong W, Chen S, Zhao X, Luo D, Xie Y. Surgical Staging of Locally Advanced Cervical Cancer: Current Status and Research Progress. Front Oncol 2022; 12:940807. [PMID: 35875158 PMCID: PMC9296854 DOI: 10.3389/fonc.2022.940807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/10/2022] [Indexed: 12/02/2022] Open
Abstract
Locally advanced cervical cancer (LACC) has large localized lesions, high recurrence and metastasis rate under standard treatment, and low survival rate. The current guidelines still use concurrent radiotherapy as the gold standard of treatment for locally advanced cervical cancer. Several recent studies have shown that surgical staging has higher accuracy in determining metastasis in the para-aortic lymph nodes, bringing survival benefits to some patients. However, the indications for surgical staging and whether surgical staging can improve prognosis are still controversial. We will review the current status and research progress of surgical staging for locally advanced cervical cancer.
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Nasioudis D, Rush M, Taunk NK, Ko EM, Haggerty AF, Cory L, Giuntoli RL, Kim SH, Latif NA. Oncologic outcomes of surgical para-aortic lymph node staging in patients with advanced cervical carcinoma undergoing chemoradiation. Int J Gynecol Cancer 2022; 32:823-827. [PMID: 35788115 DOI: 10.1136/ijgc-2022-003394] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We aimed to evaluate the utilization and impact of surgical para-aortic lymph node staging on the survival of patients with locally advanced stage cervical carcinoma receiving definitive chemoradiation. METHODS We identified patients in the National Cancer Database diagnosed between January 2010 and December 2015 with locally advanced (FIGO 2009 stage IB2-IVA) cervical carcinoma who did not undergo hysterectomy, received primary chemoradiation and had at least 1 month of follow-up. Two groups of patients were formed based on the assessment method of para-aortic lymph node status - radiologic assessment only versus surgical lymphadenectomy. Overall survival was compared with the log-rank test after Kaplan-Meier curves were generated. A Cox model was constructed to control for a priori selected confounders. RESULTS We identified a total of 3540 patients who met the inclusion criteria. Para-aortic staging was performed in 333 (9.4%) patients. These patients were younger (median age 46 vs 52 years, p<0.001), less likely to have co-morbidities (8.7% vs 15.6%, p<0.001), more likely to have private insurance (48.9% vs 37.8%, p<0.001) and receive brachytherapy (76.9% vs 70.9%, p=0.022). The rate of para-aortic lymphadenectomy was comparable between patients with stage IB2-II and III-IVA disease (9.4% for both groups, p=0.98). Patients who underwent para-aortic lymphadenectomy were also more likely to have lymph nodes categorized as positive compared with those who had imaging only (27.3% vs 13.2%, p<0.001). There was no difference in overall survival between patients who underwent radiologic only or surgical para-aortic lymph node assessment (p=0.80 from log-rank test); 4 year overall survival rates were 62.9% and 63%. After controlling for confounders, performance of para-aortic lymphadenectomy was not associated with a survival benefit (HR 1.07, 95% CIs: 0.88 to 1.31). CONCLUSIONS In a large cohort of patients with locally advanced stage cervical carcinoma, para-aortic lymphadenectomy was rarely performed and not associated with a survival benefit.
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Affiliation(s)
- Dimitrios Nasioudis
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Margaret Rush
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Neil K Taunk
- Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Emily M Ko
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Ashley F Haggerty
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Lori Cory
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Robert L Giuntoli
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Sarah H Kim
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Nawar A Latif
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
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