Evaluation of surgical resection in the locally advanced cervical carcinomas after neoadjuvant external beam radiation therapy

Abstract

Cervical carcinomas are common in developing countries. More than 60 % of all cases are locally advanced, considered as no carcinologic resectable because of the frequent pelvic structures involvement. The aim of this study is to evaluate the surgical resection of locally advanced of the cervical carcinoma after neo-adjuvant external beam radiotherapy. It was retrospective study and we enrolled 48 cervical carcinomas staging FIGO : IIA (18,8 %), IIB (58,3 %), III (16,7 %) and IVA (6,2 %) with objective response and operated after neo-adjuvant radiotherapy from 2000 to 2003. The mean age was 48,8 years and squamous cells carcinomas represented 95,8 %. We studied surgical assessment, macroscopic residual tumour, histological evaluation and follow-up. The mean delay of the surgery was 13,2 weeks. We realized radical hysterectomy Piver's type III in 75 %, type II in 8,3 %, and extrafacial hysterectomy in 12,5 %. Pelvic lymphadenectomy was done in 26 cases. We noted 15 haemorrhages, 2 injuries of bladder and ureteri, 2 urinary fistulas and 1 radic cystitis. Two patients died of pulmonary embolism. Macroscopic residual tumour noted in 29,2 %. Of the 30 cases with histological evaluation, complete sterilization was 60 % and partial sterilization 40 %. The mean follow-up was 40 months. The rate of local control was 60,4 %. A 36 months survival was 55 % and without recurrence 92 %. Very few patients presenting locally advanced of the cervical carcinoma benefit treatment. Our results may be validate by cases control studies between patient treated by exclusive radiotherapy and patient treated by radiotherapy follow up radiotherapy of surgery.