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Surgical Principles for Managing Stage IB2, IIA2, and IIB Uterine Cervical Cancer (Bulky Tumors) in Japan: A Survey of the Japanese Gynecologic Oncology Group

Mikami, Mikio MD, PhD*; Aoki, Yoichi MD, PhD; Sakamoto, Masaru MD, PhD; Shimada, Muneaki MD, PhD§; Takeshima, Nobuhiro MD, PhD; Fujiwara, Hisaya MD, PhD; Matsumoto, Takashi MD, PhD#; Kita, Tunekazu MD, PhD**; Takizawa, Ken MD, PhD; Disease Committee of Uterine Cervical and Vulvar Cancer, Japanese Gynecologic Oncology Group

International Journal of Gynecological Cancer:
doi: 10.1097/IGC.0000000000000202
Cervical Cancer

Objective: The aim of this study was to determine the current operative management of International Federation of Gynecology and Obstetrics (FIGO) stage IB2, IIA2, and IIB uterine cervical cancer (bulky tumors) in Japan by surveying the member institutions of the Japanese Gynecologic Oncology Group.

Methods: We conducted a survey to assess current operative management, including indications and treatment, at all 199 active member institutions of the Japanese Gynecologic Oncology Group.

Results: A total of 166 institutions (83.4%) responded to the survey. For patients with stage IIB squamous cell carcinoma, 35.5% (59/166) of the institutions performed surgery. For stage IIB nonsquamous cell carcinoma, surgery was performed at 88 (53.7%) of 164 institutions. Neoadjuvant chemotherapy was provided by 75 (45.5%) of 165 institutions (actively in 44 and reluctantly in 31). At 101 (61.2%) of 165 institutions, para-aortic node dissection was performed as part of radical surgery in patients with any indications. At 96 (57.9%) of 166 institutions, high-risk patients underwent chemoradiotherapy after surgery. On the other hand, adjuvant chemotherapy was given to high-risk and intermediate-risk patients at 19.9% and 33.1% institutions, respectively. More than half of the 166 institutions considered the number of metastatic nodes (91/166, 54.8%) and tumor histology (116/166, 69.9%) when selecting adjuvant therapy.

Conclusions: This survey provided information regarding the current surgical management of uterine cervical cancer (stages IB2, IIA2, and IIA) in Japan.

Author Information

*Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Kanagawa; †Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, Nishihara; ‡Department of Gynecology, Sasaki Foundation Kyoundo Hospital, Tokyo; §Department of Obstetrics and Gynecology, Tottori University School of Medicine, Tottori; ∥Departments of Gynecology, Cancer Institute Hospital, Tokyo; ¶Department of Obstetrics and Gynecology, Hiroshima University Graduate School of Medicine, Hiroshima; #Department of Obstetrics and Gynecology, Ehime University School of Medicine, Ehime; and **Department of Obstetrics and Gynecology, Nara Prefectural Hospital, Nara, Japan.

Address correspondence and reprint requests to Mikio Mikami, MD, PhD, Department of Obstetrics and Gynecology, Tokai University School of Medicine, Shimokasuya 143, Isehara, Kanagawa 259-1193, Japan. E-mail:

The authors declare no conflicts of interest.

Supported in part by a grant-in-aid for scientific research from the Ministry of Education, Culture, Sports, Science and Technology (no. 23592465), the program supported by the Ministry of Education, Culture, Sports, Science and Technology for the Strategic Research Foundation at Private Universities 2012–2014, and a grant from Tokai University Research Aid.

Received April 4, 2014

Accepted May 27, 2014

© 2014 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.