Stage IB-IIB Cervical Cancer Research Articles

Pulmonary Toxicity after a Quick Course of Combinatorial Vincristine, Bleomycin, and Cisplatin Neoadjuvant Chemotherapy in Cervical Cancer

Pulmonary toxicity is one of the most serious adverse effects associated with a quick course of vincristine, bleomycin, and cisplatin neoadjuvant chemotherapy (NAC-VBP). The aim of this study was to evaluate pulmonary toxicity related to a quick course NAC-VBP. A total of consecutive 61 patients, who underwent at most 3 cycles of NAC-VBP every 10 days in the International Federation of Gynecology and Obstetrics (FIGO) stage IB-IIB cervical cancer from 1995 to 2007, were retrospectively analyzed. Of the 61 study subjects, 7 (11.5%) were identified to have pulmonary toxicity and 2 (3.3%) died of pulmonary fibrosis progression despite aggressive treatment and the use of a multidisciplinary approach. No factor predisposing pulmonary toxicity was identified. Initial symptoms were non-specific, but bronchiolitis obliterans organizing pneumonia and interstitial pneumonitis were characteristic findings by high-resolution computed tomography of the chest. The benefit of steroid therapy was uncertain and was associated with steroid-induced diabetes mellitus requiring insulin therapy in two patients. Fatal pulmonary toxicity is a major concern of a quick course NAC-VBP. In conclusion, these patients require special monitoring for bleomycin-induced pulmonary toxicity.

Comparison of the outcome between cervical adenocarcinoma and squamous cell carcinoma patients with adjuvant radiotherapy after radical surgery: SGSG/TGCU Intergroup Surveillance

5585 Background: We conducted the present surveillance to clarify the significance of adjuvant radiotherapy and the cause of poor outcome of adenocarcinoma (AC). Methods: A total of 825 patients with FIGO stage Ib-IIb cervical cancer, who underwent type III radical hysterectomy in 10 institutes of SGSG/ TGCU Intergroup between April 1997 and March 2003, were enrolled in this study. There were 543 patients with squamous cell carcinoma (SCC) (261 in stage Ib1, 67 in Ib2, 83 in IIa, 132 in IIb) and 282 with AC (186 in stage Ib1, 39 in Ib2, 11 in IIa, 46 in IIb). Mean age of patients was 49.0 yrs (range: 19–84 yrs) in SCC and 46.6 yrs (range: 18–84) in AC. Two hundred and fifty-five patient with SCC and 69 with AC received adjuvant radiotherapy including CCRT. Results: The 5-year overall survival rate (OS) for patients with SCC and AC were 87.4% and 83.4%. The OS for stage I patients did not differ between SCC and AC. Stage II patients with AC showed significantly worse prognosis compared with SCC (54.5% vs. 87.4% in IIa, 63.3% vs. 78.8% in IIb). There was a significant difference in OS for patients receiving adjuvant treatment between SCC and AC (83.0% vs. 73.9%). Although the OS for stage I patients did not differ between SCC and AC, the OS for stage II patients with AC was significantly lower (86.9% vs. 50.0% in IIa, 75.5% vs. 61.1% in stage IIb). In patients with stage I, SCC showed significantly higher lymphnode involvement compared with AC (16.5% vs. 9.7% in Ib1, 46.3% vs. 20.1% in Ib2). The incidence of lymphnode involvement did not differ between SCC and AC in patients with stage II (36.4% vs.34.9% in IIa and 39.1% vs.45.5% in IIb). When patients had lymphnode involvement, the outcome of patients with AC showed significantly worse than those with SCC (46.4% vs. 72.3%). The local failure defined as recurrence in stump and pelvis was more frequent in patients with AC compared with SCC (24.6% vs.10.7%). Conclusions: Although the incidence of lymphnode involvement did not differ between AC and SCC, AC patients with lymphnode involvement showed significantly worse outcome. The present study indicates that lower sensitivity to radiotherapy might be an important cause for the poorer prognosis in AC. No significant financial relationships to disclose.

Brachytherapy versus radical hysterectomy after external beam chemoradiation: a non-randomized matched comparison in IB2-IIB cervical cancer patients

BackgroundA current paradigm in the treatment of cervical cancer with radiation therapy is that intracavitary brachytherapy is an essential component of radical treatment. This is a matched retrospective comparison of the results of treatment in patients treated with external beam chemoradiation (EBRT-CT) and radical hysterectomy versus those treated with identical chemoradiation followed by brachytherapy.MethodsIn this non-randomized comparison EBRT-CT protocol was the same in both groups of 40 patients. In the standard treated patients, EBRT-CT was followed by one or two intracavitary Cesium (low-dose rate) applications within 2 weeks of finishing external radiation to reach a point A dose of at least 85 Gy. In the surgically treated patients, radical hysterectomy with bilateral pelvic lymph node dissection and para-aortic lymph node sampling were performed within 7 weeks after EBRT-CT. Response, toxicity and survival were evaluated.ResultsA total of 80 patients were analyzed. The patients receiving EBRT-CT and surgery were matched with the standard treated cases. There were no differences in the clinicopathological characteristics between groups or in the delivery of EBRT-CT. The pattern of acute and late toxicity differed. Standard treated patients had more chronic proctitis while the surgically treated had acute complications of surgery and hydronephrosis. At a maximum follow-up of 60 months, median follow-up 26 (2–31) and 22 (3–27) months for the surgery and standard therapy respectively, eight patients per group have recurred and died. The progression free and overall survival are the same in both groups.ConclusionThe results of this study suggest that radical hysterectomy can be used after EBRT-CT without compromising survival in FIGO stage IB2-IIB cervical cancer patients in settings were brachytherapy is not available. A randomized study is needed to uncover the value of surgery after EBRT-CT.

Prognostic significance of neutropenia during adjuvant concurrent chemoradiotherapy in early cervical cancer

To evaluate the prognostic significance of adjuvant concurrent chemoradiotherapy-induced neutropenia with survival in patients with squamous cell carcinoma of the uterine cervix. Data from 107 patients with stage IB-IIB cervical cancer were retrospectively analyzed. The median follow-up was 37.5 (4.2-72.7) months. All patients had received radical surgery, including pelvic lymphadenectomy, followed by paclitaxel plus carboplatin-based concurrent chemoradiotherapy. Relative neutropenia, defined as an absolute neutrophil count <1,000/mm(3) at the concurrent chemoradiotherapy cycle nadir, correlated to the pathologic findings and survival outcomes. Sixty-six patients experienced neutropenia at least once during concurrent chemoradiotherapy, and demonstrated marginal improvement in disease-free survival (p=0.055), although not in overall survival. By subgroup analyses, the gain of disease free survival mainly originated from the node metastasis subgroup (p=0.033). Treatment-induced neutropenia proved to be the only significant independent factor for recurrence in cervical cancer (p=0.042) by multivariate analysis. Concurrent chemoradiotherapy-induced neutropenia may be a prognostic factor of recurrence in patients with cervical cancer. Individualized dose titration of the tolerable myelosuppression might be beneficial.

Unilateral or bilateral nerve-sparing radical hysterectomy: a surgical technique to preserve the pelvic autonomic nerves while increasing radicality

We performed unilateral or bilateral nerve-sparing (UNS or BNS) radical hysterectomies combined with a parametrial excision in patients with locally advanced cervical cancer. The parametrial excision technique is characterized by a meticulous sharp dissection of the avascular plane outside the visceral fascia of the uterus and vagina under direct vision, providing an en bloc parametria and ensuring that all regional spread of the disease is contained within negative surgical margins. The aim of this study was to describe this surgical technique and to retrospectively evaluate the feasibility and the impact on early bladder function. From February 2005 to November 2006, 32 patients with FIGO stage IB-IIB cervical cancer, who had the tumor of more than 20 mm in diameter, underwent the UNS surgery or BNS surgery. A parametrial excision was performed in all the patients. The surgical procedure was safely completed in all the patients. Though 14 patients had tumor invasion to the parametria, none of the patients had a positive surgical margin in the parametrium. The bladder function of patients in the UNS group immediately after surgery was more damaged than that in the BNS group. However, all the patients in both groups recovered spontaneous voiding with no need of self-catheterization during the perioperative periods. This preliminary study showed that the surgical technique is feasible and safe. For confirmation of the efficacy of this technique, further large prospective studies are needed.

Prognostic factors in pathologic parametrium-positive patients with stage IB–IIB cervical cancer treated by radical surgery and adjuvant therapy

Objective. The purpose of the present study was to identify prognostic factors and recurrent patterns in pathologic parametrium-positive patients with stage IB–IIB cervical cancers treated by radical surgery and adjuvant therapy. Methods. The patient population consisted of 84 individuals presenting with stage IB–IIB cervical cancers and histologically proven parametrial invasion. All these patients were treated postoperatively with adjuvant external whole pelvic irradiation, combination chemotherapy, or chemoradiotherapy. Results. The 5-year disease-free survival rate was found to be 67.2% and 5-year overall survival rate, 75.4%. Multivariate analysis revealed that vaginal invasion ( p = 0.0008), lymph node metastasis ( p = 0.002), and non-squamous histology ( p = 0.010) were independent indicators of the disease-free survival rates and that the vaginal invasion ( p = 0.009) and lymph node metastasis ( p = 0.011) were independent prognostic factors for the overall survival rates. The 5-year overall survival rate was approximately 90% for patients without these risk factors. Disease recurrence was observed in 26 patients (31.0%) with a median time of 16.5 months (range, 5–59 months) from the surgery. Hematogenous recurrences, including those in the lung, liver, and bone, were significantly higher in patients with non-squamous cell carcinomas ( p = 0.008). Distant lymph node recurrences were significantly higher in patients with positive pelvic lymph node and vaginal invasion ( p = 0.004 and p = 0.023, respectively). Pelvic recurrences were significantly higher in patients with vaginal invasion ( p = 0.026). Conclusions. Vaginal invasion and lymph node metastasis are independent indicators for disease-free and overall survival rates in pathologic parametrium-positive patients with stage IB–IIB cervical cancer treated by radical surgery and adjuvant therapy. The survival rate is excellent in the patients without these risk factors. Hematogenous recurrence may be evident in patients with non-squamous cell carcinomas.

0060: Systematic Radical Pelvic and Paraaortic Lymphadenectomy in Stage Ib-Iib Cervical Cancer

0060: Systematic Radical Pelvic and Paraaortic Lymphadenectomy in Stage Ib-Iib Cervical Cancer

Prognostic factors in node-positive patients with stage IB-IIB cervical cancer treated by radical hysterectomy and pelvic lymphadenectomy

Objective The purpose of the present study was to identify prognostic factors in surgically treated patients with stage IB-IIB cervical cancers, who also presented with positive pelvic nodes. Method The patient population consisted of 68 individuals presenting with stage IB-IIB cervical cancers and with histologically proven pelvic lymph nodes. Result We found no association between the type of adjuvant therapy and patient outcome. Multivariate analysis revealed that non-squamous histology was an independent prognostic factor for disease-free and overall survival rates. In squamous cell carcinomas, the bilateral nature of the positive nodes was found to be a significant factor for disease-free survival rates. In non-squamous cell carcinomas, positive nodes of more than 2 cm in size were found to be a significant factor for disease-free survival rates. Conclusion Non-squamous histology was an independent prognostic factor and chemoradiotherapy did not improve the survival outcomes of the patients in this study population.

Ovarian metastasis in carcinoma of the uterine cervix

Background. The present study was conducted to determine the frequency and clinicopathological features of ovarian metastasis in a large population of patients with stage Ib–IIb cervical cancer. Methods. The study population consisted of 3471 patients with stage Ib to IIb cervical cancer who underwent radical hysterectomy, including pelvic lymphadenectomy and bilateral salpingo-oophorectomy, at our six institutions between 1981 and 2000. To our knowledge, this study is the largest review of patients with ovarian metastasis from cervical cancer. We reviewed the patients' medical records to determine clinicopathological features. Results. Fifty-two patients (1.50%) had ovarian metastases: 6 in stage Ib1, 12 in stage Ib2, 5 in stage IIa, and 29 in stage IIb. The mean age of patients with ovarian metastasis was 49.9 years (range: 29–73 years). The incidence of ovarian metastasis in patients with cervical cancer was 0.22% for stage Ib, 0.75% for stage IIa, and 2.17% for stage IIb with squamous cell carcinoma, and 3.72%, 5.26%, and 9.85%, respectively, in adenocarcinoma. Ovarian metastasis occurred more frequently among patients with adenocarcinoma than among those with squamous cell carcinoma (5.31% vs. 0.79%). Outcome for patients with ovarian metastasis was very poor and not related to FIGO stage and histological type. The presence of ovarian metastasis did not correlate with lymph node involvement or parametrial invasion. Conclusion. Study results indicate that ovaries can be preserved in patients with stage Ib–IIa squamous cell carcinoma but removed in all patients with adenocarcinoma.

Electrosurgical bipolar vessel sealing for radical abdominal hysterectomy

Objective We analyzed the use of an electrosurgical bipolar vessel sealing system for radical abdominal hysterectomy. Methods We compared operating time, transfusion requirements and other surgical parameters in 52 patients undergoing radical abdominal hysterectomy with systematic pelvic ± paraaortic lymphadenectomy for stage IB1–IIB cervical cancer between January 2001 and June 2004. At 21 operations between January 2001 and March 2002, the parametrium, paracolpos and vaginal cuff were resected with clamps and the pedicles suture ligated; 31 operations between November 2001 and June 2004 were done with a bipolar vessel sealing system (LigaSure Vessel Sealing System, Valleylab, Boulder, CO). Four surgeons did all operations. Data were compared with the t test. Results Patients operated with the LigaSure system received fewer packed RBC transfusions than those operated with clamps (mean, 0.61 ± 1.1 vs. 2.14 ± 2.6 units, respectively; P = 0.01), even when looking at patients who underwent only pelvic (without paraaortic) lymphadenectomy (mean, 0.52 ± 1.1 vs. 1.29 ± 1.2 units, respectively; P = 0.02). The transfusion rate in the two groups was 26% (8/31) and 67% (14/21), respectively ( P < 0.05). Operating time did not differ significantly (199 ± 33 vs. 213 ± 45 min, respectively). There were no significant differences between the groups in number of pelvic nodes removed, febrile morbidity, postoperative stay, or days until residual urine <100 ml. One patient in the LigaSure group developed a ureterovaginal fistula that resolved with stenting. Conclusion The LigaSure system appears useful to reduce blood loss at radical abdominal hysterectomy.

Ten-Year Survival of Patients with Locally Advanced, Stage IB–IIB Cervical Cancer after Neoadjuvant Chemotherapy and Radical Hysterectomy

Objective(s). The aim of this study was to evaluate the effects of neoadjuvant chemotherapy and radical hysterectomy on long-term survival in stage IB–IIB locally advanced cervical cancer by conducting a 10-year follow-up.Methods. Between August 1983 and May 1990, 80 locally advanced, stage IB–IIB cervical cancer patients with tumor diameter greater than or equal to 4 cm were treated with neoadjuvant VBP chemotherapy (cisplatin, vinblastine, and bleomycin) followed by radical hysterectomy with pelvic lymphadenectomy. After this therapeutic modality, patients were followed for more than 10 years. Ten-year survival rates and factors affecting recurrence after this therapy were evaluated.Results. Of 80 patients, 75 (93.7%) showed a reduction in tumor size after neoadjuvant chemotherapy. At pathologic examination, stage reduction was noted in 53 (66.2%) patients and 20 patients (25%) showed no residual or microinvasive cervical tumor. Pelvic lymph node metastases were found in 17 patients (21.3%). During the 10-year follow up, 2 patients were lost and 16 patients recurred. Overall 5-year and 10-year disease-free actual survival rates were 82.0 (64/78) and 79.4% (62/78), respectively. Clinical stage, initial tumor size, clinical response, and residual tumor size were not risk factors for recurrence after this therapy. However, pelvic lymph node metastasis was a significant risk factor for recurrence.Conclusion(s). Neoadjuvant VBP chemotherapy followed by radical hysterectomy in locally advanced, stage IB–IIB cervical cancer patients seemed to improve the long-term survival rate for these patients compared to that of conventional therapy. However, randomized controlled trials are needed to confirm this result.

Vascular endothelial growth factor-C expression and its relationship to pelvic lymph node status in invasive cervical cancer.

Vascular endothelial growth factor-C (VEGF-C) has been implicated in lymphangiogenesis, the process of new lymphatics formation. The present study investigated VEGF-C mRNA expression in invasive cervical cancer tissue. Additionally, the association of VEGF-C mRNA with clinicopathological features was examined. VEGF-C mRNA expression was assessed by reverse transcription-polymerase chain reaction using β-action as an internal control. 75 patients presenting with invasive cervical cancer were included in the trial. VEGF-C mRNA expression was markedly higher in tumours in which pelvic lymph node metastasis was diagnosed by magnetic resonance (MR) imaging (P = 0.002). 53 patients displaying stage Ib–IIb cervical cancer underwent radical hysterectomy and pelvic lymphadenectomy. VEGF-C expression was significantly higher in tumours exhibiting deep stromal invasion, pelvic lymph node metastasis and lymph-vascular space involvement (P = 0.016, P = 0.006 and P = 0.036, respectively). Multivariate analysis revealed VEGF-C mRNA expression to be the sole independent factor influencing pelvic lymph node metastasis. Subjects demonstrating VEGF-C mRNA expression displayed significantly poorer prognoses than those lacking VEGF-C mRNA expression (P = 0.049). These findings provide evidence supporting the involvement of VEGF-C expression in the promotion of lymph node metastasis in cervical cancer. Furthermore, examination of VEGF-C expression in biopsy specimens may be beneficial in the prediction of pelvic lymph node metastasis. © 2001 Cancer Research Campaign http://www.bjcancer.com

Chemotherapy versus Radiotherapy versus Observation for High-Risk Cervical Carcinoma after Radical Hysterectomy: A Randomized, Prospective, Multicenter Trial

Background.Adjuvant treatment modalities after radical hysterectomy have long been used in an attempt to eradicate microscopic tumor residuals in patients at high risk for recurrence. However, it has not been clearly demonstrated that adjuvant radiation, adjuvant chemotherapy, or both improve the outcome. To evaluate the effect of adjuvant treatment in patients with high-risk cervical cancer after radical hysterectomy, the Austrian Gynecologic Oncology Group conducted a prospective, randomized, multicenter clinical trial between 1989 and 1995.Material and Methods.Seventy-six patients with stage IB–IIB cervical cancer treated with radical hysterectomy with pelvic lymph node metastases and/or vascular invasion randomly received adjuvant chemotherapy (400 mg/m2carboplatin, and 30 mg bleomycin), standardized external pelvic radiation therapy, or no further treatment.Results.After a median follow-up of 4.1 years (range, 2–7) there were no statistically significant differences (P= 0.9530) in disease-free survival among the three treatment arms.Conclusion.The data suggest that adjuvant chemotherapy or radiation do not improve survival or recurrence rates in high-risk cervical cancer patients after radical hysterectomy. The most important treatment for these patients seems to be radical abdominal hysterectomy with systematic pelvic lymphadenectomy.

Prognostic factors in surgically-treated stage IB-IIB squamous cell carcinoma of the cervix with positive lymph nodes

Dawlatly B, Lavie O, Cross PA, Maini M, Lopes A, Monaghan JM. Prognostic factors in surgically-treated stage IB–IIB squamous cell carcinoma of the cervix with positive lymph nodes. Int J Gynecol Cancer 1998; 8: 467–470. The aim of this study was to define possible prognostic factors in patients with squamous cell carcinoma of the cervix with lymph node metastases. Between December 1985 and December 1994, 527 patients with FIGO stage IB–IIB cervical cancer treated with radical hysterectomy and pelvic lymph node dissection were identified from the departmental database; 102 of these (19.35%) cases were found to have lymph node metastases. Histological specimens were available in 81 cases, 63 of which were pure squamous cell carcinoma (SCC), and these form the basis of this analysis. Tumors were re-staged according to the 1995 FIGO classification. The mean follow-up was 54 months, and 51 patients (81%) were followed up for more than 2 years, while 12 patients (19%) died within two years of surgery. There were 32 recurrences (51%) during the follow-up period, and 26 of 29 deaths in the study population were due to cervical cancer. In univariate log rank analysis, tumor differentiation (P= 0.011), number of positive lymph nodes (P= 0.021), and extent of metastatic disease in positive lymph nodes (P= 0.035) were statistically significant factors for crude survival. Other factors including age, maximum diameter of the primary tumor, lymph vascular space involvement, completeness of excision, extracapsular spread, unilateral or bilateral node involvement, inflammatory reaction and maximum diameter of the largest metastases were not found to be statistically significant. In multivariate analysis (Cox regression) differentiation of primary tumor and extent of metastatic disease were the only independent variables (P= 0.009 and P= 0.045, respectively). In the group of patients with poorly differentiated SCC and extent of metastatic disease of 20 mm or more, 78% died of disease, while in the group with moderately differentiated SCC and extent of metastatic disease of less than 20 mm, only 23% died of disease (P= 0.0017). For patients with only one of the two risk factors, 45 % died of disease. In the presence of positive lymph nodes, differentiation of the primary tumor and the extent of lymph nodes metastases are important factors for risk of death due to cervical cancer.

Different Angiogenic Pathways in Human Cervical Cancers

Objective.The objective of this study is to clarify the association between the expression of two types angiogenic factors, vascular endothelial growth factor (VEGF) and platelet-derived endothelial cell growth factor (PD-ECGF)/thymidine phosphorylase(dThdPase) and clinicopathological features, including tumor angiogenesis, in cervical cancers.Methods.The expression of VEGF and PD-ECGF was evaluated by immunohistochemical staining of tumor specimens from 73 patients with stage Ib–IIb cervical cancer (51, squamous cell carcinoma; 19, adenocarcinoma; 3, adenosquamous carcinoma) who underwent radical hysterectomy. The microvessel density was assessed by immunostaining for factor VIII-related antigen in the most neovascularized area.Results.The microvessel density in adenocarcinomas was significantly higher than that in squamous cell carcinomas (P< 0.01). The intensity of VEGF expression in adenocarcinomas was significantly stronger than that in squamous cell carcinomas (P< 0.05). In contrast, the expression of PD-ECGF in squamous cell carcinomas was significantly higher than that in adenocarcinomas (P< 0.0001) and adenosquamous carcinomas (P< 0.01). There was an inverse relationship between VEGF expression and PD-ECGF expression among all patients studied (P< 0.001). The microvessel density was significantly correlated with the intensity of VEGF expression (P< 0.05). In contrast, there was no correlation between the microvessel density and the expression of PD-ECGF.Conclusions.The expression of VEGF appears to be involved in the promotion of angiogenesis in cervical cancers. Furthermore, we propose that angiogenic pathways may be different in different types of cervical cancers.

Serum M3/M21 in cervical cancer patients.

Cytokeratins are polypeptides which constitute a subclass of intermediate filaments in epithelial cells. The serum tumour marker M3/M21 is based on monoclonal antibodies against the epitopes M3 and M21 of cytokeratin 18. In the present study, we measured M3/M21 serum levels in 50 patients with FIGO stage IB-IIB cervical cancer and in 50 control subjects using a two-site radiometric immunoassay directed against soluble fragments of cytokeratin 18. Median serum levels of M3/M21 in patients with cervical cancer and in normal controls were 70.6 U/ml (range 0-397.7) and 6.5 U/ml (range 0-205.2), respectively (Mann-Whitney U-test, P = 0.0001). Median serum levels of M3/M21 prior to therapy and 4 weeks after therapy were 104.2 U/ml (range 24.6-397.7) and 39.3 U/ml (range 0-234.7), respectively (Mann-Whitney U-test, P = 0.004). We found a significant correlation between elevated M3/M21 serum levels and metastatic disease in pelvic lymph nodes (Mann-Whitney U-test, P = 0.002). 24 patients relapsed after complete remission. In these patients, elevated M3/M21 serum levels before the detection of relapse by computed tomography was observed in 13 cases. Considering these preliminary results, further studies with an increased number of patients are justified to clarify the prognostic value and the monitoring abilities of M3/M21 in cervical cancer patients.

Determinants of Response to a Cisplatin-Based Regimen as Neoadjuvant Chemotherapy in Stage IB–IIB Invasive Cervical Cancer

The response rate and the determinants of response to a cisplatin-based regimen of neodjuvant chemoterapy (NACT) in women with a histologically confirmed first-diagnosis of invasive bulky stage IB–IIB cervical cancer are analyzed. A total of 79 cases were treated with cisplatin (40 mg/m2) each 7 days for seven courses. During the first, fourth, and seventh cycles, ifosfamide (3.5 g/m2) was given by infusion for 24 hr. At the end of the seven cycles, 51 had a partial response (64.5%) and 4 a complete pathological response (5.1%). The overall 24-month cumulative survival was 80%, being 93% in responders and 43% in nonresponders (log-rank test,P< 0.05). With respect to the 66 subjects for whom pretreatment status of pelvic lymph nodes was available, complete or partial response was obtained in 35 of 42 subjects with negative pelvic lymph nodes at computed tomography, but in only 13 of 24 with positive lymph nodes. The corresponding odds ratios of response was 0.2 for women with positive status in comparison with those with negative status (95% confidence interval, 0.1–0.4). With respect to the 66 women who underwent surgery after NACT, of the 24 women with pretreatment positive lymph nodal status, 15 had positive nodes at surgery, but in 9 cases the histological analysis of nodes showed negative findings. Positive nodes at surgery were observed in 2 of the 42 subjects with negative nodes before treatment.

Urological complications after radical hysterectomy with or without radiotherapy for cervical cancer

We reviewed urologic complications in 320 patients who underwent radical abdominal hysterectomy for stage Ib-IIb cervical cancer. 145 patients received adjuvant radiotherapy, and 116 were available for urodynamic testing 1-14 years later. The overall incidence of fistulas was 4.4%. Three of eight fistulas following surgery alone healed spontaneously; all fistulas following adjuvant radiotherapy required surgical correction. Nocturia and urgency were reported more often after adjuvant radiotherapy than after surgery alone. We conclude that urologic complications after radical hysterectomy can be made more intractable by adjuvant radiotherapy.