Postoperative pelvic radiotherapy for cervical cancer patients with positive parametrial invasion.
OBJECTIVE
To evaluate patterns of failure in cervical cancer patients with histopathologic parametrial invasion treated with postoperative pelvic radiation therapy.


METHODS
Records of 117 stages IB-IIB cervical cancer patients with parametrial invasion treated with postoperative radiation therapy from 1985 to 2002 were retrospectively reviewed. Patients were divided into two groups based on status of pelvic lymph nodes. Patterns of recurrence and prognosis by status of pelvic lymph nodes were statistically analyzed.


RESULTS
Status of pelvic lymph nodes had significant impact on both recurrence and survival. Extrapelvic recurrence was observed in 23 of 66 node-positive patients compared with 6 of 51 node-negative patients (P = 0.005). Of 66 patients with a positive pelvic lymph node, 18 developed visceral metastases, whereas only three visceral metastases were noted in the 51 node-negative patients (P = 0.003). Five-year overall survival in node-positive and -negative patients was 52% and 89%, respectively (P = 0.0005). Corresponding rates for recurrence-free survival were 44% and 83%, respectively (P = 0.0002). The correlation between nodal metastasis and prognosis was enhanced when node-positive patients were stratified into two groups based on number of positive nodes (n = 1 and n > or = 2). Five-year recurrence-free survival rates for patients with negative, one positive, and two or more positive nodes were 83%, 61%, and 31%, respectively (P = 0.0001).


CONCLUSIONS
Extrapelvic recurrence was uncommon in node-negative patients with parametrial invasion. These findings do not support use of systemic therapy for cervical cancer patients with parametrial invasion if pelvic lymph node metastasis is negative.
Uno
Takashi
T
Department of Radiology, Chiba University, Graduate School of Medicine, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba 260-8670, Japan. unotakas@ho.chiba-u.ac.jp
Ito
Hisao
H
Isobe
Koichi
K
Kaneyasu
Yuko
Y
Tanaka
Naotake
N
Mitsuhashi
Akira
A
Suzuka
Kiyomi
K
Yamazawa
Koji
K
Shigematsu
Naoyuki
N
Itami
Jun
J
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000473:pathology; D009367:Neoplasm Staging; D010386:Pelvic Neoplasms / Q000473:pathology / Q000532:radiotherapy; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery