Could lymphadenectomy be avoided in locally advanced cervical cancer patients administered preoperative chemoradiation? A large-scale retrospective study

Maria Gabriella Ferrandina, Vincenzo Valentini, Giovanni Scambia, Floriana Mascilini, Valerio Gallotta, Francesco Cosentino, Barbara Costantini, Alfredo Ercoli, Luigi Pedone Anchora, Francesco Fanfani, Vito Chiantera

Risultato della ricerca: Contributo in rivistaArticolo in rivista

3 Citazioni (Scopus)

Abstract

Introduction To identify a subset of cervical cancer (CC) patients administered chemoradiation (CT/RT) plus radical surgery (RS), who can be spared lymphadenectomy, and complications. Patients and methods 430 Stage IB2-IIB patients without LN involvement at imaging were accrued (March 1996–December 2015) at Gynecologic Oncology Unit of the Catholic University of Rome/Campobasso. CT/RT consisted of pelvic irradiation plus cisplatin based chemotherapy. Objective response was evaluated according to RECIST criteria; radical hysterectomy and pelvic ± aortic lymphadenectomy was attempted in patients achieving response or stable disease. Surgical morbidity was classified according to the Chassagne grading system. Results 421 cases underwent RS; metastatic pelvic and aortic LNs were documented in 10.7%, and 8.8% of cases, respectively. In patients without residual tumor in the cervix, there was only 1 case (0.53%) with positive pelvic LNs, and 1 case (2.3%) with metastatic aortic LNs. Analysis of patients according to pre- and post-CT/RT imaging was able to select cases without any metastatic LNs: in patients with negative pelvic LNs at pre- and post-CT/RT imaging, none of cases without residual disease in the cervix had metastatic pelvic or aortic LNs. Of 149 early complications, 76 (51.0%) were lymphovascular. The most frequent late complications were lymphovascular (N = 25/61, 41.0%). Conclusion Lymphadenectomy could be avoided in stage IB2-IIB CC patients undergoing preoperative CT/RT, when a careful evaluation of pre- and post-CT/RT imaging and histological assessment of no residual disease in the cervix is made. This approach may avoid lymphadenectomy in 40% of patients with a favourable impact on lymphovascular morbidity.
Lingua originaleEnglish
pagine (da-a)2270-2276
Numero di pagine7
RivistaEuropean Journal of Surgical Oncology
Volume43
DOI
Stato di pubblicazionePubblicato - 2017

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents
  • Cervical cancer
  • Chemoradiation
  • Chemoradiotherapy
  • Cisplatin
  • Combined Modality Therapy
  • Complications
  • Female
  • Humans
  • Hysterectomy
  • Lymph Node Excision
  • Lymphadenectomy
  • Middle Aged
  • Neoplasm Staging
  • Oncology
  • Radical surgery
  • Retrospective Studies
  • Surgery
  • Treatment Outcome
  • Uterine Cervical Neoplasms

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