Journal of gynecologic oncology · 2026
Primary chemoradiation versus radical hysterectomy with lymphadenectomy for stage IIICr cervical cancer without parametrial involvement: gynecologic oncology research investigators collaboration study (GORILLA-1002).
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Han Kyung Hee, Yang Eunjung, Kim Namkyeong, Son Joo-Hyuk, Kong Tae Wook, Shim Seung-Hyuk, Suh Dong Hoon, Chang Suk-Joon, Kim Hee Seung
Аннотация
OBJECTIVE: To compare the effectiveness and adverse events of primary chemoradiation versus radical hysterectomy with pelvic or para-aortic lymphadenectomy in patients with 2018 International Federation of Gynecology and Obstetrics stage IIICr cervical cancer without clinical parametrial involvement.
METHODS: This retrospective study included patients diagnosed with stage IIICr cervical cancer who had pelvic or para-aortic lymph nodes measuring at least 1 cm in short diameter on preoperative imaging between 2000 and 2020. Primary chemoradiation consisted of external beam radiation therapy and brachytherapy, while adjuvant chemoradiation following radical surgery was administered based on pathological results.
RESULTS: A total of 204 patients underwent primary chemoradiation (n=66) or radical hysterectomy with systematic lymphadenectomy (n=138). There were no significant differences in disease stage or histological type between the groups. In patients with tumors ≥4 cm, primary chemoradiation improved progression-free survival (PFS) compared to radical surgery (5-year survival: 91.1% vs. 61.7%; p<0.005). Favorable factors for PFS included stage IIIC1 disease, primary chemoradiation, and tumor size <4 cm. Stage IIIC1 was associated with better PFS and overall survival than stage IIIC2 (p=0.048 and p=0.020, respectively). Central recurrence was more common after primary chemoradiation, while pelvic sidewall or distant recurrence was more frequent after radical hysterectomy with lymphadenectomy (p=0.009). Anemia was more frequent in the primary chemoradiation group, while lymphedema was less common than in the radical surgery group.
CONCLUSION: Primary chemoradiation may be more effective than radical hysterectomy with systematic lymphadenectomy in patients with stage IIICr cervical cancer without parametrial invasion.
METHODS: This retrospective study included patients diagnosed with stage IIICr cervical cancer who had pelvic or para-aortic lymph nodes measuring at least 1 cm in short diameter on preoperative imaging between 2000 and 2020. Primary chemoradiation consisted of external beam radiation therapy and brachytherapy, while adjuvant chemoradiation following radical surgery was administered based on pathological results.
RESULTS: A total of 204 patients underwent primary chemoradiation (n=66) or radical hysterectomy with systematic lymphadenectomy (n=138). There were no significant differences in disease stage or histological type between the groups. In patients with tumors ≥4 cm, primary chemoradiation improved progression-free survival (PFS) compared to radical surgery (5-year survival: 91.1% vs. 61.7%; p<0.005). Favorable factors for PFS included stage IIIC1 disease, primary chemoradiation, and tumor size <4 cm. Stage IIIC1 was associated with better PFS and overall survival than stage IIIC2 (p=0.048 and p=0.020, respectively). Central recurrence was more common after primary chemoradiation, while pelvic sidewall or distant recurrence was more frequent after radical hysterectomy with lymphadenectomy (p=0.009). Anemia was more frequent in the primary chemoradiation group, while lymphedema was less common than in the radical surgery group.
CONCLUSION: Primary chemoradiation may be more effective than radical hysterectomy with systematic lymphadenectomy in patients with stage IIICr cervical cancer without parametrial invasion.