Preoperative Concurrent Radiation Therapy and Chemotherapy for Bulky Stage IB2, IIA, and IIB Carcinoma of the Uterine Cervix With Proximal Parametrial Invasion
- Department of Radiation Oncology, Tenon Hospital A.P.-H.P., Cancerest, GHU Est, Paris VI University, Paris (France)
- Department of Public Health, Tenon Hospital A.P.-H.P., Cancerest, GHU Est, Paris VI University, Paris (France)
- Department of Gynecologic Surgery, Pitie-Salpetriere Hospital A.P.-H.P., Paris (France)
- Department of Gynecology and Obstetrics, Tenon Hospital A.P.-H.P., Cancerest, GHU Est, Paris VI University, Paris (France)
- Department of Gynecology and Obstetrics, Saint-Antoine Hospital A.P.-H.P., Paris (France)
- Department of Gynecology and Obstetrics, Fontainebleau Hospital, Fontainebleau (France)
- Department of Gynecology and Obstetrics, Rothschild Hospital A.P.-H.P., Paris (France)
- Department of Gynecology and Obstetrics, Jean Verdier Hospital, Bondy (France)
Purpose: 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.
- OSTI ID:
- 21172513
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 72, Issue 5; Other Information: DOI: 10.1016/j.ijrobp.2008.03.054; PII: S0360-3016(08)00579-8; Copyright (c) 2008 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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