Chemoradiotherapy for Stage Ib2 and IIb Cervical Cancer Vivek Nama UHBT Existing Evidence Keys trial Cervical Cancers gt 4cm RCT post radiotherapy 30cGy to point A the hysterectomy arm ID: 483963
Download Presentation The PPT/PDF document "Hysterectomy after" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Hysterectomy after Chemoradiotherapy for Stage Ib2 and IIb Cervical Cancer
Vivek
Nama
UHBTSlide2
Existing Evidence:Keys trialCervical Cancers > 4cm RCT post radiotherapy30cGy to point A the hysterectomy arm40cGy to Point A in the non hysterectomy arm
256
(123 in each arm)Slide3
ResultsHysterectomy did not increase the grade 3 and 4 adverse effects46% progressed among the radiation group and 37% progressed in the adjuvant hysterectomy group5 years local relapse was 27% in radiation only group and 14% in combined treatment groupOverall survival not different - distant relapsesSlide4
ChangesChemoradiotherapySignificant decrease in local and distant recurrence (CD008285)MRICombined histologyNegative histology
Negative histology had higher distant recurrenceSlide5
Post Chemo-radiotherapy MRI showing complete response
Intervention Arm – Simple Hysterectomy
Control Arm – Routine follow up
Routine follow up 3 months after completion of treatment for 2 years
Routine follow up 6 monthly for 3 yearsSlide6
Outcomes:Primary outcome: Overall SurvivalSecondary Outcome measures: Progression free survival, Treatment related morbidity (CTACE 4.0)
Quality
of life (
EORTC/FACT)Slide7
Has any one tried?FrenchDifficulty recruitingSurgeons felt that randomization into a non intervention arm was harmful to their patientsSlide8
Funding?NIHR agendaCharity organizationsNIHR CRN fundsSlide9
Why us?CentreBristolBathTauntonExeterCheltenham
Truro
10 cases eachSlide10
Thank you