Completed versus aborted radical hysterectomy for node-positive stage IB cervical cancer in the modern era of chemoradiation therapy

• Published in: Gynecologic oncology Vol. 126; no. 1; pp. 69 - 72
• Main Authors: Ziebarth, Angela J., Smith, Haller, Killian, Mary E., Nguyen, Nguyet A., Durst, Jennifer K., Subramaniam, Akila, Kim, Kenneth H., Leath, Charles A., Straughn, J. Michael, Alvarez, Ronald D.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2012
• Subjects: Adult; Brachytherapy; Cervical cancer; Disease-Free Survival; Female; Hematology, Oncology and Palliative Medicine; Humans; Hysterectomy - methods; Lymph Node Excision; Lymphatic Metastasis; Middle Aged; Neoplasm Staging; Obstetrics and Gynecology; Radiotherapy, Adjuvant; Stage I cervical cancer; Treatment Outcome; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - radiotherapy; Uterine Cervical Neoplasms - surgery; Vaginal brachytherapy; Stage I cervical cancer; Cervical cancer; Vaginal brachytherapy
• ISSN: 0090-8258; 1095-6859; 1095-6859
• DOI: 10.1016/j.ygyno.2012.03.046

Debate continues about optimal management of patients with node-positive stage I cervical cancer. Our objective was to determine if patient outcomes are affected by radical hysterectomy in the modern era of adjuvant chemoradiation. Cervical cancer patients diagnosed from 2000 to 2008 were identified. Demographics, therapy, clinicopathologic data, progression free survival (PFS), overall survival (OS), total radiation exposure, and grade 3–4 complications were analyzed by student t, Mann–Whitney, Fisher's exact, Kaplan–Meier, and log rank tests. This single-institution review evaluated forty-one of 334 (13.4%) patients scheduled to undergo radical hysterectomy that had gross nodal disease diagnosed intraoperatively. 15 underwent aborted radical hysterectomy following lymphadenectomy; the remaining 26 underwent radical hysterectomy and lymphadenectomy. Eleven patients undergoing radical hysterectomy underwent whole pelvic radiation therapy (WPRT) while 8 (30.7%) patients underwent WPRT and postoperative vaginal brachytherapy (BT) for local treatment secondary to close margins. All patients undergoing aborted radical hysterectomy underwent WPRT and BT. With mean follow-up of 42.3months, there were no significant differences in urinary, gastrointestinal, or hematologic complications between groups. When comparing those undergoing radical hysterectomy to aborted radical hysterectomy, there were no significant differences in local recurrence (11.5% vs 26.7%, p=0.39) or distant recurrence (19.2% vs. 33.3%, p=0.45), PFS (74.9months vs 46.8months, p=0.106), or OS (91.8months vs 69.4months, p=0.886). Treatment of patients with early stage cervical cancer and nodal metastasis may be tailored intraoperatively. Completion of radical hysterectomy and lymphadenectomy decreases radiation exposure without apparently compromising safety or outcome in the era of adjuvant chemoradiation. ► Debate continues about optimal management of stage 1 cervical cancer patients when grossly positive nodal disease is identified intraoperatively. ► These patients may be treated with lymphadenectomy and radiation therapy with or without radical hysterectomy. ► Completion of radical hysterectomy/lymphadenectomy decreases radiation exposure without apparently compromising safety or outcome in the era of chemoradiation.