Cvx Ca

Question 1

Previously treated Cvx ca pts in basket phII KEYNOTE-158 study of pembrolizumab:
PDL-1 positivity
Response rate among PDL-1
Time to response and % responding at 9 and 12 months

Answer 1

PDL-1 positivity (CPS=,>1): 84%

Response rate among PDL-1: ORR - 15% (12pts)

Time to response: 2 m

% responding at 9 and 12 months: 91 and 80%

Question 2

SUCCOR study: rate of 🔄 in MIS cohort who had protective vaginal closure?

Answer 2

3/43=7% 🔄 at 4.5 years = laparotomy

25% 🔄 rate among MIS w/o vaginal closure

In LACC: 3.5% 🔄 rate in Xlap at 4.5 y; power calculations were done for 10% rate

Question 3

% if CIN3 progressing to cancer?

Answer 3

12-40%

Question 4

Rate of recurrent CIN2/3 after excisional or ablative tax?

Answer 4

5-17%

~size of lesion
~endocervical glands involvement
~positive margins

Question 5

Sexual functioning at 12 months after NSRH via TL vs XLap per Ceccaroni’s retrospective cohort study 2021?

Answer 5

No difference between approaches

87% recovered sexual activity: of those recovered, 72% considered it “satisfactory” (only 17% had XRT)

whereas in “unsatisfactory sexual quality” group - 80% had XRT p<0.001

Question 6

Main difference after NSRH via TL vs XLap per Ceccaroni’s retrospective cohort study 2021 (Raspagliesi open technique)?

Answer 6

Urinary incontinence and voiding difficulties persistent at 12 and 24 months

14 vs 26% and 10 vs 25% p<0.01

0 vs 5.5% rate of complete urinary retention w/ XLap

Question 7

Voiding dysfunction ~ type of parametrectomy in prospective SENTIX trial: 300 pts/47sites/18EU countries?

Answer 7

Predictors of voiding recovery >7d in multivariate analysis:
SH - reference
B- 4.7
C1- 3.6
C2- 5.8

with 98% recovering within a month
5/7 recovering longer had catheter due to urinary complications

No difference between C1s Lap vs. XLAP

Question 8

Catheter management after RH ~ parametrectomy and previous pregnancy (OR 0.3; p-0.033) in prospective SENTIX trial: 300 pts/47sites/18EU countries?

Answer 8

Should attempt removal based on median successful time for:
B and C1:
nulliparous - POD#2
previous pregnancy - POD#4

C2: POD#6

If PVR 50-150: reassess in 1-2 days;
If PVR >150: catheter + reassess in 1-2 days

Question 9

Recurrent or metastatic squamous cvx/vulva/vaginal ca who are HPV + or unknown, being part of phI-II CheckMate 358 Trial of Nivolumab (Ig PD-1i): (63% of tu >1% PD-L1 expression): ORR- SD? Median duration of response? Discontinuation rate?

Answer 9

ORR- SD: 26-42%

Median duration of response: 23m

Discontinuation rate: 5%

Question 10

Radical trachelectomy vaginally - systematic review: 21 series/1364🙎‍♀️: 🔄 rate ~ tumor size:

Answer 10

> 2 cm: 17%

< 2 cm: 4%

2% of patients with 🔄 died

UpToDate 11/2021

Question 11

Radical trachelectomy: ideal margin?

Answer 11

Should be at least 10 mm per MRI, to ensure at least 5 mm per final pathology

Question 12

Cone for fertility preservation in cvx ca: size cut off?

Answer 12

< 1 cm tumors

Question 13

Pregnancy outcomes in 50🙎‍♀️ (2007-2020) undergoing simple trachelectomy and LN assessment for cvx ca <2 cm size?

Answer 13

40 🤰:
12% 1/3 SAB
2.5% 2/3 SAB
7.5% 3🧑‍🍼late preterm
75% delivered at >36ga

Question 14

Oncologic outcomes in 50🙎‍♀️ (2007-2020) undergoing simple trachelectomy and LN assessment for cvx ca <2 cm size?

Answer 14

Median follow up: 76 months

1🔄 leading to exenteration and cancer ✝️

5y PFS and OS: 98%

Int J Gyn Ca 2020; 30(7):981

Question 15

Parametrial extension in cvx ca <2cm: probability?

Answer 15

<1%.

UpToDate 11/2021

Question 16

ConCerv - oncologic outcomes?
prospective, single arm study: 100🙎‍♀️; (2010-2019) of =|< 2cm cvx ca w/ no LVSI, <10 mm depth of invasion and negative conization margins (>1 mm and no AIS or >CIN2) w/ 96% of patiens undergoing MIS;

Answer 16

Oncologic outcomes ~ tx:

5% LN+

🔄 rate:
2y PFS of 95%:
0/36 for cone + hyst/LND
2.4% (1/42) cone + LND (invasion >10 mm and dysplasia at margin)
12.5% (2/16) inadvertent hyst + LND

Question 17

s. Ib3 cvx ca, fertility preservation: risk of LN involvement?

Answer 17

10-15%

Question 18

s. Ib3 cvx ca, fertility preservation: oncologic and obstetric outcomes of NACT/VRT vs ART? similar attempt to conceive at 40%; per UpToDate 11/2021

Answer 18

🤰 rate among attempting: 70 vs 21%

live birth 🧑‍🍼: 63 vs 43% of pregnancies

🔄 rate: 10 vs 7%

✝️ rate: 2.9 vs 3.4%

Question 19

How long was the tx (all q3wks) in KEYNOTE-826 w/ Paclitaxel 175
Cisplatin 50mg/m2
or Carbo AUC 5
Pembrolizumab 200mg
+/- bevacizumab 15mg/kg

Answer 19

Pembrolizumab up to cycle #35

Chemo: 6 cycles, but could continue longer if clinical benefit, no side effects and approved by the sponsor

Question 20

% of patients using opioids at 3 & 6 months after XRT: risk factors?

Answer 20

3m - 29%
6m - 25%

> h/o substance abuse - OR: 6
depression and anxiety - OR: 6

Question 21

PALN chimney - extended field RT to T12 or L1: toxicity?

Answer 21

GOG study of 95🙋‍♀️ from 1998:
3y PFS and OS: 34 and 39% respectively

g3 GI toxicity at 19% vs. 21 and 28% for g3&4 in RTOG study of 29 pts with Cis75 and bid XRT

late morbidity at 4y: 14%

Question 22

LND at RH: extensiveness for early cvx after SENTIX study in ESGOg 2023?

Answer 22

if SNL frozen is negative - only level I LND

only 2% (N-355 SENTIX) had isolated LNm at level II, cranially to iliac bifurcation

Question 23

ESGOg 2023 on borders for PALN XRT ~ indications: p34

Answer 23

for + pelvic LN: May include PALN up to renal (45 Gy)

for + PALN, target volume includes at minimum the region up to the renal vessels

Question 24

ESGOg 2023 cvx: options for tx of + LN: p35

Answer 24

Integrated or sequential boost: total with brachytherapy 55-60 Gy

vs.

debulking of enlarged lymph nodes

Question 25

Radiation fibrosis tx:

Answer 25

Pentoxifylline 800 mg/d Tocopherol 1000 u/d for 2-4y; rebound fibrosis if 6-12 m max regression at 16 vs. 28 months if < 6 m fibrosis duration PENTOCLO for jaw radionecrosis: healing at 49 vs 169 d for chXRT