Indications for adjunctive conservative extrafascial hysterectomy in selected cases of carcinoma of the uterine cervix

Am J Roentgenol Radium Ther Nucl Med. 1975 Jan;123(1):91-9. doi: 10.2214/ajr.123.1.91.

Abstract

The survival rates for a selected group of patients with large central lesions, either squamous cell carcinoma or adenocarcinoma and managed by combining irradiation and a conservative extrafascial hysterectomy, are comparable to those of carcinoma of the cervix in general. Death is caused much more often by distant metastases and intercurrent disease than by failure within the irradiated volume.

PIP: The survival rates and complications of 212 patients treated for squamous cell carcinoma or adenocarcinoma of the cervix by slightly less than radical radiotherapy with a conservative extrafascial hysterectomy are discussed. The presence of bulky or barrel-shaped endocervical disease was the main indication for hysterectomy, as adequate irradiation could not be employed. The 5-year survival rates were comparable with those for carcinoma of the cervix in general. The incidence of severe complications when whole pelvis irradiation was 4000 rads or less was 5.4%, but 2 of 3 patients who received more than 4000 rads had severe complications. Lymphadenectomy doubled the complication rate. 4 fatal complications occurred in the lymphadenectomy group, whereas none occurred in its absence. Adenocarcinoma in itself is not to be considered an indication for hysterectomy. Death is usually caused by distant metastases and intercurrent disease rather than by failure of the irradiated volume.

Publication types

  • Evaluation Study

MeSH terms

  • Adenocarcinoma / pathology
  • Adenocarcinoma / radiotherapy
  • Adenocarcinoma / surgery*
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / radiotherapy
  • Carcinoma, Squamous Cell / surgery*
  • Cobalt Radioisotopes / therapeutic use
  • Female
  • Humans
  • Hysterectomy / methods*
  • Intestinal Obstruction / etiology
  • Lymph Node Excision / adverse effects
  • Middle Aged
  • Pelvis / radiation effects
  • Radiation Injuries
  • Radiotherapy Dosage
  • Rectovaginal Fistula / etiology
  • Uterine Cervical Neoplasms / pathology
  • Uterine Cervical Neoplasms / radiotherapy
  • Uterine Cervical Neoplasms / surgery*
  • Vesicovaginal Fistula / etiology

Substances

  • Cobalt Radioisotopes