Advantage of complex treatment of IIA–IIIB cervical cancer with extended lymphodissection

• Hakimova G.G.
• Hakimov G.A.
• Sabirova S.A.
• Mamazhonov H.I.
• Tashmetov M.N.
• Hakimova S.G.
• Rakhmonov A.N.

Abstract

The aim of the study was to evaluate the overall and recurrence–free survival of patients with cervical cancer of stages IIA–IIIB stages treated with neoadjuvant chemotherapy (NAChT) and radical extended surgery.

Material and methods. The long-term results of treatment of 154 patients with morphologically verified cervical cancer of IIA and IIIB stages were studied in the clinical. Histologically, the tumor is predominantly represented by squamous cell carcinoma 87% (n=134), in other cases adenocarcinoma. Patients underwent combined treatment as part of NAChT with platinum preparations and taxane derivatives and extended uterine extirpation with appendages (n=154). Depending on the morphological characteristics of the tumor in the adjuvant mode, 46.7% (n=72) (group 1) remained under observation; 35.1% (n=54) received non-adjuvant chemotherapy (group 2) and 18.2% (n=28) chemoradiotherapy (group 3). The median follow-up time was 43.5 [16.7;58.9] months (from 3.3 to 80.7 months).

Results. Radical operations (R0) after chemotherapy were performed in 93.5% (n=144) cases, and R1 resections were significantly higher in group 2 patients, 18% (n=5), p=0.018 with glandular tumor differentiation of 21.4% (n=6); 42.9% (n=66) of deaths were registered during the follow-up. The 3-year disease-free survival rate was 60.5%, the overall survival rate (S) was 61.3%, where the lowest value was recorded in the group with AChT of 53.6%.

Conclusion. NAChT for cervical cancer of stages IIA–IIIB stages allows in some cases to achieve conditions for performing radical operations. The use of complex treatment, including neoadjuvant chemotherapy followed by radical surgery, can improve relapse-free survival rates. Carrying out the developed modification of the operation of extended uterine extirpation of type III with extended lymphodissection after NAChT makes it possible to achieve high survival rates in patients with cervical cancer of stages IIA–IIIB, regardless of the volume and type of adjuvant therapy.

Keywords: cervical cancer; neoadjuvant chemotherapy; radical hysterectomy; recurrence-free survival; chemoradiotherapy; overall survival

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