title: Matched-case comparison for the role of surgery in FIGO stage Ib1-IIa squamous cell carcinoma of cervix and suspicious para-aortic lymph node metastasis.
abstract: We sought to compare the efficacy and toxicity between surgery followed by concurrent chemoradiation and primary concurrent chemoradiation in patients with International Federation of Gynecology and Obstetrics (FIGO) stage Ib1-IIa squamous cell carcinoma of cervix and suspicious para-aortic lymph node metastasis by preoperative computed tomographic and magnetic resonance imaging. From January 2000 to December 2007, 48 patients treated with radical hysterectomy with pelvic and para-aortic lymphadenectomy followed by concurrent chemoradiation (group 1) were matched to 16 patients treated with primary concurrent chemoradiation (group 2) from medical records. Primary end points were progression-free survival (PFS) and overall survival, and secondary end points were late complications by concurrent chemoradiation and pattern of disease recurrence. Among 48 patients in group 1, 39 (81.3%) and 35 (72.9%) had histologic pelvic and para-aortic lymph node metastases, respectively. Distant metastasis was more frequent in group 2 than in group 1 (37.6% vs. 12.5%, p = 0.027), although there was no difference in locoregional recurrence between the two groups. Surgery followed by concurrent chemoradiation and FIGO stage Ib1 were only statistically significant factors for improved PFS (adjusted hazard ratio, 0.231 and 0.244; 95% confidence interval, 0.072-0.821 and 0.086-0.697), although there was no prognostic factor for overall survival. Furthermore, there was no difference in grade 3 or 4 late complications between groups 1 and 2 (25.0% vs. 31.3%, p = 0.745). Surgery followed by concurrent chemoradiation may improve PFS and reduce distant metastasis without difference in late complications compared with primary concurrent chemoradiation in patients with FIGO stage Ib1-IIa squamous cell carcinoma of cervix and suspicious para-aortic lymph node metastasis.
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 28 Yungun-Dong, Chongno-Gu, Seoul, 110-744, Republic of Korea.
authors.forename: Hee Seung
authors.initials: HS
authors.lastname: Kim
authors.forename: Noh Hyun
authors.initials: NH
authors.lastname: Park
authors.forename: Hong Gyun
authors.initials: HG
authors.lastname: Wu
authors.forename: Jeong Yeon
authors.initials: JY
authors.lastname: Cho
authors.forename: Hyun Hoon
authors.initials: HH
authors.lastname: Chung
authors.forename: Jae Weon
authors.initials: JW
authors.lastname: Kim
authors.forename: Yong Sang
authors.initials: YS
authors.lastname: Song
authors.forename: Seung Hyup
authors.initials: SH
authors.lastname: Kim
authors.forename: Soon Beom
authors.initials: SB
authors.lastname: Kang
mesh_terms: D000230:Adenocarcinoma / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery*; D016022:Case-Control Studies; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010220:Para-Aortic Bodies; D011379:Prognosis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*
chemical_list: D000970:Antineoplastic Agents