Journal of Gynecologic Oncology | 2019
Adjuvant hysterectomy in patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy
Abstract
https://ejgo.org Since the publication of 5 randomized controlled trials, concurrent chemoradiation therapy (CCRT) is accepted as treatment for locally advanced cervical cancer (LACC), including stages IB2 to IVA according to the 2014 International Federation of Gynecology and Obstetrics staging system [1]. Although CCRT improves survival outcomes in these patients compared with radiotherapy alone, the 5-year overall survival rate remains approximately 70%. Moreover, 24%–48% of patients harbor residual tumors after definitive CCRT [2], and those with residual tumors ≥2 cm have even poorer prognosis than those who achieve complete response after CCRT [3,4]. To extirpate the residual tumor and improve local control and overall survival, some investigators have administered adjuvant hysterectomy (AH) after radiotherapy. Before the era of CCRT, the Gynecologic Oncology Group-71 trial had evaluated the role of AH in 256 patients with bulky stage IB cervical cancer who were treated with radiation without concomitant chemotherapy. Patients were randomly assigned to the AH arm after radiation (n=132) or radiation only (n=124) [5]. There was no difference in overall survival between the 2 arms, although the 5-year local recurrence rate was lower in the AH arm (14% vs. 27%). In the era of CCRT, there are few studies with high-quality data regarding the therapeutic effect of AH after definitive CCRT. One randomized controlled trial by a French group evaluated this issue in patients who achieved clinical and radiological complete response after definitive CCRT [6]. In this trial, there was no significant difference in 3-year event-free survival (72% vs. 89%) and overall survival (86% vs. 97%) rates between the AH and no-AH arms. However, the trial was discontinued prematurely due to insufficient accrual (n=61) and thus had suboptimal power to draw concrete results [7].