Is There a Role for Adjuvant Hysterectomy after Suboptimal Concurrent Chemoradiation in Cervical Carcinoma?

Walji, Nawaz; Chue, Amy L; Yap, Christina; Rogers, Linda; El-Modir, Ahmed; Chan, Kenneth K.; Singh, Kavita; Fernando, Indrajit

doi:10.1016/j.clon.2009.11.006

Cited by 23 publications

(29 citation statements)

References 23 publications

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“…Está bien documentado el valor que tiene la cirugía de rescate para pacientes en las que ha fracasado RTQTCC 1,3,4 , destacando algunos autores la utilidad de llevar a cabo cirugías complementarias no exenterativas en pacientes con sospecha o demostración de persistencia tumoral central 7,9,10 y otros, la conveniencia de consolidar con mas ciclos de quimioterapia la terapéutica convencional de RTQTCC 7,11 . En esta serie, 10 de 12 pacientes con sospecha de residual tumoral, persistencia, o recurrencia, fueron sometidas a procedimientos quirúrgicos complementarios o de rescate y solo en un caso se obtuvo fracaso terapéutico, al desarrollar una paciente con persistencia tumoral tratada con histerectomía radical clase 3 una recurrencia tumoral y perderse en estas condiciones.…”

Section: Discussionunclassified

“…Las cirugías realizadas permitieron mejorar en un 10.1% los resultados obtenidos previamente con RTQTCC (p = 0.437, NS). Estos resultados recuerdan los referidos en la bibliografía con terapéuticas similares 4,7,9,10 . Aunque en cuatro casos de los 10 referidos (40%) los especímenes quirúrgicos mostraron ausencia de residual tumoral, lo cual se interpreta como una respuesta patológica completa a la RTQTCC, preoperatoriamente se tenía documentada la necesidad o conveniencia de llevar a cabo las intervenciones quirúrgicas referidas.…”

Section: Discussionunclassified

“…Mientras que en sus etapas tempranas los resultados terapéuticos son muy alentadores, los obtenidos en las etapas avanzadas, en las que se utiliza radioterapia como tratamiento de base, se acompañan de fracasos terapéuticas que oscilan entre un 20% a un 75% según el estadio clínico en que se diagnostique la enfermedad 3,4 . Si bien el advenimiento de la quimioterapia a base de platino como agente radiosensibilizador para el tratamiento de las etapas avanzadas mejoró hasta en un 12% 5,6 los resultados obtenidos previamente con la terapia convencional, no ha tenido el impacto deseado para estas etapas, de ahí los esfuerzos llevados a cabo por diversos autores por incrementar los periodos libres de enfermedad para estos casos y la supervivencia a 5 años sin tumor 1,3,4,[7][8][9][10] . Mientras que para el CaCu avanzado algunos autores recomiendan una terapéutica de consolidación tras la radioterapia y la quimioterapia concomitantes, (RTQTCC) mediante esquemas a base de platino 7,11 y otros sugieren cirugías complementarias 7,9,10 o incluso el empleo de quimioterapia previo a cirugías de rescate en pacientes con persistencia o recurrencia tumoral 3 ; aún estamos en espera de la terapéutica que permita mejorar ostensiblemente los resultados obtenidos hasta ahora en el tratamiento de esta penosa enfermedad.…”

Section: Introductionunclassified

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Cáncer cervicouterino estadios IB2-IIB en pacientes jóvenes: resultados del tratamiento y una propuesta de manejo

Torres-Lobatón

Carrillo-Nolasco

Oliva-Posada

et al. 2022

GAMO

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Gaceta Mexicana de Oncologia. 2017;16(3):160-166 Resumen Introducción: El cáncer cervicouterino (CaCu) avanzado continúa representando en nuestro país un importante problema de salud. Un porcentaje cada vez mayor se diagnostica en mujeres jóvenes. Objetivo: Mostrar una experiencia institucional con la terapéutica convencional en pacientes menstruantes con CaCu en estadios IB2-IIB, agregando en casos indicados cirugías complementarias o de rescate y proponer para estas pacientes alguna alternativa quirúrgica de manejo. Material y métodos: Análisis de la casuística del Servicio de Oncología del Hospital General de México de pacientes de CaCu IB2-IIB con 45 años de edad o menos, que recibieron radioterapia y quimioterapia concomitante (RTQTCC) con o sin cirugía ulterior. Resultados: Se trataron 98 pacientes con edad promedio de 37.1 años. En 89 de ellas se realizó seguimiento, de las cuales 63 (70.7%) evolucionaron un promedio de 30 meses sin evidencia de enfermedad: 12/19 (63.1%) en estadio IB2 y 51/70 (72.8%) en estadios II (p > 0.05). En estadio IB2, únicamente 4/8 adenocarcinomas (50%) tuvieron estos resultados, vs. 8/11 (72.7%) carcinomas epidermoides (p > 0.05). En estadios II, las cifras fueron 8/11 para los adenocarcinomas, (72.7%) y 43/59 para los epidermoides (72.8%). Con cirugías ulteriores los resultados se mejoraron en un 10.1%. Se demostró fracaso de la terapéutica establecida en 17 pacientes (19.3%). Cuatro por progresión locorregional (23.5%) y 13 (76.4%) por diseminación a distancia. Conclusiones: Los resultados para el estadio IB2 fueron menores a los de los estadios II y la mayoría de los fracasos se relacionaron con metástasis a distancia. A fin de evitar menopausias precoces, se sugiere explorar el empleo de quimioterapia neoadyuvante más histerectomía radical en pacientes jóvenes. (creativecommons.org/licenses/by-nc-nd/4.0/). Abstract Introduction: Advanced cervical cancer still represents a major health problem in our country. The percentage diagnosed in young women has been increasing. Objective: We present our institutional experience with conventional therapy in menstruating patients with advanced cervical cancer (stages IB2-IIB); adding in selected cases complementary or rescue surgery as indicated, and our proposal for alternative surgical management for these patients. Methods: We analyzed the cases attended in the Oncology Service, at Hospital General de PALABRAS CLAVECáncer cervicouterino pacientes jóvenes KEY WORDSCervical Cancer Stages IB2-IIB In young patients

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Section: Discussionunclassified

Section: Introductionunclassified

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Cáncer cervicouterino estadios IB2-IIB en pacientes jóvenes: resultados del tratamiento y una propuesta de manejo

Torres-Lobatón

Carrillo-Nolasco

Oliva-Posada

et al. 2022

GAMO

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“…In such situations adjuvant hysterectomy may have to be resorted to. Walji et al [4] published a study assessing the role of adjuvant hysterectomy in the treatment of cervical carcinoma after unsuccessful intracavitary brachytherapy insertion. Recurrence-free survival was improved in their series of five patients who underwent adjuvant hysterectomy in comparison to those who received external beam radiotherapy alone.…”

Section: Discussionmentioning

confidence: 99%

The Role of Adjuvant Hysterectomy After Radiotherapy in Cervical Cancer

et al. 2014

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The aim of this study was to evaluate the morbidity and survival outcome following radical hysterectomy after chemoradiotherapy in the International Federation of Gynecology and Obstetrics (FIGO) stages IB-IIB cervical cancer patients in whom intracavitory brachytherapy was not feasible. We retrospectively reviewed the medical records of our patients who underwent adjuvant radical hysterectomy between January 2005 and December 2012. Post-operative complications were graded according to the grading system of Chassagne et al. (Radiother Oncol 26:195-202, 1993). Survival analysis was done using Kaplan-Meir method. Between January 2005 and December 2012, 43 patients underwent type 2 radical hysterectomy after external beam radiotherapy and concurrent chemotherapy. The median age of the study group was 44 years (range 28-63 years). There were no perioperative deaths. In the early post-operative period, there were 45 complications in 29 patients of which three were of grade 3 severity. The most common post operative complications were urinary tract infections and lymphoedema. The median follow-up time was 29 months (range 9-68 months). The 5-year overall survival was 85.5 % and disease-free survival 82.1 %. This study shows that radical hysterectomy is feasible with good survival outcome and acceptable morbidity after chemoradiotherapy in cervical cancer patients.

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“…When this therapeutic approach is chosen, it would be helpful to correctly assess whether residual parametrial involvement after neoadjuvant CRT is present by MRI. This would be useful as a "road map" to guide surgical treatment in order to achieve a less aggressive approach, while identification of parametrial residual involvement could represent a fundamental element to plan the extent of radical adju¬vant surgery (19)(20)(21)(22). However, cyto- …”

Section: Implications Of Mri On Surgical Treatmentmentioning

confidence: 99%

MRI anatomy of parametrial extension to better identify local pathways of disease spread in cervical cancer

Valentini

Gui²,

Miccò³

et al. 2016

Diagn Interv Radiol

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T here are two main treatment options in patients with cervical cancer: radical surgery, including trachelectomy or radical hysterectomy, which is usually performed in early stage disease as suggested by the International Federation of Gynecology and Obstetrics (FIGO stages IA, IB1, and IIA), or primary radiotherapy with concurrent administration of platinum-based chemotherapy (CRT) for patients with bulky FIGO stage IB2/ IIA2 tumors (> 4 cm) or locally advanced disease (FIGO stage IIB or greater). Some authors suggested the use of CRT followed by surgery for bulky tumors or locally advanced disease (1). Others proposed resection of the Müllerian compartment (fallopian tubes, uterus, proximal and middle vagina, enveloped by peritoneal and subperitoneal mesotissue known as mesometrium) and pelvic lymph node dissection by total mesometrial resection, without adjuvant radiation in FIGO stages IB, IIA, and selected IIB (2), following their ontogenetic theory of locoregional cancer spread (3-6). In all cases, pretreatment assessment of tumor extension and presence of parametrial invasion are of paramount importance to help define an appropriate management strategy. Staging of cervical cancer is still based on FIGO criteria, which are based on clinical findings. Its accuracy is limited in the advanced stages (7). Magnetic resonance imaging (MRI) has been shown to be the most reliable imaging technique in local staging, treatment planning, and follow-up of cervical cancer (8, 9), with staging accuracy ranging from 75% to 96% (10). In 2010, National Comprehensive Cancer Network (NCCN-2010) included MRI in the basic work-up of patients suffering from cervical cancer for stages greater than IB1.The aim of this paper is to show MRI anatomy of the parametrium, paying special attention to the pelvic landmarks, using a series of T2-weighted and diffusion-weighted imaging (DWI) findings that are useful to identify its complete extension (i.e., anterior and posterior extensions, in addition to the lateral extension). Technical suggestionsThe MRI protocol for cervical cancer usually includes anatomical and morphologic sequences of the pelvis, such as T1-weighted imaging in the axial plane and T2-weighted imaging in the axial and sagittal planes, and high spatial resolution axial oblique (short axis of cervix) and coronal oblique (long axis of cervix) T2-weighted imaging with small fieldof-view, which improve identification of parametrial invasion (12). Large field-of-view axial T1-and/or T2-weighted imaging of the abdomen is applied to identify enlarged lymph nodes and hydronephrosis. Dynamic multiphase contrast-enhanced three-dimensional T1-weighted imaging sequence is not routinely used for staging cervical carcinoma, unless the tumor is small and the patient is considered for fertility-sparing surgery or to distinguish ABSTRACTThis paper highlights an updated anatomy of parametrial extension with emphasis on magnetic resonance imaging (MRI) assessment of disease spread in the parametrium in patients with locally advanced cer...

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Is There a Role for Adjuvant Hysterectomy after Suboptimal Concurrent Chemoradiation in Cervical Carcinoma?

Cited by 23 publications

References 23 publications

Cáncer cervicouterino estadios IB2-IIB en pacientes jóvenes: resultados del tratamiento y una propuesta de manejo

Cáncer cervicouterino estadios IB2-IIB en pacientes jóvenes: resultados del tratamiento y una propuesta de manejo

The Role of Adjuvant Hysterectomy After Radiotherapy in Cervical Cancer

MRI anatomy of parametrial extension to better identify local pathways of disease spread in cervical cancer

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