Assessment of routine surveillance of patients after primary treatment for cervical cancer in stage I. and II.: retrospective analysis

Česká verzia

Authors: E. Lajtman; M. Mlynček; P. Uharček; M. Matejka; M. Urban
Authors place of work: Gynekologicko-pôrodnícka klinika FN Nitra a Univerzita Konštantína Filozofa Nitra, prednosta prof. MUDr. M. Mlynček, CSc.
Published in the journal: Ceska Gynekol 2010; 75(2): 135-140

Summary

Objective:
Evaluate the monitoring and diagnosis of recurrence after primary treatment for cervical cancer.

Design:
Retrospective analysis.

Setting:
Department of Obstetrics and Gynecology Faculty Hospital and Constantine the Philosopher University Nitra.

Methods:
We retrospectively analyzed 199 patients who have undergone surgical treatment for cervical cancer between 2000 and 2008 at the Faculty Hospital Nitra and they received chemo-radioterapy after evaluation of risk factors. Monitoring after primary treatment consisted of general physical examination, gynecological examination, vaginal and abdominal ultrasonography, chest X‑ray and determining the level of SCCA. The examinations were performed by gynecologist and clinical oncologist. We compared the survival of patients with symptomatic and asymptomatic recurrences.

Results:
The recurrence after 6 months post primary therapy were identified in 17 cases.

At the time recurrence diagnosis 3 patients were asymptomatic and 14 were symptomatic. Recurrences all 3 asymptomatic patients were detected during regular examinations. Asymptomatic and symptomatic patients had similar survival.

Conclusion:
Regular monitoring of patients after primary treatment of cervical cancer in the rigid intervals and diagnosis of recurrence in the asymptomatic stage does not improve survival compared with symptomatic patients. It is necessary to re-evaluate the algorithm of follow-up not only in terms of survival but also in terms of economic consequences.

Key words:
cervical cancer, follow-up, recurrence.

Zdroje

1. Ansink, AC., De Barros Lopes, A., Naik, R., et al. Recurrent stage IB cervical carcinoma: evaluation of the effectiveness of routine follow-up of surveillance. Br J Obstet Gynaecol 1996, 103, p. 1156-1158.

2. Barter, JF., Soong, SJ., Hatch, KD., et al. Diagnosis and treatment of pulmonary metastases from cervical carcinoma. Gynecol Oncol 1990, 38, p. 347-351.

3. Bodurka-Bevers, D., Morris, M., Eifel, PJ., et al. Posttherapy surveillance of women with cervical cancer: an outcomes analysis. Gynecol Oncol 2000, 78, p. 187-193.

4. Bolli, JA., Doering, DL., Bosscher, JR., et al. Squamous cell carcinoma antigen: clinical utility in squamous cell carcinoma of the uterine cervix. Gynecol Oncol 1994, 55, p. 169-173.

5. Dooms, GC., Hricak, H., Crooks, LE., et al. Magnetic resonance imaging of the lymph nodes: comparison with CT. Radiology, 1984, 153, p. 719-728.

6. Dreyer, G., Snyman, L., Mount, A., et al. Management of recurrent cervical cancer. Best Pract Res Clin Obstet Gynecol 2006, 19, p. 631-644.

7. Duyn, A., Van Eijkeren, MV., Kenter, G., et al. Recurrent cervical cancer detection and prognosis. Acta Obstet Gynecol Scand 2002, 81, p. 351-355.

8. Esajas, MD., Duk, JM., de Bruijn, HW., et al. Clinical value of routine serum squamous cell carcinoma antigen in follow-up of patients with early-stage cervical cancer. J Clin Oncol 2001, 19, p. 3960-3966.

9. Greenlee, RT., Murray, T., Bolden, S., et al. Cancer statistics, 2000. CA Cancer J Clin, 2000, 50, p. 7-33.

10. Grigsby, PW., Siegel, BA., Dehdashti, F., et al. Posttherapy surveillance monitoring of cervical cancer by FDG-PET. Int J Radiat Oncol Biol Phys, 2003, 55, p. 907-913.

11. Hricak, H., Powell, CB., Yu, KK., et al. Invasive cervical carcinoma: role of MR imaging in pretreatment work-up versus cost minimization and diagnostic efficacy analysis. Radiology, 1996, 198, p. 403-409.

12. http://data.nczisk.sk/rocenky/rocenka_2007.pdf

13. Chan, YM., Ng, TY., Ngan, HY., et al. Monitoring of serum squamous cell carcinoma antigen levels in invasive cervical cancer: is it cost-effective? Gynecol Oncol, 2002, 84, p. 7-11.

14. Chien, CR., Ting, LL., Hsieh, CY., et al. Post-radiation Pap smear for Chinese patients with cervical cancer: a ten-year follow-up. Eur J Gynaecol Oncol, 2005, 26, p. 619-622.

15. Choi, JI., Kim, SH., Seong, CK., et al. Recurrent uterine cervical carcinoma: spectrum of imaging findings. Korean J Radiol, 2000, 1, p. 198-207.

16. Chung, HH., Jo, H., Kang WJ., et al. Clinical impact of integrated PET/CT on the management of suspected cervical cancer recurrence. Gynecol Oncol, 2007, 104, p. 529-534.

17. Chung, HH., Kim, SK., Kim, TH., et al. Clinical impact of FDG-PET imaging in post-therapy surveillance of uterine cervical cancer: from diagnosis to prognosis. Gynecol Oncol, 2006, 103, p. 165-170.

18. Injumpa, N., Suprasert, P., Srisomboon, J., et al. Limited value of vaginal cytology in detecting recurrent disease after radical hysterectomy for early stage cervical carcinoma. Asian Pac J Cancer Prev, 2006, 7, p. 656-658.

19. Jeong, YY., Kang, HK., Chung, TW., et al. Uterine cervical carcinoma after therapy: CT and MR imaging findings. Radiographics, 2003, 23, p. 969-981.

20. Kato, H., Torigoe, T. Radioimmunoassay for tumor antigen of human cervical squamous cell carcinoma. Cancer, 1977, 40, p. 1621-1628.

21. Kosary, CL., Schiffman, MH., Trimble, EL. Cervix uteri. In: Miller, BA., Ries, LAG., Hankey, BF., et al. SEER Cancer Statistic Review. Bethesda, MD: US Department of Health and Human Services, 1993, p. 1973-1990.

22. Lim, KC., Howells, RE., Evans, AS. The role of clinical follow up in early stage cervical cancer in South Wales. BJOG, 2004, 111, p. 1444-1448.

23. Mlynček, M. Sledování po ukončení léčby. In: Cibula, D., Petruželka, L. a kol. Onkogynekologie. Praha: Grada Publishing, 2009, p. 450-451.

24. Monk, BJ., Tewari, KS. Invasive cervical cancor. In: DiSaia, PJ., Creasman, WT. Clinical Gynecologic Oncology. 6th ed. St Louis, MO: Mosby, 2007, p. 55-125.

25. Morice, P., Deyrolle, C., Rey, A., et al. Value of routine follow-up procedures for patients with stage I/II cervical cancer treated with combined surgery-radiation therapy. Ann Oncol, 2004, 15, p. 218-223.

26. Olaitan, A., Murdoch, J., Anderson, R., et al. A critical evaluation of current protocols for the follow-up of women treated for gynecological malignancies: a pilot study. Int J Gynecol Cancer, 2001, 11, p. 349-353.

27. Soisson, AP., Geszler, G., Soper, JT., et al. A comparison of symptomatology, physical examination, and vaginal cytology in the detection of recurrent cervical carcinoma after radical hysterectomy. Obstet Gynecol, 1990, 76, p. 106-109.

28. Yen, TC., Lai, CH., Ma, SY., et al. Comparative benefits and limitations of (18)F-FDG PET and CT-MRI in documented or suspected recurrent cervical cancer. Eur J Nucl Med Mol Imaging, 2006, 33, p. 1399-1407.