title: Stromal invasion of the cervix can be excluded from the criteria for using adjuvant radiotherapy following radical surgery for patients with cervical cancer.
abstract: BACKGROUND
  Regarding complications of radiotherapy, the indications for adjuvant radiotherapy should be restricted. We conducted the present study to determine whether deep stromal invasion of the cervix could be excluded from the criteria used to identify patients for this treatment surgery.
  
  
  METHODS
  This study included 115 patients with FIGO stage Ib to IIb cervical cancer who underwent radical hysterectomy and pelvic lymph node dissection. Patients had the following tumors: 61 nonkeratinizing squamous cell carcinoma, 21 keratinizing squamous cell carcinoma, 26 adenocarcinoma, and 7 adenosquamous cell carcinoma. Our study criteria for using adjuvant radiotherapy included positive lymph node involvement, a compromised surgical margin, or parametrial extension. Deep stromal invasion of the cervix was excluded from the criteria in this study.
  
  
  RESULTS
  Seventy-two of the 115 patients (62.6%) underwent radical surgery only and all were alive. The remaining 43 patients received a complete course of external irradiation following radical surgery. The estimated 5-year survival rate is 100% for patients with stage Ib, 93.3% for stage IIa, and 52.7% for stage IIb. Fifty-five patients (47.8%) had deep stromal invasion. The prognosis for patients with deep stromal invasion was significantly worse than that for patients without deep stromal invasion (5-year survival rate, 69.8% vs. 98.0%). However, 21 patients (18.3%) with deep stromal invasion, but without positive lymph node involvement, compromised surgical margin, or parametrial extension, were alive without recurrence. Multivariate analysis showed that lymph node involvement and parametrial extension were independent prognostic factors, but that deep stromal invasion was not.
  
  
  CONCLUSIONS
  Deep stromal invasion of the cervix can be excluded from the list of criteria for selecting patients with cervical cancer who would benefit from adjuvant radiotherapy following radical surgery.
authors.affiliation: Department of Obstetrics and Gynecology, Tottori University, School of Medicine, Yonago, Japan.
authors.forename: Muneaki
authors.initials: M
authors.lastname: Shimada
authors.forename: Junzo
authors.initials: J
authors.lastname: Kigawa
authors.forename: Masakuni
authors.initials: M
authors.lastname: Takahashi
authors.forename: Yukihisa
authors.initials: Y
authors.lastname: Minagawa
authors.forename: Makoto
authors.initials: M
authors.lastname: Okada
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Kanamori
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Itamochi
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Oishi
authors.forename: Takahiro
authors.initials: T
authors.lastname: Iba
authors.forename: Naoki
authors.initials: N
authors.lastname: Terakawa
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D000328:Adult; D000368:Aged; D018196:Carcinoma, Adenosquamous / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D017154:Stromal Cells / Q000473:pathology; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery