जर्नल ऑफ ऑन्कोलॉजी मेडिसिन एंड प्रैक्टिस

Surgical Resection after Concurrent Chemoradiotherapy for Locally Advanced Cervical Carcinoma

Abstract

Maghous A, Elmarjany M, Marnouche E, Andaloussi K, Bazine A, Lalya I, Zaghba N, Hadadi K, Sifat H, Habib MAB, Kouach J, Moussaoui DR and Mansouri H

Background: Completion surgery after chemoradiotherapy (CRT) in management of locally advanced cervical cancers (LACC) still controversial. The aim of this study was to compare disease-free and overall survival rates in patients who had completion surgery and who were therefore treated conservatively by exclusive concomitant chemoradiotherapy (CCRT).

Materials and methods: This is a retrospective study from January 2005 to December 2014 included 130 patients with LACC, managed by standard CCRT followed by brachytherapy at the radiotherapy department of Military Hospital Mohamed V of Rabat in Morocco.

Inclusion criteria were the following: Biopsy-proven carcinoma of the cervix, FIGO stage IB2 to IVA and treatment with CCRT followed by brachytherapy. All patients had good response to standard CCRT, with a clinical decrease in tumor volume of more than 50%. Patients were divided into two groups depending on the authors practice: Group 1 consisted of patients without completion surgery who had theoretically a good response to standard treatment and Group 2 consisted of patients treated by completion surgery with pelvic control on final pathology.

One hundred and two patients are included in Group 1 and 28 in Group 2. The mean age of the patients was 50.9 years (range 29–82). Squamous cell carcinoma 115 (89.8%) was the leading histological type. Tumor size was 4.77 ± 1.44 cm clinically and 46.72 ± 15.42 mm in MRI. The parametrial was invaded in 113 (87.6%) of cases and the pelvic lymph nodes were suspected in 29 (23%) of cases.

Major of patients whom underwent a completion surgery showed a complete response on final pathology. Overall, 20.8% (27/130) of patients had a recurrence, with a median time to recurrence of 8 months [2-55]. With a mean follow-up of 44 months (2 to 118), the local control rate was 68.5% (n=89) and 20 (15.4%) patients were lost to follow-up.

The overall survival (OS) at 5 years in Group 1 and 2 was respectively 59.8% and 88.9% and the relapse-free survival (RFS) was respectively 73.3% and 88.9%. A significant benefit of completion surgery was seen only in OS (p=0.011).

Conclusion: completion surgery after CCRT has a place in the multimodality management of locally advanced cervical cancer with significant benefice in local control and OS.