title: [Survival and prognostic factors after completion surgery in patients undergoing initial chemoradiation therapy for locally advanced cervical cancer].
abstract: OBJECTIVE
  The aim of this study was to evaluate the prognostic factors of patients undergoing completion surgery for locally advanced-stage cervical cancer after initial chemoradiation therapy (CRT).
  
  
  METHODS
  Patients fulfilling the following inclusion criteria were studied: stage IB2-IVA cervical carcinoma; tumour initially confined to the pelvic cavity on conventional imaging; pelvic external radiation therapy with delivery of 45 Gy to the pelvic cavity and concomitant chemotherapy (cisplatin 40 mg/m(2) per week) followed by utero-vaginal brachytherapy; completion surgery after the end of radiation therapy including at least a hysterectomy.
  
  
  RESULTS
  One-hundred and fifty patients treated between 1998 and 2007 fulfilled inclusion criteria. Nineteen patients had pelvic nodes involved and 19 had para-aortic nodes involved. Seventy-two patients (48%) had complete surgical sterilization of the cervix. Prognostic factors for overall survival in the multivariable analysis were the presence and level of nodal spread (positive pelvic nodes alone: HR = 2.03, positive para-aortic nodes: HR = 5.46; P < 001) and the presence and size of residual disease (RD) in the cervix (RD ≤ 1 cm: HR = 1.92, RD > 1cm: HR = 3.85; P = 02).
  
  
  CONCLUSIONS
  In this series, the presence and size of RD and histologic nodal involvement were the strongest prognostic factors. Such results suggest that the survival of these patients could potentially be enhanced by improving the rate of complete response in the irradiated area and by initially detecting patients with para-aortic spread.
authors.affiliation: Département de Chirurgie Gynécologique, Institut Gustave-Roussy, 39 rue Camille-Desmoulins, 94805 Villejuif, France. cyril.touboul@gmail.com
authors.forename: C
authors.initials: C
authors.lastname: Touboul
authors.forename: C
authors.initials: C
authors.lastname: Uzan
authors.forename: A
authors.initials: A
authors.lastname: Mauguen
authors.forename: S
authors.initials: S
authors.lastname: Gouy
authors.forename: A
authors.initials: A
authors.lastname: Rey
authors.forename: P
authors.initials: P
authors.lastname: Pautier
authors.forename: C
authors.initials: C
authors.lastname: Haie-Meder
authors.forename: P
authors.initials: P
authors.lastname: Morice
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002277:Carcinoma / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin