The effect of postoperative external radiotherapy on cervical carcinoma stage IB and IIA

Himmelmann, Anna; Holmberg, Erik; Jansson, Iner; Odén, Anders; Skogsberg, K.

doi:10.1016/0090-8258(85)90010-1

Cited by 23 publications

(6 citation statements)

References 17 publications

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“…Considering LVSI in addition to LNM as an indication for adjuvant therapy increased the proportion of patients receiving adjuvant radiation therapy from 30% to 41%. Many institutes will consider this too high in view of the unproven survival benefit ( 56 , 57 ) and increased complication rate from adjuvant radiation therapy after radical hysterectomy ( 58 ) . Studies have shown that patients with LVSI receiving adjuvant radiation therapy are less likely to develop disease recurrence than are patients undergoing radical surgery only ( 55 , 59 ) .…”

Section: Discussionmentioning

confidence: 99%

The prognostic significance of p53, mdm2, c-erbB-2, cathepsin D, and thrombocytosis in stage IB cervical cancer treated by primary radical hysterectomy

Jonge

Viljoen²,

Lindeque

et al. 1999

Int J Gynecol Cancer

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The objective of this study was to evaluate the value of platelet count, p53, MDM2, c-erbB-2, and cathepsin D immunoreactivity as predictors of lymph node metastasis (LNM) as well as their prognostic significance in patients with stage IB cervical cancer treated by radical hysterectomy between 1991 through 1995. We also report on the outcome of a protocol considering lymph-vascular space invasion (LVSI) in addition to LNM as a strong motivation for adjuvant radiotherapy. A total of 93 patients were the subject of this retrospective study. The incidence of positive nodes was high (30.1%). Thrombocytosis (>/= 400.000/mm3) was present in 6.7% of patients. Positive immunostaining was found for p53 (50.6%), MDM2 (21.7%), c-erbB-2 (14.5%), and cathepsin D (45.8%), but none of them was able to predict LNM. Only thrombocytosis was associated with an unfavorable prognosis: a statistically significant association was shown with relapse-free and overall survival in an univariate analysis (P = 0.0431 and P = 0.0012, respectively) with a tendency to significance in multivariate analysis (P = 0.079 and P = 0.0882, respectively). We postulate that thrombocytosis in early stage cervical cancer could be a marker for subclinical tumor burden. LVSI, regarded as an indication for adjuvant radiotherapy, was no longer associated with poor relapse-free or overall survival, but resulted in a 41% postoperative irradiation rate. Further research is needed to establish the value of LVSI in postoperative radiotherapy decision making.

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Section: Discussionmentioning

confidence: 99%

The prognostic significance of p53, mdm2, c-erbB-2, cathepsin D, and thrombocytosis in stage IB cervical cancer treated by primary radical hysterectomy

Jonge

Viljoen²,

Lindeque

et al. 1999

Int J Gynecol Cancer

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“…11,12 Surgery permits 1) the preservation of ovarian function and of a functional (although shortened) vagina, and 2) provides the additional prognostic information conferred by histologic assessment of the tumor and lymph nodes. 10,[13][14][15] Surgery is also the treatment of choice for younger patients, due to the potential for greater long term morbidity after radiotherapy, such as radiation-induced proctitis, cystitis, vaginal stenosis, and the risk of secondary malignancies within the irradiated field. 15,16 Although it is generally accepted that morbidity rates are much lower after RH than after radiotherapy, we recently have reported significant pelvic dysfunction after RH, with bladder, anorectal, and sexual problems.…”

Section: Abstract: Radical Hysterectomy Abdominal Hysterectomy Automentioning

confidence: 99%

“…10,[13][14][15] Surgery is also the treatment of choice for younger patients, due to the potential for greater long term morbidity after radiotherapy, such as radiation-induced proctitis, cystitis, vaginal stenosis, and the risk of secondary malignancies within the irradiated field. 15,16 Although it is generally accepted that morbidity rates are much lower after RH than after radiotherapy, we recently have reported significant pelvic dysfunction after RH, with bladder, anorectal, and sexual problems. 9 At a mean postoperative follow-up period of 16.4 months, 91.7% of women reported 1 or more symptoms, with associated reduction in quality of life.…”

Section: Abstract: Radical Hysterectomy Abdominal Hysterectomy Automentioning

confidence: 99%

Pelvic nerve plexus trauma at radical and simple hysterectomy: a quantitative study of nerve types in the uterine supporting ligaments

Butler‐Manuel

Buttery

A’Hern

et al. 2002

Journal of the Society for Gynecologic Investigation

126

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Significantly more autonomic nerves are transected in the more lateral division of the uterine supporting ligaments during a radical hysterectomy than during a simple hysterectomy. Sympathetic, parasympathetic, sensory, and sensory-motor nerve types are present within the CL and USL. The proportions of each nerve type differ between the two ligaments, and sympathetic nerves in the USL are the single largest nerve type. The uterine supporting ligaments are a major pathway for autonomic nerves to the pelvic organs.

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“…The efficacy of RH for FIGO Stage IBb tumors has been shown in numerous large series, with 5‐year survival rates of approximately 88% for those with lymph node negative disease, and 38–61% for those with metastatic lymph node involvement 11, 12. Surgery permits 1) the preservation of ovarian function and of a functional (although shortened) vagina, and 2) provides the additional prognostic information conferred by histologic assessment of the tumor and lymph nodes 10, 13–15. Surgery is also the treatment of choice for younger patients, due to the potential for greater long term morbidity after radiotherapy, such as radiation‐induced proctitis, cystitis, vaginal stenosis, and the risk of secondary malignancies within the irradiated field 15, 16…”

mentioning

confidence: 99%

“…Surgery permits 1) the preservation of ovarian function and of a functional (although shortened) vagina, and 2) provides the additional prognostic information conferred by histologic assessment of the tumor and lymph nodes 10, 13–15. Surgery is also the treatment of choice for younger patients, due to the potential for greater long term morbidity after radiotherapy, such as radiation‐induced proctitis, cystitis, vaginal stenosis, and the risk of secondary malignancies within the irradiated field 15, 16…”

mentioning

confidence: 99%

Pelvic nerve plexus trauma at radical hysterectomy and simple hysterectomy

Butler‐Manuel

Buttery

A’Hern

et al. 2000

Cancer

130

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BACKGROUND A major cause of the pelvic morbidity after a radical hysterectomy (RH) is thought to be damage to the pelvic nerve plexus, but direct evidence is lacking. We set out to determine the nerve content of the uterosacral ligaments (USLs) and cardinal ligaments (CLs) at the level at which they are divided during a radical hysterectomy and a simple hysterectomy. METHODS Intraoperative cross‐sectional biopsies were collected from the lateral third of the uterosacral ligaments (USLs) and cardinal ligaments (CLs) in 20 women undergoing radical hysterectomy (RH) and from the uterine insertion of these ligaments in 11 women undergoing a simple hysterectomy. Quantitative immunocytochemistry was utilized to demonstrate and quantify the nerve content of the uterine supporting ligaments at the level at which they are divided in a RH and in a simple hysterectomy. Indirect immunofluorescence staining of frozen cryostat sections was performed using primary antibodies to PGP 9.5 (a pan‐neuronal marker). A computer‐assisted image analyzer measured the percentage area of immunoreactivity (PAI) that was used to quantify the nerve density. Confocal microscopy was used to determine the composition and spatial arrangement of nerve fibers in the ligaments. RESULTS The PAI was significantly greater in the RH biopsies than in the simple hysterectomy biopsies, for both the CLs (P < 0.001) and the USLs (P < 0.001). In the RH biopsies, more nerve tissue was present in the USL than CL (P = 0.01), and compared with the CL more of the nerve fibers in the USL were concentrated in large trunks. Excluding these trunks and autonomic ganglia, the free nerve content of the USL was lower than that of the CL (P < 0.001). The presence of nerve trunks, autonomic ganglia, and free nerve fibers within the lateral third of the USL and CL is consistent with extension of the inferior hypogastric plexus along these ligaments to the pelvic organs. CONCLUSIONS The uterine supporting ligaments contain autonomic nerves and ganglia, as extensions of the inferior hypogastric plexus. The USLs have a greater nerve density than the CLs. Because RH disrupts more nerve tissue than a simple hysterectomy, these data provide further evidence for the neurogenic etiology of pelvic morbidity after RH. Cancer 2000;89:834–41. © 2000 American Cancer Society.

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The effect of postoperative external radiotherapy on cervical carcinoma stage IB and IIA

Cited by 23 publications

References 17 publications

The prognostic significance of p53, mdm2, c-erbB-2, cathepsin D, and thrombocytosis in stage IB cervical cancer treated by primary radical hysterectomy

The prognostic significance of p53, mdm2, c-erbB-2, cathepsin D, and thrombocytosis in stage IB cervical cancer treated by primary radical hysterectomy

Pelvic nerve plexus trauma at radical and simple hysterectomy: a quantitative study of nerve types in the uterine supporting ligaments

Pelvic nerve plexus trauma at radical hysterectomy and simple hysterectomy

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