the role of surgery in locally advanced cervical cancer

8/8/2019 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

the role of surgery in locally advanced cervical cancer

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