title: Tailoring adjuvant radiotherapy for stage IB-IIA node negative cervical carcinoma after radical hysterectomy and pelvic lymph node dissection using the GOG score.
abstract: OBJECTIVE
  The use of adjuvant radiotherapy for early stage node negative patients varies for different institutions. The recognized factors such as deep stromal invasion, lymph vascular space invasion, and size of tumor are the most common factors cited for adjuvant radiotherapy. Studies done have shown that this increases local control but may increase chronic toxicity rates. We report on our use of the GOG score to tailor our treatment decisions.
  
  
  METHODS
  A review of all patients staged IB-IIA who underwent Type 3 Radical Hysterectomy and pelvic lymph node dissection (RH) from 1997 to 2007. The GOG score proposed by Delgado et al. was applied, and patients were stratified into 3 groups; <40: no adjuvant treatment, 40-120: Small Field RT (SmRT), and >120: Standard Field RT (StRT) RESULTS: A total of 126 patients matched these criteria. Sixty one patients underwent either SmRT or StRT. There were only 2 known relapses and one death due to inter current illness. The median follow up was 57 months and the 5 year Disease Free Survival was 98.2%. There were no documented Grade 3 or 4 chronic toxicities. There were significantly less (p=0.025) patients with lower limb lymphedema in the SmRT group compared to StRT.
  
  
  CONCLUSIONS
  Our study confirms the utility of the GOG score to tailor radiotherapy for this cohort of patients. This has been proven to be high in efficacy and low in morbidity.
authors.affiliation: Department of Radiation Oncology, National Cancer Centre, Singapore. Richard.Yeo.M.C@nccs.com.sg
authors.forename: Richard M C
authors.initials: RM
authors.lastname: Yeo
authors.forename: Yin N
authors.initials: YN
authors.lastname: Chia
authors.forename: Rama P D
authors.initials: RP
authors.lastname: Namuduri
authors.forename: Swee P
authors.initials: SP
authors.lastname: Yap
authors.forename: Yoke L
authors.initials: YL
authors.lastname: Soong
authors.forename: Philip K L
authors.initials: PK
authors.lastname: Yam
authors.forename: Timothy Y K
authors.initials: TY
authors.lastname: Lim
authors.forename: Hoon S
authors.initials: HS
authors.lastname: Khoo-Tan
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008209:Lymphedema / Q000453:epidemiology; D008875:Middle Aged; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery