Surgical treatment of recurrent gynecological malignancies
Authors:
Tomáš Crha 1; Vít Weinberger 1; Luboš Minář 1; Michal Felsinger 1; Markéta Bednaříková 2; Jitka Hausnerova 3
Authors‘ workplace:
Onkogynekologické centrum, Gynekologicko-porodnická klinika LF MU a FN Brno
1; Interní hematologická a onkologická klinika LF MU a FN Brno
2; Ústav patologie, LF MU a FN Brno
3
Published in:
Ceska Gynekol 2024; 89(4): 309-318
Category:
doi:
https://doi.org/10.48095/cccg2024309
Overview
Objective: A comprehensive overview of surgical treatment of recurrent gynecological malignancies. Recurrent breast malignancies are not included in this review. Methodology: A review providing overview of surgical treatment options for recurrent malignancies of adnexa of the uterus (ovary, fallopian tube), uterine corpus, uterine cervix, and carcinoma of the vagina and vulva. Conclusion: Optimal surgical treatment for patients with recurrent cancer is based on multidisciplinary approach with stratification according to individual prognostic markers. These include patient’s performance status, outcome of primary surgery, current extent of recurrence, and histopathological, molecular, and biochemical characteristics. Decision about choice of treatment should be individually discussed and evaluated by the multidisciplinary oncogynecological commission board.
Keywords:
surgery – endometrial cancer – cervical cancer – ovarian cancer – vulvar cancer – recurrent cancer
Sources
1. Dušek L, Mužík J, Kubásek M et al. Epidemiologie zhoubných nádorů v České republice. Masarykova univerzita. 2007 [online]. Dostupné z: http: //www.svod.cz.
2. Imoto S, Inamine M, Kudaka W et al. Prognostic factors in patients with vulvar cancer treated with primary surgery: a single-center experience. Springerplus 2016; 5: 125. doi: 10.1186/s40064-016-1767-7.
3. Oonk MH, Planchamp F, Baldwin P et al. European society of gynaecological oncology guidelines for the management of patients with vulvar cancer. Int J Gynecol Cancer 2017; 27 (4): 832–837. doi: 10.1097/IGC.0000000000000975.
4. O’Donnell RL, Verleye L, Ratnavelu N et al. Locally advanced vulva cancer: a single centre review of anovulvectomy and a systematic review of surgical, chemotherapy and radiotherapy alternatives. Is an international collaborative RCT destined for the “too difficult to do” box? Gynecol Oncol 2017; 144 (2): 438–447. doi: 10.1016/j.ygyno.2016.12.007.
5. Abdulrahman GO, Das N, Chandrasekaran TV et al. Pelvic exenteration for the treatment of locally advanced vulvar cancer in south west wales. Cancers (Basel) 2022; 14 (7): 1767. doi: 10.3390/cancers14071767.
6. Cibula D, Dostálek L, Jarkovsky J et al. The annual recurrence risk model for tailored surveillance strategy in patients with cervical cancer. Eur J Cancer 2021; 158: 111–122. doi: 10.1016/j.ejca.2021.09.008.
7. Marnitz S, Köhler C, Müller M et al. Indications for primary and secondary exenterations in patients with cervical cancer. Gynecol Oncol 2006; 103 (3): 1023–1030. doi: 10.1016/j.ygyno.2006.06.027.
8. Höckel M, Dornhöfer N. Pelvic exenteration for gynaecological tumours: achievements and unanswered questions. Lancet Oncol 2006; 7 (10): 837–847. doi: 10.1016/S1470-2045 (06) 70903-2.
9. Benedetti Panici P, Manci N, Bellati F et al. Vaginectomy: a minimally invasive treatment for cervical cancer vaginal recurrence. Int J Gynecol Cancer 2009; 19 (9): 1625–1631. doi: 10.1111/IGC.0b013e3181a80a0a.
10. Abe A, Matoda M, Okamoto S et al. Resection of the vaginal vault for vaginal recurrence of cervical cancer after hysterectomy and brachytherapy. World J Surg Onc 2015; 13 (1): 137. doi: 10.1186/s12957-015-0495-8.
11. Brunschwig A. The surgical treatment of cancer of the cervix uteri; radical operation for cancer of the cervix. Bull N Y Acad Med 1948; 24 (10): 672–683.
12. Höckel M, Horn LC, Einenkel J. (Laterally) extended endopelvic resection: surgical treatment of locally advanced and recurrent cancer of the uterine cervix and vagina based on ontogenetic anatomy. Gynecol Oncol 2012; 127 (2): 297–302. doi: 10.1016/j.ygyno.2012.07.120.
13. Höckel M. Laterally extended endopelvic resection (LEER) – principles and practice. Gynecol Oncol 2008; 111 (2 Suppl): S13–S17. doi: 10.1016/j.ygyno.2008.07.022.
14. Benn T, Brooks RA, Zhang Q et al. Pelvic exenteration in gynecologic oncology: a single institution study over 20 years. Gynecol Oncol 2011; 122 (1): 14–18. doi: 10.1016/j.ygyno.2011. 03.003.
15. PelvEx Collaborative. Palliative pelvic exenteration: a systematic review of patient-centered outcomes. Eur J Surg Oncol 2019; 45 (10): 1787–1795. doi: 10.1016/j.ejso.2019.06.011.
16. Hilton P, Spirtos NM, Monaghan JM et al. Bonney’s gynaecological surgery. 12th ed. UK: Wiley-Blackwell 2018.
17. Lampe B, Luengas-Würzinger V, Weitz J et al. Opportunities and limitations of pelvic exenteration surgery. Cancers (Basel) 2021; 13 (24): 6162. doi: 10.3390/cancers13246162.
18. Sardain H, Lavoue V, Redpath M et al. Curative pelvic exenteration for recurrent cervical carcinoma in the era of concurrent chemotherapy and radiation therapy. A systematic review. Eur J Surg Oncol 2015; 41 (8): 975–985. doi: 10.1016/j.ejso.2015.03.235.
19. Peiretti M, Zapardiel I, Zanagnolo V et al. Management of recurrent cervical cancer: a review of the literature. Surg Oncol 2012; 21 (2): e59–e66. doi: 10.1016/j.suronc.2011.12.008.
20. Concin N, Matias-Guiu X, Vergote I et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer 2021; 31 (1): 12–39. doi: 10.1136/ijgc-2020-002230.
21. Connor EV, Rose PG. Management strategies for recurrent endometrial cancer. Expert Rev Anticancer Ther 2018; 18 (9): 873–885. doi: 10.1080/14737140.2018.1491311.
22. Papadia A, Bellati F, Ditto A et al. Surgical treatment of recurrent endometrial cancer: time for a paradigm shift. Ann Surg Oncol 2015; 22 (13): 4204–4210. doi: 10.1245/s10434-015-4504-5.
23. Huh WK, Straughn JM Jr, Mariani A et al. Salvage of isolated vaginal recurrences in women with surgical stage I endometrial cancer: a multiinstitutional experience. Int J Gynecol Cancer 2007; 17 (4): 886–889. doi: 10.1111/j.1525-1438.2007.00858.
24. Schmidt AM, Imesch P, Fink D et al. Pelvic exenterations for advanced and recurrent endometrial cancer: clinical outcomes of 40 patients. Int J Gynecol Cancer 2016; 26 (4): 716–721. doi: 10.1097/IGC.0000000000000678.
25. Zanfagnin V, Ferrero A, Biglia N et al. The role of surgery in recurrent endometrial cancer. Expert Rev Anticancer Ther 2016; 16 (7): 741–750. doi: 10.1080/14737140.2016.1190650.
26. Dowdy SC, Mariani A, Cliby WA et al. Radical pelvic resection and intraoperative radiation therapy for recurrent endometrial cancer: technique and analysis of outcomes. Gynecol Oncol 2006; 101 (2): 280–286. doi: 10.1016/j.ygyno.2005.10.018.
27. Creutzberg CL, van Putten WL, Koper PC et al. Survival after relapse in patients with endometrial cancer: results from a randomized trial. Gynecol Oncol 2003; 89 (2): 201–209. doi: 10.1016/s0090-8258 (03) 00126-4.
28. Barlin JN, Puri I, Bristow RE et al. Cytoreductive surgery for advanced or recurrent endometrial cancer: a meta-analysis. Gynecol Oncol 2010; 118 (1): 14–18. doi: 10.1016/j.ygyno.2010.04.005.
29. Aletti GD, Dowdy SC, Gostout BS et al. Aggressive surgical effort and improved survival in advanced-stage ovarian cancer. Obstet Gynecol 2006; 107 (1): 77–85. doi: 10.1097/01.AOG.0000192407.04428.bb.
30. Colombo N, Sessa C, du Bois A et al. ESMO--ESGO Ovarian Cancer Consensus Conference Working Group. ESMO-ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease. Ann Oncol 2019; 30 (5): 672–705. doi: 10.1093/annonc/mdz062.
31. Burger RA, Brady MF, Bookman MA et al. Incorporation of bevacizumab in the primary treatment of ovarian cancer. N Engl J Med 2011; 365 (26): 2473–2483. doi: 10.1056/NEJMoa 1104390.
32. Moore KN, Pignata S. Trials in progress: IMagyn050/GOG 3015/ ENGOT-OV39. A phase III, multicenter, randomized study of atezolizumab versus placebo administered in combination with paclitaxel, carboplatin, and bevacizumab to patients with newlydiagnosed stage III or stage IV ovarian, fallopian tube, or primary peritoneal cancer. Int J Gynecol Cancer 2019; ijgc-2018-000071. doi: 10.1136/ijgc-2018-000071.
33. du Bois A, Reuss A, Pujade-Lauraine E et al. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO- -OVAR) and the Groupe d’Investigateurs Nationaux Pour les Etudes des Cancers de l’Ovaire (GINECO). Cancer 2009; 115 (6): 1234–1244. doi: 10.1002/cncr.24149.
34. Harter P, du Bois A, Hahmann M et al. Surgery in recurrent ovarian cancer: the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR trial. Ann Surg Oncol 2006; 13 (12): 1702–1710. doi: 10.1245/s10434-006-9058-0.
35. Harter P, Sehouli J, Reuss A et al. Prospective validation study of a predictive score for operability of recurrent ovarian cancer: the Multicenter Intergroup Study DESKTOP II. A project of the AGO Kommission OVAR, AGO Study Group, NOGGO, AGO-Austria, and MITO. Int J Gynecol Cancer 2011; 21 (2): 289–295. doi: 10.1097/IGC.0b013e31820aaafd.
36. Harter P, Sehouli J, Vergote I et al. Ran- domized trial of cytoreductive surgery for relapsed ovarian cancer. N Engl J Med 2021; 385 (23): 2123–2131. doi: 10.1056/NEJMoa2103294.
37. Horowitz NS, Miller A, Rungruang B et al. Does aggressive surgery improve outcomes? Interaction between preoperative disease burden and complex surgery in patients with advanced-stage ovarian cancer: an analysis of GOG 182. J Clin Oncol 2015; 33 (8): 937–943. doi: 10.1200/JCO.2014.56.3106.
38. Taskiran C, Vatansever D, Giray B et al. Upper abdominal debulking surgery for ovarian cancer total colectomy, total peritonectomy, and extended upper abdominal debulking surgery. Int J Gynecol Cancer 2020; 30 (10): 1648–1649. doi: 10.1136/ijgc-2020-001531.
39. Sehouli J, Grabowski JP. Surgery in recurrent ovarian cancer. Cancer 2019; 125 Suppl 24: 4598–4601. doi: 10.1002/cncr.32511.
40. Coleman RL, Spirtos NM, Enserro D et al. Secondary surgical cytoreduction for recurrent ovarian cancer. N Engl J Med 2019; 381 (20): 1929–1939. doi: 10.1056/NEJMoa1902626.
41. Felsinger M, Minar L, Weinberger V et al. Secondary cytoreductive surgery – viable treatment option in the management of platinum-sensitive recurrent ovarian cancer. Eur J Obstet Gynecol Reprod Biol 2018; 228: 154–160. doi: 10.1016/j.ejogrb.2018.06.036.
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Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineArticle was published in
Czech Gynaecology
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