Stage IB2 cervical cancer: brachytherapy followed by radical hysterectomy.
OBJECTIVE
Stage IB2 squamous cell cervical cancer can be treated by radiation therapy alone or by radical hysterectomy and lymphadenectomy (pelvic-/+para-aortic). Preoperative radiation therapy followed by extrafascial hysterectomy has been recommended as an effective combined treatment method.


METHODS
During the period January 1994-January 2004, 114 patients with stage IB2 cervical cancer were treated with preoperative brachytherapy followed by radical hysterectomy (Piver class III) with pelvic lymphadenectomy.


RESULTS
Histology showed that 56 (49%) patients were without cervical malignant disease. Positive lymph nodes were found in 5 (9%) of them and negative in 51 (91%). In 58 (51%) patients cervical cancer still existed after brachytherapy and among them 26 (45%) were with lymph node metastasis. Patients with residual cervical carcinoma and positive lymph nodes after brachytherapy were older than those with no residual carcinoma and negative lymph nodes.


CONCLUSIONS
Women with stage IB2 squamous cell cervical cancer primarily treated with brachytherapy must be assessed by appropriate diagnostic procedures to evaluate local effects of brachytherapy and the status outside the pelvis. Negative local findings with positive lymph nodes point to further treatment of patients, while positive local findings point to radical surgery which may increase recurrence-free interval.
Mandić
A
A
Department of Gynecologic Oncology, Institute of Oncology Sremska Kamenica, Serbia and Montenegro.
Novaković
P
P
Erak
M
M
Vitorović
S
S
Zikić
D
D
Nincić
D
D