Histopathological findings in postoperative specimens in cervical cancer patients with stages IB2-IVA after neoadjuvant chemotherapy and preoperative plus postoperative radiotherapy.

PURPOSE: To determine the incidence of the histopathological findings indicative for risk of recurrence in patients with locally advanced cervical cancer (LACC) who were treated with neoadjuvant chemotherapy (NCT) and radiation therapy (RT) before operation.

PATIENTS AND METHODS: Sixty-three patients were included: 45 patients (group 1) underwent external beam RT and then surgical treatment followed by postoperative RT, and 18 (group 2) patients were treated with NCT and surgery followed by postoperative RT. Surgery was class III-V radical hysterectomy with pelvic lymph node dissection (LND), and paraaortic LND at indication. NCT included 2-3 courses of cisplatin, ifosfamide and bleomycin administered at 3-week intervals. In group 1 FIGO stage IIB prevailed (n=29, 64.4%). Forty-four (97.8%) patients had squamous cell carcinoma and 1 (5.6%) adenosquamous carcinoma. In group 2 stage IIB also prevailed (n=13, 72.2%), whereas all 18 (100%) patients had squamous cell carcinoma. The average age in group 1 and 2 was 48.8 years (range 31-69) and 46.3 years (range 32-64), respectively.

RESULTS: In group 1 lymph node metastases (LNM) were found in 35.56% of the cases, macroscopically detectable LNM in 15.6%, LNM above the common iliac artery level in 11.1%, multiple LNM (>3 LNM) in 17.8%, parametrial invasion in 4.4%, deep stromal invasion in 31.1%, lymphovascular space invasion (LVSI) in 13.3%, infiltration of canalis cervicalis in 15.6%, infiltration of isthmus uteri in 8.9% and ovarian metastases in 4.4%. In group 2 LNM were found in 38.89% of the patients, macroscopically detectable metastases in 22%, multiple (>3 LNM) LNM in 17%, LNM above the common iliac artery level in 22%, deep stromal invasion in 47%, parametrial infiltration in 24%, LVSI in 12%, tumor infiltration in canalis cervicalis in 12%, and ovarian metastases in 6%.

CONCLUSION: NCT followed by surgical treatment and RT leads to postoperative histological results that are not worse than the standard preoperative RT approach.