Preoperative Chemoradiotherapy in Locally Advanced Bulky Squamous Cell Carcinoma of the Uterine Cervix. Issue 9 (November 2017)

• Record Type: Journal Article
• Authors: Nakao, Yoshifumi; Hashiguchi, Mariko; Nishiyama, Satoshi; Aihara, Satomi; Iwasaka, Tsuyoshi; Yokoyama, Masatoshi
• Is Part Of: International journal of gynecological cancer. Volume 27:Issue 9(2017)
• Publication Date: 2017-11
• Subjects: Chemoradiotherapy -- Hysterectomy -- Uterine cervical cancer; Generative organs, Female -- Cancer -- Periodicals; 616.99465
• DOI: 10.1097/IGC.0000000000001094
• Languages: English
• ISSNs: 1048-891X

Abstract

Abstract : Objectives: The aim of this study was to evaluate long-term survival and feasibility in patients with bulky squamous cell carcinoma of the uterine cervix who underwent surgery after concurrent chemoradiotherapy. Methods: A review of patients with locally advanced bulky squamous cell cervical cancer who underwent chemoradiation followed by surgery with pelvic lymphadenectomy was performed. Chemoradiotherapy included 2 monthly doses of intra-arterial chemotherapy with cisplatin (50 mg/m 2 ) and mitomycin C (10 mg/body) and external irradiation to the whole pelvis and high-dose-rate brachytherapy. From 2000 to 2006, 23 patients were enrolled in a single institution. Patient distribution according to the International Federation of Gynecology and Obstetrics stage was as follows: 9 stage IB2, 10 stage IIB, and 4 stage IIIB. Radiological lymph node involvement was present in 69.6% (16/23), including 2 cases of para-aortic lymph node swelling. The radiological response, pathological response, overall and disease-free survival, and late complications were assessed. Results: Among the patients, 12 (52.2%) showed pathological complete response, and 11 (47.8%) showed a pathological partial response for cervical lesions. Among the cases of radiological pelvic lymph node swelling, the response rate was 93.3% (14/15). Only 1 case showed viable cancer cells in the resected pelvic lymph nodes among radiological complete response cases. In the median follow-up duration (121 months; range, 17–180 months), the 5-year overall survival and disease-free survival were 95.7% and 86.7%, respectively. Seven events in 4 patients led to the development of postoperative fistula formation requiring a rescue surgery. Conclusions: Chemoradiotherapy followed by surgery was effective for patients with bulky squamous cell carcinoma of the uterine cervix. Further investigation to select suitable patients for this multimodal treatment will be required.