title: Completion surgery after intensity-modulated arc therapy in the treatment of locally advanced cervical cancer: feasibility, surgical outcome, and oncologic results.
abstract: BACKGROUND
  Since the addition of chemotherapy to radiotherapy, the survival rates of locally advanced cervical cancer (LACC) have improved but are still disappointing. Therefore, the idea of surgery after chemoradiation in case of LACC or bulky disease was adopted. One of the concerns regarding surgery following chemoradiotherapy is surgery-related morbidity.
  
  
  OBJECTIVE
  The objectives of this study were to investigate the feasibility of surgery after advanced radiotherapy techniques such as intensity-modulated arc therapy (IMAT) and to describe the morbidity.
  
  
  METHODS
  This was a prospective study of primary inoperable LACC patients primary treated with IMAT, in most cases combined with weekly cisplatin. Then the resectability was reevaluated. If resectable patients were treated with Wertheim type 2 surgery ± pelvic lymphadenectomy (on positron emission tomography-computed tomography indication). If tumor is not resectable, patients were treated with brachytherapy.
  
  
  RESULTS
  Since 2006, 41 consecutive patients were included. After neoadjuvant IMAT, 34 were considered resectable and underwent surgery, whereas 7 proceeded with brachytherapy. The operative mortality rate was nil. There were no major perioperative complications. No ureter, bladder, or bowel injuries occurred. No postoperative urinary/digestive fistulae or stenoses were noted. Eleven patients had postoperatively urinary retention problems. At the time of discharge, 5 patients still needed self-catheterization. All problems resolved within 3 months. In 4 cases, we saw significant lymphoceles. In all patients intended to treat, overall survival and disease-free survival at 3 years were 63% and 74%. In the Wertheim group, overall survival and disease-free survival at 3 years were 81% and 91%.
  
  
  CONCLUSIONS
  Completing surgery after chemoradiation therapy (with IMAT) for LACC or bulky disease is feasible, and complication rates are comparable with those of primary surgery for cervical cancer.
authors.affiliation: Division of Gynecologic Oncology, Departments of Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium. philippe.tummers@ugent.be
authors.forename: Philippe
authors.initials: P
authors.lastname: Tummers
authors.forename: Amin
authors.initials: A
authors.lastname: Makar
authors.forename: Katrien
authors.initials: K
authors.lastname: Vandecasteele
authors.forename: Gert
authors.initials: G
authors.lastname: De Meerleer
authors.forename: Hannelore
authors.initials: H
authors.lastname: Denys
authors.forename: Pieter
authors.initials: P
authors.lastname: De Visschere
authors.forename: Louke
authors.initials: L
authors.lastname: Delrue
authors.forename: Geert
authors.initials: G
authors.lastname: Villeirs
authors.forename: Kathleen
authors.initials: K
authors.lastname: Lambein
authors.forename: Rudy Van
authors.initials: RV
authors.lastname: den Broecke
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000401:mortality*; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D050397:Radiotherapy, Intensity-Modulated / Q000401:mortality*; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*