title: Early stage cervical cancer: adjuvant treatment in negative lymph node cases.
abstract: OBJECTIVE
  In early stage cervical carcinoma, most studies of the literature show that adjuvant radiotherapy significantly reduced local relapse; its impact on survival improvement is controversial. In this retrospective study, we analyze the role of adjuvant radiotherapy in negative node patients and the possibility of this treatment to improve survival in selected groups.
  
  
  METHODS
  Four hundred fifty-four patients with stage IB-IIA carcinoma of the uterine cervix were treated with primary radical hysterectomy and pelvic lymphadenectomy. The patients with negative nodes but with pathologic prognostic factors predictive of a poor outcome, underwent adjuvant radiation therapy, according to personalized indications.
  
  
  RESULTS
  Disease-free actuarial 5-year survival (DFS) was 80%: 88% and 57% in patients with negative and positive nodes, respectively. The population of negative node patients was stratified in three risk categories according to the number of worsening prognostic factors: parametrial invasion, depth of stromal invasion (SI) >1/3 and presence of lymph vascular space involvement (LVSI). In the medium risk category (1 or 2 unfavorable prognostic factors), DFS showed significant advantage for patients submitted to post-operative external beam radiation. In the subset of cases without parametrial extension (pT1B) with one or two risk factors on the surgical specimen (LVSI and/or SI >1/3), there was no difference in DFS between the two groups treated or not with adjuvant radiotherapy.
  
  
  CONCLUSIONS
  Post-operative radiotherapy is controversial in node-negative pathologic stage IB cervical cancer; radical surgery alone has low morbidity, enable more accurate prediction of prognosis and may be sufficient therapy in the majority of patients with lymph node-negative early stage cervical cancer.
authors.affiliation: Gynecologic-Oncology Division of University of Brescia, Italy. sartori@med.unibs.it
authors.forename: Enrico
authors.initials: E
authors.lastname: Sartori
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Tisi
authors.forename: Francesca
authors.initials: F
authors.lastname: Chiudinelli
authors.forename: Beniamino
authors.initials: B
authors.lastname: La Face
authors.forename: Rossella
authors.initials: R
authors.lastname: Franzini
authors.forename: Sergio
authors.initials: S
authors.lastname: Pecorelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*