Combined radiation therapy and extrafascial hysterectomy in the treatment of stage IB barrel-shaped cervical cancer

Abstract

Seventy-five patients with bulky barrel-shaped Stage IB cervical cancers, treated at the University of Kentucky from 1965 to 1981, were the subjects of this investigation. Thirty-two of these patients were treated with radiation therapy alone and 43 were treated with radiation followed by extra-fascial hysterectomy. There were no significant differences in age, gravidity, or tumor cell type between the two treatment groups. Patients were seen at regular intervals from 2 to 11 years after treatment and none were lost to follow-up. Recurrent cancer was noted in 47% of patients treated by radiation alone as compared to 16% of those treated with combined therapy (P less than 0.01). The incidence of pelvic recurrence was reduced from 19% to 2% and extrapelvic recurrence from 16% to 7% in patients treated by combination therapy. No rectal or urinary tract fistulae were noted after extra-fascial hysterectomy. The findings of this study suggest that the use of extra-fascial hysterectomy following radiation therapy in patients with bulky Stage IB cervical cancer causes a significant reduction in tumor recurrence without producing an increase in treatment-related complications.

The epidermal growth factor receptor pathway in relation to pelvic lymph node metastasis and survival in early-stage cervical cancer

“…In cases with poor clinicopathologic factors, adjuvant radiotherapy with or without chemotherapy is often administered. Conventional prognostic factors in early-stage cervical cancer are tumor size, depth of stromal invasion, lymphovascular space involvement, parametrial invasion, and pelvic lymph node metastasis [1][2][3][4]. Pelvic lymph node metastasis appears to be the most important of these parameters [5], with a 5-year survival approximating 90% in node-negative early-stage cervical cancer patients primarily treated with surgery and decreasing to approximately 65% in patients with pelvic lymph node metastasis [6].…”

Laparoscopic Extrafascial Hysterectomy (Completion Surgery) After Primary Chemoradiation in Patients With Locally Advanced Cervical Cancer: Technical Aspects and Operative Outcomes

“…Indeed, most of the studies suggests an impact in reduction of local recurrence but has failed to demonstrate an unequivocal benefit in survival. 4,8,14,15 Nevertheless, most of these publications have several biases, are retrospective, have flexible inclusion criteria, are heterogeneous in type of surgery, or even confound some therapy concepts. The absence of reliable data concerning therapeutic importance of completion surgery allied to the potential use of laparoscopy in this situation has motivated us to study an alternative strategy of care intending to reduce operative morbidity and improve cancer local control.…”

Preoperative external beam radiotherapy and reduced dose brachytherapy for carcinoma of the cervix: survival and pathological response

“…They also carry a worse prognosis if they remain affected after irradiation [4,6,19]. The evaluation of cervical residual disease also allow the demonstration of tumor sensitivity to radiation and its impact on treatment results [4,6,7,17,18,20,21,32,33]. Also, in the future with the study of genetic and bio-molecular features it may be possible to relate genetic expression with tumor response to radiotherapy.…”