Management of Locally Advanced Cervical Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Survivorship and Quality of Life".

Deadline for manuscript submissions: closed (20 December 2023) | Viewed by 4384

Special Issue Editors


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Guest Editor
Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Meibergdreef, 1105 AZ Amsterdam, The Netherlands
Interests: radiation oncology

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Guest Editor
Department of Obstetrics and Gynecology, Center for Gynecological Oncology Amsterdam (CGOA), Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
Interests: gynecologic oncology

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Guest Editor
Department of Research and Development, Netherlands Comprehensive Cancer Organization, 3501 DB Utrecht, The Netherlands
Interests: epidemiology

Special Issue Information

Dear Colleagues,

Cervical cancer is the fourth most common cancer among women. The disease particularly disrupts the lives of women and their families in low- and middle-income countries [1], and in high-income countries women with a barrier to prevention, to early detection and to appropriate care [ref 2]. International efforts against cervical cancer are primarily focused on prevention by vaccination of HPV and screening for pre-malignant stages [3]. The reality is that most preventive strategies will be effective only in the distant future, 20 to 30 years from now, and they do not adequately reach the high-risk population who would benefit most. In underserved populations, the majority of patients present with locally advanced cervical cancer disease (LACC). Therefore, optimal management of women with LACC remains a major and difficult challenge.

In this forthcoming Special Issue, a motivated international team of experts from many medical disciplines will address a comprehensive scope of topics. Topics ranging from a description of the history, epidemiology and demography of patients with LACC, to clinical reviews and original papers on diagnosis, the role of radiotherapy and combined modality treatment, the role of surgery, particularly for nodal disease and for recurrent disease, and the promises of innovative drugs and therapeutic vaccination are all welcome. Considering the major burden of disease and its treatment, the management of late toxicity, and preservation of quality of life will be covered in separate chapters. Since social and economic determinants strongly determine the fate of women with LACC, we will pay special attention to social and economic issues, such as the organization and cost of care for women in low-, middle- and high-income countries.

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021:71:209–49. doi:10.3322/caac.21660.
  2. Paper on SES and cervical cancer in Western countries.
  3. WHO—World Health Organization. Cervical Cancer, 22 February 2022.

Prof. Dr. Lukas Stalpers
Dr. Constantijne H. Mom
Dr. Maaike A. Van der Aa
Guest Editors

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Published Papers (4 papers)

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Research

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9 pages, 486 KiB  
Article
Treatment Strategies Guided by [18F]FDG-PET/CT in Patients with Locally Advanced Cervical Cancer and [18F]FDG-Positive Lymph Nodes
by Ester P. Olthof, Hans H. B. Wenzel, Jacobus van der Velden, Lukas J. A. Stalpers, Constantijne H. Mom and Maaike A. van der Aa
Cancers 2024, 16(4), 717; https://doi.org/10.3390/cancers16040717 - 8 Feb 2024
Viewed by 748
Abstract
Background: Modern treatment guidelines for women with advanced cervical cancer recommend staging using 2-deoxy-2-[18F]fluoro-D-glucose positron emission computed tomography ([18F]FDG-PET/CT). However, the risk of false-positive nodes and therapy-related adverse events requires caution in treatment planning. Using data from the Netherlands [...] Read more.
Background: Modern treatment guidelines for women with advanced cervical cancer recommend staging using 2-deoxy-2-[18F]fluoro-D-glucose positron emission computed tomography ([18F]FDG-PET/CT). However, the risk of false-positive nodes and therapy-related adverse events requires caution in treatment planning. Using data from the Netherlands Cancer Registry (NCR), we estimated the impact of [18F]FDG-PET/CT on treatment management in women with locally advanced cervical cancer, i.e., on nodal boosting, field extension, and/or debulking in cases of suspected lymph nodes. Methods: Women diagnosed between 2009 and 2017, who received chemoradiotherapy for International Federation of Gynaecology and Obstetrics (2009) stage IB2, IIA2-IVB cervical cancer with an [18F]FDG-positive node, were retrospectively selected from the NCR database. Patients with pathological nodal examination before treatment were excluded. The frequency of nodal boosting, extended-field radiotherapy, and debulking procedures applied to patients with [18F]FDG-positive lymph nodes was evaluated. Results: Among the 434 eligible patients with [18F]FDG-positive nodes, 380 (88%) received interventions targeting these lymph nodes: 84% of these 380 patients received nodal boosting, 78% extended-field radiotherapy, and 12% debulking surgery. [18F]FDG-positive nodes in patients receiving these treatments were more likely to be classified as suspicious than inconclusive (p = 0.009), located in the para-aortic region (p < 0.001), and larger (p < 0.001) than in patients who did not receive these treatments. Conclusion: While existing guidelines advocate [18F]FDG-PET/CT-guided treatment planning for the management of advanced cervical cancer, this study highlights that not all cases of [18F]FDG-positive nodes received an intervention, possibly due to the risk of false-positive results. Improvement of nodal staging may reduce suboptimal treatment planning. Full article
(This article belongs to the Special Issue Management of Locally Advanced Cervical Cancer)
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12 pages, 963 KiB  
Article
Why Is Surgery Still Done after Concurrent Chemoradiotherapy in Locally Advanced Cervical Cancer in Romania?
by Silviu Cristian Voinea, Cristian Ioan Bordea, Elena Chitoran, Vlad Rotaru, Razvan Ioan Andrei, Sinziana-Octavia Ionescu, Dan Luca, Nicolae Mircea Savu, Cristina Mirela Capsa, Mihnea Alecu and Laurentiu Simion
Cancers 2024, 16(2), 425; https://doi.org/10.3390/cancers16020425 - 19 Jan 2024
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Abstract
The incidence and mortality of cervical cancer are high in Romania compared to other European countries, particularly for locally advanced cervical cancer cases, which are predominant at the time of diagnosis. Widely accepted therapeutic guidelines indicate that the treatment for locally advanced cervical [...] Read more.
The incidence and mortality of cervical cancer are high in Romania compared to other European countries, particularly for locally advanced cervical cancer cases, which are predominant at the time of diagnosis. Widely accepted therapeutic guidelines indicate that the treatment for locally advanced cervical cancer consists of concurrent chemoradiotherapy (total dose 85–90 Gy at point A), with surgery not being necessary as it does not lead to improved survival and results in significant additional morbidity. In Romania, the treatment for locally advanced cervical cancer differs, involving lower-dose chemoradiotherapy (total dose 60–65 Gy at point A), followed by surgery, which, under these circumstances, ensures better local control. In this regard, we attempted to evaluate the role and necessity of surgery in Romania, considering that in our study, residual lesions were found in 55.84% of cases on resected specimens, especially in cases with unfavorable histology (adenocarcinoma and adenosquamous carcinoma). This type of surgery was associated with significant morbidity (28.22%) in our study. The recurrence rate was 24.21% for operated-on patients compared to 62% for non-operated-on patients receiving suboptimal concurrent chemotherapy alone. In conclusion, in Romania, surgery will continue to play a predominant role until radiotherapy achieves the desired effectiveness for local control. Full article
(This article belongs to the Special Issue Management of Locally Advanced Cervical Cancer)
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17 pages, 2010 KiB  
Article
The Role of Multimodal Imaging in Pathological Response Prediction of Locally Advanced Cervical Cancer Patients Treated by Chemoradiation Therapy Followed by Radical Surgery
by Tina Pasciuto, Francesca Moro, Angela Collarino, Maria Antonietta Gambacorta, Gian Franco Zannoni, Marco Oradei, Maria Gabriella Ferrandina, Benedetta Gui, Antonia Carla Testa and Vittoria Rufini
Cancers 2023, 15(12), 3071; https://doi.org/10.3390/cancers15123071 - 6 Jun 2023
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Abstract
Purpose: This study aimed to develop predictive models for pathological residual disease after neoadjuvant chemoradiation (CRT) in locally advanced cervical cancer (LACC) by integrating parameters derived from transvaginal ultrasound, MRI and PET/CT imaging at different time points and time intervals. Methods: Patients with [...] Read more.
Purpose: This study aimed to develop predictive models for pathological residual disease after neoadjuvant chemoradiation (CRT) in locally advanced cervical cancer (LACC) by integrating parameters derived from transvaginal ultrasound, MRI and PET/CT imaging at different time points and time intervals. Methods: Patients with histologically proven LACC, stage IB2–IVA, were prospectively enrolled. For each patient, the three examinations were performed before, 2 and 5 weeks after treatment (“baseline”, “early” and “final”, respectively). Multivariable logistic regression models to predict complete vs. partial pathological response (pR) were developed and a cost analysis was performed. Results: Between October 2010 and June 2014, 88 patients were included. Complete or partial pR was found in 45.5% and 54.5% of patients, respectively. The two most clinically useful models in pR prediction were (1) using percentage variation of SUVmax retrieved at PET/CT “baseline” and “final” examination, and (2) including high DWI signal intensity (SI) plus, ADC, and SUVmax collected at “final” evaluation (area under the curve (95% Confidence Interval): 0.80 (0.71–0.90) and 0.81 (0.72–0.90), respectively). Conclusion: The percentage variation in SUVmax in the time interval before and after completing neoadjuvant CRT, as well as DWI SI plus ADC and SUVmax obtained after completing neoadjuvant CRT, could be used to predict residual cervical cancer in LACC patients. From a cost point of view, the use of MRI and PET/CT is preferable. Full article
(This article belongs to the Special Issue Management of Locally Advanced Cervical Cancer)
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Review

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18 pages, 826 KiB  
Review
The Role of Pelvic Exenteration in Cervical Cancer: A Review of the Literature
by Ana Carla Franco Ubinha, Priscila Grecca Pedrão, Aline Cássia Tadini, Ronaldo Luis Schmidt, Marcelo Henrique dos Santos, Carlos Eduardo Mattos da Cunha Andrade, Adhemar Longatto Filho and Ricardo dos Reis
Cancers 2024, 16(4), 817; https://doi.org/10.3390/cancers16040817 - 18 Feb 2024
Cited by 1 | Viewed by 1110
Abstract
Pelvic exenteration represents a radical procedure aimed at achieving complete tumor resection with negative margins. Although it is the only therapeutic option for some cases of advanced tumors, it is associated with several perioperative complications. We believe that careful patient selection is related [...] Read more.
Pelvic exenteration represents a radical procedure aimed at achieving complete tumor resection with negative margins. Although it is the only therapeutic option for some cases of advanced tumors, it is associated with several perioperative complications. We believe that careful patient selection is related to better oncologic outcomes and lower complication rates. The objectives of this review are to identify the most current indications for this intervention, suggest criteria for case selection, evaluate recommendations for perioperative care, and review oncologic outcomes and potential associated complications. To this end, an analysis of English language articles in PubMed was performed, searching for topics such as the indication for pelvic exenteration for recurrent gynecologic neoplasms selection of oncologic cases, the impact of tumor size and extent on oncologic outcomes, preoperative and postoperative surgical management, surgical complications, and outcomes of overall survival and recurrence-free survival. Full article
(This article belongs to the Special Issue Management of Locally Advanced Cervical Cancer)
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