STAGE IB2–IIIB CERVICAL CANCER: NEOADJUVANT CHEMOTHERAPY, RADICAL SURGERY AND PATIENT SURVIVAL
https://doi.org/10.21294/1814-4861-2021-20-3-82-89
Abstract
The aim of the study was to evaluate the five-year survival rate in patients with stage ib2–iiib cervical cancer treated with neoadjuvant chemotherapy and radical surgery.
Material and Methods. Long-term treatment outcomes were studied in 173 patients with histologically-verified stage ib2–iiib cervical squamous cell carcinoma. The patients underwent neoadjuvant chemotherapy using intravenous infusion of cytostatic drugs (n=106) and intra-arterial infusion of cytostatic drugs in combination with embolization of tumor-feeding arteries (n=67). Patients with resectable tumors underwent radical surgery. Disease-free survival was assessed.
Results. The median follow-up time was 66 months, and the maximum follow-up period was 144 months. 160 (92.5 %) patients underwent radical surgery after chemotherapy. 55 (34.4 %) patients did not receive adjuvant radiation therapy. The five-year disease-free survival rate was 79.6 %.
Conclusion. For the group of patients with locally advanced cervical cancer, who achieved respectability following neoadjuvant chemotherapy, radical surgery could be performed. Chemotherapy followed by radical surgery can improve disease-free survival rates in patients with stage ib2–iiib cervical cancer.
About the Authors
D. L. Ovodenko
National Medical Research Center for Obstetrics, Gynecology and Perinatology named after V.I. Kulakov, Ministry of Health of Russia
Russian Federation
Russian Federation
MD, PhD, Head of Clinical Medicine Department, Oncologist of the Department of Innovative Oncology and Gynecology
4, Oparina street, 117997, Moscow, Russia
G. N. Khabas
National Medical Research Center for Obstetrics, Gynecology and Perinatology named after V.I. Kulakov, Ministry of Health of Russia
Russian Federation
Russian Federation
MD, PhD, Head of the Department of Innovative Oncology and Gynecology
4, Oparina street, 117997, Moscow, Russia
Yu. M. Kreinina
Russian Scientific Center of Roentgenoradiology, Ministry of Health of Russia
Russian Federation
Russian Federation
MD, DSc, Leading Researcher, Laboratory of Innovative Technologies for Cancer Radiochemotherapy
86, Profsoyuznaya street, 117997, Moscow, Russia
A. A. Seregin
National Medical Research Center for Obstetrics, Gynecology and Perinatology named after V.I. Kulakov, Ministry of Health of Russia
Russian Federation
Russian Federation
MD, Postgraduate
4, Oparina street, 117997, Moscow, Russia
O. I. Aleshikova
Russian Scientific Center for Roentgenoradiology
Russian Federation
Russian Federation
MD, PhD, Senior Researcher, Laboratory for Cancer Prevention, Diagnosis and Treatment
86, Profsoyuznaya street, 117997, Moscow, Russia
L. A. Ashrafyan
National Medical Research Center for Obstetrics, Gynecology and Perinatology named after V.I. Kulakov, Ministry of Health of Russia
Russian Federation
Russian Federation
MD, DSc, Professor, Member of the Russian Academy of Sciences, Deputy Director; Director of the Institute of Oncogynecology and Mammology
4, Oparina street, 117997, Moscow, Russia
References
1. Moshkovich O., Lebrun-Harris L., Makaroff L., Chidambaran P., Chung M., Sripipatana A., Lin S.C. Challenges and Opportunities to Improve Cervical Cancer Screening Rates in US Health Centers through Patient-Centered Medical Home Transformation. Adv Prev Med. 2015; 2015: 182073. doi: 10.1155/2015/182073.
2. Ferlay J., Colombet M., Soerjomataram I., Mathers C, Parkin D.M., Piñeros M., Znaor A., Bray F. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer. 2019 Apr 15; 144(8): 1941–1953. doi: 10.1002/ijc.31937.
3. Kaprin A.D., Starinskiy V.V., Petrova G.V. Malignant neoplasms in Russia in 2017 (morbidity and mortality). Mosсow, 2018. 250 p. (in Russian).
4. Quinn M.A., Benedet J.L., Odicino F., Maisonneuve P., Beller U., Creasman W.T., Heintz A.P., Ngan H.Y., Pecorelli S. Carcinoma of the cervix uteri. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet. 2006 Nov; 95 Suppl 1: S43–103. doi: 10.1016/S0020-7292(06)60030-1.
5. Melamed A., Margul D.J., Chen L., Keating N.L., Del Carmen M.G., Yang J., Seagle B.L., Alexander A., Barber E.L., Rice L.W., Wright J.D., Kocherginsky M., Shahabi S., Rauh-Hain J.A. Survival after Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer. N Engl J Med. 2018 Nov 15; 379(20): 1905–1914. doi: 10.1056/NEJMoa1804923.
6. Vordermark D. Radiotherapy of Cervical Cancer. Oncol Res Treat. 2016; 39(9): 516–20. doi: 10.1159/000448902.
7. Naga Ch.P., Gurram L., Chopra S., Mahantshetty U. The management of locally advanced cervical cancer. Curr Opin Oncol. 2018 Sep; 30(5): 323–329. doi: 10.1097/CCO.0000000000000471.
8. Rose P.G. Chemoradiotherapy for cervical cancer. Eur J Cancer. 2002 Jan; 38(2): 270–8. doi: 10.1016/s0959-8049(01)00352-5.
9. Nakao Y., Hashiguchi M., Nishiyama S., Aihara S., Iwasaka T., Yokoyama M. Preoperative Chemoradiotherapy in Locally Advanced Bulky Squamous Cell Carcinoma of the Uterine Cervix. Int J Gynecol Cancer. 2017 Nov; 27(9): 1943–1948. doi: 10.1097/IGC.0000000000001094.
10. Zou W., Han Y., Zhang Y., Hu C., Feng Y., Zhang H., Wang J. Neoadjuvant chemotherapy plus surgery versus concurrent chemoradiotherapy in stage IB2-IIB cervical cancer: A systematic review and meta-analysis. PLoS One. 2019 Nov 14; 14(11): e0225264. doi: 10.1371/journal.pone.0225264.
11. Koh W.J., Abu-Rustum N.R., Bean S., Bradley K., Campos S.M., Cho K.R., Chon H.S., Chu C., Clark R., Cohn D., Crispens M.A., Damast S., Dorigo O., Eifel P.J., Fisher C.M., Frederick P., Gaffney D.K., Han E., Huh W.K., Lurain J.R., Mariani A., Mutch D., Nagel C., Nekhlyudov L., Fader A.N., Remmenga S.W., Reynolds R.K., Tillmanns T., Ueda S., Wyse E., Yashar C.M., McMillian N.R., Scavone J.L. Cervical Cancer, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2019 Jan; 17(1): 64–84. doi: 10.6004/jnccn.2019.0001.
12. Marth C., Landoni F., Mahner S., McCormack M., GonzalezMartin A., Colombo N.; ESMO Guidelines Committee. Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and followup. Ann Oncol. 2017 Jul 1; 28(suppl_4): iv72–iv83. doi: 10.1093/annonc/mdx220.
13. Yang S., Gao Y., Sun J., Xia B., Liu T., Zhang H., Li Q., Xiao M., Zhang Y. Neoadjuvant chemotherapy followed by radical surgery as an alternative treatment to concurrent chemoradiotherapy for young premenopausal patients with FIGO stage IIB squamous cervical carcinoma. Tumour Biol. 2015 Jun; 36(6): 4349–56. doi: 10.1007/s13277-015-3074-2.
14. Gupta S., Maheshwari A., Parab P., Mahantshetty U., Hawaldar R., Sastri Chopra S., Kerkar R., Engineer R., Tongaonkar H., Ghosh J., Gulia S., Kumar N., Shylasree T.S., Gawade R., Kembhavi Y., Gaikar M., Menon S., Thakur M., Shrivastava S., Badwe R. Neoadjuvant Chemotherapy Followed by Radical Surgery Versus Concomitant Chemotherapy and Radiotherapy in Patients With Stage IB2, IIA, or IIB Squamous Cervical Cancer: A Randomized Controlled Trial. J Clin Oncol. 2018; 36(16): 1548–55. doi: 10.1200/JCO.2017.75.9985.
15. Maksimov S.Ya. Primarily multiple tumors of the organs of the reproductive system. Practical Oncology. 2009; 10(2): 117–123. (in Russian).
16. Ashrafyan L.A., Antonova I.B., Aleshikova O.I., Dobrovolskaya N.Yu. Surgical stage as one of the main components in the treatment of cervical cancer stages IIb–IIIb. Russian Journal of Oncology. 2007; 3: 21–25. (in Russain).
17. Ashrafyan L.A., Aleshikova O.I., Babaeva N.A., Antonova I.B., Ivashina S.V., Vashakmadze S.L., Myagkova A.A., Motskobili T.A. Complex ultrasound diagnostic assessment of the results of neoadjuvant chemotherapy for locally advanced cervical cancer (stages IIB–IIIB). Tumors of female reproductive system. 2015; 2: 76–81. (in Russian).
18. Angioli R., Plotti F., Luvero D., Aloisi A., Guzzo F., Capriglione S., Terranova C., De Cicco Nardone C., Benedetti-Panici P. Feasibility and safety of carboplatin plus paclitaxel as neoadjuvant chemotherapy for locally advanced cervical cancer: a pilot study. Tumour Biol. 2014 Mar; 35(3): 2741–6. doi: 10.1007/s13277-013-1361-3.
19. Li X., Huang K., Zhang Q., Shen J., Zhou H., Yang R., Wang L., Liu J., Zhang J., Sun H., Jia Y., Du X., Wang H., Deng S., Ding T., Jiang J., Lu Y., Li S., Wang S., Ma D. Early response to neoadjuvant chemotherapy can help predict long-term survival in patients with cervical cancer. Oncotarget. 2016 Dec 27; 7(52): 87485–87495. doi: 10.18632/oncotarget.11460.
20. He D., Duan C., Chen J., Lai L., Chen J., Chen D. The safety and efficacy of the preoperative neoadjuvant chemotherapy for patients with cervical cancer: a systematic review and meta analysis. Int J Clin Exp Med. 2015 Sep 15; 8(9): 14693–700.
21. Kosenko I.A., Litvinova T.M., Matylevich O.P. New opportunities for surgical treatment of patients with initially unresectable uterine cervix cance. Siberian Journal of Oncology. 2016; 15(1): 44–48. (in Russian). doi: 10.21294/1814-4861-2016-15-1-44-48
22. Bhatla N., Aoki D., Sharma D.N., Sankaranarayanan R. Cancer of the cervix uteri. Int J Gynaecol Obstet. 2018; 143 Suppl 2: 22–36. doi: 10.1002/ijgo.12611.
23. Khokhlova S.V., Kolomiets L.A., Kravets O.A., Krikunova L.I., Morkhov K.Yu., Nechushkina V.M., Novikova E.G., Teletaeva G.M., Urmancheeva A.F., Tyulyandina A.S. Practical recommendations for drug treatment of cervical cancer. Practical recommendations for the treatment of malignant tumors of the Russian Society of Clinical Oncology. Moscow: RUSSCO, 2016. Practical recommendations for the treatment of malignant tumors of the Russian Society of Clinical Oncology. RUSSCO. 2019; 9(# 3s2): 203–217. (in Russian).
24. Kravets O.A., Kuznetsov V.V., Morkhov K.Yu., Nechushkina V.M., Khokhlova S.V. Clinical practice guidelines for the diagnosis and treatment of cervical cancer. Moscow, 2018.17 p. (in Russian).
25. Chopra S., Gupta M., Mathew A., Mahantshetty U., Engineer R., Lavanya G., Gupta S., Ghosh J., Thakur M., Deodhar K., Menon S., Rekhi B., Bajpai J., Gulia S., Maheshwari A., Kerkar R., Shylasree T.S., Shrivastava S.K. Locally advanced cervical cancer: A study of 5-year outcomes. Indian J Cancer. 2018 Jan-Mar; 55(1): 45–49. doi: 10.4103/ijc.IJC_428_17.
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For citations:
Ovodenko D.L., Khabas G.N., Kreinina Yu.M., Seregin A.A., Aleshikova O.I., Ashrafyan L.A. STAGE IB2–IIIB CERVICAL CANCER: NEOADJUVANT CHEMOTHERAPY, RADICAL SURGERY AND PATIENT SURVIVAL. Siberian journal of oncology. 2021;20(3):82-89. (In Russ.) https://doi.org/10.21294/1814-4861-2021-20-3-82-89
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