Prognostic Factors in Patients with Bulky Stage IB or IIA Cervical Carcinoma Undergoing Neoadjuvant Chemotherapy and Radical Hysterectomy

Lai, Chyong‐Huey; Hsueh, Swei; Chang, Ting‐Chang; Tseng, Chih-Jen; Huang, Kuan-Gen; Chou, Hung-Hsueh; Chen, Shiow-Meei; Chang, Ming-Fang; Shum, Hin-Cheung

doi:10.1006/gyno.1996.4603

Cited by 52 publications

(44 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Fruscio et al (2012) reported that chemotherapy during the second or third trimester of pregnancy has no obvious adverse effect on the fetus, even though the putative risk is to promote the progress of the tumor since chemotherapy is not the radical treatment for cervical cancer (Lai et al, 1997;Benhaim et al, 2008;Favero et al, 2010). No patient in the current report received neoadjuvant chemotherapy with the purpose of continuing the pregnancy.…”

Section: Discussionmentioning

confidence: 78%

Treatment and prognosis of cervical cancer associated with pregnancy: analysis of 20 cases from a Chinese tumor institution

Zhang

Yong-liang

Yang

2015

J. Zhejiang Univ. Sci. B

View full text Add to dashboard Cite

Abstract:This study was designed to investigate the therapeutic approaches and prognosis for cervical cancer associated with pregnancy. Clinical information, therapeutic strategies, and follow-up results of 20 patients with cervical cancer associated with pregnancy from Jan. 2000 to June 2009 in the Zhejiang Cancer Hospital were retrospectively analyzed. The International Federation of Gynecology and Obstetrics (FIGO) stages were: in situ (n=1), stage IA1 (n=1), stage IB1 (n=5), stage IB2 (n=1), stage IIA (n=8), stage IIB (n=3), and stage IIIB (n=1). Eight patients were in the first trimester of pregnancy, four in the second, two in the third, and six at postpartum when diagnosed. The therapeutic strategies were either single or combined modalities, including surgery, radiotherapy, and chemotherapy. Fourteen patients survived, five patients died (four of remote metastasis and one of uremia), and one patient was lost to follow-up. One newborn from a patient at stage IIA carcinoma in the third trimester with postponed therapy six weeks after diagnosis survived. Retarded fetal growth was observed in one patient receiving neoadjuvant chemotherapy and cesarean section. Out of the six postpartum patients, three underwent cesarean section and survived, whereas only one out of the three who underwent vaginal delivery survived. The remaining two died of remote metastasis. Therefore, personalized treatment is necessary for cervical cancer associated with pregnancy. Cervical cancer patients in the third trimester of pregnancy can continue the pregnancy for a short period of time. There may be potential risk for the fetus by chemotherapy during pregnancy. Cesarean section is the preferred mode of delivery for pregnant cervical cancer patients.

show abstract

Section: Discussionmentioning

confidence: 78%

Treatment and prognosis of cervical cancer associated with pregnancy: analysis of 20 cases from a Chinese tumor institution

Zhang

Yong-liang

Yang

2015

J. Zhejiang Univ. Sci. B

View full text Add to dashboard Cite

show abstract

“…NAC is potentially capable of reducing localized lesions, improving parametrial involvement and increasing the surgical resection rate (8). NAC prior to radiotherapy or surgery-induced blood rheology variation in the local tumor is beneficial for the …”

Section: Discussionmentioning

confidence: 99%

Treatment of early bulky cervical cancer with neoadjuvant paclitaxel, carboplatin and cisplatin prior to laparoscopical radical hysterectomy and pelvic lymphadenectomy

2011

View full text Add to dashboard Cite

Abstract. The objective of this study was to evaluate the efficacy and safety of neoadjuvant chemotherapy (NAC) with paclitaxel combined with carboplatin and cisplatin prior to laparoscopic radical hysterectomy and pelvic lymphadenectomy. A total of 19 patients who had bulky cervical cancer of International Federation of Gynecology and Obstetrics (FIGO) Stage Ib2 to IIb2 (lesion diameter >4 cm) received NAC with paclitaxel combined with carboplatin and cisplatin prior to laparoscopic radical hysterectomy and pelvic lymphadenectomy. The tumor diameter, the response rate, the resection rate and the lymph node metastasis rate after chemotherapy, as well as the toxicity were evaluated. All patients successfully received NAC, with the exception of 1 patient with FIGO Stage Ib2 and 7 cm tumor diameter, who rejected complete therapy. The tumor diameter was reduced from 4.93±0.81cm before NAC to 2.57±1.90 cm after treatment (P<0.01), and the overall response rate [complete remission (CR) + partial remission (PR)] was 78.9% (15/19). Two patients received radiotherapy after NAC, 1 patient was found to have cystic metastasis during the surgery and the operative rate was 83.3% (15/18). Pelvic lymph node metastasis was found in 2 of the 18 patients (11.1%) without parametrial and vaginal margin involvement. Hematological toxicity was the most common side effect and the 3-4 toxicity level was only 11.1% (2/18). In conclusion, NAC with paclitaxel, combined with carboplatin and cisplatin, followed by laparoscopic radical hysterectomy and pelvic lymphadenectomy was found to be effective and safe. Thus, NAC is the ideal treatment for patients with early bulky cervical cancer.

show abstract

“…Previous studies have relied on clinical evaluation by pelvic examination with or without ultrasonography to assess the response (Eddy et al, 1995;Lai et al, 1997;Sardi et al, 1997;Benedetti-Panici et al, 1998;Hwang et al, 2001). Reductions in tumour volume of up to 100% with as many as 15 -20% having complete clinical response after three cycles of chemotherapy (Lai et al, 1997;Benedetti-Panici et al, 1998) have been reported, but on comparison with subsequent histopathology these assessments have been shown to be inaccurate (Eddy et al, 1995). MR imaging using an endovaginal receiver coil allows an improved signal-to noise ratio immediately adjacent to the region of interest and provides accurate assessment of tumour volume and parametrial extension (deSouza et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

Use of neoadjuvant chemotherapy prior to radical hysterectomy in cervical cancer: monitoring tumour shrinkage and molecular profile on magnetic resonance and assessment of 3-year outcome

et al. 2004

View full text Add to dashboard Cite

The objective of this study is to assess tumour response to neoadjuvant chemotherapy prior to radical hysterectomy in cervical cancer using magnetic resonance (MR) to monitor tumour volume and changes in molecular profile and to compare the survival to that of a control group. Eligibility included Stage Ib -IIb previously untreated cervical tumours 410 cm 3 . Neoadjuvant chemotherapy in 22 patients (methotrexate 300 mg m À2 (with folinic acid rescue), bleomycin 30 mg m À2 , cisplatin 60 mg m À2 ) was repeated twice weekly for three courses and followed by radical hysterectomy. Post-operative radiotherapy was given in 14 cases. A total of 23 patients treated either with radical surgery or chemoradiotherapy over the same time period comprised the nonrandomised control group. MR scans before and after neoadjuvant chemotherapy and in the control group documented tumour volume on imaging and metabolites on in vivo spectroscopy. Changes were compared using a paired t-test. Survival was calculated using the Kaplan -Meier method. There were no significant differences between the neoadjuvant chemotherapy and control groups in age (mean, s.d. 43.3710, 44.778.5 years, respectively, P ¼ 0.63) or tumour volume (medians, quartiles 35.8, 17.8, 57.7 cm 3 vs 23.0, 15.0, 37.0 cm 3 , respectively, P ¼ 0.068). The reduction in tumour volume post-chemotherapy (median, quartiles 7.5, 3.0, 19.0 cm 3 ) was significant (P ¼ 0.002). The reduction in -CH 2 triglyceride approached significance (P ¼ 0.05), but other metabolites were unchanged. The 3-year survival in the chemotherapy group (49.1%) was not significantly different from the control group (46%, P ¼ 0.94). There is a significant reduction in tumour volume and -CH 2 triglyceride levels after neoadjuvant chemotherapy, but there is no survival advantage.

show abstract

Prognostic Factors in Patients with Bulky Stage IB or IIA Cervical Carcinoma Undergoing Neoadjuvant Chemotherapy and Radical Hysterectomy

Cited by 52 publications

References 18 publications

Treatment and prognosis of cervical cancer associated with pregnancy: analysis of 20 cases from a Chinese tumor institution

Treatment and prognosis of cervical cancer associated with pregnancy: analysis of 20 cases from a Chinese tumor institution

Treatment of early bulky cervical cancer with neoadjuvant paclitaxel, carboplatin and cisplatin prior to laparoscopical radical hysterectomy and pelvic lymphadenectomy

Use of neoadjuvant chemotherapy prior to radical hysterectomy in cervical cancer: monitoring tumour shrinkage and molecular profile on magnetic resonance and assessment of 3-year outcome

Contact Info

Product

Resources

About