title: Completion surgery or not after concurrent chemoradiotherapy for locally advanced cervical cancer?
abstract: OBJECTIVE
  The role of additional surgery in patients responding to radiation and chemotherapy for locally advanced cervical cancer is controversial. The goal of this study was to compare disease-free survival (DFS) and overall survival (OS) of two groups of patients, with or without additional surgery.
  
  
  METHODS
  One hundred and eleven patients with advanced cervical cancer who responded to chemoradiotherapy followed by brachytherapy were included in a retrospective, multicenter series.
  
  
  RESULTS
  Of the patients who had completion surgery (Group 1), 22.4% (15/67) had recurrence compared with 36.4% (16/44) of those who did not have surgery (Group 2). The difference is statistically significant (p=0.01). The relative risk of disease progression or death was 0.41 (95% confidence interval 0.20-0.85) (p=0.01) in favor of completion surgery. After multivariate analysis, only age, pathology and initial tumor size remained significant (respectively p=0.003, p=0.001 and p=0.03). Among the locations of recurrence in Group 1, 46.7% were pelvic (7/15) compared with 56.2% in Group 2 (9/16). In Group 1, 16.4% (11/67) of the patients died of disease compared to 20.4% (9/44) in Group 2. Of these, 45.4% (5/11) in Group 1 died after pelvic recurrence as compared to 77.8% (7/9) in Group 2.
  
  
  CONCLUSIONS
  Completion surgery does not improve OS but may improve DFS. There is no consensus regarding completion surgery in advanced cervical cancer with a good response to the standard treatment but we think it is safer to propose it.
authors.affiliation: Service de Chirurgie Générale et Gynécologique, Centre Hospitalier et Universitaire Rangueil, avenue Jean Poulhes 31000 Toulouse, France. leguevaque.p@chu-toulouse.fr
authors.forename: Pierre
authors.initials: P
authors.lastname: Lèguevaque
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Motton
authors.forename: Martine
authors.initials: M
authors.lastname: Delannes
authors.forename: Denis
authors.initials: D
authors.lastname: Querleu
authors.forename: Marc
authors.initials: M
authors.lastname: Soulé-Tholy
authors.forename: Gerard
authors.initials: G
authors.lastname: Tap
authors.forename: Gilles
authors.initials: G
authors.lastname: Houvenaeghel
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001918:Brachytherapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010386:Pelvic Neoplasms / Q000401:mortality / Q000556:secondary; D012189:Retrospective Studies; D055502:Secondary Prevention; D016019:Survival Analysis; D047368:Tumor Burden / Q000187:drug effects / Q000528:radiation effects; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*
chemical_list: D000970:Antineoplastic Agents