Present status of sentinel lymph node biopsy in cervical cancer

Cervical cancer is the fourth most common cancer in women, and seventh overall. This disease represents a medical, economic and social burden. In early FIGO stage patients (IA, IB1 and IIA1), nodal involvement is the most important prognostic factor. Imaging evaluation of nodal metastasis is of limited value. In order to determine lymph node involvement, allow loco-regional control of the disease, define the need for adjuvant radiotherapy and improve survival, standard surgery for early disease is radical hysterectomy with systematic pelvic lymphadenectomy. However, this surgical treatment has risks and complications: longer operative time, larger blood loss, neurovascular or ureteral injury, lower-limb lymphedema, symptomatic lymphocysts, hydronephrosis. A method that allows to define the presence of regional metastasis with less morbidity and equal or greater precision is particularly relevant. The use of the sentinel lymph node biopsy is intended to reach that purpose. The present study reviews recent literature on the role of sentinel lymph node biopsy in cervical cancer, analyzing its indications and contraindications, injection and detection techniques, tracers used, surgical and pathological approaches and its applicability in up-to-date clinical practice.     

Treatment of pathologic spinal fractures with combined radiofrequency ablation and balloon kyphoplasty

Background

A current paradigm in the treatment of cervical cancer with radiation therapy is that intracavitary brachytherapy is an essential component of radical treatment. This is a matched retrospective comparison of the results of treatment in patients treated with external beam chemoradiation (EBRT-CT) and radical hysterectomy versus those treated with identical chemoradiation followed by brachytherapy.

Methods

In this non-randomized comparison EBRT-CT protocol was the same in both groups of 40 patients. In the standard treated patients, EBRT-CT was followed by one or two intracavitary Cesium (low-dose rate) applications within 2 weeks of finishing external radiation to reach a point A dose of at least 85 Gy. In the surgically treated patients, radical hysterectomy with bilateral pelvic lymph node dissection and para-aortic lymph node sampling were performed within 7 weeks after EBRT-CT. Response, toxicity and survival were evaluated.

Results

A total of 80 patients were analyzed. The patients receiving EBRT-CT and surgery were matched with the standard treated cases. There were no differences in the clinicopathological characteristics between groups or in the delivery of EBRT-CT. The pattern of acute and late toxicity differed. Standard treated patients had more chronic proctitis while the surgically treated had acute complications of surgery and hydronephrosis. At a maximum follow-up of 60 months, median follow-up 26 (2–31) and 22 (3–27) months for the surgery and standard therapy respectively, eight patients per group have recurred and died. The progression free and overall survival are the same in both groups.

Conclusion

The results of this study suggest that radical hysterectomy can be used after EBRT-CT without compromising survival in FIGO stage IB2-IIB cervical cancer patients in settings were brachytherapy is not available. A randomized study is needed to uncover the value of surgery after EBRT-CT.     

Matched-Case Comparisons in a Single Institution to Determine Critical Points for Inexperienced Surgeons’ Successful Performances of Laparoscopic Radical Hysterectomy versus Abdominal Radical Hysterectomy in Stage IA2-IIA Cervical Cancer

This is a retrospective study which aims to identify major determinants of successful laparoscopic radical hysterectomy (LRH) versus abdominal radical hysterectomy (ARH) performed by inexperienced surgeons for stage IA2-IIA cervical cancer. A total of 161 consecutive patients with stage IA2–IIA cervical cancer who underwent RH were grouped into 2 groups according to the surgeons’ experience with LRH: experienced surgeon versus inexperienced surgeon. After matching for age and risk factors, surgical and survival outcomes were compared. Experienced surgeon selected patients with earlier-stage and fewer risk factors for LRH than ARH, but inexperience surgeons did not. After matching, the vaginal tumor-free margin of LRH was shorter than that of ARH in experienced surgeon group (1.3 versus 1.7 cm, p=0.007); however, the vaginal tumor-free margin was longer than that of ARH in the inexperienced surgeon group (1.8 versus 1.3 cm, p=0.035). The postoperative hospital stay of LRH was shorter than that of ARH in experienced surgeon group (5.5 versus 7.7 days, p<0.001), but not different from that of ARH in the inexperienced surgeon group. Vaginal tumor-free margin >1.8 cm (OR 7.33, 95% CI 1.22–40.42), stage >IB1 (OR 8.83, 95% CI 1.51–51.73), and estimated blood loss >575 mL (OR 33.95, 95% CI 4.87–236.79) were independent risk factors for longer postoperative hospital stay in the inexperienced surgeon group. There was no difference of 5-year-profression-free survival of LRH patients between experienced surgeon and inexperienced surgeon groups after matching (55.1 versus 33.3%, p=0.391). Selection of earlier-stage disease and moderate vaginal tumor-free margin might be important for an inexperienced surgeon to successfully perform LRH with minimal complications in stage IA2–IIA cervical cancer.     

宫颈癌患者四维能量多普勒超声血管血流参数与疾病分期的相关性分析

摘要 目的：探究宫颈癌患者四维能量多普勒超声血管血流参数与其疾病分期的相关性。方法：选择2019年8月至2022年7月于我院接受治疗的80例确诊为宫颈癌患者为研究组,另取同期入院检测的50例宫颈癌上皮内瘤变患者为CIN组,取同期确诊为子宫良性病变的50例患者为对照组,分别对其进行了四维能量多普勒超声检测,对比三组患者超声参数差异,将研究组患者按照FIGO标准区分为不同疾病分期（I期23,II期34,III期23）,对比不同分期宫颈癌患者超声参数差异,通过绘制受试者曲线（ROC）的方式评估超声参数对不同宫颈癌分期的鉴别价值。结果：研究组、CIN组和对照组之间超声血流参数PSV及RI存在显著差异,同时两两相比较同样组间差异具有统计学意义（P<0.05）;不同宫颈癌分期患者超声血流参数之间存在显著差异,以FIGO III期的PSV最高,RI最低,各组两两相比较同样差异具有统计学意义（P<0.05）;PSV对FIGO I期至FIGO II期诊断AUC为0.6829（95% CI=0.5333-0.8324,P=0.0200）,对FIGO II期至FIGO III期诊断AUC为0.7698（95% CI=0.6402-0.8995,P=0.0006）,对FIGO I期至FIGO III期诊断AUC为0.7505（95% CI=0.6072-0.8937,P=0.0036）;RI对FIGO I期至FIGO II期诊断AUC为0.9309（95% CI=0.8662-0.9957,P<0.0001）,对FIGO II期至FIGO III期诊断AUC为0.7148（95% CI=0.5804-0.8493,P=0.0063）,对FIGO I期至FIGO III期诊断AUC为0.9811（95% CI=0.9504-1.000,P<0.0001）。结论：宫颈癌患者四维能量多普勒超声血管血流参数与其疾病分期具有一定的关联,将PSV和RI指数应用于宫颈癌分期鉴别中具有较好的应用价值,具有推广应用意义。     

Influence of cytology development on frequency of pre-cancerous lesions and cervical cancer in east Croatia, 1978-2001

We analyzed the influence of cytology development to frequency of precancerosa (Cervical intraepithelial neoplasia grade 3 - CIN 3) and cervical cancer. The number of examined Pap smears increased significantly in the analyzed period. The calculated linear trend shows an average four-year increase of 17,283.35 smears. The number of detected CIN 3 increased accordingly. The calculated linear trend shows an average four-year increase by 45.03 and decrease of the rate of 0.07. A slight increase in cervical cancer was also noticed. The calculated linear trend shows an average four-year increase in cancer by 1.6 and decrease in the rate of 0.51. Analyses of cervical cancer by stages showed an increase in number of stage I and decrease of other stages. The calculated linear trend shows an average four-year increase of stage I by 4.94 or decrease in other stages of cervical cancer of 3.29 respectively. The rate of cervical cancer stage I decreased by 0.11 and of other stages by 0.39. Further analyses of the stage I showed that the linear trend of IA stage had an average four-year increase by 5.40 and decrease in stage IB of 0.48. The rate of the cervical cancer stage IA increased by 0.02, whereas the rate of IB decreased by 0.13. Cytology development in our country has resulted in detection of higher number of CIN 3 and the earliest stage (IA) of cervical cancer whereas the number of other stages (IB, II, III, IV) has decreased. However, a total number of cervical cancers haven't changed over the whole period. Thus, it is obvious that opportunistic program of detection, which has been using in Croatia, could not decrease frequency of cervical cancer. In order to achieve it, well-organized national program of detection is needed.     

Post-operative small pelvic field radiation therapy in patients with intermediate risk early stage cervix cancer: a safe and efficient treatment modality

BackgroundThe treatment of early stage cervical cancer has different therapeutic options. Adjuvant external beam radiotherapy for surgically treated intermediate risk cervical cancer patients has shown acceptable oncological outcomes with a low incidence of toxicity. The aim of this study was to analyze the oncological outcomes and safety of adjuvant small pelvic field radiotherapy in surgically treated stage IB1-2 cervical cancer patients who met the Sedlis intermediate-risk criteria.Materials and methodsA retrospective cohort study was carried out with 28 patients treated from 2007 to November 2019 with biopsy proven intermediate risk stage IB1–2 cervical cancer previously treated with radical hysterectomy and bilateral lymphadenectomy who received adjuvant small pelvic field radiotherapy. The primary endpoints were local and distant control and overall survival. Secondary endpoints were acute and late gastrointestinal and genitourinary toxicity. Survival curves were analyzed using the Kaplan-Meier method.ResultsAfter a median follow up period of 41.5 (27.5–80.5) months, adjuvant small pelvic field radiotherapy showed a 100% overall survival rate, 81.82% disease free survival and 86.36% local recurrence-free survival with no incidence of grade 3 or 4 acute or late toxicity. Three patients suffered from relapse, 1 in the vaginal cuff, 1 in the retrovesical area and 1 patient in the retroperitoneal area.ConclusionsAdjuvant small pelvic field radiotherapy is an efficient and safe treatment option that offers excellent oncological outcomes to surgically treated intermediate-risk stage IB1–2 cervical cancer patients with an excellent toxicity profile.     

腹腔镜子宫切除术对宫颈癌患者近期疗效及远期复发率的影响

目的:探讨腹腔镜根治性子宫切除术对宫颈癌患者近期疗效及远期复发率和生存率的影响。方法:选取2013年5月-2015年5月在我院接受手术切除治疗的宫颈癌患者71例为研究对象,根据手术方法不同将所选患者分为两组。腹腔镜组37例患者采用腹腔镜根治性子宫切除术,开腹手术组34例患者采用改良式根治性肿瘤切除术。观察并比较两组患者的手术时间、术中出血量、肿瘤切除长度、淋巴结清扫数、盆腔引流量、术后拔管时间等近期疗效,以及远期复发率及生存率。结果:与开腹手术组比较,腹腔镜组患者手术时间长、术中出血量少,差异具有统计学意义(P0.05);两组患者的肿瘤切除长度及淋巴结清除数比较,差异无统计学意义(P0.05);与开腹手术组比较,腹腔镜组患者的盆腔引流量较少,术后排气时间较早,差异具有统计学意义(P0.05);但两组患者术后拔管时间及住院时间比较,差异无统计学意义(P0.05);两组患者术后五年的复发率及生存率比较,差异无统计学意义(P0.05)。结论:腹腔镜根治性子宫切除术治疗宫颈癌的近期疗效显著,且不会影响患者的远期复发率及生存率。     

宫颈癌根治术泌尿系损伤的临床分析

目的：手术是治疗早期宫颈癌的主要手段,本文回顾性分析宫颈癌根治术泌尿系损伤的发生率、探讨防治措施,以减少泌尿系损伤的并发症,提高患者生活质量。方法：对新疆肿瘤医院2003年1月-2008年1月收治的482例早中期子宫颈癌行根治术的患者进行回顾性分析。其中Ia期6例,Ib期131例,IIa期142例,IIb期;鳞癌：440例,腺癌：31例,其他类型：11例。结果：发生泌尿系损伤9例,发生率为1．9％。其中输尿管损伤7例,膀胱损伤2例,其发生率分别为1．5％,0．4％。结论：宫颈癌根治手术致泌尿系损伤是少见但较严重的并发症,对输尿管损伤及时发现及时修补可以避免术后尿瘘的发生,严格操作步骤仍然是子宫颈癌根治术泌尿系损伤防治的关键问题。     

Adjuvant therapy after radical surgery of cervical cancer: Zagreb experience

The results of the analysis of the treatment of 72 patients with carcinoma of the uterine cervix are presented. Seventy-two patients with Stage IB1 carcinoma of the cervix underwent a radical hysterectomy and pelvic lymphadenectomy. The low-risk group includes the patients without unfavourable prognostic factors that were treated by surgery alone. The high-risk group included women with pelvic node metastases, clinical tumour size greater than 3.0 cm, depth of stromal invasion greater than 1/3 of the cervical wall, Grade 3 tumours and the presence of lympho-vascular space involvement. High-risk patients received whole pelvic radiotherapy between two and four weeks following surgery. Thirty-four patients (47.2%) were in the low-risk group and thirty-eight patients (52.8%) were in the high-risk group. Locoregional recurrences were diagnosed in three cases (8.8%) in the surgery group and in four patients (10.5 %) assigned to postoperative radiotherapy. The incidence of distant metastases was 2.9% in the group treated by surgery alone and 5.3% in the group treated by surgery and radiotherapy. Overall survival at five years was 91.2% in the low-risk group and 89.5% in the high-risk group of patients. Five-year overall survival, locoregional and distant metastases were similar in the low-risk and high-risk groups of patients, which emphasizes the value of whole pelvic radiation in patients with one or more unfavourable prognostic factors after radical surgery in Stage IB1 cervical cancer     

评估宫颈微浸润腺癌不同外科治疗的结果

目的:通过大样本的病例回顾,明确宫颈微浸润腺癌需要彻底外科治疗的病变范围。方法:46例因患宫颈微浸润腺癌(浸润深度小于或等于5mm)行外科手术治疗的病人,来自中国人民解放军总医院妇产科,同一位病理专家确定组织学类型、肿瘤分级、浸润深度、肿瘤宽度、有无淋巴管间的浸润、肿瘤边缘状况、宫旁状况以及是否有结节状的转移。病变分级参照FIGO(2009)的标准。结果:46例患者按照现行的FIGO分期标准,34例ⅠA1期,12例ⅠA2期。治疗方式主要有宫颈锥切、单纯全子宫切除、全子宫切除加淋巴结清扫、广泛子宫切除加淋巴结清扫。31例广泛全子宫切除的患者没有发现宫旁浸润。34例行淋巴结清扫的病人没有发现淋巴结转移。平均随访80个月未见复发。结论:关于微浸润腺癌的处理仍旧有争议,相对于微浸润宫颈鳞状细胞癌而言,传统的治疗宫颈微浸润腺癌彻底外科治疗更多一些。通过本次研究,我们认为宫颈为浸润癌基质浸润深度小于3mm或者FIGOIA1期的患者,简单的全子宫切除足够,不需要淋巴结清扫、广泛的子宫切除和卵巢切除。     

腹腔镜结肠癌根治术与传统开腹结肠癌根治术的临床对比分析

目的:探讨腹腔镜结肠癌根治术与传统开腹结肠癌根治术疗效的差别。方法:随机将86例结肠癌患者分为两组,各43例。腹腔镜组采用腹腔镜结肠癌根治术,传统开腹组采用开腹结肠癌根治术,观察两组患者手术情况及术后并发症情况。结果:腹腔镜组手术时间、淋巴结清扫数与传统开腹组比较无显著差异(P0.05);腹腔镜组术中出血量少于传统开腹组、住院时间短于传统开腹组(P0.05);腹腔镜组排气时间短于传统开腹组(P0.01),两组并发症发生率差异有统计学意义(P0.01)。结论:腹腔镜结肠癌根治术具有术中出血量少、创伤小、术后恢复快、住院时间明显缩短等特点,可达到传统开腹手术的效果,值得广泛应用。     

放化疗与介入性动脉化疗治疗局部晚期宫颈癌的临床研究

目的:比较分析放化疗与介入性动脉化疗治疗局部晚期动脉宫颈癌的临床效果。方法:选择我院局部晚期宫颈癌患者97例,依据治疗方法分为常规组(行传统放化疗)55例和介入组(行介入性动脉化疗)42例。观察治疗后肿瘤大小、近期疗效、根治性手术率、术后并发症,对生活质量指数进行评分,评价两种方法的临床效果。结果:治疗后,两组患者近期疗效比较差异无统计学意义(P0.05);介入组肿瘤直径明显小于常规组,而根治性手术率明显高于常规组,差异均具有统计学意义(P0.05);介入组患者日常生活、健康、总体情况以及总的评分均明显高于常规组,差异具有统计学意义(P0.05),同时介入组并发症较少。结论:放化疗与介入性动脉化疗治疗局部晚期动脉宫颈癌近期临床疗效均较好,但介入性动脉化疗具有较高的根治性手术率以及生活质量,且并发症少。     

Cervical intraepithelial neoplasia and associated condylomatous lesions. A preliminary report on 4,764 women from Northern Israel

During the period spanning the years 1973 to 1981, 4,764 women visited the Gynecology Out-Patient Clinics and Colposcopy Unit of the Nahariyya Hospital to be examined colposcopically and cytologically (and histologically whenever indicated) for precancerous and cancerous lesions of the cervix. Of these women, 2,614 (55%) were referred because of symptoms of cervical pathology and 2,150 (45%) for other (prophylactic) reasons. The subdivision of all women according to their demographic backgrounds afforded a comparison of the findings in Israeli-born Jewesses with those of foreign-born Jewesses and non-Jewish females living in the same geographic area of the Western Galilee district of Israel. Despite the low prevalence of cervical cancer in Jewesses throughout the world, the preliminary report of our pilot study demonstrated that the percentage rates of all degrees of dysplasia/cervical intraepithelial neoplasia (CIN I, II and III) of the uterine cervix of Israeli-born Jewesses was 5.4% in patients with cervical pathology and 3.24% in noncervical-pathology patients. These rates were the highest recorded for any of the demographic groups: 2.06% and 0.33%, respectively, in Moslem women; 1.23% in Christian women with cervical pathology; 2.38% and 1.78%, respectively, in European/American-born Jewesses; and 1.63% and 0.48%, respectively, in Asian/African-born Jewesses. The highest proportion of CIN lesions occurred in the 15- to 30-year-old age groups. Of 100 CIN lesions found in all patients, 45 were cytohistologically associated with the cells of condylomatous lesions. Of 36 patients in whom cervical squamous-cell carcinoma lesions were detected, 18 (50%) were staged (FIGO) as carcinoma in situ (stage 0); the remainder were in stages IA, IB, IIA and IIB, with none in stages III or IV.     

Treatment of invasive cervical cancer: Rijeka experience

The aim of this retrospective analysis was to evaluate the survival rate in 661 patients with cervical cancer regarding two time periods 1990-1996 and 1997-2003 and the specific stage related risk factors. The respective five-year survival was 71.7% and 80.0%. Analyzing the risk factors in the univariate and multivariate regression modalities ultimately only two parameters, the two time periods and FIGO staging were found to be independent prognostic factors. The observed total improvement in the survival rate of the second time period is followed by an increase in conservative surgery in stage TIA1, a reduction in the use of adjuvant radiotherapy among operable stages Tlbl, Tlb2 and T2A, while the treatment of locally advanced cervical cancer did not differ significantly.     

The role of frozen section in surgical staging of low risk endometrial cancer

Background

The role of frozen section (FS) in intraoperative decision making for surgical staging of endometrial cancer is controversial. Objective of this study is to assess the agreement rate between the FS and paraffin section (PS); and the potential impact of the role of FS in the intra-operative decision making for the complete surgical staging in low risk endometrial cancer.

Methods

This is a retrospective analysis of patients diagnosed with intra-operative FS stage I, grade I or II endometrial cancer from 1995–2004. FS results were compared with final pathology results with regard to tumor grade, depth of myometrial invasion, cervical involvement, lymphovascular invasion, and lymph node involvement. Agreement statistic with kappa was calculated using SPSS statistical software. Categorical variables were tested using chi-square test with p value of ≤0.05 being statistically significant.

Results

Of the 457 patients with endometrial cancer, 146 were evaluated by intra-operative FS and met inclusion criteria. FS results were in disagreement with permanent section in 35% for the grade (kappa 0.58, p = 0.003), 28% for depth of myometrial invasion (kappa 0.61, p<0.0001), 13% for cervical involvement (kappa 0.78, p = 0.002), and 32% for lymphovascular invasion (kappa 0.6, p = 0.01). Permanent pathology upstaged 31.9% & 23.2% of FS stage IA, & IB specimen respectively. Lymph node dissection was done in 56.8%. Lymph node metastasis was identified in 8.4%. Use of intraoperative FS would have resulted in suboptimal surgical treatment in 13% stage IA and 6.6% of stage IB patients respectively by foregoing lymphadenectomy.

Conclusion

A significant number of patients with low risk endometrial cancer by FS were upstaged and upgraded on final pathology. Before placing absolute reliance on intraoperative FS to undertake complete surgical staging, the inherent limitation of the same in predicting final stage and grade highlighted by our data need to be carefully considered.     

Clinical management of patients with invasive cervical cancer following a negative Pap smear

Among 535 patients with invasive cervical carcinoma seen between January 1975 and June 1986, 26 were found to have developed the disease within six months (65 percent), 35 within 12 months (88 percent), 37 within 13 months (93 percent), and three developed the disease within 17 months after a negative Pap smear. Eighty-eight percent of these 40 patients were under age 40 at diagnosis. Rapidly progressive cancers are highly resistant to radiation therapy. Seven stage IB patients treated only with radiation died within nine to 29 months after initial therapy. By contrast, 15 patients treated by radical hysterectomy and four by radical hysterectomy and post-surgical radiation were alive with no evidence of disease from six to 109 months after surgery (median, 30 months). Six of nine patients with stage II to IV disease treated with radiation have died; the remaining three are alive. One patient is well 14 months after therapy, but two others have developed metastases seven and 12 months after treatment. Surprisingly, 37 of 40 patients had symptoms of pain, bleeding, and discharge at the initial diagnosis, but their physicians had a false sense of security because of a recent negative Pap smear. Early biopsy diagnosis and radical hysterectomy with bilateral pelvic lymphadenectomy is the most effective management for this cancer.     

Life-threatening bleeding after pelvic lymphadenectomy for cervical cancer: endovascular management of ruptured false aneurysm of the external iliac artery

ABSTRACT: Late rupture of external iliac artery pseudo-aneurysm is an uncommon complication in patients who undergo extensive gynecologic radical surgeries. A 28-year-old woman with stage IB cervical cancer underwent pelvic lymphadenectomy and extrafascial trachelectomy. Two months after surgery, massive bleeding from ruptured pseudo-aneurysm of the external iliac artery occurred. Endovascular management with covered stent placement was feasible and safe to stop bleeding.     

保留盆腔自主神经的宫颈癌根治术对Ib期宫颈癌患者性生活质量及膀胱直肠功能的影响

目的:探讨保留盆腔自主神经的宫颈癌根治术对Ib期宫颈癌患者性生活质量及膀胱直肠功能的影响。方法:选取我院于2010年1月~2017年1月期间收治的90例Ib期宫颈癌患者为研究对象,按乱数表法分为对照组和观察组,每组患者各45例。对照组患者采用传统的宫颈癌根治术治疗,观察组采用保留盆腔自主神经的宫颈癌根治术治疗。比较两组患者的手术情况、性生活质量以及膀胱直肠功能。结果:相比于对照组,观察组患者的手术时间较长,但住院时间较短(P0.05)。观察组术后残余尿量100 m L、50 m L的时间、肛门排气时间、排便时间与对照组比较均明显较短(P0.05)。术后观察组性生活质量各项评分低于对照组(P0.05)。观察组并发症发生率为6.67%,明显低于对照组的22.22%(P0.05)。结论:保留盆腔自主神经的宫颈癌根治术治疗Ib期宫颈癌患者临床疗效显著,有利于患者术后膀胱直肠功能的快速恢复,对患者的性生活质量影响较小,且术后并发症较少。     

Could the Extent of Lymphadenectomy Be Modified by Neoadjuvant Chemotherapy in Cervical Cancer? A Large-Scale Retrospective Study

Background

The effect of neoadjuvant chemotherapy (NACT) on topographical distribution patterns of lymph node metastasis in cervical cancer was unknown.

Methods

Patients with FIGO stage IB1-IIB who underwent radical surgery with or without NACT were enrolled (3527 patients). A matched-case comparison design was used to compare the effects of NACT on lymph node metastasis.

Results

We analyzed groups of 167 and 140 patients who were diagnosed with lymph node metastasis in the matched primary surgery group and NACT group, respectively, and no significant difference was observed (p = 0.081). The incidence of lymph node metastasis was significantly decreased in the NACT-responsive group compared to the non-responsive group (18.4% vs. 38.6%, P<0.001). The metastatic rates for every lymph node group also declined in the NACT-responsive group except for the deep inguinal and the para-aortic lymph node groups. Clinical response, deep stromal, parametrial and lymph vascular invasions were independent risk factors for lymph node metastasis in the NACT group. Furthermore, deep stromal invasion and lymph vascular invasion, but not the response to NACT, were independently associated with upper LNM. The number of lymph nodes involved, response to NACT, tumor histology and a positive vaginal margin were independent prognostic factors affecting DFS or OS rates in node-positive patients treated with NACT plus radical surgery.

Conclusion

The frequency and topographic distribution of LNM are not modified by NACT, and clinical non-responders showed more involved LNs. A systemic and extensive lymphadenectomy should be performed in patients treated with NACT plus surgery regardless of the response to NACT.     

INDICATIONS FOR OPERATION IN LARYNGEAL CANCER

Improvements in the surgical treatment of laryngeal cancer by combined laryngectomy and radical neck dissection have given new importance to selection of the mode of treatment for various stages of disease at that site. To cast light on the subject, the cases of 63 patients with cancer of the larynx were reviewed. Twenty-one of them were operated on for recurrence after radiation therapy; and 42 were treated surgically at the outset, 36 of them having combined laryngectomy and radical neck dissection. In almost 80 per cent of the patients the lesion was extrinsic.In the entire series, 51 patients had combined operations, and in 41 of them the cervical lymph nodes were positive for metastasis.Reports in the literature also make note of a very high incidence of cervical node metastasis not only in cases of extrinsic cancer, but also in those in which the lesion is intrinsic.Because of the frequency of cervical node spread, and its occult nature, choice between radiation and surgical operation must be made after candid, critical appraisal of the individual condition in each patient.