| Resectability rates of previously irradiated recurrent cervical cancer (PIRCC) treated with pelvic exenteration: is still the clinical involvement of the pelvis wall a real contraindication? a twenty-year experience. | |
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MedLine Citation:
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PMID: 19878978 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: (1) To determine the accuracy of a standard clinical and radiological assessment of resectability in patients with previously irradiated recurrent cervical cancer (PIRCC), and (2) to report the outcome and prognostic factors in this high-risk population treated with an exenterative procedure. METHODS: Forty-eight patients with centrally located (n=20, 41.7%) or lateralized (n=28, 58.3%) PIRCC treated with exenterative procedures were analyzed. All patients underwent standard assessment of resectability with pelvic exam and radiological studies. Patients with centrally located tumors were considered as resectable and lateralized tumors were deemed unresectable. RESULTS: Complete surgical resection with negative margins (R0) was achieved in 28.6% of the patients with lateral recurrences and in 65.0% of the patients with central recurrences (p<0.019). After a median follow-up of 114.6 months (3.0-244.9 months), the 10-year local control rate for the whole group was 36.3%, 43.1% in the central PIRCC group and 31.5% in the lateral PIRCC group, respectively (p=0.290). Multivariate analysis showed that improved local control was significantly associated with the presence of negative margins (p=0.004). The 10-year distant failure rate was 69%, 56.6% in the central PIRCC group and 83.2% in the lateral PIRCC group (p=0.178), respectively. Multivariate analysis showed that the development of distant metastases was significantly correlated with the absence of local control (p=0.01). The 10-year disease-specific survival (DSS) for central and lateral PIRCC was 27.2% and 14.9%, respectively (p=0.239). Multivariate analysis showed that negative margins (p=0.001), local control (p=0.001) and distant control (p=0.006) were all significantly associated with improved DSS. Location of PIRCC (central vs. lateral) was irrelevant for DSS in completely resected (R0) patients. Overall morbidity rate was 65.0% and 73.3% for central and lateral PIRCC patients, respectively (p=0.528). CONCLUSION: About one-third of the patients with lateral PIRCC classified as unresectable with non-surgical means may ultimately undergo complete (R0) resections and about one-third of the patients with centrally located PIRCC and judged as resectable will undergo non-curative (R1) resections. A curative (R0) resection significantly impacts local control rates, distant metastases-free rates and DSS. |
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Authors:
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Matías Jurado; Juan Luis Alcázar; Rafael Martinez-Monge |
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Publication Detail:
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Type: Journal Article Date: 2009-10-29 |
Journal Detail:
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Title: Gynecologic oncology Volume: 116 ISSN: 1095-6859 ISO Abbreviation: Gynecol. Oncol. Publication Date: 2010 Jan |
Date Detail:
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Created Date: 2009-12-07 Completed Date: 2009-12-11 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0365304 Medline TA: Gynecol Oncol Country: United States |
Other Details:
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Languages: eng Pagination: 38-43 Citation Subset: IM |
Affiliation:
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Department of Gynecology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain. mjurado@unav.es |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Antineoplastic Combined Chemotherapy Protocols / therapeutic use Disease-Free Survival Female Humans Middle Aged Neoadjuvant Therapy Neoplasm Invasiveness Pelvic Exenteration Pelvis / pathology Treatment Outcome Uterine Cervical Neoplasms / drug therapy, pathology, radiotherapy, surgery* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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