Residual Disease in the Uterus After Preoperative Radiotherapy and Hysterectomy in Stage IB Cervical Carcinoma

Abstract

Sixty-one patients with FIGO IB cervical cancer treated with planned preoperative radiotherapy (dose to point A: 52-93 Gy, mean 73 Gy) and hysterectomy from 1969 to 1993 were retrospectively reviewed. Patient characteristics and treatment parameters and their association with residual tumor in the hysterectomy specimen were analyzed. Glandular (adenocarcinoma and adenosquamous) tumors were smaller than squamous tumors: 6/11 (55%) were < 6 cm in diameter, versus 12/50 (24%) squamous tumors (p = 0.03). Glandular tumors had a higher incidence of residual disease: 10/11 (91%) versus 24/50 (48%) (p = 0.01). There was no association between presence of pathologic residual disease in the hysterectomy specimen and tumor size, morphology (endophytic vs. exophytic), patient age, dose to point A, time to deliver radiotherapy, or interval between radiotherapy and hysterectomy. Overall 34/61 (56%) patients had residual disease in their hysterectomy specimens after planned preoperative radiotherapy. There were significantly more glandular tumors than squamous tumors with residual disease, even though glandular tumors were a group of smaller tumors.

The Prognostic Value of TRAIL and its Death Receptors in Cervical Cancer

“…In our study, patients with adenocarcinomas compared with squamous cell carcinomas obtained a pathologic complete response to irradiation less frequently, which has also been observed in a smaller FIGO Stage IB population (24). Despite the use of a different irradiation technique than ours, Rouzier et al (25) also showed a near significant difference (p value 0.07) in complete pathologic response to radiotherapy between squamous cell carcinomas (62%) and adenocarcinomas (38%).…”

Survival benefits with the addition of adjuvant hysterectomy to radiochemotherapy for treatment of stage I‐II adenocarcinoma of the uterine cervix

“…In a study of 211 patients with stage I‐II cervical cancer, Mazeron et al found that patients who received radical hysterectomy plus radiochemotherapy (n = 54) did not have better survival outcomes than those who received only radiochemotherapy. However, 83.4% of their patients had squamous cell carcinoma and only 14.2% of patients had adenocarcinoma, and the rate of residual disease was relatively low . Although the SEER database does not have information on the response to radiochemotherapy, approximately 26.6% of patients in our study underwent adjuvant surgery after radiochemotherapy, which is comparable to the proportions in previous studies .…”

“…However, cervical adenocarcinoma patients generally have smaller tumors at diagnosis and are less likely to need prolonged treatment . Studies on patients receiving preoperative radiotherapy/radiochemotherapy or definitive radiochemotherapy have shown that the proportion of patients with macroscopic residual tumor is higher, and the overall pathological complete response rate lower, in those with adenocarcinoma than in those with squamous cell carcinoma, indicating that histologic subtype is an independent predictor of radiochemotherapy resistance . Achieving pathological complete response is crucial for good outcomes and residual tumor is associated with increased risk of local disease progression .…”

“…However, several recent studies have found that the rate of macroscopic residual tumor after definitive radiochemotherapy is significantly higher in cervical adenocarcinoma than in cervical squamous cell carcinoma. More than 60% of adenocarcinoma patients still have macroscopic residual tumor after definitive radiotherapy, suggesting that cervical adenocarcinoma may be resistant to radiochemotherapy . Several researchers have investigated the benefits of addition of radical hysterectomy to radiochemotherapy in adenocarcinoma patients, but these studies had heterogeneous designs and limited number of patients .…”

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.…”