Combined brachytherapy and surgery for early carcinoma of the uterine cervix: Analysis of extent of surgery on outcome

Purpose: The aim of this retrospective study was to evaluate the survival d ata and rates and patterns of complications and recurrences for patients wh o had early uterine cervix carcinoma and underwent brachytherapy and subseq uent surgery. Methods and Materials: Between January 1990 and December 1997, 192 women wi th cervical carcinoma (Stages IA2 with vascular invasion [n = 28], IB1 [n = 144], and IIA [n = 20]) underwent brachytherapy, delivering 60 Gy and then hysterectomy with external iliac lymphadenectomy. Fiver class I, II, and I II hysterectomies were performed on 136, 38, and 18 patients, respectively. Adjuvant chemoradiotherapy was delivered to patients with positive lymph n odes. Results: The median follow-up time was 61 months. After brachytherapy, a pa thologically complete response (CR) was observed in 137 (71.3%) of 192 wome n. The distribution of CRs according to tumor stage was as follows: Stage I A2, 24 (85.7%) of 28; Stage IB1, 105 (72.9%) of 144; and Stage IIA, 8 (40%) of 20. Patients with Stage IB1 cancer had 13 lymph node metastases (9%), a s did 6 with Stage IIA disease (30%). Pelvic recurrences occurred in 9 (4.6 %) of the 192 patients; in 3, local relapses were associated with relapses at distant sites. Ten patients had systemic relapses (5.2%). Recurrences at distant sites were more frequent (p < 0.02) in partial responders, and oth er recurrences were more frequent in patients with lymph node metastases (p < 0.04). The overall 5-year disease-free survival rate was 91.2% (96.2% fo r Stage IA2, 91% for Stage IB1, and 84.4% for Stage IIA cancers). The class of hysterectomy did not influence the outcome. Late complications occurred in 28 patients (Grade 1, 24 [12.5%]; Grade 2, 4 [2%]; and Grade 3, 1 [0.5% ] of 192 patients). Conclusions: Combined treatments resulted in high local control and low mor bidity rates in patients with early-stage cervical carcinoma. Limited surge ry seemed to be adequate after intracavitary therapy. (C) 2001 Elsevier Sci ence Inc.