Laparoscopic Radical Hysterectomy After Concomitant Chemoradiation in Locally Advanced Cervical Cancer: A Prospective Phase II Study

被引:19
作者
Gallotta, Valerio [1 ]
Ferrandina, Gabriella [1 ]
Chiantera, Vito [2 ]
Fagotti, Anna [3 ]
Fanfani, Francesco [1 ]
Ercoli, Alfredo [4 ]
Legge, Francesco [2 ]
Costantini, Barbara [1 ]
Alletti, Salvatore Gueli [1 ]
Bottoni, Carolina [1 ]
Anchora, Luigi Pedone [1 ]
Nero, Camilla [1 ]
Scambia, Giovanni [1 ]
机构
[1] Univ Cattolica Sacro Cuore, Div Gynecol Oncol, I-00168 Rome, Italy
[2] Fdn Giovanni Paolo II, Div Gynecol Oncol, Campobasso, Italy
[3] Univ Perugia, St Maria Hosp, Div Minimally Invas Gynecol Surg, Terni, Italy
[4] Polyclin Abano Terme, Padua, Italy
关键词
Cervical cancer; Laparoscopy; Neoadiuvant chemoradiation; Radical hysterectomy; CONCURRENT CHEMORADIOTHERAPY; PREOPERATIVE CHEMORADIATION; NEOADJUVANT CHEMOTHERAPY; COMPLETION SURGERY; RADIATION-THERAPY; STAGE; TRIAL; LYMPHADENECTOMY; CARCINOMA; COMPLICATIONS;
D O I
10.1016/j.jmig.2015.04.014
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Objective: To assess the feasibility of laparoscopic radical surgery in patients with locally advanced cervical cancer (LACC) who receive chemoradiation therapy (CT/RT). Design: Prospective phase II study (Canadian Task Force classification II-1). Intervention: Patients with LACC (FIGO stage IB2 III) were evaluated for accrual at the Gynecologic Oncology Unit of Catholic University, Rome/Campobasso. Neoadjuvant CT/RT included whole-pelvic irradiation (total dose, 45.0-50.4 Gy) combined with cisplatin and 5-fluorouracil. Objective response to treatment was evaluated according to Response Evaluation Criteria in Solid Tumors criteria. Laparoscopic radical hysterectomy (RH) plus pelvic and/or aortic lymphadenectomy was attempted within 6 to 8 weeks after CT/RT. The feasibility of laparoscopic RH, as well as the rate, pattern, and severity of early and late postoperative complications, were analyzed. Results: Between January 2010 and October 2013, a total of 58 patients were enrolled into the study. After CT/RT, 23 patients (39.6%) underwent type B2 RH, 31 (53.4%) underwent type Cl RH, and 4 (6.9%) underwent type C2 RH. Pelvic lymphadenectomy was performed in all cases. Laparoscopic RH was feasible in 55 of 58 cases (feasibility rate, 94.8%). No intraoperative complications were recorded. During the observation period (median, 22 months; range, 5-50 months), there were 28 complications, of which only 21.4% were grade 2 complications and 14.3% were grade 3 complications. As of January 2015, disease recurrence was documented in 4 cases (6.9%). Conclusion: Total laparoscopic radical surgery is feasible in patients with LACC receiving preoperative CT/RT, providing perioperative outcomes comparable to those registered in early-stage disease. (C) 2015 AAGL. All rights reserved.
引用
收藏
页码:877 / 883
页数:7
相关论文
共 39 条
[1]   Postoperative lymphocysts after lymphadenectomy for gynaecological malignancies: preventive techniques and prospects [J].
Achouri, Aziz ;
Huchon, Cyrille ;
Bats, Anne-Sophie ;
Bensaid, Cherazade ;
Nos, Claude ;
Lecuru, Fabrice .
EUROPEAN JOURNAL OF OBSTETRICS & GYNECOLOGY AND REPRODUCTIVE BIOLOGY, 2012, 161 (02) :125-129
[2]   Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: individual patient data meta-analysis [J].
Alberts, David S. ;
Brady, Mark ;
Cikaric, Slobodan ;
Chen, Hongwei ;
Dinshaw, Ketayun ;
Eifel, Patricia J. ;
Garipagaoglu, Melahat ;
Jakobsen, Anders ;
Kantardzic, Nermina ;
Keys, Henry ;
Lal, Punita ;
Lanciano, Rachelle ;
Leborgne, Felix ;
Lorvidhaya, Vicharn ;
Onishi, Hiroshi ;
Parmar, Mahesh K. B. ;
Pearcey, Robert G. ;
Pras, Elizabeth ;
Roberts, Kenneth ;
Rose, Peter G. ;
Stewart, Lesley A. ;
Tierney, Jayne F. ;
Thomas, Gillian ;
Trimble, Ted ;
Vale, Claire ;
Whitney, Charles W. .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2010, (01)
[3]   Neoadjuvant chemotherapy and radical surgery versus exclusive radiotherapy in locally advanced squamous cell cervical cancer: Results from the Italian Multicenter Randomized study [J].
Benedetti-Panici, P ;
Greggi, S ;
Colombo, A ;
Amoroso, M ;
Smaniotto, D ;
Giannarelli, D ;
Amunni, G ;
Raspagliesi, F ;
Zola, P ;
Mangioni, C ;
Landoni, F .
JOURNAL OF CLINICAL ONCOLOGY, 2002, 20 (01) :179-188
[4]   Chemoradiation with concomitant boost followed by radical surgery in locally advanced cervical cancer: A dose-escalation study [J].
Cellini, Numa ;
Smaniotto, Daniela ;
Scambia, Giovanni ;
Luzi, Stefano ;
Balducci, Mario ;
Ferrandina, Gabriella ;
Corvari, Barbara ;
Margariti, Pasquale A. ;
Valentini, Vincenzo ;
D'Agostino, Giuseppe .
AMERICAN JOURNAL OF CLINICAL ONCOLOGY-CANCER CLINICAL TRIALS, 2008, 31 (03) :280-284
[5]   Brachytherapy versus radical hysterectomy after external beam chemoradiation with gemcitabine plus cisplatin: a randomized, phase III study in IB2-IIB cervical cancer patients [J].
Cetina, L. ;
Gonzalez-Enciso, A. ;
Cantu, D. ;
Coronel, J. ;
Perez-Montiel, D. ;
Hinojosa, J. ;
Serrano, A. ;
Rivera, L. ;
Poitevin, A. ;
Mota, A. ;
Trejo, E. ;
Montalvo, G. ;
Munoz, D. ;
Robles-Flores, J. ;
de la Garza, J. ;
Chanona, J. ;
Jimenez-Lima, R. ;
Wegman, T. ;
Duenas-Gonzalez, A. .
ANNALS OF ONCOLOGY, 2013, 24 (08) :2043-2047
[6]   A GLOSSARY FOR REPORTING COMPLICATIONS OF TREATMENT IN GYNECOLOGICAL CANCERS [J].
CHASSAGNE, D ;
SISMONDI, P ;
HORIOT, JC ;
SINISTRERO, G ;
BEY, P ;
ZOLA, P ;
PERNOT, M ;
GERBAULET, A ;
KUNKLER, I ;
MICHEL, G .
RADIOTHERAPY AND ONCOLOGY, 1993, 26 (03) :195-202
[7]   Surgery after concurrent chemoradiotherapy and brachytherapy for the treatment of advanced cervical cancer: Morbidity and outcome: Results of a multicenter study of the GCCLCC (Groupe des Chirurgiens de Centre de Lutte Contre le Cancer) [J].
Classe, J. M. ;
Rauch, P. ;
Rodier, J. F. ;
Morice, P. ;
Stoeckle, E. ;
Lasry, S. ;
Houvenaeghel, G. .
GYNECOLOGIC ONCOLOGY, 2006, 102 (03) :523-529
[8]   Total laparoscopic radical hysterectomy for locally advanced cervical carcinoma (stages IIB, IIA and bulky stages IB) after concurrent chemoradiation therapy: Surgical morbidity and oncological results [J].
Colombo, P. E. ;
Bertrand, M. M. ;
Gutowski, M. ;
Mourregot, A. ;
Fabbro, M. ;
Saint-Aubert, B. ;
Quenet, F. ;
Gourgou, S. ;
Kerr, C. ;
Rouanet, P. .
GYNECOLOGIC ONCOLOGY, 2009, 114 (03) :404-409
[9]   Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer: An update of radiation therapy oncology group trial (RTOG) 90-01 [J].
Eifel, PJ ;
Winter, K ;
Morris, M ;
Levenback, C ;
Grigsby, PW ;
Cooper, J ;
Rotman, M ;
Gershenson, D ;
Mutch, DG .
JOURNAL OF CLINICAL ONCOLOGY, 2004, 22 (05) :872-880
[10]   Preoperative concomitant chemoradiotherapy in locally advanced cervical cancer: Safety, outcome, and prognostic measures [J].
Ferrandina, G. ;
Legge, F. ;
Fagotti, A. ;
Fanfani, F. ;
Distefano, M. ;
Morganti, A. ;
Cellini, N. ;
Seambia, G. .
GYNECOLOGIC ONCOLOGY, 2007, 107 (01) :S127-S132