Abstract
To evaluate the outcomes of surgical treatment in patients with chemoradiotherapy (CRT)-resistant and locally advanced cervical cancer (LACC). Patients with LACC who underwent surgery due to resistance to CRT between 2005 and 2015 were reviewed retrospectively. Disease-free survival (DFS) and overall survival (OS) related factors were analyzed. A total of 23 patients were included in the study and the median age was 51 years old. A total of 14 patients (60.8%) experienced recurrence; among these recurrences, 8 of them were local, 5 were distant, 1 was both distant and local. A total of 9 patients (39%) died. The Median DFS and OS durations were 15 and 32 months, respectively. A total of 17 patients (74%) had undergone simple hysterectomy, 4 (17%) radical hysterectomy, and 2 (9%) total pelvic exenteration. Postoperative grade 3 and 4 complications were seen in 12 patients (52%). Macroscopic tumor presence in the pathology specimen was associated with distant recurrence and positive surgical margins with local recurrence (Log-Rank test p = 0.029 and p = 0.048, respectively). The only factor associated with OS was surgical margin positivity (Log-Rank test p = 0.008). The type of surgery, grades 3 and 4 postoperative complications, brachytherapy, and tumor histology were not associated with recurrence. In patients with LACC, hysterectomy is an option in the presence of a central residual tumor after CRT. However, the risk of grades 3 and 4 complications of performed surgery is high. The presence of macroscopic tumor in the pathology specimen and positive surgical margins are poor prognostic factors. The goal of the surgeon should be to achieve a negative surgical margin. It does not seem important if the surgery is simple or radical.
Highlights
The incidence of invasive cervical cancer is declining, especially in developed countries, due to successful screening programs and HPV vaccination
The surgical margins had been positive in 43.4% (n 1⁄4 10) of the patients and negative in 56.5% (n 1⁄4 13)
The histological diagnosis had been squamous in 69.5% (n 1⁄4 16) and nonsquamous in 30.5%
Summary
The incidence of invasive cervical cancer is declining, especially in developed countries, due to successful screening programs and HPV vaccination. Introduction of chemoradiotherapy instead of radiotherapy alone ~ 20 years ago, which was shown to be beneficial to survival, is a major advance in locally advanced cervical cancer (LACC) therapy.[1] the relative survival rate of these patients seems to have remained unchanged over the last 40 years, according to The Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute data.[2]. The standard treatment approach in LACC (stage 1B2–4A) is external beam radiation therapy (EBRT) followed by intracavitary brachytherapy (ICBT) and concomitant cisplatin-based chemotherapy.[3,4,5] Studies showed that a response between received November 6, 2018 accepted November 22, 2019.
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