title: Impact of surgical staging in locally advanced cervical cancer and subsequent chemotherapy.
abstract: BACKGROUND
  Surgical staging (SS) is the gold standard for determination of the true extent of a patient's disease and is an important prognostic factor in cervical cancer. We investigated whether lymph node dissection (LND) prior to chemotherapy (CT) followed by radical surgery (RS) could modified overall (OS) and disease-free survival (DFS).
  
  
  METHODS
  We performed a cohort analysis of 98 patients with cervical carcinoma. The experimental group consisted of 36 patients who underwent SS followed by neoadjuvant chemotherapy, and then by RS (objective response) or chemo-radiation therapy (with or without subsequent surgery when not possible). The control group consisted of 62 similarly treated patients without pretreatment SS. The value of this procedure as a diagnostic tool in defining the extent of disease was evaluated. Furthermore, LND/CT-associated treatment complications and the impacts on OS and DFS were also evaluated.
  
  
  RESULTS
  Fourteen (38.9%) patients had pelvic LN metastases and three (8.3%) patients had pelvic and para-aortic LN metastases. The 39-month OS and DFS rates for the current study were 80.6% for the staged group and 52% for non-staged treatment (P < 0.001).
  
  
  CONCLUSIONS
  SS in cervical cancer is a feasible and safe pretreatment procedure, and when associated with CT, it improves OS and DFS.
authors: Oncology Section, Department of Gynecology and Obstetrics, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil. marana@keynet.com.br
authors: Heitor Ricardo Cosiski
authors: HR
authors: Marana
authors: Jurandyr Moreira
authors: JM
authors: de Andrade
authors: Francisco José Cândido
authors: FJ
authors: Dos Reis
authors: Daniel Guimarães
authors: DG
authors: Tiezzi
authors: Fábio Eduardo
authors: FE
authors: Zola
authors: Willan Simões
authors: WS
authors: Clagnan
authors: Alexandre Pavan
authors: AP
authors: Garieri
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002277:Carcinoma / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D016022:Case-Control Studies; D002945:Cisplatin / Q000008:administration & dosage; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy
chemical_list: D002945:Cisplatin; D005472:Fluorouracil