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Analysis of isolated loco-regional recurrence rate in intermediate risk early cervical cancer after a type C2 radical hysterectomy without adjuvant radiotherapy
  1. Jacobus van der Velden1,
  2. Constantijne H Mom1,
  3. Luc van Lonkhuijzen1,
  4. Ming Y Tjiong1,
  5. Henrike Westerveld2 and
  6. Guus Fons1
  1. 1Gynecologic Oncology, Academic Medical Center, Amsterdam, The Netherlands
  2. 2Department of Radiotherapy, Academic Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Mr Jacobus van der Velden, Center for Gynecologic Oncology, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands; j.vandervelden{at}amc.uva.nl

Abstract

Background The efficacy of adjuvant radiotherapy in patients with intermediate risk early cervical cancer after radical hysterectomy is still under debate. Most guidelines recommend adjuvant radiotherapy, whereas others consider observation a viable option.

Objective To investigate if patients with intermediate risk factors for cervical cancer who underwent radical hysterectomy may benefit from adjuvant radiotherapy.

Methods Consecutive patients with tumor confined to the cervix and intermediate risk factors (according to Sedlis), treated between January 1982 and December 2014 who were observed after a type C2 radical hysterectomy formed the basis for this study. The frequency of recurrences, specifically isolated loco-regional recurrences, and the risk of death from recurrences, were analyzed. Data were analyzed using SPSS, version 23.0 for Windows

Results A total of 161 patients were included in the analysis. Median age was 40 (range 20–76). Stages IB1 and IB2 were seen in 87 (54%) and 74 patients (46%), respectively. Squamous cell and non-squamous histology was seen in 114 (70.8%) and 47 patients (29.2%), respectively. Of the 161 patients, 25 (15.5%) had recurrent disease, of whom nine had an isolated loco-regional recurrence (5.6%). Median time to recurrence for isolated loco-regional recurrences was 28 months (range 9–151). Treatment for an isolated loco-regional recurrence was radiotherapy (n = 4) and chemoradiotherapy (n = 5). Four patients (2.5%) died from disease as a result of an isolated loco-regional recurrence. Actuarial disease- specific survival was 93.0% for the total group. No variables were found that predicted an isolated loco-regional recurrence.

Discussion The mortality from isolated loco-regional recurrence in patients with intermediate risk factors for cervical cancer who underwent only radical hysterectomy type C2 was 2.5%. Further studies should compare outcomes between patients who undergo a type C2 radical hysterectomy without adjuvant radiotherapy with those undergoing a less radical hysterectomy but with adjuvant radiotherapy.

  • cervical cancer

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Footnotes

  • Contributors All authors contributed to the acquisition of the data, critically revised the manuscript, gave final approval for publication, and agree to be accountable for all aspects of the study. JvdV, CHM, and GF also analyzed and interpreted the data. JvdV was responsible for the conception and the design of the study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available upon reasonable request.

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