Impact of Adjuvant Radiotherapy and Reversibility of Neurogenic Bladder on Bladder Storage Function and Impact of Urethral Resistance on Bladder Emptying Function after Radical Hysterectomy

Abstract Background and purpose How to protect the ovarian function during radiotherapy is uncertain. The purpose of this study was to explore the association between the location of the transposed ovary and the ovarian dose in patients with cervical cancer received radical hysterectomy, ovarian transposition, and postoperative pelvic radiotherapy. Methods A retrospective analysis was conducted of 150 young patients with cervical cancer who received radical hysterectomy, intraoperative ovarian transposition, and postoperative adjuvant radiotherapy in Zhejiang Cancer Hospital. Association between location of the transposed ovaries and ovarian dose was evaluated. The transposed position of ovaries with a satisfactory dose was explored using a receiver operator characteristic curve (ROC) analysis. Patients’ ovarian function was followed up 3 months and 1 year after radiotherapy. Results A total of 32/214 (15%) transposed ovaries were higher than the upper boundary of the planning target volume (PTV). The optimum cutoff value of > 1.12 cm above the iliac crest plane was significantly associated with ovaries above the upper PTV boundary. When the ovaries were below the upper boundary of PTV, the optimum cutoff value of transverse distance > 3.265 cm between the ovary and PTV was significantly associated with ovarian max dose (Dmax) ≤ 4Gy, and the optimum cutoff value of transverse distance > 2.391 cm was significantly associated with ovarian Dmax≤5Gy. A total of 77 patients had received complete follow-up, and 56 patients (72.7%) showed preserved ovarian function 1 year after radiotherapy, which was significantly increased compared with 3 months (44.2%) after radiotherapy. Conclusions The location of transposed ovaries in patients with cervical cancer is significantly correlated with ovarian dose in adjuvant radiotherapy. We recommend transposition of ovaries > 1.12 cm higher than the iliac crest plane to obtain ovarian location above PTV. When the transposed ovary is below the upper boundary of PTV, ovarian Dmax ≤4Gy may be obtained when the transverse distance between the ovary and PTV was > 3.265 cm, and the ovarian Dmax≤5Gy may be obtained when the transverse distance was > 2.391 cm.

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Long‐term evaluation of renal function and neurogenic bladder following radical hysterectomy in patients with uterine cervical cancer

Journal of Obstetrics and Gynaecology Research ◽

10.1111/jog.14394 ◽

2020 ◽

Vol 46 (10) ◽

pp. 2108-2114

Author(s):

Hiroaki Komatsu ◽

Tetsuro Oishi ◽

Daiken Osaku ◽

Akiko Kudoh ◽

Ruri Shimogai ◽

...

Keyword(s):

Cervical Cancer ◽

Renal Function ◽

Neurogenic Bladder ◽

Radical Hysterectomy ◽

Uterine Cervical Cancer ◽

Term Evaluation

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An observational longitudinal study to evaluate miction, defecation, and sexual function after radical hysterectomy with pelvic lymphadenectomy for early-stage cervical cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200605000-00027 ◽

2006 ◽

Vol 16 (3) ◽

pp. 1119-1129 ◽

Cited By ~ 15

Author(s):

Q. D. Pieterse ◽

C. P. Maas ◽

M. M. Ter Kuile ◽

M. Lowik ◽

M. A. Van Eijkeren ◽

...

Keyword(s):

Cervical Cancer ◽

Longitudinal Study ◽

Sexual Function ◽

Radical Hysterectomy ◽

Adjuvant Radiotherapy ◽

Early Stage ◽

Pelvic Lymphadenectomy ◽

Control Group ◽

Negative Effects ◽

Early Stage Cervical Cancer

The objective of this study was to evaluate the problems with miction, defecation, and sexuality after a radical hysterectomy with or without adjuvant radiotherapy for the treatment of cervical cancer stage I–IIA. This study included an observational longitudinal study of self-reported bladder, defecation, and sexual problems with a baseline score. Ninety-four women were included in the study. An age-matched control group consisted of 224 women. The patients showed significantly more negative effects on sexual function compared with both the controls and their situation before the treatment throughout 24 months of follow-up. The problems included less lubrication, a narrow and short vagina, senseless areas around the labia, dyspareunia, and sexual dissatisfaction. Up to 12 months after the treatment, the patients complained significantly more of little or no urge to urinate and diarrhea as compared with the controls. Adjuvant radiotherapy did not increase the risk of bladder dysfunction, colorectal motility disorders, and sexual functions. We conclude that a radical hysterectomy for the treatment of early-stage cervical carcinoma is associated with adverse effects mainly on sexual functioning.

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220The prognostic value of BCL-2 expression in patients with cervical cancer treated with radical hysterectomy and adjuvant radiotherapy

Radiotherapy and Oncology ◽

10.1016/s0167-8140(96)80229-5 ◽

1996 ◽

Vol 40 ◽

pp. S58

Author(s):

W. Tjalma ◽

Ch. De Pooter ◽

J. Weyler ◽

E. Van Marck ◽

G. Goovaerts ◽

...

Keyword(s):

Cervical Cancer ◽

Radical Hysterectomy ◽

Adjuvant Radiotherapy ◽

Prognostic Value

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Adjuvant radiotherapy following radical hysterectomy for patients with early-stage cervical carcinoma (1984-1996)

Radiotherapy and Oncology ◽

10.1016/s0167-8140(99)00056-0 ◽

1999 ◽

Vol 51 (2) ◽

pp. 161-167 ◽

Cited By ~ 34

Author(s):

A Snijders-Keilholz ◽

B.W.J Hellebrekers ◽

A.H Zwinderman ◽

M.J van de Vijver ◽

J.B Trimbos

Keyword(s):

Cervical Carcinoma ◽

Radical Hysterectomy ◽

Adjuvant Radiotherapy ◽

Early Stage

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Delayed adjuvant radiotherapy in early-stage cervical cancer with intermediate-risk features has a detrimental effect on survival that cannot be corrected by adjuvant chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.6037 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 6037-6037

Author(s):

Joyson Kodiyan ◽

Adel Guirguis ◽

Hani Ashmalla

Keyword(s):

Cervical Cancer ◽

Adjuvant Chemotherapy ◽

Radical Hysterectomy ◽

Adjuvant Radiotherapy ◽

Early Stage ◽

Positive Margin ◽

Pelvic Lymphadenectomy ◽

Intermediate Risk ◽

Early Stage Disease ◽

Early Stage Cervical Cancer

6037 Background: GOG-0263 is currently investigating the role of adjuvant chemotherapy (CT) concurrently with radiotherapy (RT) in patients with early stage cervical cancer that underwent radical hysterectomy and pelvic lymphadenectomy harboring intermediate risk features. We used a retrospective database to investigate whether adjuvant chemotherapy significantly influenced overall survival (OS), and whether its effectiveness is influenced by delays in radiotherapy. Methods: All data was obtained from the NCDB (National Cancer Database) and initially contained 115,747 cases of cervical cancer diagnosed between 2004 and 2015. Analyzed patients had early stage disease, received radical hysterectomy with pathologic stage I to IIA, and had intermediate risk features including size greater than 4 cm or lymphovascular invasion. All patients received adjuvant RT with or without CT. Cases with positive margin or nodes, with parametrial extension, or metastasis were excluded. Cases were weighted by inverse probability of treatment (CT) using clinical and socioeconomic variables, and analyzed for OS using multivariate models. Predictors of receiving CT were determined using multivariate logistic regression. Results: The final cohort was 557 patients with median follow-up of 43 months (range, 1.54-143.7). Median survival without CT (n = 244) versus with CT (n = 313) was 42.2 versus 43.9 months (HR 0.81, 95%CI 0.661-0.995, p = 0.045). Median time from diagnosis to RT was 91 days (range, 21-691), and predicted for inferior OS (p = 0.007). No significant interaction existed between RT delay and receipt of CT (p = 0.997). Cases with squamous histology were less likely to receive CT than adenocarcinoma histology (OR 0.345, 95%CI 0.159-0.725, p = 0.006). Conclusions: Poor survival outcomes are observed in patients with early stage cervical cancer harboring intermediate risk features when adjuvant radiotherapy is delayed. This outcome was not corrected by addition of chemotherapy.

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