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Adjuvant hysterectomy after radiochemotherapy for locally advanced cervical cancer

Adjuvante Hysterektomie nach Radiochemotherapie bei lokal fortgeschrittenem Zervixkarzinom

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Abstract

Background

External beam radiation therapy (EBRT) with concomitant chemotherapy (cCT) (=RCT) plus intracavitary (±interstitial) brachytherapy (iBT) is standard of care for advanced cervical cancer. The aim of this study was to evaluate morbidity and survival outcome of simple adjuvant hysterectomy (AH) after EBRT/cCT and to compare it with the standard treatment.

Patients and methods

Patients with FIGO stage III cervical cancer were treated with EBRT/cCT and then divided in two groups: group 1 was further treated with standard intracavitary/interstitial BT, while group 2 underwent AH.

Results

From 881 women with cervical cancer, 248 were eligible for analysis: 161 received iBT and 87 underwent AH. The median follow-up of the study was 53 months. Clinical and pathological characteristics were well balanced in the two groups. After EBRT/cCT, complete clinical response was observed in 121 (48.8%) of 246 patients. Clinical complete response was observed in 81 (50.3%) of 161 patients in group 1. At 6 weeks after EBRT/cCT, 40 (46.0%) of 87 patients in the surgery group had pathological complete response. Intra- and postoperative complications were observed in 10 (11.5%) of 87 cases. The rates of locoregional recurrence and metastasis were similar in both groups. Progression-free (PFS) and disease-specific overall survival (DOS) for these patients were similar between the control and surgery group. Interestingly, PFS and DOS were significantly improved by AH for the patients with residual tumor.

Conclusion

AH could improve survival in patients with residual disease after RCT and is characterized by a low complication rate.

Zusammenfassung

Hintergrund

Die Teletherapie (EBRT) mit begleitender Chemotherapie (cCT), entsprechend einer Radiochemotherapie (RCT), plus intrakavitäre (± interstitielle) Brachytherapie (iBT) ist Standard in der Behandlung des fortgeschrittenen Zervixkarzinoms. Ziel dieser Studie war es, die Morbidität und das Überleben zwischen der einfachen adjuvanten Hysterektomie (AH) nach EBRT/cCT und dem Standardverfahren zu vergleichen.

Patienten und Methoden

Patienten mit Zervixkarzinom im FIGO-Stadium III wurden mit EBRT/cCT behandelt und dann in zwei Gruppen unterteilt: Gruppe 1 wurde weiter mit der standardmäßigen intrakavitären/interstitiellen Brachytherapie behandelt, Gruppe 2 unterzog sich einer AH.

Ergebnisse

Von 881 Frauen mit Zervixkarzinom waren 246 für die Analyse geeignet: 161 erhielten eine iBT und 87 eine AH. Das mediane Follow-up der Studie betrug 53 Monate. Die klinischen und pathologischen Eigenschaften waren in den zwei Gruppen gut ausgewogen. Nach EBRT/cCT wurde eine klinische Komplettremission bei 121 (48,8 %) von 246 Patienten beobachtet. In Gruppe 1 wurde bei 81 (50,3 %) von 161 Patientinnen eine klinische Komplettremission beobachtet. Sechs Wochen nach EBRT/cCT hatten 40 (64,0 %) von 87 Patienten in der AH-Gruppe eine pathologische Komplettremission. Intra- und postoperative Komplikationen wurden in 10 (11,5 %) der 87 Fälle beobachtet. Die Rate der lokoregionären Rezidive und Metastasen war in den beiden Gruppen ähnlich. Das progressionsfreie Überleben (PFS) und das krankheitspezifische Gesamtüberleben (DOS) für diese Patienten waren in den beiden Gruppen ähnlich. Interessanterweise waren das PFS und das DOS für die Patienten mit Resttumor durch die AH signifikant verlängert.

Schlussfolgerungen

Die AH könnte das Überleben von Patienten mit Residualtumor nach RCT verbessern und ist durch eine geringe Komplikationsrate gekennzeichnet.

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Authors and Affiliations

  1. Department of Radiation Oncology, Universitätsklinikum Magdeburg, Magdeburg, Germany

    Peter Hass

  2. Department of Obstetrics and Gynecology, Otto-von-Guericke University, G.-Hauptmann Str. 35, 39108, Magdeburg, Germany

    Holm Eggemann, Serban Dan Costa & Atanas Ignatov

Authors
  1. Peter Hass
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  2. Holm Eggemann
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  3. Serban Dan Costa
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  4. Atanas Ignatov
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Corresponding author

Correspondence to Atanas Ignatov.

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Conflict of interest

P. Hass, H. Eggemann, S.D. Costa and A. Ignatov declare that they have no competing interests.

Ethical standards

This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from all patients before treatment. An additional individual consent for this analysis was not needed.

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Hass, P., Eggemann, H., Costa, S.D. et al. Adjuvant hysterectomy after radiochemotherapy for locally advanced cervical cancer. Strahlenther Onkol 193, 1048–1055 (2017). https://doi.org/10.1007/s00066-017-1174-1

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  • DOI: https://doi.org/10.1007/s00066-017-1174-1

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