title: Evaluation and impact of residual disease in locally advanced cervical cancer after concurrent chemoradiation therapy: results of a multicenter study.
abstract: BACKGROUND
  The aim of this study was to evaluate the diagnosis and impact of residual disease (RD) after concurrent chemoradiation therapy (CRT) in locally advanced cervical cancer (FIGO IB2-IVA).
  
  
  METHODS
  This retrospective multicenter study included 159 patients who were treated with completion surgery after CRT between 2006 and 2012. Magnetic resonance imaging (MRI) was performed 4-6 weeks after CRT and compared to pathological evidence of residual disease. Kaplan-Meier survival curves were plotted and univariate/multivariate analyses were performed to assess the association between RD and the outcome.
  
  
  RESULTS
  Residual disease was present in 45.3% of the patients and detected by MRI in 57.1%. The MRI had a 29.2% false positive rate and an 11.1% false negative rate. The overall survival (OS) rates at 3 and 5 years were 78.6% (CI 95% [71%-86.9%]) and 76.5% (CI 95% [68.2%-85.7%]), respectively. The disease free survival (DFS) rates at 3 and 5 years were 73.4% (CI 95% [65.6%-82%]) and 71.1% (CI 95% [62.7%-80.1%]), respectively. RD greater than 10 mm decreased DFS (HR = 4.84, p = 0.03), whereas RD between 1 and 10 mm (HR = 0.31, p = 0.58) and less than 1 mm (HR = 0.37, p = 0.54) had no impact on DFS. The OS was not changed by RD.
  
  
  CONCLUSIONS
  The MRI accuracy value is not sufficient to select patients who might benefit from completion surgery. Residual disease over 10 mm decreased DFS but did not impact OS.
authors.affiliation: Department of Obstetrics and Gynecology, Lariboisière Hospital, AP-HP, 2 rue Ambroise Paré, 75010 Paris, France; University Paris-Diderot, Sorbonne Paris Cité, 10 Avenue de Verdun 75010 Paris, France. Electronic address: delphine.hequet@gmail.com.
authors.forename: D
authors.initials: D
authors.lastname: Hequet
authors.forename: E
authors.initials: E
authors.lastname: Marchand
authors.forename: V
authors.initials: V
authors.lastname: Place
authors.forename: V
authors.initials: V
authors.lastname: Fourchotte
authors.forename: A
authors.initials: A
authors.lastname: De La Rochefordière
authors.forename: S
authors.initials: S
authors.lastname: Dridi
authors.forename: C
authors.initials: C
authors.lastname: Coutant
authors.forename: F
authors.initials: F
authors.lastname: Lecuru
authors.forename: A-S
authors.initials: AS
authors.lastname: Bats
authors.forename: M
authors.initials: M
authors.lastname: Koskas
authors.forename: J-J
authors.initials: JJ
authors.lastname: Bretel
authors.forename: A
authors.initials: A
authors.lastname: Bricou
authors.forename: Y
authors.initials: Y
authors.lastname: Delpech
authors.forename: E
authors.initials: E
authors.lastname: Barranger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002277:Carcinoma / Q000175:diagnosis / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007044:Hysterectomy; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018365:Neoplasm, Residual; D012189:Retrospective Studies; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000628:therapy*; D055815:Young Adult
chemical_list: D002945:Cisplatin; D005472:Fluorouracil
keywords: Advanced cervical cancer; Completion surgery; Residual disease