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Survival Impact of Residual Cancer Cells in Intraoperative Peritoneal Washes following Radical Hysterectomy for Cervical Cancer. J Clin Med 2022; 11:jcm11092659. [PMID: 35566784 PMCID: PMC9102082 DOI: 10.3390/jcm11092659] [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: 04/20/2022] [Revised: 05/01/2022] [Accepted: 05/07/2022] [Indexed: 11/30/2022] Open
Abstract
Objective: Residual cancer cells (RCCs) contribute to cancer recurrence either because of tumor spillage or undetectable pre-existing micrometastatic tumor clones. We hypothesized that the pathologic evaluation of intraoperative peritoneal washes may reveal RCCs. The aim of this study was to evaluate the survival impact of RCCs identified in intraoperative peritoneal washes and their correlation with clinicopathologic parameters following radical hysterectomy for cervical cancer. Methods: A total of 229 patients with cervical cancer who underwent radical hysterectomy with pelvic and/or paraaortic lymphadenectomy were included. The intraoperative peritoneal washes after surgery were filtered through a strainer and the presence of tumor cells in the residual aspirate was determined. Univariate and multivariate analyses of clinicopathological parameters were performed to identify predictors of recurrence. Results: RCCs in intraoperative peritoneal washes were identified in 19 patients (8.3%). Multivariate analysis revealed that deep stromal invasion (hazard ratio [HR], 13.32; 95% confidence interval [CI], 1.81–98.27; p = 0.0111), lymph node metastasis (HR, 2.00; 95% CI, 1.01–3.99; p = 0.0482), and neoadjuvant chemotherapy (HR, 2.34; 95% CI, 1.89–4.61; p = 0.0139) were associated with tumor recurrence. However, the presence of RCCs was not associated with tumor recurrence (HR, 2.60; 95% CI, 0.74–9.11; p = 0.1352). Multiple logistic regression analysis revealed that RCCs were associated with neoadjuvant chemotherapy (odds ratio [OR], 0.22; 95% CI, 0.05–0.99; p = 0.0488) and large tumor size (OR, 4.16; 95% CI, 0.77–22.48; p = 0.0981). Conclusions: Although the presence of RCCs in intraoperative peritoneal washes do not significantly impact survival outcomes, there was a tendency of inferior survival outcomes in patients with RCCs. RCCs were associated with neoadjuvant chemotherapy and large tumor size.
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Mousavi A, Modarres Gilani M, Akhavan S, Sheikh Hasani S, Alipour A, Gholami H. The Outcome of Locally Advanced Cervical Cancer in Patients Treated with Neoadjuvant Chemotherapy Followed by Radical Hysterectomy and Primary Surgery. IRANIAN JOURNAL OF MEDICAL SCIENCES 2021; 46:355-363. [PMID: 34539010 PMCID: PMC8438343 DOI: 10.30476/ijms.2020.81973.0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 07/26/2019] [Accepted: 09/01/2019] [Indexed: 12/04/2022]
Abstract
Background: In recent years, before radical hysterectomy, neoadjuvant chemotherapy (NACT) has been administered to patients with locally advanced cervical cancer to shrink large tumors.
It has been reported that this treatment significantly reduces the need for radiotherapy after surgery. The current study aimed to assess the outcome
(survival, recurrence, and the need for adjuvant radiotherapy) of locally advanced cervical cancer in patients treated with NACT followed by radical hysterectomy and primary surgery. Methods: In a retrospective cohort study, the records of 258 patients with cervical cancer (stage IB2, IIA, or IIB), who referred to Imam Khomeini Hospital (Tehran, Iran)
from 2007 to 2017 were evaluated. The patients were assigned into two groups; group A (n=58) included patients, who underwent radical hysterectomy and group B (n=44)
included those, who underwent a radical hysterectomy after NACT. The outcome measures were the recurrence rate, five-year survival rate, and the need for adjuvant radiotherapy. Results: The median for overall survival time in group A and B was 113.65 and 112.88 months, respectively (P=0.970). There was no recurrence among patients with stage
IB2 cervical cancer in group B, while the recurrence rate in group A was 19.5% with a median recurrence time of 59.13 months. Lymph node involvement was the
only factor that affected patients’ survival. The need for postoperative adjuvant radiotherapy in group B was lower than in group A (P=0.002). Conclusion: NACT before the hysterectomy was found to reduce the need for postoperative radiotherapy in patients with locally advanced cervical cancer according to disease stages.
As a direct result, adverse side effects and the recurrence rate were reduced, and the overall survival rate of patients with stage IIB cervical cancer was increased.
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Affiliation(s)
- Azamsadat Mousavi
- Department of Oncology, Emam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Modarres Gilani
- Department of Oncology, Emam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Setareh Akhavan
- Department of Oncology, Emam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Sheikh Hasani
- Department of Oncology, Emam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Alipour
- Thalassemia Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hamideh Gholami
- Department of Oncology, Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
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Bogani G, DI Donato V, Chiappa V, Lopez S, Monti M, Muzii L, Benedetti Panici P, Ditto A, Raspagliesi F. Minimally invasive surgery in cervical cancer. Minerva Obstet Gynecol 2021; 73:145-148. [PMID: 33306287 DOI: 10.23736/s2724-606x.20.04726-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In recent years, minimally invasive surgery has replaced open surgery for almost all surgical indications in gynecological practice. Recently, the results of the laparoscopic approach to cervical cancer (LACC) trial questioned the role of minimally invasive surgery for patients affected by early-stage cervical cancer. In the present paper, we discussed the current evidence regarding the adoption of minimally invasive surgery for patients with cervical cancer. We evaluated the current evidence focusing on four interesting features: 1) the impact of tumor volume; 2) reasons explaining worse outcomes of patients undergoing minimally invasive surgery; 3) methods to reduce the risk of recurrence during minimally invasive surgery; and 4) the effect of minimally invasive surgery in patients with locally advanced cervical cancer. At the moment, in the light of current evidence, minimally invasive radical hysterectomy should be offered only in the context of clinical trials. Extensive counseling and appropriate patients' selection are needed. Further prospective evidence is warranted to identify the better approach for cervical cancer patients.
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Affiliation(s)
- Giorgio Bogani
- National Cancer Institute of Milan (INT), Milan, Italy -
| | - Violante DI Donato
- Department of Maternal and Child Health and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | | | | | - Marco Monti
- Department of Maternal and Child Health and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | | | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Antonino Ditto
- Department of Maternal and Child Health and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
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Radical Surgery in Advanced Cervical Cancer Patients Receiving Bevacizumab-Containing Chemotherapy: A "Real Life Experience". Int J Gynecol Cancer 2019; 28:1569-1575. [PMID: 30157167 DOI: 10.1097/igc.0000000000001350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Platinum-based chemotherapy plus bevacizumab is the new standard of care in stage IVB cervical cancer (CC) patients. In this new scenario, radical surgery could be offered in selected cases with an optimal clinical response. Potential surgical complications related to previous bevacizumab treatment have never been described before in this type of setting. METHODS This is a single-institutional retrospective study on women with CC who received radical pelvic surgery after platinum-based chemotherapy (platinum-taxol) plus bevacizumab. RESULTS Between April 2016 and September 2017, 15 patients with CC underwent radical surgery after bevacizumab-containing chemotherapy (platinum-taxol) at the Division of Gynecologic Oncology, Catholic University of the Sacred Heart in Rome, Italy.All patients received at least 3 cycles of treatment. Fourteen (93.4%) patients underwent radical hysterectomy, whereas 1 patient received pelvic anterior exenteration. Median operating time was 290 minutes (range, 220-400), and estimated blood loss was 250 mL (range, 50-1500). Median time of hospitalization was 5 days (range, 2-21). Pathological response in the cervix was complete in 3 cases and microscopic in 1 patient (26.7%). Intraoperative complications occurred in 3 cases: 2 vascular injuries and 1 ureteral injury. Three patients (20.0% of the whole series) experienced grade 3 complications.At last follow-up (median time, 9 months), the median overall survival is 13 months (range, 6-31): 7 (46.7%) women were free of disease, 8 (53.3%) patients progressed, and 3 of them died of disease. CONCLUSIONS Radical surgery can be performed in women with CC previously treated with a bevacizumab-containing regimen.
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Zhao H, He Y, Zhu LR, Wang JL, Guo HY, Xu T, Wang YQ, Yao Y, Wu YM. Effect of neoadjuvant chemotherapy followed by radical surgery for FIGO stage IB2/IIA2 cervical cancer: A multi-center retrospective clinical study. Medicine (Baltimore) 2019; 98:e15604. [PMID: 31124937 PMCID: PMC6571268 DOI: 10.1097/md.0000000000015604] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study compared the efficacy of neoadjuvant chemotherapy (NACT) followed by radical surgery (RS) vs primary surgical treatment (PST) in patients diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IB2/IIA2 cervical cancer.Data of 303 cervical cancer patients who received primary therapy for stage IB2/IIA2 cervical cancer at 7 medical centers in Beijing, China between January 1, 2009 and December 31, 2016 and followed through December 31, 2017 were collected retrospectively. The response rates, surgical characteristics, and overall survival (OS) durations of patients who received NACT followed by RS were compared to those of patients who received PST.An improved short-term complete response rate was observed among patients who received intra-arterial chemotherapy compared with patients who had intravenous chemotherapy (18.3% vs 4.1%, Pdifference = .020). Patients who received NACT were more likely to undergo laparoscopic surgery and to have a lower blood loss volume (555.4 ± 520.2 ml vs PST, 682.5 ± 509.8 ml; P = .036) and increased estimated operative time (249.9 ± 101.9 vs PST, 225.1 ± 76.5 min; P = .022). No differences in high-risk factors (HRFs), the effects of supplemental treatment, or 5-year OS were observed between patients who received NACT and PST.Our findings indicate that patients who received NACT for FIGO stage IB2/IIA2 cervical cancer were more likely to undergo laparoscopic surgery. These findings have important implications regarding treatment with curative intent for stage IB2/IIA2 cervical cancer and warrant a further analysis of treatment strategies to ensure adequate treatment and patient-centered care.
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Affiliation(s)
- Hui Zhao
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Dongcheng District
| | - Yue He
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Dongcheng District
| | - Li-Rong Zhu
- Department of Gynecology and Obstetrics, Peking University First Hospital
| | - Jian-Liu Wang
- Department of Gynecology and Obstetrics, Peking University People's Hospital
| | - Hong-Yan Guo
- Department of Gynecology and Obstetrics, Peking University Third Hospital, Beijing, China
| | - Ting Xu
- Department of Gynecology and Obstetrics, Peking University First Hospital
| | - Yi-Qin Wang
- Department of Gynecology and Obstetrics, Peking University People's Hospital
| | - Ying Yao
- Department of Gynecology and Obstetrics, Peking University Third Hospital, Beijing, China
| | - Yu-Mei Wu
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Dongcheng District
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Di Tucci C, Schiavi MC, Faiano P, D'Oria O, Prata G, Sciuga V, Giannini A, Palaia I, Muzii L, Benedetti Panici P. Therapeutic vaccines and immune checkpoints inhibition options for gynecological cancers. Crit Rev Oncol Hematol 2018; 128:30-42. [PMID: 29958629 DOI: 10.1016/j.critrevonc.2018.05.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/21/2018] [Accepted: 05/14/2018] [Indexed: 12/18/2022] Open
Abstract
Treatments for gynecological cancer include surgery, chemotherapy, and radiation. However, overall survival is not improved, and novel approaches are needed. Immunotherapy has been proven efficacious in various types of cancers and multiple approaches have been recently developed. Since numerous gynecological cancers are associated to human papilloma virus (HPV) infections, therapeutic vaccines, targeting HPV epitopes, have been developed. The advancing understanding of the immune system, regulatory pathways and tumor microenvironment have produced a major interest in immune checkpoint blockade, Indeed, immune checkpoint molecules are important clinical targets in a wide variety of tumors, including gynecological. In this review, we will describe the immunotherapeutic targets and modalities available and review the most recent immunotherapeutic clinical trials in the context of gynecological cancers. The synergic results obtained from the combination of HPV therapeutic vaccines with radiotherapy, chemotherapy, or immune checkpoint inhibitors, may underlie the potential for a novel therapeutic scenario for these tumors.
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Affiliation(s)
- Chiara Di Tucci
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy.
| | - Michele Carlo Schiavi
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy.
| | - Pierangelo Faiano
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy.
| | - Ottavia D'Oria
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy.
| | - Giovanni Prata
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy.
| | - Valentina Sciuga
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy.
| | - Andrea Giannini
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Innocenza Palaia
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Ludovico Muzii
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
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