Analysis of isolated loco-regional recurrence rate in intermediate risk early cervical cancer after a type C2 radical hysterectomy without adjuvant radiotherapy

Abstract

BackgroundThe efficacy of adjuvant radiotherapy in patients with intermediate risk early cervical cancer after radical hysterectomy is still under debate. Most guidelines recommend adjuvant radiotherapy, whereas others consider observation a viable option.ObjectiveTo investigate if patients with intermediate risk factors for cervical cancer who underwent radical hysterectomy may benefit from adjuvant radiotherapy.MethodsConsecutive patients with tumor confined to the cervix and intermediate risk factors (according to Sedlis), treated between January 1982 and December 2014 who were observed after a type C2 radical hysterectomy formed the basis for this study. The frequency of recurrences, specifically isolated loco-regional recurrences, and the risk of death from recurrences, were analyzed. Data were analyzed using SPSS, version 23.0 for WindowsResultsA total of 161 patients were included in the analysis. Median age was 40 (range 20–76). Stages IB1 and IB2 were seen in 87 (54%) and 74 patients (46%), respectively. Squamous cell and non-squamous histology was seen in 114 (70.8%) and 47 patients (29.2%), respectively. Of the 161 patients, 25 (15.5%) had recurrent disease, of whom nine had an isolated loco-regional recurrence (5.6%). Median time to recurrence for isolated loco-regional recurrences was 28 months (range 9–151). Treatment for an isolated loco-regional recurrence was radiotherapy (n = 4) and chemoradiotherapy (n = 5). Four patients (2.5%) died from disease as a result of an isolated loco-regional recurrence. Actuarial disease- specific survival was 93.0% for the total group. No variables were found that predicted an isolated loco-regional recurrence.DiscussionThe mortality from isolated loco-regional recurrence in patients with intermediate risk factors for cervical cancer who underwent only radical hysterectomy type C2 was 2.5%. Further studies should compare outcomes between patients who undergo a type C2 radical hysterectomy without adjuvant radiotherapy with those undergoing a less radical hysterectomy but with adjuvant radiotherapy.

Role of adjuvant radiation therapy after radical hysterectomy in patients with stage IB cervical carcinoma and intermediate risk factors

“…van der Velden reported the oncologic outcomes of 161 patients from The Netherlands diagnosed between 1982 and 2014 with intermediate-risk cervical cancer based on the Sedlis criteria who did not receive adjuvant radiation therapy following type C2 radical hysterectomy. 8 A total of 25 patients (15.5%) experienced a relapse while the rate of isolated loco-regional relapse was 5.6% (nine cases) at a median of 28 months. 8 Interestingly, the relapse rate was higher for patients with non-squamous histology (23.4% vs 12.3%).…”

“…8 A total of 25 patients (15.5%) experienced a relapse while the rate of isolated loco-regional relapse was 5.6% (nine cases) at a median of 28 months. 8 Interestingly, the relapse rate was higher for patients with non-squamous histology (23.4% vs 12.3%). 8 Mortality from isolated loco-regional recurrence was low, 2.5% (four patients).…”

Morbidity of radical hysterectomy combined with caesarean section in pregnant patients with cervical cancer

“…Patients were all treated at a tertiary referral centre for gynaecological cancer and obstetrics in the Netherlands. All radical hysterectomies were open procedures and performed according to the Okabayashi method (Querleu type C2 radical hysterectomy) [8]. Controls were non-pregnant cervical cancer patients treated with RHLD, matched on a 1 : 2 ratio for year of treatment, age (both with a 5 year interval), International Federation of Gynaecology and Obstetrics (FIGO) 2009 stage and clinical tumour size ( < 2 cm, 2-4 cm and > 4 cm) measured by physical exam or imaging, all at time of diagnosis.…”

Pharmacological Treatment of Patients with Metastatic, Recurrent or Persistent Cervical Cancer Not Amenable by Surgery or Radiotherapy: State of Art and Perspectives of Clinical Research

“…Radiotherapy or CCRT is the standard treatment for central or lateral pelvic recurrence in patients primarily treated with radical hysterectomy without adjuvant radiotherapy [ 16 , 17 , 18 , 19 , 20 ]. Radical hysterectomy has been seldom used in patients with small (<2 cm) persistent tumor or centrally located recurrence in the cervix or vaginal fornices after definitive radiotherapy [ 16 , 21 , 22 , 23 , 24 ].…”