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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

Tummers, Philippe MD*; Makar, Amin MD, PhD*; Vandecasteele, Katrien MD, PhD; De Meerleer, Gert MD, PhD; Denys, Hannelore MD, PhD; De Visschere, Pieter MD§; Delrue, Louke MD, PhD§; Villeirs, Geert MD, PhD§; Lambein, Kathleen MD; den Broecke, Rudy Van MD, PhD*

International Journal of Gynecological Cancer: June 2013 - Volume 23 - Issue 5 - p 877–883
doi: 10.1097/IGC.0b013e31828d1ec0
Cervical Cancer

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 brachytherapy. 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.

*Division of Gynecologic Oncology, Departments of Obstetrics and Gynecology, †Radiotherapy, ‡Oncology, §Radiology, and ∥Pathology, Ghent University Hospital, Ghent, Belgium.

Address correspondence and reprint requests to Philippe Tummers, MD, De Pintelaan 185, 9000 Gent, Belgium. E-mail:

The research and its publication were entirely funded by the Department of Obstetrics and Gynecology and the Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.

The authors declare no conflicts of interest.

Received October 24, 2012

Accepted February 13, 2013

Copyright © 2013 by IGCS and ESGO