Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Why Is Surgery Still Done after Concurrent Chemo-Radiotherapy in Locally Advanced Cervical Cancer in Romania?

Version 1 : Received: 20 December 2023 / Approved: 21 December 2023 / Online: 21 December 2023 (15:02:34 CET)

A peer-reviewed article of this Preprint also exists.

Voinea, S.C.; Bordea, C.I.; Chitoran, E.; Rotaru, V.; Andrei, R.I.; Ionescu, S.-O.; Luca, D.; Savu, N.M.; Capsa, C.M.; Alecu, M.; Simion, L. Why Is Surgery Still Done after Concurrent Chemoradiotherapy in Locally Advanced Cervical Cancer in Romania? Cancers 2024, 16, 425. Voinea, S.C.; Bordea, C.I.; Chitoran, E.; Rotaru, V.; Andrei, R.I.; Ionescu, S.-O.; Luca, D.; Savu, N.M.; Capsa, C.M.; Alecu, M.; Simion, L. Why Is Surgery Still Done after Concurrent Chemoradiotherapy in Locally Advanced Cervical Cancer in Romania? Cancers 2024, 16, 425.

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 85-90Gy 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 chemotherapy (total dose 60-65Gy 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 patients compared to 62% for non-operated 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.

Keywords

locally advanced cervical cancer; concurrent chemoradiotherapy; adjuvant surgery; local control; high cervical cancer morbidity; residual disease; cervical cancer in Romania

Subject

Medicine and Pharmacology, Oncology and Oncogenics

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