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

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.

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SURGERY FOR RESIDUAL DISEASE AFTER RADIOTHERAPY IN LOCALLY ADVANCED CERVICAL CANCER

Problems in oncology ◽

10.37469/0507-3758-2019-65-5-721-725 ◽

2019 ◽

Vol 65 (5) ◽

pp. 721-725

Author(s):

Elmira Shakirova ◽

Andrey Panov ◽

Alevtina Akhmetzyanova ◽

Aliya Gafiullina ◽

L. Ibragimova ◽

...

Keyword(s):

Cervical Cancer ◽

Residual Disease ◽

Locally Advanced ◽

Residual Tumor ◽

Advanced Cervical Cancer ◽

Mri Imaging ◽

Recurrent Cervical Cancer ◽

Locally Advanced Cervical Cancer ◽

Visible Effect ◽

Adjuvant Hysterectomy

Aims: Chemoradiation (CRT) is the standard treatment for locally advanced cervical cancer (LACC). However part of the patients develop recurrence during the first year after treatment despite good visible effect at the first follow-up. The role of completion surgery after radiotherapy (RT) is still debated. A number of papers have showed that up to 60% of patients have residual tumor after CRT and RT. But such a surgery is not widely recommended because of increased morbidity of the treatment. The aim of this study was to assess the results of surgery after radiotherapy of LACC. Method: We retrospectively evaluated data on 86 patients with cervical cancer IB - IIIB stages (mostly stage IIB) who underwent surgery in different modalities after CRT and RT with good clinical response in our department in 2015-2018. Results: When small asymptomatic residual disease was detected early after radiotherapy radical hysterectomy was feasible in most of the cases. Patients with clinical manifestation of recurrence had very poor prognosis. Surgery of recurrent cervical cancer sufficiently deteriorates quality of life, even if possible. Conclusion: Thorough examination with adding MRI imaging after initial treatment of cervical cancer needed to identify patients who may benefit from adjuvant hysterectomy.

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PRospective Imaging of CErvical cancer and neoadjuvant treatment (PRICE) study: role of ultrasound to assess residual tumor in locally advanced cervical cancer patients undergoing chemoradiation and radical surgery

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.18953 ◽

2018 ◽

Vol 52 (1) ◽

pp. 110-118 ◽

Cited By ~ 6

Author(s):

A. C. Testa ◽

F. Moro ◽

T. Pasciuto ◽

M. C. Moruzzi ◽

A. Di Legge ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Patients ◽

Radical Surgery ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Residual Tumor ◽

Advanced Cervical Cancer ◽

Locally Advanced Cervical Cancer

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Immunohistochemical staining for XRCC1, XRCC3 and Ku70/80 proteins and their correlation with clinical outcome in locally advanced cervical cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.15011 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 15011-15011

Author(s):

J. E. O’Hagan ◽

A. Dodson ◽

C. S. Foster

Keyword(s):

Cervical Cancer ◽

Clinical Response ◽

Locally Advanced ◽

Disease Free Survival ◽

Strand Break ◽

Rank Test ◽

Advanced Cervical Cancer ◽

Single Strand Break ◽

Locally Advanced Cervical Cancer ◽

Break Repair

15011 Background: Locally advanced cervical cancer can be successfully treated with radiotherapy but the toxicity of this treatment is at the limit of tolerability (5–15% serious late complications). A test of the cancer’s likely response to radiotherapy would be invaluable to clinically individualize treatment. Protein XRCC1 is involved in DNA single strand break repair and sister chromatid exchanges. Protein XRCC3 is involved in homologous recombinational repair forming a heterodimer with RAD51L2. XRCC5 codes for the Ku70/80 heterodimer and is involved in double strand break repair and V(D)J recombination. The objective of this study was to correlate protein expression with the clinical response to treatment, disease free survival (DFS) and overall survival (OS). Methods: The archived paraffin embedded tissue blocks from 122 women with locally advanced cervical cancer previously treated with either radiotherapy or chemoradiotherapy were stained for XRCC1, XRCC3 and Ku70/80 proteins. The slides were reviewed and the intensity of the staining graded from 0 to 3 (none - strong). Clinical data from the patients’ case notes included baseline characteristics, response at the time of brachytherapy, response at 3months, dates of diagnosis, relapse, last clinic visit and death. The χ2 test, log rank test and Kaplan-Meier methods were used for statistical analysis. Results: The median follow up was 31 months (range 1–76 months). Clinical response at 3 months (RECIST criteria) was strongly correlated with both OS and DFS, patients who progressed had a mean OS of 9.5months (CI 4.2–14.7) compared to patients who had a partial response, mean OS 45.2months (32.6–57.8), and patients who had a complete response had 60% OS at 4years. However, no significant relationships were found between staining for XRCC1, XRCC3 or Ku70/80, OS, DFS or clinical response. Conclusions: This study did not find an association between expression of XRCC1, XRCC3 and Ku70/80 proteins and clinical response, OS or DFS in locally advanced cervical cancer. No significant financial relationships to disclose.

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