Adjuvant radiotherapy following radical hysterectomy for patients with stage IB and IIA cervical cancer

Soisson, AP; Soper, JT; Clarke-Pearson, D.; Berchuck, Andrew; Montana, Gustavo S.; Wt, Creasman

doi:10.1016/0020-7292(91)90408-w

Cited by 25 publications

(35 citation statements)

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“…Generally, tumor size is regarded as a major prognostic factor in early stage cervical carcinoma 5, 21. However, as demonstrated in this study as well as in previous studies,18 tumor size is closely related to other variables associated with tumor volume, such as depth of invasion in absolute millimeters and as a fraction of cervical stroma penetration.…”

Section: Discussionsupporting

confidence: 60%

“…In the literature, varying results have been reported with respect to the prognostic significance of tumor histology. In some multivariate studies, adenocarcoma was found to be a poor prognostic factor,14, 15 whereas in other studies, tumor histology had no influence on survival 5, 16, 17. None of these studies, however, had focused on lymph node negative patients only.…”

Section: Discussionmentioning

confidence: 99%

“…One of the most important critical determinants for prognosis is probably pelvic lymph node metastasis. The reported 5‐year survival rate of patients with negative pelvic lymph nodes is approximately 90%, compared with 50‐65% for patients with positive lymph nodes 1‐6. It is therefore not surprising that efforts made to improve prognosis after radical surgery have mainly focused on the lymph node positive group 7‐9.…”

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confidence: 99%

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Surgical pathologic factors that predict recurrence in stage IB and IIA cervical carcinoma patients with negative pelvic lymph nodes

Samlal

Velden

Kate

et al. 1997

Cancer

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with pelvic lymph node dissection. The study group was composed of 196 lymph node negative patients. Pathology slides were reviewed and multivariate analysis 1 Department of Obstetrics and Gynecology, Acperformed to identify independent prognostic factors. ademic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. RESULTS.The recurrence rate in the study group was 7.7%. In multivariate analysis, the following factors were identified as independent risk factors for recurrence: 2 Department of Pathology, Academic Medical adenocarcinoma (P Å 0.003), depth of invasion as a fraction of tumor penetration Center, University of Amsterdam, Amsterdam, of the cervical stroma (P Å 0.01), and an extensive stromal inflammatory cell The Netherlands.infiltrate (P Å 0.04). Based on these factors, the following risk groups were identi- patterns for these patients showed a predominance of pelvic recurrences.CONCLUSIONS. This study showed that among patients with Stage IB and IIA cervical carcinoma and negative pelvic lymph nodes, a subset with a significant risk for recurrence could be identified. Because the majority of recurrences in the lymph node negative group were pelvic recurrences, the value of adjuvant radiotherapy as a treatment for selected lymph node negative patients should be evaluated in a prospective study.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Surgical pathologic factors that predict recurrence in stage IB and IIA cervical carcinoma patients with negative pelvic lymph nodes

Samlal

Velden

Kate

et al. 1997

Cancer

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“…Risk factors for the recurrence of early‐stage cervical cancer after radical hysterectomy have been evaluated in many studies . The risk groups, such as intermediate‐risk and high‐risk groups, have also been defined according to the prognostic significance of each factor.…”

Section: Prognostic Risk Factors For Recurrencementioning

confidence: 99%

“…Pelvic lymph node metastasis is a well‐known high‐risk factor . Patients with lymph node metastasis have an increase in their recurrence rate of up to 40% in the context of postoperative cervical cancer compared with those without this factor, and node‐positive patients have a greater rate of distant failure .…”

Section: Prognostic Risk Factors For Recurrencementioning

confidence: 99%

The issues regarding postoperative adjuvant therapy and prognostic risk factors for patients with stage I–II cervical cancer: A review

Takekuma

Kasamatsu

Kado

et al. 2017

J of Obstet and Gynaecol

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The treatment for most patients with early-stage cervical cancer involves radical hysterectomy and pelvic lymph node dissection, and indications for postoperative adjuvant therapy have been determined by evaluating the prognostic risk factors for recurrence in each case. The aim of this review is to raise and discuss the various issues that have not yet been resolved regarding the prognostic risk factors and postoperative adjuvant therapy. Several clinicopathological factors, such as tumor size, lymphovascular space involvement, deep stromal invasion, parametrial involvement and lymph node metastasis, have been identified to have prognostic significance in early-stage cervical cancer. However, this remains controversial because there is suggested to be substantial heterogeneity among patients after radical hysterectomy and lymphadenectomy and it would be difficult to define the risk groups clearly. This indicates the need to develop more convenient and accurate criteria to define risk groups. According to the currently available evidence, patients in the high-risk group should receive adjuvant concurrent chemoradiotherapy (CCRT) with cisplatin (CDDP) and fluolouracil. However, CCRT with CDDP administered weekly (CCRT-P) has instead been applied in a clinical context worldwide. Whether CCRT-P has a survival benefit compared with radiotherapy (RT) alone is unknown because no randomized phase III trials have been performed for patients in the high-risk group after radical surgery. Patients with high-risk factors have a high incidence of distant metastasis, for whom systemic chemotherapy might be a key to improving overall survival. The pivotal study that investigated the role of RT alone for patients with intermediate-risk factors after hysterectomy is the GOG092 trial. This trial showed a 47% reduction in the risk of recurrence after RT compared with no further treatment (NFT). However, the improvement in overall survival with RT did not reach statistical significance, while patients allocated to the RT group did experience an increase in severe toxicities compared with the NFT group. This could be why many physicians are reluctant to treat patients with this approach, although guidelines recommend RT for patients with intermediate-risk factors. With regard to toxicities, postoperative RT would be problematic because the organs in the pelvis targeted by RT have already been damaged by radical surgery. To reduce the toxicities, intensity-modulated radiotherapy would best be used worldwide. Further improvement in adjuvant therapy will come from enhanced definition of prognostic risk factors, better patient selection, and refinements in both local and systematic therapies.

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Preoperative lymph node staging of early‐stage cervical carcinoma by [¹⁸F]‐fluoro‐2‐deoxy‐D‐glucose–positron emission tomography

Wright

Dehdashti

Herzog

et al. 2005

Cancer

162

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BACKGROUND. Increasing evidence has documented the value of positron emission tomography (PET) in oncology, but only limited data are available comparing PET findings with the pathologic status of regional lymph nodes in patients with cervical carcinoma. The objective of this study was to determine the sensitivity and specificity of PET in detecting lymph node metastasis in women with early-stage cervical carcinoma. METHODS. The authors performed a retrospective review of all patients with Stage IA-IIA cervical carcinoma who underwent PET before surgery from 1999 to 2004. The status of the regional lymph nodes was correlated with lymph node pathology. RESULTS. Fifty-nine patients were identified. Pelvic lymph node metastases were present in 32% of the patients and were detected by PET with a sensitivity of 53%, a specificity of 90%, a positive predictive value (PPV) of 71%, and a negative predictive value (NPV) of 80%. Paraaortic lymph node disease was present in 9% of patients and was detected by PET with a sensitivity of 25%, a specificity 98%, a PPV of 50%, and an NPV of 93%. The mean size of the tumor deposits was larger in the PET-positive pelvic nodes (15.2 mm; range, 2-35 mm) than in the PET-negative lymph nodes (7.3 mm; range, 0.3-20 mm; P ϭ 0.002). Computed tomography (CT) scans were obtained before surgery in 42 patients. The combined sensitivity of PET and CT in these patients was 75%. PET alone detected 9 (36%) of the positive lymph node groups, whereas CT alone detected 3 (12%) of the positive lymph node groups. Neither PET nor CT detected the positive lymph node groups in 8 patients (32%). CONCLUSIONS. Pathologic validation of PET imaging demonstrated a low sensitivity and a high specificity for PET in patients with early-stage cervical carcinoma.

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Adjuvant radiotherapy following radical hysterectomy for patients with stage IB and IIA cervical cancer

Cited by 25 publications

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Surgical pathologic factors that predict recurrence in stage IB and IIA cervical carcinoma patients with negative pelvic lymph nodes

Surgical pathologic factors that predict recurrence in stage IB and IIA cervical carcinoma patients with negative pelvic lymph nodes

The issues regarding postoperative adjuvant therapy and prognostic risk factors for patients with stage I–II cervical cancer: A review

Preoperative lymph node staging of early‐stage cervical carcinoma by [¹⁸F]‐fluoro‐2‐deoxy‐D‐glucose–positron emission tomography

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Adjuvant radiotherapy following radical hysterectomy for patients with stage IB and IIA cervical cancer

Cited by 25 publications

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Surgical pathologic factors that predict recurrence in stage IB and IIA cervical carcinoma patients with negative pelvic lymph nodes

Surgical pathologic factors that predict recurrence in stage IB and IIA cervical carcinoma patients with negative pelvic lymph nodes

The issues regarding postoperative adjuvant therapy and prognostic risk factors for patients with stage I–II cervical cancer: A review

Preoperative lymph node staging of early‐stage cervical carcinoma by [18F]‐fluoro‐2‐deoxy‐D‐glucose–positron emission tomography

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Preoperative lymph node staging of early‐stage cervical carcinoma by [¹⁸F]‐fluoro‐2‐deoxy‐D‐glucose–positron emission tomography