the role of surgery in locally advanced cervical cancer
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THE ROLE OF SURGERY IN LOCALLY
ADVANCED CERVICAL CANCER
Nasdaldy
Division of Gynecologic Cancer
Dharmais Cancer Center/Hospital
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Magnitude of the problem
Cervical cancer continues to have a major impact on women
worldwide.
Nearly 80% of cases are in developing countries, where screeningprograms are not well established or are minimally effective.
A womens reproductive health problem
It is the 3rd most common cancer worldwide
One of the leading cause of death from cancer among women
particularly in developing countries
(Reproductive Health Outlook)
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Incidence and mortality rates for cervical
cancer by geographic regionContinent Region Incidence Mortality Ration
Incidence:Mortality
Africa
Central America
South America
North America
Asia
Europe
Developed countries
Developing countries
East
CentralNorth
Tropical zone
China
Japan
Southeast
East
North
South
37.4
26.611.3
44.4
31.8
9.1
5
9.7
18.6
13.7
12.5
10.4
11.2
18.2
18.7
15.16.3
17.4
17.3
3.4
2.8
3.4
9.9
7.0
4.9
4.0
4.8
9.6
2.0
1.81.8
2.6
1.8
2.7
1.8
2.9
1.9
2.0
2.6
2.6
2.3
1.9
Age-standard incidence and mortality rates per 100,000 women. Adjusted for the age distribution of the world population of 1960, CME J of Gyn Oncol 2001;6:173
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Relative survival rates by time since diagnosis of
invasive cervical cancer for selected countries
Country Province/population Patients
diagnosed in:
Relative Survival Rates
1 year 2 year 5year
England
France
Denmark
India
China
Philippines
Australia
Canada
USA
Banglore
Shanghai
Rizal
Quebec
British Columbia
SEER, all races
SEER, all races
1983-1984
1983-1985
1983-1984
1982-1989
1988-1991
1987
1977-1994
1984-1986
1970-1988
1984-1986
1989-1991
82 65 60
86 70 67
82 68 64
78 53 40
76 58 52
70 38 29
88 78 72
88 78 74
87 76 72
87 75 67
89 75 71
CME J of Gynec Oncol 2001;6:173
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Cancer and Cervical Cancer in Indonesia
No population registries data available, it is currently
estimated at least 170-190 new cancer cases annually per
100,000 population
The incidence increased 2-8% per year during the last
decade
From 13 pathological lab shows that cervical, breast,
lymph node, skin and nasopharynx are the five anatomical
sites for cancer disease
Among females, the most common are cervix, breast and
ovary
Tjindarbumi D, Mangunkusumo R. Jpn J. Clin. Oncol 2002;32
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JUMLAH KANKER GINEKOLOGI PASIEN RAWAT JALAN (KASUS BARU)
PERIODE TAHUN 2002 - 2006
RS. KANKER "DHARMAIS"
NO NAMA PENYAKIT 2002 2003 2004 2005 2006 TOTAL
1 CA. VULVA 1 1 2 3 0 7
2 CA. CERVIX 147 192 192 226 232 989
3 CA. ENDOMETRIUM 16 17 16 22 23 94
4 CA. UTERUS 1 1 2 0 0 4
5 CA. OVARIUM 30 37 16 31 64 178
6 CA. VAGINA 0 1 2 1 4 8
195 249 230 283 323 1280
Sumber :Catatan pasien ginekologi RSKD
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Cervical Cancer in Dharmais
Background
10 years data (1993-2003)
12,396 cancer pts was diagnosed
Nearly 3,800 cervical cancer cases ( 200 newcases/year)
Second place after breast cancer
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Patients Characteristic
Ethnic
Group into: Java-Bali (53.7%), Outside Java-Bali (22.0%),
and Chinese (24.3%)
Stage and race/ethnic:
Early stage; Java-Bali (60.9%) and Chinese (20.3%)
Advanced stage; Java-Bali (50.3%) and Chinese
(26.2%)
Deviany PE, 2004
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Patients Characteristic
Age- all stages
Age (year)
2-year survival
Deviany Dwipoyono B
< 40
4060
> 60
61.09 77.2
62.73 75.0
50.11 70.7
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Disease outcome:
Pts undergoing radical surgery
Disease free rate (3-years):
1993-1999, early stage
N = 60,some factors
The least: Age 40-60: 85.37%
Tumor size > 3 cm: 75.0%
Lymph node involvement: 85.7%
Survival (5-years): 1993-2002, early stage
N = 146, some factors
Stage Ia-Ib: 96.62%, stage IIa: 76.85%
Lymph node involvement: 75.2%
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Survival:
Overall
58% (5-years) Stages:
Early 77.3 - 88.9% (2-years), 76.6% (5-years)
Advanced 52.353.2% (2 years), 49.7% (5 years)
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Treatment modality
Surgery
Radiation therapy
Chemotherapy
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Surgery
Early Stage
Young age
Compromise
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Surgery
Facility
Staff ( well trained )
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Radiation Therapy
Advanced stage
Old age
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Radiation Therapy
Fascility ( onli in Java )
Staff ( well trained )
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Surgery for Locally advanced
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NACT approach in Cervical Cancer Treatment
Author N Regimen FU
OC
OS PFS
Lee, Korea
200499
Cisplatin +Etoposide, 3
cycles
49
mths
91,3 % - 3 y88,1 % - 5 y
77,2% - 3 y
Panici, Italia,1999
210 Cisplatin34
mths62 % - 4y 59 % - 4y
Panici, Italia,
199642
1 P,B, MTX
2 dose PB3 Platin
doxorubicin
1 3 cycles
54 71% - 5y 88% - 5y
FU = Follow up; N = Jumlah
OC = Outcome ; OS = overall survival; PFS = progression free survival
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2 Radical Hysterectomy for stage IIB CervicalCancer: 20 year Experience at the National CancerCentre Hospital in Tokyo.Kasamatsu, Onda, Sawada,et.al.
National Cancer Centre Hospital, Gynecology, Tokyo, Japan.
139 patients FIGO IIB treated with radical hysterectomyfollowed by radiation therapy. FU = 36 months. 5 y Survival rate69%+ relapse-free survival 72%.
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3. Radical Hysterectomy in Residual and RecurrentCervical Cancer Following Radiation Therapy:MNJIO & RCC, India Experience.U.R. Poli, R.Maturi, S.R. Taminedu,2004 - 2005
MNJ Institute of Oncology & Regional Cancer Center,Hyderabad, India
n = 21 pts with residual or recurrent disease folowingradiation. Randomitation in two groups, undergo radical
hysterectomy (n = 15) or extended surgery (n = 6). FU 6
24mths. No surgical morbidity or ureteric fistulae in group 1.
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Neoadjuvant Chemotherapy
Apply chemotherapy prior definitive
treatment, mostly surgery
Aim: to lower the stage (down staging),improve survival
High risk cervical cancer, bulky tumor ( 4
cm) and stage IIB
Period 2002-2004
Preliminary data
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RESULT
Tumor shrinkage:
50% in 10 pts,
50% in 3 pts, 1 pts radio-resistant and 1 pts lost tofollow up
Radical surgery:
Yes in 13 pts, 1 pts radiation and 1 pts lost to followup
Time to definitive treatment: 2-3 weeks in 9 pts
> 2-3 weeks in 5 pts
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DHARMAIS CANCER HOSPITAL
JAKARTA
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