Inadvertent Simple Hysterectomy in Carcinoma of Cervix Uteri: A Comparison of Simple Hysterectomy Followed by Chemoradiation and Upfront Chemoradiation

The objective was to analyze the outcomes of the patients, who received salvage radiotherapy for incidentally discovered cervical cancer following simple hysterectomy and to compare the progression-free survival and overall survival to those who received upfront chemoradiation. Data of 38 patients with occult cervical cancer who underwent simple hysterectomy and were referred to Dr. B. Borooah Cancer Institute, Guwahati, for salvage radiotherapy from January 2015 to December 2016 were collected. All the patients received concurrent chemoradiation with intracavitary radiotherapy. Local control, progression-free survival, overall survival and treatment-related toxicity were investigated between the two group (simple hysterectomy and upfront radiation group). The median follow-up time was 36 months. The 3-year progression-free survival for stages IB2, IIA, IIB, IIIA and IIIB was 85.7%, 75%, 50%, 0.0% and 0.0% (P = 0.063) in the hysterectomy group and 88.0%, 100% and 54.5% for stages IIB, IIIA and IIIB in the radiation group (P = 0.036). In the hysterectomy group, seven (18.4%) patients with stage IB2 and eight (21.1%) with stage IIA had a 3-year overall survival rate of 100%. The survival rate dropped to 61.1% for 18 (47.4) patients with stage IIB (HR 2.472; 95% CI 0.577–10.588, P = 0.023) and 50% for two (5.30%) patients with stage IIIA. Three (7.90%) patients with stage IIIB disease died of disease at 3 years (HR 7.588; 95% CI 1.341–42.920, P = 0.022). In the radiation group, the overall survival was 92.0% for 25 (65.8%) patients with stage IIB, 100% for two (5.30%) patients with stage IIIA and 54.5% for 11 (28.9%) patients with stage IIIB (HR 5.499; 95% CI 1.054–28.173, P = 0.043). Early complication and late complication occurred in both the group but more so in the hysterectomy group. Patients with occult invasive cervical cancer discovered following simple hysterectomy could be treated safely and effectively with salvage radiotherapy. However, those with positive surgical margin, adenocarcinoma histology, gross residual disease on paracervical areas and time elapsed between surgery and radiotherapy have a poor prognosis compared to upfront radiation group.