title: Results of radical surgery in women with stage IB2/IIA2 cervical cancer.
abstract: BACKGROUND
  There is ongoing discussion about the primary treatment of women with bulky early-stage cervical cancer. Because of the high number of patients who need adjuvant (chemo)radiotherapy after initial surgical treatment, some state that primary (chemo)radiotherapy should be the treatment of choice to prevent morbidity. The aim of our study is to assess the results of radical surgery for women with bulky early-stage cervical cancer in terms of recurrence patterns and survival.
  
  
  METHODS
  We conducted a retrospective cohort study. We included 129 women who underwent a radical hysterectomy with pelvic lymphadenectomy for stage IB2/IIA2 cervical cancer between 1984 and June 2010. Disease-specific survival was measured using a Kaplan-Meier method and univariate and multivariate regression analyses were performed to determine prognostic factors associated with survival. A literature search was performed to analyze our data in the context of findings from the literature.
  
  
  RESULTS
  Five-year disease-specific survival was 84%. Fifty percent of the women received adjuvant treatment. The pelvic recurrence rate was 8%. With our multivariate analysis we found that histology, tumor diameter, and parametrial involvement were independently associated with disease-specific survival. Our literature search showed wide diversity in rates of adjuvant treatment after initial surgery as well as for survival and recurrence rates.
  
  
  CONCLUSIONS
  In the context of current knowledge about survival and side effects of various treatments for bulky early-stage cervical cancer, radical surgery is a good treatment option in these patients. Depending on the type of surgery used, adjuvant radiotherapy can be minimized.
authors.affiliation: Department of Gynecology, Academic Medical Center - Center for Gynecological Oncology Amsterdam, Amsterdam, the Netherlands.
authors.forename: Marloes
authors.identifier: http://orcid.org/0000-0002-8833-9310
authors.initials: M
authors.lastname: Derks
authors.affiliation: Department of Gynecology, Academic Medical Center - Center for Gynecological Oncology Amsterdam, Amsterdam, the Netherlands.
authors.forename: Petra
authors.initials: P
authors.lastname: Biewenga
authors.affiliation: Department of Gynecology, Academic Medical Center - Center for Gynecological Oncology Amsterdam, Amsterdam, the Netherlands.
authors.forename: Jacobus
authors.identifier: http://orcid.org/0000-0002-5985-1163
authors.initials: J
authors.lastname: van der Velden
authors.affiliation: Department of Gynecology, Academic Medical Center - Center for Gynecological Oncology Amsterdam, Amsterdam, the Netherlands.
authors.forename: Gemma G
authors.identifier: http://orcid.org/0000-0002-7284-3918
authors.initials: GG
authors.lastname: Kenter
authors.affiliation: Department of Radiotherapy, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Lukas J A
authors.identifier: http://orcid.org/0000-0001-9574-0295
authors.initials: LJ
authors.lastname: Stalpers
authors.affiliation: Department of Gynecology, Academic Medical Center - Center for Gynecological Oncology Amsterdam, Amsterdam, the Netherlands.
authors.forename: Marrije R
authors.initials: MR
authors.lastname: Buist
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D008197:Lymph Node Excision; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Cervical carcinoma; radical hysterectomy; stage IB2; stage IIA2; surgery