title: Completion hysterectomy after radiation therapy for bulky cervical cancer stages IB, IIA, and IIB: complications and survival rates.
abstract: OBJECTIVE
  The purpose of this study was to assess survival and morbidity when completion hysterectomy follows radiation for bulky cervical cancer.
  
  
  METHODS
  This was a retrospective observational descriptive review that assessed the survival and morbidity of patients with bulky cervical cancer that was treated with radiation followed by completion hysterectomy between 1993 and 2002. Chemotherapy, external beam radiation, and brachytherapy data were collected.
  
  
  RESULTS
  Fifty-five cases were reviewed. Fifty-three patients received brachytherapy. Twenty-nine patients underwent sensitizing chemotherapy. All patients had hysterectomies. There were 12 early postoperative complications (21.8%) and 10 late complications (19.6%). Eleven patients are dead of disease (21.6%); 3 patients are alive with disease (5.9%), and 37 patients are free of disease (72.5%). Four patients were lost to follow-up. Seven patients who are free of disease had residual cancer in the specimen at hysterectomy.
  
  
  CONCLUSIONS
  Complications of combined therapy were comparable to radiation or radical hysterectomy alone. In cases in which an incomplete response to radiation and chemotherapy leaves potential residual carcinoma, adjuvant hysterectomy may be a reasonable treatment option.
authors.affiliation: Department of Obstetrics and Gynecology Education, Memorial Heralth University Medical Center, Mercer University School Of Medicine, Savannah, GA, USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Decker
authors.forename: James J
authors.initials: JJ
authors.lastname: Burke
authors.forename: Donald G
authors.initials: DG
authors.lastname: Gallup
authors.forename: Robert W
authors.initials: RW
authors.lastname: Silverio
authors.forename: David
authors.initials: D
authors.lastname: Weems
authors.forename: John
authors.initials: J
authors.lastname: Duttenhaver
authors.forename: Dent
authors.initials: D
authors.lastname: Purcell
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D000328:Adult; D000368:Aged; D001918:Brachytherapy; D018196:Carcinoma, Adenosquamous / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D008875:Middle Aged; D015999:Multivariate Analysis; D011882:Radiotherapy, High-Energy; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*