title: Influence of margin status and radiation on recurrence after radical hysterectomy in Stage IB cervical cancer.
abstract: OBJECTIVE
  To examine the relationship between margin status and local recurrence (LR) or any recurrence after radical hysterectomy (RH) in women treated with or without radiotherapy (RT) for Stage IB cervical carcinoma.
  
  
  METHODS
  This study included 284 patients after RH with assessable margins between 1980 and 2000. Each margin was scored as negative (> or =1 cm), close (>0 and <1 cm), or positive. The outcomes measured were any recurrence, LR, and relapse-free survival.
  
  
  RESULTS
  The crude rate for any recurrence was 11%, 20%, and 38% for patients with negative, close, and positive margins, respectively. The crude rate for LR was 10%, 11%, and 38%, respectively. Postoperative RT decreased the rate of LR from 10% to 0% for negative, 17% to 0% for close, and 50% to 25% for positive margins. The significant predictors of decreased relapse-free survival on univariate analysis were the depth of tumor invasion (hazard ratio [HR] 2.14/cm increase, p = 0.007), positive margins (HR 3.92, p = 0.02), tumor size (HR 1.3/cm increase, p = 0.02), lymphovascular invasion (HR 2.19, p = 0.03), and margin status (HR 0.002/increasing millimeter from cancer for those with close margins, p = 0.03). Long-term side effects occurred in 8% after RH and 19% after RH and RT.
  
  
  CONCLUSIONS
  The use of postoperative RT may decrease the risk of LR in patients with close paracervical margins. Patients with other adverse prognostic factors and close margins may also benefit from the use of postoperative RT. However, RT after RH may increase the risk of long-term side effects.
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA 02115, USA. aviswanathan@partners.org
authors.forename: Akila N
authors.initials: AN
authors.lastname: Viswanathan
authors.forename: Hang
authors.initials: H
authors.lastname: Lee
authors.forename: Emily
authors.initials: E
authors.lastname: Hanson
authors.forename: Ross S
authors.initials: RS
authors.lastname: Berkowitz
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Crum
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007044:Hysterectomy; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*