Comparison between gynecologic oncology ultrasound and magnetic resonance imaging in the assessment of early-stage cervical cancer: A local experience in cancer imaging / Philippine Journal of Obstetrics and Gynecology

Objective@#This study aimed to compare the diagnostic accuracy of gynecologic oncology ultrasound and magnetic resonance imaging (MRI) in the assessment of early-stage cervical cancer.@*Methodology@#This was a prospective, cross-sectional study of patients with early-stage cervical cancer eligible for radical hysterectomy in a tertiary government institution from November 25, 2020, to August 2, 2022. Preoperative gynecologic oncology (transabdominal/transvaginal/transrectal) ultrasound and MRI measurements were obtained and compared with histopathologic findings. Sensitivity, specificity, positive predictive value, negative predictive value, and positive likelihood ratio were used to check for the diagnostic accuracy of each modality.@*Results@#A total of 27 patients were enrolled in the study. Four were stage IB1 (14.81%), 10 were stage IB2 (37.03%), nine were stage IB3 (33.33%), two were stage IIA1 (7.40%), and two were stage IIA2 (7.40%). Ultrasound has a comparable diagnostic accuracy with MRI to assess tumor size length, width, and height with an area under the curve of 0.789, 0.753, and 0.806, respectively. Both modalities can predict the absence of parametrial invasion and nodal involvement with a specificity of 100% and a negative predictive value of 88.89% and 81.48%, respectively. The results of the gynecologic oncology ultrasound showed good agreement with MRI.@*Conclusion@#Ultrasound has comparable diagnostic accuracy with MRI in assessing tumor size, parametrial invasion, and nodal involvement in patients with early-stage cervical cancer. It is a good alternative imaging modality to MRI in staging cervical cancer, especially in low- to middle-income countries.

The Clinical Observation of Pelvic lymphadenoetomy and Vaginal Radical Trachelectomy Procedure in both the Effect and Reproductive Outcome for 16 Cases of Early-stage Cervical Cancer / 实用妇产科杂志

Objective:To investigate the clinical effectiveness and reproductive outcome of fertility-preserving surgery(pelvic lymphadenoetomy +Vaginal radical trachelectomy(VRT)in women with early stage cervical cancer.Methods:A perspective observation of 16 patients who had undergone pelvic lymphadenoetomy + VRT with early stage cervical cancer(study group) since Jan 2011 to Dec 2015 was carried out.30 patients who undergone laparoscopic radical hysterectomy(LRH) + pelvic lymphadenoetomy with early stage cervical cancer were set as the control group.The clinical efficiency were compared between the two groups,and the cumulative pregnancy rate and pregnancy outcome were followed up in study group.Results:There was no statistic difference in age,clinical staging,pathologicalgrade,LVSI,SCC expression,operating-time,pastoper ationfever,operative complications,tumor recurrence between the two groups(P＞0.05).Compare to control group,the index of amount of bleeding was fewer and the average hospital stay was shorter in study group(P ＜ 0.05),12 patients got pregnant and cumulative pregnancy 15 times within one year after operation,there were 4 mature delivery(33.3％) and 11 fetal loss(73.3％).Conclusions:For the young patients with early stage cervical cancer,pelvic lymphadenoetomy + VRT is the treatment procedure with the same clinical effectiveness with radical hysterectomy + pelvic lymphadenoetomy and has the advantage of fertility preserving,but the pregnancy and reproductive outcome need to be improved.

Surgical and oncologic outcomes after robotic radical hysterectomy as compared to open radical hysterectomy in the treatment of early cervical cancer / 부인종양

OBJECTIVE: The use of robotic radical hysterectomy has greatly increased in the treatment of early stage cervical cancer. We sought to compare surgical and oncologic outcomes of women undergoing robotic radical hysterectomy compared to open radical hysterectomy. METHODS: The clinic-pathologic, treatment, and recurrence data were abstracted through an Institutional Review Board-approved protocol at 2 separate large tertiary care centers in Seattle, Swedish Medical Center and the University of Washington. Data were collected from 2001–2012. Comparisons between the robotic and open cohorts were made for complications, recurrence, progression-free survival (PFS), and overall survival (OS). RESULTS: In the study period, 109 robotic radical hysterectomies were performed. These were compared to 202 open radical hysterectomies. The groups were comparable in terms of age and body mass index (BMI). Length of stay (LOS) was considerably shorter in the robotic group (42.7 vs. 112.6 hours, p<0.001) as was estimated blood loss (EBL; 105.9 vs. 482.6 mL, p<0.001). There were more complications in the open radical hysterectomy group, 23.4% vs. 9.2% in the robotic group (p=0.002). The recurrence rate was comparable between the groups (10.1% vs. 10.4%, p=0.730). In multivariate adjusted analysis, robotic surgery was not a statistically significant predictor of PFS (p=0.230) or OS (0.85). CONCLUSION: Our study, one of the largest multi-institution cohorts of patients undergoing robotic radical hysterectomy, suggest robotic radical hysterectomy leads to comparable oncologic outcomes in the treatment of early stage cervical cancer with improved short-term surgical outcomes such as decreased LOS and EBL.

Protective effects of gonadotropin releasing hormone agonist on ovarian function in patients with early stage cervical cancer undergoing ovarian preservation / 中国生化药物杂志

Objective To investigate the protective effect of gonadotropin releasing hormone agonist on ovarian function in patients with early stage cervical cancer.Methods80 cases ofadmitted patients with early stage cervical cancerfrom January 2015 to January 2016 in Yinzhou Second Hospital were selected, were randomly divided to observation group and control group.Patients in the observation group were retained ovarian resection, while giving the gonadotropin releasing hormone (GnRH) agonist treatment, the control group patients only with reservation of ovary resection and compared between the two groups before and after chemotherapy in patients with basal follicle stimulation hormone (bFSH) levels, serum anti Mullerian tube hormone (AMH) level, basic estrogen (bE2) levels, and the basal antral follicle number (bafc).ResultsThere were no significant differences in two groups of chemotherapy in patients with anterior bFSH and bE2 level, after chemotherapy, the observation group patients bFSH and bE2 level was significantly lower than that in control group (P<0.05) and chemotherapy after bFSH level of two groups of patients were higher than that in the chemotherapy before.bE2 levels were lower than those before chemotherapy (P<0.05);chemotherapy the number of patients in the two groups of AMH level and bafc without significant difference, after chemotherapy, the observation group AMH levels and bafc number were significantly higher than those of the control group (P<0.05) and chemotherapy after two groups of patients with AMH levels and bafc number lower than the chemotherapy before (P<0.05).ConclusionGnRH agonists can effectively protect the early cervical cancer patients with radical resection of ovarian reserve and ovarian reserve function, clinical application is worthy of further promotion.

Comparison of outcomes between radical hysterectomy followed by tailored adjuvant therapy versus primary chemoradiation therapy in IB2 and IIA2 cervical cancer / 부인종양

OBJECTIVE: To compare survival outcomes and treatment-related morbidities between radical hysterectomy (RH) and primary chemoradiation therapy (CRT) in patients with bulky early-stage cervical cancer. METHODS: We selected 215 patients with stage IB2 and IIA2 cervical cancer (tumor diameter > 4 cm on magnetic resonance imaging) who underwent RH followed by tailored adjuvant therapy (n=147) or primary CRT (n=68) at two tertiary referral centers between 2001 and 2010. RESULTS: About twenty nine percent of patients were cured by RH alone and these patients experienced the best survival outcomes with the lowest morbidity rates. After the median follow-up times of 40 months, 27 RH (18.4%) and 20 CRT (29.4%) patients had recurrence (p=0.068) and 23 (15.6%) and 17 (25%) patients died of disease (p=0.101). The 5-year progression-free survival were 77% and 66% (p=0.047), and the 5-year overall survival were 78% and 67% (p=0.048) after RH and primary CRT, respectively. In multivariate analysis, patients who received primary CRT was at higher risk for tumor recurrence (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.24 to 4.14; p=0.008) and death (OR, 3.02; 95% CI, 1.53 to 5.98; p=0.001) than those who received RH. Grade 3-4, early (17% vs. 30.9%, p=0.021) and late (1.4% vs. 8.8%, p=0.007) complications were significantly less frequent after RH than primary CRT. CONCLUSION: Thirty percent of patients were cured by RH alone. A treatment outcome was better in this retrospective study in terms of morbidity and survival. Randomized trials are needed to confirm this result.

Comparison of outcomes between radical hysterectomy followed by tailored adjuvant therapy versus primary chemoradiation therapy in IB2 and IIA2 cervical cancer / 부인종양

OBJECTIVE: To compare survival outcomes and treatment-related morbidities between radical hysterectomy (RH) and primary chemoradiation therapy (CRT) in patients with bulky early-stage cervical cancer. METHODS: We selected 215 patients with stage IB2 and IIA2 cervical cancer (tumor diameter > 4 cm on magnetic resonance imaging) who underwent RH followed by tailored adjuvant therapy (n=147) or primary CRT (n=68) at two tertiary referral centers between 2001 and 2010. RESULTS: About twenty nine percent of patients were cured by RH alone and these patients experienced the best survival outcomes with the lowest morbidity rates. After the median follow-up times of 40 months, 27 RH (18.4%) and 20 CRT (29.4%) patients had recurrence (p=0.068) and 23 (15.6%) and 17 (25%) patients died of disease (p=0.101). The 5-year progression-free survival were 77% and 66% (p=0.047), and the 5-year overall survival were 78% and 67% (p=0.048) after RH and primary CRT, respectively. In multivariate analysis, patients who received primary CRT was at higher risk for tumor recurrence (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.24 to 4.14; p=0.008) and death (OR, 3.02; 95% CI, 1.53 to 5.98; p=0.001) than those who received RH. Grade 3-4, early (17% vs. 30.9%, p=0.021) and late (1.4% vs. 8.8%, p=0.007) complications were significantly less frequent after RH than primary CRT. CONCLUSION: Thirty percent of patients were cured by RH alone. A treatment outcome was better in this retrospective study in terms of morbidity and survival. Randomized trials are needed to confirm this result.

Histerectomía radical vaginal en cáncer cérvicouterino de estadio precoz / Radical vaginal hysterectomy in early stage cervical cancer

Objetivo: Comunicar una técnica mínimamente invasiva para el manejo quirúrgico del cáncer cérvicouterino en estadio precoz y sus resultados. Método: 40 pacientes con cáncer cérvicouterino en estadios IA2 y IB1 operadas en un período de 2,5 años. Se les efectúa linfadenectomía pelviana sistemática laparoscópica seguidas de histerectomía vaginal radical, excepto aquellas pacientes que tienen compromiso ganglionar detectado en biopsia contemporánea. Resultados: 40 pacientes son sometidas a esta técnica. Cuatro pacientes son abortadas de su cirugía, 3 por presentar ganglios positivos para carcinoma en biopsia contemporánea y 1 por tener un extenso compromiso cervical al momento de efectuar la histerectomía vaginal radical. Los 36 casos restantes tienen una edad promedio de 43,9 años, ninguna nulípara y 8 tienen el antecedente de cesárea. El IMC promedio fue de 30,49 y 14 conizadas previas. El tiempo operatorio promedio fue de 238 minutos. La estadía postoperatoria promedio fue de 2,9 días. El sangrado estimado fue de 139 cc y ninguna paciente requirió transfusión. Se conservan los anexos en 13 pacientes y en todas se suspenden por vía laparoscópica. El promedio de ganglios obtenidos fue de 30. Cuatro pacientes sufren lesión vesical, 1 fístula vesicovaginal y 3 disfunciones vesicales. Conclusión: El cáncer cérvicouterino en estadio precoz es factible de ser tratado con esta técnica y brinda las ventajas de la cirugía laparoscópica y vaginal con mínimas complicaciones.

Objective: To communicate a minimally invasive technique for surgical handling of early stage cervical cancer and its results. Methods: 40 patients with cervical cancer in stages IA2 and IB1, all of them operated in a period of 2.5 years, are presented. Laparoscopic systemic pelvic lymphadenectomy with posterior radical vaginal hysterectomy was performed, with the exception of those patients who had compromised nodes detected in contemporary biopsy. Results: 40 patients were submitted to this technique. 4 patients had their surgery aborted: 3 presented positive nodes for carcinoma in contemporary biopsy and 1 had extensive cervical compromise when performing radical vaginal hysterectomy. Analysis of the remaining 36 cases shows an average age of 43.9 years, all of them had given birth before, 8 of them through Cs-section. BMI averaged 30.49 and 14 had had cone surgery performed previously. Average duration of surgery was of 238 minutes. Postoperative hospitalization averaged 2.9 days. Bleeding volume was estimated at 139 cc and no patient required blood transfusion. 13 uterine annexes were kept and all of them were suspended by means of laparoscopy. On average, 30 nodes were obtained. 4 patients suffered bladder injury, one had vesicovaginal fistula and there were 3 bladder dysfunctions. Conclusion: The early stage cervical cancer is likely to be treated with this technique and provides de benefits of laparoscopic and vaginal surgery with minimal complications.

Propriety and Efficacy of Postoperative Adjuvant Concurrent Chemoradiotherapy for High Risk Group Early Stage Cervical Ccancer Patients Following Radical Hysterectomy and Pelvic Lymph Node Dissection / 대한산부인과학회잡지

OBJECTIVE: This study was undertaken to evaluate the efficacy of postoperative concurrent chemoradiotherapy (CCRT) and to investigate the recurrence and survival rates after adjuvant CCRT in high risk early cervical cancer (stage IA2, IB, IIA) patients who were treated by radical hysterectomy and pelvic lymphadenectomy. METHODS: From July 1994 to June 2003, we reviewed the chart of 146 patients who underwent radical abdominal hysterectomy and pelvic lymphadenectomy at Ajou University Hospital for early cervical cancer (stage IA2, IB, IIA). CCRT was performed in 30 patients with high risk factors such as positive pelvic lymph node, positive parametrial involvement, or positive surgical margins. Chemotherapy consisted of cisplatin (70 mg/m2 on day 1) and 5-FU (1000 mg/m2 on day 2-5) for 4 cycles every 4 weeks beginning 2-3 weeks after operation. Pelvic radiotherapy were started with 2nd and 3rd cycle of chemotherapy concurrently. We compared the recurrence rate and survival rate with 114 patients who received no adjuvant therapy after operation. The mean follow up period was 49 months (24-94 months). RESULTS: Disease recurred in 9 of 144 patients treated with surgery (6.3%). There were recurrences in 3 patients after CCRT (10.0%), and in 6 patients in the control group (5.3%) respectively. The actuarial 5-year overall survival rates for patients with adjuvant CCRT, and with no adjuvant treatment were 100%vs. 96.8% (p>0.05). The recurrence and progression-free survival rates were 9.5% vs 6.3%, 90.5% vs. 93.7% (p>0.05). CONCLUSION: This study shows good local control and 5 years overall and progression free survival rates in the high-risk cervical cancer patients after CCRT which is similar results seen in control group. Our results indicate that adjuvant concurrent chemoradiotherapy seems to be effective in stage IA2-IIA cervical cancer patients with high risk.

Therapeutic Results of Postoperative Radiation Therapy for Early Stage Uterine cervical Cancer / 대한치료방사선과학회지

This is a retrospective analysis of 67 patients with histologically proven invasive carcinoma of uterine cervix treated with surgery followed by adjuvant radiotherapy at Inje University Seoul Paik Hospital between october 1983 and september 1991. Postoperative radiotherapy was carried out in patients with high risks of locoregional recurrence such as positive pelvic lymph node (38 pts), large tumor size more than 3 cm (22 pts), cervical stromal invasion more than 2/3 (46 pts), parametrial involvement (9 pts), positive resection margin (147ts), endo/myometrial extension (10 pts), and angiolymphatic invasion (13 pts). Stage IA, IB, and IIA were 2(3%), 39(58.2%), and 26(38.8%), respectively. Median follow-up period was 48 months with ranges from 13 to 115 months. All 67 patients were treated externally with standard pelvic field with radiation dose ranging from 4080 to 6120 cGy in 4~6 weeks period of time. Of these, 45 patients received intracavitary radiotherapy. The overall survival rate and disease free survival rate at 5-year were 88.0% and 82.1%, respectively. The survival rates by stage were 87.l% in IB and 88.4% in IIA. Local control rate was 86.6%(58 pts). The treatment failure was noted in 12 of 67 Patients(17.9%): locoregional failure in 7(10.4%), distant metastasis in 3(4.5%), and locoregional and distant metastasis in 2 (3%). The univariate analysis of prognostic factors disclosed endo/myometrial extension as a significant factor of survival and recurrence (70.0% vs 91.l% P< 0.05 & 30.0% vs 15.8%, respectively). The complication of postoperative radiothrapy was not significant and all patient were well tolerated. In conclusion, postoperative radiotherapy in patients with high risks of locoreginal recurrence is relatively well tolerated and it gives significantly improved survival rate especially in patients with positive lymph nodes, bulky tumor size( 3 cm), parametrial involvement, cervical stromal invasion more than 2/3, positive resection margin and angiolymphatic invasion.