Comparison of outcomes between radical hysterectomy followed by tailored adjuvant therapy versus primary chemoradiation therapy in IB2 and IIA2 cervical cancer
Identifieur interne : 004431 ( Main/Exploration ); précédent : 004430; suivant : 004432Comparison of outcomes between radical hysterectomy followed by tailored adjuvant therapy versus primary chemoradiation therapy in IB2 and IIA2 cervical cancer
Auteurs : Jeong-Yeol Park [Corée du Sud] ; Dae-Yeon Kim [Corée du Sud] ; Jong-Hyeok Kim [Corée du Sud] ; Yong-Man Kim [Corée du Sud] ; Young-Tak Kim [Corée du Sud] ; Young-Seok Kim [Corée du Sud] ; Ha Jeong Kim [Corée du Sud] ; Jeong-Won Lee [Corée du Sud] ; Byoung-Gie Kim [Corée du Sud] ; Duk-Soo Bae [Corée du Sud] ; Seung Jae Huh [Corée du Sud] ; Joo-Hyun Nam [Corée du Sud]Source :
- Journal of Gynecologic Oncology [ 2005-0380 ] ; 2012.
Abstract
To compare survival outcomes and treatment-related morbidities between radical hysterectomy (RH) and primary chemoradiation therapy (CRT) in patients with bulky early-stage cervical cancer.
We selected 215 patients with stage IB2 and IIA2 cervical cancer (tumor diameter > 4 cm on magnetic resonance imaging) who underwent RH followed by tailored adjuvant therapy (n=147) or primary CRT (n=68) at two tertiary referral centers between 2001 and 2010.
About twenty nine percent of patients were cured by RH alone and these patients experienced the best survival outcomes with the lowest morbidity rates. After the median follow-up times of 40 months, 27 RH (18.4%) and 20 CRT (29.4%) patients had recurrence (p=0.068) and 23 (15.6%) and 17 (25%) patients died of disease (p=0.101). The 5-year progression-free survival were 77% and 66% (p=0.047), and the 5-year overall survival were 78% and 67% (p=0.048) after RH and primary CRT, respectively. In multivariate analysis, patients who received primary CRT was at higher risk for tumor recurrence (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.24 to 4.14; p=0.008) and death (OR, 3.02; 95% CI, 1.53 to 5.98; p=0.001) than those who received RH. Grade 3-4, early (17% vs. 30.9%, p=0.021) and late (1.4% vs. 8.8%, p=0.007) complications were significantly less frequent after RH than primary CRT.
Thirty percent of patients were cured by RH alone. A treatment outcome was better in this retrospective study in terms of morbidity and survival. Randomized trials are needed to confirm this result.
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DOI: 10.3802/jgo.2012.23.4.226
PubMed: 23094125
PubMed Central: 3469857
Affiliations:
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wicri:level="3"><nlm:aff id="A3">Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul</wicri:regionArea><placeName><settlement type="city">Séoul</settlement><region type="capital">Région capitale de Séoul</region></placeName></affiliation></author><author><name sortKey="Kim, Byoung Gie" sort="Kim, Byoung Gie" uniqKey="Kim B" first="Byoung-Gie" last="Kim">Byoung-Gie Kim</name><affiliation wicri:level="3"><nlm:aff id="A3">Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan 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Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul</wicri:regionArea><placeName><settlement type="city">Séoul</settlement><region type="capital">Région capitale de Séoul</region></placeName></affiliation></author><author><name sortKey="Kim, Dae Yeon" sort="Kim, Dae Yeon" uniqKey="Kim D" first="Dae-Yeon" last="Kim">Dae-Yeon Kim</name><affiliation wicri:level="3"><nlm:aff id="A1">Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul</wicri:regionArea><placeName><settlement type="city">Séoul</settlement><region type="capital">Région capitale de Séoul</region></placeName></affiliation></author><author><name sortKey="Kim, Jong Hyeok" sort="Kim, Jong Hyeok" uniqKey="Kim J" first="Jong-Hyeok" last="Kim">Jong-Hyeok Kim</name><affiliation wicri:level="3"><nlm:aff id="A1">Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul</wicri:regionArea><placeName><settlement type="city">Séoul</settlement><region type="capital">Région capitale de Séoul</region></placeName></affiliation></author><author><name sortKey="Kim, Yong Man" sort="Kim, Yong Man" uniqKey="Kim Y" first="Yong-Man" last="Kim">Yong-Man Kim</name><affiliation wicri:level="3"><nlm:aff id="A1">Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul</wicri:regionArea><placeName><settlement type="city">Séoul</settlement><region type="capital">Région capitale de Séoul</region></placeName></affiliation></author><author><name sortKey="Kim, Young Tak" sort="Kim, Young Tak" uniqKey="Kim Y" first="Young-Tak" last="Kim">Young-Tak Kim</name><affiliation wicri:level="3"><nlm:aff id="A1">Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul</wicri:regionArea><placeName><settlement type="city">Séoul</settlement><region type="capital">Région capitale de Séoul</region></placeName></affiliation></author><author><name sortKey="Kim, Young Seok" sort="Kim, Young Seok" uniqKey="Kim Y" first="Young-Seok" last="Kim">Young-Seok Kim</name><affiliation wicri:level="3"><nlm:aff id="A2">Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul</wicri:regionArea><placeName><settlement type="city">Séoul</settlement><region type="capital">Région capitale de Séoul</region></placeName></affiliation></author><author><name sortKey="Kim, Ha Jeong" sort="Kim, Ha Jeong" uniqKey="Kim H" first="Ha Jeong" last="Kim">Ha Jeong Kim</name><affiliation wicri:level="3"><nlm:aff id="A3">Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul</wicri:regionArea><placeName><settlement type="city">Séoul</settlement><region type="capital">Région capitale de Séoul</region></placeName></affiliation></author><author><name sortKey="Lee, Jeong Won" sort="Lee, Jeong Won" uniqKey="Lee J" first="Jeong-Won" last="Lee">Jeong-Won Lee</name><affiliation wicri:level="3"><nlm:aff id="A3">Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul</wicri:regionArea><placeName><settlement type="city">Séoul</settlement><region type="capital">Région capitale de Séoul</region></placeName></affiliation></author><author><name sortKey="Kim, Byoung Gie" sort="Kim, Byoung Gie" uniqKey="Kim B" first="Byoung-Gie" last="Kim">Byoung-Gie Kim</name><affiliation wicri:level="3"><nlm:aff id="A3">Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul</wicri:regionArea><placeName><settlement type="city">Séoul</settlement><region type="capital">Région capitale de Séoul</region></placeName></affiliation></author><author><name sortKey="Bae, Duk Soo" sort="Bae, Duk Soo" uniqKey="Bae D" first="Duk-Soo" last="Bae">Duk-Soo Bae</name><affiliation wicri:level="3"><nlm:aff id="A3">Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul</wicri:regionArea><placeName><settlement type="city">Séoul</settlement><region type="capital">Région capitale de Séoul</region></placeName></affiliation></author><author><name sortKey="Huh, Seung Jae" sort="Huh, Seung Jae" uniqKey="Huh S" first="Seung Jae" last="Huh">Seung Jae Huh</name><affiliation wicri:level="3"><nlm:aff id="A4">Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul</wicri:regionArea><placeName><settlement type="city">Séoul</settlement><region type="capital">Région capitale de Séoul</region></placeName></affiliation></author><author><name sortKey="Nam, Joo Hyun" sort="Nam, Joo Hyun" uniqKey="Nam J" first="Joo-Hyun" last="Nam">Joo-Hyun Nam</name><affiliation wicri:level="3"><nlm:aff id="A1">Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul</wicri:regionArea><placeName><settlement type="city">Séoul</settlement><region type="capital">Région capitale de Séoul</region></placeName></affiliation></author></analytic><series><title level="j">Journal of Gynecologic Oncology</title><idno type="ISSN">2005-0380</idno><idno type="eISSN">2005-0399</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objective</title><p>To compare survival outcomes and treatment-related morbidities between radical hysterectomy (RH) and primary chemoradiation therapy (CRT) in patients with bulky early-stage cervical cancer.</p></sec><sec><title>Methods</title><p>We selected 215 patients with stage IB2 and IIA2 cervical cancer (tumor diameter > 4 cm on magnetic resonance imaging) who underwent RH followed by tailored adjuvant therapy (n=147) or primary CRT (n=68) at two tertiary referral centers between 2001 and 2010.</p></sec><sec><title>Results</title><p>About twenty nine percent of patients were cured by RH alone and these patients experienced the best survival outcomes with the lowest morbidity rates. After the median follow-up times of 40 months, 27 RH (18.4%) and 20 CRT (29.4%) patients had recurrence (p=0.068) and 23 (15.6%) and 17 (25%) patients died of disease (p=0.101). The 5-year progression-free survival were 77% and 66% (p=0.047), and the 5-year overall survival were 78% and 67% (p=0.048) after RH and primary CRT, respectively. In multivariate analysis, patients who received primary CRT was at higher risk for tumor recurrence (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.24 to 4.14; p=0.008) and death (OR, 3.02; 95% CI, 1.53 to 5.98; p=0.001) than those who received RH. Grade 3-4, early (17% vs. 30.9%, p=0.021) and late (1.4% vs. 8.8%, p=0.007) complications were significantly less frequent after RH than primary CRT.</p></sec><sec><title>Conclusion</title><p>Thirty percent of patients were cured by RH alone. A treatment outcome was better in this retrospective study in terms of morbidity and survival. Randomized trials are needed to confirm this result.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Jemal, A" uniqKey="Jemal A">A Jemal</name></author><author><name sortKey="Bray, F" uniqKey="Bray F">F Bray</name></author><author><name sortKey="Center, Mm" uniqKey="Center M">MM Center</name></author><author><name sortKey="Ferlay, J" uniqKey="Ferlay J">J Ferlay</name></author><author><name sortKey="Ward, E" uniqKey="Ward E">E Ward</name></author><author><name sortKey="Forman, D" uniqKey="Forman D">D Forman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jung, Kw" uniqKey="Jung K">KW Jung</name></author><author><name sortKey="Park, S" uniqKey="Park S">S Park</name></author><author><name sortKey="Kong, Hj" uniqKey="Kong H">HJ Kong</name></author><author><name sortKey="Won, Yj" uniqKey="Won Y">YJ Won</name></author><author><name sortKey="Lee, Jy" uniqKey="Lee J">JY 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S">S Gouy</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ferrandina, G" uniqKey="Ferrandina G">G Ferrandina</name></author><author><name sortKey="Distefano, M" uniqKey="Distefano M">M Distefano</name></author><author><name sortKey="Ludovisi, M" uniqKey="Ludovisi M">M Ludovisi</name></author><author><name sortKey="Morganti, A" uniqKey="Morganti A">A Morganti</name></author><author><name sortKey="Smaniotto, D" uniqKey="Smaniotto D">D Smaniotto</name></author><author><name sortKey="D Agostino, G" uniqKey="D Agostino G">G D'Agostino</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Houvenaeghel, G" uniqKey="Houvenaeghel G">G Houvenaeghel</name></author><author><name sortKey="Lelievre, L" uniqKey="Lelievre L">L Lelievre</name></author><author><name sortKey="Rigouard, Al" uniqKey="Rigouard A">AL Rigouard</name></author><author><name sortKey="Buttarelli, M" uniqKey="Buttarelli M">M Buttarelli</name></author><author><name sortKey="Jacquemier, J" uniqKey="Jacquemier J">J Jacquemier</name></author><author><name sortKey="Viens, P" uniqKey="Viens P">P Viens</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Berveling, Mj" uniqKey="Berveling M">MJ Berveling</name></author><author><name sortKey="Langendijk, Ja" uniqKey="Langendijk J">JA Langendijk</name></author><author><name sortKey="Beukema, Jc" uniqKey="Beukema J">JC Beukema</name></author><author><name sortKey="Mourits, Mj" uniqKey="Mourits M">MJ Mourits</name></author><author><name sortKey="Reyners, Ak" uniqKey="Reyners A">AK Reyners</name></author><author><name sortKey="Pras, E" uniqKey="Pras E">E Pras</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gruen, A" uniqKey="Gruen A">A Gruen</name></author><author><name sortKey="Musik, T" uniqKey="Musik T">T Musik</name></author><author><name sortKey="Kohler, C" uniqKey="Kohler C">C Kohler</name></author><author><name sortKey="Fuller, J" uniqKey="Fuller J">J Fuller</name></author><author><name sortKey="Wendt, T" uniqKey="Wendt T">T Wendt</name></author><author><name sortKey="Stromberger, C" uniqKey="Stromberger C">C Stromberger</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Corée du Sud</li></country><region><li>Région capitale de Séoul</li></region><settlement><li>Séoul</li></settlement></list><tree><country name="Corée du Sud"><region name="Région capitale de Séoul"><name sortKey="Park, Jeong Yeol" sort="Park, Jeong Yeol" uniqKey="Park J" first="Jeong-Yeol" last="Park">Jeong-Yeol Park</name></region><name sortKey="Bae, Duk Soo" sort="Bae, Duk Soo" uniqKey="Bae D" first="Duk-Soo" last="Bae">Duk-Soo Bae</name><name sortKey="Huh, Seung Jae" sort="Huh, Seung Jae" uniqKey="Huh S" first="Seung Jae" last="Huh">Seung Jae Huh</name><name sortKey="Kim, Byoung Gie" sort="Kim, Byoung Gie" uniqKey="Kim B" first="Byoung-Gie" last="Kim">Byoung-Gie Kim</name><name sortKey="Kim, Dae Yeon" sort="Kim, Dae Yeon" uniqKey="Kim D" first="Dae-Yeon" last="Kim">Dae-Yeon Kim</name><name sortKey="Kim, Ha Jeong" sort="Kim, Ha Jeong" uniqKey="Kim H" first="Ha Jeong" last="Kim">Ha Jeong Kim</name><name sortKey="Kim, Jong Hyeok" sort="Kim, Jong Hyeok" uniqKey="Kim J" first="Jong-Hyeok" last="Kim">Jong-Hyeok Kim</name><name sortKey="Kim, Yong Man" sort="Kim, Yong Man" uniqKey="Kim Y" first="Yong-Man" last="Kim">Yong-Man Kim</name><name sortKey="Kim, Young Seok" sort="Kim, Young Seok" uniqKey="Kim Y" first="Young-Seok" last="Kim">Young-Seok Kim</name><name sortKey="Kim, Young Tak" sort="Kim, Young Tak" uniqKey="Kim Y" first="Young-Tak" last="Kim">Young-Tak Kim</name><name sortKey="Lee, Jeong Won" sort="Lee, Jeong Won" uniqKey="Lee J" first="Jeong-Won" last="Lee">Jeong-Won Lee</name><name sortKey="Nam, Joo Hyun" sort="Nam, Joo Hyun" uniqKey="Nam J" first="Joo-Hyun" last="Nam">Joo-Hyun Nam</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix 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