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Ishizawa C, Taguchi A, Tanikawa M, Honjo H, Nishijima A, Eguchi S, Miyamoto Y, Sone K, Tsuruga T, Mori M, Osuga Y. Effect of pelvic radiotherapy on patients with stage IB‑IIA cervical cancer after radical hysterectomy: A single‑center retrospective study. Oncol Lett 2023; 25:112. [PMID: 36817060 PMCID: PMC9932628 DOI: 10.3892/ol.2023.13698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/19/2022] [Indexed: 02/05/2023] Open
Abstract
The effects of post-operative adjuvant radiotherapy (RT) on intermediate-risk patients with cervical cancer have not been fully elucidated. Therefore, the present study aimed to investigate the impact of RT on intermediate-risk cervical cancer. The data of 112 patients with stage IB and IIA cervical cancer treated with radical hysterectomy between January 2009 and December 2018 were retrospectively reviewed. Overall survival (OS), progression-free survival (PFS), and the frequency of adverse events were compared between patients with and without adjuvant RT (RT+ and RT-, respectively). Subgroup analyses of PFS based on tumor size, cervical stromal invasion, lymphovascular space invasion and histology [squamous cell carcinoma (SCC) vs. non-SCC] were performed. Among the 112 patients, 41 received adjuvant RT. Although there were no significant differences in OS or PFS between the RT+ and RT- groups, the frequency of adverse events was much higher in the RT+ group. Patients in the RT+ group also had more recurrent risk factors than those in the RT- group. Based on the subgroup analyses, although no significant differences were observed between any of the groups, RT demonstrated a different impact on PFS between SCC and non-SCC: No difference was observed in the SCC group, whereas patients in the RT+ group tended to have poorer prognoses compared to those in the RT- group of the non-SCC group. These results suggest that the impact of post-operative RT on stage IB and IIA cervical cancer is limited and is accompanied by increased adverse events. The eligibility of patients for post-operative RT should be carefully determined based on the therapeutic effect of RT in each subgroup.
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Affiliation(s)
- Chihiro Ishizawa
- Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Ayumi Taguchi
- Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo 113-8655, Japan,Correspondence to: Dr Ayumi Taguchi, Department of Obstetrics and Gynecology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan, E-mail:
| | - Michihiro Tanikawa
- Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Harunori Honjo
- Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Akira Nishijima
- Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Satoko Eguchi
- Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Yuichiro Miyamoto
- Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Kenbun Sone
- Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Tetsushi Tsuruga
- Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Mayuyo Mori
- Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
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Saito M, Tanabe H, Yamauchi K, Kuroda T, Takano H, Yamada K, Okamoto A. Evaluation of non-hematologic toxicity in patients with cervical cancer after Type 3 radical hysterectomy followed by concurrent chemoradiotherapy: a retrospective study. Jpn J Clin Oncol 2023; 53:393-400. [PMID: 36651690 DOI: 10.1093/jjco/hyac211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/29/2022] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To investigate the safety of concurrent chemoradiotherapy after Type 3 radical hysterectomy, focusing on non-hematologic toxicity. METHODS Between January 2010 and December 2017, 236 patients diagnosed with cervical cancer Stages IB1-II (FIGO2008) and who had undergone Type 3 radical hysterectomy at the Jikei Medical University School-related four hospitals were included. Of these 236 patients, 134 had undergone adjuvant concurrent chemoradiotherapy after Type 3 radical hysterectomy (radical hysterectomy + concurrent chemoradiotherapy group), and 102 received no adjuvant therapy after Type 3 radical hysterectomy (radical hysterectomy group). The frequency of non-hematologic toxicities, especially lymphedema, pelvic infection, renal dysfunction, ileus and diarrhea, was investigated in the radical hysterectomy + concurrent chemoradiotherapy and radical hysterectomy groups using univariate and multivariate analyses. In these analyses, age, extent of lymph node dissection and preoperative clinical stage were included as risk factors for five complications. The risk factors for grade ≤ 2 adverse events were statistically evaluated. RESULTS The frequency of lower extremity lymphedema (22 vs. 10%), renal dysfunction (13 vs. 3%), and diarrhea (13 vs. 0%) was significantly higher in the radical hysterectomy + CRRT group than that in the radical hysterectomy group. Logistic regression analysis revealed that adjuvant concurrent chemoradiotherapy significantly affected the occurrence of grade ≥ 2 lymphedema (P < 0.01) and renal dysfunction (P < 0.01). CONCLUSIONS Concurrent chemoradiotherapy after Type 3 radical hysterectomy is associated with a higher incidence of renal dysfunction, lower extremity lymphedema and diarrhea. A more appropriate adjuvant therapy needs to be established.
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Affiliation(s)
- Motoaki Saito
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroshi Tanabe
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kishihito Yamauchi
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takafumi Kuroda
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hirokuni Takano
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kyosuke Yamada
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
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Wang T, Sun H, Han F, Sun W, Chen Z. Evaluation of parametrial infiltration in cervical cancer with voxel-based segmentation of integrated 18F-FDG PET/MRI images: A preliminary study. Eur J Radiol 2019; 118:147-152. [PMID: 31439234 DOI: 10.1016/j.ejrad.2019.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/09/2019] [Accepted: 07/16/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE To identify parametrial infiltration (PMI) in cervical cancer with voxel-based segmentation of integrated PET/MRI images. METHOD This retrospective study enrolled 79 cervical cancer patients confirmed by pathology (FIGO stage IB to IIB) who underwent 18F-FDG PET/MRI prior to surgery. Region of interest (ROI) at the largest tumor level was delineated on the T2W-MR image, and the ROI was applied to PET image of the corresponding layer. Then, these images were postprocessed with segmentation and gray level calculations in the parauterine area. RESULTS In total, 37 patients (46.8%) had postoperative pathology-confirmed PMI, and 42 patients (53.2%) showed no PMI. There was a moderate correlation between pathological results and the gray level values of each region (rs > 0.5, P < 0.001). According to FIGO stage, as the cervical lesions became more malignant, the gray level values gradually increased. The diagnostic results of MRI and PET/MRI were in good agreement (kappa = 0.693, P < 0.001); the accuracy (78.5%), sensitivity (64.9%) and NPV (74.5%) of PET/MRI were slightly higher than those of MRI (74.7%,59.5%,71.2%, respectively), with no statistically significant difference (P = 1.000). The diagnostic results of MRI and PET/MRI+gray level values were generally consistent (kappa = 0.475, P < 0.001); the accuracy (87.3%), sensitivity(83.8%) and NPV(86.4%) of PET/MRI+gray level values were higher than those of MRI, with statistically significant differences (all P values < 0.05). CONCLUSIONS It is feasible to evaluate PMI based on PET/T2W-MRI voxel segmentation and to obtain quantitative and visual indicators. PET/MRI and gray level values considered together can also improve the accuracy, sensitivity and NPV of PMI diagnosis.
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Affiliation(s)
- Tong Wang
- Department of Radiology, Shengjing Hospital of China Medical University, China
| | - Hongzan Sun
- Department of Radiology, Shengjing Hospital of China Medical University, China.
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Kasamatsu T, Ishikawa M, Murakami N, Okada S, Ikeda SI, Kato T, Itami J. Identifying selection criteria for non-radical hysterectomy in FIGO stage IB cervical cancer. J Obstet Gynaecol Res 2019; 45:882-891. [PMID: 30672089 PMCID: PMC6590221 DOI: 10.1111/jog.13902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/14/2018] [Indexed: 11/29/2022]
Abstract
Aim This retrospective study sought to identify the selection criteria required for a non‐radical hysterectomy with minimal parametrectomy in patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB invasive cervical cancer. Methods Overall, 461 patients with FIGO stage IB cervical cancer who underwent a radical hysterectomy were reviewed clinicopathologically according to pathological tumor size (≤2 cm, >2 – ≤4 cm, and > 4 cm). Results The pathological parametrial involvement rate in the less than equal to 2 cm group (2%) was significantly lower than in greater than 2–less than equal to 4 cm (13%) or greater than 4 cm (29%) groups (both P < 0.001). The 5‐year overall survival rate was significantly higher in the less than equal to 2 cm group (97%, 95% confidence interval [CI] 94–99%) compared with greater than 2–less than equal to 4 cm (90%, 95% CI 94–86%) and greater than 4 cm (70%, 95% CI 79–60%) groups (both P < 0.001). Cox model analysis identified tumor size to be an independent prognostic factor for survival (95% CI 1.33–5.78) and recurrence (95% CI 1.31–5.66) compared to other pathological factors. However, a significant difference between the three groups was not found in rates of Grade 3 or 4 adverse events following radical hysterectomy (P = 0.19). Conclusions Tumor size is an independent prognostic factor for survival in patients with FIGO stage IB invasive cervical cancer. This retrospective study suggests that FIGO stage IB patients with a less than equal to 2 cm tumor size are optimal candidates for non‐radical hysterectomy with minimal parametrectomy, and without resulting bladder dysfunction.
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Affiliation(s)
- Takahiro Kasamatsu
- Department of Obstetrics and Gynecology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Mitsuya Ishikawa
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Satoshi Okada
- Department of Women's Oncology Center/Gynecology, Sanno Hospital, Tokyo, Japan
| | - Shun-Ichi Ikeda
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoyasu Kato
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
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Sun H, Cao D, Shen K, Yang J, Xiang Y, Feng F, Wu L, Zhang Z, Ling B, Song L. Piver Type II vs. Type III Hysterectomy in the Treatment of Early-Stage Cervical Cancer: Midterm Follow-up Results of a Randomized Controlled Trial. Front Oncol 2018; 8:568. [PMID: 30555800 PMCID: PMC6280766 DOI: 10.3389/fonc.2018.00568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/13/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: With the expansion of value-based medicine, we explore whether using type III hysterectomy to treat low-risk, early-stage cervical cancer constitutes overtreatment. In present study, we evaluate the midterm safety and postoperative quality of life of patients who underwent type II hysterectomy vs. type III hysterectomy with systematic lymphadenectomy for low-risk early-stage cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) IA2-IB1; maximum tumor diameter < 2 cm). Patients and methods: The main study was a multicenter, phase III, randomized controlled trial (NCT02368574, https://www.clinicaltrials.gov/ct2/show/NCT02368574). Patients meeting the criteria were randomly divided into type II and type III hysterectomy groups between 2015 and 2018. Midterm outcomes were analyzed at 36 months after the first eligible patient was enrolled. The primary end point was disease-free survival, and the secondary end point was postoperative quality of life. Results: A total of 97 patients were preliminarily enrolled, 93 of whom were included in the final analysis. The general information of the two groups did not differ. The 2-year DFS rate in the type II group was 100% compared with 97.9% in the type III group (P > 0.05). Compared to the type III group, the patients who underwent type II hysterectomy showed a shorter surgical time (163 ± 18.8 min vs. 226 ± 16.4 min, P = 0.014), less intraoperative blood loss (174 ± 27.7 ml vs. 268 ± 37.4 ml, P = 0.047), less postoperative urinary retention (5/46 vs. 11/47 cases, P = 0.109), and milder bladder injuries. The postoperative symptom experience scores of the type II group were significantly lower than those of the type III group. Moreover, the postoperative sexual/vaginal functioning and lubrication scores of the type II group were significantly lower than those of the type III group in subgroup analyses of patients who did not undergo postoperative chemoradiotherapy. Sexual apprehension scores were increased postoperatively in both groups. Conclusion: Based on the midterm analysis, the two groups show considerable security within 2 years after surgery, but long-term security requires further analysis. Type II hysterectomy can effectively reduce the surgical time and intraoperative blood loss, decrease postoperative complications, and improve the quality of life of early-stage cervical cancer patients.
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Affiliation(s)
- Hengzi Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengzhi Feng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lingying Wu
- Department of Gynecological Oncology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Zhenyu Zhang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Beijing, China
| | - Bin Ling
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing, China
| | - Lei Song
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, China
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Arimoto T, Kawana K, Adachi K, Ikeda Y, Nagasaka K, Tsuruga T, Yamashita A, Oda K, Ishikawa M, Kasamatsu T, Onda T, Konishi I, Yoshikawa H, Yaegashi N. Minimization of curative surgery for treatment of early cervical cancer: a review. Jpn J Clin Oncol 2015; 45:611-6. [DOI: 10.1093/jjco/hyv048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/10/2015] [Indexed: 11/14/2022] Open
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Kato T, Takashima A, Kasamatsu T, Nakamura K, Mizusawa J, Nakanishi T, Takeshima N, Kamiura S, Onda T, Sumi T, Takano M, Nakai H, Saito T, Fujiwara K, Yokoyama M, Itamochi H, Takehara K, Yokota H, Mizunoe T, Takeda S, Sonoda K, Shiozawa T, Kawabata T, Honma S, Fukuda H, Yaegashi N, Yoshikawa H, Konishi I, Kamura T. Clinical tumor diameter and prognosis of patients with FIGO stage IB1 cervical cancer (JCOG0806-A). Gynecol Oncol 2015; 137:34-9. [PMID: 25662625 DOI: 10.1016/j.ygyno.2015.01.548] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/29/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE In order to determine indications for less radical surgery such as modified radical hysterectomy, the risk of pathological parametrial involvement and prognosis of FIGO stage IB1 cervical cancer patients undergoing standard radical hysterectomy with pre-operatively assessed tumor diameter≤2 cm were investigated. METHODS We conducted a retrospective multi-institutional chart review of patients with FIGO stage IB1 cervical cancer who underwent primary surgical treatment between 1998 and 2002. The eligibility criteria for the analyses were (i) histologically-proven squamous cell carcinoma, adenocarcinoma or, adenosquamous cell carcinoma, (ii) radical hysterectomy performed, (iii) clinical tumor diameter data available by MR imaging or specimens by cone biopsy, and (iv) age between 20 and 70. Based on the clinical tumor diameter, patients were stratified into those with the following tumors: i) 2 cm or less (cT≤2 cm) and ii) greater than 2 cm (cT>2 cm). We expected 5-year OS of ≥95% and parametrial involvement<2-3% for patients with cT≤2 cm who underwent radical hysterectomy. RESULTS Of the 1269 patients enrolled, 604 were eligible for the planned analyses. Among these, 571 underwent radical hysterectomy (323 with cT≤2 cm and 248 with cT>2 cm). Parametrial involvement was present in 1.9% (6/323) with cT≤2 cm and 12.9% (32/248) with cT>2 cm. Five-year overall survivals were 95.8% (95% CI 92.9-97.6%) in cT≤2 cm and 91.9% (95% CI 87.6-94.8%) in cT>2 cm patients. CONCLUSION Patients with cT≤2 cm had lower risk of parametrial involvement and more favorable 5-year overall survival. They could therefore be good candidates for receiving less radical surgery.
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Affiliation(s)
- Tomoyasu Kato
- Department of Gynecologic Oncology, National Cancer Center Hospital, Japan.
| | - Atsuo Takashima
- Japan Clinical Oncology Group Data Center, Multi-institutional Clinical Trial Support Center, National Cancer Center, Japan
| | - Takahiro Kasamatsu
- Department of Gynecologic Oncology, National Cancer Center Hospital, Japan
| | - Kenichi Nakamura
- Japan Clinical Oncology Group Data Center, Multi-institutional Clinical Trial Support Center, National Cancer Center, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center, Multi-institutional Clinical Trial Support Center, National Cancer Center, Japan
| | - Toru Nakanishi
- Department of Gynecologic Oncology, Aichi Cancer Center, Japan
| | | | - Shoji Kamiura
- Department of Gynecology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan
| | - Takashi Onda
- Department of Obstetrics and Gynecology, Kitasato University, Japan
| | - Toshiyuki Sumi
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Japan
| | - Masashi Takano
- Department of Obstetrics and Gynecology, National Defense Medical College, Japan
| | | | - Toshiaki Saito
- Gynecologic Service, National Kyushu Cancer Center, Japan
| | | | | | - Hiroaki Itamochi
- Department of Obstetrics and Gynecology, Tottori University, Japan
| | | | - Harushige Yokota
- Department of Gynecologic Oncology, Saitama Cancer Center, Japan
| | - Tomoya Mizunoe
- Department of Gynecologic Oncology, Kure Medical Center, Japan
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Japan
| | - Kenzo Sonoda
- Department of Obstetrics and Gynecology, Kyushu University, Japan
| | - Tanri Shiozawa
- Department of Obstetrics and Gynecology, Shinshu University, Japan
| | - Takayo Kawabata
- Department of Obstetrics and Gynecology, Kagoshima City Hospital, Japan
| | - Shigeru Honma
- Department of Gynecology, Niigata Cancer Center Hospital, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center, Multi-institutional Clinical Trial Support Center, National Cancer Center, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University, Japan
| | | | - Ikuo Konishi
- Department of Gynecology and Obstetrics, Kyoto University, Japan
| | - Toshiharu Kamura
- Department of Obstetrics and Gynecology, Kurume University, Japan
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