title: Long-term survival after concomitant chemoradiotherapy prior to surgery in advanced cervical carcinoma.
abstract: OBJECTIVE
  To report the long-term survival of 35 patients who underwent surgery after concomitant chemoradiation for locally advanced cervical cancers.
  
  
  METHODS
  From 1988 to 1992, 20 bulky IB-IIB patients and 15 stage III-IVA patients underwent surgery after concurrent chemotherapy (CDDP and 5-FU) and radiotherapy. 26 had a hysterectomy, 8 had an exenteration, 1 had no tumor resection. 21 had a para-aortic lymphadenectomy. Endpoints were recurrence and distant metastasis rates, overall survival (OS) and disease-free survival (DFS) at 5 and 10 years. Analysis included FIGO stage, type of surgery (palliative or curative), response to chemoradiation or para-aortic lymphatic status.
  
  
  RESULTS
  Surgery had been only palliative in 6 cases (17.1%). A pelvic control has been achieved in 31 patients (88.6%). Pelvic recurrences occurred after a median interval of 7 months. Distant metastases occurred in 10 patients (28.6%), after a median interval of 20 months. So far, 16 patients have died (45.7%). The 10-year DFS is 56.7% in the whole series. Only the type of surgery significantly affected the OS. Only the para-aortic lymphatic status significantly affected the DFS.
  
  
  CONCLUSIONS
  Associating chemoradiation with curative surgery, we obtained a 10-year DFS of 66.4% (OS 57.7%). Adjuvant surgery may increase the survival as it reduces the risk of local relapse.
authors.affiliation: Department of Surgery, Institut Paoli-Calmettes, 232 Bd Sainte Marguerite, Marseilles, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Houvenaeghel
authors.forename: Loic
authors.initials: L
authors.lastname: Lelievre
authors.forename: Laurence
authors.initials: L
authors.lastname: Gonzague-Casabianca
authors.forename: Max
authors.initials: M
authors.lastname: Buttarelli
authors.forename: Vincent
authors.initials: V
authors.lastname: Moutardier
authors.forename: Anthony
authors.initials: A
authors.lastname: Goncalves
authors.forename: Michel
authors.initials: M
authors.lastname: Resbeut
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007044:Hysterectomy; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D010385:Pelvic Exenteration; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000628:therapy*
chemical_list: D002945:Cisplatin; D005472:Fluorouracil