Chemotherapy and extended-field radiation therapy to <i>para</i>
-aortic area in patients with histologically proven metastatic cervical cancer to para-aortic nodes: A phase II pilot study

Husseinzadeh, Nader; Shrake, Philip D.; DeEulis, Timothy; Rowley, K.; Aron, Bernard S.

doi:10.1016/0020-7292(94)90609-2

Cited by 4 publications

(4 citation statements)

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“…In our series, combined chemotherapy with irradiation proved to be a superior definitive therapy, compared with other reports. 13 A poor positive detection rate using computed tomography was noted in this study (Table 1). Only five out of 11 positive cases were predicted.…”

Section: Discussionmentioning

confidence: 55%

Laparoscopic para‐aortic lymphadenectomy in advanced cervical carcinoma: the Taiwan experience. II

1998

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Objectives To present the Taiwanese experience of para‐aortic lymphadenectomy by laparoscopy in the pretreatment surgical staging of advanced cervical cancer and evaluate the benefits of these procedures. Design Patients were prospectively evaluated for different treatment modalities and the results were analysed. Setting The Chang Gung Memorial Hospital, Keelung Center. Subjects 43 consecutive, eligible patients with advanced cervical cancer, operated upon and followed up for at least 20 months, were included in this study. Interventions Right‐ and left‐sided para‐aortic lymphadenectomies by laparoscopy were performed. Two groups of patients were delineated, for different treatment modalities. Patients with negative para‐aortic lymph nodes were treated with whole‐pelvic irradiation only; patients with proven para‐aortic lymph node metastasis in surgical staging were treated concurrently with chemotherapy. Main outcome measures The 2‐year survival rates for patients with metastasis (receiving concurrent chemotherapy) and without metastasis (receiving irradiation only). Results On average, 10.8 lymph nodes were retrieved from both sides of the aorta. The operating time for the procedure ranged from 53 to 138 min, with an average of 93.5 min. After a median follow up of 36.8 months, the progression‐free interval for all patients was 6–55 months (median 26 months). The 2‐year survival rates for patients with metastasis and without metastasis were 68% and 85.5%, respectively. Conclusions Laparoscopic para‐aortic lymphadenectomy was an efficient and feasible surgical staging procedure for the pretreatment evaluation of advanced carcinoma of the uterine cervix, and made possible a better choice of treatment modality by the clinician.

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Section: Discussionmentioning

confidence: 55%

Laparoscopic para‐aortic lymphadenectomy in advanced cervical carcinoma: the Taiwan experience. II

1998

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“…The median number of harvested pelvic and para-aortic lymph nodes in our surgical staging arm was 19 (1-70) and 17 (3-74), respectively, and the median number of pelvic and paraaortic lymph node metastases was 2.4 (0-24) and 1.3 (0-25), respectively [49] . Patients with para-aortic lymph node metastases of cervical cancer have a poorer prognosis, with a 5-year overall survival between 5 and 58% depending on nodal size, the number of involved lymph nodes, the achievement of debulking surgery, and adequate CRTx schemas [9,22,24,30,38,50,[52][53][54] . This wide range of survival data potentially reflects the detection methods used to indicate EFRT (also in the RTOG 7920 [55] and EORTC trials [39] of prophylactic para-aortic irradiation), which include CT, lymphoscintigram, PET-CT, surgical staging, and a combination of these approaches.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Histologically Proven Pelvic and Para-Aortic Lymph Node Metastases and Rate of Upstaging in Patients with Locally Advanced Cervical Cancer: Results of a Prospective Randomized Trial

Tsunoda

Marnitz²,

Nunes

et al. 2017

Oncology

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Background: Surgical staging is associated with a significant rate of upstaging compared to clinical/radiological staging in patients with locally advanced cervical cancer. Objective: To analyze the stage-specific percentage of pelvic and para-aortic lymph node metastases and the upstaging ratio in a prospective randomized trial (Uterus-11). Methods: FIGO stage IIB-IVA cervical cancer patients were randomized to surgical staging (arm A) or to clinical staging and primary chemoradiation (arm B). Arm B patients underwent CT-guided biopsy of suspicious para-aortic lymph nodes. Confirmed para-aortic metastasis patients received extended-field radiation therapy. Results: A total of 234 patients were enrolled, including 120 (arm A) and 114 (arm B) treated per protocol. The groups were well balanced. Pelvic and para-aortic lymph node metastases were identified after surgical staging in 51 and 24% of patients, respectively (p < 0.001). Pelvic and para-aortic lymph node metastases were confirmed in 45 and 20% of IIB patients and in 71 and 37% of IIIB patients, respectively. Upstaging occurred in 39/120 (33%) in arm A and in 9/114 (8%) in arm B (p < 0.001). Conclusion: The histological results in both groups led to a considerable rate of upstaging. Oncological data from the Uterus-11 study may reveal whether modified therapy translates into a survival benefit.

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“…Although primary pelvic radiotherapy or radical hysterectomy is associated with good local control, many patients (up to 30%), particularly those with bulky stage I or II primary disease, have PALN disease and undergo failed treatment. 12,13 FDG-PET is a more sensitive method for detecting PALN involvement [14][15][16][17][18] and determining radiation field placement 19 compared with CT and MRI. Dual-phase imaging has been shown to increase the sensitivity of PALN detection.…”

Section: Paln Involvementmentioning

confidence: 99%

Expanding Role of Positron Emission Tomography in Cancer of the Uterine Cervix

Rajendran

Greer

2006

J Natl Compr Canc Netw

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Molecular imaging through positron emission tomography (PET) is playing a very important role in the management of several different cancers. Its noninvasive nature and ability to study biologic function are ideal for oncology practice. PET is establishing itself in staging, guiding therapy, and follow-up of patients with cervical cancer. The emergence and widespread availability of combined PET/computed tomography technology has further consolidated the role of molecular scanning in managing these patients. This technology is now accessible to every cancer center in the United States and is also available in most countries. Although it is approved for staging patients with cervical cancer, its use in other clinical management situations is being evaluated. The real power of molecular imaging will be to predict treatment response and guide therapy and applications of novel PET tracers for studying complex cellular functions that characterize the tumor for individualized treatment approaches. Although PET technology is beyond the reach of many developing countries, the experience gained in major centers would help devise more effective and simpler treatments that can be introduced.

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Chemotherapy and extended-field radiation therapy to para -aortic area in patients with histologically proven metastatic cervical cancer to para-aortic nodes: A phase II pilot study

Cited by 4 publications

References 0 publications

Laparoscopic para‐aortic lymphadenectomy in advanced cervical carcinoma: the Taiwan experience. II

Laparoscopic para‐aortic lymphadenectomy in advanced cervical carcinoma: the Taiwan experience. II

Incidence of Histologically Proven Pelvic and Para-Aortic Lymph Node Metastases and Rate of Upstaging in Patients with Locally Advanced Cervical Cancer: Results of a Prospective Randomized Trial

Expanding Role of Positron Emission Tomography in Cancer of the Uterine Cervix

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