title: Is Routine Curettage a Useful Tool to Evaluate Persistent Tumor in Patients Who Underwent Primary Chemoradiation for Locally Advanced and/or Lymph Node Positive Cervical Cancer?
abstract: Response evaluation after primary chemoradiation (RCTX) in patients with cervical cancer remains difficult. Routine hysterectomy after primary RCTX is associated with considerable surgical morbidity without impact on survival. The purpose of the present study was to evaluate value of routine curettage after RCTX to detect persistent tumor.
  
  
  
  Between 2006 and 2012, patients (n = 217) with cervical cancer in International Federation of Gynecology and Obstetrics stages IB1 N1 (14%), IB2 (9%), IIA (5%), IIB (46%), IIIA (4%), IIIB (15%), IVA (6%), and IVB (1%), respectively, underwent primary RCTX. After RCTX, curettage was recommended to all patients to evaluate response.
  
  
  
  In 136 (63%) of patients with cervical cancer, 1 or 2 consecutive curettages were performed at least 6 weeks after primary RCTX without any complications. In 21 (15%) patients, at least 1 curettage was positive for cervical cancer. In 7 patients, secondary hysterectomy was performed after 1 positive finding and persistent tumor was found in all of them. In the remaining 14 patients, there were 2 positive curettages in 5, 1 undetermined result followed by 1 positive in 3, and 1 positive followed by 1 negative in 6 patients, respectively. In the latter group, no tumor was detected in the uterus, whereas in all other patients with 2 curettages except one, residual carcinoma was detected. Five (24%) of 21 patients with positive histology are free of disease during follow-up. Decision for or against secondary hysterectomy was correct due to histological finding of curettage in 99%.
  
  
  
  Routine curettage is a useful tool to guide decision for secondary hysterectomy with high accuracy after primary RCTX and avoids overtreatment.
authors.affiliation: *Department of Radiooncology, Charité-Universitätsmedizin, Berlin; †Institute for Applied Biostatistics and Clinical Epidemiology, University Tübingen, Tübingen, Germany; ‡Department of Gynecologic Oncology, Barretos Cancer Centre, Barretos, Brazil; and §Department of Gynecology, Charité-Universitätsmedizin, Berlin, Germany.
authors.forename: Simone
authors.initials: S
authors.lastname: Marnitz
authors.forename: Eva Christine
authors.initials: EC
authors.lastname: Abt
authors.forename: Peter
authors.initials: P
authors.lastname: Martus
authors.forename: Audrey
authors.initials: A
authors.lastname: Tsunoda
authors.forename: Christhardt
authors.initials: C
authors.lastname: Köhler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D004107:Dilatation and Curettage / Q000379:methods*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000628:therapy*; D055815:Young Adult