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Is postoperative radiotherapy (PORT) a viable option in high-risk early-stage cervical cancer after upfront or downstaged radical surgery? A comparative study


1 Department of Surgical Oncology, Division of Gynecological Oncology, Delhi State Cancer Institute (GNCT of Delhi), Dilshad Garden, Delhi, India
2 Molecular Oncology Department, Delhi State Cancer Institute (GNCT of Delhi), Dilshad Garden, Delhi, India
3 Surgical Gynecological Oncology, Delhi State Cancer Institute (GNCT of Delhi), Dilshad Garden, Delhi, India
4 ICMR-National Institute for implementation Research in Non-Communicable Diseases, New Pali Rd, Air Force Area, Jodhpur, Rajasthan, India
5 Department of Radiation Oncology, Maulana Azad Medical College (MAMC), Delhi, India

Correspondence Address:
Viniita Kumar Jaggi,
Assistant Professor, Department of Surgical Oncology, Division of Gynecological Oncology, Delhi State Cancer Institute (GNCT of Delhi), Dilshad Garden, Delhi – 110 095
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcrt.jcrt_253_22

BACKGROUND: Radical surgery for cervical cancer has inherent benefits, and as upfront or post neoadjuvant chemotherapy (NACT), is extendable to locally advanced cancer cervix (LACC), with postoperative radiotherapy (PORT) for high-risk factors. Objective of the study was to compare the effectiveness and survival between non-PORT and PORT in high-risk early stages. MATERIALS AND METHODS: Radical hysterectomies conducted between January 2014 and December 2017 were evaluated and followed till December 2019. Clinical, surgical–pathologic characteristics, and oncological outcomes were compared between non-PORT and PORT groups. A similar comparison was made between alive and dead patients within each group. The impact of PORT was assessed. RESULTS: Of 178 radical surgeries, early-LACC constituted 70%. Most (37%) of the patients belonged to stage 1b2, while stage 2b formed 5%. Mean age of patients was 46.5 years; 69% were below 50 years of age. Abnormal bleeding (41%) was the predominant symptom, followed by postcoital (20%) and postmenopausal bleeding (12%). Upfront surgeries formed 70.2%, and the average waiting period was 1.93 months (range: 1–10 months). PORT patients were 97 (54.5%) in number and the remaining formed the non-PORT group. Mean follow-up was 34 months, with 118 (66%) alive patients. Significant adverse prognostic factors were tumors >4 cm (44.4% patients), positive margins (10%), lymphatic vascular space invasion (LVSI; 42%), malignant nodes (33%), multiple metastatic nodes averaging seven (range: 3–11), and delayed (>6 months) presentation, but not deep stromal invasion (77% patients) and positive parametrium (8.4% patients). PORT overcame the adverse effects of tumors >4 cm, multiple metastatic nodes, positive margins, and LVSI. Total recurrences (25%) were balanced for both groups, but recurrences within 2 years were significantly more for PORT. Two-year overall survival (78%) and recurrence-free survival (72%), median overall survival (21 months), and median recurrence-free interval (19 months) were significantly better for PORT, with the complication rates being similar. CONCLUSION: PORT had significantly better oncological outcomes compared to non-PORT. Multimodal management is worthwhile.


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    -  Jaggi VK
    -  Ansari MA
    -  Khanna A
    -  Gehlot S
    -  Sharma A
    -  Singh K
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