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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2005

01-04-2005

Results of Hysterectomy in Patients With Bulky Residual Disease at the End of Chemoradiotherapy for Stage IB2/II Cervical Carcinoma

Authors: Elie Azria, MD, Philippe Morice, MD, Christine Haie-Meder, MD, Anne Thoury, MD, Patricia Pautier, MD, Catherine Lhomme, MD, Pierre Duvillard, MD, Damienne Castaigne, MD

Published in: Annals of Surgical Oncology | Issue 4/2005

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Abstract

Background

We assessed the clinical outcome after hysterectomy in patients with bulky residual disease after chemoradiotherapy for stage IB2/II cervical carcinoma.

Methods

Subjects were 10 patients who had bulky (>2 cm) residual disease in the cervix after external radiotherapy (45 Gy) combined with concomitant chemotherapy (cisplatin 40 mg/m2/week) and uterovaginal brachytherapy (15 Gy).

Results

Extrafascial hysterectomy was performed in three patients, type II radical hysterectomy was performed in six patients, and pelvic exenteration was performed in one patient. Pelvic lymphadenectomy was performed in eight patients, and para-aortic lymphadenectomy was performed in eight. Five patients had nodal involvement (pelvic nodes in four and para-aortic nodes in four), and six had lymphovascular space involvement. Surgical margins were free in nine patients. Seven patients developed grade 2 (n = 3) and/or grade 3 (n = 4) complications. The median duration of follow-up after surgery was 22 months (range, 1–37 months). With follow-up available in nine patients, seven relapsed, and only two remained disease free.

Conclusions

This series confirms the high rate of nodal spread in patients with bulky residual cervical disease after chemoradiotherapy. Furthermore, patients who underwent hysterectomy had a high complication rate. Only two patients are alive and disease free. The results of surgery are disappointing; surgery does not seem to improve the survival of these patients.
Literature
1.
Parkin, DM 2001Global cancer statistics in the year 2000Lancet Oncol253343
2.
International Commission on Radiation Units and Measurements. Dose and Volume Specification for Reporting Intracavitary Therapy in Gynecology. Report 38. Bethesda, MD: Oxford University Press, 1985
3.
Piver, MS, Rutledge, F, Smith, JP 1974Five classes of extended hysterectomy for women with cervical cancerObstet Gynecol4426572
4.
Chassagne, D, Sismondi, P, Horiot, JC,  et al. 1993A glossary for reporting complications of treatment in gynecological cancersRadiother Oncol26195202
5.
Michel, G, Morice, P, Castaigne, D, Leblanc, M, Rey, A, Duvillard, P 1998Lymphatic spread of stage IB/II cervical carcinoma: anatomy and surgical implicationsObstet Gynecol913603
6.
Green, JA, Kirwan, JM, Tierney, JF,  et al. 2001Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysisLancet3587816
7.
Morris, M, Eifel, PJ, Lu, J,  et al. 1999Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancerN Engl J Med3401137 43
8.
Peters, WA,III, Liu, PY, Barrett, RJ,II,  et al. 2000Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant treatment after radical surgery in high-risk early-stage cancer of the cervixJ Clin Oncol18160613
9.
Keys, HM, Bundy, BN, Stehman, FB,  et al. 1999Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinomaN Engl J Med340115461
10.
Rose, PG, Bundy, BN, Watkins, EB,  et al. 1999Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancerN Engl J Med340114453
11.
Whitney, CW, Sause, W, Bundy, BN,  et al. 1999Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage II-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group studyJ Clin Oncol17133948
12.
Gallion, HH, Nagell, JR, Donaldson, ES,  et al. 1985Combined radiation therapy and extrafascial hysterectomy in the treatment of stage IB barrel-shaped cervical cancerCancer562625
13.
Thoms, WW, Eifel, P, Smith, T,  et al. 1992Bulky endocervical carcinoma: a 23-year experienceInt J Radiat Oncol Biol Phys234919
14.
Perez, CA, Kao, MS 1985Radiation therapy alone or combined with surgery in the treatment of barrel-shaped carcinoma of the uterine cervix (stages IB, IIA, IIB)Int J Radiat Oncol Biol Phys1119039
15.
Weems, DH, Mendenhall, WM, Bova, FJ, Marcus, RB, Morgan, LS, Million, RR 1985Carcinoma of the intact uterine cervix, stage IB-IIA-B, >6 cm in diameter: irradiation alone vs preoperative irradiation and surgeryInt J Radiat Oncol Biol Phys1119114
16.
Mendenhall, WM, McCarty, PJ, Morgan, LS, Chafe, WE, Million, RR 1991Stage IB or IIA-B carcinoma of the intact uterine cervix ≥6 cm in diameter: is adjuvant extrafascial hysterectomy beneficial? Int J Radiat Oncol Biol Phys21899904
17.
Touboul, E, Lefranc, JP, Blondon, J,  et al. 1992Preoperative radiation therapy and surgery in the treatment of “bulky” squamous cell carcinoma of the uterine cervix (stage IB, IIA and IIB operable tumors)Radiother Oncol243240
18.
Bernard, A, Touboul, E, Lefranc, JP,  et al. 2002Epidermoid carcinoma of the uterine cervix at operable bulky stage I and II treated with combined primary radiation therapy and surgeryCancer Radiother68598
19.
Resbeut, M, Cowen, D, Viens, P,  et al. 1994Concomitant chemoradiation prior to surgery in the treatment of advanced cervical carcinomaGynecol Oncol546875
20.
Morice, P, Haie-Meder, C, Rey, A,  et al. 2000Radiotherapy and radical surgery for patients with bulky stage IB and II cervical carcinomaInt J Gynecol Cancer1023946
21.
Keys, HM, Bundy, BN, Stehman, FB,  et al. 2003Radiation therapy with or without extrafascial hysterectomy for bulky stage IB cervical carcinoma: a randomized trial of the Gynecologic Oncology GroupGynecol Oncol8934353
22.
Hacker, NF, Wain, GV, Nicklin, JL 1995Resection of bulky positive lymph nodes in patients with cervical carcinomaInt J Gynecol Cancer52506
23.
Downey, GO, Potish, RA, Adcock, LL, Prem, KA, Twiggs, LB 1989Pretreatment surgical staging in cervical carcinoma: therapeutic efficacy of pelvic lymph node resectionAm J Obstet Gynecol160105561
24.
Cosin, JA, Fowler, JM, Chen, MD, Paley, PJ, Carson, LF, Twiggs, LB 1998Pretreatment surgical staging of patients with cervical carcinoma The case for lymph node debulkingCancer8222418
25.
Morice, P, Castaigne, D, Pautier, P,  et al. 1999Interest of pelvic and para-aortic lymphadenectomy in patients with stage IB and II cervical carcinomaGynecol Oncol7310610
26.
Morice, P, Le Bouedec, G, Pomel, C,  et al. 2001Complications of primary external radiation therapy followed by radical hysterectomy for bulky stage IB and II cervical cancerEur J Cancer37S332
Metadata
Title
Results of Hysterectomy in Patients With Bulky Residual Disease at the End of Chemoradiotherapy for Stage IB2/II Cervical Carcinoma
Authors
Elie Azria, MD
Philippe Morice, MD
Christine Haie-Meder, MD
Anne Thoury, MD
Patricia Pautier, MD
Catherine Lhomme, MD
Pierre Duvillard, MD
Damienne Castaigne, MD
Publication date
01-04-2005
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 4/2005
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/ASO.2005.05.020

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