Results of Hysterectomy in Patients With Bulky Residual Disease at the End of Chemoradiotherapy for Stage IB2/II Cervical Carcinoma

Abstract

This series confirms the high rate of nodal spread in patients with bulky residual cervical disease after chemoradiotherapy. Furthermore, patients who underwent hysterectomy had a high complication rate. Only two patients are alive and disease free. The results of surgery are disappointing; surgery does not seem to improve the survival of these patients.

Prognostic Factors and Morbidities After Completion Surgery in Patients Undergoing Initial Chemoradiation Therapy for Locally Advanced Cervical Cancer

“…One half to two thirds of the patients with RD had millimetric RD, and many of them would have had total surgical sterilization of the cervix if surgery had been performed later. In patients with larger RD (Ͼ1 cm in the current series or Ͼ2 cm in other series [6,10,20]), surgery has a theoretical major therapeutic impact. But given the greater risk for extracervical disease (nodal spread or distant disease) in patients with RD, the real impact on survival of completion surgery in this subgroup remains unproven and is still debated [6,20].…”

“…In patients with larger RD (Ͼ1 cm in the current series or Ͼ2 cm in other series [6,10,20]), surgery has a theoretical major therapeutic impact. But given the greater risk for extracervical disease (nodal spread or distant disease) in patients with RD, the real impact on survival of completion surgery in this subgroup remains unproven and is still debated [6,20]. Given the frequency of histologic RD, the burning question is how to improve local control of the disease without significantly increasing morbidity (as we observed after completion surgery).…”

“…A radical hysterectomy is more "logical" in patients with RD to guarantee free margins. However, such a basic proposal would also increase the morbidity of surgery, whereas the therapeutic value of completion surgery in patients with bulky RD (Ͼ1 cm or 2 cm according to the series) remains totally unproven because these poor responders also run a higher risk for extrapelvic disease (nodal involvement or distant metastasis) [6,20]. This point also raises the important question of the evaluation of response (and thus, the potential presence of RD) at the end of CRT (should completion surgery be discussed).…”

“…In such patients, the role and modalities of completion surgery (after CRT) continue to be debated. In the literature, very few data are available on the results of completion surgery in patients treated with CRT [3][4][5][6][7][8][9][10]. Nevertheless, even if the therapeutic impact of completion hysterectomy continues to fuel debate, the analysis of prognostic factors (and mainly histologic factors) in hysterectomy and lymphadenectomy specimens could add interesting data in order to improve local and distant control for future patients undergoing CRT.…”

Results of the GYNECO 02 Study, an FNCLCC Phase III Trial Comparing Hysterectomy with No Hysterectomy in Patients with a (Clinical and Radiological) Complete Response After Chemoradiation Therapy for Stage IB2 or II Cervical Cancer

“…After 1999, the use of CRT became the new standard for the treatment of cervical cancer Ͼ4 cm [1,2]. Several countries (mainly in Europe and Asia) considered CRT as neoadjuvant therapy and proposed hysterectomy in this context [3][4][5][6][7][8][9][10]. Nevertheless, this surgery could impair the postoperative quality of life of patients because there is a potential risk for major morbidities with CRT, which should be clearly balanced with the true therapeutic benefit of such a hysterectomy [19].…”