Comparison of outcomes between radical hysterectomy followed by tailored adjuvant therapy versus primary chemoradiation therapy in IB2 and IIA2 cervical cancer

Abstract

ObjectiveTo compare survival outcomes and treatment-related morbidities between radical hysterectomy (RH) and primary chemoradiation therapy (CRT) in patients with bulky early-stage cervical cancer.MethodsWe selected 215 patients with stage IB2 and IIA2 cervical cancer (tumor diameter > 4 cm on magnetic resonance imaging) who underwent RH followed by tailored adjuvant therapy (n=147) or primary CRT (n=68) at two tertiary referral centers between 2001 and 2010.ResultsAbout twenty nine percent of patients were cured by RH alone and these patients experienced the best survival outcomes with the lowest morbidity rates. After the median follow-up times of 40 months, 27 RH (18.4%) and 20 CRT (29.4%) patients had recurrence (p=0.068) and 23 (15.6%) and 17 (25%) patients died of disease (p=0.101). The 5-year progression-free survival were 77% and 66% (p=0.047), and the 5-year overall survival were 78% and 67% (p=0.048) after RH and primary CRT, respectively. In multivariate analysis, patients who received primary CRT was at higher risk for tumor recurrence (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.24 to 4.14; p=0.008) and death (OR, 3.02; 95% CI, 1.53 to 5.98; p=0.001) than those who received RH. Grade 3-4, early (17% vs. 30.9%, p=0.021) and late (1.4% vs. 8.8%, p=0.007) complications were significantly less frequent after RH than primary CRT.ConclusionThirty percent of patients were cured by RH alone. A treatment outcome was better in this retrospective study in terms of morbidity and survival. Randomized trials are needed to confirm this result.

Preoperatively Assessable Clinical and Pathological Risk Factors for Parametrial Involvement in Surgically Treated FIGO Stage IB–IIA Cervical Cancer

“…However, only 30% of patients with a tumor diameter larger than 4 cm are cured by surgery alone; others will require adjuvant radiation, and 50% will require adjuvant chemoradiation for high-risk features. 22,23 Thus, FIGO staging in this group does not yield to select the patients who can be treated by surgery alone. In this study group, 29.1% of patients with stage IBYIIA cervical cancer required adjuvant chemoradiation for PMI.…”

Comparison of Laparoscopic Versus Abdominal Radical Hysterectomy for FIGO Stage IB and IIA Cervical Cancer With Tumor Diameter of 3 cm or Greater

“…Some retrospective studies suggested that a primary surgical approach with tailored postoperative therapy for bulky cervical cancer can achieve good survival rates with tolerably low morbidity. 1,21 In the current study, all patients had no evidence of LN metastasis in preoperative MRI and PET-CT. However, in the postoperative histopathologic examinations, 7 and 8 patients had microscopic pelvic LN metastasis in the LRH and the ARH group, respectively.…”

“…These findings suggest that the primary radical surgery itself decreases the incidence of unnecessary adjuvant therapy and provides critical information to select adjuvant therapy for appropriate patients. Kim 21 reported that only RH without adjuvant therapy was curative in 30% of patients with bulky early-stage cervical cancer. In our study, 54.1% in the ARH and 45.8% of the patients in the LRH group were also cured by RH alone without adjuvant therapy.…”

Surgical and Pathological Outcomes of Laparoscopic Versus Abdominal Radical Hysterectomy With Pelvic Lymphadenectomy and/or Para-aortic Lymph Node Sampling for Bulky Early-Stage Cervical Cancer

“…Various retrospective studies suggested that a primary surgical approach with tailored postoperative therapy for bulky cervical cancer can achieve good survival rates with tolerably low morbidity. 16,17 In the postoperative histopathologic examinations of this study, 7 and 20 patients had microscopic pelvic LN metastases in the LRH and ARH groups, respectively. In our study, 9 patients (30.0%) in the LHR group and 28 patients (34.1%) in the ARH group did not necessarily receive adjuvant therapy.…”

“…patients with bulky early-stage cervical cancer was 70% to 82% after RH followed by tailored adjuvant therapy and 61% to 76% after CCRT. 17,20,22 Therefore, we believe that RH may be a more effective treatment strategy for patients with bulky early-stage cervical cancer and that LRH exhibits similar therapeutic efficacy to ARH in these patients.…”