New Combined Modality treatment for Stage II B Cervical Cancer.

Arulraj, P (2007) New Combined Modality treatment for Stage II B Cervical Cancer. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION : Cancer cervix is the second commonest malignancy among women globally, with over 4,50,000 cases detected annually and accounting for almost 2,10,000 deaths per year. During the past 5 decades the incidence of invasive cervical carcinoma has dropped dramatically which is attributed to the development of effective screening techniques for identification of pre-invasive lesions. The scenario, however, is still grim in the developing world wherein a combination of inadequate screening facilities, social stigma and ignorance contribute to patient presenting with locally advanced disease. AIM : 1. To evaluate the role of radical surgery in stage II B patients after external beam RT. 2. To establish surgery as an useful modality in prevention of late recurrences. 3. To avoid intracavity RT and its long term complications like adhesive vaginitis, bladder and rectal morbidities. 4. To improve local and regional control and possibly survival of the patient. CONCLUSION : Tumor size, grade of disease and positive pelvic node residue are well recognized prognostic factors which influence therapeutic outcome in cancer of the cervix. The high failure rates seen in locally advanced cancer cervix with radiotherapy alone may be attributed to the presence of relatively radio-resistant hypoxic cells within the tumor mass. The following conclusions can be drawn from this preliminary phase III trial which showed the benefit of addition of surgery with radiation in stage IIB cervical cancer patients. Combined radiotherapy and radical surgery give the following benefits: 1. Pathologic evaluation of residual disease provides precious information about tumor behavior and sensitivity to tailor adjuvant therapies. 2. Lesser complication rate compared with radical RT or chemoradiation. 3. Better local control and disease free survival. In the current study, the use of radical surgery 4 weeks after completion of EBRT with the dose of 50 Gy had shown an increased locoregional control which was demonstrated with statistically significant values. This radical surgery not only shown added benefit in the treatment of stage II B disease but also increased the local control with acceptable complications. The benefits are more pronounced in 1. Young patients, 2. Tumor size ≤ 4 cm size, 3. Pelvic node negative patients. The patients are on regular follow up for accrual of long term results. The impact of this study on long term survival as well as the long term morbidity associated with this protocol are to be analyzed in the future with a larger sample size in a randomized study.

Item Type: Thesis (Masters)
Uncontrolled Keywords: New Combined Modality treatment ; Stage II B Cervical Cancer.
Subjects: MEDICAL > Surgical Oncology
Depositing User: Kambaraman B
Date Deposited: 25 Jul 2017 03:15
Last Modified: 25 Jul 2017 03:15

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