Radiation therapy with and without extrafascial hysterectomy for bulky stage IB cervical carcinoma: a randomized trial of the Gynecologic Oncology Group☆

Keys, Henry; Bundy, Brian N.; Stehman, Frederick B.; Okagaki, Takashi; Gallup, Donald G.; Burnett, Alexander; Rotman, Marvin; Fowler, Wesley C.

doi:10.1016/s0090-8258(03)00173-2

Cited by 253 publications

(174 citation statements)

References 25 publications

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“…The value of adjuvant hysterectomy in the treatment of cervical cancer after radiation therapy has been investigated; most of these studies suggest a decreased incidence of local relapse but no benefit in progression-free survival (Perez et al, 1987;Keys et al, 2003). Keys et al (2003) reported in a Gynecologic Oncology Group trial that performing adjuvant hysterectomy in every case of cervical cancer after radiation therapy is of little value in improving survival, although no significant increase in treatment-related morbidity is observed.…”

Section: Discussionmentioning

confidence: 99%

“…Keys et al (2003) reported in a Gynecologic Oncology Group trial that performing adjuvant hysterectomy in every case of cervical cancer after radiation therapy is of little value in improving survival, although no significant increase in treatment-related morbidity is observed. In addition, Whitney et al (1999) reported that 7 of 30 (23.3%) stage IB patients with residual disease showed recurrence, whereas only 1 of 50 patients (2%) showed recurrence in the absence of evidence of persistent residual disease.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2008

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2008

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“…It has been suggested recently that radical surgery could lower the rate of local recurrence in patients with bulky cervical cancer, by removing potential radio-and chemoresistant foci of disease. In the trial by Keys et al [9], rates of complete pathological response after concurrent chemoradiation in stage IB2 cervical cancer ranged from 41 to 52 %. The 5-year disease-free survival was 62 % in those who underwent adjuvant hysterectomy and 53 % in the absence of hysterectomy.…”

Section: Discussionmentioning

confidence: 99%

The Role of Adjuvant Hysterectomy After Radiotherapy in Cervical Cancer

et al. 2014

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The aim of this study was to evaluate the morbidity and survival outcome following radical hysterectomy after chemoradiotherapy in the International Federation of Gynecology and Obstetrics (FIGO) stages IB-IIB cervical cancer patients in whom intracavitory brachytherapy was not feasible. We retrospectively reviewed the medical records of our patients who underwent adjuvant radical hysterectomy between January 2005 and December 2012. Post-operative complications were graded according to the grading system of Chassagne et al. (Radiother Oncol 26:195-202, 1993). Survival analysis was done using Kaplan-Meir method. Between January 2005 and December 2012, 43 patients underwent type 2 radical hysterectomy after external beam radiotherapy and concurrent chemotherapy. The median age of the study group was 44 years (range 28-63 years). There were no perioperative deaths. In the early post-operative period, there were 45 complications in 29 patients of which three were of grade 3 severity. The most common post operative complications were urinary tract infections and lymphoedema. The median follow-up time was 29 months (range 9-68 months). The 5-year overall survival was 85.5 % and disease-free survival 82.1 %. This study shows that radical hysterectomy is feasible with good survival outcome and acceptable morbidity after chemoradiotherapy in cervical cancer patients.

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“…A retrospective institutional experience of the University of Florida found no differences in the rate of pelvic recurrence before and after the adoption of adjuvant hysterectomy [16]. The only phase III prospective randomised trial was conducted by the GOG [17]. In this study, 282 patients with bulky IB stage cervical cancer were recruited over a period of 7 years.…”

Section: Is Adjuvant Hysterectomy After Rt a Recommended Approach?mentioning

confidence: 99%

Treatment of cervical cancer: the importance of a multidisciplinary team approach

2011

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C ervical cancer is a worldwide major concern, as it is the second most common malignancy in women and a major cause of morbidity and mortality in developing countries. Management of patients with cervical cancer is a complex issue but close collaboration among clinicians of different disciplines can achieve long-term survival in 70% of patients. Surgery is the most accepted strategy for early cervical cancer and chemoradiation is the standard approach for more advanced stages (IIB-IIIA-IIIB-IVA-IVB). However, the optimal approach for stages IB2-IIA is somewhat controversial and different sequential strategies have been explored in this setting. This editorial aims to address several important questions in the therapeutic planning of this disease.What is the standard approach for early cervical cancer? Concurrent chemoradiationIn 1997 Landoni et al. [1] evaluated the role of radiotherapy alone vs. surgery in stages IB-IIA. Radiotherapy demonstrated signifi cantly less severe morbidity vs. surgery (12% vs. 28%) with identical survival. Moreover, in patients with stage IB2 treated with surgery, adjuvant radiotherapy was required in 84% due to high-risk features.Several trials evaluating the addition of chemotherapy with both platinum and non-platinum regimens demonstrated a benefi t vs. radiotherapy alone in locally advanced cervical cancer. A metanalysis with 4921 patients from 24 randomised trials confi rmed that concurrent chemoradiation is superior to radiotherapy alone. Chemoradiotherapy with both platinum and non-platinum agents improved disease-free and overall survival and reduced both local and distant recurrences [2]. A second metanalysis limited to studies assessing effi cacy of cisplatin-based regimens concurrent with radiotherapy confi rmed a benefi t in overall survival with a reduction in the relative risk of death by 26% favouring concomitant cisplatin [3].Concurrent chemoradiation not only prolonged survival but may have achieved pelvic control rates up to 90%. Thus, treatment with concurrent chemoradiation is the current standard of care in Europe for stages IB2-IVA [4]. This strategy was followed by Reig et al. [5], in this retrospective analysis of 56 patients stage IB2-IV treated with external radiation with concurrent weekly cisplatin followed by brachytherapy. With a proportion of stage III-IV being 14.4%, median survival at 5 years was 80.4% and pelvic control rate was 71.5% in this study.New techniques like extended fi eld intensity-modulated radiation therapy (IMRT) have the potential to improve the therapeutic ratio because of its ability to escalate dose to cancer targets while sparing adjacent healthy tissue [6]. Several retrospective series of patients treated with IMRT claimed dosimetric and clinical benefi ts, with reduction in acute toxicity compared with historic controls [7].Another recent improvement in the planifi cation and staging of radiation therapy is the use of PET/CT. By providing metabolic imaging information, this technique has demonstrated a high accuracy (85.1%) and ...

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Radiation therapy with and without extrafascial hysterectomy for bulky stage IB cervical carcinoma: a randomized trial of the Gynecologic Oncology Group☆

Cited by 253 publications

References 25 publications

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

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

The Role of Adjuvant Hysterectomy After Radiotherapy in Cervical Cancer

Treatment of cervical cancer: the importance of a multidisciplinary team approach

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