Article Text
PDF
Abstract
Introduction Pelvic exenteration can be performed with curative or palliative intent for treatment of recurrent gynecologic malignancies. We evaluated progression-free survival (PFS) and overall survival (OS) in association with postoperative chemotherapy following pelvic exenteration for recurrent gynecologic malignancies.
Methods We retrospectively reviewed patients with recurrent uterine, cervical, vulvar, or vaginal carcinoma who underwent pelvic exenteration from 5/01/2005–12/31/2019. Patients were excluded if surgery was performed for palliation without recurrence. Survival was assessed for allcomers and by uterine and cervical primary sites.
Results Of 123 patients identified, 32% (39/123) were referred to medical oncology; 25 (64%) of 39 were offered and 19 (76%) of 25 received postoperative chemotherapy. Regimens included carboplatin/cisplatin and paclitaxel (n=12), another platinum doublet (n=4), or single-agent platinum (n=3). Patients who received postoperative chemotherapy, compared with those who did not, more often had positive surgical margins (21% vs. 7%, p=0.025), a uterine primary (58% vs. 18% p=0.003), and endometrioid histology (53% vs. 13% p=0.010). One patient in the no-chemotherapy group received postoperative pelvic radiation. Of the 19 patients who received postoperative chemotherapy, 7 (37%) recurred— 5 (26%) locally and 2 (11%) distantly (brain, bowel). There was no difference in 2-year PFS rate (68.4% SE ±1.1 vs. 68.9% SE ±0.05) or 2-year OS rate (78.9% SE ±1.0 vs. 74.5% SE ±0.05) between patients who did and did not undergo postoperative chemotherapy, respectively.
Conclusion/Implications In this early assessment of postoperative chemotherapy following pelvic exenteration there was no association with outcome. Postoperative treatment decisions, especially in higher risk cases, require larger series and must be individualized.
Clinicopathological demographics of patients who underwent pelvic exenteration compared with those who received postoperative chemotherapy and those who did not receive postoperative chemotherapy
A) Progression-free survival for all patients compared by receipt of postoperative chemotherapy or not (n=123). B) Overall survival for all patients compared by receipt of postoperative chemotherapy or not (n=123). C) Progression-free survival for patients with uterine histology by receipt of postoperative chemotherapy or not (n=29). D) Overall survival for patients with uterine histology by receipt of postoperative chemotherapy or not (n=29). E) Progression-free survival for patients with cervical histology by receipt of postoperative chemotherapy or not (n=41). F) Overall survival for patients with cervical histology by receipt of postoperative chemotherapy or not (n=41)