Extrafascial hysterectomy after concurrent chemoradiotherapy in locally advanced cervical adenocarcinoma

Abstract

ObjectiveTo evaluate whether adjuvant simple hysterectomy after concurrent chemoradiotherapy (CCRT) improves progression-free survival (PFS) compared with current standard care in locally advanced cervical adenocarcinoma (LACAC).MethodsWe reviewed a cohort of 55 patients with LACAC (International Federation of Gynecology and Obstetrics [FIGO] stage IB2, IIA2, IIB, III without distant metastasis) diagnosed and treated with radical CCRT at Peking Union Medical College Hospital between January 2004 and October 2014. We compared 34 patients who underwent adjuvant extrafascial hysterectomy with 21 patients with standard care after CCRT. The primary outcome was PFS. Overall survivals (OS) between the two groups were also compared. Surgery feasibility, operative complications, and pathologic features after radiation therapy were also analyzed.ResultsPFS was significantly improved in surgery group (log-rank p=0.0097; hazard ratio [HR], 0.3431; 95% CI, 0.152 to 0.772), as were OS (log-rank p=0.0419; HR, 0.3667; 95% CI, 0.139 to 0.964). Analysis of stage IIB demonstrates a similar result. There were no severe complications related to postradiation surgery in this series. The mean blood loss was less in laparoscopic group than those in the open group (87 mL vs. 208 mL, p=0.036, Mann-Whitney U-test). Approximately 47% patients (16/34) had pathologic residue tumor on hysterectomy specimens. About 94% patients (32/34) got complete remission after adjuvant surgery.ConclusionAdjuvant hysterectomy after CCRT improves survival outcome for patients with LACAC compared with current standard care. Extrafascial hysterectomy is sufficient in tumor reduction and laparoscopic procedure may be more promising with lower blood loss and expedite recovery.

The role of surgery following concurrent chemoradiotherapy in cervical adenocarcinoma

“…In our study, we found surgery following CCRT provided a superiority in AC patients on 3-year OS (68.6% vs. 52.8%, p = 0.044), compared with non-surgery group. This was consistent with the findings of a previous study from our hospital based on a smaller patient population, that 3-year PFS and LPFS also had a trend to increase in surgery group [16]. However, clinical response after CCRT was not balanced in present study, which could influence the outcomes.…”

Post‑radiotherapy hysterectomy does not benefit females with cervical adenocarcinoma

“…Surgical complications related to procedures following radiotherapy may be higher than expected (15). In the studied cases, hysterectomy procedures after radiotherapy probably had a longer duration than expected (2 h and 30 min).…”

“…The use of concurrent chemoradiotherapy in locally advanced cervical carcinomas has shown an improved response to treatment and could justify the lower number of surgical indications, as observed in this study with fewer cases operated since 2003 (15,16). Although this study did not resolve the effect of chemoradiation on the therapeutic outcome, this study may have directed the perception that any gain with hysterectomy following radiotherapy using older protocols may have been compensated due to the higher rate of chemoradiation that has been recently applied.…”

“…Few studies have reported outcomes of hysterectomies after radiotherapy in specific cases of females with cervical adenocarcinoma, and most have described salvage situations, with evident persistent residual disease after completion of actinic treatment. The study with the largest number of post-radiotherapy hysterectomies for cervical adenocarcinoma (34 cases) was published in 2016 by Yang et al (15), with only 18 cases exhibiting complete clinical response after chemoradiation. The study concluded that hysterectomy improved survival but counted patients who submitted to salvage surgery.…”

Chemoradiotherapy alone vs. chemoradiotherapy and hysterectomy for locally advanced cervical cancer: A systematic review and updated meta‑analysis

“…However, no consensus over the benefit of such adjuvant surgery in LACC has been reached in the literature ( 8 ). Advocates of additional surgery argue that early hysterectomy leads to better disease control and avoidance of more extensive surgery, such as pelvic exenteration, in the event of a future recurrence ( 7 , 9 ). On the other hand, adjuvant hysterectomy is not morbidity-free and the rate of grade-3 adverse events may be as high as 26.5% ( 8 ).…”