An analysis of outcomes of patients with locally advanced cervical cancer treated by emergency hysterectomy due to vaginal hemorrhage followed by chemoradiation and surgery in cases of locally advanced cervical cancer

Objectives: The standard treatment for patients with locally advanced cervical cancer (LACC) consists of chemoradiation followed by vaginal brachytherapy. However, many patients with LACC undergo hysterectomy while receiving comprehensive cancer treatment. The aim of the present study was to analyze the survival data of those patients who underwent hysterectomy due to vaginal bleeding or hemorrhage prior to definitive chemoradiation. Materials and methods: The study group included 35 patients with stage IIB (according to the FIGO classification) cervical cancer who received chemoradiation following emergency hysterectomy performed due to severe bleeding. The control group consisted of 44 patients with stage IIB cervical cancer treated with primary chemoradiation without completion hysterectomy. We compared the rates of treatment toxicity and overall survival. Results: We did not observe an inferior survival probability among patients treated with hysterectomy prior to receiving chemoradiation compared to those treated with chemoradiation alone (P = 0.77). The 5-year survival probability of patients treated with initial surgery was 62%, compared to 61% for those treated with primary chemoradiation. Six (17%) patients from the group treated with hysterectomy experienced severe adverse events. The application of radiation therapy after hysterectomy was associated with a higher rate of early gastrointestinal toxicity compared to the rate found in patients treated with chemoradiation alone. Conclusion: Hysterectomy performed due to vaginal hemorrhage prior to chemoradiation in patients with stage IIB cervical cancer is not associated with an inferior probability of survival. However, this treatment approach is associated with a higher rate of toxicity when compared to patients with stage IIB cervical cancer treated only with chemoradiation.

Cervical carcinoma; Locally advanced cervical cancer; Radical hysterectomy; Chemoradiation

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