Cvx Ca Flashcards
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
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%
SUCCOR study: rate of 🔄 in MIS cohort who had protective vaginal closure?
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
% if CIN3 progressing to cancer?
12-40%
Rate of recurrent CIN2/3 after excisional or ablative tax?
5-17%
~size of lesion
~endocervical glands involvement
~positive margins
Sexual functioning at 12 months after NSRH via TL vs XLap per Ceccaroni’s retrospective cohort study 2021?
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
Main difference after NSRH via TL vs XLap per Ceccaroni’s retrospective cohort study 2021 (Raspagliesi open technique)?
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
Voiding dysfunction ~ type of parametrectomy in prospective SENTIX trial: 300 pts/47sites/18EU countries?
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
Catheter management after RH ~ parametrectomy and previous pregnancy (OR 0.3; p-0.033) in prospective SENTIX trial: 300 pts/47sites/18EU countries?
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
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?
ORR- SD: 26-42%
Median duration of response: 23m
Discontinuation rate: 5%
Radical trachelectomy vaginally - systematic review: 21 series/1364🙎♀️: 🔄 rate ~ tumor size:
> 2 cm: 17%
< 2 cm: 4%
2% of patients with 🔄 died
UpToDate 11/2021
Radical trachelectomy: ideal margin?
Should be at least 10 mm per MRI, to ensure at least 5 mm per final pathology
Cone for fertility preservation in cvx ca: size cut off?
< 1 cm tumors
Pregnancy outcomes in 50🙎♀️ (2007-2020) undergoing simple trachelectomy and LN assessment for cvx ca <2 cm size?
40 🤰: 12% 1/3 SAB 2.5% 2/3 SAB 7.5% 3🧑🍼late preterm 75% delivered at >36ga
Oncologic outcomes in 50🙎♀️ (2007-2020) undergoing simple trachelectomy and LN assessment for cvx ca <2 cm size?
Median follow up: 76 months
1🔄 leading to exenteration and cancer ✝️
5y PFS and OS: 98%
Int J Gyn Ca 2020; 30(7):981
Parametrial extension in cvx ca <2cm: probability?
<1%.
UpToDate 11/2021