Treatment strategy for locally advanced squamous cell cervical cancer with clinically positive pelvic lymph nodes metastasis

Abstract

Aim To determine the optimal treatment for locally advanced squamous cell cervical cancer with clinical positive pelvic lymph nodes metastasis (cN1). Methods We enrolled patients with squamous cell cervical cancer with 2008 FIGO stages IB, IIA, or IIB diagnosed with cN1, who were treated at Hyogo Cancer Center between April 2010 and December 2016. Patients with para‐aortic lymph nodes metastasis were excluded. Results Of the 69 eligible patients, 24 underwent concurrent chemoradiotherapy (CCRT), 11 underwent radical hysterectomy with pelvic lymphadenectomy (RH) with or without adjuvant RT, and 34 underwent neoadjuvant chemotherapy (NAC) followed by RH as initial treatment. The regimens of NAC included dose‐dense TC (paclitaxel 80 mg/m2, days 1, 8, 15; and carboplatin at an area under the curve = 6 on day 1, every 3 weeks) and dose‐dense TP (paclitaxel 80 mg/m2 on days 1, 8, 15; and cisplatin 75 mg/m2 on day 1, every 3 weeks). The median observation period was 57 (12–107) months. The 5‐year disease‐free survival rates of the CCRT, RH, and NAC groups were 78.7%, 63.6%, and 88.2%, respectively (p = 0.14). The 5‐year overall survival rates of the CCRT, RH, and NAC groups were 78.6%, 70.1%, and 94.1%, respectively (p = 0.11). Conclusions We recommend avoiding RH as primary treatment for cN1 with locally advanced squamous cell cervical cancer. Although CCRT should be considered for cN1, further studies are required to determine if NAC followed by RH will serve as an effective option.

Treatment Strategies and Prognostic Factors of 2018 FIGO Stage IIIC Cervical Cancer: A Review

“…NACT plus surgery, which could reduce LNM and even achieve longer 5-year DFS and OS, may represent a new therapeutic option for stage IIIC cervical cancer. 37 , 38 A systematic review and meta-analysis showed that in stages IB1 to IIB, preoperative NACT plus radical surgery resulted in a 23% probability of LNM, which was lower than those receiving radical surgery only. In stages IIA and IIB, the effect of NACT on reducing LNM was more obvious.…”

Comparison of oncological outcomes between radical hysterectomy and radiochemotherapy for FIGO 2018 stage IIIC1 cervical adenocarcinoma：a retrospective multicentre cohort study

“…There was some studies on this issue.Lijie Cao et al [12]conducted a retrospective study involving 861 cases of cervical squamous cell carcinoma with lymph node metastasis,with 85 patients received no adjuvant treatment, 283 patients treated with radiotherapy, and 493 patients with concurrent chemoradiotherapy(CCRT).They concluded that adjuvant radiotherapy or CCRT was not associated with a survival bene t compared to surgery with no adjuvant treatment. Some studies, however, had a different view.Takashi Shibutani et al [13] conducted a study involving 69 squamous cell cervical cancer with lymph node metastases.They recommend avoiding RH as primary treatment for those patients and CCRT should be considered.A single-center, retrospective study conducted by Jongmoo Park et al [14]reached similar conclusions.For cervical cancer patients with pelvic lymph node metastases, more studies focused on the treatment of postoperative adjuvant therapy,because these studies were conducted before the FIGO 2018 staging system was published. At present, the treatment strategies for patients with FIGO 2018 stage IIIC1 cervical cancer are inconclusive and few studies have been conducted, and there is no discussion on adenocarcinoma.In 2021, Shuko Miyahara et al [15] conducted a study of 92 patients with stage IIB-IVA cervical cancer who received radical radiotherapy.…”