Adjuvant hysterectomy for treatment of residual disease in patients with cervical cancer treated with radiation therapy

Abstract

The objective of this retrospective study was to determine the efficacy of adjuvant hysterectomy for treatment of residual disease in cervical carcinoma treated with radiation therapy. Between 1971 and 1996, 1590 patients with carcinoma of the uterine cervix (stages I -IIIb) were treated with radiation therapy. Three months after completion of radiation therapy, the status of local control was investigated, and total abdominal hysterectomy was performed in cases in which central residual disease existed in the cervix. Of the 1590 patients, residual disease was identified in 162 patients. Among these patients, 35 showed an absence of distant metastasis or lateral parametrial invasion and underwent hysterectomy. The overall 5-and 10-year survival rates for these patients were 68.6 and 65.7%, respectively. There was no significant difference in survival between patients with squamous cell carcinoma and those with non-squamous cell carcinoma or between patients with stage I/II carcinoma and those with stage III carcinoma. With respect to treatment-related morbidity, five (14.3%) patients suffered grade III or IV complications after hysterectomy. Adjuvant hysterectomy is an effective addition to radiation therapy in the treatment of cervical cancer, even in patients with stage III disease and in those with non-squamous cell carcinoma.

Results of the GYNECO 02 Study, an FNCLCC Phase III Trial Comparing Hysterectomy with No Hysterectomy in Patients with a (Clinical and Radiological) Complete Response After Chemoradiation Therapy for Stage IB2 or II Cervical Cancer

“…There was no difference in terms of survival between the two arms (hysterectomy versus no hysterectomy), but the 5-year local relapse rates were 27% in the external radiation alone arm and 14% in the external radiation therapy followed by extrafascial hysterectomy arm [18]. Other retrospective studies suggested that surgery after external radiation therapy could exert a potential therapeutic impact [3][4][5][6][7][8][9][10], but none of those studies were randomized trials. After 1999, the use of CRT became the new standard for the treatment of cervical cancer Ͼ4 cm [1,2].…”

“…After 1999, the use of CRT became the new standard for the treatment of cervical cancer Ͼ4 cm [1,2]. Several countries (mainly in Europe and Asia) considered CRT as neoadjuvant therapy and proposed hysterectomy in this context [3][4][5][6][7][8][9][10]. Nevertheless, this surgery could impair the postoperative quality of life of patients because there is a potential risk for major morbidities with CRT, which should be clearly balanced with the true therapeutic benefit of such a hysterectomy [19].…”

“…Such a trial was opened in France 6 years ago. Only patients with a macroscopic and radiological complete response after CRT for stage IB2 or II cervical cancer were included because most of the teams participating in the trial considered that the presence of residual disease at the end of CRT and brachytherapy might be an indication for surgery after CRT [6,10,20]. Nevertheless, the true therapeutic impact of surgery in such cases is really unproven because patients with macroscopic residual disease after CRT have a higher risk for extracervical disease (nodal spread or extrapelvic spread) that cannot be adequately cured using surgery [6,19].…”

“…For such patients, the place and modality of completion surgery (after CRT) continue to be debated [3][4][5][6][7][8][9][10][11]. A trial was opened 8 years ago in France to evaluate the therapeutic impact of hysterectomy after CRT in patients with complete clinical and radiological response in this context.…”

Prognostic Factors and Morbidities After Completion Surgery in Patients Undergoing Initial Chemoradiation Therapy for Locally Advanced Cervical Cancer

“…In such patients, the role and modalities of completion surgery (after CRT) continue to be debated. In the literature, very few data are available on the results of completion surgery in patients treated with CRT [3][4][5][6][7][8][9][10]. Nevertheless, even if the therapeutic impact of completion hysterectomy continues to fuel debate, the analysis of prognostic factors (and mainly histologic factors) in hysterectomy and lymphadenectomy specimens could add interesting data in order to improve local and distant control for future patients undergoing CRT.…”