BULKY STAGE IB2 CERVICAL CANCER: FEASABILITY AND SURVIVAL WITH SURGICAL MANAGEMENT VS RADIATION ALONE

Emery Salom,MD. Luis Mendez,MD, Nicholas Lambrou,MD, Aimee Kamat,MS, Orlando Gómez-Marín,PhD, Giselle Ghurani,MD, Ramin Mirhashemi,MD, Zoyla Almeida,MD, Manuel Penalver,MD, and Hervy Averette,MD,

Division of Gynecologic Oncology, University of Miami School of Medicine, Miami, Florida

   Objective: To compare outcomes of exploration for radical hysterectomy vs radiation alone in patients with bulky clinical stage IB2 cervical carcinomas of the uterine cervix.

   Methods: A retrospective chart review was performed of all women diagnosed at our institution with clinical stage IB2 carcinoma of the uterine cervix between 1992 and 2001. Data were obtained from medical records, phone interviews, and the Florida Cancer Tumor Registry. The patients were divided into 3 groups: patients who underwent a type III radical abdominal hysterectomy and lymphadenectomy (the RH Group); patients in which a radical hysterectomy was aborted secondary to advanced disease, but in which a lymphadenectomy was performed (the LND Group); and patients who received primary radiation with or without chemotherapy (the XRT Group). Statistical analysis included Chi-square and Kaplan Meier survival methods followed by Log Rank tests to compare different groups with respect to disease-free survival (DFS).

   Results: A total of 148 patients were identified. Thirty-six (24%) patients received XRT alone. 112 patients were explored with 88 (60%) patients classified in the RAH group and 24 (16%) classified in the LND group (ie. Lymphadenectomy alone). Patients received postoperative radiation (or chemoradiation) therapy according to high-risk factors. Among the RAH group, a negative histology was reported as follows: 73% vaginal margins, 88% parametrial margin, 96% para-aortic lymph nodes, and 65% pelvic lymph nodes. In the LND group 74% had negative para-aortic lymph nodes and 76% were aborted secondary to advanced pelvic disease. After a median follow up of 19 months, overall survival was significantly improved for the RH group when compared to the LND and the XRT groups (p=0.028).

   Conclusion: In bulky stage IB2 cervical carcinoma, radical hysterectomy is a viable treatment modality with a high feasibility and improved survival rates.