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Current Oncology (Toronto, Ont.) May 2024The Laparoscopic Approach to Cervical Cancer (LACC) trial was published in 2018 and demonstrated that minimally invasive surgery (MIS) yields inferior survival outcomes...
The Laparoscopic Approach to Cervical Cancer (LACC) trial was published in 2018 and demonstrated that minimally invasive surgery (MIS) yields inferior survival outcomes in early-stage cervical cancer compared to open surgery. This study investigates how the results of the LACC trial have impacted the selection of the primary treatment modality and adjuvant radiation utilization in early-stage cervical cancer. Using the National Cancer Database (NCDB), we compared patients with stage IA2-IB1 cervical cancer before (1/2016-12/2017) and after (1/2019-12/2020) the LACC trial. A total of 7930 patients were included: 4609 before and 3321 after the LACC trial. There was a decline in MIS usage from 67% pre-LACC to 35% thereafter ( < 0.001). In both the pre- and post-LACC periods, patients undergoing radical MIS more frequently had small volume disease (pre-LACC tumors ≤ 2 cm, 48% MIS vs. 41% open, = 0.023; post-LACC stage IA2, 22% vs. 15%, = 0.002). Pre-LACC, MIS radical hysterectomy was associated with White race (82% vs. 77%, = 0.001) and private insurance (63% vs. 54%, = 0.004), while there was no difference in socioeconomic factors in the post-LACC period. Although the proportion of patients treated with primary chemoradiation remained stable, the post-LACC cohort had a younger median age (52.47 vs. 56.37, = 0.005) and more microscopic disease cases (13% vs. 5.4%, = 0.002). There was no difference in the rate of radiation after radical hysterectomy before and after the trial (26% vs. 24%, = 0.3). Conclusions: Post-LACC, patients were less likely to undergo MIS but received adjuvant radiation at similar rates, and primary chemoradiation patients were younger and more likely to have microscopic disease.
Topics: Humans; Female; Uterine Cervical Neoplasms; Middle Aged; Databases, Factual; United States; Neoplasm Staging; Aged; Hysterectomy; Adult; Radiotherapy, Adjuvant
PubMed: 38785496
DOI: 10.3390/curroncol31050215 -
Frontiers in Oncology 2024This study aims to develop and validate a pretreatment MRI-based radiomics model to predict lymph node metastasis (LNM) following neoadjuvant chemotherapy (NACT) in...
BACKGROUND
This study aims to develop and validate a pretreatment MRI-based radiomics model to predict lymph node metastasis (LNM) following neoadjuvant chemotherapy (NACT) in patients with locally advanced cervical cancer (LACC).
METHODS
Patients with LACC who underwent NACT from two centers between 2013 and 2022 were enrolled retrospectively. Based on the lymph node (LN) status determined in the pathology reports after radical hysterectomy, patients were categorized as LN positive or negative. The patients from center 1 were assigned as the training set while those from center 2 formed the validation set. Radiomics features were extracted from pretreatment sagittal T2-weighted imaging (Sag-T2WI), axial diffusion-weighted imaging (Ax-DWI), and the delayed phase of dynamic contrast-enhanced sagittal T1-weighted imaging (Sag-T1C) for each patient. The K-best and least absolute shrinkage and selection operator (LASSO) methods were employed to reduce dimensionality, and the radiomics features strongly associated with LNM were selected and used to construct three single-sequence models. Furthermore, clinical variables were incorporated through multivariate regression analysis and fused with the selected radiomics features to construct the clinical-radiomics combined model. The diagnostic performance of the models was assessed using receiver operating characteristic (ROC) curve analysis. The clinical utility of the models was evaluated by the area under the ROC curve (AUC) and decision curve analysis (DCA).
RESULTS
A total of 282 patients were included, comprising 171 patients in the training set, and 111 patients in the validation set. Compared to the Sag-T2WI model (AUC, 95%CI, training set, 0.797, 0.722-0.782; validation set, 0.648, 0.521-0.776) and the Sag-T1C model (AUC, 95%CI, training set, 0.802, 0.723-0.882; validation set, 0.630, 0.505-0.756), the Ax-DWI model exhibited the highest diagnostic performance with AUCs of 0.855 (95%CI, 0.791-0.919) in training set, and 0.753 (95%CI, 0.638-0.867) in validation set, respectively. The combined model, integrating selected features from three sequences and FIGO stage, surpassed predictive ability compared to the single-sequence models, with AUC of 0.889 (95%CI, 0.833-0.945) and 0.859 (95%CI, 0.781-0.936) in the training and validation sets, respectively.
CONCLUSIONS
The pretreatment MRI-based radiomics model, integrating radiomics features from three sequences and clinical variables, exhibited superior performance in predicting LNM following NACT in patients with LACC.
PubMed: 38779088
DOI: 10.3389/fonc.2024.1376640 -
Journal of Mid-life Health 2024Rhabdomyosarcoma (RMS) is one of the most common soft-tissue sarcomas that engage the embryonal skeletal muscle cells as the female reproductive tract. Embryonal RMS...
Rhabdomyosarcoma (RMS) is one of the most common soft-tissue sarcomas that engage the embryonal skeletal muscle cells as the female reproductive tract. Embryonal RMS (ERMS) is the most prevalent subtype of RMS in the female genital tract. Botryoid RMS is a rapidly growing rare malignancy and a polypoid variant of ERMS that occurs in childhood and constituting approximately 3% of all RMSs among young children and 1% among adolescents and young adults. A 50 year old menopause woman who had been vaginal discharge and bleeding for about 2 years without dysuria, dyspareunia, or postcuital bleeding was informed consent for presenting. A vaginal examination, pathology examination, sonography, magnetic resonance imaging, immunohistochemistry, surgery and radical hysterectomy, radiation therapy, and two sessions of brachytherapy were performed. After 22 months of follow-up, the patient had no evidence of recurrence or any problem in sexual activity. Oncological surgical treatment based on the carcinoma site and adjuvant chemotherapy is helpful for the treatment of RMS. However, applying the standard treatment guidelines is essential, although it is very scarce and difficult.
PubMed: 38764926
DOI: 10.4103/jmh.jmh_215_23 -
American Journal of Obstetrics and... May 2024
PubMed: 38763342
DOI: 10.1016/j.ajog.2024.05.019 -
BMC Women's Health May 2024The aim of this study is to explore the efficacy and safety of chemotherapy (CT) as a monotherapy in patients with recurrent intermediate/high-risk factors following...
Efficacy and safety of chemotherapy as monotherapy in patients with recurrent intermediate/high-risk factors following radical hysterectomy for stage IB-IIA cervical cancer: a single-center retrospective analysis.
OBJECTIVE
The aim of this study is to explore the efficacy and safety of chemotherapy (CT) as a monotherapy in patients with recurrent intermediate/high-risk factors following radical hysterectomy for stage IB-IIA cervical cancer.
METHODS
A retrospective analysis was conducted on the medical records of patients diagnosed with stage IB-IIA cervical cancer who underwent radical hysterectomy at the People's Hospital of Suzhou High-tech District between 2010 and 2020. A total of 66 patients with intermediate or high-risk factors for recurrence were treated exclusively with CT. This cohort included 42 patients in the intermediate-risk group and 24 in the high-risk group. Treatment protocols consisted of 4-6 cycles of paclitaxel and cisplatin drugs for the intermediate-risk group, and 6 cycles for the high-risk group. The relapse-free survival (RFS), recurrence rates, and common CT-related adverse reactions, including bone marrow suppression, nausea and vomiting, and diarrhea, were assessed for both groups.
RESULTS
(1) The cumulative 3-year RFS rates for the intermediate-risk and high-risk groups were 97.3% (36/37) and 82.4% (14/17), respectively, with cumulative 5-year RFS rates of 97.1% (34/35) and 82.4% (14/17), respectively. The Log rank test revealed no significant difference between the two groups (P > 0.05), (χ² = 2.718, P = 0.099). The 5-year recurrence rates in the intermediate-risk and high-risk groups were 2.38% (1/42) and 12.50% (3/24), respectively. (2) The incidence of grade III bone marrow suppression in the intermediate-risk and high-risk groups was 21.19% (11/42) and 25.00% (6/24), respectively, while the incidence of grade IV bone marrow suppression was 11.90% (5/42) and 8.33% (2/24), respectively. There was no statistically significant difference in bone marrow suppression grades between the two groups (P > 0.05).
CONCLUSION
CT with paclitaxel and cisplatin, administered as monotherapy post-radical hysterectomy for stage IB-IIA cervical cancer, demonstrates satisfactory survival benefits with an acceptable safety profile. Moreover, no significant differences were observed in prognosis or adverse reactions between the different risk groups treated solely with CT.
Topics: Humans; Female; Uterine Cervical Neoplasms; Retrospective Studies; Hysterectomy; Middle Aged; Neoplasm Recurrence, Local; Adult; Paclitaxel; Cisplatin; Neoplasm Staging; Risk Factors; Antineoplastic Combined Chemotherapy Protocols; Aged; Antineoplastic Agents
PubMed: 38762459
DOI: 10.1186/s12905-024-03135-7 -
Journal of Minimally Invasive Gynecology May 2024To synthesize the terminology utilized in nerve-sparing surgical literature and propose standardized and nonconflicting terms to allow for consistent vocabulary.
OBJECTIVE
To synthesize the terminology utilized in nerve-sparing surgical literature and propose standardized and nonconflicting terms to allow for consistent vocabulary.
DESIGN
We performed a literature search on PubMed using the search terms "pelvis" and "nerve-sparing." Nongynecologic surgery and animal studies were excluded. A narrative review was performed, focusing on nerves, fasciae, ligaments, and retroperitoneal spaces. Terms from included papers were discussed by all authors, who are surgeons versed in nerve-sparing procedures and one anatomist, and recommendations were made regarding the most appropriate terms based on the frequency of occurrence in the literature and the possibility of overlapping names with other structures.
RESULTS
224 articles were identified, with 81 included in the full-text review. Overall, 48% of articles focused on cervical cancer and 26% on deeply infiltrating endometriosis. Findings were synthesized both narratively and visually. Inconsistencies in pelvic anatomical nomenclature were prevalent across publications. The structure with the most varied terminology was the rectal branch of the inferior hypogastric plexus with 14 names. A standardized terminology for pelvic autonomic nerve structures, fasciae, ligaments, and retroperitoneal spaces was proposed to avoid conflicting terms.
CONCLUSION
Surgeons and anatomists should use consistent terminology to facilitate increased uptake of nerve-sparing techniques in gynecologic surgery through a better understanding of surgical technique description. We have proposed a standardized terminology believed to facilitate this goal.
PubMed: 38761917
DOI: 10.1016/j.jmig.2024.05.013 -
American Journal of Obstetrics and... May 2024
PubMed: 38761842
DOI: 10.1016/j.ajog.2024.05.020 -
The New England Journal of Medicine May 2024
Topics: Humans; Uterine Cervical Neoplasms; Female; Hysterectomy
PubMed: 38749049
DOI: 10.1056/NEJMc2403906 -
The New England Journal of Medicine May 2024
Topics: Humans; Uterine Cervical Neoplasms; Female; Hysterectomy; Risk
PubMed: 38749048
DOI: 10.1056/NEJMc2403906 -
Frontiers in Medicine 2024Radical hysterectomy has long been considered as the standard surgical treatment for early-stage cervical cancer (IA2 to IB1 stages), according to the 2009 International...
OBJECTIVE
Radical hysterectomy has long been considered as the standard surgical treatment for early-stage cervical cancer (IA2 to IB1 stages), according to the 2009 International Federation of Obstetrics and Gynecology. This study aims to conduct an in-depth evaluation of the effectiveness and safety of non-radical surgery as an alternative treatment for patients with early-stage cervical cancer.
METHODS
A systematic search of online databases including PubMed, Embase, and the Cochrane Library was conducted to identify relevant literature on surgical treatment options for early-stage cervical cancer. Keywords such as "cervical cancer," "conservative surgery," "early-stage," "less radical surgery," and "simple hysterectomy" were used. Meta-analysis was performed using Stata 15.0 software, which included randomized controlled trials (RCTs) and cohort studies.
RESULTS
This meta-analysis included 8 eligible articles covering 9 studies, with 3,950 patients in the simple hysterectomy (SH) surgery group and 6,271 patients in the radical hysterectomy (RH) surgery group. The results indicate that there was no significant difference between the two groups in terms of the Overall Survival (OS) (HR = 1.04, 95% CI: 0.86-1.27, = 0.671; Heterogeneity: = 33.8%, = 0.170), Disease Free Survival (DFS) (HR = 1.39, 95% CI: 0.59-3.29, = 0.456; Heterogeneity: = 0.0%, = 0.374), Cervical Cancer Specific Survival (CCSS) (HR = 1.11, 95% CI: 0.80-1.54, = 0.519; Heterogeneity: = 11.9%, = 0.287) and recurrence rate (RR = 1.16, 95% CI: 0.69-1.97, = 0.583; Heterogeneity: = 0.0%, = 0.488). However, the mortality rate (RR = 1.35, 95% CI: 1.10-1.67, = 0.006; Heterogeneity: = 35.4%, = 0.158) and the rate of postoperative adjuvant therapy (RR = 1.59, 95% CI: 1.16-2.19, = 0.004; Heterogeneity: = 92.7%, < 0.10) were higher in the SH group compared to those in the RH group. On the other hand, the incidence of surgical complications was lower in the SH group (RR = 0.36, 95% CI: 0.21-0.59, = 0.004; Heterogeneity: = 0.0%, = 0.857) than that in the RH group. Subgroup analysis revealed that patients in the IB1 stage SH group had a significantly higher mortality rate compared to those in the RH group (RR = 1.59, 95% CI: 1.23-2.07, < 0.001; Heterogeneity: = 0.0%, = 0.332). However, there was no significant difference in mortality rates between the two groups for patients at stage IA2 (RR = 0.84, 95% CI: 0.54-1.30, = 0.428; Heterogeneity: = 26.8%, = 0.243). In the subgroups positive for Lymphovascular Space Invasion (LVSI), patients in the SH group had a significantly higher mortality rate than those in the RH group (RR = 1.34, 95% CI: 1.09-1.65, = 0.005; Heterogeneity: = 41.6%, = 0.128). However, in the LVSI-negative subgroups, there was no significant difference in mortality rates between the two groups (RR = 0.33, 95% CI: 0.01-8.04, = 0.499).
CONCLUSION
For patients with early-stage cervical cancer patients at IA2 without LVSI involvement, comparisons between the two groups in terms of OS, DFS, CCSS, recurrence rate, and mortality rates revealed no statistically significant differences, indicating that the choice of surgical approach does not affect long-term survival outcomes for this specific patient group. For patients at IB1 and IA2 stages with LVSI involvement, while there were no significant differences between the two groups in OS, DFS, CSS, and recurrence rate, a significant increase in mortality rates was observed in the SH group. This indicates a potential elevated risk of mortality associated with SH in this subset of patients. Notably, the incidence of surgical complications was significantly lower in the SH group compared to the RH group, highlighting the safety profile of SH in this context. Significantly, among patients in the SH group, an increase in the rate of postoperative adjuvant treatment is associated with a higher occurrence of treatment-related complications. To facilitate more precise patient selection for conservative surgical management, future prospective studies of superior quality are imperative to gain deeper insights into this matter.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO (CRD42023451609: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023451609).
PubMed: 38745744
DOI: 10.3389/fmed.2024.1337752