Role of Surgery in the treatment of Cervical Cancer Persistent to Chemoradiotherapy and its Importance in the Management of Adenocarcinomas: Experience with 100 Patients

Abstract

1.1. Objective: To show the results of complementary and rescue surgeries in patients with Locally Advanced Cervical Cancer (LACC), Squamous Cell Carcinoma (SCC) and Adenocar-Cinoma (ADC), with confirmation orsuspicion of tumor persistence to treatment with Chemo-Radio Therapy (CRT) with or without Intra-Cavitary Brachy Therapy (ICBT). 1.2. Material and Methods: Retrospective study of patients treated in the Oncology Service of the General Hospital of Mexico (GHM) in the period from 2008 to 2015, who had a diagnosis of Persistent Cervical Cancer (PCC) and were laparotomized in order to perform complementary or rescue surgeries. 1.3. Results: We performed 100 surgeries, 61 Complementary Hysterectomies (CH) with or without lymphadenectomy, 24 Pelvic Exenterations (PE) and 15 laparotomies because the neoplasm was unresectable. Major Complications (MC) occurred in 11/65 (16.9%) Page -01 World Journal of Medical Oncology Open Access patients treated with CRT and ICBT, and 1/20 (5.0%) of patients in the CRT group without ICBT (p = 0.2290). There was no postoperative mortality. Disease Free Survival (DFS) was 30.5 months in 66/90 (73.3%) of all patients; by surgery 51/56 (91.0%) CH and 15/19 (78.9%) PE; by histopatology, 35/56 (62.5%) with SCC and 31/34 (91.1%) with ADC (p = 0.003); and for stage II the main clinical stage with 58 patients: 22/36 (61.1%) for SCC and 20/22 (90.9%) for ADC (p = 0.0145). 1.4. Conclusions: Adyuvant surgery has a place in the management of LACC with tumor persistence or suspicion of this after conventional treatment with CRT. External Beam Radiation Therapy (EBRT) plus Chemo-Therapy (QT) plus surgery can be considered for the treatment of ADC from CS IB3.

Pelvic Exenteration for Cervical Cancer that is Persistent or Recurrent after Radiotherapy or Chemoradiation. Institutional Experience of 51 Years

“…Thirdly, fewer patients are being diagnosed with stage IVA disease. Finally, laparotomies are performed in patients who have suspected tumor persistence due to tumor size and pathologies that indicate a poor prognosis [19][20][21][22].…”