Oncology

Clinical Study

Locally Advanced Cervical Cancer: Is a Trimodality Treatment a Safe and Effective Approach?

Lorusso D.a · Martinelli F.a · Maltese G.a · Fontanella C.a · Sabatucci I.a · Ditto A.a · Signorelli M.a · Bogani G.a · Lepori S.a · Tripodi E.a · Pappalardi B.b · Scaffa C.a · Cerrotta A.b · Rapagliesi F.a

Author affiliations

aDepartment of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
bDepartment of Diagnostic Imaging and Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

Keywords: Cervical cancerChemoradiotherapyAdjuvant chemotherapyExtraperitoneal laparoscopic lymphadenectomyTrimodality treatment

Related Articles for ""
Oncology 2018;95:239–245
https://doi.org/10.1159/000489886

Log in to MyKarger to check if you already have access to this content.




Forgot your password
Sign up to MyKarger

Buy

  • FullText & PDF
  • Unlimited re-access via MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more
CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!


If you would like to redeem your KAB credit, please log in.

Save over 20% compared to the individual article price.

Learn more

Rent/Cloud

  • Rent for 48h to view
  • Buy Cloud Access for unlimited viewing via different devices
  • Synchronizing in the ReadCube Cloud
  • Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00

Select

Subscribe

  • Access to all articles of the subscribed year(s) guaranteed for 5 years
  • Unlimited re-access via Subscriber Login or MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

Subcription rates

Select
* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview
Abstract of Clinical Study

Received: September 04, 2017
Accepted: May 07, 2018
Published online: June 19, 2018
Issue release date: September 2018

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 3

ISSN: 0030-2414 (Print)
eISSN: 1423-0232 (Online)

For additional information: https://www.karger.com/OCL

Abstract

Background: Chemoradiotherapy (CRT) is the standard of care for locally advanced cervical cancer (LACC). Pre-treatment lymph nodes (LN) assessment may have an important therapeutic role. CRT followed by adjuvant chemotherapy increased progression free survival (PFS) and overall survival (OS). Our study evaluated the feasibility and the effectiveness of a trimodality strategy in patients with LACC and positive LN. Methods: Consecutive patients with LACC treated at the National Cancer Institute of Milan were enrolled. All patients underwent pelvic and para-aortic extraperitoneal laparoscopic lymphadenectomy to assess the nodal status. After surgery, patients received radiotherapy followed by chemotherapy according to the stage of disease. Results: Between April 2012 and October 2013, 19 cervical cancer patients were enrolled. Overall, 10 (52.6%) patients presented with positive LN: 6 in the pelvic area and 4 both in the pelvic and para-aortic area. No perioperative major complications occurred. The most common surgical-related adverse events were bleeding (26%), respiratory distress (5%), infection (5%) and the development of lymphoceles (25%). Overall, 15 (78.9%) complete responses and 2 (10.5%) partial responses were registered. After a median follow-up of 43.3 months, 89.5% of patients were alive at the last visit, and 3-year PFS was 63%. Conclusions: Trimodality treatment appears feasible, well tolerated and promising in terms of oncologic outcome.

© 2018 S. Karger AG, Basel



Related Articles:

References

  1. National Cancer Institute: Clinical Announcement on Cervical Cancer. Bethesda, National Institutes of Health, 1999. http://rex.nci.nih.gov/massmedia/backgrounders/cervical.htm (accessed on May 16, 2017).
  2. Morice P, Castaigne D, Pautier P, et al: Interest of pelvic and para-aortic lymphadenectomy in patients with stage IB and II cervical carcinoma. Gynecol Oncol 1999; 73: 106–110.
  3. Leblanc E, Narducci F, Frumovitz M, et al: Therapeutic value of pretherapeutic extraperitoneal laparoscopic staging of locally advanced cervical carcinoma. Gynecol Oncol 2007; 105: 304–311.
  4. Goff B, Muntz HG, Paley PJ, Tamimi HK, et al: Impact of surgical staging in women with locally advanced cervical cancer. Gynecol Oncol 1999; 74: 436–442.
  5. Berman ML, Keys H, Creasman W, et al: Survival and patterns of recurrence in cervical cancer metastatic to periaortic lymph nodes (a Gynecologic Oncology group Study). Gynecol Oncol 1984; 19: 8–16.
  6. Lanciano R, Martz K, Coia L, et al: Tumor and treatment factors improving outcome in stage III-B cervix cancer. Int J Radiat Oncol Biol Phys 1991; 20: 95–100.
  7. Toita T, Nakano M, Higashi M, et al: Prognostic value of cervical size and pelvic lymph node status assessed by computed tomography for patients with uterine cervical cancer treated by radical radiation therapy. Int J Radiat Oncol Biol Phys 1995; 33: 843–849.
  8. Gouy S, Morice P, Narducci F, Uzan C, Martinez A, Rey A, Bentivegna E, Pautier P, Deandreis D, Querleu D, Haie-Meder C, Leblanc E: Prospective multicenter study evaluating the survival of patients with locally advanced cervical cancer undergoing laparoscopic para-aortic lymphadenectomy before chemoradiotherapy in the era of positron emission tomography imaging. J Clin Oncol 2013; 31: 3026–3033.
  9. Ferrandina G, Distefano M, Ludovisi M, et al: Lymph node involvement in locally advanced cervical cancer patients administered preoperative chemoradiation versus chemotherapy. Ann Surg Oncol 2007; 14: 1129–1135.
  10. Duenas-Gonzalez A, Zarba JJ, Patel F, et al: Phase III, open-label, randomized study comparing concurrent gemcitabine plus cisplatin and radiation followed by adjuvant gemcitabine and cisplatin versus concurrent cisplatin and radiation in patients with stage IIB to IVA carcinoma of the cervix. J Clin Oncol 2011; 29: 1678–1685.
  11. Cervical Cancer Staging. http://emedicine.medscape.com/article/2006486-overview (accessed on May 16, 2017).
  12. Querleu D, Dargent D, Ansquer Y, et al: Extraperitoneal endosurgical aortic and common iliac dissection in the staging of bulky or advanced cervical carcinomas. Cancer 2000; 88: 1883–1891.
  13. Michel G, Morice P, Castaigne D, et al: Lymphatic spread in stage Ib and II cervical carcinoma: anatomy and surgical implications. Obstet Gynecol 1998; 91: 360–363.
  14. Dindo D, Demartines N, Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205–213.
  15. Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration: Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from  18 randomized trials. J Clin Oncol 2008; 26: 5802–5812.
  16. Eifel PJ, Winter K, Morris M, et al: Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer: an update of radiation therapy oncology group trial (RTOG) 90–01. J Clin Oncol 2004,22: 872–880.
  17. Del Pino M, Fusté P, Pahisa J, et al: Laparoscopic lymphadenectomy in advanced cervical cancer: prognostic and therapeutic ­value. Int J Gynecol Cancer 2013; 9: 1675–1683.
  18. Rotman M, Pajak T, Choi K, et al: Prophylactic extended-field irradiation of para-aortic lymph nodes in stages IIB and bulky IB and IIA cervical carcinomas. Ten-year treatment results of RTOG 79–20. JAMA 1995; 274: 387–393.
  19. Amendola M, Hricak H, Mitchell D, et al: Utilization of diagnostic studies in the pretreatment evaluation of invasive cervical cancer in the United States: results of intergroup protocol ACRIN 6651/GOG 183. J Clin Oncol 2005; 23: 7454–7459.
  20. Varia MA, Bundy BN, Deppe G, et al: Cervical carcinoma metastatic to para-aortic nodes: E­xtended field radiation therapy with concomitant 5-fluorouracil and cisplatin chemotherapy: a Gynecologic Oncology Group study. Int  J Radiat Oncol Biol Phys 1998; 42: 1015–1023.
  21. Choi H, Roh J, Seo S, et al: Comparison of the accuracy of magnetic resonance imaging and positron emission tomography/computed tomography in the presurgical detection of lymph node metastases in patients with uterine cervical carcinoma: a prospective study. Cancer 2006; 106: 914–922.
  22. Hertel H, Kohler C, Elhawary T, et al: Laparoscopic staging compared with imaging techniques in the staging of advanced cervical cancer. Gynecol Oncol 2002; 87: 46–51.
  23. Havrilesky L, Kulasingam S, Matchar D, et al: FDG-PET for management of cervical and ovarian cancer. Gynecol Oncol 2005; 97: 183–191.
  24. Boughanim M, Leboulleux S, Rey A, et al: Histologic results of para-aortic lymphadenectomy in patients treated for stage IB2/II cervical cancer with negative [18F]fluorodeoxyglucose positron emission tomography scans in the para-aortic area. J Clin Oncol 2008; 26: 2558–2561.
  25. Ramirez PT, Jhingran A, Macapinlac HA, et al: Laparoscopic extraperitoneal para-aortic lymphadenectomy in locally advanced cervical cancer: a prospective correlation of surgical findings with positron emission tomography/computed tomography findings. Cancer 2011; 117: 1928–1934.
  26. Houvenaeghel G, Lelievre L, Rigouard AL, et al: Residual pelvic lymphnode involvement after concomitant chemoradiation for locally advanced cervical cancer. Gynecol Oncol 2006; 102: 74–79.
  27. Ferrandina G, Margariti PA, Smaniotto D, et al: Long-term analysis of clinical outcome and complications in locally advanced cervical cancer patients administered concomitant chemoradiation followed by radical surgery. Gynecol Oncol 2010; 119: 404–410.
  28. Beadle BM, Jhingran A, Yom SS, et al: ­Patterns of regional recurrence after definitive radiotherapy for cervical cancer. Int J Radiat Oncol Biol Phys 2010,76: 1396–1403.
  29. Cosin J, Fowler J, Chen M, et al: Pretreatment surgical staging of patients with cervical carcinoma: the case for lymph node debulking. Cancer 1998; 82: 2241–2248.
  30. Podczaski E, Palombo C, Manetta A, et al: Assessment of pretreatment laparotomy in patients with cervical carcinoma prior to radiotherapy. Gynecol Oncol 1989; 33: 71–75.
  31. Marnitz S, Köhler C, Roth C, et al: Is there a benefit of pretreatment laparoscopic transperitoneal surgical staging in patients with advanced cervical cancer?. Gynecologic Oncology 2005; 99: 546–544.
  32. Gold MA, Tian C, Whitney CW, et al: Surgical versus radiographic determination of para-aortic lymph node metastases before chemoradiation for locally advanced cervical carcinoma: a Gynecologic Oncology Group Study. Cancer 2008; 112: 1954–1963.
  33. Cheung TH, Lo KW, Yim SF, et al: Debulking metastatic pelvic nodes before radiotherapy in cervical cancer patients: a long-term follow-up result. Int J Clin Oncol 2011; 16: 546–552.
  34. Lai C, Huang K, Hong J, et al: Randomized trial of surgical staging (extraperitoneal or laparoscopic) versus clinical staging in locally advanced cervical cancer. Gynecol Oncol 2003; 89: 160–167.
  35. Brockbank E, Kokka F, Bryant A, et al: Pre-treatment surgical para-aortic lymph node ­assessment in locally advanced cervical ­cancer. Cochrane Database Syst Rev 2013; 3: CD008217.
  36. Uzan C, Souadka A, Gouy S, et al: Analysis of morbidity and clinical implications of laparoscopic para-aortic lymphadenectomy in a continuous series of 98 patients with advanced-stage cervical cancer and negative positron emission tomography-CT imaging in the para-aortic area. Oncologist 2011; 16: 1021–1027.
  37. Gouy S, Morice P, Narducci F, et al: Nodalstaging surgery for locally advanced cervical cancer in the era of positron emission tomography. Lancet Oncol 2012; 13:e212–e220.
  38. Peters WA 3rd, Liu PY, Barrett RJ 2nd, et al: Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol 2000; 18: 1606–1613.
  39. Petereit DG, Sarkaria JN, Chappell R, et al: The adverse effect of treatment prolongation in cervical carcinoma. Int J Radiat Oncol Biol Phys 1995; 32: 1301–1307.
  40. Dueňas-González A, Orlando M, Zhou Y, et al: Efficacy in high burden locally advanced cervical cancer with concurrent gemcitabine and cisplatin chemoradiotherapy plus adjuvant gemcitabine and cisplatin: prognostic and predictive factors and the impact of disease stage on outcomes from a prospective randomized phase III trial.Gynecol Oncol 2012; 126: 334–340.

Article / Publication Details

First-Page Preview
Abstract of Clinical Study

Received: September 04, 2017
Accepted: May 07, 2018
Published online: June 19, 2018
Issue release date: September 2018

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 3

ISSN: 0030-2414 (Print)
eISSN: 1423-0232 (Online)

For additional information: https://www.karger.com/OCL

Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Article Tools
Article Details

2018, Vol.95, No. 4

September 2018

Article

Recommend This
TOP