Comparison of outcomes between radical hysterectomy followed by tailored adjuvant therapy versus primary chemoradiation therapy in IB2 and IIA2 cervical cancer

다국어 초록 (Multilingual Abstract)

Objective: The purpose of this study was to determine the predictive factors for residual/recurrent disease and to analyze the timing for Pap smears and human papillomavirus (HPV) testing during follow-up after loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia (CIN) 2 or worse.
Methods: We retrospectively analyzed 183 patients (mean age, 39.3 years) with CIN 2/3 who were treated with LEEP. Post-LEEP follow-up was performed by Pap smear and HPV hybrid capture2 (HC2) testing. The definition of persistent/recurrent disease was biopsy-proven CIN 2 or worse.
Results: Among 183 patients, punch biopsies were CIN 2 in 31 (16.9%) and CIN 3 in 152 (83.1%). HPV HC2 tests before LEEP were positive in 170 (95.5%) of 178 patients. During follow-up, 12 patients (6.6%) had residual/recurrent CIN 2+. LEEP margin status was a significant predictive factor for persistent/recurrent disease. Other factors such as age, HPV HC2 viral load (≥100 relative light units), and HPV typing (type 16/18 vs. other types) did not predict recurrence. Early HPV HC2 testing at 3 months after LEEP detected all cases of residual/recurrent disease. The sensitivity and negative predictive value of the HPV HC2 test for residual/recurrent disease were both 100% at 3 and 6 months.
Conclusion: Margin involvement in conization specimens was a significant factor predicting residual/recurrent disease after LEEP. HPV test results at 3 and 6 months after treatment were comparable. Early 3-month follow-up testing after LEEP can offer timely information about residual/recurrent disease and alleviate patient anxiety early about treatment failure.

다국어 초록 (Multilingual Abstract)

Objective: The purpose of this study was to determine the predictive factors for residual/recurrent disease and to analyze the timing for Pap smears and human papillomavirus (HPV) testing during follow-up after loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia (CIN) 2 or worse.
Methods: We retrospectively analyzed 183 patients (mean age, 39.3 years) with CIN 2/3 who were treated with LEEP. Post-LEEP follow-up was performed by Pap smear and HPV hybrid capture2 (HC2) testing. The definition of persistent/recurrent disease was biopsy-proven CIN 2 or worse.
Results: Among 183 patients, punch biopsies were CIN 2 in 31 (16.9%) and CIN 3 in 152 (83.1%). HPV HC2 tests before LEEP were positive in 170 (95.5%) of 178 patients. During follow-up, 12 patients (6.6%) had residual/recurrent CIN 2+. LEEP margin status was a significant predictive factor for persistent/recurrent disease. Other factors such as age, HPV HC2 viral load (≥100 relative light units), and HPV typing (type 16/18 vs. other types) did not predict recurrence. Early HPV HC2 testing at 3 months after LEEP detected all cases of residual/recurrent disease. The sensitivity and negative predictive value of the HPV HC2 test for residual/recurrent disease were both 100% at 3 and 6 months.
Conclusion: Margin involvement in conization specimens was a significant factor predicting residual/recurrent disease after LEEP. HPV test results at 3 and 6 months after treatment were comparable. Early 3-month follow-up testing after LEEP can offer timely information about residual/recurrent disease and alleviate patient anxiety early about treatment failure.

참고문헌 (Reference)

1 Zivanovic O, "Treatment patterns of FIGO Stage IB2 cervical cancer: a single-institution experience of radical hysterectomy with individualized postoperative therapy and definitive radiation therapy" 111 : 265-270, 2008

2 김우영, "Treatment Patterns and Outcomes in Bulky Stage IB2 Cervical Cancer Patients: A Single Institution" KARGER 71 (71): 19-23, 2011

3 M. Steven Piver, "The twenty-first century role of Piver-Rutledge type III radical hysterectomy and FIGO stage IA, IB1, and IB2 cervical cancer in the era of robotic surgery: a personal perspective" 대한부인종양학회 21 (21): 219-224, 2010

4 Rungruang B, "Surgery versus radiation therapy for stage IB2 cervical carcinoma: a populationbased analysis" 22 : 484-489, 2012

5 Pecorelli S, "Revised FIGO staging for carcinoma of the cervix" 105 : 107-108, 2009

6 Houvenaeghel G, "Residual pelvic lymph node involvement after concomitant chemoradiation for locally advanced cervical cancer" 102 : 74-79, 2006

7 Landoni F, "Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer" 350 : 535-540, 1997

8 Havrilesky LJ, "Radical hysterectomy and pelvic lymphadenectomy for stage IB2 cervical cancer" 93 : 429-434, 2004

9 Rotman M, "Prophylactic irradiation of the para-aortic lymph node chain in stage IIB and bulky stage IB carcinoma of the cervix, initial treatment results of RTOG 7920" 19 : 513-521, 1990

10 Bansal N, "Primary therapy for early-stage cervical cancer: radical hysterectomy vs radiation" 201 : 485.e1-485.e9, 2009

11 Jewell EL, "Primary surgery versus chemoradiation in the treatment of IB2 cervical carcinoma: a cost effectiveness analysis" 107 : 532-540, 2007

12 Eifel PJ, "Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer: an update of radiation therapy oncology group trial (RTOG) 90-01" 22 : 872-880, 2004

13 Beadle BM, "Patterns of regional recurrence after definitive radiotherapy for cervical cancer" 76 : 1396-1403, 2010

14 Delpech Y, "Para-aortic involvement and interest of paraaortic lymphadenectomy after chemoradiation therapy in patients with stage IB2 and II cervical carcinoma radiologically confined to the pelvic cavity" 14 : 3223-3231, 2007

15 Park JY, "Outcomes after radical hysterectomy according to tumor size divided by 2-cm interval in patients with early cervical cancer" 22 : 59-67, 2011

16 Rocconi RP, "Management strategies for stage IB2 cervical cancer: a cost-effectiveness analysis" 97 : 387-394, 2005

17 Ferrandina G, "Lymph node involvement in locally advanced cervical cancer patients administered preoperative chemoradiation versus chemotherapy" 14 : 1129-1135, 2007

18 Maaike J. Berveling, "Health-related quality of life and late morbidity in concurrent chemoradiation and radiotherapy alone in patients with locally advanced cervical carcinoma" 대한부인종양학회 22 (22): 152-160, 2011

19 Jemal A, "Global cancer statistics" 61 : 69-90, 2011

20 Piver MS, "Five classes of extended hysterectomy for women with cervical cancer" 44 : 265-272, 1974

21 김재훈, "Efficacy of different types of treatment in FIGO stage IB2 cervical cancer in Korea: Results of a multicenter retrospective Korean study (KGOG-1005)" 17 : 132-136, 200701

22 Peters WA 3rd, "Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in highrisk early-stage cancer of the cervix" 18 : 1606-1613, 2000

23 정규원, "Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2008" 대한암학회 43 (43): 1-11, 2011

24 Gruen A, "Adjuvant chemoradiation after laparoscopically assisted vaginal radical hysterectomy (LARVH) in patients with cervical cancer: oncologic outcome and morbidity" 187 : 344-349, 2011

25 Sedlis A, "A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: a Gynecologic Oncology Group Study" 73 : 177-183, 1999