[Caring for stage IB cancer of the cervix. Proposal for a protocol based on a review of the literature].
A review of the literarure indicates that there are two essential prognostic factors in stage Ib cancer of the cervix: the size of the tumour (determined by a physical examination and MRI) and invasion of the lymph nodes (determined by lymphadenectomy). Of the available means of treatment, many workers use surgery at stage Ib1 and a combination of chemotherapy and radiotherapy at stage Ib2. Hence, our pre-therapeutic assessment usually includes a physical examination under general anaesthesia, MRI of the abdomen and pelvis, and laparoscopic pelvic lymphadenectomy for stage Ib1 and laparoscopic lumbo-aortic lymphadenectomy for stage Ib2. For stage Ib1 < 2 cm, if extemporaneous examination of the pelvic lymph nodes is positive, we perform lymphadenectomy of the lumbo-aortic lymph nodes and initiate treatment with chemotherapy and radiotherapy. If pelvic lymphadenectomy gives negative results in a woman who does not wish to remain fertile, we carry out radical vaginal hysterectomy (Schauta-Stoeckel) rather than radical hysterectomy (Piver 2) by laparotomy or laparoscopy. If the margins are healthy and devoid of vascular or lymphatic involvement, no further treatment is given. If this is not the case, we suggest a postoperative radio-chemotherapy. For patients who wish to retain their fertility, we carry out radical cervicectomy. For tumours measuring between 2 and 4 cm, and if pelvic lymphadenectomy is positive, we propose radio-chemotherapy, or radical hysterectomy as for small tumours. For Ib2 tumours, and if no lumbar adenopathy is seen at MRI, we perform a lumbo-aortic lymphadenectomy, followed by a radio-chemotherapy. If invasion of lumbar lymph nodes is suspected at MRI, we perform a biopsy on the left scalenic lymph nodes; if invasion is present at this level, we give palliative treatment with simple pelvic radiotherapy. If lumbo-aortic lymphadenectomy reveals invasion, radiotherapy is directed at these nodes. If, at the end of combined chemotherapy and radiotherapy, some remaining tumour is discovered at the MRI assessment, we carry out extrafacial hysterectomy.
Aubard
Y
Y
Service de gynécologie-obstétrique, centre hospitalier universitaire Dupuytren, 87000, Limoges, France. yves.aubard@unilim.fr
Genet
D
D
Philippe
H J
HJ
D000375:Aging; D000970:Antineoplastic Agents / Q000627:therapeutic use; D024221:Antineoplastic Protocols; D003131:Combined Modality Therapy; D005260:Female; D005298:Fertility; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D009367:Neoplasm Staging; D011379:Prognosis; D011878:Radiotherapy; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*
D000970:Antineoplastic Agents