scholarly journals Comparison of Postoperative Adjuvant Chemotherapy and Concurrent Chemoradiotherapy for FIGO2018 Stage IIIC1 Cervical Cancer: A Retrospective Study

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 548
Author(s):  
Masahiro Kagabu ◽  
Takayuki Nagasawa ◽  
Shunsuke Tatsuki ◽  
Yasuko Fukagawa ◽  
Hidetoshi Tomabechi ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Lymph Node Metastasis ◽  
Radical Hysterectomy ◽  
Concurrent Chemoradiotherapy ◽  
Postoperative Adjuvant Chemotherapy ◽  
Node Metastasis ◽  
Significant Difference ◽  
Advanced Stages

Background and Objectives: In October 2018, the International Federation of Gynecology and Obstetrics (FIGO) revised its classification of advanced stages of cervical cancer. The main points of the classification are as follows: stage IIIC is newly established; pelvic lymph node metastasis is stage IIIC1; and para-aortic lymph node metastasis is stage IIIC2. Currently, in Japan, radical hysterectomy is performed in advanced stages IA2 to IIB of FIGO2014, and concurrent chemoradiotherapy (CCRT) is recommended for patients with positive lymph nodes. However, the efficacy of CCRT is not always satisfactory. The aim of this study was to compare postoperative adjuvant chemotherapy (CT) and postoperative CCRT in stage IIIC1 patients. Materials and Methods: Of the 40 patients who had undergone a radical hysterectomy at Iwate Medical University between January 2011 and December 2016 and were pathologically diagnosed as having positive pelvic lymph nodes, 21 patients in the adjuvant CT group and 19 patients in the postoperative CCRT group were compared. Results: The 5 year survival rates were 77.9% in the CT group and 74.7% in the CCRT group, with no significant difference. There was no significant difference in overall survival or progression-free survival between the two groups. There was no significant difference between CT and CCRT in postoperative adjuvant therapy in the new classification IIIC1 stage. Conclusions: The results of the prospective Japanese Gynecologic Oncology Group (JGOG) 1082 study are pending, but the present results suggest that CT may be a treatment option in rural areas where radiotherapy facilities are limited.

Phase II study of adjuvant chemotherapy with paclitaxel and nedaplatin for FIGO stage IB-IIA uterine cervical cancer with lymph node metastasis following radical hysterectomy: A Kansai Clinical Oncology Group study (KCOG-G1101).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17024-e17024
Author(s):  
Munetaka Takekuma ◽  
Yuka Kasamatsu ◽  
Shin Nishio ◽  
Hideo Omi ◽  
Tsutomu Tabata ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Survival Rate ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Lymph Node Metastasis ◽  
Adverse Events ◽  
Radical Hysterectomy ◽  
Uterine Cervical Cancer ◽  
Node Metastasis

e17024 Background: A multicenter phase II trial was conducted to assess the efficacy and toxicity of paclitaxel and nedaplatin as the initial postoperative adjuvant chemotherapy for high-risk uterine cervical cancer. Methods: The patients with FIGO stages IB1-IIA2 squamous cell carcinoma of the uterine cervix were enrolled. Histologic confirmation of lymph node metastasis was mandatory. Intravenous paclitaxel 175 mg/m(2) over 3hours and nedaplatin 80 mg/m(2) over 1 hour were administered on day 1 of a every 28 day cycle, of which there were 5 cycles after radical hysterectomy. Results: 62 patients were enrolled into the study protocol from November 2011 to July 2015. The median age of patients was 48.5 years (range; 28-64). Median tumor diameter was 37 mm (0-34). 10 patients (16.1%) had parametrial invasion, 44 (71.0%) had deep stromal invasion, and 53 (85.5%) had lymph-vascular invasion. 30 patients (48.4%) had one metastatic lymph node, 11 (17.7%) had two, 3 (4.8%) had three, 5 (8.1%) had four and 13 (21.0%) had five or more. With a median follow-up of 36.9 months (range: 17.2-61.5), the 2-year progression-free survival rate and pelvic disease progression-free rate were 78.9% (95% CI, 68.5% to 89.3%) and 85.0% (95% CI, 75.8% to 94.3%), respectively. The 2-year overall survival rate was 93.3% (95% CI, 86.8% to 99.8%). Adverse events were almost acceptable. Grade 3-4 adverse events (NCI-CTC ver4.0) that occurred in 5% or more patients were neutropenia (60.7%) and infection (6.6%). The proportion of patients who completed 5 cycles of treatment was 90.3%. Conclusions: Adjuvant chemotherapy with paclitaxel and nedaplatin for patients with high-risk cervical cancer after radical hysterectomy was demonstrated to be an effective and feasible treatment. Phase III trial should compare this with concurrent chemoradiotherapy. Clinical trial information: 000005605.

scholarly journals Significance of Concurrent Chemoradiotherapy as Primary Treatment in Patients with Metastatic Cervical Cancer

2021 ◽  
Vol 28 (3) ◽  
pp. 1663-1672
Author(s):  
Satomi Hattori ◽  
Nobuhisa Yoshikawa ◽  
Kazumasa Mogi ◽  
Kosuke Yoshida ◽  
Masato Yoshihara ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Tumor Size ◽  
Concurrent Chemoradiotherapy ◽  
Primary Treatment ◽  
Prognostic Impact ◽  
Primary Tumor Size ◽  
Node Metastasis ◽  
Aortic Lymph Node

(1) This study investigated the prognostic impact of tumor size in patients with metastatic cervical cancer. (2) Methods: Seventy-three cervical cancer patients in our institute were stratified into two groups based on distant metastasis: para-aortic lymph node metastasis alone (IIIC2) or spread to distant visceral organs with or without para-aortic lymph node metastasis (IVB) to identify primary tumor size and concurrent chemoradiotherapy. (3) Results: The overall survival (OS) for patients with a tumor >6.9 cm in size was significantly poorer than that for patients with a tumor ≤6.9 cm in the IVB group (p = 0.0028); the corresponding five-year OS rates in patients with a tumor ≤6.9 and >6.9 cm were 53.3% and 13.4%, respectively. In the multivariate analysis, tumor size and primary treatment were significantly associated with survival in metastatic cervical cancer. (4) Conclusions: Tumor size ≤6.9 cm and concurrent chemoradiotherapy as the primary treatment were favorable prognostic factors for patients with metastatic cervical cancer.

Further stratification of risk groups in patients with lymph node metastasis after radical hysterectomy for early-stage cervical cancer

2010 ◽  
Vol 117 (1) ◽  
pp. 53-58 ◽  
Author(s):  
Jeong-Yeol Park ◽  
Dae-Yeon Kim ◽  
Jong-Hyeok Kim ◽  
Yong-Man Kim ◽  
Young-Tak Kim ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Radical Hysterectomy ◽  
Early Stage ◽  
Risk Groups ◽  
Node Metastasis ◽  
Early Stage Cervical Cancer

scholarly journals Expression of Fas Ligand is Higher in Early Stage Cervical Cancer with Lymph Nodes Metastasis

2016 ◽  
Author(s):  
Yahya Irwanto
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Radical Hysterectomy ◽  
Fas Ligand ◽  
Pelvic Lymph Node ◽  
Lymph Nodes Metastasis ◽  
Node Metastasis ◽  
Pelvic Lymph Node Metastasis ◽  
Spearman Test

Objective: To know whether the expression of Fas Ligand has correlation with incidene of metastasis of pelvic lymph node and lymph-vascular stromal invasion (LVSI). Methods: All patients diagnosed of cervical cancer stage IB or IIA who underwent radical hysterectomy in Dr. Cipto Mangunkusumo Central General Hospital from January 2008 until December 2009 were included in analytic cross sectional study. We tested expression of Fas Ligand in cervical cancer specimen by immunohystochemistry with monoclonal antibody. The expression of Fas Ligand was compared between the group of patients with a positive and negative pelvic lymph node and between LVSI positive and negative. The difference of expression in both group were statistically analized with Chi-square test and the correlation Spearman test. Result: Ninety one patients underwent radical hysterectomy for two years and 43 patients were included in these study. The expression of Fas Ligand in 7 patients (16.3%) were negative and the others were positive, with weak, moderate and strong expression were 4 (9.3%), 27 (62.8%), and 5 (11.6%) respectively. The expression of Fas Ligand was significantly higher in the group of patients with positive pelvic lymph node compared to the group of the patients with negative pelvic lymph node (p=0.007) but there was no significant difference between group of the patients with LVSI positive and negative. With Spearman test, we found that the expression of Fas Ligand had a strong correlation with pelvic lymph nodes metastasis (coeff. correlation=0.519 and p=0.00) and have no correlation with LVSI (coef. corellation=0.112 and p=0.474). Conclusion: These finding suggested that expression of Fas Ligand in cervical cancer patients has a strong correlation with the incidence of pelvic lymph node metastasis and none with LVSI. [Indones J Obstet Gynecol 2012; 36-4: 194-9] Keywords: cervical cancer, fas ligand, immunohystochemistry, LVSI, pelvic lymph node metastasis

scholarly journals Effect of Cervical Conization with Positive Margins on Lymph Node Metastasis in Cervical Cancer

2021 ◽  
Author(s):  
Yukari Nagao ◽  
Akira Yokoi ◽  
Kosuke Yoshida ◽  
Masanori Sumi ◽  
Masato Yoshihara ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Radical Surgery ◽  
Locally Advanced ◽  
Pelvic Lymph Node ◽  
Positive Margins ◽  
Node Metastasis ◽  
Significant Difference ◽  
Cervical Conization

Abstract Radical surgery after cervical conization is a common approach for the treatment of cervical cancer. Clinically, rapid disease progression is sometimes observed in patients with positive margins at conization, but the details are unclear. This study aimed to investigate the clinical impact of positive margins at conization in cervical cancer. The medical records of patients with cervical cancer between 2010 and 2020 were reviewed retrospectively and we identified 101 eligible patients who underwent radical hysterectomy, including pelvic lymph node dissection. The association between the positive margins of the conization samples and outcomes, including subsequent lymph node metastasis, was evaluated. The rate of lymphovascular space invasion positivity at radical surgery was significantly higher in patients with positive margins (p = 0.017) than in those with negative margins, although there was no significant difference in the rate of pelvic lymph node metastasis (p = 0.155). Moreover, Kaplan–Meier curves showed that there were no significant difference in overall survival or progression-free survival between the two groups (p = 0.332 and p = 0.200, respectively). A positive margin at conization presented no significant prognostic disadvantage, and therefore, diagnostic conization is one of the reasonable options for locally advanced cervical cancer.

scholarly journals Clinical effects of cervical conization with positive margins in cervical cancer

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yukari Nagao ◽  
Akira Yokoi ◽  
Kosuke Yoshida ◽  
Masanori Sumi ◽  
Masato Yoshihara ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Disease Progression ◽  
Radical Surgery ◽  
Pelvic Lymph Node ◽  
Positive Margins ◽  
Node Metastasis ◽  
Significant Difference ◽  
Cervical Conization

AbstractRadical surgery after cervical conization is a common approach for the treatment of cervical cancer. In some cases, disease progression is observed after positive margins at conization, but the effect of conization on disease progression remains unclear. Thus, the aim of this study was to investigate the clinical outcomes of positive margins at conization in cervical cancer. A total of 101 patients who underwent cervical conization before radical hysterectomy and pelvic lymph node dissection were considered eligible by reviewing medical records. The association between the positive margins and patient outcomes, including subsequent lymph node metastasis, was evaluated. The rate of lymphovascular space invasion (LVSI) positivity at radical surgery was significantly higher in patients with positive margins (p = 0.017) than in those with negative margins, although there was no significant difference in the rate of pelvic lymph node metastasis (p = 0.155). Moreover, there was no significant difference in the overall survival or progression-free survival between the two groups (p = 0.332 and 0.200, respectively). A positive margin at conization presented no significant prognostic disadvantage; thus, diagnostic conization is one of the most suitable treatment options for early-stage cervical cancer that is difficult to accurately assess.

scholarly journals Radioactive 125I Seed Implantation for Recurrent Cervical Carcinoma After Surgery and Radiotherapy: A Case Report

2021 ◽  
Author(s):  
Shiqi Qiao ◽  
Hongtao Zhang ◽  
Xuemin Di ◽  
JinXin Zhao ◽  
Juan Wang
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Radical Hysterectomy ◽  
125I Seed ◽  
Retroperitoneal Lymph Node ◽  
Recurrent Cervical Cancer ◽  
Seed Implantation ◽  
Node Metastasis ◽  
125I Seed Implantation

Abstract Background: The prognosis of cervical cancer is remarkable, but there are still instances of pelvic and/or extrapelvic recurrence after radical hysterectomy with platinum-based chemoradiotherapy. Sixty percent of the patients with radiotherapy (RT) failure have pelvic recurrence, and 80% of them relapse within two years after treatment. Recurrent cervical cancer seriously affects the prognosis and survival rate of patients. Due to the dose limitation for normal tissue, it is difficult to deliver a sufficient number of doses to recurrent lesions through reirradiation. With the rapid development of brachytherapy technologies such as three-dimensional afterloading brachytherapy, interstitial brachytherapy and radioactive 125I seed implantation, the overall survival (OS) of patients with recurrent cervical cancer has been improving. In the present study, a case in which the patient was successfully treated with radioactive 125I seed implantation is reported.Case presentation: The patient, a 47-year-old woman, was initially diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IB cervical cancer and received preoperative radiotherapy, radical hysterectomy, pelvic lymph node dissection and postoperative radiotherapy. After 95 months of follow-up, retroperitoneal lymph node metastasis and edema of the left lower limb . The size of the retroperitoneal lesion was 2.3 × 2.0 cm, and the size of the left supraclavicle lesion was 2.0 × 1.5 cm. Radioactive 125I seed implantation was performed for retroperitoneal lymph node metastasis and left supraclavicular metastasis. Paclitaxel and cisplatin chemotherapy were given after the operation. Three months after implantation, the size of the retroperitoneal focus was 1.5 × 1.1 cm, and the size of the left supraclavicular lesion was 1.0 × 0.6 cm. Thirteen months after implantation, according to the RECIST standard, the therapeutic effect reached CR. At the time of submission, the patient's progression-free survival was 6 years and 4 months.Conclusions: CT-guided 125I seed implantation is a safe, effective, and minimally invasive method for treating patients with recurrent cervical cancer after radiotherapy. The response of this patient indicates that 125I seed implantation can be used as a complementary treatment for recurrent cervical cancer after chemoradiotherapy and may also prove to be reliable for comprehensive treatment of cervical cancer.

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