Survival benefit of laparoscopic surgical staging-guided radiation therapy in locally advanced cervical cancer

Abstract

Objective: This study was designed to evaluate the survival benefit of laparoscopic surgical staging (LSS)-guided tailored radiation therapy (RT) in locally advanced cervical cancer (LACC). Methods: We retrospectively reviewed 89 LACC patients' medical records who primarily received non-surgical treatment, of which pretreatment LSS was performed in 20 (LSS group) and primary chemoradiation therapy (CCRT) without LSS (CCRT group) was carried out in 69 from January 2000 to January 2006. We analyzed clinical characteristics, pretreatment imaging study results and survival outcomes including disease free survival (DFS) and overall survival (OS) to compare them between the two groups. Results: There were as many as eight cases (40%) of LSS related complications. The mean time interval between LSS and RT or CCRT was 26.6 days (±18.8 days). Six out of twenty (30%) in LSS group and 10 out of 69 (14.5%) in CCRT group received extended field RT when paraaortic lymph nodes (LNs) were positive based on the pathologic findings after LSS and the results of imaging studies, respectively. Three-year DFS and OS were both better in 33 imaging-negative CCRT group patients than those in 4 imaging-negative/pathology-positive (false negative) patients after LSS (3-year DFS, 50% vs. 87%, p=0.022; 3-year OS, 50% vs. 84%, p=0.033). The 5-year DFS rates were 52% and 55% in LSS group and in CCRT group, respectively (p=0.28). The 5-year OS rates were 68% in LSS group and 62% in CCRT group without significant difference between the two groups (p=0.79). Conclusion:We found that LSS-based RT tailoring did not show survival benefit in LACC despite inaccuracy of imaging-based RT tailoring. Further studies are required to find new method to overcome this inaccuracy and improve survival outcomes.

Cost-effectiveness of para-aortic lymphadenectomy before chemoradiotherapy in locally advanced cervical cancer

“…Other limitations of this study include the assumption that there was no delay in the administration of definite CRT after nodal staging surgery. A major drawback of nodal staging surgery is the resultant delay in starting curative treatment, attributable to either an overburdened surgical schedule or postoperative morbidity [ 27 ].…”

Laparoscopic Lymphadenectomy in Advanced Cervical Cancer: Prognostic and Therapeutic Value

“…5 Nevertheless, a number of studies have shown that, as observed in our study, lymphadenectomy-tailored RT does not seem to provide a benefit on survival in patients with LACC. 4,36 Some studies have shown a minimal therapeutic benefit for surgical LN removal by itself in women with LACC and positive LNs. 7,22,23,37 However, the only prospective randomized study comparing surgical and clinical staging showed a significantly worse outcome for patients who underwent surgical staging owing to a higher complication rate in this group, without any benefit associated to the resection of the metastatic LNs.…”