Comparative study of chemoradiation and neoadjuvant chemotherapy effects before radical hysterectomy in stage IB?IIB bulky cervical cancer and with tumor diameter greater than 4 cm

2005 ◽  
Vol 15 (3) ◽  
pp. 483-488 ◽  
Author(s):  
M. Modarress ◽  
F.Q. Maghami ◽  
M. Golnavaz ◽  
N. Behtash ◽  
A. Mousavi ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Comparative Study ◽  
Radical Hysterectomy ◽  
Tumor Diameter ◽  
Stage Ib

Comparative study of chemoradiation and neoadjuvant chemotherapy effects before radical hysterectomy in stage IB–IIB bulky cervical cancer and with tumor diameter greater than 4 cm

2005 ◽  
Vol 15 (3) ◽  
pp. 483-488
Author(s):  
M. Modarress ◽  
F. Q. Maghami ◽  
M. Golnavaz ◽  
N. Behtash ◽  
A. Mousavi ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Radical Hysterectomy ◽  
Tumor Size ◽  
Pathologic Complete Response ◽  
Residual Tumor ◽  
Preoperative Treatment ◽  
Tumor Diameter ◽  
Stage Ib ◽  
Significant Difference

Tumor size seems to be a determinant in the prognosis of early cervical cancer. Patients with tumor greater than 4 cm (bulky) in diameter have worse outcome. The purpose of this study was to compare the efficacy of preoperative combined chemoradiation and neoadjuvant chemotherapy (NAIC) programs followed by radical hysterectomy in stage IB–IIB bulky cervical cancer. From September 1999 to April 2002, 60 patients with stage IB–IIB bulky cervical cancer were treated with preoperative external-beam radiotherapy to 45 Gy plus weekly cisplatin 50 mg/m2 or preoperative NAIC by cisplatin 50 mg/m2 and vincristin 1 mg/m2 every 7–10 days, for three courses. Surgery was performed 4–6 weeks after the completion of the preoperative treatment. There were no significant difference between age, stage, tumor size, and histopathologic type in two groups (P > 0.05). Toxicity associated with two treatment methods was usually mild. In chemoradiation group, two patients developed vesicovaginal fistula, and four patients developed long-term hydronephrosis that needed urethral stenting. Before surgery, complete and partial clinical response had no significant difference between two groups (P > 0.05). After surgery, lymph node and parametrial involvement had no significant difference between two groups (P > 0.05). In NAIC group, more patients had significantly residual tumor (P = 0.012), but residual tumor size had no significant difference between two groups (P > 0.05). Pathologic complete response was significantly higher in chemoradiation group (P = 0.004). According to the result of this study, it seems that NAIC and chemoradiation had similar effects in survival prognostic factors.

Comparison of Laparoscopic Versus Abdominal Radical Hysterectomy for FIGO Stage IB and IIA Cervical Cancer With Tumor Diameter of 3 cm or Greater

2014 ◽  
Vol 24 (2) ◽  
pp. 280-288 ◽  
Author(s):  
Tae Wook Kong ◽  
Suk-Joon Chang ◽  
Jisun Lee ◽  
Jiheum Paek ◽  
Hee-Sug Ryu
Keyword(s):  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Operating Time ◽  
Figo Stage ◽  
Tumor Diameter ◽  
Pelvic Magnetic Resonance Imaging ◽  
Laparoscopic Radical Hysterectomy ◽  
Stage Ib ◽  
Estimated Blood Loss ◽  
The Mean

ObjectiveThere have been many comparative reports on laparoscopic radical hysterectomy (LRH) versus abdominal radical hysterectomy (ARH) for early-stage cervical cancer. However, most of these studies included patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA2 and small (tumor diameter ≤2 or 3 cm) IB1 disease. The purpose of this study was to compare the feasibility, morbidity, and recurrence rate of LRH and ARH for FIGO stage IB and IIA cervical cancer with tumor diameter of 3 cm or greater.Materials and MethodsWe conducted a retrospective analysis of 88 patients with FIGO stage IB and IIA cervical cancer with tumor diameter of 3 cm or greater. All patients had no evidence of parametrial invasion and lymph node metastasis in preoperative gynecologic examination, pelvic magnetic resonance imaging, and positron emission tomography–computed tomography, and they all underwent LRH or ARH between February 2006 and March 2013.ResultsAmong 88 patients, 40 patients received LRH whereas 48 underwent ARH. The mean estimated blood loss was 588.0 mL for the ARH group compared with 449.1 mL for the LRH group (P< 0.001). The mean operating time was similar in both groups (246.0 minutes in the ARH vs 254.5 minutes in the LRH group,P= 0.589). Return of bowel motility was observed earlier after LRH (1.8 vs 2.2 days,P= 0.042). The mean hospital stay was significantly shorter for the LRH group (14.8 vs 18.0 days,P= 0.044). There were no differences in histopathologic characteristics between the 2 groups. The mean tumor diameter was 44.4 mm in the LRH and 45.3 mm in the ARH group. Disease-free survival rates were 97.9% in the ARH and 97.5% in the LRH group (P= 0.818).ConclusionsLaparoscopic radical hysterectomy might be a feasible therapeutic procedure for the management of FIGO stage IB and IIA cervical cancer with tumor diameter of 3 cm or greater. Further randomized studies that could support this approach are necessary to evaluate long-term clinical outcome.

scholarly journals Single-dose intra-arterial neoadjuvant chemotherapy while waiting for radical hysterectomy for stage IB-IIB cervical cancer

2016 ◽  
Vol 4 (6) ◽  
pp. 1068-1072 ◽  
Author(s):  
KIYOSHI YOSHINO ◽  
AYAKO HOSOI ◽  
KEIGO OSUGA ◽  
TAKAYUKI ENOMOTO ◽  
YUTAKA UEDA ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Single Dose ◽  
Neoadjuvant Chemotherapy ◽  
Radical Hysterectomy ◽  
Stage Ib

scholarly journals Perioperative treatments for stage IB–IIB uterine cervical cancer

2019 ◽  
Vol 50 (2) ◽  
pp. 99-103
Author(s):  
Muneaki Shimada ◽  
Hideki Tokunaga ◽  
Hiroaki Kobayashi ◽  
Mitsuya Ishikawa ◽  
Nobuo Yaegashi
Keyword(s):  
Cervical Cancer ◽  
High Risk ◽  
Neoadjuvant Chemotherapy ◽  
Radical Hysterectomy ◽  
Adjuvant Radiotherapy ◽  
Concurrent Chemoradiotherapy ◽  
Risk Groups ◽  
Perioperative Chemotherapy ◽  
Stage Ib ◽  
Risk Patients

Abstract Japan Society of Gynecologic Oncology guidelines recommended either radical hysterectomy-based approach or the definitive radiotherapy including concurrent chemoradiotherapy as primary treatment for patients with not only stage IB1/IIA1, but also stages IB2, IIA2 and IIB. Based on pathological findings of surgical specimens, patients who underwent radical hysterectomy are divided into three recurrent-risk groups, low-risk, intermediate, and high-risk groups. Although some authors reported the usefulness of adjuvant chemotherapy for intermediate/high-risk patients, radiotherapy was standard adjuvant treatment for pathological-risk patients after radical hysterectomy. It has been uncertain whether neoadjuvant chemotherapy followed by radical hysterectomy is beneficial for stage IB2–IIB patients. Recently, the randomized phase III study revealed that neoadjuvant chemotherapy followed by radical hysterectomy failed to improve survival of stage IB2–IIB patients compared to concurrent chemoradiotherapy. Majority of stage IB2–IIB patients are required adjuvant radiotherapy after radical hysterectomy. The multimodality strategy consisting of radical hysterectomy followed by adjuvant radiotherapy is associated with not only impaired quality of life, but also conflicting of cost-effectiveness. Thereby, some authors investigated the significance of multimodality strategy consisting of chemotherapy before/after radical hysterectomy for stage IB2–IIB cervical cancer. Multimodality strategy consisting of radical hysterectomy/perioperative chemotherapy needs higher curability of radical hysterectomy, higher response to perioperative chemotherapy and less perioperative complications. Consequently, gynecologic oncologists have to examine the patients strictly before treatment and judge whether radical hysterectomy-based approach or definitive irradiation is appropriate for the patient with stage IB–IIB cervical cancer.

Ten-Year Survival of Patients with Locally Advanced, Stage IB–IIB Cervical Cancer after Neoadjuvant Chemotherapy and Radical Hysterectomy

2001 ◽  
Vol 82 (1) ◽  
pp. 88-93 ◽  
Author(s):  
Youn Yeoung Hwang ◽  
Hyung Moon ◽  
Sam Hyun Cho ◽  
Kyung Tai Kim ◽  
Young Jin Moon ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Radical Hysterectomy ◽  
Locally Advanced ◽  
Advanced Stage ◽  
Stage Ib

scholarly journals Neoadjuvant Chemotherapy Followed by Surgery Versus Abdominal Radical Hysterectomy Alone for Oncological Outcomes of Stage IB3 Cervical Cancer—A Propensity Score Matching Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Weili Li ◽  
Wenling Zhang ◽  
Lixin Sun ◽  
Li Wang ◽  
Zhumei Cui ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Multivariate Analysis ◽  
Neoadjuvant Chemotherapy ◽  
Radical Hysterectomy ◽  
Protective Factor ◽  
Postoperative Radiotherapy ◽  
Disease Free Survival ◽  
Oncological Outcomes ◽  
Response To Chemotherapy ◽  
Sensitive Group

ObjectiveTo compare the 5-year overall survival (OS) and disease-free survival (DFS) of patients with cervical cancer who received neoadjuvant chemotherapy followed by surgery (NACT) with those who received abdominal radical hysterectomy alone (ARH).MethodsWe retrospectively compared the oncological outcomes of 1410 patients with stage IB3 cervical cancer who received NACT (n=583) or ARH (n=827). The patients in the NACT group were divided into an NACT-sensitive group and an NACT-insensitive group according to their response to chemotherapy.ResultsThe 5-year oncological outcomes were significantly better in the NACT group than in the ARH group (OS: 96.2% vs. 91.2%, respectively, p=0.002; DFS: 92.2% vs. 87.5%, respectively, p=0.016). Cox multivariate analysis suggested that NACT was independently associated with a better 5-year OS (HR=0.496; 95% CI, 0.281-0.875; p=0.015), but it was not an independent factor for 5-year DFS (HR=0.760; 95% CI, 0.505-1.145; p=0.189). After matching, the 5-year oncological outcomes of the NACT group were better than those of the ARH group. Cox multivariate analysis suggested that NACT was still an independent protective factor for 5-year OS (HR=0.503; 95% CI, 0.275-0.918; p=0.025). The proportion of patients in the NACT group who received postoperative radiotherapy was significantly lower than that in the ARH group (p&lt;0.001). Compared to the ARH group, the NACT-sensitive group had similar results as the NACT group. The NACT-insensitive group and the ARH group had similar 5-year oncological outcomes and proportions of patients receiving postoperative radiotherapy.ConclusionAmong patients with stage IB3 cervical cancer, NACT improved 5-year OS and was associated with a reduction in the proportion of patients receiving postoperative radiotherapy. These findings suggest that patients with stage IB3 cervical cancer, especially those who are sensitive to chemotherapy, might consider NACT followed by surgery.

scholarly journals The value of sentinel lymphadenectomy in radical operative treatment of cervical cancer

2009 ◽  
Vol 66 (7) ◽  
pp. 539-543 ◽  
Author(s):  
Vladimir Pazin ◽  
Svetlana Dragojevic ◽  
Zeljko Mikovic ◽  
Milan Djukic ◽  
Snezana Rakic ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Nodes ◽  
Sentinel Node ◽  
Cervical Carcinoma ◽  
Radical Hysterectomy ◽  
Predictive Value ◽  
Sentinel Nodes ◽  
Sentinel Lymphadenectomy ◽  
Stage Ib ◽  
The Mean

Background/Aim. Therapy of the early stages of cervical carcinoma is surgical or radiation therapy, and for advanced stages chemoradiotherapy. Pelvic and paraaortic lymphadenectomy in early stages offers the most important prognostic factor for survival. To evaluate the method and possible influence on surgical staging and therapy of the disease, we performed sentinel node (SN) identification and excision during open radical hysterectomy and lymphadenectomy in stage Ib-IIa cervical carcinoma. Methods. Fifty patients initially diagnosed with invasive squamous-cell cervical cancer stage Ib-IIa were included in the study. Only blue dye was used for sentinel node mapping. During the surgery sentinel nodes were identified and sent to histopathology separately from the other lymph nodes. After lymphadenectomy, radical hysterectomy was performed. Results. The mean age of our fifty patients was 49.10 years (SD = 5.92), and the mean number of extracted lymph nodes per patient was 25.78 (SD = 5.58). The number of sentinel nodes identified per patient was between 0 and 5, mean 2.60 (SD = 1.54). There were no inframesenteric paraaortic sentinel nodes found among the patients. The dominant tumor grades were 1 and 2, 40% and 50% respectively, and 37 out of 50 patients (74%) had tumor diameter less than 2 cm. In four patients (8%) SN were not identified. In the rest of 46 patients the presence of SN was bilateral (19 patients, 38%) or unilateral (27 patients, 54%). Positive SN were found in 17 patients (34%), and negative in 29 patients (58%). Out of the whole group of patients (50), 21 of them (42%) had positive lymph nodes (LN). In the crosstab statistics, no differences were noticed in the group without SN found, in comparison with tumor grade and diameter. Finally, our test showed sensitivity of 85% (SE = 8%), specificity 100%, positive predictive value of 100%, negative predictive value of 89.6% (SE = 5.6%), and effectiveness of 93% (SE = 3.6%) regarding sentinel lymphadenectomy. Conclusion. This method of sentinel lymph node identification is simple, but not reliable enough to support further laparoscopic SN excision in order to make the final decision about the treatment of cervical cancer.

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