ESGO Survey on Current Practice in the Management of Cervical Cancer

Dostálek, Lukáš; Åvall‐Lundqvist, Elisabeth; Creutzberg, Carien L.; Kurdiani, Dina; Ponce, Jordi; Dostálková, Iva; Cibula, David

doi:10.1097/igc.0000000000001314

Cited by 43 publications

(32 citation statements)

References 8 publications

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“…However, data on this approach are scarce, and it remains controversial. According to a recently performed European Society of Oncology survey on current practice in the management of cervical cancer, the cervical procedure is abandoned in 61% of centers 14. In the analysis based on the Surveillance, Epidemiology, and End Results database, Richard and colleagues retrospectively analyzed a set of 218 patients who underwent a complete pelvic and para-aortic lymphadenectomy, and were found to have positive pelvic lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

Oncologic outcome after completing or abandoning (radical) hysterectomy in patients with cervical cancer and intraoperative detection of lymph node positivity; ABRAX (ABandoning RAd hyst in cerviX cancer)

Dostálek

Runnebaum

Raspagliesi

et al. 2019

Int J Gynecol Cancer

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BackgroundThe management of patients with intraoperative detection of lymph node involvement remains controversial. The most significant aspect is the decision regarding the completion of the cervical procedure, such as hysterectomy, radical hysterectomy, or a fertility sparing procedure.Primary objectiveThe primary objective of the ABandoning RAd hyst in cerviX cancer (ABRAX) trial is to determine whether the completion of the cervical procedure (ie, radical hysterectomy) improves oncological outcome in patients with intraoperatively detected lymph node involvement before they are referred for definitive chemoradiation.Study hypothesisWe hypothesize that, in patients with intraoperative lymph node involvement, completion of radical hysterectomy or other cervical procedure does not improve the oncological outcome of definitive chemoradiation.Trial designThe ABRAX trial is a multicenter, retrospective, cohort study. Patients with negative lymph nodes in clinical staging, in whom lymph node involvement is detected intraoperatively, are included. Completion or abandonment of the planned cervical procedure stratifies the cohort into two subgroups in which oncological outcome and morbidity will be compared.Major Inclusion/Exclusion criteriaPatients with early stage (pT1a–pT2b) cervical cancer, who did not have positive lymph nodes on preoperative imaging, who were scheduled for primary surgical treatment, and in whom metastatic involvement of pelvic lymph node was found during surgery either as a grossly (macroscopically) involved or on intraoperative pathology assessment will be enrolled. Patients can be included irrespective of surgical approach (minimal invasive surgery or laparotomy) and type of cervical procedure performed (hysterectomy, radical hysterectomy, or a fertility sparing procedure).Primary endpointThe primary endpoint of this retrospective study is a progression free survival in two subgroups with abandoned or completed cervical procedure followed by definitive chemoradiation in both groups.Sample sizeThe assumed sample size is 718 patients (in total for both groups).Estimated dates for completing accrual and presenting resultsEstimated end of data collection: December 2019; estimated date of presenting results: Q2/3 2020.Trial registrationClinicaltrials.gov: NCT04037124.

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Section: Discussionmentioning

confidence: 99%

Oncologic outcome after completing or abandoning (radical) hysterectomy in patients with cervical cancer and intraoperative detection of lymph node positivity; ABRAX (ABandoning RAd hyst in cerviX cancer)

Dostálek

Runnebaum

Raspagliesi

et al. 2019

Int J Gynecol Cancer

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“…41 However, it should be considered that currently, it is an experimental technique with a low implantation rate. 42 To perform SLN biopsy in cervical cancer, MB can be used with or without Tc99. It must be injected into the cervix immediately after the anesthesia had been established.…”

Section: Cervixmentioning

confidence: 99%

“…So that we can see that ICG is a promising tool for SLN in cervical cancer, since it seems less affected by the stage of the disease, with a higher detection rate compared to traditional methods. 42 In addition, currently the detection of the sentinel node with GI by means of robotics with the da Vinci Xi supposes an added advantage. 44 We want to highlight an additional advantage of SLN biopsy in cervical cancer.…”

Section: Cervixmentioning

confidence: 99%

The sentinel node in pelvic gynaecological tumors: an updated view

Castelo-Branco¹,

Gómez²,

David³

et al. 2019

OGIJ

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“…The European Society of Gynecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology guidelines recommended performing intraoperative pathological assessment for SLNs to immediately triage patients towards radical surgery or concurrent chemoradiotherapy. 10 However, the National Comprehensive Cancer Network (NCCN) guidelines did not make the same recommendation. 11 As a result, some gynecologists tend to immediately perform lymphadenectomy for patients with positive SLN identified on intraoperative assessment, whereas others directly exempt lymphadenectomy for all patients and plan chemoradiotherapy for those presenting positive SLN on final pathology.…”

Section: Introductionmentioning

confidence: 99%

Potential Risks in Sentinel Lymph Node Biopsy for Cervical Cancer: A Single-Institution Pilot Study

Wan

Zhang

et al. 2020

Preprint

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KEYWORDSCervical cancer, sentinel lymph node biopsy, metastasis, lymphovascular invasion 2 Abstract Background: Sentinel lymph node (SLN) biopsy is an attractive technique that widely performed in many oncological surgeries. However, the potential risks in SLN biopsy for cervical cancer remains largely unclear. Methods: Seventy-five patients with histologically confirmed cervical cancer were enrolled between May 2014 and June 2016. SLN biopsies were performed followed by pelvic lymphadenectomies and all resected nodes were labeled according to their anatomic areas. Only bilateral detections of SLNs were considered as successful. Patients' clinicopathologic feature, performance of SLN detection, and distributions of lymph node metastases were analyzed. Results: Of the 75 enrolled patients, at least one SLN was detected in 69 (92.0%), including 33 in bilateral and 36 in unilateral. SLNs were most detected in obturator area (52 of 69 patients, 75.4%)and 26 (37.7%) patients presented SLNs in more than one area of hemipelvis. Lymphovascular invasion was found to be the only factor that adversely influenced SLN detection, while the tumor diameter, growth type, histological grade, deep stromal invasion and neoadjuvant chemotherapy showed no significant impacts. Patients with lymphovascular invasion showed significantly higher rate to have unsuccessful detection (90.9% versus 41.5%, P<0.001) and lymph node metastasis (40.9% versus 3.8%, P<0.001) compared with those without. Nodal metastases were confirmed in 11 patients, of whom 9 (81.8%) had lymphovascular invasion and 7 (63.6%) had non-SLN metastasis.The most frequently involved SLNs were obturator nodes (9/11, 81.8%). In addition, the parametrial nodes also has high rate to be positive (4/11, 36.4%), although they were relatively less identified as SLNs. Besides, 3 patients showed metastases in the laterals without SLN detected.Conclusions: In cervical cancer, lymphovascular invasion is a significant factor for unsuccessful SLN detection, which harbors the risk of omitting nodal metastasis. The risk of having undetected metastasis is high when SLN is positive, therefore further lymphadenectomy may be necessary for these patients.

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ESGO Survey on Current Practice in the Management of Cervical Cancer

Abstract: The results of this survey indicate considerable differences in the workup and treatment of cervical cancer in current clinical practice.

Cited by 43 publications

References 8 publications

Oncologic outcome after completing or abandoning (radical) hysterectomy in patients with cervical cancer and intraoperative detection of lymph node positivity; ABRAX (ABandoning RAd hyst in cerviX cancer)

Oncologic outcome after completing or abandoning (radical) hysterectomy in patients with cervical cancer and intraoperative detection of lymph node positivity; ABRAX (ABandoning RAd hyst in cerviX cancer)

The sentinel node in pelvic gynaecological tumors: an updated view

Potential Risks in Sentinel Lymph Node Biopsy for Cervical Cancer: A Single-Institution Pilot Study

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