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Bebia V, Díaz-Feijoo B, Tejerizo Á, Torne A, Benito V, Hernández A, Gorostidi M, Domingo S, Bradbury M, Luna-Guibourg R, Gil-Moreno A. Patterns of First Recurrence and Oncological Outcomes in Locally Advanced Cervical Cancer Patients: Does Surgical Staging Play a Role? Cancers (Basel) 2024; 16:1423. [PMID: 38611101 PMCID: PMC11011205 DOI: 10.3390/cancers16071423] [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: 02/11/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND We aimed to determine whether surgical aortic staging by minimally invasive paraaortic lymphadenectomy (PALND) affects the pattern of first recurrence and survival in treated locally advanced cervical cancer (LACC) patients when compared to patients staged by imaging (noPALND). METHODS This study was a multicenter observational retrospective cohort study of patients with LACC treated at tertiary care hospitals throughout Spain. The inclusion criteria were histological diagnosis of squamous carcinoma, adenosquamous carcinoma, and/or adenocarcinoma; FIGO stages IB2, IIA2-IVA (FIGO 2009); and planned treatment with primary chemoradiotherapy between 2000 and 2016. Propensity score matching (PSM) was performed before the analysis. RESULTS After PSM and sample replacement, 1092 patients were included for analysis (noPALND n = 546, PALND n = 546). Twenty-one percent of patients recurred during follow-up, with the PALND group having almost double the recurrences of the noPALND group (noPALND: 15.0%, PALND: 28.0%, p < 0.001). Nodal (regional) recurrences were more frequently observed in PALND patients (noPALND:2.4%, PALND: 11.2%, p < 0.001). Among those who recurred regionally, 57.1% recurred at the pelvic nodes, 37.1% recurred at the aortic nodes, and 5.7% recurred simultaneously at both the pelvic and aortic nodes. Patients who underwent a staging PALND were more frequently diagnosed with a distant recurrence (noPALND: 7.0%, PALND: 15.6%, p < 0.001). PALND patients presented poorer overall, cancer-specific, and disease-free survival when compared to patients in the noPALND group. CONCLUSION After treatment, surgically staged patients with LACC recurred more frequently and showed worse survival rates.
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Affiliation(s)
- Vicente Bebia
- Gynecologic Oncology Division, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain (M.B.); (A.G.-M.)
| | - Berta Díaz-Feijoo
- Gynecologic Oncology Division, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain (M.B.); (A.G.-M.)
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08035 Barcelona, Spain
| | - Álvaro Tejerizo
- Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Aureli Torne
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08035 Barcelona, Spain
| | - Virginia Benito
- Department of Gynecologic Oncology, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Las Palmas de Gran Canaria, Spain
| | - Alicia Hernández
- Department of Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Mikel Gorostidi
- Department of Gynecology and Obstetrics, Hospital Universitario Donostia, 20014 San Sebastián, Spain;
| | - Santiago Domingo
- Department of Gynecology Oncology, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Melissa Bradbury
- Gynecologic Oncology Division, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain (M.B.); (A.G.-M.)
| | - Rocío Luna-Guibourg
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain;
| | - Antonio Gil-Moreno
- Gynecologic Oncology Division, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain (M.B.); (A.G.-M.)
- CIBERONC Centro de Investigación Biomédica en Red Cáncer, 08193 Madrid, Spain
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Li H, Wang S, Liu Y, Wang T, Jin S, Liu Z. Prophylactic extended-field irradiation for locally advanced cervical cancer. Gynecol Oncol 2022; 166:606-613. [PMID: 35868881 DOI: 10.1016/j.ygyno.2022.07.009] [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: 04/04/2022] [Revised: 07/03/2022] [Accepted: 07/10/2022] [Indexed: 11/04/2022]
Abstract
Concomitant chemoradiotherapy is the standard treatment for locally advanced cervical cancer. Pelvic irradiation is commonly recommended for patients with negative para-aortic lymph nodes(PALNs). However, owing to the development of imaging-guided brachytherapy, distant failure has become the main failure pattern. The PALNs are a vital site of distant metastasis, and the para-aortic region may contain occult microscopic metastases that are barely detected owing to imaging technology restriction. The prognostic of patients who experienced PALN failure is dismal. Typically, there are four ways to decrease PALN failure. First, surgical staging can be performed to assess the occurrence of metastasis in the para-aortic region; however, the application of surgical staging is decreasing owing to controversial survival benefits and accompanying complications of surgery. Second, regular imaging surveillance and timely salvage of early recurrences could reduce PALN failure. Third, better systemic adjuvant therapy could be recommended since it has enormous potential to reduce distant metastases and improve overall survival. Fourth, performing prophylactic extended-field irradiation (EFI), including pelvic and para-aortic region irradiation, can sterilize occult microscopic metastases in the para-aortic region and improve survival. Prior investigations have revealed that prophylactic EFI could reduce PALN failure as well as distant metastasis and present the benefit of survival. Yet, owing to the serious morbidity induced by enlarged irradiation field in the era of conventional irradiation techniques, further research on EFI is stagnated. Nowadays, with the development of new technologies, intensity modulated radiation therapy can deliver a higher dose to tumors with acceptable toxicity. Prophylactic EFI regained attention. However, the inclusion criteria of prophylactic EFI in existing studies reveal great discrepancies. Thus, it is urgent to precisely identify indications for better survival and lower complications in patients with cervical cancer. In this review, we identify indications and summary guidelines for prophylactic EFI, which may provide a foundation for further trials and clinical applications.
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Affiliation(s)
- Huanhuan Li
- Department of radiation oncology, The Second affiliated Hospital of Jilin University, Changchun 130041, China
| | - Shu Wang
- Department of radiation oncology, The Second affiliated Hospital of Jilin University, Changchun 130041, China
| | - Yingying Liu
- Department of radiation oncology, The Second affiliated Hospital of Jilin University, Changchun 130041, China
| | - Tiejun Wang
- Department of radiation oncology, The Second affiliated Hospital of Jilin University, Changchun 130041, China
| | - Shunzi Jin
- NHC Key Laboratory of Radiobiology,Jilin University, Changchun 130021, China
| | - Zhongshan Liu
- Department of radiation oncology, The Second affiliated Hospital of Jilin University, Changchun 130041, China.
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Nasioudis D, Rush M, Taunk NK, Ko EM, Haggerty AF, Cory L, Giuntoli RL, Kim SH, Latif NA. Oncologic outcomes of surgical para-aortic lymph node staging in patients with advanced cervical carcinoma undergoing chemoradiation. Int J Gynecol Cancer 2022; 32:823-827. [PMID: 35788115 DOI: 10.1136/ijgc-2022-003394] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We aimed to evaluate the utilization and impact of surgical para-aortic lymph node staging on the survival of patients with locally advanced stage cervical carcinoma receiving definitive chemoradiation. METHODS We identified patients in the National Cancer Database diagnosed between January 2010 and December 2015 with locally advanced (FIGO 2009 stage IB2-IVA) cervical carcinoma who did not undergo hysterectomy, received primary chemoradiation and had at least 1 month of follow-up. Two groups of patients were formed based on the assessment method of para-aortic lymph node status - radiologic assessment only versus surgical lymphadenectomy. Overall survival was compared with the log-rank test after Kaplan-Meier curves were generated. A Cox model was constructed to control for a priori selected confounders. RESULTS We identified a total of 3540 patients who met the inclusion criteria. Para-aortic staging was performed in 333 (9.4%) patients. These patients were younger (median age 46 vs 52 years, p<0.001), less likely to have co-morbidities (8.7% vs 15.6%, p<0.001), more likely to have private insurance (48.9% vs 37.8%, p<0.001) and receive brachytherapy (76.9% vs 70.9%, p=0.022). The rate of para-aortic lymphadenectomy was comparable between patients with stage IB2-II and III-IVA disease (9.4% for both groups, p=0.98). Patients who underwent para-aortic lymphadenectomy were also more likely to have lymph nodes categorized as positive compared with those who had imaging only (27.3% vs 13.2%, p<0.001). There was no difference in overall survival between patients who underwent radiologic only or surgical para-aortic lymph node assessment (p=0.80 from log-rank test); 4 year overall survival rates were 62.9% and 63%. After controlling for confounders, performance of para-aortic lymphadenectomy was not associated with a survival benefit (HR 1.07, 95% CIs: 0.88 to 1.31). CONCLUSIONS In a large cohort of patients with locally advanced stage cervical carcinoma, para-aortic lymphadenectomy was rarely performed and not associated with a survival benefit.
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Affiliation(s)
- Dimitrios Nasioudis
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Margaret Rush
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Neil K Taunk
- Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Emily M Ko
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Ashley F Haggerty
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Lori Cory
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Robert L Giuntoli
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Sarah H Kim
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Nawar A Latif
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
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Surgical Outcomes of Laparoscopic Pelvic Lymph Node Debulking during Staging Aortic Lymphadenectomy in Locally Advanced Cervical Cancer: A Multicenter Study. Cancers (Basel) 2022; 14:cancers14081974. [PMID: 35454880 PMCID: PMC9025856 DOI: 10.3390/cancers14081974] [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: 03/15/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary Lymph node metastasis is an important prognostic factor in locally advanced cervical cancer (LACC), which makes correct staging crucial. In contrast to existing studies evaluating pelvic lymphadenectomy after aortic lymphadenectomy, this study focuses on the pelvic node (PLN) debulking technique which has the dual objective of staging and cytoreduction. This is a multicenter retrospective study of patients with LACC and positive pelvic nodes on imaging tests. Feasibility, morbidity and delay in the initiation of chemoradiotherapy (CRT) were evaluated for the PLN debulking by comparing it with a control group of aortic lymphadenectomy alone. Excision of the bulky nodes was possible in 99.4% of patients. There were no differences in complications between the groups and a shorter time from diagnosis and from surgery to the start of CRT was observed in the study group. Abstract Background: Few studies have evaluated laparoscopic pelvic lymph node (PLN) debulking during staging aortic lymphadenectomy in locally advanced cervical cancer (LACC). It allows us to know the lymph node status and facilitates the action of chemoradiotherapy (CRT) by reducing tumor burden. We evaluated its feasibility and compared the perioperative morbidity and the time to CRT with a control group. Methods: This was a multicenter retrospective study of patients with LACC FIGO stage IIIC1r who were recipients of CRT. We compared two cohorts: group 1, which consisted of 164 patients with surgical staging by laparoscopic aortic lymphadenectomy and PLN debulking, and group 2, which consisted of 111 patients with aortic lymphadenectomy alone. Results: Excision of the bulky nodes was possible in all patients in group 1 except for one. Surgery lasted a median of 82 min longer in group 1 but there was no greater intraoperative bleeding or increased hospital stay. There were no significant differences in intraoperative or postoperative complications between the groups. A significantly shorter time from surgery to the start of RT was observed in group 1. Conclusions: It is feasible to perform laparoscopic PLN debulking in the same procedure as the staging aortic lymphadenectomy in LACC without increasing surgical or postoperative complications and without delaying the start of CRT compared to single aortic lymphadenectomy.
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Zaccarini F, Sanson C, Maulard A, Scherier S, Pautier P, Leary A, Genestie C, Chargari C, Morice P, Gouy S. [Surgical de-escalation in gynecologic oncology]. Bull Cancer 2021; 108:1155-1161. [PMID: 34629168 DOI: 10.1016/j.bulcan.2021.06.012] [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: 06/09/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 12/01/2022]
Abstract
The evolution of knowledge in gynecologic oncology is leading to surgical de-escalation in several areas, particularly in lymph node staging. Sentinel lymph node biopsy that was initially used in low and intermediate risk endometrial cancer, has now been extended to high-intermediate and high-risk endometrial cancer. Sentinel lymph node biopsy plays also an important role in the nodal staging of early-stage cervical cancer. The radicality of hysterectomies in patients with early cervical cancer is under debate. Similarly, surgical staging with para-aortic lymphadenectomy in locally advanced cervical cancer should be performed only for few cases. Systematic pelvic and para-aortic lymphadenectomy in patients with advanced ovarian cancers is not recommended anymore.
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Affiliation(s)
- François Zaccarini
- Service de chirurgie gynécologique, Gustave-Roussy, 94805 Villejuif, France.
| | - Claire Sanson
- Service de chirurgie gynécologique, Gustave-Roussy, 94805 Villejuif, France
| | - Amandine Maulard
- Service de chirurgie gynécologique, Gustave-Roussy, 94805 Villejuif, France
| | - Stéphanie Scherier
- Service de chirurgie gynécologique, Gustave-Roussy, 94805 Villejuif, France
| | - Patricia Pautier
- Service d'oncologie médicale, Gustave-Roussy, 94805 Villejuif, France
| | - Alexandra Leary
- Service d'oncologie médicale, Gustave-Roussy, 94805 Villejuif, France
| | - Catherine Genestie
- Service de pathologie morphologique, Gustave-Roussy, 94805 Villejuif, France
| | - Cyrus Chargari
- Service de radiothérapie, Gustave Roussy, 94805 Villejuif, France
| | - Philippe Morice
- Service de chirurgie gynécologique, Gustave-Roussy, 94805 Villejuif, France
| | - Sébastien Gouy
- Service de chirurgie gynécologique, Gustave-Roussy, 94805 Villejuif, France
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Li W, Xiong L, Zhu Q, Lu H, Zhong M, Liang M, Jiang W, Wang Y, Cheng W. Assessment of retroperitoneal lymph node status in locally advanced cervical cancer. BMC Cancer 2021; 21:484. [PMID: 33933005 PMCID: PMC8088051 DOI: 10.1186/s12885-021-08208-6] [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: 03/09/2020] [Accepted: 04/18/2021] [Indexed: 12/12/2022] Open
Abstract
Background The assessment of retroperitoneal lymph node status in patients with locally advanced cervical cancer is still a problem. This study aimed to explore the choice of these assessment methods. Methods Laparoscopic retroperitoneal lymphadenectomy was performed in 96 patients with advanced cervical cancer. The positive rates of lymph node metastasis were analyzed. The values of computed tomography lymph node minimum axial diameter (MAD) and squamous cell carcinoma antigen (SCC-Ag), and their combination in predicting retroperitoneal lymph node metastasis were compared. High-risk factors for common iliac lymph node (CILN) and/or para-aortic lymph node (PALN) metastasis were analyzed. Results The lymph node metastasis rate was 62.50% and the CILN and/or PALN metastasis rate was 31.25%. Overall, 96 patients had 172 visible lymph nodes. The positive rate of lymph node metastasis was significantly higher in the MAD ≥1.0 cm group (83.33%) than in the 0.5 cm ≤ MAD < 1.0 cm group (26.82%). The critical values of MAD and SCC-Ag in determining lymph node metastasis were 1.0 cm and 5.2 ng/mL, respectively. The accuracy, specificity, and Youden index of MAD ≥1.0 cm combined with SCC-Ag ≥ 5.2 ng/mL for evaluating lymph node metastasis were 75.71%, 100%, and 0.59, respectively, and were significantly different from the values for the MAD ≥1.0 cm (72.09%, 80.56%, and 0.47, respectively) and SCC-Ag ≥ 5.2 ng/mL (71.43%, 68.97%, and 0.42, respectively) groups. Correlation analysis showed that non-squamous cell carcinoma, pelvic lymph node (PLN) MAD ≥1.0 cm plus number ≥ 2, and 1 PLN MAD ≥1.0 cm with CILN and/or PALN MAD 0.5–1.0 cm were risk factors for CILN and/or PALN metastasis. Conclusion Patients with MAD ≥1.0 cm and SCC-Ag ≥ 5.2 ng/mL, as well as high risk factors for CILN and/or PALN metastasis, should undergo resection of enlarged lymph nodes below the common iliac gland and lymphadenectomy of CILN/PALN to reduce tumor burden and to clarify lymph node metastasis status for accurate guidance in follow-up treatment. Patients with MAD < 1.0 cm and SCC-Ag < 5.2 ng/mL may be treated with chemoradiotherapy directly based on imaging, given the low lymph node metastasis rate.
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Affiliation(s)
- Wei Li
- Department of Gynecology, Hunan Maternal and Child Health Hospital, Changsha, Hunan, China
| | - Li Xiong
- Department of Gynecology, Hunan Maternal and Child Health Hospital, Changsha, Hunan, China
| | - Qiaoling Zhu
- Department of Gynecology, Hunan Maternal and Child Health Hospital, Changsha, Hunan, China
| | - Hong Lu
- Department of Pathology, Hunan Maternal and Child Health Hospital, Changsha, Hunan, China
| | - Meiling Zhong
- Department of Oncology, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Meirong Liang
- Department of Oncology, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Wei Jiang
- Department of Oncology, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Yanan Wang
- Department of Oncology, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Wei Cheng
- Department of Gynecology, Hunan Maternal and Child Health Hospital, Changsha, Hunan, China.
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Gouy S, Seebacher V, Chargari C, Terroir M, Grimaldi S, Ilenko A, Maulard A, Genestie C, Leary A, Pautier P, Morice P, Deandreis D. False negative rate at 18F-FDG PET/CT in para-aortic lymphnode involvement in patients with locally advanced cervical cancer: impact of PET technology. BMC Cancer 2021; 21:135. [PMID: 33549033 PMCID: PMC7866875 DOI: 10.1186/s12885-021-07821-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background The identification of factors responsible for false negative (FN) rate at 18F- Fluorodeoxyglucose (FDG) Positron Emission Tomography /Computed Tomography (PET/CT) in para-aortic (PA) lymph nodes in the presurgical staging of patients with locally advanced cervical cancer (LACC) is challenging. The aim of this study was to evaluate the impact of PET/CT technology. Methods A total of 240 consecutive patients with LACC (International Federation of Gynecology and Obstetrics, FIGO, stage IB2-IVA) and negative Magnetic Resonance Imaging (MRI) and/or Computed Tomography (CT) and negative 18F-FDG PET/CT in the PA region, undergoing laparoscopic PA lymphadenectomy before chemoradiotherapy were included. The FN rate in patients studied with Time of flight (TOF) PET/CT (TOF PET) or non-Time of flight PET/CT (no-TOF PET) technology was retrospectively compared. Results Patients presented with FIGO stage IB (n = 78), stage IIA-B (n = 134), stage III (n = 18) and stage IVa (n = 10), squamous cell carcinoma (n = 191) and adenocarcinoma (n = 49). 141/240 patients were evaluated with no-TOF PET/CT and 99/240 with TOF PET/CT. Twenty-two patients (9%) had PA nodal involvement at histological analysis and considered PET/CT FN findings. The FN rate was 8.5% for no-TOF PET and 10% for TOF PET subgroup respectively (p = 0.98). Ninety patients (38%) presented with pelvic node uptakes at PET/CT. The FN rate in the PA region was 18% (16/90) and 4% (6/150) in patients with and without pelvic node involvement at PET/CT respectively (19 vs 3% for no-TOF PET and 17 vs 5% for TOF PET subgroup). Conclusions In LACC, FN rate in PA lymph nodes detection is a clinical issue even for modern PET/CT, especially in patients with pelvic uptake. Surgical lymphadenectomy should be performed in case of negative PET/CT at PA level in these patients, while it could be discussed in the absence of pelvic uptake.
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Affiliation(s)
- Sebastien Gouy
- Department of Gynecologic Surgery, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, Villejuif, France.,University Paris Sud, Orsay, France.,Unit INSERM 1030, 114 Rue Edouard Vaillant, Villejuif, France
| | - Veronika Seebacher
- Department of Gynecologic Surgery, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, Villejuif, France
| | - Cyrus Chargari
- University Paris Sud, Orsay, France.,Department of Radiotherapy and Brachytherapy Unit, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, Villejuif, France.,Effets biologiques des rayonnements, Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France
| | - Marie Terroir
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Serena Grimaldi
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Anna Ilenko
- Department of Gynecologic Surgery, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, Villejuif, France
| | - Amandine Maulard
- Department of Gynecologic Surgery, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, Villejuif, France
| | - Catherine Genestie
- Department of Pathology, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, Villejuif, France
| | - Alexandra Leary
- Department of Medical Oncology, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, Villejuif, France
| | - Patricia Pautier
- Department of Medical Oncology, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, Villejuif, France
| | - Philippe Morice
- Department of Gynecologic Surgery, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, Villejuif, France.,University Paris Sud, Orsay, France.,Unit INSERM 1030, 114 Rue Edouard Vaillant, Villejuif, France
| | - Désirée Deandreis
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, 94800, Villejuif, France. .,Department of Medical Sciences, Nuclear Medicine Division, the University of Turin, C.so Dogliotti, 14 10126, Turin, Italy.
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[Para-aortic lymph node staging in grade IB2 and above cervical cancers: Comparison of 18FDG PET-CT with para-aortic lymphadenectomy, using data from the Côte d'Or gynaecological cancer registry from 2003 to 2016]. ACTA ACUST UNITED AC 2021; 49:677-683. [PMID: 33484900 DOI: 10.1016/j.gofs.2021.01.013] [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: 09/02/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Current guidelines (ASCO, ESTRO, and ESGO) recommend para-aortic lymphadenectomy (PAL) for lymph node staging in patients with a negative initial PET-CT in locally advanced cervical cancer (LACC), with the aim to determine the radiation fields for radiochemotherapy. The main goal of this study was to compare overall survival (OS) in two groups, which differed according to the para-aortic lymph node staging technique used: imaging alone versus imaging and PAL. Secondary objectives were to determine recurrence-free survival (RFS), the proportion of false negatives on PET-CT, and surgery-related complications. METHODS We conducted a retrospective, observational study on data from the Côte d'Or gynaecological cancer registry collected from 2003 to 2016, and compared two groups of LACC with different techniques for staging para-aortic lymph nodes: PET-CT alone (iN group) (n=99) and PET-CT associated with PAL (pN group) (n=35) for a total of 134 patients. RESULTS OS (HR=1.04 (95% CI: 0.53-2.03); P=0.9) and RFS (HR=0.65 (95% CI: 0.29-1.45); P=0.29) were similar in both groups. There were 11.4% of false negatives in PET-CT, and 2.9% of patients who underwent PAL experienced complications. The staging method, iN or pN, had no impact on the time to the implementation of concomitant radiochemotherapy. CONCLUSION For lymph node staging in LACC, PAL after a PET-CT as compared with PET-CT staging alone, had no significant impact on OS or RFS.
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Marnitz S, Tsunoda AT, Martus P, Vieira M, Affonso Junior RJ, Nunes J, Budach V, Hertel H, Mustea A, Sehouli J, Scharf JP, Ulrich U, Ebert A, Piwonski I, Kohler C. Surgical versus clinical staging prior to primary chemoradiation in patients with cervical cancer FIGO stages IIB-IVA: oncologic results of a prospective randomized international multicenter (Uterus-11) intergroup study. Int J Gynecol Cancer 2020; 30:1855-1861. [PMID: 33293284 PMCID: PMC7788482 DOI: 10.1136/ijgc-2020-001973] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 12/26/2022] Open
Abstract
Objective Revised staging of patients with locally advanced cervical cancer is based on clinical examination, imaging, and potential surgical findings. A known limitation of imaging techniques is an appreciable rate of understaging. In contrast, surgical staging may provide more accurate information on lymph node involvement. The aim of this prospective study was to evaluate the impact of pre-treatment surgical staging, including removal of bulky lymph nodes, on disease-free survival in patients with locally advanced cervical cancer. Methods Uterus-11 was a prospective international multicenter study including patients with locally advanced cervical cancer who were randomized 1:1 to surgical staging (experimental arm) or clinical staging (control arm) followed by primary platinum-based chemoradiation. Patients with histologically proven squamous cell carcinoma, adenocarcinoma, or adenosquamous cancer International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IIB–IVA underwent gynecologic examination and pre-treatment imaging including abdominal computed tomography (CT) and/or abdominal magnetic resonance imaging (MRI). Patients had chest imaging (any of the following: X-ray, CT, or PET-CT). The primary endpoint was disease-free survival and the secondary endpoint was overall survival. An ad hoc analysis was performed after trial completion for cancer-specific survival. Randomization was conducted from February 2009 to August 2013. Results A total of 255 patients (surgical arm, n=130; clinical arm, n=125) with locally advanced cervical cancer were randomized. Of these, 240 patients were eligible for analysis. The two groups were comparable with respect to patient characteristics. The surgical approach was transperitoneal laparoscopy in most patients (96.6%). Laparoscopic staging led to upstaging in 39 of 120 (33%) patients. After a median follow-up of 90 months (range 1–123) in both arms, there was no difference in disease-free survival between the groups (p=0.084). For patients with FIGO stage IIB, surgical staging is superior to clinical staging with respect to disease-free survival (HR 0.51, 95% CI 0.30 to 0.86, p=0.011). In the post-hoc analysis, surgical staging was associated with better cancer-specific survival (HR 0.61, 95% CI 0.40 to 0.93, p=0.020). Conclusion Our study did not show a difference in disease-free survival between surgical and clinical staging in patients with locally advanced cervical cancer. There was a significant benefit in disease-free survival for patients with FIGO stage IIB and, in a post-hoc analysis, a cancer-specific survival benefit in favor of laparoscopic staging. The high risk of distant metastases in both arms emphasizes the need for further evaluation.
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Affiliation(s)
- Simone Marnitz
- Department of Radiooncology, Medical Faculty of the University of Cologne, Cologne, Germany
| | | | - Peter Martus
- Institute for Clinical Epidemiology and Biometry, Eberhard Karls University Tübingen Faculty of Medicine, Tubingen, Germany
| | - Marcelo Vieira
- Department for Gynecologic Oncology, Hospital de Amor de Barretos, Barretos, Brazil
| | | | - João Nunes
- Gynecologic Oncology Department, Hospital Erasto Gaertner, Curitiba, Brazil.,Gynecologic Oncology Department, Instituto de Oncologia do Paraná, Curitiba, Brazil
| | - Volker Budach
- Department of Radiooncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Hermann Hertel
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Alexander Mustea
- Department of Gynecology and Gynecologic Oncology, University of Bonn, Bonn, Germany
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jens-Peter Scharf
- Department of Gynecology and Obstetrics, Sana-Clinics Berlin Lichtenberg, Berlin, Germany
| | - Uwe Ulrich
- Department of Gynecology and Obstetrics, Martin-Luther-Hospital Berlin, Berlin, Germany
| | - Andreas Ebert
- Outpatient Clinics for Women's Health, Berlin, Germany
| | - Iris Piwonski
- Institute of Pathology, Charite Medical Faculty Berlin, Berlin, Germany
| | - Christhardt Kohler
- Department of Gynecology, University of Cologne, Koln, Germany.,Department of Special Operative and Oncologic Gynecology, Asklepios-Clinic Hamburg-Altona, Asklepios Hospital Group, Hamburg, Germany
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Delara R, Yang J, Buckner-Petty S, Magtibay P, Butler K. Surgical or imaging lymph node assessment in locally advanced cervical cancer: a systematic review and meta-analysis. J Gynecol Oncol 2020; 31:e79. [PMID: 33078589 PMCID: PMC7593228 DOI: 10.3802/jgo.2020.31.e79] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/28/2020] [Accepted: 06/07/2020] [Indexed: 12/24/2022] Open
Abstract
Objective To evaluate the survival impact of imaging vs surgical nodal assessment in patients with cervical cancer stage IB2–IVA prior to definitive chemoradiotherapy (CRT). Methods PubMed, MEDLINE, Cochrane Library, and ClinicalTrials.gov were used to search for publications in English and Chinese over a 50-year period. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols was used to conduct this review. Inclusion criteria were studies that compared survival outcomes in International Federation of Gynecology and Obstetrics 2009 stage IB2–IVA cervical cancer patients with pre-therapy pelvic and/or aortic lymphadenectomy (LND) or imaging. One or more of the following modalities were used for nodal assessment: computed tomography (CT), magnetic resonance imaging, or positron emission tomography-CT. The National Institutes of Health Quality Assessment Tool was utilized to assess study quality. Results The initial search identified 65 studies, and five met the inclusion criteria. There were a total of 1,112 patients. Seven hundred and fifty-four underwent pelvic and/or aortic LND and 358 had imaging. When compared to LND, imaging had a sensitivity and specificity of 88.9% and 22.2% for pelvic lymph node (LN), and 33%–62.5% and 92%–95.5% for para-aortic LN. There were no differences in progression-free survival (PFS) (hazard ratio [HR]=1.13; 95% confidence interval [CI]=0.73–1.74; I2=75%; p<0.01) and overall survival (OS) (HR=1.06; 95% CI=0.66–1.69; I2=75%; p<0.01) between surgical and imaging nodal assessment. Conclusions Imaging and surgical nodal assessment has comparable PFS and OS in patients with cervical cancer stage IB2–IVA. Trial Registration PROSPERO Identifier: CRD42020155486
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Affiliation(s)
- Ritchie Delara
- Department of Gynecologic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Jie Yang
- Department of Gynecologic Surgery, Mayo Clinic, Phoenix, AZ, USA.,Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Skye Buckner-Petty
- Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic, Phoenix, AZ, USA
| | - Paul Magtibay
- Department of Gynecologic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Kristina Butler
- Department of Gynecologic Surgery, Mayo Clinic, Phoenix, AZ, USA.
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11
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Martinez A, Angeles MA, Querleu D, Ferron G, Pomel C. How should we stage and tailor treatment strategy in locally advanced cervical cancer? Imaging versus para-aortic surgical staging. Int J Gynecol Cancer 2020; 30:1434-1443. [PMID: 32788263 DOI: 10.1136/ijgc-2020-001351] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 12/24/2022] Open
Abstract
Para-aortic lymph node status at initial assessment is the most important prognostic factor and a key point for the therapeutic strategy in patients with locally advanced cervical cancer. Undiagnosed lymph node metastasis is a major clinical problem as the finding of positive para-aortic lymph nodes leads to treatment modification, with a possible impact on disease free survival. When aortic lymph node disease is discovered, radiotherapy is extended to the para-aortic area, and other treatment modalities may be considered. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) is the most accurate imaging examination to assess para-aortic extension in patients with locally advanced cervical cancer. The gold standard to identify para-aortic extension remains histologic evaluation of the lymph nodes. Indeed, PET/CT fails to detect approximately 10-15% of patients with negative PET/CT aortic nodes who have lymph node metastasis on pathologic staging. Patients with positive pelvic lymph nodes have para-aortic extension in 25-30% of cases, and surgical staging will lead to treatment modification and probably to improved para-aortic and distant control. Surgical staging also avoids unnecessary toxicity associated with extended field radiation in approximately 75% of patients with pelvic lymph node metastasis. The best modality to identify para-aortic extension is histological evaluation of the lymph nodes, but the survival benefit of surgical staging remains controversial. On the other hand, current studies include a majority of patients without pelvic lymph node spread, who are likely to be those who will benefit the least from surgical staging.
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Affiliation(s)
- Alejandra Martinez
- INSERM CRCT Team 1, Tumor Immunology and Immunotherapy, Toulouse, France .,Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole - Institut Claudius Regaud, Toulouse, France
| | - Martina Aida Angeles
- Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole - Institut Claudius Regaud, Toulouse, France
| | - Denis Querleu
- Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
| | - Gwenael Ferron
- Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole - Institut Claudius Regaud, Toulouse, France.,INSERM CRCT Team 19, ONCOSARC - Oncogenesis of sarcomas, Toulouse, France
| | - Christophe Pomel
- Department of Surgical Oncology, Institut Jean Perrin, Clermont-Ferrand, France
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12
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Added value of para-aortic surgical staging compared to 18F-FDG PET/CT on the external beam radiation field for patients with locally advanced cervical cancer: An ONCO-GF study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:883-887. [DOI: 10.1016/j.ejso.2019.11.496] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/31/2019] [Accepted: 11/10/2019] [Indexed: 11/20/2022]
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13
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Díaz-Feijoo B, Torné A, Tejerizo Á, Benito V, Hernández A, Ruiz R, Domingo S, Luna-Guibourg R, Llueca A, Coronado P, Gilabert-Estelles J, Bebia V, Gil-Ibáñez B, Gil-Moreno A. Prognostic Value and Therapeutic Implication of Laparoscopic Extraperitoneal Paraaortic Staging in Locally Advanced Cervical Cancer: A Spanish Multicenter Study. Ann Surg Oncol 2020; 27:2829-2839. [PMID: 32152774 DOI: 10.1245/s10434-020-08329-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE To assess the impact of laparoscopic extraperitoneal paraaortic staging in therapeutic planning and prognosis of patients with locally advanced cervical cancer (LACC) as compared with imaging staging. METHODS Retrospective multicenter study of stage IB2 and IIA2 to IVA (FIGO 2009) LACC patients who were candidates for primary chemoradiotherapy. The study (surgical) group included 634 patients undergoing laparoscopic/robotic extraperitoneal paraaortic staging treated with extended-field radiotherapy (EFRT) if lymph node involvement was confirmed. The control (imaging) group included 288 patients treated with EFRT when lymph node involvement was suspected on positron emission tomography-computed tomography scans and/or magnetic resonance imaging. RESULTS In the study group, a median of 13 (range 9-17) lymph nodes were removed, with a rate of positive paraaortic nodes of 18%, with metastatic size ≤ 5 mm in 20.4% of cases. Paraaortic EFRT was administered to 18% of patients in the study group and in 58% of controls. In 34% of patients from the surgical group, EFRT was modified according to surgical findings with respect to imaging staging. The median follow-up in the study and control groups was 3.7 and 4.8 years, respectively. In both groups, the overall survival and cancer-specific disease-free survival were similar. The time interval between diagnosis and starting EFRT was 18 days longer in the study group, without differences in overall survival as compared with controls (hazard ratio 1.00, 95% confidence interval 0.998-1.005; p = 0.307). CONCLUSIONS Laparoscopic extraperitoneal paraaortic staging in LACC patients is safe and modified therapeutic planning, allowing better selection of candidates for EFRT.
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Affiliation(s)
- Berta Díaz-Feijoo
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
| | - Aureli Torné
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Álvaro Tejerizo
- Department of Obstetrics and Gynecology, Hospital Universitario, Madrid, Spain
| | - Virginia Benito
- Department of Gynecologic Oncology, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Alicia Hernández
- Department of Gynecology, Hospital Universitario La Paz, Madrid, Spain
| | - Rubén Ruiz
- Service of Gynecology and Obstetrics, Hospital Universitario Donostia, Donostia-San Sebastián, Spain
| | - Santiago Domingo
- Department of Gynecology Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Rocío Luna-Guibourg
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Llueca
- Department of Obstetrics and Gynecology, Hospital General Universitari de Castelló, Castelló de la Plana, Spain
| | - Pluvio Coronado
- Women's Health Institute, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Juan Gilabert-Estelles
- Department of Obstetrics and Gynecology, Hospital General Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Vicente Bebia
- Gynecological Oncology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Blanca Gil-Ibáñez
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Antonio Gil-Moreno
- Gynecological Oncology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer, CIBERONC, Madrid, Spain
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14
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Martinez A, Voglimacci M, Lusque A, Ducassou A, Gladieff L, Dupuis N, Angeles MA, Martinez C, Tanguy Le Gac Y, Chantalat E, Hitzel A, Courbon F, Ferron G, Gabiache E. Tumour and pelvic lymph node metabolic activity on FDG-PET/CT to stratify patients for para-aortic surgical staging in locally advanced cervical cancer. Eur J Nucl Med Mol Imaging 2020; 47:1252-1260. [PMID: 31915897 DOI: 10.1007/s00259-019-04659-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of our study was to comprehensively evaluate the most valuable metabolic parameters of cervical tumours and pelvic lymph nodes (PLN) by FDG-PET/CT to predict para-aortic lymph node (PALN) metastasis and stratify patients for surgical staging. METHODS The study included patients with locally advanced cervical cancer, negative PALN uptake on preoperative FDG-PET/CT, and para-aortic lymphadenectomy. Two senior nuclear medicine physicians expert in gynaecologic oncology reviewed all PET/CT exams, and extracted tumour SUVmax, MTV, and TLG, as well as PLN. Prognostic parameters of PALN involvement were identified using ROC curves and logistic regression analysis. RESULTS One hundred and twenty-five consecutive locally advanced cervical cancer patients were included. The FDG-PET/CT false-negative rate was, respectively, 27.7% (13/47) and 5.1% (4/78) in patients with and without FDG-PET/CT PLN uptake. The AUC of cervical tumour size, SUVmax, MTV, and TLG was, respectively, 0.75 (0.62-0.87), 0.59 (0.44-0.76), 0.75 (0.60-0.90), and 0.71 (0.56-0.86). The AUC of PLN size, SUVmax, SUVmean, PLN SUVmax/Tumour SUVmax ratio, MTV, and TLG was, respectively, 0.57 (0.37-0.78), 0.82 (0.68-0.95), 0.77 (0.61-0.94), 0.85 (0.72-0.98), 0.69 (0.51-0.87), and 0.74 (0.57-0.91). The metabolic parameter showing the best trade-off between sensitivity and specificity to predict PALN involvement was the ratio between PLN and tumour SUVmax. CONCLUSION The risk of PALN metastasis in FDG-PET/CT negative PLN patients is very low, so para-aortic lymphadenectomy does not seem justified. In patients with preoperative PLN uptake on FDG-PET/CT, surgical staging led to treatment modification in more than 25% of cases and should therefore be performed. Patients with more than one positive PLN and high PLN metabolic activity are at high risk of para-aortic extension and recurrence. Further prospective evaluation is required to consider intensified treatment modalities without prior PALN dissection.
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Affiliation(s)
- A Martinez
- Surgical Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer -Toulouse Oncopole, Toulouse, France.
- Cancer Research Center of Toulouse (CRCT), INSERM UMR, 1037, Toulouse, France.
| | - M Voglimacci
- Surgical Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer -Toulouse Oncopole, Toulouse, France
| | - A Lusque
- Biostatistics Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - A Ducassou
- Radiotherapy Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - L Gladieff
- Medical Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - N Dupuis
- Surgical Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer -Toulouse Oncopole, Toulouse, France
| | - M A Angeles
- Surgical Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer -Toulouse Oncopole, Toulouse, France
| | - C Martinez
- Surgical Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer -Toulouse Oncopole, Toulouse, France
- Cancer Research Center of Toulouse (CRCT), INSERM UMR, 1037, Toulouse, France
| | - Y Tanguy Le Gac
- Gynecology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - E Chantalat
- Gynecology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - A Hitzel
- Nuclear Medicine Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - F Courbon
- Nuclear Medicine Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - G Ferron
- Surgical Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer -Toulouse Oncopole, Toulouse, France
- Cancer Research Center of Toulouse (CRCT), INSERM UMR, 1037, Toulouse, France
| | - E Gabiache
- Nuclear Medicine Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
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15
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Comparing survival outcomes between surgical and radiographic lymph node assessment in locally advanced cervical cancer: A propensity score-matched analysis. Gynecol Oncol 2019; 156:320-327. [PMID: 31843274 DOI: 10.1016/j.ygyno.2019.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/06/2019] [Accepted: 12/07/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate progression-free survival (PFS) and overall survival (OS) between women who underwent surgical versus radiographic assessment of pelvic lymph nodes (PLN) and para-aortic lymph nodes (PALN) prior to chemoradiation therapy for cervical cancer. METHODS In this retrospective cohort analysis, patients with stage IB2 - IIIB squamous cell, adenocarcinoma and adenosquamous carcinoma of the cervix who completed concurrent chemoradiation therapy (CCRT) between 2000 and 2017 from the Mayo Clinic Cancer Registry were identified. A 1:2 propensity score matching between surgical and imaging groups was performed and PFS and OS were compared between groups. RESULTS 148 patients were identified and after propensity score matching, 35 from the surgical group and 70 from the imaging group were included in the analysis. There were no statistical differences in baseline characteristics between the 2 groups. The median follow-up time was 41 months (range 7-218) for the surgical group and 51.5 months (range 7-198) for the imaging group. Five-year PFS was 62.6% for the surgical group and 72.4% in imaging group (HR 1.11, 95% CI 0.54-2.30, p = 0.77). Five-year OS was 70.2% for the surgical group and 70.5% for the imaging group (HR 1.02, 95% CI 0.46-2.29, p = 0.96). FIGO stage, PALN metastasis, and parametrial involvement were found to be poor prognosticators for PFS and OS in univariate analysis. Only PALN metastasis significantly predicted unfavorable PFS (HR 2.76, 95% CI 1.23-6.18, p = 0.01) and OS (HR 3.46, 95% CI 1.40-8.55, p = 0.01) in multivariate analysis. There were no differences in locoregional recurrence and distant metastasis between the two groups (p = 0.33 and 0.59 respectively). CONCLUSION Patients with cervical cancer who underwent radiographic assessment of PLN and PALN had comparable survival outcomes to surgical assessment.
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Mezquita G, Muruzabal JC, Perez B, Aguirre S, Villafranca E, Jurado M. Para-aortic plus pelvic lymphadenectomy in locally advanced cervical cancer: A single institutional experience. Eur J Obstet Gynecol Reprod Biol 2019; 236:79-83. [PMID: 30889424 DOI: 10.1016/j.ejogrb.2019.02.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 02/08/2019] [Accepted: 02/22/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study is to assess the safety and efficacy of transperitoneal laparoscopic para-aortic and pelvic lymphadenectomy in the setting of surgical staging of patients with locally advanced cervical cancer (LACC), and to analyse the prognostic value and impact of this staging on the survival prognosis of this condition. STUDY DESIGN Data from 67 patients with LACC who underwent transperitoneal laparoscopic para-aortic and pelvic lymphadenectomy and who received chemo-radiation therapy were retrospectively analysed. RESULTS Metastatic lymph nodes (LN) were identified in 32 patients (47.7%), 20 (29.8%) had metastatic LN in the pelvic area and 12 (17.9%) had metastatic LN in the pelvic and para-aortic area. There were no skip metastases in the para-aortic area. After a median follow-up of 54.6 months (5-122.2 months), the 5-year local control and disease-free survival (DFS) rates for the whole group were 91.1% and 60.5% respectively. The five-year DFS for patients without LN metastasis was 86.4%, while for patients with pelvic LN metastases or pelvic and para-aortic metastases was 34.2% and 24.2% respectively (p < 0.001). The five-year overall survival (OS) for the whole group was 67.3%. The mortality rate in patients with para-aortic nodal metastases was increased compared to patients with negative nodes (5-year OS 21.3% vs 81.6% respectively, p = 0.005), but the OS rate was similar in patients with negative nodes and those with only pelvic nodes affected (5-year OS 81.6% vs 70.8% respectively, p = 0.380). This approach allowed the modification of the initial treatment plan in the para-aortic area in 13.4% of patients and in the pelvic area in 28.3%. The overall intraoperative morbidity rate was 5.9%, while the postoperative morbidity rate was 10.4%, with only 3 patients presenting grade 3 morbidity. CONCLUSIONS Transperitoneal para-aortic and pelvic lymphadenectomy provides precise information about nodal state and allows personalized treatment planning in patients with LACC, avoiding false negative (FN) and false positive (FP) imaging results. In 17.9% of patients, the external beam radiotherapy (EBRT) field had to include the aortic area, whilst 47.7% received pelvic boost to the involved nodes.
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Affiliation(s)
- Gonzalo Mezquita
- Gynecologic Oncology, Department of Complejo Hospitalario de Navarra, Pamplona, Spain; Obstetrics and Gynaecology, Department of Royal Free Hospital NHS Foundation Trust, London, UK.
| | - Juan Carlos Muruzabal
- Gynecologic Oncology, Department of Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Beatriz Perez
- Gynecologic Oncology, Department of Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Sara Aguirre
- Gynecologic Oncology, Department of Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Elena Villafranca
- Radiation Oncology, Department of Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Matias Jurado
- Gynecologic Oncology, Department of Clínica Universidad de Navarra, Pamplona, Spain
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Poitevin Chacón A, Chavez-Nogueda J, Ramos-Prudencio R, Villavicencio-Queijeiro MA, Lozano-Ruiz F. The role of para-aortic nodal irradiation in cervical cancer. Rep Pract Oncol Radiother 2018; 23:540-546. [PMID: 30534018 DOI: 10.1016/j.rpor.2018.09.009] [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: 01/29/2018] [Revised: 08/13/2018] [Accepted: 09/15/2018] [Indexed: 12/20/2022] Open
Abstract
The current standard of care for locally advanced cervical cancer is whole pelvis and para-aortic radiation when indicated, delivered concomitantly with chemotherapy and brachytherapy. Para-aortic node involvement is a predictor of survival in locally advanced disease but presence of metastases is difficult to determine because the currently available imaging methods lack enough sensitivity to be able to detect accurately para-aortic metastases when surgical staging is not feasible. The objective of this review is to describe the current status of para-aortic lymph node irradiation in locally advanced cervical cancer. It includes analysis of the diagnostic imaging and surgical approaches for assessment of para-aortic lymph node dissemination, together with indications for radiotherapy and radiotherapeutic techniques.
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18
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Comparison of pelvic and para-aortic lymphadenectomy versus para-aortic lymphadenectomy alone for locally advanced FIGO stage IB2 to IIB cervical cancer using a propensity score matching analysis: Results from the FRANCOGYN study group. Eur J Surg Oncol 2018; 44:1921-1928. [DOI: 10.1016/j.ejso.2018.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/12/2018] [Accepted: 08/22/2018] [Indexed: 11/23/2022] Open
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Dabi Y, Simon V, Carcopino X, Bendifallah S, Ouldamer L, Lavoue V, Canlorbe G, Raimond E, Coutant C, Graesslin O, Collinet P, Bricou A, Daraï E, Huchon C, Ballester M, Haddad B, Touboul C. Therapeutic value of surgical paraaortic staging in locally advanced cervical cancer: a multicenter cohort analysis from the FRANCOGYN study group. J Transl Med 2018; 16:326. [PMID: 30477530 PMCID: PMC6260775 DOI: 10.1186/s12967-018-1703-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/20/2018] [Indexed: 12/15/2022] Open
Abstract
Background The prognostic impact of surgical paraaortic staging remains unclear in patients with locally advanced cervical cancer (LACC). The objective of our study was to evaluate the survival impact of surgical staging in patients with LACC and no evidence of paraaortic lymph node (PALN) metastasis on pre-operative imaging work-up. Methods Data of 1447 patients with cervical cancer treated between 1996 and 2016 were extracted from maintained databases of 10 French University hospitals. Patients with locally advanced disease (IB2 or more) treated by concurrent chemoradiation therapy (CRT) and no evidence of paraaortic metastasis on pre-operative imaging work-up were selected for further analysis. The Kaplan–Meier method was used to estimate the survival distribution. A Cox proportional hazards model was used to account for the influence of multiple variables. Results Six hundred and forty-seven patients were included, 377 (58.3%) with surgical staging and 270 (41.7%) without, with a mean follow up of 38.1 months (QI 13.0–56.0). Pathologic analysis revealed positive lymph nodes in 47 patients (12.5%). In multivariate model analysis, surgical staging remained an independent prognostic factor for DFS (OR 0.64, CI 95% 0.46–0.89, p = 0.008) and OS (OR 0.43, CI 95% 0.27–0.68, p < 0.001). The other significant parameter in multivariate analysis for both DFS and OS was treatment by intracavitary brachytherapy (OR respectively of 0.7 (0.5–1.0) and 0.6 (0.4–0.9), p < 0.05). Conclusion Nodal surgical staging had an independent positive impact on survival in patients with LACC treated with CRT with no evidence of metastatic PALN on imaging. Electronic supplementary material The online version of this article (10.1186/s12967-018-1703-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yohann Dabi
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Faculté de médecine de Créteil UPEC - Paris XII, 40 Avenue de Verdun, 94000, Créteil, France
| | - Vanille Simon
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Faculté de médecine de Créteil UPEC - Paris XII, 40 Avenue de Verdun, 94000, Créteil, France
| | - Xavier Carcopino
- Department of Obstetrics and Gynecology, Hopital Nord, APHM, Marseilles, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), University Pierre and Marie Curie, Paris 6, France
| | - Lobna Ouldamer
- Department of Obstetrics and Gynaecology, Centre hospitalier régional universitaire de Tours, hôpital Bretonneau, Tours, France
| | - Vincent Lavoue
- Service de Gynécologie, CRLCC Eugène-Marquis, CHU de Rennes, Université de Rennes 1, Rennes, France
| | - Geoffroy Canlorbe
- Department of Gynaecology and Obstetrics, Pitié Salpetrière University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), University Pierre and Marie Curie, Paris 6, France
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Charles Coutant
- Centre de lutte contre le cancer Georges François Leclerc, Dijon, France
| | - Olivier Graesslin
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Pierre Collinet
- Department of Obstetrics and Gynecology, Centre Hospitalier Régional Universitaire, Lille, France
| | - Alexandre Bricou
- Department of Obstetrics and Gynecology, Assistance Publique des Hôpitaux de Paris (AP-HP), Jean-Verdier University Hospital, Bondy, France
| | - Emile Daraï
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), University Pierre and Marie Curie, Paris 6, France
| | - Cyrille Huchon
- Department of Gynaecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, 78103, Poissy, France
| | - Marcos Ballester
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), University Pierre and Marie Curie, Paris 6, France
| | - Bassam Haddad
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Faculté de médecine de Créteil UPEC - Paris XII, 40 Avenue de Verdun, 94000, Créteil, France
| | - Cyril Touboul
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Faculté de médecine de Créteil UPEC - Paris XII, 40 Avenue de Verdun, 94000, Créteil, France.
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Angeles MA, Martínez-Gómez C, Migliorelli F, Voglimacci M, Figurelli J, Motton S, Tanguy Le Gac Y, Ferron G, Martinez A. Novel Surgical Strategies in the Treatment of Gynecological Malignancies. Curr Treat Options Oncol 2018; 19:73. [DOI: 10.1007/s11864-018-0582-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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