Pretreatment surgical staging of patients with cervical carcinoma
The routine use of extraperitoneal surgical staging prior to radiation therapy in patients with bulky or locally advanced cervical carcinoma remains controversial.METHODSA review was performed of 266 patients with cervical carcinoma who underwent extraperitoneal pelvic and paraaortic lymphadenectomy prior to receiving radiotherapy. Patients were divided into groups based on their lymph node status. Group A had negative lymph nodes; Group B had resected, microscopic lymph node metastases; Group C had macroscopically positive lymph nodes that were resectable at the time of surgery; and Group D had unresectable lymph nodes. All patients received standard radiotherapy utilizing external beam and brachytherapy. Patients with lymph node metastases received extended field irradiation. Survival probabilities were computed by the Kaplan-Meier product limits method with statistical significance determined by the Mantel-Cox log rank test.RESULTSLymph node metastases were detected in 49% of patients. Five- and 10-year disease free survival rates were similar for all patients in Groups B and C. All patients in Group D recurred. There was a 10.5% incidence of severe radiation-related morbidity and a 1.1% incidence of treatment-related deaths.CONCLUSIONS
Pretreatment extraperitoneal staging of patients with bulky or locally advanced cervical carcinoma may afford a survival benefit via the debulking of macroscopically positive lymph nodes without significantly increasing treatment-related morbidity or mortality. Cancer 1998;82:2241-2248. © 1998 American Cancer Society.
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ABSTRACT: The prognostic impact of FIGO stage, histology, histologic grade, age and race in survival for cancers of the female gynecological (cervix, endometrium, ovary, vulva, vagina) were examined using cases obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program that were diagnosed between 1973 and 1987. Utilizing Cox proportional hazards modeling and relative survival rates analysis of 17,119 cases of cervical cancer indicated that the International Federation of Gynecology and Obstetrics (FIGO) stage, histology, histological grade, lymph node status, and age at diagnosis were all independently prognostic. No evidence was found of survival differences between squamous cell carcinoma and adenocarcinoma. Younger women were not found to have a poorer prognosis, survival declined with increased age. Analysis of 41,120 cases of endometrial cancer indicated that FIGO stage, histology, histologic grade, lymph node status, age at diagnostic, and race were all prognostic factors. Clear cell adenocarcinoma, leiomyosarcoma, and mixed mullerian tumors were all found to have poorer prognosis. Analysis of 21,240 cases of ovarian cancer indicated that FIGO stage, histology, histologic grade, lymph node status, age at diagnosis, presence of ascites, and race were all prognostically significant. Analysis of 2,575 cases of vulvar cancer indicated that FIGO stage, histology, histologic grade, age, and race were all prognostically significant. Analysis of 916 cases of vaginal cancer indicated that FIGO stage, histologic grade, lymph node status, and age are all prognostically significant. Additional analysis of the data by combinations of independent prognostic factors indicates that the interaction of factors may be more predictive of outcome than any one factor separately.Seminars in Surgical Oncology 01/1994; 10(1):31-46.
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ABSTRACT: From January 1987 to April 1992, 34 patients had resection of bulky positive lymph nodes, detected either at the time of radical hysterectomy (n = 23) or by computed tomographic (CT) scan of the pelvis and abdomen prior to radiation therapy for more advanced cervical cancer (n = 11). Following nodal resection, 33 patients received pelvic external beam radiation, 28 received pelvic and para-aortic radiation, and 23 received four cycles of cisplatin chemotherapy. The median number of resected positive nodes was 4, with a range of 1-44. All macroscopic nodal metastases could be resected in each patient and morbidity was acceptably low. Positive nodes were confined to the pelvis in 17 patients, involved the common iliac group in nine patients, and involved the para-aortic area in eight patients. With a mean follow-up of 36 months, 23 patients (67.6%) were alive, of whom 20 were free of disease. For patients having a radical hysterectomy, actuarial 5-year survival was 80% for patients with disease involving pelvic and common iliac lymph nodes, and 48% for those with positive para-aortic nodes. Survival for patients with completely resected bulky pelvic and common iliac nodes was comparable to that for patients with micrometastases. This study suggests that every effort should be made to identify patients with cervical cancer who have bulky positive lymph node metastases, and to remove these nodes surgically prior to radiation therapy.International Journal of Gynecological Cancer 08/1995; 5(4):250-256. · 1.94 Impact Factor
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ABSTRACT: Clinical staging, bipedal lymphangiography, and extraperitoneal pelvic and paraaortic lymphadenectomy were performed in 95 patients with invasive squamous carcinoma of the cervix. Radiation therapy was modified on the basis of findings at operative staging. Patients have been followed from 16 to 91 months, with a mean of 41 months. The accuracy of clinical staging and the relative abilities of lymphangiography and lymphadenectomy to assess the retroperitoneal lymph nodes have been determined. Five-year survival with respect to stage of disease and status of the pelvic and paraaortic lymph nodes was calculated by the life-table method. Seventy-five percent of patients with no lymph node metastases are projected to be alive at 5 years without recurrence. Fifty-six percent with pelvic lymph node metastases and 23% of those with paraaortic lymph node involvement are projected to be free of disease at 5 years. The risk of lymph node metastases increases with either the stage of disease or the volume of the primary tumor independently of stage. The presence of lymph node metastases adversely affects survival regardless of the stage of the primary tumor. Clinical staging as accepted by FIGO is inadequate in that it ignores patients with pelvic or paraaortic lymph node metastases. The accuracy of detection in the individual patient does not increase with the addition of lymphangiography. Operative staging can be performed safely by the extraperitoneal route and radiation therapy can be modified on the basis of the true extent of disease. Radiation therapy fails to cure patients because of distant dissemination of disease as well as an inability of conventional radiotherapeutic techniques to sterilize a large primary tumor volume.Obstetrics and Gynecology 02/1981; 57(1):90-5. · 4.80 Impact Factor