Maghous A, Elmarjany M, Marnouche E, Andaloussi K, Bazine A, Lalya I, Zaghba N, Hadadi K, Sifat H, Habib MAB, Kouach J, Moussaoui DR and Mansouri H
Background: Completion surgery after chemoradiotherapy (CRT) in management of locally advanced cervical cancers (LACC) still controversial. The aim of this study was to compare disease-free and overall survival rates in patients who had completion surgery and who were therefore treated conservatively by exclusive concomitant chemoradiotherapy (CCRT).
Materials and methods: This is a retrospective study from January 2005 to December 2014 included 130 patients with LACC, managed by standard CCRT followed by brachytherapy at the radiotherapy department of Military Hospital Mohamed V of Rabat in Morocco.
Inclusion criteria were the following: Biopsy-proven carcinoma of the cervix, FIGO stage IB2 to IVA and treatment with CCRT followed by brachytherapy. All patients had good response to standard CCRT, with a clinical decrease in tumor volume of more than 50%. Patients were divided into two groups depending on the authors practice: Group 1 consisted of patients without completion surgery who had theoretically a good response to standard treatment and Group 2 consisted of patients treated by completion surgery with pelvic control on final pathology.
One hundred and two patients are included in Group 1 and 28 in Group 2. The mean age of the patients was 50.9 years (range 29–82). Squamous cell carcinoma 115 (89.8%) was the leading histological type. Tumor size was 4.77 ± 1.44 cm clinically and 46.72 ± 15.42 mm in MRI. The parametrial was invaded in 113 (87.6%) of cases and the pelvic lymph nodes were suspected in 29 (23%) of cases.
Major of patients whom underwent a completion surgery showed a complete response on final pathology. Overall, 20.8% (27/130) of patients had a recurrence, with a median time to recurrence of 8 months [2-55]. With a mean follow-up of 44 months (2 to 118), the local control rate was 68.5% (n=89) and 20 (15.4%) patients were lost to follow-up.
The overall survival (OS) at 5 years in Group 1 and 2 was respectively 59.8% and 88.9% and the relapse-free survival (RFS) was respectively 73.3% and 88.9%. A significant benefit of completion surgery was seen only in OS (p=0.011).
Conclusion: completion surgery after CCRT has a place in the multimodality management of locally advanced cervical cancer with significant benefice in local control and OS.
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