A Matched Control study on the outcomes of patients of early stage Carcinoma Cervix treated with Neoadjuvant Radiotherapy and Wertheim’s Hysterectomy compared with definitive radiotherapy

Mayank Pancholi, (2013) A Matched Control study on the outcomes of patients of early stage Carcinoma Cervix treated with Neoadjuvant Radiotherapy and Wertheim’s Hysterectomy compared with definitive radiotherapy. Masters thesis, Cancer Institute (WIA), Chennai.


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BACKGROUND: Cervical cancer is the second most common cancer in women worldwide and one of the commonest female cancers in many developing countries. The mean age for cervical cancer is 51.4 years. Early diagnosis of cervical cancer can be challenging because of these factors: 1. Frequently asymptomatic nature of early stage disease, 2. Origin of some cancers from within the endocervical canal or beneath the epithelium of the ectocervix, making visualization on speculum examination difficult, 3. Difficult access to health care and socioeconomic factors, 4. Significant false negative rate for Pap smears, even in women having regular screening. Diagnosis of early stage invasive carcinoma cervix not only has the advantage of favourable outcome for the patients but also allows physicians to choose between treatment options available for a particular case depending on patientspreference and desired side effect profile, whereas in advanced carcinoma cervix the choice of treatment is limited to chemoradiotherapy or chemotherapy. AIMS OF THE STUDY: 1. To study the outcome of patients of carcinoma cervix treated with neoadjuvant radiotherapy followed by Wertheim’s hysterectomy and bilateral pelvic dissection during a period of five years (2000-2004) in terms of pathological response rate, disease free survival and complications. 2. To compare the outcome of study population with outcome of matched patients treated with definitive radiotherapy during the same time period. MATERIAL AND METHODS: This is a retrospective study of patients of invasive Cervical Cancer stage IA/IB and IIA, who underwent treatment in our institute between years 2000 to 2004. Eligible patients were those who received a course of less than radical radiotherapy by either intracavitary application or external beam radiotherapy. Our operation record registers were searched for the patients who underwent surgery for carcinoma cervix during the foresaid period, all the available records were scrutinized and details were entered in a standard format which was uniform for study and control population except surgery details which were applicable only to the study group. All patients underwent clinical examination before treatment by an experienced clinician, and haemogram, renal and hepatic function tests, coagulation profile as well as cardiac evaluation was done with standard metastatic work up. A biopsy confirmation of the disease was done and a clinical stage was assigned by the same physician to all patients. In the case of discrepancy between the findings of two clinicians, findings of the above mentioned clinician were considered for the purpose of this study. Whenever a single clinical stage could not be assigned due to ambiguous clinical findings and discrepancy occurred, the lower stage assigned was taken as the final stage. Inclusion Criteria: 1. Women with histologically proven invasive carcinoma of the uterine cervix, stages IA, IB, IIA. 2. Age between 18-70 years. 3. No evidence of visceral, skeletal or distant nodal metastases. 4. No history of past or coexisting second malignancy. 5. Good performance status (Karnofsky performance score > 70 or ECOG PS<2). 6. Normal hematologic & biochemical parameters. 7. No prior treatment for the same cancer elsewhere. Exclusion criteria: 1. All patients who did not have preoperative diagnosis of invasive cervical carcinoma. 2. All patients who were too elderly to be considered for surgery. 3. All patients who did not undergo standard Wertheim’s hysterectomy with bilateral pelvic dissection. 4. Any preoperative uncontrolled comorbidity medical or otherwise which would lead to preference of one treatment over the other. 5. Any patients not satisfying the inclusion criteria. RESULTS: Total patient records studied for the purpose of this study were 300, out of which 153 records were found suitable for the purpose of inclusion in study group and 92 were found eligible for inclusion in the control group. The results from this study show that disease free survival is similar in both the study and control group. The factors tosignificantly affect outcome in univariate analysis for study groupwere tumour stage, present of residue after neoadjuvant radiation, positive nodal status on final histopathology and positive resection margin. In control group haemoglobin value less than 10 g% and adenocarcinoma histology were correlating with reduced disease free survival. Haemoglobin level did not have a significant impact on disease free survival in study group. Menopausal status had no effect in both the groups. Stage at treatment was important in study group whereas there was no difference in outcome with stage in control group. In multivariate analysis after balancing confounding factors stage had significant impact on disease free survival. Complications in both the groups are not comparable as both the treatment modalities are different and have complications unique to them, however complications likely to reduce quality of life like adhesive vaginitis with vaginal shortening, dryness were more with definitive radiotherapy, similarly side effects needing evaluation like haematuria and cystitis were more in definitive radiation group, which are likely to be a cause of concern to patient. CONCLUSION: In conclusion, the side effect profile should be the directing factor to choice of treatment, in our study on univariate analysis patients with adenocarcinoma of cervix fared significantly worse than their squamous cell counterpart when treated by definite radiotherapy (p=0.013). So we conclude that, neoadjuvant radiotherapy followed by radical surgery is the preferred treatment option for early stage carcinoma of cervix, especially so in adenocarcinoma histology where disease free survival is likely to be better and in younger patients where quality of sexual life is likely to be better also long term side effects of definitive radiation would also be avoided.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Early stage Carcinoma Cervix, Neoadjuvant Radiotherapy, Wertheim’s Hysterectomy, definitive radiotherapy.
Subjects: MEDICAL > Surgical Oncology
Depositing User: Subramani R
Date Deposited: 01 Mar 2020 06:56
Last Modified: 01 Mar 2020 06:56
URI: http://repository-tnmgrmu.ac.in/id/eprint/12073

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