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Objective: The objective of the ConCerv Trial was to prospectively evaluate the feasibility of conservative surgery in women with early-stage, low-risk cervical cancer., Methods: From April 2010 to March 2019, a prospective, single-arm, multicenter study evaluated conservative surgery in participants from 16 sites in nine countries. Eligibility criteria included: (1) FIGO 2009 stage IA2-IB1 cervical carcinoma; (2) squamous cell (any grade) or adenocarcinoma (grade 1 or 2 only) histology; (3) tumor size < 2 cm; (4) no lymphovascular space invasion; (5) depth of invasion < 10 mm; (6) negative imaging for metastatic disease; and (7) negative conization margins. Cervical conization was performed to determine eligibility, with one repeat cone permitted. Eligible women desiring fertility preservation underwent a second surgery with pelvic lymph node assessment, consisting of sentinel lymph node biopsy and/or full pelvic lymph node dissection. Those not desiring fertility preservation underwent simple hysterectomy with lymph node assessment. Women who had undergone an 'inadvertent' simple hysterectomy with an unexpected post-operative diagnosis of cancer were also eligible if they met the above inclusion criteria and underwent a second surgery with pelvic lymph node dissection only., Results: 100 evaluable patients were enrolled. Median age at surgery was 38 years (range 23-67). Stage was IA2 (33%) and IB1 (67%). Surgery included conization followed by lymph node assessment in 44 women, conization followed by simple hysterectomy with lymph node assessment in 40 women, and inadvertent simple hysterectomy followed by lymph node dissection in 16 women. Positive lymph nodes were noted in 5 patients (5%). Residual disease in the post-conization hysterectomy specimen was noted in 1/40 patients-that is, an immediate failure rate of 2.5%. Median follow-up was 36.3 months (range 0.0-68.3). Three patients developed recurrent disease within 2 years of surgery-that is, a cumulative incidence of 3.5% (95% CI 0.9% to 9.0%)., Discussion: Our prospective data show that select patients with early-stage, low-risk cervical carcinoma may be offered conservative surgery., Competing Interests: Competing interests: The authors have the following disclosures: MH: consulting/speaker for Stryker and research support from GlaxoSmithKline and Astra Zeneca., (© IGCS and ESGO 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: In the phase 3 LACC trial and a subsequent population-level review, minimally invasive radical hysterectomy was shown to be associated with worse disease-free survival and higher recurrence rates than was open radical hysterectomy in patients with early stage cervical cancer. Here, we report the results of a secondary endpoint, quality of life, of the LACC trial., Methods: The LACC trial was a randomised, open-label, phase 3, non-inferiority trial done in 33 centres worldwide. Eligible participants were women aged 18 years or older with International Federation of Gynaecology and Obstetrics (FIGO) stage IA1 with lymphovascular space invasion, IA2, or IB1 adenocarcinoma, squamous cell carcinoma, or adenosquamous carcinoma of the cervix, with an Eastern Cooperative Oncology Group performance status of 0 or 1, who were scheduled to have a type 2 or 3 radical hysterectomy. Participants were randomly assigned (1:1) to receive open or minimally invasive radical hysterectomy. Randomisation was done centrally using a computerised minimisation program, stratified by centre, disease stage according to FIGO guidelines, and age. Neither participants nor investigators were masked to treatment allocation. The primary endpoint of the LACC trial was disease-free survival at 4·5 years, and quality of life was a secondary endpoint. Eligible patients completed validated quality-of-life and symptom assessments (12-item Short Form Health Survey [SF-12], Functional Assessment of Cancer Therapy-Cervical [FACT-Cx], EuroQoL-5D [EQ-5D], and MD Anderson Symptom Inventory [MDASI]) before surgery and at 1 and 6 weeks and 3 and 6 months after surgery (FACT-Cx was also completed at additional timepoints up to 54 months after surgery). Differences in quality of life over time between treatment groups were assessed in the modified intention-to-treat population, which included all patients who had surgery and completed at least one baseline (pretreatment) and one follow-up (at any timepoint after surgery) questionnaire, using generalised estimating equations. The LACC trial is registered with ClinicalTrials.gov, NCT00614211., Findings: Between Jan 31, 2008, and June 22, 2017, 631 patients were enrolled; 312 assigned to the open surgery group and 319 assigned to the minimally invasive surgery group. 496 (79%) of 631 patients had surgery completed at least one baseline and one follow-up quality-of-life survey and were included in the modified intention-to-treat analysis (244 [78%] of 312 patients in the open surgery group and 252 [79%] of 319 participants in the minimally invasive surgery group). Median follow-up was 3·0 years (IQR 1·7-4·5). At baseline, no differences in the mean FACT-Cx total score were identified between the open surgery (129·3 [SD 18·8]) and minimally invasive surgery groups (129·8 [19·8]). No differences in mean FACT-Cx total scores were identified between the groups 6 weeks after surgery (128·7 [SD 19·9] in the open surgery group vs 130·0 [19·8] in the minimally invasive surgery group) or 3 months after surgery (132·0 [21·7] vs 133·0 [22·1])., Interpretation: Since recurrence rates are higher and disease-free survival is lower for minimally invasive radical hysterectomy than for open surgery, and postoperative quality of life is similar between the treatment groups, gynaecological oncologists should recommend open radical hysterectomy for patients with early stage cervical cancer., Funding: MD Anderson Cancer Center and Medtronic., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: The role of sentinel lymph node (SLN) biopsy alone for staging of early-stage cervical cancer remains controversial. We aimed to determine the validity of this technique in women with early-stage cervical cancer., Methods: We retrospectively reviewed women with early-stage cervical cancer who underwent SLN mapping followed by complete pelvic lymphadenectomy as part of initial surgical management from August 1997 through October 2015. All modes of surgical approach were included. Lymphatic mapping was performed using blue dye, technetium-99m sulfur colloid (Tc-99), and/or indocyanine green (ICG). We determined SLN detection rates, sensitivity and negative predictive value., Results: One hundred eighty-eight patients were included, and 35 (19%) had lymph node metastases. At least one SLN was identified in 170 patients (90%), and bilateral SLNs were identified in 117 patients (62%). The majority of SLNs (83%) were found in the pelvis. There was no difference in detection rates between mapping agents, surgical approach, patients with and without prior conization or between patients with tumors <2cm and ≥2cm. The detection rate for bilateral SLNs was significantly lower in women with body mass index (BMI)>30kg/m 2 than in women with lower BMI (p=0.03). Metastatic disease in sentinel nodes was detected by H&E staining in 78% of cases and required ultrastaging/immunohistochemistry in 22% of cases. Only one patient had a false-negative result, yielding a sensitivity of 96.4% (95% CI 79.8%-99.8%) and negative predictive value of 99.3% (95% CI 95.6%-100%). The false-negative rate was 3.6%., Conclusions: In these women with early-stage cervical cancer, SLN biopsy had very high sensitivity and negative predictive value. We believe it is time to change the standard of care for women with early-stage cervical cancer to SLN biopsy only., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objectives: The aim of this study was to assess patient preferences regarding side effects associated with cervical cancer treatment., Methods/materials: The visual analog scale (VAS) and modified standard gamble (SG) were used to elicit preferences of women with no evidence of disease after primary treatment of cervical cancer. Higher scores on VAS and SG indicated more favorable ratings for a given health state. Health states (HS) included vaginal shortening, diarrhea, dietary changes, menopause, moderate nausea/vomiting, rectal bleeding, sexual dysfunction, and urinary self-catheterization. Descriptive statistics, Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed-ranks tests and correlation coefficients were used for statistical analysis., Results: Seventy-eight patients participated in the study. Median age was 44.1 years (range, 24.9-67.8 years). Median time since treatment completion was 31.2 months (range, 1.0-113.3 months). The HSs rated as most favorable by VAS were also rated as most favorable by SG. Increasing age was associated with higher VAS scores for menopause and vaginal shortening (P = 0.04 and 0.036). African Americans had higher VAS scores for dietary changes (P = 0.05), sexual dysfunction (P = 0.028), and diarrhea (P = 0.05) when compared with Hispanic and non-Hispanic white patients. Women receiving radiation had more favorable VAS scores for menopause compared with women undergoing radical hysterectomy (P = 0.05). Women receiving chemotherapy rated urinary self-catheterization less favorably by VAS score compared with those not receiving chemotherapy (P = 0.045)., Conclusions: Multiple demographic and clinical factors influence the severity of treatment-related adverse effects perceived by women surviving cervical cancer. A better understanding of factors influencing patient preferences regarding treatment side effects will allow providers to formulate care better tailored to the individual desires of each patient.

Objective: Cervical adenocarcinoma in situ (AIS) is increasing in incidence among reproductive-age women. Cervical conization is an alternative to hysterectomy that allows future fertility, however reports regarding the risk of residual AIS and underlying adenocarcinoma are conflicting. The purpose of this study was to determine the outcomes of a large cohort of women treated for AIS., Methods: The medical records of 180 women with cervical AIS evaluated at the University of Texas MD Anderson Cancer Center and its outlying clinics between 1983 and 2011 were reviewed for demographic information, treatment history, pathologic findings and outcomes., Results: The mean age at diagnosis was 33.8years (range 17.6-76.1years). 172 of the 180 women had at least one cone biopsy performed, with 110 (64.0%) undergoing a cold knife cone (CKC), and 62 (36.0%) undergoing a loop electrosurgical excision procedure (LEEP) as their initial method of treatment. Positive margins were noted in 35.0% of patients undergoing CKC compared with 55.6% undergoing LEEP (p=0.017). 71 patients ultimately underwent hysterectomy with residual disease noted in 10 patients (14.1%), 8 patients (11.3%) with residual AIS and 2 patients (2.8%) with invasive carcinoma. Of the 101 patients who did not undergo hysterectomy, 2 patients (2.0%) developed recurrent AIS at a median of 27.5months (range 18-37months) from the last cone, and none developed invasive carcinoma., Conclusion: Patients undergoing conservative management for AIS with cervical conization alone should be monitored closely and counseled regarding the potential risks of residual and recurrent disease, even when negative cone margins are obtained., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: To describe the rate of port-site metastasis in patients who underwent robotic surgery for suspected gynecological malignancy., Methods: Using a prospective database, we identified all patients who underwent robotic surgery performed by the Gynecologic Oncology service at 1 institution between December 2006 and March 2010. Records of patients with confirmed malignancy were reviewed for clinicopathological data and information about port-site metastasis., Results: One hundred eighty-one patients met the inclusion criteria. The median age was 55.4 years (range, 19-82 years), and the median body mass index was 29.6 kg/m² (range, 17.9-70.7 kg/m²). Port-site metastases were detected in 2 patients (1.1%) at 3 weeks (patient 1) and 11 months (patient 2) after surgery. Patient 1 underwent surgery for an adnexal mass, and pathological examination revealed gallbladder adenocarcinoma metastatic to the ovary. She had a recurrence in the right lateral abdominal wall robotic trocar site with concurrent metastases in the gallbladder fossa and liver. Patient 2 was diagnosed with adenocarcinoma of unclear (cervical vs endometrial) origin. Imaging showed metastases in pelvic and para-aortic lymph nodes. She underwent laparoscopy and was found intraoperatively to have gross disease on the right ovary. The patient underwent right salpingo-oophorectomy and chemoradiation. She had residual disease in the cervix and subsequently underwent robotic hysterectomy and left salpingo-oophorectomy. Pathological examination revealed endometrial cancer. She had a recurrence at the transumbilical trocar site concurrent with retroperitoneal lymphadenopathy and carcinomatosis. There were no cases of isolated port-site metastasis., Conclusions: The rate of port-site metastasis after robotic surgery in women with gynecological cancer is low and similar to the rate for laparoscopic procedures.

Objective: To evaluate the utility of preoperative magnetic resonance imaging (MRI) in determining whether primary disease site is cervical or endometrial in patients with inconclusive preoperative endometrial biopsy., Methods: We retrospectively identified all patients who underwent pelvic MRI and who had a preoperative diagnosis of cervical or endometrial cancer at MD Anderson Cancer Center between 1990 and 2006. The subset in which endometrial biopsy did not clarify the primary disease site was analyzed. Magnetic resonance imaging results were compared with postoperative histopathologic findings., Results: A total of 168 patients who underwent MRI who had a preoperative diagnosis of cervical or endometrial cancer were identified. Of these patients, 51 had an inconclusive endometrial biopsy. Magnetic resonance imaging suggested an endometrial primary tumor without cervical invasion in 28 patients, of whom 21 (75%) actually had such a tumor and 7 had an endometrial primary tumor with cervical invasion. Magnetic resonance imaging suggested an endometrial primary tumor with cervical invasion in 3 patients, all of whom had such a tumor. Magnetic resonance imaging suggested a cervical primary tumor in 6 patients, of whom 5 had such a tumor and 1 had an endometrial primary tumor without cervical invasion. Magnetic resonance imaging was inconclusive (did not clarify primary disease site or no lesion visualized) in 14 (27%) of 51 patients, 6 of whom had an endocervical primary tumor or an endometrial tumor with cervical involvement. Overall, preoperative MRI was either inaccurate or unhelpful in 22 (43%) of 51 patients., Conclusion: Preoperative MRI in patients with inconclusive endometrial biopsy is inaccurate or unhelpful in nearly half of patients.

Objective: We compared two different methods of microscopic lymph node examination of cervical cancer radical hysterectomy specimens to ascertain which method translates into higher nodal counts and improved detection of nodal metastasis, at M. D. Anderson Cancer Center (MDACC) and the University of North Carolina (UNC)., Methods: We retrospectively reviewed the records of 155 patients with early-stage cervical cancer who underwent open radical hysterectomy and pelvic lymph node dissection from 2000 to 2006. At MDACC lymph nodes were grossly dissected from submitted adipose tissue surgical specimens and then microscopically examined. At UNC, grossly detected lymph nodes and the remaining adipose tissue were microscopically examined. Data regarding clinicopathologic features and lymph node dissection were available for all patients., Results: No differences in stage, grade or histology were noted between the two centers. The median age and body mass index were both higher at MDACC (40 versus 36 years of age; 28 versus 26 mg/m(2); P < 0.05) The median lymph node count was lower at MDACC (16 versus 23; P = 0.001). By multivariate analysis, UNC evaluation was associated with higher total lymph node count (P = 0.001). However, no significant difference was noted between institutions in proportion of patients with nodal metastases (MDACC 20.3%; UNC 13.5%; P = 0.47)., Conclusion: The UNC method of microscopically examining the entire adipose tissue sample may be associated with higher nodal count at open radical hysterectomy. Higher nodal count, however, may not translate into increased identification of nodal metastases.

Background: The differential diagnoses for pelvic masses with elevated CA 125 and serum testosterone are many, including primary tumors and metastases from nongynecologic primary cancers., Case: A 63-year-old woman presented with a pelvic mass, abdominal pain and virilization. CA 125 and testosterone were elevated (74 U/mL and 384 ng/dL, respectively). Preoperative clinical diagnosis was suggestive of Sertoli-Leydig tumor. Final diagnosis was stage IV primary gallbladder malignancy with metastases to the ovaries., Conclusion: Ovarian metastases from other sites can clinically mimic primary ovarian tumors. In women with complex pelvic masses, metastasis should be considered as part of the differential diagnosis.

Study Objective: Cervical cancer is a significant health problem in countries of the developing world. Although case series suggest advantages of total laparoscopic radical hysterectomy (TLRH) compared with total abdominal radical hysterectomy (TARH), no randomized controlled trial is currently available to establish TLRH as the new standard treatment. In this study, TLRH or total robotic radical hysterectomy (TRRH) will be performed without a vaginally assisted portion of the procedure., Design: A biphasic randomized controlled trial was designed to test feasibility of recruitment and equivalence in regard to disease-free survival (Canadian Task Force classification I)., Setting: Tertiary referral hospital., Patients: Patients with histologically confirmed invasive squamous cell carcinoma or adenocarcinoma of the cervix, stage IA1 (with lymphovascular space invasion), IA2, and IB1 are eligible., Interventions: During the first phase, 100 patients will be randomized (1:1) to receive either TLRH/TRRH or TARH, with the primary end point being the rate of enrollment. During the second phase, recruitment will be extended by another 640 patients in a 1:1 TLRH/TRRH:TARH allocation, to determine equivalence with respect to disease-free survival with 80% power and alpha=0.05., Measurements and Main Results: Equivalence will be assumed if the difference in disease-free survival does not exceed 7% at 4 years. Secondary outcomes include treatment-related morbidity, costs and cost effectiveness, patterns of recurrence, quality of life, pelvic floor function, feasibility of intraoperative sentinel node sampling, and overall survival. All data from this multicenter study will be entered using online electronic case report forms, allowing real-time assessment of data completeness and patient follow-up., Conclusion: This prospective trial aims to show the equivalence of a TLRH/TRRH versus TARH approach for patients with early stage cervical cancer following a 2-phase protocol. This trial was developed and designed with the input and approval of the members of the Gynecologic Oncology Committee from the American Association of Gynecologic Laparoscopists.

Objective: To evaluate whether histology (adenocarcinoma versus adenosquamous carcinoma) is an independent prognostic indicator in patients with stage IB1 cervical cancer after radical hysterectomy., Methods: All patients with adenocarcinoma or adenosquamous carcinoma who underwent radical hysterectomy between October 1990 and December 2006 at The University of Texas M. D. Anderson Cancer Center were evaluated. Clinico-pathological data collected included age, disease stage, tumor grade, lymph node status, parametrial involvement, depth of invasion, evidence of lymph-vascular space invasion (LVSI), and adjuvant therapy. Patients were categorized as having "low-risk" or "high-risk" disease depending on the final pathologic findings., Results: We identified 126 patients with stage IB1 adenosquamous (n=29) or adenocarcinoma (n=97) cervical cancer. The median follow-up was 79 months (range 1.7-184.6). The median age was 40.3 years for patients with adenocarcinoma and 35.2 years for patients with adenosquamous carcinoma (P=0.88). Grade III histology and LVSI were more common in patients with adenosquamous tumors than in patients with adenocarcinoma (85% versus 16%; P<0.01 and 56.5% versus 32.8; P=0.04). Histology was not associated with lymph node or parametrial involvement. There was no difference in recurrence rates between the two histologic groups, but the time to recurrence was shorter for patients with adenosquamous carcinoma (7.9 months versus 15 months; P=0.01). There was no difference between cell types with regards to recurrence and recurrence-free survival rates in the low- and high-risk groups., Conclusion: We found no evidence that histologic subtype affects outcome; however, the median time to recurrence was shorter in patients with adenosquamous carcinoma. Our study suggests that in patients with stage IB1 adenosquamous carcinoma or adenocarcinoma, the presence of high-risk features is more important than histologic subtype.

Background: Metastasis to the uterine cervix from a non-gynecologic neoplasm is extremely rare. To our knowledge, only three cases of primary carcinoma of the gallbladder with metastasis to the cervix have been previously reported. We report a case of metastatic gallbladder carcinoma mimicking a stage IIIB cervical carcinoma., Case: A 74 year-old woman presented with pain in her left lumbar area radiating to her left flank. On physical examination, a 6 cm cervical tumor involving the left parametrium was noted. A computed tomography (CT) scan of the pelvis showed left-sided hydronephrosis and hydroureter with distal ureteral obstruction. A Pap smear revealed adenocarcinoma, and a biopsy of the endocervical canal was consistent with poorly differentiated adenocarcinoma. The patient was referred to a tertiary care center. On review of the biopsy after referral, the carcinoma was felt to be unusual for an endocervical primary and immunohistochemical stains were ordered. The carcinoma was positive for cytokeratin 7, had only focal cytoplasmic staining for p16, and was negative for carcinoembryonic antigen and cytokeratin 20. Upon presentation, the patient complained of new onset of shortness of breath and cough. A chest CT revealed multiple lesions in both lungs suggestive of metastatic disease, and an abdominal CT revealed a gallbladder tumor with extension into the liver. The patient underwent a CT-guided biopsy of one of the lung lesions and the pathologic findings were consistent with metastatic adenocarcinoma. The patient was diagnosed with stage IVB primary gallbladder adenocarcinoma and was treated with capecitabine, but her condition deteriorated rapidly and she died 5 months later., Conclusion: In patients with an atypical presentation for cervical adenocarcinoma, it is important to consider a metastatic tumor in the differential diagnosis and to perform a thorough work-up for metastatic disease before initiating therapy.

Background: There are limited data from retrospective studies regarding whether survival outcomes after laparoscopic or robot-assisted radical hysterectomy (minimally invasive surgery) are equivalent to those after open abdominal radical hysterectomy (open surgery) among women with early-stage cervical cancer.Methods: In this trial involving patients with stage IA1 (lymphovascular invasion), IA2, or IB1 cervical cancer and a histologic subtype of squamous-cell carcinoma, adenocarcinoma, or adenosquamous carcinoma, we randomly assigned patients to undergo minimally invasive surgery or open surgery. The primary outcome was the rate of disease-free survival at 4.5 years, with noninferiority claimed if the lower boundary of the two-sided 95% confidence interval of the between-group difference (minimally invasive surgery minus open surgery) was greater than -7.2 percentage points (i.e., closer to zero).Results: A total of 319 patients were assigned to minimally invasive surgery and 312 to open surgery. Of the patients who were assigned to and underwent minimally invasive surgery, 84.4% underwent laparoscopy and 15.6% robot-assisted surgery. Overall, the mean age of the patients was 46.0 years. Most patients (91.9%) had stage IB1 disease. The two groups were similar with respect to histologic subtypes, the rate of lymphovascular invasion, rates of parametrial and lymph-node involvement, tumor size, tumor grade, and the rate of use of adjuvant therapy. The rate of disease-free survival at 4.5 years was 86.0% with minimally invasive surgery and 96.5% with open surgery, a difference of -10.6 percentage points (95% confidence interval [CI], -16.4 to -4.7). Minimally invasive surgery was associated with a lower rate of disease-free survival than open surgery (3-year rate, 91.2% vs. 97.1%; hazard ratio for disease recurrence or death from cervical cancer, 3.74; 95% CI, 1.63 to 8.58), a difference that remained after adjustment for age, body-mass index, stage of disease, lymphovascular invasion, and lymph-node involvement; minimally invasive surgery was also associated with a lower rate of overall survival (3-year rate, 93.8% vs. 99.0%; hazard ratio for death from any cause, 6.00; 95% CI, 1.77 to 20.30).Conclusions: In this trial, minimally invasive radical hysterectomy was associated with lower rates of disease-free survival and overall survival than open abdominal radical hysterectomy among women with early-stage cervical cancer. (Funded by the University of Texas M.D. Anderson Cancer Center and Medtronic; LACC ClinicalTrials.gov number, NCT00614211 .). [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine the proportion of young patients with early-stage invasive cervical cancer treated with radical hysterectomy who may have been eligible for fertility-sparing surgery consisting of cervical conization with pelvic lymph node dissection. Methods: We retrospectively identified all patients with early-stage cervical cancer (stages IA1-IB1) who underwent a radical hysterectomy at The University of Texas M. D. Anderson Cancer Center between 1990 and 2009. We reviewed these patients'' records to identify patients who were <40years who had not previously undergone tubal ligation and who would have been considered candidates for cold-knife conization with pelvic lymph node dissection—i.e., women with tumors smaller than 2cm, low-risk histology (squamous, adenocarcinoma, or adenosquamous), and no lymphovascular space invasion (LVSI). Results: A total of 507 patients with early-stage cervical cancer were identified who underwent radical hysterectomy during the review period. Of these women, 277 (55%) were 40years or younger. Of these 277 patients, 75 (27%) had had a previous tubal ligation and 202 (73%) had not. Of these 202 patients potentially interested in fertility preserving surgery, 53 (26%) had favorable pathologic characteristics including low-risk histology, tumors ≤2cm in size and no LVSI present. Of these 53 patients, none had parametrial involvement or positive lymph nodes. Conclusion: Among 202 women with age younger than 40years and no previous tubal ligation who underwent radical hysterectomy, 53 (26%) may have been eligible for fertility-sparing surgery such as cold-knife conization with pelvic lymph node dissection. [Copyright &y& Elsevier]

Abstract: Objective: To assess the usefulness of preoperative tumor grade and intraoperative assessment of gross depth of myometrial invasion as “predictors” of final grade, final depth of myometrial invasion and surgical stage in patients with “low-risk” endometrial cancer. Methods: We retrospectively compared preoperative histology and intraoperative gross depth of invasion with final pathologic evaluation on hysterectomy specimens. For patients traditionally considered intraopertively to be “low-risk” for lymph node metastasis (grade 1 or 2 adenocarcinoma with less than 50% myometrial invasion), “predictors” combining preoperative histology and intraoperative gross depth of myometrial invasion were established; that is, a preoperative biopsy of grade 1 adenocarcinoma with an intraoperative gross depth of myometrial invasion of 30% was assigned the predictor IbG1 (Stage Ib, grade 1). These predictors were then compared to final grade and surgical stage. Sensitivity, specificity, and positive predictive value were then calculated. Results: A total of 153 patients had both a preoperative biopsy and intraoperative assessment of gross depth of invasion. Twenty-four patients had the IaG1 predictor; eight had stage IaG1 on final pathologic evaluation (sensitivity, 0.50; specificity, 0.88; positive predictive value, 0.33). Eight patients had the IaG2 predictor; none had stage IaG2 on final pathologic evaluation (sensitivity, 0; specificity, 0.95; positive predictive value, 0). Eighty-nine patients had the IbG1 predictor; forty-six had stage IbG1 on final pathologic evaluation (sensitivity, 0.72; specificity, 0.52; positive predictive value, 0.52). Thirty-two patients had the IbG2 predictor; 11 had stage IbG2 on final pathologic evaluation (sensitivity, 0.46; specificity, 0.84; positive predictive value, 0.34). Conclusion: A clinically significant number of patients will have more advanced disease than predicted by preoperative or intraoperative prognostic factors. These predictors should not be relied on in the staging of endometrial cancer. [Copyright &y& Elsevier]

We reviewed reported cases of grade 1 endometrial adenocarcinoma that were conservatively managed with hormonal therapy in an effort to identify the most effective treatment regimen.We searched MEDLINE and other databases for English-language articles describing patients with grade 1 endometrial adenocarcinoma who were treated with hormonal therapy. The search included articles published between January 1966 and December 2003. The following key words were used: endometrial cancer, uterine cancer, adenocarcinoma, hormones, progesterone, medroxyprogesterone acetate, megestrol acetate, conservative therapy, fertility, and female. A total of 79 articles were found. Studies were excluded for the following reasons: advanced stage, metastatic or recurrent disease, progestin use after radiation, chemotherapy, or surgery, concurrent with radiation therapy or chemotherapy, administration of progestin other than orally or intramuscularly, tumor confined to a polyp, grade 2 or 3 disease, undocumented grade, nonendometrioid histology, progestin use in conjunction with ovarian wedge resection or other hormones, and hyperplasia. Our study ultimately included 81 patients in 27 articles.Sixty-two patients (76%) responded to treatment. The median time to response was 12 weeks (range, 4–60 weeks). Fifteen patients (24%) who initially responded to treatment recurred. The median time to recurrence was 19 months (range, 6–44 months). Ten (67%) of the patients with recurrence ultimately underwent total abdominal hysterectomy. Residual endometrial carcinoma was found in six patients (60%). Nineteen patients never responded. Twenty patients were able to become pregnant at least once after completing treatment. The median follow-up was 36 weeks (range, 0 weeks–30 years). No patients died of their disease.The majority of patients reported with well-differentiated endometrial adenocarcinoma who undergo conservative treatment with a progestational agent respond to treatment. When an initial response is not achieved or when disease recurs, carcinoma extending beyond the uterus is rare. [Copyright &y& Elsevier]

Background: Standard treatment of early cervical cancer involves a radical hysterectomy and retroperitoneal lymph node dissection. The existing evidence on the incidence of adverse events after minimally invasive vs open radical hysterectomy for early cervical cancer is either nonrandomized or retrospective.Objective: The purpose of this study was to compare the incidence of adverse events after minimally invasive vs open radical hysterectomy for early cervical cancer.Study Design: The Laparoscopic Approach to Carcinoma of the Cervix trial was a multinational, randomized noninferiority trial that was conducted between 2008 and 2017, in which surgeons from 33 tertiary gynecologic cancer centers in 24 countries randomly assigned 631 women with International Federation of Gynecology and Obstetrics 2009 stage IA1 with lymph-vascular invasion to IB1 cervical cancer to undergo minimally invasive (n = 319) or open radical hysterectomy (n = 312). The Laparoscopic Approach to Carcinoma of the Cervix trial was suspended for enrolment in September 2017 because of an increased risk of recurrence and death in the minimally invasive surgery group. Here we report on a secondary outcome measure: the incidence of intra- and postoperative adverse events within 6 months after surgery.Results: Of 631 randomly assigned patients, 536 (85%; mean age, 46.0 years) met inclusion criteria for this analysis; 279 (52%) underwent minimally invasive radical hysterectomy, and 257 (48%) underwent open radical hysterectomy. Of those, 300 (56%), 91 (16.9%), and 69 (12.8%) experienced at least 1 grade ≥2 or ≥3 or a serious adverse event, respectively. The incidence of intraoperative grade ≥2 adverse events was 12% (34/279 patients) in the minimally invasive group vs 10% (26/257) in the open group (difference, 2.1%; 95% confidence interval, -3.3 to 7.4%; P=.45). The overall incidence of postoperative grade ≥2 adverse events was 54% (152/279 patients) in the minimally invasive group vs 48% (124/257) in the open group (difference, 6.2%; 95% confidence interval, -2.2 to 14.7%; P=.14).Conclusion: For early cervical cancer, the use of minimally invasive compared with open radical hysterectomy resulted in a similar overall incidence of intraoperative or postoperative adverse events. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether apparent diffusion coefficient (ADC) value is predictive of survival after definitive chemoradiation for cervical cancer independent of established imaging and clinical prognostic factors.Methods and Materials: Between 2011 and 2013, the pretreatment MRI scans for 69 patients treated with definitive chemoradiation for newly diagnosed cervical cancer were retrieved. Scans were acquired with a 1.5-T magnetic resonance scanner, including diffusion-weighted imaging sequences. Mean ADC value was measured within a region of interest in the primary cervical cancer on the baseline MRI scan. Baseline tumor maximum standardized uptake value on positron emission tomography/computed tomography was determined by the reading radiologist. Treatment included external beam radiation therapy to the pelvis followed by brachytherapy in 97%, and with concurrent weekly cisplatin in 99% of patients. Univariate and multivariate analyses were done to investigate the association of clinical and imaging variables with disease control and survival endpoints using a Cox proportional hazard test.Results: Median follow-up was 16.7 months (range, 3.1-44.2 months). The 1-year overall survival, locoregional recurrence-free survival, and disease-free survival rates were 91%, 86%, and 74%, respectively. The median ADC value was 0.941 × 10-3 mm2/s (range, 0.256-1.508 × 10-3 mm2/s). The median standardized uptake value in the primary tumor was 15 (range, 6.2-43.4). In multivariate analysis, higher ADC value (hazard ratio [HR] 0.36, 95% confidence interval [CI] 0.15-0.85, P=.02), higher stage (HR 2.4, 95% CI 1.1-5.5, P=.033), and nonsquamous histology (HR 0.23, 95% CI 0.07-0.82, P=.024) were independent predictors of disease-free survival.Conclusions: The mean ADC value of the primary tumor on pretreatment MRI was the only imaging feature that was an independent predictor of disease-free survival in cervical cancer patients treated with chemoradiation. Further validation will be needed to determine whether ADC values may prove useful in identifying cervical patients at high risk of recurrence. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The goal of this review is to summarize the latest literature on the subject of radical trachelectomy and fertility outcomes in patients with early-stage cervical cancer. Methods: We analyzed the published literature in search of all articles addressing surgical techniques, intraoperative and perioperative outcomes, and obstetrical results in patient undergoing radical trachelectomy for cervical cancer. Results: It is estimated that 43% of all cases of cervical cancer in the United States are diagnosed in women younger than 45 years of age. As of 2007, a total of 520 patients had been reported to have undergone a radical vaginal trachelectomy. The majority of patients (60%) had a diagnosis of squamous cell carcinoma; adenocarcinoma was the second most common histologic subtype (40%). Data on outcomes after radical abdominal trachelectomy are less extensive—only approximately 50 cases have been reported worldwide. Approximately 43% of patients who undergo a radical trachelectomy subsequently attempt to become pregnant. Seventy percent of these women are successful at achieving a pregnancy. Conclusions: Radical trachelectomy is safe and feasible and pregnancy outcomes are very favorable. All patients interested in future fertility who are diagnosed with cervical cancer are encouraged to discuss radical trachelectomy with their physician. [Copyright &y& Elsevier]