Radical hysterectomy with adequate dissection of areas of possible metastasis in locally advanced cervical cancer
- Authors: Khakimov G.A1,2, Negmadzhanov B.B3, Khakimova G.G.1, Tashmetov M.N1, Musurmonov K.U1,2, Khakimova S.G1,4, Kadyrov S.S.1,2, Usmanova S.T1,2
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Affiliations:
- Tashkent Pediatric Medical Institute
- Tashkent City Branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology
- Samarkand State Medical Institute
- Moscow Research Institute of Oncology n.a. P.A. Herzen - branch of the National Medical Research Center of Radiology
- Issue: Vol 28, No 11 (2021)
- Pages: 70-76
- Section: Articles
- URL: https://journals.eco-vector.com/2073-4034/article/view/313279
- DOI: https://doi.org/10.18565/pharmateca.2021.11.70-76
- ID: 313279
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Abstract
Background. Using modern chemotherapy regimens, elements of aggressive oncosurgery in gynecological oncology, it is possible to achieve an increase in the number of cured patients with locally advanced cervical cancer (CC), providing an improvement in the immediate and long-term results of treatment. The proposed method of surgical treatment is the method of choice for the surgical treatment of patients with locally advanced cervical cancer (IIA-IIIB stage). Objective. Introduction of the method of surgical treatment of IIA - IIIB stage cervical cancer into clinical practice. Methods. Long-term results of treatment of 155 patients with morphologically verified IIA - IIIB stage cervical cancer were analyzed. Patients received neoadjuvant chemotherapy (NACT) (n=110) and chemoradiation therapy (CRT) (n=45). After achievement of resectability, the patients underwent surgical treatment using a new technique. Overall survival (OS) and progression-free survival (PFS) outcomes were assessed. Results. In the period from 2017 to 2020, 155 patients with IIA - IIIB stage cervical cancer after NACT (n=110) and CRT (n=45) underwent combined radical hysterectomy according to our patented method. The most frequent postoperative complications were urinary disorders in 67(60.9%) and 19 (42.2%) patients, lymphatic cysts in 20 (18.2%) and 10 (22.2%) and vesicovaginal fistula in 5 (4.6%) and 2 (4.4%) patients, respectively. According to the results of pathomorphological examination, the most frequent tumor response to NACT was grade III therapeutic pathomorphosis (TP) in 44 patients (40%) of group 1 and grade IV TP in 21 patients, accounting for 46.6%. The median follow-up was 28.7 (3.6 to 51.1) months. During this time, 30 patients died in both groups (17 [15.5%] and 13 [28.9%]), (P=0.047). Disease progression occurred in 16 (10.3%) patients (6 [5.5%] and 10 [22.2%]) (P=0.004), respectively. The 3-year OS was 83.8±3.7and 71.0±6.8% (P=0.131), PFS - 93.5±2.6and 77.7±6.6% (P=0.006). Conclusion. The proposed method of surgical treatment of IIA - IIIB stage cervical cancer has a novelty and can be used in practical medicine for surgical treatment of cervical cancer.
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About the authors
G. A Khakimov
Tashkent Pediatric Medical Institute; Tashkent City Branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and RadiologyDepartment of Oncology, Pediatric Oncology Tashkent, Uzbekistan
B. B Negmadzhanov
Samarkand State Medical InstituteSamarkand, Uzbekistan
Gulnoz G. Khakimova
Tashkent Pediatric Medical Institute
Email: hgg_doc@mail.ru
Cand. Sci. (Med.), Teaching Assistant at the Department of Oncology, Pediatric Oncology Tashkent, Uzbekistan
M. N Tashmetov
Tashkent Pediatric Medical InstituteDepartment of Oncology, Pediatric Oncology Tashkent, Uzbekistan
Kh. U Musurmonov
Tashkent Pediatric Medical Institute; Tashkent City Branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and RadiologyDepartment of Oncology, Pediatric Oncology Tashkent, Uzbekistan
Sh. G Khakimova
Tashkent Pediatric Medical Institute; Moscow Research Institute of Oncology n.a. P.A. Herzen - branch of the National Medical Research Center of RadiologyDepartment of Oncology, Pediatric Oncology Tashkent, Uzbekistan
Sh. Sh Kadyrov
Tashkent Pediatric Medical Institute; Tashkent City Branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and RadiologyDepartment of Oncology, Pediatric Oncology Tashkent, Uzbekistan
Sh. T Usmanova
Tashkent Pediatric Medical Institute; Tashkent City Branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and RadiologyDepartment of Oncology, Pediatric Oncology Tashkent, Uzbekistan
References
- Moshkovich O., Lebrun-Harris L., Makaroff L., et al. 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: 10.1155/2015/1820 73.
- Ferlay J., Colombet M., Soerjomataram I., et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer. 2019;144(8):1941-1953. doi: 10.1002/ijc.31937.
- Каприн А.Д., Старинский В.В., Петрова Г.В. Злокачественные новообразования в России в 2017 году (заболеваемость и смертность). М., 2018. 250 с.
- Каприн А.Д., В.В. Старинский, А.О. Шахзадова. Злокачественные новообразования в России в 2019 году (заболеваемость и смертность). М., 2020
- Рейес Сантьяго Д.К.,Хаджимба А.С., Соболев И.В. и др. Результаты комбинированного лечения рака шейки матки IIA-IIIB стадий. Опухоли женской репродуктивной системы 2018;14(4):50-5
- Gong Lin M.D., Zhang Jia-Wen M.D., Yin Ru-Tie M.D., et al. Safety and efficacy of neoadjuvant chemotherapy followed by radical surgery versus radical surgery alone in locally advanced cervical cancer patient. Int J Gynecol Cancer. 2016;26(4):722-28. Doi: 10.1097/ IGC.0000000000000658.
- Soderini.A, Bermudez A., Snaidas L., Vighi S, Gomez Rueda N., di Paola G. Long-term follow-up of the first randomized trial using neoadjuvant chemotherapy in stage Ib squamous carcinoma of the cervix: the final results. Gynecol Oncol. 1997;67(1):61-9. doi: 10.1006/gyno.1997.4812. PMID: 9345358.
- Napolitano U., Imperato F., Mossa B., et al. The role of neoadjuvant chemotherapy for squamous cell cervical cancer (Ib-IIIb): a long-term randomized trial. Eur J Gynaecol Oncol. 2003;24(1):51-9.
- Shan H.B., Cai Y.C., Liu Y., et al. Cytotoxicity of cantharidin analogues targeting protein phosphatase 2A. Anti-cancer drugs. 2006;17:905-911. doi: 10.1097/01. cad.0000217428.90325.35.
- Katsumata N., Yoshikawa H., Kobayashi H., et al. Phase III randomised controlled trial of neoadjuvant chemotherapy plus radical surgery vs radical surgery alone for stages IB2, IIA2, and IIB cervical cancer: a Japan Clinical Oncology Group trial (JCOG 0102). Br J Cancer. 2013;108(4):1957-63. doi: 10.1038/bjc.2013.179.
- Eddy G.L., et al. Treatment of ("bulky") stage IB cervical cancer with or without neoadjuvant vincristine and cisplatin prior to radical hysterectomy and pelvic/para-aortic lymphadenectomy: a phase III trial of gynecologic oncology group. Gyneocol Oncol. 2007;106(2):362-69. Doi: 10.1016/j. ygyno.2007.04.007.
- Rydzewska L., Tierney J., Vale C.L., Symonds PR. Neoadjuvant chemotherapy plus surgery versus surgery for cervical cancer. Cochrane Database of Systematic Reviews. 20 January 2010.
- Park J.Y., Kim D.Y., Kim J.H., et al. Comparison of outcomes between radical hysterectomy followed by tailored adjuvant therapy versus primary chemoradiation therapy in IB2 and IIA2 cervical cancer. J Gynecol Oncol. 2012;23(4):226-34. Doi: 10.3802/ jgo.2012.23.4.226.
- Sun H., Xin J., Lu Z., et al. Potential molecular mechanisms for improved prognosis and outcome with neoadjuvant chemotherapy prior to laparoscopical radical hysterectomy for patients with cervical cancer. Cell Physiol Biochem. 2013;32(5):1528-40. doi: 10.1159/000356590.
- Landoni F., Sartori E., Maggino T, et al. Is there a role for postoperative treatment in patients with stage Ib2-IIb cervical cancer treated with neoadjuvant chemotherapy and radical surgery? An Italian multicenter retrospective study. Gynecol Oncol. 2014;132(3):611-17. Doi: 10.1016/j. ygyno.2013.12.010.
- Ferrandina G., Palluzzi E., Gallotta V., et al. Neoadjuvant platinum-based chemotherapy followed by chemoradiation and radical surgery in locally advanced cervical cancer (Lacc) patients: A phase II study. Eur J Surg Oncol. 2018;44(7):1062-68. doi: 10.1016/j.ejso.2018.04.019.
- Dargent D., Lamblin G., Romestaing P., et al. Effect of radiotherapy on pelvic lymph node metastasis in cervical cancer stages IB2-IVA: a retrospective analysis of two comparative series. Int J Gynecol Cancer. 2005;15(3):468-74.
- Оводенко Д.Л., Хабас Г.Н., Крейнина Ю.М. и др. Рак шейки матки стадий IB2-IIIB: неоадъювантная химиотерапия, радикальные операции и выживаемость пациенток. Сибирский онкологический журнал. 2021;20(3):82-89.
- Jesus P., et al. Wertheim-Meigs radical hysterectomy Säo Paulo medical journal=Revista paulista de medicina. 1994;112(2):539-42. doi: 10.1590/S1516-31801994000200003.
- Frutuoso C., Amaral N., Marques C., et al. Resultados de 10 anos [Wertheim-Meigs procedure. 10-year results]. Acta Med Port. 1997;10(10):631-36. Portuguese. PMID: 9477585.
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