scholarly journals Novel approaches to diagnostic imaging of locally advanced cervical cancer

2019 ◽  
Vol 18 (2) ◽  
pp. 83-91
Author(s):  
N. G. Trukhacheva ◽  
I. G. Frolova ◽  
L. A. Kolomiets ◽  
A. V. Usova ◽  
E. G. Grigor’ev ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Diagnostic Imaging ◽  
Lymph Nodes ◽  
Fdg Pet ◽  
Locally Advanced ◽  
Radiotherapy Planning ◽  
Advanced Cervical Cancer ◽  
Contrast Enhanced Ultrasound ◽  
Locally Advanced Cervical Cancer ◽  
Contrast Enhanced

Cervical cancer is the second most common cancer after breast cancer and the third most common cause of cancer-related death followed by breast and lung cancers among women worldwide. advances in diagnostic imaging techniques provide better assessment of regional and distant cervical cancer metastasis. the use of contrast-enhanced ultrasound is a revolutionary imaging modality; it has several advantages over ct: no radiation exposure, nephrotoxicity, obtaining real-time information, relatively low cost and ease of use. currently, the contrast agent sonoVue is widely used in ultrasound imaging of liver, kidneys and pancreas lesions, as well as for closed abdominal injuries, multiple organ failure, breast and prostate cancers, etc. However, the role of contrast-enhanced ultrasound in gynecology is not clearly established. one of the most effective tools for the detection of locally advanced cervical cancer is mRi, which is used mainly to determine the local extent of the tumor. However, the use of functional mRitechniques has not yet been included in the standards. cervical cancer tissue has been found to show significantly lower diffusion-weighted imaging (dWi) values than normal cervical tissue, thus facilitating the detection of tumor and its spread. dWiis also used for differentiating changes after biopsy from residual tumor and for identifying small lymph nodes. the pEt/cttechnique combines the metabolic images of pEtwith anatomical images of ctand is more accurate than high resolution ctalone, especially in determining the involvement of regional lymph nodes and distant organs. 18-Fdg-pEt/cthas been successfully used for accurate staging of the disease (especially late stage), assessment of treatment response, radiotherapy planning, and detection of disease progression. in patients with advanced stages of cervical cancer (iiBiV stage), the 18-Fdg-pEt/ ctfindings can determine the treatment strategy in most cases, primarily due to high sensitivity (75–100 %) and specificity (87–100 %) in the detection of lymph node metastases.

THE ROLE OF SURGICAL STAGE IN COMBINATION THERAPY FOR PATIENTS WITH LOCALLY ADVANCED CERVICAL CANCER

2019 ◽  
Vol 65 (5) ◽  
pp. 749-755
Author(s):  
D. Reyes Santyago ◽  
Anzhella Khadzhimba ◽  
M. Smirnova ◽  
Sergey Maksimov
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Combination Therapy ◽  
Lymph Nodes ◽  
Locally Advanced ◽  
Advanced Cervical Cancer ◽  
Relapse Free Survival ◽  
Regional Lymph Nodes ◽  
Free Survival ◽  
Locally Advanced Cervical Cancer

Objective: to justify the expediency of the surgical stage as a part of the combination treatment for stage IIA-IIIB cervical cancer. Materials and methods. The study included 343 women with stage IIA-IIIB cervical cancer treated from 2013 to 2016 with mandatory follow-up for at least 2 years. Patients were divided into 2 groups. The first group included 214 patients who received a combination treatment. At the first stage, neoadjuvant chemoradiation therapy was performed (remote radiation therapy 5 days a week with radio modification with Cisplatin once a week at a dose of 40 mg/m2). After evaluating the effect, patients were subjected to surgical treatment or continued chemoradiotherapy. The second group (n = 129) received standard combined radiation therapy. Various schemes of combination and complex treatment and standard combined radiation therapy were evaluated using the indices of general and relapse-free survival. Results. The proposed scheme for the combination therapy for patients with locally advanced cervical cancer showed significantly higher survival rates at all the analyzed stages. For the combined treatment group with complete cytoreduction, the two-year overall and relapse-free survival with stage IIA is 94.1% vs. 82.4%, with IIB 90.8% vs. 80.3%, with IIB 87.5% vs. 75%, with IIB with metastatic lesion of regional lymph nodes 85% vs. 70%. For the second group, two-year overall and relapse-free survival with stage IIA 75% vs. 50%, with IIB 70.9% vs. 56.3%, with IIB 59.1% vs. 40.9%, with IIB with metastatic lesion of regional lymph nodes 62.2% and 40.5%. The advantages of this approach are most clearly seen within patients with metastatic lesions of regional lymph nodes (85% vs. 62% accordingly). Conclusion. Cytoreductive surgery in combination with the combination therapy allows to achieve a significant increase in overall and relapse-free survival for patients with locally advanced cervical cancer compared with standard treatment programs.

scholarly journals Is Prophylactic Irradiation to Para-aortic Lymph Nodes in Locally Advanced Cervical Cancer Necessary?

2014 ◽  
Vol 46 (4) ◽  
pp. 374-382 ◽  
Author(s):  
Seung Gyu Park ◽  
Jin Hee Kim ◽  
Young Kee Oh ◽  
Sang Jun Byun ◽  
Mi Young Kim ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Nodes ◽  
Locally Advanced ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer ◽  
Prophylactic Irradiation

scholarly journals Impact of radiation dose and standardized uptake value of (18)FDG PET on nodal control in locally advanced cervical cancer

2015 ◽  
Vol 54 (9) ◽  
pp. 1567-1573 ◽  
Author(s):  
Anne Ramlov ◽  
Petra S. Kroon ◽  
Ina M. Jürgenliemk-Schulz ◽  
Astrid A. C. De Leeuw ◽  
Lars Christian Gormsen ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Dose ◽  
Fdg Pet ◽  
Locally Advanced ◽  
Standardized Uptake Value ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer ◽  
Nodal Control

Circulating Human Papillomavirus DNA as a Biomarker of Response in Patients With Locally Advanced Cervical Cancer Treated With Definitive Chemoradiation

2018 ◽  
pp. 1-8 ◽  
Author(s):  
Kathy Han ◽  
Eric Leung ◽  
Lisa Barbera ◽  
Elizabeth Barnes ◽  
Jennifer Croke ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Fdg Pet ◽  
Residual Disease ◽  
Locally Advanced ◽  
Progression Free Survival ◽  
Advanced Cervical Cancer ◽  
Free Survival ◽  
Hpv Dna ◽  
Locally Advanced Cervical Cancer ◽  
Undetectable Plasma

Purpose To determine whether plasma human papillomavirus (HPV) DNA predates clinical recurrence and compare its accuracy with 3-month fluorodeoxyglucose positron emission tomography (FDG-PET) in locally advanced cervical cancer. Methods This prospective multicenter study accrued 23 women with stage IB to IVA cervical cancer planned for definitive chemoradiation therapy (CRT). Plasma HPV DNA was measured serially by digital polymerase chain reaction, and FDG-PET was performed at 3 months post-CRT. Results Of the 19 women with HPV+ cervical cancer included in this analysis, 32% were stage IB, 58% IIB, and 10% IIIB/IVA. Median follow-up was 24 months (range, 18 to 30 months). All patients had detectable plasma HPV DNA before treatment. Six patients had detectable plasma HPV DNA at the end of CRT, and three of them developed metastases at 3 months. Of the 13 patients with undetectable plasma HPV DNA at end of CRT, to date, only one has developed recurrence. Six of those 13 patients had a positive 3-month FDG-PET with no definite residual disease on subsequent imaging or clinical examination to date, and four of these six had undetectable plasma HPV DNA at 3 months. Patients with undetectable plasma HPV DNA at end of CRT had significantly higher 18-month progression-free survival than those with detectable plasma HPV DNA (92% v 50%; P = .02). The area under the receiver operating characteristic curve (accuracy) of 3-month plasma HPV DNA and 3-month FDG-PET imaging for predicting recurrence at 18 months were 77% and 60%, respectively ( P = .008). Conclusion Detectable plasma HPV DNA at end of CRT predates the clinical diagnosis of metastases and is associated with inferior progression-free survival. Moreover, 3-month plasma HPV DNA level is more accurate than 3-month FDG-PET imaging in detecting residual disease. The clinical utility of plasma HPV DNA detection for guiding adjuvant/salvage therapy should be evaluated in future studies.

Risk Assessment Tool for Distant Recurrence After Platinum-Based Concurrent Chemoradiation in Patients With Locally Advanced Cervical Cancer: A Korean Gynecologic Oncology Group Study

2012 ◽  
Vol 30 (19) ◽  
pp. 2369-2374 ◽  
Author(s):  
Sokbom Kang ◽  
Byung-Ho Nam ◽  
Jeong-Yeol Park ◽  
Sang-Soo Seo ◽  
Sang-Young Ryu ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Clinical Trials ◽  
Fdg Pet ◽  
Locally Advanced ◽  
Distant Recurrence ◽  
Competing Risk ◽  
Advanced Cervical Cancer ◽  
Concordance Index ◽  
Good Discrimination ◽  
Locally Advanced Cervical Cancer

Purpose Our study aimed to develop a model to predict distant recurrence in locally advanced cervical cancer, which can be used to select high-risk patients in enriched clinical trials. Patients and Methods Our study was a retrospective analysis of a multi-institutional cohort of patients treated between 2001 and 2009. According to the order of data submission, data from three institutions were allocated to a model development cohort (n = 434), and data from the remaining two institutions were allocated to an external validation cohort (n = 115). Patient information including [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) data and clinical outcome was modeled using competing risk regression analysis to predict 5-year cumulative incidence of distant recurrence. Results The competing risk analysis revealed that the following four parameters were significantly associated with distant recurrence: pelvic and para-aortic nodal positivity on FDG-PET, nonsquamous cell histology, and pretreatment serum squamous cell carcinoma antigen levels. This four-parameter model showed good discrimination and calibration, with a bootstrap-adjusted concordance index of 0.70. Also, the validation set showed good discrimination with a bootstrap-adjusted concordance index of 0.73. A user-friendly Web-based nomogram predicting 5-year probability of distant recurrence was developed. Conclusion We have developed a robust model to predict the risk of distant recurrence in patients with locally advanced cervical cancer. Further, we discussed how the selective enrichment of the patient population could facilitate clinical trials of systemic chemotherapy in locally advanced cervical cancer.

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