Clinical efficacy of conservative laser therapy for early-stage cervical cancer

Abstract

The objective of this study was to evaluate the clinical efficacy of conservative laser therapy for early-stage cervical cancer. Seven hundred fifty-two and 271 patients with carcinoma in situ (CIS) and microinvasive squamous cell carcinoma (MIC), respectively, were treated by laser conization with vaporization. One hundred eighty-four patients with preclinical invasive diseases underwent radical surgery without conization. Their postoperative histologic findings and clinical outcomes were evaluated retrospectively. The cone specimens of 1023 cases were reported as showing that 54 had dysplasia, 663 had CIS, 239 had stage Ia1 without lymph vascular space invasion (LVSI), 14 had stage Ia1 with LVSI, 14 had stage Ia2, and 39 had stage Ib1 diseases. Incomplete excision occurred in 4 (7.4%) of 54 dysplasia, 48 (7.2%) of 663 CIS, and 16 (6.7%) of 239 stage Ia1 cases, but failure rates were only 1 (1.9%), 8 (1.2%), and 4 (1.7%), respectively. The other 67 of 1023 cases underwent abdominal operation. Final pathology results were analyzed for 67 and 184 cases with stages Ia1 to Ib1 receiving radical surgery with or without initial laser therapy. Lymph node metastasis was not observed in 154 Ia1 and 30 Ia2 with stromal invasion of under 4 mm in depth regardless of LVSI, but was detected in 2 of 16 Ia2 with stromal invasion of over 4 mm in depth and in 9 of 51 Ib1 cases. CIS and Ia1 disease without LVSI can be treated only by laser therapy. The limit of stromal invasion for conservative laser therapy in stage Ia cancer may be 4 mm in depth regardless of LVSI.

Analysis of treatment modalities and prognosis on microinvasive cervical cancer: a 10-year cohort study in China

“…In our study no parametrial and ovarian involvement was found in patients with MIC which was similar as previous reports [ 6 , 11 , 12 , 13 ]. The risk of lymph node metastasis in patients with stage IA1 MIC ranged from 0% to 2.48% compared with 0.5% to 8.7% for the patients with stage IA2 MIC [ 4 , 9 , 10 , 20 , 23 , 24 ]. We found that no lymph node metastasis was detected in patients with stage IA1 MIC and only one staged IA2 patient with LVSI had lymph node metastasis.…”

The Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions: Background and Consensus Recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology

“…Nevertheless, some have adopted the presence of LVI, or ''extensive'' LVI, as an exclusion criterion for conservative management [105,110,111,134]. In contrast, there is an increased prevalence of both lymph node metastases and recurrence after local excision in FIGO IA2, and many studies conclude that local excision alone is inadequate for this group of patients [39,103,118,126,128,130,[134][135][136][137][138].…”

“…The proportion of patients with lymph node metastases in FIGO IA1 or invasive carcinomas 3 mm or less in depth is negligible, and many authors have concluded that local excision is adequate management [97,121,[126][127][128][129][130][131][132][133]. Nevertheless, some have adopted the presence of LVI, or ''extensive'' LVI, as an exclusion criterion for conservative management [105,110,111,134].…”

Conservative Treatment of Microinvasive Adenocarcinoma of Uterine Cervix

“…To preserve fertility in these patients, conservative treatment has been studied. There are many indications that cone biopsy with clear margins may be sufficient in squamous cell carcinoma, stage IA1 without LVSI, because of very low incidence of lymph node metastases [21]. Definitive therapy in these lesions consists of simple extrafascial hysterectomy (type 1 according to Piver et al): radical hysterectomy (types 2 or 3 according to Piver et al [20]) is not indicated because there are less then 0.5% metastatic lesions to the parametria at pathological examination [22].…”