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.

THREE-DIMENSIONAL PLANNING OF BRACHYTHERAPY FOR LOCALLY ADVANCED CERVICAL CANCER BY CT/MRI IMAGES

2018 ◽  
Vol 64 (5) ◽  
pp. 645-650
Author(s):  
Olga Kravets ◽  
Yelena Romanova ◽  
Oleg Kozlov ◽  
Mikhail Nechushkin ◽  
A. Gavrilova ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Local Control ◽  
Control Volume ◽  
Locally Advanced ◽  
Three Dimensional ◽  
Advanced Cervical Cancer ◽  
3D Ct ◽  
Mri Imaging ◽  
Tumor Target ◽  
Locally Advanced Cervical Cancer

We present our results of 3D CT/MRI brachytherapy (BT) planning in 115 patients with locally advanced cervical cancer T2b-3bN0-1M0. The aim of this study was to assess the differences in the visualization of tumor target volumes and risk organs during the 3D CT/MRI BT. The results of the study revealed that the use of MRI imaging for dosimetric planning of dose distribution for a given volume of a cervical tumor target was the best method of visualization of the soft tissue component of the tumor process in comparison with CT images, it allowed to differentially visualize the cervix and uterine body, directly the tumor volume. Mean D90 HR-CTV for MRI was 32.9 cm3 versus 45.9 cm3 for CT at the time of first BT, p = 0.0002, which is important for local control of the tumor process. The contouring of the organs of risk (bladder and rectum) through MRI images allows for more clearly visualizing the contours, which statistically significantly reduces the dose load for individual dosimetric planning in the D2cc control volume, і.є. the minimum dose of 2 cm3 of the organ of risk: D2cc for the bladder was 24.3 Gy for MRI versus 34.8 Gy on CT (p = 0.045); D2cc for the rectum - 18.7 Gy for MRI versus 26.8 Gy for CT (p = 0.046). This is a prognostically important stage in promising local control, which allows preventing manifestation of radiation damage.

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.

Fusion imaging of ultrasound and MRI in the assessment of locally advanced cervical cancer: a prospective study

2020 ◽  
Vol 30 (4) ◽  
pp. 456-465 ◽  
Author(s):  
Francesca Moro ◽  
Benedetta Gui ◽  
Damiano Arciuolo ◽  
Valentina Bertoldo ◽  
Roberta Borzi ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Ultrasound Examination ◽  
Residual Disease ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Fusion Imaging ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer ◽  
Before And After ◽  
The Right

BackgroundFusion imaging is a new diagnostic method that integrates MRI and ultrasound. It may improve the detection and staging of locally advanced cervical cancer.ObjectiveTo evaluate the feasibility and accuracy of fusion imaging in patients with locally advanced cervical cancer.MethodsPatients with suspicion of locally advanced cervical cancer at clinical examination and/or imaging, who were candidates for neoadjuvant treatment (chemotherapy or chemoradiation) followed by surgery, were prospectively enrolled between March and November 2018. MRI, ultrasound, and fusion images were obtained before and after neoadjuvant treatment. Feasibility, success of the fusion examination, and time needed to perform fusion studies were evaluated. The rates of concordance between MRI and ultrasound before and after performing fusion, using Cohen, Spearman, and McNemar tests were calculated. The agreement between MRI and ultrasound examination, and the agreement between radiologist and gynecologist during the fusion technique in assessing local extension of disease and the presence of residual disease after neoadjuvant therapy, were also analyzed. The rates of concordance between MRI and ultrasound examination before and after performing fusion imaging, using Cohen’s kappa and Spearman’s rank correlation coefficient were calculated. A McNemar test was used to assess if there were statistical significant differences in the parameters’ agreement before and after performing fusion imaging.Results40 patients were selected and of these, 33 were analyzed. A total of 52 fusion examinations were performed: 33 (63.5%) of 52 at the time of diagnosis and 19 (36.5%) of 52 after neoadjuvant treatment. Fusion imaging was feasible in 50 (96%) of 52 studies. The median overall time of fusion execution was 13 min (range 6–30) and the time spent in performing a fusion examination decreased from the first to the last examination (20 vs 6 min). The agreement between MRI and ultrasound parameters increased after performing fusion, particularly for parametrial infiltration (74% vs 86%, p=0.014 for the right posterior parametrium; 66% vs 80%, p=0.008 for the left posterior parametrium, 70% vs 82%, p=0.014 for the right lateral parametrium).ConclusionsFusion of MRI and ultrasound is feasible in patients with locally advanced cervical cancer and may increase the diagnostic accuracy of the single imaging methods. Fusion provides multiple diagnostic opportunities in gynecological oncology.

Laparoscopic Extrafascial Hysterectomy (Completion Surgery) After Primary Chemoradiation in Patients With Locally Advanced Cervical Cancer: Technical Aspects and Operative Outcomes

2014 ◽  
Vol 24 (3) ◽  
pp. 608-614 ◽  
Author(s):  
Giovanni Favero ◽  
Juliana Pierobon ◽  
Maria Luiza Genta ◽  
Marcia Pereira Araújo ◽  
Giovanni Miglino ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Residual Disease ◽  
Locally Advanced ◽  
International Federation ◽  
Advanced Cervical Cancer ◽  
Histologic Finding ◽  
Locally Advanced Cervical Cancer ◽  
Gynecology And Obstetrics ◽  
Completion Surgery ◽  
The Mean

ObjectiveThis study aimed to evaluate the feasibility and safety of laparoscopic extrafascial hysterectomy and bilateral salpingo-oophorectomy after primary chemoradiation (CRT) in patients with locally advanced cervical cancer (LACC) without evidence of nodal metastasis.BackgroundCurrently, the standard of care for patients with advanced cervical cancer is concurrent CRT. There is an unequivocal correlation between presence of residual disease and risk of local relapse. Nevertheless, the importance of hysterectomy in adjuvant setting remains controversial.MethodsProspective study with patients affected by bulky LACC (International Federation of Gynecology and Obstetrics stage IB2 up to IIB) treated initially with radical CRT who underwent laparoscopic surgery 12 weeks after therapy conclusion. Inclusion criteria were absence of signs for extrapelvic or nodal involvement on initial imaging staging, as well as complete clinical and radiologic response.ResultsFrom January 2011 to March 2013, 33 patients were endoscopically operated. The mean age was 44 years (range, 21–77 years). Histologic finding revealed squamous cell carcinoma in 19 (60%) cases and adenocarcinoma in 14 (40%) cases. International Federation of Gynecology and Obstetrics stages distribution were as follow: 1B2, n = 3 (9%); IIA, n = 4 (11%); and IIB, n = 26 (80%). The mean pretherapeutic tumor size was 5.2 cm (range, 4–10.2 cm). Estimated blood loss was 80 mL (range, 40–150 mL), and mean operative time was approximately 104 minutes (range, 75–130 minutes). No casualty or conversion to laparotomy occurred. Hospital stay was in average 1.7 days (range, 1–4 days). Significant complication occurred in 12% of the cases; 2 vaginal vault dehiscence, 1 pelvic infection, and 1 ureterovaginal fistula. Nine (27%) patients had pathologic residual disease, and in 78% of these cases, histologic finding was adenocarcinoma (P = −0.048). All patients had free margins. After median follow-up of 16 months, all women have no signs of local recurrence.ConclusionsLaparoscopic extrafascial hysterectomy (completion surgery) after primary CRT in patients with apparent node-negative LACC is a feasible and safe strategy to improve tumor local control mainly in cases of adenocarcinoma.

scholarly journals High-Grade Cervical Dysplasia following Radiation Therapy for Invasive Cervical Cancer: A Report of Four Cases

2015 ◽  
Vol 8 (2) ◽  
pp. 217-221 ◽  
Author(s):  
Mila Pontremoli Salcedo ◽  
Andrea M. Milbourne ◽  
Anuja Jhingran ◽  
Patricia J. Eifel ◽  
Pedro T. Ramirez ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Gynecologic Oncology ◽  
Invasive Cervical Cancer ◽  
Locally Advanced ◽  
Cervical Dysplasia ◽  
High Grade ◽  
Advanced Cervical Cancer ◽  
Recurrent Cervical Cancer ◽  
Locally Advanced Cervical Cancer

Introduction: The standard treatment for locally advanced cervical cancer is chemoradiation, with the majority of patients having a complete response to the therapy. The current surveillance recommendations from the Society of Gynecologic Oncology include annual cytology, with a small proportion of patients subsequently diagnosed with high-grade cervical dysplasia (CIN 2/3). To date, there is limited information regarding the optimal treatment and outcome for patients diagnosed with CIN 2/3. The current report describes the diagnosis, management and outcome of 4 patients diagnosed with CIN 2/3 following chemoradiation. Case Description: We describe 4 patients who developed CIN 2/3 seven months to 8 years following radiation therapy for locally advanced cervical cancer. All 4 patients were asymptomatic and the abnormalities were first detected by a Pap test. Three of the patients were managed conservatively with observation, and the CIN 2/3 resolved without intervention. One patient underwent 2 cervical conizations followed by a hysterectomy with no residual dysplasia noted on the hysterectomy specimen. Conclusion: The majority of patients with recurrent cervical cancer after chemoradiation are symptomatic, and most cases are detected by a physical examination. The role of cytology, colposcopy and biopsies may be of limited value. Furthermore, the significance of the diagnosis of CIN 2/3 in patients previously treated with radiation therapy was not associated with recurrent disease in the 4 patients described. Our results suggest that cytology may be of limited value in detecting recurrence in patients following radiation therapy, even when CIN 2/3 is detected.

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