An Alternative Triage Strategy Based on Preoperative MRI for Avoiding Trimodality Therapy in Stage IB Cervical Cancer

다국어 초록 (Multilingual Abstract)

Purpose Adjuvant chemoradiation following primary surgery is frequently indicated in patients with stage IB cervical cancer. The aim of this study is to evaluate the role of a magnetic resonance imaging (MRI)-based strategy in avoiding trimodality therapy.

Materials and Methods We retrospectively reviewed all patients with stage IB cervical cancer treated initially with primary surgery at Seoul National University Hospital. We suggest an alternative triage strat- egy in which the primary treatment modality is determined based on preoperative MRI find- ings. Using this strategy, primary surgery is only indicated when there is no evidence of parametrial involvement (PMI) and lymph node metastasis (LNM) in the MRI results; when there is evidence of either or both of these factors, primary chemoradiation is selected.

Assuming that this strategy is applied to our cohort, we evaluate how the rate of trimodality therapy is affected.

Results Of the 254 patients in our sample, 77 (30.3%) had at least one category 1 risk factor (PMI, LNM, positive resection margin) upon pathologic examination. If the MRI-based strategy had been applied to our cohort, 168 patients would have undergone primary surgery and 86 would have undergone primary chemoradiation. Only 25 patients (9.8%) would have required trimodality therapy based on an indication of at least one category 1 pathologic risk factor following radical hysterectomy.

Conclusion The inclusion of MRI in the decision-making process for primary treatment modality could have reduced the number of patients requiring trimodality therapy based on the indication of a category 1 risk factor from 30.3% to 9.8% in our cohort.

참고문헌 (Reference)

1 Goyal BK, "Value of PET-CT in avoiding multimodality therapy in operable cervical cancer" 20 : 1041-1045, 2010

2 Marnitz S, "Validity of laparoscopic staging to avoid adjuvant chemoradiation following radical surgery in patients with early cervical cancer" 83 : 346-353, 2012

3 Amendola MA, "Utilization of diagnostic studies in the pretreatment evaluation of invasive cervical cancer in the United States : results of intergroup protocol ACRIN 6651/GOG 183" 23 : 7454-7459, 2005

4 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

5 Kim WY, "Treatment patterns and outcomes in bulky stage IB2 cervical cancer patients : a single institution's experience over 14 years" 71 : 19-23, 2011

6 Lee JY, "Treatment of stage IB2, IIA bulky cervical cancer : a singleinstitution experience of neoadjuvant chemotherapy followed by radical hysterectomy and primary radical hysterectomy" 284 : 477-482, 2011

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

8 Schover LR, "Sexual dysfunction and treatment for early stage cervical cancer" 63 : 204-212, 1989

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

10 Frumovitz M, "Quality of life and sexual functioning in cervical cancer survivors" 23 : 7428-7436, 2005

11 Galic V, "Prognostic significance of adenocarcinoma histology in women with cervical cancer" 125 : 287-291, 2012

12 Lee JY, "Preoperative MRI criteria for trials on less radical surgery in Stage IB1 cervical cancer" 134 : 47-51, 2014

13 Capelle L, "Patterns of care for cervical cancer in Auckland, New Zealand, 2003-2007" 55 : 82-89, 2011

14 Fiorica JV, "Morbidity and survival patterns in patients after radical hysterectomy and postoperative adjuvant pelvic radiotherapy" 36 : 343-347, 1990

15 Pandharipande PV, "MRI and PET/CT for triaging stage IB clinically operable cervical cancer to appropriate therapy : decision analysis to assess patient outcomes" 192 : 802-814, 2009

16 Jung DC, "Identification of a patient group at low risk for parametrial invasion in early-stage cervical cancer" 119 : 426-430, 2010

17 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

18 James RM, "Guideline Development Group. Management of cervical cancer: summary of SIGN guidelines" 336 : 41-43, 2008

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

20 Ryu HS, "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, 2007

21 Choi HJ, "Diagnostic performance of computer tomography, magnetic resonance imaging, and positron emission tomography or positron emission tomography/computer tomography for detection of metastatic lymph nodes in patients with cervical cancer : meta-analysis" 101 : 1471-1479, 2010

22 Barter JF, "Complications of combined radical hysterectomy-postoperative radiation therapy in women with early stage cervical cancer" 32 : 292-296, 1989

23 박정열, "Comparison of outcomes between radical hysterectomy followed by tailored adjuvant therapy versus primary chemoradiation therapy in IB2 and IIA2 cervical cancer" 대한부인종양학회 23 (23): 226-234, 2012

24 National Comprehensive Cancer Center, "Cervical cancer clinical practice guidelines in oncology (v.I.2014)" National Comprehensive Cancer Center

25 정규원, "Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2011" 대한암학회 46 (46): 109-123, 2014