The Bulky 6-cm Barrel-Shaped Lesion of the Cervix: Primary Surgery and Postoperative Chemoradiation

doi:10.1006/gyno.2000.5911

Gynecologic Oncology

Volume 78, Issue 3, September 2000, Pages 313-317

https://doi.org/10.1006/gyno.2000.5911 Get rights and content

Abstract

Objective. The purpose of this report is to detail what appears to be the largest reported experience of primary radical hysterectomy for bulky barrel-shaped cervical cancers of 6 cm or greater in diameter, followed in all instances by radiation therapy and chemotherapy.

Methods. Twenty-two unselected cases were operated primarily. One had unresectable aortic node disease. Twenty-one were treated with intent to cure. All patients received extended field radiation therapy beginning 4 weeks after surgery. All patients also received infusion chemotherapy during weeks 1, 4, and 7 of their radiation therapy. Initially, 5-FU was the drug of choice; more recently, Platinol has been employed.

Results. The Berkson–Gage relative survival of the total 22 cases was 71.3%. For the 21 cases treated with intent to cure, the survival was 75.4%. Complications were minimal.

Conclusion. The experienced pelvic surgeon can accomplish this exercise with a high degree of safety; and this multimodality approach is offered as another therapeutic alternative for these high-risk patients.

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This chapter covers cervical cancer, vulvar cancer, and vaginal cancer. It discusses the etiology, diagnosis, and pathologic features of all the different cancers in each category. Diagnosis and treatment of preinvasive in addition to invasive disease in all three categories are examined, including surgical therapy, radiation therapy, and chemotherapy. Recent studies and evidence in the diagnosis and treatment of these three very different cancers are reported.
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To evaluate patient compliance and acute toxicity accompanying concurrent weekly cisplatin and radiotherapy (RT) in the routine management of cervical cancer.
Locally advanced or high-risk early-stage cervical cancer patients treated with RT and concurrent weekly cisplatin at a dose of 40 mg/m² i.v. (maximum dose, 70 mg) for five cycles. Definitive RT included whole pelvis external beam RT to the International Commission on Radiation Units and Measurements reference dose of 40 Gy plus a 10-Gy boost to the parametrium and two brachytherapy applications of 20 Gy to point A each. Postoperative RT consisted of pelvic external beam RT to the International Commission on Radiation Units and Measurements reference dose of 50 Gy and one brachytherapy application of 30 Gy at a depth of 0.5 cm from the applicator surface.
Included in this analysis were 112 consecutive cervical cancer patients treated at one institution with concurrent cisplatin and RT between May 1999 and September 2002. The median age was 48 years (range, 28–79 years). Definitive RT was administered to 57 International Federation of Gynecology and Obstetrics “bulky” Stage IB or IIB-IVA patients, and 53 patients underwent postoperative RT; 2 patients underwent RT for stump carcinoma. All but 2 patients (both administered definitive RT) completed RT. A total of 454 cisplatin cycles were administered (median 4 cycles/patient, range 1–6). Overall, 74% of patients received at least four cycles of cisplatin. The planned five cisplatin cycles were administered to 50 patients (45%); 42% were irradiated definitively and 47% postoperatively. The full and timely planned cisplatin dose was administered to 29 patients (26%). For 29% of patients, the interval between cycles was prolonged because of toxicity (n = 11; 10%) or for reasons not related to toxicity (n = 10; 9%). Of the 112 patients, 62 (55%) did not undergo the planned five cycles of cisplatin because of treatment toxicity (n = 35; 31%) or noncompliance with the treatment schedule because of delayed administration of the first cycle or omission of a cycle for reasons other than toxicity (n = 23; 21%). The most common side effects resulting in chemotherapy discontinuation included GI complications (n = 7) and impaired renal function (n = 5). Of the 112 patients, 49 (44%) experienced Grade 1 or 2 leukopenia and 6 (5%) Grade 3 or 4 leukopenia.
Our results show that pelvic RT combined with weekly cisplatin in cervical cancer patients is accompanied by considerable acute toxicity. Furthermore, a number of patients were unable to comply with the treatment schedule owing to reasons unrelated to treatment toxicity. Thus, administration of the full chemotherapy dose may be difficult, although the delivery of planned RT was generally not compromised. Additional follow-up is needed to assess the late toxicity of combined modality treatment.

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^☆: Presented in part at the meetings of the American Radium Society, Kona, Hawaii, April 1997, the Felix Rutledge Society, Winnipeg, Manitoba, June 1999, the Society of Pelvic Surgeons, Calgary, Alberta, September 1999, and the Peruvian Cancer Congress, Lima, Peru, November 1999.

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Regular ArticleThe Bulky 6-cm Barrel-Shaped Lesion of the Cervix: Primary Surgery and Postoperative Chemoradiation☆

Abstract

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Regular Article
The Bulky 6-cm Barrel-Shaped Lesion of the Cervix: Primary Surgery and Postoperative Chemoradiation☆