Individualization of surgical management of cervical cancer stages IA1, IA2

Česká verzia

Authors: T. Pichlík ¹ ; Lukáš Rob ¹ ; H. Robová ¹ ; Michael Jiří Halaška ¹ ; J. Drozenová ² ; Martin Hruda ¹ ; V. Drochýtek ¹
Authors place of work: Gynekologicko-porodnická klinika, Onkogynekologické centrum 3. LF UK a FNKV, Praha, přednosta prof. MUDr. L. Rob, CSc. ¹; Ústav patologie 3. LF UK a FNKV, Praha, přednosta doc. MUDr. R. Matěj, Ph. D. ²
Published in the journal: Ceska Gynekol 2019; 84(3): 172-176
Category: Original Article

Summary

Objective: To evaluate the risk of involvement of sentinel lymph nodes in cervical cancer stage IA1 with lymphovascular space invasion and IA2 using the detection of sentinel lymph nodes.

Design: Original article.

Settings: Department of Gynecology and Obstetrics 3rd Faculty of Medicine, Charles University, Faculty Hospital Královské Vinohrady, Prague; Oncogynecological centrum; Department of Pathology 3rd Faculty of Medicine, Charles University, Faculty Hospital Kralovské Vinohrady, Prague.

Methods: The study included women from prospective protocols LAP I and LAP II with cervical cancer stage IA1 with lymphovascular space invasion and stage IA2 from 2002 to 2018 classified according to FIGO 2014 staging, TNM 8. Detection of sentinel lymph nodes throughout this period was performed using ultra-short protocol with Tc and patent blau and also by histopathological examination.

Results: In the first group (28 women) with stage IA1 and lymphovascular space invasion diagnosed from cone biopsy there were two women with positive lymph nodes (7.1%). In the group stage IA2 (34 women) there were 13 women (38.2%) with positive lymphovascular space invasion and two women had positive lymph nodes (5.9%). The risk of positive lymph nodes for stage IA1 with lymphovascular space invasion and for stage IA2 is not statistically significant OR = 0.8125 (95% CI 0.1070–6.172).

Conclusion: The detection of sentinel lymph nodes aids to individualize the therapy of early stage cervical cancer and helps to reduce the radicalization of surgery. The risk of positive lymph nodes in stage IA1 with lymphovascular space invasion and stage IA2 with/without lymphovascular space invasion is the same. The results confirm, that the detection of sentinel lymph nodes in stage IA1 with lymphovascular space invasion is fully indicated.

Keywords:

cervical uterine cancer – sentinel lymph node biopsy

Zdroje

1. Bean, LM., Ward, KK., Plaxe, SC., McHale, MT. Survival of women with microinvasive adenocarcinoma of the cervix is not improved by radical surgery. Am J Obstet Gynecol, 2017, 217(3), p. 332–338.

2. Bhatla, N., Aoki, D., Sharma, DN., et al. Cancer of the cervix uteri. Int J Gynaecol Obstet, 2018, 143, Suppl. 2, p. 22–36.

3. Dundr, P., Němejcová, K. Guideline – Prekancerózy a karcinomy děložního hrdla. Doporučený postup pro bioptické vyšetření. Společnost českých patologů, 2018, září. http://www.patologie.info/standardy/34

4. Gadducci, A., Sartori, E., Maggino, T., et al. The clinical outcome of patients with stage Ia1 and Ia2 squamous cell carcinoma of the uterine cervix: a Cooperation Task Force (CTF) study. Eur J Gynaecol Oncol, 2003, 24(6), p. 513–516.

5. Hsu, HC., Tai, YJ., Chen, YL., et al. Factors predicting parametrial invasion in patients with early-stage cervical carcinomas. PLoS One, 2018, 13(10).

6. Koh, WJ., Abu-Rustum, NR., Bean, S., et al. Cervical Cancer, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2019, 17(1), p. 64–84.

7. Lee, SW., Kim, YM., Son, WS., et al. The efficacy of conservative management after conization in patients with stage IA1 microinvasive cervical carcinoma. Acta Obstet Gynecol Scand, 2009, 88(2), p. 209–215.

8. Lv, K., Guo, HM., Lun,YJ., et al. Role of 18F-FDG PET/CT in detecting pelvic lymph - node metastases in patient with early – stage uterine cervical cancer: comparison with MRI findings. Nucl Med Commun, 2014, 35(12), p. 1204–1211.

9. Melamed, A., Margul, DJ., Chen, L., et al. Survival after minimally invasive radical hysterectomy for early-stage cervical cancer. N Engl J Med, 2018, 79(20), p. 1905–1914.

10. Papakonstantinou, K., Kyrgiou, M., Lyons, D., et al. Management of stage Ia1 squamous cervical cancer and the importance of excision margins: a retrospective study of long-term outcome after 25 years of follow-up. Am J Obstet Gynecol, 2014, 211(6), p. 625–632.

11. Pennington, KP., Urban, RR., Gray, HJ. Revisiting minimally invasive surgery in the management of early-stage cervical cancer. J Natl Compr Canc Netw, 2019, 17(1), p. 86–90.

12. Pluta, M., Rob, L., Charvát, M., et al. Less radical surgery than radical hysterectomy in early stage cervical cancer – a pilot study. Gynecol Oncol, 2009, 113, p. 181–184.

13. Ramirez, PT., Frumovitz, M., Pareja, R., et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med, 2018, 379(20), p. 1895–1904.

14. Rob, L., Strnad, P., Robova, H., et al. Study of lymphatic mapping and sentinel node identification in early stage cervical cancer. Gynecol Oncol, 2005, 98(2), p. 281–288.

15. Rob, L., Charvát, M., Robová, H., et al. Fertilitu zachovávající operace u časného stadia karcinomu děložního hrdla dnes a zítra. Čes Gynek, 2006, 71(4), s. 302–307.

16. Rob, L., Charvát, M., Robová, H., et al. Less radical fertility-sparing surgery than radical trachelectomy in early cervical cancer. Int J Gynecol Cancer, 2007, 17, p. 304–310.

17. Rob, L., Halaska, M., Robova, H. Nerve-sparing and individually tailored surgery for cervical cancer. Lancet Oncol, 2010, 11, p. 292–301.

18. Rob, L., Robova, H., Chmel, R., et al. Surgical options in early cervical cancer. Int J Hyperthermia, 2012, 28(6), p. 489–500.

19. Rob, L., Robova, H., Halaska, MJ., et al. Current status of sentinel lymph node mapping in the management of cervical cancer. Expert Rev Anticancer Ther, 2013, 13(7), p. 861–870.

20. Sevin, BU., Nadji, M., Averette, HE., et al. Microinvasive carcinoma of the cervix. Cancer, 1992, 70(8), 2121-8. Review.

21. Shim, SH., Lim, MC., Kim, HJ., et al. Can simple trachelectomy or conization show comparable survival rate compared with radical trachelectomy in IA1 cervical cancer patients with lymphovascular space invasion who wish to save fertility? A systematic review and guideline recommendation. PLoS One, 2018, 13(1).

22. Strnad, P., Robová, H., Škapa, P., et al. A prospective study of sentinel lymph node status and parametrial involvement in patients with small tumor volume cervical cancer. Gynecol Oncol, 2008, 109, p. 280–284.

23. Ševčík, J., Klát, P., Gráf, P., et. al. Detekce sentinelové uzliny u časných stadií cervikálního karcinomu kombinovanou metodou s užitím nanokoloidu technecia Tc99 a patentní modři. Čes Gynek, 2007, 72(2), s. 120–125.

24. Tanaka, T., Sasaki, S., Tsuchihashi, H., et al. Which is better for predicting pelvic lymph node metastases in patients with cervical cancer: Fluorodeoxyglucose-positron emission tomography/computed tomography or a sentinel node biopsy? A retrospective observational study. Medicine (Baltimore), 2018, 97(16), p. e0410.

25. van der Velden, J., Mom, CH. Tailoring radicality in early cervical cancer: how far can we go? J Gynecol Oncol, 2019, 30(1).

26. Yahata, H., Kobayashi, H., Sonoda, K., et al. Prognostic outcome and complications of sentinel lymph node navigation surgery for early-stage cervical cancer. Int J Clin Oncol, 2018, 23(6), p. 1167–1172.

27. Zigras, T., Lennox, G., Willows, K., Covens, A. Early cervical cancer: current dilemmas of staging and surgery. Curr Oncol Rep, 2017, 19, p. 51.

28. http://www.onkogynekologie.com/wp-content/uploads/2011/03/Guideline-C53_2013.pdf.