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Is Routine Curettage a Useful Tool to Evaluate Persistent Tumor in Patients Who Underwent Primary Chemoradiation for Locally Advanced and/or Lymph Node Positive Cervical Cancer?
  1. Simone Marnitz, MD*,
  2. Eva Christine Abt, MD*,
  3. Peter Martus, PhD,
  4. Audrey Tsunoda, MD and
  5. Christhardt Köhler, MD§
  1. * Department of Radiooncology, Charité-Universitätsmedizin, Berlin;
  2. Institute for Applied Biostatistics and Clinical Epidemiology, University Tübingen, Tübingen, Germany;
  3. Department of Gynecologic Oncology, Barretos Cancer Centre, Barretos, Brazil; and
  4. § Department of Gynecology, Charité-Universitätsmedizin, Berlin, Germany.
  1. Address correspondence and reprint requests to Simone Marnitz, MD, Department of Radiation Oncology, University Medicine Charité, Augustenburger Platz 1, 13353 Berlin, Germany. E-mail: simone.marnitz{at}charite.de.

Abstract

Objective Response evaluation after primary chemoradiation (RCTX) in patients with cervical cancer remains difficult. Routine hysterectomy after primary RCTX is associated with considerable surgical morbidity without impact on survival. The purpose of the present study was to evaluate value of routine curettage after RCTX to detect persistent tumor.

Methods Between 2006 and 2012, patients (n = 217) with cervical cancer in International Federation of Gynecology and Obstetrics stages IB1 N1 (14%), IB2 (9%), IIA (5%), IIB (46%), IIIA (4%), IIIB (15%), IVA (6%), and IVB (1%), respectively, underwent primary RCTX. After RCTX, curettage was recommended to all patients to evaluate response.

Results In 136 (63%) of patients with cervical cancer, 1 or 2 consecutive curettages were performed at least 6 weeks after primary RCTX without any complications. In 21 (15%) patients, at least 1 curettage was positive for cervical cancer. In 7 patients, secondary hysterectomy was performed after 1 positive finding and persistent tumor was found in all of them. In the remaining 14 patients, there were 2 positive curettages in 5, 1 undetermined result followed by 1 positive in 3, and 1 positive followed by 1 negative in 6 patients, respectively. In the latter group, no tumor was detected in the uterus, whereas in all other patients with 2 curettages except one, residual carcinoma was detected. Five (24%) of 21 patients with positive histology are free of disease during follow-up. Decision for or against secondary hysterectomy was correct due to histological finding of curettage in 99%.

Conclusions Routine curettage is a useful tool to guide decision for secondary hysterectomy with high accuracy after primary RCTX and avoids overtreatment.

  • Locally advanced cervical cancer
  • Follow-up
  • Primary chemoradiation
  • Persistent tumor
  • Dilatation and curettage

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Footnotes

  • The authors declare no conflicts of interest.

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