title: Results of hysterectomy in patients with bulky residual disease at the end of chemoradiotherapy for stage IB2/II cervical carcinoma.
abstract: BACKGROUND
  We assessed the clinical outcome after hysterectomy in patients with bulky residual disease after chemoradiotherapy for stage IB2/II cervical carcinoma.
  
  
  METHODS
  Subjects were 10 patients who had bulky (>2 cm) residual disease in the cervix after external radiotherapy (45 Gy) combined with concomitant chemotherapy (cisplatin 40 mg/m2/week) and uterovaginal brachytherapy (15 Gy).
  
  
  RESULTS
  Extrafascial hysterectomy was performed in three patients, type II radical hysterectomy was performed in six patients, and pelvic exenteration was performed in one patient. Pelvic lymphadenectomy was performed in eight patients, and para-aortic lymphadenectomy was performed in eight. Five patients had nodal involvement (pelvic nodes in four and para-aortic nodes in four), and six had lymphovascular space involvement. Surgical margins were free in nine patients. Seven patients developed grade 2 (n = 3) and/or grade 3 (n = 4) complications. The median duration of follow-up after surgery was 22 months (range, 1-37 months). With follow-up available in nine patients, seven relapsed, and only two remained disease free.
  
  
  CONCLUSIONS
  This series confirms the high rate of nodal spread in patients with bulky residual cervical disease after chemoradiotherapy. Furthermore, patients who underwent hysterectomy had a high complication rate. Only two patients are alive and disease free. The results of surgery are disappointing; surgery does not seem to improve the survival of these patients.
authors.affiliation: Department of Surgery, Institut Gustave Roussy, 39 Rue Camille Desmoulins, 94805, Villejuif, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Azria
authors.forename: Philippe
authors.initials: P
authors.lastname: Morice
authors.forename: Christine
authors.initials: C
authors.lastname: Haie-Meder
authors.forename: Anne
authors.initials: A
authors.lastname: Thoury
authors.forename: Patricia
authors.initials: P
authors.lastname: Pautier
authors.forename: Catherine
authors.initials: C
authors.lastname: Lhomme
authors.forename: Pierre
authors.initials: P
authors.lastname: Duvillard
authors.forename: Damienne
authors.initials: D
authors.lastname: Castaigne
mesh_terms: D000328:Adult; D000368:Aged; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007044:Hysterectomy; D008207:Lymphatic Metastasis; D008875:Middle Aged; D018365:Neoplasm, Residual; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use; D011878:Radiotherapy / Q000379:methods; D012189:Retrospective Studies; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*
chemical_list: D011838:Radiation-Sensitizing Agents; D002945:Cisplatin