title: Validity of laparoscopic staging to avoid adjuvant chemoradiation following radical surgery in patients with early cervical cancer.
abstract: OBJECTIVE
  To determine the rate of unavoidable adjuvant chemoradiation (RCTX) due to histologic results after radical surgery in patients with early cervical cancer.
  
  
  METHODS
  Between May 2004 and July 2011, 448 consecutive patients diagnosed with invasive cervical cancer stage IA1 L1 to IIA underwent laparoscopic staging at the Department of Gynecology and Gynecologic Oncology at Charité Berlin. Only in patients without lymph node metastases (n = 394) on frozen section, radical operation was continued either by laparoscopic radical hysterectomy (n = 228) or by radical vaginal trachelectomy (n = 166). The decision for adjuvant RCTX was reached among the members of an interdisciplinary tumor board according to the presence of risk factors. The mean age of patients was 39 years. Squamous cell cancer was found in 62.5%, adenocarcinoma in 32.7%, adenosquamous cancer in 3.8% and others in 1% of patients. Adjuvant treatment was indicated if at least one category 1 risk factor (pN1, R1 or RX, parametrial involvement) and/or any combination of category 2 risk factors (lymphovascular space involvement (LVSI), hemovascular space involvement, grading 3, young age, deep stromal invasion, large tumor size) were present.
  
  
  RESULTS
  In 39 of 394 patients (9.9%), adjuvant RCTX was recommended due to category 1 risk factors (n = 25/6.4%) and category 2 risk factors (n = 14/3.5%). Tumor-involved (R0) or unclear resection margins (RX) were present in 4 (1%) and 1 (0.3%), parametrial involvement in 12 (3%) and positive lymph nodes in 11 (2.8%) patients, respectively. Hemovascular involvement was found in 14 (3.5%), LVSI in 113 (28.7%) and grading 3 in 122 (31%) patients, respectively.
  
  
  CONCLUSIONS
  Laparoscopic staging is a reliable tool to keep the rate of tri-modal (surgery + chemotherapy + radiotherapy) treatments in patients with cervical cancer stage I and IIA after radical surgery at 10%. This percentage should be used as benchmark for the quality of interdisciplinary treatment of patients diagnosed with cervical cancer.
authors.affiliation: Department of Radiooncology, Charité Universitätsmedizin Berlin, Berlin, Germany. simone.marnitz @ charite.de
authors.forename: Simone
authors.initials: S
authors.lastname: Marnitz
authors.forename: Christhardt
authors.initials: C
authors.lastname: Köhler
authors.forename: Renato Jose
authors.initials: RJ
authors.lastname: Affonso
authors.forename: Achim
authors.initials: A
authors.lastname: Schneider
authors.forename: Vito
authors.initials: V
authors.lastname: Chiantera
authors.forename: Audrey
authors.initials: A
authors.lastname: Tsounoda
authors.forename: Filiberto
authors.initials: F
authors.lastname: Vercellino
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059186:Chemoradiotherapy, Adjuvant; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D014621:Vagina / Q000601:surgery; D055815:Young Adult