Two pillars in modern oncology are treatment personalization and the reduction in treatment-related morbidity. For decades, the one-fits-all concept of radical hysterectomy has been the cornerstone of early-stage cervical cancer surgical treatment. However, no agreement exists about the prevalent method of parametrial invasion, and the literature is conflicting regarding the extent of parametrectomy needed to achieve adequate surgical radicality. Therefore, authors started investigating if less radical surgery was feasible and oncologically safe in these patients. Two historical randomized controlled trials (RCTs) compared classical radical hysterectomy (RH) to modified RH and simple hysterectomy. Less radical surgery showed a drastic reduction in morbidity without jeopardizing oncological outcomes. However, given the high frequency of adjuvant radiotherapy, the real impact of reduced radicality could not be estimated. Subsequently, several retrospective studies investigated the chance of tailoring parametrectomy according to the tumor's characteristics. Parametrial involvement was shown to be negligible in early-stage low-risk cervical cancer. An observational prospective study and a phase II exploratory RCT have recently confirmed the feasibility and safety of simple hysterectomy in this subgroup of patients. The preliminary results of a large prospective RCT comparing simple vs. radical surgery for early-stage low-risk cervical cancer show strong probability of giving a final answer on this topic.

Bianchi, T., Grassi, T., Bazzurini, L., Di Martino, G., Negri, S., Fruscio, R., et al. (2023). Radical Hysterectomy in Early-Stage Cervical Cancer: Abandoning the One-Fits-All Concept. JOURNAL OF PERSONALIZED MEDICINE, 13(9) [10.3390/jpm13091292].

Radical Hysterectomy in Early-Stage Cervical Cancer: Abandoning the One-Fits-All Concept

Bianchi T.
Primo
;
Negri S.;Fruscio R.;Landoni F.
Ultimo
2023

Abstract

Two pillars in modern oncology are treatment personalization and the reduction in treatment-related morbidity. For decades, the one-fits-all concept of radical hysterectomy has been the cornerstone of early-stage cervical cancer surgical treatment. However, no agreement exists about the prevalent method of parametrial invasion, and the literature is conflicting regarding the extent of parametrectomy needed to achieve adequate surgical radicality. Therefore, authors started investigating if less radical surgery was feasible and oncologically safe in these patients. Two historical randomized controlled trials (RCTs) compared classical radical hysterectomy (RH) to modified RH and simple hysterectomy. Less radical surgery showed a drastic reduction in morbidity without jeopardizing oncological outcomes. However, given the high frequency of adjuvant radiotherapy, the real impact of reduced radicality could not be estimated. Subsequently, several retrospective studies investigated the chance of tailoring parametrectomy according to the tumor's characteristics. Parametrial involvement was shown to be negligible in early-stage low-risk cervical cancer. An observational prospective study and a phase II exploratory RCT have recently confirmed the feasibility and safety of simple hysterectomy in this subgroup of patients. The preliminary results of a large prospective RCT comparing simple vs. radical surgery for early-stage low-risk cervical cancer show strong probability of giving a final answer on this topic.
Articolo in rivista - Articolo scientifico
cervical cancer; morbidity; parametrectomy; radical hysterectomy; surgical oncology; tailoring radicality;
English
24-ago-2023
2023
13
9
1292
none
Bianchi, T., Grassi, T., Bazzurini, L., Di Martino, G., Negri, S., Fruscio, R., et al. (2023). Radical Hysterectomy in Early-Stage Cervical Cancer: Abandoning the One-Fits-All Concept. JOURNAL OF PERSONALIZED MEDICINE, 13(9) [10.3390/jpm13091292].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/446398
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