Management of occult invasive cervical cancer found after simple hysterectomy

Ann Oncol. 2010 May;21(5):994-1000. doi: 10.1093/annonc/mdp426. Epub 2009 Oct 25.

Abstract

Background: To estimate safety and efficacy of radical parametrectomy (RP) and radiation therapy (RT) or concurrent chemoradiation therapy (CCRT) for patients with occult invasive cervical cancer found after simple hysterectomy.

Materials and methods: We retrospectively evaluated outcomes in 147 patients with occult invasive cervical cancer.

Results: Forty-eight patients with IA1 lesions (IA1 group) did not receive further treatment. Of the 99 patients with IA2-IIA lesions, 26 received no definitive treatment (observation group), 44 received RT or CCRT (RT/CCRT group), and 29 underwent RP (RP group). After a median follow-up of 116 months (range 3-235 months), recurrent disease was observed in 0%, 34.6%, 6.8%, and 0% of patients in the IA1, observation, RT/CCRT, and RP groups, respectively. In the RT/CCRT group, treatment was delayed due to severe diarrhea in 4 patients (9%) and 12 patients (27%) had late complications related to RT requiring further management (including two surgical interventions). Five patients in the RP group (17%) experienced perioperative complications which were easily managed, intraoperatively or conservatively. Late complications were not observed in the RP group.

Conclusion: Although RP and RT/CCRT had similar therapeutic efficacy, the lower rate of late complications observed with RP makes it preferable to RT/CCRT.

Publication types

  • Comparative Study

MeSH terms

  • Adenocarcinoma / complications
  • Adenocarcinoma / pathology
  • Adenocarcinoma / therapy*
  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Carcinoma, Squamous Cell / complications
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / therapy*
  • Cervical Intraepithelial Neoplasia / complications
  • Cervical Intraepithelial Neoplasia / pathology
  • Cervical Intraepithelial Neoplasia / therapy*
  • Chemotherapy, Adjuvant
  • Cohort Studies
  • Combined Modality Therapy
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Hysterectomy*
  • Middle Aged
  • Neoplasm Recurrence, Local / complications
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / therapy*
  • Postoperative Complications / pathology
  • Postoperative Complications / therapy*
  • Radiotherapy, Adjuvant
  • Survival Rate
  • Treatment Outcome
  • Uterine Cervical Neoplasms / complications
  • Uterine Cervical Neoplasms / pathology
  • Uterine Cervical Neoplasms / therapy*