Role of Extrafascial Hysterectomy Following Concurrent Chemoradiation in Patients Diagnosed with Adenocarcinoma of Cervix Stage IB2-IIB

Introduction

Despite clinical differences between squamous and adenocarcinoma cervix, treatment guidelines involve concurrent chemoradiation, especially for stage IB2 and beyond. Effectiveness of surgical interventions for cervical adenocarcinoma remains a subject of debate. This study presents outcomes regarding extrafascial hysterectomy after concurrent chemoradiation, conducted at an Indian cancer centre.

Aims

Primary objective was to assess disease-free and overall survival rates, while secondary objectives were clinicopathological features, recurrence patterns, and risk factor analysis.

Settings and Design

Inclusion criteria comprised adenocarcinoma stage IB2-IIB with clinicoradiological response after CCRT treated between 2013 and 2018. Exclusion criteria were non-adenocarcinoma histology, stages beyond IIB, individuals treated solely with concurrent chemoradiation.

Methods and Material

Clinical data obtained from electronic medical records. Eligible patients received CCRT, radiation dose of 45-55 Gy, along with weekly cisplatin at 40 mg/m2 for 5–6 weeks. Post-treatment clinical response evaluated. Those with positive response were treated with extrafascial hysterectomy, and those with pathological residual disease were offered vaginal brachytherapy.

Statistical Analysis.

Descriptive statistics utilised for all variables. Data analysis executed via SPSS Statistics 25 software. Kaplan–Meier analyses assessing recurrence-free and overall survival.

Results

Median follow-up duration was 49 months. 5-year OS and DFS rates were 67 and 63.6%, respectively. Corresponding average survival duration of 51.24 months for OS and 47.73 months for DFS. Significant risk factors associated were pathological residual disease (p = 0.001), deep stromal invasion (p = 0.001), and margin positivity (p = 0.023).

Conclusions

This study underscores higher prevalence of pathological residual disease in adenocarcinoma following CCRT which significantly influences survival outcomes. Consequently extrafascial hysterectomy emerges as potential option for early-stage bulky adenocarcinoma cervix patients, offering enhanced local control and improved survival.