The Role of Adjuvant Hysterectomy After Radiotherapy in Cervical Cancer

Abstract

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.

Adjuvant hysterectomy following primary chemoradiation for stage IB2 and IIA2 cervical cancer: a retrospective comparison of complications for open versus minimally invasive surgery

“…These women have historically high local recurrence rates and it has been suggested that the geometry of these bulky tumors and the associated tumor hypoxia was better addressed by hysterectomy than by additional intracavitary radiation [ 5 ]. Studies have shown no difference in overall survival for patients who undergo adjuvant hysterectomy, but patients with large tumors may benefit from the procedure by decreasing local recurrence rates [ 5 – 7 ]. As a result, it had been standard practice at our institution to perform adjuvant hysterectomy for these patients.…”

Salvage hysterectomy after radiotherapy for cervical cancer: literature review

“…Такая операция носит название спасительной (salvage), или адъювантной, гистерэктомии, или так называемой завершающей операции (completion surgery). Существует ряд работ, в которых показаны возможность и выполнимость оперативного лечения после ЛТ [20][21][22][23][24][25]. Сторонники завершающей операции, проводимой после окончания ЛТ, показали, что остаточная опухоль гистологически выявляется в 42-60 % случаев [22][23][24][25][26][27] даже после проведения ХЛТ в оптимальном объеме.…”

“…Существует ряд работ, в которых показаны возможность и выполнимость оперативного лечения после ЛТ [20][21][22][23][24][25]. Сторонники завершающей операции, проводимой после окончания ЛТ, показали, что остаточная опухоль гистологически выявляется в 42-60 % случаев [22][23][24][25][26][27] даже после проведения ХЛТ в оптимальном объеме. Классическое исследование P. Morice и соавт.…”

Adjuvant Hysterectomy Following Primary Chemoradiation for Stage IB2 and IIA2 Cervical Cancer: a Retrospective Comparison of Complications for Open Versus Minimally Invasive Surgery

“…These women have historically high local recurrence rates and it has been suggested that the geometry of these bulky tumors and the associated tumor hypoxia was better addressed by hysterectomy than by additional intracavitary radiation 5 . Studies have shown no difference in overall survival for patients who undergo adjuvant hysterectomy, but patients with large tumors may bene t from the procedure by decreasing local recurrence rates [5][6][7] . As a result, it had been standard practice at our institution to perform adjuvant hysterectomy for these patients.…”