Utility of 3T MRI in Women with IB1 Cervical Cancer in Determining the Necessity of Less Invasive Surgery

Purpose: Cervical cancer that is invisible on magnetic resonance imaging (MRI) may suggest lower tumor burden than physical examination. Recently, 3 tesla (3T) MRI has been widely used prior to surgery because of its higher resolution than 1.5T MRI. The aim was to retrospectively evaluate the utility of 3T MRI in women with early cervical cancer in determining the necessity of less invasive surgery. Materials and methods: Between January 2010 and December 2015, a total of 342 women with FIGO stage IB1 cervical cancer underwent 3T MRI prior to radical hysterectomy, vaginectomy, and lymph node dissection. These patients were classified into cancer-invisible (n = 105) and cancer-visible (n = 237) groups based on the 3T MRI findings. These groups were compared regarding pathologic parameters and long-term survival rates. Results: The cancer sizes of the cancer-invisible versus cancer-visible groups were 11.5 ± 12.2 mm versus 30.1 ± 16.2 mm, respectively (p < 0.001). The depths of stromal invasion in these groups were 20.5 ± 23.6% versus 63.5 ± 31.2%, respectively (p < 0.001). Parametrial invasion was 0% (0/105) in the cancer-invisible group and 21.5% (51/237) in the cancer-visible group (odds ratio = 58.3, p < 0.001). Lymph node metastasis and lymphovascular space invasion were 5.9% (6/105) versus 26.6% (63/237) (5.8, p < 0.001) and 11.7% (12/105) versus 40.1% (95/237) (5.1, p < 0.001), respectively. Recurrence-free and overall 5-year survival rates were 99.0% (104/105) versus 76.8% (182/237) (p < 0.001) and 98.1% (103/105) versus 87.8% (208/237) (p = 0.003), respectively. Conclusions: 3T MRI can play a great role in determining the necessity of parametrectomy in women with IB1 cervical cancer. Therefore, invisible cervical cancer on 3T MRI will be a good indicator for less invasive surgery.

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EPV065/#372 Role for neoadjuvant chemotherapy and less invasive surgery in management of early stage cervical cancer in Botswana

10.1136/ijgc-2021-igcs.133 ◽

2021 ◽

Author(s):

S Tuli ◽

J George ◽

R Luckett ◽

P Gaolebale ◽

B Monare ◽

...

Keyword(s):

Cervical Cancer ◽

Neoadjuvant Chemotherapy ◽

Invasive Surgery ◽

Early Stage ◽

Less Invasive Surgery ◽

Less Invasive ◽

Early Stage Cervical Cancer

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Less invasive surgery for early gastric cancer based on the low probability of lymph node metastasis

Surgery ◽

10.1016/s0039-6060(99)70258-8 ◽

1999 ◽

Vol 125 (2) ◽

pp. 148-154 ◽

Cited By ~ 107

Author(s):

Shunichi Tsujitani ◽

Shinichi Oka ◽

Hiroaki Saito ◽

Akira Kondo ◽

Masahide Ikeguchi ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Early Gastric Cancer ◽

Invasive Surgery ◽

Less Invasive Surgery ◽

Less Invasive ◽

Node Metastasis ◽

Low Probability

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RISK SCORING SYSTEM FOR THE PREOPERATIVE ESTIMATION OF PELVIC LYMPH NODE METASTASIS IN PATIENTS WITH FIGO STAGE IA-IIA CERVICAL CANCER

10.26226/morressier.599bdc78d462b80296ca0ac0 ◽

2017 ◽

Author(s):

Hyun Ju Lee

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Scoring System ◽

Figo Stage ◽

Node Metastasis ◽

Pelvic Lymph Node Metastasis ◽

Risk Scoring ◽

Stage Ia ◽

Risk Scoring System

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Triplet induction chemotherapy followed by less invasive surgery without reconstruction for human papillomavirus-associated oropharyngeal cancers: Why is it successful or unsuccessful?

International Journal of Clinical Oncology ◽

10.1007/s10147-021-01894-z ◽

2021 ◽

Author(s):

Tomoya Yokota ◽

Tetsuro Onitsuka ◽

Satoshi Hamauchi ◽

Hiromichi Shirasu ◽

Yusuke Onozawa ◽

...

Keyword(s):

Human Papillomavirus ◽

Induction Chemotherapy ◽

Invasive Surgery ◽

Less Invasive Surgery ◽

Less Invasive

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Application of nuclear medicine to achieve less invasive surgery for malignant solid tumors in children

Pediatrics International ◽

10.1111/ped.12368 ◽

2014 ◽

Vol 56 (6) ◽

pp. 896-901

Author(s):

Ryo Hotta ◽

Takumi Fujimura ◽

Naoki Shimojima ◽

Tadaki Nakahara ◽

Yasushi Fuchimoto ◽

...

Keyword(s):

Nuclear Medicine ◽

Solid Tumors ◽

Invasive Surgery ◽

Less Invasive Surgery ◽

Less Invasive

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Survival After Curative Pelvic Exenteration for Primary or Recurrent Cervical Cancer: A Retrospective Multicentric Study of 167 Patients

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e3182a80aec ◽

2014 ◽

Vol 24 (5) ◽

pp. 916-922 ◽

Cited By ~ 28

Author(s):

Vito Chiantera ◽

Martina Rossi ◽

Pierandrea De Iaco ◽

Christardt Koehler ◽

Simone Marnitz ◽

...

Keyword(s):

Cervical Cancer ◽

Overall Survival ◽

Lymph Node ◽

Pelvic Exenteration ◽

Cell Cancer ◽

Pelvic Lymph Node ◽

Term Survival ◽

Primary Tumors ◽

Multicentric Study ◽

Recurrent Cervical Cancer

ObjectiveEvaluate the survival of patients who underwent pelvic exenteration (PE) with curative intent for primary persistent or recurrent cervical cancer.MethodsWe retrospectively investigated 167 consecutive patients, referred to the gynecological oncology units of 4 centers in Germany or Italy, who underwent PE. Data regarding surgery, histology, and oncologic outcomes were collected and statistically evaluated. Survival was determined from the day of exenteration until last follow-up or death.ResultsThe median age was 51 years. Twenty-seven patients (16.2%) underwent PE owing to advanced primary tumors (group A), 34 patients (20.4%) underwent PE owing to persistent cancer after chemotherapy or chemoradiation (group B), and 106 patients (63.4%) underwent PE owing to recurrence (group C). The prevalent histologic type was squamous cell cancer. A complete tumor resection (R0), was achieved in 121 patients (72.5%). Forty-nine patients (29.3%) had pelvic lymph node metastases and 44 patients (26.3%) had pelvic sidewall involvement. Overall survival at the end of the study was 40.7%. The cumulative 5-year overall survival for the entire cohort was 38%. Resection margins, pelvic lymph node state, and sidewall involvement were independent prognostic factors in multivariate analysis.ConclusionPelvic exenteration is a valid therapeutic option for patients with locally advanced primary persistent or recurrent cervical cancer, with a long-term survival in 40% of the patients.

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Extended-field intensity-modulated radiotherapy and dosage boost for lymph node metastasis are beneficial for the prognosis of FIGO IIICr and IVA cervical cancer patients with positive regional lymph nodes

10.21203/rs.3.rs-17075/v1 ◽

2020 ◽

Author(s):

Yuhua Zhao ◽

Gong Li ◽

Lei Gao

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Intensity Modulated Radiotherapy ◽

Figo Stage ◽

Concurrent Chemotherapy ◽

Regional Lymph Nodes ◽

Free Survival ◽

Node Metastasis ◽

Extended Field

Abstract Background: This study aimed to evaluate the therapeutic efficacy of extended-field intensity-modulated radiotherapy (EF-IMRT) and dosage boost for positive lymph nodes, prognostic factors, treatment failure, and toxicity for Federation of Gynecology and Obstetrics (FIGO) stage IIICr and IVA cervical cancer patients with positive regional lymph nodes.Methods: We retrospectively evaluated 34 patients with stage IIICr and IVA who had received treatment in our institute between 2013 and 2016. Patients with stage IVA cervical cancer who had been enrolled in the analysis all had positive regional lymph nodes (pelvic or/and para-aortic). All 34 patients were treated with EF-IMRT and simultaneously integrated boost-IMRT (SIB-IMRT) for lymph node metastasis with concurrent chemotherapy and brachytherapy. Positive regional lymph nodes (short-axis diameter ≥5 mm in computed tomography [CT] or magnetic resonance imaging [MRI]) remaining after SIB-IMRT were then treated with sequential boost-IMRT (SeB-IMRT). The prognostic factors for overall survival (OS); disease-free survival (DFS); local control rate (LCR); regional control rate (RCR); distant metastasis-free survival (DMFS), including age, FIGO stage, pretreatment hemoglobin (HB) level, tumor size, para-aortic lymph node (PALN) metastasis, point A equivalent dose in 2-Gy fractions (EQD2 dose), concurrent chemotherapy, and adjuvant chemotherapy cycles, were analyzed.Results: Complete response (CR) was achieved in 31 (91.2%) patients with acceptable adverse effects. Notably, the three-year OS, DFS, LCR, RCR, DMFS for these patients were 73.5%, 70.6%, 88.1%, 87.9%, and 81.6%, respectively. In particular, the three-year OS, DFS, LCR, RCR, and DMFS of patients with positive PALNs was 41.7%, 33.3%, 65.6%, 72.2%, and 60.2%, respectively. The corresponding values in patients without positive PALNs were 90.9%, 90.9%, 100%, 95.5%, and 90.9%, respectively.Conclusions: Our study suggested that the EF-IMRT and nodal dosage boost decreased regional node failure and that patients with stage IIIC1r and IVA cervical cancer without PALN metastasis who received EF-IMRT and SIB-IMRT with or without SeB-IMRT had a significant survival advantage in terms of the DFS and OS.

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Stereotactic radiotherapy in patients with oligometastatic or oligoprogressive gynecological malignancies: a multi-institutional analysis

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-001115 ◽

2020 ◽

Vol 30 (6) ◽

pp. 865-872 ◽

Cited By ~ 2

Author(s):

Cem Onal ◽

Melis Gultekin ◽

Ezgi Oymak ◽

Ozan Cem Guler ◽

Melek Tugce Yilmaz ◽

...

Keyword(s):

Cervical Cancer ◽

Overall Survival ◽

Local Control ◽

Stereotactic Body Radiotherapy ◽

Survival Rates ◽

Progression Free Survival ◽

Complete Response ◽

Term Survival ◽

Free Survival ◽

Oligometastatic Disease

IntroductionData supporting stereotactic body radiotherapy for oligometastatic patients are increasing; however, the outcomes for gynecological cancer patients have yet to be fully explored. Our aim is to analyze the clinical outcomes of stereotactic body radiotherapy in the treatment of patients with recurrent or oligometastatic ovarian cancer or cervical cancer.MethodsThe clinical data of 29 patients (35 lesions) with oligometastatic cervical cancer (21 patients, 72%) and ovarian carcinoma (8 patients, 28%) who were treated with stereotactic body radiotherapy for metastatic sites were retrospectively evaluated. All patients had <5 metastases at diagnosis or during progression, and were treated with stereotactic body radiotherapy for oligometastatic disease. Patients with ≥5 metastases or with brain metastases and those who underwent re-irradiation for primary site were excluded. Age, progression time, mean biologically effective dose, and treatment response were compared for overall survival and progression-free survival.ResultsA total of 29 patients were included in the study. De novo oligometastatic disease was observed in 7 patients (24%), and 22 patients (76%) had oligoprogression. The median follow-up was 15.3 months (range 1.9–95.2). The 1 and 2 year overall survival rates were 85% and 62%, respectively, and the 1 and 2 year progression-free survival rates were 27% and 18%, respectively. The 1 and 2 year local control rates for all patients were 84% and 84%, respectively. All disease progressions were observed at a median time of 7.7 months (range 1.0–16.0) after the completion of stereotactic body radiotherapy. Patients with a complete response after stereotactic body radiotherapy for oligometastasis had a significantly higher 2 year overall survival and progression-free survival compared with their counterparts. In multivariate analysis, early progression (≤12 months) and complete response after stereotactic body radiotherapy for oligometastasis were the significant prognostic factors for improved overall survival. However, no significant factor was found for progression-free survival in the multivariable analysis. No patients experienced grade 3 or higher acute or late toxicities.ConclusionsPatients with early detection of oligometastasis (≤12 months) and with complete response observed at the stereotactic body radiotherapy site had a better survival compared with their counterparts. Stereotactic body radiotherapy at the oligometastatic site resulted in excellent local control rates with minimal toxicity, and can potentially contribute to long-term survival.

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