FIGO 2018 Staging for Cervical Cancer: Influence on Stage Distribution and Outcomes in the 3D-Image-Guided Brachytherapy Era

Abstract

<jats:p>Recent widespread use of three-dimensional image-guided brachytherapy (3D-IGBT) has improved radiotherapy outcomes of cervical cancer dramatically. In 2018, the International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer was revised. However, the influence of the revisions on the stage distribution and outcomes of cervical cancers treated with 3D-IGBT remains unclear. Here, we retrospectively analyzed 221 patients with cervical squamous cell carcinoma treated with definitive radiotherapy using 3D-IGBT (median follow-up, 60 months). The stage distribution and outcomes were compared between the 2009 and 2018 schemas. Stage migration occurred in 52.9% of the patients. Patients classified with the 2018 criteria as stage IIICr had the highest proportion (43.8%) of migration, and were mainly from the 2009 stages IIB and IIIB. The 2009 and 2018 schemas showed comparable performance at stratifying 5-year overall survival (OS) and 5-year progression-free survival (PFS) for patients in stages IB–IVA. The 2018 criteria effectively stratified 5-year OS and PFS in the stage III substages. The 5-year OS and PFS for stage IIIC1r patients varied according to tumor T stage. These data provide evidence for the utility of the revised 2018 FIGO staging system in the clinical management of cervical cancers in the 3D-IGBT era.</jats:p>

Stage Migration in Cervical Cancer Using the FIGO 2018 Staging System: A Retrospective Survival Analysis Using a Single-Institution Patient Cohort

“…Grigsby et al reported that 53% of patients had stage migration when the FIGO 2018 system was used [ 13 ]. Tomizawa et al noted that stage migration occurred in 53% of the patients from their single-institution study [ 14 ]. Our analysis identified that 59% of patients were upstaged: 4% to Stage IB3 and 48% to stage IIIC, with the other stages accounting for the rest when restaged using FIGO 2018.…”

“…The incidence of para-aortic node (PAN) metastasis increases with the FIGO tumor stage [ 15 - 17 ]. For FIGO stages IB, II B, and III B disease, the risk of paraaortic node metastasis was about 5%, 20%, and 30%, respectively [ 14 - 16 ]. The presence of PANs was found to be the single most important independent predictor of relapse and survival in a multivariate analysis of 626 patients who were enrolled in Gynecologic Oncology Group (GOG) trials [ 18 ].…”

The Non-Cancer Specific Elevation of the Serum Squamous Cell Carcinoma Antigen during the Post-Radiotherapy Follow-Up of Cervical Cancer Patients

“…The patients in this study were followed up for at least 3 years; the median follow-up period exceeded 5 years. Multiple studies have analyzed the radiotherapy outcomes of cervical cancer by employing inclusion criteria compatible with those used for this study; these studies show that the onset of disease progression after 3 years post-radiotherapy is rare [ 15 , 47 , 48 ]. From this standpoint, the progression-free disease status and the resultant incidence of non-cancer specific SCC elevation identified in this study cohort is highly reliable.…”

Rectovaginal fistula in a cervical cancer patient treated with sequential radiotherapy and bevacizumab: A dose‐volume analysis

“…1 Chemoradiotherapy is the standard definitive treatment for locally advanced cervical cancers. [2][3][4][5] On the other hand, addition of bevacizumab to the chemotherapy regimen (either cisplatin plus paclitaxel or topotecan plus paclitaxel) improves survival of those with recurrent or metastatic cancer. 6 The downside is that bevacizumab increases the risk of gastrointestinal fistula (by approximately 7% for Grade-2 or Grade-3 fistulas based on the Common Terminology Criteria for Adverse Events [CTCAE] version 3.0) in patients with a previous history of pelvic irradiation.…”

“…Cervical cancer is the fourth most common cancer in women worldwide 1 . Chemoradiotherapy is the standard definitive treatment for locally advanced cervical cancers 2‐5 . On the other hand, addition of bevacizumab to the chemotherapy regimen (either cisplatin plus paclitaxel or topotecan plus paclitaxel) improves survival of those with recurrent or metastatic cancer 6 .…”