Adjuvant Hysterectomy in Patients After Radiation for Locally Advanced Cervical Cancer: A Single-Center Prospective...

Area of Science:

• Gynecologic Oncology
• Radiation Oncology
• Surgical Oncology

Background:

• Locally advanced cervical cancer (LACC) residual or recurrent disease post-chemoradiotherapy (CCRT) presents a significant clinical challenge.
• Literature on the role and outcomes of hysterectomy for LACC post-radiation is limited.
• Hysterectomy in this setting is controversial due to potential difficulties in achieving tumor-free margins and high morbidity rates.

Purpose of the Study:

• To evaluate the outcomes and morbidities associated with hysterectomy in LACC patients with residual or recurrent disease following radiation therapy.
• To assess the feasibility and safety of adjuvant hysterectomy in the management of LACC post-CCRT.

Main Methods:

• A prospective observational study was conducted on 30 LACC patients (Stage IIB-III) who received radiotherapy and subsequently underwent adjuvant hysterectomy for residual or recurrent disease.
• Patients were divided into those who underwent extrafascial hysterectomy (18/30) and radical hysterectomy (12/30).

Main Results:

• No significant differences in complications, tumor-free margins, or recurrence rates were observed between extrafascial and radical hysterectomy.
• Five cases of recurrence were detected post-adjuvant hysterectomy.
• Factors associated with recurrence included non-squamous histology, absence of preoperative brachytherapy, deep stromal invasion, and positive surgical margins.
• Median follow-up was 14 months (range: 12-27 months).

Conclusions:

• Adjuvant hysterectomy can be a feasible option for managing residual or recurrent LACC after chemoradiotherapy.
• The procedure offers good outcomes with acceptable morbidity when patients are carefully selected.
• Appropriate patient selection is crucial for successful outcomes in adjuvant hysterectomy for LACC post-CCRT.