Citation Information :
Shanmugam S. Retrospective Analysis on the Need for Surgery for Residual Disease after Chemoradiation in Carcinoma Cervix. J South Asian Feder Obs Gynae 2023; 15 (4):382-384.
Introduction: Concurrent chemoradiation is the treatment of choice for patients from stage IB3–IVA disease. We analyzed patients with carcinoma cervix who underwent definitive chemoradiation, and had residual disease either clinically or radiologically during the period from July 2021 to August 2022. In the past 1 year, we treated 11 patients with definitive chemoradiation residue. We did radical surgery for those patients.
Results: Out of the 11 patients who had residual disease after definitive chemoradiation, 4 patients had clinical residual disease and 7 patients on imaging. Postoperative histopathological examination (HPE) showed 4 out of 10 patients were without any disease and all those patients were diagnosed by imaging. Out of 11 patients, 1 had an intraoperative ureteric injury, 2 patients had postoperative ureteric/vesicovaginal fistula, 1 patient had intraoperative bleeding, 1 patient had intraoperative bowel injury and there was 1 death. Three patients had minor complications.
Conclusion: Even though our numbers are less, we found out that there is a possibility of misinterpretation of postradiation changes as a residual disease by magnetic resonance imaging (MRI) and while operating for these patients, we should anticipate more complications and chances of no residual disease. We suggest a strong clinical correlation along with histopathological confirmation before surgical intervention, which may avoid unwanted radical surgery for such patients. At the same time, we cannot neglect the possibility of a real risk of residual disease (6/10 had residual disease) progressing further leading to a missed opportunity for a cure.
Cibula D, Pötter R, Planchamp F, et al. The European society of gynaecological oncology/European society for radiotherapy and oncology/European society of pathology guidelines for the management of patients with cervical cancer. Int J Gynecol Cancer 2018;28(4):641–655. DOI: 10.1007/s00428-018-2362-9.
WHO Estimated number of new cases of uterine cervical cancer in 2020 worldwide. Available from: https://gco.iarc.fr/today/data/factsheets/cancers/23-Cervix-uteri-fact-sheet.pdf [Last accessed on 10 Aug 2021].
WHO cancer cervix data 2019, https://www.who.int/cancer/prevention/diagnosis-screening/cervical-cancer/en/.
Bhatla N, Aoki D, Sharma DN, et al. Cancer of the cervix uteri. Int J Gynecol Obstet 2018;143:22–36.DOI: 10.1002/ijgo.12611.
Singh VY. Papillary squamotransitional cell carcinoma cervix: case report of a rare variant. J South Asian Feder Obs Gynae 2018;10 (4S2):429–431. DOI: 10.5005/jp-journals-10006-1638.
Hussain SA, Mani JG. Comparison of neoadjuvant chemotherapy followed by radical hysterectomy and neoadjuvant chemoradiation followed by radical hysterectomy with concurrent chemoradiation in locally advanced carcinoma cervix (FIGO Stages IB2, IIA2, IIB): interim results of a randomized control study. J South Asian Feder Obs Gynae 2019;11(1):35–43. DOI: 10.5005/jp-journals-10006-1647.
Bhatla N, Berek JS, Cuello Fredes M, et al. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynaecol Obstet 2019;145(1):129–135. DOI: 10.1002/ijgo.12749.
Rose PG, Bundy BN, Watkins EB, et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 1999;340(15):1144–1153. DOI: 10.1056/NEJM199904153401502.
Green JA, Kirwan JM, Tierney JF, et al. Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis. Lancet. 2001;358(9284):781–786. DOI: 10.1016/S0140-6736(01)05965-7.
Pervin S, Ruma FI, Rahman K, et al. Adjuvant hysterectomy in patients with residual disease after radiation for locally advanced cervical cancer: a prospective longitudinal study. J Glob Oncol 2019;5:1–7. DOI: 10.1200/JGO.18.00157.
Keys HM, Bundy BN, Stehman FB, et al. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med. 1999;340(15):1154–1161. DOI: 10.1056/NEJM199904153401503.
Alberts DS, Brady M, Cikaric S, et al. Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: Individual patient data meta-analysis. Cochrane Database Syst Rev. 2010;20:CD008285. DOI: 10.1002/14651858.CD008285.
Quinn MA, Benedet JL, Odicino F, et al. Carcinoma of the cervix uteri. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynecol Obstet 2006;95(Supp 1):43–103. DOI: 10.1016/S0020-7292(06)60030-1.
Shi D, Liang Z, Zhang C, et al. The effect of surgery on the survival status of patients with locally advanced cervical cancer after radiotherapy/chemoradiotherapy: a meta-analysis. BMC Cancer. 2018;18(1):308. DOI: 10.1186/s12885-018-4232-x.
Shim SH, Kim SN, Chae SH, et al. Impact of adjuvant hysterectomy on prognosis in patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy: a metaanalysis. J Gynecol Oncol. 2018;29(2):e25. DOI: 10.3802/jgo.2018.29.e25.
Manganaro L, Lakhman Y, Bharwani N, et al. Staging, recurrence and follow-up of uterine cervical cancer using MRI: updated guidelines of the European Society of Urogenital Radiology after revised FIGO staging 2018. Eur Radiol 2021;31(10):7802–7816. DOI: 10.1007/s00330-020-07632-9.
Schreuder SM, Lensing R, Stoker J, et al. Monitoring treatment response in patients undergoing chemoradiotherapy for locally advanced uterine cervical cancer by additional diffusion-weighted imaging: a systematic review. J Magn Reson Imaging 2015;42(3):572–594. DOI: 10.1002/jmri.24784.
Viswanathan AN, Lee LJ, Eswara JR, et al. Complications of pelvic radiation in patients treated for gynecologic malignancies. Cancer. 2014;120(24):3870–3883. DOI: 10.1002/cncr.28849.
Ota T, Takeshima N, Tabata T, et al. Adjuvant hysterectomy for treatment of residual disease in patients with cervical cancer treated with radiation therapy. Br J Cancer 2008;99:1216–1220. DOI: 10.1038/sj.bjc.6604619.
Coleman RL, Keeney ED, Freedman RS, et al. Radical hysterectomy for recurrent carcinoma of the uterine cervix after radiotherapy. Gynecol Oncol. 1994;55(1):29–35. DOI: 10.1006/gyno.1994.1242.
Xiao M, Gao H, Bai H, et al. Quality of life and sexuality in disease-free survivors of cervical cancer after radical hysterectomy alone: A comparison between total laparoscopy and laparotomy. Medicine (Baltimore). 2016;95(36):e4787. DOI: 10.1097/MD.0000000000004787.
Ashing-Giwa KT, Lim J-W, Tang J. Surviving cervical cancer: does health-related quality of life influence survival? Gynecol Oncol 2010;118(1):35–42. DOI: 10.1016/j.ygyno.2010.02.027.
Kim JY, Byun SJ, Kim YS, et al. Disease courses in patients with residual tumor following concurrent chemoradiotherapy for locally advanced cervical cancer. Gynecol Oncol 2017;144(1):34–39. DOI: 10.1016/j.ygyno.2016.10.032.
Sundström H, Blomqvist L, Hellman K. Uterine cervical carcinoma treated with chemoradiotherapy: impact of three-month MRI follow-up on clinical management and outcome. J Cancer Metastasis Treat 2021;7:65. DOI: 10.20517/2394-4722.2021.139.