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Results of Adjuvant Radiotherapy Based on Sedlis Criteria in Early Stage Cervical Cancer

Year 2023, , 439 - 443, 31.05.2023
https://doi.org/10.16899/jcm.1241809

Abstract

Background/Aims:
Investigation of the efficacy of adjuvant RT in cervical cancer stage I-IIA according to FIGO (2018) in terms of risk factors and oncologic outcomes.
Methods:
The study included 113 patients with FIGO stage I-IIA. Patients who received adjuvant external pelvic RT and/or intracavitary brachytherapy (ICBT) after surgery retrospectively analyzed for demographic data , histology, grade, tumor size , stage, LVSI, stromal invasion depth, type of lymphadenectomy, number of dissected pelvic / paraaortic lymph nodes , surgical margin, adjuvant therapies, local relapse, distant failure, overall survival, and progression-free survival.
Results:
After a median follow-up of 160 months, local recurrence was observed in 3 patients, distant metastasis in 6 patients and all-cause death in 15 patients. It was observed that only SID had a statistically significant effect on overall survival among the Sedlis criteria (p=0.04). The ten-year DFS and OS rates were 95% and 94%, respectively .
Conclusions:
Promising oncological results were obtained in early stage cervical cancer with adjuvant RT based on Sedlis criteria.

Supporting Institution

none

Project Number

none

Thanks

none

References

  • 1. Singh D, Vignat J, Lorenzoni V, et al. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. Lancet Glob Health. 2022 Dec 14:S2214-109X(22)00501-0. doi: 10.1016/S2214-109X(22)00501-0. Epub ahead of print. PMID: 36528031.
  • 2. Khanna N, Rauh LA, Lachiewicz MP. Margins for cervical and vulvar cancer. J Surg Oncol 2016;113:304-9.
  • 3. Sedlis A, Bundy BN, Rotman MZ, et al. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A Gynecologic Oncology Group Study. Gynecol Oncol 1999;73:177-183.
  • 4. Ryu SY, Kim MH, Nam BH, et al. Intermediate-risk grouping of cervical cancer patients treated with radical hysterectomy: a Korean Gynecologic Oncology Group study. Br J Cancer 2014;110:278-285.
  • 5. Noh JM, Park W, Kim YS, et al. Comparison of clinical outcomes of adenocarcinoma and adenosquamous carcinoma in uterine cervical cancer patients receiving surgical resection followed by radiotherapy: a multicenter retrospective study (KROG 13-10). Gynecol Oncol 2014;132:618-623.
  • 6. Diaz ES, Aoyama C, Baquing MA, et al. Predictors of residual carcinoma or carcinoma-in-situ at hysterectomy following cervical conization with positive margins. Gynecol Oncol 2014;132:76-80.
  • 7. Estape RE, Angioli R, Madrigal M, et al. Close vaginal margins as a prognostic factor after radical hysterectomy. Gynecol Oncol 1998;68:229-232.
  • 8. Kim H, Park W, Kim YS, Kim YJ. Chemoradiotherapy is not superior to radiotherapy alone after radical surgery for cervical cancer patients with intermediate-risk factor. J Gynecol Oncol. 2020 May;31(3):e35. doi: 10.3802/jgo.2020.31.e35. Epub 2019 Nov 21. PMID: 31912685; PMCID: PMC7189075.
  • 9. Levinson K, Beavis AL, Purdy C, et al. Beyond Sedlis-A novel histology-specific nomogram for predicting cervical cancer recurrence risk: An NRG/GOG ancillary analysis. Gynecol Oncol. 2021 Sep;162(3):532-538. doi: 10.1016/j.ygyno.2021.06.017. Epub 2021 Jul 1. Erratum in: Gynecol Oncol. 2021 Dec;163(3):616-617. PMID: 34217544; PMCID: PMC8405564.
  • 10. Volkova LV, Pashov AI, Omelchuk NN. Cervical Carcinoma: Oncobiology and Biomarkers. Int J Mol Sci. 2021 Nov 22;22(22):12571. doi: 10.3390/ijms222212571. PMID: 34830452; PMCID: PMC8624663.
  • 11. Chu R, Zhang Y, Qiao X, et al. Risk Stratification of Early-Stage Cervical Cancer with Intermediate-Risk Factors: Model Development and Validation Based on Machine Learning Algorithm. Oncologist. 2021 Dec;26(12):e2217-e2226. doi: 10.1002/onco.13956. Epub 2021 Sep 16. PMID: 34427018; PMCID: PMC8649058.
  • 12. Wan T, Tu H, Liu L, Huang H, Feng Y, Liu J. Perineural Invasion Should Be Regarded as an Intermediate-Risk Factor for Recurrence in Surgically Treated Cervical Cancer: A Propensity Score Matching Study. Dis Markers. 2021 Aug 3;2021:1375123. doi: 10.1155/2021/1375123. PMID: 34394773; PMCID: PMC8357507.
  • 13. Bhatla N, Aoki D, Sharma DN, Sankaranarayanan R. Cancer of the cervix uteri. Int J Gynaecol Obstet. 2018 Oct;143 Suppl 2:22-36. doi: 10.1002/ijgo.12611. PMID: 30306584.
  • 14. Kim SI, Kim JY, Wee CW, et al. Survival impact of additional chemotherapy after adjuvant concurrent chemoradiation in patients with early cervical cancer who underwent radical hysterectomy. BMC Cancer. 2021 Nov 22;21(1):1260. doi: 10.1186/s12885-021-08940-z. PMID: 34809599; PMCID: PMC8609857.
  • 15. Liu Y, Tu H, Zhang L, Zhong M, Wang Y, Li L, Xiang X. The best postoperative adjuvant therapy for patients with early stage cervical adenosquamous carcinoma. BMC Womens Health. 2022 Apr 12;22(1):112. doi: 10.1186/s12905-021-01588-8. PMID: 35410240; PMCID: PMC9003999.
  • 16. Zhou Y, Wang W, Hu K, Zhang F. Comparison of Outcomes and Prognostic Factors Between Early-Stage Cervical Adenocarcinoma and Adenosquamous Carcinoma Patients After Radical Surgery and Postoperative Adjuvant Radiotherapy. Cancer Manag Res. 2021 Oct 4;13:7597-7605. doi: 10.2147/CMAR.S329614. PMID: 34675656; PMCID: PMC8500504.
  • 17. Rotman M, Sedlis A, Piedmonte MR, et al. A phase III randomized trial of postoperative pelvic irradiation in stage Ib cervical carcinoma with poor prognostic features: follow-up of a Gynecologic Oncology Group study. Int J Radiat Oncol Biol Phys 65: 169-176, 2006.
  • 18. Gan YX, Du QH, Li J, et al. Adjuvant Radiotherapy After Minimally Invasive Surgery in Patients With Stage IA1-IIA1 Cervical Cancer. Front Oncol. 2021 Jul 26;11:690777. doi: 10.3389/fonc.2021.690777. PMID: 34381715; PMCID: PMC8350763.
  • 19. Solis JA, Rosenberg IP, Olivares J, Tudela B, Veillon G, Lazcano G. Post-operative small pelvic field radiation therapy in patients with intermediate risk early stage cervix cancer: a safe and efficient treatment modality. Rep Pract Oncol Radiother. 2021 Jun 9;26(3):360-366. doi: 10.5603/RPOR.a2021.0043. PMID: 34277089; PMCID: PMC8281917.
  • 20. Fabrini MG, Gadducci A, Perrone F, et al. Clinical outcome of tailored adjuvant postoperative chemoradiotherapy in IB FIGO stage cervical cancer. Anticancer Res. 2009 Oct;29(10):4205-10. PMID: 19846974.
  • 21. Guo Q, Wang R, Jin D, Yin Z, Hu B, Li R, Wu D. Comparison of adjuvant chemoradiotherapy versus radiotherapy in early-stage cervical cancer patients with intermediate-risk factors: A systematic review and meta-analysis. Taiwan J Obstet Gynecol. 2022 Jan;61(1):15-23. doi: 10.1016/j.tjog.2021.11.006. PMID: 35181028.
  • 22. Huang H, Feng YL, Wan T, et al. Effectiveness of Sequential Chemoradiation vs Concurrent Chemoradiation or Radiation Alone in Adjuvant Treatment After Hysterectomy for Cervical Cancer: The STARS Phase 3 Randomized Clinical Trial. JAMA Oncol. 2021 Mar 1;7(3):361-369. doi: 10.1001/jamaoncol.2020.7168. PMID: 33443541; PMCID: PMC7809615.
  • 23. Nie J, Wu Q, Yan A, Wu Z. Impact of different therapies on the survival of patients with stage I-IIA cervical cancer with intermediate risk factors. Ann Transl Med. 2021 Jan;9(2):142. doi: 10.21037/atm-20-7679. PMID: 33569444; PMCID: PMC7867952.
  • 24. Yu XL, Hu J, Cai XL, et al. Role of brachytherapy in post-operative cervical cancer patients with risk factors other than positive stump. Brachytherapy. 2023 Mar-Apr;22(2):166-173. doi: 10.1016/j.brachy.2022.10.002. Epub 2022 Nov 12. PMID: 36376227.

Erken Evre Serviks Kanserinde Sedlis Kriterleri Gözönünde Bulundurularak Uygulanan Adjuvant Radyoterapi Sonuçları

Year 2023, , 439 - 443, 31.05.2023
https://doi.org/10.16899/jcm.1241809

Abstract

ÖZ:
Amaç:
FIGO (2018) Evre I-IIA serviks kanserinde adjuvan RT ‘nin risk faktörleri ve onkolojik sonuçlar açısından etkinliğinin araştırılmasıdır.
Metod:
FIGO evre I-IIA olan 113 hasta çalışmaya dahil edilmiştir. Cerrahi sonrası adjuvan eksternal pelvik RT ve / ve ya intrakaviter brakiterapi (ICBT ) uygulanan hastalar demografik veriler, histoloji, grade, tümör boyutu , evre, LVSI, stromal invazyon derinliği (SID), lenfadenektomi tipi, diseke edilen pelvik/paraaortik lenf nodu sayısı , cerrahi sınır durumu, uygulanan adjuvant tedaviler, lokal relaps, uzak hastalık, genel sağkalım (OS), and hastalıksız sağkalım (DFS) açısından retrospektif olarak incelenmiştir.
Bulgular:
Medyan 160 aylık takip sonunda 3 hastada lokal nüks, 6 hastada uzak metastaz, 15 hastada tüm nedenlere bağlı ölüm gözlenmiştir. Sedlid kriterleri içerisinde sadece SID ‘ın OS üzerinde istatistiksel anlamlı olarak etkili olduğu gözlenmiştir. (p=0.04). On yıllık DFS ve OS oranı sırasıyla 95% ve 94% olarak bulunmuştur.
Sonuç:
Erken evre serviks kanserinde Sedlis kriterlerine dayalı adjuvan RT ile yüz güldürücü onkolojik sonuçlar elde edilmiştir.

Project Number

none

References

  • 1. Singh D, Vignat J, Lorenzoni V, et al. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. Lancet Glob Health. 2022 Dec 14:S2214-109X(22)00501-0. doi: 10.1016/S2214-109X(22)00501-0. Epub ahead of print. PMID: 36528031.
  • 2. Khanna N, Rauh LA, Lachiewicz MP. Margins for cervical and vulvar cancer. J Surg Oncol 2016;113:304-9.
  • 3. Sedlis A, Bundy BN, Rotman MZ, et al. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A Gynecologic Oncology Group Study. Gynecol Oncol 1999;73:177-183.
  • 4. Ryu SY, Kim MH, Nam BH, et al. Intermediate-risk grouping of cervical cancer patients treated with radical hysterectomy: a Korean Gynecologic Oncology Group study. Br J Cancer 2014;110:278-285.
  • 5. Noh JM, Park W, Kim YS, et al. Comparison of clinical outcomes of adenocarcinoma and adenosquamous carcinoma in uterine cervical cancer patients receiving surgical resection followed by radiotherapy: a multicenter retrospective study (KROG 13-10). Gynecol Oncol 2014;132:618-623.
  • 6. Diaz ES, Aoyama C, Baquing MA, et al. Predictors of residual carcinoma or carcinoma-in-situ at hysterectomy following cervical conization with positive margins. Gynecol Oncol 2014;132:76-80.
  • 7. Estape RE, Angioli R, Madrigal M, et al. Close vaginal margins as a prognostic factor after radical hysterectomy. Gynecol Oncol 1998;68:229-232.
  • 8. Kim H, Park W, Kim YS, Kim YJ. Chemoradiotherapy is not superior to radiotherapy alone after radical surgery for cervical cancer patients with intermediate-risk factor. J Gynecol Oncol. 2020 May;31(3):e35. doi: 10.3802/jgo.2020.31.e35. Epub 2019 Nov 21. PMID: 31912685; PMCID: PMC7189075.
  • 9. Levinson K, Beavis AL, Purdy C, et al. Beyond Sedlis-A novel histology-specific nomogram for predicting cervical cancer recurrence risk: An NRG/GOG ancillary analysis. Gynecol Oncol. 2021 Sep;162(3):532-538. doi: 10.1016/j.ygyno.2021.06.017. Epub 2021 Jul 1. Erratum in: Gynecol Oncol. 2021 Dec;163(3):616-617. PMID: 34217544; PMCID: PMC8405564.
  • 10. Volkova LV, Pashov AI, Omelchuk NN. Cervical Carcinoma: Oncobiology and Biomarkers. Int J Mol Sci. 2021 Nov 22;22(22):12571. doi: 10.3390/ijms222212571. PMID: 34830452; PMCID: PMC8624663.
  • 11. Chu R, Zhang Y, Qiao X, et al. Risk Stratification of Early-Stage Cervical Cancer with Intermediate-Risk Factors: Model Development and Validation Based on Machine Learning Algorithm. Oncologist. 2021 Dec;26(12):e2217-e2226. doi: 10.1002/onco.13956. Epub 2021 Sep 16. PMID: 34427018; PMCID: PMC8649058.
  • 12. Wan T, Tu H, Liu L, Huang H, Feng Y, Liu J. Perineural Invasion Should Be Regarded as an Intermediate-Risk Factor for Recurrence in Surgically Treated Cervical Cancer: A Propensity Score Matching Study. Dis Markers. 2021 Aug 3;2021:1375123. doi: 10.1155/2021/1375123. PMID: 34394773; PMCID: PMC8357507.
  • 13. Bhatla N, Aoki D, Sharma DN, Sankaranarayanan R. Cancer of the cervix uteri. Int J Gynaecol Obstet. 2018 Oct;143 Suppl 2:22-36. doi: 10.1002/ijgo.12611. PMID: 30306584.
  • 14. Kim SI, Kim JY, Wee CW, et al. Survival impact of additional chemotherapy after adjuvant concurrent chemoradiation in patients with early cervical cancer who underwent radical hysterectomy. BMC Cancer. 2021 Nov 22;21(1):1260. doi: 10.1186/s12885-021-08940-z. PMID: 34809599; PMCID: PMC8609857.
  • 15. Liu Y, Tu H, Zhang L, Zhong M, Wang Y, Li L, Xiang X. The best postoperative adjuvant therapy for patients with early stage cervical adenosquamous carcinoma. BMC Womens Health. 2022 Apr 12;22(1):112. doi: 10.1186/s12905-021-01588-8. PMID: 35410240; PMCID: PMC9003999.
  • 16. Zhou Y, Wang W, Hu K, Zhang F. Comparison of Outcomes and Prognostic Factors Between Early-Stage Cervical Adenocarcinoma and Adenosquamous Carcinoma Patients After Radical Surgery and Postoperative Adjuvant Radiotherapy. Cancer Manag Res. 2021 Oct 4;13:7597-7605. doi: 10.2147/CMAR.S329614. PMID: 34675656; PMCID: PMC8500504.
  • 17. Rotman M, Sedlis A, Piedmonte MR, et al. A phase III randomized trial of postoperative pelvic irradiation in stage Ib cervical carcinoma with poor prognostic features: follow-up of a Gynecologic Oncology Group study. Int J Radiat Oncol Biol Phys 65: 169-176, 2006.
  • 18. Gan YX, Du QH, Li J, et al. Adjuvant Radiotherapy After Minimally Invasive Surgery in Patients With Stage IA1-IIA1 Cervical Cancer. Front Oncol. 2021 Jul 26;11:690777. doi: 10.3389/fonc.2021.690777. PMID: 34381715; PMCID: PMC8350763.
  • 19. Solis JA, Rosenberg IP, Olivares J, Tudela B, Veillon G, Lazcano G. Post-operative small pelvic field radiation therapy in patients with intermediate risk early stage cervix cancer: a safe and efficient treatment modality. Rep Pract Oncol Radiother. 2021 Jun 9;26(3):360-366. doi: 10.5603/RPOR.a2021.0043. PMID: 34277089; PMCID: PMC8281917.
  • 20. Fabrini MG, Gadducci A, Perrone F, et al. Clinical outcome of tailored adjuvant postoperative chemoradiotherapy in IB FIGO stage cervical cancer. Anticancer Res. 2009 Oct;29(10):4205-10. PMID: 19846974.
  • 21. Guo Q, Wang R, Jin D, Yin Z, Hu B, Li R, Wu D. Comparison of adjuvant chemoradiotherapy versus radiotherapy in early-stage cervical cancer patients with intermediate-risk factors: A systematic review and meta-analysis. Taiwan J Obstet Gynecol. 2022 Jan;61(1):15-23. doi: 10.1016/j.tjog.2021.11.006. PMID: 35181028.
  • 22. Huang H, Feng YL, Wan T, et al. Effectiveness of Sequential Chemoradiation vs Concurrent Chemoradiation or Radiation Alone in Adjuvant Treatment After Hysterectomy for Cervical Cancer: The STARS Phase 3 Randomized Clinical Trial. JAMA Oncol. 2021 Mar 1;7(3):361-369. doi: 10.1001/jamaoncol.2020.7168. PMID: 33443541; PMCID: PMC7809615.
  • 23. Nie J, Wu Q, Yan A, Wu Z. Impact of different therapies on the survival of patients with stage I-IIA cervical cancer with intermediate risk factors. Ann Transl Med. 2021 Jan;9(2):142. doi: 10.21037/atm-20-7679. PMID: 33569444; PMCID: PMC7867952.
  • 24. Yu XL, Hu J, Cai XL, et al. Role of brachytherapy in post-operative cervical cancer patients with risk factors other than positive stump. Brachytherapy. 2023 Mar-Apr;22(2):166-173. doi: 10.1016/j.brachy.2022.10.002. Epub 2022 Nov 12. PMID: 36376227.
There are 24 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Research
Authors

Necla Gürdal 0000-0001-5627-3436

Özge Kandemir Gürsel 0000-0002-6960-4115

Project Number none
Publication Date May 31, 2023
Acceptance Date March 28, 2023
Published in Issue Year 2023

Cite

AMA Gürdal N, Kandemir Gürsel Ö. Results of Adjuvant Radiotherapy Based on Sedlis Criteria in Early Stage Cervical Cancer. J Contemp Med. May 2023;13(3):439-443. doi:10.16899/jcm.1241809