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Abstract
Aims: Chemoradiation (CRT) is the standard treatment for locally advanced cervical cancer (LACC). However part of the patients develop recurrence during the first year after treatment despite good visible effect at the first follow-up. The role of completion surgery after radiotherapy (RT) is still debated. A number of papers have showed that up to 60% of patients have residual tumor after CRT and RT. But such a surgery is not widely recommended because of increased morbidity of the treatment. The aim of this study was to assess the results of surgery after radiotherapy of LACC.
Method: We retrospectively evaluated data on 86 patients with cervical cancer IB - IIIB stages (mostly stage IIB) who underwent surgery in different modalities after CRT and RT with good clinical response in our department in 2015-2018.
Results: When small asymptomatic residual disease was detected early after radiotherapy radical hysterectomy was feasible in most of the cases. Patients with clinical manifestation of recurrence had very poor prognosis. Surgery of recurrent cervical cancer sufficiently deteriorates quality of life, even if possible.
Conclusion: Thorough examination with adding MRI imaging after initial treatment of cervical cancer needed to identify patients who may benefit from adjuvant hysterectomy.
References
Cibula D., Potter R.,Chiva L. et al. The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology Guidelines for the Management of Patients With Cervical Cancer // Int. J. Gynecol. Cancer. - 2018. - Vol. 28(4). - P 641-655. - DOI: 10.1097/igc.0000000000001216
Злокачественные опухоли [спецвыпуск журнала]: Практические рекомендации Российского общества клинической онкологии. Лекарственное лечение злокачественных опухолей. Поддерживающая терапия в онкологии / под ред. В.М. Моисеенко - М. Общероссийское общ. организация "Рос. общество клин. онкологии", 2018. - С. 178-189
Eifel P.J., Levenback C., Wharton J.T., Oswald M.J. Time course and incidence of late complications in patients treated with radiation therapy for FIGO stage IB carcinoma of the uterine cervix // Int. J. Radiat. Oncol. Biol.Phys. - 1995. - Vol. 32(5). - P. 1289-300. -//doi. org/-i DOI: 10.1016/0360-3016(95)00118
Espenel S., Garcia M., Trone J. et al. From IB2 to IIIB locally advanced cervical cancers: report of a ten-year experience //Radiat. Oncol. - 2018. - № 13. - P. 16. - DOI: 10.1186/s13014-018-0963-8
Robin T.P., Amini A., Schefter T.E. et al. Disparities in standard of care treatment and associated survival decrement in patients with locally advanced cervical cancer // Gynecol. Oncol. - 2016. - № 143. - P 319325. - DOI: 10.1016Zj.ygyno.2016.09.009
Smith G.L., Jiang J., Giordano S.H. et al. Trends in the quality of treatment for patients with intact cervical cancer in the United States, 1999 through 2011 // Int. J. Radiat. Oncol. Biol. Phys. - 2015. - № 92. - P 260-367. - DOI: 10.1016/j.ijrobp.2015.01.037
Boers A., Arts H.J., Klip H. et al. Radical surgery in patients with residual disease after (chemo)radiation for cervical cancer // Int. J. Gynecol. Cancer. - 2014. - Vol. 24(7). - P. 1276-85. - DOI: 10.1097/igc.0000000000000171
Ota T, Takeshima N., Tabata T. et al. Adjuvant hysterectomy for treatment of residual disease in patients with cervical cancer treated with radiation therapy // Br. J. Cancer. - 2008. - Vol. 99(8). - P. 1216-1220. - DOI: 10.1038/sj.bjc.6604619
Rema P, Suchetha S., Kumar A., Ahmed I. The role of adjuvant hysterectomy after radiotherapy in cervical cancer // Indian J. Surg. - 2015. - Vol. 77(Suppl 3). - P. 902-905. -DOI: 10.1007/s12262014-1060-3
Touboul C., Uzan C., Mauguen A. et al. Prognostic factors and morbidities after completion surgery in patients undergoing initial chemoradiation therapy for locally advanced cervical cancer // Oncologist. - 2010. - Vol. 15(4). - P 405-415. - DOI: 10.1634/theoncologist.2009-0295
Touboul C., Uzan C., Mauguen A. et al. Survival and prognostic factors after completion surgery in patients undergoing initial chemoradiation therapy for locally advanced cervical cancer // Gynecol. Obstet. Fertil. - 2011. - Vol. 39(5). - P 274-280.
Walji N., Chue A.L., Yap C. et al. Is there a role for adjuvant hysterectomy after suboptimal concurrent chemoradiation in cervical carcinoma? // Clin. Oncol. - 2010. -Vol. 22(2). - P. 140-146. - DOI: 10.1016/j.clon.2009.11.006
Morice P., Uzan C., Zafrani Y et al. The role of surgery after chemorediation therapy and brachytherapy for stage IB2/ II cervical cancer // Gynecol.Oncol. - 2007. - Vol. 107 (1 Suppl 1). - P 122-124. - DOI: 10.1016/j.ygyno.2007.07.015
Motton S., Houvenaeghel G., Delannes M. et al. Results of surgery after concurrent chemoradiotherapy in advanced cervical cancer: comparison of extended hysterectomy and extrafascial hysterectomy // Int. J. Gynecol. Cancer. - 2010. - Vol. 20(2). - P. 268-75. -DOI: 10.1111/igc.0b013e3181c9e385
Ferrandina G., Ercoli A., Fagotti A. et al. Completion surgery after concomitant chemoradiation in locally advanced cervical cancer: a comprehensive analysis of pattern of postoperative complications // Ann. Surg. Oncol. - 2014. - Vol. 21(5). - P 1692-9. - DOI: 10.1245/s10434-013-3471-y
Ильин К.А., Замятин А.В. Роль тазовой эвисцерации в лечении постлучевых рецидивов рака шейки матки на современном этапе (обзор литературы) // Онкогинекология. - 2013. - № 1. - С. 43-53.
Friedlander M., Grogan M. Guiedelines for the treatment of recurrent and metastatic cervical cancer // The oncologist. - 2002. - №7. - P. 342-347.
Rema P, Mathew A.P, Suchetta S., Ahmed I. Salvage surgery for cervical cancer recurrences // Indian J. Surg. Oncol. - 2007. - Vol. 8(2). - P 146-149. - DOI: 10.1007/s13193-015-0472-2
Костюк И.П., Шестаев А.Ю., Шостка К.Г. и др. Паллиативные эвисцерации органов малого таза в хирургическом лечении местно-распространенного и рецидивного рака шейки матки // Вестн. Рос. Воен.-Мед. Акад. - 2012. - №1(37). - C. 65-70.
Алешикова О.И. Лучевые и молекулярно-биологические критерии оценки эффективности неоадъювантной химиотерапии местнораспространенного рака шейки матки (IIB - IIIB стадий) // Вестн. РНЦРР - 2007. - № 7. - vestnik.rncrr.ru/vestnik/v7/papers/ alesh_v7.htm.
Тарачкова Е.В., Стрельцова О.Н., Панов В.О. и др. Мультипараметрическая магнитно-резонансная томография в диагностике рака шейки матки // Вестник рентгенологии и радиологии. - 2015. - № 6. - С. 43-55.
Трухачева Н.Г., Фролова И.Г, Коломиец Л.А. и др. МРТ в оценке эффективности химиолучевого лечения местнораспространенного рака шейки матки // Си-бир.Онкол.Журнал. - 2015. - № 5. - С. 84-91.
Шавладзе З.Н., Березовская Т.П., Прошин А.А. и др. Роль магнитно-резонансной томографии в диагностике рецидивов рака шейки матки // опухоли женской репродуктивной системы. - 2011. - № 2. - С. 4955.
Vincens E., Balleyguier C., Rey A. et al. Accuracy of magnetic resonance imaging in predicting residual disease in patients treated for stage IB2/II cervical carcinoma with chemoradiation therapy: correlation of radiologic findings with surgicopathologic results // Cancer. - 2008. - Vol. 113(8). - P. 2158-2165. - DOI: 10.1002/cncr.23817
Elit L., Fyles A.W., Devries M.C. et al. Follow-up for women after treatment for cervical cancer: a systematic revew // Gynecol. Oncol. - 2009. - Vol. 114(3). - P. 528-535. - DOI: 10.1016/j.ygyno.2009.06.001
Elit L., Kennedy E.B., Fyles A., Metser U. Follow-up for cervical cancer: a program in evidence-based care systematic review and clinical practice guideline update // Curr. Oncol. - 2016. - Vol. 23(2). - P 109-118. - DOI: 10.3747/co.23.2742
Lanceley A., Fiander A., McCormack M., Bryant A. Follow-up protocols for women with cervical cancer after primary treatment // Cochrane Database Syst Rev. - 2013. -Vol. 25(11). - СD008767. - DOI: 10.1002/14651858.cd008767.pub2
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