From the Journals

Consider hysterectomy in patients with post-irradiated residual cervical cancer



Hysterectomy is a viable option for women with residual cervical cancer, especially in resource-limited regions where women may not receive adequate radiation, according to a study of Bangladeshi patients with cervical cancer.

“Surgical intervention by either extrafascial or radical hysterectomy should be strongly considered for women with biopsy-confirmed residual disease after chemoradiation,” wrote lead authors Shahana Pervin, MBBS, and Farzana Islam Ruma, MBBS, of the National Institute of Cancer Research and Hospital and of the Railway General Hospital, respectively, in Dhaka, Bangladesh, and their associates. The study was published in the Journal of Global Oncology.

From 2009 to June 2013, this prospective longitudinal study collected data from 40 patients with biopsy-confirmed persistence of cervical cancer. The patients, who were being treated at one of two hospitals in Dhaka, Bangladesh, underwent either radical or extrafascial hysterectomy at least 12 weeks after initial radiation therapy.

At 5 years of follow-up, 36 (90%) had no evidence of disease. Of the 29 women who underwent extrafascial hysterectomy, 4 (14%) developed recurrent disease and 1 died. None of the 11 women who underwent radical hysterectomy had recurrences during the study period; that group, however, did suffer from “intraoperative, postoperative, and long-term complications.”

The investigators acknowledged the study’s several limitations, including a lack of standardized preoperative therapy, incomplete records of radiation dosing, and a limited number of patients. Along the same lines, another larger prospective trial to evaluate the two types of hysterectomy would “help guide what should be the standard of care for salvage therapy,” they wrote.

However, their findings emphasized the need for physicians in limited resource areas to have “a strong index of suspicion” when evaluating patients with locally advanced cervical cancer for residual disease. “Close clinical follow-up is crucial to identify these women in a timely manner,” the investigators added.

The Massachusetts General Hospital Gynecologic Oncology Global Health Fund supported the study. The authors reported no conflicts of interest.

SOURCE: Pervin S et al. J Glob Oncol. 2019 Feb 1. doi: 10.1200/JGO.18.00157.

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