Cervical Cancer (must knows) (both NCCN and Perez) (under construction) Flashcards
What are the components of Sedlis Criteria, which are intermediate risk factors that guide adjuvant treatment?
> 1/3 stromal invasion
CLSI (capillary lymphatic space invasion)
T >4 cm
What are the predictors of lymph node involvement in cervical adenocarcinoma?
pattern of stromal invasion
LVSI
(not T stage/size)
What is the “fertility sparing approach” for FIGO IA1 without LVSI?
conization + negative margins (>3mm)
*repeat cone biopsy if positive margins
What is added to the “fertility sparing approach” for FIGO IA1 if “with” LVSI?
+lymphadenectomy
(base treatment is a conization with negative margins, may also consider radical trachelectomy)
consider SLN mapping
What is the “fertility sparing approach” for FIGO IA2, IB1 or select IB2?
radical trachelectomy +pelvic lymphadenectomy
±paraaortic lymphadenectomy
consider SLN mapping
Although radical trachelectomy has been used for bigger tumors, what is generally considered the cut-off size?
For bigger size than the cuttoff, what approach to radical trachelectomy is preferred?
≤2 cm
abdominal
What FIGO stage can be adequately treated by a simple extrafascial hysterectomy?
IA1 no LVSI
What are the treatment options for FIGO IA1+LVSI, IA2?
for patients who do not wish to preserve fertility
Modified radical hysterectomy
+pelvic lymphadenectomy
consider SLN mapping
or
Pelvic EBRT + brachytherapy
What are the treatment options for FIGO IB1, IB2, IIA1?
for patients who do not wish to preserve fertility
Radical hysterectomy + pelvic lymphadenectomy (1)
±para aortic lymphadenectomy (2b)
consider SLN mapping
or
Pelvic EBRT + brachytherapy
±concurrent chemotherapy (1)
What is the preferred treatment (category I NCCN) for FIGO IB3, IIA2 cervical tumors? (>4 cm)
(for patients who do not wish to preserve fertility)
Pelvic EBRT + brachytherapy
+concurrent chemotherapy
(cat1)
+ selective completion +hysterectomy (cat3 for hys)
or
radical hys +pelvic lymphadenectomy ±paraoartic lymphadenectomy (2b)
or
If after surgical treatment, findings are negative parametria, negative nodes, negative margins, what are the options?
observe
or adjuvant RT (Sedlis criteria) - Cat 1
±concurrent chemotherapy (2B)
If after surgical treatment, findings are + pelvic nodes, or margin, or parametria, what is the next step if imaging is negative for metastases?
EBRT + concurrent chemotherapy (1)
± vag. brachytherapy
EFRT if para-aortic node+
If after surgical treatment for advanced FIGO stages (>IIB), imaging findings are negative for nodes, what is the next step?
EBRT + concurrent chemotherapy
+brachytherapy
If after surgical treatment for advanced FIGO stages (>IIB), imaging findings are negative for para-aortic nodes, but + for pelvic nodes, what is the next step?
EBRT + concurrent chemotherapy
+brachytherapy
±para-aortic node RT
How do you regularly follow-up patients after EBRT?
every 3-6 months for first 2 years
every 6-12 months for succeeding 3-5 years
then annually
What are the predictors of para-aortic lymph node metastases in FIGO IB and IIB?
+pelvic node
T >2cm
+common iliac nodes
Trials have shown a ___ to ___% decrease in the risk of death following CCRT in locally advanced cervical cancers compared to RT alone.
30 to 50
Landmark Trials in Cervical Cancer CCRT
Identify the study group and number based on the primary author:
Whitney et al.
GOG 85
Landmark Trials in Cervical Cancer CCRT
Identify the study group and number based on the primary author:
Eiffel et al.
(Morris)
RTOG 90-01
Landmark Trials in Cervical Cancer CCRT
Identify the study group and number based on the primary author:
Peters et al.
SWOG 8797 / GOG 109 / RTOG 91-12
Landmark Trials in Cervical Cancer CCRT
Identify the study group and number based on the primary author:
Keys et al.
(Stehman et al.)
GOG 123
Landmark Trials in Cervical Cancer CCRT
Identify the study group and number based on the primary author:
Rose et al.
(Bundy, Watkins et al.)
GOG 120
Landmark Trials in Cervical Cancer CCRT
- Identify the study population:
- Describe the study’s control and investigational arm:
Keys/Stehman et al. (GOG 123)
IB2 (bulky IB ≥4 cm)
RT
vs.
RT+cisplatin
RT
vs.
RT+weekly cisplatin (40 mg/m2 IV weekly x 6 wk)
Landmark Trials in Cervical Cancer CCRT
- Identify the study population:
- Describe the study’s control and investigational arm:
Whitney (GOG 85)
IIB-IVA
RT+hydroxyurea vs. RT+CIS/FU
RT + hydroxyurea (80mg/kg PO 2x/wk)
vs.
RT + cisplatin (50 mg/m2 IV days 1, 28) + 5-FU infusion (1g/m2 per day, days 2–5, 30–33
RT dose: 51 Gy + 30(Pt A)
Landmark Trials in Cervical Cancer CCRT
- Identify the study population:
- Describe the study’s control and investigational arm:
Rose (GOG 120)
IIB-IVA
RT+hydroxyurea
vs.
RT+weekly cisplatin
--- RT + hydroxyurea (3 g/m2 PO 2x/wk) vs. RT+ RT + cisplatin (50 mg/m2 IV days 1, 29) + 5 FU infusion (1 g/m2 per day, days 1–4, 29–33) + hydroxyurea PO (2 g/m2 2x/wk x 6 wk) and RT + cisplatin (40 mg/m2 weekly x 6 wk) versus
Landmark Trials in Cervical Cancer CCRT
- Identify the study population:
- Describe the study’s control and investigational arm:
Eiffel et al. (RTOG 90-01)
IB2-IVA (≥5 cm + nodes)
EFRT
vs.
RT+CIS/FU
RT (pelvic + para-aortic)
vs.
RT + cisplatin (75 mg/m2 IV day 1) + 5-FU infusion (1 g/m2 per day, days 1–5 3x q3 wk)
Landmark Trials in Cervical Cancer CCRT
- Identify the study population:
- Describe the study’s control and investigational arm:
Peters et al. (SWOG 8797/GOG 109/RTOG9112)
IB or IIA (post op/pathologic stage)
+ positive pelvic nodes and/or positive margins and/or microscopic involvement of the parametria
RT
vs.
RT+CIS/FU
RT + cisplatin (70 mg/m2 IV) + 5-FU infusion (1 g/m2 days 1–5 x 4 q3 wk)
