The role of surgery in locally advanced carcinoma of cervix after sub-optimal chemoradiation: Indian scenario.
BACKGROUND
Standard treatment of advanced cervical cancer is concurrent chemoradiation. Radical radiotherapy for carcinoma cervix includes pelvic external beam radiotherapy (EBRT) with the concomitant platinum based chemotherapy followed by intracavitary brachytherapy (ICBT) to boost central disease. Management of patients who are suboptimally treated, especially, after unsuccessful ICBT insertion is not well-defined. This study explores the role of hysterectomy in these patients.


METHODS
From January 2006 to December 2011, 38 patients with locally advanced cervical cancer, in whom ICBT insertion was unsuccessful, were analyzed retrospectively. Operable patients with no parametrial involvement underwent hysterectomy and outcomes (recurrence free and overall survival) were noted.


RESULTS
The major complications in post operative period were wound infection, paralytic ileus and bladder atony all of which were conservatively managed with no mortality. At median follow-up of 36 months (range 12-60 months) there was no recurrence in patients with stage 1B2 and stage IIA, 25 out of 38 (65.8%) were event free and the overall survival was 71%.


CONCLUSIONS
Many patients in Indian scenario receive suboptimal therapy in locally advanced cervical cancer. EBRT with chemotherapy followed by type 1 extra-fascial hysterectomy can be a good alternative for these patients.
Department of Gynec-Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India.
Rajshekar S
RS
Kundargi
Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India.
B
B
Guruprasad
Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India.
Nikesh
N
Hanumantappa
Department of Gynec-Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India.
Praveen Shankar
PS
Rathod
Department of Gynec-Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India.
Uma K
UK
Devi
Department of Gynec-Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India.
U D
UD
Bafna
Carcinoma cervix; hysterectomy; unsuccessful intracavitary brachytherapy