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The 25 th European Congress of Obstetrics and Gynecology

The 25 th European Congress of Obstetrics and Gynecology. Neoadjuvant chemotherapy with Paclitaxel, Cisplatin and Bevacizumab for advanced cervical cancer.

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The 25 th European Congress of Obstetrics and Gynecology

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  1. The 25th European Congress of Obstetrics and Gynecology Neoadjuvant chemotherapy with Paclitaxel, Cisplatin and Bevacizumab for advanced cervical cancer Takuji Ueno, Shinji Monoe, Yu Yaegashi, Takuma Yamada, Takehiko Takeda, ShoTano, Kaname Uno, MichinoriMayama, MayuUkai, Teppei Suzuki, YasuyukiKishigami and HidenoriOguchi The Department of Obstetrics and Gynecology, TOYOTA Memorial Hospital, Aichi, Japan

  2. Introduction • Concurrent chemoradiotherapy (CCRT) and radical hysterectomy (RH) are the standard treatment of cervical cancer1). • They often associated with significant complications such as bladder dysfunction, and reduce patients’ quality of life. • Nerve sparing RH (NSRH) that remains hypogastric plexus and bladder branchesis said to reduce bladder dysfunction. 1) Cervical Cancer Guideline(Version 1. 2016). NCCN Crinical Practice Guidelines in Oncology

  3. Introduction • Recently, the utility of Bevacizumab, a vascular endothelial growth factor monoclonal antibody, has been reported in advanced cervical cancer2). • Some reports show neoadjuvantchemotherapy with conventional regimen followed by RH is valid3). 2) Tewari KS, et al. N Engl J Med. 2014; 370: 734-43 3) Pierluigi BP, et al. Annals of Surgical Oncology 14(9):2643–2648

  4. Objective The aim of this study is to analyze the feasibility and efficacy of neoadjuvant chemotherapy with Bevacizumab followed by NSRH in patients with advanced cervical cancer.

  5. Material & Method • Between 2016 and 2017, patients with advanced cervical cancer were enrolled in this study. • Patients who had a bulky cervical mass over 4 cm, took neoadjuvant chemotherapy, Paclitaxel, Cisplatin, and Bevacizumab (TPB) treatment followed by NSRH were enrolled.

  6. Material & Method • When TPB treatment was feasible, that was continued 3 courses before NSRH. • After operation we analyzed complications, response in pathological findings and bladder dysfunction at one month. • We evaluated the efficacy of TPB treatment by serous SCC levels, ultrasound and magnetic resonance imaging (MRI).

  7. Patients

  8. Results CR : Complete Response PR : Partial Response

  9. Case 1 (StageⅡB) Before Therapy After TPBx3

  10. Case 1 (StageⅡB)

  11. Results CR : Complete Response PR : Partial Response

  12. Case 4 (StageⅢB) Before Therapy After TPBx3

  13. Results CR : Complete Response PR : Partial Response

  14. Case 6 (StageⅣB) Before Therapy After TPBx3

  15. Case 6 (StageⅣB) Before Therapy After TPBx3

  16. Results • All patients underwent 3 courses TPB, and accomplished NSRH. • In all cases the chemotherapy reduced the size of tumor remarkably. • SCC decreased in all cases.

  17. Case 6

  18. Case 6 Bafore Therapy Squamaous Cell Carcinoma

  19. Case 6 Residual Tumor

  20. Results • Two patients achieved pathological CR • The other 4 patients achieved clinical and pathological PR

  21. Results • Two patients achieved pathological CR • The other 4 patients achieved clinical and pathological PR

  22. Side Effects • Two patients (case 1,4) complicated gastro-duodenum ulcer, and one patient (case 1) got pulmonary embolism a few days after operation. • No other major side effect of Bevacizmab has occurred. • No patient got bladder dysfunction one month after the operation.

  23. Discussion1 : Efficacy • The additional effect of chemotherapy with Bevacizumab was proved by GOG-0240 study2). • In our all cases, TPB treatment reduced the size of tumor remarkably, and NSRH was feasible. • Two of them achieved pathological CR.

  24. Discussion 2 : Side Effects • Gastrointestinal or genitourinary fistula is major side effect of Bevacizumab. • It is reported that thromboembolic events and hypertension are increased with Bevacizumab containing chemotherapy. • We experienced two gastrointestinal ulcer, and one pulmonary embolism, but they were cured with medication.

  25. Discussion 3 : Operation • After RH, bladder dysfunction is common complication developed in about 70% of the patients and usually resolves within 6-12 months4)5). • NSRH is valid for reducing bladder dysfunction and keep the efficacy and oncology safety6). • In our 6 cases, all patients’ bladder dysfunction improved in one month. 4) Chanita K, et al. Int Urogynecol J (2014) 25:91–96 5) Chen GD, et al. Gynecol Oncol (2002) 85:292–297 6) Ju-Won R, et al J Gynecol Oncol Vol. 26, No. 2:90-99

  26. Conclusion • TPB treatment followed by NSRH for advanced cervical cancer was reasonable. • In addition, TPB treatment reduced bladder dysfunction, and improved quality of life. • We must be careful of complications of chemotherapy and operation. • Long term follow-up should be conducted.

  27. Thank You Teşekkürler

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