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Chemoradiation with and without adjuvant extrafascial hysterectomy for IB2 cervical carcinoma
  1. C. J. Darus*,
  2. M. B. Callahan,
  3. Q.-N. Nguyen,
  4. L. M. Pastore,
  5. B. F. Schneider,
  6. L. W. Rice* and
  7. A. A. Jazaeri*
  1. *Thornton Gynecologic Oncology Service,
  2. Department of Obstetrics and Gynecology,
  3. Department of Radiation Oncology, University of Virginia Health System, Charlottesville, Virginia
  1. Address correspondence and reprint requests to: Christopher J. Darus, MD, (current address) Maine Women's Surgery and Cancer Center, 102 Campus Drive # 116, Scarborough, ME 04074, USA. Email: cdarus{at}gmail.com

Abstract

The optimal treatment strategy for stage IB2 cervical carcinoma that maximizes survival while minimizing toxicity remains controversial. The purpose of this study was to compare survival and toxicity in stage IB2 cervical cancer patients treated with chemoradiation and adjuvant extrafascial hysterectomy (cRT + H) versus definitive chemoradiation (cRT). Data were abstracted from patients with IB2 cervical carcinoma primarily treated at a single institution from January 1994 to December 2004. All patients received chemotherapy concurrent with external beam radiation therapy. Patients were subsequently treated with either a single low–dose rate brachytherapy applicator followed by adjuvant extrafascial hysterectomy (n= 24) or a second brachytherapy application to complete full-dose definitive chemoradiation (n= 30). Analyses were conducted using Kaplan–Meier survival and Chi-square statistics. Groups did not differ demographically with the exception of smoking. Smokers were significantly (P= 0.04) more likely to have been treated with definitive chemoradiation. Median tumor size was similar between groups. There was no difference in overall or disease-free survival between patients who received cRT + H versus cRT (P= 0.82 and 0.75, respectively). All recurrences in the cRT arm were in smokers. There were two grade 3–4 toxicities in each group. No treatment-related deaths occurred. In this small retrospective cohort study, we observed no difference in survival between patients treated with cRT + H versus cRT. These data complement published results of Gynecologic Oncology Group studies in patients with IB2 cervical cancer. Definitive comparison between the two treatment strategies would require a randomized prospective trial with stratification based on smoking.

  • adjuvant hysterectomy
  • cervical cancer
  • chemoradiation

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Footnotes

  • Poster presented at the 37th Annual Meeting on Women's Cancer, Society of Gynecologic Oncologists, Palm Springs, CA, March 22–26, 2006.

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