Possibilities of aggressive oncosurgery in treatment of IIA–IIIB stages of cervical cancer

Abstract

Introduction. Arming gynecological oncology with modern chemotherapy schemes, elements of aggressive oncosurgery, it is possible to achieve an increase in the number of cured patients with locally advanced forms of cervical cancer (CC), providing an improvement in the immediate and long-term results of treatment. The proposed method of surgical treatment is the method of choice for the surgical treatment of patients with locally advanced forms of cervical cancer (stages IIA–IIIB).Purpose of the study. Introduction into clinical practice of the method of surgical treatment of IIA–IIIB stages of cervical cancer.Material and methods. Long-term results of treatment of 155 patients with morphologically verified stage IIA–IIIB cervical cancer were studied. The patients underwent neoadjuvant chemotherapy (NACT) (n = 110) and chemoradiotherapy (CRT) (n = 45). When resectability was achieved, the patients underwent surgical treatment using a new technique. Overall survival (OS) and progression-free survival (PFS) outcomes were assessed.Results. In the period from 2017 to 2020, 155 patients with stage IIA–IIIB cervical cancer after NACT (n = 110) and CRT (n = 45) underwent combinedextended extirpation of the uterus with appendages according to our patented method. The most frequent postoperative complications were urination disorders in 106 (67 [60.9%] and 19 [42.2%]) patients, lymphatic cysts in 30 (20 [18.2%] and 10 [22.2%]) patients and vesicovaginal fistula in 7 patients (5 [4.6%] and 2 [4.4%]), respectively. According to the results of a pathomorphological study, the most frequent tumor response to NACT was III degree of therapeutic pathomorphosis (TP) in 44 (40.0%) patients of group 1 and in 21 patients – IV-degree TP, amounting to 46.6%. The median follow-up was 28.7 (from 3.6 to 51.1) months. During this time, 30 patients died in both groups (17 [15.5%] and 13 [28.9%]) (p = 0.047). Disease progression occurred in 16 (10.3%) patients (6 [5.5%] and 10 [22.2%]) (p = 0.004), respectively. The 3-year OS was 83.8 ± 3.7 and 71.0 ± 6.8 (p = 0.131), PFS – 93.5 ± 2.6 and 77.7 ± 6.6 (p = 0.006).Conclusions. The proposed method of surgical treatment of IIA–IIIB stages of cervical cancer has a novelty and can be used in practical medicine for the surgical treatment of oncology diseases in cervical cancer