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Preoperative concurrent radiation therapy and chemotherapy for bulky stage IB2, IIA, and IIB carcinoma of the uterine cervix with proximal parametrial invasion.

By Florence Huguet, Oana-Maria Cojocariu, Pierre Levy, Jean-Pierre Lefranc, Emile Darai, Denis Jannet, Yan Ansquer, Pierre-Eugène Lhuillier, Jean-Louis Benifla, Nathalie Seince and Emmanuel Touboul

Abstract

International audiencePURPOSE: To evaluate toxicity, local tumor control, and survival after preoperative chemoradiation for operable bulky cervical carcinoma. METHODS AND MATERIALS: Between December 1991 and July 2006, 92 patients with operable bulky stage IB2, IIA, and IIB cervical carcinoma without pelvic or para-aortic nodes on pretreatment imaging were treated. Treatment consisted of preoperative external beam pelvic radiation therapy (EBRT) and concomitant chemotherapy (CT) during the first and fourth weeks of radiation combining 5-fluorouracil and cisplatin. The pelvic radiation dose was 40.5 Gy over 4.5 weeks. EBRT was followed by low-dose rate uterovaginal brachytherapy with a total dose of 20 Gy in 62 patients. After a median rest period of 44 days, all patients underwent Class II modified radical hysterectomy with bilateral pelvic lymphadenectomy. Thirty patients who had not received preoperative uterovaginal brachytherapy underwent postoperative low-dose-rate vaginal brachytherapy at a dose of 20 Gy. The mean follow-up was 46 months. RESULTS: Pathologic residual tumor was observed in 43 patients. After multivariate analysis, additional preoperative uterovaginal brachytherapy was the single significant predictive factor for pathologic complete response rate (p = 0.019). The 2- and 5-year disease-free survival (DFS) rates were 80.4% and 72.2%, respectively. Pathologic residual cervical tumor was the single independent factor decreasing the probability of DFS (p = 0.020). Acute toxicities were moderate. Two severe ureteral complications requiring surgical intervention were observed. CONCLUSIONS: Concomitant chemoradiation followed by surgery for operable bulky stage I-II cervical carcinoma without clinical lymph node involvement can be used with acceptable toxicity. Pathologic complete response increases the probability of DFS

Topics: MESH : Adenocarcinoma, MESH : Adult, MESH : Lymph Node Excision, MESH : Lymphatic Metastasis, MESH : Middle Aged, MESH : Neoplasm Invasiveness, MESH : Neoplasm Staging, MESH : Preoperative Care, MESH : Recurrence, MESH : Retrospective Studies, MESH : Uterine Cervical Neoplasms, MESH : Aged, MESH : Brachytherapy, MESH : Carcinoma, Squamous Cell, MESH : Combined Modality Therapy, MESH : Endometrium, MESH : Female, MESH : Humans, MESH : Hysterectomy, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie
Publisher: Elsevier
Year: 2008
DOI identifier: 10.1016/j.ijrobp.2008.03.054
OAI identifier: oai:HAL:hal-00597597v1
Provided by: Hal-Diderot
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