Prognostic Factors for Curative Pelvic Exenterations in Patients With Recurrent Uterine Cervical or Vaginal Cancer

Sardain, Hugo; Lavoué, Vincent; Laviolle, Bruno; Henno, Sébastien; Foucher, Fabrice; Lévèque, Jean

doi:10.1097/igc.0000000000000288

Cited by 13 publications

(11 citation statements)

References 21 publications

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“…However, contradictory data have been reported. For example, in a series of total pelvic exenteration for recurrent gynecological cancer, Sardain et al16 and Mourton et al17 reported that the rate of mesorectal nodal metastasis was 19% and 10%, respectively. They also found that MRNM is common in patients with rectal wall involvement in recurrent cervical cancer as well as ovarian cancer 18.…”

Section: Discussionmentioning

confidence: 99%

Incidence of mesorectal node metastasis in locally advanced cervical cancer: its therapeutic implications

Cordero-Gallardo

Burnett

McNamara

et al. 2019

Int J Gynecol Cancer

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ObjectiveTo evaluate the incidence and risk factors for mesorectal node metastasis (MRNM) in locally advanced cervical cancer.Methods/MaterialsWe performed an observational retrospective cohort study of 122 patients with cervical cancer who received definitive chemo-radiation treatment between December 2013 and June 2017 to evaluate the incidence of MRNM. Three diagnostic radiologists assessed all available pre-treatment images. In this study, the pelvic node metastasis was defined as ≥ 1.0 cm and MRNM as ≥ 0.5 cm for CT and MRI scans and as a maximum standardized uptake value of > 2.5 for PET/CT. The relationship of MRNM with FIGO stage, pelvic node metastasis, and mesorectal fascia involvement was evaluated.ResultsThe incidence of MRNM in all 122 patients was 8 (6.6%). However, in advanced stage (III– IV) patients, MRNM occurred in 4 of 39 (10.3%) compared with 4 of 83 (4.8%) in early stage (IB1–IIB) patients (p = 0.27). In patients with a positive pelvic node, MRNM occurred in 7 of 55 (12.7%) and 1 of 67 (1.5%) in those with negative pelvic node (p = 0.02). In addition, the incidence of MRNM was 3 of 9 (33.3%) in the presence of mesorectal fascia involvement and 5 of 113 (4.4%) among those without mesorectal fascia involvement (p = 0.013).ConclusionThis study indicates that pelvic node metastasis and mesorectal fascia involvement are high-risk factors for MRNM. Therefore, vigilance of reviewing images in the mesorectum for MRNM is necessary for high-risk patients.

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Section: Discussionmentioning

confidence: 99%

Incidence of mesorectal node metastasis in locally advanced cervical cancer: its therapeutic implications

Cordero-Gallardo

Burnett

McNamara

et al. 2019

Int J Gynecol Cancer

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“…The median time of recurrence, after initial treatment, is 18-24 months and occurs in 20%-30% of patients initially treated with concomitant chemotherapy for recurrent cervical cancer [18]. The overall limitation of the existing studies is the heterogeneity in the inclusion criteria and the consideration of several types of cancers (of the cervix, endometrium, vulva, and ovaries) [19]. A 5-year survival of 46% for primary advanced and 17% for locally recurrent rectal cancer has also been shown [20].…”

Section: Outcome and Prognosismentioning

confidence: 99%

Pelvic Exenteration for the Management of Pelvic Malignancies

Paramythiotis¹,

Kofina²,

AntoniosMichalopoulos³

2015

Approaches to Hysterectomy

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Pelvic exenteration is a surgical procedure first described by Brunschwig in as a curative or palliative treatment for pelvic and perineal tumors. It is actually a radical operation, involving en bloc resection of pelvic organs, including reproductive structures, bladder, and rectosigmoid. In patients with recurrent cervical and vaginal malignancy, it is associated with a -year survival of more than %. In spite of advances in surgical management, consequences such as stomas, are still frequently unavoidable for radical tumor excision. Most candidates for this procedure have been diagnosed with recurrent cervical cancer that has previously been treated with surgery and radiation, or radiation alone. Complications of pelvic exenteration are more severe than those of standard resection of a colorectal carcinoma, so it is not commonly performed, including wound infection, wound dehiscence also described as burst abdomen the creation of fistulae perineal-fecal, uretero-vaginal, between conduit and perineal wound , urinary tract infections, perineal hernias and intestinal obstruction. Patients need to be carefully selected and counseled about risks and long-term issues related to the surgery. A comprehensive evaluation is required in order to exclude unresectable or metastatic disease. Evolution of the technique through laparoscopy and minimally invasive surgery may result in a reduction of morbidity and mortality.

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“…The 5-year survival rates of patients who undergo total pelvic exenteration range from 20 to 60% [12,13,14]. Clearly, exenteration is a major surgical procedure and is associated with a procedure-associated mortality of up to 10% [12,13,14,15,16,17,18]. Therefore, extensive counselling of patients is necessary before undergoing this treatment.…”

Section: Treatment Of Local Pelvic Recurrencementioning

confidence: 99%

“…A systematic review of the literature of the Cochrane Collaboration identified no randomized trial and concluded that there is no evidence to inform decisions about exenterative surgery for women with recurrent gynecologic malignancies [19]. Sardain et al [18] performed pelvic exenterations in 13 women with recurrent cervical cancer and 3 women with recurrent vaginal cancer. All of the patients had received pelvic irradiation before; the median tumor size was 4.3 cm.…”

Section: Treatment Of Local Pelvic Recurrencementioning

confidence: 99%

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State-of-the-Art Treatment and Novel Agents in Local and Distant Recurrences of Cervical Cancer

Tempfer

Beckmann²

2016

Oncol Res Treat

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Depending on the stage at initial presentation, cervical cancer will recur in 25-61% of women. Typical manifestations of recurrent cervical cancer include the central pelvis and the pelvic side walls as well as retroperitoneal lymph node basins in the pelvis and the para-aortic region, and - more rarely - supraclavicular lymph nodes. There are no typical symptoms of recurrent cervical cancer. Women with suspected recurrence after cervical cancer based on gynecological examination or organ-specific symptoms must undergo imaging studies and - if technically feasible - biopsy with histological verification, especially in cases of distant metastases, in order to rule out a second primary. Radiotherapy-naïve women should be treated with salvage radiochemotherapy with curative intention. For women with previous radiotherapy, surgery in the form of hysterectomy, local resection, or pelvic exenteration is the treatment of choice. Pelvic exenteration can lead to cure in selected patients, but at the price of a high rate of complications and significant morbidity and mortality. If complete surgical resection is not feasible or if the woman is not a candidate for surgery, chemotherapy with palliative intent should be offered. Patients with recurrent disease outside the pelvis are candidates for systemic chemotherapy. Several agents have shown to be active in this situation, either in single-agent or combination regimens. Platinum-containing regimens have a superior efficacy over non-platinum regimens and bevacizumab may be added to chemotherapy.

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Prognostic Factors for Curative Pelvic Exenterations in Patients With Recurrent Uterine Cervical or Vaginal Cancer

Abstract: The presence of vascular emboli is a new prognostic factor in cases of recurrent cervical or vaginal cancer. Assessing the presence of vascular emboli on pretherapeutic biopsies could facilitate the selection of patients eligible for curative pelvic exenterations.

Cited by 13 publications

References 21 publications

Incidence of mesorectal node metastasis in locally advanced cervical cancer: its therapeutic implications

Incidence of mesorectal node metastasis in locally advanced cervical cancer: its therapeutic implications

Pelvic Exenteration for the Management of Pelvic Malignancies

State-of-the-Art Treatment and Novel Agents in Local and Distant Recurrences of Cervical Cancer

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