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Long-term survival after concomitant chemoradiotherapy prior to surgery in advanced cervical carcinoma
Gilles Houvenaeghel1, Loic Lelievre, Laurence Gonzague-Casabianca
1Department of Surgery, Institut Paoli-Calmettes, 232 Bd Sainte Marguerite, Marseilles, France.
Objective:
To report the long-term survival of 35 patients who underwent surgery after concomitant chemoradiation for locally advanced cervical cancers.
Methods:
From 1988 to 1992, 20 bulky IB-IIB patients and 15 stage III-IVA patients underwent surgery after concurrent chemotherapy (CDDP and 5-FU) and radiotherapy. 26 had a hysterectomy, 8 had an exenteration, 1 had no tumor resection. 21 had a para-aortic lymphadenectomy. Endpoints were recurrence and distant metastasis rates, overall survival (OS) and disease-free survival (DFS) at 5 and 10 years. Analysis included FIGO stage, type of surgery (palliative or curative), response to chemoradiation or para-aortic lymphatic status.
Results:
Surgery had been only palliative in 6 cases (17.1%). A pelvic control has been achieved in 31 patients (88.6%). Pelvic recurrences occurred after a median interval of 7 months. Distant metastases occurred in 10 patients (28.6%), after a median interval of 20 months. So far, 16 patients have died (45.7%). The 10-year DFS is 56.7% in the whole series. Only the type of surgery significantly affected the OS. Only the para-aortic lymphatic status significantly affected the DFS.
Conclusion:
Associating chemoradiation with curative surgery, we obtained a 10-year DFS of 66.4% (OS 57.7%). Adjuvant surgery may increase the survival as it reduces the risk of local relapse.
