Why Is Surgery Still Done after Concurrent Chemoradiotherapy in Locally Advanced Cervical Cancer in Romania?

Author:

Voinea Silviu Cristian12,Bordea Cristian Ioan12ORCID,Chitoran Elena13ORCID,Rotaru Vlad13,Andrei Razvan Ioan14,Ionescu Sinziana-Octavia13,Luca Dan13,Savu Nicolae Mircea5,Capsa Cristina Mirela6,Alecu Mihnea13,Simion Laurentiu13

Affiliation:

1. “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania

2. General Surgery and Surgical Oncology Department II, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania

3. General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania

4. General Surgery Department, “Sf. Ioan” Clinical Emergency Hospital, 042122 Bucharest, Romania

5. Radiotherapy Department, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania

6. Radiology Department, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania

Abstract

The incidence and mortality of cervical cancer are high in Romania compared to other European countries, particularly for locally advanced cervical cancer cases, which are predominant at the time of diagnosis. Widely accepted therapeutic guidelines indicate that the treatment for locally advanced cervical cancer consists of concurrent chemoradiotherapy (total dose 85–90 Gy at point A), with surgery not being necessary as it does not lead to improved survival and results in significant additional morbidity. In Romania, the treatment for locally advanced cervical cancer differs, involving lower-dose chemoradiotherapy (total dose 60–65 Gy at point A), followed by surgery, which, under these circumstances, ensures better local control. In this regard, we attempted to evaluate the role and necessity of surgery in Romania, considering that in our study, residual lesions were found in 55.84% of cases on resected specimens, especially in cases with unfavorable histology (adenocarcinoma and adenosquamous carcinoma). This type of surgery was associated with significant morbidity (28.22%) in our study. The recurrence rate was 24.21% for operated-on patients compared to 62% for non-operated-on patients receiving suboptimal concurrent chemotherapy alone. In conclusion, in Romania, surgery will continue to play a predominant role until radiotherapy achieves the desired effectiveness for local control.

Funder

University of Medicine and Pharmacy Carol Davila

Publisher

MDPI AG

Subject

Cancer Research,Oncology

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