Mariangela Amoroso

Squamous cell carcinoma antigen: prognostic significance and role in the monitoring of neoadjuvant chemotherapy response in cervical cancer.

PURPOSE The aim of the study was to investigate the role of squamous cell carcinoma antigen (SCC) in the management of patients with locally advanced cervical cancer treated by neoadjuvant chemotherapy and radical surgery. PATIENTS AND METHODS SCC assay was performed with a radioimmunoassay kit in a series of 102 patients with locally advanced cervical cancer. The values of 2.5, 5, and 7 ng/mL were used to define SCC antigen positivity. The chi 2 and Fishers exact test and the stepwise logistic regression were used to evaluate the distribution of marker values. Analysis of survival was performed using the Kaplan and Meier test and Cox multivariate regression analysis. RESULTS SCC levels were elevated in 65%, 45%, and 32% of patients with primary tumors for cutoff values of 2.5, 5, and 7 ng/mL, respectively. SCC pretreatment levels correlated with stage, tumor volume and lymph node status. In the multivariate analysis, SCC expression proved to be an independent predictor of response to neoadjuvant chemotherapy. SCC posttreatment levels were strongly related to chemotherapy response. Moreover, the overall correlation between the clinical course of the disease and the variation of SCC levels was 83%. In patients with squamous cell tumors, survival was significantly longer in SCC-negative cases compared with SCC-positive cases (P = .04). Moreover, in patients undergoing surgery after response to neoadjuvant chemotherapy, low SCC values were associated with better prognosis (P = .02). In the multivariate analysis, parametrial involvement and SCC status proved to retain an independent prognostic value. CONCLUSION Our data show that SCC assay may provide useful information to improve the prognostic characterization and disease monitoring of patients with locally advanced cervical cancer undergoing neoadjuvant chemotherapy.

The value of squamous cell carcinoma antigen in patients with locally advanced cervical cancer undergoing neoadjuvant chemotherapy

The value of squamous cell carcinoma antigen in patients with locally advanced cervical cancer undergoing neoadjuvant chemotherapy Scambia G; Benedetti Panici P: Baiocchi G: Amoroso M; Foti E: Greggi S; Mancuso S Because of the high degree of selection bias no valid comparisons can be made of recurrence-free interval in these groups. The 5-year recurrence-free interval for patients with negative surgicalpathological risk factors (other than grade and myoinvasion) was 92.7% involvement of the isthmus/cervix 69.8% positive pelvic cytology 56.0%: vascular space invasion 55.0%; pelvic node or adnexal metastases 57.8%; and aortic node metastases or gross laparotomy findings 41.2%. It is not clear that cervix invasion per se diminishes survival, because it is more often associated with poor tumor differentiation (34.7% versus 24.0%. grade 3) and deep myoinvasion (47.0% vs 18.6%)) than cases without cervix invasion. The relapse rate among cervix-positive and -negative cases with grade 3 lesions and deep myoinvasion is not dramatically different (48.8% vs 39.8%). The proportion of failures which were vaginal/pelvic (34.6% for the surgery only group compared to 12.5% of the RT group) appears to favor the use of adjuvant radiation for patients with more than onethird myoinvasion and grade 2 or 3 tumor. There were 97 patients in the study group with malignant cytology of which 29.1% had regional/distant failure, which compares to 10.5% of the cytology-negative patients. These data seem to implicate malignant cytology as a serious adverse finding, especially with respect to the risk for regional/distant and abdominal failure

Tratamiento del cáncer de cuello uterino en estadio III y IV

Resumen El tratamiento clinico del cancer de cuello uterino localmente avanzado constituy un desafio terapeutico para los ginecologos-oncologos, radioterapeutas y oncologos. Pese a l implantacion de programas de busqueda y la existencia de metodos fiables para su deteccio precoz, la cuarta parte de los casos de cancer cervicouterino se diagnostican en estadio III o IV. La norma terapeutica actual para las mujeres con un cancer cervicouterino en estadios III o IVA es la radioterapia, mientras que en el estadio IVB solo estan indicados los tratamientos paliat vos. En los ultimos decenios, los avances tecnicos en radioterapia han permitido prolongar sig nificativamente la supervivencia a 5 anos de las pacientes en estadio III. No obstante, la evo lucion a largo plazo y la morbilidad asociada con la radioterapia continuan representando u problema importante, las probabilidades de que estas mujeres continuen vivas durante 5 anos y no sufran una enfermedad moderada o grave son minimas. En los ultimos anos se han ensa yado nuevas estrategias terapeuticas para tratar el cancer de cuello uterino localmente avan zado. Los resultados de los distintos ensayos aleatorizados parecen indicar que la quimiotera pia y la radioterapia concomitantes, asi como la quimioterapia neoadyuvante seguida de l cirugia radical, representan los protocolos terapeuticos mas prometedores en ese estadio clin co. No obstante, se requieren estudios de confirmacion y seguimiento antes de introducir esta nuevas modalidades terapeuticas en la practica clinica. La quimioterapia basada en compue: tos de platino y la radioterapia son eficaces para el tratamiento paliativo de las pacientes e estadio IVB. Siempre que se decida la estrategia terapeutica para este grupo de pacientes incu rables se tomaran en cuenta los sintomas clinicos y tambien la calidad de vida.