title: [Epidermoid carcinoma of the uterine cervix at operable bulky stages IB and II treated with combined primary radiation therapy and surgery].
abstract: OBJECTIVE
  To identify prognostic factors and treatment toxicity in a series of operable bulky stages I and II cervical carcinomas treated with a therapeutic modality combining primary irradiation and surgery.
  
  
  METHODS
  Between July 1982 and May 1996, 66 patients with bulky squamous-cell cervical carcinomas (stage IB2, IIA, and IIB with 1/3 proximal parametrial invasion) underwent primary external beam pelvic radiation therapy (37.40 Gy to 40 Gy over 4.5 weeks) and low-dose-rate uterovaginal brachytherapy (20 Gy) followed, 5 to 6 weeks later, by class II modified radical hysterectomy with bilateral pelvic lymphadenectomy. The four last patients received concomitant chemotherapy during the first and the fourth radiation week combining 5-FU and cisplatin. A clinical pelvic lymph node involvement had been observed in 7 patients. The clinical median tumor size was 5 cm in diameter (range: 4.5-8 cm). The median follow-up was 97 months.
  
  
  RESULTS
  Pathologic complete tumor response in specimen of hysterectomy were observed in 46 patients. Six patients had pathologic unilateral iliac lymph node involvement. The 5- and 10-year specific survival rates were 79 and 74%, respectively. The 5- and 10-year disease-free survival rates were 76% and 71%, respectively. The 10-year local control rate was 85%. The 10-year probability for pelvic recurrence was significantly influenced by the pathologic tumor response: 26% in the residual group vs 5% in the complete tumor response group, P = 0.024). After multivariate analysis, the independent factors decreasing the probability of disease-free survival were: pathologic pelvic lymph node involvement (P = 0.029), and parametrial invasion (P = 0.031). Five late severe complications requiring surgical intervention were observed: 2 bowel obstructions, 1 ureteral stenosis, 1 vesicovaginal fistula, and 1 radiation induced unilateral femoral necrosis.
  
  
  CONCLUSIONS
  A good local control is obtained after combined primary radiation therapy and surgery for bulky stages I and II cervical carcinomas. In our more recent practice, the treatment combines primary concomitant chemoradiation followed by surgery including pelvic and para-aortic lymphadenectomy.
authors.affiliation: Hôpital Tenon AP-HP, 4, rue de la Chine, 75020 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Bernard
authors.forename: E
authors.initials: E
authors.lastname: Touboul
authors.forename: J P
authors.initials: JP
authors.lastname: Lefranc
authors.forename: E
authors.initials: E
authors.lastname: Deniaud-Alexandre
authors.forename: C
authors.initials: C
authors.lastname: Genestie
authors.forename: S
authors.initials: S
authors.lastname: Uzan
authors.forename: J
authors.initials: J
authors.lastname: Blondon
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*