scholarly journals The Belarus Experience of Pelvic Artery Embolisation in Patients with Advanced and Recurrent Cervical Cancer Presenting with Haemorrhage

2018 ◽  
Vol 14 (1) ◽  
pp. 45
Author(s):  
Olga P Matylevich ◽  
Vladimir V Akinfeev ◽  
Thomas C Randall ◽  
Kathleen M Schmeler ◽  
Oleg G Sukonko
Keyword(s):  
Cervical Cancer ◽  
Recurrent Disease ◽  
Locally Advanced ◽  
Primary Treatment ◽  
Recurrent Cervical Cancer ◽  
Gynecology And Obstetrics ◽  
Antineoplastic Treatment ◽  
Pelvic Artery ◽  
Invasive Intervention

To determine the efficacy of pelvic artery embolisation (PAE) in patients with locally advanced and recurrent cervical cancer (CC) complicated by haemorrhage, a retrospective study was performed of 81 patients with locally advanced or recurrent CC who underwent PAE for haemorrhage. Of the 81 patients included in the study, 68 (84%) had primary locally advanced CC and 13 (16%) had recurrent disease. Distribution of patients with primary disease according to the International Federation of Gynecology and Obstetrics (FIGO) stages was: IIB (n=4, 6%), IIIB (n=44, 65%), IV (n=20, 29%). The PAE controlled the haemorrhage in 76 patients (94%). After successful embolisation, 46 of 68 (68%) patients with primary CC started antineoplastic treatment a median of 3 days (range 1–17 days) after treatment. Twenty-nine of these women (43%) subsequently completed primary treatment for their disease. During the follow-up period, 67 patients (83%) died of disease and 4 (5%) died of other causes. The adjusted 1-year survival was 41.4% (standard error [SE] 5.6%), 5-year survival was 17.9% (SE 4.5%), and median adjusted survival was 8.4 months. Survival of the 22 patients (32%) who did not receive further treatment and 46 patients (68%) who continued the treatment was significantly different, with a 1-year adjusted survival of 15.2% (SE 8.1%) and 53.5% (SE 7.4%) respectively. None of the patients who did not receive further treatment survived 5 years, whereas in the group undergoing further treatment, the 5-year adjusted survival was 24.0% (SE 6.8%) and the median adjusted survival was 5.4 months and 12.8 months, respectively (p<0.001). Pelvic artery embolisation was effective in controlling haemorrhage in 94% of patients with locally advanced and recurrent CC. Sixty-eight percent of patients were able to undergo further antitumor treatment. Pelvic artery embolisation is a minimally invasive intervention that can be effective at any stage of treatment in patients with CC presenting with haemorrhage.

Adjuvant chemotherapy following chemoradiation as primary treatment for locally advanced cervical cancer compared to chemoradiation alone: The randomized phase III OUTBACK Trial (ANZGOG 0902, RTOG 1174, NRG 0274).

2021 ◽  
Vol 39 (18_suppl) ◽  
pp. LBA3-LBA3
Author(s):  
Linda R. Mileshkin ◽  
Kathleen N. Moore ◽  
Elizabeth Barnes ◽  
Val Gebski ◽  
Kailash Narayan ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Adjuvant Chemotherapy ◽  
Locally Advanced ◽  
Disease Recurrence ◽  
Primary Treatment ◽  
Phase Iii ◽  
Advanced Cervical Cancer ◽  
Treatment Groups ◽  
Locally Advanced Cervical Cancer

LBA3 Background: Cervical cancer is a common cause of cancer-related death among women worldwide. Standard treatment for locally advanced disease is chemoradiation. However, a significant percentage of women still relapse and die from the development of distant metastatic disease. OUTBACK was designed to determine the effects of giving adjuvant chemotherapy after chemoradiation on survival. Methods: OUTBACK is an international randomized phase III trial of the Gynecologic Cancer InterGroup (GCIG). Participating groups (countries) included ANZGOG (Australia and New Zealand), NRG (USA, Saudi Arabia, Canada, China), and Singapore. Eligible women had locally advanced cervical cancer (FIGO 2008 stage IB1 and node positive, IB2, II, IIIB or IVA) that was suitable for primary treatment with chemo-radiation with curative intent. Women were randomly assigned to either standard cisplatin-based chemo-radiation (control) or standard cisplatin-based chemo-radiation followed by adjuvant chemotherapy (ACT) with 4 cycles of carboplatin and paclitaxel, after stratification for nodal status, participating site, FIGO stage, age, and planned extended-field radiotherapy. The primary end point was overall survival (OS) at 5 years. Secondary endpoints included progression-free survival (PFS); adverse events (AE); and patterns of disease recurrence. The target sample size of 900 provided 80% power with 95% confidence to detect an improvement in OS at 5 years from 72% (control) to 80% (ACT), with some over-accrual to account for non-compliance with ACT and loss to follow-up. Results: 919 of 926 women recruited from April 2011 to June 2017 were eligible and included in the primary analysis: 463 assigned ACT, 456 control. ACT was started in 361 (78%) women assigned to receive it. Median follow-up was 60 months (IQR 45-65). OS at 5 years was similar in those assigned ACT versus control (72% vs 71%, difference <1%, 95% CI -6 to +7; P = 0.91). The hazard ratio for OS was 0·91, (95% CI 0.70 to 1.18). PFS at 5 years was similar in those assigned ACT versus control (63% vs 61%, difference 2%, 95% CI -5 to +9; P = 0.61). The hazard ratio for PFS was 0·87, (95% CI 0.70 to 1.08). AE of grade 3-5 within a year of randomisation occurred in 81% who were assigned and received ACT versus 62% assigned control. There was no evidence of differences between treatment groups in AE beyond 1 year of randomisation. Patterns of disease recurrence were similar in the two treatment groups. Conclusions: Adjuvant chemotherapy given after standard cisplatin-based chemoradiation for women with locally advanced cervical cancer did not improve OS or PFS. Clinical trial information: ACTRN12610000732088.

Is Routine Curettage a Useful Tool to Evaluate Persistent Tumor in Patients Who Underwent Primary Chemoradiation for Locally Advanced and/or Lymph Node Positive Cervical Cancer?

2017 ◽  
Vol 27 (6) ◽  
pp. 1216-1221 ◽  
Author(s):  
Simone Marnitz ◽  
Eva Christine Abt ◽  
Peter Martus ◽  
Audrey Tsunoda ◽  
Christhardt Köhler
Keyword(s):  
Cervical Cancer ◽  
Locally Advanced ◽  
Histological Finding ◽  
International Federation ◽  
Positive Finding ◽  
Response Evaluation ◽  
Surgical Morbidity ◽  
Gynecology And Obstetrics ◽  
Impact On Survival

ObjectiveResponse evaluation after primary chemoradiation (RCTX) in patients with cervical cancer remains difficult. Routine hysterectomy after primary RCTX is associated with considerable surgical morbidity without impact on survival. The purpose of the present study was to evaluate value of routine curettage after RCTX to detect persistent tumor.MethodsBetween 2006 and 2012, patients (n = 217) with cervical cancer in International Federation of Gynecology and Obstetrics stages IB1 N1 (14%), IB2 (9%), IIA (5%), IIB (46%), IIIA (4%), IIIB (15%), IVA (6%), and IVB (1%), respectively, underwent primary RCTX. After RCTX, curettage was recommended to all patients to evaluate response.ResultsIn 136 (63%) of patients with cervical cancer, 1 or 2 consecutive curettages were performed at least 6 weeks after primary RCTX without any complications. In 21 (15%) patients, at least 1 curettage was positive for cervical cancer. In 7 patients, secondary hysterectomy was performed after 1 positive finding and persistent tumor was found in all of them. In the remaining 14 patients, there were 2 positive curettages in 5, 1 undetermined result followed by 1 positive in 3, and 1 positive followed by 1 negative in 6 patients, respectively. In the latter group, no tumor was detected in the uterus, whereas in all other patients with 2 curettages except one, residual carcinoma was detected. Five (24%) of 21 patients with positive histology are free of disease during follow-up. Decision for or against secondary hysterectomy was correct due to histological finding of curettage in 99%.ConclusionsRoutine curettage is a useful tool to guide decision for secondary hysterectomy with high accuracy after primary RCTX and avoids overtreatment.

Abdominal Scar Recurrences of Cervical Cancer: Incidence and Characteristics: A Case-Control Study

2010 ◽  
Vol 20 (6) ◽  
pp. 1031-1040 ◽  
Author(s):  
Sabrina A. H. M. van den Tillaart ◽  
Annelies Schoneveld ◽  
Inge T. Peters ◽  
J. Baptist M. Trimbos ◽  
Astrid Van Hylckama Vlieg ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Recurrent Disease ◽  
Figo Stage ◽  
Resection Margins ◽  
Control Group ◽  
Case Group ◽  
Tumor Diameter ◽  
Gynecology And Obstetrics ◽  
Mean Time

Background:Tumor recurrence in the surgical scar after radical hysterectomy for cervical cancer has been reported, but the incidence is unknown. Facts about patient and tumor characteristics and follow-up are lacking. The objective of this study was to analyze the incidence and characteristics of cervical cancer scar recurrences.Methods:All patients who were surgically treated for cervical cancer in our center between 1984 and 2007 were reviewed for scar recurrences. For each case, 5 random controls were selected. Clinical characteristics were compared between the cases and controls.Results:Eleven (1.3%) of 842 patients developed a scar recurrence. Mean time between surgery and scar recurrence was 16 months (range, 2-45 months). For 8 patients (73%), the scar recurrence was the first disease recurrence. Five patients (45%) died, and 2 (18%) were lost to follow-up. Mean time between scar recurrence and death was 9 months. Ninety-one percent of the cases had recurrent disease besides the scar recurrence during follow-up. The case group had a higher percentage of advanced FIGO (International Federation of Gynecology and Obstetrics) stage and postoperatively found involvement of parametria or resection margins and tumor diameter greater than 4 cm, whereas lymph nodes were more often involved in the control group.Conclusions:The incidence of scar recurrences after primary surgery for cervical cancer was 1.3%. Time to development was variable, and prognosis was poor. Besides higher FIGO stage and concurrent unfavorable pathological characteristics, we found no outstanding characteristics of patients with scar recurrence. Scar recurrences go hand in hand with recurrent disease at other locations and seem a manifestation of tumors with extensive metastatic potential.

3D HDR intracavitary brachytherapy combined with complementary applicator-guided external beam radiotherapy for 338 patients with stage IIB-IIIB uterine cervical cancer: A single-center phase II prospective study with long-term follow-up.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 5530-5530 ◽  
Author(s):  
Jin Yi Lang ◽  
Zixuan Fan ◽  
Peng Xu ◽  
Mei Feng ◽  
Weidong Wang
Keyword(s):  
Cervical Cancer ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
Uterine Cervical Cancer ◽  
Intracavitary Brachytherapy ◽  
External Beam ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer ◽  
Gynecology And Obstetrics

5530 Background: For uterine cervical cancer (UCC) patients with asymmetric parametric lesions, 3D HDR-intracavitary brachytherapy (HDR-ICBT) could not cover all the lesions, resulting in residual lesion and treatment failure. To settle this problem, a novel treatment modal of 3D HDR-ICBT combined with complementary applicator-guided external beam radiotherapy (EBRT) was used for UCC patients with stage IIB-IIIB in present study. Methods: Between June 2010 and June 2015, 338 patients with locally advanced cervical cancer (International Federation of Gynecology and Obstetrics stage IIB-IIIB) were treated with concurrent chemoradiotherapy. Imaged guided IMRT was used for external beam radiotherapy, 45Gy/25f. The chemotherapy was weekly cisplatin (40mg/m2). Four fractions of 3D HDR-ICBT combined with complementary applicator-guided external beam radiotherapy were used. The prescribed dose for HR-CTV and IR-CTV was 7Gy (D90) and 5Gy (D90). Dose constraints for organs at risk were D2cc <70 Gy for rectum, and D2cc<90 Gy for bladder in terms of equivalent total dose in 2 Gy fractions as GEC-ESTRO recommendations. Results: Median follow-up was 64 months (11–71 months). The D90 of GTV, HR-CTV, and IR-CTV in all cases were 93.4 (85.1-107.8) Gy, 86.4 (79.9-91.3) Gy and 72.3 (70.8-75.2) Gy, respectively. The D2CC of bladder, rectum and sigmoid were 74.3Gy、65.5Gy and 64.1Gy, respectively. 5-year LRC, DFS, and OS was 90.8%, 84.1% and 80.8%, respectively. Treatment was well tolerated. The grade ≥3 genitourinary and gastrointestinal acute and late toxicities were 2.1% and 5.2%, respectively. Conclusions: The combination of HDR-ICBT with an applicator-guided IMRT is feasible for uterine cervical cancer patients with asymmetric parametric lesions. Further study is needed to determine whether this treatment modal could be used to replace the invasive interstitial brachytherapy (ISBT) in the cases of locally advanced cervical cancer where HR-CTV coverage cannot be obtained with ICBT.

Long Follow-up of Patients With Locally Advanced Cervical Cancer Treated With Concomitant Chemobrachyradiotherapy With Cisplatin and Ifosfamide Followed by Consolidation Chemotherapy

2015 ◽  
Vol 25 (2) ◽  
pp. 315-319 ◽  
Author(s):  
Branka Petric Miše ◽  
Tihana Boraska Jelavic ◽  
Ante Strikic ◽  
Darijo Hrepic ◽  
Krešimir Tomic ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Locally Advanced ◽  
Late Toxicity ◽  
Local Control Rate ◽  
Advanced Cervical Cancer ◽  
Consolidation Chemotherapy ◽  
Locally Advanced Cervical Cancer ◽  
Gynecology And Obstetrics ◽  
Valuable Treatment

ObjectivesLocally advanced cervical cancer (LACC) is one of the leading health problems of the developing countries. We present long-term outcomes of treatment with a concomitant chemobrachyradiotherapy followed by consolidation chemotherapy regimen.Materials and MethodsWe treated 118 patients with LACC (International Federation of Gynecology and Obstetrics stages IB2-IVA) with external radiotherapy (50 Gy in 25 fractions) and concomitant chemobrachyradiotherapy (low-dose rate). Chemotherapy was applied during brachyradiotherapy (cisplatin on day 1 in combination with 24-hour infusion of ifosfamide and mesna uroprotection). Four cycles of consolidation chemotherapy were given starting 4 weeks after the second concomitant chemobrachyradiotherapy cycle.ResultsAfter median follow-up period of 99.3 months, we observed acceptable acute and late toxicity, local control rate of 97.5%, and an overall survival of 74.6% at 96 months.ConclusionsChemobrachyradiotherapy regimen followed by consolidation chemotherapy described in this article is a valuable treatment option for LACC.

scholarly journals Emergency Embolization of Pelvic Vessels in Patients With Locally Advanced Cervical Cancer and Massive Vaginal Bleeding: A Case Series in a Latin American Oncological Center

2020 ◽  
pp. 1376-1383
Author(s):  
Adriana Alméciga ◽  
Juliana Rodriguez ◽  
Julián Beltrán ◽  
James Sáenz ◽  
Abel Merchán ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Latin American ◽  
Vaginal Bleeding ◽  
Recurrent Disease ◽  
Locally Advanced ◽  
Case Series ◽  
Severe Bleeding ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer

PURPOSE Locally advanced cervical cancer may present with uncontrollable vaginal bleeding in up to 70% of cases. Pelvic vessel embolization has been used as an urgent maneuver for achieving fast hemostatic control. This report describes outcomes of selective pelvic vessel embolization in patients with severe bleeding due to a locally advanced cervical cancer. METHODS In this retrospective study, technical aspects, clinical variables, and bleeding-related morbidity were described. The frequency of recurrent disease and the vital status at 1 year of follow-up were determined. Analysis was performed with statistical software R, version 3.6.2. The setting was Instituto Nacional de Cancerología- Bogotá, Colombia, between January 2009 and July 2017. RESULTS A total of 47 patients were included. Median age was 44 years (range, 26-70 years). The pre-embolization median hemoglobin level was 7.9 g/dL (range, 5.0-11.3 g/dL). Blood transfusions were administered to 41 women (87.2%). Bleeding control was achieved in 95.7% of cases in the first 24 hours after the embolization. There were no major complications. In 17 cases (36.2%), minor complications were reported; the most common was pelvic pain. In 17.1% of cases, a second embolization was required. After 12 months of follow-up, 27.7% of patients were alive without disease, 44.7% were alive with disease, and 25.5% of them have died of cervical cancer progression. CONCLUSION Selective pelvic vessel embolization is a useful alternative in patients with locally advanced cervical cancer and life-threatening bleeding. Its impact on recurrent disease and death due to oncologic cause is not clear.

SURGERY FOR RESIDUAL DISEASE AFTER RADIOTHERAPY IN LOCALLY ADVANCED CERVICAL CANCER

2019 ◽  
Vol 65 (5) ◽  
pp. 721-725
Author(s):  
Elmira Shakirova ◽  
Andrey Panov ◽  
Alevtina Akhmetzyanova ◽  
Aliya Gafiullina ◽  
L. Ibragimova ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Residual Disease ◽  
Locally Advanced ◽  
Residual Tumor ◽  
Advanced Cervical Cancer ◽  
Mri Imaging ◽  
Recurrent Cervical Cancer ◽  
Locally Advanced Cervical Cancer ◽  
Visible Effect ◽  
Adjuvant Hysterectomy

Aims: Chemoradiation (CRT) is the standard treatment for locally advanced cervical cancer (LACC). However part of the patients develop recurrence during the first year after treatment despite good visible effect at the first follow-up. The role of completion surgery after radiotherapy (RT) is still debated. A number of papers have showed that up to 60% of patients have residual tumor after CRT and RT. But such a surgery is not widely recommended because of increased morbidity of the treatment. The aim of this study was to assess the results of surgery after radiotherapy of LACC. Method: We retrospectively evaluated data on 86 patients with cervical cancer IB - IIIB stages (mostly stage IIB) who underwent surgery in different modalities after CRT and RT with good clinical response in our department in 2015-2018. Results: When small asymptomatic residual disease was detected early after radiotherapy radical hysterectomy was feasible in most of the cases. Patients with clinical manifestation of recurrence had very poor prognosis. Surgery of recurrent cervical cancer sufficiently deteriorates quality of life, even if possible. Conclusion: Thorough examination with adding MRI imaging after initial treatment of cervical cancer needed to identify patients who may benefit from adjuvant hysterectomy.

scholarly journals PD-1 Inhibitor Maintenance Therapy Combined Iodine-125 Seed Implantation Successfully Salvage Recurrent Cervical Cancer after CCRT: A Case Report

2021 ◽  
Vol 28 (6) ◽  
pp. 4577-4586
Author(s):  
Guangchao Wei ◽  
Fuxin Guo ◽  
Ang Qu ◽  
Weijuan Jiang ◽  
Yuliang Jiang ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Partial Response ◽  
Checkpoint Inhibitors ◽  
Organs At Risk ◽  
Recurrence Rates ◽  
Recurrent Cervical Cancer ◽  
Seed Implantation ◽  
Normal Tissues ◽  
Gynecology And Obstetrics ◽  
Choice Of Treatment

Cervical cancer is the fourth most common cancer in females worldwide. Patients with stage III and IV cervical cancer based on the Federation of Gynecology and Obstetrics (FIGO) classification have higher recurrence rates. Because of organs at risk (OAR) protection and the low indication rate of salvage surgery, the choice of treatment is always challenging. Systemic chemotherapy is palliative and can be performed in conjunction with surgery or radiotherapy; however, it has no significant benefit to survival. Brachytherapy and stereotactic body radiotherapy (SBRT) are characterized by extremely high radiation doses applied to tumor cells while sparing the normal tissues. Several studies have investigated the efficacy of these technologies in recurrent cervical cancer and showed promising results. The immune checkpoint inhibitors approach was also investigated and showed promising results too. Herein, we report a case of a patient with cervical cancer that recurred five months after adjuvant chemotherapy and concurrent chemoradiotherapy. The disease prognosis after interstitial implantation brachytherapy (IIB) was determined. Then, the patient underwent radioactive 125I-seed implantation combined with PD-1 inhibitor treatment. The patient exhibited a partial response after seed implantation, and up to now, the duration of this partial response was 24 months.

Follow up protocols for women with cervical cancer after primary treatment

2010 ◽  
Author(s):  
Anne Lanceley ◽  
Mary McCormack ◽  
Eleanor Armstrong ◽  
Alison Fiander ◽  
Hilary Jefferies ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Primary Treatment

Premalignant and malignant disease of the cervix

2020 ◽  
pp. 766-776
Author(s):  
Walter Prendiville
Keyword(s):  
Cervical Cancer ◽  
Ovarian Function ◽  
Early Stage ◽  
Locally Advanced ◽  
Developed Countries ◽  
High Coverage ◽  
Hpv Dna ◽  
Gynecology And Obstetrics ◽  
Cervical Stroma ◽  
Specialist Nurses

Cervical cancer is a disease of poor and unscreened populations. Globally, it is the fourth most common cancer in women with over half a million new cases and over a quarter of a million deaths per year. About 85% of cases occur in less developed regions. Systematic high coverage and quality-assured population screening for precursors to cervical cancer is highly effective. Human papillomavirus (HPV) DNA testing will probably replace or complement cytology as the primary screening tool in many developed countries for women over 30 years of age. Because of the absolute relationship between oncogenic HPV and cervical cancer, its negative predictive value is very high. Management of cervical cancer is to determine the stage of the disease and to treat both the primary lesion and other extracervical disease. Cervical cancers spread by direct spread into the cervical stroma, parametrium, and beyond, and by lymphatic metastasis into parametrial, pelvic sidewall, and para-aortic nodes. Women should be fully staged using the International Federation of Gynecology and Obstetrics system and discussed in expert multidisciplinary forums with specialist surgeons, oncologists, pathologists, radiologists, and specialist nurses. Both surgery and radiotherapy are effective in early-stage disease, whereas locally advanced disease relies on treatment by radiation or chemoradiation. Surgery does provide the advantage of conservation of ovarian function. Women who have been treated for cervical precancer are much more likely to develop cervical cancer. Post-treatment HPV testing is the most sensitive test, has the best negative predictive values, and is the best test of cure.

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