Surgical morbidity and oncologic results after concurrent chemoradiation therapy for advanced cervical cancer

Abstract

Objective: To evaluate the surgical morbidity and oncologic results after concurrent chemoradiotherapy (CCRT) followed by completion surgery for advanced cervical carcinoma.

Methods: The present retrospective analysis included 192 patients with advanced cervical cancer (stage IIB-IVA) treated with CCRT followed by surgery and 186 control patients without completion surgery. Disease-free and overall survival rates were compared.

Results: Of the patients who underwent surgery, 27 (14.1%) had pathologic evidence of residual disease; the local control rate with CCRT was 85.9%. After a median follow-up period of 190 months, 32 (16.7%) patients who underwent completion surgery had a recurrence compared with 59 (31.7%) of those who did not. The overall survival rate among patients who underwent extrafascial hysterectomy, extended hysterectomy, or no surgery was 72.2%, 60.1%, and 45.9% at 3 years, and 53.5%, 40.7%, and 32.2% at 5 years, respectively.

Conclusion: Surgery after CCRT for advanced cervical cancer enabled evaluation of the pathologic response to therapy, improved local disease control in patients with a partial pathologic response, and enhanced survival. The most appropriate surgical approach was extrafascial hysterectomy with pelvic lymph node dissection.

Keywords: Cervical cancer; Complications; Concurrent chemoradiotherapy; Surgery.