Neoadjuvant chemotherapy in gynaecological cancers – Implications for staging

Kumar, Lalit; Pramanik, Raja; Kumar, Sunesh; Bhatla, Neerja; Malik, Shilpa

doi:10.1016/j.bpobgyn.2015.02.008

Cited by 20 publications

(21 citation statements)

References 67 publications

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“…The randomized trials can be broadly classified as NACT ± RT or NACT ± surgery. In the first group of trials, the response rate varied from 40 to 80% with b 10% complete response; however, these trials failed to show any improvement in overall or progression-free survival [4]. These results led to the hypothesis that removal of residual disease after NACT by surgery may result in survival benefit.…”

Section: Discussionmentioning

confidence: 86%

“…The benefit of addition of chemotherapy on survival decreases with advanced stage (10% for stage Ia-IIa, 7% for stage IIb, and 3% for stage III and IVa) [3]. Residual pelvic disease and locoregional recurrence remain the main causes of treatment failure in such settings [4]. Therefore, newer treatment modalities need to be explored for better tumor control.…”

Section: Introductionmentioning

confidence: 98%

See 1 more Smart Citation

Low-dose fractionated radiation and chemotherapy prior to definitive chemoradiation in locally advanced carcinoma of the uterine cervix: Results of a prospective phase II clinical trial

Das

John

Reddy

et al. 2015

Gynecologic Oncology

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Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 98%

Low-dose fractionated radiation and chemotherapy prior to definitive chemoradiation in locally advanced carcinoma of the uterine cervix: Results of a prospective phase II clinical trial

Das

John

Reddy

et al. 2015

Gynecologic Oncology

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“…These two randomized prospective trials showed that in selected patients, interval debulking surgery after neoadjuvant chemotherapy showed equivalent survival with less morbidity compared with primary cytoreductive surgery. NACT followed by IDS may be particularly useful in patients with a poor performance status, significant medical co‐morbidities, visceral metastases, and those who have large pleural effusions and/or gross ascites . In selected patients whose primary cytoreduction is considered suboptimal, particularly if a gynecologic oncologist did not perform the initial operation, interval debulking may be considered after 2–3 cycles of systemic chemotherapy .…”

Section: Primary Surgerymentioning

confidence: 99%

“…NACT followed by IDS may be particularly useful in patients with a poor performance status, significant medical co-morbidities, visceral metastases, and those who have large pleural effusions and/or gross ascites. 54 In selected patients whose primary cytoreduction is consid- (Table 3). The accepted standard is 6 cycles of platinum-based combination chemotherapy, with a platinum (carboplatin or cisplatin) and a taxane (paclitaxel or docetaxel).…”

Section: Interval Debulkingmentioning

confidence: 99%

Cancer of the ovary, fallopian tube, and peritoneum

Berek

Kehoe

Kumar

et al. 2018

Intl J Gynecology & Obste

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278

221

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The Gynecologic Oncology Committee of FIGO in 2014 revised the staging of ovarian cancer, incorporating ovarian, fallopian tube, and peritoneal cancer into the same system. Most of these malignancies are high‐grade serous carcinomas (HGSC). Stage IC is now divided into three categories: IC1 (surgical spill); IC2 (capsule ruptured before surgery or tumor on ovarian or fallopian tube surface); and IC3 (malignant cells in the ascites or peritoneal washings). The updated staging includes a revision of Stage IIIC based on spread to the retroperitoneal lymph nodes alone without intraperitoneal dissemination. This category is now subdivided into IIIA1(i) (metastasis ≤10 mm in greatest dimension), and IIIA1(ii) (metastasis >10 mm in greatest dimension). Stage IIIA2 is now “microscopic extrapelvic peritoneal involvement with or without positive retroperitoneal lymph node” metastasis. This review summarizes the genetics, surgical management, chemotherapy, and targeted therapies for epithelial cancers, and the treatment of ovarian germ cell and stromal malignancies.

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“…However, delay of definitive treatment, i.e. radiation and selection of resistant clone, are potential disadvantages of NACT [11] . Apart from locally advanced disease, the role of NACT has also been explored in patients with early-stage (IB-IIA) disease prior to surgery or radiation.…”

Section: Neo-adjuvant Chemotherapymentioning

confidence: 99%

Integrating Chemotherapy in the Management of Cervical Cancer: A Critical Appraisal

Kumar

Gupta

2016

Oncology

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The management of locally advanced cervix cancer has undergone a paradigm shift during the last decade. Concurrent chemoradiation (CCRT) (with cisplatin alone or in combination) is currently the standard treatment approach. CCRT results in a 5-year overall survival rate of 66% and a disease-free survival of 58%. About 30-40% of patients with locally advanced cervical cancer fail to achieve complete response to CCRT; alternative approaches are needed to improve the outcome for such patients. Weekly paclitaxel and carboplatin for 4-6 weeks as dose-dense chemotherapy prior to CCRT could be one such potential approach. The role of adjuvant chemotherapy after CCRT in patients with positive lymph nodes, larger tumor volume and stage III-IVA disease needs further exploration. Adjuvant chemotherapy is also being investigated for early-stage (stages IA2, IB1 or IIA) cervical cancer with presence of risk factors such as lymph node metastasis, lymphovascular space invasion and invasion depth of more than 10 mm, microscopic parametrial invasion, non-squamous histology and positive surgical margins. For patients with early-stage disease (IA2-IIA), short-course chemotherapy prior to surgery is associated with an improved outcome in many studies. Neo-adjuvant chemotherapy followed by fertility preservation surgery is feasible in carefully selected young patients with bulky stage IB1 disease. Recently, a number of molecular pathways have been identified as potential therapeutic targets. Bevacizumab - an inhibitor of vascular endothelial growth factor - is associated with improved survival in patients with recurrent/metastatic cervical cancer. Whether bevacizumab and other similar novel agents targeting molecular pathways could be used in front-line treatment along with cytotoxic chemotherapy is likely to be an area of research in future studies.

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Neoadjuvant chemotherapy in gynaecological cancers – Implications for staging

Cited by 20 publications

References 67 publications

Low-dose fractionated radiation and chemotherapy prior to definitive chemoradiation in locally advanced carcinoma of the uterine cervix: Results of a prospective phase II clinical trial

Low-dose fractionated radiation and chemotherapy prior to definitive chemoradiation in locally advanced carcinoma of the uterine cervix: Results of a prospective phase II clinical trial

Cancer of the ovary, fallopian tube, and peritoneum

Integrating Chemotherapy in the Management of Cervical Cancer: A Critical Appraisal

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