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Zeng S, Xiao S, Xu Y, Yang P, Hu C, Jin X, Liu L. Efficacy and safety analysis of non-radical surgery for early-stage cervical cancer (IA2 ~ IB1): a systematic review and meta-analysis. Front Med (Lausanne) 2024; 11:1337752. [PMID: 38745744 PMCID: PMC11091289 DOI: 10.3389/fmed.2024.1337752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/09/2024] [Indexed: 05/16/2024] Open
Abstract
Objective Radical hysterectomy has long been considered as the standard surgical treatment for early-stage cervical cancer (IA2 to IB1 stages), according to the 2009 International Federation of Obstetrics and Gynecology. This study aims to conduct an in-depth evaluation of the effectiveness and safety of non-radical surgery as an alternative treatment for patients with early-stage cervical cancer. Methods A systematic search of online databases including PubMed, Embase, and the Cochrane Library was conducted to identify relevant literature on surgical treatment options for early-stage cervical cancer. Keywords such as "cervical cancer," "conservative surgery," "early-stage," "less radical surgery," and "simple hysterectomy" were used. Meta-analysis was performed using Stata 15.0 software, which included randomized controlled trials (RCTs) and cohort studies. Results This meta-analysis included 8 eligible articles covering 9 studies, with 3,950 patients in the simple hysterectomy (SH) surgery group and 6,271 patients in the radical hysterectomy (RH) surgery group. The results indicate that there was no significant difference between the two groups in terms of the Overall Survival (OS) (HR = 1.04, 95% CI: 0.86-1.27, p = 0.671; Heterogeneity: I2 = 33.8%, p = 0.170), Disease Free Survival (DFS) (HR = 1.39, 95% CI: 0.59-3.29, p = 0.456; Heterogeneity: I2 = 0.0%, p = 0.374), Cervical Cancer Specific Survival (CCSS) (HR = 1.11, 95% CI: 0.80-1.54, p = 0.519; Heterogeneity: I2 = 11.9%, p = 0.287) and recurrence rate (RR = 1.16, 95% CI: 0.69-1.97, p = 0.583; Heterogeneity: I = 0.0%, p = 0.488). However, the mortality rate (RR = 1.35, 95% CI: 1.10-1.67, p = 0.006; Heterogeneity: I2 = 35.4%, p = 0.158) and the rate of postoperative adjuvant therapy (RR = 1.59, 95% CI: 1.16-2.19, p = 0.004; Heterogeneity: I2 = 92.7%, p < 0.10) were higher in the SH group compared to those in the RH group. On the other hand, the incidence of surgical complications was lower in the SH group (RR = 0.36, 95% CI: 0.21-0.59, p = 0.004; Heterogeneity: I2 = 0.0%, p = 0.857) than that in the RH group. Subgroup analysis revealed that patients in the IB1 stage SH group had a significantly higher mortality rate compared to those in the RH group (RR = 1.59, 95% CI: 1.23-2.07, p < 0.001; Heterogeneity: I2 = 0.0%, p = 0.332). However, there was no significant difference in mortality rates between the two groups for patients at stage IA2 (RR = 0.84, 95% CI: 0.54-1.30, p = 0.428; Heterogeneity: I2 = 26.8%, p = 0.243). In the subgroups positive for Lymphovascular Space Invasion (LVSI), patients in the SH group had a significantly higher mortality rate than those in the RH group (RR = 1.34, 95% CI: 1.09-1.65, p = 0.005; Heterogeneity: I2 = 41.6%, p = 0.128). However, in the LVSI-negative subgroups, there was no significant difference in mortality rates between the two groups (RR = 0.33, 95% CI: 0.01-8.04, p = 0.499). Conclusion For patients with early-stage cervical cancer patients at IA2 without LVSI involvement, comparisons between the two groups in terms of OS, DFS, CCSS, recurrence rate, and mortality rates revealed no statistically significant differences, indicating that the choice of surgical approach does not affect long-term survival outcomes for this specific patient group. For patients at IB1 and IA2 stages with LVSI involvement, while there were no significant differences between the two groups in OS, DFS, CSS, and recurrence rate, a significant increase in mortality rates was observed in the SH group. This indicates a potential elevated risk of mortality associated with SH in this subset of patients. Notably, the incidence of surgical complications was significantly lower in the SH group compared to the RH group, highlighting the safety profile of SH in this context. Significantly, among patients in the SH group, an increase in the rate of postoperative adjuvant treatment is associated with a higher occurrence of treatment-related complications. To facilitate more precise patient selection for conservative surgical management, future prospective studies of superior quality are imperative to gain deeper insights into this matter. Systematic review registration PROSPERO (CRD42023451609: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023451609).
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Affiliation(s)
- Siyuan Zeng
- Department of Obstetrics and Gynecology, Dalian Municipal Central Hospital, Dalian, China
- Dalian Municipal Central Hospital, China Medical University, Shenyang, China
| | - Simin Xiao
- Radiology Department, XinDu Hospital of Traditional Chinese Medicine, Chengdu, China
| | - Yang Xu
- Department of Obstetrics and Gynecology, Dalian Municipal Central Hospital, Dalian, China
- Dalian Municipal Central Hospital, China Medical University, Shenyang, China
| | - Ping Yang
- Department of Radiation Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chenming Hu
- Department of Obstetrics and Gynecology, Dalian Municipal Central Hospital, Dalian, China
| | - Xianyu Jin
- Dalian Municipal Central Hospital, China Medical University, Shenyang, China
| | - Lifeng Liu
- Department of Obstetrics and Gynecology, Dalian Municipal Central Hospital, Dalian, China
- Dalian Municipal Central Hospital, China Medical University, Shenyang, China
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Taliento C, Scutiero G, Arcieri M, Pellecchia G, Tius V, Bogani G, Petrillo M, Pavone M, Bizzarri N, Driul L, Greco P, Scambia G, Restaino S, Vizzielli G. Simple hysterectomy versus radical hysterectomy in early-stage cervical cancer: A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108252. [PMID: 38471373 DOI: 10.1016/j.ejso.2024.108252] [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] [Received: 02/03/2024] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND This systematic review (SR) and meta-analysis aims to compare the surgery-related results and oncological outcomes between SH and RH in patients with early-stage cervical cancer. METHOD We systematically searched databases including PubMed, Embase and Cochrane to collect studies that compared oncological and surgery-related outcomes between SH and RH groups in patients with stage IA2 and IB1 cervical cancer. A random-effect model calculated the weighted average difference of each primary outcome via Review Manager V.5.4. RESULT Seven studies comprising 6977 patients were included into our study. For oncological outcomes, we found no statistical difference in recurrence rate [OR = 0.88; 95% CI (0.50, 1.57); P = 0.68] and Overall Survival (OS) [OR = 1.23; 95% CI (0.69, 2.19), P = 0.48]. No difference was detected in the prevalence of positive LVSI and lymph nodes metastasis between the two groups. Concerning surgery-related outcomes, the comprehensive effects revealed that the bladder injury [OR = 0.28; 95% CI (0.08, 0.94), P = 0.04] and bladder disfunction [OR = 0.10; 95% CI (0.02, 0.53), P = 0.007] of the RH group were higher compared to the SH group. CONCLUSION This meta-analysis suggested there are no significant differences in terms of both recurrence rate and overall survival among patients with stage IA2-IB1 cervical cancer undergoing SH or RH, while the SH group has better surgery-related outcomes. These data confirm the need to narrow the indication for RH in early-stage cervical cancer.
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Affiliation(s)
- C Taliento
- Department of Medical Sciences, Obstetrics and Gynecology Unit, University of Ferrara, Italy; Department of Development and Regeneration - Woman and Child, KU Leuven, Leuven, Belgium
| | - G Scutiero
- Department of Medical Sciences, Obstetrics and Gynecology Unit, University of Ferrara, Italy
| | - M Arcieri
- Clinic of Obstetrics and Gynecology, "Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Medical Area Department (DAME), University of Udine, Udine, Italy
| | - G Pellecchia
- Clinic of Obstetrics and Gynecology, "Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Medical Area Department (DAME), University of Udine, Udine, Italy
| | - V Tius
- Clinic of Obstetrics and Gynecology, "Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Medical Area Department (DAME), University of Udine, Udine, Italy
| | - G Bogani
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - M Petrillo
- Department of Obstetrics and Gynecology. University of Sassari, Sassari, Italy
| | - M Pavone
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy; Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
| | - N Bizzarri
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - L Driul
- Clinic of Obstetrics and Gynecology, "Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Medical Area Department (DAME), University of Udine, Udine, Italy
| | - P Greco
- Department of Medical Sciences, Obstetrics and Gynecology Unit, University of Ferrara, Italy
| | - G Scambia
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - S Restaino
- Clinic of Obstetrics and Gynecology, "Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Department of Obstetrics and Gynecology. University of Sassari, Sassari, Italy.
| | - G Vizzielli
- Clinic of Obstetrics and Gynecology, "Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Medical Area Department (DAME), University of Udine, Udine, Italy
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Viveros-Carreño D, Pareja R, Plante M. De-escalation of surgical radicality for non-fertility preserving management in patients with early-stage cervical cancer: a systematic review. Int J Gynecol Cancer 2024; 34:386-392. [PMID: 38438182 DOI: 10.1136/ijgc-2023-004593] [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: 03/06/2024] Open
Abstract
OBJECTIVE We sought to evaluate the oncologic outcomes of simple hysterectomy in patients with low-risk early-stage cervical cancer (tumors ≤2 cm with limited stromal invasion). METHODS This study was registered in PROSPERO (registration number CRD42023433840) following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) checklist. MEDLINE (through Ovid), EmMBASEbase, and Cochrane Central Register of Controlled Trials were searched from inception until June 2023. Randomized controlled trials and observational studies with two arms of comparison (simple hysterectomy with lymph node assessment vs radical hysterectomy with lymph node assessment) in patients with low-risk early-stage cervical cancer were considered. RESULTS The search identified 1270 articles; eighteen studies were considered potentially eligible after removing duplicates, and four met the selection criteria. Three studies were randomized controlled trials, and the other was a retrospective cohort study. In total, 981 patients were included. There were 485 (49.4%) and 496 (50.6%) patients in the simple hysterectomy and radical hysterectomy groups, respectively. Simple hysterectomy with lymph node assessment was not associated with a higher risk of death at 5 years (RR 0.98, 95% CI: 0.31 to 3.10; I2=0%, two randomized controlled trials, 141 patients, for an absolute risk reduction of zero percentage points [95% CI -9.0 to 9.0]), pelvic recurrence at 3 years (97.5% and 97.8% for simple hysterectomy and radical hysterectomy, respectively, p=0.79), and overall recurrence at 3 years (95 %% and 100% for simple hysterectomy and radical hysterectomy, respectively, p=0.30). CONCLUSION Simple hysterectomy with lymph node evaluation for low-risk early-stage cervical cancer is not associated with a detrimental effect on oncologic outcomes and has a better morbidity profile.
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Affiliation(s)
- David Viveros-Carreño
- Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, Colombia
- Gynecologic Oncology, Clínica Universitaria Colombia And Clínica Los Nogales, Bogotá, Colombia
| | - Rene Pareja
- Gynecologic Oncology, Clinica ASTORGA, Medellin, and Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Marie Plante
- Obstetrics and Gynecology, Centre Hospitalier Universitaire de Quebec, Quebec, Quebec, Canada
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Shim SH, Lee JY, Lee YY, Park JY, Lee YJ, Kim SI, Han GH, Yang EJ, Noh JJ, Yim GW, Son JH, Kim NK, Kim TH, Kong TW, Choi YJ, Cho A, Lim H, Jang EB, Cho HW, Suh DH. Major clinical research advances in gynecologic cancer in 2023: a tumultuous year for endometrial cancer. J Gynecol Oncol 2024; 35:e66. [PMID: 38330382 PMCID: PMC10948978 DOI: 10.3802/jgo.2024.35.e66] [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] [Received: 01/11/2024] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 02/10/2024] Open
Abstract
In the 2023 series, we summarized the major clinical research advances in gynecologic oncology based on communications at the conference of Asian Society of Gynecologic Oncology Review Course. The review consisted of 1) Endometrial cancer: immune checkpoint inhibitor, antibody drug conjugates (ADCs), selective inhibitor of nuclear export, CDK4/6 inhibitors WEE1 inhibitor, poly (ADP-ribose) polymerase (PARP) inhibitors. 2) Cervical cancer: surgery in low-risk early-stage cervical cancer, therapy for locally advanced stage and advanced, metastatic, or recurrent setting; and 3) Ovarian cancer: immunotherapy, triplet therapies using immune checkpoint inhibitors along with antiangiogenic agents and PARP inhibitors, and ADCs. In 2023, the field of endometrial cancer treatment witnessed a landmark year, marked by several practice-changing outcomes with immune checkpoint inhibitors and the reliable efficacy of PARP inhibitors and ADCs.
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Affiliation(s)
- Seung-Hyuk Shim
- Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Jung-Yun Lee
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Yoo-Young Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong-Yeol Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yong Jae Lee
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Gwan Hee Han
- Department of Obstetrics and Gynecology, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Eun Jung Yang
- Department of Obstetrics and Gynecology, Research Institute of Medical Science, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Joseph J Noh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ga Won Yim
- Department of Obstetrics and Gynecology, Dongguk University College of Medicine, Goyang, Korea
| | - Joo-Hyuk Son
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Nam Kyeong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae-Hyun Kim
- Department of Obstetrics and Gynecology, Konyang University Hospital, Daejeon, Korea
| | - Tae-Wook Kong
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Youn Jin Choi
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Angela Cho
- Department of Obstetrics and Gynecology, Medical School of Jeju National University, Jeju National University Hospital, Jeju, Korea
| | - Hyunji Lim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Eun Bi Jang
- Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Hyun Woong Cho
- Department of Obstetrics and Gynecology, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.
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Bizzarri N, Querleu D, Dostálek L, van Lonkhuijzen LRCW, Giannarelli D, Lopez A, Salehi S, Ayhan A, Kim SH, Ortiz DI, Klat J, Landoni F, Pareja R, Manchanda R, Kosťun J, Ramirez PT, Meydanli MM, Odetto D, Laky R, Zapardiel I, Weinberger V, Dos Reis R, Pedone Anchora L, Amaro K, Akilli H, Abu-Rustum NR, Salcedo-Hernández RA, Javůrková V, Mom CH, Scambia G, Falconer H, Cibula D. Survival associated with extent of radical hysterectomy in early-stage cervical cancer: a subanalysis of the Surveillance in Cervical CANcer (SCCAN) collaborative study. Am J Obstet Gynecol 2023; 229:428.e1-428.e12. [PMID: 37336255 DOI: 10.1016/j.ajog.2023.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/11/2023] [Accepted: 06/14/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND International guidelines recommend tailoring the radicality of hysterectomy according to the known preoperative tumor characteristics in patients with early-stage cervical cancer. OBJECTIVE This study aimed to assess whether increased radicality had an effect on 5-year disease-free survival in patients with early-stage cervical cancer undergoing radical hysterectomy. The secondary aims were 5-year overall survival and pattern of recurrence. STUDY DESIGN This was an international, multicenter, retrospective study from the Surveillance in Cervical CANcer (SCCAN) collaborative cohort. Patients with the International Federation of Gynecology and Obstetrics 2009 stage IB1 and IIA1 who underwent open type B/C1/C2 radical hysterectomy according to Querleu-Morrow classification between January 2007 and December 2016, who did not undergo neoadjuvant chemotherapy and who had negative lymph nodes and free surgical margins at final histology, were included. Descriptive statistics and survival analyses were performed. Patients were stratified according to pathologic tumor diameter. Propensity score match analysis was performed to balance baseline characteristics in patients undergoing nerve-sparing and non-nerve-sparing radical hysterectomy. RESULTS A total of 1257 patients were included. Of note, 883 patients (70.2%) underwent nerve-sparing radical hysterectomy, and 374 patients (29.8%) underwent non-nerve-sparing radical hysterectomy. Baseline differences between the study groups were found for tumor stage and diameter (higher use of non-nerve-sparing radical hysterectomy for tumors >2 cm or with vaginal involvement; P<.0001). The use of adjuvant therapy in patients undergoing nerve-sparing and non-nerve-sparing radical hysterectomy was 27.3% vs 28.6%, respectively (P=.63). Five-year disease-free survival in patients undergoing nerve-sparing vs non-nerve-sparing radical hysterectomy was 90.1% (95% confidence interval, 87.9-92.2) vs 93.8% (95% confidence interval, 91.1-96.5), respectively (P=.047). Non-nerve-sparing radical hysterectomy was independently associated with better disease-free survival at multivariable analysis performed on the entire cohort (hazard ratio, 0.50; 95% confidence interval, 0.31-0.81; P=.004). Furthermore, 5-year overall survival in patients undergoing nerve-sparing vs non-nerve-sparing radical hysterectomy was 95.7% (95% confidence interval, 94.1-97.2) vs non-nerve-sparing 96.5% (95% confidence interval, 94.3-98.7), respectively (P=.78). In patients with a tumor diameter ≤20 mm, 5-year disease-free survival was 94.7% in nerve-sparing radical hysterectomy vs 96.2% in non-nerve-sparing radical hysterectomy (P=.22). In patients with tumors between 21 and 40 mm, 5-year disease-free survival was 90.3% in non-nerve-sparing radical hysterectomy vs 83.1% in nerve-sparing radical hysterectomy (P=.016) (no significant difference in the rate of adjuvant treatment in this subgroup, P=.47). This was confirmed after propensity match score analysis (balancing the 2 study groups). The pattern of recurrence in the propensity-matched population did not demonstrate any difference (P=.70). CONCLUSION For tumors ≤20 mm, no survival difference was found with more radical hysterectomy. For tumors between 21 and 40 mm, a more radical hysterectomy was associated with improved 5-year disease-free survival. No difference in the pattern of recurrence according to the extent of radicality was observed. Non-nerve-sparing radical hysterectomy was associated with better 5-year disease-free survival than nerve-sparing radical hysterectomy after propensity score match analysis.
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Affiliation(s)
- Nicolò Bizzarri
- Unità Operativa Complessa Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - Denis Querleu
- Unità Operativa Complessa Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Lukáš Dostálek
- First Faculty of Medicine, Department of Obstetrics and Gynecology, Gynecologic Oncology Center, Charles University and General University Hospital (Central and Eastern European Gynecologic Oncology Group), Prague, Czech Republic
| | - Luc R C W van Lonkhuijzen
- Center for Gynaecologic Oncology Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Diana Giannarelli
- Biostatistics Unit, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Aldo Lopez
- Department of Gynecological Surgery, National Institute of Neoplastic Diseases, Lima, Peru
| | - Sahar Salehi
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ali Ayhan
- Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Baskent University School of Medicine, Ankara, Turkey
| | - Sarah H Kim
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Isla Ortiz
- Gynecology Oncology Center, National Institute of Cancerology Mexico, Mexico City, Mexico
| | - Jaroslav Klat
- Faculty of Medicine, Department of Obstetrics and Gynecology, University Hospital and University of Ostrava, Ostrava, Czech Republic
| | - Fabio Landoni
- IRCCS Fondazione San Gerardo - Università Milano Bicocca, Monza, Italy
| | - Rene Pareja
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Ranjit Manchanda
- Wolfson Institute of Population Health, Barts Cancer Centre, Queen Mary University of London, and Barts Health NHS Trust, London, United Kingdom; Department of Gynaecological Oncology, Barts Health NHS Trust, London, United Kingdom; Faculty of Public Health and Policy, Department of Health Services Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jan Kosťun
- Department of Gynaecology and Obstetrics, University Hospital Pilsen, Charles University, Prague, Czech Republic
| | | | - Mehmet M Meydanli
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Diego Odetto
- Department of Gynecologic Oncology, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina
| | - Rene Laky
- Department of Gynecology, Medical University of Graz, Graz, Austria
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | - Vit Weinberger
- Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czechia
| | - Ricardo Dos Reis
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil
| | - Luigi Pedone Anchora
- Unità Operativa Complessa Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Karina Amaro
- Oncology Unit, Cayetano Heredia Hospital, Lima, Peru
| | - Huseyin Akilli
- Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Baskent University School of Medicine, Ankara, Turkey
| | | | | | - Veronika Javůrková
- Faculty of Medicine, Department of Obstetrics and Gynecology, University Hospital and University of Ostrava, Ostrava, Czech Republic
| | - Constantijne H Mom
- Center for Gynaecologic Oncology Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Giovanni Scambia
- Unità Operativa Complessa Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Henrik Falconer
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - David Cibula
- First Faculty of Medicine, Department of Obstetrics and Gynecology, Gynecologic Oncology Center, Charles University and General University Hospital (Central and Eastern European Gynecologic Oncology Group), Prague, Czech Republic
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Bianchi T, Grassi T, Bazzurini L, Di Martino G, Negri S, Fruscio R, Trezzi G, Landoni F. Radical Hysterectomy in Early-Stage Cervical Cancer: Abandoning the One-Fits-All Concept. J Pers Med 2023; 13:1292. [PMID: 37763060 PMCID: PMC10532817 DOI: 10.3390/jpm13091292] [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: 07/14/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
Two pillars in modern oncology are treatment personalization and the reduction in treatment-related morbidity. For decades, the one-fits-all concept of radical hysterectomy has been the cornerstone of early-stage cervical cancer surgical treatment. However, no agreement exists about the prevalent method of parametrial invasion, and the literature is conflicting regarding the extent of parametrectomy needed to achieve adequate surgical radicality. Therefore, authors started investigating if less radical surgery was feasible and oncologically safe in these patients. Two historical randomized controlled trials (RCTs) compared classical radical hysterectomy (RH) to modified RH and simple hysterectomy. Less radical surgery showed a drastic reduction in morbidity without jeopardizing oncological outcomes. However, given the high frequency of adjuvant radiotherapy, the real impact of reduced radicality could not be estimated. Subsequently, several retrospective studies investigated the chance of tailoring parametrectomy according to the tumor's characteristics. Parametrial involvement was shown to be negligible in early-stage low-risk cervical cancer. An observational prospective study and a phase II exploratory RCT have recently confirmed the feasibility and safety of simple hysterectomy in this subgroup of patients. The preliminary results of a large prospective RCT comparing simple vs. radical surgery for early-stage low-risk cervical cancer show strong probability of giving a final answer on this topic.
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Affiliation(s)
- Tommaso Bianchi
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy; (T.B.); (S.N.); (R.F.); (F.L.)
- Clinic of Obstetrics and Gynecology, IRCCS Fondazione San Gerardo dei Tintori, 20900 Monza, Italy; (L.B.); (G.D.M.); (G.T.)
| | - Tommaso Grassi
- Clinic of Obstetrics and Gynecology, IRCCS Fondazione San Gerardo dei Tintori, 20900 Monza, Italy; (L.B.); (G.D.M.); (G.T.)
| | - Luca Bazzurini
- Clinic of Obstetrics and Gynecology, IRCCS Fondazione San Gerardo dei Tintori, 20900 Monza, Italy; (L.B.); (G.D.M.); (G.T.)
| | - Giampaolo Di Martino
- Clinic of Obstetrics and Gynecology, IRCCS Fondazione San Gerardo dei Tintori, 20900 Monza, Italy; (L.B.); (G.D.M.); (G.T.)
| | - Serena Negri
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy; (T.B.); (S.N.); (R.F.); (F.L.)
- Clinic of Obstetrics and Gynecology, IRCCS Fondazione San Gerardo dei Tintori, 20900 Monza, Italy; (L.B.); (G.D.M.); (G.T.)
| | - Robert Fruscio
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy; (T.B.); (S.N.); (R.F.); (F.L.)
- Clinic of Obstetrics and Gynecology, IRCCS Fondazione San Gerardo dei Tintori, 20900 Monza, Italy; (L.B.); (G.D.M.); (G.T.)
| | - Gaetano Trezzi
- Clinic of Obstetrics and Gynecology, IRCCS Fondazione San Gerardo dei Tintori, 20900 Monza, Italy; (L.B.); (G.D.M.); (G.T.)
| | - Fabio Landoni
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy; (T.B.); (S.N.); (R.F.); (F.L.)
- Clinic of Obstetrics and Gynecology, IRCCS Fondazione San Gerardo dei Tintori, 20900 Monza, Italy; (L.B.); (G.D.M.); (G.T.)
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7
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Buda A, Fanfani F. The patterns of growth of cervical cancer: a challenge to personalized radical surgery. Int J Gynecol Cancer 2023:ijgc-2023-004556. [PMID: 37185140 DOI: 10.1136/ijgc-2023-004556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Affiliation(s)
- Alessandro Buda
- Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Fanfani
- Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
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8
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Serouart B, Cordoba A, Martinez-Gomez C, Bogart E, Le Deley MC, Leblanc É, Hudry D, Escande A, Le Tinier F, Pasquesoone C, Taieb S, El Hajj H, Narducci F. Results of a 20 Year Retrospective Analysis of Early-Stage Cervical Cancer: Should 3 cm Be Considered the New Ariadne's Thread in Early Cervical Cancer Treatment? Cancers (Basel) 2023; 15:cancers15051570. [PMID: 36900360 PMCID: PMC10001182 DOI: 10.3390/cancers15051570] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
(1) This study aims to evaluate the overall survival (OS) and recurrence-free survivals (RFS) and assess disease recurrence of early-stage cervical cancer (ESCC) patients treated with minimally invasive surgery (MIS). (2) This single-center retrospective analysis was performed between January 1999 and December 2018, including all patients managed with MIS for ESCC. (3) All 239 patients included in the study underwent pelvic lymphadenectomy followed by radical hysterectomy without the use of an intrauterine manipulator. Preoperative brachytherapy was performed in 125 patients with tumors measuring 2 to 4 cm. The 5-year OS and RFS rates were 92% and 86.9%, respectively. Multivariate analysis found two significant factors associated with recurrence: previous conization with HR = 0.21, p = 0.01, and tumor size > 3 cm with HR = 2.26, p = 0.031. Out of the 33 cases of disease recurrence, we witnessed 22 disease-related deaths. Recurrence rates were 7.5%, 12.9%, and 24.1% for tumors measuring ≤ 2 cm, 2 to 3 cm, and > 3 cm, respectively. Tumors ≤ 2 cm were mostly associated with local recurrences. Tumors > 2 cm were frequently associated with common iliac or presacral lymph node recurrences. (4) MIS may still be considered for tumors ≤ 2 cm subject to first conization followed by surgery with the Schautheim procedure and extended pelvic lymphadenectomy. Due to the increased rate of recurrence, a more aggressive approach might be considered for tumors > 3 cm.
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Affiliation(s)
- Benjamin Serouart
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France
| | - Abel Cordoba
- Department of Radiotherapy, Oscar Lambret Center, 59000 Lille, France
| | | | - Emilie Bogart
- Department of Biostatistics, Oscar Lambret Center, 59000 Lille, France
| | | | - Éric Leblanc
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France
| | - Delphine Hudry
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France
| | - Alexandre Escande
- Department of Radiotherapy, Oscar Lambret Center, 59000 Lille, France
| | | | | | - Sophie Taieb
- Department of Imaging, Oscar Lambret Center, 59000 Lille, France
| | - Houssein El Hajj
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France
- Correspondence: ; Tel.: +33-7-69-21-12-99
| | - Fabrice Narducci
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France
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9
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Carneiro VCG, Batista TP, Andrade MR, Barros AV, Câmara LHLD, Ramalho NM, Lucena MA, Fontão DFS, Tancredi R, Silva Júnior TC, Bezerra ALR, Baiocchi G. Proof-of-concept randomized phase II non-inferiority trial of simple versus type B2 hysterectomy in early-stage cervical cancer ≤2 cm (LESSER). Int J Gynecol Cancer 2023; 33:498-503. [PMID: 36696980 DOI: 10.1136/ijgc-2022-004092] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To evaluate the non-inferiority and safety of simple hysterectomy in early stage (<2 cm) cervical cancer. METHODS This proof-of-concept randomized phase II non-inferiority trial was performed between May 2015 and April 2018 in three oncological centers in Northeast Brazil. Patients with International Federation of Gynecology and Obstetrics (FIGO) 2009 stages IA2-IB1 cervical cancer and tumors ≤2 cm were treated with either simple or modified radical hysterectomy (Querleu-Morrow type B2). Intention-to-treat analysis was carried out. The primary endpoint was 3-year disease-free survival and secondary endpoints were overall survival, operative outcomes, adjuvant therapy, and patient's health-related quality of life (QoL). RESULTS A total of 40 patients underwent either simple hysterectomy (n=20) or modified radical hysterectomy (n=20). All patients except three underwent open procedures (n=37/40, 92.5%). At a median follow-up of 52.1 months (IQR 43.9-60.1), 3-year disease-free survival was 95% (95% CI 68% to 99%) after simple hysterectomy and 100% (95% CI 100% to 100%) after modified radical hysterectomy (log-rank p=0.30). The corresponding 5-year overall survival rates were 90% (95% CI 64% to 97%) and 91% (95% CI 50% to 98%), respectively (log-rank p=0.46). The operative time was shorter after simple hysterectomy than after modified radical hysterectomy (150 min (IQR 137.5-180) vs 199.5 min (IQR 140-230); p=0.003), with a trend towards a longer time for vesical catheterization removal (1 day (IQR 1-1) vs 1 day (IQR 1-2); p=0.043). There was no post-operative mortality and the rates of post-operative complications were not statistically different between arms (15% and 25%; p=0.69). QoL questionnaires were received from only 17 patients (42.5%), with no major differences observed over time between the surgical arms. CONCLUSIONS Simple hysterectomy is safe and potentially non-inferior to the radical surgery in patients with early-stage cervical cancer ≤2 cm. TRIAL REGISTRATION NUMBER NCT02613286.
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Affiliation(s)
- Vandré Cabral Gomes Carneiro
- Surgery/Oncology, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil.,Gynecology, Hospital de Cancer de Pernambuco, Recife, Brazil
| | - Thales Paulo Batista
- Surgery/Oncology, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil .,Surgery, UFPE, Recife, Brazil
| | - Manoel Rodrigues Andrade
- Gynecology, Hospital de Cancer de Pernambuco, Recife, Brazil.,Gynecology, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
| | | | | | | | - Márcia Angélia Lucena
- Gynecology, Hospital de Cancer de Pernambuco, Recife, Brazil.,Surgery/Oncology, Universidade de Pernambuco, Recife, Brazil
| | - Diogenes Fernando Santos Fontão
- Gynecology, Hospital de Cancer de Pernambuco, Recife, Brazil.,Gynecology, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
| | - Rodrigo Tancredi
- Clinical Oncology, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil.,Clinical Oncology, Hospital de Cancer de Pernambuco, Recife, Brazil
| | | | - Artur Lício Rocha Bezerra
- Gynecology, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil.,Surgery/Oncology, Universidade de Pernambuco, Recife, Brazil
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10
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Markovina S, Rendle KA, Cohen AC, Kuroki LM, Grover S, Schwarz JK. Improving cervical cancer survival-A multifaceted strategy to sustain progress for this global problem. Cancer 2022; 128:4074-4084. [PMID: 36239006 PMCID: PMC10042221 DOI: 10.1002/cncr.34485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 02/03/2023]
Abstract
Cervical cancer is associated with profound socioeconomic and racial disparities in incidence, mortality, morbidity, and years of life lost. The last standard-of-care treatment innovation for locally advanced cervical cancer occurred in 1999, when cisplatin chemotherapy was added to pelvic radiation therapy (chemoradiation therapy). Chemoradiation therapy is associated with a 30%-50% failure rate, and there is currently no cure for recurrent or metastatic disease. The enormity of the worldwide clinical problem of cervical cancer morbidity and mortality as well as the egregiously unchanged mortality rate over the last several decades are recognized by the National Institutes of Health as urgent priorities. This is reflected within the Office of Research on Women's Health effort to advance National Institutes of Health research on the health of women, as highlighted in a recent symposium. In the current review, the authors address the state of the science and opportunities to improve cervical cancer survival with an emphasis on improving access, using technology in innovative and widely implementable ways, and improving current understanding of cervical cancer biology. LAY SUMMARY: Cervical cancer is associated with profound socioeconomic and racial disparities in incidence, mortality, morbidity, and years of life lost. In this review, the state of the science and opportunities to improve cervical cancer survival are presented with an emphasis on improving access, using technology in innovative and widely implementable ways, and improving current understanding of cervical cancer biology.
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Affiliation(s)
- Stephanie Markovina
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis
- Siteman Cancer Center, Washington University School of Medicine in St. Louis
| | - Katharine A. Rendle
- Departments of Family Medicine & Community Health and of Biostatistics, Informatics, and Epidemiology, Perelman School of Medicine, University of Pennsylvania
- Abramson Cancer Center, University of Pennsylvania
| | - Alexander C. Cohen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis
| | - Lindsay M. Kuroki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis
| | - Surbhi Grover
- Abramson Cancer Center, University of Pennsylvania
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania
| | - Julie K. Schwarz
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis
- Siteman Cancer Center, Washington University School of Medicine in St. Louis
- Department of Cell Biology and Physiology, Washington University School of Medicine in St. Louis
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11
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Matias-Guiu X, Selinger CI, Anderson L, Buza N, Ellenson LH, Fadare O, Ganesan R, Ip PPC, Palacios J, Parra-Herran C, Raspollini MR, Soslow RA, Werner HMJ, Lax SF, McCluggage WG. Data Set for the Reporting of Endometrial Cancer: Recommendations From the International Collaboration on Cancer Reporting (ICCR). Int J Gynecol Pathol 2022; 41:S90-S118. [PMID: 36305536 DOI: 10.1097/pgp.0000000000000901] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Endometrial cancer is one of the most common cancers among women. The International Collaboration on Cancer Reporting (ICCR) developed a standardized endometrial cancer data set in 2011, which provided detailed recommendations for the reporting of resection specimens of these neoplasms. A new data set has been developed, which incorporates the updated 2020 World Health Organization Classification of Female Genital Tumors, the Cancer Genome Atlas (TCGA) molecular classification of endometrial cancers, and other major advances in endometrial cancer reporting, all of which necessitated a major revision of the data set. This updated data set has been produced by a panel of expert pathologists and an expert clinician and has been subject to international open consultation. The data set includes core elements which are unanimously agreed upon as essential for cancer diagnosis, clinical management, staging, or prognosis and noncore elements which are clinically important, but not essential. Explanatory notes are provided for each element. Adoption of this updated data set will result in improvements in endometrial cancer patient care.
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12
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Bogani G, Di Donato V, Scambia G, Raspagliesi F, Chiantera V, Sozzi G, Golia D’Augè T, Muzii L, Benedetti Panici P, D’Oria O, Vizza E, Giannini A. Radical Hysterectomy for Early Stage Cervical Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811641. [PMID: 36141917 PMCID: PMC9517651 DOI: 10.3390/ijerph191811641] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 05/21/2023]
Abstract
Radical hysterectomy and plus pelvic node dissection are the primary methods of treatment for patients with early stage cervical cancer. During the last decade, growing evidence has supported the adoption of a minimally invasive approach. Retrospective data suggested that minimally invasive surgery improves perioperative outcomes, without neglecting long-term oncologic outcomes. In 2018, the guidelines from the European Society of Gynaecological Oncology stated that a "minimally invasive approach is favored" in comparison with open surgery. However, the phase III, randomized Laparoscopic Approach to Cervical Cancer (LACC) trial questioned the safety of the minimally invasive approach. The LACC trial highlighted that the execution of minimally invasive radical hysterectomy correlates with an increased risk of recurrence and death. After its publication, other retrospective studies investigated this issue, with differing results. Recent evidence suggested that robotic-assisted surgery is not associated with an increased risk of worse oncologic outcomes. The phase III randomized Robotic-assisted Approach to Cervical Cancer (RACC) and the Robotic Versus Open Hysterectomy Surgery in Cervix Cancer (ROCC) trials will clarify the pros and cons of performing a robotic-assisted radical hysterectomy (with tumor containment before colpotomy) in early stage cervical cancer.
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Affiliation(s)
- Giorgio Bogani
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy
- Correspondence: ; Tel.: +39-3803933116
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00182 Rome, Italy
| | - Francesco Raspagliesi
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, University of Palermo, 90127 Palermo, Italy
| | - Giulio Sozzi
- Department of Gynecologic Oncology, University of Palermo, 90127 Palermo, Italy
| | - Tullio Golia D’Augè
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy
| | - Ottavia D’Oria
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Andrea Giannini
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy
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13
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Abstract
PURPOSE OF REVIEW This article discusses recent developments towards less radical surgical treatment for early-stage cervical cancer. RECENT FINDINGS Surgery is the standard treatment for early-stage cervical cancer. In the last decades, new treatment strategies have been developed aiming to reduce morbidity, without hampering oncological safety. We provide an update of the latest knowledge on safety and morbidity following less radical surgical procedures in early-stage cervical cancer. In cervical cancer with a tumour size of 2 cm or less, radical surgery (simple hysterectomy or fertility-sparing conisation) may be a well tolerated option. For patients with larger lesions (>2 cm) and wishing to preserve fertility, administration of neoadjuvant chemotherapy followed by less extensive surgery appears to be a feasible and well tolerated alternative to abdominal trachelectomy. With regard to lymph node assessment, increasing evidence shows the feasibility of the sentinel lymph node procedure instead of full pelvic lymphadenectomy. Prospective trials reporting on oncological safety are awaited.It is important to exercise caution when new surgical strategies are introduced. Despite promising retrospective data, prospective randomized studies may present unexpected results, for instance, minimally invasive radical hysterectomy showed inferior results compared to laparotomy. SUMMARY There is a shift towards less radical treatment for early-stage cervical cancer. This review explores whether and when less is really more.
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14
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Bogani G, Di Donato V, Muzii L, Casarin J, Ghezzi F, Malzoni M, Greggi S, Landoni F, Bazzurini L, Zanagnolo V, Multinu F, Angioli R, Plotti F, Caruso G, Fischetti M, Ferrandina G, Palaia I, Benedetti Panici P, Scambia G, Raspagliesi F. Assessing the role of minimally invasive radical hysterectomy for early-stage cervical cancer. Eur J Obstet Gynecol Reprod Biol 2022; 275:64-69. [PMID: 35753229 DOI: 10.1016/j.ejogrb.2022.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/19/2022] [Accepted: 06/04/2022] [Indexed: 11/04/2022]
Abstract
Surgery is the mainstay of treatment in the management of early-stage cervical cancer. Until the publication of the Laparoscopic Approach to Cervical Cancer (LACC) trial, minimally invasive radical hysterectomy was the recommended approach to treat patients with early-stage disease. The results of the LACC trial questioned the adoption of minimally invasive surgery in cervical cancer. In comparison with the open approach, minimally invasive surgery correlated with worse disease-free and cancer-specific survival. Similarly, other retrospective studies highlighted this correlation, thus corroborating the results of the LACC trials. In the present review, we evaluated current evidence and further prospective of the adoption of minimally invasive radical hysterectomy in cervical cancer. Moreover, we sought to assess some unsolved issues regarding the role of minimally invasive surgery in early-stage cervical cancer patients.
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Affiliation(s)
- Giorgio Bogani
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Violante Di Donato
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy.
| | - Ludovico Muzii
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Mario Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Stefano Greggi
- Gynecology Oncology Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Fabio Landoni
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Luca Bazzurini
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Vanna Zanagnolo
- Gynecology Oncology Unit, Istituto Europeo di Oncologia, Milano, Italy
| | - Francesco Multinu
- Gynecology Oncology Unit, Istituto Europeo di Oncologia, Milano, Italy
| | | | | | - Giuseppe Caruso
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Margherita Fischetti
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Gabriella Ferrandina
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Innocenza Palaia
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | | | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Francesco Raspagliesi
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
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15
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Oncologic outcomes of patients with FIGO 2014 stage IB-IIA cervical adenocarcinoma who underwent radical surgery. Arch Gynecol Obstet 2022; 306:1657-1664. [PMID: 35303151 DOI: 10.1007/s00404-022-06507-2] [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: 06/22/2021] [Accepted: 03/04/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To identify prognostic factors of early-stage cervical adenocarcinoma in patients with FIGO IB-IIA, who were treated with radical surgery. MATERIALS AND METHODS Clinical data of 64 patients with stage IB-IIA cervical adenocarcinoma who underwent radical hysterectomy and lymphadenectomy with or without adjuvant therapy between 1993 and 2019 were retrospectively reviewed. The clinicopathologic factors that affect the oncological outcomes were evaluated. The Kaplan-Meier method was used for the assessment of survival outcomes. Survival curves were compared using the log-rank test. RESULTS The 5-year recurrence-free survival and 5-year disease-specific survivals were 83% and 98%, respectively. Tumor size, stage of disease and uterine spread were significantly related prognostic factors for shorter recurrence-free survival. During the follow-up, nine (14.1%) patients recurred. Five of them were extrapelvic recurrence. No correlation was identified between histopathologic subtype and extrapelvic recurrence (p = 0.265). There was no difference between adjuvant only radiotherapy and concurrent chemoradiotherapy on recurrence-free survival in a univariate analysis adjusting for prognostic factors. CONCLUSION It is important to determine the prognostic factors that predict disease outcome in surgically treated cervical adenocarcinoma for tailored adjuvant treatment. Tumor size, stage and uterine spread are determinant factors for recurrence. Risk stratifications, including uterine spread may especially be useful for patients with AC.
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16
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Bogdanova A, Andrawos C, Constantinou C. Cervical cancer, geographical inequalities, prevention and barriers in resource depleted countries (Review). Oncol Lett 2022; 23:113. [PMID: 35251344 PMCID: PMC8850967 DOI: 10.3892/ol.2022.13233] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/25/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Anna Bogdanova
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, CY‑1700 Nicosia, Republic of Cyprus
| | - Charles Andrawos
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, CY‑1700 Nicosia, Republic of Cyprus
| | - Constantina Constantinou
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, CY‑1700 Nicosia, Republic of Cyprus
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17
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Gauci PA, Kee DLC, Thamphya B, Schiappa R, Delotte J, Chand-Fouche ME, Hannoun-Levi JM. Preoperative high-dose-rate brachytherapy for high-risk early-stage cervical cancer: Long-term clinical outcome analysis. Brachytherapy 2022; 21:273-282. [PMID: 35094933 DOI: 10.1016/j.brachy.2021.11.007] [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] [Received: 09/09/2021] [Revised: 11/16/2021] [Accepted: 11/24/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report long-term oncological and toxicity outcomes after high-dose-rate brachytherapy (HDB) followed by oncologic surgery for patients with early-stage cervical cancer. METHODS AND MATERIALS From 2005 to 2019, all patients treated with preoperative HDB at Antoine Lacassagne Cancer Center for early-stage (IB1-IB2-IIA - FIGO 2018) cervical cancer with local relapse risk factors were included. HDB was performed followed by hysterectomy. Oncological and toxicity outcomes were evaluated prospectively. RESULTS We identified 61 patients, with a median follow-up of 84 months. Posthysterectomy complete pathological response was observed in 46 patients (75.4%). Six patients (9.8%) experienced recurrence, including 4 local relapses (6.6%), and 2 deaths (3.3%) due to cervical cancer. Five-year local, nodal and metastatic relapse-free survivals were 94% (95% CI 87-100%), 96% (95% CI 90-100%) and 93% (95% CI 86-100%) respectively. Five-year overall survival was 98% (95% CI 95-100%). No grade ≥ 3 acute toxicity was observed, and 3 patients (4.9%) experienced grade 2 acute toxicity. One patient presented grade 4 late digestive toxicity, and 6 patients had grade 2 late toxicity. Only 1 patient still had grade 2 toxicity, after 9 years follow-up. CONCLUSIONS To our knowledge, we are reporting the longest follow-up of a preoperative HDB cohort. With similar oncological outcomes and less morbidity compared to primary surgery treatment followed more or less by adjuvant radiotherapy, HDB followed by hysterectomy could be a promising therapeutic option for early-stage cervical cancers with poor prognostic factors.
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Affiliation(s)
- Pierre-Alexis Gauci
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d'Azur, Nice Cedex 2, Nice, France; Department of Obstetrics and Gynecology, Reproduction and Fetal Medicine, CHU de Nice, University of Côte d'Azur, Nice, France
| | - Daniel Lam Cham Kee
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d'Azur, Nice Cedex 2, Nice, France
| | - Brice Thamphya
- Department of Statistics, Antoine Lacassagne Cancer Center - University of Côte d'Azur, Nice, France
| | - Renaud Schiappa
- Department of Statistics, Antoine Lacassagne Cancer Center - University of Côte d'Azur, Nice, France
| | - Jerome Delotte
- Department of Obstetrics and Gynecology, Reproduction and Fetal Medicine, CHU de Nice, University of Côte d'Azur, Nice, France
| | - Marie-Eve Chand-Fouche
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d'Azur, Nice Cedex 2, Nice, France
| | - Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d'Azur, Nice Cedex 2, Nice, France.
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18
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Yüksel D, Karataş Şahin E, Ünsal M, Çakır C, Kılıç Ç, Kimyon Cömert G, Korkmaz V, Türkmen O, Turan T. The prognostic factors in 384 patients with FIGO 2014 stage IB cervical cancer: What is the role of tumor size on prognosis? Eur J Obstet Gynecol Reprod Biol 2021; 266:126-132. [PMID: 34634671 DOI: 10.1016/j.ejogrb.2021.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/26/2021] [Accepted: 09/26/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To define the relationship of tumor size with surgico-pathological factors and oncological outcome in FIGO 2014 stage IB cervical cancer. METHODS This study retrospectively evaluated 384 FIGO 2014 Stage IB cervical cancer patients who underwent radical hysterectomy and lymphadenectomy. Tumor size was stratified according to 2 cm (≤ 2cm, 2-≤4 cm, >4 cm) and 4 cm (≤4 cm, >4 cm), and the relationship with poor prognostic factors, and the effects on survival were examined. The distribution of prognostic factors was compared between three subgroups: ≤2 cm vs. 2-≤4 cm; 2-≤4 cm vs. > 4 cm and ≤ 2 cm vs. > 4 cm. Survival rate was evaluated using the Kaplan-Meier method and compared with the log-rank test. Multivariate analysis was performed using Cox proportional-hazards regression. RESULTS Stratification of tumor size according to 4 cm was found to better determine pelvic lymph node determination. Parametrial involvement, uterine involvement and deep cervical stromal invasion were correlated with increasing tumor size. Lymph node involvement and uterine involvement were an independent prognostic risk factor for recurrence and cancer-specific survival. Tumor size showed no association with prognosis. CONCLUSION There is no meaningful cut-off value for tumor size determining all surgico-pathological factors. There was also seen to be no association between tumor size and recurrence or disease-related mortality.
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Affiliation(s)
- Dilek Yüksel
- Gynecologic Oncology Department, Health Sciences University Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara, Turkey.
| | - Ediz Karataş Şahin
- Gynecology and Obstetrics Department, Health Sciences University Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Mehmet Ünsal
- Gynecology and Obstetrics Department, Health Sciences University Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Caner Çakır
- Gynecologic Oncology Department, Health Sciences University Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara, Turkey
| | - Çiğdem Kılıç
- Gynecologic Oncology Department, Health Sciences University Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara, Turkey
| | - Günsu Kimyon Cömert
- Gynecologic Oncology Department, Health Sciences University Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara, Turkey
| | - Vakkas Korkmaz
- Gynecologic Oncology Department, Health Sciences University Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara, Turkey
| | - Osman Türkmen
- Gynecologic Oncology Department, Health Sciences University Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara, Turkey
| | - Taner Turan
- Gynecologic Oncology Department, Health Sciences University Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara, Turkey
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Charoenkwan P, Shoombuatong W, Nantasupha C, Muangmool T, Suprasert P, Charoenkwan K. iPMI: Machine Learning-Aided Identification of Parametrial Invasion in Women with Early-Stage Cervical Cancer. Diagnostics (Basel) 2021; 11:diagnostics11081454. [PMID: 34441388 PMCID: PMC8391438 DOI: 10.3390/diagnostics11081454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 01/18/2023] Open
Abstract
Radical hysterectomy is a recommended treatment for early-stage cervical cancer. However, the procedure is associated with significant morbidities resulting from the removal of the parametrium. Parametrial cancer invasion (PMI) is found in a minority of patients but the efficient system used to predict it is lacking. In this study, we develop a novel machine learning (ML)-based predictive model based on a random forest model (called iPMI) for the practical identification of PMI in women. Data of 1112 stage IA-IIA cervical cancer patients who underwent primary surgery were collected and considered as the training dataset, while data from an independent cohort of 116 consecutive patients were used as the independent test dataset. Based on these datasets, iPMI-Econ was then developed by using basic clinicopathological data available prior to surgery, while iPMI-Power was also introduced by adding pelvic node metastasis and uterine corpus invasion to the iPMI-Econ. Both 10-fold cross-validations and independent test results showed that iPMI-Power outperformed other well-known ML classifiers (e.g., logistic regression, decision tree, k-nearest neighbor, multi-layer perceptron, naive Bayes, support vector machine, and extreme gradient boosting). Upon comparison, it was found that iPMI-Power was effective and had a superior performance to other well-known ML classifiers in predicting PMI. It is anticipated that the proposed iPMI may serve as a cost-effective and rapid approach to guide important clinical decision-making.
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Affiliation(s)
- Phasit Charoenkwan
- College of Arts, Media and Technology, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Watshara Shoombuatong
- Center of Data Mining and Biomedical Informatics, Faculty of Medical Technology, Mahidol University, Bangkok 73170, Thailand;
| | - Chalaithorn Nantasupha
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (C.N.); (T.M.); (P.S.)
| | - Tanarat Muangmool
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (C.N.); (T.M.); (P.S.)
| | - Prapaporn Suprasert
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (C.N.); (T.M.); (P.S.)
| | - Kittipat Charoenkwan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (C.N.); (T.M.); (P.S.)
- Correspondence:
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20
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Wu J, Logue T, Kaplan SJ, Melamed A, Tergas AI, Khoury-Collado F, Hou JY, St Clair CM, Hershman DL, Wright JD. Less radical surgery for early-stage cervical cancer: a systematic review. Am J Obstet Gynecol 2021; 224:348-358.e5. [PMID: 33306971 DOI: 10.1016/j.ajog.2020.11.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE A systematic review was performed to examine the outcomes of simple hysterectomy for women with low-risk, early-stage cervical cancer. DATA SOURCES MEDLINE, Embase, Web of Science, and ClinicalTrials.gov were searched from inception until November 4, 2020. STUDY ELIGIBILITY CRITERIA Original research reporting recurrence or survival outcomes among women with early-stage cervical cancer (defined as stage IA2 to IB1 disease) who were treated with simple hysterectomy. METHODS Data regarding study characteristics, tumor characteristics, other treatment modalities, adjuvant therapy, recurrence, and survival outcomes were analyzed. Studies that reported both simple hysterectomy and radical hysterectomy outcomes were compared in a subgroup analysis. Summary statistics were reported and eligible studies were further analyzed to determine an estimated hazard ratio comparing simple hysterectomy with radical hysterectomy. RESULTS A total of 21 studies were included, of which 3 were randomized control trials, 14 retrospective studies, 2 prospective studies, and 2 population-level data sets. The cohort included 2662 women who underwent simple hysterectomy, of which 36.1% had stage IA2 disease and 61.0% stage IB1 disease. Most cases (96.8%) involved tumors of ≤2 cm in size, and 15.4% of cases were lymphovascular space invasion positive. Approximately 71.8% of women who underwent simple hysterectomy had a lymph node assessment, and 30.7% of women underwent adjuvant chemotherapy or radiation. The most common complications described were lymphedema (24%), lymphocysts (22%), and urinary incontinence (18.5%). The total death rate for studies that reported deaths was 5.5%. By stage, there was a 2.7% mortality rate among IA2 disease and a 7.3% mortality rate among IB1 disease. Of note, 18 studies reported outcomes for both simple and radical hysterectomy, with a 4.5% death rate in the radical hysterectomy group and a 5.8% death rate in the simple hysterectomy group. Estimated and reported hazard ratio demonstrated no significant association for mortality between radical and nonradical surgeries for IA2 disease but potentially increased risk of mortality among IB1 disease. All studies had a moderate to high risk of bias, including the 3 randomized control trials. Level of evidence was limited to III to IV. CONCLUSION The use of less radical surgery for women with stage IA2 and small volume IB1 cervical cancers appears favorable. However, there is concern that simple hysterectomy in women with stage IB1 tumors may adversely impact survival. Overall, the quality of studies available is modest, limiting the conclusions that can be drawn from the available literature.
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21
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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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22
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Plotti F, Ficarola F, Messina G, Terranova C, Montera R, Guzzo F, DE Cicco Nardone C, Rossini G, Schirò T, Gatti A, Luvero D, Feole L, Angioli R. Tailoring parametrectomy for early cervical cancer (Stage IA-IIA FIGO): a review on surgical, oncologic outcome and sexual function. Minerva Obstet Gynecol 2020; 73:149-159. [PMID: 33249819 DOI: 10.23736/s2724-606x.20.04683-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Cervical cancer is currently one of the most common cancers afflicting the female population worldwide and in industrialized countries the presence of screening and a specific diagnostic and therapeutic process has favored early diagnosis of cervical cancer. In literature have found that reducing the radicality on the parametria in early cervical cancer (ECC), reduces complications without impacting oncological outcomes, but the data in the literature are not yet clear. EVIDENCE ACQUISITION Searching on PubMed, we included 1473 articles from January 1974 to 2020. We identified all the studies that compared different type of radical hysterectomy in the primary surgical treatment of ECC. 16 articles were elected for the review. EVIDENCE SYNTHESIS Modified radical hysterectomy (Piver II/Querleu-Morrow Type B) in ECC, if compared to CRH (Piver III/Querleu-Morrow Type C2), is not associated with worse cancer outcome and patient survival, but it is associated with a minor operating time, lower blood loss and minor bladder dysfunction. Nerve sparing radical hysterectomy approach (NSRH/Querleu-Morrow Type C1) compared to CRH (Piver III/Type C2) in the ECC, with our data we can confirm a non-inferiority regarding the oncological outcome. CONCLUSIONS Reduced radicality on the parametrium offers positive effects on the quality of life (sexual life and bladder function) of patients without impacting on survival, oncological outcome.
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Affiliation(s)
- Francesco Plotti
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Fernando Ficarola
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy -
| | - Giuseppe Messina
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Corrado Terranova
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Roberto Montera
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Federica Guzzo
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | | | - Gianmarco Rossini
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Teresa Schirò
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Alessandra Gatti
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Daniela Luvero
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Laura Feole
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Roberto Angioli
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
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23
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Gill CM, Orfanelli T, Yoxtheimer L, Roy-McMahon C, Suhner J, Tomita S, Kalir T, Liu Y, Houldsworth J, Kolev V. Histology-specific FGFR2 alterations and FGFR2-TACC2 fusion in mixed adenoid cystic and neuroendocrine small cell carcinoma of the uterine cervix. Gynecol Oncol Rep 2020; 34:100668. [PMID: 33241100 PMCID: PMC7672274 DOI: 10.1016/j.gore.2020.100668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 01/28/2023] Open
Abstract
Neuroendocrine small cell carcinoma of the uterine cervix portends a dismal prognosis with limited treatment options. Rarely, tumors of mixed-lineage appear in gynecologic malignancies. Here, we report a 77-year-old woman who presented with complete uterine prolapse and 4-month history of vaginal bleeding. Histopathologic evaluation revealed a mixed adenoid cystic carcinoma and neuroendocrine small cell carcinoma of the uterine cervix. The tumor was PD-L1 and HPV 35 positive. The patient was treated with up-front surgery and adjuvant radiation. Independent, histology-specific alterations in FGFR2 and a FGFR2-TACC2 fusion were identified. Progression of disease occurred within 6 months for which she received chemotherapy and immunotherapy. However, the patient expired within a year. We comprehensively review how screening for and targeting of FGFR alterations in recurrent and metastatic cervical cancer might serve as a touchstone for future treatment regimens.
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Affiliation(s)
- Corey M Gill
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Theofano Orfanelli
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Lorene Yoxtheimer
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Christine Roy-McMahon
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jessa Suhner
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Shannon Tomita
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Tamara Kalir
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Yuxin Liu
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jane Houldsworth
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Valentin Kolev
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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24
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Buda A, Casarin J, Mueller M, Fanfani F, Zapardiel I, Mereu L, Puppo A, De Ponti E, Adorni M, Ferrari D, Gasparri ML, Ghezzi F, Scambia G, Papadia A. The impact of low-volume metastasis on disease-free survival of women with early-stage cervical cancer. J Cancer Res Clin Oncol 2020; 147:1599-1606. [PMID: 33130942 DOI: 10.1007/s00432-020-03435-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 10/21/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE We aimed to assess the impact of low-volume metastasis (micrometastasis and isolated tumor cells) on disease-free survival (DFS) of women with early-stage cervical cancer. METHODS Women with clinically suspected stage 1A-IB2 (FIGO 2018 classification) disease who underwent retroperitoneal nodal staging between October 2010 and April 2018, were retrospectively analyzed. The group of women who had undergone lymphadenectomy and standard node pathologic analysis (H&E group), were compared to the group undergoing sentinel node mapping (SLN) and ultrastaging with or without lymphadenectomy (ultrastaging group). At a median follow-up of 45 months, the DFS curves were analyzed. RESULTS Overall, 573 patients were revised (272 in the H&E group and 302 in the ultrastaging group). Eighty-five patients presented lymph node metastasis (32 in H&E, 53 in ultrastaging). Ultrastaging protocol increased the rate of low-volume metastasis by 5.6%. Twenty patients showed exclusive micrometastasis or ITC's. Seventy-three recurrences occurred (35 in H&E, 38 in ultrastaging). Only 1 out of 53 patients in the ultrastaging group (1.9%) presented with micrometastasis recurred. The 3-year disease-free survival was 89% for the H&E group, and 88% for the ultrastaging group, respectively (p = 0.175). CONCLUSION Ultrastaging analysis allowed increasing the detection of low volume metastasis in women with early-stage cervical cancer. However, the type of nodal staging did not have an impact on patients' 3-year disease-free survival.
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Affiliation(s)
- Alessandro Buda
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
| | - Jvan Casarin
- Obstetrics and Gynecology Department, University of Insubria, Varese, Italy
| | - Michael Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Francesco Fanfani
- Dipartimento della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento Scienze della vita e sanità pubblica, Sacred Heart Catholic University, Rome, Italy
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital-IdiPAZ, Madrid, Spain
| | - Liliana Mereu
- Department of Obstetrics and Gynecology, Santa Chiara Hospital, Trento, Italy
| | - Andrea Puppo
- Clinic of Obstetrics and Gynecology, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Elena De Ponti
- Department of Physical Medicine, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Marco Adorni
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Debora Ferrari
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Maria Luisa Gasparri
- Department of Gynecology and Obstetrics, University of the Italian Switzerland (USI), Ente Ospedaliero Cantonale of Lugano, Lugano, Switzerland
| | - Fabio Ghezzi
- Obstetrics and Gynecology Department, University of Insubria, Varese, Italy
| | - Giovanni Scambia
- Dipartimento della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento Scienze della vita e sanità pubblica, Sacred Heart Catholic University, Rome, Italy
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland.,Department of Gynecology and Obstetrics, University of the Italian Switzerland (USI), Ente Ospedaliero Cantonale of Lugano, Lugano, Switzerland
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25
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Zapardiel I, Gracia M, Rychlik A, Querleu D. Adapting Radicality in Early Cervical Cancer When Quality of Life Becomes a Prominent Issue. Ann Surg Oncol 2020; 28:3429-3430. [PMID: 33057861 DOI: 10.1245/s10434-020-09193-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/23/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain.
| | - Myriam Gracia
- Gynecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | - Agnieszka Rychlik
- Gynecologic Oncology Unit, The National Research Institute of Oncology, Warsaw, Poland
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26
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Reed N, Balega J, Barwick T, Buckley L, Burton K, Eminowicz G, Forrest J, Ganesan R, Harrand R, Holland C, Howe T, Ind T, Iyer R, Kaushik S, Music R, Sadozye A, Shanbhag S, Siddiqui N, Syed S, Percival N, Whitham NL, Nordin A, Fotopoulou C. British Gynaecological Cancer Society (BGCS) cervical cancer guidelines: Recommendations for practice. Eur J Obstet Gynecol Reprod Biol 2020; 256:433-465. [PMID: 33143928 DOI: 10.1016/j.ejogrb.2020.08.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/05/2020] [Accepted: 08/21/2020] [Indexed: 01/20/2023]
Abstract
Cervix cancer in many countries is declining and screening programmes and immunisation will reduce the incidence in the next few decades. This guideline attempts to cover management of invasive disease reflecting diagnosis and imaging including new imaging and sentinel lymph node biopsies. Smaller volume disease is usually managed surgically whereas advanced disease is treated with (chemo)- radiation. It also includes discussion of fertility sparing procedures. Practices are changing frequently for all aspects of care usually in attempts to reduce complications and improve quality of life. The management of advanced disease is treated by chemotherapy and the use of newer agents is also discussed. Other sections discuss specialist situations such as cancer in pregnancy, rare cervical tumours, late effects and supportive measures and fertility preserving approaches.
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Affiliation(s)
- Nick Reed
- Beatson Oncology Centre, Glasgow, United Kingdom.
| | | | | | - Lynn Buckley
- Clinical Nurse Specialist, Hull University Teaching Hospitals NHS Trust, United Kingdom
| | | | | | | | | | | | | | | | - Thomas Ind
- Royal Marsden Hospital, London, United Kingdom
| | - Rema Iyer
- East Kent Hospitals University Foundation NHS Trust, United Kingdom
| | | | - Robert Music
- Jo's Cervical Cancer Trustt, London, United Kingdom
| | | | - Smruta Shanbhag
- University Hospitals Coventry and Warwickshire NHS Trust, United Kingdom
| | | | - Sheeba Syed
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | | | - Natasha Lauren Whitham
- Lancashire Teaching Hospitals (Royal Preston Hospital, Fulwood, Lancashire), United Kingdom
| | - Andy Nordin
- East Kent Gynaecological Oncology Centre, East Kent Hospitals University Foundation Nhs Trust, Queen Elizabeth The Queen Mother Hospital, Margate, United Kingdom
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27
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Predictors of recurrence following laparoscopic radical hysterectomy for early-stage cervical cancer: A multi-institutional study. Gynecol Oncol 2020; 159:164-170. [PMID: 32665147 DOI: 10.1016/j.ygyno.2020.06.508] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/28/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To assess predictors of recurrence following laparoscopic radical hysterectomy (LRH) for apparent early stage cervical cancer (CC). METHODS This is a retrospective multi-institutional study reviewing data of consecutive patients who underwent LRH for FIGO 2009 stage IA1 (with lymphovascular space invasion (LVSI)), IA2 and IB1(≤4 cm) CC, between January 2006 and December 2017. The following histotypes were included: squamous, adenosquamous, and adenocarcinoma. Multivariable models were used to estimate adjusted odds ratio (OR) and corresponding 95% CI. Factors influencing disease-free survival (DFS) and disease-specific survival (DSS) were also explored. RESULTS 428 patients were included in the analysis. With a median follow-up of 56 months (1-162) 54 patients recurred (12.6%). At multivariable analysis, tumor size (OR:1.04, 95%CI:1.01-1.09, p = .02), and presence of cervical residual tumor at final pathology (OR: 5.29, 95%CI:1.34-20.76, p = .02) were found as predictors of recurrence; conversely preoperative conization reduced the risk (OR:0.32, 95%CI:0.11-0.90, p = .03). These predictors remained significant also in the IB1 subgroup: tumor size: OR:1.05, 95%CI:1.01-1.09, p = .01; residual tumor at final pathology: OR: 6.26, 95%CI:1.58-24.83, p = .01; preoperative conization: OR:0.33, 95%CI:0.12-0.95, p = .04. Preoperative conization (HR: 0.29, 95%CI: 0.13-0.91; p = .03) and the presence of residual tumor on the cervix at the time of surgery (HR: 8.89; 95%CI: 1.39-17.23; p = .01) independently correlated with DFS. No independent factors were associated with DSS. CONCLUSIONS In women with early stage CC the presence of high-volume disease at time of surgery represent an independent predictor of recurrence after LRH. Conversely, preoperative conization and the absence of residual disease at the time of surgery might play a protective role.
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Wolf B, Espig O, Stolzenburg JU, Horn LC, Aktas B, Höckel M. Preservation of the mesureter to reduce urinary complications: analysis of data from the observational Leipzig School MMR study. BJOG 2020; 127:859-865. [PMID: 32037645 DOI: 10.1111/1471-0528.16167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the feasibility and effect of mesureteral preservation on urinary complications in the context of total mesometrial resection (TMMR), a surgical treatment for cervical cancer. DESIGN Retrospective cohort study with historic control. SETTING Single tertiary academic centre. POPULATION Women older than 18 with primary cervical cancer staged FIGO IB1-IIB enrolled in the prospective Leipzig School MMR study and underwent total mesometrial resection (TMMR) without adjuvant radiation. METHOD We retrospectively analysed 100 consecutive TMMR procedures which were performed for cancer of the uterine cervix and in which the mesureter was preserved (intervention group, 01/2014-06/2017). We compared this group with the previous 100 consecutive TMMRs, which were performed before the introduction of mesureteral preservation (control group, 09/2010-01/2014). MAIN OUTCOME MEASURES The occurrence of urological and specifically ureteral complications. RESULTS Mesureteral preservation was feasible and was associated with a significant decrease in ureteral complications (11% without mesureteral preservation versus 3% with mesureteral preservation, P = 0.049). Furthermore, we found a significant decrease in the number of postoperative percutaneous nephrostomies and re-operations (7% versus none, P = 0.014). There was also a trend towards a decrease in other urinary complications such as postoperative bladder atony and uretero-vaginal fistulas. CONCLUSION The mesureter constitutes a convenient dissection plane enabling the preservation of lateral ureteral blood supply during TMMR. In our study, maintenance of mesureteral integrity was associated with a significant reduction in ureteral complications. Mesureteral preservation might also be useful in other types of pelvic surgeries that carry a high risk of ureteral damage. TWEETABLE ABSTRACT Surgical preservation of the mesureter in cervical cancer patients was associated with a reduction in urinary complications.
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Affiliation(s)
- B Wolf
- Department of Gynaecology, University Hospital Leipzig, Leipzig, Germany
| | - O Espig
- Department of Urology, University Hospital Leipzig, Leipzig, Germany
| | - J-U Stolzenburg
- Department of Urology, University Hospital Leipzig, Leipzig, Germany
| | - L-C Horn
- Division of Gynaecologic, Breast, and Perinatal Pathology, University Hospital Leipzig, Leipzig, Germany
| | - B Aktas
- Department of Gynaecology, University Hospital Leipzig, Leipzig, Germany
| | - M Höckel
- Department of Gynaecology, University Hospital Leipzig, Leipzig, Germany
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Kohler C, Hertel H, Herrmann J, Marnitz S, Mallmann P, Favero G, Plaikner A, Martus P, Gajda M, Schneider A. Laparoscopic radical hysterectomy with transvaginal closure of vaginal cuff - a multicenter analysis. Int J Gynecol Cancer 2020; 29:845-850. [PMID: 31155516 DOI: 10.1136/ijgc-2019-000388] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 03/30/2019] [Accepted: 04/08/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Laparoscopic/robotic radical hysterectomy has been historically considered oncologically equivalent to open radical hysterectomy for patients with early cervical cancer. However, a recent prospective randomized trial (Laparoscopic Approach to Cervical Cancer, LACC) has demonstrated significant inferiority of the minimally invasive approach. The aim of this study is to evaluate the oncologic outcomes of combined laparoscopic-vaginal radical hysterectomy. METHODS Between August 1994 and December 2018, patients with invasive cervical cancer were treated using minimally-invasive surgery at the Universities of Jena, Charité Berlin (Campus CCM and CBF) and Cologne and Asklepios Clinic Hamburg. 389 patients with inclusion criteria identical to the LACC trial were identified. In contrast to the laparoscopic/robotic technique used in the LACC trial, all patients in our cohort underwent a combined transvaginal-laparoscopic approach without the use of any uterine manipulator. RESULTS A total of 1952 consecutive patients with cervical cancer were included in the analysis. Initial International Federation of Gynecology and Obstetrics (FIGO) stage was IA1 lymphovascular space invasion (LVSI+), IA2 and IB1/IIA1 in 32 (8%), 43 (11%), and 314 (81%) patients, respectively, and histology was squamous cell in 263 (68%), adenocarcinoma in 117 (30%), and adenosquamous in 9 (2%) patients. Lymphovascular invasion was confirmed in 106 (27%) patients. The median number of lymph nodes was 24 (range 2-86). Lymph nodes were tumor-free in 379 (97%) patients. Following radical hysterectomy, 71 (18%) patients underwent adjuvant chemoradiation or radiation. After a median follow-up of 99 (range 1-288) months, the 3-, 4.5-, and 10-year disease-free survival rates were 96.8%, 95.8%, and 93.1 %, and the 3-, 4.5-, and 10-year overall survival rates were 98.5%, 97.8%, and 95.8%, respectively. Recurrence location was loco-regional in 50% of cases with recurrence (n=10). Interestingly, 9/20 recurrences occurred more than 39 months after surgery. CONCLUSION The combined laparoscopic-vaginal technique for radical hysterectomy with avoidance of spillage and manipulation of tumor cells provides excellent oncologic outcome for patients with early cervical cancer. Our retrospective data suggest that laparoscopic-vaginal surgery may be oncologically safe and should be validated in further randomized trials.
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Affiliation(s)
- Christhardt Kohler
- Department of Gynecology, Medical Faculty of the University of Cologne, Koln, Germany .,Department of Special Operative and Oncologic Gynecology, Asklepios Klinik Altona, Hamburg, Germany
| | - Hermann Hertel
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Jörg Herrmann
- Department of Obstetrics and Gynecology, Sophien und Hufeland Klinikum, Weimar, Germany
| | - Simone Marnitz
- Department of Radiooncology, Medical Faculty of the University of Cologne, Koln, Germany
| | - Peter Mallmann
- Department of Gynecology, Medical Faculty of the University of Cologne, Koln, Germany
| | - Giovanni Favero
- Department of Gynecology, HELIOS Mariahilf Klinik Hamburg, Hamburg, Germany
| | - Andrea Plaikner
- Department of Special Operative and Oncologic Gynecology, Asklepios Klinik Altona, Hamburg, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Biometry, Eberhard Karls University Tübingen Faculty of Medicine, Tubingen, Germany
| | - Mieczyslaw Gajda
- Institute for Pathology, Friedrich-Schiller-University of Jena Faculty of Medicine, Jena, Germany
| | - Achim Schneider
- Center for Dysplasia and Cytology, MVZ Fürstenbergkarree Berlin, Berlin, Germany
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Bataille B, Escande A, Le Tinier F, Parent A, Bogart E, Collinet P, Bresson L, Narducci F, Leblanc E, Lemaire AS, Taieb S, Lartigau E, Mirabel X, Cordoba A. Outcomes of pre-operative brachytherapy followed by hysterectomy for early cervical cancer. Int J Gynecol Cancer 2019; 30:181-186. [PMID: 31871113 DOI: 10.1136/ijgc-2019-000617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVE The standard of care for early cervical cancer is radical hysterectomy; however, consideration of pre-operative brachytherapy has been explored. We report our experience using pre-operative brachytherapy plus Wertheim-type hysterectomy to treat early stage cervical cancer. METHODS This single-center study evaluated consecutive patients with histologically proven node-negative early stage cervical cancer (International Federation of Gynecology and Obstetrics 2009 stage IB1-IIB) that was treated using pre-operative brachytherapy and hysterectomy. Pre-brachytherapy staging was performed using magnetic resonance imaging (MRI) and pelvic lymph node assessment was performed using lymphadenectomy. The tumor and cervical tissues were treated using brachytherapy (total dose 60 Gy) followed by Wertheim-type hysterectomy. The study included patients from January 2000 to December 2013. RESULTS A total of 80 patients completed a median follow-up of 6.7 years (range 5.4-8.5). The surgical specimens revealed a pathological complete response for 61 patients (76%). Patients with incomplete responses generally had less than 1 cm residual tumor at the cervix, and only one patient had lymphovascular space involvement. The estimated 5-year rates were 88% for overall survival (95% CI 78% to 94%) and 82% for disease-free survival (95% CI 71% to 89%). Toxicities were generally mild-to-moderate, including 26 cases (33%) of grade 2 late toxicity and 10 cases (13%) of grade 3 late toxicity. Univariate analyses revealed that poor disease-free survival was associated with overweight status (≥25 kg/m2, HR 3.05, 95% CI 1.20 to 7.76, p=0.019) and MRI tumor size >3 cm (HR 3.05, 95% CI 1.23 to 7.51, p=0.016). CONCLUSIONS Pre-operative brachytherapy followed by Wertheim-type hysterectomy may be safe and effective for early stage cervical cancer, although poorer outcomes were associated with overweight status and MRI tumor size >3 cm.
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Affiliation(s)
- Benoit Bataille
- Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France
| | - Alexandre Escande
- Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France
| | - Florence Le Tinier
- Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France
| | - Audrey Parent
- Methodology and Biostatistics Department, Centre Oscar Lambret, Lille, France
| | - Emilie Bogart
- Methodology and Biostatistics Department, Centre Oscar Lambret, Lille, France
| | - Pierre Collinet
- Gynecological Surgery Department, Hopital Jeanne de Flandre, Lille, Hauts-de-France, France
| | - Lucie Bresson
- Gynecological Surgery Department, Centre Oscar Lambret, Lille, France
| | - Fabrice Narducci
- Gynecological Surgery Department, Centre Oscar Lambret, Lille, France
| | - Eric Leblanc
- Gynecological Surgery Department, Centre Oscar Lambret, Lille, France
| | | | - Sophie Taieb
- Medical Imaging Department, Centre Oscar Lambret, Lille, France
| | - Eric Lartigau
- Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France
| | - Xavier Mirabel
- Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France
| | - Abel Cordoba
- Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France
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Sia TY, Chen L, Melamed A, Tergas AI, Khoury-Collado F, Hou JY, St Clair CM, Ananth CV, Neugut AI, Hershman DL, Wright JD. Trends in Use and Effect on Survival of Simple Hysterectomy for Early-Stage Cervical Cancer. Obstet Gynecol 2019; 134:1132-1143. [PMID: 31764721 DOI: 10.1097/aog.0000000000003523] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To identify use and outcomes of simple hysterectomy compared with radical hysterectomy for women with early-stage cervical cancer. METHODS The National Cancer Database was used to review the cases of women with stage IA2 and IB1 (2 cm or less) cervical cancer from 2004 to 2015. Patients were classified based on whether they underwent simple or radical hysterectomy. Survival was examined after propensity score weighting. RESULTS Simple hysterectomy was performed in 44.6% of women with stage IA2 (n=1,530) and 35.3% of those with stage IB1 (n=3,931) tumors. Rates of simple hysterectomy increased from 37.8% to 52.7% from 2004 to 2014 for stage IA2 cancers and from 29.7% to 43.8% between 2004 and 2013 for stage IB1 cancers. For stage IA2 cancers, younger women and those treated at an academic medical center were less likely to undergo simple hysterectomy. For stage IB1 cancers, black women were more likely to undergo simple hysterectomy, and those treated at an academic medical center were less likely to undergo simple hysterectomy. After propensity score weighting, there was no association between route of hysterectomy and survival for stage IA2 cancers (hazard ratio [HR] 0.70, 95% CI 0.41-1.20, 5-year survival 95.1% for radical hysterectomy vs 97.6% for simple hysterectomy). For stage IB1 cancers, patients who underwent simple hysterectomy were at 55% increased risk of death (HR 1.55, 95% CI 1.18-2.03, and 5-year survival was 95.3% for radical hysterectomy vs 92.4% for simple hysterectomy). CONCLUSION Although there was no association between surgical radicality and survival for women with stage IA2 tumors, there was a 55% increase in mortality for women with stage IB1 neoplasms who underwent simple compared with radical hysterectomy. Radical hysterectomy is the treatment of choice for women with stage IB1 cervical cancer.
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MESH Headings
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Adenosquamous/mortality
- Carcinoma, Adenosquamous/pathology
- Carcinoma, Adenosquamous/surgery
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Databases, Factual
- Demography
- Female
- Humans
- Hysterectomy/statistics & numerical data
- Hysterectomy/trends
- Middle Aged
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/surgery
- Neoplasm Staging
- Propensity Score
- Survival Analysis
- United States/epidemiology
- Uterine Cervical Neoplasms/mortality
- Uterine Cervical Neoplasms/pathology
- Uterine Cervical Neoplasms/surgery
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Affiliation(s)
- Tiffany Y Sia
- Columbia University College of Physicians and Surgeons, the Joseph L. Mailman School of Public Health, Columbia University, the Herbert Irving Comprehensive Cancer Center, and New York Presbyterian Hospital, New York, New York; and the Rutgers Robert Wood Johnson Medical School, New Brunswick, and Environmental and Occupational Health Sciences Institute (EOHSI), Piscataway, New Jersey
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Surgical Treatment of Early-Stage Cervical Cancer: A Multi-Institution Experience in 2124 Cases in The Netherlands Over a 30-Year Period. Int J Gynecol Cancer 2019; 28:757-763. [PMID: 29595758 DOI: 10.1097/igc.0000000000001228] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study aimed to describe the pattern of recurrence and survival related to prognostic variables, including type of surgery as a clinical variable, in patients surgically treated for early cervix cancer. METHODS Records of 2124 patients who underwent a radical hysterectomy for International Federation of Gynaecology and Obstetrics stage I/IIA cervical cancer between 1982 and 2011 were reviewed. Clinical-pathologic prognostic variables, also including extent of parametrectomy, were identified and used in a multivariable Cox proportional hazard model to explore associations between disease-free survival (DFS) and prognostic variables. RESULTS The 5-year DFS for the total group was 86%. Large tumor diameter, nonsquamous histology, lymph node metastases, parametrial involvement, lymph vascular space invasion, deep stromal invasion, and less radical surgery were independent poor prognostic variables for survival. Disease-free survival was independently associated with the type of radical hysterectomy with pelvic lymphadenectomy in favor of more radical parametrectomy (hazard ratio, 2.0; 95% confidence interval, 1.6-2.5). This difference was not found in tumors with a diameter of at least 20 mm. CONCLUSIONS This study confirms that variables such as large tumor diameter, nonsquamous histology, lymph vascular space invasion, deep stromal invasion, positive lymph nodes, and parametrial infiltration are poor prognostic variables in early cervix cancer treated by surgery. The extent of parametrectomy had no influence on survival in tumors of 20 mm or less. For larger tumors, a more radical hysterectomy might be associated with better DFS. Taking into account the possible bias in this study as a result of its retrospective design, ideally a prospective cohort study with clear definition of radicality is necessary to answer this important clinical question.
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Machida H, Matsuo K, Furusawa A, Kita T, Kitagawa R, Mikami M. Profile of treatment-related complications in women with clinical stage IB-IIB cervical cancer: A nationwide cohort study in Japan. PLoS One 2019; 14:e0210125. [PMID: 30615679 PMCID: PMC6322763 DOI: 10.1371/journal.pone.0210125] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/16/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To examine clinico-pathological factors associated with surgical complications and postoperative therapy for clinical stage IB-IIB cervical cancer. METHODS This nationwide multicenter retrospective study examined women with clinical stage IB-IIB cervical cancer who underwent radical hysterectomy plus pelvic and/or para-aortic lymphadenectomy between 2008-2009 at 87 institutions of the Japanese Gynecologic Oncology Group (n = 693). Multivariate models were used to identify independent predictors of perioperative grade 3-4 complications and bladder dysfunction. RESULTS The overall intraoperative and postoperative complication rates were 3.3% and 9.8%, respectively. Clinical stage was not associated with perioperative complications (P = 0.15). Radiotherapy-based adjuvant therapy was significantly associated with an increased risk of postoperative complications (radiotherapy alone: adjusted-odds ratio [OR] 3.19, 95% confidence interval [CI] 1.46-6.99, P = 0.004; radiotherapy plus chemotherapy: adjusted-OR 3.26, 95%CI 1.66-6.41, P = 0.001), whereas chemotherapy was not (P = 0.45). Nerve-sparing surgery significantly reduced the risk of postoperative bladder dysfunction (adjusted-OR 0.57, 95%CI 0.37-0.90, P = 0.02) whereas adjuvant chemotherapy increased the risk of bladder dysfunction (adjusted-OR 2.06, 95%CI 1.16-3.67, P = 0.01). Among women receiving adjuvant chemotherapy, nerve-sparing radical hysterectomy significantly reduced the risk of bladder dysfunction (15.0% versus 32.9%, OR 0.31, 95%CI 0.14-0.68, P = 0.004). After propensity score matching, survival outcomes were similar with both types of adjuvant therapy (radiotherapy-based versus chemotherapy, P>0.05). CONCLUSION Our study highlighted two distinct complication profiles of adjuvant therapy after radical hysterectomy for clinical stage IB-IIB cervical cancer, with radiotherapy increasing grade 3-4 adverse events and chemotherapy increasing bladder dysfunction. In this setting, nerve-sparing surgery may be useful if chemotherapy is being considered for adjuvant therapy.
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Affiliation(s)
- Hiroko Machida
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, United States of America
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, United States of America
| | - Akiko Furusawa
- Department of Gynecology, Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tsunekazu Kita
- Department of Obstetrics and Gynecology, Nara Prefecture General Medical Center, Nara, Japan
| | - Ryo Kitagawa
- Department of Obstetrics and Gynecology, Tohoku Medical and Pharmaceutical University, Miyagi, Japan
| | - Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan
- * E-mail:
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Class I hysterectomy in stage Ia2-Ib1 cervical cancer. Wideochir Inne Tech Maloinwazyjne 2018; 13:494-500. [PMID: 30524620 PMCID: PMC6280091 DOI: 10.5114/wiitm.2018.76832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/13/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction During the last 3 decades, the standard treatment for stage Ia2-Ib1 cervical cancer has been Piver-Rutledge class II or III radical hysterectomy. However, this surgery is associated with a high rate of urologic morbidity. Aim To determine the efficacy of class I radical hysterectomy compared with class III radical hysterectomy in terms of morbidity, overall survival, and patterns of relapse in patients with Ia2-Ib1 cervical cancer undergoing primary surgery. Material and methods A total of 101 patients with stage Ia2-Ib1 cervical cancer < 2 cm were randomized to class I and class III hysterectomy groups. Clinical, pathologic, and follow-up data were prospectively collected. Univariate analysis was carried out. Of the total patients, 45 were randomized to class I surgery and 56 to class III surgery. No significant differences were observed in terms of pathologic findings or adjuvant treatment (p > 0.05). The morbidity rates were higher after class III surgery. Results The difference in recurrence rate between the class I and class III groups was not statistically significant (p > 0.05). The 5-year overall survival rate was 93% and 91%, respectively (p > 0.05). There were no significant differences in terms of recurrence rate or overall survival among patients with stage Ia2-Ib1 cervical cancer < 2 cm who underwent class I or radical (class III) hysterectomy. Morbidity was proportional to the extent of radicality. Conclusions These data confirm the need for reducing surgical radicality in the treatment of patients with early cervical cancer, by tailoring the extent of resection according to the extent of disease.
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van der Velden J, Mom CH. Tailoring radicality in early cervical cancer: how far can we go? J Gynecol Oncol 2018; 30:e30. [PMID: 30479099 PMCID: PMC6304411 DOI: 10.3802/jgo.2019.30.e30] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 11/14/2018] [Indexed: 12/27/2022] Open
Abstract
Today, the patient who is diagnosed with early cervical cancer is offered a variety of treatments apart from standard therapy. Patients can be treated with a less radical hysterectomy (RH) regarding parametrectomy, a trachelectomy either vaginal or abdominal, and this can be performed through a minimal invasive or open procedure. All this in combination with nerve sparing and/or sentinel node technique. Level 1 evidence for the oncological safety of all these modifications is only available from 3 randomized controlled trials (RCTs). Two RCTs on more or less radical parametrectomy both showed that oncological safety was not compromised by doing less radical surgery. Because of the heterogeneity of the patient population and the high frequency of adjuvant radiotherapy, the true impact of surgical radicality cannot be assessed. Regarding the issue of oncological safety of fertility sparing treatments, case-control and retrospective case series suggest that trachelectomy is safe as long as the tumor diameter does not exceed 2 cm. Recently, both a RCT and 2 case-control studies showed a survival benefit for open surgery compared to minimally invasive surgery, whereas many previous case-control and retrospective case series on this subject did not show impaired oncological safety. In a case-control study the survival benefit for open surgery was restricted to the group of patients with a tumor diameter more than 2 cm. Although modifications of the traditional open RH seem safe for tumors with a diameter less than 2 cm, ongoing prospective RCTs and observational studies should give the final answer.
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Affiliation(s)
- Jacobus van der Velden
- Department of Gynecologic Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
| | - Constantijne H Mom
- Department of Gynecologic Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Hsu HC, Tai YJ, Chen YL, Chiang YC, Chen CA, Cheng WF. Factors predicting parametrial invasion in patients with early-stage cervical carcinomas. PLoS One 2018; 13:e0204950. [PMID: 30335786 PMCID: PMC6193633 DOI: 10.1371/journal.pone.0204950] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 09/16/2018] [Indexed: 11/18/2022] Open
Abstract
We aimed to identify factors predicting parametrial invasion in early-stage cervical cancer patients undergoing radical hysterectomy. We recruited women with invasive cervical cancer who underwent radical hysterectomy at a single medical institute from 2000–2011. The clinical and pathological characteristics and outcomes were retrospectively recorded, and the risk factors for parametrial invasion were analyzed. We enrolled 339 patients, including 7 with stage IA1 carcinomas, 10 with stage IA2, 266 with stage IB1, 39 with stage IB2, 14 with stage IIA1, and 3 with stage IIA2. The majority (237/339, 69.9%) had squamous cell carcinoma, while 32 (12.4%) had parametrial invasion. The 16 patients with stage IB1 tumors and parametrial invasion were older (55.9±9.5vs. 49.0±9.9 years, p = 0.005, Mann-Whitney U test), and had deeper cervical stromal invasion (9.59±4.87 vs. 7.47±5.48 mm, p = 0.048, Mann-Whitney U test), larger tumor size (2.32±1.15 vs. 1.74±1.14cm, p = 0.043, Mann-Whitney U test), higher incidences of lymphovascular space invasion (87.5% vs. 28.8%, p<0.001, chi-square test), and greater lymph node metastasis (68.8% vs. 10.8%, p<0.001, chi-square test) than the 260 patients without parametrial invasion. Among the patients with stage IB1 tumor size >2 cm,10% had parametrial invasion and 24.2% had lymph node metastasis compared with only 4% and 9.4% of stage IB1 patients with a tumor size <2 cm, respectively. Only one (0.9%) of the 109 patients aged less than 50 years had parametrial invasion compared with 6 (9.7%) of the 62 patients aged over 50 years. Patients with stage IA2 and IB1 tumors <2 cm may not need radical hysterectomy owing to the low incidence of parametrial invasion.
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Affiliation(s)
- Heng-Cheng Hsu
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Obstetrics and Gynecology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Jou Tai
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Li Chen
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Anatomy and Cell Biology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ying-Cheng Chiang
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-An Chen
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Fang Cheng
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
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Nama V, Angelopoulos G, Twigg J, Murdoch JB, Bailey J, Lawrie TA. Type II or type III radical hysterectomy compared to chemoradiotherapy as a primary intervention for stage IB2 cervical cancer. Cochrane Database Syst Rev 2018; 10:CD011478. [PMID: 30311942 PMCID: PMC6516889 DOI: 10.1002/14651858.cd011478.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cervical cancer is the fourth most common cancer in women, with 528,000 estimated new cases globally in 2012. A large majority (around 85%) of the disease burden occurs in low- and middle-income countries (LMICs), where it accounts for almost 12% of all female cancers. Treatment of stage IB2 cervical cancers, which sit between early and advanced disease, is controversial. Some centres prefer to treat these cancers by radical hysterectomy, with chemoradiotherapy reserved for those at high risk of recurrence. In the UK, we treat stage IB2 cervical cancers mainly with chemoradiotherapy, based on the rationale that a high percentage will have risk factors necessitating chemoradiotherapy postsurgery. There has been no systematic review to determine the best possible evidence in managing these cancers. OBJECTIVES To determine if primary surgery for stage IB2 cervical cancer (type II or type III radical hysterectomy with lymphadenectomy) improves survival compared to primary chemoradiotherapy.To determine if primary surgery combined with postoperative adjuvant chemoradiotherapy, for stage IB2 cervical cancer increases patient morbidity in the management of stage IB2 cervical cancer compared to primary chemoradiotherapy. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 3), MEDLINE via Ovid (1946 to April week 2, 2018) and Embase via Ovid (1980 to 2018 week 16). We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of included studies up to April 2018. SELECTION CRITERIA We searched for randomised controlled trials (RCTs), quasi-RCTs or non-randomised studies (NRSs) comparing surgery to chemoradiotherapy in stage IB2 cervical cancers. DATA COLLECTION AND ANALYSIS Two review authors independently assessed whether potentially relevant studies met the inclusion criteria, abstracted data, assessed risk of bias and analysed data using standard methodological procedures expected by Cochrane. MAIN RESULTS We identified 4968 records from the literature searches, but we did not identify any RCTs that compared primary surgery with chemoradiotherapy in stage IB2 cervical cancer.We found one NRS comparing surgery to chemoradiotherapy in IB2 and IIA2 cervical cancers which met the inclusion criteria. However, we were unable to obtain data for stage IB2 cancers only and considered the findings very uncertain due to a high risk of selection bias. AUTHORS' CONCLUSIONS There is an absence of high-certainty evidence on the relative benefits and harms of primary radical hysterectomy versus primary chemoradiotherapy for stage IB2 cervical cancer. More research is needed on the different treatment options in stage IB2 cervical cancer, particularly with respect to survival, adverse effects, and quality of life to facilitate informed decision-making and individualised care.
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Affiliation(s)
- Vivek Nama
- Croydon University HospitalGynaecological OncologyLondon RoadCroydonUKCR7 7YE
| | - Georgios Angelopoulos
- The James Cook University HospitalGynaecological OncologyMarton RoadMiddlesbroughUKTS4 3BW
| | - Jeremy Twigg
- South Tees NHS Foundation TrustMarton RoadMiddlesbroughUKTS4 3BW
| | - John B Murdoch
- St Michael's HospitalDepartment of Gynaecological OncologySouthwell StreetBristolUKBS2 8EG
| | - Jo Bailey
- St Michael's HospitalDepartment of Gynaecological OncologySouthwell StreetBristolUKBS2 8EG
| | - Theresa A Lawrie
- 1st Floor Education Centre, Royal United HospitalCochrane Gynaecological, Neuro‐oncology and Orphan Cancer GroupCombe ParkBathUKBA1 3NG
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Tseng JH, Aloisi A, Sonoda Y, Gardner GJ, Zivanovic O, Abu-Rustum NR, Leitao MM. Less versus more radical surgery in stage IB1 cervical cancer: A population-based study of long-term survival. Gynecol Oncol 2018; 150:44-49. [PMID: 29776598 DOI: 10.1016/j.ygyno.2018.04.571] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/26/2018] [Accepted: 04/29/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Standard surgical treatment for women with stage IB1 cervical cancer consists of radical hysterectomy. This study assesses survival outcomes of those treated with less radical surgery (LRS; conization, trachelectomy, simple hysterectomy) compared to more radical surgery (MRS; modified radical, radical hysterectomy). METHODS Using the Surveillance, Epidemiology and End Results database, we identified women <45 years with FIGO stage IB1 cervical cancer diagnosed from 1/1998 to 12/2012. Only those who underwent lymph node (LN) assessment were analyzed. Disease-specific survivals (DSSs) of LRS were compared with those of MRS. RESULTS Of 2571 patients, 807 underwent LRS and 1764 underwent MRS, all with LN assessment. For LRS vs. MRS, 28% vs. 23% were diagnosed with adenocarcinoma (p = 0.024), 31% vs. 39% had G3 disease (p < 0.001), 40% vs. 45% had tumor size >2 cm (p < 0.001), and 27% vs. 29% received adjuvant radiation therapy (p = 0.005). Median follow-up was 79 months (range, 0-179). Ten-year DSS for LRS vs. MRS was 93.5% vs. 92.3% (p = 0.511). There was no difference in 10-year DSS when stratified by tumor size ≤2 cm (LRS 95.1% vs. MRS 95.6%, p = 0.80) or > 2 cm (LRS 90.1% vs. MRS 88.2%, p = 0.48). Factors independently associated with increased risk of death included adenosquamous histology (HR 2.37), G3 disease (HR 2.86), tumors >2 cm (HR 1.82), and LN positivity (HR 2.42). Compared to MRS, LRS was not associated with a higher risk of death. CONCLUSIONS In a select group of young women with stage IB1 cervical cancer, LRS compared to MRS does not appear to compromise DSS.
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Affiliation(s)
- Jill H Tseng
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alessia Aloisi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ginger J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Gungorduk K, Kocian R, Basaran D, Turan T, Ozdemir A, Cibula D. Are patients and physicians willing to accept less-radical procedures for cervical cancer? J Gynecol Oncol 2018; 29:e50. [PMID: 29770621 PMCID: PMC5981102 DOI: 10.3802/jgo.2018.29.e50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/10/2018] [Accepted: 02/28/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the opinions of women who underwent surgery for cervical cancer (CC) and physicians who treat CC about the acceptability of increased oncological risk after less-radical surgery. METHODS One hundred eighty-two women who underwent surgery for CC and 101 physicians participated in a structured survey in 3 tertiary cancer centers in Czech Republic and Turkey. Patients and physicians were asked whether they would accept any additional oncological risks, which would be attributable to the omission of parametrectomy (radical hysterectomy/trachelectomy vs. simple hysterectomy/trachelectomy) or pelvic lymph node dissection (systematic resection vs. sentinel lymph node sampling). RESULTS Although 52.2% of patients reported morbidity related to their previous treatment, the majority of patients would not accept less-radical surgical treatment if it was associated with any increased risk of recurrence (50%-55%, no risk; 17%-24%, risk <0.1%). Physicians tended to accept a significantly higher risk than patients in the Czech Republic, but not in Turkey. Patients with higher education levels, more advanced-stage of disease, or adverse events related to previous cancer treatment, and patients who received adjuvant therapy were significantly more likely to accept an increased oncological risk. CONCLUSION Patients, even if they suffered from morbidity related to previous CC treatment, do not want to choose between oncological safety and a better quality of life. Physicians tend to accept the higher oncological risk associated with less-radical surgical procedures, but attitudes differ regionally. Professionals should be aware of this tendency when counselling the patients before less-radical surgery.
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Affiliation(s)
- Kemal Gungorduk
- Department of Gynecologic Oncology, Muğla Sıtkı Koçman University, Education and Research Hospital, Muğla, Turkey.
| | - Roman Kocian
- Department of Obstetrics and Gynecology, Gynecologic Oncology Center, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Derman Basaran
- Department of Gynecologic Oncology, Etlik Zübeyde Hanım Education and Research Hospital, Ankara, Turkey
| | - Taner Turan
- Department of Gynecologic Oncology, Etlik Zübeyde Hanım Education and Research Hospital, Ankara, Turkey
| | - Aykut Ozdemir
- Department of Gynecologic Oncology, Muğla Sıtkı Koçman University, Education and Research Hospital, Muğla, Turkey
| | - David Cibula
- Department of Obstetrics and Gynecology, Gynecologic Oncology Center, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Abstract
PURPOSE OF REVIEW Advances in cervical cancer screening and treatment have resulted in high cure rates in developed countries for early-stage disease. Current research focuses on minimizing morbidity and maximizing quality of life. RECENT FINDINGS Imaging has been disappointing in identifying small volume metastases. Sentinel lymph node biopsy represents a significant advantage with high sensitivity, low false negative rates, reduced morbidity, and equivalent survival in recent studies compared to pelvic lymphadenectomy. Non-radical surgical options are currently being investigated for early cervical cancer in a number of large prospective studies in patients at low risk for metastases. Evidence suggests that sentinel lymph node biopsy and non-radical surgery are safe approaches for the staging and management of early cervical cancer in appropriately selected patients with the potential to significantly reduce treatment-related morbidity.
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Gross T, Furrer M, Schorno P, Wuethrich PY, Schneider MP, Thalmann GN, Burkhard FC. Reproductive organ-sparing cystectomy significantly improves continence in women after orthotopic bladder substitution without affecting oncological outcome. BJU Int 2018. [DOI: 10.1111/bju.14191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Tobias Gross
- Department of Urology; University of Bern; Bern Switzerland
- Department of Urology; Royal Melbourne Hospital; Parkville Vic. Australia
| | - Marc Furrer
- Department of Urology; University of Bern; Bern Switzerland
| | - Petra Schorno
- Department of Urology; University of Bern; Bern Switzerland
| | - Patrick Y. Wuethrich
- Department of Anaesthesiology and Pain Medicine; University of Bern; Bern Switzerland
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Preoperatively Assessable Clinical and Pathological Risk Factors for Parametrial Involvement in Surgically Treated FIGO Stage IB-IIA Cervical Cancer. Int J Gynecol Cancer 2018; 27:1722-1728. [PMID: 28617687 DOI: 10.1097/igc.0000000000001060] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Determining the risk factors associated with parametrial involvement (PMI) is of paramount importance to decrease the multimodality treatment in early-stage cervical cancer. We investigated the preoperatively assessable clinical and pathological risk factors associated with PMI in surgically treated stage IB1-IIA2 cervical cancer. METHODS A retrospective cohort study of women underwent Querleu-Morrow type C hysterectomy for cervical cancer stage IB1-IIA2 from 2001 to 2015. All patients underwent clinical staging examination under anesthesia by the same gynecological oncologists during the study period. Evaluated variables were age, menopausal status, body mass index, smoking status, FIGO (International Federation of Obstetrics and Gynecology) stage, clinically measured maximal tumor diameter, clinical presentation (exophytic or endophytic tumor), histological type, tumor grade, lymphovascular space invasion, clinical and pathological vaginal invasion, and uterine body involvement. Endophytic clinical presentation was defined for ulcerative tumors and barrel-shaped morphology. Two-dimensional transvaginal ultrasonography was used to measure tumor dimensions. RESULTS Of 127 eligible women, 37 (29.1%) had PMI. On univariate analysis, endophytic clinical presentation (P = 0.01), larger tumor size (P < 0.001), lymphovascular space invasion (P < 0.001), pathological vaginal invasion (P = 0.001), and uterine body involvement (P < 0.001) were significantly different among the groups with and without PMI. In multivariate analysis endophytic clinical presentation (odds ratio, 11.34; 95% confidence interval, 1.34-95.85; P = 0.02) and larger tumor size (odds ratio, 32.31; 95% confidence interval, 2.46-423.83; P = 0.008) were the independent risk factors for PMI. Threshold of 31 mm in tumor size predicted PMI with 71% sensitivity and 75% specificity. We identified 18 patients with tumor size of more than 30 mm and endophytic presentation; 14 (77.7%) of these had PMI. CONCLUSIONS Endophytic clinical presentation and larger clinical tumor size (>3 cm) are independent risk factors for PMI in stage IB-IIA cervical cancer. Approximately 78% of the patients with a tumor size of more than 3 cm and endophytic presentation will require adjuvant chemoradiation for PMI following radical surgery. Considering clinical tumor presentation along with tumor size can enhance the physician's prediction of PMI in early-stage cervical cancer.
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Querleu D, Cibula D, Abu-Rustum NR. 2017 Update on the Querleu-Morrow Classification of Radical Hysterectomy. Ann Surg Oncol 2017; 24:3406-3412. [PMID: 28785898 DOI: 10.1245/s10434-017-6031-z] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND One of the most important principles in modern cervical cancer surgery is the concept of tailoring surgical radicality. In practice, this means abandoning the "one-fits-all" concept in favor of tailored operations. The term "radical hysterectomy" is used to describe many different procedures, each with a different degree of radicality. Anatomic structures are subjected to artificial dissection artifacts, as well as different interpretations and nomenclatures. This study aimed to refine and standardize the principles and descriptions of the different classes of radical hysterectomy as defined in the Querleu-Morrow classification and to propose its universal applicability. METHODS All three authors independently examined the current literature and undertook a critical assessment of the original classification. Images and pathologic slides demonstrating different types of radical hysterectomy were examined to document a consensual vision of the anatomy. The Cibula 3-D concept also was included in this update. RESULTS The Querleu-Morrow classification is based on the lateral extent of resection. Four types of radical hysterectomy are described, including a limited number of subtypes when necessary. Two major objectives remain constant: excision of central tumor with clear margins and removal of any potential sites of nodal metastasis. CONCLUSION Studies evaluating radicality in the surgical management of cervical cancer should be based on precise, universally accepted descriptions. The authors' updated classification presents standardized, universally applicable descriptions of different types of hysterectomies performed worldwide, categorized according to degree of radicality, independently of theoretical considerations.
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Affiliation(s)
- Denis Querleu
- Department of Surgery, Institut Bergonié, Bordeaux, France.
| | | | - Nadeem R Abu-Rustum
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical School, New York, NY, USA
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Lennox GK, Covens A. Management Of Early Stage Cervical Cancer: When Is Non-Randomized Data Good Enough? Gynecol Oncol 2017. [PMID: 28625331 DOI: 10.1016/j.ygyno.2017.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Genevieve K Lennox
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, M700-610 University Avenue, Toronto, ON M5G 2M9, Canada
| | - Allan Covens
- Division of Gynecologic Oncology, T2051 Odette Cancer Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
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Wu ES, Jeronimo J, Feldman S. Barriers and Challenges to Treatment Alternatives for Early-Stage Cervical Cancer in Lower-Resource Settings. J Glob Oncol 2017; 3:572-582. [PMID: 29094097 PMCID: PMC5646895 DOI: 10.1200/jgo.2016.007369] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Cervical cancer is one of the most common cancers among women worldwide, and approximately 85% of new diagnoses occur in less-developed regions of the world. Global efforts in cervical cancer to date have focused on primary and secondary prevention strategies of human papillomavirus vaccination and cervical cancer screening. Cervical cancer screening is effective to reduce the incidence of cervical cancer and can result in diagnosis at earlier stages, but it will take time to realize its full impact. With expansion of screening programs, there is now a greater imperative to increase access to treatment for women who have cervical cancer, particularly in earlier stages of disease, when it is still curable. Resources for multimodality treatment can be limited-or even absent-in many less-developed regions of the world and may be associated with geographic, social, and financial barriers for the patient. However, there is evidence that, in many cases, less-invasive and less-resource-intensive treatment options are still effective. To this end, the National Comprehensive Cancer Network and American Society of Clinical Oncology have published guideline adaptations for specific resource constraints, and research about more conservative approaches to the treatment of cervical cancer continues. This review focuses on potential barriers and challenges to provision of safe and effective treatment of early-stage cervical cancer in lower-resource settings, and it suggests future directions for expansion of access to cervical cancer treatment around the world.
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Affiliation(s)
- Emily S Wu
- , University of Washington; , PATH, Seattle, WA; and , Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jose Jeronimo
- , University of Washington; , PATH, Seattle, WA; and , Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sarah Feldman
- , University of Washington; , PATH, Seattle, WA; and , Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Huertas A, Oldrini S, Nesseler JP, Courrech F, Rétif P, Charra-Brunaud C, Peiffert D. FIGO stage IB1 cervical carcinoma: Place and principles of brachytherapy. Cancer Radiother 2017; 21:155-163. [DOI: 10.1016/j.canrad.2016.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 09/21/2016] [Accepted: 09/21/2016] [Indexed: 02/06/2023]
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Lim MC, Lee M, Shim SH, Nam EJ, Lee JY, Kim HJ, Lee YY, Lee KB, Park JY, Kim YH, Ki KD, Song YJ, Chung HH, Kim S, Lee JW, Kim JW, Bae DS, Lee JM. Practice guidelines for management of cervical cancer in Korea: a Korean Society of Gynecologic Oncology Consensus Statement. J Gynecol Oncol 2017; 28:e22. [PMID: 28382794 PMCID: PMC5391389 DOI: 10.3802/jgo.2017.28.e22] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 02/23/2017] [Accepted: 03/04/2017] [Indexed: 01/16/2023] Open
Abstract
Clinical practice guidelines for gynecologic cancers have been developed by academic society from several countries. Each guideline reflected their own insurance system and unique medical environment, based on the published evidence. The Korean Society of Gynecologic Oncology (KSGO) published the first edition of practice guidelines for gynecologic cancer treatment in late 2006; the second edition was released in July 2010 as an evidence-based recommendation. The Guidelines Revision Committee was established in 2015 and decided to develop the third edition of the guidelines in an advanced format based on evidence-based medicine, embracing up-to-date clinical trials and qualified Korean data. These guidelines cover strategies for diagnosis and treatment of primary and recurrent cervical cancer. The committee members and many gynecologic oncologists derived key questions through discussions, and a number of relevant scientific literature were reviewed in advance. Recommendations for each specific question were developed by the consensus conference, and they are summarized here, along with the details. The objective of these practice guidelines is to establish standard policies on issues in clinical practice related to the management in cervical cancer based on the results in published papers to date and the consensus of experts as a KSGO Consensus Statement.
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Affiliation(s)
- Myong Cheol Lim
- Gynecologic Cancer Branch, Center for Uterine Cancer, and Center for Clinical Trials, Research Institute and Hospital and Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Maria Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hyuk Shim
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea
| | - Eun Ji Nam
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Yun Lee
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Yoo Young Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Beom Lee
- Department of Obstetrics and Gynecology, Gil Medical Center, Gachon University, Incheon, Korea
| | - Jeong Yeol Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yun Hwan Kim
- Department of Obstetrics and Gynecology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kyung Do Ki
- Department of Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Yong Jung Song
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Pusan, Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Sunghoon Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Won Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Duk Soo Bae
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Min Lee
- Department of Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea.
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Wallin E, Flöter Rådestad A, Falconer H. Introduction of robot-assisted radical hysterectomy for early stage cervical cancer: impact on complications, costs and oncologic outcome. Acta Obstet Gynecol Scand 2017; 96:536-542. [PMID: 28186616 DOI: 10.1111/aogs.13112] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/26/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The objective was to assess the impact of robot-assisted radical hysterectomy (RRH) on surgical and oncologic outcome and costs compared with open radical hysterectomy (ORH) at a tertiary referral center in Sweden. MATERIAL AND METHODS In this retrospective analysis all patients treated with radical hysterectomy and pelvic lymphadenectomy for early stage uterine cervical cancer during 2006-2015 were included (n = 304). The patients were divided into two groups, ORH (n = 155) and RRH (n = 149). Patient characteristics, FIGO stage, histology, adjuvant therapy, operation time, length of stay (LOS), lymph node yield, recurrence rate and survival were retrieved from medical records. Complications were graded according to the Clavien-Dindo classification. In addition, costs related to the surgical treatments were calculated. RESULTS Blood loss, LOS and intraoperative complications were significantly lower as well as lymph node yield after RRH. No differences in postoperative complications or costs were observed between the two groups. Recurrence of disease was detected in 13.4 and 10.3% after RRH and ORH, respectively. Regression analysis demonstrated that histology, tumor size, positive lymph nodes and type of operation (RRH) were significantly associated with recurrence. CONCLUSION The introduction of RRH was accompanied by similar postoperative complication rates and costs but lower LOS compared with ORH. An initial learning curve may account for the higher recurrence rate observed after RRH. These data reinforce the need for structured training and monitoring of outcomes when novel treatment modalities are introduced.
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Affiliation(s)
- Emelie Wallin
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.,Division of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - Angelique Flöter Rådestad
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.,Division of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Falconer
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.,Division of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
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Outcome of early stage cervical cancer patients treated according to a radiosurgical approach: Clinical results and prognostic factors. Gynecol Oncol 2017; 144:541-546. [DOI: 10.1016/j.ygyno.2016.12.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 12/28/2016] [Accepted: 12/31/2016] [Indexed: 11/21/2022]
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Wang W, Shang CL, Du QQ, Wu D, Liang YC, Liu TY, Huang JM, Yao SZ. Class I versus Class III radical hysterectomy in stage IB1 (tumor ≤ 2 cm) cervical cancer: a matched cohort study. J Cancer 2017; 8:825-831. [PMID: 28382145 PMCID: PMC5381171 DOI: 10.7150/jca.17663] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/29/2016] [Indexed: 11/23/2022] Open
Abstract
Background & Aims: The long-term oncological outcome of Class I hysterectomy to treat stage IB1 cervical cancer is unclear. The aim of the present study was to compare the surgical and long-term oncological outcomes of Class I hysterectomy and Class III radical hysterectomy for treatment of stage IB1 cervical cancer (tumor ≤ 2 cm). Methods: Seventy stage IB1 cervical cancer patients (tumor ≤ 2 cm) underwent Class I hysterectomy and 577 stage IB1 cervical cancer patients (tumor ≤ 2 cm) underwent Class III radical hysterectomy were matched with known risk factors for recurrence by greedy algorithm. Clinical, pathologic and follow-up data were retrospectively collected. Five-year survival outcomes were assessed using Kaplan-Meier model. Results: After matching, a total of 70 patient pairs (Class I - Class III) were included. The median follow-up times were 75 (range, 26-170) months in the Class III group and 75 (range, 27-168) months in the Class I group. The Class I and Class III group had similar 5-year recurrence-free survival rates (RFS) (98.6% vs. 97.1%, P = 0.56) and overall survival rates (OS) (100.0% vs. 98.5%, P = 0.32). Compared with the Class III group, the Class I group resulted in significantly shorter operating time, less intra-operative blood loss, less intraoperative complications, less postoperative complications, and shorter hospital stay. Conclusions: These findings suggest that Class I hysterectomy is an oncological safe alternative to Class III radical hysterectomy in treatment of stage IB1 cervical cancer (tumor ≤ 2 cm) and Class I hysterectomy is associated with fewer perioperative complication and earlier recovery.
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Affiliation(s)
- Wei Wang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Zhongshan Second Road 58, Guangzhou 510700, China
| | - Chun-Liang Shang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Zhongshan Second Road 58, Guangzhou 510700, China
| | - Qi-Qiao Du
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Zhongshan Second Road 58, Guangzhou 510700, China
| | - Di Wu
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Zhongshan Second Road 58, Guangzhou 510700, China
| | - Yan-Chun Liang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Zhongshan Second Road 58, Guangzhou 510700, China
| | - Tian-Yu Liu
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Zhongshan Second Road 58, Guangzhou 510700, China
| | - Jia-Ming Huang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Zhongshan Second Road 58, Guangzhou 510700, China
| | - Shu-Zhong Yao
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Zhongshan Second Road 58, Guangzhou 510700, China
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