scholarly journals Should the Number of Metastatic Pelvic Lymph Nodes Be Integrated into the 2018 Figo Staging Classification of Early Stage Cervical Cancer?

Cancers ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1552
Author(s):  
Luigi Pedone Anchora ◽  
Vittoria Carbone ◽  
Valerio Gallotta ◽  
Francesco Fanfani ◽  
Francesco Cosentino ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Nodes ◽  
Early Stage ◽  
Disease Free Survival ◽  
Staging System ◽  
Lymph Node Status ◽  
P Value ◽  
Pelvic Lymph Nodes ◽  
Early Stage Cervical Cancer ◽  
The Impact

Introduction: Lymph node status has become part of the new staging system for cervical cancer (CC). It has been shown that patients staged as IIIC1 had heterogeneous prognoses and, in some cases, experienced better outcomes than patients with lower stages. We evaluated the impact of the number of metastatic pelvic lymph nodes (MPLNs) among patients with stage IIIC1 cervical cancer. Methods: Survival analyses were conducted in order to identify the best cut-off prognostic value relative to the number of MPLNs. Disease free survival (DFS) was considered the main outcome. Results: 541 patients were included in the study. Eighty-nine patients were of stage IIIC1. The best prognostic cut-off value of the number of MPLNs was 2. Patients with >2 MPLNs (n > 2 group) had worse DFS compared with those having <2 (N1-2 group) (5 yr DFS: 54.7% vs. 78.1%, p value = 0.006). Multivariate analyses demonstrated that the extent of MPLNs had little impact on DFS and that replacement of IIIC1 staging with N1-2 and n > 2 grouping provided a better, statistically significant model (p value = 0.006). Discussion: Using a cut-off value of 2, the number of MPLNs could better predict prognostic outcomes within stage IIIC1 cervical cancer and have potential implications for therapeutic decision-making in the treatment of patients with stage IIIC1 CC.

A Phase I Study of Concurrent Weekly Carboplatin and Paclitaxel Combined With Intensity-Modulated Pelvic Radiotherapy as an Adjuvant Treatment for Early-Stage Cervical Cancer Patients With Positive Pelvic Lymph Nodes

2013 ◽  
Vol 23 (7) ◽  
pp. 1279-1286 ◽  
Author(s):  
Seiji Mabuchi ◽  
Ryoko Takahashi ◽  
Fumiaki Isohashi ◽  
Takeshi Yokoi ◽  
Kimihiko Ito ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Dose Level ◽  
Adjuvant Treatment ◽  
Early Stage ◽  
Pelvic Radiotherapy ◽  
Pelvic Lymph Nodes ◽  
Early Stage Cervical Cancer ◽  
Grade 3

ObjectivesThe objective of this study was to determine the maximum tolerated dose (MTD) and acute dose-limiting toxicities (DLTs) of intravenous carboplatin plus paclitaxel combined with intensity-modulated pelvic radiotherapy (pelvic IMRT) as an adjuvant treatment for early-stage cervical cancer patients with positive pelvic lymph nodes.MethodsWomen with uterine cervical cancer who were treated with radical hysterectomy and pelvic lymphadenectomy and displayed positive pelvic lymph nodes were eligible for this study. The patients were postoperatively treated with pelvic IMRT (50.4 Gy). The concurrent weekly chemotherapy consisted of carboplatin (area under the curve [AUC], 2) and paclitaxel (starting at 35 mg/m2and escalating by 5 mg/m2in 3 patient cohorts). The primary end point of the escalation study was acute DLT that occurred within 30 days of the completion of radiation therapy.ResultsNine patients were enrolled and treated at 2 dose levels until DLT occurred. The median age of the patients was 47 years (range, 28–66 years). The median radiotherapy treatment time was 39.5 days (range, 38–64 days). At dose level I (35 mg/m2paclitaxel), 2 grade 3 leukopenia and a neutropenia were observed, but no DLT occurred. At dose level II (40 mg/m2paclitaxel), the first patient experienced a grade 2 hypersensitive reaction, which resulted in discontinuation of planned treatment. Thus, 2 more patients were evaluated at this dose level. Of these, 1 patient experienced febrile neutropenia, which was considered to be a DLT, and the other patient experienced long-lasting grade 3 leukopenia and grade 3 neutropenia, which resulted in the discontinuation of chemotherapy for 2 weeks (a DLT). We then evaluated 3 more patients at dose level 1, but no DLT occurred. The MTD of paclitaxel and carboplatin was thus defined as 35 mg/m2and an AUC of 2.0, respectively.ConclusionsWeekly paclitaxel/carboplatin and pelvic IMRT is a reasonable adjuvant treatment regimen for cervical cancer patients after radical hysterectomy. The MTD of paclitaxel and carboplatin for future phase II trials of this regimen is 35 mg/m2and an AUC of 2.0, respectively.

scholarly journals Impact of surgeon learning curve in minimally invasive radical hysterectomy on early stage cervical cancer patient survival

2021 ◽  
Vol 13 (3) ◽  
pp. 233-244
Author(s):  
L Pedone Anchora ◽  
N Bizzarri ◽  
V Gallotta ◽  
V Chiantera ◽  
F Fanfani ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Minimally Invasive ◽  
Learning Curve ◽  
Early Stage ◽  
Disease Free Survival ◽  
Free Survival ◽  
Surgeon Experience ◽  
Early Stage Cervical Cancer ◽  
The Impact ◽  
Disease Free

Background: Recently, it has been sustained that only surgeons skilled in minimally invasive radical hysterectomy (MI-RH) could provide valuable oncological outcomes in early-stage cervical cancer. Still, literature lacks data correlating surgeon experience with patient survival rate. We aimed to investigate the impact of surgeon training on this rate. Methods: This is a retrospective study of 243 early-stage cervical cancer treated with MI-RH. Multiple regression analyses were undertaken to investigate the impact of the surgeons learning curve, according to the number of MI-RH, on patients prognosis. Results: A steady trend of reduction in disease recurrence risk is associated with increased surgeon experience. The peak of the learning curve was shown at the 19th MI-RH (hazard ratio of disease-free survival: 0.321; 95%CI: 0.140-0.737; p= 0.007). The 3 years disease-free survival that a surgeon could provide to patients is significantly lower at the beginning of his/her learning path comparing to what he/she could guarantee once adequate experience had been achieved (75.4% and 91.6% respectively, p=0.005). Surgeon experience appears to be an independent prognostic factor. Conclusion: The experience that a surgeon can achieve practicing in MI-RH significantly influences oncological outcomes of early-stage cervical cancer patients. Future studies comparing minimally invasive and open surgery should take this into account. It would be advisable that the scientific community precisely establishes the minimum training required in the field of MI-RH for early-stage cervical cancer.

scholarly journals Micrometastases in Sentinel Lymph Nodes Represent a Significant Negative Prognostic Factor in Early-Stage Cervical Cancer: A Single-Institutional Retrospective Cohort Study

Cancers ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1438 ◽  
Author(s):  
Roman Kocian ◽  
Jiri Slama ◽  
Daniela Fischerova ◽  
Anna Germanova ◽  
Andrea Burgetova ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Nodes ◽  
Early Stage ◽  
Frozen Section ◽  
Preoperative Staging ◽  
Prognostic Significance ◽  
Disease Free Survival ◽  
Primary Surgery ◽  
Negative Prognostic Factor ◽  
Early Stage Cervical Cancer

The data on the prognostic significance of low volume metastases in lymph nodes (LN) are inconsistent. The aim of this study was to retrospectively analyze the outcome of a large group of patients treated with sentinel lymph node (SLN) biopsy at a single referral center. Patients with cervical cancer, stage T1a-T2b, common tumor types, negative LN on preoperative staging, treated by primary surgery between 01/2007 and 12/2016, with at least unilateral SLN detection were included. Patients with abandoned radical surgery due to intraoperative SLN positivity detected by frozen section were excluded. All SLNs were postoperatively processed by an intensive protocol for pathological ultrastaging. Altogether, 226 patients were analyzed. Positive LN were detected in 38 (17%) cases; macrometastases (MAC), micrometastases (MIC), isolated tumor cells (ITC) in 14, 16, and 8 patients. With the median follow-up of 65 months, 22 recurrences occurred. Disease-free survival (DFS) reached 90% in the whole group, 93% in LN-negative cases, 89% in cases with MAC, 69% with MIC, and 87% with ITC. The presence of MIC in SLN was associated with significantly decreased DFS and OS. Patients with MIC and MAC should be managed similarly, and SLN ultrastaging should become an integral part of the management of patients with early-stage cervical cancer.

An individual prediction of the future (disease-free) survival of patients with a history of early-stage cervical cancer, multistate model

2008 ◽  
Vol 18 (3) ◽  
pp. 432-438 ◽  
Author(s):  
Q. D. Pieterse ◽  
G. G. Kenter ◽  
P. H.C. Eilers ◽  
J. B.M.Z. Trimbos
Keyword(s):  
Cervical Cancer ◽  
Lymph Nodes ◽  
Early Stage ◽  
Disease Free Survival ◽  
Risk Models ◽  
Free Survival ◽  
The Future ◽  
Early Stage Cervical Cancer ◽  
History Of ◽  
Disease Free

To evaluate the possibility to give a prediction of the future (disease-free) survival, given the fact that a patient with a history of early-stage cervical cancer has been disease free for a specific period after treatment. Between January 1984 and April 2005, 615 patients with cervical cancer stages I–IIA underwent radical hysterectomy with or without adjuvant radiotherapy. The Kaplan–Meier method was used to detect statistical significance and multistate risk models to estimate the influence of covariates and to generate predicted survival curves by simulation. Simulations were done for patients with positive lymph nodes (n= 123), patients with negative lymph nodes (n= 492), and 4 hypothetical patients. The 5-year cancer-specific survival and disease-free survival of the entire group was 84% and 76%, respectively. The probability of death of the two lymph node groups and the four hypothetical patients was demonstrated in predicted cumulative probability plots. It is possible with multistate risk models to give a detailed prediction of the future (disease-free) survival, given the fact that a patient has been disease free for a specific period after treatment. This possibility is an important step forward to improve the quality of cancer care.

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