Abstract
Introduction
To identify a subset of cervical cancer (CC) patients administered chemoradiation
(CT/RT) plus radical surgery (RS), who can be spared lymphadenectomy, and complications.
Patients and methods
430 Stage IB2-IIB patients without LN involvement at imaging were accrued (March 1996–December
2015) at Gynecologic Oncology Unit of the Catholic University of Rome/Campobasso.
CT/RT consisted of pelvic irradiation plus cisplatin based chemotherapy. Objective
response was evaluated according to RECIST criteria; radical hysterectomy and pelvic ± aortic
lymphadenectomy was attempted in patients achieving response or stable disease. Surgical
morbidity was classified according to the Chassagne grading system.
Results
421 cases underwent RS; metastatic pelvic and aortic LNs were documented in 10.7%,
and 8.8% of cases, respectively. In patients without residual tumor in the cervix,
there was only 1 case (0.53%) with positive pelvic LNs, and 1 case (2.3%) with metastatic
aortic LNs. Analysis of patients according to pre- and post-CT/RT imaging was able
to select cases without any metastatic LNs: in patients with negative pelvic LNs at
pre- and post-CT/RT imaging, none of cases without residual disease in the cervix
had metastatic pelvic or aortic LNs. Of 149 early complications, 76 (51.0%) were lymphovascular.
The most frequent late complications were lymphovascular (N = 25/61, 41.0%).
Conclusion
Lymphadenectomy could be avoided in stage IB2-IIB CC patients undergoing preoperative
CT/RT, when a careful evaluation of pre- and post-CT/RT imaging and histological assessment
of no residual disease in the cervix is made. This approach may avoid lymphadenectomy
in 40% of patients with a favourable impact on lymphovascular morbidity.
Keywords
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References
- New standard of care for cervical cancer sets stage for next questions.J Natl Cancer Inst. 1999; 91: 500-501
- Reducing uncertainties about the effect of chemoradiotherapy for cervical cancer: individual patient data meta-analysis.Cochrane Database Syst Rev. 2010 Jan; 20 (CD008285)
- Neoadjuvant chemotherapy and radical surgery versus exclusive radiotherapy in locally advanced squamous cell cervical cancer: results from the Italian multicenter randomized study.J Clin Oncol. 2002; 20: 179-188
- Neoadjuvant chemotherapy for locally advanced cervical cancer: a systematic review and meta-analysis of individual patient data from 21 randomised trials.Eur J Cancer. 2003; 39: 2470-2486
- Gynecologic Oncology Group. Radiation therapy with and without extrafascial hysterectomy for bulky stage IB cervical carcinoma: a randomized trial of the Gynecologic Oncology Group.Gynecol Oncol. 2003; 89: 343-353
- Long-term analysis of clinical outcome and complications in locally advanced cervical cancer patients administered concomitant chemoradiation followed by radical surgery.Gynecol Oncol. 2010; 119: 404-410
- Surgery after concurrent chemoradiotherapy and brachytherapy for the treatment of advanced cervical cancer: morbidity and outcome: results of a multicenter study of the GCCLCC (Groupe des Chirurgiens de Centre de Lutte Contre le Cancer).Gynecol Oncol. 2006; 102: 523-529
- What to expect from immediate salvage hysterectomy following concomitant chemoradiation and image-guided adaptive brachytherapy in locally advanced cervical cancer.Cancer Radiother. 2015; 19: 710-717
- Results of the GYNECO 02 study, an FNCLCC Phase III trial comparing hysterectomy with no hysterectomy in patients with a (clinical and radiological) complete response after chemoradiation therapy for stage IB” or II cervical cancer.Oncologist. 2012; 17: 64-71
- Brachytherapy versus radical hysterectomy after external beam chemoradiation with gemcitabine plus cisplatin: a randomized, phase III study in IB2-IIB cervical cancer patients.Ann Oncol. 2013; 24: 2043-2047
- Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer: an update of radiation therapy oncology group trial (RTOG) 90–01.J Clin Oncol. 2004; 22: 872-880
- Toxicity after cervical cancer treatment using radiotherapy and chemotherapy.Clin Oncol. 2009; 21: 56-63
- Severe late toxicities following concomitant chemoradiotherapy compared to radiotherapy alone in cervical cancer: an inter-era analysis.Int J Radiat Oncol Biol Phys. 2012; 84: 973-982
- Completion surgery after concomitant chemoradiation in locally advanced cervical cancer: a comprehensive analysis of Pattern of Postoperative Complications.Ann Surg Oncol. 2014; 21: 1692-1699
- Results of surgery after concurrent chemoradiotherapy in advanced cervical cancer: comparison of extended hysterectomy and extrafascial hysterectomy.Int J Gynecol Cancer. 2010; 20: 268-275
- Prognostic factors and morbidities after completion surgery in patients undergoing initial chemoradiation therapy for locally advanced cervical cancer.Oncologist. 2010; 15: 405-415
- Surgical resection after chemotherapy for advanced cervical carcinoma.Cancer Radiother. 2006; 10: 471-476
- Can radicality of surgery be safely modulated on the basis of MRI and PET/CT imaging in locally advanced cervical cancer patients administered preoperative treatment?.Cancer. 2012; 118: 392-403
- Preoperative concomitant chemoradiotherapy in locally advanced cervical cancer: safety, outcome, and prognostic measures.Gynecol Oncol. 2007; 107: S127-S132
- Prolonged chemoradiation in locally advanced carcinoma of the uterine cervix: final results of a phase II study (ESTER-1).Am J Clin Oncol. 2010; 33: 577-582
- Concomitant boost plus large-field preoperative chemoradiation in locally advanced uterine cervix carcinoma: phase II clinical trial final results (LARA-CC-1).Gynecol Oncol. 2012; 125: 594-599
- Chemoradiation with concomitant boosts followed by radical surgery in locally advanced cervical cancer: long-term results of the ROMA-2 prospective phase 2 study.Int J Radiat Oncol Biol Phys. 2014; 90 (15): 778-785
- New guidelines to evaluate the response to treatment in solid tumors: european organization for research and treatment of cancer, national cancer institute of the United States, national cancer institute of Canada.J Natl Cancer Inst. 2000; 92: 205-216
- Five classes of extended hysterectomy for women with cervical cancer.Obstet Gynecol. 1974; 44: 265-272
- A glossary for reporting complications of treatment in gynecological cancers.Radiother Oncol. 1993; 26: 195-202
- Non parametric estimation from incomplete observations.Am J Stat Assoc. 1958; 53: 457-481
- Evaluation of survival data and two new rank order statistics arising in its consideration.Cancer Chemother Rep. 1966; 50: 163-170
- Risk factors for postoperative lower-extremity lymphedema in endometrial cancer survivors who had treatment including lymphadenectomy.Gynecol Oncol. 2010; 119: 60-64
- Quality of life and emotional distress in early stage and locally advanced cervical cancer patients: a prospective, longitudinal study.Gynecol Oncol. 2012; 124: 389-394
- Long-term prospective longitudinal evaluation of emotional distress and quality of life in cervical cancer patients who remained disease-free 2-years from diagnosis.BMC Cancer. 2013; 13: 127
- Australian National Endometrial Cancer Study Group. Incidence, risk factors and estimates of a woman's risk of developing secondary lower limb lymphedema and lymphedema-specific supportive care needs in women treated for endometrial cancer.Gynecol Oncol. 2015; 136: 87-93
- Lymph node involvement in locally advanced cervical cancer patients administered preoperative chemoradiation versus chemotherapy.Ann Surg Oncol. 2007; 14: 1129-1135
- Pre-hysterectomy cone biopsy is able to predict response in locally advanced cervical cancer patients submitted to neo-adjuvant chemoradiation.Eur J Surg Oncol. 2013; 39: 1025-1029
- Selective changes in the immune profile of tumor-draining lymph nodes after different neoadjuvant chemoradiation regimens for locally advanced cervical cancer.Int J Radiat Oncol Biol Phys. 2010; 76: 1546-1553
- Lymph node metastases: the importance of the microenvironment.Cancer. 2000; 88: 175-179
- Laparoscopic radical hysterectomy after concomitant chemoradiation in locally advanced cervical cancer: a prospective phase II study.J Minim Invasive Gynecol. 2015; 22: 877-883
- Robotic radical hysterectomy after concomitant chemoradiation in locally advanced cervical cancer: a prospective phase II study.J Minim Invasive Gynecol. 2016; (S1553–4650): 31045-31047
Article info
Publication history
Published online: September 23, 2017
Accepted:
September 7,
2017
Identification
Copyright
© 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
