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Yan XJ, Yang Y, Chen X, Wang SG, Niu SH, Niu HX, Liu H. A new technique for performing interstitial implants for gynecologic malignancies using transvaginal ultrasound guidance. Front Oncol 2022; 12:858620. [PMID: 36033491 PMCID: PMC9410761 DOI: 10.3389/fonc.2022.858620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/24/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives This study concerns a new technique that aims to achieve precise interstitial brachytherapy of pelvic recurrent tumors under transvaginal ultrasound (US) guidance, enhance the conformity index of the brachytherapy (BT), and improve the curative effect of radiotherapy for gynecological oncology patients with pelvic relapse. Methods A real-time transvaginal US-guided interstitial implant device was developed to assist in implant BT. Prior to implant brachytherapy, the size and location of the tumor in the pelvis and the interrelationship with adjacent organs were first assessed with intracavitary ultrasound. The transvaginal US-guided interstitial implant device was then placed on the endoluminal ultrasound probe, the probe was oriented intravaginally to determine a safe needle path, the implant needle was placed into the needle passage of the device, and the implant needle was inserted into the tumor tissue in the direction guided by the ultrasound puncture guide line. After the implant needle was placed in place, the cover of the transvaginal US-guided interstitial implant device was opened perpendicular to the ultrasound probe, and the needle was separated from the ultrasound probe smoothly, and then the cover was re-covered for subsequent implantation. Results In this study, 56 patients who underwent real-time transvaginal ultrasound-guided implantation for gynecologic oncology were enrolled, and insertion of 736 implant needles was completed. Among them, 13 patients had recurrent pelvic tumors after cervical cancer surgery and 6 patients had recurrent pelvic tumors after endometrial cancer surgery. Thirty-two patients who underwent radical radiation therapy for cervical cancer did not have adequate regression of parametrial invaded tissue after completion of standard EBRT treatment; and 5 patients had recurrent tumors in the radiation field after previous standard course of pelvic radiotherapy. The accuracy of the implant therapy was improved. The radiotherapy dose for recurrent pelvic masses was successfully increased, and the cumulative dose of external irradiation combined with BT was augmented to 80–100 Gy. The use of a new device for transvaginal implant for recurrent masses located in the lateral wall of the pelvic cavity was successful. Conclusion This intravascular US-guided interstitial implant device can realize interstitial implant with the shortest path under transvaginal US guidance. With convenient operation, high precision, and good security, the device not only improves the accuracy of implant therapy, but it also reduces the risks of anesthesia and organ injury, so it is suitable for widespread promotion and use.
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Affiliation(s)
- Xiao-Jing Yan
- Gynecology and Obstetrics Ultrasound Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yi Yang
- Gynecology and Obstetrics Ultrasound Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xi Chen
- Department of Gynecologic Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shi-Guang Wang
- Department of Gynecologic Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shu-Huai Niu
- Department of Gynecologic Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hui-Xian Niu
- Department of Gynecologic Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hong Liu
- Department of Gynecologic Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Hong Liu,
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Shen Z, Qu A, Jiang P, Jiang Y, Sun H, Wang J. Re-Irradiation for Recurrent Cervical Cancer: A State-of-the-Art Review. Curr Oncol 2022; 29:5262-5277. [PMID: 35892987 PMCID: PMC9331513 DOI: 10.3390/curroncol29080418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
The recurrence rate of cervical cancer after primary treatment can reach 60%, and a poor prognosis is reported in most cases. Treatment options for the recurrence of cervical cancer mainly depend on the prior treatment regimen and the location of recurrent lesions. Re-irradiation is still considered as a clinical challenge, owing to a high incidence of toxicity, especially in in-field recurrence within a short period of time. Recent advances in radiotherapy have preliminarily revealed encouraging outcomes of re-irradiation. Several centers have concentrasted on stereotactic body radiation therapy (SBRT) for the treatment of well-selected cases. Meanwhile, as the image-guiding techniques become more precise, a better dose profile can also be achieved in brachytherapy, including high-dose-rate interstitial brachytherapy (HDR-ISBT) and permanent radioactive seed implantation (PRSI). These treatment modalities have shown promising efficacy with a tolerable toxicity, providing further treatment options for recurrent cervical cancer. However, it is highly unlikely to draw a definite conclusion from all of those studies due to the large heterogeneity among them and the lack of large-scale prospective studies. This study mainly reviews and summarizes the progress of re-irradiation for recurrent cervical cancer in recent years, in order to provide potential treatment regimens for the management of re-irradiation.
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Miyata Y, Murakami N, Okuma K, Shimizu Y, Takahashi A, Kashihara T, Kaneda T, Takahashi K, Inaba K, Sakuramachi M, Kojima K, Aoshika T, Morishima K, Nakayama Y, Itami J, Kato T, Ogo E, Igaki H. Salvage image-guided freehand interstitial brachytherapy for pelvic sidewall recurrence after hysterectomy for uterine malignancies. Brachytherapy 2022; 21:647-657. [PMID: 35750619 DOI: 10.1016/j.brachy.2022.04.009] [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: 03/04/2022] [Revised: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Pelvic sidewall recurrence after hysterectomy for uterine malignances has a poor prognosis, and the salvage therapy for this type of recurrence is still challenging. The purpose of this study was to investigate the efficacy of freehand high-dose-rate interstitial brachytherapy (HDR-ISBT) through the perineum using transrectal ultrasonography for this disease. METHODS AND MATERIALS We retrospectively evaluated 42 patients with pelvic sidewall recurrence after hysterectomy for uterine cervical and endometrial cancers. We investigated patients' characteristics, the 2-year local control and survival rates, and late adverse events of the rectum and bladder. RESULTS The 2-year overall survival, local control, and progression-free survival rates were 73.7% (95% confidence interval [CI], 60.8-89.3%), 69.4% (95% CI, 55.4-80.1%), and 37.3% (95% CI, 24.6-56.5%), respectively. In Cox multivariate analysis, tumor size at recurrence (<45 mm vs. ≥45 mm) (p = 0.04) and disease-free periods after hysterectomy (<10 months vs. ≥10 months) (p < 0.01) were significant prognostic factors for overall survival. Lymph node metastasis at recurrence (p < 0.01) was also a significant prognostic factor for progression-free survival. Three patients experienced Grade 3-4 late proctitis (7%). CONCLUSIONS Transperineal freehand salvage HDR-ISBT using transrectal ultrasonography was demonstrated to be a curative treatment option for patients with pelvic sidewall recurrence following hysterectomy. Based on the findings of this study, we emphasize the importance of HDR-ISBT for pelvic sidewall recurrence.
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Affiliation(s)
- Yusaku Miyata
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan; Department of Radiology, Kurume University School of Medicine, Fukuoka, Japan
| | - Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan.
| | - Kae Okuma
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuri Shimizu
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Ayaka Takahashi
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tairo Kashihara
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoya Kaneda
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kana Takahashi
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Koji Inaba
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Madoka Sakuramachi
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kanako Kojima
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomomi Aoshika
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kosuke Morishima
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuko Nakayama
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoyasu Kato
- Department of Gynecologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Etsuyo Ogo
- Department of Radiology, Kurume University School of Medicine, Fukuoka, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
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Kim HJ, Chang JS, Koom WS, Lee KC, Kim GE, Kim YB. Radiotherapy is a safe and effective salvage treatment for recurrent cervical cancer. Gynecol Oncol 2018; 151:208-214. [DOI: 10.1016/j.ygyno.2018.08.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/18/2018] [Accepted: 08/20/2018] [Indexed: 12/29/2022]
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Pelvic exenterations for gynecologic cancers: A retrospective analysis of a 30-year experience in a cancer center. Eur J Surg Oncol 2018; 44:1929-1934. [PMID: 30262326 DOI: 10.1016/j.ejso.2018.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 08/23/2018] [Accepted: 08/24/2018] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The objective of this study was to report a 30-year experience of PE for gynecologic malignancies in a cancer center. MATERIALS AND METHODS A retrospective study was conducted at Institut Paoli-Calmette including patients who underwent PE for gynecologic malignancies. Four periods were evaluated: P1 before 1992, P2 between 1993 and 1999, P3 between 2000 and 2006 and P4 after 2006. The study evaluated the number of PE performed during each period, the type of PE, its level, indication, location of the primary tumor, patient age, previous radiotherapy ≥45 Gy, the rate of "curative" PE and exenteration-related reconstructive techniques. 90-day post-operative mortality and morbidity using the National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI-CTCAE) v 4.03 were reported. RESULTS 277 PE were performed. The number of PE performed for recurrences rose during the study period (p = 0.042), PE performed for central tumors increased during P3 (64.4%) and P4 (67.4%) (p < 0.0001) and administration of radiotherapy ≥45 Gy was more frequent (p < 0.0001). The rate of "curative" PE increased (p < 0.0001). In multivariate analysis, "curative" PE were correlated with PE type, central locations and study period. Pelvic filling was progressively more frequently performed (p = 0.002). 90-day complication rate was 56.3%. In multivariate analysis there was a significant difference in distribution of CTCAE grade 3-4-5 morbidity depending on the period. Overall survival (OS) improved during the 2 last periods (p = 0.008). CONCLUSION A better selection of eligible patients for PE, namely through improvement in imaging techniques, has enabled to raise the rate of curative PE.
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Murakami N, Shima S, Okuma K, Iijima K, Tselis N, Uematsu M, Takagawa Y, Kashihara T, Masui K, Yoshida K, Takahashi K, Inaba K, Igaki H, Nakayama Y, Itami J. Artificial ascites for organs at risk sparing in intrapelvic brachytherapy: a case report of recurrent uterine cervical carcinoma adjacent to the bowel. BJR Case Rep 2018; 5:20180067. [PMID: 31131133 PMCID: PMC6519505 DOI: 10.1259/bjrcr.20180067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 07/31/2018] [Indexed: 12/23/2022] Open
Abstract
Artificial ascites has been reported as an effective technique to reduce the risk
of thermal injury in radiofrequency ablation of liver tumors by increasing the
distance of collateral organs located next to the ablated sites. In this case
report we share our experience with artificial ascites in an attempt to reduce
the toxicity of collateral adjacent organs in the setting of re-irradiation for
recurrent cervical cancer. A 52-year-old female who developed local recurrence
after definitive radiation therapy was treated with interstitial re-irradiation
by means of image-guided, (single-implant/multi fraction) high-dose-rate
brachytherapy. Because the sigmoid colon was in close proximity to the recurrent
tumor lesion, artificial ascites was generated before each treatment fraction by
percutaneous injection of a defined amount of saline solution through the
abdominal wall to create additional space between the two volumes. Artificial
ascites showed a dosimetric improvement by reducing the sigmoid colon
D0.1cc per fraction from 286 cGy before to 189 cGy after saline
injection. No severe complication was associated with the injection
procedure.
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Affiliation(s)
- Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Satoshi Shima
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kae Okuma
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kotaro Iijima
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Nikolaos Tselis
- Department of Radiotherapy and Oncology, Goethe-University, Frankfurt, Germany
| | - Masakazu Uematsu
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshiaki Takagawa
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan.,Department of Radiotherapy and Oncology, Goethe-University, Frankfurt, Germany.,Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Radiation Oncology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Tairo Kashihara
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan.,Department of Radiotherapy and Oncology, Goethe-University, Frankfurt, Germany.,Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Radiation Oncology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Koji Masui
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ken Yoshida
- Department of Radiation Oncology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Kana Takahashi
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Koji Inaba
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuko Nakayama
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
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Hasan S, Ricco A, Jenkins K, Lanciano R, Hanlon A, Lamond J, Yang J, Feng J, Good M, Noumoff J, Brady L. Survival and Control Prognosticators of Recurrent Gynecological Malignancies of the Pelvis and Para-aortic Region Treated with Stereotactic Body Radiation Therapy. Front Oncol 2016; 6:249. [PMID: 27921006 PMCID: PMC5118455 DOI: 10.3389/fonc.2016.00249] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/09/2016] [Indexed: 01/30/2023] Open
Abstract
Purpose To define prognostic factors associated with improved survival and local control (LC) for gynecologic cancer recurrences limited to the pelvis and para-aortic (PA) region using stereotactic body radiation therapy (SBRT). Methods Between 2/2008 and 7/2014, 30 women (35 targets) with pelvic or PA recurrence of endometrioid (n = 12), cervical (n = 11), ovarian (n = 3), uterine-serous (n = 2), or carcinosarcoma (n = 2) cancer were treated with SBRT. Eleven recurrences were located in the central pelvis, 11 along the pelvic sidewall (PSW), and 13 in the PA region. Results Five-year survival for all patients was 42% with a median survival of 43.4 months. Multivariate analysis revealed better performance status (PS), and smaller clinical tumor volume was significant for improved survival (p < 0.05). Conclusion SBRT is a local therapy for recurrent gynecological malignancies in the pelvis and PA region with curative potential. SBRT is especially effective for LC when targeting PSW or PA recurrence and for patients with a cervical/endometrioid uterine primary. Survival is improved for patients with better PS and smaller recurrence volume prior to SBRT.
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Affiliation(s)
- Shaakir Hasan
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Anthony Ricco
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Kaylette Jenkins
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Rachelle Lanciano
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Alexandra Hanlon
- University of Pennsylvania School of Nursing , Philadelphia, PA , USA
| | - John Lamond
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Jun Yang
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Jing Feng
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Michael Good
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Joel Noumoff
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Luther Brady
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
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Salvage Surgery for Cervical Cancer Recurrences. Indian J Surg Oncol 2015; 8:146-149. [PMID: 28546709 DOI: 10.1007/s13193-015-0472-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 10/04/2015] [Indexed: 10/23/2022] Open
Abstract
Cervical cancer usually presents in advanced stages and is treated with chemoradiation. About 15-20 % patients present with local recurrence after chemoradiation. Radical surgical resection is the only treatment modality offering long term survival benefit in recurrent cervical cancer. The most common surgical option for these patients is pelvic exenteration. Radical hysterectomy may be done for patients with a small centrally located recurrence in the cervix with no infiltration of adjacent structures. The aim of this study was to evaluate the morbidity and survival outcome following radical hysterectomy and pelvic exenteration for recurrent cancer cervix. We retrospectively reviewed the medical records of our patients who underwent surgery for cancer cervix recurrence from January 2010 to December 2014. The postoperative morbidity was considered early if it happened in the initial 30 days of surgery and late if it occurred after 30 days. All patients were followed up till February 2015. Survival analysis was done using Kaplan- Meir method. Between January 2010 and December 2014, 20 patients with recurrent cervical cancer underwent radical surgical resection. The median age of the study group was 43 years (range 28-63 years). Seventeen patients had squamous cell carcinoma and 3 had adenocarcinoma. 13 underwent pelvic exenteration and 7 patients underwent radical type 2 hysterectomy with bilateral pelvic lymphnode dissection. In the exenteration group, 8 patients had anterior exenteration, 4 had total exenteration and one had posterior exenteration. Urinary diversion was done by ileal conduit in 8 patients, double barrel colostomy in two and wet colostomy in two patients. There were no immediate postoperative deaths. Operating time, blood transfusions needed and hospital stay was more in the exenteration group compared to radical hysterectomy patients. After pelvic exenteration post-operative complications were seen in 76.9 % of which the most common was of the urinary tract including 3 patients with pyelonephritis, 5 had renal insufficiency and 2 patients developed urinary fistulae. Post-operative morbidity was lower in radical hysterectomy patients. There were two patients in the hysterectomy group who developed vault recurrence while none in the exenteration group had local recurrence. The median follow up time was 19 months (range 9-53 months).Three year overall survival for the entire cohort was 43 %. Median survival time for the exenteration group was 28 months which was significantly higher than 14 months for the radical hysterectomy group. This study shows that radical surgical resection is feasible with good survival outcome and acceptable morbidity in recurrent cancer cervix patients. Radical hysterectomy can be done in selected patients but pelvic exenteration has better long-term survival but with the potential for both short- & long-term complications.
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Ahmadi N, Tan KK, Solomon MJ, Al-Mozany N, Carter J. Pelvic Exenteration for Primary and Recurrent Gynecologic Malignancies Is Safe and Achieves Acceptable Long-Term Outcomes. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Nima Ahmadi
- Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Ker-Kan Tan
- Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Michael J. Solomon
- Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- University of Sydney, Sydney, Australia
| | - Nagham Al-Mozany
- Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Jonathan Carter
- University of Sydney, Sydney, Australia
- Sydney Gynaecological Oncology Group, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Tian XP, Qian D, He LR, Huang H, Mai SJ, Li CP, Huang XX, Cai MY, Liao YJ, Kung HF, Zeng YX, Xie D. The telomere/telomerase binding factor PinX1 regulates paclitaxel sensitivity depending on spindle assembly checkpoint in human cervical squamous cell carcinomas. Cancer Lett 2014; 353:104-14. [PMID: 25045845 DOI: 10.1016/j.canlet.2014.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 07/03/2014] [Accepted: 07/09/2014] [Indexed: 01/14/2023]
Abstract
Paclitaxel is a main ingredient in the combination chemotherapy treatment of advanced human cervical squamous cell carcinomas. We investigated the roles and underlying molecular mechanisms of PinX1 in cervical squamous cell carcinomas (CSCC) cells response to paclitaxel and its clinical significances. The expression dynamics of PinX1 was first examined by immunohistochemistry in 122 advanced CSCC patients treated with cisplatin/paclitaxel chemotherapy. The expression of PinX1 was significantly associated with the effects of cisplatin/paclitaxel chemotherapy in advanced CSCCs (P<0.05). High expression of PinX1 correlated with CSCC's response to cisplatin/paclitaxel chemotherapy, and was an independent predictor of shortened survival (P<0.05). A series of in vivo and in vitro assays were performed to elucidate the function of PinX1 on CSCC cells chemosensitivity to paclitaxel and underlying mechanisms. In CSCC cells, the levels of PinX1 were only associated with the cytotoxicity and sensitivity of paclitaxel, in which knockdown of PinX1 dramatically enhanced paclitaxel cytotoxicity, whereas the reestablishment of PinX1 levels substantially reduced the paclitaxel-induced killing effect. In addition, we identified that the ability of PinX1 to stabilize the tension between sister kinetochores and maintain the spindle assembly checkpoint was the main reason CSCC cells undergo apoptosis when treated with paclitaxel, and further studies demonstrated that shortened distance between sisters kinetochores by nocodazole confers upon PinX1-replenished cells a sensitivity to the death inducing paclitaxel effects. Furthermore, our study of CSCC cells xenografts in nude mice confirmed the role of PinX1 in paclitaxel sensitivity in vivo. Our data reveal that PinX1 could be used as a novel predictor for CSCC patient response to paclitaxel, and the role of PinX1-mediated paclitaxel sensitivity might represent a new direction for the development of a new generation of microtubule drugs.
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Affiliation(s)
- Xiao-Peng Tian
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Dong Qian
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Li-Ru He
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - He Huang
- Department of Gynecology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Shi-Juan Mai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Chang-Peng Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Xiao-Xia Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Mu-Yan Cai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China; Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yi-Ji Liao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Hsiang-fu Kung
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yi-Xin Zeng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Dan Xie
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.
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11
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Seo Y, Kim MS, Yoo HJ, Jang WI, Rhu SY, Choi SC, Kim MH, Kim BJ, Lee DH, Cho CK. Salvage stereotactic body radiotherapy for locally recurrent uterine cervix cancer at the pelvic sidewall: Feasibility and complication. Asia Pac J Clin Oncol 2014; 12:e280-8. [PMID: 24889550 DOI: 10.1111/ajco.12185] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2014] [Indexed: 12/20/2022]
Abstract
AIMS To determine the feasibility of stereotactic body radiotherapy (SBRT) in patients with pelvic sidewall recurrence of uterine cervical cancer after radical hysterectomy or definitive radiotherapy. METHODS We retrospectively reviewed 23 patients with locally recurrent uterine cervical cancer limited to the pelvic sidewall who were treated with SBRT at our institution between January 2003 and May 2010. The SBRT dose ranged from 27 to 45 Gy (median, 39 Gy) in three fractions, and the fractional SBRT dose ranged from 9 to 15 Gy (median, 13 Gy). RESULTS The 2-year overall survival, local progression-free survival and disease progression-free survival rates were 43%, 65% and 52%, respectively. Patients with small tumors (gross tumor volume <30 cm(3) ) had a significantly longer 2-year overall survival rate and 2-year local progression-free survival rate than did patients with large tumors (overall survival rate: 89% vs 12%; P = 0.0001 and local progression-free survival: 85% vs 0%; P = 0.0199). There were three cases (13%) of severe toxicities (rectovaginal fistula). Pelvic pain relief was achieved in all patients. In particular, 10 of 14 patients (71%) achieved analgesic (nonsteroidal anti-inflammatory drug or narcotic) reduction of 50% or more from baseline. CONCLUSION SBRT is a feasible treatment option for women with pelvic sidewall tumors from recurrent uterine cervical cancer, especially for small recurrent tumors. However, SBRT should be used carefully in the treatment of large tumors, as the incidence of severe late toxicity increases with the size of the tumor.
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Affiliation(s)
- YoungSeok Seo
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Mi-Sook Kim
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Hyung-Jun Yoo
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Won-Il Jang
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Sang-Young Rhu
- Department of Gynecology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Suck-Chul Choi
- Department of Gynecology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Moon-Hong Kim
- Department of Gynecology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Beob-Jong Kim
- Department of Gynecology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Dong-Han Lee
- CyberKnife Center, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Chul-Koo Cho
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
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Ang C, Bryant A, Barton DPJ, Pomel C, Naik R. Exenterative surgery for recurrent gynaecological malignancies. Cochrane Database Syst Rev 2014; 2014:CD010449. [PMID: 24497188 PMCID: PMC6457731 DOI: 10.1002/14651858.cd010449.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cancer is a leading cause of death worldwide. Gynaecological cancers (i.e. cancers affecting the ovaries, uterus, cervix, vulva and vagina) are among the most common cancers in women. Unfortunately, given the nature of the disease, cancer can recur or progress in some patients. Although the management of early-stage cancers is relatively straightforward, with lower associated morbidity and mortality, the surgical management of advanced and recurrent cancers (including persistent or progressive cancers) is significantly more complicated, often requiring very extensive procedures. Pelvic exenterative surgery involves removal of some or all of the pelvic organs. Exenterative surgery for persistent or recurrent cancer after initial treatment is difficult and is usually associated with significant perioperative morbidity and mortality. However, it provides women with a chance of cure that otherwise may not be possible. In carefully selected patients, it may also have a place in palliation of symptoms. The biology of recurrent ovarian cancer differs from that of other gynaecological cancers; it is often responsive to chemotherapy and is not included in this review. OBJECTIVES To evaluate the effectiveness and safety of exenterative surgery versus other treatment modalities for women with recurrent gynaecological cancer, excluding recurrent ovarian cancer (this is covered in a separate review). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE up to February 2013. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of clinical guidelines and review articles and contacted experts in the field. SELECTION CRITERIA Randomised controlled trials (RCTs) or non-randomised studies with concurrent comparison groups that included multivariate analyses of exenterative surgery versus medical management in women with recurrent gynaecological malignancies. DATA COLLECTION AND ANALYSIS Two review authors independently assessed whether potentially relevant studies met the inclusion criteria. No studies were found; therefore no data were analysed. MAIN RESULTS The search strategy identified 1311 unique references, of which seven were retrieved in full, as they appeared to be potentially relevant on the basis of title and abstract. However, all were excluded, as they did not meet the inclusion criteria of the review. AUTHORS' CONCLUSIONS We found no evidence to inform decisions about exenterative surgery for women with recurrent cervical, endometrial, vaginal or vulvar malignancies. Ideally, a large RCT or, at the very least, well-designed non-randomised studies that use multivariate analysis to adjust for baseline imbalances are needed to compare exenterative surgery versus medical management, including palliative care.
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Affiliation(s)
- Christine Ang
- Northern Gynaecological Oncology CentreQueen Elizabeth HospitalSheriff HillGatesheadUKNE9 6SX
| | - Andrew Bryant
- Newcastle UniversityInstitute of Health & SocietyMedical School New BuildRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Desmond PJ Barton
- Royal Marsden HospitalDivision of Gynaecological OncologyFulham RoadLondonUKSW3 6JJ
| | - Christophe Pomel
- Jean Perrin Comprehensive Cancer Centre of AuvergneSurgical OncologyClermont‐FerrandFrance
| | - Raj Naik
- Northern Gynaecological Oncology CentreQueen Elizabeth HospitalSheriff HillGatesheadUKNE9 6SX
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Okazawa K, Yuasa-Nakagawa K, Yoshimura RI, Shibuya H. Permanent interstitial re-irradiation with Au-198 seeds in patients with post-radiation locally recurrent uterine carcinoma. JOURNAL OF RADIATION RESEARCH 2013; 54:299-306. [PMID: 23071003 PMCID: PMC3589930 DOI: 10.1093/jrr/rrs092] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 08/26/2012] [Accepted: 09/17/2012] [Indexed: 06/01/2023]
Abstract
This study sought to analyze the outcome of patients with post-treatment locally recurrent uterine carcinoma treated with Au-198 seed permanent interstitial re-irradiation (Au-198 IRI). A retrospective review of the data of 15 patients with post-treatment locally recurrent uterine carcinoma treated with Au-198 IRI between 1991 and 2009 was performed to evaluate the disease response, local control, overall survival and complication rates. All the patients had received definitive radiation therapy or surgery as the initial treatment. None were judged as being suitable candidates for surgical treatment, and were referred for Au-198 IRI. Au-198 IRI was performed for the vaginal wall in 8 patients, vaginal stump in 4 patients, vulva in 2 patients, and cervix in 1 patient. The median tumor volume was 1.3 cm(3)(range, 0.4-6.9), the median treated volume was 6.3 cm(3)(range, 1.8-11), and the median prescribed dose was 76 Gy (range, 68-90). At a median follow-up duration of 19 months (range, 4.3-146.9), 13 of 15 patients (87%) showed complete responses after Au-198 IRI, although 10 of these 13 patients (77%) developed repeat central recurrence again between 2.5 and 49.7 months after the Au-198 IRI (median, 12.5 months). The overall 2-year local control rate and 2-year overall survival rate in the 15 patients were 33% and 64%, respectively. Two (13%) of the 15 patients experienced late complications that were more severe than Grade III. As a result, Au-198 IRI is considered to be one of the salvage treatment modalities with tolerable complications for inoperable centrally recurrent uterine carcinoma.
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Affiliation(s)
- Kaori Okazawa
- Department of Diagnostic Radiology and Oncology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
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Risk factors and clinical aspects of recurrent invasive cervical carcinoma. J Obstet Gynaecol India 2012; 62:674-8. [PMID: 24293846 DOI: 10.1007/s13224-012-0227-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Accepted: 06/14/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES Recurrence of cervical cancer is one of the important and plausible discussions in oncology especially in patients with advanced stages. The purpose of this study was to introduce probability invasive cervical carcinoma recurrence as well as determining characteristics and the prognostic factors of this entity. METHODS A retrospective study was designed to identify risk factors and pattern of uterine cervical carcinoma recurrence evaluating the outcome of 36 registered patients. Recurrence was defined based on clinical or para-clinical documentation over at least 6 months after complete remission following surgery or radiotherapy. Treatment consisted of a radiosurgical combination and exclusive radiotherapy. RESULTS Mean age in selected patients is 54.8 ± 12.0 years. The pathological reports of primary diagnosis are squamous cell carcinoma in 94.44 % and adenocarcinoma in remaining patients. Mean duration of recurrence among patients is 2.75 ± 1.5 years after the initial treatment. Metrorrhagia is mostly revealing symptom which patients present in recurrent episode. Usually, the recurrence of cervical cancer is presented in pelvic cavity locally. Marginal involvement is documented in 50 % of cases and lymph node in 33.3 % of patients with recurrent episode being involved. Most important prognostic factors are improper treatment (16.66 % of cases) after initial diagnosis. CONCLUSIONS Prognostic factors such as selection of appropriate method for treatment are an important point for reducing the rate of recurrence. Moreover, warning patients about symptoms and frequent episodes of follow up is necessary for early diagnosis of recurrence.
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Guckenberger M, Bachmann J, Wulf J, Mueller G, Krieger T, Baier K, Richter A, Wilbert J, Flentje M. Stereotactic body radiotherapy for local boost irradiation in unfavourable locally recurrent gynaecological cancer. Radiother Oncol 2010; 94:53-9. [PMID: 20079550 DOI: 10.1016/j.radonc.2009.12.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 11/20/2009] [Accepted: 12/17/2009] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate outcome of radiotherapy for locally recurrent cervical and endometrial cancer. MATERIALS AND METHODS Nineteen patients were treated for a locally recurrent cervical (n=12) or endometrial (n=7) cancer median 26 months after initial surgery (n=18) or radiotherapy (n=1). The whole pelvis was irradiated with 50Gy conventionally fractionated radiotherapy (n=16). Because of large size of the recurrent cancer (median 4.5 cm) and peripheral location (n=12), stereotactic body radiotherapy (SBRT; median 3 fractions of 5Gy to 65%) was used for local dose escalation instead of (n=16) or combined with (n=3) vaginal brachytherapy. RESULTS After median follow-up of 22 months, 3-year overall survival was 34% with systemic progression the leading cause of death (7/10). Median time to systemic progression was 16 months. Three local recurrences resulted in a local control rate of 81% at 3 years. No correlation between survival, systemic or local control and any patient or treatment characteristic was observed. The rate of late toxicity>grade II was 25% at 3 years: two patients developed a grade IV intestino-vaginal fistula and one patient suffered from a grade IV small bowel ileus. CONCLUSION Image-guided SBRT for local dose escalation resulted in high rates of local control but was associated with significant late toxicity.
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Affiliation(s)
- Matthias Guckenberger
- Department of Radiation Oncology, Julius-Maximilians University, Wuerzburg, Germany.
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Benedetti Panici P, Manci N, Bellati F, Di Donato V, Marchetti C, De Falco C, Di Tucci C, Angioli R. Vaginectomy: A Minimally Invasive Treatment for Cervical Cancer Vaginal Recurrence. Int J Gynecol Cancer 2009; 19:1625-31. [DOI: 10.1111/igc.0b013e3181a80a0a] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective:Radiotherapy and/or pelvic exenteration represent the treatment of vaginal recurrence, but the prognosis remains unsatisfactory and with long-term complications. We investigated the possible role of vaginectomy for isolated vaginal relapse (IVR) in cervical cancer (CC).Methods:Patients with vaginal CC recurrence were evaluated for surgical treatment consisting in vaginectomy. Data were prospectively collected and analyzed to identify independent prognostic factors.Results:Twenty-nine patients with IVR from CC were enrolled. Early and late complications were observed in 7 (24%) and 6 (21%) patients, respectively. After a median follow-up of 57.5 months (range, 8-100 months), 16 patients (55%) were disease-free. The 5-year overall survival and progression-free survival rates were 70.5% and 59.4%, respectively.Conclusions:In carefully selected patients, vaginectomy may be considered a therapeutic option for IVR. Older patients with long disease-free interval and small recurrences benefit the most from this bladder-sparing surgical technique.
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Marnitz S, Dowdy S, Lanowska M, Schneider A, Podratz K, Köhler C. Exenterations 60 Years After First Description. Int J Gynecol Cancer 2009; 19:974-7. [DOI: 10.1111/igc.0b013e3181a8351e] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Haasbeek CJ, Uitterhoeve AL, van der Velden J, González DG, Stalpers LJ. Long-term results of salvage radiotherapy for the treatment of recurrent cervical carcinoma after prior surgery. Radiother Oncol 2008; 89:197-204. [DOI: 10.1016/j.radonc.2008.01.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Revised: 11/22/2007] [Accepted: 01/03/2008] [Indexed: 11/24/2022]
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de Wilt JHW, van Leeuwen DHJ, Logmans A, Verhoef C, Kirkels WJ, Vermaas M, Ansink AC. Pelvic exenteration for primary and recurrent gynaecological malignancies. Eur J Obstet Gynecol Reprod Biol 2007; 134:243-8. [PMID: 16950559 DOI: 10.1016/j.ejogrb.2006.07.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Revised: 04/21/2006] [Accepted: 07/14/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Analyse the outcome of pelvic exenteration for gynaecological malignancies in a tertiary referral center. Post-operative in-hospital morbidity, long-term morbidity, disease free and overall survival rates were studied. STUDY DESIGN Between 1991 and 2004, 42 patients underwent an anterior, total or posterior exenteration for gynaecological malignancies. Follow-up was obtained from patient files; disease free and overall survival were calculated and prognostic factors were studied. RESULTS A pelvic exenteration was performed in 14 patients for primary and 28 patients for recurrent gynaecological cancers. In-hospital complications occurred in 19 patients (45%) of whom seven patients needed a reoperation (17%). Late complications occurred in 31 patients (75%); 21 reinterventions were performed (50%). Five-year disease free and overall survival was, respectively, 48 and 52%. Age, type of surgery, histology, localisation of the tumour, lateral wall involvement, completeness of resection and primary versus recurrent cancer were not identified as prognostic factors for recurrence or survival. CONCLUSION Long-term survival is possible in about 50% of patients after pelvic exenteration for gynaecological cancers, but is associated with significant post-operative morbidity.
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Affiliation(s)
- Johannes H W de Wilt
- Department of Surgical Oncology, Erasmus MC-Daniel den Hoed Cancer Center, P.O. Box 5201, 3008 AE Rotterdam, The Netherlands.
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Kasamatsu T, Sasajima Y, Onda T, Sawada M, Kato T, Tanikawa M. Surgical treatment for neuroendocrine carcinoma of the uterine cervix. Int J Gynaecol Obstet 2007; 99:225-8. [PMID: 17897648 DOI: 10.1016/j.ijgo.2007.06.051] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2007] [Revised: 06/06/2007] [Accepted: 06/07/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To identify the best operative approach for neuroendocrine cervical carcinoma (NECC). METHODS The records of surgically treated patients with stages IB to IIB NECC were reviewed. RESULTS Of 10 patients who met the study criteria for NECC and underwent radical hysterectomy, 4 had pT1bN0, 4 had pT1bN1, 1 had pT2aN0, and 1 had pT2bN1 disease. Those with pT1bN1 or pT2bN1 disease received postoperative adjuvant radiotherapy and/or chemotherapy, and recurrence occurred in 7 patients (70%). Among these 7 patients, 5 (71%) had a primary NECC tumor with deep stromal invasion and 5 (71%) had extrauterine disease (parametrium and/or lymph node). The recurrences in 6 patients (86%) were located outside the pelvis (lung, liver, or brain). Stromal invasion was 6 mm or less in the 3 patients who did not experience disease recurrence. CONCLUSIONS Pelvic control by radical hysterectomy may not be beneficial for patients with NECC except for those with an early invasive lesion.
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Affiliation(s)
- T Kasamatsu
- Division of Gynecology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.
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Marnitz S, Köhler C, Müller M, Behrens K, Hasenbein K, Schneider A. Indications for primary and secondary exenterations in patients with cervical cancer. Gynecol Oncol 2006; 103:1023-30. [PMID: 16890276 DOI: 10.1016/j.ygyno.2006.06.027] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Revised: 05/08/2006] [Accepted: 06/15/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Fifty years after the introduction of exenterative surgery in gynecologic oncology, the indication for primary and secondary exenteration is controversially discussed in cervical cancer patients. In addition, the term "palliative exenteration" is not precisely defined. We evaluate the role of primary exenteration in patients with stage IVA cervical cancer and the role of secondary palliative exenteration. METHODS The study retrospectively analyzed surgical and oncologic data of 55 patients who underwent exenterative surgery in the Department of Gynecology at the University of Jena between February 1998 and January 2004. Primary surgery was performed in 20 patients with laparoscopically confirmed stage IVA cervical cancer, while 35 patients with recurrent cervical cancer underwent secondary exenteration. Fifty-one had total, 3 posterior and 1 anterior exenteration. Survival was analyzed in relation to the patient's age, indication (primary versus secondary, curative versus palliative), previous therapy (operation, radiation, chemotherapy, radiochemotherapy), histology, resection margins, pelvic nodal involvement, time interval from primary therapy to recurrence, type of exenteration and adjuvant therapy. Early and late postoperative complications as well as perioperative mortality were reviewed. RESULTS The overall cumulative survival of all patients after exenteration was 36.8% at 5 years with 52.5% in the primary group and 26.7% in the recurrent one (p=0.0472). Complications were noted in 56.9% of patients, most commonly fistulas or gastrointestinal complications. Operative mortality was 5.5%. Survival correlated significantly with the time interval between primary treatment and recurrence (within 1-2 years 16.8% five-year survival, 2-5 years 28%, >5 years 83.2%, p=0.0105) as well as with curative or palliative intention (2-year survival rate of 60% in patients with curative intent, 10.5% in those with palliative intent, p=0.0001) and with tumor-free resection margins (2-year survival of 10.2% for positive margins, 5-year survival of 55.2% for negatives ones, p=0.0057). The age, the type of exenteration, the histologic type and the metastatic spread to pelvic lymph nodes had no significant influence on long-term survival. CONCLUSION In patients with histopathologically confirmed stage IVA cervical cancer primary, exenteration is a valid alternative to primary chemoradiation. In patients with persistent or recurrent tumor limited to the pelvis, secondary exenteration should be offered in the absence of other therapeutic options. Palliative and curative attempts can best be differentiated by the resection margin status.
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Affiliation(s)
- Simone Marnitz
- Department of Radiooncology, Charite Universitätsmedizin, Berlin, Germany
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Höckel M, Dornhöfer N. Pelvic exenteration for gynaecological tumours: achievements and unanswered questions. Lancet Oncol 2006; 7:837-47. [PMID: 17012046 DOI: 10.1016/s1470-2045(06)70903-2] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pelvic exenteration has been used for 60 years to treat cancers of the lower and middle female genital tract in radiated pelves. The mainstay for treatment success in terms of locoregional control and long-term survival is resection of the pelvic tumour with clear margins (R0). New ablative techniques based on developmentally derived surgical anatomy and laterally extended endopelvic resection have raised the number of R0 resections done, even for tumours that extend to the pelvic side wall, which were traditionally judged a contraindication for exenteration. Although mortality has fallen to less than 5%, treatment-related severe morbidity of pelvic exenteration still exceeds 50%, possibly because of compromised healing of irradiated tissue and use of complex reconstructive techniques. The benefits of exenteration for patients who have advanced primary disease or recurrent tumours after surgery, versus those who have chemoradiotherapy, are not proven by results of controlled trials, but can be assumed from retrospective data. Comparative findings are missing, and arguments are unconvincing to favour pelvic exenteration over less extensive treatments and best supportive care for palliation of cancer symptoms in most patients.
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Affiliation(s)
- Michael Höckel
- Department of Obstetrics and Gynaecology, University of Leipzig, Philipp-Rosenthal-Str 55, 04103 Leipzig, Germany.
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Lin CT, Yen TC, Chang TC, Ng KK, Tsai CS, Ho KC, Lai CH. Role of [18F]fluoro-2-deoxy-D-glucose positron emission tomography in re-recurrent cervical cancer. Int J Gynecol Cancer 2006; 16:1994-2003. [PMID: 17177837 DOI: 10.1111/j.1525-1438.2006.00729.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Cervical cancer patients with histologically documented re-recurrence after curative salvage therapy or unexplained tumor marker elevation (negative computed tomography and/or magnetic resonance imaging [CT-MRI]) proven to be a re-recurrence when a further attempt for cure (or control of cancer) appeared feasible were enrolled. Lesion status was determined from pathology or clinical follow-up for at least 12 months. Management decisions were recorded with CT-MRI alone and incorporating [18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET), respectively. The benefits calculated were based on clinical impact because of the FDG-PET findings. Cox proportional hazards model was used to select independent prognostic covariates. Of the 26 patients who were eligible for analysis, 12 (46.2%) patients had positive impacts due to PET. Squamous cell carcinoma (SCC,P= 0.029), re-recurrence at distant metastasis only (P= 0.012), and level of SCC antigen ≤4 ng/mL (P= 0.005) were significantly associated with better survival. A scoring system using these covariates defined three distinct prognostic groups (P= 0.0001). Patients with score 0 had a 36-month cumulative survival rate of 80%. Using this prognostic scoring system, FDG-PET may facilitate selecting appropriate management for the individual patient with re-recurrent cervical cancer.
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Affiliation(s)
- C-T Lin
- Departments of Obstetrics and Gynecology, Nuclear Medicine, Diagnostic Radiology, and Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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