title: Stage IB cervix cancer with nodal involvement treated with primary surgery or primary radiotherapy: Patterns of failure and outcomes in a contemporary population.
abstract: BACKGROUND
  The purpose of this study is to evaluate patterns of failure, overall survival (OS), disease-free survival (DFS), prognostic factors and late toxicities in node positive International Federation of Gynaecology and Obstetrics (FIGO) stage IB cervix cancer treated with curative intent.
  
  
  METHODS
  Patients with FIGO stage IB cervix cancer and positive nodes were identified from the Peter MacCallum Cancer Centre prospective gynaecology database. Patients were treated with primary surgery and adjuvant radiotherapy (S + RT) or primary radiotherapy (primary RT). Prognostic factors examined were tumour size, histology, grade, lymphovascular invasion or corpus uterine invasion, MRI tumour volume, number of nodes involved, highest site of nodal involvement, treatment modality, age and smoking.
  
  
  RESULTS
  Of the 103 eligible patients, 43 patients had S + RT and 60 patients had primary RT. Tumours were significantly smaller in the S + RT group (mean 3.0 cm vs. 4.5 cm, P < 0.001). Five-year OS (95% confidence interval) and DFS (95% confidence interval) for the whole cohort was 67.6% (56.5-76.4%) and 66.1% (55.7-74.6%), respectively. Tumour diameter and number of positive nodes were significant prognostic factors for OS and DFS and smoking was related to DFS. Treatment modality was not a significant prognostic factor in OS and DFS. Of 33 patients that relapsed, 32 patients relapsed outside the pelvis. One patient failed in the pelvis only.
  
  
  CONCLUSIONS
  Early stage cervix cancer with nodal involvement is associated with excellent pelvic disease control following curative intent treatment. Almost all relapses occurred beyond the pelvis and therefore more aggressive local treatment is unlikely to improve survival in these patients.
authors.affiliation: Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.|Alfred Health Radiation Oncology, The Alfred, Melbourne, Victoria, Australia.
authors.forename: Carminia
authors.identifier: http://orcid.org/0000-0003-2596-1353
authors.initials: C
authors.lastname: Lapuz
authors.affiliation: Rural Clinical School, School of Medicine, University of Queensland, Toowoomba, Queensland, Australia.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Kondalsamy-Chennakesavan
authors.affiliation: Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Bernshaw
authors.affiliation: Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Pearly
authors.initials: P
authors.lastname: Khaw
authors.affiliation: Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.|Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Kailash
authors.initials: K
authors.lastname: Narayan
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003127:Colposcopy / Q000401:mortality* / Q000706:statistics & numerical data; D003131:Combined Modality Therapy / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D015182:Lymphatic Irradiation / Q000401:mortality* / Q000706:statistics & numerical data; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D015995:Prevalence; D011832:Radiation Injuries / Q000401:mortality*; D020266:Radiotherapy, Conformal / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D017211:Treatment Failure; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000628:therapy*; D014739:Victoria / Q000453:epidemiology
keywords: cervix cancer; chemoradiation; node positive; radiotherapy; stage IB; surgery