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Adjuvant chemoradiation after laparoscopically assisted vaginal radical hysterectomy (LARVH) in patients with cervical cancer

Oncologic outcome and morbidity

Adjuvante Radiochemotherapie nach laproskopisch assistierter vaginaler radikaler Hysterektomie (LARVH) bei Patientinnen mit Zervixkarzinom. Onkologische Ergebnisse und Morbidität

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Strahlentherapie und Onkologie Aims and scope Submit manuscript

Purpose:

Compared to laparotomic surgery, laparoscopically assisted radical vaginal hysterectomy (LARVH) offers decreased blood loss during surgery and faster convalescence of the patient postoperatively, while at the same time delivering similar oncologic results. However, there is no data on outcome and toxicity of LARVH followed by (chemo)radiation.

Patients and Methods:

A total of 55 patients (range 28–78 years) with cervical cancer on FIGO stages IB1–IIIA (Tables 1 and 2) with risk factors were submitted to either external beam radiotherapy alone [EBRT, n = 8 (14%), including paraaortic irradiation, n = 4 (2.2%); EBRT and brachytherapy (BT), n = 33 (60%); BT alone, n = 14 (25.5%)] or chemoradiation after LARVH.

Results:

At a median follow-up of 4.4 years, the 5-year disease-free survival (DFS) was 81.8% with 84.5% overall survival (OS). Acute grade 3 side effects were seen in 4 patients. These were mainly gastrointestinal (GI) and genitourinary (GU) symptoms. Grade 4 side effects were not observed.

Conclusion:

With similar oncologic outcome data and mostly mild side effects, LARVH followed by (chemo)radiation is a valid alternative in the treatment of cervical cancer patients.

Ziel:

Die laparoskopisch assistierte radikale Hysterektomie (LAVRH) bietet gegenüber offenen Verfahren bei Patientinnen mit gynäkologischen Tumoren die Vorteile eines geringeren Blutverlusts und einer schnelleren Rekonvaleszenz bei onkologisch gleichwertigen Ergebnissen. Bisher existieren keine Daten zu onkologischen Ergebnissen und Toxizität nach LARVH und adjuvanter Radio(chemo)therapie.

Patienten und Methodik:

55 Patientinnen (28–78 Jahre) mit Zervixkarzinomen (FIGO IB1 bis IIIA), (Tabellen 1, 2) wurden ausgewertet. Die Patientinnen wurden nach LARVH aufgrund von Risikofaktoren einer postoperativen perkutanen Strahlentherapie [EBRT: n = 8 (14%), inklusive Paraaortalfeld (EFRT): n = 4 (2,2%), einer EBRT und Brachytherapie (BT): n = 33 (60%), einer alleinigen BT: n = 14 (25,5%)] bzw. kombinierten Radiochemotherapie zugeführt.

Ergebnisse:

Nach 4,4 Jahren mittlerer Nachbeobachtungszeit ergab sich ein krankheitsfreies Überleben (DFS) nach 5 Jahren von 81,8% bei einem Gesamtüberleben (OS) von 85,4%. Grad-3-Akutnebenwirkungen entwickelten 4 Patientinnen. Grad-4-Nebenwirkungen wurden nicht beobachtet.

Schlussfolgerung:

Bei insgesamt sehr niedrigen Raten gastrointestinaler (GI) und urogenitaler (GU) Toxizität stellt die LARVH im Kontext mit der adjuvanten Radio(chemo)- bzw. Brachytherapie eine valide Alternative zu offenen Verfahren in der Behandlung von Patientinnen mit Zervixkarzinomen dar.

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Authors and Affiliations

  1. Department of Radiooncology, Charité – University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany

    Arne Gruen, Thabea Musik, Carmen Stromberger, Volker Budach & Simone Marnitz

  2. Department of Gynaecology, Charité – University Medicine Berlin, Campus Mitte und Benjamin Franklin, Berlin, Germany

    Christhardt Köhler & Achim Schneider

  3. Department of Radiooncology, University Hospital, Jena, Germany

    Jürgen Füller & Thomas Wendt

  4. Department of Radiooncology, Charité University Medicine, Charitéplatz 1, 10117, Berlin, Germany

    Simone Marnitz

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  1. Arne Gruen
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Gruen, A., Musik, T., Köhler, C. et al. Adjuvant chemoradiation after laparoscopically assisted vaginal radical hysterectomy (LARVH) in patients with cervical cancer. Strahlenther Onkol 187, 344–349 (2011). https://doi.org/10.1007/s00066-011-2197-7

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  • DOI: https://doi.org/10.1007/s00066-011-2197-7

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