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Chemotherapy in recurrent or advanced cervical cancer
THURSDAY,
SEPTEMBER
7
P4.02.03 CERVICAL CANCER: FEASIBILITY AND PRELIMINARY RESULTS OF SIX CASES UNDERGOING LAPAROSCOPIC ASSISTED RADICAL VAGINAL HYSTERECTOMY M. Pinho de Oliveira, H. Carneiro de Oliveira, L.A. Melki, State University of Rio de Janeiro, R. Coelho neto 551201, Laranjeiras, Rio de Janeiro, Brazil, 22231-110. Objectives: The aim of the study was to evaluate any recurrency of cervical cancer after laparoscopic assisted radical vaginal hysterectomy Study Methods: Six women between 24 -48 years were prospectively followed for at least one year (l-4 years). Three cases were classified as FIG0 Ia and three as Ibl (< 3 cm). Five cases were epidermoid carcinoma and one case adenocarcinoma. No adjuvant therapy were used postoperatively. Results: Laparoscopic phase consisted of pelvic lymphadenectomy (common iliac, external iliac, hypogastric and obturatory vessels), uterine vessels ligature and ureteral dissection. One case was associated with a myoma (6 cm) and severe adhesion. The ovaries were preserved in one case (youngest patient) and they were fixed laterally and in a higher position. Laparoscopic duration time was from 220 to 300 min (mean 240 min). The vaginal phase ranged from 60 to 120 min (mean 90 min). No transfusion were necessary. Postoperatively no infections or fistulae were found. Hospital stay ranged from 3 to 7 days (mean 5 days). Number of lymphonodes retrieved varied from 13 to 18. None of them were metastatic. In a follow up of 1 to 4 years (mean 2 years) all patientes are alive and no recurrencies were noted. Conclusions: This study demonstrate the feasibility of the technique. Larger studies are encouraged with 5-year survival as the event of interest
P4.02.04 CHEMOTHERAPY IN RECURRENT OR ADVANCED CERVICAL CANCER M. C. Navarro, B. Certa, R. Yazigi, R. Castilla, .I. Garrido, S. Prado, Dept. OBIGYN, Chemotherapy Group, National Institute of Cancer, Santiago, Chile. Objective: During the past years, treatment in cervical cancer has been mainly surgery and radiation therapy and to a lesser degree, chemotherapy. Currently, the last one has become more important in coadyuvant treatment. Chemotherapy is the only treatment observed for those cases with metastasic disease or local recurrence with no indication of surgical or radiation therapy. In a review of the literature, the rate of response to chemotherapy of the squamous tumors of the cervix reaches the 25% with no evidence of improvement in life quality or survival. The aim of this study is to present the experience of chemotherapy treatment in cervical cancer in the National Institute of Cancer in Chile. Study Methods: We analyzed 21 patients with cervical cancer in the period between January 1995 and July 1999 who met the following criteria: recurrence or persistence of disease during or after the standard treatments with surgery or radiation. The data was collected from the patients’ records and analyzed through the programs File Maker 4.0 and StatView 4.5. Results: Among the 21 patients, 16 presented recurrence of disease and 5 presented disease persistence. In the recurrence group, there were 15 cases of squamous cancer. The stages were 1 case lbl, 2 cases lb2,8 cases llb and 4 cases lllb. The treatments were 1 case surgery, 3 cases surgery plus radiation and only radiation 11 cases. The average free time of disease was 36.8 months (6-240 months). The recurrence places were mostly cervix, vagina and paracervical tissues. The chemotherapy drug used was Cis platino in all cases, doses of 75 mg/m2 in 15 patients and 100 mg/m2 in one case. There was no serious toxicity in our serie. There was one complete response, 2 partial response and no response in 12 patients. In the persistence group, all the 5 cases were squamous histologic type. The stages were lb1 2 cases, llb 1 case, lllb 2 cases. The drug used for chemotherapy was Cis platino in all cases at 75 mg/m2 dose. All the patients presented mild or moderate toxicity. There was no response to chemotherapy in 4 patients. Conclusion: The standard treatments of cervical cancer are surgery and radiation with participation of chemotherapy especially in coadyuvant therapy. The indications for chemotherapy are distant metastasisc disease, recurrence disease which cannot be treated by surgery or radiation and coadyuvant with radiation therapy. The results of the use
87
of chemotherapy in recurrence and persistence disease have failed to show improvement in quality of life or survival rate. The drug mostly used is Cis platino. The results of the National Institute of Cancer in Chile following the international guides have failed to show response or better survival rates.
P4.02.05 COMPARISON BETWEEN HYDROXYUREA (HU) AND MITOMYCIN-C (MMC) AS CHEMOTHERAPY ADJUVANT ON CARCINOMA OF THE UTERINE CERVIX (CUC) RADIOTHERAPY M.T.Sutoto. H. Kristanto, E.W. Ambari, Dept. OBIGYN, Diponegoro University, Dr. Kariadi Hospital, Semarang, Indonesia. Sutoto et al. (1987) reported that MMC adjuvant gave better results in the treatment of CUC radiotherapy. Piver (1989) also reported good results on CUC radiotherapy by giving HU as radiomimetic agent. Objective: To compare the results of treatment of HU and MMC as chemotherapy adjuvant on CUC radiotherapy. Study Methods: A prospective randomized clinical trial was carried out on epidermoid CUC patients stage III-B who were treated with radiotherapy. One group got high dose MMC (49) and the other group (34) got HU as described by Piver et al. The study began from June 1, 1997 until December, 1998, and then followed-up until November, 1999, at Dr. Kariadi Hospital. Survival of patients were calculated with Kaplan Meier logrank test. Characteristics of patients and complications were calculated with Xz and t-Student tests as appropriate. Results: No difference in characteristics, which consist of age (p=O.98), hemoglobin level (p=O.994), histological radiation response (p=O.l), types of radiotherapy (external Co with/without Cs after loading) (p=O.517), were found. There were no differences in the survival between those 2 groups (p=O.677). No differences in complications were found: hematology (p=O.989), gastrointestinal (p=O.457), and cutaneus. No pelvic fistula was found. Conclusions: No significant differences were found between the characteristics among those 2 groups, resulting no significant difference in survival between those 2 groups. There were also no differences in complications found among those 2 groups of patients, but MMC is more expensive; on the other hand HU needs more discipline in taking regularly.
P4.02.06 CONSERVATIVE SURGICAL TREATMENT OF INVASIVE CERVICAL CARCINOMA IN YOUNGER WOMEN L. N. Prokic, N. Antic, S. Runic, V. Rajkovic, S. Jankovic, Z. Perisic, R. Radosavljevic, T. Moskovic, R.Lukic, F. Canovic, Dept. OBIGYN, Clinic “Narodni Front” School of Medicine University of Belgrade, Belgrade, Yugoslavia. Objectives: The aim of this study is to evaluate the possibility of an application of the conservative surgical treatment in younger patients suffering form the invasive cervical carcinoma stage I-A according to the FIG0 classification, motivated for the childbearing. Study Methods: There were 12 patients under 30 years of age operated in our Clinic during the three years period. In the first act, the conisation due to the diagnosed invasive squamous epithelial carcinoma of the uterine cervix, stage I, N-l, was done in all the observed patients. Afterwards in the second act, the amputation of the cervix together with the bilateral lymphadenectomy in the small pelvis was performed in all the patients. Results: In seven patients (58%) the hystopathological diagnosis was: chronic cervicitis in the amputated part of the cervix; at the same time between 12 to 19 lymph nodes obtained from the obturatory fossaes were without elements of tumorous tissue. For these patients the amputation and the bilateral lymphadenectomy was the definite operative treatment. In three patients (25%), the early stromal invasion up to 3 m was discovered, also there were between 12 and 18 lymph nodes without elements of the tumorous tissue. For these patients the amputation of the uterine cervix with bilateral lymphadenetomy was the definite treatment. In two patients (17%), the invasive squamous epithelium carcinoma of the uterine cervix (G-2, N-) was discovered in the part of the uterine cervix. In one patient there were three positive lymph nodes on the left side out of totally 16 (3116). Besides this, there were no changes in 18 lymph nodes in another patient. Both patients
SEPTEMBER
7
P4.02.03 CERVICAL CANCER: FEASIBILITY AND PRELIMINARY RESULTS OF SIX CASES UNDERGOING LAPAROSCOPIC ASSISTED RADICAL VAGINAL HYSTERECTOMY M. Pinho de Oliveira, H. Carneiro de Oliveira, L.A. Melki, State University of Rio de Janeiro, R. Coelho neto 551201, Laranjeiras, Rio de Janeiro, Brazil, 22231-110. Objectives: The aim of the study was to evaluate any recurrency of cervical cancer after laparoscopic assisted radical vaginal hysterectomy Study Methods: Six women between 24 -48 years were prospectively followed for at least one year (l-4 years). Three cases were classified as FIG0 Ia and three as Ibl (< 3 cm). Five cases were epidermoid carcinoma and one case adenocarcinoma. No adjuvant therapy were used postoperatively. Results: Laparoscopic phase consisted of pelvic lymphadenectomy (common iliac, external iliac, hypogastric and obturatory vessels), uterine vessels ligature and ureteral dissection. One case was associated with a myoma (6 cm) and severe adhesion. The ovaries were preserved in one case (youngest patient) and they were fixed laterally and in a higher position. Laparoscopic duration time was from 220 to 300 min (mean 240 min). The vaginal phase ranged from 60 to 120 min (mean 90 min). No transfusion were necessary. Postoperatively no infections or fistulae were found. Hospital stay ranged from 3 to 7 days (mean 5 days). Number of lymphonodes retrieved varied from 13 to 18. None of them were metastatic. In a follow up of 1 to 4 years (mean 2 years) all patientes are alive and no recurrencies were noted. Conclusions: This study demonstrate the feasibility of the technique. Larger studies are encouraged with 5-year survival as the event of interest
P4.02.04 CHEMOTHERAPY IN RECURRENT OR ADVANCED CERVICAL CANCER M. C. Navarro, B. Certa, R. Yazigi, R. Castilla, .I. Garrido, S. Prado, Dept. OBIGYN, Chemotherapy Group, National Institute of Cancer, Santiago, Chile. Objective: During the past years, treatment in cervical cancer has been mainly surgery and radiation therapy and to a lesser degree, chemotherapy. Currently, the last one has become more important in coadyuvant treatment. Chemotherapy is the only treatment observed for those cases with metastasic disease or local recurrence with no indication of surgical or radiation therapy. In a review of the literature, the rate of response to chemotherapy of the squamous tumors of the cervix reaches the 25% with no evidence of improvement in life quality or survival. The aim of this study is to present the experience of chemotherapy treatment in cervical cancer in the National Institute of Cancer in Chile. Study Methods: We analyzed 21 patients with cervical cancer in the period between January 1995 and July 1999 who met the following criteria: recurrence or persistence of disease during or after the standard treatments with surgery or radiation. The data was collected from the patients’ records and analyzed through the programs File Maker 4.0 and StatView 4.5. Results: Among the 21 patients, 16 presented recurrence of disease and 5 presented disease persistence. In the recurrence group, there were 15 cases of squamous cancer. The stages were 1 case lbl, 2 cases lb2,8 cases llb and 4 cases lllb. The treatments were 1 case surgery, 3 cases surgery plus radiation and only radiation 11 cases. The average free time of disease was 36.8 months (6-240 months). The recurrence places were mostly cervix, vagina and paracervical tissues. The chemotherapy drug used was Cis platino in all cases, doses of 75 mg/m2 in 15 patients and 100 mg/m2 in one case. There was no serious toxicity in our serie. There was one complete response, 2 partial response and no response in 12 patients. In the persistence group, all the 5 cases were squamous histologic type. The stages were lb1 2 cases, llb 1 case, lllb 2 cases. The drug used for chemotherapy was Cis platino in all cases at 75 mg/m2 dose. All the patients presented mild or moderate toxicity. There was no response to chemotherapy in 4 patients. Conclusion: The standard treatments of cervical cancer are surgery and radiation with participation of chemotherapy especially in coadyuvant therapy. The indications for chemotherapy are distant metastasisc disease, recurrence disease which cannot be treated by surgery or radiation and coadyuvant with radiation therapy. The results of the use
87
of chemotherapy in recurrence and persistence disease have failed to show improvement in quality of life or survival rate. The drug mostly used is Cis platino. The results of the National Institute of Cancer in Chile following the international guides have failed to show response or better survival rates.
P4.02.05 COMPARISON BETWEEN HYDROXYUREA (HU) AND MITOMYCIN-C (MMC) AS CHEMOTHERAPY ADJUVANT ON CARCINOMA OF THE UTERINE CERVIX (CUC) RADIOTHERAPY M.T.Sutoto. H. Kristanto, E.W. Ambari, Dept. OBIGYN, Diponegoro University, Dr. Kariadi Hospital, Semarang, Indonesia. Sutoto et al. (1987) reported that MMC adjuvant gave better results in the treatment of CUC radiotherapy. Piver (1989) also reported good results on CUC radiotherapy by giving HU as radiomimetic agent. Objective: To compare the results of treatment of HU and MMC as chemotherapy adjuvant on CUC radiotherapy. Study Methods: A prospective randomized clinical trial was carried out on epidermoid CUC patients stage III-B who were treated with radiotherapy. One group got high dose MMC (49) and the other group (34) got HU as described by Piver et al. The study began from June 1, 1997 until December, 1998, and then followed-up until November, 1999, at Dr. Kariadi Hospital. Survival of patients were calculated with Kaplan Meier logrank test. Characteristics of patients and complications were calculated with Xz and t-Student tests as appropriate. Results: No difference in characteristics, which consist of age (p=O.98), hemoglobin level (p=O.994), histological radiation response (p=O.l), types of radiotherapy (external Co with/without Cs after loading) (p=O.517), were found. There were no differences in the survival between those 2 groups (p=O.677). No differences in complications were found: hematology (p=O.989), gastrointestinal (p=O.457), and cutaneus. No pelvic fistula was found. Conclusions: No significant differences were found between the characteristics among those 2 groups, resulting no significant difference in survival between those 2 groups. There were also no differences in complications found among those 2 groups of patients, but MMC is more expensive; on the other hand HU needs more discipline in taking regularly.
P4.02.06 CONSERVATIVE SURGICAL TREATMENT OF INVASIVE CERVICAL CARCINOMA IN YOUNGER WOMEN L. N. Prokic, N. Antic, S. Runic, V. Rajkovic, S. Jankovic, Z. Perisic, R. Radosavljevic, T. Moskovic, R.Lukic, F. Canovic, Dept. OBIGYN, Clinic “Narodni Front” School of Medicine University of Belgrade, Belgrade, Yugoslavia. Objectives: The aim of this study is to evaluate the possibility of an application of the conservative surgical treatment in younger patients suffering form the invasive cervical carcinoma stage I-A according to the FIG0 classification, motivated for the childbearing. Study Methods: There were 12 patients under 30 years of age operated in our Clinic during the three years period. In the first act, the conisation due to the diagnosed invasive squamous epithelial carcinoma of the uterine cervix, stage I, N-l, was done in all the observed patients. Afterwards in the second act, the amputation of the cervix together with the bilateral lymphadenectomy in the small pelvis was performed in all the patients. Results: In seven patients (58%) the hystopathological diagnosis was: chronic cervicitis in the amputated part of the cervix; at the same time between 12 to 19 lymph nodes obtained from the obturatory fossaes were without elements of tumorous tissue. For these patients the amputation and the bilateral lymphadenectomy was the definite operative treatment. In three patients (25%), the early stromal invasion up to 3 m was discovered, also there were between 12 and 18 lymph nodes without elements of the tumorous tissue. For these patients the amputation of the uterine cervix with bilateral lymphadenetomy was the definite treatment. In two patients (17%), the invasive squamous epithelium carcinoma of the uterine cervix (G-2, N-) was discovered in the part of the uterine cervix. In one patient there were three positive lymph nodes on the left side out of totally 16 (3116). Besides this, there were no changes in 18 lymph nodes in another patient. Both patients