FIGO Stage IB-IIA Cervical Cancer Research Articles

Comparison of clinical outcomes of adenocarcinoma and adenosquamous carcinoma in uterine cervical cancer patients receiving surgical resection followed by radiotherapy: A multicenter retrospective study (KROG 13-10)

ObjectiveTo evaluate the prognostic influence of adenocarcinoma (AC) and adenosquamous carcinoma (ASC) in patients with FIGO stage IB–IIA cervical cancer who received radical hysterectomy followed by adjuvant radiotherapy (RT) or concurrent chemoradiotherapy (CCRT). MethodsWe analyzed 1323 patients who satisfied the following criteria: histologically proven squamous cell carcinoma (SCC), AC, or ASC of the uterine cervix; FIGO stage IB–IIA disease; no history of neoadjuvant chemotherapy; and a history of radical hysterectomy with pelvic lymph node (PLN) dissection, followed by postoperative pelvic RT at a dose ≥45Gy. The median age was 50years. Median RT dose delivered to the whole pelvis was 50.4Gy, and 219 (16.6%) patients received brachytherapy at a median dose of 24Gy. Concurrent chemotherapy was delivered to 492 (37.2%) patients. ResultsPathologic risk factors were not different according to pathologic subtype. The median follow-up duration was 75.7months. Locoregional recurrence-free survival, relapse-free survival (RFS), and overall survival were significantly affected by histology, tumor size, PLN metastasis, parametrial invasion, lymphovascular invasion, and deep stromal invasion. The 5-year RFS rates were 83.7%, 66.5%, and 79.6% in patients with SCC, AC, and ASC histology, respectively (P<0.0001). By multivariate analysis, AC histology was the only significant prognostic factor affecting all survival outcomes. ConclusionsAC histology was associated with poor survival outcomes in patients with FIGO stage IB–IIA cervical cancer who received adjuvant RT or CCRT. Prognosis of ASC histology was closer to that of SCC histology than that of AC histology.

Correlation between tumor size and surveillance of lymph node metastasis for IB and IIA cervical cancer by magnetic resonance images

PurposeTo assess the feasibility of preoperative MRI based measurement of tumor size with regard to lymph node (LN) metastasis in early uterine cervical cancer. Material and MethodsA retrospective review of patients with FIGO stage IB–IIA cervical cancer who underwent lymphadenectomy was performed. Diagnostic accuracy of MRI in detecting LN metastasis and rate of LN recurrence in terms of tumor size (≤4cm versus >4cm) were analyzed. ROC curve analysis was used to determine LN size for differentiating LN metastasis in terms of tumor size. P<0.05 was considered statistically significant. ResultsOf the 200 patients, 45 (22.3%) had LN metastasis. There was no statistical difference between patients-based and region-specific analysis. The patients with tumor size with >4cm revealed higher diagnostic accuracy of MRI in detecting LN metastasis (85.4% versus 50.6%, P=0.023) and rate of LN recurrence (20.0% versus 6.4%, P=0.031) in than those with size with ≤4cm, the differences were statistically significant. Discriminant analysis of LN size for the differentiation of metastasis from non-metastasis resulted in cut-off values (11.8mm; size with >4cm versus 8.3mm; size with ≤4cm) and diagnostic accuracy (84.0% of size with >4cm versus 72.0% of size with ≤4cm). ConclusionMRI has limited sensitivity, but high specificity in predicting surveillance of LN metastasis in the preoperative early cervical cancer, especially useful tool for patients with tumor size with >4cm.

Prospective evaluation of PET/CT for lymph node status in FIGO stage IB–IIA cervical cancer

Prospective evaluation of PET/CT for lymph node status in FIGO stage IB–IIA cervical cancer

Differing prognosis of cervical cancer patients with high risk of treatment failure after radical hysterectomy warrants trial treatment modification

The aim of this study was to ascertain whether all cervical cancer patients who received adjuvant concurrent chemoradiation (CCRT) for high risk of treatment failure after radical hysterectomy are at the same risk of treatment failure, and if not, to propose trial treatment modification. Between January 1999 and December 2007, 58 patients with FIGO stage Ib-IIa cervical cancer received adjuvant CCRT due to high risk factors such as positive lymph nodes or positive parametrium, or positive vaginal resection margins. Patients were divided into two Groups. Group A were patients with negative parametrium, negative vaginal resection margins, and only unilateral lymph node metastasis (involved L/N</=2). Group B were those with either bilateral pelvic lymph node involvement, or more than 2 lymph node involvement, or positive parametrium with lymph node involvement. During a median follow-up period of 34 months (range, 6 to 102 months), 9 patients (15.5%) experienced recurrence; among whom 2 patients (2/28, 7.1%) were Group A, and 7 patients (7/30, 23.3%) were Group B. At 3 years, the estimated progression-free survival rate of all 58 patients was 78.3%, and the overall survival rate was 89.7%. Patients in Group A had significantly better progression-free survival (88.2% vs. 68.2%, p=0.042) and overall survival rate (100% vs. 78.8%, p=0.034) than Group B. Treatment modifications such as consolidation chemotherapy after CCRT may be considered based on the poor prognosis of very high risk patients such as those patients in Group B.

Comparison of adjuvant chemotherapy and radiation in patients with intermediate risk factors after radical surgery in FIGO stage IB–IIA cervical cancer

The aim of this study was to compare the outcome of chemotherapy or radiation as adjuvant therapy for patients with FIGO stage IB-IIA cervical cancer and surgically confirmed intermediate risk factors. Data were collected from patients with uterine cervical cancer FIGO stage IB-IIA who had adjuvant chemotherapy following radical hysterectomy with pelvic lymph node dissection (RHLND, cases) or adjuvant radiotherapy following RHLND (controls). The study groups consisted of 38 cases and 42 controls. Adjuvant treatment was given to the patients with a combination of intermediate risk factors including deep stromal invasion (>50%), lymphvascular space invasion, large tumor size (3-6 cm), or close vaginal resection margin (<1 cm). Comparison of the cases with the controls revealed no significant differences in variables studied including median age (P = 0.18), stage distribution (P = 0.30), histologic subtype (P = 0.93), pathologic tumor size (P = 0.46), depth of the stromal invasion (P = 0.29), lymphvascular space invasion (P = 0.50), and close vaginal resection margin (P = 0.62). The difference in disease-free survival rates was not significant (P = 0.68). However, the overall survival analysis was incomplete due to the limited number of events available at the end of the study period. The findings of this study suggest that adjuvant chemotherapy in patients with FIGO stage IB-IIA uterine cervical cancer and surgically confirmed intermediate risk factors may be effective.

Nerve-sparing class III radical hysterectomy: a modified technique to spare the pelvic autonomic nerves without compromising radicality

The objectives were to describe our nerve-sparing class III radical hysterectomy technique and assess the feasibility and safety of the procedure as well as its impact on voiding function. From January to August 2005, 21 consecutive patients with FIGO stage IB-IIA cervical cancer and 1 patient with clinical stage II endometrial cancer underwent nerve-sparing radical hysterectomy with systematic pelvic lymphadenectomy. The transurethral catheter was removed on the seventh postoperative day. Then intermittent self-catheterization was performed and post-void residual urine volume (PVR) was recorded. The nerve-sparing procedure was completed successfully and safely in all of the patients. Eight (36%) and 6 (27%) patients had the PVR of &lt; 100 ml and &lt; 50 ml respectively at the initial removal of the catheter. On the fourteenth day, 82% and 77% of the patients had the PVR of &lt; 100 ml and &lt; 50 ml, respectively. The mean duration before the PVR became &lt; 50 ml was 11.27 (5–26) days. In conclusion, the technique described in this preliminary study appears safe, adequate, and feasible in our population with satisfactory recovery of voiding function. A larger comparative study is needed on long-term urinary, bowel, and sexual function as well as recurrence and survival.

Nerve-sparing class III radical hysterectomy: a modified technique to spare the pelvic autonomic nerves without compromising radicality

The objectives were to describe our nerve-sparing class III radical hysterectomy technique and assess the feasibility and safety of the procedure as well as its impact on voiding function. From January to August 2005, 21 consecutive patients with FIGO stage IB-IIA cervical cancer and 1 patient with clinical stage II endometrial cancer underwent nerve-sparing radical hysterectomy with systematic pelvic lymphadenectomy. The transurethral catheter was removed on the seventh postoperative day. Then intermittent self-catheterization was performed and post-void residual urine volume (PVR) was recorded. The nerve-sparing procedure was completed successfully and safely in all of the patients. Eight (36%) and 6 (27%) patients had the PVR of < 100 ml and < 50 ml respectively at the initial removal of the catheter. On the fourteenth day, 82% and 77% of the patients had the PVR of < 100 ml and < 50 ml, respectively. The mean duration before the PVR became < 50 ml was 11.27 (5-26) days. In conclusion, the technique described in this preliminary study appears safe, adequate, and feasible in our population with satisfactory recovery of voiding function. A larger comparative study is needed on long-term urinary, bowel, and sexual function as well as recurrence and survival.

Interleukin-6 in Cervical Cancer: The Relationship with Vascular Endothelial Growth Factor

Objective. Interleukin-6 (IL-6), a central proinflammatory cytokine, has been implicated in cervical cancer, though its role remains elusive. This study was an attempt to elucidate the role of IL-6 in the pathogenesis of cervical cancer, with particular emphasis on tumor angiogenesis.Methods. Cytosolic IL-6, vascular endothelial growth factor (VEGF), and platelet-derived growth factor (PDGF) levels were determined via enzyme immunoassay in 60 FIGO stage IB–IIA cervical cancer patients. Immunohistochemical staining in tissue sections was performed to analyze the distributions of IL-6 and IL-6 receptors. Meanwhile, human papillomavirus (HPV) DNA was detected by polymerase chain reaction-based survey. In vitro studies of two cervical cancer cell lines, C33A and SiHa, for the interaction between IL-6 and VEGF were also performed.Results. Consistently higher expression of IL-6 and VEGF was evident in cancerous tissues than in adjacent noncancer tissues in early-stage cervical cancer patients (P < 0.01). After recombinant human IL-6 was added, VEGF was induced in a time- and dose-dependent manner in cervical cancer cell line C33A. Correspondingly, interrupting the IL-6 autocrine machinery with either anti-IL-6 or anti-IL-6 receptor antibody markedly reduced the expression of VEGF at the transcriptional level in SiHa cells. Significantly higher levels of IL-6 in cancer tissues were observed in patients older than 45 (P < 0.01), patients with tumors >2 cm (P < 0.01), patients with oncogenic HPV-16 or -18 infections (P < 0.01), and patients with squamous cell carcinoma (P = 0.02). Patients with a deeper stromal invasion, vaginal invasion, lymphovascular emboli, or lymph node metastasis appeared to have higher intratumoral IL-6 levels, although the differences were statistically insignificant.Conclusions. Substantially high microenvironmental IL-6 levels promote tumor angiogenesis and the development of cervical cancer. Thus, inhibition of the biological activity of IL-6 may be potentially beneficial.

Recurrence of cancer cervix in patients treated by radical hysterectomy followed by adjuvant external beam radiotherapy

One hundred and twenty patients with FIGO stage Ib-IIa cervical cancer who had radical hysterectomy prior to January 2003 in different hospitals of Bangladesh and thereafter received external beam pelvic radiotherapy (RT) at National Institute of Cancer Research and Hospital, Dhaka were studied. Until December 2007, 50 (42%) patients developed recurrence. Thirty-four (70%) patients experienced local recurrence, 13 (26%) distant recurrence and 2 (4%) both local and distant recurrence. Of 15 patients with distant metastasis, 6 (40%) experienced it in extra-pelvic lymph nodes. The median time to recurrence was 19 months (range 6-120 months) for local failure, 33 months (range 12-108 months) for distant failure and 25 months (range 13-36 months) for those with both local and distant failure. Eighty percent recurrences occurred within 36 months. There was significant correlation between lymph node metastasis and recurrence. All 5 (100%) patients with adenocarcinoma who had positive nodes experienced local recurrence compared with 18 of 49 (37%) squamous cell carcinoma patients with positive nodes. Recurrence more than 5 years after treatment developed in 5 (4%) patients. Mentionable, 4 (80%) out of 5 patients with late recurrence had squamous cell carcinoma with negative pelvic nodes.