Positive lymph nodes at time of hysterectomy A B A N D O N S U R G - - PowerPoint PPT Presentation

positive lymph nodes at time of hysterectomy
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Positive lymph nodes at time of hysterectomy A B A N D O N S U R G - - PowerPoint PPT Presentation

Positive lymph nodes at time of hysterectomy A B A N D O N S U R G E R Y A N D P R O C E E D T O S U R G E R Y 5-yr survival rates - Stage IB Landoni et al. (1997) Burghardt et al. (1992) Radical Hysterectomy Hopkins and Morley (1991)


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SLIDE 1

A B A N D O N S U R G E R Y A N D P R O C E E D T O S U R G E R Y

Positive lymph nodes at time of hysterectomy

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SLIDE 2

5-yr survival rates - Stage IB

Liu and Meigs (1955) Piver and Chung (1975) Hoskins et al.(1976) Boyce et al. (1981) Volterrani et al. (1983) Inoue et al. (1984) Fuller et al. (1989) Kenter et al. (1989) Lee et al. (1989) Alvarez et al. (1991) Hopkins and Morley (1991) Burghardt et al. (1992) Landoni et al. (1997)

0% 20% 40% 60% 80% 100%

Landoni et al. (1997) Montana et al. (1987) Horiot et al. (1988) Coia et al. (1990) Lowrey et al. (1992) Perez et al. (1992) Eifel et al. (1994) Barillot et al. (1997) Landoni et al. (1997)

Radical Hysterectomy Radiation Therapy

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SLIDE 3

RT vs. RH for FIGO IB–IIA - Pathologic risk factors requiring postop RT

170 analyzed 2 protocol violations

RH - 172 pts

167 analyzed 4 protocol violations

RT - 171 pts

Randomize 343 eligible 1986-1991—468 pts . Stage I–IIA

Landoni et al. Lancet 350:535, 1997

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SLIDE 4

RT vs. RH for FIGO IB–IIA - Pathologic risk factors requiring postop RT

Paracervical involvement 22 (19%) 19 (35%) < 3 mm safe stroma 44 (39%) 25 (45%) Positive margin 7 (6%) 12 (22%) Positive lymph nodes 28 (25%) 17 (31%) ADJUVANT RT 62 (54%) 46 (84%)

Risk factor ≤4 cm (114) >4 cm (55) RT pts (n = 170)

Landoni et al. Lancet 350:535, 1997

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SLIDE 5

RT vs. RH for FIGO IB–IIA - Complications of treatment

5 10 15 20

RH alone RH + RT RT alone

 RH

  GU, lymphatic   Overall

 RH + RT

  SBO, GU,

lymphatic  RT alone

  Proctitis

Hydronephrosis Atonic bladder Other GU SBO Proctitis Leg edema Lymphocyst

Landoni et al. Lancet 350:535, 1997

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SLIDE 6

Other costs

 Lost work during 4-6 weeks of post-

hysterectomy recovery as well as with radiation therapy

 Hysterectomy does not reduce the need for

concurrent chemotherapy or radiation

 Overall treatment time –

 Radiation alone – 6-8 weeks  Surgery + radiation – 9-12 weeks

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SLIDE 7

NIH Consensus Development Conference Statement - Cervical Cancer (April, 1996)

“Efforts should be made to carefully select patients for treatment in order to ensure that they are treated with RT or surgery, but not both. The combined use of radical surgery followed by radiation substantially increases the cost and morbidity of treatment.”