'Is there a role for adjuvant pelvic radiotherapy after radical hysterectomy in early stage cervical cancer?'

Pearcey, R.; Dundas, George; Schepansky, A.; Birchall, I. W. J.; Capstick, Valerie; MacLean, G D; Hugh, Judith

doi:10.1046/j.1525-1438.1992.02010056.x

Cited by 3 publications

(4 citation statements)

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“…In the present study, postoperative adjuvant CCRT with single cisplatin did not meaningfully improve DFS or distant recurrence-free survival in patients with adverse factors compared with RT, whereas SCRT with combination of cisplatin and taxane did improve the prognosis, especially for the patients with high-risk factors. According to previous reports, patients with lymph node metastasis had a high risk for recurrence and distant failure. It is thus necessary for postoperative adjuvant therapy not only to control local recurrence, but also to prevent distant metastasis.…”

Section: Discussionmentioning

confidence: 92%

Effectiveness of Sequential Chemoradiation vs Concurrent Chemoradiation or Radiation Alone in Adjuvant Treatment After Hysterectomy for Cervical Cancer

et al. 2021

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IMPORTANCEThere is no current consensus on the role of chemotherapy in addition to radiation for postoperative adjuvant treatment of patients with early-stage cervical cancer with adverse pathological factors.OBJECTIVE To evaluate the clinical benefits of sequential chemoradiation (SCRT) and concurrent chemoradiation (CCRT) compared with radiation alone (RT) as a postoperative adjuvant treatment in early-stage cervical cancer. DESIGN, SETTING, AND PARTICIPANTSAfter radical hysterectomy at 1 of 8 participating hospitals in China, patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB to IIA cervical cancer with adverse pathological factors were randomized 1:1:1 to receive adjuvant RT, CCRT, or SCRT. Data were collected from February 2008 to December 2018.INTERVENTIONS Patients received adjuvant RT (total dose, 45-50 Gy), CCRT (weekly cisplatin, 30-40 mg/m 2 ), or SCRT (cisplatin, 60-75 mg/m 2 , plus paclitaxel, 135-175 mg/m 2 ) in a 21-day cycle, given 2 cycles before and 2 cycles after radiotherapy, respectively. MAIN OUTCOMES AND MEASURESThe primary end point was the rate of disease-free survival (DFS) at 3 years.RESULTS A total of 1048 women (median [range] age, 48 [23-65] years) were included in the analysis (350 in the RT group, 345 in the CCRT group, and 353 in the SCRT group). Baseline demographic and disease characteristics were balanced among the treatment groups except that the rate of lymph node involvement was lowest in the RT group (18.3%). In the intention-to-treat population, SCRT was associated with a higher rate of DFS than RT (3-year rate, 90.0% vs 82.0%; hazard ratio [HR], 0.52; 95% CI, 0.35-0.76) and CCRT (90.0% vs 85.0%; HR, 0.65; 95% CI, 0.44-0.96). Treatment with SCRT also decreased cancer death risk compared with RT (5-year rate, 92.0% vs 88.0%; HR, 0.58; 95% CI, 0.35-0.95) after adjustment for lymph node involvement. However, neither DFS nor cancer death risk was different among patients treated with CCRT or RT. CONCLUSIONS AND RELEVANCEIn this randomized clinical trial, conducted in a postoperative adjuvant treatment setting, SCRT, rather than CCRT, resulted in a higher DFS and lower risk of cancer death than RT among women with early-stage cervical cancer.

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Section: Discussionmentioning

confidence: 92%

Effectiveness of Sequential Chemoradiation vs Concurrent Chemoradiation or Radiation Alone in Adjuvant Treatment After Hysterectomy for Cervical Cancer

et al. 2021

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“…Nodal metastasis is an important parameter in postoperative adjuvant therapy decisions, given its strong correlation with recurrence. Radical hysterectomy with pelvic lymphadenectomy is a widely disseminated treatment for Ib-IIa cervical cancer stages, with excellent survival rates above 80% [17][18][19]. Despite these good results, 20% of patients develop recurrences and eventually die [20].…”

Section: Viral Dna Extraction From Tumorsmentioning

confidence: 99%

“…Patients with negative PLNs have a low risk of recurrence, but in absolute numbers they account for 50% of all cervical cancer recurrences [18,19]. In patients with negative PLNs, many risk factors have been proposed and evaluated, such as tumor size, stromal invasion, lymphovascular invasion, microscopic parametric infiltration, etc, whose presence would decide adjuvant radiotherapy (RT), but data are not consistent and uniform in different studies [21,22].…”

Section: Viral Dna Extraction From Tumorsmentioning

confidence: 99%

Detection of E6/E7 human papilloma virus (HPV) transcripts in lymph nodes of patients with cervical cancer

Basiletti¹,

Soderini²,

Picconi³

et al. 2017

Integr Cancer Sci Therap

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Volume 4(5): [1][2][3][4][5] types that taxonomically correspond to A7 (HPV 18, 39, 45, 59 and 68) and A9 species (HPV 16,31, 33, 35, 52 and 58) Hospital Nacional "Profesor Alejandro Posadas", Argentina 5Hospital Municipal "Juan A. Fernández", Argentina AbstractPersistent high risk Human Papillomavirus (HPV) infection is necessary for the development of cervical cancer (CC). HPV carcinogenesis is based on viral E6 and E7 proteins' capacity to interfere in cell proliferation control. The metastasis status of pelvic lymph nodes (PLN) is a critical parameter in post-operative decisions on adjuvant therapy, given its strong correlation with recurrence in CC. In order to complement the histopathological evaluation of subclinical node metastases, we evaluated the application of a commercial HPV E6 / E7 mRNA kit, to detect viral messenger RNAs in lymph nodes and tumors of patients with CC.Forty five cervical primary tumors and 152 PLN ( 3-4 from each patient) were included. HPVs were typed in tumors by PCR (polymerase chain reaction) using generic primers PGMY and reverse line blot hybridization (RLB) with type-specific oligo probes corresponding to 37 HPV types that infect the anogenital tract. PNL were collected in RNAlater (Invitrogen) and mRNA was extracted using the MiniMag (Biomerieux) system. Detection of E6 and E7 mRNAs corresponding to HPVs types 16, 18, 31, 33 and 45 was carried out using isothermal real time PCR (NucliSENS EasyQ HPV, Biomerieux).HPV was detected in the tumors of 42 patients; the viral types identified were HPV16 (n = 32), HPV18 (n = 5), HPV31 (n = 3), HPV45 (n = 2), HPV59 (n = 1) and HPV73 (n = 1). These last 2 cases were not considered in the study because the mRNA detection system does not include these viral types. Also excluded were 2 cases whose tumors were HPV negative. There was a high correlation between the histological and virological results. Seventy-two percent of the histologically positive PLN were positive for E6-E7 mRNA; while 93% (125/134) of the negative PLN were also negative for E6-E7 mRNA assay. There was, however 8% (9/134) of negative PLN in which viral messengers were detected.Patients' follow up was limited (4 years) and except for two patients who died (both positive for HPV 45) in the period under review, no recurrences were recorded in any of the patients included in the study.The presence of HPV in PLN may indicate a metastasis, as since the virus is not able of producing viremia or invading tissues it can only be "transported" by the cancer cell. The presence of HPV mRNA indicates viral genome transcription, a process which occurs in a lymph node only in CC metastatic cells, as these viruses can only replicate in epithelial-origin cells. Therefore, the findings of these mRNAs in the negative pelvic lymph nodes point out a very early metastasis, detectable at molecular level, but unobservable on histological diagnosis.The commercial kits for HPV E6/E7 mRNA detection, usually applied for the cervical disease management, may be used also to evaluate PLN biopsie...

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“…As previously mentioned, positive lymph nodes are an important prognostic factor in cervical cancer, with a recurrence rate of greater than 40% compared to patients without lymph node metastasis. Lymph node involvement has also been shown to have a higher rate of distant failure [ 8 9 10 ]. Considering these findings, systemic chemotherapy has been proposed as postsurgical adjuvant therapy to control both local recurrence and prevent distant metastatic disease.…”

mentioning

confidence: 99%

Should adjuvant chemotherapy be formally studied among patients found to have pelvic lymph node metastases following radical hysterectomy with lymphadenectomy for early-stage cervical cancer?

Bujnak

Tewari

2021

J Gynecol Oncol

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'Is there a role for adjuvant pelvic radiotherapy after radical hysterectomy in early stage cervical cancer?'

Cited by 3 publications

References 0 publications

Effectiveness of Sequential Chemoradiation vs Concurrent Chemoradiation or Radiation Alone in Adjuvant Treatment After Hysterectomy for Cervical Cancer

Effectiveness of Sequential Chemoradiation vs Concurrent Chemoradiation or Radiation Alone in Adjuvant Treatment After Hysterectomy for Cervical Cancer

Detection of E6/E7 human papilloma virus (HPV) transcripts in lymph nodes of patients with cervical cancer

Should adjuvant chemotherapy be formally studied among patients found to have pelvic lymph node metastases following radical hysterectomy with lymphadenectomy for early-stage cervical cancer?

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