Khalifa Hisham, Ayaty Mohamed, Oreaba Reham, Emad Reem, Salama Mohamed, Elsebahy Khaled, Ghoniem Wael A Wahab
National cancer institute Egypt, cairo, Egypt.
J Egypt Natl Canc Inst. 2025 Jun 7;37(1):46. doi: 10.1186/s43046-025-00292-0.
Following external beam radiation therapy (EBRT) with concurrent chemotherapy, we analyzed the benefits of surgical resection for locally advanced cervical carcinoma in terms of the frequency and severity of complications and disease-free survival, including cases of adjuvant hysterectomy after failure of resolution post-brachytherapy.
Retrospective analysis was utilized to determine the eligibility of 145 cases treated at the National Cancer Institute between January 2015 and June 2021. Of those, 17 patients did not match the requirements, and 8 patients declined to take part in the study. Depending on the major treatment technique, 120 FIGO stage IB3-FIGO stage IVA cervical cancer patients were split into two equal groups of 60 patients each. Sixty patients (50%) received neo-adjuvant EBRT and concurrent platinum-based chemotherapy followed by hysterectomy (group A) and 60 (50%) received definitive radiotherapy only (group B).
The age at diagnosis of patients was similar, with a mean of 52.5 (range 34-77) and 53.4 (range 25 81) years in group A and group B, respectively (P = 0.675). Majority of the cases in both groups were pathologically squamous cell carcinomas (88.3% in group A and 83.3% in group B) and of grade II differentiation (73.7% in group A and 71.2% in group B). Majority of cases in both groups being FIGO stage II (45% in group A and 40% in group B) and FIGO stage III (40% in group A and 43.3% in group B). Only 17 patients (28.3%) in group A had postoperative complications, while 37 patients (61.7%) in group B suffered from post-treatment complications (P value < 0.001). In group B, 14 patients (23.3%) failed to show complete remission of the disease after completion of treatment, with a mean residual disease of 4.3 cm in diameter (range 2-6 cm), either local or nodal. Salvage hysterectomy post-definitive radiotherapy was done for 8 patients with residual disease (13.3%). In group A, 48 patients had no recurrence during follow-up (80%), while 11 of the patients had either locoregional or metastatic recurrences, or both (18.3%). DFS was comparable between both groups (P = 0.493), excluding 23.3% of group B where failure of complete remission of the disease after completion of treatment barred the patients from the disease-free calculations. The 1-year DFS was 88.1% in group A and 82.6% in group B, while the 3-year DFS was 74.1% in group A and 70.1% in group B.
There was no difference in disease-free survival or the incidence of locoregional and metastatic recurrence between patients with cervical cancer who had surgery and those who received brachytherapy following EBRT and concomitant chemotherapy. In almost 50% of cases, the surgical patients showed full pathological recovery.
在体外放射治疗（EBRT）联合同步化疗后，我们从并发症的发生频率和严重程度以及无病生存期方面分析了手术切除对局部晚期宫颈癌的益处，包括近距离放射治疗后缓解失败而行辅助子宫切除术的病例。
采用回顾性分析来确定2015年1月至2021年6月期间在国家癌症研究所接受治疗的145例患者的入选资格。其中，17例患者不符合要求，8例患者拒绝参与研究。根据主要治疗技术，120例国际妇产科联盟（FIGO）IB3期至FIGO IVA期宫颈癌患者被平均分为两组，每组60例。60例患者（50%）接受新辅助EBRT和同步铂类化疗，随后行子宫切除术（A组），60例患者（50%）仅接受根治性放疗（B组）。
两组患者的诊断年龄相似，A组平均年龄为52.5岁（范围34 - 77岁），B组平均年龄为53.4岁（范围25 - 81岁）（P = 0.675）。两组中的大多数病例在病理上为鳞状细胞癌（A组88.3%，B组83.3%），且为II级分化（A组73.7%，B组71.2%）。两组中的大多数病例为FIGO II期（A组45%，B组40%）和FIGO III期（A组40%，B组43.3%）。A组仅17例患者（28.3%）有术后并发症，而B组有37例患者（61.7%）出现治疗后并发症（P值<0.001）。在B组中，14例患者（23.3%）在治疗完成后疾病未完全缓解，平均残留病灶直径为4.3厘米（范围2 - 6厘米），可为局部或淋巴结病灶。对8例有残留病灶的患者（13.3%）在根治性放疗后行挽救性子宫切除术。在A组中，48例患者在随访期间无复发（80%），而11例患者有局部或远处复发，或两者皆有（18.3%）。两组的无病生存期具有可比性（P = 0.493），B组中23.3%的患者在治疗完成后疾病未完全缓解，这些患者被排除在无病生存期计算之外。A组1年无病生存率为88.1%，B组为82.6%，A组3年无病生存率为74.1%，B组为70.1%。
接受手术的宫颈癌患者与接受EBRT和同步化疗后行近距离放射治疗的患者在无病生存期或局部及远处复发发生率方面无差异。在近50%的病例中，手术患者显示出完全的病理恢复。
