OBJECTIVE: To evaluate whether adjuvant simple hysterectomy after concurrent chemoradiotherapy (CCRT) improves progression-free survival (PFS) compared with current standard care in locally advanced cervical adenocarcinoma (LACAC). METHODS: We reviewed a cohort of 55 patients with LACAC (International Federation of Gynecology and Obstetrics [FIGO] stage IB2, IIA2, IIB, III without distant metastasis) diagnosed and treated with radical CCRT at Peking Union Medical College Hospital between January 2004 and October 2014. We compared 34 patients who underwent adjuvant extrafascial hysterectomy with 21 patients with standard care after CCRT. The primary outcome was PFS. Overall survivals (OS) between the two groups were also compared. Surgery feasibility, operative complications, and pathologic features after radiation therapy were also analyzed. RESULTS: PFS was significantly improved in surgery group (log-rank p=0.0097; hazard ratio [HR], 0.3431; 95% CI, 0.152 to 0.772), as were OS (log-rank p=0.0419; HR, 0.3667; 95% CI, 0.139 to 0.964). Analysis of stage IIB demonstrates a similar result. There were no severe complications related to postradiation surgery in this series. The mean blood loss was less in laparoscopic group than those in the open group (87 mL vs. 208 mL, p=0.036, Mann-Whitney U-test). Approximately 47% patients (16/34) had pathologic residue tumor on hysterectomy specimens. About 94% patients (32/34) got complete remission after adjuvant surgery. CONCLUSION: Adjuvant hysterectomy after CCRT improves survival outcome for patients with LACAC compared with current standard care. Extrafascial hysterectomy is sufficient in tumor reduction and laparoscopic procedure may be more promising with lower blood loss and expedite recovery.
Adenocarcinoma/mortality/*therapy ; Adult ; *Chemoradiotherapy ; Cohort Studies ; Disease-Free Survival ; Female ; Humans ; Hysterectomy/*methods ; Middle Aged ; Uterine Cervical Neoplasms/mortality/*therapy

OBJECTIVE: To evaluate whether adjuvant simple hysterectomy after concurrent chemoradiotherapy (CCRT) improves progression-free survival (PFS) compared with current standard care in locally advanced cervical adenocarcinoma (LACAC). METHODS: We reviewed a cohort of 55 patients with LACAC (International Federation of Gynecology and Obstetrics [FIGO] stage IB2, IIA2, IIB, III without distant metastasis) diagnosed and treated with radical CCRT at Peking Union Medical College Hospital between January 2004 and October 2014. We compared 34 patients who underwent adjuvant extrafascial hysterectomy with 21 patients with standard care after CCRT. The primary outcome was PFS. Overall survivals (OS) between the two groups were also compared. Surgery feasibility, operative complications, and pathologic features after radiation therapy were also analyzed. RESULTS: PFS was significantly improved in surgery group (log-rank p=0.0097; hazard ratio [HR], 0.3431; 95% CI, 0.152 to 0.772), as were OS (log-rank p=0.0419; HR, 0.3667; 95% CI, 0.139 to 0.964). Analysis of stage IIB demonstrates a similar result. There were no severe complications related to postradiation surgery in this series. The mean blood loss was less in laparoscopic group than those in the open group (87 mL vs. 208 mL, p=0.036, Mann-Whitney U-test). Approximately 47% patients (16/34) had pathologic residue tumor on hysterectomy specimens. About 94% patients (32/34) got complete remission after adjuvant surgery. CONCLUSION: Adjuvant hysterectomy after CCRT improves survival outcome for patients with LACAC compared with current standard care. Extrafascial hysterectomy is sufficient in tumor reduction and laparoscopic procedure may be more promising with lower blood loss and expedite recovery.
Adenocarcinoma/mortality/*therapy ; Adult ; *Chemoradiotherapy ; Cohort Studies ; Disease-Free Survival ; Female ; Humans ; Hysterectomy/*methods ; Middle Aged ; Uterine Cervical Neoplasms/mortality/*therapy

Cervical, endometrial, and ovarian cancers, have both high morbidity and mortality among the gynecologic malignant tumors in Japan. The present study was conducted using both the population-based cancer registry and the gynecologic cancer registry to elucidate the characteristics of gynecologic malignant tumors in Japan. Based on nationwide estimates from the population-based cancer registry in Japan, the morbidities and mortality of cervical, endometrial, and ovarian cancers were obtained and used for analysis. Clinicopathologic factors for cervical cancer, endometrial cancer, ovarian cancer, including age, clinical stage, postsurgical stage, histological type, therapeutic strategy, and prognosis were retrieved from the gynecologic cancer registry published by the Japan Society of Obstetrics and Gynecology and used for analysis. The morbidities of cervical, endometrial, and ovarian cancers were 10,908, 13,606, and 9,384 women in 2012, respectively. The prevalence of endometrial cancer has significantly and consistently been increasing and represents the most common gynecologic malignant tumor in Japan. The mortalities of cervical, endometrial, and ovarian cancers were 2.1, 1.3, and 3.2 per 100,000 in 2012, respectively. In 2014, 52.2% of cervical cancer patients were classified as stage I, 22.5% as stage II, 10.2% as stage III, and 11.2% as stage IV. In addition, 71.9% of endometrial cancer patients were classified as stage I, 6.0% as stage II, 13.3% as stage III, and 7.5% as stage IV. Finally, 43.2% of ovarian cancer patients were classified as stage I, 9.1% as stage II, 27.6% as stage III, and 7.2% as stage IV. Twelve point five percent of ovarian cancer patients received neoadjuvant chemotherapy.
Drug Therapy ; Endometrial Neoplasms ; Female ; Genital Neoplasms, Female ; Gynecology ; Humans ; Japan* ; Mortality ; Obstetrics ; Ovarian Neoplasms ; Prevalence ; Prognosis ; Registries ; Uterine Cervical Neoplasms

This study analyzes the clinical characteristics of the brain metastasis (BM) of gynecologic cancer based on the type of cancer. In addition, the study examines the factors influencing the survival. Total 61 BM patients of gynecologic cancer were analyzed retrospectively from January 2000 to December 2012 in terms of clinical and radiological characteristics by using medical and radiological records from three university hospitals. There were 19 (31.1%) uterine cancers, 32 (52.5%) ovarian cancers, and 10 (16.4%) cervical cancers. The mean interval to BM was 25.4 months (21.6 months in ovarian cancer, 27.8 months in uterine cancer, and 33.1 months in cervical cancer). The mean survival from BM was 16.7 months (14.1 months in ovarian cancer, 23.3 months in uterine cancer, and 8.8 months in cervical cancer). According to a multivariate analysis of factors influencing survival, type of primary cancer, Karnofsky performance score, status of primary cancer, recursive partitioning analysis class, and treatment modality, particularly combined therapies, were significantly related to the overall survival. These results suggest that, in addition to traditional prognostic factors in BM, multiple treatment methods such as neurosurgery and combined chemoradiotherapy may play an important role in prolonging the survival for BM patients of gynecologic cancer.
Adult ; Aged ; Brain/*pathology ; Brain Neoplasms/*mortality/*secondary/therapy ; Chemoradiotherapy ; Female ; Genital Neoplasms, Female/*mortality/pathology/therapy ; Humans ; Middle Aged ; Multivariate Analysis ; Ovarian Neoplasms/mortality/pathology/therapy ; Prognosis ; Retrospective Studies ; Uterine Cervical Neoplasms/mortality/pathology/therapy ; Uterine Neoplasms/mortality/pathology/therapy ; Young Adult

OBJECTIVE: To investigate the effect of neoadjuvant chemotherapy on cervical carcinoma and its association with clinical data. METHODS: A total of 97 patients with stage Ib2 approximately IIIa of cervical cancinoma were treated with neoadjuvant chemotherapy. The effect of chemotherapy, factors associated with outcome of chemotherapy, and histology were analyzed. RESULTS: Effective rate of chemotherapy was 86.6% which was associated with clinical stage and histology. Eight-four patients received radical hysterectomy. The histological grade of 17 patients was lowered, lymph nodes in 19 patients were positive, and 6 patients had parametrium invasion. One patient died within 1 year after the operation, and 5 patients recurred. CONCLUSION The effect of neoadjuvant chemotherapy for locally advanced cervical cancinoma is good. Surgery after chemotherapy can improve the prognosis and 5-year survival rate.
Adenocarcinoma ; drug therapy ; mortality ; surgery ; Adult ; Carcinoma, Squamous Cell ; drug therapy ; mortality ; surgery ; Female ; Humans ; Middle Aged ; Neoadjuvant Therapy ; methods ; Prognosis ; Survival Rate ; Uterine Cervical Neoplasms ; drug therapy ; mortality ; surgery

OBJECTIVE: We aimed to assess the efficacy of neoadjuvant chemotherapy followed by surgery (NACT+S), and compared the clinical outcome with that of concurrent chemoradiotherapy (CCRT) in patients with International Federation of Gynecology and Obstetrics (FIGO) IB-IIB cervical cancer. METHODS: We reviewed 85 patients with FIGO IB-IIB cervical cancer who received NACT+S between 1989 and 2012, and compared them to 358 control patients who received CCRT. The clinical application of NACT was classified based on the following possible therapeutic benefits: increasing resectability after NACT by reducing tumor size or negative conversion of node metastasis; downstaging adenocarcinoma regarded as relatively radioresistant; and preservation of fertility through limited surgery after NACT. RESULTS: Of 85 patients in the NACT+S group, the pathologic downstaging and complete response rates were 68.2% and 22.6%, respectively. Only two young patients underwent limited surgery for preservation of fertility. Patients of the NACT+S group were younger, less likely to have node metastasis, and demonstrated a higher proportion of FIGO IB cases than those of the CCRT group (p≤0.001). The 5-year locoregional control, progression-free survival, and overall survival rates in the NACT+S group were 89.7%, 75.6%, and 92.1%, respectively, which were not significantly different from the rates of 92.5%, 74%, and 84.9% observed in the CCRT group, respectively (p>0.05). CONCLUSION: NACT+S has no therapeutic advantages over CCRT, the standard treatment. Therefore, NACT+S should be considered only in selected patients through multidisciplinary discussion or clinical trial setting.
Adult ; Aged ; Aged, 80 and over ; *Chemoradiotherapy ; Chemotherapy, Adjuvant ; Female ; Humans ; *Hysterectomy ; Middle Aged ; *Neoadjuvant Therapy ; Neoplasm Staging ; Retrospective Studies ; Treatment Outcome ; Uterine Cervical Neoplasms/diagnosis/mortality/pathology/*therapy

INTRODUCTION: The prevalence and mortality of patients with invasive cervical carcinoma have decreased. However, therapeutic results in advanced cervical carcinoma with systemic metastasis was not satisfactory and the therapeutic modalities had lots of morbidities. To know exact extent of disease is important in order to decide pertinent therapeutic modality to each patient. OBJECTIVES: We intended to evaluate the risk factors, clinical characteristics, and survival of the cervical cancer patients with scalene lymph node metastasis and, to assess the need of the scalene lymph node biopsy in baseline study of advanced carcinoma of cervix or recurrent carcinoma of cervix. Materials and METHODS: We have reviewed clinical charts of total 3624 patients treated for carcinoma of cervix at the department of Obstetrics and Gynecology, Yonsei University College of medicine, from Jan.1981 to Dec.1995. 25 patients (0.68%) were proven to have scalene lymph node metastasis by way of studies including radiologic imaging, physical examination, and lymph node biopsy. RESULTS: Patient' s age ranged from 22 to 80 years with a median of 50 years. The incidence of metastasis was related with the stage at initial diagnosis, pathological type of tumor, existence of para-arotic lymph node metastasis. The patients had other metastasis in 14 cases(66%) and 5 cases had multiple metastatic sites. In spite of aggressive systemic chemotherapy or radiotherapy, the survivial after diagnosis of metastasis was extremely poor, 2- year survival rate was only 9.52%, respectively. CONCLUSION: The incidence of scalene lymph node metastasis in patients with carcinoma of cervix was very rare in our series, we couldn' t recommend the scalene lymph node biopsy as a modality of baseline study. In patients with paraaortic lymph node metastasis or clinically palpable lymph node, the scalene lymph node biospy may help patients omit aggressive, unnecessary treatment. To prove the value of biopsy of scalene lymph node, well-designed large prospective study would be necessary.
Biopsy ; Cervix Uteri ; Diagnosis ; Drug Therapy ; Female ; Gynecology ; Humans ; Incidence ; Lymph Nodes* ; Mortality ; Neoplasm Metastasis* ; Obstetrics ; Physical Examination ; Prevalence ; Radiotherapy ; Risk Factors ; Survival Rate ; Uterine Cervical Neoplasms

OBJECTIVETo investigate the effect of adjuvant chemotherapy on the prognosis of patients with low-risk cervical cancer (without pelvic lymph node metastasis, parametrial involvement, positive surgical margin, primary tumor size > 4 cm, deep cervical stromal invasion, or lymph-vascular space invasion).

METHODSThe clinical data of 208 patients with low-risk cervical cancer were studied retrospectively to analyze the indications of adjuvant chemotherapy and its relationship with tumor recurrence and the patients' survival.

RESULTSThe median follow-up time of the cohort was 73 months. The overall tumor recurrence rate was 4.8% and the total 5-year survival rate of the patients was 96.0%. Sixty-nine of the patients received adjuvant chemotherapy (Taxol+Cisplatin) after the operation with a median of 2.5 (2-4) courses. Univariate analysis showed that the histological tumor grade was significantly associated with adjuvant chemotherapy (P<0.001). In the 114 grade III patients, 50 received adjuvant chemotherapy as compared with 19 in the 94 grade I-II patients. Among the grade III patients, no significant differences was found in the overall survival rate (97.0% vs 95.0%) or tumor recurrence rate (4.0% vs 4.7%) rate between the patients with adjuvant chemotherapy and those without. The tumor size (2 cm or less vs >2 cm) was significantly associated with tumor recurrence rate (1.1% vs 7.5%, P=0.034) and the overall 5-year survival rate (100.0% vs 93.0%, P=0.034) in the 208 patients. In the 139 patients receiving only surgical treatment, the tumor recurrence and 5-year survival rates were not significantly correlated with the histologic grade, age, FIGO staging, gross type, tumor size or histologic type.

CONCLUSIONB There has been no sufficient evidence to support the prescription of postoperative adjuvant chemotherapy for low-risk cervical cancer based on histological grading of the tumor, which may not help in reducing tumor recurrence or improving the long-term survival of the postoperative patients.

Adult ; Aged ; Chemotherapy, Adjuvant ; Female ; Humans ; Middle Aged ; Prognosis ; Retrospective Studies ; Survival Rate ; Treatment Outcome ; Uterine Cervical Neoplasms ; drug therapy ; mortality ; pathology ; Young Adult

OBJECTIVETo summarize retrospectively the 5-year survival rates and long-term complication of stage Ib-IIIa cervical carcinoma treated by combination of subradical external radiation and brachytherapy plus radical operation.

METHODS106 patients with cervical carcinoma were all treated by radical hysterectomy and pelvic lymphadenectomy, of whom 78 had had preoperative radiotherapy (external radiation and brachytherapy), 16 combination of brachytherapy and radical operation, 12 adjuvant postoperative radiotherapy (external radiation and brachytherapy). (60)Co was used for external radiation, in which the point B dose was 25 - 30 Gy in preoperative radiation and 40 - 50 Gy in postoperative radiation. (192)Ir high-dose-rate afterloading unit was used in brachytherapy, with a dose of 6 - 18 Gy at point A.

RESULTSThe follow up rate was 95.3%. The overall 5-year survival rates were 78.2% (61/78) in the preoperative radiotherapy group, 68.8% (11/16) in brachytherapy plus radical operation, 33.3% (4/12) in the postoperative radiotherapy group, showing a higher 5-year survival rate in the preoperative radiotherapy group than the postoperative radiotherapy group (P < 0.05). In stage II patients, the preoperative radiotherapy group -77.6% (45/58) also gave a higher survival than the postoperative radiotherapy group -25.0% (1/4) (P < 0.05). But all the other groups gave differences of insignificance. The chief long-term complications were radio-proctitis and cystitis, with incidences of 34.6% (27/78), 31.3% (5/16), 33.3% (4/12) in the preoperative radiotherapy group, brachytherapy plus radical operation group and the postoperative radiotherapy group (P > 0.05).

CONCLUSIONThe overall 5-year survival rate of combined subradical external radiation and brachytherapy plus radical operation was obviously higher than that of postoperative radiotherapy for stage Ib-IIIa and II patients, with statistically significant differences. However, the incidence of long-term complications give no statistical significance in the preoperative radiotherapy group or brachytherapy plus the operation group as compared with the postoperative radiotherapy group.

Adult ; Aged ; Aged, 80 and over ; Brachytherapy ; Combined Modality Therapy ; Female ; Humans ; Middle Aged ; Prognosis ; Retrospective Studies ; Survival Rate ; Uterine Cervical Neoplasms ; mortality ; radiotherapy ; surgery

OBJECTIVETo evaluate the feasibility of surgical management for patients with locally advanced carcinomas of uterine cervix after radical radiation therapy who were prone to develop central recurrence.

METHODSThese 40 patients were treated by combined pre-operative radiotherapy with dose at point A of > 70 Gy in 30 patients, 60 approximately 70 Gy in 7, 50 approximately 59 Gy in 2 and 44 Gy in 1. The interval between radiation and surgery was 1 - 6 weeks. Extrafascial hysterectomy was performed in 15 patients, subradical hysterectomy in 23 and radical hysterectomy with pelvic lymphadenectomy in 2 cases.

RESULTSThese patients have been followed up for 1 - 8 years with 2 died of other diseases and 12 died of cancer. Eighteen of the 26 survivors have been followed up for more than 5 years. The 3- and 5-year survival rates were 74.9% and 66.8%. Half of the death occurred within the first year after treatment. The 2-year death rate was 9/12 (75.0%). Three patients suffered from long term complications after the treatment, but all were cured by conservative management.

CONCLUSIONThe combination of hysterectomy performed shortly after radical radiotherapy, ie, for patients with locally poor prognostic cervical carcinoma is reasonable and feasible.

Adult ; Cervix Uteri ; Combined Modality Therapy ; Female ; Humans ; Hysterectomy ; Middle Aged ; Neoplasm Staging ; Survival Rate ; Uterine Cervical Neoplasms ; mortality ; radiotherapy ; surgery