Sentinel node detection in a patient with recurrent endometrial cancer initially treated by hysterectomy and radiotherapy

This is the first article reporting sentinel node identification in a patient with endometrial cancer recurring in the vagina. A 79-year-old woman presented with a midvaginal recurrence of a stage IB, grade II endometroid carcinoma that had been treated 3 years earlier by a total abdominal hysterectomy, bilateral salpingoophorectomy, and pelvic lymph node sampling, followed by adjuvant brachytherapy to the vaginal vault. A staging examination under anesthetic was performed. Preoperatively, 60-MBq technetium-labeled nannocolloid was injected in the mucosa at 3, 6, 9, and 12 o'clock just adjacent to the tumor recurrence. Three sentinel nodes were detected, respectively, in the left obturator fossa (two) and the right external iliac region, using a laparoscopic probe (Navigator) and removed for pathological assessment. As they proved to be negative, the patient underwent a total vaginectomy, parametrectomy with pelvic lymphadenectomy. The tumor was completely removed, and all lymph nodes proved to be negative. The accuracy of sentinel node identification in patients with recurrent gynecological tumors needs further evaluation. This unique case shows that sentinel node detection is possible after previous radiotherapy and surgery and hopes to stimulate further research in this field.     

Invasive cervical cancer complicating intrauterine pregnancy: treatment with radical hysterectomy.

OBJECTIVE: Radical hysterectomy and bilateral pelvic lymph node dissection have become the mainstay of treatment for early-stage cervical cancer because of both a high success rate and acceptable morbidity. However, those cervical lesions that occur concomitant with an intrauterine pregnancy have historically been treated with irradiation. We report the morbidity and results of radical hysterectomy and bilateral pelvic lymph node dissection for the treatment of early-stage cervical cancer complicating intrauterine pregnancy. METHODS: Between 1955-1991, 13 patients were treated with radical hysterectomy and bilateral pelvic lymph node dissection with the fetus in situ, and eight others with cesarean delivery followed by radical hysterectomy and bilateral pelvic lymph node dissection. Charts were reviewed retrospectively. RESULTS: Mean operative time was 281 minutes. The mean blood loss was 777 mL with radical hysterectomy and bilateral pelvic lymph node dissection alone, and 1750 mL with cesarean delivery, radical hysterectomy, and bilateral pelvic lymph node dissection (P less than .01). Intraoperative morbidity included a single accidental cystotomy that was complicated in the postoperative period by a vesicovaginal fistula. Fever was the most common postoperative cause of morbidity (29%), while two patients (10%) had wound seromas and a single patient (5%) each had a pulmonary embolism, cystitis, and transfusion-related hepatitis. No perioperative deaths occurred. After documentation of maturity, seven healthy infants were delivered with no major morbidity. Twenty patients (95%) are alive and free of disease with a mean follow-up of 40 months. CONCLUSION: Radical surgery offers immediate treatment for early-stage cervical cancer during intrauterine pregnancy, with low associated morbidity, acceptable survival, and preservation of ovarian function.     

Invasive cervical cancer

Cervical cancer is the second most common cancer in women worldwide and is the leading cause of death in women in sub-Saharan Africa. In this review, the aetiology of cervical cancer is discussed plus HPV vaccination, diagnosis, imaging techniques, FIGO staging and management with surgical options for stage 1a1–1b1 and non-surgical options for stage 1b2–3b cervical cancer. Palliative treatments and exenterative surgery are included.     

Invasive cervical cancer

In this review, the aetiology of cervical cancer is discussed plus HPV vaccination, diagnosis, imaging techniques, the new FIGO staging and management with surgical options for stage 1a1-1b2 and non-surgical options for stage 1b3-3b cervical cancer. Palliative treatments and exenterative surgery are included.     

The prognostic factors for patients with early cervical cancer treated by radical hysterectomy and postoperative radiotherapy

PURPOSE: This study was undertaken to evaluate the efficacy of postoperative radiotherapy (post-OP RT) and to investigate the prognostic factors for early-stage cervical cancer patients who were treated by radical surgery, and the pathological findings suggested a relatively high risk of relapse with surgery alone. MATERIALS AND METHODS: From January 1990 to December 1995, 222 patients with stage IB-IIA cervical cancer, treated by radical surgery and a full course of post-OP RT, were included in this study. The indications for post-OP RT were based on pathological findings, including lymph node metastasis, positive surgical margins, parametrial extension, lymphovascular permeation, and invasion of more than two-thirds of the cervical wall thickness. The radiation dose of external beam was 44-45 Gy to the whole pelvis and 50-54 Gy to the true pelvis. One hundred seventy-two patients also received intravaginal brachytherapy as a local boost. The minimal follow-up period was 2 years. RESULTS: The actuarial 5-year overall and disease-specific survival rates for all patients were 76 and 82%, respectively. The tumor control rate within the pelvis reached 94%, and distant metastasis was the major cause of treatment failure. Univariate analysis of clinical and pathological parameters revealed that clinical stage, bulky tumor size, positive lymph nodes, parametrial extension, and histologic type were significant prognostic factors. After multivariate analysis, only positive lymph nodes (P = 0.01), bulky tumor size (P = 0.02), and parametrial extension (P = 0.05) independently influenced the disease-specific survival (DSS). For patients with lymph node metastasis, the number and location of the nodal involvement significantly affected the prognosis. The 5-year DSS for patients with no, one, and more than one lymph node metastasis were 87, 84, and 61% (P = 0.0001), respectively. Patients with upper pelvic lymph node metastasis had a higher incidence of distant metastasis (50% vs 16% in lower pelvic node group, P = 0.03). In the subgroup of single lower pelvic nodal metastasis, the prognosis was similar to that of patients without lymph node involvement (5-year DSS 85% vs 87%, P = 0.71). CONCLUSION: Our results indicate that post-OP RT can achieve very good local control in stage IB-IIA cervical cancer patients whose pathological findings show risk features for relapse after radical surgery. The prognostic factors for treatment failure identified in this study can be used as selection criteria for clinical trials to test the effects of other adjuvant treatments, such as chemotherapy. Patients with a single lower pelvic lymph node metastasis have a relatively good prognosis and may not need adjuvant treatment beyond radiation therapy.     

Prognostic factors in node-positive patients with stage IB-IIB cervical cancer treated by radical hysterectomy and pelvic lymphadenectomy.

OBJECTIVE: The purpose of the present study was to identify prognostic factors in surgically treated patients with stage IB-IIB cervical cancers, who also presented with positive pelvic nodes. METHOD: The patient population consisted of 68 individuals presenting with stage IB-IIB cervical cancers and with histologically proven pelvic lymph nodes. RESULT: We found no association between the type of adjuvant therapy and patient outcome. Multivariate analysis revealed that non-squamous histology was an independent prognostic factor for disease-free and overall survival rates. In squamous cell carcinomas, the bilateral nature of the positive nodes was found to be a significant factor for disease-free survival rates. In non-squamous cell carcinomas, positive nodes of more than 2 cm in size were found to be a significant factor for disease-free survival rates. CONCLUSION: Non-squamous histology was an independent prognostic factor and chemoradiotherapy did not improve the survival outcomes of the patients in this study population.     

Invasive cervical cancer in young women

Between 1970 and 1979, 103 women below 35 years of age with invasive cervical cancer were treated at the First Obstetrics and Gynaecology Clinic of the University of Milan. Nine patients were pregnant or less than 3 months postpartum. Estimated 10-year disease-free survival, determined by the life-table method, was 100% in stage IA (37 patients), 79% in stage IB (45 patients), 67% in stage II (15 patients), 0% in stages III (5 patients) and IV (1 patient). Prognosis was also strongly associated with lymph-node involvement, 10-year actuarial survival decreasing from 93% in lymph-node-negative to 44% in lymph-node-positive patients (P less than 0.001). The prognostic relevance of the clinical stage decreased after adjustment for lymph-node involvement, but the statistical significance of lymph-node involvement was unaffected when stage was allowed for. In the present series, the estimated 10-year disease-free survival was 80% in patients treated by radical hysterectomy compared with 62% in the group treated by total hysterectomy (stage IB to IV patients only); this difference, however, was not statistically significant when the data were adjusted for clinical stage (P = 0.10). None of the 20 patients with recurrent disease could be managed successfully.     

Invasive cervical cancer in young women

Summary. Between 1970 and 1979, 103 women below 35 years of age with invasive cervical cancer were treated at the First Obstetrics and Gynaecology Clinic of the University of Milan. Nine patients were pregnant or less than 3 months postpartum. Estimated 10–year disease–free survival, determined by the life–table method, was 100% in stage IA (37 patients), 79% in stage IB (45 patients), 67% in stage 11 (15 patients), 0% in stages III (5 patients) and IV (1 patient). Prognosis was also strongly associated with lymph–node involvement, 10–year actuarial survival decreasing from 93% in lymph–node–negative to 44% in lymph–node– positive patients ( P 相似文献   

Survival of 231 cervical cancer patients, treated by radical hysterectomy, according to clinical and histopathological features

PURPOSE OF INVESTIGATION: The purpose of the study was to estimate the five-year survival of cervical cancer patients after radical hysterectomy, taking into account clinical data and histopathological parameters. METHODS: 231 patients with invasive cervical carcinoma were diagnosed, surgically treated--Piver III--and followed-up. Histological examination of specimens was performed according to the British NHS-CSP guidelines. RESULTS: We discovered no statistical significance as regards age at diagnosis, age at menarche and menopause, and number of pregnancies, deliveries and abortions, in relation to survival. We concluded that the clinical stage according to FIGO classification influenced survival. Statistical significances were: Ia2 vs Ib, Ib vs IIa and IIa vs more advanced than IIa. The following histopathological parameters correlated with survival: depth of cervical invasion, primary lesion volume, and parametrial, uterine, vaginal and lymph node involvement. Using Cox's proportional hazards model we found that only lymph node status and FIGO staging were independent parameters correlating with survival and mortality risk in our study. CONCLUSION: Prognostic indexes classifying patients at specific disease stages into different categories of risk should be based on histopathological features listed above. Such indexes are yet to be validated in larger, prospective studies conducted in different patient populations.     

Urodynamic study on postsurgical bladder function in cervical cancer treated with systematic nerve-sparing radical hysterectomy

The objective of this study was to assess the postsurgical bladder function by urodynamic study in patients with cervical cancer treated with nerve-sparing radical hysterectomy. A total of 27 consecutive patients were included in the study. Of the 27 patients, autonomic nerves had been completely preserved at least on one side in 22 patients (group A), and autonomic nerves could not be successfully preserved in five patients (group B). In group A, there was no significant difference in compliance at the moment of strong desire to void, maximum flow rate, and residual urine volume between before the operation and at 12 months after the operation. However, abdominal pressure at maximum flow had significantly increased in patients of group B than of group A. Detrusor contraction pressure at maximum flow had significantly decreased in patients of group B than of group A. Bladder sensation was diminished in three cases (60%) of group B but preserved in all the patients of group A. Although it is still preliminary, our surgical technique described in this report is thought to be effective for preservation of bladder function. For further evaluation of the efficacy of nerve-sparing radical hysterectomy in terms of quality of life and survival of patients, a prospective randomized trial needs to be performed.     

Prognostic factors of stage Ib cervical carcinoma treated by radical abdominal hysterectomy.

From 1982 to 1984, 189 patients with stage Ib carcinoma of the uterine cervix underwent radical abdominal hysterectomies as primary treatment at Chang Gung Memorial Hospital. Of these patients, six were lost to follow-up. Nineteen of the 183 patients with regular follow-up recurred at intervals of from 9 to 55 months. An assessment of prognostic factors was made by reviewing the chart and pathological findings and correlating them with the patient's present status. Using univariate analysis, bulky tumor size was found to bear the greatest risk of tumor recurrence. Six of the 15 patients (40%) with a diameter of more than 4 cm recurred. The other risk factors included parametrial involvement, histologic type of adenosquamous or adenocarcinoma, lymph node metastasis, poor differentiation, deep cervical stromal invasion, and lymphatic or vascular space invasion. In conclusion, analysis of prognostic factors identified a group of patients at high risk of recurrence and decreased survival, for whom prospective trials of adjunctive treatment should be considered.     

Occult tumor cells in surgical specimens from cases of early cervical cancer treated by liposuction-assisted nerve-sparing radical hysterectomy

Abstract. Horn LCE, Fischer U, Höckel M. Occult tumor cells in surgical specimens from cases of early cervical cancer treated by liposuction-assisted nerve-sparing radical hysterectomy.
Tumor recurrence in patients with cervical cancer after primary radical surgery with complete tumor resection (R0) may be caused by occult tumor cell deposits (OTCD) in potentially tumor-bearing pelvic tissue. New surgical techniques, like liposuction-assisted nerve-sparing radical abdominal hysterectomy (LANS-RH) might be performed to remove this tissue. In a preliminary study of 30 cases, treated with LANS-RH, the liposuction specimens were examined on hematoxylin & eosin (H&E)-stained step sections and at immunohistochemical levels, using the antibody cocktails MNF 116 and AE1/AE3 for cytokeratins to detect occult tumor cells.
In nine cases microscopically tumor-free lymph nodes were detected in the liposuction material. One case presented lymphovascular space involvement in the capsular region of a node on H&E stained slides. Two additional cases showed tumor cell deposits in pelvic perinodal fatty tissue on immunohistochemical examination. We conclude that the LANS-RH technique is capable of resecting potentially tumor-bearing pelvic tissue. Careful histologic handling and immunohistochemical techniques may improve the detection of OTCD.     

Vaginal cuff recurrence of endometrial cancer treated by laparoscopic-assisted vaginal hysterectomy

BACKGROUND: Laparoscopic-assisted vaginal hysterectomy (LAVH) has been suggested as an alternative to total abdominal hysterectomy (TAH) for the treatment of early endometrial cancer. Although studies have reported good results with equivalent rates of recurrence and survival, the need for use of intrauterine manipulators during the LAVH raises the concern for operative dissemination of tumor cells. CASES: We report three patients with stage I, noninvasive or superficially invasive endometrial cancer with vaginal cuff recurrence within 9 months of treatment by LAVH. CONCLUSION: While LAVH may be a technically acceptable alternative to TAH for the management of early-stage endometrial cancer, its routine use should be undertaken with caution, as the long-term risks for recurrence and survival have yet to be defined in a randomized, controlled fashion.