Treatment Of Early Cervical Cancer Research Articles

Fertility-sparing surgery for uterine cervical cancer.

The standard treatment for early cervical cancer of the uterus (CC) is radical hysterectomy with resection of the parametrium and pelvic lymphadenectomy. At least 40% of patients develop early-stage CC during child-bearing age, therefore preserving the uterus to maintain fertility has been an important consideration. Several surgical procedures including conization and vaginal or abdominal radical trachelectomy have been reported. These procedures are safe for removing lymph node negative CC tumors with <2 cm diameter. Recently, less radical surgical procedures that maintain fertility, such as conization, simple trachelectomy, minimally invasive surgery and neoadjuvant chemotherapy, have been indicated for tumors greater than 2 cm in diameter. In this review, we discuss the currently accepted surgical approaches for treating CC while maintaining fertility.

Squamous cell carcinoma antigen (SCC-Ag) during follow-up of cervical cancer patients: Role in the early diagnosis of recurrence

ObjectiveThe aim of this study was to assess the potential benefit of routine squamous cell carcinoma antigen (SCC-Ag) assessment during follow-up of patients after treatment for early cervical cancer with regard to early diagnosis of cancer recurrence before clinical signs and symptoms occur. MethodsAll clinical, pathological, and serological data of patients referred to the Department of Gynecologic Oncology between July 1999 and June 2014, were retrospectively collected and analyzed. The SCC-Ag levels of 197 patients with diagnosis of stage I or II cervical squamous carcinoma, were performed. ResultsIn the univariate analysis, serum SCC-Ag was not significantly associated with grading (p=0.85), LVSI (p=0.95) and FIGO stage (p=0.83) but it was significantly associated with recurrence of disease (p<0.001). The Cox multivariate analyses showed that serum SCC-Ag level was an independent and statistically significant prognostic factor for OS and PFS. The median time interval between SCC-Ag test and diagnosis of recurrence were 0.3 and 1.8months for positive and negative SCC-Ag groups respectively (p=0.01). Considering patients with recurrence, no significant difference in terms of DFS and OS was found between women with high or low SCC-Ag levels. ConclusionsSerum SCC-Ag reflects the response to treatment, and rising antigen levels often precede the clinical detection of recurrent disease, and may lead to early diagnosis. However such an advantage does not seem to improve the cure rate of patients with elevated SCC-Ag levels, most likely due to the lack of curative salvage treatments.

Evaluation of Clinical and Pathologic Risk Factors May Reduce the Rate of Multimodality Treatment of Early Cervical Cancer.

To assess the rate of postoperative adjuvant treatment in patients who underwent radical hysterectomy for early cervical cancer and to suggest criteria for the triage of patients who have a high probability of multimodality treatment. This was a multicenter retrospective study of 514 patients with FIGO stages IA2-IIA cervical cancer who underwent radical hysterectomy between 1999 and 2010. The patients were divided into 2 groups according to whether or not postoperative radiation was administered. The 2 groups were compared with regard to clinical and histopathologic variables divided into major and minor criteria (intermediate risk factors) based on lymph nodes status, parametrial involvement, tumor size, deep stromal invasion, and lymph-vascular space invasion. We identified 294 (57.2%) patients who received adjuvant postoperative radiotherapy (RT) or chemoradiation. Fifty-three percent of these patients who were treated by adjuvant radiation had only intermediate risk factors. Combining the various combinations of 2 out of 3 of the following criteria, we found that 89% of patients with tumors ≥2 cm and lymph-vascular space invasion received RT, 76% of patients with tumors ≥2 cm and depth of invasion >10 mm received RT, and 87% of patients with tumors depth of invasion >10 mm and lymph-vascular space invasion received RT. This study suggests that in patients with early cervical cancer, clinicopathologic evaluation of tumor size and lymph-vascular space invasion should be undertaken before performing radical hysterectomy. This approach can serve to tailor treatment, reducing the rate of employing both radical hysterectomy and chemoradiation.

Neoadjuvant chemotherapy in cervical cancer in pregnancy

Cervical cancer is the most common gynecological cancer encountered in pregnancy. The standard treatment of early cervical cancer is usually surgical removal of the cervix (in selected cases) or, more commonly, the uterus. However, when cervical cancer develops during pregnancy, definitive surgical treatment often needs to be postponed until the fetus reaches maturity. Neoadjuvant chemotherapy (NACT) is an innovative approach in the management of these patients. It helps in controlling the disease and delaying delivery. The paper presents a literature review of the history of NACT, as well as practice points and agenda for further research.

Then and now: outcomes of surgical treatment for early cervical cancer 1902.

Then and now: outcomes of surgical treatment for early cervical cancer 1902.

Effect of sentinel lymph-node biopsy alone on the morbidity of the surgical treatment of early cervical cancer: Results from the prospective randomized study Senticol2.

5521 Background: Sentinel lymph node (SLN) biopsy is now part of the management of early cervical cancer. Feasibility and low false negative rate in case of bilateral detection have been demonstrat...

Minimization of curative surgery for treatment of early cervical cancer: a review.

Surgery is effective and useful for curative treatment of patients with early invasive cervical cancer, yet minimization of surgical procedures provides many additional advantages for patients. Because the mean age of patients diagnosed with cervical precancer and invasive cancer has been decreasing, the need for minimization of surgery to reduce disruption of fertility is increasing. Trachelectomy is an innovative procedure for young patients with invasive cancer. Minimally invasive procedures are increasingly implemented in the treatment of patients with early cervical cancer, such as laparoscopic/robotic surgery and sentinel lymph node navigation. The use of modified radical hysterectomy may not only be curative but also minimally invasive for Stage IA2-IB1 patients with a tumor size <2 cm in diameter. Here, we have summarized and discussed the minimally invasive procedures for the treatment of patients with early cervical cancer.

Radical trachelectomy for early stage cervical cancer: the Queensland experience.

Radical trachelectomy and pelvic lymph node dissection are an increasingly recognised treatment for early cervical cancer in women wishing to retain their fertility. To analyse and summarise the outcomes of women having undergone radical trachelectomies at the Queensland Centre for Gynaecological Cancer (QCGC) between June 2000 and June 2012. Retrospective study of data collected on the QCGC database. 17 women underwent radical trachelectomies, with six subsequently giving birth to a total of seven live term babies, all delivered by caesarean section. There was one-first trimester miscarriage, but no major obstetric complications. There have been no cancer recurrences, deaths or major complications. Radical trachelectomy should be offered as an alternative treatment for women with early stage cervical cancer who wish to preserve their fertility as long as they are aware of the increased risk of infertility and preterm birth.

Abstract 7: Long-term survival following robot-assisted surgical treatment of early cervical cancer

Abstract 7: Long-term survival following robot-assisted surgical treatment of early cervical cancer

Laparoscopically assisted radical vaginal hysterectomy versus radical abdominal hysterectomy for the treatment of early cervical cancer

Cervical cancer is the second most common cancer among women and is the most frequent cause of death from gynaecological cancers worldwide. Standard surgical management for selected early-stage cervical cancer is radical hysterectomy. Traditionally, radical hysterectomy has been carried out via the abdominal route and this remains the gold standard surgical management of early cervical cancer. In recent years, advances in minimal access surgery have made it possible to perform radical hysterectomy with the use of laparoscopy with the aim of reducing the surgical morbidity and promoting a faster recovery. To compare the effectiveness and safety of laparoscopically assisted radical vaginal hysterectomy (LARVH) and radical abdominal hysterectomy (RAH) in women with early-stage (1 to 2A) cervical cancer. We searched the Cochrane Gynaecological Cancer Group Trials Register, and Cochrane Register of Controlled Trials (CENTRAL) Issue 7, 2013, MEDLINE, and EMBASE up to July 2013. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. Randomised controlled trials (RCTs) that compared laparoscopically assisted radical hysterectomy and radical abdominal hysterectomy, in adult women diagnosed with early (stage 1 to 2A) cervical cancer. Two review authors independently abstracted data and assessed risk of bias. We found one RCT, which included 13 women, that met our inclusion criteria and this trial reported data on LARVH versus RAH.Women who underwent LARVH for treatment of early-stage cervical cancer appeared to have less blood loss compared with those who underwent RAH. The trial reported a borderline significant difference between the two types of surgery (median blood loss 400 mL (interquartile range (IQR): 325 to 1050) and 1000 mL (IQR: 800 to 1025) for LARVH and RAH, respectively, P value = 0.05). RAH was associated with significantly shorter operation time compared with LARVH (median: 180 minutes with LARVH versus 138 minutes with RAH, P value = 0.05).There was no statistically significant difference in the risk of perioperative complications in women who underwent LARVH and RAH. The trial reported two (29%) and four (57%) cases of intraoperative and postoperative complications, respectively, in the LARVH group and no (0%) reported cases of intraoperative complications and five (83%) cases of postoperative complications in the RAH group. There were no reported cases of severe perioperative complications.Bladder and bowel dysfunction of either a transient or chronic nature remain major morbidities after radical hysterectomy, and the one included study showed that there may be significantly less after LARVH. The included trial lacked statistical power due to the small number of women in each group and the low number of observed events. Therefore, the absence of reliable evidence, regarding the effectiveness and safety of the two surgical techniques for the management of early-stage cervical cancer, precludes any definitive guidance or recommendations for clinical practice. The trial did not report data on long-term outcomes, but was at moderate risk of bias due to very low numbers of included women.

Human Papillomavirus Genotypes Associated with Mucopurulent Cervicitis and Cervical Cancer in Hangzhou, China

To investigate the infection status and predominant genotype distribution of human papillomavirus (HPV) infection among Chinese patients with mucopurulent cervicitis (MPC) or cervical cancer (CC) in Hangzhou. Initially, 217 cases of healthy cervix controls (n=50), acute MPC (n=89), and CC (n=78) were included; samples were collected between January 1, 2010, and January 30, 2013. Cervical specimens were screened for HPV using a nested polymerase chain reaction assay and DNA sequencing. Overall prevalence of HPV infection was 16.7% in the control group, 51.9% in the MPC group, and 84.4% in the CC group. The predominant genotype detected in all 3 groups was the oncogenic variant HPV 16 (55.8%, 17.3%, and 6.3% in the CC, MPC and control specimens, respectively), HPV58 was the second most predominant HPV type in CC (9.1%), MPC (8.6%), and control group (4.2%). Most or all of the genotypes were oncogenic in the three groups. Infection with HPV was found to be prevalent among Chinese women with MPC or CC and oncogenic variants were in the majority. Therefore, peoples who suffered MPC with HPV DNA positive should be regularly followed-up, for prevention and early treatment of cervical cancer.

Laparoendoscopic single-site radical hysterectomy for treatment of early cervical cancer

Objective: Performance of radical hysterectomy via laparoendoscopic single- site surgery (LESS) demonstrates the potential of LESS to be safely used for completion of even the most technically challenging of gynecologic surgical procedures. We hope to spur further interest in the development of this exciting approach within minimally invasive surgery.

English

English

Long-term survival following robot-assisted surgical treatment of early cervical cancer.

5607 Background: To determine progression-free survival (PFS) and overall survival (OS) for patients with early stage cervical cancer surgically treated using robotic-assisted laparoscopy compared to open radical hysterectomy. Methods: A retrospective analysis of women that underwent a robotic-assisted surgery (RAS) for early stage cervical cancer was performed. Surgical procedures included radical hysterectomy, parametrectomy, and trachelectomy from 2005 to May 2012. Patient demographics, clinicopathologic data, and disease status were analyzed. Comparison was made to open radical hysterectomies (ORH) from 2000 to May 2012. Survival statistics were analyzed using the Kaplan-Meier method. Results: 147 patients underwent RAS; 97 patients underwent ORH in our comparison group. Surgery was aborted in 8 RAS and 5 ORH due to extent of disease. The robotic surgical treatments included 121 (82.3%) radical hysterectomies, 14 (9.5%) trachelectomies, and 12 (8.2%) parametrectomies. In the RAS, the mean age was 44.3 (range 17-75); the mean body mass index (BMI) was 27.7 (range 16-50). Most patients presented with clinical stage IBI disease (79.9%). Squamous cell histology was most common (55.4%) followed by adenosquamous (36.7%). No significant differences were found between the RAS and ORH with regards age, BMI, surgical stage, grade, short and long-term complications, and comorbidities. The mean follow up time was 24.7 (range 0-82.1) months. Recurrence was documented in 3 patients after RAS and 11 patients after ORH; 3 deaths were recorded in the RAS group and 10 in the ORH. One patient had persistent adenocarcinoma in situ after robotic trachelectomy. Compared to ORH, there was a significantly better PFS in RAS (HR .312, CI 0 .099-0.98, p = 0.046) while no difference was seen in OS (p = 0.172). Conclusions: The results demonstrate that RAS is associated with lower rates of recurrence and no difference in overall survival. These findings provide further evidence that robotic-assisted surgical treatment is not associated with inferior results when compared to laparotomy or traditional laparoscopy. As robotic-assisted surgery is associated with a less steep learning curve, it may become the surgical approach of choice.

A Review of Surgical Options to Preserve Fertility in the Treatment of Early Cervical Cancer

A Review of Surgical Options to Preserve Fertility in the Treatment of Early Cervical Cancer

Values of loop electrosurgical excision procedure and colposcopy-directed cervical biopsy in the diagnosis and treatment of CNI and early cervical cancer

Objective To further assess the values of colposcopy-directed cervical biopsy and loop electrosurgical excision procedurec ( LEEP ) in the diagnosis and treatment of cervical intraepithelial neoplasia ( CIN ) and early cerical cancer.Methods LEEP was performed on 96 patients diagnosed as CIN by colposcopy-directed cervical biopsy.The pathological findings from the biopsy samples were compared with those from the LEEP samples.Results The pathological findings from the two different samples were coincided in 70 patients; and the pathological classification was upgraded in 17 patients while downgraded in 9.90.63％ of the patients were cured in a 1-year follow-up.Conclusions Colposcopy-directed cervical biopsy has its owns limitations in the diagnosis of cervical intraepithelial neoplasia.Proper LEEP plays a role in the further diagnosis and treatment of the disorder. Key words: Loop electrosurgical excision procedure; Colposcope; Biopsy; Cervical intraepithelial neoplasia; Early Cervical Cancer

Radical trachelectomy versus radical hysterectomy for the treatment of early cervical cancer: a systematic review

To assess the efficacy and safety of radical trachelectomy (RT) and radical hysterectomy (RH) for patients with early cervical cancer. Systematic review with meta-analysis. Women who had early cervical cancer. Prospective controlled clinical trials comparing RT with RH were identified using a predefined search strategy. Recurrence, five-year recurrence-free survival rate, five-year overall survival rate, postoperative mortality, intraoperative and postoperative complications between the two operations were compared by using the methods provided by the Cochrane Handbook for Systematic Reviews of Interventions. Three controlled clinical trials involving 587 participants were included. Meta-analysis showed that there was no significant difference between the two groups in recurrence rate [1.38; 95% confidence interval (CI) 0.58-3.28, p=0.47], five-year recurrence-free survival rate (1.17; 95% CI 0.54-2.53, p=0.69), five-year overall survival rate (0.86; 95% CI 0.30-2.43, p=0.78), postoperative mortality (1.14; 95% CI 0.42-3.11, p=0.80), intraoperative complications (1.66; 95% CI 0.11-25.28, p=0.72), postoperative complications (0.52; 95% CI 0.11-2.48, p=0.41), blood transfusion (0.29; 95% CI 0.06-1.36, p=0.12) and number of harvested lymph nodes. However, RT, compared with RH, reduced blood loss and shortened duration to normal urine residual volume and postoperative hospital stay. Moreover, RT may achieve to normal conception rates, while RH makes patients sterile. Radical trachelectomy has similar efficacy and safety to RH as the surgical treatment for early cervical cancer. Moreover, it reduced blood loss and shortened the duration to normal urine residual volumes and postoperative hospital stay. Radical trachelectomy can be used to treat early stage cervical cancer as an alternative operation for patients who wish to preserve fertility.

Establishing a sentinel lymph node mapping algorithm for the treatment of early cervical cancer

Objective To establish an algorithm that incorporates sentinel lymph node (SLN) mapping to the surgical treatment of early cervical cancer, ensuring that lymph node (LN) metastases are accurately detected but minimizing the need for complete lymphadenectomy (LND). Methods A prospectively maintained database of all patients who underwent SLN procedure followed by a complete bilateral pelvic LND for cervical cancer (FIGO stages IA1 with LVI to IIA) from 03/2003 to 09/2010 was analyzed. The surgical algorithm we evaluated included the following: 1. SLNs are removed and submitted to ultrastaging; 2. any suspicious LN is removed regardless of mapping; 3. if only unilateral mapping is noted, a contralateral side-specific pelvic LND is performed (including inter-iliac nodes); and 4. parametrectomy en bloc with primary tumor resection is done in all cases. We retrospectively applied the algorithm to determine how it would have performed. Results One hundred twenty-two patients were included. Median SLN count was 3 and median total LN count was 20. At least one SLN was identified in 93% of cases (114/122), while optimal (bilateral) mapping was achieved in 75% of cases (91/122). SLN correctly diagnosed 21 of 25 patients with nodal spread. When the algorithm was applied, all patients with LN metastasis were detected; with optimal mapping, bilateral pelvic LND could have been avoided in 75% of cases. Conclusions In the surgical treatment of early cervical cancer, the algorithm we propose allows for comprehensive detection of all patients with nodal disease and spares complete LND in the majority of cases.

Local Control After Tailored Surgical Treatment of Early Cervical Cancer

It was the aim of our study to analyze oncological outcome and prognostic parameters in patients with early stages cervical cancer after tailored and well-standardized surgical treatment with an adequate follow-up. Oncological outcome and prognostic parameters were evaluated in a group of 192 patients with cervical cancer stages IA2 to 2B who had undergone radical hysterectomy (n = 171), radical parametrectomy (n = 12), or radical trachelectomy (n = 9). Procedures were classified as type B (n = 72), type C1 nerve sparing (n = 103), or type C2 (n = 17). Event-free and overall 5-year survivals probabilities reached 92.7% (confidence interval, 89.5%-95.9 %) and 94.1% (confidence interval, 90.9%-97.3 %). There was only 1 isolated pelvic recurrence found of the total of 10 recurrences. Adjuvant radiotherapy was given to only 22% of patients. The most significant independent prognostic parameters in stage IB tumors were lymph node status, histological type, and tumor volume, whereas in stage II, the parameters included histological type and tumor volume, the latter being inversely related to the prognosis. We have shown an excellent prognosis, especially local control, after tailored surgical treatment of stages IA2 to IIB of cervical cancer, with low prevalence of adjuvant treatment. Different prognostic parameters were observed for stages IB1/IB2 and IIA/B.

Establishing an optimal sentinel lymph node mapping algorithm for the treatment of early cervical cancer

Objective: The aim of this study was to establish a sentinel lymph node (SLN) mapping algorithm for the treatment of early cervical cancer that accurately detects lymph node (LN) metastasis but minimizes the need for complete lymphadenectomy.