Postoperative radiation therapy for stage IB-IIB carcinoma of the cervix with poor prognostic factors.
BACKGROUND
To investigate failure pattern and to evaluate the prognostic impact of lymph node metastasis in patients with cervical cancer treated with postoperative adjuvant pelvic irradiation.


METHODS
Ninety-eight patients with FIGO IB to IIB cervical cancer were treated with radical hysterectomy, bilateral pelvic lymphadenectomy and postoperative radiation therapy. All the patients had at least one of the following pathologic risk factors for pelvic recurrence; 1) positive margins, 2) positive pelvic lymph nodes other than common iliac node, 3) deep stromal invasion more than 50% or parametrial invasion.


RESULTS
The 5-year overall survival (OAS) rate for the entire patient group was 82%. Causes of the first failure were pelvic recurrence in 5 cases and distant metastasis in 15 cases. Fifteen of the 47 patients with positive pelvic lymph nodes developed distant metastasis, whereas distant metastasis was noted in only 1 of 51 patients without lymph node metastasis. The 5-year OAS rates for patients with and without pelvic lymph node metastasis were 76% and 89%, respectively (p = 0.018).


CONCLUSIONS
Despite receiving postoperative pelvic irradiation, apparently lower survival was observed for node positive patients.
Department of Radiology, Chiba University, School of Medicine, Japan. unotakas@ho.chiba-u.ac.jp
T
T
Uno
H
H
Ito
J
J
Itami
S
S
Yasuda
K
K
Isobe
R
R
Hara
T
T
Sato
S
S
Minoura
N
N
Shigematsu
A
A
Kubo
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D007410:Intestinal Diseases / Q000209:etiology; D008207:Lymphatic Metastasis; D008209:Lymphedema / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010386:Pelvic Neoplasms / Q000532:radiotherapy / Q000556:secondary; D011182:Postoperative Care; D011183:Postoperative Complications; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D011882:Radiotherapy, High-Energy / Q000009:adverse effects; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery