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Completing or Abandoning Radical Hysterectomy in Early-Stage Lymph Node–Positive Cervical Cancer: Impact on Disease-Free Survival and Treatment-Related Toxicity
  1. Marloes Derks, MD*,
  2. Freek A. Groenman, MD, PhD,
  3. Luc R.C.W. van Lonkhuijzen, MD, PhD*,
  4. Paulien C. Schut, MD,
  5. Henrike Westerveld, MD, PhD,
  6. Jacobus van der Velden, MD, PhD* and
  7. Gemma G. Kenter, MD, PhD*,
  1. *Center for Gynecologic Oncology Amsterdam, Academic Medical Center;
  2. Center for Gynecologic Oncology Amsterdam, Antoni van Leeuwenhoek–Netherlands Cancer Institute; and
  3. Department of Radiotherapy, Academic Medical Center, Amsterdam, the Netherlands.
  1. Address correspondence and reprint requests to Marloes Derks, MD, Department of Gynecologic Oncology, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, the Netherlands. E-mail: m.derks@amc.nl.

Abstract

Introduction Management regarding completing hysterectomy in case of intraoperative finding of positive lymph nodes in early-stage cervical cancer differs between institutions. The aim of this study was to compare survival and toxicity after completed hysterectomy followed by adjuvant (chemo-)radiotherapy versus abandoned hysterectomy and primary treatment with chemoradiotherapy (CRT).

Methods A retrospective multicenter cohort study was performed. All patients were scheduled for radical hysterectomy with pelvic lymphadenectomy (RHL). In the RHL group, hysterectomy was completed followed by adjuvant (chemo-)radiotherapy. In the second group, hysterectomy was abandoned, and CRT was conducted. Primary outcomes were disease-free survival (DFS) and overall survival. A multivariable analysis on DFS was performed. Toxicity was scored according to the National Cancer Institute CTCAE (Common Terminology Criteria for Adverse Events) v4.03.

Results A total of 121 patients were included (RHL, n = 89; CRT, n = 32). There was no difference in overall survival (84% vs 77%). Five-year DFS was in favor of completing RHL (81% vs 67%). Multivariable analysis showed that, corrected for lymph node variables, treatment regimen was not associated with DFS. After RHL, pelvic recurrence rate was significantly lower compared with CRT (2% vs 16%). CTCAE grade 3–4 toxicity rates were higher in the CRT compared with the RHL group (59% vs 30%), mainly because of differences in chemotherapy-related hematologic toxicity.

Conclusions In patients with clinically N0 early-stage cervical cancer with intraoperative detection of positive nodes, completing RHL followed by adjuvant (chemo-)radiotherapy may result in a better pelvic control compared with abandoning hysterectomy and treatment with chemoradiotherapy. However, if corrected for lymph node variables, treatment (RHL or CRT) was not associated with DFS.

  • Lymph node–positive early-stage cervical cancer
  • Pelvic control
  • Primary chemoradiotherapy
  • Radical hysterectomy with pelvic lymphadenectomy
  • Survival
  • Toxicity

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Footnotes

  • The authors declare no conflicts of interest.

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