Pathologic characteristics and prognosis of a rare advanced cervical cancer treated with radical surgery and radiotherapy.

ABSTRACT

OBJECTIVE: To assess the prognosis of rare advanced.cervical carcinoma with post-radical-radiation surgery and to compare the clinic value between further surgery treatment group and non-surgery group after radical radiation therapy. MATERIALS AND METHODS: From January 2002 to July 2010 there were 68 patients with advanced stage cervical carcinoma retrospectively analysed in Maternal and Child Health Hospital of Jiangxi Province. All patients were confirmed by histopathology before treatment, and clinical staging was based on updated 2009 FIGO staging. All patients were Stage Ib2 (local advanced) and more severe. There were 36 patients (29 adenocarcinoma (AC), six adenosquamous carcinoma (ASC), and one undifferentiated carcinoma) classified into observation group that was treated with radical radiation therapy + surgery (total hysterectomy + bilateral salpingo-oophorectomy); other 32 patients (26 AC, five ASC, and one undifferentiated carcinoma) classified into control group that was treated with radical radiation therapy with no further surgery. The radical radiation therapy included external-beam radiation and intracavitary therapy, standard point A dose added up to 85 Gy (these doses are recommended for most patients based on summation of conventional external-beam fractionation and low-dose rate 40-70 cGy/h brachytherapy equivalents), and 45-55 Gy was given to point B. All of the patients were followed up. The average follow-up time was 65.6 months and the survival rate between two groups were compared and analyzed whether there was residual lesion, metastasis, lymph vascular space invasion (LVSI) in the observation group. RESULTS: In observation group there were 15 patients found positive. The positive rate was 41.7% (15/36), in which there nine cases with LVSI and residual foci, four cases with uterus invasion, and one case with only residual foci. Both of the two groups were followed up and the average follow-up time was 65.6 months (range 36-136). In observation group there were 25 cases that have survived until now and the average survival time was 66.6 months (range 36-136). Eleven patients died with an average survival time of 10.4 months (range 2-37). In control group there are 22 cases that survived until now (July 2013); the average survival time was 64.4 months (range 36-136). Ten patients died with an average survival time of 10.3 months (range 3-28). Three cases experienced serious complication in observation group and two cases in control group. There was no significant difference in survival time between the two groups. CONCLUSION: Due to low efficacy results, post-radical-radiation surgery is not a feasible treatment regimen for rare advanced cervical carcinoma.