title: Long-term treatment results of invasive cervical cancer patients undergoing inadvertent hysterectomy followed by salvage radiotherapy.
abstract: OBJECTIVE
  To evaluate the long-term results of salvage radiotherapy for patients of invasive cervical cancer after inadequate surgery.
  
  
  METHODS
  Between October 1975 and January 1994, 90 patients were treated with radiotherapy for invasive cervical carcinoma after simple hysterectomy. The inadequate surgery was performed for a variety of reasons. All patients had postoperative external beam irradiation or intravaginal brachytherapy, or both. The end points of this study were local control, survival, and treatment-related toxicity.
  
  
  RESULTS
  The patients' age varied between 33 and 76 with a median of 53 years. The most common histopathology was squamous cell carcinoma, which accounted for 91% of the patients. The most frequent reason for inadvertent hysterectomy was understaged disease with preoperative diagnosis as carcinoma in situ for 51 patients (57%). Malignancy was not suspected before surgery in 28 patients (31%). After surgery, 72 patients (80%) were restaged as Ib, 12 patients (13.3%) as IIa, and 6 patients (6.7%) as IIb. Median follow-up time was 83 months. Seventy-three patients had follow-up times of 5 years or more. The overall 5-year and 10-year survival rates of 90 patients were 85.5% and 74.1%, respectively. Disease-specific 5-year and 10-year survival rates were 85.5% and 80.5%, respectively. All 16 patients with either locoregional or distant failure eventually died of disease. Fourteen patients (15.5%) had late morbidities. Radiation proctitis developed in 6 patients, intestinal obstruction in 4 patients, and hemorrhagic cystitis in 3. There was only 1 patient (1%) with terminal ileum stenosis and severe intestinal obstruction requiring surgical intervention.
  
  
  CONCLUSIONS
  Most cases of inadequately treated invasive cervical cancer were the result of suboptimal preoperative workups. Patients who had early tumors and no gross residual tumor after inadequate hysterectomy can have excellent prognoses when given postoperative radiotherapy. The severe long-term complication related to salvage radiotherapy is rare.
authors.affiliation: Department of Radiation Oncology, Buddhist Tzu-Chi Medical Center, Hualien, Taiwan.
authors.forename: Wen-Lin
authors.initials: WL
authors.lastname: Hsu
authors.forename: Pei-Wei
authors.initials: PW
authors.lastname: Shueng
authors.forename: Yee-Min
authors.initials: YM
authors.lastname: Jen
authors.forename: Ching-Jung
authors.initials: CJ
authors.lastname: Wu
authors.forename: Jing-Min
authors.initials: JM
authors.lastname: Hwang
authors.forename: Li-Ping
authors.initials: LP
authors.lastname: Chang
authors.forename: Chang-Ming
authors.initials: CM
authors.lastname: Chen
authors.forename: Lu-Ching
authors.initials: LC
authors.lastname: Lin
authors.forename: Bin S
authors.initials: BS
authors.lastname: Teh
mesh_terms: D000328:Adult; D000368:Aged; D002278:Carcinoma in Situ / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D016879:Salvage Therapy; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*