Akusherstvo i ginekologiia · 2007
[Histopathological findings in postoperative specimens in cervical cancer patients (IB2-IVA) after neoadjuvant chemotherapy and preoperative radiotherapy].
Клиническое исследованиеСтатьяНазвание и аннотация: Перевод в очереди
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Kornovski Ia, Gorchev G
Аннотация
OBJECTIVES: To determine the incidence rate of the histopathological findings indicative of recurrence risk in patients with locally advanced cervical cancer (LACC) having been treated with neoadjuvant chemotherapy (NCT) and radiation therapy (RT) before operation.
MATERIALS AND METHODS: Sixty-three patients were included, of whom 45 patients (group 1) underwent a percutaneous TGT and surgical treatment, and 18 patients were treated with NCT and surgery (group 2). The surgical treatment was class Ill-V radical hysterectomy with pelvic lymph node dissection, and paraaortic lymph node dissection at indication. NCT included a triple cytostatic combination - cisplatin, holoxan and bleomycin delivered in 3 courses at intervals of 21 days. In group 1, 13 patients were staged IB2 (28,9%), 29 were staged I/B (64,4%), 2 were staged 11B (4,4%), and 1 was staged IVA (2,2). Forty-four patients had a squamous cell carcinoma (97,8%) and 1 had adenocarcinoma (2,2%). In group 2, 13 patients were staged IIB (72,2%), 4 were staged 11B (22,25) and 1 was staged IVA (5,6%), whereas all 18 patients had a squamous cell carcinoma (100%). The average age in group 1 and 2 was 48,8 (range from 31 to 69 years) and 46,3 ( range from 32 to 64 years) respectively.
RESULTS: In group 2 (NCT + surgical treatment) lymph node metastases (LM) were found in 38,89%, macroscopic detectable metastases in 22%, multiple (>3 LM) in 17%, LM above the a. aliaca comm. level in 22%, deep stromal invasion in 47%, parametral infiltration in 24%,lymphovascular space invasion (LVSI) in 12%, tumor infiltration in canalis cervicalis (CC) in 12%, and ovarian metastases in 6%. In group 1 (RT + surgical treatment) we found LM in 35,56%, macroscopic detectable LM in 15,6%, LM above the a.iliaca comm. level - 11, 1%, multiple LM in 17,8%, parametral invasion in 4,4%, deep stromal invasion in 31,1%, LVSI - 13,3%, infiltration in can.cerv. - 15,6%, infiltration in isthmus uteri- 8,9% and ovarian metastases - 4,4%.
CONCLUSION: NCT followed by surgical treatment leads to histological results in the postoperative specimen that are not worse than the standard preoperative RT
MATERIALS AND METHODS: Sixty-three patients were included, of whom 45 patients (group 1) underwent a percutaneous TGT and surgical treatment, and 18 patients were treated with NCT and surgery (group 2). The surgical treatment was class Ill-V radical hysterectomy with pelvic lymph node dissection, and paraaortic lymph node dissection at indication. NCT included a triple cytostatic combination - cisplatin, holoxan and bleomycin delivered in 3 courses at intervals of 21 days. In group 1, 13 patients were staged IB2 (28,9%), 29 were staged I/B (64,4%), 2 were staged 11B (4,4%), and 1 was staged IVA (2,2). Forty-four patients had a squamous cell carcinoma (97,8%) and 1 had adenocarcinoma (2,2%). In group 2, 13 patients were staged IIB (72,2%), 4 were staged 11B (22,25) and 1 was staged IVA (5,6%), whereas all 18 patients had a squamous cell carcinoma (100%). The average age in group 1 and 2 was 48,8 (range from 31 to 69 years) and 46,3 ( range from 32 to 64 years) respectively.
RESULTS: In group 2 (NCT + surgical treatment) lymph node metastases (LM) were found in 38,89%, macroscopic detectable metastases in 22%, multiple (>3 LM) in 17%, LM above the a. aliaca comm. level in 22%, deep stromal invasion in 47%, parametral infiltration in 24%,lymphovascular space invasion (LVSI) in 12%, tumor infiltration in canalis cervicalis (CC) in 12%, and ovarian metastases in 6%. In group 1 (RT + surgical treatment) we found LM in 35,56%, macroscopic detectable LM in 15,6%, LM above the a.iliaca comm. level - 11, 1%, multiple LM in 17,8%, parametral invasion in 4,4%, deep stromal invasion in 31,1%, LVSI - 13,3%, infiltration in can.cerv. - 15,6%, infiltration in isthmus uteri- 8,9% and ovarian metastases - 4,4%.
CONCLUSION: NCT followed by surgical treatment leads to histological results in the postoperative specimen that are not worse than the standard preoperative RT