Preoperative nomogram for prediction of microscopic parametrial infiltration in patients with FIGO stage IB cervical cancer treated with radical hysterectomy

Kong, Tae-Wook; Kim, Jayoun; Son, Joo-Hyuk; Kang, Seong Woo; Paek, Jiheum; Chun, Mison; Chang, Suk-Joon; Ryu, Hee Sug

doi:10.1016/j.ygyno.2016.05.010

Cited by 29 publications

(23 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Disruption of the cervical stromal ring on magnetic resonance imaging (MRI) is strongly predictive of microscopic parametrial infiltration in patients with early invasive cervical cancer (76,77). The patients with this MRI finding, if submitted to primary surgery, usually receive adjuvant radiotherapy or CCRT.…”

Section: Resultsmentioning

confidence: 99%

Neoadjuvant Chemotherapy in Locally Advanced Cervical Cancer: Review of the Literature and Perspectives of Clinical Research

Gadducci

Cosio

2020

Anticancer Res

View full text Add to dashboard Cite

Concurrent cisplatin-based chemotherapy and radiotherapy (CCRT) plus brachytherapy is standard treatment for locally advanced cervical cancer. Platinumbased neoadjuvant chemotherapy (NACT) followed by radical hysterectomy has been proposed as an alternative approach, especially for patients with stage Ib2-IIb disease. This review analyzes the most commonly used combination regimens in this clinical setting and the randomized trials comparing chemo-surgery versus definitive radiotherapy or CCRT. The combination of paclitaxel plus ifosfamide plus cisplatin (TIP regimen) obtained the highest rates of optimal pathological response, associated with elevated hematological toxicity. In a recent phase II study, a dose-dense regimen consisting of weekly paclitaxel plus carboplatin for 9 cycles has achieved optimal pathological response rates similar to those of TIP with better toxicity profile. Further studies are strongly warranted to better define the optimal regimen for the patients selected to receive NACT followed by radical surgery. GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries have shown 569,874 new cases of cervical cancer and 311,365 deaths due to this malignancy in 2018 (1). Concurrent cisplatin (CDDP)-based chemotherapy and radiotherapy (CCRT) plus brachytherapy represents the standard of care in patients with locally advanced disease, i.e. in stage FIGO 2009 Ib2-IIa2-IIb-III-IVa (2-6). A meta-analysis of 13 randomized trials showed that CCRT significantly improved 5year overall disease-free survival (DFS) [hazard ratio (HR)=0.78, 95% confidence interval (CI)=0.70-0.87], 5-year loco-regional disease-free survival (HR=0.76, 95%CI=0.68-0.86), 5-year metastases-free survival (HR=0.81, 95%CI=0.72-0.91) and 5year overall survival (OS) (HR=0.81, 95%CI=0.71-0.91) compared to radiotherapy alone (7). A larger survival advantage emerged for the two further trials in which adjuvant chemotherapy was administered after CCRT. An additional trial appeared to confirm the clinical benefit of this adjuvant treatment (8). In in vitro studies gemcitabine (GEM) was found to synergize with CDDP and have a radiosensitizing effect in six cervical cancer cell lines (9). A Mexican phase III trial randomized 515 patients with stage IIb-IVa cervical cancer to receive either CCRT (with CDDP 40 mg/m 2 + GEM 125 mg/m 2 weekly) plus brachytherapy followed by two cycles of adjuvant chemotherapy with CDDP (50 mg/m 2 day 1) + GEM 1000 mg/m 2 (days 1 and 8) every 3 weeks or the standard CCRT (with CDDP 40 mg/m 2 weekly) plus brachytherapy (8). The former arm experienced a trend significantly lower distant recurrence rate (8.1% versus 16.4%, p=0.005) a trend to a lower local recurrence rate (11.2% versus 16.4%, p=0.097), a significantly better progression-free survival (PFS) (HR=0.68, 95%CI=0.49-0.95) and a significantly better OS (HR=0.68, 95%CI=0.49-0.95), associated with increased, but manageable toxicity. Further investigations are needed to clarify the role of adjuvant chemotherapy after CCRT, especia...

show abstract

Section: Resultsmentioning

confidence: 99%

Neoadjuvant Chemotherapy in Locally Advanced Cervical Cancer: Review of the Literature and Perspectives of Clinical Research

Gadducci

Cosio

2020

Anticancer Res

View full text Add to dashboard Cite

show abstract

“…Several authors have reported that cervical tumors in elderly women are prone to grow endophytically because the squamocolumnar junction is within the canal, and they have a higher incidence of PMI even when their tumors are 2 to 3 cm or less in size. 20,27,28 Kong et al 29 have reported that postmenopausal women had smaller tumor volumes (10.1 cm 3 in the premenopausal group vs 7.8 cm 3 in the postmenopausal group, P = 0.017) and lower FIGO stage compared with those in premenopausal women. However, the current study emphasizes that independently of menopausal status, endophytic growth is one of the most important preoperative features reflecting deep infiltration and PMI, which might be unrecognized in pelvic examination.…”

Section: Discussionmentioning

confidence: 97%

Preoperatively Assessable Clinical and Pathological Risk Factors for Parametrial Involvement in Surgically Treated FIGO Stage IB–IIA Cervical Cancer

Canaz

Özyürek

Erdem

et al. 2017

International Journal of Gynecological Cancer

View full text Add to dashboard Cite

Endophytic clinical presentation and larger clinical tumor size (>3 cm) are independent risk factors for PMI in stage IB-IIA cervical cancer. Approximately 78% of the patients with a tumor size of more than 3 cm and endophytic presentation will require adjuvant chemoradiation for PMI following radical surgery. Considering clinical tumor presentation along with tumor size can enhance the physician's prediction of PMI in early-stage cervical cancer.

show abstract

“…Nomograms have recently been developed to assess an individual probability of a certain event with validated indications in other gynecological malignancies [ 31 , 32 ]. Kong et al recently described such a nomogram for patients with stage IB disease [ 33 ]. Their model includes four parameters combining biological and imaging criteria to accurately predict parametrial invasion preoperatively.…”

Section: Discussionmentioning

confidence: 99%

Identification of a low risk population for parametrial invasion in patients with early-stage cervical cancer

Dabi

Willecocq

Ballester³

et al. 2018

J Transl Med

View full text Add to dashboard Cite

BackgroundRecent studies have challenged radical procedures for less extensive surgery in selected patients with early-stage cervical cancer at low risk of parametrial invasion. Our objective was to identify a subgroup of patients at low risk of parametrial invasion among women having undergone surgical treatment.MethodsData of 1447 patients with cervical cancer treated between 1996 and 2016 were extracted from maintained databases of 10 French University hospitals. Patients with early-stage (IA2–IIA) disease treated by radical surgery including hysterectomy and trachelectomy, were selected for further analysis. The Kaplan–Meier method was used to estimate the survival distribution. A Cox proportional hazards model including all the parameters statistically significant in univariate analysis, was used to account for the influence of multiple variables.ResultsOut of the 263 patients included for analysis, on final pathology analysis 28 (10.6%) had parametrial invasion and 235 (89.4%) did not. Factors significantly associated with parametrial invasion on multivariate analysis were: age > 65 years, tumor > 30 mm in diameter measured by MRI, lymphovascular space invasion (LVSI) on pathologic analysis. Among the 235 patients with negative pelvic lymph nodes, parametrial disease was seen in only 7.6% compared with 30.8% of those with positive pelvic nodes (p < 0.001). In a subgroup of patients presenting tumors < 30 mm, negative pelvic status and no LVSI, the risk of parametrial invasion fell to 0.6% (1/173 patients).ConclusionOur analysis suggests that there is a subgroup of patients at very low risk of parametrial invasion, potentially eligible for less radical procedures.Electronic supplementary materialThe online version of this article (10.1186/s12967-018-1531-6) contains supplementary material, which is available to authorized users.

show abstract

Preoperative nomogram for prediction of microscopic parametrial infiltration in patients with FIGO stage IB cervical cancer treated with radical hysterectomy

Cited by 29 publications

References 40 publications

Neoadjuvant Chemotherapy in Locally Advanced Cervical Cancer: Review of the Literature and Perspectives of Clinical Research

Neoadjuvant Chemotherapy in Locally Advanced Cervical Cancer: Review of the Literature and Perspectives of Clinical Research

Preoperatively Assessable Clinical and Pathological Risk Factors for Parametrial Involvement in Surgically Treated FIGO Stage IB–IIA Cervical Cancer

Identification of a low risk population for parametrial invasion in patients with early-stage cervical cancer

Contact Info

Product

Resources

About