title: Rethinking the use of radiation and chemotherapy after radical hysterectomy: a clinical-pathologic analysis of a Gynecologic Oncology Group/Southwest Oncology Group/Radiation Therapy Oncology Group trial.
abstract: OBJECTIVE
  To retrospectively analyze data from a previously reported randomized trial of either pelvic radiation (RT) or RT + chemotherapy (CT) in patients undergoing radical hysterectomy and pelvic lymphadenectomy with positive pelvic lymph nodes, parametrial involvement, or surgical margins; to explore associations between RT + CT; and to investigate histopathologic and clinical factors which might be predictive of recurrence.
  
  
  METHODS
  Histopathologic sections from biopsies and hysterectomies and clinical data were reviewed from patients with stage IA2, IB, or IIA cervical cancer treated with RT or RT + CT (cisplatin 70 mg/m2 plus fluorouracil 1000 mg/m2 every 3 weeks for four cycles). A univariate analysis was performed because the relatively small sample size limited the interpretation of a multivariate analysis.
  
  
  RESULTS
  Of the 268 enrolled women, 243 (RT = 116; RT + CT = 127) were evaluable. The beneficial effect of adjuvant CT was not strongly associated with patient age, histological type, or tumor grade. The prognostic significance of histological type, tumor size, number of positive nodes, and parametrial extension in the RT group was less apparent when CT was added. The absolute improvement in 5-year survival for adjuvant CT in patients with tumors < or =2 cm was only 5% (77% versus 82%), while for those with tumors >2 cm it was 19% (58% versus 77%). Similarly, the absolute 5-year survival benefit was less evident among patients with one nodal metastasis (79% versus 83%) than when at least two nodes were positive (55% versus 75%).
  
  
  CONCLUSIONS
  In this exploratory, hypothesis-generating analysis, adding CT to RT after radical hysterectomy, appears to provide a smaller absolute benefit when only one node is positive or when the tumor size is < 2 cm. Further study of the role of CT after radical hysterectomy in patients with a low risk of recurrence may be warranted.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Chao Family Comprehensive Cancer Center, University of California, Irvine Medical Center, 101 The City Drive, Building 23, Room 107, Orange, CA 92868, USA. bjmonk@uci.edu
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Monk
authors.forename: Jianmin
authors.initials: J
authors.lastname: Wang
authors.forename: Samuel
authors.initials: S
authors.lastname: Im
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Stock
authors.forename: William A
authors.initials: WA
authors.lastname: Peters
authors.forename: P Y
authors.initials: PY
authors.lastname: Liu
authors.forename: Rolland J
authors.initials: RJ
authors.lastname: Barrett
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Berek
authors.forename: Luis
authors.initials: L
authors.lastname: Souhami
authors.forename: Perry W
authors.initials: PW
authors.lastname: Grigsby
authors.forename: William
authors.initials: W
authors.lastname: Gordon
authors.forename: David S
authors.initials: DS
authors.lastname: Alberts
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D000328:Adult; D018196:Carcinoma, Adenosquamous / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D012189:Retrospective Studies; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery