Could Lymphadenectomy be Avoided in Locally Advanced Cervical Cancer Patients Administered Preoperative Chemoradiation? A Large-Scale Retrospective Study

Publication date: Available online 23 September 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Gabriella Ferrandina, Mariagrazia Distefano, Floriana Mascilini, Valerio Gallotta, Vito Chiantera, Francesco Cosentino, Barbara Costantini, Alfredo Ercoli, Luigi Pedone Anchora, Francesco Fanfani, Alessandro Pasquale Margariti, Vincenzo Valentini, Giovanni Scambia
IntroductionTo identify a subset of cervical cancer (CC) patients administered chemoradiation (CT/RT) plus radical surgery (RS), who can be spared lymphadenectomy, and complications.Patients and methods430 Stage IB2-IIB patients without LN involvement at imaging were accrued (March 1996-December 2015) at Gynecologic Oncology Unit of the Catholic University of Rome/Campobasso. CT/RT consisted of pelvic irradiation plus cisplatin based chemotherapy. Objective response was evaluated according to RECIST criteria; radical hysterectomy and pelvic ± aortic lymphadenectomy was attempted in patients achieving response or stable disease. Surgical morbidity was classified according to the Chassagne grading system.Results421 cases underwent RS; metastatic pelvic and aortic LNs were documented in 10.7%, and 8.8% of cases, respectively. In patients without residual tumor in the cervix, there was only 1 case (0.53%) with positive pelvic LNs, and 1 case (2.3%) with metastatic aortic LNs. Analysis of patients according to pre- and post-CT/RT imaging was able to select cases without any metastatic LNs: in patients with negative pelvic LNs at pre- and post-CT/RT imaging, none of cases without residual disease in the cervix had metastatic pelvic or aortic LNs. Of 149 early complications, 76 (51.0%) were lymphovascular. The most frequent late complications were lymphovascular (N=25/61, 41.0%).ConclusionLymphadenectomy could be avoided in stage IB2-IIB CC patients undergoing preoperative CT/RT, when a careful evaluation of pre- and post-CT/RT imaging and histological assessment of no residual disease in the cervix is made. This approach may avoid lymphadenectomy in 40% of patients with a favourable impact on lymphovascular morbidity.



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