title: Preoperative concurrent radiation therapy and chemotherapy for bulky stage IB2, IIA, and IIB carcinoma of the uterine cervix with proximal parametrial invasion.
abstract: OBJECTIVE
  To evaluate toxicity, local tumor control, and survival after preoperative chemoradiation for operable bulky cervical carcinoma.
  
  
  METHODS
  Between December 1991 and July 2006, 92 patients with operable bulky stage IB2, IIA, and IIB cervical carcinoma without pelvic or para-aortic nodes on pretreatment imaging were treated. Treatment consisted of preoperative external beam pelvic radiation therapy (EBRT) and concomitant chemotherapy (CT) during the first and fourth weeks of radiation combining 5-fluorouracil and cisplatin. The pelvic radiation dose was 40.5 Gy over 4.5 weeks. EBRT was followed by low-dose rate uterovaginal brachytherapy with a total dose of 20 Gy in 62 patients. After a median rest period of 44 days, all patients underwent Class II modified radical hysterectomy with bilateral pelvic lymphadenectomy. Thirty patients who had not received preoperative uterovaginal brachytherapy underwent postoperative low-dose-rate vaginal brachytherapy at a dose of 20 Gy. The mean follow-up was 46 months.
  
  
  RESULTS
  Pathologic residual tumor was observed in 43 patients. After multivariate analysis, additional preoperative uterovaginal brachytherapy was the single significant predictive factor for pathologic complete response rate (p = 0.019). The 2- and 5-year disease-free survival (DFS) rates were 80.4% and 72.2%, respectively. Pathologic residual cervical tumor was the single independent factor decreasing the probability of DFS (p = 0.020). Acute toxicities were moderate. Two severe ureteral complications requiring surgical intervention were observed.
  
  
  CONCLUSIONS
  Concomitant chemoradiation followed by surgery for operable bulky stage I-II cervical carcinoma without clinical lymph node involvement can be used with acceptable toxicity. Pathologic complete response increases the probability of DFS.
authors.affiliation: Department of Radiation Oncology, Tenon Hospital A.P.-H.P., Cancerest, GHU Est, Paris VI University, Paris, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Huguet
authors.forename: Oana-Maria
authors.initials: OM
authors.lastname: Cojocariu
authors.forename: Pierre
authors.initials: P
authors.lastname: Levy
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Lefranc
authors.forename: Emile
authors.initials: E
authors.lastname: Darai
authors.forename: Denis
authors.initials: D
authors.lastname: Jannet
authors.forename: Yan
authors.initials: Y
authors.lastname: Ansquer
authors.forename: Pierre-Eugène
authors.initials: PE
authors.lastname: Lhuillier
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Benifla
authors.forename: Nathalie
authors.initials: N
authors.lastname: Seince
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Touboul
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy; D004717:Endometrium / Q000473:pathology; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011300:Preoperative Care; D012008:Recurrence; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery