Five-year survival (with no evidence of disease) in patients with biopsy-confirmed aortic node metastasis from cervical carcinoma

Piver, M. Steven; Barlow, Joseph J.; Krishnamsetty, Ramachandra M.

doi:10.1016/0002-9378(81)90519-6

Cited by 96 publications

(31 citation statements)

References 3 publications

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“…Aside from extra cost and patient morbidity, some investigators have reported significantly worse disease-free and overall survival among patients surgically staged compared to those clinically staged. 7 Extended-field radiation itself incurs a high rate of intestinal morbidity 8,9 and prophylactic treatment of the para-aortic region has not been conclusively shown to provide any survival benefit. 10,11 Unfortunately, in patients with unresectable disease, cervical biopsy material alone does not provide reliable histopathologic features to predict the presence of lymphatic invasion, nodal metastasis, or patient outcome to guide in therapy.…”

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confidence: 99%

Low podoplanin expression in pretreatment biopsy material predicts poor prognosis in advanced-stage squamous cell carcinoma of the uterine cervix treated by primary radiation

et al. 2006

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Lymphatic invasion and nodal metastasis are predictors of poor outcome in cervix carcinoma. We have recently found that low podoplanin immunoreactivity in cervix carcinoma correlated with the presence of lymphatic invasion and nodal metastasis. In the current study, we examined whether podoplanin expression in pretreatment cervical biopsies can predict the presence lymphatic invasion, nodal metastasis, and outcome in advanced-stage tumors treated by nonsurgical means. Podoplanin expression was analyzed by immunohistochemistry in 48 cervical biopsies and corresponding hysterectomy specimens of early-stage invasive squamous cell carcinoma and in 74 pretreatment biopsies from advanced-stage tumors treated with primary radiation. We found a highly significant correlation between podoplanin expression obtained in biopsy and corresponding hysterectomy materials (r ¼ 0.8962, Po0.0001). Low podoplanin expression showed a significant correlation with lymphatic invasion (Po0.0001) and nodal metastasis (P ¼ 0.0058). Low podoplanin expression in pretreatment biopsy material showed a significant correlation with poor disease-free (P ¼ 0.0009) and overall (P ¼ 0.0002) survival in advanced-stage tumors. Our results suggest that in advanced-stage cervix carcinomas treated by radiation, when traditional prognostic indicators are not available and treatment decisions are based on biopsy material and clinical staging parameters, examination of podoplanin expression in pretreatment biopsy material may be a useful marker to predict lymphatic metastasis and patient outcome. Prospective studies involving larger numbers of patients are needed to further evaluate the clinical utility of examination of podoplanin expression in patients with cervix carcinoma.

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confidence: 99%

Low podoplanin expression in pretreatment biopsy material predicts poor prognosis in advanced-stage squamous cell carcinoma of the uterine cervix treated by primary radiation

et al. 2006

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“…Pilleron et al [109] noted a 5-year survival rate of only 16% of patients with positive common iliac nodes in stages I and II. In advanced stages, 5-year survival rates of patients with para-aortic disease ranging from 16 to 32% have been described, illustrating the bleak prognosis [3,11,63,112,115]. Pelvic 70 195 194 108 362 139 418 124 98 363 193 143 293 145 63 73 363 193 98 202 293 98 140 254 171 143 183 51 3 (4) 18 (9) 19 (10) 11 (10) 47 (13) 20 (14) 62 (15) 22 (18) 19 (19) 73 (20) 42 (22) 35 (24) 71 (24) 39 (27) 19 (30) 25 (34) 8 (2) 4 (2) 3 (3) 5 (3) 20 (7) 3 (3) 6 (4) 9 (4) 9 (5) 8 (6) 11 (6) 5 (10) 62 2 61 79 64 16 47 19 30 70 127 76 71 110 89 24 70 127 30 60 71 30 63 99 47 76 11 8 a Figures in parenthesis denote percentages.…”

Section: Lymph Node Metastasesmentioning

confidence: 99%

A review of prognostic factors in early-stage carcinoma of the cervix (FIGO I B and II A) and implications for treatment strategy

Bommel¹,

Lindert²,

Kock³

et al. 1987

European Journal of Obstetrics & Gynecology and Reproductiv

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Several prognostic factors in stages I B and II A cervical carcinoma have been widely studied to define groups of patients with a poor prognosis. Most of these factors are interrelated. The characteristics which should be regarded as main factors have not yet been defined, because the studies reported were based on mainly retrospective and non-randomized analysis. Reviewing the literature, lymph node metastasis, differentiation grade, tumor size, parametrial extension, lymphblood vessel invasion and cervical invasion seem to be prognostically important factors, which suggests that the subdivision of patients according to the FIG0 classification alone is inaccurate. It seems useful to define subgroups of patients according to tumor characteristics, determined after surgical treatment and accurate histologic examination of the surgical specimen. Patients with one or more of these tumor features need additional treatment to improve survival. The current treatment modalities, such as postoperative radiotherapy, have not been thoroughly evaluated, but doubt exists as to their efficacy. Data in the literature suggest that particularly patients with para-aortic or multiple pelvic lymph node metastasis (> 3) have already developed distant metastases at the time of primary treatment and therefore need adjuvant systemic therapy. Patients with tumors larger than 4 cm in diameter, differentiation grade III, lymph-blood vessel invasion or cervical invasion (of more than 70%) seem to have high recurrence rates at both pelvic and distant sites, indicating that there is also a need for better pelvic control.

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“…By contrast, advanced stages of cervical cancer (stages IIB-IVA) are typically treated with radiation therapy and cisplatin-based chemotherapy (3,4). However, cervical cancer with metastasis to the PAN has a poor prognosis (5,6). In such cases, concurrent cisplatin-based chemotherapy with extended-field radiotherapy (EFRT) is the standard treatment strategy.…”

Section: Introductionmentioning

confidence: 99%

“…The delivery of radiation to grossly involved nodes has been limited due to its toxicity to adjacent organs and tissues (6). However, IMRT has been shown to permit delivery of ≤60 Gy to para-aortic and/or pelvic nodes, with substantially reduced doses to the bowel, bladder and bone marrow (17,32).…”

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Extended field intensity-modulated radiotherapy plus concurrent nedaplatin treatment in cervical cancer

Liu

Qian

et al. 2016

Oncology Letters

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Abstract. The present study assessed the efficacy and toxicity of definitive extended-field intensity-modulated radiotherapy (EF-IMRT) plus concurrent chemotherapy in cervical cancer. A total of 48 patients with cervical cancer received the planning target volume between 39.6 and 50.4 Gy in 1.8-2.0 Gy daily fractions, while the enlarged pelvic and/or para-aortic nodes were treated with a total dose of 55-60 Gy in 2.0-2.4 Gy daily fractions using simultaneous integrated boost-IMRT. All patients underwent high dose-rate brachytherapy. Concurrent to EF-IMRT, nedaplatin was administered weekly at a median dose of 30 mg/m 2 (range, 25-40 mg/m 2 ) for 5 weeks with a total of 150 mg/m 2 . Of the 48 patients, 46 patients exhibited initial complete responses and 2 patients had partial responses, with a response rate of 100%. After 4-24 months of treatment, 12 patients (27.08%) had local and/or distant failure and 39 patients (81.25%) were alive at the last follow-up. The 12-month overall survival (OS) and disease-free survival (DFS) were 87.5 and 75.8%, respectively, while the 24-month OS and DFS were 69.7 and 49.7%, respectively. Grade ≥3 acute neutropenia and thrombcytopenia occurred in 20 (41.7%) and 4 (8.3%) patients, respectively, while 2 patients (4.2%) developed grade ≥3 diarrhea and 2 (4.2%) had grade ≥3 late toxicities. However, no patients exhibited grade ≥3 vomiting. Thus, concurrent nedaplatin chemotherapy with definitive EF-IMRT was effective and relatively safe for treating patients with cervical cancer. Furthermore, EF-IMRT was able to deliver ≤60 Gy to enlarged para-aortic and/or pelvic nodes using simultaneous integrated boost without increased acute and late gastrointestinal toxicity.

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Five-year survival (with no evidence of disease) in patients with biopsy-confirmed aortic node metastasis from cervical carcinoma

Cited by 96 publications

References 3 publications

Low podoplanin expression in pretreatment biopsy material predicts poor prognosis in advanced-stage squamous cell carcinoma of the uterine cervix treated by primary radiation

Low podoplanin expression in pretreatment biopsy material predicts poor prognosis in advanced-stage squamous cell carcinoma of the uterine cervix treated by primary radiation

A review of prognostic factors in early-stage carcinoma of the cervix (FIGO I B and II A) and implications for treatment strategy

Extended field intensity-modulated radiotherapy plus concurrent nedaplatin treatment in cervical cancer

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