Adjuvant Hysterectomy for Cervical Cancer Patients Treated with Chemoradiation Therapy: A Systematic Review on the Pathology-Proven Residual Disease Rate.

Kim Van Kol,Jurgen Piek,Maaike Beugeling,Tineke Vergeldt,Ruud Bekkers,Renée Ebisch

doi:10.3390/cancers13246190

Abstract

Simple SummaryThe treatment for patients with locally advanced cervical cancer generally consists of platinum-based chemotherapy during external beam radiotherapy, followed by brachytherapy. Some medical centers perform adjuvant hysterectomy after chemoradiation therapy, even though the international guideline advises otherwise. Performing adjuvant hysterectomy after chemoradiation therapy is associated with a high complication rate and the percentage residual disease in adjuvant hysterectomy specimen is unknown. Therefore, the aim of our systematic review was to determine the percentage of residual disease in the adjuvant hysterectomy specimen. Furthermore, we want to determine if there is an association between the time of adjuvant hysterectomy and the percentage residual disease in adjuvant hysterectomy specimens. Findings from this research provide insight into potential complications, survival benefits, and an overtreatment rate. Patients need to be well informed before considering an adjuvant hysterectomy.Objective: To determine the incidence of pathology-proven residual disease in adjuvant hysterectomy specimens in patients with cervical cancer, treated with chemoradiation therapy. Secondly, to assess a possible association for pathology-proven residual disease regarding the time between chemoradiation therapy and adjuvant hysterectomy. Additionally, the survival rate and complication rate were assessed. Methods: PubMed, EMBASE, and the Cochrane database were searched from inception up to 8 March 2021. Results: Of the 4601 screened articles, eleven studies were included. A total of 1205 patients were treated with chemoradiation therapy and adjuvant hysterectomy, ranging from three to twelve weeks after chemoradiation therapy. A total of 411 out of 1205 patients (34%) had pathology-proven residual disease in the adjuvant hysterectomy specimen. There was no association found in the time between chemoradiation therapy and adjuvant hysterectomy. Follow-up ranged from 2.4 to 245 months, during which 270 patients (22%) relapsed, and 298 patients (27%) were deceased. A total of 202 (35%) complications were registered in 578 patients. Conclusion: there is no association found in the time between chemoradiation therapy and residual disease on adjuvant hysterectomy specimens. The survival rates after chemoradiation therapy and adjuvant hysterectomy are suboptimal, while the risk of complications after adjuvant hysterectomy is high.

Highlights

Cervical cancer is the fourth most common malignancy in patients worldwide, within2018, an estimated number of 570,000 patients were diagnosed with cervical cancer [1,2].Approximately 30–40% of patients with cervical cancer in developed countries have locally advanced cervical cancer at initial diagnosis [3]
No association was found between the time between chemoradiation therapy and for pathology-proven residual disease on adjuvant hysterectomy specimens
We reported an overall survival of 73% after chemoradiation therapy and adjuvant hysterectomy, which seems to be equivalent to treatment with chemoradiation therapy alone

Summary

Introduction

Cervical cancer is the fourth most common malignancy in patients worldwide, within2018, an estimated number of 570,000 patients were diagnosed with cervical cancer [1,2].Approximately 30–40% of patients with cervical cancer in developed countries have locally advanced cervical cancer at initial diagnosis [3]. Cervical cancer is the fourth most common malignancy in patients worldwide, within. 2018, an estimated number of 570,000 patients were diagnosed with cervical cancer [1,2]. 30–40% of patients with cervical cancer in developed countries have locally advanced cervical cancer at initial diagnosis [3]. Advanced cervical cancer is classified as stage IIB-IVA according to the International Federation of Gynecology and Obstetrics (FIGO) 2018 staging system [2]. The standard treatment for patients with locally advanced cervical cancer is concurrent chemoradiation therapy. This treatment generally consists of platinum-based chemotherapy during external beam radiotherapy, followed by brachytherapy [4]. There is still a reported overall local pelvic recurrence rate of 14.5%

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Discussion

Conclusion