Neoadjuvant Chemotherapy Followed by Radical Vaginal Trachelectomy and Adjuvant Chemotherapy for Clear Cell Cancer of the Cervix: A Feasible Approach and Review

2011 ◽  
Vol 21 (1) ◽  
pp. 137-140 ◽  
Author(s):  
Piksi Singh ◽  
James Nicklin ◽  
Timothy Hassall
Keyword(s):  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
Adjuvant Treatment ◽  
Clear Cell ◽  
Cell Cancer ◽  
Pelvic Lymphadenectomy ◽  
Clear Cell Adenocarcinoma ◽  
Radical Trachelectomy ◽  
Radical Vaginal Trachelectomy ◽  
Laparoscopic Pelvic Lymphadenectomy

Background:Clear cell adenocarcinoma of the cervix (CCAC) may affect pediatric and younger women in absence of diethylstilbestrol exposure and other classic predisposing factors for cervical cancer. Prognosis is similar for early-stage CCAC, squamous cell cancer and non-clear cell adenocarcinoma of the cervix. Vaginal radical trachelectomy (VRT) and abdominal radical trachelectomy (ART) with pelvic lymph node dissection have evolved as valuable fertility-preserving treatment options. Neoadjuvant chemotherapy (NACT) before abdominal radical trachelectomy/VRT may reduce tumor size and thereby facilitate surgery. In some cases, adjuvant treatment in the presence of high-risk prognostic features may be required to optimize treatment.Methods:A 13-year-old adolescent with International Federation of Obstetrics and Gynecology stage IB1 CCAC was treated with NACT using carboplatin and paclitaxel (CP) followed by laparoscopic pelvic lymphadenectomy, VRT, and adjuvant chemotherapy.Results:Neoadjuvant chemotherapy using CP was well tolerated with no toxicity. Neoadjuvant chemotherapy reduced the tumor size and facilitated radical vaginal trachelectomy. Adjuvant treatment was recommended in the presence of risk factors. The patient elected to conserve the uterus and underwent 3 further cycles of adjuvant chemotherapy with CP.Conclusions:This is the first reported case of CCAC treated with NACT using CP followed by laparoscopic pelvic lymphadenectomy, VRT, and adjuvant chemotherapy. A successful treatment outcome achieved using this novel approach suggests its applicability in selected cases.

scholarly journals Clear cell carcinoma of cervix in post-menopausal female

2019 ◽  
Vol 14 (2) ◽  
pp. 65-66
Author(s):  
Shreena Shrestha ◽  
Ganesh Dangal ◽  
Kabin Bhattachan
Keyword(s):  
Postmenopausal Woman ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
Cell Carcinoma ◽  
Clear Cell ◽  
Clear Cell Carcinoma ◽  
Pelvic Lymphadenectomy ◽  
Carcinoma Of Cervix ◽  
History Of ◽  
Post Menopausal

Clear cell carcinoma of cervix is a rare neoplasm accounting for round 4% of all adenocarcinomas. It is usually seen in patients with a history of intrauterine exposure to diethylstilbestrol. We are reporting a case of clear cell carcinoma of cervix in a 50 years old P1L1 postmenopausal woman, with no history of exposure to diethylstilbestrol in-utero or synthetic non-steroidal estrogen, and who was managed with neoadjuvant chemotherapy followed by modified radical hysterectomy with pelvic lymphadenectomy and adjuvant chemotherapy.

scholarly journals Radical Vaginal Trachelectomy

2021 ◽  
Author(s):  
Tsuyoshi Saito ◽  
Motoki Matsuura ◽  
Masato Tamate ◽  
Masahiro Iwasaki ◽  
Tasuku Mariya
Keyword(s):  
Minimally Invasive ◽  
Pregnancy Rate ◽  
Cervical Carcinoma ◽  
Vaginal Hysterectomy ◽  
Tumor Size ◽  
Surgical Procedure ◽  
Pelvic Lymphadenectomy ◽  
Radical Trachelectomy ◽  
Radical Vaginal Trachelectomy ◽  
Laparoscopic Pelvic Lymphadenectomy

AbstractRecently, radical vaginal hysterectomy (RVH) has developed into laparoscopically assisted radical vaginal hysterectomy (LARVH), which is associated with the laparoscopical procedure, and it is applied as radical vaginal trachelectomy and semi-radical vaginal hysterectomy. LARVH is indicated for patients with stage IB1 and IIA1 cervical carcinoma, especially those with a tumor size of less than 2 cm, because the cardinal ligaments cannot be resected widely. Although RVH that is associated with laparoscopic pelvic lymphadenectomy is the most used surgical procedure, radical trachelectomy may be performed either abdominally or vaginally (laparoscopic or robotic). One report found that the pregnancy rate was higher in patients who underwent minimally invasive or radical vaginal trachelectomy than in those who underwent radical abdominal trachelectomy.

scholarly journals Adjuvant Treatment of Early Ovarian Clear Cell Carcinoma: A Population-Based Study of Whole Abdominal Versus Pelvic Nodal Radiotherapy

2021 ◽  
Vol 19 (2) ◽  
pp. 172-180
Author(s):  
Soumyajit Roy ◽  
Paul Hoskins ◽  
Anna Tinker ◽  
Harinder Brar ◽  
Gale Bowering ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Cell Carcinoma ◽  
Adjuvant Treatment ◽  
Clear Cell ◽  
Clear Cell Carcinoma ◽  
Final Analysis ◽  
Population Based ◽  
Ovarian Clear Cell Carcinoma ◽  
Population Based Study ◽  
Significant Difference

Background: Adjuvant treatment in early ovarian clear cell carcinoma (OCCC) is not yet standardized. The objective of this population-based study was to compare the outcome of patients with early OCCC treated with adjuvant chemotherapy versus chemoradiotherapy (chemoRT) and evaluate the association of adjuvant radiotherapy regimens (whole abdominal radiotherapy [WART] versus pelvic nodal radiotherapy [PRT]) with outcome. Patients and Methods: Chart review was conducted to identify patients with stage I and II OCCC with complete information on staging. Patients with stage IA, IB, or IC OCCC purely resulting from capsular rupture were excluded because the provincial protocol does not recommend adjuvant treatment. Results: Overall, 403 patients were identified and 343 received adjuvant treatment, of whom 255 had stage IC or II OCCC and 153 were eligible for final analysis. On Cox multivariable regression, receipt of chemoRT (n=90) was associated with an improvement in failure-free survival (FFS) (hazard ratio [HR], 0.57; 95% CI, 0.34–0.94) compared with chemotherapy alone (n=63). Use of chemoRT also resulted in 54% reduction in the cumulative incidence of cancer-specific mortality (subdistribution HR, 0.46; 95% CI, 0.24–0.89). However, there was no significant difference in the HR for overall survival (OS) between the chemoRT (HR, 0.70; 95% CI, 0.43–1.13) and chemotherapy group. Relative to chemotherapy + WART (chemo-WART), chemotherapy + PRT (chemo-PRT) was not associated with any significant difference in HR for FFS (HR, 1.34; 95% CI, 0.40–4.44) or OS (HR, 1.13; 95% CI, 0.37–3.46). Conclusions: Adjuvant chemoRT was associated with a lower risk of failure compared with chemotherapy alone. However, there was no difference in OS between the adjuvant chemotherapy and chemoRT regimens. Additionally, no significant difference in terms of FFS or OS was found between the chemo-WART and chemo-PRT groups.

scholarly journals Effectiveness and safety of pegylated liposomal doxorubicin versus epirubicin as neoadjuvant or adjuvant chemotherapy for breast cancer: a real-world study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jin Zhang ◽  
Hongchuan Jiang ◽  
Jian Zhang ◽  
Guoqiang Bao ◽  
Guoqiang Zhang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
Lower Limit ◽  
Adjuvant Treatment ◽  
Real World ◽  
Liposomal Doxorubicin ◽  
Pegylated Liposomal Doxorubicin ◽  
Secondary Outcome ◽  
Rate Difference

Abstract Background Pegylated liposomal doxorubicin (PLD) is an improved formulation of doxorubicin with comparable effectiveness but significantly lower cardiotoxicity than conventional anthracycline. This study aimed to evaluate the real-world effectiveness and safety of PLD versus epirubicin as neoadjuvant or adjuvant treatment for breast cancer. Methods Clinical data of invasive breast cancer patients who received neoadjuvant or adjuvant chemotherapy with PLD or epirubicin were retrospectively collected. Propensity score matching (PSM) was performed to reduce the risk of selection bias. The molecular typing of these patients included Luminal A, Luminal B, HER2-positive, and basal-like/triple-negative. The primary outcome was pathological complete response (pCR) rate for neoadjuvant chemotherapy and 3-year disease-free survival (DFS) rate for adjuvant chemotherapy. Noninferiority was suggested if the lower limit of the 95% CI for the 3-year DFS rate difference was greater than − 10%. The secondary outcome was adverse reactions. Results A total of 1213 patients were included (neoadjuvant, n = 274; adjuvant, n = 939). pCR (ypT0/Tis ypN0) rates of patients who received neoadjuvant chemotherapy were 11.6% for the PLD group and 7.0% for the epirubicin group, but the difference was not statistically significant (P = 0.4578). The 3-year DFS rate of patients who received adjuvant chemotherapy was 94.9% [95%CI, 91.1–98.6%] for the PLD group and 95.4% [95%CI, 93.0–97.9%] for the epirubicin group (P = 0.5684). Rate difference between the two groups and its 95% CI was - 0.55 [− 5.02, 3.92]. The lower limit of the 95% CI was − 5.0% > − 10.0%, suggesting that PLD is not be inferior to epirubicin in adjuvant chemotherapy for breast cancer. The incidences of myelosuppression, decreased appetite, alopecia, gastrointestinal reactions, and cardiotoxicity were lower in the PLD group than in the epirubicin group, while the incidence of nausea was higher in the PLD group. Conclusions In the neoadjuvant and adjuvant treatment of breast cancer, effectiveness is similar but toxicities are different between the PLD-containing regimen and epirubicin-containing regimen. Therefore, further study is warranted to explore PLD-based neoadjuvant and adjuvant chemotherapy for breast cancer.

Fertility-sparing surgery of cervical cancer >2 cm (International Federation of Gynecology and Obstetrics 2009 stage IB1–IIA) after neoadjuvant chemotherapy

2019 ◽  
Vol 30 (1) ◽  
pp. 115-121 ◽  
Author(s):  
Freweini Martha Tesfai ◽  
Judith R Kroep ◽  
Katja Gaarenstroom ◽  
Cor De Kroon ◽  
Rhiannon Van Loenhout ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Neoadjuvant Chemotherapy ◽  
International Federation ◽  
Obstetric Outcomes ◽  
Clear Cell Adenocarcinoma ◽  
Radical Trachelectomy ◽  
Fertility Sparing Surgery ◽  
Gynecology And Obstetrics ◽  
Fertility Sparing ◽  
Cervical Tumors

ObjectiveTo assess the feasibility, safety, oncological, and obstetric outcomes in patients with cervical tumors >2 cm treated with neoadjuvant chemotherapy in preparation for abdominal radical trachelectomy.MethodsA retrospective analysis of patients with cervical cancer >2 cm (up to 6 cm) was conducted in patients who were selected to receive neoadjuvant chemotherapy before abdominal radical trachelectomy. Surgical and clinical outcomes were examined in relation to radiological and pathological results. In addition, obstetric outcomes were described. The Mann–Whitney U test and Fisher’s exact test were performed to compare radiological findings between successful and unsuccessful abdominal radical trachelectomy procedures. International Federation of Gynecology and Obstetrics (FIGO) 2009 staging classification was used for this study.ResultsA total of 19 women were treated with neoadjuvant chemotherapy for cervical tumors >2 cm at our institution between May 2006 and July 2018. The median age was 28 years (range 19–36). The distribution of FIGO stages was seven patients stage IB1 (37%), 10 patients stage IB2 (53%), and two patients (10%) stage IIA. Mean clinical tumor size was 4.4 cm (range 3.5–6.0). Histology revealed 74% cases of squamous cell carcinoma. The remaining patients had adenocarcinoma (21%) and only one patient had clear cell adenocarcinoma (5%). Chemotherapy consisted of six weekly cycles of cisplatin (70 mg/m2) and paclitaxel (70 mg/m2). In 15 of the 19 patients (74%) fertility was successfully preserved. In the four patients in whom fertility preservation failed, one patient had stable disease after three cycles and did not meet the criteria for fertility-sparing surgery and three patients had intra- or post-operative indications for adjuvant therapy. Three of the 19 patients (15.7%) had a relapse, two of whom died. One case was in the group of successful abdominal radical trachelectomy.ConclusionNeoadjuvant chemotherapy followed by fertility-sparing surgery may be a feasible and safe option in select patients with cervical tumors >2 cm. Unfavorable prognostic factors are defined as non-responsiveness and non-squamous pathology, which can help in patient selection for fertility-sparing surgery.

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