The Outcome of Locally Advanced Cervical Cancer in Patients Treated with Neoadjuvant Chemotherapy Followed by Radical Hysterectomy and Primary Surgery.
Hysterectomy
Recurrence
Survival
Uterine cervical neoplasms
Journal
Iranian journal of medical sciences
ISSN: 1735-3688
Titre abrégé: Iran J Med Sci
Pays: Iran
ID NLM: 8104374
Informations de publication
Date de publication:
09 2021
09 2021
Historique:
received:
13
07
2019
revised:
26
07
2019
accepted:
01
09
2019
entrez:
20
9
2021
pubmed:
21
9
2021
medline:
27
10
2021
Statut:
ppublish
Résumé
In recent years, before radical hysterectomy, neoadjuvant chemotherapy (NACT) has been administered to patients with locally advanced cervical cancer to shrink large tumors. It has been reported that this treatment significantly reduces the need for radiotherapy after surgery. The current study aimed to assess the outcome (survival, recurrence, and the need for adjuvant radiotherapy) of locally advanced cervical cancer in patients treated with NACT followed by radical hysterectomy and primary surgery. In a retrospective cohort study, the records of 258 patients with cervical cancer (stage IB2, IIA, or IIB), who referred to Imam Khomeini Hospital (Tehran, Iran) from 2007 to 2017 were evaluated. The patients were assigned into two groups; group A (n=58) included patients, who underwent radical hysterectomy and group B (n=44) included those, who underwent a radical hysterectomy after NACT. The outcome measures were the recurrence rate, five-year survival rate, and the need for adjuvant radiotherapy. The median for overall survival time in group A and B was 113.65 and 112.88 months, respectively (P=0.970). There was no recurrence among patients with stage IB2 cervical cancer in group B, while the recurrence rate in group A was 19.5% with a median recurrence time of 59.13 months. Lymph node involvement was the only factor that affected patients' survival. The need for postoperative adjuvant radiotherapy in group B was lower than in group A (P=0.002). NACT before the hysterectomy was found to reduce the need for postoperative radiotherapy in patients with locally advanced cervical cancer according to disease stages. As a direct result, adverse side effects and the recurrence rate were reduced, and the overall survival rate of patients with stage IIB cervical cancer was increased.
Sections du résumé
Background
In recent years, before radical hysterectomy, neoadjuvant chemotherapy (NACT) has been administered to patients with locally advanced cervical cancer to shrink large tumors. It has been reported that this treatment significantly reduces the need for radiotherapy after surgery. The current study aimed to assess the outcome (survival, recurrence, and the need for adjuvant radiotherapy) of locally advanced cervical cancer in patients treated with NACT followed by radical hysterectomy and primary surgery.
Methods
In a retrospective cohort study, the records of 258 patients with cervical cancer (stage IB2, IIA, or IIB), who referred to Imam Khomeini Hospital (Tehran, Iran) from 2007 to 2017 were evaluated. The patients were assigned into two groups; group A (n=58) included patients, who underwent radical hysterectomy and group B (n=44) included those, who underwent a radical hysterectomy after NACT. The outcome measures were the recurrence rate, five-year survival rate, and the need for adjuvant radiotherapy.
Results
The median for overall survival time in group A and B was 113.65 and 112.88 months, respectively (P=0.970). There was no recurrence among patients with stage IB2 cervical cancer in group B, while the recurrence rate in group A was 19.5% with a median recurrence time of 59.13 months. Lymph node involvement was the only factor that affected patients' survival. The need for postoperative adjuvant radiotherapy in group B was lower than in group A (P=0.002).
Conclusion
NACT before the hysterectomy was found to reduce the need for postoperative radiotherapy in patients with locally advanced cervical cancer according to disease stages. As a direct result, adverse side effects and the recurrence rate were reduced, and the overall survival rate of patients with stage IIB cervical cancer was increased.
Identifiants
pubmed: 34539010
doi: 10.30476/ijms.2020.81973.0
pii: IJMS-46-5
pmc: PMC8438343
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
355-363Informations de copyright
Copyright: © Iranian Journal of Medical Sciences.
Références
Eur J Cancer. 2003 Nov;39(17):2470-86
pubmed: 14602133
Gynecol Oncol. 2008 Sep;110(3):308-15
pubmed: 18606439
Int J Gynaecol Obstet. 2012 Apr;117(1):23-6
pubmed: 22265255
J Clin Oncol. 2002 Jan 1;20(1):179-88
pubmed: 11773168
Gynecol Oncol. 2014 Aug;134(2):419-25
pubmed: 24918866
Oncol Rev. 2014 Sep 23;8(2):250
pubmed: 25992238
Ann Surg Oncol. 2016 Dec;23(Suppl 5):841-849
pubmed: 27678502
Gynecol Oncol. 2012 Nov;127(2):290-6
pubmed: 22819938
Gynecol Oncol. 2014 Mar;132(3):611-7
pubmed: 24342439
J Obstet Gynaecol Res. 2006 Jun;32(3):315-23
pubmed: 16764623
J Clin Oncol. 2008 Dec 10;26(35):5802-12
pubmed: 19001332
Gynecol Oncol. 2007 Aug;106(2):362-9
pubmed: 17493669
Med Oncol. 2016 Oct;33(10):110
pubmed: 27577931
J Gynecol Oncol. 2016 Sep;27(5):e52
pubmed: 27329200
Ann Surg Oncol. 2015 Dec;22 Suppl 3:S944-51
pubmed: 26268452
Biomedicine (Taipei). 2018 Sep;8(3):18
pubmed: 30141405
Cancer Res Treat. 2018 Jul;50(3):768-776
pubmed: 28724282
Eur J Surg Oncol. 2013 Feb;39(2):115-24
pubmed: 23084091
Gynecol Oncol. 2013 Mar;128(3):524-9
pubmed: 23146686
Gynecol Oncol. 1995 Oct;59(1):136-42
pubmed: 7557599
Cochrane Database Syst Rev. 2012 Dec 12;12:CD007406
pubmed: 23235641
Gynecol Oncol. 2013 Jan;128(1):49-53
pubmed: 23063763
Chin J Cancer. 2011 Sep;30(9):645-54
pubmed: 21880186
Cochrane Database Syst Rev. 2015 Apr 07;(4):CD010260
pubmed: 25847525