Top

International Journal of Clinical Oncology

Published in:

01-02-2020 | Cervical Cancer | Original Article

The role of additional hysterectomy after concurrent chemoradiation for patients with locally advanced cervical cancer

Authors: Kosuke Yoshida, Hiroaki Kajiyama, Masato Yoshihara, Satoshi Tamauchi, Yoshiki Ikeda, Nobuhisa Yoshikawa, Kimihiro Nishino, Kaoru Niimi, Shiro Suzuki, Fumitaka Kikkawa

Published in: International Journal of Clinical Oncology | Issue 2/2020

Abstract

Background

The standard treatment for cervical cancer is chemoradiation although some patients showed treatment resistance. The purpose of this study was to investigate the clinical efficacy of surgery after chemoradiation for cervical cancer.

Methods

Patients with FIGO stage IB2 to IIB cervical cancer were included in the study between 2005 and 2015. A total of 50 patients who underwent surgery after neoadjuvant chemoradiation and 76 patients who received only chemoradiation were compared. Baseline differences between the two groups were adjusted with inverse probability of treatment weighting method using propensity scores composed of the following independent variables: age, stage, tumor size, lymph node metastasis, and histological subtypes.

Results

Median follow-up was 64.8 (range 4.8–143.9) months. After adjustment with inverse probability of treatment weighting, Kaplan–Meier curves showing adjusted progression-free survival and overall survival were significantly longer in the neoadjuvant chemoradiation compared with the chemoradiation-only group (p = 0.027 and p = 0.017, respectively). Moreover, in patients with squamous cell carcinoma, recurrence in previously irradiated field and recurrence both in and out of previously irradiated field were significantly decreased in the neoadjuvant chemoradiation compared with the chemoradiation-only group (3.1% and 18.4%, respectively; OR 0.142, p = 0.001]. Adverse events of surgery after chemoradiation were acceptable, although temporary hydronephrosis was frequently observed (23.1%).

Conclusions

Surgery after chemoradiation reduced pelvic recurrence, and as a result, patients who underwent neoadjuvant chemoradiation showed more favorable survival outcomes compared with those who only underwent chemoradiation.

Torre LA, Bray F, Siegel RL et al (2015) Global cancer statistics, 2012. CA Cancer J Clin 65(2):87–108CrossRef

Waggoner SE (2003) Cervical cancer. Lancet 361(9376):2217–2225CrossRef

Small W Jr, Bacon MA, Bajaj A et al (2017) Cervical cancer: a global health crisis. Cancer 123(13):2404–2412CrossRef

Rose PG, Bundy BN, Watkins EB et al (1999) Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 340(15):1144–1153CrossRef

Mikami M, Aoki Y, Sakamoto M et al (2014) Surgical principles for managing stage IB2, IIA2, and IIB uterine cervical cancer (Bulky Tumors) in Japan: a survey of the Japanese Gynecologic Oncology Group. Int J Gynecol Cancer 24(7):1333–1340CrossRef

Yuan L, Guo J, Zhang X et al (2018) Feasibility of radical hysterectomy in women with FIGO stage IIB cervical cancer: an observation study of 10-year experience in a tertiary center. Onco Targets Ther 11:5527–5533CrossRef

Legge F, Chiantera V, Macchia G et al (2015) Clinical outcome of recurrent locally advanced cervical cancer (LACC) submitted to primary multimodality therapies. Gynecol Oncol 138(1):83–88CrossRef

Kim TH, Kim MH, Kim BJ et al (2017) Prognostic importance of the site of recurrence in patients with metastatic recurrent cervical cancer. Int J Radiat Oncol Biol Phys 98(5):1124–1131CrossRef

Yoshida K, Kajiyama H, Utsumi F et al (2018) A post-recurrence survival-predicting indicator for cervical cancer from the analysis of 165 patients who developed recurrence. Mol Clin Oncol 8(2):281–285PubMed

10.

Osman M (2014) The role of neoadjuvant chemotherapy in the management of locally advanced cervix cancer: a systematic review. Oncol Rev 8(2):250CrossRef

11.

Lee J, Kim TH, Kim GE et al (2016) Neoadjuvant chemotherapy followed by surgery has no therapeutic advantages over concurrent chemoradiotherapy in International Federation of Gynecology and Obstetrics stage IB–IIB cervical cancer. J Gynecol Oncol 27(5):e52CrossRef

12.

Gadducci A, Landoni F, Cosio S et al (2018) Neoadjuvant platinum-based chemotherapy followed by radical hysterectomy for stage IB2–IIB adenocarcinoma of the uterine cervix—an Italian Multicenter Retrospective Study. Anticancer Res 38(6):3627–3634CrossRef

13.

Keys HM, Bundy BN, Stehman FB et al (1999) Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med 340(15):1154–1161CrossRef

14.

Mancuso S, Smaniotto D, Benedetti Panici P et al (2000) Phase I–II trial of preoperative chemoradiation in locally advanced cervical carcinoma. Gynecol Oncol 78(3 Pt 1):324–328CrossRef

15.

Shibata K, Kikkawa F, Suzuki Y et al (2004) Usefulness of preoperative chemoradiation in locally advanced cervical carcinoma. Gynecol Obstet Invest 57(2):93–99CrossRef

16.

Sun L, Sheng X, Jiang J et al (2014) Surgical morbidity and oncologic results after concurrent chemoradiation therapy for advanced cervical cancer. Int J Gynaecol Obstet 125(2):111–115CrossRef

17.

Leguevaque P, Motton S, Delannes M et al (2011) Completion surgery or not after concurrent chemoradiotherapy for locally advanced cervical cancer? Eur J Obstet Gynecol Reprod Biol 155(2):188–192CrossRef

18.

Azria E, Morice P, Haie-Meder C et al (2005) Results of hysterectomy in patients with bulky residual disease at the end of chemoradiotherapy for stage IB2/II cervical carcinoma. Ann Surg Oncol 12(4):332–337CrossRef

19.

Touboul C, Uzan C, Mauguen A et al (2010) Prognostic factors and morbidities after completion surgery in patients undergoing initial chemoradiation therapy for locally advanced cervical cancer. Oncologist 15(4):405–415CrossRef

20.

Austin PC, Stuart EA (2015) Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med 34(28):3661–3679CrossRef

21.

Rubin DB (2001) Using propensity scores to help design observational studies: application to the tobacco litigation. Health Serv Outcomes Res Method 2:169–188CrossRef

22.

Zhou J, Wu SG, Sun JY et al (2017) Comparison of clinical outcomes of squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma of the uterine cervix after definitive radiotherapy: a population-based analysis. J Cancer Res Clin Oncol 143(1):115–122CrossRef

23.

Houvenaeghel G, Lelievre L, Buttarelli M et al (2007) Contribution of surgery in patients with bulky residual disease after chemoradiation for advanced cervical carcinoma. Eur J Surg Oncol 33(4):498–503CrossRef

24.

Frobe A, Jones G, Bokulic T et al (2014) High-dose-rate brachytherapy and concurrent chemoradiotherapy followed by surgery for stage Ib-IIb cervical cancer: single institution experience. Anticancer Res 34(7):3861–3866PubMed

25.

Mariagrazia D, Anna F, Gabriella F et al (2005) Preoperative chemoradiotherapy in locally advanced cervical cancer: long-term outcome and complications. Gynecol Oncol 99(3 Suppl 1):S166–S170CrossRef

26.

Classe JM, Rauch P, Rodier JF et al (2006) Surgery after concurrent chemoradiotherapy and brachytherapy for the treatment of advanced cervical cancer: morbidity and outcome: results of a multicenter study of the GCCLCC (Groupe des Chirurgiens de Centre de Lutte Contre le Cancer). Gynecol Oncol 102(3):523–529CrossRef

27.

Ferrandina G, Lucidi A, Paglia A et al (2012) Role of comorbidities in locally advanced cervical cancer patients administered preoperative chemoradiation: impact on outcome and treatment-related complications. Eur J Surg Oncol 38(3):238–244CrossRef

28.

Chereau E, De la Hosseraye C, Ballester M et al (2013) The role of completion surgery after concurrent radiochemotherapy in locally advanced stages IB2–IIB cervical cancer. Anticancer Res 33(4):1661–1666PubMed

29.

Pervin S, Ruma FI, Rahman K et al (2019) Adjuvant hysterectomy in patients with residual disease after radiation for locally advanced cervical cancer: a prospective longitudinal study. J Glob Oncol 5:1–7CrossRef

30.

Shim SH, Kim SN, Chae SH et al (2018) Impact of adjuvant hysterectomy on prognosis in patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy: a meta-analysis. J Gynecol Oncol 29(2):e25CrossRef

31.

Hequet D, Marchand E, Place V et al (2013) Evaluation and impact of residual disease in locally advanced cervical cancer after concurrent chemoradiation therapy: results of a multicenter study. Eur J Surg Oncol 39(12):1428–1434CrossRef

32.

Morice P, Uzan C, Zafrani Y et al (2007) The role of surgery after chemoradiation therapy and brachytherapy for stage IB2/II cervical cancer. Gynecol Oncol 107(1 Suppl 1):S122–124CrossRef

33.

Anglemyer A, Horvath HT, Bero L (2014) Healthcare outcomes assessed with observational study designs compared with those assessed in randomized trials. Cochrane Database Syst Rev 4:Mr000034

Title: The role of additional hysterectomy after concurrent chemoradiation for patients with locally advanced cervical cancer
Authors: Kosuke Yoshida
Hiroaki Kajiyama
Masato Yoshihara
Satoshi Tamauchi
Yoshiki Ikeda
Nobuhisa Yoshikawa
Kimihiro Nishino
Kaoru Niimi
Shiro Suzuki
Fumitaka Kikkawa
Publication date: 01-02-2020
Publisher: Springer Singapore
Keywords: Cervical Cancer
Cervical Cancer
Hysterectomy
Published in: International Journal of Clinical Oncology / Issue 2/2020
Print ISSN: 1341-9625
Electronic ISSN: 1437-7772
DOI: https://doi.org/10.1007/s10147-019-01551-6

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2020

Leptomeningeal metastases arising from gynecological cancers

The efficacy and safety of the addition of olanzapine to ondansetron and dexamethasone for prevention of chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy

FDG-PET reflects tumor viability on SUV in colorectal cancer liver metastasis

Prognostic value of alkaline phosphatase in hormone-sensitive prostate cancer: a systematic review and meta-analysis

Impact of histology on patterns of failure and clinical outcomes in patients treated with definitive chemoradiotherapy for locally advanced non-small cell lung cancer

‘Trifecta’ outcomes of robot-assisted partial nephrectomy: a large Japanese multicenter study

Keynote webinar | Spotlight on antibody–drug conjugates in cancer