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Completion surgery after intensity-modulated arc therapy in the treatment of locally advanced cervical cancer feasibility, surgical outcome, and oncologic results

Philippe Tummers (UGent) , Amin Makar (UGent) , Katrien Vandecasteele (UGent) , Gert De Meerleer (UGent) , Hannelore Denys (UGent) , Pieter De Visschere (UGent) , Louke Delrue (UGent) , Geert Villeirs (UGent) , Kathleen Lambein (UGent) and Rudy Van den Broecke (UGent)
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Abstract
Introduction: Since the addition of chemotherapy to radiotherapy, the survival rates of locally advanced cervical cancer (LACC) have improved but are still disappointing. Therefore, the idea of surgery after chemoradiation in case of LACC or bulky disease was adopted. One of the concerns regarding surgery following chemoradiotherapy is surgery-related morbidity. Aim: The objectives of this study were to investigate the feasibility of surgery after advanced radiotherapy techniques such as intensity-modulated arc therapy (IMAT) and to describe the morbidity. Methods: This was a prospective study of primary inoperable LACC patients primary treated with IMAT, in most cases combined with weekly cisplatin. Then the resectability was reevaluated. If resectable patients were treated with Wertheim type 2 surgery +/- pelvic lymphadenectomy (on positron emission tomography-computed tomography indication). If tumor is not resectable, patients were treated with brachytherapy. Results: Since 2006, 41 consecutive patients were included. After neoadjuvant IMAT, 34 were considered resectable and underwent surgery, whereas 7 proceeded with brachy-therapy. The operative mortality rate was nil. There were no major perioperative complications. No ureter, bladder, or bowel injuries occurred. No postoperative urinary/digestive fistulae or stenoses were noted. Eleven patients had postoperatively urinary retention problems. At the time of discharge, 5 patients still needed self-catheterization. All problems resolved within 3 months. In 4 cases, we saw significant lymphoceles. In all patients intended to treat, overall survival and disease-free survival at 3 years were 63% and 74%. In the Wertheim group, overall survival and disease-free survival at 3 years were 81% and 91%. Conclusions: Completing surgery after chemoradiation therapy (with IMAT) for LACC or bulky disease is feasible, and complication rates are comparable with those of primary surgery for cervical cancer.
Keywords
Intensity-modulated arc therapy, CONCOMITANT CHEMORADIATION, LYMPH-NODE INVOLVEMENT, Completion surgery, Locally advanced cervical cancer, RADIATION-THERAPY, HYSTERECTOMY, CARCINOMA, RADIOTHERAPY, CISPLATIN, CHEMORADIOTHERAPY, CHEMOTHERAPY, SURVIVAL

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Chicago
Tummers, Philippe, Amin Makar, Katrien Vandecasteele, Gert De Meerleer, Hannelore Denys, Pieter De Visschere, Louke Delrue, Geert Villeirs, Kathleen Lambein, and Rudy Van den Broecke. 2013. “Completion Surgery After Intensity-modulated Arc Therapy in the Treatment of Locally Advanced Cervical Cancer Feasibility, Surgical Outcome, and Oncologic Results.” International Journal of Gynecological Cancer 23 (5): 877–883.
APA
Tummers, Philippe, Makar, A., Vandecasteele, K., De Meerleer, G., Denys, H., De Visschere, P., Delrue, L., et al. (2013). Completion surgery after intensity-modulated arc therapy in the treatment of locally advanced cervical cancer feasibility, surgical outcome, and oncologic results. INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER, 23(5), 877–883.
Vancouver
1.
Tummers P, Makar A, Vandecasteele K, De Meerleer G, Denys H, De Visschere P, et al. Completion surgery after intensity-modulated arc therapy in the treatment of locally advanced cervical cancer feasibility, surgical outcome, and oncologic results. INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER. 2013;23(5):877–83.
MLA
Tummers, Philippe, Amin Makar, Katrien Vandecasteele, et al. “Completion Surgery After Intensity-modulated Arc Therapy in the Treatment of Locally Advanced Cervical Cancer Feasibility, Surgical Outcome, and Oncologic Results.” INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER 23.5 (2013): 877–883. Print.
@article{4382041,
  abstract     = {Introduction: Since the addition of chemotherapy to radiotherapy, the survival rates of locally advanced cervical cancer (LACC) have improved but are still disappointing. Therefore, the idea of surgery after chemoradiation in case of LACC or bulky disease was adopted. One of the concerns regarding surgery following chemoradiotherapy is surgery-related morbidity.
Aim: The objectives of this study were to investigate the feasibility of surgery after advanced radiotherapy techniques such as intensity-modulated arc therapy (IMAT) and to describe the morbidity.
Methods: This was a prospective study of primary inoperable LACC patients primary treated with IMAT, in most cases combined with weekly cisplatin. Then the resectability was reevaluated. If resectable patients were treated with Wertheim type 2 surgery +/- pelvic lymphadenectomy (on positron emission tomography-computed tomography indication). If tumor is not resectable, patients were treated with brachytherapy.
Results: Since 2006, 41 consecutive patients were included. After neoadjuvant IMAT, 34 were considered resectable and underwent surgery, whereas 7 proceeded with brachy-therapy. The operative mortality rate was nil. There were no major perioperative complications. No ureter, bladder, or bowel injuries occurred. No postoperative urinary/digestive fistulae or stenoses were noted. Eleven patients had postoperatively urinary retention problems. At the time of discharge, 5 patients still needed self-catheterization. All problems resolved within 3 months. In 4 cases, we saw significant lymphoceles. In all patients intended to treat, overall survival and disease-free survival at 3 years were 63\% and 74\%. In the Wertheim group, overall survival and disease-free survival at 3 years were 81\% and 91\%.
Conclusions: Completing surgery after chemoradiation therapy (with IMAT) for LACC or bulky disease is feasible, and complication rates are comparable with those of primary surgery for cervical cancer.},
  author       = {Tummers, Philippe and Makar, Amin and Vandecasteele, Katrien and De Meerleer, Gert and Denys, Hannelore and De Visschere, Pieter and Delrue, Louke and Villeirs, Geert and Lambein, Kathleen and Van den Broecke, Rudy},
  issn         = {1048-891X},
  journal      = {INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER},
  language     = {eng},
  number       = {5},
  pages        = {877--883},
  title        = {Completion surgery after intensity-modulated arc therapy in the treatment of locally advanced cervical cancer feasibility, surgical outcome, and oncologic results},
  url          = {http://dx.doi.org/10.1097/IGC.0b013e31828d1ec0},
  volume       = {23},
  year         = {2013},
}

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