Outcome of patients with incomplete resection after surgery for stage IB2/II cervical carcinoma with chemoradiation therapy

Abstract

Objective: Standard treatment of stage IB2/II cervical carcinoma is chemoradiation therapy. Residual disease is evaluated clinically and by magnetic resonance imaging. The place of surgery after this treatment is debated, except when there is suspicion of residual disease. There is no standard management when surgical resection is incomplete. The aim of this study was to describe the outcome of these patients.

Methods: A retrospective review was undertaken of patients fulfilling the following inclusion criteria: (1) stage IB2/II cervical cancer, (2) external radiotherapy (45 Gy) with concomitant chemotherapy followed by uterovaginal brachytherapy (15 Gy), (3) magnetic resonance imaging performed between 3 and 8 weeks after brachytherapy, and (4) completion surgery with incomplete resection of pelvic disease. Patients with distant metastasis or carcinosis were excluded.

Results: Ten patients treated between 2003 and 2006 fulfilled all inclusion criteria. The locations of the incomplete resection were (some patients had several locations) the parametrium (n = 4), lateral limit of the cervix (n = 4), anterior (n = 2), posterior (n = 3), and vagina (n = 2). Further surgery had been proposed for 3 patients but only performed once and this patient had rapid disease progression. One patient had received chemotherapy for metastatic para-aortic nodes. Seven patients died with a median period of 11 months after surgery (range, 3-21 months). One patient is alive with recurrent disease, and 2 are free of disease with 23 and 33 months of follow-up.

Conclusions: The prognosis is poor when resection is incomplete after chemoradiation therapy in advanced-stage cervical cancer, and further surgery does not seem to improve this outcome.