Main Article Content
Objectives: To analyze the survival outcomes and to determine the surgical complication of patients with persistent cervical cancer who had undergone hysterectomy after completion of radiotherapy at Srinagarind Hospital, Khon Kaen University, Thailand between January 1996 and December 2010. Methods: The medical records of patients who met the study criteria were reviewed. The inclusion criteria are all patients who have residual cervical cancer after complete radiation therapy and biopsy proven. Extracted data included patient’s age, stage, histological subtype, type of radiotherapy received, type of hysterectomy procedure, pathological results, surgical complications, and survival. Results: Forty-three women suitable for study inclusion were identified. The majority of women (53.5%) were in stage IIB. Thirteen (30.2%) women received concurrent chemoradiation while the remaining 30 (69.8%) underwent radiotherapy alone. Thirty-four (79.1%) women underwent extrafascial hysterectomy (EH) while the remaining 9 (20.9%) underwent radical hysterectomy (RH). Median operative time and median amount of estimated blood loss were higher among women undergoing RH compared to those who underwent EH. Overall, grade III-IV complications were noted in 34.9% of patients. The rate of grade III-IV complications was higher among women undergoing RH compared to those in EH group (44.4% vs. 32.4%, respectively). The 5-year survival rate of all women was 54.6%. Median overall survival of all patients was 6.25 years. Median overall survival of women undergoing RH was comparable to those who underwent EH (6.25 years vs. 6.84 years, respectively). Conclusion: Hysterectomy in women who were initially treated with curative intent radiotherapy but subsequently found to have residual tumor may improve survival outcomes, allowing a 5-year survival rate of approximately 55%. The incidence of severe complication was considerably high particularly among those women who had undergone radical hysterectomy.
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
2. Landoni F, Maneo A, Colombo A, Placa F, Milani R, Perego P, et al. Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet 1997; 350(9077):535-40.
3. Green J, Kirwan J, Tierney J, Vale C, Symonds P, Fresco L, et al. Concomitant chemotherapy and radiation therapy for cancer of the uterine cervix. Cochrane Database Syst Rev 2005:CD002225.
4. Motton S, Houvenaeghel G, Delannes M, Querleu D, Soule-Tholy M, Hoff J, et al. Results of surgery after concurrent chemoradiotherapy in advanced cervical cancer: comparison of extended hysterectomy and extrafascial hysterectomy. Int J Gynecol Cancer 2010;20(2):268-75.
5. Kunos C, Ali S, Abdul-Karim FW, Stehman FB, Waggoner S. Posttherapy residual disease associates with long-term survival after chemoradiation for bulky stage 1B cervical carcinoma: a Gynecologic Oncology Group study. Am J Obstet Gynecol 2010;203(4):351 e1-8.
6. Morice P, Uzan C, Zafrani Y, Delpech Y, Gouy S, Haie-Meder C. The role of surgery after chemoradiation therapy and brachytherapy for stage IB2/II cervical cancer. Gynecol Oncol 2007;107(1 Suppl 1):S122-4.
7. Ota T, Takeshima N, Tabata T, Hasumi K, Takizawa K. Adjuvant hysterectomy for treatment of residual disease in patients with cervical cancer treated with radiation therapy. Br J Cancer 2008;99(8):1216-20.
8. Keys HM, Bundy BN, Stehman FB, Okagaki T, Gallup DG, Burnett AF, et al. Radiation therapy with and without extrafascial hysterectomy for bulky stage IB cervical carcinoma: a randomized trial of the Gynecologic Oncology Group. Gynecol Oncol 2003;89(3):343-53.
9. Coleman RL, Keeney ED, Freedman RS, Burke TW, Eifel PJ, Rutledge FN. Radical hysterectomy for recurrent carcinoma of the uterine cervix after radiotherapy. Gynecol Oncol 1994;55(1):29-35.
10. Azria E, Morice P, Haie-Meder C, Thoury A, Pautier P, Lhomme C, et al. Results of hysterectomy in patients with bulky residual disease at the end of chemoradiotherapy for stage IB2/II cervical carcinoma. Ann Surg Oncol 2005;12(4):332-7.
11. Contag SA, Gostout BS, Clayton AC, Dixon MH, McGovern RM, Calhoun ES. Comparison of gene expression in squamous cell carcinoma and adenocarcinoma of the uterine cervix. Gynecol Oncol 2004;95(3):610-7.
12. Lee EJ, McClelland M, Wang Y, Long F, Choi SH, Lee JH. Distinct DNA methylation profiles between adenocarcinoma and squamous cell carcinoma of human uterine cervix. Oncol Res. 2010;18(9):401-8.
13. Dahlstrom LA, Ylitalo N, Sundstrom K, Palmgren J, Ploner A, Eloranta S, et al. Prospective study of human papillomavirus and risk of cervical adenocarcinoma. Int J Cancer. 2010 Oct 15;127(8):1923-30.
14. Cohen Y, Singer G, Lavie O, Dong SM, Beller U, Sidransky D. The RASSF1A tumor suppressor gene is commonly inactivated in adenocarcinoma of the uterine cervix. Clin Cancer Res 2003;9(8):2981-4.
15. Chen RJ, Lin YH, Chen CA, Huang SC, Chow SN, Hsieh CY. Influence of histologic type and age on survival rates for invasive cervical carcinoma in Taiwan. Gynecol Oncol 1999; 73(2):184-90.
16. Galic V, Herzog TJ, Lewin SN, Neugut AI, Burke WM, Lu YS, et al. Prognostic significance of adenocarcinoma histology in women with cervical cancer. Gynecol Oncol 2012; 125(2):287-91.
17. Katanyoo K, Sanguanrungsirikul S, Manusirivithaya S. Comparison of treatment outcomes between squamous cell carcinoma and adenocarcinoma in locally advanced cervical cancer. Gynecol Oncol 2012;125(2):292-6.
18. Nag S, Chao C, Erickson B, Fowler J, Gupta N, Martinez A, et al. The American Brachytherapy Society recommendations for low-dose-rate brachytherapy for carcinoma of the cervix. Int J Radiat Oncol Biol Phys 2002;52(1):33-48.
19. Nag S, Erickson B, Thomadsen B, Orton C, Demanes JD, Petereit D. The American Brachytherapy Society recommendations for high-dose-rate brachytherapy for carcinoma of the cervix. Int J Radiat Oncol Biol Phys 2000;48(1):201-11.
20. Walji N, Chue AL, Yap C, Rogers LJ, El-Modir A, Chan KK, et al. Is there a role for adjuvant hysterectomy after suboptimal concurrent chemoradiation in cervical carcinoma? Clin Oncol (R Coll Radiol) 2010;22(2):140-6.