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OBJECTIVE: To describe our experience with concurrent chemoradiotherapy using three-dimensional conformal radiotherapy (3D-CRT) and high-dose-rate intracavitary brachytherapy with weekly cisplatin in the treatment of patients with locally advanced cervical cancer. METHODS: Forty-three patients were identified between January 2009 and December 2015. Their medical records were retrospectively reviewed, and data on patient characteristics, tumour, treatment and toxicities were collected and analysed. RESULTS: The median age was 45 years (interquartile range (IQR): 26) The median tumour size was 45 mm (IQR: 20). Thirty-eight patients (88%) had a cervical tumour with a size of ≥ 40 mm. The median cervical tumour size evaluated by magnetic resonance imaging (MRI) was 52 mm (IQR: 17). Twenty-two patients (51%) had enlarged lymph nodes on MRI (≥ 10 mm). MRI demonstrated the involvement of the parametrium in 29 patients (67%). Fifteen patients had positive para-aortic nodes (36%). The median total treatment time was 58 days (IQR: 20). Sixteen patients (39%) received extended-field radiotherapy. Cisplatin was administered simultaneously for a median of five courses. The median follow-up period was 32 months (IQR: 28 months). Grade 3 acute toxicity was observed at the gastrointestinal level in seven patients (16%). Late grade 3/4 toxicity was observed in 14 patients (33%). Seven patients (16%) persisted with the disease and five died. The local relapse rate was 9%. Eleven patients underwent a hysterectomy after treatment. The disease-free interval was 24.2 months. The 2-year global survival rate was 82.9%. CONCLUSION: Concurrent chemo-radiotherapy appears to be an effective regimen, with acceptable toxicity, for patients with locally advanced cervical cancer.
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Objectives: to describe the perioperative and oncological outcomes of a serie of cases treated with laparoscopic surgery for isolated nodal metastasis of gynecologic malignancies at the Gynecology Service of Hospital Italiano de Buenos Aires and conduct a literature review on the surgical treatment provided to patients with this condition. Methods: A search was conducted in the surgery records of the Gynecology Service of Hospital Italiano of patients who underwent laparoscopic cytoreductive surgery for isolated nodal recurrence of a gynecologic primary tumor in the period 2009-2015. The medical records were reviewed and data on the patients' characteristics, the tumor, the surgery and its complications were collected and analyzed. A literature search was conducted in Pubmed by the term "isolated nodal recurrence in gynecology" and a subsequent snowball search was performed. Results: As results, nine patients are presented. The median age was 66 years old (RI 7). The initial cancer location was: ovary (n=3), endometrium (n=3), cervix (n=2) and breast (n=1). The location site of the single nodal recurrence was the para-aortic area (n=8) and the pelvic area (n=1). The median of the disease-free interval to recurrence was 42.8 months (RI 40.2). Either the retroperitoneal or the transperitoneal approach was used based on the location of the recurrence. The median surgery time was 120 minutes (RI 36). No conversion to laparotomy was performed in any patient. No intraoperative or postoperative complications were reported, nor any requirement for blood transfusion. The median hospital stay was 36 hours. Adjuvant treatment with chemotherapy was applied to 8/9 patients. Only one patient recurred in para-aortic lymph nodes and peritoneal carcinomatosis after eight months and died of her disease. The literature review confirms the possibility of laparoscopic resection of the single nodal recurrence with low complication rate. Conclusion: The laparoscopic lymph node cytoreductive surgery is a valid and safe treatment option considering the perioperative and oncological outcomes in our hospital.
Objetivos: Describir los resultados perioperatorios y oncológicos de una serie de casos operados con laparoscopía por metástasis única ganglionar de cánceres ginecológicos en el Servicio de Ginecología del Hospital Italiano de Buenos Aires y realizar una revisión bibliográfica sobre el tema. Métodos: Se llevó a cabo una búsqueda de pacientes en los registros de cirugía del servicio de Ginecología del Hospital que hayan recibido tratamiento quirúrgico de citoreducción laparoscópica por recurrencia ganglionar aislada de un tumor primario ginecológico en el período 2009-2015. Se revisaron las historias clínicas y se recolectaron y analizaron datos referidos a características de las pacientes, del tumor, de la cirugía y sus complicaciones. Se realiza una búsqueda bibliográfica en Pubmed con el concepto "isolated nodal recurrence in gynecology" y posterior búsqueda en bola de nieve. Resultados: Se presentan 9 pacientes. La mediana de edad fue de 66 años (RI 7). La localización del cáncer inicial fue ovario (n=3), endometrio (n=3), cuello (n=2) y mama (n=1). El sitio de localización de la recurrencia ganglionar única fue el área lumboaórtica (n=8) y el área pelviana (n=1). La mediana de intervalo libre de enfermedad a la recurrencia fue de 42.8 meses (RI 40.2). Se utilizó un abordaje retroperitoneal o transperitoneal según la localización de la recurrencia. La mediana de tiempo operatorio fue de 120 minutos (RI 36). No se realizó conversión a laparotomía en ninguna paciente. No se reportaron complicaciones intraoperatoria o postoperatorias, así como tampoco requerimiento de transfusión sanguínea. La mediana de estadía hospitalaria fue de 36 horas. Realizaron tratamiento adyuvante con quimioterapia 8/9 pacientes. Solo 1 paciente recurrió a nivel lumboaórtico y peritoneal luego de 8 meses y falleció de su enfermedad.La revisión de la literatura confirma la posibilidad de realizar la resección de la recurrencia ganglionar única por vía laparoscópica con baja tasa de complicaciones. Conclusión: la citorreducción ganglionar laparoscópica es una opción de tratamiento válida y segura en relación a los resultados perioperatorios y oncológicos en nuestra institución.
Assuntos
Carcinoma/cirurgia , Procedimentos Cirúrgicos de Citorredução/métodos , Neoplasias dos Genitais Femininos/cirurgia , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Idoso , Argentina , Intervalo Livre de Doença , Feminino , Humanos , Pessoa de Meia-Idade , Período Perioperatório , Recidiva , Resultado do TratamentoRESUMO
BACKGROUND AND OBJECTIVES: Our objectives are to describe our surgical technique for laparoscopic radical trachelectomy, to evaluate its feasibility, and to present the perioperative results at Hospital Italiano de Buenos Aires, Argentina. METHODS: We analyzed 4 patients who underwent laparoscopic radical trachelectomy for early-stage cervical cancer between December 2011 and May 2013. RESULTS: Four patients were included in this study. Total laparoscopic radical trachelectomy was performed in all cases. The mean age was 26 years (range, 19-32 years), the mean body mass index was 21 (range, 18-23), and the mean length of hospital stay was 33 hours (range, 24-36 hours). The mean operative time was 225 minutes (range, 210-240 minutes), and no complications were reported. During the postoperative period, only 1 patient presented with left vulvar edema, which resolved spontaneously. The pelvic and parametrial lymph nodes, as well as the vaginal cuff and cervical resection margins, were negative for malignancy in all cases. On average, 18 pelvic lymph nodes (range, 15-20) were removed. The tumor stage was IB in all 4 patients, and the mean tumor size was 17 mm (range, 12-31 mm). No patient required conversion to laparotomy. CONCLUSION: We consider laparoscopic radical trachelectomy, performed by trained surgeons, a feasible and safe therapeutic option as a fertility-sparing surgical technique, with good perioperative outcomes for women with early-stage cervical cancer with a desire to preserve their fertility. Minimally invasive surgery provides the widely known benefits of this type of approach.