Long-term analysis of clinical outcome and complications in locally advanced cervical cancer patients administered concomitant chemoradiation followed by radical surgery

Ferrandina, Gabriella; Margariti, Pasquale Alessandro; Smaniotto, D.; Petrillo, Marco; Salerno, Maria Giovanna; Fagotti, Anna; Macchia, G.; Morganti, Alessio Giuseppe; Cellini, Numa; Scambia, Giovanni

doi:10.1016/j.ygyno.2010.08.004

Cited by 99 publications

(75 citation statements)

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“…Accumulated evidence demonstrates that concurrent chemoradiotherapy achieves better survival and decreases mortality than chemotherapy alone (Kuzuya., 2004;Ferrandina et al, 2007). Concurrent chemoradiotherapy is thus a standard regimen for medium-term and advanced cervical cance (Mariagrazia et al, 2005;Ferrandina et al, 2010). It is considered that it may be also applied for early cervical cancer (Goksedef et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

Values of Three Different Preoperative Regimens in Comprehensive Treatment For Young Patients with Stage Ib2 Cervical Cancer

Zhao¹,

Wang²,

Chen³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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Cervical cancer tends to occur at an early age. Treatment for cervical cancer includes surgery, chemotherapy, radiotherapy or their combination. The 2-year survival of early cervical cancer after surgery or chemoradiothearpy reaches over 80%. Stage Ib2 cervical cancer, however, is a high-risk early stage cervical cancer with easy recurrence and metastasis. Its 5-year survival is as low as about 50%. Thus how to increase survival and decreases mortality of stage Ib2 cervical cancer is a hot spot in genealogical cancer research. Materials and Methods General dataOne hundred and twelve young patients below 35 years with stage Ib2 cervical cancer were enrolled retrospectively in our hospital from January, 2003 to June, 2005. They ranged in age from 20 to 35 years with a median age of 32 years. The cases of cervical cancer were all confirmed as invasive cancer by our Department of Pathology, including (Group 1, n=38), the neoadjuvant chemotherapy (Group 2, n=49), and the intracavity brachytherapy group (Group 3, n=25). Radical hysterectomy was performed following these regimens. Chemotherapy and radiotherapy were given according to pelvic lymph node metastasis, deep cervical stromal invasion, intravascular cancer emboli, histological grading, vaginal stump and positive surgical margin. Results: The cancer disappearance and superficial muscle invasion rates were statistically significantly better in the concurrent chemoradiotherapy group than in the other two groups (P<0.01). No statistically significant difference was noted in the deep muscle invasion rate, surgical time and intraoperative blood loss among three groups, but significantly more postoperative complications occurred in the concurrent chemoradiotherapy group. The 2-year pelvic recurrence was statistically significantly lower in the concurrent chemoradiotherapy group compared to other two groups, while the 5-year survival was higher. Conclusion: Concurrent chemoradiotherapy is efficacious for young patients with stage Ib2 cervical cancer.

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Section: Discussionmentioning

confidence: 99%

Values of Three Different Preoperative Regimens in Comprehensive Treatment For Young Patients with Stage Ib2 Cervical Cancer

Zhao¹,

Wang²,

Chen³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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“…After extensive counseling the patient was offered a multimodal approach consisting of CT/RT followed by RS [8]. CT/RT included cisplatin (20 mg/m 2 , 2 h i.v.…”

Section: Case Reportmentioning

confidence: 99%

“…Given the rarity of the disease, optimal treatment management is far from being defined and currently follows the same approaches employed for more common histotypes: in early stage disease, radical surgery (RS) followed by adjuvant chemoradiation (CT/RT) in case of high-risk pathological findings is usually utilized [5], while different therapeutic strategies, including exclusive CT/RT, have been employed in locally advanced CCAC patients [5,6,7]. Although data about clinical outcome remain controversial [8,9], some studies suggest that prognosis of patients bearing cervical CCAC or other variants of uterine cervical adenocarcinoma is worse compared to squamous cell tumors [5,10,11], thus making the investigation of multimodal treatment strategies clinically worthwhile.…”

Section: Introductionmentioning

confidence: 99%

Successful Treatment of a Young Patient with Locally Advanced Clear Cell Adenocarcinoma<b> </b>of the Uterine Cervix Undergoing Chemoradiation Followed by Radical Surgery

Ferrandina

Lucidi

Ninno³

et al. 2013

Gynecol Obstet Invest

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Clear cell adenocarcinoma (CCAC) of the uterine cervix is a rare variant of cervical adenocarcinoma accounting for approximately 4-9% of this disease. Given the rarity of this pathological entity, the optimal treatment management is far from being defined. Earlier evidence suggested that the prognosis of patients bearing cervical CCAC is worse than with other histotypes, thus making the investigation of multimodal treatment strategies clinically worthwhile. Herein, we report the first case of locally advanced, large size cervical CCAC in a young woman who was triaged to concomitant chemoradiotherapy followed by radical surgery and experienced a pathologically assessed optimal response to this multimodal approach.

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“…In a recently reported series [22] of patients treated with concomitant chemoradiation followed by radical hysterectomy, pathologic assessment was identifi ed as an independent prognostic factor for disease-free and overall survival.…”

Section: What Is the Best Way To Evaluate Prognosis: Surgical Specimementioning

confidence: 99%

Treatment of cervical cancer: the importance of a multidisciplinary team approach

2011

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C ervical cancer is a worldwide major concern, as it is the second most common malignancy in women and a major cause of morbidity and mortality in developing countries. Management of patients with cervical cancer is a complex issue but close collaboration among clinicians of different disciplines can achieve long-term survival in 70% of patients. Surgery is the most accepted strategy for early cervical cancer and chemoradiation is the standard approach for more advanced stages (IIB-IIIA-IIIB-IVA-IVB). However, the optimal approach for stages IB2-IIA is somewhat controversial and different sequential strategies have been explored in this setting. This editorial aims to address several important questions in the therapeutic planning of this disease.What is the standard approach for early cervical cancer? Concurrent chemoradiationIn 1997 Landoni et al. [1] evaluated the role of radiotherapy alone vs. surgery in stages IB-IIA. Radiotherapy demonstrated signifi cantly less severe morbidity vs. surgery (12% vs. 28%) with identical survival. Moreover, in patients with stage IB2 treated with surgery, adjuvant radiotherapy was required in 84% due to high-risk features.Several trials evaluating the addition of chemotherapy with both platinum and non-platinum regimens demonstrated a benefi t vs. radiotherapy alone in locally advanced cervical cancer. A metanalysis with 4921 patients from 24 randomised trials confi rmed that concurrent chemoradiation is superior to radiotherapy alone. Chemoradiotherapy with both platinum and non-platinum agents improved disease-free and overall survival and reduced both local and distant recurrences [2]. A second metanalysis limited to studies assessing effi cacy of cisplatin-based regimens concurrent with radiotherapy confi rmed a benefi t in overall survival with a reduction in the relative risk of death by 26% favouring concomitant cisplatin [3].Concurrent chemoradiation not only prolonged survival but may have achieved pelvic control rates up to 90%. Thus, treatment with concurrent chemoradiation is the current standard of care in Europe for stages IB2-IVA [4]. This strategy was followed by Reig et al. [5], in this retrospective analysis of 56 patients stage IB2-IV treated with external radiation with concurrent weekly cisplatin followed by brachytherapy. With a proportion of stage III-IV being 14.4%, median survival at 5 years was 80.4% and pelvic control rate was 71.5% in this study.New techniques like extended fi eld intensity-modulated radiation therapy (IMRT) have the potential to improve the therapeutic ratio because of its ability to escalate dose to cancer targets while sparing adjacent healthy tissue [6]. Several retrospective series of patients treated with IMRT claimed dosimetric and clinical benefi ts, with reduction in acute toxicity compared with historic controls [7].Another recent improvement in the planifi cation and staging of radiation therapy is the use of PET/CT. By providing metabolic imaging information, this technique has demonstrated a high accuracy (85.1%) and ...

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Long-term analysis of clinical outcome and complications in locally advanced cervical cancer patients administered concomitant chemoradiation followed by radical surgery

Cited by 99 publications

References 32 publications

Values of Three Different Preoperative Regimens in Comprehensive Treatment For Young Patients with Stage Ib2 Cervical Cancer

Values of Three Different Preoperative Regimens in Comprehensive Treatment For Young Patients with Stage Ib2 Cervical Cancer

Successful Treatment of a Young Patient with Locally Advanced Clear Cell Adenocarcinoma<b> </b>of the Uterine Cervix Undergoing Chemoradiation Followed by Radical Surgery

Treatment of cervical cancer: the importance of a multidisciplinary team approach

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