Does lymph node involvement affect the patterns of recurrence in stage IB cervical cancer?
To investigate the variations in the recurrence patterns of stage IB cervical cancer according to lymph node involvement. Materials and methods: We reviewed the medical records of 170 patients who had undergone type III radical hysterectomy and systematic lymphadenectomy from 1993 to 2007. Results: Among the patients in the study group, 115 did not have lymph node metastases, whereas 55 did. A total of 27 patients developed recurrences. Twelve were in the lymph node-negative group, and 15 were in the lymph node-positive group. The recurrence rate was higher in lymph node-positive group (27.3% versus 10.4%, P = 0.011). The recurrence pattern was not affected by lymph node involvement. However, distant recurrence was more common in the lymph node-positive group (53.3% versus 25%, P = 0.137). Additionally, distant failure was observed only in the patients in the lymph node-negative group who received adjuvant radiotherapy. In this group, 3 patients who did not receive adjuvant radiotherapy developed recurrences only in the pelvic region. Conclusion: The presence of lymph node involvement in stage IB cervical cancer does not affect the site of recurrence. However, distant recurrence was more frequent in the lymph node-positive group.
Does lymph node involvement affect the patterns of recurrence in stage IB cervical cancer?
To investigate the variations in the recurrence patterns of stage IB cervical cancer according to lymph node involvement. Materials and methods: We reviewed the medical records of 170 patients who had undergone type III radical hysterectomy and systematic lymphadenectomy from 1993 to 2007. Results: Among the patients in the study group, 115 did not have lymph node metastases, whereas 55 did. A total of 27 patients developed recurrences. Twelve were in the lymph node-negative group, and 15 were in the lymph node-positive group. The recurrence rate was higher in lymph node-positive group (27.3% versus 10.4%, P = 0.011). The recurrence pattern was not affected by lymph node involvement. However, distant recurrence was more common in the lymph node-positive group (53.3% versus 25%, P = 0.137). Additionally, distant failure was observed only in the patients in the lymph node-negative group who received adjuvant radiotherapy. In this group, 3 patients who did not receive adjuvant radiotherapy developed recurrences only in the pelvic region. Conclusion: The presence of lymph node involvement in stage IB cervical cancer does not affect the site of recurrence. However, distant recurrence was more frequent in the lymph node-positive group.
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- Waggoner SE. Cervical cancer. Lancet 2003; 361: 2217–2225.
- Parkin DM, Bray FI, Devesa SS. Cancer burden in the year 2000. The global picture. Eur J Cancer 2001; 37: S4–S66. 3. Landoni F, Maneo A, Colombo A, Placa F, Milani R, Perego P, Favini G, Ferri L, Mangioni C. Randomised study of radical surgery versus radiotherapy for stage Ib–IIa cervical cancer. Lancet 1997; 350: 535–540.
- Tinga DJ, Timmer PR, Bouma J, Aalders JG. Prognostic significance of single versus multiple lymph node metastases in cervical carcinoma stage Ib. Gynecol Oncol 1990; 39: 175–180.
- Sardi J, Sananes C, Giaroli A, Bayo J, Rueda NG, Vighi S, Guardado N, Paniceres G, Snaidas L, Vico C et al. Results of a prospective trial with neoadjuvant chemotherapy in stage IB bulky, squamous carcinoma of the cervix. Gynecol Oncol 1993; 49: 156–165.
- Benedetti-Panici P, Maneschi F, D’Andrea G, Cutillo G, Rabitti C, Congiu M, Coronetta F, Capelli A. Early cervical carcinoma: the natural history of lymph node involvement redefined on the basis of thorough parametrectomy and giant section study. Cancer 2000; 88: 2267–2274.
- Horn LC, Fischer U, Raptis G, Bilek K, Hentschel B. Tumor size is of prognostic value in surgically treated FIGO stage II cervical cancer. Gynecol Oncol 2007; 107: 310–315.
- Finan MA, DeCesare S, Fiorica JV, Chambers R, Hoffman MS, Kline RC, Roberts WS, Cavanagh D. Radical hysterectomy for stage IB1 vs IB2 carcinoma of the cervix: does the new staging system predict morbidity and survival? Gynecol Oncol 1996; 62: 139–147.
- Kawagoe T, Kashimura M, Matsuura Y, Sugihara K, Toki N, Aoki T. Clinical significance of tumor size in stage IB and II carcinoma of the uterine cervix. Int J Gynecol Cancer 1999; 9: 421–426.
- Kamelle SA, Rutledge TL, Tillmanns TD, Gould NS, Cohn DE, Wright J, Herzog TJ, Rader JS, Gold MA, Johnson GA et al. Surgical-pathological predictors of disease-free survival and risk groupings for IB2 cervical cancer: do the traditional models still apply? Gynecol Oncol 2004; 94: 249–255.
- Trattner M, Graf AH, Lax S, Forstner R, Dandachi N, Haas J, Pickel H, Reich O, Staudach A, Winter R. Prognostic factors in surgically treated stage Ib-IIb cervical carcinomas with special emphasis on the importance of tumor volume. Gynecol Oncol 2001; 82: 11–16.
- Burghardt E, Baltzer J, Tulusan AH, Haas J. Results of surgical treatment of 1028 cervical cancers studied with volumetry. Cancer 1992; 70: 648–655.
- Stehman FB, Bundy BN, DiSaia PJ, Keys HM, Larson JE, Fowler WC. Carcinoma of the cervix treated with radiation therapy. I. A multi-variate analysis of prognostic variables in the Gynecologic Oncology Group. Cancer 1991; 67: 2776– 2785.
- Rutledge TL, Kamelle SA, Tillmanns TD, Gould NS, Wright JD, Cohn DE, Herzog TJ, Rader JS, Gold MA, Johnson GA et al. A comparison of stage IB1 and IB2 cervical cancers treated with radical hysterectomy. Is size the real difference? Gynecol Oncol 2004; 95: 70–76.
- Metindir J, Bilir G. Prognostic factors affecting disease-free survival in early-stage cervical cancer patients undergoing radical hysterectomy and pelvic-paraaortic lymphadenectomy. Eur J Gynaecol Oncol 2007; 28: 28–32.
- Rosa DD, Medeiros LR, Edelweiss MI, Pohlmann PR, Stein AT. Adjuvant platinum-based chemotherapy for early stage cervical cancer. Cochrane Database Syst Rev 2012; 6: 5342.
- Hosaka M, Watari H, Kato T, Odagiri T, Konno Y, Endo D, Mitamura T, Kikawa S, Suzuki Y, Sakuragi N. Clinical efficacy of paclitaxel/cisplatin as an adjuvant chemotherapy for patients with cervical cancer who underwent radical hysterectomy and systematic lymphadenectomy. J Surg Oncol 2012; 105: 612–616.
- Ratanatharathorn V, Powers WE, Steverson N, Han I, Ahmad K, Grimm J. Bone metastasis from cervical cancer. Cancer 1994; 73: 2372–2379.
- Thanapprapasr D, Nartthanarung A, Likittanasombut P, Na Ayudhya NI, Charakorn C, Udomsubpayakul U, Subhadarbandhu T, Wilailak S. Bone metastasis in cervical cancer patients over a 10-year period. Int J Gynecol Cancer 2010; 20: 373–378.
- Kim RY, Weppelmann B, Salter MM, Brascho DJ. Skeletal metastases from cancer of the uterine cervix: frequency, patterns, and radiotherapeutic significance. Int J Radiat Oncol 1987; 13: 705–708.
- Nartthanarung A, Thanapprapasr D. Comparison of outcomes for patients with cervical cancer who developed bone metastasis after the primary treatment with concurrent chemoradiation versus radiation therapy alone. Int J Gynecol Cancer 2010; 20: 1386–1390.