Impact of time interval between radical hysterectomy with pelvic node dissection and initial adjuvant therapy on oncological outcomes of early stage cervical cancer

Hanprasertpong, Jitti; Jiamset, Ingporn; Geater, Alan; Leetanaporn, Kittinun; Peerawong, Thanarpan

doi:10.3802/jgo.2017.28.e42

Cited by 11 publications

(12 citation statements)

References 24 publications

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“…The median TI from surgery to RT was within seven weeks; despite some differences in both groups, the slight disparity has little impact on DFS. Consistent with our results, Hanprasertpong J. et al [25] found that delaying adjuvant therapy in patients with early-stage squamous cell cervical cancer beyond four weeks after surgery resulted in a lower RFS. And Jhawar.…”

Section: Discussionsupporting

confidence: 93%

Minimally Invasive Versus Open Surgery for Radical Hysterectomy Followed By Adjuvant Radiotherapy in Intermediate- or High-Risk Early-Stage Cancer of The Cervix: A Retrospective Study

Zhang¹,

Li²,

Wang³

et al. 2021

Preprint

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Background Postoperative radiotherapy (RT) or chemoradiotherapy (CRT) improves outcomes of cervical cancer patients with risk factors. Minimally invasive surgery (MIS) has an inferior survival than open radical hysterectomy (ORH), however, the impact of MIS on postoperative RT remains uncertain. The study compared the impacts of MIS versus ORH on delivering of adjuvant RT or CRT for intermediate- or high-risk early-stage cervical cancer. Methods Data on stage IB1-IIA2 patients who underwent radical hysterectomy and postoperative RT/CRT in our institution, from 2014 to 2017, were retrospectively collected. Patients with high or intermediate-risk factors who met the Sedlis criteria received postoperative pelvic external beam radiotherapy (50Gy/25f) with platinum-based chemotherapy (0–6 cycles) according to guidelines. Disease-free survival (DFS) and overall survival (OS) were compared in the two surgical groups. Results One hundred and twenty-nine patients eligible for the study (68 in ORH; 61 in MIS groups) had similar clinicopathologic features except for the stage (highest in MIS was IB1; IIA1 in ORH) and presence of lymph vascular space invasion (higher in MIS group). The median time interval from surgery to chemotherapy and to RT was shorter in the MIS group. Three-year DFS and OS were similar in both groups. Further sub-analysis indicated that the DFS and OS in intermediate/high-risk groups had no significant difference. Cox-multivariate analyses found that tumor size > 4 cm and time interval from surgery to RT beyond seven weeks were adverse independent prognostic factors for DFS. Conclusions In early-stage (IB1-IIA2) cervical cancer patients with intermediate or high-risk factors who received postoperative RT or CRT, no matter they received ORH or MIS as their primary treatment, the DFS and OS had no significant difference, despite TI from surgery to postoperative adjuvant therapy being shorter in the MIS group than ORH.

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Section: Discussionsupporting

confidence: 93%

Minimally Invasive Versus Open Surgery for Radical Hysterectomy Followed By Adjuvant Radiotherapy in Intermediate- or High-Risk Early-Stage Cancer of The Cervix: A Retrospective Study

Zhang¹,

Li²,

Wang³

et al. 2021

Preprint

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“…PI was defined as either positive parametrial lymph nodes or malignant cells in the parametrial tissue. Postoperative adjuvant treatment was administered according to surgical predictive factors [14]. …”

Section: Methodsmentioning

confidence: 99%

Predictive Factors of Pelvic Lymph Node Metastasis in Early-Stage Cervical Cancer

Nanthamongkolkul

Hanprasertpong²

2018

Oncol Res Treat

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Background: Pelvic lymphadenectomy, which is the routine surgical treatment for early-stage cervical cancer, causes serious morbidity. The goal of the current retrospective study was to identify predictive factors of lymph node metastasis (LNM) in patients with early-stage cervical cancer. Patients and Methods: The study included 496 patients diagnosed with stages IA2-IB1cervical cancer who underwent a radical hysterectomy with pelvic lymphadenectomy. The predictive factors of LNM were evaluated. Results: The incidence of LNM in this study was 4.6%. LNM was more common in patients with deep stromal invasion (DSI), tumor size > 2 cm, lymph vascular invasion and parametrial involvement (PI). Multivariate analysis showed DSI (p = 0.010) and PI (p = 0.005) were independently associated with LNM. The median follow-up time was 56.9 months. The patients with LNM had poorer 5-year overall survival (77.8%; 95% confidence interval (CI) 44.2-92.6) than the patients without LNM (98.2%; 95% CI 95.6-99.2; p = 0.002) and also poorer 5-year recurrence-free survival (65.5%; 95% CI 38.6-82.8) than the patients without LNM (90.2%; 95% CI 86.5-92.9; p < 0.001). Conclusion: The predictive factors of pelvic lymph node metastasis in stage IA2-IB1 cervical cancer patients were DSI and PI. LNM was associated with poorer oncological outcomes.

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“…However, it was found that the delay in initiating adjuvant therapy after surgery beyond 4 weeks might result in poorer RFS in patients with SCC, whereas patients with adenocarcinoma (AC) or adenosquamous cell carcinoma (ASC) did not show any detriments from delayed administration of adjuvant therapy. 4 In another study conducted by Kim et al, 98 patients with pelvic lymph node metastasis, positive resection margins, and/or parametrial invasion who received adjuvant chemo-RT were included. The first cycle of platinum-based adjuvant chemotherapy was initiated within 2 to 3 weeks after surgery (median, 12 days) and continued every 4 weeks for a total of 4 cycles.…”

Section: Discussionmentioning

confidence: 99%

“…However, there is no robust evidence supporting that, and the optimal interval between surgery and adjuvant therapy has not yet been fully determined. 4 Besides, various reports have suggested that the time interval (TI) from surgery to adjuvant therapy may have an impact on survival in patients with many types of cancer, including breast, colorectal, endometrial, and head and neck cancers. 5 – 8 It is reasonable to consider that this TI may also influence survival in patients with cervical cancer.…”

mentioning

confidence: 99%

The Selection of Time Interval Between Surgery and Adjuvant Therapy in Early Stage Cervical Cancer

You

Zhou

Jiang

et al. 2018

Int J Gynecol Cancer

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ObjectivesThe optimal interval between surgery and adjuvant treatment has not yet been found in cervical cancer. And whether patients with different FIGO stage should choose different interval is unknown. The purpose of this study was to evaluate whether interval has a different effect on oncologic outcome for patients with different tumor stages.MethodsWe performed a retrospective study of 226 cervical cancer patients who were treated by surgery and adjuvant therapy from May 2005 to August 2015. All patients were divided into 2 groups according to the interval of 5 weeks. Overall survival (OS) and disease-free survival (DFS) were compared between patients with interval shorter and longer than 5 weeks in the whole group and subgroups. Recurrence patterns were also analyzed. Multivariate analysis was performed to explore clinical factors significantly associated with DFS, local recurrence-free survival and distant metastasis-free survival for patients with stage IB2–IIA.ResultsFor patients with stage IA2–IB1, the 5-year OS and DFS were similar between groups of short and long interval with also the comparable results of local and distant failure. For patients with IB2–IIA, both the OS and DFS in the short-interval group were higher than that in the long-interval group. Besides, the rates of local recurrence were found higher in the group of long interval compared with short interval. Multivariable analysis indicated that time interval was an independent predictor of DFS and local recurrence-free survival for patients with stage IB2–IIA.ConclusionsIn cervical cancer patients, time interval between surgery and adjuvant therapy may have different effects on the prognosis in different FIGO stages.

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Impact of time interval between radical hysterectomy with pelvic node dissection and initial adjuvant therapy on oncological outcomes of early stage cervical cancer

Cited by 11 publications

References 24 publications

Minimally Invasive Versus Open Surgery for Radical Hysterectomy Followed By Adjuvant Radiotherapy in Intermediate- or High-Risk Early-Stage Cancer of The Cervix: A Retrospective Study

Minimally Invasive Versus Open Surgery for Radical Hysterectomy Followed By Adjuvant Radiotherapy in Intermediate- or High-Risk Early-Stage Cancer of The Cervix: A Retrospective Study

Predictive Factors of Pelvic Lymph Node Metastasis in Early-Stage Cervical Cancer

The Selection of Time Interval Between Surgery and Adjuvant Therapy in Early Stage Cervical Cancer

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