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Carcinoma of the cervical stump: retrospective analysis of 77 cases
J M Hannoun-Lévi1, D Peiffert, S Hoffstetter
1Department of Brachytherapy, Centre Alexis Vautrin, Vandoeuvre les Nancy, France.
Background And Purpose:
Although supracervical hysterectomy is becoming a rare procedure, there are still many women with retained cervical stump. The purpose of this retrospective study was to assess the results of treatment in patients with carcinoma of the cervical stump.
Materials And Methods:
From 1974 to 1990, 77 patients were treated for an infiltrating carcinoma of the cervical stump. This group accounted for 6.6% of the cervical carcinoma diagnosed during the same period. The pathological examination showed, 91% of squamous cell carcinomas and 9% of adenocarcinomas. FIGO stage distribution was: I (35%), II (45%), III (18%), IV (2%). According to the stages, the treatment used a combination of external beam radiation therapy (EBRT) with plesiobrachytherapy (PBT), and in a few cases, patients underwent surgery or interstitial brachytherapy (IBT). In patients with bulky tumour or advanced stage and/or lymphatic node involvement, EBRT was first delivered. Most of Stage I and Stage II patients, began their treatment with PBT. All stages included, 95% of the patients were treated by exclusive radiation therapy. Complications were classified according to the recommendations of late effects normal tissues (LENT) scoring system described by the EORTC/RTOG.
Results:
Three-year pelvic control was achieved in 59 of 77 patients (76.6%) in the whole series. Three-year pelvic control probabilities were 77% (95% CI: 66-85%), and 89% (95% CI: 72-96%), 73.7% (95% CI: 65-88%) and 56% (95% CI: 28-80%) in the whole series and in Stage I-III tumour patients, respectively. The 5-year and 10-year overall survival probabilities in the whole series, were 66.4% (95% CI: 55-76%) and 61.2% (95% CI: 50-72%), respectively. Ten patients (12.8%) developed 17 late complications distributed as follows: G1, nine patients (11.7%); G2, five patients (6.5%); G3, one patient (1.3%); and G4, two patients (2.6%).
Conclusions:
Treatment results are similar both in patients with carcinoma of the cervical stump and in patients with carcinoma of the intact uterus. Indeed, it is sometimes difficult to perform a correct PBT application because of the pelvic anatomic modifications induced by the subtotal hysterectomy and its consequences on the new organisation of critical organs into the treated volume.
