What to expect from immediate salvage hysterectomy following concomitant chemoradiation and image-guided adaptive brachytherapy in locally advanced cervical cancer
Concomitant chemoradiation followed by brachytherapy is the standard treatment for locally advanced cervical cancers. The place of adjuvant hysterectomy remains unclear but tends to be limited to incomplete responses to radiotherapy or local relapse. The aim was to analyse the benefit from immediate...
Gespeichert in:
| Veröffentlicht in: | Cancer radiothérapie 2015-12, Vol.19 (8), p.710-717 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 717 |
|---|---|
| container_issue | 8 |
| container_start_page | 710 |
| container_title | Cancer radiothérapie |
| container_volume | 19 |
| creator | Castelnau-Marchand, P. Chargari, C. Bouaita, R. Dumas, I. Farha, G. Kamsu-Kom, L. Rivin del Campo, E. Martinetti, F. Morice, P. Haie-Meder, C. Mazeron, R. |
| description | Concomitant chemoradiation followed by brachytherapy is the standard treatment for locally advanced cervical cancers. The place of adjuvant hysterectomy remains unclear but tends to be limited to incomplete responses to radiotherapy or local relapse. The aim was to analyse the benefit from immediate salvage surgery following radiation therapy in incomplete responders.
Among the patients with locally advanced cervical cancer treated with concomitant chemoradiation followed by 3D image-guided adaptive brachytherapy and hysterectomy, cases with genuine macroscopic remnant, defined as at least 1cm in width, were identified. Their clinical data and outcomes were retrospectively reviewed and compared to the patients treated with the same modalities.
Fifty-eight patients were included, with a median follow-up of 4.2 years. After hysterectomy, 9 patients had macroscopic residual disease, 10 microscopic and the remaining 39 patients were considered in complete histological response. The 4-year overall survival and disease-free survival rates were significantly decreased in patients with macroscopic residual disease: 50 and 51% versus 92% and 93%, respectively. Intestinal grades 3–4 toxicities were reported in 10.4% and urinary grades 3–4 in 8.6% in the whole population without distinctive histological features. Planning aims were reached in only one patient with macroscopic residuum (11.1%). In univariate analysis, overall treatment time (>55 days) and histological subtype (adenocarcinomas or adenosquamous carcinomas) appeared to be significant predictive factors for macroscopic remnant after treatment completion (P=0.021 and P=0.017, respectively). In multivariate analysis, treatment time was the only independent factor (P=0.046, odds ratio=7.0).
Although immediate salvage hysterectomy in incomplete responders provided a 4-year disease-free survival of 51%, its impact on late morbidity is significant. Efforts should focus on respect of treatment time and dose escalation. Adenocarcinoma might require higher high-risk clinical target volume planning aims.
La chimioradiothérapie concomitante suivie de curiethérapie utérovaginale est le traitement standard des cancers du col utérin localement évolués. La place de l’hystérectomie adjuvante reste incertaine mais tend à se limiter aux réponses incomplètes et aux rechutes locales. L’objectif de l’étude était d’analyser le bénéfice de la chirurgie de rattrapage immédiate après radiothérapie.
Parmi les patientes atteintes d |
| doi_str_mv | 10.1016/j.canrad.2015.05.025 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1750003136</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1278321815003595</els_id><sourcerecordid>1750003136</sourcerecordid><originalsourceid>FETCH-LOGICAL-c362t-3d7a8dc9f8595ec98e84274501d0ccfbf4bad35a96fd9446841f2cb009da34143</originalsourceid><addsrcrecordid>eNp9kduK1TAUhosozjj6BiK59KbbHJq0vRFk8DAw4I3iZVhNVnezaZuaZHfs8_iipuzRSyGQA9-_Vtb_F8VrRg-MMvXudDAwB7AHTpk80Ly4fFJcs1q1pVKyeZrPvG5KwVlzVbyI8UQpVaqVz4srriRtBKfXxe8fAySSPMFfC5pE-uAn4qYJrYOEJMK4whHJsMWEIQN-2kjvx9E_uPlIjJ-Nn1yCOREz4OTzf7LO-ZnAbHOdrC2PZ2fRErCwJLci6QKYYUsDBlg24mYyegPjuGVihdlk1GBYXX4jZr-Hl8WzHsaIrx73m-L7p4_fbr-U918_391-uC-NUDyVwtbQWNP2jWwlmrbBpuJ1JSmz1Ji-66sOrJDQqt62VaWaivXcdJS2FkTFKnFTvL3UXYL_ecaY9OSiwXGEGf05albLbKFgQmW0uqAm-BgD9noJedqwaUb1Ho8-6Us8eo9H07y4zLI3jx3OXbb4n-hvHhl4fwEwz7k6DDoah7spbndfW-_-3-EP-cmnug</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1750003136</pqid></control><display><type>article</type><title>What to expect from immediate salvage hysterectomy following concomitant chemoradiation and image-guided adaptive brachytherapy in locally advanced cervical cancer</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Castelnau-Marchand, P. ; Chargari, C. ; Bouaita, R. ; Dumas, I. ; Farha, G. ; Kamsu-Kom, L. ; Rivin del Campo, E. ; Martinetti, F. ; Morice, P. ; Haie-Meder, C. ; Mazeron, R.</creator><creatorcontrib>Castelnau-Marchand, P. ; Chargari, C. ; Bouaita, R. ; Dumas, I. ; Farha, G. ; Kamsu-Kom, L. ; Rivin del Campo, E. ; Martinetti, F. ; Morice, P. ; Haie-Meder, C. ; Mazeron, R.</creatorcontrib><description>Concomitant chemoradiation followed by brachytherapy is the standard treatment for locally advanced cervical cancers. The place of adjuvant hysterectomy remains unclear but tends to be limited to incomplete responses to radiotherapy or local relapse. The aim was to analyse the benefit from immediate salvage surgery following radiation therapy in incomplete responders.
Among the patients with locally advanced cervical cancer treated with concomitant chemoradiation followed by 3D image-guided adaptive brachytherapy and hysterectomy, cases with genuine macroscopic remnant, defined as at least 1cm in width, were identified. Their clinical data and outcomes were retrospectively reviewed and compared to the patients treated with the same modalities.
Fifty-eight patients were included, with a median follow-up of 4.2 years. After hysterectomy, 9 patients had macroscopic residual disease, 10 microscopic and the remaining 39 patients were considered in complete histological response. The 4-year overall survival and disease-free survival rates were significantly decreased in patients with macroscopic residual disease: 50 and 51% versus 92% and 93%, respectively. Intestinal grades 3–4 toxicities were reported in 10.4% and urinary grades 3–4 in 8.6% in the whole population without distinctive histological features. Planning aims were reached in only one patient with macroscopic residuum (11.1%). In univariate analysis, overall treatment time (>55 days) and histological subtype (adenocarcinomas or adenosquamous carcinomas) appeared to be significant predictive factors for macroscopic remnant after treatment completion (P=0.021 and P=0.017, respectively). In multivariate analysis, treatment time was the only independent factor (P=0.046, odds ratio=7.0).
Although immediate salvage hysterectomy in incomplete responders provided a 4-year disease-free survival of 51%, its impact on late morbidity is significant. Efforts should focus on respect of treatment time and dose escalation. Adenocarcinoma might require higher high-risk clinical target volume planning aims.
La chimioradiothérapie concomitante suivie de curiethérapie utérovaginale est le traitement standard des cancers du col utérin localement évolués. La place de l’hystérectomie adjuvante reste incertaine mais tend à se limiter aux réponses incomplètes et aux rechutes locales. L’objectif de l’étude était d’analyser le bénéfice de la chirurgie de rattrapage immédiate après radiothérapie.
Parmi les patientes atteintes de cancer du col utérin localement évolué dont le traitement a été une chimioradiothérapie suivie de curiethérapie adaptative guidée par l’image et hystérectomie, les cas avec résidu postopératoire macroscopique, défini comme au moins 1cm de grand axe, ont été identifiés. Leurs données ont été revues rétrospectivement et comparées à celles des patientes traitées selon les mêmes modalités.
Cinquante-huit patientes ont été incluses, avec un suivi médian de 4,2ans. Après hystérectomie, neuf patientes étaient atteintes d’une maladie résiduelle macroscopique, dix microscopique, et les 39 autres étaient en situation de réponse histologique complète. Les probabilités de survie globale et de survie sans récidive à 4ans étaient significativement plus faibles en cas de résidu macroscopique : respectivement 50 et 51 % contre 92 et 93 %. Une toxicité intestinale de grades 3–4 a été rapportée dans 10,4 %, et urinaire dans 8,6 %, dans l’ensemble de la population, sans distinction en fonction du groupe de réponse. Les objectifs de planification n’ont été atteints que pour une seule patiente, chez qui a été mis en évidence un résidu macroscopique (11,1 %). En analyse unifactorielle, l’étalement du traitement (plus de 55jours) et le sous-type histologique (adénocarcinomes et carcinomes adénosquameux) semblaient être des facteurs prédictifs significatifs d’un résidu macroscopique (p=0,021 et p=0,017, respectivement). En analyse multifactorielle, l’étalement était le seul facteur indépendant (p=0,046, odds ratio=7,0).
Bien que l’hystérectomie immédiate de rattrapage ait permis d’obtenir une probabilité de survie sans rechute de 51 % à 4ans, son impact sur la morbidité tardive est significatif, et les efforts doivent se concentrer sur l’optimisation des plans de traitement et le respect de l’étalement. Les adénocarcinomes pourraient requérir des objectifs de planification plus élevés.</description><identifier>ISSN: 1278-3218</identifier><identifier>EISSN: 1769-6658</identifier><identifier>DOI: 10.1016/j.canrad.2015.05.025</identifier><identifier>PMID: 26508320</identifier><language>eng</language><publisher>France: Elsevier SAS</publisher><subject>Adult ; Aged ; Brachytherapy ; Cancer du col utérin localement avancé ; Carcinoma - pathology ; Carcinoma - therapy ; Chemoradiotherapy ; Chimioradiothérapie concomitante ; Combined Modality Therapy ; Concomitant chemoradiation ; Curiethérapie adaptative guidée par l’image ; Disease-Free Survival ; Female ; Humans ; Hysterectomy ; Hystérectomie ; Image-guided adaptive brachytherapy ; Locally advanced cervical cancer ; Maladie résiduelle ; Middle Aged ; Neoplasm Staging ; Neoplasm, Residual ; Residual disease ; Retrospective Studies ; Salvage Therapy ; Time Factors ; Treatment Outcome ; Uterine Cervical Neoplasms - pathology ; Uterine Cervical Neoplasms - therapy</subject><ispartof>Cancer radiothérapie, 2015-12, Vol.19 (8), p.710-717</ispartof><rights>2015 Société française de radiothérapie oncologique (SFRO)</rights><rights>Copyright © 2015 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c362t-3d7a8dc9f8595ec98e84274501d0ccfbf4bad35a96fd9446841f2cb009da34143</citedby><cites>FETCH-LOGICAL-c362t-3d7a8dc9f8595ec98e84274501d0ccfbf4bad35a96fd9446841f2cb009da34143</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1278321815003595$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26508320$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Castelnau-Marchand, P.</creatorcontrib><creatorcontrib>Chargari, C.</creatorcontrib><creatorcontrib>Bouaita, R.</creatorcontrib><creatorcontrib>Dumas, I.</creatorcontrib><creatorcontrib>Farha, G.</creatorcontrib><creatorcontrib>Kamsu-Kom, L.</creatorcontrib><creatorcontrib>Rivin del Campo, E.</creatorcontrib><creatorcontrib>Martinetti, F.</creatorcontrib><creatorcontrib>Morice, P.</creatorcontrib><creatorcontrib>Haie-Meder, C.</creatorcontrib><creatorcontrib>Mazeron, R.</creatorcontrib><title>What to expect from immediate salvage hysterectomy following concomitant chemoradiation and image-guided adaptive brachytherapy in locally advanced cervical cancer</title><title>Cancer radiothérapie</title><addtitle>Cancer Radiother</addtitle><description>Concomitant chemoradiation followed by brachytherapy is the standard treatment for locally advanced cervical cancers. The place of adjuvant hysterectomy remains unclear but tends to be limited to incomplete responses to radiotherapy or local relapse. The aim was to analyse the benefit from immediate salvage surgery following radiation therapy in incomplete responders.
Among the patients with locally advanced cervical cancer treated with concomitant chemoradiation followed by 3D image-guided adaptive brachytherapy and hysterectomy, cases with genuine macroscopic remnant, defined as at least 1cm in width, were identified. Their clinical data and outcomes were retrospectively reviewed and compared to the patients treated with the same modalities.
Fifty-eight patients were included, with a median follow-up of 4.2 years. After hysterectomy, 9 patients had macroscopic residual disease, 10 microscopic and the remaining 39 patients were considered in complete histological response. The 4-year overall survival and disease-free survival rates were significantly decreased in patients with macroscopic residual disease: 50 and 51% versus 92% and 93%, respectively. Intestinal grades 3–4 toxicities were reported in 10.4% and urinary grades 3–4 in 8.6% in the whole population without distinctive histological features. Planning aims were reached in only one patient with macroscopic residuum (11.1%). In univariate analysis, overall treatment time (>55 days) and histological subtype (adenocarcinomas or adenosquamous carcinomas) appeared to be significant predictive factors for macroscopic remnant after treatment completion (P=0.021 and P=0.017, respectively). In multivariate analysis, treatment time was the only independent factor (P=0.046, odds ratio=7.0).
Although immediate salvage hysterectomy in incomplete responders provided a 4-year disease-free survival of 51%, its impact on late morbidity is significant. Efforts should focus on respect of treatment time and dose escalation. Adenocarcinoma might require higher high-risk clinical target volume planning aims.
La chimioradiothérapie concomitante suivie de curiethérapie utérovaginale est le traitement standard des cancers du col utérin localement évolués. La place de l’hystérectomie adjuvante reste incertaine mais tend à se limiter aux réponses incomplètes et aux rechutes locales. L’objectif de l’étude était d’analyser le bénéfice de la chirurgie de rattrapage immédiate après radiothérapie.
Parmi les patientes atteintes de cancer du col utérin localement évolué dont le traitement a été une chimioradiothérapie suivie de curiethérapie adaptative guidée par l’image et hystérectomie, les cas avec résidu postopératoire macroscopique, défini comme au moins 1cm de grand axe, ont été identifiés. Leurs données ont été revues rétrospectivement et comparées à celles des patientes traitées selon les mêmes modalités.
Cinquante-huit patientes ont été incluses, avec un suivi médian de 4,2ans. Après hystérectomie, neuf patientes étaient atteintes d’une maladie résiduelle macroscopique, dix microscopique, et les 39 autres étaient en situation de réponse histologique complète. Les probabilités de survie globale et de survie sans récidive à 4ans étaient significativement plus faibles en cas de résidu macroscopique : respectivement 50 et 51 % contre 92 et 93 %. Une toxicité intestinale de grades 3–4 a été rapportée dans 10,4 %, et urinaire dans 8,6 %, dans l’ensemble de la population, sans distinction en fonction du groupe de réponse. Les objectifs de planification n’ont été atteints que pour une seule patiente, chez qui a été mis en évidence un résidu macroscopique (11,1 %). En analyse unifactorielle, l’étalement du traitement (plus de 55jours) et le sous-type histologique (adénocarcinomes et carcinomes adénosquameux) semblaient être des facteurs prédictifs significatifs d’un résidu macroscopique (p=0,021 et p=0,017, respectivement). En analyse multifactorielle, l’étalement était le seul facteur indépendant (p=0,046, odds ratio=7,0).
Bien que l’hystérectomie immédiate de rattrapage ait permis d’obtenir une probabilité de survie sans rechute de 51 % à 4ans, son impact sur la morbidité tardive est significatif, et les efforts doivent se concentrer sur l’optimisation des plans de traitement et le respect de l’étalement. Les adénocarcinomes pourraient requérir des objectifs de planification plus élevés.</description><subject>Adult</subject><subject>Aged</subject><subject>Brachytherapy</subject><subject>Cancer du col utérin localement avancé</subject><subject>Carcinoma - pathology</subject><subject>Carcinoma - therapy</subject><subject>Chemoradiotherapy</subject><subject>Chimioradiothérapie concomitante</subject><subject>Combined Modality Therapy</subject><subject>Concomitant chemoradiation</subject><subject>Curiethérapie adaptative guidée par l’image</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Humans</subject><subject>Hysterectomy</subject><subject>Hystérectomie</subject><subject>Image-guided adaptive brachytherapy</subject><subject>Locally advanced cervical cancer</subject><subject>Maladie résiduelle</subject><subject>Middle Aged</subject><subject>Neoplasm Staging</subject><subject>Neoplasm, Residual</subject><subject>Residual disease</subject><subject>Retrospective Studies</subject><subject>Salvage Therapy</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Uterine Cervical Neoplasms - pathology</subject><subject>Uterine Cervical Neoplasms - therapy</subject><issn>1278-3218</issn><issn>1769-6658</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kduK1TAUhosozjj6BiK59KbbHJq0vRFk8DAw4I3iZVhNVnezaZuaZHfs8_iipuzRSyGQA9-_Vtb_F8VrRg-MMvXudDAwB7AHTpk80Ly4fFJcs1q1pVKyeZrPvG5KwVlzVbyI8UQpVaqVz4srriRtBKfXxe8fAySSPMFfC5pE-uAn4qYJrYOEJMK4whHJsMWEIQN-2kjvx9E_uPlIjJ-Nn1yCOREz4OTzf7LO-ZnAbHOdrC2PZ2fRErCwJLci6QKYYUsDBlg24mYyegPjuGVihdlk1GBYXX4jZr-Hl8WzHsaIrx73m-L7p4_fbr-U918_391-uC-NUDyVwtbQWNP2jWwlmrbBpuJ1JSmz1Ji-66sOrJDQqt62VaWaivXcdJS2FkTFKnFTvL3UXYL_ecaY9OSiwXGEGf05albLbKFgQmW0uqAm-BgD9noJedqwaUb1Ho8-6Us8eo9H07y4zLI3jx3OXbb4n-hvHhl4fwEwz7k6DDoah7spbndfW-_-3-EP-cmnug</recordid><startdate>201512</startdate><enddate>201512</enddate><creator>Castelnau-Marchand, P.</creator><creator>Chargari, C.</creator><creator>Bouaita, R.</creator><creator>Dumas, I.</creator><creator>Farha, G.</creator><creator>Kamsu-Kom, L.</creator><creator>Rivin del Campo, E.</creator><creator>Martinetti, F.</creator><creator>Morice, P.</creator><creator>Haie-Meder, C.</creator><creator>Mazeron, R.</creator><general>Elsevier SAS</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201512</creationdate><title>What to expect from immediate salvage hysterectomy following concomitant chemoradiation and image-guided adaptive brachytherapy in locally advanced cervical cancer</title><author>Castelnau-Marchand, P. ; Chargari, C. ; Bouaita, R. ; Dumas, I. ; Farha, G. ; Kamsu-Kom, L. ; Rivin del Campo, E. ; Martinetti, F. ; Morice, P. ; Haie-Meder, C. ; Mazeron, R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c362t-3d7a8dc9f8595ec98e84274501d0ccfbf4bad35a96fd9446841f2cb009da34143</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Brachytherapy</topic><topic>Cancer du col utérin localement avancé</topic><topic>Carcinoma - pathology</topic><topic>Carcinoma - therapy</topic><topic>Chemoradiotherapy</topic><topic>Chimioradiothérapie concomitante</topic><topic>Combined Modality Therapy</topic><topic>Concomitant chemoradiation</topic><topic>Curiethérapie adaptative guidée par l’image</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Humans</topic><topic>Hysterectomy</topic><topic>Hystérectomie</topic><topic>Image-guided adaptive brachytherapy</topic><topic>Locally advanced cervical cancer</topic><topic>Maladie résiduelle</topic><topic>Middle Aged</topic><topic>Neoplasm Staging</topic><topic>Neoplasm, Residual</topic><topic>Residual disease</topic><topic>Retrospective Studies</topic><topic>Salvage Therapy</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Uterine Cervical Neoplasms - pathology</topic><topic>Uterine Cervical Neoplasms - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Castelnau-Marchand, P.</creatorcontrib><creatorcontrib>Chargari, C.</creatorcontrib><creatorcontrib>Bouaita, R.</creatorcontrib><creatorcontrib>Dumas, I.</creatorcontrib><creatorcontrib>Farha, G.</creatorcontrib><creatorcontrib>Kamsu-Kom, L.</creatorcontrib><creatorcontrib>Rivin del Campo, E.</creatorcontrib><creatorcontrib>Martinetti, F.</creatorcontrib><creatorcontrib>Morice, P.</creatorcontrib><creatorcontrib>Haie-Meder, C.</creatorcontrib><creatorcontrib>Mazeron, R.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Cancer radiothérapie</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Castelnau-Marchand, P.</au><au>Chargari, C.</au><au>Bouaita, R.</au><au>Dumas, I.</au><au>Farha, G.</au><au>Kamsu-Kom, L.</au><au>Rivin del Campo, E.</au><au>Martinetti, F.</au><au>Morice, P.</au><au>Haie-Meder, C.</au><au>Mazeron, R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>What to expect from immediate salvage hysterectomy following concomitant chemoradiation and image-guided adaptive brachytherapy in locally advanced cervical cancer</atitle><jtitle>Cancer radiothérapie</jtitle><addtitle>Cancer Radiother</addtitle><date>2015-12</date><risdate>2015</risdate><volume>19</volume><issue>8</issue><spage>710</spage><epage>717</epage><pages>710-717</pages><issn>1278-3218</issn><eissn>1769-6658</eissn><abstract>Concomitant chemoradiation followed by brachytherapy is the standard treatment for locally advanced cervical cancers. The place of adjuvant hysterectomy remains unclear but tends to be limited to incomplete responses to radiotherapy or local relapse. The aim was to analyse the benefit from immediate salvage surgery following radiation therapy in incomplete responders.
Among the patients with locally advanced cervical cancer treated with concomitant chemoradiation followed by 3D image-guided adaptive brachytherapy and hysterectomy, cases with genuine macroscopic remnant, defined as at least 1cm in width, were identified. Their clinical data and outcomes were retrospectively reviewed and compared to the patients treated with the same modalities.
Fifty-eight patients were included, with a median follow-up of 4.2 years. After hysterectomy, 9 patients had macroscopic residual disease, 10 microscopic and the remaining 39 patients were considered in complete histological response. The 4-year overall survival and disease-free survival rates were significantly decreased in patients with macroscopic residual disease: 50 and 51% versus 92% and 93%, respectively. Intestinal grades 3–4 toxicities were reported in 10.4% and urinary grades 3–4 in 8.6% in the whole population without distinctive histological features. Planning aims were reached in only one patient with macroscopic residuum (11.1%). In univariate analysis, overall treatment time (>55 days) and histological subtype (adenocarcinomas or adenosquamous carcinomas) appeared to be significant predictive factors for macroscopic remnant after treatment completion (P=0.021 and P=0.017, respectively). In multivariate analysis, treatment time was the only independent factor (P=0.046, odds ratio=7.0).
Although immediate salvage hysterectomy in incomplete responders provided a 4-year disease-free survival of 51%, its impact on late morbidity is significant. Efforts should focus on respect of treatment time and dose escalation. Adenocarcinoma might require higher high-risk clinical target volume planning aims.
La chimioradiothérapie concomitante suivie de curiethérapie utérovaginale est le traitement standard des cancers du col utérin localement évolués. La place de l’hystérectomie adjuvante reste incertaine mais tend à se limiter aux réponses incomplètes et aux rechutes locales. L’objectif de l’étude était d’analyser le bénéfice de la chirurgie de rattrapage immédiate après radiothérapie.
Parmi les patientes atteintes de cancer du col utérin localement évolué dont le traitement a été une chimioradiothérapie suivie de curiethérapie adaptative guidée par l’image et hystérectomie, les cas avec résidu postopératoire macroscopique, défini comme au moins 1cm de grand axe, ont été identifiés. Leurs données ont été revues rétrospectivement et comparées à celles des patientes traitées selon les mêmes modalités.
Cinquante-huit patientes ont été incluses, avec un suivi médian de 4,2ans. Après hystérectomie, neuf patientes étaient atteintes d’une maladie résiduelle macroscopique, dix microscopique, et les 39 autres étaient en situation de réponse histologique complète. Les probabilités de survie globale et de survie sans récidive à 4ans étaient significativement plus faibles en cas de résidu macroscopique : respectivement 50 et 51 % contre 92 et 93 %. Une toxicité intestinale de grades 3–4 a été rapportée dans 10,4 %, et urinaire dans 8,6 %, dans l’ensemble de la population, sans distinction en fonction du groupe de réponse. Les objectifs de planification n’ont été atteints que pour une seule patiente, chez qui a été mis en évidence un résidu macroscopique (11,1 %). En analyse unifactorielle, l’étalement du traitement (plus de 55jours) et le sous-type histologique (adénocarcinomes et carcinomes adénosquameux) semblaient être des facteurs prédictifs significatifs d’un résidu macroscopique (p=0,021 et p=0,017, respectivement). En analyse multifactorielle, l’étalement était le seul facteur indépendant (p=0,046, odds ratio=7,0).
Bien que l’hystérectomie immédiate de rattrapage ait permis d’obtenir une probabilité de survie sans rechute de 51 % à 4ans, son impact sur la morbidité tardive est significatif, et les efforts doivent se concentrer sur l’optimisation des plans de traitement et le respect de l’étalement. Les adénocarcinomes pourraient requérir des objectifs de planification plus élevés.</abstract><cop>France</cop><pub>Elsevier SAS</pub><pmid>26508320</pmid><doi>10.1016/j.canrad.2015.05.025</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1278-3218 |
| ispartof | Cancer radiothérapie, 2015-12, Vol.19 (8), p.710-717 |
| issn | 1278-3218 1769-6658 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1750003136 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adult Aged Brachytherapy Cancer du col utérin localement avancé Carcinoma - pathology Carcinoma - therapy Chemoradiotherapy Chimioradiothérapie concomitante Combined Modality Therapy Concomitant chemoradiation Curiethérapie adaptative guidée par l’image Disease-Free Survival Female Humans Hysterectomy Hystérectomie Image-guided adaptive brachytherapy Locally advanced cervical cancer Maladie résiduelle Middle Aged Neoplasm Staging Neoplasm, Residual Residual disease Retrospective Studies Salvage Therapy Time Factors Treatment Outcome Uterine Cervical Neoplasms - pathology Uterine Cervical Neoplasms - therapy |
| title | What to expect from immediate salvage hysterectomy following concomitant chemoradiation and image-guided adaptive brachytherapy in locally advanced cervical cancer |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-09T07%3A45%3A50IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=What%20to%20expect%20from%20immediate%20salvage%20hysterectomy%20following%20concomitant%20chemoradiation%20and%20image-guided%20adaptive%20brachytherapy%20in%20locally%20advanced%20cervical%20cancer&rft.jtitle=Cancer%20radioth%C3%A9rapie&rft.au=Castelnau-Marchand,%20P.&rft.date=2015-12&rft.volume=19&rft.issue=8&rft.spage=710&rft.epage=717&rft.pages=710-717&rft.issn=1278-3218&rft.eissn=1769-6658&rft_id=info:doi/10.1016/j.canrad.2015.05.025&rft_dat=%3Cproquest_cross%3E1750003136%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1750003136&rft_id=info:pmid/26508320&rft_els_id=S1278321815003595&rfr_iscdi=true |