Ferrandina G, et al. - This study sought to assess a subset of cervical cancer (CC) patients administered chemoradiation (CT/RT) plus radical surgery (RS), who can be spared lymphadenectomy, and complications. As per findings, researchers suggested avoiding lymphadenectomy in stage IB2-IIB CC patients undergoing preoperative CT/RT, when a careful evaluation of pre- and post-CT/RT imaging and histological assessment of no residual disease in the cervix is made. Lymphadenectomy could be avoided in 40% of patients with a favourable impact on lymphovascular morbidity with application of this approach.

Methods

• Researchers accrued 430 stage IB2-IIB patients without LN involvement at imaging (March 1996-December 2015) at Gynecologic Oncology Unit of the Catholic University of Rome/Campobasso.
• In this study, CT/RT comprised of pelvic irradiation plus cisplatin based chemotherapy.
• They evaluated objective response in accordance to RECIST criteria; in patients achieving response or stable disease, radical hysterectomy and pelvic ± aortic lymphadenectomy was attempted.
• In accordance to the Chassagne grading system, surgical morbidity was classified.

Results

• RS was performed on 421 cases; metastatic pelvic and aortic LNs were documented in 10.7%, and 8.8% of cases, respectively.
• Only 1 case (0.53%) with positive pelvic LNs, and 1 case (2.3%) with metastatic aortic LNs were identified in patients without residual tumor in the cervix.
• Analysis of patients in accordance to pre- and post-CT/RT imaging seemed capable of selecting cases without any metastatic LNs: in patients with negative pelvic LNs at pre- and post-CT/RT imaging, none of cases without residual disease in the cervix had metastatic pelvic or aortic LNs.
• 76 of 149 early complications (51.0%) were lymphovascular.
• As per observations, the most frequent late complications were lymphovascular (N=25/61, 41.0%).