The Role of Lymph Node Downstaging Following Neoadjuvant Treatment in a Group of Patients with Advanced Stage Cervical Cancer

Q: What is the study’s main focus regarding advanced cervical cancer?

The study examines how lymph node downstaging after neoadjuvant treatment relates to survival, including the roles of radiotherapy and lymphadenectomy in controlling lymph node invasion.

Q: How were treatments delivered in the patient cohort?

All patients received radiotherapy, and two-thirds received concomitant chemotherapy. A radical surgical intervention with pelvic lymphadenectomy was performed 6 to 8 weeks after neoadjuvant treatment.

Q: Which factors were linked to overall survival in the analysis?

Overall survival depended on post-radiotherapy FIGO stage and lymph node status assessed during surgery. Risk of death increased with low preoperative hemoglobin and more advanced FIGO stage determined during surgical intervention.

Sep 24, 2026

Uploaded by Rowan

Background and objectives: Cervical cancer is a common malignancy driven by persistent high-risk human papillomavirus infection. After neoadjuvant treatment, imaging reassessment evaluates whether disease stage changes through lymph node downstaging, a prognostic factor for recurrence and survival. Methods and results: Patients with FIGO stage IIIC1 received radiotherapy, often with concomitant chemotherapy, followed by radical hysterectomy and pelvic lymphadenectomy. Downstaging was assessed with statistical tests, survival analyzed via Kaplan-Meier curves, and risk factors evaluated using Cox modeling. Conclusions support the survival relevance of radiotherapy-associated downstaging and the prognostic role of preoperative hemoglobin.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages16

Reading Time40 min

AccessFree to download

Abstract

1. Introduction

2. Materials and Methods

3. Results

4. Discussion

5. Conclusions

medicina Article The Role of Lymph Node Downstaging Following Neoadjuvant Treatment in a Group of Patients with Advanced Stage Cervical Cancer Irinel-Gabriel Dicu-Andreescu 1,2, Marian-Augustin Marincas, 1,2,*, Anca-Angela Simionescu 1,3, *, Ioana Dicu-Andreescu 1, Sînziana-Octavia Ionescu 1,2, Virgiliu-Mihail Prunoiu 1,2, Eugen Brătucu 1,2 and Laurentiu Simion 1,2 , Citation: Dicu-Andreescu, I.-G.; Marincas,, M.-A.; Simionescu, A.-A.; Dicu-Andreescu, I.; Ionescu, S.-O.; Prunoiu, V.-M.; Brătucu, E.; Simion, L. The Role of Lymph Node Downstaging Following Neoadjuvant Treatment in a Group of Patients with Advanced Stage Cervical Cancer. Medicina 2024, 60, 871. [https://](https://)[ ](https://)[doi.org/10.3390/medicina60060871](doi.org/10.3390/medicina60060871) Academic Editor: Konstantinos Dimas Received: 29 March 2024 Revised: 13 May 2024 Accepted: 24 May 2024 Published: 26 May 2024 Copyright: © 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://](https://)[ ](https://)[creativecommons.org/licenses/by/](creativecommons.org/licenses/by/)[ ](creativecommons.org/licenses/by/)[4.0/](4.0/)) . 1 Clinical Department No 10, General Surgery, University of Medicine and Pharmacy ”Carol Davila”, 050474 Bucharest, Romania; [andreescugabriel43@gmail.com](andreescugabriel43@gmail.com) (I.-G.D.-A.) 2 Department of Oncological Surgery, Oncological Institute ”Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania 3 Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania * Correspondence: [augustin.marincas@gmail.com](augustin.marincas@gmail.com) (M.-A.M.); [anca.simionescu@umfcd.ro](anca.simionescu@umfcd.ro) (A.-A.S.) Abstract: Background and Objectives: Cervical cancer is the fourth most frequent type of neoplasia in women. It is most commonly caused by the persistent infection with high-risk strands of human papillomavirus (hrHPV). Its incidence increases rapidly from age 25 when routine HPV screening starts and then decreases at the age of 45 . This reflects both the diagnosis of prevalent cases at first-time screening and the likely peak of HPV exposure in early adulthood. For early stages, the treatment offers the possibility of fertility preservation.. However, in more advanced stages, the treatment is restricted to concomitant chemo-radiotherapy, combined, in very selected cases with surgical intervention. After the neoadjuvant treatment, an imagistic re-evaluation of the patients is carried out to analyze if the stage of the disease remained the same or suffered a downstaging. Lymph node downstaging following neoadjuvant treatment is regarded as an indubitable prognostic factor for predicting disease recurrence and survival in patients with advanced cervical cancer. This study aims to ascertain the important survival role of radiotherapy in the downstaging of the disease and of lymphadenectomy in the control of lymph node invasion for patients with advanced-stage cervical cancer. Material and Methods: We describe the outcome of patients with cervical cancer in stage IIIC1 FIGO treated at Bucharest Oncological Institute. All patients received radiotherapy and two-thirds received concomitant chemotherapy. A surgical intervention consisting of type C radical hysterectomy with radical pelvic lymphadenectomy was performed six to eight weeks after the end of the neoadjuvant treatment. Results: The McNemar test demonstrated the regression of lymphadenopathies after neoadjuvant treatment—p: <0.001 . However, the persistence of adenopathies was not related to the dose of irradiation (p: 0.61), the number of sessions of radiotherapy (p: 0.80), or the chemotherapy (p: 0.44) . Also, there were no significant differences between the adenopathies reported by imagistic methods and those identified during surgical interventi

FAQs

What is the study’s main focus regarding advanced cervical cancer?

The study examines how lymph node downstaging after neoadjuvant treatment relates to survival, including the roles of radiotherapy and lymphadenectomy in controlling lymph node invasion.

How were treatments delivered in the patient cohort?

All patients received radiotherapy, and two-thirds received concomitant chemotherapy. A radical surgical intervention with pelvic lymphadenectomy was performed 6 to 8 weeks after neoadjuvant treatment.

Which factors were linked to overall survival in the analysis?

Overall survival depended on post-radiotherapy FIGO stage and lymph node status assessed during surgery. Risk of death increased with low preoperative hemoglobin and more advanced FIGO stage determined during surgical intervention.

Sep 24, 2026

Uploaded by Rowan