Limitations of adjunctive surgery in carcinoma of the cervix

Rotman, Marvin; John, Madhu; Moon, Shi H.; Choi, Kwang Nam; Stowe, Steven M.; Abitbol, Andre; Herskovic, Thomas; Sall, Sanford

doi:10.1016/0360-3016(79)91211-2

Cited by 46 publications

(6 citation statements)

References 16 publications

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“…It also should be emphasized that some of the possible complications are severe and potentially life threatening. 16,22,30,40 A recent retrospective study by Sandadi et al 41 addressed this issue of treatment-related complications in 153 early-stage cervix cancer patients treated by surgery alone versus 69 patients treated by surgery and adjuvant RT ± chemotherapy. They have shown that although the complication rate was higher in surgery + RT cohort (12% vs. 32%, P < 0.001), the rate of grade 3 or higher complications was not significantly different (5% vs. 4; P = 0.999).…”

Section: Discussionmentioning

confidence: 98%

Evaluation of Clinical and Pathologic Risk Factors May Reduce the Rate of Multimodality Treatment of Early Cervical Cancer

Gemer

Lavie

Gdalevich

et al. 2016

American Journal of Clinical Oncology

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Section: Discussionmentioning

confidence: 98%

Evaluation of Clinical and Pathologic Risk Factors May Reduce the Rate of Multimodality Treatment of Early Cervical Cancer

Gemer

Lavie

Gdalevich

et al. 2016

American Journal of Clinical Oncology

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“…Later retrospective investigations demonstrated similar local control and survival rates regardless of the addition of extrafascial hysterectomy to radiation therapy (4)(5)(6)(7) . Eifel et al reviewed 1526 patients with tumors 4-8 cm treated with radiation alone and only 2-3% had central pelvic recurrence (5) .…”

mentioning

confidence: 96%

mentioning

confidence: 98%

Chemoradiation with and without adjuvant extrafascial hysterectomy for IB2 cervical carcinoma

Darus¹,

Callahan²,

Nguyen

et al. 2008

International Journal of Gynecological Cancer

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The optimal treatment strategy for stage IB2 cervical carcinoma that maximizes survival while minimizing toxicity remains controversial. The purpose of this study was to compare survival and toxicity in stage IB2 cervical cancer patients treated with chemoradiation and adjuvant extrafascial hysterectomy (cRT + H) versus definitive chemoradiation (cRT). Data were abstracted from patients with IB2 cervical carcinoma primarily treated at a single institution from January 1994 to December 2004. All patients received chemotherapy concurrent with external beam radiation therapy. Patients were subsequently treated with either a single low-dose rate brachytherapy applicator followed by adjuvant extrafascial hysterectomy (n = 24) or a second brachytherapy application to complete full-dose definitive chemoradiation (n = 30). Analyses were conducted using Kaplan-Meier survival and Chi-square statistics. Groups did not differ demographically with the exception of smoking. Smokers were significantly (P = 0.04) more likely to have been treated with definitive chemoradiation. Median tumor size was similar between groups. There was no difference in overall or disease-free survival between patients who received cRT + H versus cRT (P = 0.82 and 0.75, respectively). All recurrences in the cRT arm were in smokers. There were two grade 3-4 toxicities in each group. No treatment-related deaths occurred. In this small retrospective cohort study, we observed no difference in survival between patients treated with cRT + H versus cRT. These data complement published results of Gynecologic Oncology Group studies in patients with IB2 cervical cancer. Definitive comparison between the two treatment strategies would require a randomized prospective trial with stratification based on smoking.

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“…Some authors argue that preoperative radiotherapy carry higher rates of toxicity than each modality alone [2,16], but it is definitely not a consensus [2-4,6,18,24]. In the RTOG 84/20 both RT alone and RT→S were well tolerated producing similar rates of grade 3 or 4 adverse effects [6].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2007

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Purpose: To evaluate the pathologic response of cervical carcinoma to external beam radiotherapy (EBRT) and high dose rate brachytherapy (HDRB) and outcome. Materials and methods:Between 1992 and 2001, 67 patients with cervical carcinoma were submitted to preoperative radiotherapy. Sixty-five patients were stage IIb. Preoperative treatment included 45 Gy EBRT and 12 Gy HDRB. Patients were submitted to surgery after a mean time of 82 days. Lymphadenectomy was performed in 81% of patients. Eleven patients with residual cervix residual disease on pathological specimen were submitted to 2 additional insertions of HDRB.Results: median follow up was 72 months. Five-year cause specific survival was 75%, overall survival 65%, local control 95%. Complete pelvic pathological response was seen in 40%. Surgery performed later than 80 days was associated with pathological response. Pelvic nodal involvement was found in 12%. Complete pelvic pathological response and negative lymphnodes were associated with better outcome (p = .03 and p = .005). Late grade 3 and 4 urinary and intestinal adverse effects were seen in 12 and 2% of patients. Conclusion:Time allowed between RT and surgery correlated with pathological response. Pelvic pathological response was associated with improved outcome. Postoperative additional HDRB did not improve therapeutic results. Treatment was well tolerated.

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Limitations of adjunctive surgery in carcinoma of the cervix

Cited by 46 publications

References 16 publications

Evaluation of Clinical and Pathologic Risk Factors May Reduce the Rate of Multimodality Treatment of Early Cervical Cancer

Evaluation of Clinical and Pathologic Risk Factors May Reduce the Rate of Multimodality Treatment of Early Cervical Cancer

Chemoradiation with and without adjuvant extrafascial hysterectomy for IB2 cervical carcinoma

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

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