title: Isolated full-thickness cervical stromal invasion warrants post-hysterectomy pelvic radiotherapy in FIGO stages IB-IIA uterine cervical carcinoma.
abstract: OBJECTIVE
  To evaluate the potential benefit of postoperative radiotherapy (PORT) in women with isolated full-thickness cervical stromal invasion (FTSI) as an unfavorable pathological finding after radical hysterectomy and pelvic lymph node dissection (PLND) in FIGO stages IB-IIA cervical carcinoma.
  
  
  METHODS
  A total of 1868 patients with stages IB-IIA cervical carcinoma underwent radical hysterectomy and PLND between January 1982 and December 2002. Seventy-four of these patients had isolated FTSI without any other unfavorable pathological finding, such as lymph node metastasis, microscopic parametrial involvement, involved resection margin, lympho-vascular space invasion, or large clinical tumor diameter (>4 cm). Forty-one of these patients had no adjuvant treatment (S group) and 33 received PORT (PORT group). Patients with isolated FTSI who received chemotherapy were excluded. Treatment outcomes in the PORT and S groups were compared.
  
  
  RESULTS
  Ten-year disease-free survival (DFS) and pelvic-failure-free survival (PFFS) of S group vs. PORT group were 73.2% vs. 92.4% (P=0.038) and 79.8% vs. 97.0% (P=0.044), respectively. According to a Cox proportional hazards model developed by forward, stepwise regression incorporating all prognostic variables, only PORT was marginally significant for DFS (RR 0.234; 95% CI 0.051-1.067; P=0.061) and significant for PFFS (RR 0.055; 95% CI 0.005-0.620; P=0.019). A grade 4 late complication developed in two patients (6%) in PORT group.
  
  
  CONCLUSIONS
  PORT administered to patients with isolated FTSI after radical hysterectomy and PLND improves pelvic control in FIGO stages IB-IIA cervical carcinoma with acceptable morbidity.
authors.affiliation: Department of Radiation Oncology, Seoul National University College of Medicine, Republic of Korea.
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Moon
authors.forename: Hong-Gyun
authors.initials: HG
authors.lastname: Wu
authors.forename: Sung W
authors.initials: SW
authors.lastname: Ha
authors.forename: Hyo Pyo
authors.initials: HP
authors.lastname: Lee
authors.forename: Soon Beom
authors.initials: SB
authors.lastname: Kang
authors.forename: Yong Sang
authors.initials: YS
authors.lastname: Song
authors.forename: Noh Hyun
authors.initials: NH
authors.lastname: Park
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Kim
authors.forename: In Ae
authors.initials: IA
authors.lastname: Park
authors.forename: Baek Hui
authors.initials: BH
authors.lastname: Kim
mesh_terms: D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D011878:Radiotherapy / Q000009:adverse effects; D017154:Stromal Cells / Q000473:pathology; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery