Stage IB-IIB Cervical Cancer Research Articles

ASGO 2nd International Workshop on Gynecologic Oncology

ASGO 2nd International Workshop on Gynecologic Oncology

Laparoscopic Versus Open Radical Hysterectomy for Stage IB2–IIB Cervical Cancer in the Setting of Neoadjuvant Chemotherapy: A Multi-institutional Cohort Study

Despite the lack of conclusive evidence supporting this treatment modality, neoadjuvant chemotherapy (NACT) prior to radical surgery is a commonly accepted strategy to manage locally advanced cervical cancer. Radical hysterectomy in chemotherapy-treated patients can be technically challenging due to large volume of residual disease, desmoplastic reaction, and loss of normal tissue planes as a result of the cytotoxic treatment. We sought to assess whether surgical outcomes of laparoscopic radical hysterectomy (LRH) and its open counterpart are equivalent in the setting of NACT. Prospectively maintained databases of five gynecologic oncology services were searched for stage IB2-IIB cervical cancer patients undergoing surgery after NACT. LRH and open radical hysterectomy (RAH) patients were compared with respect to perioperative outcomes and mid-term survival. Adjustment for potential selection bias in surgical approach was made with propensity score (PS) matching. LRH cases (n=68) were associated with lower-stage, lower-grade tumors compared with RAH group (n=273). When patients were grouped by stage at presentation (IB2-IIA and IIB), complication rates and perioperative outcomes were equivalent between LRH and RAH groups. LRH offered less blood loss, lower transfusion rate, and shorter hospitalization. These differences remained significant after PS matching. In the PS-matched cohort, Cox proportional hazards model including tumor stage, grade, histotype, nodal status, institution, and time period of surgery showed that laparoscopic approach was not associated with impaired survival. Laparoscopic approach seems a valuable alternative to open surgery for patients with locally advanced cervical carcinoma who have received NACT.

O3-019 - The Prognostic Significance of Multiple Pelvic Node Metastases in Cervical Cancer Patients Treated with Radical Hysterectomy Plus Adjuvant Chemoradiotherapy

ABSTRACT Background Lymph node metastasis is an important prognostic factor in cervical cancer. According to previous reports, the survival of early-stage cervical cancer patients with three or more positive nodes was significantly shorter than that of those with one or two positive nodes, indicating the prognostic significance of multiple pelvic node metastases. However, because these previous investigations were conducted before the introduction of concurrent chemoradiotherapy (CCRT), the prognostic significance of multiple pelvic node metastases in patients treated with CCRT is unknown. We investigated the prognostic significance of multiple pelvic node metastases in cervical cancer patients who were treated with radical hysterectomy plus adjuvant CCRT. Methods We retrospectively reviewed the medical records of 311 patients with FIGO stage IB1–IIB cervical cancer who had been treated with radical hysterectomy plus adjuvant RT between April 1996 and December 2008. Of these, 119 received adjuvant RT alone (RT group) and 192 received CCRT (CCRT group). Multivariate analysis for progression-free survival (PFS) was carried out using the Cox proportional hazards regression model. Survival was calculated using the Kaplan–Meier method and compared using the log-rank test. Results Multivariate analysis demonstrated pelvic node metastasis to be an independent prognostic factor for shorter PFS in both groups. When the node-positive patients were analyzed according to the number of positive pelvic nodes, we found that the patients with multiple pelvic node metastases (>3) displayed significantly shorter PFS than those with 1 or 2 pelvic node metastases in the RT group. In contrast, in the CCRT-group, the PFS of the patients with multiple pelvic node metastases (>3) was similar to that observed of the patients with 1 or 2 pelvic node metastases. Conclusions The presence of multiple pelvic node metastases was not an independent predictor of shorter PFS in the CCRT group.

A randomized phase III adjuvant study in high-risk cervical cancer: simultaneous radiochemotherapy with cisplatin (S-RC) versus systemic paclitaxel and carboplatin followed by percutaneous radiation (PC-R): a NOGGO-AGO Intergroup Study

Simultaneous adjuvant platinum-based radiochemotherapy in high-risk cervical cancer (CC) is an established treatment strategy. Sequential paclitaxel (Taxol) and platinum followed by radiotherapy may offer further advantages regarding toxicity. An open-labeled randomized phase III trial was conducted to compare paclitaxel (175 mg/m(2)) plus carboplatin (AUC5) followed by radiation (50.4 Gy) (experimental arm-A) versus simultaneous radiochemotherapy with cisplatin (40 mg/m(2)/week) (arm-B) in patients with stage IB-IIB CC after surgery. Primary objective was progression-free survival (PFS). Overall, 271 patients were randomized and 263 were eligible for evaluation; 132 in arm-A and 131 in arm-B appropriately balanced. The estimated 2-year PFS was 81.8% [95% confidence interval (CI) 74.4-89.1] in arm-B versus 87.2% (95% CI 81.2-93.3) in arm-A (P = 0.235) and the corresponding 5-year survival rates were 85.8% in arm-A and 78.9% in arm-B (P = 0.25). Hematological grade 3/4 toxicity was higher in arm-B. Alopecia (87.9% versus 4.1%; P < 0.001) and neurotoxicity (65.9% versus 15.6%; P < 0.001) were significantly higher in arm-A. Early treatment termination was significantly more frequent in arm-B than in arm-A (32.1% versus 12.9%; P = 0.001). Sequential chemotherapy and radiation in high-risk CC could not show any significant survival benefit; however, a different toxicity profile appeared. This sequential regime may constitute an alternative option when contraindications for immediate postoperative radiation are present.

The effects of age on treatment and outcomes in women with stage IB-IIB cervical cancer.

5100 Background: Advanced age may affect the treatment choice and subsequent outcome in elderly patients with cervical cancer. Given the potential for cure with either surgery or chemoradiation in early stage disease, we aimed to determine whether a patient’s age influenced the treatment received and the outcome. Methods: Our retrospective cohort identified a total of 303 patients diagnosed with Stage IB1 through IIB cervical carcinoma who were treated at our institution between 2000 and 2010. The eligible patients were divided into two groups based on age at the time of diagnosis: &lt;65 and &gt; 65 years. Adjusted odd ratios were calculated to determine variables associated with treatment received (chemoradiation or surgery). Single and multivariate Cox proportional hazards modeling were used to estimate hazard ratios for variables associated with disease specific survival. Results: Of the patients meeting inclusion criteria, 253 were &lt;65 years and 50 were &gt; 65 years. The distribution of tumor histology, stage and grade was not different between the two groups. After adjusting for histology, stage and a validated comorbidity score, the odds ratio of receiving chemoradiation vs. surgery for the cohort &gt; 65 years was 1.69 (OR 95% CI: 0.68-4.17). There was no significant difference in the type of primary treatment received between the two groups (P = 0.16). Persistent disease was seen in 46 (18%) of the younger patients and in 19 (38%) of the older patients (P = 0.02). In the elderly cohort the treatment received did not influence disease-specific or all-cause mortality. However, compared to women under 65, older women treated surgically had increased disease specific (HR 3.18, 95% CI: 0.98-10.3) and all-cause mortality (HR 6.53, 95% CI: 2.57-16.6). Conclusions: Age does not appear to be a factor influencing the treatment received by patients with Stage IB1-IIB cervical cancer. The type of treatment received does not seem to affect disease-specific mortality among older versus younger women. However, surgery was associated with a 6.5-fold increased risk of all cause mortality among older women when compared to women under 65 years.

Pilot study of a computed tomography-compatible shielded intracavitary brachytherapy applicator for treatment of cervical cancer

PurposeThe traditional Fletcher-Williamson tandem and ovoid brachytherapy applicators for treatment of cervical cancer have ovoid shields that reduce the dose to the bladder and rectum. However, these shields produce artifact on computed tomography (CT) that prevents acquisition of high-quality images. To address this limitation, we designed and tested a novel CT-compatible applicator with movable shields, called MDA3. Methods and MaterialsFifteen patients with stage IB1-IIB cervical cancer requiring definitive radiation therapy were enrolled in a prospective pilot study to evaluate image quality with the MDA3. Image quality was assessed by comparing an initial scan obtained with the shields shifted to minimize shield artifact to a second scan obtained with the shields in treatment position. The 2 scans were then compared by a radiation oncologist blinded to the image source. In addition, image quality was assessed by analysis of Hounsfield values in the normal tissues. ResultsThe MDA3 was successfully employed for intracavitary brachytherapy in 15 patients. CT images obtained with the shields shifted were superior to CT images obtained with the shields in treatment position in every case as evaluated by the radiation oncologist (P < .0001). The presence of the shields in the treatment position significantly increased the mean Hounsfield values within the bladder (P = .002) and rectum (P = .001) due to high-density image artifact. ConclusionsThis novel applicator provides a clinically feasible solution to overcome the limitation of lack of ovoid shields on currently available CT-compatible applicators.

Matched-case comparison of neoadjuvant chemotherapy in patients with FIGO stage IB1-IIB cervical cancer to establish selection criteria

ObjectiveNeoadjuvant chemotherapy (NACT) for cervical cancer still remains controversial. NACT was evaluated to establish selection criteria. MethodsA matched-case comparison was designed for the NACT group (n=707) and primary surgery treatment (PST; n=707) group to investigate short-term responses and high/intermediate risk factors (HRFs/IRFs). The 5-year disease-free survival (DFS) and overall survival (OS) rates were stratified by NACT response, HRFs/IRFs, International Federation of Gynecology and Obstetrics (FIGO) stage and tumour size, respectively. ResultsThe clinical and pathological response rates were 79.3% and 14.9% in the NACT group. In comparison to the PST group, IRFs but not HRFs were significantly decreased (P<0.05), and the 5-year DFS rate was significantly improved in the NACT group (88.4% versus 83.1%, P=0.021). Moreover, the 5-year DFS and OS rates were favourably increased in the clinical responders in comparison to the PST group and the clinical non-responders (P<0.05). Compared to those of clinical non-responders, the 5-year DFS and OS rates of clinical responders, with or without HRFs, were also significantly increased (P<0.01). In stage IB2, the 5-year DFS and OS rates were significantly increased, whereas operation duration declined in the NACT group (P<0.05). For patients with stage IB tumours of 2–5cm, the 5-year DFS and OS rates of clinical responders were significantly improved (P<0.05). ConclusionsNACT is a suitable option for patients with cervical cancer, especially for NACT responders and patients with stage IB, which provides a new concept of fertility preservation for young patients.

The Prognostic Significance of Multiple Pelvic Node Metastases in Cervical Cancer Patients Treated With Radical Hysterectomy Plus Adjuvant Chemoradiotherapy

We investigated the prognostic significance of multiple pelvic node metastases in cervical cancer patients who were treated with radical hysterectomy plus adjuvant chemoradiotherapy. We retrospectively reviewed the medical records of 311 patients with International Federation of Gynecology and Obstetrics stage IB1-IIB cervical cancer who had been treated with radical hysterectomy plus adjuvant radiotherapy (RT) between January 1998 and December 2008. Of these, 119 received adjuvant RT and 192 received adjuvant concurrent chemoradiotherapy (CCRT) postoperatively. Multivariate analysis for progression-free survival (PFS) was performed using the Cox proportional hazards regression model to investigate the prognostic significance of pelvic node metastases in the 2 treatment groups. Survival was calculated using the Kaplan-Meier method and compared using the log-rank test. Multivariate analysis demonstrated pelvic node metastasis to be an independent prognostic factor for shorter PFS in both treatment groups. When the node-positive patients were analyzed according to the number of positive pelvic nodes, we found that the patients with multiple pelvic node metastases (≥3) displayed significantly shorter PFS than those with 1 or 2 pelvic node metastases in the RT group. In contrast, in the CCRT group, the PFS of the patients with multiple pelvic node metastases (≥3) was similar to that observed of the patients with 1 or 2 pelvic node metastases. The presence of multiple pelvic node metastases was not an independent predictor of shorter PFS in the CCRT group.

Clinical Behaviors and Outcomes for Adenocarcinoma or Adenosquamous Carcinoma of Cervix Treated by Radical Hysterectomy and Adjuvant Radiotherapy or Chemoradiotherapy

To compare clinical behaviors and treatment outcomes between patients with squamous cell carcinoma (SCC) and adenocarcinoma/adenosquamous carcinoma (AC/ASC) of the cervix treated with radical hysterectomy (RH) and adjuvant radiotherapy (RT) or concurrent chemoradiotherapy (CCRT). A total of 318 Stage IB-IIB cervical cancer patients, 202 (63.5%) with SCC and 116 (36.5%) with AC/ASC, treated by RH and adjuvant RT/CCRT, were included. The indications for RT/CCRT were deep stromal invasion, positive resection margin, parametrial invasion, or lymph node (LN) metastasis. Postoperative CCRT was administered in 65 SCC patients (32%) and 80 AC/ASC patients (69%). Patients with presence of parametrial invasion or LN metastasis were stratified into a high-risk group, and the rest into an intermediate-risk group. The patterns of failure and factors influencing survival were evaluated. The treatment failed in 39 SCC patients (19.3%) and 39 AC/ASC patients (33.6%). The 5-year relapse-free survival rates for SCC and AC/ASC patients were 83.4% and 66.5%, respectively (p = 0.000). Distant metastasis was the major failure pattern in both groups. After multivariate analysis, prognostic factors for local recurrence included younger age, parametrial invasion, AC/ASC histology, and positive resection margin; for distant recurrence they included parametrial invasion, LN metastasis, and AC/ASC histology. Compared with SCC patients, those with AC/ASC had higher local relapse rates for the intermediate-risk group but a higher distant metastasis rate for the high-risk group. Postoperative CCRT tended to improve survival for intermediate-risk but not for high-risk AC/ASC patients. Adenocarcinoma/adenosquamous carcinoma is an independent prognostic factor for cervical cancer patients treated by RH and postoperative RT. Concurrent chemoradiotherapy could improve survival for intermediate-risk, but not necessarily high-risk, AC/ASC patients.

Clinical curative effects of preoperative neoadjuvant chemotherapy on cervical cancer: analysis of 62 patients

To explore the clinical curative effects of preoperative neoadjuvant chemotherapy (NACT) on locally advanced cervical cancer. A total of 62 patients of stage Ib2-IIb cervical cancer received neoadjuvant chemotherapy of paclitaxel plus cisplatin for 2 - 3 courses. The clinical curative effects were evaluated according to the changes of lesion size, intraoperative conditions and postoperative pathological reactions. The overall response rate was 90.32% (56/62) and the complete response rate 30.65% (19/62). The tumor volumes decreased after NACT. The differences were significant (P < 0.05). After NACT, 56 patients undergoing radical hysterectomy recovered smoothly. The surgical resection rate was 90.32%. Chemotherapeutic reactions of cancerous tissue and a large number of infiltrated lymphocytes were seen in 50 cases. Lymph nodes were positive in 3 cases. There were parametrial invasion (n = 2) and vascular tumor emboli (n = 2). Preoperative neoadjuvant chemotherapy is efficacious in cervical cancer. The parametrium becomes softer and the tumor staging decreases.

Clinical evaluation of neoadjuvant chemotherapy followed by radical surgery in the management of stage IB2–IIB cervical cancer

ObjectiveTo evaluate clinical efficacy, toxicity, and survival outcomes of neoadjuvant chemotherapy (NACT) followed by radical surgery (RS) among patients with cervical cancer stage IB2–IIB. MethodsIn a retrospective clinical study at West China Second Hospital, Chengdu, data were analyzed from 414 patients who underwent NACT followed by radical surgery (NACT–RS) or RS alone between January 2008 and November 2009. ResultsThe clinical response for NACT was 90%. Lymph node metastasis (25% versus 48%, P<0.05) and deep cervical stromal invasion more than 0.5, (68% versus 91%, P<0.05) were significantly lower among responders than among non-responders, respectively, in the NACT–RS group. The 2-year progression-free survival and 2-year overall survival were 93.0% and 95.5% in the NACT–RS group, and 94.5% and 97.1% in the RS group (P>0.05). Parametric infiltration (hazard ratio [HR], 7.668; P<0.05) and lymph node metastasis (HR, 7.714; P<0.05) were independent risk factors for all study patients. ConclusionCompared with RS, NACT–RS did not show a significant advantage for patients with locally advanced cervical cancer. However, the data provide the rationale for assessing NACT–RS in a multicenter randomized clinical trial setting. NACT may be considered as an alternative treatment when radiotherapy is not available.

Type II radical hysterectomy and adjuvant therapy for pelvic lymph node metastasis with stage IB–IIB cervical carcinoma: A retrospective study of 288 patients

The aim of this study was to evaluate type II radical hysterectomy with or without adjuvant therapy as a treatment for patients with pelvic lymph node metastasis (PLNM) and stage IB-IIB cervical carcinoma. A total of 288 patients with stage IB-IIB cervical carcinoma and confirmed PLNM who underwent a type II radical hysterectomy between 1995 and 2005 were retrospectively evaluated. The 5-year overall survival (OS) rate for this cohort was 65.6%, and independent prognostic factors identified for PLNM patients included a non-squamous cell histological subtype and parametrial involvement. Survival differences between patients that received or did not receive adjuvant treatment were also evaluated, and the 5-year OS and DFS rates for patients who did not receive adjuvant therapy (47 and 41.4%, respectively) were much lower than the rates for patients who did receive adjuvant therapies (67.7 and 59.4%, respectively). However, these differences were not statistically significant (OS, P = 0.057; DFS, P = 0.080). Type II radical hysterectomy, in combination with adjuvant therapies, is an efficient treatment for PLNM patients with stage IB-IIB cervical cancer.

Prognostic Significance of Amplification of thec-MYCGene in Surgically Treated Stage IB-IIB Cervical Cancer

Cervical cancer is the second most common cancer among women world-wide, with about 470,000 newly diagnosed cases and almost 250,000 deaths every year. Furthermore, cervical cancer is the most common cause of death from gynecological malignancy in developing countries. Typically, type III radical hysterectomy (RH) is prescribed for patients diagnosed with stage IB-IIA cervical cancer who can tolerate an aggressive surgical approach, and want to avoid the long-term adverse effects of radiation therapy. For stage IIB patients, radiation therapy has been commonly prescribed. However, in some countries in Europe and Asia, type III radical hysterectomies are prescribed for patients with stage IB-IIB cervical cancer. Various clinico-pathological variables evaluated as possible prognostic factors for survival after RH, including depth of invasion, parametrial margin involvement, pelvic lymph node metastasis, number of lymph node metastases, histological type and pre-treatment squamous cell carcinoma (SQCC)-antigen level, are significant factors for clinical outcome. In addition to these clinico-pathologic variables, increasing attention has focused on various new approaches to molecular and genetic changes in cervical cancer. Molecular and genetic alterations are important in the pathogenesis of cervical cancer, especially in association with human papillomavirus (HPV) infections. One of considerable interest is c-MYC gene status. cMYC activation, triggered by insertion of HPV DNA sequences into near the c-MYC locus, is now regarded to be an important genetic event in cervical oncogenesis, c-MYC gene maps to chromosomal band 8q24, which is reportedly a common site for integration of HPV DNA. Gene amplification is an important mechanism for protein overexpression and oncogene activation in tumor cells. c-MYC amplification is well documented in cervical cancer. Amplification of the c-MYC gene is also addressed in breast cancer, bladder cancer, prostate cancer, and lung cancer. Although strong prognostic impact o f c-MYC gene amplification on histologic grade, disease stage and patients survival have been well documented in certain types of tumors, data on prognostic significance of both gain and amplification of c-MYC is lacking in cervical cancer. Therefore, in this study, we assessed c-MYC gene status in human cervical cancer samples using fluorescence in situ hybridization (FISH) to analyze the relation between c-MYC gene amplification and clinicopathologic factors. The prognostic value Prognostic Significance of Amplification of the c-MYC Gene in Surgically Treated Stage IB-IIB Cervical Cancer

Total laparoscopic radical hysterectomy and pelvic lymphadenectomy in locally advanced stage IB2-IIB cervical cancer patients after neoadjuvant chemotherapy

Objective To evaluate the feasibility and morbidity of total laparoscopic class C2 radical hysterectomy (TLRH) with pelvic lymphadenectomy in patients with locally advanced cervical cancer stage IB2 to IIB after neoadjuvant chemotherapy (NACT). Methods A prospective study was conducted from October 2004 to September 2009. Cervical cancer patients, stage IB2-IIB with complete clinical response after 3 courses of NACT with paclitaxel 175 mg/m 2, ifosfamide 5 g/m 2 and cisplatin 75 mg/m 2 (TIP) underwent TLRH. Results Forty patients were included, with a median age of 46 years (range, 25–65), BMI of 24 kg/m 2 (range, 15–49). FIGO staging was IB2 in 23, IIA > 4 cm in 6 and IIB in 11 patients. Four patients required conversion to laparotomy. Pathological evaluation showed 9 complete response (pCR), 9 partial response (pPR1) with microscopic tumour, and 15 partial response (pPR2) with macroscopic tumour. Three patients had no response. The median operative time was 305 min (range, 215–430); the median estimated blood loss was 250 ml (range, 100–400), with four postoperative blood transfusion; the median number of removed pelvic lymph nodes was 25 (range, 11–64). The median length of hospital stay was 6 days (range, 3–12). The median follow-up time was 37 months (range, 10–69), with three patients having a recurrence. One patient died of disease (DOD) after 12 months. Conclusions TLRH can be safely performed in patients with stage IB2-IIB carcinoma of cervix after NACT, with advantages of minimal blood loss and morbidity.

Evaluation of the effects of type II radical hysterectomy in the treatment of 960 patients with stage IB–IIB cervical carcinoma: A retrospective study

This retrospective study evaluated the feasibility and effectiveness of type II radical hysterectomies alone, or in combination with adjuvant treatment, for the treatment of patients with stage IB-IIB cervical cancer with or without high-risk factors. A total of 960 stage IB-IIB patients who underwent type II radical hysterectomies between 1995 and 2004 were enrolled and retrospectively analyzed. Uterine corpus invasion, parametrial margin involvement, and pelvic lymph node metastasis were identified as independent prognostic factors for stage IB patients. For stage IIA-IIB patients, histologic type, parametrial margin involvement, and pelvic lymph node metastasis were identified as independent prognostic factors. The 5-year overall survival (OS) rates for patients with stage IB versus stage IIA-IIB cervical carcinomas were 88.4% and 78.5%, respectively. Moreover, adjuvant radiotherapy and chemotherapy improved the 5-year OS rates of stage IIA-IIB patients associated with high-risk factors. The overall recurrence rate for this cohort was 14.4%. Our findings show that type II radical hysterectomy is a feasible treatment option for stage IB-IIB cervical carcinoma patients. Furthermore, type II radical hysterectomy combined with adjuvant post-operative therapy improves the OS of women with high-risk factors for cervical carcinoma.

Pretreatment platelet and hemoglobin levels are neither predictive nor prognostic variables for patients with locally advanced cervical cancer treated with neoadjuvant chemotherapy and radical hysterectomy: a retrospective Italian study.

To assess the predictive and prognostic values of pretreatment platelet and hemoglobin levels in patients with locally advanced cervical cancer who underwent neoadjuvant chemotherapy followed by radical hysterectomy. The authors retrospectively assessed 140 patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB2-IIB cervical cancer who underwent chemosurgical treatment. Median pretreatment platelet and hemoglobin levels were 272,000/μL and 12.5 g/dL, respectively. Fourteen patients achieved a pathologically complete response, and 26 had an optimal partial response, with an optimal pathological response rate of 28.6%. By univariate analysis, optimal pathological response rate was associated with well/moderately differentiated grade (P = 0.02) and platinum-/paclitaxel-based chemotherapy regimen (P = 0.04), but not with platelet and hemoglobin levels. Multiple logistic regression confirmed that tumor grade (odds ratio, 2.827; 95% confidence interval [95% CI], 1.250-6.397; P = 0.01) and chemotherapy regimen (odds ratio, 5.416; 95% CI, 1.459-20.110; P = 0.01) were independent predictors of optimal pathological response. Five-year recurrence-free survival and 5-year overall survival were 66 % and 73%, respectively. By log-rank test, recurrence-free survival and overall survival were associated with pathological response (P = 0.0002 and P = 0.001), lymph node status, (P = 0.008 and P = 0.002), lymphovascular space status (P = 0.005 and P = 0.003), and parametrial and/or surgical margin status (P = 0.004 and P = 0.001), but not with platelet and hemoglobin levels. On multivariate analysis, pathological response (hazard ratio [HR], 7.999; 95% CI, 1.916-33.394; and HR, 6.007; 95% CI, 1.426-25.307) and parametrial and/or surgical margin status (HR, 2.061; 95%CI, 1.047-4.058; and HR, 2.561; 95% CI, 1.244-5.271) were independent prognostic variables of recurrence-free survival and overall survival. The achievement of an optimal pathological response is the strongest independent prognostic variable for patients with cervical cancer treated with neoadjuvant chemotherapy and radical hysterectomy, whereas pretreatment platelet and hemoglobin levels seem to be neither predictive of response to chemotherapy nor prognostic of long-term outcome.

Neoadjuvant chemotherapy followed by radical hysterectomy plus postoperative chemotherapy but no radiotherapy for Stage IB2-IIB cervical cancer—Irinotecan and platinum chemotherapy

Objective To evaluate the effectiveness of neoadjuvant chemotherapy (NAC) followed by radical hysterectomy plus postoperative chemotherapy but no radiotherapy for stage IB2-IIB cervical cancer. Methods Forty-six consecutive patients with stage IB2-IIB cervical cancer were treated with NAC followed by radical hysterectomy plus postoperative chemotherapy. Median (range) body mass index (BMI) of the patients was 20.2 (16.2–26.4). Regimens for NAC and postoperative chemotherapy were irinotecan and cisplatin (CPT-11/CDDP) or CPT-11 and nedaplatin (CPT-11/NDP). A total of six cycles of NAC and postoperative chemotherapy were prescribed. No use of radiotherapy was scheduled, except in the case of a recurrence. Results With a median follow-up period for survivors of 38.8 months (range 24–54 months), the 2- and 3-year progression-free survival rates were 91.2% and 86.1%, respectively. Overall response rate of NAC was 80.4%. Recurrence was observed in seven patients. In the absence of radiotherapy, pelvic recurrence was observed in only three patients; another two had para-aortic lymph nodes and the remaining two distant metastases. Toxicities due to chemotherapy were generally tolerable. Postoperative complications included urinary fistula (four patients, 8.7%) and bowel obstruction (two patients, 4.3%), all of which required surgical intervention. Conclusion The results indicate that NAC followed by surgery plus postoperative chemotherapy but no radiotherapy offers a viable option in the treatment of stage IB2-IIB cervical cancer. Although a relatively large incidence of postsurgical complications was observed among low-BMI patients, this treatment offers the advantage of minimizing radiation-induced morbidity, allowing radiotherapy to be reserved for the possible event of pelvic recurrence.

High-risk group for locoregional recurrence in patients with stage IB-IIB squamous cell carcinoma of the cervix treated with concurrent chemoradiotherapy.

e15519 Background: To identify predictive factors for locoregional recurrence in patients with FIGO stage IB-IIB cervical cancer treated with concurrent chemoradiotherapy (CCRT). Methods: We analyz...

Indoleamine 2,3-dioxygenase expression predicts impaired survival of invasive cervical cancer patients treated with radical hysterectomy

Objective Indoleamine 2,3-dioxygenase (IDO) is a tryptophan-catabolizing enzyme that induces tolerance to host immune surveillance within the tumor microenvironment. The present study aimed to investigate IDO expression and its prognostic significance in invasive cervical cancer. Methods Immunohistochemical expression of IDO in tumor tissues and its association with clinicopathological factors and survival were analyzed in 112 stage IB–IIB cervical cancer patients treated with radical hysterectomy and pelvic lymphadenectomy. Results IDO was diffusely expressed in tumor cells in 29 (26%) cases and focally expressed at the invasive front in 29 (26%) cases, while the other 54 (48%) cases were IDO-negative. IDO expression was positively correlated with clinical stage, lymph node metastasis, and lymph-vascular space invasion, but not with histological type. Patients with diffuse IDO expression had significantly reduced overall survival (OS) and disease-free survival (DFS) compared to patients with no IDO expression. The 5-year OS/DFS rates for the IDO-negative, focally positive, and diffusely positive groups were 92.3%/84.9%, 89.5%/75.8%, and 65.5%/51.7%, respectively. When we analyzed patients with stage IB disease alone ( n = 67), the OS and DFS for the IDO-diffusely positive group were significantly lower than those for the IDO-negative group. In multivariate analysis, diffuse IDO expression was found to be an independent prognostic factor for impaired OS and DFS. Conclusions Diffuse expression of IDO in the tumor obtained from Stage IB–IIB cervical cancer patients who underwent radical hysterectomy was correlated with an unfavorable clinical outcome. These findings suggest that IDO may be a novel post-operative prognostic indicator for stage IB–IIB cervical cancer.

Prognostic factors in stage IB–IIB cervical adenocarcinoma patients treated with radical hysterectomy and pelvic lymphadenectomy

The purpose of the present study was to identify prognostic factors and patterns of recurrence in patients with stage IB-IIB cervical adenocarcinoma who had undergone radical surgery and to compare these patterns with those observed in squamous cell carcinoma (SCC) patients. We retrospectively reviewed 303 patients (97 with adenocarcinoma and 206 with SCC) with stage IB-IIB cervical cancer who had undergone radical hysterectomy and pelvic lymphadenectomy. In the case of the adenocarcinoma patients, lymph node metastasis and parametrial invasion were independent indicators of disease-free survival, whereas lymph node metastasis was the only independent prognostic factor for the overall survival of the patients. The sites of recurrence did not significantly differ between the adenocarcinoma and SCC patients. In parametrium-positive patients, adenocarcinoma was found to be an independent prognostic factor for disease-free survival. In patients with positive pelvic lymph node, adenocarcinoma was found to be an independent prognostic factor for both disease-free and overall survival. Adenocarcinoma was found to be an independent prognostic factor for survival in patients with positive pelvic node or parametrial extension. Furthermore, the patterns of recurrence did not differ significantly between the adenocarcinoma and SCC patients.