title: [Contribution of sentinel lymph-node biopsy to treatment of locally advanced stages of cervical cancers].
abstract: OBJECTIVE
  Usage of sentinel lymph-node (SLN) concept in locally advanced cervical cancers might help to individualise management. According to SLN status could be patients refered to neoadjuvant chemotherapy (NAC) with subsequent surgery or to primary chemoradiation. The aim of our study was to evaluate sensitivity of SLN detection in locally advanced cervical cancers and to assess the impact of NAC on frequency of their metastatic involvement.
  
  
  METHODS
  Retrospective clinical study.
  
  
  METHODS
  Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Medical Faculty, Charles University, Prague.
  
  
  METHODS
  Included were patients with cervical cancer stages FIGO IB1 (> 3 cm), IB2, IIA2 and selected cases of stages IIB with incipient parametrial involvement. Patients were distributed into two different protocols - patients in group NAC-SLN were refered to radical hysterectomy with SLN biopsy after 3 cycles of NAC, other patients (group SLN) underwent SLN biopsy and NAC was administered only in SLN-negative cases.
  
  
  RESULTS
  Altogether 101 patients were included (group SLN = 62, group NAC-SLN = 39). Detection of SLN in whole cohort reached 90.1% per patient and 68.3% bilaterally. No differences were found between SLN group and NAC-SLN group in frequency of per patient SLN detection (90.3% vs 89.7%) and bilateral detection (69.4% vs 66.7%). Prevalence of macrometastases, micrometastases and ITC in the SLN group was 37.1% (23/62), 11.3% (7/62) and 8.1% (5/62), respectively. In the NAC-SLN group macrometastases in SLN were detected in 17.9% (7/39) patients, in 1 patient was detected micrometastis in SLN and no patient had ITC. Difference in frequency of metastases in SLN was significant (p = 0,013). No patient had progressed during NAC, complete response was seen in 15.1% (11/73) patients and reduction of tumour volume > 30% in 84.9% (62/73) patients.
  
  
  CONCLUSIONS
  Detection of SLN in locally advanced cervical cancers reached comparable results to early stages. NAC did not influence frequency of SLN detection, but it significantly decreased prevalence of metastatic SLN involvement.
authors.forename: J
authors.initials: J
authors.lastname: Sláma
authors.forename: M
authors.initials: M
authors.lastname: Zikán
authors.forename: D
authors.initials: D
authors.lastname: Fischerová
authors.forename: R
authors.initials: R
authors.lastname: Kocián
authors.forename: A
authors.initials: A
authors.lastname: Germanová
authors.forename: F
authors.initials: F
authors.lastname: Frühauf
authors.forename: D
authors.initials: D
authors.lastname: Cibula
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D059248:Chemoradiotherapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008207:Lymphatic Metastasis / Q000473:pathology; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents
keywords: cervical cancer; neoadjuvant chemotherapy sentinel lymph-node.