title: Gynecologic examination and cervical biopsies after (chemo) radiation for cervical cancer to identify patients eligible for salvage surgery.
abstract: OBJECTIVE
  The aim of this study was to evaluate efficacy of gynecologic examination under general anesthesia with cervical biopsies after (chemo) radiation for cervical cancer to identify patients with residual disease who may benefit from salvage surgery.
  
  
  METHODS
  In a retrospective cohort study data of all cervical cancer patients with the International Federation of Gynecology and Obstetrics (FIGO) Stage IB1 to IVA treated with (chemo) radiation between 1994 and 2001 were analyzed. Patients underwent gynecologic examination under anesthesia 8 to 10 weeks after completion of treatment. Cervical biopsy samples were taken from patients judged to be operable. In case of residual cancer, salvage surgery was performed.
  
  
  RESULTS
  Between 1994 and 2001, 169 consecutive cervical cancer patients received primary (chemo) radiation, of whom 4 were lost to follow-up. Median age was 56 years (interquartile range [IQR], 44-71) and median follow-up was 3.5 years (IQR, 1.5-5.9). In each of 111 patients a biopsy sample was taken, of which 90 (81%) showed no residual tumor. Vital tumor cells were found in 21 of 111 patients (19%). Salvage surgery was performed in 13 of 21 (62%) patients; of these patients, 5 (38%) achieved long-term, complete remission after salvage surgery (median follow-up, 5.2 years; range, 3.9-8.8 years). All patients with residual disease who did not undergo operation (8/21) died of progressive disease. Locoregional control was more often obtained in patients who underwent operation (7 of 13) than in patients who were not selected for salvage surgery (0 of 8 patients) (p < 0.05).
  
  
  CONCLUSIONS
  Gynecologic examination under anesthesia 8 to 10 weeks after (chemo) radiation with cervical biopsies allows identification of those cervical cancer patients who have residual local disease, of whom a small but significant proportion may be salvaged by surgery.
authors.affiliation: Department of Gynecologic Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Esther R
authors.initials: ER
authors.lastname: Nijhuis
authors.forename: Ate G J
authors.initials: AG
authors.lastname: van der Zee
authors.forename: Bertha A
authors.initials: BA
authors.lastname: in 't Hout
authors.forename: Jantine J
authors.initials: JJ
authors.lastname: Boomgaard
authors.forename: Joanne A
authors.initials: JA
authors.lastname: de Hullu
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Pras
authors.forename: Harry
authors.initials: H
authors.lastname: Hollema
authors.forename: Jan G
authors.initials: JG
authors.lastname: Aalders
authors.forename: Hans W
authors.initials: HW
authors.lastname: Nijman
authors.forename: Pax H B
authors.initials: PH
authors.lastname: Willemse
authors.forename: Marian J E
authors.initials: MJ
authors.lastname: Mourits
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D001706:Biopsy; D018196:Carcinoma, Adenosquamous / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D002584:Cervix Uteri / Q000473:pathology*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D018365:Neoplasm, Residual; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery