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CC BY 4.0 · Rev Bras Ginecol Obstet 2020; 42(01): 035-042
DOI: 10.1055/s-0040-1701459
Original Article
Oncology
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Is Surgical Treatment an Option for Locally Advanced Cervical Cancer in the Presence of Central Residual Tumor after Chemoradiotherapy?

Samet Topuz 
1   Department of Gynecological Oncology, Istanbul University, Fatih, Istanbul, Turkey
,
Alpaslan Kaban 
1   Department of Gynecological Oncology, Istanbul University, Fatih, Istanbul, Turkey
,
Seden Küçücük 
1   Department of Gynecological Oncology, Istanbul University, Fatih, Istanbul, Turkey
,
Yavuz Salihoglu 
1   Department of Gynecological Oncology, Istanbul University, Fatih, Istanbul, Turkey
› Author Affiliations
Further Information

Publication History

06 November 2018

22 November 2019

Publication Date:
27 February 2020 (online)

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Abstract

Objective To evaluate the outcomes of surgical treatment in patients with chemoradiotherapy (CRT)-resistant and locally advanced cervical cancer (LACC).

Methods Patients with LACC who underwent surgery due to resistance to CRT between 2005 and 2015 were reviewed retrospectively. Disease-free survival (DFS) and overall survival (OS) related factors were analyzed.

Results A total of 23 patients were included in the study and the median age was 51 years old. A total of 14 patients (60.8%) experienced recurrence; among these recurrences, 8 of them were local, 5 were distant, 1 was both distant and local. A total of 9 patients (39%) died. The Median DFS and OS durations were 15 and 32 months, respectively. A total of 17 patients (74%) had undergone simple hysterectomy, 4 (17%) radical hysterectomy, and 2 (9%) total pelvic exenteration. Postoperative grade 3 and 4 complications were seen in 12 patients (52%). Macroscopic tumor presence in the pathology specimen was associated with distant recurrence and positive surgical margins with local recurrence (Log-Rank test p = 0.029 and p = 0.048, respectively). The only factor associated with OS was surgical margin positivity (Log-Rank test p = 0.008). The type of surgery, grades 3 and 4 postoperative complications, brachytherapy, and tumor histology were not associated with recurrence.

Conclusion In patients with LACC, hysterectomy is an option in the presence of a central residual tumor after CRT. However, the risk of grades 3 and 4 complications of performed surgery is high. The presence of macroscopic tumor in the pathology specimen and positive surgical margins are poor prognostic factors. The goal of the surgeon should be to achieve a negative surgical margin. It does not seem important if the surgery is simple or radical.

Keywords

cervical cancer - brachytherapy - chemoradiotherapy - recurrence - resistant tumor

Contributors

All of the authors contributed with the project and data interpretation, the writing of the article, the critical review of the intellectual content, and with the final approval of the version to be published.


 

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