Indications for Adjunctive Conservative Extrafascial Hysterectomy in Selected Cases of Carcinoma of the Uterine Cervix

Nelson, Alvah J.; Fletcher, Gilbert H.; Jt, Wharton

doi:10.1097/00006254-197604000-00022

Cited by 7 publications

(8 citation statements)

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“…The first strategy for FIGO stage IB2 cancer of the cervix has been RT and/or hysterectomy, which is at present an outdated modality. About 40 years ago, Fletcher stated that “in the bulky expansile lesions of the endocervix, tumor cells deep in the myometrium are beyond the zone of adequate dosage because of the pear‐shaped isodose distribution of the vaginal and intrauterine radium.” The above author therefore attempted RT followed by hysterectomy to minimize central tumor recurrence (4) . Thereafter, extrafascial hysterectomy after radiation was added for the management of this criterion of disease, with improvement of survival from 64% to 75% (5) .…”

Section: Discussionmentioning

confidence: 99%

Efficacy of different types of treatment in FIGO stage IB2 cervical cancer in Korea: results of a multicenter retrospective Korean study (KGOG-1005)

Ryu

Kang

Kim

et al. 2007

Int J Gynecol Cancer

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The purpose of this study is to review FIGO stage IB2 cervical cancers in Korea for the past 10 years, and evaluate the most frequently employed and appropriate management strategy, and also assess the survival benefits of neoadjuvant chemotherapy (NAC). This is a retrospective chart review of 727 FIGO stage IB2 patients from 1995 to 2005. Six hundred ninety-two patients were enrolled, and all dates on which the patients died were double checked through the "National Registry of Death Statistics" of the Korea National Statistical Office. Management strategies were divided into five groups according to the primary treatment modality. The most frequently employed primary treatment modality for stage IB2 cervical cancer in Korea during the past 10 years was radical hysterectomy (RH). The next was NAC, followed by radiotherapy (RT) and/or extrafascial hysterectomy, concurrent chemoradiotherapy (CCRT) and/or extrafascial hysterectomy, in descending order. The surgery group showed the best results, with an 89% 5-year disease-free survival rate. However, there was no statistical difference between the surgery, NAC, and CCRT groups. For FIGO stage IB2 cervical cancer during the past 10 years in Korea, RH and adjuvant RT or CCRT was the most frequently employed treatment strategy. As a primary modality, RH, NAC, and CCRT showed similar survival rates. However, RH demonstrated the best survival rate among the above treatment strategies.

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Section: Discussionmentioning

confidence: 99%

Efficacy of different types of treatment in FIGO stage IB2 cervical cancer in Korea: results of a multicenter retrospective Korean study (KGOG-1005)

Ryu

Kang

Kim

et al. 2007

Int J Gynecol Cancer

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“…Nelson in 1975 reported 73% five-year survival for adenocarcinoma and squamous cell carcinomas treated by combined therapy. 24 Failures were more often distant (-50%) than central and pelvic, whereas before, nearly all (-90%) had central pelvic failure. However, the combination of surgery and irradiation may not necessarily be associated with improved survival25 unless used selectively as described by us' and by others.…”

Section: Discussionmentioning

confidence: 97%

Tumor regression and histologic clearance after neutron brachytherapy for bulky localized cervical carcinoma

Maruyama

Yoneda

Nagell

et al. 1982

Cancer

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The response of bulky, advanced Stage IB and early Stage II carcinoma of the cervix to neutron brachytherapy (NT and radiotherapy) was studied using combined NT radiation and extrafascial hysterectomy with histologic evaluation. Scheduling of neutron therapy relative to external beam photon therapy, tumor volume, tumor stage, tumor histology, and clinical tumor clearance were assessed in these studies. NT was easily combined with surgery in this study. Low stage tumors, small tumor volume and ‘early’ neutron implants (scheduled within ± one week of the start of fractionated radiation) showed more frequent histologic clearance of tumor. Long‐term tumor control has been achieved and failures developed distant metastases without pelvic or local recurrence. This experience indicates that NT was effective for tumor clearance and control and represents a promising new modality for localized, advanced tumor therapy.

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“…Based on these studies and in other smaller reports, Nelson and O'Quin introduced guidelines for hysterectomy after irradiation [15,23]. Several institutions around the world then adopted pre-operative irradiation as the standard treatment of bulky uterine cervical cancer and new conflicting data began to appear.…”

Section: Discussionmentioning

confidence: 99%

Preoperative external beam radiotherapy and reduced dose brachytherapy for carcinoma of the cervix: survival and pathological response

et al. 2007

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Purpose: To evaluate the pathologic response of cervical carcinoma to external beam radiotherapy (EBRT) and high dose rate brachytherapy (HDRB) and outcome. Materials and methods:Between 1992 and 2001, 67 patients with cervical carcinoma were submitted to preoperative radiotherapy. Sixty-five patients were stage IIb. Preoperative treatment included 45 Gy EBRT and 12 Gy HDRB. Patients were submitted to surgery after a mean time of 82 days. Lymphadenectomy was performed in 81% of patients. Eleven patients with residual cervix residual disease on pathological specimen were submitted to 2 additional insertions of HDRB.Results: median follow up was 72 months. Five-year cause specific survival was 75%, overall survival 65%, local control 95%. Complete pelvic pathological response was seen in 40%. Surgery performed later than 80 days was associated with pathological response. Pelvic nodal involvement was found in 12%. Complete pelvic pathological response and negative lymphnodes were associated with better outcome (p = .03 and p = .005). Late grade 3 and 4 urinary and intestinal adverse effects were seen in 12 and 2% of patients. Conclusion:Time allowed between RT and surgery correlated with pathological response. Pelvic pathological response was associated with improved outcome. Postoperative additional HDRB did not improve therapeutic results. Treatment was well tolerated.

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Indications for Adjunctive Conservative Extrafascial Hysterectomy in Selected Cases of Carcinoma of the Uterine Cervix

Cited by 7 publications

References 1 publication

Efficacy of different types of treatment in FIGO stage IB2 cervical cancer in Korea: results of a multicenter retrospective Korean study (KGOG-1005)

Efficacy of different types of treatment in FIGO stage IB2 cervical cancer in Korea: results of a multicenter retrospective Korean study (KGOG-1005)

Tumor regression and histologic clearance after neutron brachytherapy for bulky localized cervical carcinoma

Preoperative external beam radiotherapy and reduced dose brachytherapy for carcinoma of the cervix: survival and pathological response

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