1007 - Wertheim surgery for locally advanced cervical cancer following chemoradiation with intensity modulated ARC therapy. Prospective analysis

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Anti-Cancer Agents & Biologic Therapy
Cervical Cancer
Surgery and/or Radiotherapy of Cancer
Presenter Amin Makar
Authors A.P. Makar1, K. Vandecasteele2, P. Tummers3, P. Ost2, L. Delrue4, S. Van Belle5, R. van den Broecke5, W. De Never2, V. Fonteyne2, G. De Meerleer2
  • 1Department Of Gynecologic Oncology, University Hospital of Ghent, 9000 - Ghent/BE
  • 2Department Of Radiation Oncology, University Hospital of Ghent, Ghent/BE
  • 3Department Of Gynecologic Oncology, University Hospital of Ghent, Ghent/BE
  • 4Department Of Radiology, University Hospital of Ghent, Ghent/BE
  • 5Department Of Medical Oncology, University Hospital Ghent, 9000 - Ghent/BE

Abstract

Purpose/objective

To report on toxicity, resection rate and outcome after IMAT ± cisplatin for primary irresectable cervical cancer.

Material/methods

Fourty one patients with Figo IIB-IVA cervix carcinoma were treated with IMAT ± cisplatin pre-operatively. Pre-treatment work-up included clinical examination and imaging (18FDG-PET/CT and MRI). IMAT dose prescription was as follows: 62 Gy and 60 Gy (Dmed) to the primary tumour and PET/CT-positive lymph nodes respectively; 58 Gy and 56 Gy (Dmed) to CTV (uterus, cervix, upper vaginal 1/3 to 1/2 and parametria) and its PTV; minimal dose of 45 Gy to pelvic lymph nodes. IMAT was delivered in 25 fractions, resulting in a SIB. Within 4 weeks after IMAT, tumour resectability was assessed clinically and radiologically. Wertheim-Meigs hysterectomy was performed within 6-8 weeks after end of IMAT. If irresectable, brachytherapy (BT) was performed. Acute toxicity was scored weekly during IMAT and 1 and 3 months thereafter. Late toxicity scoring started ≥ 6 months after ending IMAT and was scored 3 monthly during the first 2 years, and 6 monthly thereafter. Disease control was evaluated clinically (3-monthly) and with imaging (6-monthly).

Results

7/41(17%) were inoperable because of progression (2/7), insufficient response (4/7) or reduced general condition (1/7.

Pathology revealed complete response in 14/34 (41%). Surgical margins were free of disease in all cases. There was no postoperative mortality and no excess in morbidity. One patient needed a re-intervention due to large lymphocoeles. At 3 years OS and DFS were 81% and 91% respectively in the wertheim group. Non of patients in the brachytherapy group survived 3 years.

Conclusion

Wertheim surgery following IMAT ± cisplatin is associated with no mortality and acceptable morbidity IMAT has low toxicity and is excellent in rendering irresectable cervical cancer resectable.

Disclosure

All authors have declared no conflicts of interest.