Radical Surgery in Patients With Residual Disease After (Chemo)Radiation for Cervical Cancer

Abstract

More radical surgery in patients with (minimal) central residual disease identified by routine biopsy 8 to 10 weeks after (chemo)radiation does not improve survival and should not be recommended.

Radical hysterectomy after radiotherapy for recurrent or persistent cervical cancer

“…The most common severe adverse events include urinary tract injury (20%–26%), fistula formation (17%–28%), and ureteral stenosis. Although no treatment‐related deaths occurred in the present study, severe postoperative adverse events were observed in 27% of the patients treated with RH‐AR and were more frequent than among patients treated with P‐RH; this was in agreement with previous reports . The most common severe adverse events experienced by patients who underwent RH‐AR in the present study were also consistent with those described in previous reports (i.e., urinary tract injuries, fistula formation, and ureteral stenosis).…”

“…One of the major clinical issues associated with RH-AR is the high incidence of treatment-related morbidity. [10][11][12][13][14] Previous studies have reported severe postoperative adverse events occurring in 27%-64% of patients, along with postoperative deaths (Table S1). The most common severe adverse events include urinary tract injury (20%-26%), fistula formation (17%-28%), and ureteral stenosis.…”

“…evaluated the utility of type III RH including pelvic lymph node and PALN sampling in 34 patients with recurrent or persistent cervical cancer, reporting a 5‐year survival rate of 49% . Recently, Boers et al . reported their experience with RH‐AR (type I–IV) in 61 patients with persistent cervical cancer; the estimated 5‐year survival rate was approximately 50%.…”

“…RH‐AR is considered to be more technically challenging than primary RH (P‐RH) for newly‐diagnosed cervical cancer. In contrast to the numerous reports regarding pelvic exenteration, few reports have examined the safety and efficacy of RH‐AR in patients with recurrent or persistent cervical cancer . Moreover, although some previous studies involving relatively small numbers of patients have reported favorable oncology outcomes for RH‐AR (Table ), there is limited information on these outcomes with RH‐AR owing to different RH types being used across studies …”

The role of positron emission tomography in the selection of patients for salvage hysterectomy following chemoradiotherapy for locally advanced cervical cancer

“…The remaining 12 (80%) patients underwent hysterectomy unnecessarily. Boers et al reported the outcome of curative surgery for patients with residual tumor on histology following chemoradiotherapy and only two-thirds of the patients had residual tumor on hysterectomy specimen 8. Azria et al reported on patients with histology proven bulky residual disease following radiotherapy who were subsequently managed with adjuvant hysterectomy 9.…”