Simultaneous Modulated Accelerated Radiotherapy in Cervical Cancer With Retroperitoneal Lymph Node Metastasis After Radical Hysterectomy and Pelvic Lymphadenectomy

2015 ◽  
Vol 25 (5) ◽  
pp. 903-909 ◽  
Author(s):  
Xing-lan Li ◽  
Zhen-yun Chen ◽  
Yong-chun Cui ◽  
Xui-gui Sheng
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Radical Hysterectomy ◽  
Pelvic Lymphadenectomy ◽  
Retroperitoneal Lymph Node ◽  
Accelerated Radiotherapy ◽  
Node Metastasis

scholarly journals Radioactive 125I Seed Implantation for Recurrent Cervical Carcinoma After Surgery and Radiotherapy: A Case Report

2021 ◽  
Author(s):  
Shiqi Qiao ◽  
Hongtao Zhang ◽  
Xuemin Di ◽  
JinXin Zhao ◽  
Juan Wang
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Radical Hysterectomy ◽  
125I Seed ◽  
Retroperitoneal Lymph Node ◽  
Recurrent Cervical Cancer ◽  
Seed Implantation ◽  
Node Metastasis ◽  
125I Seed Implantation

Abstract Background: The prognosis of cervical cancer is remarkable, but there are still instances of pelvic and/or extrapelvic recurrence after radical hysterectomy with platinum-based chemoradiotherapy. Sixty percent of the patients with radiotherapy (RT) failure have pelvic recurrence, and 80% of them relapse within two years after treatment. Recurrent cervical cancer seriously affects the prognosis and survival rate of patients. Due to the dose limitation for normal tissue, it is difficult to deliver a sufficient number of doses to recurrent lesions through reirradiation. With the rapid development of brachytherapy technologies such as three-dimensional afterloading brachytherapy, interstitial brachytherapy and radioactive 125I seed implantation, the overall survival (OS) of patients with recurrent cervical cancer has been improving. In the present study, a case in which the patient was successfully treated with radioactive 125I seed implantation is reported.Case presentation: The patient, a 47-year-old woman, was initially diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IB cervical cancer and received preoperative radiotherapy, radical hysterectomy, pelvic lymph node dissection and postoperative radiotherapy. After 95 months of follow-up, retroperitoneal lymph node metastasis and edema of the left lower limb . The size of the retroperitoneal lesion was 2.3 × 2.0 cm, and the size of the left supraclavicle lesion was 2.0 × 1.5 cm. Radioactive 125I seed implantation was performed for retroperitoneal lymph node metastasis and left supraclavicular metastasis. Paclitaxel and cisplatin chemotherapy were given after the operation. Three months after implantation, the size of the retroperitoneal focus was 1.5 × 1.1 cm, and the size of the left supraclavicular lesion was 1.0 × 0.6 cm. Thirteen months after implantation, according to the RECIST standard, the therapeutic effect reached CR. At the time of submission, the patient's progression-free survival was 6 years and 4 months.Conclusions: CT-guided 125I seed implantation is a safe, effective, and minimally invasive method for treating patients with recurrent cervical cancer after radiotherapy. The response of this patient indicates that 125I seed implantation can be used as a complementary treatment for recurrent cervical cancer after chemoradiotherapy and may also prove to be reliable for comprehensive treatment of cervical cancer.

scholarly journals The Proportion of Lymph Node Metastasis in Patients with Stage IIA1 and IIA2 Cervical Cancer who were Treated for Radical Hysterectomy and Pelvic Lymphadenectomy

2019 ◽  
pp. 65
Author(s):  
Andrijono Andrijono ◽  
Wahyu Ginealdy
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Radical Hysterectomy ◽  
Cross Sectional Study ◽  
Pelvic Lymphadenectomy ◽  
Cervical Cancer Patient ◽  
Cancer Stage ◽  
Cross Sectional ◽  
Node Metastasis

Objective: This study was designed to determine a difference in prognosis of stage IIA1 cervical cancer compared to stage IIA2 based on the incidence of metastasis to pelvic lymph nodes by radical hysterectomy. Methods:A cross sectional study was conducted among 108 stage II cervical cancer patient post radical hysterectomy in obstetric gynecologic department of Dr. CiptoMangunkusumo hospital since 2006-2016. Results: From 108 patients with cervical cancer stage IIA, 80 (74%) patients are stage IIA1 and the remaining the remaining 28 (26%) patients are stage IIA2. The average age of patients at stage IIA2 (47.79 years) younger than IIA1 (55.85 years) and also patient at stage IIA1 having a higher parity number which is 4 compare to stage IIA2 with the number of parity 2. The Involvement of lymph node metastasis in patients with stage IIA1 and IIA2 cervical cancer were 51 (63.75%) and 16 (57.14%) respectively. Conclusion: Metastatic factor to lymphnode in both stage have the same result. There was no difference in the proportion of lymph node metastasis occurring in both stage IIA cervical cancer stage which was corrected with radical hysterectomy and pelvic lymphadenectomy with p = 0,535. Changing staging does not seem to improve the prognosis. Keywords: cervical cancer, stage IIA, lymphnode metastatic   Tujuan:Membuktikan adanya perbedaan prognosis kanker servik stadium IIa1 dibanding stadium IIa2 berdasarkan kejadian metastasis ke kelenjar getah bening pelvik yang dilakukan histerektomi radikal. Metode: Dengan menggunakan metode potong lintang dilakukan pengambilan data  108 sampel pasien kanker serviks stadium IIA yang dilakukanpembedahanhisterektomiradikal di Departemen OnkologiGinekologi RSUP. Dr. Cipto Mangunkusumo Jakarta sejak tahun 2006 hingga tahun 2016. Hasil: Pasien kanker serviks stadium IIA1 sebanyak 80 (74%) pasien dan stadium IIA2 sebanyak 28 (26 %) pasien. Pada stadium IIA2 (47.79 tahun) didapatkan rata ratausiapasienlebihmudadibandingkan IIA1 (55.85 tahun). Pada stadium IIA1 jugadidapatkanjumlahparitas yang lebihtinggiyaitu 4 sedangkanpada stadium IIA2 denganjumlahparitas 2. Keterlibatan metastasis kelenjar getah bening pada pasien kanker serviks stadium IIA1 dan IIA2 berjumlah 51 (63.75%) dan 16 (57.14%) secara berurutan. Tidak terdapat perbedaan proporsi kejadian metastasis kelenjar getah bening pada kedua kelompok stadium kanker serviks pada stadium IIA dengan nilai p = 0,535. Kesimpulan: Faktor metastasis kelenjar getah bening pada kedua stadium memiliki hasil yang serupa.Tidak terdapat perbedaan proporsi kejadian metastasis kelenjar getah bening pada kedua kelompok stadium kanker serviks stadium IIA1 dan IIA2 yang ditatalaksna dengan histerektomi radikal dan limfadenektomi pelvis. Perubahan penetapan stadium sepertinya tidak memperbaiki prognosis. Kata kunci : Kanker serviks, stage IIA, kelenjar getah bening, faktor prognostik

Prospective Study of Sentinel Lymph Node Biopsy Without Further Pelvic Lymphadenectomy in Patients With Sentinel Lymph Node–Negative Cervical Cancer

2012 ◽  
Vol 22 (7) ◽  
pp. 1244-1250 ◽  
Author(s):  
Hitoshi Niikura ◽  
Satoshi Okamoto ◽  
Takeo Otsuki ◽  
Kosuke Yoshinaga ◽  
Hiroki Utsunomiya ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Node Metastasis ◽  
Lower Extremity ◽  
Radical Hysterectomy ◽  
Pelvic Lymphadenectomy ◽  
Node Metastasis ◽  
Gynecology And Obstetrics ◽  
Number Of Patients

ObjectiveThe aim of the present study was to evaluate the incidence of lymphedema and cancer recurrence rate in patients with cervical cancer who undergo sentinel lymph node (SLN) biopsy alone in the absence of SLN metastases.Patients and MethodsThe study included 35 consecutive patients with cervical cancer scheduled for radical hysterectomy at Tohoku University Hospital between May 2006 and July 2009. All patients had International Federation of Gynecology and Obstetrics stages IA1 to IIA1 disease. Patients in whom SLNs were detected unilaterally or not detected and/or whose lymph nodes were diagnosed intraoperatively as positive metastasis underwent systemic pelvic lymphadenectomy. Patients who were found negative for SLN metastasis did not undergo further pelvic lymphadenectomy.ResultsThe mean number of detected SLNs was 4.1 (range, 1–11). True lymph node metastasis could be detected in 11 (31%) of the 35 cases. Intraoperative frozen section identified correctly in 8 of 11 metastatic patients. Twenty-three patients underwent SLN biopsy alone without systematic pelvic lymphadenectomy. None of the 23 patients diagnosed with negative SLNs have experienced a lymph node recurrence in the pelvic cavity. New symptomatic lower extremity lymphedema was identified in 2 (8.7%) of the 23 patients who underwent SLN biopsy alone and in 5 (42%) of 12 patients who underwent systematic lymphadenectomy.ConclusionRadical hysterectomy with SLN biopsy alone seems to be a safe and effective strategy for detection of lymph node metastasis and for reducing the number of patients with lower extremity lymphedema, but a more convenient and sensitive procedure for intraoperative diagnosis needs to be established.

Preoperative Neutrophil-Lymphocyte Ratio Before Platelet-Lymphocyte Ratio Predicts Clinical Outcome in Patients With Cervical Cancer Treated With Initial Radical Surgery

2014 ◽  
Vol 24 (7) ◽  
pp. 1319-1325 ◽  
Author(s):  
Yu Zhang ◽  
Le Wang ◽  
Yunduo Liu ◽  
Shuxiang Wang ◽  
Pan Shang ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Confidence Interval ◽  
Radical Hysterectomy ◽  
Pelvic Lymphadenectomy ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Node Metastasis ◽  
Platelet Lymphocyte Ratio

ObjectiveSeveral inflammatory parameters are applied to predict the survival of patients with various cancers. Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are 2 nonspecific markers of systemic inflammation. This study aimed to evaluate the clinicopathologic and prognostic values of NLR and PLR in patients with cervical cancer undergoing primary radical hysterectomy with pelvic lymphadenectomy.MethodsA total of 460 cervical cancer patients were enrolled in this study. These patients were histologically confirmed with cervical cancer from February 2005 to June 2008, at the Department of Gynecology, the Third Affiliated Hospital of Harbin Medical University, China. Their clinical and histopathological markers and complete blood counts were collected and analyzed. Prognostic factors were assessed by univariate and multivariate analyses.ResultsThe median NLR and PLR were 2.213 and 150.9, respectively. The clinicopathologic analysis showed that NLR was highly associated with depth of stromal infiltration (P = 0.007) and lymph node metastasis (P = 0.003), and PLR was significantly related to tumor size (P = 0.020) and lymph node metastasis (P = 0.027).Univariate analysis identified high NLR as a statistically significant poor predictive factor for the progression-free survival (PFS) (P = 0.008) and overall survival (OS) (P = 0.014), and PLR exhibited no significance on PFS (P = 0.075) and OS (P = 0.110).Multivariable analysis showed that the NLR was an independent prognostic marker for PFS (hazard ratio, 1.799; 95% confidence interval, 1.069–3.028; P = 0.027), but not for OS (hazard ratio, 1.631; 95% confidence interval, 0.968–2.750; P = 0.066).ConclusionsPreoperative NLR and PLR were found to be correlated to unfavorable histopathologic features of cervical cancer. The preoperative NLR, but not PLR, may be used as a potential and easy biomarker for survival prognosis in patients with cervical cancer receiving initial radical hysterectomy with pelvic lymphadenectomy.

scholarly journals Comparison of Postoperative Adjuvant Chemotherapy and Concurrent Chemoradiotherapy for FIGO2018 Stage IIIC1 Cervical Cancer: A Retrospective Study

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 548
Author(s):  
Masahiro Kagabu ◽  
Takayuki Nagasawa ◽  
Shunsuke Tatsuki ◽  
Yasuko Fukagawa ◽  
Hidetoshi Tomabechi ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Lymph Node Metastasis ◽  
Radical Hysterectomy ◽  
Concurrent Chemoradiotherapy ◽  
Postoperative Adjuvant Chemotherapy ◽  
Node Metastasis ◽  
Significant Difference ◽  
Advanced Stages

Background and Objectives: In October 2018, the International Federation of Gynecology and Obstetrics (FIGO) revised its classification of advanced stages of cervical cancer. The main points of the classification are as follows: stage IIIC is newly established; pelvic lymph node metastasis is stage IIIC1; and para-aortic lymph node metastasis is stage IIIC2. Currently, in Japan, radical hysterectomy is performed in advanced stages IA2 to IIB of FIGO2014, and concurrent chemoradiotherapy (CCRT) is recommended for patients with positive lymph nodes. However, the efficacy of CCRT is not always satisfactory. The aim of this study was to compare postoperative adjuvant chemotherapy (CT) and postoperative CCRT in stage IIIC1 patients. Materials and Methods: Of the 40 patients who had undergone a radical hysterectomy at Iwate Medical University between January 2011 and December 2016 and were pathologically diagnosed as having positive pelvic lymph nodes, 21 patients in the adjuvant CT group and 19 patients in the postoperative CCRT group were compared. Results: The 5 year survival rates were 77.9% in the CT group and 74.7% in the CCRT group, with no significant difference. There was no significant difference in overall survival or progression-free survival between the two groups. There was no significant difference between CT and CCRT in postoperative adjuvant therapy in the new classification IIIC1 stage. Conclusions: The results of the prospective Japanese Gynecologic Oncology Group (JGOG) 1082 study are pending, but the present results suggest that CT may be a treatment option in rural areas where radiotherapy facilities are limited.

Further stratification of risk groups in patients with lymph node metastasis after radical hysterectomy for early-stage cervical cancer

2010 ◽  
Vol 117 (1) ◽  
pp. 53-58 ◽  
Author(s):  
Jeong-Yeol Park ◽  
Dae-Yeon Kim ◽  
Jong-Hyeok Kim ◽  
Yong-Man Kim ◽  
Young-Tak Kim ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Radical Hysterectomy ◽  
Early Stage ◽  
Risk Groups ◽  
Node Metastasis ◽  
Early Stage Cervical Cancer

scholarly journals Theurapeutic Response of Neoadjuvant Chemotherapy between Platinum and Ifosfamide Combination and Platinum, Vincristine and Bleomycin Combination in Cervical Carcinoma Stage IB2

2016 ◽  
Author(s):  
Kartiwa H Nuryanto ◽  
Sigit Purbadi
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Neoadjuvant Chemotherapy ◽  
Acute Toxicity ◽  
Cervical Carcinoma ◽  
Radical Hysterectomy ◽  
Complete Response ◽  
Pelvic Lymphadenectomy ◽  
Chemotherapy Response ◽  
Node Metastasis

Objective: To evaluate the theurapeutic response and acute toxicity of neoadjuvant chemotherapy between the combination of Platinum and Ifosfamide, and the combination of Platinum, Vincristine and Bleomycin in Cervical Carcinoma Stage IB2 and then continued with radical hysterectomy and pelvic lymphadenectomy. Method: Thirteen samples received neoadjuvant chemotherapy of Platinum and Ifosfamide and 17 samples received neoadjuvant chemotherapy of Platinum, Vincristine and Bleomycin, after receiving the neoadjuvant chemotherapy, clinically complete response samples underwent radical hysterectomy and pelvic lymphadenectomy (PI VS PVB = 3 VS 1). Histopathology examination was performed to evaluate the presence of malignant viable cells at the cervix, pelvic lymph node metastasis and parametrium metastasis. Acute toxicity evaluation was performed based on gastrointestinal, genitourinarius and hematology sign and symptom. Result: Theurapeutic response of PI is 1.12 higher than PVB (p>0.05). Subanalysis of group response of PI is 1.962 higher than PVB. PI and PVB have the same risk to have pelvic lymph node metastasis, but not parametrial metastasis. There were no differences in terms of the risk of gastrointestinal, genitourinarius and hematologic toxicity between PI and PVB. Conclusion: There was no statistical difference in clinical and pathological response, and also in acute toxicity between the two combination (p>0.05). [Indones J Obstet Gynecol 2016; 1: 47-51] Keywords: acute toxicity, cervical carcinoma stage IB2, neoadjuvant chemotherapy, response

scholarly journals Expression of Fas Ligand is Higher in Early Stage Cervical Cancer with Lymph Nodes Metastasis

2016 ◽  
Author(s):  
Yahya Irwanto
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Radical Hysterectomy ◽  
Fas Ligand ◽  
Pelvic Lymph Node ◽  
Lymph Nodes Metastasis ◽  
Node Metastasis ◽  
Pelvic Lymph Node Metastasis ◽  
Spearman Test

Objective: To know whether the expression of Fas Ligand has correlation with incidene of metastasis of pelvic lymph node and lymph-vascular stromal invasion (LVSI). Methods: All patients diagnosed of cervical cancer stage IB or IIA who underwent radical hysterectomy in Dr. Cipto Mangunkusumo Central General Hospital from January 2008 until December 2009 were included in analytic cross sectional study. We tested expression of Fas Ligand in cervical cancer specimen by immunohystochemistry with monoclonal antibody. The expression of Fas Ligand was compared between the group of patients with a positive and negative pelvic lymph node and between LVSI positive and negative. The difference of expression in both group were statistically analized with Chi-square test and the correlation Spearman test. Result: Ninety one patients underwent radical hysterectomy for two years and 43 patients were included in these study. The expression of Fas Ligand in 7 patients (16.3%) were negative and the others were positive, with weak, moderate and strong expression were 4 (9.3%), 27 (62.8%), and 5 (11.6%) respectively. The expression of Fas Ligand was significantly higher in the group of patients with positive pelvic lymph node compared to the group of the patients with negative pelvic lymph node (p=0.007) but there was no significant difference between group of the patients with LVSI positive and negative. With Spearman test, we found that the expression of Fas Ligand had a strong correlation with pelvic lymph nodes metastasis (coeff. correlation=0.519 and p=0.00) and have no correlation with LVSI (coef. corellation=0.112 and p=0.474). Conclusion: These finding suggested that expression of Fas Ligand in cervical cancer patients has a strong correlation with the incidence of pelvic lymph node metastasis and none with LVSI. [Indones J Obstet Gynecol 2012; 36-4: 194-9] Keywords: cervical cancer, fas ligand, immunohystochemistry, LVSI, pelvic lymph node metastasis

Phase II study of adjuvant chemotherapy with paclitaxel and nedaplatin for FIGO stage IB-IIA uterine cervical cancer with lymph node metastasis following radical hysterectomy: A Kansai Clinical Oncology Group study (KCOG-G1101).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17024-e17024
Author(s):  
Munetaka Takekuma ◽  
Yuka Kasamatsu ◽  
Shin Nishio ◽  
Hideo Omi ◽  
Tsutomu Tabata ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Survival Rate ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Lymph Node Metastasis ◽  
Adverse Events ◽  
Radical Hysterectomy ◽  
Uterine Cervical Cancer ◽  
Node Metastasis

e17024 Background: A multicenter phase II trial was conducted to assess the efficacy and toxicity of paclitaxel and nedaplatin as the initial postoperative adjuvant chemotherapy for high-risk uterine cervical cancer. Methods: The patients with FIGO stages IB1-IIA2 squamous cell carcinoma of the uterine cervix were enrolled. Histologic confirmation of lymph node metastasis was mandatory. Intravenous paclitaxel 175 mg/m(2) over 3hours and nedaplatin 80 mg/m(2) over 1 hour were administered on day 1 of a every 28 day cycle, of which there were 5 cycles after radical hysterectomy. Results: 62 patients were enrolled into the study protocol from November 2011 to July 2015. The median age of patients was 48.5 years (range; 28-64). Median tumor diameter was 37 mm (0-34). 10 patients (16.1%) had parametrial invasion, 44 (71.0%) had deep stromal invasion, and 53 (85.5%) had lymph-vascular invasion. 30 patients (48.4%) had one metastatic lymph node, 11 (17.7%) had two, 3 (4.8%) had three, 5 (8.1%) had four and 13 (21.0%) had five or more. With a median follow-up of 36.9 months (range: 17.2-61.5), the 2-year progression-free survival rate and pelvic disease progression-free rate were 78.9% (95% CI, 68.5% to 89.3%) and 85.0% (95% CI, 75.8% to 94.3%), respectively. The 2-year overall survival rate was 93.3% (95% CI, 86.8% to 99.8%). Adverse events were almost acceptable. Grade 3-4 adverse events (NCI-CTC ver4.0) that occurred in 5% or more patients were neutropenia (60.7%) and infection (6.6%). The proportion of patients who completed 5 cycles of treatment was 90.3%. Conclusions: Adjuvant chemotherapy with paclitaxel and nedaplatin for patients with high-risk cervical cancer after radical hysterectomy was demonstrated to be an effective and feasible treatment. Phase III trial should compare this with concurrent chemoradiotherapy. Clinical trial information: 000005605.

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