The bulky 6-cm barrel-shaped lesion of the cervix: Primary surgery and postoperative chemoradiation

Objective. The purpose of this report is to detail what appears to be the largest reported experience of primary radical hysterectomy for bulky barrel-shaped cervical cancers of 6 cm or greater in diameter, followed in all instances by radiation therapy and chemotherapy, Methods. Twenty-two unselected cases were operated primarily. One had unresectable aortic node disease. Twenty-one were treated with intent to cure. All patients received extended field radiation therapy beginning 4 weeks after surgery, All patients also received infusion chemotherapy during weeks 1, 4, and 7 of their radiation therapy. Initially, 5-FU was the drug of choice; more recently, Platinol has been employed. Results. The Berkson-Gage relative survival of the total 22 cases was 71.3%. For the 21 cases treated with intent to cure, the survival was 75.4%, Complications were minimal. Conclusion. The experienced pelvic surgeon can accomplish this exercise with a high degree of safety; and this multimodality approach is offered as another therapeutic alternative for these high-risk patients. (C) 2000 Academic Press.