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Bello Roufai D. [Place of innovative therapies in the management of cervical cancer]. Bull Cancer 2024; 111:51-61. [PMID: 38087730 DOI: 10.1016/j.bulcan.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 01/22/2024]
Abstract
Despite optimized screening and prevention strategies, cervical cancer remains a major public health problem, even in developed countries. In France, the incidence is estimated at 3159 cases per year in 2023. While the management of early-stage cases is now highly standardized, few therapeutic advances were made in the treatment of metastatic stages before 2021, before the therapeutic arsenal that we know today took off. The aim of this review is to summarize these advances.
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Affiliation(s)
- Diana Bello Roufai
- Département d'oncologie médicale, Institut Curie, 35, rue Dailly, 92210 Saint-Cloud, France.
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2
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Boustani J, Achkar S, Bertaut A, Genestie C, Gouy S, Pautier P, Morice P, Haie-Meder C, Chargari C. Glassy cell carcinoma of the uterine cervix: 20-year experience from a comprehensive cancer center. Cancer Radiother 2021; 25:207-12. [PMID: 33408051 DOI: 10.1016/j.canrad.2020.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Glassy cell carcinoma (GCC) of the uterine cervix is a rare entity. This study aims at describing the clinical characteristics and outcomes of cervical GCC patients treated in a comprehensive cancer center. MATERIAL AND METHODS We retrospectively reported patients and tumors characteristics, therapeutic management, overall survival (OS), progression-free progression (PFS), relapse rates, and toxicities. RESULTS Between 1994 and 2014, 55 patients were treated with curative intent. The median age at diagnosis was 41 years (range, 20-68). Among 22 patients with early stage tumors (IA2-IB1-IIA1), 17 had preoperative brachytherapy, followed by radical hysterectomy. Among 33 patients with locally advanced disease (≥IB2), 32 underwent chemoradiation±brachytherapy boost. After a median follow-up of 5.4 years (range, 0.15-21.7 years), 18/55 (33%) patients experienced tumor relapse. Local recurrence occurred in 2/22 (9%) patients with early disease (treated with upfront surgery) and in 3/32 (9%) patients with locally advanced disease. Most frequent relapses were distant, occurring in a total of 11/55 patients (20%). PFS rates at 5-year were 86.4% (95% CI: 63.4-95.4) for early stage versus 75.9% (95% CI: 55.2-89.2) for locally advanced stages, respectively (P=0.18). CONCLUSION Large cohort data are warranted to guide the optimal management of GCC. From this retrospective analysis, a multimodal approach yielded to good disease control in early stages tumors. Given the high-risk of distant failure, consideration should be given to adjuvant chemotherapy in locally advanced disease.
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Gauthier T, Lacorre A, Sallee C, Tardieu A, Guyon F, Margueritte F, Gouy S. [Impact of the LACC study. A SFOG survey]. Bull Cancer 2020; 107:551-555. [PMID: 32245607 DOI: 10.1016/j.bulcan.2020.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The LACC (Laparoscopic Approach to Cervical Cancer Trial) study, released in 2018, described oncological findings in favour of open surgery compared to the minimally invasive pathway in the management of early stage cervical cancers. Our aim was to assess the impact of this study on surgical practices in France. METHOD Online questionnaire, consisting of 13 questions addressed to gynecology oncology french society (SFOG) surgeons. RESULTS Forty questionnaires were collected. The median annual number of radical hysterectomy was 5 (0-20). Prior to the study, 92.5 % of cervical cancer patients had radical hysterectomy by minimally invasive surgery. In case of laparoscopy or robot, the uterine manipulator was used in 67.6 % and the colpotomy was performed intra-abdominally (78.4 %). After the LACC study, 60 % changed their practice. Open surgery was favored by 75 % of those who modified their practice. Among those continuing to perform minimally invasive surgeries, the manipulator and the intracorporeal colpotomy were discontinued. One-third of surgeons have changed their surgical practice for endometrial cancer in parallel. CONCLUSION The results of the LACC study led to a change in surgical practices with an increase in open surgery and a stop in the use of the uterine manipulator and the laparoscopic/robotic intracorporeal colpotomy in the surgical management of early stage of cervical cancer.
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Affiliation(s)
- Tristan Gauthier
- CHU Limoges, hôpital Mère-Enfant, service de gynécologie-obstétrique, 8, avenue Dominique-Larrey, 87042 Limoges, France.
| | - Aymeline Lacorre
- CHU Limoges, hôpital Mère-Enfant, service de gynécologie-obstétrique, 8, avenue Dominique-Larrey, 87042 Limoges, France
| | - Camille Sallee
- CHU Limoges, hôpital Mère-Enfant, service de gynécologie-obstétrique, 8, avenue Dominique-Larrey, 87042 Limoges, France
| | - Antoine Tardieu
- CHU Limoges, hôpital Mère-Enfant, service de gynécologie-obstétrique, 8, avenue Dominique-Larrey, 87042 Limoges, France
| | - Frédéric Guyon
- Institut Bergonié, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - François Margueritte
- CHU Limoges, hôpital Mère-Enfant, service de gynécologie-obstétrique, 8, avenue Dominique-Larrey, 87042 Limoges, France
| | - Sébastien Gouy
- Département de chirurgie, Gustave Roussy Cancer Campus, 94800 Villejuif, France
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Balaya V, Guani B, Bonsang-Kitzis H, Deloménie M, Ngô C, Montero Macias R, Koual M, Nguyen-Xuan HT, Bats AS, Mathevet P, Lécuru F. [Sentinel lymph node biopsy in early-stage cervical cancer: current state of art]. Bull Cancer 2019; 107:696-706. [PMID: 31627905 DOI: 10.1016/j.bulcan.2019.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/15/2019] [Indexed: 01/05/2023]
Abstract
Lymph node status is the most important prognostic factor of survival in women with early stage cervical cancer. Sentinel lymph node (SLN) biopsy is an accurate method for the assessment of lymph nodal involvement in early-stages cervical cancer and has been increasingly used instead of systematic pelvic lymph node dissection (PLND). Less-radical lymph node dissection decreases the associated morbidity of PLND, especially the risk of lower-leg lymphoedema, which affects severely patient quality of life. SLN biopsy allows nodes ultrastaging and provides supplementary histological information by increasing the detection of tumor low-volume (isolated tumors cells and micrometastases). Moreover, SLN biopsy provides accurate anatomical information on pelvic lymphatic drainage pathway by identifying nodes outside of routine lymphadenectomy areas. Selection of a population at low-risk of nodal metastasis, a minimal training, and simple rules may ensure a low false negative rate. Several studies have shown that SLN mapping in these patients is feasible, with excellent detection rates and sensitivity. Combined detection with technetium-99 and blue dye has been widely used but recently, there has been increasing interest in the use of fluorescent dies such as indocyanine green (ICG) which would improve SLN detection. Although recent international guidelines recommend performing SLN biopsy in addition to PLND, SLN biopsy alone is not the gold-standard yet due to lack of prospective evidence, especially on long-term oncological safety. Some points remain controversial such as the low accuracy of intraoperative SLN status assessment by frozen section and the impact of micrometastasis on prognostic. The prospective randomized clinical trial SENTICOL III will answer to these problematics.
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Affiliation(s)
- Vincent Balaya
- Hôpital Européen Georges Pompidou, service de chirurgie cancérologique gynécologique et du sein, 20, rue Leblanc, 75908 Paris Cedex 15, France; Faculté de Médecine, Université de Paris, 12, rue de l'école de médecine 75006, Paris, France.
| | - Benedetta Guani
- Centre Hospitalo-Universitaire Vaudois, Service de Gynécologie, rue du Bugnon 46, 1005 Lausanne, Suisse
| | - Hélène Bonsang-Kitzis
- Hôpital Européen Georges Pompidou, service de chirurgie cancérologique gynécologique et du sein, 20, rue Leblanc, 75908 Paris Cedex 15, France; Faculté de Médecine, Université de Paris, 12, rue de l'école de médecine 75006, Paris, France
| | - Myriam Deloménie
- Hôpital Européen Georges Pompidou, service de chirurgie cancérologique gynécologique et du sein, 20, rue Leblanc, 75908 Paris Cedex 15, France; Faculté de Médecine, Université de Paris, 12, rue de l'école de médecine 75006, Paris, France
| | - Charlotte Ngô
- Hôpital Européen Georges Pompidou, service de chirurgie cancérologique gynécologique et du sein, 20, rue Leblanc, 75908 Paris Cedex 15, France; Faculté de Médecine, Université de Paris, 12, rue de l'école de médecine 75006, Paris, France
| | - Rosa Montero Macias
- Hôpital Européen Georges Pompidou, service de chirurgie cancérologique gynécologique et du sein, 20, rue Leblanc, 75908 Paris Cedex 15, France; Faculté de Médecine, Université de Paris, 12, rue de l'école de médecine 75006, Paris, France
| | - Meriem Koual
- Hôpital Européen Georges Pompidou, service de chirurgie cancérologique gynécologique et du sein, 20, rue Leblanc, 75908 Paris Cedex 15, France; Faculté de Médecine, Université de Paris, 12, rue de l'école de médecine 75006, Paris, France
| | - Huyen-Thû Nguyen-Xuan
- Hôpital Européen Georges Pompidou, service de chirurgie cancérologique gynécologique et du sein, 20, rue Leblanc, 75908 Paris Cedex 15, France; Faculté de Médecine, Université de Paris, 12, rue de l'école de médecine 75006, Paris, France
| | - Anne Sophie Bats
- Hôpital Européen Georges Pompidou, service de chirurgie cancérologique gynécologique et du sein, 20, rue Leblanc, 75908 Paris Cedex 15, France; Faculté de Médecine, Université de Paris, 12, rue de l'école de médecine 75006, Paris, France
| | - Patrice Mathevet
- Centre Hospitalo-Universitaire Vaudois, Service de Gynécologie, rue du Bugnon 46, 1005 Lausanne, Suisse
| | - Fabrice Lécuru
- Hôpital Européen Georges Pompidou, service de chirurgie cancérologique gynécologique et du sein, 20, rue Leblanc, 75908 Paris Cedex 15, France; Faculté de Médecine, Université de Paris, 12, rue de l'école de médecine 75006, Paris, France
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Montagner C, Bricou A, Selle F, Kafé H, Mauhin W, Fredeau L, Duval-Chopard L, Slama J, Durand P, Beal C, London J, Lidove O. [Glassy cell carcinoma of the uterine cervix: An aggressive type of cancer]. Rev Med Interne 2019; 40:754-757. [PMID: 31431320 DOI: 10.1016/j.revmed.2019.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/19/2019] [Accepted: 07/17/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cervical cancer is the twelfth most frequent cancer in women in France. Glassy cell carcinoma is a rare histological entity, rapidly aggressive, associated with a poor prognosis. CASE REPORT A 30-year-old woman was admitted in an internal medicine department for polyarthralgia with high grade fever, evolving for 3 weeks. There was an inflammatory syndrome. The 18-FDG-PET-scan showed inflammatory lymph nodes as well as disseminated osteolytic lesions, and a primitive pelvic tumor. A 3cm tumor of the cervix was found during the gynaecologic examination. Histological analysis elicited a high-index mitotic carcinoma, glassy cell carcinoma type. Despite chemotherapy, the outcome was poor, with early death occurring after three months of follow-up. CONCLUSION The glassy cell carcinoma of the cervix should be considered as an aetiology of bone metastases in young female patients.
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Affiliation(s)
- C Montagner
- Service de médecine interne, Groupe Hospitalier Diaconesses Croix Saint Simon, rue d'Avron, 75020 Paris, France.
| | - A Bricou
- Service de chirurgie gynécologique et mammaire, Groupe Hospitalier Diaconesses Croix Saint Simon, rue d'Avron, 75020 Paris, France
| | - F Selle
- Service d'oncologie, Groupe Hospitalier Diaconesses Croix Saint Simon, rue d'Avron 75020 Paris, France
| | - H Kafé
- Centre de pathologie, 19, rue de Passy, 75016, France
| | - W Mauhin
- Service de médecine interne, Groupe Hospitalier Diaconesses Croix Saint Simon, rue d'Avron, 75020 Paris, France
| | - L Fredeau
- Service de médecine interne, Groupe Hospitalier Diaconesses Croix Saint Simon, rue d'Avron, 75020 Paris, France
| | - L Duval-Chopard
- Service de médecine interne, Groupe Hospitalier Diaconesses Croix Saint Simon, rue d'Avron, 75020 Paris, France
| | - J Slama
- Paris Service de médecine nucléaire, Hôpital Beaujon, 100, boulevard du Général Leclerc, 92110 Clichy, France
| | - P Durand
- Service de radiologie, Groupe Hospitalier Diaconesses Croix Saint Simon, rue d'Avron, 75020 Paris, France
| | - C Beal
- Service de rhumatologie, Groupe Hospitalier Diaconesses Croix Saint Simon, rue d'Avron, 75020 Paris, France
| | - J London
- Service de médecine interne, Groupe Hospitalier Diaconesses Croix Saint Simon, rue d'Avron, 75020 Paris, France
| | - O Lidove
- Service de médecine interne, Groupe Hospitalier Diaconesses Croix Saint Simon, rue d'Avron, 75020 Paris, France
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Bourgin C, Estevez JP, Collinet P. [Post therapeutic cervical cancer surveillance in France: Priority for examination]. ACTA ACUST UNITED AC 2018; 46:503-5. [PMID: 29615374 DOI: 10.1016/j.gofs.2018.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Indexed: 11/21/2022]
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Sun R, Mazeron R, Chargari C, Barillot I. CTV to PTV in cervical cancer: From static margins to adaptive radiotherapy. Cancer Radiother 2016; 20:622-8. [PMID: 27614513 DOI: 10.1016/j.canrad.2016.07.088] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 07/17/2016] [Accepted: 07/19/2016] [Indexed: 01/31/2023]
Abstract
Intensity-modulated radiotherapy (IMRT) is increasingly used in order to minimize the gastrointestinal, genitourinary, and hematological toxicity in cervical and uterine cancers. However, the benefit of this high-precision approach is detracted by the margins applied to the clinical target volume (CTV) to generate the planning tumor volume (PTV), taking into account tumor and surrounding organs movements, deformations, and volume changes. Adequate PTV margins should be large enough to prevent geographical misses, but not excessive, which might end the benefit from IMRT. The objectives of this review were: (a) to present the evidence available for the determination of CTV-PTV margin for uterine cancers; (b) to highlight the impact of these margins in the context of adaptive radiotherapy; and (c) to discuss the role of the PTV concept in intracavitary brachytherapy.
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Affiliation(s)
- R Sun
- Radiation Oncology Department, Gustave-Roussy Cancer Campus, Paris-Sud University, 94805 Villejuif cedex, France.
| | - R Mazeron
- Radiation Oncology Department, Gustave-Roussy Cancer Campus, Paris-Sud University, 94805 Villejuif cedex, France
| | - C Chargari
- Radiation Oncology Department, Gustave-Roussy Cancer Campus, Paris-Sud University, 94805 Villejuif cedex, France
| | - I Barillot
- Radiation Oncology Department, Bretonneau University Hospital, 37000 Tours, France; François-Rabelais University, 37000 Tours, France
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8
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Estevez JP, Hequet D, Dubot C, Fourchotte V, De La Motte Rouge T, Becette V, Rouzier R. [Fertility sparing treatment in women affected by cervical cancer larger than 2cm]. Bull Cancer 2015; 103:173-9. [PMID: 26681641 DOI: 10.1016/j.bulcan.2015.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 10/27/2015] [Accepted: 11/10/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We report our experience on fertility sparing treatment in young women affected by cervical cancer of more than 2cm. METHODS Between July 2012 and February 2014, five patients presenting cervical tumors larger than 2cm (IB1>2cm) (23-35) and wishing to preserve fertility have been treated at our institution. Laparoscopic pelvic and para-aortic lymphadenectomy was performed for all patients. When lymph nodes were free of disease, patients had neoadjuvant chemotherapy followed by surgical conservative treatment. RESULTS Four patients underwent a cisplatin based neoadjuvant chemotherapy before conservative surgery: radical trachelectomy or simple trachelectomy. One patient with nodal involvement underwent a 3cycle chemotherapy followed by concurrent radiochemotherapy. Hematologic toxicity grade 3 was observed in one patient leading to a change of chemotherapy. Two patients showed complete disappearance of tumor and two a partial response to neoadjuvant treatment. After a mean follow up of 20.5months (14-33), no relapse was observed. To date, no pregnancy was obtained. CONCLUSION Lymph node staging followed by neoadjuvant chemotherapy and radical trachelectomy seems to be a promising treatment scheme for patients with cervical tumors IB1>2cm pN0 seeking parenthood.
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Affiliation(s)
| | - Delphine Hequet
- Hôpital, institut Curie, département de chirurgie, 5248 Paris, France
| | - Coraline Dubot
- Hôpital, institut Curie, département d'oncologie médicale, 5248 Paris, France
| | | | | | - Véronique Becette
- Hôpital, institut Curie, département d'anatomopathologie, 5248 Paris, France
| | - Roman Rouzier
- Hôpital, institut Curie, département de chirurgie, 5248 Paris, France
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9
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Vieillefosse S, Thubert T, Trichot C, Deffieux X. [Cervical carcinoma and complete genital prolapse]. Prog Urol 2014; 24:533-4. [PMID: 24875573 DOI: 10.1016/j.purol.2014.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/02/2014] [Accepted: 04/02/2014] [Indexed: 11/26/2022]
Affiliation(s)
- S Vieillefosse
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92141 Clamart, France.
| | - T Thubert
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92141 Clamart, France
| | - C Trichot
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92141 Clamart, France
| | - X Deffieux
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92141 Clamart, France
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10
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Lépinoy A, Lescut N, Lassabe C, Bosset JF, Servagi-Vernat S. [Glassy cell carcinoma: a rare cervical neoplasm. Case report of two patients and review of the literature]. Cancer Radiother 2014; 18:211-4. [PMID: 24819246 DOI: 10.1016/j.canrad.2014.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 04/03/2014] [Accepted: 04/09/2014] [Indexed: 11/25/2022]
Abstract
The main histological types of cervix cancer are squamous cell carcinoma and adenocarcinoma. The glassy cell carcinoma is a rare form found in less than 2% of cases and it is an entity, aggressive and unknown, of worse prognosis, whose current treatment is not distinguished from other histological types. We report the cases of two patients with glassy cell carcinoma of the cervix with a review of the literature.
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Affiliation(s)
- A Lépinoy
- Service d'oncologie radiothérapie, centre hospitalier universitaire Jean-Minjoz, 3, boulevard Fleming, 25000 Besançon, France
| | - N Lescut
- Service d'oncologie radiothérapie, centre hospitalier universitaire Jean-Minjoz, 3, boulevard Fleming, 25000 Besançon, France
| | - C Lassabe
- Département d'anatomopathologie, centre hospitalier de Belfort-Montbéliard, 90000 Belfort, France
| | - J-F Bosset
- Service d'oncologie radiothérapie, centre hospitalier universitaire Jean-Minjoz, 3, boulevard Fleming, 25000 Besançon, France
| | - S Servagi-Vernat
- Service d'oncologie radiothérapie, centre hospitalier universitaire Jean-Minjoz, 3, boulevard Fleming, 25000 Besançon, France.
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Riethmuller D, Ramanah R, Carcopino X, Levêque J. [The follow up of the women vaccinated against HPV]. ACTA ACUST UNITED AC 2013; 42:525-33. [PMID: 23669416 DOI: 10.1016/j.jgyn.2013.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 03/14/2013] [Accepted: 03/22/2013] [Indexed: 10/26/2022]
Abstract
HPV vaccine decreases significantly the risk of cervical cancer in women. However, continuing screening strategies in vaccinated women remains relevant as there is a small residual risk of cancer and pre-cancerous lesions even after prophylactic vaccination. The follow-up strategy to adopt has been the object of reflection by many experts, and especially since the vaccination catch-up population concerning women until 23 years of age will soon become the target screening population following recent guidelines. Finally, the arrival of HPV vaccines forces us to think about screening organization and optimization in a broader way so as it benefits all women concerned, whether vaccinated or not, and not only barely half of them as is the case now. The aim of this work was to clarify the issue and to make proposals for management.
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Affiliation(s)
- D Riethmuller
- Service de gynécologie-obstétrique, CHU Jean-Minjoz, 3, boulevard Flemming, 25000 Besançon, France.
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