Abstract
BACKGROUNDThe optimal treatment of patients with "high risk" cancer involving the uterine cervix has not been defined. These patients include those with "bulky" or barrel shaped cervical tumors, individuals with adenocarcinomas or sarcomas, and those who respond poorly to radiation. As these patients are at high risk of failure if treated with radiation, it has been proposed that radical hysterectomy be performed in combination with radiation to improve local control of disease. We review our recent experience with this combined modality approach. METHODSWe reviewed patients treated at UCLA Medical Center between 1982 and 1990. All patients had multiple risk factors for poor local control. Twenty patients underwent radical hysterectomy (12 (60%) class II, 5 (25%) class III, one (5%) class IV, 2 (10%) class V) after pelvic irradiation. Fifty percent had "bulky" (> 4 cm) Stage I cervical cancer, while 45% had Stage II and 5% Stage III. Fifty percent of the patients had an element of adenocarcinoma. Two patients (10%) had uterine sarcoma with cervical involvement. Thirty percent of the study group had a poor response to preoperative radiation. RESULTSSeventy percent of patients had nodal metastasis. Post-operative morbidity included infections (50%), urinary retention (10%), and ileus (5%). Long term morbidity included ureteral obstruction (30%), small bowel obstruction (20%), chronic gastrointestinal dysfunction (10%), chronic pelvic pain (10%), urinary fistula (10%), and vault necrosis (5%). Morbidity was less if patients only received preoperative brachy or teletherapy alone. Sixty-five percent of subjects are alive without disease with a mean follow up of 26 months. CONCLUSIONAlthough limited by the number of patients, we conclude that radical hysterectomy after radiation is morbid but may be effective in treating patients with 1) large cervical tumors, 2) cervical cancer that responds poorly to radiation, 3) small recurrent cervical tumors, 4) patients unable to undergo brachytherapy for cervical cancer, and 5) uterine sarcomas involving the cervix.