Bulky stage IB cervical carcinoma managed by primary radical hysterectomy followed by tailored radiotherapy

Bloss, Jeffrey D.; Berman, Michael L.; Mukhererjee, J.; Manetta, Alberto; Emma, Dennis; Ramsanghani, Nilam S.; DiSaia, Philip J.

doi:10.1016/0090-8258(92)90069-u

Cited by 51 publications

(3 citation statements)

References 23 publications

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“…In patients who require chemoradiation after surgery, there may be an increased risk of complications as compared to either modality alone (16, 17). ART is potentially beneficial for patients with larger tumors (2–4cm) and no spread to the parametria or lymph nodes at the time of trachelectomy.…”

Section: Discussionmentioning

confidence: 99%

Radical vaginal versus abdominal trachelectomy for stage IB1 cervical cancer: A comparison of surgical and pathologic outcomes

Einstein

Park

Sonoda

et al. 2009

Gynecologic Oncology

108

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Objectives To compare the surgical and pathologic outcomes utilizing two surgical approaches for fertility-sparing radical trachelectomy in patients with stage IB1 cervical cancer. Methods A prospectively maintained database of vaginal radical trachelectomy (VRT) and abdominal radical trachelectomy (ART) procedures was analyzed. All procedures were performed in a standardized manner by the same surgical group. Parametrial measurements were recorded from the final pathology report. Standard statistical tests were used. Results Between 12/2001 and 7/2007, 43 adult patients with FIGO stage IB1 cervical cancer underwent surgery with the intent to perform a fertility-sparing radical trachelectomy. VRT was attempted in 28 patients (65%) and ART in 15 patients (35%). The median measured parametrial length in the VRT group was 1.45 cm compared to 3.97 cm in the ART group, P<0.0001. None of the parametrial specimens in the VRT group contained parametrial nodes. Parametrial nodes were detected in 8 (57.3%) of the ART specimens (P=0.0002). There was no difference in histologic subtypes, lymph vascular space invasion, or median total regional lymph nodes removed in the two groups. Median blood loss was greater but not clinically significant in the ART group, and median operating time was less in the ART group. The overall complication rate was not significantly different in the two groups. Conclusions Using standardized techniques, radical abdominal trachelectomy provides similar surgical and pathologic outcomes with possibly a wider parametrial resection, including contiguous parametrial nodes, as compared to the radical vaginal approach.

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Section: Discussionmentioning

confidence: 99%

Radical vaginal versus abdominal trachelectomy for stage IB1 cervical cancer: A comparison of surgical and pathologic outcomes

Einstein

Park

Sonoda

et al. 2009

Gynecologic Oncology

108

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“…The decision of therapy for patients with stage IB1 squamous carcinomas depends primarily on patient desire, risks associated with general anesthesia and surgery, physician preference, and an awareness of the nature and occurrence of problems with hysterectomy and radiation. Some surgeons have also advocated radical hysterectomy as the first line of therapy for individuals with stage IB2 tumors [24,25]. Then again, patients with tumors larger than 4 cm in diameter usually have enough risk factors to necessitate adjuvant EBRT or chemoradiation, increasing the treatment time and adverse events [23,26].…”

Section: Treatmentmentioning

confidence: 99%

Cervical Cancer

Natelauri

2023

Radiation Therapy

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Cervical cancer is a worldwide public health problem. The leading cause of cervical cancer is persistent infection with high-risk human papillomavirus (HPV). Vaccines exist that protect against high-risk HPV types, and screening programs can detect signs of disease at an early stage, allowing for effective treatment and management of the condition. While being one of the most preventable and treatable forms of cancer, the mortality rate is high, especially in low- and middle-income countries. Early diagnoses, proper staging, and a multidisciplinary approach is the cornerstone of disease management. Surgical treatment, radiation therapy, chemotherapy, immune therapy, and supportive and palliative care are all essential parts of the complex treatment. A simple hysterectomy or brachytherapy for early-stage cervical cancer results in a 5-year OS of more than 98%. For selected patients, radical trachelectomy represents a fertility-sparing treatment option. Radiotherapy (RT), with or without cisplatin-based concurrent chemotherapy after radical or modified radical hysterectomy, is recommended for patients with intermediate- or high-risk features. RT, including brachytherapy plus concurrent chemotherapy, is the treatment of choice for patients with locally advanced disease. Irradiation often provides excellent short-term relief of pain and bleeding, particularly in patients with no history of prior RT.

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“…în 50% din cazuri, iar Landoni și colab. folosesc terapia radiantă postoperatorie la 84% dintre pacientele aflate în stadiul IB2 de boală [3,9,10].…”

Section: Histerectomia Radicală Urmată De Radio-și Eventual Chimioterunclassified

Modalități Diverse de Tratament în Cancerul de Col Uterin Clinic Evident (Stadiile I B și II A)

2014

J de Chirurgie

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This paper aims to update certain aspects of the therapeutic attitude on cervical cancer, a disease that currently is, worldwide, the second leading cause of cancer death in women and thus has increasingly come to the attention of general surgeons. The obvious clinical forms of cervical cancer are brought into discussion, meaning those in the FIGO IB1, IB2 and IIA stages, these being, by far, the most numerous cases we meet in the clinic. Unlike early cervical neoplastic lesions (stages 0 and IA) where the therapeutic attitude is relatively well codified and uniform, in obvious clinical forms there is a great variability of therapeutic approaches, with results that are close to those from the studied literature, indicating according to various statistics a survival rate at 5 years of 80% and 90% for stage I disease and between 60% and 80% for stage II patients.Keywords: Cervical Uterin Cancer; Radical Hysterectomy; Radiotherapy; Chemotherapy IntroducereCancerul de col uterin continuă să reprezinte o problemă de sănătate, peste tot în lume fiind a doua mare cauza de deces prin cancer în rândul femeilor cu peste 500.000 de cazuri noi diagnosticate anual și cu o rată a mortalității de aproximativ 50% [1]. Dintre cazurile noi diagnosticate, aproximativ 79% apar în țările în curs de dezvoltare în timp ce în Statele Unite, cancerul de col uterin este a șasea leziune malignă, ca frecvență, în rândul femeilor cu 12.900 noi cazuri diagnosticate pe an și cu aproximativ 4.400 decese anual [1].Aceste discrepanțe se explică prin diferențele privind implementarea programelor de prevenție a cancerului de col uterin, mult mai ferme în țările dezvoltate.În aceste țări, citologia cervicală reprezintă un foarte bun instrument de screening pentru leziunile pre-invazive, pe când în țările în curs de dezvoltare cele mai multe femei sunt diagnosticate cu forme invazive cu simptomatologie asociată și, în consecință, cu un prognostic mai rezervat [2]. Tratamentul cancerului de col uterin clinic evidentSpre deosebire de leziunile cervicale incipiente (stadiile 0 și IA) unde atitudinea terapeutică este relativ bine codificată și unitară, în formele clinic evidente (stadiile IB și IIA) există o mare variabilitate de abordare terapeutică, cu rezultate foarte apropiate așa cum reiese și din studiile analizate.Atât chirurgia cât și radioterapia pot fi utilizate ca primă modalitate terapeutică a cancerului de col uterin în stadiile IA și IIA, cu rezultate aparent asemănătoare.Astfel, Landoni și colab. au analizat, într-un studiu randomizat, rezultatele chirurgiei radicale versus radioterapie în stadiile IB și IIA ale cancerului cervical, negăsind diferențe semnificative nici în ceea ce privește intervalul liber de boală și nici în ceea ce privește supraviețuirea la distanță. Totuși, la 84% dintre pacientele cu tumori cervicale mari (> 4 cm), supuse intervenției chirurgicale radicale ca prim timp, li s-a efectuat radioterapie adjuvantă în condițiile existenței unor factori de risc adiționali [3]. Este recunoscut faptul că, în cazul tumo...

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Bulky stage IB cervical carcinoma managed by primary radical hysterectomy followed by tailored radiotherapy

Cited by 51 publications

References 23 publications

Radical vaginal versus abdominal trachelectomy for stage IB1 cervical cancer: A comparison of surgical and pathologic outcomes

Radical vaginal versus abdominal trachelectomy for stage IB1 cervical cancer: A comparison of surgical and pathologic outcomes

Cervical Cancer

Modalități Diverse de Tratament în Cancerul de Col Uterin Clinic Evident (Stadiile I B și II A)

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