The Efficacy of Adjuvant Hysterectomy after Definitive Radiotherapy or Concurrent Chemoradiotherapy in Patients with Cervical Adenocarcinoma

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To study the outcomes of patients with cervical adenocarcinoma (AC) primarily treated by definitive radiotherapy or concurrent chemoradiotherapy (CCRT) and whether adjuvant hysterectomy can improve the outcomes of those patients. We performed a retrospective analysis of 106 patients with International Federation of Gynecology and Obstetrics Stage IB-IVA AC of the cervix who were treated at Peking Union Medical College Hospital between 2005 and 2015. All patients were treated with external radiation(45-50.4Gy in 25 to 28 fractions) and brachytherapy (27-36Gy in 4 to 7 fractions), whereas 85.8% patients were combined with concurrent chemotherapy including weekly cisplatin (40 mg/m2) or weekly paclitaxel (75 mg/m2). Outcomes were compared between 51 patients who underwent adjuvant hysterectomy after radiotherapy with 55 patients who did not. After a median follow-up duration of 45 months(range, 5-117months), the 3-year overall survival (OS) and progression-free survival (PFS) were 82.3% and 57.8%, respectively. The 3-year OS, PFS, pelvic control and distant control rates of the adjuvant hysterectomy group and standard RT group were 82.2% and 82.5%( p=0.15), 66.4% and 49.4%( p=0.098), 85.6% and 74.5%( p=0.22), and 73.8% and 59.5%( P=0.168), respectively. Of the 106 patients, 38 (35.8%) patients had died, and 49 (46.2%) patients had relapsed. Of those, 9 cases(8.5%) were mere local recurrences and 28 (26.4%) cases were mere distant recurrences. In addition, 12(11.3%) patients developed both local and distant relapse. 18 of 51 (35.2%) patients undergoing surgery showed a pathological complete response. After univariate analysis, pathologic subtype and elevated CA-125 level prior to RT were significant prognostic factors of OS (p=0.003 and 0.034,respectively). Tumor size and response status after RT were significant factors of PFS (p=0.033 and 0.022,respectively). Patients with residue tumor in surgical pathology had significantly worse regional control ( p=0.021) and poorer OS(p=0.049). After multivariate analysis, pathologic subtype and elevated CA-125 were independent factors of OS (p=0.018 and 0.036,respectively). Elevated CA-125 and concurrent chemotherapy were independent factors of PFS (p=0.001 and 0.003,respectively). Subgroup analysis showed hysterectomy did not improve OS or PFS in patients with partial response of RT. Hysterectomy did not significantly improve outcomes of AC patients after RT in this study, regardless of RT response. More prospective studies are needed to illuminate the role of adjuvant surgery after definitive RT in AC patients.