title: Postoperative radiotherapy for cervix cancer incidentally discovered after a simple hysterectomy for either benign conditions or noninvasive pathology.
abstract: OBJECTIVE
  Report the long-term outcome of patients who received postoperative radiotherapy for incidentally discovered cervix cancer following simple hysterectomy.
  
  
  METHODS
  We recorded tumor status, treatment complications, and survival of 25 patients treated at our institution from 1961 to 2004 with postoperative RT for invasive cervix cancer discovered following simple hysterectomy (median follow-up, 17 years). All patients had stage IA2-II squamous cell carcinoma (76%) or adenocarcinoma (24%) of the cervix.
  
  
  RESULTS
  One patient had an isolated vaginal-cuff recurrence and was cured long-term with salvage surgery. No patient died of cervix cancer. The actuarial rate of tumor control and relapse-free survival at 5, 10, and 20 years was 96%. One patient died of a treatment-related complication. Cause-specific survival was 100% at 5 and 10 years, but 92% at 20 years. Overall survival was 100% at 5 years, 95% at 10 years, and 62% at 20 years.The complications rate from therapy was surprising. The overall grade 2 to 5 complications rate was 36% (9 of 25). Twenty percent (5 of 25) of patients experienced grade 4 or 5 complications.
  
  
  CONCLUSIONS
  This series demonstrates the price we pay for adding comprehensive radiotherapy to simple hysterectomy for early-stage cervix cancer. The findings support 2 recommendations: (1) Avoid postoperative radiotherapy by aggressively screening patients for invasive disease before performing simple hysterectomy. (2) Raise the threshold for delivering pelvic radiotherapy following simple hysterectomy with an incidental diagnosis of invasive cervix cancer. We recommend vaginal brachytherapy alone in patients with negative postoperative imaging, negative surgical margins, and <10 mm tumor invasion.
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, 2000 SW Archer Rd., Gainesville, FL 32610, USA.
authors.forename: Kristy Breuhl
authors.initials: KB
authors.lastname: Smith
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Amdur
authors.forename: Anamaria R
authors.initials: AR
authors.lastname: Yeung
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Morris
authors.forename: Jessica
authors.initials: J
authors.lastname: Kirwan
authors.forename: Linda S
authors.initials: LS
authors.lastname: Morgan
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D004751:Enteritis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006394:Hemangiosarcoma / Q000209:etiology; D006801:Humans; D007044:Hysterectomy; D033162:Incidental Findings; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009381:Neoplasms, Radiation-Induced / Q000209:etiology; D016609:Neoplasms, Second Primary / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D011655:Pulmonary Embolism / Q000209:etiology; D011832:Radiation Injuries / Q000209:etiology; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D014591:Uterine Diseases / Q000601:surgery; D014846:Vulvar Neoplasms / Q000209:etiology