Is surgical treatment an option for locally advanced cervical cancer in the presence of central residual tumor after chemoradiotherapy?

Abstract Objective To evaluate the outcomes of surgical treatment in patients with chemoradiotherapy (CRT)-resistant and locally advanced cervical cancer (LACC). Methods Patients with LACC who underwent surgery due to resistance to CRT between 2005 and 2015 were reviewed retrospectively. Disease-free survival (DFS) and overall survival (OS) related factors were analyzed. Results A total of 23 patients were included in the study and the median age was 51 years old. A total of 14 patients (60.8%) experienced recurrence; among these recurrences, 8 of them were local, 5 were distant, 1 was both distant and local. A total of 9 patients (39%) died. The Median DFS and OS durations were 15 and 32 months, respectively. A total of 17 patients (74%) had undergone simple hysterectomy, 4 (17%) radical hysterectomy, and 2 (9%) total pelvic exenteration. Postoperative grade 3 and 4 complications were seen in 12 patients (52%). Macroscopic tumor presence in the pathology specimen was associated with distant recurrence and positive surgical margins with local recurrence (Log-Rank test p = 0.029 and p = 0.048, respectively). The only factor associated with OS was surgical margin positivity (Log-Rank test p = 0.008). The type of surgery, grades 3 and 4 postoperative complications, brachytherapy, and tumor histology were not associated with recurrence. Conclusion In patients with LACC, hysterectomy is an option in the presence of a central residual tumor after CRT. However, the risk of grades 3 and 4 complications of performed surgery is high. The presence of macroscopic tumor in the pathology specimen and positive surgical margins are poor prognostic factors. The goal of the surgeon should be to achieve a negative surgical margin. It does not seem important if the surgery is simple or radical.

Prognostic significance of MRD [minimal residual disease] quantification by PCR in childhood acute leukaemia

Twenty five cases with acute lymphoblastic leukaemia were included in this study. They received induction, intensification and maintenance chemotherapy [Modified Berlin-Frankfurt-Munster BMP 76/79 Protocol], plus prophylactic cranial irradiation to a total dose of 1800 cGy/ 2 weeks/ 10 fractions. MRD quantification was done using real-time PCR. It was found that patients with negative MRD had much better overall and relapse-free survivals than those with positive one, 100% versus 20% and 100% versus 25% at the end of 24 months follow-up. Again, it was found that PCR-MRD levels > 0.01 or more can predict the relapse and the prognosis of those cases was much worse than those with lower levels

Carcinoma avançado da cérvix uterina: tumor residual como fator prognóstico / Advanced cervix uteri carcinoma: Residual tumor as prognostic factor

O carcinoma da cérvix é a neoplasia mais frequente na mulher brasileira e tem uma alta taxa de morbidade. O Recife está entre as cidades de maior incidência mundial dessa neoplasia. A presença da neoplasia residual piora o prognóstico do carcinoma cervical uterino. A presente investigaçÝo objetivou analisar a sobrevida das pacientes portadoras de carcinoma da cérvix uterina ECIIIb, tratadas exclusivamete por radioterapia, com e sem tumor residual. Foram estudadas 165 pacientes. A sobreviada a cinco anos das pacientes sem tumor residual foi de 68,3 por cento. Nenhuma das pacientes com tumor residual sobreviveu 2 anos. Este estudo permitiu reafirmar o pobre diagnóstico das pacientes com tumores residuais. Modalidade de tratamento mais agressivos devem ser indicados nessas pacientes