Completion surgery or not after concurrent chemoradiotherapy for locally advanced cervical cancer?

OBJECTIVES

The role of additional surgery in patients responding to radiation and chemotherapy for locally advanced cervical cancer is controversial. The goal of this study was to compare disease-free survival (DFS) and overall survival (OS) of two groups of patients, with or without additional surgery.

STUDY DESIGN

One hundred and eleven patients with advanced cervical cancer who responded to chemoradiotherapy followed by brachytherapy were included in a retrospective, multicenter series.

RESULTS

Of the patients who had completion surgery (Group 1), 22.4% (15/67) had recurrence compared with 36.4% (16/44) of those who did not have surgery (Group 2). The difference is statistically significant (p=0.01). The relative risk of disease progression or death was 0.41 (95% confidence interval 0.20-0.85) (p=0.01) in favor of completion surgery. After multivariate analysis, only age, pathology and initial tumor size remained significant (respectively p=0.003, p=0.001 and p=0.03). Among the locations of recurrence in Group 1, 46.7% were pelvic (7/15) compared with 56.2% in Group 2 (9/16). In Group 1, 16.4% (11/67) of the patients died of disease compared to 20.4% (9/44) in Group 2. Of these, 45.4% (5/11) in Group 1 died after pelvic recurrence as compared to 77.8% (7/9) in Group 2.

CONCLUSION

Completion surgery does not improve OS but may improve DFS. There is no consensus regarding completion surgery in advanced cervical cancer with a good response to the standard treatment but we think it is safer to propose it.