Platinum-Based Neoadjuvant Chemotherapy Followed by Radical Surgery for Cervical Carcinoma International Federation of Gynecology and Obstetrics Stage IB2-IIB

2013 ◽  
Vol 23 (9) ◽  
pp. 1647-1654 ◽  
Author(s):  
Lucas Minig ◽  
Nicoletta Colombo ◽  
Vanna Zanagnolo ◽  
Fabio Landoni ◽  
Luca Bocciolone ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Neoadjuvant Chemotherapy ◽  
Cervical Carcinoma ◽  
Progression Free Survival ◽  
Figo Stage ◽  
International Federation ◽  
Gynecology And Obstetrics ◽  
European Institute ◽  
Parametrial Involvement ◽  
Node Metastases

ObjectiveThe objective of this study was to determine the response rate to chemotherapy, as well as the progression-free survival (PFS), the overall survival (OS), and the main prognostic factors in patients treated at the European Institute of Oncology in Milan, Italy.MethodsRetrospective data were collected on patients with uterine cervical carcinoma, International Federation of Gynecology and Obstetrics (FIGO) stage IB2 to IIB, who underwent platinum-based neoadjuvant chemotherapy (NACT) followed by radical hysterectomy.ResultsA total of 121 patients were studied. The median (range) age was 45 years old (23–69 years). The distribution of patients by International Federation of Gynecology and Obstetrics stage was as follows: n = 88 (73%) with stage IB2, n = 7 (6%) with stage IIA, and n = 26 (21%) with stage IIB. The median (range) tumor size was 50 mm (20–90 mm). Neoadjuvant chemotherapy involved a combination of cisplatin, paclitaxel, and ifosfamide in 80 patients (65%). Using this treatment, 112 patients (93%) received 3 cycles of NACT, whereas 6 (5%) received 4 cycles. Complete and partial pathology response was observed in 9 patients (7%) and 79 patients (66%), respectively. Adjuvant radiotherapy was not necessary in 65% of patients. A 5-year PFS and OS of 58% and 71%, respectively, were observed. Independent prognostic factors for PFS and OS were identified, including response to NACT, persistent lymph node metastases, and parametrial involvement.ConclusionsNeoadjuvant chemotherapy in this group of tumors is a promising treatment strategy and should be discussed with patients. Although these results are comparable to those obtained by standard chemoradiation treatment, one strategy should not be recommended over the other until the results of the ongoing phase 3 trial for NACT are released.

Anemia before and during concurrent chemoradiotherapy in patients with cervical carcinoma: Effect on progression-free survival

2003 ◽  
Vol 13 (5) ◽  
pp. 633-639 ◽  
Author(s):  
A. Obermair ◽  
R. Cheuk ◽  
K. Horwood ◽  
M. Neudorfer ◽  
M. Janda ◽  
...  
Keyword(s):  
Cervical Carcinoma ◽  
Concurrent Chemoradiotherapy ◽  
Progression Free Survival ◽  
Figo Stage ◽  
Tumor Stage ◽  
Free Survival ◽  
Parametrial Involvement ◽  
The Impact ◽  
Relevant Factors

To determine the impact of anemia before and during chemoradiation in patients with cervical cancer, we collected data on hemoglobin (Hb) levels before and during treatment from 60 unselected patients with cervical carcinoma. All patients had FIGO stage IB to IVA disease and were treated with concurrent chemoradiation for the aim of cure. Patients with an Hb value below or equal to the lower 25th quartile were considered anemic. Progression-free survival (PFS) was evaluated by univariate and multivariate analyses. After a median follow-up of 26.3 months, 20 patients developed disease progression. The lowest Hb during chemoradiation (nadir Hb), the stage of disease, and parametrial involvement were correlated significantly with PFS. On multivariate analysis, the nadir Hb (relative risk [RR] 0.29) and tumor stage (RR 3.4) remained the only prognostically relevant factors predicting PFS. At 60 months the PFS was 39.1% for anemic patients and 48.0% for nonanemic patients (P < 0.0002). In patients undergoing chemoradiation for cervical carcinoma, a low nadir Hb is highly predictive of shortened PFS, whereas the Hb before treatment is prognostically not significant.

Parametrial Involvement in FIGO Stage IB1 Cervical Carcinoma: Diagnostic Impact of Tumor Diameter in Preoperative Magnetic Resonance Imaging

2011 ◽  
Vol 21 (2) ◽  
pp. 349-354 ◽  
Author(s):  
Teruyo Kamimori ◽  
Kimihiko Sakamoto ◽  
Kiyoshi Fujiwara ◽  
Kenji Umayahara ◽  
Yuko Sugiyama ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Prognostic Factors ◽  
Magnetic Resonance ◽  
Cell Carcinoma ◽  
Cervical Carcinoma ◽  
Radical Surgery ◽  
Figo Stage ◽  
Tumor Diameter ◽  
Resonance Imaging ◽  
Parametrial Involvement

Background:In the surgical treatment for early-stage cervical carcinoma, it is important to identify preoperatively a low-risk group of patients as candidates for less radical surgery to avoid the morbidity associated with radical hysterectomy. The aim of this study was to evaluate the correlation between tumor diameter measured preoperatively using magnetic resonance imaging (MRI) and pathological prognostic factors in International Federation of Gynecology and Obstetrics (FIGO) stage IB1 cervical carcinoma.Methods:A total of 125 patients with FIGO stage IB1 cervical cancer were included in this study. Clinical records, pathology reports, and MRI findings were retrospectively reviewed.Results:Histological diagnosis was squamous cell carcinoma in 57 patients and nonsquamous cell carcinoma in 68 patients. All patients underwent preoperative evaluation by MRI within a median period of 13.5 days before surgery. The tumor diameter measured by MRI ranged from zero (no tumor detected) to 42 mm, with a median of 23 mm. Pathological prognostic factors included parametrial involvement, lymph node metastasis, deep stromal invasion, and lymphovascular space invasion. All these factors were found less frequently in patients with a smaller tumor diameter. Most notably, parametrial involvement was seen in none of the patients with tumors 20 mm or less and was detected only in patients with tumors greater than 20 mm (P= 0.01).Conclusions:In the FIGO stage IB1 cervical carcinoma, the tumor diameter measured preoperatively by MRI correlates well with other pathological prognostic factors, especially with parametrial involvement. This finding suggests that the tumor diameter measured in preoperative MRI may serve as a strong predictor of parametrial involvement in FIGO stage IB1 cervical carcinoma, which can be used to select a candidate population for less radical surgery without the need for a cone biopsy before hysterectomy.

Randomized trial comparing two combination chemotherapy regimens (CHAP-5 v CP) in advanced ovarian carcinoma.

1987 ◽  
Vol 5 (8) ◽  
pp. 1157-1168 ◽  
Author(s):  
J P Neijt ◽  
W W ten Bokkel Huinink ◽  
M E van der Burg ◽  
A T van Oosterom ◽  
P H Willemse ◽  
...  
Keyword(s):  
Ovarian Carcinoma ◽  
Stage Iv ◽  
Progression Free Survival ◽  
Therapeutic Index ◽  
Residual Tumor ◽  
Figo Stage ◽  
Gynecology And Obstetrics ◽  
Adequate Hydration ◽  
Karnofsky Index

One hundred ninety-one patients with advanced epithelial ovarian carcinoma were treated with either a combination of doxorubicin and a five-day course of cisplatin alternating with cyclophosphamide and hexamethylmelamine orally for 14 days (CHAP-5) or cyclophosphamide and cisplatin both administered intravenously (IV) on a single day at 3-week intervals (CP). At a median follow-up time of 45 months, treatment with each of these combinations resulted in the same remission rates (80% and 74%, respectively) and exactly the same progression-free survival and overall survival (median, 26 months). Despite adequate hydration, more renal toxicity was encountered in the CP-treated patients than in those who received CHAP-5. Disabling neurotoxicity and severe myelosuppression were encountered more frequently in the patients treated with CHAP-5. Because the toxicity was lower and CP treatment required shorter hospitalization, the single-day regimen was considered preferable for future use. The Karnofsky index was the only independent predictor for response, whereas both this index and the size of residual tumor before chemotherapy were predictive of survival. After correcting for other prognostic factors, it was determined that tumor size associated with improved survival was less than 1 cm. The site of metastases in International Federation of Gynecology and Obstetrics (FIGO) stage IV patients did not influence survival within this category. The results of this study confirm our previous findings that patients with microscopic remnants at second-look have a survival similar to that of patients who are histopathologically free of disease. This makes the significance of so-called pathologically confirmed complete remission questionable. The survival benefit of debulking surgery performed during chemotherapy seems only minimal for patients in whom debulking has already been attempted before treatment. Like others, we have found the CP regimen to have a good therapeutic index.

scholarly journals Treatment of cervical cancer in the Republic of Srpska

2011 ◽  
Vol 64 (11-12) ◽  
pp. 588-591 ◽  
Author(s):  
Nenad Lucic ◽  
Zora Antonic ◽  
Vesna Ecim ◽  
Dragica Draganovic ◽  
Ljiljana Latinovic
Keyword(s):  
Cervical Cancer ◽  
Postoperative Complications ◽  
Radical Hysterectomy ◽  
Invasive Cervical Cancer ◽  
Figo Stage ◽  
International Federation ◽  
Gynecology And Obstetrics ◽  
The Republic ◽  
Banja Luka ◽  
Cervical Tumors

Introduction. Since 1897, when the first radical hysterectomy with lymphadenectomy was done by Wertheim in Vienna, this operation has had the central role in the surgical treatment of invasive cervical tumors. Material and methods. In the period from 1997 to 2010, 177 patients diagnosed with invasive cervical cancer according to the International Federation of Gynecology and Obstetrics (FIGO) stage IB1 - II were operated at the Department of Obstetrics and Gynecology in Banja Luka. All patients underwent radical hysterectomy by Wertheim - Meigs. The aim of this study is to present the technique of this operation, as well as its effectiveness in the treatment of cervical cancer. Results. The distribution of the patients having invasive cervical cancer according to the International Federation of Gynecology and Obstetrics classification was as follows: I B1 - 35.67%, I B2 - 23.17%, II A - 15.48%, II B - 25.68% on average is 21.3 removed lymph glands. The rate of intraoperative and postoperative complications was 8 (4.51%) and 17 (9.60%), respectively. Of the 26 patients who were operated in the period from 2005 - 2010, 13 had stage II B according to the International Federation of Gynecology and Obstetrics; there were 6 lethal outcomes (23.08) and the five-year survival rate was 76.92%. Discussion and conclusion. By applying the proper surgical technique and early prevention of immediate complications, we achieved satisfactory results in operative morbity and mortality, intraoperative and postoperative complications of the lesion for radical surgery by the Wertheim- Meigs-in the treatment of cancer of the uterus in the I B - II B stage according to the International Federation of Gynecology and Obstetrics classification.

scholarly journals Expression of CD133 and Aldehyde Dehydrogenase 1A1 in Borderline Ovarian Tumor and Their Correlation with International Federation of Gynecology and Obstetrics

2020 ◽  
Vol 8 (A) ◽  
pp. 160-163
Author(s):  
Birgitta M. Dewayani ◽  
Hasrayati Agustina ◽  
Desi Puspita ◽  
Bethy S. Hernowo ◽  
Sri Suryanti
Keyword(s):  
Cell Proliferation ◽  
Aldehyde Dehydrogenase ◽  
Ovarian Tumor ◽  
Figo Stage ◽  
International Federation ◽  
Borderline Ovarian Tumor ◽  
Chi Square ◽  
Cross Sectional ◽  
Epithelial Ovarian Tumor ◽  
Gynecology And Obstetrics

BACKGROUND: Borderline ovarian tumor (BOT) is an epithelial ovarian tumor with atypical epithelial proliferation without stromal invasion. BOTs may have an aggressive fashion with associated microinvasion feature, peritoneal “implants,” regional lymphadenopathy, and higher International Federation of Gynecology and Obstetrics (FIGO) stage. CD133 is cancer stem cells (CSCs) marker that promotes cell proliferation and tumor invasion through induction of nuclear factor kappa B and upregulation of MMP9. Aldehyde dehydrogenase 1A1 (ALDH1A1) is CSCs marker that promotes cell proliferation through the upregulation of c-MYC and cyclin-D1. AIM: The aim of this study was to investigate the correlation between CD133 and ALDH1A1 expression with FIGO stage. This research was performed as an analytic-observational with a cross-sectional design. METHODS: This research using a paraffin block of patients diagnosed as BOT in Hasan Sadikin Hospital Bandung. Samples were divided in two groups: FIGO stage IA and FIGO stage >IA. All samples were stained by immunohistochemistry CD133 and ALDH1A1. All data were analyzed using the Chi-square test with a significant level 5%. RESULTS: This study showed a statistically significant correlation between CD133 (p = 0.047) and ALDH1A1 (p = 0.042) expression with FIGO stage in BOT. Multivariate analysis showed there was no correlation between CD133 and ALDH1A1 in the affected of FIGO stage in BOT. CONCLUSION: CD133 and ALDH1A1 in BOT can be considered as a factor to predict the prognosis of BOT through predict FIGO stage.

scholarly journals Re-staging surgery in endometrial cancer: an audit on its value

2020 ◽  
Vol 9 (12) ◽  
pp. 4898
Author(s):  
Sanjay Badesara ◽  
Ashitha R. Gangadharan ◽  
Rambeer Singh ◽  
Adarsh Dharmarajan
Keyword(s):  
Endometrial Cancer ◽  
Figo Stage ◽  
International Federation ◽  
Surgical Staging ◽  
Carcinoma Endometrium ◽  
Gynecology And Obstetrics ◽  
Anticancer Treatment ◽  
Staging Surgery ◽  
Completion Surgery

Background: Incomplete surgical staging in carcinoma endometrium is not an uncommon entity in developing world. Proper surgical staging has got a role in prognostication and planning adjuvant treatment. So, an audit was done to assess the extent of upstaging in women with endometrial cancers who were referred to index centre from outside hospitals with incomplete surgical staging.Methods: It is a retrospective study. The demographic, clinical and treatment details of women with complete data having at-least one follow up after completion surgery were analyzed. Patients who had any other anticancer treatment elsewhere were excluded. The extent of upstaging was studied based on International federation of gynecology and obstetrics (FIGO) 2008 staging.Results: A total of 88 patients of endometrial cancer were evaluated retrospectively, of which 10 had completion surgery. 10% of the patients were upstaged according to the FIGO stage (one from IA to IB), while one patient upstaged from IIIA to IVB after slide review by index centre. According to FIGO Grade, 40% patient upgraded (one upgraded from I to II, three from II to III) while one downgraded from II to I. Recurrence rate was 40%.Conclusions: Upstaging is seen in 10% of patient after completion surgery, which requires the necessity of evaluation by gynecologic oncologist selectively. However, larger and multi-centric studies needed to draw definite conclusion. There is a significant discordance in grade and histology after the review at index centre.

Stage III disease of ovarian, tubal and peritoneal cancers can be accurately diagnosed with pre-operative CT. Japan Clinical Oncology Group Study JCOG0602

2020 ◽  
Author(s):  
Takashi Onda ◽  
Yumiko Oishi Tanaka ◽  
Satomi Kitai ◽  
Tomoko Manabe ◽  
Mitsuya Ishikawa ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
International Federation ◽  
Stage Iii ◽  
Debulking Surgery ◽  
Peritoneal Disease ◽  
Predictive Values ◽  
Primary Debulking Surgery ◽  
Gynecology And Obstetrics

Abstract Purpose Computed tomography of the abdomen and pelvis is a useful imaging modality for identifying origin and extent of ovarian cancer before primary debulking surgery. However, the International Federation of Gynecology and Obstetrics staging for ovarian cancer is determined based on surgico-pathological findings. The purpose of this study is to determine whether computed tomography staging can be the surrogate for surgico-pathological International Federation of Gynecology and Obstetrics staging in advanced ovarian cancer undergoing neoadjuvant chemotherapy. Methods Computed tomography staging was compared with surgico-pathological International Federation of Gynecology and Obstetrics staging in primary debulking surgery arm patients in a randomized controlled trial comparing primary debulking surgery and neoadjuvant chemotherapy (JCOG0602). The cancer of primary debulking surgery arm was identically diagnosed regarding the origin and extent with the cancer of neoadjuvant chemotherapy arm before accrual, using imaging studies (computed tomography and/or magnetic resonance imaging), cytological examination (ascites, pleural effusion or tumor contents fluid) and tumor marker (CA125 &gt; 200 U/mL and CEA &lt; 20 ng/mL). Institutional computed tomography staging was also compared with computed tomography staging by central review. Results Among 149 primary debulking surgery arm patients, 147 patients who underwent primary debulking surgery immediately were analyzed. Positive predictive values and sensitivity of computed tomography staging for surgical stage III disease (extra-pelvic peritoneal disease and/or retroperitoneal lymph node metastasis) were 99%. Meanwhile, positive predictive values for the presence of small (≤2 cm) extra-pelvic peritoneal disease were low; &lt;20% in omentum. Accuracy of institutional computed tomography staging was comparable with computed tomography staging by central review. Conclusions Preoperative computed tomography staging in each institution can be the surrogate for surgico-pathological diagnosis in stage III disease of ovarian cancer patients undergoing neoadjuvant chemotherapy without diagnostic surgery, but reliability of diagnosis of stage IIIB disease is inadequate. Clinical trial registration: UMIN000000523(UMIN-CTR).

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