Evaluation of Clinical and Pathologic Risk Factors May Reduce the Rate of Multimodality Treatment of Early Cervical Cancer.
OBJECTIVE
To assess the rate of postoperative adjuvant treatment in patients who underwent radical hysterectomy for early cervical cancer and to suggest criteria for the triage of patients who have a high probability of multimodality treatment.


METHODS
This was a multicenter retrospective study of 514 patients with FIGO stages IA2-IIA cervical cancer who underwent radical hysterectomy between 1999 and 2010. The patients were divided into 2 groups according to whether or not postoperative radiation was administered. The 2 groups were compared with regard to clinical and histopathologic variables divided into major and minor criteria (intermediate risk factors) based on lymph nodes status, parametrial involvement, tumor size, deep stromal invasion, and lymph-vascular space invasion.


RESULTS
We identified 294 (57.2%) patients who received adjuvant postoperative radiotherapy (RT) or chemoradiation. Fifty-three percent of these patients who were treated by adjuvant radiation had only intermediate risk factors. Combining the various combinations of 2 out of 3 of the following criteria, we found that 89% of patients with tumors ≥2 cm and lymph-vascular space invasion received RT, 76% of patients with tumors ≥2 cm and depth of invasion >10 mm received RT, and 87% of patients with tumors depth of invasion >10 mm and lymph-vascular space invasion received RT.


CONCLUSIONS
This study suggests that in patients with early cervical cancer, clinicopathologic evaluation of tumor size and lymph-vascular space invasion should be undertaken before performing radical hysterectomy. This approach can serve to tailor treatment, reducing the rate of employing both radical hysterectomy and chemoradiation.
*Barzilai Medical Center, Ashkelon †Carmel Medical Center, Haifa ‡Rabin Medical Center, Petah Tikva §Soroka Medical Center, Beer Sheva ∥Assaf Harofe Medical Center, Tzrifin ¶Shaare Zedek Medical Center, Jerusalem #Meir Medical Center, Kfar Saba **Wolfson Medical Center, Holon ††Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv ‡‡Hadassah Medical Center, Sharett Institute of Oncology, Jerusalem §§Ziv Medical Center, Safed ∥∥Kaplan Medical Center, Rehovot, Israel.
Ofer
O
Gemer
Ofer
O
Lavie
Michael
M
Gdalevich
Ram
R
Eitan
Ela
E
Mamanov
Benjamin
B
Piura
Alex
A
Rabinovich
Hanoch
H
Levavi
Bozhena
B
Saar-Ryss
Reuvit
R
Halperin
Shachar
S
Finci
Uzi
U
Beller
Ilan
I
Bruchim
Tally
T
Levy
Amichay
A
Meirovitz
Inbar Ben
IB
Shachar
Alon Ben
AB
Arie
D000230:Adenocarcinoma / Q000473:pathology* / Q000628:therapy; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018196:Carcinoma, Adenosquamous / Q000473:pathology* / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000628:therapy; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods*; D002945:Cisplatin / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010388:Pelvis; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D047368:Tumor Burden; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000628:therapy
D000970:Antineoplastic Agents; D002945:Cisplatin